US20140180380A1

Movatterモバイル変換

Info

Publication number: US20140180380A1
Application number: US13/943,863
Authority: US
Inventors: Patrick W. Kelly
Original assignee: Sanford Health
Current assignee: Sanford Health
Priority date: 2012-12-20
Filing date: 2013-07-17
Publication date: 2014-06-26
Also published as: US9095465B2; DK2934398T3; EP2934398A1; EP2934398B1; WO2014100596A1; US20140180381A1

Abstract

A stent deployment device and methods for use, where the device comprises: (a) an outer sheath having a proximal end and a distal end, (b) a pull apparatus at least partially disposed within the outer sheath, where a portion of the pull apparatus is sized and shaped to receive a stent or a stent graft, (c) a push apparatus, where a portion of the push apparatus is sized to fit within a portion of the pull apparatus, and (d) a push-pull drive mechanism in mechanical communication with the pull and push apparatuses, where the push-pull drive mechanism includes at least a push and a pull gear or a push and a pull reel sized and shaped based on a stent ratio.

Description

RELATED APPLICATIONS

This application is a non-provisional of and claims priority to U.S. Provisional Application No. 61/740,161 entitled “Stent Deployment Device,” filed Dec. 20, 2012 and to U.S. Provisional Application No. 61/834,014 entitled “Stent Deployment Device,” filed Jun. 12, 2013 which are hereby incorporated by reference in their entirety.

BACKGROUND OF THE INVENTION

Stent deployment devices are utilized to direct the placement of a stent in a human or animal body and to ultimately eject and deploy a stent in a targeted lumen. Conventional stent deployment methods and devices can only be used with stents, as opposed to stent grafts. This is because known stent restraint mechanisms that prevent premature deployment must physically interact with the stent wires. This interaction is not possible with a stent graft because the graft covering prevents the stent restraint from locking onto the wireframe of a stent graft.

In addition, a stent often has a constrained, compressed length that is much longer than its unconstrained, expanded length. These customary methods and devices deploy stents in a manner that moves the stent in a back-and-forth motion. This results in the stent structure making delayed contact with the target lumen's wall and the stents become elongated in vivo.

SUMMARY OF THE INVENTION

The present invention provides a stent deployment device that is capable of deploying either a stent or a stent graft based on a stent ratio such that contact with the target lumen's wall is not delayed and in some embodiments may optionally result in packing the stent or stent graft in the target lumen. This capability allows the stent deployment device to deploy a stent or stent graft in a more reliable manner with respect to stent positioning and stent fixation within the target lumen. In one embodiment, the stent deployment device has the additional benefit of having a stent restraint that allows the device to recapture a compatible stent or woven stent graft, such that the device is capable of pulling a partially deployed stent back into the deployment device. Notably, the stent restraint is effective to recapture a stent that has up to 90% of its length deployed in a target lumen. The stent or stent graft may then be released once the desired positioning is achieved. The present invention further provides methods for use of the stent deployment device.

Thus, in a first aspect, the present invention provides a stent deployment device comprising: (a) an outer sheath, where the outer sheath has a proximal end and a distal end, (b) a pull apparatus at least partially disposed within the outer sheath, where a portion of the pull apparatus is sized and shaped to receive a stent or a stent graft, (c) a push apparatus, where a portion of the push apparatus is sized to fit within a portion of the pull apparatus, and (d) a push-pull drive mechanism in mechanical communication with the pull apparatus and the push apparatus, where the push-pull drive mechanism includes at least a push gear and a pull gear or a push reel and a pull reel that are sized and shaped based on a stent ratio.

In one embodiment, the invention provides that the push-pull drive mechanism comprises: (a) a pull reel coupled to a proximal end of the pull apparatus, (b) a pull gear in mechanical communication with the pull reel, (c) a push reel coupled to a proximal end of the push apparatus, (d) a push gear in mechanical communication with the push reel, and (e) a drive gear in mechanical communication with the push gear and the pull gear, where the push gear and the pull gear are sized and shaped based on the stent ratio.

In another embodiment, the invention provides that the push-pull drive mechanism comprises: (a) the pull reel, (b) the push reel, where the push reel and the pull reel are sized and shaped based on the stent ratio, and (c) a drive gear, where the pull reel, the push reel and the drive gear are coupled together along a shared axis.

In still a further embodiment, the invention provides that the push-pull drive mechanism comprises: (a) a push rack coupled to the push apparatus, where the push rack defines a plurality of teeth, (b) a push pinion engaged with at least one tooth of the plurality of teeth of the push rack, (c) the push gear coupled to the push pinion, (d) a pull rack coupled to the pull apparatus, where the pull rack defines a plurality of teeth, (e) a pull pinion engaged with at least one tooth of the plurality of teeth of the pull rack, (f) the pull gear coupled to the pull pinion, and (g) a drive gear coupled to both the push gear and the pull gear, where the push gear and the pull gear are sized and shaped based on the stent ratio.

In a second aspect, the present invention also provides a method for placement of a stent graft comprising: (a) simultaneously advancing a stent or a stent graft distally with a push apparatus of a stent deployment device and retracting a pull apparatus of the stent deployment device proximally at two different rates based on a stent ratio, and (b) deploying the stent or the stent graft into a lumen.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a cross-sectional side view of the stent deployment device in accordance with one embodiment of the invention.

FIG. 2A is detail view A ofFIG. 1 showing a cross-section of the push-pull drive mechanism and a portion of an outer sheath, a push apparatus and a pull apparatus according to one embodiment.

FIG. 2A, Section A:A is a cross-sectional front view of an example push-pull drive mechanism.

FIG. 2A, Section B:B is a cross-sectional front view of a portion of the outer sheath, the push apparatus and the pull apparatus in a first region of the device.

FIG. 2B is detail view B ofFIG. 1 showing a cross-section of a portion of the outer sheath, the pull apparatus and the push apparatus according to one embodiment.

FIG. 2B, Section C:C is a cross-sectional front view of a portion of the outer sheath, the pull apparatus and the push apparatus in a second region of the device.

FIG. 2B, Section D:D is a cross-sectional front view of a portion of the outer sheath, the pull apparatus and the push apparatus in a third region of the device.

FIG. 2C is detail view C ofFIG. 1 showing a cross-section of a portion of the outer sheath, the pull apparatus and the push apparatus according to one embodiment.

FIG. 2C, Section E:E is a cross-sectional front view of a portion of the outer sheath, the pull apparatus and the push apparatus in a fourth region of the device.

FIG. 2D is detail view D ofFIG. 1 showing a cross-section of a guidewire and a nose cone according to one embodiment.

FIG. 3 is a side view showing an example configuration of an unconstrained length L_uof a to-be-deployed stent or stent graft and a constrained length L_cof the stent or stent graft.

FIG. 4A is an exploded isometric view of the push-pull drive mechanism and a handle housing of the stent deployment device in accordance with one embodiment of the invention.

FIG. 4B is a side view of the gear box shown inFIG. 4A.

FIG. 5A is an isometric view of the inward face of a first side of the handle housing for the push-pull drive mechanism shown inFIG. 4A.

FIG. 5B is an isometric view of the inward face of a second side of the handle housing for the push-pull drive mechanism shown inFIG. 4A.

FIG. 6A is a side view of a portion of the push-pull drive mechanism according to a rack and pinion embodiment of the invention.

FIG. 6B is an isometric view of a portion of the push-pull drive mechanism according to a rack and pinion embodiment of the invention.

FIG. 7A is a side view of the pull apparatus, the push apparatus and a stopper wedge at a first time T1 prior to deployment.

FIG. 7B is a side view of the pull apparatus, the push apparatus and a stopper wedge at a second time T2 with the pull apparatus partially retracted.

FIG. 7C is a side view of the pull apparatus, the push apparatus and the stopper wedge at a third time T3 with the stent partially deployed.

FIG. 7D is a side view of the pull apparatus, the push apparatus and the stopper wedge at a fourth time T4 with the stent fully deployed.

FIG. 8 is a side cross-sectional view according to an embodiment utilizing a three-tube manifold.

FIG. 8, Section F:F shows a front cross-sectional view of a portion of an outer sheath, a pull wire lumen, a push wire lumen and a guidewire lumen according to one embodiment in a first region.

FIG. 8, Section G:G shows a front cross-sectional view of a portion of the outer sheath, the pull apparatus, the push apparatus and the guidewire lumen according to one embodiment in a second region.

FIG. 8, Section H:H shows a front cross-sectional view of a portion of the outer sheath, the pull apparatus, the push apparatus and the guidewire lumen according to one embodiment in a third region.

DETAILED DESCRIPTION OF THE INVENTION

In a first aspect, as shown in FIGS.1 and2A-D,4,5A-B and6A-B, the present invention may take the form of a stent deployment device10 comprising: (a) anouter sheath15, where theouter sheath15 has aproximal end16 and adistal end17, (b) apull apparatus20 at least partially disposed within theouter sheath15, where aportion21 of thepull apparatus20 is sized and shaped to receive a stent or astent graft25, (c) apush apparatus30, where aportion31 of thepush apparatus30 is sized to fit within thepull apparatus20, and (d) a push-pull drive mechanism35 in mechanical communication with thepull apparatus20 and thepush apparatus30, where the push-pull drive mechanism35 includes at least apush gear40 and apull gear45 or apush reel50 and apull reel55 that are sized and shaped based on a stent ratio.

As used herein, with respect to measurements and calculations, “about” means+/−5%.

As used herein, “stent” is used broadly to refer to both stents andstent grafts25. The stent orstent graft25 is self-expandable. As used herein, “stent” is typically a cylindrical frame and means any device or structure that adds rigidity, expansion force, or support to a prosthesis or native vasculature, while “stent graft” refers to a prosthesis comprising a stent and a graft material associated therewith that forms a fluid-tight lumen through at least a portion of its length. For example, the stent structure may comprise coiled, mesh, zig zag, braided, knitted or woven wires. The stent structure could also comprise a laser cut sheet or a laser cut tube that may have various lengths, diameters or wall thickness. Alternatively, the stent may comprise injection molded metal. A “graft” is a cylindrical liner that may be disposed on the stent's interior, exterior or both. Further, when used in combination with a graft, the stent structure may further comprise a series of spaced apart stent rings disposed along the graft. A wide variety of attachment mechanisms are available to join the stent and graft together, including but not limited to, sutures, adhesive bonding, heat welding, and ultrasonic welding.

The stent can be made of any suitable material, including but not limited to biocompatible metals, implantable quality nitinol, cobalt chromium, stainless steel wires, nickel and titanium alloys, and biocompatible plastics attached to a graft. Any suitable fluid tight graft material can be used. In a preferred embodiment, the graft material is a biocompatible fabric, including but not limited to woven or knitted polyester, such as poly(ethylene terephthalate), polylactide, polyglycolide and copolymers thereof; fluorinated polymers, such as PTFE, expanded PTFE and poly(vinylidene fluoride); polysiloxanes, including polydimethyl siloxane; and polyurethanes, including polyetherurethanes, polyurethane ureas, polyetherurethane ureas, polyurethanes containing carbonate linkages and polyurethanes containing siloxane segments. Materials that are not inherently biocompatible may be subjected to surface modifications in order to render the materials biocompatible. Examples of surface modifications include graft polymerization of biocompatible polymers from the material surface, coating of the surface with a crosslinked biocompatible polymer, chemical modification with biocompatible functional groups, and immobilization of a compatibilizing agent such as heparin or other substances. The graft material may also include extracellular matrix materials.

The covered stent grafts can be made of any suitable material, including but not limited topolytetrafluoroethylene (ePTFE) lined nickel-titanium alloy stent. The stent grafts are preferably covered and flexible. The stent grafts may contain any other suitable components, such as surface modifications including but not limited to covalent attachment of heparin.

As shown inFIG. 3,stent25 has unconstrained, expanded length L_uand a constrained, compressed length L_c. The unconstrained length L_uof the stents orstent grafts25 may range from about 40 mm to about 200 mm and, in various embodiments, may be between about 40-180 mm, 40-160 mm, 40-140 mm, 40-120 mm, 40-100 mm, 40-80 mm, 40-60 mm, 60-200 mm, 80-200 mm, 100-200 mm, 120-200 mm, 140-200 mm, 160-200 mm, 180-200 mm, 40 mm, 60 mm, 80 mm, 120 mm or 200 mm. The constrained length L_cof thestent25 is a factor of the stent's unconstrained diameter, the length of the unconstrained stent, the weave pattern of a woven stent and the size of the French sheath into which the stent is to be constrained.

As used herein, the “stent ratio” is equal to a ratio of a quantity of the constrained length L_cof a to-be-deployed stent25 less an unconstrained length L_uof thestent25 to the unconstrained length L_uof thestent25 and is defined based on the following relationship:

\emptyset_{g} = \frac{L_{c} - L_{u}}{L_{u}}

In various embodiments, in which either the pull reel and the push reel diameters are the same size or in the absence of the push and pull reels,

- Ø_g: ratio of pull gear diameter to push gear diameter
- L_c: length of a constrained stent
- L_u: length of an unconstrained stent.
  For example, if a stent has an unconstrained length of 40 cm and a constrained length of 100 cm, then the stent ratio is (100 cm-40 cm)/40 cm or 1.5. Thus, in this example, the pull gear will have a diameter 1.5 times larger than the diameter of the push gear such that the push shaft will advance at a faster rate than the rate that the pull apparatus is retracted.

In various alternative embodiments, in which either the pull gear and push gear diameters are the same size, the pull reel and push reel share a single axis with a drive gear or in the absence of the push and pull gears, the stent ratio is defined as:

\emptyset_{r} = \frac{L_{c} - L_{u}}{L_{u}}

- Ø_r: ratio of push reel diameter to pull reel diameter
- L_c: length of a constrained stent
- L_u: length of an unconstrained stent.
  For example, if a stent has an unconstrained length of 40 cm and a constrained length of 100 cm, the stent ratio will be 1.5 and the push reel will have a diameter 1.5 times larger than the diameter of the pull reel. In another example, if the constrained length of the stent is 100 cm and the unconstrained length is 60 cm, then the stent ratio is (100 cm-60 cm)/60 cm or 2/3. In this example, the push reel diameter is 2/3 the size of the pull reel diameter and the push shaft will advance at a rate slower than the pull apparatus is retracted. In various alternative embodiments, many other gear and reel combinations may achieve the “stent ratio” through proper sizing based on accepted machine design concepts.

The stent ratio may range from about 0 to about 5 and, in various embodiments, may be between about 0 to 0.375, 0 to 0.6251, 0 to 1.5, 0 to 1.75, 0 to 2, 0 to 2.25, 0 to 2.5, 0 to 2.75, 0 to 3, 0 to 3.25, 0 to 3.5, 0 to 3.75, 0 to 4, 0 to 4.25, 0 to 4.5, 0 to 4.75, 0 to 5, 4.75 to 5, 4.5 to 5, 4.25 to 5, 4 to 5, 3.75 to 5, 3.5 to 5, 3.25 to 5, 3 to 5, 2.75 to 5, 2.5 to 5, 2.25 to 5, 2 to 5, 1.75 to 5, 1.5 to 5, 1.25 to 5, 1 to 5, 0.75 to 5, 0.5 to 5, 0.25 to 5, 0, 1, 2, 3, 4 or 5. Note that a stent comprising a laser cut nitinol tube, for example, will have substantially the same unconstrained length and constrained length and a corresponding stent ratio of zero.

In additional embodiments, the “stent” may also include septal, patent foramen ovale or percutaneous, transcatheter occluders or self-expanding valves, such as the Corevalve® manufactured by Medtronic, that each have a constrained and an unconstrained length.

Further, in various embodiments, it may be desirable to “pack” the stent into the vessel in which the stent is being deployed such that the stent is 5-15% shorter than the original unconstrained length. Stent “packing” is desirable because it causes the stent to apply additional radial force to the vessel. Stent “packing” is achieved by applying additional force via the push shaft during deployment by modifying the ratio of the push gear diameter to the pull gear diameter or the ratio of the push reel diameter to the pull reel diameter. Specifically, in one embodiment, a ratio of the push gear diameter to the pull gear diameter is equal to the stent ratio plus 5-15% of the stent ratio. In a preferred embodiment, the ratio of the push gear diameter to the pull gear diameter is equal to the stent ratio plus 10% of the stent ratio. In another embodiment, a ratio of the push reel diameter to the pull reel diameter is equal to the stent ratio plus 5-15% of the stent ratio. In a further preferred embodiment, the ratio of the push reel diameter to the pull reel diameter is equal to the stent ratio plus 10% of the stent ratio.

In one embodiment, shown in FIGS.1 and2A-D, the invention provides that the push-pull drive mechanism35 comprises: (a) apull reel55 coupled to aproximal end22 of thepull apparatus20, (b) apull gear45 in mechanical communication with thepull reel55, (c) apush reel50 coupled to aproximal end32 of thepush apparatus30, (d) apush gear40 in mechanical communication with thepush reel50, and (e) adrive gear60 in mechanical communication with thepush gear40 and thepull gear45, where thepush gear40 and thepull gear45 are sized and shaped based on the stent ratio.

In one push-pull coil system embodiment, shown inFIG. 2A, Section B:B, at least a portion of theouter sheath15 defines (i) acentral core90 for receiving aguidewire91, (ii) achannel95 for receiving thepull ribbon65, and (iii) achannel100 for receiving thepush ribbon80. In addition, thepull apparatus20 may comprise aribbon65 at itsproximal end22 that transitions to apull shaft70 and thepull shaft70 then transitions to apull tube75 at the distal end23 of thepull apparatus20. Thepull shaft70 may define a pull central core92 for receiving aguidewire91 and may further define achannel100 for receiving thepush ribbon80. In an additional embodiment, thepull apparatus20 may further comprise a series of sheaths capable of telescoping in a direction distal from theouter sheath15. Thepush apparatus30 may comprise aribbon80 at itsproximal end32 that transitions to apush shaft85 at the distal end33 of thepush apparatus30. Thepush shaft85 has a distal end33 configured to engage in facial contact with an end of the to-be-deployed stent25. Alternatively, thepush shaft85 may include astent restraint26, discussed in more detail below, that interfaces with the to-be-deployed stent25. Thepush shaft85 may further define a pushcentral core93 for receiving aguidewire91. In a further embodiment, the stent deployment device10 may include aguidewire91 disposed within the outer sheathcentral core90, the pull central core92 and the pushcentral core93. In still another embodiment, the stent deployment device10 may include a stent or astent graft25 positioned within thepull tube75.

In one embodiment, theouter sheath15, thepull apparatus20 and thepush apparatus30 are constructed from a stiff, non-kinkable material such as nitinol, a nitinol alloy, polyimide or a hypotube comprising nickel-titanium alloy. As used herein, “non-kinkable” means that the material does not twist, curl, or double over or bend back upon itself. In various other embodiments in which the pull apparatus and the push apparatus define a ribbon portion, the ribbon portions may be contained in narrow ribbon channels in the outer sheath and/or in the pull apparatus that prevent kinking and therefore bending stiffness is not a significant factor. Further, in some embodiments, theouter sheath15,pull apparatus20 and thepush apparatus30 each preferably have a hydrophilic coating for a smooth in vivo deployment or another similar non-stick, low-friction surface coating or lubricant, like Polytetrafluoroethylene (PTFE) or Teflon®. Specifically, (a) theouter sheath15 has a hydrophilic coating disposed on inner surfaces configured to interface with thepull apparatus20, thepush apparatus30 and aguidewire91, (b) thepull apparatus20 has a hydrophilic coating disposed on an outer surface configured to interface with theouter sheath15 and on inner surfaces configured to interface with thepush apparatus30, astent25 and aguidewire91, and (c) thepush apparatus30 has a hydrophilic coating disposed on outer surfaces configured to interface with theouter sheath15 and thepull apparatus20 and on an inner surface configured to interface with aguidewire91. In addition, the surfaces of the pull apparatus and the push apparatus that are exposed to bodily fluids in vivo are preferably hydrophobic. Theouter sheath15 and/or handle

housing

437,438 may comprise a different material on its outer surface that may be gripped by the operator with a frictional, non-slip engagement, such as comprise acrylonitrile butadiene styrene (ABS) plastic, polycarbonate, Delrin® acetal resin (available from DuPont) or rubber, for example. The gear block may also be made out of Delrin acetal resin in some embodiments.

The length of thepush shaft85 preferably is at least as long as theconstrained stent25. The length of thepull tube75 preferably is long enough to receive both thepush shaft85 and theconstrained stent25. In various embodiments, it is preferred that a to-be-deployed stent be disposed at the distal end of thepull tube75 to effect the shortest path of travel for both thepull tube75 and thepush shaft85 during stent deployment. In certain embodiments, the outer diameter of theouter sheath15 is 5 Fr (0.066 inches; 1.67 mm) or 4 Fr (0.053 inches; 1.33 mm). Other outer diameters of theouter sheath15 are also possible. In various other embodiments, the outer diameter of theouter sheath15 is sized to fit within a 6 Fr sheath (0.079 inches; 2.0 mm) or within a 7 Fr sheath (0.092 inches; 2.3 mm).

In one embodiment, the pull sheath may include a radiopaque marker disposed halfway between the distal end of thepull tube75 and the distal end of the push shaft prior to deployment. In operation, a user would center the radiopaque marker in the middle of a targeted lesion, for example, and then deploy the stent. In an alternative embodiment, the pull sheath may include a radiopaque marker disposed on the distal end of thepull tube75. In operation, a user would align the radiopaque marker at the end of a targeted lesion, for example, and then deploy the stent.

The “central core” is a channel for receiving acentral core guidewire91. The outer sheathcentral core90, the pull central core92 and the pushcentral core93 are all aligned in series to receive thecentral core guidewire91. In a preferred embodiment, the central core guidewire91 comprises a flexible spiral tube made of nitinol or a nitinol alloy, for example. The central core guidewire91 preferably has a hydrophilic coating or another similar non-stick, low-friction surface coating or lubricant for a smooth in vivo deployment. The super-elastic nitinol or nitinol alloy resists kinks to maintain device integrity and retains shape for consistent reliability through procedure. The diameter of the central core guidewire91 may range from about 0.014 inches to about 0.038 inches, and is preferably about 0.014 inches or about 0.018 inches. The length of the central core guidewire91 may range from about 80 cm to about 260 cm. The central core guidewire91 may optionally include tungsten in a polyurethane jacket to enhance radiopacity for better visibility during the procedure.

In operation, in one embodiment in which thepull gear45 is mounted above thepush gear40, for example, thepull ribbon65 is wound onto thepull reel55 from the bottom of thepull reel55, whereas thepush ribbon80 unwinds from the top of thepush reel50. Adrive gear60 is coupled to both thepush gear40 and thepull gear45 such that when thedrive gear60 is driven by hand or bymotor61, thepush gear40 and thepull gear45 turn in the same direction, but the orientation of thepush gear40 and pullgear45 relative to each other and to thedrive gear60 causes thepush ribbon80 to be unwound and advanced forward and thepull ribbon65 to be wound and retracted. As noted above, in one embodiment, thedrive gear60 is coupled to a forward-reverse motor61, for example. In another embodiment, thedrive gear60 may be coupled to a manual override. The manual override comprises athumb wheel62. Alternatively, thedrive gear60 itself may be configured to be manually turned by hand. In one embodiment, adrive gear60 may be in mechanical communication with both thepush gear40 and thepull gear45 such that when thedrive gear60 is driven by hand or bymotor61, thepush gear40 and thepull gear45 turn in the same direction. In this example, the orientation of the gears causes thepush ribbon80 to be unwound and advanced forward and thepull ribbon65 to be wound and retracted.

In the embodiment shown inFIGS. 1 and 2A, thepush gear40 and thepull gear45 are sized based on the stent ratio. Here, the push gear is smaller than the pull gear. In alternative embodiments, the push reel and the pull reel are sized based on the stent ratio and the push reel is larger than the pull reel.

In a further embodiment, the stent deployment device10 may include astent restraint26. In one embodiment, the stent restraint may comprise a releasable hook system, as shown inFIG. 2C. The hooks interlock with the weavings, coils or struts, for example, of the stent structure. In some embodiments, the stent graft may have one or more uncovered struts at the end of the stent. In a preferred embodiment, hooks are attached to one end of recapture wires, while the other end of the wires is connected to thepush apparatus30. The recapture wires are outwardly biased towards thepull apparatus20 providing a smooth transition for thestent25 to be released from the hooks when thestent restraint26 exits the distal end of thepull apparatus20. This configuration allows thestent25 to be recaptured after partial deployment outside the stent device in the target lumen. In other words, theentire stent25 may be drawn back into thepull tube75 and/orouter sheath15 and redeployed and positioned in the lumen. This arrangement permits spontaneous release of the stent from thestent restraint26 once the stent expands at a distal end to a diameter larger than the radial reach of the recapture wires. The length of the recapture wires is long enough to create a smooth transition from the distal end of the deployment device into the target lumen for stent release. Thestent restraint26 preferably has a minimum of two opposed wire hooks in contact with thestent25 to avoid creating eccentricity. In an alternative embodiment, thestent restraint26 may comprise a shape memory nitinol metal, for example, that is hook shaped at room temperature and straightens out at body temperature.

FIGS. 4A-5B, illustrate another example arrangement of the push-pull drive mechanism435. Specifically,FIG. 4A shows athumbwheel462 intended to be in facial contact with thepush reel450. Thepush reel450 shows anoptional notch452 that aids in tangential loading and alignment of the push ribbon with thepush reel450. A connection mechanism, in this example adowel453, is disposed within and extends on either side of agear block439 and is press fit, for example, into thepush reel450 on one end and fixed at the other end to thepush gear440 via a set screw, for example. Thepush gear440 is in mechanical communication with thepull gear445, which is disposed below the push gear in thegear block439. In the embodiment shown, thepush gear440 is mated with atranslational gear441, and thetranslational gear441 is in turn mated with thepull gear445. The purpose of thetranslational gear441 in this embodiment is to cause thepush gear440 to rotate in the same direction as thepull gear445. A connection mechanism, in this example adowel458, is disposed within and extends on either side of thegear block439. Thepull gear445 is fixed to one end of thedowel458 via a set screw, for example, and apull reel455 is press fit, for example, to the other end of thedowel458. Thepull reel455 also shows andoptional notch457 that aids in tangential loading and alignment of the pull ribbon with thepull reel455. In this example embodiment, thepull gear445 and thepush gear440 are disposed between a first side of thegear block439 and a first side of ahandle housing438, while thethumbwheel push reel450 and thepull reel455 are disposed between a second side of thegear block439 and a second side of ahandle housing437.

As shown inFIG. 4B, in this example embodiment,

cavities

451,456 are defined within thegear block439 and are designed to receive the push reel and the pull reel, respectively. The gear block further definespush ribbon channel481 and pullribbon channel466 to help guide the push and pull ribbons onto and off of their respective reels. In addition, the gear block defines acentral core490 between thepush ribbon channel481 and thepull ribbon channel456 in order to receiveguidewire491. This guidewirecentral core490 likewise extends through the

handle housing

437,438, as shown inFIGS. 5A-B, and to the outer sheath.

In another embodiment, not shown, the invention provides that the push-pull drive mechanism comprises: (a) the pull reel, (b) the push reel, where the push reel and the pull reel are sized and shaped based on the stent ratio, and (c) a drive gear, where the pull reel, the push reel and the drive gear are coupled together along a shared axis. In various embodiments, the pull reel, the push reel and the drive gear are mounted on a single axle. In one embodiment, the pull reel and the push reel may be mounted on opposing sides of the drive gear. In one embodiment, a drive gear, the push reel and the pull reel are coupled together along a shared axis with facial contact and rotatably mounted within a housing for the push-pull mechanism. In another embodiment, the drive gear, the push reel and the pull reel are statically mounted on a single axle either with facial contact or in an adjacent but spaced apart configuration, where the axle's ends are fixed between opposing sides of a housing for the push-pull-mechanism. This allows the push ribbon and the pull ribbon to wind and unwind with minimal resistance. In another embodiment, the pull reel may be mounted in between the drive gear and the push reel. In a further embodiment, the push reel may be mounted in between the drive gear and the pull reel. The push reel and the pull reel are sized based on the stent ratio.

In still a further embodiment shown inFIGS. 6A-B, the invention provides that the push-pull drive mechanism635 comprises: (a) a push apparatus that comprises apush rack630 that defines a plurality of teeth, (b) apush pinion629 engaged with at least one tooth of the plurality of teeth of thepush rack630, (c) thepush gear640 coupled to thepush pinion629, (d) a pull apparatus that comprises apull rack620 that defines a plurality of teeth, (e) apull pinion619 engaged with at least one tooth of the plurality of teeth of thepull rack620, (f) thepull gear645 coupled to thepull pinion619, and (g) adrive gear660 coupled to both thepush gear640 and thepull gear645, where thepush gear640 and thepull gear645 are sized and shaped based on the stent ratio.

This rack and pinion system converts rotational motion from thepull gear645 andpush gear640 into linear motion. Thepush pinion629 and thepull pinion619 are circular gears that engage teeth on linear “gear” bars, here thepush rack630 and pullrack620; rotational motion applied to the pinions causes the racks to move, thereby translating the rotational motion of the pinions into the linear motion of the racks. In one embodiment, the teeth on thepush rack630 and the teeth on thepull rack620 face away from each other when thepush rack630 and pullrack620 are adjacent one another, but when thepush pinion629 and pullpinion619 are placed in between thepush rack630 and thepull rack620, then the teeth on thepush rack630 face the teeth on thepull rack620. Adrive gear660 is coupled to both thepush gear640 and thepull gear645 such that when thedrive gear660 is driven by hand or by motor, thepush gear640 and thepull gear645 turn in the same direction, but the orientation of thepush rack630 and pullrack620 relative to the

pinions

619,629 cause thepush rack630 to be advanced forward and thepull rack620 to be retracted. Thepush gear640 and thepull gear645 are sized based on the stent ratio.

In a combination of both a rack and pinion and push-pull coil systems, not shown, a pull reel is coupled to the proximal end of the pull apparatus. The pull apparatus comprises a ribbon at the proximal end that transitions to a pull shaft and the pull shaft then transitions to a pull tube at the distal end. In this example embodiment, the pull ribbon defines a plurality of teeth on one side and the pull gear is engaged with at least one tooth of the plurality of teeth of the pull ribbon. The push reel is likewise coupled to the proximal end of the push apparatus. The push apparatus comprises a ribbon at the proximal end that transitions to a push shaft at the distal end. In this embodiment, the push ribbon defines a plurality of teeth on one side and the push gear is engaged with at least one tooth of the plurality of teeth of the push ribbon. The push reel and the pull reel are each mounted on a rotating axle, where each axle's ends are fixed between opposing sides of a housing for the push-pull mechanism, to allow the push ribbon and the pull ribbon to wind and unwind with minimal resistance. In one preferred embodiment, the pull reel and the push reel are mounted distal to the pull gear and push gear, respectively.

In one embodiment, the pull ribbon and the push ribbon are each guided through a channel in the outer sheath. In one embodiment, this channel may be shared by the push and pull ribbons. In another embodiment, there may be a channel for each of the pull ribbon and the push ribbon. In each embodiment, the guiding channel(s) should be narrow to prevent kinking of the push and pull ribbons. Further, the pull ribbon and the push ribbon may each have a cross-section of any shape, for example, rectangular, square, round, hexagonal etc., and may further take the form of a wire.

In a ratcheting push-pull coil system, shown inFIGS. 7A-D, a pull reel is coupled to the proximal end of the pull apparatus. The pull apparatus comprises a ribbon at the proximal end that transitions to a pull shaft and the pull shaft then transitions to apull tube775 at thedistal end723 of the pull apparatus. In this embodiment, thepull tube775 defines a plurality ofteeth776 along at least a portion of an inner wall of thepull tube775. The plurality ofteeth776 on thepull tube775 are uniform but asymmetrical, such that each tooth has a first slope on afirst edge777 and a second slope on asecond edge778, where the second slope is greater than the first slope. In some embodiments, the first slope can range from about 1/100 to 1 and the second slope can range from about 1.5 to about infinity. In a preferred embodiment, thesecond edge778 is vertical, providing a slope of infinity for the second slope or, put another way, thesecond edge778 is ninety degrees from the inner wall of thepull tube775. In some embodiments, thefirst edge777 and thesecond edge778 meet in an apex and, in various other embodiments, as shown inFIGS. 7A-D, each tooth has a blunt finish. In one embodiment, the plurality ofteeth776 are defined in at least one track extending between thedistal end723 and proximal end of thepull tube775. In a preferred embodiment, at least two tracks of teeth are defined on opposing sides of the inner wall of thepull tube775. In another embodiment, the plurality of teeth are annular such that each tooth spans 360 degrees of the inner wall and the plurality of teeth extend along at least a portion of the length of thepull tube775. In a further embodiment, thepull tube775 comprises a slit along the length of thepull tube775. In an embodiment in which thepull tube775 is injection molded, the slit aids in the manufacturing process by allowing an internal mold for the teeth to be removed from the pull tube after the material has cured.

A push reel is likewise coupled to the proximal end of the push apparatus. The push apparatus comprises a ribbon at the proximal end that transitions to apush shaft785 at thedistal end733. Astopper wedge786 is attached to thedistal end733 of thepush shaft785 to prevent the pull apparatus from moving distally and stretching out thestent725 after the pull apparatus has been advanced proximally. Specifically, thestopper wedge786 is configured to have a slopedouter surface787 and acentral core788 adapted to receive aguidewire791. Theouter surface787 of thestopper wedge786 is sized and shaped to fit into the depressions between the teeth lining the inner surface of thepull tube775. The slope of the stopper wedge'souter surface787 preferably matches the first slope of theteeth776 on thepull tube775, such that thefirst edge777 of a respective tooth slides over thesurface787 of thestopper wedge786 as thepull tube775 is moved in an unrestricted (i.e., proximal) direction. Thepull tube teeth776 and/or thestopper wedge786 are constructed from a resilient but flexible material that allows flexure when the apex of thepull tube teeth776 advance toward and meet theproximal edge789 of the stopper wedge's outer surface allowing atooth776 to move proximal to thestopper wedge786. If the device attempts to move thepull tube teeth776 in the opposite (i.e., distal) direction, thestopper wedge786 catches against thesecond edge778 of the first tooth it encounters, thereby locking thestopper wedge786 against the respective tooth and preventing any further movement in that direction.

FIG. 7A shows thepush shaft785 and thestopper wedge786 disposed adjacent the proximal end of theconstrained stent725 at a first time T1 prior to deployment. At time T1, theconstrained stent725 is disposed within thepull tube775, while thepull tube775 is disposed within anouter sheath715.FIG. 7B shows the stent deployment device at a second time T2 with theouter sheath715 partially retracted from thepull tube775.FIG. 7C shows the stent deployment device at a third time T3 with thestopper wedge786 displaced distally within thepull tube775 and thestent725 partially deployed.FIG. 7D shows the stent deployment device at a fourth time T4 with thestent725 fully deployed and thestopper wedge786 displaced to thedistal end723 of thepull tube775.

In an alternative embodiment, shown inFIG. 8, theguidewire core890 may be off-center and adjacent to the pull apparatus and the push apparatus within the outer sheath. In this embodiment, the outer sheath acts as a three-tube manifold815. Theouter sheath815 may be heat shrunk around three stainless steel hypodermic tubes to create three lumens. Onelumen890 receives a guidewire891, another lumen receives apush wire830 and the remaining lumen receives apull wire820. In one embodiment the three-tube manifold is about 2.5 inches long and comprises a stiff polymer tube that is ⅜ inches in diameter. The three-tube manifold transitions into a length of unsupported wire and the stiff nature of the outer sheath minimizes kinking during stent deployment. The length of the unsupported wire should be slightly longer than the distance of travel of the pull tube875 to prevent the pull tube875 from bottoming out against the three-tube manifold. In one embodiment, the push wire is pinch fit into the push wire lumen with an overlap of approximately 2 inches.

In example embodiments, the push ribbon and pull ribbon may comprise a nitinol wire or braided stainless steel. Thepush ribbon880 and thepull ribbon865 move through a drilled out and capped channel that ultimately transitions into separate laser cut channels, for example. These channels terminate at the distal end of the push-pull drive mechanism. From there, thepush ribbon880 and thepull ribbon865 pass through a three-tube manifold, as described above, which are heat shrunk together, for example, in a non-concentric manner. Thepush ribbon880 and pullribbon865 pass through a separate hypotube (e.g., the guide wire lumen, the push ribbon lumen, pull ribbon lumen). The foregoing system provides support and guidance for the wires.

In alternative arrangements, the three-tube manifold may comprise a continuous stainless steel hypotube that originates from either of its respective reels or a guide wire luer lock. This flexible hypotube fits into a machined groove in the outer handle, for example. The groove acts as a guide that holds the hypotube in place. In the case of thepush ribbon880 and pullribbon865, this continuous hypotube has the advantage of continuously supporting thepush ribbon880 in the push segment and thepull ribbon865 in the pull segment. In the case of the guidewire supporting lumen890, the continuous tubing has the advantage of providing fluid management for water/lubricants added from the luer lock while minimizing the number of transitions and gaskets needed. This approach has an added benefit in that it minimizes the amount of expensive, high-precision laser cut through holes.

In an example embodiment, thepull ribbon865 transitions directly into a pull tube875. In this example, thepull ribbon865 may be secured to the pull tube875 with heat shrink, thepush ribbon880 is pinch fit into one of the lumens of a two-lumen balloon that acts as the push shaft885, and the guide wire891 passes freely through theguide wire lumen890 of the two-lumen balloon. Alternatively, a plurality of wires extend from the proximal end of the pull tube; some of the plurality of wires may be cut and the remainder braided into a single cable. For example, in one embodiment, the pull tube is made from a polymer sheath that has 16 wires connected around the sheath's periphery, for example. These wires are woven to act as the pull ribbon and to add strength and rigidity to the pull apparatus. And, in some example embodiments, twelve (12) of the sixteen (16) wires will be cut at the proximal end of the pull tube, while the remaining four (4) connected wires are braided together to form the pull apparatus. In another example, the pull wire could be solid bonded to the pull tube.

The push shaft could be manufactured in a number of ways. One is through a wire braiding process similar to the pull apparatus. Another embodiment is through solid bonding to the push shaft. A third example embodiment is a coiled wire defining an inner lumen. This coiled wire transitions to an uncoiled straight segment where the guide wire enters on the proximal end of the coil. The coil then continues through the distal end of the push apparatus, allowing the guide wire to pass through.

All embodiments of the stent deployment device10 of the invention can be used in the methods of the second aspect of the invention. Note that any of the foregoing embodiments of any aspect may be combined together to practice the claimed invention.