US20140343658A1 - Stent-graft with proximal and distal attachment, delivery catheter and methods of making same - Google Patents

Abstract

A metallic or pseudometallic covered stent in which the stent component and the cover component are each fabricated of biocompatible metallic or pseudometallic materials, in which the cover and the stent are joined by at least one juncture at each of a proximal and distal end of the stent and the cover. A method of joining the stent and the cover is also disclosed.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• The present application claims priority as a continuation application to U.S. patent application Ser. No. 13/445,131, which was filed on Apr. 12, 2012, which claims priority as a divisional application to U.S. patent application Ser. No. 11/215,984, which was filed on Aug. 31, 2005, now U.S. Pat. No. 8,187,318, each of which is incorporated by reference in its entirety.
BACKGROUND OF THE INVENTION
• The present invention pertains generally to implantable medical devices and, more particularly, to implantable medical devices which are capable of being implanted utilizing minimally-invasive delivery techniques. More particularly, the present invention relates to covered stents, stent-grafts and stent-graft-type devices that are implanted into anatomical passageways using minimally invasive delivery techniques. More specifically, the present invention comprises covered stents, stent-grafts and stent-graft-type devices that are fabricated entirely of biocompatible metals or of biocompatible materials which exhibit biological response and material characteristics substantially the same as biocompatible metals, such as for example composite materials (hereinafter referred to as “pseudometals” or by the property of being “pseudometallic”). Most specifically, the present invention relates to metal stents and metal stent covers wherein the metal stent cover is attached by at least one juncture between the metal stent at each of proximal and distal ends thereof.
• Stents are typically lattice structures capable of adopting both a diametrically compressed configuration, for delivery to the site of deployment, and a diametrically expanded configuration, in which the stent presses outward and against the inner wall of the anatomical passageway to provide structural support to the vessel, restore and maintain vascular patency. Endoluminal stents, for example, are frequently used post-angioplasty to provide a structural support for a blood vessel and reduce the incidence of restenosis following percutaneous balloon angioplasty. For example, endovascular stents may be introduced to a site of disease or trauma within the body's vasculature from an introductory location remote from the disease or trauma site using an introductory catheter, passed through the vasculature communicating between the remote introductory location and the disease or trauma site, and released from the introductory catheter at the disease or trauma site to maintain patency of the blood vessel at the site of disease or trauma.
• In many applications, it is desirable to provide a stent with a covering capable of conferring particularly desirable properties that the stent alone does not possess. For example, bare stents have been associated with significant restenosis rates and, due to the typically large fenestrations in the walls of the stent required to accommodate stent expansion from the compressed to the expanded diametric stage, permit particulate material, such as fragmented plaque, to pass from the vessel wall into the bloodstream. The relatively large fenestrations permit particulate material resident on the vascular walls, such as friable plaque or embolic material, to pass through the fenestrations and into the general circulation. Such undesirable effects may be reduced, however, by providing the stent with a covering over either the luminal or abluminal surfaces, or both surfaces, thereby forming a covered-stent or for purposes of this application, synonymously, a stent-graft.
SUMMARY OF THE INVENTION
• In accordance with the present invention, a covered stent having proximal and distal affixation points between the stent and the cover components is provided.
• Additionally, a method of attaching the cover to the stent is provided in which the stent is loaded into a restraining sheath having a pusher assembly concentrically engaged in the restraining sheath; the stent is loaded to a depth within the restraining sheath which permits the proximal end of the stent to remain exposed from the end of the restraining sheath; the cover is concentrically engaged about the outer circumference of the restraining sheath and aligned such that the proximal end of the cover is in concentric alignment with the proximal end of the stent; a proximal affixation is created between the proximal end of the stent and the proximal end of the cover; the restraining sheath is then positioned in co-axial alignment with a distal end of a constraining tube, and the pusher assembly actuated to push the stent and the proximally affixed cover into the distal end of the constraining tube to a point where the distal end of the stent and the distal end of the cover are exposed; a distal affixation is created between the distal end of the stent and the distal end of the cover, and the now proximally and distally affixed stent and cover are passivated and subsequently positioned in co-axial alignment with a distal end of a constraining tube, and a pusher assembly actuated to push the stent and the proximally affixed cover into the distal end of the delivery catheter lumen; a pusher assembly is then loaded into the delivery catheter from the proximal end of the catheter, and a guidewire and atraumatic tip is loaded in retrograde fashion from the distal end of the delivery catheter.
• The foregoing summary, as well as the following detailed description of preferred embodiments of the invention, will be better understood when read in conjunction with the appended drawings. For the purpose of illustrating the invention, there is shown in the drawings embodiments which are presently preferred. It should be understood, however, that the invention is not limited to the precise arrangements and instrumentalities shown.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIGS. 1A-1D present sequential side-elevational cross-sectional views depicting a loading assembly in accordance with an inventive apparatus and method for preparing a proximally-joined covered stent assembly.
• FIGS. 2A-2B present sequential side-elevational cross-sectional views of a transfer assembly in accordance with the inventive apparatus and method for preparing a proximally- and distally-joined covered stent assembly.
• FIGS. 3A-3C presents sequential side-elevational cross-sectional views depicting loading of the inventive proximally and distally-joined covered stent assembly into a delivery catheter.
• FIGS. 4A-4B presents sequential side-elevational cross-sectional views depicting loading of a proximally- and distally-joined covered stent assembly into a tapered catheter sheath in accordance with an alternative preferred embodiment of the present invention.
• FIGS. 5A-5B presents sequential side-elevational cross-sectional views depicting catheter assembly in accordance with the alternative preferred embodiment of the present invention.
• FIG. 6A is an expanded side view of the stent with proximal and distal junction points; andFIG. 6B is an enlarged side view of the stent with the proximal and distal junction points.
• FIG. 7 is a photomicrograph illustrating a junction point of a stent welded to a cover.
DETAILED DESCRIPTION OF THE INVENTION
• Turning now to the accompanying figures,FIGS. 1A-1D depict the preparation of a proximally-joined covered stent using a loading/welding fixture40.FIG. 1A depicts the loading ofstent10 into the lumen of loadingsheath30 of loading/welding fixture40. Loading/welding fixture40 consists generally of thecylindrical loading sheath30 and apusher rod32 having anabutment member34 coupled to one end of thepusher rod32. Theabutment member34 is concentrically engaged within the lumen of loadingsheath30 and is capable of reciprocal movement therein. Theabutment member34 andpusher rod32 serve dual functions: first, theabutment member34 acts as a stop during insertion of thestent10 into the lumen of theloading sheath30 to properly position thestent10 therein, and second, thepusher rod32 andabutment member34 act to eject the proximally-affixed stent and cover from the lumen of theloading sheath30.
• FIG. 1B depicts the loading ofcover20 over an abluminal surface of theloading sheath30. As is shown inFIG. 1B,abutment member34 is positioned within the lumen of loading sheath30 a distance d₂, such that the remaining opening of the lumen ofloading sheath30 has a length of d₁. Length d₁also corresponds to the degree of overhang or exposure ofstent10 from theproximal end region31 ofloading sheath30 that is required for affixation of thecover20 to thestent10. Thecover20 is concentrically positioned over the abluminal surface of theloading sheath30 and a proximal end of thecover20 is aligned with the proximal end of thestent10, such that theloading sheath30 is positioned intermediate thestent10 and thecover20, with the exposedproximal end11 of thestent10 and theproximal end21 of thecover20 being in adjacent proximity therebetween. Therefore, as shown in the circled portion ofFIG. 1C, aftercover20 has been loaded overloading sheath30, theproximal end region11 ofstent10 andproximal end region21 ofcover20 may be joined without interference fromproximal end region31 ofloading sheath30.FIG. 1D depicts an exploded view of the circled region ofFIG. 1C, with an example of such a join betweenproximal end region11 ofstent10 andproximal end region21 ofcover20 shown bysolid box15. ThusFIG. 1D depicts a proximally-joined covered stentassembly comprising stent10 contained withincover20 with a joiningpoint15 between theproximal end regions11 and21 ofstent10 andcover20.
• FIGS. 2A-2B depict loading the proximally joinedstent10 and cover20 into a constrainingtube50 and the subsequent formation of adistal juncture16 between thedistal end12 ofstent10 and thedistal end22 ofcover20.FIG. 2A depicts a proximally-joined covered stent assembly prepared as inFIG. 1, which has been ejected from theloading sheath30 by axial movement of thepusher rod32 and theabutment member34 within theloading sheath30. By bringing a constrainingtube50 into co-axial alignment with theloading sheath30, as the proximally-joined covered stent assembly is ejected from theloading sheath30, it is pushed into the constrainingtube50. The proximally-joined covered stent assembly is positioned in the constrainingtube50 such that the assembly extends and is exposed from the distal end of the constraining tube50 a distance d₃. The exposed distal end of the assembly permits formation of adistal junction16 between thestent10 and thecover20.
• FIGS. 3A-3C depict the preparation of an assembly comprising acatheter sheath60, a proximally- and distally-joinedcovered stent25, apusher member80, aguidewire shaft70 and anatraumatic tip90. InFIG. 3A, a proximally- and distally-joined covered stent assembly is partially contained within acatheter sheath60. The proximally- and distally-joinedcovered stent assembly25 ofFIG. 3A may be obtained as shown inFIGS. 1 and 2. InFIG. 3B, the proximally- and distally-joined covered stent assembly ofFIG. 3A has been pushed completely withincatheter sheath60, while inFIG. 3C aguidewire shaft70 is co-axially inserted through the central lumen of the coveredstent assembly25 and extends beyond the terminal (proximal) end of thepusher member80 and thecatheter sheath60. Anatraumatic tip90 is affixed to a distal end of theguidewire shaft70 prior to insertion of theguidewire shaft70. Theatraumatic tip90 is retracted into abutting relation with a distal end of thecatheter sheath60, thereby enclosing the coveredstent assembly25 within thecatheter sheath60.
• In accordance with the best mode for practicing the invention, cover20 is preferably in its martensitic state and unstrained at room temperature, when positioned on theloading sheath30. Thestent10, however, is preferably austenitic and should be loaded into theloading sheath30 in the presence of a cooling medium, e.g., liquid nitrogen bath, dry ice and alcohol bath, flow of chilled gas, etc. The stent in its compressed diameter is strained, thus, in order to operate the other manipulative steps, needs to be within the constrainingtube50 or the catheter tube. The protruding proximal or distal ends of the stent will, however, flare slightly as they are exposed to room temperatures after being loaded into theloading sheath30 and the constrainingtube50. This very slight flare, however, ensures good apposition between thestent10 andcover20 and facilitates forming a junction between thestent10 and thecover20, such as by resistance spot welding.
• FIGS. 4A-4B illustrate loading of the inventive covered stent assembly into acatheter sheath100 which acts to constrain the device from expansion.FIG. 4B depicts the proximally- and distally-joined covered stent assembly prepared as inFIGS. 1A-1D, substantially inserted into constrainingcatheter sheath100.
• FIGS. 5A-5B depict the steps in completing thedelivery catheter assembly120 after apusher member110 is pre-engaged within thecatheter sheath100, as assembly of thepusher member110 after the coveredstent assembly25 is in thecatheter sheath100 would be impracticable. The coveredstent assembly25 may then be fully inserted into thecatheter sheath100 as shown inFIG. 5A, such as by using a pusher member similar to thepusher member34,32 shown inFIG. 1A, such that it abuts or is immediately adjacent to thepusher member110. Once the coveredstent assembly25 is fully inserted into thecatheter sheath100 and positioned so that it abuts or is immediately adjacent to thepusher member110, aguidewire shaft122 is co-axially inserted through the central lumen of the coveredstent assembly25 and extends beyond the terminal end of thepusher member110 and thecatheter sheath100. Anatraumatic tip130 is affixed to a distal end of theguidewire shaft122 prior to insertion of theguidewire shaft122. Theatraumatic tip130 is retracted into abutting relation with a distal end of thecatheter sheath100, thereby enclosing the coveredstent assembly25 within thecatheter sheath100.
• In accordance with all aspects of the present invention, it is desirable that joiningpoints15 or16 be formed by thermal methods, such as such as laser welding, plasma welding, resistance welding, and e-beam welding where both thestent10 and thecover20 are fabricated of metal or pseudometallic materials, preferably shape memory or superelastic materials, most preferably, nickel-titanium alloys. However, where thestent10 and thecover20 are dissimilar materials, such as nickel-titanium alloy and stainless steel, welding is generally not an acceptable method for joining nickel-titanium alloy to other materials, such as stainless steel, because brittle intermetallics are formed in the weld zone. Thus, where nickel-titanium alloy is to be joined to another biocompatible material, it is desirable to employ soldering, epoxies or adhesives to form the joiningpoint15. Alternatively, if welding dissimilar materials to nickel-titanium is desired, it is known to provide an interlayer material, such as tantalum, to minimize formation of brittle intermetallics during welding.
• Finally, in accordance with the best mode of the invention and the preferred embodiment thereof and as illustrated inFIGS. 6A and 6B, it is preferably to configure thestent10 such that it has proximal anddistal junction points150 which provide a relatively larger, substantially planar surface area for creating the junction between thecover20 and thestent10. The junction points150 may have a generally quadrilateral shape in the X-Y axis of either the luminal or abluminal surface of thestent10, preferably has the same Z-axis wall thickness as the remaining portions of thestent10, and have a slight curvature corresponding generally to the curvature of thetubular stent10.FIG. 7 is a photomicrograph illustrating ajunction point150 of astent10 welded to acover20.
• Alternatively, as described more fully in co-pending, commonly assigned patent application U.S. Publication No. US20040186554A1, entitled, “Endoluminal stent having mid-strut interconnecting members” or in co-pending, commonly assigned patent application U.S. Publication No. US20040098094A1, entitled “Implantable graft and methods of making same” thejunction points150 may be projections from terminal proximal and/or distal cylindrical members forming the tubular stent10 (See, e.g., FIG. 1,element 11 in the '554 Publication or FIG. 27, elements 307 and 304a-e in the '094 Publication), each publication is hereby expressly incorporated by reference.
• It is preferable, in accordance with the preferred embodiments of the invention, that when employing shape memory materials for both the stent and the cover, that the stent and the cover have different transition temperatures, such that the stent have its transition temperature below body temperature and diametrically expand when exposed to body temperature, while the cover preferably has a transition temperature above body temperature so that it undergoes detwinned martensitic plastic deformation due to expansion of the stent upon implanting into the body. Thus, it is preferred that the stent have an A_f≦29° C.±3° C. and the cover have an have an A_fbetween about 60 to 100° C. In this manner, the cover remains martensitic under all conditions which are likely to be encountered during manufacture, delivery and after being implanted in vivo. The stent, on the other hand, having an A_fless than body temperature, will be constrained in the delivery catheter and readily expand during implantation in vivo, and readily expand the martensitic cover along with the radial expansion of the stent. Since the cover and the stent will be affixed to each other, it is desirable that the stent and the cover exhibit compatible degrees of foreshortening upon radial expansion of the resulting covered stent device.
• The following examples are provided in order to illustrate the alternative embodiments of the invention, and are not intended to limit the scope of the invention.
Example 1Preparation of a Proximally- and Distally-Joined Stent Assembly Using a Constant Outer Diameter Catheter Sheath
• A self-expanding shape memory nickel-titanium stent having a wall thickness of 127 μm, a 0.965 mm inner diameter (“ID”) and 1.168 mm outer diameter (“OD”) is loaded into a loading sheath of 1.194 mm ID and 1.295 mm OD of a loading/welding fixture, and a cover of 1.257 mm OD and 4.5 micron wall thickness is loaded over the loading sheath. The proximal end region of the cover is then welded to the proximal end region of the crimped stent.
• The resulting proximally-joined covered stent assembly is slid into the distal end of a constraining tube having a 1.193 mm ID and 1.295 mm OD. The loading sheath of the loading/welding fixture is then retracted, the distal end region of the cover is welded to the distal end region of the stent, and the weld is passivated in a nitric acid solution.
• The resulting proximally- and distally-joined covered stent assembly is then slid completely into the constant outer diameter catheter sheath. In one non-limiting embodiment of the present invention, this assembly is chilled in order to facilitate sliding. A pusher shaft of 0.031″ ID and 0.051″ OD is then inserted from the proximal end of the constant outer diameter catheter sheath, and a guidewire shaft of 0.018″ ID and 0.027″ OD comprising a proximal tip is inserted from the distal end of the constant outer diameter catheter sheath. Alternatively, the insertion of the guidewire shaft may precede the insertion of the pusher shaft.
Example 2Preparation of a Proximally- and Distally-Joined Stent Assembly Using a Tapered Catheter Sheath
• A self-expanding shape memory stent having a wall thickness of 127 μm is crimped to an inner diameter (“ID”) of 0.97 mm with an outer diameter (“OD”) of 1.17 mm. The crimped stent is then loaded into a loading sheath having a 1.19 mm ID and 1.295 mm OD of a loading/welding fixture, and a cover of 1.257 mm OD and 4.5 micron wall thickness is loaded over the loading sheath. The proximal end region of the cover is then welded to the proximal end region of the crimped stent.
• The resulting proximally-joined covered stent assembly is slid into a constraining tube having a 1.193 mm ID and a 1.295 mm OD. The loading sheath of the loading/welding fixture is then retracted, the distal end region of the cover is welded to the distal end region of the stent, and the weld is passivated in a nitric acid solution.
• The resulting proximally- and distally-joined covered stent assembly is then slid completely into the distal end of a tapered catheter sheath having an ID of 1.397 mm and a 1.600 mm OD distally, tapered to 1.092 mm ID and 1.295 mm OD proximally, where this tapered catheter sheath contains a preloaded catheter pusher shaft of 0.737 mm ID and 1.295 mm OD distally, tapered to 0.737 mm ID and 0.991 mm OD proximally. In one non-limiting embodiment of the present invention, this assembly is chilled in order to facilitate sliding. A guidewire sheath of 0.457 mm ID and 0.686 mm OD and including an atraumatic tip is then inserted from the distal end of the tapered diameter catheter sheath.
• While the present invention has been described with reference to its preferred embodiments, one of ordinary skill in the relevant art will understand that the present invention is not intended to be limited by these preferred embodiments, and is instead contemplated to include all embodiments consistent with the spirit and scope of the present invention as defined by the appended claims.

Claims (20)

What is claimed is:

1. An implantable covered-stent, comprising:

a) a self-expanding stent having structural members and a length defined between a most proximal vertex and a most distal vertex of the structural members, at least one enlarged member projecting from at least one of the most proximal vertex or the most distal vertex, wherein each of the at least one enlarged members has a substantially planar surface and a width greater than the width of any structural member of the stent, and at least one fenestration is disposed between the most proximal vertex and the most distal vertex; and

b) a metal cover member having a proximal end region, a distal end region, wall surfaces and a plurality of openings passing through the wall surfaces, wherein each of the plurality of openings has an open surface area less than an open surface area of the at least one fenestration;

wherein the metal cover at least partially occludes the at least one fenestration to form the implantable covered-stent.

2. The implantable covered-stent ofclaim 1, wherein the stent and the metal cover have compatible degrees of foreshortening.

3. The implantable covered-stent ofclaim 1, wherein the stent and the metal cover are each composed of at least one material selected from the group consisting of titanium, vanadium, aluminum, nickel, tantalum, zirconium, chromium, silver, gold, silicon, magnesium, niobium, scandium, platinum, cobalt, palladium, manganese, molybdenum and alloys thereof, zirconium-titanium-tantalum alloys, nickel-titanium alloys, cobalt-chromium alloys, and stainless steel.

4. The implantable covered-stent ofclaim 1, wherein the proximal end region of the metal cover is joined by a thermal method in a first join to the at least one enlarged member.

5. The implantable covered-stent ofclaim 4, wherein the distal end region of the metal cover is joined by a thermal method in a second join to the at least one enlarged member.

6. The implantable covered-stent ofclaim 5, wherein the first join and the second join further comprise welds.

7. The implantable covered-stent ofclaim 6, wherein the welds are passivated.

8. The implantable covered-stent ofclaim 1, wherein the stent and the metal cover member are formed of the same biocompatible metal.

9. The implantable covered-stent ofclaim 1, wherein the stent has a transition temperature less than body temperature.

10. The implantable covered-stent ofclaim 9, wherein the metal cover has a transition temperature between about 60 to 100 degrees Centigrade.

11. The implantable covered-stent ofclaim 10, wherein the at least one enlarged member of the stent flares at room temperature.

12. The implantable covered-stent ofclaim 1, further comprising a constant outer diameter catheter sheath and a guidewire sheath.

13. The implantable covered-stent ofclaim 1, said covered-stent further comprising a tapered catheter sheath and a guidewire sheath.

14. The implantable covered-stent ofclaim 1, further comprising an outer diameter catheter sheath, a pusher member, a guidewire shaft, and an atraumatic tip, wherein the implantable covered-stent is partially contained within the catheter sheath, the guidewire shaft is coaxially coupled through a central lumen of the pusher member and a central lumen of the implantable covered-stent to the atraumatic tip, the atraumatic tip is affixed to a distal end of the guidewire shaft, and the atraumatic tip abuts with a distal end of the catheter sheath thereby enclosing the implantable covered-stent within the catheter sheath.

15. The implantable covered-stent ofclaim 1, wherein the at least one enlarged member includes a generally quadrilateral shape in the X-Y axis of the luminal surface of the stent cover.

16. The implantable covered-stent ofclaim 1, wherein the stent and the metal cover member are formed of a dissimilar biocompatible metal.

17. An implantable covered-stent, comprising:

a) a self-expanding stent having structural members and a length defined between a most proximal vertex and a most distal vertex of the structural members, at least one enlarged proximal member projecting proximally from the most proximal vertex and at least one enlarged distal member projecting distally from the most distal vertex, wherein each of the enlarged proximal and distal members has a substantially planar surface and a width greater than the width of any structural member of the stent, and at least one fenestration is disposed between the at least one enlarged proximal member and the at least one enlarged distal member; and

b) a metal cover member having a proximal end region, a distal end region, wall surfaces and a plurality of openings passing through the wall surfaces, wherein each of the plurality of openings has an open surface area less than an open surface area of the at least one fenestration;

wherein the metal cover at least partially occludes the at least one fenestration to form the implantable covered-stent.

18. The implantable covered-stent ofclaim 17, wherein the proximal end region of said metal cover is joined by a thermal method including a first interlayer material in a first join to the at least one enlarged proximal member.

19. The implantable covered-stent ofclaim 18, wherein the distal end region of the metal cover is joined by a thermal method including a second interlayer material in a second join to the at least one enlarged distal member

20. The implantable covered-stent ofclaim 17, wherein the stent and the metal cover member are formed of a dissimilar metal.

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