FR2890306A1 - Vascular pocket treating device for use in kit, has occlusion element and stowing element assembled using articulation, where stowing element passes from closed to open position in which stowing element is closed and deployed, respectively - Google Patents

Abstract

The device (100) has an occlusion element (101) formed of an armature (104) on which a membrane (106) is mounted. The armature passes from a closed position, in which the membrane is closed, to an open position in which the membrane is deployed. A stowing element (102) passes from closed position, in which the element (102) is closed, to an open position in which the element (102) is deployed. An assembly unit is between the elements which are assembled using an articulation (103).

Description

The subject of the present invention is a device for the treatment of a

vascular pocket.

  By vascular pocket is meant a blind pocket resulting from the localized dilation of the wall of a vessel. When such a pocket affects an artery, it is called aneurysm. The rupture of such aneurysms, when they sit in the brain, can have dramatic and even fatal consequences.

  In France, the frequency of aneurysms is estimated between 2 to 5% of the population, the preferred seat of development of aneurysms being the "Willis polygon". In the case of unruptured aneurysms, the patient is asymptomatic and the aneurysm can not be identified. However, in some cases, doctors have the opportunity to discover an unruptured aneurysm, for example, during an examination performed for another reason; they then evaluate the risk of rupture of the aneurysm compared to the risks related to an intervention of exclusion of the aneurysm. While therapeutic abstention is often preferred for aneurysms smaller than 5 to 7 mm, the existence of risk factors may be helpful for intervention.

  The treatment of vascular bags can also be done urgently, during a rupture of said bag, if the broken bag remains sacciform and is accessible to treatment.

  It is known to treat saccular sac pockets by surgery, by placing one or more clips on the neck of said pocket (i.e. on the communication zone between the sac-like sac and the vessel ). The clip, usually made of titanium, closes around the neck, interrupting the communication between the vascular pocket, or aneurysm, and the vessel.

  However, for such surgical treatment, it is often preferred endovascular treatment consisting of a filling by means of turns. This treatment involves bringing a microcatheter through the vessel to the level of the vascular pocket. A filling element adapted to pass to the state of three-dimensional coil, but being in a flattened configuration, is then introduced through this microcatheter into the vascular pocket. Once the filling element is in position in the vascular pocket, it can adopt a configuration deployed in a three-dimensional coil. As many turns as needed are used to fill the vascular pocket, which can be a considerable cost in some cases of wide neck aneurysms. To prevent a portion of the coil from migrating out of the vascular pocket, an occlusion element, such as a temporary balloon or a definitive stent, is generally introduced before, or at the same time as, placing the or the turns. By unfolding, this occlusion element partially or completely closes the neck of the vascular pocket, serving as a support for the turns placed in the pocket.

  It is also possible to close a vascular pocket at the neck by means of an occlusion element without filling the said pocket with turns. The effectiveness of such devices is increased when associated with them a lashing element, opposite to the occlusion element, and which has lashing tabs attached to the wall of the vessel, out of the pocket thus immobilizing the device. See US 6,036,720, PCT / US 9815690 and US2004 / 0087998, for example.

  To further reinforce the stowage, a stent, that is to say a mesh sheath, is sometimes placed in the vessel, at the level of the vascular pocket, overflowing on one side and the other of the collar, the meshes of the stent providing retaining means to said tabs.

  If the devices of the prior art are effective for saccular sac pockets whose transverse axis is substantially perpendicular to the vessel wall, their performance is much lower when the transverse axis of the vascular pocket occupies a different position, which is the most common case. Indeed, when the transverse axis of the vascular pocket is not perpendicular to the wall of the vessel, the contact between one or more of the lashing tabs of the device and the wall may be insufficient, or even non-existent, for that a good hanging is obtained. It follows that the stability of the device is not absolutely reliable over time, with a risk of harmful repealing.

  The invention therefore proposes to solve this problem by means of a device formed of an occlusion element and a securing element articulated with respect to each other.

  More specifically, the device according to the present invention comprises: an occlusion element, adapted to be positioned in a vascular pocket, and which is formed of an armature on which at least one membrane is mounted, said armature being capable of passing a closed position, in which said membrane is constricted, to an open position in which said membrane is deployed; a lashing element, adapted to be positioned in a vessel at said vascular pocket, and which is capable of passing from a closed position, in which said lashing element is tightened, to an open position in which said stowage member is deployed, and - a meeting member between said occlusion member and said securing member, said occlusion member and said securing member being joined through a hinge.

  By membrane is meant here a thin material without limitation as to its structure, composition or properties.

  The presence of a joint between the two elements of the device gives, on the one hand, more flexibility to the device in the tightened state, which facilitates its progression through the microcatheter during its installation and, on the other hand, on the other hand, an adaptability of the device at various angles that can be made by the transverse axis of the vascular pocket with the wall of the vessel, by misalignment of the longitudinal axis of the securement element with respect to the longitudinal axis of the occlusion element. The removal of the microcatheter, with successive deployment of the occlusion element and the securing element, is in a direction imposed by the angle that the transverse axis of the vascular pocket with the wall of the vessel and thanks to the possible pivoting movement between the occlusion and docking element, the latter can be deployed around a direction imposed on it by the microcatheter when it is withdrawn. This allows the securing element to come into contact with the vessel wall at points which otherwise would be inaccessible to it.

  In a preferred embodiment of the invention, the joint is a ball joint, thereby allowing a multiplicity of relative positions between the occlusion member and the securing member.

  According to a first embodiment of the invention, the armature comprises rods radiating around a first central point, in the manner of an umbrella armature, the articulation being situated substantially at the level of said first central radiation point. . In the following, this embodiment is called "right umbrella mode". In the closed position, the stems and membrane are tightened to an elongated, narrow configuration allowing the device to pass through a microcatheter disposed in the vessel. In the open position, the rods deploy, stretching the membrane between them, which allows to obtain an occlusion area as large as possible for the minimum congestion in the tightened state.

  Preferably, the rods of the armature are curved towards the longitudinal axis of the armature.

  In a particular embodiment of the right umbrella mode, the membrane fills the armature from said first central point of radiation, along at least a portion of the rods of the frame, in the manner of a canvas. umbrella. When the device thus produced is in place in a vascular pocket, the first central point of radiation is at the neck of the vascular pocket, and the membrane then forms a portion of sphere whose convexity is turned towards said neck.

  According to a second embodiment of the invention, the armature comprises rods radiating around a first central point, in the manner of an umbrella armature, and an axial shaft fixed at one of its ends, at said first central point of radiation, in the manner of an umbrella handle, the articulation being located substantially at the end of the handle opposite to said first central radiation point, and said handle constituting a traction member adapted to control at least the final deployment of the frame. In the following, this embodiment is called "inverted umbrella mode". The process of introducing the inverted umbrella mode into the vascular pocket and its deployment (or at least the beginning of its deployment) are substantially identical to those of the right umbrella mode. However, in this case, the deployment is obtained, at least as regards its final phase, by a traction exerted on the handle which forces the armature to a deformation by a slight crushing against the inner face of the pocket, in the area adjacent to the collar.

  In a particular embodiment of the inverted umbrella mode, the membrane is preferably attached to the ends of the radiating rods, opposite said first central point of radiation. Thus, during the deployment of the rods, the membrane is tensioned in the direction of the collar and, when the armature crushes slightly against the inner face of the pocket, in the area adjacent to the collar, the tensioned membrane is applied 2890306 6 firmly against the inner wall of the pocket, adjacent to the collar.

  According to a third embodiment of the invention, instead of being constituted by radiating rods, the armature comprises a plurality of deployable loops, each of which circumscribes a membrane. In the closed position, the loops are constricted into an elongate and flattened shape, allowing the device to pass through a microcatheter disposed in the vessel. In the open position, the loops unfold, tending their respective membranes, and allow occlusion of the vascular pocket at the neck.

  In practice, the membrane is advantageously in the form of a net. Compared to a solid web, a net makes it possible to use a material of lower surface mass, and thus to produce a smaller occlusion element, while obtaining optimal occlusion of the vascular pocket.

  The net, connecting the rods or forming the interior of the loops, may be made of poly (glycolic acid), polytetrafluoroethylene, a hydrogel-forming material such as those cited, for example, in the published US patent application. n 2004/0087998, or any other biocompatible and / or inert material that will occur to those skilled in the art. These different materials can be coated with various products inducing cell migration, which allows the healing of the endothelium at the neck of the vascular pocket. Thus, once the occlusion element in place in the vascular pocket, the body will react by colonizing it with cells, which will eventually lead to the total closure of the vascular pocket.

  In an advantageous embodiment of the invention, the device comprises, on or in the vicinity of the joining member between said occlusion element and said securing element, on the securing element side, an adapted temporary fastening means. to receive the end of a pusher. The pusher, secured to the joint, makes it possible to advance the device through a microcatheter (placed beforehand in the vessel) to the level of the neck of the vascular pocket. Once the occlusion element in place, the pusher may possibly allow to guide the securement element, thanks to the joint, depending on the configuration of the vascular pocket, in order to achieve the contact the as much as possible between the securing element and the vessel wall or the best penetration of the securing element into the meshes of an auxiliary stent, if such a stent is used. Once the occlusion element and the securing element are in place, the pusher can be detached from the device and removed at the end of the procedure with the microcatheter. The device formed of the occlusion element and the securing element can, in the closed state and thanks to the securing with the pusher, be extracted at any moment from the vessel as long as the securing is maintained.

  The temporary securing means may be a mechanical actuation system, thermal, or electrolytic or hydraulic. By way of example, the mechanical system may use a pair of matched threads on the pusher and the hinge, the thermal system may use a union between the pusher and the hinge by a solder melting at a predetermined temperature caused by the passage a microcurrent the electrolytic system can use a meeting between the pusher and the joint by welding electrolysis destroying the passage of such microcurrent, and the hydraulic system can use a pressure syringe.

  In a particular embodiment, the securing element is formed of a plurality of tabs radiating around a second central point, the meeting between the occlusion element and the securing element being at the level of said second central point of radiation.

  The use of tabs allows attachment of the lashing element more effective insofar as the tabs can come into contact with the vessel wall at several points apart from each other.

  In a particular embodiment, more particularly suitable when the device of the invention is used at the same time as a stent, the tabs can be of identical length, because the presence of the stent facilitates their stowage.

  According to another embodiment of the invention, the tabs are of different lengths, which makes it possible to optimize the stowage as a function of the configuration of the vascular pocket, in particular when the transverse axis of said pocket is not perpendicular to the vessel wall.

  Advantageously, the legs of the securing element and / or the rods of the armature have microsculptures at their end opposite their respective central point of radiation. By providing a non-slippery surface, these microsculptures help to secure the legs at the vessel or, where appropriate, the stent, as they help maintain the hold between the armature rods and the inner wall of the vessel. vascular pocket. The anti-slip effect of microsculptures can be obtained by nanotechnological processes.

  To conveniently achieve deployment of the entire device, the occlusion member and / or the securing member are preferably made of a shape memory material, i.e. 'a material that allows them to' educate 'them by' teaching 'them the shape they will have to have at body temperature, while allowing them to be given another form, tightened, at a lower temperature. In this constricted (closed) configuration, the device is routed into the vascular pocket through a microcatheter. Then the microcatheter is removed, and the occlusion member and the securing member deploy under the effect of body temperature. An example of a shape memory material is nitinol (a nickel and titanium alloy).

  Finally, the invention relates to a kit comprising a device according to the invention and a pusher connected or temporarily connectable to said device and, where appropriate, a stent.

  Embodiments of the invention will now be described with reference to the accompanying drawings, in which: FIGS. 1A-C show a first embodiment of the device according to the invention, called "right umbrella mode", at different stages of implementation; - Figure 2A-C show a second embodiment of the device according to the invention, called "inverted umbrella mode", at different stages of implementation; - Figures 3A-C show an alternative embodiment of the device according to the invention, wherein the occlusion element comprises loops; - Figures 4A-C show the steps of the introduction into a vascular pocket of a variant of the device according to the invention in right umbrella mode; FIG. 5 is a view similar to FIG. 4C, showing the device of FIGS. 1A-1C, in place in a vascular pocket, and secured to the stitches of a stent.

  Figures 1A-1C to 3 are intended only to allow the description of the various elements of various embodiments of the device, without the interest of the planned articulation between the occlusion element and the element lashing appears. This interest is illustrated in Figures 4A-4C and 5.

  The device 100, shown in FIGS. 1A-1C, comprises an occlusion element 101, having a longitudinal axis W-W ', and a securing element 102, having a longitudinal axis Z-Z', joined by a hinge Patella 103. The axes WW 'and ZZ' are combined in the representations of FIGS. 1A-1C to 3.

  The occlusion element 101 is formed of an armature 104 comprising, on the one hand, four rods such as 105 radiating around a first central point C1 and slightly curved towards the axis WW 'and, on the other hand, a net 106 mounted on a part of the length of the rods 105 from said central point C1. The reason why the net is mounted only on part of the rods is that its presence is not necessary, once deployed. , at the level of the neck of the vascular pocket and the immediate surroundings of the neck, the length of the rods beyond the net being justified for reasons of stability.

  The tie-down member 102 is formed of four legs such as 107 radiating around a second radiation point C2 (FIG. 1C).

  The ball joint 103 consists of a first spherical portion 108, attached to the occlusion member 101 in the region of the radiation point C1 of the rods 105, and a second spherical cup shaped portion 109 fixed as for it, the securing element 102 in the area of the second radiation point C2. The two parts 108 and 109 of the ball joint are in inseparable engagement allowing the rotation of the sphere 108 in the section 109. On its opposite side to the sphere 108, the section 109 has a small tail 110 threaded externally.

  Figures 1A-1C show this threaded shank 110 engaged with a pusher 111 having a paired internal thread.

  In FIG. 1A, the device 100 is represented in the closed state in a microcatheter 112, in the vicinity of the free end thereof and the collar of a vascular pocket schematized by the dashed line L, the microcatheter 112 being himself in a vessel not shown. The rods 105, the net 106 and the tabs 107 are tightened, which gives the device 100 an elongated and narrow shape allowing it to be inserted into the microcatheter 112 and conveyed along the latter by pushing it by means of the pusher 111 .

  In Figure 1B, the occlusion member 101 has crossed the line L and the stems 105 have begun to unfold by opening the net 106 in the manner of an umbrella. At this stage, the securing element 102 is still in the closed state in the microcatheter 112, upstream of the line L. In FIG. 1C, the microcatheter 112 has been withdrawn, thus releasing the tabs 107 and allowing their deployment, while the deployment of the rods 105 and the tension of the net 106 continued. The next phase would be the unscrewing of the pusher 111 and its extraction from the vessel at the same time as that of the microcatheter 112.

  In Figures 2A-2C, elements unchanged from Figures 1A1C retain the same numerals and modified elements, but having a similar function, have as references those of Figures 1A, 1B and 1C increased by 100.

  The embodiment of Figures 2A-2C is essentially distinguished from the previous one by reversing the orientation of the occlusion member with respect to the securing member.

  More specifically, while in the embodiment of FIGS. 1A-1C, the occlusion element 101 is joined to the articulation 103 at the radiation point C1 of its rods 105, in the embodiment of FIGS. 2A-2C, this meeting is done via a sleeve 213 fixed at one of its ends to the rods 205 in the area of said first radiation point C1 and at its other end to the part spherical 208 of the joint 203, so that the convexity of the armature 204, in the expanded state, is turned to the opposite of the joint. In addition, the thread 206 is not fixed along the rods 205 but only at the ends of the rods opposite to the radiation point C1 and this thread 206 has a passage 214 whose utility will appear later.

  In FIG. 2A, the device 200 is, in the closed state, inserted into a microcatheter 112, and it can be seen that it is through the radiation point C1 that the occlusion element 201 will enter the pocket. vascular and not by the tip of the rods, as in the case of the device 100. We see, further that the joint 203 and the securing element 202 are housed between the rods 205 of the frame 204, with the legs stowing 207 oriented so that their free ends are radiation point side C1.

  In Figure 2B, the entire device has passed the neck of the vascular pocket symbolized by the dotted line L and the occlusion member 201 has begun to unfold. The rods 205 have moved away from the handle 213 and the thread 206 has begun to stretch between the ends of the rods 205 by adopting a substantially flat configuration.

  In FIG. 2C, the microcatheter 112 has been slightly pulled back and it has been pulled on the pusher 111 to make the thread 206 pass to the articulation 203 and to the securement element 202, via the passage 214 provided for this purpose. , and to complete the deployment of the frame 204. It is understood that the orientation of the lashing tabs 207, before deployment, is chosen to facilitate the crossing of the net 206. The end of at least most of the rods 205 of the armature 204 being in contact with the inner wall of the vascular pocket, the force exerted on the handle 213 has forced the armature 204 to deform by a slight crushing and the thread 206 to conform to the inner face of the edges of the neck . For their part, the securing lugs 207 have deployed in a configuration similar to that they have in Figure 1C.

  Figures 3A and 3B relate to a device 300 similar to the device 100 and shown by views similar to Figures 1A and 1B. The device 300 differs however from the device 100 in that the armature of its occlusion element 301 is not made of rods with a thread common to the different rods, but four loops, such as 305, of which each circumscribes a net, such as 306.

  For the rest, it is unnecessary to describe the various elements of this embodiment in that they are identical to those of the device 100 and identified either by the same reference or by the same reference increased by 200.

  FIG. 3C shows the device 300 deployed, seen from inside the vascular pocket, the neck of said pocket being represented by the dotted line L '.

  Figures 4A, 4B and 4C show the steps of inserting a variant 400 of the device 100 into a vascular pocket 415.

  In Figure 4A, there is shown a vessel 416 whose wall forms a vascular pocket 415, the neck of said pocket being designated L as in the previous figures. As seen, the X-X 'axis of the pocket 415 is not perpendicular to the general direction Y-Y' of the vessel, and moreover, at the neck, the pocket 415 is not tightened but widely open. Such situations are very difficult to treat satisfactorily according to the prior art, but it is understood that the application of the device according to the invention is not limited to this type of case.

  A microcatheter 112 is threaded on a microguide 417 which protrudes from the leading end of said microcatheter 112. The microguide has a body which is more rigid than the microcatheter but its protruding end is more flexible than said microcatheter, which facilitates its penetration in the vascular pocket 415 and positioning the microcatheter relative to said pocket. The microguide 417 is then pulled out of the microcatheter 112 and is substituted for the device 400 according to the invention, pushed by means of its pusher until the occlusion element 401 emerges from the leading end. microcatheter 112 in the pocket 415, as seen in Figure 4B, with the beginning of deployment of the rods 405. Their full deployment is achieved by combining a hold in place of the pusher and a slight withdrawal of the microcatheter until clearing the articulation 403 (Figure 4B). A further slight shrinkage is imposed on the microcatheter 112 to disengage the lugs 407, 407 ', which in turn deploy in the configuration shown in FIG. 4C. The pusher is then unscrewed and withdraws from the pusher, then to that of the microcatheter 112. As can be seen, the device 400 illustrated differs from the device 100 of FIGS. 1A-1C in that it comprises five rods instead of four rods. , and that the legs of the securing element are of different lengths, two short 407 and two long 407 '.

  In the absence of articulation, the axis ZZ 'of the securing element and the axis WW' of the occlusion element would be merged and, then, or the legs would occupy the position shown but the armature would not be optimally oriented in the pocket 415 so that the net 406 closes it as well as possible and as close as possible to the collar L, or the armature would be properly oriented relative to the pocket, but the legs would be in a position unsuitable for a satisfactory stowage. Thanks to the articulation 403, it is possible to give independently to the occlusion element and the securing element a position each appropriate to their function, and the different lengths of the legs increase the chances of coming into contact with said elements. legs with the vessel wall 416.

  The positioning of the lashing lugs 407, 407 'is either of itself under the effect of the beginning of the withdrawal of the microcatheter 112, which forces the lashing member 402 to a natural rotational movement with respect to the occlusion member 401, while the pusher is still engaged with the joint; or, if necessary, the positioning of the tabs 407, 407 'is perfect by maneuvering the cup-shaped part 409 with the pusher before unscrewing it.

  Figure 5 shows a device 500 in a position corresponding to that already described with reference to Figure 4C. This time, before the introduction of the microcatheter, a stent 518 has been placed in the vessel 416 on either side of the neck L of the pocket 415. Since the stitches of the stent 518 offer a multiplicity of points, anchoring to the legs 107, it is possible to use a device that has only short legs, all of the same length.

  Whatever the embodiment of the device according to the invention, the stems of the occlusion element and the lashing tabs are advantageously made of a shape memory alloy and they have been shaped so as to assume their shape. deployed when they are at body temperature. It is thus possible to put them in place while they are in the tightened state, at a temperature below body temperature, and to let them bloom with their warming. This solution has the advantage of not requiring control means of their deployment.

  It is also possible to obtain this deployment not mechanical means. For example, the reinforcement rods and the lashing legs can be made of a resilient material that will keep them tight as long as they are trapped in the microcatheter but will deploy as soon as they are released. an effect however is sufficiently soft and progressive so that it is not harmful. With regard to the securing element, it is possible, alternatively and for example, to adopt, for securing between the pusher and the cut-away piece of the hinge, a system which not only ensures this securing but also allows the control of the lashing legs by means of the pusher.

  It is understood that the invention is not limited to the embodiments described and shown. Thus, for example, although modes of execution having four stems and four legs have been described, this number is not imperative; likewise, although embodiments having a ball joint have been described and which are provided with a net as a membrane, it would be possible to use another type of articulation and use, as a membrane, a veil full or perforated film or not.

  Finally, the pusher could be temporarily secured to the device by means other than a pair of matched threads, such as one of the means indicated above.

Claims (19)

  A device (100; 200; 300; 400; 500) for treating a vascular pocket, comprising: - an occlusion member (101; 201; 301; 401) formed of an armature (104; 204; 304) on which is mounted at least one membrane (106; 206; 306,406), said armature being capable of passing from a closed position, in which said membrane is tightened, to an open position in which said membrane is deployed; a lashing member (102; 202; 302; 402) capable of passing from a closed position in which said lashing member is tightened to an open position in which said lashing member is deployed, and a meeting member between said occlusion member and said securing member, characterized in that said occlusion member (101; 201; 301; 401) and said docking member (102; 202; 302; 402); are joined via a hinge (103; 203; 303; 403).   2. Device (100; 200; 300; 400; 500) according to claim 1, characterized in that said hinge (103; 203; 303; 403) is a ball joint.   3. Device (100; 400; 500) according to claim 1 or 2, characterized in that said armature (104) comprises rods (105; 405) radiating around a first central point (Cl), in the manner of an umbrella frame, and in that the meeting between the occluding member (101; 401) and the securing member (102; 402) is at said first central radiation point (C1).   4. Device (100; 400; 500) according to claim 3, characterized in that said membrane (106; 406) lends said armature (104) from said first central radiation point (C1) along at least one part of the rods (105; 405) of the frame, in the manner of an umbrella cloth.   5. Device (200) according to claim 1 or 2, characterized in that said frame comprises rods (205) radiating around a first central point (Cl), in the manner of an umbrella frame, and in that that an axial shaft (213) is attached at one of its ends at said first central radiation point (C1), in the manner of an umbrella shaft, the union between the occlusion element (201) ) and the securing element (202) being at the end of the handle opposite to the first central radiation point (C1), and said handle (213) constituting a traction member adapted to control at least the deployment final of the frame.   6. Device (200) according to claim 5, characterized in that said membrane (206) is fixed to the ends of the rods (205) opposite said first central radiation point (Cl).   7. Device according to any one of claims 3 to 6, characterized in that said rods (105; 205; 405) have microsculptures at their end opposite said first central point of radiation (Cl).   8. Device (100; 200; 400; 500) according to any one of claims 3 to 7, characterized in that the rods (105; 205; 405) of the armature (104; 204) are bent in the direction of the longitudinal axis (W-W ') of the armature.   9. Device (300) according to claim 1 or 2, characterized in that said armature comprises a plurality of deployable loops (305) each of which circumscribes a membrane (306).   10. Device (100; 200; 300; 400; 500) according to any one of the preceding claims, characterized in that said membrane is a net (106; 206; 306,406).   11. Device (100; 200; 300; 400; 500) according to claim 10, characterized in that said net (106; 206; 306,406) is made of poly (glycolic acid), polytetrafluoroethylene or a form-forming material. hydrogel.   12. Device (100; 200) according to any one of the preceding claims, characterized in that it comprises, on or in the vicinity of the meeting member between said occlusion element and said securing element, element side securing means, a temporary securing means (110) adapted to receive the end of a pusher (111).   13. Device (100; 200; 300; 400; 500) according to claim 12, characterized in that the temporary fastening means is a system with mechanical actuation, thermal, hydraulic or electrolytic.   Device (100; 200; 400; 500) according to one of the preceding claims, characterized in that the securing element (102; 202; 402) is formed of a plurality of tabs (107; 407,407 ') radiating about a second center point (C2), the meeting between the occluding member (101; 201; 401) and the securing element (102; 202; said second central radiation point (C2).   15. Device (100; 200; 500) according to claim 14, characterized in that said tabs (107; 207) are of identical lengths.   16. Device (400) according to claim 14, characterized in that said tabs (407, 407 ') are of different lengths.   17. Device (100; 200; 400; 500) according to any one of claims 14 to 16, characterized in that said tabs have microsculptures at their end opposite said second central point of C2 radiation.   18. Device (100; 200; 300; 400; 500) according to any one of the preceding claims, characterized in that said occlusion element (101; 201; 301; 401) and / or said securing element ( 102; 202; 302; 402) is (are) made of a shape memory material.   19. Kit comprising: - a device (100; 200; 300; 400; 500) according to any one of the preceding claims; - A pusher (111) connected or temporarily connectable to said device; and, optionally, a stent (518).