EP2170230A1 - Système de mise en place d'appareil médical avec gaine et position relative du ballon - Google Patents

Système de mise en place d'appareil médical avec gaine et position relative du ballon

Info

Publication number
EP2170230A1
EP2170230A1 EP08771745A EP08771745A EP2170230A1 EP 2170230 A1 EP2170230 A1 EP 2170230A1 EP 08771745 A EP08771745 A EP 08771745A EP 08771745 A EP08771745 A EP 08771745A EP 2170230 A1 EP2170230 A1 EP 2170230A1
Authority
EP
European Patent Office
Prior art keywords
sheath
wing
balloon
delivery system
distal end
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP08771745A
Other languages
German (de)
English (en)
Inventor
David Slattery
Damian Kelly
Therese O'connor
Joseph Kerins
Michael Gilmore
Mark Steckel
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Cappella Inc
Original Assignee
Cappella Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US11/766,198 external-priority patent/US20080319388A1/en
Priority claimed from US11/930,634 external-priority patent/US20090112159A1/en
Application filed by Cappella Inc filed Critical Cappella Inc
Priority to EP13178193.2A priority Critical patent/EP2656871B1/fr
Publication of EP2170230A1 publication Critical patent/EP2170230A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M25/1027—Making of balloon catheters
    • A61M25/1038—Wrapping or folding devices for use with balloon catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/958—Inflatable balloons for placing stents or stent-grafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/962—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
    • A61F2/97—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve the outer sleeve being splittable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/958—Inflatable balloons for placing stents or stent-grafts
    • A61F2002/9583—Means for holding the stent on the balloon, e.g. using protrusions, adhesives or an outer sleeve

Definitions

  • the present invention relates to a delivery system and method for deployment of a medical device, e.g., a self-expanding vascular device, in the vasculature of a patient. More particularly, a delivery system having a sheath with portions specifically positioned relative to a balloon positioned therein is described.
  • treatment of vascular blockages due to any one of a number of conditions often comprises balloon dilatation and treatment of the inner vessel wall by placement of a stent.
  • These stents are positioned to prevent restenosis of the vessel walls after the dilatation.
  • Other devices often referred to as drug eluting stents, are now being used to deliver medicine to the vessel wall to also help reduce the occurrence of restenosis.
  • These stents i.e., tubular prostheses, typically fall into two general categories of construction.
  • the first category of prosthesis is made from a material that is expandable upon application of a controlled force applied by, for example, a balloon portion of a dilatation catheter upon inflation.
  • the expansion of the balloon causes the compressed prosthesis to expand to a larger diameter and then left in place within the vessel at the target site.
  • the second category of prosthesis is a self-expanding prosthesis formed from, for example, shape memory metals or super-elastic nickel-titanium (NiTi or Nitinol) alloys, that will automatically expand from a compressed or restrained state when the prosthesis is advanced out of a delivery catheter and into the blood vessel.
  • Some known prosthesis delivery systems for implanting self-expanding stents include an inner lumen upon which the compressed or collapsed prosthesis is mounted and an outer restraining sheath that is initially placed over the compressed prosthesis prior to deployment.
  • the outer sheath When the prosthesis is to be deployed in the body vessel, the outer sheath is moved in relation to the inner lumen to "uncover" the compressed prosthesis, allowing the prosthesis to move to its expanded condition.
  • Some delivery systems utilize a "push-pull” type technique in which the outer sheath is retracted while the inner lumen is pushed forward.
  • Still other systems use an actuating wire that is attached to the outer sheath. When the actuating wire is pulled to retract the outer sheath and deploy the prosthesis, the inner lumen must remain stationary, preventing the prosthesis from moving axially within the body vessel.
  • systems that rely on a "push-pull design” can experience movement of the collapsed prosthesis within the body vessel when the inner lumen is pushed forward. This movement can lead to inaccurate positioning and, in some instances, possible perforation of the vessel wall by a protruding end of the prosthesis.
  • Systems that utilize an actuating wire design will tend to move to follow the radius of curvature when placed in curved anatomy of the patient. As the wire is actuated, tension in the delivery system can cause the system to straighten. As the system straightens, the position of the prosthesis changes because the length of the catheter no longer conforms to the curvature of the anatomy. This change of the geometry of the system within the anatomy can also lead to inaccurate prosthesis positioning.
  • a self- expanding stent is kept in its compressed state by a sheath positioned about the prosthesis.
  • a balloon portion of the delivery catheter is provided to rupture the sheath and, therefore, release the prosthesis.
  • the stent may be provided around the balloon, with the sheath around the stent, that is, the balloon, stent, and sheath are co-axially positioned, such that expansion of the balloon helps to expand the self-expanding stent as well as rupture the sheath.
  • the balloon is outside the stent and the sheath is around both the balloon and the stent.
  • perforations in the sheath.
  • the intention of the perforations is to make the rupturing or separation of the sheath easier upon expansion of the balloon. While the perforations may help to control the rupturing of the sheath by providing a "weak" portion, the dynamics of sheath rupturing are still not well controlled.
  • a delivery system comprises: a catheter having a distal end and a proximal end; a balloon portion, having a deflated state and an inflated state, positioned at the distal end of the catheter and wrapped about the distal end of the catheter, the balloon portion comprising at least two wing portions; a medical device, having a compressed state and an expanded state, positioned about the balloon portion; and a sheath, comprising sheath material, positioned about the medical device to hold the medical device in the compressed state, the sheath material comprising a predetermined sheath portion, wherein the predetermined sheath portion is located at a predetermined position as a function of positions of the at least two wing portions of the balloon portion.
  • a delivery system comprises: a catheter having a distal end and a proximal end; a balloon portion positioned at the distal end of the catheter; a medical device, having a compressed state and an expanded state, positioned about the balloon portion; and a sheath positioned about the medical device to hold the medical device in the compressed state.
  • the sheath comprises: a distal sheath portion located at a distal end of the sheath, the distal sheath portion having a first diameter and a first longitudinal length; a transition portion, of a second longitudinal length, having a distal end located adjacent the proximal end of the distal sheath portion, the distal end of the transition portion being of the first diameter and having a proximal end with a second diameter greater than the first diameter; a body portion of a third longitudinal length, having a distal end adjacent a proximal end of the transition portion, the body portion being of the second diameter; and an opening provided in an outer surface of the sheath.
  • Figure 1A is a view of a device delivery system
  • Figure 1 B is a cross-sectional view of the device delivery system along line 1 B-1 B as shown in Fig. 1A;
  • Figures 2A and 2B are views of a portion of a device delivery system
  • Figure 3 is a cross-sectional view of a dual-wing PTCA balloon
  • Figure 4 is a cross-sectional view of the dual-wing PTCA balloon of Fig. 3 in a bi-folded configuration and wrapped within a sheath;
  • Figure 5 is a cross-sectional view of the partially expanded PTCA balloon of Figures 3 and 4;
  • Figure 6 is a perspective view of an initial cut positioned on a sheath
  • Figure 7 is a cross-sectional view of a tri-wing PTCA balloon
  • Figure 8 is a cross-sectional view of the tri-wing PTCA balloon of Fig. 7 in a tri-folded configuration and wrapped within a sheath;
  • Figure 9 is a cross-sectional view of a dual-wing PTCA balloon in a U-fold configuration and wrapped within a sheath;
  • Figure 10 is a method of placing a sheath split with respect to an orientation of a balloon placed within;
  • Figure 11 is an alternate method of loading a device on a delivery system and orienting the splits in the sheath with a balloon;
  • Figure 12 is a perspective view of the dual-wing PTCA balloon of Fig. 3;
  • Figure 13 is a representation of a sheath similar to the one shown in Figure 7 while being positioned in a vessel;
  • Figure 14 is a profiled sheath in accordance with one embodiment of the present invention.
  • Figure 15 is a representation of the sheath shown in
  • Figure 14 positioned on a delivery system
  • Figure 16 is a representation of a portion of the sheath of Figure 14 as the sheath is being expanded:
  • Figures 17 - 19 represent one embodiment of a method of manufacturing the sheath of Figure 14.
  • Figure 20 is a flowchart of the steps of an embodiment of a method of manufacturing the sheath of Figure 14. DETAILED DESCRIPTION
  • a medical device delivery system as shown in Fig. 1A, includes a delivery catheter 12 with a balloon 14 positioned at, or enclosing, a distal end 11 of the catheter 12.
  • a lumen is provided to inflate the balloon 14 as necessary during the procedure to deliver a device 16, for example, a stent, that is placed at the distal end of the catheter 12 and around the balloon 14.
  • the device 16 is a self expanding device and, therefore, a sheath 18 is also disposed at the distal end 1 1 of the catheter 12 so as to enclose the device 16 and the balloon 14.
  • the sheath 18 is attached to the catheter 12 at some point proximal to the distal end 1 1 of the catheter 12.
  • FIG. 1 B A cross section of the system 10, along line 1 B-1 B, is presented in Fig. 1 B. As shown, the sheath 18 surrounds the stent or device 16 and the balloon 14 positioned on the catheter 12.
  • FIG. 2A a simpler representation of the system 10 of Fig. 1 A, is shown where a distal end 202 of the sheath 18 is positioned a distance A proximally from a distal end 201 of the balloon 14. Placing the distal edge 202 of the sheath 18 a predetermined distance proximal to the distal end 201 of the balloon 14 allows for maximum effectiveness of the balloon 14 with respect to rupturing of the sheath 18.
  • Fig. 2B corresponding to Fig. 2A, with the device 16 removed for clarity, a perforation 200 is provided in the sheath 18. The perforation 200 is shown here at the distal end 202 of the sheath 18.
  • the perforation 200 facilitates the separation or rupture of the sheath 18 as the balloon 14 is expanded.
  • the perforation 200 may comprise, in one embodiment, one or more discontinuous slits in the sheath material 18.
  • a slit does not involve the removal of sheath material.
  • the sheath 18 may be created by weakening a portion of the sheath 18 by chemical and/or mechanical means.
  • the perforation 200 may comprise one or more holes, where each hole is created by the removal of sheath material. While the perforation 200 is shown here at the distal end of the sheath 18, of course, one of ordinary skill in the art would understand that were the sheath 18 to be connected to the catheter 12 at the distal end of the sheath 18, then the perforation 200 may be positioned at a proximal end of the sheath 18. Further, more than one perforation 200 may be provided, for example, one at each of the proximal and distal ends of the sheath 18, respectively. [0037] As an alternative to the perforation 200, a single initial cut 602, as shown in Fig. 6, may be implemented.
  • the sheath is made from a material having a grain, or fibers, that can be longitudinally oriented, for example, PTFE.
  • the sheath 18, upon expansion of the balloon 14, will tear along the perforation 200 or initial cut 602 in substantially a straight line following a longitudinal axis of the sheath 18 as defined, generally, by the catheter 12.
  • the PTCA balloon catheter included a 2.0 mm by 30 mm nylon balloon 14.
  • the particular type of balloon 14 that was used in these experiments exhibited semi-compliant behavior, in that it has a compliance of approximately 5% at 2 mm with 6 atmospheres of nominal pressure, i.e., the balloon diameter ranges from 1.9 mm to 2.1 mm at 6 atmospheres.
  • the external polymer sheath 18 was provided in two sizes: a) 0.043 inches inner diameter by 0.002 inches wall thickness; and b) 0.047 inches inner diameter by 0.002 inches wall thickness.
  • the sheath was positioned substantially as shown in Figs. 1A and 1 B. Further, an initial cut was placed at the distal end of the sheath 18.
  • the PTCA balloon 30, once mounted on the delivery system, is folded such that the wings 32, 34 "wraparound" the body of the balloon 30 in such a way so as to not interfere with each other as the balloon 30 is inflated, i.e., a "wrap bi-fold" orientation.
  • a wing tip portion 36' of the wing 34 is folded along a circumferential direction A (shown by arrow) toward the base portion 38 of the wing 32.
  • the wing tip portion 36 of the wing 32 is folded toward the wing base portion 38' of the wing 34, continuing in the direction A.
  • the present inventors have observed that placement of the perforation 200 or split 602 to take advantage of the mechanical leverage provided from the folded wings 32, 34 of the balloon 30 will aid in establishing a consistent and repeatable splitting of the sheath at a specific pressure, or relatively narrow range of pressures, of the balloon.
  • the split or perforation on the sheath were randomly placed, irrespective of any geometry of the balloon around which the sheath was disposed.
  • a sheath 40 has been provided around a dual-wing balloon 30 in a wrap bi-folded configuration. Two placement areas 42, 44 along the circumference of the sheath 40 are defined. Placing the perforation 200 or cut 602 within at least one of these placement areas optimizes the tearing or rupturing of the sheath 40. These two areas 42, 44 are defined or predetermined with respect to the orientation of the folded balloon.
  • the sheath 40 will split at a uniform and consistent and repeatable pressure of the balloon. It should be noted that one initial cut or perforation in either of the areas 42, 44 is sufficient to initiate the full split of the sheath 40. It has been observed, however, that a split or perforation may be placed in each of the areas 42, 44 to facilitate separation of the sheath 40.
  • a second set of experiments was performed where sheaths, with the same construction as those previously described, are provided around the PTCA balloon except that the perforation or initial cuts are placed in one of the areas 42, 44, i.e., relative to the orientation of the balloon 30. Once again, the balloon is inflated in increments of 1 atmosphere. As shown in Table 2, the balloon pressure necessary to fully split the sheath 40 was repeatedly 5 atmospheres.
  • Table 2 [0050] The specific placement of the initial cut 602 or perforation 200 with respect to the folded geometry or orientation of the balloon provides consistent and repeatable sheath splitting performance. The repeatability and consistency of obtaining a full split provides an advantage with respect to using a delivery system with a balloon expandable sheath to deliver a self expanding medical device.
  • the present inventors have recognized that the folds or wings 32, 34 of the PTCA balloon 30 play a role in splitting the sheath 40, due to the placement of the split 602 or perforation 200. Further, optimum positions about the circumference of the sheath can be predetermined as a function of the balloon's placement and folded geometry about the catheter.
  • the placement areas 42, 44 can be defined as those locations around the circumference of the sheath 40 at which the resultant force exerted by the wings 32, 34, against the sheath as the balloon is inflated, is at a maximum. It can be considered that the balloon 30 expands symmetrically from its center C as it is being inflated.
  • the wings 32, 34 exert, respectively, forces F and F', against the sheath 40 at points 52, 54, respectively. The cumulative effect of the forces of the wings 32, 34 against the sheath 40 is maximized in the two placement areas 42, 44.
  • placement areas 42, 44 located about the circumference of the sheath 40 may be considered to be defined as located generally halfway between circumferentially adjacent points where the balloon wings 32, 34 exert a respective force against the sheath 40 upon inflation of the balloon.
  • the placement areas 42, 44 in one embodiment are located along the circumference of the sheath within a portion of the circumference that is in a range of 40-60% of the distance between the points 52, 54.
  • the location of the placement areas 42, 44 may be described as being located between a wing tip 36 and a wing base 38 of adjacent wings of the balloon. As shown in Figure 5, due to the bi-fold of the balloon 30, the wing tip portion 36' is adjacent the wing base portion 38. The placement area 42 is, therefore, located substantially half-way between these two wing portions.
  • the placement areas 42, 44 are easily discernible by viewing the folded balloon within the sheath.
  • the balloon 30, as shown in Figure 3, is of a dual-wing design.
  • a balloon 700 of a tri-wing design as shown in cross-section in Figure 7, may be used.
  • the balloon 700 has three wings 702, 704, 706 symmetrically disposed about the circumference of the balloon.
  • Each of the wings has a wing tip 36 and a wing base 38.
  • placement areas 802, 804, 806 are positioned about the circumference of the sheath 40. Similar to the foregoing description, the placement areas 804, 806 are, respectively, located between adjacent wing tip portions 36 and wing base portions 38.
  • the dual-wing balloon is folded in a U-fold, where the wings 32, 34 have their respective wingtip portions 36, 36' adjacent one another.
  • the wing 34 is wrapped in the circumferential direction A (as shown by the arrow A) while the wing 32 is wrapped in an opposite circumferential direction B (as shown by the arrow B) opposite that of direction A.
  • the placement area 90 is then located along the circumference of the sheath 40 substantially midway between the wingtip portions 36, 36'. It is expected that as the balloon is inflated in this orientation the cumulative effect of the wing portions pushing on this sheath will be maximized within the placement area 90.
  • step 1002 the balloon is mounted on the catheter.
  • the balloon is mostly deflated, i.e., a vacuum is created within the balloon lumen.
  • step 1006 it has to be determined whether or not the balloon is of a dual-wing or tri-wing construction. If it is the latter, control passes to step 1008 where the balloon is folded in a tri-fold configuration.
  • the balloon is then placed in the inside diameter of the device 16 and within the sheath, step 1010.
  • One or more locations between an adjacent wing-tip and wing-base are then determined at step 1012. Once the location of the placement area is determined in step 1012, the perforation or slit is provided at step 1014.
  • step 1016 if the balloon is of a dual-wing construction then control passes to step 1016 where the balloon is folded.
  • step 1018 it is determined as to whether or not the balloon was folded in a bi-fold configuration or a U-fold configuration. If it is determined that is the former configuration then control passes to step 1010 and operation continues as described above. If, however, it is the U-fold configuration then, at step 1020, the balloon is then placed in the inside diameter of the device 16 and within the sheath. Subsequently, step 1022, the location between adjacent wing tips about the circumference of the sheath is determined. Finally, step 1024, the perforation or slit is placed in the determined location.
  • FIG. 11 An alternate method 1 100 for assembling a system in accordance with another embodiment of the present invention will now be described with respect to the flowchart shown in Figure 11.
  • a self-expanding device is loaded into a sheath, step 1102.
  • a micro- hole is then punched into the sheath, step 1 104, in order to facilitate the flow-through of liquid, for example, blood, as may be found in a vessel in which the device will be placed.
  • One or more slits or perforations or holes are placed in the sheath, step 1106.
  • a deflated balloon, with its wings folded in one of the orientations described above, is positioned on a catheter which is then inserted within the device/sheath assembly, step 1 108.
  • this expansion of the sheath 218 is similar to an open mouth of a fish.
  • This "fish-mouthing" of the sheath 218 is problematic as the sheath 218 may catch on lesions in the vessel and/or prevent the delivery system from properly tracking distally across a lesion. This interference with the tracking, or the catching on lesions, can lead to significant complications in the procedure, and may increase the time of the procedure, any of which can adversely affect patient safety.
  • the inventors of the present application have noted that adjustment of either the inner diameter of the sheath or the wall thickness of the material from which the sheath is made, does not sufficiently reduce the occurrence of fish-mouth. It appears that the initiation slit 402 is one of the leading factors that contributes to the size of the fish-mouth.
  • the length of the initiation slit 402 was reduced from 1.5mm to .5mm and the amount of fish-mouth width, i.e., diameter, was substantially reduced. While the amount of fish-mouthing was reduced, however, the benefit of a lower and consistent pressure of the balloon portion necessary to consistently open, i.e., rupture, the sheath 218, was negatively affected.
  • merely reducing the length of the initiation slit 402 while it does reduce the width of the fish-mouth, prevents consistent release of the device at a lower balloon pressure.
  • a profiled sheath 900 reduces lesion crossing issues and, therefore, reduces the occurrences of complications that may adversely affect the proper and safe delivery of a self-expanding medical device.
  • the profiled sheath 900 includes a distal end 902 and a proximal end 904.
  • a distal lead portion 906 is located at the distal end 902 and has a corresponding longitudinal length C.
  • Located proximal to the distal lead portion 906 is a cone/transition portion 908 having a corresponding longitudinal length of B.
  • Located proximal to the cone/transition portion 908 is a body portion 910 having a corresponding longitudinal length A.
  • the distal lead portion 906 has a corresponding width E and the body portion 910 has a corresponding width F.
  • the cone/transition portion 908 transitions from the width E to the width F as between the distal lead portion 906 and the body portion 910, respectively.
  • width is referring to the diameter of the tubular sheath.
  • portions e.g., distal lead portion 906, the profiled sheath 900 is, in one embodiment, of a unitary construction.
  • the sheath 900 is made from material similar to that referenced above. Further, the grain direction of this material is oriented in a longitudinal direction along the profiled sheath 900 running from the distal end 902 to the proximal end 904.
  • An initiation opening 912 is provided across a junction or boundary between the distal lead portion 906 and the cone/transition portion 908.
  • a distal-most part of the opening 912 is located a distance D from the distal end 902 of the sheath 900.
  • the opening 912 is “set back" from the distal end 902 of the sheath 900. It is advantageous to position the opening 912 across the boundary between the distal lead portion 906 and the cone/transition portion 908.
  • the opening 912 need not, however, be symmetrically positioned across the boundary.
  • the opening 912 may be implemented as a slice in the sheath material, where no material has been removed, and where there are sharp edges at each end of the opening 912.
  • the sharp edges assist in the consistent splitting of the sheath.
  • the opening 912 may be created by a slicing operation or a punching operation.
  • the opening 912 may be implemented by operation of a sharp blade or a slicing laser device could be used. Alternatively, the opening 912 may result from an operation where material is removed, i.e., "punched out.”
  • the profiled sheath 900 is disposed about a self-expanding stent 100 and a balloon portion 214 of a delivery system 212 in substantially the same way as has been described above.
  • the distal end 902 is located about a balloon portion 214, i.e., proximal to a distal end of the balloon portion 214.
  • the sheath 900 is positioned with respect to the stent 100 such that the distal lead portion 906 and the cone/transition portion 908 are located distal to a distal-most end of the device 100.
  • the device 100 corresponds substantially with the body portion 910 of the profiled sheath 900.
  • the proximal end 904 of the profiled sheath 900 is attached to the delivery catheter 212 to facilitate withdrawal of the ruptured sheath subsequent to deployment of the medical device 100.
  • the opening 912 will expand as shown in Figure 16.
  • the fibers of the material from which the profiled sheath 900 is made are oriented longitudinally, therefore, as the balloon portion 214 inflates, the opening 912 will expand and the profiled sheath 900 will rupture.
  • the distance D is chosen to minimize the amount of rupturing of the profiled sheath 900 at the opening 912 due to tensile forces.
  • an opening 912 approximately 1.5mm long is placed not more than about 0.5mm from the distal end 902 of the sheath 900.
  • a profiled sheath 900 is made from any suitable material for a sheath as has been described above.
  • the material is initially provided as a cylindrical tube of material 1202 and is attached to one end of a mandrel 1204, as shown in Figure 17.
  • the material tube 1202 may be attached to a cap portion consisting of a ring 1206 and an inset portion 1208.
  • a coupling ring or tab 1210 is attached to the free end of the material tube 1202.
  • An RF coil 1212 is then positioned about the material tube 1202.
  • the RF coil 1212 is activated while, at the same time, a pulling force is applied to the free end 1210 in a direction Y, as shown in Figures 17 and 18.
  • the active RF coil 1212 raises the temperature of the sheath material making it soft and malleable. In one embodiment, raising the temperature of the PTFE material to about 230 0 C is sufficient to soften the material without melting.
  • the activation of the RF coil 1212, in conjunction with the pulling force on the material 1202 causes the tube material to, generally, create a lengthened portion 1302 of the tube having a smaller diameter than the cylindrical tube initially possessed.
  • a method 1500 for manufacturing the profiled sheath 900 begins with mounting the cylindrical material on the mandrel 1204, step 1502. Subsequently, step 1504, the sheath material is softened, e.g., via the RF coil, while the sheath material is pulled, step 1506.
  • an amount of pressure used to grip the sheath is 6 bar while power to the RF coil is on for approximately 3 seconds.
  • the heating is stopped, i.e., the RF coil is turned off, and the sheath is actively air-cooled with ambient air for about 8 seconds in one embodiment while still maintaining a pulling force on the material, step 1508.
  • the pull rate is approximately 2.3 mm/sec. After a predetermined amount of time, the pulling is stopped, step
  • a stretched length is approximately 5.5 mm.
  • the profiled sheath 900 is then cut to length, step 1514, and the initiation opening is created, step 1516.
  • a heater, microwave device, steam device, or infrared (IR) laser could also be used. Choosing the apparatus or method for softening the sheath material is within the capabilities of one of ordinary skill in the art.
  • the profiled sheath 900 can be oriented with respect to the orientation of the folded balloons as described above.
  • the initiation opening 912 can be positioned about the circumference at a location where the force from the opening of the wings from the balloon is at a local maximum.
  • the present invention can be implemented with any balloon having two or more wings where the initial cut or perforation are placed in the sheath with respect to those points on the sheath at which the wings of the balloon exert force against the sheath as the balloon is being inflated.
  • the placement of one or more initial cuts or series of perforations in a sheath that is provided to constrain a self expanding device, for example, a stent prior to delivery is determined with respect to a geometry and orientation of a folded balloon around which the sheath is provided.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Public Health (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • General Health & Medical Sciences (AREA)
  • Child & Adolescent Psychology (AREA)
  • Hematology (AREA)
  • Biophysics (AREA)
  • Pulmonology (AREA)
  • Anesthesiology (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Vascular Medicine (AREA)
  • Media Introduction/Drainage Providing Device (AREA)

Abstract

La présente invention concerne un système de mise en place destiné à mettre en place un dispositif médical autodéployant tel qu'une endoprothèse vasculaire (16) qui comprend une endoprothèse vasculaire montée sur la portion de ballon (30) d'un cathéter. Une gaine (18, 40) entoure l'endoprothèse afin de maintenir le dispositif en place à l'état comprimé. Une portion de la gaine (42, 44) est positionnée à un endroit prédéterminé ou bien dans une zone prédéterminée sur la circonférence de la gaine. L'emplacement ou la zone prédéterminés sont choisis par rapport à la configuration de la portion de ballon. La gaine peut être profilée ou façonnée de manière à réduire les cas d'interférence entre une extrémité distale de la gaine et un vaisseau ou bien avec tout lésion(s) pouvant être présente dans le vaisseau. La gaine est formée en modifiant un cylindre de tissu de gaine afin d'inclure trois portions et une fente d'initiation (602) qui commande la rupture de la gaine afin de faciliter le dégagement du dispositif médical.
EP08771745A 2007-06-21 2008-06-23 Système de mise en place d'appareil médical avec gaine et position relative du ballon Withdrawn EP2170230A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP13178193.2A EP2656871B1 (fr) 2007-06-21 2008-06-23 Système de délivrance de dispositif médical avec gaine à position relative du ballon

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US11/766,198 US20080319388A1 (en) 2007-06-21 2007-06-21 Device delivery system with balloon-relative sheath positioning
US92995807A 2007-10-30 2007-10-30
US11/930,634 US20090112159A1 (en) 2007-10-31 2007-10-31 Delivery System With Profiled Sheath Having Balloon-Oriented Position
PCT/US2008/067898 WO2008157830A1 (fr) 2007-06-21 2008-06-23 Système de mise en place d'appareil médical avec gaine et position relative du ballon

Related Child Applications (1)

Application Number Title Priority Date Filing Date
EP13178193.2A Division EP2656871B1 (fr) 2007-06-21 2008-06-23 Système de délivrance de dispositif médical avec gaine à position relative du ballon

Publications (1)

Publication Number Publication Date
EP2170230A1 true EP2170230A1 (fr) 2010-04-07

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EP08771745A Withdrawn EP2170230A1 (fr) 2007-06-21 2008-06-23 Système de mise en place d'appareil médical avec gaine et position relative du ballon
EP13178193.2A Not-in-force EP2656871B1 (fr) 2007-06-21 2008-06-23 Système de délivrance de dispositif médical avec gaine à position relative du ballon

Family Applications After (1)

Application Number Title Priority Date Filing Date
EP13178193.2A Not-in-force EP2656871B1 (fr) 2007-06-21 2008-06-23 Système de délivrance de dispositif médical avec gaine à position relative du ballon

Country Status (4)

Country Link
EP (2) EP2170230A1 (fr)
JP (1) JP5667873B2 (fr)
IL (1) IL202838A (fr)
WO (1) WO2008157830A1 (fr)

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JP6459589B2 (ja) * 2015-02-12 2019-01-30 株式会社カネカ バルーンカテーテルの製造装置及び製造方法
US10548631B2 (en) * 2016-03-04 2020-02-04 Boston Scientific Scimed Inc. Introducer with expandable capabilities
JP6949546B2 (ja) * 2017-04-28 2021-10-13 川澄化学工業株式会社 搬送用カテーテル及び血管内留置具搬送装置
EP3849646B1 (fr) 2018-09-10 2022-10-26 Boston Scientific Scimed, Inc. Introducteur avec capacités de déploiement

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Also Published As

Publication number Publication date
JP5667873B2 (ja) 2015-02-12
IL202838A0 (en) 2010-06-30
EP2656871B1 (fr) 2020-12-09
EP2656871A1 (fr) 2013-10-30
WO2008157830A1 (fr) 2008-12-24
IL202838A (en) 2015-11-30
JP2010530792A (ja) 2010-09-16

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