WO2008112435A2 - An implant including a coil and a stretch-resistant member - Google Patents

An implant including a coil and a stretch-resistant member Download PDF

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Publication number
WO2008112435A2
WO2008112435A2 PCT/US2008/055173 US2008055173W WO2008112435A2 WO 2008112435 A2 WO2008112435 A2 WO 2008112435A2 US 2008055173 W US2008055173 W US 2008055173W WO 2008112435 A2 WO2008112435 A2 WO 2008112435A2
Authority
WO
WIPO (PCT)
Prior art keywords
implant
lumen
stretch
detachment
coil
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.)
Ceased
Application number
PCT/US2008/055173
Other languages
English (en)
French (fr)
Other versions
WO2008112435A3 (en
Inventor
Brian Michael Strauss
Todd Jeffery Hewitt
Ramon Torres Carrillo
Khoa Dang Vu
William Robert Patterson
Stacy Leon Faught
Lawrason Charles Wilbur
Scott William Brennan
Vince Divino
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.)
Micro Therapeutics Inc
Original Assignee
Micro Therapeutics 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
Application filed by Micro Therapeutics Inc filed Critical Micro Therapeutics Inc
Priority to ES08730876.3T priority Critical patent/ES2437619T3/es
Priority to EP08730876.3A priority patent/EP2124762B1/en
Priority to CA2680607A priority patent/CA2680607C/en
Priority to JP2009553680A priority patent/JP5249249B2/ja
Priority to AU2008226694A priority patent/AU2008226694B8/en
Priority to CN2008800157814A priority patent/CN101835430B/zh
Publication of WO2008112435A2 publication Critical patent/WO2008112435A2/en
Publication of WO2008112435A3 publication Critical patent/WO2008112435A3/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06—Blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
    • A61B17/12109—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel
    • A61B17/12113—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel within an aneurysm
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
    • A61B17/1214—Coils or wires
    • A61B17/12145—Coils or wires having a pre-set deployed three-dimensional shape
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
    • A61B17/1214—Coils or wires
    • A61B17/1215—Coils or wires comprising additional materials, e.g. thrombogenic, having filaments, having fibers, being coated
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
    • A61B17/1214—Coils or wires
    • A61B17/12154—Coils or wires having stretch limiting means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
    • A61B17/12181—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device formed by fluidized, gelatinous or cellular remodelable materials, e.g. embolic liquids, foams or extracellular matrices
    • A61B17/1219—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device formed by fluidized, gelatinous or cellular remodelable materials, e.g. embolic liquids, foams or extracellular matrices expandable in contact with liquids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/14—Macromolecular materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A61L27/54—Biologically active materials, e.g. therapeutic substances
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00004—(bio)absorbable, (bio)resorbable or resorptive
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B2017/1205—Introduction devices
    • A61B2017/12054—Details concerning the detachment of the occluding device from the introduction device
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B2017/1205—Introduction devices
    • A61B2017/12054—Details concerning the detachment of the occluding device from the introduction device
    • A61B2017/12059—Joint of soluble material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B2017/1205—Introduction devices
    • A61B2017/12054—Details concerning the detachment of the occluding device from the introduction device
    • A61B2017/12063—Details concerning the detachment of the occluding device from the introduction device electrolytically detachable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B2017/1205—Introduction devices
    • A61B2017/12054—Details concerning the detachment of the occluding device from the introduction device
    • A61B2017/12068—Details concerning the detachment of the occluding device from the introduction device detachable by heat
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B2017/1205—Introduction devices
    • A61B2017/12054—Details concerning the detachment of the occluding device from the introduction device
    • A61B2017/12081—Details concerning the detachment of the occluding device from the introduction device detachable by inflation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0801—Prevention of accidental cutting or pricking
    • A61B2090/08021—Prevention of accidental cutting or pricking of the patient or his organs

Definitions

  • This invention relates to implantable coils and, more particularly, to a coil implant having a stretch-resistant member internal to the coil.
  • Implants are delivered to a vascular site, such as an aneurysm, of a patient via a microcatheter to occlude or embolize the vascular site.
  • the implant is engaged at the distal end of either the delivery microcatheter or the guidewire contained within the microcatheter and controllably released therefrom into the vascular site to be treated.
  • the clinician delivering the implant must navigate the microcatheter or guide catheter through the vasculature and, in the case of intracranial aneurysms, navigation of the microcatheter is through tortuous micro vasculature. This delivery may be visualized by fluoroscopy or another suitable means.
  • the clinician must then begin to articulate the implant in the vascular site to ensure that the implant will be positioned in a manner to sufficiently embolize the site.
  • the clinician must then detach the implant from the catheter or guidewire without distorting the positioning of the implant. Detachment may occur through a variety of means, including, chemical detachment, mechanical detachment, hydraulic detachment, and thermal detachment.
  • the procedure of delivering the implant to the vascular site can be complicated for a number of reasons.
  • One common complication found with implants of the art is that the doctor is not able to effectively articulate, rotate, and/or control the implant during positioning in the vascular site to provide sufficient embolization.
  • One reason that the implant may not be able to effectively articulate is that the proximate portion of the implants of the art are often rigid. This portion is referred to as the "stiff zone" and may also contain the detachment mechanism.
  • This portion is referred to as the "stiff zone” and may also contain the detachment mechanism.
  • One drawback of an implant having a "stiff zone” is that this "stiff zone" may cause catheter kick-out after deployment of the implant to the vascular site.
  • U.S. Patent 5,582,619 teaches a stretch-resistant member that is fixedly attached at both ends or at one end and then at another point in the lumen of the catheter. Due to the stretch-resistant member being fixedly attached in two locations, the implant, after delivery, will maintain some stretch-resistant properties. If the implant is stretch resistant after delivery, this may inhibit the implant's ability to substantially conform to the vascular site.
  • the implant may contain a traumatic (or sharp) portion or stem. This traumatic portion most frequently occurs with implants that are mechanically or electrolytically detached from the delivery device.
  • the invention is directed to, in one embodiment, an implant with a stretch- resistant member.
  • the implant further includes a member for engaging a positioning device or a positioner.
  • the member for engaging a positioning device and the stretch-resistant member are coupled together.
  • the member for engaging a positioning device is free to move with respect to the coil thereby allowing for the implant to articulate and be positioned more accurately.
  • the implant includes a primary coil that defines a lumen disposed on an axis.
  • a proximal end of the primary coil defines a proximal aperture, and a distal end of the primary coil defines a distal aperture.
  • a stretch-resistant member is disposed in the lumen, with a coupling portion of the stretch-resistant member coupled in the lumen to the member for engaging a positioning device that has an engagement portion exterior to the lumen.
  • the stretch-resistant member can be a line, a filament, or a braid.
  • the implant optionally can include a secondary coil.
  • the secondary coil is disposed at least in part in the lumen, and that further defines the proximal aperture.
  • the secondary coil is coaxial with the primary coil.
  • the coupling portion of the stretch-resistant member can be coupled to a distal end of the member for engaging a positioning device which can preferably be an eyelet.
  • the stretch-resistant member can also couple to the engagement member with a wrap or a knot, and can also extend back to the distal end of the primary coil so that two lengths of line extend along the length of the lumen.
  • the line can also have an end that engages a retainer at the distal end of the primary coil.
  • the retainer is ball-shaped or rounded.
  • the member for engaging a positioning device can preferably be a rod and have a proximal end with an engagement portion, and the engagement portion can preferably be a ball mounted on the proximal end of the member for engaging a positioning device.
  • the member for engaging a positioning device can also extend through the proximal aperture so that the engagement portion is disposed at the proximal-most end of the implant.
  • the member for engaging a positioning device and the coupling portion of the stretch-resistant member can be freely disposed at the proximal end of the implant so that the member for engaging a positioning device and the coupling portion are not connected to or attached to the primary or secondary coils.
  • the member for engaging a positioning device can have a central axis that intersects the proximal aperture at various points.
  • the member and engagement portion are free to move distally into the lumen of the primary (or primary and secondary) coil. In one embodiment, the member and engagement portion can move distally to be completely in the lumen of the coil.
  • the invention is directed to a method of embolizing a vascular site in a patient.
  • the implant is introduced to the vascular site via a positioner and then detached from the positioner thereby embolizing the vascular site.
  • the implant can be detached from the positioner by chemical detachment, electrolytic detachment, mechanical detachment, hydraulic detachment, or thermal detachment.
  • the engagement portion is contained within the interior lumen. In one embodiment, the engagement portion is completely contained within the interior lumen.
  • Figure IA is a plan view of an exemplary positioning system and a plan view of an exemplary implant.
  • Figure IB is a closer view of a portion of Fig. IA.
  • Figure 2 is a plan view of a positioning system of Fig. 1 within the human body.
  • Figure 3 is a partial cross-sectional plan view of the implant of Fig. 1 with an exemplary positioning device.
  • Figure 4A is a closer view of a portion of Fig. 2 showing the positioning system in partial cross-section and an exemplary implant in a position within the human body prior to deployment of the implant.
  • Figure 4B is a closer view of a portion of Fig. 2 showing the positioning system in partial cross-section and an exemplary implant in another position within the human body after deployment but before detachment.
  • Figure 5 is a partial cross-sectional plan view of an implant with a stretch- resistant member in partial cross-section.
  • Figures 6 A and 6B show an implant of the invention prior to detachment (Fig. 6A) and after detachment (Fig. 6B) from the positioner in partial cross-section.
  • Figure 7 is a plan view of an embodiment of the stretch-resistant member of Fig. 5.
  • Figure 8 A illustrates one embodiment, in plan view, an exemplary wrapping pattern of the fibers around the stretch resistant member.
  • Figure 8B is a cross-sectional view of the wrapping pattern of the fibers around the stretch-resistant member shown in Fig. 8A.
  • the implant of the invention may be used with a positioning device 70 that may optionally include an actuator 90 operated by an operator, a positioning tube 76 engaging the actuator 90, and an implant interface 78 at the distal end of the positioning tube 76.
  • a portion of the implant interface 78 engages a complementary portion of an implant 10.
  • the positioning device 70 is more specifically described below in Fig. 3.
  • an operator uses a guide tube or guide catheter 12 to position a delivery tube or microcatheter 14 in a patient's vasculature, as illustrated in Fig. 2.
  • the procedure involves inserting the guide catheter 12 into the patient's vasculature through an access point such as the groin, and directing the distal end 12a of the guide catheter 12 through the vascular system until it reaches the carotid artery.
  • a microcatheter 14 After removing a guide wire (not shown) from the guide catheter 12, a microcatheter 14 is inserted into the guide catheter 12 and the distal end 14a of the microcatheter 14 subsequently exits the guide catheter distal end 12a and is positioned near the target site 16, such as an aneurysm in the patient's brain.
  • the microcatheter 14 includes microcatheter markers 15 and 15a that facilitate imaging of the distal end 14a of the microcatheter 14 with common imaging systems and, in the illustrated embodiment, the microcatheter markers 15 and 15a are made of a radiopaque material.
  • the positioning device 70 (as shown in Fig. IA) of the illustrated embodiment is then inserted into the microcatheter 14 to position the implant interface 78 at the distal end of the positioning device 70 near the target site 16, as illustrated in Fig. 4B.
  • the implant 10 is attached to the implant interface 78 prior to inserting the positioning device 70 into the microcatheter 14.
  • This mode of implant delivery is illustrated in Figs. 2 and 4A-B.
  • the delivery of the implant 10 is facilitated by disposing the microcatheter marker 15a near the target site 16, and aligning the microcatheter marker 15 with a positioner marker 15b in the positioner tube 76 which, when the two markers (markers 15 and 15b) are aligned with each other as illustrated in Fig. 4B, indicates to the operator that the implant interface 78 is in the proper position for the release of the implant 10 from the positioning device 70.
  • a second implant 10 can be deposited at the target site 16 by removing the positioning device 70 from the microcatheter 14 and inserting a second positioning device 70 with an attached second implant 10 into the microcatheter 14 in a manner similar to the method used with the insertion of the first implant 10. The same procedure can be used for a third implant 10 and subsequent implants if clinically necessary. If the implant 10 is already in the patient's body to be retrieved or repositioned, the positioning device 70 is inserted into the microcatheter 14 without the implant 10.
  • the implant 10 and positioning device 70 (not shown) have a reduced "stiff zone" at the interface 78 to better allow delivery through the tortuous vasculature, responsive placement into the target site 16, and for the ability to reposition the implant 10.
  • the implant of the invention maintains a high level of articulation, including the ability to torque, prior to deployment thereby providing responsive placement and repositioning prior to deployment. This level of articulation is partially due to a lack of having or having a very small "stiff zone" in its proximal end. Further and as explained below, in one embodiment, the implant of the invention is stemless after detachment. As a result of the implant being stemless, the level of trauma associated with deployment of an implant in the vasculature is minimized.
  • the implant of the invention has a stretch- resistant member and this feature eases delivery by allowing the clinician to reposition as necessary without the implant deforming while maintaining its secondary shape. After the implant of the invention is delivered, the implant of the invention no longer retains its "stretch resistance" properties thereby allowing the implant to better substantially conform to the vascular site.
  • the implant 10 illustrated in Fig. 5 includes a primary coil 20, a secondary coil 30, a stretch-resistant member 40, a retainer 50, and a member 60 for engaging a positioning device 70 (shown in Figs. IA, IB, and 3).
  • the member 60 for engaging a positioning device 70 is preferably a rod that includes a ball 62 and an eyelet 64.
  • the primary coil 20 has a proximal end 22 and a distal end 24 defining an internal lumen 26 extending between the ends of the primary coil.
  • the primary coil 20 can be formed in a variety of shapes once heat setting of the coil form is performed.
  • One such shape of the primary coil can be found in USSN 12/ , , filed on even date herewith as attorney docket number 355492-7601 and titled "An implant, a mandrel, and a method of forming an implant.” This application is incorporated by reference into its entirety.
  • the optional secondary coil 30 is disposed at the proximal end 22 of the primary coil 20 and further defines the proximal aperture.
  • the secondary coil 30 has an outer diameter that is sized to fit within the internal lumen 26 of the primary coil 20 and the primary coil 20 partially envelops the secondary coil 30.
  • the secondary coil 30 has an outer diameter which is less than the inner diameter of the primary coil 20.
  • the secondary coil 30 has an outer diameter equal or less than the outer diameter of the primary coil 20.
  • the secondary coil 30 is adjacent to the primary coil 20.
  • the secondary coil 30 may be affixed by any means, such as welded, to the proximal end 22 of the primary coil 20 with weld 36, with a distal portion 34 of the secondary coil 30 disposed within the internal lumen 26 and a proximal portion 32 disposed proximal to the primary coil 20.
  • the retainer 50 engages the distal end 24 of the primary coil 20.
  • the retainer 50 if present, is shaped such that there is minimized trauma to the vascular site upon delivery.
  • the retainer 50 is ball-shaped.
  • the retainer 50 is rounded on the portion that is exterior to the lumen 26 and the diameter of the retainer 50 is equal to or slightly less that than the outer diameter of the primary coil 20.
  • the stretch-resistant member 40 is disposed in the internal lumen 26.
  • a distal end 44 of the stretch-resistant member engages the retainer 50.
  • a proximal end 42 of the stretch-resistant member 40 engages the eyelet 64 of the rod 60.
  • the distal portion of the rod 60 and the eyelet 64 are disposed in the internal lumen 26.
  • a proximal portion of the rod 60 and the ball 62 extends proximally from the internal lumen 26 and is disposed proximal to the primary and secondary coils 20 and 30.
  • the rod 60 and the proximal end 42 of the stretch- resistant member 40 are not connected to or attached to the primary or secondary coils 20 and 30 and are free to move within the internal lumen 26 in the direction of the longitudinal axis of the implant 10 and to move so that the rod 60 can assume an angle relative to the longitudinal axis of the implant 10.
  • the proximal end 42 of the stretch-resistant member 40 and the eyelet 64 form a coupling that can comprise any type of connection.
  • the stretch-resistant member 40 is preferably a single line 46 that extends from the retainer 50 to the eyelet 64, passes through the eyelet 64, and extends from the eyelet 64 to the retainer 50.
  • the line 46 can also be a filament or a braid.
  • the line 46 is preferably wrapped through the eyelet 64 to form a knot 48, and is most preferably formed as a hitch knot as illustrated in Fig. 7.
  • the line 46 can be one or more separate lines that terminate at the eyelet 64 to form a coupling with the eyelet 64.
  • the coupling can be formed in the stretch-resistant member 40 in a middle portion disposed between proximal and distal portions of the stretch-resistant member 40, such as with a knot coupling the proximal and distal portions of the stretch-resistant member 40 together within the internal lumen 26.
  • the coupling can be a combination of a knot and a wrapping, or a combination of multiple lines 46 employing different couplings.
  • the coupling can also involve the modification of the stretch-resistant member 40 at the point of coupling, such as by deforming or melting of the stretch-resistant member 40 to join the end of a line 46 back onto itself to form a closed loop.
  • an eyelet can be formed at the proximal end of the stretch-resistant member 40 that is coupled to the distal end of the rod 60, with the distal end of the rod 60 knotted to form the coupling, or with the distal end of the rod 60 deformed or melted back onto itself to form a closed loop.
  • the inner diameter of the secondary coil 30 is selected to engage the eyelet
  • the rod 60 can have various cross-sectional shapes, such as a circular or triangular shape.
  • the ball 62 can be replaced with another structure such as a disc, hook, or ring structure that preferably provides an external diameter or equivalent dimension comparable to the ball 62. Fibers
  • the primary coil 20, secondary coil 30, and the stretch-resistant member 40 can also comprise at least one fiber 85.
  • the fiber(s) 85 can be a plurality of fibers, at least one bundle of fibers, or a plurality of fiber bundles.
  • the fiber(s) 85 can be enlaced, tied, or knotted to a number of places on the implant 10.
  • the fibers or fiber bundles 85 can be disposed so that they are not tied or knotted to the implant 10, thereby avoiding potentially obstructive bundles that might hinder deployment of the implant 10 or might mechanically damage the implant 10.
  • the use of fibers with coils is disclosed in U.S. Publ. No. 2006/0036281, which is incorporated by reference in its entirety. In one embodiment illustrated in Fig.
  • the fiber 85 is wrapped at least one or two times around the stretch-resistant member 40.
  • the fiber(s) 85 include a plurality of fibers, at least one bundle of fibers, or a plurality of fiber bundles wrapped at least one or two times round the stretch-resistant member 40.
  • the fiber(s) 85 are enlaced through a single loop around the primary coil 20 and optionally the secondary coil 30. In another embodiment, the fiber(s) 85 are enlaced through a pair of loops of the primary coil 20 and optionally the secondary coil 30. In yet another embodiment, the fiber(s) 85 are enlaced in a "S" pattern through a plurality of loops in the primary coil 20 and optionally the secondary coil 30. In still yet another embodiment, the fiber(s) 85 are enlaced adjacent to each other in a "S" pattern on the primary coil 20 and optionally the secondary coil 30.
  • the primary and secondary coils 20 and 30 and rod 60 are preferably made of a biocompatible metal or metal alloy wire that does not react adversely with tissues and fluids when used in the body.
  • the wire may be round, square, oval, triangular, or another shape.
  • the wire commonly has a diameter of from about 0.025 to about 0.09 mm, from about 0.03 to about 0.08 mm from about 0.04 to about 0.06 mm.
  • the wire has a diameter of about 0.05 mm.
  • the wire may be comprised only of a primary shape e.g., a simple single helix.
  • the wire component may comprise a primary shape e.g., helical coil and a secondary shape which the coil is biased to form upon release from the catheter or guidewire.
  • the secondary shape may comprise a complicated three dimensional shape. These shapes include spherical, cubic and other space-filling shapes, such as those created by winding the wire in a series of mobius loops. This embodiment is described in can be found in USSN 12/ , , filed on even date herewith as attorney docket number 355492- 7601 and titled "An implant, a mandrel, and a method of forming an implant.” This application is incorporated by reference in its entirety.
  • the wire can comprise a coil of coils or double helix.
  • the outer or secondary diameter of the outer helix may be from about 1 to about 25 mm in some embodiments and from about 2 to 20 mm in certain other embodiments.
  • the primary (inner) helix may typically have an outside diameter of from about 0.1 to about 0.8 mm in some embodiments, and from about 0.15 to about 0.6 mm in other embodiments and from about 0.2 to about 0.4 mm in yet other embodiments.
  • Certain specific embodiments provide for coils having a primary diameter of about 0.28 mm sized to pass through a correspondingly dimensioned catheter.
  • Yet other embodiments provide for coils having a primary diameter of about 0.24 mm sized to pass through a correspondingly dimensioned catheter.
  • the material of the primary and secondary coils 20 and 30 and rod 60 are made of a material that may be heat set at a temperature of approximately 650 0 C.
  • the metal or metal alloy can be radiopaque so that the position and location of the implant in the body can be monitored with radiological techniques.
  • Suitable metals include, but are not limited to the noble metals such as the platinum group metals which include platinum, palladium, rhodium and rhenium as well as iridium, gold, silver, tungsten, and tantalum and alloys of these metals with one another. Additional metals include the super elastic metals such as "Nitinol" and the like.
  • the primary and secondary coils 20 and 30 are made of a platinum alloy
  • the rod 60 is made of stainless steel.
  • the overall axial length of the implant 10 of this invention ranges from about 5 to about 400 mm in some embodiments and from about 10 to about 300 mm in other embodiments. This length may be selected depending upon the particular application of use and may be longer than about 400 mm in some embodiments.
  • the stretch-resistant member 40 and the retainer 50 are preferably made from a wide variety of materials. These materials can include any of the metals suitable for making the primary and secondary coils 20 and 30.
  • the stretch-resistant member 40 and the retainer 50 can also be made of a radiopaque material, or of a polymer.
  • the stretch-resistant member 40, retainer 50, and fibers/fiber bundles 85 are preferably made of polymeric materials, and most preferably made of polypropylene.
  • the retainer 50 is also preferably formed from a melt of the stretch-resistant member 40.
  • the polymeric materials can include materials approved for use as implants in the body or which could be so approved. They can be nonbiodegradable polymers such as polyethylene, polyacrylics, polypropylene, polyvinylchloride, polyamides such as nylon, e.g., Nylon 6.6, polyurethanes, polyvinylpyrrolidone, polyvinyl alcohols, polyvinylacetate, cellulose acetate, polystyrene, polytetrafluoroethylene, polyesters such as polyethylene terephthalate (Dacron), silk, cotton, and the like.
  • nonbiodegradable polymers such as polyethylene, polyacrylics, polypropylene, polyvinylchloride, polyamides such as nylon, e.g., Nylon 6.6, polyurethanes, polyvinylpyrrolidone, polyvinyl alcohols, polyvinylacetate, cellulose a
  • the nonbiodegradable materials for the polymer component can comprise polyesters, polyethers, polyamides and polyfluorocarbons.
  • the polymeric materials can be biodegradable as well.
  • Representative biodegradable polymers include: polyglycolic acid/polylactic acid (PGLA), polycaprolactone (PCL), polyhydroxybutyrate valerate (PHBV), polyorthoester (POE), polyethyleneoxide/polybutylene terephthalate (PEO/PBTP), polylactic acid (PLA), polyglycolic acid (PGA), poly(p-dioxanone), poly(valerolactone), poly(tartronic acid), poly( ⁇ -malonic acid), poly(propylene fumarate), poly(anhydrides), and tyrosine-based polycarbonates.
  • PGLA polyglycolic acid/polylactic acid
  • PCL polycaprolactone
  • PHBV polyhydroxybutyrate valerate
  • POE polyorthoester
  • the biodegradable polymer can be comprised of copolymers of lactic acid and glycolic acid.
  • the copolymer can be comprised of glyco lie/lactic acid in the ratio of 90: 10.
  • the ratio of glycolic to lactic acid can be chosen from 99:1; 90:10; 95:5; 50:50; 10:90; 5:95; and 1 :99.
  • the fibers can also be comprised of Nylon 6.6.
  • the stretch resistant member 40 and the fiber(s) 85 may also comprise a bioactive coating.
  • the bioactive coating may be selected from growth factor, a gene, an oligonucleotide, a peptide, a marine biopolymer, a monosaccharide, a disaccharide, a polysaccharide, collagen and combinations thereof.
  • the illustrated stretch-resistant member 40 preferably has a tensile strength of 0.2 and 1.2 Newton. In some embodiments, the tensile strength is 0.6 Newton.
  • the implant described herein may be delivered by a variety of suitable microcatheters and positioning devices.
  • the invention is directed to a kit having one or more implants of the invention and a positioning device.
  • the kit includes a microcatheter. Suitable microcatheters positioning devices are described in WO 2007/121405 entitled “System and Method For Mechanically Positioning Intravascular Implants” which is hereby incorporated by reference in its entirety.
  • the implant 10 can engage a positioning device 70 such that the ball 62 and the proximal portion of the rod 60 engage the distal end 74 of the positioning device 70.
  • the illustrated positioning device 70 can include a positioner 75 with a positioner tube 76 having an actuator interface 77 and an implant interface 78 that terminates at an end cap 79.
  • the end cap 79 can have a port 80 through which the rod 60 communicates with the positioner lumen 81.
  • the positioner 75 can also include a cord 82 that occludes a portion of the port 80 to prevent the disengagement of the implant 10 from the implant interface 78.
  • implant 10 can be mechanically released from positioning device 70 by retracting cord 82 so that the aperture of implant interface 78 is now sufficiently wide to permit ball 62 to traverse therethrough whereupon implant 10 is released into the vascular site.
  • ball 62 and rod 60 move in a distal direction relative to the primary coil as described below or the primary coil 20 and secondary coil 30 move proximally relative to the ball 62 and rod 60.
  • Such movement places the ball 62 and rod 60 further into the internal lumen 26 within the primary coil 20, and in some embodiments fully enter the internal lumen 26 of the primary coil 20.
  • ball 62 and rod 60 are fully engulfed within lumen 26 so as to form a stemless implant.
  • catheter kick out refers to the movement of the catheter from its preformed shape after deployment of the implant and is typically measured by the angle of deflection, shown in Fig. 4B as 92.
  • Implants of this invention typically have a catheter deflection of 40°, 30°, 20°, 19°, 15°, 10° or less. This reduction of catheter kick out is at least a 20%, 30%, 40%, 50%, and even 60% improvement over implants of the art.
  • the coil assumes two orientations, a microcatheter orientation when disposed in a microcatheter and a deployed orientation when external to the microcatheter.
  • the transition of the coil from the microcatheter orientation to the deployed orientation is believed to cause the primary coil 20 to curve or bend and to extend slightly in length on at least one side of the primary coil 20, while the stretch-resistant member 40 does not so extend, thereby causing the proximal end of the implant 10 move relative to rod 60 and ball 62 and surround the rod and ball.
  • This movement of the primary and secondary coils 20 and 30 relative to the rod 60 and ball 62, to enclose the rod and ball within the lumens of the coils 20 and 30, is believed to advantageously provide a structurally stable proximal implant end because any additional movement of the rod 60 and ball 62 is contained within the coils 20 and 30. It is further contemplated that the implant 10 is better able to conform to the desired vascular site.
  • the implant may be deployed into the body by a number of means, including, but not limited to electrolytic detachment, chemical detachment, hydraulic detachment, thermal detachment, as well as other types of mechanical detachments. It is contemplated that the implant remains stemless after deployment into the body because after deployment, the rod 60 and ball 62 will be displaced in the inner lumen of the secondary coil 30. In other words, the ball 62 is drawn into the inner lumen of at least the secondary coil 30.
  • Electrolytic detachment may be performed by providing a weakened section at a junction between the implant 10 and the positioner 75. Regardless of the junction, due to the stretch-resistant member, the rod 60 and ball 62 will still be displaced in the inner lumen of the secondary coil 30 and possibly the primary coil 20. This weakened section may be easily vaporized by application an electric current.
  • the rod 60 and/or ball 62 may be replaced by a wire that may be detached by an electrical force, such as a 9V electric power source that can apply a current of about 0.3 milliamps for detachment.
  • an electrical detachment mechanism is described in U.S. Pat. No. 5,928,226, which is incorporated herein by reference.
  • a dissolvable detachment section is included between the positioning device 70 and the implant 10 or at the distal end of the positioner 75.
  • the dissolvable detachment section is dissolved, softened, swollen, degraded, or otherwise changed by the injection of a biocompatible chemical through the catheter. After the section is eroded, the rod 60 and ball 62 move distally into the lumen of the secondary coil 30 or the primary coil 20 and secondary coil 30.
  • chemical detachment systems include dissolvable detachment sections, such as a polymer section which is dissolved by dimethylsulfoxide, a nylon section which is dissolved by a fluorinated hydrocarbon, or sections which are dissolved by an aqueous saline solution or any of the other biocompatible solvents discussed above.
  • a hydraulic detachment mechanism may also be used with the implant of the invention. Hydraulic detachment means are within the scope of the art.
  • the implant interface 78 is formed of a material having a durometer such that when an appropriate fluid pressure is applied to the interior of the positioning device 70, the implant interface 78 expands thereby releasing the ball 62 and allowing the ball 62 to move distally into the lumen of the secondary coil and optionally the primary coil.
  • the implant of the invention may also be configured to be thermally detached from the positioner.
  • This embodiment is similar to the electrolytic detachment described above; however, instead of applying an electric current, heat is applied thereby allowing the engagement portion to detach from the position 70 and move distally into the lumen of the catheter.

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PCT/US2008/055173 2007-03-13 2008-02-27 An implant including a coil and a stretch-resistant member Ceased WO2008112435A2 (en)

Priority Applications (6)

Application Number Priority Date Filing Date Title
ES08730876.3T ES2437619T3 (es) 2007-03-13 2008-02-27 Un implante que incluye un arrollamiento helicoidal y un elemento resistente al estiramiento
EP08730876.3A EP2124762B1 (en) 2007-03-13 2008-02-27 An implant including a coil and a stretch-resistant member
CA2680607A CA2680607C (en) 2007-03-13 2008-02-27 An implant including a coil and a stretch-resistant member
JP2009553680A JP5249249B2 (ja) 2007-03-13 2008-02-27 コイルと耐伸張性部材とが含まれているインプラント
AU2008226694A AU2008226694B8 (en) 2007-03-13 2008-02-27 An implant including a coil and a stretch-resistant member
CN2008800157814A CN101835430B (zh) 2007-03-13 2008-02-27 包括线圈和抗拉伸构件的植入物

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US60/894,589 2007-03-13
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US20130331883A1 (en) 2013-12-12
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US9289215B2 (en) 2016-03-22
CA2680607A1 (en) 2008-09-18
KR20100015520A (ko) 2010-02-12
US8328860B2 (en) 2012-12-11
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JP5249249B2 (ja) 2013-07-31
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CN101835430A (zh) 2010-09-15
ES2437619T3 (es) 2014-01-13

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