WO2013033791A1 - Moyens pour l'étanchéification contrôlée de dispositifs endovasculaires - Google Patents

Moyens pour l'étanchéification contrôlée de dispositifs endovasculaires Download PDF

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Publication number
WO2013033791A1
WO2013033791A1 PCT/AU2012/001080 AU2012001080W WO2013033791A1 WO 2013033791 A1 WO2013033791 A1 WO 2013033791A1 AU 2012001080 W AU2012001080 W AU 2012001080W WO 2013033791 A1 WO2013033791 A1 WO 2013033791A1
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WO
WIPO (PCT)
Prior art keywords
seal
endoluminal
prosthesis
implant
hydrogel
Prior art date
Application number
PCT/AU2012/001080
Other languages
English (en)
Inventor
Jens Sommer-Knudsen
Ashish Sudhir Mitra
Martin Kean Chong Ng
Pak Man Victor WONG
Ben Colin BOBILLIER
Original Assignee
Endoluminal Sciences Pty Ltd
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 US13/476,695 external-priority patent/US9216076B2/en
Priority claimed from US13/596,894 external-priority patent/US20130190857A1/en
Application filed by Endoluminal Sciences Pty Ltd filed Critical Endoluminal Sciences Pty Ltd
Priority to CN201280043199.5A priority Critical patent/CN103889472B/zh
Priority to BR112014005395A priority patent/BR112014005395A2/pt
Priority to JP2014528801A priority patent/JP6185470B2/ja
Priority to AU2012307020A priority patent/AU2012307020B2/en
Priority to CA2847687A priority patent/CA2847687C/fr
Priority to EP12829481.6A priority patent/EP2753372A4/fr
Publication of WO2013033791A1 publication Critical patent/WO2013033791A1/fr
Priority to AU2015205978A priority patent/AU2015205978B2/en

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Classifications

    • 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
    • A61F2/0063—Implantable repair or support meshes, e.g. hernia meshes
    • 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
    • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2412—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves
    • A61F2/2418—Scaffolds therefor, e.g. support stents
    • 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
    • A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
    • A61L24/001—Use of materials characterised by their function or physical properties
    • A61L24/0031—Hydrogels or hydrocolloids
    • 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
    • A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
    • A61L24/001—Use of materials characterised by their function or physical properties
    • A61L24/0036—Porous materials, e.g. foams or sponges
    • 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
    • A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
    • A61L24/04—Surgical adhesives or cements; Adhesives for colostomy devices containing macromolecular materials
    • A61L24/06—Surgical adhesives or cements; Adhesives for colostomy devices containing macromolecular materials obtained by reactions only involving carbon-to-carbon unsaturated bonds
    • 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
    • A61L27/16—Macromolecular materials obtained by reactions only involving carbon-to-carbon unsaturated bonds
    • 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
    • A61L27/52—Hydrogels or hydrocolloids
    • 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
    • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
    • A61L31/14—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A61L31/145—Hydrogels or hydrocolloids
    • 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
    • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • 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
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • 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
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2002/823—Stents, different from stent-grafts, adapted to cover an aneurysm
    • 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
    • A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0061—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof swellable
    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0069—Sealing means
    • 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
    • A61L2430/00—Materials or treatment for tissue regeneration
    • A61L2430/20—Materials or treatment for tissue regeneration for reconstruction of the heart, e.g. heart valves

Definitions

  • the present disclosure is directed generally to endoluminal devices and associated systems and methods, and specifically to a method and devices for controlled actuation of means for sealing of an endolum inal prosthesis to a vessel wall.
  • An aneurysm is a localized, blood-filled dilation of a blood vessel caused by disease or weakening of the vessel wall.
  • Aneurysms affect the ability of the vessel to conduct fluids, and can be life threatening if left untreated. Aneurysms most commonly occur in arteries at the base of the brain and in the aorta. As the size of an aneurysm increases, there is an increased risk of rupture, which can result in severe hemorrhage or other complications including sudden death.
  • Aneurysms are typically treated by surgically removing a part or all of the aneurysm and implanting a replacement prosthetic section into the body lumen. Such procedures, however, can require extensive surgery and recovery time. Patients often remain hospitalized for several days following the procedure, and can require several months of recovery time. Moreover, the morbidity and. mortality rates associated with such major surgery can be significantly high.
  • Another approach for treating aneurysms involves remote deployment of an endovascular graft assembly at the affected site. Such procedures typically require intravascular delivery of the endovascular graft assembly to the site of the aneurysm. The graft is then expanded or deployed in situ and the ends of the graft are anchored to the body lumen on each side of the aneurysm. In this way, the graft effectively excludes the aneurysm sac from circulation.
  • endoleak is defined as a persistent blood or other fluid flow outside the lumen of the endoluminal graft, but within the aneurysm sac or adjacent vascular segment being treated by the device. When an endoleak occurs, it can cause continuous pressurization of the aneurysm sac and may result in an increased risk of rupture.
  • endoleaks In addition to endoleaks, another concern with many conventional endovascular graft assemblies is subsequent device migration and/or dislodgement. For example, after a surgeon has found an optimal location for the graft, the device must be fixed to the wall of the body lumen and fully sealed at each end of the graft to prevent endoleaks and achieve a degree of fixation that will prevent subsequent device migration and/or dislodgement.
  • Aortic stenosis also known as aortic valve stenosis, is characterized by an abnormal narrowing of the aortic valve. The narrowing prevents the valve from opening fully, which obstructs blood flow from the heart into the aorta. As a result, the left ventricle has to work harder to maintain adequate blood flow through the body. If left untreated, aortic stenosis can lead to life-threatening problems including heart failure, irregular heart rhythms, cardiac arrest, and chest pain.
  • Aortic stenosis is typically due to age-related progressive calcification of the normal trileaflet valve, though other predisposing conditions include congenital heart defects, calcification of a congenital bicuspid aortic valve, and acute rheumatic fever.
  • Transcatheter aortic-valve implantation is a procedure in which a bioprosthetic valve is inserted through a catheter and implanted within the diseased native aortic valve.
  • the most common implantation routes include the transapical approach (TA) and transfermoral (TF), though trans-subclavian and trans-aortic routes are also being explored (Ferrari, et al., Swiss Med Wkly,
  • the major potential offered by solving leaks with transcatheter heart valves is in growing the market to the low risk patient segment.
  • the market opportunity in the low-risk market segment is double the size of that in the high risk segment and therefore it is imperative for a TAV device to have technology to provide superior long-term hemodynamic performance so that the physicians recommend TAV over SAVR.
  • MR mitral regurgitation
  • Functional MR can be found in 84% of patients with congesti ve heart failure and in 65% of them the degree of regurgitation is moderate or severe.
  • the long term prognostic implications of functional mitral regurgitation have demonstrated a significant increase in risk for heart failure or death, which is directly related to the severity of the regurgitation. Compared to mild regurgitation, moderate to severe regurgitation was associated with a 2.7 fold risk of death and 3.2 fold risk of heart failure, and thus significantly higher health care cost.
  • mitral valve regurgitation depends on the severity and progression of signs and symptoms. Left unchecked, mitral regurgitation can lead to heart enlargement, heart failure and further progression of the severity of mitral regurgitation. For mild cases, medical treatment may be sufficient. For more severe cases, heart surgery might be needed to repair or replace the valve. These open-chest/open-heart procedures carry significant risk, especially for elderly patients and those with severe co-morbidities. While several companies are attempting to develop less invasive approaches to repair the mitral valve, they have found limited anatomical applicability due to the heterogeneous nature of the disease and, so far, have had a difficult time demonstrating efficacy that is equivalent to surgical approaches.
  • TAV and TMVI devices may also be used to treat the disease states of aortic insufficiency (or aortic regurgitation) and mitral stenosis respectively, which are less prevalent compared to the aforementioned valvular disease states, yet have similar or worse clinical prognosis/severity. They can also be implanted within failing bioprostheses that are already implanted surgically, referred to as a valve-in-valve procedure.
  • An improved device for treatment of these conditions includes a means for sealing the device at the site of placement, using a sealing ring that is activated by pressure as it is expanded in situ. As the device expands, a swellable material is released into the sealing means that causes the sealing means to expand and conform to the vessel walls, securing it in place. See WO2010/083558 by Endoluminal Sciences Pty Ltd. The mechanical constraints of these seals are extremely difficult to achieve - require rapid activation in situ, sufficient pressure to secure but not to deform or displace the implanted prosthesis, biocompatibility, and retention of strength and flexibility in situ over a prolonged period of time.
  • Expandable sealing means for endoluminal devices have been developed for controlled activation. These include a means for controlled activation at the site where the device is to be secured, and thereby avoids premature activation that could result in misplacement or leakage at the site.
  • the sealing means for placement at least partially between an endoluminal prosthesis and a wall of a body lumen has a first relatively reduced radial configuration and a second relatively increased radial configuration which is activated by means of a wire Or other similar means, by the pressure of expansion at the site of implantation, or simply by virtue of the expansion of .
  • a swellable material such as a hydrogel, foal or sponge into the sealing means, for example, by rupture of a capsule containing the swellable material, which then swells upon contact with fluid at the site to expand the sealing means into secure contact with the lumen walls.
  • a semi-permeable membrane is used to prevent the hydrogel gel material from escaping the seal, yet allows access of the fluid to the hydrogel.
  • the swellable material is spray dried onto the interior of the seal, optionally tethered to the material chemically by covalent crosslinking. This material typically has a permeability in the range of five to 70 microns, most preferably 35 to allow rapid access of the fluid to the hydrogel.
  • the sealing means is particularly advantageous since it expands into sites to eliminate all prosthetic-annular incongruities, as needed.
  • a major advantage of these devices is that the sealing means creates little to no increase in profile, since it remains flat/inside or on the device until the sealing means is activated.
  • Exemplary endoluminal devices including the sealing means for controlled activation include stents, stent grafts for aneurysm treatment and transcutaneously implanted aortic valves (TAV) or mitral, tricuspid or pulmonary valves.
  • the sealing means is configured to maintain the same low profile as the device without the sealing means.
  • the sealing means is positioned posterior to the prosthetic implant, and is expanded or pulled up into a position adjacent to the implant at the time of placement/deployment or sealing.
  • the seal is placed around the skeleton of the TAV, so that it expands with the skeleton at the time of implantation of the TAV.
  • the seal is placed between the TAV and the skeleton, and expands through the skeleton sections at the time of implantation to insure sealing.
  • hydrogel/expandable material operates under sufficient low pressure so that it does not push the stent away from the wall or alter the device configuration.
  • These materials must expand quickly (less than ten minutes, more preferably less than five minutes to full swelling), expand to a much greater volume (from two to 100 fold, more preferably from 50 to 90 fold, most preferably sixty fold) and retain the desired mechanical and physiochemical properties for an extended period of time, even under the stress of being implanted with the vasculature or heart.
  • Gels having the desired mechanical and swellable properties have been developed, as demonstrated by the examples.
  • a mechanism enables both deployment and retrieval of the system * This is particularly important from the ease of use and placement accuracy perspective. This feature enables the physician to change/alter the placement of the device in vivo if it was not properly positioned in the first attempt. Also, in the event of some complication during the operation, the physician can completely retrieve the device out of the patient (even after the "expandable material" has completely expanded).
  • FIGS 1A, IB and 1C are perspective views of a transcatheter aortic valve (TAV) ( Figure 1A), a controlled activatable seal (Figure I B), and the sea! placed around the TAV ( Figure 1 C).
  • TAV transcatheter aortic valve
  • FIGS 2A, 2B and 2C are perspective views of the TAV of Figure 1C crimped toward the inflow side of the TAV in a telescopic manner (Figure 2A), with the TAV and seal in an expanded state with the stent aligned with the bottom section of the TAV, with the activation wire activated to expose the seal to fluids (Figure 2B), and post deployment, with the seal expanded by swelling of the hydrogel within the seal when it contacts the blood.
  • Figure 3 is a perspective cross-sectional view of the seal, showing the inner and outer membranes, hydrogel within the inner membrane and the rupture/activation site.
  • Figures 4A, 4B and 4C are perspective views of the seal prior to rupture and expansion of the seal (Figure 4 A), during application of pressure from a wire to rupture the swelling material container and with partial expansion of the seal (Figure 4B), and after rupture of the swelling material container and with full expansion (Figure 4C).
  • Figures 5A-5E are perspective views of a method depicting a "method” to crimp and load the device with the "activation wire”.
  • the "activation wire” has to be shortened in length during the crimping/loading process so that the "activation or rupture” can be triggered during deployment/placement of the device. Before crimping/loading the "activation wire” is long enough so that the "activation mechanism” is far from activation and the hydrogel can remain completely sealed/de-activated during storage.
  • Figures 6A-6B are perspective views of a seal that is placed inside of the TAV device.
  • Figures 6C-6D are perspective views of a seal that is placed on the exterior of the TAV device.
  • Figure 6E shows the seal placed on the inside of the device such that the outer impermeable membrane is moulded to the stent scaffold and protrudes from within, in alignment with the stent pattern, while the inner permeable membrane remains in abutment with the inner circumference of the device. Hydrogels expand and cause the balloons to pop out.
  • Figures 7A-7D are perspective views of an impermeable sealing system to protect the implantable device during storage in a preservative solution such as glutaraldehyde, seals in place ( Figure 7A); exterior seal being removed
  • Figure 8 is a cross-sectional view of the exterior and interior seals of Figures 7A-7D.
  • Figures 9A-9D are schematics of the placement of a Sapien valve with and without the disclosed sealing means.
  • the Sapien valve When the Sapien valve is placed too low into the LVOT leading to the graft skirt not completely apposing against the vasculature ( Figure 9A), perivalvular leak may occur from the gaps/area above the skirt and around the device, through the open cells of the stent ( Figure 9B).
  • the Sapien valve with sealing means even when placed too low into the LVOT, seals the valve uniformly against the inner wall of the LVOT ( Figure 9C).
  • Figure 9D shows how no perivalvular leak occurs when the seal is in place, preventing the "leaking" blood from going back into the left ventricle.
  • Figure 10A shows a correctly placed SJM Medtronic TAV device.
  • Figure 10B depicts an incorrectly placed SJM/Medtronic TAV device, resulting in PV leaks.
  • Figure IOC shows how perivascular leaks are prevented with an incorrectly placed SJM/Medtronic TAV device with sealing means.
  • Figures 1 1A and 1 IB are prospective views of a self-aligning support member design for self-expanding TAV prosthesis, which enables system deployment and retrieval without the use of "activation sutures”.
  • Figures 12A-12F are prospective view of the self-aligning support as it is deployed, showing how the self-aligning support members are deployed from the catheter first to align the catheter and subsequently the frame of the prosthetic exits and extends outwardly and over the support members to position the prosthetic.
  • Figures 13A-13E are photographs of the deployment of the TAV using the sealing support members to position seal at time of placement.
  • Figures 14A and 14B are graphs of percent swelling for the various formulations at 5 min ( Figure 14A) and 60 min ( Figure 14B).
  • Figures 15A-15B show an in vitro model of a paravalvular leak site due to device inapposition ( Figure 15 A) and the leak site sealed with the seal capsule without disturbing the base geometry of the device ( Figure 15B).
  • the conformation of the seal happens actively only in places where there are leak sites.
  • the seal does not decrease the central orifice area of the device not having any adverse effect on the blood flow as a result. View from heart into aorta; device of Figures 2A-2C.
  • Hydrogel refers to a substance formed when an organic polymer (natural or synthetic) is crosslinked via covalent, ionic, or hydrogen bonds to create a three-dimensional open-lattice structure which entraps water molecules to form a gel .
  • Biocompatible generally refers to a material and any metabolites or degradation products thereof that are generally non-toxic to the recipient and do not cause any significant adverse effects to the subject.
  • Biodegradable generally refers to a material that will degrade or erode by hydrolysis or enzymatic action under physiologic conditions to smaller units or chemical species that are capable of being metabolized, eliminated, or excreted by the subject.
  • the degradation time is a function of material composition and morphology.
  • rapidly expanding refers to a material which reaches its desired dimensions in less than ten minutes after activation or exposure to fluid, more preferably in less than five minutes.
  • Endoluminal prosthesis and sealing devices are advanced through a body lumen in a first undeployed and reduced profile configuration.
  • the sealing device expands from its reduced radial profile configuration to a second configuration with an increased radial profile.
  • the sealing device is configured to be positioned between the prosthesis and the wall of the body lumen.
  • the endoluminal prosthesis when the endoluminal prosthesis is at the desired location in the body lumen, it is typically deployed from an introducer catheter whereupon it may move to an expanded radial configuration by a number of mechanisms.
  • the prosthesis may be spring expandable.
  • a balloon or expandable member can be inflated within the lumen of the prosthesis to cause it to move to an expanded radial configuration within the vessel. This radial expansion, in turn, presses the sealing device against a wall of the body lumen.
  • the sealing device is configured to fully seal a proximal, central and/or distal end of the endoluminal prosthesis for endovascular aneurysm repair (EVAR) to prevent endoleaks and prevent subsequent migration and/or dislodgement of the prosthesis.
  • EVAR endovascular aneurysm repair
  • the sealing device is configured to fully seal a transcatheter aortic valve.
  • Figures 1A, IB and 1 C are perspective views of a transcatheter aortic valve (TAV) 10 (Figure 1A), a controlled activatable seal (Figure IB) 12, and the seal placed around the TAV 14 ( Figure 1C).
  • Figures 2A, 2B and 2C are perspective views of the TAV 14 of Figure 1C crimped toward the inflow side of the TAV10 in a telescopic manner ( Figure 2 A), with the TAV 10 and seal 12 in an expanded state with the stent aligned with the bottom section of the TAV, with the activation wire 16 activated to expose the seal 12 to fluids (Figure 2B). and post deployment, with the seal 12 expanded by swelling of the hydrogel within the seal when it contacts the blood.
  • the endoluminal device may be configured such that it moves independently of the endoluminal prosthesis.
  • the endoluminal device may be connected to the prosthesis for delivery to a target site.
  • the endoluminal device may be connected to the prosthesis by any number of means including suturing, crimping, elastic members, magnetic or adhesive connection.
  • the sealing means is positioned posterior to the prosthetic implant, and is expanded and pulled up into a position adjacent to the implant at the time of sealing. This is achieved using sutures or elastic means to pull the seal up and around the implant at the time of placement, having a seal that expands up around implant, and/or crimping the seal so that it moves up around implant when implant comes out of introducer sheath. This is extremely important with large diameter implants such as aortic valves, which are already at risk of damage to the blood vessel walls during transport.
  • a key feature of the latter embodiment of the seal technology is that it enables preservation of the crimped profile of the endoluminal prosthesis.
  • the seal technology is crimped distal or proximal to the prosthesis.
  • the seal is aligned with the prosthesis by expansion of the seal.
  • the seal zone of the prosthesis is aligned with the seal zone prior to expansion of the prosthesis b use of activation members.
  • the seal is aligned with the seal zone of the prosthesis prior to prosthesis expansion by use of activation members, which can be made of an elastic or non-elastic material.
  • the seal is positioned between the device skeleton and the device, or on the exterior of the skeleton.
  • the endoluminal device may further include one or more engagement members.
  • the one or more engagement members may include staples, hooks or other means to engage with a vessel wall, thus securing the device thereto.
  • the seal includes a flexible component that is configured to conform to . irregularities between the endoluminal prosthesis and a vessel wall.
  • the seal includes a generally ring-like structure having a first or inner surface and a second or outer surface. It contains a material that swells upon contact with a fluid or upon activation of a foam, following placement, to inflate and conform the seal around the device.
  • the seal 12 is a capsule-within-a capsule.
  • the seal 12 can be provided in a variety of shapes, depending on the device it is to be used with.
  • a "D" shape is the preferred embodiment, with the flat portion being attached to the support structure and/or device to be implanted.
  • the seal can be composed of a permeable, semi-permeable, or impermeable material. It may be biostable or biodegradable.
  • the seal may be composed of natural or synthetic polymers such as polyether or polyester polyurethanes, polyvinyl alcohol (PVA), silicone, cellulose of low to high density, having small, large, or twin pore sizes, and having the following features: closed or open cell, flexible or semi-rigid, plain, melamine, or post- treated impregnated foams.
  • Additional materials for the seal can include polyvinyl acetal sponge, silicone sponge rubber, closed cell silicone sponges, silicone foam, and fluorosilicone sponge. Specially designed structures using vascular graft materials including polytetrafluoroethylene (PTFE),
  • PEEK polyethylterephthalate
  • PP polypropylene
  • collagen or protein based matrix may also be used.
  • PEEK is the preferred material at this time since the strength is high so that there will be no damage leading to failure when the TAV device is expanded against sharp/calcified nodules and at the same time a relatively thin sheet of material can be used, helping maintain a lower profile.
  • the seal material may be used independently or in combination with a mesh made from other types of polymers, titanium, surgical steel or shape memory alloys.
  • the capsule may be segmented to include one or more compartments.
  • the compartments may be relatively closely spaced. Further, the distance between adjacent compartments may vary.
  • the segmented capsule of this embodiment may not extend completely around the endoluminal prosthesis when the support member is in its second increased radial configuration.
  • the support member includes a capsule
  • the capsule may be substantially surrounded by the support member. In other embodiments, however, the capsule may be only partially enveloped by the support member,
  • the capsule may include an outer wall to hold the agent therein.
  • the outer wall may be made of a suitably flexible and biocompatible material.
  • the capsule may include a more rigid structure having a predesigned failure mechanism to allow the release of agent therefrom.
  • suitable materials include, but are not limited to, low density polyethylene, high density polyethylene, polypropylene, polytetrafluoroethylene, silicone, or fluorosilicone.
  • fluoropolymers that may be used for the construction of the capsule include: polytetrafluoroethylene, perfluoroalkoxy polymer resin, fluorinated ethylene-propylene, polyethylenetetrafluoroethylene,
  • the capsule may be composed of a material or combination of materials different from those provided above.
  • the rate of release of the agent from the support member may vary, In some embodiments, pressure exerted on the support member to rupture a capsule may release one or more agents. This rate of almost immediate release is particularly useful for delivering adhesive agents to a vessel to affix a prosthesis to a wall of the vessel. However, other agents may be released at a slower or at least a variable rate. Further, the agents may be released after the initial release of a primary agent (e.g. the adhesive).
  • a primary agent e.g. the adhesive
  • the first agent to be released may be held in one or more "immediate release" sub-compartments which include an outer wall configured to rupture under a pre-defined initial pressure.
  • the support member may include one or more slow release sub-compartments having outer walls configured to withstand the initial pressure but which either rupture when subjected to a greater pressure or which do not rupture but rather degrade over a certain period of time to release an agent held therein.
  • the capsule is configured to rupture to release one or more agents at a predetermined range of pressures.
  • the range of rupture pressures includes between 5 and 250 psi, between 5 and 125 psi, between 10 and 75 psi, or at approximately 50 psi.
  • a process for forming a pressure activated capsule includes pre-stressing the capsule during formation.
  • the pre-stressed material will have a limited capacity to stretch when subjected to external pressure, and will fail when reaching critical stress on the stress-strain curve.
  • the first stage of this method includes selecting a biocompatible capsule material that is also compatible with its contents (e.g., the agent which can include adhesive material or a wide variety of other types of materials).
  • the capsule material should also have a tensile strength suitable for the particular application in which the capsule will be used.
  • the next stage of this method includes forming an undersized capsule.
  • the undersized capsule is essentially shaped as an extruded, elongated tube (e.g., a "sausage") with one end of the tube sealed (e.g., by dipping, dip molding, vacuum forming blow molding, etc.).
  • the process continues by expanding the capsule to its final shape.
  • the capsule can be expanded, for example, by stretching (e.g., either hot or cold) using appropriate tooling so that the capsule material is pre-stressed to within a stress level, and whereby the clinically relevant balloon inflation pressure will exceed the failure stress of the capsule material.
  • the method can further include filling the capsule with the desired contents while the capsule is under pressure so as to achieve pre-stressing in a single step.
  • the capsule can be sealed (e.g., using a heat welding process, laser welding process, solvent welding process, etc.).
  • a capsule in another embodiment, can be formed by forming an air pillow or bubble wrap-type capsule assembly using a vacuum form process or other suitable technique. The next stage of this process includes perforating a film at the base of the capsule assembly and filling the individual capsules with the desired contents under an inert atmosphere. After filling the capsules, the puncture hole can be resealed by application of another film over the puncture hole and localized application of heat and/or solvent. Other methods can be used to seal the puncture hole.
  • the capsule can be configured such that the puncture hole re-ruptures at the same pressure as the capsule itself so that there is some agent (e.g., adhesive material within the capsule) flowing onto the corresponding portion of the endoluminal prosthesis.
  • One or more failure points can be created within a capsule.
  • This process can include creating a capsule shaped as an extruded, elongated tube with one end of the tube sealed (e.g., by dipping, dip molding, vacuum forming blow molding, etc.).
  • the capsule can be composed of a polymer material (e.g., polyethylene, polypropylene, polyolefin, polytetrafiuoroethylenes, and silicone rubber) or another suitable material.
  • the process can include creating areas of substantially reduced thickness.
  • These areas can be formed, for example, using a tool (e.g., a core pin with a razor blade finish along the length of the capsule), laser ablation, creating partially penetrating holes, creating an axial adhesive joint (e.g., tube from a sheet) that is weaker than the substrate, or other suitable techniques.
  • the method next includes filing the capsule with the desired contents at a pressure below that required to rupture the thinned or weakened areas. After filling the capsule, the open end of the capsule can be sealed using one of the welding processes described above or other suitable processes.
  • one or more stress points can be created within a capsule.
  • This method can include forming a capsule and filling the capsule with the desired contents using any of the techniques described above. After forming the capsule and with the capsule in an undeployed configuration, the process can further include wrapping a suture (e.g.. a nitinol wire) about the capsule at a predetermined pitch and tension. When the capsule is moved from the undeployed state to a deployed configuration and takes on a curved or circumferential shape, the suture compresses the capsule at the predetermined points. Stress points are created in the capsule walls at these points because of the increased pressure at such points:
  • the device may include one or more pressure points on the supporting member such as spikes or other raised areas which cause the penetration of the capsule once a predetermined pressure is applied thereto.
  • Still yet another particular embodiment for forming a pressure activated capsule or compartment includes creating a double walled capsule in which an inner compartment of the capsule is sealed and separated from an outer compartment of the capsule that contains the adhesive or other desired agent.
  • the inner compartment can be composed of a compliant or flexible material, and the outer compartment can be composed of a substantially less compliant material.
  • the outer compartment may or may not have failure points.
  • the inner compartment is in fluid communication via a one way valve with a low compliance reservoir.
  • the reservoir is configured to be pressurized by inflation of an expandable member or balloon to a high pressure, thereby allowing the valve to open and pressurize and expand the inner compartment. This process in turn pressurizes the outer compartment (that contains the adhesive) until the outer compartment ruptures.
  • One advantage of this particular embodiment is that it can increase the pressure within the capsule to a value higher than otherwise possible with an external expandable member or balloon alone.
  • the capsule has an inner compartment made from a relatively rigid material or mesh and an outer compartment made from a relatively flexible material.
  • the inner compartment acts as a reservoir, containing the agent and is designed to break or rupture at a predetermined pressure.
  • the outer compartment may also have a failure pressure point to allow release of the agent.
  • the rigidity of the inner compartment may provide a longer-term stability and shelf life of the encapsulated agent.
  • the application of rupture pressure may be carried out either locally or remotely, e.g. via a tube directly connected to the capsule that is connected to an external source at the delivery device entry site (e.g. femoral artery).
  • a seal entirely surrounds the capsule sueh that the capsule is "suspended" within the seal.
  • the seal 12 can include a porous material configured to prevent any embolization (distal or proximal) of released agent(s) 108 from the capsule 106.
  • the seal may have a graded degree of relative porosity from relatively porous to relatively non-porous. Preferred porosity size is from five to seventy microns, more preferably about 35 microns so that the fluid can rapidly access the swellable material.
  • the capsule is a single annular
  • the capsule may include one or more additional compartments or sections, and may not extend completely around the endoluminal prosthesis.
  • the capsule may or may not be contained within the seal, and can be positioned at a different location on the apparatus relative to the seal.
  • the capsule can have a variety of different shapes and/or sizes depending upon the particular application, the agent(s), the configuration of the endoluminal prosthesis, and a number of other factors.
  • the seal 12 includes two membranes, an inner membrane 18 and an outer membrane 20.
  • An expandable material such as a foam or hydrogel 22 is placed within the inner membrane 18.
  • the inner membrane 18 is semi-permeable (allowing fluid ingress but not egress of entrapped hydrogel or foam) whi le the outer membrane 20 is impermeable except at an optional pre-determined rupture point 24.
  • the outer membrane 20 is designed to be impermeable to fluid during storage and transport and during any pre-procedural preparations e.g. rinsing or washing of the device, to protect the polymer 22 from premature swelling.
  • the outer membrane 20 is also designed to be strong and puncture resistant so that it does not tear or is punctured or pierced by the sharp edges of the nati ve calcification even when subject to pressures up to 14atm. This prevents the rupture of the inner membrane 18, mitigating any risk of embolization of the expandable material or hydrogel 22.
  • the rupture point 24 allows fluid such as blood to penetrate into the expandable seal only when the seal is expanded in place, thereby preventing leaks.
  • Permeable membranes may be made from a variety of polymer or organic materials, including polyimides, phospholipid bilayer, thin film composite membranes (TFC or TFM), cellulose ester membranes (CEM), charge mosaic membranes (CMM), bipolar membranes (BPM), and anion exchange membranes (AEM).
  • TFC or TFM thin film composite membranes
  • CEM cellulose ester membranes
  • CCM charge mosaic membranes
  • BPM bipolar membranes
  • AEM anion exchange membranes
  • a preferred pore size range for allowing fluid in but not hydrogel to escape is from five to seventy microns, more preferably about 35 to seventy microns, most preferably about 35 microns, so that the fluid can rapidly access the swellable material.
  • the permeable membrane may be formed only of permeable material, or may have one or more areas that are impermeable. This may be used to insure that swelling does not disrupt the shape of the seal in an undesirable area, such as on the interior of the device where it abuts the implant or prosthesis, or where it contacts the device support members.
  • the second impermeable membrane is applied with plasma vapour deposition, vacuum deposition, co-extrusion, or press lamination.
  • Expandable materials which swell in contact with an aqueous fluid are preferred. Most preferably, these materials expand from two to 100 times; more preferably from 50 to 90 fold, most preferably about 60 fold. Blood and/or other fluids at the site of implantation can penetrate into the seal after it is breached, causing dried or expandable materials to absorb the fluid and swell or react to expand due to formation or release of gas reaction products.
  • the semipermeable inner membrane 18 prevents the expandable material 22 from escaping the seal 12, but allows fluid to enter. By expanding in volume, the material seals the endoluminal space.
  • the expandable material having suitable physical and chemical properties may be used.
  • the expandable material is a hydrogel.
  • Other suitable materials include foams and sponges formed at the time of activation.
  • Expandable materials are chosen to be stable at both room temperature and 37-40 °C and to be sterilizable by one or more means such as radiation or steam. Sponges or foams can be made from biocompatible materials that allow tissue ingrowth or endothelialisation of the matrix. Such endothelialisation or tissue ingrowth can be facilitated either through selection of appropriate polymeric materials or by coating of the polymeric scaffold with suitable growth promoting factors or proteins.
  • Hydrogels are selected to provide rapid swelling as well as to be biocompatible in the event of a breach of capsule integrity. Two or more hydrogels or other materials that swell may be used.
  • Expandable gels have been developed that are stronger and more resilient than current expandable gels. These gels are able to expand rapidly to at least l Ox, 20x, 25x, 30, or 40x of the dry state and more preferably up to 50 x their dry state when exposed to physiological liquids in less than 25, 24, 23, 22, 21, 20, 19, 18, 17, 16, 15, 14, 13, 12, 1 1, 10, 9, 8, 7, 6, 5, or 4 minutes. These stronger gels are synthesized using long chain cross-linkers, typically molecules with more than 20 carbon atoms and/or a molecular weight greater than 400Da, more preferably more than 40 carbon atoms and/or a molecular weight greater than 800 Da, that will act as molecular reinforcement molecules, creating a more resilient and longer lasting gel while maintaining excellent swelling properties.
  • the swelling force of these gels can also be adjusted to not exert more radial force than necessary, typically around 0.0005N/mm 2 to 0.025N/mm 2 , preferably 0.002N/mm 2 to 0.012N/mm 2 .
  • these gels can be spray dried onto, or eovalently attached to, a base membrane or mesh used to encapsulate the gel before being fitted to the surgical device.
  • the gels can be eovalently attached by introducing one or more functional groups that can form covalent bonds to One or more functional groups on the base membrane or mesh. Suitable functional groups include, but are not limited to, allylic, vinyl or acrylic groups. The functional groups can be introduced directly onto the gel and/or membrane or mesh or as part of a longer/larger chemical moiety.
  • Acrylic refers to a group having the structure
  • the preferred IUPAC name for the group is prop-2-enoyl, and it is also (less correctly) known as acrylyl or simply acryl.
  • Compounds containing an acryloyl group can be referred to as "acrylic compounds".
  • the long chain hydrophilic crosslinking agents described above have at least two and preferably more than two reactive functional groups (e.g., allyl, acrylic, vinyl, etc.) capable of participating in a free radical polymerization reaction or additional reaction, such as Michael addition, and where at least part of the molecule is attached to a substrate, anchoring the gel to the substrate to prevent release of smaller gel particles in case of gel fracture.
  • a free radical polymerization reaction or additional reaction such as Michael addition
  • crosslinking agents described herein includes long chain hydrophilic polymer (such as PVA, PEG, PVAc, natural polysaccharides such as dextran, HA, agarose, and starch) with multiple polymerizable/reactive groups.
  • the long chain crosslinking agents result in a hydrogel which is less susceptible to "fragmenting" which is important as it minimizes any risk of small gel particles breaking off and embolizing to the brain.
  • the long chain crosslinking agents also result in increased integrity of the hydrogel, making it more pliable and thereby increasingly resilient under cyclic loads, an important factor for long-term durability of the hydrogel.
  • the benefits are a much stronger hydrogel, approximately 0.0005N/mm 2 to 0.025N/mm 2 . more preferably between
  • Suitable components of such gels include, but are not limited to, acrylic acid, acrylamide or other polymerizable monomers; cross-linkers such as polyvinyl alcohols as well as partially hydrolyzed poly vinyl acetates, 2- hydroxyethyl methacrylates (HEMA) or various other polymers with reactive side groups such as acrylic, allylic, and vinyl groups, can be used.
  • cross-linkers such as polyvinyl alcohols as well as partially hydrolyzed poly vinyl acetates, 2- hydroxyethyl methacrylates (HEMA) or various other polymers with reactive side groups such as acrylic, allylic, and vinyl groups
  • HEMA 2- hydroxyethyl methacrylates
  • Reagents such as allyl glycidyl ether, allyl bromide, allyl chloride etc.
  • rapidly swelling hydrogels include, but are not limited to, acrylic acid polymers and copolymers, particularly crosslinked acrylic acid polymer and copolymers.
  • Suitable crosslinking agents include acrylamide, di(ethylene glycol) diacrylate, poly(ethylene glycol) diacrylate, and long-chain hydrophilic polymers with multiple polymerizable groups, such as poly vinyl alcohol (PVA) derivatized with al yl glycidyl ether.
  • materials which can be used to form a suitable hydrogel include polysaccharides such as alginate, polyphosphazines, poly(acrylic acids), poly(methacrylic acids), poly(alkylene oxides), polyvinyl acetate), polyvinylpyrrolidone (PVP), and copolymers and blends of each. See, for example, U.S. Patent No. 5,709,854, 6, 129,761 and 6,858,229.
  • these polymers are at least partially soluble in aqueous solutions, such as water, buffered salt solutions, or aqueous alcohol solutions.
  • aqueous solutions such as water, buffered salt solutions, or aqueous alcohol solutions.
  • the polymers have charged side groups or are monovalent ionic salts thereof.
  • Examples of polymers with acidic side groups that can be reacted with cations are poly(phosphazenes), poly(acrylic acids),
  • Copolymers having acidic side groups formed by reaction of acrylic or methacrylic acid and vinyl ether monomers or polymers can also be used. Examples of acidic groups are carboxylic acid groups and sulfonic acid groups.
  • the ammonium or quaternary salt of the polymers can also be formed from the backbone nitrogens or pendant imino groups.
  • basic side groups are amino and imino groups.
  • a water-soluble gelling agent such as a polysaccharide gum, more preferably a polyanionic polymer like alginate can be cross-linked with a polycationic polymer (e.g., an amino acid polymer such as polylysine) to form a shell. See e.g., U.S. Patent Nos.
  • Amino acid polymers that may be used to crosslink hydrogel forming polymers such as alginate include the cationic poly(amino acids) such as polylysine, polyarginine, polyornithine, and copolymers and blends thereof.
  • exemplary polysaccharides include chitosan, hyaluronan (HA), and chondroitin sulfate.
  • Alginate and chitosan form crosslinked hydrogels under certain solution conditions, while HA and chondroitin sulfate are preferably modified to contain crosslinkable groups to form a hydrogel.
  • Alginate forms a gel in the presence of divalent cations via ionic crosslinking.
  • the properties of the hydrogel can be controlled to some degree through changes in the alginate precursor (molecular weight, composition, and macromer concentration), alginate does not degrade, but rather dissolves when the divalent cations are replaced by monovalent ions. In addition, alginate does not promote cell interactions. See U.S. Patent No.
  • PBAAs poly( ⁇ -amino alcohols)
  • Chitosan is made by partially deacetylating chitin, a natural
  • nonmammalian polysaccharide which exhibits a close resemblance to mammalian polysaccharides, making it attractive for cell encapsulation.
  • Chitosan degrades predominantly by lysozyme through hydrolysis of the acetylated residues. Higher degrees of deacetylation lead to slower degradation times, but better cell adhesion due to increased hydrophpbicity. Under dilute acid conditions (pH ⁇ 6), chitosan is positively charged and water soluble, while at physiological pH, chitosan is neutral and hydrophobic, leading to the formation of a solid physically crosslinked hydrogel.
  • the addition of polyol salts enables encapsulation of cells at neutral pH, where gelation becomes temperature dependent.
  • Chitosan has many amine and hydroxyl groups that can be modified.
  • chitosan has been modified by grafting methacrylic acid to create a crosslinkable macromer while also grafting lactic acid to enhance its water solubility at physiological pH.
  • This crosslinked chitosan hydrogel degrades in the presence of lysozyme and chondrocytes.
  • Photopolymerizable chitosan macromer can be synthesized by modifying chitosan with photoreactive azidobenzoic acid groups. Upon exposure to UV in the absence of any initiator, reactive nitrene groups are formed that react with each other or other amine groups on the chitosan to form an azo crosslink.
  • Hyaluronan is a glycosaminoglycan present in many tissues throughout the body that plays an important role in embryonic development, wound healing, and angiogenesis. In addition, HA interacts with cells through cell-surface receptors to influence intracellular signaling pathways. Together, these qualities make HA attractive for tissue engineering scaffolds.
  • HA can be modified with crosslinkable moieties, such as methacrylates and thiols, for cell encapsulation.
  • Crosslinked HA gels remain susceptible to degradation by hyaluronidase, which breaks HA into oligosaccharide fragments of varying molecular weights/ Auricular chondrocytes can be encapsulated in
  • photopolymerized HA hydrogels where the gel structure is controlled by the macromer concentration and macromer molecular weight.
  • photopolymerized HA and dextran hydrogels maintain long-term culture of undifferentiated human embryonic stem cells.
  • HA hydrogels have also been fabricated through Michael-type addition reaction mechanisms where either acrylated HA is reacted with PEG-tetrathiol, or thiol-modified HA is reacted with PEG diacrylate.
  • Chondroitin sulfate makes up a large percentage of structural proteoglycans found in many tissues, including skin, cartilage, tendons, and heart valves, making it an attractive biopolymer for a range of tissue engineering applications.
  • Photocrossl inked chondroitin sulfate hydrogels can be been prepared by modifying chondroitin sulfate with methacrylate groups.
  • the hydrogel properties were readily controlled by the degree of methacrylate substitution and macromer concentration in solution prior to polymerization. Further, the negatively charged polymer creates increased swelling pressures allowing the gel to imbibe more water without sacrificing its mechanical properties.
  • Copolymer hydrogels of chondroitin sulfate and an inert polymer, such as PEG or PVA, may also be used.
  • Biodegradable PEG hydrogels can be been prepared from triblock copolymers of poly(ot-hydroxy esters)-b-poly (ethylene glycol)-b-poly(a- hydroxy esters) endcapped with (meth)acrylate functional groups to enable crosslinking.
  • PLA and poly(8-caprolactone) (PCL) have been the most commonly used poly(a-hydroxy esters) in creating biodegradable PEG macromers for cell encapsulation.
  • the degradation profile and rate are controlled through the length of the degradable block and the chemistry.
  • the ester bonds may also degrade by esterases present in serum, which accelerates degradation.
  • Biodegradable PEG hydrogels can also be fabricated from precursors of PEG-bis-[2-acryloyloxy propanoate].
  • PEG-based dendrimers of poly(glycerol-succinic acid)-PEG which contain multiple reactive vinyl groups per PEG molecule, can be used.
  • An attractive feature of these materials is the ability to control the degree of branching, which consequently affects the overall structural properties of the hydrogel and its degradation. Degradation will occur through the ester linkages present in the dendrimer backbone.
  • the biocompatible, hydrogel -forming polymer can contain
  • a phosphoester can be incorporated into the backbone of a phosphoester
  • crosslinkable PEG macromer poly(ethylene glycol)-di-[ethylphosphatidyl (ethylene glycol) methacrylate] (PhosPEG-dMA), to form a biodegradable hydrogel.
  • PhosPEG-dMA poly(ethylene glycol)-di-[ethylphosphatidyl (ethylene glycol) methacrylate]
  • PhosPEG-dMA poly(ethylene glycol)-di-[ethylphosphatidyl (ethylene glycol) methacrylate]
  • the addition of alkaline phosphatase, an ECM component synthesized by bone cells enhances degradation.
  • the degradation product, phosphoric acid reacts with calcium ions in the medium to produce insoluble calcium phosphate inducing autocalcification within the hydrogel.
  • Poly(6-aminoethyl propylene phosphate), a polyphosphoester can be modified with methacrylates to create multivinyl macromers where the degradation rate was controlled by the degree of der
  • Polyphosphazenes are polymers with backbones consisting of nitrogen and phosphorous separated by alternating single and double bonds. Each phosphorous atom is covalently bonded to two side chains.
  • polyphosphazenes suitable for cross-linking have a majority of side chain groups which are acidic and capable of forming salt bridges with di- or trivalent cations.
  • preferred acidic side groups are carboxylic acid groups and sulfonic acid groups.
  • Hydrolytically stable polyphosphazenes are formed of monomers having carboxylic acid side groups that are crosslinked by divalent or trivalent cations such as Ca 2+ or Al 3+ . Polymers can be synthesized that degrade by hydrolysis by incorporating monomers having imidazole, amino acid ester, or glycerol side groups.
  • Bioerodible polyphosphazines have at least two differing types of side chains, acidic side groups capable of forming salt bridges with multivalent cations, and side groups that hydrolyze under in vivo conditions, e.g., imidazole groups, amino acid esters, glycerol and glucosyl. Hydrolysis of the side chain results in erosion of the polymer. Examples of hydrolyzing side chains are unsubstituted and substituted imidizoles and amino acid esters in which the group is bonded to the phosphorous atom through an amino linkage (polyphosphazene polymers in which both R groups are attached in this manner are known as polyaminophosphazenes). For polyimidazolephosphazenes, some of the "R" groups on the polyphosphazene backbone are imidazole rings, attached to phosphorous in the backbone through a ring nitrogen atom.
  • the hydrogel/expandable material operates under sufficient low pressure so that it does not push the stent away from the wall or alter the device configuration.
  • the expandable material is contained within a material, such as a semi-permeable or impermeable material so that it is retained at the site where it is needed to seal a leak.
  • the material is selected based on the means for activation. If the material is expanded by mechanical shear or exposure to a foaming agent, these materials are provided internally within the seal, allowing an external activating agent such as an activation wire to disrupt the means for isolating the activation agent from the expandable material.
  • the material is activated by contact with fluid, no additional means for isolation are required if the device is stored dry prior to use, since it will activate in situ when exposed to body fluids. If the material is stored wet prior to use, a second impermeable membrane is required to keep the expandable material dry prior to activation. This will typically include a rupture site which is opened at the time of implantation to allow biological fluid to reach the expandable material through the semi-permeable material (i.e., where semipermeable refers to a material retaining the expandable material but allowing fluid to pass).
  • the impermeable material may not include a rupture site but simply be removed after the device is removed from storage and washed with saline, prior to loading into the catheter, so that once the device is deployed, in situ liquid will cause the hydrogel to swell.
  • the properties of the different materials complement each other. For example, in the time immediately after valve deployment it is important that the material swells quickly to seal perivalvular leaks as soon as possible.
  • the mechanical strength of the hydrogel(s) is from about 0.0005 N/mm 2 to about 0.025 N/mm 2 , preferably from about 0.002 N/mm 2 to about 0.012 N/ram 2 .
  • the mechanical strength should be high enough to allow swelling and thereby "actively" conform to the gaps leading to leakage but not high enough to disturb the physical or functional integrity of the prosthesis or implant or to push the prosthesis or implant away from the wall.
  • Another important consideration is that the mechanical strength ' should not be so high as to exert excess pressure on the anatomy, particularly around the Left Bundle Branch (LBB), which is responsible for the cardiac conduction.
  • LBB Left Bundle Branch
  • LBBB Left Bundle Branch Block
  • a degradable material which may be a hydrogel, that swells quickly, may be used in conjunction with a nondegradable material, which may be a hydrogel, that swells slower but has higher mechanical strength.
  • the degradable material capable of rapid swelling will quickly seal the perivalvular leak. Over time, this material degrades and will be replaced by the material exhibiting slower swelling and higher mechanical strength. Eventually, the seal will be composed of the slower swelling nondegradable material. It is also possible to use only one material in the seal, but in two or more different forms. For example, two different crystal sizes of hydrogels may be used in the seal, because different particle sizes of hydrogel may exhibit different properties.
  • a foam generated prior to implantation can also be used as a swellable material to form a seal.
  • a suitable matrix such as a biocompatible polymer or crosslinkable prepolymer
  • Foaming agents include compounds or mixtures of compounds which generate a gas in response to a stimulus. When dispersed within a matrix and exposed to a stimulus, the foaming agents evolve a gas, causing the matrix to expand as fine gas bubbles become dispersed within the matrix.
  • suitable foaming agents include compounds which evolve a gas when hydrated with biological fluids, such as mixture of a physiologically acceptable acid (e.g., citric acid or acetic acid) and a physiologically acceptable base (e.g., sodium bicarbonate or calcium carbonate).
  • a physiologically acceptable acid e.g., citric acid or acetic acid
  • a physiologically acceptable base e.g., sodium bicarbonate or calcium carbonate.
  • suitable foaming agents include dry particles containing pressurized gas, such as sugar particles containing carbon dioxide (see, U.S. Patent No.
  • Suitable examples include changing the morphology of known hydrogel materials in order to decrease swelling times.
  • Means for changing the morphology include increasing the porosity of the material, for example, by freeze-drying or porogen techniques.
  • particles can be produced by spray drying by dissolving a biocompatible material such as a polymer and surfactant or lipid in an appropriate solvent, dispersing a pore forming agent as a solid or as a solution into the solution, and then spray drying the solution and the pore forming agent, to form particles.
  • the polymer solution and pore forming agent are atomized to form a fine mist and dried by direct contact with hot carrier gases.
  • the polymer solution and pore forming agent may be atomized at the inlet port of the spray dryer, passed through at least one drying chamber, and then collected as a powder.
  • the temperature may be varied depending on the gas or polymer used.
  • the temperature of the inlet and outlet ports can be controlled to produce the desired products.
  • the size and morphology of the particles formed during spray drying is a function of the nozzle used to spray the solution and the pore forming agent, the nozzle pressure, the flow rate of the solution with the pore forming agent, the polymer used, the concentration of the polymer in solution, the type of polymer solvent, the type and the amount of pore forming agent, the temperature of spraying (both inlet and outlet temperature) and the polymer molecular weight.
  • Pore forming agents are included in the polymer solution in an amount of between 0.01% and 90% weight to volume of polymer solution, to increase pore formation.
  • a pore forming agent such as a volatile salt, for example, ammonium bicarbonate, ammonium acetate, ammonium carbonate, ammonium chloride or ammonium benzoate or other volatile salt as either a solid or as a solution in a solvent such as water can be used.
  • the solid pore forming agent or the solution containing the pore forming agent is then emulsified with the polymer solution to create a dispersion or droplets of the pore forming agent in the polymer.
  • This dispersion or emulsion is then spray dried to remove both the polymer solvent and the pore forming agent.
  • the hardened particles can be frozen and lyophilized to remove any pore forming agent not removed during the polymer precipitation step.
  • Fast swelling can be achieved by preparing small particles of dried hydrogels.
  • the extremely short diffusion path length of microparticles makes it possible to complete swelling in a matter of minutes.
  • Large dried hydrogels can be made to swell rapidly regardless of their size and shape by creating pores that are interconnected to each other throughout the hydrogel matrix. The interconnected pores allow for fast absorption of water by capillary force.
  • a simple method of making porous hydrogel is to produce gas bubbles during polymerization. Completion of polymerization while the foam is still stable results in formation of superporous hydrogels.
  • Superporous hydrogels can be synthesized in any molds, and thus, three-dimensional structure of any shape can be easi ly made.
  • the size of pores produced by the gas blowing (or foaming) method is in the order of 100 mm and larger.
  • Expandable sponges or foams can also be used for sealing of surgical implantations. These sponges or foams and be cut into a strips or annular shapes and either dried down or dehydrated by other means and then be allowed to rapidly re-hydrate once the device is in place. Alternatively, such materials can be hydrated and then squeezed to reduce their volume to allow these to be attached to the surgical implement and then allowed to expand to form a seal once the surgical implement is in place. Such swelling would be nearly instant.
  • One further benefit of sealing material in the form of sponges or foams is that their expansion can be reversible so that they can easier be retracted from their implanted position back into the delivery catheter and thereby enable complete re-positioning of the device multiple times and/or complete retrievability of the device.
  • Such sponges and foams can be made from a range of materials including, but not limited to, synthetic polymers, natural polymers or mixtures thereof. Such materials can be formed by including pore forming substances such as gas or immiscible solvents in the monomer/polymer mix prior to polymerization and/or cross-linking. By using the appropriate monomers and/or polymeric cross-linkers such sponges/foams can be made to withstand cyclic stress; such materials could also further be reinforced with compatible fibres or whiskers to increase strength and reduce the probability for breakage.
  • these sponges or foams can be chemically attached to a base membrane or mesh used to encapsulate the sponge/foam before being fitted to the surgical device. This could be done by attaching either allylic or acrylic groups to the base substrate, either as small molecules or as long chain tentacles anchoring the expandable to the substrate preventing release of smaller particles in case of fracture.
  • Foams may be designed to expand without the need for the semipermeable membrane.
  • C. The support member or skeleton
  • the seal may be sufficiently flexible to conform to irregularities between the endoluminal prosthesis and a vessel wall.
  • the band of material may include a mesh-like or a generally ring-like structure configured to receive at least a portion of an endoluminal prosthesis such that it is positioned between the portion of the prosthesis and a vessel wall. This is usually referred to as a skeleton or support member.
  • the seal 12 has a stent/metal backing or skeleton 26.
  • the skeleton 26 provides structure and enables crimping, loading and deployment.
  • the skeleton 26 can be either a balloon expanding or a self- expanding stent.
  • the skeleton 26 is attached to the surface of the outer membrane 20.
  • the support member When the support member is in the second reduced radial configuration, it may form a substantially helical configuration.
  • the helical structure of the support member provides an internal passage therein to receive at least a portion of an endoluminal prosthesis.
  • the support member may include steel such as MP35N, SS316LVM, or L605, a shape memory material or a plastically expandable material.
  • the shape memory material may include one or more shape memory alloys. In this embodiment, movement of the shape memory material in a pre-determined manner causes the support member to move from the first reduced radial configuration to the second increased radial
  • the shape memory material may include Nickel-Titanium alloy (Nitinol).
  • the shape memory material may include alloys of any one of the following combinations of metals: copper-zinc-aluminium, copper- aluminium-nickel, copper-aluminium-nickel, iron-manganese-silicon- chromium-manganese and copper-zirconium.
  • At least part of the support member may also include any one of the following combinations of metals: Ag-Cd 44/49 at.% Cd; Au-Cd 46.5/50 at.% Cd; Cu-AI-Ni 14/14.5 wt.% Al and 3/4.5 wt.% Ni, Cu-Sn approx.
  • the shape memory material of the support member may act as a spine along the length of the support member.
  • the plastically-expandable or balloon-expandable materials may include stainless steel (316L, 316LVM, etc.), Elgiloy, titanium alloys, platinum-iridium alloys, cobalt chromium alloys (MP35N, L605, etc.), tantalum alloys, niobium alloys and other stent materials.
  • the support member may be composed of a biocompatible polymer such as polyether or polyester, polyurethanes or polyvinyl alcohol.
  • the material may further include a natural polymer such as cellulose ranging from low to high density, having small, large, or twin pore sizes, and having the following features: closed or open cell, flexible or semi-rigid, plain, melamine, or post- treated impregnated foams.
  • Additional materials for the support member include polyvinyl acetal sponge, silicone sponge rubber, closed cell silicone sponges, silicone foam, and fluorosilicone sponge. Specially designed structures using vascular graft materials such as PTFE, PET and woven yarns of nylon, may also be used.
  • At least part of the support member may be composed of a permeable material.
  • at least part of the support member may be semi- permeable.
  • at least part of the support member may be composed of an impermeable material.
  • the support member may further include semi-permeable membranes made from a number of materials.
  • semi-permeable membranes made from a number of materials.
  • Example include polyimide, phospholipid bilayer, thin film composite membranes (TFC or TFM), cellulose ester membrane (CEM), charge mosaic membrane (CMM), bipolar membrane (BPM) or anion exchange membrane (AEM).
  • the support member may include at least a porous region to provide a matrix for tissue in-growth.
  • the region may further be impregnated with an agent to promote tissue in-growth.
  • the support member itself may be impregnated with the agent or drug.
  • the support member may further include individual depots of agent connected to or impregnated in an outer surface thereof.
  • the agent may be released by rupturing of the capsule. Whether the agent is held in capsules, depots, in a coating or impregnated in the material of the support member, a number of different agents may be released from the support member.
  • the capsule may include an annular compartment divided by a frangible wall to separate the compartment into two or more sub- compartments. A different agent may be held in each sub-compartment.
  • the annular compartment may be divided longitudinally with at least one inner sub-compartment and at least one outer sub-compartment.
  • the capsule may be divided radially into two or more sub- compartments.
  • the sub-compartments may be concentric relative to one another.
  • the different compartments may hold different agents therein.
  • the support member may have hooks, barbs or similar/other fixation means to allow for improved/enhanced anchoring of the sealing device to the vasculature.
  • the support member may serve as the "landing zone" for the device when there may be the need to position the device in a more reinforced base structure, for example, in the case of valves where there is insufficient calcification for adquate anchoring, short and angulated necks of abdominal and thoracic aortic aneurysms, etc.
  • the support member may be connected to a graft or stent by a tethering member.
  • the tethering member may be made of an elastomeric material.
  • the tethering member may be non- elastomeric and have a relatively fixed length or an appropriately calculated one for desired activation mechanism.
  • the capsule may include a single annular compartment within the support member.
  • the capsule when the support member is in its second increased radial configuration, the capsule extends completely around the periphery of the endoluminal prosthesis. Alternatively, the capsule may only partially extend around the periphery of the prosthesis. Two or more capsules may extend around the prosthesis.
  • the capsule 80 may have an accordion-like structure to allow for wider, deeper expansion into the potential leak sites and also keep more room for expansion with any vascular remodeling and thereby ensure constant and durable sealing. This can be .
  • agent therapeutic, prophylactic or diagnostic agents
  • the rate of release of agent may be controlled by a number of methods including varying the following the ratio of the absorbable material to the agent, the molecular weight of the absorbable material, the composition of the agent, the composition of the absorbable polymer, the coating thickness, the number of coating layers and their relative thicknesses, the agent concentration, and/or physical or chemical binding or linking of the agents to the device or sealing material .
  • Top coats of polymers and other materials, including absorbable polymers, may also be applied to control the rate of release.
  • Exemplary therapeutic agents include, but are not limited to, agents that are anti-inflammatory or immunomodulators, antiproliferative agents, agents which affect migration and extracellular matrix production, agents which affect platelet deposition or formation of thrombis, and agents that promote vascular healing and re-endothelialization, described in Tanguay et al. Current Status of Biodegradable Stents, Cardiology Clinics, 12:699-713 (1994), J. E. Sousa, P. W. Serruys and M. A. Costa, Circulation 107 (2003) 2274 (Part I), 2283 (Part II), K. J. Salu, J. M. Launs, H. Bult and C. J. Vrints, Acta Cardiol 59 (2004) 5 1.
  • antithrombin agents include, but are not limited to, Heparin (including low molecular heparin), R-Hirudin, Hirulog, Argatroban, Efegatran, Tick anticoagulant peptide, and Ppack.
  • antiproliferative agents include, but are not limited to,
  • Paclitaxel (Taxol), QP-2 Vincristin, Methotrexat, Angiopeptin, Mitomycin, BCP 678, Antisense c-myc, ABT 578, Actinomycin-D, RestenASE, 1 -Chlor- deoxyadenosin, PCNA Ribozym, and Celecoxib.
  • Agents modulating cell replication/proliferation include targets of rapamycin (TOR) inhibitors (including sirolimus, everolirnus and ABT-578), paclitaxel and antineoplastic agents, including alkylating agents (e.g., cyclophosphamide, mechlorethamine, chlorambucil, melphalan, carmustine, lomustine, ifosfamide, procarbazine, dacarbazine, temozolomide, altretamine, cisplatin, carboplatin and oxaliplatin), antitumor antibiotics (e.g., bleomycin, actinomycin D, mithramycin, mitomycin C, etoposide, teniposide, amsacrihe, topotecan, irinotecan, doxorubicin, daunorubicin, idarubicin, epirubicin, mitoxantrone and mitoxantrone), antimetabol
  • anti-restenosis agents include, but are not limited to, immunomodulators such as Sirolimus (Rapamycin), Tacrolimus, Biorest, Mizoribin, Cyclosporin, Interferon .gamma. l b, Leflunomid, Tranilast,
  • immunomodulators such as Sirolimus (Rapamycin), Tacrolimus, Biorest, Mizoribin, Cyclosporin, Interferon .gamma. l b, Leflunomid, Tranilast,
  • anti -migratory agents and extracellular matrix modulators include, but are not limited to Halofuginone, Propyl-hydroxylase-Inhibitors, C- Proteinase-Inhibitors, MMP-Inhibitors, Batimastat, Probucol. -
  • antiplatelet agents include, but are not limited to, heparin.
  • wound healing agents and endothelialization promoters include vascular epithelial growth factor ("VEGF”), 17 -Estradiol, Tkase- Inhibitors, BCP 671 , Statins, nitric oxide (“NO”)-Donors, and endothelial progenitor cell (“EPC”)-antibodies.
  • VEGF vascular epithelial growth factor
  • 17 -Estradiol 17 -Estradiol
  • Tkase- Inhibitors BCP 671
  • Statins nitric oxide
  • NO nitric oxide
  • EPC endothelial progenitor cell
  • active agents may be incorporated.
  • antibiotic agents may be incorporated into the device or device coating for the prevention of infection.
  • active agents may be incorporated into the device or device coating for the local treatment of carcinoma.
  • the agent(s) released from the seal or support member may also include tissue growth promoting materials, drugs, and biologic agents, gene-delivery agents and/or gene-targeting molecules, more specifically, vascular endothelial growth factor, fibroblast growth factor, hepatocyte growth factor, connective tissue growth factor, placenta-derived growth factor, angiopoietin- 1 or granulocyte-macrophage colony-stimulating factor.
  • Agents for modulating cellular behaviour include microfibrillar collagen, fibronectin, fibrin gels, synthetic Arg-Gly-Asp (RGD) adhesion peptides, tenascin-C, Del-1 , CCN family (e.g., Cyr61) hypoxia-inducible factor- 1 , acetyl choline receptor agonists and monocyte chemoattractant proteins.
  • RGD Arg-Gly-Asp
  • Gene delivery agents include viral vectors for gene delivery (e.g., adenoviruses, retroviruses, Antiviruses, adeno- associated viruses) and non-viral gene delivery agents/methods (e.g., polycation polyethylene imine, functional polycations, consisting of cationic polymers with cyclodextrin rings or DNA within crosslinked hydrogel microparticles, etc.).
  • the one or more agents may include monoclonal antibodies.
  • the monoclonal antibody may be an angiogenesis inhibitor such as Bevacizumab or have anti-inflammatory properties.
  • monoclonal antibodies include, but are not limited to, Adalimumab, Basiliximab, Certolizumab pegol, Cetuximab Daclizumab, Eculizumab, Efalizumab, Gemtuzumab, Ibritumomab tiuxetan, Infliximab Muromonab-CD3, Natalizumab, Omalizumab, Palivizumab, Panitumumab, Ranibizumab, Rituximab, Tositumomab or Trastuzumab.
  • the agent(s) may be steroids such as corticosteroids, estrogens, androgens, progestogens and adrenal androgens.
  • the agent(s) may include antiplatelet, antithrombotic and fibrinolytic agents such as glycoprotein Ilb/lIIa inhibitors, direct thrombin inhibitors, heparins, low molecular weight heparins, platelet adenosine diphosphate (ADP) receptor inhibitors, fibrinolytic agents (e.g., streptokinase, urokinase, recombinant tissue plasminogen activator, reteplase and tenecteplase, etc).
  • antiplatelet antithrombotic and fibrinolytic agents
  • fibrinolytic agents e.g., streptokinase, urokinase, recombinant tissue plasminogen activator, reteplase and tenecteplase, etc.
  • gene targeting molecules such as small interference RNA, micro RNAs, DNAzymes and antisense oligonucleotides, or cells such as progenitor cells (e.g., endothelial progenitor cells, CD34+ or
  • CD133+monocytes hemopoietic stem cells, mesenchymal stem cells, embryonic stem cells, multipotent adult progenitor cells and inducible pluripotent stem cells
  • differentiated cells e.g., endothelial cells, fibroblasts, monocytes and smooth muscle cells
  • drug delivery agents like mucoadhesive polymers (e.g., thiolated polymers), or pharmacologic agents of local treatment of atherosclerosis such as high density lipoprotein cholesterol (HDL), HDL mimetics, heme oxygenase- 1 inducers (e.g.
  • probucol and its analogues may be included agents.
  • resveratol and its analogues may be included agents.
  • hydroxvmethylglutaryl CoA (HMG-CoA) reductase inhibitors may be included agents.
  • fibrates including fenofibrate, gemfibrozil, clofibrate etc.
  • the agent(s) ma also modulate cellular behavior in relation to bioprosthesis, such as microfibrillar collagen, fibronectin, fibrin gels, synthetic Arg-Gly-Asp (RGD) adhesion peptides, tenascin-C, Del-1, CCN family (e.g., Cyr61) hypoxia-inducible factor- 1 , acetyl choline receptor agonists and monocyte chemoattractant proteins.
  • bioprosthesis such as microfibrillar collagen, fibronectin, fibrin gels, synthetic Arg-Gly-Asp (RGD) adhesion peptides, tenascin-C, Del-1, CCN family (e.g., Cyr61) hypoxia-inducible factor- 1 , acetyl choline receptor agonists and monocyte chemoattractant proteins.
  • a contrast agent such as a contrast agent, radiopaque markers, or other additives to allow the device to be imaged in vivo for tracking, positioning, and other purposes.
  • Such additives could be added to the absorbable composition used to make the device or device coating, or absorbed into, melted onto, or sprayed onto the surface of part or all of the device.
  • Preferred additives for this purpose include silver, iodine and iodine labeled compounds, barium sulfate, gadolinium oxide, bismuth derivatives, zirconium dioxide, cadmium, tungsten, gold tantalum, bismuth, platinum, iridium, and rhodium. These additives may be, but are not limited to, mircro- or nano-sized particles or nano particles. Radio-opacity may be determined by fluoroscopy or by x-ray analysis.
  • one or more low molecular weight drug such as an anti-inflammatory drug are covalently attached to the hydrogel forming polymer.
  • the low molecular weight drug such as an antiinflammatory drug is attached to the hydrogel forming polymer via a linking moiety that is designed to be cleaved in vivo.
  • the linking moiety can be designed to be cleaved hydrolytically, enzymatically, or combinations thereof, so as to provide for the sustained release of the low molecular weight drug in vivo.
  • Both the composition of the linking moiety and its point of attachment to the drug are selected so that cleavage of the linking moiety releases either a drug such as an anti-inflammatory agent, or a suitable prodrug thereof.
  • the composition of the linking moiety can also be selected in view of the desired release rate of the drug.
  • Linking moieties generally include one or more organic functional groups.
  • suitable organic functional groups include secondary amides (-CONH-), tertiary amides (-CONR-), secondary carbamates (-OCONH- ; -NHCOO-), tertiary carbamates (-OCONR-; -NRCOO-), ureas (-NHCONH-; - NRCONH-; -NHCONR-, -NRCONR-), carbinols (-CHOH-, -CROH-), disulfide groups, hydrazones, hydrazides, ethers (-0-), and esters (-COO-, -CH2O2C-, CHR0 2 C-), wherein R is an alkyl group, an aryl group, or a heterocyclic group.
  • the identity of the one or more organic functional groups within the linking moiety can be chosen in view of the desired release rate of the antiinflammatory agents.
  • the one or more organic functional groups can be chosen to facilitate the covalent attachment of the anti-inflammatory agen ts to the hydrogel forming polymer.
  • the linking moiety contains one or more ester linkages which can be cleaved by simple hydrolysis in vivo to release the anti-inflammatory agents.
  • the linking moiety includes one or more of the organic functional groups described above in combination with a spacer group.
  • the spacer group can be composed of any assembly of atoms, including oligomeric and polymeric chains; however, the total number of atoms in the spacer group is preferably between 3 and 200 atoms, more preferably between 3 and 150 atoms, more preferably between 3 and 100 atoms, most preferably between 3 and 50 atoms.
  • suitable spacer groups include alkyl groups, heteroalkyl groups, alkylaryl groups, oligo- and polyethylene glycol chains, and oligo- and poly(amino acid) chains. Variation of the spacer group provides additional control over the release of the drug in vivo.
  • one or more organic functional groups will generally be used to connect the spacer group to both the drug and the hydrogel forming polymer.
  • the one or more drugs are covalently attached to the hydrogel forming polymer via a linking moiety which contains an alkyl group, an ester group, and a hydrazide group.
  • Figure 1 illustrates conjugation of the anti-inflammatory agent dexamethasone to alginate via a linking moiety containing an alkyl group, an ester group connecting the alkyl group to the anti-inflammatory agent, and a hydrazide group connecting the alkyl group to carboxylic acid groups located on the alginate.
  • hydrolysis of the ester group in vivo releases dexamethasone at a low dose over an extended period of time.
  • the seal can further serve as a porous matrix for tissue in-growth and can aid in promoting tissue in-growth, for example, by adding growth factors, etc. This should improve the long-term fixation of the endoluminal prosthesis.
  • the seal can be impregnated with activators (e.g., adhesive activator) that induce rapid activation of the agent (e.g., a tissue adhesive) after the agent has been released from the capsule.
  • activators e.g., adhesive activator
  • the seal can be composed of different materials and/or include different features.
  • the agent(s) in the capsule can include adhesive materials, tissue growth promoting materials, sealing materials, drugs, biologic agents, gene-delivery agents, and/or gene-targeting molecules.
  • the one or more agent may be sheathed for delivery to a target site. Once positioned at the target site, the one or more agent may be unsheathed to enable release to the surrounding environment. This embodiment may have particular application for solid or semi-solid state agents.
  • Adhesives that may be used to aid in securing the seal to the lumen, or to the device to be implanted include one or more of the following cyanoacrylates (including 2-octyl cyanoacrylate, n-butyl cyanoacrylate, iso-butyl-cyanoacrylate and methyl-2- and ethyl-2-cyanoacrylate), albumin based sealants, fibrin glues, resorcinol-formaldehyde glues (e.g., gelatin-resorcinol-formaldehyde), ultraviolet-(UV) light-curable glues (e.g., styrene-derivatized (styrenated) gelatin, poly(ethylene glycol) diacrylate (PEGDA), carboxylated
  • cyanoacrylates including 2-octyl cyanoacrylate, n-butyl cyanoacrylate, iso-butyl-cyanoacrylate and methyl-2- and eth
  • hydrogel sealants-eosin based primer consisting of a copolymer of polyethylene glycol with acrylate end caps and a sealant consisting of polyethylene glycol and polylactic acid, collagen-based glues and polymethylmethacrylate.
  • the seal may be sterile packaged for distribution and use. In the alternative, it may be packaged as part of, or in a kit with, the device it is designed to seal, such as a TAV or stent. This additional encapsulation prevents the activation of the expandable material during storage with in solutions (e.g. glutaraldehyde, alcohol) by acting as a 100% moisture barrier.
  • solutions e.g. glutaraldehyde, alcohol
  • Heart valves both transcatheter and surgical, are stored in glutaraldehyde or similar solutions primarily to preserve the tissue component of the device. Before the device is implanted, it is prepared for implantation by removing it from the solution and rinsing it thoroughly so that all the glutaraldehyde is washed off.
  • the outer impermeable layer of the sealing device/capsule is meant to prevent any penetration of water from the glutaraldehyde into the capsule, there is a likelihood that the thickness may be insufficient given the profile constraints and as a result there may only be a limited shelf-life that may be obtained.
  • an additional impermeable layer may be needed. This additional impermeable layer is not required once the device is removed out of the storage solution, and is rinsed to wash all the glutaraldehyde away. This will typically be removed after removing the device from the storage fluid and just before implantation.
  • the thickness of the outer and inner membranes has to be kept to the minimum. If the sealing device is stored submerged in a solution, as in the case with transcatheter valves, for its shelf- life, the low profile, thin membranes may allow moisture to permeate through 5 them and thereby risk the premature activation of the sealing means. Therefore, an additional means is necessary to ensure the appropriate shelf-life of the sealing device can be obtained.
  • this additional means can be an additional layer 92 of encapsulation over the "impermeable" outer membrane 10 94.
  • This additional layer 92 may be much thicker and may be laminated by metallic layers several microns in thickness to make it 100% moisture impermeable.
  • This additional encapsulation layer is removable and is designed to have a mechanism which enables easy peeling of the hermetic sealing capsule/layer
  • the layer can be removed using different means, including peeling off, cracking off, melting off, vapouring off after the rinsing process is complete and the device is ready to load.
  • the additional encapsulation layer may be designed with a mechanism so that it can be attached to the device assembly with the sealing means during the assembly process by suturing or other appropriate means such that the removal process insures that integrity of the sealing means and its assembly with the base device remains completely intact.
  • a moisture impermeable film composite comprises a combination of polymer films, metalized polymer films and metal films.
  • the polymer layers can be comprised of, but not limited to; Polyether ether ketone (PEEK),
  • Polyethylene terephthalate PET
  • Polypropylene PP
  • Polyamide PI
  • Polyetherimide PEI
  • Polytetrafluroethylene PTFE
  • Metal films 30 may not be mineral filled with either glass or carbon.
  • Polymer films will have a thickness of 6um or above.
  • Metal films and coatings include aluminum, stainless steel, gold, mineral filled (glass & carbon) and titanium with a thickness of 9um or above. Coatings can be applied with processes such as plasma vapor deposition, press lamination, vacuum deposition, and co-extrusion. Metal films can be laminated to polymer films via press lamination.
  • the sealing means is positioned posterior to the prosthetic implant, and is expanded or pulled up into a position adjacent to the implant at the time of sealing. This is achieved using sutures or elastic means to pull the seal up and around the implant at the time of placement, having a seal that expands up around implant, and/or crimping the seal so that it moves up around implant when implant comes out of introducer sheath. This is extremely important with large diameter implants such as aortic valves, which are already at risk of damage to the blood vessel walls during transport.
  • a key feature of the latter embodiment of the seal technology is that it enables preservation of the crimped profile of the endoluminal prosthesis.
  • the seal technology is crimped distal or proximal to the prosthesis.
  • the seal is aligned with the prosthesis by expansion of the seal.
  • the seal zone of the prosthesis is aligned with the seal zone prior to expansion of the prosthesis by use of activation members.
  • the seal is aligned with the seal zone of the prosthesis prior to prosthesis expansion by use of activation members, which can be made of an elastic or non-elastic material.
  • the endoluminal device may further include one or more engagement members.
  • the one or more engagement members may include staples, hooks or other means to engage with a vessel wall, thus securing the device thereto.
  • self-aligning support members 82 made of Nitinol eliminate the use of attachment sutures within the catheter 80.
  • the dual-membrane capsule containing the hydrogel can be attached to these members and is activated with the expansion of the prosthesis.
  • the self-aligning members 82 can be directly laser-cut as part of the prosthesis frame 84 or can be connected using sutures.
  • the primary advantage of this mechanism is that it eliminates any failure mode with the "activation member" (sutures, etc.) that enables the alignment of the capsule with the distal/proximal/middle section of the prosthesis.
  • a mechanism enables both deployment and retrieval of the system. This is particularly important from the ease of use and placement accuracy perspective. This feature enables the physician to change/alter the placement of the device in vivo if it was not properly positioned in the first attempt. Also, in the event of some complication during the operation, the physician can completely retrieve the device out of the patient (even after the "expandable material" has completely expanded).
  • the device and seal can be utilized for sealing in a variety of tissue lumens, including cardiac chambers, cardiac appendages, cardiac walls, cardiac valves, arteries, veins, nasal passages, sinuses, trachea, bronchi, oral cavity, esophagus, small intestine, large intestine, anus, ' ureters, bladder, urethra, vagina, uterus, fallopian tubes, biliary tract or auditory canals.
  • the endoluminal prosthesis is positioned intravascu!arly within a patient so that the prosthesis is at a desired location along a vessel wall.
  • a balloon or other expandable member is then expanded radially from within the endoluminal prosthesis to press or force the apparatus against the vessel wal .
  • the activation wire is triggered, rupturing the capsule and causing the seal to swell, and in some embodiment, releasing agents.
  • the agent includes an adhesive material and when the capsule ruptures, the adhesive material flows through the pores of the seal. As discussed above, the seal can control the flow of the adhesive to prevent embolization of the adhesive material.
  • the device may be used to seal a graft or stent within an aorta of a patient.
  • the device may be used to seal an atrial appendage.
  • the device may deliver an agent to effect the seal of a prosthetic component across the opening to the atrial appendage.
  • the device may be used to seal a dissection in a vessel.
  • the support member is positioned adjacent the opening of the false lumen and an intraluminal stent subsequently delivered thereto. Upon radial expansion of the stent, the support member is caused to release adhesive therefrom to seal the tissue creating the false lumen against the true vessel wall.
  • the device is used to seal one or more emphysematous vessels.
  • the device may be used to seal an artificial valve within a vessel or tissue structure such as the heart.
  • an example includes the sealing of an artificial heart valve such as a TAV. It is envisaged that the seal provided by the present device will prevent paravalvular leaks.
  • the activation of the polymer 22 within the seal 12 takes place when a section of the outer membrane 20 is ruptured at the designated rupture point 24 using the activation wire 16.
  • This is shown in Figure 4A prior to rupture where the seal 12 is relatively flat; the designated rupture site 24 is opened as shown in Figure 4B, then the seal 12 is expanded, as shown in Figure 4C.
  • the rupture site 24 is formed by weakening the surface of the membrane 20 at the site 24 using means such as a laser to partially cut into or perforate the membrane 20.
  • An activation wire 16 is secured to the rupture site 24 by means of an adhesive, suture, or restraining means such as a brad, rivet, staple or clamp.
  • the rupture site 24 is opened at a pre-determined pressure or location by pulling of the active wire, typically connected to the prosthesis or a part of the placement catheter.
  • FIGS 5A-5E depict a method to crimp and load the device with the "activation wire” 16.
  • the activation wire 16 has to be shortened in length during the crimping/loading process so that the "activation or rupture” can be triggered during deployment/placement of the device. Before crimping/loading the activation wire 16 is long enough so that the "activation mechanism" is far from activation and the hydrogel in the seal 14 can remain completely sealed/deactivated during storage and shelf-life.
  • the metal crimp is used to shorten the length of the activation wire 16 during the crimping/loading procedure. During storage the metal crimp in the "uncrimped” state and after the completion of the insertion of the device into the catheter it is "crimped” and the excess activation wire 16 is cut off. After this step the final steps of completely loading the TAV device in the catheter are completed and the device is ready to be inserted into the patient.
  • the device with seal is inserted in a manner typical for the particular device. After reaching the implantation site, the seal is ruptured and the seal expands to seal the site. The guidewire and insertion catheter are then withdrawn and the insertion site closed.
  • Figures 9A-9D are diagrams of the placement of a Sapien valve 50 with and without the disclosed sealing means 52.
  • the Sapien valve 50 When the Sapien valve 50 is placed too low into the LVOT leading to the graft skirt not completely apposing against the vasculature ( Figure 9A), perivalvular leaking will occur from the gaps/area above the skirt and arouhd the device, through the open cells of the stent ( Figure 9B).
  • Figure 9C shows how no perivalvular leak occurs when the seal 52 is in place, preventing the "leaking" blood from going back into the left ventricle.
  • FIG. 10A shows a correctly placed SJM/Medtronic TAV device 60.
  • Figure 10B depicts an incorrectly placed SJM/Medtronic TAV device 60, resulting in PV leaks.
  • Figure IOC shows how perivascular leaks are prevently with an incorrectly placed SJM/Medtronic TAV device 60 with sealing means 62.
  • Figures 6A-6B are perspective views of a seal that is placed inside of the TAV device.
  • Figures 6C-6D are perspective views of a seal that is placed on the exterior of the TAV device.
  • Figure 6E shows the seal placed on the inside of the device such that the outer impermeable membrane is moulded to the stent scaffold and protrudes from within, in alignment with the stent pattern, while the inner permeable membrane remains in abutment with the inner circumference of the device. Hydrogels expand and cause the balloons to pop out.
  • Figures 7A-7D are perspective views of an impermeable sealing system to protect the implantable device during storage in a preservative solution such as glutaraldehyde, seals in place (Figure 7 A); exterior seal being removed (Figure 7B); exterior seal removed and interior seals being removed (Figure 7C, 7D).
  • Figure 8 is a cross-sectional view of the exterior and interior seals of Figures 7A-7D.
  • self-aligning support members 82 made of Nitinol eliminate the use of attachment sutures within the catheter 80.
  • the dual-membrane capsule containing the hydrogel can be attached to these members and is activated with the expansion of the prosthesis.
  • the self-aligning members 82 can be directly laser-cut as part of the prosthesis frame 84 or can be connected using sutures.
  • the primary advantage of this mechanism is that it eliminates any failure mode with the "activation member" (sutures, etc.) that enables the alignment of the capsule with the distal/proximal/middle section of the prosthesis. This embodiment allows placement of the device and sealing at the same time, and insures proper alignment of the device at the time of implantation.
  • the self-expanding TAV prosthesis frame 90 is released from the catheter 94 during deployment.
  • Self-aligning support members 92 after release from the catheter "flip” and align themselves (and anything attached to it) to the base of the TAV prosthesis. The steps are followed in the reverse order during retrieval.
  • Figures 13 A- 13E show the deployment of a TAV device 1 10 using attachment sutures 1 12 that pull the seal 1 14 into place adjacent the device frame 1 16 at the time of implantation.
  • the seal may be sterile packaged for distribution and use. In the alternative, it may be packaged as part of, or in a kit with, the device it is designed to seal, such as a TAV or stent.
  • Acrylic acid polymers are capable of rapid swelling and are regarded as having good biocompatibility.
  • a number of commercially available cross- linkers can be used to crosslink the polymers to form a hydrogel. These include Bis acrylamide, di(ethylene glycol) diacrylate, and poly(ethylene glycol) diacrylate (MW 500 Da). Materials and Methods
  • the gels were cut into small pieces and dried until complete dryness. Small pieces of gel were then collected and re-swollen in phosphate buffered saline (PBS). The weight of the gel pieces were then recorded at regular intervals.
  • PBS phosphate buffered saline
  • compositions and swelling data are shown in Tables 1 and 2. .
  • Shape triangle Shape Shape house Shape square Shape triangle Shape rectangle base side 1 base side I
  • gel No. 23 is the best gel based on swelling data alone.
  • Gel No. 23 consists of 15% Acrylic acid and 0.05% po!y(ethylene glycol) diacrylate.
  • Gel No. 19 consists of 10% Acrylic acid and 0.05% poly(ethylene glycol) diacrylate.
  • crosslinkers rather than having a short cross-linker with only two polymerizable groups, a polyvalent crosslinker (i.e., a long-chain hydrophilic polymer with multiple polymerizable groups) is being used. A much stronger hydrogel is obtained compared to short chain, divalent crosslinkers. While these gels are very firm, they possess very good swelling characteristics. Very strong gels do not normally swell very much.
  • a polyvalent crosslinker i.e., a long-chain hydrophilic polymer with multiple polymerizable groups
  • Poly vinyl alcohol (PVA) was derivatized with allyl glycidyl ether under alkaline conditions. Gels were made by combing acrylic acid with the PVA- based crosslinker and then polymerizing the mixture by free radical
  • the crosslinker can be made with a number of different starting materials: A range of PVAs as well as partially hydrolyzed poly vinyl acetates, 2-hydroxyethyl methacrylates (HEMA) or various other polymers with reactive side groups can be used as the basic polymeric backbone.
  • HEMA 2-hydroxyethyl methacrylates
  • a wide range of natural hydrocolloids such as dextran, cellulose, agarose, starch, galactomannans, pectins, hyaluronic acid etc. can be used.
  • a range of reagents such as allyl glycidyl ether, allyl bromide, allyl chloride etc. can be used to incorporate the necessary double bonds into this backbone.
  • a number of other reagents can be used to incorporate reactive double bonds.
  • Polyvinyl alcohol (PVA, 30-70 kDa) was derivatized with allyl glycidyl ether under alkaline conditions. 2g PVA was dissolved in 190 ttiL water. Once fully dissolved, 10 mL 50% NaOH was added, followed by 1 mL allyl glycidyl ether and 0.2g sodium borohydride. The reaction was allowed to proceed for 16 hours. Subsequently, the crosslinker was precipitated from the reaction mixture by addition of isopropanol. The precipitate was collected by filtration, washed with isopropanol, and re-dissolved in 50 mL of water. The crossl inker was utilized for gel formation, as described below without further purification or characterization,
  • Gels were formed by combining acrylic acid with the PVA -based crosslinker prepared above, and then polymerizing the mixture by free radical polymerization using ammonium persulfate and TEMED as initiators.
  • Three gels were prepared containing 15% acrylic acid in combination with various ratios/concentrations of the PVA-based crosslinker.
  • the components listed in Table 3 (excluding initiators) were mixed and degassed by placing the tubes in a desiccator with a vacuum applied. After 10 minutes, the vacuum was turned off, and the tubes remained in the desiccator for a further 10 minutes under vacuum. The desiccator was opened, and the initiator was added. The contents of the tubes were then mixed thoroughly. The tubes were capped and left overnight to polymerize, forming hydrogels.
  • the gel had a faint pink color, and exhibited a pH of approximately 7.7 when gelled. An increase in opacity in the gels was observed, with gel 23a having the lowest opacity, and gel 23c having the highest opacity.
  • the gels had gel strength that was significantly higher than the gels made with the poly(ethylene glycol) diacrylate as crosslinker.
  • the gels had very good mechanical properties as well as very good swelling. The swelling rates for gels 23a-c were measured, and are shown in Table 4. Percent swelling was measured after 5 minutes and 60 minutes.
  • Example 3 Demonstration of Sealing in in vitro model.
  • FIG. 15 A-l 5B An in vitro model of a TAV implantation shown in Figures 15 A-l 5B was constructed using a tube having placed therein a TAV formed of a collapsible mesh 102 securing heart leaflets 104. In the model the mesh 102 did not seat uniformly into the tube, creating a paravalvular leak site 106 between a region of the mesh 102 and the tube 100.
  • the TAV includes an expandable seal as described above with reference to Figures 2A-2C.
  • the seal 12 was expanded using wire 16 to expose seal 12 to the surrounding fluid (blood), causing the hydrogel to expand and press the seal 12 against the interior of the tube 100, causing the seal 12 membrane to seal the perivalvular leak site 108.
  • Figure I SA shows a paravalvular leak site 106 due to device
  • Figure 15B shows the leak site is sealed with the seal capsule 108 without disturbing the base geometry of the device.
  • the conformation of the seal happens actively only in places where there are leak sites.
  • the seal does not decrease the central orifice area of the device not having any adverse effect on the blood flow as a result.

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  • Health & Medical Sciences (AREA)
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  • General Health & Medical Sciences (AREA)
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  • Dispersion Chemistry (AREA)
  • Transplantation (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Cardiology (AREA)
  • Medicinal Chemistry (AREA)
  • Dermatology (AREA)
  • Materials Engineering (AREA)
  • Chemical Kinetics & Catalysis (AREA)
  • Prostheses (AREA)
  • Materials For Medical Uses (AREA)

Abstract

La présente invention concerne des moyens d'étanchéification pour des dispositifs endoluminaux qui ont été développés pour activation contrôlée. Les dispositifs présentent les bénéfices d'un mécanisme à encombrement réduit (à la fois pour une prothèse auto-expansée et à expansion par ballonnet), la libération contrôlée et non ouverte du matériau, la conformation active aux « sites de fuite » de sorte que les zones de fuite soient remplies sans rompre l'intégrité physique et fonctionnelle de la prothèse, et l'activation commandée, à la demande, qui peut ne pas être activée par pression.
PCT/AU2012/001080 2011-09-09 2012-09-10 Moyens pour l'étanchéification contrôlée de dispositifs endovasculaires WO2013033791A1 (fr)

Priority Applications (7)

Application Number Priority Date Filing Date Title
CN201280043199.5A CN103889472B (zh) 2011-09-09 2012-09-10 用于血管内装置的受控密封的构件
BR112014005395A BR112014005395A2 (pt) 2011-09-09 2012-09-10 hidrogel biocompatível ou espuma, selagem endoluminal e método para selar um lúmen
JP2014528801A JP6185470B2 (ja) 2011-09-09 2012-09-10 血管内装置を制御下でシール付けするための手段
AU2012307020A AU2012307020B2 (en) 2011-09-09 2012-09-10 Means for controlled sealing of endovascular devices
CA2847687A CA2847687C (fr) 2011-09-09 2012-09-10 Moyens pour l'etancheification controlee de dispositifs endovasculaires
EP12829481.6A EP2753372A4 (fr) 2011-09-09 2012-09-10 Moyens pour l'étanchéification contrôlée de dispositifs endovasculaires
AU2015205978A AU2015205978B2 (en) 2011-09-09 2015-07-27 Means for controlled sealing of endovascular devices

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US201161532814P 2011-09-09 2011-09-09
US61/532,814 2011-09-09
US13/476,695 US9216076B2 (en) 2011-09-09 2012-05-21 Means for controlled sealing of endovascular devices
US13/476,695 2012-05-21
US13/596,894 2012-08-28
US13/596,894 US20130190857A1 (en) 2011-09-09 2012-08-28 Means for controlled sealing of endovascular devices

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CN105232187A (zh) 2016-01-13
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CA2847687A1 (fr) 2013-03-14
EP2753372A4 (fr) 2015-08-05
AU2012307020B2 (en) 2015-04-30
EP2753372A1 (fr) 2014-07-16
BR112014005395A2 (pt) 2017-03-28
CN103889472A (zh) 2014-06-25
AU2015205978B2 (en) 2017-04-06
AU2012307020A1 (en) 2014-03-13
CN103889472B (zh) 2016-08-24
CA2952464A1 (fr) 2013-03-14
HK1217279A1 (zh) 2017-01-06
CA2847687C (fr) 2017-10-17

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