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US20090306702A1 - Device for the Removal of Thrombi - Google Patents

Device for the Removal of Thrombi Download PDF

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Publication number
US20090306702A1
US20090306702A1 US12/084,596 US8459606A US2009306702A1 US 20090306702 A1 US20090306702 A1 US 20090306702A1 US 8459606 A US8459606 A US 8459606A US 2009306702 A1 US2009306702 A1 US 2009306702A1
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US
United States
Prior art keywords
distal
fibers
core wires
proximal
cage
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US12/084,596
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English (en)
Inventor
Elina Miloslavski
Ralf Hannes
Holgar Pracht
Fabian Dieste
Hermann Monstadt
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Phenox GmbH
Original Assignee
Phenox GmbH
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 DE102005053434A external-priority patent/DE102005053434A1/de
Application filed by Phenox GmbH filed Critical Phenox GmbH
Priority claimed from PCT/EP2006/010751 external-priority patent/WO2007054307A2/fr
Assigned to PHENOX GMBH reassignment PHENOX GMBH ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: HANNES, RALF, MONSTADT, HERMANN, DIESTE, FABIAN, MILOSLAVSKI, ELINA, PRACHT, HOLGER
Publication of US20090306702A1 publication Critical patent/US20090306702A1/en
Abandoned legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Instruments for taking body samples for diagnostic purposes; Other methods or instruments for diagnosis, e.g. for vaccination diagnosis, sex determination or ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B2010/0216—Sampling brushes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22001—Angioplasty, e.g. PCTA
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/22031—Gripping instruments, e.g. forceps, for removing or smashing calculi
    • A61B2017/22034—Gripping instruments, e.g. forceps, for removing or smashing calculi for gripping the obstruction or the tissue part from inside
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A61B2017/22042—Details of the tip of the guide wire
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22079—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with suction of debris
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A61B2017/2212—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having a closed distal end, e.g. a loop
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/397—Markers, e.g. radio-opaque or breast lesions markers electromagnetic other than visible, e.g. microwave

Definitions

  • the invention relates to a device for the removal of foreign bodies and thrombi from body cavities and blood vessels using a guide wire provided with one or several distal elements.
  • Thromboembolic diseases such as cardiac infarction, pulmonary embolism, peripheral thrombosis, organ embolisms etc. are typically caused by a thromboembolism (hereinafter for short thromb or thrombus), i.e. a visco-elastic blood clot comprising platelets, fibrinogen, coagulation factors etc. forming in a blood vessel which it obstructs either wholly or in part.
  • thromboembolism hereinafter for short thromb or thrombus
  • a visco-elastic blood clot comprising platelets, fibrinogen, coagulation factors etc. forming in a blood vessel which it obstructs either wholly or in part.
  • the obstruction of organ arteries also leads to the supply of oxygen and nutrients to the associated tissue being interrupted.
  • the disorder of the functional metabolism linked with functional losses is closely followed by a failure of the structural metabolism resulting in the relevant tissue becoming destroyed (infarction). Organs most frequently affected in
  • thrombotic occlusions are frequently occurring in the leg and pelvic veins.
  • the disease pattern of the thrombotic occlusion of an intracranial sinus may lead to severe intracerebral hemorrhage due to a failure of venous drainage of brain tissue.
  • thrombolytic agents such as streptokinase or urokinase or anticoagulants intended to achieve thrombolysis or limit the growth of thrombi. Since treatment methods of this kind are usually very time consuming they are frequently combined with invasions aimed at reducing the size of or removing the thrombus or embolus mechanically.
  • this objective is reached by providing a device for the removal of foreign bodies and thrombi from body cavities and blood vessels using a guide wire and one or several distal elements that comprise at least two core wires which are twisted around each other and between which fibers are arranged transversely to the extension of the core wires, with said fibers being twisted together with the core wires, so that the fibers project radially outward from the distal element.
  • the distal element thus has the form of a brush provided with bristle-like outwardly projecting fibers.
  • the fibers serve the purpose of capturing and stabilizing a thrombus in that they hook themselves into the thrombus and in this manner facilitate its retrieval.
  • the fibers/bristles are designed so as to be flexible so that due to the mechanical resistance in proximal direction they press against the distal element when the device is moved forward. When the external strain caused by the micro-catheter is omitted the brush unfolds to assume its full brush structure. Accordingly, to fulfill their intended purpose of securing the thrombus the fibers must have adequate stiffness but at the same time must be sufficiently flexible and bendable so that they can be passed through a catheter and do not damage the vessel walls.
  • the fibers or bristles are suited to capture and stabilize a thrombus, especially if they are made of or finished with thrombogeneous materials.
  • the fibers/bristles may also consist of a natural substance, polymer material, metal, ceramic material, glass or combinations thereof. Especially preferred are polymer materials.
  • Suitable materials in this respect are primarily polyurethane, polyacrylics, polyester, polytetrafluoroethylene, polyamide or polyethylene and, due to its peptide-like bond structure, most notably polyurethane and polyamide, e.g. nylon, which enable the thrombus to excellently attach/adhere to the fibers.
  • metals also well suited for the intended purpose.
  • Suitable metallic materials for treatment purposes are all metals that do not have detrimental effects on the patients.
  • stainless steel fibers made of metal alloys having shape-memory properties such as for example nitinol fibers. Fibers made of shape-memory materials offer the advantage that when under the external strain exerted by a micro-catheter they are initially shaped to fit closely and after having been released from the micro-catheter assume a second orthogonal shape allowing them to stick out freely.
  • gold and platinum are suitable materials as well.
  • ceramic materials, fiber glass and carbon fibers are also well suited for the intended purpose.
  • Particularly suitable for the treatment of vessels of especially small lumen are fibers having a length of 0.5 to 6 mm and preferably 0.5 to 3 mm so that an outer diameter of 1 to maximum 12 mm of the fiber-carrying part of the distal element is attained even when the fibers are arranged radially.
  • outer diameter should be sized slightly smaller than the inner diameter of the relevant blood vessel.
  • the fibers extend over a length of the distal element which ranges between 0.5 and 5 cm. To make sure the thrombus is sufficiently anchored it is expedient if the fibers are arranged on the distal element of the guide wire with a density ranging between 20 and 100 per cm.
  • the fibers or bristles to be used according to the invention preferably project at an angle ranging between 70° and 110°, preferably at an angle of between 80° and 90° from the longitudinal axis of the device.
  • angle indications are to be understood such that angles ⁇ 90° characterize a proximal orientation of the fibers whereas angles>90° signify a distal orientation of the fibers.
  • Embodiments providing for an angle which is slightly smaller than 90° are particularly atraumatic when being moved into the vessel or through the thrombus and at the same time result in an especially effective anchoring within the thrombus when being pulled out of the blood vessel.
  • the guide wire is made of a medical stainless steel or shape-memory material, preferably nitinol. It is expedient in this case to provide a guide wire having an outer diameter ranging between 0.2 and 0.4, preferably 0.22 and 0.27 mm. A typical guide wire length ranges between 50 and 180 cm, but may as well amount to several meters.
  • the fibers are coated.
  • this coating may be a neutral one consisting of Parylene or polytetrafluoroethylene (Teflon), but may also be comprised of collagen or may be a coating of a material conducive to blood coagulation, preferably having one or several coagulation factors.
  • This embodiment serves to strengthen the anchorage of the fibers inside the thrombus and alleviates the risk of the thrombus disintegrating to such an extent that fragments of it remain in the blood vessel or may be allowed to be released in the blood stream.
  • thrombogeneous materials and coatings for this purpose are known from literature to those skilled in the art. Especially suitable to this end are, for example, one or several of the factors fibrin, thrombin, factor XIII and/or factor VIII.
  • the device is transferred to the application site with the aid of a small-lumen micro-catheter.
  • the device situated inside the micro-catheter may either be 1) initially maneuvered to the distal location of the thrombus and then retracted, 2) released from the micro-catheter in the area of the thrombus, or 3) pushed out of the micro-catheter at a point proximal to the thrombus and then penetrate the thrombus anterogradedly.
  • Said larger catheter is usually a guide catheter by means of which a micro-catheter can be introduced coaxially which in turn is used to bring the device to the target area.
  • the thrombus thus secured via the device will then preferably be retracted into the guide catheter and contained in this catheter eliminated from the body.
  • distal and proximal are to be understood as viewed from the direction of the attending physician.
  • the distal end is thus the end situated away from the attending physician which relates to the components of the device advanced farther into the blood vessel system whereas proximal means facing towards the attending physician, i.e. the proximally arranged components of the device are introduced less far into the blood vessel system.
  • the inventive device is manufactured in such a way that the fibers ultimately forming the brush are placed adjacent to each other and, if so desired, also superimposed on each other between two core wires, with said fibers extending orthogonally to the core wires.
  • an orthogonal extension shall not exclusively mean an angle of exactly 90° but rather any transverse configuration of the fibers in relation to the core wires, i.e. the fibers primarily extend transversely to the core wires, not in parallel. Accordingly, also angles of for instance 700 may be viewed as being orthogonal in the framework of the invention.
  • Quantity as well as density of the fibers can be controlled via the number of core wire twistings or windings so that different hardness characteristics can be produced with respect to the radial force exerted by the brush because the higher the number of windings the more fibers can be arranged per unit of brush length.
  • the bending stiffness of the core can be adjusted, inter alia, via the number of core wires and twistings provided. For example, by providing for a great number of twistings or windings of two or more core wires a double helix of these two core wires is formed that is less rigid than with a design wherein fewer windings are provided.
  • the at least two core wires may be connected with each other at the distal end and thus form a loop.
  • a single core wire is used that first extends up to the distal end and then leads back in such a manner that it twists together the two parallelly arranged lines of the core wire with the fibers arranged in between.
  • the core wires may be connected by means of a coil to additional components of the device located in proximal direction.
  • additional components may, in particular, consist of a guide wire or another distal element designed in the form of a brush.
  • a connection with the help of coils of this nature is sufficiently known in the field of medical technology, particularly when occlusion helixes are employed to treat aneurysms. Connecting the coil with the core wires may be brought about in this case by welding, bonding, soldering or mechanical (i.e. force- and/or form-closed) joining methods.
  • the core wires may consist of platinum or its alloys, in particular of a platinum-iridium alloy, stainless steel, nickel-titanium alloys such as nitinol, or of tungsten and tungsten alloys as well as of combinations of the materials named here.
  • the core wires and thus the entire brush may have a straight configuration or form into a secondary structure, for example be shaped in the form of a wave or helix, i.e. the core wires themselves which are twisted together are designed such that the core itself has a wave or helix form.
  • a wave and a helix the difference between a wave and a helix is that the geometry of a wave is merely two-dimensional whereas a helix has a three-dimensional configuration.
  • Brushes having a wave or helix form offer advantages in terms of an improved cleaning efficiency.
  • the diameter of the helix may increase either from proximal to distal or from distal to proximal.
  • an elongation preventing filament may additionally be run through the inner space of the secondary structure or external to it, with said filament ruling out an axial extension of the device beyond the nominal length.
  • Elongation preventing filaments of this nature may be made of polymer materials (e.g. nylon) or metal, such as, for example, nickel-titanium alloys (nitinol).
  • the filaments in this case are connected both distally and proximally to the secondary structure formed by the core wires.
  • the elongation preventing filament itself may have a straight, wave-like or helix-shaped geometry, with the two latter variants allowing for a certain tolerance or play in longitudinal direction with respect to a possible axial extension.
  • to achieve a still sufficient protection against elongation such a helix should have a very high pitch resulting in the tolerance or play with respect to axial extension to be kept within certain limits.
  • the core wires mentioned above must not necessarily be conventional wires having a round cross section but may be provided in the form of cut or shaped form elements, for example if the core wires are cut from a plate.
  • the cross section of the core wires is not round but quadratic or foursquare.
  • the device is provided with several distal elements from which fibers stick out radially.
  • a system consisting of several brushes may, for example, offer benefits if particularly large thrombi or, as the case may be, several thrombi have to be eliminated from the blood vessel system.
  • a brush located farther distally may serve, if need be, to intercept and remove fragments of a thrombus that detach from the proximally arranged brush.
  • each individual brush may be provided with shorter fibers because the fibers need not extend from the center of the device to the inner wall of the vessel but merely from the individual distal elements that are near the vessel walls in the event they are arranged side by side. Since fibers that are shorter or stick less far out of the distal element are in any case harder the cleaning efficiency may be improved even more in this way.
  • the individual brushes may also be twisted further so as to form a helix.
  • the distal elements may be provided with braces (expediently at least 3) that start out from the distal end of the distal element, extend radially outward and again converge centrally at the proximal end of the distal element.
  • the radial extension of the braces preferably corresponds roughly to the radial extension of the fibers. Throughout the middle area the braces thus extend for the main part in parallel with the inner core of the distal element.
  • the provision of braces on the distal element serves as additional guide for the system in the blood vessel.
  • the braces impart a resemblance to cage structures, but the braces in this case need not be arranged such closely so that it cannot be said in any circumstance that a true cage structure exists.
  • the braces may span in each case over one distal element or over several distal elements.
  • the braces may, for example, extend from the distal end of the distal element located farthest away in distal direction and only converge at the proximal end of the proximal brush.
  • additional intermediate braces between the braces and the centrally extending core wires and in this way enhance the stability of the structure formed by the braces.
  • the brushes have a tapered structure, i.e. the radial extension of the fibers which eventually corresponds to the brush diameter increases from proximal to distal.
  • the main advantage of such a tapered brush form is that irrespective of the width of the blood vessel to be cleaned at a time there are always at least some brush portions the fibers of which are of optimum length. Fibers have an optimum length for a given blood vessel especially if the fibers contact the walls of the blood vessel in such a way that they are not bent in distal direction when the device is moved proximally. In this case the cleaning efficiency of the fibers is particularly good.
  • a tapered distal element wherein the radial extension of the fibers increases from proximal to distal. This can be achieved in that fibers of increasing length are placed from proximal to distal between the core wires. Such a brush offers the advantage that should the situation arise the distally arranged longer fibers are capable of also capturing individual thrombus fragments if the device is retracted in proximal direction.
  • tapered brushes are also conceivable wherein the radial extension of the fibers increases from distal to proximal.
  • tapered brushes may be of different shape, and it will basically be adequate of they are of tapered configuration.
  • several tapered brushes may be provided which are interconnected by means of an articulated joint, or many short tapered segments on a single distal element.
  • the fibers in the proximal area of a distal element may also be designed to be harder than in the distal area.
  • the harder fibers in the proximal area in this case mainly serve to scrape off a thrombus adhering to the vessel wall while the softer fibers in the distal area primarily serve to secure or retain the thrombus or fragments of a thrombus.
  • Another possibility warranting that fibers of different length are provided so that at least some fibers always have an optimum length is to arrange the individual fibers in such a way that they have a shorter and a longer side when sticking out on both sides of the core wires twisted around each other. This can be brought about by placing the fibers, before the core wires are twisted around each other, not exactly centered between the core wires but in an irregular fashion.
  • the brush of the distal element may be differently designed along its core. Some areas, for example, especially the area in the middle of a brush may be provided with softer fibers, with these fibers serving to retain the clot. Areas located further proximally or distally provided with harder fibers on the other hand are rather intended to produced a more intense cleaning effect.
  • a similar effect is achieved if the density of the fiber coverage in some areas is lower, especially in the middle area of the distal element, than in other areas. This as well produces the effect that the proximal and distal areas of the brush where the fibers are more densely arranged primarily serve to enhance the cleaning effect on the walls of the vessel whereas the less densely covered middle area is intended to capture the clot.
  • the fibers placed between the twisted core wires are primarily secured in that they are clamped in place when twisting is carried out. However, further fixation can be achieved additionally or alternatively by bonding, knotting and/or fusing methods.
  • the fiber ends located radially outward beneficially are provided with slubs or thicker nubs, for example of spherical shape, so that increased surface is available for better clot mass retention.
  • slubs or thicker nubs for example of spherical shape
  • Another advantage of this embodiment makes it possible in this way to provide fiber ends that have an atraumatic effect.
  • the thicker nubs at the ends of the fibers may for example be produced by cutting the fibers with the aid of methods like micro-laser cutting, electron beam cutting etc.
  • the fiber ends located radially outward are at least partially connected with each other via loops.
  • the fibers connected in this manner thus comprise or are made up by a single fiber and not two fibers with the single fiber having a loop-shaped configuration.
  • the fiber emerges from the core, extends to the outer rim of the brush where it forms into a loop and then runs back to the core.
  • the fiber in this case extends such that an elliptical shape is formed.
  • This embodiment offers advantages in that, similar to the thicker nubs at the end of the fiber, there is a larger surface available for clot mass retention which results in the thrombus capturing effect being improved.
  • the roundness of the loop makes it atraumatic.
  • the fibers have increased stiffness due to the loop-shaped fiber configuration exhibiting a behavior similar to that of two fibers arranged side by side.
  • the core wires in the cross section of the distal element extend outside the center, i.e. have eccentric extension.
  • a brush with an eccentrically arranged core has the effect that on one side of the brush relatively short fibers are located while long ones exist on the other side of the core.
  • the short ends of the fibers have significantly harder characteristic and the long fiber ends are significantly softer so that in this case as well the harder fibers rather improve the cleaning effect whereas the softer fibers enable a better retention of the captured thrombus.
  • a brush with eccentrically arranged core offers still another advantage in that such a brush can be maneuvered past the side of a clot more easily and then be retracted so that while the brush moves back in proximal direction the thrombus is captured.
  • the brush-shaped devices described hereinbefore may basically be used for the filling of aneurysms as well.
  • the brushes should be designed in the form of a helix which are relatively short in comparison to brushes that serve the purpose of eliminating thrombi.
  • the distal element(s) have to be designed so as to be detachable from the guide wire.
  • the bristles may also be provided with an adhesive or a thrombogeneous coating.
  • the tapered form of a brush as described earlier where the diameter of the distal element increases from proximal to distal has turned out to be especially advantageous.
  • another device is as well basically conceivable for the removal of foreign objects and thrombi from body cavities and blood vessel wherein the distal element has a tapered form, the diameter of the distal element thus increasing from proximal to distal or vice versa.
  • Preferred is a tapered form wherein the distal element has a diameter that distally is greater than proximally.
  • a device with guide wire for the elimination of foreign objects and thrombi from body cavities and blood vessels, wherein said device is provided with a cage structure at the distal end of the guide wire which is composed of individual braces and suited to be flatly collapsible under the external strain exerted by a micro-catheter and capable of being transported inside the micro-catheter and unfolding to its full cage structure as soon as the external strain caused by the micro-catheter is omitted, with said cage structure comprising at least two cages arranged in longitudinal direction one behind the other.
  • Such a device with cage structure for the removal of thrombi is in principle intended to accommodate thrombi in its interior and in this way enable thrombi to be eliminated.
  • the cage structure in collapsed condition is transported inside a micro-catheter through the blood vessels to the target site where it is then pushed out of the micro-catheter distally of the thrombus to be removed whereupon the device unfolds and assumes its full cage structure.
  • the cage structure may accommodate the thrombi to be removed either completely or in fragmented form.
  • the device is retracted through the blood system and, after it has been pulled into a catheter which may be provided in the form of an additional guide catheter having a greater inner diameter than the micro-catheter within which the cage structure was brought to the target site, finally and completely removed from the blood vessel system together with the thrombus.
  • a catheter which may be provided in the form of an additional guide catheter having a greater inner diameter than the micro-catheter within which the cage structure was brought to the target site, finally and completely removed from the blood vessel system together with the thrombus.
  • the cage structure has an oblong, ship-like structure of a length ranging between 5 and 50 mm with a diameter of between 2 and 6 mm in expanded state.
  • the cage structure is composed of peripheral, in particular longitudinally extending braces which as a rule are regularly spaced over the circumference.
  • this cage structure comprises at least two cages arranged in longitudinal direction one after the other so that a double-cage structure is formed.
  • Two or more successively arranged cages offer the advantage that the cages may serve different purposes.
  • the proximally arranged cage may serve as cutting tool for the thrombus or clot that has formed within the vessel whereas the distal cage serves to accommodate the thrombus or the fragments of it.
  • Such a fragmentation of the clot is of special significance if the clot in its entirety is too big to be accommodated entirely within the cage structure or has hardened to such an extent that it is very difficult to maneuver it into the cage structure. It is to be assumed that especially older thrombi show such hardening tendencies.
  • the cage structure is composed of braces which preferably extend at least partially in longitudinal direction. It is to be noted in this respect that by ‘braces extending in longitudinal direction’ not only braces are meant that are running exactly parallelly to the longitudinal axis but also those extending at a certain degree of ⁇ 90° to the longitudinal axis in distal or proximal direction. It is to be noted further that in order to form a true cage structure it must preferably be composed of at least three, but even better of four to eight braces.
  • the cage structure and thus the braces prefferably be made of shape-memory material, preferably nitinol, which enables said structure to be transported in folded-up condition in a micro-catheter and unfold automatically when released from the micro-catheter.
  • the process of unfolding to the full cage structure upon omission of the external strain exerted by the micro-catheter must not necessarily take place automatically but may also be effected manually.
  • an additional guide wire may be attached to the cage structure which causes the cage structure to unfold when being advanced.
  • a core filament extends centrally through the cage structure.
  • This core filament constitutes the distal segment of the guide wire or is a separate core filament serving as continuation of the guide wire in distal direction.
  • the cage structure should be movable relative to the core filament at least at its proximal end. This can be achieved in such a manner that the cage structure terminates in a sleeve at its proximal end through which the core filament movably extends in longitudinal direction.
  • the cage arranged further distally shall primarily serve as cutting tool for the clot to be removed whereas the distal cage is intended to accommodate the clot, it is considered expedient to appropriately design the cages such that they can fulfill their duty optimally.
  • the distally located cage may thus be designed to be longer for instance to make available sufficient space for the thrombus to be taken in.
  • the proximal cage intended to fragment the thrombus may be designed to be shorter in longitudinal direction.
  • the proximally arranged cage must exert such forces on the thrombus that are necessary to fragment it, it is moreover deemed expedient to design this cage so as to be harder than the distally arranged cage.
  • a harder design in this context is to be understood such that the radial forces required to bring about deformation are higher than the radial forces necessary to deform the distally arranged cage.
  • proximally and distally arranged cages can be manufactured of different materials, and for this purpose a harder material should be used for the proximal cage as mentioned above.
  • a harder material should be used for the proximal cage as mentioned above.
  • different nitinol materials may be used here, i.e. especially different alloys.
  • the braces of which the proximally arranged cage is formed may have a greater diameter than the braces of which the distally arranged cage is composed. In this way it is ensured as well that the proximal cage not only is harder but also capable of withstanding higher radial forces.
  • the braces of which the proximally arranged cage is made may thus extend in relation to the longitudinal axis at least partially at an angle greater than that of the braces of the distally arranged cage which results in the proximally arranged cage to be less easily collapsible by radial forces.
  • the distally arranged cage thus has a somewhat flatter structure which will be noticeable particularly if the distal cage is designed to be longer than the proximal cage.
  • cage structures may be employed that comprise more than two cages. All the cages thus provided distally of the proximally arranged cage will then serve to accommodate clot material.
  • the cages may be composed of braces of different number with the highest cage density being achieved of course in the cage that has been provided with the greatest number of braces. It has turned out, however, that depending on application it may be expedient not to provide too many braces lest the proximal opening of the cage structure through which the thrombus shall enter the cage structure may be too small. Viewed in the proximal cross section of the cage structure the partial openings between the braces will be all the greater the fewer braces are provided. This is of special significance if the thrombus is rather old and thus firm and coherent and creates problems when it is attempted to capture it through the openings in the cage structure. To handle thrombi of this type it has turned out to be especially advantageous to provide for a number of braces ranging between four and six.
  • Conceivable are of course also combinations configured in such a way that the proximal cage which the thrombus must first enter when the cage structure is retracted within the blood vessel system is provided with fewer braces than the distally arranged cage which is designed to accommodate the thrombus already fragmented by the proximal cage.
  • each cage usually meet at the distal and at the proximal end of the cage each in a point which is preferably arranged centrally.
  • the braces may be connected with each other directly or indirectly by means of a connecting element.
  • the connecting element may be designed in the form of a sleeve which in relation to a centrally extending core filament is longitudinally movable so as to facilitate in this way stretching and contraction of the cage structure when moved into or out of the catheter.
  • the proximal opening of the cage structure can be made larger, said method providing for the partial openings existing between the braces to be enlarged at least partially, so that in this manner a strongly coherent thrombus is allowed to enter more easily.
  • the large partial openings existing between the braces are enlarged which in turn causes the size of small partial openings to reduce.
  • This can be brought about by arranging the braces of at least one cage, preferably the proximally arranged cage, such that they extend, with the cage structure unfolded, from the point where the braces at the proximal cage end converge, in groups along a first section, e.g.
  • braces do not uniformly extend along the entire cage equally spaced over the circumference but such an equal distribution is provided in distal direction only some distance away from the proximal opening. Due to the fact that the braces at the proximal end of the cage initially are grouped close to each other, partial openings are created the size of which giving the impression as if only half or a third of the number of braces were used.
  • the braces forming the cages may be of identical design for the proximal and distal cage.
  • the braces will extend from the proximal end of the proximally arranged cage to the distal end of the distally located cage.
  • the braces will preferably cross each other at least partially so that the junction point where the braces meet constitutes the distal end of the proximally arranged cage and at the same time the proximal end of the distally located cage.
  • Such an embodiment offers the advantage that the radial forces being exerted on the distal cage and on the proximal cage will influence each other because the radial forces in the braces are transmitted to the other cage. In this manner the device may retain its unfolded shape even if the nominal diameter cannot be realized in a given vessel. This is particularly true if the measures for a length adjustment of the cage structure as described hereinbefore have been provided.
  • braces may be interconnected and/or attached to the core filament. Preferably, no connection will be provided, however, because the radial forces effect will not be disturbed in this manner.
  • the radial forces may also be influenced by not entirely pushing the device out of the micro-catheter. For example, if only the distal cage is moved out whereas the proximal one is kept within the micro-catheter the radial force of the distally arranged cage increases. This may be advantageous in the event especially firm clots/thrombi have to be retrieved.
  • the radial forces will influence each other particularly well if from the proximally arranged cage to the next distally located cage the braces are run to the opposite side of the cage structure, i.e. if there is an offset by 180° from one cage to the next.
  • the cage arranged farthest in distal direction may expediently be designed to have a net structure at least distally so as to provide increased safety against losing thrombus fragments that may slip out of the cage when the device is retracted out of the blood vessel.
  • This net structure may in particular be composed of braided wire for which, same as for the braces, nitinol can be used.
  • such a net structure of a cage is arranged especially at the distal end because for the removal of the thrombus the cage structure after all is moved in proximal direction so that a net structure located at the proximal end of the cage would be less desirable as it could in fact prevent the thrombus from entering the cage.
  • the net structure should only be located at the distal end of the cage or should become more fine-meshed from proximal to distal. Moreover, a greater mesh size in the proximal area of the cage facilitates the retraction of the cage into the catheter with the structures collapsing and containing the thrombus.
  • a function similar to that of the net structure just described can also be achieved by providing a cover on the distal side of the distally arranged cage in the form of a polymer skin.
  • a polymer skin which may for example consist of expanded PTFE (polytetrafluoroethylene) results in the distal end of the cage forming a bag-like structure.
  • the polymer skin in this case extends from the distal tip of the cage along the braces on to a desired position, for example to roughly the middle of the cage.
  • the polymer skin may be provided with one or several openings of a size big enough to allow liquid, especially blood, to pass through without difficulty whereas the thrombus or fragments of a thrombus captured by means of the cage structure are retained. This is advantageous, in particular, when the cage structure is retracted because such a configuration will in fact not impair the flow of blood while the thrombus itself can be completely eliminated from the blood vessel system.
  • the braces of the cage structure are arranged in a helical fashion, i.e. the distal end and the proximal end are offset against each other by an angle ranging between 45° and 180°, preferably by approx. 90°.
  • a helical line arrangement allows a thrombus adhering to a vessel wall to be sheared or cut off when the cage structure is moved forward without the necessity of having to turn to device.
  • the braces extend along a wave line with a lateral deflection of between 45° and 90°, i.e. the braces at first extend in lateral direction until they have reached for instance a point offset by 90° to the starting point and then along the second half of their length extend back to the starting point.
  • the proximal end and the distal end are not offset against each other.
  • the device not only comprises a cage structure arranged at the distal end of the guide wire but in the area of the cage structure has additionally been provided with fibers or bristles projecting radially outward, with said fibers or bristles being arranged individually or in bundles.
  • the fibers or bristles are connected with a distal element of the guide wire in a manner known per se, for example, as is known from the fabrication of fiber-equipped embolization spirals. This may be achieved through entwinement with the distal element, by gluing, welding or any other suitable fastening method.
  • the device is provided with one or several radiopaque markers.
  • radiopaque markers may, for example, be made of platinum or a platinum alloy. Radiopaque markers of this kind may be located both in areas from which the fibers or bristles emanate and as well on the cage structure to enable the attending physician to monitor the treatment with the help of image-forming methods conducive to the purpose.
  • the tip of the entire device is designed so as to be atraumatic, i.e. is rounded off for example.
  • the distal element of the device which is provided with fibers expediently extends centrally in the cage structure, i.e. the fiber-covered element is in fact located in the center of the cages.
  • the beneficial effect of the cage structure on the one hand and those of the fibers arranged on the distal element on the other are combined with each other.
  • This design enables the captured thrombus to be secured and retained most safely both by means of the cage structure and the fibers so that the thrombus can be retrieved and drawn into a catheter.
  • the fibers or bristles may be arranged on and attached to in particularly one or several movable filaments located on the core filament extending through the cage structure so that the fibers/bristles virtually stick out radially from the cage structure in radiated form.
  • the movable filament may, for example, consist of a helically wound wire.
  • fibers or bristles may also be secured to the braces of the cage structure.
  • the embodiment providing for a double-cage structure may have additional fibers
  • the embodiment providing for fibers emanating from the distal element may additionally have a cage structure.
  • a combination of double-structure and distal element composed of core wires twisted around each other with outwardly protruding fibers is also possible.
  • the invention also relates to the combination of the device with a guide and/or micro-catheter in which the device is maneuvered to the application site and when filled with the thrombus removed from the blood vessel system. It may be expedient to additionally design the catheter in the form of an aspiration catheter capable of accommodating micro-catheters.
  • the above described invention is of special significance to the removal of thrombi from vessels of especially small lumen, in particular intracranial.
  • the invention may of course be used also for the elimination of thrombi from other parts of the body, for example the heart, lungs, legs etc.
  • the invention may also be used for the removal of other foreign objects from blood vessels, for example removing embolization spirals and stents.
  • FIG. 1 shows the making of a brush-like distal element
  • FIG. 2 a is a longitudinal section of the distal element
  • FIG. 2 b is a longitudinal section of the distal element
  • FIG. 2 c is a cross-sectional view of the distal element
  • FIG. 3 shows an embodiment with tapered brush
  • FIG. 4 is a longitudinal view of another embodiment of the distal element
  • FIG. 5 shows a distal element provided with a wave-like core
  • FIG. 6 shows a helically extending core
  • FIG. 7 illustrates a helically extending core with outwardly protruding fibers
  • FIG. 8 shows an embodiment with two distal elements arranged in succession
  • FIG. 9 shows an embodiment with two distal elements arranged one after the other and additional braces
  • FIG. 10 shows another embodiment with two distal elements arranged one after the other and with additional braces
  • FIG. 11 shows an embodiment with tapered brush elements
  • FIG. 12 shows a further embodiment with tapered brush elements
  • FIG. 13 shows an embodiment with fibers having different hardness characteristics
  • FIG. 14 shows an embodiment with a fiber coverage of different density
  • FIG. 15 a is a longitudinal view of an embodiment with eccentrically arranged core
  • FIG. 15 a is a cross-sectional view of an embodiment with eccentrically arranged core
  • FIG. 16 shows an embodiment with cage structure and brush element
  • FIG. 17 a is a side view showing a double-cage structure
  • FIG. 17 b shows the double-cage structure of FIG. 17 a viewed from distal end
  • FIG. 18 a shows another side view of a double-cage structure
  • FIG. 17 b illustrates the double-cage structure of FIG. 18 a viewed from distal end
  • FIG. 19 a is the proximal view of a cage structure in accordance with an embodiment
  • FIG. 19 b is the proximal view of a cage structure in accordance with an alternative embodiment
  • FIG. 20 a is the proximal view of a cage structure in accordance with another embodiment
  • FIG. 20 b is the proximal view of a cage structure in accordance with another embodiment
  • FIG. 20 c is the proximal view of a cage structure in accordance with another embodiment
  • FIG. 21 is a side view of the cage structure shown in FIG. 20 a;
  • FIG. 22 shows a side view of another embodiment of the invention.
  • FIG. 1 shows two core wires 14 arranged in parallel, with orthogonal fibers 6 being arranged between the two core wires 14 .
  • the core wires 14 are restrained at location 15 and twisted around each other by performing a torsional movement T.
  • a brush-like distal element 27 is obtained from which fibers 6 are projecting radially outward.
  • FIGS. 2 a to 2 c When core wires 14 have been twisted around each other the distal element 27 appears as shown in FIGS. 2 a to 2 c , said FIGS. 2 a and 2 b being longitudinal sections, whereas FIG. 2 c shows a view from the proximal or distal end. It can be seen that the fibers 6 are equally distributed over the circumference of the distal element 27 and protude radially outward.
  • the brush-like distal element 27 is has a tapered shape, i.e. its diameter increases from proximal to distal.
  • the proximal diameter A typically ranges between 1 and 3 mm
  • the distal diameter B between 2 and 5 mm.
  • the length of the distal element 27 is in the range of between 10 and 20 mm, the length D of guide wire 18 for example is 3000 mm.
  • core 14 will consist of core wires twisted around each other, however tapered brush forms provided with fibers 6 attached to core 14 by some other method are conceivable as well.
  • the device is fitted with radiopaque markers 9 arranged at the proximal and distal end of the distal element 27 .
  • FIG. 4 illustrates another embodiment of the inventive distal element 27 wherein fibers 6 are shown as a consistent, homogeneous area produced on account of the density of the fiber coverage.
  • the core wires 14 at the distal end of the distal element are connected with each other via a loop 16 so that in fact a single core wire 14 exists that extends from proximal to distal where it forms into a loop and then extends back in proximal direction. In this way both ends of core wire 14 are thus twisted around each other.
  • distal element 27 can be attached via a helix 17 to other components of the device located farther proximally, in particular to a guide wire 28 .
  • FIG. 5 an extension of core wire 14 is shown in a wave-like or sine-wave form. Fibers 6 as well follow this wave-like extension which is thus provided for the entire distal element 27 . In comparison to core wires 14 of straight configuration this results in an improved cleaning efficiency.
  • core 14 is also composed of at least two core wires 14 twisted around each other and forming a primary helix comprising of twisted core wires 14 .
  • the secondary helix shown in FIG. 6 must therefore not be confused with a primary helix arrived at by twisting core wires 14 together.
  • a helical structure of the distal element offers advantages in that the inner walls of vessels are cleaned more efficiently and, moreover, such an embodiment may serve to place shorter brushes into an aneurysm for the purpose of occluding the same.
  • FIG. 7 is a longitudinal section showing the fiber coverage 6 as a schematic view.
  • FIG. 8 shows an embodiment of the invention consisting of several distal elements 27 .
  • Each distal element 27 is composed of core wires 14 twisted around each other and provided with a fiber coverage 6 .
  • Distal elements 27 in this case are connected with each other by articulated joint 20 so that a certain degree of flexibility is achieved when advancing and retracting the device within vessels.
  • the distal element is attached via a coil 17 to a push or guide wire 18 .
  • the device is provided with a rounded tip 19 . Since fibers 6 of the two distal elements 27 have different characteristics in this example, a different color shading has been selected here.
  • FIG. 9 shows several distal elements with said embodiment largely corresponding to the one depicted in FIG. 8 .
  • the device additionally has braces 21 extending from the distal end of the distal element 27 , projecting radially outward and again joining centrally at the proximal end of the distal element 27 .
  • the radial extension of the braces 21 in this case coincides with the radial extension of the fibers 6 .
  • Such an embodiment comprising additional braces 21 serves to improve the guidance of the system within the vessel.
  • braces 21 extend along and over all distal elements 27 . Additional stabilization in this case is obtained, however, by providing intermediate braces 22 .
  • each distal element 27 having a tapered structure.
  • the radial extension of the fibers of distal elements 27 increases here from proximal to distal, i.e. in each case the distal elements 27 are wider in the distal than in the proximal area.
  • Such an embodiment has the benefit in that irrespective of the blood vessel width fibers 6 are always available that are of optimum length.
  • each distal element 27 consists of several tapered brushes.
  • FIG. 13 illustrates an embodiment wherein the center area 24 of the distal element 27 has been provided with softer fibers, whereas in the proximal as well as distal area 23 harder fibers have been arranged.
  • the center area 24 primarily serves to accommodate clots while the proximal and distal areas 23 are designed to intensify the cleaning effect.
  • FIG. 14 serves a similar purpose with the exception that a similar effect is brought about here due to the fiber coverage in area 26 being thinner than in proximal and distal areas 25 .
  • a distal element 27 can be seen as a longitudinal section as well as a proximal/distal view wherein the twisted core wires 14 extend eccentrically. Accordingly, fibers 6 project significantly farther on one side than on the other. This is especially advantageous if the distal element 27 must be moved laterally past a thrombus.
  • FIG. 16 shows an embodiment wherein a cage structure 3 has been combined with a brush structure.
  • the distal element 27 here also consists of core wires 14 twisted around each other and fibers 6 radially projecting outward, with said element being arranged proximal to cage 3 .
  • the cage 3 has a polymer skin 10 with transverse braces 11 connecting the polymer skin 10 with braces 4 .
  • the device comprises radiopaque markers 9 and a guide wire 18 . Upon retraction of the device in proximal direction a thrombus is initially captured and secured by means of the distal element 27 via fibers 6 .
  • FIG. 17 a represents a cage structure 1 consisting of a proximal cage 2 and a distal cage 3 in accordance with the invention.
  • the two individual cages 2 , 3 in this case are formed in that the braces 4 that form the cages 2 , 3 cross each other at the center, with said braces of the proximal cage 2 being offset in relation to the distal cage 3 by 180° each.
  • a core filament 5 extends centrally through the cage structure 1 and is connected to braces 4 at the distal end whereas the braces 4 at the proximal end are movably designed in relation to the core filament 5 .
  • the cage structure 1 is capable of being moved to a certain extent in longitudinal direction which is important when the cage structure 1 is moved into or discharged out of a micro-catheter.
  • both cages 2 , 3 are formed by the same braces 4 it is ensured that radial forces are transmitted from one cage to the next, and, for example, radial forces acting on the proximal cage 2 increase the outwardly acting radial forces exerted by the distal cage 3 .
  • the distal cage 3 may be pushed out of a micro-catheter while the proximal cage 2 is left inside the micro-catheter so that as a result of the external constraint the micro-catheter exerts on the proximal cage 2 the outwardly acting radial force of distal cage 3 is significantly increased.
  • FIG. 17 a is merely a schematic representation which only show two braces 4 .
  • more braces 4 are usually used, for example three to six braces 4 .
  • FIG. 17 b shows the cage structure 1 of FIG. 17 a viewed from the distal end.
  • the core filament 5 extends through the center whereas, viewed in longitudinal direction, the braces 4 turn around the core filament 5 forming a right-hand helix.
  • FIG. 18 a is a side view of another cage structure 1 wherein the proximal cage 2 is arranged on the left-hand side and the distal cage 3 on the right-hand side.
  • Four braces 4 each are shown here that form both cages 2 , 3 and intersect at a junction point 8 located between the two cages 2 , 3 .
  • a core filament 5 extends on which filaments 7 are arranged movable in longitudinal direction, said filaments being reinforced through fibers 6 projecting radially outward.
  • These fibers 6 are flexible such that when the device is moved forward through a micro-catheter they fold in the direction of the longitudinal axis but when the device has been discharged from the micro-catheter assume an upright position.
  • Fibers 6 serve the purpose of additionally securing a captured thrombus and, moreover, have a stabilizing effect which results from the thrombogeneous coating of the fibers 6 .
  • radiopaque markers 9 are arranged by means of which the system can be monitored with the aid of image-forming methods.
  • Core filament 5 is interrupted at the point marked by a circle so that upon contraction or unfolding of the cage structure 1 the proximal portion of the core filament 5 is allowed to move to and from in longitudinal direction within the filament 7 . In this manner the longitudinal expansion and contraction of the cage structure 1 is significantly facilitated.
  • the radiopaque marker 9 located at the distal end of the device has a rounded tip which has an atraumatic effect.
  • FIG. 18 b is a view of the cage structure 1 illustrated in FIG. 18 a as seen from the distal end showing six braces 4 equally distributed over the circumference. Fibers 6 in this case are arranged in bundles projecting radially outward. Core filament 5 again forms the longitudinal axis.
  • FIGS. 19 a and 19 b views of proximal openings of a cage structure can be seen, with the cage structure shown in FIG. 19 a being composed of four, the cage structure in FIG. 19 b of six braces 4 .
  • the cage structure shown in FIG. 19 a being composed of four
  • the cage structure in FIG. 19 b of six braces 4 On the one hand, using six braces 4 brings about a more enclosed cage structure 1 , but if only four braces 4 are arranged the proximal openings of the cage structure 1 between braces 4 will be significantly larger.
  • the latter arrangement may be advantageous in the event of especially firm and coherent thrombi because in this manner the thrombus can be more easily maneuvered through the proximal opening into the cage structure 1 .
  • FIGS. 20 a , 20 b and 20 c an alternative arrangement is illustrated by means of which the partial openings 12 , 13 existing between the braces 4 can be made larger.
  • the braces 4 at the proximal end of the cage structure 1 emanate from a common point and initially extend in distal direction in groups close to each other and in parallel before they diverge at a point somewhat farther distally of a first section and finally assume their end position in which the braces 4 are equally distributed over the circumference of the cage.
  • four braces are used four partial openings are obtained as already shown in FIG. 19 a but due to the novel configuration of the braces the large partial openings 12 are significantly enlarged whereas the size of the small partial openings 13 is considerably reduced.
  • braces 4 extending close to each other in pairs and parallel partial openings 12 , 13 are created which almost coincide with the partial openings that would exist if only half the number of braces 4 were used, i.e. in FIG. 20 a the proximal opening is cut into halves nearly, in FIG. 20 b where six braces 4 are shown approximately into thirds.
  • FIG. 20 c three braces 4 each initially extend in groups close to each other so that two approximately semicircular partial openings 12 are created although a total of six braces 4 are arranged.
  • FIG. 21 again illustrates as a side view the cage structure 1 shown in FIG. 20 a where it can be seen that starting out from marker 9 the braces 4 initially extend parallelly in pairs before they diverge and are equally distributed over the circumference of the cage structure 1 . It is to be observed in this case that FIG. 21 only shows one cage of the cage structure 1 with the center portion having been omitted.
  • FIG. 22 another cage structure 1 can be seen with only the distal cage 3 being shown here.
  • Said cage consists of four braces 4 extending between two radiopaque markers 9 .
  • Core filament 5 runs centrally through the cage structure 1 .
  • the special feature of the embodiment shown in FIG. 22 is the polymer skin 10 arranged at the distal end of the cage structure 1 .
  • Arranged transversely to braces 4 cross braces 11 can be seen which in each case constitute the limit of the polymer skin 10 in proximal direction.
  • This design provides for a pocket being formed at the distal end of the cage structure 1 which serves to accommodate a thrombus.
  • the transversely extending connecting braces 11 serve to stabilize the edge structure of the polymer skin 10 and additionally secure the braces in relation to each other.

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US12/084,596 2004-08-23 2006-11-09 Device for the Removal of Thrombi Abandoned US20090306702A1 (en)

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DE102004040868A DE102004040868A1 (de) 2004-08-23 2004-08-23 Vorrichtung zur Entfernung von Thromben
PCT/EP2005/009057 WO2006021407A2 (fr) 2004-08-23 2005-08-22 Dispositif d'ablation de thrombi
DE102005053434.1 2005-11-09
DE102005053434A DE102005053434A1 (de) 2005-08-22 2005-11-09 Vorrichtung zur Entfernung von Thromben
PCT/EP2006/010751 WO2007054307A2 (fr) 2005-11-09 2006-11-09 Dispositif pour eliminer des thromboses

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US11/678,285 Active 2026-10-25 US9055963B2 (en) 2004-08-23 2007-02-23 Device for the removal of thrombi
US14/693,493 Expired - Lifetime US9707002B2 (en) 2004-08-23 2015-04-22 Device for the removal of thrombi

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US20150297252A1 (en) 2015-10-22
ES2541219T3 (es) 2015-07-16
CN101035474B (zh) 2013-02-27
CN101035474A (zh) 2007-09-12
DE102004040868A1 (de) 2006-03-09
JP2008510541A (ja) 2008-04-10
EP2404561B1 (fr) 2015-04-01
EP1885257A2 (fr) 2008-02-13
US20070198028A1 (en) 2007-08-23
EP2404561A2 (fr) 2012-01-11
ES2741316T3 (es) 2020-02-10
EP2926747B1 (fr) 2019-05-22
EP2404561A3 (fr) 2012-03-21
US9055963B2 (en) 2015-06-16
EP2926747A1 (fr) 2015-10-07
US9707002B2 (en) 2017-07-18
WO2006021407A2 (fr) 2006-03-02
WO2006021407A3 (fr) 2006-06-01

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