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WO2025186739A1 - Procédé d'accès sélectif à un vaisseau cible à l'aide d'un dispositif d'articulation - Google Patents

Procédé d'accès sélectif à un vaisseau cible à l'aide d'un dispositif d'articulation

Info

Publication number
WO2025186739A1
WO2025186739A1 PCT/IB2025/052395 IB2025052395W WO2025186739A1 WO 2025186739 A1 WO2025186739 A1 WO 2025186739A1 IB 2025052395 W IB2025052395 W IB 2025052395W WO 2025186739 A1 WO2025186739 A1 WO 2025186739A1
Authority
WO
WIPO (PCT)
Prior art keywords
region
deflection
elongate
vessel
distal
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.)
Pending
Application number
PCT/IB2025/052395
Other languages
English (en)
Other versions
WO2025186739A8 (fr
Inventor
Ahmad DASTJERDI
Luke KEAVENEY
Amanda Hartley
Yara ALAWNEH
Samantha Lee
Jodi MACKEIL
Jacob Miller
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Baylis Medical Technologies Inc
Baylis Medical Technologies Usa Inc
Original Assignee
Baylis Medical Technologies Inc
Baylis Medical Technologies Usa Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Baylis Medical Technologies Inc, Baylis Medical Technologies Usa Inc filed Critical Baylis Medical Technologies Inc
Publication of WO2025186739A1 publication Critical patent/WO2025186739A1/fr
Publication of WO2025186739A8 publication Critical patent/WO2025186739A8/fr
Pending legal-status Critical Current
Anticipated expiration legal-status Critical

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0133—Tip steering devices
    • A61M25/0147—Tip steering devices with movable mechanical means, e.g. pull wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0041—Catheters; Hollow probes characterised by the form of the tubing pre-formed, e.g. specially adapted to fit with the anatomy of body channels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0043—Catheters; Hollow probes characterised by structural features
    • A61M25/005—Catheters; Hollow probes characterised by structural features with embedded materials for reinforcement, e.g. wires, coils, braids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/06—Body-piercing guide needles or the like
    • A61M25/0662—Guide tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M2025/0042—Microcatheters, cannula or the like having outside diameters around 1 mm or less
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0043—Catheters; Hollow probes characterised by structural features
    • A61M25/0045—Catheters; Hollow probes characterised by structural features multi-layered, e.g. coated
    • A61M2025/0046—Coatings for improving slidability
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0133—Tip steering devices
    • A61M2025/0161—Tip steering devices wherein the distal tips have two or more deflection regions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0108—Steering means as part of the catheter or advancing means; Markers for positioning using radio-opaque or ultrasound markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0133—Tip steering devices
    • A61M25/0138—Tip steering devices having flexible regions as a result of weakened outer material, e.g. slots, slits, cuts, joints or coils
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/09—Guide wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M29/00—Dilators with or without means for introducing media, e.g. remedies

Definitions

  • the disclosure relates to medical devices, and more particularly to devices and methods for accessing blood vessels within tortuous anatomy.
  • Diagnostic catheters come in a variety of shapes to maneuver through various shapes of vasculature.
  • selecting an appropriate diagnostic shape prior to a procedure can be challenging due to varying patient anatomies.
  • Certain anatomies pose more challenges than others, including type III aortic arches, bovine arches and tortuous vessels.
  • the complexity of neurovascular anatomy can make accessing specific arteries difficult.
  • Another common issue is the guide catheter dislodging and falling into the aortic arch, due to resistive forces encountered during navigation and due to the vessels’ highly lubricous characteristics, which do not provide the additional friction required to stabilize a catheter’s position.
  • a clinical challenge in neurovascular procedures arises when physicians gain access to the origin of the target arteries.
  • the goal is to navigate the distal end of the guiding catheter as close as possible to a treatment location, which is typically situated in the distal cranial arteries.
  • the intricate curvature of the aortic arch, coupled with counteractive forces, impedes the desired advancement direction. Consequently, the axial load applied to the proximal end of the guiding catheter is not effectively transferred to the distal end. This disconnect poses a significant obstacle for physicians attempting to maneuver the catheter toward the distal cranial arteries, which can result in procedural delays or even failure.
  • a key element of a successful mechanical thrombectomy procedure is maintaining the position of a catheter within the target vessel. It is important that the catheter does not slip down the internal carotid artery or herniate into the aortic arch as thrombectomy devices are passed through it. It is common for catheters to have a lubricous coating to facilitate advancement through blood vessels, for example a hydrophilic coating. Using a hydrophilic coating on the distal portion of the catheter improves trackability, however the bracing capability is reduced due to the reduction in the coefficient of friction between the catheter and vessel wall.
  • the catheter it is therefore advantageous for the catheter to have features that assist in selecting a target vessel, and features that prevent slipping throughout the procedure.
  • FIG. 1 A is an illustration of the anatomy of the aortic arch and surrounding blood vessels
  • FIGS. IB to ID are illustrations of various types of aortic arches
  • FIG. 2 is an illustration of a catheter access system for facilitating the treatment of neurological procedures, in accordance with an embodiment of the present invention
  • FIGS. 3 A to 3C are illustrations showing the challenges encountered when advancing devices within tortuous blood vessels
  • FIGS. 4A and 4B are illustrations of an articulating catheter in accordance with an embodiment of the present invention.
  • FIG. 4C is a cross-section illustration of an articulating catheter shaft in accordance with an embodiment of the present invention.
  • FIG. 4D is an illustration of the pull mechanisms located within the shaft of an articulating catheter in accordance with an embodiment of the present invention.
  • FIGS. 5A-5D are illustrations of various curved configurations of the articulating catheter in accordance with an embodiment of the present invention.
  • FIG. 6 is an illustration of the articulating catheter aiming towards a target vessel in tortuous anatomy in accordance with an embodiment of the present invention
  • FIGS. 7A and 7B are illustrations of an articulating catheter comprising hypotubes in accordance with alternative embodiments of the present invention.
  • FIG. 8 is a flow diagram showing a method of selectively accessing a blood vessel as part of a procedure for treating a neurological condition in accordance with an embodiment of the present invention
  • FIGS. 9A to 9D illustrate a method of selectively accessing a blood vessel within a neurovascular system in accordance with an embodiment of the present invention
  • FIGS. 10A to 10C are illustrations of the articulating catheter adopting various curved configurations within a blood vessel in accordance with an embodiment of the present invention
  • FIG. 11 is a flow diagram showing a method of advancing a plurality of devices within one or more blood vessels as part of a procedure for treating a neurological condition in accordance with an embodiment of the present invention
  • FIGS. 12A to 12E illustrate a method of advancing a plurality of devices within a neurovascular system in accordance with an embodiment of the present invention
  • FIGS. 13 A to 13D are illustrations of an articulating catheter having coated and uncoated regions in accordance with an embodiment of the present invention.
  • FIGS. 14A and 14B are illustrations of the articulating catheter having coated and uncoated regions within a blood vessel in accordance with an embodiment of the present invention.
  • embodiments of the present invention comprise a method of selectively accessing a target vessel from an initial vessel using an elongate device, the elongate device including at least two deflection regions, the method comprising the steps of: positioning a distal region of the elongate device within the initial vessel; manipulating the elongate device at a first deflection region, to move a distal end of the elongate device away from the target vessel; manipulating the elongate device at a second deflection region to orient the distal end in a direction of the target vessel; and manipulating the elongate device at the first deflection region to move the distal end toward the target vessel.
  • the first deflection region is proximal to the second deflection region.
  • the first deflection region extends from about 1.5 cm to about 15 cm from the distal end.
  • the second deflection region is within the distal region of the elongate device.
  • the first deflection region comprises a first curve, curving away from a shaft longitudinal axis, and the second deflection region comprises a second curve curving in a substantially opposite direction to the first curve.
  • the method further comprises a step of advancing the distal region of the elongate device further into the target vessel.
  • the method further comprises a step of manipulating the elongate device to deflect at least one of the deflection regions such that the at least one deflection region braces against a wall of the target vessel.
  • the method further comprises a step of manipulating the elongate device to deflect at least two of the deflection regions such that the at least two deflection regions brace against a wall of the target vessel.
  • the first deflection region braces against the wall of the target vessel at a first contact point and the second deflection region braces against the wall of the target vessel at a second contact point.
  • the first contact point is distanced substantially 180 degrees radially from the second contact point.
  • the elongate device comprises at least three deflection regions, and the method further comprises a step of manipulating the elongate device to deflect a third deflection region such that the third deflection region braces against a wall of the target vessel.
  • the third deflection region is located proximal to the first deflection region.
  • the initial vessel is an aortic arch
  • the target vessel is selected from a group consisting of a brachiocephalic artery, a left common carotid artery, and a left subclavian artery.
  • embodiments of the present invention comprise a method of selectively accessing a target vessel from an initial vessel using an elongate device, the elongate device operable in a relaxed configuration and one or more biased configurations, the method comprising the steps of: while in the relaxed configuration, positioning a distal region of the elongate device within the initial vessel; applying tension to a proximal deflection mechanism associated with the elongate device such that the elongate device adopts a first biased configuration whereby a distal end of the elongate device is deflected away from the target vessel; applying tension to a distal deflection mechanism associated with the elongate device such that the elongate device adopts a second biased configuration whereby the distal end is oriented towards the target vessel; and releasing tension on the proximal deflection mechanism, such that the elongate device adopts a third biased configuration whereby the distal end moves towards the target vessel.
  • the elongate device comprises a distal deflection region and a proximal deflection region, and while the elongate device is in the first biased configuration, the elongate device defines a curve in the proximal deflection region.
  • the elongate device comprises a distal deflection region and a proximal deflection region, and while the elongate device is in the second biased configuration, the elongate device defines a first curve in the proximal deflection region and a second curve in the distal deflection region.
  • the first curve and the second curve are in substantially opposite directions within a single plane.
  • the elongate device comprises a distal deflection region and a proximal deflection region, and while the elongate device is in the third biased configuration, the elongate device defines a curve in the distal deflection region.
  • the initial vessel is an aortic arch
  • the target vessel is selected from a group consisting of a brachiocephalic artery, a left common carotid artery, and a left subclavian artery.
  • embodiments of the present invention include a method for advancing a plurality of elongate devices within vasculature, the plurality of elongate devices including an inner device and an outer device, the outer device configured to have a flexible configuration for advancing through vasculature, and a biased configuration for supporting advancement of the inner device therethrough, the method comprising the steps of: advancing the outer device to a first location while the outer device is in the flexible configuration; causing the outer device to adopt the biased configuration at the first location; and advancing the inner device through the outer device to a second location while the outer device is maintained in the biased configuration; where a position of the outer device is substantially maintained during the step of advancing the inner device to facilitate advancement of the inner device therethrough.
  • the outer device while in the biased configuration, the outer device defines a curve.
  • the outer device while in the biased configuration, defines a first curve and a second curve.
  • the first curve and the second curve are in substantially opposite directions within a single plane.
  • causing the outer device to adopt a biased configuration comprises manipulating an actuator on a control hub coupled to the outer device.
  • the method further comprises a step of locking the outer device in the biased configuration.
  • the steps of advancing the outer device, causing the outer device to adopt a biased configuration, and advancing the inner device are repeated one or more times.
  • the first location and the second location are within a vessel, and the vessel is selected from a group consisting of a brachiocephalic artery, a common carotid artery, an internal carotid artery, and a middle cerebral artery.
  • the vasculature comprises a first vessel and a second vessel of a patient’s neurovasculature, and the first location is within the first vessel and the second location is within the second vessel.
  • the first vessel and the second vessel are selected from a group consisting of a brachiocephalic artery, a common carotid artery, a proximal internal carotid artery, a distal internal carotid artery, and a middle cerebral artery.
  • the method further comprises a step of advancing at least one treatment device through the elongate device.
  • the at least one treatment device is selected from a group consisting of a stent retriever, an aspiration catheter, a microcatheter, a microwire, an intermediate catheter, a distal access catheter, a flow diverter, an implantable device, and a device for delivering an embolic agent.
  • the inner device comprises a diagnostic catheter.
  • the inner device comprises a guidewire.
  • initial vessel is an abdominal aorta
  • target vessel is selected from a group consisting of a left renal artery, a right renal artery, a superior mesenteric artery, and an inferior mesenteric artery.
  • embodiments of the present invention include a method of selectively accessing a target vessel from an initial vessel using an elongate device, the elongate device including at least two deflection regions, the method comprising the steps of: positioning a distal region of the elongate device within the initial vessel; manipulating the elongate device at a first deflection region to orient a distal end in the direction of the target vessel; and manipulating the elongate device at a second deflection region to move the distal region toward the target vessel.
  • the method further comprises a step of: prior to the step of manipulating the elongate device at the first deflection region, manipulating the elongate device at the second deflection region, to move the distal region of the elongate device away from the target vessel.
  • the elongate device is manipulated at the second deflection region to move the distal region toward the target vessel, the distal end is advanced into the target vessel.
  • the second deflection region is proximal to the first deflection region.
  • the initial vessel is an aortic arch
  • the target vessel is selected from a group consisting of a brachiocephalic artery, a left common carotid artery, and a left subclavian artery.
  • embodiments of the present invention comprise an articulating catheter comprising an elongate member comprising at least one deflection mechanism and defining a distal region, a proximal region, and at least one deflection region located between the distal region and the proximal region, a traction portion of the at least one deflection region having a coefficient of friction higher than a coefficient of friction of portions of the distal and proximal regions, where applying tension to the at least one deflection mechanism causes the elongate member to adopt a curve in the at least one deflection region, and, in use, a location of the traction portion substantially corresponds to a location of the curve.
  • At least one of the distal region and proximal region comprise a lubricous coating.
  • the lubricous coating comprises a hydrophilic coating.
  • the lubricous coating comprises a hydrophobic coating.
  • the location of the traction portion substantially corresponds to the apex of the curve.
  • the traction portion extends 360 degrees circumferentially around the elongate member.
  • a portion of the deflection region comprises a lubricous coating.
  • the elongate member comprises a surface feature located in the traction portion.
  • the surface feature comprises a polymer having a higher durometer than a durometer in the distal and proximal regions
  • the surface feature comprises a surface modification on an outer wall on the elongate member.
  • the surface feature comprises a tacky material.
  • embodiments of the present invention comprise an articulating catheter comprising an elongate member comprising a first deflection mechanism and a second deflection mechanism, the elongate member defining a distal region, a proximal region, a first deflection region, and a second deflection region, each of the first and second deflection regions located between the distal region and the proximal region, the first deflection region having a first traction portion and the second deflection region having a second traction portion, each traction portion having a coefficient of friction higher than coefficients of friction of portions of the distal and proximal regions, where applying tension to the first deflection mechanism causes the elongate member to adopt a first curve in the first deflection region and applying tension to the second deflection mechanism causes the elongate member to adopt a second curve in the second deflection region; and in use, a location of the first traction portion substantially corresponds to a location of the first curve and
  • the elongate member further defines an intermediate region located between the first and second deflection regions, and wherein the first and second traction portions have a higher coefficient of friction than a coefficient of friction of a portion of the intermediate region.
  • At least one of the distal region and proximal region comprise a lubricous coating.
  • At least one of the distal region, proximal region, and intermediate region comprise a lubricous coating.
  • the lubricous coating comprises a hydrophilic coating.
  • the location of the first traction portion substantially corresponds to the apex of the first curve and the location of the second traction portion substantially corresponds to the apex of the second curve.
  • a portion of at least one of the first deflection region and the second deflection region comprises a lubricous coating.
  • the elongate member comprises at least one surface feature located in at least one of the first traction portion and the second traction portion.
  • the surface feature comprises a surface modification on an outer wall on the elongate member.
  • the surface feature comprises a tacky material.
  • FIG. 1 A is a diagram of neurovasculature within a patient’s body showing aortic arch 10 including ascending aorta 10a and descending aorta 10b, brachiocephalic artery 12 (or innominate artery), leading to the right common carotid artery 14 and right subclavian artery 16.
  • FIG. 1 A also shows left common carotid artery 18 and left subclavian artery 20.
  • FIGS. IB to ID show aortic arch classification where: Type I is normal, Type II being a descended arch, and Type III being an extremely descended arch. Type III is the most tortuous and most clinically challenging case.
  • a catheter access system 1000 includes plurality of elongate medical devices which can be used to facilitate advancement of one or more treatment devices for a neurovascular procedure described herein.
  • catheter access system 1000 includes an articulating catheter 100, a diagnostic catheter 200, a guidewire 300, and a dilator 500.
  • Articulating catheter 100 may also be referred to as “steerable catheter” or “anchoring catheter” and will be described in greater detail below.
  • Catheter access system 1000 is configured to be compatible with other treatment devices which can be used as part of an overall procedure to treat a neurological condition.
  • Treatment devices can include, but are not limited to, a stent retriever, an aspiration catheter, a microwire, a microcatheter, an intermediate catheter, a distal access catheter, other wires, other catheters, devices for delivering embolic agents, flow diverters, or other implantable devices.
  • diagnostic catheter 200 may be any commonly known flexible catheter. For example, it may be similar to the Penumbra SelectTM diagnostic catheter or any of the Beacon® catheters by Cook Medical, for example SIM, VTK, JB.
  • diagnostic catheter 200 comprises a pre-curved/fixed curve distal region (not shown).
  • guidewire 300 may be any guidewire or wire guide, known by those skilled in the art, for example a flexible wire having a 0.035” or 0.038” outer diameter.
  • Guidewire 300 may have a range of properties including various stiffness properties or distal shapes, for example straight, curved, angled.
  • dilator 500 may be any commonly known dilator used in interventional radiology. Dilator 500 may be used at the beginning of the procedure to facilitate delivering the components of the catheter access system 1000 into the patient.
  • FIGS. 3 A to 3C illustrate the potential navigational challenges encountered when attempting to advance medical device through tortuous anatomy, for example in neurological procedures.
  • FIG. 3A shows an elongated device, for example a guidewire 300 located in the aortic arch.
  • an occlusion may be located somewhere in the internal carotid artery or middle cerebral artery.
  • the elongate device must be advanced into the target blood vessel.
  • Type III aortic arches it can be challenging to select the appropriate blood vessel due to the curvature of anatomy.
  • the inventors have developed novel solutions to 1) aid in selectively accessing a targeted blood vessel and 2) add additional bracing features to the access catheter, including using the vessel walls, to reduce the risk of prolapse. These additional aiming and active bracing features are possible because a physician is able to manipulate some feature on the catheter proximal end, such that the catheter switches from a first, “relaxed” or flexible configuration, to one or more biased configurations.
  • the “biased” configuration may also be referred to as a “curved” configuration.
  • the relaxed configuration may also be referred to as a “flexible” or “maneuverable” configuration).
  • the relaxed configuration is used when advancing the device within a blood vessel, and the one or more curved configurations can be used to aim the distal end towards a targeted blood vessel, and also to maintain the position of the catheter while inner devices are moved therethrough and resist the tendency to prolapse. In other words, to actively brace the device and hold it in place within a blood vessel.
  • articulating catheter 100 has a distal end 102, a proximal end 104, and includes a shaft 106 comprising inner wall 108a and outer wall 108b defining a lumen 110, also referred to as “primary lumen”, which terminates at distal opening 124.
  • Shaft 106 comprises a distal region 114 and a proximal region 116.
  • Articulating catheter 100 further comprises control hub 118, for example a handle 118, located at the proximal end 104. Shaft proximal region 116 is coupled to handle 118.
  • handle 118 comprises a hub 122 and one or more actuators 120.
  • Actuator 120 may be a commonly known device such as a lever, knob, or a slider. Actuator 120 is coupled to one or more deflection mechanisms and can be manipulated to control a deflection or curve in a portion of shaft 106.
  • hub 122 may be a luer connection, a hemostatic valve, or other known mechanism used to receive an inner device, for example, diagnostic catheter 200, guidewire 300, or a treatment device, through lumen 110 such that the inner device can move through primary lumen 110 and exit at distal opening 124.
  • shaft 106 comprises a plurality of segments of varying flexibility/rigidity extending along shaft 106.
  • shaft 106 comprises three segments, a distal segment, proximal segment, and intermediate segment, the intermediate segment located between the distal segment and proximal segment.
  • distal segment is the most flexible/least rigid
  • proximal segment is the stiffest.
  • shaft 106 can have any number of varying stiffness segments, and the stiffness characteristics in each segment can be modified to achieve various curved configurations. Segments of varying stiffness may be achieved using materials having different stiffness properties.
  • distal region 114 is more flexible than proximal region 116, such that it can more easily deflect away from a device longitudinal axis X, as shown in Fig.4B.
  • Distal region 114 has a bend radius R.
  • FIG. 4C shows a cross section of shaft 106 taken along line A-A in FIG. 4B.
  • shaft 106 comprises one or more layers 112, for example a first layer 112a, second layer 112b, and third layer 112c.
  • first layer 112a comprises a lubricous polytetrafluorethylene “PTFE” (or similar material)
  • second layer 112b comprises a reinforced layer such as a braid, coil, or laser cut hypotube
  • third layer 112c comprises a reflown thermoplastic layer.
  • Shaft 106 also defines one or more minor lumens 126 (also referred to as “wire lumens”) located between inner wall 108a and outer wall 108b. In other embodiments, minor lumens 126 may be underneath, on top of, or within the second layer 112b.
  • shaft 106 has a lubricous layer, for example a hydrophilic or hydrophobic polymer (not shown).
  • shaft 106 comprises two wire lumens 126a, 126b that are spaced substantially 180 degrees apart radially, as shown in FIG. 4C.
  • the radial distance between wire lumens 126a and 126b may be any other radial distance, for example offset by 90 degrees, 135 degrees, or any other distance to obtain various curved shapes.
  • the wire lumens 126 may be positioned at any other point along the circumference.
  • articulating catheter 100 further comprises one or more pull wires 128 located within the one or more wire lumens 126. At the proximal end of the device, pull wires 128 are connected to one or more actuators 120 located in handle 118. The distal end of each pull wire 128 is coupled to one or more pull mechanisms, for example pull rings 130, embedded within shaft 106. In one example, pull wires 128 are laser welded to pull rings 130.
  • an actuator is coupled to a deflection mechanism.
  • “Deflection mechanism” as used herein, includes a pull wire and a pull mechanism. Pull wire extends along the length of the shaft, and is coupled to the pull mechanism, which is embedded within the shaft, between inner and outer walls, or attached to the outside of the wall, or within the inner wall.
  • pull wire 128 When actuated, pull wire 128 is tensioned and shaft 106 deflects or curves in a region near the pull mechanism, creating a deflection region.
  • a portion of the shaft adopts a curved configuration.
  • the curved configuration changes the profile of shaft 106, and, when the deflection region is a distal region of the shaft, the device is “steered” or “aimed” within the vasculature.
  • “aiming” means orienting or positioning the distal end so that the distal opening 124 faces a desired location, for example pointing at a target blood vessel, and any device that exits the distal opening 124 will be advanced towards that target location.
  • articulating catheter 100 comprises two pull wires 128a, 128b, each connected to a separate pull ring 130a, 130b respectively.
  • Pull ring 130a may be referred to as proximal pull ring and pull ring 130b may be referred to as distal pull ring.
  • Pull wire 128a may be referred to as proximal pull wire and pull wire 128b may be referred to as distal pull wire.
  • the portion of the shaft comprising pull ring 130a may be referred to as proximal anchor 132a, and the portion of the shaft comprising pull ring 130b may be referred to as distal anchor 132b.
  • Each anchor being located with a deflection region, for example, proximal anchor 132a is located within deflection region 151 and distal anchor 132b is located within deflection region 153 (as shown in FIGS. 5A to 5D).
  • Such an embodiment may be referred to as a “dual-anchor” catheter 100.
  • anchors may be described as being “activated” or “actuated” when tension is applied to the anchor’s corresponding deflection mechanism. Similarly, “deactivating” an anchor means releasing tension from the anchor’s deflection mechanism.
  • Dual-anchor catheter 100 is configured such that shaft 106 can adopt a double curve or “S-shaped” curve.
  • S-shaped curve means a first curve in a first deflection region and second curve in a second deflection region, the second curve in a generally opposite direction to the first curve, as shown in FIG. 5D.
  • both curves share a common plane.
  • the first and second curves are in two different planes, for example, perpendicular to each other.
  • the radius of the first curve is different than the radius of the second curve.
  • the deflectable regions/curved regions may also be referred to as “anchor points”, and, in some embodiments, the rigidity at an anchor point increases when the shaft is curved in that region. The increased rigidity aids in bracing the device such that it supports advancement of an inner device therethrough.
  • the dual-anchor catheter design incorporates two distinct anchor points which offer a high degree of articulation. This feature is critical for achieving a custom shape within the aortic arch, accommodating a wide range of anatomical variations among patients.
  • the anchors enable the catheter to adopt a shape which is highly advantageous for navigating into and engaging with target arteries.
  • One of the most notable benefits of this design is its potential to eliminate the need for a diagnostic catheter when selecting a target vessel, streamlining the process.
  • articulating catheter 100 comprises two actuators, 120a, 120b, (not shown) each actuator configured to tension a single pull wire 128.
  • pull wires 128a and 128b are connected to a single actuator 120.
  • Actuator 120 may be a lever, slider, a rotary knob, a wheel, or other known mechanism used on steerable devices.
  • distal wire lumen 126b and distal pull wire 128b pass under proximal pull ring 130a, for example, distal wire lumen 128b is under a braid, and proximal pull ring 130a is placed over the braid.
  • distal wire lumen 126 and distal pull wire 128b passes through a channel located in proximal pull ring 130a (not shown).
  • articulating catheter 100 may comprise two pull rings, two actuators, and four pull wires running through four wire lumens, where each pull ring connected to one actuator via two pull wires.
  • articulating catheter 100 has additional pull rings to allow multiple curved portions of the shaft, for example three or more deflection regions allowing for three or more curves.
  • a third deflection region (not shown) is located proximal to first deflection region 151.
  • articulating catheter 100 comprises one or more locking features (not shown), in order to lock the device in one or more curved configurations.
  • Locking features may be located on the handle, and may use any known mechanism, for example a switch, a push button, or a spring-loaded feature. Locking features may also comprise an auto-lock feature, where the actuator must be manipulated in order for shaft to return to the undeflected/relaxed state.
  • articulating catheter 100 comprises radiopaque features (not shown) that allow the portions of shaft 106 to be viewed under various known imaging modalities.
  • Radiopaque features can include one or more marker bands, for example platinum iridium, located anywhere along shaft 106.
  • one or more layers 112 comprises a radiopaque filler that may provide visibility under fluoroscopy.
  • the radiopaque filler is a high concentration of BaSO4.
  • articulating catheter 100 may toggle between a relaxed (flexible) configuration and at one or more biased (curved) configurations.
  • tension is not applied to either deflection mechanism, and the shaft is in its most flexible state, which may be advantageous for advancing through vasculature.
  • the shaft In this state, it is possible for the shaft to curve at various regions, but it is not actively curved, that is, no tension is applied to either pull wire.
  • shaft 106 At rest in the flexible configuration, shaft 106 is substantially straight, but deformable.
  • Flexible configuration may also be referred to as “slack” or a “slack configuration”.
  • FIG. 5 A shows two shafts 106 in a slack configuration, the first substantially straight and in line with a shaft longitudinal axis X.
  • the second shows the shaft 106 curve in relation to the X-axis, but the curve is not due to a tension in a pull wire, rather the curve is a result of the flexible properties of the shaft construction.
  • shaft 106 when shaft 106 is deformed, it will return to a substantially straight configuration upon release. In other configurations, shaft 106 may retain a slight curve upon being released.
  • a first biased configuration tension is applied to the first deflection mechanism, and not the second deflection mechanism, such that only one anchor is actuated, and shaft 106 curves in a first deflection region 151.
  • the proximal anchor 132a is activated and shaft 106 adopts a proximal curve 150.
  • a second biased configuration tension is applied to the second deflection mechanism, and not the first deflection mechanism, such that shaft curves in a second deflection region 153, different from the first deflection region 151.
  • distal anchor 132b is activated and shaft 106 adopts a distal curve 152, as shown in FIG. 5C.
  • the number of degrees of curvature from the longitudinal X-axis may vary considerably at one or both anchor points.
  • a curve may be considered as any actuated curve greater than zero degrees deviation from the longitudinal X-axis. In some examples, a curve may vary between 0 degrees and 180 degrees. In other examples, a curve may be greater than 180 degrees.
  • the deflection mechanisms described herein can be used to “aim” a distal end 102 towards a target blood vessel while a portion of shaft 106 is located within an initial vessel.
  • “Aiming” means that the distal end 102 and distal opening 124 point towards the target vessel.
  • the initial vessel may be the aortic arch 10 and the target vessel may be the brachiocephalic artery 12.
  • the brachiocephalic artery 12 branches off from the aorta, or, in other words, is in fluid communication with the aorta.
  • the S-curve of the articulating catheter 100 facilitates advancement of one or more devices through the articulating catheter 100, into the brachiocephalic artery 12, as shown in FIG. 6.
  • Proximal curve 150 helps guide the device over the aortic arch 10 and distal curve 152 aims the distal end 102 towards brachiocephalic artery 12.
  • proximal curve 150 and distal curve 152 are not shown in FIG. 6
  • the brachiocephalic artery 12 is one example, the articulating catheter 100 can be manipulated to take other shapes to facilitate advancement into any number of other vessels, for example the left common carotid artery 18 or left subclavian artery 20.
  • articulating catheter 100 comprises one or more hypotubes 140 located between inner wall 108a and outer wall 108b.
  • Hypotube 140 may comprise 304-stainless steel, 316-stainless steel, nitinol, or any other suitable material.
  • hypotube 140 comprises a series of slits, slots, cuts, cutouts, or laser-cut pattern, configured to allow hypotube 140 to deflect.
  • articulating catheter 100 comprises two hypotubes 140a, 140b, where hypotube 140b is located proximal of distal pull ring 130b and hypotube 140a is located proximal of proximal pull ring 130a, as shown in FIG. 7A.
  • Laser-cut pattern is configured to facilitate bending in the first and second deflection regions 151, 153.
  • pull rings 132 may affixed to shaft 106 below, on top of, or in line with hypotubes 140.
  • the deflection mechanism comprises a pull wire 128 coupled to a hypotube 140.
  • the pull mechanism is a hypotube.
  • articulating catheter 100 comprises two hypotubes 140a and 140b.
  • Hypotube 140b may extend from at or near the distal end 102, or may be located a linear distance from the distal end 102, and hypotube 140a is proximal to hypotube 140b.
  • layers 112 are not shown in the figures so that pull wires 128a, 128b, are visible.
  • the pull wires 128 are radially above of hypotubes 140.
  • the pull wires 128 are radially below hypotubes 140.
  • the inventors have developed a novel method to selectively access a blood vessel within tortuous anatomy, for example during a procedure to treat a neurological condition.
  • FIG. 8 illustrates a method 800 for selectively accessing a target blood vessel using the (dual-anchor) articulating catheter 100 disclosed herein.
  • the method comprises a series of planned steps designed to maximize safety and efficacy.
  • Method 800 may be better understood with reference to FIGS 9A to 9D.
  • the anatomy has a Type III aortic arch and the target vessel is brachiocephalic artery 12.
  • Method 800 may be used to access other vessels as well, for example, the left common carotid artery 18 or the left subclavian artery 20.
  • the articulating catheter 100 is advanced into the aortic arch 10. If necessary, in some examples, the distal end 102 advances past the target blood vessel. As shown in FIG. 9 A, distal region 114 of shaft 106 curves downward, pointing away from the target blood vessel, and towards and/or into the ascending aorta 10a. The distal deflection region 153 is located near the target blood vessel.
  • a physician actuates the proximal anchor 132a, causing the proximal deflection region 151 to deflect, such that the device adopts a first curved configuration (proximal curve 150) and the distal end 102 moves downwards and away from the target blood vessel, as shown in FIG. 9B.
  • This action creates a distance between the distal region 114 and the roof of the aortic arch 10, which ensures there is sufficient space for the articulating catheter 100 to be manipulated and shaped according to the specific anatomical requirements of the procedure.
  • the physician actuates the distal anchor 132b, causing the distal deflection region 153 to deflect, such that the device adopts a second curved configuration: a distal curve 152 and a proximal curve 150, each curve in opposite directions forming an S-shaped curve.
  • the distal end 102 turns upwards and moves toward the target blood vessel. In other words, the device distal end is aimed towards the target blood vessel.
  • the physician deactivates (releases) proximal anchor 132a (i.e., actuates the proximal anchor 132a in an opposite direction to the actuation at step 802), causing the proximal deflection region 151 to deflect in the opposite direction as in step 802, in other words reducing the curve.
  • the curve may be reduced to zero or near- zero deflection, such that the device adopts a third curved configuration (distal curve 152).
  • the distal end 102 moves toward the target blood vessel.
  • the distal end 102 enters the target blood vessel, as shown in FIG. 9D.
  • This step may also involve moving the articulating catheter 100 in a longitudinal direction, to guide the distal end 102 into the target vessel.
  • one or more inner devices may be advanced through lumen 110 and into the target blood vessel.
  • a diagnostic catheter 200 and/or guidewire 300 may be advanced further into the distal cranial arteries or toward a treatment location.
  • Treatment location may be a location comprising a clot (not shown), for example during a procedure for treating acute ischemic stroke.
  • the articulating catheter 100 may be advanced further into the target blood vessel and into one or more distal blood vessels.
  • the articulating catheter 100 may be advanced using a method described herein, in which the articulating catheter 100 is advanced in a relaxed configuration, using an inner device as a rail, and the inner device is advanced while the articulating catheter 100 is braced against a vessel wall while in a curved configuration.
  • a physician may activate or deactivate the anchors as needed in any number of combinations, to switch between a relaxed configuration and a curved configuration, thereby facilitating advancement of the articulating catheter 100 through tortuous anatomy.
  • the anchoring features on the articulating catheter 100 may be used to provide active bracing for advancement of inner devices during a neurological procedure.
  • articulating catheter 100 when articulating catheter 100 is located within a blood vessel, actuating one or more deflection mechanisms will cause the curved regions to come into contact with the vessel walls, which will hinder longitudinal movement of the device within the vessel. In other words, the longitudinal position of the articulating catheter 100 is maintained while an inner device is advanced through primary lumen 110. In such a configuration, articulating catheter 100 is actively braced against a vessel wall.
  • the inner device may exert a force that causes the articulating catheter 100 to move longitudinally.
  • FIG. 10A shows articulating catheter 100 having distal curve 152 where deflection region 153 contacts the wall of vessel, for example, right common carotid artery 14.
  • guidewire 300 exerts a force in the opposite direction to which it is travelling on portions of the articulating catheter 100.
  • Some of the force that normally urges the articulating catheter 100 downward is absorbed by the vessel wall and helps to brace articulating catheter 100, limiting longitudinal movement. In other words, maintaining the position of the articulating catheter 100.
  • the force is shown by the arrows in FIGS. 10A to 10C.
  • FIG. 10B shows articulating catheter 100 with proximal curve 150
  • FIG. 10C shows both proximal curve 150 and distal curve 152.
  • deflection region 151 braces against the vessel wall at a first point of contact
  • deflection region 153 braces against the vessel wall at a second point of contact.
  • the first and second contact points are radially offset by approximately 180 degrees.
  • FIG. 11 illustrates a method 1100 for advancing a plurality of elongate devices through blood vessels within tortuous anatomy, for example during the treatment of a neurological condition.
  • method 1100 may be used in combination with method 800.
  • the method may be better understood with reference to FIGS 12A to 12H.
  • the first vessel is the brachiocephalic artery 12
  • the devices are advanced into the right common carotid artery 14, internal common carotid artery 15 and further, such as middle cerebral artery 22.
  • the same method may be used to advance through other vessels as well, for example the left common carotid artery 18.
  • the technique described in this method was developed to address the challenges of cannulation in the neurovasculature, specifically aiming to improve the success rate and safety of accessing and navigating through the intricate cranial and carotid arterial system.
  • This technique makes use of anchor points to advance and stabilize the articulating catheter into the desired locations within the neurovasculature, offering a step-by-step approach to overcome the complexities associated with these delicate procedures.
  • the elongate device assembly includes an outer device and at least one outer device, where the at least one inner device is received within a lumen of the outer device and moveable therethrough.
  • the outer device is the articulating catheter 100 described herein
  • the inner device is a diagnostic catheter 200.
  • the inner device may be guidewire 300 or other type of flexible catheter.
  • three devices are used: a guidewire 300 which is received within diagnostic catheter 200, which is received within articulating catheter 100.
  • this method may occur after method 800 has been used to select a blood vessel, and in such cases is a continuation from step 805b described above.
  • the inner device is flexible enough to move through the lumen of the outer device while the anchors are actuated, i.e., when the outer device has a curved/biased configuration.
  • Method 1100 begins after a blood vessel has been accessed. In other words, distal region 114 of articulating catheter 100 is within a blood vessel, for example the brachiocephalic artery 12, previously shown in FIG. 9D.
  • a physician advances the articulating catheter 100 to a first location.
  • the physician then activates the proximal and/or distal anchors such that the device adopts a biased configuration having proximal curve 150 and/or distal curve 152.
  • Deflection region 151 comes into contact with the vessel wall at a first contact point, and/or a deflection region 153 contacts the vessel wall at a second contact point, as shown in FIG. 12A.
  • the first and second contact points on the vessel wall are offset by 180 degrees, as previously shown in FIG. 10C.
  • only one anchor is activated and a portion of shaft 106 contacts the vessel wall at one point of contact, as previously shown in either FIG. 10A or 10B.
  • the deflection regions 151, 153 contacting the vessel wall allow articulating catheter 100 to be substantially braced in a longitudinal direction within the vessel. In other words, longitudinal movement of the outer device is limited when the anchors are activated.
  • diagnostic catheter 200 is advanced through primary lumen 110 to a second location, distal to the first location, shown in FIG 12B.
  • the second location is the right common carotid artery 14.
  • the proximal and distal anchors are deactivated, such that the deflection regions 151, 153 and/or curves 150, 152 are reduced to zero or near-zero deflection, and the articulating catheter 100 assumes a relaxed configuration.
  • Articulating catheter 100 is then advanced or “tracked” over the diagnostic catheter 200, using the diagnostic catheter 200 as a rail.
  • the articulating catheter 100 is advanced until distal end 102 has reached the second location, as shown in FIG. 12C.
  • the second location is the right common carotid artery 14.
  • the distal end 102 is advanced to a location distal to the distal end of the diagnostic catheter 200. In other examples, distal end 102 is advanced to a location proximal to the distal end of the diagnostic catheter 200. In further examples, distal end 102 is advanced to substantially at the same location as diagnostic catheter 200 distal end.
  • the proximal and distal anchors are activated such that the articulating catheter 100 takes a curved configuration, similar to step 1101, and braces at the second location.
  • the diagnostic catheter 200 is then advanced further into the vasculature to a third location, the third location being distal to the second location, as shown in FIG. 12D.
  • the third location is the internal carotid artery 15.
  • the third location is the proximal internal carotid artery 15a.
  • the third location is the distal internal carotid artery 15b.
  • the previous steps are repeated as needed to advance all of the devieces further into the neurovasculature, until the articulating catheter has reached a treatment location, for example, the middle cerebral artery 22.
  • the treatment location is at or near a clot (not shown) that is to be removed for the treatment of acute ischemic stroke.
  • the treatment location is the Ml -sphenoidal branch (not shown) or M2-insular branch (not shown) of the middle cerebral artery 22.
  • diagnostic catheter 200 is removed from the articulating catheter 100 and one or more treatment devices may then be advanced through the articulating catheter 100 to the treatment location.
  • the treatment devices may then be used to treat the neurological condition and the method ends.
  • an anchoring guide catheter can be used to brace against a wall of a blood vessel to help maintain position within the vessel, i.e., to prevent the device from moving longitudinally within the vessel.
  • features on the catheter for example a hydrophilic coating that improve trackability, have the opposite effect for bracing.
  • the inventors have developed novel solutions to improve trackability within a vessel and improve bracing in a biased configuration.
  • the catheter has discrete hydrophilic coated regions, which solves the problem of the catheter slipping by having uncoated regions at the apex of the curve(s) to increase the friction where the catheter contacts the vessel wall.
  • the catheter has a hydrophilic coating in certain regions, and has other regions which are uncoated. The size and shape of the coated and uncoated regions and location of each will impact how well the device is able to track through the vessel and brace against vessel walls when the anchors are activated.
  • articulating catheter 100 comprises shaft 106 that defines one or more regions (or segments) that facilitate advancement through a vessel, and one or more regions that facilitate bracing against a vessel wall.
  • regions that facilitate bracing resist slipping in a vessel.
  • the regions that resist advancement may be referred to as “traction portions”.
  • shaft 106 comprises coated regions 180a, 180b, 180c, and traction portions 181a, 181b.
  • Coated regions 180a, 180b, 180c have a coating that increases lubricity and assists with advancing through a blood vessel, for example a hydrophilic coating, a hydrophobic coating, or other similar coating.
  • traction portions 181a, 181b comprise uncoated regions 182a and 182b.
  • Uncoated regions 182a, 182b do not have a lubricous coating, and when these regions come into contact with a vessel wall, friction is higher compared to the coated regions, which facilitates bracing. In other words, the uncoated regions 182 resist movement through the vessel. Uncoated regions 182a, 182b are substantially located within deflection regions 151 and 153. In some embodiments, uncoated regions 182a and 182b are located proximal to the pull rings 130b, 130a respectively.
  • traction portions 181/uncoated regions 182 may be another type of coating that increases friction or may comprise a feature that resists a sliding motion, i.e., increases friction/facilitates bracing compared to the coated regions.
  • any combination of hydrophilic coating, hydrophobic coating, or lack thereof may be used to achieve the desired result.
  • the coated regions 180 are very lubricous and have a low coefficient of friction and the uncoated regions 182 have a higher coefficient of friction than the coated regions 180. While surface friction is a property of two surfaces in contact, the surface coatings (e.g., hydrophilic) on the catheter will reduce friction with any contact surface, as it becomes extremely slippery when in use.
  • the surface coatings e.g., hydrophilic
  • saying an uncoated region 182 has a higher coefficient of friction than a coated region 180 means: the coefficient of friction between the uncoated region 182 and a vessel wall is higher than the coefficient of friction between the coated region 180 and the vessel wall.
  • Uncoated regions 182 are configured such that the outer wall 108b of the shaft 106, or a modification to the outer wall 108b, increases friction against a vessel wall, compared to other portions of the shaft 106.
  • the coated segments 180 facilitate advancement through a vessel
  • the uncoated segments 182 facilitate bracing in a vessel.
  • the uncoated segments resist slipping in a vessel wall.
  • traction portion 181 comprises a surface feature that can be applied to the outer wall of the shaft, for example a polymer with a higher durometer, or a tacky material that increases friction.
  • the surface feature may be a variation in surface texture on the outer wall 108b that increases the coefficient of friction, for example a rough surface, bumps, ridges, or any other non-smooth shape or texture.
  • distal deflection region 153 extends from at or near the distal end 102 to a location within coated region 180b, and proximal deflection region 151 extends from a location within coated region 180b to a location within coated region 180c. In some examples, distal and proximal deflection regions 153, 151 are separated by little space or even zero space.
  • the size or shape of traction portions 181/uncoated regions 182 may vary.
  • the uncoated region 182 extends 360 degrees around the outer wall of the shaft, as shown in FIG. 13C(i). In such an embodiment, the uncoated region 182 separates the coated regions 180 along shaft 106 into discrete segments.
  • shaft 106 (or a distal region of shaft 106) has a coating that is substantially continuous along its length, and one or more traction portions 181/uncoated regions 182 are located at various points along shaft 106, in a variety of shapes and/or sizes. In other words, the uncoated region 182 does not encircle 360 degrees of shaft 106.
  • the shape of traction portion 181/uncoated region 182 may be any shape, such a circle/ellipse as shown in FIG. 13C(ii) or a half cylinder as shown in FIG. 13C(iii).
  • FIG. 13D shows a cross section of shaft 106 where traction portion 181/uncoated region 182 does not extend 360 degrees around shaft 106.
  • traction portion 181 extends less than 360 degrees circumferentially around shaft 106.
  • the non-traction portion 183 comprises a lubricous coating.
  • a portion of the deflection region (151 and/or 153) comprises a lubricous coating.
  • FIG. 14A shows the articulating catheter 100 advancing or “tracking” through a vessel in a flexible configuration as described herein.
  • FIG. 14B shows articulating catheter 100 braced in the vessel in a biased configuration, i.e., through activation of the proximal and distal anchors.
  • the biased configuration the uncoated regions 182a, 182b contact the vessel wall at the apex of the curves (152, 150), increasing the contact friction in this area.
  • the articulating catheter 100 is less likely to slip (move longitudinally).
  • the devices and methods disclosed herein can be used for any number of applications that require delivering devices to the neurovascular system, including mechanical thrombectomy, stenting, coiling, pipeline/flow diversion, stent-assisted coiling, aneurysm embolization, and balloon assisted coiling.
  • the devices and methods disclosed herein may be used in other areas of a patient’s body, including in renal artery selection, for example, the devices and methods can be used to access arteries that branch from the abdominal aorta, including left and right renal arteries, celiac trunk, superior mesenteric artery, and inferior mesenteric artery.
  • Another application may be for lead placement in the heart where stabilizing a lead in a complex cardiac environment is difficult.

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Abstract

L'invention concerne des systèmes, des dispositifs et des procédés destinés à accéder sélectivement à un vaisseau sanguin cible et faciliter l'avancement de dispositifs de traitement à l'intérieur du système neurovasculaire. Le procédé consiste à amener un dispositif allongé à adopter une série de configurations incurvées, qui visent et déplacent une extrémité distale du dispositif vers un vaisseau cible. Une fois qu'une partie du dispositif allongé est située à l'intérieur d'un vaisseau, les configurations incurvées peuvent être manipulées pour utiliser des éléments de renforcement actifs pour permettre à un dispositif interne d'avancer à travers le vaisseau d'une manière contrôlée. Le dispositif allongé peut ensuite suivre le dispositif interne, en utilisant le dispositif interne comme un rail. Des parties du dispositif allongé sont conçues pour faciliter le renforcement où les courbes entrent en contact avec les parois de vaisseau.
PCT/IB2025/052395 2024-03-08 2025-03-05 Procédé d'accès sélectif à un vaisseau cible à l'aide d'un dispositif d'articulation Pending WO2025186739A1 (fr)

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5441483A (en) * 1992-11-16 1995-08-15 Avitall; Boaz Catheter deflection control
US20110009957A1 (en) * 2000-01-31 2011-01-13 Edwards Lifesciences Ag Percutaneous mitral annulplasty with cardiac rhythm management
JP2015066331A (ja) * 2013-09-30 2015-04-13 テルモ株式会社 カテーテル
WO2020194907A1 (fr) * 2019-03-26 2020-10-01 テルモ株式会社 Cathéter et méthode de traitement
WO2021044923A1 (fr) * 2019-09-02 2021-03-11 テルモ株式会社 Cathéter

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5441483A (en) * 1992-11-16 1995-08-15 Avitall; Boaz Catheter deflection control
US20110009957A1 (en) * 2000-01-31 2011-01-13 Edwards Lifesciences Ag Percutaneous mitral annulplasty with cardiac rhythm management
JP2015066331A (ja) * 2013-09-30 2015-04-13 テルモ株式会社 カテーテル
WO2020194907A1 (fr) * 2019-03-26 2020-10-01 テルモ株式会社 Cathéter et méthode de traitement
WO2021044923A1 (fr) * 2019-09-02 2021-03-11 テルモ株式会社 Cathéter

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