Branch stent graft for aortic aneurysm repair
Described is a method for deploying a stent-graft in the aorta, the method including positioning a shunt to go along a portion of a brain-supplying artery (BSA) into the aorta; deploying a stent-graft in the aorta along a portion of the shunt; and removing the shunt. Also described is a removable shunt adapted for deployment along a brain-supplying artery into an aorta to supply blood to the artery during deployment of a stent-graft in the aorta, the removable shunt including a stiff segment that is stiff enough to remain at least partially open when between the aorta and the stent-graft and large enough to allow sufficient blood supply to the brain during the deployment of the stent-graft; and a mechanism for facilitating safe removal of the shunt from between the stent-graft and the aorta. Also described is a method of deploying a branch stent graft having a flaring portion in a blood vessel branching at a bifurcation from an aorta to connect to an aortic stent graft deployed in the aorta across the bifurcation, a branch stent-graft useful in the method, and a delivery system useful in the method.
1. A method for deploying a stent-graft in the aorta, the method comprising
(a) positioning a shunt so that it extends inside a portion of a brain-supplying artery (BSA) and into the aorta;
(b) deploying a stent-graft in the aorta along a portion of the shunt, wherein deploying the stent graft comprises forming in the stent graft an opening facing a BSA or aligning an opening in the stent graft to face a BSA; and
(c) removing the shunt.
2. The method according to claim 1 , wherein deploying the stent-graft comprises forming in the stent-graft an opening facing a BSA.
3. The method according to claim 1 , wherein deploying the stent-graft comprises aligning an opening in the stent-graft to face a BSA.
4. The method according to claim 1 , wherein deploying the stent-graft comprises positioning a side-branch of the stent-graft in one or more of the BSAs, such that the side-branch is connected to the stent-graft at the vicinity of an opening in the stent-graft, the opening facing the BSA.
5. The method according to claim 4 , wherein the stent-graft comprises a side-branch, and positioning a side-branch of the stent-graft in a BSA comprises extending said side-branch into the BSA.
6. The method according to claim 4 , wherein positioning a side-branch in a BSA comprises preparing the side-branch in situ.
7. The method according to claim 6 , wherein positioning a side-branch in a BSA comprises insertion of a side-branch from a femoral artery through the stent-graft and an opening in the stent-graft, said opening facing said BSA.
8. The method according to claim 6 , wherein positioning a side-branch in a BSA comprises insertion of a side-branch from the BSA into an opening in the stent-graft, and dilating a portion of the side-branch to hold the stent-graft from the inside of the stent-graft.
9. The method according to claim 1 , further comprising holding the stent-graft in place to prevent its dislodging during removal of the shunt.
10. The method according to claim 9 , wherein holding the stent-graft in place comprises inflating a balloon inside the stent-graft.
11. The method according to claim 9 , wherein holding the stent-graft in place comprises momentarily stopping the heart.
12. The method according to claim 1 , wherein the brain-supplying artery is one of the following: the left subclavian artery; the left common carotid artery, the right common carotid artery and the innominate artery.
13. The method according to claim 1 , wherein removing the shunt comprises expanding an expandable device between the stent-graft and the aorta to facilitate release of the shunt.
14. The method according to claim 13 , wherein the expandable device is a balloon.
15. The method according to claim 1 , wherein the shunt comprises a stiff segment and a sleeve going around and along the stiff segment, and removing the shunt comprises inverting the sleeve.
16. The method according to claim 1 , further comprising connecting the brain-supplying artery to a second brain-supplying artery with a carotid perfusion catheter, such that if the passage between the aorta and the second brain-supplying artery is occluded, blood flows into the second brain-supplying artery through the carotid perfusion catheter.
17. The method according to claim 16 , further comprising insertion of a fenestration instrument through the second BSA and forming an opening in the stent-graft, the opening facing the second BSA.
18. The method according to claim 1 , wherein after the shunt is removed from the brain-supplying artery a fenestration instrument is inserted through the brain-supplying artery and an opening is formed in the stent-graft, the opening facing the brain-supplying artery.