Apparatus and method for deploying stent across adjacent tissue layers
Transluminal access system includes a stent delivery catheter having a handle control mechanism. The catheter comprises a number of components for establishing an initial penetration between adjacent body lumens and subsequently implanting a stent or other luminal anchor therebetween. Manipulation of the stent components is achieved using control mechanisms on the handle while the handle is attached to an endoscope which provides access to a first body lumen.
1. A method for delivering a stent from a first body lumen, through adjacent opposing luminal walls, to a second body lumen to form an anastomosis, said method comprising:
advancing an endoscope having a working channel to a target site on a wall of the first lumen;
providing a stent deployment apparatus having a control handle and a stent deployment catheter assembly;
advancing at least a portion of the stent deployment catheter assembly into the working channel of the endoscope;
attaching the control handle to the endoscope so that the control handle is immobilized relative to the endoscope;
advancing the stent deployment catheter assembly including a shaft, a self-expanding stent carried on the shaft, and a sheath constraining the stent on the shaft relative to the control handle and the endoscope and through a passage from the first body lumen, through the opposing walls at the target site, and into the second body lumen;
retracting the sheath relative to the endoscope, control handle and shaft by a distance sufficient to release a distal portion of the stent and form a distal flange;
pulling proximally on the stent deployment catheter assembly such that the shaft, the stent and the sheath move simultaneously in the proximal direction to engage the distal flange against the wall of the second body lumen to draw the two luminal walls into closer apposition while a proximal flange of the stent remains constrained by the sheath; and
further retracting the sheath relative to the endoscope, control handle, and shaft to release portions of the stent remaining constrained by the sheath, wherein the proximal flange expands against the wall of the first body lumen.
2. A method as in claim 1 , wherein the passage was pre-formed before advancing the stent deployment catheter.
3. A method as in claim 1 , further comprising forming the passage by advancing a needle carried by the stent deployment catheter relative to the control handle and the endoscope to penetrate the needle through the opposing walls.
4. A method as in claim 3 , wherein the stent deployment catheter is advanced over the needle through the opposing walls after the needle has penetrated said opposing walls.
5. A method as in claim 4 , further comprising applying tension to a tension wire which has an anchor in the second body lumen while the stent deployment catheter is advanced over the needle.
6. A method as in claim 5 , wherein the tension wire is deployed through an axial passage in the needle.
7. A method as in claim 1 , wherein advancing the stent deployment catheter comprises manually advancing a catheter slider on the control handle, wherein the catheter slider is coupled to said catheter assembly to move the shaft, the sheath, and the stent in unison relative to the control handle and endoscope.
8. A method as in claim 7 , wherein retracting the sheath comprises manually retracting a collar slider on the control handle, wherein the collar slider is coupled to said sheath to move the sheath relative to the shaft, the stent, the control handle and the endoscope.
9. A method as in claim 3 , wherein advancing the needle comprises manually advancing a needle slider on the control handle, wherein the needle slider is coupled to said needle to move said needle relative to the shaft, the stent, the control handle and the endoscope.
10. A method as in claim 1 , wherein the first body lumen is selected from the group consisting of the esophagus, the stomach, the duodenum, the small intestines, and the large intestines and the second body lumen is selected from the bile duct, the pancreatic duct, the gallbladder, cysts, pseudocysts, abscesses, the pancreas, the liver, the urinary bladder, duodenum, jejunum, and colon.
11. A method as in claim 1 , further comprising a step of locking a proximally pulled position of the deployment catheter assembly relative to the control handle and the endoscope after the step of pulling proximally on the deployment catheter assembly but before the step of further retracting the sheath.