METHODS AND APPARATUS FOR TREATING NEUROVASCULAR VENOUS OUTFLOW OBSTRUCTION
Methods and devices are disclosed for treating neurovascular venous outflow obstructions, with or without implantation of a prosthetic valve. The valve may be carried by a support, such as a stent, which may be self-expandable or balloon expandable. Both transvascular and direct surgical access is contemplated.
1 . A method of treating cerebrospinal venous insufficiency, comprising the steps of:
identifying a patient having at least a partial obstruction at a site in the venous outflow track from the brain;
removing the obstruction; and
implanting a valve in fluid communication with the site, to permit venous outflow and reduce retrograde pressure.
2 . A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein the removing step comprises inflating a balloon at the site.
3 . A method of treating cerebrospinal venous insufficiency as in claim 2 , wherein the balloon carries an implant at the time of the inflating step.
4 . A method of treating cerebrospinal venous insufficiency as in claim 2 , further comprising removing the balloon and thereafter performing the implanting a valve step.
5 . A method of treating cerebrospinal venous insufficiency as in claim 2 , wherein the balloon is carried by a catheter introduced into the vasculature at an access point spaced apart from the site.
6 . A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein the removing step comprises surgically removing a section of vein.
7 . A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein the implanting step comprises surgically attaching a valve at the site.
8 . A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein the implanting step comprises releasing a valve having a self expandable support at the site.
9 . A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein the implanting step comprises inflating a balloon within a balloon expandable portion of a valve support at the site.
10 . A method of treating cerebrospinal venous insufficiency as in claim 7 , wherein the implanting step comprises implanting a tubular graft having a valve mounted therein.
11 . A method of treating cerebrospinal venous insufficiency as in claim 7 , wherein the implanting step comprises attaching a first end of the graft at a first anastomosis to the left internal jugular vein and attaching a second end of the graft at a second anastomosis to the left innominate vein.
12 . A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein the valve is implanted in the left internal jugular vein.
13 . A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein the valve is implanted in the right internal jugular vein.
14 . A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein the valve is implanted in the azygos vein.
15 . A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein the valve is implanted in the superior vena cava.
16 . A method of treating cerebrospinal venous insufficiency as in claim 10 , wherein the graft comprises a tubular ePTFE wall.
17 . A method of treating cerebrospinal venous insufficiency as in claim 10 , wherein the graft comprises a section of saphenous vein.
18 . A cerebrospinal venous insufficiency catheter, comprising:
a first elongate, tubular shaft, having an inflation lumen extending therethrough;
a first balloon carried by the shaft;
a second elongate, tubular shaft, having a central lumen, and axially movably carried by the first shaft, the central lumen having a distal opening;
wherein the distal opening is axially movably positionable between a first position in which the first balloon is at least partially within the central lumen, and a second position in which the first balloon is fully exposed beyond the distal opening.
19 . A cerebrospinal venous insufficiency catheter as in claim 18 , further comprising a second balloon carried by the first shaft.
20 . A cerebrospinal venous insufficiency catheter as in claim 18 , further comprising a third balloon carried by the second shaft.
21 . An implant, for positioning in the neurovascular venous outflow tract, comprising:
a radially expandable frame, for engaging the wall of a vein; the frame having a flowpath therethrough;
an occluder support within the frame, extending across the flow path at an inclined angle relative to the central axis of blood flow; and
a thin film occluder, movable between a first position spaced apart from the occluder support sufficient to permit flow through the flow path in a first direction, and a second position in contact with the support such that it inhibits flow through the flow path in a second direction.
22 . An implant as in claim 21 , further comprising at least one anchor on the frame for engaging the wall of the vein.