System and methods for intracranial vessel access
View Patent ↗The invention relates to systems and methods for intracranial vessel access. In particular, a system including a co-axial combination of a steerable variable thickness microwire operatively supporting a tapered larger bore support and larger bore distal access catheter is described. Methods of advancing the intracranial access system through the vasculature are also described.
1. A system for intracranial access through a patient's vasculature to access an intracranial occlusion, the system comprising:
a variable diameter guide and support system for steering and advancing through the patient's vasculature, the variable diameter guide and support system having a distal tip region, a proximal support section, and an expanded section;
an axis of the variable diameter guide and support system passing centrally through the proximal support section, the expanded section, and at least partially through the distal tip region;
wherein the expanded section has a distal tapering surface that connects to and substantially symmetrically decreases in diameter to the distal tip region;
wherein the expanded section has a proximal tapering surface that connects to and substantially symmetrically decreases in diameter to the proximal support section;
wherein the expanded section proximal to the distal tapering surface and distal to the proximal tapering surface has a cylindrical surface having an outer diameter greater than both a diameter of the distal tip region and a diameter of the proximal support section; wherein the proximal support section has an outer diameter less than the cylindrical surface and is configured to advance the variable diameter guide and support system through a vasculature;
wherein the expanded section, the proximal support section, and the distal tip region have a passage therethrough configured for passage and relative movement of a wire; and,
a distal access catheter operatively connected to the variable diameter guide and support system and wherein the distal access catheter has a distal inner diameter substantially corresponding to the outer diameter of the cylindrical surface and wherein the cylindrical surface of the variable diameter guide and support system is maintained at least partially distal of a distal end of the catheter during advancement through the patient's vasculature wherein the inner diameter of the distal access catheter and the outer diameter of the cylindrical surface are sized to prevent coaxial separation between the variable diameter guide and support system and a distal edge of the distal access catheter while being advance through curved vasculature and the cylindrical surface has a length to allow torsional and coaxial movements of the variable diameter guide and support system relative to said distal access catheter while being advanced through curved vasculature without causing coaxial separation of the expanded section from the distal inner diameter of the distal access catheter.
2. The system as in claim 1 wherein the proximal support section is composed of a flexible line of material.
3. The system as in claim 2 , wherein the proximal support section has a diameter of about 0.035 inches.
4. The system as in claim 1 , wherein the distal access catheter can move coaxially relative to the cylindrical surface.
5. The system as in claim 4 , wherein the cylindrical surface has an axial length of 6-10 cm.
6. The system as in claim 4 , wherein the distal tapering surface has an axial length of 4-6 cm.
7. The system as in claim 4 , wherein the distal access catheter has an outer diameter of 0.065-0.075 inches.
8. The system as in claim 1 , wherein the outer diameter of the cylindrical surface is about 0.058-0.075 inches.
9. The system as in claim 1 , wherein the diameter of the distal tip region is about 0.014-0.016 inches.
10. The system as in claim 1 , wherein the expanded section has a flexibility enabling movement through a vessel having a 1-1.5 cm diameter.
11. The system of claim 1 , wherein said distal tip region and said expanded section are integral with each other.
12. The system of claim 1 , wherein said distal tip region and said expanded section are coaxially movable relative to each other.
13. A method of accessing an intracranial occlusion through a patient's vasculature comprising the step of:
advancing an inner guide and support system through the patient's vasculature, the inner guide and support system having a distal tip region, a proximal support section, and an expanded section;
the variable diameter guide and support system having an axis passing centrally through the proximal support section, the expanded section, and at least partially through the distal tip region;
wherein the expanded section has a distal tapering surface that connects to and substantially symmetrically decreases in diameter to the distal tip region;
wherein the expanded section has a proximal tapering surface that connects to and substantially symmetrically decreases in diameter to the proximal support section;
wherein the expanded section proximal to the distal tapering surface and distal to the proximal tapering surface has a cylindrical surface having an outer diameter greater than a diameter of the distal tip region; wherein the proximal support section has an outer diameter less than the cylindrical surface and is configured to advance the variable diameter guide and support system through a vasculature; and wherein the expanded section, the proximal support section, and the distal tip region have a passage therethrough configured for passage and relative movement of a wire; and,
wherein the inner guide and support system is operatively connected to a distal access catheter having a distal inner diameter substantially corresponding to the outer diameter of the cylindrical surface and wherein the distal access catheter can move coaxially relative to the cylindrical surface;
maintaining the distal tapering surface partially outside of a distal end of the distal access catheter while being advanced through a curved portion of the patient's vasculature and while causing torsional and coaxial movements of the inner guide and support system relative to said distal access catheter, the distal inner diameter of the distal access catheter and the outer diameter of the cylindrical surface being sized and having a length to prevent separation between the inner guide and support system and a distal edge of the distal access catheter; and,
manipulating the inner guide and support system and distal access catheter through the patient's vasculature by a combination of torsional movements of the inner guide and support system and coaxial movements of the inner guide and support system relative to the distal access catheter to move the distal access catheter through regions of the patient's vasculature having a high tortuosity and without causing coaxial separation of the cylindrical surface from the distal inner diameter of the distal access catheter.