Mechanical thrombectomy apparatuses and methods
Methods and apparatuses for mechanically removing objects from a body. In particular, described herein are thrombectomy methods and mechanical thrombectomy apparatuses for removal of blood clots from within a lumen of a blood vessel.
1. A mechanical thrombectomy apparatus for removing a clot from a vessel, the apparatus comprising:
a catheter having a distal end and a distal end opening, wherein the material hardness of the catheter decreases over the distal end of the catheter until the distal end opening, wherein the distal end opening has a material hardness that is greater than a material hardness of a region immediately proximal to the distal end, further wherein the distal end opening has a rounded lip profile;
a flexible tube extending within the catheter and doubling back over the distal end of the catheter, wherein the flexible tube is configured to invert over the distal end opening when a first end of the flexible tube is pulled proximally within the catheter, further wherein the flexible tube is biased so that a region of the flexible tube inverting over the catheter bulges radially away from the distal end opening; and
a guidewire lumen through the catheter and the flexible tube configured to pass a guidewire.
2. The apparatus of claim 1 , wherein the flexible tube comprises a mesh tube.
3. The apparatus of claim 1 , wherein the flexible tube has at least one porous section having a pore pattern having a longitudinal separation between pores of less than about 0.005 inches in width.
4. The apparatus of claim 1 , further comprising a releasable attachment between the flexible tube and an outer surface of the catheter, configured to release when the flexible tube is pulled with a force that is greater than a predetermined force threshold.
5. The apparatus of claim 4 , wherein the releasable force threshold is 0.01 N.
6. The apparatus of claim 1 , wherein the distal end opening comprises a plurality of notches or channels into which fibers or strips forming the flexible tube are drawn as the flexible tube inverts over the distal end opening.
7. The apparatus of claim 1 , wherein the flexible tube comprises a polymeric tube having a plurality of holes therethrough.
8. The apparatus of claim 1 , further comprising a handle adapted to draw the flexible tube proximally relative to the catheter.
9. The apparatus of claim 1 , further comprising an outer catheter or sleeve extending over the catheter and flexible tube.
10. The apparatus of claim 1 , wherein the flexible tube is configured to invert over the distal end opening when a first end of the flexible tube is pulled proximally within the catheter wherein the flexible tube is configured such that the flexible mesh tube has a diameter of greater than half the inner diameter of the catheter when pulled proximally within the catheter with sufficient force to invert over the distal end opening.
11. The apparatus of claim 1 , further comprising an elongate puller within the catheter and coupled to a distal end of the flexible tube.
12. The apparatus of claim 1 , further comprising an elongate puller within the catheter and coupled to a distal end of the flexible tube, wherein the elongate puller comprises a hypotube having an inner lumen that is continuous with the guidewire lumen though the flexible tube.
13. The apparatus of claim 1 , wherein the flexible tube comprises an outer mesh member formed from 36 to 144 stands, having a thickness of 0.0020 inches or less in diameter, wherein the mesh tubular member extends in a longitudinal axis, further wherein the mesh tubular member has a length that is greater than 5 cm, and a portion of the tube expands to a diameter of greater than 1.5 times an inner diameter of the catheter outside of the catheter when unconstrained.
14. The apparatus of claim 13 , where the strand is formed of any of the following; monofilament polymer, multifilament polymer, NiTi filament, NiTi tube with radiopaque metallic center, Nylon, Polyester, Polyethylene terephthalate, and Polypropylene.
15. The apparatus of claim 1 , further comprising a retaining ring around a distal end region of the flexible tube configured to hold the flexible tube against the catheter.
16. The apparatus of claim 1 , wherein the flexible tube is shape set to have different diameter when within the catheter after being pulled proximally into the catheter.
17. The apparatus of claim 1 , wherein the flexible tube comprises a plurality of woven or knitted filaments.
18. The apparatus of claim 1 , wherein the flexible tube comprises a plurality of woven or knitted filaments, and further wherein the proximal end of the flexible tube forms a tapered opening opposite from a bundle of filaments forming a pull wire.
19. The apparatus of claim 1 , wherein the flexible tube is formed from a sleeve of polymer having a thickness less than 0.020 inches, wherein the sleeve comprises a perforation pattern in which the perforations extend through the polymer.
20. The apparatus of claim 19 , wherein the perforation pattern comprises perforations having a shaped consisting of one or more of: round holes, rectangular holes and zig-zag shapes.
21. The apparatus of claim 1 , further comprising a pull wire coupled to one side of a proximal end of the flexible tube configured to be drawn proximally to pull the flexible tube within the catheter.
22. The apparatus of claim 1 , wherein the flexible tube is 3 to 50 cm.
23. The apparatus of claim 1 , wherein the flexible tube of the apparatus is configured so that the flexible tube may be retracted into the catheter by applying less than 300 grams of force to a distal end of the flexible tube.
24. The apparatus of claim 1 , further comprising an outer catheter vacuum pump coupled to a space between the catheter and the flexible tube and configured to apply a vacuum within a lumen of the catheter between an inner wall of the catheter and the flexible tube.
25. The apparatus of claim 1 , wherein the distal end opening has a radius of 0.00025″ or greater.
26. The apparatus of claim 1 , wherein the distal end opening has a radius of between 0.00025″ and 0.0005″.
27. A mechanical thrombectomy apparatus for removing a clot from a vessel, the apparatus comprising:
a catheter having a distal end and a distal end opening, wherein the material hardness of the catheter decreases over the distal end of the catheter until the distal end opening, wherein the distal end opening has a material hardness that is greater than a material hardness of a region immediately proximal to the distal end, further wherein the distal end opening has a rounded lip profile;
a flexible tube extending within the catheter and doubling back over the distal end of the catheter, wherein the flexible tube is configured to invert over the distal end opening when a first end of the flexible tube is pulled proximally within the catheter, further wherein the flexible tube is biased so that a region of the flexible tube inverting over the catheter bulges radially away from the distal end opening;
a releasable attachment between the flexible tube and an outer surface of the catheter, configured to release when the flexible tube is pulled with a predetermined force that is greater than 0.01 N; and
a guidewire lumen through the catheter and the flexible tube configured to pass a guidewire.
28. A mechanical thrombectomy apparatus for removing a clot from a vessel, the apparatus comprising:
a catheter having a distal end and a distal end opening;
a flexible tube extending within the catheter and doubling back over the distal end of the catheter, wherein the flexible tube is configured to invert over the distal end opening when a first end of the flexible tube is pulled proximally within the catheter and wherein the flexible tube is configured such that the flexible tube has a diameter of greater than half the inner diameter of the catheter when pulled proximally within the catheter with sufficient force to invert over the distal end opening, further wherein the flexible tube is biased so that a region of the flexible tube inverting over the catheter bulges radially away from the distal end opening;
a releasable attachment between the flexible tube and an outer surface of the catheter, configured to release when the flexible tube is pulled with a predetermined force that is greater than 0.01 N; and
a guidewire lumen through the catheter and the flexible tube configured to pass a guidewire.