Method of pulsatile neurovascular aspiration with telescoping catheter
A method of aspirating a vascular occlusion from a remote site is provided. The method includes the steps of advancing a first elongate tubular body through a vascular access site and into a body vessel, advancing a second tubular body distally to extend beyond the first elongate tubular body to reach the remote site, and aspirating thrombus from the site into the lumen by applying pulsatile vacuum to the first elongate tubular body. The second tubular body has a lumen and a length that is shorter than the first elongate tubular body. The pulsatile application of vacuum may cause the distal tip of the second tubular body to open and close like a jaw, which facilitates reshaping the thrombus or biting or nibbling the thrombus material into strands or pieces to facilitate proximal withdrawal under negative pressure through the lumen of the second tubular body.
1. A method of aspirating a vascular occlusion from a remote site, comprising the steps of:
advancing a first elongate tubular body through a vascular access site and into a body vessel, the first elongate tubular body having a distal end;
thereafter advancing a second tubular body distally such that the second tubular body extends beyond the first elongate tubular body distal end to reach the remote site, the second tubular body having a lumen and a length, the length of the second tubular body being shorter than a length of the first elongate tubular body, wherein advancing the second tubular body distally comprises:
distally advancing a control wire, the control wire comprising a central lumen and a distal end, the distal end of the control wire being attached to and extending proximally from a proximal end of the second tubular body;
aspirating a thrombus from the remote site into the lumen of the second tubular body by applying pulsatile vacuum to the first elongate tubular body; and
advancing an agitator distally through the central lumen of the control wire such that a distal end of the agitator extends beyond the distal end of the control wire and is positioned within the lumen of the second tubular body, wherein the agitator extends beyond the distal end of the control wire and is positioned within the lumen of the second tubular body while applying the pulsatile vacuum such that the agitator is configured to agitate the thrombus and to facilitate the aspirating the thrombus through the lumen of the second tubular body during the application of pulsatile vacuum.
2. A method of aspirating a vascular occlusion as in claim 1 , wherein the aspirating comprises biting the thrombus by changing the size of a distal opening on the second tubular body.
3. A method of aspirating a vascular occlusion as in claim 2 , wherein the changing the size of the distal opening is accomplished in response to the application of pulsatile vacuum.
4. A method of aspirating a vascular occlusion as in claim 1 , further comprising vibrating the first elongate tubular body during the advancing of the first elongate tubular body.
5. A method of aspirating a vascular occlusion as in claim 1 , further comprising vibrating the second tubular body during the advancing of the second tubular body.
6. A method of aspirating a vascular occlusion as in claim 1 , further comprising vibrating at least a distal section of the second tubular body during the aspirating of the thrombus.
7. A method of aspirating a vascular occlusion as in claim 1 , wherein the second tubular body has a proximal opening, and the proximal opening is positioned within the first elongate tubular body within about 25 cm of the distal end of the first elongate tubular body following the advancing of the second tubular body distally.
8. A method of aspirating a vascular occlusion as in claim 1 , wherein the second tubular body is introduced into the first elongate tubular body following the advancing of the first elongate tubular body.
9. A method of aspirating a vascular occlusion as in claim 1 , wherein the second tubular body is carried within the first elongate tubular body during the advancing of the first elongate tubular body.
10. A method of aspirating a vascular occlusion as in claim 1 , further comprising introducing a lubricant through the agitator to assist the aspirating of the thrombus.
11. A method of aspirating a vascular occlusion as in claim 10 , wherein introducing the lubricant comprises introducing polyethylene glycol through the agitator to assist the aspirating of the thrombus.
12. A method of aspirating a vascular occlusion as in claim 1 , wherein the applying pulsatile vacuum comprises applying intermittent negative pressure to the first elongate tubular body.
13. A method of aspirating a vascular occlusion as in claim 1 , wherein the applying pulsatile vacuum comprises applying alternating negative and positive pressure to the first elongate tubular body.
14. A method of aspirating a vascular occlusion as in claim 1 , further comprising rotating the agitator after advancing the agitator distally through the control wire until the distal end of the agitator is positioned beyond the control wire and exposed within the lumen of the second tubular body.
15. A method of aspirating a vascular occlusion as in claim 1 , further comprising axially reciprocating the agitator after advancing the agitator distally through the control wire until the distal end of the agitator is positioned beyond the control wire and exposed within the lumen of the second tubular body.
16. A method of aspirating a vascular occlusion as in claim 1 , wherein a portion of the agitator configured to agitate the thrombus is asymmetrically distributed across a cross section of the second tubular body when the distal end of the agitator is positioned beyond the control wire and exposed within the lumen of the second tubular body.
17. A method of aspirating a vascular occlusion as in claim 1 , wherein the agitator comprises a shaft and the central lumen of the control wire is configured to receive the shaft, the central lumen being sized to substantially constrain at least a portion of the shaft from laterally moving within the second tubular body.
18. A method of aspirating a vascular occlusion as in claim 1 , wherein at least a portion of the distal end of the agitator expands radially outward after emerging from the distal opening of the control wire.
19. A method of aspirating a vascular occlusion as in claim 1 , further comprising introducing the distal end of the agitator into a proximal opening of the control wire prior to advancing the agitator distally through the control wire.
20. A method of aspirating a vascular occlusion as in claim 1 , wherein the distal end of the agitator is a single flexible wire.