Anti-jamming and macerating thrombectomy apparatuses and methods
Mechanical thrombectomy apparatuses that may be configured to prevent or reduce jamming (e.g., “anti-jamming” thrombectomy devices), grab clot, and/or macerate the thrombus, e.g., clot, being removed. These mechanical thrombectomy apparatuses may include a tractor comprising a flexible tube of material that inverts as it rolls over itself while being drawn into a catheter in a conveyor-like motion. In particular, described herein are mechanical thrombectomy apparatuses having tractors selectably extendable projections that may aid in grabbing and/or macerating a clot. Also described herein are seesawing tractors for mechanical thrombectomy apparatuses.
1. A mechanical thrombectomy apparatus for removing a clot from a vessel without jamming, the apparatus comprising:
an elongate inversion support comprising a catheter having a distal end and a distal end opening;
a tractor comprising a flexible tube that extends distally in an un-inverted configuration within the catheter, inverts over the distal end opening of the catheter and extends proximally in an inverted configuration along the distal end of the catheter, wherein the tractor is configured to invert by rolling over the distal end opening of the catheter when a first end of the tractor is pulled proximally within the catheter,
wherein the tractor is biased to self-expand to have an inner diameter that is greater than or equal to the outer diameter of the catheter in the inverted configuration and is biased to self-expand to have an inner diameter that is greater than or equal to 75% of the inner diameter of the catheter in the un-inverted configuration when tensioned; and
an elongate puller coupled to the first end of the tractor.
2. The apparatus of claim 1 , wherein the tractor comprises a woven tube.
3. The apparatus of claim 1 , wherein the tractor comprises a braided tube.
4. The apparatus of claim 1 , wherein the tractor comprises a knitted material.
5. The apparatus of claim 1 , further comprising an outer catheter within which the elongate inversion support extends distally.
6. The apparatus of claim 1 , further comprising outer catheter within which the elongate inversion support extends distally and a vacuum source coupled to a proximal end of the outer catheter.
7. The apparatus of claim 1 , further comprising outer catheter within which the elongate inversion support extends distally, and a vacuum source coupled to a proximal end of the outer catheter, wherein there is at least about 0.002 inches or greater between the outer diameter of the catheter and the inner diameter of the outer catheter.
8. The apparatus of claim 1 , wherein the tractor is sufficiently soft such that without support from the catheter, it collapses radially under an axial compression of less than 200 g of force when inverting.
9. The apparatus of claim 1 , wherein the elongate inversion support is configured to withstand buckling of an axial compression of greater than 500 g of force.
10. The apparatus of claim 1 , wherein the elongate inversion support is configured to withstand buckling of an axial compression of greater than 1500 g of force.
11. The apparatus of claim 1 , wherein the tractor comprises one or more coatings from the group of: a lubricious coating, a metal coating, a heparin coating, an adhesive coating, and a drug coating.
12. A mechanical thrombectomy apparatus for removing a clot from a vessel without jamming, the apparatus comprising:
an elongate inversion support comprising a catheter having a distal end and a distal end opening;
a tractor comprising a flexible tube that extends distally in an un-inverted configuration within the catheter, inverts over the distal end opening of the catheter and extends proximally in an inverted configuration along the distal end of the catheter, wherein the tractor is configured to invert by rolling over the distal end opening of the catheter when a first end of the tractor is pulled proximally within the catheter,
wherein the tractor is biased to self-expand to greater than or equal to the outer diameter of the catheter in the inverted configuration and is biased to self-expand to greater than the inner diameter of the catheter in the un-inverted configuration, and further wherein a distal-facing end of the tractor flares open from a proximal angle of approach so that an outer diameter of the distal-facing region is greater than an outer diameter of a proximal region of the tractor in the inverted configuration as the tractor rolls over the distal end opening of the catheter when the first end of the tractor is pulled proximally within the catheter;
an elongate puller coupled to a first end of the tractor and configured to pull the tractor proximally to invert the tractor over the distal end opening; and
a guidewire lumen extending through the elongate inversion support, puller, and tractor that is configured to pass a guidewire.
13. The apparatus of claim 12 , wherein the tractor comprises a woven tube.
14. The apparatus of claim 12 , wherein the tractor comprises a braided tube.
15. The apparatus of claim 12 , wherein the tractor comprises a knitted material.
16. The apparatus of claim 12 , further comprising an outer catheter within which the elongate inversion support extends distally.
17. The apparatus of claim 12 , further comprising outer catheter within which the elongate inversion support extends distally and a vacuum source coupled to a proximal end of the outer catheter.
18. The apparatus of claim 12 , further comprising outer catheter within which the elongate inversion support extends distally, and a vacuum source coupled to a proximal end of the outer catheter, wherein there is at least about 0.002 inches or greater between the outer diameter of the catheter and the inner diameter of the outer catheter.
19. The apparatus of claim 12 , wherein the tractor is sufficiently soft such that without support from the catheter, it collapses radially under an axial compression of less than 200 g of force when inverting.
20. The apparatus of claim 12 , wherein the elongate inversion support is configured to withstand buckling of an axial compression of greater than 500 g of force.
21. The apparatus of claim 12 , wherein the elongate inversion support is configured to withstand buckling of an axial compression of greater than 1500 g of force.
22. The apparatus of claim 12 , wherein the tractor comprises one or more coatings from the group of: a lubricious coating, a metal coating, a heparin coating, an adhesive coating, and a drug coating.