Protuberant aneurysm bridging device deployment method
An aneurysm bridging device can be placed in the neurovasculature of a patient by advancing the aneurysm bridging device in a small-diameter configuration a delivery catheter to a target region within the neurovasculature and securing the distal region of the aneurysm bridging device to the neurovasculature. While the distal region of the aneurysm bridging device is secured to the neurovasculature, the proximal region of the aneurysm bridging device can be advanced to permit the aneurysm bridging device to expand from the small-diameter configuration and to deform and twist in a central region of the aneurysm bridging device. The proximal region of the aneurysm bridging device can be secured within the neurovasculature to maintain the central region of the aneurysm bridging device in a deformed state.
1. A method of treating an aneurysm in neurovasculature of a patient at a bifurcation of a parent artery into a first and second branch artery, the method comprising:
advancing a first catheter to the bifurcation;
advancing a bridging device from the first catheter to position a distal region of the bridging device across a neck of the aneurysm, the bridging device comprising a wire frame structure having a bridging region disposed between the distal region and a proximal region thereof, the bridging device being self-expandable from a small diameter configuration to a large diameter, deformed configuration;
advancing the distal region from the first catheter to permit the distal region to expand into apposition with the first branch artery, thereby fixing the distal region within the first branch artery;
adjusting the position of the bridging device, so that a proximal edge of the distal region is aligned with a junction of the aneurysm neck and the first branch artery; and
advancing the bridging region from the first catheter to permit the bridging region to self-expand and twist relative to the distal region to assume the large diameter, deformed configuration spanning the aneurysm neck; and
advancing the proximal region from the catheter such that the proximal region twists relative to the distal region to permit the proximal region to expand into apposition with the parent artery.
2. The method of claim 1 , wherein advancing the proximal region comprises advancing the proximal region without applying proximally compressive force on the distal region.
3. The method of claim 1 , further comprising detaching the bridging device from the first catheter and removing the first catheter from the bifurcation, leaving the bridging device within the bifurcation, spanning the neck of the aneurysm.
4. The method of claim 1 , further comprising delivering an occlusive device or substance from a second catheter into a sac of the aneurysm.
5. The method of claim 4 , further comprising withdrawing the bridging device into the first catheter and removing the bridging device from the bifurcation after delivering the occlusive device or substance.
6. A method of treating an aneurysm in neurovasculature proximate a bifurcation in neurovasculature of a patient, the bifurcation having an inlet vessel providing blood flow to first and second outlet vessels, the method comprising:
providing a bridging device for bridging the aneurysm, the bridging device comprising struts extending from an inlet anchoring portion thereof to an outlet anchoring portion thereof, the bridging device having a collapsed configuration and an expanded, deformed configuration;
positioning the outlet anchoring portion in the first outlet vessel;
releasing the bridging device from the collapsed configuration into the inlet vessel to the expanded, deformed position by pushing and twisting the inlet anchoring portion relative to the outlet anchoring portion, in which the struts twist away from the collapsed configuration and protrude toward the aneurysm and the second outlet vessel; and
positioning the inlet anchoring portion in the inlet vessel.
7. The method of claim 6 , further comprising implanting an embolizing mass into the aneurysm, such that the struts of the bridging device retain the embolizing mass within the aneurysm and maintain a flow path from the inlet vessel to the second outlet vessel which is substantially un-occluded by the embolizing mass.
8. The method of claim 6 , wherein the aneurysm is a basilar tip aneurysm, the inlet vessel is a basilar artery, the first outlet vessel is a first posterior cerebral artery, and the second outlet vessel is a second posterior cerebral artery.
9. The method of claim 6 , wherein the bifurcation is a bifurcation of a middle cerebral artery, an internal carotid artery, an anterior communicating artery, a superior cerebellar artery, a pericallosal artery, a basilar artery or a posterior inferior cerebellar artery.
10. The method of claim 6 , wherein the releasing comprises releasing the bridging device from the collapsed configuration without applying proximally compressive force on the outlet anchoring portion.
11. The method of claim 10 , further comprising the steps of:
wherein the bridging device comprises a pseudo-elastic or elastic material and is self-expandable to the expanded, deformed configuration in which a bridging region of the bridging device has a larger diameter than the inlet and outlet anchoring portions; and
wherein the releasing comprises releasing the bridging device from a delivery catheter to cause the aneurysm bridging device to self-expand toward the expanded, deformed configuration, in addition to deforming the bridging device by pushing and twisting the inlet anchoring portion relative to the outlet anchoring portion.
12. A method of treating an aneurysm in neurovasculature proximate a bifurcation in neurovasculature of a patient, the bifurcation having an inlet vessel providing blood flow to first and second outlet vessels, the method comprising:
providing a bridging device for bridging the aneurysm, the bridging device comprising struts extending from an inlet anchoring portion thereof to an outlet anchoring portion thereof, the bridging device having a collapsed configuration and an expanded, deformed configuration;
positioning the outlet anchoring portion in the first outlet vessel;
releasing the bridging device from the collapsed configuration into the inlet vessel to the expanded, deformed position in which the struts twist away from the collapsed configuration and protrude toward the aneurysm and the second outlet vessel;
positioning the inlet anchoring portion in the inlet vessel; and
removing the bridging device from the bifurcation after delivering an occlusive device or substance to the aneurysm.
13. The method of claim 12 , wherein releasing comprises pushing and/or twisting the inlet anchoring portion relative to the outlet anchoring portion.
14. The method of claim 12 , wherein the releasing comprises releasing the bridging device from the collapsed configuration without applying proximally compressive force on the outlet anchoring portion.
15. The method of claim 12 , further comprising delivering the occlusive device or substance to the aneurysm, such that the struts of the bridging device retain the the occlusive device or substance within the aneurysm and maintain a flow path from the inlet vessel to the second outlet vesel which is substantially un-occluded by the occlusive device or substance.
16. The method of claim 12 , wherein the bridging device spans a neck of the aneurysm.