Methods for advancing inverting mechanical thrombectomy apparatuses in the vasculature
Mechanical thrombectomy apparatuses (devices, systems, etc.) and methods for positioning them within a vessel and using them to remove a thrombus, e.g., clot, from within a vessel. In particular, described herein are methods of advancing an inverting tractor thrombectomy apparatus having a tractor comprising a flexible tube of material that inverts over itself as it rolls over a distal end opening of an elongate inversion support by extending the tractor region and/or a puller coupled to the tractor distally beyond the end of the catheter. Also described herein are power-driven mechanical thrombectomy apparatuses.
1. A method of removing a clot from a vessel using a mechanical thrombectomy apparatus including a catheter extending from a proximal end to a distal end, a puller extending distally within the catheter and a flexible and tubular tractor, wherein the tractor is coupled to a distal end region of the puller and further wherein the tractor is inverted over a distal end opening of the catheter so that the tractor extends proximally over the catheter, the method comprising:
(a) advancing the puller distally within the catheter and within the vessel towards a clot, so that the tractor extends distally beyond the distal end opening of the catheter, forming a gap between the tractor and the distal end opening of the catheter;
(b) advancing the catheter distally over the puller and into the gap;
(c) repeating (a) and (b) until the distal end opening of the catheter is adjacent to the clot; and
(d) drawing the clot into the catheter with the tractor by pulling the tractor proximally within the catheter so that the tractor rolls and inverts over the distal end opening of the catheter.
2. The method of claim 1 , further comprising, while repeating (a) and (b), pulling the puller proximally within the catheter to invert a portion of the tractor over the distal end opening of the catheter.
3. The method of claim 1 , wherein drawing the clot into the catheter further comprises advancing the catheter distally while pulling the puller proximally.
4. The method of claim 1 , wherein advancing the puller distally comprises advancing the puller without using a guidewire extending distal to the puller.
5. The method of claim 1 , wherein advancing the puller comprises extending the distal end of the puller out of the distal end opening of the catheter.
6. The method of claim 1 , wherein advancing the puller comprises extending the tractor distally within the vessel, further wherein the tractor comprises a woven flexible and tubular tractor.
7. The method of claim 1 , wherein advancing the puller comprises extending the tractor distally within the vessel, further wherein the tractor comprises a knitted tractor.
8. The method of claim 1 , wherein advancing the puller comprises extending the tractor distally within the vessel, further wherein the puller comprises a central lumen configured to pass a guidewire therethrough.
9. The method of claim 1 , wherein advancing the puller comprises advancing the puller within an internal carotid artery.
10. A method of removing a clot from a vessel using a mechanical thrombectomy apparatus including a catheter extending from a proximal end to a distal end, a puller extending distally within the catheter and a flexible and tubular tractor, wherein the tractor is coupled to a distal end region of the puller and further wherein the tractor is inverted over a distal end opening of the catheter so that the tractor extends proximally over the catheter, the method comprising:
(a) advancing the puller distally towards the clot, so that the distal end region of the puller and the tractor extend distally beyond the distal end opening of the catheter;
(b) advancing the catheter distally over the puller so that the distal end region of the puller is within the catheter;
(c) repeating and alternating (a) and (b) until the distal end opening of the catheter is adjacent to the clot; and
drawing the clot into the catheter with the tractor by pulling the tractor proximally within the catheter so that the tractor rolls and inverts over the distal end opening of the catheter.