Methods and systems for treatment of acute ischemic stroke
A system of devices for treating an artery includes an arterial access sheath adapted to introduce an interventional catheter into an artery and an elongated dilator positionable within the internal lumen of the sheath body. The system also includes a catheter formed of an elongated catheter body sized and shaped to be introduced via a carotid artery access site into a common carotid artery through the internal lumen of the arterial access sheath. The catheter has an overall length and a distal most section length such that the distal most section can be positioned in an intracranial artery and at least a portion of the proximal most section is positioned in the common carotid artery during use.
1. A method of performing a medical procedure at a treatment site in a cerebral vessel of a patient, the method comprising:
assembling a coaxial system of devices, the assembled coaxial system of devices comprising:
a catheter having a catheter lumen and a distal end; and
a tapered inner member extending through the catheter lumen, wherein a distal end of the tapered inner member extends distal to the distal end of the catheter, the tapered inner member having a lumen; and
advancing the assembled coaxial system of devices together through the internal carotid artery from a transfemoral access site of the patient;
further advancing the assembled coaxial system of devices together after the distal end of the catheter is distal to a petrous portion of the internal carotid artery.
2. The method of claim 1 , further comprising removing the tapered inner member after the catheter is placed at or near the treatment site.
3. The method of claim 2 , further comprising advancing a treatment device into the lumen of the catheter so that the treatment device resides at or near the treatment site.
4. The method of claim 2 , further comprising removing occlusive material while applying a negative pressure to the catheter lumen to capture occlusive material at, within, or through the distal end of the catheter.
5. The method of claim 4 , wherein the step of removing occlusive material comprises:
inserting a retrievable stent device through the catheter;
capturing the occlusive material with the retrievable stent device; and
removing the occlusive material and the retrievable stent device from the treatment site.
6. The method of claim 1 , wherein the cerebral vessel is an intracranial vessel and wherein the treatment site is an occlusion or a region near a face of an occlusion within the intracranial vessel.
7. The method of claim 1 , wherein the distal end of the tapered inner member tapers distally from a first outer diameter to a second outer diameter that is smaller than the first outer diameter.
8. The method of claim 1 , wherein the tapered inner member further comprises a proximal portion extending proximally from the tapered inner member to outside the body of the patient, the proximal portion having a single lumen that communicates with the lumen of the tapered inner member.
9. The method of claim 1 , wherein the catheter comprises a flexible distal luminal portion and a proximal tether element extending proximally from a point of attachment near a proximal end of the flexible distal luminal portion, the proximal tether element extending proximally to outside the body of the patient.
10. The method of claim 9 , wherein an outer diameter of the proximal tether element at the point of attachment is smaller than an outer diameter of the distal luminal portion at the point of attachment.
11. The method of claim 9 , wherein the proximal tether element has sufficient rigidity to push the catheter distally towards the treatment site.
12. The method of claim 9 , wherein the proximal tether element is solid or has a lumen.
13. The method of claim 9 , further comprising:
introducing through an insertion site of the patient an arterial access device, the arterial access device comprising an elongate body sized and shaped to be introduced into a carotid artery, the elongate body defining an internal lumen and a distal end; and
advancing the arterial access device into the carotid artery.
14. The method of claim 13 , wherein the advancing step is performed after the arterial access device is advanced into the carotid artery and further comprises:
inserting the assembled coaxial system into the internal lumen of the elongate body; and
advancing the assembled coaxial system of devices through the internal lumen and past the distal end of the arterial access device.
15. The method of claim 13 , wherein a length of the flexible distal luminal portion is less than an insertable length of the arterial access device.
16. The method of claim 15 , wherein the insertable length of the arterial access device is between 80 cm and 120 cm and the length of the flexible distal luminal portion is between 10 cm and 25 cm or between 25 cm and 50 cm.
17. The method of claim 1 , wherein advancing the assembled coaxial system of device comprises advancing them together over a guidewire.
18. The method of claim 1 , wherein the assembled coaxial system of devices further comprises a guidewire positioned within the lumen of the tapered inner member during the advancing step.
19. The method of claim 1 , wherein the assembled coaxial system of devices further comprises a guidewire positioned within the lumen of the tapered inner member such that a distal end of the guidewire protrudes from the distal end of the tapered inner member during the advancing step.