Methods and apparatus for flow restoration
Methods for restoring blood flow in occluded blood vessels using an apparatus having a self-expandable distal segment that is pre-formed to assume a superimposed structure in an unconstrained condition but can be made to take on a volume-reduced form making it possible to introduce it with a microcatheter and a push wire arranged at the proximal end, with the distal segment in its superimposed structure assuming the form of a longitudinally open tube and having a mesh structure of interconnected strings or filaments or struts. In a preferred embodiment, the distal segment has a tapering structure at its proximal end where the strings or filaments or struts converge at a connection point.
1. An apparatus for removal of a thrombus in a cerebral blood vessel, comprising:
a self-expandable tubular structure of interconnected struts comprising a plurality of mesh cells having a proximal end and a distal end, the proximal end and the distal end being open, wherein the self-expandable tubular structure is configured to expand from a compressed form to an expanded form at a site of the thrombus;
a tapering portion operatively connected to the proximal end of the self-expandable tubular structure;
a connection portion operatively connected to a proximal end of the tapering portion wherein the tapering portion is configured to converge at the connection portion; and
a push or guide wire, wherein a distal end of the push or guide wire is configured to be permanently attached to the connection portion,
wherein the self-expandable tubular mesh structure can take a volume-reduced form, and the self-expandable tubular mesh structure forms edges and is curled up such that the edges overlap in the volume-reduced form,
wherein the self-expandable tubular structure is configured to apply an outward radial force on the thrombus during and after the self-expandable tubular structure expands, and
wherein the self-expandable tubular structure is configured to interlock with at least a portion of the thrombus, the portion of the thrombus extending both inside of the self-expandable tubular structure and outside of the self-expandable tubular structure.
2. The apparatus of claim 1 , wherein:
the mesh cells comprise a first plurality of mesh cells; and
the tapering portion comprises a second plurality of mesh cells.
3. The apparatus of claim 2 , wherein:
the first plurality of mesh cells is of a first size;
the second plurality of mesh cells is of a second size; and
the first size is different from the second size.
4. The apparatus of claim 1 , wherein the apparatus further comprises one or more radiopaque markers at the proximal end of the tapering portion and at the distal end of the self-expandable tubular structure.
5. The apparatus of claim 1 , wherein the self-expandable tubular structure is configured to be visible under fluoroscopy for proper placement.
6. The apparatus of claim 1 , wherein the apparatus is configured to be positioned inside the thrombus in the compressed form and apply the outward radial force by expanding inside the thrombus.
7. The apparatus of claim 1 , wherein the apparatus is configured to be positioned adjacent to the thrombus and between the thrombus and a wall of the blood vessel in the compressed form and apply the outward radial force by expanding adjacent to the thrombus.
8. The apparatus of claim 1 , wherein the self-expandable tubular structure is further configured to reduce a cross-sectional area of the thrombus during and after the self-expandable tubular structure expands.
9. The apparatus of claim 8 , wherein the self-expandable tubular structure is further configured to reduce the cross-sectional area of the thrombus during and after the self-expandable tubular structure expands by applying the outward radial force.
10. The apparatus of claim 8 , wherein the self-expandable tubular structure is further configured to reduce the cross-sectional area of the thrombus by 30% to 95% of its original cross-sectional area during and after the self-expandable tubular structure expands by applying the outward radial force.
11. The apparatus of claim 8 , wherein the self-expandable tubular structure is further configured to restore blood flow through the blood vessel past the thrombus during and after the self-expandable structure expands by reducing the cross-sectional area of the thrombus.
12. The apparatus of claim 1 , wherein the self-expandable tubular structure is further configured to apply the outward radial force on the thrombus in a position adjacent to the thrombus.
13. The apparatus of claim 1 , wherein the self-expandable tubular structure is further configured to apply the outward radial force on the thrombus in a position within the thrombus.
14. The apparatus of claim 1 , wherein the apparatus is used alongside at least one clot-busting drug administered at the site of the thrombus.
15. The apparatus of claim 1 , wherein the expanded form of the self-expandable tubular structure widens towards the distal end of the self-expandable tubular structure, whereby the distal end of the self-expandable tubular structure has a greater diameter than the proximal end of the self-expandable tubular structure.
16. The apparatus of claim 1 , wherein the self-expandable tubular structure is further configured to have a greater diameter at the distal end of the self-expandable tubular structure than at the proximal end of the self-expandable tubular structure after the expansion at the site of the thrombus.
17. The apparatus of claim 1 , wherein the self-expandable tubular structure is operatively connected to the tapering portion by an intermediate portion.
18. The apparatus of claim 1 , further comprising filaments between the self-expandable tubular structure and the tapering portion configured to facilitate the connection between the self-expandable tubular structure and the tapering portion.
19. The apparatus of claim 1 , wherein the self-expandable tubular structure is further configured to create an opening through the thrombus during and after the self-expandable structure expands by applying the outward radial force.
20. The apparatus of claim 1 , wherein the expanded form of the self-expandable tubular structure is a longitudinally open tube.