Rapid aspiration thrombectomy system and method
An intravascular access system for facilitation of intraluminal medical procedures within the neurovasculature through an access sheath. The system includes an aspiration or support catheter having a flexible, distal luminal portion having an inner diameter defining a lumen extending between a proximal opening at a proximal end of the luminal portion and a distal opening at a distal end of the luminal portion. The catheter has a rigid spine coupled to at least the proximal end of the luminal portion and extending proximally therefrom. The system includes a dilator having a flexible, distal dilator portion sized to be received within the lumen of the luminal portion. Associated systems, devices, and methods of use are also described.
1. A method of performing a medical procedure at a treatment site in a cerebral vessel of a patient, the method comprising:
assembling a system of devices, the system of devices comprising:
an aspiration catheter having a flexible tubular portion defining a single catheter lumen extending between a proximal end defining a proximal opening and a distal end defining a distal opening, the catheter further comprising a proximal control element coupled near the proximal opening from the single catheter lumen and extending proximally from the proximal end of the tubular portion; and
an inner member comprising a proximal portion having sufficient rigidity to push the system of devices distally towards the treatment site, the inner member sized to extend through the catheter lumen, wherein a tapered distal end of the inner member extends distal to the distal end of the catheter forming an assembled system of devices;
locking the catheter and the inner member into a fixed position relative to one another forming a locked assembly;
advancing the locked assembly within a petrous portion of an internal carotid artery;
removing the inner member from the single catheter lumen; and
removing occlusive material while applying a negative pressure to the single catheter lumen to capture occlusive material at, within, or through the distal end of the catheter.
2. The method of claim 1 , further comprising unlocking the catheter and the inner member; and advancing the inner member to the treatment site in the cerebral vessel.
3. The method of claim 2 , further comprising advancing the catheter over the inner member after advancing the inner member to the treatment site.
4. The method of claim 3 , wherein removing the inner member comprises removing the inner member after the catheter is placed at or near the treatment site.
5. The method of claim 4 , 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.
6. The method of claim 1 , wherein the distal end of the inner member tapers distally from a first outer diameter to a second outer diameter that is smaller than the first outer diameter.
7. The method of claim 6 , wherein the distal end of the inner member tapers over a length between 1 cm and 3 cm.
8. The method of claim 6 , wherein the proximal portion extends proximally from the inner member to outside the body of the patient.
9. The method of claim 8 , wherein the proximal portion is a stiff wire or a hypotube.
10. The method of claim 8 , wherein the first outer diameter is between about 0.003″ about 0.010″ smaller than an inner diameter of the catheter lumen.
11. The method of claim 10 , wherein the inner diameter of the catheter lumen is between about 0.040″ to about 0.088″.
12. The method of claim 6 , wherein the proximal portion of the inner member has a third outer diameter that is smaller than the first outer diameter of the inner member.
13. The method of claim 1 , wherein the inner member further includes a single lumen.
14. The method of claim 1 , wherein the proximal control element is solid or has a lumen.
15. The method of claim 1 , wherein the proximal portion further includes a tab and the proximal control element includes a gripping member, the tab and the gripping member configured to lock the inner member and the catheter together.
16. The method of claim 15 , wherein the tab is movable along the proximal portion.
17. The method of claim 1 , 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.
18. The method of claim 17 , wherein the advancing the locked assembly is performed after the arterial access device is advanced into the carotid artery and further comprises:
inserting the locked assembly into the internal lumen of the elongate body; and
advancing a distal end of the locked assembly through the internal lumen and past the distal end of the arterial access device.
19. The method of claim 17 , wherein a length of the flexible tubular portion is less than an insertable length of the arterial access device.
20. The method of claim 19 , wherein the insertable length of the arterial access device is between 80 cm and 120 cm and the length of the flexible tubular portion is between 10 cm and 25 cm or between 25 cm and 50 cm.
21. The method of claim 17 , wherein a length of the inner member is greater than an insertable length of the arterial access device.
22. The method of claim 1 , further comprising:
shaping the distal end of the inner member extending distal to the distal end of the catheter, wherein the distal end of the inner member is shaped to an angle relative to a longitudinal axis of the inner member.
23. The method of claim 1 , wherein the step of advancing the locked assembly within the petrous portion of the internal carotid artery is performed without a guidewire.
24. The method of claim 1 , wherein the step of locking comprises using a mechanical lock coupled to the proximal control element to lock the catheter and the inner member into the fixed position.
25. The method of claim 1 , wherein the proximal control element comprises a flat ribbon.