Inverting thrombectomy apparatuses and methods of use
Described herein are methods using mechanical inverting tube apparatuses to remove clot (e.g., thrombectomy), the apparatuses including an inversion support catheter having an expandable funnel-shaped distal end, and a flexible tube that can be continuously rolled over the funnel-shaped distal end and invert into the inner lumen of the inversion support catheter.
1. A method of removing a clot from a blood vessel, the method comprising:
advancing an inverting tube apparatus through the blood vessel until a distal end portion of the inverting tube apparatus is located proximate to the clot, wherein the inverting tube apparatus comprises an inversion support catheter having an elongate and flexible catheter body, an internal catheter lumen, and an expandable funnel disposed at a distal end of the catheter body, wherein a distal end of the funnel defines an opening in communication with an interior of the funnel and the catheter lumen, respectively, the inverting tube apparatus further comprising a flexible tube inverted over the distal end of the expandable funnel and having a first region at least partially disposed within the interior of the funnel, and a second region at least partially extending over an exterior surface of the funnel;
expanding the funnel from a collapsed delivery configuration into an expanded configuration within the blood vessel proximate to the clot; and
pulling the first region of the flexible tube proximally to thereby roll the second region of the flexible tube over the distal end of the funnel so that the flexible tube captures the clot and pulls the clot proximally into the respective funnel interior and catheter lumen,
wherein pulling the first region of the flexible tube proximally to roll the second region of the flexible tube over the distal end of the funnel comprises applying between 500 g and 3000 g of compressive force on the funnel.
2. The method of claim 1 , wherein capturing the clot and pulling the clot proximally into the respective funnel interior and catheter lumen comprises compressing the clot and releasing fluid from the clot laterally out of fluid egress openings in a proximal portion of the funnel.
3. The method of claim 1 , further comprising selecting a size of the inverting tube apparatus based on the size of the blood vessel.
4. The method of claim 1 , wherein pulling the first region of the flexible tube proximally to roll the second region of the flexible tube over the distal end of the funnel causes the funnel to assume a jammed configuration in which a structure of the funnel locks at least a portion of the funnel into the expanded configuration.
5. The method of claim 1 , wherein in the expanded configuration, the expandable funnel has an outer diameter that is greater than at least ⅓ of a width of the clot.
6. The method of claim 1 , wherein in the expanded configuration, the expandable funnel has an outer diameter that is greater than at least 50% of a width of the clot.
7. The method of claim 1 , wherein expanding the funnel comprises extending the expandable funnel distally out of an intermediate catheter.
8. The method of claim 1 , further comprising removing the flexible tube from the catheter lumen and loading a new flexible tube onto the inversion support catheter.
9. The method of claim 1 , wherein expanding the funnel comprises allowing the funnel to self-expand.
10. The method of claim 1 , wherein expanding the funnel comprises pulling the first region of the flexible tube proximally to expand the funnel.
11. A method of removing a clot from a blood vessel, the method comprising:
advancing an inverting tube apparatus through the blood vessel until a distal end portion of the inverting tube apparatus is located proximate to the clot, wherein the inverting tube apparatus comprises an inversion support catheter having an elongate and flexible catheter body, an internal catheter lumen, and an expandable funnel disposed at a distal end of the catheter body, wherein a distal end of the funnel defines an opening in communication with an interior of the funnel and the catheter lumen, respectively, the inverting tube apparatus further comprising a flexible tube inverted over the distal end of the expandable funnel and having a first region at least partially disposed within the interior of the funnel, and a second region at least partially extending over an exterior surface of the funnel;
allowing the funnel to self-expand from a collapsed delivery configuration into an expanded configuration within the blood vessel proximate to the clot; and
pulling the first region of the flexible tube proximally to thereby roll the second region of the flexible tube over the distal end of the funnel so that the flexible tube captures the clot and pulls the clot proximally into the respective funnel interior and catheter lumen,
wherein capturing the clot and pulling the clot proximally into the respective funnel interior and catheter lumen comprises compressing the clot and releasing fluid from the clot laterally out of fluid egress openings in a proximal portion of the funnel,
wherein pulling the first region of the flexible tube proximally to roll the second region of the flexible tube over the distal end of the funnel comprises applying between 500 g and 3000 g of compressive force on the funnel.
12. The method of claim 11 , wherein pulling the first region of the flexible tube proximally to roll the second region of the flexible tube over the distal end of the funnel causes the funnel to assume a jammed configuration in which a structure of the funnel locks at least a portion of the funnel into the expanded configuration.
13. The method of claim 11 , wherein in the expanded configuration, the expandable funnel has an outer diameter that is greater than at least ⅓ of a width of the clot.
14. The method of claim 11 , wherein in the expanded configuration, the expandable funnel has an outer diameter that is greater than at least 50% of a width of the clot.
15. A method of removing a clot from a blood vessel, the method comprising:
advancing an inverting tube apparatus through the blood vessel until a distal end portion of the inverting tube apparatus is located proximate to the clot, wherein the inverting tube apparatus comprises an inversion support catheter having an elongate and flexible catheter body, an internal catheter lumen, and an expandable funnel disposed at a distal end of the catheter body, wherein a distal end of the funnel defines an opening in communication with an interior of the funnel and the catheter lumen, respectively, the inverting tube apparatus further comprising a flexible tube inverted over the distal end of the expandable funnel and having a first region at least partially disposed within the interior of the funnel, and a second region at least partially extending over an exterior surface of the funnel;
expanding the funnel from a collapsed delivery configuration into an expanded configuration within the blood vessel proximate to the clot; and
pulling the first region of the flexible tube proximally to thereby roll the second region of the flexible tube over the distal end of the funnel so that the flexible tube captures the clot and pulls the clot proximally into the respective funnel interior and catheter lumen,
wherein pulling the first region of the flexible tube proximally to roll the second region of the flexible tube over the distal end of the funnel causes the funnel to assume a jammed configuration,
wherein in the jammed configuration, the funnel has a greater column strength than when the funnel is not in the jammed configuration.