Methods and systems for treatment of acute ischemic stroke
Described are methods and systems for transcervical access of the cerebral arterial vasculature and treatment of cerebral occlusions, including ischemic stroke. The methods and devices may include methods and devices which may provide aspiration and passive flow reversal, those which protect the cerebral penumbra during the procedure to minimize injury to brain, as well as distal catheters and devices to remove an occlusion. The methods and devices that provide passive flow reversal may also offer to the user a degree of flow control. Devices and methods which provide a way to securely close the access site in the carotid artery to avoid the potentially devastating consequences of a transcervical hematoma are also described.
1. A system for intracranial access through a patient's vasculature to access an intracranial occlusion, the system comprising:
an inner member for steering and advancing through the patient's vasculature, the inner member having a distal tip region, a tapered section and a proximal section, wherein an axis of the inner member passes centrally through the proximal section, the tapered section, and at least partially through the distal tip region, wherein the proximal section, proximal to the distal tip region, has a cylindrical surface having an outer diameter greater than the distal tip region, wherein the proximal section is configured to advance the inner member through the vasculature, and wherein the proximal section, the tapered section, and the distal tip region have a passage therethrough configured for passage and relative movement of a wire; and
a distal access catheter operatively connected to the inner member and wherein the distal access catheter has a distal inner diameter substantially corresponding to the outer diameter of the cylindrical surface, wherein the cylindrical surface of the inner member is maintained at least partially distal of a distal end of the catheter during advancement through the patient's vasculature, and wherein the inner diameter of the distal access catheter and the outer diameter of the cylindrical surface are sized to prevent coaxial separation between the inner member and the distal edge of the distal access catheter while being advanced through the curved vasculature and the cylindrical surface has a length to allow torsional and coaxial movements of the inner member relative to the distal access catheter while being advanced through curved vasculature without causing separation of the inner member from the distal inner diameter of the distal access catheter.
2. The system of claim 1 , wherein the inner member is composed of a flexible material.
3. The system of claim 1 , wherein the distal tip region and the tapered section are integral with each other.
4. The system of claim 1 , wherein the inner member can move coaxially relative to the distal access catheter.
5. The system of claim 1 , wherein the passage has a diameter between about 0.020 inches and 0.024 inches.
6. The system of claim 1 , wherein the passage has a diameter between about 0.030 inches and 0.040 inches.
7. The system of claim 1 , wherein the passage has a diameter between about 0.042 inches and 0.044 inches.
8. The system of claim 1 , further comprising a stent retriever disposed in the passage of the distal tip region.
9. The system of claim 1 , further comprising a radiopaque marker disposed at a distal end of the distal tip region.
10. The system of claim 9 , wherein the radiopaque marker is fabricated from a material selected from the group consisting of: platinum/iridium, tungsten, platinum, and tantalum-impregnated polymer.
11. The system of claim 1 , wherein the inner member is constructed with variable stiffness, wherein a distal segment of the inner member is constructed of a softer material with successively stiffer materials towards a proximal end of the inner member.
12. A method of accessing an intracranial occlusion through a patient's vasculature, the method comprising:
advancing an inner member through the patient's vasculature, the inner member having a distal tip region, a tapered section, and a proximal section, the inner member having an axis passing centrally through the proximal section, the tapered section, and at least partially through the distal tip region, wherein the proximal section, proximal to the distal tapering surface has a cylindrical surface having an outer diameter greater than a diameter of the distal tip region, wherein the proximal section is configured to advance the inner member through the vasculature, wherein the proximal section, the tapered section, and the distal tip region have a passage therethrough configured for passage and relative movement of a wire, and wherein the inner member is operatively connected to a distal access catheter having a distal inner diameter substantially corresponding to the outer diameter of the cylindrical surface and wherein the distal access catheter can move coaxially relative to the cylindrical surface;
maintaining the distal tapering surface partially outside of a distal end of the distal access catheter while being advanced through a curved portion of the patient's vasculature and while causing torsional and coaxial movements of the inner member relative to the distal access catheter, the distal inner diameter of the distal access catheter and the outer diameter of the cylindrical surface being sized and having a length to prevent separation between the inner member and a distal edge of the distal access catheter; and
manipulating the inner member and distal access catheter through the patient's vasculature by a combination of torsional movements of the inner member and coaxial movements of the inner member relative to the distal access catheter to move the distal access catheter through regions of the patient's vasculature having a high tortuosity and without causing coaxial separation of the cylindrical surface from the distal inner diameter of the distal access catheter.