Methods and apparatus for treating embolism
A method and apparatus for treating a clot in the blood vessel of a patient, and particularly the treatment of a pulmonary embolism is disclosed. The treatment includes restoring flow through the clot followed by clot removal, either partially or substantially completely. The clot treatment device is expandable into the blood vessel and may contain radial extensions that assist in restoring flow as well as in removing clot material.
1. A system for treating a pulmonary embolism, comprising:
a clot treatment device including—
an expandable flow restoration portion; and
a plurality of capture elements including at least a first capture element and a second capture element, wherein the flow restoration portion is positioned between the first and second capture elements, wherein the flow restoration portion and the capture elements are configured to move from a low-profile undeployed state sized to fit within a delivery catheter to a deployed state in which the flow restoration portion has a cross-sectional dimension greater than that of the undeployed state and the capture elements project outwardly from the flow restoration portion, and wherein the flow restoration portion has a first longitudinal dimension and each of the capture elements has a second longitudinal dimension, the first longitudinal dimension being greater than the second longitudinal dimension;
a guide catheter having a shaft with a distal end portion, wherein the shaft includes a lumen configured to receive the clot treatment device in the undeployed state; and
an expandable guide member at the distal end portion of the shaft, wherein the expandable guide member is configured to guide clot material into the guide catheter as the clot treatment device is withdrawn into the guide catheter.
2. The system of claim 1 wherein at least a portion of the expandable guide member is permeable to allow blood to flow through the expandable guide member.
3. The system of claim 1 wherein the expandable guide member comprises at least one of a self-expanding mesh structure or a self-expanding braided structure.
4. The system of claim 1 wherein the expandable guide member is formed from a tubular braid of elastic or super-elastic filaments that have been heat set to have a desired expanded shape.
5. The system of claim 1 wherein, when the guide catheter is positioned within a pulmonary vessel, the expandable guide member is configured to expand radially outward to contact or nearly contact the pulmonary vessel and block less than about 50% of blood flow about the guide catheter.
6. The system of claim 1 wherein the expandable guide member is configured to position the shaft at or near a center of a pulmonary vessel in which the guide catheter is positioned.
7. The system of claim 1 wherein the expandable guide member has a tapered or funnel shape for guiding thrombus material into a distal opening in the shaft.
8. The system of claim 1 wherein the expandable guide member includes a permeable portion and a substantially non-permeable portion.
9. The system of claim 8 wherein the expandable guide member comprises a mesh, and wherein the non-permeable portion comprises a non-permeable coating formed on a proximal portion of the mesh.
10. The system of claim 1 wherein the expandable guide member has a substantially non-permeable portion affixed to the distal end portion of the shaft and a permeable portion extending distally from the substantially non-permeable portion.
11. The system of claim 10 wherein the permeable portion comprises a radially expanding mesh having a tapered or funnel shape, and wherein the substantially non-permeable portion comprises an elastic material.
12. A system for treating pulmonary embolism, comprising:
a clot treatment device including—
an outer elongated member having a distal end;
an inner elongated member within the outer elongated member, wherein the inner elongated member and the outer elongated member slide relative to each other, and wherein the inner elongated member has a distal end; and
an expandable member having a proximal portion fixed to the distal end of the outer elongated member and a distal portion fixed to the distal end of the inner elongated member, the expandable member having a flow restoration portion and a plurality of capture elements arranged along the flow restoration portion, wherein the flow restoration portion and the capture elements are configured to move from a low-profile undeployed state sized to fit within a delivery catheter to a deployed state in which the flow restoration portion has a cross-sectional dimension greater than that of the undeployed state and the capture elements project outwardly from the flow restoration portion, and wherein the flow restoration portion has a first longitudinal dimension and each of the capture elements has a second longitudinal dimension, the first longitudinal dimension being greater than the second longitudinal dimension
a guide catheter having a shaft with a distal end portion, wherein the shaft includes a lumen configured to receive the clot treatment device in the undeployed state; and
a radially expandable guide member having a first portion affixed to the distal end portion of the shaft and a second portion extending distally from the first portion, wherein the guide member is configured to guide clot material into the guide catheter as the clot treatment device is withdrawn into the guide catheter.
13. The system of claim 12 wherein, when the guide member is expanded—
the guide member defines a distal opening,
the first portion has a first diameter, and
the second portion has a second diameter greater than the first diameter.
14. The system of claim 12 wherein, when the guide catheter is positioned within a pulmonary vessel and the guide member is expanded—
the first portion of the guide member is substantially non-permeable to divert blood flow away from the distal end portion of the shaft, and
the second portion of the guide member is permeable to allow blood to flow through the guide member and around the guide catheter.
15. The system of claim 12 wherein the first portion is permeable.
16. The system of claim 12 wherein the first portion is substantially non-permeable.
17. The system of claim 12 wherein the second portion comprises a radially expanding mesh having a tapered or funnel shape, and wherein the first portion comprises an elastic material configured to flex with expansion of the second portion.