Inverting thrombectomy apparatuses having enhanced tracking
Mechanical thrombectomy apparatuses, and particularly knitted rolling tube mechanical thrombectomy apparatuses configured to have improved tracking for delivery through tortious vessels are described herein. Also described herein are methods of removing clots using a mechanical thrombectomy apparatuses in which the clot is larger than the tractor portion of the mechanical thrombectomy apparatus.
1. An inverting tube apparatus,
comprising:
an inversion support catheter;
a puller at least partially disposed within a lumen of the inversion support catheter; and
a knitted flexible tube extending over a distal end of the inversion support catheter in a compressed state, the knitted flexible tube having a plurality of interlocking loops, a first end coupled to a distal end region of the puller, and a second end disposed on an outer surface of the inversion support catheter,
wherein the knitted flexible tube extends distally from the second end and over the outer surface of the inversion support catheter with the plurality of interlocking loops overlapping to form a knit overlap configured to hold the knitted flexible tube in the compressed state, and
wherein the knitted flexible tube is configured to be pulled proximally into the inversion support catheter by pulling the puller proximally so that the knitted flexible tube stretches from the compressed state, and rolls and inverts over a distal end of the inversion support catheter;
wherein the inversion support catheter comprises a plurality of slots or cut-out regions configured to enhance flexibility while maintaining column strength of the inversion support catheter such that the inversion support catheter is able to withstand at least about 500 g of compressive force without buckling.
2. The apparatus of claim 1 , wherein, in the compressed state, the interlocking loops of the knitted flexible tube overlap to form the knit overlap, and wherein the knit overlap extends more than 20% of a longitudinal length of the interlocking loops.
3. The apparatus of claim 1 , wherein the interlocking loops of the knitted flexible tube comprise woven links that are connected end-to-end, forming a helical winding pattern.
4. The apparatus of claim 1 , wherein one or more regions of the knitted flexible tube are held against the outer surface of the inversion support catheter to thereby maintain the knitted flexible tube in the compressed state.
5. The apparatus of claim 1 , further comprising a releasable stop or lock disposed on the outer surface of the inversion support catheter and engaging with one or more regions of the knitted flexible tube to thereby maintain the knitted flexible tube in the compressed state.
6. The apparatus of claim 5 , wherein the releasable stop or lock comprises a plurality of finger elements that engage with respective loops of the knitted flexible tube.
7. The apparatus of claim 1 , further comprising a proximal port in fluid communication with a lumen of the puller, and configured to couple with a vacuum source to apply vacuum through the puller lumen.
8. The apparatus of claim 1 , further comprising an intermediate catheter having a lumen through which the inversion support catheter extends, the intermediate catheter lumen in fluid communication with a proximal port configured to couple with a vacuum source to apply vacuum between the intermediate catheter and the inversion support catheter.
9. The apparatus of claim 1 , further comprising an intermediate catheter extending over the inversion support catheter, wherein the knitted flexible tube is disposed between the intermediate catheter and the inversion support catheter.
10. The apparatus of claim 1 , wherein the knitted flexible tube comprises a filament knitted to form the plurality of interlocking loops, and wherein the plurality of interlocking loops have a longitudinal length that is between 0.5 mm and 10 mm.
11. The apparatus of claim 1 , wherein the knitted flexible tube has an inner diameter that is no more than 20% greater than an outer diameter of the inversion support catheter.
12. The apparatus of claim 1 , wherein the knitted flexible tube is shape set to a first configuration that has an outer diameter between 0.5 mm and 10 mm, and a second configuration that has an inner diameter that is at least 60% of an inner diameter of the inversion support catheter.
13. The apparatus of claim 1 , wherein the puller comprises a puller catheter.
14. The apparatus of claim 1 , wherein the inversion support catheter comprises a plurality of slits or openings around a perimeter and along a length, respectively, of the inversion support catheter.
15. The apparatus of claim 1 , further comprising a guidewire within the puller.
16. The apparatus of claim 1 , wherein puller comprises a micro-catheter or a guidewire.
17. An inverting tube apparatus,
comprising:
an inversion support catheter;
a puller at least partially disposed within a lumen of the inversion support catheter; and
a knitted flexible tube extending over a distal end of the inversion support catheter in a compressed state, the knitted flexible tube having a plurality of interlocking loops, a first end coupled to a distal end region of the puller, and a second end disposed on an outer surface of the inversion support catheter, wherein
the knitted flexible tube extends distally from the second end and over the outer surface of the inversion support catheter with the interlocking loops overlapping to form a knit overlap configured to hold the knitted tube in the compressed state,
the knit overlap extends more than 20% of a longitudinal length of the interlocking loops in the compressed state, and
the knitted flexible tube is configured to be pulled proximally into the inversion support catheter by pulling the puller proximally so that the knitted flexible tube rolls and inverts over a distal end of the inversion support catheter,
wherein the inversion support catheter comprises a plurality of slits or openings around a perimeter and along a length, respectively, of the inversion support catheter.
18. An inverting tube apparatus, comprising:
an inversion support catheter;
a puller at least partially disposed within a lumen of the inversion support catheter;
a knitted flexible tube extending over a distal end of the inversion support catheter in a compressed state, the knitted flexible tube having a plurality of interlocking loops, a first end coupled to a distal end region of the puller, and a second end disposed on an outer surface of the inversion support catheter, wherein
the knitted flexible tube extends distally from the second end and over the outer surface of the inversion support catheter with the interlocking loops overlapping to form a knit overlap,
the knit overlap extends more than 20% of a longitudinal length of the interlocking loops in the compressed state, and
the knitted flexible tube is configured to be pulled proximally into the inversion support catheter by pulling the puller proximally so that the knitted flexible tube rolls and inverts over a distal end of the inversion support catheter; and
a releasable stop or lock disposed on the outer surface of the inversion support catheter, the releasable stop or lock engaging with one or more regions of the knitted flexible tube to thereby maintain the knitted flexible tube in the compressed state, wherein the releasable stop or lock comprises a plurality of finger elements that engage with respective loops of the knitted flexible tube.