Inverting thrombectomy apparatuses and methods of use
Inverting tube thrombectomy apparatus for removing clot that are configured to prevent compression of the apparatus that may separate the distal end of the apparatus from the clot and may make it difficult to advance the apparatus to engage with the clot, particularly in a tortious vessel. The apparatuses and methods of using them described herein may be adapted to prevent tension in the flexible tube that is rolling and inverting over the distal end of the inversion support catheter when capturing a clot. Also described herein are inverting tube thrombectomy apparatus that are configured to reload either automatically or manually within the vessel to capture additional clot material.
1. An apparatus for removing a clot, the apparatus comprising:
an intermediate catheter comprising an outer surface and an inner surface defining a lumen;
an inversion support catheter comprising an outer surface and an inner surface defining a lumen, the inversion support catheter being disposed within the lumen of the intermediate catheter;
a puller disposed within the lumen of the inversion support catheter;
a flexible tube having a first end coupled at a distal end region of the puller, and a second end held between the outer surface of a distal end region of the inversion support catheter and the inner surface of the intermediate catheter, wherein the flexible tube comprises a slack region formed by a portion of the flexible tube being bunched up on itself on the outer surface of the distal end region of the inversion support catheter, wherein the intermediate catheter is configured to be advanced distally to form the slack region.
2. The apparatus of claim 1 , wherein the first end of the flexible tube is coupled proximal to the distal end region of the puller by greater than 0.5 mm.
3. The apparatus of claim 1 , wherein the puller is a puller catheter.
4. The apparatus of claim 1 , wherein the puller is a wire.
5. The apparatus of claim 1 , wherein the flexible tube comprises a woven or knitted material.
6. The apparatus of claim 1 , wherein the flexible tube comprises a braided material.
7. The apparatus of claim 1 , wherein an outer diameter of the puller is within about 10% of an inner diameter of the inversion support catheter.
8. The apparatus of claim 1 , further comprising a guidewire extending through the flexible tube.
9. The apparatus of claim 1 , wherein the second end of the flexible tube includes a cuff.
10. The apparatus of claim 9 , wherein the cuff is less flexible than a region of the flexible tube adjacent to the cuff.
11. The apparatus of claim 9 , wherein the intermediate catheter is configured to be retracted or removed over the flexible tube and then be advanced distally against the cuff to distally drive the flexible tube and form the slack region.
12. The apparatus of claim 1 , wherein the flexible tube comprises a woven flexible tube and the slack region comprises compressed weaves.
13. The apparatus of claim 1 , wherein an outside region of the flexible tube is configured to be compressed to form the slack region.
14. The apparatus of claim 13 , wherein the outside region of the flexible tube adjacent to the first end coupled at the distal end region of the puller is configured to be compressed to form the slack region.
15. The apparatus of claim 1 , wherein the intermediate catheter is configured to be advanced distally to axially compress an outside region of the flexible tube to form the slack region.