Method for treating vascular occlusion
A method is disclosed for removing a vascular occlusion, such as a clot, from a blood vessel. A tubular sheath is inserted into the vessel and a self-expanding Nitinol mesh filter is deployed from a distal end of the tubular sheath at a location proximal to a clot. An inner catheter is advanced through the tubular sheath and through the mesh filter for contacting the clot. An expandable agitation element is provided along a distal end portion of the inner catheter for cutting or chopping the clot, thereby facilitating removal of the clot and improving blood flow through the vessel. Resulting clot particles are captured by the mesh filter. Negative pressure may be applied along a proximal end portion of the sheath for aspirating remaining particles. Certain embodiments of the method are well-suited for treating deep vein thrombosis and do not require the use of thrombolytic drugs.
1. A system for removing a vascular thrombus from a blood vessel of a patient, comprising:
a catheter having a lumen and a distal end portion;
a self-expanding filter body including a permeable mesh configured for blood to pass therethrough and having a proximal end portion with a tapered shape and an open distal end sized to conform to an inner wall of the blood vessel when deployed in the blood vessel, wherein the distal end of the self-expanding filter body is configured to be deployed distally with respect to the distal end portion of the catheter; and
an inner elongated member configured to extend through the lumen of the catheter and through the self-expanding filter body, the inner elongated member having a thrombus engagement member, and the thrombus engagement member having flexible radially extending members that diverge radially outward in a distal direction and are expandable to an expanded profile having an expanded diameter sized for contacting the thrombus when deployed in the blood vessel, wherein the members each have a radially-outward most portion that is at least partially curved, and wherein the inner elongated engagement member and the thrombus engagement member are longitudinally slidable for disrupting and removing the thrombus from the blood vessel;
wherein the self-expanding filter body is adapted for capturing thrombus material that has been acted upon by the thrombus engagement member.
2. The system of claim 1 wherein the inner elongated member is moveable linearly with respect to the catheter such that thrombus engagement member moves linearly as it engages the thrombus.
3. The system of claim 1 wherein the thrombus engagement member is configured to expand when deployed in the blood vessel to suit the diameter of the blood vessel.
4. The system of claim 1 wherein the permeable mesh comprises nitinol.
5. The system of claim 1 wherein the mesh is braided.
6. The system of claim 5 wherein the braided mesh is configured to capture and hold clot material while the self-expanding filter body is withdrawn.
7. The system of claim 6 wherein the proximal end portion of the self-expanding filter body is attached to the distal end portion of the catheter.
8. The system of claim 1 further comprising an outer sheath having a lumen, wherein the catheter is configured to be received in the lumen of the outer sheath.
9. The system of claim 8 wherein the system further comprises an aspiration source configured to aspirate the lumen of the outer sheath.
10. A method of capturing and removing a thrombus from a blood vessel in a human, comprising:
advancing an inner elongated member having a thrombus engagement member to a thrombus in the blood vessel;
positioning a catheter in the blood vessel such that a distal end of the catheter is proximal to the thrombus in the blood vessel;
deploying a filter body having a tapered proximal end portion and an open distal end such that the open distal end of the filter body self-expands to a diameter of the vessel at a location between the distal end of the catheter and the thrombus;
expanding the thrombus engagement member and moving the thrombus engagement member linearly such that it engages and disrupts the thrombus, wherein the thrombus engagement member has flexible radially extending members that diverge radially outward in a distal direction and are capable of engaging the vessel wall, and wherein the members each have a radially-outward most portion that is at least partially curved; and
capturing thrombus material with the filter body.
11. The method of claim 10 wherein expanding the thrombus engagement member comprises expanding the thrombus engagement member until it is at least proximate the blood vessel wall.
12. The method of claim 10 wherein expanding the thrombus engagement member comprises expanding the thrombus engagement member to suit the diameter of the blood vessel.
13. The method of claim 10 wherein the filter body comprises a braided mesh.
14. The method of claim 13 wherein a proximal end portion of the filter body is attached to the distal end of the catheter.
15. The method of claim 14 wherein the method further comprises holding the captured thrombus material in the filter body while the filter body is withdrawn from the blood vessel.
16. The method of claim 10 wherein the method further comprises positioning the catheter within a lumen of an outer sheath.
17. The method of claim 16 wherein the method further comprises aspirating the lumen of the outer sheath.
18. The method of claim 17 wherein aspirating the lumen of the outer sheath creates a fluid flow through the filter body.
19. The method of claim 17 wherein aspirating the lumen of the outer sheath creates a fluid flow into the open distal end of the filter body.