Aspiration catheter systems and methods of use
Systems and methods are described for removing an embolus in a cerebral vessel of a patient. The assembled system of devices includes a catheter having a catheter lumen and a distal end and a catheter advancement element extending through the catheter lumen. A tapered distal end region of the catheter advancement element extends distal to the distal end of the catheter. The assembled system of devices is advanced together towards an occlusion site in a cerebral vessel of a patient visible on angiogram. The occlusion site includes an angiographic limit of contrast and an embolus downstream of the angiographic limit of contrast. The catheter advancement element is advanced to a location past the angiographic limit of contrast without crossing the embolus. The catheter is advanced to position the distal end of the catheter at a treatment site located past the angiographic limit of contrast and aspiration applied.
1 . A method of removing an embolus in a cerebral vessel of a patient, the method comprising:
assembling a system of devices, the assembled system of devices comprising: a catheter having a catheter lumen and a distal end, the catheter lumen having an inner diameter of at least about 0.070″; and a catheter advancement element extending through the catheter lumen, wherein a tapered distal end region of the catheter advancement element extends distal to the distal end of the catheter;
advancing the assembled system of devices towards an occlusion site in the cerebral vessel of the patient, the occlusion site identifiable on angiogram, the occlusion site comprising an angiographic limit of contrast and an embolus downstream of the angiographic limit of contrast;
advancing the catheter advancement element to a location past the angiographic limit of contrast so that a distal end of the catheter advancement element is in contact with a portion of the embolus without crossing the embolus;
advancing the catheter over the catheter advancement element to position the distal end of the catheter at a treatment site located past the angiographic limit of contrast;
removing the catheter advancement element from the catheter lumen after the catheter is at the treatment site and allowing the distal end region of the catheter to move in a distal direction through the cerebral vessel so the distal end of the catheter seats against a proximal face of the embolus; and
applying aspiration to the catheter after removing the catheter advancement element.
2 . The method of claim 1 , wherein advancing the catheter advancement element comprises positioning a distal end of the catheter advancement element between a portion of the embolus and a vessel wall.
3 . The method of claim 1 , wherein the distal end of the catheter seated onto the proximal face of the embolus compresses the embolus.
4 . The method of claim 1 , wherein advancing the catheter comprises advancing the distal end of the catheter through a soft clot material proximal of the embolus to reach the proximal face of the embolus.
5 . The method of claim 1 , wherein advancing the catheter advancement element comprises positioning a distal end of the catheter advancement element without crossing the embolus with the distal end of the catheter advancement element.
6 . The method of claim 1 , wherein advancing the catheter comprises positioning the distal end of the catheter past the angiographic limit of contrast until resistance is felt indicating the proximal face of the embolus.
7 . The method of claim 1 , wherein the step of advancing the catheter advancement element comprises advancing a distal end of the catheter advancement element as far as possible without buckling of the catheter advancement element.
8 . The method of claim 1 , wherein the step of advancing the catheter advancement element including interrogating the treatment site to locate the proximal face of the embolus.
9 . The method of claim 1 , wherein the step of advancing the catheter advancement element includes using the tapered distal end region of the catheter advancement element to dissect past a soft clot material at the proximal face of the embolus and probe denser material of the embolus.
10 . The method of claim 1 , further comprising capturing occlusive material while applying the aspiration at, within, or through the distal end of the catheter.
11 . The method of claim 1 , further comprising injecting contrast agent into the cerebral vessel to visualize the occlusion site by angiogram.
12 . The method of claim 11 , wherein the contrast agent forms a plurality of visible zones.
13 . The method of claim 12 , wherein a first zone of the plurality of visible zones comprises a high contrast zone located proximal to the angiographic limit of contrast.
14 . The method of claim 13 , wherein the high contrast zone identifies blood flow through the cerebral vessel.
15 . The method of claim 14 , wherein a second zone of the plurality of visible zones comprises a low contrast region zone located distal to the angiographic limit of contrast.
16 . The method of claim 15 , wherein advancing the catheter advancement element comprises positioning a distal end of the catheter advancement element past the low contrast zone and positioning the distal end of the catheter comprises positioning the distal end of the catheter past the low contrast zone.
17 . The method of claim 15 , wherein the low contrast zone infiltrates slowly or minimally with contrast.
18 . The method of claim 17 , wherein the low contrast zone identifies a location of the embolus and/or soft clot material proximal of the location of the embolus.
19 . The method of claim 1 , wherein the distal end region of the catheter advancement element tapers distally from a first outer diameter to a second outer diameter that is smaller than the first outer diameter, wherein the catheter advancement element further comprises a proximal portion comprising a proximal end extending outside a body of the patient, the proximal portion having a single lumen that communicates with a lumen of the catheter advancement element.
20 . The method of claim 19 , wherein the distal end region is formed of a material having a material hardness of about Shore 62A or no more than Shore 35D that transitions proximally towards increasingly harder materials.
21 . The method of claim 19 , wherein the distal end region tapers over a length of 2 cm to 5 cm.
22 . The method of claim 19 , wherein the distal end region tapers over a length of 0.05 cm to 2 cm.
23 . The method of claim 19 , wherein the distal end region tapers along a distance that is between about 1 cm and about 3 cm.
24 . The method of claim 23 , wherein a guidewire is positioned within the lumen of the catheter advancement element such that a distal end of the guidewire is within the catheter advancement element during the step of advancing the assembled system of devices together and is extendable from the catheter advancement element when needed for navigation.
25 . The method of claim 23 , wherein the first outer diameter is at least 1.5 times the second outer diameter.
26 . The method of claim 19 , wherein a distal opening from the lumen of the catheter advancement element has an inner diameter between 0.018″ and 0.024″.
27 . The method of claim 19 , wherein the second outer diameter is between about 0.026″ and about 0.040″.
28 . The method of claim 27 , wherein the first outer diameter is between about 0.062″ and about 0.080″.
29 . The method of claim 19 , wherein the catheter advancement element comprises at least one radiopaque marker along its length.
30 . The method of claim 19 , further comprising at least one radiopaque marker identifying the distal end region of the catheter advancement element.
31 . The method of claim 30 , further comprising a first radiopaque marker disposed near the first outer diameter and a second radiopaque marker disposed near the second outer diameter.
32 . The method of claim 1 , wherein the catheter comprises a flexible distal luminal portion and a proximal tether element extending proximally from a point of attachment near a proximal end of the flexible distal luminal portion, the proximal tether element extending proximally to outside a body of the patient.
33 . The method of claim 32 , wherein an outer diameter of the proximal tether element at the point of attachment is smaller than an outer diameter of the distal luminal portion at the point of attachment.
34 . The method of claim 1 , wherein the assembled system of devices further comprises a guidewire positioned within the lumen of the catheter advancement element during advancing the assembled system.
35 . The method of claim 34 , wherein the guidewire is positioned within the lumen of the catheter advancement element such that a distal end of the guidewire protrudes from a distal end of the catheter advancement element during at least one of advancing the assembled system of devices together towards the occlusion site, advancing the catheter advancement element to the location past the angiographic limit of contrast, or advancing the catheter over the catheter advancement element.
36 . A method of removing an embolus in a cerebral vessel of a patient, the method comprising:
assembling a system of devices, the assembled system of devices comprising: a catheter having a catheter lumen and a distal end; and a catheter advancement element extending through the catheter lumen, wherein a tapered distal end region of the catheter advancement element extends distal to the distal end of the catheter;
advancing the assembled system of devices towards an occlusion site in the cerebral vessel of the patient, the occlusion site identifiable on angiogram, the occlusion site comprising an angiographic limit of contrast and an embolus downstream of the angiographic limit of contrast;
advancing the catheter advancement element to a location past the angiographic limit of contrast without crossing the embolus so that a distal end of the catheter advancement element is in contact with a portion of the embolus;
withdrawing the catheter advancement element proximally through the catheter lumen of the catheter causing a distal end region of the catheter to move in a distal direction through the cerebral vessel and the distal end of the catheter to seat onto a proximal face of the embolus; and
applying aspiration to the catheter.
37 . The method of claim 36 , further comprising automatically creating vacuum within the catheter due to withdrawing the catheter advancement element.
38 . The method of claim 37 , wherein the vacuum automatically created occurs prior to applying aspiration to the catheter.
39 . The method of claim 36 , further comprising applying a manual force on the catheter to aid in moving the distal end region of the catheter in a distal direction through the cerebral vessel.
40 . The method of claim 36 , wherein the step of advancing the catheter advancement element comprises positioning a distal end of the catheter advancement element between a portion of the embolus and a vessel wall.
41 . The method of claim 36 , wherein the distal end of the catheter seated onto the proximal face of the embolus compresses the embolus.
42 . The method of claim 36 , wherein the distal end of the catheter moves in the distal direction through a soft clot material proximal of the embolus to reach the proximal face of the embolus.
43 . The method of claim 36 , wherein the step of advancing the catheter advancement element comprises advancing a distal end of the catheter advancement element as far as possible without buckling of the catheter advancement element.
44 . The method of claim 36 , wherein the distal end region of the catheter advancement element tapers distally from a first outer diameter to a second outer diameter that is smaller than the first outer diameter, wherein the catheter advancement element further comprises a proximal portion comprising a proximal end extending outside a body of the patient, the proximal portion having a single lumen that communicates with a lumen of the catheter advancement element.
45 . The method of claim 44 , wherein the distal end region tapers over a length of 2 cm to 5 cm.
46 . The method of claim 44 , wherein the distal end region tapers over a length of 0.05 cm to 2 cm.
47 . The method of claim 44 , wherein the distal end region tapers along a distance that is between about 1 cm and 3 cm.
48 . The method of claim 47 , wherein the first outer diameter is at least 1.5 times the second outer diameter.
49 . The method of claim 36 , wherein a guidewire is positioned within the lumen of the catheter advancement element such that a distal end of the guidewire is within the catheter advancement element during the step of advancing the assembled system of devices together and is extendable from the catheter advancement element when needed for navigation.
50 . The method of claim 49 , wherein the step of applying aspiration to the catheter is performed through an RHV of a base sheath through which the system of devices is positioned.
51 . The method of claim 39 , further comprising capturing occlusive material at, within, or through the distal end of the catheter while removing the catheter advancement element.
52 . The method of claim 51 , wherein capturing occlusive material at, within, or through the distal end of the catheter occurs before the step of applying aspiration to the catheter.
53 . The method of claim 36 , wherein the step of applying aspiration to the catheter is performed by removing the catheter advancement element.
54 . The method of claim 53 , wherein a second step of applying aspiration to the catheter is performed through an RHV of a base sheath through which the system of devices is positioned.
55 . The method of claim 36 , further comprising injecting contrast agent into the cerebral vessel to visualize the occlusion site by angiogram, wherein the contrast agent forms a plurality of visible zones comprising a high contrast zone located proximal to the angiographic limit of contrast, wherein the high contrast region zone identifies blood flow through the cerebral vessel; and a low contrast zone located distal to the angiographic limit of contrast.
56 . The method of claim 55 , wherein the low contrast zone infiltrates slowly or minimally with contrast and the low contrast zone identifies a location of the embolus and/or soft clot material proximal of the location of the embolus.
57 . The method of claim 56 , wherein advancing the catheter advancement element comprises positioning a distal end of the catheter advancement element past the low contrast zone and positioning the distal end of the catheter comprises positioning the distal end of the catheter past the low contrast zone.