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 thrombus extraction system for removing a vascular thrombus from a blood vessel of a person, the thrombus extraction system comprising:
an outer sheath;
a catheter extending through the sheath, the catheter including a tubular portion with a distal region and an expandable section at the distal region of the tubular portion, wherein the expandable section is tapered having an increasing diameter in a distal direction and an open distal end in an expanded state, and the catheter and the outer sheath are longitudinally moveable with respect to each other;
an elongated structure extending through the catheter and being longitudinally moveable along the catheter; and
an agitator extending from the elongated structure, wherein at least a portion of the agitator extends distally of the expandable section in a deployed state and the agitator is configured to (a) be radially and longitudinally moveable with respect to the expandable section and (b) incrementally engage and macerate a proximal portion of clot material as the agitator moves distally with respect to the expandable section of the tubular portion such that at least a portion of the clot material enters the expandable section and is removed from the blood vessel, and wherein the agitator has flexible members that extend distally and diverge radially outwardly as the agitator moves distally with respect to the expandable section of the tubular portion such that a radially outward-most portion of the members is immediately adjacent an inner surface of the vessel wall, and wherein the radially-outward most portion of the members is at least partially rounded.
2. The system of claim 1 , further comprising a vacuum source configured to fluidically draw clot material into the expandable section.
3. The system of claim 1 wherein the agitator comprises a thrombus extraction member that moves linearly as it engages the thrombus.
4. The system of claim 3 wherein the thrombus extraction member is actively driven longitudinally and radially against the thrombus via the elongated structure to cause a portion of the thrombus to enter the expandable section.
5. A method of capturing and removing a thrombus from a blood vessel in a human, comprising:
advancing an outer sheath to a location proximal a thrombus;
advancing a catheter distally with respect the outer sheath, the catheter having a tubular portion with a distal region and an expandable section at the distal region of the tubular portion, wherein the catheter is advanced distally such that the expandable section is in an expanded state in which it is tapered having an increasing diameter in a distal direction and an open distal end;
advancing an agitator extending from an elongated structure through the catheter such that at least a portion of the agitator extends distally beyond the expandable section of the catheter; and
moving the agitator radially and longitudinally against the thrombus and thereby disrupting material from a proximal portion of the thrombus such that at least a portion of the thrombus enters the expandable member for removal from the blood vessel, and wherein the agitator has flexible members that extend distally and diverge radially outwardly as they expand such that a radially outward-most portion of the members is immediately adjacent an inner surface of the vessel wall, and wherein the radially-outward most portion of the members is at least partially rounded.
6. The method of claim 5 wherein the elongated structure actively drives the agitator axially and radially against the thrombus.
7. The method of claim 5 , further comprising applying a vacuum to the catheter to fluidically draw at least a portion of the thrombus into the expandable section.
8. A thrombus extraction system for removing a vascular thrombus from a blood vessel of a patient, the thrombus extraction system comprising:
a first catheter;
a second catheter extending through the first catheter, the second catheter including tubular portion with a distal region and an expandable section at the distal region of the tubular portion, wherein the expandable section is tapered having an increasing diameter in a distal direction and an open distal end in an expanded state, and the second catheter and the first catheter are longitudinally moveable with respect to each other;
an elongated structure extending through the second catheter and being longitudinally moveable along the second catheter;
an agitator extending from the elongated structure, wherein at least a portion of the agitator extends distally of the expandable section in a deployed state and the agitator is configured to (a) be radially and longitudinally moveable with respect to the expandable section and (b) incrementally engage and macerate a proximal portion of clot material as the agitator moves distally with respect to the expandable section of the tubular portion such that at least a portion of the clot material enters the expandable section and is removed from the blood vessel, and wherein the agitator has members that extend distally and diverge radially outwardly as the agitator moves distally with respect to the expandable section of the tubular portion such that a radially outward-most portion of the members is immediately adjacent an inner surface of the vessel wall, and wherein the radially-outward most portion of the members is at least partially rounded; and a vacuum source fluidically coupled to the first catheter and configured to aspirate the first catheter.
9. The system of claim 8 , wherein the vacuum source is configured to aspirate the first catheter to fluidically draw the clot material into the expandable section.