Methods and systems for treatment of acute ischemic stroke
A system of devices for treating an artery includes an arterial access sheath adapted to introduce an interventional catheter into an artery and an elongated dilator positionable within the internal lumen of the sheath body. The system also includes a catheter formed of an elongated catheter body sized and shaped to be introduced via a carotid artery access site into a common carotid artery through the internal lumen of the arterial access sheath. The catheter has an overall length and a distal most section length such that the distal most section can be positioned in an intracranial artery and at least a portion of the proximal most section is positioned in the common carotid artery during use.
1. A catheter system comprising:
1) an access sheath comprising a tubular sheath body with a central lumen having a uniform inner diameter, a proximal end and a distal opening;
2) a first catheter comprising:
a distal portion having a single inner lumen extending between a proximal opening and a distal opening at a distal end of the distal portion and an outer diameter that is smaller than the uniform inner diameter of the access sheath; and
a proximal tether extending proximally from a point of attachment between the proximal tether and the distal portion near the proximal opening,
wherein the first catheter is sized to extend from a femoral access site to a carotid artery,
wherein the first catheter is configured to slide within the central lumen of the sheath body to change the relative position of the first catheter within the central lumen and provide for at least a portion of the distal portion to extend through the distal opening of the sheath body such that an overlap region is formed between the first catheter and the access sheath, and
wherein a seal is formed in the overlap region between an outer surface of the first catheter and an inner surface of the central lumen of the sheath body, and wherein a contiguous lumen is collectively formed by the single inner lumen of the first catheter and the central lumen of the access sheath, wherein the seal is sufficient for aspiration thrombectomy and/or removal of a clot through the contiguous lumen; and
3) an assembled system of devices comprising:
a second catheter comprising a lumen extending between a proximal end and a distal end; and
an inner member having a length and an outer diameter smaller than the inner diameter of the second catheter so as to extend through the lumen of the second catheter, the inner member being a single-lumen tube with a tapered distal end region, wherein the tapered distal end region of the inner member extends distal to the distal end of the second catheter when assembled with the second catheter, and
wherein the assembled system of devices is sized to insert into the central lumen of the sheath body and through the single inner lumen of the distal portion of the first catheter out the distal end of the first catheter and through a petrous portion of the internal carotid artery,
wherein the inner member is configured to be withdrawn through the lumen of the second catheter upon delivery of the second catheter to the petrous portion of the internal carotid artery.
2. The catheter system of claim 1 , wherein an outer diameter of the proximal tether at the point of attachment is smaller than an outer diameter of the distal portion at the point of attachment.
3. The catheter system of claim 1 , wherein the proximal tether is solid or has a lumen.
4. The catheter system of claim 1 , wherein the distal portion of the first catheter has a first outer diameter and the outer surface of the first catheter has a second outer diameter that is larger than the first outer diameter.
5. The catheter system of claim 1 , wherein the distal portion of the first catheter comprises a step up from a first outer diameter to a larger, second outer diameter located proximal of the first outer diameter.
6. The catheter system of claim 5 , wherein the step up is over a transition section.
7. The catheter system of claim 6 , wherein the transition section is between 3 mm and 10 mm in length.
8. The catheter system of claim 5 , wherein the first outer diameter extends along a distal 10-25 cm and wherein the second outer diameter extends along a remainder of a working length of the distal portion.
9. The catheter system of claim 1 , wherein the assembled system of devices further comprises a guidewire positioned within the single-lumen tube such that a distal end of the guidewire protrudes from the tapered distal end region of the inner member when assembled.
10. The catheter system of claim 1 , wherein the inner member further comprises a proximal portion extending proximally from the inner member to outside the body of the patient, the proximal portion having a single lumen that communicates with the single-lumen tube.
11. The catheter system of claim 1 , further comprising a connector operably connected with the sheath body and is configured to receive the first catheter and the second catheter for insertion of the first catheter and the second catheter into the central lumen of the sheath.
12. The catheter system of claim 11 , wherein the connector is attachable to tubing for drawing aspiration or delivering fluid through the sheath body.
13. The catheter system of claim 1 , wherein the seal is formed in the overlap region by a tight fit between the outer surface and the inner surface.
14. The catheter system of claim 1 , wherein the outer surface of the first catheter and the inner surface of the central lumen of the sheath body forming the seal are cylindrical.
15. The catheter system of claim 1 , wherein the outer surface of the first catheter is an inclined surface flaring outward in a proximal direction forming the seal with the inner surface of the central lumen.
16. A catheter system comprising:
1) a first catheter comprising:
a distal portion having a single inner lumen extending between a proximal opening and a distal opening at a distal end of the distal portion; and
a proximal tether extending proximally from a point of attachment between the proximal tether and the distal portion near the proximal opening, wherein the first catheter is sized to extend from a femoral access site to an intracranial artery; and
2) an assembled system of devices comprising:
a second catheter comprising a lumen extending between a proximal end and a distal end, the proximal end having a connector attachable to a hemostasis valve, the lumen of the second catheter having an inner diameter; and
an inner member having a length and an outer diameter smaller than the inner diameter of the second catheter so as to extend through the connector and into the lumen of the second catheter, the inner member being a single-lumen tube with a tapered distal end region, wherein the tapered distal end region of the inner member extends distal to the distal end of the second catheter when assembled with the second catheter, and
wherein the assembled system of devices is sized to insert into the single inner lumen of the distal portion of the first catheter past the distal end of the first catheter and through a petrous portion of the internal carotid artery,
wherein the inner member is configured to be withdrawn through the lumen of the second catheter upon delivery of the second catheter to the petrous portion of the internal carotid artery.
17. The catheter system of claim 16 , wherein an outer surface of the first catheter is an inclined surface flaring outward in a proximal direction.
18. The catheter system of claim 17 , wherein the inclined surface forms a seal with an inner lumen of an access sheath.