Two-piece stent combination for percutaneous arterialization of the coronary sinus and retrograde perfusion of the myocardium
View Patent ↗The present invention contemplates a method for percutaneously providing oxygenated blood retrogradely from the left ventricle via coronary sinus to the heart tissue without a significant left-to-right shunt. The present invention contemplates a two-piece stent combination generally having an arterializing stent and a restricting covered stent.
1. A two-piece stent combination for facilitating retrograde supply of oxygenated blood to heart tissue through a coronary sinus comprising:
an arterializing stent having a leading end configured to be positioned in a left ventricle and a trailing end configured to be positioned in a coronary sinus, and
a restricting covered stent having an underlying restricting stent and a covering, and having a coronary sinus distal end configured to be positioned in the coronary sinus, and a right atrial proximal end, and exhibiting a constriction between said coronary sinus distal end and said right atrial proximal end.
2. Two-piece stent combination according to claim 1 , wherein a cross section of said restricting covered stent tapers toward said constriction.
3. The two piece stent combination according to claim 1 , wherein a cross section of said restricting covered stent is appropriately sized to control blood flow from said coronary sinus into right atrium.
4. The two-piece stent combination according to claim 1 , wherein said arterializing stent further exhibits a constriction along its length and a cross sectional tapering toward the constriction.
5. The two-piece stent combination according to claim 1 , wherein a cross section of said arterializing stent is appropriately sized to control blood flow from said left ventricle into said coronary sinus.
6. The two-piece stent combination according to claim 1 , wherein a cross section of said restricting covered stent at said constriction and a cross section of said arterializing stent are appropriately sized to keep pressure inside the coronary sinus from rising above about 50 mm Hg while avoiding excessive left-to-right shunting.
7. The two-piece stent combination according to claim 1 , wherein a cross section of said restricting covered stent at said constriction and a cross section of said arterializing stent are appropriately sized to keep pressure inside said coronary sinus from rising above about half systemic pressure.
8. The two-piece stent combination according to claim 1 , wherein said restricting covered stent and said arterializing stent allow compression to fit within a delivery catheter.
9. The two-piece stent combination according to claim 1 , wherein said restricting covered stent and said arterializing stent allow expansion after delivery.
10. The two-piece stent combination according to claim 1 , wherein said arterializing stent and said restricting covered stent are flexible.
11. The two-piece stent combination according to claim 1 , wherein said covering of said restricting covered stent is inside underlying restricting stent.
12. The two-piece stent combination according to claim 1 , wherein said covering of said restricting covered stent is outside said underlying restricting stent.
13. The two-piece stent combination according to claim 1 , wherein said covering of said restricting covered stent partially covers said underlying restricting stent.
14. The two-piece stent combination according to claim 1 , wherein said arterializing stent further comprises a covering.
15. The two-piece stent combination according to claim 14 , wherein said covering of said arterializing stent is inside arterializing stent.
16. The two-piece stent combination according to claim 1 , wherein said arterializing stent is from about 1 cm to about 4 cm in length.
17. The two-piece stent combination according to claim 1 , wherein a cross section of said arterializing stent tapers from the trailing end to the leading end.
18. The two-piece stent combination according to claim 17 , wherein said trailing end of said arterializing end is from about 4 mm to about 6 mm in diameter and said leading end of said arterializing stent is from about 2 mm to about 5 mm in diameter.
19. The two-piece stent combination according to claim 1 , wherein said arterializing stent has a constant cross section.
20. The two-piece stent combination according to claim 19 , wherein said arterializing stent is from about 1 mm to about 6 mm in diameter.
21. The two-piece stent combination according to claim 1 , wherein said restricting covered stent is from about 1 mm to about 15 mm in diameter.
22. The two-piece stent combination according to claim 1 , wherein said constriction of said restriction covered stent is from about 1 mm to about 6 mm in diameter.
23. The two-piece stent combination according to claim 1 , wherein said arterializing stent and said restricting covered stent are of mesh construction.
24. The two-piece stent combination according to claim 1 , wherein said arterializing stent and said restricting covered stent are of coiled construction.
25. The two-piece stent combination according to claim 1 , wherein said arterializing stent and said restricting covered stent are connected.
26. The two-piece stent combination according to claim 2 , wherein said right atrial proximal end of said restricting covered stent is positioned within the right atrium.
27. A method for retrogradely supplying oxygenated blood from a left ventricle to heart tissue via a coronary sinus comprising:
puncturing a hole through said coronary sinus and a wall of said left ventricle,
delivering an arterializing stent through said hole, wherein a leading end is placed in said left ventricle and a trailing end is placed in said coronary sinus,
and delivering a restricting covered stent with a coronary sinus distal end positioned within said coronary sinus.
28. The method according to claim 27 , wherein said arterializing stent and said restricting covered stent are delivered percutaneously.
29. The method according to claim 27 , further comprising expanding said arterializing stent after delivery within the hole.
30. The method according to claim 27 , wherein said constriction of said restricting covered stent is positioned to fit approximately within a coronary ostium.
31. The method according to claim 27 , wherein said right atrial end of said restricting covered stent is positioned within a right atrium.
32. The method according to claim 27 , wherein said constriction and said right atrial end of said restricting covered stent are positioned within the coronary sinus.
33. The method according to claim 27 , wherein said arterializing stent is appropriately sized to control blood flow from said left ventricle into said coronary sinus.
34. The method according to claim 27 , wherein said restricting covered stent tapers toward said constriction and is appropriately sized to control blood flow from said coronary sinus into a right atrium.
35. The method according to claim 27 , wherein a cross section at said constriction of said restricting covered stent and a cross section at said arterializing stent are appropriately sized to keep pressure inside the coronary sinus from rising above about 50 mm Hg while avoiding excessive left-to-right shunting.
36. The method according to claim 27 , wherein a cross sectional at said constriction of said restricting covered stent and a cross section at said arterializing stent are appropriately sized to keep the pressure inside the coronary sinus from rising above about half the systemic pressure.