Methods, devices, and systems for postconditioning with clot removal
New devices, systems, and methods are disclosed for preventing, treating, and/or at least minimizing ischemia and/or reperfusion injury by restoring and/or modulating blood flow, particularly in the cerebral vasculature where blood vessels are narrow and tortuous. These devices, systems, and methods make it possible for a clinician to adequately and systematically restore blood flow to ischemic tissue while simultaneously modulating the blood flow to minimize reperfusion injury. New thrombectomy devices and systems, which, for example, expand with greater radial force, further enable improved binding with clots and restoration of blood flow.
1. A method of using an assembly able to treat ischemia in a patient, comprising:
identifying a blood clot in a blood vessel;
inserting a catheter into the blood vessel, the catheter including a proximal region, a distal region, and a single lumen, wherein a pushwire with a proximal end and a distal end is placed at least partially within the single lumen;
modulating blood flow in the blood vessel by selectively decreasing and increasing the flow of fluid through the blood vessel with a flow modulation member at least twice, wherein the flow modulation member is coupled to the distal region of the catheter and comprises an inflatable balloon having a balloon inflation aperture with the single lumen and adapted to receive inflating fluid from the single lumen, wherein one or more sealing members are provided along the lumen to reduce the volumetric flow rate of inflating fluid leaving the single lumen; and
increasing the flow rate in the blood vessel by translating the catheter relative to the pushwire to deploy a flow restoration member, wherein the flow restoration member is coupled to the pushwire near the distal end of the pushwire and comprises a self-expanding scaffold able to engage the clot.
2. The method of claim 1 , wherein the catheter used in the method comprises a first section in the proximal region and a second section in the distal region, the area in the second section of the lumen, in the plane normal to the central axis of the catheter, being smaller than the area in the first section of the lumen, in the plane normal to the central axis of the catheter.
3. The method of claim 2 , wherein the one or more sealing members used in the method comprise a sealing ring coupled to the pushwire at a location in the single lumen proximal to the flow restoration member, wherein the sealing ring is able to engage the distal region of the catheter.
4. The method of claim 1 , wherein the one or more sealing members comprise a sealing tip coupled to the distal end of the catheter, wherein the sealing tip is adapted to selectively sealingly engage when the catheter is translated relative to the pushwire.
5. The method of claim 4 , wherein the sealing tip is able to allow the flow restoration member to pass the sealing tip when the catheter is translated relative to the pushwire.
6. An assembly able to treat ischemic in a patient, comprising:
an intermediate catheter with a proximal region, a distal region, and a single intermediate lumen;
a flow modulation member coupled to the proximal region of the intermediate catheter and comprising an inflatable balloon to reversibly decrease and increase the flow of fluid through a blood vessel for modulating blood flow through the blood vessel, wherein the inflatable balloon has a balloon lumen continuous with the single intermediate lumen and receives inflating fluid from the lumen of the intermediate catheter;
a microcatheter with a single microcatheter lumen, wherein the microcatheter is at least partially within the lumen of the intermediate catheter;
a pushwire with a proximal end and a distal end, wherein the pushwire is at least partially within the lumen of the microcatheter;
a flow restoration member coupled to the distal end of the pushwire and comprising a self-expanding scaffold able to engage a clot in a blood vessel; and
one or more sealing members able to reduce the volumetric flow rate of inflating fluid leaving the single intermediate lumen.
7. The assembly of the claim 6 , wherein the self-expanding scaffold is a stent.
8. The assembly of claim 6 , wherein the intermediate catheter comprises a first section in the proximal region and a second section in the distal region, the area in the second section of the lumen, in the plane normal to the central axis of the catheter, being smaller than the area in the first section of the lumen, in the plane normal to the central axis of the intermediate catheter.
9. The assembly of claim 8 , wherein the one or more sealing members comprise a protrusion which reduces the space between the pushwire and the protrusion through which fluid can flow around the location of the protrusion coupled to the microcatheter, wherein the protrusion facilitates the inflation of the balloon when the protrusion is within or near the distal region of the intermediate catheter.
10. The assembly of claim 9 , wherein the protrusion is annular.
11. The assembly of claim 6 , wherein the one or more sealing members comprise a sealing tip coupled to the distal end of the intermediate catheter, wherein a luminal edge of the sealing tip comes in close proximity with the pushwire and slows the flow of fluid through the lumen when the pushwire is placed through the sealing tip.