Rapid aspiration thrombectomy system and method
An intravascular access system for facilitation of intraluminal medical procedures within the neurovasculature through an access sheath. The system includes an aspiration or support catheter having a flexible, distal luminal portion having an inner diameter defining a lumen extending between a proximal opening at a proximal end of the luminal portion and a distal opening at a distal end of the luminal portion. The catheter has a rigid spine coupled to at least the proximal end of the luminal portion and extending proximally therefrom. The system includes a dilator having a flexible, distal dilator portion sized to be received within the lumen of the luminal portion. Associated systems, devices, and methods of use are also described.
1. A method of performing a medical procedure at a treatment site in a cerebral vessel of a patient, the method comprising:
assembling a system of devices, the system of devices comprising:
an aspiration catheter having a flexible tubular portion defining a single catheter lumen extending between a proximal end and a distal end of the tubular portion, the catheter further comprising a solid, proximal control element coupled near a proximal opening from the single catheter lumen and extending proximally from the proximal end of the flexible tubular portion; and
an inner member, having a lumen, and a proximal portion having sufficient rigidity to push the system of devices distally towards the treatment site, the inner member extending through the catheter lumen, wherein a tapered distal end of the inner member extends distal to the distal end of the aspiration catheter forming an assembled system of devices; and
advancing the assembled system of devices together within a petrous portion of an internal carotid artery without a guidewire.
2. The method of claim 1 , further comprising removing the inner member after the aspiration catheter is placed at or near the treatment site.
3. The method of claim 2 , further comprising advancing a treatment device into the catheter lumen so that the treatment device resides at or near the treatment site.
4. The method of claim 2 , further comprising removing occlusive material while applying a negative pressure to the catheter lumen to capture occlusive material at, within, or through the distal end of the aspiration catheter.
5. The method of claim 4 , wherein the step of removing occlusive material comprises:
inserting a retrievable stent device through the aspiration catheter;
capturing the occlusive material with the retrievable stent device; and
removing the occlusive material and the retrievable stent device from the treatment site.
6. The method of claim 1 , wherein the cerebral vessel is an intracranial vessel and wherein the treatment site is an occlusion or a region near a face of an occlusion within the intracranial vessel.
7. The method of claim 1 , wherein the tapered distal end of the inner member tapers distally from a first outer diameter to a second outer diameter that is smaller than the first outer diameter.
8. The method of claim 7 , wherein the distal end of the inner member tapers over a length between 1 cm and 3 cm.
9. The method of claim 7 , wherein the proximal portion extends proximally from the inner member to outside the body of the patient.
10. The method of claim 9 , wherein the proximal portion has a third outer diameter that is smaller than the first outer diameter of the inner member.
11. The method of claim 10 , wherein the proximal portion is a stiff wire or a hypotube.
12. The method of claim 10 , wherein the first outer diameter is between about 0.003″- about 0.010″ smaller than an inner diameter of the catheter lumen.
13. The method of claim 12 , wherein the inner diameter of the catheter lumen is between about 0.040″ to about 0.088″.
14. The method of claim 1 , wherein an outer diameter of the proximal control element of the aspiration catheter at a point of attachment is smaller than an outer diameter of the flexible tubular portion.
15. The method of claim 14 , wherein the proximal control element of the aspiration catheter has sufficient rigidity to push the aspiration catheter distally towards the treatment site.
16. The method of claim 1 , further comprising:
introducing an arterial access device through an insertion site of the patient, the arterial access device comprising an elongate body sized and shaped to be introduced into a carotid artery, the elongate body defining an internal lumen and a distal end; and
advancing the arterial access device into the carotid artery.
17. The method of claim 16 , wherein the advancing the assembled system of devices step is performed after the arterial access device is advanced into the carotid artery and further comprises:
inserting the assembled system of devices into the internal lumen of the elongate body; and
advancing the assembled system of devices through the internal lumen until the distal end of the catheter is past the distal end of the arterial access device.
18. The method of claim 16 , wherein a length of the flexible tubular portion is less than an insertable length of the arterial access device.
19. The method of claim 18 , wherein the insertable length of the arterial access device is between 80 cm and 120 cm and the length of the flexible tubular portion is between 10 cm and 25 cm or between 25 cm and 50 cm.
20. The method of claim 1 , further comprising locking the aspiration catheter and the inner member into a fixed position relative to one another forming a locked assembly, wherein advancing the assembled system of devices comprises advancing the locked assembly.
21. The method of claim 20 , wherein locking the aspiration catheter and the inner member comprises using a mechanical locking element or gripping the aspiration catheter and the inner member by hand.
22. The method of claim 21 , wherein the mechanical locking element is configured to be placed in a locked configuration to maintain the fixed position and an unlocked configuration to allow for relative sliding.
23. The method of claim 1 , wherein advancing the assembled system of devices together further comprises advancing the assembled system of devices together after the distal end of the aspiration catheter is advanced distal to the petrous portion of the internal carotid artery.
24. The method of claim 1 , further comprising manipulating the assembled system of devices as a single unit at a single hemostasis valve.
25. The method of claim 24 , wherein the catheter lumen has an inner diameter of at least 0.072″.
26. The method of claim 24 , further comprising removing the inner member after the aspiration catheter is placed at or near the treatment site.
27. The method of claim 26 , further comprising advancing an interventional device through the hemostasis valve out the distal end of the aspiration catheter to the treatment site.
28. The method of claim 27 , wherein the interventional device is a snare, coil, stent, guidewire, or microcatheter.
29. The method of claim 26 , further comprising removing occlusive material while applying a negative pressure to the catheter lumen to capture occlusive material at, within, or through the distal end of the aspiration catheter.
30. The method claim 29 , wherein the hemostasis valve is on an access sheath and the negative pressure is applied from an aspiration source coupled to the hemostasis valve of the access sheath.
31. The method of claim 24 , wherein the cerebral vessel is an intracranial vessel and wherein the treatment site is an occlusion or a region near a face of an occlusion within the intracranial vessel.