Delivery system and method for self-centering a proximal end of a stent graft
A method for implanting a prosthesis centrally within a curved lumen includes loading a prosthesis into a delivery sheath, advancing the sheath in a patient towards the curved lumen to place at least the proximal end of the prosthesis within the curved lumen, and centering the proximal end of the prosthesis and/or the distal end of the sheath within the curved lumen. In a first advancing step, the outer catheter containing the inner sheath is advanced together towards the curved lumen to a location proximal of the curved lumen and, in a second advancing step, the inner sheath containing the prosthesis is advanced into the curved lumen to place at least the proximal end within the curved lumen while the outer catheter substantially remains at the location. After centering, the proximal end of the prosthesis is deployed centered within the curved lumen.
1. A centering system for an aortic stent graft prosthesis, comprising:
a) guidewire catheter ( 620 ) having a proximal end and a distal end;
b) a nose cone ( 630 ) fixed to the distal end of the guidewire catheter ( 620 );
c) an apex capture device ( 634 ) at the nose cone ( 630 );
d) a stent graft prosthesis ( 1 , 1100 ) having a proximal end 02 ) and a distal end ( 14 ), and a clasping stent ( 1130 ) defining bare apices ( 1132 ) at the proximal end of the stent graft prosthesis ( 1 , 1100 ), wherein, during delivery to a treatment site, the apices ( 1132 ) are releasably captured by the apex capture device ( 634 );
e) an inner sheath ( 652 ) extending about the stent graft prosthesis ( 1 , 1100 );
f) a plurality of wires ( 480 ), each independently fixed to the apex capture device ( 634 ) and collectively distributed radially about the guidewire catheter ( 620 ), wherein the plurality of wires ( 480 ) extend distally between the stent graft prosthesis ( 1 , 1100 ) and the inner sheath ( 652 ), whereby relative longitudinal movement of the wires ( 480 ) along the guidewire catheter ( 620 ) causes a change in orientation of the apex capture device ( 634 ) at the proximal end of the stent graft prosthesis ( 1 , 1100 ) to thereby center the proximal end of the stent graft prosthesis ( 1 , 1100 ) within an aorta at a treatment site; and
g) a tapered windsock ( 490 ) outside of the stent graft prosthesis ( 1 , 1100 ), the tapered windsock ( 490 ) having a proximal open end ( 492 ) and a distal end ( 494 ) that is smaller than the proximal open end ( 492 ), the proximal open end being attached to the apex capture device ( 634 ) by sutures, wherein the distal end ( 494 ) of the tapered windsock ( 490 ) is attached to a portion of the remainder of the centering system distal to the proximal end ( 12 ) of the stent graft ( 1 , 1100 ), and wherein the distal end ( 494 ) of the tapered windsock ( 490 ) defines openings.