Anchoring delivery system and methods
An anchoring delivery system for use in an intracranial artery is provided including a tethering device having an elongated tether and an anchor coupled to a distal end of the tether. The anchor is deployable from a low profile configuration to a higher profile configuration to fix the distal end of the tether at an anchoring site in an anchoring vessel. The tethering device is configured to be used with a guide-sheath having a lumen configured to receive the tether. Related devices, systems, and methods 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:
delivering a neurovascular catheter through a working lumen of a sheath to a treatment location distal to a petrous portion of an internal carotid artery, the neurovascular catheter comprising:
an elongate control element configured to advance the neurovascular catheter comprising a flat ribbon; and
a distal luminal portion extending along a longitudinal axis having a proximal end region coupled to the control element, wherein the distal luminal portion has a side wall defining a single, inner lumen, the side wall comprising:
a tubular inner liner;
a reinforcement structure wound around and bonded to the tubular inner liner; and
an outer jacket surrounding the reinforcement structure,
wherein a distal end of the elongate control element is coupled to the proximal end region of the distal luminal portion sandwiched between layers of the side wall, and
wherein the proximal end region of the distal luminal portion includes a step-up in outer diameter to form a seal with the working lumen of the sheath; and
applying suction through the working lumen of the sheath and the single, inner lumen of the neurovascular catheter to the treatment location from a single source of suction.
2. The method of claim 1 , wherein the distal luminal portion has a transition section near where the distal luminal portion couples to the elongate control element.
3. The method of claim 2 , wherein the transition section has an angled cut.
4. The method of claim 3 , wherein the proximal opening is formed within the transition section and the proximal end region of the distal luminal portion is coupled to the distal end region of the control element adjacent the transition section.
5. The method of claim 1 , wherein a proximal end of the elongate flexible control element is coupled to a tab.
6. The method of claim 1 , further comprising organizing the control element of the neurovascular catheter and a component used with the catheter by engaging a reversible coupling feature on the control element to the component.
7. The method of claim 1 , wherein the flat ribbon has a rectangular cross-sectional dimension that is wider than it is thick.
8. The method of claim 1 , wherein a maximum cross-sectional dimension of the flat ribbon is 0.025″.
9. The method of claim 1 , advancing the neurovascular catheter through the sheath from a transfemoral access site to a middle cerebral artery so that the proximal end region of the distal luminal portion remains outside the aortic arch.
10. The method of claim 9 , further comprising the steps of:
inserting the sheath into a blood vessel from the transfemoral access site, wherein the working lumen of the sheath extends between a proximal end region and a distal end region of the sheath, the distal end region having at least one opening in communication with the working lumen; and
advancing the sheath toward a treatment location.
11. The method of claim 10 , further comprising advancing the sheath over a tethering device anchored at an anchoring site proximal of the treatment site.
12. The method of claim 10 , wherein the sheath is advanced to a location within the petrous segment of the internal carotid artery.
13. The method of claim 1 , wherein delivering the neurovascular catheter to a treatment location distal to the petrous portion comprises advancing a catheter system comprising the neurovascular catheter and a catheter advancement element positioned within the inner lumen of the catheter, wherein a tapered distal tip of the catheter advancement element extends distal to a distal end of the neurovascular catheter during the delivering.
14. The method of claim 13 , further comprising withdrawing the catheter advancement element from the single, inner lumen.
15. The method of claim 14 , further comprising placing the distal end of the neurovascular catheter on or near a proximal face of an occlusion at the treatment location.
16. The method of claim 15 , further comprising removing occlusive material while applying suction capturing the occlusive material at, within, or through the distal end of the neurovascular catheter.
17. The method of claim 16 , wherein applying suction through the sheath and the inner lumen of the neurovascular catheter comprises initiating aspiration from the single source of suction at a level suitable for distal embolic protection.
18. The method of claim 16 , wherein applying suction through the sheath and the inner lumen of the neurovascular catheter comprises initiating aspiration from the single source of suction at a level suitable for aspiration thrombectomy.
19. The method of claim 1 , wherein applying suction through the sheath and the inner lumen of the neurovascular catheter comprises applying suction through a contiguous lumen formed by the single, inner lumen of the distal luminal portion and the working lumen of the sheath to remove occlusive material through the contiguous lumen.
20. The method of claim 19 , further comprising delivering a fluid through the working lumen of the sheath.
21. The method of claim 20 , wherein the fluid comprises angiographic contrast, saline, or at least one drug.
22. The method of claim 19 , wherein applying suction through the contiguous lumen comprises applying suction to a distal end of the neurovascular catheter as the neurovascular catheter is retracted inside of the sheath.
23. The method of claim 19 , further comprising advancing a second catheter through the neurovascular catheter to a second treatment location, the second treatment location distal to the first treatment location.
24. The method of claim 23 , wherein the second catheter, the neurovascular catheter, and the sheath form an extended contiguous lumen.
25. The method of claim 24 , wherein applying suction from the single source of suction delivers suction to a distal end of the second catheter through the extended contiguous lumen.
26. A neurovascular catheter, comprising:
an elongate control element configured to advance the catheter, the control element comprising a flat ribbon, a proximal end region, and a distal end region; and
a distal luminal portion extending along a longitudinal axis having a proximal end region coupled to the distal end region of the control element,
wherein the distal luminal portion has a side wall defining a single, inner lumen extending between a proximal opening into the inner lumen at the proximal end region and a distal opening from the central lumen at the distal end region, the side wall comprising:
a tubular inner liner having an outer surface coated with a compound suitable for bonding;
a reinforcement structure that is a helical coil bonded to the coated outer surface of the tubular inner liner; and
an outer jacket surrounding the helical coil,
wherein the distal end region of the elongate control element is coupled to the proximal end region of the distal luminal portion sandwiched between layers of the side wall,
wherein the proximal end region of the distal luminal portion where the distal end region of the elongate control element is coupled has a step-up in outer diameter compared to an outer diameter of the distal luminal portion distal to the proximal end region of the distal luminal portion.
27. A neurovascular catheter as in claim 26 , wherein a distal end of the flat ribbon has a feature that facilitates a mechanical joint during a weld.
28. A neurovascular catheter as in claim 27 , wherein the feature comprises a textured surface, protruding feature, or cut-out feature.
29. Neurovascular catheter as in claim 26 , wherein the distal luminal portion and the flat ribbon are joined by a weld bond, a mechanical bond, or an adhesive bond.
30. A neurovascular catheter as in claim 26 , wherein a distal end of the flat ribbon is skived, ground or cut.
31. A neurovascular catheter as in claim 26 , wherein a region of overlap between a distal end of the ribbon and the proximal end region of the distal luminal portion is at least about 1 cm.
32. A neurovascular catheter as in claim 26 , wherein the distal luminal portion has a transition section near where the distal luminal portion couples to the elongate control element.
33. A neurovascular catheter as in claim 32 , wherein the transition section has an angled cut.
34. A neurovascular catheter as in claim 33 , wherein the proximal opening is formed within the transition section and the proximal end region of the distal luminal portion is coupled to the distal end region of the control element adjacent the transition section.
35. A neurovascular catheter as in claim 26 , wherein a proximal end of the distal luminal portion is angled in an oblique manner relative to a longitudinal axis of the catheter.
36. A neurovascular catheter as in claim 35 , wherein the proximal end and the proximal opening into the lumen are at an angle other than 90 degrees to the longitudinal axis of the catheter.
37. A neurovascular catheter as in claim 26 , wherein the outer jacket is formed from a plurality of tubular segments positioned coaxially about the helical coil.
38. A neurovascular catheter as in claim 37 , wherein a proximal one of the plurality of tubular segments has a durometer of at least about 60D and a distal one of the plurality of tubular segments has a durometer of no more than about 35D.
39. A neurovascular catheter as in claim 26 , wherein the tubular liner comprises polytetrafluoroethylene.
40. A neurovascular catheter as in claim 26 , wherein the helical coil comprises a shape memory material.
41. A neurovascular catheter as in claim 40 , wherein the helical coil comprises Nitinol.
42. A neurovascular catheter as in claim 37 , wherein the outer jacket is formed from at least five discrete tubular segments.
43. A neurovascular catheter as in claim 37 , wherein the outer jacket is formed from more than five discrete tubular segments.
44. A neurovascular catheter as in claim 43 , wherein a difference in durometer between a proximal one of the tubular segments and a distal one of the tubular segments is at least about 20D.
45. A neurovascular catheter as in claim 44 , wherein the difference is at least about 30D.
46. A neurovascular catheter as in claim 26 , wherein the distal luminal portion is non-expandable.
47. A neurovascular catheter as in claim 26 , wherein a proximal end of the elongate flexible control element is coupled to a tab.
48. A neurovascular catheter as in claim 26 , wherein the control element further comprises a reversible coupling feature configured to engage with a component used with the catheter to aid in organization of the catheter and the component.
49. A neurovascular catheter as in claim 26 , wherein a distal end of the tubular segment is angled in an oblique manner relative to the longitudinal axis.
50. A neurovascular catheter as in claim 26 , wherein the flat ribbon has a rectangular cross-sectional dimension that is wider than it is thick.
51. A neurovascular catheter as in claim 26 , wherein a maximum cross-sectional dimension of the flat ribbon is 0.025″.
52. A neurovascular catheter as in claim 26 , wherein a length of the distal luminal portion is sufficient to reach from a transfemoral access site to a middle cerebral artery so that the proximal end region of the distal luminal portion remains outside the aortic arch.