Methods and apparatus for treating neurovascular venous outflow obstruction
Methods and devices are disclosed for treating neurovascular venous outflow obstructions, with or without implantation of a prosthetic valve. The valve may be carried by a support, such as a stent, which may be self-expandable or balloon expandable. Both transvascular and direct surgical access is contemplated.
1. A method of treating cerebrospinal venous insufficiency to treat the symptoms of multiple sclerosis, comprising the steps of:
identifying a human patient having at least a partial obstruction at a site in a vein of a venous outflow track from the brain;
removing the obstruction; and
implanting a first valve in the vein in fluid communication with the site, to permit venous outflow and reduce retrograde pressure;
wherein the valve comprises a self expandable tubular support having a radially outwardly extending projection having a deployed outside configuration such that the projection deforms a wall of the vein and wherein the implanting step comprises implanting the first valve in the vein such that the wall of the vein deformed by the projection provides an interference fit with a foramen in the base of the skull through which the vein extends to resist migration of the valve within the vein.
2. A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein the removing step comprises inflating a balloon at the site.
3. A method of treating cerebrospinal venous insufficiency as in claim 2 , further comprising removing the balloon and thereafter performing the implanting a valve step.
4. A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein the removing step comprises surgically removing a section of vein.
5. A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein the implanting step comprises surgically attaching the valve.
6. A method of treating cerebrospinal venous insufficiency as in claim 5 , wherein the implanting step comprises implanting a tubular graft having the valve mounted therein.
7. A method of treating cerebrospinal venous insufficiency as in claim 6 , wherein the graft comprises a tubular ePTFE wall.
8. A method of treating cerebrospinal venous insufficiency as in claim 6 , wherein the graft comprises a section of saphenous vein.
9. A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein a second valve is implanted in a left internal jugular vein.
10. A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein a second valve is implanted in a right internal jugular vein.
11. A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein a second valve is implanted in an azygos vein.
12. A method of treating cerebrospinal venous insufficiency as in claim 1 , wherein a second valve is implanted in a superior vena cava.