Abstract:
A device for removing material from a patient&#39;s body comprising a shaft and an adhesive carrying surface extending from the shaft. The adhesive carrying surface is movable with respect to the shaft and has an adhesive on at least a portion of its outer surface. The adhesive has sufficient stickiness to adhere to a body material to remove the material when the shaft is removed from the patient&#39;s body.

Description:
[0001]     This application claims priority from provisional application Ser. No. 60/799,055, filed May 9, 2006, the entire contents of which are incorporated herein by reference. 
     
    
     BACKGROUND  
       [0002]     1. Technical Field  
         [0003]     This application relates to medical devices for removing plaque, clot or other material from the body or for retrieving foreign bodies from the body.  
         [0004]     2. Background of Related Art  
         [0005]     Currently there exists various mechanical devices for removing a clot from vessels. One current device is in the form of a corkscrew which is twisted into the clot and then pulled out with the clot engaged. Another known device utilizes several jaws which clamp onto the clot to remove the clot.  
         [0006]     These devices suffer from several disadvantages due in part to the fact that clots are not uniform. In addition to varying size and being irregularly shaped, clots vary in their softness/calcification. In fact, this variation in hardness can exist within the clot itself, with some regions being more calcified than others. Due to this variation, a one size mechanical removal device is not always effective in removing the clot. In addition, if not properly grasped, the clot can become detached during the removal procedural, dangerously causing the clot to enter the bloodstream.  
         [0007]     The need therefore exists for an improved device for removing clot or other body material from the vascular system. It would be advantageous if such device reduced the likelihood of the clot detaching from the retrieval device during removal. It would also be advantageous if such device enhanced access to the clot.  
       SUMMARY  
       [0008]     The present application overcomes the problems and deficiencies of the prior art. The present application provides a device for removing body material from a patient&#39;s body comprising a shaft and an adhesive carrying surface extending from the shaft. The adhesive carrying surface is movable with respect to the shaft from an insertion position to an engagement position. An adhesive is on at least a portion of the outer surface, and of sufficient stickiness to adhere to the body material to remove the material when the shaft is removed from the patient&#39;s body.  
         [0009]     In one embodiment, the adhesive carrying surface comprises a balloon. In one embodiment, the proximal surface of the balloon contains the adhesive to adhere to a distal portion of the body material to be removed. In another embodiment, the adhesive carrying surface comprises first and second movable arms, wherein the adhesive is on a surface portion of the arms. In one embodiment, the arms are formed from a shape memory tube cut into sections.  
         [0010]     In one embodiment the adhesive carrying surface comprises at least one arm extending from the shaft wherein the arm is movable with respect to the shaft from a first open position more in line with the shaft to a second position at a greater angle to the shaft to engage body material. In one embodiment, the arm extends toward the proximal end of the shaft.  
         [0011]     In an alternate embodiment, the device further comprises a mesh positioned distal of the adhesive carrying surface wherein the mesh is expandable to engage the body material. A portion of the region between the mesh and the adhesive carrying surface can also have an adhesive material thereon.  
         [0012]     In an alternate embodiment the adhesive carrying material comprises an expandable mesh.  
         [0013]     The present invention also provides a device for removing material from a patient&#39;s body comprising an elongated member having a cutout formed therein and an adhesive on at least a portion of an outer surface of the cutout area. The adhesive has sufficient stickiness to adhere to the body material to remove the material when the shaft is removed from the patient&#39;s body.  
         [0014]     In one embodiment, the elongated member is a guidewire or hypotube. In another embodiment, the elongated member is a catheter. Optionally, at least one spacer can be provided extending from the elongated member to keep the adhesive out of contact with the vessel wall.  
     
    
     BRIEF DESCRIPTION OF DRAWINGS  
       [0015]     Preferred embodiments of the present invention are described herein with reference to the drawings wherein:  
         [0016]      FIG. 1A  is a side view of a first embodiment of the balloon catheter of the present invention showing the balloon with adhesive on its surface in the collapsed (deflated) condition within the delivery sheath;  
         [0017]      FIG. 1B  shows the balloon of  FIG. 1  exposed from the delivery sheath and in the expanded inflated condition.  
         [0018]      FIGS. 1C-1G  illustrate use of the catheter of  FIG. 1  to remove plaque from the vessel, wherein  
         [0019]      FIG. 1C  is a side view of the vessel showing plaque on the vessel wall;  
         [0020]      FIG. 1D  shows the catheter with deflated balloon being inserted to cross the lesion so the balloon is in the area of the vessel containing the plaque;  
         [0021]      FIG. 1E  shows the sheath retracted and the balloon being inflated so the adhesive engages and attaches to the plaque;  
         [0022]      FIG. 1F  shows the balloon inflated and the adhesive engaging and adhering to the plaque; and  
         [0023]      FIG. 1G  shows the balloon deflated and being withdrawn with some of the plaque attached to the balloon.  
         [0024]      FIG. 2A  is a side view of an alternate embodiment of the present invention showing a spherical balloon with an adhesive on its surface in the collapsed condition within the delivery sheath;  
         [0025]      FIG. 2B  illustrates the balloon of  FIG. 2A  in the expanded (inflated) condition exposed from the delivery sheath;  
         [0026]      FIGS. 3A and 3B  are side views showing alternate embodiments of a balloon having an adhesive on its surface, the balloon shown in the inflated condition;  
         [0027]      FIGS. 4A and 4B  are other alternate embodiments of a balloon having an adhesive, the balloon shown in the inflated condition;  
         [0028]      FIGS. 5-8  illustrate an alternate embodiment of the present invention having arms with an adhesive, wherein  
         [0029]      FIG. 5  is a side view of the arms in the collapsed position (condition) within a delivery sheath;  
         [0030]      FIG. 6A  is a side view showing the arms advanced distal of the sheath and in the expanded position;  
         [0031]      FIG. 6B  is a front view of the arms of  FIG. 6A ;  
         [0032]      FIG. 7  shows the device engaging a proximal portion of the clot in the vessel; and  
         [0033]      FIG. 8  shows the clot attached to the arms and being removed from the vessel.  
         [0034]      FIGS. 9-12  illustrate another alternative embodiment of the present invention having proximally facing arms with adhesive, wherein  
         [0035]      FIG. 9A  is a side view showing the arms released from the cover and in the open position;  
         [0036]      FIG. 9B  is a front view of the arms of  FIG. 9A ;  
         [0037]      FIG. 10  shows the open arms positioned distal of the clot in the vessel;  
         [0038]      FIG. 11  shows the device engaging the clot with the cover being retracted to engage the arms; and  
         [0039]      FIG. 12  shows the clot attached to the adhesive surface of the arms and being removed from the vessel.  
         [0040]      FIG. 13A  is a side view of an alternative embodiment of the arms of  FIG. 6  having two arms with adhesive and a series of teeth formed on the clot engaging surface of the arms, the arms shown in the open position;  
         [0041]      FIG. 13B  is a front view of the arms of  FIG. 13A ;  
         [0042]      FIGS. 14A-14C  illustrate another alternate embodiment of a material retrieval device of the present invention, wherein  
         [0043]      FIG. 14A  shows the anchor and mesh of the device in the collapsed position;  
         [0044]      FIG. 14B  shows the anchor and mesh in the expanded position; and  
         [0045]      FIG. 14C  shown the clot attached between the anchor and mesh by adhesive.  
         [0046]      FIG. 15A  illustrates an alternate embodiment of the present invention having a mesh structure with adhesive and a distal ball tip anchor, the mesh shown in the collapsed configuration;  
         [0047]      FIG. 15B  illustrates the mesh structure of  FIG. 15A  in the expanded configuration to enable the adhesive surface to attach to the plaque;  
         [0048]      FIG. 16  illustrates an alternate embodiment of the mesh structure of  FIG. 15A  having cutting blades, the mesh shown in the expanded position;  
         [0049]      FIG. 17  illustrates an alternate embodiment of the present invention having a balloon with adhesive and a catheter with a curved tip;  
         [0050]      FIG. 18A  is a side view of a catheter of the present invention having adhesive (glue nodules) on its outer surface;  
         [0051]      FIG. 18B  is a front view of the catheter of  FIG. 18A ;  
         [0052]      FIG. 19A  illustrates a side view of a dual lumen catheter of the present invention having one of its lumens cut away to create a region for adhesive;  
         [0053]      FIG. 19B  shows the catheter of  FIG. 19A  engaging a clot with its adhesive for withdrawal from the vessel;  
         [0054]      FIGS. 20A-20C  are side views of a catheter of the present invention having an adhesive at the flared end, wherein  
         [0055]      FIG. 20A  shows the catheter being advanced in the vessel;  
         [0056]      FIG. 20B  shows the catheter being further advanced to a position adjacent a clot; and  
         [0057]      FIG. 20C  shows the adhesive engaging a proximal surface of the clot for withdrawal of the clot.  
         [0058]      FIG. 21  is a side view of a hypotube of the present invention having a portion cut away to create a region for adhesive;  
         [0059]      FIG. 22  is an alternate embodiment of the hypotube of  FIG. 21  having a pair of spacers;  
         [0060]      FIG. 23A  is a side view of another alternate embodiment of the present invention having a balloon with a portion removed to create a region for adhesive;  
         [0061]      FIG. 23B  is a front view of the device of  FIG. 23A ;  
         [0062]      FIG. 24A  is a side view of a guidewire of the present invention having a reduced diameter portion to create a region for adhesive;  
         [0063]      FIG. 24B  illustrates the device of  FIG. 24A  engaging a clot with the adhesive for removal from the vessel;  
         [0064]      FIGS. 25A-25C  illustrate an alternate embodiment of the guidewire of the present invention having a clamping arm and a reduced diameter region to receive adhesive, wherein  
         [0065]      FIG. 25  shows the arm cover in the retracted position to maintain the arms in a closed position;  
         [0066]      FIG. 25B  shows the clamping arm exposed from the cover and in an open position to engage clot in the vessel; and  
         [0067]      FIG. 25C  shows the adhesive attached to the clot and the clamping arm clamping the clot for withdrawal from the vessel. 
     
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0068]     In the drawings, wherein like reference numerals identify similar or like components throughout the several views, various embodiments of medical devices of the present invention are described for removing plaque, clots or other materials from the body, and more particularly from blood vessels. The devices can also be used for retrieving foreign bodies such as stents, coils and filters. In general, each of the devices of the present invention has an element with a “sticky” material on at least part of its surface which engages the body material so it adheres or attaches thereto. Once adhered, the device is removed from the vessel, carrying the material with it. The devices herein are shown by way of example withdrawing a particular material, e.g. blood clot or loose plaque. It should be understood that each of these devices can be used to remove/retrieve other body materials, such as kidney stones or foreign materials as well. The term “adhesive” as used herein is to define a biocompatible “sticky” substance that adheres or attaches to the material to be removed with sufficient force so it can be removed. Examples of adhesive material can include, cyanoacrylate, hydrogel and fibrin glue, or a combination of these materials, although it is contemplated that other sticky materials could be utilized. Additionally, a wet adhesive can be used so the surface is sticky when inserted to the desired surgical site or a time release adhesive can be utilized so the adhesive will be released or activated from the surface after a predetermined amount of time, or activated by the addition of an activator to the treatment site. The adhesive can be in the form of a coating placed by methods such as spraying or dipping. Other methods of attaching the adhesive are also contemplated.  
         [0069]     In some embodiments the adhesive is shown covering an entire surface. It should be appreciated that the adhesive can be placed over only a portion of the surface, or placed intermittently on the surface, so long as there is sufficient adhesive to perform the function of attaching the material for retrieval from the body.  
         [0070]     In certain embodiments, the medical device includes a balloon, mesh or other structure radially extending from a catheter which contains the “sticky” material, which could also be of varying degrees of adhesion on the device. In other embodiments, the catheter itself contains the adhesive material. In still other embodiments, designed to provide a lower profile, a portion of a guidewire or hypotube contains the adhesive. These various embodiments are discussed below in detail.  
         [0071]     The device can be advanced through a PTCA catheter, a microcatheter, or delivery sheath, or alternatively, not inserted through any other device and used as a stand alone device as it is inserted to the treatment area.  
         [0072]     In the embodiments of  FIGS. 1-5 , a balloon is utilized to withdraw the material. More particularly, in  FIGS. 1A-1B , the device (catheter) includes sheath  12 , shaft  14  and balloon  16  attached to the shaft. Radiopaque marker bands, such as bands  13  and  15 , can be provided on the shaft or the balloon for visualization. An adhesive material  19  is placed on the outer surface  17  of the balloon. Although adhesive  19  is shown extending along the entire surfaces  17   a,    17   b,  it is also contemplated that it extends only along part of the surfaces or extends on the illustrated angled surfaces, or even over the entire outer surface of the balloon. The balloon  16  is shown in the collapsed position in  FIG. 1A  within delivery sheath  12 . When advanced from the sheath, or the sheath  12  is retracted (or both moved relative to each other), the balloon can be inflated to expand to the position of  FIG. 1B .  
         [0073]     Alternate configurations of the balloon are illustrated in  FIGS. 2A and 2B . In  FIG. 2A , the collapsed balloon  26 , attached to shaft  24 , is in the deflated state within sheath  22  for insertion. Relative movement of the sheath  22  and shaft  24 , i.e. proximal movement of the sheath  22 , distal movement of shaft  24 , or movement of both in opposite directions, exposes the balloon  26  for expansion (inflation) as shown in  FIG. 2B  to an engagement position. Adhesive  29  is shown covering the entire exterior surface, although as explained above with respect to all embodiments herein, covering less of the exterior surface with an adhesive coating is also contemplated.  
         [0074]     In  FIG. 3A , a conical shaped balloon  36  on shaft  34  has adhesive  39  on a proximal surface  37 . The balloon is pulled back proximally so the proximal surface engages and sticks to a distal portion of the material to be removed. The balloon  36  is then further retracted to pull out the material which is adhered to surface  37 . In  FIG. 3B , the proximal tapered or angled outer surfaces  47 ,  48  of balloon  46  have adhesive  49 . The adhesive on these surfaces  47 ,  48  engage and adhere to a distal portion of the material to be removed. The adhesive could optionally be on the distal surface of balloon  36  and  46  to attach to a proximal portion of the clot or other material to be removed. As mentioned above, as in the other embodiments disclosed herein, the adhesive can be placed on the entire surface or only part of the surface of the balloon or other structure.  
         [0075]     Adhesive  59  is placed on the outer surfaces of the different balloon configurations  50 ,  52  of  FIGS. 4A-4B . Coating all or only select parts of the exterior surfaces of the balloons of  FIGS. 3A-4B  is contemplated.  
         [0076]     Use of the adhesively coated balloon to remove plaque will now be described in conjunction with the embodiment of  FIG. 1  by way of example.  FIG. 1C  illustrates plaque P extending from the vessel wall W. The catheter  10  is inserted through the vascular system over guidewire  11  until the balloon  16 , with adhesive  19 , is aligned with the plaque to be removed as shown in  FIG. 1D . The sheath  12  is withdrawn exposing balloon  16 , which is subsequently inflated to engage and loosen the plaque. The adhesive  19  engages the loose plaque as shown in  FIG. 1F , the balloon  16  is deflated, with the loose plaque P 2  attached to the balloon  16  as it sticks to the adhesive  19 , and the catheter  10  with loose plaque is removed in the direction of the arrow as shown in  FIG. 1G .  
         [0077]      FIGS. 5-13B  illustrate alternate embodiments of the present invention utilizing expandable arms with adhesive coating to retrieve the material from the body. Turning first to  FIGS. 5-8 , shape memory tube  100 , preferably made of Nitinol (although other shape memory materials such as platinum or shape memory plastic are contemplated), is cut at its distal end into quarter sections to form four arms  102   a,    102   b,    102   c  and  102   d.  Initially, when inside the delivery sheath  104  for insertion, the arms  102   a - 102   d  are maintained in more of a closed position. When exposed from the sheath  104 , either by movement of the sheath  104 , tube  100 , or both, the arms  102   a - 102   d  return to their open shape memory position as shown in  FIGS. 6 and 7 . The outer surface of arms  102   a - 102   d  has adhesive material  106 . As shown in  FIG. 7 , the arms  102   a - 102   d  are advanced to clot C. When engaged with the proximal portion of clot C within vessel V, the clot adheres to adhesive  106  and the tube  100  is withdrawn from the vessel, in the direction of the arrow of  FIG. 8 . Optionally, depending on the collapsibility of the clot, tube  100  can be withdrawn through the sheath  104 , to remove the clot. The sheath  104  could optionally be advanced prior to removal to provide a clamping force on the arms  102 , to enhance retention of the clot (or other material).  
         [0078]     Optionally, the arms of the cut tube can include a series of teeth to enhance their grasping of the clot. Also, optionally, instead of being formed into quarters, the tube can be cut into halves to form two arms. This is shown for example in  FIGS. 13A and 13B  which has both these features. Shape memory tube  110  is cut at its distal end into half to form two arms  112  and  114 . Each arm has a series of teeth  115  formed on surface  116 . Surface  116  also has an adhesive surface  119  (removed for clarity in  FIG. 13   b ). This device functions in a similar manner as the device of  FIG. 6 . (Other numbers of arms are also contemplated).  
         [0079]     In the embodiment of  FIGS. 9-12 , tube  120  is cut to form two rearwardly facing arms  122  and  124 . The arms  122  and  124  open in the proximal direction. Adhesive  126  is placed on the inner surface  125  of the arms. Adhesive  126  can also optionally be placed on outer surface  121  of tube  120 . Cover or sheath  128  is attached to tube (or wire)  132 . When arms  122  and  124  are contained within the sheath  128 , (for insertion) they are in a more closed position with the arms closer to the tube. When the arms  122  and  124  are no longer constrained by cover  128 , the arms move to their shape memory position as shown in  FIG. 9A .  
         [0080]     In use, the device  100  is advanced in the vessel with the arms  122 ,  124  within cover  128  so that the region of the tube  120  containing the arms is positioned past clot D as shown in  FIG. 10 . The sheath  128  is either advanced from the arms  122 ,  124  or the tube  120  with arms  122  and  124  is retracted from the sheath, or both are moved away from each other. This relative movement exposes arms  122  and  124  and enables them to move to their shape memory open position. The device is retracted so the adhesive  126  engages a distal portion of clot D. Cover  128  is then retracted by retraction of tube  132  to force the arms  122 ,  124  towards their closed position, as shown in  FIG. 11 , to provide additional clamping force on the clot. The device  100  is then retracted through the vessel, in the direction of the arrow of  FIG. 12 , with the clot adhered to arms  122 ,  124  for removal.  
         [0081]      FIGS. 14A-14C  illustrates an alternate embodiment for capturing the clot between an expandable mesh structure and a pair of arms. More particularly, catheter  200  includes an outer tube  202 , preferably composed of shape memory material such as Nitinol (although other shape memory materials are contemplated), cut at its distal end to form two arms  203 ,  204 . Arms  203 ,  204  have an adhesive  208  on their inner surface  213 . A wire (or tube)  206  extends through the outer tube  202  and is attached to ball tip  207  of inner tube  209 . A mesh structure  210  is positioned proximal of the ball tip  207  and attached to inner tube  209 , or formed integrally with tube  209 . An outer sheath  218  maintains the arms  202 ,  204  in the closed (collapsed) position.  
         [0082]     In use, the device  200  is moved relative to the sheath  212  to expose the two arms  203 ,  204 , allowing them to expand radially to their shape memory position as shown in  FIG. 14B . Wire  206  is retracted, thereby pulling ball tip  207  rearwardly, and compressing the mesh structure  210  so it expands radially. (Alternatively, the outer tube  202  could be pushed forward to compress the mesh with the inner tube attached to the outer tube  202  at its distal end.) Mesh structure  210  has an adhesive  212 . Region  209  of tube  206  can also have an adhesive. As shown in  FIG. 14C , clot E adheres to the region  209  of the tube, as well as to proximal surface  211  of mesh  210  and surface  213  of arms  203 ,  204  due to the adhesive. The clot E is also captured, and even in certain instances compressed, between the mesh  210  and arms  203 ,  204  to provide additional grasping force on the clot to facilitate removal.  
         [0083]     In the embodiment of  FIGS. 15A, 15B  a mesh or stent  210  like structure  230  has an adhesive material  236  on its outer surface. The mesh  230  is attached at a distal end to the ball tip  234 . The adhesive can be placed on all or part of the outer surface. Retraction of wire  232  moves ball tip  234  proximally, thereby compressing the mesh  230  and forcing it to expand radially so the adhesive  236  can engage the clot F. The device is shown in  FIG. 15A  inserted through sheath  321 .  
         [0084]     In the embodiment of  FIG. 16 , mesh structure  240  has cutting blades  242  on its outer surface  245 , designed to cut into plaque. Adhesive  243  is attached to the outer surface  245 , and optionally to the blades  242  as well. The mesh is expanded by pull wire  247  in the same manner as in the embodiment of  FIG. 15B . Alternatively, the cutting blades can be placed on a balloon with the balloon and/or blades having an adhesive.  
         [0085]     In  FIG. 17 , catheter  260  has a curled or angled tip  262 . Balloon  264  has an adhesive  266  on its outer surface. Curled tip is placed through the obstruction and the balloon is inflated. The clot is wedged between the inflated balloon  264  and the curled tip  262  to further grasp the clot adhesively attached to the balloon  264 .  
         [0086]      FIGS. 18-25  illustrate another approach to removing clots or other material by use of adhesive in which the adhesive is placed on the catheter or guidewire itself.  
         [0087]     In  FIGS. 18A and 18   b,  glue nodules  302  are placed on the outer surface  303  of catheter  301 . The glue  302  adheres to the clot so removal of the catheter carries the clot from the body. In an alternate embodiment, catheter  301  could be used as an outer covering placed over a guidewire or other catheter, and secured thereto.  
         [0088]     Adhesive can be applied to a skived or cut out region of the catheter, as shown for example in  FIGS. 19A, 19B . Dual lumen catheter  320 , having lumen  321  for receiving guidewire  323 , has a cut out region  322  formed in its side wall. Adhesive material is placed in this cutout area  322 , forming a side “sticky” region. The catheter  320  is placed underneath or above the clot, depending on the clot location and orientation, so the region  322  is aligned with a respective bottom or top portion of the clot. The adhesive region  324  is then moved into contact with the clot L so that it adheres to the adhesive, and the catheter is withdrawn in the direction of the arrow, optionally through sheath  325  (depending on clot collapsibility), carrying the attached clot L from the body.  
         [0089]     Adhesive can alternatively be applied to the distal end of the catheter so the clot can be contacted from its proximal end portion, rather than underneath or above as in  FIG. 19 . This is shown for example in  FIGS. 20A-20C , wherein catheter  330  has a flared end  332  to create an enlarged surface area  335 . Adhesive  334  is attached to the distal surface area  335 . The catheter  330  is advanced to the clot M until its adhesive covered distal end surface is in contact with a proximal end portion of the clot M. The catheter  330  is withdrawn as shown in  FIG. 20C  carrying attached clot M.  
         [0090]     In the alternate embodiments of  FIGS. 21, 22  and  24 , a guidewire or hypotube has an adhesive area, thereby creating a lower profile for clot, plaque or other material retrieval. This is beneficial in cerebral application as well as other applications. The adhesive can be placed directly on the wire or hypotube, or on a transition tube positioned thereover. More particularly, in  FIG. 21 , cut out area  342  of guidewire  340  (or alternatively a hypotube) contains adhesive  344 . This cut out area is positioned proximal of the coiled tip  344  of the guidewire  340 . To keep the adhesive out of contact with the vessel wall, optionally a pair of spacers could be provided as shown in  FIG. 22 . Proximal spacer  356  is positioned proximal of cut out area  352  and distal spacer  354  is positioned distal of the cut out area. Both spacers are proximal to the coiled tip  357 . In this manner, the top and bottom surfaces  354   a,    354   b  and  356   a,    356   b,  have a dimension larger than the cross-sectional dimension (or diameter) of guidewire  350 . Since the plaque or clot extends from the vessel wall, the adhesive  355  can engage the extending portion of the clot without contacting or with minimal contact of the vessel wall. The spacers  354 ,  356 , also reduce the likelihood of vessel wall contact by the adhesive once the guidewire is exposed from sheath  360  and is manipulated in the vessel to the desired site. Spacers can also be provided on the catheter of  FIG. 19 .  
         [0091]     In  FIGS. 24A, 24B , the adhesive  374  is placed on a reduced diameter region  371  of the guidewire  370 , formed between distal and proximal coils,  375 ,  377 , respectively. Clot N is engaged by the adhesive  374  and the guidewire  370  with attached clot is withdrawn in the direction of the arrow of  FIG. 24B .  
         [0092]     In the alternate embodiment of  FIGS. 25A-25C , clamping arms  386  are released by cover  382  in the same manner as in the embodiment of  FIG. 9 . This embodiment differs from that of  FIG. 9  in that instead of adhesive on a catheter, adhesive is placed on a guidewire, and more specifically the reduced diameter region  384  of guidewire  380 . Region  384  is between distal and proximal coils  385 ,  387 . Cover  382  is retracted to move clamping arms  386  towards a closed position to clamp clot F as shown in  FIG. 25C . Adhesive  388  can also optionally be placed on clamping arms  386 .  
         [0093]     In the embodiment of  FIGS. 23A, 23B , a balloon  402 , mounted on catheter shaft  401 , has a cut out region  404 . Adhesive  406  is placed in the cutout region. As in previously described embodiments, the cutout region reduces undesired contact of the adhesive with the vessel wall as it isolates the adhesive from the wall.  
         [0094]     While the above description contains many specifics, those specifics should not be construed as limitations on the scope of the disclosure, but merely as exemplifications of preferred embodiments thereof. For example, although multiple arms are shown, a single arm is also contemplated. Also, although shown as removing a clot, other material can also be removed. Neurovascular, cardiovascular as well as other applications are contemplated. Those skilled in the art will envision many other possible variations that are within the scope and spirit of the disclosure.