Abstract:
A collapsing clip including a plurality of collapsed self expanding wire frame segments is contained within the distal end of a catheter. The clip can be delivered to the neck of an aneurysm within the neurovascular system using a catheter. The collapsing clip impinges the distal and proximal framed wire segments onto the neck of the aneurysm. The framed wire segments are inter positioned so that the diamond shaped spaces between the wires are substantially blocked. The neck of the aneurysm is blocked by the distal and proximal framed wire segments forming a barrier.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 12/434,137, filed on May 1, 2009, now U.S. Pat. No. 7,993,364, which is a continuation of U.S. patent application Ser. No. 11/039,908 filed on Jan. 24, 2005, now abandoned, which was a divisional of U.S. patent application Ser. No. 09/925,433, filed on Aug. 10, 2001, now U.S. Pat. No. 6,855,154, which claims priority to U.S. Provisional Patent Application No. 60/224,361, filed Aug. 11, 2000. The entire disclosures of these prior applications are incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     The present invention relates to systems and processes for treating an aneurysm, and more particular to an endovascular system and process for collapsing an aneurysm. 
     BACKGROUND OF THE INVENTION 
     Aneurysm treatments have been proposed using a wide variety of processes and devices, which have enjoyed various levels of success and acceptance. Such systems and processes include aneurysm clips, intravascular coils, intravascular injections, detachable intravascular balloons, and the like. 
     These prior devices, however, have proven to be difficult to employ, oftentimes do not lend themselves to deployment in all sizes of aneurysms, can be imprecise in their deployment, their installation can be very time consuming, risk rupture of the aneurysm because they increase its size, can risk recanalization and/or migration of the device in the patient&#39;s vasculature, and may not treat the mass effect that the aneurysm may have caused. Furthermore, the presence of adhesions in the aneurysm makes it difficult to collapse the aneurysm. There therefore remains an unmet need in the art for systems and processes which do not suffer from one or more of these deficiencies. 
     SUMMARY OF THE INVENTION 
     According to a first aspect of the invention, a method of treating an aneurysm in a patient comprises the steps of advancing a compressed clip through the distal end of a catheter and into the aneurysm, expanding portions of the clip inside the aneurysm, and folding a distal segment of the clip on itself together with the adjacent wall of the aneurysm as it becomes dislodged from the stretching bar. 
     According to a second aspect of the invention, a system useful for treating an aneurysm in a blood vessel of a mammalian patient, the aneurysm having a neck, a wall, and a cavity, comprises an elongated shaft having a proximal end, a distal end, a longitudinal direction defined between the proximal end and the distal end, and including at least one lumen extending therethrough, and a self-expanding frame positioned at the distal end of the shaft, the frame including a plurality of self-expanding sections and at least one joint, each of the plurality of self-expanding sections having an unbiased, expanded condition and a biased, collapsed condition, each of the plurality of self-expanding sections being foldable about one of the at least one joint when in a biased, collapsed condition. 
     According to a third aspect of the invention, a catheter useful for accessing a vascular location adjacent to an aneurysm, comprises a hollow shaft including a proximal end, a distal end, a longitudinal direction defined between the proximal end and the distal end, a port in a distal portion of the shaft, and including at least one lumen extending therethrough. and an inflatable member mounted on the shaft adjacent to the shaft distal end, the inflatable member in fluid communication with the shaft at least one lumen, the inflatable member including a proximal end, a distal end, and a wall between the proximal end and the distal end which extends to the shaft so that the shaft port is directly exposed to the exterior of the balloon, the wall delimiting a central working channel. 
     According to a fourth aspect of the invention, a method of treating an aneurysm in a patient comprises the steps of advancing a compressed clip through the distal end of a catheter and into the aneurysm, expanding portions of the clip inside the aneurysm, and folding a distal segment of the clip on itself together with the adjacent wall of the aneurysm as it becomes dislodged from the stretching bar. 
     Still other objects, features, and attendant advantages of the present invention will become apparent to those skilled in the art from a reading of the following detailed description of embodiments constructed in accordance therewith, taken in conjunction with the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention of the present application will now be described in more detail with reference to preferred embodiments of the apparatus and method, given only by way of example, and with reference to the accompanying drawings, in which: 
         FIGS. 1   a  and  1   b  illustrates longitudinal and cross-sectional views of an exemplary embodiment of an apparatus in accordance with the present invention; 
         FIG. 2  illustrates the apparatus of  FIG. 1  in use according to an exemplary method; 
         FIG. 3  illustrates a step later than that illustrated in  FIG. 2  in the exemplary method; 
         FIGS. 4   a  and  4   b  illustrate a step later than that illustrated in  FIG. 2  in the exemplary method, utilizing two embodiments of apparatus illustrated in  FIG. 1 ; 
         FIGS. 5   a  and  5   b  illustrate two embodiments of apparatus in accordance with the present invention; 
         FIGS. 6   a - 6   c  illustrate successive steps of use of an apparatus in accordance with the present invention; 
         FIG. 7  illustrates a vascular aneurysm after collapse thereof in accordance with the present invention; 
         FIG. 8  illustrates a distal end of yet another embodiment of a device in accordance with the present invention; 
         FIG. 9  illustrates a side elevational view of a catheter in accordance with the present invention; 
         FIG. 10  illustrates a top plan view of the catheter of  FIG. 9 ; 
         FIGS. 11-17  diagrammatically illustrate several steps of treating an aneurysm in accordance with an aspect of the present invention; 
         FIGS. 18-21  diagrammatically illustrate several steps of treating an aneurysm in accordance with another aspect of the present invention; 
         FIG. 22  illustrates a distal end of yet another embodiment of a device in accordance with the present invention; and 
         FIGS. 23-28  diagrammatically illustrate several steps of treating an aneurysm in accordance with yet another aspect of the present invention. 
     
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Apparatus and methods in accordance with the present invention have numerous advantages over prior aneurysm clips and methods. Among these advantages, immediate closure of an aneurysm can be achieved with a relatively easy-to-use method. The apparatus and methods can be used to treat all aneurysms regardless of the size or the neck width, and can achieve precise locational deployment and decreased procedure time. The risk of rupture can be decreased, since the aneurysm volume is never increased. Additionally, occlusion of the aneurysm neck can be achieved by a balloon in case rupture does occur. Decreased risk of distal embolization, little or no risk of recanalization or migration, strengthening of the arterial wall at the site of the aneurysm, good visualization of the device during and after deployment, and immediate elimination of any mass effect the aneurysm may have caused can also be achieved. 
     Referring to the drawing figures, like reference numerals designate identical or corresponding elements throughout the several figures. 
       FIGS. 1   a  and  1   b  illustrate a first exemplary embodiment of a system in accordance with the present invention. The system  100  includes a triple lumen catheter  102  having a sidewall  104  and three lumenae  106 ,  108 ,  110  extending longitudinally therethrough. An inflatable member  112 , such as a balloon. is positioned adjacent a distal end  114  of the catheter, and is in fluid communication with one of the three lumenae, e.g., lumen  106 . A collapsible element or clip  116  is removably mounted to the distal end of the catheter and is movable between a retracted and collapsed condition, illustrated in  FIG. 1   a , and an extended and expanded condition, illustrated in  FIGS. 4   a ,  4   b ,  5   a , and  5   b . In order to effect collapse and expansion of the clip  116 , a longitudinally movable stretching bar  118  extends proximally from the distal end of the catheter, and preferably extends both within the clip  116  and the one of the catheter lumenae, e.g., lumen  108 . 
     The system  100  also preferably includes a flexible portion in the distal end of the catheter  102  so that the catheter can more easily navigate the sometimes tortuous paths encountered during endovascular procedures. By way of example and not of limitation, a spring  120  can be incorporated into the distal portions of the catheter  102 , preferably proximal of the balloon  112 , to permit the catheter to more easily flex and bend. A pair of steering wires  122  are attached to the catheter distal to the flexible portion  120  and to a steering mechanism or station  124  at the proximal end of the catheter. Steering mechanisms for catheters have previously been proposed in the patent literature, and therefore a detailed description of station  124  will be omitted herein. 
     The catheter  102  also preferably includes at least one, and more preferably, several distal side perfusion holes  126  which are in fluid communication with one of the three lumenae, e.g., lumen  110 . The catheter also includes a one way valve  128  positioned distally of the balloon  112  and also in fluid communication with one of the lumenae. Valve  128  is oriented to permit a vacuum drawn in the catheter to suction through the valve, for purposes which will be explained in greater detail below. In accordance with one preferred embodiment, both the side holes  126  and the valve  128  are in fluid communication with the same lumen; because the one way valve  128  only permits flow into the catheter through the valve, perfusion of fluid, e.g. contrast agent, through the side holes  126  will not exit out the catheter through the valve. 
     Turning briefly to  FIGS. 5   a ,  5   b , and  6   a - 6   c , further details of clips in accordance with the present invention are illustrated. In general, clips in accordance with the present invention are releasable from the catheter or other deployment device inside an aneurysm. The clips also have a collapsed condition into which the clips are biased by their own structures, and an expanded condition into which the clips must be moved.  FIGS. 5   a  and  5   b  illustrate two different versions of a clip  116  in an expanded condition, with the stretching bar  118  extending through the catheter  102  and through the clip  116 . As illustrated in  FIGS. 5   a  and  5   b , the stretching bar  118  also includes a thread, wire, or the like  130  which is connected to the distal most end of the stretching bar and extends proximally through the catheter  102 , preferably within the stretching bar itself. 
     The stretching bar  118  includes at least one, and preferably several telescoping sections  132   a - f  of decreasing outer diameter. Thus, section f can slide into section e, section e into section d, and so forth, when the wire  130  is pulled proximally. The clip  116  includes at least one, and preferably several rings  134   a - f  which are releasably held on the outer surface of the stretching bar  118 , e.g., by a friction fit, a frangible coupling, or the like. To each ring  134  a set of arms  136  are attached so that the arms can articulate and fold in toward the stretching bar, in a manner somewhat similar to an umbrella. An outer trellis or covering  138  extends between the opposite ends of the arms. 
     In order to deploy the clip  116 , the distal end of the catheter  102  is positioned in the neck of an aneurysm, as illustrated in  FIG. 2 . The stretching bar, which is already in its own expanded condition, is pushed distally, carrying with it the collapsed clip  116 . As the clip exits the distal end of the catheter, as through a distal port  140 , successive sections of the clip expand outward until the clip is fully exposed and outside of the catheter. The wire  130  is then pulled proximally, causing the sections of the stretching bar to telescope into one another, with the distalmost section  132   f  moving proximally first into the next most distal section  132   e . As the distalmost end of the section  132   f  moves into the distalmost end of the section  132   e , the ring  134  which was received on the section  132   f  is pulled off of the stretching bar, leaving that distalmost section of the clip collapsed proximally against the adjacent section. The wire  130  is pulled proximally until each of the sections  132  has telescoped into the adjacent section, causing a collapsing cascade of the clip sections proximally. When the proximalmost section of the stretching bar has been retracted, the clip is left fully collapsed and separated from the stretching bar and the deployment device, e.g., catheter  102 .  FIGS. 6   a - c  illustrate successive views of this serial collapse of the clip from a side view, while  FIG. 7  schematically illustrates the completely collapsed clip in situ. 
     According to additional embodiments, the releasable connections between the arms  136  and the stretching bar  118  can be formed as twist locks, meltable connections, for which a resistive heater is positioned at each arm and voltage source is connected thereto, or the like as will be readily appreciated by one of ordinary skill in the art. 
     Turning now to  FIG. 8 , yet another embodiment of a clip in accordance with the present invention is illustrated. Clip  200  includes a longitudinally extending hollow, preferably cylindrical shaft  202  which extends to a closed, and optionally sealed, distal end  204 . A self-expanding frame  206  is mounted about the distal portions of the shaft  202 , and includes a number of segments which can fold about a number of collapsing joints  208 . Preferably, the joints  208  are positioned in an alternating fashion on different sides of the clip  200 , so that the clip can be folded up in an accordion-type manner. When each of the segments of the frame  206  fold about each joint  208 , that segment folds onto an adjacent segment, as described in greater detail below. Each joint  208  includes a laterally extending leaf spring which has an unbiased, V-shaped orientation and a biased, flat orientation. Because of the presence of the spring in each joint  208 , each segment is biased to fold upon itself, as illustrated in the drawing figures. A stiffening wire, stretching bar, or mandrel  210  extends through each of the segments of the frame, and prevents the springs of each of the joints  208  from folding each segment upon itself, as described in greater detail below. 
     The stiffening wire or stretching bar  210  extends longitudinally through the shaft  202 . The wire or bar  210  allows the practitioner to straighten or laterally collapse the frame  206 ; that is, when the bar/wire/mandrel  210  is pushed distally against the distal end  204 , the frame  206  can be stretched and collapsed, and proximal retraction removes this force on the frame and permits the frame to expand. Self-expanding frames are well known to those of skill in the art, such as those known for use in constructing vascular stents, and therefore the constructional details of frame  206  are omitted from this description for brevity&#39;s sake. As described in greater detail below, the self-expanding frame is constrained from expanding when advanced through the vasculature because the frame is carried in a catheter shaft which is sized to prevent the frame from expanded until the clip is moved out of the catheter. Such a practice is also known in the art of vascular stents, which are typically carried in a collapsed condition inside a carrier catheter, and thereafter pushed out of the catheter which permits them to expand. 
     Preferably, at least portions of the shaft  202  are configured so that upon rotation of the shaft about the longitudinal axis, the shaft is released from the frame  206 . By way of example and not of limitation, distal portions of the shaft  202  can include a detent which will pass through correspondingly sized and shaped holes in the sections of the frame  206  only when the shaft is rotated to align the detent and hole. Other suitable mechanisms will be readily apparent to those of skill in the art. 
       FIGS. 9 and 10  illustrate side elevational and top plan views, respectively, of a catheter  220  which is useful for accessing and positioning a clip, such as clip  200 , in an aneurysm  10 . The catheter  220  includes a longitudinally extending shaft  222  dimensioned and formed of materials so that it can traverse the vasculature of the patient to be positioned immediately next to an aneurysm that the practitioner intends to treat. An inflatable balloon  224  is mounted on the distal end of the shaft  222 , and includes proximal  226  and distal  228  inflatable portions. A central working channel  228  is formed in the balloon  224  by a portion  246  of the wall of the balloon extending inward to the shaft  222 . Preferably, at least one, and more preferably several radiopaque markers  230  are located around the central working channel  228  so that its position in the patient can be monitored fluoroscopically. 
     The catheter  220  also preferably includes a mechanism or the like which directs a clip radially outward through the working channel  228  when the clip is pushed distally through the shaft  222 . According to one exemplary embodiment, this mechanism can be a ramp shaped surface formed in the lumen of the shaft  222 , so that when the clip is pushed distally through the shaft, the clip&#39;s distal motion is converted into radial motion out of the shaft and into the working channel. According to yet another exemplary embodiment, a deflectable tube  234  can be mounted on the shaft at the base of the working channel  228 , and a steering thread  232  is attached to the tube  234 . The steering thread extends proximally through the shaft  222  and exits the shaft or is otherwise made available to the practitioner to manipulate. Upon proximal pulling on the steering thread  232 , the tube  236  can be deflected to point toward the central working channel  228 , thus directing any clip, such as clip  200 , which is pushed through the tube  234  into the working channel. 
     Several lumenae extend through the shaft  222 . A suction lumen  236  extends from a distal port  248 , located where the working channel  228  meets the shaft  222 , to a proximal fitting or suction end  238 , and includes a lock  242 . The lock  242  is operable to seal the lumen  236  so that a relative vacuum can be maintained in the lumen. For example, lock  242  can be a stopcock valve. A proximal fitting  244  leads to another lumen of the shaft  222 , and is the lumen which leads to the deflectable tube  234  and is the lumen in which the clip, e.g., clip  200 , is longitudinally advanceable. Thus, the clip  200  can be loaded through the fitting  244  or the tube  234 , into the shaft  222  with proximal portions of the clip extending proximally out of the fitting  244 . In this orientation. the clip is in a collapsed condition because the internal dimensions of the lumen are selected to constrain the clip from self-expanding. Thereafter, the clip can be advanced distally, through the tube  234  and laterally into the working channel  228 . 
       FIGS. 11-17  illustrate several steps in an exemplary method in accordance with the present invention which utilizes clip  200  and catheter  220 , and are described in more detail below. 
     Turning now to  FIG. 22 , yet another embodiment of a clip in accordance with the present invention is illustrated. Clip  300  includes a longitudinally extending hollow, preferably cylindrical shaft (not illustrated) which contains a wire/bar/mandrel  308  to move the clip into an aneurysm. A pair of circular or oval self expanding frames  302 ,  304  are mounted on the end of the clip  300 , and include a spring activated collapsing joint  306 . See  FIG. 27  and  FIG. 28 . As in other embodiments herein, radiopaque markers  310  are preferably provided on the frames to assist in positioning the clip  300  in the aneurysm neck  12 . The diameter of the self expanding frames is broader than the diameter of the neck. See  FIG. 25  through  FIG. 28 . The joint  306  includes at least one, and preferably a plurality (two are illustrated) leaf springs, as described above. The springs are oriented with both ends on one lateral side of the each of the frames, Le., a first V-spring is mounted on the right side of the frames as illustrated in  FIG. 22 , and a second V-spring is mounted on the left side of the frames. Thus, when unconstrained by a carrying catheter, such as catheter  220 , the frames tend to open up to the orientation illustrated in  FIG. 22  and form a barrier  312 . The clip is therefore self expanding. The frames support a lattice  309 A and  309 B. The alignment of the lattice cross structure  309 A of the distal frame  302  can be offset from the alignment of the lattice cross structure  309 B for the proximal frame  304 . Hence when the frames are brought together by collapse of the joint  306 , the combined frames form a barrier across the aneurysm neck. See  FIG. 28 . 
     Another aspect of the present invention includes methods of treating an aneurysm. Several embodiments of methods in accordance with the present invention will now be described with reference to several of the drawing figures, and with reference to several of the exemplary devices described herein. The methods of the present invention are not restricted to the particular devices described herein, but may be performed using other devices which are employable into an aneurysm cavity and onto the outer surface of which the aneurysm wall can be collapsed. By way of example and not of limitation, vascular coils, such as those described in the numerous U.S. patents to Guglielmi et al (see, e.g., U.S. Pat. No. 6,083,220), can be used as a device in the methods of the present invention. 
     A first exemplary embodiment of a method in accordance with the present invention, given by way of example and not of limitation, includes, but is not limited to, the steps of:
         1. Perform a road-mapping arteriogram with measurement of the three dimensional size of an aneurysm  10  and its neck  12  within the small and tortuous neurovascular systems.   2. Access the aneurysm neck using a steerable catheter, e.g. catheter  102 .   3. Lock the distal end of the catheter in a position perpendicular to the center of the neck transverse axis.   4. Slowly inflate a balloon mounted on the distal end of the catheter with a diluted contrast medium up to the previously measured size of the neck (see  FIG. 2 ).   5. Verify complete occlusion of the neck  12  by injection of contrast agent through side holes in the catheter positioned just proximal to the balloon, and simultaneously applying suction through a one-way valve at the distal end of the catheter. When no inflow of the contrast into the catheter is demonstrated together with deformation of the aneurysm with the suction, the aneurysm neck is completely closed.   6. With the neck completely closed, continue suction to almost complete collapse of the aneurysm by creating a vacuum within the aneurysm (see  FIG. 3 ).   7. Obtain transverse and longitudinal measurement of the aneurysm, e.g. using MRI, CT scan, or the like.   8. Advance a compressed clip, the size of which has been chosen according to the previous measurements, through the distal end of the catheter. The clip, which is constructed using a principal similar to a self-expanding vascular stent, will start to expand as it is advanced into the aneurysm. The transverse axis of the clip is preferably maintained parallel to the longitudinal axis of the artery  14  from which the aneurysm  10  is arising (see  FIGS. 4 and 5 ).   9. Maintain the vacuum within the aneurysm with continuous suction to ensure adherence of the aneurysm wall to the sides of the clip ( FIG. 6   a ).   10. Begin proximal pulling of the wire or thread mounted within the stretching bar to telescope the very distal segment into the next proximal segment (see  FIG. 6   b ).   11. The distal segment of the clip, which folds on itself if not stretched from both ends as described above, will start folding on itself together with the adjacent wall of the aneurysm as it becomes dislodged from the stretching bar (see  FIG. 6   c ). The aneurysm wall is held to the outside of the clip by the suction.   12. By repeating the process described in steps  10  and  11 , successive segments of the stretching bar and clip will continue to fold and complete collapse of the aneurysm will be achieved. (see  FIG. 7 ) The catheter can then be withdrawn.       

     A second exemplary embodiment of a method in accordance with the present invention, given by way of example and not of limitation, includes, but is not limited to, the steps of:
         1. Perform a road-mapping arteriogram.   2. Obtain measurements of the aneurysm, the neck of the aneurysm, and the parent artery.   3. Using a transvascular approach, e.g., a right femoral approach, position the balloon catheter  200  in the parent artery (using the guidance of the radiopaque markers on the periphery of the central working channel) with the distal segment of the balloon distal, e.g., immediately distal, of the aneurysm neck, and the proximal segment proximal, e.g., immediately proximal, to the aneurysm neck (see  FIGS. 9-11 ).   4. Slowly inflate the balloon to achieve occlusion of the parent artery both proximal and distal to the neck.   5. Pull the steering thread within the catheter shaft to direct the steerable section of the catheter to a position as close and as perpendicular as possible to the neck (see  FIG. 12 ).   6. Apply a moderate amount of suction using a suitable device, e.g., a syringe attached to a lock mounted on the proximal end of the catheter to decompress the aneurysm; activate the lock to maintain the relative vacuum in the aneurysm (see  FIG. 10 ).   7. Stiffen the distal segment of the aneurysm clip with the stiffening wire by pulling on the proximal segment of the wire and then push it until it reaches the sealed top of the clip.   8. Push both the stiffening wire and the clip into the aneurysm cavity, firmly holding both of these elements together; the self-expanding frame of the clip will start to expand as the clip is deployed (see  FIG. 13 ).   9. Apply strong suction through the catheter to collapse the aneurysm wall completely around the expanded clip (see  FIG. 14 ).   10. Turn off the vacuum lock at the proximal end of the catheter while applying strong vacuum to the catheter lumen to ensure that a vacuum is maintained within the aneurysm to assist, and preferably ensure, that the aneurysm wall adheres to the outside of the clip.   11. Start pulling the stiffening wire through the sealed proximal end of the catheter to release the most distal segment of the clip, which will fold onto itself about the joint because of the action of the springs in the joints, together with the adjacent aneurysm wall which is held by the vacuum (see  FIGS. 15 ,  16 ), which may be at least in part assisted by the force of the vacuum pushing inward on the frames of the clip.   12. Repeat steps  10  and  11  so that successive segments or sections of the clip continue to fold and at least partial, and preferably complete, collapse of the aneurysm will be achieved (see  FIG. 17 ).   13. Rotate the shaft, e.g., counterclockwise, to dislodge the shaft from the collapsed segment(s) of the clip.       

     A third exemplary embodiment of a method in accordance with the present invention, given by way of example and not of limitation, includes, but is not limited to, the steps of the above described second embodiment, with the following modification. The clip is positioned at the neck of the aneurysm and the very proximal end of the aneurysm segment. Only the portion of the clip that is in the aneurysm is folded, leaving the rest of the aneurysm decompressed but not fully collapsed onto the outer surface of the clip (see  FIGS. 18-21 ). This and other aspects of the invention can be particular useful in the treatment of aneurysms which include adhesions, which make complete collapse of the aneurysm wall difficult because they make the wall less pliable. 
     A fourth exemplary embodiment of a method in accordance with the present invention, given by way of example and not of limitation, includes, but is not limited to, utilizing the clip  300  (see  FIG. 22 ) in the following manner and including the steps of:
         1. Perform steps  1 - 6  as described in the second embodiment above.   2. Introduce the distal segment of the clip  300  to a point just distal of the neck of the aneurysm  10 , i.e., just inside the aneurysm cavity (see  FIG. 25 ).  FIG. 25  shows the diameter of the expanded distal segment of the clip to be larger than the diameter of the aneurysm neck  12 .   3. Apply strong suction and lock it in to maintain vacuum in the aneurysm cavity.   4. Pull the distal segment  302  of the clip to push (fold) down the aneurysm neck  12  (see  FIG. 26 ).   5. Introduce the proximal segment  304  of the clip into the parent artery  14 , e.g., through a catheter  220 , just proximal of the neck and permit or cause the joint of the proximal segment to collapse thereby compressing the neck (see  FIG. 27 ).   6. Dislodge the pushing wire by turning it, e.g., in a counterclockwise direction (see  FIG. 28 ). The double frame of the proximal and distal clip occludes the flow of blood into the aneurysm. The double frame comprises a barrier  312  to an aneurysm created by the self expanding distal and proximal segments installed and forming a barrier across the aneurysm neck. The combined effect of the proximal and distal frame of the clip is to form a permanent barrier across the neck of the aneurysm to impede or obstruct the blood flow to the inside sac of the aneurysm leading to thrombosis and occlusion of the aneurysm. Also the lattice of the frame acts as a scaffolding for the lining of the vessel to grow causing permanent sealing of the aneurysm.       

     As will be readily appreciated by one of skill in the, the present invention also extends to the combination of a deployment catheter, such as catheter  220 , with any of the embodiments of the aneurysm clips described herein to access and treat an aneurysm. 
     While the invention has been described in detail with reference to preferred embodiments thereof, it will be apparent to one skilled in the art that various changes can be made, and equivalents employed, without departing from the scope of the invention. Each of the aforementioned published documents is incorporated by reference herein in its entirety.