Patent Publication Number: US-10765545-B2

Title: Suture esophageal stent introducer

Description:
RELATED APPLICATION 
     This application claims the benefit of U.S. Provisional Patent Application Ser. No. 62/415,302 filed Oct. 31, 2016, which is incorporated by reference in its entirety. 
    
    
     BACKGROUND 
     1. Technical Field Text 
     This invention relates to a medical device, and in particular to a mechanically expandable device for delivering and deploying a stent or dilation and a method of delivering and deploying the stent into a body lumen. 
     2. Background Information 
     A self-expanding stent is typically introduced into the body using a delivery device that includes an outer sheath coaxially disposed and slidable over an inner catheter. The stent is disposed at the distal end of the device between the inner catheter and the outer sheath and held in a compressed position by the outer sheath. The inner catheter and the outer sheath move coaxially with respect to each other. The stent may be deployed by proximally pulling back the outer sheath relative to the inner catheter until the stent is exposed. The self-expanding stent expands from the stent distal end to the stent proximal end as the sheath is proximally withdrawn. 
     Several problems may occur with the sheathed delivery device described above. The sheath release delivery devices are difficult to reposition or remove and slow to operate. The stent may only be partially deployed prior to reconstrainment of the stent by the sheath in order to still reposition or remove the stent. Once the stent is fully deployed, i.e. readially expanded, the sheath cannot reconstrain the stent. For example, utilizing a conventional outer sheath/inner catheter delivery device may cause the physician to inadvertently use excessive force and pull back the outer sheath too far, thereby prematurely deploying the stent in an incorrect position within a body lumen. At this step in the procedure, repositioning of the stent becomes difficult, if not impossible, because the stent has already radially self-expanded into the body lumen. Additionally, retraction of the outer sheath may not be achieved with controlled movement because the physician is manually retracting the outer sheath which may lead to uneven or inadvertent jerking back of the outer sheath that can lead to improper position of the stent. 
     Additionally, in a typical sheath release device where the outer sheath is proximally withdrawn, the first portion of the self-expanding stent to make contact with the body vessel is the most distal portion of the stent. This type of release may cause difficulty in accurately placing the proximal portion of the stent because the distal end of the stent is positioned first while the proximal portion of the stent is still covered by the outer sheath. Accurate placement of the proximal portion of the stent and/or the stent body may be important in certain applications, for example to prevent stent migration or to properly open a stricture along the entire length of the stricture. An additional drawback occurs with the sheathed stent delivery system where direct visualization of the stent is required. For example, in endoscopically placed stents, the sheath tends to prevent or obscure the location of the stent, making accurate placement of the stent more difficult. 
     Further potential drawbacks for the conventional sheathed stent delivery system involve the stent placement within the system prior to use within a patient. Loading and anchoring of a conventional sheathed stent delivery device is an involved process that may require preloading the stent into the device so that the stent remains compressed within the sheath during shipment and storage prior to use in the patient. Extended compression of the stent may lead to an alteration in the stent mechanical properties. 
     Conventional sheathed stent delivery devices also require a high force to overcome the friction between the stent and the sheath that may also be a problem for proper stent placement within the patient. The introducer must be mechanically stronger to overcome the frictional forces to avoid undesirable frictional consequences such as stretching of the introducer catchers and hysterics in the movement of the stent. The sheathed stent delivery device also requires more space within an endoscope compared to a sheathless device and also adds additional expense to the delivery system. 
     Accordingly, in view of the drawbacks of current technology, there is a desire for a mechanically expandable delivery system and dilation system that can increase the control, accuracy and ease of placement of a stent during deployment of the stent within a patient or dilation of a lumen within a patient. The delivery system would ideally reduce the risk of malfunction while providing for a smoother, more accurate and quicker deployment of the entire stent. The delivery system also would provide the ability to reconstrain, recapture, reposition and/or remove the stent after expansion of the stent. 
     BRIEF SUMMARY 
     Accordingly, it is an object of the present invention to provide a device and a method having features that resolve or improve on one or more of the above-described drawbacks. 
     The foregoing object is obtained in one aspect of the present invention by providing a stent delivery system. The stent delivery system includes an elongate shaft including a proximal portion, a distal portion, at least one lumen extending at least partially therethrough, and a stent receiving portion on the distal portion of the elongate shaft. A stent is positioned on the stent receiving portion of the elongate shaft, the stent having a first configuration and a second configuration. A proximal constraining arrangement is engaged with a proximal end of the stent, the proximal constraining arrangement comprising a first proximal constraining member having a proximal portion and a second proximal portion and a second proximal constraining member having a first proximal portion and a distal portion, the distal portion of the first proximal constraining member engaged with a first proximal portion of the stent and the distal portion of the second proximal constraining member engaged with a second proximal portion of the stent. A distal constraining arrangement is engaged with a distal end of the stent, the distal constraining arrangement comprising a first distal constraining member having a proximal portion and a second proximal portion and a second distal constraining member having a proximal portion and a distal portion, the distal portion of the first distal constraining member engaged with a first distal portion of the stent and the distal portion of the second proximal constraining member engaged with a second distal portion of the stent. A handle assembly comprising a first shuttle operably connected to the proximal constraining arrangement and a second shuttle operably connected to the distal constraining arrangement. A brake assembly is positioned within the handle assembly, the proximal constraining arrangement being coupled to the brake assembly. The proximal constraining arrangement and the distal constraining member applies an axial mechanical force to at least a portion of the stent in the first configuration. 
     In another aspect of the present invention, a method of implanting a stent in a patient&#39;s lumen is provided. The method includes inserting a distal portion of a stent delivery system into a lumen of a patient, the stent delivery system comprising: an elongate shaft including a proximal portion, a distal portion, at least one lumen extending at least partially therethrough, and a stent receiving portion on the distal portion of the elongate shaft. A stent is positioned on the stent receiving portion of the elongate shaft, the stent having a first configuration and a second configuration. A proximal constraining arrangement is engaged with a proximal end of the stent, the proximal constraining arrangement comprising a first proximal constraining member having a proximal portion and a second proximal portion and a second proximal constraining member having a proximal portion and a distal portion, the distal portion of the first proximal constraining member engaged with a first proximal portion of the stent and the distal portion of the second proximal constraining member engaged with a second distal portion of the stent. A distal constraining arrangement is engaged with a distal end of the stent, the distal constraining arrangement comprising a first distal constraining member having a proximal portion and a second proximal portion and a second distal constraining member having a proximal portion and a distal portion, the distal portion of the first distal constraining member engaged with a first distal portion of the stent and the distal portion of the second proximal constraining member engaged with a second proximal portion of the stent. A handle assembly comprising a first shuttle operably connected to the proximal constraining arrangement and a second shuttle operably connected to the distal constraining arrangement. A brake assembly is positioned within the handle assembly, the proximal constraining arrangement being coupled to a portion of the brake assembly. The method includes holding the stent in the first configuration with longitudinal tensile force applied to the stent by the proximal constraining member and the distal constraining member and tensioning the stent for delivery of the stent to an implant site. The method also includes positioning the stent at the implant site. The method further includes expanding the stent by manipulating the first shuttle and the second shuttle in a distal direction and releasing longitudinal force on the stent. 
     In another aspect of the present invention, a system is provided. The system includes an inner elongate shaft including a proximal portion, a distal portion, at least one lumen extending at least partially therethrough, and a stent receiving portion on the distal portion of the elongate shaft. The stent system includes an outer elongate having a proximal portion, a distal portion, at least one lumen extending at least partially therethrough, the inner elongate shaft extending coaxially at least partially within the lumen of the outer elongate shaft, the outer sheath moveably positionable relative to the inner elongate shaft. A stent is positioned on the stent receiving portion of the elongate shaft, the stent having a first configuration and a second configuration. A proximal constraining arrangement is engaged with a proximal end of the stent, the proximal constraining arrangement comprising a first proximal constraining member having a proximal portion and a second proximal portion and a second proximal constraining member having a proximal portion and a distal portion, the distal portion of the first proximal constraining member engaged with a first proximal portion of the stent and the distal portion of the second proximal constraining member engaged with a second proximal portion of the stent. A distal constraining arrangement is engaged with a distal end of the stent, the distal constraining arrangement comprising a first distal constraining member having a proximal portion and a second proximal portion and a second distal constraining member having a proximal portion and a distal portion, the distal portion of the first distal constraining member engaged with a first distal portion of the stent and the distal portion of the second proximal constraining member engaged with a second proximal portion of the stent. A release wire is disposed through the elongate shaft and releasably engaged with portion of the proximal constraining arrangement and the distal constraining arrangement member. A handle assembly comprising a first shuttle is operably connected to the proximal constraining arrangement and a second shuttle is operably connected to the distal constraining arrangement. A brake assembly is positioned within the handle assembly, the proximal constraining arrangement being coupled to a portion of the brake assembly. The proximal constraining arrangement and the distal constraining member applies an axial mechanical force to at least a portion of the stent in the first configuration. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIGS. 1A and 1B  illustrate a stent delivery system  10  in accordance with embodiments of the present invention. 
         FIG. 2  illustrates a sectional view of the stent delivery system shown in  FIG. 1 . 
         FIG. 3 . illustrates a distal end of the stent delivery system shown  FIG. 1 . 
         FIGS. 4A and 4B  illustrate a first section of the distal end of the stent delivery system shown in  FIGS. 1A and 1B . 
         FIG. 5  illustrates the second section of the distal end of the stent delivery system shown in  FIGS. 1A and 1B . 
         FIG. 6  illustrates an embodiment of a proximal end of the stent of the stent delivery system. 
         FIG. 7  illustrates a cross-section through an inner tube of the of the stent delivery system. 
         FIG. 8  illustrates an alternative embodiment a stent delivery system in accordance with embodiments of the present invention. 
         FIGS. 9A and 9B  illustrate a side view of the stent delivery system shown in  FIG. 8 . 
         FIGS. 10A-10C  illustrate a distal end of the stent delivery system of  FIG. 8 . 
         FIG. 11  illustrates a proximal end of the stent delivery system of  FIG. 8 . 
         FIG. 12  illustrates a sectional view of the stent delivery system of  FIG. 8 . 
         FIG. 13A  and  FIG. 13B  illustrates operation of the stent delivery system of  FIG. 8 . 
         FIG. 14  illustrates a sectional view of an alternate embodiment of a stent delivery system. 
         FIG. 15  illustrates a cross-section through an outer shaft of an embodiment of a stent delivery system. 
         FIG. 16  is a sectional view of the embodiment of the system of  FIG. 14 . 
         FIGS. 17A-17C  illustrate operation of the embodiment of the system of  FIG. 14 . 
         FIG. 18  illustrates of an alternative embodiment of a handle assembly of a stent delivery system. 
         FIG. 19  is a schematic view of the handle assembly of  FIG. 18 . 
         FIGS. 20A and 20B  illustrate operation of the embodiment of the handle assembly of  FIG. 18 . 
         FIG. 21  illustrates of schematic view of an alternative embodiment of a handle assembly of a stent delivery system. 
         FIGS. 22A and 22B  illustrate operation of the embodiment of  FIG. 21 . 
         FIG. 23  illustrates of schematic view of an alternative embodiment of a handle assembly of a stent delivery system. 
         FIGS. 24A-24C  illustrate operation of the embodiment of the system of  FIG. 23 . 
         FIG. 25  illustrates a cross-section through an alternative outer shaft of the present invention. 
         FIG. 26  illustrates a schematic view of an alternative embodiment of a handle assembly of a stent delivery system. 
         FIG. 27  illustrates operation of this embodiment of the system of  FIG. 26 . 
     
    
    
     DETAILED DESCRIPTION OF THE DRAWINGS AND THE PRESENTLY PREFERRED EMBODIMENTS 
     The invention is described with reference to the drawings in which like elements are referred to by like numerals. The relationship and functioning of the various elements of this invention are better understood by the following detailed description. However, the embodiments of this invention are not limited to the embodiments illustrated in the drawings. It should be understood that the drawings are not to scale, and in certain instances details have been omitted which are not necessary for an understanding of the present invention, such as conventional fabrication and assembly. 
     As used in the specification, the terms proximal and distal should be understood as being in the terms of a physician delivering the stent to a patient. Hence the term “distal” means the portion of the delivery system that is farthest from the physician and the term “proximal” means the portion of the delivery system that is nearest to the physician. 
       FIG. 1A  illustrates a stent delivery system  10  in accordance with embodiments of the present invention. The stent delivery system  10  includes an inner shaft  22  and a handle  26  at a proximal portion  27  of the system  10 . A stent  28  is positionable on a stent region  30  of the inner shaft  22  at a distal portion  31  of the delivery system  10 . As shown, the stent  28  is in an expanded configuration  66 . The stent delivery system  10  may optionally include an outer sheath slidably positionable over a portion the inner shaft  22  to cover the stent region  30  and the stent  28 . The stent delivery system  10  may also include a guidewire extendable through a port of the inner shaft  22  through a distal tip  41  at the distal portion  31  of the delivery system  10 . The stent  28  may be placed in a constrained position, as shown in  FIG. 1B . 
       FIG. 2  illustrates a sectional view of the stent delivery system  10  shown in  FIG. 1 . As shown in  FIG. 2 , the stent  28  is in an expanded configuration  66  while still connected to the inner shaft  22 . In some embodiments, the stent  28  may be a self-expanding stent. The stent  28  may be any kind of stent that has a tendency to radially collapse when a longitudinal force is applied to the ends of the stent. By way of non-limiting example, the stent  28  may be formed as a woven mesh formed from a metal or polymer or a laser cut pattern formed in a metal stent. The stent  28  may also be formed from a bioabsorbable material. One example of a woven stent is the EVOLUTION® stent (Wilson-Cook Medical, Inc.). The stent  28  is held in the constrained configuration  40  by a mechanism that may be provided with or without an outer sheath. In one embodiment that is described in detail below, that includes a proximal stent constraining member  44  and a distal stent constraining member  46  to longitudinally constrain the stent  28  and hold the stent  28  collapsed against the inner shaft  22 . The proximal and distal stent constraining members  44 ,  46  are operably connected to the handle  26 . In particular, the distal stent constraining member  46  is connected to the handle via a restraining member disposed through a port in the inner shaft  22 . The restraining member  56  includes a proximal end  58  and a distal end  57 . The restraining member  56  is releaseably connected to the distal constraining member  46 . The proximal end  58  of the restraining member  56  is connected to the handle  26  of the stent delivery system  10 . The restraining member  56  is configured to allow the user to move the distal end  33  of the stent  28  from a constrained configuration  40  (as shown in  FIG. 1B ) to an expanded configuration  66  without fully deploying the stent. The proximal stent constraining member  44  is connected to the handle  26  via release wire  59 . The release wire  59  includes a distal end  60  and a proximal end  61 . The proximal end  61  of the release wire  59  is connected to the handle  26  on a proximal end of the stent delivery system  10 . As shown in the figures, the release wire releasably engages the proximal constraining member and releasably connects the proximal end of the stent to the inner shaft  22 . The distal end  60  of the release wire  59  engages the distal end  57  of the restraining member  56  and releasably connect the distal end  60  of the release wire  59  to the inner shaft  22 . As shown in  FIG. 2 , the stent  28  is held compressed against the inner shaft  22  by the proximal and distal stent constraining members  44 ,  46  in a first position  47  applying longitudinal force to the stent  28  in opposite directions. When present, an outer sheath may provide some compressive force to the stent in addition to the proximal and distal constraining members  44 ,  46 . 
       FIG. 3 . shows a view of the distal end of the system  10 . As shown, the stent  28  is shown in an expanded configuration  66  in  FIG. 3  where the stent  28  is expanded away from the inner shaft  22 . The distal constraining members  46  is in a second position  49  and remain connected to the stent  28  but the longitudinal force on the stent  28  has been removed to allow the stent  28  to expand. The distal constraining member, in this embodiment, includes a pair of distal grasping loops  48 ,  50 . The distal grasping loops  48 ,  50  may be interwoven through one or more peaks of the stent so that the distal grasping loops  48 ,  50  when pulled taut will collapse the peaks  29  of the stent  28  onto the inner shaft  22 . The distal grasping loops  48 ,  50  may be positioned on opposing sides of the stent  28 , as provided in this embodiment. In alternative embodiments, the grasping loops  48 ,  50  may be placed in different positions. The distal grasping loops  48 ,  50  of the distal constraining member  46  may be anchored at one or more points to better secure the stent  28  on the inner shaft  22 . In other embodiments, the stent  28  may include a suture about the proximal end  31  and the distal end  33  of the stent  28 . The grasping loops may be interwoven about the suture at the ends of the stent  28 . In the embodiment shown in  FIG. 3 , the distal grasping loops  48 ,  50  are configured to remain attached to the stent  28  upon deployment within the lumen of a patient. In alternative embodiments, the distal grasping loops  48 ,  50  may be configured to be released from the stent upon deployment within the lumen of a patient. 
     As shown, the restraining member  56  extends within a first opening  23  disposed in the inner shaft  22  and exits from the port  38  at a distal end  24  of the inner shaft  22 . In this embodiment, the restraining member  56  is a suture. One of skill in the art will understand other materials may be suitable for the restraining member  56 . The restraining member  56  is configured to keep the distal end  33  of the stent  28  attached to the inner tube  22  prior to deployment within the lumen of a patient while allowing the stent  28  to be released from the constrained configuration  40  to the expanded configuration  66 . As shown, the restraining member  56  exits from a port  38  at the distal end  24  of the inner shaft  22 . In this embodiment, the restraining member  56  extends in a proximal direction and engages with a distal point  51  of the distal grasping loops  48 ,  50  of the distal constraining member  46 . After exiting the distal grasping loops  48 ,  50  of the distal constraining member  46 , the restraining member  56  extends in a distal direction and enters into a suture lumen  34  of inner tube  22  of the system  10  near the distal tip  41  of the system  10 . Upon entering the lumen  34  of the inner tube  22  of the system  10 , the restraining member  56  extends through the length of the inner tube  22  and engages with a handle  26 . The handle  26  allows for control of the restraining member  56  in order to move the stent  28  from the constrained configuration  40  to the expanded configuration  66  so that the release of the tension on the stent  28  is uniform within the patient&#39;s lumen. The restraining member  56  moves the distal end  33  of the stent  28  so that the longitudinal tension exerted on the stent  28  is relaxed when the distal grasping loops of the distal constraining member  44  are further apart and the stent  28  expands uniformly due to the uniform release of the tension on the stent  28  by the distal constraining member  46 . 
     The stent  28  may be repeatedly moved between the constrained configuration  40  and the expanded configuration  66  by manipulating the restraining member either in a proximal direction or a distal direction until the stent is properly positioned. With the stent repositioned in the constrained configuration  40 , an outer sheath may be repositioned over the stent  28  as shown in  FIG. 2  and the stent  28  may even be withdrawn from the patient, for example if an incorrect size of stent was originally selected. The stent configurations may be changed multiple times within the patient for repositioning or removal until the proximal and distal constraining members  44 ,  46  are released from connection with the stent  28  as described below. 
       FIGS. 4A and 4B  illustrate the first section  42  of the distal end  24  of the system  10 . As shown, the system  10  includes a distal tip  41 , an inner shaft  22 , a distal end portion  57  of the restraining member  56 , and a distal end portion  60  of the release wire  59 . The inner tube  22  includes an opening  23 , where the distal end portion  57  of the restraining member  56  and the distal end portion  60  of the release wire  59  are disposed. The release wire  59  is releasably engaged within a lumen of the inner tube  22  and terminates proximal to the distal tip  41  of the system  10 . In this embodiment, the distal end portion  57  of the restraining member  56  is anchored to the inner tube  22  by the release wire  59 . The proximal portion the release wire (not shown) is engaged with a handle of the system. As will be discussed below, upon release of the release wire  59  by the user of the system  10 , the proximal end of the restraining member is also released, allowing the distal end  33  of the stent  28  to be deployed within the lumen of the patient. In this embodiment, the restraining member  56  is a looped suture. In alternative embodiments, the restraining member  56  may have alternative configurations or materials, including a single suture. The release wire  59  may be frictionally engaged with a portion of the inner tube  22  of the system  10  to hold the release wire  59  in position until the stent  28  is in the proper position for release as discussed above. The release wire  59  may be proximally withdrawn to release the distal constraining member  46 . 
     As shown in  FIG. 4B , the system  10  includes an inner shaft  22 , distal tip  41 , and a distal end portion  57  of the restraining member  56 . The inner shaft  22  further includes access to the suture lumen  34  of the inner tube  22  of the system  10 . In this embodiment, the opening  23  in the inner shaft  22 , where the distal end portion  57  of the restraining member  56  and the distal end portion  60  of the release wire  59  are disposed, is also visible. The release wire  59  is releasably engaged within a port  38  of the inner tube  22  and terminates proximal to the distal tip  41  of the system  10 . The restraining member  56  enters into the inner tube  22  at a port  39  distal to the stent  28  and proximal of the distal tip  41 . The second opening  39  is disposed distal to the first port  38  on the distal end of the system. As discussed above, the restraining member  56  enters into this second port  39  and extends to a handle, which allows for a user to manipulate the position of the distal end  33  of the stent  28 . 
       FIG. 5  illustrates the second section  43  of the distal end  24  of the system  10 . As shown, the system  10  includes a distal tip  41 , an inner shaft  22 , a distal end portion  57  of the restraining member  56 , and a distal end portion  60  of the release wire  59 . The distal end  57  of restraining member  56 , in this embodiment, is engaged with the grasping loops  48 ,  50  of the distal constraining member  46 . As shown, the grasping loops  48 ,  50  of the distal constraining member are positioned on a distal end  33  of the stent  28 . The stent  28  is still connected to the inner shaft  22  of the system  10  by the restraining member  59 . 
     The materials used to manufacture the components of the stent delivery systems and mechanical dilator systems described herein may be any materials known to one skilled in the art that are suitable for use in patients. By way of non-limiting example, the shafts and sheaths may be formed from polytetrafluorothylene (PTFE) particularly when a low friction outer sheath is desirable. Nylon and HDPE may also be used for clarity. Additional possible materials include, but are not limited to the following, polyethylene ether ketone (PEEK), fluorinated ethylene propylene (FEP), perfluoroalkoxy polymer resin (PFA), polyamide, polyurethane, high density or low density polyethylene, and nylon including multi-layer or single layer structures and the like and may also include reinforcement wires, braid wires, coils, coil springs and or filaments. The stent may be formed from but is not limited to the following materials: Nickel titanium alloys, for example, nitinol, stainless steel, cobalt alloys and titanium alloys. The loops of the constraining members may be made from common suture material as known in the art, for example polyester suture such as 4-0 Tevdek®, nylon, silk, polypropylene, ultra-high molecular weight polyethylene (UHMPE) and the like. The sutures may be monofilament, braided, twisted or multifilament. The loops and the retaining wires may also be made from a metallic alloy such as stainless steel or nickel titanium. In some embodiments, the stent, the loops and/or the retaining wires may be made from biodegradable materials. A number of bioabsorbable homopolymers, copolymers, or blends of bioabsorbable polymers are known in the medical arts. These include, but are not necessarily limited to, polyesters including poly-alpha hydroxy and poly-beta hydroxy polyesters, polycaprolactone, polyglycolic acid, polyether-esters, poly(p-dioxanone), polyoxaesters; polyphosphazenes; polyanhydrides; polycarbonates including polytrimethylene carbonate and poly(iminocarbonate); polyesteramides; polyurethanes; polyisocyantes; polyphosphazines; polyethers including polyglycols polyorthoesters; expoxy polymers including polyethylene oxide; polysaccharides including cellulose, chitin, dextran, starch, hydroxyethyl starch, polygluconate, hyaluronic acid; polyamides including polyamino acids, polyester-amides, polyglutamic acid, poly-lysine, gelatin, fibrin, fibrinogen, casein, collagen. 
       FIG. 6  illustrates an embodiment of a proximal end  32  of the stent  28  of the system  10 . As shown, the stent  28  is shown in an expanded configuration  66 . The proximal constraining member  44  may comprise one or more distal grasping loops  52 ,  54 . In this embodiment, the proximal constraining member  44  comprises two loops  52 ,  54  that are interwoven through one or more peaks  29  of the stent  28  so that when pulled taut, the proximal constraining member  44  will collapse the peaks  29  of the stent  28  onto the inner shaft  22 . The proximal grasping loops  52 ,  54  of the proximal constraining member  44  may be anchored at one or more points to better secure the stent  28  on the inner shaft  22 . In the embodiment shown in  FIG. 6 , the proximal grasping loops  52 ,  54  are configured to remain attached to the stent  28  upon deployment within the lumen of a patient. In alternative embodiments, the proximal grasping loops  52 ,  54  may be configured to be released from the stent  28  upon deployment within the lumen of a patient. The proximal end  32  of the stent  28  remains connected to the inner shaft  22  even in the expanded configuration when the release wire  59  is engaged in the proximal grasping loops  52 ,  54  of the proximal constraining member  44 . As shown, the release wire  59  extends within the inner shaft  22  and engages the two proximal grasping loops  52 ,  54  of the proximal constraining arrangement  44 . In this embodiment, the proximal end  32  of the stent  28  is released from the constrained configuration  40  to the expanded configuration  66  by manipulation of a sheath. 
     In an alternative embodiment, the system  10  may include a second restraining member engaged with the proximal grasping loops of the proximal constraining member. In this alternative embodiment, the restraining member extends within a port disposed in the inner shaft and exits from the port at a proximal end of the inner shaft. The restraining member is configured to keep the distal end of the stent attached to the inner tube prior to deployment within the lumen of a patient while allowing the stent  28  to be released from the constrained configuration  40  to the expanded configuration  66 . The proximal end stent  28  is released from the constrained configuration  40  to the expanded configuration  66  by manipulation in response to the proximal and distal manipulation of the second restraining member by the user of the system. In alternative embodiments, a second retaining member may be included in the system. The second restraining member may engage the proximal constraining member. In these embodiments, the second constraining member is configured to keep the proximal end of the stent attached to the inner tube prior to deployment within the lumen of a patient while allowing the stent  28  to be released from the constrained configuration  40  to the expanded configuration  66 . The stent  28  is released from the constrained configuration  40  to the expanded configuration  66  by manipulation in response to the proximal and distal manipulation of the restraining member by the user of the system. 
       FIG. 7  illustrates a cross-section through an inner tube  22  of the of the stent delivery system  10 . In this embodiment, the system  10  is provided in an over-the-wire configuration. In this over the wire configuration, the cross-section throughout the inner tube  22  is the same throughout its length. The inner tube  22  includes a suture lumen  34 , a first lumen  72 , and a second lumen  74 . The suture lumen  34 , the second lumen  72 , and the third lumen  74  are disposed through the entire length of the inner tube  22 . The suture lumen  34  may be used to facilitate the introduction of a medical device, such as a guidewire. The second lumen  72  is provided to receive at least a portion of the restraining member  56 . The third lumen  74  is provided and is configured to receive a release wire  59  for use with the system  10 . Each of the suture lumen  34 , the second lumen  72 , and the third lumen  74  are accessible from the proximal end  25  of the inner shaft  22 . Exemplary materials for forming the shaft include, but are not limited to, metal alloys such as stainless steel, tantalum or its alloys, tungsten, platinum, gold, copper, palladium, rhodium, or a superelastic alloys, such as nitinol or polymers that can be provided with sufficient shore hardness, such as Pebax, Peek, polyimide, liquid crystal polymers (LCP) such as Vectran, polyethylene, polyethylene terephthalate and Nylon. In alternative embodiments, the inner tube  22  may further include additional lumens. In one embodiment, a fourth lumen may be included within the inner tube  22 . In this embodiment, the fourth lumen may be used to provide a conduit for a second restraining member for the proximal constraining member  44  of the stent  28 . 
       FIG. 8  illustrates an alternative embodiment of a stent delivery system  110  in accordance with embodiments of the present invention. The stent delivery system  110  includes an inner shaft  122  and a handle  126  at a proximal portion  125  of the system  110 . A stent  128  (shown in  FIG. 2 ) is positionable on a stent region  130  of the inner shaft  122  at a distal portion  131  of the delivery system  110 . The stent delivery system  110  includes an outer sheath  112  slidably positionable over a portion the inner shaft  122  to cover the stent region  130  and the stent  128 . The stent delivery system  110  may also include a guidewire extendable through a port of the inner shaft  122  through a distal tip  141  at the distal portion  131  of the delivery system  110 . The handle  126  is comprised of at least two parts: a sheath shuttle  163  that is operatively connected to the outer sheath  112  and a constraining shuttle  165 . 
       FIG. 9A  illustrates a side view of the stent delivery system  110  shown in  FIG. 8 . As shown in  FIG. 9A , the stent  128  is in a constrained configuration collapsed against the inner shaft  122 . As shown, the sheath  112  is disposed over the stent  128  has been withdrawn proximally in order to provide a detailed look of the stent  128  in the constrained configuration  140 . In some embodiments, the stent  128  may be a self-expanding stent. The stent  128  may be any kind of stent that has a tendency to radially collapse when a longitudinal force is applied to the ends of the stent. By way of non-limiting example, the stent  128  may be formed as a woven mesh formed from a metal or polymer or a laser cut pattern formed in a metal stent. The stent may also be formed from a bioabsorbable material. One example of a woven stent is the EVOLUTION® stent (Wilson-Cook Medical, Inc.). The stent  128  is held in the constrained configuration  140  by a mechanism that may be provided with or without an outer sheath  112 . In one embodiment, that is described in detail below, that includes a proximal stent constraining arrangement  144  and a distal stent constraining arrangement  146  to longitudinally constrain the stent  128  and hold the stent  128  collapsed against the inner shaft  122 . The proximal and distal stent constraining arrangements  144 ,  146  are operably connected to the constraining shuttle  165  of the handle  126 . In particular, the proximal constraining arrangement  144  and the distal constraining arrangement  146  is connected to the handle through at least one port in the inner shaft  122 , where a release wire (not shown) is disposed therethrough. As shown in  FIG. 9A , the stent  128  is held compressed against the inner shaft  122  by the proximal and distal stent constraining members  144 ,  146  in a first position  147  applying longitudinal force to the stent  128  in opposite directions. 
     The stent  128  is shown in an expanded configuration  166  in  FIG. 9B  where the stent  128  is expanded away from the inner shaft  122 . The proximal and distal constraining assemblies  144 ,  146  are in a second position  149  and remain connected to the stent  128  but the longitudinal force on the stent  128  has been removed to allow the stent  128  to expand. This second position  149  of the proximal constraining arrangement  144  and distal constraining arrangement  146  is achieved by manipulating a handle attached to the proximal constraining arrangement and the distal constraining arrangement  146  in a proximal direction. 
       FIG. 10A  shows a view of a first side of the distal end of the system  110 . As shown, the stent  128  is shown in an expanded configuration  166  in  FIG. 10  where the stent  128  is expanded away from the inner shaft  122 . The distal constraining arrangement  146  is in a second position  149  and remain connected to the stent  128  but the longitudinal force on the stent  128  has been removed to allow the stent  128  to expand. As shown, the first and second distal restraining loops  148 ,  150  extend from a first opening  123  at the distal end  133  of the inner shaft  122 . The first and second distal restraining loops  148 ,  150  are engaged are tethered to the inner tube  122  by a release wire  159 . The proximal portion of the release wire (not shown) is engaged with the handle  126  of the system  110 . In this embodiment, the first distal restraining loop  148  extends in a proximal direction and is interwoven with the peaks of the distal end  133  of the stent  128 . After traversing the peaks of the stent  128 , the first distal restraining loop  148  exits the distal end  133  of the stent and extends in a distal direction toward the distal tip  141  of the system  110 . Similarly, the second distal restraining loop  150  extends in a proximal direction and is interwoven with the peaks of the distal end  133  of the stent  128 . After traversing the peaks of the stent  128 , the second distal restraining loop  150  exits the distal end  133  of the stent  128  and extends in a distal direction toward the distal tip  141  of the system  110 . In this embodiment, the distal constraining arrangement  146 , in this embodiment, includes a first distal loop  148 , and a second distal loop  150 . The distal loops  148 ,  150  may be interwoven through one or more peaks of the stent so that the distal loops  148 ,  150  when pulled taut will collapse the peaks of the stent onto the inner shaft. The distal grasping loops may be positioned on opposing sides of the stent, as provided in this embodiment. In particular, the first distal loop  148  is interwoven through six peaks of one side of the distal end  133  of the stent  128  halfway around the stent circumference. The second distal loop  150  is interwoven through six peaks  129  of the distal end  133  of the stent  128  on the side opposite of the first distal loop  148  halfway around the circumference. 
     Upon release of the release wire  159  by the user of the system  110 , the first distal restraining loop  148  and the second distal restraining loop  150  is also released, allowing the distal end  133  of the stent  128  to be deployed within the lumen of the patient. The release wire  159  may be frictionally engaged with a portion of the inner shaft  122  of the system  110  to hold the release wire  159  in position until the stent  128  is in the proper position for release. The first distal restraining loop  148  and the second distal restraining loop  150  moves the distal end  133  of the stent  128  so that the longitudinal tension exerted on the stent  128  is relaxed when the first distal restraining loop  148  and the second distal restraining loop  150  of the distal constraining arrangement  146  are farther apart and the stent  128  expands uniformly due to the uniform release of the tension on the stent  128  by the distal constraining arrangement  144 . 
       FIG. 10B  shows a view second side of the distal end of the system  110 . As shown in this embodiment, a second opening  135  proximal to the distal tip  141  is in communication with a suture lumen  134  of the inner shaft  122 . The second opening  135  is positioned on an opposite side of the inner shaft  122  than the first opening  123 . The first distal restraining loop  148  enters into a suture lumen  134  of inner tube  122  of the system  110  through the second opening  135  of the inner shaft. Upon entering the lumen  134  of the inner tube  122  of the system  110 , the first distal restraining loop  148  extends through the length of the inner tube  122  and engages with a handle  126 . The constraining shuttle  165  of the handle  126  allows for control of the distal constraining assembly member in order to move the stent  28  from the constrained configuration  140  to the expanded configuration  166  so that the release of the tension on the stent  128  is uniform within the patient&#39;s lumen. Similarly, the second distal restraining loop  150  enters into the suture lumen  134  of inner tube  122  of the system  110  through the second opening  135  of the inner shaft  122 . Upon entering the suture lumen  134  of the inner tube  122  of the system  110 , the second distal restraining loop  150  extends through the length of the inner tube and engages with a handle  126 . 
       FIG. 10C  shows an alternative arrangement for the distal constraining arrangement  146 . In this embodiment, the distal constraining arrangement  146 , in this embodiment, includes a first distal loop  148 , and a second distal loop  150 . The distal loops  148 ,  150  may be interwoven through one or more peaks of the stent so that the distal loops  148 ,  150  when pulled taut will collapse the peaks of the stent onto the inner shaft. The distal grasping loops may be positioned on opposing sides of the stent, as provided in this embodiment. In particular, the first distal loop  148  is interwoven through eight peaks of one side of the distal end  133  of the stent  128  halfway around the stent circumference. The second distal loop  150  is interwoven through six peaks of the distal end  133  of the stent  128  on the side opposite of the first distal loop  148  halfway around the circumference. 
       FIG. 11  shows a view of the proximal end of the system  10 . As shown, the stent  128  is shown in an expanded configuration  166  in  FIG. 11  where the stent  128  is expanded away from the inner shaft  122 . The proximal constraining arrangement  144  is in a second position and remains connected to the stent  128  but the longitudinal force on the stent  128  has been removed to allow the stent  128  to expand. The proximal constraining arrangement  144 , in this embodiment, includes a first proximal loop  152 , and a second distal loop  154 . The proximal loops  152 ,  154  may be interwoven through one or more peaks of the stent so that the proximal loops  152 ,  154  when pulled taut will collapse the peaks of the stent  128  onto the inner shaft  122 . The proximal restraining loops  152 ,  154  may be positioned on opposing sides of the stent  128 , as provided in this embodiment. In particular, the first proximal loop  152  is interwoven through six peaks of one side of the proximal end  132  of the stent  128  halfway around the circumference. The second proximal loop  154  is interwoven through six peaks of the proximal end  132  of the stent  128  on the side opposite of the first proximal loop  152  halfway around the circumference. In alternative embodiments, the first proximal loop  152  and the second proximal loop  154  may be interwoven through more peaks of the stent  128  or fewer peaks of the stent  128 . 
     As shown, the first proximal loop  152  and the second proximal loop  154  are tethered to the inner shaft  122  by a release wire  159 . The proximal portion of the release wire (not shown) is engaged with a handle  126  of the system  110 . The release wire  159  may be proximally withdrawn to release the first proximal loop  152  and the second proximal loop  154 . In this embodiment, the first proximal restraining loop  152  extends in a proximal direction and is interwoven with the peaks of the proximal end  132  of the stent  128 . After traversing the peaks of the stent  128 , the first proximal restraining loop  152  exits the proximal end  132  of the stent  128  and extends in a proximal direction toward the handle  126  of the system. The first proximal restraining loop  152  enters into a suture lumen  134  of inner tube  122  of the system  110 . Upon entering the lumen  134  through an opening  136  of the inner shaft  122  of the system  110 , the first proximal restraining loop  152  extends through the inner tube  122  and engages with the constraining shuttle  165  of the handle  126 . The handle  126  allows for control of the proximal constraining arrangement  144  in order to move the stent  128  from the constrained configuration  140  to the expanded configuration  166  so that the release of the tension on the stent  128  is uniform within the patient&#39;s lumen. 
     Similarly, the second proximal constraining loop  154  extends in a distal direction and is interwoven with the peaks of the proximal end  132  of the stent  128 . After traversing the peaks of the stent  128 , the second proximal restraining loop  154  exits the proximal end  132  of the stent  128  and extends in a proximal direction toward the handle  126  of the system  110 . The second proximal constraining loop  154  enters into a suture lumen  134  of inner tube of the system through an opening of the inner shaft  122 . Upon entering the lumen  134  of the inner tube  122  of the system  110 , the second proximal constraining loop  154  extends through the inner tube  122  and engages with the constraining shuttle  165  of the handle  126 . Upon release of the release wire  159  by the user of the system  110 , the proximal end of the restraining member is also released, allowing the proximal end  132  of the stent  126  to be deployed within the lumen of the patient. The release wire  159  may be frictionally engaged with a portion of the inner shaft  122  of the system  110  to hold the release wire  159  in position until the stent  128  is in the proper position for release. The first proximal loop  152  and the second proximal loop  154  moves the proximal end  132  of the stent  128  so that the longitudinal tension exerted on the stent  128  is relaxed when first proximal loop  152  and the second proximal loop  154  of the proximal constraining member  144  are farther apart and the stent  128  expands uniformly due to the uniform release of the tension on the stent  28  by the distal constraining member  44 . 
       FIG. 12  is a schematic view of an embodiment of the present invention. The stent delivery system  110  includes an inner shaft  122  and a handle (not shown) at a proximal portion  127  of the system  110 . A stent  128  is positionable on a stent region  130  of the inner shaft  122  at a distal portion  131  of the delivery system  110 . The stent  128  is shown in an expanded position. As shown, the proximal and distal stent constraining arrangements  144 ,  146  are operably connected to the handle  126  and are disposed through the suture lumen  134 . The stent delivery system  110  may also include a guidewire extendable through a second lumen  172  of the inner shaft  122  through a distal tip  141  at the distal portion  131  of the delivery system  110 . A release wire is disposed in through the third lumen  174  and is engaged with a portion of the proximal and distal constraining arrangements  144 ,  146  to anchor the proximal and distal constraining arrangements  144 ,  146  to the inner shaft  122 . 
     Operation of an embodiment of the system is illustrated in  FIG. 13A  and  FIG. 13B . For ease of depiction, the stent  128  is not shown. In  FIG. 13A , the system includes an inner shaft  122  and a handle  126  at a proximal portion  127  of the system  110 . The handle  126  includes a constraining shuttle  165  and a sheath shuttle  167 . A sheath  112  is operably connected to the sheath shuttle  167  of the handle  126 . As shown, the proximal and distal stent constraining arrangements  144 ,  146  are operably connected to the constraining handle  165  and are disposed through the suture lumen  134 . The sheath  112  and sheath shuttle  167  is distally positioned upon the system  110  in the stent attachment portion  130  of the system  110 . The constraining shuttle  165  of the handle  126  are also positioned distally in a locked position and maintaining the stent  128  in a constrained position  140 . As shown in  FIG. 13B , in order to deploy the stent  128 , the user proximally moves the sheath shuttle  167 , which uncovers the stent  128 . The user then unlocks the constraining shuttle  165  of the handle  126  and moves the constraining shuttle  165  in a proximal direction. The proximal movement of the constraining shuttle  165  moves the stent from the constrained position to the expanded position. Once the stent  128  is placed in the correct position, the user may release the release wire  159  and deploy the stent  128  within the vessel of the patient. 
       FIG. 14  illustrates a sectional view of an alternate embodiment of a stent delivery system  210 . The stent delivery system  210  includes an inner shaft  222  and an outer shaft  221 . A stent  228  is positionable on a stent region  230  of the inner shaft  222  at a distal portion  231  of the delivery system  210 . The stent  228  is shown in an expanded configuration  266  in  FIG. 14  where the stent  228  is expanded away from the inner shaft  222 . The distal constraining assembly  246  is in a second position and remain connected to the stent  228  but the longitudinal force on the stent  228  has been removed to allow the stent  228  to expand. This second position of the proximal and distal constraining member  244 ,  246  is manipulated in a proximal direction through the use of a handle  226  attached to the system  210 . The inner shaft  222  includes a first, suture lumen  234 , a second lumen  272 , a third lumen  274 . As shown, the distal stent constraining arrangement  246  is disposed through the suture lumen  234 . A release wire  259  is disposed through the third lumen  274  and is engaged with a portion of the proximal and distal constraining arrangements  244 ,  246  to anchor the proximal and distal constraining arrangements  244 ,  246  to the inner tube  222 . The stent delivery system  210  may also include a guidewire extendable through the second lumen  272  of the inner shaft  222  through a distal tip  241  at the distal portion  231  of the delivery system  210 . The outer shaft  221  includes a first lumen  280  and a second lumen  282 . The inner shaft  222  is concentrically positioned within the first lumen  280  of the outer shaft  221 . The proximal stent constraining arrangement  244  is disposed through the second lumen  282  of the outer shaft  221 . In this embodiment, the proximal constraining arrangement  244  and the distal constraining arrangement  246  are positioned within different lumens and do not interfere with one another. Thus, the proximal constraining arrangement  244  and the distal constraining arrangement  246  can operate independently from each other. With this embodiment, the proximal constraining arrangement  244  and the distal constraining arrangement  246  allow for the distal end  231  of the stent  228  and the proximal end  232  of the stent  228  can be moved from the constrained position  240  to the expanded position  266  at different times and by different amounts. 
       FIG. 15  illustrates a cross-section through an outer shaft  221  of an embodiment of the present invention. In this embodiment, the system  210  is provided in an over-the-wire configuration. In this over the wire configuration, the cross-section throughout the outer tube  221  is the same throughout its length. The outer tube  221  includes a first lumen  280  and a second lumen  282 . The first lumen  280  and the second lumen  282  are disposed through the entire length of the outer tube  221 . The second lumen  282  is provided to receive at least a portion of the distal restraining arrangement  244 . The first lumen  280  may be used to facilitate reception of the inner shaft  222 . Each of the first lumen  280  and the second lumen  282  are accessible from the proximal end of the outer shaft  221 . Exemplary materials for forming the outer shaft  221  include, but are not limited to, metal alloys such as stainless steel, tantalum or its alloys, tungsten, platinum, gold, copper, palladium, rhodium, or a superelastic alloys, such as nitinol or polymers that can be provided with sufficient shore hardness, such as Pebax, Peek, polyimide, liquid crystal polymers (LCP) such as Vectran, polyethylene, polyethylene terephthalate and Nylon. In alternative embodiments, the outer tube  221  may further include additional lumens. 
       FIG. 16  is a sectional view of an embodiment of the present invention. The stent delivery system  310  includes an inner shaft  322  and a handle  326  at a proximal portion  327  of the system  310 . A stent retaining region  330  is present at the proximal end  327  of the system in order to provide an area for placement of a stent for use with the system  310 . The inner shaft  322  includes a first, suture lumen, a second lumen, and a third lumen. The outer shaft  321  includes a first lumen and a second lumen  382 . The inner shaft  322  is disposed within the second lumen  382  of the outer shaft  321  such that the inner shaft  322  is concentric with the outer shaft  321 . The distal loops  348 ,  350  of the distal constraining arrangement  346  are disposed within the suture lumen of the inner shaft  322 . The proximal loops of the proximal constraining arrangement  344  are disposed within the first lumen of the outer shaft. The handle  326  is disposed about the outer surface of the outer shaft  321  and includes a hub  363 , a sheath shuttle  367 , and a constraining shuttle  365 . A sheath  312  is operably connected to the sheath shuttle  367  of the handle  326 . As shown, the proximal loops of the proximal constraining arrangement  344  exit the suture lumen of the inner shaft  322  and engage with at least a portion of the constraining shuttle  365 . Similarly, the distal loops of the distal constraining arrangement  344  exit the first lumen  380  of the outer shaft  321  and are operably connected with at least a portion of the constraining shuttle  365 . In this embodiment, the proximal loops of the proximal constraining arrangement  344  and the distal loops of the distal constraining arrangement  346  are operably connected to a brake assembly  390  disposed within the housing of the constraining shuttle  365 . The brake assembly  390 , in this embodiment, comprises a washer  392  and a break spring  394  disposed about the surface of the outer shaft  321  of the system  310 . The spring  394  of the brake assembly  390  keeps the washer  392  at an angle with respect to the outer shaft  321  and keeps the brake washer  392  ready to engage with the shaft upon activation of the brake assembly  390 . This arrangement prevents the brake  390  from failing to engage and this arrangement decreases the time taken for the break to engage upon activation. 
     In one embodiment, the distal loops of the distal constraining arrangement  346  are positioned underneath the brake assembly  390  and are attached to the constraining shuttle  365  at the proximal end  327  of the system  310 . The proximal loops of the proximal constraining arrangement  344  maybe looped around the brake assembly  390  in order to accommodate the additional length required in order to make the proximal constraining arrangement  344  operable with this embodiment of the brake assembly  390 . In this embodiment, the distal loops  3118 ,  350  of the distal constraining arrangement  346  may be pulled proximally up to three times further then the proximal loops of the proximal constraining arrangement  344  upon operation of the constraining shuttle  365  of the handle  326  in the proximal direction. One of ordinary skill in the art will understand that alternative arrangements may be utilized with this aspect of the present invention. As will be as will be discussed, the brake assembly  390  allows for staged deployment of the proximal end of a stent and the distal end of a stent. A release wire is disposed through the second lumen and is engaged with a portion of the proximal and distal constraining arrangements  344 ,  346  to anchor the proximal and distal constraining arrangements  344 ,  346  to the inner tube  322 . 
       FIGS. 17A-17C  illustrate operation of this embodiment of the system  310  of the present invention. Referring to  FIG. 17  A, the sheath shuttle  367  has been moved in a proximal direction and in abutting relation with the hub  363  of the handle  326 . Upon moving the sheath shuttle  367  in the proximal direction, the sheath attached to the sheath shuttle  367  is retracted in the proximal direction and uncovers the stent. In this position, the stent is still in the constrained configuration  340 . The constraining shuttle  365  of the handle  326  is in a distal position with respect to the hub  363  of the handle  326 . In this distal position, the proximal constraining arrangement  344  and the distal constraining arrangement  346  remain in the taut configuration which maintains the stent in the collapsed configuration  340 . In some embodiments, the system  310  may include a locking apparatus to maintain the constraining shuttle  365  in this distal position. In these embodiments, the lock assembly may prevent premature deployment of the stent prior to proper positioning of the stent within the target lumen of the patient. As shown by  FIG. 17A , the brake washer  392  and the brake spring  394  are engaged. When the brake assembly  390  is engaged, the proximal constraining arrangement  344  and the distal constraining arrangement  346  are maintained in the taut configuration. This brake assembly  390  also prevents premature deployment expansion of the stent prior to proper positioning of the stent within the lumen of the patient. 
     Referring now to  FIG. 17  B, the constraining shuttle  365  has been moved in a proximal direction with respect to the hub  363  of the handle  326 . The proximal movement of the constraining shuttle  365  disengages the brake assembly  390 . In this embodiment, the washer  392  of the brake assembly  390  is pulled into a vertical configuration. In addition, the brake spring  394  of the brake assembly  390  is compressed, which allows for the washer to be positioned vertically within the body of the constraining shuttle  365 . Upon disengagement, the entire brake assembly  390  is able to move in conjunction with the movement of the constraining shuttle  365  of the handle  326 . This movement of the brake assembly  390 , allows for the proximal constraining arrangement  344  and the distal constraining arrangement  346  to move in the proximal direction. 
     Referring now to  FIG. 17  C, the constraining shuttle  365  has been fully moved in the proximal direction with respect to the hub  363  of the handle  326 . As shown the brake assembly  390  has also been moved in the proximal direction. In this position, the stent  328  is now moved from the constrained configuration  340  to the expanded configuration  366 . In this embodiment, this proximal movement of the proximal constraining arrangement  344  and the distal constraining arrangement  346  release the stent  328  from the constrained configuration  340  to the expanded configuration  366 . In alternative embodiments, the system  310  may allow for staged a release of the distal end and the proximal end of the stent. The stent, while in the expanded configuration, is still connected to the system  310  by the proximal constraining arrangement  344  and the distal constraining arrangement  346 . The stent  328  may be repeatedly moved between the constrained configuration and the expanded configuration by manipulating the proximal constraining arrangement  344  and the distal constraining arrangement  346  either in a proximal direction or a distal direction until the stent  328  is properly positioned through the use of the constraining shuttle  365 . Upon moving the constraining shuttle  365  in the distal direction the distal loops of the distal constraining configuration  346  are pulled first, which constrains the distal end of the stent prior to the proximal end of the stent which allows for any additional material of the loops of the proximal constraining arrangement  344  to also be pulled by the constraining handle  365 . Upon removal of any slack material of the proximal constraining arrangement  344 , the distal end and the proximal end of the stent are constrained simultaneously. 
       FIG. 18  illustrates of an alternative embodiment of a handle assembly  426  of a stent delivery system  410 . The handle assembly  426  includes a hub  463 , a sheath shuttle  467 , a constraining shuttle  465 , and a handle back stop  468  positioned on a proximal end of the handle assembly  426 . A first conduit  484  and a second conduit  486  of the hub  463  are engaged with the handle back stop  468 . In a particular embodiment, as shown in  FIG. 18 , the first conduit  484  and the second conduit  486  are cylindrical tubules. An outer shaft  421  is disposed through a lumen of the first conduit  484 . As shown, the sheath shuttle  467  is engaged with an outer surface of the first conduit  484  and is configured to travel longitudinally with respect to the first conduit  484 . The sheath  412  is operably connected to the sheath shuttle  467  of the handle  426 . In some embodiments, the sheath  412  may include additional features, including, but not limited to, the ability to be torn away from the device or the ability to crumple. The constraining shuttle  465  is engaged with an outer surface of the second conduit  484  and is configured to travel longitudinally with respect to the second conduit is disposed on the second conduit  484 . As shown in the embodiment of  FIG. 18 , the constraining shuttle  465  is positioned distal to the sheath shuttle  467 . In this particular embodiment, the constraining shuttle  465  is configured to move proximally following movement of the sheath shuttle  467  in the proximal direction. In alternative embodiments, the constraining shuttle  465  and the sheath shuttle  467  may be configured such that the constraining shuttle  465  may be moved independent of the movement of the sheath shuttle  467 . 
       FIG. 19  is a schematic view of an embodiment of the system  410  and the handle assembly  426 . The handle assembly  426  includes a hub  463 , a sheath shuttle  467 , a constraining shuttle  465 , and a handle back stop  468  positioned on a proximal end of the handle assembly  326 . A first conduit  484  and a second conduit  486  of the hub  463  are engaged with the handle back stop  468 . The first conduit  484  and the second conduit  486  each have a lumen disposed therethrough. An outer shaft  421  and an inner shaft  422  are disposed through a lumen of the first conduit  484 . As shown, proximal loops of a proximal constraining arrangement  444  exit a lumen of the inner shaft  422  and engage with at least a portion of the constraining shuttle  465 . Similarly, distal loops of the distal constraining arrangement  446  exit a lumen of the outer shaft  421  and are operably connected with at least a portion of the constraining shuttle  465 . In this embodiment, the proximal loops of the proximal constraining arrangement  444  and the distal loops of the distal constraining arrangement  446  are operably connected to a brake assembly  490  disposed within the housing of the constraining shuttle  465 . A pathway  469  connecting the first conduit  484  and the second conduit  486  is provided within the handle back stop  468  to allow the proximal loops of the proximal constraining arrangement  444  and the distal loops of the distal constraining arrangement  446  to pass from the outer shaft  421 , inner shaft  422 , and the first conduit  484  into a lumen of the second conduit  486 . The proximal loops of the proximal constraining arrangement  444  and the distal loops of the distal constraining arrangement  446  enter into the lumen of the second conduit  486  through a port  487 . The brake assembly  490 , in this embodiment, comprises a washer  492  and a break spring  494  disposed about the surface of the outer shaft  421  of the system  410 . The break spring  494  of the brake assembly  490  keeps the washer  492  at an angle with respect to the outer shaft  421  and keeps the brake washer  492  ready to engage with the shaft upon activation of the break. This arrangement prevents the brake from failing to engage and decreases the time taken for the break to engage upon activation. 
     In one embodiment, the distal loops of the distal constraining arrangement  446  are positioned underneath the brake assembly  490  and are attached to the constraining shuttle  465  at the proximal end. The proximal loops of the proximal constraining arrangement  444  maybe looped around the brake assembly  490  in order to accommodate the additional length required in order to make the proximal constraining arrangement  444  operable with this embodiment of the handle brake assembly  490 . In this embodiment, the distal loops of the distal constraining arrangement  446  may be pulled proximally up to three times further then the proximal loops of the proximal constraining arrangement  444  upon operation of the constraining shuttle  465  of the handle  426  in the proximal direction. One of ordinary skill in the art will understand that alternative arrangements may be utilized with this aspect of the present invention. As will be as will be discussed, the brake arrangement  490  allows for staged deployment of the proximal end of a stent and the distal end of a stent. A release wire may be disposed in through the second lumen  472  and is engaged with a portion of the proximal and distal constraining arrangements  444 ,  446  to anchor the proximal and distal constraining arrangements  444 ,  446  within the system  410 . 
     As shown, the sheath shuttle  467  is engaged with an outer surface of the first conduit  484  and the sheath  412  is operably connected to the sheath shuttle  467  of the handle  426 . The constraining shuttle  465  is engaged with an outer surface of the second conduit  484  and is configured to travel longitudinally with respect to the second conduit  484 . The sheath shuttle  467  includes an opening  471 . The opening  471  allows the sheath shuttle  467  to move along the first conduit  484  while not interfering with the constraining shuttle  465  and the second conduit. Likewise, the constraining shuttle  465  also includes an opening  473 . The opening  473  allows the constraining shuttle  465  to move along the second conduit  486  while not interfering with the sheath shuttle  467  and the first conduit  484 . 
       FIGS. 20A and 20B  illustrate operation of this embodiment of the system  410  of the present invention. Referring to  FIG. 20  A, the sheath shuttle  465  has been moved in a proximal direction and in abutting relation with the handle back stop  468  of the handle  426 . Upon moving the sheath shuttle  467  in the proximal direction, the sheath  412  attached to the sheath shuttle  467  is retracted in the proximal direction and uncovers the stent  428 . In this position, the stent  428  is still in the constrained configuration  440 . The constraining shuttle  465  of the handle  426  is in a distal position with respect to the hub  463  of the handle  426 . In this distal position, the proximal constraining arrangement  444  and the distal constraining arrangement  446  remain in the taut configuration which maintains the student in the collapsed configuration. In some embodiments, the system  410  may include a locking apparatus to maintain the constraining shuttle in this distal position. In these embodiments the lock may prevent premature deployment of the stent prior to proper positioning of the stent within the target lumen of the patient. As shown by  FIG. 20A , the washer  492  and the brake spring  494  are engaged. When the brake assembly  490  is engaged, the proximal constraining arrangement  444  and the distal constraining arrangement  446  are maintained in the taut configuration. This brake assembly  490  also prevents premature deployment expansion of the stent  428  prior to proper positioning of the stent  428  within the lumen of the patient. 
     Referring now to  FIG. 20B , the constraining shuttle  465  has been fully moved in the proximal direction with respect to the hub  463  of the handle  426 . The proximal movement of the constraining shuttle  465  this engages the brake assembly  490 . In this embodiment, the washer  494  of the brake assembly  490  is pulled into a vertical configuration. In this position, the stent is now moved from the constrained configuration  440  to the expanded configuration  464 . In this embodiment, this proximal movement of the proximal constraining arrangement  444  and the distal constraining arrangement  446  release the stent from the constrained configuration  440  to the expanded configuration  466 . In alternative embodiments, the system  410  may allow for staged a release of the distal end and the proximal end of the stent. The stent, while in the expanded configuration, is still connected to the system  410  by the proximal constraining configuration  444  and the distal constraining configuration  446 . The stent may be repeatedly moved between the constrained configuration  440  and the expanded configuration  466  by moving the constraining shuttle  465  distally with respect to the hub  463  of the handle  426 . Upon moving the constraining shuttle  465  in the distal direction the distal loops  448 ,  450  of the distal constraining configuration  446  are pulled first, which constrains the distal end of the stent prior to the proximal end of the stent which allows for any additional material of the proximal loops of the proximal constraining arrangement  444  to also be pulled by the constraining handle  465 . Upon removal of any slack material of the proximal constraining arrangement  444 , the distal end  433  and the proximal end  432  are constrained simultaneously. 
       FIG. 21  illustrates of schematic view of an alternative embodiment of a handle assembly  526  of a stent delivery system  510 . The stent delivery system  510  includes an inner shaft  522 , outer shaft  521 , and a handle  526  at a proximal portion of the system  510  having a handle back stop  568 . A stent retaining region  530  is present at the distal end  527  of the system  510  in order to provide an area for placement of a stent for use with the system  510 . The inner shaft  522  includes a suture lumen, a second lumen, and a third lumen. The outer shaft  521  includes a first lumen, and a second lumen. The inner shaft  522  may be disposed within the first lumen of the outer shaft  521  such that the inner shaft  521  is concentric with the outer shaft  521 . The distal loops of the distal constraining arrangement  546  are disposed within the suture lumen of the inner shaft  522 . The proximal loops of the proximal constraining arrangement  544  are disposed within the first lumen of the outer shaft  521 . The handle assembly  526  is disposed about the outer surface of the outer shaft  521  and includes a hub  563 , a sheath shuttle  567 , and a constraining shuttle  565 . A sheath  512  is operably connected to the sheath shuttle  567  of the handle  526 . The constraining shuttle  565  comprises an outer shuttle  576  and an inner shuttle  578 . As shown, the proximal loops of the proximal constraining arrangement  544  exit the first lumen of the outer shaft  521  and engage with at least a portion of the constraining shuttle  565 . Similarly, the distal loops of the distal constraining arrangement  546  exit the inner shaft  522  and are operably connected with at least a portion of the constraining shuttle  565 . In this embodiment, the proximal loops of the proximal constraining arrangement  544  are operably connected to a brake assembly  590  disposed within the housing of the constraining shuttle  565 . The brake assembly  590 , in this embodiment, comprises a washer  592  and a break spring  594  disposed about the surface of the outer shaft  521  of the system  510 . The spring  594  of the brake assembly  590  keeps the washer  592  at an angle with respect to the outer shaft  521  and keeps the brake washer  592  ready to engage with the shaft  521  upon activation of the brake assembly  590 . This arrangement prevents the brake from failing to engage and this arrangement decreases the time taken for the brake to engage upon activation. The distal loops of the distal constraining arrangement  546  are connected to the inner shuttle  578 . A compressed spring  579  is engaged with the inner shuttle  578  and maintains the distal end of the stent in the compressed position. 
       FIGS. 22A and 22B  illustrate operation of this embodiment of the system  510  of the present invention. Referring to  FIG. 22  A, the sheath shuttle  567  has been moved in a proximal direction and in abutting relation with the handle back stop  568  of the handle  526 . Upon moving the sheath shuttle  567  in the proximal direction, the sheath  512  attached to the sheath shuttle  565  is retracted in the proximal direction and uncovers the stent. In this position, the stent is still in the constrained configuration. The constraining shuttle  565  of the handle  526  is in a proximal position with respect to the hub  563  of the handle  526 . In this proximal position, the proximal constraining arrangement  544  and the distal constraining arrangement  546  remain in the taut configuration which maintains the stent in the collapsed configuration. In some embodiments, the system  510  may include a locking apparatus to maintain the constraining shuttle  565  in this distal position. In these embodiments, the lock may prevent premature deployment of the stent prior to proper positioning of the stent within the target lumen of the patient. 
     Referring now to  FIG. 22  B, the constraining shuttle  565  has been fully moved in the distal direction with respect to the hub of the handle. The distal movement of the constraining shuttle  565  this engages the brake assembly  590 . In this embodiment, the washer  594  of the brake assembly  590  is pulled into a vertical configuration. In this position, the stent is now moved from the constrained configuration to the expanded configuration. In this embodiment, this distal movement of the proximal constraining arrangement  544  and the distal constraining arrangement  546  release the stent from the constrained configuration  540  to the expanded configuration  566 . In alternative embodiments, the system  510  may allow for staged a release of the distal end and the proximal end of the stent. The stent, while in the expanded configuration  566 , is still connected to the system  510  by the proximal constraining configuration  544  and the distal constraining configuration  546 . The stent may be moved from the expanded configuration to the constrained configuration by moving the constraining shuttle  565  in the proximal direction with respect to the hub  563  of the handle assembly  526 . Upon moving the constraining shuttle  565  in the proximal direction the distal loops of the distal constraining configuration  546  are pulled first, which constrains the distal end of the stent prior to the proximal end of the stent which allows for any additional material of the proximal loops of the proximal constraining arrangement  544  to also be pulled by the constraining handle  565 . Upon removal of any slack material of the proximal constraining arrangement  544 , the distal end and the proximal end of the stent are constrained. In this embodiment, the distal end of the stent is constrained prior to the proximal end of the stent. Due to the distal constraining arrangement  546  traveling a different path than the proximal constraining arrangement  544  and the sequence of constraining the distal end of the stent prior to the proximal end of the stent, the amount of force needed to constrain the stent may be reduced. 
       FIG. 23  illustrates of schematic view of an alternative embodiment of a handle assembly  626  of a stent delivery system  610 . The stent delivery system  610  includes an inner shaft  622  and a handle  626  at a proximal portion  627  of the system  610 , and a handle back stop  668 . A stent retaining region  630  is present at the proximal end  627  of the system  610  in order to provide an area for placement of a stent for use with the system  610 . The inner shaft  622  includes a suture lumen, a second lumen, and a third lumen. The outer shaft  621  includes a first lumen, and a second lumen. The inner shaft  622  is disposed within the second lumen of the outer shaft  621  such that the inner shaft  622  is concentric with the outer shaft  621 . The distal loops of the distal constraining arrangement  646  are disposed within the suture lumen of the inner shaft  622 . The proximal loops of the proximal constraining arrangement  644  are disposed within the outer shaft  621 . The handle assembly  626  is disposed about the outer surface of the outer shaft  621  and includes a hub  663 , a sheath shuttle  667 , and a constraining shuttle  665 . A sheath  612  is operably connected to the sheath shuttle  667  of the handle  626 . As shown, the proximal loops of the proximal constraining arrangement  644  exit the lumen of the inner shaft  621  and engage with at least a portion of the constraining shuttle  665 . Similarly, the distal loops of the distal constraining arrangement  646  exit the lumen of the outer shaft  621  and operably connected with at least a portion of the constraining shuttle  665 . In this embodiment, the proximal loops of the proximal constraining arrangement  644  are operably connected to a first brake assembly  690  disposed within the housing of the constraining shuttle  665 . Likewise, the distal loops of the distal constraining arrangement  646  are operably connected to a second brake assembly  691  disposed within the housing of the constraining shuttle  665 . The second brake assembly  691  is positioned proximal to the first brake assembly  690 . The first brake assembly  690 , in this embodiment, comprises a washer  692  and a break spring  694  disposed about the surface of the outer shaft  621  of the system  610 . The break spring  694  of the first brake assembly  690  keeps the washer  692  at an angle with respect to the outer shaft  621  and keeps the brake washer  692  ready to engage with the outer shaft  621  upon activation of the first brake assembly  690 . This arrangement prevents the first brake assembly  690  from failing to engage and this arrangement decreases the time taken for the first brake assembly  690  to engage upon activation. The second brake assembly  691  also comprises a washer  693  and a break spring  695  disposed about the surface of the outer shaft  621  of the system  610 . The second break assembly  691  further includes a projection  696  extending from the washer  693 . A leaf spring  697  and collar  698  are positioned within the interior surface of the handle assembly  626 . The projection  696  of the second brake assembly  691  is configured to allow the leaf spring  697  to slide over second brake assembly  691  when the constraining shuttle  665  is moved distally and configured to engage the leaf spring  697  when the constraining shuttle  665  is moved proximally. 
       FIGS. 24A-24C  illustrate operation of this embodiment of the system  610  of the present invention. Referring to  FIG. 24  A, the sheath shuttle  667  has been moved in a proximal direction and in abutting relation with the handle back stop  668  of the handle assembly  626 . Upon moving the sheath shuttle  667  in the proximal direction, the sheath  612  attached to the sheath shuttle  667  is retracted in the proximal direction and uncovers the stent  628 . In this position, the stent is still in the constrained configuration  640 . The constraining shuttle  665  of the handle assembly  626  is in a proximal position with respect to the hub  663  of the handle  665 . In this proximal position, the proximal constraining arrangement  644  and the distal constraining arrangement  646  remain in the taut configuration which maintains the stent in the collapsed configuration  640 . In some embodiments, the system  610  may include a locking apparatus to maintain the constraining shuttle  665  in this distal position. In these embodiments the lock may prevent premature deployment of the stent prior to proper positioning of the stent within the target lumen of the patient. As shown by  FIG. 24A , the first brake assembly  690  and the brake spring  692  are engaged. When the first brake assembly  690  is engaged, the proximal constraining arrangement is maintained in the taut configuration. Likewise, the second brake assembly  691  and the brake spring  693  are engaged. When the second brake assembly  691  is engaged, the distal constraining arrangement is maintained in the taut configuration. This first brake assembly  690  and the second brake assembly  691  also prevent premature deployment expansion of the stent  628  prior to proper positioning of the stent  628  within the lumen of the patient. 
     Referring now to  FIG. 24  B, the constraining shuttle  665  has been fully moved in the distal direction with respect to the hub  663  of the handle. The distal movement of the constraining shuttle  665  disengages the second brake assembly  691 . The proximal end of the constraining shuttle  665  disengages the second brake assembly  691  and unlocks it, which causes the second brake assembly  691  to move in the distal direction. This distal movement of the second brake assembly  691  releases the tension on the distal constraining arrangement  646  and the distal end of the stent is expanded. As the constraining shuttle  665  continues to move in the distal direction, the second brake assembly  691  moves along with it and comes into contact with the first brake assembly  690  and disengages it. The disengaged first brake assembly  690  moves in the distal direction and the tension on the proximal constraining arrangement  644  and the proximal end of the stent is expanded. In this embodiment, this distal movement of the proximal constraining arrangement  644  and the distal constraining arrangement  646  release the stent from the constrained configuration to the expanded configuration. In alternative embodiments, the system  610  may allow for staged a release of the distal end and the proximal end of the stent. The stent, while in the expanded configuration  646 , is still connected to the system  610  by the proximal constraining configuration  644  and the distal constraining configuration  646 . The stent may be moved from the expanded configuration to the constrained configuration by moving the constraining shuttle  665  in the proximal direction with respect to the hub  663  of the handle. 
       FIG. 24C  illustrates how the stent may be moved from the expanded configuration  666  to the constrained configuration  640 . Upon moving the constraining shuttle  665  in the proximal direction, the leaf spring  697  engages the projection  696  of the second brake assembly  691  and moves it in the proximal direction. The leaf spring and the collar apply sufficient force to move the second brake assembly  691  in the proximal direction. This proximal movement of the second brake assembly  691  causes the distal loops of the distal constraining configuration  646  to be pulled taut, which constrains the distal end  633  of the stent prior to the proximal end of the stent. The second brake assembly  691  is also engaged, which prevents the distal end  633  of the stent from being released from the constrained position  640 . As the constraining shuttle  665  is moved further in the proximal direction, the first brake assembly  691  is also pulled proximally. Upon removal of any slack material of the proximal constraining arrangement  644 , the distal end and the proximal end are constrained. When both the distal end and the proximal end of the stent are constrained, the leaf spring  697  is released from the second brake assembly  691 , as the amount of force of constraining sheath  665  exceeds the force of the leaf spring  697 . In this embodiment, the distal end of the stent is constrained prior to the proximal end of the stent. 
       FIG. 25  illustrates a cross-section through an alternative outer shaft  721  of an embodiment of the present invention. In this embodiment, the system  710  is provided in an over-the-wire configuration. In this over the wire configuration, the cross-section throughout the outer tube  721  is the same throughout its length. The outer tube  721  includes a first lumen  780 , a second lumen  782 , and a third lumen  784 . The first lumen  780 , a second lumen  782 , and a third lumen  784  are disposed through the entire length of the outer tube  721 . The first lumen  780  may be used to facilitate the introduction of a medical device, such as a guidewire. The second lumen  782  and third lumen  784  is provided to receive one proximal loop, respectively, of the proximal constraining member  744 . Each of first lumen  780 , a second lumen  782 , and a third lumen  784 , are accessible from the proximal end of the outer shaft  721 . Exemplary materials for forming the shaft include, but are not limited to, metal alloys such as stainless steel, tantalum or its alloys, tungsten, platinum, gold, copper, palladium, rhodium, or a superelastic alloys, such as nitinol or polymers that can be provided with sufficient shore hardness, such as Pebax, Peek, polyimide, liquid crystal polymers (LCP) such as Vectran, polyethylene, polyethylene terephthalate and Nylon. In alternative embodiments, the inner tube may further include additional lumens. In one embodiment, a fourth lumen may be included within the inner tube. In this embodiment, the fourth lumen may be used to provide a conduit for a second restraining member for the proximal constraining member of the stent. 
       FIG. 26  illustrates a perspective view of an alternative embodiment of a handle assembly  826  of a stent delivery system  810 . The stent delivery system  810  includes an inner shaft  822  and a handle  826  at a proximal portion of the system  810 . The inner shaft  822  includes a suture lumen, a second lumen, and a third lumen. The outer shaft  821  includes a first lumen and a second lumen. The inner shaft  822  is disposed within the outer shaft  821  such that the inner shaft  822  is concentric with the outer shaft  821 . The distal loops of the distal constraining arrangement  846  are disposed within the suture lumen  834  of the inner shaft  822 . The proximal loops of the proximal constraining arrangement  844  are disposed within the first lumen  880  of the outer shaft  821 . The handle assembly  826  is disposed about the outer surface of the outer shaft  821  and includes a hub  863 , a sheath shuttle  867 , and a constraining shuttle  865 . A sheath  812  is operably connected to the sheath shuttle  867  of the handle  826 . As shown, the proximal loops of the proximal constraining arrangement  844  exit the first lumen  880  of the outer shaft  821  and engage with at least a portion of the constraining shuttle  865 . Similarly, the distal loops of the distal constraining arrangement  846  exit the suture lumen  834  of the inner shaft  822  and operably connected with at least a portion of the constraining shuttle  865 . In this embodiment, the proximal loops of the proximal constraining arrangement  844  are operably connected to proximal shuttle  878  disposed within the housing of the constraining shuttle  865 . Likewise, the distal loops of the distal constraining arrangement  846  are operably connected to a distal shuttle  876  disposed within the housing of the constraining shuttle  865 . The proximal shuttle  876  and the distal shuttle  876  are configured to engage with the constraining shuttle  865  and each have dedicated tracks to allow for longitudinal movement with respect to the constraining shuttle  865 . As shown, the constraining shuttle  865  has been moved in the distal direction with respect to the hub  863  of the handle  826 . The distal movement of the constraining shuttle  865  first engages distal shuttle  876  and moves it in the distal direction. In this position, the stent  828  is now moved from the constrained configuration  840  to the expanded configuration  866 . In this embodiment, this distal movement of the distal shuttle  876  releases the distal end  833  of the stent  828  from the constrained configuration  840  to the expanded configuration  866 . Once the distal end  833  of the stent  828  is deployed, the constraining shuttle  865  is continually moved in the distal direction and disengages from the proximal shuttle  878 . Subsequently, the constraining shuttle  865  engages the proximal shuttle  878  and moves it in the distal direction. The distal movement of the proximal shuttle  878  releases proximal end of the stent from the constrained configuration  840  to the expanded configuration  866 . The stent, while in the expanded configuration, is still connected to the system  810  by the proximal constraining arrangement  844  and the distal constraining arrangement  846 . 
       FIG. 27  illustrates operation of this embodiment of the handle  826  of the present invention. The constraining shuttle  865  of the handle  826  is in a distal position with respect to the hub  863  of the handle  826 . In this distal position, the proximal constraining arrangement  844  and the distal constraining arrangement  846  remain in the taut configuration which maintains the stent in the collapsed configuration  840 . In some embodiments, the system  810  may include a locking apparatus to maintain the constraining shuttle  865  in this distal position. In these embodiments the lock may prevent premature deployment of the stent prior to proper positioning of the stent within the target lumen of the patient. As shown by  FIG. 27 , the proximal shuttle  878  and distal shuttle  876  are also positioned proximally and in locked position. A ratchet mechanism may be added to prevent the user from changing the direction of movement of the shuttle during operation. 
     The stent may be moved from the expanded configuration  866  to the constrained configuration  868  by moving the constraining shuttle  865  in the proximal direction with respect to the hub  863  of the handle  826 . Upon moving the constraining shuttle  865  in the proximal direction the distal shuttle  868  is engaged and the distal loops of the distal constraining configuration  846  are pulled first, which constrains the distal end of the stent prior to the proximal end of the stent. Further movement of the constraining shuttle  865  in the proximal direction also engages the proximal shuttle  878  and begins to pull the proximal end of the stent taut. Upon removal of any slack material of the proximal constraining arrangement  844 , the distal end and the proximal end of the stent are constrained. In this embodiment, the distal end of the stent is constrained prior to the proximal end of the stent. Due to the distal constraining arrangement  846  traveling a different path than the proximal constraining arrangement  844  and the sequence of constraining the distal end of the stent prior to the proximal end of the stent, the amount of force needed to constrain the stent may be reduced. 
     Throughout this specification various indications have been given as to preferred and alternative examples and aspects of the invention. However, the foregoing detailed description is to be regarded as illustrative rather than limiting and the invention is not limited to any one of the provided aspects. It should be understood that it is the appended claims, including all equivalents, that are intended to define the spirit and scope of this invention.