Patent Publication Number: US-11654037-B2

Title: Vascular remodeling device

Description:
RELATED APPLICATIONS 
     This application is a continuation of U.S. application Ser. No. 14/713,011, filed May 15, 2015, which is a continuation of U.S. application Ser. No. 13/629,678, filed Sep. 28, 2012, now U.S. Pat. No. 9,060,886, which claims priority, pursuant to 35 U.S.C. § 119, to U.S. Provisional Patent Application No. 61/540,643, filed Sep. 29, 2011. The entire contents of each of the aforementioned applications are incorporated herein by reference. 
    
    
     BACKGROUND 
     Neurovascular or cerebral aneurysms affect about 5% of the population. Aneurysms may be located, for example, along arterial side walls (e.g., the aneurysm  10  illustrated in  FIG.  1   ) and at arterial bifurcations (e.g., the aneurysm  20  illustrated in  FIG.  2   ). The direction of fluid flow is generally indicated by the arrows  16 ,  26 . The aneurysms  10 ,  20  each have a fundus  12 ,  22 , a neck  14 ,  24 , and a fundus-to-neck ratio or “neck ratio.” If the neck ratio is greater than 2 to 1 or if the neck  14 ,  24  is less than 4 mm, the aneurysm  10 ,  20  may be treated with embolization coils alone because the coils will generally constrain themselves within the aneurysm  10 ,  20  without herniating into parent vessels. If the neck ratio is less than 2 to 1 or if the neck  14 ,  24  is greater than 4 mm, the aneurysms  10 ,  20  may be difficult to treat with embolization coils alone because the coils may be prone to herniating into parent vessels, as illustrated in  FIGS.  3 A and  3 B . Herniation of coils may cause arterial occlusion, stroke, and/or death. Compared to the bifurcation illustrated in  FIG.  2   , the efferent vessels of the bifurcation may be at substantially different angles, have substantially different sizes, and/or be a different quantity (e.g., three or more). Compared to the bifurcation illustrated in  FIG.  2   , the aneurysm  20  of the bifurcation may be offset with respect to the junction (e.g., having a neck substantially open to one efferent vessel), tilted with respect to a plane created by the vessels (e.g., into or out of the page), etc. Each of these would still be accurately characterized as a “bifurcation” herein. 
     In order to inhibit such herniation, tubular neck remodeling devices, for example Neuroform®, available from Boston Scientific, and Enterprise™, available from Cordis Neurovascular, may be used to keep coils or other materials within the fundus of the aneurysm and out of the vessels. Tubular remodeling devices generally consist of a braided wire or cut metallic stent or stents covering the neck of the aneurysm. As illustrated in  FIG.  4 A , tubular remodeling devices  40  are generally useful for side wall aneurysms  10 . As illustrated in  FIGS.  4 B and  4 C , tubular remodeling devices  42 ,  44  are generally less useful for aneurysms  20  at bifurcations (e.g., the basilar tip area), for example because positioning/shaping the remodeling devices to preserve blood flow through the afferent and efferent vessels while also inhibiting herniation of coils  28  out of the aneurysm  20  can be difficult. 
     SUMMARY 
     The present disclosure includes, without limitation, the following embodiments. Various embodiments of the subject technology are described as numbered clauses (1, 2, 3, etc.) for convenience. These are provided as examples, and do not limit the subject technology or the present disclosure. It is noted that any of the dependent clauses may be combined in any combination, and placed into any independent clause. The other clauses can be presented in a similar manner. 
     1. A vascular remodeling device, comprising:
         an anchor section configured for deployment in a blood vessel, the anchor section having a longitudinal axis and being radially expandable from a collapsed state to an expanded state, the anchor section having a first waist comprising the radially largest region of the anchor section when in the expanded state;   a distal section configured for deployment at a junction of two or more blood vessels, the distal section being radially expandable from a collapsed state to an expanded state, the distal section comprising a second waist configured to engage a wall of the junction when the distal section is in its expanded state, the distal section comprising a proximal face located proximal to the second waist and a distal face located distal to the second waist; the proximal face comprising:   (i) a plurality of first proximal strut portions extending distally from the intermediate section,   (ii) a plurality of first distal strut portions extending proximally from the second waist, and   (iii) a plurality of first sub-struts, wherein, from each first proximal strut portion, two of the first sub-struts each extend to a respective one of the first distal strut portions; and   the distal face comprising:   (i) a plurality of second distal strut portions extending proximally from a distal end of the distal section,   (ii) a plurality of second proximal strut portions, each of the second proximal strut portions extending from a respective one of the first distal strut portions at the second waist and extending distally from the second waist, and   (iii) a plurality of second sub-struts, wherein, from each second proximal strut portion, two of the second sub-struts each extend to a different one of the second distal strut portions; and   an intermediate section that couples the anchor section and the distal section.       

     2. The device of clause 1, wherein the number of the first proximal strut portions is equal to the number of the first distal strut portions. 
     3. The device of clause 1, wherein the number of the first sub-struts is double the number of the first distal strut portions. 
     4. The device of clause 1, wherein the number of the second proximal strut portions is equal to the number of the second distal strut portions. 
     5. The device of clause 1, wherein the number of the second sub-struts is double the number of the second distal strut portions. 
     6. The device of clause 1, wherein the second waist comprises the radially largest region of the distal section when the distal section is in its expanded state. 
     7. The device of clause 1, wherein each of the first sub-struts extends between a first proximal strut portion and a first distal strut portion that are angularly offset with respect to each other. 
     8. The device of clause 1, wherein each of the second sub-struts extends between a second proximal strut portion and a second distal strut portion that are angularly offset with respect to each other. 
     9. The device of clause 1, wherein the distal face is configured to face an aneurysm adjacent the junction when the second waist engages the wall and the distal section is in its expanded state 
     10. The device of clause 1, wherein the distal face is configured to perform a therapeutic blocking function at the aneurysm, the function comprising at least one of (a) supporting maintenance of a therapeutically effective amount and/or density of at least one filling material and/or device in the aneurysm, (b) promoting thrombogenesis, and (c) diverting flow from the aneurysm. 
     11. The device of clause 1, wherein the distal section is configured to prevent members of the second waist from moving substantially toward a side of the blood vessel. 
     12. A vascular remodeling device, comprising:
         an anchor section configured for deployment in a blood vessel, the anchor section having a longitudinal axis and being radially expandable from a collapsed state to an expanded state, the anchor section having a first waist comprising the radially largest region of the anchor section when in the expanded state, the anchor section comprising:   (i) a plurality of proximal strut portions extending distally from a proximal end of the anchor section;   (ii) a plurality of first sub-struts extending distally from each proximal strut portion;   (iii) a plurality of waist struts extending at the first waist, the waist struts formed on a proximal side of the first waist by an adjoining of two adjacent first sub-struts extending from different proximal strut portions;   (iv) a plurality of second sub-struts, two of the second sub-struts extending from each waist strut on a distal side of the first waist; and   (v) a plurality of distal strut portions, formed by an adjoining of two adjacent second sub-struts that each extend distally from a different waist strut; and   a distal section configured for deployment at a junction of two or more blood vessels, the distal section being radially expandable from a collapsed state to an expanded state, the distal section comprising a second waist configured to engage a wall of the junction when the distal section is in its expanded state; and   an intermediate section that couples the anchor section and the distal section.       

     13. The device of clause 12, wherein the number of the proximal strut portions is equal to the number of the waist struts. 
     14. The device of clause 12, wherein the number of the first sub-struts is double the number of the waist struts. 
     15. The device of clause 12, wherein the number of the waist struts is equal to the number of the distal strut portions. 
     16. The device of clause 12, wherein the number of the second sub-struts is double the number of the distal strut portions. 
     17. The device of clause 12, wherein the first waist comprises the radially largest region of the distal section when the distal section is in its expanded state. 
     18. The device of clause 12, wherein each of the first sub-struts extends between a proximal strut portion and a waist strut that are angularly offset with respect to the longitudinal axis. 
     19. The device of clause 12, wherein each of the second sub-struts extends between a waist strut and a distal strut portion that are angularly offset with respect to the longitudinal axis. 
     20. The device of clause 12, wherein the distal section is configured to prevent members of the first waist from moving substantially toward a side of the blood vessel. 
     21. The device of clause 12, wherein each of the waist struts comprises: (i) a first distal strut portion extending proximally from the first waist and (ii) a second proximal strut portion extending distally from the first waist. 
     22. A vascular device, comprising:
         a plurality of sections, each section being radially expandable from a collapsed state to an expanded state, each section having a longitudinal axis and a waist comprising the radially largest region of the section when in the expanded state; each section anchor section further comprising:   (i) a plurality of proximal strut portions extending distally from a proximal end of the section;   (ii) a plurality of first sub-struts extending distally from each proximal strut portion;   (iii) a plurality of waist struts extending at the first waist, the waist struts formed on a proximal side of the waist by an adjoining of two adjacent first sub-struts extending from different proximal strut portions;   (iv) a plurality of second sub-struts, two of the second sub-struts extending from each waist strut on a distal side of the waist; and   (v) a plurality of distal strut portions, formed by an adjoining of two adjacent second sub-struts that each extend distally from a different waist strut;   an intermediate section between each longitudinally adjacent pair of the sections.       

     23. The device of clause 22, wherein the intermediate section maintains a substantially constant radial dimension in both the collapsed state and the expanded state. 
     24. The device of clause 22, wherein each of the first sub-struts extends between a proximal strut portion and a waist strut that are angularly offset with respect to each other. 
     25. The device of clause 22, wherein each of the second sub-struts extends between a waist strut and a distal strut portion that are angularly offset with respect to each other. 
     26. The device of clause 22, further comprising a wire tethered to a proximalmost one of the sections. 
     For purposes of summarizing the invention and the advantages that may be achieved over the prior art, certain objects and advantages of the invention are described herein. Of course, it is to be understood that not necessarily all such objects or advantages need to be achieved in accordance with any particular embodiment. Thus, for example, those skilled in the art will recognize that the invention may be embodied or carried out in a manner that achieves or optimizes one advantage or group of advantages as taught or suggested herein without necessarily achieving other objects or advantages as may be taught or suggested herein. 
     All of these embodiments are intended to be within the scope of this disclosure. These and other embodiments are presented in the following detailed description having reference to the attached figures, the disclosure not being limited to any particular disclosed embodiment(s). 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    illustrates an example embodiment of a side wall aneurysm. 
         FIG.  2    illustrates an example embodiment of a bifurcation having an aneurysm. 
         FIG.  3 A  illustrates an example embodiment of a side wall aneurysm with herniating embolization coils. 
         FIG.  3 B  illustrates an example embodiment of a bifurcation having an aneurysm with herniating embolization coils. 
         FIG.  4 A  illustrates an example embodiment of a side wall aneurysm treated with embolization coils and a tubular remodeling device. 
         FIGS.  4 B and  4 C  illustrates example embodiments of a bifurcation having an aneurysm treated with embolization coils and tubular remodeling devices. 
         FIG.  5    illustrates an example embodiment of a vascular remodeling device. 
         FIG.  6    illustrates a partial end view of the device of  FIG.  5   , taken along the direction indicated by the arrows  6 - 6  in  FIG.  5   . 
         FIG.  7    illustrates a partial end view of the device of  FIG.  5   , taken along the direction indicated by the arrows  7 - 7  in  FIG.  5   . 
         FIG.  8    illustrates the device of  FIG.  5    in an example of a use environment in a vascular bifurcation with an aneurysm. 
         FIG.  9    illustrates the device of  FIG.  5    in an example of a use environment in a vascular bifurcation with an aneurysm and an angled or curving parent vessel. 
         FIG.  10    illustrates a variation of the device of  FIG.  5   , in which a proximal section of the device forms an extended waist portion. 
         FIG.  11    illustrates the device of  FIG.  10    in an example of a use environment in a vascular bifurcation with an aneurysm. 
         FIG.  12    illustrates an example configuration of a widened portion for use on struts of the device of  FIG.  5    or the device of  FIG.  10   . 
         FIG.  13    illustrates a cut pattern for use in making a device similar to the device of  FIG.  5   , but with six struts in the distal section thereof. 
         FIG.  14    is a detail view illustrating the distal section and part of the proximal section of the cut pattern of  FIG.  13   . 
         FIG.  15    is a detail view illustrating a proximal end portion of the cut pattern of  FIG.  13   . 
         FIG.  16    illustrates a cut pattern for use in making a device similar to the device of  FIG.  5   , but with four struts in each of the proximal and distal sections thereof. 
         FIG.  17    is a detail view illustrating the distal section and part of the proximal section of the cut pattern of  FIG.  16   . 
         FIG.  18    is a detail view illustrating a proximal end portion of the cut pattern of  FIG.  16   . 
         FIG.  19    illustrates part of a method of inserting a vascular remodeling device into a vascular bifurcation having an aneurysm, and/or of treating the aneurysm. 
         FIG.  20    illustrates another part of the method of  FIG.  19   . 
         FIG.  21    illustrates another part of the method of  FIGS.  19 - 20   . 
         FIG.  22    illustrates part of a method of placing filling material in an aneurysm located near a bifurcation having a remodeling device therein. 
         FIG.  23    illustrates another part of the method of  FIG.  22   . 
         FIG.  24    illustrates another part of the method of  FIGS.  22 - 23   . 
         FIG.  25    illustrates a cut pattern for use in making another embodiment of the device. 
         FIG.  26    illustrates a detail view of a proximal section of the cut pattern of  FIG.  25   . 
         FIG.  27    illustrates a detail view of a distal section of the cut pattern of  FIG.  25   . 
         FIG.  28    illustrates a device made with the cut pattern of  FIGS.  25 - 27   , in an expanded state. 
         FIG.  29    illustrates a detail view of the proximal section of the device of  FIG.  28   . 
         FIG.  30    illustrates a proximal end view of the proximal section of the device of  FIG.  28   . 
         FIG.  31    illustrates a detail view of the distal section of the device of  FIG.  28   . 
         FIG.  32    illustrates a distal end view of the distal section of the device of  FIG.  28   . 
         FIG.  33    illustrates a cut pattern for use in making another embodiment of the device. 
         FIG.  34    illustrates a detail view of a distal section of the cut pattern of  FIG.  33   . 
         FIG.  35    illustrates a distal section and part of a proximal section of a device made with the cut pattern of  FIGS.  33 - 34   , in an expanded state. 
         FIG.  36    illustrates a distal section and part of a proximal section of the device of  FIG.  35   . 
         FIG.  37    illustrates a distal end view of the device of  FIGS.  35 - 36   . 
     
    
    
     DETAILED DESCRIPTION 
     Although certain embodiments and examples are described below, it should be appreciated that this disclosure extends beyond the specifically disclosed embodiments and/or uses and obvious modifications and equivalents thereof. Thus, it is intended that the scope of this disclosure should not be limited by any particular embodiments described below. 
       FIGS.  5 - 7    illustrate an example embodiment of a vascular remodeling device  50 . It will be appreciated that the device  50  may be more compliant than the vasculature in which it is deployed such that it may be somewhat misshapen after being deployed, and that certain shapes described herein are when the device  50  is an expanded (e.g., further expanded) state with no restriction. The device  50  comprises a proximal section  52  (or “bottom section” or “proximal portion” or “anchor portion”), an intermediate section  54  (or “middle section” or “junction” or “pivot junction”), and a distal section  56  (or “top section” or “distal portion”). The device  50  can be delivered via a catheter (e.g., microcatheter) into a bifurcation to support an aneurysm filling device with minimal interruption of blood flow in afferent and efferent vessels. In some embodiments, the device  50  may be retrieved and/or repositioned. 
     The proximal section  52  can be radially self-expanding and comprise a plurality of radially self-expanding struts  58 . Six struts  58  are depicted in the proximal section  52  of  FIGS.  5 - 6    (and only four of the struts  58  are visible in  FIG.  5   ), but more or fewer struts may be employed in the proximal section  52 , as described in further detail herein. The struts  58  converge toward the radial center of the proximal section  52  at the distal end of the proximal section  52 , where the proximal section joins the proximal end of the intermediate section  54 , and at the proximal end of the proximal section  52 , where the proximal section joins a proximal end portion  60  of the device  50 . 
     The proximal end portion  60 , located at the proximal end of the device  50 , may comprise a simple interconnection of the proximal ends of the struts  58 , or it may comprise a coupling to facilitate delivery and/or re-sheathability and re-positionability of the device  50 . Such a coupling may comprise an electrolytic, mechanical, chemical and/or instant detachment mechanism, configured to connect the device  50  to a delivery member such as a pusher wire. 
     When the device  50  is in the expanded configuration shown in  FIGS.  5 - 7   , the proximal struts  58  extend radially outward as they advance from the proximal and distal ends of the proximal section  52 , thereby forming proximal and distal tapering portions or faces  62 ,  64  of the proximal section  52 . The struts  58  reach their radially outermost extent in a waist portion  66  of the proximal section  52 , between the proximal and distal faces  62 ,  64 . When the device  50  is deployed in a patient&#39;s vasculature, the waist  66  may engage a vessel wall to hold the proximal section  52  and device  50  in place as desired. (Depending on the shape or orientation of the vessel, bifurcation, etc., other portions of the proximal section  52  may engage the vessel wall in addition to or instead of the waist  66 .) In the depicted waist portion  66 , the struts  58  are curved and form curving radial crests or peaks. Alternatively, in the waist  66  the struts  58  can be flat and generally straight and parallel, to form an elongate and/or cylindrical waist  66 . 
     The struts  58  of the proximal section  52  can have a substantially rectangular or flat cross section (e.g., where the struts  58  comprise uncut portions of a metallic tube or sheet). The struts  58  can alternatively have a substantially round (e.g., circular, elliptical, ovoid) cross section (e.g., where the struts  58  comprise round filaments). The proximal section  52  can comprise two or more struts  58 , or between two and twelve struts  58 . Although the proximal section  52  depicted in  FIGS.  5 - 7    comprises six struts  58 , the proximal section can alternatively comprise two, three, four, five, seven, eight, nine, ten, eleven or twelve struts  58 . Still other numbers of struts are possible. As seen in  FIG.  6   , the proximal struts  58  may be equally angularly spaced and/or oriented around the central longitudinal axis of the device  50  (e.g., six struts 60° apart from each adjacent strut as shown in  FIG.  6   , two struts 180° apart from each other, three struts 120° apart, four struts 90° apart, etc.). Although the arrangement of the struts are shown in the figures as substantially isometric, the arrangement can place the struts in various angles relative to each other (e.g., six struts varying about 20°, about 40°, about 50°, about 70°, and about 80° apart from each adjacent strut). When the device  50  is placed at a bifurcation, the proximal section allows flow to efferent vessels because the struts  58  do not block fluid flow. 
     The tapered proximal face  62  of the proximal section  52  may allow the device  50  or portions thereof (e.g., the proximal section  52 ) to be retrieved back (e.g., in the proximal direction) into a delivery catheter via a distal opening thereof. For example, if the device  50  is being pulled into a catheter, the tapered proximal face  62  may radially compress the proximal section  52 . The ability to retrieve the device  50  or proximal section  52  facilitates removal or re-positioning of the device  50  if an initial placement is not satisfactory. 
     The distal section  56  can be radially self-expanding and comprise a plurality of radially self-expanding struts  68 . Eight struts  68  are depicted in the distal section  56  of  FIGS.  5  and  7    (and only five of the struts  68  are visible in  FIG.  5   ), but more or fewer struts may be employed in the distal section  56 , as will be described in further detail below. The struts  68  converge toward the radial center of the distal section  56  at the proximal end of the distal section  56 , where the distal section joins the distal end of the intermediate section  54 , and at the distal end of the distal section  56 , where the distal section joins a distal end portion  70  of the device  50 . 
     When the device  50  is in the expanded configuration shown in  FIGS.  5 - 7   , the distal struts  68  extend radially outward as they advance from the proximal and distal ends of the distal section  56 , thereby forming proximal and distal tapering portions or faces  72 ,  74  of the distal section  56 . The struts  68  reach their radially outermost extent in a waist portion  76  of the distal section  56 , between the proximal and distal faces  72 ,  74 . When the device  50  is deployed in a patient&#39;s vasculature, the waist  76  may engage a vessel wall to hold the distal section  56  and device  50  in place as desired. (Depending on the shape or orientation of the vessel, bifurcation, etc., other portions of the distal section  56  may engage the vessel wall in addition to or instead of the waist  76 .) In the depicted waist portion  76 , the struts  68  are curved and form curving radial crests or peaks. Alternatively, in the waist  76  the struts  68  can be flat and generally straight and parallel, to form an elongate and/or cylindrical waist  76 . 
     One or more of the struts  68  of the distal section  56  can optionally include or form widened portions or leaves  78  on the distal face  74  of the distal section. As best seen in  FIG.  7   , the widened portions  78  can provide a blocking function to prevent or reduce the passage of materials or fluids through the distal face  74 . For example, in one aspect, the widened portions may be wider than a width of the struts forming the proximal face of the distal section. 
     In another aspect, the widened portions may comprise a first and second ramp, where the first ramp extends from an edge of the strut to an edge of the widened portion, and the second ramp extends from the edge of the widened portion to the edge of the strut. In this manner, the widened portions  78  can help support aneurysm filling materials or devices (such as coils or embolic materials) within an aneurysm, and/or reduce or block fluid flow through the distal face  74  to promote thrombogenicity and increase the occlusiveness of the distal face. 
     Instead of or in addition to the widened portion(s)  78 , a mesh, membrane or other covering may be employed on the distal face  74  to perform similar function(s). Notwithstanding the presence of the widened portion(s)  78 , mesh, membrane or other covering, the distal face  74  can include sufficient open space to allow a microcatheter or other similar device to pass through, to place coils or other aneurysm filling materials or devices in an aneurysm covered by the distal face  74 . 
     The distal section  56  can therefore allow for safe and controlled placement of coils, and can be designed to support a certain packing density of coil. If desired, the widened portion(s)  78 , mesh, membrane or other covering can block fluid and material passage through the distal face  74  of the distal section  56  to a degree sufficient to provide a flow diversion effect, and serve as a flow diverter, which may allow omission of any coils or other aneurysm filling materials or devices. 
     The struts  68  of the distal section  56  can have a substantially rectangular or flat cross section (e.g., where the struts  68  comprise uncut portions of a metallic tube or sheet). The struts  68  can alternatively have a substantially round (e.g., circular, elliptical, ovoid) cross section (e.g., where the struts  68  comprise round filaments). A circular, elliptical or ovoid cross-section may be imparted to otherwise square or rectangular struts  58 / 68  by processing steps such as electropolishing. The distal section can comprise two or more struts  68 , or between two and twelve struts  68 . Although the distal section  56  depicted in  FIGS.  5 - 7    comprises eight struts  68 , the distal section can alternatively comprise two, three, four, five, six, seven, nine, ten, eleven or twelve struts  68 . Still other numbers of struts are possible. As seen in  FIG.  7   , the distal struts  68  may be equally angularly spaced and/or oriented around the central longitudinal axis of the device  50  (e.g., eight struts 45° apart from each adjacent strut as shown in  FIG.  6   , two struts 180° apart from each other, three struts 120° apart, four struts 90° apart, etc.). When the device  50  is placed at a bifurcation, the proximal face  72  of the distal section  56  allows flow to efferent vessels because the struts  68  of the proximal face  72  do not block fluid flow. 
     The tapered proximal face  72  of the distal section  56  may allow the device  50  or portions thereof (e.g., the distal section  56 ) to be retrieved back (e.g., in the proximal direction) into a delivery catheter via a distal opening thereof. For example, if the device  50  is being pulled into a catheter, the tapered proximal face  72  may radially compress the distal section  56 . The ability to retrieve the device  50  or distal section  56  facilitates removal or re-positioning of the device  50  if an initial placement is not satisfactory. 
     One or both of the proximal and distal sections  52 ,  56  can optionally be generally spherical in shape when in the expanded or deployed state. 
     The intermediate section  54  connects the proximal section  52  and the distal section  56 , and can be relatively short and relatively narrow (relative to the length and width of the proximal and distal sections  52 ,  56  when they are expanded). The intermediate section  54  can be located in a radially central region of the device  50 , and can be confined to that radially central region (e.g., the device  50  can lack any interconnection between the proximal and distal sections  52 ,  56  radially outward of the intermediate section  54 ). So configured, the intermediate section  54  allows the distal section  56  to pivot with respect to the proximal section and thereby allow the device  50  to be deployed in tortuous vasculature. 
     The intermediate section  54  may permit “multiaxial” pivoting or tilting, e.g. at least about a first axis through the intermediate section  54  and orthogonal to the plane of the page in  FIGS.  5  and  8 - 9   , and about a second axis through the intermediate section  54  and orthogonal to the first axis. The intermediate section  54  may permit “omniaxial” pivoting or tilting, about the first and second axes described above, and any radially-oriented axis passing through the intermediate section  54 . 
     The intermediate section  54  may comprise a relatively short uncut tube defining a generally tubular outer surface and the proximal and distal struts  58 ,  68  can comprise proximal and distal extensions of the intermediate section  54  and its tubular outer surface, and be integral and monolithic with the intermediate section  54  and its outer surface. The struts  58 ,  68  can extend radially outward as they extend proximally (proximal struts  58 ) and distally (distal struts  68 ) from the proximal and distal ends, respectively, of the intermediate portion  54 . The proximal struts  58  and/or the distal struts  68  can be co-cylindrical with the intermediate portion  54  where they join the intermediate portion  54  at its proximal and distal ends, respectively. Where they join the intermediate portion  54 , the proximal struts  58  and/or the distal struts  68  can be wider (in the circumferential direction with respect to the tubular form of the intermediate portion) than they are thick, and of similar thickness as the sidewall of the intermediate portion  54 , as disclosed further herein. For example, the struts can have width of about 0.003-0.006 inches and thickness of about 0.001-0.004 inches. By providing proper thickness to width ratio, the struts may achieve adequate wall apposition while applying adequate forces against vessel walls. 
     The device  50  may provide multiaxial or omniaxial pivoting or tilting up to relatively high deflection angles (e.g., up to 90 degrees) without significantly affecting the ability of the proximal and distal sections  52 ,  56  to maintain their expanded states and engage the adjacent portions of the bifurcation  25  (see  FIGS.  8 ,  9   ). This capability can be facilitated by making the proximal struts  58  independent of the distal struts  68 , e.g. as depicted in  FIGS.  5 ,  8 - 11 ,  13  and  16   . The two groups of struts are independent of each other in that forces acting solely on, and/or deflections occurring solely in, the proximal struts  58  do not significantly affect the ability of the distal struts  68  to maintain their expanded state and/or maintain engagement with adjacent portions of the bifurcation  25 , and forces acting solely on, and/or deflections occurring solely in, the distal struts  68  do not significantly affect the ability of the proximal struts  58  to maintain their expanded state and/or maintain engagement with adjacent portions of the bifurcation  25 . 
     One, some or all of the struts  58  can bend or pivot with respect to the intermediate section  54  independently of one, some or all of the struts  68 , and vice versa. The intermediate section  54  may promote independence by interconnecting the struts  58  and the struts  68  in a radially central region of the device  50 , and physically and functionally separating them, absorbing bending stresses from the struts  58  and the struts  68  rather than transmitting them from the struts  58  to the struts  68  or vice versa. 
     Instead of or in addition to independence of the proximal struts  58  as a group, from the distal struts  68  as a group, the struts  58  may be independent of each other (within the group of struts  58 ), and/or the struts  68  may be independent of each other (within the group of struts  68 ). In the device  50  as depicted in  FIGS.  5 - 9   , the proximal struts  58  are independent of each other and the distal struts  68  are independent of each other. Each proximal strut  58  can bend or pivot with respect to the intermediate section  54  independently of the other proximal struts  58 , and each distal strut  68  can bend or pivot with respect to the intermediate section  54  independently of the other distal struts  68 . Independence is promoted within each group of struts  58 ,  68  by interconnecting them only at their proximal and distal ends, and in a radially central region of the device  50 . 
     It should be noted, however, that independence as used herein does not exclude interconnecting independent components by members (e.g. membranes, very fine wires and the like) that are insufficiently rigid to cause one component to significantly affect the action of the other. The proximal struts  58  and/or the distal struts  68  can also be independent of each other, but only within a limited region of the proximal section  52  and/or distal section  58 . For example, the proximal struts  58  may be independent of each other within the distal face  64  of the proximal section, and/or the distal struts  68  may be independent of each other within the proximal face  72  of the distal section  56 . 
     The tapered distal face  64  of the proximal section  52  and tapered proximal face  72  of the distal section  56  also allow the sections  52 ,  56  to pivot significantly without contact between the sections  52 ,  56  other than at the intermediate section  54 . 
     The intermediate section  54  can be rigid or flexible. Where the intermediate section  54  is rigid, the pivotability of the device  50  can be provided by the flexibility and/or independence of the struts  58  in the distal face  64  of the proximal section  52  and of the struts  68  in the proximal face  72  of the distal section  56 . In this example, the proximal and distal sections are able to pivot multiaxially relative to each other without requiring plastic deformation of the intermediate section. Each of struts  58  and struts  68  may be capable of flexing, extending, bowing, straightening, bending, or other elastic or plastic deformation along the length or a portion thereof. 
     As struts  58  and struts  68  independently flex and extend, sections  52 ,  56  can pivot about intermediate section  54  and relative to each other. For example, struts on one side of a section may flex (e.g., bend), and struts on an opposing side of a section may extend (e.g., straighten), whereby the section pivots about the region where the struts connect to intermediate section  54 . 
     According to embodiments, such action is facilitated along one or more sections of the device. According to embodiments, this pivot action is provided without requiring plastic deformation of intermediate section  54  or any action along the length of intermediate section  54 . The intermediate section  54  can comprise a short length of hypotube (e.g., a short length of uncut hypotube when the proximal and/or distal sections  52 ,  56  are cut from the hypotube) which may be flexible or rigid. According to embodiments, the intermediate section  54  can comprise a flexible coil, longitudinally oriented such that its winds spiral around the central longitudinal axis of the device  50 , or the intermediate section  54  can comprise a ball-and-socket joint, a length of flexible wire, or other flexible member. 
     The device  50  can further comprise one or more radiopaque markers (e.g. coils) coupled to or wound around portions of the device. For example, the device  50  can include radiopaque markers on one, two or all three of the proximal end portion  60 , intermediate section  54 , and distal end portion  70 . Instead of or in addition to those markers, the device  50  can include radiopaque markers on one or more of the struts  58 , and/or on one or more of the struts  68 . According to embodiments, when any of the proximal end portion  60 , intermediate section  54 , or distal end portion  70  defines a central lumen therethrough (e.g., when the device  50  is cut or etched from a tube or sheet), radiopaque material may be placed within some, one or all of those lumens to make the portion(s)  60 / 54 / 70  radiopaque. For example, radiopaque material maybe provided within a lumen of at least one of portion(s)  60 / 54 / 70  with securement at one or both of the ends of the lumen. 
     The device  50  can comprise a self-expanding, super elastic, and/or a shape-memory material (e.g., comprising Nitinol, CoCr alloy, shape memory polymers (e.g., polyglycolic acid, polylactic acid), etc.), thereby causing the device  50  to be self-expanding under certain conditions (e.g., when not restrained by a catheter). In some embodiments, the proximal section  52 , the intermediate section  54 , and/or the distal section  56  may comprise different materials. For example, the distal section  56  may comprise polymer material while the proximal section  52  and the intermediate section  54  comprise metallic material, a different polymer material, etc. For another example, the distal section  56  may comprise metallic material while the proximal section  52  and the intermediate section  54  comprise different metallic materials, polymer material, etc. Other combinations of materials are also possible. The device  50  can assume a low profile compressed state (e.g., confined within a catheter) for delivery. When cut from a tube or sheet, the device  50  may assume substantially the diameter of the tube or rolled sheet when in the compressed state. Upon deployment from the catheter, the device  50  expands from the compressed state to an expanded state. 
       FIG.  8    depicts one example of the device  50  in use, positioned at a junction  36  of a bifurcation  25  (e.g., a neurovascular bifurcation (e.g., the basilar tip area)) comprising at least one afferent or parent vessel  30 , efferent or branch vessels  32 ,  34 , the junction  36  of the vessels  30 ,  32 ,  34 , and an aneurysm  20  having a fundus  22  and a neck  24 . The proximal section  52  is positioned in the parent vessel  30  in an expanded state, such that the waist  66  contacts the inner wall of the vessel  30 . Where the proximal section  52  is self-expanding, the struts  58  are biased radially outward and the struts in the waist  66  may engage or “grip” the vessel wall, thereby anchoring the proximal section  52  and the device  50  in the parent vessel  30 . The distal section  56  is positioned in the junction  36  in an expanded state, such that the waist  76  contacts the inner wall of the junction  36 . Where the distal section  56  is self-expanding, the struts  68  are biased radially outward and the struts in the waist  76  may engage or “grip” the junction wall, thereby anchoring the distal section  56  and the device  50  in the junction  36 . The struts  68  of the distal section  56  may also center the distal section  56  (and the distal face  74  thereof) in the junction  36  and/or aneurysm neck  24 . 
     When the proximal and distal sections  52 ,  56  are in their expanded state, the friction force developed between the proximal section  52  and the inner wall of the parent vessel  30 , and/or the friction force developed between the distal section  56  and the inner wall of the junction  36 , may suffice to prevent the device  50  from moving significantly in the proximal direction, away from the aneurysm  20  and in the distal direction, toward the aneurysm  20 . 
     In the implementation depicted in  FIG.  8   , the distal face  74  of the distal section  56  extends into and occupies at least a portion of the neck  24  of the aneurysm  20 . The struts  68  and widened portion(s)  78  (or another structure, such as a mesh or membrane) make the distal face  74  sufficiently low in porosity that the face  74  and device  50  can act as a scaffolding to inhibit or prevent herniation or prolapse of objects (e.g., embolization coils or materials, thrombi, etc.) out of the neck  24  of the aneurysm  20 . 
     The device  50  can permit blood to flow from the parent vessel  30  to the efferent vessels  32 ,  34  of the bifurcation. The proximal section  52  presents minimal axially-facing or proximally-facing surface area (see  FIG.  6   ) toward oncoming blood flow in the parent vessel  30  so that blood passes through the proximal section  52  with little or no blockage. The proximal face  72  of the distal section  56  likewise presents minimal axially-facing or proximally-facing surface area toward blood flow that has passed through the proximal section  52 , so that such blood passes into or through the distal section  56  with little or no blockage. In addition, depending on the manner in which the device  50  is positioned in the bifurcation  25 , blood that has passed through the proximal section  52  may flow around the distal section  56  and into one or both efferent vessels  32 ,  34  (indicated by arrow  80  in  FIG.  8   ), instead of or in addition to blood that flows through the distal section  56  and into the vessel(s)  32 ,  34 . 
     The depicted distal face  74  of the distal section  56  is configured to impede or block blood flow therethrough, via the widened portions  78  and/or other structures as disclosed elsewhere herein. Accordingly, blood tends to stagnate in and around the distal face  74 , promoting thrombogenesis, occlusion of the aneurysm  20 , and retention of any filling materials and thrombi in the aneurysm. 
       FIG.  9    depicts another example of the device  50  in use, positioned at a junction of a bifurcation  25  which is similar to that depicted in  FIG.  8   , with the exception that the parent vessel  30  is significantly angled or curved with respect to the efferent vessels  32 ,  34 , the junction  36 , and/or the aneurysm  22 . For example, in such a bifurcation the central axis of the parent vessel  30  can be non-coaxial and non-parallel with a central axis of the junction  36  and/or a central axis of the aneurysm  20 . 
     As depicted in  FIG.  9   , the various components of the device  50  perform the same functions in the same manner as described with regard to  FIG.  8   , except that the proximal and distal portions  52 ,  56  are not coaxial, but are in a tilted orientation (e.g., their respective central axes form an included angle of less than 180 degrees). In addition, one, two or all three of (a) the intermediate portion  54 , (b) the struts  58  of the distal face  64  of the proximal portion  52 , and (c) the struts  68  of the proximal face  72  of the distal portion  56 , may flex or pivot to accommodate the tilted orientation of the portions  52 ,  56  with respect to each other. In this manner, despite the tortuosity of the bifurcation  25 , the proximal portion  52  can engage the parent vessel  30  and support the distal portion  56  in the junction  36  and neck  24  sufficiently to prevent significant migration of the device  50  in the distal or proximal directions, and the distal portion  56  can be approximately centered within the junction  36  and neck  24  (and, where appropriately configured, can engage the inner wall of the junction  36  to provide additional anti-migratory support). 
     To facilitate tilting/flexing/pivoting in the manner depicted in  FIG.  9   , the connections of the struts  58  and/or the struts  68  to the intermediate portion  54  may be configured to provide pivoting action, such as by making the struts  58 / 68  slightly thinner where they meet or connect to the intermediate portion  54 . Such a pivotable arrangement of the struts and intermediate portion may allow the portions  52  and  56  to tilt with respect to each other without significantly buckling or deforming the struts and altering the expanded shape of the portions  52 ,  56 . In other words, the pivoting connections of the struts  58 / 68  to the intermediate portion (instead of, or in addition to, a flexible intermediate portion  54 ) can relieve some or all of the bending stress imparted to the struts  58 / 68  when the device  50  takes on a tilted orientation as in  FIG.  9   . These structural features may be employed instead of or in addition to others disclosed herein to promote pivoting/tilting the sections  52 ,  56  without substantially affecting their ability to remain expanded or engage adjacent portions of the bifurcation. The device  50  may be configured to allow the portions  52 ,  56  to tilt/flex/pivot with respect to each other up to 90 degrees. 
       FIGS.  10 - 11    depict another example of the device  50 , which can be similar in structure, function, methods of use and construction, etc. to the device  50  described herein with reference to  FIGS.  5 - 9   , except as further described herein. Accordingly, like reference numerals refer to like components in  FIGS.  5 - 9   , on the one hand, and  FIGS.  10 - 11    on the other hand, except where a description or depiction to the contrary is provided expressly herein. In the device  50  of  FIGS.  10 - 11   , the waist  66  comprises a number of waist members  67  that interconnect both laterally (e.g., circumferentially) and longitudinally. The waist members  67  can thus form a number of bands of diamond forms  69  which are expandable in circumference to engage or grip the inner wall of the parent vessel  30  when the device  50  is in use. The waist members  67  can be arranged in circumferentially expandable patterns other than the one depicted in  FIGS.  10 - 11   , with or without the use of diamond forms  69 . 
     The struts  58 , and the proximal and distal faces  62 ,  64  of the proximal section  52 , can be similar to those described herein with reference to the device  50  of  FIGS.  5 - 9   . In the device  50  of  FIGS.  10 - 11    the proximal face  62  of the proximal section  52  and the proximal end portion  60  may be omitted altogether, to create a device  50  with an open proximal end. 
     In a variation of the device  50  of  FIGS.  5 - 9   , or of the device  50  of  FIGS.  10 - 11   , the waist  66  can comprise an expandable woven mesh, woven from filaments of any material disclosed herein as suitable for constructing the device  50 . Such a woven mesh can be cylindrical in form, with the distal edge thereof connected to the proximal ends of the struts  58  of the distal face  64  of the proximal portion  52 . The proximal edge of the cylindrical mesh can be connected to the distal ends of the struts  58  of the proximal face  62  of the proximal portion  52 . According to embodiments, the proximal face  62  of the proximal section  52  and the proximal end portion  60  may be omitted altogether, to create a device  50  with an open proximal end. 
       FIG.  11    depicts one example of the device  50  of  FIGS.  10 - 11    in use, positioned at a junction  36  of a bifurcation  25  in a manner similar to that depicted in  FIG.  8   . The proximal section  52  is positioned in the parent vessel  30  in an expanded state, such that the waist  66  contacts the inner wall of the vessel  30 . Where the proximal section  52  is self-expanding, the struts  58  are biased radially outward and the waist member  67  and diamond forms  69  are biased to a circumferentially expanded state so that the waist  66  engages or “grips” the vessel wall, thereby anchoring the proximal section  52  and the device  50  in the parent vessel  30 . Furthermore, the functions, modes of action, and methods of use of these and the other components of the device  50  of  FIGS.  10 - 11    are the same as described elsewhere herein (including in connection with  FIGS.  8 - 9   ) for the device  50  of  FIGS.  5 - 9   . 
       FIG.  12    depicts one example of a widened portion  78  that may be employed with any of the embodiments of the device  50  disclosed herein. One, some or all of the widened portions  78  (and struts  68 ) of the device  50  may take the form depicted in  FIG.  12    and further described herein. To form the widened portion  78 , the strut  68  can be longitudinally split into sub-struts  82  that surround an opening  84  in the widened portion  78 . The opening  84  can be left as an open space, in which case the thrombogenicity of the distal face  74  of the distal section  56  is enhanced by the division of the struts  68  of the distal face into a larger number of narrower, spread-apart sub-struts  82 . According to embodiments, the opening  84  can be filled or covered with radiopaque material, and/or radiopaque coils can be wound around the sub-struts  82 . According to embodiments, a combination of open and covered/filled radiopaque widened portions  78 , and sub-struts  82  bearing radiopaque coils, can be employed. The widened portions may also alternate or vary in size from one strut  68  to the next. 
     The struts  68  can be configured to form the sub-struts  82  and opening  84  via tapering portions  86  on either side of the opening  84 . Distal and proximal of the tapering portions  86 , the struts  68  can be of substantially uniform width. The proximal portion  88  of the strut  68  (proximal of the widened portion  78 ) can be wider than the distal portion  90  of the strut  68  (distal of the widened portion  78 ). In such a case, the width of the proximal strut portion  88  can nonetheless be substantially uniform from the proximal tapering portion  86  to the intermediate portion  54 , and the width of the distal strut portion  90  can be substantially uniform (but narrower than the width of the proximal strut portion  88 ) from the distal tapering portion  86  to the distal tip portion  70  of the device  50 . By employing struts  68  that are narrower in their distal portions  90  than in their proximal portions  88 , the distal face of the distal portion  56  can be made relatively compliant and therefore more easily conformable to any embolic material in the aneurysm  20 , while retaining a desired degree of stiffness in the proximal components of the device  50 . 
     The various versions of the vascular remodeling device  50  disclosed herein (e.g. the devices  50  of  FIGS.  5 - 12   ) can be manufactured in a process comprising cutting (or electrochemically etching) and shaping a metallic tube or sheet (e.g., a laser cut hypotube or sheet). A laser or electrochemical etcher may cut out portions of the tube, leaving in place the various structural elements of the proximal section  52 , the intermediate section  54 , and/or the distal section  56 . In the device  50  depicted in  FIGS.  5 - 9  and  12   , or the device  50  depicted in  FIGS.  10 - 12   , the proximal section  52 , the intermediate section  54 , and the distal section  56  can be integrally formed from a metallic tube and not cut away from each other. In devices  50  in which all sections  52 ,  54 ,  56  are integrally fabricated by being cut, etched, etc. from the same tube or sheet, the device  50  is of single-piece construction, taking the form of a single, partial tube or sheet. Alternatively, the sections  52 ,  54 ,  56  can be formed separately and then assembled together using any suitable technique, such as welding, gluing, interlocking, crimping, swaging, braiding, deposition, etc. Where the intermediate section  54  comprises a coil, the sections  52  and  56  may be formed from the same or separate tubes, and then attached to either end of the coil using any such suitable technique. 
     After cutting from one or more tubes, the device  50  or section(s)  52 / 54 / 56  thereof may be reshaped and heat treated to impart shape setting to the device or section(s). The shape setting process may include several steps comprising, for example, stretching and confining the cut tube into a new shape during the heat treatment. At the end of each heat treatment step, the cut tube assumes the shape in which it was confined during the heat treatment process. The final shape (e.g., expanded state) and size may obtained by several such steps. The device  50  or cut tube may be electropolished during manufacture, which can reduce the initial wall thickness of the tube to a final, desired thickness. 
     Although the device  50  is depicted in its expanded state in  FIGS.  5 - 11   , the device  50  can have a contracted state in which the proximal and distal sections  52 ,  56  take on a smaller diameter than in the expanded state. For example, in the contracted state the sections  52 ,  56  can have a diameter small enough to fit within a delivery device, such as a microcatheter. Where the sections  52 ,  54 ,  56  are cut from a single tube, the diameter of one or both of the proximal and distal sections  52 ,  56  when in the contracted state can be substantially equal to the diameter of the tube from which the device  50  is cut, and/or substantially equal to the diameter of the intermediate section  54 . 
     The table below provides an example set of dimensions that can be employed in constructing the device  50  of  FIGS.  5 - 9  and  12   . Such a device  50  can have a proximal section  52  with six struts  58 , and a distal section  56  with eight struts  68 . The table below also provides an example set of dimensions for all components of the device  50  of  FIGS.  10 - 12    that are common with the device  50  of  FIGS.  5 - 9  and  12   . The dimensions provided below should not be taken as limiting with respect to the device  50  of  FIGS.  5 - 9  and  12    or the device  50  of  FIGS.  10 - 12   . One, several, or all of these dimensions can be disregarded when constructing the device  50  of  FIGS.  5 - 9  and  12    or the device  50  of  FIGS.  10 - 12   . 
     
       
         
           
               
               
               
             
               
                   
               
               
                 Compo- 
                   
                   
               
               
                 nent 
                 Dimension 
                 Size 
               
               
                   
               
             
            
               
                 proximal 
                 diameter at waist 66 (expanded) 
                 3-14 mm 
               
               
                 section 52 
                 diameter at waist 66 (contracted) 
                 0.015 in., 0.010-0.030 in. 
               
               
                   
                 length (expanded) 
                 10 mm, 2-20 mm or more 
               
               
                   
                 width of struts 58 
                 0.0045 in., 0.003-0.006 in. 
               
               
                   
                 thickness of struts 58 
                 0.0015 in., 0.001-0.004 in. 
               
               
                 interme- 
                 length 
                 0.15 mm, 0-5 mm 
               
               
                 diate 
                 diameter 
                 0.015 in., 0.010-0.030 in. 
               
               
                 section 54 
                 wall thickness 
                 0.0015 in., 0.001-0.004 in. 
               
               
                 distal 
                 diameter at waist 76 (expanded) 
                 2-20 mm, 4-15 mm 
               
               
                 section 56 
                 diameter at waist 76 (contracted) 
                 0.015 in., 0.010-0.030 in. 
               
               
                   
                 length (expanded) 
                 2-20 mm, 4-15 mm 
               
               
                   
                 width of struts 68 
                 0.0035 in. (proximal of 
               
               
                   
                   
                 widened portions 78) 
               
               
                   
                   
                 0.003 in. (distal of widened 
               
               
                   
                   
                 portions 78) 
               
               
                   
                 thickness of struts 68 
                 0.0015 in., 0.001-0.004 in. 
               
               
                   
                 width of sub-struts 82 
                 0.002 in., 0.001-0.003 in. 
               
               
                   
                 thickness of sub-struts 82 
                 0.0015 in., 0.001-0.004 in. 
               
               
                   
                 length of opening 84 
                 2-5 mm 
               
               
                   
                 width of opening 84 
                 0.5-4 mm 
               
               
                   
               
            
           
         
       
     
       FIGS.  13 - 15    depict an example of a cut pattern  100  that can be employed (e.g., in laser cutting or etching a hypotube or sheet) to construct the device  50  of  FIGS.  5 - 9  and  12   . The cut pattern  100  of  FIGS.  13 - 15    is suitable for a device  50  having six struts  68  in the distal portion  56 ; otherwise, the device  50  formed via the cut pattern  100  can be similar in structure, function and method of use to the device  50  depicted in  FIGS.  5 - 9  and  12    and described elsewhere herein. The cut pattern  100  provides uncut areas that form the various components of the device  50 . Those components of the device  50  are marked in  FIGS.  13 - 15    with the same reference numerals as in  FIGS.  5 - 9  and  12    (and, for common components, as in  FIGS.  10 - 11   ). 
       FIGS.  16 - 18    depict another example of a cut pattern  200  that can be employed (e.g., in laser cutting or etching a hypotube or sheet) to construct the device  50  of  FIGS.  5 - 9  and  12   . The cut pattern  200  of  FIGS.  16 - 18    is suitable for a device  50  having four struts  58  in the proximal portion  52  and four struts  68  in the distal portion  56 . The cut pattern  200  also forms widened portions  78  whose longitudinal midpoints are on the waist  66  of the distal portion  56 , rather than on the distal face  74  thereof. Otherwise, the device  50  formed via the cut pattern  200  can be similar in structure, function and method of use to the device  50  depicted in  FIGS.  5 - 9  and  12    and described elsewhere herein. The cut pattern  200  provides uncut areas that form the various components of the device  50 . Those components of the device  50  are marked in  FIGS.  16 - 18    with the same reference numerals as in  FIGS.  5 - 9  and  12    (and, for common components, as in  FIGS.  10 - 11   ). 
       FIGS.  8 ,  9  and  11    illustrate examples of the placement of the device  50  at a bifurcation  25 . The proximal section  52  is anchored in the afferent or parent vessel  30 , the intermediate section  54  allows perfusion to the branch or efferent vessels  32 ,  34 , and the distal section  56  acts as scaffolding to inhibit herniation of embolic material from the aneurysm  20 , and/or to induce thrombogenesis in the aneurysm  20 . 
     Positioning of the device  50  using the parent vessel  30  as the delivery path for the device  50  may be accomplished via, for example, the method illustrated in  FIGS.  19 - 21   . First, as shown in  FIG.  19   , a delivery catheter  300  (e.g., a microcatheter or other catheters that can be tracked through and reach the location of the aneurysm  20 ) is inserted into the patient&#39;s vasculature and advanced distally through the parent vessel  30  until a distal tip  302  of the catheter  300  is placed in the junction  36 , or in the parent vessel  30  proximal of but near the junction  36 , or in the aneurysm  22 . The device  50  is then is inserted in the proximal end of the catheter  300  (or it may be positioned in the catheter  300  prior to placement of the distal tip  302 ). 
     As seen in  FIG.  20   , the distal section  56  of the device  50  is then pushed out of the distal end of the catheter  300  (e.g., using a push wire and pulling the catheter back), allowing the distal section  56  to expand (e.g., self-expand). While the proximal section  52  remains at least partially contracted within the catheter  300  as shown in  FIG.  20   , the position of the expanded distal section  56  relative to the junction  36 , aneurysm neck  24  and parent vessel  30  can be adjusted via manipulation of the catheter  300  (and/or push wire, etc.). 
     One example of a desired placement of the distal section  56  is depicted in  FIG.  20   , in which the distal face  74  of the distal section  56  spans the aneurysm neck  24  and/or reduces the effective size of the neck. Such spanning and/or reduction can involve positioning the distal section  56  such that the distal face  74  projects into the neck  24 , as depicted in  FIG.  20   . The placement of the distal section  56  can also involve causing the expanded waist  76  to engage the inner wall of the junction  36 . Such engagement of the waist  76  (and/or other portions of the distal section  56 ) with the inner wall of the junction  36  can establish and/or maintain both the longitudinal (proximal-distal) and lateral (transverse to the longitudinal direction) position of the distal section  56  relative to the aneurysm neck  24 . 
     To achieve a desired degree of engagement of the distal section  56  with the junction  36 , the presently described method can include determining the size, width or diameter of the junction  36 , and selecting a device  50  whose distal section  56  has an unconstrained expanded size, width or diameter (e.g. at the waist  76  thereof) which is larger than that of the junction  36 . Preferably, the selected distal section  56  is somewhat larger than the junction  36 , for example by about 0.5-1.0 mm. 
     When the distal section  56  is positioned in the junction  36  as shown in  FIG.  20   , the inward-tapering, minimally occlusive struts  68  of the proximal face  72  can allow blood to flow with minimal or no obstruction from the parent vessel  30  to the branch vessels  32 ,  34 , either through the proximal face  72  (arrow  79 ) or around the proximal face  72  (arrow  80 ). At the same time, the relatively highly occlusive distal face  74  can span the neck  24  and/or reduce the effective size of the neck. 
     The deployment of the device  50  can further proceed with additional proximal withdrawal of the catheter  300  (and/or distal pushing of the device  50 ) so that the intermediate section  54  emerges from the catheter  300 , followed by the proximal section  52 , which is allowed to expand (e.g. self-expand). In this manner, the waist  66  can engage the inner wall of the parent vessel  30  as shown in  FIG.  21   , and the proximal section  52  can secure the position of the device  50 , particularly against longitudinal movement. Additionally, the extension of the proximal section  52  into the parent vessel  30  can prevent rotation of the distal section  56  in the junction  36  (or, where applicable, the neck  24  or aneurysm  20 ), and help maintain the waist  76  in engagement with the inner wall of the junction (or neck, or aneurysm). 
     Where the parent vessel  30  is angled or curved with respect to the efferent vessels  32 ,  34  or the aneurysm  20  (see, e.g.  FIG.  9   ), the presently described method can involve tilting, flexing or pivoting the distal section  56  relative to the proximal section  52  (or vice versa), e.g. as the device  50  is advanced into position, and/or adjusted in position or orientation once advanced and deployed or partially deployed. Where the blood vessel has a bend, the device may be a maneuvered around the bend allowing the distal section and the proximal section to pivot relative to each other at or near the intermediate section. The device  50  can be left in its tilted/flexed/pivoted configuration following deployment, as depicted in  FIG.  9   . When the device  50  is deployed in such angled or curved vasculature, portions of the proximal section  52  other than the waist  66  may engage the inner wall of the parent vessel  30 , depending on the degree to which the sections  52 ,  56  are tilted with respect to each other. For example, the proximal and/or distal faces  62 ,  64  of the proximal section  52  may engage the inner wall of the parent vessel  30 . The proximal section  52  can be tilted within the parent vessel  30  such that one side of the proximal face  62  and the opposite side of the distal face  64  both engage the inner wall of the vessel. In addition, the intermediate section  54  may engage or contact the vessel wall as well. 
     Where a suitable proximal end portion  60  and deployment apparatus are employed, the device  50  can be fully retrieved inside the catheter  300 , the position of the catheter  300  can be adjusted, and the device  50  can be redeployed, for example to a more desirable position if the position of any section  52 ,  54 ,  56  after initial deployment of the device  50  was not as desired after initial deployment. Additionally or alternatively, the device  50  can be fully retrieved inside the catheter  300  and a different catheter or the same catheter  300  with a different device  50  (e.g., a device  50  having different dimensions such as diameter of the proximal portion  52 , length of the intermediate portion  54 , etc.) can be deployed, for example at a more desirable position or with more desirable properties (e.g., better anchoring, better neck coverage, etc.). Once the device  50  is positioned, the device  50  can be detached from the catheter  300 , pusher wire, etc. electrolytically, mechanically, or chemically, and the catheter  300  withdrawn (see  FIG.  21   ). The catheter  300  may then be withdrawn from the bifurcation  25 , thereby leaving or permanently positioning the device  50  at the junction  36  of the bifurcation  25 . 
     Embolic material may be placed in the aneurysm  20  before, after, and/or during positioning of the device  50 .  FIGS.  22 - 24    depict placement of embolic material (in particular, embolic coil(s)) after placement of the device  50 . A catheter, which can comprise the catheter  300  or a separate catheter  310  as shown in  FIG.  22   , is advanced distally through the parent vessel  30  and the proximal and distal sections  52 ,  56  of the device  50  until a distal tip  312  thereof passes through and is positioned distal of the distal section  56 , in the fundus  22 . As seen in  FIG.  23   , one or more coils  320  (and/or other aneurysm filling material) can then be advanced distally through the catheter  310  and into the fundus  22 . Sufficient coils  320  and/or other material can be so delivered into the fundus  22  to create a mass  330  of filling material in the fundus ( FIG.  24   ). The device  50 , in particular the distal face  74  of the distal section  56 , can act as a scaffolding to support the mass  330  in the aneurysm  20  and prevent herniation of coils or other material through the neck  24 . 
       FIGS.  25 - 32    depict a version of the device  50  (and a cut pattern  300  for constructing it) that can be similar to any of the other versions or embodiments of the device  50  disclosed or summarized herein, in structure, configuration, function, method of manufacture, method of use, and material choice, except as further discussed herein. In the device  50  of  FIGS.  25 - 32   , the struts  58  of the proximal section  52  comprise a number (e.g.  6 , as depicted, or any other suitable number) of proximal strut portions  58   a  and a corresponding number of distal strut portions  58   b.    
     The proximal portions  58   a  and the distal portions  58   b  are rotated or shifted laterally with respect to each other, such that each proximal portion  58   a  opposes (e.g., approximately one-half of each of) two distal portions  58   b , and vice versa. From the distal end of each proximal portion  58   a , two sub-struts  58   c  extend distally to the two distal portions  58   b  that oppose (e.g., are longitudinally, radially, and/or angularly adjacent) the proximal portion  58   a  from which the sub-struts  58   c  extend. Accordingly, each proximal portion  58   a  is connected to the two adjacent or opposing distal portions  58   b  (and vice versa) via sub-struts  58   c . For example, each strut may have a proximal end, a distal end, and a center portion therebetween, the center portion connected to adjacent struts. 
     As used herein, elements that are “longitudinally adjacent” or “longitudinally offset” have a different longitudinal position with respect to an axis. As used herein, elements that are “radially adjacent” or “radially offset” have a different radial distance from an axis. For example, under a polar coordinate system, two members being radially offset would have distinct radial coordinates with respect to an axis. As used herein, elements that are “angularly adjacent” or “angularly offset” have a different angular position with respect to an axis. For example, under a polar coordinate system, two members being angularly offset would have distinct angular coordinates with respect to an axis. 
     In another example, each strut may extend from an origination junction and be divided into a first and second branch, wherein the first branch is connected to a first adjacent strut and the second branch is connected to a second adjacent strut. In this example, a length of the first branch and a length of the second branch may be different such that a connecting point between the strut and the first adjacent strut is disposed at a different longitudinal position than a connecting point between the strut and the second adjacent strut. 
     According to embodiments, the length of the first branch and the length of the second branch may be the same. According to embodiments, the length of the first branch and the length of the second branch may different. For example, one branch may have a different longitudinal position relative to another branch. By further example, one branch may be offset relative to another branch with a different longitudinal position when connected to an adjacent strut. In another example, at least one strut may extend proximally from the intermediate section and be divided into a first and second branch at or near the waist of the proximal section. The first branch may be connected to the first adjacent strut and the second branch may be connected to the second adjacent strut. The first and second adjacent struts may extend proximally from the waist of the proximal section toward the radially central region of the device. 
     According to embodiments, one or more sections  52 ,  56  may have a first plurality of struts extending from a proximal end of the section and a second plurality of struts extending from the distal end of the section. The first and second plurality of struts may be interconnected at the waist or middle portion of the section by a third plurality of struts. Each of the first plurality of struts may be connected to two or more of the third plurality of struts. Each of the second plurality of struts may be connected to two or more of the third plurality of struts. The number of the first plurality of struts may equal the number of the second plurality of struts. The number of the third plurality of struts may be double, triple, or another multiple of one or each of the number of the first plurality of struts and the number of the second plurality of struts. 
     When the proximal section  52  of the device  50  of  FIGS.  25 - 32    is expanded, the sub-struts  58   c  extend both longitudinally to interconnect the proximal end portion  60  and the intermediate section  54 , and laterally or circumferentially to each neighboring proximal or distal portion  58   a  or  58   b . The resulting lateral or circumferential interconnection of the struts  58  of the proximal section  52  increases the outward radial force exerted by the proximal section  52  (and the inward radial force that the proximal section  52  can withstand without collapse) when expanded and thereby improves the ability of the proximal portion  52  to “grip” the vessel wall (e.g. of the parent vessel  30 ) and prevent migration of the deployed device  50  along the vessel lumen. In addition, the lateral/circumferential interconnection of the struts of the proximal section  52  reduces the tendency of the expanded struts  58  to bunch together in the vessel or “half-moon.” Further, the lateral/circumferential interconnection of the struts of the proximal section maintains the three dimensional shape of the proximal section. Moreover, the lateral/circumferential interconnection of the struts of the proximal section provides structural support for the interconnected struts. 
     As depicted in  FIGS.  25 - 26  and  28 - 29   , the sub-struts  58   c  (e.g., the peaks thereof) can form the waist  66  of the proximal portion  52 , or otherwise comprise the radially outermost portion of the proximal portion  52 . The sub-struts  58   c  can optionally be approximately longitudinally centered on the longitudinal midpoint of the proximal portion  52 , such that the midpoint approximately evenly divides the sub-struts  58   c  in the longitudinal direction. Such an arrangement is also depicted in  FIGS.  25 - 26  and  28 - 29   . 
     As depicted in  FIGS.  27  and  31 - 32   , the widened portions  78  on the distal face  74  of the distal portion  56  can be formed via the lateral/circumferential interconnection arrangement employed in the proximal section  52  and discussed above. To accomplish this, the proximal strut portions  88  and distal strut portions  90  of the distal struts  68  are rotated or shifted laterally with respect to each other, such that each proximal portion  88  opposes (e.g., approximately one-half of each of) two distal portions  90 , and vice versa. From the distal end of each proximal portion  88 , two sub-struts  82  extend distally to the two distal portions  88  that oppose (e.g., are longitudinally, radially, and/or angularly adjacent) the proximal portion  88  from which the sub-struts  82  extend. Accordingly, each proximal portion  88  is connected to the two adjacent or opposing distal portions  90  (and vice versa) via sub-struts  82 . For example, at least one strut may extend distally from the intermediate section and be divided into a first and second branch at or near the waist of the distal section. The first branch may be connected to the first adjacent strut and the second branch may be connected to the second adjacent strut. The first and second adjacent struts may extend distally from the waist of the distal section toward the radially central region of the device. 
     When the distal section  56  of the device  50  of  FIGS.  25 - 32    is expanded, the sub-struts  82  extend both longitudinally to interconnect the intermediate section  54  and the distal end portion  70 , and laterally or circumferentially to each neighboring proximal or distal strut portion  88  or  90 . Thus is formed the widened portions  78  having openings  84 , in a configuration that increases the outward radial force exerted by the distal section  56  and its ability to grip the inner wall of a vessel, e.g. at the junction  36 . In addition, the lateral/circumferential interconnection of the struts  68  of the distal section  56  reduces the tendency of the expanded struts  68  to bunch together in the vessel or “half-moon.” Further, the lateral/circumferential interconnection of the struts of the distal section maintains the three dimensional shape of the distal section. Moreover, the lateral/circumferential interconnection of the struts of the distal section provides structural support for the interconnected struts. 
     As depicted in  FIGS.  25 ,  27  and  31 - 32   , the widened portions  78  and the sub-struts  82  can be located on the distal face  74  of the distal portion  56 . The widened portions  78  and sub-struts  82  can optionally be located wholly distal of the waist  76  of the distal portion  56 . Such an arrangement is also depicted in  FIGS.  25 - 26  and  28 - 29   . In other aspects, the widened portions may resemble the structures as disclosed elsewhere herein. 
     The device  50  of  FIGS.  25 - 32    can be employed in performing any of the methods disclosed herein, e.g. any of the disclosed methods for treating aneurysms or blood vessels such as those depicted and described with reference to  FIG.  8 - 9  or  19 - 24   . The device  50  of  FIGS.  25 - 32    can be deployed in vasculature, e.g. at a bifurcation, in the manner depicted in  FIG.  8 ,  9  or  19 - 24   . The features, components, materials or properties of the device  50  of  FIGS.  25 - 32    can be combined with any of the features, components, materials or properties of any of the other versions or embodiments of the device  50  depicted, described or summarized herein. The configuration of one or both of the proximal and distal sections  52 ,  56  of the device  50  of  FIGS.  25 - 32    can be employed when constructing the proximal and/or distal sections of any of the other versions or embodiments of the device  50  depicted, described, or summarized herein. 
       FIGS.  33 - 37    depict a version of the device  50  (and a cut pattern  400  for constructing it) that can be similar to any of the other versions or embodiments of the device  50  disclosed or summarized herein, in structure, configuration, function, method of manufacture, method of use, and material choice, except as further discussed herein. The device  50  of  FIGS.  33 - 37    can be a variation of the device  50  of  FIGS.  25 - 32   , in which the strut pattern employed to form the widened portions  78  on the distal face  74  of the distal portion  56 , is also employed on the proximal face  72  of the distal portion  56 . 
     Accordingly, in the device  50  of  FIGS.  33 - 37   , the distal portion  56  can comprise a proximal face  72  having a laterally-/circumferentially-interconnecting strut pattern as described above with respect to  FIGS.  25 - 32   . The struts of the proximal face  72  comprise a number (e.g. 6, as depicted, or any other suitable number) of first proximal strut portions  188  and a corresponding number of first distal strut portions  190 . The first proximal strut portions  188  and the first distal strut portions  190  are rotated or shifted laterally with respect to each other, such that each first proximal strut portion  188  opposes (e.g., approximately one-half of each of) two first distal strut portions  190 , and vice versa. From the distal end of each first proximal strut portion  188 , two first sub-struts  182  extend distally to the two first distal strut portions  190  that oppose (e.g., are longitudinally, radially, and/or angularly adjacent) the first proximal strut portion  188  from which the sub-struts  182  extend. Accordingly, each first proximal strut portion  188  is connected to the two adjacent or opposing first distal strut portions  190  (and vice versa) via sub-struts  182 . As shown in  FIGS.  35 - 36   , the first sub-struts  182  have first and second ends, wherein every one of the first proximal strut portions  188 , extending distally from the intermediate section  54 , divides into the first ends of two of said plurality of first sub-struts  182 , with the second ends of those two of said plurality of first sub-struts  182  extending, respectively, to two different first distal strut portions  190 . The number of first distal strut portions  190  may be equal to the number of first proximal strut portions  188 . Accordingly, the number of first sub-struts  182  may be double the number of first distal strut portions  190  or the number of first proximal strut portions  188 . 
     According to some embodiments, any given pair of one of the first proximal strut portions  188  and one of the first distal strut portions  190  is connected to each other by a single sub-strut  182 . According to some embodiments, no pair of first sub-struts  182  extending from the same first proximal strut portion  188  connects to the same first distal strut portion  190 . Conversely, each of a given pair of first sub-struts  182  extending from a given first proximal strut portion  188  connects to a different first distal strut portion  190 . 
     The distal portion  56  can further comprise a distal face  74  having an identical (as depicted) or substantially similar laterally-/circumferentially-interconnecting strut pattern as described above for the proximal face. The struts of the distal face  74  comprise a number (e.g. 6, as depicted, or any other suitable number) of second proximal strut portions  288  and a corresponding number of second distal strut portions  290 . The second proximal strut portions  288  and the second distal strut portions  290  are rotated or shifted laterally with respect to each other, such that each second proximal strut portion  288  opposes (e.g., approximately one-half of each of) two second distal strut portions  290 , and vice versa. From the distal end of each second proximal strut portion  288 , two sub-struts distal  282  extend distally to the two second distal strut portions  290  that oppose (e.g., are longitudinally, radially, and/or angularly adjacent) the second proximal strut portion  288  from which the sub-struts  282  extend. Accordingly, each second proximal strut portion  288  is connected to the two adjacent or opposing second distal strut portions  290  (and vice versa) via sub-struts  282 . As shown in  FIGS.  35 - 36   , the second sub-struts  282  having first and second ends, wherein every one of the second proximal strut portions  288 , connecting to a respective one of the first distal strut portions  190  at the second waist and extending distally from the second waist, divides into the first ends of two of said plurality of second sub-struts  282 , with the second ends of those two of said plurality of second sub-struts  282  extending, respectively, to two different second distal strut portions  290 . 
     The number of second distal strut portions  290  may be equal to the number of second proximal strut portions  288 . Accordingly, the number of second sub-struts  282  may be double the number of second distal strut portions  290  or the number of second proximal strut portions  288 . According to some embodiments, the number of second distal strut portions  290  or the number of second proximal strut portions  288  may be equal to the number of first distal strut portions  190  or the number of first proximal strut portions  188 . There may be provided the same number of second distal strut portions  290 , second proximal strut portions  288 , first distal strut portions  190 , first proximal strut portions  188 , and waist struts  92 . 
     According to some embodiments, any given pair of one of the second proximal strut portions  288  and one of the second distal strut portions  290  is connected to each other by a single sub-strut  282 . According to some embodiments, no pair of second sub-struts  282  extending from the same second proximal strut portion  188  connects to the same second distal strut portion  290 . Conversely, each of a given pair of second sub-struts  282  extending from a given second proximal strut portion  288  connects to a different second distal strut portion  290 . 
     The struts of the proximal face  72  and the struts of the distal face  74  are interconnected by a number of waist struts  92 , the number of which may correspond to the number of first distal strut portions  190  (or to half the number of proximal-face sub-struts  182 ) and/or the number of second proximal strut portions  288  (or to half the number of distal-face sub-struts  282 ). The waist struts  92  form the waist  76  between the proximal face  72  and the distal face  74 . Accordingly, the distal portion  56  can comprise two laterally-/circumferentially-interconnecting strut patterns as shown in  FIGS.  33 - 34   , disposed on either side of a relatively radially wide (or the widest) region of the distal portion  56 . In contrast, a relatively radially narrow (or the narrowest) region of the device  50  (the intermediate portion  54 ) is disposed between the laterally-/circumferentially-interconnecting strut pattern of the proximal portion  52 , and that of the proximal face  72  of the distal portion  56 . 
     As shown in  FIG.  33 - 37   , one or more of sections  52 ,  54 ,  56  and their respective parts can form a monolithic structure. For example, first proximal strut portions  188 , first sub-struts  182 , first distal strut portions  190 , waist struts  92 , second proximal strut portions  288 , second sub-struts  282 , and/or second distal strut portions  290  can form a monolithic structure. By further example, at least one of the first proximal strut portions  188 , at least two of the first sub-struts  182 , and at least one of the first distal strut portions  190  form a monolithic structure. 
     The proximal portion  52  of the device  50  of  FIGS.  33 - 37    can be identical or substantially similar to the proximal portion  52  of the device  50  of  FIGS.  25 - 32   , or of any other embodiment of the device  50  disclosed herein. For example, in the device  50  of  FIGS.  33 - 37   , the struts  58  of the proximal section  52  comprise a number (e.g. 6, as depicted, or any other suitable number) of proximal strut portions  58   a  and a corresponding number of distal strut portions  58   b . The proximal portions  58   a  and the distal portions  58   b  are rotated or shifted laterally with respect to each other, such that each proximal portion  58   a  opposes (e.g., approximately one-half of each of) two distal portions  58   b , and vice versa. From the distal end of each proximal portion  58   a , two sub-struts  58   c  extend distally to the two distal portions  58   b  that oppose (e.g., are longitudinally, radially, and/or angularly adjacent) the proximal portion  58   a  from which the sub-struts  58   c  extend. Accordingly, each proximal portion  58   a  is connected to the two adjacent or opposing distal portions  58   b  (and vice versa) via sub-struts  58   c.    
     The device  50  of  FIGS.  33 - 37    can be employed in performing any of the methods disclosed herein, e.g. any of the disclosed methods for treating aneurysms or blood vessels such as those depicted and described with reference to  FIG.  8 - 9  or  19 - 24   . The device  50  of  FIGS.  33 - 37    can be deployed in vasculature, e.g. at a bifurcation, in the manner depicted in  FIG.  8 ,  9  or  19 - 24   . The features, components, materials or properties of the device  50  of  FIGS.  33 - 37    can be combined with any of the features, components, materials or properties of any of the other versions or embodiments of the device  50  depicted, described or summarized herein. The configuration of one or both of the proximal and distal sections  52 ,  56  of the device  50  of  FIGS.  33 - 37    can be employed when constructing the proximal and/or distal sections of any of the other versions or embodiments of the device  50  depicted, described or summarized herein. 
     Instead of or in addition to the placement of the mass  330  in the aneurysm  20 , the device  50  can be configured as a flow diverter by making the distal face  74  of the distal section  56  sufficiently occlusive to inhibit blood flow out of the fundus  22  and promote formation of thrombus therein. 
     In methods in which embolic material was previously inserted in an aneurysm but has herniated, the device  50  can be used as a “rescue device” to push the herniated material back into the aneurysm and to act as a scaffolding to inhibit or prevent further herniation or prolapse of the embolic material. In certain such methods, deployment of the device  50  may advantageously avoid traversal of the junction comprising the herniated material by wires or a catheter, which may cause the herniated material to become tangled and/or dislodged and which may cause rupture of the aneurysm. 
     According to embodiments, a device  50  may be used to act upon a thrombus of foreign body within a blood vessel. For example, the device  50  may be used for thrombectomy procedures to remove at least a portion of a thrombus from a blood vessel. 
     According to embodiments, the device  50  comprises any number of sections having structure similar to distal section  56 , as disclosed herein. For example, the device  50  may comprise proximal section  52 , distal section  56 , and any number of additional sections proximal to, between or distal to proximal section  52  and distal section  56 . For example, the device  50  may comprise one, two, three, four, five, six, seven, eight, nine, ten, or more sections, each having structural configurations according to the present disclosure. According to embodiments, the device  50  comprises a wire tethered to a proximalmost section thereof. 
     According to embodiments, while in a collapsed state within a catheter, the device  50  is positioned at or near a thrombus which resides within a vasculature. From the catheter, the device  50  achieves a deployed or partially-deployed state within the blood vessel. At least one section of the device  50  (e.g., distal section  56 ) is positioned distal to the thrombus. A distal or proximal motion of the vascular intervention device  50  is generally initiated by a user who can controllably operate the device  50  at the proximal end and may be accomplished by any number of means, for example, proximal motion of the catheter, distal motion of the device  50 , or both. The device  50  is movable proximally back into the catheter through a distal opening thereof after engaging the thrombus. The proximal motion of the device  50  effectively retrieves the thrombus into the catheter. The proximal movement also causes the expanded segment(s) to revert back to a collapsed state. Suction, aspiration, or negative pressure may be provided, to facilitate capture of the thrombus within the catheter. Further, balloon devices, such as balloon catheters, may be provided and utilized to manage flow through the vasculature at the location of the thrombus. For example, a balloon may be expanded proximal to the thrombus to substantially slow or stop flow downstream to the location of the thrombus. Use of a balloon and aspiration creates a flow path that facilitates capture of the thrombus within the catheter. 
     One of the advantages of multiple segments is that relatively less precision is required during the positioning process since any of the segments can engage the thrombus. Optionally, the relatively distal segments may act as a filter by having, for example, widened portions that increase the occlusiveness of the distal segment. Thus, parts of thrombus that may be broken up during the engagement of the intermediate segment to the thrombus may be filtered downstream by the distal segment. 
     Some embodiments provide a device for retrieving vascular debris in a vasculature comprising: at least two segments radially expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; at least one intermediate portion, each intermediate portion comprising a pivot that connects adjacent segments, each pivot having a diameter comprising the radially largest region of the pivot; a sheath that is configured to encase the segments in the compressed state; and a tether that is configured to retract the expanded segment into the outer sheath. 
     Some embodiments provide a device for retrieving vascular debris in a vasculature comprising: at least three segments expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; at least two intermediate portion, each intermediate portion comprising a pivot that connects adjacent segments, each pivot having a diameter comprising the radially largest region of the pivot; a sheath that is configured to encase the segments in a compressed state; and a tether that is configured to retract the segments into the sheath. 
     Some embodiments provide a method of retrieving vascular debris from a vasculature comprising: inserting into the vasculature of a patient at least a portion of a sheath comprising a distal opening and encasing at least two or more segments expandable from a collapsed state to an expanded state, each segment having a waist comprising the radially largest region of the segment and two longitudinal ends; releasing at least a portion of a segment outside the distal opening wherein at least a portion of the segment expands to engage the vascular debris; and retrieving the segment and at least a portion of the vascular debris inside the sheath. 
     Incorporated by reference, as if fully set forth herein, are U.S. patent application Ser. No. 13/428,199, filed Mar. 23, 2012, and U.S. patent application Ser. No. 13/428,237, filed Mar. 23, 2012. 
     The foregoing description is provided to enable a person skilled in the art to practice the various configurations described herein. While the subject technology has been particularly described with reference to the various figures and configurations, it should be understood that these are for illustration purposes only and should not be taken as limiting the scope of the subject technology. 
     There may be many other ways to implement the subject technology. Various functions and elements described herein may be partitioned differently from those shown without departing from the scope of the subject technology. Various modifications to these configurations will be readily apparent to those skilled in the art, and generic principles defined herein may be applied to other configurations. Thus, many changes and modifications may be made to the subject technology, by one having ordinary skill in the art, without departing from the scope of the subject technology. 
     It is understood that the specific order or hierarchy of steps in the processes disclosed is an illustration of exemplary approaches. Based upon design preferences, it is understood that the specific order or hierarchy of steps in the processes may be rearranged. Some of the steps may be performed simultaneously. The accompanying method claims present elements of the various steps in a sample order, and are not meant to be limited to the specific order or hierarchy presented. 
     As used herein, the phrase “at least one of” preceding a series of items, with the terms “and” or “or” to separate any of the items, modifies the list as a whole, rather than each member of the list (i.e., each item). The phrase “at least one of” does not require selection of at least one item; rather, the phrase allows a meaning that includes at least one of any one of the items, and/or at least one of any combination of the items, and/or at least one of each of the items. By way of example, the phrases “at least one of A, B, and C” or “at least one of A, B, or C” each refer to only A, only B, or only C; any combination of A, B, and C; and/or at least one of each of A, B, and C. 
     Terms such as “top,” “bottom,” “front,” “rear” and the like as used in this disclosure should be understood as referring to an arbitrary frame of reference, rather than to the ordinary gravitational frame of reference. Thus, a top surface, a bottom surface, a front surface, and a rear surface may extend upwardly, downwardly, diagonally, or horizontally in a gravitational frame of reference. 
     Furthermore, to the extent that the term “include,” “have,” or the like is used in the description or the claims, such term is intended to be inclusive in a manner similar to the term “comprise” as “comprise” is interpreted when employed as a transitional word in a claim. 
     The word “exemplary” is used herein to mean “serving as an example, instance, or illustration.” Any embodiment described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other embodiments. 
     A reference to an element in the singular is not intended to mean “one and only one” unless specifically stated, but rather “one or more.” Pronouns in the masculine (e.g., his) include the feminine and neuter gender (e.g., her and its) and vice versa. The term “some” refers to one or more. Underlined and/or italicized headings and subheadings are used for convenience only, do not limit the subject technology, and are not referred to in connection with the interpretation of the description of the subject technology. All structural and functional equivalents to the elements of the various configurations described throughout this disclosure that are known or later come to be known to those of ordinary skill in the art are expressly incorporated herein by reference and intended to be encompassed by the subject technology. Moreover, nothing disclosed herein is intended to be dedicated to the public regardless of whether such disclosure is explicitly recited in the above description. 
     While certain aspects and embodiments of the invention have been described, these have been presented by way of example only, and are not intended to limit the scope of the invention. Indeed, the novel methods and systems described herein may be embodied in a variety of other forms without departing from the spirit thereof. The accompanying claims and their equivalents are intended to cover such forms or modifications as would fall within the scope and spirit of the invention. 
     Although invention(s) have been disclosed herein in the context of certain embodiments and examples, it will be understood by those skilled in the art that the invention(s) extend beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the invention(s) and obvious modifications and equivalents thereof. In addition, while several variations of the embodiments of the invention(s) have been shown and described in detail, other modifications, which are within the scope of this disclosure, will be readily apparent to those of skill in the art based upon the present specification and drawings. It is also contemplated that various combinations or sub-combinations of the specific features and aspects of the embodiments and examples may be made and still fall within the scope of the present disclosure. It should be understood that various features and aspects of the disclosed embodiments/examples can be combined with, or substituted for, one another in order to form varying modes of the embodiments/examples of the disclosed invention(s). Thus, it is intended that the scope of the invention(s) herein disclosed should not be limited by the particular embodiments/examples described above.