Patent Publication Number: US-2023149696-A1

Title: Device Delivery Tool

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     This application claims priority to Provisional Application No. 63/280,357, filed Nov. 17, 2021, which is herein incorporated by reference in its entirety. 
    
    
     TECHNICAL FIELD 
     The present disclosure relates to a device used to facilitate the intravascular delivery of a medical device. More specifically, the disclosure relates to percutaneous circulatory support systems having a cannula and a device to facilitate delivery of the cannula through delivery sheathing. 
     BACKGROUND 
     Certain medical devices, such as circulatory support devices, are delivery intravascularly. The introduction of such devices to the vasculature often involves passing the devices through one or more delivery sheaths, and then guiding the device through the patient&#39;s vasculature to its final position. In the case of a circulatory support device to be placed in the left side of the heart, the device is commonly introduced into the femoral artery and passed through the vasculature until device enters the aorta. The cannula incorporated into the device is then passed through the aortic valve and into the left ventricle. Due to the size and construction of the such devices, and in particular the cannulas incorporated into circulatory support devices, passage of the devices through delivery sheaths may be difficult. 
     SUMMARY 
     In Example 1, a percutaneous circulatory support system includes a device including a housing and a cannula coupled to the housing, a cannula delivery tool configured for receiving and radially compressing the cannula, the cannula delivery tool having a proximal portion positioned adjacent a tapered portion, and a distal portion positioned adjacent the tapered portion. 
     In Example 2, the system of Example 1 further includes wherein the cannula delivery tool is a laser cut tube and the cannula delivery tool comprises a plurality of closed cells. 
     In Example 3, the system of Example 1 further includes wherein the percutaneous circulatory support system includes a starter tube for receiving the cannula delivery tool and the cannula, wherein the cannula delivery tool is configured to compress when inserted into the starter tube. 
     In Example 4, the system of Example 3 further includes wherein the percutaneous circulatory support system further includes an introducer sheath, wherein the introducer sheath comprises an inner diameter, and when the cannula delivery tool is compressed, the cannula delivery tool is defined by an outer diameter that is less than the inner diameter of the introducer sheath. 
     In Example 5, the system of Example 1 further includes wherein the cannula delivery tool is composed of nitinol. 
     In Example 6, the system of Example 1 further includes wherein the proximal portion of the cannula delivery tool comprises a curved plate that extends on a first side of the cannula delivery tool, and wherein a tether extends from the curved plate and extends proximally to couple with the introducer sheath. 
     In Example 7, the system of Example 1 further includes wherein the cannula delivery tool includes a surface coating along the surface of the cannula delivery tool. 
     In Example 8, the system of Example 4 further includes wherein a coefficient of friction between the cannula and the introducer sheath is greater than a coefficient of friction between the cannula delivery tool and the introducer sheath. 
     In Example 9, the system of Example 6 further includes wherein the system further comprises a guidewire that extends within the cannula delivery tool and the cannula, and wherein the guidewire extends through a second side of the cannula delivery tool, the second side being opposite the first side relative to a longitudinal axis of the cannula delivery tool. 
     In Example 10, a method of deploying a percutaneous device includes providing a percutaneous support system including the percutaneous device having at least a housing coupled to a cannula, a handle for actuation of the percutaneous support system, a starter tube loaded on a catheter of the percutaneous support system, a cannula delivery tool loaded onto the catheter, and an introducer sheath. The method further includes extending the cannula delivery tool over the cannula, retracting the cannula delivery tool and the percutaneous support device into the starter tube and inserting the starter tube at least partially into the introducer sheath. The method further includes extending the cannula delivery tool out of a distal portion of the starter tube and at least partially out of a distal portion of the introducer sheath and extending the cannula out of the cannula delivery tool. 
     In Example 11, the method of Example 10 further includes wherein retracting the delivery tool into the starter tube compresses cannula delivery tool such that the cannula delivery tool comprises an outer diameter that is less than an inner diameter of the introducer sheath. 
     In Example 12, the method of Example 10 further includes wherein the percutaneous support system further includes a guidewire, and wherein the method further includes extending the guidewire through the cannula delivery tube and the percutaneous support device prior to extending the cannula delivery tool over the cannula. 
     In Example 13, the method of Example 12 further includes wherein the percutaneous support system further comprises a tether coupled to the introducer sheath and the cannula delivery tool, such that a length of the tether dictates how far the cannula delivery tool extends out of the introducer sheath. 
     In Example 14, the method of Example 10 further includes wherein the method further comprises retracting the tether in order to retract the cannula delivery tool through the introducer sheath and into the starter tube. 
     In Example 15, the method of Example 11 further includes wherein the cannula delivery tool comprises a tapered portion and a surface treatment, both configured to allow the cannula delivery tool to compress when retracted into the start tube. 
     In Example 16, a percutaneous circulatory support system includes a percutaneous circulatory support device including an impeller disposed within an impeller housing, the impeller being rotatable relative to the impeller housing to cause blood flow through the impeller housing. The system further includes a cannula coupled to the impeller housing, a cannula delivery tool configured for receiving and radially compressing the cannula, the cannula delivery tool having a proximal portion positioned adjacent a tapered portion, and a distal portion positioned adjacent the tapered portion. 
     In Example 17, the system of Example 16 further includes wherein the cannula delivery tool is a laser cut tube and the cannula delivery tool comprises a plurality of closed cells. 
     In Example 18, the system of Example 16 further includes wherein the percutaneous circulatory support system includes a starter tube for receiving the cannula delivery tool and the cannula, wherein the cannula delivery tool is configured to compress when inserted into the starter tube. 
     In Example 19, the system of Example 18 further includes wherein the percutaneous circulatory support system further includes an introducer sheath, wherein the introducer sheath comprises an inner diameter, and when the cannula delivery tool is compressed, the cannula delivery tool is defined by an outer diameter that is less than the inner diameter of the introducer sheath. 
     In Example 20, the system of Example 16 further includes wherein the cannula delivery tool is composed of nitinol. 
     In Example 21, the system of Example 16 further includes wherein the proximal portion of the cannula delivery tool comprises a curved plate that extends on a first side of the cannula delivery tool, and wherein a tether extends from the curved plate and extends proximally to couple with the introducer sheath. 
     In Example 22, the system of Example 21 further includes wherein the system further comprises a guidewire that extends within the cannula delivery tool and the cannula, and wherein the guidewire extends through a second side of the cannula delivery tool, the second side being opposite the first side relative to a longitudinal axis of the cannula delivery tool. 
     In Example 23, the system of Example 16 further includes wherein the cannula delivery tool comprises a surface coating along the surface of the cannula delivery tool. 
     In Example 24, the system of Example 23 further includes wherein the surface coating is silicone. 
     In Example 25, the system of Example 19 further includes wherein a coefficient of friction between the cannula and the introducer sheath is greater than a coefficient of friction between the cannula delivery tool and the introducer sheath. 
     In Example 26, a cannula delivery tool configured for delivering a cannula includes a proximal portion opposite a distal portion and a body portion extending therebetween, wherein the body portion comprises a tapered portion, a curved plate extending from the proximal portion configured for easing the introduction of the cannula delivery tool into a sheath, and a plurality of closed cells along the body portion formed by laser cutting a tube that forms the cannula delivery tool. 
     In Example 27, the cannula delivery tool of Example 26 further includes herein a tether is coupled to the curved plate and extends proximally from the curved plate of the cannula delivery tool, and wherein the tether is welded to the curved plate. 
     In Example 28, the cannula delivery tool of Example 26 further includes wherein the cannula delivery tool is composed of one of nitinol and stainless steel, and wherein the cannula delivery tool comprises a surface treatment. 
     In Example 29, the cannula delivery tool of Example 26 further includes wherein the cannula delivery tool is configured to compress from an expanded configuration having an expanded outer diameter to a compressed configuration have a compressed outer diameter. 
     In Example 30, a method of deploying a percutaneous support device includes providing a percutaneous support system including the percutaneous support device having at least an impeller housing coupled to a cannula, a handle for actuation of the percutaneous support system, a starter tube loaded on a catheter of the percutaneous support system, a cannula delivery tool loaded onto the catheter, and an introducer sheath. The method further includes extending the cannula delivery tool over the cannula, retracting the cannula delivery tool and the percutaneous support device into the starter tube and inserting the starter tube at least partially into the introducer sheath. The method further includes extending the cannula delivery tool out of a distal portion of the starter tube and at least partially out of a distal portion of the introducer sheath and extending the cannula out of the cannula delivery tool. 
     In Example 31, the method of Example 30 further includes wherein retracting the delivery tool into the starter tube compresses cannula delivery tool such that the cannula delivery tool comprises an outer diameter that is less than an inner diameter of the introducer sheath. 
     In Example 32, the method of Example 30 further includes wherein the percutaneous support system further includes a guidewire, and wherein the method further includes extending the guidewire through the cannula delivery tube and the percutaneous support device prior to extending the cannula delivery tool over the cannula. 
     In Example 33, the method of Example 32 further includes wherein the percutaneous support system further comprises a tether coupled to the introducer sheath and the cannula delivery tool, such that a length of the tether dictates how far the cannula delivery tool extends out of the introducer sheath. 
     In Example 34, the method of Example 30 further includes wherein the method further comprises retracting the tether in order to retract the cannula delivery tool through the introducer sheath and into the starter tube. 
     In Example 35, the method of Example 31 further includes wherein the cannula delivery tool comprises a tapered portion and a surface treatment, both configured to allow the cannula delivery tool to compress when retracted into the start tube. 
     While multiple embodiments are disclosed, still other embodiments of the present invention will become apparent to those skilled in the art from the following detailed description, which shows and describes illustrative embodiments of the invention. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not restrictive. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    illustrates a diagram of a circulatory support system, in accordance with embodiments of the subject matter disclosed herein. 
         FIG.  2 A  illustrates a sectional view of a portion of the circulatory support system, in accordance with embodiments of the subject matter disclosed herein. 
         FIG.  2 B  illustrates a sectional view of a portion of the circulatory support system, in accordance with embodiments of the subject matter disclosed herein. 
         FIG.  3    illustrates a top view of a cannula delivery tool, in accordance with embodiments of the subject matter disclosed herein. 
         FIG.  4    illustrates a side view of the cannula delivery tool of  FIG.  3   , in accordance with embodiments of the subject matter disclosed herein. 
         FIG.  5    illustrates an enlarged top view of a portion of the cannula delivery tool of  FIG.  3   , in accordance with embodiments of the subject matter disclosed herein. 
         FIG.  6    illustrates an enlarged view of a portion of the cannula delivery tool of  FIG.  3   , in accordance with embodiments of the subject matter disclosed herein. 
         FIG.  7    is a flow chart of a method of delivering a circulatory support device, in accordance with embodiments of the subject matter disclosed herein. 
     
    
    
     DETAILED DESCRIPTION 
     Various modifications and additions can be made to the exemplary embodiments discussed without departing from the scope of the present invention. 
     For example, while the embodiments described above refer to particular features, the scope of this invention also includes embodiments having different combinations of features and embodiments that do not include all of the above described features. 
       FIG.  1    depicts a side sectional view of several components of an illustrative percutaneous circulatory support system  100  in accordance with embodiments of the subject matter disclosed herein. Generally, the system  100  includes a percutaneous circulatory support device  102  (also referred to herein, interchangeably, as a “blood pump”), a cannula  116 , and an introducer sheath  134  (shown in  FIG.  2 A ). In some embodiments, the system  100  may also include a guidewire  120  (shown in  FIG.  2 A ). As described in further detail below with reference to  FIG.  7   , the introducer sheath  134  facilitates percutaneous delivery of the blood pump  102  and the cannula  116 , to a target location within a patient, such as within the patient&#39;s heart. 
     With continued reference to  FIG.  1   , the system  100  also includes a handle  104  connected to a starter tube hemostatic valve  106 . The starter tube hemostatic valve  106  is coupled to both a starter tube  108  and a starter tube flushing line  110 . The handle  104  may also couple with a proximal catheter  112 . The starter tube  108  is illustrated as coupled to a cannula delivery tool  170  which is configured to receive the cannula  116  prior to and during delivery of the blood pump  102  and the cannula  116 , as will be described further herein. In these embodiments, at least handle  104 , starter tube  108 , starter tube hemostatic valve  106 , introducer sheath  134  ( FIG.  3   ) and the cannula delivery tool  170  are configured for delivering the blood pump  102  and the cannula  116 , to the target location with the patient, as will be described further herein. In some embodiments, the guidewire  120  ( FIG.  2   ) may also be used to facilitate the delivery of the percutaneous circulatory support device  102 . While described herein with reference to the percutaneous circulatory support system  100 , cannula delivery tool  170  may be used for delivery of various other types of medical devices and is not limited to the exampled described herein. 
     As illustrated in  FIG.  2 A , the blood pump  102  generally includes an impeller assembly housing  140  and a motor housing  142 . In some embodiments, the impeller assembly housing  140  and the motor housing  142  may be integrally or monolithically constructed. In other embodiments, the impeller assembly housing  140  and the motor housing  142  may be separate components configured to be removably or permanently coupled. 
     The impeller assembly housing  140  carries an impeller assembly  144  therein. The impeller assembly  144  includes an impeller shaft  146  and an impeller  148  that rotates relative to the impeller assembly housing  140  to drive blood through the blood pump  102 . More specifically, the impeller  148  causes blood to flow from a blood inlet  150  formed on the impeller assembly housing  140 , through the impeller assembly housing  140 , and out of a blood outlet  152  formed on the impeller assembly housing  140 . In some embodiments the impeller shaft  146  and the impeller  148  may be integrated, and in other embodiments the impeller shaft  146  and the impeller  148  may be separate components. As shown in  FIGS.  1  and  2   , the inlet  150  and/or the outlet  152  may each include multiple apertures. In other embodiments, the inlet  150  and/or the outlet  152  may each include a single aperture. As shown in  FIG.  2 A , the inlet  150  may be formed on an end portion of the impeller assembly housing  140  and the outlet  152  may be formed on a side portion of the impeller assembly housing  140 . In other embodiments, the inlet  150  and/or the outlet  152  may be formed on other portions of the impeller assembly housing  140 . In some embodiments, the impeller assembly housing  140  may couple to a distally extending cannula (not shown), and the cannula may receive and deliver blood to the inlet  150 . 
     With continued reference to  FIG.  2 A , the motor housing  142  carries a motor  154 , and the motor  154  is configured to rotatably drive the impeller  148  relative to the impeller assembly housing  140 . In the illustrated embodiment, the motor  154  rotates a drive shaft  156 , which is coupled to a driving magnet  158 . Rotation of the driving magnet  158  causes rotation of a driven magnet  160 , which is connected to the impeller assembly housing  140 . More specifically, in embodiments incorporating the impeller shaft  146 , the impeller shaft  146  and the impeller  148  are configured to rotate with the driven magnet  160 . In other embodiments, the motor  154  may couple to the impeller assembly housing  140  via other components. 
     In some embodiments, a controller (not shown) may be operably coupled to the motor  154  and configured to control the motor  154 . In some embodiments, the controller may be disposed within the motor housing  142 . In other embodiments, the controller may be disposed outside of the motor housing  142  (for example, in a catheter handle, an independent housing, etc.). In some embodiments, the controller may include multiple components, one or more of which may be disposed within the motor housing  142 . According to embodiments, the controller may be, may include, or may be included in one or more Field Programmable Gate Arrays (FPGAs), one or more Programmable Logic Devices (PLDs), one or more Complex PLDs (CPLDs), one or more custom Application Specific Integrated Circuits (ASICs), one or more dedicated processors (e.g., microprocessors), one or more central processing units (CPUs), software, hardware, firmware, or any combination of these and/or other components. Although the controller is referred to herein in the singular, the controller may be implemented in multiple instances, distributed across multiple computing devices, instantiated within multiple virtual machines, and/or the like. In other embodiments, the motor  154  may be controlled in other manners. 
       FIG.  2 A  illustrates a partial sectional view of various components of the system  100  after insertion into a blood vessel V, the process of which will be described further with reference to  FIG.  7   . Specifically,  FIG.  2 A  illustrates the proximal portion  172  of the cannula delivery tool  170  and the percutaneous circulatory support device  102  positioned within the introducer sheath  134 , such that the introducer sheath  134  surrounds the cannula delivery tool  170  during at least a portion of the delivery process of blood pump  102 . For example, the introducer sheath  134  has an inner diameter  192  that is larger than a compressed outer diameter  194  of the cannula delivery tool  170  such that cannula delivery tool  170  fits entirely circumferentially within the introducer sheath  134 . In this way, the cannula delivery tool  170  is positioned between the introducer sheath  134  and at least a portion of the percutaneous circulatory device  102 . 
       FIG.  2 B  illustrates a partial sectional view of various components of the system  100  after insertion into the blood vessel V. Specifically,  FIG.  2 B  illustrates the distal portion  174  of the cannula delivery tool  170  compressed onto the cannula  116  and the cannula delivery tool  170  positioned within the introducer sheath  134 . Similar to the illustrative embodiment of  FIG.  2 A , the cannula deliver tool  170  is configured to have the compressed outer diameter  194 . In this way, the cannula delivery tool  170  is positioned between the introducer sheath  134  and the cannula  116 , and therefore, the cannula  116  does not come into direct contact with the introducer sheath  134 . This may provide the benefit of reducing the frictional force between the introducer sheath  134  and the cannula  116  that would otherwise occur, as will be described further herein. While the cannula  116  and the cannula delivery tool  170  are described with reference to a use with the percutaneous circulatory support device  102 , various other percutaneous circulatory support devices that may be different than device  102  may be used. Further, the cannula  116  and the cannula delivery tool  170  may be used with any variety of percutaneous devices and delivery systems. The cannula delivery tool  170  will be described further in detail herein. 
       FIG.  3    illustrates a top view of the cannula delivery tool  170  in an expanded configuration having an expanded outer diameter  196  that is larger than the compressed outer diameter  194  as illustrated in the configuration of  FIG.  2   . Additionally, the cannula delivery tool  170  comprises a proximal portion  172 , a distal portion  174 , and a body portion  176  extending between the proximal portion  172  and the distal portion  174  along a longitudinal axis L. At least a section of the body portion  176  comprises a tapered portion  178  which may be configured to aid in the retraction of the cannula delivery tool  170  into the starter tube  108  ( FIG.  1   ), as will be described further with reference to  FIG.  7   . Additionally, the body portion  176  of the cannula delivery tool  170  is defined by a plurality of closed cells  180  that have been machined into the cannula delivery tool  170 . In some embodiments, the cannula delivery tool  170  is composed of a metal material, such as nitinol or stainless steel, that has been laser cut to form the plurality of closed cells  180 . The use of laser cutting or otherwise machining the plurality of closed cells  180  allows for openings to be formed into the cannula delivery tool  170  that may contribute to the ability of the cannula delivery tool  170  to be compressible and expandable, while still minimizing a thickness of the cannula delivery tool  170 . For example, in conventional methods a braided design may be used for creating a plurality of closed cells in a delivery tool. However, the braided design increases the thickness of the delivery tool as the material has to weave and form intersections wherein some of the material is stacked on top of one another. This may be a disadvantage if the delivery tool needs to be positioned within an additional structure, for example, as is the case with the cannula delivery tool  170  described herein. Additionally, in some embodiments, the cannula delivery tool  170  has a surface coating such as silicone or PET to optimize the surface properties during delivery, as will be described further with reference to  FIG.  7   . In further embodiments, the surface coating may be any other lubricious coating or surface treatment which may reduce a coefficient of the cannula delivery tool  170 . 
     With continued reference to  FIG.  3   , the proximal portion  172  comprises a plate  182 . As illustrated, the plate  182  is curved and extends proximally of the cannula delivery tool  170  and couples to a tether  184 . The plate  182  may be laser cut from the cannula delivery tool  170  or otherwise machined. The plate  182  is shown having an apex  185  that extends out onto a first side  186  of the device, the first side  186  defined as a first side  186  of the device relative to the longitudinal axis L of the cannula delivery tool  170 . The first side  186  may be referred to as an upper side of the cannula delivery tool  170 . While the embodiments herein are illustrated comprising the plate  182  at the proximal portion  172 , in other embodiments, the cannula delivery tool  170  does not comprise the plate  182 . In these embodiments, the delivery tool  170  may have an end formed similar to the configuration of the distal portion  174  and/or the configuration of the body portion  176 . 
       FIG.  4    illustrates a side view of the cannula delivery tool  170  of  FIG.  3   , showing the tether  184  extending proximally from the plate  182 . In various embodiments, the tether  184  may be a separate wire that is welded to the plate  182 . When welded, the tether  184  may comprise a weld protecting surface coating to increase the stability of the tether  184 . For example, a heat shrink may be incorporated about the tether  184 . In further embodiments, the tether  184  may be formed through laser cutting an original tube that forms the cannula delivery tool  170 . In these embodiments, there may be an advantage provided in that the tether  184  is formed in one piece with the cannula delivery tool  170  and likelihood of breakage at the coupling point is reduced. Various other embodiments of the tether may be incorporated, and further methods of manufacture may be imagined. 
       FIG.  5    illustrates an enlarged and sectional view of the proximal portion  172  of the cannula delivery tool  170  having the plate  182  coupled to the tether  184 . The tether  184  extends along the same side as the plate  182 , illustratively the first side  186 . The tether  184  may additionally comprise radiopaque markers to aid the physician in identifying the positioning of the tether  184 , and thus the cannula delivery tool  170 , during delivery. As previously disclosed, the guidewire  120  may be used in combination with the illustrative percutaneous circulatory support system  100  for delivering the percutaneous circulatory support device  102  and the cannula  116 . For example,  FIG.  5    illustrates the cannula delivery tool  170  in use with the guidewire  120 . Due to the configuration of plate  182  extending only on the first side  186  of the cannula delivery tool  170 , the guidewire  120  has an open and relatively non-impeded passageway into the cannula delivery tool  170  on a second side  188  of the cannula delivery tool  170 . The second side  188  is positioned opposite to the first side  186  relative to the longitudinal axis L. This may increase the ease with which the guidewire  120  may pass through the cannula delivery tool  170  as there is an integrated opening in the cannula delivery tool  170  formed for the guidewire  120  and the interaction between the guidewire  120 , the cannula  116  and the cannula delivery tool  170  during insertion of the guidewire  120  can be reduced. However, as previously described, the illustrative percutaneous circulatory support system  100  can be used without the guidewire  120  as well. 
     Further,  FIG.  6    illustrates the distal portion  174  of the cannula delivery tool  170  in more detail. Specifically, the distal portion  174  of the cannula delivery tool  170  may be designed such that it provides an atraumatic end  174   a , thus functioning to reduce harsh and/or sharp impact, or any damage to the vasculature by the cannula delivery tool  170  during delivery. Additionally, the cannula delivery tool  170  may not dislodge calcification that may be present on a vessel wall if the distal portion  174  includes an atraumatic end  174   a . For example, the illustrative embodiment of  FIG.  6    shows various configurations of the plurality of closed cells  180  having rounded apices  190  that extend distally from the distal portion  174 . The rounded apices  190  provide the benefit of a less harsh or sharp interface than would otherwise be present if a jutted or pointed end were incorporated. While illustrated as having rounded apices  190 , the distal portion  174  may be varied in configuration to provide this atraumatic end  174   a.    
       FIG.  7    illustrates a method  200  of delivering a percutaneous circulatory support device, for example the percutaneous circulatory support device  102  described with reference to  FIGS.  1  and  2   , using cannula delivery tool  170 . The following method  200  will be described with reference to  FIG.  7    and the components as illustrated in at least  FIGS.  1  and  2   . 
     At block  202 , the method first comprises providing a percutaneous support system, for example, the percutaneous circulatory support system  100 . Further, at block  204 , the method  200  includes extending the cannula delivery tool  170  over the cannula  116  of the illustrative percutaneous circulatory support system  100 . Extending the cannula delivery tool  170  over the cannula  116  may include positioning the cannula delivery tool  170  such that the entire cannula  116  is enclosed by the cannula delivery tool  170 . During this step, the cannula delivery tool  170  is in an expanded configuration such that the cannula delivery tool  170  has the expanded outer diameter  196  ( FIG.  3   ) to facilitate positioning over the cannula  116 . 
     Additionally, the method  200  comprises the step illustrated at block  206  of retracting the cannula delivery tool  170  and the percutaneous circulatory support device  102  into the starter tube  108 . As such, the cannula delivery tool  170 , the cannula  116  and the percutaneous circulatory support device  102  are retracted into the starter tube  108  to prepare for insertion into the body of a patient. During this step, the cannula delivery tool  170  is configured to compress from the expanded outer diameter  196  ( FIG.  3   ) to the compressed outer diameter  194  ( FIG.  2 A  and FIG.  2 B) such that the cannula delivery tool  170  fits within the starter tube  108  and eventually the introducer sheath  134 . The ability of the cannula delivery tool  170  to compress to have the compressed outer diameter  194  is at least in part due to the curved shape of the plate  182 , the tapered portion  178  of the cannula delivery tool  170 , and the material forming the cannula delivery tool  170 . During this step, the cannula delivery tool  170  may be compressed down to the compressed outer diameter  194  such that cannula delivery tool  170  is in direct contact with the cannula  116 . 
     At block  208 , the method  200  includes inserting the starter tube  108 , which includes the cannula delivery tool  170  and circulatory support device  102 , into the introducer sheath  134 . In various embodiments, the introducer sheath  134  has already been positioned at least partially into an artery of the patient, for example the femoral artery, of the patient. 
     At block  210 , the method  200  further includes extending the cannula delivery tool  170  out of the starter tube  108  and partially out of the introducer sheath  134 . This step further includes wherein the starter tube  108  is not extended entirely out of a distal portion of the introducer sheath  134 , such that when the cannula delivery tool  170  is pushed out of the starter tube  108 , the cannula delivery tool  170  is in direct contact with the interior of the introducer sheath  134 , for example as shown in  FIG.  2   . As a result of the cannula delivery tool  170  being positioned at the compressed outer diameter  194 , the cannula delivery tool  170  is already configured to fit within the introducer sheath  134  when deployed from the starter tube  108 . As previously described, cannula delivery tool  170  includes a surface coating that may increase the ease with which the cannula delivery tool  170  slides within the introducer sheath  134 . Additionally, the laser cut plurality of closed cells  180  formed into the cannula delivery tool  170 , as opposed to the use of a braided structure, may also increase the ease with which that the cannula delivery tool  170  slides within the cannula delivery tool  170 , as the cannula delivery tool  170  comprises one main layer of material, rather than stacked intersections of material. More specifically, the cannula delivery tool  170  may have a coefficient of friction when in contact with the introducer sheath  134  that is less than the coefficient of friction that would result between contact of the introducer sheath  134  and the cannula  116 . In this way, the use of the cannula delivery tool  170  provides an advantage to the illustrative percutaneous circulatory support system  100  in that there is less friction during the deployment of the cannula  116  through the introducer sheath  134 , which may otherwise cause deficiencies in the delivery process, including malfunctions and damage to the components. 
     With reference again to  FIG.  7   , during the step at block  210 , the cannula delivery tool  170 , which is still surrounds the cannula  116 , is extended out of the distal portion of the introducer sheath  134 , however, the extent that which the cannula delivery tool  170  is extended is limited by the tether  184 , as the tether  184  couples the cannula delivery tool  170  and the introducer sheath  134 . The tether  184  also allows for the ability to retract the cannula delivery tool  170  back into the introducer sheath  134  when desired. As the cannula delivery tool  170  extends out of the distal portion of the introducer sheath  134 , the cannula delivery tool  170  expands radially. In various embodiments, the cannula delivery tool  170  expands radially such that the cannula delivery tool  170  is defined by the expanded outer diameter  196  again. 
     The method  200  then comprises the step at block  212 , including extending the cannula  116  out of the cannula delivery tool  170 . During this step, the cannula  116  and thus the percutaneous circulatory support device  102  that is coupled with the cannula  116 , are released from the cannula delivery tool  170 . The circulatory support device  102  can then be deployed through the patient&#39;s vasculature and into the heart of the patient. Once the circulatory support device  102  passes out of the cannula delivery tool  170 , the cannula delivery tool  170  may be retracted into the introducer sheath  134  and further into the starter tube  108 . When retracted into the introducer sheath  134 , the diameter of the cannula delivery tool  170  is compressed down, as described further herein. 
     Further, in various embodiments, the illustrative percutaneous circulatory support system  100  may include the guidewire  120  for use in deploying the cannula  116  and the  102 . For example, in these embodiments, prior to extending the cannula delivery tool over the cannula, the method  200  includes extending the guidewire  120  through the cannula delivery tool  170 , specifically through the first side  186  as discussed with reference to  FIG.  5   , and through the percutaneous circulatory support device  102 . The guidewire  120  may be used to aid in the delivery and the positioning of the cannula  116  and percutaneous circulatory support device  102 . 
     Additionally, in embodiments, the method  200  may include retracting the tether  184  to retract the cannula delivery tool  170  through the introducer sheath  134  and into the starter tube  108  for removal. This step is optimized by the curved shape of the plate  182  of the cannula delivery tool  170 , specifically in that the curved shape of the plate  182  allows for the cannula delivery tool  170  to be more easily captured back into the introducer sheath  134  and compressed back down to the compressed outer diameter  196  ( FIG.  2 A  and  FIG.  2 B ). 
     While the cannula delivery tool  170  and the cannula  116  are described throughout as begin used with a percutaneous circulatory support system  100  for delivering the percutaneous circulatory support device  102 , the cannula delivery tool  170  and the cannula  116  may be used with a variety of different systems. Specifically, the cannula delivery tool  170  may also be used with a variety of the different medical devices, such as devices including balloon, stents, or other radially compressible and expandable devices that are introduced intravascularly. The embodiments described herein are not meant to be limiting and are provided as an example thereof. 
     Various modifications and additions can be made to the exemplary embodiments discussed without departing from the scope of the present invention. For example, while the embodiments described above refer to particular features, the scope of this invention also includes embodiments having different combinations of features and embodiments that do not include all of the described features. Accordingly, the scope of the present invention is intended to embrace all such alternatives, modifications, and variations as fall within the scope of the claims, together with all equivalents thereof.