Patent Publication Number: US-2022225997-A1

Title: Aneurysm treatment device

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     The present application is a continuation application of U.S. patent application Ser. No. 16/366,235 filed Mar. 27, 2019, the entire contents of which are hereby incorporated by reference. 
    
    
     FIELD OF INVENTION 
     The present invention generally relates to medical instruments, and more particularly, to embolic implants for aneurysm therapy. 
     BACKGROUND 
     Cranial aneurysms can be complicated and difficult to treat due to their proximity to critical brain tissues. Prior solutions have included endovascular treatment whereby an internal volume of the aneurysm sac is removed or excluded from arterial blood pressure and flow. Current alternatives to endovascular or other surgical approaches can include intravascularly delivered treatment devices that either fill the sac of the aneurysm with embolic material or block the entrance or neck of the aneurysm. Both approaches attempt to prevent blood flow into the aneurysm. When filling an aneurysm sac, the embolic material clots the blood, creating a thrombotic mass within the aneurysm. When treating the aneurysm neck, blood flow into the entrance of the aneurysm is inhibited, inducing venous stasis in the aneurysm and facilitating a natural formation of a thrombotic mass within the aneurysm. 
     Current intravascularly delivered devices typically utilize multiple embolic coils to either fill the sac or treat the entrance. Naturally formed thrombotic masses formed by treating the entrance of the aneurysm with embolic coils can improve healing compared to aneurysm masses packed with embolic coils by reducing possible distention from arterial walls and permitting reintegration into the original parent vessel shape along the neck plane. However, embolic coils delivered to the neck of the aneurysm can potentially have the adverse effect of impeding the flow of blood in the adjoining blood vessel; at the same time, if the entrance is insufficiently packed, blood flow can persist into the aneurysm. Treating certain aneurysm morphology (e.g. wide neck, bifurcation, etc.) can required ancillary devices such a stents or balloons to support the coil mass and obtain the desired packing density. Once implanted, the coils cannot easily be retracted or repositioned. Furthermore, embolic coils do not always effectively treat aneurysms as aneurysms treated with multiple coils often recanalize or compact because of poor coiling, lack of coverage across the aneurysm neck, because of flow, or large aneurysm size. 
     Alternatives to embolic coils are being explored, for example a tubular braided implant is disclosed in US Patent Publication Number 20180242979, incorporated herein by reference. Tubular braided implants have the potential to easily, accurately, and safely treat an aneurysm or other arterio-venous malformation in a parent vessel without blocking flow into perforator vessels communicating with the parent vessel. Compared to embolic coils, however, tubular braided implants are a newer technology, and there is therefore capacity for improved geometries, configurations, delivery systems, etc. for the tubular braided implants. 
     There is therefore a need for improved methods, devices, and systems for implants for aneurysm treatment. 
     SUMMARY 
     It is an object of the present invention to provide systems, devices, and methods to meet the above-stated needs. Generally, in examples herein, an implant having an elongated portion and an expandable braided sack portion can be delivered through a catheter and implanted in an aneurysm such that elongated portion loops within the braided sack and the braided sack at least partially occludes the aneurysm neck. 
     An example implant can include an expandable braided sack portion, an elongated looping portion joined to the braided sack portion, and a detachment feature joined to the elongated looping portion. The implant can move from a delivery configuration to an implanted configuration. In the delivery configuration, the implant can be sized to be delivered through a lumen of a catheter to a treatment site, and in the implanted configuration, the implant can be sized to secure within an aneurysm. In the delivery configuration, the expandable braided sack portion can extend from a distal end of the implant, the elongated looping portion can extend proximally from the expandable braided sack portion, the detachment feature can be positioned near a proximal end of the implant, and the detachment feature can be detachably attached to a delivery system. 
     The expandable braided sack portion can be unattached to the delivery system when the implant is in the delivery configuration, in the implanted configuration, and throughout the transition from the delivery configuration to the implanted configuration during treatment of an aneurysm. In the implanted configuration, the expandable braided sack portion can be sized to contact a majority of an interior wall of the aneurysm, can contain the elongated looping portion, and can occlude some or all of the opening of the neck of the aneurysm. The expandable braided sack portion can have a free end, and in the implanted configuration, the free open end can be positioned at the aneurysm neck. In the implanted configuration the elongated looping portion can wind within the expandable braided sack portion. 
     In the delivery configuration the implant can have a fold at its&#39; distal end, the expandable braided sack portion can encompass some of the elongated looping portion, and the free open end of the expandable braided sack portion can encircle the elongated looping portion. In the implanted configuration, a fold can define a boundary between the elongated looping portion and the expandable braided sack portion, and the fold can be positioned along a distal surface of the interior aneurysm wall. the fold at the distal end of the implant in the delivery configuration can be the same fold positioned along the distal surface of the aneurysm wall in the implanted configuration. 
     Alternatively, in the delivery configuration, the free open end can be positioned at the distal end of the implant and the implant can extend from the free open end at the distal end of the implant to the detachment feature at the proximal end of the implant. When the implant configured thusly, exits a catheter and the braided sack portion enters the aneurysm, a fold can form, and the fold can be positioned along a distal surface of the interior aneurysm wall. 
     The elongated looping portion and the expandable braided sack portion can be portions of a contiguous tubular braid. A fold can define a boundary between the elongated looping portion and the expandable braided sack portion, and the elongated looping portion can have a length measurable from the fold to the detachment feature. The elongated looping portion of the contiguous tubular braid can have a substantially uniform circumference along most of its length 
     Alternatively, the elongated looping portion can have an embolic coil and the expandable braided sack portion can be a tubular braid. 
     When the implant is implanted and left in an aneurysm at the completion of an aneurysm treatment, the implant can include only the sack portion, the elongated looping portion, and the detachment feature. The implant need not have any other features such as additional detachment features or anchoring elements. 
     An example method of treating an aneurysm can include one or more of the following steps presented in no particular order, and the method can include additional steps not included here. An implant having an expandable portion and an embolic coiling portion can be provided. The embolic coiling portion can be detachably attached to a delivery system. The implant can be positioned within a microcatheter such that the embolic coiling portion extends distally from a proximal end of the implant, the expandable portion extends proximally from the distal end of the implant, and the expandable portion is unattached to the delivery system. The distal end of the microcatheter can be positioned near the aneurysm neck. The implant can be delivered through the microcatheter to the distal end of the microcatheter. The expandable portion can be expelled from the distal end of the microcatheter. The expandable portion can be expanded to contact a majority of the interior wall of the aneurysm. The embolic coiling portion can be expelled from the distal end of the microcatheter. The embolic coiling portion can be placed to wind within the expanded expandable portion. The embolic coiling portion can be detached from the delivery system. 
     When the implant is positioned in a microcatheter, a fold can be positioned at the distal end of the implant and the expandable portion can be positioned to encompass at least a portion of the embolic coiling portion. Alternatively, when the implant is positioned in a microcatheter, a free open end of the implant can be positioned at the distal end of the implant. 
     The expandable portion can be anchored to the interior wall of the aneurysm, and the expandable portion can be placed to inhibit the embolic coiling portion from exiting a sac of the aneurysm. The expandable portion can have a free open end, and the free open end can be positioned at the aneurysm neck. The implant can be folded to create a fold that defines a boundary between the expandable portion and the embolic coiling portion. The fold can be positioned near a distal surface of the interior aneurysm wall. 
     When the implant having the expandable portion and the embolic portion is provided, a contiguous tubular braid can be provided, and the expandable portion and the embolic portion can be portions of the contiguous tubular braid. When the embolic coiling portion of the contiguous braid is placed to wind within the expanded expandable portion, a substantially uniform circumference can be maintained along most of the length of the embolic coiling portion. Alternatively, when the implant having the expandable portion and the embolic portion is provided, a tubular braid joined an embolic coil can be provided such that the tubular braid includes the expandable portion and the embolic coil includes the embolic portion. 
     A detachment feature can be provided and affixed to the embolic coiling portion. The detachment feature can be detachably attached to the delivery system. To implant the expandable portion, embolic coiling portion, and the detachment feature in the aneurysm, the detachment feature can be detached from the delivery system. When the detachment feature is detached, only the expandable portion, embolic coiling portion, and the detachment feature can remain implanted in the implant. 
     Another example method for treating an aneurysm can include one or more of the following steps presented in no particular order, and the method can include additional steps not included here. An implant can be provided having a braided portion and an embolic portion. The braided portion can include a memory shape material and can have a spherical or globular predetermined shape. The embolic portion can be detachably attached to an implant delivery system. The implant and the delivery system can be positioned within a lumen of a microcatheter. When the implant and the delivery system is positioned in the microcatheter, the braided portion can be collapsed to fit in the lumen and positioned in the lumen to extend proximally from the distal end of the implant, the embolic portion can be positioned to extend distally from the proximal end of the implant, and the delivery system can be positioned to extend proximally from the embolic portion. The implant and the delivery system can traverse through the lumen of the microcatheter while the braided portion is unattached to the delivery system. The implant can be expelled from the microcatheter. When the implant is expelled, the braided portion can be expelled from the microcatheter and expanded to form a sack shape based on the spherical predetermined shape, the embolic portion can be expelled from the microcatheter and coiled within the sack shape of the braided portion. When the implant is expelled, an opening can be positioned in the sack shape of the braided portion can be positioned near the aneurysm neck, a fold can be positioned to define a boundary between the braided portion and the embolic portion near a distal surface of the aneurysm wall, and the embolic portion can traverse through the opening in the sack shape. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The above and further aspects of this invention are further discussed with reference to the following description in conjunction with the accompanying drawings, in which like numerals indicate like structural elements and features in various figures. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating principles of the invention. The figures depict one or more implementations of the inventive devices, by way of example only, not by way of limitation. 
         FIGS. 1A through 1C  are illustrations of an example implant in a collapsed or delivery configuration ( FIG. 1A ), a cross section of the collapsed implant of  FIG. 1A  ( FIG. 1C ), and the example implant in an implanted or expanded configuration ( FIG. 1B ) according to aspects of the present invention; 
         FIGS. 2A through 2E  are illustrations of an example implant during implantation steps according to aspects of the present invention; 
         FIGS. 3A and 3B  are illustrations of an example implant in a collapsed or delivery configuration ( FIG. 3A ) and in an implanted or expanded configuration ( FIG. 3B ) according to aspects of the present invention; 
         FIGS. 4A and 4B  are illustrations of an example implant in a collapsed or delivery configuration ( FIG. 4A ) and in an implanted or expanded configuration ( FIG. 4B ) according to aspects of the present invention; 
         FIGS. 5A through 5E  are illustrations of an example implant during implantation steps according to aspects of the present invention; 
         FIGS. 6A and 6B  are illustrations of an example implant in a collapsed or delivery configuration ( FIG. 6A ) and in an implanted or expanded configuration ( FIG. 6B ) according to aspects of the present invention; and 
         FIGS. 7 through 10  are flow diagrams outlining example method steps for treating an aneurysm according to aspects of the present invention. 
     
    
    
     DETAILED DESCRIPTION 
     As object of the present invention is to provide an embolic implant suitable for endovascular treatment of an aneurysm in a patient. The implant can have two parts that can reshape upon delivery to a treatment site. 
       FIG. 1A  illustrates an example implant  200  in a collapsed or delivery configuration. In the delivery configuration, the implant  200  can be sized to be delivered to a treatment site through a catheter inserted in vasculature of a patient.  FIG. 1C  illustrates a cross sectional view of the collapsed implant  200  as indicated in  FIG. 1A .  FIG. 1B  illustrates the example implant  200  illustrated in  FIG. 1A  in an expanded or implanted configuration. In the implanted configuration, the implant  200  can be positioned in a sac  12  of an aneurysm  10  to divert blood flow from a neck  16  of the aneurysm  10  and fill the sac  12  with embolic material. The embolic material in the aneurysm sac  12  can promote the formation of a thrombotic mass in the aneurysm  10 , and the diversion of blood flow from the aneurysm neck  16  can induce venous stasis in the aneurysm and reduce the likelihood that the aneurysm recanalizes after an aneurysm treatment procedure. 
     Referring collectively to  FIGS. 1A through 1C , the implant  100  can include an elongated portion  204 , an expandable sack portion  202 , and a detachment feature  230 . The elongated portion  204  and the expandable sack portion  202  can each be braided. The expandable sack portion  202  and elongated portion  204  can be manufactured as two separate structures or as a contiguous braided structure. Braided portions can be made from braided Nitinol, cobalt, chromium, plastic, or other suitable material. Portions of the implant  200  can be made from a memory shape material having a predetermined shape and a deformed shape. The memory shape material can be in the deformed shape when the implant  200  is in the delivery configuration and can move toward the predetermined shape when the implant  200  is in the expanded or implanted configuration. When implanted, the memory shape material can be restricted by anatomical geometries and the memory shape material can take a shape that approaches the predetermined shape but does not match the predetermined shape due to the anatomical restrictions. 
     The detachment feature  230  can be joined to the elongated portion  204 , and the detachment feature  230  can be detachably attached to a delivery system when the implant  200  is delivered through a catheter to a treatment site. 
     Referring to  FIG. 1A , in the delivery configuration, the detachment feature  230  can be positioned at the proximal end  212  of the implant  200 , the elongated portion  204  can extend distally from the detachment feature  230  to a fold  203  positioned at a distal end  214  of the implant  200 , and the expandable braided sack portion  202  can extend proximally from the fold  203 . In the delivery configuration, the expandable braided sack portion  202  can extend distally from the fold  203  to wrap around a part of the length L of the elongated portion  204 , and the expandable braided sack portion  202  can have an open end  226  that circles the elongated portion  204 . The open end  226  is preferably simply the open end of a braid without any ancillary attachments. The open end  226  need not be attached to a delivery system as the implant  200  is delivered through a catheter to the treatment site or as the implant  200  is deployed within the aneurysm. Strands of the braid  210  at the open end  226  can be free, cut ends; or, alternatively, the strands at the open end  226  be closed, meaning strands within the braid at the open end are attached to each other by glue, weld, etc. or the strands bend back at the open end. Free cut ends can have an advantage of being easier to manufacture while the closed ends can have an advantage of being more atraumatic compared to the cut ends. 
     Referring to  FIGS. 1A and 1B , the implant  200  can include memory shape material and can be pre-shaped such that the expandable braided sack portion  202  forms a globular or spherical shape and a fold  203  separates the elongated looping portion  204  from the expandable braided sack portion  202 . The memory shape material can be heat set into the predetermined shape. The spherical shape, fold  203 , and the loops of the elongated portion can be shaped by heat setting. The implanted shape illustrated in  FIG. 1B  can be based on the predetermined shape and the shape of the interior wall  14  of the aneurysm  10 . To collapse the implant from the predetermined shape so that it can be delivered through a catheter, the elongated looping portion  204  can be extended and straightened and the sack portion  202  can be compressed around the elongated looping portion  204 . The fold created when the implant was pre-shaped can be further folded to define a boundary between the sack portion  202  and the elongated looping portion  204  when the implant  200  is in the delivery configuration. 
     Referring to  FIG. 1B , in the implanted configuration, the expandable braided sack portion  202  can expand to contact a majority of the interior wall  14  of the aneurysm  10 . The fold  203  can be positioned near a distal surface  15  of the aneurysm wall  14 . The elongated portion  204  can wind within the aneurysm sac  12  and within the braided sack portion  202 . By anchoring within the sac  12 , the expandable braided sack portion  202  can maintain proper positioning of the implant  200  in the aneurysm  10  and prevent portions of the implant  200 , such as the elongated portion  204 , from extending into a blood vessel  20   a ,  20   b ,  21  or exiting the aneurysm sac  12 . 
     The free open end  226  of the expandable braided sack portion  202  can define an opening in the sack when the implant is in the implanted or pre-shaped configuration, and when implanted, the opening can be positioned near the aneurysm neck  16 . The opening can be sized such that a portion of the expandable braided sack portion  202  extends across the aneurysm neck  16  to occlude the neck. The elongated portion  204  can enter the aneurysm sac  12  and the sack of the expandable braided sack portion  202  through the opening. The elongated portion  204  can wind or loop around in a complex coiled shape within the expandable braided sack portion  202  and within the aneurysm sac  12 . The looped elongated portion  204  can press against the braided sack  202  and provide a force against an interior surface of the braided sack  202  to press an exterior surface of the braided sack  202  to the aneurysm wall  14  to further secure the anchoring of the braided sack  202  within the aneurysm sac  12 . 
     The looped elongated portion  204  can fill a majority of the aneurysm sac  12 . The implanted braided sack  202  can be a braided mesh with a porosity sized to inhibit blood flow into the aneurysm  10 . The elongated portion can have a substantially uniform circumference  206  along much or all of its length L, and it can maintain the substantially uniform circumference  206  as it moves from the delivery configuration to the implanted configuration. 
       FIGS. 2A through 2E  are illustrations of an example implant during implantation steps.  FIG. 2A  illustrates an implant  200  positioned within a catheter  600  near an aneurysm  10 . The aneurysm  10  is illustrated positioned at a bifurcated blood vessel having a stem vessel  21 , a first side branch vessel  20   a , and a second side blood vessel  20   b . The catheter  600  can approach the aneurysm  10  from the stem vessel  21 . It is contemplated that example implants  200  disclosed herein can be used for treating sidewall vessels according to methods described herein and as would be understood by a person of ordinary skill in the art. At the instant illustrated in  FIG. 2A , the implant  200  is collapsed in the catheter  600 . The implant  200  can include memory shape material that is in a deformed shape while it is collapsed in the catheter  600 . 
       FIG. 2B  illustrates the implant  200  during implantation. The implant  200  can include an expandable braided sack portion  202  and an elongated embolic portion  204 . As the implant  200  is translated distally through the catheter  600 , a fold  203  can be positioned at a distal end  214  of the implant  200 , and the expandable braided sack portion  202  and the elongated looping portion  204  can extend proximally from the fold  203 . Configured thusly, the braided sack portion  202  can be oriented in the catheter  600  so that when the implant  200  is pushed distally out of the catheter  600 , the braided sack portion  202  is pushed out of the catheter  600  and into the sac  12  before a majority of the elongated looping portion  204  is begins to exit the catheter  600 . 
       FIG. 2C  illustrates the implant  200  after the braided sack portion  202  has exited the catheter  600  and expanded within the aneurysm  12 . The braided sack portion  202  can expand to contact all or a majority of the interior wall  14  of the aneurysm  10 . The braided sack  202  can expand toward the predetermined shape upon exiting the catheter  600 . Contact with warm bodily fluid can cause the memory shape material in the braided sack  202  to move to the predetermined shape. The free open end  226  can define an opening in the braided sack  202 , and the opening can be positioned at the aneurysm neck  16 . 
     A fold  203  defining a boundary between the expanded braided sack  202  and the elongated portion  204  can be positioned near a distal surface  15  of the aneurysm wall  14 . At the stage of implantation illustrated in  FIG. 2C , the elongated portion  204  can extend from the fold  203 , through the opening in the braided sack  202 , and into the catheter  600 . 
       FIG. 2D  illustrates the elongated portion  204  exiting the catheter  600 , entering the braided sack portion  202  through the free open end  226 , and winding within the sack  202 . As the elongated portion  204  exits the catheter  600 , the elongated portion  204  can maintain its circumference  206  as it exits the catheter  600 . The elongated portion  204  can wind or loop within the aneurysm sac  12  in response to contacting an interior surface of the expanded braided sack  202 . Additionally, or alternatively, the elongated portion  204  can include memory shape material having a predetermined shape and a deformed shape. The predetermined shape can be a complex looped shape, and the deformed shape can be substantially straight. The elongated portion  204  can wind or loop within the aneurysm sac  12  in response to the memory shape material moving from the deformed shape toward the predetermined shape as the elongated portion  204  contacts blood as it exits the catheter  600 . Additionally, or alternatively, the elongated portion  204  can include a flexible elastically deformable material having a relaxed shape that is a looped shape. The flexible elastically deformable material can be uncoiled to a substantially straight strand during delivery through a catheter and can collapse into the looped shape upon exiting the catheter  12 . 
     At the instant illustrated in  FIG. 2D  the detachment feature  230  can remain attached to a delivery system. While the implant  200  is attached to the delivery system, the delivery system can be pulled proximally to withdraw all or portions of the implant  200 . The delivery system can subsequently be pushed distally to reposition the implant  200 . 
       FIG. 2E  illustrates the implant  200  in a final implanted configuration such as described in relation to  FIG. 1B . The detachment feature  230  can be moved distally by the delivery system past the plane of the aneurysm  16 , through the open end  226  of the expanded sack portion  202 , and into the aneurysm sac  12  prior to detachment from the delivery system. The elongated portion  204  can have a predetermined shape configured to facilitate the movement of the detachment feature  230  past the plane of the aneurysm neck  16  once the implant  200  is implanted. Additionally, or alternatively, the delivery system can be manipulated to place the detachment feature  230  within the sack portion  202 . Once the implant  200  is implanted as illustrated in  FIG. 2E , the delivery system can be detached and withdrawn, and the microcatheter  600  can be moved or extracted from the patient. 
     The open end  226  can remain open at the completion of the implantation, and the elongated portion  204 , once secured within the sack  202 , can be coiled near the opening defined by the open end  226  in such a way that blood flow is obstructed from entering the opening. In other words, sack  202  can occlude a portion of the neck  16  around the perimeter of the neck, and the elongated portion  204  can occlude the neck  16  at the opening in the sack  202  defined by the open end  226 . 
       FIG. 3A  illustrates an example implant  200   a  in a collapsed or delivery configuration. In the delivery configuration, the implant  200   a  can be collapsed to a size that can be delivered to a treatment site through a catheter inserted in vasculature of a patient.  FIG. 3B  illustrates the example implant  200   a  illustrated in  FIG. 3A  in an expanded or implanted configuration. In the implanted configuration, the implant  200   a  can be positioned in a sac  12  of an aneurysm  10  to divert blood flow from a neck  16  of the aneurysm  10  and fill the sac  12  with embolic material. The embolic material in the aneurysm sac  12  can promote the formation of a thrombotic mass in the aneurysm  10 , and the diversion of blood flow from the aneurysm neck  16  can induce venous stasis in the aneurysm and reduce the likelihood that the aneurysm recanalizes after an aneurysm treatment procedure. 
     Comparing the example implant  200   a  illustrated in  FIGS. 3A and 3B  to the implant  200  illustrated in  FIGS. 1A through 2E , the elongated portion  204   a  of the implant  200   a  in  FIGS. 3A and 3B  can be an embolic coil  204   a  rather than a braid  204  as illustrated in  FIGS. 1A through 2E . The implant  200   a  illustrated in  FIGS. 3A and 3B  can be implanted following a procedure like that illustrated in  FIGS. 2A through 2E . 
     Referring collectively to  FIGS. 3A and 3B , the implant  200   a  can include the embolic coil  204   a , an expandable braided sack portion  202   a , a detachment feature  230   a , and a connecting band  222  joining the embolic coil  204   a  to the expandable braid  202   a . The connecting band  222  can include radiopaque material to facilitate visibility of the implant  200   a  under X-ray. The expandable braided sack portion  202   a  can be braided. Portions of the implant  200   a , including the embolic coil  204   a , can be made from a memory shape material having a predetermined shape and a deformed shape. The memory shape material can be in the deformed shape when the implant  200   a  is in the delivery configuration and can move toward the predetermined shape when the implant  200   a  is in the expanded or implanted configuration. When expanded or implanted, the memory shape material can be restricted by anatomical geometries and the memory shape material can take a shape that approaches the predetermined shape but does not match the predetermined shape due to the anatomical restrictions. 
     The detachment feature  230   a  can be joined to the elongated portion  204   a , and the detachment feature  230   a  can be detachably attached to a delivery system when the implant  200   a  is delivered through a catheter to a treatment site. 
     Referring to  FIG. 3A , in the delivery configuration, the detachment feature  230   a  can be positioned at the proximal end  212   a  of the implant  200   a , the elongated portion  204  can extend distally from the detachment feature  230   a  to the connecting band  222 , the braided portion  202   a  can have a fold  203   a  positioned at a distal end  214   a  of the implant  200   a , and the expandable braided sack portion  202   a  can extend proximally from the fold  203   a . In the delivery configuration, the expandable braided sack portion  202   a  can extend distally from the fold  203   a  to wrap around a part of the length L′ of the embolic coil  204   a , and the expandable braided sack portion  202   a  can have a free open end  226   a  that circles the embolic coil  204   a . Strands of the braided portion  202   a  at the open end  226   a  can be free, cut ends; or, alternatively, the strands at the open end  226   a  be closed, meaning strands within the braid at the free open end  226   a  are attached to each other by glue, weld, etc. or the strands bend back at the open end  226   a . Free cut ends can have an advantage of being easier to manufacture while the closed strand ends can have an advantage of being more atraumatic compared to the cut ends. 
     Referring to  FIGS. 3A and 3B , the implant  200   a  can include memory shape material and can be pre-shaped such that the expandable braided sack portion  202   a  forms a globular or spherical shape and the braid can have a fold  203   a  near the connecting band  222 . The memory shape material can be heat set into the predetermined shape. The implanted shape illustrated in  FIG. 3B  can be based on the predetermined shape and the shape of the interior wall  14  of the aneurysm  10 . To collapse the implant from the predetermined shape so that it can be delivered through a catheter, the embolic coil  204   a  can be extended and straightened and the sack portion  202   a  can be compressed around the elongated looping portion  204   a . The fold created when the implant was pre-shaped can be further folded and positioned at the distal end  214   a  of the implant  200   a  when the implant  200   a  is in the delivery configuration. 
     Referring to  FIG. 3B , in the implanted configuration, the expandable braided sack portion  202   a  can expand to contact a majority of the interior wall  14  of the aneurysm  10 . The fold  203   a  can be positioned near a distal surface  15  of the aneurysm wall  14 . The embolic coil  204   a  can wind within the aneurysm sac  12  and within the braided sack portion  202   a . By anchoring within the sac  12 , the expandable braided sack portion  202   a  can maintain proper positioning of the implant  200   a  in the aneurysm  10  and prevent portions of the implant  200   a , such as the embolic coil  204   a , from extending into a blood vessel  20   a ,  20   b ,  21  or exiting the aneurysm sac  12 . 
     The free end  226   a  of the expandable braided sack portion  202   a  can define an opening in the sack when the implant  200   a  is in the implanted or pre-shaped configuration, and when implanted, the opening can be positioned near the aneurysm neck  16 . The opening can be sized such that a portion of the expandable braided sack portion  202   a  extends across the aneurysm neck  16  to occlude the neck. The embolic coil  204   a  can enter the aneurysm sac  12  and the sack of the expandable braided sack portion  202   a  through the opening. The elongated portion  204   a  can wind or loop around in a complex coiled shape within the expandable braided sack portion  202   a  and within the aneurysm sac  12 . The looped elongated portion  204   a  can press against the braided sack  202   a  and provide a force against an interior surface of the braided sack  202   a  to press an exterior surface of the braided sack  202   a  to the aneurysm wall  14  to further secure the anchoring of the braided sack  202   a  within the aneurysm sac  12 . 
     The looped embolic coil  204   a  can fill a majority of the aneurysm sac  12 . The implanted braided sack  202   a  can be a braided mesh with a porosity sized to inhibit blood flow into the aneurysm  10 . 
     As an alternative to shaping the implant in the delivery configuration such that the expandable braided sack portion  202 ,  202   a  envelopes the elongated portion  204 ,  204   a  as illustrated in  FIGS. 1A and 3A , the implant can be elongated in the delivery configuration as illustrated in  FIGS. 4A and 6A . The implant  200  illustrated in  FIGS. 1A and 1B  can have an essentially identical predetermined shape and/or implanted configuration compared to the implant  300  illustrated in  FIGS. 4A and 4B . Likewise, the implant  200   a  illustrated in  FIGS. 3A and 3B  can have an essentially identical predetermined shape and/or implanted configuration compared to the implant  300   a  illustrated in  FIGS. 6A and 6B . 
     Comparing  FIGS. 1B and 4B , once implanted, the implants  200 ,  300  formed of a contiguous tubular braid  210 ,  310  can be indistinguishable. Likewise, comparing  FIGS. 3B and 6B , once implanted, the implants  200   a ,  300   a  formed of a braided portion  202   a ,  302   a  and an embolic coil  204   a ,  304   a  can be indistinguishable. Significant difference between the implants  200 ,  200   a  illustrated in  FIGS. 1A through 3B  and the implants  300 ,  300   a  illustrated in  FIGS. 4A through 6B  include presence of the fold  203 ,  203   a  or lack thereof in each respective deformed shape, position of the free open end  226 ,  226   a ,  314 ,  314   a  during delivery, and process of expanding the expandable braided portion  202 ,  202   a ,  302 ,  302   a  within the aneurysm  10  during treatment. 
     Referring to  FIGS. 4A and 4B , an implant  300  can include a contiguous tubular braid  310  and a detachment feature  330 . As illustrated in  FIG. 4A , in the delivery configuration, the detachment feature  330  can be positioned at the proximal end  312  of the implant  300 , the elongated portion  304  can extend distally from the detachment feature  330 , the expandable braided sack portion  302  can extend distally from the elongated portion  304 , and the expandable braided sack portion  302  can have a free open end positioned at the distal end  314  of the implant  300 . In the delivery configuration, the implant  300  need not have any discernable boundary to indicate which portion of the tubular braid  310  is the elongated looping portion  304  and which portion is the expandable sack portion  302 . Strands at the open end  314  can be free, cut ends; or, alternatively, the strands at the open end  314  be closed, meaning strands within the braid at the free open end  314  are attached to each other by glue, weld, etc. or the strands bend back at the open end  314 . Free cut ends can have an advantage of being easier to manufacture while the closed strand ends can have an advantage of being more atraumatic compared to the cut ends. 
     The implant  300  can include memory shape material and can be pre-shaped such that the expandable braided sack portion  302  forms a globular or spherical shape and a fold  303  separates the elongated looping portion  304  from the expandable braided sack portion  302 . The memory shape material can be heat set into the predetermined shape. The implanted shape illustrated in  FIG. 4B  can be based on the predetermined shape and the shape of the interior wall  14  of the aneurysm  10 . To collapse the implant  300  from the predetermined shape (similar to the implanted configuration illustrated in  FIG. 4B ) to the deformed shape (such as illustrated in  FIG. 4A ) so that it can be delivered through a catheter, the elongated looping portion  304  can be extended and straightened, the sack portion  302  can be inverted and stretch, and the fold  303  can be opened and flattened. 
     Referring to  FIG. 4B , in the implanted configuration, the expandable braided sack portion  302  can expand to contact a majority of the interior wall  14  of the aneurysm  10 . The fold  303  can be positioned near a distal surface  15  of the aneurysm wall  14 . The elongated portion  304  can wind within the aneurysm sac  12  and within the braided sack portion  302 . By anchoring within the sac  12 , the expandable braided sack portion  302  can maintain proper positioning of the implant  300  in the aneurysm  10  and prevent portions of the implant  300 , such as the elongated portion  304 , from extending into a blood vessel  20   a ,  20   b ,  21  or exiting the aneurysm sac  12 . 
     The free end  314  of the expandable braided sack portion  302  can define an opening in the sack when the implant is in the implanted or pre-shaped configuration, and when implanted, the opening can be positioned near the aneurysm neck  16 . The opening can be sized such that a portion of the expandable braided sack portion  302  extends across the aneurysm neck  16  to occlude the neck. The elongated portion  304  can enter the aneurysm sac  12  and the sack of the expandable braided sack portion  302  through the opening. The elongated portion  304  can wind or loop around in a complex coiled shape within the expandable braided sack portion  302  and within the aneurysm sac  12 . The looped elongated portion  304  can press against the braided sack  302  and provide a force against an interior surface of the braided sack  302  to press an exterior surface of the braided sack  302  to the aneurysm wall  14  to further secure the anchoring of the braided sack  302  within the aneurysm sac  12 . 
     The looped elongated portion  304  can fill a majority of the aneurysm sac  12 . The implanted braided sack  302  can be a braided mesh with a porosity sized to inhibit blood flow into the aneurysm  10 . The elongated portion can have a substantially uniform circumference  306  along much or all of its length, and it can maintain the substantially uniform circumference  306  as it moves from the delivery configuration to the implanted configuration. 
       FIGS. 5A through 5E  are illustrations of an example implant  300  during implantation steps.  FIG. 5A  illustrates an implant  300  positioned within a catheter  600  near an aneurysm  10 . The aneurysm  10  is illustrated positioned at a bifurcated blood vessel having a stem vessel  21 , a first side branch vessel  20   a , and a second side blood vessel  20   b . The catheter  600  can approach the aneurysm  10  from the stem vessel  21 . It is contemplated that example implants  300  disclosed herein can be used for treating sidewall vessels according to methods described herein and as would be understood by a person of ordinary skill in the art. At the instant illustrated in  FIG. 5A , the implant  300  is collapsed in the catheter  600 . The implant  300  can include memory shape material that is in a deformed shape while it is collapsed in the catheter  600 . 
       FIG. 5B  illustrates the implant  300  during implantation. The implant  300  can include an expandable braided sack portion  302  and an elongated embolic portion  304 . As the implant  300  is translated distally through the catheter  600 , the free open end  314  of the expandable braided sack portion  302  can be positioned at a distal end  314  of the implant  300 , the expandable portion  302  can extend proximally from its free open end  314 , and the elongated embolic or looping portion  304  can extend proximally from the expandable portion  302 . Configured thusly, the expandable portion  302  can be completely expelled from the catheter  600  before the elongated portion  304  begins to exit the catheter  600 . 
     As illustrated in  FIG. 5B , the expandable braided sack portion  302  can begin to invert after exiting the catheter  600 . The free open end  314  can encircle the braid  310 , and portions of the braid  310  can be translated through the opening of the free open end  314 . The free end  314  of the implant  300  need not be attached to a delivery system for the braided sack portion  302  to invert. The inversion can be a result of the braided sack portion  302  moving toward its predetermined shape. 
       FIG. 5C  illustrates the implant  300  after the braided sack portion  302  has exited the catheter  600  and expanded within the aneurysm  12 . The braided sack portion  302  can expand to contact all or a majority of the interior wall  14  of the aneurysm  10 . The braided sack  302  can expand toward the predetermined shape upon exiting the catheter  600 . Contact with warm bodily fluid can cause the memory shape material in the braided sack  302  to move to the predetermined shape. The free open end  314  can define an opening in the braided sack  302 , and the opening can be positioned at the aneurysm neck  16 . 
     A fold  303  defining a boundary between the expanded braided sack  302  and the elongated portion  304  when in the implant  300  is in the implanted configuration can be positioned near a distal surface  15  of the aneurysm wall  14 . At the stage of implantation illustrated in  FIG. 5C , the elongated portion  304  can extend from the fold  303 , through the opening in the braided sack  302 , and into the catheter  600 . 
       FIG. 5D  illustrates the elongated portion  304  exiting the catheter  600 , entering the braided sack portion  302  through the free open end  314 , and winding within the sack  302 . As the elongated portion  304  exits the catheter  600 , the elongated portion  304  can maintain its circumference  306  as it exits the catheter  600 . The elongated portion  304  can wind or loop within the aneurysm sac  12  in response to contacting an interior surface of the expanded braided sack  302 . Additionally, or alternatively, the elongated portion  304  can include memory shape material having a predetermined shape and a deformed shape. The predetermined shape can be a complex looped shape, and the deformed shape can be substantially straight. The elongated portion  304  can wind or loop within the aneurysm sac  12  in response to the memory shape material moving from the deformed shape toward the predetermined shape as the elongated portion  304  contacts blood as it exits the catheter  600 . Additionally, or alternatively, the elongated portion  304  can include a flexible elastically deformable material having a relaxed shape that is a looped shape. The flexible elastically deformable material can be uncoiled to a substantially straight strand during delivery through a catheter and can collapse into the looped shape upon exiting the catheter  12 . 
     At the instant illustrated in  FIG. 5D  the detachment feature  330  can remain attached to a delivery system. While the implant  300  is attached to the delivery system, the delivery system can be pulled proximally to withdraw all or portions of the implant  300 . The delivery system can subsequently be pushed distally to reposition the implant  300 . 
       FIG. 5E  illustrates the implant  300  in a final implanted configuration such as described in relation to  FIG. 4B . The detachment feature  330  can be moved distally by the delivery system past the plane of the aneurysm  16 , through the open end  314  of the expanded sack portion  302 , and into the aneurysm sac  12  prior to detachment from the delivery system. The elongated portion  304  can have a predetermined shape configured to facilitate the movement of the detachment feature  314  past the plane of the aneurysm neck  16  once the implant  300  is implanted. Additionally, or alternatively, the delivery system can be manipulated to place the detachment feature  314  within the sack portion  302 . Once the implant  300  is implanted as illustrated in  FIG. 5E , the delivery system can be detached and withdrawn, and the microcatheter  600  can be moved or extracted from the patient. 
     The open end  314  can remain open at the completion of the implantation, and the elongated portion  304 , once secured within the sack  302 , can be coiled near the opening defined by the open end  314  in such a way that blood flow is obstructed from entering the opening. In other words, sack  302  can occlude a portion of the neck  16  around the perimeter of the neck, and the elongated portion  304  can occlude the neck  16  at the opening in the sack  302  defined by the open end  314 . 
       FIG. 6A  illustrates an example implant  300   a  in a collapsed or delivery configuration. In the delivery configuration, the implant  300   a  can be collapsed to a size that can be delivered to a treatment site through a catheter inserted in vasculature of a patient.  FIG. 6B  illustrates the example implant  300   a  illustrated in  FIG. 6A  in an expanded or implanted configuration. In the implanted configuration, the implant  300   a  can be positioned in a sac  12  of an aneurysm  10  to divert blood flow from a neck  16  of the aneurysm  10  and fill the sac  12  with embolic material. The embolic material in the aneurysm sac  12  can promote the formation of a thrombotic mass in the aneurysm  10 , and the diversion of blood flow from the aneurysm neck  16  can induce venous stasis in the aneurysm and reduce the likelihood that the aneurysm recanalizes after an aneurysm treatment procedure. 
     Comparing the example implant  300   a  illustrated in  FIGS. 6A and 6B  to the implant  300  illustrated in  FIGS. 4A through 5E , the elongated portion  304   a  of the implant  300   a  in  FIGS. 6A and 6B  can be an embolic coil  304   a  rather than a braid  304  as illustrated in  FIGS. 4A through 5E . The implant  300   a  illustrated in  FIGS. 6A and 6B  can be implanted following a procedure like that illustrated in  FIGS. 5A through 5E . 
     Referring collectively to  FIGS. 6A and 6B , the implant  300   a  can include the embolic coil  304   a , an expandable braided sack portion  302   a , a detachment feature  330   a , and a connecting band  322  joining the embolic coil  304   a  to the expandable braid  302   a . The expandable braided sack portion  302   a  can be braided. Portions of the implant  300   a , including the embolic coil  304   a , can be made from a memory shape material having a predetermined shape and a deformed shape. The memory shape material can be in the deformed shape when the implant  300   a  is in the delivery configuration and can move toward the predetermined shape when the implant  300   a  is in the expanded or implanted configuration. When expanded or implanted, the memory shape material can be restricted by anatomical geometries and the memory shape material can take a shape that approaches the predetermined shape but does not match the predetermined shape due to the anatomical restrictions. 
     The detachment feature  330   a  can be joined to the elongated portion  304   a , and the detachment feature  330   a  can be detachably attached to a delivery system when the implant  300   a  is delivered through a catheter to a treatment site. 
     Referring to  FIG. 6A , in the delivery configuration, the detachment feature  330   a  can be positioned at the proximal end  312   a  of the implant  300   a , the elongated portion  304  can extend distally from the detachment feature  330   a  to the connecting band  322 , the braided portion  302   a  can extend distally from the connecting band  322 , and the braided portion  302   a  can have a free open end  314   a  positioned at a distal end of the implant  300   a . Strands of the braided portion  302   a  at the open end  314   a  can be free, cut ends; or, alternatively, the strands at the open end  314   a  be closed, meaning strands within the braid at the free open end  314   a  are attached to each other by glue, weld, etc. or the strands bend back at the open end  314   a . Free cut ends can have an advantage of being easier to manufacture while the closed strand ends can have an advantage of being more atraumatic compared to the cut ends. 
     Referring to  FIGS. 6A and 6B , the implant  300   a  can include memory shape material and can be pre-shaped such that the expandable braided sack portion  302   a  forms a globular or spherical shape and the braid can have a fold  303   a  near the connecting band  322 . The memory shape material can be heat set into the predetermined shape. The implanted shape illustrated in  FIG. 6B  can be based on the predetermined shape and the shape of the interior wall  14  of the aneurysm  10 . To collapse the implant from the predetermined shape so that it can be delivered through a catheter, the embolic coil  304   a  can be extended and straightened, the sack portion  302   a  can be inverted and stretched, and the fold  303  can be opened and flattened. 
     Referring to  FIG. 6B , in the implanted configuration, the expandable braided sack portion  302   a  can expand to contact a majority of the interior wall  14  of the aneurysm  10 . The fold  303   a  can be positioned near a distal surface  15  of the aneurysm wall  14 . The embolic coil  304   a  can wind within the aneurysm sac  12  and within the braided sack portion  302   a . By anchoring within the sac  12 , the expandable braided sack portion  302   a  can maintain proper positioning of the implant  300   a  in the aneurysm  10  and prevent portions of the implant  300   a , such as the embolic coil  304   a , from extending into a blood vessel  20   a ,  20   b ,  21  or exiting the aneurysm sac  12 . 
     The free end  314   a  of the expandable braided sack portion  302   a  can define an opening in the sack when the implant  300   a  is in the implanted or pre-shaped configuration, and when implanted, the opening can be positioned near the aneurysm neck  16 . The opening can be sized such that a portion of the expandable braided sack portion  302   a  extends across the aneurysm neck  16  to occlude the neck. The embolic coil  304   a  can enter the aneurysm sac  12  and the sack of the expandable braided sack portion  302   a  through the opening. The elongated portion  304   a  can wind or loop around in a complex coiled shape within the expandable braided sack portion  302   a  and within the aneurysm sac  12 . The looped elongated portion  304   a  can press against the braided sack  302   a  and provide a force against an interior surface of the braided sack  302   a  to press an exterior surface of the braided sack  302   a  to the aneurysm wall  14  to further secure the anchoring of the braided sack  302   a  within the aneurysm sac  12 . 
     The looped embolic coil  304   a  can fill a majority of the aneurysm sac  12 . The implanted braided sack  302   a  can be a braided mesh with a porosity sized to inhibit blood flow into the aneurysm  10 . 
       FIG. 7  is a flow diagram outlining example method steps for treating an aneurysm. The method steps can be implemented by example devices presented herein or by other means as would be known to one of ordinary skill in the art. 
     Referring to method  700  outlined in  FIG. 7 , in step  702 , an implant having an expandable portion and an embolic coiling portion can be provided. In step  704 , the embolic coiling portion can be detachably attached to a delivery system. In step  706 , the implant can be positioned in a microcatheter with the embolic coiling portion extending distally from a proximal end of the implant, the expandable portion extending proximally form the distal end of the implant, and the expandable portion being unattached to the delivery system. In step  708 , the distal end of the microcatheter can be positioned near an aneurysm neck. In step  710 , the implant can be delivered through the microcatheter to the distal end of the microcatheter. In step  712 , the expandable portion can be expelled from the distal end of the microcatheter. In step  714 , the expandable portion can expand to contact most of the interior wall of the aneurysm. In step  716 , the embolic coiling portion can be expelled from the distal end of the microcatheter. In step  718 , the embolic coiling portion can be placed to wind within the expanded expandable portion. In step  720 , the embolic coiling portion can be detached from the delivery system. 
     Referring to method  800  outlined in  FIG. 8 , in step  810 , an implant having an embolic portion and a braided portion having a memory shape material can be provided. In step  820 , the braided portion can be shaped to have a spherical predetermined shape. In step  830 , the embolic portion can be attached to an implant delivery system so that it can later be detached. In step  840 , the implant and the delivery system can be positioned within a microcatheter. In step  850 , the implant and delivery system can traverse through the microcatheter while the braided portion is unattached to the delivery system. In step  860 , the implant can be expelled from the microcatheter. 
     Step  840  in method  800 , positioning the implant and the delivery system in the microcatheter, can include sub steps as illustrated in  FIG. 9 . In sub step  842 , the braided portion can be collapsed to fit within the microcatheter. In sub step  844 , the braided portion can be positioned to extend proximally from a distal end of the implant. In sub step  846 , the embolic portion can be positioned to extend distally from a proximal end of the implant. In sub step  848 , the delivery system can be positioned to extend proximally form the embolic portion. 
     Step  860  in method  800 , expelling the implant from the microcatheter, can include sub steps as illustrated in  FIG. 10 . In sub step  862 , the braided portion can be expelled from the microcatheter. In sub step  864 , the braided portion can be expanded to form a sack shape based on the spherical predetermined shape. In sub step  866 , the embolic portion can be expelled from the microcatheter. In sub step  868 , the embolic portion can be coiled within the sack shape of the braided portion. 
     The descriptions contained herein are examples of embodiments of the invention and are not intended to limit the scope of the invention. As described herein, the invention contemplates many variations and modifications of an implant, system, or method that can be used to occlude and fill an aneurysm. Variations can include but are not limited to combining elements of various embodiments, utilizing alternative geometries of elements and components described herein, utilizing alternative materials for each component or element (e.g. radiopaque materials, memory shape materials, etc.), utilizing additional components including components to deliver the implant to a treatment site, position the implant at a treatment site, retract the implant, and/or eject a portion of the implant from a catheter, utilizing additional component to perform functions describe herein, and utilizing additional components to perform functions not described herein, for example. These modifications would be apparent to those having ordinary skill in the art to which this invention relates and are intended to be within the scope of the claims which follow.