Patent Publication Number: US-11638639-B2

Title: Branched stent graft device and deployment

Description:
CROSS REFERENCE RELATED APPLICATIONS 
     This Patent Application is a Continuation of U.S. patent application Ser. No. 15/072,037, filed Mar. 16, 2016, which is a Divisional of U.S. patent application Ser. No. 13/584,650, filed Aug. 13, 2012, now U.S. Pat. No. 9,314,328, issued Apr. 19, 2016, which claims priority to and the benefit of U.S. Provisional Patent Application No. 61/524,256 filed on Aug. 16, 2011, all of which are incorporated herein by reference in their entireties for all purposes. 
    
    
     BACKGROUND 
     Field 
     The present disclosure relates to stent grafts for treating disease of the vasculature and, more particular, to stent graft devices and methods of deployment of the same for treating disease of branched vasculature. 
     Discussion of the Related Art 
     Disease of the vasculature is increasingly common and, because of the tortuous nature and complexity of the vasculature, is difficult for medical practitioners to treat. By way of example, aortic dissections commonly begin at or near the aortic valve root and continue to the ascending aorta and the aortic arch, and may also affect the upper part of the descending aorta. The three branch vessels off the aortic arch, namely, the brachiocephalic (innominate) artery and the left common carotid and left subclavian arteries, are anatomically difficult for medical practitioners to access and ultimately treat effectively. 
     It remains desirable to provide improved devices, delivery systems and methods for repairing disease along the aorta and branches extending therefrom. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       In the Figures: 
         FIG.  1    is a perspective view of a main body of a branched device in accordance with exemplary embodiments for treating a vessel and branch vessels extending outwardly therefrom; 
         FIG.  2    is a perspective view of the branched device of  FIG.  1    showing branch members extending through openings in a recessed portion of the main body 
         FIG.  3    is a perspective view of a main body of a branched device in accordance with exemplary embodiments for treating a vessel and branch vessels extending outwardly therefrom; 
         FIG.  4    is a perspective view of the branched device of  FIG.  3    showing branch members extending through openings in a recessed portion of the main body; 
         FIGS.  5 - 9    illustrate methods of deploying the main body and branch device in accordance with exemplary embodiments; and 
         FIG.  10    is a perspective view of a main body of a branched device in accordance with exemplary embodiments for treating a vessel and branch vessels extending outwardly therefrom. 
     
    
    
     DETAILED DESCRIPTION 
     The present disclosure provides an improved, less invasive, and simplified device, system and method for treating disease of the vasculature, particularly along a main vessel and related branch vessels. 
     Throughout this specification and in the claims, it should be readily appreciated that the term “branch vessel” refers to a vessel that branches outwardly from a main vessel. The “branch vessels” extending from the aortic arch, for example, include the brachiocephalic artery, the left common carotid and left subclavian arteries. Other “branch vessels” extending from the aorta include, but are not limited to: the celiac, inferior phrenic, superior mesenteric, lumbar, inferior mesenteric, middle sacral, middle suprarenal, renal, internal spermatic, ovarian (in the female), and innominate. As another example, the hypogastric artery is a branch vessel to the common iliac, which is a main vessel in this context. Thus, it should be seen that “branch vessel” and main vessel” are relative terms. 
     When discussing application of the present disclosure to the aorta or other blood vessels, the term “distal” with respect to such devices is intended to refer to a location that is, or a portion of the device that when implanted is, further downstream with respect to blood flow; the term “distally” means in the direction of blood flow or further downstream. 
     The term “proximal” is intended to refer to a location that is, or a portion of the device that when implanted, is further upstream with respect to blood flow; the term “proximally” means in the direction opposite to the direction of blood flow or further upstream. 
     A device in accordance with various embodiments for treating disease along a main vessel and at least one branch vessel extending from the main vessel is shown and generally indicated at  10  in  FIGS.  1  and  2   . The device  10  includes a main body  100  for deployment in the main vessel and having a main lumen  110 . The device  10  also includes at least one branch member  200  for deployment in the at least one branch vessel and having a branch lumen  210 . 
     The main body  100  of the device  10  has opposite first  102  and second  104  ends, and a wall  106  extending generally longitudinally between the first  102  and second  104  ends. The wall  106  has an internal surface  108  that defines the main lumen  110 . The wall  106  also has an outer surface  112  opposite the inner surface  108 . 
     The wall  106  includes a recessed portion  120  that is recessed relative to the outer surface  112  of the wall  106  and positioned between the first  102  and second  104  ends of the main body  100 . The main body  100  further includes at least one opening  130  formed in the recessed portion  120  of the wall  106  that receives the at least one branch member  200  therethrough such that the branch lumen  210  is in fluid communication with the main lumen  110 . 
     In various embodiments, one or more support walls can be incorporated into the main body, each for supporting a branch member extending through an opening in the recessed portion of the wall. A support wall can have any preferred length, diameter, wall thickness or secondary lumen shape, such as an oval, polygon or “D shape”. Support walls can incorporate a support member such as a stent. A support wall can incorporate a support wall to branch member attachment feature such as a hook anchor, flared stent apex, or other securing means commonly known in the art. A secondary lumen can be tapered along its length and can include radiopaque markers. As shown in  FIGS.  1  and  2   , for example, the main body  100  can include a generally tubular support wall  140  that extends from each opening  130  toward one of the first  102  and second  104  ends of the main body  100  Each support wall  140  forms a secondary lumen  142 , which receives one of the at least one branch members  200  therethrough such that the branch lumen  210  is in fluid communication with the main lumen  110 . 
     In various embodiments, for example as illustrated in  FIG.  2   , multiple support walls  140  and secondary lumens  142 , incorporated into a single main body  100 , can be oriented in generally opposing directions relative to the support wall longitudinal axis. A first support wall and secondary lumen having a first longitudinal orientation will therefore define a first blood flow direction. A “blood flow direction” is defined as the direction defined by the blood flow as it enters into a secondary lumen open end, as generally indicated at  107 ,  109  in  FIG.  2   . A second support wall and secondary lumen having a second longitudinal orientation will therefore define a second blood flow direction. The first and second blood flow directions can, if desired, be oriented 180° from each other as depicted in  FIG.  2   . Further details on internal support walls for supporting branch members extending through openings in the main body are disclosed in U.S. Pat. No. 6,645,242 to Quinn, the contents of which are hereby incorporated by reference in its entirety. 
     In other exemplary embodiments, the device may be used for treating disease along an aortic arch and a plurality of branch vessels extending from the aortic arch. In the particular embodiment illustrated in  FIGS.  1  and  2   , a pair of openings  130  is formed in the recessed portion  120  of the wall  106  and disposed on generally opposite sides of the recessed portion  120  for treating, for example, the aortic arch and the left subclavian and brachiocephalic arteries with the branch members  200 ,  202 . It should be appreciated that the openings may be positioned near or adjacent to each other for treating different combinations of branch arteries, such as the left common carotid and left subclavian arteries. 
     Referring to  FIGS.  3  and  4   , wherein like prime numerals indicate like parts from previously described exemplary embodiments, the device  10 ′ may include a main body  100 ′ for deployment in the aortic arch and a plurality of branch members  200 ′ each for deployment in one of the plurality of branch vessels extending from the aortic arch, including the brachiocephalic, the left common carotid and left subclavian arteries. The main body  100 ′ has a plurality of openings  130 ′ formed in the recessed portion  120 ′ of the wall  106 ′. Each branch member  200 ′ has a branch lumen  210 ′ and extends respectively through one of the plurality of openings  130 ′ such that each branch lumen  210 ′ is in fluid communication with the main lumen  110 ′. 
     In accordance with other exemplary embodiments, a method for deploying the device to a treatment site for treating disease along a main vessel and at least one branch vessel extending from the main vessel is described below in connection with  FIGS.  5  through  9   . The embodiments shown in  FIGS.  5 - 9    and described illustrate deployment of the device along the aortic arch and related branch vessels, though it should be appreciated that use and deployment of the device may be applied to other branched treatment sites along the aortic vasculature. 
     Referring to  FIG.  5   , a main guidewire  400  is routed to the aortic arch via the femoral artery. A first branch guidewire  402  is routed to the carotid artery via the femoral artery. 
     The main body of the device can be provided in a constrained state by a flexible primary sleeve on a proximal end of a catheter. A flexible secondary sleeve can be provided and disposed around the main body to constrain the main body in a partially deployed state after opening the primary sleeve to facilitate positioning of the device at the treatment prior to final deployment. Further detail of the sleeves, construction and deployment are provided in U.S. Pat. No. 5,919,225 to Lau et al., and U.S. Publication 2010/0049294 to Zukowski et al., the entire contents of which are incorporated herein by reference for all purposes. 
     In a number of embodiments, for example as illustrated in  FIG.  6   , a guidewire tube or conduit  410  for each branch member to be deployed is positioned through the main lumen and each recess opening in the main body  100 ″ and constrained together with the main body  100 ″ by the primary sleeve  404 . The guidewire tube or conduit  410  preserves a lumen through which a branch guidewire can be inserted while the main body  100 ″ remains constrained by the primary sleeve  404 . Further detail of the conduit, construction and deployment are provided in U.S. Patent Publication 2008/0269866 to Hamer et al., the entire content of which is incorporated herein by reference for all purposes. 
     The main guidewire  400  is inserted through the main lumen. The first branch guidewire is inserted through the conduit  410  while the main body  100 ″ and conduit  410  are constrained by the primary sleeve  100 ″. As illustrated in  FIG.  7   , the constrained main body  100 ″ is advanced along the respective main  400  and first branch  402  guidewires toward the treatment site. The conduit  410  is displaced from the main body  100 ″ and remains outside of the body while the constrained main body  100 ″ is advanced along the main  400  and first branch  402  guidewires toward the treatment site. 
     Referring to  FIG.  8   , the main body  100 ″ is then partially deployed by opening the primary sleeve, thereby allowing the main body to expand outwardly until the main body is constrained by the secondary sleeve  414  to an intermediate peripheral dimension smaller than its fully deployed outer peripheral dimension. Maintaining the main body  100 ″ in the intermediate peripheral dimension facilitates fine positioning of the device at the treatment site prior to full deployment. 
     With the recessed portion  120 ″ of the main body now exposed, each opening in the recessed portion is then generally aligned with each branch vessel to be treated. The secondary sleeve  414  includes a window  416  aligned with the recessed portion  120 ″ to allow access between the main lumen and the branch vessels to be treated. In other embodiments, a length of the main body along which the recessed portion is located can have a reduced diameter or outer peripheral dimension so as to facilitate access through the openings while the main body is in a partially deployed state in the secondary sleeve. 
     Referring to  FIG.  9   , a first branch member  200   a  of the device is provided in a constrained state on a proximal end of a first branch catheter utilizing a branch constraining sleeve, as described above for the main body. The first branch member is then advanced and positioned along the first branch guidewire through an opening  130 ″ to one of the branch vessels along the aortic arch. The recessed portion facilitates routing and advancement of the first branch guidewire, as well as the constrained first branch member, to the branch vessel to be treated. As illustrated in  FIG.  9   , the first branch member is positioned for treatment of the left carotid artery. 
     Once the first branch member is in place, the main body is then fully deployed by opening the secondary sleeve. The first branch member can then be deployed by opening the branch constraining sleeve. 
     Still referring to  FIG.  9   , second  200   b  and third  200   c  branch members may also be delivered along respective second and third branch guidewires, as necessary, to other branch vessels. As shown, the second and third branch members can be positioned for treatment of the innominate and left subclavian arteries, respectively. Prior to advancement of the first branch member to the left carotid artery, as described above, a second branch guidewire can be routed via the innominate artery toward the aortic arch and into the main lumen via a second opening in the recessed portion. Similarly, a third branch guidewire can be routed via the left subclavian artery toward the aortic arch and into the main lumen via a third opening in the recessed portion. 
     The second  200   b  and third  200   c  branch members are then provided in constrained states each on a proximal end of respective second and third branch catheters utilizing branch constraining sleeves, as described above for the first branch member. The second and third branch members are then advanced and positioned along the second and third branch guidewires to the remaining branch arteries, which in the illustrated embodiment, are the innominate and left subclavian arteries, respectively. 
     Once all of the branch members  200   a ,  200   b ,  200   c  are in place, the main body is then fully deployed by opening the secondary sleeve. The first, second and third branch members can then be deployed by opening the respective branch constraining sleeves. The branch members may be deployed in any order as necessary, as dictated by the site and/or procedure. 
     Referring to  FIG.  10   , in accordance with other exemplary embodiments, the main body  100 ″ may include four openings  130 ″ disposed in pairs arranged along opposite ends of the recessed portion  120 ″ for deploying branch members  200 ″ to treatment sites, for example, along the superior mesenteric, celiac, and renal arteries. The branch members  200 ″ in this embodiment may be delivered and deployed to the respective branch vessels through the openings  130 ″ in the recessed portion  120 ″ of the main body  100 ″ as described in above for the other exemplary embodiments. It should be appreciated that the number of openings and branch members can vary depending on the desired number of branch vessels to be treated. 
     In various embodiments, the wall or at least the recessed portion of the wall can be configured to allow the recessed portion to be displaced outwardly when pressure in the main lumen exceeds pressure outside of the main body, thereby allowing increased blood flow through the main lumen. 
     The devices, including the main bodies and branch members, described above may be made up of any material which is suitable for use as a graft or stent graft in the chosen body lumen. The grafts can be composed of the same or different materials. Furthermore, the grafts can comprise multiple layers of material that can be the same material or different material. Although the graft can have several layers of material, the graft may have a layer that is formed into a tube (innermost tube) and an outermost layer that is formed into a tube (outermost tube). 
     Many graft materials are known, particularly known are those that can be used as vascular graft materials. In one embodiment, the materials can be used in combination and assembled together to comprise a graft. The graft materials, used in a stent-graft, can be extruded, coated or formed from wrapped films, or a combination thereof. Polymers, biodegradable and natural materials can be used for specific applications. 
     Examples of synthetic polymers include, but are not limited to nylon, polyacrylamide, polycarbonate, polyformaldehyde, polymethylmethacrylate, polytetrafluoroethylene, polytrifluorochlorethylene, polyvinylchloride, polyurethane, elastomeric organosilicon polymers, polyethylene, polypropylene, polyurethane, polyglycolic acid, polyesters, polyamides, their mixtures, blends and copolymers are suitable as a graft material. In one embodiment, the graft is made from a class of polyesters such as polyethylene terephthalate including DACRON® and MYLAR® and polyaramids such as KEVLAR®, polyfluorocarbons such as polytetrafluoroethylene (PTFE) with and without copolymerized hexafluoropropylene (TEFLON® or GORE-TEX®), and porous or nonporous polyurethanes. In another embodiment, the graft comprises expanded fluorocarbon polymers (especially PTFE) materials. Included in the class of preferred fluoropolymers are polytetrafluoroethylene (PTFE), fluorinated ethylene propylene (FEP), copolymers of tetrafluoroethylene (TFE) and perfluoro (propyl vinyl ether) (PFA), homopolymers of polychlorotrifluoroethylene (PCTFE), and its copolymers with TFE, ethylenechlorotrifluoroethylene (ECTFE), copolymers of ethylene-tetrafluoroethylene (ETFE), polyvinylidene fluoride (PVDF), and polyvinylfluoride (PVF). Especially preferred, because of its widespread use in vascular prostheses, is ePTFE. In another embodiment, the graft comprises a combination of the materials listed above. In another embodiment, the graft is substantially impermeable to bodily fluids. The substantially impermeable graft can be made from materials that are substantially impermeable to bodily fluids or can be constructed from permeable materials treated or manufactured to be substantially impermeable to bodily fluids (e.g. by layering different types of materials described above or known in the art). In one embodiment, the main body and branch members, as described above, are made from any combinations of the materials above. In another embodiment, the main body and branch members, as described above, comprise ePTFE. 
     The stents, as described above, may be generally cylindrical when restrained and/or when unrestrained and comprise helically arranged undulations having plurality of helical turns. The undulations preferably are aligned so that they are “in-phase” with each other. More specifically, undulations comprise apices in opposing first and second directions. When the undulations are in-phase, apices in adjacent helical turns are aligned so that apices can be displaced into respective apices of a corresponding undulation in an adjacent helical turn. In one embodiment, the undulations have a sinusoidal shape. In another embodiment, the undulations are U shaped. In another embodiment, the undulations are V shaped. In another embodiment, the undulations are ovaloid shaped. These shapes are fully described in U.S. Pat. No. 6,042,605. U.S. Pat. No. 6,042,605 is incorporated by reference herein in its entirety for all purposes. 
     In another embodiment, the stents, as described above, may also be provided in the form of a series of rings arranged generally coaxially along the graft body. 
     In various embodiments, the stent can be fabricated from a variety of biocompatible materials including commonly known materials (or combinations of materials) used in the manufacture of implantable medical devices. Typical materials include 316L stainless steel, cobalt-chromium-nickel-molybdenum iron alloy (“cobalt-chromium”), other cobalt alloys such as L605, tantalum, nitinol, or other biocompatible metals. In one embodiment, any stent-graft described herein is a balloon expandable stent-graft. In another embodiment, any stent-graft described herein is a self-expanding stent-graft. In another embodiment, the stent is a wire wound stent. In another embodiment, the wire wound stent comprise undulations. 
     Numerous characteristics and advantages of the present invention have been set forth in the preceding description, including preferred and alternate embodiments together with details of the structure and function of the invention. The disclosure is intended as illustrative only and as such is not intended to be exhaustive. It will be evident to those skilled in the art that various modifications may be made, especially in matters of structure, materials, elements, components, shape, size and arrangement of parts within the principals of the invention, to the full extent indicated by the broad, general meaning of the terms in which the appended claims are expressed. To the extent that these various modifications do not depart from the spirit and scope of the appended claims, they are intended to be encompassed therein. In addition to being directed to the embodiments described above and claimed below, the present invention is further directed to embodiments having different combinations of the features described above and claimed below. As such, the invention is also directed to other embodiments having any other possible combination of the dependent features claimed below. It will be apparent to those skilled in the art that various modifications and variations can be made in the present invention without departing from the spirit or scope of the invention. Thus, it is intended that the present invention cover the modifications and variations of this invention provided they come within the scope of the appended claims and their equivalents.