Patent Description:
Disease of the vasculature can be difficult for medical practitioners to treat because of the tortuous nature and complexity of the vasculature. 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, can be anatomically difficult for medical practitioners to access and ultimately treat effectively. Treatment of the vasculature of a patient with an expandable implant is disclosed in <CIT>, which discloses an implant that is constrained to a reduced delivery profile for delivery within the vasculature by at least one sleeve. The implant may be constrained to other diameters, such as an intermediate configuration having a diameter larger than the delivery profile and smaller than the deployment diameter. The sleeves may be expanded, allowing for expansion of the diameter of the expandable implant, by disengaging a coupling member from the sleeve or sleeves from outside of the body of the patient. The expandable implant may comprise a number of side branch fenestrations or fenestratable portions.

The invention relates to an endoprosthesis delivery system as defined by claim <NUM>. This disclosure is generally directed to staged deployment techniques for an expandable endoprosthesis including a side branch portal, such as a thoracic branch endoprosthesis. Disclosed staged deployment techniques include endoprosthesis delivery system with first and second primary sleeves in parallel releasably constraining an expandable endoprosthesis to a collapsed configuration, and a secondary sleeve in series with and within the first primary sleeve that releasably constrains the proximal portion of the expandable endoprosthesis to a partially expanded configuration following release of the first primary sleeve. The secondary sleeve can allow access to the side branch portal via a partially expanded proximal portion of the expandable endoprosthesis. The disclosed techniques may be particularly useful for delivery and deployment of an expandable endoprosthesis including a side branch portal within a complex or tortuous vasculature. In one variation, an endoprosthesis delivery system includes an expandable endoprosthesis including a side branch portal, a first primary sleeve releasably constraining a proximal portion of the expandable endoprosthesis to a collapsed configuration, a second primary sleeve parallel with the first primary sleeve, the second primary sleeve releasably constraining a distal portion of the expandable endoprosthesis to the collapsed configuration, and a secondary sleeve within the first primary sleeve. Upon release of the first primary sleeve, the secondary sleeve releasably constrains the proximal portion of the expandable endoprosthesis to a partially expanded configuration allowing access to the side branch portal via the partially expanded proximal portion of the expandable endoprosthesis.

In another variation, a method of implanting an endoprosthesis within a vasculature of a patient includes inserting a first guidewire into the vasculature, inserting a second guidewire into the a side branch of the vasculature, advancing an expandable endoprosthesis including a side branch portal over the first and second guidewires to a location proximate the side branch, partially expanding a proximal portion of the expandable endoprosthesis while leaving a distal portion of the expandable endoprosthesis fully constrained, advancing a side branch component over the second guidewire into the side branch via the partially expanded proximal portion of the expandable endoprosthesis while the distal portion of the expandable endoprosthesis is fully constrained, locating the expandable endoprosthesis and the side branch component to their intended deployment locations, and fully expanding both the proximal and the distal portions of the expandable endoprosthesis with the side branch component in the side branch.

Various examples of the present disclosure are directed to staged deployment techniques for an expandable endoprosthesis including an expandable main component and a side branch portal, such as a thoracic branch endoprosthesis. Disclosed staged deployment techniques include an endoprosthesis delivery system with first and second primary sleeves in parallel releasably constraining an expandable endoprosthesis to a collapsed configuration, and a secondary sleeve within the first primary sleeve that releasably constrains the proximal portion of the expandable endoprosthesis to a partially expanded configuration following release of the first primary sleeve. The secondary sleeve can allow access to the side branch portal via a partially expanded proximal portion of an expandable main component. Allowing positioning of a side branch portal through a partially deployed proximal portion of the main component in an expandable endoprosthesis may allow precise positioning of the expandable main component by allowing the side branch portal to register with a side branch vessel prior to full deployment of the expandable main component.

Example staged deployment techniques for an expandable endoprosthesis including a side branch portal are described with respect to <FIG>. <FIG> illustrate perspective views of delivery systems having constraining sleeves such as those described in further detail with respect to <FIG>.

<FIG> illustrates a side view of a delivery system <NUM> for an expandable implant including a main component and a side branch component, delivery system <NUM> including a set of constraining sleeves <NUM>, <NUM> facilitating staged deployment of the main component; in this example, the main component is expandable implant <NUM>. Expandable implant <NUM> can comprise any endoluminal device suitable for delivery to the treatment area of a vasculature. Such devices may include, for example, stents, grafts, and stent grafts. Thus, expandable implant <NUM> can include one or more stent components with one or more associated graft members disposed over and/or under the stent, which can dilate from a delivery diameter, through a range of larger intermediary diameters, and toward a maximal, pre-determined functional diameter.

For example, expandable implant <NUM> may include one or more stent components made of nitinol and a graft member made of ePTFE, such as an ePTFE film. However, and as discussed below, any suitable combination of stent component(s) and graft member(s) is within the scope of the present disclosure.

Stent components of expandable implant <NUM> can have various configurations such as, for example, rings, cut tubes, wound wires (or ribbons) or flat patterned sheets rolled into a tubular form. Stent components can be formed from metallic, polymeric or natural materials and can comprise conventional medical grade materials such as nylon, polyacrylamide, polycarbonate, polyethylene, polyformaldehyde, polymethylmethacrylate, polypropylene, polytetrafluoroethylene, polytrifluorochlorethylene, polyvinylchloride, polyurethane, elastomeric organosilicon polymers; metals such as stainless steels, cobalt-chromium alloys and nitinol and biologically derived materials such as bovine arteries/veins, pericardium and collagen. Stent components can also comprise bioresorbable materials such as poly(amino acids), poly(anhydrides), poly(caprolactones), poly(lactic/glycolic acid) polymers, poly(hydroxybutyrates) and poly(orthoesters). Any expandable stent component configuration which can be delivered by a catheter is in accordance with the present disclosure.

Potential materials for graft members of expandable implant <NUM> include, for example, expanded polytetrafluoroethylene (ePTFE), polyester, polyurethane, fluoropolymers, such as perfluoroelastomers and the like, polytetrafluoroethylene, silicones, urethanes, ultra-high molecular weight polyethylene, aramid fibers, and combinations thereof. Other examples for a graft member material can include high strength polymer fibers such as ultra-high molecular weight polyethylene fibers (e.g., Spectra®, Dyneema Purity®, etc.) or aramid fibers (e.g., Technora®, etc.). The graft member may include a bioactive agent. In one example, an ePTFE graft includes a carbon component along a blood contacting surface thereof. Any graft member that can be delivered by a catheter is contemplated for use in accordance with the present disclosure.

In various examples, a stent component and/or graft member of expandable implant <NUM> can comprise a therapeutic coating. In these examples, the interior and/or exterior of the stent component and/or graft member can be coated with, for example, a CD34 antigen. Additionally, any number of drugs or therapeutic agents can be used to coat the graft member, including, for example heparin, sirolimus, paclitaxel, everolimus, ABT-<NUM>, mycophenolic acid, tacrolimus, estradiol, oxygen free radical scavenger, biolimus A9, anti-CD34 antibodies, PDGF receptor blockers, MMP-<NUM> receptor blockers, VEGF, G-CSF, HMG-CoA reductase inhibitors, stimulators of iNOS and eNOS, ACE inhibitors, ARBs, doxycycline, and thalidomide, among others.

In various examples, expandable implant <NUM> can comprise a radially collapsed configuration suitable for delivery to the treatment area of the vasculature of a patient. Expandable implant <NUM> can be constrained toward a radially collapsed configuration and releasably mounted onto a delivery device such as catheter shaft <NUM>. The diameter of expandable implant <NUM> in the collapsed configuration is small enough for expandable implant <NUM> to be delivered through the vasculature to the treatment area. In various examples, the diameter of the collapsed configuration is small enough to minimize the crossing profile of delivery system <NUM> and reduce or prevent tissue damage to the patient. In the collapsed configuration, expandable implant <NUM> can be guided by catheter shaft <NUM> through the vasculature.

In various examples, expandable implant <NUM> can comprise a radially expanded configuration suitable for implanting the device in the treatment area of a patient's vasculature. In the expanded configuration, the diameter of expandable implant <NUM> can be approximately the same as the vessel to be repaired. In other examples, the diameter of expandable implant <NUM> in the expanded configuration can be larger than the vessel to be treated to provide a traction fit within the vessel.

In various examples, expandable implant <NUM> can comprise a self-expandable device, such as a self-expandable stent graft. Self-expandable devices dilate from a radially collapsed configuration to a radially expanded configuration when unconstrained. In other examples, expandable implant <NUM> can comprise a device that is expanded with the assistance of a secondary device such as, for example, a balloon. In any of these examples, expandable implant <NUM> may represent an expandable main component of an expandable endoprosthesis including an expandable main component and a side branch, such as expandable main component <NUM>, as described with respect to <FIG> and <FIG>. In this manner, the descriptions of expandable implant <NUM> also apply to expandable main component <NUM>, and the description of expandable main component <NUM> may also apply to expandable implant <NUM>.

Within delivery system <NUM>, sleeves <NUM>, <NUM> each include a single coupling member woven through openings in edges of a sheet to form the tubular configurations of sleeves <NUM>, <NUM> from single sheets of material. Specifically, coupling member <NUM> is woven through openings in the sheet of sleeve <NUM>, and coupling member <NUM> is woven through openings in the sheet of sleeve <NUM>. In this manner, coupling member <NUM> secures the edges of sleeve <NUM> such that sleeve <NUM> maintains a proximal portion of expandable implant <NUM> toward a reduced diameter or outer peripheral dimension suitable for endoluminal delivery. Likewise, coupling member <NUM> secures the edges of sleeve <NUM> such that sleeve <NUM> maintains a distal portion of expandable implant <NUM> toward a reduced diameter or outer peripheral dimension suitable for endoluminal delivery.

Release of sleeves <NUM>, <NUM> allows expandable implant <NUM> to expand to a deployed or partially deployed configuration. Specifically, disengaging coupling member <NUM> from sleeve <NUM> releases sleeve <NUM> to allow a proximal portion of expandable implant <NUM> expanded toward a larger diameter or outer peripheral dimension. Likewise, disengaging coupling member <NUM> from sleeve <NUM> releases sleeve <NUM> to allow a distal portion of expandable implant <NUM> expanded toward a larger diameter or outer peripheral dimension. Thus, the proximal and distal portions of expandable implant <NUM> can be separately released in a staged deployment as facilitated by the parallel configuration of sleeves <NUM>, <NUM>.

After release, sleeves <NUM>, <NUM> can be removed in order to allow expandable implant <NUM> to expand toward a functional diameter and achieve a desired therapeutic outcome. Alternatively, sleeves <NUM>, <NUM> can remain coupled to expandable implant <NUM> or otherwise implanted while not interfering with expandable implant <NUM>.

For either self-expandable or balloon-expandable configurations, sleeves <NUM>, <NUM> constrain expandable implant <NUM> in a collapsed configuration for endoluminal delivery of expandable implant <NUM> to a treatment portion of the vasculature of a patient. For the purposes of the disclosure, the term "constrain" may mean (i) to limit the expansion, either through self-expansion or assisted by a device, of the diameter of an expandable implant or (ii) to cover or surround but not otherwise constrain an expandable implant (e.g., for storage or biocompatibility reasons and/or to provide protection to the expandable implant and/or the vasculature). In delivery system <NUM>, for example, sleeves <NUM>, <NUM> surround and constrain expandable implant <NUM> toward a reduced diameter or collapsed configuration.

To facilitate staged deployment as discussed herein, medical systems comprise multiple sleeves including parallel sleeves (partially not overlapping) and in series (includes a secondary sleeve overlapped by one or more primary sleeves). Parallel sleeves each constrain different portions of an expandable implant at the same time, whereas sleeves in series are each configured to constrain overlapping portions of an expandable implant. Generally, sleeves in series will constrain the overlapping portions of an expandable implant at different sizes with the outer sleeve of sleeves in series being configured to constrain the overlapping portions of the expandable implant to a smaller size than the configuration of inner sleeve(s) of the sleeves in series. In this manner, the inner sleeve(s) of the sleeves in series may only constrain the overlapping portions of the expandable implant after the release of any outer sleeves constraining the overlapping portions of the expandable implant.

When expandable implant <NUM> is in a desired position within the vasculature, coupling members <NUM>, <NUM> can each be disengaged from sleeves <NUM>, <NUM>, respectively, from outside of the body of the patient, which allows sleeves <NUM>, <NUM> to open and expandable implant <NUM> to expand. In various examples, expandable implant <NUM> can be self-expanding, or expandable implant <NUM> can be expanded by an expanding device, such as a balloon.

In some examples, coupling members <NUM>, <NUM> can be disengaged by applying sufficient tension to their respective proximal portions. For example, one or more translatable elements can be attached to coupling members <NUM>, <NUM> outside of the body. Displacement of the translatable elements, such as rotation of a dial or rotational member or translation of a handle or knob, may provide sufficient tension to displace and disengage coupling members <NUM>, <NUM>. In another example, coupling members <NUM>, <NUM> can be disengaged from sleeves <NUM>, <NUM> by a mechanical mechanism (not shown), such as a cutting edge or other mechanism operated from outside of the body of the patient.

In various examples, the parallel configuration of sleeves <NUM>, <NUM> facilitates staged deployment of expandable implant <NUM> by allowing separate expansion of proximal and distal portions of expandable implant <NUM>. As described with respect to <FIG> and <FIG> and delivery system <NUM>, such control may facilitate delivery of a side branch component into a side branch vessel through an expanded proximal portion of expandable implant <NUM>.

<FIG> and <FIG> illustrate perspective views of a delivery system <NUM> for an expandable implant <NUM> (<FIG>). Expandable implant <NUM> includes an expandable main component <NUM> and a side branch component <NUM>. Delivery system <NUM> includes expandable main component <NUM> releasably mounted onto catheter shaft <NUM>. Delivery system <NUM> also includes a set of constraining sleeves <NUM>, <NUM>, <NUM> facilitating staged deployment of expandable main component <NUM>.

While expandable main component <NUM> combines with side branch component <NUM> to form expandable implant <NUM>, expandable main component <NUM> itself also represents an expandable implant in that expandable main component <NUM> may be independently deployed in a vasculature without any other components. In this manner, expandable main component <NUM> represents one example of expandable implant <NUM> as described with respect to <FIG>. In the same or different examples, expandable main component <NUM> represents an expandable endoprosthesis, such as a stent, a graft, or a stent graft. For example, expandable main component <NUM> may include one or more stent components made of nitinol and a graft member made of ePTFE. However, any suitable combination of stent component(s) and graft member(s) is within the scope of the present disclosure, including, but not limited to the description of stent component(s) and graft member(s) discussed with respect to expandable implant <NUM>.

As shown in <FIG>, expandable main component <NUM> is constrained by a set of sleeves which circumferentially surrounds expandable main component <NUM>. Specifically, delivery system <NUM> comprises primary sleeves <NUM>, <NUM> and secondary sleeve <NUM>. Primary sleeves <NUM>, <NUM> circumferentially surround expandable main component <NUM> and constrain it toward a collapsed configuration, in which the diameter is less than the diameter of an unconstrained or otherwise deployed implant for delivery within the vasculature. Primary sleeves <NUM>, <NUM> are in parallel with one another. Specifically, primary sleeve <NUM> releasably constrains a proximal portion of expandable main component <NUM>, and primary sleeve <NUM> releasably constrains a distal portion of expandable main component <NUM>. Secondary sleeve <NUM> is in series with and within primary sleeve <NUM>. As shown in <FIG>, upon release of primary sleeve <NUM>, secondary sleeve <NUM> releasably constrains the proximal portion of expandable main component <NUM> to a partially expanded configuration allowing access to side branch portal <NUM> via the partially expanded proximal portion of expandable main component <NUM>.

In a collapsed configuration within sleeves <NUM>, <NUM>, <NUM>, expandable main component <NUM> can be introduced to a vasculature and directed by a delivery system to a treatment area of the vasculature. Once in position in the treatment area of the vasculature, sleeves <NUM>, <NUM>, <NUM> may be released according to the staged deployment techniques described with respect to <FIG>, and expandable main component <NUM> can be expanded to an expanded configuration.

For example, as shown in <FIG>, coupling member <NUM> secures the edges of sleeve <NUM> such that sleeve <NUM> maintains a proximal portion of expandable main component <NUM> toward a reduced diameter or outer peripheral dimension suitable for endoluminal delivery. Likewise, coupling member <NUM> secures the edges of sleeve <NUM> such that sleeve <NUM> maintains a distal portion of main component <NUM> toward a reduced diameter or outer peripheral dimension suitable for endoluminal delivery.

In various examples, sleeves <NUM>, <NUM>, <NUM> are formed from a sheet of one or more materials wrapped or folded about expandable main component <NUM>. For each sleeve, the sheet of material(s) used to form the sleeve comprises a series of openings, such that the openings extend from one edge of the sheet to the other. Coupling members <NUM>, <NUM>, <NUM> are woven or stitched through the series of openings in the sheets of material(s), securing each of the two edges together and forming a tube. In various examples, coupling members <NUM>, <NUM>, <NUM> can comprise a woven fiber. In other examples, coupling members <NUM>, <NUM>, <NUM> can comprise a monofilament fiber. Any type of string, cord, thread, fiber, or wire which is capable of maintaining a sleeve in a tubular shape is within the scope of the present disclosure. While the illustrative examples herein are described as comprising one or more tubular sleeves, sleeves of any non-tubular shape that corresponds to an underlying expandable implant or that are otherwise appropriately shaped for a given application are also within the scope of the present disclosure.

As shown in <FIG>, following the release of sleeve <NUM> and coupling member <NUM>, coupling member <NUM> secures the edges of secondary sleeve <NUM> such that secondary sleeve <NUM> maintains the proximal portion of expandable main component <NUM> toward an intermediate configuration larger than the collapsed configuration and smaller than the deployed configuration suitable for precise positioning of expandable main component <NUM> adjacent a target location within a vasculature. In the intermediate configuration, the proximal portion of expandable main component <NUM> is constrained in a diameter smaller than the expanded configuration and larger than the collapsed configuration. For example, the diameter of proximal portion of expandable main component <NUM> in the intermediate configuration can be about <NUM>% of the diameter of the proximal portion of expandable main component <NUM> in the expanded configuration. However, any diameter of the intermediate configuration which is less than the diameter of the expanded configuration and larger than the collapsed configuration is contemplated by this disclosure.

With reference to <FIG>, after primary sleeve <NUM> has been expanded, secondary sleeve <NUM> constrains the expandable main component <NUM> toward the intermediate configuration. In the intermediate configuration, expandable main component <NUM> can be oriented and adjusted (e.g., by bending and torsional rotation) to a desired location within the treatment area of the vasculature. In specific embodiments, such precise positioning may include delivering a side branch component through side branch portal <NUM>, which is exposed following the partial expansion of the proximal portion of expandable main component <NUM> toward an intermediate configuration.

In various examples, expandable main component <NUM> may comprise a fenestratable portion covering side branch portal <NUM>. In such configurations, expandable main component <NUM> may include a frangible material which may be fenestrated by an endoluminal tool after expandable main component <NUM> has been partially or completely implanted in the vasculature of a patient. Once fenestrated, fenestratable portion may be used, for example, to install branching stent grafts to expandable main component <NUM>. Side branch fenestrations allow for branching devices, such as branching stent grafts, to be connected to and in with communication expandable main component <NUM>. Such fenestrations and branching stent grafts may facilitate conforming expandable main component <NUM> and additional branching stent grafts to the anatomy of a patient, such as iliac arteries and associated vascular branches.

<FIG> illustrate techniques for implanting, including positioning and deployment, expandable implant <NUM> using the delivery system of <FIG> and <FIG> in thoracic aorta <NUM> of a patient. The techniques of <FIG> may be used to treat a thoracic aortic aneurysm of thoracic aorta <NUM> of a patient. However, the disclosed examples are not limited to implantation within thoracic aorta <NUM> and may be readily applied to other vasculatures including one or more side branches. In the particular example, of <FIG>, thoracic aorta <NUM> includes ascending aorta <NUM>, aortic arch <NUM> and descending aorta <NUM>. Side branch vessels, including brachiocephalic trunk artery <NUM>, left common carotid artery <NUM>, and left subclavian artery <NUM> extend from thoracic aorta <NUM>.

As shown in <FIG>, guidewires <NUM>, <NUM> are inserted into the vasculature. Specifically, guidewire <NUM> is inserted into thoracic aorta <NUM>, whereas guidewire <NUM> is inserted into a side branch via thoracic aorta <NUM>. In the example of <FIG>, guidewire <NUM> is inserted into left subclavian artery <NUM> via thoracic aorta <NUM> although in other examples, guidewire <NUM> may be inserted into a different side branch, such as brachiocephalic trunk artery <NUM> or left common carotid artery <NUM>.

As shown in <FIG>, main component <NUM> is advanced over guidewires <NUM>, <NUM> to a location proximate the side branch of the vasculature, in this example, left subclavian artery <NUM>. Whereas guidewire <NUM> is routed through a central lumen a main component <NUM> before exiting a distal end of main component <NUM>, guidewire <NUM> is routed through the central lumen of main component <NUM>, before passing through side branch portal <NUM>. Due to the routing of guidewire <NUM> through the central lumen of main component <NUM>, advancement of main component <NUM> meets resistance once the opening of side branch portal <NUM> is adjacent the side branch, left subclavian artery <NUM>.

As shown in <FIG>, following the advancement of main component <NUM>, an expandable endoprosthesis including a side branch portal <NUM>, over guidewires <NUM>, <NUM> to a location proximate the side branch, left subclavian artery <NUM>, a proximal portion of main component <NUM> is partially expanded. For example, coupling member <NUM> may be activated to release primary sleeve <NUM> to allow a proximal portion of main component <NUM> to expand to an intermediate configuration filling secondary sleeve <NUM>. In the intermediate configuration, the proximal portion of expandable main component <NUM> is constrained in a diameter smaller than the expanded configuration and larger than the collapsed configuration. During the partial expansion of the proximal portion of main component <NUM>, the distal portion of main component <NUM> remains fully constrained by primary sleeve <NUM>. Following partial expansion of the proximal portion of main component <NUM>, side branch portal <NUM> exits expandable main component <NUM> via a space between primary sleeve <NUM> and secondary sleeve <NUM>.

As shown in <FIG>, following the partial expansion of the proximal portion of expandable main component <NUM>, side branch component <NUM> is advanced over guidewire <NUM>, through catheter shaft <NUM>, into a proximal portion of the central lumen of expandable main component <NUM>, exiting the central lumen of expandable main component <NUM> via side branch portal <NUM>. During this advancement of side branch component <NUM>, the proximal portion of main component <NUM> remains in an intermediate configuration constrained by primary sleeve <NUM>, and the distal portion of main component <NUM> remains fully constrained by primary sleeve <NUM>.

As shown in <FIG>, expandable main component <NUM> and side branch component <NUM> are located to their intended deployment locations. For example, expandable main component <NUM> and side branch component <NUM> may be located to their intended deployment locations by locating expandable main component <NUM> within thoracic aorta <NUM> such that the side branch component <NUM> registers with the side branch, left subclavian artery <NUM>.

As shown in <FIG>, after, expandable main component <NUM> and side branch component <NUM> are located to their intended deployment locations, expandable main component <NUM> is fully expanded by release of distal primary sleeve <NUM> and proximal secondary sleeve <NUM>. For example, coupling member <NUM> may be activated to release primary sleeve <NUM> to allow the distal portion of main component <NUM> to fully expand from the fully collapsed configuration, and coupling member <NUM> may be activated to release secondary sleeve <NUM> to allow the proximal portion of main component <NUM> to fully expand from the intermediate configuration. As side branch component <NUM> is already located within the side branch, left subclavian artery <NUM>, full expansion of main component <NUM> occurs with side branch portal <NUM> in proper alignment with left subclavian artery <NUM>. Guidewire <NUM> may optionally be withdrawn after the full expansion of expandable main component <NUM>.

As shown in <FIG>, after, expandable main component <NUM> is fully expanded, side branch component <NUM> is fully expanded within the side branch, left subclavian artery <NUM>, to form expandable implant <NUM> including main component <NUM> and side branch component <NUM>. For example, side branch component <NUM> may be self-expanding or balloon expanding. In either example, side branch component <NUM> may include a removable sleeve that may be removed to facilitate expansion within left subclavian artery <NUM>. In other examples, a sleeve may be retained on side branch component <NUM> following expansion or side branch component <NUM> may be constrained and released by other techniques, such as a suture. Guidewire <NUM> may optionally be withdrawn after the full expansion of side branch component <NUM>. Catheter <NUM> may also be withdrawn.

Claim 1:
An endoprosthesis delivery system (<NUM>) comprising:
an expandable endoprosthesis (<NUM>) defining a central lumen and a first guidewire (<NUM>) extended through the central lumen, the expandable endoprosthesis (<NUM>) including a side branch portal;
a first primary sleeve (<NUM>) releasably constraining at least a first portion of the expandable endoprosthesis toward a collapsed configuration;
a second primary sleeve (<NUM>) arranged in parallel with the first primary sleeve (<NUM>), wherein upon release of the first primary sleeve (<NUM>), the second primary sleeve (<NUM>) is configured to releasably constrain a second portion of the expandable endoprosthesis (<NUM>) while allowing access to the side branch portal via the first portion of the expandable endoprosthesis;
a side branch component configured for delivery through the side branch portal via the first portion of the expandable endoprosthesis (<NUM>); and
a second guidewire (<NUM>) configured to extend through the first portion of the expandable endoprosthesis (<NUM>) and the side branch component.