Patent Description:
Aneurysms are an abnormal bulging or ballooning of a blood vessel that can result from the vessel wall being weakened by disease, injury, or a congenital abnormality. Aneurysms have thin, weak walls and a tendency to rupture, which can lead to stroke, death, disability, etc. Aneurysms may be treated by positioning an occlusive device (e.g., coils, braids, liquid embolics, etc.) within the aneurysm to reduce blood flow and promote thrombosis and embolization within the aneurysm. However, intrasaccular occlusive devices may relocate out of the aneurysm and into the vessel with aneurysms with wide necks, which may lead to arterial occlusion, stroke, and/or death.

Another method of treating aneurysms includes inserting a flow-diverting stent or braid into a parent vessel that includes the aneurysm to be treated. Such stents or braids can be inserted into a vessel in a radially constrained state, positioned next to the neck of the aneurysm, and expanded into apposition with the vessel wall. If the stent or braid has a sufficiently low porosity, it can function to block the flow of blood through the device and into the aneurysm to induce embolization of the aneurysm. A flow-diverting device may be placed within two vessels (e.g., a parent vessel and a first branching vessel, a first branching vessel and a second branching vessel) to treat a bifurcation aneurysm between the vessels. However, flow-diverting devices typically comprise a tubular structure. Consequently, when such flow-diverting devices are placed across the neck of the aneurysm, a portion of the device is positioned across a juncture to another blood vessel and disrupts blood flow to the vessel. Accordingly, there exists a need for improved flow-diverting devices for treating bifurcation aneurysms.

<CIT> describes an apparatus (<NUM>) for creating a connection between a first body lumen (<NUM>) of a subject and a second body lumen (<NUM>) of the subject.

<CIT> describes a bifurcated stent comprising a body portion, a first branch portion, a second branch portion, a first pivot portion and a second pivot portion constructed from a common continuous sheet of stent material. The body portion, first branch portion and second branch portion provided with a substantially tubular shape, the tubular shape of each defines a lumen respectively therethrough.

The present technology is directed to devices for treating bifurcation aneurysms and associated systems and methods. According to some embodiments, the expandable devices of the present technology comprise an expandable mesh having circumferentially discontinuous articulating portions configured to be positioned at an angle with respect to a tubular body portion of the mesh when the device is expanded. The expandable devices of the present technology may be particularly beneficial for treating bifurcation aneurysms at a location in which a parent blood vessel branches into two or more branching vessels. For example, the expandable meshes of the present technology may be configured to be positioned adjacent the bifurcation aneurysm such that the tubular body portion of the mesh is positioned within a first branching vessel, one of the articulating portions is positioned within a second branching vessel, and another one of the articulating portions is positioned within a parent vessel such that one or more portions of the expandable mesh is positioned across a neck of the bifurcation aneurysm and prevents blood flow into the aneurysm.

The invention is directed to an expandable device configured to be positioned across a neck of an aneurysm at a bifurcation of a blood vessel of a patient as defined in claim <NUM>.

The subject technology is illustrated, for example, according to various aspects described below, including with reference to <FIG>.

Many aspects of the present disclosure can be better understood with reference to the following drawings. The components in the drawings are not necessarily to scale. Instead, emphasis is placed on illustrating clearly the principles of the present disclosure.

The present technology relates to expandable devices and associated systems and methods. Some embodiments of the present technology, for example, are directed to flow-diverting expandable meshes configured to be positioned within one or more blood vessels at a blood vessel bifurcation and across a neck of a bifurcation aneurysm. Specific details of several embodiments of the technology are described below with reference to <FIG>.

With regard to the terms "distal" and "proximal" within this description, unless otherwise specified, the terms can reference a relative position of the portions of an interventional device such as a flow-diverting device and/or an associated delivery device with reference to an operator and/or a location in the vasculature. For example, in referring to a delivery system including the expandable flow-diverting devices described herein, "proximal" can refer to a position closer to the operator of the device or an incision into the vasculature, and "distal" can refer to a position that is more distant from the operator of the device or further from the incision along the vasculature (e.g., the end of the catheter).

As used herein, "radially constrained configuration" refers to an unexpanded configuration of the expandable device in which the expandable device is configured to be delivered or withdrawn through a catheter to or from a treatment site. As used herein, "expanded configuration" refers to a configuration of the expandable device in which the expandable device is partially or fully expanded. An expanded configuration may be achieved via actuation only (for example, via inflation of a balloon), via self-expansion only, or both. Unless provided otherwise herein, "fully expanded," as used to describe a configuration of the expandable device, refers to a configuration of the expandable device in which the portions of the expandable device are positioned relative to the other portions of the expandable device as desired for treatment or facilitating treatment. For example, the fully expanded configuration of the expandable device may comprise an articulating portion of the expandable device positioned at an angle to a tubular body portion of the expandable device such that the articulating portion is configured to be positioned within a lumen of a branching vessel and across a neck of a bifurcation aneurysm and the tubular body portion is configured to be positioned within a lumen of a second branching vessel. As used herein, "intermediate expanded configuration" refers to a configuration of the expandable device in between the radially constrained configuration and the fully expanded configuration.

As used herein, the term "longitudinal" refers to a direction along an axis that extends through the lumen of the expandable device and/or stent while in a tubular configuration and the term "circumferential" can refer to a direction within a plane that is orthogonal to the longitudinal axis and extends around the circumference of the device when in a tubular configuration. As used herein, "circumferentially continuous" can refer to a portion of the device that has a closed circumference such that an axial cross-sectional shape of the device is a complete circle. As used herein, "circumferentially discontinuous" can refer to a portion of the device that has an open circumference such that an axial cross-sectional shape of the device is an arc that subtends an angle less than <NUM> degrees.

As used herein, "vessel bifurcation" refers to a location at which a parent blood vessel branches into two or more branching blood vessels. A bifurcation aneurysm refers to an aneurysm positioned between two branching blood vessels or between a parent blood vessel and a branching blood vessel.

As used herein, the terms "generally," "substantially," "about," and similar terms are used as terms of approximation and not as terms of degree, and are intended to account for the inherent variations in measured or calculated values that would be recognized by those of ordinary skill in the art.

Devices of the present technology may be configured to treat bifurcation aneurysms located at a bifurcation in a patient's vasculature in which a parent blood vessel P splits into two or more branching blood vessels B1, B2 (e.g., the aneurysm A illustrated in <FIG>). Compared to the bifurcation depicted in <FIG>, the branching vessels of the bifurcation may be at substantially different angles, have substantially different sizes, and/or be a different quantity (e.g., three or more). The aneurysm A of the bifurcation may be offset with respect to the junction (e.g., having a neck substantially open to one branching vessel), tilted with respect to a plane created by the vessels (e.g., into or out of the page), etc. Fluid flow into the aneurysm can cause the aneurysm A to rupture, which can lead to stroke, death, disability, etc. Consequently, it may be advantageous to treat the aneurysm to reduce blood flow into the aneurysm and, thereby, reduce the risk of adverse outcomes.

Intrasaccular occlusive devices such as, but not limited to, embolization coils <NUM> may be used to treat the aneurysm A. However, if the aneurysm A has a wide neck, the aneurysm A may be difficult to treat with an intrasaccular device (e.g., embolization coils <NUM>) alone because the intrasaccular device may be prone to relocating through the aneurysm neck into the parent vessel, as illustrated in <FIG>. Relocation or herniation of the coils may cause arterial occlusion, stroke, and/or death. Flow-diverting devices may be used alone or in conjunction with intrasaccular devices to prevent blood flow into the aneurysm. However, tubular flow-diversion devices may insufficiently cover the neck of the aneurysm and may undesirably block blood flow into one of the vessels at the bifurcation. Thus, one or more devices, systems, and methods of the present technology are directed towards flow-diverting devices configured be positioned across a bifurcation aneurysm to prevent blood flow into the aneurysm while permitting blood flow from a parent vessel into two or more branching vessels.

<FIG> are isometric views of an expandable, flow-diverting device ("device <NUM>") configured in accordance with the present technology. The device <NUM> can comprise an expandable, flow-diverting mesh ("mesh <NUM>") configured to interfere with blood flow to a degree sufficient to lead to thrombosis of the aneurysm. For example, the mesh <NUM> may have a sufficiently low porosity to prevent or reduce blood flow across a thickness of the mesh <NUM>. Although <FIG> depict a device <NUM> comprising a single mesh <NUM>, in some embodiments, the device <NUM> comprises multiple occlusive devices (e.g., stents, braids, etc.). A second occlusive can be positioned radially within the mesh <NUM>, radially over the mesh <NUM>, across the mesh <NUM>, and/or end-to-end with the mesh <NUM>. For example, a device of the present technology may comprise a first tubular mesh positioned radially within a second tubular mesh such that the device comprises a combined porosity that is less than a porosity of either the first or second meshes. In some embodiments, a device of the present technology device can comprise a mesh configured to divert blood flow and a stent configured to provide structural support for the mesh. Additional occluding devices can be formed integrally with or independently of the mesh.

According to some embodiments, for example as shown in <FIG>, the mesh <NUM> comprises an entire length and/or circumference of the device. However, the mesh <NUM> may comprise only a portion of the length and/or circumference of the device <NUM>, for example, when combined with a second occlusive device. In some embodiments, a length of the mesh <NUM> is based at least in part on a length of an aneurysm neck to be treated. In some embodiments, properties of the mesh <NUM> (e.g., porosity, thickness, material properties) can be the same throughout the entire device. However, the properties of the mesh <NUM> may also be varied throughout the device <NUM>. For example, an expandable device of the present technology may comprise one portion configured to be positioned adjacent to the neck of the aneurysm and comprising a low porosity mesh and other portions configured to anchor to a vessel wall and having greater porosity than the porosity of the mesh.

<FIG> shows the device <NUM> in a radially constrained state configured for delivery. In the radially constrained state, the device <NUM> may comprise a generally tubular shape. The device <NUM> can comprise a first end portion <NUM>, a second end portion <NUM>, and a longitudinal axis L extending between the first and second end portions <NUM>, <NUM>. In some embodiments, the first end portion <NUM> is a distal end portion and the second end portion <NUM> is a proximal end portion. The device may comprise an outer surface, an inner surface, a thickness between the inner and outer surfaces, and a lumen defined by the inner surface and extending from the first end portion <NUM> to the second end portion <NUM>. One or more ends of the device may be open (i.e., the lumen extends through the end(s) of the device).

According to some embodiments, a diameter and/or a length of the device <NUM> in the tubular configuration can be based at least in part on anatomy to be treated. For example, in some cases it may be beneficial to select a diameter of the device <NUM> to be slightly greater than a diameter of the vessel the device is configured to be positioned within. Oversizing the diameter of the device <NUM> may promote anchoring of the device <NUM> to the vessel wall. In some embodiments, the diameter of the device <NUM> varies along a length of the device <NUM>. For example, the first end portion <NUM> and/or the second end portion <NUM> can taper in a distal direction or a proximal direction. Alternatively, or in addition, the first end portion <NUM> and/or the second end portion <NUM> may flare in a distal direction or a proximal direction. In some embodiments, the diameter of the device <NUM> is generally constant along a length of the device <NUM>. According to some embodiments, a length of the device can be configured based on a length of a parent vessel, a length of a branching vessel, an angle between two vessels, a length of an aneurysm neck, etc. In some embodiments, the device <NUM> does not comprise a tubular shape in the radially constrained state. The device <NUM> can comprise any suitable hollow shape including, but not limited to, round, ovular, elliptical, rectangular, prismatic, etc..

According to some embodiments, the second end portion <NUM> of the mesh <NUM> can comprise one or more articulating portions movable relative to the first end portion <NUM> of the mesh <NUM>. The articulating portions may be separated by one or more slits. For example, as shown in <FIG>, the second end portion <NUM> of the mesh <NUM> can comprise circumferentially discontinuous first and second articulating portions 208a, 208b (collectively "articulating portions <NUM>"). The articulating portions <NUM> can be separated by first and second slits <NUM>. Each articulating portion <NUM> can comprise edges <NUM> formed by the slits (e.g., longitudinal edges 212a, 212b). According to some embodiments, the number of articulating portions is directly proportional to the number of slits. For example, two slits can form two articulating portions, three slits can form three articulating portions, four slits can form four articulating portions, etc. In some embodiments, the number of slits is greater or less than the number of articulating portions.

In some embodiments, for example as depicted in <FIG>, the slits <NUM> extend along a longitudinal axis L of the device <NUM>. The slits <NUM> may also extend along a circumference of the device and/or along a direction oblique to the longitudinal and/or circumferential directions. Each of the slits <NUM> can have a first end, a second end, and a length therebetween. The first and/or second ends of one of the slits <NUM> can be generally longitudinally aligned with the first and/or second ends of the other slit(s), respectively. In some embodiments, the first ends of the slits <NUM> are longitudinally offset. In some embodiments, the second ends of the slits <NUM> are longitudinally offset. The slits <NUM> may comprise the same length. In some embodiments, the first slit 210a has a length different from or the same as a length of the second slit 210b. As shown in <FIG>, in some embodiments, the slits <NUM> extend through a terminus of the device <NUM>. The slits may extend through one, both, or none of the termini of the device <NUM>.

Each of the slits <NUM> can have a width that defines an opening between an edge <NUM> of the first articulating portion 208a and a corresponding edge <NUM> of the second articulating portion 208b adjacent to the slit. In some embodiments, for example as shown in <FIG>, the slit width is negligible such that the adjacent edges <NUM> of first and second articulating portions are disconnected but contact when the device <NUM> is in the tubular configuration. The slit width can be greater than zero such that the edges <NUM> of adjacent first and second articulating portions are disconnected and spaced apart by at least the width of the slit.

According to some embodiments, a device of the present technology can be configured to assume an expanded state in which articulating portions are positioned at desired angles to a body portion of the device. For example, <FIG> depicts the device <NUM> in an expanded configuration. In the expanded configuration, the first articulating portion 208a and the second articulating portion 208b can diverge from one another. The first articulating portion 208a (e.g., a longitudinal axis of the first articulating portion 208a) may be positioned at a first angle θ1 to a longitudinal axis of the device L. As shown in <FIG>, the first angle may be approximately zero such that the first articulating portion 208a is generally parallel to the longitudinal axis L. The second articulating portion 208b may be positioned at a second angle θ to the longitudinal axis of the device L. In some embodiments, the second angle θ is between about <NUM> degrees and about <NUM> degrees. In some embodiments, the first angle is substantially non-zero such that the first articulating portion 208a is not generally parallel with the first end portion <NUM>. The first angle may be between about <NUM> degrees and about <NUM> degrees. According to some embodiments, the first angle and/or the second angle θ is between about <NUM> degrees and about <NUM> degrees.

Each of the first end portion <NUM>, first articulating portion 208a, and second articulating portion 208b may be configured to be positioned within a lumen of a blood vessel at a bifurcation aneurysm treatment site, as shown in <FIG>. The first end portion <NUM> can be configured to be positioned within a lumen of the first branching blood vessel B1. The device <NUM> can be expanded into a fully expanded configuration (<FIG>) in which the second articulating portion 208b is positioned within the second branching blood vessel B2 and the first articulating portion 208a is expanded within the parent blood vessel P. As shown in <FIG>, the first end portion <NUM> and/or the second articulation portion 208b can be configured to be positioned across the neck of the aneurysm A. The flow-diverting properties these portions of the mesh <NUM> can be configured to block blood flow into the aneurysm. In some embodiments, any single portion of the device <NUM> or multiple portions of the device <NUM> can be configured to be positioned across the neck of the aneurysm.

Each portion (e.g., first end portion <NUM>, first articulating portion 208a, second articulating portion 208b) of the device <NUM> can be configured to anchor to a blood vessel wall. The extent of anchorage can be based at least in part on a surface area of the portion contacting the vessel wall, a radial force exerted on the vessel wall by the portion, a diameter of the portion relative to a diameter of the vessel wall, a material of the portion, etc. For example, the tubular first end portion <NUM> may contact an entire circumference of the wall of the first branching blood vessel B1. In contrast, the circumferentially discontinuous second articulating portion 208b may contact only a portion of the circumference of the wall of the second branching blood vessel B2 and, therefore, may anchor to the second branching blood vessel B2 to a lesser extent than the first end portion <NUM> anchors to the first branching blood vessel B1.

One or more portions of a device of the present technology can be circumferentially discontinuous to enable the device to anchor to each vessel at a bifurcation, sufficiently cover the neck of the aneurysm, and permit minimally disrupted blood flow from the parent blood vessel to both branching blood vessels, as depicted in <FIG>. Each of the articulating portions can have a width defined by the angle that the articulating portion subtends, which may be based on radial spacing of the slits separating adjacent articulating portions. For example, <FIG> depicts a device <NUM> with first and second articulating portions 408a, 408b separated by first and second slits 410a, 401b extending along a longitudinal axis of the device. <FIG> shows an axial cross-sectional view of the first end portion <NUM> of the mesh taken along line 4B-4B. As shown in <FIG>, an axial cross-sectional shape of the circumferentially continuous first end portion <NUM> is a complete circle. The circumferentially discontinuous first and second articulating portions 408a, 408b can each have an axial cross-sectional shape of an arc that subtends an angle (see <FIG>). For example, as shown in <FIG>, the first articulating portion 408a subtends a first angle ϕ1 and the second articulating portion 408b subtends a second angle ϕ2. The first and second slits 410a, 410b are spaced apart by about <NUM> degrees, therefore, both ϕ1 and ϕ2 are equal to about <NUM> degrees and the first and second articulating portions 408a, 408b comprise approximately equivalent widths (and subtended angles).

In some embodiments, the articulating portions subtend different angles and comprise different widths. For example, <FIG> show isometric and cross-sectional views, respectively, of a device <NUM> with a first articulating portion 508a subtending a first angle ϕ1 and a second articulating portion 508b subtending a second angle ϕ2 that is greater than ϕ1. In some embodiments, the magnitude of angles ϕ1 and ϕ2 can be based on radial spacing of slits <NUM>. In embodiments in which a device comprises more than two articulating portions, some or all of the articulating portions may comprise the same width. In some embodiments, some or all of the articulating portions may comprise different widths. A width of an articulating portion may be selected based on an intended position of the articulating portion at a treatment site. For example, in some embodiments it may be advantageous for an articulating portion configured to be positioned at least partially across an aneurysm neck to have a larger width to ensure complete coverage of the aneurysm neck.

An expandable device in accordance with the present technology can have any suitable number of articulating portions. For example, the device <NUM> depicted in <FIG> comprises a tubular first end portion <NUM> and one articulating portion <NUM> extending from the first end portion <NUM>. The circumferentially discontinuous articulating portion <NUM> can subtend an angle as previously described. In some embodiments, the articulating portion <NUM> subtends an angle of about <NUM> degrees to form a half tubular shape, as shown in <FIG>. According to some embodiments, the articulating portion <NUM> subtends an angle between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, between about <NUM> degrees and about <NUM> degrees, or between about <NUM> degrees and about <NUM> degrees.

When the device <NUM> is in the radially constrained state, as shown in <FIG>, a longitudinal axis of the articulating portion <NUM> may be generally parallel to a longitudinal axis L of the device <NUM>. In the expanded state, the articulating portion <NUM> may be configured such that the longitudinal axis of the articulating portion <NUM> is positioned at an angle θ relative to the longitudinal axis L of the device <NUM>. According to some embodiments, the device <NUM> may be configured to be positioned across an aneurysm between branching vessels, between a parent vessel and a first branching vessel, and/or between a parent vessel and a second branching vessel. The angle θ between the longitudinal axis L of the device <NUM> and the articulating portion <NUM> may be based in part on the treatment site. For example, the first end portion <NUM> may be configured to be positioned within a first branching vessel and the articulating portion <NUM> may be configured to be positioned within a second branching vessel and the angle θ may be based on an angle between the first and second branching vessels. In some embodiments, the angle θ is between about <NUM> degrees and about <NUM> degrees. According to some embodiments, the angle θ is between about <NUM> degrees and about <NUM> degrees.

According to some embodiments, for example as shown in <FIG>, a device <NUM> of the present technology can comprise a mesh <NUM> having a tubular first end portion <NUM> and a second end portion <NUM> comprising a first articulating portion 708a and a second articulating portion 708b. The first articulating portion 708a can comprise a circumferentially discontinuous portion, as previously described, and circumferentially continuous tubular portion. In some embodiments, the tubular first end portion is a distal end portion configured to be positioned within a first branching blood vessel and the tubular portion of the first articulating portion 708a is a proximal portion configured to be positioned within a parent blood vessel. The second articulating portion 708b may comprise three edges that are disconnected from the first articulating portion 708a by three slits <NUM>. As shown in <FIG>, two slits 710a, 710b can extend longitudinally and one slit 710c can extend circumferentially between the two longitudinal slits 710a, 710b. The two longitudinal slits 710a, 710b may extend along only a portion of the second end portion <NUM> and do not extend through a terminus of the device <NUM>. The second articulating portion can subtend an angle of about <NUM> degrees, as shown in <FIG>. In some embodiments, the second articulating portion 708b can subtend an angle between about <NUM> degrees and about <NUM> degrees, as previously described. In the expanded configuration (<FIG>), the first articulating portion 708a can be configured to be generally parallel to the first end portion <NUM> or the first articulating portion 708a can be configured to be positioned at a non-zero first angle relative to the first end portion <NUM>. The second articulating portion 708b may be positioned at a second angle θ relative to the first end portion <NUM> in the expanded configuration. As previously described, the angle θ may be between about <NUM> degrees and about <NUM> degrees. According to some embodiments, the angle θ is between about <NUM> degrees and about <NUM> degrees.

According to some embodiments, for example as shown in <FIG>, an expandable, flow-diverting device of the present technology, such as device <NUM>, may be used with additional occlusive devices to treat the aneurysm A. Embolic coils <NUM> may be placed within the aneurysm prior to deployment of the device <NUM> at the treatment site. In the expanded configuration, at least one portion of the device <NUM> (e.g., first end portion <NUM> and second articulating portion 708b in <FIG>) is configured to be positioned across the neck of the aneurysm. The portion(s) of the device <NUM> covering the neck of the aneurysm may prevents the embolic coils <NUM> from prolapsing out of the aneurysm and into the branching and/or parent blood vessels. The occlusive device may be any suitable occlusive device such as embolic coils, liquid embolics, braids, etc..

An expandable device of the present technology, such as device <NUM> shown in <FIG>, can comprise a radiopaque material (e.g., platinum, platinum-iridium, tantalum, gold, tungsten) to improve visualization of the device <NUM> within a patient's vasculature. For example, the device <NUM> can comprise one or more radiopaque markers <NUM> that can be attached to the mesh <NUM>. The radiopaque markers <NUM> can comprise coils, bands, plated material, etc. The radiopaque markers <NUM> may be permanently coupled the device <NUM> by welding, mechanical attachment, adhesive, or another suitable joining method. In some embodiments, the radiopaque markers are detachably coupled to the device <NUM>. The radiopaque markers may be disposed on an outer surface of the device <NUM>, an inner surface of the device <NUM>, and/or between the inner and outer surfaces of the device <NUM>. In some embodiments, one or more portions of the mesh <NUM> of the device <NUM> (e.g., one or more mesh struts, one or more mesh wires) are formed of the radiopaque material.

As illustrated in <FIG>, the radiopaque markers <NUM> can be attached to the device <NUM> in a specific pattern to visualize and/or distinguish certain portions of the device. For example, radiopaque markers <NUM> may be attached to the device <NUM> in a longitudinal region that is adjacent a second end portion <NUM> of the device <NUM>. Multiple radiopaque markers <NUM> may be attached around a circumference of the device <NUM> in the longitudinal region. The radiopaque markers <NUM> may be evenly or unevenly spaced around the circumference of the device <NUM>. In addition, or alternatively, the radiopaque markers <NUM> can be attached to articulating portion(s) <NUM>. When the device <NUM> comprises multiple articulating portions <NUM>, one articulating portion <NUM> may comprise a greater number of radiopaque markers <NUM> than the other articulating portion <NUM> and/or a different arrangement of radiopaque markers <NUM> to facilitate identification of the articulating portions <NUM> when the device <NUM> is within the patient's vasculature. For example, the first articulating portion 908a shown in <FIG> comprises one radiopaque marker, whereas the second articulating portion 908b comprises four radiopaque markers. Radiopaque markers <NUM> may be spaced circumferentially around each of the articulating portions <NUM>. Although <FIG> shows eight radiopaque markers, any suitable number and distribution of radiopaque markers <NUM> can be used. In various embodiments, the distribution of radiopaque markers <NUM> along the device <NUM> can be circumferentially asymmetric, such that the first and second articulating portions 908a and 908b can be distinguished from one another under fluoroscopy.

The expandable devices disclosed herein can be manufactured using any suitable techniques or materials. Forming an expandable device of the present technology may include obtaining an expandable mesh formed from one or more metals, polymers, composites, and/or biologic materials. In some embodiments, the expandable mesh may be formed from metal(s) or alloy(s) including superelastic metals/alloys (e.g., nickel-titanium alloys such as Nitinol, etc.) or other metals/alloys such as stainless steel, cobalt-chromium alloys, cobalt-nickel alloys (e.g., 35N LT™ available from Fort Wayne Metals of Fort Wayne, Indiana USA), etc., and be configured to self-expand when released from a delivery catheter as described elsewhere herein. In some embodiments, the expandable mesh can be formed from platinum, platinum-tungsten alloy, gold, magnesium, iridium, chromium, zinc, titanium, tantalum, and/or alloys of any of the foregoing metals or including any combination of the foregoing metals. In several embodiments, the expandable mesh may be highly polished and/or surface treated to further improve hemocompatibility. The expandable mesh may be constructed solely from metallic materials without the inclusion of any polymer materials or may include a combination of polymer and metallic materials. Some or all of the expandable mesh may be formed at least in part from radiopaque material, metal or alloy.

In some embodiments, some or all of the mesh may be formed of strands or wires that have been braided or woven together. The strands may have a bi-component (or multi-component) configuration comprising an inner core material surrounded by an outer shell material. The core material may include any of the materials disclosed in the preceding paragraph, and the outer material may include any of the materials disclosed in the preceding paragraph. In some embodiments, the core material may be different than the outer material. For example, in some embodiments, the core material is a radiopaque material (e.g., platinum, platinum-tungsten alloy, tantalum, gold, tungsten, etc., or generally one that is more radiopaque than the outer material), and the outer material is a resilient or highly elastic and/or superelastic material (e.g., Nitinol, 35N LT, etc., or generally one that is of higher Young's modulus than the outer material). The core material may have a cross-sectional area (based on a cross-sectional dimension dc) that comprises about <NUM>% to about <NUM>%, about <NUM>% to about <NUM>%, about <NUM>% to about <NUM>%, about <NUM>%, about <NUM>%, about <NUM>%, about <NUM>%, about <NUM>%, about <NUM>%, about <NUM>%, about <NUM>% of the total-cross-sectional area of the individual strands (this measure is referred to as the "percent fill" of the strand <NUM> accounted for by the core material <NUM>).

Some suitable materials and combinations for the strands of the expandable mesh include: (a) all strands of coaxial bi-component configuration, with a cobalt-nickel outer material and a platinum or platinum-tungsten (or other radiopaque) core material; (b) all strands of coaxial bi-component configuration, with a nickel-titanium outer material and a platinum or platinum-tungsten (or other radiopaque) core material; (c) a combination of some coaxial bi-component strands of cobalt-nickel outer material and a platinum or platinum-tungsten (or other radiopaque) core material, and some single-component strands of cobalt-nickel; (d) a combination of some coaxial bi-component strands of nickel-titanium outer material and a platinum or platinum-tungsten (or other radiopaque) core material, and some single-component strands of nickel-titanium; (e) a combination of some single-component strands of cobalt-nickel or nickel-titanium with some single-component strands of platinum or platinum-tungsten (or other radiopaque material).

In some embodiments, the mesh may be formed from sheet or tube of any suitable material such as, but not limited to, the materials described elsewhere herein. Any suitable cutting process such as cutting, laser cutting, milling, chemical etching, wire electrical discharge machining (EDM), water jetting, punching (stamping), chemical etching, etc. may be used to cut the mesh from the material. The sheet or tube of material can have a thickness selected to achieve the desired material properties of the resulting mesh. In various embodiments, the thickness of the sheet or tube of material can be uniform or can vary (e.g., along a gradient, being thinned at particular regions using etching, grinding, etc., or thickened at particular regions using deposition, etc.). In some embodiments, the mesh is formed directly as a sheet or tube by an additive process such as thin film deposition, 3D printing, etc..

In some embodiments, the mesh can be bent or otherwise manipulated to create the tubular configuration of the mesh (e.g., the radially constrained configuration). For example, in embodiments in which the mesh is initially formed of a flat sheet of material (e.g., by laser cutting a sheet, by thin film deposition, etc.), the tubular configuration can be created by removably coupling the mesh to a tubular mold or fixture and subjecting the mesh to a heat treatment process, as described elsewhere herein. In some embodiments, the tubular configuration is formed by deforming the flat sheet of material into a generally tube-like shape such that the longitudinal edges of the flat pattern are positioned adjacent to or in contact with one another. The longitudinal edges can be joined (e.g., via laser welding) along all or a portion of their respective lengths. In some embodiments, the edges can overlap so that the overlapping portion comprises two radial layers of the mesh.

Articulating portions of the present technology can be formed by creating slits in the mesh. In some embodiments, the slits can be formed by a suitable cutting process such as, but not limited to, the cutting processes previously described. The cut edges of the mesh can be secured by welding, crimping, melting, gluing, braiding, clamping, or another suitable securing method. In some embodiments, various portions of the mesh (e.g., first end portion, articulating portions) can be formed separately and then coupled together. The portions of the mesh can be coupled by any suitable joining method such as, but not limited to, welding, crimping, melting, gluing, etc. In some embodiments, an articulating portion can be formed by extruding a material forming the first end portion of the mesh.

In some embodiments, the mesh can be bent or otherwise manipulated via a shape setting process to create the expanded configuration of the mesh in which one or more articulating portions are positioned at an angle to a first end portion of the device. In some embodiments, the shape set process comprises manipulating the mesh into the intended expanded configuration (e.g., by coupling to a mold or fixture) and subjecting the mesh to a heat treatment. One example, of a heat treatment procedure can include heating the mesh to a selected temperature for a selected period of time, followed by rapid cooling. The rapid cooling can be achieved by any suitable cooling procedure such as, but not limited to water quench or air-cooling. In particular examples, the heat treatment procedure may be carried out in an air or vacuum furnace, salt bath, fluidized sand bed or other suitable system. In other examples, other suitable heat-treating procedures may be employed including, but not limited to, resistive heating or heating by running a current though the metal of the appliance structure. One or more additional post processing operations may be provided on the mesh after preliminary shape setting, including, but not limited to, abrasive grit blasting, shot peening, polishing, chemical etching, electropolishing, electroplating, coating, ultrasonic cleansing, sterilizing or other cleaning or decontamination procedures.

In some embodiments, a single shape-setting step may be completed to deform the mesh to its desired expanded configuration. However, in certain embodiments the shape setting may include two or more shape-setting steps (e.g., two or more heat treatment processes, potentially using two or more different fixtures). In such cases, the amount of deformation imparted to the mesh within each shape-setting step may be limited, with each subsequent shape-setting step moving the mesh further toward the desired expanded configuration.

The present disclosure also includes methods of treating a vascular condition, such as an aneurysm, with any of the embodiments of the expandable devices disclosed herein. The expandable device may be deployed across the neck of an aneurysm and its flow-diverting properties employed to reduce blood flow between the aneurysm and the parent vessel, cause the blood inside the aneurysm to thrombose, and/or lead to healing of the aneurysm.

<FIG> shows a side view of an example of a delivery system <NUM> in accordance with the present technology. The delivery system may comprise an elongate tube <NUM> (e.g., a microcatheter) having a proximal end portion <NUM>, a distal end portion <NUM>, a lumen <NUM> extending from the proximal end portion <NUM> to the distal end portion <NUM>, and an inner surface <NUM> defining the lumen <NUM>. At the distal end portion <NUM>, the elongate tube <NUM> may be open. The elongate tube <NUM> may be configured to slidably receive a core member <NUM> configured to carry an expandable device <NUM>. The core member <NUM> may be configured to be advanced beyond the distal portion <NUM> to expand or deploy the expandable device <NUM> within a blood vessel. In operation, the core member <NUM> may be distally advanced relative to the tube <NUM>, or the tube <NUM> may be proximally retracted relative to the core member <NUM>. The elongate tube <NUM> can define a generally longitudinal dimension extending between the proximal end portion <NUM> and the distal end portion <NUM>. When the delivery system <NUM> is in use, the longitudinal dimension need not be straight along some or any of its length.

The core member <NUM> may comprise a distal portion 1013a configured to extend generally longitudinally through the lumen of the elongate tube <NUM>. The core member <NUM> may further comprise a first proximal portion 1013b and a second proximal portion 1013c. The first and second proximal portions 1013b, 1013c may be radially spaced apart, as shown in <FIG>. The first proximal portion 1013b may be configured to move the entire expandable device <NUM> and/or a first articulating portion of the expandable device <NUM> through the elongate tube <NUM>, whereas the second proximal portion 1013c may be configured to move and/or deploy a second articulating portion 1008b of the expandable device <NUM>. The core member <NUM> can generally comprise any member(s) with sufficient flexibility and column strength to move the expandable device <NUM> through the elongate tube <NUM>. The core member <NUM> can therefore comprise a wire, tube (e.g., hypotube), braid, coil, or other suitable member(s), or a combination of wire(s), tube(s), braid(s), coil(s), etc..

The delivery system <NUM> can also include a coupling assembly <NUM> or resheathing assembly <NUM> configured to releasably retain the expandable device <NUM> with respect to the core member <NUM>. The coupling assembly <NUM> can be configured to engage the expandable device <NUM>, via abutment of the proximal end or edge of the expandable device <NUM>, mechanical interlock with the pores and filaments of the expandable device <NUM>, frictional engagement with the inner wall of the expandable device <NUM>, any combination of these modes of action, or another suitable mode of action. The coupling assembly <NUM> can therefore cooperate with the inner surface <NUM> of the elongate tube <NUM> to grip and/or abut the expandable device <NUM> such that the coupling assembly <NUM> can move the expandable device <NUM> along and within the elongate tube <NUM>, e.g., distal and/or proximal movement of the core members <NUM> relative to the elongate tube <NUM> results in a corresponding distal and/or proximal movement of the expandable device <NUM> within the elongate tube lumen <NUM>.

In some embodiments, the coupling assembly <NUM> can comprise one or more proximal restraints <NUM> and a distal restraint <NUM>. The proximal and distal restraints <NUM>, <NUM> can be fixed to the core member(s) <NUM> to prevent or limit proximal or distal movement of the coupling assembly <NUM> along the longitudinal dimension of the core member <NUM>. For example, the proximal and distal restraints <NUM>, <NUM> can be soldered or fixed with adhesive to the core member(s) <NUM>. In some embodiments, as described in further detail below, the proximal restraint <NUM> can be sized to abut the proximal end of the expandable device <NUM> and be employed to push the device distally during delivery. The distal restraint <NUM> can taper in the distal direction down towards the core member <NUM>. This tapering can reduce the risk of the distal restraint <NUM> contacting an inner surface of the expandable device <NUM>, particularly during navigation of tortuous vasculature, in which the system <NUM> can assume a highly curved configuration.

As depicted in <FIG>, the proximal restraint <NUM> may be configured to abut the proximal end or proximal edge of the expandable device <NUM>. The proximal restraint <NUM> may comprise a first portion 1028a fixed to the first proximal portion 1013b of the core member <NUM> and a second portion 1028b fixed to the second proximal portion 1013c of the core member <NUM>. The second portion 1028b of the proximal restraint may be movable relative to the first portion 1028a of the proximal restraint. The first portion 1028a of the proximal restraint <NUM> can be configured to abut a first articulating portion 1008a of the expandable device <NUM> and the second portion 1028b of the proximal restraint <NUM> can be configured to abut a second articulating portion 1008b of the expandable device <NUM>. In this arrangement each portion of the proximal restraint <NUM> can be used to move (e.g., push) the corresponding articulating portion of the expandable device <NUM>. A push force can be applied to the first proximal portion 1013b of the core member <NUM> such that the first portion 1028a of the proximal restraint <NUM> abuts the first articulating portion 1008a of the expandable device <NUM> and moves the entire expandable device <NUM> or only the first articulating portion 1008a distally through the elongate tube <NUM>. A push force can be applied to the second proximal portion 1013c of the core member <NUM> such that the second portion 1028b of the proximal restraint <NUM> abuts the second articulating portion 1008b of the expandable device <NUM> and moves the second articulating portion 1008b distally through the elongate tube <NUM>.

The coupling assembly <NUM> can also include a resheathing member <NUM> positioned about the core member <NUM> between the proximal and distal restraints <NUM>, <NUM>. The resheathing member <NUM> can be a rigid plate, sprocket, pad, or other suitable member with a central aperture configured to receive the core member <NUM> therethrough. The resheathing member <NUM> may be configured to frictionally engage, mechanically interlock with or otherwise engage the expandable device <NUM> such that the resheathing member <NUM> restrains the expandable device <NUM> from moving longitudinally with respect to the core member <NUM>. One or more spacers (not shown) can be disposed about the core member <NUM> between the resheathing member and the proximal restraints <NUM>, the distal restraint <NUM>, and/or additional resheathing members <NUM> to define a relative longitudinal positioning between the components on either end of the spacer. The spacer can comprise a wire coil, a solid tube, or other structural element that can be mounted over the core member <NUM>. In some embodiments, the spacer can be a zero-pitch coil with flattened ends. In some embodiments, the spacer can be a solid tube (e.g., a laser-cut tube) that can be rotatably mounted or non-rotatably fixed (e.g., soldered) to the core member <NUM>. The spacers can have a radially outermost dimension that is smaller than a radially outermost dimension of the resheathing member <NUM> such that the spacer does not contact the expandable device <NUM> during normal operation of the system <NUM>. Although the embodiment illustrated in <FIG> includes one resheathing member <NUM> and no spacers, the number of resheathing members and spacers can vary. In at least one embodiment, the coupling assembly <NUM> includes only a single resheathing member <NUM> without any spacers. In other embodiments, the number of resheathing members can vary, for example two, three, four, five, six, or more resheathing members separated by spacers.

When the proximal restraint <NUM> is configured to push the expandable device <NUM> distally, the proximal restraint accordingly transmits some, most, or all of the distal longitudinal (push) force to the expandable device <NUM>, wholly or partially in place of the resheathing member(s) <NUM>. In such a configuration, the resheathing members <NUM> can transmit little or no push force to the expandable device <NUM> while the expandable device <NUM> is delivered distally along the length of the elongate tube <NUM>. Advantageously, this reduces or eliminates the tendency of the resheathing member(s) <NUM> to distort pores of the expandable device <NUM>. Use of the proximal restraint <NUM> to move the expandable device <NUM> in this manner can also reduce or eliminate longitudinal movement of the expandable device <NUM> relative to the core members <NUM> that sometimes accompanies the pore distortion described above. In most cases, the vast majority of the travel of the expandable device <NUM> within the elongate tube <NUM> is in the distal or "push" direction during delivery to the treatment location, in contrast to the relatively short travel involved in resheathing the expandable device <NUM>, in the proximal or "pull" direction. Therefore, configuring the proximal restraint <NUM> to transmit most or all of the push force to the expandable device <NUM> can significantly reduce or substantially eliminate such distortion and/or relative longitudinal movement of the stent.

The coupling assembly <NUM> of <FIG> can therefore employ the proximal restraint <NUM> as a pushing element to transmit at least some, or most or all, distally directed push force to the expandable device <NUM> during delivery. In such a coupling assembly <NUM>, the resheathing member(s) <NUM> do not transmit any distally directed push force to the expandable device <NUM> during delivery (or transmit only a small portion of such force, or do so only intermittently). The resheathing member(s) <NUM> can transmit proximally-directed pull force to the expandable device <NUM> during retraction or resheathing, and the proximal restraint <NUM> can transmit no proximally directed pull force to the stent (or it may do so occasionally or intermittently, for example when a portion of the expandable device <NUM> becomes trapped between the outer edge of the proximal restraint <NUM> and the inner wall of the elongate tube <NUM>).

In some embodiments, the resheathing member(s) <NUM> are employed for both distal and proximal movement of the expandable device <NUM> with respect to the elongate tube <NUM>. The resheathing member(s) <NUM> can transmit distally directed force to the expandable device <NUM> to move it distally within the elongate tube <NUM> during delivery, and proximally directed force to the expandable device <NUM> to move it proximally into the elongate tube <NUM> during resheathing. In such embodiments, the proximal restraint <NUM> can be made with a relatively small outer diameter, and /or be positioned sufficiently proximal of the proximal end of the expandable device <NUM>, to prevent the proximal restraint <NUM> from transmitting distally directed push forces to the expandable device <NUM> during delivery.

The resheathing members <NUM> can be fixed to the core member <NUM> so as to be immovable relative to the core member <NUM>, in a longitudinal/sliding manner and/or in a radial/rotational manner. Alternatively, the resheathing members <NUM> can be coupled to (e.g., mounted on) the core member <NUM> so that the resheathing members <NUM> can rotate about the longitudinal axis of the core member <NUM>, and/or move or slide longitudinally along the core member <NUM>. In such embodiments, the resheathing members <NUM> can each have an inner lumen or aperture that receives the core member <NUM> therein such that the resheathing members <NUM> can slide and/or rotate relative to the core member <NUM>.

In some embodiments, the resheathing members <NUM> can be mounted onto the core member <NUM> to permit not only rotational movement but also a degree of tilting of the resheathing members <NUM> with respect to a longitudinal axis of the core member <NUM>. For example, the holes in the resheathing members <NUM> can be larger than the outer diameter of the corresponding portion of the core member <NUM>, thereby permitting both rotational movement and tilting with respect to the core member <NUM>. "Tilting" as used herein means that the long axis of the resheathing member <NUM> (i.e., an axis extending along the longest dimension of the resheathing member <NUM>, substantially parallel to the proximal-facing and distal-facing end faces of the resheathing member <NUM>) is non-orthogonal to a longitudinal axis of the core member <NUM>. For example, in one tilted configuration, the long axis of the resheathing member <NUM> can intersect the core member <NUM> at approximately <NUM> degrees, indicating <NUM> degrees of tilt. Depending on the dimensions of the resheathing members <NUM> and the core member <NUM>, the degree of tilting permitted can vary. In some embodiments, one or both of the resheathing members <NUM> can tilt with respect to the core member <NUM> by <NUM> degrees or less, <NUM> degrees or less, <NUM> degrees or less, or <NUM> degrees or less. In some embodiments, one or both of the resheathing members <NUM> can tilt with respect to the core member by at least <NUM> degrees, by at least <NUM> degrees, by at least <NUM> degrees, or more.

Proper positioning of an expandable device of the present technology requires an articulating portion to be oriented adjacent to the vessel it is intended to be expanded into. The delivery system <NUM> can comprise an orientation member <NUM> to facilitate proper rotation of the expandable device <NUM> during delivery. The orientation member <NUM> can be coupled to the first and/or second proximal portions 1013a, 1013b of the core member <NUM>. In some embodiments, the orientation member <NUM> is fixed to the first proximal portion 1013b of the core member <NUM> and is slidable over the second proximal portion 1013c of the core member <NUM>. As a result, the first and second proximal portions 1013b and 1013c can be slidably moved relative to one another.

In operation, the expandable device <NUM> can be moved distally or proximally within the elongate tube <NUM> via the core member <NUM> and the coupling assembly <NUM>. To move the expandable device <NUM> out of the elongate tube <NUM>, either one or both proximal portions of the core member <NUM> are moved distally while the elongate tube <NUM> is held stationary or the one or more proximal portions of the core member <NUM> are held stationary while the elongate tube <NUM> is withdrawn proximally. When the proximal portion(s) of the core member <NUM> are moved distally, the distal face of the proximal restraint <NUM> bears against the proximal end of the expandable device <NUM> and causes the expandable device to be advanced distally, and ultimately out of the distal portion <NUM> of the elongate tube <NUM>. In embodiments wherein the resheathing member(s) <NUM> are employed to transmit pushing force to the expandable device <NUM>, the mechanical engagement or interlock between the resheathing member <NUM> and the expandable device <NUM>, in response to the application of a distally directed force to the core member <NUM>, causes the expandable device <NUM> to move distally through and out of the elongate tube <NUM>. Conversely, to resheath or otherwise move the expandable device <NUM> into the elongate tube <NUM>, the relative movement between the core member <NUM> and the elongate tube <NUM> is reversed compared to moving the expandable device <NUM> out of the elongate tube such that the proximal region of the distal restraint <NUM> bears against the distal end of the expandable device and thereby causes the resheathing member <NUM> to be retracted relative to the elongate tube <NUM>. The mechanical engagement between the resheathing member <NUM> and the expandable device <NUM> may accordingly hold the expandable device <NUM> with respect to the core member <NUM> such that proximal movement of the expandable device <NUM> relative to the elongate tube <NUM> enables re-sheathing of the expandable device <NUM> back into the distal portion <NUM> of the elongate tube <NUM>. This can be useful when the expandable device <NUM> has been partially deployed and a portion of the expandable device <NUM> remains disposed between at least one resheathing member <NUM> and the inner surface <NUM> of the elongate tube <NUM> because the expandable device <NUM> can be withdrawn back into the distal opening of the elongate tube <NUM> by moving the core member <NUM> proximally relative to the elongate tube <NUM> (and/or moving the elongate tube <NUM> distally relative to the core member <NUM>). Resheathing in this manner remains possible until the resheathing member <NUM> and/or elongate tube <NUM> have been moved to a point where the resheathing member <NUM> is beyond the distal opening of the elongate tube <NUM> and the expandable device <NUM> is released from between the resheathing member <NUM> and the elongate tube <NUM>.

In some embodiments, delivering an expandable device of the present technology can begin with obtaining percutaneous access to the patient's arterial system, typically via a major blood vessel in a leg or arm. A guidewire can be placed through the percutaneous access point and advanced to the treatment location, which can be in an intracranial artery, or any neurovascular artery, peripheral artery, or coronary artery. The elongate tube <NUM> (e.g., a microcatheter) can be advanced over the guidewire to a treatment site having an aneurysm at a vessel bifurcation. The distal portion <NUM> of the elongate tube <NUM> can be advanced into the first branching vessel. The guidewire can then be withdrawn from the elongate tube <NUM> and the core member <NUM> and core assembly <NUM>, together with the expandable device <NUM> mounted thereon or supported thereby, can be advanced through the elongate tube <NUM> to the distal portion <NUM> of the elongate tube <NUM>. Radiopaque markers of the expandable device <NUM> can be visualized with fluoroscopy to identify the orientation and/or position of the expandable device <NUM> at the treatment site. The orientation member <NUM> can be used to rotate the expandable device <NUM> within the elongate tube <NUM> and/or within the vessel to achieve the proper rotational orientation. A first (e.g., distal) end portion <NUM> of the expandable device <NUM> can be expanded within the first branching vessel as previously described by applying a push force to the first proximal portion 1013b of the core member <NUM>. The expandable device <NUM> may self-expand into apposition with the inner wall of the first branching blood vessel. In some embodiments, an additional expansion device (e.g., balloon, energy source) can be used to facilitate or cause expansion of the device <NUM>. In some embodiments, once the first end portion <NUM> of the expandable device <NUM> is deployed, the second articulating portion 1008b may be deployed into the second branching blood vessel. A force can be applied to the second proximal portion 1013c of the core member <NUM> to cause the second portion 1028b of the proximal restraint <NUM> to move the second articulating portion 1008b into the second branching blood vessel. For example, the second portion 1028b of the proximal restraint <NUM> can be distally advanced relative to the first portion 1028a. By virtue of this distal advancement, the second portion 1028b of the proximal restraint can urge the second articulating portion 1008b radially outwardly. The second articulating portion 1008b can expand into apposition with the inner wall of the second branching blood vessel so that at least a portion of the first end portion <NUM> and/or the second articulating portion 1008b is positioned across the neck of an aneurysm between the first and second branching blood vessels. The first articulating portion 1008a may be advanced out of the elongate tube <NUM> and expanded into apposition with the inner wall of the parent blood vessel. The delivery system <NUM> can be removed from the patient, leaving the implanted expandable device <NUM> positioned within the parent and branching vessels and across the neck of the bifurcation aneurysm.

Although many of the embodiments are described above with respect to systems, devices, and methods for treating cerebral aneurysms, the technology is applicable to other applications and/or other approaches, such as pulmonary or cardiac applications. Moreover, other embodiments in addition to those described herein are within the scope of the technology. Additionally, several other embodiments of the technology can have different configurations, components, or procedures than those described herein. A person of ordinary skill in the art, therefore, will accordingly understand that the technology can have other embodiments with additional elements, or the technology can have other embodiments without several of the features shown and described above with reference to <FIG>.

The descriptions of embodiments of the technology are not intended to be exhaustive or to limit the technology to the precise form disclosed above. Where the context permits, singular or plural terms may also include the plural or singular term, respectively. Although specific embodiments of, and examples for, the technology are described above for illustrative purposes, various equivalent modifications are possible within the scope of the technology, as those skilled in the relevant art will recognize. For example, while steps are presented in a given order, alternative embodiments may perform steps in a different order. The various embodiments described herein may also be combined to provide further embodiments.

Claim 1:
An expandable device (<NUM>) configured to be positioned across a neck of an aneurysm (A) at a bifurcation of a blood vessel (P) of a patient, the device comprising:
a generally tubular mesh (<NUM>) having a first end portion (<NUM>) and a second end portion, the second end portion (<NUM>) comprising a first articulating region (208a) and a second articulating region (208b),
characterised in that the first articulating region is separated from the second articulating region by first and second slits (210a, 201b), the first and second slits extending along a longitudinal axis (L) of the mesh, and
wherein, when the mesh is in an expanded state, the first articulating region is positioned at a first angle (θ1) relative to the first end portion and the second articulating region is positioned at a second angle (θ) relative to the first end portion.