Patent Description:
Catheter systems, such as treatment, delivery, and/or deployment catheters, are used to treat patients internally. For example, delivery catheter systems are used to deliver and deploy prosthetic devices, such as prosthetic heart valves, at locations inside the body. Prosthetic heart valves can be delivered to a treatment site (e.g., aortic, mitral, tricuspid, and/or pulmonary valve position) within a patient using transcatheter techniques.

Introducer sheaths can be used to safely introduce delivery devices, such as delivery catheters, into a patient's vasculature using various approaches, such as a transfemoral approach via the femoral artery. Such introducer sheaths protect the local tissue and ease the introduction of the delivery catheter into the patient. A typical introducer sheath generally has an elongated sleeve that is inserted into the vasculature, and a housing that remains outside the patient and which contains one or more sealing valves that minimize blood loss out of the sheath as a delivery apparatus is advanced into the patient via the elongated sleeve and housing.

Conventional methods of accessing a vessel, such as a femoral artery, prior to introducing the delivery system include dilating the vessel using multiple dilators or sheaths that progressively increase in diameter. This repeated insertion and vessel dilation can increase the amount of time the procedure takes, as well as the risk of damage to the vessel.

Radially expanding access sheaths are known in the art. Such sheaths may have complex mechanisms, such as ratcheting mechanisms that maintain the sheath in an expanded configuration once a device with a larger diameter than the sheath's original diameter is introduced. Other sheaths can elastically deform, and can temporarily radially expand in an elastic fashion responsive to outward pressure caused by a delivery catheter or other device as it passes within the sheath. Some of these sheaths will elastically deform/radially expand in local areas as wider portions of the delivery catheter are passed therethrough, and then retract to a smaller (e.g., original) diameter when the wider parts of the delivery system have passed that particular portion of the sheath. However, the local radial expansion may create changes in the overall length of the sheath, which can cause portions of the sheath to change position in the patient's vasculature. Additionally, current expandable sheath technology fails to relieve compression along the entire length of the delivery catheter body, and can actually increase the sheath's compressive forces as the sheath is expanded. These compressive forces may interfere with advancement of the catheter/implant through the sheath, and/or require high delivery forces to advance the catheter/implant through the sheath.

<CIT> shows devices and methods for providing endovascular therapy, including facilitating establishment of vascular access, placement of endovascular sheaths, catheter tip localization, and administration of vascular occlusion. The devices include a vessel cannulation device, an expandable sheath, an occlusion catheter, and a localizer each of which may be provided separately or used as part of a system. In one embodiment, a vessel cannulation device includes: a housing having a distal end with a distal tip and a proximal end; a guidewire lumen passing through the housing and at least the distal tip; a sensor coupled to the guidewire lumen; and an advancing member, which is configured for advancing at least one of a guidewire or a sheath and which is operably coupled to the sensor.

<CIT> shows an expandable introducer sheath provided with a steering mechanism. The introducer sheath is configured for providing a prosthesis delivery system percutaneous access to a patient's vasculature. The introducer sheath includes a sheath component defining a central lumen and having a longitudinally-extending, radially-expandable portion. The sheath component also includes a steering wire slidably disposed within a wall thereof that longitudinally extends along the radially-expandable portion. When the steering wire is in a slackened configuration , the steering wire permits a width of the radially-expandable portion to increase. When the steering wire is in a taut configuration, the steering wire permits a distal portion of the sheath component to be manipulated or bent in order to align a distal port of the introducer sheath, for instance, with an ostium of a branch vessel.

<CIT> shows an expandable introducer sheath for use in inserting a medical device into a body vessel of a patient, which includes a body which extends from a proximal end to a distal end along an axis. The body includes an inner layer, an outer layer, and an expandable reinforcement member which is disposed between said inner and outer layers. The expandable reinforcement member is configured to radially expand as the medical device is axially advanced or retracted through said introducer sheath. Once the medical device has exited the introducer sheath, the expandable reinforcement member facilitates a return of the introducer sheath to its original or unexpanded condition.

There is a need for delivery sheaths which can locally radially expand to accommodate delivery catheters/devices without causing changes in the overall length of the sheath. There is also a need for delivery sheaths that relieve compression on the larger delivery catheter as the delivery catheter is passed through the sheath body. The current invention fulfills these needs.

The present invention provides systems, and devices for accessing a patient's body using an access sheath and a delivery/deployment/treatment catheter, such as may be desired during heart valve implant procedures such as transcatheter heart valve delivery. The present invention relates to a delivery sheath as defined in claim <NUM>. Embodiments of the invention are recited in the dependent claims.

In one embodiment, a sheath is configured that can locally lengthen responsive to and proportional to corresponding local radial expansion, and/or vice versa, i.e., locally radially expand responsive to and proportional to corresponding local surface lengthening. The local surface lengthening permits the sheath overall length to remain constant during local radial expansion. The local radial expansion creates a larger diameter lumen that can accommodate larger structures, and may also provide for decreased compressive forces onto a catheter and/or implant passing through the sheath. The local surface lengthening may preferably occur in direct response to the local radial expansion, and without the need for the application of any other forces (other than the force(s) which caused the local radial expansion). The local radial expansion may preferably occur in direct response to the local surface lengthening, and without the need for the application of any other forces (other than the force(s) which caused the local surface lengthening.

Sheaths of the invention may exhibit a negative Poisson ratio. In prior expandable sheaths, the act of passing a delivery catheter within the sheath caused radial expansion of the sheath but also cause increased compressive forces by the sheath against the delivery catheter, typically leading to a need for increased insertion forces to advance the catheter through the sheath. By contrast, the sheath of the current invention has a negative Poisson ratio, where radial expansion of the sheath (which can be caused by longitudinal tensile forces and/or radially expansive forces) results in reduction of compressive forces from the sheath as the sheath expands. The reduction of compressive forces during radial expansion causes a decrease in the internal resistance of the sheath against advancement of the catheter/implant through the sheath. This lowers the overall force required to introduce and advance the delivery catheter/implant through the sheath, and may aid in reducing procedural complexity and also reduce the forces imposed on the patient's anatomy during the procedure.

The sheath may preferably be configured so that radial expansion and lengthening are proportional and interconnected with each other, such as where radial expansion is proportional to local surface lengthening, and/or where local surface lengthening is proportional to radial expansion. Radial expansion may be caused, in whole or in part, by lengthwise tensile forces locally along the sheath. For example, advancing a catheter through the sheath may cause lengthwise tensile forces locally on the sheath, which can cause local surface lengthening which in turn causes local radial expansion. Lengthening may be caused, in whole or in part, by radially outward forces along the length of the sheath. For example, expanding a device within the sheath may cause radially expansive forces locally on the sheath, which can cause radial expansion which in turn causes local surface lengthening.

Sheaths according to the invention may include a stent-like frame which provides desired expansion/lengthening/Poisson ratio performance. The stent-like frame may also provide improved kink resistance/performance, even at very small diameters and very small wall thicknesses.

The sheath of an embodiment of the invention has an insertion body and a hub, with the insertion body being elongated and configured for advancement into a patient, such as into a femoral artery. The sheath may have an outer elastic layer, an inner lining layer, and a stent-like frame between the inner and outer layers, and may also have adhesive to secure the layers/frame together. The stent-like frame may be configured to locally radially expand responsive to local surface lengthening of the stent-like frame, and/or to locally lengthen responsive to local radially expansion. The sheath may be configured to slidingly receive a catheter therein (such as a delivery catheter with implant thereon) and to radially expand and lengthen locally responsive to the catheter being slidingly advanced through the sheath.

The stent-like frame of a sheath may have a plurality of circumferential links, a plurality of nodes, and a plurality of longitudinal links, with a plurality of ring-like elements extending about a circumference of the stent-like frame, each ring-like element comprising circumferential links ring-like elements alternating with nodes and extending circumferentially about the ring-like element. Adjacent ring-like elements may be secured to each other via longitudinal links extending longitudinally between and connecting the nodes of the adjacent ring-like elements. In an unexpanded and unlengthened configuration of the stent-like frame the longitudinal links and circumferential links have more-curved shapes, and in an expanded and lengthened configuration of the stent-like frame the longitudinal links and circumferential links have less-curved shapes.

Expansion of the stent-like frame may cause the circumferential links to at least partially straighten, which causes the nodes to at least partially rotate, which causes the longitudinal links to at least partially straighten. Lengthening of the stent-like frame may cause the longitudinal links to at least partially straighten, which causes the nodes to at least partially rotate, which causes the circumferential links to at least partially straighten.

A system for delivering a prosthetic heart valve within a native valve annulus of a patient according to an embodiment of the invention includes an introducer sheath, a delivery catheter configured to be advanced through a patient internal vessel, and an implant secured to the delivery catheter.

In addition, methods of using the invention for treating a patient are disclosed, such as by delivering a heart valve repair implant within the heart of a patient, wherein such methods themselves do not belong to the invention and may include: creating an incision in the patient leading from an access site on and outer skin surface of the patient and into a first blood vessel; advancing a distal end of an access sheath through the incision and into the first blood vessel, wherein the access sheath is configured to locally radially expand and locally lengthen as a catheter and implant are advanced therethrough; advancing a guide wire from the access site thru the incision and access sheath and the first blood and to a position at or adjacent a treatment site; advancing a catheter distal end along the guide wire to the treatment site, wherein advancing the catheter comprises locally expanding and locally lengthening the access sheath responsive to advancement of the catheter therethrough; applying treatment at the treatment site via the catheter; removing the catheter from the patient; removing the guide wire from the patient; removing the access sheath from the patient; and closing the incision. The first blood vessel may be a femoral artery, and the distal end of the access sheath may be advanced into the aorta. The treatment site may be at or adjacent a heart valve. The catheter may be a delivery catheter having a prosthetic heart valve at the catheter distal end. Locally lengthening the access sheath may be caused by tension applied longitudinally to the access sheath by advancement of the catheter, and locally expanding the access sheath is caused by locally lengthening the access sheath. The systems, and devices of the present invention can be utilized in various catheter-based procedures, including minimally-invasive procedures and percutaneous procedures. In some embodiments the systems/devices may used with transapical deliveries through a small chest incision. In other embodiments, the systems/devices can be used in transatrial procedures. In yet other embodiments, the systems/devices can be used in percutaneous procedures, such as via a catheter or catheters into the patient's arterial system (e.g., through the femoral or brachial arteries).

It should be understood that each of the elements disclosed herein can be used with any and all of the elements disclosed herein, even though the specific combination of elements may not be explicitly shown in the figures herein. In other words, based on the explanation of the particular device, one of skill in the art should have little trouble combining the features of certain of two such devices. Therefore, it should be understood that many of the elements are interchangeable, and the invention covers all permutations thereof.

Other objects, features, and advantages of the present invention will become apparent from a consideration of the following detailed description.

<FIG> illustrates a system <NUM> according to the present invention for delivering and deploying a prosthetic heart valve <NUM> or other medical device at a desired site in a patient. The system <NUM> includes a delivery catheter <NUM> (such as a balloon catheter) with prosthetic heart valve thereon being advanced through a delivery sheath <NUM>. Generally, sheath <NUM> is passed through an incision <NUM> in the patient and into a vessel <NUM>, such as the transfemoral blood vessel, such that the distal end <NUM> of the sheath <NUM> is inserted into the vessel <NUM>. Sheath <NUM> can include a hub <NUM> at a sheath proximal end <NUM>, with a hemostasis valve <NUM> contained within the hub <NUM> to prevent body fluid loss through the hub <NUM>. The delivery catheter <NUM> with prosthetic valve <NUM> thereon can be inserted into and advanced through the sheath <NUM> in order to advance and position the prosthetic device <NUM> at a desired treatment location in the patient. A sheath <NUM> according to an embodiment of the invention is depicted in <FIG>. The sheath <NUM> has a distal end <NUM> and proximal end <NUM>, with an elongated insertion body <NUM> and a hub <NUM>. A sheath lumen <NUM> passes through sheath <NUM> from the proximal end <NUM> to the distal end <NUM>.

The elongated insertion body <NUM> of the sheath <NUM> may be formed of a multilayer construction. In the particular embodiment depicted, a low-friction liner <NUM> (such as PTFE, FEP, PEBAX, etc., which may be compounded with lubricious materials, e.g., PEBAX with PROPEL) is provided which defines the walls of the sheath lumen <NUM>. The low-friction liner <NUM> facilitates the advancement of catheters and other devices through the sheath <NUM>. A layer of adhesive <NUM> may be provided, such as a tie-layer adhesive. A stent-like frame <NUM> may provide desired expansion/retraction characteristics. An elastomeric jacket <NUM> may enclose the sheath exterior. Note that with respect to the liner <NUM>, adhesive <NUM>, stent-like frame <NUM>, and jacket <NUM>, an insertion body <NUM> according to the invention may include all, none, or any combination of these elements. For example, a stent-like frame <NUM> may be used, but without the use of an inner liner <NUM>, adhesive <NUM>, and/or outer jacket/liner <NUM>. The entire insertion body <NUM> is configured so that it can locally expand in a radial fashion but still maintain a constant length of the overall insertion body length by causing a local surface length extension in the wall portion of the insertion body <NUM> to accommodate local distortions in the wall portion caused by the radial expansion. The insertion body <NUM> may preferably have a length <NUM> sufficient to permit the sheath distal end <NUM> to be extended to a desired location in the patient (e.g., a desired location in a blood vessel, such as in an ascending aorta where the access is made via a transfemoral approach) while the hub <NUM> remains outside of the patient.

Lengths <NUM> that are within the scope of the invention include <NUM>-<NUM> inches (<NUM>-<NUM>), <NUM>-<NUM> inches (<NUM> to <NUM>), etc. (for transfemoral approaches), although other lengths are also within the scope of the invention depending on the particular application. The insertion body <NUM> may have an initial outer diameter 46A small enough to easily fit through the access point, target blood vessel (e.g., the aorta), and any intervening body features (e.g., femoral artery). Initial (unexpanded) outer diameters that are within the scope of the invention include <NUM>-<NUM> for transfemoral procedures, although other lengths are also within the scope of the invention depending on the particular application. During expansion, the sheath's outer diameter may potentially expand by <NUM>% (or more), <NUM>% (or more), <NUM>% (or more), or even <NUM>% (or more).

<FIG> depict a sheath <NUM> according to the invention having an insertion body portion <NUM> which locally expands both radially and lengthwise during catheter advancement while maintaining the same overall insertion body length <NUM>. As shown in <FIG>, prior to advancement of a catheter and implant through the sheath <NUM>, the insertion body portion <NUM> of the sheath <NUM> has a diameter <NUM> and an overall length <NUM>. As a delivery catheter <NUM> with implant <NUM> (e.g., prosthetic heart valve) thereon is advanced through the sheath <NUM>, as depicted in <FIG>, the insertion body portion <NUM> is locally expanded in a radial fashion around the implant <NUM>. As the sheath/insertion body portion <NUM> is expanded, the compressive forces of the sheath/insertion body portion are reduced due to the negative Poisson ratio of the stent-like frame <NUM> during radial expansion. This reduction in compressive forces translates to less resistance from the sheath to advancement of the catheter/implant through the sheath.

The local radial expansion causes contour distortions along the exterior surface of the insertion body portion <NUM>, such as at the "shoulders" <NUM> created on the insertion body portion <NUM> at either side of the implant <NUM>. These surface distortions would result in an overall shortening of the sheath if they were not accompanied by local surface lengthening of the sheath exterior surface. As shown in <FIG>, the local surface lengthening provides a surface distance or contour length <NUM> (i.e., the distance along the surface of the insertion body portion) which is longer than the "linear" overall length <NUM> of the sheath insertion portion <NUM>. The result is that the overall length <NUM> of the sheath insertion portion <NUM> remains constant as the surface distance/contour length <NUM> of the sheath surface varies to accommodate the radial expansion of the sheath <NUM>. As depicted in <FIG>, after the catheter and implant are removed from the sheath <NUM>, the insertion portion <NUM> returns to its original diameter.

<FIG> show a stent-like frame <NUM> for use with a sheath <NUM> according to an embodiment of the invention. The stent-like frame <NUM> has a series of circumferentially-extending links <NUM> having circumferential link ends <NUM> secured to nodes <NUM> to form ring-like elements <NUM> extending radially around the stent-like frame, and longitudinally-extending links <NUM> having longitudinal link ends <NUM> secured to the nodes <NUM> such that the longitudinally-extending links <NUM> connect adjacent ring-like elements <NUM>. Each node is secured to a total of four (<NUM>) links, with two (<NUM>) circumferential link ends <NUM> secured to opposing sides of each node <NUM> and two (<NUM>) longitudinal link ends <NUM> secured to opposing sides of each node <NUM>. The specific structure of nodes <NUM> and links <NUM>, <NUM> can result in a frame <NUM> in which local radial expansion inherently causes a corresponding local surface length extension, but where the structure causes the stent-like frame <NUM> to return to its original surface length when it returns to its original diameter. The reverse may also be true, where the specific structure of nodes <NUM> and links <NUM>, <NUM> can result in a frame <NUM> in which local surface lengthening inherently causes a corresponding local radial expansion, but where the structure causes the stent-like frame <NUM> to return to its original diameter when it returns to its original surface length.

The embodiment of <FIG> is just one example of a specific geometry in accordance with the invention. Note that other stent-like frame configurations which accomplish the desired negative Poisson ratio are also within the scope of the invention. Also, stent-like frames of the invention may be formed from various materials. For example, the frame <NUM> may be formed of a memory material such as nitinol that permits the sheath to locally expand/lengthen responsive to the outward pressure caused by the catheter and implant being advanced though the sheath, and then returns to its original diameter/local surface length once the catheter/implant have cleared the sheath.

<FIG> depict an insertion portion <NUM> of a sheath <NUM> which includes a stent-like frame <NUM> such as that depicted in <FIG>, with the other layers (e.g., inner liner <NUM>, elastomeric jacket <NUM>, etc.) in the particular embodiment depicted being relatively transparent so that the frame <NUM> can be seen. As a delivery catheter <NUM> and implant <NUM> are advanced through the sheath <NUM>, as shown in <FIG>, the insertion portion <NUM> and stent-like frame <NUM> locally deform, including radially expansion and lengthening locally, to accommodate the catheter <NUM> and implant <NUM>, while maintaining the overall sheath length.

The operational characteristics of a general node-and-link design of the invention involve specific interactions between respective links and nodes. As shown in <FIG>, prior to local expansion and lengthening the circumferential links <NUM> and longitudinal links <NUM> have pronounced curves. If radially outward forces or other forces cause radial expansion, as the radial expansion occurs, the circumferential links <NUM> are stretched into a less curved/more straight configuration. As the circumferential links <NUM> are stretched and straightened, the circumferential link ends <NUM> transfer force against the nodes <NUM> and cause a rotational moment on the nodes <NUM>. The rotational moment causes the nodes <NUM> to rotate through an angle <NUM>, which in turn causes the rotational moment to be transferred through the node <NUM> and into the longitudinal link ends <NUM> to rotate same, thus causing the longitudinal links <NUM> to at least partially straighten. The at least partial straightening of the longitudinal links <NUM> causes local surface lengthening of the stent structure, as shown in <FIG>. Similarly, if longitudinal tensile forces or other lengthening-inducing forces cause local surface lengthening, as the surface lengthening occurs the longitudinal links <NUM> are stretched into a less curved/more straight configuration. As the longitudinal links <NUM> are stretched and straightened, the longitudinal links ends <NUM> transfer force against the nodes <NUM> and cause a rotational moment on the nodes <NUM>. The rotational moment causes the nodes <NUM> to rotate through an angle <NUM>, which in turn causes the rotational moment to be transferred through the node <NUM> and into the circumferential link ends <NUM> to rotate same, thus causing the circumferential links <NUM> to at least partially straighten. The at least partial straightening of the circumferential links <NUM> causes local radial expansion of the stent structure, as shown in <FIG>.

Note that the angle <NUM> through which the node is rotated may be relatively large. For example, the angle could be <NUM> to <NUM> degrees, <NUM> to <NUM> degrees, <NUM> degrees (or more), <NUM> degrees (or more), <NUM> degrees (or more), or even <NUM> degrees (or more).

A specific stent-like frame portion <NUM> as depicted in <FIG> includes longitudinal links <NUM> having thinner center portions <NUM> and wider end portions <NUM> where the link is secured to a node <NUM>. Similarly, circumferential links <NUM> having thinner center portions <NUM> and wider end portions <NUM> where the link is secured to a node <NUM>. The combination of thinner center portions and wider end portions makes it easier for the links <NUM>, <NUM> to bend into straighter forms in their center portions <NUM>, <NUM>, while making it more difficult for the links <NUM>, <NUM> to bend at or adjacent the end portions <NUM>, <NUM> at the points the links <NUM>, <NUM> are secured to the nodes <NUM>. The result is that rotational moments are more easily transferred into and out of the nodes <NUM> via the links <NUM>, <NUM> as the links are straightened.

Nodes <NUM> according to the invention may include internal cutouts, such as the circular cutouts <NUM> depicted in <FIG>. The circular cutouts <NUM> reduce the mass of the node <NUM> and also of the overall stent frame. The reduction in node mass reduces the rotational moment of inertia of each node <NUM>, making it easier for each node <NUM> to rotate and to transfer rotational moments from circumferential links <NUM> to longitudinal links <NUM> and vice-versa.

The stent-like frame <NUM> is depicted in <FIG> in its pre-expansion, pre-lengthened form. Note that the stent-like frame may be may formed in various ways, such as by being laser cut or otherwise cut from a tube (such as a metal tube, e.g., nitinol tube). As a portion of the stent-like frame is expanded, as depicted in <FIG>, the straightening out of the circumferential links <NUM> cause the nodes <NUM> to rotate and thereby cause the longitudinal links <NUM> to bend to a more straightened configuration. Similarly, as a portion of the stent-like frame is lengthened, as depicted in <FIG>, the straightening out of the longitudinal links <NUM> cause the nodes <NUM> to rotate and thereby cause the circumferential links <NUM> to bend to a more straightened configuration. As depicted in <FIG>, when fully expanded the nodes <NUM> are rotated even further, and the circumferential links <NUM> and longitudinal links <NUM> are almost completely straight - thereby resulting in local radial expansion combined with proportional local surface lengthening.

Various approaches for treatments, including advancing the catheters into position via the sheath, are possible. One preferred approach (e.g., when treating an aortic valve) is a transcatheter approach via a femoral artery. The method may include deployment of a transcatheter aortic valve replacement (TAVR), which may be performed using the same transcatheter approach.

In one example of a procedure to deploy a prosthetic aortic heart valve, which does not belong to the invention, femoral artery access is obtained via the access sheath of the invention which is dimensioned for use in TAVR procedures. An incision is created in the patient, leading to an internal blood vessel such as a femoral artery. The distal end of the access sheath is advanced through the incision and femoral artery and into a desired position within the aorta, with the hub positioned just outside the patient adjacent the incision/access site. A guide wire is advanced from the femoral access site thru the aortic arch and into the patient's left ventricle. The steerable shaft of the imaging catheter and/or delivery catheter can be advanced over the guide wire, such as via standard over-the-wire techniques, to advance the distal end of the device to the target location. For example, the device may have a guide wire lumen. Echo and/or fluoroscopic and/or other visualization techniques may be used as well as the electrophysiological 3D mapping techniques. The treatment and/or implant deployment can occur, such as by deploying the prosthetic heart valve at the target location. Once the proper deployment is confirmed, the catheter can be removed from the patient, the guidewire can be removed from the patient, the sheath can be removed from the patient, and the incision(s) closed, such as via sutures.

Note that each element of each embodiment and its respective elements disclosed herein can be used with any other embodiment and its respective elements disclosed herein.

All dimensions listed are by way of example, and devices according to the invention may have dimensions outside those specific values and ranges. The dimensions and shape of the device and its elements depend on the particular application.

Unless otherwise noted, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs. In order to facilitate review of the various embodiments of the disclosure, the following explanation of terms is provided:
The singular terms "a", "an", and "the" include plural referents unless context clearly indicates otherwise. The term "or" refers to a single element of stated alternative elements or a combination of two or more elements, unless context clearly indicates otherwise.

The term "includes" means "comprises. " For example, a device that includes or comprises A and B contains A and B, but may optionally contain C or other components other than A and B. Moreover, a device that includes or comprises A or B may contain A or B or A and B, and optionally one or more other components, such as C.

The term "subject" refers to both human and other animal subjects. In certain embodiments, the subject is a human or other mammal, such as a primate, cat, dog, cow, horse, rodent, sheep, goat, or pig. In a particular example, the subject is a human patient.

It is noted that various individual features of the inventive systems may be described only in one exemplary embodiment herein. The particular choice for description herein with regard to a single exemplary embodiment is not to be taken as a limitation that the particular feature is only applicable to the embodiment in which it is described. All features described herein are equally applicable to, additive, or interchangeable with any or all of the other exemplary embodiments described herein, and in any combination or grouping or arrangement. In particular, use of a single reference numeral herein to illustrate, define, or describe a particular feature does not mean that the feature cannot be associated or equated to another feature in another drawing figure or description. Further, where two or more reference numerals are used in the figures or in the drawings, this should not be construed as being limited to only those embodiments or features, they are equally applicable to similar features or not a reference numeral is used or another reference numeral is omitted.

Claim 1:
A delivery sheath (<NUM>), comprising:
a tubular insertion body (<NUM>) comprising a tubular stent-like frame (<NUM>) extending lengthwise along the tubular insertion body, wherein the stent-like frame (<NUM>) is adapted to locally radially expand in a section thereof proportional to local lengthwise surface lengthening of the section thereof; and
a hub (<NUM>).