阅读说明：本技术 脉管闭塞的脉管内治疗以及相关的装置、系统和方法 (Intravascular treatment of vascular occlusions and related devices, systems, and methods ) 是由 P·马尔尚 J·C·瑟瑞斯 J·F·卢瓦 布莱恩·J.·考克斯 理查德·奎克 于 2016-10-24 设计创作，主要内容包括：本文中公开了从患者体内的血管移除血栓的系统和方法。该方法可包括：提供血栓提取装置,该血栓提取装置包括近侧自扩展构件、远侧大致圆柱形部分和内轴构件,近侧自扩展构件由整体有孔结构形成,远侧大致圆柱形部分由网络状丝网状结构形成,内轴构件连接至网络状丝网状结构的远端；使约束血栓提取装置的导管前进通过脉管血栓,展开血栓提取装置；缩回血栓提取装置,以从血管壁分离血栓的一部分,并将血栓的该部分捕获在网络状丝网状结构中；以及从体内撤回血栓提取装置,以从患者体内移除血栓。(Disclosed herein are systems and methods for removing thrombus from a blood vessel in a patient. The method can comprise the following steps: providing a thrombus extraction device comprising a proximal self-expanding member formed of a unitary foraminous structure, a distal generally cylindrical portion formed of a mesh-like wire-like structure, and an inner shaft member connected to a distal end of the mesh-like wire-like structure; advancing a catheter of the constrained thrombus extraction device through the vascular thrombus, deploying the thrombus extraction device; retracting the thrombus extraction device to separate a portion of the thrombus from the vessel wall and capture the portion of the thrombus in the reticulated mesh-like structure; and withdrawing the thrombus extraction device from the body to remove the thrombus from the patient.)

1. A thrombus extraction device for removing a vascular thrombus from a patient's blood vessel, the thrombus extraction device comprising:

a catheter having a proximal end and a distal end, an outer shaft defining a first lumen, an intermediate shaft defining a second lumen, wherein the intermediate shaft is coaxial with the first lumen, and an inner shaft coaxial with the second lumen;

a proximal self-expanding coring element having a proximal end and a distal end and configured to core and separate a portion of a vascular thrombus from a blood vessel, wherein the proximal end of the self-expanding coring element is coupled to the distal end of the intermediate shaft; and

a distal expandable cylindrical portion formed from a wire mesh structure having a proximal end and a distal end and configured to capture a vascular thrombus portion, wherein the proximal end of the mesh structure is attached to the distal end of the self-expanding coring element, and wherein the distal end of the mesh structure is coupled to the distal end of the inner shaft, wherein expansion of the mesh structure and the self-expanding coring element varies based on the position of the intermediate shaft of the catheter relative to the inner shaft.

Background

Thrombus is a term for a blood clot that occurs inside a blood vessel, and venous thrombus is a blood clot (thrombus) that forms within a vein. A common type of venous thrombosis is Deep Vein Thrombosis (DVT). DVT is the formation of blood clots (thrombi) within deep veins, mainly in the legs. Non-specific markers may include pain, swelling, redness, heat, and congestion in the superficial veins.

If the thrombus breaks off (becomes an embolus) and flows to the lungs, it may become a life-threatening Pulmonary Embolism (PE), a blood clot in the lungs. In addition to loss of life that may be caused by PE, DVT can cause significant health problems, such as post-thrombotic syndrome, which can cause chronic swelling, pressure, pain, and ulceration due to valve and vessel damage. Furthermore, DVT can lead to significant healthcare costs, either directly or indirectly through associated complication treatment and patient inoperability.

Three processes are believed to lead to venous thrombosis. These processes are reduced blood flow rate (venous stasis), increased propensity for clotting (hypercoagulable state), and changes to the vessel wall. The formation of DVT generally begins within the valves of the calf vein, where blood is relatively hypoxic, activating specific biochemical pathways. Several medical conditions increase the risk of DVT, including diabetes, cancer, trauma, and antiphospholipid syndrome. Other risk factors include greater age, surgery, immobility (e.g., bed rest, orthodontics, sitting on long flights), combination with oral contraceptives, pregnancy, late stage of birth, and genetic factors. The incidence of DVT increases dramatically from children to the elderly, with approximately 1 of 1000 developing into DVT per year in adults.

While existing devices and methods exist for preventing and/or treating DVT, there are a number of unresolved drawbacks, such as a high incidence of DVT recurrence, the use of devices that are not designed to remove large clot volumes, and/or complex treatments involving multiple treatment devices and/or medications. Thus, new devices, systems, and methods for treating thrombi, particularly DVT, are desired.

Disclosure of Invention

Aspects of the present application relate to systems and methods for thrombus extraction, particularly for extracting thrombus from peripheral vasculature. The thrombus extraction device of the present invention is designed to remove large clot volumes, including mature and organized clots, wherein the need for drugs such as thrombolytic agents is reduced. This reduces bleeding risk, post-treatment recovery time, and reduces healthcare procedure costs. The thrombus extraction device may include a self-expanding coring portion connected to a woven mesh to effectively core and separate a large volume of thrombus from a large blood vessel, such as in the venous or arterial systems, while capturing the separated thrombus in the woven mesh.

In some embodiments, the thrombus may be extracted by using a thrombectomy system including an introducer sheath having a self-expanding funnel and a thrombus extraction catheter including a thrombus extraction device. The thrombus extraction device can include a self-expanding coring portion, which can be a stent portion, and a self-expanding cylindrical portion, which can be a woven wire mesh. A self-expanding cylindrical portion may be formed on the distal end of the self-expanding coring portion, thereby forming an integral thrombus extraction device. In some embodiments, the coring element may have a sharp cutting edge to further enhance its ability to detach thrombus from the vessel wall.

One aspect of the present application relates to a method of treating deep vein thrombosis in a peripheral vasculature of a patient. The method includes providing a thrombus extraction device comprising a proximal self-expanding coring portion, which may be a stent and formed of an integral foraminous structure, and a distal expandable cylindrical portion, which may be tubular and formed of a braided wire mesh structure. In some embodiments, the mesh structure is integrally formed with the foraminous structure such that a proximal end of the mesh structure is attached to a distal end of the foraminous structure. The method includes advancing a catheter constraining a thrombus extraction device through a vascular thrombus in a venous vessel. In some embodiments, the intermediate shaft slidably extends through the catheter and has a distal end coupled to the proximal end of the apertured structure. In some embodiments, the inner shaft slidably extends through the intermediate shaft and has a distal end coupled to the distal end of the mesh structure. The method includes deploying the thrombus extraction device from the catheter from a constrained configuration to an expanded configuration. In some embodiments, upon full expansion, the thrombus extraction device engages at least a vein vessel wall distally past a portion of the vessel thrombus. The method includes proximally retracting the thrombus extraction device such that the coring portion cores from the vein vessel wall and separates a portion of the vessel thrombus while the mesh structure captures the portion of the vessel thrombus. The method includes withdrawing the thrombus extraction device from the patient to remove a vascular thrombus portion from the venous vessel.

In some embodiments, advancing the catheter includes inserting the catheter into the venous vessel until a radiopaque distal tip of the catheter passes distally through the vascular thrombus portion. In some embodiments, deploying the thrombus extraction device from the catheter from the constrained configuration to the expanded configuration comprises advancing the intermediate shaft distally until the coring portion of the thrombus extraction device exceeds the distal end of the catheter.

In some embodiments, deploying the thrombus extraction device further comprises: locking the intermediate shaft relative to the catheter; retracting the inner shaft relative to the catheter and the intermediate shaft until stop features fixed on the inner shaft engage corresponding features on a stent section slidably connected to the inner shaft for full expansion of the thrombus extraction device, the stent section maintaining sufficient radial force on the vein vessel wall to core and separate the vessel thrombus section upon full expansion; and dynamically coupling the inner shaft relative to the intermediate shaft. In some embodiments, the coring angle of the coring portion is between 30 degrees and 45 degrees when the thrombus extraction device is in full extension. In some embodiments, deploying the thrombus extraction device further comprises determining a position of the thrombus extraction device relative to the catheter by imaging of a first radiopaque marker located on the catheter and a second radiopaque marker located on at least one of the intermediate shaft, the inner shaft, the stent portion, or the mesh structure.

In some embodiments, the vascular thrombus portion is captured in the mesh structure by accessing the expandable tubular portion and/or the cylindrical portion at least through an opening or hole located at the proximal end of the self-expanding stent portion. In some embodiments, the method includes inserting a catheter into a venous blood vessel through an access site, the access site being a popliteal access site, a femoral access site, or an intracarvical access site. In some embodiments, the blood vessel is at least 5 millimeters in diameter and is at least one of a femoral vein, an iliac vein, a popliteal vein, a posterior tibial vein, an anterior tibial vein, or a peroneal vein.

In some embodiments, the method further comprises: percutaneously accessing a patient's venous blood vessel by introducing a sheath through an access site into the patient's venous blood vessel; advancing the distal end of the introducer sheath to a location proximal to the vascular thrombus; deploying a self-expanding funnel on a distal end of the introducer sheath; and inserting the catheter through the lumen of the introducer sheath such that the distal tip of the catheter passes distally through the thrombotic portion of the vessel. In some embodiments, deploying the self-expanding funnel comprises: advancing an obturator having a capture sheath feature on a distal end thereof to expose the self-expanding funnel from a constrained configuration within the capture sheath feature to a deployed configuration without the capture sheath feature; and removing the obturator from the introducer sheath by retracting the obturator through or external to the deployed self-expanding funnel and through or external to the lumen of the introducer sheath. In some embodiments, withdrawing the thrombus extraction device from the patient comprises: retracting the thrombus extraction device relative to the introducer sheath until the opening of the self-expanding stent portion is within the self-expanding funnel; collapsing the stent portion and the mesh structure, thereby compressing the vascular thrombus portion therein; retracting the stent portion and the mesh structure into the introducer sheath; and removing the thrombus extraction device from the introducer sheath.

In some embodiments, the method further comprises extruding at least some of the vascular thrombus portion through an aperture located at a distal portion of the expandable tubular portion and/or the cylindrical portion and capturing a portion of the at least some of the vascular thrombus portion in a self-expanding funnel or further compressing at least one of the vascular thrombus portion through a mesh of the self-expanding funnel. In some embodiments, the method further comprises withdrawing at least one piece of the vessel thrombus portion remaining within the self-expanding funnel from the venous vessel and through a withdrawal port connected to the proximal end of the introducer sheath.

In some embodiments, the method further comprises verifying by fluoroscopy that the opening of the self-expanding stent portion is within the self-expanding funnel prior to collapsing the stent portion and the mesh structure. In some embodiments, collapsing the stent portion and the mesh structure comprises: disconnecting the inner shaft and the intermediate shaft; and advancing the inner shaft distally relative to the middle shaft. In some embodiments, the method includes withdrawing the thrombolytic agent from the venous vessel or injecting the thrombolytic agent into the venous vessel before, during, or after thrombus extraction.

One aspect of the present application relates to a method of treating deep vein thrombosis in a peripheral vasculature of a patient. The method comprises the following steps: percutaneously accessing a patient's venous vasculature by introducing a sheath through the popliteal access site into the patient's venous vasculature; and inserting a catheter constraining a thrombus extraction device through the lumen of the introducer sheath such that a distal tip of the catheter passes distally through a portion of the vascular thrombus in the venous vessel, the thrombus extraction device comprising a proximal self-expanding stent portion formed of a unitary porous structure and a distal expandable tubular portion and/or cylindrical portion formed of a braided wire mesh structure. In some embodiments, the proximal end of the mesh structure is attached to the distal end of the foraminous structure. The method includes deploying the thrombus extraction device from the catheter from the constrained configuration to the expanded configuration by advancing a middle shaft distally until a stent portion of the thrombus extraction device exceeds a distal end of the catheter, the middle shaft slidably extending through the catheter and having a distal end coupled to a proximal end of the foraminous structure. The method includes proximally retracting the thrombus extraction device such that the stent portion cores from the venous blood vessel wall and separates a portion of the vascular thrombus while the mesh structure captures the portion of the vascular thrombus. The method includes withdrawing the thrombus extraction device from the patient.

In some embodiments, deploying the thrombus extraction device further comprises retracting the inner shaft relative to the catheter and the intermediate shaft until stop features on the inner shaft engage corresponding features on the stent portion for full expansion of the thrombus extraction device. In some embodiments, the stent portion maintains sufficient radial force on the vein wall to core and separate the thrombus portion of the vessel when fully expanded, and in some embodiments, an inner shaft slidably extends through the intermediate shaft and has its distal end coupled to the distal end of the mesh structure. In some embodiments, the method includes deploying a self-expanding funnel on a distal end of an introducer sheath proximal to the vascular thrombus. In some embodiments, deploying the self-expanding funnel comprises: advancing an obturator having a capture sheath feature on a distal end thereof to expose the self-expanding funnel from a constrained configuration within the capture sheath feature to a deployed configuration without the capture sheath feature; and removing the obturator from the introducer sheath by retracting the obturator through or external to the deployed self-expanding funnel and through or external to the lumen of the introducer sheath.

One aspect of the present application relates to a method of removing a thrombus from a blood vessel, which may be an artery or a vein, in a patient. The method comprises the following steps: providing a thrombus extraction device comprising a proximal self-expanding member formed of an integral foraminous structure, a distal generally cylindrical portion formed of and attached to a reticulated mesh-like structure, and an inner shaft member connected to a distal end of the reticulated mesh-like structure; the method includes advancing a catheter constraining the thrombus extraction device through the vascular thrombus, and deploying the thrombus extraction device by advancing the thrombus extraction device beyond a distal end of the catheter or retracting the catheter relative to the thrombus extraction device, thereby exposing the thrombus extraction device distally past a portion of the thrombus and allowing the thrombus extraction device to expand to engage the vessel wall. The method comprises the following steps: retracting the thrombus extraction device to separate a portion of the thrombus from the vessel wall and capture the portion of the thrombus in the reticulated mesh-like structure; and withdrawing the thrombus extraction device from the body to remove the thrombus from the patient.

In some embodiments, advancing the catheter includes inserting the catheter into the blood vessel until a radiopaque distal tip of the catheter passes distally past the thrombus portion. In some embodiments, the mesh-like wire mesh structure is integrally formed with the foraminous structure such that a proximal end of the mesh-like wire mesh structure is attached to a distal end of the foraminous structure. In some embodiments, the self-expanding member of the thrombus extraction device comprises a stent portion, such that retracting the thrombus extraction device further comprises coring the thrombus portion from the vessel wall with the stent portion. In some embodiments, the thrombus portion is captured by the mesh-like wire mesh structure by accessing the mesh-like wire mesh structure through at least one hole or opening located at the proximal end of the stent portion.

In some embodiments, the thrombus extraction device is advanced beyond the distal end of the catheter by advancing an intermediate shaft distally through the catheter, the intermediate shaft slidably extending through the catheter, and the distal end of the intermediate shaft coupled to the proximal end of the foraminous structure. In some embodiments, the method comprises: retracting the inner shaft member relative to the catheter and the intermediate shaft until stop features fixed on the inner shaft member engage corresponding features on the apertured structure, and locking the inner shaft member relative to the intermediate shaft for full expansion of the thrombus extraction device. In some embodiments, the inner shaft member can be dynamically locked relative to the intermediate shaft.

In some embodiments, the method comprises: before withdrawing the thrombus extraction device from the body, the thrombus extraction device is collapsed, thereby compressing the thrombus portion therein. In some embodiments, collapsing includes unlocking the inner shaft member and the intermediate shaft, and advancing the inner shaft member distally relative to the intermediate shaft.

In some embodiments, the method comprises: monitoring deployment of the thrombus extraction device by fluoroscopy, and stopping advancement of the thrombus extraction device beyond the distal end of the catheter or retraction of the catheter relative to the thrombus extraction device based on a position of a first radiopaque marker located on the catheter relative to a second radiopaque marker located on the thrombus extraction device. In some embodiments, the thrombus is located in the peripheral vasculature of the patient, and the blood vessel is at least 5 millimeters in diameter and includes at least one of a femoral vein, an iliac vein, a popliteal vein, a posterior tibial vein, an anterior tibial vein, or a peroneal vein.

In some embodiments, the method comprises: the vessel may be a venous vessel of the patient by introducing a sheath percutaneously through the popliteal access site, and inserting a catheter through a lumen of the introducing sheath and into the venous vessel of the patient. In some embodiments, the method comprises: the venous vessel of the patient is percutaneously accessed by introducing a sheath through the femoral access site and inserting a catheter through a lumen of the introducing sheath and into the venous vessel of the patient, the thrombus extraction device extending within the popliteal sheath and the thrombus extraction device being retracted in the direction of blood flow. In some embodiments, the method comprises: percutaneously accessing a patient's venous vasculature through an access site in the neck by introducing a sheath and inserting a catheter through a lumen of the introducing sheath and into the patient's venous vasculature, the thrombus extraction device extending within a popliteal sheath extending from within the patient, and the thrombus extraction device being retracted in a direction of blood flow. In some embodiments, the method comprises: the thrombolytic agent is withdrawn from the blood vessel or injected into the blood vessel before, during or after thrombus extraction.

One aspect of the present application relates to a thrombus extraction device for removing a vascular thrombus from a patient's blood vessel. This thrombus extraction element includes: a catheter having a proximal end and a distal end, an outer shaft defining a first lumen, an intermediate shaft defining a second lumen, the intermediate shaft coaxial with the first lumen, and an inner shaft coaxial with the second lumen; a proximal self-expanding coring element formed from an integral foraminous structure having a proximal end and a distal end and configured to core and separate a portion of a vascular thrombus from a blood vessel, the proximal end of the foraminous structure coupled to the distal end of the intermediate shaft; and a distal expandable cylindrical portion formed from a braided wire mesh structure having a proximal end and a distal end and configured to capture the vascular thrombus portion, the proximal end of the mesh structure being attached to the distal end of the foraminous structure, and the distal end of the mesh structure being coupled to the distal end of the inner shaft. In some embodiments, the full expansion of the mesh and fenestration varies based on the position of the catheter's middle shaft relative to the inner shaft.

In some embodiments, the coring element comprises a stent. In some embodiments, the stent includes a ring feature slidably coupled to the inner shaft and/or one or several struts of the stent, and the inner shaft includes a stop feature fixed to the inner shaft, the stop feature configured to engage with the ring feature when the mesh structure and stent are in full expansion.

In some embodiments, the apparatus comprises: a locking mechanism that can fix the inner shaft relative to the intermediate shaft when the mesh structure and the stent are in a fully expanded state. In some embodiments, the locking mechanism may maintain a desired radial force on the vessel wall when the stent is compressed. In some embodiments, the locking mechanism movably fixes the inner shaft relative to the intermediate shaft by a spring.

In some embodiments, the proximal end of the mesh structure is integrally formed with the distal end of the foraminous structure to create a unitary structure. In some embodiments, the coring element and the mesh structure may be received within the outer shaft. In some embodiments, the coring element and the mesh structure are in the constrained configuration when received within the outer shaft and the coring element and the mesh structure are in the expanded configuration when the outer shaft is not constrained.

In some embodiments, the mesh structure includes a plurality of radial ribs or grooves spaced longitudinally between the proximal and distal ends of the mesh structure. In some embodiments, the mesh structure has a first pore size at the proximal portion and a second pore size at the distal portion, the first pore size being different from the second pore size. In some embodiments, the second pore size is larger than the first pore size.

In some embodiments, the proximal end of the foraminous structure is coupled to the distal end of the intermediate shaft via a plurality of struts extending at a coring angle relative to a longitudinal axis of the thrombus extraction device. In some embodiments, the coring angle ranges between 30 degrees and 45 degrees. In some embodiments, such as in the collapsed state, the coring element has a length ranging between 25 millimeters and 100 millimeters and the mesh structure has a length ranging between 100 millimeters and 500 millimeters. In some embodiments, the diameter of the coring element ranges between 8mm and 25mm when fully expanded, and the diameter of the mesh structure ranges between 8mm and 25mm when fully expanded.

In some embodiments, the foraminous structure includes a plurality of interconnected struts. In some embodiments, the proximal end of the foraminous structure has fewer struts than the distal end of the foraminous structure, thereby facilitating maintaining the coring orientation and facilitating collapse of the coring element when the blood vessel is distorted. In some embodiments, the foraminous structure includes a plurality of interconnected struts that define an opening at a proximal end of the foraminous structure. In some embodiments, at least some of the plurality of interconnected struts defining the opening therein comprises a sharp proximal edge.

In some embodiments, the apparatus comprises: a first radiopaque marker on the outer shaft and a second radiopaque marker on the distal end of the inner shaft. In some embodiments, the apparatus comprises: a locking mechanism that can fix the relative position of the outer shaft with respect to the intermediate shaft. In some embodiments, the apparatus comprises: a handle including a plunger that controls and selectively fixes the relative position of the inner shaft with respect to the intermediate shaft.

One aspect of the present application relates to an introducer sheath for accessing and removing thrombus within a patient's vessel. The introducer sheath includes: an elongate sheath comprising a proximal end, a distal end, and a lumen extending therebetween; a self-expanding funnel affixed to the distal end of the elongate sheath; and an obturator including an elongate shaft having a capture sheath positioned proximal to a distal end of the obturator, the capture sheath being operable to retain the self-expanding funnel in a constrained configuration, and the obturator being configured to be received within a lumen of the elongate sheath.

In some embodiments, the introducer sheath includes a sealing hub at the proximal end of the elongate sheath. In some embodiments, the seal hub includes an aspirate port. In some embodiments, the diameter of the self-expanding funnel is less than or equal to the diameter of the elongate sheath when the self-expanding funnel is in the constrained configuration. In some embodiments, the obturator includes an atraumatic tip positioned at a distal end of the obturator, the atraumatic tip being radiopaque. In some embodiments, the obturator includes a connection fitting configured to sealingly connect with the distal end of the elongate sheath. In some embodiments, the self-expanding funnel is permeable to blood. In some embodiments, the self-expanding funnel comprises a taper comprised of at least one of a battlement-shaped nitinol braid, a nitinol braided stent, a laser cut nitinol, a laser cut polymer tube, an injection molded polymer structure, or an inflatable balloon.

One aspect of the present application relates to a method for accessing and removing thrombus from a patient's venous vasculature. The method comprises the following steps: providing an introducer sheath comprising an elongate sheath defining a lumen, a self-expanding funnel affixed to a distal end of the elongate sheath, and an elongate obturator extending through the lumen and retaining the self-expanding funnel in a restraining configuration within a capture sheath of the obturator; percutaneously accessing a patient's venous vasculature through an access site, including a popliteal access site, a femoral access site, or an intracarvical access site, with an introducer sheath; advancing the distal end of the introducer sheath to a location proximal to the thrombus; deploying the self-expanding funnel from a constrained configuration within the capture sheath to an expanded configuration without the capture sheath; capturing the thrombus in a self-expanding funnel; and withdrawing the captured material through the lumen of the elongate sheath.

In some embodiments, deploying the self-expanding funnel comprises advancing the obturator distally relative to the elongate sheath to expose the self-expanding funnel from the constrained configuration to the expanded configuration, and removing the obturator from the introducer sheath by proximally retracting the obturator through the deployed self-expanding funnel and through the lumen of the elongate sheath. In some embodiments, deploying the self-expanding funnel comprises proximally retracting the sheath over the obturator to expose the self-expanding funnel from the constrained configuration to the expanded configuration, and removing the obturator from the introducer sheath by proximally retracting the obturator through or external to the deployed self-expanding funnel and through or external to the lumen of the elongate sheath.

In some embodiments, the method comprises: inserting a catheter constraining the thrombus extraction device through the lumen of the elongate sheath such that the distal tip of the catheter passes distally through the thrombus portion of the vessel, deploying the thrombus extraction device from the catheter, and retracting the thrombus extraction device proximally relative to the introducer sheath until the opening of the thrombus extraction device is within the self-expanding funnel. In some embodiments, the method comprises: a portion of the thrombus captured by the thrombus extraction device is extruded through the thrombus extraction device. In some embodiments, the thrombus captured by the self-expanding funnel comprises an extruded portion of the thrombus captured by the thrombus extraction device.

One aspect of the present application relates to a thrombectomy system for removing vascular thrombus from a patient's blood vessel. The thrombectomy system includes a thrombus extraction catheter including a thrombus extraction device. This thrombus extraction element includes: a proximal self-expanding coring element formed from an integral foraminous structure; and a distal expandable cylindrical portion formed from a braided wire mesh structure having a proximal end attached to the distal end of the foraminous structure. The thrombectomy system includes: a catheter including a lumen constraining the thrombus extraction device, a middle shaft connected to the proximal end of the self-expanding coring element, and an inner shaft connected to the distal end of the expandable cylindrical portion and slidably displaceable relative to the middle shaft to control expansion of the expandable cylindrical portion. The thrombectomy system includes: an introducer sheath, the introducer sheath comprising: an elongate sheath defining an insertion lumen; a self-expanding funnel affixed to the distal end of the elongate sheath; and an elongated obturator including a sheath capture feature configured to retain the self-expanding funnel in a constrained configuration.

In some embodiments, the obturator is configured to be received within the lumen of the elongate sheath and includes a connection fitting configured to sealingly connect with the distal end of the elongate sheath. In some embodiments, the length of the self-expanding funnel is at least equal to the length of the self-expanding coring element. In some embodiments, the introducer sheath includes a self-sealing bore at the proximal end of the introducer sheath.

In some embodiments, the thrombectomy system includes a hole dilator sized to be received within the self-sealing hole, and in the sealing configuration, an inner diameter of the hole dilator is greater than a diameter of the self-sealing hole. In some embodiments, the introducer sheath includes an aspirate port at the proximal end of the insertion sheath that is selectively fluidly connected to the insertion lumen via an aspirate valve.

In some embodiments, the insertion lumen is sized to slidably receive a thrombus extraction catheter. In some embodiments, the expandable cylindrical portion is formed on a self-expanding coring element to form an integral thrombus extraction device.

One aspect of the present application relates to a method of manufacturing a unitary thrombus extraction device comprising a proximal foraminous structure having a plurality of struts, and a distal reticulated mesh-like wire structure formed on a distal end of the foraminous structure. The method comprises the following steps: identifying a plurality of shaped points formed by ones of the plurality of struts in the unitary foraminous structure; threading a unique pair of wires comprising a first wire and a second wire superimposed on the first wire through each forming point; and weaving the net-like wire-mesh structure from a single pair of wires such that one of the first and second wires does not form a loop around the forming point through which the first and second wires are threaded, and such that the other of the first and second wires forms a loop around the forming point through which the first and second wires are threaded.

In some embodiments, the reticulated wire mesh structure is woven from a single pair of wires such that the first wire does not form a loop around a forming point through which the first wire is threaded and such that the second wire forms a loop around a forming point through which the second wire is threaded. In some embodiments, each shaping point comprises an apex strut. In some embodiments, the foraminous structure includes 12 apex struts. In some embodiments, the reticulated wire mesh comprises 48 wires. In some embodiments, the reticulated wire mesh structure is hand-woven. In some embodiments, the mesh-like wire mesh structure is automatically woven.

Further areas of applicability of the present invention will become apparent from the detailed description provided hereinafter. It should be understood that the detailed description and specific examples, while indicating various embodiments, are intended for purposes of illustration only and are not intended to necessarily limit the scope of the disclosure.

Drawings

FIG. 1 is a perspective view of one embodiment of a thrombectomy system for removing thrombus from a blood vessel of a patient.

FIG. 2 is a side view of an embodiment of a thrombus extraction catheter with a thrombus extraction device in a deployed configuration.

FIG. 3 is a side view of an embodiment of a thrombus extraction catheter with the thrombus extraction device in a fully expanded configuration.

FIG. 4 is a side view of one embodiment of a self-expanding coring element.

FIG. 5 is a top view of one embodiment of a self-expanding coring element.

FIG. 6 is an elevation view of one embodiment of a self-expanding coring element.

FIG. 7 is a side view of one embodiment of a thrombus extraction device in a fully expanded configuration.

FIG. 8 is a view of one embodiment of a spherical thrombus captured in the thrombus extraction device.

FIG. 9 is a side view of one embodiment of a woven wire mesh structure having multiple pore sizes.

FIG. 10 is a side view of one embodiment of a thrombus extraction device comprising a plurality of circumferential grooves.

Fig. 11 is a schematic view of one embodiment of a weave and/or weave pattern for forming a cylindrical portion and/or a woven wire mesh-like structure on a self-expanding coring element.

Fig. 12 is a cross-sectional view of an embodiment of the handle with the plunger in a first position.

Fig. 13 is a cross-sectional view of an embodiment of the handle with the plunger in a second position.

FIG. 14 is a close-up cross-sectional view of a portion of the handle with the plunger in a second position.

FIG. 15 is a side view of one embodiment of an obturator having a constant size elongate shaft.

FIG. 16 is a side view of one embodiment of an obturator having a variable sized elongate shaft.

FIG. 17 is a detailed cross-sectional view of one embodiment of a capture sheath of the obturator.

FIG. 18 is a side view of one embodiment of an introducer sheath in a non-deployed configuration.

FIG. 19 is a side view of one embodiment of an introducer sheath in a partially deployed configuration.

FIG. 20 is a side view of one embodiment of an introducer sheath in a deployed configuration.

FIG. 21 is a side view of one embodiment of an introducer sheath including an inflatable balloon.

Figure 22 is a schematic view of one embodiment of accessing a blood vessel via a popliteal access site.

Fig. 23-a to 23-H are views showing one embodiment of a process for fully expanding a thrombus extraction device in a blood vessel.

FIGS. 24-A and 24-B are diagrams illustrating alternative steps in a process for fully expanding a thrombus extraction device in a blood vessel.

FIGS. 25-A to 25-H are views showing one embodiment of a process for removing thrombus by the expanded thrombus extraction device.

FIG. 26 is a schematic view of an embodiment of accessing a blood vessel via an access site within the neck.

Figure 27 is a schematic view of one embodiment of a vessel accessed via the popliteal access site by extension sheath 2300.

Figure 28 is a schematic view of one embodiment of accessing a blood vessel by way of a popliteal access site and a femoral access site.

Detailed Description

The present application relates to a thrombectomy system for removing vascular thrombus from a patient's blood vessel. The thrombectomy system may remove thrombus from a blood vessel, particularly from a patient's venous blood vessel, by coring and/or separating thrombus from the blood vessel wall, which may occur as the thrombectomy system is retracted through the vascular thrombus. Thrombi that are cored and/or detached from the vessel wall can be captured within the thrombectomy system and removed from the patient.

The thrombectomy system may include a thrombus extraction catheter including a thrombus extraction device ("TED"). The TED may include a proximal self-expanding coring element, which may be a stent portion and/or may be formed from a unitary foraminous structure. The TED may include a distal expandable cylindrical portion formed from a braided wire mesh structure. A braided wire mesh structure may be formed over the coring element, thereby forming an integral TED. This formation of the woven wire mesh-like structure directly on the coring element eliminates problems such as: inconsistent material properties, reduced flexibility, reduced strength and/or quality control device problems caused by connecting woven wire mesh structures to coring elements, for example, by welding and adhesives.

The expansion of the TED may be controlled by the relative motion of portions of the thrombus extraction catheter. For example, the proximal end of the TED, and in particular the proximal end of the self-expanding coring element, may be connected to an intermediate shaft that is slidable within the outer shaft of the thrombus extraction catheter. The distal end of the TED, in particular the distal end of the expandable cylindrical portion, may be connected to an inner shaft that is slidable within the intermediate shaft of the thrombus extraction catheter. As the inner and intermediate shafts are slidable relative to the outer shaft, the TED may be withdrawn into the outer shaft to constrain the TED to an undeployed configuration, also referred to herein as a constrained configuration. Similarly, the TED may be deployed from the outer shaft by relative movement of the intermediate shaft with respect to the outer shaft. After the TED has been deployed from the outer shaft, the inner and intermediate shafts may be moved relative to each other to expand or contract the expandable cylindrical portion of the TED and fully expand the self-expanding coring element.

The thrombectomy system can include an introducer sheath sized to slidably receive the outer sheath of the thrombus extraction catheter. The introducer sheath can include a sealed bore at the proximal end of the introducer sheath and a self-expanding funnel. A self-expanding funnel may be positioned at a distal end of the introducer sheath and may be selectively retained in a constrained position by the capture sheath. In some embodiments, the self-expanding funnel may be slidably contained within the introduction sheath, and may in particular be slidable relative to the distal end of the introduction sheath. In some embodiments, the self-expanding funnel is distally slidable from a constrained configuration within the introducer sheath to a deployed configuration in which the self-expanding funnel extends from the distal end of the capture sheath.

The self-expanding funnel may be sized to engage the self-expanding coring element when the TED is retracted toward the funnel. As the TED is retracted, as in the funnel, the funnel compresses the TED, and in particular the coring element, and guides the TED, and in particular the coring element, into a lumen defined by the introducer sheath. The TED may be retracted until it is fully contained within the introduction sheath, and then the TED and thrombus trapped in the TED may be removed from the patient via the sealed aperture.

Thrombectomy systems may access blood vessels containing thrombi through multiple access sites. These access sites may include, for example, an intra-cervical (IJ) access site, a femoral access site, a popliteal access site, or other venous or arterial access site. The thrombectomy system can be used to extract thrombi and/or emboli from various venous and/or arterial vessels, which can be peripheral vessels, including any vessel, a non-limiting example being a venous vessel having a diameter of at least 5 millimeters (mm). The thrombectomy system may be inserted into the patient's circulatory system through an entry point and may be advanced to a position proximate the thrombus. The TED may then be advanced through the thrombus, and after expanding distally of the thrombus, the TED may be retracted through the thrombus, capturing all or a portion of the thrombus.

Referring now to fig. 1, one embodiment of a thrombectomy system 100, also referred to herein as a thrombus extraction system 100, is shown. The thrombectomy system 100 may be used to access a portion of a blood vessel, such as a venous blood vessel, containing a thrombus, and the thrombectomy system 100 may be used to remove all or a portion of the thrombus from the blood vessel. The thrombectomy system 100 can include an introducer sheath 102 and a thrombus extraction catheter 104.

The introducer sheath 102 includes an elongate member 106, also referred to herein as an elongate sheath 106, having a proximal end 108 and a distal end 110. The elongated member 106 may be resilient and/or flexible. The elongated member 106 may include any desired length and any desired diameter. In some embodiments, the outer diameter of the elongate sheath 106 may be at least 10 French, at least 12 French, at least 14 French, at least 18 French, at least 20 French, at least 22 French, between 14 French and 24 French, between 15 French and 21 French, between 16 French and 22 French, and/or any other or intermediate dimension.

The elongate member 106 may include radiopaque markers, which may be, for example, part of the distal end 110 of the elongate member 106. The elongate member 106 defines a lumen extending between a proximal end 108 and a distal end 110. The lumen 1701 of the elongate member 106 (shown in fig. 17) may be sized to slidably receive the thrombus extraction catheter 104. In some embodiments, the inner diameter of the lumen 1701 of the elongate member 106 may be at least 2 french, at least 10 french, at least 14 french, at least 18 french, at least 20 french, at least 22 french, between 14 french and 12 french, between 10 french and 22 french, between 14 french and 21 french, between 16 french and 20 french, and/or any other or intermediate dimension. The lumen 1701 may terminate at a seal bore 112, also referred to herein as a seal hub 112, located at the proximal end 108 of the elongate member 106. In some embodiments, the seal aperture 112 may be self-sealing and/or may include a self-sealing seal.

The introducer sheath 102 can also include an aspirate port 114, and the aspirate port 114 can be connected to the proximal end 108 of the elongate member 106 at the proximal end 108 of the elongate member 106 and/or via a connecting tube 116, for example. In some embodiments, the aspirate port 114 can be part of the seal hub 112 and/or connected to the seal hub 112. In some embodiments, the aspirate port 114 may be selectively fluidly connected to the lumen 1701, such as via a valve 118, also referred to herein as an aspirate valve 118, which valve 118 may be a tube clamp that may be positioned along the connecting tube 116 at a location between the lumen 1701 and the aspirate port 114.

The introducer sheath 102 can also hold an obturator 120, also referred to herein as a dilator 120. The obturator 120 may be configured to retain a self-expanding funnel attachable to the distal end 110 of the elongate member 106 in a constrained configuration and to release the self-expanding funnel from the constrained configuration. The obturator 120 can include a proximal end 122, a distal end 124, and an elongate shaft 126 extending therebetween. In some embodiments, the length of the elongate shaft 126 can be greater than the length of the elongate member 106 introduced into the sheath 102. The obturator 120 may also define a lumen extending through the obturator 120 that may receive a guide wire. In some embodiments, the guide wire may comprise any desired dimensions, and in some embodiments, the diameter may be about 0.035 inches. The obturator 120 may be sized and shaped to be slidably movable through the lumen of the elongate member 106.

The thrombectomy system 100 may include a thrombus extraction catheter 104. The thrombus extraction catheter 104 can have a proximal end 130 and a distal end 132. A handle 134, also referred to herein as a deployment handle 134, may be located at the proximal end 130 of the thrombus extraction catheter 104 and may be connected to a catheter portion 136, also referred to herein as a catheter 136.

The catheter 136 may include an outer shaft 138, an intermediate shaft 140, and an inner shaft. The outer shaft 138 may include various lengths and sizes. In some embodiments, the outer shaft 138 may be sized to slidably fit within the introducer sheath 102. In some embodiments, the outer shaft 138 may be sized at least 8 french, at least 10 french, at least 11 french, at least 12 french, at least 14 french, at least 16 french, between 8 french and 14 french, between 11 french and 12 french, and/or any other or intermediate size.

Each of the outer shaft 138, intermediate shaft 140, and inner shaft may define an inner lumen, which may be a central axial lumen. In some embodiments, the intermediate shaft 140 may be sized and/or shaped to slidably fit within the inner lumen 802 (shown in fig. 8) of the outer shaft 138 such that the intermediate shaft 140 and the outer shaft 138 are coaxial. Similarly, in some embodiments, the inner shaft can be sized and/or shaped to slidably fit within the lumen 804 (shown in fig. 8) of the intermediate shaft 140 such that the inner and intermediate shafts 140 are coaxial. In this configuration, each of the outer shaft 138, the intermediate shaft 140, and the inner shaft may be displaced relative to the other of the outer shaft 138, the intermediate shaft 140, and the inner shaft.

In some embodiments, each of the outer shaft 138, the intermediate shaft 140, and the inner shaft may have the same length, and in some embodiments, some or all of the outer shaft 138, the intermediate shaft 140, and the inner shaft may have different lengths. In some embodiments, for example, the intermediate shaft 140 may be relatively longer than the outer shaft 138, and in some embodiments, the inner shaft may be relatively longer than the intermediate shaft 140.

The thrombus extraction catheter 104 may also include a Thrombus Extraction Device (TED). The TED may be connected to the intermediate shaft 140 and the inner shaft, and may be contained within the inner lumen 802 of the outer shaft 138 in an undeployed configuration. In some embodiments, the relative positioning of the outer shaft 138, the intermediate shaft 140, and/or the inner shaft may result in the TED being in an undeployed configuration, a deployed configuration, a partially expanded configuration, and/or a fully expanded configuration. In some embodiments, the TED in the deployed configuration may be in a fully expanded configuration or a partially expanded configuration.

Handle 134 may include a distal end 142, also referred to herein as a locking end 142, and a proximal end 144, also referred to herein as a plunger end 144. In some embodiments, the intermediate shaft 140 is connected to the distal end 132 of the thrombus extraction catheter 104 and extends distally from the distal end 142 of the handle 134 toward the distal end 132 of the thrombus extraction catheter 104.

As seen in fig. 1, the distal end 142 of the handle 134 may include a locking feature 146, such as a spin lock. Locking feature 146 may be selectively and/or lockingly engaged with a mating feature 148 located on a proximal end 150 of outer sheath 138. In some embodiments, for example, the outer sheath 138 may be slid proximally over the intermediate sheath 140 until the locking feature 146 engages the mating feature 148, thereby fixing the position of the outer sheath 138 relative to the intermediate sheath 140. In embodiments where the intermediate shaft 146 is relatively longer than the outer shaft 138, a portion of the intermediate shaft 146 extends distally from the distal end 152 of the outer shaft 138 when the outer shaft 138 is lockingly engaged with the locking feature 146.

The handle 134 may include a plunger 154, and the plunger 154 may be movable between a first non-extended position and a second extended position. In some embodiments, plunger 154 may be moved from the first position to the second position by proximally displacing plunger 154 relative to handle 134. Plunger 154 may be lockable in one or both of the first position and/or the second position.

Plunger 154 may be connected to the inner shaft such that the inner shaft may be displaced relative to handle 134, outer shaft 138, and/or intermediate shaft 140 by moving plunger 154 from a first position to a second position. In some embodiments where the inner shaft is relatively longer than intermediate shaft 140 and/or outer shaft 138, the length of the inner shaft may be such that the inner shaft extends distally past the distal end of intermediate shaft 140 regardless of whether plunger 154 is in the first position or the second position.

The thrombus extraction catheter 104 can also include a first irrigation port 155 connected to the outer shaft 138 and a second irrigation port 156 connected to the handle 134. In some embodiments, the first irrigation port 155 can be fluidly connected to the inner lumen 802 of the outer shaft 138, thereby allowing irrigation of the inner lumen 802 of the outer shaft 138 through the first irrigation port 155. In some embodiments, the second irrigation port 156 can be fluidly connected to an inner portion of the handle 134, and thus to the lumen of the middle shaft 140, allowing irrigation of the lumen of the middle shaft 140.

The thrombectomy system 100 may also include a loading funnel 158. The loading funnel 158 may include a funnel portion 160 and a shaft portion 162. The funnel portion 160 may define a funnel-shaped internal volume connected to the lumen of the shaft portion 162. The funnel-shaped internal volume may be sized and shaped to receive and move the self-expanding funnel to a restraining position as the self-expanding funnel is advanced through the funnel portion 160. The funnel-shaped interior volume and the lumen may be sized to allow the distal end 124 of the obturator 120 to pass completely through the loading funnel 158.

In some embodiments, the loading funnel 158 may be configured to facilitate loading of the self-expanding funnel into the obturator 102. In some embodiments, the self-expanding funnel may be loaded by inserting the obturator 120 through the elongate member 106 such that the obturator 120 extends from the distal end 110 of the elongate member 106 and beyond the self-expanding funnel. Next, the loading funnel 158 may be slid proximally over the obturator 120 and the self-expanding funnel until the self-expanding funnel is fully enclosed by the loading funnel 158 and/or until the self-expanding funnel is in a constrained configuration. The obturator 120 may then be retracted, thereby loading and/or capturing the self-expanding funnel within a portion of the obturator 120, and the loading funnel 158 may then be removed from the obturator 120 and the elongate member 106.

The thrombectomy system 100 can also include a seal hub dilator 170, also referred to herein as a seal dilator 170, and/or a bore dilator 170. A cross-sectional view of the seal dilator 170 is shown in fig. 1. The seal dilator 170 may be sized and shaped to be inserted into the seal bore 112 prior to removal of thrombus through the seal bore 112. By thus inserting the seal bore 112, the seal dilator 170 can expand the seal bore 112. In some embodiments, this expansion of the seal bore 112 may prevent forces from being applied to the thrombus from the seal bore 112 during removal of the thrombus through the seal bore 112. In some embodiments, seal dilator 170 may include an insertion portion 172 configured to facilitate insertion of seal dilator 170 into seal bore 112. The seal dilator 170 may also include a body portion 174, the body portion 174 alone or with the insertion portion 172 may define an extraction lumen 176 through which thrombus may be removed from the lumen 1701 of the elongate member 106. In some embodiments, in the sealed configuration, the inner diameter of the extraction lumen 176 may be greater than the diameter of the seal bore 112.

Referring now to FIG. 2, a side view of one embodiment of the thrombus extraction catheter 104 is shown. The thrombus extraction catheter 104 includes a handle 134, an outer shaft 138, an intermediate shaft 140, an inner shaft 200, and a thrombus extraction device 202, also referred to herein as a TED 202. As shown in fig. 2, outer shaft 138 is displaced proximally relative to handle 134 such that mating feature 148 of outer shaft 138 contacts locking feature 146 of handle 134. Due to this positioning of outer shaft 138 relative to handle 134, each of intermediate shaft 140, inner shaft 200, and TED 202 extends distally beyond distal end 204 of outer shaft 138. The thrombus extraction device 202 is shown in fig. 2 in a deployed and partially expanded configuration.

The thrombus extraction device 202 can include a self-expanding coring element 206 and an expandable cylindrical portion 208. The self-expanding coring element 206 may be positioned relatively more proximally on the thrombus extraction catheter 104 than the expandable cylindrical portion 208. The self-expanding coring element 206 may include a proximal end 210 and a distal end 214, the proximal end 210 being connected to the distal end 212 of the intermediate shaft 140, the distal end 214 being connected to the proximal end 216 of the expandable cylindrical portion 208. Distal end 217 of expandable cylindrical portion 208 may be connected to distal end 218 of inner shaft 200.

In some embodiments, the distal end 218 of the inner shaft 200 can also include a tip 220, such as an atraumatic tip and/or a radiopaque marker 222. In some embodiments, the tip 220 may include radiopaque markers 222. Further, radiopaque markers may be positioned, for example, on the outer shaft 138, specifically on the distal end 204 of the outer shaft 138 and/or the distal end 212 of the intermediate shaft 140. In some embodiments, one or both of the distal end 204 of the outer shaft 138 and the distal end 212 of the intermediate shaft 140 may each include radiopaque markers. In some embodiments, atraumatic tip 220 may define a channel configured to allow a guide wire to pass through atraumatic tip 220.

Referring now to fig. 3, a side view of one embodiment of the thrombus extraction catheter 104 is shown with the thrombus extraction device 202 in a deployed and fully expanded configuration. In contrast to the embodiment in fig. 2, the plunger 154 is in a second position proximally retracted from the handle 134, and the inner shaft 200 is thus proximally retracted relative to the intermediate shaft 140 to thereby fully expand the expandable cylindrical portion 208 and secure the expandable cylindrical portion 208 and the self-expanding coring element 206 in a fully expanded configuration and/or to be fully expanded.

The thrombus extraction catheter 104 can include one or several features configured to secure the thrombus extraction device 202, and in particular the self-expanding coring element 206 and/or the expandable cylindrical portion 208, in a fully expanded position and/or to a fully expanded. As used herein, full expansion occurs when the thrombus extraction device 202 is deployed and when the plunger 154 is in the second position. In some embodiments, one or several dimensions of the thrombus extraction device 202 may change when the thrombus extraction device 202 is in full extension. In some embodiments, this may facilitate a desired force or level of force applied by the thrombus extraction device 202 against the vessel wall and/or by the thrombus extraction device 202.

In some embodiments, plunger 154 may be locked in the second position by, for example, rotating plunger 154 relative to handle 134 to thereby engage one or several locking features on plunger 154 and in handle 134. In some embodiments, by locking the plunger 154 in the second position, the thrombus extraction device 202, and in particular the self-expanding coring element 206 and/or the expandable cylindrical portion 208, can be fixed in full expansion by fixing the position of the inner shaft 200 relative to the intermediate shaft 140. In some embodiments, fixing the position of inner shaft 200 relative to intermediate shaft 140 may include locking inner shaft 200 relative to intermediate shaft 140 and/or coupling the position of inner shaft 200 relative to the position of intermediate shaft 140. In some embodiments, such locking and/or coupling may be static, referred to herein as statically locking and/or statically coupling, due to the fixed position of the inner shaft 200 relative to the position of the intermediate shaft 140, while in some embodiments, the locking and/or coupling may be dynamic, referred to herein as dynamically locking and/or dynamically coupling, due to the limited position of the inner shaft 200 relative to the intermediate shaft 140. In some embodiments, as will be discussed at greater length below, the inner shaft 200 can be dynamically locked to the plunger 154 by a compliant spring 1214, the compliant spring 1214 allowing some movement of the inner shaft 200 relative to the middle shaft 140 when the plunger is locked in the second position. Thus, in this embodiment, inner shaft 200 is dynamically locked and/or dynamically coupled to intermediate shaft 140, and/or is dynamically locked and/or dynamically coupled with respect to intermediate shaft 140.

Referring now to FIG. 4, a side view of one embodiment of the self-expanding coring element 206 is shown. The self-expanding coring element 206 may comprise various shapes and sizes, and may be made from various materials. In some embodiments, the self-expanding coring element may be made of a shape memory material, such as a shape memory alloy and/or a shape memory polymer. In some embodiments, the self-expanding coring element 206 may comprise nitinol and/or nitinol alloys.

The self-expanding coring element 206 may be made using a variety of techniques including, for example, welding, laser welding, cutting, laser cutting, expanding (expanding), and the like. In some embodiments, the self-expanding coring element 206 may be laser cut from a piece of nitinol, such as a nitinol tube, after which the self-expanding coring element 206 may be inflated and/or expanded.

The self-expanding coring element 206 may comprise an integral foraminous structure 400 and/or a stent or stent portion, which may be configured to core and separate a portion of a thrombus, such as a vascular thrombus, from a blood vessel containing the thrombus. The unitary foraminous structure 400 can include a plurality of struts 402, the plurality of struts 402 collectively defining a plurality of voids 404. The struts can include various shapes and sizes, and in some embodiments, the thickness and/or diameter of each strut can be between about 0.05 to 0.15 inches, between about 0.075 to 0.125 inches, between about 0.09 to 0.1 inches, and/or about 0.096 inches.

In some embodiments, the self-expanding coring element 206 may include a first region 406 and a second region 408. The second region 408 may be generally tubular and may include a plurality of interconnected struts 402. As seen in fig. 5, the first region 406 may include a reduced number of struts 402 as compared to the second region to facilitate collapse of the self-expanding coring element 206 to an unexpanded configuration and maintain a coring orientation when the blood vessel is distorted. In some embodiments, the first region may also include two curved struts 410-A, 410-B, the struts 410-A, 410-B twisting in opposite directions about a central axis 412, also referred to herein as a longitudinal axis 412, of the self-expanding coring element 206 to define a mouth 414 of the self-expanding coring element 206.

In some embodiments, the connection of the self-expanding coring element 206 to the intermediate shaft 140 through the two curved struts 410-A, 410-B may improve the operation of the thrombus extraction device 202 by flexibly connecting the self-expanding coring element 206 to the intermediate shaft 140. In particular, removing the struts from the region 420 of the self-expanding coring element 206 allows the self-expanding coring element 206 to flex about the connection member 415 located at the proximal end 210 of the self-expanding coring element 206 and connecting the self-expanding coring element 206 to the intermediate shaft 140 of the thrombus extraction catheter 104. This flexibility may facilitate maintaining the coring orientation in the event of vessel distortion. In some embodiments, such flexing of the self-expanding coring element 206 may cause the region 420 to act as the mouth 414.

As seen in fig. 4, the curved strut 410 extends from a bottom 416 of the self-expanding coring element 206 at an angle θ, also referred to herein as a coring angle, relative to the central axis 412 toward a top 418 of the self-expanding coring element 206. In some embodiments, the angle may be between 20 degrees and 50 degrees and/or 30 degrees and 45 degrees when fully expanded.

In some embodiments, the coring angle may advantageously or adversely affect the operation of the TED 202. For example, a coring angle that is too deep may prevent the self-expanding coring element 206 from becoming collapsible and thus prevent the self-expanding coring element 206 from retracting into the introducer sheath 102. In addition, too shallow an inclination angle may cause the self-expanding coring element 206 to collapse too easily, which may reduce the coring capability of the self-expanding coring element 206. In some embodiments, this reduction in the coring capability of the self-expanding coring element 206 may result in the self-expanding coring element 206 no longer effectively coring the thrombus.

In some embodiments, the proximal-most edges of the two curved struts 410-A, 410-B, referred to herein as leading edges 411, may be sharp, and/or the leading edges 411 of the two curved struts 410-A, 410-B may include cutting elements, blades, or the like.

The self-expanding coring element 206 may comprise various dimensions. In some embodiments, the length of the self-expanding coring element 206, defined as the shortest distance between the proximal end 210 of the self-expanding coring element 206 and the distal end 214 of the self-expanding coring element 206, may be between about one and 3 inches, between about 1.5 and 2.5 inches, between about 1.75 and 2.25 inches, between about 1.9 and 2.0 inches, and/or about 1.96 inches. In some embodiments, the fully expanded diameter of the self-expanding coring element 206 may be between about 2 to 50mm, between about 4 to 25mm, between about 6 to 20mm, and/or between about 8 to 16 mm. In some embodiments, the self-expanding coring element may be applied to reduce tumors in arteries or veins, such as the inferior vena cava. In some embodiments, such tumor reduction may be performed in response to occlusion and/or partial occlusion of one or several filters in the inferior vena cava.

In some embodiments, the length and diameter of the self-expanding coring element 206 may be selected based on the size of the blood vessel, particularly the diameter of the blood vessel from which the thrombus is to be extracted. In some embodiments, the length of the self-expanding coring element 206 may be selected based on the fully expanded diameter of the self-expanding coring element 206 to prevent undesired eversion and/or rotation of the self-expanding coring element within the blood vessel relative to the blood vessel. As used anywhere herein, "about" refers to a range of +/-10% of the value and/or range of values for which "about" is used.

Referring now to FIG. 7, a side view of one embodiment of a thrombus extraction device 202 is shown. As seen in fig. 7, the self-expanding coring element 206 is connected to the distal end 212 of the intermediate shaft 140 at the proximal end 210 of the self-expanding coring element 206 by a connection member 415. The proximal end 216 of the expandable cylindrical portion 208 is connected to the distal end 214 of the self-expanding coring element 206. In some embodiments, the expandable cylindrical portion 208, and in particular, the proximal end 216 of the expandable cylindrical portion 208, is formed on the distal end 214 of the self-expanding coring element 206, thereby forming the overall thrombus extraction device 202. Distal end 217 of expanded cylindrical portion 208 is connected to distal end 218 of inner shaft 200.

In some embodiments, and as seen in fig. 7, the self-expanding coring element 206 may be engaged with all or part of the inner shaft 200 to affect expansion of the self-expanding coring element 206. Specifically, in some embodiments, the self-expanding coring element 206 may include a ring 700, also referred to herein as a ring feature 700. The ring 700 may be the same material as the self-expanding coring element 206 or may be a different material than the self-expanding coring element 206. The ring 700 may be integrally formed with the self-expanding coring element 206 and/or may be attached to the self-expanding coring element by, for example, one or several welds, adhesive, one or several mechanical fasteners, or the like. The diameter of ring 700 may be larger than the diameter of inner shaft 200 such that ring 700 may slide along inner shaft 200.

As further seen in fig. 7, the inner shaft 200 can include a stop 702. In some embodiments, the stop 702 can comprise a polymeric and/or metallic member affixed to a portion of the inner shaft 200. In some embodiments, the stop 702 may be sized and shaped to engage the ring 700 to apply a proximally directed force to the self-expanding coring element 206 when the inner shaft 200 is proximally displaced by movement of the plunger 154 to the second position. In some embodiments, a portion of the self-expanding coring element 206 positioned between the loop 700 and the connecting member 415 may be forcibly expanded to the loop 700 by the application of the proximally directed force, moving the self-expanding coring member to full expansion.

In some embodiments, the inner shaft 200 of the thrombus extraction catheter 104 may be selectively connected to the distal end 217 of the expandable cylindrical portion 208. This may allow for displacement of the inner shaft 200 to fully expand the self-expanding coring element 206 by engagement of the ring feature 700 with the stop 702. In some embodiments, after self-expanding coring element 206 is at full expansion, inner shaft 200 may be recoupled to distal end 217 of expandable cylindrical portion 208 such that expandable cylindrical portion 208 is fully expanded, and/or inner shaft 200 may be recoupled to distal end 217 of expandable cylindrical portion 208 such that expandable cylindrical portion 208 compresses expandable cylindrical portion 208 when plunger 154 is moved from the second position to the first position.

In some embodiments, the expandable cylindrical portion 208 may include a braided wire mesh structure 704, and the braided wire mesh structure 704 may be configured to capture thrombus. In some embodiments, the braided wire mesh-like structure may be coextensive with the expandable cylindrical portion 208, and thus may share the proximal end 216 and/or the distal end 217. In the embodiment shown in fig. 7, the braided wire mesh structure 704 is a braid of resilient wires having a generally tubular elongated portion 706 and a distal tapered portion 708. In other embodiments, the woven wire mesh-like structure 704 may be any porous structure and/or may have other suitable shapes, sizes, and configurations (e.g., the distal portion 708 may be substantially cylindrical, etc.).

Due to the connection of the braided wire mesh structure 704 to the distal end 218 of the inner shaft 200, axial movement of the inner shaft 200 radially expands/shortens and collapses/elongates the braided wire mesh structure 704 of the TED 200. For example, as long as the intermediate shaft 140 is fixed and/or constrained to move axially at a rate less than that of the inner shaft 200: (1) distal movement of inner shaft 200 stretches braided wire mesh structure 704 along a longitudinal axis of braided wire mesh structure 704 such that a radius of braided wire mesh structure 704 decreases and a length of braided wire mesh structure 704 increases; and (2) proximal movement of inner shaft 200 compresses braided wire mesh structure 704 along a longitudinal axis of braided wire mesh structure 704 such that a radius of braided wire mesh structure 704 increases and a length of braided wire mesh structure 704 decreases. In particular embodiments, the length of the braided wire mesh structure 704 in the collapsed configuration may be between about 5 and 30 inches, between about 10 and 20 inches, and/or about 16 inches, and in some embodiments, the length of the braided wire mesh structure 704 in the expanded configuration may be between about 1 and 25 inches, between about 10 and 20 inches, and/or about 11 inches.

In some embodiments, knitted wire mesh structure 704 may be formed by a knitting machine and/or a textile machine, and in some embodiments, knitted wire mesh structure 704 may be hand-knitted and/or woven. It is advantageous to utilize a knitting machine and/or textile machine that does not employ a bobbin or other take-up mechanism as is common in many conventional knitting machines, as these mechanisms make it much more difficult to form a knit on the self-expanding coring element 206. The braiding machine and/or textile machine in which the wire is freely suspended allows for much simpler loading directly on the self-expanding coring element 206. In some embodiments, the woven wire mesh structure 704 may be woven using methods or devices included in some or all of the following documents: us patent No. 8,833,224 entitled "knitting MECHANISM AND METHOD OF USE" filed on 8.5.2013; U.S. patent No. 8,826,791 entitled "knitting MECHANISM AND METHOD OF USE" filed on 9, 10, 2012; united states patent No. 8,261,648 entitled "knitting MECHANISM AND METHOD OF USE" filed on 17.10.2011; us patent No. 8,820,207 entitled "knitting MECHANISM AND METHOD OF USE" filed on 26/4/2013; U.S. patent publication No. 2016/0030155 entitled "anerysm GRAFT WITH stabillization (ANEURYSM graft with stability)" and entered the us national stage at 9/14/2015; and U.S. patent publication No. 2014/0318354 entitled "knitting MECHANISM AND METHOD OF USE" filed on 11/7/2014; each of which is incorporated by reference herein in its entirety.

In some embodiments, the braided wire mesh structure 704 may be formed into a tubular braid, which may then be further shaped using a heat setting process. In some embodiments, the braid may be a tubular braid of pure metal wires, such as nitinol (nickel titanium alloy), platinum, cobalt chromium alloy, stainless steel, tungsten, or titanium. In some embodiments, the braided wire mesh structure 704 may be formed at least in part from a cylindrical braid of elastic wires. Thus, the braid may be radially constrained without plastic deformation and will self-expand when the radial constraint is released. Such elastic wire braids are referred to herein as "self-expanding braids".

In some embodiments, the thickness of the braid filaments may be less than about 0.15 mm. In some embodiments, the braid may be manufactured from filaments and/or wires having a diameter in the range of about 0.05mm to about 0.25 mm. In some embodiments, braid filaments having different diameters may be combined to impart different characteristics, including: rigidity, elasticity, structure, radial force, pore size, plug capture or filtration capability, and the like. In some embodiments, the count of braided filaments is between 20 and 80, greater than 30, and/or about 24. The mesh size of the braid mesh in the elongated portion 706 may be in the range of about 0.4mm to 4.0 mm. In some embodiments, the pore size may be in the range of 0.5mm to 2.5 mm.

In some cases, when the thrombus is within the woven wire mesh-like structure 704, the thrombus may form a shape that is difficult to retract into the introducer sheath 102. This situation is illustrated in fig. 8, where the thrombus extraction device 202, in particular the woven wire mesh structure 704, is partially retracted into the introducer sheath 102. As shown in FIG. 8, the thrombus 800 has formed a sphere with a diameter greater than the diameter of the introducer sheath 102. This manifestation of the thrombus 800 may impede removal of the TED200 and thrombus 800 from the patient. Figures 9 and 10 focus on features of this behavior to prevent thrombosis.

Fig. 8 also shows a cross-sectional view of the elongate member 106 such that the inner lumen 1701 of the elongate member is visible, a cross-sectional view of the outer shaft 138 such that the inner lumen 802 of the outer shaft 138 is visible, and a cross-sectional view of the intermediate shaft 140 such that the inner lumen 804 of the intermediate shaft 140 is visible.

Referring now to fig. 9, a side view of one embodiment of a woven wire mesh structure 704 including a variety of hole sizes is shown. As can be seen, the woven wire mesh structure 704 includes a first portion 900 and a second portion 902, the first portion 900 including a first set of a plurality of apertures 904 and the second portion 902 including a second set of a plurality of apertures 906. In some embodiments, the first portion 900 can correspond to the elongated portion 706 and the second portion 902 can correspond to the distal tapered portion 708.

As shown in fig. 9, the first portion 900 of the woven wire mesh structure 704 is relatively more proximal than the second portion 902. As further shown, the apertures in the first plurality of apertures 904 of the first portion 900 are smaller than the apertures in the second plurality of apertures 906 of the second portion 902. In some embodiments, the larger pores of distal second portion 902 have an average size of 1.5mm or greater, and in some embodiments between about 1.0mm and 4.0 mm.

In this embodiment, the larger size of the apertures of the second plurality of apertures 906 may allow and/or facilitate extrusion of a portion of the thrombus when the woven wire mesh structure 704 is moved to the unexpanded configuration and/or when the woven wire mesh structure 704 is retracted into the introducer sheath 102. In some embodiments, this extrusion of a portion of the thrombus may prevent a situation in which the thrombus may not be retractable into the introducer sheath 102. Further, in some embodiments, relatively new portions of the thrombus may be extruded before relatively old portions of the thrombus, as the relatively new portions of the thrombus may be softer and/or more malleable. These relatively new portions of thrombus may then be captured and/or broken down by features introduced into the sheath 102.

Referring now to fig. 10, a side view of one embodiment of the TED200 is shown, the TED200 including a plurality of circumferential recesses 1000, also referred to herein as circumferential grooves, radial ribs, and/or radial grooves. In some embodiments, some or all of the plurality of circumferential recesses 1000 may extend inwardly toward the central axis 1002 and/or the midline 1002 of the thrombus extraction device 202. In some embodiments, the plurality of circumferential recesses 1000 may be longitudinally spaced and/or equally spaced along the expandable cylindrical portion 208 and/or the braided wire mesh structure 704 between the proximal end 216 and the distal end 217 of the cylindrical portion 208 and/or the braided wire mesh structure 704. In some embodiments, these circumferential recesses 1000 can engage portions of the thrombus contained within the cylindrical portion 208 and/or the braided wire mesh structure 704 as the thrombus extraction device 202 moves from the expanded configuration to the unexpanded configuration to inhibit movement of the thrombus relative to one or both of the proximal end 216 and the distal end 217 of the cylindrical portion 208 and/or the braided wire mesh structure 704. This inhibition of thrombus movement can reduce the likelihood of creating a thrombus that cannot be retracted into the introducer sheath 102.

Although shown in separate figures, some embodiments of the thrombus extraction device 202 may include both the plurality of circumferential recesses discussed with respect to fig. 10 and the plurality of hole sizes discussed with respect to fig. 9.

Referring now to fig. 11, a schematic diagram of one embodiment of a weave pattern for forming the cylindrical portion 208 and/or the braided wire mesh-like structure 704 at one or several forming points 1103 on the self-expanding coring element 206 is shown. As can be seen, the self-expanding coring element 206 comprises a plurality of struts 402, the plurality of struts 402 connected at a forming point 1103, the forming point 1103 comprising an apex 1100, also referred to herein as an apex strut 1100. As can be seen, each vertex 1100 is formed by the intersection of a first leg 402-A and a second leg 402-B, which intersecting legs 402-A, 402-B form a vertex aperture 1101.

In some embodiments, the self-expanding coring element 206 may include a plurality of apices 1100, the plurality of apices 1100 extending around the distal end of the self-expanding coring element 206. Plurality of vertices 1100 may include 4 vertices 1100, 6 vertices 1100, 8 vertices 1100, 10 vertices 1100, 12 vertices 1100, 16 vertices 1100, 20 vertices 1100, 24 vertices 1100, between 4 and 50 vertices, between 8 and 20 vertices, and/or any other or intermediate number of vertices.

The cylindrical portion 208 and/or the braided wire mesh structure 704 may include a plurality of wires 1102 woven and/or braided together to form the cylindrical portion 208 and/or the braided wire mesh structure 704. In some embodiments, the plurality of wires may include a first wire 1104 and a second wire 1106 for each apex 1100 of the self-expanding coring element 206. The first 1104 and second 1106 filaments may be woven and/or knitted to their respective apices. In some embodiments, first and second filaments 1104, 1106 may be woven and/or knitted onto their respective vertices such that one or both of first and second filaments 1104, 1106 form loops around their respective vertices. Thus, in some embodiments, only first filament 1104 forms a loop around its apex, only second filament 1106 forms a loop around its apex, or both first and second filaments 1104, 1106 form loops around their apexes. Referring to the embodiment in fig. 11, the first wire 1104 may be inserted straight through the apex aperture 1101 of its apex such that the first wire 1104 does not loop over itself immediately adjacent to its apex, more particularly immediately distal to its apex.

The first wire 1104 may be inserted through the apex aperture 1101 of its apex 1100 such that the first wire 1104 passes over the first strut 402-a and under the second strut 402-B when viewed from the exterior of the self-expanding coring element 206 to the interior of the self-expanding coring element 206.

The second wire 1106 may be inserted through the apex aperture 1101 of its apex such that the second wire 1106 is separated from the apex by the first wire 1104 through a portion of the apex aperture 1101. Further, a second wire 1106 may be inserted through the apex aperture 1101 such that the second wire 1106 passes below the first strut 402-a and above the second strut 402-B. After insertion through the apex aperture 1101, the second wire 1106 may loop over itself to form a loop 1108 immediately distal of its apex 100.

In some embodiments, as each wire 1104, 1106 is inserted through the apex aperture 1101, each wire 1104, 1106 may be treated for weaving or weaving purposes to include a first wire extending from its apex 1100 to a first end of the wire 1104, 1106 and a second wire extending from its apex to a second end of the wire 1104, 1106. Thus, in some embodiments where the self-expanding coring portion 206 includes 12 vertices, the cylindrical portion 208 and/or the braided wire mesh-like structure 704 may be formed from 24 wires 1104, 1106, which 24 wires 1104, 1106 may be woven and/or braided into 48 wires to form a 48-wire mesh and/or weave.

In some embodiments, the cylindrical portion 208 and/or the wire mesh-like structure 704 may be braided/woven by identifying a plurality of forming points 1103 formed by some struts 402 of the self-expanding coring element 206. A unique pair of wires may be threaded through each forming point 1103, specifically adjacent to each forming point 1103, through the apex aperture 1101. In some embodiments, each unique pair of wires may include a first wire 1104 and a second wire 1106 superimposed on the first wire 1104. Thus, the first and second wires may be woven and/or knitted from only a single pair of wires into the cylindrical portion 208 and/or into the network of wire mesh structures 704 such that the first wire 1104 does not form a loop around the forming point 1103 through which the first wire 1104 is threaded and such that the second wire 1106 forms a loop 1108 around the forming point 1103 through which the second wire 1106 is threaded.

Referring now to fig. 12, a cross-sectional view of an embodiment of handle 134 is shown with plunger 154 in a first position, and referring to fig. 13, a cross-sectional view of an embodiment of handle 134 is shown with plunger 154 in a second position. The handle 134 may include a housing 1200, the housing 1200 defining an interior volume 1202. The plunger shaft 1204 may extend through all or portions of the inner volume 1202 and may be connected to the inner shaft 200, which inner shaft 200 may define the previously referenced inner lumen 1400, also referred to herein as inner shaft lumen 1400. The plunger shaft 1204 may terminate at a plunger guide 1208, the plunger guide 1208 being affixed to the plunger shaft 1204. In some embodiments, as seen in fig. 12 and 13, the plunger 154 may be biased toward the first position by a plunger spring 1209, which plunger spring 1209 may engage a plunger guide 1208 and a portion of the handle 134. Thus, when the plunger 154 is in the first position as shown in fig. 12, the plunger spring 1209 is less compressed, and when the plunger 154 is in the second position as shown in fig. 13, the plunger spring 1209 is more compressed. In some embodiments, this bias toward the first position may create a bias toward a partially expanded configuration in the thrombus extraction device 202.

As seen in fig. 14, a close-up view of circled portion "a" indicated in fig. 13, plunger guide 1208 may be positioned between a proximal stopper 1210 and a distal stopper 1212, which proximal stopper 1210 and distal stopper 1212 may each be affixed to an inner shaft 200 comprising an inner shaft lumen 1400. The plunger guide 1208 may be dynamically connected to the proximal stop 1210 by a stent compliance spring 1214, also referred to herein as a compliance spring 1214. In some embodiments, using a compliant spring 1214 to connect the plunger guide 1208 and the proximal stop 1210 may allow the diameter of the self-expanding coring element 206 to vary depending on the compressive force applied to the self-expanding coring element 206.

In some embodiments, the radial compressive force applied to the self-expanding coring element 206 may be transferred from the self-expanding coring element 206 through the ring feature 700 and the stop 702 to the compliant spring 1214, for example, through the interaction of the ring feature 700 and the stop 702. In embodiments where the compressive force is greater than the spring force, the compliant spring 1214 may be compressed and the inner shaft 200 may be advanced distally relative to the middle shaft 140, reducing the diameter of the self-expanding coring element 206 until the compressive force equals the spring force. This compliance achieved by the compliance spring 1214 enables the use of the thrombus extraction catheter 104 in a vessel, which may be an arterial or venous vessel having a non-constant diameter, while maintaining the desired contact of the self-expanding coring element 206 on the wall of the vessel, vein, or venous vessel. In some embodiments, this compliance may result in a constant outward force applied to the vessel wall by the self-expanding coring element 206 when the diameter of the vessel is between about 1 to 30mm, 2 to 25mm, 5 to 20mm, and/or any other or intermediate diameter. In some embodiments, the constant outward force may mean that the outward force is within a predetermined range. In some embodiments, for example, the outward force may be about 5N when the diameter of the self-expanding coring element 206 is about 20mm, and the outward force may be about 20N when the diameter of the self-expanding coring element 206 is about 5 mm. Thus, in some embodiments, a locking mechanism, which may include a plunger 154 and a compliant spring 1214, may be configured to maintain a desired radial force on the vessel wall as the stent is compressed by the vessel wall. In some embodiments, when the self-expanding coring element 206 is in full expansion, the desired force may be a radial force on the vessel wall sufficient to core and/or separate all or part of the thrombus from the vessel wall.

Referring now to fig. 15 and 16, a side view of an embodiment of an obturator 120 is shown. As seen, the obturator 120 includes a proximal end 122, a distal end 124, and an elongate shaft 126. As further seen, the obturator 120 may include a capture sheath 1500 extending proximally from the distal end 124 of the obturator 120.

The obturator 120 may also include a tip, such as an atraumatic tip 1502, located at the distal end 124 of the obturator 120. In some embodiments, atraumatic tip 1502 may be radiopaque. The obturator 120 can also include a connection fitting 1504, which connection fitting 1504 can be located at the proximal end 1506 of the capture sheath 1500. In some embodiments, the connection fitting 1504 can be configured to sealingly connect with the distal end 110 of the elongate sheath 106 of the introducer sheath 102.

The obturator 120 may also include a stop portion 1508 located at the proximal end 122 of the obturator 120. In some embodiments, the stop portion 1508 may have a diameter greater than the lumen 1701 of the elongate member 106 of the introduction sheath 102 and/or greater than the diameter of the seal aperture 112 at the proximal end 108 of the introduction sheath 102, thereby preventing the stop portion 1508 from entering the lumen 1701 of the elongate member 106 and/or the seal aperture 112.

In some embodiments, the elongate shaft 126 can comprise a constant size and/or diameter, and in some embodiments, the elongate shaft 126 can comprise a plurality of sizes and/or diameters. For example, diameter 1510 of elongate shaft 126 shown in fig. 15 is constant along the length of elongate shaft 126. In contrast, the elongate shaft 126 shown in fig. 16 has at least a first diameter 1512 along one or more first portions 1513 of the elongate shaft 126 and a second diameter 1514 along one or more second portions 1515 of the elongate shaft 126.

In some embodiments, one or several second portions 1515 of the elongate shaft can be positioned along the length of the elongate shaft 126 such that when the obturator 120 is received within the elongate member 106 of the introducer sheath 102 and positioned such that the connection fitting 1504 seals with the distal end 110 of the elongate sheath 106, the one or several second portions 1515 extend through the seal bore 112. In such embodiments, the second diameter 1514 may be selected such that one or several second portions do not contact and/or expand the seal bore 112 and/or a seal within the seal bore 112. Since such embodiments of the obturator 120 do not expand the seal of the sealing aperture 112 as the one or several second portions extend through the sealing aperture 112, the introducer sheath 102 may be stored, packaged, and/or sold with the obturator 120 pre-positioned to extend through the lumen 1701 of the elongate member 106.

Referring now to FIG. 17, a detailed cross-sectional view of one embodiment of a capture sheath 1500 is shown. As seen, the capture sheath 1500 includes an atraumatic tip 1502 and is coupled to the elongate shaft 126 of the obturator 120, the elongate shaft 126 extending through the lumen 1701 of the elongate member 106. As further seen, lumen 1700 extends through atraumatic tip 1502 and elongate shaft 126, the lumen 1700 may be configured to receive a guide wire.

The capture sheath 1500 includes a capture housing 1702 with the capture housing 1702 extending distally from the atraumatic tip 1502 to a proximal end 1506 of the capture sheath 1500. The capture housing 1702 terminates in a connection fitting 1504. The inner diameter 1704 of the capture housing 1702 is greater than the diameter 1706 of a portion of the elongate shaft 126 extending through the capture housing 1702. Due to the larger inner diameter 1704 of the capture housing 1500, a receiving space is created between the capture housing 1702 and a portion of the elongate shaft 126 extending through the capture housing 1702. In some embodiments, the receiving space may be sized and shaped to receive and/or retain the self-expanding funnel 1708 in a constrained configuration. In some embodiments, the diameter of the self-expanding funnel 1708 may match the inner diameter 1704 of the capture housing 1702 when the self-expanding funnel 1708 is in a constrained configuration. In some embodiments, this diameter of the self-expanding funnel may be less than or equal to the diameter 1716 of the elongate member 106.

The self-expanding funnel 1708 may comprise various shapes and sizes, and may be made of various materials. In some embodiments, the maximum diameter of the self-expanding funnel 1708 may be greater than and/or equal to the diameter of the self-expanding coring element 206 in the fully expanded state, and in some embodiments, the minimum diameter of the self-expanding funnel 1708 may be equal to the diameter 1716 of the elongate member 106 and/or equal to the diameter of the lumen 1701 of the elongate member 106. In some embodiments, the length of the self-expanding funnel 1708 may be greater than and/or equal to the length of the self-expanding coring element 206, such that the self-expanding coring element 206 may be received and contained within the self-expanding funnel 1708.

In some embodiments, the self-expanding funnel 1708 may have a tapered portion, particularly a frustoconical portion. In some embodiments, the self-expanding funnel may be comprised of at least one of a battlement-shaped nitinol braid, a nitinol braided stent, a laser cut nitinol, a laser cut polymeric tube, an injection molded polymeric structure, or an inflatable balloon. In some embodiments, the self-expanding funnel 1708 may comprise a mesh with pores of a size small enough to prevent dangerous thrombi from passing through the pores of the mesh. In some embodiments, the self-expanding funnel 1708 may be permeable to blood.

Referring now to fig. 18-20, side views of embodiments of an introducer sheath 120 of different configurations are shown. In fig. 18, the introducer sheath 102 is shown in a non-deployed configuration, in fig. 19, the introducer sheath 102 is shown in a partially deployed configuration, and in fig. 20, the introducer sheath 102 is shown in a fully deployed and/or deployed configuration.

Specifically, as seen in fig. 18, the obturator 120 extends through the lumen 1701 of the elongate member 106, and the self-expanding funnel 1708 is contained within the capture sheath 1500 in a constrained configuration. In fig. 19, the obturator 120 has been advanced distally, releasing the self-expanding funnel 1708 from the constrained configuration and/or deploying the self-expanding funnel 1708. In some embodiments, the length of the obturator 120, and in particular the length of the elongate member, between the proximal end of the capture sheath 1500 and the stop portion 1508 is sufficient to allow deployment of the self-expanding funnel 1708 from the capture sheath 1500 before further distal movement of the obturator 120 is prevented by the collision between the stop portion 1508 and the sealing aperture 112.

After the self-expanding funnel 1708 has been deployed, the obturator 120 may be proximally retracted through the lumen 1701 of the elongate member 106 and the sealing aperture 112, and may be removed from the introducer sheath 102. After the obturator 120 has been removed from the introducer sheath 102, the introducer sheath is in a fully deployed configuration as shown in FIG. 20.

In some embodiments, as seen in fig. 21, the introducer sheath 102 can include an inflatable balloon 2100, the inflatable balloon 2100 being positioned at or near the distal end 110 of the elongate member 106. In some embodiments, the balloon 2100 may include a tapered inner portion 2102, and the tapered inner portion 2102 may be sized and shaped to receive the thrombus extraction device 202, and in particular, the length of the tapered inner portion 2102 may be greater than or equal to the length of the self-expanding coring element 206.

Referring now to fig. 22, an introduction technique for accessing a thrombus 2200 is shown. As shown, the thrombus 2200 can be positioned in a blood vessel and accessed through an access site 2260, such as a popliteal access site. The introduction sheath 102 may extend from a popliteal access site 2260 to a deployed position 2262, where the self-expanding funnel 1708 may be deployed 2262, and the deployed position 2262 may be proximal to the thrombus 2200. The TED 202 may pass through the clot 2200 in the direction of blood flow, and the TED 202 may retract through the clot 2200 in the opposite direction of blood flow. Retraction of the TED 202 through the clot 2200 may result in coring of the clot by the self-expanding coring element 206 and capturing of the clot in the expandable cylinder 208.

In some such embodiments, as shown in fig. 23, all or a portion of the TED 202 may extend into one of the iliac veins and/or inferior vena cava. Furthermore, as the TED 202 is retracted from a proximal position to a distal position relative to the heart, the diameter of the blood vessel 2202 will decrease as the TED 202 is retracted toward the access site 2260. This may result in an increased compressive force on the TED 202, and in particular on the self-expanding coring element 206. These compressive forces may be transferred through the ring feature 700 and the stop 702 to the compliant spring 1214. By stretching or compressing the compliance spring 1214, the diameter of the TED 202, and in particular the coring element 206, may be varied to match the diameter of the blood vessel, and a desired radial force and/or force level may be maintained.

Fig. 23-a to 23-H, fig. 24-a and 24-B, and fig. 25-a to 25-H illustrate a process of using the thrombus extraction system 100 to remove a thrombus from a patient, particularly from a blood vessel in the patient, which may be a venous blood vessel. The process comprises the following steps: accessing a blood vessel through one or several percutaneous access sites, which may provide direct access to the blood vessel or indirect access to the blood vessel via one or several other blood vessels; advancing the introducer sheath to a position proximal to the thrombus; deploying a self-expanding funnel of the introducer sheath; advancing the distal end 132 of the thrombus extraction catheter 104 to a position proximal to the thrombus; deploying the thrombus extraction device 202; capturing the thrombus in the thrombus extraction device 202 by retracting the thrombus extraction device 202 through the thrombus; collapsing the thrombus extraction device 202; and removing the thrombus extraction device 202 and captured thrombus from the introduction sheath 102 and from the patient. In some embodiments, these one or several access sites may include, for example, a popliteal access site, a femoral access site, and/or an intra-cervical access site. In some embodiments, the thrombolytic agent may be injected into and/or withdrawn from the blood vessel before, during, or after removal or extraction of the thrombus. The thrombolytic agent may include, for example, Tissue Plasminogen Activator (TPA) or other clot-dissolving drugs.

In any of the embodiments disclosed herein, the device and/or delivery system may be adapted to deliver energy to the device and thrombus or tissue surrounding the device at the treatment site for facilitating removal of the thrombus or treatment of tissue adjacent the device, or both. In some embodiments, energy can be delivered through a delivery system to a device for treating the vasculature of a patient such that the device is heated or actuated by the energy. Examples of energy that may be delivered include, but are not limited to, light energy, thermal energy, vibrational energy, electromagnetic energy, radio frequency energy, and ultrasound energy. For some embodiments, energy delivered to the device may trigger release of a chemical or biological agent to promote separation of thrombus from the vessel wall and/or to tissue of the patient, for treating a vascular structure of the patient, treating tissue disposed adjacent to the device, or a combination thereof.

The process of using the thrombus extraction system 100 shown in fig. 23-a to 23-H, fig. 24-a and 24-B, and fig. 25-a to 25-H may be performed in a blood flow direction or an anti-blood flow direction. Thus, in some embodiments, the direction of blood flow in FIGS. 23-A to 23-H, 24-A and 24-B, and 25-A to 25-H may be from left to right or from right to left.

Referring now to fig. 23-a to 23-H, a process for expanding a thrombus extraction device 202 in a blood vessel, such as a venous blood vessel, is shown. The process for expanding the thrombus extraction device 202 in a blood vessel may be performed using all or part of the thrombus extraction system 100. In some embodiments, the process for expanding the thrombus extraction device 202 in a blood vessel may be performed in conjunction with monitoring techniques, such as fluoroscopy, angiography, and/or ultrasound monitoring. In some embodiments, monitoring techniques may be used to monitor the deployment of the TED 202 in the vessel by observing one or several radiopaque markers located on the introducer sheath 102 and/or the thrombus extraction catheter 104.

The process begins at fig. 23-a, where a thrombus 2200 is identified in a blood vessel 2202, such as a venous blood vessel. In some embodiments, the thrombus 2200 can be located in the peripheral vasculature of the patient's body. The thrombus 2200, also referred to herein as clot 2200, can comprise a proximal end 2204 and a distal end 2206. In some embodiments, the identification of the vessel 2202 can also include determining whether the thrombus 2200 in the vessel 2202 is suitable for thrombus extraction. In some embodiments, the thrombus 2200 in the blood vessel 2202 can be suitable for extraction when the diameter of the blood vessel 2202 is at least 5 millimeters. In some embodiments, thrombus 2200 in blood vessel 2202 can be suitable for extraction when blood vessel 2202 is at least 5 millimeters in diameter and at least one of a femoral vein, an iliac vein, a popliteal vein, a posterior tibial vein, an anterior tibial vein, or a peroneal vein.

After the thrombus has been identified, the process continues to the step shown in fig. 23-B, wherein the introducer sheath 102 is advanced in or against the direction of blood flow in the vessel such that the distal end of the introducer sheath 102 and/or the obturator 120 is proximate to the thrombus 2200, and in particular proximate to the thrombus 2200 at a location proximal to the thrombus. In some embodiments, this may include providing an introducer sheath 102 and percutaneously accessing a circulatory system of a patient, particularly a blood vessel or venous blood vessel of the patient, through an access site 2208, which access site 2208 may be one of the access sites described above.

As shown in fig. 23-C, after the introducer sheath 102 has been advanced to a desired position, the self-expanding funnel 1708 may be deployed and/or exposed from a constrained configuration to an expanded configuration. In some embodiments, the self-expanding funnel 1708 may be deployed by relative distal movement of the obturator 120 relative to the elongate member 106 until the funnel 1708 is no longer constrained by the capture sheath 1500, and then the obturator 120 may be proximally retracted through the lumen 1701 of the elongate member 106 until the obturator 120 is removed from the introducer sheath 102.

In some embodiments, relative distal movement of the obturator 120 relative to the elongate member may include fixing the position of the obturator 120 relative to the blood vessel 2202 and proximally retracting the elongate member 106 over the obturator 120 to expose the self-expanding funnel 1708 until the stop 1508 contacts the sealing aperture 112 and/or until monitoring of radiopaque markers (which may be fluoroscopic monitoring), for example, located in the tip 1502 of the obturator 120 and the distal end 110 of the elongate member 106, indicates that the self-expanding funnel 1708 is deployed and/or is no longer constrained by the capture sheath 1500. Alternatively, in some embodiments, relative distal movement of the obturator 120 relative to the elongate member may include fixing the position of the elongate member 106 relative to the blood vessel 2202 and advancing the obturator 120 distally to expose the self-expanding funnel 1708 until the stop 1508 contacts the sealing aperture 112 and/or until monitoring of radiopaque markers (which may be fluoroscopic monitoring), for example, located in the tip 1502 of the obturator 120 and the distal end 110 of the elongate member 106, indicates that the self-expanding funnel 1708 is deployed and/or is no longer constrained by the capture sheath 1500.

As shown in fig. 23-D, after the self-expanding funnel 1708 has been deployed, a portion of the thrombus extraction catheter 104, such as the outer shaft 138, may be inserted into the lumen 1701 of the introducer sheath 102 via the sealing aperture 112. In some embodiments, this may include providing a thrombus extraction catheter 104, the thrombus extraction catheter 104 including a thrombus extraction device 202. In some embodiments, the thrombus extraction device 202 can be constrained within the outer shaft 138 and can be inserted into the inner lumen of the elongate member 106 with the outer shaft 138 via the seal bore 112. In some embodiments, the diameter of the outer shaft 138 of the thrombus extraction catheter 104 can facilitate expanding the seal of the seal bore 112 such that the seal bore 112 seals around the outer shaft 138 and to the outer shaft 138.

As shown in fig. 23-E, after the outer shaft 138 has been inserted into the lumen 1701 of the introducer sheath 102, a portion of the thrombus extraction catheter 104 may be inserted into the blood vessel 2202 via the introducer sheath 102. In some embodiments, the distal end 132 of the thrombus extraction catheter 104 can be advanced to a position proximal to the thrombus 2200 and/or to a position proximal to the thrombus 2200. In some embodiments, insertion and/or advancement of the thrombus extraction catheter 104 may be monitored, particularly by fluoroscopy. In some embodiments, the position of one or several radiopaque markers (including radiopaque marker 222) of the thrombus extraction catheter 104 may be monitored.

As shown in fig. 23-F, after a portion of the thrombus extraction catheter 104 has been inserted into the blood vessel 2202, a portion of the thrombus extraction catheter 104 can be advanced distally through the clot 2200. In some embodiments, this distal advancement through the clot 2200 may be in or against the direction of blood flow. In some embodiments, distal advancement of a portion of the thrombus extraction catheter 104 through the clot 2000 can contain and/or constrain the thrombus extraction device 202. In some embodiments, advancing a portion of the thrombus extraction catheter 104 distally through the clot may comprise advancing a portion of the thrombus extraction catheter 104 until a radiopaque marker 222, which may be monitored by fluoroscopy and may be located at the distal end 218 of the inner shaft 200, passes distally through the thrombus 2200 and/or a portion of the thrombus 2200.

As shown in fig. 23-G, the thrombus extraction device 202 can be deployed after a portion of the thrombus extraction catheter 104 is advanced distally through the clot 2200. In some embodiments, the thrombus extraction device 202 can be deployed by advancing the thrombus extraction device 202 beyond the distal end 204 of the outer shaft 138 or by retracting the outer shaft 138 relative to the thrombus extraction device 202 until the thrombus extraction device 202 exceeds the distal end 204 of the outer shaft 138. In some embodiments, the thrombus extraction device can be deployed such that the thrombus extraction device 202 passes distally through the thrombus 2200 and/or passes distally through a desired portion of the thrombus 2200.

In some embodiments, the thrombus extraction device is advanced beyond the distal end 204 of the outer shaft 138 by advancing the intermediate shaft 140 distally relative to the outer shaft 138. In some embodiments, the intermediate shaft 140 can be advanced distally until the locking feature 146 contacts the mating feature 148, and the locking feature 146 can be mated and/or secured to the mating feature 148 to fix the relative position of the intermediate shaft 140 with respect to the outer shaft 138.

In some embodiments, the deployment of the thrombus extraction device 202 may be monitored, in particular, the deployment of the thrombus extraction device 202 may be monitored by fluoroscopy, e.g., by radiopaque markers 222 and radiopaque markers located at one or both of the distal end 204 of the outer sheath 138 and the distal end 212 of the intermediate sheath 140. In some embodiments, deployment of the thrombus extraction device 202, in particular advancement of the thrombus extraction device 202 beyond the distal end 204 of the outer shaft 138 or retraction of the outer shaft 138 relative to the thrombus extraction device 202, may be stopped based on the position of the distal end 204 of the outer sheath 138 including the radiopaque marker (first radiopaque marker) relative to the radiopaque marker 222 (second radiopaque marker) located on the thrombus extraction device 202.

As shown in fig. 23-H, after the thrombus extraction device 202 is deployed, the thrombus extraction device 202 can be fully expanded. In some embodiments, this may include allowing full expansion of the thrombus extraction device 202 such that the thrombus extraction device 202 engages the wall 2220 of the blood vessel 2202. In some embodiments, the thrombus extraction device 202 can be fully expanded by moving the plunger 154 from the first position to the second position and fixing the plunger 154 in the second position, thereby fixing the relative position of the inner shaft 200 with respect to the intermediate shaft 140. In some embodiments, movement of plunger 154 from the first position to the second position proximally retracts inner shaft 200 relative to intermediate shaft 140, thereby fully expanding expandable cylindrical portion 208 of thrombus extraction device 202. Proximal retraction of inner shaft 200 relative to intermediate shaft 140 may also engage stop 702 with ring feature 700, fully expanding self-expanding coring element 206. In some embodiments, the fixation of the plunger 154 in the second position may fix the self-expanding coring element 206 and the thrombus extraction device 202 in the fully expanded state by engagement of the stop 702 with the ring feature 700.

Referring now to FIGS. 24-A and 24-B, an alternative embodiment of the steps shown in FIGS. 23-G and 23-H is shown. In some embodiments, these alternative embodiments may be implemented when the diameter of the vessel 2202 containing the thrombus 2200 is reduced to less than a desired grade distally beyond the thrombus 2200. In some embodiments, for example, the diameter of the vessel 2202 may decrease as the distance from the heart increases. In some embodiments, the diameter may be reduced to a point where the thrombus extraction device 202 may no longer be usable.

In this embodiment, the extension sheath 2300, also referred to herein as the popliteal sheath 2300, may be percutaneously inserted into the vessel 2202 through a wall 2220 of the vessel 2202 such that at least a portion of the extension sheath 2300 extends from the patient. In some embodiments, the extension sheath 2300 may be percutaneously inserted into the vessel 2202 at a location prior to the vessel diameter being reduced below a desired value, such as less than 1mm, 2mm, 3mm, 4mm, 5mm, 6mm, 8mm, 10mm, or any other or intermediate value. In some embodiments, the extension sheath 2300 may be inserted into the vessel 2202 via an access site, such as a popliteal access site.

As shown in fig. 24-a, the thrombus extraction device 202 can be deployed. In some embodiments, the thrombus extraction device 202 can be deployed by advancing the thrombus extraction device 202 beyond the distal end 204 of the outer shaft 138 and into the extension sheath 2300 or by advancing the outer shaft 138 including the thrombus extraction device 202 into the extension sheath and then retracting the outer shaft 138 relative to the thrombus extraction device 202 until the thrombus extraction device 202 exceeds the distal end 204 of the outer shaft 138. In some embodiments, the thrombus extraction device can be deployed such that the thrombus extraction device 202 passes distally through the thrombus 2200 and/or passes distally through a desired portion of the thrombus 2200. In some embodiments, all or part of the thrombus extraction device can be contained within the extension sheath 2300.

In some embodiments, the outer shaft 138 of the thrombus extraction catheter 104 can be separated into first and second pieces. In some embodiments, the separation may occur at a separation point, which may include, for example, any feature configured to allow separation of the first and second pieces. These features may include partial depth slits or indentations in the outer shaft 138, overlapping friction fits in the outer shaft 138, and the like. In some embodiments, a detachable outer shaft 138 may be used in place of the extension sheath 2300. In such embodiments, the outer shaft 138 may exit the vessel 2202 at the entry point via the entry site such that the detachable portion extends from inside the vessel 2202 to outside the patient's body. In such embodiments, when the thrombus extraction device 202 is retracted, the detached portion of the outer sheath 138 can serve as the extension sheath 2300 and can remain in the entry point. Thus, the thrombus extraction device 202 may be deployed by fixing the position of the detached portion of the outer sheath 138 and retracting the thrombus extraction device 202 from the detached portion of the outer sheath 138.

In some embodiments, the thrombus extraction device can be advanced beyond the distal end 204 of the outer shaft 138 by advancing the intermediate shaft 140 distally relative to the outer shaft 138. In some embodiments, the intermediate shaft 140 may be advanced distally until the locking feature 146 contacts the mating feature 148. In some embodiments, the locking features 146 may mate and/or be secured to the mating features 148 to fix the relative position of the intermediate shaft 140 with respect to the outer shaft 138.

In some embodiments, the deployment of the thrombus extraction device 202 may be monitored by fluoroscopy, in particular, the deployment of the thrombus extraction device 202 may be monitored by fluoroscopy, for example, by the radiopaque marker 222 and the radiopaque marker located at one or both of the distal end 204 of the outer sheath 138 and the distal end 212 of the intermediate sheath 140. In some embodiments, deployment of the thrombus extraction device 202, in particular advancement of the thrombus extraction device 202 beyond the distal end 204 of the outer shaft 138 or retraction of the outer shaft 138 relative to the thrombus extraction device 202, may be arrested based on the position of the distal end 204 of the outer sheath 138 including the radiopaque marker (first radiopaque marker) relative to the radiopaque marker 222 (second radiopaque marker) located on the thrombus extraction device 202.

As shown in fig. 24-B, after the thrombus extraction device 202 is deployed, the thrombus extraction device 202 can be fully expanded. In some embodiments, the thrombus extraction device 202 can be fully expanded when all or a portion of the thrombus extraction device 202 is contained in the extension sheath 2300. In such embodiments, a portion of the thrombus extraction device 202 contained in the extension sheath may be prevented from reaching full expansion by the extension sheath 2300. In such embodiments, the thrombus extraction device 202 may reach full expansion as it is withdrawn proximally from the extension sheath 2300.

In some embodiments, full expansion of the thrombus extraction device 202 can include allowing expansion of the thrombus extraction device 202 such that the thrombus extraction device 202 engages the wall 2220 of the blood vessel 2202. In some embodiments, the thrombus extraction device 202 can be fully expanded by moving the plunger 154 from the first position to the second position and fixing the plunger 154 in the second position, thereby fixing the relative position of the inner shaft 200 with respect to the intermediate shaft 140. Movement of plunger 154 from the first position to the second position may retract inner shaft 200 proximally relative to intermediate shaft 140, thereby expanding expandable cylindrical portion 208 of thrombus extraction device 202. In some embodiments, proximal retraction of the inner shaft 200 relative to the intermediate shaft 140 can also engage the stop 702 with the ring feature 700, thereby fully expanding the self-expanding coring element 206. In some embodiments, the fixation of the plunger 154 in the second position may fix the self-expanding coring element 206 and the thrombus extraction device 202 in the fully expanded state by engagement of the stop 702 with the ring feature 700.

In some such embodiments in which the TED 202 is wholly or entirely contained within the extension sheath 2300, the TED 202 may be retracted until the self-expanding coring element 206 is outside the extension sheath 2300, at which point the inner shaft 200 may be separated from the distal end 217 of the expandable cylindrical portion 208 and the plunger 154 may be moved from the first position to the second position to fully expand the self-expanding coring element 206. Then, the TED 202 may be further retracted and the expandable cylindrical portion 208 may be expanded by gradually recoupling the distal end 217 of the expandable cylindrical portion 208 to the inner shaft 200 as the expandable cylindrical portion 208 exits the extension sheath 2300 until the expandable cylindrical portion 208 has completely exited the extension sheath 2300 and fully expanded, wherein the distal end 217 of the expandable cylindrical portion 208 is recoupled to the inner shaft 140. Alternatively, in some embodiments, the distal end 217 of the expandable cylindrical portion 208 can remain decoupled from the inner shaft 140 until the expandable cylindrical portion 208 has fully exited the extension sheath 2300. Once the expandable cylindrical portion 208 has fully exited the extension sheath 2300, the distal end 217 of the expandable cylindrical portion 208 can be recoupled to the inner shaft 200 and the expandable cylindrical portion 208 can expand to full expansion.

Referring now to fig. 25-a to 25-H, the process of removing a thrombus 2200 through the expanded thrombus extraction device 202 is shown. In some embodiments, the thrombus 2200 can be removed by proximally retracting the thrombus extraction device 202 through the thrombus 2200 and capturing the thrombus in the thrombus extraction device 202, which proximal retraction of the thrombus extraction device 202 can be, for example, in the direction of blood flow through the blood vessel 2202 or opposite the direction of blood flow through the blood vessel 2202. In some embodiments, proximal retraction of the thrombus extraction device 202 through the thrombus 2200 can result in capture of the distal end 2206 of the thrombus 2200 occurring before capture of the proximal end 2204 of the thrombus 2200.

In some embodiments, proximal retraction of the thrombus extraction device 202 can result in separation and/or coring of at least a portion of the thrombus 2200 from the wall 2220 of the blood vessel 2202, for example, by the self-expanding coring element 206 and/or the scaffold portion, and capturing the separated portion of the thrombus 2200 within the expandable cylindrical portion 208. In some embodiments, the expandable cylindrical portion 208 may be formed from a braided wire mesh structure, which may be, for example, a mesh wire mesh structure. In some embodiments, a portion of the thrombus may be captured within the expandable cylindrical portion 208 by entering the expandable cylindrical portion 208 via the mouth 414 of the self-expanding coring element 206 and/or via one or several voids 404 of the self-expanding coring element 206.

As seen in fig. 25-a, the distal end 2206 of the thrombus 2200 is detached and/or cored from the wall 2220 of the blood vessel 2202 by the self-expanding coring element 206 by proximal retraction of the thrombus extraction device 202. As seen in fig. 25-B, the distal end 2206 of the thrombus 2200 is captured in the expandable cylindrical portion 208 of the thrombus extraction device by continued proximal retraction of the thrombus 2200 by the thrombus extraction device. The separation and capture and/or coring and capturing of other portions of the thrombus 2200 by continued proximal retraction of the thrombus extraction device 202 is illustrated in FIGS. 25-C, 25-D, and 25-E. As seen in fig. 25-E, as the thrombus extraction device 202 is proximally retracted toward the self-expanding funnel 1708, the proximal end 2204 of the thrombus 2200 is cored and captured.

In some embodiments, as seen in fig. 25-F, the thrombus extraction device 202 may be proximally retracted until a portion of the self-expanding coring element 206 is contained within the self-expanding funnel 1708, specifically until the mouth 414 of the self-expanding coring element 206 is contained within the self-expanding funnel 1708. In some embodiments, the inclusion of the mouth 414 within the self-expanding funnel 1708 may be verified by fluoroscopy. In some embodiments, based on the alignment/relative positioning of the distal end 212 of the middle shaft 140 including the radiopaque marker 2450 and/or the radiopaque marker 222 relative to the distal end 110 of the elongate member 106 of the introducer sheath 102 including the radiopaque marker 2452, it can be determined by fluoroscopic monitoring that the mouth 414 is entirely contained within the self-expanding funnel 1708.

When a portion of the self-expanding coring element 206 is contained within the self-expanding funnel 1708, or specifically when the mouth 414 of the self-expanding coring element 206 is contained entirely within the self-expanding funnel 1708, the plunger 154 may be unlocked from the second position and may be moved from the second position to the first position, thereby moving the thrombus extraction device 202 from the expanded configuration to the unexpanded configuration. In some embodiments, unlocking of plunger 154 from the second position can unlock and/or separate inner shaft 200 relative to intermediate shaft 140, and moving plunger 154 from the second position to the first position can cause inner shaft 200 to advance distally relative to intermediate shaft 140.

In some embodiments, the thrombus extraction device 202 can be collapsed by moving the thrombus extraction device 202 from the expanded configuration to the unexpanded configuration prior to withdrawing the thrombus extraction device 202 from the patient, thereby compressing the thrombus 2200 captured by the thrombus extraction device 202. In some embodiments, compression of the thrombus 2200 by the thrombus extraction device 202 can fix the position of the thrombus within the thrombus extraction device 202, which in some embodiments is accomplished by engagement of one or several of the plurality of circumferential recesses 1000 with the thrombus 2200.

As shown in fig. 25-G, after the thrombus extraction device 202 has collapsed, the thrombus extraction device 202 may be proximally retracted through the self-expanding funnel 1708 into the elongate member 106. In some embodiments, collapse of the thrombus extraction device 202 and/or retraction of the thrombus extraction device 202 into the self-expanding funnel 1708 and/or the elongate member may cause all or part of the thrombus 2200 to be extruded through the apertures of the expandable cylindrical portion 208 of the thrombus extraction device 202, including, for example, some or all of the first set of plurality of apertures 904 and/or the second set of plurality of apertures 906. In some embodiments, all or a portion of the thrombus 2200 can be extruded through some or all of the second plurality of holes 906, and the second plurality of holes 906 can be larger than the first plurality of holes 904. In some embodiments, the size of the apertures in the second plurality of apertures 906 may be small enough such that any portion of the thrombus 2200 that is extruded through the apertures is small enough to have little or no clinical significance. In some embodiments, all or a portion of these extruded portions of the thrombus 2200 may be captured by the self-expanding funnel 1708.

As shown in fig. 25-H, the thrombus extraction device 202 may continue to be proximally retracted until the thrombus extraction device 202 and the captured thrombus 2200 are fully contained within the elongate member 106. In some embodiments, the seal dilator 170 can be inserted into the seal aperture 112, and then the thrombus extraction device 202 and captured thrombus 2200 can be withdrawn or removed from the patient and from the elongate member 106 via the seal aperture 112 in the seal dilator 170. In some embodiments, the thrombus captured by the self-expanding funnel 1708 may then be directed into the elongate member 106, specifically into the lumen 1701 of the elongate member 106, or further compressed and/or broken by the self-expanding funnel 1708, and then allowed to pass through the self-expanding funnel 1708 and specifically through the mesh of the self-expanding funnel 1708. In some embodiments, the thrombus may be withdrawn through the lumen 1701 of the elongate member 106 and the aspirate port 114. In some embodiments, the extraction of thrombus via the aspirate port 114 may include opening the aspirate valve 118. After the thrombus captured by the self-expanding funnel 1708 is withdrawn, the introducer sheath 102 may be removed from the patient.

Referring now to fig. 26-28, an introduction technique for accessing a thrombus 2200 is shown. In some embodiments, these introduction techniques may allow for the use of a larger sized introducer sheath 102 due to the larger size of the vessel in the path to the thrombus. In some embodiments, this larger size of the introducer sheath 102 may facilitate removal of thrombus through the introducer sheath 102, as the size of the lumen 1701 of the introducer sheath 102 may increase with increasing size of the introducer sheath 102 in some embodiments. Further, in some embodiments, the use of a larger sized introducer sheath 102 can allow for the removal of larger thrombi. In some embodiments, the length of the components of the thrombus extraction system 100, particularly the length of the introducer sheath 102 and the thrombus extraction catheter 104, can vary based on the technique selected for accessing the thrombus and/or based on the location of the thrombus.

As seen in fig. 26, the introducer sheath 102 may be inserted into the patient via the cervical access site 2500. The introducer sheath 102 can extend from the neck access site 2500 to a deployed position 2502, which deployed position 2502 can be proximal to the thrombus 2200. In embodiments where the introducer sheath 102 includes a self-expanding funnel 1708, the self-expanding funnel 1708 can be deployed at the deployed position 2502. In the embodiment shown in fig. 26, the introducer sheath can extend from the cervical access site 2500 through the superior and inferior vena cava to a deployed position 2502 in one of the common iliac veins. In some embodiments, the deployed position 2502 may be located, for example, in one of the inferior vena cava, iliac vein, femoral vein, popliteal vein, before or beyond the iliac arch, or any other location proximal to the thrombus 2200 and/or proximal to the thrombus 2200. In some embodiments, the use of the neck access site 2500 may allow for a larger diameter of the elongate member 106.

As seen in fig. 27, in some embodiments, the use of an intra-cervical access site 2500 can be combined with the use of an extension sheath 2300, which can be inserted into the blood vessel 2202 at the popliteal access site 2600. In some such embodiments, the thrombus extraction device can be wholly or partially removed from the patient's body and contained within the extension sheath 2300 prior to retraction through the thrombus 2200.

As seen in fig. 28, in some embodiments, the introducer sheath may be inserted into the patient via the common iliac vein into an access site connected to a vessel 2202 containing thrombus. In the particular embodiment shown in fig. 28, this may be accomplished by insertion into the patient through a femoral access site 2700. In some embodiments, the use of an access site connected to the vessel 2202 via the common iliac vein, particularly the use of the femoral access site 2700, may be combined with the use of an extension sheath 2300, which may be inserted into the vessel 2202 at the popliteal access site 2600. In some such embodiments, the thrombus extraction device can be wholly or partially removed from the patient's body and contained within the extension sheath 2300 prior to retraction through the thrombus 2200.

Other variations are within the spirit of the invention. While certain exemplary embodiments of the invention have been illustrated in the accompanying drawings and described in the foregoing detailed description, the invention is capable of various modifications and alternative constructions. It should be understood, however, that there is no intention to limit the invention to the specific form or forms disclosed, but on the contrary, the intention is to cover all modifications, alternative constructions, and equivalents falling within the spirit and scope of the invention as defined in the appended claims.

In the foregoing description, various embodiments of the invention have been described. For purposes of explanation, specific configurations and details are set forth in order to provide a thorough understanding of the embodiments. However, it will be apparent to one skilled in the art that the present invention may be practiced without these specific details. Furthermore, well-known features may be omitted or simplified in order not to obscure the described embodiments.

The use of the terms "a" and "an" and "the" and similar referents in the context of describing the invention (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. The terms "comprising," "having," and "containing" are to be construed as open-ended terms (i.e., meaning "including, but not limited to,") unless otherwise noted. The term "connected," even if something is interposed therebetween, is to be understood as being partially or wholly contained within "attached to" or "joined together. Recitation of ranges of values herein are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range, unless otherwise indicated herein, and each separate value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., "such as") provided herein, is intended merely to better illuminate embodiments of the invention and does not pose a limitation on the scope of the invention unless otherwise claimed. No language in the specification should be construed as indicating any non-claimed element as essential to the practice of the invention.

Preferred embodiments of this invention are described herein, including the best mode known to the inventors for carrying out the invention. Variations of those preferred embodiments may become apparent to those of ordinary skill in the art upon reading the foregoing description. The inventors expect skilled artisans to employ such variations as appropriate, and the inventors intend for the invention to be practiced otherwise than as specifically described herein. Accordingly, this invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the invention unless otherwise indicated herein or otherwise clearly contradicted by context.

All references, including publications, patent applications, and patents, cited herein are hereby incorporated by reference to the same extent as if each reference were individually and specifically indicated to be incorporated by reference and were set forth in its entirety herein.