US20100030314A1 - Implantable support device with graft - Google Patents
Implantable support device with graft Download PDFInfo
- Publication number
- US20100030314A1 US20100030314A1 US12/576,481 US57648109A US2010030314A1 US 20100030314 A1 US20100030314 A1 US 20100030314A1 US 57648109 A US57648109 A US 57648109A US 2010030314 A1 US2010030314 A1 US 2010030314A1
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- Prior art keywords
- support frame
- medical device
- implantable medical
- graft member
- barbs
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2475—Venous valves
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2412—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves
- A61F2/2418—Scaffolds therefor, e.g. support stents
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/848—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents having means for fixation to the vessel wall, e.g. barbs
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0008—Fixation appliances for connecting prostheses to the body
- A61F2220/0016—Fixation appliances for connecting prostheses to the body with sharp anchoring protrusions, e.g. barbs, pins, spikes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/005—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using adhesives
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0058—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements soldered or brazed or welded
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0017—Angular shapes
- A61F2230/0026—Angular shapes trapezoidal
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0028—Shapes in the form of latin or greek characters
- A61F2230/0054—V-shaped
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0095—Saddle-shaped
Definitions
- the invention relates to medical devices. More particularly, the invention relates to intraluminal support devices with attached graft members. Exemplary embodiments of the invention relate to intraluminal prosthetic valves, such as prosthetic venous valves.
- venous valves are susceptible to becoming insufficient due to one or more of a variety of factors. Over time, the vessel wall may stretch, affecting the ability of the valve leaflets to close. Furthermore, the leaflets may become damaged, such as by formation of thrombus and scar tissue, which may also affect the ability of the valve leaflets to close. Once valves are damaged, venous valve insufficiency is present, and can lead to discomfort and possibly ulcers in the legs and ankles.
- venous valve insufficiency treatments for venous valve insufficiency include the use of compression stockings that are placed around the leg of a patient. Surgical techniques are also employed in which valves can be bypassed or replaced with autologous sections of veins with competent valves.
- Minimally invasive techniques and instruments for placement of intraluminal medical devices have developed over recent years.
- a wide variety of treatment devices that utilize minimally invasive technology has been developed and includes stents, stent grafts, occlusion devices, infusion catheters and the like.
- Minimally invasive intravascular devices have especially become popular with the introduction of coronary stents to the U.S. market in the early 1990's.
- Coronary and peripheral stents have been proven to provide a superior means of maintaining vessel patency, and have become widely accepted in the medical community.
- the use of stents has been extended to treat aneurisms and to provide occlusion devices, among other uses.
- prosthetic valves have been developed that use a support frame such as a stent.
- a graft member is attached to the support frame and provides a valve function to the device.
- the graft member can be in the form of a leaflet that is attached to a stent and movable between first and second positions. In a first position, the valve is open and allows fluid flow to proceed through a vessel in a first direction, and in a second direction the valve is closed to prevent fluid flow in a second, opposite direction.
- An example of this type of prosthetic valve is described in commonly owned U.S. Pat. No.
- a tube that terminates in leaflets is attached to one or more support frames to form a valve.
- the leaflets open to permit fluid flow in a first direction in response to fluid pressure on one side of the leaflets, and close to prevent fluid flow in a second, opposite direction in response to fluid pressure on opposite sides of the leaflets.
- An example of this configuration is provided in U.S. Pat. No. 6,494,909 to Greenhalgh for AN ENDOVASCULAR VALVE, which is hereby incorporated by reference in its entirety.
- Prosthetic valves are designed to replace or supplement the function of incompetent natural valves.
- the use of an expandable support frame in valve devices allows for the use of minimally invasive delivery devices and techniques for placement of the valves within body vessels, which will likely lower the overall cost of treatment and increase the acceptance of these medical devices by practitioners and patients alike.
- a support frame and a valve member such as a graft member
- a valve member such as a graft member
- the dynamic environment in which prosthetic valves are placed requires a connection that minimizes migration of the graft member on the support frame.
- the invention provides intraluminal medical devices that include structural features adapted to enable a more stable connection between the graft member and the support frame.
- the invention provides implantable medical devices that include a graft member attached to a support frame that defines structural features that enable a more stable connection between the graft member and the support frame.
- medical devices according to the invention provide a valve for regulating fluid flow through a body vessel. The device is particularly well suited for percutaneous delivery through a body vessel to a point of treatment, and comprises a prosthetic venous valve in an illustrative embodiment.
- the prosthetic venous valves according to the invention include a support frame, such as an endoluminal stent, that has radially compressed and radially expanded configurations.
- the support frame can comprise any suitable support frame, including self expandable, balloon expandable, wire, tube, metal, polymeric, composite, and other types of support frames known in the art.
- the devices also include at least one graft member attached to the support frame.
- the graft member preferably provides a valve function to the device.
- the graft member comprises a valve leaflet that moves between first and second positions while remaining attached to the support frame. In the first position, the leaflet substantially blocks the lumen of the vessel, while the lumen is substantially open when the leaflet is in the second position.
- the leaflet permits fluid flow through the vessel in a first direction when in the first position, and substantially prevents fluid flow in a second, opposite direction when in the second position.
- the graft member can also be formed into other suitable valve configurations, such as a duckbill configuration, a tube or partial tube configuration, and an evertable tube configuration.
- the graft member can be formed of any suitable material, including natural and synthetic materials.
- the graft member is formed of an Extracellular Matrix (ECM) material, such as Small Intestine Submucosa (SIS).
- ECM Extracellular Matrix
- SIS Small Intestine Submucosa
- the graft member can be attached to the support frame in a variety of ways, such as by sutures or other suitable attachment elements.
- the support frame defines one or more structural features that provide a securement position at which the graft member can be attached to the support frame.
- the structural feature is adapted to prevent migration of the graft material relative to the support frame.
- the type of structural feature utilized depends on the type of support frame used. For example, when a wire support frame is utilized, a loop or eyelet structure can be formed readily in the wire of the support frame. The loop or eyelet can be used as a securement position at which the graft member can be attached to the support frame by an attachment element.
- a tube member such as a stent cut from a solid tube of material
- the formation of loops and eyelets may be difficult.
- other structural features such as contoured struts, areas of enlarged width, barbs formed on the struts, strut projections, clips, and other structures can be used.
- various attachment techniques can be utilized for attaching the graft member to the support frame.
- the graft member is adhered to itself or to the support frame with agents such as tissue adhesives, cross-linkers, or natural materials such as fibrin. Also, techniques such as laser welding can be used. Furthermore, the graft member itself can define structural features that facilitate attachment to a support frame, such as a tab and corresponding slot.
- FIG. 1 is a top view of a support frame for use in medical devices according to the invention.
- FIG. 1 a is an enlarged partial cross sectional view of the support frame illustrated in FIG. 1 .
- FIG. 2 is a perspective view of the support frame of FIG. 1 deployed inside a body vessel.
- FIG. 3 is a top view of a prosthetic venous valve according to a first exemplary embodiment of the invention.
- FIG. 4 is an enlarged partial view of the prosthetic venous valve illustrated in FIG. 3 .
- FIG. 5 is a perspective view of a support frame for use in medical devices according to the invention.
- FIG. 6 is a perspective view of the support frame illustrated in FIG. 5 in a radially compressed configuration.
- FIG. 7 is a partial view of a contoured strut for use in a medical device according to one embodiment of the invention.
- FIG. 8 is a partial view of a contoured strut for use in a medical device according to another embodiment of the invention.
- FIG. 9 is a partial view of a contoured strut for use in a medical device according to another embodiment of the invention.
- FIG. 10 is a partial view of a contoured strut for use in a medical device according to another embodiment of the invention.
- FIG. 11 is a partial view of a contoured strut having an area of increased width for use in a medical device according to another embodiment of the invention.
- FIG. 12 is a partial view of a contoured strut defining projections for use in a medical device according to another embodiment of the invention.
- FIG. 13 is a partial view of a support frame for use in a medical device according to another embodiment of the invention.
- FIG. 14 is an enlarged partial view of the support frame illustrated in FIG. 13 .
- FIG. 15 is a top view of a support frame for use in medical devices according to another embodiment of the invention.
- FIG. 16 is a perspective view of a medical device according to the invention positioned within a body vessel.
- FIG. 17 is a partial cross-sectional view taken along line a-a in FIG. 16 .
- FIG. 18 is a schematic illustration of one configuration of barbs on a strut according to an embodiment of the invention.
- FIG. 19 is a schematic illustration of one configuration of barbs on a strut according to another embodiment of the invention.
- FIG. 20 is a schematic illustration of one configuration of barbs on a strut according to another embodiment of the invention.
- FIG. 21 is a partial cross-sectional view of a medical device according to another embodiment of the invention.
- FIG. 22 a is a schematic illustration of the fabrication of the medical device illustrated in FIG. 21 .
- FIG. 22 b is a schematic illustration of the fabrication of the medical device illustrated in FIG. 21 .
- FIG. 22 c is a schematic illustration of the fabrication of the medical device illustrated in FIG. 21 .
- FIG. 23 is a partial cross-sectional view of a medical device according to an embodiment of the invention.
- FIG. 24 is a partial cross-sectional view of a medical device according to another embodiment of the invention.
- FIG. 25 is a partial cross-sectional view of a medical device according to another embodiment of the invention.
- FIG. 26 is a partial cross-sectional view of a medical device according to another embodiment of the invention.
- FIG. 27 is a partial cross-sectional view of a medical device according to another embodiment of the invention.
- FIG. 28 is a partial cross-sectional view of a medical device according to another embodiment of the invention.
- FIG. 29 is a partial view of a medical device according to another embodiment of the invention.
- FIG. 30 is a top view of a medical device according to another embodiment of the invention.
- FIG. 31 is a partial view of a medical device according to another embodiment of the invention.
- FIG. 32 is an enlarged partial view of a medical device according to another embodiment of the invention.
- FIG. 33 is a partial view of a medical device according to another embodiment of the invention.
- FIG. 34 is a partial view of a medical device according to another embodiment of the invention.
- FIG. 35 is a partial view of a medical device according to another embodiment of the invention.
- a medical device provides a support frame with an attached graft member.
- Exemplary embodiments of the invention provide a valve for regulating fluid flow through a body vessel.
- Medical devices according to these embodiments include a support frame and a graft member that imparts a valve function to the device.
- the support frame provides an attachment member for the graft member.
- a wide variety of support frames are known in the art, and any suitable support frame can be utilized.
- the support frame can also provide a stenting function, i.e., exert a radially outward force on the interior vessel wall, although this function is not necessary and is considered optional.
- the medical devices of the invention can provide both a stenting and a valving function at a point of treatment.
- the stent art provides numerous support frames acceptable for use in the invention, and any suitable stent can be used.
- the support frame need only provide the desired attachment member for the graft member.
- the specific support frame chosen will depend on numerous factors, including the vessel in which the device is being implanted, the axial length of the treatment site, the number of valves desired in the support frame, the inner diameter of the vessel, the delivery method for placing the support frame and valve, and others. Those skilled in the art can determine an appropriate support frame based on these and other factors.
- the support frame can be either self-expandable or balloon expandable.
- a balloon expandable support frame may provide advantage to treatment sites where greater radial strength is desired.
- Self-expandable stents provide a relatively simple deployment at the point of treatment.
- Suitable support frames can also have a variety of configurations, including braided strands, helically wound strands, ring members, consecutively attached ring members, tube members, and frames cut from solid tubes.
- Suitable support frames can be made from a variety of materials, and need only be biocompatible, or able to be made biocompatible, and provide the desired stenting function, if appropriate.
- suitable materials include, without limitation, stainless steel, nickel titanium (NiTi) alloys, e.g., nitinol, other shape memory and/or superelastic materials, cobalt-chromium alloys, natural and synthetic polymers, and composite materials.
- suitable polymeric materials include polypropylenes and polyethylenes.
- a resorbable material can also be use for the support frame.
- the term “resorbable” refers to the ability of a material to be absorbed into a tissue and/or body fluid upon contact with the tissue and/or body fluid.
- resorbable materials are known in the art, and any suitable resorbable material can be used.
- suitable types of resorbable materials include resorbable homopolymers, copolymers, or blends of resorbable polymers.
- suitable resorbable materials include poly-alpha hydroxy acids such as polylactic acid, polylactide, polyglycolic acid (PGA), or polyglycolide; trimethlyene carbonate; polycaprolactone; poly-beta hydroxy acids such as polyhydroxybutyrate or polyhydroxyvalerate; or other polymers such as polyphosphazines, polyorganophosphazines, polyanhydrides, polyesteramides, polyorthoesters, polyethylene oxide, polyester-ethers (e.g., polydioxanone) or polyamino acids (e.g., poly-L-glutamic acid or poly-L-lysine).
- PGA polyglycolic acid
- trimethlyene carbonate such as polyhydroxybuty
- Stainless steel and nitinol are currently considered desirable materials for use in the support frame due at least to their biocompatibility, shapeability, and well-characterized nature.
- suitable support frames for use in medical devices according to the invention include those described in U.S. Pat. No. 6,464,720 to Boatman et al. for a RADIALLY EXPANDABLE STENT; U.S. Pat. No. 6,231,598 to Berry et al. for a RADIALLY EXPANDABLE STENT; U.S. Pat. No. 6,299,635 to Frantzen for a RADIALLY EXPANDABLE NON-AXIALLY CONTRACTING SURGICAL STENT; U.S. Pat. No.
- FIG. 1 illustrates a suitable wire support frame 10 for use in a medical device according to the invention.
- This support frame 10 is exemplary of suitable support frames that can be modified to include the invention.
- Support frame 10 is described in detail in U.S. Pat. No. 6,508,833 to Pavcnik et al. for a MULTIPLE-SIDED INTRALUMINAL MEDICAL DEVICE, which is hereby incorporated by reference in its entirety.
- the support frame 10 is made of resilient material, preferably metal wire formed from stainless steel or a superelastic alloy, such as nitinol.
- the frame 10 comprises a closed circumference of a single piece of material that is formed into a device having a plurality of sides 12 interconnected by a series of bends 14 , 16 , 18 , 20 .
- the depicted embodiment includes four sides 12 of approximately equal length.
- Alternative embodiments include forming a frame into any polygonal shape, for example, a pentagon, hexagon, octagon, etc. In the embodiment of FIG.
- each of the bends 14 , 16 , 18 , 20 interconnecting the sides 13 comprise a coil 14 of approximately one and a quarter turns.
- Alternative bend embodiments include outward-projecting fillets and inward-projecting fillets comprising a series of curves. Fillets are well known in the stent art as a means to reduce stresses in bends. When using stainless steel wire, the size of the wire which should be selected depends on the size of device and the application. Wire that is too stiff can damage the vessel, not conform well to the vessel wall, and increase the profile of the device when loaded in the delivery system prior to deployment.
- the single piece of material comprising the frame 10 is formed into the closed circumference by securing the first and second ends 24 , 26 with an attachment mechanism 28 such as a piece of metal cannula (see FIG. 1A ).
- the ends 24 , 26 of the single piece are inserted into the cannula 28 and secured with solder 30 , a weld, adhesive, or crimping to form the closed frame 10 .
- the ends 24 , 26 of the single piece can be joined directly without addition of a cannula 28 , such as by soldering, welding, or other methods to join ends 24 , 26 .
- the frame could be fabricated as a single piece of material, by stamping or cutting the frame 10 from another sheet (e.g., with a laser), fabricating from a mold, or some similar method of producing a unitary frame.
- the support frame 10 depicted in FIG. 1 is shown in a first configuration 25 whereby all four bends 14 , 16 , 18 , 20 and each of the sides 12 generally lie within a single flat plane.
- a second configuration 35 shown in FIG. 2
- the frame 10 of FIG. 1 is folded twice, first along one diagonal axis 32 with opposite bends 16 and 20 being brought into closer proximity, followed by opposite bends 14 and 18 being folded toward one another and brought into closer proximity.
- the second configuration 35 depicted in FIG.
- the medical device in the second configuration 35 can be used as a stent to maintain an open lumen 36 in a vessel 38 , such as a vein, artery, or duct.
- the bending stresses introduced to the frame 10 by the first and second folds required to form the second configuration 35 apply force radially outward against the vessel wall 40 to hold the frame 10 in place and prevent vessel closure.
- the second configuration 35 when not in the vessel or subject to other constraining means, will at least partially return to the first configuration 25 , although some deformation can occur depending on the material used. It is also possible to plastically deform the frame 10 into the second configuration 35 , such that it does not unfold when restraint is removed. This might be particularly desired if the device is made from nitinol or a superelastic alloy.
- FIG. 3 illustrates a medical device 100 formed from a wire support frame 110 configured into a diamond shape 112 .
- a graft member 114 is attached to the support frame 110 and has two leaflets 116 , 118 that define a central opening 120 .
- the graft member 114 is attached to the support frame 110 by attachment elements 122 .
- attachment element refers to any member that can be used to form a connection between a support frame and a graft member. Examples of suitable attachment elements include, without limitation, sutures, coils, wires, clips, rings, and other suitable members.
- the attachment element can comprise a separate member or can be integrally formed by the support frame or graft member.
- the specific attachment element chosen for a particular embodiment of the invention will depend on various considerations, including the type and configuration of the support frame and/or graft member.
- the support frame 110 illustrated in FIG. 3 includes bends 124 , 126 , 128 and 130 that each comprise a coil 132 .
- the coil 132 provides an eyelet configuration in the support frame 110 .
- the coil 132 defines a structural feature in the support frame 110 to which the graft member 114 can be attached.
- FIG. 4 illustrates a magnified view of a coil 132 in the device 100 illustrated in FIG. 3 .
- the graft member 114 has a notch area that receives the coil 132 and allows for the placement of attachment elements 122 around the portion of the support frame 110 in the coil 132 and through the adjacent graft member 114 .
- the coil 132 provides an additional attachment point for the graft member 114 .
- the graft member 114 is not able to migrate along the support frame 110 near the position of the coil 132 because the overlap region 134 blocks the attachment elements 122 from traveling along the support frame 110 .
- the overlap region 134 is a length along the support frame 110 that includes at least two thicknesses of the wire member that forms the support frame 110 . To further prevent migration in this area, the two portions of the support frame 110 that overlap in the overlap region 134 can be joined together by various means, such as placement of an attachment element at the overlapping portions.
- FIGS. 5 and 6 illustrate a second type of support frame 210 suitable for use in medical devices according to the invention.
- Support frame 210 is described in detail in U.S. Pat. No. 6,299,635, to Frantzen.
- the support frame 210 comprises a unitary member cut from a solid piece of metal tubing, such as by laser cutting.
- a variety of unitary support frames cut from tubes are known to those skilled in the art. Any suitable support frame of this type can be utilized in the invention.
- these support frames such as the support frame 210 illustrated in FIG. 5 , include a plurality of struts 212 of the tube material left after the cutting process.
- a plurality of open spaces 214 is formed by the removal of the material between the struts 212 .
- struts 212 and open spaces 214 can be utilized. The configuration chosen will depend on numerous factors, including the size of the vessel, the desired radial strength of the stent, and the desired longitudinal flexibility of the stent. Also, as will be described more fully below, the struts 212 can be configured in a variety of manners in accordance with the invention to provide the desired attachment of the graft member to the support frame 210 .
- FIG. 6 illustrates the radially compressed configuration of the support frame 210 .
- the open spaces 214 are reduced in size when the support frame is in the radially compressed configuration.
- Support frames cut from tube members, such as the frame 210 illustrated in FIGS. 5 and 6 are typically balloon expandable support frames.
- Medical devices include a support frame and a graft member.
- the graft member can be attached to the support frame in a variety of configurations.
- the support can define structural features that are adapted to substantially prevent movement of the graft member along the struts of the support frame.
- struts of the support frame are contoured to provide at least one non-linear segment across which a graft member can be attached.
- FIGS. 7 through 10 illustrate portions of medical devices in accordance with this first series of embodiments.
- FIG. 7 illustrates a portion of a medical device 300 according to an embodiment of the invention.
- a strut 310 defines a serpentine path 312 that includes a plurality of non-linear segments 314 .
- the serpentine path 312 is defined by a single strut 310 , and does not include any bend or other transition to another strut.
- FIG. 35 illustrates an alternate embodiment in which one strut 1800 defines a structural feature, such as enlarged region 1802 , that cooperates with one or more other struts 1804 , 1806 to prevent migration of an attachment element 1808 that attaches a graft member 1810 to the strut 1800 .
- a structural feature such as enlarged region 1802
- the graft member 316 is secured to the strut 310 by two or more attachment elements 318 that surround a circumference of the strut 310 and extend through the graft member 316 .
- the graft member 316 is a sheet of material and an edge 317 of the graft member 316 is in contact with a surface of the strut 310 . This contact can be an abutting relationship.
- an attachment element 318 can be disposed on each side of a non-linear segment 314 along the strut 310 .
- a series of attachment elements 318 are secured to the strut 310 and graft member 316 along a series of non-linear segments 314 on the strut 310 .
- the graft member 316 is substantially prevented from migrating due to the curvilinear path that would need to be traveled by the attachment elements 318 for such migration to occur.
- the graft member can comprise any suitable material for implantation in a body vessel.
- the graft member need only be biocompatible or be able to be made biocompatible.
- suitable materials for the graft member include natural materials, synthetic materials, and combinations thereof.
- suitable natural materials include ECMs, such as small intestine submucosa (SIS), and other bioremodellable materials, such as bovine pericardium.
- ECMs such as small intestine submucosa (SIS), and other bioremodellable materials, such as bovine pericardium.
- Other examples of ECM materials that can be used for the graft member include stomach submucosa, liver basement membrane, urinary bladder submucosa, tissue mucosa, and dura mater.
- suitable synthetic materials include polymeric materials, such as expanded polytetrafluoroethylene and polyurethane.
- ECMs are particularly well suited materials for use in the graft member, at least because of their abilities to remodel and become incorporated into adjacent tissues. These materials can provide a scaffold onto which cellular in-growth can occur, eventually allowing the material to remodel into a structure of host cells.
- FIG. 8 illustrates a portion of medical device 400 according to another embodiment of the invention.
- the strut 410 defines a plurality of angulated linear segments 412 .
- the attachment elements 414 are preferably disposed across these angulated segments.
- an edge 417 of the graft member 416 is in contact with a surface of the strut 410 .
- the graft member 416 has one or more folds 418 that are substantially coaxial with a portion of the strut 410 and provide a point at which the graft member 416 can be secured to the strut 410 by attachment element 414 .
- FIG. 9 illustrates a portion of a medical device 500 according to another embodiment of the invention. This embodiment is similar to that illustrated in FIG. 8 , except that the graft member 516 does not include folds.
- the strut 510 includes a plurality of angulated linear segments 512 .
- a series of attachment elements 514 secure the graft member 516 to the strut 510 .
- the graft member 516 follows a substantially linear path.
- an edge 517 of the graft member is in contact with a surface of the strut 510 .
- FIG. 10 illustrates a portion of a medical device 600 according to another embodiment of the invention. This embodiment is similar to the embodiment illustrated in FIG. 7 , except as described below.
- the strut 610 includes linear portions 612 disposed between adjacent curvilinear segments 614 .
- the linear segment 612 provides an area for attachment of attachment elements 616 to the strut 610 .
- the curvilinear portions 614 are disposed between two linear segments 612 and provide a structural feature that substantially prevents sliding of attachment elements 616 along the strut 610 .
- An edge 617 of the graft member 618 is in contact with a surface of the strut 610 .
- FIG. 11 illustrates a portion of a medical device 700 according to another embodiment of the invention.
- the strut 710 includes a portion 712 having an increased width w 2 .
- the width w 2 of the area 712 is greater than the width w 1 of at least one other portion of the strut 710 .
- the term “width” refers to any dimension of a strut other than length, and includes a width of a substantially two dimensional strut, a thickness of a three dimensional strut, and a diameter of a strut with a substantially circular cross-sectional shape. As illustrated in FIG.
- a portion 712 having an increased width w 2 is disposed between two portions 714 of a lesser width, such as width w 1 .
- Attachment elements 716 are disposed around a circumference of the strut 710 and through the graft member 718 at a position on the strut between portions 712 and 714 .
- the attachment elements 716 are drawn tight to the circumference of the strut 710 at these locations. Consequently, each attachment element 716 is substantially prevented from migrating towards an adjacent portion 712 of increased width w 2 .
- the prevention of migration is effective in both directions because migration of one attachment element 716 towards an adjacent portion 714 of lesser width w 1 necessarily involves migration of the other attachment element 716 towards the portion of increased width w 2 , which is prevented due to the taught nature of the connection between the attachment element 716 and the strut 710 .
- An edge 717 of the graft member 718 is in contact with a surface of the strut 710 .
- FIG. 12 illustrates a portion of a device 800 according to another embodiment of the invention.
- the strut 810 defines one or more projections 812 .
- Attachment elements 814 are placed across a circumference of the strut 810 and through the graft member 816 , adjacent one or more projections 812 .
- An edge 817 of the graft member 818 is in contact with a surface of the strut 710 .
- the projections 812 define stops that prevent migration of the attachment element 814 along the length of the strut 810 .
- the projections 812 can take a variety of forms, including the barb like forms illustrated in FIG. 12 , as well as bumps, nibs, and rings.
- the projections 812 can be defined by the strut 810 , or alternatively can comprise separate members attached to the strut 810 .
- FIG. 12 illustrates three configurations of the projections 812 on the strut 810 .
- the strut 810 includes a single projection 812 .
- the attachment element 814 is disposed adjacent the projection 812 .
- two projections 812 are placed on a single side of the strut 810 .
- An attachment element 814 is disposed between the projections 812 .
- This configuration effectively captures the attachment element 814 between the projections 812 .
- two projections 812 are disposed on opposite sides of the strut 810 .
- the attachment element 814 is disposed between the opposing projections 812 .
- the projections 812 define stops on each side of the attachment element 814 .
- attachment elements 814 can be disposed across the strut 810 in areas that do not include any projections 812 .
- the use of one or several projections 812 along the length of the strut 810 substantially prevents migration of the graft member 816 along the strut 810 .
- FIGS. 13 and 14 illustrate a support frame 900 suitable for use in medical devices according to the invention.
- the support frame 900 defines one or more barbs 902 along its length.
- the barbs 902 preferably comprise pointed members extended away from the surface of the support frame 900 .
- the pointed configuration of the barb 902 allows for piercing through an attached graft member.
- Each barb 902 can be formed from a portion of the material of the support frame 900 , as shown in FIG. 14 , or can comprise a separately attached member.
- the barbs 902 at a first end 906 of the support frame 900 can extend in a first direction
- the barbs 902 at a second end 908 of the support frame 900 can extend in a second direction.
- This configuration is particularly well suited for support frames, such as the frame 900 illustrated in FIG. 13 , in which the two opposing ends are brought near each other when the device is positioned within a vessel. When the two ends are brought near each other, all barbs 902 extend in the same direction, providing effective resistance to migration of an attached graft member in the opposite direction.
- FIG. 15 illustrates a support frame 1000 that includes a variety of barbs extending from its surface 1002 .
- a first series of barbs 1006 extend in a first direction
- a second series of barbs 1008 extend in a second, different direction, which can be a substantially opposite direction.
- a first series of barbs 1012 extend in a first direction and a second series of barbs 1014 extend in a second, different direction.
- all of the barbs preferably comprise pointed members extending away from the surface of the support frame 1100 .
- the first series of barbs 1006 at the first end 1004 and the first series of barbs 1012 at the second end 1010 resist migration of an attached graft member 1016 in a first direction 1018 , as illustrated in FIG. 16 , when the device is deployed in a vessel 1020 .
- the second series of barbs 1008 at the first end 1004 and the second series of barbs 1014 at the second end 1010 resist migration of the graft member 1016 in a second, different direction 1024 .
- the support frame 1000 substantially prevents migration of the graft member 1016 along the support frame 1000 in two different directions.
- FIG. 17 illustrates a cross-sectional view of a barb 1030 extending through the graft member 1016 .
- the barb 1030 substantially prevents migration of the graft member 1016 along the support frame.
- FIGS. 18 and 19 illustrate alternative configurations for barbs on support frame 1000 .
- opposing barbs 1030 , 1030 ′ are arranged on one side of support frame 1000 .
- These configurations are particularly well-suited for use in medical devices composed of flat stock or nearly flat material.
- FIG. 20 illustrates an alternative embodiment for positioning of the barbs on the support frame.
- barbs 1040 , 1040 ′ are positioned on different sides of the support frame 1000 . This is in contrast to the embodiments illustrated in FIGS. 13-19 in which the barbs are positioned on a single side of the support frame.
- FIG. 21 illustrates a portion of a medical device 1100 according to another embodiment of the invention.
- the support frame 1102 defines a plurality of projections 1104 that extend through the thickness of the graft member 1106 and along a portion of a length of the graft member 1106 .
- the projections 1104 provide additional securement of the graft member 1106 to the frame by effectively clamping the graft member 1106 to the frame 1102 .
- FIGS. 22 a , 22 b , and 22 c provide schematic illustrations of a fabrication process for the device 1100 illustrated in FIG. 21 .
- a support frame 1102 includes an upstanding projection 1104 .
- a section of graft material 1106 defining an opening 1108 is placed on the support frame 1102 such that the upstanding projection 1104 is passed through the opening 1108 .
- FIG. 22 b illustrates the intermediate product in which the graft member 1106 is positioned on the support frame 1102 and the upstanding projection 1104 extends through the opening 1108 .
- the upstanding projection 1104 is bent over a portion of the graft member 1106 so that a portion of the projection 1104 extends along a portion of a length of the graft member 1106 .
- the graft member 1106 can be further secured to the support frame 1102 by clamping or crimping the projection 1104 against the graft member 1106 and support frame 1102 , effectively capturing the graft member 1106 .
- FIGS. 23 through 27 illustrate portions of medical devices according to embodiments of the invention.
- a strut 1200 defines one or more projections that define a stop for an attachment element 1202 .
- the projections of these embodiments are similar to those illustrated in FIG. 12 and described above, except as detailed below.
- FIGS. 23 through 26 illustrate various projections that are suitable for use when it is desirable to attach a graft member 1204 to a portion of a support frame in a manner that the graft member 1204 extends substantially coplanar with the strut 1200 .
- an edge 1205 of the graft member 1204 is in contact with a surface of the strut 1200 . This contact can be an abutting relationship.
- two projections 1206 , 1208 surround a single attachment element 1202 .
- Each of the projections 1206 , 1208 define an enlarged region of the strut 1200 having a width w 2 that is greater than a width w 1 of a non-enlarged region of the strut 1200 .
- FIG. 24 illustrates a first alternative configuration of projections 1206 ′, 1208 ′.
- the cross-sectional shape of the projections 1206 ′, 1208 ′ each comprise a substantially triangular shaped region defined by the strut 1200 .
- FIG. 25 illustrates another alternative configuration of the projections 1206 ′′, 1208 ′′.
- each of the barbs 1206 ′′, 1208 ′′ comprise a square or rectangular cross-sectional shaped area of the strut 1200 .
- the projections 1206 ′′, 1208 ′′ extend outward from at least two sides of the strut 1200 .
- the projections 1206 ′′′, 1208 ′′′ also comprise square or rectangular cross-sectional shaped areas of the strut 1200 .
- the enlarged regions 1206 ′′, 1208 ′′ extend outward from only one side of the strut 1200 .
- FIGS. 23 through 26 provide projections that are suitable for use when it is desirable to extend the graft member coplanar with a strut. In some devices, however, it may be desirable to extend the graft member at an angle with respect to a strut.
- FIG. 27 illustrates a strut 1300 that defines a projection 1302 that is suitable for this purpose. As illustrated in the figure, the projection 1302 comprises a first region 1304 that extends away from one side of the strut 1300 in a first direction, and a second region 1306 that extends away from a second side of the strut 1300 in a second direction. As illustrated in FIG.
- the regions 1304 , 1306 advantageously have triangular cross-sectional shapes that are substantially opposite in arrangement relative to one another.
- the attachment element 1308 is disposed across the projection 1302 and through the graft member 1310 .
- the projection 1302 formed by the regions 1304 , 1306 allows for placement of the attachment element 1308 at an angle to a lengthwise axis of the strut 1300 , thereby allowing the graft member 1310 to be positioned at an angle with respect to the strut 1300 .
- an edge 1311 of the graft member 1310 is in contact with a surface of the strut 1300 , and can be in an abutting relationship with the strut 1300 .
- a combination of the various projections can be used in medical devices according to the invention.
- a graft extend coplanar with a strut in one portion of the device, in which a projection such as those illustrated in FIGS. 23 through 26 would be appropriate, while having a graft member extend at an angle with respect to a strut in another portion of the device, in which a projection, such as that illustrated in FIG. 27 , would be appropriate.
- a desirable number, configuration, and placement of the various projections used can be determined for a particular support frame in a medical device according to the invention.
- FIG. 28 illustrates a cross-sectional view of a portion of a medical device 1400 according to another embodiment of the invention.
- a clip member 1402 is disposed around the graft member 1404 to form a snug fit between the graft member 1404 and strut 1406 .
- the clip member 1402 is a suitable attachment element for use in embodiments of the invention.
- the clip member 1402 retains the graft member 1404 on the strut 1406 by this snug fit.
- the clip member 1402 is preferably formed of a resilient material and is force fit over the graft member 1404 and strut 1406 .
- the clip member 1402 can take a variety of configurations.
- a C-shaped clip member 1402 such as that illustrated in FIG.
- the clip member 1402 provides an opening 1408 through which the graft member 1404 and strut 1406 can be passed, while still retaining the desired snug fit.
- the clip member 1402 retains the graft member 1404 adjacent the strut 1406 by the frictional engagement of the snug fit, preventing migration of the graft member 1404 along the length of the strut 1406 .
- Multiple clip members 1402 can be arranged at various positions on a medical device according to the invention. Also, various configurations, such as various lengths, of clip members 1402 can be used. The specific number and configuration of clip members 1402 used in any particular device will depend on various factors, such as the size of the device and the desired degree of interference fit between the strut 1406 and the graft member 1404 .
- additional securement means can be utilized in conjunction with the clip member 1402 , such as another attachment element around a circumference of the strut 1406 and through the graft member 1404 , as well as other securement means such as an adhesive disposed between the graft member 1404 and strut 1406 .
- FIGS. 29 through 31 illustrate various suitable arrangements that utilize sutures as the attachment elements. It is understood that other suitable attachment elements can be used in these arrangements.
- FIG. 29 two individual attachment elements 1502 , 1504 are passed through the graft member 1506 and around individual leg struts 1510 , 1512 .
- each attachment element 1502 , 1504 is tied around connecting strut 1514 that joins leg struts 1510 , 1512 .
- the embodiment illustrated in FIG. 30 is identical to that in FIG. 29 , except that the attachment elements are tied around a junction area 1516 of connecting strut 1514 and the leg struts 1510 , 1512 .
- FIG. 31 an embodiment identical to that in FIG. 29 is illustrated, except that this embodiment uses a single attachment element 1518 , with portions 1520 and 1522 . The use of a single attachment element 1518 eliminates one knot in the attachment element.
- FIG. 32 illustrates a portion of a medical device 1600 according to an embodiment of the invention.
- strut 1602 defines an aperture 1604 .
- An attachment element 1606 is passed through the graft member 1608 , around the leg struts 1616 , 1612 , and through the aperture 1606 .
- This attachment element arrangement in combination with the structural feature of the aperture 1606 substantially prevents migration of the graft member 1608 along the leg struts 1610 , 1612 .
- FIGS. 33 and 34 illustrate portions of a medical device 1700 according to another embodiment of the invention.
- the strut 1702 defines a barb that extends away from the strut 1702 .
- An attachment element 1708 secures the graft member 1706 to the strut 1702 , and is passed behind the barb.
- the length y of the barb prevents the attachment element 1708 from separating from the barb as the length is greater than the slack present in the attachment element 1708 , and therefore no knot is needed at the barb.
- the barb can comprise a member with one or more curvilinear sides, such as barb 1704 illustrated in FIG. 33 , or a member with one or more linear sides, such as barb 1704 ′ illustrated in FIG. 34 .
- the barb advantageously includes a point 1710 , which allows the barb to also provide an anchoring function to the device.
- venous valves are exposed to fluid flow in two opposite directions once implanted in a vessel. Accordingly, it may be necessary to include features that resist migration of the graft member in the two directions.
- a combination of one or more barbs disposed at one end of a device and an attachment element configuration or other feature described above can provide the desired resistance to migration in two different directions.
Abstract
Implantable medical devices comprising a support frame and a graft member attached to the support frame. The support frame can define one or more structural features that substantially prevent migration of the graft member along the support frame.
Description
- This application is a continuation of U.S. patent application Ser. No. 10/820,918, filed on Apr. 8, 2004, which claims priority to U.S. Provisional Application Ser. No. 60/461,339, filed on Apr. 8, 2003. Each of these applications is hereby incorporated into this disclosure in its entirety.
- The invention relates to medical devices. More particularly, the invention relates to intraluminal support devices with attached graft members. Exemplary embodiments of the invention relate to intraluminal prosthetic valves, such as prosthetic venous valves.
- Many vessels in animals transport fluids from one bodily location to another. Frequently, fluid flows in a unidirectional manner along the length of the vessel. Varying fluid pressures over time, however, can introduce a reverse flow direction in the vessel. In some vessels, such as mammalian veins, natural valves are positioned along the length of the vessel and act as one-way check valves that open to permit the flow of fluid in the desired direction, and quickly close upon a change in pressure, such as a transition from systole to diastole, to prevent fluid flow in a reverse direction, i.e., retrograde flow. While these natural valves may function for an extended time, some may lose effectiveness, which can lead to physical manifestations and pathology. For example, venous valves are susceptible to becoming insufficient due to one or more of a variety of factors. Over time, the vessel wall may stretch, affecting the ability of the valve leaflets to close. Furthermore, the leaflets may become damaged, such as by formation of thrombus and scar tissue, which may also affect the ability of the valve leaflets to close. Once valves are damaged, venous valve insufficiency is present, and can lead to discomfort and possibly ulcers in the legs and ankles.
- Current treatments for venous valve insufficiency include the use of compression stockings that are placed around the leg of a patient. Surgical techniques are also employed in which valves can be bypassed or replaced with autologous sections of veins with competent valves.
- Minimally invasive techniques and instruments for placement of intraluminal medical devices have developed over recent years. A wide variety of treatment devices that utilize minimally invasive technology has been developed and includes stents, stent grafts, occlusion devices, infusion catheters and the like. Minimally invasive intravascular devices have especially become popular with the introduction of coronary stents to the U.S. market in the early 1990's. Coronary and peripheral stents have been proven to provide a superior means of maintaining vessel patency, and have become widely accepted in the medical community. Furthermore, the use of stents has been extended to treat aneurisms and to provide occlusion devices, among other uses.
- Recently, prosthetic valves have been developed that use a support frame such as a stent. Frequently, a graft member is attached to the support frame and provides a valve function to the device. For example, the graft member can be in the form of a leaflet that is attached to a stent and movable between first and second positions. In a first position, the valve is open and allows fluid flow to proceed through a vessel in a first direction, and in a second direction the valve is closed to prevent fluid flow in a second, opposite direction. An example of this type of prosthetic valve is described in commonly owned U.S. Pat. No. 6,508,833, to Pavcnik for a MULTIPLE-SIDED INTRALUMINAL MEDICAL DEVICE, which is hereby incorporated by reference in its entirety. In other examples of prosthetic valves, a tube that terminates in leaflets is attached to one or more support frames to form a valve. The leaflets open to permit fluid flow in a first direction in response to fluid pressure on one side of the leaflets, and close to prevent fluid flow in a second, opposite direction in response to fluid pressure on opposite sides of the leaflets. An example of this configuration is provided in U.S. Pat. No. 6,494,909 to Greenhalgh for AN ENDOVASCULAR VALVE, which is hereby incorporated by reference in its entirety.
- Prosthetic valves are designed to replace or supplement the function of incompetent natural valves. The use of an expandable support frame in valve devices allows for the use of minimally invasive delivery devices and techniques for placement of the valves within body vessels, which will likely lower the overall cost of treatment and increase the acceptance of these medical devices by practitioners and patients alike.
- The inclusion of a support frame and a valve member, such as a graft member, in a prosthetic valve device necessarily requires a connection between these components. The dynamic environment in which prosthetic valves are placed requires a connection that minimizes migration of the graft member on the support frame.
- In some embodiments, the invention provides intraluminal medical devices that include structural features adapted to enable a more stable connection between the graft member and the support frame. Thus, the invention provides implantable medical devices that include a graft member attached to a support frame that defines structural features that enable a more stable connection between the graft member and the support frame. In exemplary embodiments, medical devices according to the invention provide a valve for regulating fluid flow through a body vessel. The device is particularly well suited for percutaneous delivery through a body vessel to a point of treatment, and comprises a prosthetic venous valve in an illustrative embodiment.
- The prosthetic venous valves according to the invention include a support frame, such as an endoluminal stent, that has radially compressed and radially expanded configurations. The support frame can comprise any suitable support frame, including self expandable, balloon expandable, wire, tube, metal, polymeric, composite, and other types of support frames known in the art. The devices also include at least one graft member attached to the support frame. The graft member preferably provides a valve function to the device. In exemplary embodiments, the graft member comprises a valve leaflet that moves between first and second positions while remaining attached to the support frame. In the first position, the leaflet substantially blocks the lumen of the vessel, while the lumen is substantially open when the leaflet is in the second position. Thus, the leaflet permits fluid flow through the vessel in a first direction when in the first position, and substantially prevents fluid flow in a second, opposite direction when in the second position. The graft member can also be formed into other suitable valve configurations, such as a duckbill configuration, a tube or partial tube configuration, and an evertable tube configuration. The graft member can be formed of any suitable material, including natural and synthetic materials. In exemplary embodiments of the invention, the graft member is formed of an Extracellular Matrix (ECM) material, such as Small Intestine Submucosa (SIS).
- The graft member can be attached to the support frame in a variety of ways, such as by sutures or other suitable attachment elements. In exemplary embodiments, the support frame defines one or more structural features that provide a securement position at which the graft member can be attached to the support frame. Preferably, the structural feature is adapted to prevent migration of the graft material relative to the support frame. The type of structural feature utilized depends on the type of support frame used. For example, when a wire support frame is utilized, a loop or eyelet structure can be formed readily in the wire of the support frame. The loop or eyelet can be used as a securement position at which the graft member can be attached to the support frame by an attachment element. If, however, a tube member is used as the support frame, such as a stent cut from a solid tube of material, the formation of loops and eyelets may be difficult. Accordingly, other structural features, such as contoured struts, areas of enlarged width, barbs formed on the struts, strut projections, clips, and other structures can be used. Also, various attachment techniques, either alone or in combination with the various structural features, can be utilized for attaching the graft member to the support frame.
- In other embodiments, the graft member is adhered to itself or to the support frame with agents such as tissue adhesives, cross-linkers, or natural materials such as fibrin. Also, techniques such as laser welding can be used. Furthermore, the graft member itself can define structural features that facilitate attachment to a support frame, such as a tab and corresponding slot.
- A more detailed explanation of the invention is provided by the attached drawings and detailed description, which illustrate exemplary embodiments of the invention.
-
FIG. 1 is a top view of a support frame for use in medical devices according to the invention. -
FIG. 1 a is an enlarged partial cross sectional view of the support frame illustrated inFIG. 1 . -
FIG. 2 is a perspective view of the support frame ofFIG. 1 deployed inside a body vessel. -
FIG. 3 is a top view of a prosthetic venous valve according to a first exemplary embodiment of the invention. -
FIG. 4 is an enlarged partial view of the prosthetic venous valve illustrated inFIG. 3 . -
FIG. 5 is a perspective view of a support frame for use in medical devices according to the invention. -
FIG. 6 is a perspective view of the support frame illustrated inFIG. 5 in a radially compressed configuration. -
FIG. 7 is a partial view of a contoured strut for use in a medical device according to one embodiment of the invention. -
FIG. 8 is a partial view of a contoured strut for use in a medical device according to another embodiment of the invention. -
FIG. 9 is a partial view of a contoured strut for use in a medical device according to another embodiment of the invention. -
FIG. 10 is a partial view of a contoured strut for use in a medical device according to another embodiment of the invention. -
FIG. 11 is a partial view of a contoured strut having an area of increased width for use in a medical device according to another embodiment of the invention. -
FIG. 12 is a partial view of a contoured strut defining projections for use in a medical device according to another embodiment of the invention. -
FIG. 13 is a partial view of a support frame for use in a medical device according to another embodiment of the invention. -
FIG. 14 is an enlarged partial view of the support frame illustrated inFIG. 13 . -
FIG. 15 is a top view of a support frame for use in medical devices according to another embodiment of the invention. -
FIG. 16 is a perspective view of a medical device according to the invention positioned within a body vessel. -
FIG. 17 is a partial cross-sectional view taken along line a-a inFIG. 16 . -
FIG. 18 is a schematic illustration of one configuration of barbs on a strut according to an embodiment of the invention. -
FIG. 19 is a schematic illustration of one configuration of barbs on a strut according to another embodiment of the invention. -
FIG. 20 is a schematic illustration of one configuration of barbs on a strut according to another embodiment of the invention. -
FIG. 21 is a partial cross-sectional view of a medical device according to another embodiment of the invention. -
FIG. 22 a is a schematic illustration of the fabrication of the medical device illustrated inFIG. 21 . -
FIG. 22 b is a schematic illustration of the fabrication of the medical device illustrated inFIG. 21 . -
FIG. 22 c is a schematic illustration of the fabrication of the medical device illustrated inFIG. 21 . -
FIG. 23 is a partial cross-sectional view of a medical device according to an embodiment of the invention. -
FIG. 24 is a partial cross-sectional view of a medical device according to another embodiment of the invention. -
FIG. 25 is a partial cross-sectional view of a medical device according to another embodiment of the invention. -
FIG. 26 is a partial cross-sectional view of a medical device according to another embodiment of the invention. -
FIG. 27 is a partial cross-sectional view of a medical device according to another embodiment of the invention. -
FIG. 28 is a partial cross-sectional view of a medical device according to another embodiment of the invention. -
FIG. 29 is a partial view of a medical device according to another embodiment of the invention. -
FIG. 30 is a top view of a medical device according to another embodiment of the invention. -
FIG. 31 is a partial view of a medical device according to another embodiment of the invention. -
FIG. 32 is an enlarged partial view of a medical device according to another embodiment of the invention. -
FIG. 33 is a partial view of a medical device according to another embodiment of the invention. -
FIG. 34 is a partial view of a medical device according to another embodiment of the invention. -
FIG. 35 is a partial view of a medical device according to another embodiment of the invention. - The following provides a detailed description of currently exemplary embodiments of the invention. The description is not intended to limit the invention in any manner, but rather serves to enable those skilled in the art to make and use the invention.
- A medical device according to the invention provides a support frame with an attached graft member. Exemplary embodiments of the invention provide a valve for regulating fluid flow through a body vessel. Medical devices according to these embodiments include a support frame and a graft member that imparts a valve function to the device.
- The support frame provides an attachment member for the graft member. A wide variety of support frames are known in the art, and any suitable support frame can be utilized. The support frame can also provide a stenting function, i.e., exert a radially outward force on the interior vessel wall, although this function is not necessary and is considered optional. By including a support frame having stenting properties, the medical devices of the invention can provide both a stenting and a valving function at a point of treatment.
- The stent art provides numerous support frames acceptable for use in the invention, and any suitable stent can be used. The support frame need only provide the desired attachment member for the graft member. The specific support frame chosen will depend on numerous factors, including the vessel in which the device is being implanted, the axial length of the treatment site, the number of valves desired in the support frame, the inner diameter of the vessel, the delivery method for placing the support frame and valve, and others. Those skilled in the art can determine an appropriate support frame based on these and other factors.
- The support frame can be either self-expandable or balloon expandable. A balloon expandable support frame may provide advantage to treatment sites where greater radial strength is desired. Self-expandable stents provide a relatively simple deployment at the point of treatment. Suitable support frames can also have a variety of configurations, including braided strands, helically wound strands, ring members, consecutively attached ring members, tube members, and frames cut from solid tubes.
- Suitable support frames can be made from a variety of materials, and need only be biocompatible, or able to be made biocompatible, and provide the desired stenting function, if appropriate. Examples of suitable materials include, without limitation, stainless steel, nickel titanium (NiTi) alloys, e.g., nitinol, other shape memory and/or superelastic materials, cobalt-chromium alloys, natural and synthetic polymers, and composite materials. Examples of suitable polymeric materials include polypropylenes and polyethylenes. A resorbable material can also be use for the support frame. As used herein, the term “resorbable” refers to the ability of a material to be absorbed into a tissue and/or body fluid upon contact with the tissue and/or body fluid. A number of resorbable materials are known in the art, and any suitable resorbable material can be used. Examples of suitable types of resorbable materials include resorbable homopolymers, copolymers, or blends of resorbable polymers. Specific examples of suitable resorbable materials include poly-alpha hydroxy acids such as polylactic acid, polylactide, polyglycolic acid (PGA), or polyglycolide; trimethlyene carbonate; polycaprolactone; poly-beta hydroxy acids such as polyhydroxybutyrate or polyhydroxyvalerate; or other polymers such as polyphosphazines, polyorganophosphazines, polyanhydrides, polyesteramides, polyorthoesters, polyethylene oxide, polyester-ethers (e.g., polydioxanone) or polyamino acids (e.g., poly-L-glutamic acid or poly-L-lysine). There are also a number of naturally derived resorbable polymers that may be suitable, including modified polysaccharides, such as cellulose, chitin, and dextran, and modified proteins, such as fibrin and casein.
- Stainless steel and nitinol are currently considered desirable materials for use in the support frame due at least to their biocompatibility, shapeability, and well-characterized nature.
- Examples of suitable support frames for use in medical devices according to the invention include those described in U.S. Pat. No. 6,464,720 to Boatman et al. for a RADIALLY EXPANDABLE STENT; U.S. Pat. No. 6,231,598 to Berry et al. for a RADIALLY EXPANDABLE STENT; U.S. Pat. No. 6,299,635 to Frantzen for a RADIALLY EXPANDABLE NON-AXIALLY CONTRACTING SURGICAL STENT; U.S. Pat. No. 4,580,568 to Gianturco for a PERCUTANEOUS ENDOVASCULAR STENT AND METHOD FOR INSERTION THEREOF; and published United States patent application 2001/0039450 to Pavcnik et al. for an IMPLANTABLE MEDICAL DEVICE, all of which are hereby incorporated by reference in their entirety.
- In some embodiments of the invention, a support frame formed from wire is utilized.
FIG. 1 illustrates a suitablewire support frame 10 for use in a medical device according to the invention. Thissupport frame 10 is exemplary of suitable support frames that can be modified to include the invention.Support frame 10 is described in detail in U.S. Pat. No. 6,508,833 to Pavcnik et al. for a MULTIPLE-SIDED INTRALUMINAL MEDICAL DEVICE, which is hereby incorporated by reference in its entirety. Thesupport frame 10 is made of resilient material, preferably metal wire formed from stainless steel or a superelastic alloy, such as nitinol. While round wire is depicted in the figure, other wire types, e.g., flat, square, triangular, D-shaped, delta-shaped, etc. may be used to form the frame. In the illustrative embodiment, theframe 10 comprises a closed circumference of a single piece of material that is formed into a device having a plurality ofsides 12 interconnected by a series ofbends sides 12 of approximately equal length. Alternative embodiments include forming a frame into any polygonal shape, for example, a pentagon, hexagon, octagon, etc. In the embodiment ofFIG. 1 , each of thebends coil 14 of approximately one and a quarter turns. Alternative bend embodiments include outward-projecting fillets and inward-projecting fillets comprising a series of curves. Fillets are well known in the stent art as a means to reduce stresses in bends. When using stainless steel wire, the size of the wire which should be selected depends on the size of device and the application. Wire that is too stiff can damage the vessel, not conform well to the vessel wall, and increase the profile of the device when loaded in the delivery system prior to deployment. - The single piece of material comprising the
frame 10 is formed into the closed circumference by securing the first and second ends 24, 26 with anattachment mechanism 28 such as a piece of metal cannula (seeFIG. 1A ). The ends 24, 26 of the single piece are inserted into thecannula 28 and secured withsolder 30, a weld, adhesive, or crimping to form theclosed frame 10. The ends 24, 26 of the single piece can be joined directly without addition of acannula 28, such as by soldering, welding, or other methods to join ends 24, 26. Besides joining the wire, the frame could be fabricated as a single piece of material, by stamping or cutting theframe 10 from another sheet (e.g., with a laser), fabricating from a mold, or some similar method of producing a unitary frame. - The
support frame 10 depicted inFIG. 1 is shown in afirst configuration 25 whereby all fourbends sides 12 generally lie within a single flat plane. To resiliently reshape theframe 10 into asecond configuration 35, shown inFIG. 2 , theframe 10 ofFIG. 1 is folded twice, first along onediagonal axis 32 withopposite bends opposite bends second configuration 35, depicted inFIG. 2 , has two opposite bends oriented at thefirst end 32 of theframe 10, while the other opposite bends 16, 20 are oriented at thesecond end 34 of theframe 10 and rotated approximately 90° with respect tobends second configuration 35 can be used as a stent to maintain anopen lumen 36 in avessel 38, such as a vein, artery, or duct. The bending stresses introduced to theframe 10 by the first and second folds required to form thesecond configuration 35 apply force radially outward against thevessel wall 40 to hold theframe 10 in place and prevent vessel closure. Absent any significant plastic deformation occurring during folding and deployment, thesecond configuration 35, when not in the vessel or subject to other constraining means, will at least partially return to thefirst configuration 25, although some deformation can occur depending on the material used. It is also possible to plastically deform theframe 10 into thesecond configuration 35, such that it does not unfold when restraint is removed. This might be particularly desired if the device is made from nitinol or a superelastic alloy. -
FIG. 3 illustrates amedical device 100 formed from awire support frame 110 configured into adiamond shape 112. Agraft member 114 is attached to thesupport frame 110 and has twoleaflets central opening 120. Thegraft member 114 is attached to thesupport frame 110 byattachment elements 122. As used herein, the term “attachment element” refers to any member that can be used to form a connection between a support frame and a graft member. Examples of suitable attachment elements include, without limitation, sutures, coils, wires, clips, rings, and other suitable members. The attachment element can comprise a separate member or can be integrally formed by the support frame or graft member. The specific attachment element chosen for a particular embodiment of the invention will depend on various considerations, including the type and configuration of the support frame and/or graft member. - Similar to the embodiment illustrated in
FIGS. 1 and 2 , thesupport frame 110 illustrated inFIG. 3 includesbends coil 132. Thecoil 132 provides an eyelet configuration in thesupport frame 110. As such, thecoil 132 defines a structural feature in thesupport frame 110 to which thegraft member 114 can be attached. -
FIG. 4 illustrates a magnified view of acoil 132 in thedevice 100 illustrated inFIG. 3 . As illustrated inFIG. 4 , thegraft member 114 has a notch area that receives thecoil 132 and allows for the placement ofattachment elements 122 around the portion of thesupport frame 110 in thecoil 132 and through theadjacent graft member 114. In this configuration, thecoil 132 provides an additional attachment point for thegraft member 114. Thegraft member 114 is not able to migrate along thesupport frame 110 near the position of thecoil 132 because theoverlap region 134 blocks theattachment elements 122 from traveling along thesupport frame 110. Theoverlap region 134 is a length along thesupport frame 110 that includes at least two thicknesses of the wire member that forms thesupport frame 110. To further prevent migration in this area, the two portions of thesupport frame 110 that overlap in theoverlap region 134 can be joined together by various means, such as placement of an attachment element at the overlapping portions. -
FIGS. 5 and 6 illustrate a second type ofsupport frame 210 suitable for use in medical devices according to the invention.Support frame 210 is described in detail in U.S. Pat. No. 6,299,635, to Frantzen. Thesupport frame 210 comprises a unitary member cut from a solid piece of metal tubing, such as by laser cutting. A variety of unitary support frames cut from tubes are known to those skilled in the art. Any suitable support frame of this type can be utilized in the invention. Generally, these support frames, such as thesupport frame 210 illustrated inFIG. 5 , include a plurality ofstruts 212 of the tube material left after the cutting process. A plurality ofopen spaces 214 is formed by the removal of the material between thestruts 212. - A variety of configurations of the
struts 212 andopen spaces 214 can be utilized. The configuration chosen will depend on numerous factors, including the size of the vessel, the desired radial strength of the stent, and the desired longitudinal flexibility of the stent. Also, as will be described more fully below, thestruts 212 can be configured in a variety of manners in accordance with the invention to provide the desired attachment of the graft member to thesupport frame 210. - Similar to the support frame illustrated in
FIGS. 1 and 2 , thesupport frame 210 has both a radially expanded and radially compressed configuration.FIG. 6 illustrates the radially compressed configuration of thesupport frame 210. As best illustrated inFIG. 6 , theopen spaces 214 are reduced in size when the support frame is in the radially compressed configuration. Support frames cut from tube members, such as theframe 210 illustrated inFIGS. 5 and 6 , are typically balloon expandable support frames. - Medical devices according to the invention include a support frame and a graft member. The graft member can be attached to the support frame in a variety of configurations. Also, the support can define structural features that are adapted to substantially prevent movement of the graft member along the struts of the support frame.
- In a first series of embodiments of the invention, struts of the support frame are contoured to provide at least one non-linear segment across which a graft member can be attached.
FIGS. 7 through 10 illustrate portions of medical devices in accordance with this first series of embodiments. -
FIG. 7 illustrates a portion of amedical device 300 according to an embodiment of the invention. In this embodiment, astrut 310 defines aserpentine path 312 that includes a plurality ofnon-linear segments 314. Theserpentine path 312 is defined by asingle strut 310, and does not include any bend or other transition to another strut.FIG. 35 illustrates an alternate embodiment in which onestrut 1800 defines a structural feature, such asenlarged region 1802, that cooperates with one or moreother struts attachment element 1808 that attaches agraft member 1810 to thestrut 1800. In the embodiment illustrated inFIG. 7 , thegraft member 316 is secured to thestrut 310 by two ormore attachment elements 318 that surround a circumference of thestrut 310 and extend through thegraft member 316. Thegraft member 316 is a sheet of material and anedge 317 of thegraft member 316 is in contact with a surface of thestrut 310. This contact can be an abutting relationship. As illustrated in theFIG. 7 , anattachment element 318 can be disposed on each side of anon-linear segment 314 along thestrut 310. In the illustrated embodiment, a series ofattachment elements 318 are secured to thestrut 310 andgraft member 316 along a series ofnon-linear segments 314 on thestrut 310. In this configuration, thegraft member 316 is substantially prevented from migrating due to the curvilinear path that would need to be traveled by theattachment elements 318 for such migration to occur. - Any suitable graft member can be used in medical devices according to the invention. The graft member can comprise any suitable material for implantation in a body vessel. The graft member need only be biocompatible or be able to be made biocompatible. Examples of suitable materials for the graft member include natural materials, synthetic materials, and combinations thereof. Examples of suitable natural materials include ECMs, such as small intestine submucosa (SIS), and other bioremodellable materials, such as bovine pericardium. Other examples of ECM materials that can be used for the graft member include stomach submucosa, liver basement membrane, urinary bladder submucosa, tissue mucosa, and dura mater. Examples of suitable synthetic materials include polymeric materials, such as expanded polytetrafluoroethylene and polyurethane. ECMs are particularly well suited materials for use in the graft member, at least because of their abilities to remodel and become incorporated into adjacent tissues. These materials can provide a scaffold onto which cellular in-growth can occur, eventually allowing the material to remodel into a structure of host cells.
-
FIG. 8 illustrates a portion ofmedical device 400 according to another embodiment of the invention. In this embodiment, thestrut 410 defines a plurality of angulatedlinear segments 412. Theattachment elements 414 are preferably disposed across these angulated segments. Similar to the embodiment illustrated inFIG. 7 , anedge 417 of thegraft member 416 is in contact with a surface of thestrut 410. In this embodiment, thegraft member 416 has one ormore folds 418 that are substantially coaxial with a portion of thestrut 410 and provide a point at which thegraft member 416 can be secured to thestrut 410 byattachment element 414. -
FIG. 9 illustrates a portion of amedical device 500 according to another embodiment of the invention. This embodiment is similar to that illustrated inFIG. 8 , except that thegraft member 516 does not include folds. Thus, thestrut 510 includes a plurality of angulatedlinear segments 512. A series ofattachment elements 514 secure thegraft member 516 to thestrut 510. Thus, as illustrated inFIG. 9 , thegraft member 516 follows a substantially linear path. Also, anedge 517 of the graft member is in contact with a surface of thestrut 510. -
FIG. 10 illustrates a portion of amedical device 600 according to another embodiment of the invention. This embodiment is similar to the embodiment illustrated inFIG. 7 , except as described below. Thestrut 610 includeslinear portions 612 disposed between adjacentcurvilinear segments 614. Thelinear segment 612 provides an area for attachment ofattachment elements 616 to thestrut 610. As illustrated inFIG. 10 , thecurvilinear portions 614 are disposed between twolinear segments 612 and provide a structural feature that substantially prevents sliding ofattachment elements 616 along thestrut 610. Anedge 617 of the graft member 618 is in contact with a surface of thestrut 610. -
FIG. 11 illustrates a portion of amedical device 700 according to another embodiment of the invention. In this embodiment, thestrut 710 includes aportion 712 having an increased width w2. The width w2 of thearea 712 is greater than the width w1 of at least one other portion of thestrut 710. As used herein, the term “width” refers to any dimension of a strut other than length, and includes a width of a substantially two dimensional strut, a thickness of a three dimensional strut, and a diameter of a strut with a substantially circular cross-sectional shape. As illustrated inFIG. 11 , aportion 712 having an increased width w2 is disposed between twoportions 714 of a lesser width, such as width w1.Attachment elements 716 are disposed around a circumference of thestrut 710 and through thegraft member 718 at a position on the strut betweenportions attachment elements 716 are drawn tight to the circumference of thestrut 710 at these locations. Consequently, eachattachment element 716 is substantially prevented from migrating towards anadjacent portion 712 of increased width w2. When twoattachment elements 716 are disposed on either side ofportion 712 of increased width w2, the prevention of migration is effective in both directions because migration of oneattachment element 716 towards anadjacent portion 714 of lesser width w1 necessarily involves migration of theother attachment element 716 towards the portion of increased width w2, which is prevented due to the taught nature of the connection between theattachment element 716 and thestrut 710. Anedge 717 of thegraft member 718 is in contact with a surface of thestrut 710. -
FIG. 12 illustrates a portion of adevice 800 according to another embodiment of the invention. In this embodiment, thestrut 810 defines one ormore projections 812.Attachment elements 814 are placed across a circumference of thestrut 810 and through thegraft member 816, adjacent one ormore projections 812. Anedge 817 of the graft member 818 is in contact with a surface of thestrut 710. Theprojections 812 define stops that prevent migration of theattachment element 814 along the length of thestrut 810. Theprojections 812 can take a variety of forms, including the barb like forms illustrated inFIG. 12 , as well as bumps, nibs, and rings. Furthermore, theprojections 812 can be defined by thestrut 810, or alternatively can comprise separate members attached to thestrut 810. -
FIG. 12 illustrates three configurations of theprojections 812 on thestrut 810. For example, at the upper portion ofFIG. 12 , thestrut 810 includes asingle projection 812. Theattachment element 814 is disposed adjacent theprojection 812. In the middle portion ofFIG. 12 , twoprojections 812 are placed on a single side of thestrut 810. Anattachment element 814 is disposed between theprojections 812. This configuration effectively captures theattachment element 814 between theprojections 812. In the lower portion ofFIG. 12 , twoprojections 812 are disposed on opposite sides of thestrut 810. Theattachment element 814 is disposed between the opposingprojections 812. In this configuration, theprojections 812 define stops on each side of theattachment element 814. In medical devices according to the invention, a variety of these configurations can be used either exclusively or in any suitable combination with one another. Furthermore, as illustrated inFIG. 12 ,attachment elements 814 can be disposed across thestrut 810 in areas that do not include anyprojections 812. The use of one orseveral projections 812 along the length of thestrut 810 substantially prevents migration of thegraft member 816 along thestrut 810. -
FIGS. 13 and 14 illustrate asupport frame 900 suitable for use in medical devices according to the invention. In this embodiment, thesupport frame 900 defines one ormore barbs 902 along its length. As illustrated in the enlarged partial view shown inFIG. 14 , thebarbs 902 preferably comprise pointed members extended away from the surface of thesupport frame 900. The pointed configuration of thebarb 902 allows for piercing through an attached graft member. Eachbarb 902 can be formed from a portion of the material of thesupport frame 900, as shown inFIG. 14 , or can comprise a separately attached member. - As best illustrated in
FIG. 13 , thebarbs 902 at afirst end 906 of thesupport frame 900 can extend in a first direction, and thebarbs 902 at asecond end 908 of thesupport frame 900 can extend in a second direction. This configuration is particularly well suited for support frames, such as theframe 900 illustrated inFIG. 13 , in which the two opposing ends are brought near each other when the device is positioned within a vessel. When the two ends are brought near each other, allbarbs 902 extend in the same direction, providing effective resistance to migration of an attached graft member in the opposite direction. - In some applications, medical devices according to the invention will be exposed to flow that occurs in both directions at different times. For example, prosthetic venous valves are exposed to both antigrade and retrograde flow continually over time. Thus, it may be desirable to provide resistance to migration of an attached graft member in both directions.
FIG. 15 illustrates asupport frame 1000 that includes a variety of barbs extending from itssurface 1002. At afirst end 1004 of thesupport frame 1000, a first series ofbarbs 1006 extend in a first direction, and a second series ofbarbs 1008 extend in a second, different direction, which can be a substantially opposite direction. Likewise, at asecond end 1010 of the support frame, a first series ofbarbs 1012 extend in a first direction and a second series ofbarbs 1014 extend in a second, different direction. As discussed above, all of the barbs preferably comprise pointed members extending away from the surface of thesupport frame 1100. - The first series of
barbs 1006 at thefirst end 1004 and the first series ofbarbs 1012 at thesecond end 1010 resist migration of an attachedgraft member 1016 in a first direction 1018, as illustrated inFIG. 16 , when the device is deployed in avessel 1020. The second series ofbarbs 1008 at thefirst end 1004 and the second series ofbarbs 1014 at thesecond end 1010 resist migration of thegraft member 1016 in a second,different direction 1024. Thus, thesupport frame 1000 substantially prevents migration of thegraft member 1016 along thesupport frame 1000 in two different directions. -
FIG. 17 illustrates a cross-sectional view of abarb 1030 extending through thegraft member 1016. By extending through thegraft member 1016, thebarb 1030 substantially prevents migration of thegraft member 1016 along the support frame. -
FIGS. 18 and 19 illustrate alternative configurations for barbs onsupport frame 1000. InFIGS. 18 and 19 , opposingbarbs support frame 1000. These configurations are particularly well-suited for use in medical devices composed of flat stock or nearly flat material. -
FIG. 20 illustrates an alternative embodiment for positioning of the barbs on the support frame. In this embodiment,barbs support frame 1000. This is in contrast to the embodiments illustrated inFIGS. 13-19 in which the barbs are positioned on a single side of the support frame. -
FIG. 21 illustrates a portion of amedical device 1100 according to another embodiment of the invention. In this embodiment, thesupport frame 1102 defines a plurality ofprojections 1104 that extend through the thickness of thegraft member 1106 and along a portion of a length of thegraft member 1106. In this configuration, theprojections 1104 provide additional securement of thegraft member 1106 to the frame by effectively clamping thegraft member 1106 to theframe 1102. -
FIGS. 22 a, 22 b, and 22 c provide schematic illustrations of a fabrication process for thedevice 1100 illustrated inFIG. 21 . First, as illustrated inFIG. 22 a, asupport frame 1102 includes anupstanding projection 1104. A section ofgraft material 1106 defining anopening 1108 is placed on thesupport frame 1102 such that theupstanding projection 1104 is passed through theopening 1108.FIG. 22 b illustrates the intermediate product in which thegraft member 1106 is positioned on thesupport frame 1102 and theupstanding projection 1104 extends through theopening 1108. Next, theupstanding projection 1104 is bent over a portion of thegraft member 1106 so that a portion of theprojection 1104 extends along a portion of a length of thegraft member 1106. Thegraft member 1106 can be further secured to thesupport frame 1102 by clamping or crimping theprojection 1104 against thegraft member 1106 andsupport frame 1102, effectively capturing thegraft member 1106. -
FIGS. 23 through 27 illustrate portions of medical devices according to embodiments of the invention. In these embodiments, astrut 1200 defines one or more projections that define a stop for anattachment element 1202. The projections of these embodiments are similar to those illustrated inFIG. 12 and described above, except as detailed below. -
FIGS. 23 through 26 illustrate various projections that are suitable for use when it is desirable to attach agraft member 1204 to a portion of a support frame in a manner that thegraft member 1204 extends substantially coplanar with thestrut 1200. Also, anedge 1205 of thegraft member 1204 is in contact with a surface of thestrut 1200. This contact can be an abutting relationship. InFIG. 23 , twoprojections single attachment element 1202. Each of theprojections strut 1200 having a width w2 that is greater than a width w1 of a non-enlarged region of thestrut 1200. This configuration essentially captures theattachment element 1202 between theenlarged regions graft member 1204 along thestrut 1200.FIG. 24 illustrates a first alternative configuration ofprojections 1206′, 1208′. In this configuration, the cross-sectional shape of theprojections 1206′, 1208′ each comprise a substantially triangular shaped region defined by thestrut 1200.FIG. 25 illustrates another alternative configuration of theprojections 1206″, 1208″. In this embodiment, each of thebarbs 1206″, 1208″ comprise a square or rectangular cross-sectional shaped area of thestrut 1200. Theprojections 1206″, 1208″ extend outward from at least two sides of thestrut 1200. InFIG. 26 , theprojections 1206″′, 1208″′ also comprise square or rectangular cross-sectional shaped areas of thestrut 1200. In this embodiment, however, theenlarged regions 1206″, 1208″ extend outward from only one side of thestrut 1200. Each of these described configurations may provide advantages in manufacturing of support frames or in assembly of the device in which thegraft member 1204 is secured to thestrut 1200. - As described above, the embodiments illustrated in
FIGS. 23 through 26 provide projections that are suitable for use when it is desirable to extend the graft member coplanar with a strut. In some devices, however, it may be desirable to extend the graft member at an angle with respect to a strut.FIG. 27 illustrates astrut 1300 that defines aprojection 1302 that is suitable for this purpose. As illustrated in the figure, theprojection 1302 comprises afirst region 1304 that extends away from one side of thestrut 1300 in a first direction, and asecond region 1306 that extends away from a second side of thestrut 1300 in a second direction. As illustrated inFIG. 27 , theregions attachment element 1308 is disposed across theprojection 1302 and through thegraft member 1310. Theprojection 1302 formed by theregions attachment element 1308 at an angle to a lengthwise axis of thestrut 1300, thereby allowing thegraft member 1310 to be positioned at an angle with respect to thestrut 1300. Also, an edge 1311 of thegraft member 1310 is in contact with a surface of thestrut 1300, and can be in an abutting relationship with thestrut 1300. It is noted that a combination of the various projections can be used in medical devices according to the invention. For example, in a single medical device, it may be desirable to have a graft extend coplanar with a strut in one portion of the device, in which a projection such as those illustrated inFIGS. 23 through 26 would be appropriate, while having a graft member extend at an angle with respect to a strut in another portion of the device, in which a projection, such as that illustrated inFIG. 27 , would be appropriate. A desirable number, configuration, and placement of the various projections used can be determined for a particular support frame in a medical device according to the invention. -
FIG. 28 illustrates a cross-sectional view of a portion of amedical device 1400 according to another embodiment of the invention. In this embodiment, aclip member 1402 is disposed around thegraft member 1404 to form a snug fit between thegraft member 1404 andstrut 1406. Theclip member 1402 is a suitable attachment element for use in embodiments of the invention. Theclip member 1402 retains thegraft member 1404 on thestrut 1406 by this snug fit. Theclip member 1402 is preferably formed of a resilient material and is force fit over thegraft member 1404 andstrut 1406. Theclip member 1402 can take a variety of configurations. A C-shapedclip member 1402, such as that illustrated inFIG. 28 , provides anopening 1408 through which thegraft member 1404 and strut 1406 can be passed, while still retaining the desired snug fit. Once theclip member 1402 is positioned over thegraft member 1404 andstrut 1406, theclip member 1402 retains thegraft member 1404 adjacent thestrut 1406 by the frictional engagement of the snug fit, preventing migration of thegraft member 1404 along the length of thestrut 1406.Multiple clip members 1402 can be arranged at various positions on a medical device according to the invention. Also, various configurations, such as various lengths, ofclip members 1402 can be used. The specific number and configuration ofclip members 1402 used in any particular device will depend on various factors, such as the size of the device and the desired degree of interference fit between thestrut 1406 and thegraft member 1404. - To further enhance the connection between the
graft member 1404 andstrut 1406, additional securement means can be utilized in conjunction with theclip member 1402, such as another attachment element around a circumference of thestrut 1406 and through thegraft member 1404, as well as other securement means such as an adhesive disposed between thegraft member 1404 andstrut 1406. - Various configurations of attachment elements can be utilized to attach the graft member to the support frame. For example,
FIGS. 29 through 31 illustrate various suitable arrangements that utilize sutures as the attachment elements. It is understood that other suitable attachment elements can be used in these arrangements. InFIG. 29 , twoindividual attachment elements graft member 1506 and around individual leg struts 1510, 1512. Also, eachattachment element strut 1514 that joins leg struts 1510, 1512. The embodiment illustrated inFIG. 30 is identical to that inFIG. 29 , except that the attachment elements are tied around ajunction area 1516 of connectingstrut 1514 and the leg struts 1510, 1512. InFIG. 31 , an embodiment identical to that inFIG. 29 is illustrated, except that this embodiment uses a single attachment element 1518, withportions -
FIG. 32 illustrates a portion of amedical device 1600 according to an embodiment of the invention. In this embodiment,strut 1602 defines anaperture 1604. Anattachment element 1606 is passed through thegraft member 1608, around the leg struts 1616, 1612, and through theaperture 1606. This attachment element arrangement in combination with the structural feature of theaperture 1606 substantially prevents migration of thegraft member 1608 along the leg struts 1610, 1612. -
FIGS. 33 and 34 illustrate portions of amedical device 1700 according to another embodiment of the invention. In this embodiment, thestrut 1702 defines a barb that extends away from thestrut 1702. Anattachment element 1708 secures thegraft member 1706 to thestrut 1702, and is passed behind the barb. The length y of the barb prevents theattachment element 1708 from separating from the barb as the length is greater than the slack present in theattachment element 1708, and therefore no knot is needed at the barb. The barb can comprise a member with one or more curvilinear sides, such asbarb 1704 illustrated inFIG. 33 , or a member with one or more linear sides, such asbarb 1704′ illustrated inFIG. 34 . No matter the configuration, the barb advantageously includes a point 1710, which allows the barb to also provide an anchoring function to the device. - As indicated above, some medical devices, such as venous valves, are exposed to fluid flow in two opposite directions once implanted in a vessel. Accordingly, it may be necessary to include features that resist migration of the graft member in the two directions. A combination of one or more barbs disposed at one end of a device and an attachment element configuration or other feature described above can provide the desired resistance to migration in two different directions.
- The foregoing description includes the best mode for practicing the invention. The description is intended only to aid in the understanding of the invention, and is not intended to limit the scope of the invention in any manner.
Claims (27)
1. An implantable medical device, comprising:
an expandable support frame having a first end, a second end, a surface, and a plurality of struts interconnected by bends;
a first series of barbs disposed at the first end of the expandable support frame and extending in a first direction;
a second series of barbs disposed at the second end of the expandable support frame and extending in a second, different direction; and
a graft member attached to the support frame;
wherein each barb of the first and second series of barbs extends away from the surface of the expandable support frame and through the graft member.
2. The implantable medical device according to claim 1 , wherein the first direction is substantially opposite the second direction.
3. The implantable medical device according to claim 1 , wherein the expandable support frame is adapted such that the first and second ends of the support frame are brought near each other when the implantable medical device is positioned within a vessel such that the barbs of the first series of barbs and the barbs of the second series of barbs extend in the same direction.
4. The implantable medical device according to claim 1 , further comprising a third series of barbs disposed at the first end of the expandable support frame and extending in a third direction that is different than the first direction.
5. The implantable medical device according to claim 4 , wherein each barb of the third series of barbs extends away from the surface of the expandable support frame and through the graft member.
6. The implantable medical device according to claim 4 , further comprising a fourth series of barbs disposed at the second end of the expandable support frame and extending in a fourth direction that is different than the second direction.
7. The implantable medical device according to claim 6 , wherein each barb of the fourth series of barbs extends away from the surface of the expandable support frame and through the graft member.
8. The implantable medical device according to claim 1 , wherein the expandable support frame is self-expandable.
9. The implantable medical device according to claim 1 , wherein the expandable support frame is balloon-expandable.
10. The implantable medical device according to claim 1 , wherein the expandable support frame is formed from wire.
11. The implantable medical device according to claim 1 , wherein the expandable support frame is cut from a piece of tubing.
12. The implantable medical device according to claim 1 , wherein the expandable support frame is formed of one of a metal, a natural material, a synthetic material, a polymer, and a composite material.
13. The implantable medical device according to claim 1 , wherein the expandable support frame is formed of one of stainless steel, Nitinol and cobalt chromium.
14. The implantable medical device according to claim 1 , wherein the expandable support frame is formed of a resorbable material.
15. The implantable medical device according to claim 1 , wherein the graft member comprises a natural material.
16. The implantable medical device according to claim 1 , wherein the graft member comprises a bioremodellable material.
17. The implantable medical device according to claim 16 , wherein the bioremodellable material comprises an extracellular matrix material.
18. The implantable medical device according to claim 16 , wherein the bioremodellable material comprises small intestine submucosa.
19. The implantable medical device according to claim 1 , wherein the graft member comprises a synthetic material.
20. The implantable medical device according to claim 1 , wherein the graft member comprises first and second leaflets that define an opening.
21. The implantable medical device according to claim 1 , wherein the surface of the expandable support frame has first and second sides and all barbs of the first and second series of barbs are disposed on the first side.
22. The implantable medical device according to claim 1 , wherein the surface of the expandable support frame has first and second sides;
wherein at least one barb of the first series of barbs is disposed on the first side; and
wherein at least one barb of the second series of barbs is disposed on the second side.
23. The implantable medical device according to claim 1 , wherein at least one barb is integrally formed by the expandable support frame.
24. The implantable medical device according to claim 1 , wherein at least one barb comprises a separate member attached to the expandable support frame.
25. An implantable medical device according to claim 1 , wherein the graft member defines a valve for regulating fluid flow through the implantable medical device.
26. An implantable medical device, comprising:
an expandable support frame having a first end, a second end, a surface, and a plurality of struts interconnected by bends;
first and second opposing barbs disposed at the first end;
third and fourth opposing barbs disposed at the second end;
a graft member attached to the support frame;
wherein each of the barbs extends away from the surface of the expandable support frame and through the graft member.
27. An implantable medical device, comprising:
an expandable support frame having a first end, a second end, a surface, and a plurality of struts interconnected by bends;
first and second barbs disposed on a first strut of the plurality of struts and extending away from the surface in opposing directions;
a graft member having an edge in contact with at least a portion of the surface of the first strut; and
an attachment element placed across the first strut and through the graft member;
wherein the attachment element is disposed between the first and second barbs.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US12/576,481 US20100030314A1 (en) | 2003-04-08 | 2009-10-09 | Implantable support device with graft |
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US46133903P | 2003-04-08 | 2003-04-08 | |
US10/820,918 US7670366B2 (en) | 2003-04-08 | 2004-04-08 | Intraluminal support device with graft |
US12/576,481 US20100030314A1 (en) | 2003-04-08 | 2009-10-09 | Implantable support device with graft |
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US10/820,918 Continuation US7670366B2 (en) | 2003-04-08 | 2004-04-08 | Intraluminal support device with graft |
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US20100030314A1 true US20100030314A1 (en) | 2010-02-04 |
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US10/820,918 Active 2026-12-29 US7670366B2 (en) | 2003-04-08 | 2004-04-08 | Intraluminal support device with graft |
US12/576,481 Abandoned US20100030314A1 (en) | 2003-04-08 | 2009-10-09 | Implantable support device with graft |
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US10/820,918 Active 2026-12-29 US7670366B2 (en) | 2003-04-08 | 2004-04-08 | Intraluminal support device with graft |
Country Status (4)
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US (2) | US7670366B2 (en) |
EP (2) | EP2163224A1 (en) |
DE (1) | DE602004024972D1 (en) |
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US11406495B2 (en) | 2013-02-11 | 2022-08-09 | Cook Medical Technologies Llc | Expandable support frame and medical device |
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US20160074025A1 (en) * | 2009-12-31 | 2016-03-17 | Cook Medical Technologies Llc | Intraluminal occlusion devices and methods of blocking the entry of fluid into bodily passages |
US10028732B2 (en) * | 2009-12-31 | 2018-07-24 | Cook Medical Technologies Llc | Intraluminal occlusion devices and methods of blocking the entry of fluid into bodily passages |
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US11406495B2 (en) | 2013-02-11 | 2022-08-09 | Cook Medical Technologies Llc | Expandable support frame and medical device |
Also Published As
Publication number | Publication date |
---|---|
WO2004091449A1 (en) | 2004-10-28 |
EP2163224A1 (en) | 2010-03-17 |
US7670366B2 (en) | 2010-03-02 |
US20040225348A1 (en) | 2004-11-11 |
DE602004024972D1 (en) | 2010-02-25 |
EP1615593A1 (en) | 2006-01-18 |
EP1615593B1 (en) | 2010-01-06 |
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