CA2565970A1 - Interfacial stent and method of maintaining patency of surgical fenestrations - Google Patents

Interfacial stent and method of maintaining patency of surgical fenestrations Download PDF

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Publication number
CA2565970A1
CA2565970A1 CA002565970A CA2565970A CA2565970A1 CA 2565970 A1 CA2565970 A1 CA 2565970A1 CA 002565970 A CA002565970 A CA 002565970A CA 2565970 A CA2565970 A CA 2565970A CA 2565970 A1 CA2565970 A1 CA 2565970A1
Authority
CA
Canada
Prior art keywords
stent
opening
enlarged ends
intermediate portion
surgical
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
CA002565970A
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French (fr)
Inventor
Nathan R. Selden
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Oregon Health Science University
Original Assignee
Oregon Health And Science University
Nathan R. Selden
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Oregon Health And Science University, Nathan R. Selden filed Critical Oregon Health And Science University
Publication of CA2565970A1 publication Critical patent/CA2565970A1/en
Abandoned legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • 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
    • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/90—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0293—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with ring member to support retractor elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1107—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis for blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1139—Side-to-side connections, e.g. shunt or X-connections
    • 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
    • A61F2/2493—Transmyocardial revascularisation [TMR] devices
    • 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
    • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • 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
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/3006—Properties of materials and coating materials
    • A61F2002/30062—(bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
    • 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
    • A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0004—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof bioabsorbable
    • 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
    • A61F2230/0073—Quadric-shaped
    • A61F2230/0078—Quadric-shaped hyperboloidal
    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0037—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in height or in length
    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0039—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in diameter

Abstract

A method according to one embodiment for maintaining patency of an opening inside the human body comprises introducing a radially self-expanding hollow stent into the opening through an endoscope that radially compresses the stent, wherein the stent has enlarged ends and a reduced intermediate portion.
The stent is introduced into the opening such that its intermediate portion extends through the opening and the enlarged ends are positioned outside of the opening. Once deployed, the stent expands such that the enlarged ends of the stent abut against opposing faces of the opening to resist dislodgement of the stent from the opening after expansion. The stent is preferably biodegradable, such that it is eliminated from the surgical site over a period of weeks to months, by which time the patency of the opening is more assured.
The method can be used in combination with, for example, an endoscopie surgical method such as endoscopie third ventriculostomy for treating hydrocephalus of a brain.

Claims (43)

1. A method for maintaining patency of an opening inside the human body, comprising:
introducing a radially self-expanding hollow stent into the opening through an endoscope that radially compresses the stent, wherein the stent has enlarged ends and an intermediate portion having a reduced cross-sectional profile, and the stent is introduced into the opening with its intermediate portion extending through the opening and the enlarged ends positioned outside of the opening;
and allowing the self-expanding stent to expand for retention within the opening by the enlarged ends on opposing faces of the opening.
2. The method of claim 1, wherein the stent is bioabsorbable, and degrades over time within the body after a sufficient period of time to maintain patency of the opening.
3. The method of claim 1, further comprising forming the opening by forming a surgical fenestration inside the human body.
4. The method of claim 3, wherein the surgical fenestration is formed in a wall of a ventricle of the brain to establish a path of cerebrospinal fluid flow from the ventricle to a sub-arachnoid space.
5. The method of claim 4, wherein the surgical fenestration is formed in a floor of the third ventricle.
6. The method of claim 3, wherein introducing the radially self-expanding hollow stent into the opening takes place substantially immediately after the fenestration has been artificially created.
7. The method of claim 1, wherein the stent comprises a resilient material that is compressed by delivery through the endoscope, but which expands after delivery from the endoscope into the opening.
8. The method of claim 7, wherein the resilient material comprises L-lactide-glycolic acid co-polymer with a molar ratio of 80:20 (SR-PLGA 80/20), a biocompatible polymer, a biocompatible elastomer, a resilient collagen material, a polysaccharide matrix, or a bioabsorbable gelatin film.
9. The method of claim 1, wherein the intermediate portion is a tapered intermediate portion.
10. The method of claim 9, wherein the stent is symmetric in shape.
11. The method of claim 10, wherein the stent comprises two joined frustoconical sections.
12. The method of claim 1, wherein the stent further comprises a material having shape memory such that the stent is stretchable into an elongated shape along a longitudinal direction and at least partially returns to a remembered shape through expanding along a radial direction.
13. The method of claim 12, wherein the stent comprises multiple longitudinally extending filaments made of the material having shape memory.
14. The method of claim 13, wherein the multiple filaments comprise an interstitial mesh.
15. The stent of claim 1, wherein the enlarged ends of the stent each comprise an elastic material.
16. The method of claim 1, further comprising withdrawing from the opening any surgical instrument used for introducing the stent into the opening to leave the stent in the opening.
17. The method of claim 1, wherein introducing the stent into the opening comprises introducing the stent using an endoscopic surgical procedure.
18. The method of claim 17, wherein using an endoscopic surgical procedure comprises providing a multifunctional telescopic port that is used for sequentially creating the opening and delivering the stent.
19. The method of claim 1, wherein the stent is introduced into the opening through an endoscopic delivery port, the stent being constrained within a tubular portion of the delivery port and held by a retractable release device before being introduced into the opening.
20. The method of claim 1, wherein the intermediate portion contacts an edge of the opening after the stent has expanded.
21. An endoscopic surgical method for treating hydrocephalus of a brain, comprising:
introducing an endoscope into the third ventricle of the brain;

fenestrating the floor of the third ventricle to create an opening fluidly communicating between the third ventricle and a subarachnoid space;
enlarging the opening;
placing a stent into the opening; and retrieving from the opening any surgical instrument used for placing the stent into the opening to leave the stent in the opening to maintain the patency of the opening.
22. The method of claim 21, wherein the stent comprises a distal portion with a distal end, an intermediate portion, and a proximal portion with a proximal end, and after the stent has been introduced into the opening, the proximal end and the distal end each have a diameter greater than the opening, and the proximal end and the distal end are on two opposing sides of the opening while the intermediate portion passes through the opening.
23. The method of claim 22, wherein the intermediate portion of the stent has a diameter smaller than the diameters of the distal end and the proximal end.
24. The method of claim 23, wherein the stent tapers from the proximal end and the distal end toward the intermediate portion.
25. The method of claim 21, wherein the distal portion and the proximal portion each have a frustoconical or frustopyramidal shape.
26. The method of claim 21, wherein the stent is bioabsorbable.
27. The method of claim 21, wherein the stent is self-expandable.
28. The method of claim 21, wherein placing the stent into the opening further comprises:
delivering the stent through an endoscopic delivery port adjacent the opening, wherein the stent is advanced through the endoscopic delivery port by a retractable delivery device;
releasing the stent;
allowing the stent to expand such that the proximal end and the distal end each expand from a first diameter to a second diameter, wherein the second diameter of the proximal end and the second diameter of the distal end are both greater than the opening.
29. The method of claim 28, wherein the stent is delivered into the opening before it is released by the retractable delivery device.
30. A stent for maintaining patency of an opening at an interface in a human body, the stent comprising:
two enlarged ends; and an intermediate portion defining a cross-sectional profile that is smaller than that of the enlarged ends;
wherein the stent is biodegradable and expandable;
wherein the stent comprises a substantially hollow body defined by an open surface structure which allows flow of a body fluid through the stent.
31. The stent of claim 30, wherein the stent is self-expandable.
32. The stent of claim 30, wherein the stent is bioabsorbable.
33. The stent of claim 30, wherein the stent tapers from the enlarged ends toward a location intermediate the enlarged ends.
34. The stent of claim 33, wherein the stent is symmetric in shape with respect to an axial direction.
35. The stent of claim 34, wherein the stent comprises two joined frustoconical sections.
36. The stent of claim 30, wherein the open surface structure is an interstitial mesh of filaments.
37. The stent of claim 30, wherein the stent comprises a resilient material.
38. The stent of claim 37, wherein the resilient material comprises L-lactide-glycolic acid co-polymer with a molar ratio of 80:20 (SR-PLGA 80/20), a biocompatible polymer, a biocompatible elastomer, a resilient collagen material, a polysaccharide matrix, or a bioabsorbable gelatin film.
39. The stent of claim 30, wherein the stent comprises a material having shape memory.
40. The stent of claim 30, wherein the enlarged ends comprise an elastic material.
41. The stent of claim 30, wherein the stent comprises multiple filaments extending between the enlarged ends, the filaments being made of a resilient material.
42. The stent of claim 30, wherein when expanded the two enlarged ends have a diameter about the same or greater than a length of the stent.
43. An artificial fluid pathway created in a membrane in a biological body such as a human body to facilitate fluidic communication, comprising:
an artificially created opening in the membrane; and a hollow stent situated in the opening, wherein the stent has enlarged ends and a constricted intermediate portion, the intermediate portion extending through the opening and the enlarged ends being positioned outside of the opening, and wherein the stent is capable of maintaining the patency of the opening for an extended period of time without support of an additional surgical member.
CA002565970A 2004-05-11 2005-05-09 Interfacial stent and method of maintaining patency of surgical fenestrations Abandoned CA2565970A1 (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US57017804P 2004-05-11 2004-05-11
US60/570,178 2004-05-11
PCT/US2005/016350 WO2005122953A2 (en) 2004-05-11 2005-05-09 Interfacial stent and method of maintaining patency of surgical fenestrations

Publications (1)

Publication Number Publication Date
CA2565970A1 true CA2565970A1 (en) 2005-12-29

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CA002565970A Abandoned CA2565970A1 (en) 2004-05-11 2005-05-09 Interfacial stent and method of maintaining patency of surgical fenestrations

Country Status (4)

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US (1) US20070179426A1 (en)
AU (1) AU2005253930B2 (en)
CA (1) CA2565970A1 (en)
WO (1) WO2005122953A2 (en)

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AU2005253930A1 (en) 2005-12-29

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