WO2003020174A1

WO2003020174A1 - Device that forms a twisted intraluminal stent

Info

Publication number: WO2003020174A1
Application number: PCT/FR2001/002690
Authority: WO
Inventors: Manuel Robichon; Jean-Jacques Meunier
Original assignee: Vertex S.A.
Priority date: 2001-08-29
Filing date: 2001-08-29
Publication date: 2003-03-13

Abstract

The invention relates to a device that forms a twisted intraluminal stent. The inventive device is made at least partially from a biocompatible shape-memory material which can be opened out from a closed, non-deployed position into a deployed, work position. Said device comprises at least one first section (12) having an upstream end (12a) and a downstream end (12b), the construction of said section being such that, after deployment, it can essentially completely occupy, in a transverse manner, the blood vessel in which it is to be inserted. Said section (12) is made from at least one biocompatible shape-memory alloy wire or ribbon (14) which is subjected to a meshing or knitting procedure comprising bending or curving operations that define bends or folds and bend or fold apexes. The bend or fold apexes of adjacent successive meshes are interleaved inside one other. The invention is characterised in that the device is twisted as a result of a twisting step (R) during production whereby at least one end (12a) is twisted in relation to the other (12b) and a heat treatment step by means of which the device develops its shape memory property in the twisted state. The inventive device does not require the use of link means such as wires or welds.

Description

Device forming a twisted endoluminal stent

The present invention essentially relates to a device forming a twisted endoluminal stent. The applicant has described in document WO 99/43273 a device forming an intracorporeal endoluminal endoprosthesis, in particular an abdominal aortic, comprising, according to a first embodiment object of FIG. 4, a device or stent produced in a single step by meshing / knitting at least one wire, which is bent so as to form substantially annular individual units which are connected together by suitable connecting means constituted by sutures.

According to a second embodiment object of Figure 3, there is provided an upstream section for fixing the main device or base stent upstream of the renal arteries. The present invention aims to provide a new generation of devices forming endoluminal stent or stent avoiding the need for the realization of connecting means such as sutures or welds at some of the elbows or tops of individual or row units .

The present invention also aims to solve the new technical problem consisting in the supply of a solution which makes it possible to produce an intracorporeal endoluminal endoprosthesis device, in particular an abdominal aortic, the structure of which avoids the formation of folds in even tight curves.

The main object of the present invention is also to solve the new technical problem consisting in providing a solution making it possible to produce a device forming an intracorporeal endoluminal endoprosthesis, in particular an abdominal aortic, having an exceptional radial force, as well as resistance to 'crushing.

The present invention also aims to solve the new technical problems stated above, in a particularly simple manner, at a cost substantially equivalent to the previous solutions, usable on an industrial and medical scale.

The present invention makes it possible for the first time to solve all of the technical problems mentioned above, without the need for connecting means such as sutures, welding at certain vertices elbows of successive units or rows of meshes defining the endoluminal endoprosthesis device.

Thus, according to a first aspect, the present invention provides a device forming an endoluminal endoprosthesis, produced at least in part from a biocompatible material with shape memory, deployable from a closed or non-deployed position, from positioning to a deployed position. working, comprising at least a first section, having a so-called front end and a so-called downstream end, made by construction to be able, after deployment, to occupy substantially completely transversely a blood conduit in which it will be incorporated, said section being made at from at least one wire or ribbon of biocompatible alloy with shape memory subjected to a mesh or knitting procedure comprising folds or bends defining folds or elbows, as well as ply vertices or elbows including ply crests or of adjacent successive mesh bends are nested one inside the other, characterized in that it has a twist, resulting from a manufacture thereof comprising a twist step of at least one end relative to the other, as well as a heat treatment step giving it a shape memory in the 'twisted state.

According to an advantageous embodiment, this device is characterized in that the twisting of at least one end of the first section is carried out at an angle of rotation of at least 10 °, better at least 30 °, even better d at least 45 °, preferably at least 90 °, and more preferably at least 180 °, in particular approximately 180 °.

According to yet another advantageous embodiment, this device is characterized in that the twisting step comprises a twisting of each of the ends of the first section in the opposite direction, preferably at an angle of rotation of at least 10 °, better at least 30 °, more preferably at least 45 °, preferably at least 90 ° and more preferably at least 180 °, in particular about 180 °. According to yet another advantageous embodiment, this device is characterized in that the aforementioned mesh or knitting is produced without means of connecting the tops of adjacent elbows or folds.

According to yet another advantageous embodiment, this device is characterized in that the aforementioned mesh or knitting is carried out with the presence of connecting means of at least certain adjacent elbows of elbows, these connecting means possibly being for example either welds made from metals or biocompatible glues, either loop-shaped links produced for example from threads or ribbons such as suture threads or ribbons.

According to another advantageous embodiment, the knitting or knitting is carried out by passing the thread of the next stitch at least once around the thread of the previous stitch. The embodiment is patentable in itself independently of the presence or not of a twist. In other words, this embodiment does not require a twist although a twist is preferred.

According to another advantageous embodiment of the invention, the device is characterized in that the mesh or knitting is carried out in a helical manner.

According to a preferred embodiment, the above-mentioned helical mesh or knitting is produced so as to define successive rows of stitches, preferably rows in successive rings defining rows of successively substantially cylindrical shape. Preferably, the successive rings are of substantially identical size.

According to another alternative embodiment, the successive rings are of variable dimensions.

According to yet another advantageous embodiment of the invention, the device does not include a waterproof, flexible, biocompatible, substantially non-extensible cover, in particular for the treatment of stenotic or calcified blood conduits.

According to yet another advantageous embodiment of the invention, the device comprises a sealed, flexible, biocompatible, substantially non-extensible envelope, intended in particular for the treatment of blood conduits comprising a crack or deformation or aneurysm.

These envelopes are for example made of film or polyester son.

According to yet another embodiment of the invention, this device is characterized in that it comprises, in addition to the first section, at least a second section comprising at least two independent conduits, of reduced diameter compared to the diameter of the first section , each comprising a first upstream opening communicating with the first section and a second downstream opening possibly and preferably communicating with at least a third downstream section, made by construction to be able, after deployment, to have a sufficient diameter to be active in said pipe blood, in particular by facilitating access and possible insertion of at least one second device forming a stent and intended to treat the blood conduit on the downstream part. This device is preferably of the type described in the previous international application WO 99/43273. According to another advantageous characteristic of the invention, the device comprises at least one biocompatible radiopaque marker element making it possible to display the positioning of a device. These radio-opaque elements are well known to those skilled in the art and can, for example, be made of platinum, which has the advantage of being compatible with use in a blood conduit.

According to another advantageous embodiment of the invention, the aforementioned wire used to make the mesh of the device can have a circular, non-circular section, advantageously in a triangle, square or rectangular, and also have a diameter suitable for adjusting the radial force, as well as to improve resistance to crushing

On the other hand, the external protective envelope, when it is present, ensures sealing. This external envelope is flexible, substantially non-elastic, produced in a diameter corresponding substantially to the diameter in the deployed state of the endoprosthesis device, so as to ensure the actual reconstruction of the blood conduit. Such watertight, flexible, biocompatible, substantially non-extensible envelopes are well known to those skilled in the art, in particular from the prior art cited in the introduction and also from the endoprosthesis devices available on the market. . These envelopes are often made of polyester film or yarn. It is also possible to provide that the endoprosthesis device is not entirely covered by the protective envelope ensuring sealing. An upstream section of the type described in the applicant's previous application WO 99/43273 can also be provided in order to ensure a better anchoring effect upstream of the endoprosthesis device, this upstream part being advantageously not covered with a envelope.

According to a second aspect, the present invention also covers a method of manufacturing the aforementioned endoluminal endoprosthesis device, said method being characterized in that it comprises the manufacture of at least a first section having a so-called upstream end and a so-called downstream end , from at least one wire or ribbon of biocompatible alloy with shape memory which is subjected to a mesh or knitting procedure comprising folding or bends defining folds or elbows, as well as vertices of folds or elbows whose vertices of folds or elbows of successive adjacent meshes are nested in each other, characterized in that a twisting step is carried out of at least one end of said section relative to the other end, as well as a heat treatment step in the twisted position for a period of time sufficient to give said section, therefore to the device, a shape memory in the twisted state.

According to an advantageous embodiment of this method, a twist is made at least one end of the first section at an angle of rotation of at least 10 °, better at least 30 °, even better at least 45 °, preferably at least 90 °, and more preferably at least 180 °, in particular about 180 °.

According to another advantageous embodiment of the method, a twisting of each end of the first section is carried out in the opposite direction, preferably at an angle of orientation of at least 10 °, better at least 30 °, even better at least 45 °, preferably at least 90 ° and more preferably at least 180 °, in particular about 180 °.

According to another advantageous embodiment of the method, the above-mentioned mesh or knitting is carried out without means of connecting the tops of adjacent elbows or folds.

According to another advantageous embodiment of the invention independently patentable as previously described, the aforementioned mesh or knitting is carried out by passing the thread of the next stitch at least once around the thread of the previous stitch. According to yet another advantageous embodiment of the invention, the above-mentioned mesh or knitting is produced helically. Preferably, the helical mesh or knitting is produced so as to define successive rows of stitches, preferably rows in successive rings defining rows of successively substantially cylindrical shape. According to another advantageous embodiment of the invention, successive rings of substantially identical size are produced.

According to another alternative embodiment, successive rings of variable dimensions are produced.

According to yet another alternative embodiment of the method according to the invention, the device is covered with a sealing cover envelope, in particular for the treatment of blood conduits comprising a crack or deformation or aneurysm.

According to another embodiment of the method according to the invention, after having carried out the aforementioned first section, at least one second section is provided, comprising at least two independent conduits, of reduced diameter compared to the diameter of the first section, each comprising a first upstream opening communicating with the first section and a second downstream opening possibly and preferably communicating with at least a third downstream section, made by construction to be able, after deployment, to have a sufficient diameter to be active in said blood conduit, in particular by facilitating access and possible insertion of at least one second device forming a stent and intended to treat the blood conduit on the downstream part.

According to a third aspect, the present invention also relates to a method of surgical treatment of a blood conduit comprising: a) the provision of at least one device forming an endoluminal endoprosthesis according to the invention, as defined above; and b) the insertion of this endoluminal endoprosthesis device into a blood conduit to be treated, in particular to avoid an aneurysm or stenosis problem.

Advantageously, this process is carried out without having to interrupt the blood flow and advantageously without having to take a predetermined access route, in other words, the access route is indifferent.

According to a particularly preferred embodiment of the method according to the invention, it relates to a surgical treatment of an aneurysm of the abdominal aorta situated upstream of the bifurcation of the aorta in the direction of the femoral arteries.

According to yet another advantageous embodiment of the surgical method according to the invention, the endoprosthesis device comprises an upstream section which is positioned in the aorta upstream from the renal arteries, while the upstream end of the first section of the device s' essentially presses on the renal arteries, thereby allowing safe and reliable fixation of the endoprosthesis device of the invention, without trauma and without substantially disturbing the blood flow in the renal arteries and in the downstream aorta. According to yet another advantageous embodiment of the invention, the endoprosthesis device offers a wide range of diameters, in the state deployed, at least the first section, ranging from approximately 18 to approximately 40 mm, which allows the treatment of almost all the aorta diameters, in particular at the abdominal level.

It is also advantageous in the context of the invention that the two conduits of the intermediate section have, in the deployed state, a diameter of at least about 9 mm, without any conical shape, and without discontinuity with respect to the first section in particular , in particular thanks to a continuous mesh or knitting, that is to say without discontinuity, which avoids any risk of stenosis.

The devices of the invention are thus particularly intended for keeping the blood conduit correctly open after stenosis, for the reconstruction / recanalization of these blood conduits.

The devices of the invention can also be called stents.

The invention is particularly indicated percutaneously for the treatment of occlusive connections of peripheral vessels, as a transjugular intrahepatic system for the abbreviation TPS; for the palliative treatment of biliary occlusions and for the treatment of peripheral aneurysms, and particularly for abdominal and thoracic aortic aneurysms.

The device according to the invention has a prosthesis body of short length, which reduces the risk of thrombo-genecity, allows better blood flow of the laminar type because the device according to the invention allows to overlap or replace conventional vascular prostheses .

On the other hand, thanks to a wire diameter which can be used within wide limits, in particular between 0.20 and 0.70 mm, and advantageously around 0.45 mm, an increase in the radial force is obtained, the presence of a hook (s) is avoided, which induces a reduction in the risk of rupture of the wall of the blood duct, in particular aortic, and a reduction in post-operative pain, in particular abdominal pain.

On the other hand, in the embodiment comprising the presence of an intermediate section comprising independent conduits, these are preferably identical and symmetrical with respect to the longitudinal axis of the device forming a stent, this longitudinal axis of the device being intended to correspond appreciably to the longitudinal axis of the final duct in which it is inserted, which makes it possible to better adjust in positioning each device forming an auxiliary endoprosthesis often referred to as the secondary branch, relative to the birth of the hypogastric arteries, which constitutes a difference fundamental compared to the asymmetric bifurcated system of many devices of the prior art.

The invention makes it possible, thanks to the aforementioned twisting of the wire or ribbon with shape memory or thanks to the mesh of the wire or ribbon of a mesh with at least one turn around the preceding mesh, to obtain an exceptional radial force, a large resistance to crushing, as well as to avoid kinks in the even tight curves of the blood conduits, which constitutes new advantages, particularly unexpected, with respect to the devices foraiating endoprosthesis of the prior art. In the context of the invention, it will be noted the absence of connecting means, such as suturing or welding threads, vertices facing each other with elbows or folds of successive rings. In the absence of such connecting means thanks either to the twist or to the knitting of a next stitch around the previous stitch, or even both, the device according to the invention has good resistance to folding. Even if the device has a partial folding capacity under certain conditions, its length is calculated so that in the folded position, its length corresponds to the necessary length of the device for the desired treatment of the blood duct.

Other objects, characteristics and advantages of the invention will become clear in the light of the explanatory description which follows, given with reference to two currently preferred embodiments of the invention, given simply by way of illustration and which cannot therefore in no way limit the scope of the invention. Other embodiments of the invention object of Figures 1 to 7 are an integral part of the present invention in all its aspects. The invention also covers in its generality, any characteristic which appears to be new compared to any prior art, resulting from the description taken as a whole, supplemented by FIGS. 1 to 7. In the drawings:

- Figures 1 to 4 show the various stages of manufacturing a first embodiment of a device forming a stent for surgical treatment of a stenosis or an aneurysm, comprising a twisting step object of Figure 3;

- Figure 5 showing the finished device, twisted comprising a bent guide, to show that even in tight elbows, the device does not have any kinks. More precisely : - Figure 1 shows a top view of the first manufacturing step on a mandrel comprising pins, of a stent device according to the present invention, from at least one wire or ribbon according to a top view, with a partial cut; - Figure 2 shows the endoprosthesis device according to the present invention, removed from the mandrel of Figure 1;

- Figure 3 shows the twisting step in a twisting device here of each end of the device by a rotation, here performed in opposite direction of each end, in order to undergo heat treatment in the twisted position; - Figure 4 shows the device according to the invention, in the twisted state, on which a pressure P has been subjected to each of these ends so as to bring the ends together, to show the resistance to folding and the fact that the elbows or tops are positioned substantially opposite, thereby limiting the ability to fold; - Figure 5 shows the device of Figures 1 to 4, in a twisted state, in the context of a tight elbow, showing the absence of bending;

- Figure 6 shows a second embodiment of a device forming a surgical treatment stent of the present invention for treating in particular a stenosis or an aneurysm of a blood conduit, according to which each wire comprises at least the passage at least one times of a thread of the next stitch around the thread of the previous stitch; and

- Figure 7 shows the endoprosthesis device completed, in a twisted state, also bent in a tight elbow, showing the absence of bending. With reference to FIGS. 1 to 5, there is shown the first embodiment of a device forming an endoluminal stent according to the present invention, represented by the general reference number 10.

This device comprises at least a first section represented by the general reference number 12, having a so-called upstream end 12a and a so-called downstream end 12b, produced from at least one wire or ribbon 14 of biocompatible alloy with shape memory, well known to those skilled in the art, such as for example and preferably nitinol.

To manufacture this first section 12, the wire or ribbon 14 is subjected to a mesh or knitting procedure on a rigid mandrel 16, for example of substantially circular section, comprising spikes arranged at different distances such as Di, D ₂ , D ₃ , D ₄ , D ₅ of one end 16a of the mandrel 16 for define lines Li, L ₂ , L ₃ , L ₄ , L ₅ of pins 18 respectively called 18ι for the line Li, 18 ₂ for the line L ₂ , 18 ₃ for the line L ₃ , 18 for the line L ₄ and 18 ₅ for line L ₅ .

It will be observed that, advantageously, the pins of successive lines are arranged staggered or staggered, as clearly visible in FIG. 1.

The mesh or knitting procedure comprises bending or bending the wire 14 successively around a spike I8 ₁ of the line Li, then 18 of the line L ₂ , returning to the spike 18] following the line Li then to the spike along 18 ₂ of the line L ₂ , until having made the complete turn of the mandrel 16 and then, after having made the turn of the last spike I8 ₁ of the line Li, the wire 14 is lowered to the first spike 18 ₃ from line L ₃ as symbolized by the part of wire 14J _{L, L} or junction part connecting line Li to line L ₃ , and then the wire after having made the tour of the first pin 18 ₃ of line L ₃ , the latter is raised to the first spike offset from the line L, passing under the wire 14 of the ring Ai already surrounding the spike 18 of the line L ₂ . One thus obtains parts of wire 14 of junctions 14jι _t _ and 14jι _t _, respectively in a similar manner.

A person skilled in the art thus understands that a mesh or knitting procedure can be carried out comprising foldings or so-called upper bends of the first ring or ring Ai called PS Ai for the line Li, and lower folds or bends respectively called PIAi for the first ring Ai on line L; and PSA ₂ for the folds or elbows of the second upper ring A ₂ and PIA ₂ for the folds or lower elbows of the second ring A ₂ defined on the pins 18 ₃ of the line L ₃ , and successively PSA ₃ for the upper folds or elbows of the ring A ₃ ; PIA ₃ for the lower folds or elbows of the ring A ₃ ; PSA ₄ for the upper folds of the ring A ₄ and PIA ₄ for the lower folds of the ring A ₄ , etc. in case of additional rings.

It can be seen in FIG. 2 that the vertices between the junction of two successive rings such as the ring Ai, namely vertices PIAi, are nested with the vertices of the ring following A ₂ , here PA ₂ being nested one in the others.

We carry out a first heat treatment of the mandrel assembly 16, device 10 to impart a first memory deformed in a conventional manner.

The rigid mandrel 16 is then removed in a conventional manner by increasing the diameter of the device 10 with a tool to release it from the pins 18. The endoprosthesis device, conforming at this stage to that of the prior art is shown in Figure 2 where we can see in particular the nesting in each other of the vertices of the different folds or elbows between the successive rings Ai to A ₄ . In the context of the present invention, FIG. 3 shows the additional twisting step, according to which the device 10 is introduced into a twisting device 20 which is designed to firmly hold certain zones of the wire 18 at each end 12a, 12b, in a direction of rotation R, preferably in the opposite direction, as shown, whose angle of rotation is at least 10 °, better at least 30 °, even better at least 45 °, preferably at least 90 °, and more preferably at least 180 °, in particular about 180 °.

The twisting device 20 is provided to allow the twisting position to be blocked. Then the twisting device in this locked twisting position, according to the predetermined angle of rotation, is transferred to a heat treatment chamber where a new heat treatment is carried out so that the biocompatible alloy with shape memory in the form wire or ribbon 18 is heat treated for a period of time sufficient to give it a shape memory in this twisted state. With reference to FIG. 4, it is observed, after this heat treatment in the twisted state, that when a pressure P is exerted on each side 12a, 12b of the device 10, here formed the first section or single section 12, it is obtains a resistance to the reduction in size, the lower folds at the top of a ring such as PIAi for the ring Ai coming to be presented substantially opposite the next second ring, here A ₃ , such as PSA ₃ , which prevents a more complete folding of the endoprosthesis drilling device 10, here of the section 12.

We understand that thanks to this twist, without the presence of connecting means such as sutures or welds between the nested vertices of successive rings Ai, A ₂ , A ₃ , A ₄ , we obtain resistance to folding. It is thus possible to calculate the total length of the device so that its length in the partially folded state corresponds to the necessary length of the device forming a stent for the treatment of a blood conduit.

In addition, thanks to this twist, we also observe the absence of bending in the curves even tight as shown in Figure 5, the tight curvature being provided by a rigid wire 22 or guide. This device also has a high resistance to crushing. In addition, this device has an exceptional radial force, which is completely unexpected.

Naturally, if this is desired for certain applications, it is possible to provide complementary connecting means such as sutures or welding, but this does not constitute a necessary embodiment in the context of the invention.

It will be noted that the mesh or knitting can be carried out in a helical manner.

On the other hand, as shown in Figures 1 to 5, the above-mentioned helical mesh or knitting can be carried out so as to define successive rows of stitches, preferably rows in successive rings here Ai to A, defining rows of substantially shaped successive cylindrical. In the embodiment shown, the successive rings are of substantially identical size. Naturally, it is also possible to provide successive rings of variable dimensions.

On the other hand, here the device does not include a sealing cover envelope and particularly suitable for the treatment of stenotic or calcified blood conduit. It is also possible to provide a waterproof covering envelope in the case where the device is used for the treatment of blood conduits comprising a crack or deformation or aneurysm.

It is also possible to provide for the presence of a second intermediate section comprising at least two independent conduits of reduced diameter as described in the applicant's prior application WO 99/43273.

According to a second embodiment shown in Figures 6 and 7, which is independently patentable in itself, that is to say in the absence of the production of a twist as described for the embodiment of Figures 1 at 5, a mesh or knitting of the wire or ribbon is carried out, here bearing the reference number 114, that is to say increased by 100 compared to the reference number 14 given for the wire or ribbon of the first embodiment Figures 1 to 5, by passing the thread of the next stitch M ₂ at least once around the thread of the previous stitch Mi, so on for the following stitches, as is clearly understandable to a person skilled in the art from the consideration of FIG. 6 in particular. This mesh procedure with the passage of the wire of the next mesh around the wire of the previous mesh, makes it possible to exert a stiffening effect on all of the meshes, therefore on the section and finally on the stent or device, in a way particularly simple, easy to implement on an industrial and medical scale. Thanks to this particular mesh or knitting, it is no longer necessary to carry out the twisting step which was necessary in the context of the embodiment of FIGS. 1 to 5. Therefore, this particular mesh is an integral part of the present invention and is independently patentable, that is to say is patentable regardless of the presence or not of a twist. However, advantageously and preferably, a twist can also be produced in accordance with the procedure described in references 3 and 4.

In this context, one then obtains the twisted device 110 comprising a first twisted section 112 shown in FIG. 7 and which still has an increased radial force and an increased resistance to crushing, as well as a bending resistance which is further reinforced by compared to the embodiment of FIGS. 1 to 5. It will be noted that only the mesh or knitting being different compared to the embodiment of FIGS. 1 to 5, the same reference numbers have been used simply increased by 100 relative to the reference number of the embodiment of Figures 1 to 5. Naturally, the invention includes all the means constituting technical equivalents of the means described as well as their various combinations.

In addition, the procedure for fitting the endoprosthesis device according to the present invention applicable to the two embodiments of FIGS. 1 to 5 and 6 and 7 respectively, is conventional and is essentially the same as that described in the previous document. of the applicant WO 99/43273 to which a person skilled in the art can refer.

Claims

1. Device (10; 110) forming an endoluminal endoprosthesis, produced at least in part in a biocompatible material with shape memory, deployable from a closed or non-deployed position, positioning up to a deployed working position, comprising at least at least a first section (12; 112) having a so-called upstream end (12a) and a so-called downstream end (12b), produced by construction so as to be able, after deployment, to occupy substantially completely transversely a blood conduit into which it will be incorporated, said section (12; 112) being produced from at least one wire or ribbon (14; 114) of a biocompatible alloy with shape memory subjected to a mesh or knitting procedure comprising bends or bends defining folds or bends , as well as vertices of folds or elbows (PS Ai, PIAi; PSA ₂ , PIA ₂ , PSA ₃ , PIA ₃ , PSA ₄ , PIA ₄ ) whose summits of folds or elbows of successive adjacent meshes are im briqueted in each other, characterized in that it has a twist, resulting from a manufacture thereof comprising a twist step of at least one end (12a; 112a) relative to the other (12b; 112b), as well as a heat treatment step giving it a shape memory in the twisted state.

2. Device according to claim 1, characterized in that the twisting of at least one end of the first section is carried out at an angle of rotation (R) of at least 10 °, better at least 30 °, even better at least 45 °, preferably at least 90 °, and more preferably at least 180 °, in particular about 180 °.

3. Device according to claim 1 or 2, characterized in that the twisting step comprises a twisting of each of the ends of the first section in the opposite direction, preferably according to an angle of rotation (R) of at least 10 °, better at least 30 °, more preferably at least 45 °, preferably at least 90 ° and more preferably at least 180 °, in particular about 180 °.

4. Device according to one of the preceding claims, characterized in that the aforementioned mesh or knitting is carried out without means of connection of the tops of elbows or adjacent folds.

5. Device according to one of claims 1 to 3, characterized in that the aforementioned mesh or knitting is carried out with the presence of connecting means of at least some adjacent elbows, these connecting means can be for example either welds made from metals or glues biocompatible, either loop-shaped links made for example from threads or ribbons (14) such as suture threads or ribbons.

6. Device according to one of the preceding claims, characterized in that the mesh or knitting is carried out by passing the thread of the next stitch (M Aι, M ₂ A ₂ , M ₂ A ₃ , M ₂ A4) at least once around the thread of the previous stitch (M ₁ A ₁ , MιA ₂ , MιA ₃ , M ₁ A ₄ ).

7. Device according to any one of the preceding claims, characterized in that the mesh or knitting is carried out helically.

8. Device according to claim 7, characterized in that the above-mentioned helical mesh or knitting is produced so as to define successive rows of stitches, preferably rows in successive rings (Ai, A ₂ , A ₃ , A) defining successively substantially cylindrical rows.

9. Device according to any one of the preceding claims, characterized in that the successive rings (Ai, A ₂ , A ₃ , A ₄ ) are of substantially identical size.

10. Device according to one of claims 1 to 8, characterized in that the successive rings (Ai, A ₂ , A ₃ , A ₄ ) are of variable dimensions.

11. Device according to any one of the preceding claims, characterized in that the device does not comprise a sealing covering envelope, in particular for the treatment of stenotic or calcified blood conduits.

12. Device according to any one of claims 1 to 11, characterized in that the device comprises a tight covering envelope, intended in particular for the treatment of blood conduits comprising a crack or deformation or aneurysm.

13. Device according to any one of the preceding claims, characterized in that it comprises, in addition to the first section (12; 112), at least a second section comprising at least two independent conduits, of reduced diameter compared to the diameter of the first section, each comprising a first upstream opening communicating with the first section and a second downstream opening possibly and preferably communicating with at least the third downstream section, made by construction to be able, after deployment, to have a sufficient diameter to be active in said blood conduit, in particular by facilitating access and possible insertion of at least one second device forming a stent and intended to treat the blood conduit on the downstream part.

14. Device according to any one of the preceding claims, characterized in that the device (10; 110) forming a stent offers a wide range of diameters, in the deployed state, of at least the first section (12; 112) , ranging from 18 to 40 mm, which allows the treatment of almost all aorta diameters, in particular at the abdominal level.

15. A method of manufacturing a device (10; 110) forming an endoluminal endoprosthesis, characterized in that it comprises the manufacture of at least a first section (12; 112) having a so-called upstream end (12a) and an end said downstream (12b), from at least one wire or ribbon of biocompatible alloy with shape memory which is subjected to a mesh or knitting procedure comprising bends or bends defining folds or bends (PS Ai, PIAi ; PSA ₂ , PIA ₂ , PSA ₃ , PIA ₃ , PSA *, PIA ₄ ), as well as vertices of folds or elbows whose vertices of adjacent folds or elbows of mesh are nested one inside the other, characterized in what is carried out a twisting step of at least one end (12a; 112a) of said section relative to the other end (12b; 112b), as well as a heat treatment step in the twisted position for a period of sufficient time to confer on said section, therefore on the device , a shape memory in a twisted state.

16. The method of claim 15, characterized in that a twist is made of at least one end of the first section (12; 112) at an angle of rotation of at least 10 °, better at least 30 ° , more preferably at least 45 °, preferably at least 90 °, and more preferably at least 180 °, in particular about 180 °.

17. The method of claim 15 or 16, characterized in that a twisting of each of the ends of the first section (12; 112) is carried out in the opposite direction, preferably according to an orientation angle (R) of at least 10 °, better at least 30 °, even better at least 45 °, preferably at least 90 ° and more preferably at least 180 °, in particular about 180 °.

18. Method according to any one of claims 15 to 17, characterized in that the aforementioned mesh or knitting is carried out without means of connection of the summits of elbows or adjacent folds.

19. Method according to any one of claims 15 to 18, characterized in that the aforementioned knitting or knitting is carried out by passing the thread of the next stitch at least once around the thread of the previous stitch.

20. Method according to any one of claims 15 to 19, characterized in that the aforementioned mesh or knitting is carried out so helical, preferably, the helical knitting or knitting is carried out so as to define successive rows of stitches, preferably rows in successive rings (Ai, A, A ₃ , A ₄ ) defining rows of substantially cylindrical successive shape.

21. Method according to any one of claims 15 to 20, characterized in that successive rings (Ai, A ₂ , A ₃ , A ₄ ) of substantially identical size are produced.

22. Method according to any one of claims 15 to 20, characterized in that successive rings (Ai, A ₂ , A ₃ , A ₄ ) of variable dimensions are produced.

23. Method according to any one of claims 15 to 22, characterized in that the device is covered with a sealed covering envelope, in particular for the treatment of blood conduits comprising a crack or deformation or aneurysm.

24. Method according to any one of claims 15 to 23, characterized in that after having produced the first section (12; 112) above, there is provided at least a second section comprising at least two independent conduits, of diameter reduced by relative to the diameter of the first section, each comprising a first upstream opening communicating with the first section (12; 112) and a second downstream opening possibly and preferably communicating with at least a third downstream section, made by construction to be fit, after deployment , to have a diameter sufficient to be active in said blood conduit, in particular by facilitating access and possible insertion of at least one second device forming a stent and intended to treat the blood conduit on the downstream part.