An emboli capturing system captures emboli in a body lumen. A first elongate member has a proximal end and a distal end. An expandable emboli capturing device is mounted proximate the distal end of the first elongate member, and is movable between a radially expanded position and a radially contracted position. When in the expanded position, the emboli capturing device forms a basket with a proximally opening mouth. A second elongate member has a proximal and a distal end with a lumen extending therebetween. The lumen is sized to slidably receive a portion of the first elongate member. An expandable delivery device is mounted to the distal end of the second elongate member and is movable from a radially retracted position to a radially expanded position. The delivery device has a receiving end configured to receive the emboli capturing device, and retains at least the mouth of the emboli capturing device in a radially retracted position.

Distal protection device and method

An artery, vein, aneurysm, vascular malformation or arterial fistula is occluded through endovascular occlusion by the endovascular insertion of a platinum wire and/or tip into the vascular cavity. The vascular cavity is packed with the tip to obstruct blood flow or access of blood in the cavity such that the blood clots in the cavity and an occlusion if formed. The tip may be elongate and flexible so that it packs the cavity by being folded upon itself a multiple number of times, or may pack the cavity by virtue of a filamentary or fuzzy structure of the tip. The tip is then separated from the wire mechanically or by electrolytic separation of the tip from the wire. The wire and the microcatheter are thereafter removed leaving the tip embedded in the thrombus formed within the vascular cavity. Movement of wire in the microcatheter is more easily tracked by providing a radioopaque proximal marker on the microcatheter and a corresponding indicator marker on the wire. Electrothrombosis is facilitate by placing the ground electrode on the distal end of the microcatheter and flowing current between the microcatheter electrode and the tip.

Endovascular electrolytically detachable wire and tip for the formation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas

The invention is methods and devices which a surgeon may use to stabilize the beating heart during a surgical procedure on the heart. Pursuant to the invention, a stabilizing device is introduced through an opening in the chest and brought into contact with the beating heart. By contacting the heart with the device and by exerting a stabilizing force on the device, the motion of the heart caused by the contraction of the heart muscles is effectively eliminated such that the heart is stabilized and the site of the surgery moves only minimally if at all. Typically, in separate steps, the surgeon contacts the heart with the stabilizing means, assesses the degree of movement of the anastomosis site, and exerts a force on the stabilizing means such that the contraction of the beating heart causes orgy minimal excess motion at the surgery site. By fixing the position of the stabilizing means in a configuration where the motion of the beating heart is effectively eliminated, the surgeon is able to stabilize the beating heart for the duration of the procedure. The stabilizing means may be attached to a rigid support or may be attached to a semi-rigid support which is rendered motionless mechanically, chemically, or by human intervention. In certain preferred embodiments, the stabilizing means is affixed to a semi-rigid support which is caused to become rigid, by any of a variety of techniques, such that the position of the stabilizing means becomes fixed by the support, and the heart remains substantially motionless for the duration of the procedure.

Surgical instrument for stabilizing the beating heart during coronary artery bypass graft surgery

An intubation device is provided for use with a guide apparatus having a track that is adapted to be associated with an endoscope such that bending of the track is substantially decoupled from bending of the endoscope. The intubation device includes an elongated, flexible tube and a mating member attached to the tube and adapted to slidingly engage the track external of the endoscope. The intubation device further includes a tissue bolster disposed on the proximal portion of the tube and changeable between a collapsed and an expanded configuration. The tube is positionable inside the upper gastrointestinal tract of a patient such that the proximal end of the tube is externalized through the gastric and abdominal walls of the patient, and wherein the tissue bolster is securable against the inner gastric wall when the tissue bolster is in the expanded configuration.

Intubation device for enteral feeding

BACKGROUND AND PURPOSE: Aneurysm treatment by intrasaccular packing has been associated with a relatively high rate of recurrence. The use of mesh tubes has recently gained traction as an alternative therapy. This article summarizes the midterm results of using an endoluminal sleeve, the PED, in the treatment of aneurysms. MATERIALS AND METHODS: A total of 19 wide-neck aneurysms were treated in 18 patients: 10 by implantation of PEDs alone and 9 by a combination of PED and coils. Angiographic and clinical results were recorded immediately and at 6 months following treatment. RESULTS: Immediate angiographic occlusion was achieved in 4 and flow reduction, in another 15 aneurysms. Angiography at 6 months demonstrated complete occlusion in 17 and partial filling in 1 of 18 patients. There was no difference between coil-packed and unpacked aneurysms. Of 28 side branches covered by ≥1 device, the ophthalmic artery was absent immediately in 1 and at 6 months in another 2 cases. One patient experienced abrupt in-stent thrombosis resulting in a transient neurologic deficit, and 1 patient died due to rupture of a coexisting aneurysm. All giant aneurysms treated with PED alone were demonstrated by follow-up cross-sectional imaging to have involuted by 6 months. CONCLUSIONS: Treatment of large, wide-neck, or otherwise untreatable aneurysms with functional reconstruction of the parent artery may be achieved with relative safety using dedicated flow-modifying devices with or without adjunctive use of intrasaccular coil packing.

http://www.ajnr.org/content/ajnr/31/6/1139.full.pdf

Treatment of Intracranial Aneurysms by Functional Reconstruction of the Parent Artery: The Budapest Experience with the Pipeline Embolization Device

PURPOSE To study the flow of blood in aneurysms. METHODS A canine model was used to study the hemodynamics of lateral, bifurcation, and terminal aneurysms with angiography and color Doppler techniques. FINDINGS Flow within experimental aneurysms, although not laminar, is seldom if ever turbulent, but rather is highly predictable, varying primarily according to the relationship of the aneurysm to its parent artery. CONCLUSIONS These studies support earlier in vitro work and provide further evidence that not all aneurysms share similar stresses. A more complete understanding of these hemodynamic features will be useful in the establishment of criteria that allow recognition of those aneurysms that are more or less likely to rupture, to grow, or to thrombose.

http://www.ajnr.org/content/ajnr/13/4/1089.full.pdf

Aneurysm hemodynamics: an experimental study.

A device for retrieving foreign bodies, such as a vaso-occlusive coil or other articles from within vessels such as those of the cardiovascular system. Two small snare coils (60, 62) are joined at their distal ends (68, 70) to form a loop. The proximal ends of the coils are attached to one or more elongated actuator members (20, 22). The loop size is adjusted by manipulation of one or more of the proximal ends (26, 44) of the elongated actuator members. This retrieval device may be used to ensnare and either reposition or remove foreign bodies within a vessel lumen.

Dual coil medical retrieval device

1 Purpose: To investigate the hemodynamic characteristics of lateral carotid artery aneurysms in a canine model and to determine their influence on coils and balloons. Materials and Methods: Forty aneurysms were created in fourteen dogs and their hemodynamic characteristics and influence on coils and balloons were evaluated with angiography and color Doppler pre- and postplacement. Twenty aneurysms were treated with coils, eight with balloons, and 12 aneurysms served as controls. Results: The aneurysms demonstrated three distinct zones of flow: 1) an inflow zone entering at the distal aspect of the aneurysm ostium, 2) an outflow zone exiting at the proximal ostium, and 3) a central slow flow vortex. The inflow zone is a determining factor in the placement and stability of coils and balloons placed within the aneurysm and in the thrombosis of an aneurysm. The force of the inflow is considerable and can alter the shape of coils and displace both coils and balloons positioned within the aneurysm. Conclusions: Coils and balloons need to be of shapes and sizes that do not conform to the inflow and outflow zones. Filling the aneurysm and blocking or displacing the inflow zone can produce thrombosis of an aneurysm with preservation of the parent artery.

http://www.ajnr.org/content/ajnr/13/1/189.full.pdf

Flow dynamics of lateral carotid artery aneurysms and their effects on coils and balloons: an experimental study in dogs.

The objectives of this study were to investigate the consistency, patency, and natural history of a vein graft canine aneurysm model and to determine the effectiveness of various coil designs on inducing aneurysm thrombosis. Twenty-one sacculuslike aneurysms were created in mongrel dogs by anastomosing a vein pouch to the common carotid artery. The model produced wide-neck aneurysms with 100% patency. The canine vein graft aneurysm provided an excellent model for the evaluation of endovascular devices. Three types of specially designed platinum coils were placed in the aneurysms: those with simple curves, those with complex curves, and those with flower petal curves and silk fibers. These coils were placed by the endovascular route by means of microcatheters. Flower petal coils with silk fibers were effective in producing thrombosis of the aneurysms, suggesting that coils of the appropriate design may be useful in the endovascular treatment of aneurysms. The other coil designs evaluated, those with simple and complex curves without silk fibers, demonstrated insufficient thrombogenicity and spatial stability.

http://www.ajnr.org/content/ajnr/11/2/249.full.pdf

Treatment of carotid artery aneurysms with platinum coils: an experimental study in dogs.

PURPOSE To evaluate and compare the deliverability, positioning, stability, and effectiveness of aneurysm occlusion and the incidence of parent-artery thrombosis of two different types of platinum coils, using a canine carotid aneurysm model. METHODS 29 experimental canine carotid aneurysms (19 lateral, 6 bifurcation, and 4 terminal) were constructed and treated with complex-shaped fibered platinum coils and simple curved nonfibered platinum Guglielmi detachable coils (GDCs). RESULTS Fibered complex coils were stable, producing 38% complete aneurysm occlusion and 61% average reduction in aneurysm lumen size but resulting in 19% parent artery occlusions. GDC coils were stable, producing 31% complete aneurysm occlusion and 95% average reduction in aneurysm lumen size with no parent-artery occlusions. CONCLUSIONS GDC coils produced an average reduction in aneurysm lumen size of 95% without any associated parent-artery occlusions. There were no delayed migrations of GDC coils. The ability to remove, reposition, and detach a coil was the most significant feature of the GDC coil.

http://www.ajnr.org/content/ajnr/14/4/787.full.pdf

Alan Rappe

Papers

Aneurysm hemodynamics: an experimental study.

Dual coil medical retrieval device

Flow dynamics of lateral carotid artery aneurysms and their effects on coils and balloons: an experimental study in dogs.

Treatment of carotid artery aneurysms with platinum coils: an experimental study in dogs.

Treatment of Experimental Canine Carotid Aneurysms with Platinum Coils