Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
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BIFURCATED STENT AND METHOD OF M,A,KING SAME
of the Invention
The present invention relates to stents, and more .
particularly to bifurcated stents and methods of making
.C ~i'urcated stems for insertion within a branching vessel.
3ackcrround of the Invention
Stents are well known in the art. They are typically formed
e~ a cylindrical metal mesh which can expand when pressure is
internally applied. Alternatively, they can be formed of wire
wrapped into a cylindrical shape or sheets of material formed
..~. to a cyl indrical shape .
Stents are devices which are usually implanted within bodily
co.~.duits including the vascular system to reinforce collapsing,
:~a= d ally occluded, weakened, or abnormally dilated sections of
._ M ood vessel. Stents also have been successfully implanted
... ,.~z~r areas, e.g., the urinary tract or the bile duct to
_~~~orce such bodily conduits.
U.S. Patent No. 4,994,071 (MacGregor) discloses an
_::pandable, bifurcating stent having a main cylindrical lattice
_'o=-.~.=d from interconnected, flexible. Two additional cylindrical
lattices, having smaller diameters than the main lattice, are
similarly constructed. The main lattice includes a flexible wire
:ate=connecting the main lattice to ore of the additional
3. :~...~=ces. A second flexible wire interconnects the main lattice
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to the other additional lattice. The flexible wires forth
bac:~.bones that extena axially along the length or: the main
lattice and along each of the additional lattices. One
disadvantage of this bifurcating stent is the complex nature of
the interconnection of the flexible wires forming the backbones
with the loop structure of each lattice.
Summary of the Invention
The present invention solves these and other disadvantages
of the prior art by providing bifurcated stem s and methods of
fabricating and deploying bifurcated stents having a stem portion
and two leg portions.
In a first embodiment of the invention, a bifurcated stent
is made by providing three sheets patterned to a desired pattern,
wherein two sheets are substantially the same size and the third
sheet is wider than either of the first two sheets. Each of the
sheets is formed into tubes by turning up the longitudinal edges
a.~.~ 'orming a joint by welding. The larger sheet forms a tube
chat acts as the stem portion of the bifurcated stent and the
other sheets form tubes which act as the leg portions of the
bwfurcated stent. The two leg portions are then joined to the
sat~ aortion to form the bifurcated stent.
In a second embodiment of the invention, the bifurcated
stent is formed by preparing two stent sheets. For each sheet,
2~ the longitudinal edges of a portion o~ the sheet are turned up
a:~d secured to each other to form one of the two leg portions of
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the bifurcated stent. The remaining free edges of each of the
two sheets are then joined to form the stem portion of the stent.
In a third embodiment, the bifurcated stent comprises first
anc second tubular portions. The first portion has a proximal
end which forms the stem portion and a distal end which forms one
o~ the leg portions of the bifurcated stmt. A branch aperture
is disposed between the proximal end and the distal end of the
First portion. The second portion is introduced into the
longitudinal bore of the stem portion of the first portion and is
advanced through the branch aperture so that it protrudes beyond
the branch aperture to form a second leg. When the second
portion is expanded, the proximal end of the second portion
engages the material defining the branch aperture so as to secure
,e second leg in the desired position.
It is an object of this invention to provide a method of
.-..=king a bifurcated stent, comprising the steps of: a) preparing
:_~st sheet having a first edge, a second edge, a third edge,
_..~ a fourth edge; b) preparing a second sheet having a first
cage, a second edge, a third edge, and a fourth edge; c)
o=eparing a third sheet having a first edge, a second edge, a
~.._=d edge, and a fourth edge; d) attaching the second edge to
~.e th=rd edge of the first sheet to form a tubular first leg
~c:tion having a proximal end and a distal end; e) attaching the
second edge to the third edge of the second sheet to form a
2~ lobular second leg portion having a proximal end and a distal
_.. , ~) attaching the second edge to the third edge of the third
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s'.~.e=~ to form a tubular stem portion having a proximal end and a
,~_s~a1 end; and g) attaching the proximal end of the first leg
oo~~ior. and the proximal end of the second leg portion to the
cs~al end of the stem portion.
S It is another object of this invention to provide a method
oL making a bifurcated stent, comprising the steps of a)
preparing a first sheet having a proximal end and a distal end;
~b) deforming the~distal end of the first sheet to form a first
leg and deforming the proximal end of the first sheet to form a
first stem half; c) preparing a second sheet having a proximal
end and a distal end; d) deforming the distal end of the second
sheet to form a second leg and deforming the proximal end of the
sacond sheet to form a second stem half; and e) joining the first
seem half to the second stem half to form a stem.
It is yet another object of this invention to provide a
:~=thod of making a bifurcated stent comprising the steps of a)
preparing a first expandable tubular member having a proximal end
a.~.~ a distal end and a longitudinal bore therethrough, the first
Tubular member provided with a branch aperture disposed between
2C said proximal end and the distal end, the branch aperture
com~runicating with said longitudinal bore and the aperture sized
a.-:~ adapted to receive and secure a second expandable tubular
m=rtber; b) delivering the first expandable tubular member to a
bifurcated vessel having a first lumen and a second lumen so that
2S the first expandable member is disposed within the first lumen
a~d the branch aperture communicates with the second lumen; c)
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=:~-c~::ding the first expandable member in an amount sufficient to
sec=a 'the first expandable member in the first lumen; d)
n=e~aring a second expandable tubular member having a proximal
e::~ and a distal end and having longitudinal bore therethrough;
S e? widening the branch aperture; f) delivering the second
e:~andable tubular member into the branch aperture so that the
distal end of the second expandable tubular member is disposed
within the second lumen and the proximal end of the second
expandable tubular member is disposed within the longitudinal
bore of the first longitudinal member; and g) expanding the
second expandable tubular member in an amount sufficient to
secure the second expandable tubular member within the second
lumen and within said branch aperture.
__ S=ie' Description of the Drawings
FIG. 1 shows a bifurcated stent manufactured in accordance
_~.. she present invention;
FIG. 2 shows sheets used to form the legs and stem of the
s~J:.t shown in FIG. 1;
FIG. 3 shows the sheets shown in FIG. 2 after they have been
_.,_:~3 into a tubular shape;
FIG. 4 is a perspective view of the tubes shown in FIG. 3
p~.o. to assembly;
2~ FIG. 5 is an end view of the tubs shown in FIGS. 3 and 4
a=~~= they have been assembled to form a stent;
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:IG. 6 is a top view of the assembled apparatus shown in
~r~;.
FIG. 7 shows sheets used to form another embodiment of a
b_=~.:=Gated stent manufactured in accordance with the invention;
FIG. 7B shows sheets used to form another embodiment of a
bi=urcated stent manufactured in accordance with the invention;
FIG. 8 shows the sheets of FIG. 7 with demarcation points;
FIG. 9 shows the sheets of FIG. 8 after they have been
rolled into a tubular shape; -
i0 FIG. 9B shows the sheets of FIG. 7B after they have been
rolled into a tubular shape;
FIG. 10 shows the tubes of FIG. 9 just prior to assembly;
FIG. lOB shows the tubes of FIG. 9B just prior to assembly;
FIG. 11 is a side view of the tubes shown in FIGS. 9 and 10
after assembly;
FIG. 11B is a side view of the tubes shown in FIGS. 9B and
:~~3 after assembly;
~IG. 12 is an end view of the assembled apparatus shown in
;. 11 ;
2u FIG. 12B is an end view of the assembled apparatus shown in
..G. 11B;
FIG. 12C shows an alternative embodiment of a pattern that
:;,ay be used in place of the patterns shown in FIGS. 7 and 7B;
FIG. 13 shows a stem and first leg portion and a second leg
portion used to form another embodimer~t of a bifurcated stent
:~a~u.actured in accordance with this invention;
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FIG. 14 shows guide wires disposed in the trunk lumen and
bunch lumen to be treated;
FIG. 15 shows the stem and first leg portion shown in FIG.
.3 disposed on catheters and guide wires prior to introduction
S into the lumen to be treated;
FIG. 16 shows the stem and first leg portion shown in FIG.
13 after it has been delivered to the bifurcation to be treated
and prior to its~expansion;
FIG. 17 shows the second leg portion shown in FIG. 16 after
it has been expanded;
FIG. 18 shows expansion of the branch aperture;
rFIG. 19 shows the unexpanded second leg portion disposed in
the branch aperture;
FIG. 20 shows the expansion of the second leg portion shown
in FIG. 19; and
FIG. 21 shows the assembled bifurcated steer disposed in the
~__~=cared lumen to be treated.
Detailed Description
In the embodiment illustrated in FIG. 1, the bifurcation
s~=nt 3 comprises a first leg 10, a second leg 15, and a stem 20.
.:~. 2 shows a first sheet 25 which is used to form first leg 10,
second sheet 30 which is used to form second leg 15, and a
third sheet 35 which is used to form stem 20. The first sheet 25
a.~.d second sheet 30 are substantially flat and are sized to a
=~~~termin~d length and width. For many applications, the first
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sheet 25 and second sheet 30 will have substantially the same
dim»sions so as to produce legs 10 and 15 that are substantially
chi same size, however, the legs 10 and 15, and the sheets 25 and
3~ used to produce them, may be of varying sizes as specific
applications dictate. The stents of this invention may be sized
so that when assembled they are their final size, however, in a
p=eferred embodiment the stents are expandable and sized and
adapted to assume their final dimensions upon expansion. The
stent sheets 70 and 75 may be patterned or etched with
perforations forming a variety of patterns as specific
applications dictate to achieve the expandable features required
as previously discussed. The third sheet 35 is sized so that
when it is rolled into a tube its internal cross-section can be
mad= to accommodate the cross-sectional external diameters of
first~leg 10 and second leg 15. First sheet 25 has a first edge
20, a second edge 27, a third edge 28, and a fourth edge 29.
Second sheet 30 has a first edge 31, a second edge 32, a third
edJ? 33, and a fourth edge 34. Third sheet 35 has a first edge
36, a second edge 37, a third edge 38, and a fourth edge 39.
A=ter the sheet metal has been cut to form sheets 25, 30, and 35,
is deformed and rolled so as to cause two opposite edges to
meet and create a cylinder. In the example shown in FIGs. 2 and
3, edge 27 is joined to edge 29 via weld run 14 to form first leg
10. Edge 32 is joined to edge 34 via weld run 19 to form second
leg 15. Edge 37 is joined to edge 39 , is weld run 29 to form
seem 20. The edges may be joined in a wide variety of ways well
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....~_o»~ to those skilled in the art as suitable for this purpose,
screwing, crimping, soldering, however, in a preferred
e.:.bodiment welding is utilized. In an especially preferred
e:~.bodiment, spot welding is utilized. As shown in FIG. 3, first
1=g 10 has a proximal end 11, a distal end 12, and defines a
to~gitudinal bore 13. Second leg 15 has a proximal end 16, a
distal end 17, and defines a longitudinal bore 18. The stem 20
has a proximal end 26, a distal end 27, and defines a
longitudinal bore 28. FIG. 4 shows the first leg 10, second leg
15, and stem 20 just prior to assembly. To form the bifurcated
stent 5, the proximal end 11 of first leg 10 and the proximal end
16 of second leg 15 are joined to the distal end 27 of the stem
portion 20 so that the longitudinal bores 13, 18, and 28 are in
co:~~unication with each other. FIG. 5 is an end view and FIG. 6
_.. is a side view of the assembled apparatus.
FIG. 11 shows a second embodiment of a bifurcation stent
..~....~actured in accordance with this invention. The stent 50 is
_=ov~ided with a first leg 55 and a second leg 60 attached to a
stem portion 65. The bifurcation stent 50 is formed from a first
2G s~eet 70 and a second sheet 75 as shown in FIG. 7. The stent
5::~~~s 70 and 75 may be patterned or etched with perforations
.o.--:_ng a variety of patterns as specific applications dictate to
achieve the expandable features required as previously discussed.
::ze sheets 70 and 75 are substantially flat and have a
2~ p:edetermined length and width. Firs~,sheet 70 has a first edge
%., a second edge 72, a third edge 73 and a fourth edge 74. The
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second sheet 75 has a first edge 76, a second edge 77, a third
e~~e 78, and a fourth edge 79. To form the legs of the stent a
portion of edge 72 is rolled towards a portion of edge 74 and a
portion of edge 77 is rolled towards a portion of edge 79.
Demarcation points 80, 81, 82, and 83 are selected on sheets 70
and 75 as shown in FIG. 8. These demarcation points 80, 81, 82,
and 83 are selected to meet the requirement of specific
.applications and-may be adjusted depending upon the length
required for legs 55 and 60 and the length required for stem 65.
Demarcation points 80 and 81 that are equidistant from edges 73
and 71 and demarcation points 82 and 83 that are equidistant from
edges 76 and 78 will result in a stent in Which the legs 55 and
60 have a length that is substantially equal to stem portion 65.
T_° the demarcation points are selected to be closer to edges 73
and 78 than to edges 71 a_zd 76 the stem will have a length that
is greater than the length of each of the legs. If the
~~.:,arcation points are selected to be closer to edges 71 and 76
~za~ to edges 73 and 78, each of the legs 60 and 65 will have a
length that is greater than the length of the stem 65. In a
p=e~erred embodiment, however, the demarcation points 80, 81, 82,
a.~.~ 83, are selected so that proximal edges 72" , 74" , 77" , and
" are about 1/3 the length of edges 72, 74, 77, and 79. As
shown in FIG. 8, demarcation point 80 divides edge 72 at
approximately its midpoint into a distal edge 72' and a proximal
edge 72 " . Demarcation point 81 divides edge 74 at approximately
_:.s midpoint into a distal edge 74' and a proximal edge 74 " .
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D=~.arcation point 82 divides edge 77 at approximately its
~icpoint into a distal edge 77' and a proximal edge 77" and
demarcation point 83 divides edge 79 at approximately its
~idpoint into a distal edge 79' and a proximal edge 79 " .
To form the stent, edge 72' is connected to edge 74' via
weld run 90 to form first member 95 having a first leg portion 55
and a first stem half 65',as shown in FIG. 9. Edge 77' is
connected to edge 79' via weld run 91 to form second member 100
having a second leg portion 60 and a second stem half 65" . As
previously discussed, the edges may be connected in a variety of
ways well known to those skilled in the art. FIG. 10 shows the
first member 95 and the second member 100 shown in FIG. 9 in
alignment just prior to assembly. To produce the bifurcated
scent 50 shown in FIGS, 11 and 12, edge 72 " is connected to edge
79 " via weld run 92 and edge 74 " is connected to edge 77 " via
wild run 93 so that first stem half 65' and second stem half 65 "
_.,_:.. stem 65. FIG. 12 is a cross-sectional end view of the stent
s~cw:: in FIG. 11.
In the embodiment shown in FIG. 7, sheets 70 and 75 are
squares or rectangles. The sheets 70 and 75 are not limited to
~.._s configuration, however, as shown in FIG. 7B. FIG. 11B shows
~lfu=cation stent manufactured using the sheets 270 and 275
s'.~.owr. in FIG. 7B. The stent 250 is provided with a first leg
255 and a second leg 260 attached to a stem portion 265. The
2~ ~:°urcation stent 250 is formed from ,first sheet 270 and a
s=:ozd sheet 275 as shown in FIG. 7B. The stent sheets 270 and
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27~ Tay be sized and etched as previously discussed. As shown in
._~. 73, first sheet 270 has a first edge 271, a second edge 272,
a third edge 273, a fourth edge 274, a fifth edge 275, and a
si:<t~~ edge 276, a seventh edge 146, and an eighth edge 147. The
second sheet 275 has a first edge 277, a second edge 278, a third
~dg~ 279, a fourth edge 280, a fifth edge 281, a sixth edge 282,
a seventh edge 148, and an eighth edge 149. As shown in FIG. 9B,
edge 274 is connected to edge 276 via weld run 290 to form first
member 295 having a first leg portion 255 and a first stem half
265'. Edge 280 is connected to edge 282 via weld run 291 to form
second member 300 having a second leg portion 260 and a second
stem half 265 " . As previously discussed, the edges may be
connected in a variety of ways well known to those skilled in the
a:t. FIG. lOH shows the first member 295 and the second member
300 shown in FIG. 9B in alignment just prior to assembly. To
produce the bifurcated stent 250 shown in FIGS. 11B and 12B, edge
272 is connected to edge 149 via weld run 292 and edge 278 is
co.~.~=cted co edge 147 via weld run 293 so that first stem half
20'x' and second stem half 265" form stem 265. FIG. 12B is a
2u cross-sectional end view of the stent shown in FIG. 118. FIG.
12C shows an alternative pattern that may be used in place of the
patterns shwn in FIGS. 7 and 7B.
A third embodiment of this invention comprises two portions
which are deployed serially in two steps and assembled within the
2~ patient to form a bifurcated stent. FrIG. 13 shows stem and first
leg portion 110 provided with a longitudinal bore 131 and having
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. ~=~ximal end 115 defining a stem portion 125 and a distal end
_?~ defining a first leg portion 130. Second leg portion 140 is
p=tv~_ded with a longitudinal bore 132 and has a proximal end 145
a~~ a distal end 150. Stem and firs leg portion 110 and second
1?g portion 140 may be sized and patterned or etched as
p~?viously discussed. A branch aperture 135 is disposed between
t:~e proximal end 115 and the distal end 120 of stem and first leg
po=tion 110. The branch aperture 135 is sized to receive second
leg portion 140 and is adapted to engage and secure the second
_C leg portion 140 when it has been expanded within the branch
aperture 135. Second leg portion 140 is sized and adapted to
engage and be secured into branch aperture 135 upon expansion.
:GS. 14 to 21 show how the bifurcated stent is assembled within
a '~:°urcated lumen. As shown in FIGS. 14 to 21, the area to be
treated is a bifurcated lumen having a first or trunk lumen 190
a~~ a second or branch lumen 195. As shown in FIG. 14, a first
_de wire 155 is introduced into the trunk lumen 190 and a
~~t~d guide wire 156 is introduced into the branch lumen 195.
~s shown in FIG. 15, a balloon expandable stem and first leg
location 110 is disposed on the tip of a first balloon catheter
.%~ so that the balloon 175 is disposed within longitudinal bore
.?.. A second balloon catheter 171 is then introduced into
Longitudinal bore 131 of stem and first leg portion 110 and is
advanced so that the balloon 176 is disposed within aperture 135.
25 ._=s_ catheter 170 is mounted on first guide wire 155 and second
'~~~n'ar 171 is mounted on second guide wire 156. As shown in
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16, the unexpanded stem and first leg portion 110 is guide,
:~ area to be tr~atea so that zirst leg portion 13o is
disposed within trunk lumen 190 and branch aperture 135
coT~unicates with branch lumen 195. Guide wire 156 facilitates
t~? orientation of the branch aperture 135 with the branch lumen
X95. The size of the conventional catheters and balloons is not
to scale and details well known to those skilled in the axt have
been omitted for-clarity. Balloon 175 is inflated which causes
the stem and first leg portion 110 to expand, as shown in FIG.
17, to secure it in the desired position. After expansion, the
external wall of stem and first leg portion 110 would contact the
interior walls of trunk lumen 190, however, a gap has been
intentionally left for clarity. The balloon 175 on first .
catheter 170 is left inflated and the balloon 176 on second
cat~e~ter 171 is then inflated to enlarge the branch aperture 135
as shown in FIG. 18. As the branch aperture 135 is enlarged a
_~_~;on of the stent defining the branch aperture 135 is pushed
~~_~wa=d to form a branch securing lip 180.
Balloons 175 and 176 are deflated, second catheter 171
.s withdrawn, and second guide wire 156 is left in place in the
~~a.~.c~ lumen 195. Second leg portion 140 is then applied to
s~~~~~ catheter 171 so that first balloon 176 is disposed in
longitudinal bore 132 and second catheter 171 is then applied to
second guide wire 156. Second leg portion 140 is then guided to,
2~ a~~ '_ntroduced into, the longitudinal bore 131 of the stem and
:__s~ leg portion 110 and is advanced and passed through branch
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ap?rtune 135 so that the distal end 150 of the second leg portion.
~.0 protrudes into the branch lumen 195 and the proximal end 145
co.;~~unicates with longitudinal bore 131, as shown in FIG. 19.
the balloon 176 on second catheter 171 is partially inflated and
the balloon 175 on first catheter 170 is then partially inflated
to a pressure substantially equal to the pressure in balloon 176.
Both balloons 175 and 176 are then simultaneously inflated to
~substantially equal pressures. As shown in FIG. 20, inflation of
ch= balloon 176 on second catheter 171 causes second leg member
140 to expand so that its external walls engage and are secured
to the area surrounding aperture 135. Inflation of the balloon
175 on the first catheter 170 prevents stem and first leg portion
110 'nom collapsing when balloon 176 is inflated. After
=_:cpansion, the external walls of second leg 140 would contact the
~ner wall of lamer. 195, however, a gap has been intentionally
:~'c for clarity. The balloons 175 and 176 are deflated,
=~~~~:.ers 170 and 171 and guide wires 155 and 156 are withdrawn,
_.... she assembled bifurcated stent 160 is left in place as shown
_.. ..G. 21.
a~ : :. s1':DOCSVeTGECa=7016-1~Q9999~OO.s00
