Self-orienting endovascular delivery system

Abstract

An elongate delivery shaft assembly ( 30 ) includes an outer covering shaft ( 38 ) and an inner support shaft ( 40 ). When the delivery shaft assembly ( 30 ) is unconstrained and a stent-graft ( 20 ) is removably constrained in a radially-compressed delivery state along a distal end portion ( 34 ) of the delivery shaft assembly ( 30 ), radially between the outer covering shaft ( 38 ) and the inner support shaft ( 40 ): (a) the delivery shaft assembly ( 30 ) is shaped so as to define a self-orienting portion ( 50 ), which (i) is shaped so as to define at least proximal and distal curved portions ( 52 A, 52 B), the proximal curved portion ( 52 A) disposed more proximal than the distal curved portion ( 52 B), and (ii) at least one point of inflection ( 53 ) on a central longitudinal axis ( 36 ) of the delivery shaft assembly ( 30 ) longitudinally between the proximal and the distal curved portions ( 52 A, 52 B), and (b) respective smallest radii of curvature of the proximal and the distal curved portions ( 52 A, 2 B), measured at the central longitudinal axis ( 36 ), are each between 2.5 and 12 cm.

1 . Apparatus comprising an endovascular system, which comprises:
 a stent-graft, which is configured to transition from a radially-compressed delivery state to a radially-expanded state; and   an elongate delivery shaft assembly, which has proximal and distal end portions, defines a central longitudinal axis, and comprises an outer covering shaft and an inner support shaft,   wherein when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft:
 the delivery shaft assembly is shaped so as to define a self-orienting portion, which (a) is shaped so as to define at least proximal and distal curved portions, wherein the proximal curved portion is disposed more proximal than the distal curved portion, and (b) at least one point of inflection on the central longitudinal axis longitudinally between the proximal and the distal curved portions, and 
 respective smallest radii of curvature of the proximal and the distal curved portions, measured at the central longitudinal axis, are each between 2.5 and 12 cm. 
   
     
     
         2 . The apparatus according to  claim 1 , wherein the distal end portion of the delivery shaft assembly is shaped so as to define the self-orienting portion. 
     
     
         3 . (canceled) 
     
     
         4 . The apparatus according to  claim 1 , wherein the proximal and the distal curved portions together define a sinusoid. 
     
     
         5 . The apparatus according to  claim 1 , wherein the proximal and the distal curved portions have a same curve shape. 
     
     
         6 . The apparatus according to  claim 5 , wherein the proximal and the distal curved portions are the same size. 
     
     
         7 . The apparatus according to  claim 1 ,
 wherein the stent-graft is shaped so as to define a superior lateral opening,   wherein when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between outer the covering shaft and the inner support shaft, the stent-graft is axially disposed in the delivery shaft assembly such that the superior lateral opening is in the self-orienting portion, and   wherein when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between outer the covering shaft and the inner support shaft, the stent-graft is rotationally oriented with respect to the delivery shaft assembly so as to, upon release of the stent-graft from the delivery shaft assembly without rotation of the stent-graft, define a line between (a) the central longitudinal axis and (b) a central axis of the superior lateral opening parallel to the central longitudinal axis, which line is perpendicular to the central longitudinal axis, and forms an angle of no more than 30 degrees with a proximal best-fit plane defined by the proximal curved portion, wherein the proximal best-fit plane is defined when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft.   
     
     
         8 - 9 . (canceled) 
     
     
         10 . The apparatus according to  claim 1 , wherein the delivery shaft assembly is shaped so as not to define an additional curved portion, in addition to the proximal and the distal curved portions, having a smallest radius of curvature, measured at the central longitudinal axis, of between 2.5 and 12 cm. 
     
     
         11 - 14 . (canceled) 
     
     
         15 . The apparatus according to  claim 1 , wherein the respective smallest radii of curvature of the proximal and the distal curved portions are each between 4 and 10 cm. 
     
     
         16 - 17 . (canceled) 
     
     
         18 . The apparatus according to  claim 1 , wherein the endovascular system further comprises a distal tip, which is fixed to and extends distally beyond a distal end of the inner support shaft. 
     
     
         19 . The apparatus according to  claim 18 , wherein the distal tip is conical. 
     
     
         20 . The apparatus according to  claim 1 , wherein when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft:
 the self-orienting portion defines a best-fit straight axis line having a minimum sum of squares of distances between the best-fit straight axis line and the central longitudinal axis along the proximal and the distal curved portions,   the proximal and the distal curved portions have respective proximal and distal peaks with respect to the best-fit straight axis line, which define respective proximal and distal vectors, which (i) have respective origins on the best-fit straight axis line, (ii) are perpendicular to the best-fit straight axis line, and (iii) intersect the proximal and the distal peaks, respectively, and   an angle between the proximal and the distal vectors is at least 120 degrees.   
     
     
         21 . The apparatus according to  claim 20 , wherein the angle between the proximal and the distal vectors is at least 150 degrees. 
     
     
         22 . The apparatus according to  claim 1 , wherein when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft:
 the self-orienting portion defines a best-fit straight axis line having a minimum sum of squares of distances between the best-fit straight axis line and the central longitudinal axis along the proximal and the distal curved portions,   the proximal and the distal curved portions have respective proximal and distal peaks with respect to the best-fit straight axis line, and   respective distances between (a) the best-fit straight axis line and (b) the proximal and the distal peaks are each at least 3 cm.   
     
     
         23 . (canceled) 
     
     
         24 . The apparatus according to  claim 1 , wherein when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft:
 the self-orienting portion defines a best-fit straight axis line having a minimum sum of squares of distances between the best-fit straight axis line and the central longitudinal axis along the proximal and the distal curved portions, and   the delivery shaft assembly is shaped so as not to define an additional curved portion, in addition to the proximal and the distal curved portions, having a distance between the best-fit straight axis line and a peak of the additional curved portion, with respect to the best-fit straight axis line, of at least 3 cm.   
     
     
         25 . The apparatus according to  claim 1 ,
 wherein the self-orienting portion defines a best-fit straight axis line having a minimum sum of squares of distances between the best-fit straight axis line and the central longitudinal axis along the proximal and the distal curved portions, and   wherein respective axial lengths of the proximal and the distal curved portions, measured parallel to the best-fit straight axis line, are each between 4 and 18 cm, when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft.   
     
     
         26 . (canceled) 
     
     
         27 . The apparatus according to  claim 1 , wherein when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft:
 the self-orienting portion defines a best-fit straight axis line having a minimum sum of squares of distances between the best-fit straight axis line and the central longitudinal axis along the proximal and the distal curved portions,   the proximal and the distal curved portions have respective proximal and distal peaks with respect to the best-fit straight axis line, and   a distance between the proximal and the distal peaks, measured parallel to the best-fit straight axis line, is between 5 and 20 cm.   
     
     
         28 . (canceled) 
     
     
         29 . The apparatus according to  claim 1 , wherein when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft:
 the self-orienting portion defines a best-fit straight axis line having a minimum sum of squares of distances between the best-fit straight axis line and the central longitudinal axis along the proximal and the distal curved portions,   the proximal and the distal curved portions have respective proximal and distal peaks with respect to the best-fit straight axis line, and   a distance between the distal peak and a distal end of the outer covering shaft, measured parallel to the best-fit straight axis line, is between 3 and 8 cm.   
     
     
         30 - 31 . (canceled) 
     
     
         32 . The apparatus according to  claim 1 , wherein when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft:
 the self-orienting portion defines a best-fit straight axis line having a minimum sum of squares of distances between the best-fit straight axis line and the central longitudinal axis along the proximal and the distal curved portions,   the proximal and the distal curved portions define respective proximal and distal best-fit planes,   an angle between the proximal and the distal planes is no more than 60 degrees, and   the proximal and the distal best-fit planes intersect at an intersection line that is not parallel to the best-fit straight axis line.   
     
     
         33 . (canceled) 
     
     
         34 . The apparatus according to  claim 32 , wherein the angle between the proximal and the distal planes is at least 30 degrees. 
     
     
         35 - 36 . (canceled) 
     
     
         37 . The apparatus according to  claim 1 , wherein when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft:
 the delivery shaft assembly is shaped so as to define a proximal straight portion which is disposed more proximal than the self-orienting portion, and has a length of at least 50 cm,   the central longitudinal axis along the proximal straight portion defines a straight axis line, and   the proximal and the distal curved portions have respective proximal and distal peaks with respect to the straight axis line.   
     
     
         38 . The apparatus according to  claim 37 , wherein the proximal and distal peaks define proximal and distal vectors, respectively, which (i) have respective origins on the straight axis line, (ii) are perpendicular to the straight axis line, and (iii) intersect the proximal and the distal peaks, respectively, wherein an angle between the proximal and the distal vectors is at least 120 degrees, when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft. 
     
     
         39 - 42 . (canceled) 
     
     
         43 . The apparatus according to  claim 37 , wherein respective axial lengths of the proximal and the distal curved portions, measured parallel to the straight axis line, are each between 4 and 18 cm, when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft. 
     
     
         44 . (canceled) 
     
     
         45 . The apparatus according to  claim 37 , wherein a distance between the proximal and the distal peaks, measured parallel to the straight axis line, is between 5 and 20 cm, when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft. 
     
     
         46 . (canceled) 
     
     
         47 . The apparatus according to  claim 37 , wherein a distance between the distal peak and a distal end of the outer covering shaft, measured parallel to the straight axis line, is between 3 and 8 cm, when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft. 
     
     
         48 - 54 . (canceled) 
     
     
         55 . A method for treating a subject, comprising:
 providing an endovascular system that includes (a) a stent-graft, which is configured to transition from a radially-compressed delivery state to a radially-expanded state, and (b) an elongate delivery shaft assembly, which has proximal and distal end portions, defines a central longitudinal axis, and includes an outer covering shaft and an inner support shaft, wherein when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft, (a) the delivery shaft assembly is shaped so as to define a self-orienting portion, which (i) is shaped so as to define at least proximal and distal curved portions, wherein the proximal curved portion is disposed more proximal than the distal curved portion, and (ii) at least one point of inflection on the central longitudinal axis longitudinally between the proximal and the distal curved portions, and (b) respective smallest radii of curvature of the proximal and the distal curved portions, measured at the central longitudinal axis, are each between 2.5 and 12 cm;   while the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, transvascularly introducing the delivery shaft assembly into a blood vessel of the subject and advancing the distal end portion of the delivery shaft assembly to a target site in the blood vessel, such that the self-orienting portion assumes a desired rotational orientation at the target site; and   releasing the stent-graft from the distal end portion of the delivery shaft assembly by proximally withdrawing the outer covering shaft while holding the inner support shaft in place.   
     
     
         56 . The method according to  claim 55 , wherein transvascularly introducing the elongate delivery shaft assembly into the blood vessel and advancing the distal end portion of the delivery shaft assembly to the target site comprises transvascularly introducing the elongate delivery shaft assembly into a descending aorta and advancing the distal end portion of the delivery shaft assembly to an aortic arch. 
     
     
         57 . The method according to  claim 55 , wherein providing the endovascular system includes providing the endovascular system in which the respective smallest radii of curvature of the proximal and the distal curved portions are each between 4 and 10 cm. 
     
     
         58 . The method according to  claim 55 , wherein providing the endovascular system includes providing the endovascular system in which, when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft:
 the self-orienting portion defines a best-fit straight axis line having a minimum sum of squares of distances between the best-fit straight axis line and the central longitudinal axis along the proximal and the distal curved portions,   the proximal and the distal curved portions have respective proximal and distal peaks with respect to the best-fit straight axis line, and   respective distances between (a) the best-fit straight axis line and (b) the proximal and the distal peaks are each at least 3 cm.   
     
     
         59 . The method according to  claim 55 , wherein providing the endovascular system includes providing the endovascular system in which:
 the self-orienting portion defines a best-fit straight axis line having a minimum sum of squares of distances between the best-fit straight axis line and the central longitudinal axis along the proximal and the distal curved portions, and   respective axial lengths of the proximal and the distal curved portions, measured parallel to the best-fit straight axis line, are each between 4 and 18 cm, when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft.   
     
     
         60 . The method according to  claim 55 , wherein providing the endovascular system includes providing the endovascular system in which, when the delivery shaft assembly is unconstrained and the stent-graft is removably constrained in the radially-compressed delivery state along the distal end portion of the delivery shaft assembly, radially between the outer covering shaft and the inner support shaft:
 the self-orienting portion defines a best-fit straight axis line having a minimum sum of squares of distances between the best-fit straight axis line and the central longitudinal axis along the proximal and the distal curved portions,   the proximal and the distal curved portions have respective proximal and distal peaks with respect to the best-fit straight axis line, and   a distance between the proximal and the distal peaks, measured parallel to the best-fit straight axis line, is between 5 and 20 cm.