Devices and methods for delivery of expandable prostheses

Abstract

The present disclosure provides a variety of prostheses, delivery systems and techniques to facilitate closure of transvascular or transcameral access ports. Various embodiments of prostheses are provided including a plurality of radially expandable discs that can be filled with material to facilitate coagulation and to reduce or stop leakage from punctures in vessel walls.

What is claimed is: 
     
         1 . A system for delivering a deformable prosthesis, comprising:
 a) an outer tubular sheath having a proximal end and a distal end and defining a first lumen therethrough along at least a portion of its length;   b) an intermediate tubular member disposed at least partially within the first lumen and being slidably disposed with respect to the outer tubular sheath, the intermediate tubular member having a proximal end, a distal end, and, a flexible distal portion configured to be protrudable distally beyond the distal end of the outer tubular sheath, the intermediate tubular member defining a second lumen therethrough along at least a part of its length;   c) an inner elongate member being disposed at least partially within the second lumen, the inner elongate member being slidably disposed with respect to the intermediate tubular member, the inner elongate member having a proximal end and a distal end configured to be displaced distally beyond the distal end of the intermediate tubular member; and   d) a prosthesis removably mounted on the distal end of the intermediate tubular member, wherein the prosthesis can be longitudinally stretched by advancing the inner elongate member distally with respect to the intermediate tubular member and against an inner face of an end region of the prosthesis, and further wherein said longitudinal stretch of said prosthesis causes the prosthesis to collapse radially inwardly to permit said prosthesis to be withdrawn into said distal end of said outer tubular sheath.   
     
     
         2 . The system of  claim 1 , wherein the distal end of the outer tubular member is cut at an angle that is oblique with respect to a central axis defined by the system. 
     
     
         3 . The system of  claim 2 , wherein the distal end further includes a radiopaque marker proximate the distal end making the angle at which the distal end is cut being visible under fluoroscopy to help reduce canting of the prosthesis during implantation. 
     
     
         4 . The system of  claim 1 , wherein the flexible of distal portion of the intermediate tubular member is configured and adapted to permit the intermediate tubular member to be deformed into a reverse curved geometry with respect to a central axis of a proximal portion of the delivery system while inside a patient's lumen. 
     
     
         5 . The system of  claim 1 , wherein the inner elongate member is a tubular member configured to permit a guidewire to pass therethrough. 
     
     
         6 . The system of  claim 5 , wherein the distal end of the inner elongate member is configured to abut against the inner face of the end region of the prosthesis to form a guidewire lumen to permit the guidewire passing through the inner elongate member to pass through a distal face of the prosthesis. 
     
     
         7 . A method, comprising:
 a) providing a delivery system having a prosthesis removably attached to a distal end thereof;   b) delivering the delivery system over a guidewire routed to a target location within a patient's vasculature;   c) deploying the prosthesis at the target location to obstruct a vascular opening to be sealed;   d) detaching the prosthesis from the delivery system;   e) withdrawing the delivery system over the guidewire after the prosthesis has been detached therefrom;   f) advancing the delivery system toward the target location over the guidewire after the withdrawing step;   g) reattaching the prosthesis to the delivery system; and   h) performing a further step with the prosthesis.   
     
     
         8 . The method of  claim 7 , further comprising partially collapsing the prosthesis after the deploying step. 
     
     
         9 . The method of  claim 7 , further comprising at least partially repositioning the prosthesis after the deploying step. 
     
     
         10 . The method of  claim 7 , further comprising at least partially repositioning the prosthesis after the detaching step. 
     
     
         11 . The method of  claim 7 , further comprising collapsing and withdrawing the prosthesis into the delivery system. 
     
     
         12 . The method of  claim 7 , further comprising withdrawing the delivery system with the prosthesis attached thereto over the guidewire. 
     
     
         13 . A method, comprising:
 a) providing a delivery system having a prosthesis removably attached to a distal end thereof, the prosthesis being configured to radially self-expand into at least two axially spaced discs;   b) delivering the delivery system over a guidewire routed to a target location within a patient's vasculature;   c) deploying a first of said at least two discs proximate a first side of a first wall of an anatomical structure next to a vascular opening to be sealed;   d) deploying a second of said at least two discs proximate a second side of the first wall of the anatomical structure the prosthesis at the target location to obstruct the vascular opening;   e) applying tension to at least one tether routed through said at least two axially spaced discs to cause the prosthesis to collapse axially.   
     
     
         14 . The method of  claim 13 , wherein tension is applied to the at least one tether until leaks through the vascular opening are stopped. 
     
     
         15 . The method of  claim 13 , further comprising securing the at least one tether. 
     
     
         16 . The method of  claim 15 , wherein the at least one tether is secured by tying it off 
     
     
         17 . The method of  claim 15 , wherein the at least one tether is secured by applying at least one clip to it.