ORIENTABLE INTRACRANIAL OCCLUSION DEVICE AND METHOD

Abstract

A method and device to correctly orient an intracranial occlusion device, such as a stent having differential porosity, with respect to desired areas of greater or lesser blood flow (e.g., branch vessels and aneurysms, respectively), said device being particularly adapted for use in treating aneurysms in intracranial or other tortuous vasculature. An intravascular device comprising a delivery catheter having a hub and angular lumen capable of constraining a pusher wire within a packaging catheter to deploy said stent in an orientation wherein the area of least porosity abuts the aneurysm, and area of maximal porosity permits blood flow to a branch or other vessel. A method of using same.

Claims

1-70. (canceled)

71. An intravascular system configured for insertion into a blood vessel, the intravascular system comprising: a delivery catheter defining an inner lumen, the inner lumen having a first non-circular configuration; and a pusher configured for insertion into the inner lumen of the delivery catheter, the pusher having a second non-circular cross-sectional configuration configured to allow axial movement within the lumen of the delivery catheter and to inhibit rotation of the pusher within the lumen of the delivery catheter to thereby maintain a pre-determined angular orientation of the pusher within the delivery catheter.

72. The intravascular device of claim 71, wherein the first non-circular configuration and the second non-circular configuration are each defined by a plurality of linear segments.

73. The intravascular device of claim 72, wherein the delivery catheter includes radiopaque markers to identify an angular orientation of the delivery catheter within the blood vessel.

74. The intravascular device of claim 73, wherein the radiopaque markers extend along a single linear segment of the delivery catheter.

75. The intravascular device of claim 71, wherein the delivery catheter has a hub and a marker at the hub and at a marker at a distal tip.

76. The intravascular device of claim 71, wherein the first non-circular configuration of the inner lumen and the second non-circular configuration of the pusher are such that the pusher is insertable into the inner lumen in at least three distinct angular orientations.

77. The intravascular device of claim 71, wherein the first non-circular configuration and the second non-circular configuration are one of triangular rectangular, hexagonal or star shaped.

78. The intravascular device of claim 71, further comprising a packaging catheter containing the pusher, and the packaging catheter is configured to mate within a hub of the delivery catheter to deliver a stent through the lumen of the delivery catheter.

79. The intravascular device of claim 78, wherein the packaging catheter has a lumen having a non-circular configuration corresponding to the first non-circular configuration of the delivery catheter.

80. The intravascular device of claim 71, wherein the first non-circular configuration matches the second non-circular configuration.

81. The intravascular device of claim 71, wherein the cross-sectional configurations of the inner lumen and the pusher facilitate insertion of the pusher into the inner lumen in a plurality of discrete orientations separated by a defined angular increment.

82. An intravascular configured for insertion into a blood vessel, the intravascular device comprising: a delivery catheter defining an inner lumen; a pusher configured for axial movement through the inner lumen of the delivery catheter; and a stent secured to the pusher such that the stent is deployable within the blood vessel via axial movement of the pusher through the delivery catheter, the inner lumen of the delivery catheter and an outer wall of the pusher having cross-sectional configurations such that rotation of the pusher is limited within the inner lumen of the delivery catheter upon insertion of the pusher into the delivery catheter to thereby maintain a pre-determined angular orientation of a stent secured to the pusher to enable desired radial placement of the stent.

83. The intravascular device of claim 82, wherein the cross-sectional configurations of the inner lumen and the pusher facilitate insertion of the pusher into the inner lumen in a plurality of discrete orientations separated by a defined angular increment

84. The intravascular device of claim 82, wherein the inner lumen of the delivery catheter and the pusher are configured such that the defined angular increment is at least 60°.

85. The intravascular device of claim 82, wherein the stent has a free-floating cover.

86. The intravascular device of claim 82, wherein the stent has overlapping shingles.

87. The intravascular device of claim 82, wherein the stent has a cover over a circumferential segment.

88. The intravascular device of claim 82, wherein the corresponding cross-sectional configurations of the inner lumen and the pusher are selected from the group consisting of triangular, square, rectangular, hexagonal, and star-shaped.

89. The intravascular device of claim 82, wherein the stent has a non-porous side and a marker on the delivery catheter enables radial alignment of the non-porous side.

90. The intravascular device of claim 82, further comprising a packaging catheter containing the pusher, and the packaging catheter is configured to mate within a hub of the delivery catheter to deliver a stent through the lumen of the delivery catheter

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0041] FIG. 1A shows a perspective view of a cylindrical delivery catheter 330 having a triangularly shaped lumen 1.

[0042] FIG. 1B shows an embodiment of delivery catheter lumen 3 without its cylindrical sheathing (not shown), having a proximal end 1 and a distal end 2, and has been passed through vessel 1000 such that distal end hole 2 in proximal to target aneurysm 2000.

[0043] FIG. 1C is a cutaway view of delivery catheter lumen 3 having a triangular lumen with ABC angles, and pusher wire 300 passing therethrough at offset C-A-B angles, in order to deliver a differentially porous occlusion device (not shown) at a 120° angle to deploy at a desired orientation.

[0044] FIG. 2 shows proximal end 10 and distal end 20 of stent-packaging catheter 30 (outside patient's body), hub 700 attached to delivery catheter lumen 3, packaging-catheter hub port 701 displaying push-wire 300 running therethrough, further showing push-wire 300 (in dashed lines extending through delivery catheter lumen 3) continuing through delivery catheter lumen 3, said push-wire 300 having its distal end 303 releasably attached to stent 301 proximal to target aneurysm 2000. The distal end 20 of stent-packaging catheter 30 disposed inside hub port 701 delivery catheter lumen 3 (oriented with triangular proximal end hole 1, and triangular distal end hole 2 proximal to target aneurysm 2000); delivery catheter lumen 3 being deployed within vessel walls 1000.

[0045] FIG. 3 shows push-wire 300 and stent 301 disposed at push-wire distal end 303 within vessel walls 1000 following removal of delivery catheter lumen 3 (shown in FIG. 2).

[0046] FIG. 4 shows an interior view of delivery catheter lumen 3 having a triangular shape, composed of proximal sides 4, 5 and 6, corresponding with distal sides 44 (oblique distal sides 55 and 66 behind 44 are shown in FIG. 5); facing side 444 illustrates the full length of the catheter side beginning at proximal side 4 and ending in distal side 44. Alternative embodiments (not shown) may employ other regular shapes such as rectangles or stars.

[0047] FIG. 5 shows an adjacent face 555 of the interior of delivery catheter of FIG. 4 (or FIG. 4 rotated once 120.), face 555 beginning at proximal side 5 and ending in distal side 55 (oblique distal sides 44 and 66 behind 55 shown in dashed cutaway); facing side 555 further includes radio-opaque orientation-aid markers 5550.

[0048] FIG. 6 shows a stent 301 attached to push-wire 300 at distal end 303 of push-wire 300 and proximal end of stent 301. Said stent 301 is triangular in shape, with distal end 3010 and triangular edges on a plane with distal end 303, namely edges 334, 355 and 366. At the distal end 3010 of stent 301, triangular edge 3550 is shown in dotted lines disclose the other two triangular edges 3440 and 3660. Triangular edge 335 forms a planar length terminating in edge 3550. On said plane, resides radio-opaque markers 55500.

[0049] FIG. 7A and FIG. 7B show delivery catheter lumen 3 geometry with relative position of radio-opaque markers.

[0050] FIG. 8 shows one geometry of a pusher wire;

[0051] FIG. 9 shows packing catheter.

[0052] FIG. 10 shows options for packing catheter.

[0053] FIG. 11 and FIG. 12 shows positions of radio-opaque markers relative to each other.

[0054] FIG. 13 and FIG. 14 show optional embodiments of reverse unsheathing stents and FIG. 15 is a perspective view of a delivery catheter.

DETAILED DESCRIPTION OF THE INVENTION

[0055] The embodiments of the device and variants of the device of the present invention are set forth with reference to the above drawings.

[0056] Referring to FIG. 1A, a perspective view is shown of a cylindrical delivery catheter 330 having a triangularly shaped lumen 1. The present invention discloses a traditional cylindrical delivery catheter with a linear lumen such as a triangle, square, other rectangle, star, hexagon or so on. Said linear lumen is designed to allow the second of a push wire which has a similar shape, adapted to be inserted into said lumen 1 at differing, fixed relative positions.

[0057] Now referring to FIG. 1B, shown is an embodiment of delivery catheter lumen 3 without its cylindrical sheathing (not shown). Said delivery catheter lumen 3 having a proximal end 1 and a distal end 2, and has been passed through vessel 1000 such that distal end hole 2 in proximal to target aneurysm 2000. Delivery catheter lumen 3 is inserted into blood vessel 1000 until stopped such that distal end 2 is proximal to target aneurysm 2000. Due to the linear geometry of the lumen 1, the delivery catheter lumen 3 has a set orientation with respect to having one side closest to said target aneurysm 2000.

[0058] Now referring to FIG. 1C, shown is a cutaway view of delivery catheter lumen 3 having a triangular lumen with A-B-C angles, and pusher wire 300 passing therethrough at offset C-A-B angles, in order to deliver a differentially porous occlusion device (not shown) at a 120° angle to deploy at a desired orientation. The present invention teaches that the orientation of a push-wire may be fixed outside the patient's body by fixing its relative orientation with respect to the delivery catheter lumen 3. Said delivery catheter lumen 3's orientation with respect to target aneurysm 2000, having been established prior to insertion of push-wire 300, allows the user of the device of the present invention to properly insert said push-wire 300 to achieve proper orientation with respect to aneurysm 2000 without turning said push-wire 300 inside the patient. The present disclosure includes the basic concept of having a non-circular, geometrically shaped inner lumen and matched pusher wire or hypotube. This allows the user to avoid unwanted turns of devices inside the delivery catheter and inside of vessels. It also allows delivery in a predictable radial orientation, utilizing a marker at the hub and a corresponding radial marker at the delivery catheter tip, so that when the orientation of the delivery catheter tip is imaged after positioning intracranial, or in similar tortuous anatomy, the degree of torsion, if any, relative to the corresponding hub marker and relative to the target pathology can be measured. The stent device can then be inserted at an appropriate orientation relative to the hub marker, so that the desired orientation is delivered to the target vessel. For example, if the hub marker is at 12 o'clock, and the tip marker is at 4 o'clock, the device/stent can be inserted knowing that whatever porosity is inserted at the hub at 12 o'clock, will consistently be delivered through the catheter tip at 4 o'clock. Similarly, stent devices can be preloaded in packaging catheters of a similar geometric shape, and with a similar 12 o'clock marker (or similar), at various radial circumferential orientations relative to the 12 o'clock position. Then, depending on which orientation is desired, the appropriate preloaded device can be chosen and utilized. Alternatively, the devices can all be preloaded in the same orientation, and the packaging catheter can be rotated at various angles relative to the delivery catheter and its hub, in order to achieve the desired orientation of the stent device as it is transferred from the packaging catheter to the delivery catheter. As is well known in the prior art, the packaging catheter it typically shorter than the delivery wire or delivery hypotube. The stent is preloaded onto said delivery wire or hypotube within said packaging catheter. Transfer of said stent device is then achieved by mating the packaging catheter with the delivery catheter, within the hub of the delivery catheter, and then advancing/pushing the back of the wire/hypotube, which is extending out the back of the packaging catheter. Said wire/hypotube is advanced, together with the stent mounted thereon, at a minimum until the stent is completely within the delivery catheter, and most often until the majority of the pusher wire/hypotube is as well. The packaging catheter is the removed from the remainder of the hypotube/wire, and the operator continues to push said hypotube/wire until the stent reaches the end of the delivery catheter. The stent can then be deployed by pushing it out, retracting the delivery catheter to unsheathe it, and/or a combination of these. Additionally, in the preferred embodiments the pusher wire/hypotube, packaging catheter, and delivery catheter have a matching geometrical shape, with the packaging catheter and delivery catheters (excluding the hub) having similar inner dimensions; the wire/hypotube fits snugly, but slideably, into the packaging catheter and delivery catheter, fitting in a lock-in-key fashion, so it can advance within said catheters but cannot rotate in said catheters. For example, in one embodiment the pusher wire/hypotube has and outer triangular cross-sectional shape, which fits into an inner triangular shaped packaging catheter and delivery catheter.

[0059] Now referring to FIG. 2, shown is proximal end 10 and distal end 20 of stent-packaging catheter 30 (outside patient's body), hub 700 attached to delivery catheter lumen 3, packaging-catheter hub port 701 displaying push-wire 300 running therethrough, further showing push-wire 300 (in dashed lines extending through delivery catheter lumen 3 and continuing through delivery catheter lumen 3, said push-wire 300 having its distal end 303 releasably attached to stent 301 proximal to target aneurysm 2000; the distal end 20 of stent-packaging catheter 30 disposed inside hub port 701, delivery catheter lumen 3 (oriented with triangular proximal end hole 1, and triangular distal end hole 2 proximal to target aneurysm 2000); delivery catheter lumen 3 being deployed within vessel walls 1000.

[0060] Packaging catheter 30 is joined to hub 700 at port 701 such that stent 301 and push-wire 300 are oriented as desired so as to present the minimally porous surface of said stent 301 substantially toward the target aneurysm 2000.

[0061] Now referring to FIG. 3, shown is push-wire 300 and stent 301 disposed at push-wire distal end 303 within vessel walls 1000 following removal of delivery catheter lumen 3 (shown in FIG. 2). Once stent 301 is proximally paced next to aneurysm 2000, said stent 301 is activated and expands such that the substantially nonporous side of said stent 301 abuts said aneurysm 2000, while the other two sides of a triangularly elongated stent 301 are porous to promote blood flow. Additionally, the present invention discloses a single “12 o'clock” marker on the hub, and a single radio-opaque “12 o'clock” marker on the distal catheter tip.

[0062] Now referring to FIG. 4, shown is an interior view of delivery catheter lumen 3 having a triangular shape, composed of proximal sides 4, 5 and 6, corresponding with distal sides 44 (oblique distal sides 55 and 66 behind 44 are shown in FIG. 5); facing side 444 illustrates the full length of the catheter side beginning at proximal side 4 and ending in distal side 44.

[0063] The orientation of lumen of delivery catheter lumen 3 must be clearly identifiable. FIG. 4 shows a triangular shape having sides 4, 5 and 6 on the proximal end, 44 at the distal end of face 444. Alternative embodiments (not shown) may employ other regular shapes such as rectangles or stars.

[0064] Now referring to FIG. 5, shown is an adjacent face 555 of the interior of delivery catheter of FIG. 4 (or FIG. 4 rotated once 120.), face 555 beginning at proximal side 5 and ending in distal side 55 (oblique distal sides 44 and 66 behind 55 shown in dashed cutaway); facing side 555 further includes radio-opaque orientation-aid markers 5550. FIG. 5 is a rotated image of FIG. 4 displaying the opposing plane 555 which terminates at side end 5 on the proximal end, and 55 on the distal end. On said 555 surface, radio markers 5550 allow the user to ascertain the relative orientation of one side of the delivery catheter lumen 3. Using this information, the packaging catheter 30 may be properly oriented in hub port 701 such that when push-wire 300 and stent 301 are proximal to aneurysm 2000, they are properly aligned or oriented.

[0065] Now referring to FIG. 6, shown is a stent 301 attached to push-wire 300 at distal end 303 of push-wire 300 and proximal end of stent 301. Said stent 301 is triangular in shape, with distal end 3010 and triangular edges on a plane with distal end 303, namely edges 334, 355 and 366. At the distal end 3010 of stent 301, triangular edge 3550 is shown in dotted lines disclose the other two triangular edges 3440 and 3660. Triangular edge 335 forms a planar length terminating in edge 3550. On said plane, resides radio-opaque markers 55500.

First Method.

[0066] Use a delivery catheter with a “12 o'clock” marker at the proximal hub of said catheter. The 12 o'clock marker may be disposed on the hub and on the delivery catheter tip (i.e., radio-opaque on the catheter tip). The user inserts the stent-packaging catheter having a differentially porous stent or occlusion device mounted on a push-wire therein. After testing, the user rotates the packaging catheter at the hub to the desired indicator.

[0067] The indicator may be disposed in any position on the hub to point to any direction on the hub, but terming this a 12 o'clock indicator or marker is convenient for describing positions relative to the marker for anyone familiar with an analog clock face. For example, instructing a user to rotate the hub to “3 o'clock”, “6 o'clock”, or “9 o'clock” intuitively suggests a quarter turn, half turn, and three-quarter turn, respectively, with other “times” referring to approximate positions between these 90° references (e.g., 2 o'clock, 5 o'clock or 11 o'clock). The same effect could be achieved by reference to a “North” marker, utilizing terminology such as East, South, and West (or interstitial positions such as ESE or NW), but “12 o'clock” is a preferred reference. The ability to rotate the relative orientation of the delivery catheter within a 360° range manually, not the terminology employed, is material.

[0068] Use a packaging catheter having a distal marker, advance a test stent or final stent at a particular orientation relative to the 12 o'clock marker on said delivery catheter. The stent (or other marked endovascular device) will generally end in a substantially similar, but unpredictable, orientation. The process may be repeated to verify that the markers on the delivery catheter and the packaging catheter are consistently aligned. Then image the markers on the test stent/device relative to the marker on the tip of the delivery catheter to determine what orientation (i.e., at what “hour” on the “clock”) the stent needs to be loaded into the delivery catheter in order to achieve the desired orientation. Or use a stent preloaded in a delivery catheter in a desired orientation relative to the “12 o'clock” marker.

[0069] Optionally, the orientation can be confirmed with an additional test stent/device which is temporarily advanced in the predicted orientation, and then imaging can confirm, before the test device is removed and a permanent device is advanced and deployed.

[0070] By way of example, a test result shows a fenestration deploys at “7 o'clock”, which is 90° clockwise relative to the target branch vessel. The treatment would then reorient the stent-packaging catheter at “4 o'clock”, to have it appear correctly oriented proximal to the target branch.

[0071] When a catheter tip orientation is imaged, the stent loaded in the appropriate orientation relative to the similarly disposed hub marker can be deployed. Once again, if desired, “test” device/stents with additional radio-opaque markers can be retrievably deployed to confirm the orientation.

Second Method

[0072] Disclosed is a second method, using the steps and markers of the above-described First Method, and in addition using a delivery catheter having throughout its cross section a unique geometrically shaped inner lumen. In a typical embodiment, the surface of the delivery catheter will be conventionally cylindrical, substantially rounded, to facilitate advancement through circulatory vessels. An unrounded lumen minimizes the rotational tendency of a deploying stent-packaging catheter, or a wire, enhancing the predictability of orientation.

[0073] The accompanying figures show, by way of example, a triangularly shaped lumen. Alternatively, a square, hexagon, octagon, pentagon, a “house” silhouette or star shape. Any style of star may be used, such as 6-pointed, “Star of David” or others, or other geometric shapes, provided a single one is used throughout the lumen.

[0074] In a further embodiment, a packaging catheter may be shaped correspondingly to the shape of the lumen of the delivery catheter. This correspondence is shown in the accompanying FIGS. 1A and 1B, for example. This embodiment is configured such that the correspondingly shaped packaging catheter and delivery wire/hypotube are snug enough so as to not allow rotation, but loose enough to allow movement back and forth relative to one another. This embodiment will maintain a similar orientation through the advancement of the stent/device through the delivery catheter, allowing accurate and predicable deployment in appropriate and desired orientations.

[0075] Again here, a “12 O'clock” marker that is at the same orientation can be on the hub and on the catheter tip (radio-opaque on the catheter tip). So, when/if the catheter tip orientation is imaged, the stent loaded in the appropriate orientation relative to the similarly disposed hub marker can be used. Once again, if desired, “test” device/stents with additional radio-opaque markers can be retrievably deployed to confirm the orientation. When the tip marker orientation can be well imaged after delivery intracranially, or into similar tortuous vasculature, the tip marker orientation, and its relative deflection on a rotary basis from the hub marker, can most often be used to determine rotational orientation, without the need for optional retrievable test-stent devices.

Common Method

[0076] Using any of the devices and methods above, a fenestration can be accurately deployed at the origin of a branch vessel. Then a wire can be advanced through that fenestration and into the branch, and either: (a) a balloon expandable device/stent can be delivered over the wire and deployed so that the proximal end minimally overlaps with the fenestration of the first stent/device; moreover, the branch may also optionally have a taper so it is somewhat larger at the fenestration side versus the portion that extends into the branch vessel; (b) a second delivery catheter (or the first can be re-used) can be delivered into the branch (the wire can optionally be removed) and an additional branch stent, most often self-expanding, can be delivered through the delivery catheter. Again, the branch stent may also optionally have a taper so it is somewhat larger at the fenestration side versus the portion that extends into the branch vessel.

[0077] Delivery method (b), however, has difficulty accurately landing the proximal stent, especially with “woven” or “braided” stents which can significantly, and unpredictably, foreshorten during deployment (compared to their length crimped in the delivery catheter).

[0078] Another option therefore is a novel delivery device for such stents. In this embodiment, it can be loaded in a device/catheter similar to the “inner catheter with wings” of a filter-tip TAVR (transcatheter aortic valve replacement) catheter, or said another way a “central tube” and “retaining structure connected to the distal end of said central tube and extending in a direction from the distal end to the proximal end of said central tube” also described and patented by Walzman (U.S. Ser. No. 10/30,724,262). The “wings” provide the proper fixing of the orientation while being guided through the angular lumen 1 of the delivery catheter. Having a single or multiple external wires attached to a stent, in a preferred embodiment ideally attached to the proximal and distal ends of the stent (which can be “over the wire” or most ideally “rapid exchange”) once a first stent is deployed with the fenestration overlying a branch vessel origin, a second wire is advanced through the fenestration into the branch, and a second stent/device, delivered constrained within said retaining structure and having at least one second wire attached to said stent outside the central tube and/or an outer tube attached to said stent, is advanced over the wire to the desired position. The stent attached wire(s) (or, alternatively, the outer catheter) is held in place while the “inner catheter with wings” is advanced, exposing/unsheathing the stent from the proximal end first.

[0079] The present invention also discloses an unsheathing device for the branch stent. More specifically the present invention teaches a device which un-sheaths the proximal part first. In the foregoing, if the stent is attached by wires, the wires can expand with the stent. If the stent is attached to an outer catheter (which is outside the inner catheter, but still inside the stent; the wings are outside the stent), it would need to wait until entire stent is unsheathed before detaching the proximal end. Or if stent is attached circumferentially proximally to an outer catheter and also has at least one additional wire attached to the stents distal segment- or additional attachment(s) to the outer catheter at the distal stent segment, then the proximal attachments can be detached upon unsheathing the proximal segment of the stent- to ensure appropriate orientation and position overlapping minimally the fenestration but not significantly overlapping/covering the primary vessel, and then the distal stent can be detached once the entire stent is deployed.

[0080] The stent can optimally be attached only distally to the “outer catheter”, in order to advance the system, the outer catheter is pushed, which pulls the attached stent and pushes the winged portion of the inner catheter (and subsequently the entire inner catheter in unison). Then, when the stent is properly positioned, the second stent can be unsheathed by holding the outer catheter (with attached stent) in position and then advancing the inner catheter, which will unsheath the proximal stent first. Using self-expanding stents, the proximal stent will automatically expand as it is unsheathed. If position is off, the inner catheter can be pulled back again and the proximal stent can be re-sheathed, and the stent can be repositioned before unsheathing again.

[0081] Additionally, when using “braided” or “woven” stents, full expansion can be slow and unpredictable, the proximal end of stent (and optionally other parts as well) can have a nitinol wire ring to encourage more immediate opening/self-expansion to its maximal diameter. There may optionally be similar attached longitudinal wires as well to help allow smooth re-sheathing when desired. Such rings may optionally be repeated at additional intervals along the stent device.

[0082] More particularly, a preferred method may be described by the following steps, using the embodiment of the device in which the pusher wire comprises an angular shape congruent with the angular lumen of the delivery catheter (e.g., a triangularly shaped pusher wire and triangular lumen): [0083] (a) inserting said delivery catheter into a body, [0084] (b) pushing said proximal end of said delivery catheter over a delivery wire until said distal end of said delivery catheter is proximal to a target aneurysm, [0085] (c) removing said delivery wire [0086] (d) imaging the orientation of said distal end radial marker relative to said target aneurysm [0087] (e) orienting said packaging catheter relative to a 12 o'clock hub marker so as to optimize orientation of said stent relative to said target aneurysm, [0088] (f) inserting said packaging catheter into said hub, [0089] (g) pushing said pusher wire until said stent is fully within said delivery catheter [0090] (h) removing said packaging catheter [0091] (i) pushing said pusher wire until said stent is proximal to said target aneurysm, [0092] (j) deploying the majority of said differentially porous occlusion device, [0093] (k) repeating imaging to confirm expected device orientation [0094] (l) deploying fully the remainder of said differentially porous occlusion device, and [0095] (m) withdrawing said pusher wire and said delivery catheter.

Bifurcated or V-Shaped Stents

[0096] Using the foregoing procedure, a “Y” shaped stent may be assembled from two stents in vivo by reference to markers.

[0097] The present invention may employ self-expanding components.

[0098] The present invention may employ balloon-expanding components.

[0099] The present invention may optionally contain radiopaque components and/or radiopaque markers. These can be especially valuable at ends of stent and at the ends and edges of covered zone. Radio-opaque materials and markers can also be optionally present in more places, and sometimes throughout.

[0100] The present invention may have branched stent elements.

[0101] The present invention's stent elements may optionally be fully re-sheathable.

[0102] The present invention's stent elements may optionally be partly re-sheathable.

[0103] All stent elements of the present invention may be optionally be detachable.

[0104] It will be understood by those skilled in the art that the above particular embodiments are shown and described by way of illustration only. The principles and the features of the present disclosure may be employed in various and numerous embodiments thereof without departing from the scope and spirit of the disclosure as claimed. The above-described embodiments illustrate the scope of the disclosure but do not restrict the scope of the disclosure.