Systems and methods of de-endothelialization

Abstract

Apparatus and methods for treating a wall of an aneurysm formed in a vessel includes introducing a tubular member into the body lumen until a distal end of the tubular member is located within the aneurysm. A fluid is delivered via a lumen of the tubular member into the aneurysm to at least partially de-endothelialize the wall of the aneurysm, thereby causing an endothelium of the wall to generate fibrous tissue to strengthen the wall of the aneurysm.

1 . An apparatus for disrupting an endothelium of an aneurysm, an arterio-venous malformation, or a fistula, the apparatus comprising:
 an outer member having a proximal end and a distal end, the distal end having a size and shape for insertion into a body lumen;   an inner member deployable from within the outer member and comprising a proximal end, a distal end, and a first lumen extending between the proximal end and an outlet port on the distal end; and   a source of de-endothelialization fluid coupled to the proximal end of the inner member and communicating with the first lumen.   
     
     
         2 . The apparatus of  claim 1 , wherein the de-endothelialization fluid is a cytotoxic agent comprising a hypotonic fluid. 
     
     
         3 . The apparatus of  claim 1 , wherein the distal end of at least one inner and outer members includes an aspiration port and wherein at least one of the inner and outer members comprises a second lumen communicating with the aspiration port and a source of vacuum for aspirating fluid from the treatment site. 
     
     
         4 . The apparatus of  claim 3 , further comprising a sealing member carried by one of the inner and outer members proximal to the outlet port, the sealing member having a size and shape for substantially sealing the body lumen, wherein the aspiration port is disposed distal to the sealing member. 
     
     
         5 . The apparatus of  claim 1 , further comprising a coil extending from the distal end of the inner member, the coil configured for directing fluid delivered from the outlet port in a desired pattern within the treatment site. 
     
     
         6 . The apparatus of  claim 1 , further comprising a balloon carried on the distal end of the inner member, the balloon having the outlet port thereon. 
     
     
         7 . The apparatus of  claim 6 , wherein the outlet port comprises one or more openings extending through a wall of the balloon and communicating with an interior of the balloon, the interior of the balloon communicating with the first lumen, the one or more openings of the balloon sized such that when the balloon is inflated by the de-endothelialization fluid, the one or more openings expand sufficiently to allow the de-endothelialization fluid to exit from the interior of the balloon through the one or more openings. 
     
     
         8 . The apparatus of  claim 6 , wherein the balloon comprises a delivery lumen formed within a wall of the balloon communicating with the outlet port and the first lumen. 
     
     
         9 . An apparatus for disrupting an endothelium of a body lumen, comprising:
 an elongate tubular member comprising a proximal end and a distal end having a size and shape for insertion into a body lumen, the tubular member comprising an infusion lumen and an aspiration lumen extending between the proximal and distal ends;   a first fluid moving element communicating with the infusion lumen of the tubular member;   a second fluid moving element communicating with the aspiration lumen of the tubular member;   an actuator coupled to the first and second fluid moving elements, the actuator configured for simultaneously delivering fluid into the infusion lumen and withdrawing fluid from the aspiration lumen; and   a source of de-endothelialization fluid communicating with the first lumen.   
     
     
         10 . The apparatus of  claim 9 , wherein the de-endothelialization fluid is a cytotoxic agent comprising a hypotonic fluid. 
     
     
         11 . The apparatus of  claim 9 , wherein the tubular member comprises a first tubular member having a first lumen therein and a second tubular member within the lumen of the first tubular member, and wherein one of the infusion and aspiration lumens is defined between the first and second tubular members, and the other of the infusion and aspiration lumens is a lumen within the second tubular member. 
     
     
         12 . The apparatus of  claim 9 , further comprising an occlusion member associated with the tubular member for substantially sealing the body lumen. 
     
     
         13 . The apparatus of  claim 12 , wherein the occlusion member comprises an expandable member carried on the distal end of the tubular member. 
     
     
         14 . The apparatus of  claim 12 , wherein the occlusion member comprises an expandable member carried on a distal end of an elongate member. 
     
     
         15 . The apparatus of  claim 14 , wherein the expandable member comprises a compliant balloon, the balloon comprising a side port, wherein one of the infusion and aspiration lumens communicates with the side port. 
     
     
         16 . The apparatus of  claim 9 , wherein the actuator comprises a motor. 
     
     
         17 . An apparatus for disrupting an endothelium of a body lumen, comprising:
 a tubular member comprising a proximal end, a distal end having a size and shape for insertion into a body lumen, and first and second lumens extending between the first and second lumens;   a source of de-endothelialization fluid coupled to the proximal end of the tubular member and communicating with the first lumen for delivering the de-endothelialization fluid to tissue adjacent the distal end to at least partially de-endothelialize the tissue; and   a source of vacuum coupled to the proximal end of the tubular member and communicating with the second lumen for aspirating excess de-endothelialization fluid from a region adjacent the distal end of the tubular member.   
     
     
         18 . The apparatus of  claim 17 , wherein the de-endothelialization fluid is a cytotoxic agent comprising a hypotonic fluid.