Methods and apparatus for treating neurovascular venous outflow obstruction

Abstract

Methods and devices are disclosed for treating neurovascular venous outflow obstructions, with or without implantation of a prosthetic valve. The valve may be carried by a support, such as a stent, which may be self-expandable or balloon expandable. Both transvascular and direct surgical access is contemplated.

1 . A method of treating cerebrospinal venous insufficiency, comprising the steps of:
 identifying a patient having at least a partial obstruction at a site in the venous outflow track from the brain;   removing the obstruction; and   implanting a valve in fluid communication with the site, to permit venous outflow and reduce retrograde pressure.   
     
     
         2 . A method of treating cerebrospinal venous insufficiency as in  claim 1 , wherein the removing step comprises inflating a balloon at the site. 
     
     
         3 . A method of treating cerebrospinal venous insufficiency as in  claim 2 , wherein the balloon carries an implant at the time of the inflating step. 
     
     
         4 . A method of treating cerebrospinal venous insufficiency as in  claim 2 , further comprising removing the balloon and thereafter performing the implanting a valve step. 
     
     
         5 . A method of treating cerebrospinal venous insufficiency as in  claim 2 , wherein the balloon is carried by a catheter introduced into the vasculature at an access point spaced apart from the site. 
     
     
         6 . A method of treating cerebrospinal venous insufficiency as in  claim 1 , wherein the removing step comprises surgically removing a section of vein. 
     
     
         7 . A method of treating cerebrospinal venous insufficiency as in  claim 1 , wherein the implanting step comprises surgically attaching a valve at the site. 
     
     
         8 . A method of treating cerebrospinal venous insufficiency as in  claim 1 , wherein the implanting step comprises releasing a valve having a self expandable support at the site. 
     
     
         9 . A method of treating cerebrospinal venous insufficiency as in  claim 1 , wherein the implanting step comprises inflating a balloon within a balloon expandable portion of a valve support at the site. 
     
     
         10 . A method of treating cerebrospinal venous insufficiency as in  claim 7 , wherein the implanting step comprises implanting a tubular graft having a valve mounted therein. 
     
     
         11 . A method of treating cerebrospinal venous insufficiency as in  claim 7 , wherein the implanting step comprises attaching a first end of the graft at a first anastomosis to the left internal jugular vein and attaching a second end of the graft at a second anastomosis to the left innominate vein. 
     
     
         12 . A method of treating cerebrospinal venous insufficiency as in  claim 1 , wherein the valve is implanted in the left internal jugular vein. 
     
     
         13 . A method of treating cerebrospinal venous insufficiency as in  claim 1 , wherein the valve is implanted in the right internal jugular vein. 
     
     
         14 . A method of treating cerebrospinal venous insufficiency as in  claim 1 , wherein the valve is implanted in the azygos vein. 
     
     
         15 . A method of treating cerebrospinal venous insufficiency as in  claim 1 , wherein the valve is implanted in the superior vena cava. 
     
     
         16 . A method of treating cerebrospinal venous insufficiency as in  claim 10 , wherein the graft comprises a tubular ePTFE wall. 
     
     
         17 . A method of treating cerebrospinal venous insufficiency as in  claim 10 , wherein the graft comprises a section of saphenous vein. 
     
     
         18 . A cerebrospinal venous insufficiency catheter, comprising:
 a first elongate, tubular shaft, having an inflation lumen extending therethrough;   a first balloon carried by the shaft;   a second elongate, tubular shaft, having a central lumen, and axially movably carried by the first shaft, the central lumen having a distal opening;   wherein the distal opening is axially movably positionable between a first position in which the first balloon is at least partially within the central lumen, and a second position in which the first balloon is fully exposed beyond the distal opening.   
     
     
         19 . A cerebrospinal venous insufficiency catheter as in  claim 18 , further comprising a second balloon carried by the first shaft. 
     
     
         20 . A cerebrospinal venous insufficiency catheter as in  claim 18 , further comprising a third balloon carried by the second shaft. 
     
     
         21 . An implant, for positioning in the neurovascular venous outflow tract, comprising:
 a radially expandable frame, for engaging the wall of a vein; the frame having a flowpath therethrough;   an occluder support within the frame, extending across the flow path at an inclined angle relative to the central axis of blood flow; and   a thin film occluder, movable between a first position spaced apart from the occluder support sufficient to permit flow through the flow path in a first direction, and a second position in contact with the support such that it inhibits flow through the flow path in a second direction.   
     
     
         22 . An implant as in  claim 21 , further comprising at least one anchor on the frame for engaging the wall of the vein.