Endovascular interventions in neurovascular anatomy

Abstract

Method of endovascular intervention in neurovascular anatomy of a patient including deploying an anchor of a tethering device in an anchoring vessel of a neurovascular anatomy, the anchor coupled to a tether extending proximally from the anchor. Method includes advancing a guide-sheath over the tether of the tethering device anchored in the anchoring vessel and attached to the tether, the guide-sheath includes at least one lumen and a distal opening from the lumen. Method includes advancing a treatment device through the lumen of the guide-sheath and out the distal opening from the at least one lumen and through an entrance of a target intracranial vessel, and deploying the treatment device at a treatment site within the target intracranial vessel without a combined therapy of two or more anti-platelet therapeutic agents during a pen-procedural period. Related systems, devices, and methods are disclosed.

1 .- 71 . (canceled) 
     
     
         72 . A system for endovascular interventions in neurovascular anatomy of a patient, the system comprising:
 an access system comprising:
 a guide-sheath having a working lumen and an opening from the working lumen near a distal end of the guide-sheath, and a proximal end connectable to a rotating hemostatic valve; and 
 an expandable anchor deployable from a first, low-profile configuration to a second, higher-profile configuration within an anchoring vessel of a neurovascular anatomy, wherein the anchor is non-occlusive to the anchoring vessel, 
 wherein the distal end of the guide-sheath is configured to be fixed in position within the anchoring vessel by the anchor to prevent prolapse of the guide-sheath and to direct the opening from the working lumen to open towards a target intracranial vessel distal to the anchoring vessel, the target vessel having an aneurysm; and 
   an implant delivery system sized for delivery through the working lumen of the guide-sheath comprising an expandable treatment device deployable in the target vessel from the implant delivery system, the treatment device having a length in an expanded high-profile configuration that is size-matched to cover a longitudinal length of a neck of the aneurysm in the target vessel and has a vessel coverage of between 20%-40%.   
     
     
         73 . The system of  claim 72 , wherein the target intracranial vessel is distal to a carotid siphon and the anchoring vessel is proximal to the carotid siphon. 
     
     
         74 . The system of  claim 72 , wherein the treatment device is a flow diverter or a stent. 
     
     
         75 . The system of  claim 74 , wherein the vessel coverage is between 30%-35%. 
     
     
         76 . The system of  claim 72 , wherein the longitudinal length of the treatment device when in the expanded high-profile configuration is between about 4 cm and about 20 cm. 
     
     
         77 . The system of  claim 76 , wherein a collective length the treatment device extends beyond the neck of the aneurysm being treated is no more than about 1-2 mm. 
     
     
         78 . The system of  claim 72 , wherein the treatment device is a flow diverter comprising a first stent and a second stent implanted at the target intracranial vessel so as to create an overlap region between the first and second stent, the overlap region having a greater density than a density of either the first stent or the second stent, the density of the overlap region configured to block flow into a neck of the aneurysm. 
     
     
         79 . The system of  claim 78 , wherein the density of the first stent and the second stent provides the vessel coverage that is between about 20%-40%. 
     
     
         80 . The system of  claim 79 , wherein the density of the overlap region provides the vessel coverage. 
     
     
         81 . The system of  claim 78 , wherein the length of the overlap region is between about 4 mm and about 20 mm. 
     
     
         82 . The system of  claim 81 , wherein the length the overlap region extends beyond the neck of the aneurysm being treated no more than about 2 mm, no more than about 4 mm, no more than about 6 mm, no more than about 8 mm, or no more than about 10 mm. 
     
     
         83 . The system of  claim 81 , the length of the overlap region is limited to a length sufficient to bridge the neck of the aneurysm without extending substantially beyond on either side of the neck. 
     
     
         84 . The system of  claim 72 , wherein the aneurysm is a wide-necked aneurysm and the treatment device is a flow diverter. 
     
     
         85 . The system of  claim 84 , wherein the flow diverter has a length in a high-profile configuration that is between about 4 cm and about 20 cm. 
     
     
         86 . The system of  claim 85 , wherein the flow diverter is laser-cut. 
     
     
         87 . The system of  claim 84 , wherein the flow diverter comprises a first stent and a second stent implanted at the target intracranial vessel so as to create an overlap region between the first and second stent, the overlap region having a greater density than a density of either the first stent or the second stent, the density of the overlap region configured to block flow into a neck of the aneurysm.