# US 2014/0155980 A1 · Methods, devices, and systems for postconditioning with clot removal

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- Number: US 2014/0155980 A1
- Document ID: US20140155980A1
- Status: Published application
- Kind: A1
- Application number: 13/844,728
- Filed: 2013-03-15
- Published: 2014-06-05
- Earliest claimed: 2012-07-05
- Assignees: Cognition Medical Corp
- Inventors: Alexis TURJMAN; Jonah BERNSTEIN
- Web page: https://patentgrep.com/patent/US20140155980A1

## CPC

- A61B 17/221: Gripping devices in the form of loops or baskets {for gripping calculi or similar types of obstructions (surgical snare instruments A61B17/32056)}
- A61B 17/12031: {complete occlusion}
- A61B 17/12036: {partial occlusion}
- A61B 17/12109: {in a blood vessel}
- A61B 17/12136: {Balloons}
- A61B 17/12172: {having a pre-set deployed three-dimensional shape (methods of manufacturing A61B2017/00526)}
- A61B 17/3207: Atherectomy devices {working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions (A61B17/32037 takes precedence; endoscopic cutting instruments A61B17/320016)}
- A61B 17/320725: {with radially expandable cutting or abrading elements (A61B17/32075 takes precedence)}
- A61F 2/82: Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents (stent-grafts for tubular structures of the body other than blood vessels A61F2/04; stent-grafts for blood vessels A61F2/07)
- A61F 2/844: folded prior to deployment
- A61F 2/86: Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
- A61F 2/95: Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F 2/966: with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
- A61M 25/0082: {Catheter tip comprising a tool}
- A61M 25/10: Balloon catheters ({A61M25/0125 takes precedence; embolectomy A61B17/22032; retractors A61B17/02;} inflatable balloons for placing stents or stent-grafts A61F2/958 {; stomach balloons for treatment of obesity A61F5/0003; oesophagal tubes A61J15/00})
- A61B 2017/22065: {Functions of balloons}
- A61B 2017/22067: {Blocking; Occlusion (A61B2017/22054 takes precedence)}
- A61B 2017/2215: {having an open distal end}
- A61B 2017/320716: {comprising means for preventing embolism by dislodged material}
- A61M 2025/1095: {with perfusion means for enabling blood circulation while the balloon is in an inflated state or in a deflated state, e.g. permanent by-pass within catheter shaft}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)
- A61F: FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS (dental prosthetics A61C)
- A61M: DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY (introducing media into or onto the bodies of animals A61D7/00; means for inserting tampons A61F13/26; devices for administering food or medicines orally A61J; containers for collecting, storing or administering blood or medical fluids A61J1/05); DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY (surgery A61B; chemical aspects of surgical articles A61L); DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR {(Electrotherapy, e.g. producing anaesthesia by the use of alternating or intermittent currents A61N1/36021)}

## Abstract

New devices, systems, and methods are disclosed for preventing, treating, and/or at least minimizing ischemia and/or reperfusion injury by restoring and/or modulating blood flow, particularly in the cerebral vasculature where blood vessels are narrow and tortuous. These devices, systems, and methods make it possible for a clinician to adequately and systematically restore blood flow to ischemic tissue while simultaneously modulating the blood flow to minimize reperfusion injury. New thrombectomy devices and systems, which, for example, expand with greater radial force, further enable improved binding with clots and restoration of blood flow.

## Claims

### Claim 1

A method comprising:
introducing a device into a cerebral blood vessel that is at least partially blocked by a clot, applying pressure to an internal wall of the cerebral blood vessel to enhance blood flow in the vessel,
postconditioning to reduce reperfusion injury,
removing at least part of the clot from the vessel,
removing the device from the cerebral blood vessel,
the application of pressure, the removal of the clot, and the postconditioning occurring after the device is introduced and before the device is removed from the vessel.

### Claim 2 (depends on 1)

The method of claim 1 wherein the step of postconditioning comprises at least partially occluding the vessel.

### Claim 3 (depends on 1)

The method of claim 1 wherein the steps of applying, removing, and postconditioning comprise a single medical procedure.

### Claim 4 (depends on 1)

The method of claim 1 wherein the step of postconditioning includes selectively permitting flow through the vessel and reducing flow through the vessel in prescribed sequence.

### Claim 5

An apparatus comprising:
a catheter,
a balloon disposed on the catheter at a distal end of the catheter, the catheter including an orifice for inflating the balloon,
a stent in the vicinity of a distal end of a wire that extends through a lumen to an end of the catheter, and
a sealing interface between the wire and the lumen, nearer to the distal end of the catheter than is the orifice for inflating the balloon, that is adapted to seal the lumen so that the balloon may be inflated.

### Claim 6 (depends on 5)

The apparatus of claim 5, wherein the sealing interface includes an outwardly facing surface on the wire and an inwardly facing surface on the lumen.

### Claim 7 (depends on 6)

The apparatus of claim 6, wherein the inwardly facing sealing surface of the lumen has a smaller diameter than the other portions of the lumen of the catheter.

### Claim 8 (depends on 6)

The apparatus of claim 6 wherein the outwardly facing surface of the wire has a larger diameter than other portions of the wire.

### Claim 9

A device capable of transporting fluid and a push ire bearing a flow restoration member, the device comprising;
a catheter which includes a lumen that has an inner surface,
a pushwire, including a sealing ring disposed toward the distal end of the pushwire,
wherein the sealing ring is sized to sealingly engage the inner surface of the catheter so that when engaged the sealing ring substantially blocks flow of the fluid through the catheter.

### Claim 10 (depends on 9)

The device of claim 9 wherein the device is capable of transporting fluid that contains one or more of the following: contrast agent, tissue plasminogen activator PA, cyclosporine, calpain inhibitors, sodium-calcium Na+/Ca2÷ exchange inhibitors, monoclonal antibodies, temperature reducing agents, agents that slow cell metabolism, plasminogen activator, agents that may aid in removing a clot agents that aid in dissolving, dislodging, or macerating clots, pharmaceuticals or compounds commonly used for treating clots, preventing restenosis, intravascular device coatings such as vasodilators, namodopene sirolimus, paclitaxel, anti-platelet compounds and agents that promote the entanglement or attachment of a clot with a clot capture member such as fibronectin.

### Claim 11

An assembly configured to treat ischemic in a patient, comprising:
a catheter with a proximal region, distal region, and a single lumen;
a flow modulation member coupled to the proximal region of the catheter and comprising an inflatable balloon able to reversibly decrease and increase the flow of fluid through the blood vessel at least twice, and thereby modulate blood flow through the blood vessel, wherein the inflatable balloon has a balloon inflation aperture continuous with the single lumen and able to receive inflating fluid from the single lumen;
a pushwire with a proximal end and a distal end, wherein the pushwire is at least partially within the single lumen;
a flow restoration member for increasing the flow of blood through the clot, coupled to the distal end of the pushwire; and
one or more sealing members adapted to decrease the flow rate of inflating fluid leaving the single lumen.

### Claim 12 (depends on 11)

The assembly of claim 11, wherein one of the one or more sealing members is made of an electro-active compound, whereby applying and/or altering an electric current applied to the pushwire causes the electro-active sealing member to expand so as to provide more resistance to the flow of fluid through the catheter, wherein the flow modulation member is capable of expanding to produce a desired seal.

### Claim 13 (depends on 12)

The assembly of claim 12 wherein the assembly is adapted to operate with a pressure of the fluid less than 5 atm.

### Claim 14 (depends on 12)

The assembly of claim 12, wherein the flow restoration member for increasing the flow of blood through a blood vessel beyond a clot comprises a self-expanding scaffold, adapted to engage a clot in a blood vessel.

### Claim 15 (depends on 12)

The assembly of claim 12, wherein the catheter comprises a first section in the proximal region and a second section in the distal region, the area in the second section of the lumen, in the plane normal to the central axis of the catheter, being smaller than the area in the first section of the lumen, in the plane normal to the central axis of the catheter.

### Claim 16 (depends on 12)

The assembly of claim 12, wherein the one or more sealing members comprise a protrusion with an outwardly facing surface attached to the pushwire at a location on the pushwire proximal to the flow restoration member, wherein the protrusion slows the flow of fluid through the lumen when the protrusion engages an inwardly facing surface at the distal region of the catheter.

### Claim 17 (depends on 12)

The assembly of claim 12, wherein the one or more sealing members comprise a sealing tip at the distal end of the catheter, wherein a luminal edge of the sealing tip comes in close proximity with a sealing surface of the pushwire and stows the flow of fluid through the lumen when the sealing surface of the pushwire is placed through the sealing tip.

### Claim 18 (depends on 17)

The assembly of claim 17, wherein the sealing tip allows the flow restoration member to pass the sealing tip when the catheter is translated relative to the pushwire.

### Claim 19

A method of using an assembly able to treat ischemia in a patient, comprising:
identifying a blood clot in a blood vessel;
inserting a catheter into the blood vessel, the catheter including a proximal region, a distal region, and a single lumen, wherein a pushwire with a proximal end and a distal end is placed at least partially within the single lumen;
modulating blood flow in the blood vessel by selectively decreasing and increasing the flow of fluid through the blood vessel with a flow modulation member at least twice, wherein the flow modulation member is coupled to the distal region of the catheter and comprises an inflatable balloon having a balloon inflation aperture with the single lumen and adapted to receive inflating fluid from the single lumen, wherein one or more sealing members are provided along the lumen to reduce the volumetric flow rate of inflating fluid leaving the single lumen; and
increasing the flow rate in the blood vessel by translating the catheter relative to the pushwire to deploy a flow restoration member, wherein the flow restoration member is coupled to the pushwire near the distal end of the pushwire and comprises a self-expanding scaffoldable to engage the clot.

### Claim 20 (depends on 19)

The method of claim 19, wherein the catheter used in the method comprises a first section in the proximal region and a second section in the distal region, the area in the second section of the lumen, in the plane normal to the central axis of the catheter, being smaller than the area in the first section of the lumen, in the plane normal to the central axis of the catheter.

### Claim 21 (depends on 20)

The method of claim 20, wherein the one or more sealing members used in the method comprise a sealing ring coupled to the pushwire at a location in the single lumen proximal to the flow restoration member, wherein the sealing ring is able to engage the distal region of the catheter.

### Claim 22 (depends on 19)

The method of claim 19, wherein the one or more sealing members comprise a sealing tip coupled to the distal end of the catheter, wherein the sealing tip is adapted to selectively sealingly engage when the catheter is translated relative to the pushwire.

### Claim 23 (depends on 22)

The method of claim 22, wherein the sealing tip is able to allow the flow restoration member to pass the sealing tip when the catheter is translated relative to the pushwire.

### Claim 24

An assembly able to treat ischemia in a patient, comprising:
an intermediate catheter with a proximal region, a distal region, and a single intermediate lumen;
a flow modulation member coupled to the proximal region of the intermediate catheter and comprising an inflatable balloon to reversibly decrease and increase the flow of fluid through a blood vessel for modulating blood flow through the blood vessel, wherein the inflatable balloon has a balloon lumen continuous with the single intermediate lumen and receives inflating fluid from the lumen of the intermediate catheter;
a microcatheter with a single microcatheter lumen, wherein the microcatheter is at least partially within the lumen of the intermediate catheter;
a pushwire with a proximal end and a distal end, wherein the pushwire is at least partially within the lumen of the microcatheter;
a flow restoration member coupled to the distal end of the pushwire and comprising a self-expanding scaffoldable to engage a clot in a blood vessel; and
one or more sealing members able to reduce the volumetric flow rate of inflating fluid leaving the single intermediate lumen.

### Claim 25 (depends on 24)

The assembly of the claim 24, wherein the self-expanding scaffold is a stent.

### Claim 26 (depends on 24)

The assembly of claim 24, wherein the intermediate catheter comprises a first section in the proximal region and a second section in the distal region, the area in the second section of the lumen, in the plane normal to the central axis of the catheter, being smaller than the area in the first section of the lumen, in the plane normal to the central axis of the intermediate catheter

### Claim 27 (depends on 26)

The assembly of claim 26, wherein the one or more sealing members comprise a protrusion which reduces the space between the pushwire and the protrusion through which fluid can flow around the location of the protrusion coupled to the microcatheter, wherein the protrusion facilitates the inflation of the balloon when the protrusion is within or near the distal region of the intermediate catheter.

### Claim 28 (depends on 27)

The assembly of claim 27, wherein the protrusion is annular.

### Claim 29 (depends on 24)

The assembly of claim 24, wherein the one or more sealing members comprise a sealing tip coupled to the distal end of the intermediate catheter, wherein a luminal edge of the sealing tip comes in close proximity with the pushwire and slows the flow of fluid through the lumen when the pushwire is placed through the sealing tip.

### Claim 30

A method of using an assembly able to treat ischemia in a patient, comprising:
identifying a target blood clot in a blood vessel;
inserting into the blood vessel an intermediate catheter with a proximal region, a distal region, and a single intermediate lumen, wherein a microcatheter with a single microcatheter lumen is at least partially within the single intermediate lumen, wherein a pushwire with a proximal end and a distal end is at least partially within the lumen of the microcatheter;
modulating blood flow in the blood vessel by reversibly decreasing and increasing a flow of fluid through the blood vessel with a flow modulation member at least twice, wherein the flow modulation member is coupled to the distal region of the intermediate catheter and comprises an inflatable balloon having a balloon lumen continuous with the single intermediate lumen and able to receive inflating fluid from the single intermediate lumen;
reducing a rate of inflating fluid leaving the single intermediate lumen using one or more sealing members; and
increasing the flow rate in the blood vessel by translating the intermediate catheter relative to the pushwire to deploy a flow restoration member.

### Claim 31 (depends on 30)

The method of claim 30, wherein the flow restoration member used in the method is coupled to the pushwire near the distal end of the pushwire and comprises a self-expanding scaffold capable of engaging the target blood clot.

### Claim 32 (depends on 30)

The method of claim 30, wherein the intermediate catheter used in the method comprises a first section in the proximal region and a second section in the distal region, an area in the second section of the lumen, in the plane normal to the central axis of the intermediate catheter, being smaller than an area in the first section of the lumen, in the plane normal to the central axis of the intermediate catheter.

### Claim 33 (depends on 31)

The method of claim 31, wherein the one or more sealing members used in the method comprise a protrusion coupled to the pushwire at a location in the single lumen proximal to the flow restoration member, wherein the protrusion slows the flow of inflating fluid through the lumen when the protrusion engages the distal region of the intermediate catheter.

### Claim 34 (depends on 30)

The method of claim 30, wherein the one or more sealing members used in the method comprise a sealing tip coupled to the distal end of the catheter, wherein the sealing tip is able to engage the pushwire when the catheter is translated relative to the pushwire.

### Claim 35 (depends on 34)

The method of claim 34, wherein a luminal edge of the sealing tip comes in close proximity with the pushwire and slows the flow of inflating fluid through the lumen when the pushwire is placed through the sealing tip.

### Claim 36

An assembly able to treat ischemia in a patient, comprising:
a catheter with a proximal end, a distal end, and at least two catheter lumina;
one or more flow modulation members coupled to the catheter and comprising an inflatable balloon able to reversibly decrease and increase a flow of fluid through a blood vessel with a flow modulation member at least twice, wherein the inflatable balloon has a balloon lumen continuous with a first catheter lumen and able to receive inflating fluid from the first catheter lumen, wherein a distal end of the first catheter lumen is closed;
one or more pushwires with a proximal end and a distal end, wherein a first pushwire of the one or more pushwires is placed at least partially within a second catheter lumen; and
one or more flow restoration members are coupled to the first pushwire near a distal end of the first pushwire.

### Claim 37 (depends on 36)

The assembly of claim 36, wherein a flow restoration member of the one or more flow restoration members comprises a self-expanding scaffoldable to engage a clot in a blood vessel.

### Claim 38

A method of using an assembly able to treat ischemia in a patient, comprising:
identifying a blood clot in a blood vessel;
inserting a catheter into the blood vessel the catheter including a proximal end, a distal end, and at least two catheter lumina, wherein a pushwire with a proximal end and a distal end is placed at least partially within a first catheter lumen;
modulating blood flow in the blood vessel by reversibly decreasing and increasing a flow of fluid through the blood vessel with a flow modulation member at least twice, wherein the flow modulation member is coupled to the proximal end of the catheter and comprises an inflatable balloon having a balloon lumen continuous with a second catheter lumen receiving inflating fluid from the second catheter lumen, wherein one or more sealing members slow a flow rate of the inflating fluid that leaves the second catheter lumen; and
increasing the flow rate in the blood vessel by translating the catheter relative to the pushwire to deploy a flow restoration member, wherein the flow restoration member is coupled to the pushwire near the distal end of the pushwire and comprises a self-expanding scaffoldable to engage the clot.

### Claim 39

An assembly able to treat ischemia in a patient, comprising:
an intermediate catheter with a proximal end, a distal end, and at least two intermediate catheter lumina;
one or more flow modulation members coupled to the intermediate catheter and comprising an inflatable balloon or membrane able to reversibly reduce and increase a flow of fluid through a blood vessel at least twice for modulating blood flow through the blood vessel, wherein the inflatable balloon has a connecting lumen continuous with a first intermediate catheter lumen and receives inflating fluid from the first intermediate catheter lumen, wherein the distal end of the first intermediate catheter lumen is closed;
one or more microcatheters with a microcatheter lumen, wherein the microcatheter lumen is at least partially within a second intermediate catheter lumen;
one or more pushwires with a proximal end and a distal end, wherein a first pushwire of the one or more pushwires is at least partially within the microcatheter lumen; and
one or more flow restoration members coupled to near a distal end of the first pushwire and comprising a self-expanding scaffold that engages a clot in a blood vessel.

### Claim 40

A method of using an assembly to treat ischemia in a patient, comprising:
identifying a blood clot in a blood vessel;
inserting into the blood vessel an intermediate catheter with a proximal end, a distal end, and at least two intermediate catheter lumina, wherein a microcatheter with a microcatheter lumen is placed at least partially in a first intermediate catheter lumen, wherein a pushwire with a proximal end and a distal end is placed at least partially in the microcatheter lumen;
modulating blood flow in the blood vessel by reversibly decreasing and increasing a flow of fluid through the blood vessel with a flow modulation member at least twice, wherein the flow modulation member is coupled to the proximal end of the intermediate catheter and comprises an inflatable balloon having a balloon lumen continuous with a second intermediate catheter lumen and able to receive inflating fluid from the second intermediate catheter lumen; and
increasing the flow of blood in the blood vessel by translating the intermediate catheter relative to the pushwire to deploy a flow restoration member, wherein the flow restoration member is coupled to the pushwire near the distal end of the pushwire and comprises a self-expanding scaffoldable to engage the blood clot.

### Claim 41

An assembly adapted to engage a clot in a blood vessel, comprising:
a catheter with a proximal end, a distal end, and at least one lumen;
a pushwire with a proximal end and a distal end, wherein the pushwire is at least partially within the at least one lumen; and
a clot capture member coupled to the pushwire near the distal end of the pushwire and comprising a self-expanding scaffold that is capable of engaging a clot in a blood vessel when the catheter is moved so that the self-expanding scaffold is not completely within the catheter,
wherein the self-expanding scaffold comprises open cells formed by a pattern of struts,
wherein the open cells have a hexagonal cell shape able to facilitate engagement with the clot.

### Claim 42

An assembly adapted for engaging a clot in a blood vessel, comprising:
a catheter with a proximal end, a distal end, and at least one lumen;
one or more pushwires with a proximal end and a distal end, wherein the pushwire is at least partially within the at least one lumen; and
a clot capture member coupled to the distal end of the pushwire and comprising a self-expanding scaffold to engage a clot in a blood vessel when the catheter is retracted so as to at least partially not surround the self-expanding scaffold,
wherein the self-expanding scaffold comprises open cells formed by a pattern of struts,
wherein at least one of the struts has a cross-sectional shape with an angle less than 180 degrees oriented such that the angle protrudes outward from the self-expanding scaffold to facilitate engagement with the clot.

### Claim 43

A method for engaging a clot in a blood vessel, comprising:
identifying a blood clot in a blood vessel;
inserting into the blood vessel a catheter with at least one lumen, wherein a pushwire with a proximal end and a distal end is placed at least partially within the at least one lumen, wherein a clot capture member comprising a self-expanding scaffold is coupled to the distal end of the pushwire;
placing a distal end of the catheter proximate to the clot;
retracting the catheter to unsheathe and allow the self-expanding scaffold to expand within the blood vessel, wherein the self-expanding scaffold comprises open cells formed by a pattern of struts, wherein the open cells have a hexagonal cell shape able to facilitate engagement with the clot; and
extracting any clot material engaged by the self-expanding scaffold by removing the catheter and the pushwire from the blood vessel.

### Claim 44

A method for engaging a clot in a blood vessel, comprising:
identifying a blood clot in a blood vessel;
inserting into the blood vessel a catheter with at least one lumen, wherein a pushwire with a proximal end and a distal end is placed at least partially within the at least one lumen, wherein a clot capture member comprising a self-expanding scaffold is coupled to the pushwire near the distal end of the pushwire;
placing a distal end of the catheter close to a distal end of the clot;
retracting the catheter to unsheathe and allow the self-expanding scaffold to expand within the blood vessel, wherein the self-expanding scaffold comprises open cells formed by a pattern of struts, wherein at least one of the struts has a cross-sectional shape with an angle less than 180 degrees oriented such that the angle protrudes outward from the self-expanding scaffold to facilitate engagement with the clot; and
extracting any clot material engaged by the self-expanding scaffold by removing the catheter and the pushwire from the blood vessel.

### Claim 45

An assembly able to prevent and/or treat ischemic stroke in a patient, comprising:
a flow restoration member comprising a self-expanding scaffold capable of engaging a clot in a cerebral blood vessel; and
a flow modulation member to reversibly decrease and increase a flow of fluid through the cerebral blood vessel with the flow modulation member at least twice, performing one or more postconditioning cycles in the cerebral blood vessel,
wherein the members are able to be used simultaneously to prevent and/or treat ischemic stroke.

### Claim 46

A method of preventing and/or treating ischemic stroke in a patient, comprising:
identifying a blood clot in a cerebral blood vessel;
inserting an assembly able to prevent, mitigate and/or treat ischemic stroke into the cerebral blood vessel, the assembly comprising:
a flow restoration member comprising a self-expanding scaffoldable to engage a clot in the cerebral blood vessel; and
a flow modulation member able to modulate blood flow in the cerebral blood vessel,
wherein the members are able to be used simultaneously to prevent, mitigate, reduce and/or treat ischemic stroke;
deploying the self-expanding scaffold to restore blood flow in the cerebral blood vessel; and
performing one or more postconditioning cycles with the flow modulation member by reversibly decreasing and increasing a flow of fluid through the blood vessel at least twice.

### Claim 47

A device for modulating blood flow, the device comprising:
a flow modulation member having a plurality of self-expanding struts and a membrane capable of blocking blood flow;
a pushwire, wherein the flow modulation member is attached to the pushwire; and
a microcatheter with a lumen sized to receive at least a portion of the pushwire, the membrane capable of blocking blood flow attached to the microcather,
wherein relative movement between the pushwire and the microcatheter in one direction unsheathes the flow modulation member, allowing the flow modulation member to expand, and
wherein relative movement between the pushwire and the microcatheter in the opposite direction re-sheathes the flow modulation member, causing the flow modulation member to retract.

### Claim 48

A device for modulating blood flow, the device comprising:
a flow modulation member comprising a microcatheter and an inflatable balloon attached to the microcatheter adapted to selectively reduce blood flow;
a fluid conduit associated with the microcatheter for conducting inflation fluid between a proximal side of the microcatheter and the balloon,
wherein the fluid conduit is flexible and contiguous with the microcatheter.

### Claim 49 (depends on 48)

The device of claim 48, wherein the fluid conduit is a tube that travels outside the microcatheter.

### Claim 50 (depends on 48)

The device of claim 48, the fluid conduit is disposed in a helical arrangement outside the microcatheter.

### Claim 51 (depends on 48)

The device of claim 48, wherein the fluid conduit is a hollow space between an inner wall and an outer wall of the microcatheter, the inner and outer wall of the microcatheter connected at selected locations along its length.

### Claim 52

A device for engaging with a blood clot or embolus, the device comprising:
a clot capture member attached to a push wire and having a plurality of self-expanding struts with an angular cross-sectional profile, wherein a point of the profile faces outward from the clot capture member;
and
a microcatheter for housing the clot capture member,
wherein relative movement between the pushwire and the microcatheter in one direction unsheathes the clot capture member, causing the clot capture member to expand, and
wherein relative movement between the pushwire and the microcatheter in the opposite direction re-sheathes the clot capture member, allowing the clot capture member to retract.

### Claim 53

A system for achieving and modulating reperfusion, the system comprising:
a flow modulation member capable of blocking blood flow;
a pushwire with a self-expanding clot capture member attached toward a distal end, and,
a microcatheter adapted to receive at least a portion of the pushwire,
a pushwire, adapted to be introduced to vasculature through the microcatheter and wherein the self-expanding clot capture member is attached to the pushwire; and
the flow modulation member is also attached to the pushwire; and
wherein relative motion between the pushwire and the microcatheter in one direction is capable of unsheathing both the flow modulation member and the self-expanding clot capture member, causing one or both members to expand, and
wherein relative motion between the pushwire and the microcatheter in an opposite direction is capable of re-sheathing one or both of the flow modulation member and the self-expanding clot capture member, causing one or both members to retract.

### Claim 54

A system for achieving and modulating reperfusion of a vessel in the cerebral vasculature following ischemic stroke, the system comprising:
a flow modulation member capable of reversibly reducing blood flow;
a mechanism for selectively causing blood flow of the vessel to increase; and
wherein the flow modulation member is adapted to reach a location of a clot via the endovascularture;
the system adapted so that the flow modulation member is capable of performing at least two iterations of reducing and then varying flow in the vessel proximate to the location of the clot.

### Claim 55

A method for modulating blood flow, the method comprising:
inserting a microcatheter into a blood vessel;
inserting a pushwire into the microcatheter, wherein a flow modulation member is attached to the pushwire, wherein the flow modulation member has a plurality of self-expanding struts and a membrane capable of blocking blood flow;
translating the pushwire and the microcatheter relative to one another in one direction to unsheathe the flow modulation member, allowing the flow modulation member to expand;
translating the pushwire and the microcatheter relative to one another in an opposite direction to re-sheathe the flow modulation member, causing the flow modulation member to retract; and
repeating the translating steps at least once to modulate blood flow.

### Claim 56

A method for modulating blood flow for the treatment of ischemic stroke, the method comprising:
inserting a microcatheter and a fluid conduit into a blood vessel, wherein the fluid conduit is flexible and contiguous with the microcatheter, wherein a flow modulation member is attached to the microcatheter, and wherein the flow modulation member has an inflatable balloon capable of blocking blood flow;
conducting inflation fluid to the balloon, causing the balloon to expand;
conducting inflation fluid from the balloon, causing the balloon to retract; and
repeating the conducting steps at least once to modulate blood flow.

### Claim 57

A method for removing a blood clot or embolus, the method comprising:
inserting a microcatheter into an occluded blood vessel;
inserting a pushwire into the microcatheter, wherein a self-expanding clot capture member is attached to the pushwire and has a plurality of self-expanding struts with an angular cross-sectional profile, wherein a point of the profile faces outward from the self-expanding clot capture member toward a clot or embolus;
translating the pushwire and the microcatheter relative to one another in one direction to unsheathe the self-expanding clot capture member, causing the self-expanding clot capture member to expand to engage the clot or embolus.

### Claim 58

A method for achieving and modulating reperfusion, the method comprising:
inserting a microcatheter into an occluded blood vessel;
inserting a pushwire into the microcatheter, wherein both a flow modulation member capable of blocking blood flow and a self-expanding clot capture member are attached to the pushwire;
translating the pushwire or the microcatheter relative to one another in one direction to unsheathe one or both of the flow modulation member and the self-expanding clot capture member, causing one or both members to expand; and
translating the pushwire and the microcatheter relative to one another in an opposite direction to re-sheathe one or both of the flow modulation member causing the flow modulation member to retract; and
repeating the translating steps at least once to treat an occlusion and modulate reperfusion.

### Claim 59

A method for achieving and modulating reperfusion, the method comprising:
inserting a microcatheter into an occluded blood vessel;
inserting a pushwire into the microcatheter, wherein a self-expanding clot capture member is attached to the pushwire; and
a flow modulation member capable of blocking or reducing blood flow is attached to the microcatheter;
translating the pushwire and the microcatheter relative to one another in one direction to unsheathe the self-expanding clot capture member, causing the self-expanding clot capture member to expand; and
performing an expansion step to cause the flow modulation member to occlude or lessen flow; and
repeating the expansion at least once to modulate reperfusion.

### Claim 60

A system for achieving and modulating reperfusion, the system comprising:
three catheters, a narrow catheter is inside an intermediate catheter, and the intermediate catheter is inside a largest catheter;
wherein a pusher member is at least partially inside the narrow catheter; and the intermediate catheter has a flow modulation member capable of reversibly occluding or blocking flow near its distal end;
a clot capture member;
a pushwire, wherein the clot capture member is attached to the pushwire;
wherein relative translation between the pushwire and the narrow catheter in one direction is capable of unsheathing the clot capture member, causing the clot capture member to expand.