Devices, therapeutic compositions and corresponding percutaneous treatment methods for aortic dissection

#The inventions, in general, are related to percutaneous treatment methods for aortic dissection. The inventions are further related to devices used for the percutaneous treatment including the delivery of therapeutic compositions such as fillers.

#The aorta is the major artery that carries blood from the heart to the rest of the body.

#Aortic dissection occurs when the inner layer of the aortic wall (intima) tears, leading to blood flow through the tear, causing separation of the middle and inner layers of the artery wall (dissection). When blood flow dissects the artery wall, it forms a second channel for flow, creating what is termed a “false lumen”. The original flow lumen in the aorta is termed “true lumen”. These two channels compete for blood flow, sometimes leading to poor or absent flow in the true lumen and can impede perfusion of vital structures downstream such as the renal and visceral arteries. When perfusion of important arteries is impaired, this is termed “complicated” dissection. This can occur in any artery, but most often develops in areas of high pressure and shear stress like the ascending aorta (the first segment of the aorta), where the aorta originates from the heart's left ventricle (pumping chamber). This is the part of the aorta closest to the heart (thus the name “proximal aorta”). Aortic dissection can also occur in other parts of the aorta.

#FIG. 1A is a schematic diagram showing the type A common aortic dissection.

#FIG. 1B is a schematic diagram showing the type B common aortic dissection.

#FIG. 2A is a perspective diagram showing a section of aorta having type B common aortic dissection.

#Improved techniques are described for the treatment of aortic dissection and related disorders, such as aortic ulcers and aortic tears, based on treatments and/or filling of the false lumen. In some embodiments, the techniques can make use of devices that isolate portions of the aorta and/or support and expand the true lumen of the aorta. Correspondingly, the false lumen bypassing the true lumen can be decreased in volume by applying pressure through the increase in volume of the true lumen and/or by aspirating blood from the false lumen while blocking or restricting flow through opening(s) into the false lumen. The approaches described herein are designed to encourage remodeling of the aorta structure to more closely resemble the natural aorta structure.

#Aortic dissection can be classified depending on where the dissection begins in the aorta. FIG. 1A and FIG. 1B shows the two common types of aortic dissection types A and B respectively. Type A aortic dissection begins in the first (ascending) part of the thoracic aorta. Type B aortic dissection begins further in the descending thoracic aorta after the main branches that supply the brain and arms, just beyond the left subclavian artery. Referring to FIG. 1A, aorta 100 having type A aortic dissection has a false lumen or sack 102 in addition to a true lumen 104, a lining 103 separating the true lumen from the false lumen. In some cases, an intimal or internal tear or opening is present on the aortic wall. In general, the term tear is used to refer to damaged aortic tissue sites that may or may not progress to become a false lumen. The term opening is used to refer to damaged aortic tissue sites that lead to fluid communication between the false lumen and the true lumen. As shown in FIG. 1A, entrance opening 106 on the lining 103 provides fluid communication between the true lumen and the false lumen. In addition to the blood flow (indicated by curved arrows) inside the true lumen 104, in some aortic dissection patients, blood also enters the false lumen from the entrance opening 106. In some patients, blood inside the false lumen 102 can re-enter back into the true lumen of the aorta through another exit opening 108 on the lining 103.

#Similarly in FIG. 1B, aorta 110 having type B aortic dissection has a false lumen or sack 112 in addition to the true lumen 114, a lining 113 separating the true lumen from the false lumen, and in some cases an entrance opening 116 on the lining 113 that may provide fluid communication between the true lumen and the false lumen. In addition to the blood flow (indicated by curved arrows) inside the true lumen 114, in some aortic dissection patients, blood also enters the false lumen from the entrance opening 116. In some cases, blood inside the false lumen 112 can re-enter back into the true lumen of the aorta through another exit opening 118 on the lining 113. Both types of common aortic dissection can extend further down the aorta or into its branches as well.