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1. (WO2008063464) PROCÉDÉS ET DISPOSITIFS DE DÉPLOIEMENT D'UN IMPLANT DANS DES COURBES ANATOMIQUES
Note: Texte fondé sur des processus automatiques de reconnaissance optique de caractères. Seule la version PDF a une valeur juridique

What is claimed is:
1. A method for deploying an implant in a curved vessel, comprising the steps of: providing a steerable catheter having a proximal end, a distal end, and an endoluminal implant carried in a distal region of the catheter, the catheter having a longitudinal axis at the distal end of the catheter, the endoluminal implant having a leading edge and a trailing edge;
advancing the catheter into a curved region of a vessel having a centerline;
steering the catheter to substantially align the longitudinal axis with the centerline of the vessel at the region where the implant lies within the vessel; and
deploying the implant to achieve substantially uniform wall contact with the endoluminal surface of the vessel.
2. The method of claim 1 wherein the vessel is the aorta.
3. The method of claim 2, wherein the step of advancing the catheter into a curved region of a vessel comprises advancing the catheter into the aorta arch.
4. The method of claim 3, wherein the catheter is advanced into the ascending aorta upstream of the innominate artery.
5. The method of claim 3, wherein the catheter is advanced into the aortic arch downstream of the innominate artery.
6. The method of claim 3, wherein the catheter is advanced into the aortic arch downstream of the left subclavian artery.
7. The method of claim 3, wherein the aortic arch has an aortic dissection and wherein the dissection has an entry point, wherein the leading edge of the implant
substantially overlaps the entry point of the aortic dissection.

8. The method of claim 3, wherein the aortic arch has atheroma, and wherein the implant is deployed to retain the atheroma between the implant and the endoluminal surface of the aorta.
9. The method of claim 1, wherein the catheter further comprises a control member attached to a point on the catheter near the distal end and extending proximally from the point of attachment, and wherein the step of steering the catheter further comprises the step of withdrawing the control member to cause the distal end to curve.
10. The method of claim 9, wherein the control member is attached to a point on the circumference of the catheter.
11. The method of claim 1 , wherein the endoluminal implant further comprises a longitudinal adjustment member attached on the implant near the leading edge.
12. The method of claim 11, wherein the longitudinal adjustment member attached on the implant near the leading edge extends to a point of attachment near the trailing edge.

13. The method of claim 11, wherein the adjustment member is releasably attached on the implant.
14. The method of claim 11, wherein the adjustment member is fixedly attached on the implant.
15. The method of claim 1, wherein the catheter further comprises an elongate sheath slideably covering the endoluminal implant, and wherein the step of deploying the implant further comprises the step of sliding the sheath proximally to release the endoluminal implant.

16. A medical device for deploying an implant in a curved vessel, comprising:
an elongate member having a proximal end and a distal end;
an endoluminal implant releasably carried near the distal end of the elongate member; and
a control member having a distal end attached at a point near the distal end of the elongate member and extending proximal from the point of attachment,
wherein the control member causes a distal region of the catheter to bend when an axial displacement is applied to the control member.
17. The medical device of claim 16, wherein the endoluminal implant is a self-expanding stent.
18. The medical device of claim 16, wherein the endoluminal implant is a balloon-expanding stent.
19. The medical device of claim 16, wherein the elongate member is an elongate tubular catheter.
20. The medical device of claim 16, wherein the elongate member further comprises an elongate sheath slideably covering the endoluminal implant.
21. The medical device of claim 16, wherein the endoluminal implant is composed of nitinol.
22. The medical device of claim 16, wherein the endoluminal implant is a metal stent having a portion covered by textile.
23. The medical device of claim 16, wherein the elongate member further comprises a proximal handle and wherein the control member is attached to a control mechanism in the proximal handle.

24. The medical device of claim 16, wherein the axial displacement is proximal displacement.
25. The medical device of claim 16, wherein the axial displacement is distal displacement.
26. The medical device of claim 16, further comprising a second control member having a distal end attached at a point near the distal end of the elongate member and extending proximal from the point of attachment.

27. A method for deploying an implant in a curved vessel, comprising the steps of: providing a catheter having a proximal end, a distal end, and an endoluminal implant carried in a distal region of the catheter, the catheter having a longitudinal axis at the distal end of the catheter, the endoluminal implant having a leading edge and a trailing edge and further comprising a longitudinal adjustment member attached on the implant near the leading edge and extending proximally;
advancing the catheter into a curved region of a vessel having a centerline;
deploying the implant; and
moving the adjustment member to adjust the orientation of a plane defined by the leading edge of the endoluminal implant so that the endoluminal implant achieves uniform wall contact with the endoluminal surface of the vessel where the endoluminal implant engages the lesser curvature of the vessel.
28. The method of claim 27, wherein the adjustment member is attached near the leading edge of the endoluminal implant and extends proximally to a point of attachment near the trailing edge of the endoluminal implant.
29. The method of claim 28, wherein the adjustment member comprises a distal segment, a proximal segment, and an adjustable mechanism disposed between the distal and proximal segments.
30. The method of claim 29, further comprising the step of adjusting the adjustable mechanism to shorten or lengthen the adjustment member to adjust the radius of curvature of the endoluminal implant.
31. The method of claim 27 wherein the vessel is the aorta.

32. The method of claim 31 , wherein the step of advancing the catheter into a curved region of a vessel comprises advancing the catheter into the aorta arch.
33. The method of claim 32, wherein the catheter is advanced into the ascending aorta upstream of the innominate artery.
34. The method of claim 32, wherein the catheter is advanced into the aortic arch downstream of the innominate artery.
35. The method of claim 32, wherein the catheter is advanced into the aortic arch downstream of the lefi subclavian artery.
36. The method of claim 32, wherein the aortic arch has an aortic dissection and wherein the dissection has an entry point, wherein the leading edge of the implant substantially overlaps the entry point of the aortic dissection.
37. The method of claim 32, wherein the aortic arch has an aortic atheroma, and wherein the implant is deployed to retain the atheroma between the implant and the endoluminal surface of the aorta.
38. The method of claim 27, wherein the catheter further comprises a control member attached to a point on the catheter near the distal end and extending proximally from the point of attachment, and wherein the step of steering the catheter further comprises the step of withdrawing the control member to cause the distal end to curve.
39. The method of claim 27, wherein the catheter further comprises an elongate sheath slideably covering the endoluminal implant, and wherein the step of deploying the implant further comprises the step of sliding the sheath proximally to release the endoluminal implant.

40. The method of claim 27, wherein the step of deploying the implant is performed while moving the adjustment member.
41. The method of claim 27, wherein the step of deploying the implant is performed before moving the adjustment member.
42. The method of claim 27, wherein the step of deploying the implant is performed after moving the adjustment member.
43. The method of claim 27, wherein the longitudinal adjustment member is releasably attached to the implant.
44. The method of claim 27, wherein the longitudinal adjustment member is fixedly attached to the implant.

45. A method for deploying an implant in a curved vessel, comprising the steps of: providing a catheter having a proximal end, a distal end, and an endoluminal implant carried in a distal region of the catheter, the catheter having a longitudinal axis at the distal end of the catheter, the endoluminal implant having a leading edge and a trailing edge; advancing the catheter into a curved region of a vessel having a centerline;
adjusting the orientation of a plane defined by the leading edge of the endoluminal implant; and
deploying the implant so that the endoluminal implant achieves uniform wall contact with the endoluminal surface of the vessel where the endoluminal implant engages the lesser curvature of the vessel.
46. The method of claim 45, wherein the endoluminal implant further comprises a longitudinal adjustment member attached on the implant near the leading edge and extending proximally.
47. The method of claim 46, wherein the adjustment member is attached near the leading edge of the endoluminal implant and extends proximally to a point of attachment near the trailing edge of the endoluminal implant.
48. The method of claim 47, wherein the adjustment member comprises a distal segment, a proximal segment, and an adjustable mechanism disposed between the distal and proximal segments.
49. The method of claim 48, further comprising the step of adjusting the adjustable mechanism to shorten or lengthen the adjustment member to adjust the radius of curvature of the endoluminal implant.
50. The method of claim 45 wherein the vessel is the aorta.

51. The method of claim 50, wherein the step of advancing the catheter into a curved region of a vessel comprises advancing the catheter into the aorta arch.
52. The method of claim 51, wherein the catheter is advanced into the ascending aorta upstream of the innominate artery.
53. The method of claim 51, wherein the catheter is advanced into the aortic arch downstream of the innominate artery.
54. The method of claim 51, wherein the catheter is advanced into the aortic arch downstream of the left subclavian artery.
55. The method of claim 51, wherein the aortic arch has an aortic dissection and wherein the dissection has an entry point, wherein the leading edge of the implant substantially overlaps the entry point of the aortic dissection.
56. The method of claim 51, wherein the aortic arch has an aortic atheroma, and wherein the implant is deployed to retain the atheroma between the implant and the endoluminal surface of the aorta.
57. The method of claim 45, wherein the catheter further comprises a control member attached to a point on the catheter near the distal end and extending proximally from the point of attachment, and wherein the step of steering the catheter further comprises the step of withdrawing the control member to cause the distal end to curve.
58. The method of claim 45, wherein the catheter further comprises an elongate sheath slideably covering the endoluminal implant, and wherein the step of deploying the implant further comprises the step of sliding the sheath proximally to release the endoluminal implant.

59. The method of claim 45, wherein the step of deploying the implant is performed while moving the adjustment member.
60. The method of claim 45, wherein the step of deploying the implant is performed before moving the adjustment member.
61. The method of claim 45, wherein the step of deploying the implant is performed after moving the adjustment member.
62. The method of claim 46, wherein the longitudinal adjustment member is releasably attached to the implant.
63. The method of claim 46, wherein the longitudinal adjustment member is fixedly attached to the implant.
64. A medical device for deploying an implant in a curved vessel comprising:
an elongate member having a proximal end and a distal end;
an endoluminal implant releasably carried near the distal end of the elongate member, the endoluminal implant having a leading edge and a trailing edge; and
a longitudinal adjustment member comprising a distal segment attached on the implant near the leading edge and extending proximally,
wherein the adjustment member causes the leading edge of the endoluminal implant to bend into uniform wall contact with the endoluminal surface of the curved vessel.

65. The medical device of claim 64, wherein the endoluminal implant is a self-expanding stent.
66. The medical device of claim 64, wherein the endoluminal implant is a balloon-expanding stent.

67. The medical device of claim 64, wherein the elongate member is an elongate tubular catheter.
68. The medical device of claim 64, wherein the elongate member further comprises an elongate sheath slideably covering the endoluminal implant.
69. The medical device of claim 64, wherein the endoluminal implant is composed of nitinol.
70. The medical device of claim 64, wherein the endoluminal implant is a metal stent having a portion covered by textile.
71. The medical device of claim 64, wherein the elongate member further comprises a control member attached to a point on the elongate member near the distal end and extending proximally from the point of attachment.
72. The medical device of claim 71, wherein the elongate member further comprises a proximal handle and wherein the control member is attached to a control mechanism in the proximal handle.
73. The medical device of claim 64, wherein the adjustment member is attached on the circumference of the implant.
74. The medical device of claim 64, wherein the longitudinal adjustment member extends proximally to a proximal segment attached near the trailing edge.

75. A method for deploying an implant in a curved vessel, comprising the steps of: providing a steerable catheter having a proximal end, a distal end, and an endoluminal implant carried in a distal region of the catheter, the catheter having a longitudinal axis at the distal end of the catheter, the endoluminal implant having a leading edge and a trailing edge;
advancing the catheter into a curved region of a vessel having a centerline;
steering the catheter to substantially align the longitudinal axis parallel with a tangent to the centerline of the vessel at the region where the implant lies within the vessel; and
deploying the implant to achieve substantially uniform wall contact with the endoluminal surface of the vessel.
76. The method of claim 75 wherein the vessel is the aorta.
77. The method of claim 76, wherein the step of advancing the catheter into a curved region of a vessel comprises advancing the catheter into the aorta arch.
78. The method of claim 77, wherein the catheter is advanced into the ascending aorta upstream of the innominate artery.
79. The method of claim 77, wherein the catheter is advanced into the aortic arch downstream of the innominate artery.
80. The method of claim 77, wherein the catheter is advanced into the aortic arch downstream of the left subclavian artery.
81. The method of claim 77, wherein the aortic arch has an aortic dissection and wherein the dissection has an entry point, wherein the leading edge of the implant
substantially overlaps the entry point of the aortic dissection.

82. The method of claim 77, wherein the aortic arch has an aortic atheroma, and wherein the implant is deployed to retain the atheroma between the implant and the endoluminal surface of the aorta.
83. The method of claim 75, wherein the catheter further comprises a control member attached to a point on the catheter near the distal end and extending proximally from the point of attachment, and wherein the step of steering the catheter further comprises the step of withdrawing the control member to cause the distal end to curve.
84. The method of claim 75, wherein the endoluminal implant further comprises a longitudinal adjustment member attached on the implant near the leading edge and extending proximally.
85. The method of claim 75, wherein the catheter further comprises an elongate sheath slideably covering the endoluminal implant, and wherein the step of deploying the implant further comprises the step of sliding the sheath proximally to release the endoluminal implant.

86. A method for deploying an implant in a curved vessel, comprising the steps of: providing a steerable catheter having a proximal end, a distal end, and an endoluminal implant carried in a distal region of the catheter, the catheter having a longitudinal axis at the distal end of the catheter, the endoluminal implant having a leading edge and a trailing edge;
advancing the catheter into a curved region of a vessel having a centerline;
steering the catheter to substantially align the longitudinal axis parallel with a tangent to the wall of the vessel at the region where the implant lies within the vessel; and
deploying the implant to achieve substantially uniform wall contact with the endoluminal surface of the vessel.
87. The method of claim 86 wherein the vessel is the aorta.
88. The method of claim 87, wherein the step of advancing the catheter into a curved region of a vessel comprises advancing the catheter into the aorta arch.
89. The method of claim 88, wherein the catheter is advanced into the ascending aorta upstream of the innominate artery.
90. The method of claim 88, wherein the catheter is advanced into the aortic arch downstream of the innominate artery.
91. The method of claim 88, wherein the catheter is advanced into the aortic arch downstream of the left subclavian artery.
92. The method of claim 88, wherein the aortic arch has an aortic dissection and wherein the dissection has an entry point, wherein the leading edge of the implant
substantially overlaps the entry point of the aortic dissection.

93. The method of claim 88, wherein the aortic arch has an aortic atheroma, and wherein the implant is deployed to retain the atheroma between the implant and the endoluminal surface of the aorta.
94. The method of claim 86, wherein the catheter further comprises a control member attached to a point on the catheter near the distal end and extending proximally from the point of attachment, and wherein the step of steering the catheter further comprises the step of withdrawing the control member to cause the distal end to curve.
95. The method of claim 86, wherein the endoluminal implant further comprises a longitudinal adjustment member attached on the implant near the leading edge and extending proximally.
96. The method of claim 86, wherein the catheter further comprises an elongate sheath slideably covering the endoluminal implant, and wherein the step of deploying the implant further comprises the step of sliding the sheath proximally to release the endoluminal implant.