WO2008028964A2

WO2008028964A2 - Helical implant having different ends

Info

Publication number: WO2008028964A2
Application number: PCT/EP2007/059407
Authority: WO
Inventors: Achim Zipse; Andreas Block; Pauline Weise; Martin Schlun
Original assignee: Angiomed Gmbh & Co. Medizintechnik Kg
Priority date: 2006-09-07
Filing date: 2007-09-07
Publication date: 2008-03-13
Also published as: EP2063824A2; WO2008028964A3; EP2063824B1; US8500793B2; US20100004725A1

Abstract

Preferred embodiments of an implantable medical device with a high degree of flexibility is shown and described. One aspect includes an implantable stent (100) having an intermediate portion (14) with a helical winding and first (10) and second (12) end portions. The implantable stent further includes a coupling portion (15) with a helical winding, and bridges (26a) joining struts of defining the helical windings. The stent also includes a paddle (19a) providing a bridge (18a) joining the ends of the helical windings. Another aspect relates to a radially self-expansible stent with a plurality of radiopaque markers (20a) attached to it. The markers are shaped and located at the stent end such that the compressive stress exerted on the end.annulus of the stent during release of the stent is shared between the markers and the inflection zones that do not carry a marker.

Description

HELICAL IMPLANT HAVING DIFFERENT ENDS

RELATED APPLICATIONS

[0001] This application claims benefit of priority to U.S. Provisional Patent Application No, 60/842,853 filed September I₁ 2006 which is incorporated by reference in its entirety.

BACKGROUND

[0002] It is known in the medical field to utilize an implantable prosthesis to support a duct or vessel in a mammalian body. One such prosthesis may include a frame-like structure. Such frame-like structures are commonly known as a "stent", "stent-graft" or "covered stent." These structures are referred to collectively herein as a "stent", "implant", or an "implantable prosthesis."

[0003] The srent or prosthesis can be utilized to support a duct or vessel in the mammalian body that suffers from an abnormal widening (e.g., an aneurysm, vessel contraction or lesion such as a stenosis or occlusion) , or an abnormal narrowing (e.g., a stricture) . Stents are also utilized widely in the urethra, esophagus, biliary tract, intestines, arteries, veins, as well as peripheral vessels. The stent can be delivered via a small incision on a host body. Hence, the use of stents as a minimally-invasive surgical procedure has become widely accepted.

[0004] Previously developed stents for use in the biliary, venous, and arterial systems have been of two broad classes: balloon-expanded and self-expanding. In both of these classes, stents have been made by different techniques, including forming from wire and machining from a hollow tube. Such machining can be done by photo-chemical etching, laser- cutting, stamping, piercing, or other material-removal processes. Other manufacturing techniques have been proposed, such as vacuum or chemical deposition of material or forming a tube of machined flat material, but those "exotic" methods have not been widely commercialized. [0005] One common form of stent is configured as a series of essentially identical rings connected together to form a lattice-like framework that defines a tubular framework. The series of rings may or may nor have connecting linkages between the adjacent rings. One example does not utilize any connecting linkages between adjacent rings as it relies upon a direct connection from one ring to the next ring. It is believed that more popular examples utilize connecting linkages between adjacent rings, which can be seen in stent products offered by various companies in the marketplace . [0006] Ail of the above stent examples utilize a biocompatible metal alloy (e.g., stainless steel, Nitinol or Elgiloy) . The most common metal alloy utilized by these examples is Nitinol, which has strong shape memory characteristics so that the Nitinol self-expands when placed in the duct or vessel of a mammalian body at normal body temperature. In addition to self-expansion, these stents utilize a series of circular rings placed adjacent to each other to maintain an appropriate longitudinal spacing between each rings. Other examples are shown and described in U.S. Patent Publications 2004/0267353 and 2003/055485, and U.S. Patent No. 5,824,059. Examples which use a helical configuration are shown and described, to identify a few, in U.S. Patent Nos. 6,117,165; 6,488,703; 6,042,597; 5,906,639; 6,053,940; 6,013,854; 6,348,065; 6,923,828; 6,059,808; 6,238,409; 6,656,219; 6,053,940; 6,013,854; and 5, 800, 456. Examples that utilize a combination of helical and circular frameworks are shown and described in U.S. Patent Publications 2005/00033410; 2004/0158314; 2004/0158308; 2004/0186556, U.S. Patent Nos . 6,969,402; 6,190,406, and WO 01/89421. Ail of the cited documents are hereby incorporated by reference in their entireties into this application. [0007] A need is recognized for an implantable prosthesis device that maintains the patency of a vessel with the ability to adapt to the tortuous anatomy of the host by being highly flexible while being loadable into a delivery catheter of sufficiently small profile and easily deliverable to a target site in the vessel or duct by having the ability to navigate tortuous ducts or vessels.

BRIEF SUMMARY OF THE INVENTION

[0008] Accordingly, the present invention relates to various improvements of the structure of an implantable stent that embody a helical winding.

[0009] One aspect includes an implantable stent. The implantable stent includes an intermediate portion, first end portion, second end portion, and a coupling portion. The intermediate portion has a first continuous helical winding defining a plurality of circumferential sections circumscribing a longitudinal axis from a first end to a second end to define a portion of essentially a tube. The circumferential sections are spaced apart along the longitudinal axis. Each circumferential section has undulations disposed about a portion of the tube. The first end portion is disposed proximate the first end and has a second continuous helical winding that circumscribes a portion of the longitudinal axis. The second continuous helical winding has undulations of increasing lengths. The second end portion is disposed proximate the second end and has undulations that circumscribe the longitudinal axis to define a ring or a hoop. The coupling portion connects the second end portion to the intermediate portion and having a third continuous helical winding that circumscribes a portion of the longitudinal axis.

[0010] In another aspect of the implant stent, the stent includes a tubular intermediate portion defining a first helical winding and a longitudinal axis, a tubular end portion defining a different second helical winding and disposed adjacent to an end of the intermediate portion, and a paddle disposed adjacent to the end portion. The intermediate and end portions include a plurality of struts and bridges, with each strut having an end connected to an end of an adjacent strut, each bridge connected to an end of a strut, and the intermediate and end portions each having an end strut disposed proximate to an end of each helical winding. The paddle has a length and opposing ends disposed parallel to the longitudinal axis, an end of the paddle connected to a paddle strut connected to a paddle bridge, and one of the end struts connected to the paddle bridge. The stent can also have another one of the end struts connected to the paddle bridge, and at least one of the plurality of struts connected to the paddle bridge. The stent can also have another one of the end struts connected to the paddle strut, or another one of the end struts connected to the paddle. The stent can also have a ring portion disposed adjacent to the end portion, and another tubular end portion disposed at an opposing end of the intermediate portion that can define a third helical winding different from the first and second helical windings. The stent can also have another ring portion disposed adjacent to the another tubular end portion. The stent can also have another tubular end portion disposed at an opposing end of the intermediate portion, and a ring portion disposed adjacent to the another tubular end portion .

[0011] A method of delivering an implantable stent to a site in a vessel is provided. The method can be achieved by: providing an implantable stent in a delivery tubing that defines a longitudinal axis extending through the tubing and stent from a proximal end to a distal end and moving the tubing relative to the distal end of the stent. The implantable stent includes an intermediate portion having undulations circumscribing about and along the longitudinal axis to define a first continuous helical winding; a distal end portion having undulations circumscribing about and along the longitudinal axis to define a second continuous helical winding; a proximal end portion having undulations circumscribing the longitudinal axis to define an annular winding; and a coupling portion having undulations circumscribing about and along the longitudinal axis to define a third continuous helical winding. [0012] These and other embodiments, features and advantages will become apparent to those skilled in the art when taken with reference to the following more detailed description of preferred embodiments of the invention in conjunction with the accompanying drawings that are first briefly described,

BRIEF DESCRIPTION OF THE DRAWINGS

[0013] The accompanying drawings, which are incorporated herein and constitute part of this specification, illustrate exemplary embodiments of the invention, and, together with the general description given above and the detailed description given below, serve to explain the features of the invention .

[0014] FIG. IA illustrates an embodiment of a helical type implantable stent in a truncated side view, with only the foreground structures shown and the rearward structures omitted for clarity.

[0015] FIG. 13 is a schematic side view of the structure of the implantable stent of Figure IA.

[0016] FIG. 1C is a perspective view of another embodiment of the stent of Figure IA, with a plane bisecting the stent so that only foreground structures are illustrated for clarity.

[0017] FIG. ID is a perspective view of yet a further embodiment of the stent of Figure 1C, with a plane bisecting the stent so that only foreground structures are illustrated for clarity.

[0018] FIG. IE is a perspective view of another embodiment of the stent of Figure 1C, with a plane bisecting the stent so that only foreground structures are illustrated for clarity.

[0019] FIG. IF is a perspective view of another embodiment of the stent of Figure 1C, with a plane bisecting the stent so that only foreground structures are illustrated for clarity. [0020] FIG. 2 is a close-up view of a portion of one end of the stent of Figure IA in an unexpanded and unrolled configuration.

[0021] FIG. 3 is a close up view of a portion of the other end of the stent of Figure IA in an unexpanded and unrolled configuration .

[0022] FIG. 4 is a close up view of a portion of the end of the stent of Figure 2 in an expanded configuration.

[0023] FIG. 5A illustrates a portion of an end of the stent of Figure 3 in an expanded configuration.

[0024] FIG. 5B illustrates a variation of the end portion of Figure 5A.

[0025] FIG. 5C illustrates a variation of the end portion of Figure 5A.

[0026] FIGS. 5D-5G are schematic views of the end portion of Figure 5A illustrating variations of the interconnection between one helical winding having undulations of varying length to a helical winding having undulations of substantially constant length.

[0027] FIG. 6A illustrates the stent of Figure IA mounted in a delivery system.

[0028] FIG. 6B illustrates the stent of Figure IA mounted in a delivery system just prior to delivery of the stent via relative movement of the stent and an outer sheath.

[0029] FIGS. 7A and 7B are close-up views of alternatives to Figure 4.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS [0030] The following detailed description should be read with reference to the drawings, in which like elements in different drawings are identically numbered. The drawings, which are graphical representations and not necessarily to scale, depict selected embodiments and are not intended to limit the scope of the invention. The detailed description illustrates by way of example, not by way of limitation, the principles of the invention. This description will clearly enable one skilled in the art to make and use the invention, and describes several embodiments, adaptations, variations, alternatives and uses of the invention, including what is presently believed to be the best mode of carrying out the invention .

[0031] As used herein, the terms "about" or "approximately" for any numerical values or ranges indicate a suitable dimensional tolerance that allows the part or collection of components to function for its intended purpose as described herein. Also, as used herein, the terms "patient", "host" and "subject" refer to any human or animal subject and are not intended to limit the systems or methods to human use, although use of the subject invention in a human patient represents a preferred embodiment. [0032] Figures 1A-7B are graphical representations of various embodiments of the stent or its components, and a delivery system. Referring to Figures IA and IB, an implantable stent 100 is shown having a first end 5 and a second end 7 with first end portion 10, second end portion 12, an intermediate portion 14 and a coupling portion 15. The intermediate portion 14 includes a continuous helical winding 16. The winding 16 has a plurality of circumferential sections 17 that circumscribes a longitudinal axis 8 (with the continuation of each circumferential section shown in dashed lines in Figure IA) from the first end 5 to the second end 7 so as to define a portion of essentially a tube . The circumferential sections 17 are spaced apart along the longitudinal axis 8. Each circumferential section is disposed approximately 360 degrees about the longitudinal axis 8. Although only one helical winding 16 is shown, more that one helical winding can be used. For example, a helical winding with a first helical angle 13 with respect to the longitudinal axis 8 can be connected or coupled with another helical winding that has a different second helical angle. [0033] The stent 100 includes at least one bridge 18 configured to connect one circumferential section 17 to an adjacent axially spaced circumferential section 17. The bridge 18 extends generally circumferentially on a plane generally orthogonal with respect to the longitudinal axis 8. That is, the bridge 18 forms a circumferential connector or bridge member (i.e., "circumferential bridge") between circumferential sections 17 of the helical winding 16. Preferably, there is a plurality of bridges 18 interconnecting the circumferential sections 17. The stent 100 includes a plurality of struts 28, with some ends of two adjacent struts 28 engaging at a vertex 26. As shown in Figure IA, certain vertices 26a connect to the bridges 18. [0034] Variations of the stent 100 are possible but are not limited by the examples provided by the preferred embodiments. For example, in the stent 120 illustrated in Figure 1C (with a plane bisecting the stent so that only foreground structures are illustrated) , the stent 120 may have less than six paddles 19a and 19b and the cross- sectional areas of struts 28 {with the cross-section taken in a plane orthogonal to the axis 8} can be of different values. In Figure 1C, the cross-sectional area of paddle struts 28a for stent 120 are larger than any other struts 28. In Figure ID, stent 140 can be provided without struts 28 in the second end portion 12. In Figure IE, for stent 160, the struts 28 can be used between the paddles 19a in the first end portion 10 to form an annular ring 23 similar to an annular ring 22 at the second end portion 12. In all of the variations for the stent 100, the cross-sectional area of each strut 28 of the end portions 10, 12, or 15 can be less than the cross- sectional area of each strut 28 of the intermediate portion 14 so as to provide for lower radial force, increased flexibility or a combination of both characteristics. Alternatively, the cross-sectional area of each strut 28 for each portion 10, 12, 14, or 15 can be altered so as to provide similar or varying radial force (i.e., a force developed by the structural framework radially away from the longitudinal axis 8) to support a lumen extending throughout the entire stent.

[0035] Referring back to Figures IA and 1C, the first and second end portions 10 and 12 are provided with dissimilar structural frameworks. Referring to Figures 2 and 3, respectively, the first end portion 10 includes paddles 19a while second end portion 12 includes paddles 19b which have a different shape. In Figures 2 and 4, first end portion 10 includes struts 28 with undulations 30 having increasing strut 28 lengths in the direction of the longitudinal axis 8

(in the unexpanded stent) , The first end portion 10 is tied to the circumferential section 17a of intermediate portion 14 via bridges 18 with a connection strut 28b that connects the beginning of the undulations 30 of the first end portion 10 to the initial portion of circumferential section 17a (Figs. IA, 2, and 4) . In other embodiments, there can be from one to ten struts 28 between every two bridges 18 depending on the flexibility desired in the first end 5, which can be increased with a lesser number of struts 28 between every two bridges 18 or decreased with a greater number of struts 28 between every two bridges 18. In the preferred embodiments, there are ten struts 28 between every two bridges 18 in the first end portion 10. In another preferred embodiment, there are four struts 28 disposed between every two bridges 18. The circumferential width of each strut 28 is preferably generally constant over the longitudinal length of the strut 28. The flexibility of the struts 28 in the first end 5 can be varied by varying the circumferential width or length of some struts 28. Moreover, the placement of the bridges 18 can also be utilized to vary the flexibility of the first end 5 such as, for example, by varying the distance between or the number of struts 28 disposed between the bridges 18 joining adjacent circumferential sections 17. The struts 28 of the first end portion 10 can also be utilized to connect the paddles 19a.

[0036] Referring to Figure 3, the second end 7 is provided with two portions, second end portion 12 and coupling portion 15. The coupling portion 15 is provided with a connection strut 28c that ties the beginning of the coupling portion 15 to the second end portion 12 and the intermediate portion 14. The connection strut 28c is preferably a generally linear segment that ties both the intermediate portion 14 to the coupling portion 15. In the preferred embodiments, the connection strut 28c is generally diametrically opposed to the connection strut 28b. It is also preferable that the undulations 30 in coupling portion 15 include a plurality of struts 28 that extend in various lengths along the longitudinal axis 8 (in the unexpanded stent) . In the preferred embodiments, there are ten struts 28 between every two bridges 18. In another preferred embodiment, there are four struts 28 between every two bridges 18. In other embodiments, there can be from one to ten struts 28 between every two bridges 18 depending on the flexibility desired in the second end 7, which can be increased with a lesser number of struts 28 between every two bridges 18 or decreased with a greater number of struts 28 between every two bridges 18. The circumferential width of each strut 28 preferably generally constant over the longitudinal length of the strut 28. The flexibility of the struts 28 in the second end 7 can be varied by varying the circumferential width or length of some struts 28. Moreover, the placement of the bridges 18 can also be utilized to vary the flexibility of the second end 7 such as, for example, by varying the distance between or the number of struts 28 disposed between the bridges 18 joining adjacent circumferential sections 17. The struts 28 of the second end portion 12 are utilized to connect the paddles 19b.

[0037] In the preferred embodiments, the undulations 30 are formed by generally linear struts 28, which are coupled to a vertex 26 of a strut 28 pair, which are deformed during expansion and compression of the stent. The undulations can have a sinusoidal shape, a zig-zag shape, form waves of varying amplitudes, or form waves of varying displacements, and combinations of these shapes. An extended portion 26a is formed the vertices 26 that are joined together with a bridge 18, so that deformations in the struts 28 connected to the vertex 26, resulting from the expansion or compression of the stent, do not fully transmit to the bridge 18, as illustrated in Figs. 2 and 3. The stent can be made, for example, Nitinol, weak shape memory metals (e.g., stainless steel, platinum, Elgiloy) , shape memory polymers, bioresorbable metals and polymers. Preferably, the stent is a Nitinol self-expanding stent of an approximately 6 mm fully-expanded diameter, the bridge 18 is approximately 100 microns wide (in the direction the longitudinal axis 8), approximately 200 microns thick (radial to the longitudinal axis 8), and approximately 130 microns long (in the circumferential direction) . The struts 28 connecting to each bridge 18 shown in Figures IA, 2, and 3 are preferably approximately 90 microns wide (in the circuraferential direction), approximately 200 microns thick (radial to the longitudinal axis 8), and approximately 1500 microns long (in the direction of the longitudinal axis 8 in the unexpanded configuration) .

[0038] Referring to Fig. 2, if the distortions of the stent are large enough, there can be interference between or overlapping of the markers 20. These distortions may arise during manufacture of the stent or when the pre-form of a self-expanded stent is expanded to its final size. Similar distortions may arise when a finished stent is compressed for insertion into a delivery system, or when the stent is in place in vivo but held in a partially-compressed shape by the anatomy .

[0039] As provided for herein, the distortions of the stent at the ends 5 and 7 may be reduced or virtually eliminated. Specifically, a connecting structure formed by an annular ring 22 in the second end portion 12 is provided for the second end 7 in Figure 5A that includes a series of struts 28 and vertices 26 (similar to the struts 28 and vertices 26 in the intermediate portion 14) that are connected between adjacent paddles 19b in order to present reactive forces to resist expansion and compression of the struts. The connection of the struts 28 to the outer end 29 of the paddles 19b provides a leverage that maintains the longitudinal alignment of the paddles 19b while presenting radial compressive and expansion forces similar to that of the struts 28 in the intermediate portion 14. The struts 28 of uhe second end portion 12 are cut into the stent pre-form at the same time that the strut and bridge pattern for the rest of the stent is cut, typically using a laser cutting apparatus or by a suitable forming technique (e.g., etching or EDM) . The struts 28 of the second end portion 12 tend to hold the paddles 19b (which may be coupled to markers 20) and their extensions in parallel or generally in longitudinal alignment when the stent pre-form is expanded during the manufacturing process. Strain relief portions 21 can be provided to allow for movement of the struts 28 during expansion.

[0040] Once the stent pre-form has been expanded, sacrificial struts (not shown) existing in the stent pre-form between facing vertices 26 of adjacent circumferential sections 17 may be either removed or left in place to form part of the finished stent. If it is desired to remove the sacrificial struts, then the sacrificial struts may be designed with notches or other weakening features where the sacrificial struts are attached, so that the sacrificial struts may be easily removed by cutting or breaking them at the connecting point.

[0041] Alternatively, the sacrificial struts may be designed so that they remain part of the stent. In this case, there would be no artificially weakened points. After the stent pre-form is expanded, the final manufacturing operations would be completed, including cleaning, heat- treating, deburring, polishing, and final cleaning or coating. The resulting stent may then have the sacrificial struts in place as an integral part of the stent structure. [0042] In the embodiment shown in Figures 2 and 3, the markers 20 are approximately 620 microns wide (in the circumferential direction) and approximately 1200 microns long (in the longitudinal direction). Most preferably, the markers 20 are unitary with the paddles 19a and 19b, are generally rectangular in configuration, and may have the inside surface of each marker 20 curved to conform to the tubular inner surface of the helical winding 16. Alternatively, the markers 20 can be joined by welding, bonding, soldering or swaging to portions or ends of the paddles 19a/19b. In a further alternative, materials may be removed from either the luminal or ablurninal surface of the paddles 19a/19b to provide a void, and a radiopaque material can be joined to or filled in the void. The markers 20 may be mounted at the end of paddles 19a/19b. The struts 28 joining the paddles 19a/19b may Include struts that are approximately 80 microns wide (in the circumferential direction) and approximately 1500 microns long (In the longitudinal direction) . In the embodiment of Figures 3 and 5C, there are six struts 28 between two adjacent paddles 19b or markers 20. Preferably, the rectangular marker 20 may have a longitudinal length extending generally parallel to the longitudinal axis 8 and a circumferential width that is greater than two times the circumferential width of any strut 28. In one embodiment, the circumferential width of at least one strut 28 is approximately 65 microns and the circumferential width of the at least one strut 28 is approximately 80-150% of a width of a bridge 18 (in the direction of the longitudinal axis 8) . In an alternative embodiment illustrated in Fig, IF, a portion of paddles 19a or 19b can be removed and substituted with a stepped marker 20a or an angled marker 20b, or a marker of another geometry, with the marker 20a or 20b engaging the paddle 19a or 19b with a weld or another bonding technique. Alternatively, the paddles 19a or 19b can remain at their original lengths with only the ends modified to accept engagement with markers 20a or 20b, or extended to a longer length to engage markers 20a or 20b. [0043] In an alternative embodiment, the annular ring 22 includes from two to eight struts 28 (instead of six as in the other embodiment) of approximately 90 microns wide (in the circumferential direction) and approximately 2000 microns long (in the direction of longitudinal axis 8) . It should be noted that the more than four struts 28 can be utilized such as, for example, when no marker 20 is used or only a minimal number of markers 20 are needed. The markers 20 in the embodiments are approximately 620 microns wide (in the circumferential direction) and approximately 1200 microns long (in the direction of the longitudinal axis 8) , and are mounted on paddles 19a/19b that are approximately 200 microns wide (in the circumferential direction) and approximately 2000 microns long (in the direction of the longitudinal axis 8) . Preferably, the stent 100, in the form of a bare stent, can be manufactured from Nitinol tubing having a wall thickness of approximately 200 microns and an approximately 1730 micron outside diameter, and is designed to have an approximately 6 mm finished, expanded, and unimplanted outside diameter.

[0044] There are variations of the second end 7 of the stent 100. As shown in Figure 5A, the connecting strut 28c

(illustrated in Fig. 3) is eliminated so that there is one connection from the first end strut 28d and there is no direct connection from a terminal connecting strut 28e of the coupling portion 15 to the circumferential section 17b as in Figure 5C. In contrast, as shown in Figure 5C, the strut 28f is tied to both the circumferential section 17b of the intermediate portion 14 and the first end strut 28d of the coupling portion 15.

[0045] In yet another alternative arrangement, illustrated in Figure 5B, connecting strut 28f remains as in Figure 5C while the first end strut 28d is deleted. In this embodiment, the connection strut 28f is connected to the connection strut 28g and the paddle 19b by bridge 18a.

[0046] As can be seen in Figures 5A-5C, the helical winding 16 of the coupling portion 15 is initially a short end strut 28 of the second end 7. The helical winding 16

(starting with the short strut) progressively increases in length in the direction of axis 8 as the winding 16 undulates

(e.g., zig-zags about the longitudinal axis 8). As the winding 16 of coupling portion 15 progressively increases to fill in a gap between the second end portion 12 and the helical winding 16 of the intermediate portion 14, the winding 16 terminates while also coupling the second end portion 12 to the intermediate portion 14 without kinking or interference during loading or expansion. Multiple configurations provide for achievement of this result, [0047] A first configuration is illustrated in Figure 5A . In this configuration, a short segment, strut 28d, is directly connected to a long segment, strut 28e, while the initial helical winding 16 of the intermediate portion 14 is connected to a vertex 26 of two struts 28 via a bridge 18. [0048] A second configuration is illustrated in Figure 5B. In this configuration, a long strut, strut 28 f, is directly connected to the first strut 28i of the intermediate portion 14. At the same time, a long strut 28f is connected to a short strut, strut 28g via bridge 18a.

[0049] A third configuration is illustrated in Figure 5C. In this configuration, a long strut, strut 28f, is connected to both the first strut 28i of the intermediate portion 14 and a short strut, strut 28d, of the helical winding 16 of the coupling portion 15.

[0050] Other configurations to connect the helical winding 16 (of coupling portion 15) to the initial winding (circumferential section 17b of the intermediate portion 14) can be provided. For example, as shown in Figures 5D-5G, there are additional configurations available. In Figure 5D, a short strut 28h and a long strut 28e of the winding 16 for coupling portion 15 are connected to the first strut 28i of the intermediate portion 14 via two unequal length struts 28j. In Figure 5E, instead of two unequal length struts 28j, there are three unequal length struts 28k. In Figures 5F and 5G, two unequal length struts 28m can be connected with short bridges 18b.

[0051] The same configurations and alternatives illustrated and described with regard to the second end 7 can also be applied to the first end 5 of the stent to connect the helical winding 16 of the intermediate portion 14 (which has undulations of generally constant lengths along the longitudinal axis 8) to the winding of the first end portion 10 (which has undulations of varying lengths along the longitudinal axis 8).

[0052] Figures 7A and B illustrate alternative arrangements of the first end 5 illustrated in Figure 4. As illustrated, the first end 5 includes struts 28 between the paddles 19a to form an annular ring 23 similar to the annular ring 22 at the second end portion 12. As also illustrated, an initial strut 28n at the beginning of first end portion 10 is connected to a middle portion of a long strut 28o. Long strut 28o also connects to strut 28p of the first end portion 10 and to a first strut 28q of the intermediate portion 14 at the circumferential section 17a. Features identical to other embodiments are not identified again but can be altered with these end configurations . The same configurations and alternatives illustrated and described with regard to the first end 5 can also be applied to the second end 7 of the stent .

[0053] Regardless of the end (first end 5 or second end 7) utilized for the stent, the stent can be delivered using at least the following method. Initially, the stent 100 is compressed and loaded into a delivery sheath 200, illustrated in Fig. 6A. The sheath 200 includes a flexible tubular end cone 202 that allows for the end 202a of the end cone 202 (Fig. 6A) to be distorted or enlarged towards a tubular form illustrated in Fig. 6B. To implant the stent 100, the delivery sheath 200 is transported over a guide wire 204 to the target site. Markers 20 mounted on the paddles 19 of the stent 100 or delivery sheath 200 allows for radiographic location of the delivery sheath 200 and stent 100. Once at the target site, the stent 100 is moved relative to the sheath 200 in the direction of arrow 201. In other words, the stent 100 can be pushed out by a boss portion 206 that engages the second end portion 12 of the stent 100 or the sheath 200 (not shown) can be pulled back so that the end cone 202 is flared over a tulip portion 208. Continued relative movement in the direction of the arrow 201 allows the stent 100 to be delivered outside of the sheath 200. [0054] Bio-active agents can be added to the stent {e.g., either by a coating or via a carrier medium such as resorbable polymers) for delivery to the host vessel or duct. The bio~active agents can also be used to coat the entire stent. A coating can include one or more non-genetic therapeutic agents, genetic materials and cells and combinations thereof as well as other polymeric coatings. [0055] Non-genetic therapeutic agents include anti- thrombogenic agents such as heparin, heparin derivatives, urokinase, and PPack (dextrophenylalanine proline arginine chloromethylketone) ; anti-proliferative agents such as enoxaprin, angiopeptin, or monoclonal antibodies capable of blocking smooth muscle cell proliferation, hirudin, and acetylsalicylic acid; anti-inflammatory agents such as dexamethasone, prednisolone, corticosterone, budesonide, estrogen, sulfasalazine, and mesalamine; antineoplastic/antiproliferative/anti-miotic agents such as paclitaxel, 5-fluorouracil, cisplatin, vinblastine, vincristine, epothilones, endostatin, angiostatin and thymidine kinase inhibitors; anesthetic agents such as lidocaine, bupivacaine, and ropivacaine; anti-coagulants, an RGD peptide-containing compound, heparin, antithrombin compounds, platelet receptor antagonists, anti-thrombin anticodies, anti-platelet receptor antibodies, aspirin, prostaglandin inhibitors, platelet inhibitors and tick antiplatelet peptides; vascular ceil growth promotors such as growth factor inhibitors, growth factor receptor antagonists, transcriptional activators, and translational promotors; vascular cell growth inhibitors such as growth factor inhibitors, growth factor receptor antagonists, transcriptional repressors, translational repressors, replication inhibitors, cell cycle inhibitors and activators inhibitory antibodies, antibodies directed against growth factors, bifunctional molecules consisting of a growth factor and a cytotoxin, bifunctional molecules consisting of an antibody and a cytotoxin; cholesterol-lowering agents; vasodilating agents; cytostatic or cytotoxic and agents which interfere with endogenous vascoactive mechanisms. [0056] Genetic materials include anti-sense DNA and anti- sense RNA as well as other molecules working via the same mechanism of transcriptional or translational inhibition or activation. Genetic material also include (sense) DNA or (sense) RNA or equivalents thereof coding for Genes to replace defective or deficient endogenous molecules or increase their amount or stability, or encode for non- endogenous or endogenous modified molecules with biological effects. Genetic material also includes nucleic acids affecting Gene expression or other cellular mechanisms by other ways than described above . Such Genetic materials could be organized "naked, " packed with supporting molecules or in form of viruses or other vectors . Genes and their expression affected by above Genetic materials include but are not restricted to: tRNA or rRNA angiogenic factors including growth factors such as acidic and basic fibroblast growth factors, vascular endothelial growth factor, epidermal growth factor, transforming growth factor alpha and beta, platelet-derived endothelial growth factor, platelet-derived growth factor, tumor necrosis factor alpha, hepatocyte growth factor and insulin like growth factor, cell cycle inhibitors and activators including CD inhibitors, thymidine kinase ("TK") and other agents useful for interfering with cell proliferation, transcription factors, translation factors, the family of bone morphogenic proteins ("BMP's"), BMP-2, BMP-3, BMP-4, BMP-S, BMP-6 (Vgr-1), BMP-7 (OP-I), BMP-8, BMP™ 9, BiMP-IO, BMP-I, BMP-12, BMP-13, BMP-14, BMP-15, and BMP-lβ. Desirable BMP ' s are any of BMP-2, BMP-3, BMP-4, BMP-5, BMP-β and BMP-7. These dimeric proteins can be provided as homodimers , heterodimers, or combinations thereof, alone or together with other molecules. Alternatively or, in addition, molecules capable of inducing an upstream or downstream effect of a BMP can be provided. Such molecules include any of the "hedgehog" proteins, or the DNAs encoding them,

[0057] Cells can be of human origin (autologous or allogeneic) or from an animal source (xenogeneic) , genetically engineered if desired to deliver proteins of interest at the deployment site. The cells may be provided in a delivery media. The delivery media may be formulated as needed to maintain cell function and viability. [0058] Suitable polymer materials as a coating or the base material may include polycarboxylic acids, cellulosic polymers, including cellulose acetate and cellulose nitrate, gelatin, polyvinylpyrrolidone, cross-linked polyvinylpyrrolidone, polyanhydrides Including maleic anhydride polymers, polyamides, polyvinyl alcohols, copolymers of vinyl monomers such as EVA, polyvinyl ethers, polyvinyl aromatics, polyethylene oxides, glycosaminoglycans, polysaccharides including cellulose, chitin, dextran, polyesters including polyethylene terephthalate, polyacrylamides , polyethers, polyether sulfone, polycarbonate including tyrosine-derlved polycarbonate, polyalkylenes including polypropylene, polyethylene and high molecular weight polyethylene and poly (butylene terephthalate) (PBT), halogenated polyalkylenes including polytetrafluoroethylene, polyurethanes, polyorthoesters, proteins (including fibrin und casein), polypeptides, silicones, slloxane polymers, polylactic acid (PLA), polyglycolic acid (PGA), poly (lactide- co-glycolide) (PLGA) polycaprolactone, polydioxanone, poly{g- ethyl glutamate) , poly(DTH iminocarbonate) , poly (blsphenol A iminocarbonate) , poly(ortho ester), polycyanoacrylate, and polyphosphazene, polyhydroxybutyrate valerate and blends and copolymers thereof, coatings from polymer dispersions such as polyurethane dispersions (for example, BAYHDROL® fibrin, collagen and derivatives thereof, polysaccharides such as celluloses, starches, dextrans, alginates and derivatives, hyaluronic acid, squalene emulsions. Polyacrylic acid is particularly desirable. [0059] The preferred stents may also be used as the framework for a vascular graft. Suitable coverings include nylon, collagen, PTFE and expanded PTFE, polyethylene terephthalate, KEVLAR® polyaramid, and ultra-high molecular weight polyethylene. More generally, any known graft material may be used including synthetic polymers such as polyethylene, polypropylene, polyurethane, polyglycolic acid, polyesters, polyamides, their mixtures, blends and copolymers .

[0060] Preferably, some or all of the bridges may be bio- resorbed while leaving the undulating strut configuration essentially unchanged. In other embodiments, however, the entire stent can be resorbed in stages by a suitable coating over the resorbable material. For example, the bridges can resorb within a short time period after implantation, such as, for example, 30 days. The remaining helical stent framework (made of a resorbable material such as metal or polymers) can thereafter resorb in a subsequent time period, such as, for example, 90 days to 2 years from implantation. [0061] Markers 20 can be provided for all of the embodiments described above. The marker 20 can be formed from the same material as the stent 100 as long as the material is radiographic or radiopaque. The marker material can also be formed from gold, tantalum, platinum for example. One or more markers 20 can be formed from a marker material different from other markers.

[0062] The stents described herein can be, with appropriate modifications, delivered to an implantation site in a host with the delivery devices such as, for example, those shown and described in U.S. Patent Publication Nos. 2005/0090890 or 2002/0183826, and U.S. Patent Nos. 6,939,352 or 6, 866, 669.

[0063] In addition to the tubular shape of the stent described in the illustrated embodiments, the framework of the stent can also be shaped to have different tubular sections with different outer diameters, to have a tubular section coupled to a conic section, or to have a single cone. The struts of the stent can be wire-like members, and have cross-sections that are circular, rectangular, square, or polygonal .

[0064] Even though various aspects of the preferred embodiments have been described as self-expanding, Nitinol stents suitable for use in the common bile duct or superficial femoral artery, it should be apparent to a person skilled in the art that features of the illustrated embodiments can be applied to self-expanding stents of all sizes and made from any suitable material. Further, such stents can be applied to any body lumen where it is desired to place a structure to maintain patency, prevent occlusive disease, or for other medical purposes, such as to hold embolization devices in place. Further, the features described in the embodiments can be applied to balloon- expanded stents made from malleable or formable materials and intended to be expanded inside a suitable body lumen. The features described in the embodiments can also be applied to bare metal stents, stents made from other than metallic materials, stents with or without coatings intended for such purposes as dispensing a medicament or preventing disease processes, and stents where some or all of the components (e.g., struts, bridges, paddles) of the stents are biodegradable or bio-resorbable .

[0065] The embodiments use the example of a 6 mm self- expanding stent, but can be applied with equal merit to other kinds of stents and stents of other sizes. Specifically, stents for use in peripheral arteries are customarily made in outer diameters ranging from 3 mm to 12 mm, and in lengths from 10 mm to 200 mm. Stents of larger and smaller diameters and lengths can also be made accordingly. Also, stents embodying the features of the embodiments can be used in other arteries, veins, the biliary system, esophagus, trachea, and other body lumens.

[0066] Self-expansible stent matrices must satisfy rigorous failure testing procedures which prompts designers to optimize stress levels throughout the matrix of struts of the stent. The struts are beams that undergo bending stresses. Thus, stress optimization results in struts exhibiting modulated transverse cross-sectional areas along the length of each strut, but struts will generally all look much the same, in terms of shape, width and thickness (at least when they are all much the same length) . [0067] Occasional oversized struts or "paddles" would be seen as a negative design feature in that, for no good reason, they prevent the strut designer from maximizing the ratio of diameters in the radially compressed and expanded configurations of the stent. For any particular starting tube of stent material, the more paddles in the circumference, the less will be the ultimate working diameter to which the stent can be radially expanded.

[0068] However, the penalty of a smaller ultimate diameter might be tolerable if the paddles provide such a useful positive function that the loss of diameter is a worthwhile sacrifice. One such positive function is to provide a radiopaque marker function. Another is to provide an attachment edge, within the thickness of the stent matrix annulus, for a marker of more radiopaque material than the material of the stent matrix, as such.

[0069] Thus, from the paddle concept we can progress to an additional contribution to the art, namely a self-expansible stent with radiopaque markers that can be described as follows. This further invention relates to a radially self- expansible stent with a plurality of radiopaque markers attached to at least one of its ends .

[0070] Vascular stents are commonly used for the treatment of various vessel diseases. They are implanted transluminally using a catheter delivery system, to advance them to a stenting site, where they expand in order to widen the clogged or narrowed blood vessel. During the implantation procedure, the exact position of the stent within the vessel is monitored, mainly using X-ray imaging techniques. In order to ensure accurate placement, a good visibility of the stent is crucial. In general, this is achieved by attaching suitable markers which are made from materials with a radiopacity larger than that of the stent material. In addition, these markers have to be sufficiently large to provide a good X-ray contrast . For a precise determination of the stent position during delivery, it is advantageous to place the markers at both ends of the stent. [0071] A tubular stent with a plurality of radiopaque markers attached to selected inflection zones around its circumference is disclosed m WO-A-2002 /015820. The markers are spoon-shaped in a way that almost a complete ring of marker material is formed m the radially compressed state of the stent, providing a particularly high level of radiopacity during transluminal delivery. Thereby, an increase m visibility to radiation is achieved without any increase m the wall thickness of the stent at the position of the markers, maintaining a large radial opening for fluid flow as well as a small cross-sectional profile. Ideally, the number of markers in such a ring of markers as described above is to be kept small, so that each marker is large enough to facilitate sufficient visibility even m the radially expanded state of the stent. Furthermore, the number of marker/inflection zone joints should be kept at a minimum m order to redαce the risk of loss of a marker m the body following failure of such a joint after the stent has been placed .

[0072] For the case of self-expansible stents, delivery to the narrowed portion of the blood vessel is performed with the use of a co-axial catheter delivery system. Hereby, the stent is kept in its radially compressed state by an outer sheath. A co-axial cylinder inside the sheath is used for displacing the stent axially, relative to the outer sheath. Once the stent has been placed at the desired position within the vessel, the outer sheath is withdrawn while the inner cylinder pushes against one end of the compressed stent, precipitating the release of the stent from the delivery system. This procedure can impose on a stent such as the one disclosed in WO-A-2002/015820 stresses concentrated on the radiopaque markers which protrude axially beyond the axial end of the matrix of struts of the stent annuiυs. This stress, concentrating at the joints between the markers and the inflection zones from which they are cantilevered has been identified as a feature than can and should be reduced or even eliminated.

[0073] The main objective of the present further invention is to provide a self-expansible stent with radiopaque markers attached to it that offers a high degree of mechanical stability during release of the stent from the delivery system while maintaining a good visibility upon exposure to radiation. This aim is achieved by a self-expansible stent with the technical features of claim 96. Preferred embodiments of the further invention follow from subclaims 97-112.

[0074] The present further invention provides a radially self-expansible stent with two end annuli for delivery by a co-axial catheter delivery system. The end annulus to be pushed during release of the stent has a plurality of spaced inflection zones distributed in its circumference, some of which carry a radiopaque marker. The idea is to get all the inflection zones to share the release stresses, not just the ones that carry a radiopaque marker. In general, the term "inflection zone" as used herein refers to a region where two or more strut ends are connected or where two or more struts intersect. It is, however, not restricted to this interpretation. A large number of different strut patterns are being used, or have at least been proposed, for tubular stents. Each of these patterns will have points which define an end to the stent tube and which allow for the attachment of a marker. Our definition of the term "inflection zone" is such that these end points are included.

[0075] The radiopaque markers are shaped and located on the selected inflection zones such that the compressive stress exerted on the end annulus during release of the stent is shared between the markers and the inflection zones that do not carry a marker. In this way_r the strain on the marker/inflection zone joints is minimised, reducxng the risk °f physical damage, such as breakage or deformation. This concept is applicable to any stent design and allows for the use of only a small number of markers while the stability of tπe stent is secured. Keeping the number of markers at a minimum has significant advantages. First, having fewer marker/inflection zone joints reduces the danger of severed or bent markers. Self-expansible stents are extremely elastic but nevertheless not invulnerable to distortion. Fatigue performance is of vital importance with vascular stents, which flex with every heartbeat. Any stress that a stent matrix suffers locally, that exceeds the maximum planned for in the Government regulatory fatigue-testing protocol cap- adversely affect the fatigue life of the stent. This fact emphasizes the importance of a robust stent design, since even the slightest damage to the joints occurring during the release of the stent may shorten the service life of the stent. Furthermore, the circumference of the ring formed by the ensemble of markers in the radially compressed state of tne stent is limited by the circumference of the stent tube itself. Thus, keeping the number of markers small allows for larger marker sizes and consequently an improved visibility of the stent m the radially expanded state. [0076] So-called "ring stents" exhibit a plurality of rings arranged along their axial length which are interconnected between ring ends and have a plurality of inflection zones distributed in the circumference of the ring ends. In one embodiment, each of these ring ends comprises more inflection zones than the end annulus of the stent . Since, in the radially compressed state, the stent has a homogeneous circumference throughout its structure, the circumference of the end annulus of the stent will be the same as that of the ring ends, despire comprising less inflection zones. Therefore, the circumferential extent of the inflection zones that carry a marker can be increased, allowing for the attachment of larger markers, which is advantageous for reasons of visibility as discussed above. Even more space for the markers can be created within the end annulus of the stent if the inflection zones of the end annulus of the stent that do not carry a marker have a smaller circumferential extent than the inflection zones distributed in the circumference of the ring ends. Therefore, the above arrangement facilitates a possible increase in marker size without changing the number of inflection zones of the stent rings which may affect the mechanical properties of the stent, such as stability and elasticity. [0077] A further way of creating more space for the markers within the end annulus of the stent is given in another preferred embodiment, where the inflection zones of the end annulus of the stent that do not carry a marker have a larger axial length parallel to the long axis of the stent than the inflection zones distributed in the circumference of the ring ends.

[0078] Preferably, the markers are bonded to the inflection zones at a glue interface, more preferably, by a weld. The form of the weld is hereby determined by the shape and the size of the marker.

[0079] In a preferred embodiment, the inflection zones that carry a marker differ in shape, size or both shape and size from the inflection zones that do not carry a marker. The inflection zones that carry a marker may, for example, have a smaller size so as to leave more space for the attached markers or a shape particularly suited for a certain type of weld (depending on the shape and size of the marker) . In one embodiment, each inflection zone is present as a stem with an axial length parallel to the long axis of the stent. Preferably, the inflection zone stems that carry a marker have a smaller length than the inflection zone stems that do not carry a marker. This arrangement allows for the accommodation of portions of the markers (or even whole markers) between the neighbouring longer inflection zones. [0080] Preferably, the markers and the inflection zones have the same thickness but markers with a greater radial thickness are not excluded. On the one hand, an increase in marker thickness beyond the stent annulus wall thickness is not desirable, since a large radial opening for fluid flow as well as a small cross-sectional profile of the stent ought to be maintained. On the other hand, both the radiopacity and the mechanical properties of the markers depend on their thickness. Consequently, too thin a marker will give a poor contrast when exposed to radiation and may be prone to deformation or even breakage.

[0081] In a preferred embodiment, each marker subtends a larger arc of the circumference of the end annulus than each inflection zone that does not carry a marker, improving the visibility of the stent ends.

[0082] A number of different materials may be used for the fabrication of the stent and the radiopaque markers of this further invention. Preferably, the stent is made from a nickel titanium shape memory alloy. Such an alloy provides the mechanical properties necessary for reliable stent operation, namely a high degree of elasticity and physical stability. The radiopaque markers are preferably made from tantalum, gold, or a ternary alloy made from nickel, titanium and a third, radiopaque metal. All these metals offer a high level of radiopacity. Both the above stent and marker materials are non-toxic and provide a good biological compatibility with the human body. For nickel titanium stents, markers of tantalum are of special interest because their electrochemical potentials are so similar. [0083] In another preferred embodiment, the markers do not extend axially beyond the inflection zones which do not carry a marker, in the radially compressed state of the stent. This arrangement can be accomplished, for example, by making the inflection zones that carry a marker shorter than the ones that do not carry a marker. Preferably, during release of the stent from the delivery system, the markers and the inflection zones which do not carry a marker are both in physical contact with the pushing part of the delivery system, i.e., the co-axial inner cylinder. In such a configuration, the compressive stress exerted on the end annulus during release of the stent is shared between the markers and the inflection zones without markers, minimising the risk of physical damage to the stent. A marker size large enough for excellent visibility can still be maintained by choosing a small number of inflection zones in the end annuius of the stent and by making the inflection zones that carry a marker sufficiently short.

[0084] In another preferred embodiment, portions of the periphery of the markers rest on the neighbouring inflection zones in the radially compressed state of the stent, such that the compressive stress exerted by the delivery system on the markers during release of the stent is delivered to the neighbouring inflection zones by the markers. Preferably, in this configuration the markers stand axially proud of the inflection zones that do not carry a marker. In this configuration, an increase in marker size can be achieved, while the distribution of the applied pressure between markers and inflection zones without markers is still maintained.

Brief Description of the Further Drawings

[0085] FIG. 8 shows a laser cutting of a stent with radiopaque markers attached to it, according to a firsi: further preferred embodiment;

[0086] FIG. 9 shows one end of a laser cutting of a stent with radiopaque markers attached to it, according to a second further preferred embodiment; and

[0087] FIG. 10 shows a portion of the end annulus in the radially expanded state of the stent, according to a second further preferred embodiment .

Detailed Description of Further Preferred Embodiments [0088] Figure 8 shows a laser cutting of a radially self- expansible stent 410 made from Nitinol with radiopaque markers 414 made from Tantalum attached, according to a first further preferred embodiment. The markers 414 are welded to the inflection zones 412' and extend as far as the inflection zones that do not carry a marker 412. In this way, the compressive stress exerted on the end annulus 411 during release of the stent is shared between the markers 414 and the inflection zones that do not carry a marker 412. The stent comprises four interconnected rings 416 with fourteen inflection zones 412'' in the circumference of each ring end. In contrast to this, the end annuli 411, 411' only have twelve inflection zones 412, 412'. This allows for a larger circumferential extent of the inflection zones 412' and the markers 414 attached thereto since the circumferential extenc of the inflection zones 412 is identical to that of the inflection zones 412''. In addition to this, the axial length of inflection zones 412 is larger than that of inflection zones 412' ' , allowing for longer markers. Thus, the present embodiment is specifically designed for accommodating large markers 414 in order to optimise the visibility of the stent 410.

[0089] Figure 9 shows one end of a laser cutting of a stent 410 made from Nitinol with radiopague markers 414 made from Tantalum attached to it, according to a second further preferred embodiment. The markers 414 are welded to the inflection zones 412' and stand axialiy proud of the inflection zones 412 that do not carry a marker 414. As can be seen, the shape of inflection zones 412' is adapted in order to allow for a robust welded connection with marker 414 and differs significantly from that of inflection zones 412. The increased circumferential extent of inflection zones 412' as compared to inflection zones 412 is facilitated by the difference in the number of inflection zones 412, 412', 412'' between the ends of rings 416 and the end annulus 411, analogous to the first preferred embodiment. Furthermore, inflection zones 412 have grooves 418 at their top ends which are shaped to accommodate the peripheral portions of the T- shaped markers 414 in the radially compressed state of the stent 410. In this way, despite the fact that during the release of the stent 410 only the markers 414 are in physical contact with the pushing part of the delivery system, the compressive stress exerted on the markers is shared between the markers and the neighbouring inflection zones. The present configuration allows for the accommodation of particularly large irarkers 414 while at the same time maintaining the stability of the stent 410. Figure 10 shows a portion of the end annulus 411 in the radially expanded state of the stent 410, according to the present embodiment. Here, the grooves 418 are more clearly visible.

[0090] While the invention has been described in terms of particular variations and illustrative figures, those of ordinary sκill m the art will recognize that the invention is not limited to the variations or figures described. In addition, where methods and steps described above indicate certain events occurring m certain order, those of ordinary skill m the art will recognize that the ordering of certain steps may be modified and that such modifications are in accordance with the variations of the invention. Additionally, certain of the steps may be performed concurrently m a parallel process when possible, as well as performed sequentially as described above. Therefore, to the extent there are variations of the invention, which are wi thin the spirit of the disclosure or equivalent to the inventions found m the claims, it is the intent that tnis patent will cover those variations as well. Finally, all publications and patent applications cited in this specification are herein incorporated by reference m their entirety as if each individual publication or patent application were specifically and individually put forth αerein .

Claims

ClaimsWhat is claimed is:

1. An implant, comprising: a tubular intermediate portion defining a first helical winding and a longitudinal axis; a tubular end portion defining a different second helical winding and disposed adjacent to an end of the intermediate portion; and a paddle disposed adjacent to the end portion, the intermediate and end portions including a plurality of struts and bridges, each strut having an end connected to an end of an adjacent strut, each bridge connected to an end of a strut, the intermediate and end portions each having an end strut disposed proximate to an end of each helical winding, and the paddle having a length and opposing ends disposed parallel to the longitudinal axis, an end of the paddle connected to a paddle strut connected to a paddle bridge, one of the end struts connected to the paddle bridge.

2. The implant of claim 1, another one of the end struts connected to the paddle bridge.

3. The implant of claim 2, at least one of the plurality of struts connected to the paddle bridge.

4. The implant of claim 1, another one of the end struts connected to the paddle strut.

5. The implant of claim 1, another one of the end struts connected to the paddle.

6. The implant of claim 1, the paddle having a circumferential width that is greater than a circumferential width of the paddle strut.

7. The implant of claim 1, the paddle having a circumferential width that is greater than a circumferential width of one of the plurality of struts.

8. The implant of claim 1, the paddle strut having a length disposed parallel to the longitudinal axis.

9. The implant of claim 1, the implant having a first configuration defining a first outer diameter and a second configuration defining a different second outer diameter.

10. The implant of claim 1, the implant further comprising a ring portion disposed adjacent to the end portion.

11. The implant of claim 10, the implant further comprising another tubular end portion disposed at an opposing end of the intermediate portion.

12. The implant of claim 11, the another tubular end defining a third helical winding different from the first and second helical windings.

13. The implant of claim 11, the implant further comprising another ring portion disposed adjacent to the another tubular end portion.

14. The implant of claim 1, the implant further comprising another tubular end portion disposed at an opposing end of the intermediate portion.

15. The implant of claim 14, the implant further comprising a ring portion disposed adjacent to the another tubular end portion.

16. The implant of claim 1, the paddle including a radiopaque marker.

17. The implant of claim 1, wherein the end strut of the end portion includes a generally linear portion that connects the end portion to the intermediate portion.

18. The implant of claim 1, wherein the end strut of the another end portion includes a generally linear portion that connects the another end portion to the intermediate portion .

19. The implant of claim 18, wherein the end strut of the another end portion connecting to the intermediate portion also connects to another end strut of the another end portion .

20. The implant of claim 1, wherein the first helical winding of the intermediate portion defines a plurality of circumferential sections disposed along the longitudinal axis, the intermediate portion including at least one bridge configured to connect one circumferential section to an adjacent axially-spaced circumferential section, the at least one bridge extending on a plane generally orthogonal with respect to the longitudinal axis.

21. The implant of claim 20, wherein the first helical winding of the intermediate portion includes a bridge strut connected to the at least one bridge, the bridge strut having a length greater than a length of at least one of the plurality of struts of the intermediate portion.

22. The implant of claim 11, another paddle disposed proximate the opposing end of the intermediate portion.

23. The implant of claim 13, another paddle disposed proximate the ring portion disposed adjacent to the another tubular end portion.

24. The implant of any one of claims 1-23, wherein the first helical winding can have undulations defining at least one of a sinusoidal shape, a zig-zag shape, a wave shape of varying amplitude, and a wave shape of varying displacements.

25. The implant of any one of claims 1-24, wherein the second helical winding can have undulations defining at least one of a sinusoidal shape, a zig-zag shape, a wave shape of varying amplitude, and a wave shape of varying displacements.

26. The implant of any one of claims 1-25, wherein the first helical winding has a longitudinal winding width that increases circumferentially .

27. The implant of any one of claims 1-25, wherein the second helical winding has a longitudinal winding width that increases circumferentially.

28. The implant of claim 12, wherein the third helical winding has a longitudinal winding width that increases circumferentially .

29. The implant of any one of claims 1-27, wherein at least one bridge has a longitudinal width greater than a circumferential width of the plurality of struts of the first helical winding.

30. The implant of any one of claims 1-29, wherein the first helical winding comprises a plurality of individual helical windings connected to each other.

31. The implant of any one of claims 1-30, wherein at least one paddle is a rectangular marker having a length extending generally parallel to the longitudinal axis and a width greater than two times the circumferential width of at least one of the plurality of struts.

32. The implant of any one of claims 1-31, wherein a circumferential width of at least one strut is approximately 65 microns.

33. The implant of claim 32, wherein the circumferential width of the at least one strut is approximately 80% to 130% of a longitudinal width of a bridge .

34. The implant of claim 33, wherein an outer diameter of the implant is approximately 2-12 millimeters.

35. The implant of claim 34, wherein a longitudinal length between opposing end struts of at least one of the first helical winding and the second helical winding is approximately 20-200 millimeters.

36. The implant of any one of claims 1-35, wherein a number of the plurality of struts disposed in one circumferential section is between 24 and 58.

37. The implant of any one of claims 1-36, wherein a first number of struts between any two bridges in a first circumferential direction along the first helical winding of the intermediate portion is equal to a second number of struts between any two bridges in a second circumferential direction opposite to the first circumferential direction.

38. The implant of claim 37, wherein the first number is selected from a group consisting of 3, 5, 7, and 9, and the second number is selected from a group consisting of 3, 5, 7, and 9.

39. The implant of claim 38, wherein the first and second numbers are equal to five.

40. The implant of any one of claims 1-37, wherein a first number of struts disposed between any two bridges in a first circumferential direction along τ;he first helical winding of the intermediate portion is not equal to a second number of struts disposed between any two bridges in a second circumferential direction opposite to the first circumferential direction.

41. The implant of claim 40, wherein the first number is selected from a group consisting of 3, 5, 7, and 9, and the second number is selected from a group consisting of 3, 5, 7, and 9.

42. The implant of claim 41, wherein the first number is equal to five and the second number is equal to seven.

43. The implant of claim 42, wherein the first number is equal to three and the second number is equal to five,

44. The implant of any one of claims 1-37, wherein a number of struts between any two bridges along the second helical winding is at least one number selected from a group consisting of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20.

45. The implant of any one of claims 1-44, wherein the paddle includes a marker comprising a radiopaque material disposed in a recess of the paddle.

46. The implant of any one of claims 1-45, wherein the a radiopaque material is connected to the paddle.

47. An implant system comprising: an implant including: an intermediate portion having undulations circumscribing about and along the longitudinal axis to define a first continuous helical winding; a distal end portion having undulations circumscribing about and along the longitudinal axis to define a second continuous helical winding; a proximal end portion having undulations circumscribing the longitudinal axis to define an annular winding; and a coupling portion having undulations circumscribing about and along the longitudinal axis to define a third continuous helical winding; and a delivery device including: an outer tubular member that surrounds the implant, the outer tubular member having a terminal end; an inner tubular member that a guide wire is to be inserted therethrough; and a boss portion disposed in the outer tubular member and contiguous to the proximal end portion of the implant.

48. A method of delivering an implant to a site in a vessel, the method comprising: providing an implant in a delivery tubing that defines a longitudinal axis extending through the tubing and implant from a proximal end to a distal end, the implant including: an intermediate portion having undulations circumscribing about and along the longitudinal axis to define a first continuous helical winding; a distal end portion having undulations circumscribing about and along the longitudinal axis to define a second continuous helical winding; a proximal end portion having undulations circumscribing the longitudinal axis to define an annular winding; and a coupling portion having undulations circumscribing about and along the longitudinal axis to define a third continuous helical winding; and moving the tubing relative to the distal end of the implant .

49. The method of claim 48, wherein the moving comprises pulling the tubing towards the proximal end of the implant .

50. The method of claim 48, wherein the pulling comprises preventing the proximal end of the implant from substantially moving in a proximal direction.

51. An implant, comprising: an intermediate portion having a first continuous helical winding defining a plurality of circumferential sections circumscribing a longitudinal axis from a first end to a second end to define a portion of essentially a tube, the circumferential sections being spaced apart along the longitudinal axis, each circumferential section having undulations disposed about a portion of the tube; a first end portion disposed proximate the first end, the first end portion having a second continuous helical winding that circumscribes a portion of the longitudinal axis, the second continuous helical winding having undulations of increasing lengths; a second end portion disposed proximate the second end, the second end portion having undulations that circumscribe the longitudinal axis to define a ring; a coupling portion that connects the second end portion to the intermediate portion, the coupling portion having a third continuous helical winding that circumscribes a portion of the longitudinal axis; and a paddle disposed adjacent to the end portion, the paddle having a length and opposing ends disposed parallel to the longitudinal axis, an end of the paddle connected to a paddle strut connected to a paddle bridge, at least one end strut of the intermediate portion connected to the paddle bridge .

52. The implant of claim 51, an end strut of the first end portion connected to the paddle bridge .

53. The implant of claim 52, at least one of a plurality of struts connected to the paddle bridge.

54. The implant of claim 51, an end strut of the coupling portion connected to the paddle bridge.

55. The implant of claim 54, at least one of a plurality of struts connected to the paddle bridge.

56. The implant of claim 51, the paddle having a circumferential width that is greater than a circumferential width of the paddle strut.

57. The implant of claim 51, the paddle having a circumferential width that is greater than a circumferential width of any one of a plurality of struts comprising the first, second, and third helical windings.

58. The implant of claim 51, wherein the second helical winding includes a generally linear strut that connects a short strut of the second helical winding to the first helical winding, the short strut having a longitudinal length relatively shorter than a longitudinal length of another strut of the second helical winding.

59. The implant of claim 51, wherein the third helical winding includes a generally linear strut that connects a long strut of the third helical winding to the first helical winding, the long strut having a longitudinal length relatively longer than a longitudinal length of another strut of the third helical winding.

60. The implant of claim 59, wherein the long strut segment connects to a relatively shorter strut of the third helical winding.

61. The implant of claim 51, wherein the intermediate portion includes at least one bridge configured to connect one circumferential section to an adjacent axially-spaced circumferential section, the at least one bridge extending on a plane generally orthogonal with respect to the longitudinal axis .

62. The implant of claim 61, wherein the undulations of the intermediate portion includes at least one strut connected to the bridge where the at least one strut has a longitudinal length greater than a longitudinal length of other struts of the intermediate portion that are not connected to the bridge.

63. The implant of claim 51, wherein the undulations of the first end portion are connected to the intermediate portion by at least one bridge having a substantial portion of its perimeter contiguous to a plane orthogonal to the longitudinal axis.

64. The implant of claim 51, further comprising a third end portion disposed proximate the first end, the third end portion having undulations that circumscribe the longitudinal axis to define a ring,

65. The implant of any one of claims 51-64, wherein the undulations are selected from a group consisting of a sinusoidal shape, a zig-zag shape, a wave shape of varying amplitudes, and a wave shape of varying displacements and combinations thereof.

66. The implant of any one of claims 51-64, wherein the third continuous helical winding has undulations of increasing lengths along the longitudinal axis.

67. The implant of any one of claims 51-64, wherein the helical windings and the bridges are in an expanded and unimplanted condition.

68. The implant of any one of claims 51-64, wherein the undulations comprise zig-zag struts.

69. The implant of claim 61, wherein the at least one bridge comprises a minimum width greater than a width of any strut that defines the undulations.

70. The implant of any one of claims 51-64, wherein the helical windings comprise a plurality of separate helical windings connected to each other.

71. The implant of claim 68, wherein the zig-zag struts comprise four generally linear members that extends oblique to the longitudinal axis to intersect each other at two vertices spaced apart circumferentially and axially, and the at least one bridge connects the strut proximate the vertex of the zig-zag strut of one circumferential section to the strut proximate the vertex of the zig-zag of the adjacent circumferential section.

72. The implant of any one of claims 51-64, wherein at least one generally rectangular marker is connected to a circumferential section proximate one of the first and second ends, the rectangular marker having its length extending generally parallel to the longitudinal axis and its width is greater than two times the width of any strut of the undulations .

73. The implant of any one of claims 51-72, wherein the width of at least one strut is approximately 65 microns.

74. The implant of claim 73, wherein a circumferential width of the at least one strut segment is approximately 80% to 130% of a longitudinal width of a bridge.

75. The implant of claim 74, wherein an outer diameter of the helical windings is between approximately 2 millimeters and approximately 12 millimeters.

76. The implant of claim 75, wherein a length from the first end to the second end of the helical windings is from approximately 20 millimeters to approximately 200 millimeters .

77. The implant of any one of claims 51-76, wherein a number of struts in one circumferential section of the helical windings are between 24 and 58.

78. The implant of any one of claims 51-76, wherein a first number of struts between any two bridges in a first direction along the helical winding of the intermediate portion is equal to a second number of struts between any two bridges in a second direction opposite the first along the circumferential section of the helical winding.

79. The implant of claim 78, wherein the first number is selected from a group consisting of 3, 5, 7, and 9, and the second number is selected from a group consisting of 3, 5, 7, and 9.

80. The implant of claim 79, wherein the first and second numbers are equal to five.

81. The implant of any one of claims 51-76, wherein a first number of struts between any two bridges in a first direction along the helical winding of a circumferential section for the intermediate portion is not equal to a second number of struts between any two bridges in a second direction opposite the first along the circumferential section of the helical winding.

82. The implant of claim 81, wherein the first number is selected from a group consisting of 3, 5, 7, and 9, and the second number is selected from a group consisting of 3, 5, 7, and 9.

83. The implant of claim 82, wherein the first number is equal to five and the second number is equal to seven.

84. The implant of claim 83, wherein the first number is equal to three and the second number is equal to five.

85. The implant of any one of claims 51-76, wherein a number of struts between any two bridges along the helical winding of at least one of the first portion and the coupling portion is selected from a group of number consisting of 1,

2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, and combinations of different numbers thereof.

86. The implant of claim 72, wherein the marker comprises a radiopaque material disposed in a recess of the paddle .

87. The implant of claim 72, wherein the marker comprises a radiopaque material connected to the paddle.

88. The implant of any one of claims 1-30, wherein the at least one paddle includes a marker having mating surface that engages a mating surface of the at least one paddle.

89. The implant of claim 88, the mating surfaces of the marker or the at least one paddle defining a stepped shape.

90. The implant of claim 88, the mating surfaces of the marker or the at least one paddle defining a plane orthogonal to the longitudinal axis .

91. The implant of claim 88, the mating surfaces of the marker or the at least one paddle defining a plane angled relative to the longitudinal axis.

92. The implant of any one of claims 51-64, wherein the at least one generally rectangular marker includes a mating surface that engages a mating surface of the paddle.

93. The implant of claim 92, the mating surfaces of the at least one generally rectangular marker or the paddle defining a stepped shape.

94. The implant of claim 92, the mating surfaces of the at least one generally rectangular marker or the paddle defining a plane orthogonal to the longitudinal axis.

95. The implant of claim 92, the mating surfaces of the at least one generally rectangular marker or the paddle defining a plane angled relative to the longitudinal axis,

96. A radially self-expansible stent having a thickness in the radial direction and an axial length between end annuli for delivery by a co-axial catheter delivery system, a part of which during release of the stent from the delivery system pushes on one end of the stent while withdrawing a sheath from around the abluminal surface of the stent, whereupon the stent expands from a radially compressed into a radially expanded state, the end annulus to be pushed having a circumference, with a plurality of spaced inflection zones being distributed in the circumference, selected inflection zones carrying a radiopaque marker,

characterised in that

the markers are shaped and located on the selected inflection zones such that the compressive stress exerted on the end annulus during release of the stent is shared between the markers and the inflection zones chat do not carry a marker.

97. A stent according to claim 96, wherein the stent comprises a plurality of rings arranged along its axial length, the rings being interconnected between ring ends and having a plurality of inflection zones distributed in the circumference of the ring ends, each of said ring ends comprising more inflection zones than the end annulus of the stent .

98. A stent according to claim 97, wherein the inflection zones of the end annulus of the stent that do not carry a marker have a larger axial length parallel to the long axis of the stent than the inflection zones distributed in the circumference of the ring ends.

99. A stent according to claim 97 or 98, wherein the inflection zones of the end annulus of the stent that do not carry a marker have a smaller circumferential extent than the inflection zones distributed in the circumference of the ring ends .

100. A stent according to any one of the preceding claims, wherein the markers are bonded to the inflection zones at a glue interface.

101. A stent according to any one of claims 96 to 99, wherein the markers are attached to the inflection zones by a weld .

102. A stent according to any one of the preceding claims, wherein the inflection zones that carry a marker are a different shape from the inflection zones that do not carry a marker.

103. A stent according to any one of the preceding claims, wherein the inflection zones that carry a marker are a different size from the inflection zones that do not carry a marker.

104. A stent according to any one of the preceding claims, wherein each inflection zone is present as a stern with an axial length parallel to the long axis of the stent, wherein the inflection zone stems that carry a marker have a smaller length than the inflection zone stems that do not carry a marker.

105. A stent according to any one of the preceding claims, wherein the markers and the inflection zones have the same thickness.

106. A stent according to any one of the preceding claims, wherein each marker subtends a larger arc of the circumference of the end annulus than each inflection zone that does not carry a marker.

107. A stent according to any one of the preceding claims, wherein the stent is made from a nickel titanium shape memory alloy.

108. A stent according to any one of the preceding claims, wherein the radiopaque markers are made from tantalum, gold, or a ternary alloy made from nickel, titanium and a third, radiopaque metal.

109. A stent according to any one of the preceding claims, wherein, in the radially compressed state of the stent, the markers do not extend axially beyond the inflection zones which do not carry a marker.

110. A stent according to any one of the preceding claims, wherein, in the radially compressed state of the stent, during release of the stent from the delivery system, the markers and the inflection zones which do not carry a marker are both exposed on the end annulus of the stent to receive directly a pushing force from the pushing part of the delivery system.

111. A stent according to any one of the preceding claims, wherein, in the radially compressed state of the stent, portions of the periphery of the markers rest on the neighbouring inflection zones such that the compressive stress exerted by the delivery system on the markers during release of the stent is delivered to the neighbouring inflection zones by the markers.

112. A stent according to claim 111, wherein the markers stand axially proud of the inflection zones that do not carry a marker.