WO2014072501A2

WO2014072501A2 - Endovascular stent grafts, stent, stent-in-stent system, and kit

Info

Publication number: WO2014072501A2
Application number: PCT/EP2013/073484
Authority: WO
Inventors: Bernhard Danner; Tomislav STOJANOVIC
Original assignee: Georg-August-Universität Göttingen Stiftung Öffentlichen Rechts Universitätsmedizin
Priority date: 2012-11-12
Filing date: 2013-11-11
Publication date: 2014-05-15
Also published as: WO2014072501A3; DE102012110861A1

Abstract

The invention relates in a first aspect to an endovascular stent graft, which comprises a one-piece stent. In a second aspect, the invention relates to an additional endovascular stent graft. In an additional aspect, the invention relates to a stent-in-stent system comprising the aforementioned endovascular stent grafts. In a fourth aspect, the invention relates to the use of one or both endovascular stent grafts and/or the stent-in-stent system for the treatment of aneurysms and/or in the event of vascular leakages. In another aspect, the invention relates to an endovascular stent that has at least one longitudinal end that is provided with fixing elements that are arranged peripherally at the longitudinal end. In a last aspect, the invention relates to a kit, comprising one of the two or both endovascular stent grafts according to the invention and the endovascular catheter according to the invention.

Description

Endovascular stent graft, stent, stent-in-stent system and kit

The present invention in a first aspect relates to an endovascular stent graft comprising a one-piece stent. In a second aspect, the application is directed to another endovascular stent prosthesis. In another aspect, the application is directed to a stent-in-stent system comprising the above endovascular stent prostheses. In a fourth aspect, the application is directed to the use of one or both endovascular stent grafts and / or the stent-in-stent system for the treatment of aneurysms and / or vascular leakage. In another aspect, the invention is directed to an endovascular stent and, in another aspect, to an endovascular catheter. In a final aspect, the invention is directed to a kit comprising one or both of the endovascular stent prostheses according to the invention and the endovascular catheter according to the invention.

Background Art Diseases of the aortic arch include atherosclerotic aneurysms, obliterative and dilated aortic dissections, perforating aortic ulcers and traumatic ruptures, latent events such as catheter procedures, but also genetic disorders (for example the Marfan syndrome) and infections (eg Treponema pallidum) Cause aortic aneurysms. However, the most common cause of aortic arch aneurysm is degenerative pathology of the vessels due to atherosclerosis. Aortic arch aneurysms, due to their location in proximal pathologies extending from the ascending aorta to the aortic arch, may be classified into pure aortic arch pathologies as well as distal aortic arch pathologies extending from the aortic arch to the descending aorta.

In the prior art it is known to implant endovascular stent grafts (also called endovascular stent grafts) into the affected vessels for the treatment of aneurysms. Particularly in multimorbid and elderly patients, endovascular aortic arch surgery with stent prostheses has been used successfully, since open surgery of the aortic arch without the use of the heart-lung machine and without cardiac arrest in deep hypothermia is impossible.

The complex anatomy of the thoracic aorta is currently a limiting factor in the endovascular delivery of aortic arch pathologies. On the one hand, the high interindividual variability of downstream vascular discharges, especially in the area of the thoracic aorta, limits the treatment of aortic arch pathologies with preformed, endovascular stent prostheses. On the other hand, often suitable landing zones for stent prostheses, that is, areas in which the ends of the stent grafts can be securely anchored without, for example, turn off branching arteries.

With regard to the problem of using endovascular stent prostheses despite high interindividual variability of downstream vascular discharges while maintaining the supply of these vessels, various approaches are known in the prior art:

Under stented stent prostheses are understood as having the side arms. The side arms are attached to outgoing vessels endovascular. The main indications for such stent prostheses are aneurysms, which cracks from outgoing vessels, for example in visceral vessels. However, a known problem with such stented stented prostheses is that the outgoing side arms can easily snap off in situ and then can no longer be probed by catheter and thus, in some circumstances, vessel occlusions can occur.

Chimney graft refers to a stent or stent graft inserted into an outgoing vessel, parallel to the aortic stent graft, and overhanging it in the lumen of the aorta. A disadvantage of large-lumen Chimney grafts, however, is that leaks (endoleaks), d. H. unwanted, persistent blood flow between vessel wall and stent graft due to insufficient sealing between the end of the stent graft on which the chimney graft is located and the vessel wall may occur.

Fenestrated stent grafts are understood to be those having preformed holes (fenestrations) to facilitate one or more vascular discharges in the stent graft. In particular, the exact individual planning and the design of such stent prostheses as well as their exact endovascular positioning are problematic. Furthermore, fenestrated stent prostheses, since they need to be customized, can not be used in emergency situations, but may require months of waiting time due to production constraints. DE 601 04 647 T2 describes a vascular graft for the treatment of aneurysms which, in addition to a section which has a one-piece stent, also comprises a stentless prosthesis section on the vascular graft. It is a partially gested vascular prosthesis, with only the distal part of the endovascular layer is provided, the nearest part replaced a portion of the aortic arch. US 2003/01 35257 A1 discloses a kit for supplying the aortic arch, wherein the ends of the vascular prosthesis may have stents. The proportion of prostheses in this vascular prosthesis is either completely stented or stentless.

With regard to the problem of suitable landing zones, DE 1 00 65 824 A1 discloses a stent which is suitable for implantation in the ascending branch of the aorta, whose stent body has a mesh structure and, in its middle section, a sheath which is impermeable to blood. A first longitudinal end of the stent body is adapted to the anatomical shape of the aortic root and has longitudinally extending, circumferentially distributed narrow in the circumferential direction fixing elements for fixing the first longitudinal end in the vessel wall of the aorta. The soft end of this partially covered endovascular stent is anchored above the heart valve, the coronary rostrums are not affected in their function, but an endovascular supply of the coronary arteries is also not provided.

The object of the present invention is to provide endovascular stent prostheses which, despite interindividual variability of downstream vessels, can also be used as an emergency and / or can be anchored in a suitable landing zone. In addition, an endovascular stent is to be provided which can achieve particularly good fixation and sealing, in particular in combination with endovascular stent prostheses. Furthermore, an endovascular catheter is to be provided, which is particularly suitable for use in combination with the endovascular stent prostheses according to the invention.

Brief Description of the Invention Presently, new endovascular stent prostheses are provided. The first stent prosthesis according to the invention, which is also known as a stent-in-stent system with the second stent prosthesis according to the invention can be implanted together, has the advantage that it is prefabricated and adapted intraoperatively to the individual anatomical conditions of the patient with regard to the vessel outlets found. Thus, it can also be used in emergency situations. The second endovascular stent prosthesis according to the invention offers the advantage that because of the fact that it can be placed in a hitherto medically not selectable landing zone, it is also possible to supply very close to the heart valve tears or aneurysms of vessel walls. The stent-in-stent system according to the invention comprising the first and the second stent prosthesis according to the invention offers the advantage of the simultaneous endovascular supply of the entire aortic arch, which is particularly advantageous in the case of extensive aortic arch pathologies. Furthermore, the invention relates to an endovascular stent, wherein the stent has at least one longitudinal end, which is provided with fixing elements, which are arranged circumferentially at the longitudinal end. The advantage of this stent according to the invention, which is particularly suitable for interacting with the stent prostheses according to the invention, is that it can achieve a particularly secure connection in the connection region, in particular to an endovascular stent prosthesis, but also to the body's own vessels.

Detailed description of the invention

An endovascular stent graft is hollow and longitudinal for the blood. It is also referred to as endovascular stent graft and has a stent and a prosthesis.

In a first aspect, the present invention relates to an endovascular stent prosthesis comprising a one-piece stent, wherein the stent prosthesis is partially stentless.

A stent is understood to mean medical implants which after implantation Hollow organs, such as blood vessels, should be kept open. They are used for example in vessels that are occlusive or bagged. These are usually structures that are tubular or tubular in the expanded state and often have a lattice, net or loop-like structure. In particular, such loops of metal alloys, for example, those with memory effect, such as Nitinol exist.

For example, the prosthesis for a stent may consist of a PET (polyethylene terephthalate, e.g., Dacron®) or PTFE (polytetrafluoroethylene, eg, GoreTex®) membrane. Basically, however, all materials are conceivable as a prosthesis material, which allow the function of the prosthesis, namely to be a blood-tight bridging of a vessel section or an entire vessel. In particular, those materials are suitable which can adapt as well as possible to the respective anatomical conditions (for example, vessel profiles, vessel shapes, such as extensions, etc.). Further preferably, it is provided that the prosthesis material can forward pulse waves as natural as possible, in particular materials which have an elastic restoring force suitable. In a particular embodiment, it is also provided that the prosthesis can consist of several different prosthesis materials, in particular a different material can be provided as prosthesis material for the stentless area of the stent prosthesis than for the rest of the stent prosthesis. In a further embodiment it is provided that the prosthesis material in the stentless area and in the remaining area of the prosthesis are identical.

Preferably, the prosthesis extends over the entire stent, i. in this embodiment, stent and prosthesis are congruent.

A stentless region is understood to mean that in this area the stent prosthesis is not supported by the stent, ie only the prosthesis is present at the relevant site. The stentless area extends continuously over 90% -1 0%, preferably over 80% to 20%, more preferably over 70% to 30%, especially over 60% to 40% of the length of the stent graft. Throughout, it is to be understood that in the stentless region of the endovascular stent prosthesis, the stent has a uniform, uninterrupted recess. Preferably, the stentless region is entirely within the region of the stent graft supported by the one-piece stent, ie, the one-piece stent has a recess for the stentless region. More preferably, the stentless region of the stent graft is nearly centered with respect to the stent.

The endovascular stent prosthesis in the simplest case consists only of stent and prosthesis. However, there is also provided an embodiment in which the stent prosthesis has an externa ßere layer of biocompatible adhesive. This embodiment has the advantage that the endovascular stent prosthesis can be fixed particularly securely in the vessel.

According to the invention, in the first endovascular stent prosthesis according to the invention, the stentless area extends over part of the circumference of the stent prosthesis. This means that the circumference of the stent graft is not completely formed solely by the prosthesis, but only partially. The advantage is that the stent prosthesis as a whole can fulfill its function as a vascular support.

Preferably, the portion of the circumference is stentless, between 1/8 and 1/3, more preferably between 1/6 and 1/4 of the circumference of the stent graft.

In one embodiment, the stentless region is a curved surface that is round or oval. This embodiment offers the advantage of a special stability of the stent prosthesis, since the respective ends of the Stent prosthesis have a stented area, ie are supported by the stent.

In another embodiment of this first endovascular stent prosthesis according to the invention, the stentless region of the stent prosthesis can be perforated by means of mechanical, physical and / or chemical methods. According to the invention, it is provided that the perforation of the stentless region of the endovascular stent prosthesis can take place after the endovascular stent prosthesis has been introduced into the vessel to be treated, ie in situ. The perforation of the stentless area offers the advantage of attaching important vessels anatomically flexible to the endovascular stent prosthesis. For example, in the treatment of the aortic arch by the first endovascular stent prosthesis according to the invention, the brachiocephalic trunk, the common carotid artery and the subclavian artery can be flexibly connected anatomically. The first endovascular stent prosthesis according to the invention can in principle also be used for the supply of other vessels, for example abdominal vessels.

Perforatable in the sense of this invention means that the perforation can take place in situ in such a way that the resulting recess is suitable for either directly attaching a vessel or for receiving a stent or a stent prosthesis. In particular, the resulting recess must not penetrate or change its shape so that a catheterization of the recess is not possible. The perforations are generated via a peripheral vessel by means of catheters.

In particular, the stentless region of the stent prosthesis is provided so that the perforation can be effected by means of heat. The perforation preferably takes place with the aid of the endovascular catheter according to the invention described below. After perforation in the stent-less area, after wire probing, stents, in particular the endovascular stent according to the invention described below, can either be introduced via the first endovascular stent prosthesis according to the invention or via peripheral arteries, for example via the brachial arteries, and anchored in the first endovascular stent prosthesis according to the invention.

As a variant, only one or two outlets of the aortic arch can be probed, the blood supply to the other vessels then takes place via open (surgical) bypasses.

Furthermore, depending on the extent of the extension or the tear of the vessel to be supplied, for example the aorta, still further, in particular inventive stent prostheses, are connected to the in situ placed stent prosthesis according to the invention until the pathology is completely switched off. For example, the complete aorta descendens thoracalis or the aorta abdominalis can be supplied with the respective vascular discharges. That is, extensions or aneurysms that affect the entire body artery (aorta) can be successfully treated endovascularly.

In a second aspect, the present invention relates to an endovascular stent graft wherein the stent graft comprises a heart valve. Advantageously, it is possible to place the second endovascular stent prosthesis according to the invention for supplying the large vessels leaving the heart, namely the ascending aorta or the pulmonary trunk, so that the pocket flap comes to lie in the area of the valve plane (i.e., in the annulus area).

For the second endovascular stent prosthesis according to the invention both biological as well as mechanical heart valves are provided. In particular, it is provided, depending on the artery to be supplied to provide an aortic or Pulmonalisklappe. Like the first stent prosthesis according to the invention, the second stent prosthesis according to the invention is hollow and continuous in the longitudinal direction for blood.

According to the invention, the second stent prosthesis has a first and a second longitudinal end, wherein the heart valve is arranged between these two longitudinal ends. The advantage is that the landing zone can be selected in the subvalvular area and the stent prosthesis anchored there. A landing zone is the area in which the ends of stents or stent grafts are anchored. Generally, it is provided according to the invention to adapt the dimensions of the stent prostheses, of the stent described below and of the heart valves used to the respective vessels to be supplied.

In a particular embodiment, the second stent prosthesis according to the invention has recesses for supplying the coronary arteries between one of the longitudinal ends and the heart valve. This embodiment allows a particularly secure fixation of the stent prosthesis while supplying the coronary arteries. In an advantageous embodiment, the recesses can accommodate stents, in particular the stent according to the invention or stent prostheses for supplying the coronary vessels.

In a particularly advantageous embodiment, the stent prosthesis on at least one longitudinal end, which is provided with fixing elements, which are arranged circumferentially at the longitudinal end, wherein in the expanded stent the fixation of the stent graft are bent outward Shen. Advantage of this embodiment is that by the bending of the Fixation elements, the endovascular stent prosthesis can be anchored particularly firmly.

With regard to the bending of the fixing elements from the stent prosthesis, it is provided that an angle between 20 ° and 1 60 ° is enclosed between fixing elements and stent prosthesis, preferably between 40 ° and 140 °, more preferably between 60 ° and 1 20 °. In particular, a wedge between 80 ° and 1 00 ° is provided. Due to the bending of the fixing elements, the endovascular stent prosthesis can be anchored particularly firmly, for example in the subvalvular region.

In particular, it is also provided that, in the case of the expanded stent prosthesis, the fixing elements are folded up and formed in a planar manner. In general, unfolding of the stent prostheses according to the invention and of the stent according to the invention described below takes place by elastic force. Both the stent prostheses according to the invention and the stent described below according to the invention are compressed on a carrier system. They unfold to a preconfigured form, for example, upon withdrawal of an envelope surrounding the stent prostheses or stent according to the invention, either by self-expansion or after balloon expansion. In this expansion, the fixing elements are unfolded in the described corresponding embodiment and then form a surface.

Due to the planar configuration of the unfolded fixing elements, a further fixation of the stent prosthesis by the prevailing blood pressure in the sense of a sailing effect. In a particular embodiment, it is provided that the necessary contact pressure can be controlled via the size of the planar fixing elements. In a further particular embodiment, body-compatible adhesives are provided on the planar fixing elements to increase the adhesion of the fixing, for example, to the underlying tissue on.

An embodiment is also provided in which the flat fixing elements have hooks. This embodiment is particularly suitable if the fixing elements can engage, for example, in soft, uncalcified tissue.

In a further advantageous embodiment, it is provided that in the expanded stent prosthesis, the fixing elements are arranged in a fan-like overlapping manner. By this type of arrangement, a particularly good sealing is achieved, so that no blood can get between and / or under the fixing, which could affect the adhesion of the fixing. In a further aspect, the invention is directed to a stent-in-stent system comprising the endovascular stent prostheses according to the invention. With the stent-in-stent system according to the invention it is possible to achieve a complete endovascular supply, in particular of the complete aortic arch, starting from the annulus area or the subvalvular areas of the pocket flaps.

In another aspect, the application is directed to the use of one or both of the inventive endovascular stent grafts and / or the inventive stent-in-stent system for the treatment of aneurysms and / or vascular leakage.

Aneurysms and / or vascular leakages may occur, for example starting from the aortic annulus and the coronary aortic arch of the ascending aorta, including the outflows of the coronary arteries and the aorta ascendens, the aortic arch - supplying the outgoing supra-aortic vessels (both carotid arteries and the left brachial artery) - until the beginning the descending part of the main artery (descending aorta) and possibly also the other parts of the descending aorta (descending thoracic and abdominal aorta). The principle of endovascular care is based on the introduction of the folded on a support system stent prosthesis on peripheral arteries or the apex (transapical). The stent graft is then released under X-ray control at the destination by withdrawal of a sheath or by pulling on a suture. The stent prosthesis, which has been configured to a specific external size, primarily holds at the place of destination by the applied radial force.

The second endovascular stent prosthesis according to the invention keeps in that the heart valve ring or, in a particular embodiment, the subvalvular structures can be used as the landing zone. After inserting the second endovascular stent prosthesis according to the invention, the aortic valve and the coronary vessels as well as the first part of the aorta are preferably supplied by stent prosthesis. Thereafter, or alone, the first stent prosthesis according to the invention can be used. If the first stent prosthesis according to the invention serves as an extension of the second stent prosthesis according to the invention, then this first stent prosthesis is attached to the end of the second stent prosthesis remote from the heart. This also holds by radial force, the distal end of this prosthesis can come to rest for example in the descending thoracic aorta.

In a further aspect, the invention is directed to an endovascular stent having at least one longitudinal end provided with fixing elements, which are arranged circumferentially at the longitudinal end. The endovascular stent according to the invention is characterized in that when expanded Stent the fixation elements from the stent to the outside Shen are angled.

The angulation of the fixation elements from the stent can be provided as a function of the angle at which the vessels supplied with this stent meet another vessel to which they are to be connected. In particular, it is provided that between the fixing elements and stent an angle between 20 ° and 1 60 ° is included, preferably between 40 ° and 1 40 °, more preferably between 60 ° and 1 20 °. In particular, an angle between 80 ° and 1 00 ° is provided. As a result of the angling of the fixing elements, the endovascular stent can be anchored particularly firmly, for example, in the perforated first stent prosthesis according to the invention.

In a preferred embodiment, the fixing elements are folded up in the expanded stent and they have a planar design. Due to the planar formation, a further fixation of the stent by the prevailing blood pressure in the sense of a sailing effect. In a particular embodiment, it is provided that the necessary contact pressure on the size of the planar fixing elements is controlled. In a further particular embodiment, it is provided to apply body-compatible adhesives to the planar fixing elements in order to further increase the adhesion of the fixing elements to, for example, the underlying first stent prosthesis according to the invention.

In a further preferred embodiment of the endovascular stent according to the invention, the fixing elements are arranged in a fan-like overlapping manner in the expanded stent. This type of arrangement is a special achieved good sealing, so that no blood can get between and / or under the fixing, which could affect the adhesion of the fixing. The use of the endovascular stent according to the invention can be carried out, for example, in conjunction with the first stent prosthesis according to the invention. However, the stent according to the invention can also be used successfully in connection with the second stent prosthesis according to the invention or with fenestrated or stented stent prostheses.

Furthermore, an endovascular catheter with a catheter tip is provided, wherein the catheter tip is designed such that it can cooperate with the endovascular stent prosthesis, which has the stentless area, ie with the first endovascular stent prosthesis such that in the stentless area of the stent prosthesis in situ, So if the stent prosthesis is already placed in the vessel, a perforation can be produced. In particular, it is provided to use protective sleeves, in particular to provide protective sleeves on the catheter in order to avoid damage to the tissue or the blood.

In another aspect, the present invention is directed to an endovascular catheter having a catheter tip, the catheter tip being heatable. In an advantageous embodiment, the catheter tip can be heated by means of electrical current. In a further advantageous embodiment, a heating device is provided for this, which is part of the catheter, for. B. a heating coil. In an advantageous embodiment, the inner lumen of the catheter for receiving a guide wire or, for example, a glass fiber serkabels, suitable. Also, a variant is provided in which a fiber optic cable is laser heated to allow perforation, particularly when the fiber optic cable is inserted into the inner lumen of the endovascular catheter.

By means of such a catheter, the perforation site, for example the perforation site intended to facilitate the supply of supra-aortic vessels, can be delivered via e.g. a retrograde access in the stentless area of the

Stent prosthesis can be selected according to the anatomical conditions. About the perforated point is then, for. B. by Seidinger technique, in particular another stent prosthesis, inserted and thus guarantees a vascular supply and increased stability.

In particular, it is provided that the heating takes place so that a

Protective sleeve is used to prevent or at least minimize damage to the blood by coagulation or by the release of pyrolysis products. Advantageously, the protective sleeve is placed around the point to be perforated. In another advantageous embodiment, it is provided to provide the protective sleeve on the catheter. In particular, the catheter tip is intended to be heated to temperatures between 280 ° C. and 380 ° C., preferably between 300 ° C. and 360 ° C., and moreover advantageously between 320 ° C. and 340 ° C. Advantageously, no toxic products are released at these temperatures during perforation. Alternatively, a chemical or mechanical perforation can take place.

For this purpose, an endovascular catheter with a catheter tip is provided, wherein the catheter tip can absorb a chemical substance, in particular in the form of a solution. Advantageously, the catheter tip to an element that can absorb in particular liquid on. The catheter tip is preferably made impregnable, in particular by the existing its a sponge. Particularly suitable chemical substances for chemical perforation are very strong reducing agents, such as solutions of alkali metals, for example sodium, in liquid ammonia or correspondingly strong oxidizing agents, eg. B. elemental fluorine provided.

Furthermore, an endovascular catheter with a catheter tip is provided, wherein the catheter tip has a cutting device for producing a perforation for the connection of a blood vessel. Advantageously, the recess produced by the cutting device is round or oval.

In a final aspect, the invention is directed to a kit comprising one or both of the endovascular stent prostheses according to the invention and the endovascular catheter according to the invention.

The invention will be further explained with reference to the figures and the preferred embodiments. These are intended to illustrate the invention, but not its limitation. Show it :

FIG. 1 shows a particular embodiment of the first endovascular stent prosthesis according to the invention;

FIG. 2 shows a perforation of the stentless region of the first endovascular stent prosthesis according to the invention from FIG. 1 with a particular embodiment of the endovascular catheter according to the invention;

Figure 3 - the perforated first endovascular invention

Stent prosthesis of Figure 1 with stented vessel branch;

Figure 4 - A particular embodiment of the endovascular stent according to the invention in a plan view from below, showing the angled fixing elements;

FIG. 5 shows a particular embodiment of the second endovascular stent prosthesis according to the invention;

Figure 6 - a particular embodiment of the invention

Stent-in-stent system comprising the first stent prosthesis according to the invention from FIG. 1 and the second stent prosthesis according to the invention from FIG. 5;

FIG. 7 shows a perspective view of the endovascular stent

Figure 4;

Figure 8 - A perspective view of the endovascular stent

Figure 7 in the folded state.

FIG. 1 shows a particular embodiment of the first endovascular stent prosthesis 1 according to the invention. The endovascular stent prosthesis has the stentless region 3, which in the embodiment shown a represents curved oval surface. The reference numeral 2 shows the area of the first endovascular stent prosthesis according to the invention, which is gestet tet, that is supported by the stent. FIG. 2 shows the moment of the perforation of the stentless region 3 of the endovascular stent prosthesis from FIG. 1 by means of a particular embodiment of an endovascular catheter 11 according to the invention.

FIG. 3 shows the perforated stentless region 3 with an embodiment of the stent 4 according to the invention.

FIG. 4 shows an advantageous embodiment of the stent 4 according to the invention from FIG. 3 in a view from below, which shows a plan view of the angled fixing elements 5. These are unfolded, have a planar design and overlap in a planar manner.

FIG. 5 shows a particular embodiment of the second endovascular stent prosthesis 6 according to the invention, which has a heart valve 8, coronary artery 9 (openings for supplying the coronary arteries) and a longitudinal end provided with fixing elements 5 which are arranged circumferentially at the longitudinal end, wherein the expanded one Stent prosthesis 6, the fixing elements 5 are angled outward Shen. In the expanded stent prosthesis 6 shown, the fixing elements 5 are folded up and have a planar design. FIG. 6 shows an embodiment of the stent-in-stent system 110 in situ, which consists of a first stent prosthesis 1 and a second stent prosthesis 6. The coronary nerves 9 of the second endovascular stent prosthesis 6 are supplied by stents 4 in the figure. FIG. 7 shows the stent 4 from FIG. 4 in a perspective view. Here, the fixing elements 5 can be seen particularly well, which in the embodiment shown overlap in a fan-shaped manner.

Figure 8 shows the stent 4 of Figure 7 in a perspective view but in a folded form, i. with externally applied fixing elements.

Claims

claims:

1 . Endovascular stent prosthesis (1) comprising a one-piece stent, characterized in that the stent prosthesis (1) is partially stentless (3) and the stentless region (3) extends over part of the circumference of the stent graft (1).

2. Endovascular stent prosthesis (1) according to claim 1, characterized in that the stentless region (3) of the stent prosthesis (1) can be perforated by means of mechanical, physical and / or chemical methods.

3. Endovascular stent prosthesis (1) according to any one of claims 1 or 2, characterized in that the perforation can be effected by means of heat.

4. Endovascular stent prosthesis (6), characterized in that the

Stent prosthesis (6) has a heart valve (8) and the stent prosthesis (6) has a first and a second longitudinal end and the heart valve (8) is arranged between these two longitudinal ends.

5. Endovascular stent prosthesis (6) according to claim 4, characterized in that the stent prosthesis (6) between one of the longitudinal ends and the heart valve (8) has recesses (9) for supplying the coronary arteries.

6. An endovascular stent prosthesis (6) according to claim 4 or 5, wherein the

Stent prosthesis (6) has at least one longitudinal end which is provided with fixing elements (5) which are arranged circumferentially at the longitudinal end, characterized in that in the expanded stent (6) the fixing elements (5) of the stent graft (6) to Au Shen are angled.

7. Endovascular stent prosthesis (6) according to one of claims 4 to 6, characterized in that in the expanded stent prosthesis (6) the fixing elements (5) are folded up and formed flat.

8. Endovascular stent prosthesis (6) according to one of claims 4 to 7, characterized in that in the expanded stent prosthesis (6), the fixing elements (5) are arranged like a fan overlapping.

9. Stent-in-stent system (10) comprising the endovascular stent prosthesis (1) according to claim 1 and the endovascular stent prosthesis (6) according to claim 4.

1 0. Use of the endovascular stent prosthesis according to claim 1

and / or the endovascular stent graft according to claim 4 and / or the stent-in-stent system (10) according to claim 9 for the treatment of aneurysms and / or in case of vascular leakage.

1 1. Endovascular stent (4) wherein the stent (4) has at least one longitudinal end which is provided with fixing elements (5) which are arranged circumferentially at the longitudinal end, characterized in that in the expanded stent (4) the fixing elements (5) from the stent ( 4) are angled to Au Shen.

1 2. Endovascular stent (4) according to claim 1 1, characterized in that the expanded stent (4), the fixing elements (5) are present unfolded and formed flat.

1 3. Endovascular stent (4) according to any one of claims 1 1 or 1 2, characterized in that the expanded stent (4), the fixing elements (5) are arranged like a fan overlapping.

14. Endovascular catheter (11) with a catheter tip, characterized in that the catheter tip is heated.

15. A kit comprising the endovascular stent prosthesis (1) according to claim 1

and / or the endovascular stent graft (6) according to claim 4 and the endovascular catheter (11) according to claim 14.