US20020049467A1 - Embolic protection system - Google Patents

Abstract

An embolic protection system1comprises a guidewire99for advancing through a vasculature, the guidewire99having a distal end and a proximal end; an embolic protection filter1having a filter body41with a distal end and a proximal end, the filter body41providing for a collapsed configuration and an expanded deployed configuration. The embolic protection filter body41has a guidewire path for slidably receiving the guidewire99to permit movement of the filter1relative to the guidewire99when the filter1is in the collapsed configuration and the expanded deployed configuration. A delivery catheter2is advanceable over the guidewire99for delivery of the embolic protection filter1; the delivery catheter2having a proximal end and a distal end. The filter1is deployed from the distal end of the delivery catheter2into the expanded deployed configuration. A retrieval catheter3is also advancable over the guidewire99for retrieval of the filter1, the retrieval catheter3having a distal end and a proximal end; and engagement elements for engaging the embolic protection filter1with the guidewire99for retrieval of the filter1into the retrieval catheter3in the collapsed configuration.

Description

RELATED APPLICATIONS
• This application is related to, and claims the benefit of, the following patent applications, namely: U.S. application Ser. No. 09/188,472 filed Nov. 9, 1998, which claims priority from Irish Patent Application No. 970789 filed on Nov. 7, 1997 and Irish Patent Application No. 980267 filed on Apr. 8, 1998; International Application No. PCT/IE00/00045 filed on Apr. 20, 2000; Irish Patent Application No. 2001/0255 filed on Mar. 16, 2001; Irish Patent Application No. 2001/0256 filed on Mar. 16, 2001; Irish Patent Application No. 2001/0259 filed on Mar. 16, 2001; and Irish Patent Application No. 2001/0263 filed on Mar. 16, 2001; all of which are hereby incorporated herein by reference in their entirety.[0001]
INTRODUCTION
• This invention relates to a transvascular embolic protection system for safely capturing and retaining embolic material released during an interventional procedure while maintaining blood flow.[0002]
• WO-A-99/23976 describes various embolic protection systems of this type. WO-A-99/51167 and WO-A-99/51166 describe delivery catheters for delivery of an embolic protection filter to a desired site in the vascular system. Various embolic filters are described in WO-A-00/67668), WO-A-00/67669 WO-A-00/67670 and WO-A-00/67671. A retrieval catheter for use with such embolic protection systems is described in WO-A-01/12082.[0003]
• There is an economical and clinical need to provide an improved embolic protection system which will be easy and convenient for a clinician to prepare for use, to deploy and to retrieve. In addition there is a need to provide such a system which will facilitate a wide range of clinical procedures to be carried out.[0004]
STATEMENTS OF INVENTION
• According to the invention there is provided an embolic protection system comprising:[0005]
• a guidewire for advancing through a vasculature, the guidewire having a distal end and a proximal end;[0006]
• an embolic protection filter having a filter body with a distal end and a proximal end, the filter body providing for a collapsed configuration and an expanded deployed configuration;[0007]
• the embolic protection filter body having a guidewire path for slidably receiving the guidewire to permit movement of the filter relative to the guidewire when the filter is in the collapsed configuration and the expanded deployed configuration;[0008]
• a delivery catheter advanceable over the guidewire for delivery of the embolic protection filter; the delivery catheter having a proximal end and a distal end, the filter being deployed from the distal end of the delivery catheter into the expanded deployed configuration;[0009]
• a retrieval catheter advancable over the guidewire for retrieval of the filter, the retrieval catheter having a distal end and a proximal end; and[0010]
• engagement elements for engaging the embolic protection filter with the guidewire for retrieval of the filter into the retrieval catheter in the collapsed configuration.[0011]
• In one embodiment of the invention the guidewire path is in isolation from the embolic material captured within the filter body.[0012]
• In a preferred case the tubular guidewire path is defined by a tubular sleeve. Ideally the tubular sleeve extends from the proximal end to the distal end of the filter. Desirably the guidewire path is a tubular guidewire path.[0013]
• In another embodiment the engagement elements comprise a guidewire engagement element on the guidewire and a filter engagement element on the filter, the engagement elements co-operating to provide selective engagement and positioning of the filter with respect to the guidewire. Preferably the engagement element of the guidewire comprises a guidewire abutment on the guidewire.[0014]
• The guidewire abutment may be located at the distal end of the guidewire.[0015]
• The guidewire abutment may be located proximal of the distal and of the guidewire.[0016]
• In a particularly preferred embodiment the engagement element of the filter comprises a filter abutment on the filter.[0017]
• The filter abutment may be a distal abutment on the filter.[0018]
• The filter abutment may be a proximal abutment on the filter.[0019]
• Most preferably the tubular guidewire path is defined by a sleeve and the filter abutment is provided by the sleeve.[0020]
• In another embodiment of the invention the engagement elements comprise releasable locking elements. Preferably the releasable locking elements comprise a taper lock. Ideally the guidewire engagement element comprises a locking ring on the guidewire and the filter engagement element comprises a tapered surface of the filter, the locking ring having a tapered surface which is engageable with the tapered surface of the filter to lock the filter to the guidewire. Most preferably the locking ring is a split ring.[0021]
• In another case the embolic protection system includes a tube advancable over the guidewire, the locking ring being located between a distal end of the tube and the filter for retrieval of the filter.[0022]
• Desirably the releasable locking means includes a tether engageable with the filter for retrieving the filter into the retrieval catheter.[0023]
• In a preferred embodiment the embolic protection system comprises deployment means for moving the collapsed filter relative to the distal end of the delivery catheter. Preferably the deployment means comprises a tube which is advancable over the guidewire for engagement with the proximal end of the filter, the tube being movable longitudinally relative to the delivery catheter for deployment of the filter from the distal end of the delivery catheter.[0024]
• In another embodiment the embolic protection system includes loading means for loading the filter into the delivery catheter. Ideally the loading means comprises a funnel having a narrowed portion disposed at the distal end of the delivery catheter and an enlarged portion for receiving a proximal portion of the filter in the expanded configuration, the filter being progressively collapsed as it is moved through the funnel for loading into the delivery catheter.[0025]
• In a further embodiment the embolic protection system includes engagement means for engaging the filter within the retrieval catheter. Preferably the engagement means comprises a frictional engagement between the filter body and an internal surface of the distal end of the retrieval catheter. Most preferably the engagement means comprises projections on the inner surface of the retrieval catheter adjacent the distal end thereof.[0026]
• In another preferred embodiment the delivery catheter includes an elongate slot disposed in a first sidewall thereof at a first distal location which is spaced a relatively longer distance from the proximal end of the delivery catheter than from the distal end of the delivery catheter, and wherein the inner deployment catheter includes an aperture disposed in a second sidewall thereof at a second distal location which substantially corresponds with said first distal location for said elongate slot, thereby permitting cooperative movement of said filter with respect to said guidewire and associated delivery and deployment catheters for selective deployment of the filter while facilitating the rapid exchange of said catheter and filter assembly over a guidewire without the utilisation of exchange wires or extension wires.[0027]
• The embolic protection filter may comprise a collapsible filter body, the proximal inlet end of the filter body having one or more inlet openings sized to allow blood and embolic material enter the filter body, the distal outlet end of the filter body having a plurality of outlet openings sized to allow through passage of blood but to retain undesired embolic material within the filter body. Ideally the filter comprises a collapsible filter support frame having a proximal end and a distal end, the filter support frame being movable between a collapsed position for movement during delivery through the vascular system and an extended outwardly projecting position to support the filter body in an expanded position thereby urging the filter body into apposition with the vasculature upon deployment. Most preferably the embolic protection system comprises a guide olive provided at the distal end of the filter body.[0028]
• Desirably the embolic protection system comprises an inner elongate sleeve to which the filter body and the filter support frame are mounted, the sleeve having a proximal end and a distal end, the guide olive extending distally of the sleeve distal end.[0029]
• the proximal end of the filter support frame and the inlet end of the filter body are preferably attached to the proximal end of the sleeve.[0030]
• The guide olive may be integral with the filter body.[0031]
• Ideally the guide olive tapers distally inwardly.[0032]
• In another aspect the invention provides a method for the capture and removal of embolic material from a blood vessel during an interventional procedure comprising the steps of:[0033]
• advancing a guidewire through a vasculature;[0034]
• crossing a desired treatment location with the guidewire;[0035]
• introducing over the guidewire a collapsible embolic protection filter having a collapsed configuration, the collapsed configuration permitting delivery and withdrawal of the filter;[0036]
• deploying the filter distal to the treatment location;[0037]
• carrying out the interventional procedure, embolic material generated during the treatment procedure being captured by the deployed filter;[0038]
• advancing a retrieval catheter over the guidewire;[0039]
• collapsing the filter into the retrieval catheter and with it the captured embolic material;[0040]
• withdrawing the retrieval catheter and the collapsed filter from the vasculature leaving the guidewire in the vasculature.[0041]
• In one embodiment of the invention the method comprises the step of providing a catheter over the guidewire after withdrawal of the retrieval catheter.[0042]
• In another embodiment the method includes the step of moving the guidewire after withdrawal of the retrieval catheter and the collapsed filter from the vasculature to re-position the guidewire in the vasculature.[0043]
• The catheter may be a catheter for delivery of a diagnostic medium.[0044]
• The catheter may be a catheter for delivery of a lytic agent.[0045]
• The filter is preferably slidably disposed on the guidewire when the filter is in the expanded deployed configuration.[0046]
• In one preferred case the filter is rotatably disposed on the guidewire when the filter is in the expanded deployed configuration.[0047]
• In a further embodiment the method includes the steps of:[0048]
• loading the filter in a collapsed configuration within a delivery catheter;[0049]
• advancing the delivery catheter and filter over the guidewire to deliver the filter to a desired location; and[0050]
• deploying the filter from the delivery catheter at the desired location.[0051]
• Preferably the method includes the steps of:[0052]
• collapsing the filter from an expanded configuration for loading the filter into the delivery catheter;[0053]
• the filter being expanded to a deployment configuration on release from the delivery catheter.[0054]
• The treatment location may be a region of stenosis.[0055]
• In one embodiment the interventional procedure includes a balloon dilation of the stenosis while the filter is deployed.[0056]
• In another embodiment the interventional procedure includes a stenting of the treatment location while the filter is deployed.[0057]
• According to another aspect of the invention there is provided a medical catheter for transvascular delivery and deployment of an embolic protection filter, the catheter comprising:[0058]
• an outer catheter tube defining a distal end; and[0059]
• an inner catheter tube defining a distal end;[0060]
• the outer tube being at least partially movable relative to the inner tube between a delivery configuration in which the distal end of the outer tube extends distally of the distal end of the inner tube to define a reception space for an embolic protection filter within the outer tube, and a deployment configuration in which the distal end of the inner tube extends distally of the distal end of the outer tube for deployment of the embolic protection filter;[0061]
• the inner catheter tube providing compressive resistance and the outer catheter tube providing stretch resistance.[0062]
• In one embodiment the inner catheter tube at least partially comprises a relatively stiff core encased in a more pliable body.[0063]
• In another embodiment the outer catheter tube at least partially comprises a relatively stiff core encased in a more pliable body.[0064]
• The core is preferably oriented to prevent elongation of the outer catheter tube and/or compression of the inner catheter tube.[0065]
• The core may comprise a mesh.[0066]
• In one case the core comprises a plurality of longitudinally oriented strips of a stiff material. In another case the core comprises a plurality of circumferentially oriented strips of a stiff material.[0067]
• The core may be of a metallic material. The metal is preferably stainless steel.[0068]
• The pliable body may be of a plastics material. The plastic is preferably polyamide.[0069]
• In a further aspect the invention provides an embolic protection device comprising:[0070]
• a collapsible filter element for delivery through a vascular system of a patient;[0071]
• the filter element comprising a collapsible filter body and a collapsible filter support frame contacting the filter body; the filter body having an inlet end and an outlet end, the inlet end of the filter body having one or more inlet openings sized to allow blood and embolic material enter the filter body, the outlet end of the filter body having a plurality of outlet openings sized to allow through passage of blood but to retain undesired embolic material within the filter body;[0072]
• the filter support frame being movable between a collapsed position for movement through the vascular system and an extended outwardly projecting position to support the filter body in an expanded position;[0073]
• the frame having an intermediate section to urge the filter body in the expanded position into apposition with a vessel wall, and a proximal section extending radially inwardly of the intermediate section;[0074]
• at least part of the proximal section of the frame being spaced distally to accommodate inflow of embolic material through the inlet openings in the expanded position.[0075]
• In one embodiment of the invention the filter body comprises one or more linking webs between adjacent inlet openings, and a part of the proximal section of the frame extends radially inwardly in alignment with the webs.[0076]
• The frame proximal section preferably comprises one or more frame elements, at least one frame element providing the part of the proximal section spaced distally. Ideally at least one frame element provides the part of the proximal section extending radially inwardly in alignment with a linking web between adjacent inlet openings. Most preferably the number of frame elements is four, two frame elements extending radially inwardly in alignment with two webs between two inlet openings, and two frame elements spaced distally of the inlet openings.[0077]
• Desirably the support frame is gold-plated and electropolished.[0078]
• According to the invention there is also provided an assembly for loading a collapsible embolic protection filter into a catheter, the assembly comprising:[0079]
• a catheter defining a reception space at a distal end of the catheter for receiving a collapsed embolic protection filter;[0080]
• a separate removable pushing device for delivering the medical device into the reception space.[0081]
• In one embodiment the assembly comprises a separate loading device to collapse the embolic protection filter, the loading device defining an inlet end and an outlet end, the outlet end being configured for co-operative alignment with the reception space.[0082]
• The pushing device may comprises a proximal stop for engagement with the embolic protection filter. Preferably the pushing device comprises a stem, the stem having a distal stop for engaging the embolic protection filter. Ideally the pushing device comprises a handle.[0083]
• In another embodiment the loading device comprises means for radially compressing the embolic protection filter.[0084]
• the loading device preferably comprises a funnel, the inlet end defining a larger cross sectional area than the outlet end. Ideally the loading device comprises a main support having a funnel-shaped bore formed from a frusto-conical embolic protection filter receiving portion terminating in a cylindrical portion formed by a loading tube projecting from the main support for alignment with the reception space before loading.[0085]
• The cone angle of the funnel is preferably between 15° and 65°. Most preferably the cone angle is between 35° and 45°.[0086]
• In a preferred embodiment of the invention the loading device extends into the reception space.[0087]
• In another preferred embodiment of the invention the loading device extends around the outside of the reception space.[0088]
• In a further embodiment the assembly comprises a tray, the tray comprising a first retaining means for releasably supporting the pushing device in a disengaged position before delivering the embolic protection filter into the catheter. Preferably the assembly comprises a second retaining means for releasably supporting the loading device in co-operative alignment with the catheter during loading.[0089]
• The retaining means may comprises a channel for receiving the loading device and/or the catheter and/or the pushing device, and at least one projection on the channel wall projecting inwardly for snap retention of the loading device and/or the catheter and/or the pushing device.[0090]
• Ideally the tray comprises a liquid retaining bath formed by a recess in the tray, the bath having a depth sufficient to accommodate in a totally submerged state the reception space of the catheter and the embolic protection device for submerged loading of the embolic protection filter into the reception space.[0091]
• The tray preferably has a catheter holding channel communicating with the bath, the channel defining a pathway around the tray which supports the catheter in a loading position on the tray.[0092]
• In another embodiment means for securing the catheter within the channel comprises a number of retainers spaced-apart along the channel, each retainer comprising two or more associated projections which project inwardly from opposite side walls of the channel adjacent a mouth of the channel, the projections being resiliently deformable for snap engagement of the catheter within the channel behind the projections.[0093]
• A ramp may be provided at an end of the channel communicating with the bath to direct the reception space of the catheter towards a bottom of the bath.[0094]
• Ideally means is provided within the bath for supporting the reception space of the catheter above the bottom of the bath.[0095]
• Said supporting means is preferably a step adjacent the channel.[0096]
• The first retaining means may be provided within the bath.[0097]
• Desirably the assembly comprises a flushing means. Most preferably the flushing means comprises a syringe.[0098]
• In a further aspect of the invention there is provided a method of loading an embolic protection filter into a catheter, the method comprising the steps of:[0099]
• providing an embolic protection filter, the embolic protection device being collapsible;[0100]
• providing a embolic protection catheter defining a reception space at a distal end of the catheter for receiving the collapsed embolic protection filter;[0101]
• providing a pushing device for delivering the embolic protection filter into the reception space;[0102]
• delivering the embolic protection filter into the reception space using the pushing device; and[0103]
• removing the pushing device from the reception space.[0104]
• In one embodiment the method comprises the steps of:[0105]
• providing a loading device to collapse the embolic protection filter, the loading device defining an inlet end and an outlet end;[0106]
• aligning the outlet end of the loading device in co-operation with the reception space; and[0107]
• delivering the embolic protection filter through the inlet end of the loading device and into the reception space.[0108]
• In a preferred case the catheter comprises an internal proximal stop, and the method comprises the step of moving the collapsed embolic protection filter proximally in the reception space using the pushing device to engage the internal proximal stop and disassociate the loaded catheter from the loading device before removing the pushing device.[0109]
• The catheter may be constrained relative to the loading device before delivery of the embolic protection filter through the loading device into the reception space, and the method comprises the step of releasing the constraint to facilitate disassociation of the loaded catheter from the loading device.[0110]
• In another embodiment the pushing device comprises a wire for threading through the embolic protection filter, the wire defining a distal stop for engaging the embolic protection filter.[0111]
• The loading device may comprise an elongate neck at the outlet end, and the method comprises the step of at least partially positioning the elongate neck in the reception space before delivering the embolic protection filter into the reception space.[0112]
• In a preferred embodiment the method comprises the step of flushing the embolic protection filter before delivering the embolic protection filter into the reception space.[0113]
• Ideally the method comprises the step of flushing the catheter before delivering the embolic protection filter into the reception space.[0114]
• In a preferred case the catheter comprises an outer catheter tube and an inner catheter tube, the inner catheter tube defining the internal proximal stop.[0115]
• Desirably both the inner catheter tube and the outer catheter tube are flushed before delivering the embolic protection filter through the loading device.[0116]
• In another aspect the invention provides a method of loading an embolic protection filter into a catheter, the method comprising the steps of:[0117]
• providing a embolic protection filter, the embolic protection filter being collapsible;[0118]
• providing a catheter defining a reception space at a distal end of the catheter for receiving the collapsed embolic protection filter, the catheter comprising at least one internal proximal stop;[0119]
• providing a loading device to collapse the embolic protection filter, the loading device defining an inlet end and an outlet end;[0120]
• aligning the outlet end of the loading device with the reception space;[0121]
• delivering the embolic protection filter through the loading device and into the reception space; and[0122]
• moving the collapsed embolic protection filter towards its proximal end in the reception space to engage said at least one the internal proximal stop and disassociate the loaded catheter from the loading device.[0123]
• In one embodiment the method comprises the steps of:[0124]
• providing a pushing device for delivering the embolic protection filter through the loading device and into the reception space, and for engaging the collapsed embolic protection filter with the internal proximal stop; and[0125]
• removing the pushing device after disassociating the loaded catheter from the loading device.[0126]
• In a preferred embodiment the pushing device comprises a wire for threading through the embolic protection filter, the wire defining a distal stop for engaging the embolic protection filter.[0127]
• The loading device preferably comprises an elongate neck at the outlet end, and the method preferably comprises the step of at least partially aligning the elongate neck with the reception space before delivering the embolic protection filter through the loading device.[0128]
• The method may comprise the step of flushing the embolic protection filter before delivering the embolic protection filter through the loading device.[0129]
• The method may comprise the step of flushing the catheter before delivering the embolic protection filter into the reception space.[0130]
• In a preferred embodiment the catheter comprises an outer catheter tube and an inner catheter tube, the inner catheter tube defining the internal proximal stop.[0131]
• Desirably both the inner catheter tube and the outer catheter tube are flushed before delivering the embolic protection filter through the loading device.[0132]
• According to a further aspect of the invention there is provided a removable device for loading a collapsible embolic protection filter into a catheter, the device comprising a distal stop for releasably engaging with the embolic protection filter to push the embolic protection filter towards a proximal end of a catheter thereby loading the embolic protection filter into the catheter.[0133]
• The distal stop is preferably provided on an elongate stem.[0134]
• Most preferably the distal stop is integral with the stem.[0135]
• In one case the distal stop comprises a step in the stem from a small diameter portion proximal of the step to a large diameter portion distal of the step.[0136]
• The small diameter portion preferably has a diameter of approximately 0.014″ (0.3556 mm).[0137]
• The large diameter portion preferably has a diameter of approximately 0.018″ (0.4572 mm).[0138]
• The distal stop may be attached to the stem.[0139]
• Ideally the stem comprises a wire.[0140]
• The stem may comprise a low friction coating for ease of threading through the medical device. Ideally the coating is of polytetrafluoroethylene.[0141]
• In one case the device comprises a handle.[0142]
• The invention provides a clinician with the freedom to select from different guidewires prior to selection of an embolic filter.[0143]
• Prior art assemblies suffer from the disadvantage that different guidewires cannot be used with a particular filter during an interventional procedure. A clinician is thus constrained to discard both the guidewire and the filter if the guidewire proves unsuitable, for example because it is too stiff or some other mechanical property is undesirable.[0144]
• An important advantage of the invention is that because the filter is not attached to the guidewire in a collapsed configuration for delivery, the guidewire which is first advanced through the vasculature has a lower profile. Therefore the guidewire alone can more easily navigate narrow and tortuous regions of the vasculature.[0145]
• Another important advantage of the invention is that because the filter is not fixed to the guidewire, if the deployed filter is mis-sized with respect to the region of the treatment site it is free to be carried distally by blood flow to a narrow section of the vasculature at which the filter effectively achieves apposition with the vessel wall. This ensures that all blood flow with entrained embolic material passes through the filter.[0146]
BRIEF DESCRIPTION OF THE DRAWINGS
• The invention will be more clearly understood from the following description of some embodiments thereof, given by way of example only, with reference to the accompanying drawings, in which:[0147]
• FIG. 1 is a perspective view of an embolic protection system pack;[0148]
• FIG. 2 is a plan view of a delivery catheter of the embolic protection system;[0149]
• FIG. 3 is a side, partially cross-sectional view of the delivery catheter of FIG. 2;[0150]
• FIG. 4 is an enlarged view of part of the delivery catheter of FIG. 3;[0151]
• FIG. 4A is a perspective , partially cut-away view of the delivery catheter;[0152]
• FIG. 5 is a side, partially cross-sectional view of a handle piece of the delivery catheter of FIG. 3;[0153]
• FIG. 6 is an enlarged view of part of the handle piece of FIG. 5;[0154]
• FIG. 7 is an enlarged view of another part of the handle piece of FIG. 5;[0155]
• FIG. 8 is a perspective view of a female luer of the delivery catheter of FIG. 3;[0156]
• FIG. 9 is a plan view of an inner catheter of the embolic protection system;[0157]
• FIG. 10 is a side, partially cross-sectional view of the inner catheter of FIG. 9;[0158]
• FIG. 11 is an enlarged view of part of the inner catheter of FIG. 10;[0159]
• FIG. 12 is an enlarged view of another part of the inner catheter of FIG. 10;[0160]
• FIG. 12A is a perspective, partially cut-away view of the inner catheter;[0161]
• FIG. 13 is a plan view of the inner catheter and the delivery catheter assembled;[0162]
• FIG. 14 is a side, partially cross-sectional view of the catheter assembly of FIG. 13;[0163]
• FIG. 15 is an enlarged view of part of the catheter assembly of FIG. 14;[0164]
• FIG. 16 is an enlarged view of another part of the catheter assembly of FIG. 14;[0165]
• FIG. 17 is a side view of the catheter assembly of FIG. 14 with the inner catheter in a distal configuration of use;[0166]
• FIG. 18 is a side, partially cross-sectional view of an embolic protection device of the embolic protection system;[0167]
• FIG. 19 is a plan view of the embolic protection device of FIG. 18;[0168]
• FIG. 20 is a side view of a pushing device of the embolic protection system; FIG. 21 is a side, cross-sectional view of a part of the pushing device of FIG. 8;[0169]
• FIG. 22 is a side, partially cross-sectional view of a loading device of the embolic protection system;[0170]
• FIG. 23 is an enlarged view of the detail of the loading device of FIG. 22;[0171]
• FIG. 23A is a cross sectional view of an alternative loading device;[0172]
• FIGS.[0173]24 to27 are schematic views illustrating release and flushing of the catheter assembly of FIGS.13 to17;
• FIGS. 28 and 29 are schematic views illustrating release of the pushing device of FIGS. 20 and 21;[0174]
• FIG. 29A is a cross sectional view on the line AA in FIG. 29;[0175]
• FIGS.[0176]30 to32(b) are schematic views illustrating loading of the embolic protection device of FIGS. 18 and 19 into the catheter assembly of FIGS.13 to17;
• FIGS. 33 and 34 are schematic views illustrating disassociation of the loaded catheter assembly of FIG. 32([0177]a) from the loading device of FIGS. 22 and 23;
• FIGS.[0178]35 is a side view of a guidewire of the embolic protection system;
• FIGS.[0179]36 to41 are schematic views illustrating delivery and deployment of the embolic protection device of FIGS. 18 and 19 in a vasculature;
• FIGS. 42 and 43 are schematic views illustrating treatment of the vasculature;[0180]
• FIGS.[0181]44 to47 are schematic views illustrating retrieval of the embolic protection device of FIGS. 18 and 19 from the vasculature;
• FIGS.[0182]48 to56 are side, partially cross-sectional views of other embolic protection devices of the embolic protection system;
• FIGS. 57 and 58 are schematic views illustrating loading of embolic protection devices into the catheter assembly of FIGS.[0183]13 to17;
• FIGS.[0184]59 to61 are schematic views illustrating loading of the embolic protection device of FIGS. 18 and 19 into the catheter assembly of FIGS.13 to17 using a removable pulling device;
• FIG. 62 is a side view of the loaded catheter assembly;[0185]
• FIGS. 63 and 64 are schematic views illustrating loading of embolic protection devices into the catheter assembly of FIGS.[0186]13 to17 using the pulling device of FIGS.59 to61;
• FIGS.[0187]65 to69 are schematic views illustrating retrieval of an embolic protection device from a vasculature;
• FIG. 70 is a side view of another guidewire of the embolic protection system;[0188]
• FIGS.[0189]71 to74 are schematic views illustrating deployment of an embolic protection device in a vasculature;
• FIGS. 75 and 76 are schematic views illustrating deployment of another embolic protection device in the vasculature using tethers;[0190]
• FIG. 77 is a schematic view illustrating release of a tether of FIGS. 75 and 76;[0191]
• FIGS.[0192]78 to81 are schematic views illustrating delivery and deployment of an embolic protection device of a rapid exchange embolic protection system in a vasculature;
• FIG. 82 is a side, partially cross sectional view of another embolic protection system;[0193]
• FIG. 83 is a side, partially cross sectional view of a further embolic protection device; and[0194]
• FIGS. 84 and 85 are cross sectional views of a distal portion of catheters.[0195]
DETAILED DESCRIPTION
• Referring to the drawings there is illustrated a transvascular embolic protection system according to the invention for safely capturing and retaining embolic material released during an interventional procedure while maintaining blood flow.[0196]
• The embolic protection system comprises an[0197]embolic protection device1, adelivery catheter2 for delivery of theembolic protection device1 to a desired location in the vascular system and a proximal stop for deployment of theembolic protection device1. Thedevice1 is collapsible from an expanded deployed configuration to a retracted delivery configuration. Thedelivery catheter2 has apod13 at the distal end to define a reception space for theembolic protection device1 in the collapsed delivery configuration. The proximal stop in this case is provided by thedistal end27 of aninner catheter25 which extends towards thepod13 of thedelivery catheter2 for deployment of theembolic protection device1 from thepod13.
• In use, the[0198]embolic protection device1 is loaded into thepod13 of thedelivery catheter2 which is delivered over apre-positioned guidewire99. At a desired location theinner catheter25 is moved relative to thedelivery catheter2 to deploy theembolic protection device1 from thepod13. The delivery andinner catheters2,25 are then withdrawn leaving abare guidewire99 over which various devices such as a dilation balloon and/or a stent can be advanced to the treatment site. Embolic material dislodged during the treatment procedure(s) is collected in theembolic protection device1. After treatment, thedevice1 may be retrieved into aretrieval catheter3. Theguidewire99 may be left in place for further catheter advancements or may be withdrawn with or subsequent to the withdrawal of theretrieval catheter3.
• Referring in particular to FIG. 1 a[0199]pack4 is provided to safely store and prepare the embolic protection system for use. Thepack4 comprises a vacuum-formedtray5, typically of PETG. Thetray5 has achannel6 extending in a looped configuration around thetray5 for receiving thedelivery catheter2. Thedelivery catheter2 has aproximal end11 and adistal end12. Ahandle14 is provided at theproximal end11, and theinner catheter25 which extends through thedelivery catheter2 has aluer36 at the proximal end. Theluer36 is located in thetray5 adjacent to thehandle14. Thepod13 is provided at thedistal end12 of theinner catheter2. Aloading device7 in the form of a funnel piece is mounted in the tray adjacent to and, in this case extending into thepod13. Theembolic protection device1 is mounted in its expanded configuration in a well90 in thetray5 adjacent to and extending into theloading device7. A pushingdevice8 for loading the collapsibleembolic protection device1 is mounted in thetray5 adjacent to theembolic protection device1. Asyringe91 is also mounted in arecess92 of thetray5. Thesyringe91 is used to flush the system and, after flushing, the pushingdevice8 is used to push theembolic protection device1 through theloading device7 and into thepod13 of thedelivery catheter2 in the collapsed configuration. Thedelivery catheter2 is now ready for advancement over theguidewire99.
• Referring now to FIGS.[0200]2 to8, thedelivery catheter2 is illustrated in more detail. Thedelivery catheter2 comprises atubular body10, typically of polyimide, or nylon extending between aproximal end11 and adistal end12. At thedistal end12 of the tubular body10 apod13 is provided, thepod13 having a smaller wall thickness and in this case a larger internal diameter, as illustrated in FIG. 4, to define a reception space for receiving the embolic protection device in a collapsed configuration. Thehandl14, illustrated in detail in FIGS.5 to7, is attached to theproximal end11 of thetubular body10, with astrain relief member15 extending from thehandle14 partially along thetubular body10. Thehandle14 defines acentral lumen16 extending between aproximal opening17 and adistal opening18. Aside port opening19 is provided in thehandle14, theside port19 being in communication with the central lumen16 (FIG. 3). Afemale luer20, as illustrated in FIG. 8, is also provided, theluer20 being fixedly mounted in theside port19. A double-start thread is provided at the free end of theluer20 for threadable attachment of, for example, a flushingsyringe91 to theluer20.
• In this case the proximal stop is provided by an[0201]inner catheter25. As illustrated in FIGS.9 to12, theinner catheter25 comprises a tubular body extending between aproximal end26 and adistal end27. The tubular body comprises an innertubular stem28 extending between theproximal end26 and thedistal end27, and an outertubular stem29, typically of polyimide, extending from theproximal end26 only partially along theinner stem28, as illustrated in FIG. 10. Theouter stem29 terminates in a protruding O-ring shoulder30. Anannular collar31 is slidably mounted to theouter stem29 proximally of the O-ring shoulder30 (FIG. 12). The femalewinged luer piece36 is attached to theproximal end26 of the stems28,29 by means of aflair connector32. Thewinged luer36 defines acentral lumen33 extending between aproximal opening34 and adistal opening35.
• As illustrated in FIGS.[0202]13 to17, theinner catheter25 is configured for insertion through theproximal opening17 of thehandle14 and advancement through thehandle14 and thetubular body10 until thecollar31 engages the handle14 (FIG. 15) in the region of theproximal opening17. Thecollar31 is fixedly attached within theproximal opening17 of thehandle14.
• The[0203]inner catheter25 is slidable relative to thedelivery catheter2 between a retracted position, as illustrated in FIG. 14, in which thedistal end27 of theinner catheter25 is proximal of thepod13 defining the reception space in the delivery catheter2 (FIG. 16), and an extended position, in which thedistal end27 of theinner catheter25 extends distally of thepod13 of the delivery catheter2 (FIG. 17). Movement of theinner catheter25 proximally relative to thedelivery catheter2 is limited by engagement of the O-ring shoulder30 with the collar31 (FIGS. 14 and 15).
• The[0204]pod13 of thedelivery catheter2 and theinner stem28 of theinner catheter25 at least partially comprise a stiff core, for example of a metallic material, such as stainless steel, encased in a more pliable body, for example of a plastics material such as polyimide. The cores comprise a mesh of longitudinally oriented strips of the stiff material and circumferentially oriented strips of the stiff material.
• Accurate delivery of a filter to its intended location (a non-diseased vessel area) is a particularly important concern in tortuous anatomy where there is a limited area of non-diseased vessel. The accuracy of deployment is related to the build up of potential stain energy in delivery catheter systems. This strain energy is primarily a combination of strain energy produced in the outer and inner shaft during the deployment action. The designs described below referring in particular to FIGS. 4A and 12A detail a novel solution to these problems.[0205]
• During the deployment action the outer shaft or[0206]delivery catheter2 is subjected to high levels of tensile strain. The design/construction of theouter shaft2 is such that the amount of strain energy that can be stored within the outer shaft is minimised. Low flexural stiffness is also desirable in catheter design to ensure good catheter flexibility, trackability and low insertion forces. These attributes are achieved by incorporating hightensile elements21 within the wall construction of theouter shaft2. These hightensile elements2 can be high tensile longitudinal steel wires as shown in the example below or they may be flexible high tensile wires or fibers, carbon fibers and or kevlar fibers. These fibers/wires are contained within thewall22 of the catheter which may be a polymeric material (detailed in FIG. 4A is a polyimide wall). These wires/fibers provide the outer shaft with high tensile modulus (minimal stretch)which results in a shaft that can not store much strain energy. The inclusion of the above hightensile elements21 allows for a low profileouter shaft2. This low wall thickness outer catheter shaft therefore also has low flexural stiffness, good flexibility, trackability and subsequently low insertion force. Theinner surface23 of the lumen of thisshaft2 is a low friction (PTFE) material to minimise the friction strain energy incurred during the deployment action.
• During the deployment action the[0207]inner catheter shaft25 is subjected to high levels of compression strain. The design/construction of theinner shaft25 is such that the modulus of compression is high which reduces the amount of strain energy that can be stored within theinner shaft25. This is achieved by incorporatingelements24 with high compression modulus. These elements are contained within amaterial matrix24A that further enhances the compression modulus of theinner shaft25. The inclusion of the above high compression elements allows for a low profile outer shaft. The low wall thickness inner shaft will therefore also have low flexural stiffness, good flexibility and trackability. The example illustrated in FIG. 14A is a high compression modulussteel wire braid24 contained within apolymeric matrix24A. The inner lumen of theshaft25 is made of a low friction (PTFE) material layer24B. The outer surface of theshaft25 is also provided with a low friction (FEP) material layer24C. The layers24B and24C minimise the frictional strain energy incurred during delivery and deployment. Due to the combination of the above inner andouter shaft2,25 the amount of strain energy that can be stored within the system during use is very low. Due to the low strain energy build up within the system a precise, controlled, low force deployment is achieved even in difficult vessel paths.
• In this case, the[0208]embolic protection device1 comprises acollapsible filter element40 for delivery through a vascular system of a patient and deployment at a desired location in the vascular system. FIGS. 18 and 19 illustrate thefilter element40 in detail.
• The[0209]filter element40 comprises acollapsible filter body41, a collapsiblefilter support frame42 contacting thefilter body41, and an innerelongate sleeve43 to which both thefilter body41 and theframe42 are mounted. Aproximal end44 of thefilter body41 and aproximal end45 of theframe42 are both fixedly attached to aproximal end46 of thesleeve43, in this case by means of an adhesive bond. Adistal end47 of thefilter body41 and adistal end48 of theframe42 are free to slide over adistal end49 of thesleeve43.
• The[0210]filter body41 has a proximal inlet end and a distal outlet end. The inlet end of thefilter body41 has one or more, in this case two,large inlet openings50, and the outlet end has a plurality of, in this case approximately three hundred,small outlet openings51 sized to allow through passage of blood but to retain undesired embolic material within thefilter body41.
• The[0211]filter support frame42 is movable between a collapsed position for movement of thefilter element40 through a vascular system and an extended outwardly projecting position to support thefilter body41 in an expanded position. Theframe42 has adistal section52, anintermediate section53 for urging thefilter body41 in the expanded position into apposition with a vascular vessel wall, and aproximal section54 extending proximally and radially inwardly of the intermediate section53 (FIGS. 18 and 19).
• At least part of the[0212]proximal section54 of the frame is spaced distally of theinlet openings50 in thefilter body41 to accommodate inflow of embolic material through theinlets50 and into the expandedfilter body41. Thefilter body41 comprises one or more, in this case two, linkingwebs55 betweenadjacent inlets50, and a part of theproximal section54 of the frame extends radially inwardly in alignment with thewebs55, as illustrated in FIG. 19, to avoid occluding theinlets50 to thefilter body41 when thefilter body41 is in the expanded position. In this manner the possibility of embolic material becoming caught or hung-up on theproximal section54 of the frame as the embolic material flows distally through theinlet openings50 is minimised.
• The[0213]proximal section54 of the frame comprises one or more frame elements, in this case four. At least one frame element, in this case two, provides the part of theproximal section54 which is spaced distally of theinlets50, and at least one frame element, in this case two, provides the part of theproximal section54 extending radially inwardly in alignment with thewebs55.
• The proximal section of the frame runs generally parallel with a vessel wall and then turns radially inwards. The proximal arm(s) of the frame have a section that is displaced distally. The advantage of this displacement is that it creates an inlet path which is offset and therefore larger.[0214]
• The frame elements are preferably of a shape memory material, such as Nitinol, or of a superelastic material, and may have a plating of gold or other dense material around the Nitinol. The frame elements facilitate movement of the[0215]frame42 between the collapsed position and the extended outwardly projecting position. Theframe42 is electropolished.
• The[0216]sleeve43 defines alumen56 extending therethrough for exchange of thefilter element40 over theguidewire99. Thedistal end49 of thesleeve43 is engageable with a stop such as a stop on theguidewire99. This is particularly useful for retrieval of thefilter element40 from a vascular system. Thesleeve43 is typically of polyimide.
• The[0217]sleeve43 acts as a barrier between thelumen56 through which a guidewire may be exchanged, and the internal annular volume of thefilter body41 within which embolic material is retained. In particular, theproximal end46 of thesleeve43 is proximal of theinlets50, and thedistal end49 of thesleeve43 is distal of thesmall outlets51. This ensures that all blood flows into thefilter body41 through theinlets50, through thefilter body41 and out of thefilter body41 through thesmall outlets51 which are sized to retain undesired embolic material within thefilter body41. Thesleeve43 prevents escape of any embolic material from thefilter body41 into thelumen56, for example, during exchange of medical devices over a guidewire received within thelumen56, or during retrieval of thefilter element40.
• A[0218]guide olive57 is provided for atraumatic delivery of thefilter element40 through a vascular system, the guide olive57 forms an extension of thedistal end47 of thefilter body41 and tapering distally inwardly for a smooth transition profile. In this case, theguide olive57 is integral with thefilter body41 and is of the material Pellethane. As illustrated in FIGS. 18 and 19, theguide olive57 extends distally of thedistal end49 of thesleeve43. In use, the region of a vasculature in which thefilter element40 is deployed is substantially straight for a length at least equal to the longitudinal length of thefilter element40 to ensure apposition of thefilter body41 with the vasculature wall. By directly mounting the guide olive57 at thedistal end47 of thefilter body41, the overall longitudinal length of thefilter element40 is reduced to define a longitudinallycompact filter element40. Thus, the user has greater freedom when choosing a site in a vasculature to deploy thefilter element40 because the length of the vasculature which is required to be straight is correspondingly reduced.
• As illustrated in FIGS. 18 and 19, the[0219]distal end48 of theframe42 acts to reinforce the proximal section of theguide olive57 and prevents flaring of thesleeve43. Theguide olive57 has a softdistal tip58.
• Two[0220]gold marker bands59,60 are provided mounted to thesleeve43. Onemarker band59 is fixedly attached to the olive51 and onemarker band60 is fixedly attached to theproximal end45 of theframe42. Themarker bands59,60 assist in visualisation of thefilter element40 during an interventional procedure.
• A[0221]transition element61 is fixedly mounted to theproximal end46 of thesleeve43, in this case by means of an adhesive bond. Thetransition element61 is sized to fit made the lumen of thedelivery catheter2 to provide a smooth stiffness transition and prevent kinking.
• Referring now to FIGS. 20 and 21, the pushing[0222]device8 for loading thecollapsible filter element40 into thepod13 of thedelivery catheter2 is illustrated. The pushingdevice8 comprises ahandle70 for gripping the pushingdevice8 and an elongate stem in this case provided by awire71, extending from thehandle70 for threading through thelumen56 of thefilter element40. Thewire71 defines adistal stop72 for releasably engaging with thedistal end49 of thesleeve43 of thefilter element40 to push thefilter element40 into thepod13 of thedelivery catheter2.
• As illustrated in FIG. 21 the[0223]distal stop72 is provided by anend74 of anouter hypotube73 which extends from thehandle70 partially along thewire71. Thefree end74 of thehypotube73 forms a step from thesmall diameter wire71 proximal of the step to the larger diameter hypotube73 distal of the step. The small diameter is preferably approximately 0.014″ (0.3556 mm), and the large diameter is preferably approximately 0.018″ (0.4572 mm). Thehypotube73 may be attached to thewire71 by any suitable means, such as an adhesive means, or a mechanical keying means, or by brazing, or soldering, or welding, or by any other suitable means.
• The[0224]wire71 may have a low friction coating, for example of polytetrafluoroethylene, for ease of threading of thewire71 through thefilter element40. Thehandle70 facilitates ease of gripping and of use of the pushingdevice8.
• It will be appreciated that the[0225]distal stop72 may be provided integral with thewire71, for example by machining a step in thewire71.
• It will further be appreciated that the large diameter portion distal of the step may be only a locally defined feature on the[0226]wire71 that does not extend distally to thehandle70.
• The[0227]loading device7 is illustrated in detail in FIGS. 22 and 23. Theloading device7 defines a funnel having aninlet end80 and anoutlet end81, theinlet end80 defining a larger cross-sectional area than theoutlet end81, and theoutlet end81 being configured for co-operative alignment with the reception space of thedelivery catheter2.
• The[0228]loading device7 has means for radially compressing thefilter element40 from the extended outwardly projecting position to the collapsed position. In this case, theloading device7 comprises amain support82 having a funnel-shaped bore formed from a frusto-conical filter element receiving portion terminating in a cylindrical portion formed by a thinwalled loading tube83 projecting from themain support82 for positioning within the reception space of thedelivery catheter2.
• The cone angle of the bore is chosen from an angle in the range of between 15° and 65°, preferably between 35° and 45°.[0229]
• The[0230]loading tube83 is preferably formed from polyethyleneterephthalate (PET), and is mounted on ametal spigot84, typically a grit blasted hypotube, by a combination of a polyolefin shrink tube bond and an adhesive bond. Themetal spigot84 is adhesively fixed to themain support82 which is formed from “Perspex” or a similar material. Theloading tube83 may be coated with a lubricant.
• Referring to FIG. 23A there is illustrated an[0231]alternative loading device85 in which anouter support86 is provided around thepod13 of thedelivery catheter2. A smooth transition is provided by afunnel section87 and the distal end of thepod13. The area between theouter support86 and thepod13 may be a wetted annular space for ease of mounting and demounting.
• Referring to FIGS. 1 and 24 to[0232]29, thetray5 will now be described in more detail. The tray includesintegral projections9 that extend into various recesses. Theprojections9 releasably support theloading device7 in cooperative alignment with thedelivery catheter2 before loading and during the loading procedure. In particular, theloading device7 is supported with theloading tube83 extending proximally into the reception space of thedelivery catheter2 before loading and during the loading procedure. In addition, theprojections9 on the channel wall are configured to releasably support the pushingdevice8 in a position in which thedistal stop72 does not engage thefilter element40 before the loading procedure commences.
• The[0233]projections9 are also configured to releasably support theluer20 of thedelivery catheter2 in the horizontal position illustrated in FIGS. 1 and 24. In this position it is not possible to slide thedelivery catheter2 proximally in thechannel6, or, in the configuration illustrated, to flush thedelivery catheter2 through theluer20.
• A[0234]liquid retaining bath90 is provided by recesses in thetray5, thebath90 having a depth sufficient to accommodate in a totally submerged state the reception space of thedelivery catheter2 and thefilter element40 for submerged loading of thefilter element40 through theloading device7 and into thepod13 of thedelivery catheter2. As illustrated in FIG. 1, thechannel6 communicates with thebath90, and a ramp is provided at an end of thechannel6 communicating with thebath90 to direct the reception space downwards towards the bottom of thebath90 but supporting thepod13 of thedelivery catheter2 above the bottom of thebath90 by means of a step.
• The[0235]syringe91 is provided for flushing thedelivery catheter2, theinner catheter25, theloading device7 and thefilter element40. Therecess92 is provided in thetray5 for snap retention of thesyringe91 before use.
• The components of the embolic protection system are placed in the[0236]pack4 in the following manner. Theloading device7 is snapped into place in thechannel6, with theprojections9 releasably supporting theloading device7 in the position illustrated in FIG. 1.
• The[0237]inner catheter25 is inserted through theproximal opening17 of thehandle14, and advanced through thehandle14 and thetubular body10 until thecollar31 engages theproximal opening17 of thehandle14. Thecollar31 is fixedly attached within theproximal opening17 of thehandle14 by pushing thecollar31 home to create an interference fit between thecollar31 and the proximal opening walls. This catheter assembly is then looped through thechannel6 and held in place so that theloading tube83 of theloading device7 extends proximally into thepod13 of thedelivery catheter2.
• The[0238]wire71 of the pushingdevice8 is then threaded through thefilter element40, a proximal end of thewire71 is inserted through theloading device7 and extended partially through theinner catheter25. Thehandle70 is snapped into place in thechannel6 by theprojections9. In this configuration thefilter element40 is slidable over thewire71 but is normally positioned within thebath90, as illustrated in FIG. 1. Theprojections9 retain the pushingdevice8 in a position in which thedistal stop72 is spaced distally of thebath90, and so thedistal stop72 does not engage thefilter element40 in this storage configuration, as illustrated in FIG. 1.
• The[0239]syringe91 is snapped into place in therecess92, and the assembledpack4 is now ready to be sealed and stored until required for use.
• In this storage configuration the[0240]filter element40 is in the expanded configuration. This is an advantageous arrangement. If thefilter element40 was loaded into thedelivery catheter2 and stored in the collapsed position for a long period of time, thefilter element40 would be subject to material deformation, in particular to material creep. The assembledpack4 of the invention may be safely stored for long periods in a packaged configuration without risk of filter element material deformation. Thepack4 is placed in a porch and sealed.
• When the assembled[0241]pack4 is required for use, the seal is broken, thepack4 is removed and thesyringe91 is removed from therecess92. Theluer20 of thedelivery catheter2 is rotated through 90° in a “bolt-action” to release theluer20 from the snap-fit retaining projections9 in thetray5, as illustrated in FIGS. 24 and 25. Thedelivery catheter2 is now slidable proximally in thechannel6, and theluer20 is now accessible for flushing (FIG. 25). Thesyringe91 is used to flush thedelivery catheter2 through the luer20 (FIG. 26) and to flush theinner catheter25 through theproximal opening34 in thefemale luer piece36 of the inner catheter25 (FIG. 27). A saline solution is generally used for flushing thecatheters2,25. Thesyringe91 is also used to fill thebath90 with saline solution, thereby immersing thefilter element40, the reception space of thedelivery catheter2 and theloading device7 in the saline solution. This ensures all removed from the system.
• This flushing step is performed shortly before intended use. The[0242]filter element40 is completely visible and accessible to the user during prepping. In this way, the user can squeeze or pinch parts of thefilter element40 to ensure thefilter element40 is completely flushed of air. This is difficult if thefilter element40 was loaded into thedelivery catheter2 upon assembly and stored for a potentially long period in the collapsed position.
• The flushed[0243]filter element40 is now ready for loading into thepod13 of thedelivery catheter2. The pushingdevice8 is rotated through 90° in a “boltaction” to release thehandle70 from the snap-fit retaining projections9 in thetray5, as illustrated in FIGS. 28 and 29. In this configuration the pushing device is still retained to the tray (FIG. 29A).The pushingdevice8 is now free to slide proximally in the channel6 (FIG. 30), until thedistal stop72 engages with thedistal end49 of thesleeve43 of the filter element40 (FIGS.31(a) and31(b)). Continued pushing of the pushingdevice8 will push thefilter element40 proximally towards the loading device7 (FIG. 31 (a)), through theloading device7, thereby collapsing thefilter element40 from the extended outwardly projecting position of FIG. 31(a) to the collapsed position of FIG. 32(a), and into thepod13 of the delivery catheter2 (FIG. 32(a)) until thefilter element40 abuts thedistal end27 of theinner stem28 of theinner catheter25. Further pushing of the pushingdevice8 moves thecollapsed filter element40 and theinner catheter25 proximally until the O-ring shoulder30 of theinner catheter25 abuts theannular collar31 fixed in theproximal opening17 of thehandle14, as illustrated in FIGS. 14 and 15. An O-ring39 is also provided between theshoulder30 and thecollar31.
• The[0244]loading device7 has thus far remained in co-operative alignment with thedelivery catheter2. Because theluer20 of thedelivery catheter2 has been released from the snap-fit retaining projections9 in thetray5, as illustrated in FIG. 32(b), the catheter assembly is free to slide proximally in thechannel6 away from theloading device7. When the pushingdevice8 is further pushed proximally, this causes theinner catheter25 to move proximally and with it thedelivery catheter2 due to the engagement of the O-ring shoulder30 with thehandle14. In this manner, thedelivery catheter2, theinner catheter25 and thecollapsed filter element40 are all moved together proximally away from theloading device7, and thereby the loaded catheter assembly is disassociated from the loading device7 (FIG. 33). The loaded catheter assembly is then removed from thechannel6 leaving theloading device7 and the pushingdevice8 behind in thechannel6. The assembly of the loadeddelivery catheter2 and theinner catheter25, as illustrated in FIG. 34, is now ready for insertion into a vascular system of a patient.
• The[0245]filter element40 is loaded into thepod13 of thedelivery catheter2 by a simple, single-direction pushing action. This minimises potential loading difficulties.
• The components of the[0246]pack4 are retained in the correct loading alignments by thetray5. The pushingdevice8 is completely separated from the loaded catheter assembly after completion of the loading procedure.
• In addition, the loaded[0247]filter element40 is not attached or associated in any way with the pushingdevice8. Thus, the user is free to choose any suitable guidewire, as desired, for subsequent delivery of thefilter element40 through a vascular system of a patient.
• Referring now to FIG. 35 the[0248]guidewire99 of the embolic protection system is illustrated in detail. Theguidewire99 is suitable for the exchange of thefilter element40 through a vascular system of a patient over theguidewire99. Theguidewire99 defines adistal end100 and comprises adistal stop101 to prevent relative movement of thefilter element40 distally of thedistal end100 of theguidewire99. The portion of theguidewire99 proximally of thedistal stop101 is bare for exchange of thefilter element40 and/or other medical devices over theguidewire99.
• In this case the[0249]distal stop101 is provided by awire coil102 fixedly attached around thedistal end100 of the guidewire99 (FIG. 35). Thecoil102 has a larger outer diameter than the bare portion of theguidewire99 to define a step from the small diameter bare portion of theguidewire99 to the large diameter coil portion of theguidewire99. The small diameter is preferably approximately 0.014″ (0.3556 mm), and the large diameter is preferably 0.018″ (0.4572 mm). A curve is typically formed towards thedistal end100 of theguidewire99 to facilitate navigating and/or positioning theguidewire99 in a vasculature.
• The[0250]coil102 may be attached to the small diameter portion of theguidewire99 by an adhesive means, or by a mechanical keying means, or by brazing, or soldering, or welding, or by any other suitable means of attachment.
• In this case, the[0251]guidewire99 is partially of stainless steel, and partially of a radiopoque material to aid the user in positioning theguidewire99 accurately in a vasculature. Theguidewire99 has a coating of a low friction material, for example of a fluoropolymer such as polytetrafluoroethylene, or of a silicone material, or of a hydrophilic material, for ease of advancement of theguidewire99 through a vasculature and ease of exchange of thefilter element40 and/or other medical devices over theguidewire99.
• As illustrated in FIG. 35, the[0252]large diameter coil102 extends distally of the step to thedistal end100 of theguidewire99. However it will be appreciated that the large diameter portion of theguidewire99 may extend distally of the step only a part of the distance to thedistal end101 of theguidewire99. The large diameter portion may taper distally inwardly back to the small diameter in an arrow-head type shape or by gradually tapering.
• Referring now to FIGS.[0253]36 to41, delivery and deployment of thefilter element40 at a desired location within avasculature110 is illustrated. Theguidewire99 will be selected to suit the geometry of thevasculature110 to be negotiated, and/or the disease site, and/or the preference of the user.
• The[0254]guidewire99 is firstly inserted on its own into the vasculature system of a patient and advanced through thevasculature110 until thedistal stop101 of theguidewire99 is distal of a treatment site such as a region ofstenosis111 in the vasculature110 (FIG. 36).
• The curved[0255]distal end100 of theguidewire99 is often anchored in a bend in thevasculature110 distally of the stenosed region111 (FIG. 41) to facilitate some straightening of the anatomy by the user prior to delivery of thefilter element40.
• The loaded delivery catheter assembly of FIG. 34 is then inserted into the vasculature system and advanced over the[0256]guidewire99 through thevasculature110, until thepod13 of thedelivery catheter2 with thecollapsed filter element40 therein is positioned at a desired location of thevasculature110 distally of the stenosed region111 (FIG. 37). At least part of thefilter element40, in this case part of thedistal end58 of theguide olive57, protrudes distally out of thepod13 of thedelivery catheter2 during advancement of thedelivery catheter2 through the vascular system to minimise trauma to the vessel walls. The olive also provides a stiffness transition.
• The[0257]delivery catheter2 is retracted while maintaining the position of the inner catheter25 (FIG. 38). In this way thedistal end27 of theinner stem28 of theinner catheter25 acts as a proximal stop against which thetransition element61 of thefilter element40 abuts, thus thedistal end27 of theinner stem28 of theinner catheter25 prevents retraction of thecollapsed filter element40 with thedelivery catheter2. As the restrainingdelivery catheter2 is withdrawn, thefilter element40 is freed to expand from the collapsed, delivery configuration to the extended, outwardly projecting position of FIG. 39.
• The[0258]filter element40 may alternatively be deployed by advancing theinner catheter25 while maintaining the position of thedelivery catheter2. In this case thedistal end27 of theinner stem28 of theinner catheter25 effectively acts as a pusher to eject thecollapsed filter element40 from thepod13 of thedelivery catheter2, and thereby facilitate expansion of thefilter element40 to the deployed configuration of FIG. 39.
• It will be appreciated that the[0259]filter element40 may be deployed by any sufficient movement of thedelivery catheter2 proximally relative to theinner catheter25, thereby engaging thedistal end27 of theinner stem28 of theinner catheter25 with thefilter element40 to facilitate deployment of thefilter element40.
• The construction of the[0260]pod13 of thedelivery catheter2 and theinner stem28 of theinner catheter25 prevent deformation of thepod13 and theinner stem28 during deployment of thefilter element40. In particular, elongation of thepod13 and compression of theinner stem28 are avoided. This ensures that thefilter element40 is accurately and smoothly deployed in the desired location in thevasculature110.
• In the extended outwardly projecting position the[0261]filter body41 is in complete circumferential apposition with the wall of thevasculature110 over a length substantially equal to theintermediate section53 of thefilter support frame42.
• After deployment of the[0262]filter element40 both thedelivery catheter2 and theinner catheter25 are retracted and withdrawn from thevasculature110, leaving theguidewire1 in place in thevasculature110, and the deployedfilter element40 in place in thevasculature110 distally of the stenosed region111 (FIGS. 40 and 41).
• The[0263]guidewire99 is not attached to thefilter element40, and thus theguidewire99 is free to rotate and/or to move longitudinally relative to the deployedfilter element40. This is highly advantageous as it prevents any accidental movement of theguidewire99 causing twisting and/or dislodging of the deployedfilter element40. Thus, the user has more freedom to carry out a treatment procedure on thestenosed region111 without the risk of intimal abrasion, or of the deployedfilter element40 becoming dislodged or in some other way creating a potential flow path for embolic material around thefilter element40.
• In addition, the portion of the[0264]guidewire99 in place in thevasculature110 proximal of the deployedfilter element40 is bare. This bare portion of theguidewire99 facilitates the exchange of a wide variety of different medical devices, for example a treatment means, over thebare guidewire99 while the deployedfilter element40 remains in place in thevasculature110. Examples of such medical devices are atherectomy devices to carry out an atherectomy procedure on thestenosed region111, or anangioplasty balloon112 to carry out an angioplasty procedure on thestenosed region111, as illustrated in FIG. 42, or astent113 to carry out a stenting procedure on thestenosed region111, as illustrated in FIG. 43, or any possible combination of these procedures, or any other therapeutic or diagnostic procedure. Any embolic material released during such an interventional procedure will be collected and safely retained in thefilter element40.
• After completion of an interventional procedure, for example a treatment of the[0265]stenosed region111, theretrieval catheter3 is flushed, for example with a saline solution, using thesyringe91. In this case, theretrieval catheter3 comprises an elongatetubular centring catheter121. The centringcatheter121 has a tapereddistal tip122 which protrudes distally of adistal end120 of theretrieval catheter3 during advancement through thevasculature110, as illustrated in FIG. 44, to prevent snagging of theretrieval catheter3 on thestent113, and to minimise vessel trauma.
• The[0266]retrieval catheter3 is inserted into the vascular system and advanced over thebare guidewire99 until thedistal end120 of theretrieval catheter3 is distal of the stent113 (FIG. 44). Theretrieval catheter3 is then further advanced distally over theguidewire99 while maintaining the position of thecentring catheter121 until thedistal end120 of theretrieval catheter3 is immediately proximal of the deployedfilter element40. Theguidewire99 is retracted to engage thedistal stop101 with thedistal end49 of thesleeve43 of thefilter element40.
• The[0267]distal stop101 of theguidewire99 may alternatively be engaged with thedistal end49 of thesleeve43 of thefilter element40 by advancing theretrieval catheter3 further distally to engage the deployedfilter element40 and push the deployedfilter element40 distally until thedistal end49 of thesleeve43 of thefilter element40 engages thedistal stop101 of theguidewire99. In this case no retraction of theguidewire99 is necessary to engage thedistal stop101 with thedistal end49 of thesleeve43 of thefilter element40.
• It will be appreciated that any suitable combination of advancement of the[0268]retrieval catheter3 and retraction of theguidewire99 may be employed to effect engagement of thedistal stop101 of theguidewire99 with thedistal end49 of thesleeve43 of thefilter element40.
• With the[0269]distal stop101 of theguidewire99 engaging thedistal end49 of thesleeve43 of thefilter element40, theretrieval catheter3 is advanced while maintaining the position of the guidewire99 (FIG. 45). This causes thefilter element40 to collapse into theretrieval catheter3 until thefilter element40 is retrieved into the retrieval catheter3 (FIG. 46).
• The[0270]filter element40 may alternatively be retrieved into theretrieval catheter3 by retracting theguidewire99 while maintaining the position of theretrieval catheter3 to collapse and retrieve thefilter element40 into theretrieval catheter3. In this case theguidewire99 acts to pull thefilter element40 proximally into theretrieval catheter3.
• It will be appreciated that the[0271]filter element40 may be retrieved by any suitable movement of theretrieval catheter3 distally relative to theguidewire99.
• The[0272]distal stop101 facilitates retrieval of thefilter element40 by preventing thefilter element40 moving distally of thedistal end100 of theguidewire99.
• The[0273]guide olive57 of thefilter element40 may or may not protrude distally out of thedistal end120 of theretrieval catheter3 after collapse of thefilter element40.
• The[0274]retrieval filter element40 is then withdrawn from thevasculature110 by withdrawing theretrieval catheter3 and thecentring catheter121 together from thevasculature110.
• The[0275]guidewire99 may be left in place in thevasculature110 after theretrieval catheter3, the centringcatheter121, and theretrieval filter element40 have been withdrawn from thevasculature110, as illustrated in FIG. 47. Alternatively theguidewire1 may be withdrawn from thevasculature110 upon withdrawal of theretrieval catheter3, the centringcatheter121, and theretrieval filter element40.
• When the[0276]bare guidewire99 is left in place in thevasculature110 after withdrawal of theretrieval catheter3, a further treatment or diagnostic means may be advanced over thebare guidewire99 to access any desired location in thevasculature110. The position of thebare guidewire99 may be adjusted proximally or distally, as desired, to suit a further treatment or diagnostic procedure. Otherwise a fluroscopic assessment of the treated vessel may be made through the guiding catheter or sheath prior to withdrawal of the guidewire. This is desirable.
• The embolic protection system of the invention offers considerable clinical advantages. The arrangement allows a clinician to select a suitable guidewire from a range of such guidewires. This provides enhanced flexibility by ensuring that filter performance can be optimised. The embolic protection device is not dedicated to a particular guidewire.[0277]
• Because the embolic protection device is not attached to the guidewire, the guidewire which is first advanced through a vasculature can have a low profile and be tailored to the proposed procedure or vasculature. Consequently, the guidewire can easily navigate narrow and tortuous regions of the vasculature.[0278]
• Thus, a clinician may readily select a particular type of guidewire which provides the appropriate flexibility and performance required for a particular vascular procedure being performed. The system also facilitates the safe crossing of a lesion not only in a first lesion.[0279]
• Another important advantage is that because the embolic protection device is not attached to the guidewire, if the embolic protection device is undersized with respect to the region of the treatment site it is free to be carried by blood flow to a distal narrowed section of the vasculature at which the embolic protection device effectively achieves apposition with the vessel wall. This ensures that all blood flow with entrained embolic material passes through the embolic protection device. The guidewire distal stop prevents movement of the embolic protection device distally off the guidewire.[0280]
• The possibility of successfully achieving filter deployment at the intended site is significantly improved due to:[0281]
• Initial crossing with a bare guidewire is easier as a bare guidewire has an extremely low profile, is highly trackable and highly pushable.[0282]
• Attempted crossing with a bare guidewire presents a very low risk of an embolic event due to its low profile, and atraumatic tip.[0283]
• Once the bare wire is across the lesion, crossing with the filter delivery system is simplified. Advancing the tip of the guidewire and positioning it in the distal vasculature provides additional support to the filter delivery catheter.[0284]
• The possibility of successfully delivering other catheters and interventional devices to the lesion area is enhanced because of the independent movement compatibility of the deployed filter and guidewire. The guidewire tip can be advanced into the distal vasculature to provide anchorage during the advancement of additional catheters and devices. The filter position is maintained by visual apposition and blood flow forces. In this configuration the wire provides extra support to the catheter or interventional device being advanced. This increases the possibility of delivering the catheter to the intended location and minimises the possibility of an uncontrolled proximal movement of the guidewire/filter. This uncontrolled proximal movement occurs when the guidewire has insufficient support to guide an advancing catheter, through a tortuous path. With fixed wire systems the filter may be quickly withdrawn back into the lesion area with increased risk of an embolic event or stent dislodgement. The design of this invention substantially eliminates some of these serious clinical risks.[0285]
• Referring now to FIGS.[0286]48 to56 there is illustrated other embolic protection devices which are similar to the embolic protection device of FIGS.1 to47, and similar elements are assigned the same reference numerals in FIGS.48 to56.
• In the case of the embolic protection devices of FIGS.[0287]48 to51 thelumen56 of thesleeve43 is of a diameter greater than the outer diameter of the pushing devicedistal stop72, and greater than the diameter of the guidewiredistal stop101. Thus, thedistal end49 of thesleeve43 is not engageable with either thedistal stop72 of the pushingdevice8 or thedistal stop101 of theguidewire99. Instead anengagement grip130 is provided on an inner wall of thesleeve43, theengagement grip130 providing an abutment for engagement with thedistal stop72 of the pushingdevice8, and for engagement with thedistal stop101 of theguidewire99.
• The[0288]engagement grip130 may be provided at theproximal end46 of the sleeve43 (FIGS. 48 and 50) or at thedistal end49 of thesleeve43, or at any suitable point along the length of thesleeve43 as desired (FIGS. 49 and 51).
• The[0289]engagement grip130 may be provided by a relatively short stop rigidly attached to the inner wall of thesleeve43, as illustrated in FIGS. 48 and 49, for example by chemical means, such as an adhesive, or by mechanical means, such as welding, or brazing, or soldering, or keying means.
• Alternatively the[0290]engagement grip130 may be provided by crimping a portion of thesleeve43, as illustrated in FIGS. 50 and 51.
• In the case of FIGS.[0291]52 to54, thedistal end49 of thesleeve43 is engageable with thedistal stop72 of the pushingdevice8, and thedistal stop101 of theguidewire99. However, thesleeve43 does not extend along the length of thefilter body41 as far distally as in the embolic protection device of FIGS.1 to51. Thesleeve43 may terminate close to thedistal end47 of the filter body41 (FIG. 52), or close to theproximal end44 of the filter body41 (FIG. 54), or at any suitable point along the filter body41 (FIG. 53).
• In the case of FIGS. 55 and 56, a distal portion of the[0292]lumen56 of thesleeve43 is of a diameter greater than the outer diameter of the pushing devicedistal stop72, and greater than the diameter of the guidewiredistal stop101, and a proximal portion of thelumen56 of thesleeve43 is of a smaller diameter to facilitate engagement of thedistal stop72 of the pushingdevice8 and engagement of thedistal stop101 of theguidewire99 with astep140 in thesleeve43. Thestep140 may be provided by overlapping a small diameter sleeve with a large diameter sleeve (FIG. 55), or alternatively thestep140 may be provided integral with thesleeve43 for example by machining thestep140 into thesleeve43.
• Referring to FIG. 57 there is illustrated the loading of an embolic protection device, which is similar to that illustrated above in FIG. 49, into the[0293]pod13 at thedistal end12 of thedelivery catheter2. The loading procedure is similar to that described above with reference, in particular, to FIGS.28 to34. In the case of FIG. 57, thedistal stop72 on the pushingdevice8 engages theengagement grip130 on the inner wall of thesleeve43 to push the embolic protection device through theloading device7 and into the delivery catheter reception space, thereby collapsing the embolic protection device, as described previously.
• FIG. 58 illustrates the loading of an embolic protection device, which is similar to that illustrated above in FIG. 48, into the[0294]pod13 of thedelivery catheter2.
• It will be appreciated that the[0295]engagement grip130 may be of any suitable configuration that facilitates engagement with thedistal stop72 of the pushingdevice8 for loading the embolic protection device into thepod13 of thedelivery catheter2.
• Referring to FIGS.[0296]59 to62 there is illustrated an alternative loading of thefilter element40 into thepod13 at thedistal end12 of thedelivery catheter2, which is similar to the loading procedure described above with reference, in particular, to FIGS.28 to36. In this case, a pullingdevice150 is provided in place of the pushingdevice8. The pullingdevice150 is similar to the pushingdevice8 described above, in particular with reference to FIGS. 20 and 21. However, thewire71 of the pullingdevice150 extends proximally through theinner catheter25, and out of theproximal opening34 of the catheter for manipulation by a user.
• The[0297]filter element40 is loaded by pulling the pullingdevice150 proximally to engage thedistal stop72 of the pullingdevice150 with thedistal end49 of thesleeve43. Further pulling of the pullingdevice150 draws thefilter element40 through theloading device7 and into thepod13 at thedistal end12 of thedelivery catheter2, thereby collapsing thefilter element40, in a manner similar to that described previously. Further pulling of the pullingdevice150 proximally disassociates the loaded catheter assembly from the loading device7 (FIG. 62), as described previously.
• Referring to FIG. 63 there is illustrated the loading of an embolic protection device, which is similar to that illustrated above in FIG. 49, into the[0298]pod13 at thedistal end12 of thedelivery catheter2. The loading procedure is similar to that described above in FIGS.59 to62. In the case of FIG. 63, thedistal stop72 of the pullingdevice150 engages theengagement grip130 on the inner wall of thesleeve43 to pull the embolic protection device through theloading device7 and into the delivery catheter reception space, thereby collapsing the embolic protection device.
• FIG. 64 illustrates the loading of an embolic protection device, which is similar to that illustrated above in FIG. 48, into the[0299]pod13 of thedelivery catheter2 using the pullingdevice150.
• Referring to FIGS.[0300]65 to69 there is illustrated the retrieval of an embolic protection device, which is similar to that described above in FIG. 48, into theretrieval catheter3. The retrieval procedure is similar to that described above with reference, in particular, to FIGS.44 to47. In this case, thedistal stop101 on theguidewire99 engages theengagement grip130 on the inner wall of thesleeve43 to prevent the embolic protection device moving distally relative to thedistal stop101 on theguidewire1 during retrieval.
• It will be appreciated that the[0301]engagement grip130 may be of any suitable configuration that facilitates engagement with thedistal stop101 of theguidewire99 for retrieving the deployed embolic protection device into theretrieval catheter3.
• FIG. 70 illustrates another[0302]guidewire160 of the embolic protection system, which is similar to theguidewire99 of FIGS.1 to69, and similar elements are assigned the same reference numerals in FIG. 70. In this case, theguidewire160 does not comprise a step from a small diameter portion to a large diameter portion.
• FIGS.[0303]71 to74 illustrate the deployment of an embolic protection device of the embolic protection system which has been delivered over theguidewire160 of FIG. 70. The delivery and deployment procedure is similar to that described above with reference, in particular to FIGS.36 to41. In this case, however, a taperedring161 is provided slidably mounted on theguidewire160 between thedistal end27 of theinner stem28 of theinner catheter25 and aproximal end163 of the embolic protection device.
• To deploy the embolic protection device at a desired location in the[0304]vasculature110, thedelivery catheter2 is retracted while maintaining the position of theinner catheter25. The retraction of thedelivery catheter2 initially draws the embolic protection device proximally due to the frictional force acting between thepod13 of thedelivery catheter2 and the embolic protection device (FIG. 71). As the embolic protection device is initially drawn proximally it abuts the tapered ring and pushes the taperedring161 proximally until the taperedring161 abuts thedistal end27 of theinner stem28 of the inner catheter25 (FIG. 72). Further retraction of thedelivery catheter2 while maintaining the position of theinner catheter25 causes the embolic protection device and the taperedring161 to slide relative to one another along a tapered plane ofcontact162. This movement exerts an inward force on the taperedring161 to lockingly engage the taperedring161 to theguidewire160. In this way the embolic protection device is taperlocked to theguidewire160 by means of an interference fit between the embolic protection device and the taperedring161, and by means of an interference fit between thetapered ring161 and the guidewire160 (FIG. 73). Thedelivery catheter2 and theinner catheter25 may then be withdrawn from thevasculature110 to leave the deployed embolic protection device engaged to thebare guidewire160 in place in the vasculature110 (FIG. 74).
• The embolic protection device is retrieved in a manner similar to that described previously with reference to FIGS.[0305]44 to47. Theretrieval catheter3 is advanced over theguidewire160 until theretrieval catheter3 is proximally adjacent the deployed embolic protection device. Theretrieval catheter3 is then further advanced while maintaining the position of theguidewire160 to collapse and retrieve the embolic protection device into theretrieval catheter3. Because the embolic protection device is taper-locked to theguidewire160 it is not necessary to provide a distal stop on theguidewire160 for abutment with the embolic protection device. The taper-lock ensures no movement of the deployed embolic protection device distally relative to theguidewire160 is possible, and thus facilitates retrieval of the embolic protection device into theretrieval catheter3. The retrieved embolic protection device is then withdrawn from thevasculature110 by withdrawing theretrieval catheter3 and theguidewire160 together.
• Referring to FIGS.[0306]75 to77 there is illustrated an embolic protection system which is similar to the embolic protection system described above with reference to FIGS.71 to74, and similar elements are assigned the same reference numerals in FIGS.75 to77. In this case the embolic protection system comprises twotethers170 with inwardly arcinghooks172 at distal ends of thetethers170, thetethers170 extending between theinner catheter25 and thedelivery catheter2. The embolic protection device comprises co-operating recesses171 in theproximal end163 of the embolic protection device for receiving the tether hooks172, as illustrated in FIG. 76.
• Deployment of the embolic protection device proceeds in a manner similar to that described above with reference to FIGS.[0307]71 to74. During retraction of thedelivery catheter2, thetethers170 are also retracted to ensure that the embolic protection device is drawn proximally to effect a secure taper-lock of the embolic protection device to the guidewire160 (FIG. 76). Thetethers170 act in addition to the frictional force between thepod13 of thedelivery catheter2 and the embolic protection device to draw the embolic protection device proximally.
• After deployment and taper-locking of the embolic protection device, the[0308]hooks172 of thetethers170 are unclipped by advancing the inner catheter25 (FIGS. 76 and 77). Thedistal end27 of theinner stem28 of theinner catheter25 engages thehooks172 and levers thehooks172 outwardly disengaging thehooks172 from the co-operating recesses171 (FIG. 77). Thetethers170 and theinner catheter25 are then withdrawn from thevasculature110 to leave the deployed embolic protection device in place in thevasculature110 taper-locked to thebare guidewire160. Referring to FIGS.78 to81 there is illustrated a rapid exchange embolic protection system which is similar to the embolic protection systems of FIGS.1 to77, and similar elements are assigned the same reference numerals in FIGS.78 to81. In this case, thepod13 of thedelivery catheter2 comprises anelongate slit180 and theinner stem28 of theinner catheter25 comprises arapid exchange aperture181 for passage of aguidewire182 through theaperture181 and the slit180 (FIG. 78).
• The embolic protection device is delivered to a desired location in the[0309]vasculature110 distally of the stenosed region111 (FIG. 78) in a manner similar to that described previously with reference to FIGS. 36 and 37. The embolic protection device is deployed by retracting thedelivery catheter2 while maintaining the position of the inner catheter25 (FIGS.79 to81), which facilitates deployment of the embolic protection device in a manner similar to that described previously with reference to FIGS. 38 and 39.
• The[0310]slit180 in thepod13 of thedelivery catheter2 is aligned with therapid exchange aperture181 in thestem28 of theinner catheter25 to prevent occlusion of therapid exchange aperture181 during the relative movement of thedelivery catheter2 and theinner catheter25.15 Theaperture181 provided in a sidewall ofinner stem28 of inner catheter is preferably located at a position along the length of the inner catheter which is spaced a relatively longer distance from the proximal end of the catheter than from the distal end of the catheter. Additionally,delivery catheter2 desirably incorporates anelongate slit180 which is located adjacent the distal end the catheter and co-operates withaperture181 and theguide wire182 which exits therethrough to facilitate a rapid exchange of the catheter and filter assembly over the guide wire, thereby promoting ease of exchange without the necessity of utilising exchange wires or extension wires. As illustrated in FIGS.78-81, this arrangement permits use of rapid exchange wire techniques as well as controlled deployment and retrieval of the filter at thedelivery pod portion13 located at the distal end ofdelivery catheter2.
• This is advantageous in that it facilitates single operator use. A shorter guidewire may be used than for conventional systems making the device less cumbersome.[0311]
• Referring now to FIG. 82 there is illustrated another[0312]embolic protection system200 according to the invention. The system is similar to these described above and like parts are assigned the same reference numerals. In this case theguidewire99 includes a proximal stop provided by astep201 and the filter has a proximal engagement element provided byintegral projections202 which extend radially inwardly. Theprojections202 are configured to pass over theproximal step201 when the filter element is being moved distally over theguidewire99 for deployment but are prevented from moving proximally over theproximal step201. Thus, the filter element, on deployment can move between the proximal and distal stops on the guidewire. The arrangement may allow the filter to be retrieved over theproximal step202.
• Referring to FIG. 83 there is illustrated a[0313]system205 similar to that of FIG. 82 and like parts are assigned the same reference numerals. In this case the proximal step on the guidewire is provided by aproximally tapering element206.
• The embolic protection device is not restricted to use with a particular guidewire because it is not attached or engaged with the guidewire in any way as it is advanced over the guidewire. This is a highly advantageous arrangement. If the guidewire proves unsuitable for some reason, for example because it is too large or not trackable enough to access a desired site in a vascular system, the guidewire may be replaced with a more suitable guidewire, for example a guidewire with greater flexibility. However, because the embolic protection device is independent of the guidewire it may be used with any suitable guidewire.[0314]
• The invention gives greater freedom to a user by providing a choice of guidewires to suit a patient anatomy without requiring the user to select the embolic protection device to be used with the guidewire until after successful crossing of a lesion with the guidewire.[0315]
• Numerous vascular catheter functions are facilitated by the invention, such as:[0316]
• (i) Permits Dye Injections:[0317]
• After performing a therapeutic procedure (e.g. angioplasty or atherectomy), the embolic protection device can be retrieved if desired, in order to inject dye (over the remaining guidewire), such that minimal obstruction or interference occurs with the subsequent dye flow measurements.[0318]
• Alternatively, the wire can also be safely partially-retracted “behind” or “upstream” of the treated area, prior to performing the dye injection.[0319]
• (ii) Delivery of Lytic Agents:[0320]
• Depending upon therapeutic needs, lytic agents can be site-specifically delivered to a region of interest, either with the embolic protection device deployed, or with the embolic protection device retrieved, if desired.[0321]
• (iii) Facilitates Stent Procedures:[0322]
• Assuming appropriate design considerations have been incorporated, the retrieval sheath can also facilitate safe removal of the embolic protection device following a stenting procedure. For example, after deployment of an intravascular stent, the process of removing the embolic protection device favours certain sheath designs, such as a tapered distal tip. Specifically, the distal tip of the sheath needs to permit easy crossing of the stent in a manner which will not catch up or “snag” at the proximal edge of the implanted stent, nor along any inwardly-projecting surface of the interior of the implanted stent, as the sheath is being introduced. More specifically, the distal region of the retrieval sheath is also preferably formed of a material which permits radial expansion at the distal tip in order to accommodate retrieval of the embolic protection device.[0323]
• (iv) Facilitates Guidewire Replacements:[0324]
• Because this embolic protection system accommodates barewire introduction, it is possible to replace a guidewire during a procedure, if desired. For example, during treatment of two or more, distally spaced-apart lesions, it may become necessary to replace the initial guidewire during the procedure with another guidewire offering improved steering or distal flexibility. The present invention might support such guidewire replacements as follows. First, the embolic protection device is retrieved into the retrieval sheath (which has already crossed the first lesion area). Then the wire can be withdrawn (or alternatively, the wire and embolic protection device together can be withdrawn), while the sheath remains across the lesion. Subsequently, a replacement guidewire can be introduced through the sheath lumen to the area of interest.[0325]
• A number of engagement means between the embolic protection device and the guidewire are described above which ensure that the embolic protection device is anchored or tethered while the retrieval sheath is advanced over the embolic protection device. It is also envisaged that an engagement means may be provided between the embolic protection device and the retrieval sheath after the filter is retrieved, to ensure that there is a positive engagement between the embolic protection device and the sheath. For example, frictional engagement means may be provided on one or both of the embolic protection device and sheath. For example, projections, rings, or the like may be provided on the inner surface of the retrieval sheath adjacent the distal end thereof to provide a frictional fit with the retrieved embolic protection device.[0326]Typical arrangements210,220 of this type are illustrated in FIGS. 84 and 85. The frictional engagement may be provided by projections225 which may be of any type including continuous, discontinuous, radially and/or longitudinally extending.
• The invention is not limited to the embodiments hereinbefore described, which may be varied in construction and detail.[0327]

Claims (67)

1. An embolic protection system comprising:

a guidewire for advancing through a vasculature, the guidewire having a distal end and a proximal end;

an embolic protection filter having a filter body with a distal end and a proximal end, the filter body providing for a collapsed configuration and an expanded deployed configuration;

the embolic protection filter body having a guidewire path for slidably receiving the guidewire to permit movement of the filter relative to the guidewire when the filter is in the collapsed configuration and the expanded deployed configuration;

a delivery catheter advanceable over the guidewire for delivery of the embolic protection filter; the delivery catheter having a proximal end and a distal end, the filter being deployed from the distal end of the delivery catheter into the expanded deployed configuration;

a retrieval catheter advancable over the guidewire for retrieval of the filter, the retrieval catheter having a distal end and a proximal end; and

engagement elements for engaging the embolic protection filter with the guidewire for retrieval of the filter into the retrieval catheter in the collapsed configuration.

2. An embolic protection system as claimed inclaim 1 wherein the guidewire path is in isolation from the embolic material captured within the filter body.

3. An embolic protection system as claimed inclaim 1 or2 wherein the tubular guidewire path is defined by a tubular sleeve.

4. An embolic protection system as claimed inclaim 3 wherein the tubular sleeve extends from the proximal end to the distal end of the filter.

5. An embolic protection system as claimed in any preceding claim wherein the guidewire path is a tubular guidewire path.

6. An embolic protection system as claimed in any preceding claim wherein the engagement elements comprise a guidewire engagement element on the guidewire and a filter engagement element on the filter, the engagement elements co-operating to provide selective engagement and positioning of the filter with respect to the guidewire.

7. An embolic protection system as claimed inclaim 6 wherein the engagement element of the guidewire comprises a guidewire abutment on the guidewire.

8. An embolic protection system as claimed inclaim 7 wherein the guidewire abutment is located at the distal end of the guidewire.

9. An embolic protection system as claimed inclaim 7 or8 wherein the guidewire abutment is located proximal of the distal and of the guidewire.

10. An embolic protection system as claimed in any ofclaims 6 to9 wherein the engagement element of the filter comprises a filter abutment on the filter.

11. An embolic protection system as claimed inclaim 10 wherein the filter abutment is a distal abutment on the filter.

12. An embolic protection system as claimed inclaim 10 wherein the filter abutment is a proximal abutment on the filter.

13. An embolic protection system as claimed in any ofclaims 10 to12 wherein the tubular guidewire path is defined by a sleeve and the filter abutment is provided by the sleeve.

14. An embolic protection system as claimed in any preceding claim wherein the engagement elements comprise releasable locking elements.

15. An embolic protection system as claimed inclaim 14 wherein the releasable locking elements comprise a taper lock.

16. An embolic protection system as claimed inclaim 15 wherein the guidewire engagement element comprises a locking ring on the guidewire and the filter engagement element comprises a tapered surface of the filter, the locking ring having a tapered surface which is engagable with the tapered surface of the filter to lock the filter to the guidewire.

17. An embolic protection system as claimed inclaim 16 wherein the locking ring is a split ring.

18. An embolic protection system as claimed in claims16 or17 including a tube advancable over the guidewire, the locking ring being located between a distal end of the tube and the filter for retrieval of the filter.

19. An embolic protection system as claimed in any ofclaims 15 to18 wherein the releasable locking means includes a tether engagable with the filter for retrieving the filter into the retrieval catheter.

20. An embolic protection system as claimed in any preceding claim comprising deployment means for moving the collapsed filter relative to the distal end of the delivery catheter.

21. An embolic protection system as claimed inclaim 21 wherein the deployment means comprises a tube which is advancable over the guidewire for engagement with the proximal end of the filter, the tube being movable longitudinally relative to the delivery catheter for deployment of the filter from the distal end of the delivery catheter.

22. An embolic protection system as claimed in any preceding claim including loading means for loading the filter into the delivery catheter.

23. An embolic protection system as claimed inclaim 22 wherein the loading means comprises a funnel having a narrowed portion disposed at the distal end of the delivery catheter and an enlarged portion for receiving a proximal portion of the filter in the expanded configuration, the filter being progressively collapsed as it is moved through the funnel for loading into the delivery catheter.

24. An embolic protection system as claimed in any preceding claim including engagement means for engaging the filter within the retrieval catheter.

25. An embolic protection system as claimed inclaim 24 wherein the engagement means comprises a frictional engagement between the filter body and an internal surface of the distal end of the retrieval catheter.

26. An embolic protection system as claimed inclaim 24 or25 wherein the engagement means comprises projections on the inner surface of the retrieval catheter adjacent the distal end thereof.

27. An embolic protection system as claimed in any preceding claim wherein the delivery catheter includes an elongate slot disposed in a first sidewall thereof at a first distal location which is spaced a relatively longer distance from the proximal end of the delivery catheter than from the distal end of the delivery catheter, and wherein the inner deployment catheter includes an aperture disposed in a second sidewall thereof at a second distal location which substantially corresponds with said first distal location for said elongate slot, thereby permitting co-operative movement of said filter with respect to said guidewire and associated delivery and deployment catheters for selective deployment of the filter while facilitating the rapid exchange of said catheter and filter assembly over a guidewire without the utilisation of exchange wires or extension wires.

28. An embolic protection system as claimed in any preceding claim wherein the embolic protection filter comprises a collapsible filter body, the proximal inlet end of the filter body having one or more inlet openings sized to allow blood and embolic material enter the filter body, the distal outlet end of the filter body having a plurality of outlet openings sized to allow through passage of blood but to retain undesired embolic material within the filter body.

29. An embolic protection system as claimed inclaim 28 where the filter comprises a collapsible filter support frame having a proximal end and a distal end, the filter support frame being movable between a collapsed position for movement during delivery through the vascular system and an extended outwardly projecting position to support the filter body in an expanded position thereby urging the filter body into apposition with the vasculature upon deployment.

30. An embolic protection system as claimed inclaim 28 or29 comprising a guide olive provided at the distal end of the filter body.

31. An embolic protection system as claimed inclaim 30 comprising an inner elongate sleeve to which the filter body and the filter support frame are mounted, the sleeve having a proximal end and a distal end, the guide olive extending distally of the sleeve distal end.

32. A system as claimed inclaim 31 wherein the proximal end of the filter support frame and the inlet end of the filter body are attached to the proximal end of the sleeve.

33. A system as claimed in any ofclaims 30 to32 wherein the guide olive is integral with the filter body.

34. A system as claimed in any ofclaims 30 to33 wherein the guide olive tapers distally inwardly.

35. An embolic protection system substantially as hereinbefore described with reference to the accompanying drawings.

36. A method for the capture and removal of embolic material from a blood vessel during an interventional procedure comprising the steps of:

advancing a guidewire through a vasculature;

crossing a desired treatment location with the guidewire;

introducing over the guidewire a collapsible embolic protection filter having a collapsed configuration, the collapsed configuration permitting delivery and withdrawal of the filter;

deploying the filter distal to the treatment location;

carrying out the interventional procedure, embolic material generated during the treatment procedure being captured by the deployed filter;

advancing a retrieval catheter over the guidewire;

collapsing the filter into the retrieval catheter and with it the captured embolic material;

withdrawing the retrieval catheter and the collapsed filter from the vasculature leaving the guidewire in the vasculature.

37. A method as claimed inclaim 36 comprising the step of providing a catheter over the guidewire after withdrawal of the retrieval catheter.

38. A method as claimed inclaim 36 or37 including the step of moving the guidewire after withdrawal of the retrieval catheter and the collapsed filter from the vasculature to re-position the guidewire in the vasculature.

39. A method as claimed inclaim 37 or38 wherein the catheter is a catheter for delivery of a diagnostic medium.

40. A method as claimed inclaim 37 or38 wherein the catheter is a catheter for delivery of a lytic agent.

41. A method as claimed in any ofclaims 36 to40 wherein the filter is slidably disposed on the guidewire when the filter is in the expanded deployed configuration.

42. A method as claimed in any ofclaims 36 to41 wherein the filter is rotatably disposed on the guidewire when the filter is in the expanded deployed configuration.

43. A method as claimed in any ofclaims 36 to42 including the steps of:

loading the filter in a collapsed configuration within a delivery catheter;

advancing the delivery catheter and filter over the guidewire to deliver the filter to a desired location; and

deploying the filter from the delivery catheter at the desired location.

44. A method as claimed inclaim 43 including the steps of:

collapsing the filter from an expanded configuration for loading the filter into the delivery catheter;

the filter being expanded to a deployment configuration on release from the delivery catheter.

45. A method as claimed in any ofclaims 36 to44 wherein the treatment location is a region of stenosis.

46. A method as claimed inclaim 45 wherein the interventional procedure includes a balloon dilation of the stenosis while the filter is deployed.

47. A method as claimed inclaim 45 wherein the interventional procedure includes a stenting of the treatment location while the filter is deployed.

48. A method for the capture and removal of embolic material from a blood vessel substantially as hereinbefore described with reference to the accompanying drawings.

49. A medical catheter for transvascular delivery and deployment of an embolic protection filter, the catheter comprising:

an outer catheter tube defining a distal end; and

an inner catheter tube defining a distal end;

the outer tube being at least partially movable relative to the inner tube between a delivery configuration in which the distal end of the outer tube extends distally of the distal end of the inner tube to define a reception space for an embolic protection filter within the outer tube, and a deployment configuration in which the distal end of the inner tube extends distally of the distal end of the outer tube for deployment of the embolic protection filter;

the inner catheter tube providing compressive resistance and the outer catheter tube providing stretch resistance.

50. A catheter as claimed inclaim 49 wherein the inner catheter tube at least partially comprises a relatively stiff core encased in a more pliable body.

51. A catheter as claimed inclaim 49 or50 wherein the outer catheter tube at least partially comprises a relatively stiff core encased in a more pliable body.

52. A catheter as claimed inclaim 50 or51 wherein the core is oriented to prevent elongation of the outer catheter tube and/or compression of the inner catheter tube.

53. A catheter as claimed in any ofclaims 49 to52 wherein the core comprises a mesh.

54. A catheter as claimed in any ofclaims 50 to53 wherein the core comprises a plurality of longitudinally oriented strips of a stiff material.

55. A catheter as claimed in any ofclaims 50 to54 wherein the core comprises a plurality of circumferentially oriented strips of a stiff material.

56. A catheter as claimed in any ofclaims 50 to55 wherein the core is of a metallic material.

57. A catheter as claimed inclaim 56 wherein the metal is stainless steel.

58. A catheter as claimed in any ofclaims 50 to57 wherein the pliable body is of a plastics material.

59. A catheter as claimed inclaim 58 wherein the plastic is polyamide.

60. A medical catheter for transvascular delivery and deployment of an embolic protection filter substantially as hereinbefore described with reference to the accompanying drawings.

61. An embolic protection device comprising:

a collapsible filter element for delivery through a vascular system of a patient;

the filter element comprising a collapsible filter body and a collapsible filter support frame contacting the filter body;

the filter body having an inlet end and an outlet end, the inlet end of the filter body having one or more inlet openings sized to allow blood and embolic material enter the filter body, the outlet end of the filter body having a plurality of outlet openings sized to allow through passage of blood but to retain undesired embolic material within the filter body;

the filter support frame being movable between a collapsed position for movement through the vascular system and an extended outwardly projecting position to support the filter body in an expanded position;

the frame having an intermediate section to urge the filter body in the expanded position into apposition with a vessel wall, and a proximal section extending radially inwardly of the intermediate section;

at least part of the proximal section of the frame being spaced distally to accommodate inflow of embolic material through the inlet openings in the expanded position.

62. A device claimed inclaim 61 wherein the filter body comprises one or more linking webs between adjacent inlet openings, and a part of the proximal section of the frame extends radially inwardly in alignment with the webs.

63. A device as claimed in claims61 or62 wherein the frame proximal section comprises one or more frame elements, at least one frame element providing the part of the proximal section spaced distally.

64. A device as claimed inclaim 62 or63 wherein at least one frame element provides the part of the proximal section extending radially inwardly in alignment with a linking web between adjacent inlet openings.

65. A device as claimed inclaim 64 wherein the number of frame elements is four, two frame elements extending radially inwardly in alignment with two webs between two inlet openings, and two frame elements spaced distally of the inlet openings.

66. A device as claimed in any ofclaims 61 to65 wherein the support frame is gold-plated and electropolished.

67. An embolic protection device substantially as hereinbefore described with reference to the accompanying drawings.

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