US20030187495A1 - Endoluminal devices, embolic filters, methods of manufacture and use - Google Patents

Abstract

A seamless, self-expanding implantable device having a low profile is disclosed along with methods of making and using the same. The implantable device includes a frame cut out of a single piece of material that is formed into a three-dimensional shape. The implantable device may comprise an embolic filter, stent, or other implantable structure. The present invention also allows complicated frame structures to be easily formed from planar sheets of starting material, such as through laser cutting, stamping, photo-etching, or other cutting techniques.

Description

FIELD OF THE INVENTION
• The present invention relates to seamless endoluminal devices including frame patterns for filters, their manufacture and use in the filtration and/or removal of embolic matter from fluids flowing in tubular body lumens including, but not limited to: blood flow in arteries and veins; airflow within the respiratory tract; and the flow of urine in the urinary tract. The seamless filter of the present invention may be self-expanding, is deployable via a guidewire-based system and has a low profile.[0001]
BACKGROUND OF THE INVENTION
• Embolic protection is a concept of growing clinical importance directed at reducing the risk of embolic complications associated with interventional (i.e., transcatheter) and surgical procedures. In therapeutic vascular procedures, liberation of embolic debris (e.g., thrombus, clot, atheromatous plaque, etc.) can obstruct perfusion of the downstream vasculature, resulting in cellular ischemia and/or death. The therapeutic vascular procedures most commonly associated with adverse embolic complications include: carotid angioplasty with or without adjunctive stent placement and revascularization of degenerated saphenous vein grafts. Additionally, percutaneous transluminal coronary angioplasty (PTCA) with or without adjunctive stent placement, surgical coronary artery by-pass grafting, percutaneous renal artery revascularization, and endovascular aortic aneurysm repair have also been associated with complications attributable to atheromatous embolization. Intraoperative capture and removal of embolic debris, consequently, may improve patient outcomes by reducing the incidence of embolic complications.[0002]
• The treatment of stenoses of the carotid bifurcation provides a good example of the emerging role of adjuvant embolic protection. Cerebrovascular stroke is a principle source of disability among adults, and is typically associated with stenoses of the carotid bifurcation. The current incidence of cerebrovascular stroke in Europe and the United States is about 200 per 100,000 population per annum (Bamford,[0003]Oxfordshire community stroke project. Incidence of stroke in Oxfordshire. First year's experience of a community stroke register. BMJ287: 713-717, 1983;Robins,The national survey of stroke: the National Institute of Neurological and Communicative Disorders and Stroke. Office of Biometry and Field Studies Report.Chapter4.Incidence. Stroke12 (Suppl. 1): 1-57, 1981). Approximately half of the patients suffering ischemic stroke have carotid artery stenoses (Hankey,Investigation and imaging strategies in acute stroke and TIAs. Hospital Update107-124, 1992). Controlled studies have shown that the surgical procedure carotid endarterectomy (CEA) can reduce the incidence of stroke in patients compared to medical therapy with minimal perioperative complications (<6% for symptomatic patients with stenoses >70% [NASCET,Beneficial effect of carotid endarterectomy in symptomatic patients with high grade stenoses. NEJM325: 445-453, 1991] and <3% for asymptomatic patients with 60% stenoses [ACAS,Endarterectomy for asymptomatic carotid artery stenosis. JAMA273: 1321-1461, 1995]). These results provide convincing evidence of the benefit of treating carotid stenoses. Surgery, however, does have several limitations, including: increased mortality in patients with significant coronary disease (18%), restriction to the cervical portion of the extra-cranial vasculature, a predeliction for cranial palsies (7.6%-27%), and restenosis (5%-19%; Yadav,Elective stenting of the extracranial carotid arteries. Circulation95: 376381, 1997).
• Carotid angioplasty and stenting have been advocated as potential alternatives to CEA. Percutaneous techniques have the potential to be less traumatic, less expensive, viable in the non-cervical extracranial vasculature, and amenable to patients whom might otherwise be inoperable (Yadav,[0004]Elective stenting of the extracranial carotid arteries. Circulation95: 376-381, 1997). Despite the potential benefits of this approach, emboli liberated during trans-catheter carotid intervention can place the patient at risk of stroke. Emboli can be generated during initial accessing of the lesion, balloon pre-dilatation of the stenosis, and/or during stent deployment. Additionally, prolapse of atheromatous material through the interstices of the stent can embolize after the completion of the procedure.
• The fear of dislodging an embolus from an atherosclerotic plaque has tempered the application of angioplasty and endovascular stenting to the supraaortic arteries and, particularly, to the carotid bifurcation (Theron,[0005]New triple coaxial catheter system for carotid angioplasty with cerebral protection. AJNR11: 869-874, 1990). This concern is warranted due to the significant morbidity and/or mortality that such an event might produce. While the incidence of stroke may be at an acceptable level for the highly skilled practitioner, it is likely to increase as the procedure is performed by less experienced clinicians.
• Embolic protection devices typically act as an intervening barrier between the source of the clot or plaque and the downstream vasculature. In order to address the issue of distal embolization, numerous apparatus have been developed and numerous methods of embolic protection have been used adjunctively with percutaneous interventional procedures. These techniques, although varied, have a number of desirable features including: intraluminal delivery, flexibility, trackability, small delivery profile to allow crossing of stenotic lesions, dimensional compatibility with conventional interventional implements, ability to minimize flow perturbations, thromboresistance, conformability of the barrier to the entire luminal cross-section (even if irregular), and a means of safely removing the embolic filter and trapped particulates.[0006]
• For example, occlusion balloon techniques have been taught by the prior art and involve devices in which blood flow to the vasculature distal to the lesion is blocked by the inflation of an occlusive balloon positioned downstream to the site of intervention. Following therapy, the intraluminal compartment between the lesion site and the occlusion balloon is aspirated to evacuate any thrombus or atheromatous debris that may have been liberated during the interventional procedure. These techniques are described in Theron,[0007]New triple coaxial catheter system for carotid angioplasty with cerebral protection. AJNR11:869-874, 1990, and Theron,Carotid artery stenosis: Treatment with protected balloon angioplasty and stent placement. Radiology201: 627-636, 1996, and are commercially embodied in the PercuSurge Guardwire Plus™ Temporary Occlusion and Aspiration System (Medtronic AVE). The principle drawback of occlusion balloon techniques stem from the fact that during actuation distal blood flow is completely inhibited, which can result in ischemic pain, distal is stasis/thrombosis, and difficulties with fluoroscopic visualization due to contrast wash-out through the treated vascular segment.
• Another prior system combines a therapeutic catheter (e.g., angioplasty balloon) and integral distal embolic filter. By incorporating a porous filter or embolus barrier at the distal end of a catheter, such as an angioplasty balloon catheter, particulates dislodged during an interventional procedure can be trapped and removed by the same therapeutic device responsible for the embolization. One known device includes a collapsible filter device positioned distal to a dilating balloon on the end of the balloon catheter. The filter comprises a plurality of resilient ribs secured to the circumference of the catheter that extend axially toward the dilating balloon. Filter material is secured to and between the ribs. The filter deploys as a filter balloon is inflated to form a cup-shaped trap. The filter, however, does not necessarily seal around the interior vessel wall. Thus, particles can pass between the filter and the vessel wall. The device also presents a large profile during positioning and is difficult to construct.[0008]
• The prior art has also provided systems that combine a guidewire and an embolic filter. The filters are incorporated directly into the distal end of a guidewire system for intravascular blood filtration. Given the current trends in both surgical and interventional practice, these devices are potentially the most versatile in their potential applications. These systems are typified by a filter frame that is attached to a guidewire that mechanically supports a porous filter element. The filter frame may include radially oriented struts, one or more circular hoops, or a pre-shaped basket configuration that deploys in the vessel. The filter element typically includes a polymeric mesh net, which is attached in whole or in part to the filter frame and/or guidewire. In operation, blood flowing through the vessel is forced through the mesh filter element thereby capturing embolic material in the filter.[0009]
• Early devices of this type include a removable intravascular filter mounted on a hollow guidewire for entrapping and retaining emboli. The filter is deployable by manipulation of an actuating wire that extends from the filter into and through the hollow tube and out the proximal end. During positioning within a vessel, the filter material is not fully constrained so that, as the device is positioned through and past a clot, the filter material can potentially snag clot material creating freely floating emboli, prior to deployment.[0010]
• In another prior art system an emboli capture device is mounted on the distal end of a guidewire. The filter material is coupled to a distal portion of the guidewire and is expanded across the lumen of a vessel by a fluid activated expandable member in communication with a lumen running the length of the guidewire. During positioning, as the device is passed through and beyond the clot, filter material may interact with the clot to produce emboli. This device may also be difficult to manufacture.[0011]
• Another prior art device is adapted for deployment in a body vessel for collecting floating debris and emboli in a filter that includes a collapsible proximally tapered frame for operably supporting the filter between a collapsed insertion profile and an expanded deployment profile. The tapered collapsible frame includes a mouth that is sized to extend to the walls of the body vessel in the expanded deployed profile to seal the filter relative to the body vessel for collecting debris floating in the body vessel.[0012]
• A further example of an embolic filter system involves a filter material fixed to cables or spines of a central guidewire. A movable core or fibers inside the guidewire can be utilized to transition the cables or spines from approximately parallel to the guidewire to approximately perpendicular to the guidewire. The filter, however, may not seal around the interior vessel wall. Thus, particles can pass between the filter and the entire vessel wall. This umbrella-type device is shallow when deployed so that, as it is being closed for removal, particles have the potential to escape.[0013]
• Other disadvantages associated with the predicate devices are that the steerability of the guidewire may be altered as compared to the conventional guidewires due to the presence and size of the filter. The guidewire, for example, may bend, kink, and/or loop around in the vessel, making insertion of the filter through a complex vascular lesion difficult. Also, delivery of such devices in a low-profile pre-deployment configuration can be difficult. Further, some devices include complex and cumbersome actuation mechanisms. Also, retrieving such capture devices after they have captured emboli may be difficult. Further, when deployed in curved segments, the interaction of the guidewire and/or tether elements can deform the filter frame in such a way as to limit apposition to the host vessel wall, thereby allowing potential channels for passage of embolic debris. Also, the filter media of the prior art maintains a pore diameter of approximately 80 to 120 microns. It is desirable to minimize the pore size without adversely perturbing blood flow or being prone to clogging.[0014]
• Current filter designs suffer from numerous disadvantages due to their construction. A typical wire filter is formed by manipulating multiple wires together through welding or some other form of attachment. After the wire frame is constructed, it is formed into the desired shape and a filter element is affixed onto the wire cage. A typical wire frame constructed in this manner is subject to a limited range of manipulation after the wires are adhered, since the welds or attachment areas are at an increased risk of failure due to the physical constraints of the welds themselves. A wire pair is more inclined to fracture at the weakest point, typically, a wire frame, composed of numerous wire pairs, will separate at the weld before separating in the length of the wire. Additionally, the welding of metal involves the application of increased heat to join a wire pair and a risk exists of the mesh, formed by the pairs, dripping or otherwise malforming due to the proclivity of metal to run before cooling.[0015]
• A further disadvantage to a typical wire filter is that the filter element is difficult to apply to the frame since the filter is normally applied as a sock, tube, or other such shape. The typical wire frame is formed by welding and bending into the desired shape. The filter is then affixed onto the shaped wire frame by pulling the formed filter over the shaped wire frame. An additional problem evident in this construction is that the filter element could be abraded by a protrusion formed by a weld in a wire pair. Such an abrasion could form a weakness or a tear in the filter and undermine its desired functionality.[0016]
• Simple and safe blood filtering and guidewire systems that can be temporarily placed in the vasculature to prevent distal embolization during endovascular procedures, and that can be used to introduce and/or exchange various instruments to a region of interest without compromising the position of the filter or guidewire, are required. Existing guidewire-based embolic filtering devices are inadequate for these and other purposes. The present apparatus, in contrast, provides a novel means of providing these and other functions, and has the further benefit of being easier to manufacture than the devices of the prior art.[0017]
SUMMARY OF THE INVENTION
• The present invention relates to seamless implantable devices, filters, methods of manufacture, systems for deployment and methods of use.[0018]
• One aspect of the present invention is to provide a low profile filter formed from a single piece of material.[0019]
• Another aspect of the present invention is to provide a self-expanding filter that is seamless.[0020]
• A further aspect of the present invention is to provide an integral self-expanding filter frame that is seamless.[0021]
• A still further object of the present invention is to provide a seamless, low-profile filter that minimally perturbs flow.[0022]
• A further aspect of the present invention to provide a low profile, seamless filter that is readily connected to the guidewire of a endoluminal deployment system.[0023]
• A further aspect of the invention is to provide a filter apparatus, which maintains vessel wall apposition and a maximally open mouth when deployed in tortuous anatomy.[0024]
• A further aspect of the invention is to provide a filter frame, which can be rendered sufficiently radiopaque.[0025]
• A further aspect of the present invention is to provide filters which have increased capture efficiency and are capable of providing drug delivery.[0026]
• A further aspect according to the present invention includes providing a seamless frame having a proximal end, a longitudinal axis, a seamless support member circumscribing the axis and distally spaced from the proximal end, and at least one attachment strut, and optionally at least one filter strut seamlessly extending from the support member.[0027]
• Another aspect of the present invention is to provide a seamless frame having a proximal end, a longitudinal axis, a seamless support member circumscribing the axis and distally spaced from the proximal end, and at least one attachment strut, optionally at least one filter strut seamlessly extending from the support member, and at least one or more filter media layers.[0028]
• Another aspect of the present invention is to provide implantable devices that may be configured as detachable devices designed for permanent implantation and/or subsequent retrieval and are used for: temporary vascular occluders; exclusion of bleeding varices or aneurysmal vascular segments; a stent, or similar means of providing structural support to an endoluminal cavity; a thrombectomy/atherectomy instrument; an implantable prosthetic vascular conduit wherein the proximal filter frame functions as an anchoring stent, and the distal filter is configured into an open-ended, tubular configuration (similar to a windsock) allowing endoluminal lining of a vascular segment with a biocompatible liner.[0029]
• An aspect of the present invention is to provide seamless implantable devices formed from a single piece of material.[0030]
• Another aspect of the present invention is to provide seamless implantable devices that have regions of articulation and/or radiopaque markers.[0031]
• A further aspect of the present invention to provide seamless implantable devices that include radiopaque markers.[0032]
• A still further aspect of the present invention is to provide stents or similar means of providing structural support to an endoluminal cavity, and which may include regions of articulation and/or radiopaque markers.[0033]
• A further aspect of the present invention to provide a seamless stent, or similar means of providing structural support to an endoluminal cavity.[0034]
• A still further aspect of the present invention is to provide a delivery system for the inventive seamless devices, stents, occluders, filters and its use. These and other features and aspects of the invention will become more apparent in view of the following detailed description, non-limiting examples, appended claims and drawings.[0035]
BRIEF DESCRIPTION OF THE DRAWINGS
• FIGS. 1A, 1B and[0036]1C illustrate the steps of constructing a first two-dimensional frame, whereas FIGS. 1D and 1E illustrate a resulting three-dimensional shape with a filter media attached thereto.
• FIGS. 2A, 2B and[0037]2C respectively illustrate an alternate configuration of a two-dimensional frame, a resulting three-dimensional shape after annealing and a depiction of the frame with a filter media attached.
• FIGS. 3A, 3B and[0038]3C respectively illustrate an alternate configuration of a two-dimensional frame, a resulting three-dimensional shape after annealing and a depiction of the frame with a filter media attached.
• FIGS. 4A, 4B and[0039]4C respectively illustrate an alternate configuration of a two-dimensional frame, a resulting three-dimensional shape after annealing and a depiction of the frame with a filter media attached.
• FIGS. 5A, 5B and[0040]5C respectively illustrate an alternate configuration of a two-dimensional frame, a resulting three-dimensional shape after annealing and a depiction of the frame with a filter media attached.
• FIGS. 6A, 6B and[0041]6C respectively illustrate an alternate configuration of a two-dimensional frame, a resulting three-dimensional shape after annealing and a depiction of the frame with a filter media attached.
• FIGS. 7A, 7B and[0042]7C respectively illustrate an alternate configuration of a two-dimensional frame, a resulting three-dimensional shape after annealing and a depiction of the frame with a filter media attached.
• FIG. 7D illustrates an annealed frame pattern having articulation segments in the attachment struts and FIG. 7E illustrates a frame pattern having longitudinally spaced support members interconnected by articulation segments.[0043]
• FIGS. 8A, 8B and[0044]8C respectively illustrate an alternate configuration of a two-dimensional frame, a resulting three-dimensional shape after annealing and a depiction of the frame with a filter media attached.
• FIGS. 9A, 9B and[0045]9C respectively illustrate an alternate configuration of a two-dimensional frame, a resulting three-dimensional shape after annealing and a depiction of the frame with a filter media attached.
• FIGS. 10A, 10B and[0046]10C respectively illustrate an alternate configuration of a two-dimensional frame, a resulting three-dimensional shape after annealing and a depiction of the frame with an integral filter media.
• FIGS. 11A, 11B and[0047]11C respectively illustrate an alternate configuration of a two-dimensional frame, a resulting three-dimensional shape after annealing and a depiction of the frame with a filter media attached.
• FIGS. 12A, 12B,[0048]12C,12D and12E respectively illustrate alternate apex and strut configurations adapted to accept and house radio-opaque markers.
• FIG. 13 illustrates a three-dimensional frame with an attached filter media positioned between a guidewire and an atraumatic tip.[0049]
• FIGS. 14A and 14B depict the filtering apparatus as deployed within a vessel having tortuous anatomy.[0050]
• FIG. 15 illustrates an alternate system for assembling an alternate embolic filter configuration.[0051]
• FIG. 16 illustrates a system for assembling a filter-in-filter device.[0052]
• FIG. 17 illustrates the filter-in-filter assembled using the system of FIG. 16.[0053]
• FIGS. 18A, 18B and[0054]18C respectively illustrate a tooling device, a two-dimensional frame being formed into a three-dimensional configuration, and the tooling device supporting the three-dimensional frame for annealing.
• FIGS. 19A, 19B and[0055]19C respectively illustrate the steps for converting a conical filter into “sombrero” shaped filter configuration.
• FIG. 19D illustrates a three-dimensional frame supporting a “sombrero” shaped filter media.[0056]
• FIGS. 19E and 19F depict an alternative filter sack configuration in which the sack resembles an asymmetric cone.[0057]
• FIGS. 20A, 20B and[0058]20C respectively illustrate a filter-in-filter configuration with a pharmacological agent loaded in the space between the filter media, an alternate filter configuration with the filter media pre-loaded with the pharmacological agent, and the elution of the pharmacological agent in a lumen/vessel of a host.
• FIGS. 21A and 21B respectively illustrate deployment of an occluder device in a lumen/vessel of a host and the detachment of the occluder.[0059]
• FIGS. 22A and 22B respectively illustrate the deployment of an obstruction remover and collection of removed lesion debris in a lumen/vessel of a host.[0060]
• FIGS. 23A, 23B and[0061]23C illustrate the use of an anchoring device for treatment of a lesion in tortuous vessels associated with renal anatomy.
• FIGS. 24A, 24B,[0062]24C,24D and24E respectively illustrate a two dimensional frame, a three-dimensional resulting shape, an endovascular device formed from the three-dimensional frame and an open-ended windsock, the occlusion of a sacular aneurysm in a host lumen/vessel with the endovascular device and optional use of a stent lining the device.
• FIG. 25A illustrates a delivery catheter having a guidewire lumen and guidewire supported filter.[0063]
• FIGS. 25B, 25C,[0064]25D and25E respectively illustrate views of alternate distal catheter delivery tips.
• FIGS. 25F, 25G and[0065]25H respectively illustrate three-dimensional top views of catheter tube having a channel indented in its surface adjacent its distal end, a sleeve covering the indented channel and a guidewire located in the sleeve covered-indented channel.
• FIGS. 26A, 26B,[0066]26C26D and26E respectively illustrate steps followed in treating a lesion in a host lumen/vessel.
• FIGS. 27A, 27B and[0067]27C respectively illustrate a view of the distal tip a delivery catheter with an alternate auxiliary lumen configuration, a three-dimensional top view of the auxiliary lumen configuration and an auxiliary lumen mounted guidewire.
• FIG. 28 illustrates a configuration of the present invention deployed as an implantable vena cava filter.[0068]
• FIGS. 29A and 29B respectively illustrate an alternate two-dimensional planar configuration of the present invention, and a three-quarter isometric view of this configuration formed into a three-dimensional shape designed for use as an implantable stent.[0069]
• FIG. 30 is a flat pattern view of a filter frame and integral tether elements as would be cut from a tube.[0070]
• FIG. 31 is a flat pattern view of a filter frame and integral tether elements after being formed and annealed at a functional size.[0071]
• FIGS. 32A, 32B,[0072]32C,32D and32E respectively show variations in the tether geometry, designed to allow the tethers to articulate with respect to one another and to the filter frame itself.
DETAILED DESCRIPTION OF THE INVENTION
• As used herein the following terms are defined as followed:[0073]
• The term “proximal” is defined as the location closest to the catheter hub and “distal” is the location most distant from the catheter hub. With respect to the inventive three-dimensional uni-body frame, the term “proximal” is the frame end attached to the guidewire or the frame side through which debris enters to be collected by an associated filter.[0074]
• The term “uni-body” refers to a frame pattern formed from a single piece of material and therefore considered “seamless.”[0075]
• Terms such as unitary, integral, one-piece are synonymous with “uni-body” and also refer to a frame pattern that is formed from a single or common piece of material.[0076]
• Filament, wire or ribbon are alternate terms used to describe the portions/sections of pattern material that remain after etching a planar precursor frame material and form the attachment struts, the support struts, the filter/filter support struts that extend in the longitudinal, circumferential, or any other direction necessary to define a frame pattern.[0077]
• FIGS.[0078]1A-1D schematically show the four method steps that are followed to manufacture a uni-body, self-expanding filter device in accordance with the present invention. FIG. 1A shows aflat sheet material110, preferably a shape memory alloy material, e.g., a NiTi alloy, Nitinol, or any other suitable bioacceptable material, such as a metal, e.g., stainless steel, or bioacceptable polymer. Theflat sheet material110 is used to form the “uni-body”frame pattern115 of FIG. 1C, or other frame patterns described hereinafter.
• A desired pattern is formed on[0079]sheet material110, as in the case of FIG. 1B, which shows a radially symmetric filter frame pattern having six “pie” shapedwedges120. Thewedges120 are removed by etching in a chemical photo-etching process, or any other suitable technique, to form a frame defined by filament sized material. The frame pattern can also be obtained by using a laser or any other cutting procedure or process capable of precisely etching, stamping, or otherwise cutting theflat sheet110 into the preferred shape.
• Radial sides[0080]125,130 andarcuate side135 circumscribe thewedges120.Slits145 are formed andcenter section150 is removed by any suitable cutting technique. After theslits145 are formed, andwedges120 andcenter section150 removed, flashing140 is removed (such as by trimming with fine scissors or diagonal cutters), leaving the desired skeletal two-dimensional filter frame/pattern115, shown in FIG. 1C.
• [0081]Skeletal frame115 includes attachment struts155 withproximal ends165 that are to be fixed or attached to proximal connectingmember170 of FIG. 1 D, adapted to cooperate with a guidewire (not shown). Attachment struts155 extend seamlessly from support struts156 because they are formed from the same precursor material. Support struts156 are seamlessly connected to or seamlessly interconnected with one another.
• Seamlessly interconnected support struts[0082]156 define a boundary, perimeter or cell having the configuration of a six-pointed “star.” Whenframe115 is converted into a three-dimensional configuration, the seamlessly associated/interconnected struts156 typically form a “closed”support member156A that circumscribes the longitudinal axis of the three-dimensional frame, thereby providing a radial or transverse dimension to the three-dimensional frame. The boundary, perimeter, cell orsupport member156A can be any geometric configuration so long as it provides a radial dimension (transverse to the longitudinal axis) for the frame. The support member circumscribes the longitudinal axis of the frame and may also be described as being ring-shaped. In addition to providing the frame with a radial dimension, as shown in FIG. 1D, thesupport member156A is typically the location for attaching the proximalopen end161 of thefilter160. Thus the support member also functions to maintain the proximal end offilter media160 in the open operative configuration.Filter media160 may be formed from any suitable material, and also includes a closeddistal end162.
• The planar, two-dimensional frame pattern of FIG. 1C is then annealed, normally by thermal annealing, into a three-dimensional configuration. The three-dimensional annealed[0083]frame configuration175, may be further processed, as described hereinafter, to include a filter media resulting infilter100 which includes theframe175 and filtermedia160, as in FIGS. 1D and 1E. For ease of consistency and brevity throughout the remainder of the application and without relinquishing equivalents thereof, Nitinol is used as the filter frame material in each and every embodiment shown and described hereinafter. However, as discussed above, other suitable materials, such as, titanium nickel alloys, shape memory materials, biocompatible metals, e.g., stainless steel, or plastic may be used for the uni-body filter frame.
• FIGS.[0084]2A-2C through11A-11C depict alternate filter frame patterns that can be formed following the procedures described with reference to FIGS.1A-1E. As a result, the various struts are seamlessly interconnected since they are formed from the same precursor material.
• FIG. 2A illustrates a plan view of an[0085]alternate frame pattern215 having hoop shapedstruts256 connected to attachment struts255. FIG. 2B illustrates the threedimensional filter frame275 after annealing with proximal ends of the attachment struts255 fixed to the proximal connectingmember270 and struts256 seamlessly connected to one another and forming aclosed support member256A. As with FIG. 1C, struts255 seamlessly extend fromsupport member256A. FIG. 2C illustrates afilter200 attached to aguidewire280. Thefilter200 includes the three-dimensional frame275 with afilter media260 having a “butterfly” configuration. The configuration offilter media260 can also be described as substantially parabolic.
• FIG. 3A illustrates an alternate two-dimensional (plan view)[0086]frame pattern315 having attachment struts355, attachment strut proximal ends365, filter struts385 which may also supportoptional filter media360 of FIG. 3D.Filter pattern315 also includes support struts356. Support struts356 and filter struts385, which are seamlessly associated with one another, cooperate to definecell357, which is configured in the shape of a diamond.Struts355,356 and385 are seamlessly associated with one another since they are formed from the same precursor material.Struts356 define a boundary around sixcells357 and form aclosed support member356A for maintaining the three-dimensional filter of FIG. 3C in an open, operative configuration. FIG. 3B illustrates three-dimensional frame375 that is obtained after the two dimensional filter frame pattern is annealed, with the proximal ends365 of the attachment struts355 fixed to proximal connectingmember370. In the embodiment of FIG. 3B, the filter struts385 allow the device to be used as a filter, without the filter media shown in FIG. 3C. While the filter pattern of FIG. 3B shows six filter struts385, any number of filter struts or support struts can be used, including, but not limited to 4, 5, 7, 8, 9, 10, 11, 12, etc. In addition, although FIG. 3A depicts thefilter frame315 with diamond shaped cells/openings357,cells357 can be of any geometrical shape or size, so long as the openings are of sufficient size to permit blood flow and/or filtering. FIG. 3C illustrates the annealed filter frame pattern of FIG. 3B withfilter media360 attached to aguidewire380.
• FIG. 4A illustrates a two-dimensional alternate[0087]seamless frame pattern415 having attachment struts455, support struts456, and filter/filter media support struts485. The pattern is seamless because it is formed from the same precursor material. FIGS. 4B and 4C illustrate three-dimensional views offilter frame pattern475 after annealing, with the proximal ends of the attachment struts455 fixed to the proximal connectingmember470, support struts456 formingsupport member456A, and filter media support struts485 extending in a distal direction. FIG. 4C illustrates the annealedfilter frame pattern475 of FIG. 4B withfilter media460 attached to aguidewire480.
• FIG. 5A illustrates the two-dimensional alternate[0088]seamless filter pattern515 having attachment struts555, support struts556, filtermedia support members590, and filter support struts585. The pattern is seamless because it is formed from the same precursor material. FIGS. 5B and 5C illustrate three-dimensional views of thefilter frame pattern515 of FIG. 5A after annealing,frame575, with proximal ends of the attachment struts555 fixed to the connectingmember570, support struts556 of FIG. 5A form closedsupport member556A, and filter media support struts585 extend distally away from theproximal connector570. FIG. 5C illustrates the annealedfilter frame pattern575 of FIG. 5B withfilter media560 attached to aguidewire580.
• FIG. 6A illustrates the two-dimensional alternate[0089]seamless filter pattern615 having attachment struts655, support struts656 and filter support struts685. The pattern is seamless because it is formed from the same precursor material. FIGS. 6B and 6C illustrate three-dimensional views offilter frame pattern615 of FIG. 6A after annealing, with the proximal ends of the attachment struts655 fixed to the connectingmember670, support struts656 of FIG. 6A formingsupport member656A and filter media support struts685. FIG. 6C illustrates the annealedfilter frame pattern675 of FIG. 6B withfilter media660 attached to aguidewire680.
• FIG. 7A illustrates a two-dimensional view of a seamless[0090]alternate filter pattern715 having attachment struts755 and support member struts756. The pattern is seamless because it is formed from the same precursor material, for supporting the open end offilter media760 of FIG. 7C. FIGS. 7B and 7C illustrate side views of the three-dimensional filter frame775, after annealing, with the proximal ends of the attachment struts755 fixed to the connectingmember770 and support struts756 of FIG. 7A formingsupport member756A. FIG. 7C illustrates the annealed filter frame pattern of FIG. 7B withfilter media760 attached to aguidewire780. FIG. 7D illustrates the annealed frame pattern havingarticulation segments790 in the attachment struts755. FIG. 7E illustrates an alternate design, wherein there are two longitudinally spacedsupport members756A seamlessly interconnected to one another byarticulation segments790, described in greater detail hereinafter.
• FIG. 8A illustrates a two-dimensional view of an alternate spirally configured[0091]filter pattern815. FIGS. 8B and 8C illustrate three-dimensional views of thefilter frame pattern815 of FIG. 8A after annealing,frame875, with a proximal end of theframe875 fixed to the connectingmember870. FIG. 8C illustrates the annealed filter frame pattern of FIG. 8B withfilter media860 attached to aguidewire880. In the filter frame illustrated in FIG. 8B, one of the turns of the spirally shaped frame, which is not “closed,” forms the support member that provides radial dimension to the frame.
• FIG. 9A illustrates a two-dimensional view of an alternate[0092]seamless filter pattern915 having attachment struts955 and filter media support struts985. The pattern is seamless because it is formed from the same precursor material. FIGS. 9B and 9C illustrate three-dimensional views of the filter frame pattern after annealing,frame975, with the proximal ends of the attachment struts955 fixed to the proximal connectingmember970. In this embodiment the filter media support struts985 closest to the proximal connector also function as the closed support member described herein to provide the transverse dimension of the frame and support the proximal end of thefilter960. FIG. 9C illustrates the annealedfilter frame pattern975 of FIG. 9B and filtermedia960 attached to aguidewire980.
• FIG. 10A illustrates a two-dimensional view of an alternate[0093]seamless filter pattern1015 having attachment struts1055 and a central portion of the planarNitinol precursor material1010 rendered porous1090. FIGS. 10B and 10C illustrate three-dimensional views of thefilter frame pattern1015 of FIG. 10A after annealing,frame1075, with the proximal ends of the attachment struts1055 fixed to the connectingmember1070, and theporous precursor material1090 havingpleats1095. FIG. 10C illustrates the annealedfilter frame pattern1075 of FIG. 10B attached to aguidewire1080. A separate filter media is not necessary in the embodiment illustrated in FIGS.10A-11C because theporous precursor portion1090 serves as the filter media.
• FIG. 11A illustrates a two-dimensional view of an alternate[0094]seamless filter pattern1115 having attachment andfilter strut1156 which will also function as theclosed support member1156A shown in FIG. 11B. FIGS. 11B and 11C illustrate three-dimensional views of thefilter frame pattern1115 of FIG. 11A after annealing,frame1175, with the proximal end of theclosed support member1156A fixed to the connectingmember1170. FIG. 11C illustrates the annealedfilter frame pattern1175 of FIG. 11B withfilter media1160 attached to aguidewire1180.
• Although the above embodiments show a[0095]single support member156A,256A,356A,456A,556A,656A,756A,956A, etc., it is clearly within the scope of the invention to have a plurality of longitudinally spaced support members, i.e., members that circumscribe the longitudinal axis of the frame, that are seamlessly interconnected with one another via struts or articulation segments, as in FIG. 7E. Similarly other embodiments described hereinafter may also include a plurality of seamlessly interconnected support members where the mechanism for interconnection includes struts, and/or the articulation segments which are defined hereinafter. In addition, when there are more than two support members connected to one another, some or all may be interconnected with struts and some or all may be interconnected via articulation segments. Thus, there could be a series of two, three, four or more members, and in the case with at least three support members that circumscribe the pattern's longitudinal axis, both struts and articulation segments can be used in an alternating pattern.
• FIGS. 12A, 12B,[0096]12C,12D and12E illustrate alternate configurations of stent strut, and apex designs which allow for, accept and house ancillary components. FIG. 12A depicts ahousing1210, which could be machined, stamped, lasered or etched into the stent frame.Housing1210 is then filled with amaterial1250 such as gold or platinum-iridium (to provide enhanced radio-opacity) or with a therapeutic agent such as a drug (to provide a prescribed biological response). FIG. 12B depictshousing1210 located along the side of a strut. FIG. 12C depictsmultiple housings1210 along a strut. FIG. 12D depictsmultiple housings1210 located within the strut periphery. FIG. 12E depicts an alternate shape (arrowhead) housing1210 (to be used as a radiopaque marker housing) located within the strut periphery. It should be noted that multiple shapes and sizes of housings could be configured. The radiopaque markers could be located in any strut or support member of the frame of the filter or the stent. Advantages of the application of radio-opaque markers in the fashions shown are: 1) stent cross section thickness is not increased (lending to reduction in introductory device profiles), 2) allows for precise and uniform spacing of markers, and 3) allows for a multitude of shapes (dots, arrows and other characters such as letters or words) to be easily incorporated into the frame. The housings may also provide a cavity in which to insert and/or attach onboard electronics or sensors.
• FIG. 13 illustrates an embolic[0097]filter assembly system1300 that includes three functionally distinct regions.Section1300A includes a support wire that terminates at its distal end in connectingmember1370. The support wire may be theguidewire1380 used to deliver a therapeutic device, e.g., a deployment catheter or angioplasty balloon.Section1300B is any one of the embolic filter devices described in FIGS.1A-1E through11A-11C described herein, or another other device described hereinafter.Section1300C may include anatraumatic tip1396 or other suitable tip known to those skilled in the art having a proximal end fixed/attached/cooperating with distal connecting member.
• FIG. 14A depicts the[0098]filter apparatus1400 as deployed in avessel1420 with tortuous anatomy. As shown, such a condition results in a non-linear apparatus deployment configuration. In order forfilter frame1410 to maintain sufficient vessel wall apposition (which eliminates peri-device channel formations), thetether elements1430 must be capable of deforming and/or articulating.
• FIG. 14B depicts the[0099]filter apparatus1400 as deployed at a different site within thesame vessel1420 anatomy of FIG. 14A, once again demonstrating the flexibility required of the deflecting and articulatingtether elements1430. It is clear in this depiction that theguidewire1440 does not necessarily follow the host vessel centerline. This phenomenon, coupled with anatomical variances and the requirement of complete vessel wall apposition of thefilter frame1410 makes the inclusion of articulating tether elements1430 a benefit and necessity for safe and confident embolic protection of downstream vasculature.
• FIG. 15 illustrates an arrangement to attach a filter media to any of the annealed filter frames described herein. The[0100]frame1515, is sandwiched betweenfilter media portions1560A and1560B, which are respectively sandwiched betweencushion elements1500C and1500D, which layered assembly is located between heatedtop plate1500A andheated base plate1500B. Thus, resulting three-dimensional lamination of FIG. 15 has a cross-sectional view that is substantially conical. Application of heat and pressure, viaheated platens1500A and1500B, result in the integral bonding of thefilter media1560A and1560B, and the interposedframe1515. The filter frame configuration via the lamination procedure depicted in FIG. 15 results in a filter assembly configuration resembling a “butterfly net.”
• FIG. 16 schematically shows an alternate procedure for attaching filter media to an annealed filter frame. In FIG. 16, an annealed[0101]filter frame1615 is sandwiched between adjacent laminae of inner filter media1660A andouter filter media1660B. Heat and pressure are applied via upper and lower punch and dieplatens1600A and1600B. The application of heat and pressure results in an integral bonding of thefilter media1660A and1660B and interposedframe1615. During the heating and pressure lamination process, a vacuum may be applied in thelower platen1600B thereby bonding the filter media and skeletal filter frame together. The filter media shown in FIG. 16 is normally interposed only within the immediate vicinity of thefilter frame1615. Additionally, the application of the vacuum can be used to optimize the filter frame geometry. The method shown in FIG. 16 can produce a filter frame configuration that resembles a butterfly net, such as the one shown in the device of FIGS.7A-7C. This method can also be used to produce a frame-supported “filter-in-filter,” which is shown in further detail in FIG. 17, described below.
• FIG. 17 shows an alternate embodiment of the present invention incorporating a two stage “filter-in-filter” design. The filter-in-filter design will provide improved filtration efficiencies, such as allowing each filter lamina to have a different porosity by using an[0102]inner filter media1760A and anouter filter media1760B. Alternatively, eitherfilter media1760A or1760B can incorporate an integral Nitinol frame as one of the filter members. Alternatively still, both the inner andouter filter media1760A and1760B could be an integral Nitinol filter frame. Use of an uni-body Nitinol frame, such as those described herein, would provide additional structural benefits in the completed filter frame apparatus.
• FIGS. 18A, 18B, and[0103]18C schematically illustrate an annealing method in which a planar, two-dimensional filter frame is converted into a three-dimensional configuration with the use of an appropriate fixturing/tooling device, e.g., a mandrel.Mandrel1800A, shown in FIG. 18A, is used to form thefilter frame1815 of FIG. 18B into the desired shape. After cutting a flat metal sheet into the desired two dimensional configuration, such as that described above, the proximal ends1865 of attachments struts1855, i.e., the endpoints of the two-dimensional filter frame1815, are collected at a point along the axis of radial symmetry as shown in FIG. 18B. As depicted in FIG. 18C, thefilter frame1815 is placed onto the fixturing device, which, in this case, is themandrel1800A of FIG. 18A to impart a defined, three-dimensional configuration, and theframe1815 of FIG. 18B is annealed to preserve the desired configuration. After annealing, the three-dimensional filter frame1875 can be elastically deformed into its original two-dimensional shape where a filter media can be applied according to any of the methods described and illustrated herein.
• Following the attachment of the filter media, the three-dimensional filter configuration is readily obtained.[0104]
• FIGS. 19A, 19B,[0105]19C and19D illustrate an alternate filter configuration using a “sombrero” shapedfilter media1960B with a supporting frame. To form the sombrero frame and filter shown in FIG. 19D, aconical filter1960, as shown in FIG. 19A, has its closeddistal end1962 inverted toward the openproximal end1961 of theconical filter1960, to form a convex, hat-like base as shown in FIG. 19B. This inversion shortens the filter length, but retains the original area of thefilter element1960. Next, the convexity is increased until the apex1963 extends beyond theopen end1961, as shown in FIG. 19C. Thefilter1960 thus has been shortened further, but the effective filter area still remains identical to the original conical filter area. Thesombrero filter1960B is attached toframe1975, FIG. 19D. The frame includes attachment struts that are fixed to a connectingmember1970, which in turn is cooperatively associated with aguidewire1955. Compared to conventional conical filter frame designs, the sombrero filter frame allows more surface area per unit length, or, alternatively, reduces filter length without compromising filter surface area and deflection of the trapped debris away from the vessel centerline. The desired sombrero filter frame configuration will also increase the reliable removal of entrapped debris.
• FIGS. 19E and 19F depict an alternate filter sack configuration, also designed to collect and hold embolic debris away from the vessel centerline. In this case, an asymmetric cone shaped filter media sack[0106]1990 is produced and attached to thefilter frame1960. Collected emboli will tend to collect at the tip of thesack1990 and are t held offset in the vessel, thus allowing relatively unperturbed flow at the vessel centerline.
• As shown in FIGS. 20A, 20B and[0107]20C, a filter in accordance with the present invention can be used to deliver a pharmaceutical substance, anti-thrombotic agent, drug, etc., into the blood flow in a host lumen/vessel by deploying the filter in a lumen/vessel of interest. In FIG. 20A, a filter device such as that described in FIG. 17 above, can be loaded with a pharmacological agent in one or more different areas before delivery into the host. Thus, the drug can be loaded between layers of the filter media. Thedrug2098 may be retained within the zone/space/area between theinner filter media2060A andouter filter media2060B ready to be delivered to the host.
• Instead of using the filter-in-filter design of FIG. 17, any of the other filter configurations described herein can be used by imbibing the drug into the filter media itself. As shown in FIG. 20B, the[0108]drug2098 can be imbibed into themedia2060 itself.
• FIG. 20C illustrates drug administration in the host by deploying the drug delivering system of FIGS. 20A or[0109]20B in a host lumen/vessel so that the blood flows through the filter media to elute the pharmacological agent, e.g., drugs. This method of localized drug delivery is effective for eluting a pharmacological agent contained either between adjacent layers of filter media or imbibed directly into the filter media. Fluid flow through the filter device of FIGS. 20A or20B, or any other filter configuration described herein containing pharmacological agents provides a mechanism of mass transfer to downstream perfusion beds. The pharmacological agent could be pre-loaded into the filter or injected post deployment perhaps through an extension of the support/guidewire.
• As shown in FIGS. 21A and 21B, occluding[0110]device2175 can be formed as a detachable endoluminal filter frame that can be implanted in the host. Theoccluding device2175 thus implanted can either be permanently implanted or retrieved at a later point in time, such as is required in vena cava filtering applications. As shown in FIG. 21A, blood flow through the host can be obstructed by the implantation of thefilter frame apparatus2100. Thefilter frame apparatus2100, used as an indwelling or implantable occlusion device is shown in FIG. 21A. As shown in FIG. 21B, a guidewire orsupport wire2180 includes adistal end2181 that may be detached fromproximal connector2170 that is connected to theoccluding device2175 orfilter frame apparatus2100. Thesupport wire2180 is used to position or removeoccluding device2175 orfilter frame apparatus2100 from a lumen in a host. Theguidewire tip2181 may be of any design for detachment from or reattachment toproximal connector2170. Thus, theguidewire2180 can have any capture capability, including screw threads, magnetic, ball-and-socket, male-female attachment, bayonet, or any type of coupling that will allow theguidewire2180 to detach or reattach to theproximal connector2170 for placement or movement therein.
• FIGS. 22A and 22B illustrate the use of a filter (similar to the[0111]filters100 or700, respectively shown in FIGS. 1D or7C) to remove flow obstructions or to function as a thrombectomy device to remove intraluminal thrombus, for example. FIG. 22A shows an obstruction at the lumen wall in a blood vessel of the host. Though commonly the lesion will have formed in a restrictive manner, the lesion is shown in a cross-sectional area with an upper and a lower component, that has narrowed the effective diameter of the lumen.Filter2200 includes sharpenedsupport members2285 to enable the filter to be used as a type of scraper. Theframe2275 shown herein includes afilter media2260 as a “catch bag.” In FIG. 22B, thefilter2200 is pulled with sharpenedmembers2285, effectively shearing the obstruction/lesion from the vessel wall of the host. As the lesion is sheared from the wall, sheared lesion parts are collected in the catch bag orfilter media2260. In this manner, the present filter frame can be used to remove lesions and collect the debris dislodged into the blood stream, to lessen the possibility of clotting downstream of the host vessel. This approach can likewise be used to capture and remove foreign objects from bodily passageways.
• FIGS. 23A, 23B and[0112]23C respectively illustrate the use of the inventive filter as an anchoring guidewire to facilitate the retention of a guidewire position in tortuous vessels of the renal circulatory system, and in particular for branch lumens offset at angles of approximately 90°. Using the inventive filter frame as an anchor avoids or minimizes damage to the host vessel, and specifically avoids or minimizes damage to the endothelium of the host lumen/vessel. FIG. 23A shows alesion2300A in a branch lumen/vessel2300B associated with the renal anatomy of a host. In the non-limiting embodiment of FIGS.23A-23C, thebranch lumen2300B includes an approximate 90° turn toward the existing anatomy shown. As illustrated in FIG. 23B afilter frame2375 is positioned and anchored in a renalcirculatory vessel2300B to fix the position of thesupport wire2380. A slight pressure is imposed on thesupport wire2380 and the approximate 90° turn is extended to more than 90° without dislodging or altering the position of the guidewire in relation to the host anatomy as shown in FIG. 23B.
• As shown in FIG. 23C, a[0113]therapeutic catheter2300C can be inserted over thesupport wire2380 of the filter frame to perform the intervention. As a result, therapy devices can more easily negotiate a greater than900 bend as shown in FIGS. 23B and 23C. Such therapy devices include, but are not limited to balloons, stents, etc. A further useful aspect of this embodiment is that, during its use, a long “exchange length” guidewire is unnecessary. Since this device is capable of maintaining it's positioning after deployment, the necessity of “rapid exchange” or “monorail” catheters are obviated.
• FIGS. 24A, 24B,[0114]24C,24D and24E show a further embodiment of the present filter frame assembly, which is intended to function as animplantable endoprosthesis2476. As shown in FIGS. 24A and 24B, the initialseamless filter frame2475 is formed from a loop-type frame2415 from the same precursor material. In FIG. 24C, the proximal end of an open-ended “windsock” shapedgraft component2477 is attached to the loop of thefilter frame2475 to form anendoprosthesis2476. In FIG. 24D, the loop-type frame2475 with the attached open-ended windsock is deployed proximal to an aneurysmal defect, and the windsock shapedgraft component2477 extends downstream of the frame, effectively excluding theaneurysm2400A. Thus, frame and the opened ended sock function as an implantable prosthetic vascular conduit where thefilter frame2475 functions as an anchoring stent, and the open-ended sock functions as a biocompatible liner. This device, shown in FIG. 24E, may then be optionally lined with astent2480. This embodiment finds use as a stent and graft combination where the stent element would be deployed proximal to the intended therapy site and the graft element would be configured to be deployed by blood pressure.
• FIGS.[0115]25A-25H illustrate an exemplary delivery system for deploying thepresent filter frame2575 orfilter2500 of the present invention. FIG. 25A illustrates aframe2575 or frame-filter2500, such asframe175 or frame-filter100 of FIGS. 1D or1E,frame375 or frame-filter300 of FIGS. 3B and 3C, or any of the other frame or frame—filter assembly herein described, attached to a support orguidewire2580 and positioned within atubular delivery sheath2500A of a delivery catheter. FIGS.25B-25D illustrates front views taken from sectional plane A-A of FIG. 25A, but without theframe2575 or frame-filter2500. The section A-A1 (FIG. 25B) illustrates a dual lumen extrusion catheter sheath. Section A-A2 (FIG. 25C) illustrates a single lumen extrusion having an additional covering formed from a shrink tube. Section A-A3 (FIG. 25D) illustrates a second lumen adhered to the inner diameter of thetubular delivery sheath2500A of FIG. 25A.
• FIG. 25E-[0116]25H illustrate the perspective detail ofexternal guidewire2580 loading of a catheter lumen. FIG. 25E is a front view of the FIG. 25G. FIG. 25F illustrates the catheter having a longitudinally extending indented channel, which, as seen in FIG. 25G is circumscribed by atubular section2500C. Theguidewire2580 is inserted into thelongitudinally extending channel2500B between the external wall of the catheter and thetubular section2500C. In use, a filter frame or filter-frame construct is pre-loaded into the distal end of the sheath adjacent to an exterior wire guide channel. The exterior wire guide is adapted to receive a guidewire in a rapid exchange configuration, however, unlike the prior art, the filter frame andguidewire2580 are completely segregated and no aperture exists.
• FIGS. 26A, 26B,[0117]26C,26D and26E illustrate a method of using afilter frame assembly2600 in accordance with the present invention. In FIG. 26A, a lumen/vessel2600A of the host has alesion2600B. Aguidewire2680 is deployed into the lumen/vessel2600A past thetarget lesion2600B. Thereafter,guidewire2680 is back-loaded into thedelivery system2600C, such as the one described in FIGS.25B-25D,25F-25G, or FIG. 27B. Then thedelivery sheath2600C is advanced across thetarget lesion2600B. Thedelivery sheath2600C is withdrawn, thereby allowing a self-expandingfilter2600 to deploy. The self-expandingfilter2600 is normally designed to deploy spontaneously after thedelivery sheath2600C has been withdrawn in this manner. Thus, as shown in FIG. 26C, thefilter2600 is deployed downstream of thelesion2600B. Atherapeutic catheter2600D, such as an angioplasty balloon, is routed over thesupport wire2680 in FIG. 26D to treattarget lesion2600B. As also shown in FIG. 26D, when the therapy is performed, thefilter2600 functions to capture any emboli dislodged or removed by thetherapeutic catheter2600D. Thereafter, as illustrated in FIG. 26E, thefilter2600 is removed via insertion of atubular capturing catheter2600E over the support wire and retraction of thefilter2600 into thecapture catheter2600E is performed. This retraction can be performed by pulling thefilter2600 partially back into thecapture catheter lumen2600E, effectively trapping theemboli2600F. In this manner, the lesion is dissipated through a therapeutic catheter without the result of any of the dislodged emboli or debris dislodging into the host.
• FIGS. 27A, 27B and[0118]27C illustrate alumen2710 having an auxiliary, internally positionedchannel2720 for receiving aguidewire2730. FIG. 27A illustrates the tip of the sheath having an internally located, peripherally positionedauxiliary channel2720 formed by “pinching” the end of the tube wall as shown in FIG. 27B. FIG. 27C shows theguidewire2730 inserted through into the slit opening in the side of the catheter and exiting the tip.
• FIG. 28 illustrates the use of the[0119]inventive filter2800, as a vena cava filter. Since the inventive filters described herein may be readily detachable, thefilter2800 can be readily detached from a deployment guidewire.
• FIG. 29A illustrates a planar two-dimensional seamless pattern, formed from metallic material, or any other suitable biocompatible material. FIG. 29B illustrates a three-dimensional stent member formed from the planar two-dimensional pattern of FIG. 29A, for use as an intraluminal stent. When extremely thin wall sections are required, such as in coronary stents, it is appropriate to fabricate the device from a planar sheet of material.[0120]
• Planar material can be manufactured thinner than tubing due to the extra requirements of concentricity placed upon tubing stock. It should be noted that although only one design has been depicted, a wide variety of patterns and cell geometries may be produced from planar material. The various cell geometries are defined by the interconnected struts of the stent. In FIGS. 29A and 29B four[0121]interconnected struts2910 define the foursided cell2920. This planar material may be metallic or polymeric or a combination thereof, and in any case, may also be porous. Once the flat pattern is fabricated, it is formed into a 3-D shape (in the depicted instance, an open mesh tube). The formed stent may be either plastically deformable (and thus made from a malleable starting material) or may be self-expanding, in which case a super-elastic, pseudo-elastic or shape memory material may be used. Subsequent processing such as thermal treatment, diametric reduction, de-burring and polishing may be incurred, depending upon the specific stent design. It should be understood that multiple 3-D stent “units” could be manufactured in such a way and attached together to form a much longer device.
• FIG. 30 depicts a view of a flat pattern of[0122]filter frame3010A andintegral tether element3010B geometry as it would be cut from a tube. This tube may be made of a shape memory alloy such as Nitinol. Cutting could be accomplished by a variety of methods including machining, laser cutting, stamping or etching.
• FIG. 31 depicts the flat pattern geometry of FIG. 30 subsequent to forming and annealing at a larger, functional size. Upon annealing, the[0123]filter frame3010A resiliently maintains this larger diametrical profile and the at least onetether element3010B extends seamlessly from it.
• FIGS.[0124]32A-32E depict alternate articulation segments formed as an integral part of the tether element thereby forming different tether element geometries, which allow articulation of thetether elements3010B in relation to thefilter frame3010A. FIG. 32A depicts thetether element3010B with an area of reduced strut width e.g. reduced cross-sectional area, to allow increased flexibility. FIG. 32B depictstether element3010B with several individual areas of reduced strut width to allow increased flexibility. FIG. 32C depictstether element3010B with a reduced width and formed “hinging” area to increase flexibility. FIG. 32D depictstether element3010B with a reduced width and several formed “hinging” areas to increase flexibility. FIG. 32E depictstether element3010B divided in two for a portion of its length. This division effectively increases the tether element flexibility so as to allow articulation. The articulation segment of the tether element, therefore, is configured to enhance the flexibility of the filter apparatus (and thus, conformance to the host vessel wall) as well as to minimize inadvertent trauma translated to the host vessel wall by movement or manipulation of the guidewire.
• An articulation segment of the tether elements or struts is a desirable feature in that it allows adequate vessel wall apposition of the filter frame when the filter device is deployed in a curved segment of anatomy. In a curved segment, the tether element articulates and deflects to adjust for a non-linear deployment situation (See FIG. 14). Thus, the filter frame itself can maintain an uncompromised and fully deployed condition. Likewise, because of its ability to attenuate longitudinal translation, the articulation segment provides a means of mitigating trauma of the host vessel wall due to guidewire manipulation. It should also be noted that the required deflection and articulation of the tether elements could be bought about by metallurgical means rather than, or in combination with, geometrical means. For instance, the[0125]tether3010B and frame3010A elements of FIGS.32A-E, although seamless and integral, may be exposed to different thermal processing parameters (for example: through the use of fixturing to provide differential heat sink qualities), thus rendering thetether3010B ductile and pliable while theframe3010A maintains the stiffness required for adequate vessel wall apposition.
• The articulation segments, though described with respect to the various frame patterns can be incorporated into any of the endovascular devices described herein. An articulation segment is a localized region that provides enhanced longitudinal flexibility. A localized region may have a cross-sectional area that is the same as the remaining part a strut, but differs in geometry. Alternatively, the localized region could have the same geometry but a different cross-sectional area, or both the cross-sectional area and geometry of the localized region differ from the remaining part of the strut. An endovascular stent can have articulation segments in any of the interconnected struts of FIGS. 29A and 29B.[0126]
EXAMPLES OF THE PRESENT INVENTIONExample 1Nitinol Sheet Filter Frame and integral Tethers
• A radially-symmetric geometrical pattern comprising interconnected struts forming closed polygonal shaped cells was chemically etched from a sheet of Nitinol (NiTi) to produce a skeletal filter frame. The etching, preferably photoetching of Nitinol (Kemac Technologies, Irwindale, Calif.) is continued to achieve a desirable material thickness, to optimize the moment of inertia of the struts and to polish the surface finish.[0127]
• This filter frame is then subjected to a thermal treatment to set the phase transition temperature of the NiTi to approximately 37° C. by heating the filter frame to a temperature of about 450° C. for about 10 minutes in an air convection oven (Carbolite Corporation, Sheffield, England) followed by a rapid quench in ambient temperature water.[0128]
• The NiTi filter frame was then laminated between two (2) layers of an adhesive-coated porous polymer. The layers were positioned with the adhesive sides facing toward each other, and facing toward the NiTi. The adhesive was used to adhere the layers of film together as well as to the NiTi wire framework. A sacrificial porous polymer cushion material was used on each side of the device during this lamination procedure to provide compliance of the surface during compression. This compliance allows the earlier mentioned porous polymer membrane to conform to the wire shape. The composite sub-assembly which included cushion, porous polymer/adhesive laminate, NiTi, adhesive/porous polymer laminate, and cushion layers was then compressed in a SST fixture and heat treated at 320° C. for 45 minutes in an air convection oven (Grieve Oven, The Grieve Corporation, Round Lake, Ill.).[0129]
• Once the ‘sandwiched’ device was removed from the heat source and allowed to cool, the sacrificial cushion material was peeled away from each side of the device and the NiTi wires were disengaged from the fixture. A circular shape of approximately 0.625″ in diameter was trimmed into the porous polymer using a 20-watt carbon dioxide laser. The remainder of porous polymer was trimmed from the wire frame by hand and discarded-.[0130]
• Following the laser trimming operation (which can also be used to create the necessary pores in the filter media), the radially-oriented arms (struts) of the device were folded up and back on themselves to achieve a hollow, three dimensional, semi-conical shape. To maintain the device in this configuration, the NiTi struts were inserted into a SST tube. This tube measured approximately 0.05″ in length×0.035″ outer diameter×0.025″ inner diameter. This tube and indwelling NiTi wires were then crimped to a 0.014″ diameter guidewire to provide a guidewire based endoluminal embolic protection device. The device resembled a three dimensional “whisk” shape with a pleated porous polymer filter element attached to it.[0131]
• The resulting pleats are designed to increase filter media surface area over the generally conical shapes found in the prior art. This increase in surface area also allows for a shorter filter length which enhances deliverability of the device by a) decreasing friction in the delivery catheter and b) improving device overall flexibility.[0132]
Example 2Nitinol Tube Filter Frame and Integral Tethers
• A 1.3 mm Nitinol tube with a wall thickness of approx 0.1 mm (obtained from Nitinol Devices and Components, Fremenot, Calif.) was laser cut (Laserage Technologies Inc, Waukegan, Ill.) to a single, undulating 6 apex ring geometry with integral tethers. This frame was then lightly grit blasted at 40 psi with 20 micron silicon carbide media in a grit blasting machine made by Comco Inc, Burbank, Calif. The ring with integral tethers was then gently pushed up a tapered mandrel until it achieved a functional size of approx. 6 mm. The ring, tethers and mandrel were then subjected to a thermal treatment to set the phase transition temperature of the NiTi to approximately 37° C. in an air convection oven (Carbolite Corporation, Sheffield, England) One skilled in the art will realize that variances in the geometry, metallurgy, thickness and heat treating of the filter frame can all be varied to create alternate embodiments with varying desirable properties. The ring and tethers (now at functional size) were then lightly coated with an fluorinated ethylene propylene (FEP) powder (FEP 5101 , available from Dupont Corp, Wilmington, Del.) by first stirring the powder in a kitchen blender (Hamilton Beach Blendmaster, Wal-Mart) after the power was mixed into a “cloud”, the frame was hung into the blender for enough time for FEP to build up onto the surface of the ring. The frame, now coated with FEP powder was hung in an air convection oven (Grieve Oven, The Grieve Corporation, Round Lake, Ill.) set at 320° C. for approx. one minute followed by air cooling to room temp.[0133]
• The NiTi frame was then set atop a filter sack and attached though the application of localized heat (the heat causing the FEP coating on the ring to re-melt and flow onto the surface of the filter sack, thus providing a biocompatible thermoplastic adhesive). The tether lines were then routed through a gold tube (Johnson Matthey, San Diego, Calif.) radiopaque marker. The tethers were pulled until they began to apply tension to the frame. A guidewire was then inserted into the gold band (from the opposite direction of the tether lines). The marker band was then crimped to secure the tethers and guidewire together. A small amount of instant adhesive (Loctite 401, Loctite Corp, Rocky Hill, Conn.) was applied to create a smooth transition from the guidewire to the OD of the gold band. One skilled in the art will realize that attachment of the filter to the guidewire could be accomplished by adhesion, welding, soldering, brazing, a combination of these, or a number of other methods.[0134]
• Upon drying, this embodiment of the endoluminal embolic filter is ready for testing.[0135]
• Various illustrative examples of the invention have been described in detail. In addition, however, many modifications and changes can be made to these examples without departing from the nature and spirit of the invention.[0136]

Claims (71)

What is claimed is:

1. A filter comprising:

a seamless frame having a proximal end and a longitudinal axis, said frame having a seamless support member circumscribing said axis and distally spaced from said proximal end, said support member having at least one attachment strut seamlessly extending therefrom and terminating at said proximal end, and a filter media having an open, proximal end cooperating with said support member and a closed end extending distally away from said open end and defining the end of said filter.

2. The filter according toclaim 1 further including at least one filter strut seamlessly extending distally from support member and having a mid-point that is distally spaced from said support member, said at least one filter strut engaging and supporting said filter media.

3. The filter according toclaim 1, wherein said at least one attachment strut comprises a plurality of attachment struts each seamlessly extending from said support member and terminating at said proximal end.

4. The filter according toclaim 2, wherein said at least one filter strut comprises a plurality of filter struts seamlessly extending distally away from said support member.

5. The filter according toclaim 1, further including a plurality of filter struts seamlessly extending distally away from said support member.

6. The filter according toclaim 2, wherein there are at least two filter struts.

7. The filter according toclaim 2, wherein there are at least three filter struts.

8. The filter according toclaim 3, wherein there are between 4 and 12 filter struts.

9. The filter according toclaim 3, wherein there are at least 6 filter struts.

10. The filter according toclaim 3, wherein there is between 6 and 18 filter struts.

11. The filter according toclaim 1, wherein said at least one attachment strut and said support member are respectively formed from different portions of a helically configured frame having multiple turns, with one turn forming said support member.

12. An endovascular device comprising:

a seamless frame having a proximal end, a distal end and a longitudinal axis extending therebetween, said frame having a seamless support member circumscribing said axis and located between said proximal and distal ends, a first set of struts extending seamlessly from said support member towards said proximal end and a second set of struts extending seamlessly from said support member towards said distal end.

13. The device ofclaim 12, wherein at least one strut of said first and second struts sets includes radiopaque markers.

14. The filter according toclaim 1, wherein said filter media includes a plurality of filter media layers.

15. The filter according toclaim 14, wherein there are two filter media layers which are separated from one another.

16. The filter according to claims1, wherein the filter media includes a pharmacological agent.

17. The filter according toclaim 14, wherein at least one of said layers includes a pharmacological agent.

18. The filter according toclaim 15, wherein a pharmacological agent is located in a space between the separated filter media layers.

19. The filter according toclaim 14, wherein each of said plurality of filter media layers possesses different physical or chemical properties.

20. An endovascular device comprising:

a seamless frame having a proximal end, a seamless circular support member having a proximally and seamlessly extending attachment strut terminating in a proximal connecting end, and a biocompatible, open ended tubular member having a proximal end attached to said support member.

21. The device according toclaim 20, wherein said tubular member has a symmetrically tapered terminal end similar to a windsock.

22. The device according toclaim 20, wherein said tubular member is an endovascular graft.

23. The filter according toclaim 1, wherein said filter media is sombrero shaped.

24. The filter according toclaim 1, wherein said filter media is conically shaped.

25. The filter according toclaim 1, where said support member and said at least one attachment strut is formed from a biocompatible material.

26. The filter according toclaim 25, wherein the biocompatible material is self-expanding.

27. The filter according toclaim 25, wherein the biocompatible material is a polymer.

28. A method of constructing a uni-body, self-expanding filter frame comprising:

extracting a substantially two-dimensional filter frame pattern from common planar sheet of precursor material by cutting;

configuring said two-dimensional pattern into a three-dimensional configuration; and

thermally annealing said three-dimensional configuration.

29. The method according toclaim 28, wherein said pattern includes attachment struts and support struts.

30. The method according toclaim 28, wherein said pattern includes attachment struts, support struts and filter support struts.

31. The method ofclaim 29, wherein the precursor material is a shape memory alloy.

32. The method according toclaim 28, wherein the two-dimensional filter frame has at least one closed cell, the at least one cell including an area that has a circumference defined by a seamlessly continuous ribbon or strut of the same precursor material.

33. The method according toclaim 28, further comprising attaching a filter media to the filter frame before or after annealing.

34. The method according toclaim 33, wherein the filter media includes a pharmacological agent.

35. The method ofclaim 28, wherein a portion of said anneal frame is positioned between two layers or portions thereof of filter media and the layers assembly laminated together.

36. A method of attaching a biocompatible, permeable filter media to a three dimensional filter frame comprising:

providing a three-dimensional filter frame;

deforming the three-dimensional frame into a substantially planar, two dimensional configuration; and

adhering at least one layer of filter media on the frame.

37. A method of assembly a filter comprising

providing a conical filter element;

providing a three-dimensional seamless filter frame; and

laminating said filter element and frame together.

38. The filter according toclaim 3, wherein said plurality of attachment struts include at least one integral articulation segment.

39. The filter according toclaim 38, wherein said at least one integral articulation segment includes a geometrically altered cross-sectional attachment strut section.

40. The filter according toclaim 38, wherein said at least one integral articulation segment includes a zig-zag or undulating configuration.

41. The filter according toclaim 2, wherein at least one filter strut includes a radiopaque marker.

42. The device according toclaim 21, wherein said tubular member has an asymmetrically tapered terminal end.

43. The filter according toclaim 1, wherein said filter media is asymmetrically cone shaped.

44. A method of constructing a uni-body, frame comprising:

extracting a substantially two-dimensional plastically deformable frame pattern from a common planar sheet of plastically deformable material by cutting;

configuring said two-dimensional pattern into a three-dimensional configuration; and

thermally treating said three-dimensional configuration.

45. A method of constructing a uni-body, self-expanding frame comprising:

extracting a substantially two-dimensional frame pattern from a common planar sheet of a shape-memory alloy, self-expanding material by cutting;

configuring said two-dimensional pattern into a three-dimensional configuration; and

thermally annealing said three-dimensional configuration.

46. The method according toclaim 29, wherein said attachment struts have at least one articulation region.

47. The method according toclaim 30, wherein said filter struts are adapted to incorporate a radio-opaque marker without adding thickness.

48. The method according toclaim 44, wherein said pattern includes attachment struts and/or support struts.

49. The method according toclaim 44, wherein said pattern includes attachment struts, and/or support struts and/or filter support struts.

50. The method according to claim4-5, wherein said pattern includes attachment struts and/or support struts.

51. The method according toclaim 45, wherein said pattern includes attachment struts and/or support struts and/or filter support struts.

52. The method according toclaim 49, wherein any of said struts are adapted to incorporate a radio-opaque marker without adding thickness.

53. The method according toclaim 51, wherein any of said struts are adapted to incorporate a radio-opaque marker without adding thickness.

54. The filter according toclaim 3, wherein said at least one attachment strut includes metallurgical articulation segments.

55. The filter according toclaim 3, wherein said at least one attachment strut includes different articulation segments.

56. The filter according toclaim 1, wherein said at least one attachment strut includes at least one seamless and integral articulation segment.

57. The filter according toclaim 56, wherein said at least one seamless and integral articulation segment includes a geometrically altered cross-sectional attachment strut section.

58. The filter according toclaim 1, wherein said at least one attachment strut includes at least one seamless and integral metallurgical articulation segment.

59. A filter comprising:

a seamless frame having a proximal end and a longitudinal axis, said frame having a seamless support member circumscribing said axis and distally spaced from said proximal end, said support member having at least one attachment strut seamlessly extending therefrom and terminating at said proximal end, and at least one filter media having an open, proximal end cooperating with said support member and a closed end.

60. A device comprising:

a seamless frame having a proximal end, a distal end and a longitudinal axis extending therebetween, said frame having at least one seamless support member circumscribing said axis and located between said proximal and distal ends, at least one of a first set of struts extending seamlessly from said support member towards said proximal end and at least one of a second set of struts extending seamlessly from said support member towards said distal end.

61. The device according toclaim 60, wherein a plurality of seamless support members circumscribe said axis.

62. The device according toclaim 60, wherein at least one of said struts of said first and second sets of struts and said at least one support member includes at least one of an integral articulation member and a radio-opaque marker.

63. The device according toclaim 60, further including at least one seamless and integral articulation segment.

64. The device according toclaim 62, further including a plurality of circumscribing members, and at least one integral articulation segment, one of which seamlessly interconnects said members.

65. An endovascular device comprising:

a seamless frame having open proximal and distal ends and a plurality of seamless integral struts formed from a common precursor material, at least some of said struts being seamlessly interconnected with one another to define a plurality of closed cells, and at least one of said plurality of seamless struts optionally having at least one articulation segment and/or radiopaque marker.

66. The device according toclaim 65, wherein same frame is a tubular stent.

67. The device according toclaim 65, wherein said frame includes integral articulation segments.

68. The device according toclaim 65, wherein said frame includes radiopaque markers.

69. The device according toclaim 65, wherein said frame includes integral articulation segments and radiopaque markers.

70. The filter according toclaim 5, wherein said distally extending filter struts terminate at a common seamless distal end.

71. The filter according toclaim 12, wherein said distally extending filter struts terminate at a common seamless distal end.

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