US20080167677A1 - Filter element for embolic protection device - Google Patents

Abstract

A collapsible filter element (105) for a transcatheter embolic protection device (100) comprises a collapsible filter body (30) which is movable between a collapsed stored position for movement through a vascular system and an expanded position for extension across a blood vessel such that blood passing through the blood vessel is delivered through the filter element (105). A proximal inlet portion of the filter body (30) has one or more inlet openings (117) sized to allow blood and embolic material enter the filter body (30) and a distal outlet portion of the filter body (30) has a plurality of outlet openings (119) sized to allow through-passage of blood, but to retain embolic material within the filter body (30). The filter body (30) is at least partially of laminate construction comprising a membrane (31) coated with a coating (32, 33) which is biocompatible, the thickness of the coating (32, 33) being from 4% to 40% of the thickness of the membrane (31). The coating (32, 33) may be of hydrophilic material. To facilitate retrieval of captured embolic material the distal portion and/or an intermediate portion of the filter membrane (31) may be stretchable. The filter body (30) may have regions of varying hardness or stiffness.

Description

• This application is a continuation of pending prior application Ser. No. 09/985,820 filed Nov. 6, 2001, which is a Continuation Application of PCT Application No. PCT/IE00/00053, filed May 8, 2000, which claims benefit of priority from PCT/IE99/00033 and PCT/IE99/00036, both filed May 7, 1999. The entire disclosure of the prior application U.S. application Ser. No. 09/985,820, as well as prior filed PCT Application No. PCT/IE00/00053, filed May 8, 2000, priority of which is claimed under 35 U.S.C. §120, and prior filed Application Nos. PCT/IE99/00033 and PCT/IE99/00036 both filed May 7, 1999, priority of which is claimed under 35 U.S.C. § 119, are considered part of the disclosure of the present continuation application and are incorporated herein by reference.
• This invention relates to a filter element for a transcatheter embolic protection device.
INTRODUCTION
• The invention is particularly concerned with filter elements for transcatheter embolic protection devices of the type described in our WO-A-9923976. One type of such embolic filter essentially comprises a filter body mounted on an associated collapsible support frame which can be collapsed against the guide wire by means of a catheter for deployment of the filter through a patient's vascular system. Upon retraction of the catheter the support frame and filter body expand outwardly from the guidewire across a blood vessel within which the filter is positioned to filter blood flowing through the blood vessel.
• A practical problem that arises with filter elements of such embolic protection devices is that they should be able to accommodate blood vessels of different diameter as it would be impractical to manufacture a large range of filters each of different size to accommodate all possible diameters of blood vessel. To provide flexibility and accommodate a range of vessel sizes with a given size of filter a relatively soft and elastic filter body material can be used. It is, however, important that the filter when deployed maintains its shape during use and to prevent distortion or collapsing of the filter body in use. Because of this and also the need for adequate strength in the body material, the walls of the filter body tend to be relatively thick. This presents a problem in that the filter then has a relatively large crossing profile when in the collapsed deployment position, which is undesirable.
• The present invention is directed towards overcoming these and other problems.
STATEMENTS OF INVENTION
• According to the invention there is provided a collapsible filter element for a transcatheter embolic protection device, the filter element comprising:
• • a collapsible filter body which is movable between a collapsed stored position for movement through a vascular system and an expanded position for extension across a blood vessel such that blood passing through the blood vessel is delivered through the filter element;
  • a proximal inlet portion of the filter body having one or more inlet openings sized to allow blood and embolic material enter the filter body;
  • a distal outlet portion of the filter body having a plurality of outlet openings sized to allow through-passage of blood, but to retain embolic material within the filter body;
  • the filter body being at least partially of laminate construction comprising a membrane coated with a coating which is biocompatible, the thickness of the coating being from 4% to 40% of the thickness of the membrane to enhance the mechanical characteristics of the filter body.
• In a preferred embodiment the thickness of the coating is from 4% to 30% of the thickness of the membrane, ideally the thickness of the coating is approximately 20% of the thickness of the membrane.
• The membrane may be of a material selected from one or more of polyether block amide (PEBAX), polyester, polyethylene, polyurethane, terephthalate, nylon or, as appropriate copolymers thereof.
• In a preferred embodiment the coating is at least partially of a material selected from a non thrombogenic material and a fluoropolymer material.
• The coating is most preferably of a hydrophilic material. In one embodiment the coating is of a hydrogel material. In one embodiment the coating includes a physiologically acceptable additive. The additive may be a therapeutic additive. The additive is preferably an antithrombogenic additive such as heparin.
• In a preferred embodiment the filter body is surface treated prior to application of the coating.
• Preferably the filter body comprises a proximal body section, a distal body section and an intermediate body section interconnecting the proximal and distal body sections, one or more of the body sections being of laminate construction. The body sections may be of the same laminate construction. At least two of the body sections may be of different laminate construction.
• In one embodiment of the invention the filter body has regions of varying hardness or stiffness. Preferably the filter body has a durometer of between 60 D and 70 A Shore hardness.
• In one arrangement the filter body has a first relatively stiff portion and a second relatively soft portion. One portion or section of the filter body may have a larger wall thickness than the wall thickness of another section or portion.
• The filter body may comprise a proximal body section and a distal body section, one of which forms a stiff first portion and the other of which forms a soft second portion. In one embodiment a proximal body section forms the soft second portion.
• In one embodiment the filter body comprises a proximal body section and a distal body section interconnected by an intermediate body section, one or both of the proximal body section and the intermediate body section forming the soft second portion, the distal body section forming the stiff first portion.
• In an embodiment of the invention the proximal body section has a ribbed outer surface. A plurality of spaced-apart longitudinal ribs may be provided on the proximal section.
• In another embodiment the proximal body section includes corrugations.
• In a particularly preferred embodiment of the invention the filter body has expansion means to facilitate retrieval of the captured embolic material.
• Ideally at least the distal portion of the filter body is of a membrane material that is stretchable. Preferably at least the membrane is stretchable in the longitudinal direction to facilitate retrieval from the vasculature.
• In one embodiment the filter body includes an intermediate portion extending proximally of the distal portion, the intermediate portion being of a membrane material that is stretchable.
• The filter body is preferably of a membrane of a memory material especially a polymeric material.
• The invention also provides a collapsible filter element for a transcatheter embolic protection device the filter element comprising:
• • a collapsible filter body which is movable between a collapsed stored position for movement through a vascular system and an expanded position for extension across a blood vessel such that blood passing through the blood vessel is delivered through the filter element;
  • a proximal inlet portion of the filter body having one or more inlet openings sized to allow blood and embolic material enter the filter body;
  • a distal outlet portion of the filter body having a plurality of outlet openings sized to allow through-passage of blood, but to retain embolic material within the filter body;
  • the filter body having regions of varying hardness or stiffness.
• The invention further provides a collapsible filter element for a transcatheter embolic protection device, the filter element comprising:
• • a collapsible filter body which is movable between a collapsed stored position for movement through a vascular system and an expanded position for extension across a blood vessel such that blood passing through the blood vessel is delivered through the filter element;
  • a proximal inlet portion of the filter body having one or more inlet openings sized to allow blood and embolic material enter the filter body;
  • a distal outlet portion of the filter body having a plurality of outlet openings sized to allow through-passage of blood, but to retain embolic material within the filter body;
  • wherein of the filter body has expansion means to facilitate retrieval of captured embolic material.
• In a further aspect the invention provides a transcatheter embolic protection device including:
• • a delivery system comprising:
  • a tubular member having a longitudinal axis, distal and proximal portions, said distal portion of the tubular member being removably advanceable into the vasculature of a patient;
  • a medical guidewire longitudinally axially movable in said tubular member and having distal and proximal portions;
  • and a filter element of any aspect of the invention the filter body having;
    • a first collapsed, insertion and withdrawal configuration and a second expanded, deployed configuration;
    • a proximal inlet section and a distal outlet section, said proximal inlet section including inlet openings which are operable to admit body fluid when the filter body is in the second expanded configuration;
    • a plurality of outlet openings disposed on at least a portion of the filter element adjacent to the distal outlet section;
    • wherein said filter body is moved between said first and second configurations by displacement of said delivery system.
• The frame preferably comprises a plurality of support arms having proximal and distal ends. The arms may be formed of an elastic, a superelastic and/or a shape memory material. In one embodiment said frame is constructed such that filter body is biased toward said second, deployed configuration.
• Preferably said inlet openings are defined at least partially by said arms, proximal portions of said arms preferably extend generally outwardly and distally from said guidewire when said filter body is in said second, deployed configuration. Distal portions of said arms may extend generally outwardly and proximally from said guidewire when said filter body is in said second, deployed configuration.
• In one embodiment the distal portion of the tubular member further includes a pod for receiving therein the filter body when in said first, collapsed configuration.
• Preferably said filter body is urged into said first, collapsed configuration by said pod when the guidewire is moved proximally.
• In one arrangement said guidewire is solid.
• In one embodiment said filter body comprises a sleeve slidably disposed on said guidewire. Ideally the device comprises stops for limiting the range of longitudinal movement of the sleeve on said guidewire. The sleeve may further comprise a guidewire member distal to the filter body tapering distally.
BRIEF DESCRIPTION OF THE DRAWINGS
• The invention will be more clearly understood from the following description thereof given by way of example only with reference to the accompanying drawings in which:
• FIG. 1 is partially sectioned elevational view of an embolic protection device according to the invention;
• FIG. 2 is a schematic sectional elevational view of the embolic protection device ofFIG. 1;
• FIG. 3 is a sectional view of the distal end of the device ofFIG. 1 shown in its loaded condition within its delivery catheter;
• FIG. 4 is a longitudinal cross sectional view of the device ofFIG. 1;
• FIG. 5 is a cross sectional view of a distal end of the device ofFIG. 1;
• FIG. 6 is a view on the line A-A inFIG. 4;
• FIG. 7 is a perspective view of a filter body of the device ofFIGS. 1 to 6;
• FIG. 8 is a side elevational view of the filter body ofFIG. 7;
• FIG. 9 is a view on a proximal end of the filter body;
• FIG. 10 is a perspective view of a support frame;
• FIG. 11 is a side elevational view of the support frame;
• FIG. 12 is a perspective view illustrating the manufacture of the support frame;
• FIG. 13 is a view of the support frame and filter body assembly;
• FIGS. 14A to 14E are developed views of the distal end of a filter body illustrating different arrangements of outlet holes for filter sizes 6 mm, 4 mm, 4.5 mm, 5 mm, and 5.5 mm respectively;
• FIG. 15 is a side elevational view of another filter body of the invention;
• FIG. 16 is a developed view of the distal end of the filter body ofFIG. 15 illustrating an arrangement of outlet holes;
• FIGS. 17(a) and17(b) are perspective partially cut-away cross sectional views of a filter body before and after solvent polishing respectively;
• FIG. 18 is a graph of shear stress with outlet hole size and hole number;
• FIG. 19 is a longitudinal cross sectional view of a filter body according to the invention;
• FIGS. 20 to 25 are longitudinal cross sectional views of different embodiments of the filter body according to the invention;
• FIGS. 26 to 28 are longitudinal cross sectional views of further embodiments of the filter body according to the invention;
• FIG. 29 is a schematic perspective view of a filter element according to another aspect of the invention;
• FIGS. 30 to 33 are schematic perspective views of different embodiments of the filter element according to the invention;
• FIG. 34 is a schematic perspective view of a filter element according to a further aspect of the invention; and
• FIGS. 35(a) to35(d) are longitudinal side views of another filter according to the invention in different configurations of use.
DETAILED DESCRIPTION
• Referring toFIGS. 1 to 13 there is illustrated an embolic protection device as described in our WO-A-9923976 indicated generally by thereference number100. Thedevice100 has aguidewire101 with aproximal end102 and adistal end103. Atubular sleeve104 is slidably mounted on theguidewire101. Acollapsible filter105 is mounted on thesleeve104. thefilter105 being movable between a collapsed stored position against thesleeve104 and an expanded position as shown in the drawings extended outwardly of thesleeve104 for deployment in a blood vessel.
• Thesleeve104 is slidable on theguidewire101 between a pair of spaced-apart end stops, namely aninner stop106 and an outer stop which in this case is formed by aspring tip107 at thedistal end103 of theguidewire101.
• Thefilter105 comprises afilter body110 mounted over acollapsible support frame111. Thefilter body110 is mounted to thesleeve104 at each end, thebody110 being rigidly attached to aproximal end112 of thesleeve104 and thebody110 being attached to acollar115 which is slidable along adistal end114 of thesleeve104. Thus the distal end of thebody110 is longitudinally slidable along thesleeve104. Thesupport frame111 is also fixed at theproximal end112 of thesleeve104. Adistal end116 of thesupport frame111 is not attached to thesleeve104 and is thus also free to move longitudinally along thesleeve104 to facilitate collapsing thesupport frame111 against thesleeve104. Thesupport frame111 is such that it is naturally expanded as shown in the drawings and can be collapsed inwardly against thesleeve104 for loading in acatheter118 or the like.
• Thefilter body110 has largeproximal inlet openings117 and smalldistal outlet openings119. Theproximal inlet openings117 allow blood and embolic material to enter thefilter body110, however, thedistal outlet openings119 allow through passage of blood but retain undesired embolic material within thefilter body110.
• Anolive guide120 is mounted at a distal end of thesleeve104 and has a cylindricalcentral portion121 with tapered ends122,123. Thedistal end122 may be an arrowhead configuration for smooth transition between the catheter and olive surfaces. Thesupport frame111 is shaped to provide acircumferential groove125 in thefilter body110. If thefilter105 is too large for a vessel, thebody110 may crease and thisgroove125 ensures any crease does not propagate along thefilter105.
• Enlarged openings are provided at a proximal end of thefilter body110 to allow ingress of blood and embolic material into an interior of thebody110.
• Referring in particular toFIGS. 10 to 13 thecollapsible support frame111 has fourfoldable arms290 which are collapsed for deployment and upon release extend outwardly to expand thefilter body110.
• Thesupport frame111 can be manufactured from a range of metallic or polymeric components such as a shape memory alloy like nitinol or a shape memory polymer or a shaped stainless steel or metal with similar properties that will recover from the deformation sufficiently to cause thefilter body110 to open.
• Thesupport frame111 may be formed as illustrated inFIG. 12 by machining slots in atube291 of shape memory alloy such as nitinol. On machining, the unslotted distal end of thetube291 forms adistal collar293 and the unslotted proximal end of thetube291 forms aproximal collar294. In use, as described above, thedistal collar293 is slidably movable along thetubular sleeve104 which in turn is slidably mounted on theguidewire101 for deployment and retrieval. Theproximal collar294 is fixed relative to thetubular sleeve104.
• To load thefilter105 the sub assembly of thesupport frame111 andfilter body110 is pulled back into thecatheter118 to engage thedistal stop107. Thesupport arms290 are hinged inwardly and thedistal collar293 moves forward along thetubular sleeve104. As thesupport arms290 enter thecatheter118 thefilter body110 stretches as thefilter body collar115 slides along thetubular sleeve104 proximal to the olive120. On deployment, thecatheter118 is retracted proximally along theguidewire101 initially bringing the collapsed filter assembly with it until it engages theproximal stop106. The catheter sleeve then begins to pull off thefilter105 freeing thesupport arms290 to expand and thefilter body110 apposes the vessel wall.
• For retrieval a retrieval catheter is introduced by sliding it over theguidewire101 until it is positioned at the proximal end of thefilter body110 andsupport frame111. Pulling theguidewire101 will initially engage thedistal stop107 with the filter element and begin to pull it into the retrieval catheter. The initial travel into the retrieval catheter acts to close theproximal openings117 of the filter element, thus entrapping the embolic load. As thefilter105 continues to be pulled back thefilter body110 and thesupport frame111 are enveloped in the retrieval catheter. Thecollapsed filter105 may then be removed from the patient.
• Conveniently the tip of the catheter which forms a housing or pod for reception of the filter is of an elastic material which can radially expand to accommodate the filter with the captured embolic material. By correct choice of material, the same catheter or pod can be used to deploy and retrieve the filter. For deployment, the elastic material holds the filter in a tightly collapsed position to minimise the size of the catheter tip or pod. Then, when retrieving the filter, the catheter tip or pod is sufficiently elastic to accommodate the extra bulk of the filter due to the embolic material.
• Also, the filter is not fast on the guidewire and thus accidental movement of the guidewire is accommodated without unintentionally moving the filter, for example, during exchange of medical devices or when changing catheters.
• It will also be noted that the filter according to the invention does not have a sharp outer edge as with many umbrella type filters. Rather, the generally tubular filter shape is more accommodating of the interior walls of blood vessels.
• Conveniently also when the filter has been deployed in a blood vessel the catheter can be removed leaving a bare guidewire proximal to the filter for use with known devices such as balloon catheter and stent devices upstream of the filter.
• Theouter filter body110 is preferably of a resilient biocompatible elastomeric material. The material may be a polyurethane based material. There are a series of commercially available polyurethane materials that may be suitable. These are typically based on polyether or polycarbonate or silicone macroglycols together with diisocyanate and a diol or diamine or alkanolamine or water chain extender. Examples of these are described in EP-A-461,375 and U.S. Pat. No. 5,621,065. In addition, polyurethane elastomers manufactured from polycarbonate polyols as described in U.S. Pat. No. 5,254,622 (Szycher) are also suitable.
• The filter material may also be a biostable polycarbonate urethane article an example of which may be prepared by reaction of an isocyanate, a chain extender and a polycarbonate copolymer polyol of alkyl carbonates. This material is described in our WO 9924084.
• The filter body may be manufactured from a block and cut into a desired shape. The filter may be preferably formed by dipping a rod of desired geometry into a solution of the material which coats the rod. The rod is then dissolved. The final geometry of the filter may be determined in the dipping step or the final geometry may be achieved in a finishing operation. Typically the finishing operations involve processes such as mechanical machining operations, laser machining or chemical machining.
• The filter body is of hollow construction and may be formed as described above by dipping a rod in a solution of polymeric material to coat the rod. The rod is then dissolved, leaving a hollow body polymeric material. The rod may be of an acrylic material which is dissolved by a suitable solvent such as acetone.
• The polymeric body thus formed is machined to the shape illustrated inFIGS. 1 to 13. The final machined filter body comprises an inlet orproximal portion210 with aproximal neck212, and outlet ordistal portion213 with adistal neck214, and anintermediate portion215 between the proximal and distal portions.
• Alternatively the filter body may be formed by a blow moulding process using a suitably shaped mould. This results in a filter body which has thin walls.
• The inlet holes117 are provided in theproximal portion210 which allow the blood and embolic material to flow into the filter body. In this case theproximal portion210 is of generally conical shape to maximise the hole size.
• Theintermediate portion215 is also hollow and in this case is of generally cylindrical construction. This is important in ensuring more than simple point contact with the surrounding blood vessel. The cylindrical structure allows the filter body to come into soft contact with the blood vessel to avoid damaging the vessel wall.
• Theintermediate portion215 is provided with a radial stiffening means, in this case in the form of a radial strengthening ring or rim220. The ring220 provides localised stiffening of the filter body without stiffening the material in contact with the vessel. Such an arrangement provides appropriate structural strength so that line apposition of the filter body to the vessel wall is achieved. It is expected that other geometries of stiffening means will achieve a similar result.
• The tubularintermediate portion215 is also important in maintaining the stability of the filter body in situ to retain captured emboli and to ensure that flow around the filter is minimised. For optimum stability we have found that the ratio of the axial length of theintermediate portion215 of the filter body to the diameter of theintermediate portion215 is preferably at least 0.5 and ideally greater than 1.0.
• The outlet holes119 are provided in thedistal portion213 which allow blood to pass and retain embolic material in the filter body.
• The purpose of the filter is to remove larger particulate debris from the bloodstream during procedures such as angioplasty. In one case the filter is used to prevent ingress of embolic material to the smaller blood vessels distal to a newly-deployed carotid stent. A known property of the filter is that it will present a resistance to the blood flow. The maximum blood pressure in the arterial system is determined by the muscular action of the heart. The cardiovascular system is a multiple-redundant network designed to supply oxygenated blood to the tissues of the body. The path from the heart through the site of deployment of the filter and back to the heart can be traced through the system. In the absence of the filter this system has a resistance, and the flow through any part of it is determined by the distribution of resistance and by the pressure generated by the heart.
• The introduction of the filter adds a resistance on one of the paths in the network, and therefore there will be a reduced blood flow through this part of the circuit. It is reasonable to assume that the flow along the restricted carotid will be inversely proportional to the resistance of this branch of the circuit. For laminar flow in a tube the resistance is independent of the flow rate.
• The performance of vascular filters and particularly vascular filters for smaller blood vessels is determined by the relationship between the filter and the media being filtered. Blood is a complex suspension of different cell types that react differently to different stimuli. The defining geometric attributes of the filter structure will establish the filter's resistance to flow in any blood vessel. Ideally, all flow will be through the filter and will be exposed to minimal damage.
• All filters that do not have a sealing mechanism to divert flow only through it and will have some element of flow around it. We have configured the filter geometry such that flow through the filter is maximised and flow around the filter is minimised. Pressure drop across the face of the filter when related to the pressure drop through the alternate pathway will determine the filter efficiency.
• Related to the pressure drop, is the shear stress experienced by the blood elements. Red cells have an ability to deform under the influence of shear stresses. At low stresses (physiological) this deformation is recoverable. Additionally, a percentage of the red cell population is fragile and will fragment at low shear stress even in patients with “healthy” cell populations. While the body can deal with the rupture and fragmentation of small numbers of red blood cells, gross red blood cell damage are likely to be problematic clinically. Consideration must be given to the effects of the shear stresses, both the intensity and duration, on the constituent blood particles and the haemostatic mechanisms. It is the effects on the red blood cells and platelets that are of primary importance.
• Shear stresses can cause red cell destruction which is more pronounced in patients with red cell disorders, such as sickle cell disease. Haemolysis can lead to amaenia, which can impede oxygen transportation around the body, and in extreme cases causes damage to the kidneys, but this would be unlikely given the relatively short duration of deployment of vascular filters.
• More importantly though, shear stress also causes damage to the platelets themselves. Platelets play a key role in haemostasis and help orchestrate the complex cascade of events that lead to blood clot formation. The damage to the platelets causes communication chemicals to be released, and these “activate” other platelets in the vicinity. Once activated, the platelets swell and their surfaces become sticky, and this causes them to aggregate together and on available surfaces to form a “clump”. The released chemicals attract and activate other platelets in the area such that the clump grows in size. Fibrous proteins are also created and together a blood clot (thrombus) is formed. Depending on its size and position, the thrombus may occlude some of the holes in a vascular filter. It is also possible for the thrombus to become detached, particularly on removal of the device, and float freely away downstream to become an embolus. Should the embolus be large enough to become trapped in a narrow arterial vessel further along the system, flow in that vessel would be compromised and this could lead directly to stroke. Platelet aggregation occurs most effectively in stagnant and recirculating flow regions.
• It is also known that activated platelets can coat foreign bodies in the blood, such as intravasculature catheters. The foreign material surface then becomes sticky and therefore a site for further aggregation. This in turn could affect the local geometry of the device and the local flow characteristics.
• Shear may be expressed as follows:
• 
  Wall shear stress: τ=4μQ/πR³
• • Where μ is the blood viscosity
  • Q is the mass flow rate
  • R is the vessel radius
• InFIG. 18 we show the relationship under specific flow conditions in a stated diameter of vessel. This plot assumes a Newtonian fluid, equal flow rate through each hole, a flow rate of 270 ml/min and a 4 mm blood vessel.
• The relationship shows that as hole size decreases, then the required number of holes increases significantly.
• This representation of shear is a good general representation however, local conditions at the filter pores can have significant impact on the shear with flow irregularities generating the possibility of shear levels increasing by an order of magnitude. The location of the maximum shear stress is at the edges of the filter holes at their downstream side. The filter element of the invention has local radii and the filter entrance and exit holes to minimise the shear stress levels. Holes may be drilled using mechanical drilling or laser cutting. However, these processes can produce dimensionally repeatable holes but will impart surface conditions that are not suitable for small vessel filtration. Any fraying of edges due to mechanical cutting will certainly cause flow disruptions and form sites for platelet aggregation. Similarly laser cutting due to its local intense heating and vaporisation of the substrate will lead to pitting, surface inclusions, rough edges and surface imperfections.
• In the invention the holes are post processed to modify the surfaces and to radius the edges. A preferred embodiment of the filter element is manufactured using a medial grade polyurethane such as Chronoflex™ supplied by Cardiotech Inc. The filter holes are post-processed by solvent polishing using acetone or other suitable solvent.
• Referring in particular toFIG. 17(a) there is illustrated a section of a polymeric filter body with a number of machined outlet holes119. After solvent polishing the hoes are surface treated providing radiused lead-in and lead-out portions.
• Solvent polishing of the membrane is achieved by softening the material in the surface lavers of the membrane such that a local reflow process is facilitated. This reflow is achieved using one of two classes of solvent.
• • Solvents that have an ability to dissolve the polymer.
  • Solvents that have an ability to swell the polymer.
• The process for the first class of solvents involves exposing the membrane to a limited amount of the solvent. This is achieved by dipping the membrane in the solvent for a short time or exposing the membrane to concentrated vapours of the solvent for a time. The solvent is absorbed into the surface layers and they become solubilised. The solubilised surface layers act like a viscous liquid and they adopt configurations of lowest surface energy. The lowest energy configuration for a liquid is a sphere. The sharp edges and corners become rounded by the solubilisation of the surface. The solvent is dried to reveal a smooth solvent polished surface.
• Swelling solvents act slightly differently in that they cannot dissolve the material. However their ability to swell the material allows similar reflow processes to occur. The key difference is that the membrane is immersed in the solvent for a longer period of time, preferably in excess of 30 minutes. The solvent swelling process is most effective when the membrane material is a two phase polymer such as a polyurethane or a PEBAX, as the solvent can be selected to match either phase.
• Solvents will dissolve polymers when their solubility parameters are similar. Solvents will swell a polymer when their solubility parameters are slightly different. Preferably the swelling solvent swells the material by less than 30%. Above this level the solvent should be considered dissolving solvent.
• Having reduced the local shear stresses as described above, it is then desirable to minimise the propensity for the activated platelets to adhere to the filter substrate. The more preferred embodiment of filter is one where the polished polymeric surface is combined with a coating on the substrate.
• The swelling of the polymer matrix reduces residual stresses that may have developed during the coated core drying or lasering processes. During the lasering process, the material in the immediate proximity of the lasered holes will have been exposed to heat. This heat will disrupt hard segment crystallites and they will reform to lower order meta-stable structures or be completely dissolved in the soft phase. The heat will also induce the soft segments to contract, however, the re-arrangement of the hard segments imposes new restrictions on the recovery of the soft segments to an equilibrium (relaxed) state. Thus, on removal of the heat source (laser), the morphology of the block copolymer will have changed, in the sense that the new configurations of the hard segments and soft segments will have been frozen in. After lasering, the holes have sharp and well-defined geometries. After exposing the coated material to the solvent, the solvent uncoils the soft segment chains and disassociates low ordered hard segment that are dissolved in the soft segment phase, so on removal of the solvent, the polymer matrix dries in a more relaxed state. In so doing, the sharp, well-defined walls of the lasered holes are transformed to a more contoured relaxed state.
• Such applicable solvents for this application, but not limited to, are 2-propanone, methyl ethyl ketone or trichloroethylene.
• The solvent characteristics are described as follows at room temperature:
• • The solvent is organic, colourless and in a liquid state.
  • The overall solubility parameter of the solvent is quoted between 16 to 26 Mpa^0.5.
  • The solvent is polar and is also capable of hydrogen bond interactions.
  • On partitioning the overall solubility parameter of the solvent into dispersion, polar and hydrogen bonding components, the hydrogen bonding value (in its own solution) is quoted between 3 Mpa^0.5to 8.5 Mpa^0.5.
  • The solvent is infinitely miscible in water.
  • The solvent is aprotic (proton acceptor) towards the formation of hydrogen bonding between it and the polymer.
• We have found that the optimum average diameter of the outlet holes in the polymeric membrane is from 100 to 200 microns, ideally approximately 150 microns. The number of holes in thedistal portion213 is from 200 to 500, ideally about 300. This hole size and number of holes minimises shear levels by reducing localised flow rates. Thus, we have found that shear can be maintained below 800, preferably below 500 and ideally below 200 Pa at a blood flow rate of up to 270 ml/min in a 4 mm blood vessel. Ideally the holes are circular holes.
• We have found that by maintaining blood shear below 800, preferably below 500 and ideally below 200 Pa, the filter provides appropriate haemodynamics to minimise turbulence and inappropriate shear stress on native arteries and veins. Damage to flowing blood such as haemolysis which involves the destruction of red blood cells by rupture of the cell envelope and release of contained haemoglobin is avoided. The outlet hole size and number of holes is optimised in order to capture embolic material, to allow the embolic material to be entrapped in the filter body and to be withdrawn through a delivery device such as a delivery catheter on collapsing of the filter body.
• Shearing of red blood and damage to platelets during filtration is a problem easily solved in extra-corporeal circuits by providing large filter areas with consequent low flow rates through individual pores controlled to flow rates such that the shear is maintained in ranges that are below known threshold levels with clinical relevance.
• However, as shear stress increases in inverse proportion to the cube of the radius, small blood vessels do not provide space in which to control shear levels by reducing localised flow rates. At flow rates up to 270 ml/min in a 4 mm blood vessel we have found that we can maintain shear at levels below 200 Pa with 150 micron holes.
• We have also found that the porosity of the distal end of the filter membrane and the arrangement of outlet holes is important in optimising capture of embolic material without adversely effecting blood shear characteristics and the material properties of the filter body which allow it to be collapsed for delivery, expanded for deployment and collapsed for retrieval.
• Referring in particular toFIGS. 7,8 and especially14(a) to14(e) we have found that the overall porosity of the filter element is preferably between 5% and 40% and ideally between 8% and 21%. The transverse cross sectional areas of the filter body at longitudinally spaced-apart locations of the distal portion are substantially the same. Most importantly we have found that the porosity of the distal portion of the filter body should decrease towards the distal end. Arrangements ofdistal holes119 for different filter diameters are shown inFIGS. 14(a) to14(e).FIG. 14(a) shows an arrangement for a 6 mm filter,14(b) for a 4 mm filter,FIG. 14(c) for a 4.5 mm filter,FIG. 14(d) for a 5 mm filter andFIG. 14(e) for a 5.5 mm filter. The number of outlet holes119 also increases towards an outer edge of the distal portion of the filter body.
• In addition we have found that for optimum capture of embolic material while facilitating retrieval of the filter with entrapped embolic material into a retrieval catheter the distal portion of the filter element includes ablind section130 adjacent the distal end of the filter element. Ideally theblind portion130 extends longitudinally for at least 5% and preferably less than 30% of the length of the distal portion.
• In order to reduce the profile of the filter body we have significantly reduced the thickness of the filter membrane to typically in the order of 25 microns. This reduction in thickness however means that the membrane used must have a relatively high stiffness to achieve a comparable strength. However, we have found that such an increase in stiffness results in poor memory performance and is therefore undesirable.
• We have surprisingly found that by providing a filter body of laminate construction in which a membrane is coated with a coating to a thickness of from 5% to 40% of the thickness of the membrane we have been able to provide a filter body which has a low profile but which has good memory characteristics.
• In particular, we have found that hydrophilic coatings and hydrogels are highly suitable coatings as they have a similar surface to the endothelial lining of a blood vessel and are not perceived by the body's immune system as foreign. This results in at least reduction and in some cases substantial elimination of platelet adhesion and fibrin build up which could otherwise occlude the filter and/or create a harmful thrombus. The coating also provide a relatively low friction surface between the filter body and the delicate endothelial lining of a vessel wall and therefore minimise the trauma and injury to a vessel wall caused by deployment of the filter body in the vasculature.
• A hydrogel will absorb water swelling its volume. The swelling of the hydrogel will exert an expansion force on the membrane helping to pull it into its recovered or deployed shape.
• A coating that expands on contact with blood will exert an expansion force on the membrane helping to pull it into its recovered or deployed shape.
• A coating that expands when subjected to body temperature will exert an expansion force on the membrane helping to pull it into its recovered or deployed shape.
• Hydrophilic coatings can be classified by their molecular structure:
• • Linear Hydrophilic polymers can dissolve or be dispersed in water
  • Cross-linked hydrophilic polymers, which include hydrogels, can swell and retain water.
• Hydrophilic coatings may be also synthetic or natural. Synthetic hydrophilic polymers include the following:
• • Poly (2-hydroxy ethyl methacrylate)—(PHEMA)
  • Poly (vinyl alcohol)—(PVA)
  • Poly (ethylene oxide)—(PEO)
  • Poly (carboxylic acids) including:
  • Poly (acrylic acid)—(PAA)
  • Poly (methacrylic acid)—(PMAA)
  • Poly (N-vinyl-2-pyrollidone)—(PNVP)
  • Poly (sulfonic acids), poly (acrylonitrile), poly (acrylamides)
• Natural hydrophylics include:
• • Cellulose ethers
  • Collagen
  • Carrageenan
• Commercially available hydrophylic coatings suitable for coating filter membrane include, but are not limited to the following:
• • Aquamer (Sky Polymers Inc.)
  • Phosphoryicholine (PC) (Biocompatibiles Ltd)
  • Surmodics (Surmodics Inc. BSI)
  • Hydak (Biocoat Inc)
  • Hydomer (Hydormer Inc)
• Hydrogels as stated are cross-linked hydrophilic molecules. The molecular mobility of hydrogels is constant and extensive, giving ceaseless molecular motion, which contributes to the property of biocompatibility by inhibiting protein absorption.
• The extent to which a hydrogel imparts properties of biocompatibility, wettability and lubricity is directly related to the amount of water it absorbs into its molecular matrix, which is referred to as the “degree of swelling”.
• 
  W=[(Wsw−Wo)/Wsw]×100
• • Where Wsw =Weight of swollen gel
  • Wo=Weight of dry gel
• 
  Water uptake=U=[(Wsw−Wo)/Wsw]×100
• A typical hydrogel will absorb up to 20% of their dry weight of water. Superabsorbant hydrogels will absorb up to 2000% of their dry weight of water.
• Hydrogel strength is directly related to cross link density (μ) and molecular weight between cross-links (Mc).
• Hydrophilic coatings may be typically applied by dipping, spraying and/or brushing. The coatings may also be applied by solution or by colloidal dispersion.
• The membrane surface to be coated may be prepared by cleaning with a solvent and/or ultrasonic cleaning. Plasma or corona discharge may also be used to increase the surface energy and thus provide for better adhesion.
• Alternatives to Hydrophilics include low friction fluoropolymer i.e. PTFE & FEP coatings that are chemically inert and have low coefficients of friction, which also helps prevent adhesion of platelets.
• Other coatings that rely on being chemically inert include:
• • Poly-para-xylylene (Paralene N, C & D) made by Novatron Limited.
  • Diamond like carbon.
  • TetraCarbon (Medisyn Technologies Ltd.).
• Both diamond like carbon & tetracarbon also provide very thin hard surface layers, which help reduce the dynamic coefficient of friction for elastomers.
• The coating may be typically applied by dipping, spraying and/or brushing. The coatings may also be applied by solution or colloidal dispersion.
• Typically, to produce a filter according to the invention a polymeric filter membrane is first produced by machining a core of a desired shape from an inert material such as perspex. The perspex core is then dipped in a solution of a polymeric material as described above. Alternatively the membrane is formed by blow moulding. Holes are then laser machined in the dipped core. The perspex core is removed by dissolving in acetone. Residual acetone is washed out with water.
• A filter frame of gold plated Nitinol is mounted on a filter carrier in the form of a polyimide tube. The filter membrane is then slid over the filter support frame to provide an uncoated filter assembly.
• The filter assembly is dipped in a solvent such as propan 2-ol to clean the assembly. The cleaned assembly is then dipped in a solution of a coating material. A vacuum is applied to remove excess coating material prior to drying in an oven. The coating material is typically of Aquamer in a water/ethanol solution. The thickness of the coating is typically 2 to 10 microns.
• Preferably the filter body contains regions of varying stiffness and durometer hardness. The change in filter stiffness along its geometry can be achieved by varying the material properties or by modifications to the thickness or geometry of the membrane. The change in material hardness is achieved by varying the material properties. The polymer material may be one of the following: polyamides, polyurethanes, polyesters, a polyether block amide (PEBAX), olefinic elastomer, styrenic elastomer. Ideally the filter body has a durometer of between 60 D and 70 A Shore hardness.
• Referring toFIG. 19 there is illustrated a filter element comprising afilter body2 according to the invention. In this case, thefilter body2 has aproximal section3 and adistal section4 interconnected by anintermediate section5. Both theproximal section3 and thedistal section4 are made from a relatively stiff grade of polyurethane material which enables a low wall thickness to be achieved, thus advantageously minimising the bulk of the filter when it is in a collapsed position so that it has a low crossing profile while at the same time providing adequate strength. Theintermediate section5 is made from a soft elastic grade of polyurethane having good shape memory characteristics which will help the filter maintain the desired expanded shape during use of the filter. This soft portion also allows one filter size to accommodate a range of vessel sizes conforming closely to the vessel wall to prevent blood and embolic material bypassing the filter.
• In thefilter body2 illustrated inFIG. 19 the body is of generally uniform thickness in cross section. However, to achieve any desired variation in the properties of the filter body the thickness may be variable such as in thefilter body10 illustrated inFIG. 20.
• Referring toFIGS. 21 to 25, any required structural properties may also be provided by a filter body which is at least partially of a laminate construction. The layers of the laminate may be of the same or different materials. In the illustration ofFIG. 21 thedistal section4 and part of theintermediate section5 are of a twolayer21,22 construction. Thelavers21,22 may be of the same or different materials.
• Thelayers21,22 are keyed together by mechanical or chemical means the holes in thedistal section4 are then formed by boring through the twolayers21,22.
• In the illustration ofFIG. 22 theentire filter body30 is of a threelayer31,32,33 construction.Layer31 is a structural layer made from a material such as polyether block amide (PEBAX), polyester, polyethylene, polyurethane, terephthalate (PET), or nylon.Layers32,33 are coating layers made from a material such as a hydrophilic, hydrogel, non-thrombogenic, or non-stick material.Layers32,33 may be of the same or different materials. The holes at thedistal end4 are also lined with the coating layers32,33.
• When coating layers32,33 are of different materials, they are applied tostructural layer31 as follows. A temporary protective film is first sealed to the outer most surface oflayer31. Then coatinglayer33 is applied to the inner most surface oflayer31 by immersing the body formed bylayer31 in a coating solution. Excess coating solution is sucked out and the protective film is removed from the outer most surface oflayer31. Another temporary protective film is then sealed to the inner most surface oflayer33. The body formed bylayers31,33 is completely immersed in a coating solution. Excess coating solution is drawn out and the protective film is removed from the innermost surface oflayer33.
• If the coating layers32,33 are of the same material, bothlayers32,33 may be applied to thestructural layer31 in one step without the use of protective films.
• In the illustration ofFIG. 23 theentire filter body45 is of a threelayer46,47,48 construction.Layers46,47,48 are structural layers and layers47,48 are of the same material. The holes at thedistal end4 are also lined with thestructural layers47,48.
• In the illustration ofFIG. 24 theentire filter body50 is of a threelayer51,52,53 construction.Layers51,52,53 are structural layers, and in this embodiment layers52,53 are of different materials.
• In the illustration ofFIG. 25 theentire filter body55 is of a fourlayer56,57,58,59 construction.Layers56,57 are structural layers and may be of the same or different materials.Layers58,59 are coating layers and may be of the same or different materials. The holes at thedistal end4 are also lined with the coating layers58,59.
• Referring toFIG. 26 there is illustrated anotherfilter element60 according to the invention, which is similar to part of thedistal section4 offilter element2 ofFIG. 19. But having no proximal webbing members thus maximising the size of the inlet opening.
• FIG. 27 illustrates afilter element61, which is similar to thedistal section4 and part of theintermediate section5 offilter element20 ofFIG. 21, having the advantages of the laminate structure previously described, combined with the large inlet opening ofFIG. 26 and the variable distal geometry ofFIG. 19 (enabling the filter to accommodate a range of vessel sizes).
• FIG. 28 illustrates afurther filter element65, which includes asupport ring66 to maintain theintermediate section5 open to advancing blood flow.Support ring66 may be arranged perpendicular to the direction of the blood flow or inclined at an angle, as illustrated inFIG. 28. Thesupport ring66 may be of an elastic, super elastic or shape memory material. and may be either actuated remotely to appose the vessel wall in a perpendicular or close to perpendicular position, or fixed in circumference so that its inclination and shape are controlled by the diameter of the vessel.
• A different layer structure may be provided at any desired location of the filter body to achieve required properties.
• Referring now toFIG. 29 there is shown another filter element according to the invention, indicated generally by thereference70. Thefilter element70 has afilter body72 of generally similar construction to the filter element described previously, the body having aproximal section73 and a distal section74 interconnected by anintermediate section75. In this case, the distal section74 is of a relatively hard polyurethane material whilst theproximal section73 andintermediate section75 are of a softer grade polyurethane material. A number oflongitudinal ribs76 are provided around a circumference of theproximal section73. Advantageously, this construction facilitates close engagement of an outer circumference of theproximal section73 against a vessel wall to minimise the risk of embolic material bypassing thefilter element70. An internal support frame, as described above, urges theproximal section73 outwardly so that it expands against and closely conforms with the wall of the blood vessel in which thefilter element70 is mounted in use.
• Conveniently, the corrugations orribs76 allow theproximal section73 of thefilter element70 to accommodate a wider range of vessel sizes whilst maintaining good contact between the outer circumference of theproximal section73 and the vessel wall and providing improved tilter body integrity.
• Referring toFIG. 30 there is illustrated anotherfilter element80 according to the invention. In this case corrugations81 are provided for improved filter body integrity.
• Referring toFIG. 31 there is illustrated anotherfilter element82 according to the invention. In this case the cross section of thefilter element82 is of a flower petal shape with a plurality of longitudinally extendingribs83 for improved apposition. As explained in reference toFIG. 29, the “petal shaped” cross section (as for corrugations) increase the circumference of the filter body, thus enabling the body to be apposed closely against the vessel wall by a supporting structure in a wide range of vessel sizes.
• Referring toFIG. 32 there is illustrated anotherfilter element85 according to the invention. In this case slits86 are provided in the place of the corrugations or “petal shapes” shown above. Theslits86 enable the body of the filter to conform to a range of vessel diameters by overlapping and preventing creasing in small diameter vessels, or allowing the body to expand with the aid of a supporting structure in larger diameter vessels. In both instances close engagement of the outer circumference with the vessel wall is facilitated, thus minimizing the risk of embolic material bypassing the filter.
• Referring toFIG. 33 there is illustrated anotherfilter element88 according to the invention. In thiscase ribs89 are provided to prevent creases forming along thefilter element88 in the longitudinal direction, and also to allow expansion of thefilter element88.
• Referring toFIG. 34 there is illustrated afurther filter element90 according to the invention, which is of a concertina-like shape with two circumferentially extendinggrooves91,92. This circumferential grooves or ribs have several advantages. They add to the integrity of the filter body, assisting it in maintaining its shape in the vessel after deployment. They inhibit the propagation of creases between the varying diameter body segments, so that one filter can be designed for a range of vessel sizes. They enable the filter to extend in length to greatly increase its effective volume without adding to the length of the deployed device in use. This provides the benefit of safe retrieval of large embolic loads as explained with reference to stretchable membranes below.
• Referring toFIGS. 35(a) to35(d) there is illustrated another embolic protection system according to the invention incorporating afilter element94 according to the invention which is similar to those described above. The protection system includes aguidewire95 and aretrieval catheter96 which is advanced over the guidewire to retrieve the filter containing trappedembolic material97. In this case the filter body includes an intermediate98 and distal99 membrane, one or both of which are stretchable to facilitate the retrieval of the capturedembolic material97. The stretching of the membrane during the retrieval process is illustrated inFIGS. 35(b) to35(d).
• The use of such a stretchable filter membrane allows larger volumes of captured embolic material to be retrieved than would be possible with a stiffer membrane. This is possible because if a filter is to be retrieved by withdrawing it into or through a catheter of a given internal diameter, the maximum volume of material that can be retrieved is directly proportional to the length of the filter and the internal diameter of the catheter. The stretchable membrane allows the filter to increase in length upon retrieval, thus increasing the space available for retention of captured embolic material. This is particularly significant in the case of large volumes of captured embolic material, which will be more difficult to safely retrieve with a non-stretchable device.
• The stretchable section may include some or all of the filter body, and may not necessarily include the distal cone. The distal cone containing the outlet pores may be formed from a non stretch material, while the inter mediate filter body is stretchable.
• This provides the advantage of filter extension during retrieval while preventing the problem of release of captured material through expanding distal pores.
• Another advantage of the stretchable section is that the crossing profile can be reduced as the filter can be loaded into a delivery pod in a stretched, rather than bunched or folded, configuration. This reduces the volume of filter material contained in any given cross section of the loaded delivery pod.
• In addition the use of a stretchable filter material in the intermediate section can also be advantageous by providing a section of the filter body which can be circumferentially expanded by a support frame to appose the wall of a wide range of vessel sizes.
• The invention is not limited to the embodiments hereinbefore described which may be varied in both construction and detail.

Claims (20)

1. A method for reducing thrombus formation during a medical procedure, comprising:

tracking an embolic protection device through a body lumen;

moving the embolic protection device from a first position to a second position, the second position configured to at least partially filter fluid passing through the embolic protection device, wherein a portion of the embolic protection device includes a coating disposed thereon, the coating adapted to reduce thrombus formation.

2. The method according toclaim 1, wherein the coating is selected from the group consisting of hydrophilic and hydrophobic coatings.

3. The method according toclaim 2, wherein the coating further includes a physiologically acceptable additive.

4. The method according toclaim 3, wherein the additive is heparin.

5. The method according toclaim 2, wherein the coating has a thickness between about 5% and 40% of a thickness of the embolic protection device.

6. The method according toclaim 2, wherein the coating is chosen from the group comprising, Poly(2-hydroxy ethyl methacrylate)—(PHEMA), Poly(vinyl alcohol)—(PVA), Poly (ethylene oxide)—(PEO), Poly (carboxylic acids), Poly (acrylic acid)—(PAA), Poly (methacrylic acid)—(PMAA), Poly (N-vinyl-2-pyrollidone)—(PNVP), Poly (sulfonic acids), poly (acrylonitrile), poly (acrylamides), Cellulose ethers, Collagen, Carrageenan, Aquamer (Sky Polymers Inc.), Phosphorylcholine (PC) (Biocompatibiles Ltd), Surmodics (Surmodics Inc. BSI), Hydak (Biocoat Inc), Hydomer (Hydormer Inc).

7. The method according toclaim 1, wherein the coating is configured to provide a low friction surface interaction between the filter body and a wall of a body lumen.

8. The method according toclaim 1, wherein the coating is at least partially composed of a non thrombogenic material and a fluropolymer material.

9. A method for reducing thrombus formation during a medical procedure, comprising:

tracking an expandable filter within a body lumen, the filter having a frame and a filtering element associated with the frame;

deploying the filter from a first position to a second position, wherein in the second position the filtering element opposes at least a portion of the body lumen:

passively filtering fluid through the filtering element, wherein the filtering element is further provided with a coating, the coating configured to mimic an inner surface of the body lumen.

10. The method according toclaim 9, wherein the coating comprises between about 5 percent to about 40 percent of the thickness of the filtering element.

11. The method according toclaim 10, wherein the filtering element comprises a flexible membrane having a plurality of apertures formed therein.

12. The method according toclaim 9, wherein the coating comprises a first component and a second component.

13. The method according toclaim 12, wherein the first component is chosen from the group consisting of hydrogels and hydrophilics; the second component is heprin.

14. The method according toclaim 9, wherein the coating is chosen from the group comprising, Poly(2-hydroxy ethyl methacrylate)—(PHEMA), Poly(vinyl alcohol)—(PVA), Poly (ethylene oxide)—(PEO), Poly (carboxylic acids), Poly (acrylic acid)—(PAA), Poly (methacrylic acid)—(PMAA), Poly (N-vinyl-2-pyrollidone)—(PNVP), Poly (sulfonic acids), poly (acrylonitrile), poly (acrylamides), Cellulose ethers, Collagen, Carrageenan, Aquamer (Sky Polymers Inc.), Phosphorylcholine (PC) (Biocompatibiles Ltd), Surmodics (Surmodics Inc. BSI), Hydak (Biocoat Inc), Hydomer (Hydormer Inc).

15. The method according toclaim 9, wherein the coating is configured to provide a low friction surface interaction between the filter body and a wall of a body lumen.

16. The method according toclaim 9, further including the step of moving the filter from the second position back to the first position, thereby entrapping any debris within the filtering element.

17. The method according toclaim 9, further including the step of performing a medical procedure after moving the filter from the first position to the second position.

18. A method for reducing thrombus formation during a medical procedure, comprising:

providing a collapsible filter element, the filter element having a filter body, the filter body being movable between a collapsed stored position and an expanded position for extension across a body lumen, a proximal inlet portion of the filter body having one or more openings sized to allow fluid and embolic material enter the filter body, at least one distal outlet opening sized to allow passage of fluid through the filter body, but to retain the embolic material within the filter body, the filter body comprising a membrane coating with a biocompatible coating, wherein the biocompatible coating is configured to reduce the formation of thrombus from fluid contact with the membrane;

expanding the filter body from the collapsed stored position to the expanded position; and

performing at least one medical procedure proximal to the filter body.

19. The method according toclaim 18, wherein the coating is chosen from the group comprising, Poly(2-hydroxy ethyl methacrylate)—(PHEMA), Poly(vinyl alcohol)—(PVA), poly (ethylene oxide)—(PEO), Poly (carboxylic acids), Poly (acrylic acid)—(PAA), Poly (methacrylic acid)—(PMAA), Poly (N-vinyl-2-pyrollidone)—(PNVP), Poly (sulfonic acids), poly (acrylonitrile), poly (acrylamides), Cellulose ethers, Collagen, Carrageenan, Aquamer (Sky Polymers Inc.), Phosphorylcholine (PC) (Biocompatibiles Ltd), Surmodics (Surmodics Inc. BSI), Hydak (Biocoat Inc), Hydomer (Hydormer Inc).

20. The method according toclaim 18, wherein the coating is configured to provide a low friction surface interaction between the filter body and a wall of a body lumen.

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