US20110224716A1 - Percutaneous catheter and guidewire having filter and medical device deployment capabilities - Google Patents

Abstract

The invention provides a nested tubing cannula which comprises outer and inner elongate tubular members, both having a proximal end, a distal end, and a lumen therebetween. The inner tubular member is sealed at its distal end and is nested substantially coaxially within the lumen of the outer tubular member, so that the gap between the inner and the outer tubular member defines a second lumen whereas the first lumen is the lumen of the inner tubular member. A tubular sleeve is disposed coaxially between the inner and outer tubular members. A balloon is mounted on a distal region of the outer tubular member and is in communication with the first lumen. The cannula further comprises a port proximal or distal the balloon occluder and is in communication with the second lumen. Methods for making the devices herein are disclosed.

Description

• This is a continuation of application Ser. No. 121716,375, filed Mar. 3, 2010, which is a continuation of application Ser. No. 11/206,616, filed Aug. 18, 2005, now U.S. Pat. No. 7,691,123, which is a continuation of Ser. No. 10/400,003, filed Mar. 26, 2003, now U.S. Pat. No. 6,964,673, which is a continuation of application Ser. No. 09/679,911, filed Oct. 5, 2000, now U.S. Pat. No. 6,676,682, which is a continuation of application Ser. No. 09/421,138, filed Oct. 19, 1999, now U.S. Pat. No. 6,165,200, which is a continuation of application Ser. No. 09/287,217, filed Apr. 5, 1999, now U.S. Pat. No. 6,027,520, which is a continuation of application Ser. No. 09/022,510, filed Feb. 12, 1998, now U.S. Pat. No. 5,910,154, which is a continuation of application Ser. No. 08/852,867, filed May 8, 1997, now U.S. Pat. No. 5,911,734. Each of the above applications is hereby expressly and fully incorporated herein by reference.
FIELD OF THE INVENTION
• The present invention relates generally to treating plaque deposits and occlusions within major blood vessels, more particularly to an apparatus and method for preventing detachment of mobile aortic plaque within the ascending aorta, the aortic arch, or the carotid arteries, and to an apparatus and method for providing a stent and a filter in a percutaneous catheter for treating occlusions within the carotid arteries.
BACKGROUND OF THE INVENTION
• Several procedures are now used to open stenosed or occluded blood vessels in a patient caused by the deposit of plaque or other material on the walls of the blood vessels. Angioplasty, for example, is a widely known procedure wherein an inflatable balloon is introduced into the occluded region. The balloon is inflated, dilating the occlusion, and thereby increasing intraluminal diameter. Plaque material may be inadvertently dislodged during angioplasty, and this material is then free to travel downstream, possibly lodging within another portion of the blood vessel or possibly reaching a vital organ, causing damage to the patient.
• In another procedure, stenosis within arteries and other blood vessels is treated by permanently or temporarily introducing a stent into the stenosed region to open the lumen of the vessel. The stent typically comprises a substantially cylindrical tube or mesh sleeve made from such materials as stainless steel or nitinol. The design of the material permits the diameter of the stent to be radially expanded, while still providing sufficient rigidity such that the stent maintains its shape once it has been enlarged to a desired size.
• Generally, a stent having a length longer than the target region is selected and is disposed on a catheter prior to use. The catheter typically has a flexible balloon, near its distal end, designed to inflate to a desired size when subjected to internal pressure. The stent is mounted to the catheter and compressed over the balloon, typically by hand, to assure that the stent does not move as it passes through the blood vessel to the desired location within the patient. Alternatively, self-expanding stents may also be used.
• The stent is typically introduced into the desired blood vessel using known percutaneous methods. The catheter, having the stent securely crimped thereon, is directed to the region of the blood vessel being treated. The catheter is positioned such that the stent is centered across the stenosed region. The balloon is inflated, typically by introducing gas or fluid such as saline solution, through a lumen in the catheter communicating with the balloon. Balloon inflation causes the stent to expand radially, thereby engaging the stenosed material. As the stent expands, the material is forced outward, dilating the lumen of the blood vessel.
• Due to substantial rigidity of the stent material, the stent retains its expanded shape, providing-an open passage for blood flow. The balloon is then deflated and the catheter withdrawn.
• Because the stent is often constructed from a mesh material, the stent typically compresses longitudinally as it expands radially. Stenotic material trapped between the stent and the vessel wall may extend into the openings in the mesh and may be sheared off by this longitudinal compression to create embolic debris free. When this material travels downstream, it can cause serious complications. For example loose embolic material released within the ascending aorta, the aortic arch, or the carotid arteries may travel downstream to the brain, possibly causing stroke, which can lead to permanent injuries or even death of the patient.
• Thus, there is a need for an apparatus and method for delivering a stent into an arterial occlusion which substantially reduces the risk of embolic material escaping to the vessel and causing a blockage at a downstream location. There is also an apparatus and method for substantially preventing detachment of plaque deposited on the walls of the ascending aorta, the aortic arch, the descending aorta, and the carotid arteries. In addition, there is a need for an apparatus and method to substantially contain loose embolic material within the aorta and the carotid arteries during an interventional procedure, preventing it from reaching the brain.
SUMMARY OF THE INVENTION
• The present invention provides an apparatus and method for preventing embolic material from escaping a site of intervention within the aorta, the carotid arteries, and other arteries generally, thereafter causing damage to vital organs, such as the brain. More particularly, the present invention involves an apparatus and method for introducing a stent into a region of a major blood vessel within the human body having plaque deposits, such as the ascending aorta, the descending aorta, aortic arch, common carotid artery, external and internal carotid arteries, brachiocephalic trunk, middle cerebral artery, anterior cerebral artery, posterior cerebral artery, vertebral artery, basilar artery, subclavian artery, brachial artery, axillary artery, iliac artery, renal artery, femoral artery, popliteal artery, celiac artery, superior mesenteric artery, inferior mesenteric artery, anterior tibial artery, and posterior tibial artery, thereby opening occlusions and/or preventing embolic material from breaking free within the blood vessel.
• In a first embodiment, the invention includes a guidewire having an expandable filter attached to it, and a stent catheter. The catheter has an inflatable balloon mounted on or near its distal end, and an inflation lumen extending through the catheter between a proximal region of the catheter and the balloon. A stent is provided on the outer surface of the catheter, substantially engaging the balloon. Generally, the stent comprises an expandable substantially rigid tube, sheet, wire or spring, but preferably a cylindrical mesh sleeve. See Palmaz, U.S. Pat. No. 4,733,665, incorporated herein by reference.
• Alternatively, the stent may be a self-expanding sleeve, preferably from nitinol. In this case, the stent catheter does not require an inflatable balloon. Instead the stent is compressed over the catheter and a sheath or outer catheter is directed over the stent to hold it in the compressed condition until time of deployment.
• The guidewire has a filter assembly attached at or near its distal end, which includes an expansion frame which is adapted to open from a contracted condition to an enlarged condition. Filter material, typically a fine mesh, is attached to the expansion frame to filter undesirable embolic material from blood.
• The guidewire with the expansion frame in its contracted condition is provided through a sheath or cannula, or preferably is included directly in the stent catheter. The catheter typically has a second lumen extending from its proximal region to its distal end into which the guidewire is introduced. The filter assembly on the distal end of the guidewire is then available to be extended beyond the distal end of the catheter for use during stent delivery.
• The device is typically used to introduce a stent into a stenosed or occluded region of a patient, preferably within the carotid arteries. The catheter is introduced percutaneously into a blood vessel and is directed through the blood vessel to the desired region. If the filter device is provided in a separate sheath, the sheath is percutaneously inserted into the blood vessel downstream of the region being treated, and is fixed in position.
• The filter assembly is introduced into the blood vessel, and the expansion frame is opened to its enlarged condition, extending the filter mesh substantially across the blood vessel until the filter mesh substantially engages the walls of the vessel.
• The catheter is inserted through the region being treated until the stent is centered across the plaque deposited on the walls of the blood vessel. Fluid, preferably saline solution, is introduced through the inflation lumen, inflating the balloon, and expanding the stent radially outwardly to engage the plaque. The stent pushes the plaque away from the region, dilating the vessel. The balloon is deflated, and the catheter is withdrawn from the region and out of the patient. The stent remains substantially permanently in place, opening the vessel and trapping the plaque beneath the stent.
• When the stenosed region is opened, embolic material may break loose from the wall of the vessel, but will encounter the filter mesh and be captured therein, rather than traveling on to lodge itself elsewhere in the body. After the stent is delivered, the expansion frame is closed, containing any material captured in the filter mesh. The filter assembly is withdrawn back into the sheath or the catheter itself, which is then removed from the body.
• If a self-expanding stent is used, the stent catheter with the compressed stent thereon is inserted into a sheath, which restrains the stent in a compressed condition. The catheter is introduced into the patient's blood vessel and directed to the target region. Once the stent is localized across the stenosed region and the filter assembly is in position, the sheath is drawn proximally in relation to the catheter. This exposes the stent, which expands to engage the wall of the blood vessel, opening the lumen. The filter assembly is then closed and the catheter withdrawn from the patient.
• The filter assembly has a number of preferred forms. For example, the expansion frame may comprise a plurality of struts or arms attached to and extending distally from the distal end of the guidewire. The struts are connected to each other at each end and have an intermediate region which is biased to expand radially. Filter mesh is attached typically between the intermediate region and the distal ends of the struts, thereby defining a substantially hemispherical or conical shaped filter assembly.
• To allow the filter assembly to be inserted into the lumen of the sheath, the intermediate region of the expansion frame is compressed. When the filter assembly is ready to be introduced into a blood vessel, the guidewire is pushed distally. The expansion frame exits the lumen, and the struts automatically open radially. This expands the filter mesh to substantially traverse the vessel. After the stent is delivered, the guidewire is pulled proximally to withdraw the filter assembly. The struts contact the wall of the filter lumen, forcing them to compress, closing the frame as the filter assembly is pulled into the sheath.
• In another embodiment, the expansion frame includes a plurality of struts attached to the distal end of the sheath. The struts extend distally from the sheath and attach to the distal end of the guidewire which is exposed beyond the sheath. At an intermediate region, the struts are notched or otherwise biased to fold out radially. Filter mesh is attached to the struts between the intermediate region and the distal end of the guidewire.
• The filter assembly is directed into position in the blood vessel, either exposed on the end of the sheath or preferably within a second sheath which is withdrawn partially to expose the filter assembly. With the sheath fixed, the guidewire is pulled proximally. This compresses the struts, causing them to bend or buckle at the intermediate region and move radially outwardly, expanding the filter mesh across the blood vessel. After use, the guidewire is pushed distally, pulling the struts back down and closing the filter mesh.
• In an alternative to this embodiment, the struts attached to the distal end of the sheath and to the distal end of the guidewire are biased to expand radially at an intermediate region. The filter mesh is attached to the struts between the intermediate region and the distal end of the guidewire. Prior to introduction into a patient, the guidewire is rotated torsionally in relation to the sheath, twisting the struts axially around the guidewire and compressing the filter mesh. Once in position in the blood vessel, the guidewire is rotated in the opposite direction, unwinding the struts. The struts expand radially, opening the filter mesh. After use, the guidewire is rotated once again, twisting the struts and closing the filter mesh for removal.
• In yet another embodiment, the filter assembly comprises a plurality of substantially cylindrical compressible sponge-like devices attached in series to the guidewire. The devices have an uncompressed diameter substantially the same as the open regions of the blood vessel. They are sufficiently porous to allow blood to pass freely through them but to entrap undesirable substantially larger particles, such as loose embolic material.
• The devices are compressed into the lumen of the sheath prior to use. Once in position, they are introduced into the blood vessel by pushing the guidewire distally. The devices enter the vessel and expand to their uncompressed size, substantially engaging the walls of the blood vessel. After use, the guidewire is pulled proximally, forcing the devices against the distal end of the sheath and compressing them back into the lumen.
• In a second embodiment, a stent catheter and filter assembly are also provided. Unlike the previous embodiments, the filter assembly is not primarily mechanically operated, but is instead, generally fluid operated. Typically, the stent catheter includes a second balloon on or near the distal end of the catheter. A second inflation lumen extends through the catheter from the proximal region of the catheter to the balloon. The balloon is part of the expansion frame or alternatively merely activates the expansion frame, opening the filter assembly to the enlarged condition for use and closing it after being used.
• In one form, the balloon has an annular shape. Filter mesh is attached around the perimeter of the balloon, creating a conical or hemispherical-shaped filter assembly. A flexible lumen extends between the balloon and the inflation lumen within the catheter. Optionally, retaining wires are connected symmetrically between the balloon and the catheter, thereby holding the balloon substantially in a desired relationship to the catheter.
• When deflated, the balloon substantially engages the periphery of the catheter, holding the filter mesh closed and allowing the catheter to be directed to the desired location. Once the catheter is in position, the balloon is inflated. The balloon expands radially until it engages the walls of the blood vessel, the filter mesh thereby substantially traversing the vessel. After use, the balloon is deflated until it once again engages the perimeter of the catheter, thereby trapping any embolic material between the filter mesh and the outer wall of the catheter.
• Alternatively, the balloon of this embodiment may be provided on the catheter proximal of the stent for retrograde use. In this case, the filter mesh is extended between the balloon and the outer surface of the catheter, instead of having a closed end.
• In a third embodiment of the present invention, a method is provided in which a stent catheter is used to prevent the detachment of mobile aortic deposits within the ascending aorta, the aortic arch or the carotid arteries, either with or without an expandable filter assembly. A stent catheter, as previously described, is provided having an inflatable balloon and a stent thereon, or alternatively a self-expanding stent and a retaining sheath. The catheter is percutaneously introduced into a blood vessel and is directed to a region having mobile aortic plaque deposits, preferably a portion of the ascending aorta or the aortic arch.
• The stent is positioned across the desired region, and the balloon is inflated. This expands the stent to engage the plaque deposits and the walls of the blood vessel, thereby trapping the plaque deposits. The balloon is deflated, and the catheter is removed from the blood vessel. Alternatively if a self-expanding stent is used, the sheath is partially withdrawn proximally, and the stent is exposed, allowing it to expand. The stent substantially retains its expanded configuration, thereby containing the plaque beneath the stent and preventing the plaque from subsequently detaching from the region and traveling downstream.
• Optionally, a filter device similar to those already described may be introduced at a location downstream of the treated region. The filter device may be provided in a sheath which is inserted percutaneously into the blood vessel. Preferably, however, a filter device is attached to the stent catheter at a location proximal to the stent. Instead of attaching the filter assembly to a guidewire, it is connected directly to the outer surface of the catheter proximal to the stent. A sheath or cannula is typically provided over the catheter to cover the filter assembly.
• Once the catheter is in position within the vessel, the sheath is withdrawn proximally, the filter assembly is exposed and is expanded to its enlarged condition. In a preferred form, the expansion frame includes biased struts similar to the those described above, such that when the filter assembly is exposed, the struts automatically expand radially, and filter mesh attached to the struts is opened. After the stent is deployed, the sheath is moved proximally, covering the expansion frame and compressing the struts back into the contracted condition. The catheter and sheath are then withdrawn from the patient.
• Thus, an object of the present invention is to provide an apparatus and method for substantially preventing mobile aortic plaque deposited within the ascending aorta, the aortic arch, or the carotid arteries from detaching and traveling to undesired regions of the body.
• Another object is to provide an apparatus and method for treating stenosed or occluded regions within the carotid arteries.
• An additional object is to provide an apparatus and method for introducing a stent to treat a stenosed or occluded region of the carotid arteries which substantially captures any embolic material released during the procedure.
BRIEF DESCRIPTION OF THE DRAWINGS
• For a better understanding of the invention, and to show how it may be carried into effect, reference will be made, by way of example, to the accompanying drawings, in which:
• FIG. 1 is a longitudinal view of an embodiment being inserted into a blood vessel, namely a stent catheter in a stenosed region and a filter device downstream of the region.
• FIG. 2 is a longitudinal view of another embodiment, showing the filter device included in the stent catheter.
• FIG. 3 is a longitudinal view of an embodiment of the filter assembly in its enlarged condition within a blood vessel.
• FIGS. 4A,4B and4C show a longitudinal view of an embodiment of the filter assembly in a contracted condition, a partially expanded condition, and an enlarged condition respectively within a blood vessel.
• FIGS. 5A,5B and5C show a longitudinal view of another embodiment of the filter device in a contracted condition, a partially opened condition, and an enlarged condition across a blood vessel respectively.
• FIGS. 6A and 6B are longitudinal views, showing the orientation of the filter mesh in an antegrade approach to a stenosed region and in a retrograde approach respectively.
• FIG. 7 is a longitudinal view of another embodiment of the filter assembly.
• FIGS. 8A and 8B are longitudinal views of another embodiment of the filter assembly, showing the filter mesh without gripping hairs and with gripping hairs respectively.
• FIG. 9 is a longitudinal view of another embodiment of the filter assembly including sponge-like devices.
• FIG. 10 is a longitudinal view of another embodiment, namely a filter assembly attached to the outer surface of a stent catheter.
• FIGS. 11A and 11B show a filter assembly attached to the outer surface of a stent catheter, with a sheath retaining the filter assembly in the contracted condition, and with the filter assembly in the enlarged condition respectively.
• FIGS. 12A and 12B are longitudinal views of another embodiment including an inflatable filter assembly, shown in a contracted condition and an enlarged condition respectively.
• FIG. 13 is a longitudinal view of an inflatable filter assembly attached to the catheter proximal of the stent shown in an enlarged condition.
• FIG. 14 depicts a longitudinal view of a stent deployment device having a distal filter disposed within a carotid artery.
• FIGS. 15,15A,15B,15C and15D show detailed longitudinal and cross-sectional views of a guidewire filter in accordance with the present invention.
• FIGS. 16,16A,16B,16C and16D show longitudinal and cross-sectional views of an eggbeater filter in accordance with the present invention.
• FIGS. 17 and 17A show longitudinal views of a filter scroll in accordance with the present invention.
• FIGS. 18,18A, and18B show longitudinal views of a filter catheter in accordance with the present invention.
• FIG. 19 shows an alternate construction for an eggbeater filter as disclosed herein.
• FIG. 20 shows a longitudinal view of an imaging guidewire having an eggbeater filter and restraining sheath.
• FIG. 21 shows human aortic anatomy and depicts several routes for deployment of an aortic filter upstream of the carotid arteries.
• FIG. 22 depicts a longitudinal view of a generalized filter guidewire.
• FIGS. 23 and 23A depict longitudinal views of a compressible, expansible sheath disposed over a guidewire in accordance with the present disclosure.
DETAILED DESCRIPTION
• Turning toFIG. 1, a first embodiment of the present invention is shown, namely astent catheter10 and afilter device30. Thestent catheter10 typically includes acatheter body12, aninflatable balloon16, and astent20. Thecatheter body12 typically comprises a substantially flexible member having a proximal end (not shown) and adistal end14. The balloon is mounted on a region at or near thedistal end14 of thecatheter body12. Aninflation lumen18 extends longitudinally from a region at or near the proximal end of thecatheter body12 to theballoon16.
• The stent,20 is introduced over theballoon16, typically by manually compressing it onto theballoon16. Thestent20 may comprise a tube, sheet, wire, mesh or spring, although preferably, it is a substantially cylindrical wire mesh sleeve, that is substantially rigid, yet expandable when subjected to radial pressure. Many known stent devices are appropriate for use with the present invention, such as those discussed elsewhere in this disclosure. Generally the stent is furnished from materials such as stainless steel or nitinol, with stainless steel being most preferred.
• Alternatively, a self-expanding stent (not shown) may also be used, such as those disclosed in Regan, U.S. Pat. No. 4,795,458, Harada et al., U.S. Pat. No. 5,037,427, Harada, U.S. Pat. No. 5,089,005, and Mori, U.S. Pat. No. 5,466,242, the disclosures of which are incorporated herein by reference. Such stents are typically provided from nitinol or similar materials which are substantially resilient, yet compressible. When an expandable stent is used, the stent catheter does not generally include an inflatable balloon for the stent. Instead, the stent is compressed directly onto the catheter, and a sheath is placed over the stent to prevent it from expanding until deployed.
• In addition to thecatheter10, the present invention typically includes afilter device30. Thefilter device30 generally comprises anintroducer sheath32, aguidewire40, and anexpandable filter assembly50, although alternatively theguidewire40 and thefilter assembly50 may be provided directly on thecatheter10 as will be described below (seeFIG. 2). Thesheath32 has aproximal end34 and adistal end36, and generally includes ahemostatic seal38 mounted on itsproximal end34. Theguidewire40, typically a flexible, substantially resilient wire, having adistal end42 and aproximal end44, is inserted into theproximal end34 of thesheath32 through alumen33. A hub or handle46 is generally mounted on theproximal end44 for controlling theguidewire40.
• Generally, attached on or near thedistal end42 of theguidewire40 is anexpandable filter assembly50 which generally comprises anexpansion frame52 andfilter mesh60. Theexpansion frame52 is generally adapted to open from a contracted condition while it is introduced through thelumen33 of thesheath32 to an enlarged condition once it is exposed within ablood vessel70, as will be discussed more particularly below. Thefilter mesh60 is substantially permanently attached to theexpansion frame52.
• The construction of thestent catheter10 should already be familiar to those skilled in the art. Thecatheter body12 is typically made from substantially flexible materials such as polyethylene, nylon, PVC, polyurethane, or silicone, although materials such as polyethylene and PVC are preferred. Theballoon16 for delivering thestent20 is generally manufactured from a substantially flexible and resilient material, such as polyethylene, polyester, latex, silicone, or more preferably polyethylene and polyester. A variety of balloons for angioplasty or stenting procedures are available which have a range of known inflated lengths and diameters, allowing an appropriate balloon to be chosen specifically for the particular blood vessel being treated.
• Thesheath32 for thefilter device30 generally comprises a conventional flexible sheath or cannula for introducing catheters or guidewires into the blood stream of a patient. Exemplary materials include polyethylene, nylon, PVC, or polyurethane with polyethylene and pvc being most preferred. Thehemostatic seal38 generally is an annular seal designed to prevent the escape of blood from the vessel through thesheath32, and includes materials such as silicone, latex, or urethane, or more preferably silicone. Thehemostatic seal38 is substantially permanently adhered to theproximal end34 of thesheath32 using known surgically safe bonding materials.
• Theguidewire40 is generally manufactured from conventional resilient wire such as stainless steel or nitinol, although stainless steel is preferred, having a conventional hub or handle46 formed integral with attached to itsproximal end44.
• Turning now toFIG. 3, thefilter assembly50 of the present invention is generally shown extending from thedistal end36 of a sheath orcatheter32 and in an enlarged condition within ablood vessel70. Thefilter assembly50 includes anexpansion frame52 comprising a plurality of struts, ribs orwires54, eachstrut54 having a substantially fixedproximal end56 and adistal end58, which may or may not be fixed. The proximal ends56 are typically connected to thedistal end42 of theguidewire40, or alternatively to the outer surface of a distal region (not shown inFIG. 3) of theguidewire40, typically using conventional bonding methods, such as welding, soldering, or gluing. The distal ends58 of thestruts54 are connected to thefilter mesh60, or alternatively to the distal end of the guidewire (not shown). The struts generally comprise substantially resilient materials such as stainless steel or nitinol, with stainless steel being preferred.
• Generally, thefilter mesh60 comprises a fine mesh having anopen region64 substantially engaging thewall72 of theblood vessel70 and aclosed region62, shown here as the apex of a cone. An appropriate mesh is selected, having a pore size that permits blood to flow freely through the mesh, while capturing therein undesired particles of a targeted size. Appropriate filter materials are disclosed in co-pending applications Barbut et al., U.S. application Ser. No. 08/553,137, filed Nov. 7, 1995, Barbut et al., U.S. application Ser. No. 08/580,223, filed Dec. 28, 1995, Barbut et al., U.S. application Ser. No. 08/584,759, filed Jan. 9, 1996, Barbut et al., U.S. application Ser. No. 08/640,015, filed Apr. 30, 1996, Barbut et al., U.S. application Ser. No. 08/645,762, filed May 14, 1996, and Maahs, U.S. application Ser. No. 08/842,727, filed Apr. 16, 1997. The disclosure of these references and any others cited herein are expressly incorporated herein by reference. An exemplary embodiment of the mesh has a mesh area of 3-8 sq. in., a mesh thickness of 60-200 .mu.m, a thread diameter of 30-100 .mu.m, and a pore size of 60-100 .mu.m. Polyethylene meshes, such as Saati Tech and Tetko, Inc. meshes, provide acceptable filter materials, as they are available in sheet form and can be easily cut and formed into a desired shape. The mesh is formed into a desired filter shape and is sonic welded or adhesive bonded to thestruts54.
• The present invention is then typically used to introduce a stent into a stenosed or occluded region of a patient, preferably for treating a region within the carotid arteries. Referring again toFIGS. 1 and 2, thecatheter10 is first introduced into ablood vessel70 using known percutaneous procedures, and then is directed through the blood vessel to the stenosed region of the target blood vessel. Thecatheter10 is typically introduced in an upstream-to-downstream (antegrade) orientation as shown inFIGS. 1 and 14, although the catheter may also be introduced in a downstream-to-upstream (retrograde) orientation as will be described below. In a preferred example, thecatheter10 is inserted into a femoral artery and directed using known methods to a carotid artery, as shown inFIG. 14, or alternatively is introduced through a lower region of a carotid artery and directed downstream to thestenosed location74.
• Thesheath32 is percutaneously introduced into theblood vessel70 downstream of thestenosed region74, and is deployed using conventional methods. Thedistal end42 of theguidewire40 is directed through thelumen33 of thesheath32 until thefilter assembly50 is introduced into theblood vessel70 by pushing distally on thehub46 on theguidewire40. When thedistal end42 of theguidewire40 enters theblood vessel70, theexpansion frame52 is opened to its enlarged condition, extending substantially across the entire cross-section of thevessel70. Thefilter mesh60 attached to theframe52 substantially engages theluminal walls72 of thevessel70, thereby capturing any undesirable loose material passing along theblood vessel70 from the treatedregion74.
• Thecatheter10 is inserted through thestenosed region74 until thestent20 is centered across the plaque orembolic material76 deposited on thewalls72 of theblood vessel70. If theregion74 is substantially blocked, it may be necessary to first open theregion74 using a balloon catheter prior to insertion of the stent catheter (not shown inFIG. 3), as will be familiar to those skilled in the art. Once thestent20 is in the desired position, fluid, saline, or radiographic contrast media, but preferably radiographic contrast media, is introduced through theinflation lumen18 to inflate theballoon16. As theballoon16 expands, the pressure forces thestent20 radially outwardly to engage theplaque76. Theplaque76 is pushed away from theregion74, opening thevessel70. Thestent20 covers theplaque76, substantially permanently trapping it between thestent20 and thewall72 of thevessel70. Once theballoon16 is fully inflated, thestent20 provides a cross-section similar to the clear region of thevessel70. Theballoon16 is then deflated by withdrawing the fluid out of theinflation lumen18 and thecatheter12 is withdrawn from theregion74 and out of the patient using conventional methods. Thestent20 remains in place, substantially permanently covering theplaque76 in the treatedregion74 and forming part of the lumen of thevessel70.
• As thestenosed region74 is being opened, or possibly as thecatheter12 is being introduced through theregion74, plaque may break loose from thewall72 of thevessel70. Blood flow will carry the material downstream where it will encounter thefilter mesh60 and be captured therein. Once thecatheter12 is removed from the treatedregion74, theexpansion frame52 for thefilter mesh60 is closed to the contracted position, containing any material captured therein. Thefilter assembly50 is withdrawn into thelumen33 of thesheath32, and thefilter device30 is removed from the body.
• In another embodiment, shown inFIG. 2, theguidewire40 and thefilter assembly50 are included within thestent catheter10, rather than being provided in a separate sheath, thus eliminating the need for a second percutaneous puncture into the patient. As already described, thecatheter12 is provided with aninflatable balloon16 furnished near itsdistal end14 and with astent20 compressed over theballoon16. In addition to theinflation lumen18, asecond lumen19 extends through thecatheter12 from a proximal region (not shown) to itsdistal end14. Aguidewire40, having afilter assembly50 on itsdistal end42, is introduced through thelumen19 until itsdistal end42 reaches thedistal end14 of thecatheter12. As before, thefilter assembly50 comprises anexpansion frame52 andfilter mesh60, which remain within thelumen19 of thecatheter12 until deployed.
• As described above, thestent catheter10 is percutaneously introduced and is directed through the blood vessels until it reaches thestenosed region74 and thestent20 is centered across theplaque76. Theguidewire40 is pushed distally, introducing thefilter assembly50 into theblood vessel70. Theexpansion frame52 is opened to the enlarged condition until thefilter mesh60 engages thewalls72 of theblood vessel70. Theballoon16 is then inflated, pushing thestent20 against theplaque76, opening the treatedregion74. As before, thestent20 substantially permanently engages theplaque76 and becomes part of thelumen72 of thevessel70. After theballoon16 is deflated, theexpansion frame52 of thefilter assembly50 is closed to the contracted condition, and thefilter assembly50 is withdrawn into thelumen19. Thestent catheter10 is then withdrawn from the patient using conventional procedures.
• Alternatively, a self-expanding stent may be substituted for the expandable stent described above. Generally, the stent is compressed onto a catheter, and a sheath is introduced over the catheter and stent. The sheath serves to retain the stent in its compressed form until time of deployment. The catheter is percutaneously introduced into a patient and directed to the target location within the vessel. With the stent in position, the catheter is fixed and the sheath is withdrawn proximally. Once exposed within the blood vessel, the stent automatically expands radially, until it substantially engages the walls of the blood vessel, thereby trapping the embolic material and dilating the vessel. The catheter and sheath are then removed from the patient.
• Thefilter assembly50 generally described above has a number of possible configurations. Hereinafter reference is generally made to the filter device described above having a separate sheath, although the same filter assemblies may be incorporated directly into the stent catheter.
• Turning toFIGS. 4A,4B, and4C, another embodiment of thefilter device30 is shown, namely asheath32 having aguidewire40 in itslumen33 and afilter assembly50 extending from thedistal end36 ofsheath32. Thefilter assembly50 comprises a plurality ofstruts54 andfilter mesh60. Theguidewire40 continues distally through thefilter mesh60 to theclosed end region62. The proximal ends56 of thestruts54 are attached to thedistal end36 of thesheath32, while the distal ends58 of thestruts54 are attached to thedistal end42 of the guidewire. InFIG. 4A, showing the contracted condition, thestruts54 are substantially straight and extend distally. At anintermediate region57, theopen end64 of thefilter mesh60 is attached to thestruts54 using the methods previously described. Thefilter mesh60 may be attached to thestruts54 only at theintermediate region57 or preferably continuously from theintermediate region57 to the distal ends58.
• In addition, at theintermediate region57, thestruts54 are notched or otherwise designed to buckle or bend outwards when compressed. Between theintermediate region57 of thestruts54 and thedistal end36 of thesheath32, theguidewire40 includes a lockingmember80, preferably an annular-shaped ring made of stainless steel, fixedly attached thereon. Inside thelumen33 near thedistal end36, thesheath32 has a recessedarea82 adapted to receive the lockingmember80.
• Theguidewire40 andfilter assembly50 are included in asheath32 as previously described, which is introduced into ablood vessel70, as shown inFIG. 4A, downstream of the stenosed region (not shown). With thesheath32 substantially held in position, theguidewire40 is pulled proximally. This causes thestruts54 to buckle and fold outward at theintermediate region57, opening theopen end64 of thefilter mesh60 as shown inFIG. 4B. As theguidewire40 is pulled, the lockingmember80 enters thelumen33, moving proximally until it engages the recessedarea82, locking the expansion frame in its enlarged condition, as shown inFIG. 4C. With theexpansion frame52 in its enlarged condition, theopen end64 of thefilter mesh60 substantially engages thewalls72 of theblood vessel70.
• After the stent is delivered (not shown), theexpansion frame52 is closed by pushing theguidewire40 distally. This pulls thestruts54 back in towards theguidewire40, closing theopen end64 of thefilter mesh60 and holding any loose embolic material within thefilter assembly50.
• As a further modification of this embodiment, theentire sheath32 andfilter assembly50 may be provided within an outer sheath or catheter (not shown) to protect thefilter assembly50 during introduction into the vessel. Once the device is in the desired location, thesheath32 is held in place and the outer sheath is withdrawn proximally, exposing thefilter assembly50 within theblood vessel70. After thefilter assembly50 is used and closed, thesheath32 is pulled proximally until thefilter assembly50 completely enters the outer sheath, which may then be removed.
• Turning toFIGS. 5A,5B and5C, another embodiment of thefilter assembly50 is shown. The proximal ends56 of the plurality ofstruts54 are substantially fixed to thedistal end36 of thesheath32. The distal ends58 may terminate at theopen end64 of thefilter mesh60, although preferably, thestruts54 extend distally through thefilter mesh60 to theclosed end region62, where they are attached to thedistal end42 of theguidewire40.
• Referring toFIG. 5A, thefilter assembly50 is shown in its contracted condition. Theguidewire40 has been rotated torsionally, causing thestruts54 to helically twist along the longitudinal axis of theguidewire40 and close thefilter mesh60. Thefilter assembly50 is introduced into ablood vessel70 as already described, either exposed on the end of thesheath32 or, preferably, within an outer sheath (not shown) as described above.
• Once in position, thesheath32 is fixed, and theguidewire40 is rotated torsionally in relation to thesheath32. As shown inFIG. 5B, thestruts54, which are biased to move radially towards thewall72 of thevessel70, unwind as theguidewire40 is rotated, opening theopen end64 of thefilter mesh60. Once thestruts54 are untwisted, the expansion frame in its enlarged condition causes theopen end64 of thefilter mesh60 to substantially engage thewalls72 of thevessel70, as shown inFIG. 5C.
• After the stent is delivered (not shown), theguidewire40 is again rotated, twisting thestruts54 back down until theexpansion frame52 again attains the contracted condition ofFIG. 5A. Thesheath32 andfilter assembly50 are then removed from theblood vessel70.
• Another embodiment of thefilter assembly50 is shown inFIGS. 6A and 6B. Thestruts54 at their proximal ends56 are mounted on or in contact withguidewire40, and theirdistal ends58 are connected to form theexpansion frame52, and are biased to expand radially at anintermediate region57. The proximal ends56 are attached to thedistal end42 of theguidewire40 with the distal ends58 being extended distally fromsheath32.Filter mesh60 is attached to thestruts54 at theintermediate region57. If thefilter assembly50 is introduced in an antegrade orientation as previously described, thefilter mesh60 is typically attached from theintermediate region57 to the distal ends58 of thestruts54, as indicated inFIG. 6A. Alternatively, if introduced in a retrograde orientation, it is preferable to attach thefilter mesh60 between theintermediate region57 to the proximal ends56 of thestruts54, as shown inFIG. 6B, thus directing the interior of the filter mesh upstream to capture any embolic material therein.
• Thefilter assembly50 is provided with thestruts54 compressed radially in a contracted condition in thelumen33 of the sheath32 (not shown). Thefilter assembly50 is introduced into theblood vessel70 by directing the guidewire distally. As theexpansion frame52 enters the blood vessel, thestruts54 automatically expand radially into the enlarged condition shown inFIGS. 6A and 6B, thereby substantially engaging theopen end64 of thefilter mesh60 with thewalls72 of theblood vessel70. To withdraw thefilter assembly50 from thevessel70, theguidewire40 is simply pulled proximally. Thestruts54 contact thedistal end36 of thesheath32 as they enter thelumen33, compressing theexpansion frame52 back into the contracted condition.
• FIG. 8A presents another embodiment of thefilter assembly50 similar to that just described. Theexpansion frame52 comprises a plurality ofstruts54 having afilter mesh60 attached thereon. Rather than substantially straight struts bent at an intermediate region, however, thestruts54 are shown having a radiused shape biased to expand radially when thefilter assembly50 is first introduced into theblood vessel70. Thefilter mesh60 has a substantially hemispherical shape, in lieu of the conical shape previously shown.
• Optionally, as shown inFIG. 8B, thefilter mesh60 may includegripping hairs90, preferably made from nylon, polyethylene, or polyester, attached around the outside of theopen end64 to substantially minimize undesired movement of thefilter mesh60. Suchgripping hairs90 may be included in any embodiment presented if additional engagement between thefilter mesh60 and thewalls72 of thevessel70 is desired.
• FIG. 7 shows an alternative embodiment of thefilter assembly50, in which theexpansion frame52 comprises astrut54 attached to thefilter mesh60. Theopen end64 of thefilter mesh60 is biased to open fully, thereby substantially engaging thewalls72 of theblood vessel70. The mesh material itself may provide sufficient bias, or a wire frame (not shown) around theopen end64 may be used to provide the bias to open thefilter mesh60.
• Thefilter mesh60 is compressed prior to introduction into thesheath32. To release thefilter assembly50 into theblood vessel70, theguidewire40 is moved distally. As thefilter assembly50 leaves thelumen33 of thesheath32, thefilter mesh60 opens until theopen end64 substantially engages thewalls72 of theblood vessel70. Thestrut54 attached to thefilter mesh60 retains thefilter mesh60 and eases withdrawal back into thesheath32. For removal, theguidewire40 is directed proximally. Thestrut54 is drawn into thelumen33, pulling thefilter mesh60 in after it.
• In a further alternative embodiment,FIG. 9 shows afilter assembly50 comprising a plurality of substantially cylindrical, expandable sponge-like devices92, having peripheral surfaces94 which substantially engage thewalls72 of theblood vessel70. Thedevices92 are fixed to theguidewire40 which extends centrally through them as shown. The sponge-like devices have sufficient porosity to allow blood to pass freely through them and yet to entrap undesirable substantially larger particles, such as loose embolic material. Exemplary materials appropriate for this purpose include urethane, silicone, cellulose, or polyethylene, with urethane and polyethylene being preferred.
• In addition, thedevices92 may have varying porosity, decreasing along the longitudinal axis of the guidewire. Theupstream region96 may allow larger particles, such as embolic material, to enter therein, while thedownstream region98 has sufficient density to capture and contain such material. This substantially decreases the likelihood that material will be caught only on the outer surface of the devices, and possibly come loose when the devices is drawn back into the sheath.
• Thedevices92 are compressed into thelumen33 of the sheath32 (not shown), defining the contracted condition. They are introduced into theblood vessel70 by pushing theguidewire40 distally. Thedevices92 enter thevessel70 and expand substantially into their uncompressed size, engaging thewalls72 of thevessel70. After use, theguidewire40 is pulled proximally, compressing thedevices92 against thedistal end36 of thesheath32 and directing them back into thelumen33.
• Turning toFIG. 10, another embodiment of the present invention is shown, that is, astent catheter10 having afilter assembly50 provided directly on itsouter surface13. Thestent catheter10 includes similar elements and materials to those already described, namely acatheter12, aninflatable balloon16 near thedistal end14 of thecatheter12, and astent20 compressed over theballoon16. Instead of providing afilter assembly50 on a guidewire, however, thefilter assembly50 typically comprises anexpansion frame52 andfilter mesh60 attached directly to theouter surface13 of thecatheter12. Preferably, theexpansion frame52 is attached to thecatheter12 in a location proximal of thestent20 for use in retrograde orientations, although optionally, theexpansion frame52 may be attached distal of thestent20 and used for antegrade applications.
• Thefilter assembly50 may take many forms similar to those previously described for attachment to a guidewire. InFIG. 10, theexpansion frame52 includes a plurality of radially biased struts54, having proximal ends56 and distal ends58. The proximal ends56 of thestruts54 are attached to theouter.surface13 of thecatheter12 proximal of thestent20, while the distal ends58 are loose.Filter mesh60, similar to that already described, is attached to thestruts54 between the proximal ends56 and the distal ends58, and optionally to theouter surface13 of thecatheter12 where the proximal ends56 of thestruts52 are attached.
• Prior to use, asheath132 is generally directed over thecatheter12. When the sheath engages thestruts54, it compresses them against theouter surface13 of thecatheter12. Thecatheter12 and thesheath132 are then introduced into the patient, and directed to the desired location. Once thestent20 is in position, thecatheter12 is fixed and thesheath132 is drawn proximally. As thestruts58 enter theblood vessel70, the distal ends58 move radially, opening thefilter mesh60. Once thefilter assembly50 is fully exposed within theblood vessel70, the distal ends58 of thestruts54, and consequently theopen end64 of thefilter mesh60, substantially engage thewalls72 of theblood vessel70.
• After the stent is deployed, thesheath132 is pushed distally. As thestruts54 enter thelumen133 of thesheath132, they are compressed back against theouter surface13 of thecatheter12, thereby containing any captured material in thefilter mesh60. Thecatheter12 andsheath132 are then withdrawn from thevessel70.
• Turning toFIGS. 11A and 11B, an alternative embodiment of theexpansion frame50 is shown. The proximal ends56 of thestruts54 are attached or in contact with theouter surface13 of thecatheter12. Thestruts54 have a contoured radius biased to direct anintermediate region57 radially.Filter mesh60 is attached between theintermediate region57 and the proximal ends56, or between the intermediate region and the distal end (not shown).FIG. 11A shows thefilter assembly50 in its contracted condition, with asheath132 covering it. Thesheath132 compresses thestruts54 against theouter surface13 of thecatheter12, allowing the device to be safely introduced into the patient. Once in position, thesheath132 is pulled proximally as shown inFIG. 11B. As thedistal end136 of thesheath132 passes proximal of thefilter assembly50, thestruts54 move radially, causing theintermediate region57 of thestruts54 and the open end of thefilter mesh60 to substantially engage thewalls72 of theblood vessel70. After use, thesheath132 is directed distally, forcing thestruts54 back against thecatheter12 and containing any material captured within thefilter mesh60.
• In another embodiment of the present invention, shown inFIGS. 12A and 12B, astent catheter10, similar to those previously described, is provided with a fluid operatedfilter assembly50 attached on or near thedistal end14 of thecatheter12. Thecatheter12 includes afirst inflation lumen18 for thestent balloon16, and asecond inflation lumen19 for inflating anexpansion frame52 for thefilter assembly50. Theexpansion frame52 generally comprises aninflatable balloon102, preferably having a substantially annular shape. Theballoon102 generally comprises a flexible, substantially resilient material, such as silicone, latex, or urethane, but with urethane being preferred.
• Thesecond inflation lumen19 extends to a region at or near to thedistal end14 of thecatheter12, and then communicates with theouter surface13, or extends completely to thedistal end14. Aconduit104 extends between theballoon102 and theinflation lumen19. Theconduit104 may comprise a substantially flexible tube of material similar to theballoon102, or alternatively it may be a substantially rigid tube of materials such as polyethylene. Optionally, struts orwires106 are attached between theballoon102 and thecatheter12 to retain theballoon12 in a desired orientation.Filter mesh60, similar to that previously described, is attached to theballoon102.
• Turning more particularly toFIG. 12A, thefilter assembly50 is shown in its contracted condition. Theballoon102 is adapted such that in its deflated condition it substantially engages theouter surface13 of thecatheter12. This retains thefilter mesh60 against thecatheter12, allowing thecatheter12 to be introduced to the desired location within the patient'sblood vessel70. Thecatheter12 is percutaneously introduced into the patient and thestent20 is positioned within theoccluded region74. Fluid, such as saline solution, is introduced into thelumen19, inflating theballoon102. As it inflates, theballoon102 expands radially and moves away from theouter surface13 of thecatheter12.
• As shown inFIG. 12B, once theballoon102 is fully inflated to its enlarged condition, it substantially engages thewalls72 of theblood vessel70 and opens thefilter mesh60. Once thestent20 is delivered and thestent balloon16 is deflated, fluid is drawn back out through theinflation lumen19, deflating theballoon102. Once deflated, theballoon102 once again engages theouter surface13 of thecatheter12, closing thefilter mesh60 and containing any embolic material captured therein. Thecatheter12 is then withdrawn from the patient.
• Alternatively, thefilter assembly50 just described may be mounted in a location proximal to thestent20 as shown inFIGS. 13A and 13B. Theopen end64 of thefilter mesh60 is attached to theballoon102, while theclosed end62 is attached to theouter surface13 of thecatheter12, thereby defining a space for capturing embolic material. In the contracted condition shown inFIG. 13A, theballoon102 substantially engages theouter surface13 of thecatheter12, thereby allowing thecatheter10 to be introduced or withdrawn from ablood vessel70. Once thestent20 is in position across astenosed region74, theballoon102 is inflated, moving it away from thecatheter12, until it achieves its enlarged condition, shown inFIG. 13B, whereupon it substantially engages thewalls72 of theblood vessel70.
• A detailed longitudinal view of a filter guidewire is shown inFIG. 15.Guidewire40 comprises innerelongate member207 surrounded by a secondelongate member201, about which is wrappedwire211 in a helical arrangement.Guidewire40 includesenlarged segment202,208 which houses a series of radially biased struts203.Helical wires211 separate atcross-section205 to expose the eggbeater filter contained withinsegment202.Guidewire40 includes a floppyatraumatic tip204 which is designed to navigate through narrow, restricted vessel lesions. The eggbeater filter is deployed by advancing distallyelongate member201 so thatwire housing211 separates atposition205 as depicted inFIG. 15A.Elongate member207 may be formed from a longitudinally stretchable material which compresses as thestruts203 expand radially. Alternatively,elongate member207 may be slideably received withinsheath201 to allow radial expansion ofstruts203 upon deployment. The filter guidewire may optionally include acoil spring206 disposed helically aboutelongate member207 in order to cause radial expansion ofstruts203 upon deployment.
• A typical filter guidewire will be constructed so that the guidewire is about5F throughoutsegment208,4F throughoutsegment209, and3F throughoutsegment210. The typical outer diameter in a proximal region will be 0.012-0.035 inches, more preferably 0.016-0.022 inches, more preferably 0.018 inches. In the distal region, a typical outer diameter is 0.020-0.066 inches, more preferably 0.028-0.036 inches, more preferably 0.035 inches. Guidewire length will typically be 230-290 cm, more preferably 260 cm for deployment of a balloon catheter. It should be understood that reducing the dimensions of a percutaneous medical instrument to the dimensions of a guidewire as described above is a significant technical hurdle, especially when the guidewire includes a functioning instrument such as an expansible filter as disclosed herein. It should also be understood that the above parameters are set forth only to illustrate typical device dimensions, and should not be considered limiting on the subject matter disclosed herein.
• In use, a filter guidewire is positioned in a vessel at a region of interest. The filter is deployed to an expanded state, and a medical instrument such as a catheter is advanced over the guidewire to the region of interest. Angioplasty, stent deployment, rotoblader, atherectomy, or imaging by ultrasound or Doppler is then performed at the region of interest. The medical/interventional instrument is then removed from the patient. Finally, the filter is compressed and the guidewire removed from the vessel.
• A detailed depiction of an eggbeater filter is shown inFIGS. 16,16A.16B, and16C. With reference toFIG. 16, the eggbeater filter includespressure wires212,primary wire cage213,mesh52, and optionally afoam seal214 which facilitates substantial engagement of the interior lumen of a vessel wall and conforms to topographic irregularities therein. The eggbeater filter is housed withincatheter sheath32 and is deployed when the filter is advanced distally beyond the tip ofsheath32. This design will accommodate a catheter of size8F (0.062 inches, 2.7 mm), and for such design, theprimary wire cage213 would be 0.010 inches andpressure wires212 would be 0.008 inches. These parameters can be varied as known in the art, and therefore should not be 5 viewed as limiting.
• FIGS. 16A and 16B depict the initial closing sequence at a cross-section throughfoam seal214.FIG. 16C depicts the final closing sequence.
• FIGS. 17 and 17A depict an alternative filter guidewire which makes use of afilter scroll215 disposed at the distal end ofguidewire40.Guidewire40 is torsionally operated as depicted at216 in order to close the filter, while reverse operation (217) opens the filter. The filter scroll may be biased to automatically spring open through action of a helical or other spring, or heat setting. Alternatively, manual, torsional operation opens the filter scroll. In this design, guidewire40 acts as a mandrel to operate thescroll215.
• An alternative embodiment of a stent deployment blood filtration device is depicted inFIGS. 18,18A, and18B. With reference toFIG. 18,catheter225 includeshousing220 at itsproximal end221, and at itsdistal end catheter225 carriesstent223 andexpandable filter224. In one embodiment,expandable filter224 is a self-expanding filter device optionally disposed about an expansion frame. In another embodiment,filter224 is manually operable by controls atproximal region221 for deployment. Similarly,stent223 can be either a self-expanding stent as discussed above, or a stent which is deployed using a balloon or other radially expanding member. Restrainingsheath222 encloses one or both offilter224 andstent223. In use,distal region226 ofcatheter225 is disposed within a region of interest, andsheath222 is drawn proximally to firstexposed filter224 and then exposedstent223. As such,filter224 deploys beforestent223 is radially expanded, and therefore filter224 is operably in place to capture any debris dislodged during stent deployment as depicted inFIG. 18A.FIG. 18B shows an alternative embodiment which employseggbeater filter224 in the distal region.
• An alternative design for the construction of an eggbeater filter is shown inFIG. 19. This device includesinner sheath231,outer sheath230, and a plurality ofstruts232 which are connected toouter sheath230 at a proximal end of each strut, and toinner sheath231 at a distal end of each strut. Filter expansion is accomplished by movinginner sheath231 proximal relative toouter sheath230, which action causes each strut to buckle outwardly. It will be understood that the struts in an eggbeater filter may be packed densely to accomplish blood filtration without a mesh, or may include a mesh draped over aproximal portion233 or adistal portion234, or both.
• In another embodiment, a filter guidewire is equipped with a distal imaging device as shown inFIG. 20.Guidewire40 includeseggbeater filter224 and restrainingsheath222 for deployment offilter224. The distal end ofguidewire40 is equipped withimaging device235 which can be any of an ultrasound transducer or a Doppler flow velocity meter, both capable of measuring blood velocity at or near the end of the guidewire. Such a device provides valuable information for assessment of relative blood flow before and after stent deployment. Thus, this device will permit the physician to determine whether the stent has accomplished its purpose or been adequately expanded by measuring and comparing blood flow before and after stent deployment.
• In use, the distal end of the guidewire is introduced into the patient's vessel with the sheath covering the expandable filter. The distal end of the guidewire is positioned so that the filter is downstream of a region of interest and the sheath and guidewire cross the region of interest. The sheath is slid toward the proximal end of the guidewire and removed from the vessel. The expandable filter is uncovered and deployed within the vessel downstream of the region of interest. A percutaneous medical instrument is advanced over the guidewire to the region of interest and a procedure is performed on a lesion in the region of interest. The percutaneous medical instrument can be any surgical tool such as devices for stent delivery, balloon angioplasty catheters, atherectomy catheters, a rotoblader, an ultrasound imaging catheter, a rapid exchange catheter, an over-the-wire catheter, a laser ablation catheter, an ultrasound ablation catheter, and the like. Embolic material generated during use of any of these devices on the lesion is captured before the expandable filter is removed from the patient's vessel. The percutaneous instrument is then withdrawn from the vessel over the guidewire. A sheath is introduced into the vessel over the guidewire and advanced until the sheath covers the expandable filter. The guidewire and sheath are then removed from the vessel.
• Human aortic anatomy is depicted inFIG. 21. During cardiac surgery,bypass cannula243 is inserted in the ascending aorta and either balloon occlusion or an aortic cross-clamp is installed upstream of the entry point forcannula243. The steps in a cardiac procedure are described in Barbut et al., U.S. application Ser. No. 08/842,727, filed Apr. 16, 1997, and the level of debris dislodgment is described in Barbut et al., “Cerebral Emboli Detected During Bypass Surgery Are Associated With Clamp Removal,” Stroke, 25(12): 2398-2402 (1994), which is incorporated herein by reference in its entirety.FIG. 21 demonstrates that the decoupling of the filter from the bypass cannula presents several avenues for filter deployment. As discussed in Maahs, U.S. Pat. No. 5,846,260, incorporated herein by reference, a modular filter may be deployed throughcannula243 either upstream244 or downstream245. In accordance with the present disclosure, a filter may be deployed upstream of the innominate artery within the aorta by using a filter guidewire which is inserted at240 through a femoral artery approach. Alternatively, filter guidewire may be inserted throughroute241 by entry into the left subclavian artery or byroute242 by entry through the right subclavian artery, both of which are accessible through the arms. The filter guidewire disclosed herein permits these and any other routes for accessing the ascending aorta and aortic arch for blood filtration.
• In another embodiment, a generalized filter guidewire is depicted inFIG. 22.FIG. 23 shows guidewire40 havingsleeve250 disposed thereabout.Sleeve250 includes longitudinally slittedregion251 which is designed to radially expand when compressed longitudinally. Thus, when the distal end ofsleeve250 is pulled proximally, theslitted region251 buckles radially outwardly as shown inFIG. 23A to provide a form of eggbeater filter. The expanded cage thus formed may optionally includemesh52 draped over a distal portion, a proximal portion, or both.
• In use, a stent catheter, such as those previously described, is used in a retrograde application, preferably to prevent the detachment of mobile aortic plaque deposits within the ascending aorta, the aortic arch, or the descending aorta. Preferably, the stent catheter is provided with a filter assembly, such as that just described, attached to the catheter proximal of the stent. Alternatively, a stent catheter without any filter device, may also be used. The stent catheter is percutaneously introduced into the patient and directed to the desired region. Preferably, the catheter is inserted into a femoral artery and directed into the aorta, or is introduced into a carotid artery and directed down into the aorta. The stent is centered across the region which includes one or more mobile aortic deposits.
• If a filter assembly is provided on the catheter, it is expanded to its enlarged condition before the stent is deployed in order to ensure that any material inadvertently dislodged is captured by the filter. Alternatively, a sheath having a guidewire and filter assembly similar to those previously described may be separately percutaneously introduced downstream of the region being treated, and opened to its enlarged condition.
• The stent balloon is inflated, expanding the stent to engage the deposits. The stent forces the deposits against the wall of the aorta, trapping them. When the balloon is deflated, the stent substantially maintains its inflated cross-section, substantially permanently containing the deposits and forming a portion of the lumen of the vessel. Alternatively, a self-expanding stent may be delivered, using a sheath over the stent catheter as previously described. Once the stent has been deployed, the filter assembly is closed, and the stent catheter is withdrawn using conventional methods.
• Unlike the earlier embodiments described, this method of entrapping aortic plaque is for a purpose other than to increase luminal diameter. That is, mobile aortic deposits are being substantially permanently contained beneath the stent to protect a patient from the risk of embolization caused by later detachment of plaque. Of particular concern are the ascending aorta and the aortic arch. Loose embolic material in these vessels presents a serious risk of entering the carotid arteries and traveling to the brain, causing serious health problems or possibly even death. Permanently deploying a stent into such regions substantially reduces the likelihood of embolic material subsequently coming loose within a patient, and allows treatment without expensive intrusive surgery to remove the plaque.
• While the invention is susceptible to various modifications, and alternative forms, specific examples thereof have been shown in the drawings and are herein described in detail. It should be understood, however, that the invention is not to be limited to the particular forms or methods disclosed, but to the contrary, the invention is to cover all modifications, equivalents and alternatives falling within the spirit and scope of the appended claims.

Claims (1)

1. A distal protection device, comprising: a filter frame comprising a plurality of struts, the struts having proximal and distal portions; a first elongate member having a distal section, the distal section attached to the distal portion of the struts; a second elongate member having a distal section, the distal section attached to the proximal portion of the struts, wherein the struts have a first position wherein the struts are deployed away from the first elongate member, forming a filter basket; wherein the struts have a second position wherein the struts are wrapped around the first elongate member, and wherein the struts are moved between the first and second positions by rotating the first and second elongate members relative to one another.

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