Method and Apparatus for Emboli Containment
A catheter for use in an emboli containment system includes a flexible elongate member having self-expanding sealing means mounted on its distal extremeity. This self-expanding sealing means can take any suitable form, such as a braided structure formed of a suitable shape memory material such as a nickel titanium alloy. In order to prevent abrasion of a vessel, it is desirable to cover the braided structure with a covering of a suitable material such as a polymer which extends over the braided structure and which moves with the braided structure as it expands and contracts.
1 . A method of protecting a patient from embolization during a percutaneous procedure on a vessel, comprising the steps of:
providing a flexible elongate member having proximal and distal ends, a proximal and a distal region, an expandable member associated with the distal region, and a removable sheath which covers the expandable member and is slidable over the flexible elongate member;
introducing the distal end of the flexible elongate member into the patient's vessel with the sheath covering the expandable member, and positioning the expandable member downstream of a region of interest, wherein the sheath and flexible elongate member cross the region of interest;
sliding the sheath toward the proximal end of the flexible elongate member to uncover the expandable member and deploy the expandable member;
advancing over the flexible elongate member a stent-deployment catheter to the region of interest; and
expanding a stent at the region of interest,
wherein embolic material is generated and captured before the expandable member is removed from the patient's vessel.
3 . The method of claim 1 , wherein the stent is deployed by inflation of a balloon.
5 . The method of claim 1 , wherein the expandable member comprises a braided structure.
6 . The method of claim 1 , wherein the expandable member includes a covering.
7 . The method of claim 1 , wherein the expandable member is self-expanding.
9 . A percutaneous system, comprising:
a flexible elongate member having proximal and distal ends, a proximal and distal region, and an expandable member associated with the distal region;
a sheath which is shaped to receive the flexible elongate member and retain the expandable member in a contracted condition, and to slidably release the expandable member to an expanded condition when the sheath moves toward the proximal end of the flexible elongate member;
a catheter having a proximal and a distal end, a proximal and a distal region, and a lumen which slidably receives the flexible elongate member; and
an expandable stent disposed about the distal region of the catheter, the stent having a first diameter which permits intraluminal delivery of the stent into a body passageway and which places the stent in close proximity to the catheter, and having a second expanded diameter adapted to substantially engage a wall of the body passageway,
wherein, during use, the flexible elongate member is positioned across a region of interest, the expandable member is expanded, and the stent is deployed within the region of interest and remains in place after removal of the catheter from the vessel.
10 . The system of claim 9 wherein the expandable member comprises a braided structure and a covering over the braided structure.
11 . The system of claim 10 , wherein the braided structure is self-expanding.
18 . The system of claim 9 , wherein the stent and the expandable member are self-expanding.
19 . The system of claim 9 , wherein the stent is removable.
20 . The system of claim 9 , wherein the stent is self-expanding.
22 . The system of claim 9 , wherein the stent comprises a nickel-titanium alloy material.
23 . The system of claim 9 , wherein the stent is cylindrically-shaped.
25 . A method of protecting a patient from embolization during a percutaneous procedure on a vessel, comprising the steps of:
providing a guidewire having proximal and distal ends, a proximal and a distal region, an expandable filter associated with the distal region, and a removable sheath which covers the expandable filter and is slidable over the guidewire;
introducing the distal end of the guidewire into the patient's vessel with the sheath covering the expandable filter, and positioning the filter downstream of a region of interest, wherein the sheath and guidewire cross the region of interest;
sliding the sheath toward the proximal end of the guidewire and removing the sheath from the vessel, wherein the expandable filter is uncovered;
deploying the filter;
advancing over the guidewire a stent-deployment catheter to the region of interest; and
expanding the stent at the region of interest, wherein embolic material is generated and captured before the expandable filter is removed from the patient's vessel.
26 . A percutaneous system having filter and stent deployment capabilities, comprising:
a guidewire having proximal and distal ends, a proximal and distal region, and an expandable filter associated with the distal region;
a sheath which is shaped to receive the guidewire and retain the filter in a contracted condition, and to slideably release the filter to an expanded condition when the sheath moves toward the proximal end of the guidewire;
a catheter having a proximal and a distal end, a proximal and a distal region, and a lumen which slideably receives the guidewire; and
an expandable stent disposed about the distal region of the catheter, the stent having a first diameter which permits intraluminal delivery of the stent into a body passageway and which places the stent in close proximity to the catheter, and having a second expanded diameter adapted to substantially engage a wall of the body passageway, wherein, during use, the guidewire is positioned across a region of interest, the filter is expanded, and the stent is deployed within the region of interest and remains in place after removal of the catheter from the vessel.
27 . A method of protecting a patient from embolization during a percutaneous procedure on a vessel, comprising the steps of:
providing a flexible elongate member having proximal and distal extremities, a self-expanding member mounted on the distal extremity, and a sleeve covering and compressing the self-expanding member;
advancing the distal extremity of the flexible elongate member and the sleeve into the patient's vessel and positioning the self-expanding member adjacent to a stenosis to be treated;
retracting the sleeve toward the proximal end of the flexible elongate member to uncover the self-expanding member and to permit the self-expanding member to expand to a vessel wall adjacent to the stenosis;
advancing a stent delivery catheter carrying a stent thereon to the stenosis; and
expanding the stent at the stenosis while the self-expanding member is expanded, wherein emboli which may be dislodged during the delivery and expanding of the stent are captured before the self-expanding member is removed from the patient's vessel.
28 . The method of claim 27 , wherein the stent-delivery catheter is advanced in co-axial relationship relative to the flexible elongate member.
29 . The method of claim 27 , wherein the self-expanding member is braided.
30 . The method of claim 27 , wherein the self-expanding member is made of a shape memory material.
31 . The method of claim 27 , wherein the self-expanding member is made of a nickel titanium alloy.
32 . A percutaneous system having stent deployment capabilities, comprising:
a flexible elongate member having proximal and distal extremities and a self-expanding member mounted on the distal extremity;
a sleeve having a proximal and distal extremity, the sleeve having a bore to receive the flexible elongate member and to cover and compress the self-expanding member, the sleeve being retractable to uncover the self-expanding member to permit the self-expanding member to expand into engagement with a vessel wall adjacent to a stenosis to be treated; and
a stent delivery catheter having a flexible shaft and a lumen; and
an expandable stent carried on the stent delivery catheter, wherein, during use, the self expanding member is positioned and expanded adjacent to a stenosis to be treated and the stent is deployed at the stenosis and remains in place after removal of the stent delivery catheter.
33 . The percutaneous system of claim 32 , wherein the sleeve further comprises a collar mounted on the proximal extremity of the sleeve whereby the sleeve may be retracted to uncover the self-expanding member to permit the self-expanding member to expand to the vessel adjacent the stenosis to be treated.
34 . The percutaneous system of claim 32 , wherein the self-expanding member is braided.
35 . The percutaneous system of claim 32 , wherein the self-expanding member is made of a shape memory material.
36 . The percutaneous system of claim 35 , wherein the self-expanding member is made of a nickel titanium alloy.
37 . The percutaneous system of claim 32 , wherein the stent is self-expanding.
38 . A method of protecting a patient from embolization during a percutaneous procedure on a vessel, comprising the steps of:
providing a flexible elongate member having proximal and distal extremities, a braided structure mounted on the distal extremity, and an elongate sleeve which covers the braided structure;
advancing the distal extremity of the flexible elongate member into the patient's vessel with the elongate sleeve covering the braided structure, and positioning the elongate sleeve and flexible elongate member such that the elongate sleeve and flexible elongate member cross a region of interest;
retracting the elongate sleeve toward the proximal end of the flexible elongate member, wherein the braided structure is uncovered;
advancing over the flexible elongate member a stent delivery catheter to the region of interest; and
deploying a stent at the region of interest, wherein embolic material is generated and captured before the braided structure is removed from the patient's vessel.
39 . A percutaneous system having stent deployment capabilities, comprising:
a flexible elongate member having proximal and distal extremities and a braided structure mounted on the distal extremity;
an elongate sleeve having a bore to receive the flexible elongate member and retain the braided structure in a compressed condition, and is retractable toward the proximal end of the flexible elongate member to release the braided structure to an expanded condition;
a catheter having a flexible shaft and a lumen; and
an expandable stent carried on the catheter, wherein, during use, the flexible elongate member is positioned adjacent a stenosis to be treated, the braided structure is expanded, and the stent is deployed at the stenosis and remains in place after removal of the catheter from the vessel.
40 . A method of protecting a patient from embolization during a percutaneous procedure on a vessel, comprising the steps of:
providing a flexible elongate member having proximal and distal ends, a proximal and a distal region, an expandable member associated with the distal region, and a sleeve which covers the expandable member;
introducing the distal end of the flexible elongate member into the patient's vessel with the sleeve covering the expandable member, and positioning the expandable member adjacent to a region of interest to be treated;
retracting the sleeve toward the proximal end of the flexible elongate member to uncover the expandable member and deploy the expandable member;
advancing a stent-delivery catheter to the region of interest; and
expanding a stent at the region of interest,
wherein embolic material generated during the procedure is captured before the expandable member is removed from the patient's vessel.
41 . The method of claim 40 , wherein the expandable member comprises a filter.
42 . The method of claim 40 , wherein the expandable member comprises a braided structure.
43 . The method of claim 40 , wherein the expandable member is self-expanding.
44 . The method of claim 40 , wherein the flexible elongate member comprises a guidewire.
45 . The method of claim 40 , wherein the region of interest comprises a stenosis.
46 . The method of claim 40 , wherein the stent-delivery catheter is delivered over the flexible elongate member to the region of interest.
47 . The method of claim 40 , wherein the expandable member is positioned downstream of the region of interest, wherein the sleeve and the expandable member cross the region of interest.
48 . A percutaneous system, comprising:
a flexible elongate member having proximal and distal ends, a proximal and distal region, and an expandable member associated with the distal region;
a sleeve having a proximal and distal extremity, wherein the sleeve is adapted to receive the flexible elongate member and to cover the expandable member, and wherein the sleeve is adapted to retract to uncover the expandable member to permit the expandable member to expand adjacent to a region of interest; and
a stent delivery catheter having a flexible shaft and a lumen; and
an expandable stent carried by the stent delivery catheter,
wherein the expandable member is positionable and expandable adjacent to the region of interest, and
wherein the stent is deployable at the region of interest and able to remain in place after removal of the stent delivery catheter.
49 . The percutaneous system of claim 48 , wherein the expandable member comprises a filter.
50 . The percutaneous system of claim 48 , wherein the expandable member comprises a braided structure.
51 . The percutaneous system of claim 48 , wherein the expandable member is adapted to expand into engagement with a vessel wall.
52 . The percutaneous system of claim 48 , wherein the expandable member is self-expanding.
53 . The percutaneous system of claim 48 , wherein the sleeve comprises a bore to receive the flexible elongate member.
54 . The percutaneous system of claim 48 , wherein the region of interest comprises a stenosis.
55 . The percutaneous system of claim 48 , wherein the expandable stent has a first diameter which permits intraluminal delivery of the stent into a body passageway and which permits placement of the stent in close proximity to the catheter, and wherein the stent has a second expanded diameter adapted to substantially engage a wall of the body passageway.
56 . The percutaneous system of claim 48 , wherein the flexible elongate member comprises a guidewire.
57 . The percutaneous system of claim 48 , wherein the flexible elongate member is positionable across a region of interest with the expandable member expanded and the stent deployed within the region of interest.
58 . The percutaneous system of claim 48 , wherein the lumen slideably receives the flexible elongate member.
59 . The percutaneous system of claim 48 , wherein the expandable member is a self-expanding braided filter and the flexible elongate member is a guidewire.