Emboli protection devices and related methods of use
View Patent ↗An evacuation sheath assembly and method of treating occluded vessels which reduces the risk of distal embolization during vascular interventions is provided. The evacuation sheath assembly includes an elongated tube defining an evacuation lumen having proximal and distal ends. A proximal sealing surface is provided on a proximal portion of the tube and is configured to form a seal with a lumen of a guided catheter. A distal sealing surface is provided on a distal portion of the tube and is configured to form a seal with a blood vessel. Obturator assemblies and infusion catheter assemblies are provided to be used with the evacuation sheath assembly. A method of treatment of a blood vessel using the evacuation sheath assembly includes advancing the evacuation sheath assembly into the blood vessel through a guide catheter. Normal antegrade blood flow in the blood vessel proximate to the stenosis is stopped and the stenosis is treated. Retrograde blood flow is induced within the blood vessel to carry embolic material dislodged during treating into the evacuation sheath assembly. If necessary to increase retrograde flow, the coronary sinus may be at least partially occluded. Alternatively, antegrade flow may be permitted while flow is occluded at the treatment site.
1. A method of treatment of a blood vessel, comprising:
advancing an evacuation sheath assembly into the blood vessel;
stopping normal antegrade blood flow in the blood vessel proximal to a stenosis;
advancing a non-occlusive guidewire to a position in the blood vessel distal the stenosis and leaving said position in the blood vessel free of occlusion;
advancing a therapeutic catheter into the blood vessel;
treating the stenosis with the therapeutic catheter;
removing the therapeutic catheter;
advancing an infusion catheter to a location distal to the stenosis after the step of removing the therapeutic catheter;
infusing the blood vessel with a fluid supplied by the infusion catheter; and
inducing retrograde flow within the blood vessel to carry the infused fluid and embolic material dislodged during the step of treating into the evacuation sheath assembly.
2. The method of claim 1 , wherein advancing the infusion catheter includes advancing the infusion catheter through a distal end of the evacuation sheath assembly.
3. The method of claim 1 , wherein stopping blood flow includes creating a first seal between a distal portion of the evacuation sheath assembly and the blood vessel.
4. The method of claim 3 , wherein stopping blood flow further comprises creating a second seal between a guide catheter and a proximal portion of the evacuation sheath assembly.
5. The method of claim 1 , wherein inducing retrograde flow includes applying a vacuum through the evacuation sheath assembly.
6. The method of claim 1 , wherein treating the stenosis includes advancing an angioplasty catheter to the stenosis.
7. The method of claim 1 , wherein treating the stenosis includes advancing a stent delivery system to the stenosis.
8. The method of claim 1 , wherein inducing retrograde flow includes venting pressure in a collection device in fluid communication with the blood vessel with normal antegrade blood flow stopped.
9. The method of claim 8 , wherein inducing retrograde flow further includes applying suction to the collection device.
10. The method of claim 1 , wherein the blood vessel is a coronary artery.
11. The method of claim 1 , wherein the blood vessel is a saphenous vein graft.
12. The method of claim 1 , wherein the step of stopping normal antegrade flow is performed prior to advancing a device across the stenosis.
13. The method of claim 1 , wherein infusing the blood vessel with a fluid includes delivering a fluid through at least one infusion port of the infusion catheter.
14. The method of claim 1 , wherein infusing the blood vessel with a fluid includes delivering the fluid to a location distal to the treated stenosis.
15. The method of claim 1 , wherein infusing the blood vessel with a fluid includes infusing saline into the blood vessel.
16. The method of claim 1 , wherein infusing the blood vessel with a fluid includes infusing whole blood into the blood vessel.
17. The method of claim 1 , wherein infusing the blood vessel with a fluid includes infusing radiopaque dye into the blood vessel.
18. The method of claim 1 , wherein advancing the evacuation sheath assembly includes advancing the evacuation sheath assembly through a guide catheter, and further comprising applying a vacuum to the guide catheter prior to infusing the fluid.
19. The method of claim 1 , further comprising inducing retrograde flow prior to advancing the infusion catheter to move debris proximal to the treated stenosis.