Method and apparatus for treating a carotid artery
One disclosed embodiment comprises a method for treating lesions in the carotid artery of a mammalian body. The method comprises transcervical access and blocking of blood flow through the common carotid artery (with or without blocking of blood flow through the external carotid artery), shunting blood from the internal carotid artery and treating the lesion in the carotid artery.
1. A method of treating a lesion in a carotid artery of a patient having an arterial blood system and a venous blood system, comprising:
making a transcervical incision to expose a region of a common carotid artery;
positioning an arterial access device in the common carotid artery through the transcervical incision, wherein the arterial access device comprises a distal insertable length;
occluding blood flow in at least a portion of the common carotid artery to establish retrograde blood flow through the common carotid artery such that blood flows into a lumen of the arterial access device;
shunting blood from the common carotid artery to the venous system of the patient via the arterial access device and a shunt connected to the arterial access device, wherein the arterial access device comprises an elongate member defining the lumen of the arterial access device, and wherein the lumen of the arterial access device extends from a distal opening at a distal region of the arterial access device to a proximal opening at a proximal region of the arterial access device the lumen of the arterial access device configured for receiving retrograde blood flow through the distal opening from the common carotid artery, and wherein the shunt comprises a sidearm connected to the arterial access device at a location between the distal and proximal openings of the arterial access device, and wherein the internal shunt lumen provides a pathway for blood to flow out of the internal lumen of the arterial access device at a location between the distal and proximal openings of the arterial access device; and
treating the lesion by deploying a stent on the lesion.
2. The method of claim 1 , wherein the arterial access device is fluidically connected to a shunt device.
3. The method of claim 1 , further comprising controlling blood flow through the arterial access device.
4. The method of claim 3 , wherein controlling blood flow comprises controlling passive blood flow through the arterial access device.
5. The method of claim 3 , wherein controlling blood flow comprises enabling active blood flow through the arterial access device.
6. The method of claim 3 , wherein controlling blood flow comprises using a metering valve installed in a shunt device fluidically connected to the arterial access device to adjust a rate of blood flow from the arterial access device into the shunt device.
7. The method of claim 3 , wherein controlling blood flow comprises using a syringe fluidically connected to the arterial access device to aspirate the blood from the arterial access device.
8. The method of claim 3 , wherein controlling blood flow through the arterial access device comprises using a pump fluidically connected to the arterial access device to adjust a rate of blood flow from the arterial access device.
9. The method of claim 1 , further comprising occluding blood flow through at least a portion of an external carotid artery.
10. The method of claim 1 , wherein occluding blood flow in at least a portion of the common carotid artery comprises clamping the common carotid artery at a location to disrupt natural blood flow, wherein a blood inlet port of the arterial access device is positioned in the common carotid artery above the location.
11. The method of claim 1 , wherein occluding blood flow in a portion of the common carotid artery facilitates shunting of blood from the common carotid artery to the venous system of the patient.
12. The method of claim 1 , further comprising filtering the blood from the common carotid artery prior to shunting the blood to the venous system using a filter.
13. The method of claim 12 , further comprising sensing the flow of blood being shunted from the common carotid artery to the venous system using a flow sensor.
14. The method of claim 1 , wherein positioning an arterial access device in the common carotid artery further comprises deploying an anchor element on the arterial access device, wherein the anchor element prevents the arterial access device from dislodging from the common carotid artery.
15. The method of claim 14 , wherein the anchor element further occludes blood flow in the at least a portion of the common carotid artery.
16. The method of claim 1 , further comprising imparting a bent shape to at least a portion of the distal insertable length prior to positioning the arterial access device in the common carotid artery.
17. The method of claim 16 , wherein the at least a portion of the distal insertable length is generally rigid but sufficiently malleable to maintain the bent shape during positioning in the common carotid artery.
18. The method of claim 1 , wherein the distal insertable length of the arterial access device further comprises a dilator having a distal tip, wherein the dilator comprises a short taper angled towards the distal tip to prevent injury to a wall of the common carotid artery.
19. The method of claim 1 , wherein the distal insertable length is less than 15 cm.
20. The method of claim 1 , wherein shunting the blood from the common carotid artery to the venous system comprises shunting to a jugular vein of the patient.
21. The method of claim 1 , wherein positioning an arterial access device further comprises making an arterial puncture directly into the common carotid artery through the transcervical incision to position an arterial access device.
22. The method of claim 21 , further comprising removing the arterial access device from the common carotid artery and repairing the arterial puncture.
23. The method of claim 1 , wherein the patient is under mild sedation.
24. The method of claim 1 , wherein the region of the common carotid artery exposed is centered over a medial border of a portion of a sternocleidomastoid muscle.
25. A method of treating a lesion in a carotid artery of a patient having an arterial blood system and a venous blood system, comprising:
making a transcervical incision to expose a region of a common carotid artery;
positioning an arterial access device in the common carotid artery through the transcervical incision, wherein the arterial access device comprises a distal insertable length;
occluding blood flow in at least a portion of the common carotid artery;
shunting blood from the common carotid artery to a jugular vein of the patient via the arterial access device; and
treating the lesion by deploying a stent on the lesion.