Method and apparatus for treating a carotid artery

1. A method of treating a carotid artery, comprising:

forming a puncture opening through a wall of the common carotid artery;

positioning through the puncture an arterial access sheath and dilator system, wherein the arterial access sheath and dilator system comprises an arterial access sheath and a dilator inside the arterial access sheath, wherein the arterial access sheath comprises a first occlusion element adapted to occlude the common carotid artery and wherein the dilator comprises a tapered distal end;

removing the dilator from the arterial access sheath; and

expanding the first occlusion element to occlude the common carotid artery.

2. A method as in claim 1 , wherein forming the puncture opening comprises making the puncture opening directly into the common carotid artery accessed through a transcervical surgical incision.

3. A method as in claim 1 , wherein forming the puncture opening comprises performing a percutaneous puncture into the common carotid artery.

4. A method as in claim 1 , further comprising:

reversing the direction of natural blood flow in the common carotid artery; and

shunting blood from the common carotid artery to a venous system of the patient via the arterial access sheath.

5. A method as in claim 1 , further comprising:

introducing a therapeutic catheter through the arterial access sheath; and

treating the carotid artery.

6. A method as in claim 5 , wherein the therapeutic catheter is a stent delivery catheter and treating the carotid artery comprises deploying a stent using the stent delivery catheter.

7. A method as in claim 1 , wherein the arterial access sheath comprises a second occlusion element distal of the first occlusion element, and further comprising:

positioning the second occlusion element in an external carotid artery branching from the common carotid artery; and

expanding the second occlusion element to occlude the external carotid artery.

8. A method as in claim 7 , further comprising:

introducing a therapeutic catheter into the carotid artery through an exit port located on the side of the arterial access sheath between the first and second occlusion elements; and

treating the carotid artery.

9. A method as in claim 1 , wherein the first occlusion element is an inflatable balloon.

10. A method as in claim 1 , wherein the dilator comprises an internal lumen configured to receive a guidewire.

11. A method as in claim 1 , wherein forming the puncture comprises forming the puncture with a needle, and wherein positioning through the puncture an arterial access sheath and dilator system comprises inserting a guidewire through the needle, removing the needle, and advancing the arterial access sheath system over the guidewire.

12. A method as in claim 1 , wherein positioning through the puncture an arterial access sheath and dilator system comprises inserting the arterial access sheath and dilator system through the puncture without previously inserting an introducer device through the puncture.

13. A method as in claim 1 , wherein positioning through the puncture an arterial access sheath and dilator system comprises inserting the arterial access sheath through the puncture without riding the sheath over a guidewire.

14. A system for use in accessing and treating a carotid artery, the system comprising:

an arterial access sheath comprising a lumen extending between a proximal end and a distal end adapted to receive blood flow from a common carotid artery, and a dilator positionable within the lumen of the arterial access sheath, the arterial access sheath and dilator adapted to be collectively introduced through a puncture in the common carotid artery;

a first occlusion element coupled to the arterial access sheath at a distal region of the arterial access sheath and adapted to expand and occlude the common carotid artery; and

a shunt fluidly connected to the arterial access sheath, wherein the shunt provides a pathway for blood to flow from the arterial access device to a return site.

15. A system as in claim 14 , further comprising a second occlusion element coupled to the arterial access sheath at a position distal of the first occlusion element, wherein the second occlusion element is configured to expand and occlude the external carotid artery while the first occlusion element occludes the common carotid artery.

16. A system as in claim 14 , further comprising a flow control assembly directly coupled to the shunt and adapted to regulate blood flow through the shunt between at least a first blood flow state and at least a second blood flow state, wherein the flow control assembly includes one or more components that interact with the blood flow through the shunt.

17. A system as in claim 14 , wherein the first occlusion element is an inflatable balloon.

18. A system as in claim 15 , further comprising a side opening located on the side of the sheath between the two occlusion elements, the shunt fluidly connected to the arterial access sheath at an exit port of the arterial access sheath.

19. A system as in claim 14 , wherein the dilator comprises a tapered distal end.

20. A system as in claim 14 , wherein the dilator is positioned within the lumen of the arterial access sheath.

21. A system as in claim 14 , wherein the dilator is sufficiently rigid that it need not be inserted into the carotid artery over a guidewire.

22. A system as in claim 14 , wherein the arterial access sheath has sufficient rigidity to be introduced into the common carotid artery via a transcervical incision without requiring the use of an introducer element through the incision.

23. A method of treating a carotid artery, comprising:

forming a puncture opening through a wall of the common carotid artery;

positioning through the puncture an arterial access sheath and dilator system, wherein the arterial access sheath and dilator system comprises an arterial access sheath and a dilator inside the arterial access sheath, wherein the arterial access sheath comprises a first occlusion element adapted to occlude the common carotid artery and a second occlusion element distal of the first occlusion element;

removing the dilator from the arterial access sheath;

expanding the first occlusion element to occlude the common carotid artery;

positioning the second occlusion element in an external carotid artery branching from the common carotid artery;

expanding the second occlusion element to occlude the external carotid artery;

introducing a therapeutic catheter into the carotid artery through an exit port located on the side of the arterial access sheath between the first and second occlusion elements; and

treating the carotid artery.

24. A method as in claim 10 , wherein forming the puncture opening comprises making the puncture opening directly into the common carotid artery accessed through a transcervical surgical incision.

25. A method as in claim 10 , wherein forming the puncture opening comprises performing a percutaneous puncture into the common carotid artery.

26. A method as in claim 10 , further comprising:

reversing the direction of natural blood flow in the common carotid artery; and

shunting blood from the common carotid artery to a venous system of the patient via the arterial access sheath.

27. A method as in claim 10 , further comprising:

introducing a therapeutic catheter through the arterial access sheath; and

treating the carotid artery.

28. A method as in claim 27 , wherein the therapeutic catheter is a stent delivery catheter and treating the carotid artery comprises deploying a stent using the stent delivery catheter.

29. A method as in claim 10 , wherein the arterial access sheath comprises a second occlusion element distal of the first occlusion element, and further comprising:

positioning the second occlusion element in an external carotid artery branching from the common carotid artery; and

expanding the second occlusion element to occlude the external carotid artery.

30. A method as in claim 29 , further comprising:

introducing a therapeutic catheter into the carotid artery through an exit port located on the side of the arterial access sheath between the first and second occlusion elements; and

treating the carotid artery.

31. A method as in claim 10 , wherein the first occlusion element is an inflatable balloon.

32. A method as in claim 10 , wherein forming the puncture comprises forming the puncture with a needle, and wherein positioning through the puncture an arterial access sheath and dilator system comprises inserting the guidewire through the needle, removing the needle, and advancing the arterial access sheath system over the guidewire.

33. A method as in claim 10 , wherein positioning through the puncture an arterial access sheath and dilator system comprises inserting the arterial access sheath and dilator system through the puncture without previously inserting an introducer device through the puncture.

34. A method as in claim 10 , wherein positioning through the puncture an arterial access sheath and dilator system comprises inserting the arterial access sheath through the puncture without riding the sheath over a guidewire.

35. A system as in claim 16 , further comprising a second occlusion element coupled to the arterial access sheath at a position distal of the first occlusion element, wherein the second occlusion element is configured to expand and occlude the external carotid artery while the first occlusion element occludes the common carotid artery.

36. A system as in claim 16 , wherein the first occlusion element is an inflatable balloon.

37. A system as in claim 16 , further comprising a side opening located on the side of the sheath between the two occlusion elements and a shunt fluidly connected to the arterial access sheath at an exit port of the arterial access sheath, wherein the shunt provides a pathway for blood to flow from the arterial access device to a return site.

38. A system as in claim 16 , wherein the dilator comprises a tapered distal end.

39. A system as in claim 16 , wherein the dilator is positioned within the lumen of the arterial access sheath.

40. A system as in claim 16 , wherein the dilator is sufficiently rigid that it need not be inserted into the carotid artery over a guidewire.

41. A system as in claim 16 , wherein the arterial access sheath has sufficient rigidity to be introduced into the common carotid artery via a transcervical incision without requiring the use of an introducer element through the incision.

42. A system for use in accessing and treating a carotid artery, the system comprising:

an arterial access sheath comprising a lumen extending between a proximal end and a distal end adapted to receive blood flow from a common carotid artery, and a dilator positionable within the lumen of the arterial access sheath, the arterial access sheath and dilator adapted to be collectively introduced through a puncture in the common carotid artery;

a first occlusion element coupled to the arterial access sheath at a distal region of the arterial access sheath and adapted to expand and occlude the common carotid artery;

a second occlusion element coupled to the arterial access sheath at a position distal of the first occlusion element, wherein the second occlusion element is configured to expand and occlude the external carotid artery while the first occlusion element occludes the common carotid artery; and

a side opening located on the side of the sheath between the two occlusion elements and a shunt fluidly connected to the arterial access sheath at an exit port of the arterial access sheath, wherein the shunt provides a pathway for blood to flow from the arterial access device to a return site.

43. A system for use in accessing and treating a carotid artery, the system comprising:

an arterial access sheath comprising a lumen extending between a proximal end and a distal end adapted to receive blood flow from a common carotid artery, and a dilator positionable within the lumen of the arterial access sheath, the arterial access sheath and dilator adapted to be collectively introduced through a puncture in the common carotid artery; and

a first occlusion element coupled to the arterial access sheath at a distal region of the arterial access sheath and adapted to expand and occlude the common carotid artery,

wherein the dilator comprises a tapered distal end.

44. A system as in claim 43 , further comprising a second occlusion element coupled to the arterial access sheath at a position distal of the first occlusion element, wherein the second occlusion element is configured to expand and occlude the external carotid artery while the first occlusion element occludes the common carotid artery.

45. A system as in claim 43 , further comprising a shunt fluidly connected to the arterial access sheath, wherein the shunt provides a pathway for blood to flow from the arterial access device to a return site.

46. A system as in claim 45 , further comprising a flow control assembly directly coupled to the shunt and adapted to regulate blood flow through the shunt between at least a first blood flow state and at least a second blood flow state, wherein the flow control assembly includes one or more components that interact with the blood flow through the shunt.

47. A system as in claim 43 , wherein the first occlusion element is an inflatable balloon.

48. A system as in claim 46 , further comprising a side opening located on the side of the sheath between the two occlusion elements and a shunt fluidly connected to the arterial access sheath at an exit port of the arterial access sheath, wherein the shunt provides a pathway for blood to flow from the arterial access device to a return site.

49. A system as in claim 43 , wherein the dilator is positioned within the lumen of the arterial access sheath.

50. A system as in claim 43 , wherein the dilator is sufficiently rigid that it need not be inserted into the carotid artery over a guidewire.

51. A system as in claim 43 , wherein the arterial access sheath has sufficient rigidity to be introduced into the common carotid artery via a transcervical incision without requiring the use of an introducer element through the incision.