阅读说明：本技术 用于保护脑血管的系统和方法 (System and method for protecting cerebral blood vessels ) 是由 卡梅隆·保罗·珀塞尔 安东尼·J·菲尔茨 惠特克·伊恩·哈米尔 丹尼尔·韦恩·费弗 于 2018-10-29 设计创作，主要内容包括：用于过滤体液的血管过滤器和偏导器及方法。血液过滤组件可以捕获在血管内手术期间脱落或产生的栓塞物质,以抑制或防止该物质进入脑血管。血液偏导组件可以偏导在血管内手术期间脱落或产生的栓塞物质,以抑制或防止该物质进入脑血管。(Vascular filters and deflectors and methods for filtering bodily fluids. The blood filtration assembly can capture embolic material dislodged or generated during endovascular procedures to inhibit or prevent the material from entering the cerebral vasculature. The blood deflector assembly can deflect embolic material dislodged or produced during endovascular procedures to inhibit or prevent the material from entering the cerebral vasculature.)

1. An embolic protection system for isolating a cerebral blood vessel, the system comprising:

a first protection device having a proximal portion configured to be retained outside the body and a distal portion, the distal portion comprising:

an outer sheath; and

a first self-expanding filter assembly radially positioned within the outer jacket; and

a second protective device having a proximal portion configured to remain outside the body and a distal portion, the distal portion comprising:

a proximal sheath;

a proximal self-expanding filter assembly radially positioned within the proximal sheath;

a distal sheath; and

a distal self-expanding filter assembly radially positioned within the distal sheath.

2. The embolic protection system of claim 1, wherein the first self-expanding filter assembly comprises a proximally facing opening.

3. The embolic protection system of any of claims 1-2, wherein said proximal self-expanding filter assembly comprises a distally facing opening.

4. The embolic protection system of any of claims 1-3, wherein the distal self-expanding filter assembly comprises a proximally facing opening.

5. The embolic protection system of any of claims 1-4, wherein said first protective device further comprises a filter wire coupled to and extending distally from the proximal end of said first self-expanding filter.

6. The embolic protection system of claim 5, wherein second protection device further comprises a lumen configured to receive the filter wire of the first protection device.

7. The embolic protection system of claim 6, wherein the lumen extends less than the full length of the second protective device.

8. The embolic protection system of any of claims 6-7, wherein the lumen proximally communicates with a quick-exchange port spaced from a distal end of a distal sheath.

9. The embolic protection system of claim 6, wherein the lumen extends the full length of the second protective device.

10. The embolic protection system of any of claims 1-9, wherein said first protective device further comprises an inner member located radially inside said outer sheath.

11. The embolic protection system of claim 10, wherein the inner member comprises a guidewire lumen.

12. The embolic protection system of any of claims 1-11, wherein at least one of said first or second protective devices is connected to an arterial pressure monitoring device.

13. The embolic protection system of any of claims 1-12, wherein said distal sheath is articulatable.

14. The embolic protection system of any of claims 1-13, wherein each of the first self-expanding filter, the proximal self-expanding filter, and the distal self-expanding filter are configured to be deployed individually.

15. The embolic protection system of any of claims 1-14, further comprising a first handle assembly coupled to a proximal portion of a first embolic protection device and a second handle assembly coupled to a proximal portion of a second embolic protection device.

Technical Field

In general, the present disclosure relates to medical devices for filtering blood. And, more particularly, in certain embodiments, to systems and methods of filters and deflectors for protecting cerebral arteries from emboli, debris, etc. that are dislodged during endovascular or cardiac surgery.

Background

There are four arteries that carry oxygenated blood to the brain, namely, the right and left vertebral arteries, and the right and left common carotid arteries. Various procedures performed on the human body, such as Transcatheter Aortic Valve Replacement (TAVR), aortic valvuloplasty, carotid stenting, left atrial appendage closure, mitral valve annuloplasty, repair or replacement procedures, may introduce and/or shed material (whether connate or foreign), which may travel to one or more of the cerebral arteries, resulting in stroke, among others.

There are devices for protecting one or more cerebral arteries by collecting (filter) debris or deflecting (deflector) debris. Single stage filters, such as those used during carotid stenting, are such devices.

Applicants have previously patented a dual-filter embolic protection system that protects the right vertebral artery as well as the right and left common carotid arteries, see, for example, U.S. patent No.9,492,264, the contents of which are incorporated herein in their entirety. Other attempts to use deflectors placed in the aorta or aortic arch to deflect debris from entering one or more cerebral arteries are also disclosed. Each of the known medical devices, delivery systems, and methods has certain advantages and disadvantages. There is a continuing need to provide alternative medical devices and methods, as well as alternative methods for making and using medical devices.

Disclosure of Invention

Certain aspects of the present disclosure address debris, tissue, etc. that may be dislodged during endovascular surgery, which may travel toward, enter, and embolize into the cerebral vasculature, resulting in ischemia or stroke in the artery partially or completely occluded by the clot. For example, during Transcatheter Aortic Valve Replacement (TAVR), stenotic material around the valve may slough off during implantation of the prosthetic valve. In addition, atheroma along and in the aorta and aortic arch may shed as the TAVR catheter is advanced toward the diseased aortic valve and subsequently withdrawn after implantation is complete. In addition, debris from the catheter itself may be stripped away during delivery and implantation. These various forms of vascular debris, whether native or foreign, may then travel into one or more cerebral arteries, embolize and cause stroke, multiple strokes or neurocognitive disorders (for example).

Certain aspects of the present disclosure are directed to addressing these potentially devastating brain injury events by providing a delivery system that includes a filter and/or deflector and/or combinations thereof to intercept these debris before it can enter any cerebral artery.

Certain aspects of the present disclosure and its various embodiments may provide a composite system of filters and/or deflectors for collecting (and/or deflecting) debris in a manner that protects all four cerebral arteries.

Vascular filters and deflectors and methods for filtering bodily fluids are disclosed herein. The blood filtration assembly can capture embolic material dislodged or generated during endovascular procedures to inhibit or prevent the material from entering the cerebral vasculature. The blood deflector assembly can deflect embolic material dislodged or produced during endovascular procedures to inhibit or prevent the material from entering the cerebral vasculature.

In a first example, a method of inhibiting embolic material from entering a cerebral blood vessel may include positioning a guidewire through a right subclavian artery and into a left subclavian artery, and tracking a distal portion of a first protective device over the guidewire. The distal portion of the first protective device may include an outer sheath, a first self-expanding filter assembly radially within the outer sheath. The method may further comprise at least one of proximally withdrawing the outer sheath and distally advancing the self-expanding filter assembly such that the first self-expanding filter assembly deploys from the outer sheath into the left subclavian artery upstream of the left vertebral artery. After deploying the self-expanding filter assembly, the method may further comprise withdrawing the outer sheath from the right subclavian artery and withdrawing the guidewire into the innominate artery and tracking the distal portion of the second protective device over the guidewire. The distal portion of the second protective device may include: a proximal sheath; a proximal self-expanding filter assembly radially within the proximal sheath; a distal sheath; and a distal self-expanding filter assembly radially within the distal sheath. The method may further comprise: at least one of proximally withdrawing the proximal sheath and distally advancing the proximal self-expanding filter assembly, thereby deploying the proximal self-expanding filter assembly from the proximal sheath into the innominate artery; steering the distal sheath into the left common carotid artery; at least one of proximally withdrawing the distal sheath and distally advancing the distal self-expanding filter assembly, thereby deploying the distal self-expanding filter assembly from the distal sheath into the left common carotid artery; and withdrawing the proximal sheath and the distal sheath after deploying the proximal self-expanding filter assembly and the distal self-expanding filter assembly.

Alternatively or additionally to any of the examples above, in another example, the first protection device and the second protection device may be inserted into the right radial artery or the right brachial artery through the same incision.

Alternatively or additionally to any of the examples above, in another example, the method may further comprise performing an endovascular procedure during which the deployed first proximal and distal filter assemblies inhibit embolic material from entering the cerebral vasculature through the left vertebral artery, the right common carotid artery, the right vertebral artery, and the left common carotid artery.

Alternatively or additionally to any of the examples above, in another example, the method may further comprise retracting the first proximal filter assembly and the distal filter assembly after performing the endovascular procedure.

Alternatively or additionally to any of the examples above, in another example, the first protective device may further include an inner member radially inward of the outer sheath.

Alternatively or additionally to any of the examples above, in another example, the method may further comprise measuring arterial pressure using one of the first and second protective devices.

Alternatively or additionally to any of the examples above, in another example, the first protection device may further comprise a filter wire coupled to and extending distally from a proximal end of the first self-expanding filter.

Alternatively or additionally to any of the examples above, in another example, the full length of the second guard may track travel on the filter line.

Alternatively or additionally to any of the examples above, in another example, the less than full length of the second guard may trace travel on the filter line.

Alternatively or additionally to any of the examples above, in another example, the second protection device may further comprise a fast switching port.

In another example, a method of inhibiting embolic material from entering a cerebral blood vessel may include positioning a guidewire through a right subclavian artery and into a left subclavian artery, and tracking a distal portion of a first protective device over the guidewire. The distal portion of the first protection device may comprise: an outer sheath; an inner member radially inward of the outer diameter, the inner member comprising a guidewire lumen; and a first self-expanding filter assembly radially between the outer sheath and the inner member, the first self-expanding filter assembly having an opening facing the proximal end of the outer sheath. The method may further comprise: at least one of proximally withdrawing the outer sheath and distally advancing the self-expanding filter assembly, thereby deploying the first self-expanding filter assembly from the outer sheath into the left subclavian artery upstream of the left vertebral artery; after deploying the self-expanding filter assembly, withdrawing the outer sheath from the right subclavian artery and withdrawing the guidewire into the innominate artery; and tracking a distal portion of the second protective device over the guidewire. The distal portion of the second protective device may include: a proximal sheath; a proximal self-expanding filter assembly radially within the proximal sheath; an articulatable distal sheath; and a distal self-expanding filter assembly radially within the distal sheath. The method may further comprise: at least one of proximally withdrawing the proximal sheath and distally advancing the proximal self-expanding filter assembly, thereby deploying the proximal self-expanding filter assembly from the proximal sheath into the innominate artery; steering the distal sheath into the left common carotid artery; at least one of proximally withdrawing the distal sheath and distally advancing the distal self-expanding filter assembly, thereby deploying the distal self-expanding filter assembly from the distal sheath into the left common carotid artery; and withdrawing the proximal sheath and the distal sheath after deploying the proximal self-expanding filter assembly and the distal self-expanding filter assembly.

Alternatively or additionally to any of the examples above, in another example, the first protection device and the second protection device may be inserted into the right radial artery or the right brachial artery through the same incision.

Alternatively or additionally to any of the examples above, in another example, the method may further comprise performing an endovascular procedure during which the deployed first proximal and distal filter assemblies inhibit embolic material from entering the cerebral vasculature through the left vertebral artery, the right common carotid artery, the right vertebral artery, and the left common carotid artery.

Alternatively or additionally to any of the examples above, in another example, the method may further comprise retracting the first proximal filter assembly and the distal filter assembly after performing the endovascular procedure.

In another example, a method of inhibiting embolic material from entering a cerebral vessel may include positioning a guidewire in a first artery, and tracking a distal portion of a first protective device over the guidewire. The distal portion of the first protection device may comprise: a proximal sheath; a proximal self-expanding filter assembly radially within the proximal sheath; a distal sheath; a distal self-expanding filter assembly radially within the distal sheath; and a middle self-expanding filter assembly radially within the distal sheath. The method may further comprise: at least one of proximally withdrawing the proximal sheath and distally advancing the proximal self-expanding filter assembly, thereby deploying the proximal self-expanding filter assembly from the proximal sheath into the first artery; diverting the distal sheath into a second artery; at least one of proximally withdrawing the distal sheath and distally advancing the distal self-expanding filter assembly, thereby deploying the distal self-expanding filter assembly from the distal sheath into the second artery; diverting the distal sheath into a third artery; at least one of proximally withdrawing the distal sheath and distally advancing the intermediate self-expanding filter assembly, thereby deploying the distal self-expanding filter assembly from the distal sheath into the third artery; and, after deploying the proximal, distal, and intermediate self-expanding filter assemblies, withdrawing the proximal and distal sheaths.

Alternatively or additionally to any of the examples above, in another example, the first protection device may be inserted into a right radial artery or a right brachial artery.

Alternatively or additionally to any of the examples above, in another example, the method may further comprise performing an endovascular procedure during which the deployed proximal, intermediate, and distal self-expanding filter assemblies inhibit the passage of embolic material into the cerebral vasculature through the left vertebral artery, the right common carotid artery, the right vertebral artery, and the left common carotid artery.

Alternatively or additionally to any of the examples above, in another example, the method may further comprise withdrawing the proximal filter assembly, the middle filter assembly, and the distal filter assembly after performing the endovascular procedure.

Alternatively or additionally to any of the examples above, in another example, the first protective device may further comprise a tether extending between the distal self-expanding filter assembly and the intermediate self-expanding filter assembly.

Alternatively or additionally to any of the examples above, in another example, the tether may have a preformed shape configured to direct the intermediate filter assembly toward the third artery.

In another example, an embolic protection system for isolating a cerebral blood vessel may comprise: a first protection device having a proximal portion configured to remain outside the body and a distal portion; and a second protective device having a proximal portion configured to remain outside the body and a distal portion. The distal portion of the first protective device may include an outer sheath and a first self-expanding filter assembly radially within the outer sheath. The distal portion of the second protective device may include: a proximal sheath; a proximal self-expanding filter assembly radially within the proximal sheath, a distal sheath, and a distal self-expanding filter assembly radially within the distal sheath.

Alternatively or additionally to any of the examples above, in another example, the first self-expanding filter assembly may include a proximal-facing opening.

Alternatively or additionally to any of the examples above, in another example, the proximal self-expanding filter assembly may include a distal-facing opening.

Alternatively or additionally to any of the examples above, in another example, the distal self-expanding filter assembly may include a proximal-facing opening.

Alternatively or additionally to any of the examples above, in another example, the first protection device may further comprise a filter wire coupled to and extending distally from a proximal end of the first self-expanding filter.

Alternatively or additionally to any of the examples above, in another example, the second protective device may further include a lumen configured to receive the filter wire of the first protective device.

Alternatively or additionally to any of the examples above, in another example, the lumen may extend less than a full length of the second protective device.

Alternatively or additionally to any of the examples above, in another example, the lumen may communicate with a quick-swap port that is proximally spaced from a distal end of the distal sheath.

Alternatively or additionally to any of the examples above, in another example, the lumen may extend the full length of the second protective device.

Alternatively or additionally to any of the examples above, in another example, the first protective device may further include an inner member radially inward of the outer sheath.

Alternatively or additionally to any of the examples above, in another example, the inner member may comprise a guidewire lumen.

Alternatively or additionally to any of the examples above, in another example, at least one of the first or second protective devices may be connected to an arterial pressure monitoring device.

Alternatively or additionally to any of the examples above, in another example, the distal sheath may be articulatable.

Alternatively or additionally to any of the examples above, in another example, each of the first self-expanding filter, the proximal self-expanding filter, and the distal self-expanding filter may be configured to be deployed individually.

Alternatively or additionally to any of the examples above, in another example, the embolic protection system can further comprise a first handle assembly coupled to a proximal portion of the first embolic protection device, and a second handle assembly coupled to a proximal portion of the second embolic protection device.

The above summary of example embodiments is not intended to describe each disclosed embodiment or every implementation of the present disclosure.

Drawings

The present invention may be more completely understood in consideration of the following detailed description of various embodiments in connection with the accompanying drawings,

in the figure:

fig. 1A and 1B illustrate a first embodiment for deploying three filters to protect a cerebrovascular vessel structure.

FIG. 1C illustrates an alternative embodiment of the three-filter system of FIGS. 1A and 1B.

Fig. 1D and 1E illustrate alternative embodiments of the three-filter system of fig. 1C.

FIG. 2A illustrates another embodiment of a three filter system.

Fig. 2B and 2C illustrate another alternative embodiment of the three-filter system of fig. 2A.

Fig. 3A-3C illustrate another alternative embodiment of a three-filter system.

Fig. 4A-4C illustrate another alternative embodiment of a three-filter system.

Fig. 5 shows an embodiment of a dual filter system deployed to substantially protect brain organs.

Fig. 6A and 6B show an embodiment of the unfolding deflector and two filters.

Fig. 7A-7D illustrate embodiments in which only one oversized filter is deployed to protect the cerebral vessels.

While the invention is amenable to various modifications and alternative forms, specifics thereof have been shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit aspects of the invention to the particular embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the invention.

Detailed Description

For the following defined terms, these definitions shall be applied, unless a different definition is given in the claims or elsewhere in this specification.

It is contemplated herein that all numerical values will be modified by the term "about," whether or not explicitly indicated. The term "about" generally refers to a range of numbers that one of skill in the art would consider equivalent to the recited value (i.e., having the same function or result). In many instances, the term "about" can mean a number including rounding to the nearest significant figure.

The recitation of numerical ranges by endpoints includes all numbers subsumed within that range (e.g. 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.80, 4, and 5).

Although some suitable dimensional ranges and/or values are disclosed for various components, features, and/or specifications, one skilled in the art, having benefit of this disclosure, will appreciate that the desired dimensions, ranges, and/or values may deviate from the explicitly disclosed dimensions, ranges, and/or values.

As used in this specification and the appended claims, the singular forms "a", "an" and "the" include plural referents unless the context clearly dictates otherwise. As used in this specification and the appended claims, the term "or" is generally employed in its sense including "and/or" unless the context clearly dictates otherwise.

The following detailed description should be read with reference to the drawings, in which like elements in different drawings are numbered the same. The detailed description and drawings (which are not necessarily to scale) depict illustrative embodiments and are not intended to limit the scope of the invention. The described illustrative embodiments are intended to be examples only. Selected features of any illustrative embodiment may be incorporated in further embodiments unless explicitly stated otherwise.

The Sentinel system manufactured by Claret Medical, currently marketed, and the embodiment described in the above-mentioned U.S. patent No.9,492,264, has two filters, a first filter protecting the right brachiocephalic artery (from which the right and right common carotid arteries typically originate) and a second filter in the left common carotid artery. In a typical patient, about seven percent of the left vertebral artery that provides perfusion to the brain is unprotected.

One disclosed solution to protect the left vertebral artery is to use a second device for placement in the left arm (e.g., through the left radial artery), where the filter is placed in the left subclavian artery (from which the left vertebral artery typically originates). An example of this solution can be found in U.S. patent No.9,566,144, the contents of which are incorporated by reference herein in their entirety and included as part of this specification in the appendix (labeled appendix B) filed with this patent application.

While surgically compatible, it may be preferable to achieve protection of all cerebral vessels from one access point. The concept of deflectors in the arch has been previously disclosed and these devices can have a single point of entry to the right arm, left arm or femoral artery. While the concepts of deflectors located in the arch are technically feasible, they may cause significant interference with therapy (e.g., TAVR) or surgery, or may not be sufficiently compatible with the amplitude of the aortic arch's configuration and size to provide full protection to the brain.

Various single access, multi-vessel embodiments are disclosed that can provide complete brain protection with minimal arch interference.

The present disclosure relates generally to methods and devices for filtering liquids and/or deflecting debris contained in liquids, including bodily fluids such as blood. The filtering or deflecting device may be positioned in the artery during and/or prior to an endovascular procedure (e.g., transcatheter aortic valve placement (TAVI) or replacement (TAVR), transcatheter mitral valve implantation (TAMI) or replacement (TAMR), Surgical Aortic Valve Replacement (SAVR), other surgical valve repair, implantation, or replacement, cardiac ablation using various forms of energy (e.g., Radiofrequency (RF), energy, cryo, microwave, ultrasound) (e.g., pulmonary vein ablation for treatment of atrial fibrillation), cardiac bypass surgery (e.g., open-heart cardiac bypass surgery, percutaneous cardiac bypass surgery), transthoracic transversion around the aortic arch, valvuloplasty, etc.), thereby inhibiting or preventing embolic material (such as debris, emboli, thrombus, etc.) from entering the cerebral vasculature.

The devices may be used to capture and/or deflect particles in other vessels within the subject, and they may also be used outside of the vessel. The devices described herein are generally adapted for percutaneous delivery to a target location within a subject, and may be delivered in any suitable manner, and are not necessarily limited to minimally invasive procedures.

Fig. 1A is a schematic view of an aortic arch 10 including a first protection device 30. The aortic arch 10 is upstream of the left and right coronary arteries (not explicitly shown). The aortic arch 10 generally includes three major branch arteries: brachiocephalic or innominate artery 12, left common carotid artery 14, and left subclavian artery 16. Innominate artery 12 branches out of the right carotid artery 18, then the right vertebral artery 20, and thereafter the right subclavian artery 22. The right subclavian artery 22 supplies blood to the right arm and can enter directly from the right arm (referred to as right radial access). The left subclavian artery 16 branches into a left vertebral artery 24, typically in the shoulder region. The left subclavian artery 16 supplies blood to the left arm and is accessible directly from the left arm (referred to as the left radial axis). Four of the arteries shown in fig. 1A supply blood to the cerebral vessels: (1) left carotid artery 14 (about 40% of the cerebral blood supply); (2) right carotid artery 18 (about 40% of the cerebral blood supply); (3) right vertebral artery 20 (about 10% of the cerebral blood supply); and (4) the left vertebral artery 24 (about 10% of the cerebral blood supply).

It may be desirable to filter blood and/or deflector particles flowing to all four arteries 14, 18, 20, 24 supplying blood to the brain from entering the arteries 14, 18, 20, 24 supplying the brain. It may also be desirable to limit the number of cuts or incision sites required to deploy the system(s). Fig. 1A shows a first step in deploying a multi-filter system using a right-handed entry incision. A first filter 32 may be deployed in the left subclavian artery 16 upstream of the left vertebral artery 24.

The protective device or filter system 30 includes a proximal portion 34 and a distal portion 36. The proximal portion 34 is configured to be held and manipulated by a user, such as a surgeon. The distal portion 36 is configured to be positioned at a target location, such as the left subclavian artery 16 or the left vertebral artery 24. When the distal portion 36 is configured to be positioned at the left subclavian artery 16, it may be positioned upstream of the left vertebral artery 24 such that blood is filtered before entering the left vertebral artery 24.

The proximal portion 34 may include a handle 38, a control 40 (such as a slider), an outer sheath 42, a port 44, an optional inner member translation control 46 (such as a knob), and an optional hemostasis valve control 48 (such as a knob). The proximal portion 34 may also include an inner member 50 radially inward of the outer sheath 42. Although not explicitly shown, the proximal portion 34 may also include a filter wire 52b radially inward of the outer sheath 42 (and sometimes radially outward of the inner member 50). Some illustrative filter lines are described in commonly assigned U.S. patent No.9,566,144, which is incorporated herein by reference in its entirety. Filter wire 52b may be coupled to filter assembly 32 in distal end 36. The outer jacket 42 may have a diameter between about 4french (Fr) (about 1.33 millimeters (mm)) and about 6Fr (about 2mm) (e.g., about 5Fr (about 1.67 mm)).

The protective device 30 can further include a guidewire 56 disposed within the lumen of the inner member 50. The outer sheath 42 may include an atraumatic distal tip. Other features of the protector 30 and other protectors described herein may be flexible and/or atraumatic. The outer sheath 42 may have a curvature, for example, based on the intended placement location (e.g., left subclavian artery and/or left vertebral artery).

Slider 40 may be used to translate outer sheath 42 and/or filter assembly 32 (e.g., coupled to filter wire 52 b). For example, the sled 40 may retract the sheath 42 proximally, the sled 40 may advance the filter assembly 32 distally out of the outer sheath 42, or the sled 40 may retract the outer sheath 42 proximally and advance the filter assembly 32 distally (e.g., simultaneously or sequentially), which may allow the filter assembly 32 to radially expand. The slider 40 may also be configured to have an opposing translational effect, which may allow the filter assembly 32 to radially collapse (e.g., due to being compressed by the outer jacket 42) as the filter assembly 32 is drawn into the outer jacket 42. Other deployment systems are possible, including, for example: gears or other features such as a helical track (e.g., configured to compensate for any differential elongation due to perspective contraction of the filter assembly 32, configured to convert rotational motion to longitudinal motion), mechanical elements, pneumatic elements, hydraulic elements, etc., for opening and/or closing the filter assembly 32.

The port 44 is in fluid communication with the inner member 50 (e.g., via a Y-connector in the handle 38). The port 44 may be used to flush the device (e.g., with saline) before, during, and/or after use, for example, to remove air. Additionally or alternatively, the port 44 may be used to monitor blood pressure at the target location, for example, by connecting an arterial pressure monitoring device in fluid communication with the lumen of the outer sheath 42. The port 44 may also or alternatively be used to inject contrast agents, stains, thrombolytic agents (e.g., tissue plasminogen activator), and the like. The slide 40 may be independent of the inner member 50 such that the inner member 50 is longitudinally movable independent of the filter assembly 32 and the outer sheath 42. The inner member translation control 46 may be used to longitudinally translate the inner member 50, such as before, after, and/or during deployment of the filter assembly 32. The inner member translation control 46 may include a slider in the housing 38 (e.g., separate from the slider 40).

The rotatable hemostasis valve control 48 can be used to reduce or minimize blood loss through the protective device 30 during use. For example, the proximal portion and/or the middle region of the protective device may be positioned in the right subclavian artery 22 and the blood flow will be distal to proximal with respect to the direction of the device 30 so that the blood may tend to follow the pressure drop of the device 30. The hemostasis valve control 48 is shown as being rotatable, but other arrangements are possible (e.g., longitudinally displaceable). The hemostasis valve control 48 can be configured to fix the relative position of the outer sheath 42 and the filter assembly 32, for example, as described with respect to the hemostasis valve in U.S. patent No.8,876,796. The hemostasis valve 48 may include, for example, an elastomeric seal and an HV nut.

The distal portion 36 may include an outer sheath 42, a filter assembly 32 radially inside the outer sheath 42 in a delivery configuration (not expressly shown), and an optional inner member 50. In the delivery state or shape or position, the filter assembly 32 may be radially between the outer sheath 42 and the inner member 50 (e.g., radially inside the outer sheath 42, and the inner member 50 radially inside the filter assembly 32).

Filter assembly 32 may include a support element or frame 31 and a filter element 33. The frame 31 may generally provide expansion support to the filter element 33 in the expanded state. In the expanded state, the filter element 33 is configured to filter fluid (e.g., blood) flowing through the filter element 33 and inhibit or prevent particles (e.g., embolic material) from flowing through the filter element 33 by trapping the particles in the filter element 33.

The frame 31 is configured to engage or abut an inner wall of a lumen (e.g., a blood vessel) in which the frame assembly 32 expands. The frame 31 may comprise or consist of: such as nickel titanium (e.g., nitinol), nickel titanium niobium, chromium cobalt (e.g., MP35N, 35NLT), copper aluminum nickel, iron manganese silicon, silver cadmium, gold cadmium, copper tin, copper zinc silicon, copper zinc aluminum, copper zinc tin, iron platinum, manganese copper, platinum alloys, cobalt nickel aluminum, cobalt nickel gallium, nickel iron gallium, titanium palladium, nickel manganese gallium, stainless steel, combinations thereof, and the like. The frame 31 may include a line (e.g., having a rounded (e.g., circular, oval) or polygonal (e.g., square, rectangular) cross-section). For example, in some embodiments, the frame 31 comprises a straight nitinol wire that is shaped into a circular or oblong ring or a ring having one or two straight legs that extend longitudinally along or at an angle to the longitudinal axis of the frame assembly 32. At least one of the straight legs may be coupled to the filter wire 52a or the strut 52 a. These straight legs may be on the long sides of the filter assembly 32 and/or on the short sides of the filter assembly 32. The frame 31 may form the shape of the opening 35 of the filter assembly 32. The opening 35 may be circular, oval, or any shape that may suitably abut the sidewall of a blood vessel (e.g., the left subclavian artery or the left vertebral artery). The filter assembly 32 may have a generally proximally facing opening 35. In other embodiments, the opening 35 may be distally facing. The orientation of the opening 35 may vary depending on where the access incision is located.

The frame 31 may include radiopaque markers, such as small coils wrapped around or coupled to the ring to aid visualization under fluoroscopy. In some embodiments, the frame may not include other shapes than a ring, such as a spiral shape. In some embodiments, the filter assembly 32 may not include or be substantially free of a frame.

In some embodiments, frame 31 and filter element 33 form a beveled frustum having a non-uniform or unequal length around and along the length of filter assembly 32. In this configuration, along the line of the wind vane, the filter assembly 32 has a larger opening 35 (upstream) diameter and a reduced finish (downstream) diameter.

The filter element 33 may include pores configured to allow blood to flow through the filter element 33, but sufficiently small to inhibit or prevent particles (such as embolic material) from passing through the filter element 33. The filter element 33 may include a filter membrane, such as a polymer (e.g., polyurethane, Polytetrafluoroethylene (PTFE)) membrane, mounted to the frame 32. The filter element can have a thickness of between about 0.0001 inches and about 0.03 inches (e.g., no more than about 0.0001 inches, about 0.001 inches, about 0.005 inches, about 0.01 inches, about 0.015 inches, about 0.02 inches, about 0.025 inches, about 0.03 inches, ranges between these values, etc.).

The membrane may include a plurality of pores or holes or apertures extending through the membrane. The film may be formed by weaving or braiding filaments or films, and the pores may be spaces between the filaments or films. The filaments or membranes may comprise the same material, or may comprise other materials (e.g., polymers, non-polymeric materials such as metals, alloys such as nitinol, stainless steel, etc.). The pores of the filter element 33 are configured to allow passage of liquid (e.g., blood) through the filter element 33 and resist passage of embolic material carried by the liquid. The apertures may be circular, oval, square, triangular, or other geometric shapes. Certain shapes, such as equilateral triangles, square directions, and slots may provide geometric advantages, such as restricting portions larger than an inscribed circle, but providing nearly twice as large an area for fluid flow, thereby making the shape more efficient at filtering volumes of fluid. The pores may be laser drilled into the filter element 33 or through the filter element 33, although other methods are possible (e.g., piercing with a microneedle, loose weaving, or weaving). The pores may have a lateral dimension (e.g., diameter) between about 10 micrometers (μm) and about 1mm (e.g., no more than about 10 μm, about 50 μm, about 100 μm, about 150 μm, about 200 μm, about 250 μm, about 300 μm, about 400 μm, about 500 μm, about 750 μm, about 1mm, ranges between these values, etc.). Other pore sizes are also possible, for example, depending on the expected minimum size of the substance to be captured.

The material of the filter element 33 may include a smooth and/or textured surface that is folded or collapsed into a delivery state or compressed into a lumen by tension. A reinforcing fabric may be added to or embedded in the filter element 33 to accommodate the stresses exerted on the filter element 33 during compression. The reinforcing fabric may reduce stretching that may occur during deployment and/or retraction of the filter assembly 32. The embedded fabric may improve the folding of the filter, thereby helping to capture embolic debris and enabling recapture of the elastomeric membrane. The reinforcement material may include, for example, a polymer and/or metal weave to increase local strength. Reinforcing material may be embedded in the filter element 33 to reduce the thickness. For example, the embedded reinforcement material may include a polyester weave that is mounted to a portion of filter element 33 proximate to the longitudinal elements of frame 31, wherein tensile forces act on frame 31 and filter element 33 during deployment and retraction of filter assembly 32 from outer sheath 42.

In some cases, filter assembly 32 may comprise a self-expanding filter assembly (e.g., comprising a superelastic material having stress-induced martensite due to constraints in outer sheath 42). The filter assembly 32 may include a shape memory material configured to self-expand upon a change in temperature (e.g., heating to body temperature). The filter assembly 32 can include a shape memory frame or superelastic frame (e.g., including a distal end ring comprising nitinol) and a microporous material (e.g., including a polymer including laser-drilled pores) coupled to the frame, e.g., similar to the filter assembly described in U.S. patent No.8,876,796.

Filter assembly 32 may be coupled (e.g., crimped, welded, brazed, etc.) to the distal end of deployment wire or filter wire 52b via post or wire 52 a. When two or all of filter wires 52a and struts 52a are provided, filter wires 52b and struts 52a may be coupled within outer sheath 42 proximal filter assembly 30 using a crimping mechanism. In other embodiments, filter wire 52b and strut 52a may be a single, unitary structure. Filter thread 52b and/or struts 52a may comprise a rectangular band, a circular arc (e.g., circular, oval) filament, a portion of a hypotube, a braided structure (e.g., as described herein), combinations thereof, and the like. Filter wire 52b may be coupled to handle 38 and/or slider 40 to provide differential longitudinal movement relative to outer sheath 42, as indicated by arrow 54, which may sheath filter assembly 32 in and out of outer sheath 42.

The filter assembly 32 in the expanded, unconstrained state has a maximum or effective diameter (e.g., if the mouth is oval shaped) d. The diameter d may be between about 1mm and about 15mm (e.g., at least about 1mm, about 2mm, about 3mm, about 4mm, about 5mm, about 6mm, about 7mm, about 8mm, about 9mm, about 10mm, about 11mm, about 12mm, about 13mm, about 14mm, about 15mm, ranges between these values, etc.). In some embodiments (e.g., when the filter assembly is configured to be positioned in the left subclavian artery), the diameter d is between about 7mm and about 12mm (e.g., about 7mm, about 8mm, about 9mm, about 10mm, about 11mm, about 12mm, ranges between these values, etc.). In some embodiments (e.g., when the filter assembly is configured to be positioned in the left vertebral artery), the diameter d is between about 2mm and about 4.5mm (e.g., about 2mm, about 2.5mm, about 3mm, about 3.5mm, about 4mm, about 4.5mm, ranges between these values, etc.). Other diameters d or other types of lateral dimensions are also possible. The different diameters d may allow for treatment of selected subjects having different vessel sizes.

The filter assembly 32 has a maximum length/. The length l may be between about 7mm and about 50mm (e.g., at least about 7mm, about 8mm, about 9mm, about 10mm, about 11mm, about 12mm, about 13mm, about 14mm, about 15mm, about 16mm, about 17mm, about 18mm, about 19mm, about 20mm, about 21mm, about 22mm, about 23mm, about 24mm, about 25mm, about 30mm, about 35mm, about 40mm, about 45mm, about 50mm, ranges between these values, etc.). Other lengths l are also possible, for example based on the diameter or effective diameter d. For example, the length l of the filter assembly 32 may increase as the diameter d increases, and the length l of the filter assembly 32 may decrease as the diameter d decreases. The distance from the apex of the mouth of the filter assembly 32 to the elbow in the frame may be about 35 mm. Different lengths l may allow for treatment of selected subjects with different vessel sizes.

Inner member 50 may be optional, but may provide additional uses and/or advantages in conjunction with filter assembly 32. For example, inner member 50 may include a guidewire lumen (not expressly shown) allowing device 30 to track over guidewire 56 without contacting filter assembly 32. For another example, the lumen of inner member 50 can be fluidly coupled to irrigation port 44, which can allow fluid to be irrigated through inner member 50, e.g., for removing air. For yet another embodiment, the lumen of inner member 50 may be connected to an arterial pressure monitoring device, allowing measurement of pressure near the location of filter assembly 32.

The distal portion 36 may include one or more fluoroscopic markers 58a, 58b to assist the user in positioning the device 30, deploying the filter assembly 32, using the inner member 50, and the like. A fluoroscopic marker 58b may be positioned near the distal end of the outer sheath 42. Another fluoroscopic marker (not expressly shown) may be positioned near the proximal end of filter assembly 32. In some cases, another fluoroscopic marker 58b may be near the distal end of filter assembly 32. Another fluoroscopic marker (not explicitly shown) may be near the distal end of inner member 50. The fluoroscopic markers may include radiopaque materials (e.g., iridium, platinum, tantalum, gold, palladium, tungsten, tin, silver, titanium, nickel, zirconium, rhenium, bismuth, molybdenum, combinations thereof, and the like). More or fewer fluoroscopic markers are also possible.

The protective device 30 is shown as including a guidewire 56 therethrough, although the guidewire 56 may be characterized as being separate from the protective device 30, such as being sold separately, packaged, and/or guided. Guidewire 56 may extend through the lumen of outer sheath 42 or inner member 50. The lumen of outer sheath 42 or inner member 50, if so provided, can be configured to receive a guidewire 56 having a diameter of between about 0.014 inches (0.356mm) and about 0.025 inches (0.635 mm). Guidewire 56 may extend through the lumen of filter assembly 32. For example, the protective device 30 may be tracked over the guidewire 56 to position the protective device 30 at a desired location.

The filter assembly 32 may be positioned, for example, in the left subclavian artery 16 to protect the cerebral vasculature (e.g., the left vertebral artery 24) from embolic debris during an intravascular procedure such as TAVI. While the procedure described positions the first filter assembly 32 in the left subclavian artery, the method is not limited to positioning the first filter assembly 32 within the left subclavian artery, and the first filter assembly 32 may be positioned within other arteries (or other lumens) as desired. The filter assembly 32 may be positioned upstream of the left vertebral artery 24 in the left subclavian artery 16. The user may select a protective device 30 that includes a proximally facing filter assembly 32 having a diameter appropriate for the artery (or other lumen) in which it is to be deployed, such as, but not limited to, between about 7mm and about 12mm for the left subclavian artery 16. The protector 30 may be packaged in a sterile roll-up package. The protective device 30 may include an outer sheath 42 having a diameter of about 5Fr (about 1.67 mm). The outer jacket 42 may have a curvature, such as to compensate for the size or orientation of the filter assembly 32. Outer sheath 42 may be steerable (e.g., a pull wire controlled sheath).

The lumen of the protective device 30 (e.g., the lumen of the outer sheath 42 and the lumen of the inner member 50) can be flushed (e.g., with saline) one or more times before, during, and/or after the procedure. The filter assembly 32 of the guard 30 may be flushed and/or submerged (e.g., in a bowl of saline). Flushing and/or submersion of filter assembly 32 may be performed with filter assembly 32 in outer sheath 42 (e.g., in a compressed state) and/or with filter assembly 32 outside outer sheath 42 (e.g., in a deployed state). If the filter assembly 32 is flushed and/or submerged in the expanded state, the filter assembly 32 may be compressed into the outer sheath 42 prior to use.

For example, using a 5Fr introducer into the artery in the right arm. A guidewire 56 (e.g., having a diameter between about 0.014 inch and about 0.25 inch) is diverted or steered into the right subclavian artery 22, then into the innominate artery 12, then into the aortic arch 10, and finally into the left subclavian artery 16. In some cases, the distal end of the guidewire 56 may be curved (e.g., a pigtail curve) to facilitate navigation from the right subclavian artery 22 to the left subclavian artery 16. The proximal end of the guidewire may be inserted into the distal end of the protective device 30, such as into the distal end of the inner member 50. During navigation through the blood vessel, filter assembly 32 may be disposed within the lumen of the outer sheath and retained in the collapsed position therein until filter assembly 32 is advanced distally from outer sheath 42 and/or outer sheath 42 is retracted proximally relative to filter assembly 32. The guard 30 may track over the guidewire until the distal end of the guard 30 extends beyond the distal end of the introducer. In some embodiments, the guidewire and the protective device 30 may be tracked together, wherein the guidewire leads the device 30 (e.g., advancing the guidewire a distance and then advancing the device 30 about the same distance over the guidewire). In some cases, where both the guidewire and inner member 50 may be floppy or lack rigidity, they may be introduced inside the outer sheath 42 and then advanced into the vessel prior to the device 30. The guidewire may be advanced at least about 6 centimeters (cm) distally of the distal end of the guard 30.

The protective device 30 can be tracked or advanced distally over the guidewire until the proximal end of the protective device 30 (e.g., opening 35) is at a desired location, such as near the left subclavian ostium 17, just above the aortic arch 10. The tracked advancement of the protective device 30 may be performed under fluoroscopy, for example, using radiopaque markers (e.g., at the distal end of the outer sheath 42 and/or the inner member 50) and/or a radiopaque fluid or contrast medium. Radiopaque fluid may be provided through inner member 50 and/or outer sheath 42. The protective device 30 may be positioned such that the filter assembly 32 is upstream of the left vertebral artery 24 or near the ostium 17 such that the filter assembly 32 may inhibit or prevent embolic material from entering the cerebral vasculature through the left vertebral artery 24. Using surgical terminology rather than blood flow, the guard 30 is preferably positioned so that the filter assembly 32 is near the point where the left vertebral artery 24 branches in the left subclavian artery 16. However, it is contemplated that the positioning may be based on available anatomical structures.

Once the protective device 30 is in place, the filter assembly 32 may be deployed from the outer sheath 42. For example, outer sheath 42 may be proximally retracted and/or filter assembly 32 may be distally advanced. Radiopaque markers (e.g., on the filter assembly 32) may help determine when the filter assembly 32 has reached the deployed state. Differential longitudinal movement of the filter assembly 32 and the outer sheath 42 may be stopped upon full or proper deployment of the filter assembly 32. Abutment of the filter assembly 32 with the sidewall of the left subclavian artery 16 may be verified, for example, using a radiopaque fluid or contrast media. A radiopaque fluid may be provided through inner member 50. If radiopaque fluid is able to flow between the frame of the filter assembly 32 and the sidewall of the left subclavian artery 16, the filter assembly 32 may not be properly positioned (e.g., indicating insufficient deployment, insufficient sizing, calcification, etc.). The filter assembly 32 may be retracted into the outer sheath 42 and re-deployed, or a different protective device may be used.

After positioning the protective device 30, the outer sheath 42 and inner member 50 can be withdrawn, while the filter wires 52b and/or struts 52a are left in place. It is contemplated that filter wire 52b and/or support 52a may be used as a guide wire to guide outer sheath 42 back to filter assembly 32 when it is desired to remove filter assembly 32. Alternatively or additionally, the guidewire 56 may be left in place during endovascular surgery (e.g., TAVI, TAVR, TAMI, TAMR, SAVR, other surgical valve repair, implantation, or replacement, cardiac ablation, cardiac tower bridge surgery, etc.). In some embodiments, inner member 50 may be retracted to a position suitable for monitoring or sensing blood pressure. For example, a blood pressure monitoring device may be fluidly connected to inner member 50 (using a luer fitting). In embodiments where the protective device lacks an inner member, blood pressure may be monitored or sensed by connecting a blood pressure monitoring device to outer sheath 42.

The protective devices described herein may be used alone or in combination with other protective devices. For example, a second protective device as described herein may be advanced through the right subclavian artery and positioned in the innominate artery 12 and the left common carotid artery 14, thereby providing protection to the right, and left carotid arteries 14. As another example, an aortic arch filter or deflector such as an Embrella embolic deflector system, TriGuard embolic protection system, or the like may be placed across the ostium of the great branch artery and/or adjacent the sidewall of the aortic arch upstream of at least one ostium of the great branch artery. As another example, the filter system and method described in U.S. patent No.8,876,796 may be used in conjunction with the protective devices described herein to further protect cerebral blood vessels during intravascular procedures.

For example, after the first filter assembly 32 is positioned, the second protective device or filter system 60 may be deployed in the innominate artery 12 and the left common carotid artery 14, as shown in fig. 1B. Fig. 1B shows an exemplary distal portion of a second protective device 60 having two filter assemblies 62, 64 in a deployed state. An illustrative protective device including two filter assemblies is described in commonly assigned U.S. patent No.9,492,264, which is incorporated herein by reference in its entirety.

The second protection device 60 may include: a distal end region 66 including at least the filter assemblies 62, 64; and a proximal end region (not expressly shown) coupled to a handle (not expressly shown) configured to be held outside the body. In some cases, the handle of the second guard 60 may be similar in form and function to the handle 38 described herein. The distal end region 66 may include a proximal sheath 68, a proximal shaft 70 coupled to the expandable proximal filter assembly 64, a distal shaft 72 coupled to a distal articulatable sheath 74, the distal filter 62, and a guide member 76.

The proximal shaft 70 is coaxial with the proximal sheath 68, and a proximal region 78 of the proximal filter assembly 64 is secured to the proximal shaft 70. In its collapsed configuration (not expressly shown), the proximal filter assembly 64 may be disposed within the proximal sheath 68 and distally relative to the proximal shaft 70. The proximal sheath 68 may be axially (distally and proximally) movable relative to the proximal shaft 70 and the proximal filter assembly 64. The system 60 can also include a distal sheath 74 secured to a distal region of the distal shaft. The distal shaft 72 may be coaxial with the proximal shaft 70 and the proximal sheath 68. The distal sheath 74 and the distal shaft 72 may be axially movably secured to one another relative to the proximal sheath 68, the proximal shaft 70, and the proximal filter assembly 64. The system 60 may also include a distal filter assembly 62 carried by the guide member 76. Although not explicitly shown, the distal filter assembly 62 may be maintained within the distal sheath 74 in a collapsed configuration. The guide member 76 may be coaxial with the distal sheath 74 and the distal shaft 72 and the proximal sheath 68 and the proximal shaft 70. The guide member 76 may be axially movable relative to the distal sheath 74 and the distal shaft 72 and the proximal sheath 68 and the proximal shaft 70. The proximal sheath 68, distal sheath 74, and guide member 76 may each be adapted to move axially independently relative to one another. That is, the proximal sheath 68, the distal sheath 74, and the guide member 76 are adapted to translate axially independently relative to each of the other two components. It is contemplated that the handle may include control elements (such as, but not limited to, sliders, switches, buttons, dials, etc.) configured to individually actuate the proximal sheath 68, the distal sheath 74, and the guide member 76.

Proximal filter assembly 64 may include a support element or frame 65 and a filter element 67. Similarly, distal filter assembly 62 includes a support element 61 and a filter element 63. The frames 61, 65 may be similar in form and function to the frame 31 described herein. Similarly, filter elements 63, 67 may be similar in form and function to filter element 33 described herein. The support elements 61, 65 generally provide expanding support to the filter elements 63, 67 in their respective expanded configurations, while the filter elements 63, 67 are adapted to filter a fluid, such as blood, and to trap particulates flowing therethrough. The expansion supports 61, 65 are adapted to engage the wall of the lumen in which they expand. The filter elements 63, 67 have pores therein that are designed to allow blood to flow therethrough, but are small enough to prevent unwanted foreign particles from passing therethrough. Foreign particles are thus trapped by and within the filter elements 63, 67.

As shown in fig. 1B, the proximal filter 64 has a generally distally facing opening 80, and the distal filter 62 has a generally proximally facing opening 82 relative to the device 60. The filter assemblies 62, 64 may be considered to face in opposite directions. As described in more detail below, the distal sheath 74 may be adapted to turn or bend relative to the proximal sheath 68 and the proximal filter 64. When distal sheath 74 is turned, the opposite direction that the opening faces will be adjusted. Regardless of the degree to which distal sheath 74 is turned, filter assemblies 62, 64 are still considered to have openings facing in opposite directions. For example, the distal sheath 74 may be turned with an approximately 720 degree turn, in which case the filter assemblies 62, 64 would have openings 82, 80 facing in substantially the same direction, as shown in fig. 1B. If the system assumes a substantially straight configuration (not explicitly shown), the orientation of the filter openings 80, 82 is described as such. Proximal filter element 67 may taper in a proximal direction from support element 65, while distal filter element 63 may taper in a distal direction from support element 61. Fluid (e.g., blood) flows through the openings and through pores in the filter elements 63, 67, and the filter elements 63, 67 are adapted to trap foreign particles therein and prevent them from passing to a location downstream of the filter assembly.

The filters 62, 64 may be secured to separate system components. For example, the proximal filter assembly 64 is secured to the proximal shaft 70, while the distal filter assembly 62 is secured to the guide member 76. In fig. 1B, the filters 62, 64 are secured to independently actuatable components. This may allow the filters 62, 64 to be independently positioned and controlled. Further, in the collapsed configuration of the filters 62, 64, the filters 62, 64 may collapse within two different tubular members. For example, proximal filter assembly 64 collapses within proximal sheath 68, while distal filter assembly 62 collapses within distal sheath 74. In the delivery configuration of the system, the filter assemblies 62, 64 are axially spaced from one another. For example, in fig. 1B, the distal filter assembly 62 is spaced distally relative to the proximal filter assembly 64. However, in alternative embodiments, the filter assemblies 62, 64 may be positioned such that the first filter is located within the second filter.

In some embodiments, the distal sheath 74 and the proximal sheath 68 have substantially the same outer diameter. When the filter assemblies 62, 64 are collapsed within the sheath, the sheath portion of the system 60 thus has a substantially constant outer diameter, which may facilitate delivery of the system 60 through the body of the patient and increase the safety of delivery. The distal sheath 74 and the proximal sheath 68 may have substantially the same outer diameter, both of which have a larger outer diameter than the proximal shaft 70. The proximal shaft 70 may have a larger outer diameter than the distal shaft 72, with the distal shaft 72 disposed within the proximal shaft 70. The guide member 76 can have a smaller diameter than the distal shaft 72. In some embodiments, the proximal and distal sheaths 68, 74 have an outer diameter of between 3french (F) and 70F. In some embodiments, the outer diameter is between 4F and 8F. In other embodiments, the outer diameter is between 4F and 6F. In some embodiments, the sheaths 68, 74 have different outer diameters. For example, the proximal sheath 68 may have a size of 6F, while the distal sheath 74 has a size of 5F. In an alternative embodiment, the proximal sheath 68 is 5F and the distal sheath 74 is 4F. These are merely examples and are not intended to limit the sheaths 68, 74 to a particular size. A distal sheath 74 having a smaller outer diameter than the proximal sheath 68 reduces the delivery profile of the system 60 and may facilitate delivery. In some methods of use, the filter system 60 is advanced into the subject through an incision in the subject's right radial artery or alternatively the right brachial artery. In various medical procedures, a medical device is advanced through the subject's femoral artery (which is larger than the right radial artery). Delivery catheters used in femoral access procedures have a larger outer diameter than is permitted in filter systems that are advanced through the radial artery. Additionally, in some uses, the filter system is advanced from the right radial artery into the aorta via the brachiocephalic trunk. The radial artery has the smallest diameter in the vessel through which the system is advanced. Thus, when the radial artery is the access point, the radial artery limits the size of the system that can be advanced into the subject. The outer diameter of the system described herein, when advanced into a subject via the radial artery, is therefore less than the outer diameter of a guiding catheter (or sheath) typically used when gaining access via the femoral artery.

The system 60 may be delivered to the left carotid artery 14 and the innominate artery 12 in a delivery configuration. The delivery configuration of the system generally refers to the configuration when the two filter assemblies 62, 64 are in the collapsed configuration within the system. The distal articulatable sheath 74 can move independently with three degrees of freedom relative to the proximal sheath 68 and the proximal filter 64. In some embodiments, the proximal sheath 68 and the distal sheath 74 may be releasably coupled together. For example, the proximal sheath 68 may be coupled to the distal sheath 74 using an interference fit, a friction fit, a spline fit, an end-to-end butt fit, or any other type of suitable coupling between the two sheaths 68, 74. When coupled together, the components move in a unit. For example, the proximal sheath 68, proximal shaft 70, proximal filter 64, distal shaft 72, and distal filter 62 will translate and rotate axially (in either the proximal or distal direction) in a unit. The distal sheath 74 may be independently rotated, steered, or axially translated (in either the proximal or distal direction) when the proximal sheath 68 is retracted to allow the proximal filter 64 to expand. Thus, distal sheath 74 has 3 independent degrees of freedom: axial translation, rotation, and steering. The applicability of having 3 independent degrees of freedom is advantageous when positioning the distal sheath 74 at a target location, the details of which will be described below.

The system 60 is advanced into the subject's right radial artery through an incision in the right arm or alternatively through the right brachial artery. For example, the system 60 may be advanced through the same incision as the first system 30. The system is advanced through the right subclavian artery 22 and into the brachiocephalic or innominate artery 12, and a portion of the system is positioned within the aortic arch 10. The proximal sheath 68 is retracted proximally to allow the proximal filter support element 65 to expand against the wall of the innominate artery 12 to an expanded configuration, as shown in fig. 1B. The proximal filter element 67 is secured directly or indirectly to the support element 65 and is thus reconfigured to the configuration shown in fig. 1B. The position of the distal sheath 74 may be substantially maintained while the proximal sheath 68 is retracted proximally. Once expanded, the proximal filter assembly 64 filters blood traveling through the innominate artery 12, and thus filters blood traveling into the right common carotid artery 18 and the right vertebral artery 20. Thus, the expanded proximal filter assembly 64 is in place to prevent foreign particles from traveling into the right common carotid artery 18 and the right vertebral artery 20 and into the cerebral vasculature.

The distal sheath 74 is then turned or bent and the distal end 84 of the distal sheath 74 is advanced into the left common carotid artery 14. Thereafter, the guide member 76 is advanced distally relative to the distal sheath 74, allowing the distal support element 61 to expand against the wall of the left common carotid artery 14 from the collapsed configuration to the expanded configuration, as shown in fig. 1B. The distal filter element 63 is also reconfigured to the configuration shown in FIG. 1B. Once expanded, the distal filter assembly 62 filters blood traveling through the left common carotid artery 14. In some embodiments, the distal filter assembly 62 may be deployed prior to deploying the proximal filter assembly 64. Thus, the distal filter assembly 62 is in position to trap foreign particles and prevent the foreign particles from traveling into the cerebral vasculature. As can be seen in fig. 1B, first protection system 30 and second protection system 60 together trap foreign particles and prevent them from traveling into the four arteries 14, 18, 20, 24 that carry oxygenated blood to the brain.

Thereafter, the filter system(s) 30, 60 may be removed from the subject's body (or at any point in the procedure). In an exemplary embodiment, distal filter assembly 62 is first retracted to a collapsed configuration within distal sheath 74. To do so, guide member 76 is retracted proximally relative to distal sheath 74. This relative axial movement causes distal sheath 74 to engage struts or wires 86 and begin to move struts 86 toward guide members 76. The support elements 61 coupled to the struts 86 begin to collapse upon collapse of the struts 86. Thus, the filter element 63 also begins to collapse. Continued relative axial movement between guide member 76 and distal sheath 74 continues to collapse struts 86, support element 61, and filter element 63 until distal filter assembly 62 is retracted and re-collapsed back into distal sheath 74 (not expressly shown). When distal filter assembly 62 is resheathed, any foreign particles trapped within distal filter element 63 are contained therein. The distal sheath 74 is then turned to a configuration in which the distal sheath 74 is substantially parallel to the distal shaft 72. In other words, distal sheath 74 is turned such that it has a substantially linear orientation. The proximal sheath 70 is then advanced distally relative to the proximal filter assembly 64. This causes the proximal filter assembly 64 to collapse about the distal shaft 72, trapping any particulates within the collapsed proximal filter 67. The proximal sheath 68 continues to move distally toward the distal sheath 74 until the proximal sheath 68 couples or nearly couples with the distal sheath 74. The entire system 60 may then be removed from the subject.

Once second filter system 60 has been removed from the body, outer sheath 42 of first filter system 30 can be advanced (e.g., over guidewire 56 or filter wire 52b) such that filter assembly 32 can be retracted into outer sheath 42 (e.g., by advancing outer sheath 42 distally and/or by retracting filter assembly 32 proximally). The act of resheathing the filter assembly 32 may be the opposite of the act used to unsheathe the filter assembly 32 (e.g., retracting and advancing the sliders, respectively), or may be a completely different act. Inner member 50 can be advanced distally before, during, or after resheathing of filter assembly 32. Radiopaque markers (e.g., on the filter assembly 32) may help determine when the filter assembly 32 reaches a compressed state. Differential longitudinal movement of filter assembly 32 and outer sheath 42 may be stopped upon full or proper capture of filter assembly 32. Radiopaque fluid may be provided through inner member 50. Embolic material trapped in the filter assembly 32 can also be captured by the resheathing process. Once the guard 30 is in the compressed state, the guard 30 may be withdrawn proximally away from the right subclavian artery 22.

In any of the embodiments mentioned herein, the filter or filter assembly 32, 62, 64 may instead be detached from the delivery catheter and the delivery catheter removed, leaving the filter 32, 62, 64. The filter or filter assembly 32, 62, 64 may be left in place permanently or retrieved by capturing it with a retrieval catheter after a post-operative treatment period. Alternatively, the filter assembly 32, 62, 64 may remain attached to the catheter, and the catheter may be left in place for the period of treatment post-operatively. The treatment period may be at least one day, one week, three weeks, five weeks or more, depending on the clinical situation. Patients with an indwelling filter or filter assembly may be administered any of a variety of thrombolytic or anticoagulant therapies, including tissue plasminogen activator, streptokinase, coumarin, heparin, and other agents known in the art.

FIG. 1C illustrates an alternative embodiment of the system of FIGS. 1A and 1B. In fig. 1B, filter wire 52B remains within the body (e.g., within a blood vessel), but remains outside of second filter system 60. In the embodiment of FIG. 1C, the first filter system 30 may be deployed, as described above. Second filter system 60 can then be advanced over filter wire 52b of first filter system 30 via port 90 in distal sheath 74. Filter wire 52b is housed within the lumen of second filter system 60 for a length that is less than the entire length of second filter system 60, rather than extending along and outside of second filter system 60. The second filter system 60 may then be deployed, as described above.

Fig. 1D and 1E illustrate another alternative embodiment for the system of fig. 1A and 1B. In the embodiment of fig. 1D, the distal shaft 72 may include a quick-swap port 92, which is shown in more detail in fig. 1E. Quick-swap port 92 may allow filter wire 52b to exit second filter system distally near proximal filter assembly 64. A second port (not expressly shown) may be formed in second filter system 60 at a location remote from fast swap port 92, allowing filter line 52b to enter second filter system 60. In some cases, filter wire 52b may enter the second filter system through port 90 in distal sheath 74, but this is not required. It is contemplated that filter wire 52b may be accessed through a port formed in any component of second filter system 60 or through a distal opening of any component of second filter system 60, as desired. It is further contemplated that quick-change port 92 may be a port formed in any component of second filter system 60, as desired. For example, as second filter system 60 is advanced into a blood vessel, the proximal end of filter wire 52b may be inserted into port 90 (or other suitable opening). Fast exchange port 92 may include features to direct the proximal end of filter wire 52b out of fast exchange port 92 as second filter system 60 is advanced distally over filter wire 52 b. As can be seen in fig. 1E, filter line 52b may be biased into and out of fast switch port 92. It should be understood that the distal shaft 72 may include other components in its lumen 73; however, for clarity, these components are not shown.

Fig. 2A shows another illustrative protective device or filter system 100 in which three filters are delivered with a single delivery device. The filter system 100 may be similar to the second filter system 60 described above. The filter system 100 may include: a distal end region 102 including at least a first filter assembly 104, a second filter assembly 106, and a third filter assembly 108; a proximal end region (not expressly shown) coupled to a handle (not expressly shown) configured to be held outside the body. First filter assembly 104, second filter assembly 106, and third filter assembly 108 may each include a support member or frame 114, 116, 118 and a filter element 120, 122, 124. The support members 114, 116, 118 may be similar in form and function to the support member 31 described herein. The filter elements 120, 122, 124 may be similar in form and function to the filter element 33 described herein. In some cases, the handle of the filter system 100 may be similar in form and function to the handle 38 described herein. The distal end region 102 may include: a proximal sheath 110; a proximal shaft (not expressly shown) coupled to an expandable proximal or third filter assembly 108; a distal shaft 132 (see fig. 2B) coupled to the distal articulatable sheath 112; an intermediate or second filter assembly 106; a distal or first filter assembly 104; and a guide member (not explicitly shown). As can be seen, the filter system 100 may be similar in structure to the second filter system 100 described herein, and may be similarly arranged. However, in the filter system 100 shown in fig. 2A, both the first filter assembly 104 and the second filter assembly 106 may be loaded into the distal sheath 112 for delivery. First filter assembly 104 and second filter assembly 106 may be coupled together via a wire or tether 126. In some cases, the tether 126 may be made with a predetermined shape to better assist in positioning the tether 126 and spanning the distance from the ostium of the left subclavian artery 16 to the left common carotid artery 14.

The system 100 is advanced into the subject's right radial artery through an incision in the right arm or alternatively through the right brachial artery. Although not explicitly shown, the system 100 may be advanced over or in conjunction with one or more guidewires. The system is advanced through the right subclavian artery 22 and into the innominate artery 12 and a portion of the system is positioned within the aortic arch 10. The proximal sheath 110 is retracted proximally to allow the proximal filter support element 118 to expand against the wall of the innominate artery 12 to an expanded configuration, as shown in fig. 2A. The proximal filter element 124 is secured, directly or indirectly, to the support element 118 and is thus reconfigured to the configuration shown in fig. 2A. The position of the distal sheath 112 may be substantially maintained while the proximal sheath is retracted proximally. Once expanded, the proximal filter assembly 108 filters blood traveling through the innominate artery 12, and thus filters blood traveling into the right common carotid artery 18 and the right vertebral artery 20. Thus, the expanded proximal filter assembly 108 is in place to prevent foreign particles from traveling into the right common carotid artery 18 and the right vertebral artery 20 and into the cerebral vasculature.

The distal sheath 112 is then turned or bent and the distal end of the distal sheath 112 is advanced into the left subclavian artery 16. Thereafter, a guide member (not expressly shown) is advanced distally relative to the distal sheath 112, allowing the distal support element 114 to expand against the wall of the left subclavian artery 16 from the collapsed configuration to the deployed configuration, as shown in fig. 2A. Alternatively or additionally, the distal sheath 112 may be retracted proximally to deploy the distal filter assembly 104. The distal filter element 120 is also reconfigured to the configuration shown in fig. 2A. Once expanded, the distal filter assembly 104 filters blood traveling through the left subclavian artery 16. Thus, the expanded distal filter assembly 104 is positioned to prevent foreign particles from traveling into the left subclavian artery 16 and left vertebral artery 24 and into the cerebral vasculature.

Once the distal filter assembly 104 has been positioned in the left subclavian artery, the tether 126 may be advanced distally to provide additional length or "slack" to allow the distal sheath 112 to be repositioned. The distal sheath 112 may be manipulated to subsequently cannulate the left common carotid artery 14. Thereafter, a guide member (not expressly shown) is advanced distally relative to the distal sheath 112, allowing the intermediate support element 116 to expand against the wall of the left common carotid artery 14 from a collapsed configuration to a deployed configuration, as shown in fig. 2A. The intermediate filter element 122 is also reconfigured to the configuration shown in fig. 2A. Once expanded, the middle filter assembly 106 filters blood traveling through the left common carotid artery 14. In some embodiments, the distal filter assembly 104 and the intermediate filter assembly 106 may be deployed prior to deployment of the proximal filter assembly 108. Thus, the intermediate filter assembly 106 is in position to trap foreign particles and prevent the foreign particles from traveling into the cerebral vasculature. As can be seen in fig. 2A, the protection system 100 traps foreign particles and prevents them from traveling into the four arteries 14, 18, 20, 24 that carry oxygenated blood to the brain. It is contemplated that the insertion steps may be reversed to remove the system 100 when the procedure is complete.

Fig. 2B and 2C show an alternative embodiment of the illustrative protective device or filter system 100 of fig. 2A, wherein three filters are delivered with a single delivery device. In the embodiment of fig. 2B and 2C, the first filter assembly 104 and the second filter assembly 106 each include their own filter wires 128, 130. For example, the first filter assembly 104 and the second filter assembly 106 may lack the tether 126 shown in fig. 2A. The embodiment of fig. 2B and 2C may be deployed in a manner similar to the embodiment of fig. 2A.

The system 100 is advanced into the subject's right radial artery through an incision in the right arm. The system is advanced through the right subclavian artery 22 and into the innominate artery 12 and a portion of the system is positioned within the aortic arch 10. The proximal sheath 110 is retracted proximally to allow the proximal filter support element 118 to expand against the wall of the innominate artery 12 to an expanded configuration, as shown in fig. 2B. The proximal filter element 124 is secured, directly or indirectly, to the support element 118 and is thus reconfigured to the configuration shown in fig. 2B. The position of the distal sheath 112 may be substantially maintained while the proximal sheath is retracted proximally. Once expanded, the proximal filter assembly 108 filters blood traveling through the innominate artery 12, and thus filters blood traveling into the right common carotid artery 18 and the right vertebral artery 20. Thus, the expanded proximal filter assembly 108 is in place to prevent foreign particles from traveling into the right common carotid artery 18 and the right vertebral artery 20 and into the cerebral vasculature.

The distal sheath 112 is then turned or bent and the distal end of the distal sheath 112 is advanced into the left subclavian artery 16. Thereafter, a guide member (not expressly shown) is advanced distally relative to the distal sheath 112, allowing the distal support element 114 to expand against the wall of the left subclavian artery 16 from the collapsed configuration to the deployed configuration, as shown in fig. 2B. Alternatively or additionally, the distal sheath 112 may be retracted proximally to deploy the distal filter assembly 104. The distal filter element 120 is also reconfigured to the configuration shown in fig. 2A. Once expanded, the distal filter assembly 104 filters blood traveling through the left subclavian artery 16. Thus, the expanded distal filter assembly 104 is positioned to prevent foreign particles from traveling into the left subclavian artery 16 and left vertebral artery 24 and into the cerebral vasculature.

Once the distal filter assembly 104 has been positioned in the left subclavian artery, the distal sheath 112 can be manipulated to then cannulate the left common carotid artery 14. Thereafter, a guide member (not expressly shown) is advanced distally relative to the distal sheath 112, allowing the intermediate support element 116 to expand against the wall of the left common carotid artery 14 from a collapsed configuration to a deployed configuration, as shown in fig. 2C. The intermediate filter element 122 is also reconfigured to the configuration shown in fig. 2C. Once expanded, the middle filter assembly 106 filters blood traveling through the left common carotid artery 14. In some embodiments, the distal filter assembly 104 and the intermediate filter assembly 106 may be deployed prior to deployment of the proximal filter assembly 108. Thus, the intermediate filter assembly 106 is in position to trap foreign particles and prevent the foreign particles from traveling into the cerebral vasculature. As can be seen in fig. 2C, the protection system 100 traps foreign particles and prevents them from traveling into the four arteries 14, 18, 20, 24 that carry oxygenated blood to the brain.

Fig. 3A-3C show another illustrative protective device or filter system 200 in which three filters are delivered with a single delivery device. The filter system 200 may be similar to the second filter system 60 described above. The filter system 200 may include: a distal end region 202 including at least a first filter assembly 204 (see, e.g., fig. 3C), a second filter assembly 206, and a third filter assembly 208 (see, e.g., fig. 3B and 3C); and a proximal end region (not expressly shown) coupled to a handle (not expressly shown) configured to be held outside the body. First filter assembly 204, second filter assembly 206, and third filter assembly 208 may each include a support member or frame 214, 216, 218 and a filter element 220, 222, 224 (see, e.g., fig. 3C). The support members 214, 216, 218 may be similar in form and function to the support members 31 described herein. The filter elements 220, 222, 224 may be similar in form and function to the filter element 33 described herein. In some cases, the handle of the filter system 200 may be similar in form and function to the handle 38 described herein. The distal end region 202 may include: a proximal sheath 210; a proximal shaft (not explicitly shown) coupled to an expandable proximal or third filter assembly 208; a distal shaft 226 coupled to the distal articulatable sheath 212; an intermediate or second filter assembly 206; a distal or first filter assembly 204; and a guide member (not explicitly shown). As can be seen, the filter system 200 may be similar in structure to the second filter system 200 described herein, and may be similarly arranged. However, in the filter system 200 shown in fig. 3A, both the second filter assembly 206 and the third filter assembly 208 may be loaded into the proximal sheath 210 for delivery. The second filter assembly 206 and the third filter assembly 208 may be coupled together via a flexible link 228. In some cases, the flexible link 228 may be formed to have a predetermined shape to better assist in cannulating the left common carotid artery 14 with the second filter assembly 206. It is contemplated that the flexible link 228 may be formed as a two wire system in some instances.

The system 200 is advanced into the subject's right radial artery through an incision in the right arm or alternatively through the right brachial artery. Although not explicitly shown, the system 200 may be advanced over or in conjunction with one or more guidewires. The system is advanced through the right subclavian artery 22 and into the innominate artery 12 with the distal portions of both the distal sheath 212 and the proximal sheath 210 positioned within the ascending portion of the main artery 10.

The proximal sheath 210 is retracted proximally to allow the intermediate filter support element 216 to expand to an expanded configuration within the main artery 10. The system 200 may then be retracted (e.g., proximally displaced) to move the middle filter assembly 206 into the left common carotid artery 14, as indicated at arrow 230. The predetermined hook shape of the flexible link 228 may help guide the intermediate filter assembly 206 into position. The middle support member 216 moves against the wall of the left common carotid artery 14 as shown in FIG. 3B. The intermediate filter element 222 is also reconfigured to the configuration shown in fig. 3B. Once expanded, the middle filter assembly 206 filters blood traveling through the left common carotid artery 14. In some embodiments, the distal filter assembly 204 and the intermediate filter assembly 206 may be deployed prior to deploying the proximal filter assembly 208. Thus, the intermediate filter assembly 206 is in position to trap foreign particles and prevent the foreign particles from traveling into the cerebral vasculature.

The proximal sheath 210 is then further retracted proximally, as indicated at arrow 232, thereby deploying the proximal filter assembly 208. The position of distal sheath 212 may be substantially maintained while proximal sheath 210 is retracted proximally. The proximal sheath 210 is retracted proximally to allow the proximal filter support element 218 to expand against the wall of the innominate artery 12 into an expanded configuration, as shown in fig. 3B, in which the flexible link 228 spans the distance between the innominate artery 12 and the ostium of the left common carotid artery 14. In some cases, the shape and/or curvature of the flexible link 228 can be manipulated by varying the distance that the proximal sheath 210 is retracted. The proximal filter element 224 is secured, directly or indirectly, to the support element 218 and is thus reconfigured to the configuration shown in fig. 3B. Once expanded, the proximal filter assembly 208 filters blood traveling through the innominate artery 12, and thus filters blood traveling into the right common carotid artery 18 and the right vertebral artery 20. Thus, the expanded proximal filter assembly 208 is in place to prevent foreign particles from traveling into the right common carotid artery 18 and the right vertebral artery 20 and into the cerebral vasculature.

The distal sheath 212 is then turned or bent and the distal end of the distal sheath 212 is advanced into the left subclavian artery 16. Thereafter, a guide member (not expressly shown) is advanced distally relative to the distal sheath 212, allowing the distal support element 214 to expand against the wall of the left subclavian artery 16 from the collapsed configuration to the deployed configuration, as shown in fig. 3C. Alternatively or additionally, the distal sheath 212 may be retracted proximally to deploy the distal filter assembly 204. Distal filter element 220 is also reconfigured to the configuration shown in fig. 3C. Once expanded, the distal filter assembly 204 filters blood traveling through the left subclavian artery 16. Thus, the expanded distal filter assembly 204 is positioned to prevent foreign particles from traveling into the left subclavian artery 16 and left vertebral artery 24 and into the cerebral vasculature. As can be seen in fig. 3C, the protection system 200 traps foreign particles and prevents them from traveling into the four arteries 14, 18, 20, 24 that carry oxygenated blood to the brain. It is contemplated that the insertion steps may be reversed to remove system 200 when the procedure is complete.

Fig. 4A-4C show another illustrative protective device or filter system 300 in which three filters are delivered independently. Filter system 300 can include a steerable sheath 310, a first filter assembly 304, a second filter assembly 306 (see, e.g., fig. 4B), and a third filter assembly 308 (see, e.g., fig. 4C), and a proximal end region (not expressly shown) coupled to a handle (not expressly shown) configured to be held outside the body. First filter assembly 304, second filter assembly 306, and third filter assembly 308 may each include a support member or frame 314, 316, 318 and a filter element 320, 322, 324 (see, e.g., fig. 3C). The support members 314, 316, 318 may be similar in form and function to the support member 31 described herein. Filter elements 320, 322, 324 may be similar in form and function to filter element 33 described herein. In some cases, the handle of the filter system 300 may be similar in form and function to the handle 38 described herein.

Steerable sheath 310 is advanced through an incision in the right arm or alternatively through the right brachial artery into the right radial artery of the subject. Although not explicitly shown, the system 300 may be advanced over or in conjunction with one or more guidewires. The sheath 310 is advanced through the right subclavian artery 22 and into the innominate artery 12, the aortic arch 10, to a location proximal to the ostium of the left subclavian artery 16 (if the left subclavian artery 16 was not actually cannulated). First filter assembly 304 may then be advanced through the lumen of sheath 310. Alternatively, the first filter assembly 304 may be preloaded within the sheath 310 and advanced therewith. The filter assembly 304 may be advanced distally from the sheath 310 (or the sheath 310 withdrawn proximally), allowing the distal filter support element 314 to expand from the collapsed configuration against the wall of the left subclavian artery 16 to the expanded configuration, as shown in fig. 4A. The distal filter element 320 is also reconfigured to the configuration shown in fig. 4A. Once expanded, the distal filter assembly 304 filters blood traveling through the left subclavian artery 16. Thus, the expanded distal filter assembly 304 is positioned to prevent foreign particles from traveling into the left subclavian artery 16 and left vertebral artery 24 and into the cerebral vasculature.

After placement of the first filter assembly 304, the sheath 310 is fully withdrawn from the patient such that the filter wire 330 (similar in form and function to filter wire 52b described herein) is released from the sheath 310. Steerable sheath 310 is then advanced through the incision in the right arm into the subject's right radial artery. The sheath 310 is advanced through the right subclavian artery 22 and into the innominate artery 12, the aortic arch 10, to a location proximal to the ostium of the left common carotid artery 14 (if the left common carotid artery 30 was not actually cannulated). The second filter assembly 306 may then be advanced through the lumen of the sheath 310. Alternatively, the second filter assembly 306 may be preloaded within the sheath 310 and advanced therewith. The filter assembly 306 may be advanced distally from the sheath 310 (or the sheath 310 withdrawn proximally), allowing the middle filter support element 316 to expand from the collapsed configuration against the wall of the left common carotid artery 14 to the expanded configuration, as shown in fig. 4B. The intermediate filter element 322 is also reconfigured to the configuration shown in fig. 4B. Once expanded, the middle filter assembly 306 filters blood traveling through the left common carotid artery 14. Thus, the intermediate filter assembly 306 is in position to trap foreign particles and prevent the foreign particles from traveling into the cerebral vasculature.

After placement of the second filter assembly 306, the sheath 310 is again fully withdrawn from the patient such that the second filter wire 332 (similar in form and function to filter wire 52b described herein) is released from the sheath 310. Steerable sheath 310 is then advanced through the incision in the right arm into the subject's right radial artery. The sheath 310 is advanced through the right subclavian artery 22 and into the innominate artery 12. The third filter assembly 308 may then be advanced through the lumen of the sheath 310. Alternatively, the third filter assembly 308 may be preloaded within the sheath 310 and advanced therewith. The filter assembly 308 can be advanced distally from the sheath 310 (or the sheath 310 withdrawn proximally), allowing the proximal filter support element 318 to expand against the wall of the innominate artery 12 from the collapsed configuration to the deployed configuration, as shown in fig. 4C. The proximal filter element 324 is also reconfigured to the configuration shown in fig. 4C and filters blood traveling through the innominate artery 12 and, thus, the right common carotid artery 18 and the right vertebral artery 20. Thus, the expanded proximal filter assembly 308 is in place to prevent foreign particles from traveling into the right common carotid artery 18 and the right vertebral artery 20 and into the cerebral vasculature. After placement of the third filter assembly 308, the sheath 310 is again fully withdrawn from the patient such that a third filter wire (not expressly shown) (similar in form and function to filter wire 52b described herein) is released from the sheath 310. As can be seen in fig. 4C, the protection system 300 traps foreign particles and prevents them from traveling into the four arteries 14, 18, 20, 24 that carry oxygenated blood to the brain. It is contemplated that when the procedure is complete, the insertion steps may be reversed to remove system 300.

Fig. 5 shows another illustrative protective device or filter system 400 in which two filters may be utilized to protect all four arteries 14, 18, 20, 24 carrying oxygenated blood to the brain. The filter system 400 may include: an inner sheath 402; an outer sheath 404; a first or distal filter assembly 406; a second or proximal filter assembly 408; and a proximal end region (not expressly shown) coupled to a handle (not expressly shown) configured to be held outside the body. In some embodiments, one or both of inner sheath 402 and outer sheath 404 may be steerable. The first filter assembly 406 and the second filter assembly 408 may each include a support member or frame 410, 412 and a filter element 414, 416. The support members 410, 412 may be similar in form and function to the support member 31 described herein. The filter elements 414, 416 may be similar in form and function to the filter element 33 described herein. The second filter assembly 408 may be configured to be on the ostia of both the innominate artery 12 and the left common carotid artery 14. In some cases, the handle of the filter system 400 may be similar in form and function to the handle 38 described herein.

The filter system 400 may be advanced through an incision in the right arm to the right radial artery (or alternatively, the right brachial artery) of the subject. Although not explicitly shown, the system 400 may be advanced over or in conjunction with one or more guidewires. The system 400 is advanced through the right subclavian artery 22 and into the innominate artery 12 until the distal end 418 of the outer sheath 404 is adjacent the ostium 420 of the innominate artery 12. The outer sheath 404 may then be proximally retracted, thereby deploying the proximal filter assembly 408 over the ostia 420, 422 of the innominate artery 12 and the left common carotid artery 14. As can be seen, the support member 412 and filter element 416 of the proximal filter assembly 408 can be sized and shaped to extend over the ostia 420, 422 of the innominate artery 12 and the left common carotid artery 14. The inner sheath 402 may then be advanced distally toward the ostium of the left subclavian artery 16 and sometimes through the ostium 424. The inner sheath 402 may be retracted proximally, thereby deploying the distal filter assembly 406 within the left subclavian artery 16. Alternatively, the order in which the filter assemblies 406, 408 are deployed may be reversed. It is contemplated that when the procedure is complete, the insertion steps may be reversed to remove system 500.

Fig. 6A shows another illustrative protective device or filter system 500 in which a deflector 504, a distal filter assembly 506, and a proximal filter assembly 508 may be utilized to protect all four arteries 14, 18, 20, 24 carrying oxygenated blood to the brain. The filter system 500 may be similar in form and function to the filter system 100 described above. The filter system 500 may include: a distal end region 502 including at least a deflector 504, a distal filter assembly 506, and a proximal filter assembly 508; and a proximal end region (not expressly shown) coupled to a handle (not expressly shown) configured to be held outside the body. The deflector 504, the distal filter assembly 506, and the proximal filter assembly 508 may each include a support member or frame 514, 516, 518 and a filter element 520, 522, 524. The support members 514, 516, 518 may be similar in form and function to the support members 31 described herein. The filter elements 520, 522, 524 may be similar in form and function to the filter element 33 described herein. However, the deflector 504 may have a generally flat shape such that foreign particles do not have to be trapped in the filter element 520 when the deflector is removed. However, the configuration of the deflector 504 may be such that blood flow away from the ostium of the left subclavian artery 16 removes any foreign particles, thereby reducing the likelihood of foreign particles entering the left vertebral artery 24. In some cases, the handle of the filter system 500 may be similar in form and function to the handle 38 described herein.

The distal end region 502 may include: a proximal sheath 510; a proximal shaft (not expressly shown) coupled to an expandable proximal filter assembly 508; a distal shaft (not explicitly shown) coupled to the distal articulatable sheath 512; a proximal filter assembly 506; a deflector 504; and a guide member (not explicitly shown). As can be seen, filter system 500 can be similar in structure to second filter system 60 and/or filter system 100 described herein, and can be similarly arranged. However, in the filter system 500 shown in fig. 6A, both the deflector 504 and the distal filter assembly 506 may be loaded into the distal sheath 512 for delivery. The deflector 504 and the distal filter assembly 506 may be coupled together via a wire or tether 526. In some cases, the tether 526 may be made with a predetermined shape to better assist in positioning the tether 526 and spanning the distance from the ostium of the left subclavian artery 16 to the left common carotid artery 14.

The system 500 is advanced into the subject's right radial artery through an incision in the right arm or alternatively through the right brachial artery. Although not explicitly shown, the system 500 may be advanced over or in conjunction with one or more guidewires. The system is advanced through the right subclavian artery 22 and into the innominate artery 12, and a portion of the system is positioned within the aortic arch 10. The proximal sheath 510 is retracted proximally to allow the proximal filter support element 518 to expand against the wall of the innominate artery 12 to an expanded configuration, as shown in fig. 6A. The proximal filter element 524 is secured, directly or indirectly, to the support element 518 and is thus reconfigured to the configuration shown in fig. 6A. The position of the distal sheath 512 may be substantially maintained while the proximal sheath is retracted proximally. Once expanded, the proximal filter assembly 508 filters blood traveling through the innominate artery 12, and thus filters blood traveling into the right common carotid artery 18 and the right vertebral artery 20. Thus, the expanded proximal filter assembly 508 is in place to prevent foreign particles from traveling into the right common carotid artery 18 and the right vertebral artery 20 and into the cerebral vasculature.

The distal sheath 512 then turns or bends and the distal end of the distal sheath 512 is advanced into the left common carotid artery 14. Thereafter, a guide member (not expressly shown) is advanced distally relative to the distal sheath 512, thereby allowing the deflector 504 and the distal filter assembly 506 to exit from the distal end of the distal sheath 512. The pre-formed tether 526 may position the deflector proximal to the ostium of the left subclavian artery 16 while the distal filter assembly 506 is positioned in the left common carotid artery 14. When the distal filter assembly is deployed, the distal support element 516 expands against the wall of the left common carotid artery 14 from a collapsed configuration to a deployed configuration, as shown in fig. 6A. The distal filter element 522 is also reconfigured to the configuration shown in fig. 6A. Once expanded, the distal filter assembly 506 filters blood traveling through the left common carotid artery 14. Similarly, the deflector support element 514 expands against the wall of the left subclavian artery 16 from the collapsed configuration to the deployed configuration, as shown in fig. 6A. The deflector filter element 520 is also reconfigured to the configuration shown in fig. 6A. Once expanded, the deflector 504 filters the blood traveling through the left subclavian artery 16. Thus, the distal filter assembly 506 is in position to capture and prevent foreign particles from traveling into the cerebral vasculature, and the flared deflector 504 is positioned to prevent foreign particles from traveling into the left subclavian artery 16 and left vertebral artery 24 and into the cerebral vasculature.

It is contemplated that the deflector 504 may not be coupled or linked to the distal filter assembly 506 via the tether 526 (e.g., the tether 526 is not present in the system 500). In this case, the deflector 504 may include deflector lines 528a, 528 b. It is contemplated that the deflector is provided with only a single wire 528a or 528 b. However, the deflector wire 528a may be positioned outside of the distal sheath 512 (and in some cases also outside of the proximal sheath 510). In other embodiments, the deflector wire 528b may be disposed within the lumen of the proximal sheath 510 and/or the distal sheath 512.

In some embodiments, the deflector 504 and the distal filter assembly 506 may be deployed prior to deploying the proximal filter assembly 508. It is contemplated that when the procedure is complete, the insertion steps may be reversed to remove system 500. As can be seen in fig. 6A, the protection system 500 traps foreign particles and prevents them from traveling into the four arteries 14, 18, 20, 24 that carry oxygenated blood to the brain.

Fig. 6B shows an alternative embodiment of the illustrative protective system 500 of fig. 6A, in which the distal filter assembly 506 has been replaced with a spring-loaded filter assembly 540. The spring-loaded filter assembly 540 may include a spring-loaded expandable frame 542 and a filter element 544. The spring-loaded expandable frame 542 may have an elasticity or compressibility that allows the spring-loaded filter assembly 540 to be deployed within the aorta 10 and then directed into the left common carotid artery 14. The filter element 544 may be similar in form and function to the filter element 33 described herein.

In the embodiment of fig. 6B, the system 500 is advanced into the subject's right radial artery through an incision in the right arm or alternatively through the right brachial artery. Although not explicitly shown, the system 500 may be advanced over or in conjunction with one or more guidewires. The system is advanced through the right subclavian artery 22 and into the innominate artery 12 and a portion of the system may be positioned within the aortic arch 10. The deflector 504 and the spring-loaded filter assembly 540 can be advanced distally into the aorta 10 from the distal end of the distal sheath 512. The articulatable distal sheath 512 may then be manipulated to cannulate the left common carotid artery 14 to deploy the spring-loaded filter assembly 540 in the left common carotid artery 14 and the deflector 504 across the left subclavian artery 16. The proximal sheath 510 may then be retracted to deploy the proximal filter assembly 508. As can be seen in fig. 6A, the protection system 500 traps foreign particles and prevents them from traveling into the four arteries 14, 18, 20, 24 that carry oxygenated blood to the brain. It is contemplated that when the procedure is complete, the insertion steps may be reversed to remove system 500.

Fig. 7A shows another illustrative protective device 600 or filter system in which a single oversized filter assembly 604 covers the ostia of the innominate artery 12, the left common carotid artery 14, and the left subclavian artery 16, the filter assembly 604 conforming to the curvature of the aortic arch 10. Referring additionally to fig. 7B, which shows a schematic view of the filter assembly 604 outside of the body, the filter assembly 604 may include an expandable frame 606 (which may be similar in form and function to the support member 31 described herein), a porous filter material 608 (which may be similar in form and function to the filter element 33 described herein), one or more deployment wires 610, 612, and one or more pull wires 614, 616. The deployment wires 610, 612 can be actuated to exert a force on the frame 606 to bias or displace the filter assembly 604 off-axis (shown at arrow 618). The deployment wires 610, 612 can be configured to extend through the lumen of the delivery sheath 602 to a point outside the body where the deployment wires 610, 612 can be manipulated by the user. The pull wires 614, 616 may be actuated to exert a force on the frame 606 to help the frame 606 conform to the upper bends (shown at arrow 620) of the aortic arch 10. In this manner, not only are all of the cerebral arteries 14, 18, 20, 24 protected, but the filter assembly 604 does not interfere with medical devices, catheters, etc. passing through the aortic arch 10.

The system 600 is advanced into the subject's right radial artery through an incision in the right arm or alternatively through the right brachial artery. Although not explicitly shown, the system 600 may be advanced over or in conjunction with one or more guidewires. The system is advanced through the right subclavian artery 22 and into the innominate artery 12 and a portion of the system may be positioned within the aortic arch 10. The filter assembly 604 can be advanced distally from the distal end of the introducer sheath 602 and partially into the aorta 10. The deployment wires 610, 612 and/or the pull wires 614, 616 may then be manipulated to position the filter assembly 604 in a desired orientation such that the filter assembly 604 covers the ostia of the left common carotid artery 14, the innominate artery 12, and the left subclavian artery 16. The introducer sheath 602 may then be withdrawn or left within the vessel for the remainder of the procedure. As can be seen in fig. 7A, the protection system 600 traps (and/or deflects) foreign particles and prevents them from traveling into the four arteries 14, 18, 20, 24 that carry oxygenated blood to the brain. It is contemplated that the insertion step may be reversed to remove the system 6 when the procedure is complete.

Fig. 7C shows another illustrative protective device 700 or filter system, in which a single oversized filter assembly 704 covers the ostia of the left common carotid artery 14, the innominate artery 12, and the left subclavian artery 16, the filter assembly 704 conforming to the curvature of the aortic arch 10. Filter assembly 704 may include an expandable framework 706 (which may be similar in form and function to support member 31 described herein), and a porous filter material 708 (which may be similar in form and function to filter element 33 described herein). The filter material 708 may include a first shaped portion 710, a second shaped portion 712, and a third shaped portion 714 configured to prolapse into the left subclavian artery 16, the left common carotid artery 14, and the innominate artery 12, respectively. Fig. 7D shows an enlarged view of the second shape portion 712. Although FIG. 7D is described with respect to the second shaped segment 712, the first shaped segment 710 and the third shaped segment 714 are similarly formed. In some embodiments, the shaped portion 712 may be laser drilled, thereby forming holes that allow blood 716 to pass through, but filter debris. In some cases, the spacing of the holes may be denser at the top 718a of the shape portion 712 and less dense as it approaches the end 718b adjacent the mouth. However, this is not essential. When so disposed, the denser holes at the top 718a of the shape portion 712 can result in increased resistance to blood flow in the area of the shape portion closer to the mouth 718b, and conversely, where increased flow is desired, the resistance to blood flow out of the shape portion 718a is reduced. The region of increased resistance to flow (near the ostium) 718b may create better wall apposition, thus reducing the risk of debris passing between the ostium of the left common carotid artery 14, 12 innominate and left subclavian artery 16 and the membrane 708. This selective resistance to blood flow can create an effective seal without the inclusion of a filter.

The system 700 is advanced into the subject's right radial artery through an incision in the right arm or alternatively through the right brachial artery. Although not explicitly shown, the system 700 may be advanced over or in conjunction with one or more guidewires. The system is advanced through the right subclavian artery 22 and into the innominate artery 12 and a portion of the system may be positioned within the aortic arch 10. The filter assembly 704 can be advanced distally from the distal end of the introducer sheath 702 and partially into the aorta 10. The filter assembly 704 may be manipulated such that it covers the ostia of the left common carotid artery 14, innominate artery 12, and left subclavian artery 16. In some cases, the filter assembly 704 can include deployment and/or pull wires similar to the deployment and/or pull wires described with respect to fig. 7A and 7B to facilitate placement of the filter assembly 704. The introducer sheath 702 can then be withdrawn or left in the vessel for the remainder of the procedure. As can be seen in fig. 7A, the protection system 700 traps (and/or deflects) foreign particles and prevents them from traveling into the four arteries 14, 18, 20, 24 that carry oxygenated blood to the brain. It is contemplated that when the procedure is complete, the insertion steps may be reversed to remove system 700.

While specific examples of the methods and apparatus described herein have been illustrated in the accompanying drawings and described in detail herein, various modifications and substitutions can be made to the methods and apparatus described herein. It should be understood, however, that the inventive subject matter is not to be limited to the particular forms or methods disclosed, but to the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the various embodiments described and the appended claims. Moreover, any particular feature, aspect, method, property, characteristic, quality, attribute, element, etc. disclosed herein in connection with an embodiment or example may be used in all other embodiments or examples set forth herein. In any of the methods disclosed herein, the acts or operations may be performed in any suitable sequence and are not necessarily limited to any particular disclosed sequence, and may be performed out of the order described. Various operations may be described as multiple discrete operations in turn, in a manner that is helpful in understanding certain embodiments; however, the order of description should not be construed as to imply that these operations are order dependent. In addition, the structures described herein may be implemented as integrated components or as separate components. Certain aspects and advantages of the embodiments are described for purposes of comparing the various embodiments. Not all of these aspects or advantages are achieved by any particular embodiment. Thus, for example, embodiments may be implemented in a manner that achieves or optimizes one advantage or group of advantages without necessarily achieving other advantages or groups of advantages. The methods disclosed herein may include certain actions taken by the practitioner; however, these methods may also include any third party instructions, either explicit or implicit, for these actions. For example, actions such as "deploy self-expanding filter" include "command to deploy self-expanding filter". The ranges disclosed herein also encompass any and all overlaps, sub-ranges, and combinations thereof. Language such as "up to," "at least," "greater than," "less than," "between …," and the like include the recited number. Numbers beginning with terms such as "about" or "approximately" include the number recited and should be interpreted on a case by case basis (e.g., as reasonably accurate as possible, e.g., ± 5%, ± 10%, ± 15%, etc., in certain instances). For example, "about 7 mm" includes "7 mm". Phrases that begin with terms such as "substantially" include the recited phrase and should be interpreted based on the context (e.g., to the extent reasonably possible in certain circumstances). For example, "substantially straight" includes "straight.

Those skilled in the art will recognize that the present invention may be embodied in many forms other than the specific embodiments described and contemplated herein. Accordingly, departures in form and detail may be made without departing from the scope and spirit of the present invention as described in the appended claims.