Systems and methods for vascular filter retrieval

Information

  • Patent Grant
  • 6663651
  • Patent Number
    6,663,651
  • Date Filed
    Tuesday, January 16, 2001
    23 years ago
  • Date Issued
    Tuesday, December 16, 2003
    20 years ago
Abstract
Apparatus and methods for retrieving a vascular filter from a vessel are provided wherein a retrieval adapter is delivered to a treatment site concurrently along with an interventional device to reduce the number of steps required to remove the vascular filter. The retrieval adapter also reduces the possibility of entangling the vascular filter with a stent disposed within the vessel during removal of the vascular filter. A separate retrieval catheter is also described for use in conjunction with the retrieval adapter.
Description




FIELD OF THE INVENTION




The present invention relates to apparatus and methods for retrieving a vascular device, such as a filter, from within a vessel. More particularly, the present invention provides apparatus useful for retrieving a vascular filter used to prevent embolization associated with diagnostic or therapeutic interventional procedures, thrombectomy and embolectomy.




BACKGROUND OF THE INVENTION




Percutaneous interventional procedures to treat occlusive vascular disease, such as angioplasty, atherectomy, and stenting, often dislodge material from the vessel walls. This dislodged material, known as emboli, enters the bloodstream and may be large enough to occlude smaller downstream vessels, potentially blocking blood flow to tissue. The resulting ischemia poses a serious threat to the health or life of a patient if the blockage occurs in critical tissue, such as the heart, lungs, or brain.




The deployment of stents and stent-grafts to treat vascular disease, such as aneurysms, involves the introduction of foreign objects into the bloodstream, and also may result in the formation of clots or release of emboli. Such particulate matter, if released into the bloodstream, also may cause infarction or stroke.




Numerous blood filters are known that are designed to capture material liberated from vessel walls during the treatment of vascular disease. Such treatment procedures, such as angioplasty, atherectomy and stenting, typically involve transluminally inserting an interventional device to the treatment site along a guidewire. Upon completion of the procedure, the interventional device is removed from the patient's blood vessel, and a retrieval mechanism, such as a sheath, is advanced along the guidewire in order to retrieve the blood filter.




One drawback associated with using a sheath to retrieve a filter is that the retrieval process requires two steps: (1) the interventional device (e.g., angioplasty catheter) must be removed and (2) the retrieval sheath must then be advanced along the guidewire to retrieve the filter. This additional exchange adds time to the length of the procedure, involves introduction of an additional element (the retrieval catheter) into the patient's vasculature, and enhances the risk of dislodging the filter and permitting emboli to escape therefrom.




Moreover, as the retrieval sheath is advanced along the guidewire, its distal end may become entangled with a stent disposed within the patient's vessel. If, for example, a stent has been deployed, the distal end of the retrieval sheath may inadvertently engage a stent strut, preventing further advancement of the retrieval sheath within the vessel, or even possibly causing vessel dissection.




One disadvantage associated with attempting to retrieve a vascular filter using the guidewire lumen of an interventional device, such as an angioplasty catheter, is that the diameters of such lumens are typically quite small, e.g., 0.014 inch. Accordingly, it is not possible to retrieve previously known vascular filters using the guidewire lumens of most interventional devices.




In view of the foregoing, it would be desirable to provide improved apparatus and methods that streamline retrieval of a vascular filter.




It further would be desirable to provide improved apparatus and methods that facilitate retrieval of a vascular filter, with reduced risk of entangling a retrieval sheath in a deployed stent.




SUMMARY OF THE INVENTION




In view of the foregoing, it is an object of the present invention to provide improved apparatus and methods that streamline retrieval of a vascular filter.




It is another object of the present invention to provide improved apparatus and methods that facilitate retrieval of a vascular filter, with reduced risk of entangling a retrieval sheath in a deployed stent.




These and other objects of the present invention are accomplished by providing a retrieval apparatus that reduces the time and effort required to retrieve a vascular filter from a patient's vessel.




In one preferred embodiment, the present invention includes a retrieval adapter having a proximal end configured to be fitted to the end of an interventional device, such as an angioplasty catheter, and a radially expandable distal end. Upon completion of an interventional procedure such as angioplasty, the balloon of the angioplasty catheter is deflated and the angioplasty catheter then is advanced along the guidewire until the adapter captures the vascular filter.




Alternatively, upon completion of the interventional procedure, the guidewire and attached vascular filter may be withdrawn proximally until the vascular filter engages and is caused to be collapsed by the adapter. Once the vascular filter is collapsed, the vascular filter is partially withdrawn within the adapter, and the vascular filter, adapter, interventional device and guidewire are all removed from the vessel. This streamlined procedure provides a substantial improvement over previously known systems, which typically require exchanging the interventional device for a retrieval sheath before retrieving the vascular filter from the treatment site.




In another embodiment, the retrieval adapter of the present invention may be loaded directly onto the guidewire having the vascular filter so that the adapter is delivered to a treatment site concurrently with the filter. After completion of a diagnostic or therapeutic procedure involving an interventional device, such as an angioplasty catheter, the interventional device is advanced along the guidewire. As the distal end of the interventional device moves distally, it abuts against the adapter and urges the adapter into contact with the filter, thereby causing the adapter to collapse and capture the vascular filter. Alternatively, as for the previous embodiment, the interventional device may be held stationary and the vascular filter and adapter retracted proximally.




In yet another embodiment, the present invention includes a retrieval catheter having proximal and distal ends. The proximal end of the catheter is loaded onto the distal end of an interventional device, and that assemblage then is loaded onto the guidewire having the vascular filter. After completion of a diagnostic or therapeutic procedure, such as stent deployment, the retrieval catheter is advanced over the working element of the interventional device (e.g., the deflated balloon) and the vascular filter. Alternatively, the retrieval catheter may be held stationary and the vascular filter and guidewire retracted proximally to collapse and capture the filter in the retrieval sheath.











BRIEF DESCRIPTION OF THE DRAWINGS




The above and other objects and advantages of the present invention will be apparent upon consideration of the following detailed description, taken in conjunction with the accompanying drawings, in which like reference characters refer to like parts throughout, and in which:





FIG. 1

is a perspective view of a first previously known vascular filter suitable for use with the apparatus of the present invention;





FIG. 2

is a perspective view of another previously known vascular filter suitable for use with the apparatus of the present invention;





FIG. 3

is a side view of yet another vascular filter suitable for use with the apparatus of the present invention;





FIGS. 4A and 4B

are, respectively, side sectional and side views of apparatus of the present invention;





FIGS. 5A and 5B

are side sectional views illustrating the use of the apparatus of

FIG. 4

to retrieve the vascular filter of

FIG. 3

;





FIG. 6

is a side view of a retrieval catheter constructed in accordance with the principles of the present invention;





FIGS. 7A-7C

are side sectional views depicting a method of retrieving the vascular filter of

FIG. 3

using the retrieval catheter of

FIG. 6

in conjunction with the apparatus of

FIG. 4

;





FIGS. 8A-8B

are side sectional views depicting a method of retrieving the vascular filter of

FIG. 3

using the retrieval catheter of

FIG. 6

alone;





FIG. 9

is a side sectional view of an alternative method of using the apparatus of

FIG. 4

;





FIGS. 10A and 10B

are side sectional views depicting an alternative embodiment of the apparatus of

FIG. 4

;





FIGS. 11A and 11B

are side sectional views depicting another alternative embodiment of the apparatus of

FIG. 4

;





FIG. 12

is a side view of a further alternative embodiment of the apparatus of

FIG. 4

incorporated into the vascular filter of

FIG. 3

;





FIGS. 13A-13C

are side sectional views depicting a method of using apparatus of

FIG. 12

;





FIG. 14

is a side view of yet another alternative embodiment of the apparatus of

FIG. 4

incorporated into the vascular filter of

FIG. 3

; and





FIGS. 15A-15C

are side sectional views depicting a method of using apparatus of FIG.


14


.











DETAILED DESCRIPTION OF THE INVENTION




The present invention is directed to apparatus and methods for closing the mouth of a vascular filter or similar vascular device so as to prevent emboli from escaping during contraction and removal of the vascular filter or device, while reducing the number of equipment exchanges associated with such removal.




A number of vascular filters are known for providing distal protection against embolization in conjunction with a transluminal diagnostic or therapeutic procedure, such as angioplasty. These filters generally are deployed distal to a vascular lesion prior to undertaking a diagnostic or therapeutic procedure, and are designed to filter emboli liberated during the procedure from the patient's blood. A brief description of a number of these filters is provided as context for advantages achievable using the apparatus of the present invention.





FIG. 1

shows vascular filter


10


described in U.S. Pat. No. 6,129,739 to Khosravi et al., which is incorporated herein in its entirety. Vascular filter


10


includes articulated support hoop


11


carrying blood permeable sac


12


. Support hoop


11


is attached to tube


13


at point


14


, and permits guidewire


15


to be rotated independently of support hoop


11


. Blood permeable sac


12


filters emboli and other undesirable material from blood passing through the filter, while permitting blood cells to pass freely therethrough. When an interventional procedure, e.g., angioplasty or stenting, is completed, vascular filter


10


is retrieved by partially withdrawing support hoop


11


into the lumen of the interventional device (e.g., angioplasty catheter), and removing the catheter and vascular filter.





FIG. 2

depicts another type of vascular filter suitable for use with the methods and apparatus of the present invention, and is described in U.S. Pat. No. 6,152,946 to Broome et al., which is incorporated herein by reference. Vascular filter


20


includes a plurality of longitudinally-extending ribs


21


forming frame


22


that supports mouth


23


. Cone-shaped filter


24


is coupled to mouth


23


. Ribs


21


are coupled to collar


25


, which is displaced distally along guidewire


26


to expand and deploy frame


22


and filter


24


. Filter


24


includes holes


27


that permit blood to pass through the filter, while trapping emboli. Vascular filter


20


is collapsed for retrieval by applying a load against ribs


21


that causes collar


25


to slide proximally, thereby closing the vascular filter.




Referring now to

FIG. 3

, another vascular filter suitable for use with the apparatus and methods of the present invention is described. Vascular filter


30


is described in detail in U.S. patent application Ser. No. 09/764,774, filed Jan. 16, 2001 (now abandoned), and is summarily described here.




Vascular filter


30


preferably includes self-expanding support hoop


31


mounted on suspension strut


32


, and supports blood permeable sac


33


. Blood permeable sac


33


comprises a biocompatible polymeric material having a multiplicity of pores. Suspension strut


32


is affixed at proximal end


34


to tube


35


, and positions support hoop


31


approximately concentric to tube


35


when disposed in a substantially straight length of vessel, but advantageously permits the support hoop to become eccentrically displaced relative to support tube


35


when the filter is deployed in a curved vessel.




Distal end


36


of blood permeable sac


33


is illustratively mounted to nose cone


37


, which is in turn mounted to tube


35


. Filter


30


is mounted on guidewire


38


between proximal stop


39


and enlarged floppy tip


40


of the guidewire, which functions as a distal stop. Tube


35


permits guidewire


38


to rotate independently of filter


30


, thereby permitting floppy tip


40


of the guidewire to be directed within the vessel without causing the blood permeable sac to become wrapped around guidewire


38


.




Referring now to

FIGS. 4A and 4B

, apparatus constructed in accordance with the principles of the present invention is described. Apparatus


50


of the present invention, referred to hereinafter as a “retrieval adapter,” permits a conventional interventional device, such as an angioplasty catheter or stent delivery system, to be employed in retrieving a vascular filter of the types shown in

FIGS. 1-3

.




Adapter


50


preferably includes curved distal end


51


having expansion slits


52


, opening


53


, tubular body


54


having internal lumen


55


, and tapered proximal region


56


. Optionally, adapter


50


may include helical coil


57


embedded in wall


58


to reinforce the adapter. Adapter


50


preferably is constructed of a thin biocompatible material, such as polyethylene, polypropylene, polyurethane, polyester, polyethylene terephthalate, nylon, polytetrafluoroethylene, or Pebax®, however, any other suitable biocompatible material or a combination of such materials may be used, if desired.




Adapter


50


preferably is constructed so that it has sufficient stiffness to be urged along guidewire


59


and through curved vasculature within a patient's circulatory system. Tapered proximal region


56


enables adapter


50


to be coupled to a conventional interventional device, such as an angioplasty catheter or stent delivery catheter. Adapter


50


has sufficient stiffness so as to not buckle or kink when being urged into engagement with a previously deployed vascular filter during filter retrieval.




Distal end


51


preferably has a smooth, rounded tip to reduce the risk of adapter


50


from catching a flap of dissected tissue or on a stent deployed within a vessel. Expansion slits


52


permit the curved portions of distal end


51


to expand to accept a vascular filter when adapter


50


is advanced along guidewire


59


, so that opening


53


at least partially accommodates a portion of a deployed vascular filter. Adapter


50


optionally may comprise a radiopaque material, e.g., a barium sulfate-infused (BaSO


4


) polymer or by using metal markers, to permit viewing of the adapter using a fluoroscope. In addition, coil


57


also may comprise a radiopaque material.




Tapered region


56


is configured so that it engages the interior or exterior surface of a conventional interventional device, such as an angioplasty catheter or stent delivery system. Tapered region


56


also aids in disposing adapter


50


concentric with respect to guidewire


59


. In accordance with the principles of the present invention, adapter


50


is delivered at the same time as an interventional device to be used for the diagnostic or therapeutic treatment. Accordingly, adapter


50


provides a significant improvement over previously known filter retrieval systems, by eliminating the need for a separate catheter exchange to retrieve the vascular filter.




Optionally, adapter


50


may be bonded to the distal end of the interventional device using a standard biocompatible adhesive, press fitting, or other suitable means. For example, the internal surface of lumen


55


at tapered proximal end


56


may be coated with a pressure-sensitive adhesive. A clinician may then couple adapter


50


to the distal end of an interventional device and apply pressure to fix the adapter to the device. The adapter then is delivered with the interventional device, and upon completion of the diagnostic or therapeutic procedure, is used to retrieve the vascular filter. Alternatively, adapter


50


may be provided in a kit including a vascular filter mounted on a guidewire (not shown).




Referring now to

FIGS. 5A and 5B

, a method of employing the adapter of

FIG. 4

to recover a vascular filter is described. In

FIG. 5A

, vascular filter


30


of

FIG. 3

is shown deployed along guidewire


38


. After insertion of guidewire


38


and deployment of vascular filter


30


, adapter


50


is mounted to the distal end of an interventional device


60


, illustratively and angioplasty catheter


60


. Adapter


50


and angioplasty catheter


60


then are advanced along guidewire


38


to a location just proximal of, or in contact with, the vascular filter, where angioplasty catheter


60


is used to treat vascular disease. Inflation of the balloon of angioplasty catheter


60


causes emboli E to be liberated from the lesion, and be carried by the blood flow into filter


30


.




With respect to

FIG. 5B

, after the interventional procedure is completed, the balloon of angioplasty catheter


60


is deflated and catheter


60


is advanced distally along guidewire


38


to bring adapter


50


into contact with filter


30


. Filter


30


preferably is received within distal end


51


of adapter


50


when the adapter is advanced further in the distal direction. Alternatively, adapter


50


may receive at least a portion of filter


30


by retracting guidewire


38


proximally while holding angioplasty catheter


60


and adapter


50


stationary.




The degree to which vascular filter


30


is enclosed within adapter


50


may be varied depending on treatment requirements. This may be accomplished by altering the size of adapter


50


or by controlling the movement of catheter


60


along guidewire


38


. For example, in some cases it may be sufficient to enclose the mouth of filter


30


within adapter


50


to facilitate retrieval. In such a situation, adapter


50


may be constructed so that it is somewhat smaller than the length of filter


30


, so only the mouth of the device fits into the adapter. In other situations, however, it may be desired to enclose some or all of filter


30


within adapter


50


, and in such a case adapter


50


may be constructed so that it is somewhat larger than the length of vascular filter


30


.




Referring now to

FIG. 6

, a retrieval catheter


70


constructed in accordance with the principles of the present invention is described. Catheter


70


preferably includes tubular body


71


, support wire


72


, radiopaque marker


73


and opening


74


. Body


71


and internal lumen


74


preferably are constructed to a have a diameter sufficient to accommodate an angioplasty catheter and a vascular filter such as described hereinabove with respect to

FIGS. 1-3

.




Body


71


preferably is fabricated from a thin biocompatible material, such as polyethylene, polypropylene, polyurethane, polyester, polyethylene terephthalate, nylon, polytetrafluoroethylene, polyimid, or Pebax®. Body


71


also is sufficiently stiff to be advanced along a guidewire through curved vasculature, and to retrieve a vascular filter, without buckling or kinking. Retrieval catheter


70


may be made radiopaque by using metal marker


73


or by constructing it of a radiopaque material such as a barium sulfate-infused (BaSO


4


) polymer.




Retrieval catheter


70


may be mounted over a conventional interventional devices, such as an angioplasty catheter or stent delivery system, prior to inserting the interventional device into the patient's vasculature. For example, to mount retrieval catheter


70


on an angioplasty catheter, the distal end of the angioplasty catheter is inserted through distal end


75


of body


71


, and the body then is retracted proximally on the angioplasty catheter until body


71


is disposed proximally of the balloon of the angioplasty catheter, as shown in FIG.


7


A. Such backloading of the retrieval catheter is required because the inflation port of a typical angioplasty catheter precludes mounting retrieval catheter


70


from the proximal end of the angioplasty catheter.




A first mode of using retrieval catheter


70


is now described with respect to

FIGS. 7A-7C

. In

FIG. 7A

, an initial step of a treatment procedure is depicted, wherein vascular filter


30


is disposed at a distal end of guidewire


38


, just distal of adapter


50


, interventional device


60


, and retrieval catheter


70


. Adapter


50


and retrieval catheter


70


are mounted to interventional device


60


prior to insertion along guidewire


38


. After completion of the interventional procedure, the balloon of interventional device


60


is deflated, and the interventional device is urged in the distal direction to cause adapter


50


to contact with filter


30


.




As shown in

FIG. 7B

, filter


30


may be received within the distal end


51


of adapter


50


when it is advanced further in the distal direction. In particular, adapter


50


is advanced by moving interventional device


60


along guidewire


38


so that it at least partially surrounds filter


30


. Alternatively, adapter


50


may receive at least a portion of filter


30


by retracting guidewire


38


in the proximal direction while holding interventional device


60


stationary.




Next, as shown in

FIG. 7C

, retrieval catheter


70


is advanced distally so that filter


30


and adapter


50


are received within lumen


74


of retrieval catheter


70


. In this manner it is possible to reduce the risk that the filter or adapter catches on other material, e.g., a stent, deployed within the patient's vessel during removal.





FIGS. 8A and 8B

depict an alternative mode of using retrieval catheter


70


to retrieve a vascular filter without using adapter


50


. In

FIG. 8A

, an initial step of a treatment procedure is depicted, wherein vascular filter


30


is disposed at a distal end of guidewire


38


followed by the balloon of an interventional device


60


and previously mounted retrieval catheter


70


. After completing an interventional procedure, the balloon of interventional device


60


is deflated and advanced toward filter


30


.




As shown in

FIG. 8B

, retrieval catheter


70


is then advanced distally so that the distal end of interventional device


60


and filter


30


are received in lumen


74


of the retrieval catheter. In this manner, the risk that emboli will escape from filter


30


is reduced. In addition, because body


71


of retrieval catheter


70


completely encloses filter


30


, the risk that a portion of the filter sac could become entangled with a stent strut is also diminished. Alternatively, retrieval catheter


70


may be held stationary, and filter


30


retracted in the proximal direction into lumen


74


.




In

FIG. 9

, an alternative embodiment of a retrieval adapter constructed in accordance with the principles of the present invention is described. Adapter


80


is substantially similar to retrieval adapter


50


of

FIG. 4

, except that tapered proximal end


81


is configured to abut against the distal end of interventional device


60


, rather than to couple together as shown in FIG.


5


A.





FIGS. 10A and 10B

depict another alternative embodiment of the apparatus of the present invention. Adapter


90


is substantially similar to adapter


50


of

FIG. 4

, except that distal end


91


is not curved as in

FIG. 4A

, but instead includes a circular opening having a smooth, rounded edge. Lumen


92


preferably is of sufficient size to accommodate at least a portion of a deployed filter, thereby forming a close fit around at least a portion of the mouth of the filter.





FIGS. 11A and 11B

depict yet another alternative embodiment of the apparatus of the present invention. Adapter


100


is substantially similar to adapter


50


of

FIG. 4

, except that distal end


101


is not curved as in

FIG. 4A

, but instead includes an oblique opening


102


into lumen


103


. Opening


102


preferably includes a smooth, rounded edge. As for the previously-described embodiments, lumen


103


preferably is of sufficient size to accommodate at least a portion of a deployed filter, and thus form a close fit around at least a portion of the mouth of the filter.




Each of adapters


50


,


80


,


90


and


100


may be coupled to (or disposed adjacent to) the distal end of an interventional catheter so that the adapter is delivered to a treatment site at the same time as the working element (i.e., balloon or stent) of the interventional device. Such concurrent delivery eliminates the steps of removing the interventional device from the patient's vessel and inserting a separate retrieval sheath to the treatment site along the guidewire.




Referring now to

FIG. 12

, a further alternative embodiment of the apparatus of the present invention is described. In this embodiment, retrieval adapter


110


is similar in construction to retrieval adapter


50


of

FIG. 4

, except that adapter


110


is pre-mounted on suspension strut


32


of vascular filter


30


. In particular, adapter


110


includes lumen


112


and tapered proximal region


114


.




In operation, an interventional device may be advanced along guidewire


38


until it abuts proximal end


114


of adapter


110


, pushing the adapter distally along suspension strut


32


towards support hoop


31


of filter


30


, until support hoop


31


is received within lumen


112


. The extent to which adapter


110


receives support hoop


31


may of course be determined by the length of adapter


110


. Alternatively, adapter


110


may collapse and retrieve vascular filter


30


by retracting guidewire


38


such that filter


30


is retracted proximally towards the adapter while holding the interventional device stationary.





FIGS. 13A-13C

depict one method of using the apparatus of FIG.


12


. In

FIG. 13A

, during an initial step of an interventional procedure, filter


30


with pre-mounted retrieval adapter


110


is deployed in a vessel (not shown). A conventional interventional device


60


, illustratively an angioplasty catheter, is then advanced along guidewire


38


until distal end


61


of the interventional device is disposed just proximal of, or in contact with, the proximal end of the adapter. Preferably, the adapter is positioned sufficiently far from the proximal end of the vascular filter that small longitudinal movements of interventional device


60


attendant upon use of that device do not cause distal end


61


to impinge against tapered proximal region


114


of adapter


110


. It will of course be recognized that in some applications, e.g., where the vessel is short, some contact between the adapter and vascular filter can be accommodated.




Interventional device


60


then is used to perform the desired diagnostic or therapeutic treatment, during which emboli E may become dislodged from the vessel wall. Those emboli travel with antegrade blood flow and are captured in blood permeable sac


33


of filter


30


. After completion of this procedure, the balloon of the interventional device is deflated and the interventional device is advanced along guidewire


38


in the distal direction to bring distal end


61


of the interventional device into abutment with tapered proximal region


114


of adapter


110


, as shown in FIG.


13


B.




With respect to

FIG. 13C

, continued advancement of interventional device


60


in the distal direction causes support hoop


31


of filter


30


to at least partially enter lumen


112


of adapter


110


, thereby causing the support hoop to close and closing the mouth of filter sac


33


. Alternatively, adapter


110


may be caused to at least partially surround support hoop


31


by retracting guidewire


38


proximally while holding interventional device


60


stationary.




The degree to which vascular filter


30


is captured in adapter


110


depends on the length of lumen


112


within adapter


110


and also is limited by the length of the support hoop when folded over guidewire


38


. Specifically, vascular filter


30


may be received within lumen


112


of adapter


110


until the point on support hoop


31


opposite to the connection to suspension strut


32


is urged against guidewire


38


.




Because closing the vascular filter may prevent the vascular device from being re-deployed, it may be desirable to prevent the inadvertent closing of vascular filter


30


. Such inadvertent closing may be prevented by using a safety system deployed along guidewire


38


, as shown in the embodiment of FIG.


14


.




In

FIG. 14

, vascular filter


30


is disposed on guidewire


38


and includes adapter


110


disposed on suspension strut


32


in the same manner as depicted in FIG.


12


. In accordance with this aspect of the present invention, guidewire


38


includes safety system


120


comprising screw


122


, nut


124


and stop


126


. Preferably, these components are constructed of a high strength plastic or metal alloy, such as stainless steel.




Safety system


120


is intended to prevent an interventional device, such as a balloon catheter or stent delivery system, from accidentally closing vascular filter


30


. Screw


122


and stop


126


preferably are fixed on guidewire


38


, while nut


124


is configured to move freely along guidewire


38


between screw


122


and stop


126


. Stop


126


restricts movement of nut


124


in the proximal direction, while screw


122


selectively restricts movement of nut


124


in the distal direction.




Nut


124


may be advanced past screw


122


by rotating guidewire


38


such that the threads of the screw mesh with the threads of the nut, thus advancing the nut over and past the screw until the nut is disposed distally of the screw, i.e., between filter


30


and screw


122


. When nut


124


is disposed between screw


122


and stop


126


, it prevents the interventional device from advancing distally toward adapter


110


until guidewire


38


is intentionally rotated. Once the intended diagnostic or therapeutic procedure is completed, however, nut


124


is moved to a position between filter


30


and screw


122


by rotating guidewire


38


, and then the interventional device may be advanced distally over stop


126


and screw


122


to urge nut


124


into engagement with adapter


110


, thereby closing filter


30


.





FIGS. 15A-15C

depict a method of using the apparatus of FIG.


14


. In

FIG. 15A

, during an initial step of an interventional procedure, filter


30


is deployed in a vessel (not shown) and includes adapter


110


disposed on suspension strut


32


, and safety system


120


disposed on guidewire


38


. A conventional interventional device


60


, illustratively an angioplasty catheter, is advanced along guidewire


38


and then used to effect a desired diagnostic or therapeutic treatment, during which emboli E may become dislodged from the vessel wall. Those emboli travel with antegrade blood flow and are captured in blood permeable sac


33


of filter


30


.




After completion of this procedure, the balloon of the interventional device is deflated and the interventional device is advanced along guidewire


38


in the distal direction and over stop


126


until distal end


61


of the interventional device contacts nut


124


. The distal end of interventional device


61


may push nut


124


until it is in direct contact with screw


122


.




Next, as shown in

FIG. 15B

, nut


124


is advanced over and past screw


122


by rotating guidewire


38


so that the threads of nut


124


mesh with and advance over the threads of screw


122


. Interventional device


60


is then advanced distally over screw


122


to urge nut


124


into contact with the proximal end of adapter


110


. As shown in

FIG. 15C

, further advancement of interventional device


60


in the distal direction causes nut


124


to urge adapter


110


distally, whereby support hoop


31


is received at least partially within lumen


112


of the adapter. In this manner filter


30


may be collapsed for retrieval with little effort and without an additional equipment exchange or additional retrieval sheath. As for the previous embodiments, adapter


110


alternatively may be caused to at least partially surround support hoop


31


by retracting guidewire


38


proximally while holding interventional device


60


stationary.




Although the present invention is illustratively described in the context of interventional devices such as angioplasty catheters and stent delivery systems, the apparatus of the present invention advantageously may be employed with atherectomy catheters, embolectomy catheters, vascular mapping catheters or any other suitable diagnostic or therapeutic interventional device, if desired.




Although preferred illustrative embodiments of the present invention are described above, it will be evident to one skilled in the art that various changes and modifications may be made without departing from the invention. It is intended in the appended claims to cover all such changes and modifications that fall within the true spirit and scope of the invention.



Claims
  • 1. Apparatus for use in conjunction with an interventional device in retrieving a vascular filter disposed on a guidewire from a vessel, the apparatus comprising:a retrieval adapter having a proximal end, a distal end and a lumen, the retrieval adapter configured to be disposed on a distal region of the guidewire so that the proximal end engages a distal end of the interventional device, the retrieval adapter configured to receive at least a portion of the vascular filter within the lumen during retrieval of the vascular filter from the vessel.
  • 2. The apparatus of claim 1 wherein the retrieval adapter comprises a biocompatible material.
  • 3. The apparatus of claim 1 wherein the retrieval adapter comprises a radiopaque material.
  • 4. The apparatus of claim 3 wherein the radiopaque material comprises a radiopaque coil embedded in the retrieval adapter.
  • 5. The apparatus of claim 1 wherein the proximal end of the retrieval adapter is tapered to facilitate engagement with a distal end of the interventional device.
  • 6. The apparatus of claim 5 wherein the retrieval adapter is mounted on the distal end of the interventional device.
  • 7. The apparatus of claim 5 wherein the proximal end of the retrieval adapter abuts against the distal end of the interventional device.
  • 8. The apparatus of claim 1 wherein the distal end of the retrieval adapter includes at least one slit.
  • 9. The apparatus of claim 1 wherein the distal end of the retrieval adapter is perforated.
  • 10. The apparatus of claim 1 wherein the retrieval adapter has a length less than about 50 mm.
  • 11. A system for retrieving a vascular filter comprising:a guidewire having a distal end; a vascular filter disposed on the guidewire adjacent the distal end of the guidewire; an interventional device having a distal end and a lumen extending therethrough the interventional device disposed on the guidewire proximally of the vascular filter; and a retrieval adapter slidingly disposed on the guidewire and interposed between the vascular filter and the distal end of the interventional device.
  • 12. The system of claim 11 wherein the retrieval adapter includes a lumen adapted to receive at least a portion of the vascular filter.
  • 13. The system of claim 11 wherein the retrieval adapter comprises a biocompatible material.
  • 14. The system of claim 11 wherein the retrieval adapter comprises a radiopaque material.
  • 15. The system of claim 14 wherein the radiopaque material comprises a radiopaque coil embedded in the retrieval adapter.
  • 16. The system of claim 11 wherein the retrieval adapter further comprises a proximal region tapered to facilitate engagement with the distal end of the interventional device.
  • 17. The system of claim 16 wherein the retrieval adapter is configured to be mounted on the distal end of the interventional device.
  • 18. The system of claim 11 wherein a distal end of the retrieval adapter includes at least one slit.
  • 19. The system of claim 11 wherein a distal end of the retrieval adapter is perforated.
  • 20. The system of claim 11 wherein the retrieval adapter has a length of less than about 50 mm.
  • 21. A system for retrieving a vascular filter comprising:a guidewire having a distal end; a vascular filter disposed on the guidewire adjacent the distal end of the guidewire, the vascular filter comprising a suspension strut coupled to the guidewire, a support hoop coupled to the suspension strut, and a blood permeable sac coupled to the support hoop; an interventional device having a distal end and a lumen extending therethrough the interventional device disposed on the guidewire proximally of the vascular filter; and a retrieval adapter slidingly disposed on the suspension strut.
  • 22. The system of claim 21 wherein the retrieval adapter includes a lumen adapted to receive at least a portion of the vascular filter.
  • 23. The system of claim 21 wherein the retrieval adapter comprises a biocompatible material.
  • 24. The system of claim 21 wherein the retrieval adapter comprises a radiopaque material.
  • 25. The system of claim 21 wherein a distal end of the retrieval adapter is radially expandable.
  • 26. The system of claim 21 further comprising a safety device that inhibits inadvertent closing of the vascular filter.
  • 27. A method of retrieving a vascular filter comprising:providing a guidewire, a vascular filter, an interventional device and a retrieval adapter; deploying the vascular filter on the guidewire distal to a treatment site; disposing a retrieval adapter on the guidewire in engagement with a distal end of the interventional device; advancing the retrieval adapter and interventional device along the guidewire to the treatment site; performing a diagnostic or therapeutic procedure at the treatment site using the interventional device; and upon completion of the diagnostic or therapeutic procedure, advancing the interventional device distally along the guidewire so that the retrieval adapter captures the vascular filter.
  • 28. The method of claim 27 wherein advancing the interventional device distally along the guidewire cause the vascular filter to be received at least partially within a lumen of the retrieval adapter.
  • 29. A method of retrieving a vascular filter comprising:providing a guidewire, a vascular filter including a retrieval adapter and an interventional device; deploying the vascular filter and retrieval adapter on the guidewire distal to a treatment site; advancing the interventional device along the guidewire to the treatment site; performing a diagnostic or therapeutic procedure at the treatment site using the interventional device; upon completion of the diagnostic or therapeutic procedure, advancing the interventional device distal along the guidewire so that the interventional device abuts against the retrieval adapter; and advancing the interventional device further distally along the guidewire so that the interventional device causes the retrieval adapter to capture the vascular filter.
  • 30. The method of claim 29 wherein advancing the interventional device distally along the guidewire cause the vascular filter to be receive at least partially within a lumen of the retrieval adapter.
US Referenced Citations (193)
Number Name Date Kind
3472230 Fogarty Oct 1969 A
3592186 Oster Jul 1971 A
3889657 Baumgarten Jun 1975 A
3952747 Kimmell, Jr. Apr 1976 A
3996938 Clark, III Dec 1976 A
4046150 Schwartz et al. Sep 1977 A
4425908 Simon Jan 1984 A
4447227 Kotsanis May 1984 A
4580568 Gianturco Apr 1986 A
4590938 Segura et al. May 1986 A
4619246 Molgaard-Nielsen et al. Oct 1986 A
4631052 Kensey Dec 1986 A
4643184 Mobin-Uddin Feb 1987 A
4650466 Luther Mar 1987 A
4662885 DiPisa, Jr. May 1987 A
4705517 DiPisa, Jr. Nov 1987 A
4706671 Weinrib Nov 1987 A
4723549 Wholey et al. Feb 1988 A
4728319 Masch Mar 1988 A
4733665 Palmaz Mar 1988 A
4790812 Hawkins, Jr. et al. Dec 1988 A
4790813 Kensey Dec 1988 A
4794928 Kletschka Jan 1989 A
4794931 Yock Jan 1989 A
4800882 Gianturco Jan 1989 A
4807626 McGirr Feb 1989 A
4842579 Shiber Jun 1989 A
4842579 Shiber Jun 1989 A
4857045 Rydell Aug 1989 A
4857046 Stevens et al. Aug 1989 A
4867157 McGurk-Burleson et al. Sep 1989 A
4873978 Ginsburg Oct 1989 A
4898575 Fischell et al. Feb 1990 A
4907336 Gianturco Mar 1990 A
4921478 Solano et al. May 1990 A
4921484 Hillstead May 1990 A
4926858 Gifford, III et al. May 1990 A
4950277 Farr Aug 1990 A
4955895 Sugiyama et al. Sep 1990 A
4957482 Shiber Sep 1990 A
4969891 Gewertz Nov 1990 A
4979951 Simpson Dec 1990 A
4986807 Farr Jan 1991 A
4998539 Delsanti Mar 1991 A
5002560 Machold et al. Mar 1991 A
RE33569 Gifford, III et al. Apr 1991 E
5007896 Shiber Apr 1991 A
5007917 Evans Apr 1991 A
5011488 Ginsburg Apr 1991 A
5019088 Farr May 1991 A
5041126 Gianturco Aug 1991 A
5053008 Bajaj Oct 1991 A
5053044 Mueller et al. Oct 1991 A
5071407 Termin et al. Dec 1991 A
5071425 Gifford, III et al. Dec 1991 A
5085662 Willard Feb 1992 A
5087265 Summers Feb 1992 A
5100423 Fearnot Mar 1992 A
5100424 Jang et al. Mar 1992 A
5100425 Fischell et al. Mar 1992 A
5102415 Guenther et al. Apr 1992 A
5104399 Lazarus Apr 1992 A
5108419 Reger et al. Apr 1992 A
5133733 Rasmussen et al. Jul 1992 A
5135531 Shiber Aug 1992 A
5152771 Sabbaghian et al. Oct 1992 A
5152777 Goldberg et al. Oct 1992 A
5160342 Reger et al. Nov 1992 A
5171233 Amplatz et al. Dec 1992 A
5190546 Jervis Mar 1993 A
5195955 Don Michael Mar 1993 A
5224953 Morgentaler Jul 1993 A
5306286 Stack et al. Apr 1994 A
5314444 Gianturco May 1994 A
5314472 Fontaine May 1994 A
5318576 Plassche, Jr. et al. Jun 1994 A
5329942 Gunther et al. Jul 1994 A
5330484 Gunther et al. Jul 1994 A
5330500 Song Jul 1994 A
5350398 Pavcnik et al. Sep 1994 A
5354310 Garnic et al. Oct 1994 A
5356423 Tihon et al. Oct 1994 A
5366464 Belknap Nov 1994 A
5366473 Winston et al. Nov 1994 A
5370657 Irie Dec 1994 A
5370683 Fontaine Dec 1994 A
5376100 Lefebvre Dec 1994 A
5383887 Nadal Jan 1995 A
5383892 Cardon et al. Jan 1995 A
5383926 Lock et al. Jan 1995 A
5387235 Chuter Feb 1995 A
5395349 Quiachon et al. Mar 1995 A
5397345 Lazerus Mar 1995 A
5405377 Cragg Apr 1995 A
5409454 Fischell et al. Apr 1995 A
5415630 Gory et al. May 1995 A
5419774 Willard et al. May 1995 A
5421832 Lefebvre Jun 1995 A
5423742 Theron Jun 1995 A
5423885 Williams Jun 1995 A
5425765 Tiefenbrun et al. Jun 1995 A
5443498 Fontaine Aug 1995 A
5449372 Schmaltz et al. Sep 1995 A
5456667 Ham et al. Oct 1995 A
5462529 Simpson et al. Oct 1995 A
5476104 Sheahon Dec 1995 A
5484418 Quiachon et al. Jan 1996 A
5507767 Maeda et al. Apr 1996 A
5512044 Duer Apr 1996 A
5527354 Fontaine et al. Jun 1996 A
5536242 Willard et al. Jul 1996 A
5540707 Ressemann et al. Jul 1996 A
5549626 Miller et al. Aug 1996 A
5562724 Vorwerk et al. Oct 1996 A
5569274 Rapacki et al. Oct 1996 A
5569275 Kotula et al. Oct 1996 A
5634897 Dance et al. Jun 1997 A
5658296 Bates et al. Aug 1997 A
5662671 Barbut et al. Sep 1997 A
5669933 Simon et al. Sep 1997 A
5695519 Summers et al. Dec 1997 A
5709704 Nott et al. Jan 1998 A
5720764 Naderlinger Feb 1998 A
5728066 Daneshvar Mar 1998 A
5746758 Nordgren et al. May 1998 A
5749848 Jang et al. May 1998 A
5769816 Barbut et al. Jun 1998 A
5779716 Cano et al. Jul 1998 A
5792300 Inderbitzen et al. Aug 1998 A
5795322 Boudewijn Aug 1998 A
5797952 Klein Aug 1998 A
5800457 Gelbfish Sep 1998 A
5800525 Bachinski et al. Sep 1998 A
5810874 Lefebvre Sep 1998 A
5814064 Daniel et al. Sep 1998 A
5817102 Johnson et al. Oct 1998 A
5827324 Cassell et al. Oct 1998 A
5833644 Zadno-Azizi et al. Nov 1998 A
5833650 Imran Nov 1998 A
5846260 Maahs Dec 1998 A
5848964 Samuels Dec 1998 A
5876367 Kaganov et al. Mar 1999 A
5893867 Bagaoisan et al. Apr 1999 A
5895399 Barbut et al. Apr 1999 A
5902263 Patterson et al. May 1999 A
5906618 Larson, III May 1999 A
5908435 Samuels Jun 1999 A
5910154 Tsugita et al. Jun 1999 A
5911734 Tsugita et al. Jun 1999 A
5916193 Stevens et al. Jun 1999 A
5925016 Chornenky et al. Jul 1999 A
5925060 Forber Jul 1999 A
5925062 Purdy Jul 1999 A
5925063 Khosravi Jul 1999 A
5928203 Davey et al. Jul 1999 A
5928218 Gelbfish Jul 1999 A
5934284 Plaia et al. Aug 1999 A
5935139 Bates Aug 1999 A
5938645 Gordon Aug 1999 A
5941869 Patterson et al. Aug 1999 A
5941896 Kerr Aug 1999 A
5947995 Samuels Sep 1999 A
5951585 Cathcart et al. Sep 1999 A
5954745 Gertler et al. Sep 1999 A
5976172 Homsma et al. Nov 1999 A
5989210 Morris et al. Nov 1999 A
5989271 Bonnette et al. Nov 1999 A
5989281 Barbut et al. Nov 1999 A
5993469 McKenzie et al. Nov 1999 A
5997557 Barbut et al. Dec 1999 A
6001118 Daniel et al. Dec 1999 A
6007557 Ambrisco et al. Dec 1999 A
6010522 Barbut et al. Jan 2000 A
6013085 Howard Jan 2000 A
6027520 Tsugita et al. Feb 2000 A
6051014 Jang Apr 2000 A
6053932 Daniel et al. Apr 2000 A
6059814 Ladd May 2000 A
6068645 Tu May 2000 A
6086605 Barbut et al. Jul 2000 A
6129739 Khosravi Oct 2000 A
6142987 Tsugita Nov 2000 A
6152946 Broome et al. Nov 2000 A
6165200 Tsugita et al. Dec 2000 A
6168579 Tsugita Jan 2001 B1
6171327 Daniel et al. Jan 2001 B1
6179851 Barbut et al. Jan 2001 B1
6179859 Bates et al. Jan 2001 B1
6179861 Khosravi et al. Jan 2001 B1
6203561 Ramee et al. Mar 2001 B1
6214026 Lepak et al. Apr 2001 B1
6217600 DiMatteo Apr 2001 B1
20020042626 Hanson et al. Apr 2002 A1
Foreign Referenced Citations (73)
Number Date Country
28 21 048 Jul 1980 DE
34 17 738 Nov 1985 DE
40 30 998 Oct 1990 DE
0 200 688 Nov 1986 EP
0 293 605 Dec 1988 EP
0 411 118 Feb 1991 EP
0 427 429 May 1991 EP
0 437 121 Jul 1991 EP
0 472 334 Feb 1992 EP
0 472 368 Feb 1992 EP
0 533 511 Mar 1993 EP
0 655 228 Nov 1994 EP
0 686 379 Jun 1995 EP
0 696 447 Feb 1996 EP
0 737 450 Oct 1996 EP
0 743 046 Nov 1996 EP
0 759 287 Feb 1997 EP
0 771 549 May 1997 EP
0 784 988 Jul 1997 EP
0 852 132 Jul 1998 EP
1 179 321 Feb 2002 EP
2 580 504 Oct 1986 FR
2 643 250 Aug 1990 FR
2 666 980 Mar 1992 FR
2 768 326 Mar 1999 FR
2 020 557 Jan 1983 GB
8-187294 Jul 1996 JP
764684 Sep 1980 SU
WO 0049970 WO
WO 9203097 Mar 1992 WO
WO 9414389 Jul 1994 WO
WO 9424946 Nov 1994 WO
WO 9601591 Jan 1996 WO
WO 9610375 Apr 1996 WO
WO 9619941 Jul 1996 WO
WO 9623441 Aug 1996 WO
WO 9633677 Oct 1996 WO
WO 9717100 May 1997 WO
WO 9727808 Aug 1997 WO
WO 9742879 Nov 1997 WO
WO 9802084 Jan 1998 WO
WO 9802112 Jan 1998 WO
WO 9823322 Jun 1998 WO
WO 9833443 Aug 1998 WO
WO 9834673 Aug 1998 WO
WO 9836786 Aug 1998 WO
WO 9838920 Sep 1998 WO
WO 9838929 Sep 1998 WO
WO 9839046 Sep 1998 WO
WO 9839053 Sep 1998 WO
WO 9846297 Oct 1998 WO
WO 9847447 Oct 1998 WO
WO 9849952 Nov 1998 WO
WO 9850103 Nov 1998 WO
WO 9851237 Nov 1998 WO
WO 9855175 Dec 1998 WO
WO 9909895 Mar 1999 WO
WO 9922673 May 1999 WO
WO 9923976 May 1999 WO
WO 9925252 May 1999 WO
WO 9930766 Jun 1999 WO
0934729 Aug 1999 WO
WO 9940964 Aug 1999 WO
WO 9942059 Aug 1999 WO
WO 9944510 Sep 1999 WO
WO 9944542 Sep 1999 WO
WO 9955236 Nov 1999 WO
WO 9958068 Nov 1999 WO
WO 0007655 Feb 2000 WO
WO 0009054 Feb 2000 WO
WO 0016705 Mar 2000 WO
WO 0016845 Mar 2000 WO
WO 0112082 Feb 2001 WO
Non-Patent Literature Citations (22)
Entry
US 3,686,904, 8/1972, Forster (withdrawn)
“Atherosclerotic Disease of the Aortic Arch as a Risk Factor of Recurrent Ischemic Stroke,” The New England Journal of Medicine, pp. 1216-1221 (May 1996).
“Endovascular Grafts, Stents Drive Interventional Radiology Growth,” Cardiovascular Device Update, 2(3):1-12 (Mar. 1996).
“Protruding Atheromas in the Thoracic Aortic and Systemic Embolization ,” pp. 423-427 American College of Physicians (1991).
“Recognition and Embolic Potential of Intraaortic Atherosclerotic Debris,” American College of Cardiology (Jan. 1991).
Cragg, Andrew et al., “A New Percutaneous Vena Cava Filger,” AJR, 141:601-604 (Sep. 1983).
Cragg, Andrew et al., “Nonsurgical Placement of Arterial Endoprosthesis: A New Technique Using Nitinol Wire,” AJR, pp. 261-263 (Apr. 1983).
Diethrich et al., “Percutaneous Techniques for Endoluminal Carotid Interventions,” J. Endovasc. Surg., 3:182-202 (1996).
Fadali, A. Moneim, “A filtering device for the prevention of particulate embolization during the course of cardiac surgery,” Surgey, 64(3):634-639 (Sep. 1968).
Haissaguerre et al., “Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary Veins,” The New England Journal of Medicine, 339(10):659-666 (Sep. 1988).
Jordan, Jr. et al., “Microemboli Detected by Transcranial Doppler Monitoiring . . . , ” Cardiovascular Surgery, 7(1)33-38 (Jan. 1999).
Lesh, “Can Catheter Ablation Cure Atrial Fibrillation?” ACC Current Journal Review, pp. 38-40 (Sep./Oct. 1997).
Lund et al., “Long-Term Patentcy of Ductus Arteriosus After Ballon Dilation: an Experimental Study,” Laboratory Investigation, 69(4):772-774 (Apr. 1984).
Marache et al., “Percutaneous Transluminal Venous Angioplasty . . .,” American Heart Journal, 125(2 Pt 1):362-366 (Feb. 1993).
Mazur et al., “Directional Atherectomy with the Ominicath™: A Unique New Catheter System,” Catheterization and Cardiovascular Diagnosis, 31:17-84 (1994).
Moussa, MD, Issaam “Stents Don't Require Systemic Anticoagulation . . . But the Technique (and Results) Must be Optimal,” Journal of Invasive Cardiol., 8(E):3E-7E, (1996).
Nakanishi et al., “Catheter Intervention to Venous System Using Expandable Metallic Stents,” Rinsho Kyobu Geka, 14(2):English Abstract Only (Apr. 1994).
Onal et al., “Primary Stenting for Complex Atherosclerotic Plaques in Aortic and Iliac Stenoses,” Cardiovascular & Interventional Radiology, 21(5):386-392 (1998).
Theron et al., “New Triple Coaxial Catheter System for Carotid Angioplasty with Cerebral Protection,” American Journal of Neuroradiology, 11:869-874 (1990).
Tunick et al., “Protruding atherosclerotic plaque in the aortic archo f patients with systemic embolization: A new finding seen by transesophageal echocardiography,” American Heart Journal 120(3):658-660 (Sep. 1990).
Waksman et al., “Distal Embolization is Common After Directional Atherectomy . . .,” American Heart Journal, 129(3):430-435 (1995).
Wholey, Mark H. et al., PTA and Stents in the Treatment of Extracranial Circulation, The Journal of Invasive Cardiology, 8(E):25E-30E (1996).