Patent Publication Number: US-2021169510-A1

Title: Embolic protection devices, systems, and methods

Description:
BACKGROUND 
     Atherosclerosis is characterized by one or more intravascular lesions formed, in part, of plaque including blood-borne substances such as fat, cholesterol, or calcium. An intravascular lesion such as an arterial lesion can form on a wall of an arterial lumen and build out across the lumen to an opposite arterial wall. A last point of patency often occurs between the arterial lesion and the opposite arterial wall. 
     Peripheral artery disease is characterized by one or more peripheral arteries such as one or more arteries of the arms or the legs being narrowed or blocked by arterial lesions. The narrowed or blocked arteries can result in ischemia or a loss of blood flow to such peripheral arteries, complications from which can include bacterial infection, infarction or tissue necrosis, or both. If not timely addressed, such complications can require limb amputation. 
     Accepted surgical intervention for peripheral artery disease includes balloon angioplasty and stenting with balloon-expandable stents, self-expanding stents, or stent grafts to restore patency and blood flow impeded by arterial lesions. More recently, atherectomy has been shown to be an effective alternative surgical intervention to restore patency and blood flow with less vessel trauma. However, embolization of emboli such as calcifications, tissue, or other debris resulting from crossing or ablating the arterial lesions remains a concern in each of the foregoing surgical interventions. Provided herein, in some embodiments, are embolic protection devices, as well as systems and methods thereof that address at least the foregoing. 
     SUMMARY 
     Provided herein is a catheter assembly including, in some embodiments, a catheter body with a catheter-body lumen and an embolic protection device. The catheter body is sized for endoluminal advancement of a distal end portion of the catheter assembly from a puncture site at a human artery selected from a dorsalis pedis artery, a fibular artery, an anterior tibial artery, and a posterior tibial artery toward one or more larger arteries. The catheter assembly has an insertion profile when the embolic protection device is in a collapsed state, and a deployment profile when the embolic protection device is in a deployed state. The embolic protection device assumes the collapsed state while stowed in the catheter-body lumen at the distal end portion of the catheter assembly. The embolic protection device assumes the deployed state while outside the catheter-body lumen. The deployed state of the embolic protection device is configured with an opening away from the catheter body for capturing emboli dislodged from an arterial lesion while at a distal end of the arterial lesion. 
     In some embodiments, the catheter body is sized at about 3 Fr (1 mm) or less. 
     In some embodiments, the embolic protection device includes a mesh or a porous membrane. 
     In some embodiments, the embolic protection device includes non-porous membrane. 
     In some embodiments, the catheter assembly further includes a control mechanism configured to deploy the embolic protection device. The control mechanism includes a control selected from a slide button and a scroll wheel at a proximal end portion of the catheter assembly. The control mechanism connects to the embolic protection device by one or more wires configured to deploy the embolic protection device upon advancing the control to a deployment position, thereby putting the catheter assembly in the deployment profile with the embolic protection device thereof in the deployed state. 
     In some embodiments, the catheter assembly is configured for endoluminal advancement of the distal end portion of the catheter assembly over a guidewire. 
     In some embodiments, the catheter body includes a diameter commensurate with an average diameter of a human dorsalis pedis artery, the diameter obviating endoluminal advancement of the distal end portion of the catheter assembly over a guidewire. 
     In some embodiments, the distal end portion of the catheter assembly includes one or more radiopaque markings for endoluminal advancement of the catheter assembly using fluoroscopic imaging. 
     In some embodiments, at least the distal end portion of the catheter assembly is echogenic for endoluminal advancement of the catheter assembly using ultrasound. 
     In some embodiments, the catheter body further includes one or more additional lumens, each lumen of the one or more additional lumens independently configured for flushing an arterial lumen around a distal end of the arterial lesion, aspirating emboli dislodged from the arterial lesion, or both flushing and aspirating in accordance with the foregoing. 
     In some embodiments, the catheter assembly is coupled to a console configured to control one or more functions of the catheter assembly. 
     In some embodiments, the console includes a control mechanism including a control selected from a slide button, a scroll wheel, a push button, and a switch on the console configured to deploy the embolic protection device. The control mechanism connects to the embolic protection device by one or more wires configured to deploy the embolic protection device upon advancing the control to a deployment position, thereby putting the catheter assembly in the deployment profile with the embolic protection device thereof in the deployed state. 
     In some embodiments, the console further includes one or more pumps and a reservoir. The one or more pumps are fluidly connected to at least one of the one or more additional lumens for flushing the arterial lumen around a distal end of the arterial lesion, aspirating emboli dislodged from the arterial lesion, or both flushing and aspirating in accordance with the foregoing. The reservoir is configured for collecting emboli dislodged from the arterial lesion. 
     Also provided herein is a catheter system including, in some embodiments, a catheter assembly and a console configured to control one or more functions of the catheter assembly. The catheter assembly includes a catheter body with a catheter-body lumen and an embolic protection device. The catheter body is sized for endoluminal advancement of a distal end portion of the catheter assembly from a puncture site at a human artery selected from a dorsalis pedis artery, a fibular artery, an anterior tibial artery, and a posterior tibial artery toward one or more larger arteries. The catheter assembly has an insertion profile when the embolic protection device is in a collapsed state, and a deployment profile when the embolic protection device is in a deployed state. The embolic protection device assumes the collapsed state while stowed in the catheter-body lumen at the distal end portion of the catheter assembly. The embolic protection device assumes the deployed state while outside the catheter-body lumen. The deployed state of the embolic protection device is configured with an opening away from the catheter body for capturing emboli dislodged from an arterial lesion while at a distal end of the arterial lesion. The deployed state of the embolic protection device may take on the shape of a basket, funnel, cone, or the like such that the cross-sectional area of the embolic protection device decreases from the opening to the catheter body following deployment. 
     In some embodiments, the catheter body is sized at about 3 Fr (1 mm) or less. 
     In some embodiments, the catheter system further includes a control mechanism including a control selected from a slide button, a scroll wheel, a push button, and a switch on the console configured to deploy the embolic protection device. The control mechanism connects to the embolic protection device by one or more wires configured to deploy the embolic protection device upon advancing the control to a deployment position, thereby putting the catheter assembly in the deployment profile with the embolic protection device thereof in the deployed state. 
     In some embodiments, the catheter body further includes one or more additional lumens. Each lumen of the one or more additional lumens is independently configured for flushing an arterial lumen around a distal end of the arterial lesion, aspirating emboli dislodged from the arterial lesion, or both flushing and aspirating in accordance with the foregoing. 
     In some embodiments, the console further includes one or more pumps and a reservoir. The one or more pumps are fluidly connected to at least one of the one or more additional lumens for flushing the arterial lumen around a distal end of the arterial lesion, aspirating emboli dislodged from the arterial lesion, or both flushing and aspirating in accordance with the foregoing. The reservoir is configured for collecting emboli dislodged from the arterial lesion. 
     Also provided herein is a method including, in some embodiments, advancing a distal end portion of a catheter assembly through an arterial lumen to a distal end of an arterial lesion, the catheter assembly including an insertion profile with an embolic protection device stowed in the distal end portion; deploying the embolic protection device from the distal end portion of the catheter assembly, the embolic protection device including a retrograde opening; and capturing any emboli dislodged from the arterial lesion in the embolic protection device. 
     In some embodiments, the method further includes puncturing a human patient&#39;s dorsalis pedis artery, fibular artery, anterior tibial artery, or posterior tibial artery before advancing the distal end portion of the catheter assembly through the lumen to the distal end of the arterial lesion. 
     In some embodiments, the method further includes advancing a recanalizing device through the lumen to a proximal end of the arterial lesion for a recanalization procedure. The emboli dislodged from the arterial lesion include emboli dislodged during the recanalization procedure. 
     In some embodiments, the method further includes puncturing the human patient&#39;s femoral artery before advancing the recanalizing device through the lumen to the proximal end of the arterial lesion for the recanalization procedure. 
     In some embodiments, the catheter assembly of the method further includes a catheter body with a catheter-body lumen and an embolic protection device. The catheter body is sized for endoluminal advancement of a distal end portion of the catheter assembly from a puncture site at a smaller sized artery toward one or more larger sized arteries. The embolic protection device is configured with a collapsed state and a deployed state. The embolic protection device assumes the collapsed state while stowed in the catheter-body lumen at the distal end portion of the catheter assembly while the catheter assembly has the insertion profile. The embolic protection device assumes the deployed state while outside the catheter-body lumen when the catheter assembly has a deployment profile. The deployed state of the embolic protection device is configured with an opening away from the catheter body for capturing emboli dislodged from the arterial lesion while at a distal end of the arterial lesion. 
    
    
     
       DRAWINGS 
         FIG. 1  provides a schematic illustrating a catheter assembly including an embolic protection device in accordance with some embodiments. 
         FIG. 2A  provides a schematic illustrating a catheter assembly including an embolic protection device in a collapsed state in accordance with some embodiments. 
         FIG. 2B  provides a schematic illustrating a catheter assembly including an embolic protection device in a deployed state in accordance with some embodiments. 
         FIG. 3A  provides a schematic illustrating a system including a console and a catheter assembly with an embolic protection device in a collapsed state in accordance with some embodiments. 
         FIG. 3B  provides a schematic illustrating a system including a console and a catheter assembly with an embolic protection device in a deployed state in accordance with some embodiments. 
         FIG. 3C  provides a schematic illustrating an alternative for the catheter assembly of the system of  FIGS. 3A and 3B  in accordance with some embodiments. 
         FIG. 4A  provides a schematic illustrating a system including a console and a control mechanism for an embolic protection device of a catheter assembly in accordance with some embodiments. 
         FIG. 4B  provides a schematic illustrating a system including a console and a control mechanism for an embolic protection device of a catheter assembly in accordance with some embodiments. 
         FIG. 4C  provides a schematic illustrating a system including a console and a control mechanism for an embolic protection device of a catheter assembly in accordance with some embodiments. 
         FIG. 5  provides a schematic illustrating an arterial lesion impeding blood flow in an artery. 
         FIG. 6  provides a schematic illustrating arteries in a human leg including the dorsalis pedis artery, the fibular artery, the anterior and posterior tibial arteries, the popliteal artery, and the femoral artery. 
     
    
    
     DESCRIPTION 
     Before some particular embodiments are provided in greater detail, it should be understood that the particular embodiments provided herein do not limit the scope of the concepts provided herein. It should also be understood that a particular embodiment provided herein can have features that can be readily separated from the particular embodiment and optionally combined with or substituted for features of any of a number of other embodiments provided herein. 
     Regarding terms used herein, it should also be understood the terms are for the purpose of describing some particular embodiments, and the terms do not limit the scope of the concepts provided herein. Ordinal numbers (e.g., first, second, third, etc.) are generally used to distinguish or identify different features or steps in a group of features or steps, and do not supply a serial or numerical limitation. For example, “first,” “second,” and “third” features or steps need not necessarily appear in that order, and the particular embodiments including such features or steps need not necessarily be limited to the three features or steps. Labels such as “left,” “right,” “front,” “back,” “top,” “bottom,” “forward,” “reverse,” “clockwise,” “counter clockwise,” “up,” “down,” or other similar terms such as “upper,” “lower,” “aft,” “fore,” “vertical,” “horizontal,” “proximal,” “distal,” and the like are used for convenience and are not intended to imply, for example, any particular fixed location, orientation, or direction. Instead, such labels are used to reflect, for example, relative location, orientation, or directions. Singular forms of “a,” “an,” and “the” include plural references unless the context clearly dictates otherwise. 
     With respect to “proximal,” a “proximal portion” or a “proximal end portion” of, for example, a catheter provided herein includes a portion of the catheter intended to be near a clinician when the catheter is used on a patient. Likewise, a “proximal length” of, for example, the catheter includes a length of the catheter intended to be near the clinician when the catheter is used on the patient. A “proximal end” of, for example, the catheter includes an end of the catheter intended to be near the clinician when the catheter is used on the patient. The proximal portion, the proximal end portion, or the proximal length of the catheter can include the proximal end of the catheter; however, the proximal portion, the proximal end portion, or the proximal length of the catheter need not include the proximal end of the catheter. That is, unless context suggests otherwise, the proximal portion, the proximal end portion, or the proximal length of the catheter is not a terminal portion or terminal length of the catheter. 
     With respect to “distal,” a “distal portion” or a “distal end portion” of, for example, a catheter provided herein includes a portion of the catheter intended to be near or in a patient when the catheter is used on the patient. Likewise, a “distal length” of, for example, the catheter includes a length of the catheter intended to be near or in the patient when the catheter is used on the patient. A “distal end” of, for example, the catheter includes an end of the catheter intended to be near or in the patient when the catheter is used on the patient. The distal portion, the distal end portion, or the distal length of the catheter can include the distal end of the catheter; however, the distal portion, the distal end portion, or the distal length of the catheter need not include the distal end of the catheter. That is, unless context suggests otherwise, the distal portion, the distal end portion, or the distal length of the catheter is not a terminal portion or terminal length of the catheter. 
     With respect to a distal end or distal end cap of an arterial lesion,  FIG. 5  shows the distal end or the distal end cap of the arterial lesion opening or otherwise directed in an antegrade direction with a flow of blood. With respect to a proximal end or proximal end cap of an arterial lesion,  FIG. 5  also shows the proximal end or the proximal end cap of the arterial lesion opening or otherwise directed in an retrograde direction against the flow of blood. 
     Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by those of ordinary skill in the art. 
     Again, accepted surgical intervention for peripheral artery disease includes balloon angioplasty and stenting with balloon-expandable stents, self-expanding stents, or stent grafts to restore patency and blood flow impeded by arterial lesions. More recently, atherectomy has been shown to be an effective alternative surgical intervention to restore patency and blood flow with less vessel trauma. However, embolization of emboli such as calcifications, tissue, or other debris resulting from crossing or ablating the arterial lesions remains a concern in each of the foregoing surgical interventions. Provided herein, in some embodiments, are embolic protection devices, as well as systems and methods thereof that address at least the foregoing. 
     For example,  FIG. 1  provides a schematic illustrating a catheter assembly  100  including an embolic protection device  120  in accordance with some embodiments. 
     As shown, the catheter assembly  100  includes a catheter body  110  with at least one catheter-body lumen  112  from which catheter-body lumen  112  the embolic protection device  120  is deployed for capturing emboli E. The catheter body  110  is sized for endoluminal advancement of a distal end portion of the catheter assembly  100  from a puncture site at a patient&#39;s artery A toward one or more larger arteries. Such endoluminal advancement can be retrograde endoluminal advancement, the puncture site at the patient&#39;s artery A being at the dorsalis pedis artery, and the one or more larger arteries being the anterior tibial artery, the popliteal artery, or the femoral artery.  FIG. 6  provides a schematic illustrating such arteries in a human leg. The puncture site at the patient&#39;s artery A can alternatively be at the anterior tibial artery, and the one or more larger arteries can be the popliteal artery or the femoral artery. The puncture site at the patient&#39;s artery A can alternatively be at the fibular artery, and the one or more larger arteries can be the posterior tibial artery, the popliteal artery, or the femoral artery. The puncture site at the patient&#39;s artery A can alternatively be at the posterior tibial artery, and the one or more larger arteries can be the popliteal artery or the femoral artery. Such endoluminal advancement is useful for embolic protection at a distal side of an arterial lesion while treating (e.g., crossing, ablating, etc.) the arterial lesion from a proximal side of the arterial lesion. 
     The embolic protection device  120  is configured with a collapsed state and a deployed state with the deployed state of the embolic protection device  120  being shown in  FIG. 1 . The embolic protection device  120  assumes the collapsed state while stowed in the catheter-body lumen  112  at the distal end portion of the catheter assembly  100 . The embolic protection device  120  assumes the deployed state while outside the catheter-body lumen  112 . The deployed state of the embolic protection device  120  is configured with an opening such as a retrograde opening away from the catheter body  110  and toward a distal end or a distal cap of an arterial lesion. The embolic protection device  120  is configured with a basket, funnel, cone, tapered, or similar shape for capturing emboli E against blood flow. Such emboli can be dislodged from the distal end or the distal cap of the arterial lesion while crossing or ablating the arterial lesion from a proximal end or a proximal cap of the arterial lesion. The arterial lesion is shown as a chronic total occlusion (“CTO”) in  FIG. 1 . 
     The catheter assembly  100  is configured for endoluminal advancement of the distal end portion of the catheter assembly  100  from a puncture site at a patient&#39;s artery A (e.g., the dorsalis pedis artery) toward one or more larger arteries (e.g., the anterior tibial artery, the popliteal artery, or the femoral artery). In accordance with the foregoing, such endoluminal advancement can be retrograde endoluminal advancement. The catheter assembly  100  can be advanced through the patient&#39;s vasculature over a guidewire GW through both the catheter body  110  and the embolic protection device  120 . For example,  FIGS. 2A and 3A  respectively show embodiments in which the guidewire GW is optionally disposed in a catheter body  210  of a catheter assembly  200  and a catheter body  310  of a catheter assembly  300 . Alternatively, the catheter assembly  100  can be advanced through the patient&#39;s vasculature without a guidewire GW. The catheter body  110  is sized accordingly. The catheter body  110  can include a diameter commensurate with an average diameter of a human dorsalis pedis artery, thereby obviating endoluminal advancement of the distal end portion of the catheter assembly  100  over a guidewire. In such embodiments, the catheter body  110  is sized at least about 1 Fr (0.333 mm), 2 Fr (0.667 mm), 3 Fr (1 mm), 4 Fr (1.333 mm), or 5 Fr (1.667 mm), optionally in tenths of the foregoing. Alternatively, the catheter body  110  is sized at no more than about 5 Fr (1.667 mm), 4 Fr (1.333 mm), 3 Fr (1 mm), 2 Fr (0.667 mm), or 1 Fr (0.333 mm), optionally in tenths of the foregoing. As such, the catheter body  110  is sized at least about 1 Fr (0.333 mm) to about 5 Fr (1.667 mm), including about 1 Fr (0.333 mm) to about 4 Fr (1.333 mm), such as about 1 Fr (0.333 mm) to about 3 Fr (1 mm), for example, about 2 Fr (0.667 mm) to about 3 Fr (1 mm). The catheter body  110  can alternatively include a diameter compatible or commensurate with an average diameter of a human fibular artery, anterior tibial artery, or posterior tibial artery for endoluminal advancement of the distal end portion of the catheter assembly  100  through the corresponding artery. 
     The distal end portion of the catheter assembly  100  can include one or more radiopaque markings for endoluminal advancement of the catheter assembly  100  using fluoroscopic imaging. Such radiopaque marking can be on the catheter body  110 , the embolic protection device  120 , or both. For example,  FIGS. 2A and 2B  show an embodiment in which radiopaque markings  216  are optionally around a distal end portion of a catheter body  210  of a catheter assembly  200 .  FIGS. 3A and 3B , too, show an embodiment in which radiopaque markings  316  are optionally around a distal end portion of a catheter body  310  of a catheter assembly  300 . Alternatively or additionally, at least the distal end portion of the catheter assembly  100  can be echogenic for endoluminal advancement of the catheter assembly  100  using ultrasound. 
     The embolic protection device  120  can have a pliable form (e.g., a disk cut or otherwise formed from a pliable or flexible material) that facilitates the collapsed state while the embolic protection device  120  is stowed in the catheter-body lumen  112  and the deployed state while the embolic protection device  120  is outside the catheter-body lumen  112 . The embolic protection device  120  can be a mesh, a porous membrane, or a non-porous membrane, optionally in one or more individually selected layers thereof. The embolic protection device  120  can be of any polymer including, but not limited to, a woven or expanded polymer such as expanded polytetrafluoroethylene (“ePTFE”). 
       FIG. 2A  provides a schematic illustrating a catheter assembly  200  including the embolic protection device  120  in the collapsed state in accordance with some embodiments.  FIG. 2B  provides a schematic illustrating the catheter assembly  200  including the embolic protection device  120  in the deployed state in accordance with some embodiments. 
     As shown, the catheter assembly  200  includes a catheter body  210  with at least one catheter-body lumen  212  from which catheter-body lumen  212  the embolic protection device  120  is deployed for capturing emboli. The catheter assembly  200  includes an insertion profile with the embolic protection device  120  in a collapsed state, and the catheter assembly  200  includes a deployment profile with the embolic protection device  120  in a deployed state. The insertion profile of the catheter assembly  200  and the collapsed state of the embolic protection device  120  is shown in  FIG. 2A . The deployment profile of the catheter assembly  200  and the deployed state of the embolic protection device  120  is shown in  FIG. 2B . The catheter assembly  200  further includes a control mechanism  230  configured to deploy the embolic protection device  120 , thereby putting the catheter assembly  200  in the deployment profile and the embolic protection device  120  thereof in the deployed state. In some embodiments, the control mechanism  230  includes a control such as a slide button  232  or a scroll wheel at a proximal end portion of the catheter assembly  200 , the control mechanism  230  connected to the embolic protection device  120  by one or more wires configured to deploy the embolic protection device  120  upon advancing the control from a stowage position to a deployment position. At least a primary wire  234  of the one or more wires is disposed in the at least one catheter-body lumen  212  as shown in Section A-A. Any other wires of the one or more wires can be auxiliary wires  222  configured to facilitate deployment of the embolic protection device  120 . For example, the auxiliary wires  222  can be radially placed in or on a disk of a pliable or flexible material forming the embolic protection device  120 , the radially placed auxiliary wires  222  akin to ribs of an umbrella. The auxiliary wires  222  are optionally pre-compressed to spring open the embolic protection device  120  upon deployment. 
       FIG. 3A  provides a schematic illustrating a system  302  including a console  304  and a catheter assembly  300  with the embolic protection device  120  in the collapsed state in accordance with some embodiments.  FIG. 3B  provides a schematic illustrating the system  302  including the console  304  and the catheter assembly  300  including the embolic protection device  120  in a deployed state in accordance with some embodiments.  FIG. 3C  provides a schematic illustrating an alternative for the catheter assembly  300  of the system  302  of  FIGS. 3A and 3B  in accordance with some embodiments. 
     As shown, the catheter assembly  300  includes a catheter body  310  with a number of lumens  312  including at least a primary lumen  314  from which the embolic protection device  120  is deployed for capturing emboli. When additional lumens are present, each lumen of the lumens  312  other than the primary lumen  314  is independently configured for flushing an arterial lumen around a distal end or a distal cap of an arterial lesion, aspirating emboli dislodged from the arterial lesion, or both flushing and aspirating in accordance with the foregoing. In addition to the foregoing, one of the additional lumens can be configured for a guidewire GW as shown in  FIG. 3C . While two additional lumens are shown in Section C-C of  FIG. 3A  and three additional lumens are shown in Section D-D of  FIG. 3C , the catheter assembly  300  can include one, two, three, or more than three additional lumens. If the catheter assembly  300  includes one additional lumen, the one additional lumen can be configured for flushing an arterial lumen around a distal end or a distal cap of an arterial lesion, aspirating emboli dislodged from the arterial lesion, or both flushing and aspirating in accordance with the foregoing. If the catheter assembly  300  includes two additional lumens, a first additional lumen can be configured for flushing an arterial lumen around a distal end or a distal cap of an arterial lesion while a second additional lumen can be configured for aspirating emboli dislodged from the arterial lesion. If the catheter assembly  300  includes three additional lumens, a first additional lumen can be configured for flushing an arterial lumen around a distal end or a distal cap of an arterial lesion, a second additional lumen can be configured for aspirating emboli dislodged from the arterial lesion, and a third additional lumen can be configured for advancing the catheter assembly over a guidewire GW. 
     The catheter assembly  300  includes an insertion profile with the embolic protection device  120  in a collapsed state, and the catheter assembly  300  includes a deployment profile with the embolic protection device  120  in a deployed state. The insertion profile of the catheter assembly  300  and the collapsed state of the embolic protection device  120  is shown in  FIG. 3A . The deployment profile of the catheter assembly  300  and the deployed state of the embolic protection device  120  is shown in  FIGS. 3B and 3C . As opposed to the catheter assembly  200 , the console  302  includes a control mechanism  330  configured to deploy the embolic protection device  120 , collapse the embolic protection device  120 , or alternately deploy and collapse the embolic protection device  120 . In some embodiments, the control mechanism  330  includes a control such as a slide button  332  on the console  302 , the control mechanism  330  connected to the embolic protection device  120  by one or more wires or other devices configured to deploy the embolic protection device  120  upon advancing the control from a stowage position to a deployment position. At least a primary wire  334  ( FIGS. 3A and 3B ) of the one or more wires or other devices can be disposed in the primary lumen  314  as shown in Section C-C for deploying the embolic protection device  120  connected thereto. Alternatively, at least a tubular structure  335  ( FIG. 3C ) of the one or more wires or other devices can be disposed in the primary lumen  314  as shown in Section D-D for deploying the embolic protection device  120  connected thereto. The tubular structure  335  includes each lumen of the lumens  312  other than the primary lumen  314 . Any other wires of the one or more wires or other devices can be auxiliary wires such as the auxiliary wire  222  shown in  FIG. 2B , the auxiliary wires  222  configured to facilitate deployment of the embolic protection device  120 . For example, the auxiliary wires  222  can be radially placed in or on a disk of a pliable or flexible material forming the embolic protection device  120 , the radially placed auxiliary wires  222  akin to ribs of an umbrella. The auxiliary wires  222  are optionally pre-compressed to spring open the embolic protection device  120  upon deployment. 
     The console  302  can further include one or more pumps  344  and a reservoir  342  in some embodiments. The one or more pumps  344  are fluidly connected to at least one lumen of the additional lumens of lumens  312  for flushing the arterial lumen around a distal end or a distal cap of an arterial lesion, aspirating emboli dislodged from the arterial lesion, or both flushing and aspirating in accordance with the foregoing. The reservoir  342  is fluidly connected to at least one lumen of the additional lumens of lumens  312 , the reservoir  342  configured for collecting emboli dislodged from the arterial lesion. 
       FIGS. 4A, 4B, and 4C  provide schematics illustrating systems, each system of which includes a console and a different control mechanism with a different control for the embolic protection device  120 , wherein each different control mechanism is an alternative to at least the control mechanism  330  of  FIGS. 3A and 3B . 
       FIG. 4A  provides a schematic illustrating a system  400 A including a console  404 A and a scroll wheel-based control mechanism  430 A with a scroll wheel  432 A for the control. The control mechanism  430 A is configured to deploy the embolic protection device  120 , collapse the embolic protection device  120 , or alternately deploy and collapse the embolic protection device  120  by scrolling the scroll wheel  432 A. The scroll wheel-based control mechanism  430 A can be purely mechanical or include electrical components as well, for example, for electrically fine tuning a speed ratio of the scroll wheel-based control mechanism  430 A. When purely mechanical, the scroll wheel-based control mechanism  430 A can be used in place of the control mechanism  230  of the catheter assembly  200 . (See  FIGS. 2A and 2B .) 
       FIG. 4B  provides a schematic illustrating a system  400 B including a console  404 B and a push button-based control mechanism  430 B with a push button  432 B for the control. The control mechanism  430 B is configured to deploy the embolic protection device  120 , collapse the embolic protection device  120 , or alternately deploy and collapse the embolic protection device  120  by pushing the push button  432 B. 
       FIG. 4C  provides a schematic illustrating a system  400 C including a console  404 C and a switch-based control mechanism  430 C with a switch  432 C for the control. The control mechanism  430 C is configured to deploy the embolic protection device  120 , collapse the embolic protection device  120 , or alternately deploy and collapse the embolic protection device  120  by flipping the switch  432 C. 
     As shown in  FIGS. 4A, 4B, and 4C , each console of the consoles  400 A,  400 B, and  400 C can include one or more controls such as switch  343  and switch  345  configured to switch corresponding pumps of the one or more pumps  344  on and off. For example, the switch  343  can be configured to turn a first pump on and off, the first pump configured to supply a liquid such as water, saline, heparinized saline, or the like when switched on for flushing an arterial lumen around a distal end or a distal cap of an arterial lesion. For example, the switch  345  can be configured to turn a second pump on and off, the second pump configured to supply a vacuum when switched on for aspirating the arterial lumen around the distal end or the distal cap of the arterial lesion. Other controls for the one or more pumps  344  include, but are not limited to, dials, slide buttons such as the slide button  332  of the control mechanism  330 , and push buttons such as the push button  432 B of the control mechanism  430 B. 
     Currently, when surgically intervening to treat peripheral artery disease, an arterial lesion such as a CTO is crossed with a crossing device for balloon angioplasty and stenting or ablated with an atherectomy device, each surgical intervention of which can release emboli. In any patient, particularly those with already reduced vascular function or a risk for a large amount of embolic material, there is a desire to capture the emboli. In cases where the arterial lesion is a CTO, there is no way to place guidewire-based distal protection devices until the CTO has already been crossed, which can lead to a large amount of embolic material. However, embolic protection devices of the catheter assemblies provided herein can be placed distal to an arterial lesion by accessing an artery at a puncture site distal to the arterial lesion, thereby obviating crossing the arterial lesion to place an embolic protection device. 
     A method of placing an embolic protection device of a catheter assembly provided herein and capturing emboli therein includes advancing a distal end portion of the catheter assembly through an arterial lumen to a distal end or a distal cap of an arterial lesion, the catheter assembly including the embolic protection device stowed in the distal end portion; deploying the embolic protection device from the distal end portion of the catheter assembly, the embolic protection device including a retrograde opening; and capturing any emboli dislodged from the arterial lesion in the embolic protection device. Again, the method obviates crossing the arterial lesion from a proximal end or a proximal cap of the arterial lesion to place the embolic protection device at the distal end or the distal cap of the arterial lesion. 
     Before advancing the distal end portion of the catheter assembly through the arterial lumen to the distal end or the distal cap of the arterial lesion, a first puncture site is created by a puncture in an artery including the arterial lumen. The puncture can be a puncture in a smaller sized artery for advancing the distal end portion of the catheter assembly toward one or more larger sized arteries. For example, the puncture can be a retrograde puncture in the dorsalis pedis artery for advancing the distal end portion of the catheter assembly toward the anterior tibial artery, the popliteal artery, or the femoral artery. Alternatively, the puncture can be a retrograde puncture at the anterior tibial artery for advancing the distal end portion of the catheter assembly toward the popliteal artery or the femoral artery. Alternatively, the puncture can be a retrograde puncture at the fibular artery for advancing the distal end portion of the catheter assembly toward the posterior tibial artery, the popliteal artery, or the femoral artery. Alternatively, the puncture can be a retrograde puncture at the posterior tibial artery for advancing the distal end portion of the catheter assembly toward the popliteal artery or the femoral artery. 
     In addition to placing the embolic protection device of the catheter assembly at the distal end or the distal cap of the arterial lesion, the method includes advancing a recanalizing device (e.g., a device for crossing or ablating the arterial lesion) through the arterial lumen to a proximal end or a proximal cap of the arterial lesion for an antegrade recanalization procedure (e.g., balloon angioplasty, atherectomy, etc.). The emboli dislodged from the arterial lesion include emboli dislodged during the recanalization procedure. 
     Before advancing the recanalizing device through the arterial lumen to the proximal end or the proximal cap of the arterial lesion, a second puncture site is created by a puncture in an artery including the arterial lumen. The puncture can be a puncture in a larger sized artery for advancing the recanalizing device toward one or more smaller sized arteries. For example, the puncture can be an antegrade or a retrograde puncture in the femoral artery for advancing the recanalizing device toward the dorsalis pedis artery or the fibular artery, wherein the antegrade puncture can be for intraluminal recanalization and the retrograde puncture can be for subintimal recanalization. 
     While protection at the distal side of arterial lesions is largely described herein, protection at the distal side of veinal lesions is also possible with the embolic protection devices provided herein, as well as the systems and methods thereof. 
     While some particular embodiments have been provided herein, and while the particular embodiments have been provided in some detail, it is not the intention for the particular embodiments to limit the scope of the concepts presented herein. Additional adaptations and/or modifications can appear to those of ordinary skill in the art, and, in broader aspects, these adaptations and/or modifications are encompassed as well. Accordingly, departures may be made from the particular embodiments provided herein without departing from the scope of the concepts provided herein.