Patent Description:
Cerebral embolism is a known complication of cardiac surgery, cardiopulmonary bypass and catheter-based interventional cardiology and electrophysiology procedures. Embolic particles, which may include thrombus, atheroma and lipids, may become dislodged by surgical or catheter manipulations and enter the bloodstream, embolizing in the brain or other vital organs downstream. Cerebral embolism can lead to neuropsychological deficits, stroke and even death. Other organs downstream can also be damaged by embolism, resulting in diminished function or organ failure.

Prevention of embolism would benefit patients and improve the outcome of these procedures. Given that potential emboli are often dislodged during catheter-based procedures, it would be advantageous to deploy an embolic protection system as part of a catheter-based vascular procedure, such as transcatheter aortic valve replacement (TAVR). Further, the use of transcranial doppler (TCD) during TAVR has shown that cerebral emboli are generated primarily during the procedural steps of crossing the native valve and deploying the TAVR valve (<NPL>). Therefore, the integration of an embolic protection device on the TAVR delivery system itself would have the advantage that the protection is in place for the most critical steps of the procedure. Another advantage would come by integrating the embolic protection system on the catheter itself that is being used to perform the procedure, such as a transcatheter valve delivery system or electrophysiology catheter. Other embolic protection systems require separate procedural steps for installing the protector prior to the interventional or diagnostic procedure and removing it after the procedure. In many cases a different access site is required as well. The present invention avoids both the extra step and the need for an extra access site. Yet another advantage would come from providing an integrated embolic protection device that does not increase the overall diameter of the catheter.

Devices for preventing embolisms and similar events are described in the following patents and patent applications: <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; and <CIT>.

<CIT> describes a collapsible medical device for use, e.g., as a vascular filter. The device includes a mandrel having a distal end and a stop spaced proximally of the distal end. A proximal length of the mandrel extends proximally of the stop and a distal length of the mandrel extends distally of the stop. A functional element (e.g., a vascular filter) has a radially expandable body and includes a proximal slider and a distal slider. The proximal and distal sliders are slidable along the mandrel independently of one another such that the distance between the proximal slider and distal slider can be varied to effect different configurations of the functional element. <CIT> describes a single filter and multi-filter endolumenal system for filtering fluids within the body. A blood filtering system captures and removes particulates dislodged or generated during a surgical procedure and circulating in a patient's vasculature.

<CIT> describes an endoluminal catheterization device for providing protection against distal embolization of atherosclerotic debris and thrombi emboli resulting from an endoluminal catheterization procedure. The embolization protection device may be an integral part of any other intra-luminal treatment or diagnostic device that may induce embolization, such as a balloon, stent, TAVI or atherectomy. <CIT> describes a temporary valve and a filtration device that can be added to a delivery catheter or guide catheter to improve hemodynamics and provide embolic protection. Both the valve and filter can mount onto the outer diameter of a delivery or guide catheter. <CIT> describes a filter system comprising an expandable filter, with a first end of the filter attached to an end of a first tube, and a second end of the filter attached to an end of a second tube. The tubes are arranged telescopically with respect to each other such that telescopic movement of the first and second tubes with respect to each other causes the filter to move between a first collapsed, position and a second expanded position, where the filter extends outwardly. The filter may be a folded-over member, when in the expanded position, or a spiraling member.

A prosthetic heart valve delivery catheter having integrated embolic protection according to the principles of the present invention inhibits the release of emboli into the aorta, the aortic arch or branch vessels, and other vasculature to protect the brain and other downstream organs from embolization during transvascular prosthetic heart valve replacement procedures. Unlike most other embolic protection solutions, the embolic filter is integrated into an interventional or diagnostic catheter, such as a transcatheter heart valve delivery system.

In a first aspect, the present disclosure provides a prosthetic heart valve delivery catheter system having integrated embolic protection. The catheter system typically comprises a catheter shaft having a distal portion, a prosthetic valve disposed on the distal portion of the catheter shaft; and an embolic filter disposed on the distal portion of the shaft at a location proximal of the prosthetic valve. The embolic filter has a collapsed configuration and a deployed configuration, and an outer periphery of the filter is configured to contact a blood vessel wall in the expanded configuration. In some embodiments, the embolic filter comprises a filter structure having a narrow end coupled to the shaft and an open end located distally of the narrow end.

In specific embodiments, the narrow end of the filter structure may fixedly attached to the catheter shaft. In alternative embodiments, the narrow end of the filter structure is slidably mounted on the catheter shaft. The catheter may further comprise at least one of a proximal stop on the catheter shaft for limiting proximal movement of the embolic filter on the distal portion of the catheter shaft and a distal stop on the catheter shaft for limiting distal movement of the embolic filter on the distal portion of the catheter shaft.

In further specific embodiments, the filter may comprise a filter membrane and a support structure. The support structure may comprise a plurality of self-expanding axial struts connected at their proximal ends to the catheter shaft so as to open a distal end of the filter member to form a cone when released from constraint. The axial struts may have atraumatic distal tips.

In other embodiments, the filter may comprise a self-expanding conical filter. For example, the embolic filter comprises a porous material comprising a fabric of knitted, woven, or nonwoven fibers, filaments, or wires. The porous material may be made of a resilient metal, polymer material, a malleable material, a plastically deformable material, a shape-memory material, or combinations thereof. The porous material will typically have a pore size chosen to prevent emboli over a predetermined size from passing through.

In a second aspect, the present disclosure provides systems comprising a catheter as described above in combination with an outer delivery sheath configured to maintain the embolic filter in a collapsed configuration.

In a third aspect, the present disclosure provides a prosthetic heart valve delivery catheter having integrated embolic protection. The prosthetic heart valve delivery catheter typically comprises a catheter shaft having a distal portion, a prosthetic valve disposed on the distal portion of the catheter shaft; and an embolic filter disposed on the distal portion of the shaft at a location proximal of the prosthetic valve. The embolic filter will usually have a collapsed configuration and a deployed configuration and, in the expanded configuration, an outer periphery of the filter contacts a blood vessel wall The embolic filter will typically comprise a filter membrane and a support structure, wherein the support structure comprises a cage having a distal collar and a proximal collar attached to the distal portion of the catheter shaft.

In specific embodiments, at least one of the distal collar and the proximal collar is slidably attached to the distal portion of the catheter shaft. In other embodiments, at least one of the distal collar and the proximal collar is fixedly attached to the distal portion of the catheter shaft. For example, at least one of the distal collar and the proximal collar is fixedly attached to the distal portion of the catheter shaft. In other examples, at least one of the distal collar and the proximal collar is configured to be axially translated to expand and contract the cage. Typically, the cage is self-expanding so that it can be radially constrained for delivery and released from radial constraint for deployment. In still further examples, the cage has a conically tapered distal end, a conically tapered proximal end, and a cylindrical wall portion therebetween, wherein the filter membrane covers at least the conically tapered proximal end and does not cover the conically tapered distal end.

In a fourth aspect, the present disclosure provides a prosthetic heart valve delivery catheter having integrated embolic protection. The catheter comprises a catheter shaft having a distal portion, a prosthetic valve disposed on the distal portion of the catheter shaft, and an embolic filter disposed on the distal portion of the shaft at a location proximal of the prosthetic valve. The embolic filter typically has a collapsed configuration and a deployed configuration where an outer periphery of the filter is configured to contact a blood vessel wall. The embolic filter usually further comprises a cylindrical wall portion located proximal of the prosthetic valve and configured to cover a patient's aortic branch vessels and a conical wall portion proximal of the cylindrical wall portion.

In specific embodiments, a cylindrical wall portion and a conical wall portion are not continuous. For example, at least one of cylindrical wall portion and the conical wall portion may be fixedly attached to the distal portion of the catheter shaft. In other examples, at least one of cylindrical wall portion and the conical wall portion is slidably attached to the distal portion of the catheter shaft. In still other examples, at least one of cylindrical wall portion and the conical wall portion is self-expanding. In any of these examples, at least one of cylindrical wall portion and the conical wall portion is balloon expandable.

In a fifth aspect, the present disclosure provides a prosthetic heart valve delivery catheter having integrated embolic protection, where catheter comprises a catheter shaft having a distal portion, a prosthetic valve disposed on the distal portion of the catheter shaft, and an embolic filter disposed on the distal portion of the shaft at a location proximal of the prosthetic valve. The embolic filter typically has a collapsed configuration and a deployed configuration where an outer periphery of the filter is configured to contact a blood vessel wall. The embolic filter will usually further comprise a cylindrical wall having an open distal end and a closed proximal end sealing coupled to the catheter shaft, where a proximal region of the cylindrical wall is movably everted and allows the open distal end to axially translate relative to the catheter shaft while the closed proximal end remains stationary relative to the catheter shaft.

In specific embodiments, the closed proximal end is fixed to the catheter shaft. For example,.

the closed proximal end may slidably couple to the catheter shaft. At least the distal portion of the cylindrical wall may be self-expanding and at least at the distal portion of the cylindrical wall may comprise a self-expanding filter.

A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments and the accompanying drawings of which:.

For purposes of this patent application, the term "distal" refers to the end of the device that is farthest away from the operator, and closest to the heart. This is also the "upstream" direction of blood flow. The term "proximal" refers to the end of the device nearer to the operator, toward the direction of the access site where the device has been introduced into the body, and farthest away from the heart. This is also the "downstream" direction of blood flow.

<FIG> show an integrated valve system <NUM> having integrated embolic protection. A self-expanding, conical embolic filter <NUM> is mounted on a shaft <NUM> of a balloon valve delivery catheter having a balloon-expandable prosthetic cardiac valve <NUM> mounted on a distal balloon <NUM>. The balloon-expandable aortic valve may be any one of a variety of available and proposed balloon expandable cardiac valves, such as an Edwards Sapien® valve. The conical embolic filter <NUM> may be mounted on the catheter shaft <NUM> with either a fixed attachment or a sliding attachment. A fixed attachment simplifies both construction and the deployment protocol but limits the ability to adjustably position the conical filter relative to the aortic valve during delivery. When fixedly attached, the distal end of the conical filter may be positioned from <NUM> to <NUM> proximal of the proximal end of the prosthetic valve <NUM>, typically being from <NUM> to <NUM> proximal of the proximal end of the prosthetic valve. When slidably attached, the distal end of the conical filter may be adjusted (before or during deployment) to be positioned from <NUM> to <NUM> proximal of the proximal end of the prosthetic valve <NUM>, typically being from <NUM> to <NUM> proximal of the proximal end of the prosthetic valve.

The self-expanding, conical embolic filter <NUM> typically comprises a mesh or other filter material having a mesh size suitable for embolic capture and a self-expanding support structure, such as a plurality of radially self-expanding struts <NUM> to ensure full expansion of the mesh or other filter material. As illustrated, the radially self-expanding struts <NUM> have atraumatic distal tips to contact the aortic wall, e.g. distal ends of the struts may be curved, coiled, have protective pads, or have other structures to inhibit tissue injury.

The self-expanding, conical embolic filter <NUM> is typically deployed by retracting a constraining sheath <NUM> (compare <FIG>) and may be collapsed by advancing the constraining sheath and/or retracting the catheter shaft <NUM> (compare <FIG>). Optionally, after deployment of the valve <NUM>, the constraining sheath may be used to cover the deflated balloon <NUM> as well as the conical filter (<FIG>).

<FIG> shows a second embodiment of a valve system <NUM> having integrated embolic filter <NUM> on a catheter shaft <NUM>. The integrated valve system <NUM> is adapted to deliver a self-expanding prosthetic valve <NUM>, such as a Medtronic CoreValve® heart valve mounted on a distal end of the catheter shaft <NUM>. The self-expanding prosthetic valve <NUM> is initially constrained for delivery by a first retractable constraining sheath <NUM>, and the embolic filter <NUM> is initially constrained for delivery by a second retractable sheath <NUM>.

After positioning the first constraining sheath <NUM> and prosthetic valve <NUM> in the aortic valve V, the filter <NUM> is deployed by retraction of the second sheath <NUM>, allowing the filter to expand (<FIG>). The prosthetic valve <NUM> is then deployed by retraction of second retractable sheath <NUM> (<FIG>). After valve deployment, the second retractable sheath <NUM> is advanced to collapse the filter <NUM> and first sheath <NUM> for removal of the system. As shown in <FIG>, the first containing sheath <NUM> may be collapsed within the collapsed filter <NUM> which in turn is collapsed in the second constraining sheath <NUM>. Alternatively, the first retractable constraining sheath <NUM> could be advanced prior to the collapse of the filter <NUM> by advancement of the second retractable sheath <NUM>. In this alternative, the first constraining sheath <NUM> would lie distal to the second retractable sheath <NUM> as the catheter shaft <NUM> is withdrawn from the aorta.

<FIG> and <FIG> show a third embodiment of a valve system <NUM> having an integrated embolic filter assembly <NUM> on a catheter shaft <NUM>. The embolic filter assembly comprises a distal cylindrical or panel-shaped deflector 312a (as described for example in <CIT>) that is deployed across the great vessels of the aortic arch AA and a separate conical or other capture basket 312b that sits downstream or proximal of the deflector 312a in the descending aorta DA, as shown in <FIG>. The valve system <NUM> will include a prosthetic valve <NUM> which may be positioned and deployed in the patient's aortic valve V using either the balloon expandable or the self-expanding protocols described previously.

<FIG> shows a fourth embodiment of a valve system <NUM> having an integrated embolic filter. A proximal portion <NUM> everts to form a flexible section that can be reversibly "rolled" to accommodate bidirectional axial movement of the catheter shaft <NUM> without while leaving a distal portion <NUM> of the embolic filter stationary against the vessel wall. This allows a proximal end of the embolic filter, which is fixed to the delivery catheter at an attachment junction <NUM>, to move with the catheter shaft <NUM> as the catheter is advanced and retracted to position the valve for delivery without requiring the distal filter portion move and slide along the vessel wall as the catheter is advanced and retracted. Compare <FIG> which shows the filter <NUM> deployed in the aortic arch AA prior to deployment of the prosthetic aortic valve <NUM> and <FIG> which shows the filter <NUM> after the prosthetic valve <NUM> has been advanced into its deployment position within the native valve V. Note that the attachment junction <NUM> of the proximal end of the embolic filter <NUM> has advanced forward to allow the prosthetic valve <NUM> to be advanced into position without moving the main body of the embolic filter where it covers the cerebral branch vessels of the aortic arch AA. After deployment of the valve <NUM>, the filter may be retracted back into the deployment sheath <NUM>, as shown in <FIG>.

<FIG> shows a fifth embodiment of an embolic filter <NUM> where the filter is mounted around a shaft <NUM> of a valve system <NUM> catheter during initial delivery. After deployment of the filter <NUM>, the shaft <NUM> can move freely through an access port <NUM> that accommodates the catheter while inhibiting embolic debris release. The filter <NUM> is held in position and recovered with a tether <NUM> that connects to a proximal end of the filter. The tether <NUM> can be rigid to allow both proximal and distal repositioning, as well as retrieval. Retrieval can be accomplished by pulling the filter into a separate lumen of the delivery system (not shown). The filter can be collapsed for retrieval via a mechanism such as a "purse string" loop <NUM> (shown) or elongation of a support frame.

<FIG> shows a sixth embodiment of an embolic filter <NUM> in which a filter delivery sheath <NUM> is deployed and retrieved via a separate lumen <NUM> in a valve delivery catheter <NUM>. The valve delivery catheter <NUM> also has a lumen for a valve delivery shaft <NUM> which carries prosthetic valve <NUM>. Upon deployment of the embolic filter712, the prosthetic valve <NUM> can be advanced through the embolic filter and to the valve implantation site. The filter catheter <NUM> can be independently advanced and retracted so that it can be advanced ahead of the valve catheter <NUM> for deployment and positioning of the filter <NUM>, and then withdrawn while the valve catheter is advanced past the filter catheter and through the access port of the filter mesh or other filter material. After valve deployment, the valve catheter <NUM> can be withdrawn and the filter catheter <NUM> advanced to assist in retrieval of the filter mesh or other filter material.

<FIG> shows a seventh embodiment of an embolic filter <NUM> where the embolic filter is mounted with both ends of a filter support structure <NUM>, such as self-expanding cage, attached to a delivery catheter <NUM>. The embolic filter <NUM> is open (free from the filter mesh) on its distal end and closed on its proximal direction for debris capture when deployed. At least one of the proximal end or distal end of the filter support structure <NUM> is slidably attached to the delivery catheter <NUM> to allow radial opening and collapse. In some instances, both the distal and proximal ends on the support structure <NUM> will be slidably attached to catheter <NUM> to allow the balloon <NUM> and valve <NUM> to be positioned after the filter <NUM> is deployed. A conical guiding structure <NUM> ("funnel") at the end of the constraining sheath <NUM> assists in deployment and retrieval of the filter and support structure.

<FIG> show an eighth embodiment of an embolic filter <NUM> where both a prosthetic valve <NUM> and a filter <NUM><NUM> are balloon expandable. The embolic filter <NUM> is mounted on a proximal-most balloon <NUM> of a double-balloon catheter <NUM>. A balloon-expandable prosthetic valve <NUM>, such as an Edwards Lifesciences Sapien® valve, is mounted on a distal-most balloon <NUM> on the catheter <NUM>. Both the prosthetic valve <NUM> and the embolic filter <NUM> are thus deployed by balloon, where the balloons are configured to be inflated and deflated separately. As shown in <FIG>, prior to deployment, the prosthetic valve <NUM> and the embolic filter <NUM> are crimped onto balloons <NUM> and <NUM>, respectively. As shown in <FIG>, the filter <NUM> is deployed by inflation of balloon <NUM>. The filter <NUM> is then deployed by inflating balloon <NUM> (<FIG>), <NUM> is deflated once the filter has been deployed. While filter <NUM> remains expanded After valve deployment, balloon <NUM> is deflated, and a sheath <NUM> (previously used for deploying the valve delivery system) is advanced to collapse the filter <NUM> to allow removal of the system.

<FIG> shows a ninth embodiment of an embolic filter <NUM>. The embolic filter <NUM> is a self-supporting mesh basket with no additional support frame. It is deployed and retrieved by the retraction and advancement of a constraining sheath <NUM> that is part of the delivery system of a balloon-expandable valve <NUM>, such as an Edwards Lifesciences Sapien® valve. In this example, the embolic filter <NUM> is deployed via a self-expanding mechanism, while the prosthetic valve <NUM> is deployed via the inflation of a deployment balloon <NUM>. The filter <NUM> may be mounted on a separate filter deployment catheter <NUM>, which is deployed over the balloon catheter <NUM> but inside the constraining sheath <NUM>. This configuration allows the balloon catheter <NUM> to be advanced and withdrawn independent of the filter deployment catheter <NUM> and related mechanism. The embolic filter <NUM> may be deployed either by retraction of the constraining sheath <NUM>, or advancement of the catheter <NUM>, to release the embolic filter from the constraining sheath. After filter deployment, the prosthetic valve <NUM> is deployed by inflation of the deployment balloon <NUM>. After the valve <NUM> has been deployed, the deployment balloon <NUM> is deflated, and the embolic filter <NUM> is collapsed either by withdrawing the embolic filter into the constraining sheath <NUM> or by advancing the constraining sheath over the embolic filter. The may further comprise a downstream or proximal stop <NUM> on a shaft of the catheter <NUM> which limits proximal movement of the filter <NUM> (when configured to slide on the shaft) on the shaft and an upstream or distal stop <NUM> which limits distal movement of the filter on the shaft.

The embolic filter may be a mesh or other filter structure made of knitted, woven or nonwoven fibers, filaments or wires that will have a pore size chosen to allow blood to pass through but prevent emboli above a certain size from passing through. The embolic filter may also consist of a non-woven sheet, such as a thin sheet of polymer or metal, that has been perforated with holes of a single size or different sizes. The embolic filter material may be made of a metal, a polymer or a combination thereof and may optionally have an antithrombogenic coating on its surface. The embolic filter may also consist of some combination of a perforated sheet and a fiber-based mesh or other filter material or other filter structure. The embolic filter may consist of a single layer or multiple layers of any of the above configurations to increase the filtering efficiency and reduce the effective pore size.

The embolic protection device is delivered in an undeployed or retracted condition. A tubular outer delivery sheath may be used to maintain the embolic protection device in the undeployed condition. The delivery catheter may optionally include a shoulder or stop positioned proximal to the embolic protection device to maintain the position of the embolic protection device on the catheter as the delivery sheath is withdrawn during deployment. Alternatively, a pusher catheter that fits in between the catheter and the delivery sheath may be used to facilitate deployment such as the filter deployment catheter in <FIG>.

Alternatively, the filter may be deployed via the inflation of balloon inside the filter, which may be cylindrically or conically shaped, or otherwise shaped to match the geometry of the filter. Such a filter may be retrieved by withdrawing it into a retrieval sheath (<FIG>).

Another alternative delivery mechanism is to reduce the effective length of the embolic filter with a member attached to either the distal or proximal end (or both). In an embolic filter with a design such as shown in <FIG>, compressing the filter lengthwise will result in expansion of the diameter of the filter structure and resultant deployment of the filter. During retrieval, the filter may be elongated to reduce its diameter and collapse the filter. This can be accomplished with two independent filter deployment catheters that can be independently advanced or retracted to effect the change in length.

The catheter may be configured as a diagnostic catheter, a guiding catheter or therapeutic catheter. A specific example would be the delivery system for a transcatheter aortic valve.

The embolic filter will typically have at least one open end and define one or more internal collection regions which receive and capture emboli entering with blood flow through the open end. In other configurations, the embolic filter may have two open ends, for example having a cylindrical configuration which allows blood to flow in one end and out from the other end.

In many embodiments, the filter membranes will be self-supporting in the deployed condition. By self-supporting it is meant that the filter membrane can be deployed without further support into a three-dimensional configuration that maintains sufficient contact with the vessel wall to form an adequate seal to prevent emboli above a certain size from passing around the outside of the embolic protection device. In one example, the embolic filter can be constructed of a resilient mesh or other filter material that can be compressed into the undeployed condition and will self-expand into the deployed condition. Such structures are described in <CIT>.

In another example, the embolic filter may comprise a filter membrane, matrix, or the like and a separate supporting structure. The filter membrane may comprise any known structure for filtering emboli from blood, including meshes, perforated sheets, porous sheets, fibrous structures, and the like, or any combinations thereof. The filter membrane can be resilient, slack, plastically deformable, or combinations thereof.

The supporting structure may be located externally to the filter membrane, internally within the filter membrane, or both eternally and internally. For example, the supporting structure may comprise a framework that includes one or more longitudinal struts or hoops that are attached to or otherwise engage the filter membrane to hold the filter membrane in its opened or deployed configuration with the aorta or other target blood vessel. The hoops and/or struts may be formed of a resilient metal, polymer, or other material to provide a self-expanding framework that assumes a low profile or narrow configuration when constrained by a sheath for delivery and which assumes an expanded or deployed configuration when released from constraint. Alternatively, the framework or other support structure may comprise a malleable or plastically deformable material to provide expansion by applying a radial outward force to an interior of the support structure, typically using an inflatable balloon or other expansion mechanism.

Hybrid constructions that combine features of the self-supporting structure and the frame-supported structure may also be used. Hybrid deployment methods, such as balloon-assisted self-expansion or longitudinal compression of the support structure can also be utilized.

The support structures and the filter membranes of the embolic filters will often have the same lengths, but embolic filter may also be constructed with the embolic filter membrane being longer or shorter than the supporting structure. Specific relative longitudinal dimensions of the filter membranes of the embolic filters may be as shown in the drawings. In another alternate construction, the support structure and/or filter membrane can be conical with and enlarged or base end of the cone being positioned on the upstream side.

The embolic filter can be retracted and withdrawn with the catheter after the diagnostic or interventional procedure has been completed. Optionally, the embolic filter may include features to assist in retracting the device for retrieval from the patient's aorta. For example, a conical guiding structure may be slidably attached to the catheter at the proximal end of the device, the purpose of which is to assist the embolic filter in collapsing when a retrieval sheath is advanced along the conical guiding structure. In another example, portions of the embolic filter may be constructed with retraction members that are configured like purse strings or lassos around the circumference of the device. A pull loop or other graspable structure near the downstream end of the embolic filter is connected to the retraction members by one or more connecting members. In one preferred embodiment, the embolic filter is configured to close its upstream end first to assure that any captured emboli do not migrate out of the filter during retrieval. This can be accomplished by providing one or more pull loops for selectively retracting different sections of the device. The retraction members and connecting members may be made of suture, wire, plastic filament or a combination of these materials. In an alternate construction, the "Stent" Support Structure described above may also be configured to serve as the retraction members.

The embolic filter may be fixedly attached to the catheter or attached via a slidable attachment, or some combination of the two. A sliding attachment can consist of one or more rings, roller bearings or other structures that allow the embolic protection device to slide freely on the catheter. The sliding attachment will preferably have a low coefficient of friction and/or a lubricious coating so that movement of a catheter through the sliding attachment will not jostle or dislodge the embolic protection device. Alternatively, the sliding attachment can contain an additional sealing element, such as resilient flaps, an iris structure, or an expandable sealing material.

The overall undeployed diameter of the embolic filter as collapsed for delivery (including the diameter of its constraining sheath) preferably will be no larger than the largest section of the catheter (such as the collapsed diameter of a prosthetic valve, including its constraining sheath), which is most likely in the distal section of the catheter. In the case of a valve delivery system, the catheter is typically reduced in size proximal to the valve, which would potentially allow the integration of an embolic filter and its constraining member without changing the overall tracking profile of the valve delivery system.

The embolic filter is in an undeployed condition on the catheter as it is inserted into a patient's aorta. The embolic filter is ideally deployed in the ascending aorta prior to the ostia of the cerebral arteries. Optionally, a delivery sheath may be used to hold the embolic filter in the undeployed position. The embolic filter can also be constrained for delivery by crimping it onto a balloon catheter, or by elongating its support structure to reduce its diameter.

Claim 1:
A prosthetic heart valve delivery catheter having integrated embolic protection, said catheter comprising:
a catheter shaft (<NUM>) having a distal portion;
a self-expanding prosthetic valve (<NUM>) disposed on the distal portion of the catheter shaft (<NUM>); and
an embolic filter (<NUM>) disposed on the distal portion of the catheter shaft (<NUM>) at a location proximal of the prosthetic valve (<NUM>), said embolic filter (<NUM>) being configured to self-expand from a collapsed configuration to a deployed configuration wherein an outer periphery of the filter is configured to contact a wall of a patient's aorta downstream of a patient's aortic valve when embolic filter (<NUM>) is in its deployed configuration;
a first sheath (<NUM>) configured to constrain the prosthetic valve; and
a second sheath (<NUM>) configured to constrain the embolic filter (<NUM>),
wherein the embolic filter (<NUM>) comprises a filter structure having a narrow end coupled to the shaft and an open end located distally of the narrow end, and
wherein the second sheath (<NUM>) is configured to be retracted to allow the embolic filter to expand and the first sheath (<NUM>) is configured then to be retracted to deploy the self-expanding prosthetic valve (<NUM>).