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Patent US20040006367 - Emboli extraction catheter and vascular filter system - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsAn emboli extraction catheter and vascular filter system comprising a guidewire, a vascular filter attached near the distal end of the guidewire, and an emboli extraction catheter. The vascular filter has a smaller first diameter for insertion into the lumen of a vessel, and a second larger diameter...http://www.google.com/patents/US20040006367?utm_source=gb-gplus-sharePatent US20040006367 - Emboli extraction catheter and vascular filter systemAdvanced Patent SearchPublication numberUS20040006367 A1Publication typeApplicationApplication numberUS 10/603,512Publication dateJan 8, 2004Filing dateJun 25, 2003Priority dateJun 12, 2001Also published asUS6596011, US7323002, US20020188313Publication number10603512, 603512, US 2004/0006367 A1, US 2004/006367 A1, US 20040006367 A1, US 20040006367A1, US 2004006367 A1, US 2004006367A1, US-A1-20040006367, US-A1-2004006367, US2004/0006367A1, US2004/006367A1, US20040006367 A1, US20040006367A1, US2004006367 A1, US2004006367A1InventorsKrik Johnson, Patrick O'NeillOriginal AssigneeKrik Johnson, O'neill PatrickExport CitationBiBTeX, EndNote, RefManPatent Citations (20), Referenced by (74), Classifications (6), Legal Events (2) External Links: USPTO, USPTO Assignment, EspacenetEmboli extraction catheter and vascular filter system
US 20040006367 A1Abstract
An emboli extraction catheter and vascular filter system comprising a guidewire, a vascular filter attached near the distal end of the guidewire, and an emboli extraction catheter. The vascular filter has a smaller first diameter for insertion into the lumen of a vessel, and a second larger diameter for expanding to substantially equal the diameter of the lumen and to be placed in generally sealing relationship with the lumen. The emboli extraction catheter is a flexible catheter comprising a hub attached to the proximal end of the catheter. The hub further comprises a sideport and means for maintaining a seal on the guidewire. The emboli extraction catheter can be used to aspirate embolic particulates, so as to avoid their accidental release after they are captured in a vascular filter, and can also be used to empty full vascular filters of embolic particulates which may block distal flow. Images(5) Claims(26)
That which is claimed is: 1. An emboli extraction catheter and vascular filter system for insertion into a lumen of a vessel, said system comprising: a) a guidewire having a proximal end and a distal end; b) a vascular filter attached near said distal end of said guidewire, said filter comprising a proximal portion, a distal portion, and a plurality of struts extending therebetween, said filter further comprising a porous flexible filter membrane, with said porous flexible filter membrane connected to said filter distal portion and said plurality of struts, said porous filter membrane having a length less than the length of said plurality of struts, said vascular filter having a smaller first diameter for insertion into said lumen, and a second larger diameter for expanding to substantially equal the diameter of said lumen and to be placed in generally sealing relationship with said lumen; c) actuating means for causing said vascular filter to move from said smaller first diameter to said larger second diameter and back to said smaller first diameter; d) a flexible catheter having an outer diameter and an inner diameter, a proximal end and a distal end, a proximal portion and a distal portion, and an inner lumen, with said proximal end of said guidewire slidably insertable into said distal end of said catheter; e) a radio-opaque tip near said distal end of said catheter; and f) a hub permanently attached to said proximal end of said catheter, said hub having an outer diameter and an inner diameter, a proximal end and a distal end, and an inner lumen, said hub further comprising a sideport and means for maintaining a seal on the guidewire, said lumen of said hub being in fluid communication with said lumen of said catheter. 2. The emboli extraction catheter and vascular filter system according to claim 1, wherein said guidewire is made from Nickel-Titanium alloy. 3. The emboli extraction catheter and vascular filter system according to claim 1, wherein said vascular filter is made from Nickel-Titanium alloy. 4. The emboli extraction catheter and vascular filter system according to claim 1, wherein said porous flexible filter membrane is made from a flexible polymeric material chosen from a group consisting of polyurethane, polyethylene or a co-polymer thereof. 5. The emboli extraction catheter and vascular filter system according to claim 1, wherein the pore size of said porous flexible filter membrane is from about 20 to about 300 microns. 6. The emboli extraction catheter and vascular filter system according to claim 1, wherein said actuating means is a sheath. 7. The emboli extraction catheter and vascular filter system according to claim 1, wherein said catheter is made from a polymeric material. 8. The emboli extraction catheter and vascular filter system according to claim 1, wherein said proximal portion of said catheter is reinforced with braid wire. 9. The emboli extraction catheter and vascular filter system according to claim 1, wherein said proximal portion of said catheter comprises a flexible coil. 10. The emboli extraction catheter and vascular filter system according to claim 1, wherein said distal portion of said catheter is constructed of lower durometer material than said proximal portion of said catheter. 11. The emboli extraction catheter and vascular filter system according to claim 1, wherein said distal end of said catheter has a fluted or serrated shape. 12. The emboli extraction catheter and vascular filter system according to claim 1, wherein said distal end of said catheter comprises a plurality of longitudinal slits. 13. A method for capturing embolic particulates within a vascular filter in the lumen of a vessel, and retrieving them at the end of the procedure, comprising the steps of: a) inserting a guidewire into said lumen, said guidewire having a proximal end and a distal end, and a vascular filter attached near said distal end of said guidewire, said filter comprising a proximal portion, a distal portion, and a plurality of struts extending therebetween, said filter further comprising a porous flexible filter membrane, said vascular filter having a smaller first diameter for insertion into said lumen, and a second larger diameter for expanding to substantially equal the diameter of said lumen and to be placed in generally sealing relationship with said lumen; b) advancing said guidewire until said distal end of said guidewire is positioned past a vascular occlusion in said vessel; c) deploying said filter in said lumen, distal to said vascular occlusion; d) advancing additional interventional devices over said guidewire, and positioning said devices at the site of said occlusion in said vessel; e) performing additional procedures to therapeutically treat said occlusion in said vessel; f) capturing embolic particulates generated by said procedures in said filter; g) removing said interventional devices from said guidewire; h) slidably inserting a flexible catheter over said guidewire, said flexible catheter comprising an outer diameter and an inner diameter, a proximal end and a distal end, and an inner lumen, a radio-opaque tip near said distal end of said catheter, and a hub permanently attached to said proximal end of said catheter, said hub having an outer diameter and an inner diameter, a proximal end and a distal end, and an inner lumen, said lumen of said hub being in fluid communication with said lumen of said catheter, said hub further comprising a sideport and means for maintaining a seal on said guidewire; i) advancing said flexible catheter over said guidewire until said radio-opaque tip is as close as possible to said proximal portion of said filter; j) attaching a syringe to said sideport of said hub; k) using said syringe to aspirate said embolic particulates from said filter; l) removing said catheter from said lumen; m) collapsing said filter in said-lumen; and n) removing said guidewire and said filter from said lumen. 14. A method for capturing embolic particulates within a vascular filter in the lumen of a vessel, and retrieving them during the procedure, comprising the steps of: a) inserting a guidewire into said lumen, said guidewire having a proximal end and a distal end, and a vascular filter attached near said distal end of said guidewire, said filter comprising a proximal portion, a distal portion, and a plurality of struts extending therebetween, said filter further comprising a porous flexible filter membrane, said vascular filter having a smaller first diameter for insertion into said lumen, and a second larger diameter for expanding to substantially equal the diameter of said lumen and to be placed in generally sealing relationship with said lumen; b) advancing said guidewire until said distal end of said guidewire is positioned past a vascular occlusion in said vessel; c) deploying said filter in said lumen, distal to said vascular occlusion; d) advancing additional interventional devices over said guidewire, and positioning said devices at the site of said occlusion in said vessel; e) performing additional procedures to therapeutically treat said occlusion in said vessel; f) capturing embolic particulates generated by said procedures in said filter; g) removing said interventional devices from said guidewire; h) slidably inserting a flexible catheter over said guidewire, said flexible catheter comprising an outer diameter and an inner diameter, a proximal end and a distal end, and an inner lumen, a radio-opaque tip near said distal end of said catheter; and a hub permanently attached to said proximal end of said catheter, said hub having an outer diameter and an inner diameter, a proximal end and a distal end, and an inner lumen, said lumen of said hub being in fluid communication with said lumen of said catheter, said hub further comprising a sideport and means for maintaining a seal on said guidewire; i) advancing said flexible catheter over said guidewire until said radio-opaque tip is as close as possible to said proximal portion of said filter; j) attaching a syringe to said sideport of said hub; k) using said syringe to aspirate said embolic particulates from said filter; l) removing said catheter from said lumen; and m) advancing additional interventional devices over said guidewire to complete therapeutic treatment of said occlusion in said vessel. 15. An emboli extraction catheter and vascular filter system for insertion into a lumen of a vessel, the system comprising: a) a guidewire having a proximal end and a distal end; b) a vascular filter attached near said distal end of said guidewire, said filter comprising at least one support hoop, said at least one support hoop having an articulation region, said filter further comprising a porous flexible sac affixed to said at least one support hoop at the greatest distance from said distal end of said guidewire, so that said hoop forms the mouth of said sac, said vascular filter having a smaller first diameter for insertion into said lumen, and a second larger diameter for expanding to substantially equal the diameter of said lumen and to be placed in generally sealing relationship with said lumen; c) actuating means for causing said vascular filter to move from said smaller first diameter to said larger second diameter and back to said smaller first diameter; d) a flexible catheter having an outer diameter and an inner diameter, a proximal end and a distal end, a proximal portion and a distal portion, and an inner lumen, with said proximal end of said guidewire slidably insertable into said distal end of said catheter, said catheter further comprising a perforation in said catheter distal portion, with said distal portion of said catheter distal to said perforation positioned substantially parallel to but offset from the longitudinal axis of said catheter; e) a radio-opaque tip near said distal end of said catheter; and f) a hub permanently attached to said proximal end of said catheter, said hub having an outer diameter and an inner diameter, a proximal end and a distal end, and an inner lumen, said hub further comprising a sideport and means for maintaining a seal on the guidewire, said lumen of said hub being in fluid communication with said lumen of said catheter. 16. The emboli extraction catheter and vascular filter system according to claim 15, wherein said guidewire is made from Nickel-Titanium alloy. 17. The emboli extraction catheter and vascular filter system according to claim 15, wherein said vascular filter is made from Nickel-Titanium alloy. 18. The emboli extraction catheter and vascular filter system according to claim 15, wherein said porous flexible sac is made from a flexible polymeric material chosen from a group consisting of polyurethane, polyethylene or a co-polymer thereof. 19. The emboli extraction catheter and vascular filter system according to claim 15, wherein the pore size of said porous flexible sac is from about 20 to about 300 microns. 20. The emboli extraction catheter and vascular filter system according to claim 15, wherein said actuating means is a sheath. 21. The emboli extraction catheter and vascular filter system according to claim 15, wherein said catheter is made from a polymeric material. 22. The emboli extraction catheter and vascular filter system according to claim 15, wherein said proximal portion of said catheter is reinforced with braid wire. 23. The emboli extraction catheter and vascular filter system according to claim 15, wherein said proximal portion of said catheter comprises a flexible coil. 24. The emboli extraction catheter and vascular filter system according to claim 15, wherein said distal portion of said catheter is constructed of lower durometer material than said proximal portion of said catheter. 25. A method for capturing embolic particulates within a vascular filter in the lumen of a vessel, and retrieving them at the end of the procedure, comprising the steps of: a) inserting a guidewire into said lumen, said guidewire having a proximal end and a distal end, and a vascular filter attached near said distal end of said guidewire, said filter comprising at least one support hoop, said at least one support hoop having an articulation region, said filter further comprising a porous flexible sac affixed to said at least one support hoop at greatest distance from said distal end of said guidewire, so that said hoop forms the mouth of said sac, said vascular filter having a smaller first diameter for insertion into said lumen, and a second larger diameter for expanding to substantially equal the diameter of said lumen and to be placed in generally sealing relationship with said lumen; b) advancing said guidewire until said distal end of said guidewire is positioned past a vascular occlusion in said vessel; c) deploying said filter in said lumen, distal to said vascular occlusion; d) advancing additional interventional devices over said guidewire, and positioning said devices at said site of said occlusion in said vessel; e) performing additional procedures to therapeutically treat said occlusion in said vessel; f) capturing embolic particulates generated by said procedures in said filter; g) removing said interventional devices from said guidewire; h) slidably inserting a flexible catheter over said guidewire, said flexible catheter comprising an outer diameter and an inner diameter, a proximal end and a distal end, a proximal portion and a distal portion, and an inner lumen, said catheter further comprising a perforation in said distal portion, with said distal portion of said catheter distal to said perforation positioned substantially parallel to but offset from the longitudinal axis of said catheter, a radio-opaque tip near said distal end of said catheter, and a hub permanently attached to said proximal end of said catheter, said hub having an outer diameter and an inner diameter, a proximal end and a distal end, and an inner lumen, said lumen of said hub being in fluid communication with said lumen of said catheter, said hub further comprising a sideport and means for maintaining a seal on said guidewire; i) advancing said flexible catheter over said guidewire until said radio-opaque tip is inserted into said porous flexible sac of said filter; j) attaching a syringe to said sideport of said hub; k) using said syringe to aspirate said embolic particulates from said filter; l) removing said catheter from said lumen; m) collapsing said filter in said lumen; and n) removing said guidewire and said filter from said lumen. 26. A method for capturing embolic particulates within a vascular filter in the lumen of a vessel, and retrieving them during the procedure, comprising the steps of: a) inserting a guidewire into said lumen, said guidewire having,a proximal end and a distal end, and a vascular filter attached near said distal end of said guidewire, said filter comprising at least one support hoop, said at least one support hoop having an articulation region, said filter further comprising a porous flexible sac affixed to said at least one support hoop at the greatest distance from said distal end of said guidewire, so that said hoop forms the mouth of said sac, said vascular filter having a smaller first diameter for insertion into said lumen, and a second larger diameter for expanding to substantially equal the diameter of said lumen and to be placed in generally sealing relationship with said lumen; b) advancing said guidewire until said distal end of said guidewire is positioned past a vascular occlusion in said vessel; c) deploying said filter in said lumen, distal to said vascular occlusion; d) advancing additional interventional devices over said guidewire, and positioning said devices at said site of said occlusion in said vessel; e) performing additional procedures to therapeutically treat said occlusion in said vessel; f) capturing embolic particulates generated by said procedures in said filter; g) removing said interventional devices from said guidewire; h) slidably inserting a flexible catheter over said guidewire, said flexible catheter comprising an outer diameter and an inner diameter, a proximal end and a distal end, a proximal portion and a distal portion, and an inner lumen, said catheter further comprising a perforation in said distal portion, with said distal portion of said catheter distal to said perforation positioned substantially parallel to but offset from said longitudinal axis of said catheter; a radio-opaque tip near said distal end of said catheter, and a hub permanently attached to said proximal end of said catheter, said hub having an outer diameter and an inner diameter, a proximal end and a distal end, and an inner lumen, said lumen of said hub being in fluid communication with said lumen of said catheter, said hub further comprising a sideport and means for maintaining a seal on said guidewire; i) advancing said flexible catheter over said guidewire until said radio-opaque tip is inserted into said porous flexible sac of said filter; j) attaching a syringe to said sideport of said hub; k) using said syringe to aspirate said embolic particulates from said filter; l) removing said catheter from said lumen; and m) advancing additional interventional devices over said guidewire to complete therapeutic treatment of said occlusion in said vessel. Description
BACKGROUND [0001] 1. Field of the Invention [0002] The present invention relates to the treatment of vascular disease, and more particularly to an emboli extraction catheter and vascular filter system for use during medical procedures. [0003] 2. Discussion of Related Art [0004] Percutaneous transluminal coronary angioplasty (PTCA), stenting and atherectomy are therapeutic medical procedures used to increase blood flow through the coronary arteries. These procedures can often be performed as alternatives to coronary bypass surgery. Percutaneous transluminal angioplasty (PTA) and stenting can often be performed as alternatives to carotid endarterectomy, and femoral-popliteal bypass procedures. In PTCA or PTA procedures, the angioplasty balloon is inflated within the stenosed vessel, at the location of an occlusion, in order to shear and disrupt the wall components of the vessel to obtain an enlarged lumen. In stenting, an endoluminal prosthesis is implanted in the vessel to maintain patency following the procedure. In atherectomy, a rotating blade is used to shear plaque from the arterial wall. [0005] One of the complications associated with all these techniques is the accidental dislodgment of plaque, thrombus or other embolic particulates generated during manipulation of the vessel, thereby causing occlusion of the narrower vessels downstream and ischemia or infarct of the organ which the vessel supplies. Such emboli may be extremely dangerous to the patient, and may result in myocardial infarction, stroke or limb ischemia. In 1995, Waksman et al. disclosed that distal embolization is common after directional atherectomy in coronary arteries and saphenous vein grafts. See Waksman et al., American Heart Journal 129(3): 430-5 (1995). This study found that distal embolization occurs in 28% (31 out of 111) of the patients undergoing atherectomy. In January 1999, Jordan, Jr. et al. disclosed that treatment of carotid stenosis using percutaneous angioplasty with stenting procedure is associated with more than eight times the rate of microemboli seen using carotid endarterectomy. See Jordan, Jr. et al. Cardiovascular Surgery 7(1): 33-8 (1999). Microemboli, as detected by transcranial Doppler monitoring in this study, have been shown to be a potential cause of stroke. The embolic materials include calcium, intimal debris, atheromatous plaque, and thrombi. [0006] In order to initiate these PTCA or PTA procedures, one must first introduce a guidewire into the lumen of the vessel to serve as a conduit for other interventional devices, such as angioplasty balloons and stent delivery systems. This guidewire must be advanced into a position past the location of the occlusion. Guidewires must be capable of traversing tortuous pathways within the body, consisting of bends, loops and branches. For this reason, guidewires need to be flexible, but they should also be sufficiently stiff to serve as conduits for other devices. In addition, they must be “torqueable” to facilitate directional changes as they are guided into position. Guidewires are well known in the art, and are typically made of stainless steel, tantalum or other suitable materials, in a variety of different designs. For example, U.S. Pat. Nos. 4,545,390 and 4,619,274 disclose guidewires in which the distal segment is tapered for greater flexibility. The tapered section may be enclosed in a wire coil, typically a platinum coil, which provides increased column strength and torqueability. Another design is identified in U.S. Pat. No. 5,095,915, where the distal segment is encased in a polymer sleeve with axially spaced grooves to provide bending flexibility. [0007] Vascular filters are also well known in the art, especially vena cava filters, as illustrated in U.S. Pat. Nos. 4,727,873 and 4,688,553. There is also a substantial amount of medical literature describing various designs of vascular filters and reporting the results of clinical and experimental use thereof. See, for example, the article by Eichelter and Schenk, entitled “Prophylaxis of Pulmonary Embolism,” Archives of Surgery, Vol. 97 (August, 1968). See, also, the article by Greenfield, et al, entitled “A New Intracaval Filter Permitting Continued Flow and Resolution of Emboli”, Surgery, Vol. 73, No. 4 (1973). [0008] Vascular filters are often used during a postoperative period, when there is a perceived risk of a patient encountering pulmonary embolism resulting from clots generated peri-operatively. Pulmonary embolism is a serious and potentially fatal condition that occurs when these clots travel to the lungs. The filter is therefore typically placed in the vena cava to catch and trap clots before they can reach the lungs. [0009] Many of the vascular filters in the prior art are intended to be permanently placed in the venous system of the patient, so that even after the need for the filter has passed, the filter remains in place for the life of the patient. U.S. Pat. No. 3,952,747 describes a stainless steel filtering device that is permanently implanted transvenously within the inferior vena cava. This device is intended to treat recurrent pulmonary embolism. Permanent implantation is often deemed medically undesirable, but it is done because filters are implanted in patients in response to potentially life-threatening situations. [0010] To avoid permanent implantation, it is highly desirable to provide an apparatus and method for preventing embolization associated with angioplasty, stenting or other procedures. In particular, it is desirable to provide a device which can be temporarily placed within the vascular system to collect and retrieve plaque, thrombus and other embolic particulates which have been dislodged during angioplasty, stenting or other procedures. Such a device is removed at the end of the procedure. U.S. Pat. Nos. 5,814,064 and 5,827,324 describe guidewire-based filter devices, wherein the filter is expanded to a predetermined diameter through the introduction of a fluid or a gas. U.S. Pat. No. 5,910,154 describes a guidewire-based filter, which expands to a predetermined diameter through the use of a spring-based actuator. U.S. Pat. No. 6,053,932 describes a guidewire-based filter which expands to a predetermined diameter through the use of a cinch assembly. U.S. Pat. Nos. 6,179,861 and 6,001,118 describe guidewire-based filters where the filter resembles a windsock and is supported by one or more articulated support hoops. [0011] One concern commonly encountered with all these devices is that embolic particulates, once captured, might inadvertently be released during withdrawal of the filter, resulting in emboli which may lodge elsewhere in the vascular system. Another concern commonly encountered with all these devices is that the filter can become full to the point of blocking distal flow, and must then be collapsed, removed and replaced in order to continue the procedure. This complicates the procedure, and also temporarily leaves the site without a filter. [0012] The prior art makes reference to the use of aspiration catheters to remove embolic particulates released during therapeutic procedures. U.S. Pat. No. 6,159,195 describes an occlusion system wherein it is suggested to deploy a separate aspiration catheter to suction embolic material captured in the working space created by the occlusive device positioned in the vessel. U.S. Pat. No. 6,152,909 describes a dual lumen aspiration catheter to be used in therapeutic procedures in conjunction with an occlusive device. [0013] However, the prior art has yet to disclose any guidewire-based vascular filters incorporating means to retrieve embolic particulates from the filters, which can be used to address the clinical problem of avoiding accidental release of embolic particulates, once captured, during angioplasty, stenting or other procedures, and can also be used to address the clinical problem of emptying full guidewire-based filters of embolic particulates which may block distal flow, without the need to collapse, remove and replace the filter in order to continue the angioplasty, stenting or other procedure. SUMMARY OF THE INVENTION [0014] The present invention provides for a emboli extraction catheter and vascular filter system which can be used to aspirate embolic particulates, so as to avoid their accidental release after they are captured in a guidewire-based vascular filter, and can also be used to empty full guidewire-based vascular filters of embolic particulates which may block distal flow. This invention overcomes many of the concerns associated with the prior art devices, as briefly described above. [0015] In accordance with one aspect, the present invention is directed to an emboli extraction catheter and vascular filter system for insertion into a lumen of a vessel, comprising a guidewire, a basket-shaped vascular filter attached near the distal end of the guidewire, and an emboli extraction catheter. The vascular filter has a smaller first diameter for insertion into the lumen, and a second larger diameter for expanding to substantially equal the diameter of the lumen and to be placed in generally sealing relationship with the lumen. The emboli extraction catheter is a flexible catheter having a radio-opaque tip near the distal end of the catheter, and a hub attached to the proximal end of the catheter. The hub further comprises a sideport and means for maintaining a seal on the guidewire, the lumen of the hub being in fluid communication with the lumen of the catheter. [0016] The vascular filter is inserted into the lumen of a vessel and is used to capture embolic particulates released during interventional procedures. Then, the emboli extraction catheter is inserted over the guidewire, and is positioned as close as possible to the proximal end of the filter. The catheter is then used to aspirate embolic particulates from the filter, so as to avoid their accidental release. It can also be used to empty full vascular filters of embolic particulates which may block distal flow. [0017] In accordance with another aspect, the present invention is directed to an emboli extraction catheter and vascular filter system for insertion into a lumen of a vessel, comprising a guidewire, a basket-shaped vascular filter attached near the distal end of the guidewire, and an emboli extraction catheter. The vascular filter has a smaller first diameter for insertion into the lumen, and a second larger diameter for expanding to substantially equal the diameter of the lumen and to be placed in generally sealing relationship with the lumen. The emboli extraction catheter is a flexible catheter having a radio-opaque tip near the distal end of the catheter, a fluted or serrated shape, or a plurality of longitudinal slits at the distal end of the catheter, and a hub attached to the proximal end of the catheter. The hub further comprises a sideport and means for maintaining a seal on the guidewire, the lumen of the hub being in fluid communication with the lumen of the catheter. [0018] The vascular filter is inserted into the lumen of a vessel and is used to capture embolic particulates released during interventional procedures. Then, the emboli extraction catheter is inserted over the guidewire, and the fluted or serrated shape or longitudinal slits at the distal end of the catheter allow it to be positioned as close as possible to the proximal end of the filter. The catheter is then used to aspirate embolic particulates from the filter, so as to avoid their accidental release. It can also be used to empty full vascular filters of embolic particulates which may block distal flow. [0019] In accordance with another aspect, the present invention is directed to an emboli extraction catheter and vascular filter system for insertion into a lumen of a vessel, comprising a guidewire, a windsock-shaped filter attached near the distal end of the guidewire, and a emboli extraction catheter. The vascular filter has a smaller first diameter for insertion into the lumen, and a second larger diameter for expanding to substantially equal the diameter of the lumen and to be placed in generally sealing relationship with the lumen. The emboli extraction catheter is a flexible catheter having a perforation in the distal portion, with the portion of the catheter distal to the perforation positioned substantially parallel to but offset from the longitudinal axis of the catheter. The emboli extraction catheter further comprises a radio-opaque tip near the distal end of the catheter, and a hub attached to the proximal end of the catheter. The hub further comprises a sideport and means for maintaining a seal on the guidewire, the lumen of the hub being in fluid communication with the lumen of the catheter. [0020] The vascular filter is inserted into the lumen of a vessel and is used to capture embolic particulates released during interventional procedures. Then, the emboli extraction catheter is inserted over the guidewire and into the filter. The catheter is then used to aspirate embolic particulates from the filter, so as to avoid their accidental release. It can also be used to empty full vascular filters of embolic particulates which may block distal flow. [0021] The advantage of the present invention is that the embolic particulates can safely be removed from a vascular filter after they are captured, thereby avoiding their accidental release, which can result in occlusion of the narrower vessels downstream and ischemia or infarct of the organ which the vessel supplies. Another advantage of the present invention is that full filters can be emptied, and distal flow can be restored, without removing and replacing the guidewire-based filter, and without leaving the site temporarily without a filter during the procedure.
BRIEF DESCRIPTION OF DRAWINGS [0022] The foregoing and other aspects of the present invention will best be appreciated with reference to the detailed description of the invention in conjunction with the accompanying drawings, wherein: [0023] [0023]FIG. 1 is a simplified, cross-sectional view of an exemplary embodiment of the emboli extraction catheter and vascular filter system, with the emboli extraction catheter positioned as close as possible to a basket-shaped filter before the aspiration step. [0024] [0024]FIG. 2 is a simplified, cross sectional view of an exemplary embodiment of the emboli extraction catheter and vascular filter system, with the emboli extraction catheter positioned as close as possible to a basket-shaped filter during the aspiration step. [0025] [0025]FIGS. 3A, 3B and 3C are simplified, enlarged, partial cross-sectional views of other exemplary embodiments of the emboli extraction catheter and vascular filter system, wherein the distal tip of the emboli extraction catheter is fluted, serrated or slit. [0026] [0026]FIG. 4 is a simplified, cross-sectional view of an exemplary embodiment of the emboli extraction catheter and vascular filter system, with the emboli extraction catheter positioned as close as possible to a windsock-shaped filter before the aspiration step.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS [0027] The emboli extraction catheter and vascular filter system of the present invention is designed to address the clinical problem of avoiding accidental release of embolic particulates after they are captured in a guidewire-based vascular filter, and is also designed to address the clinical problem of emptying full guidewire-based vascular filters of embolic particulates which may block distal flow. [0028] The emboli extraction catheter and vascular filter system comprises a guidewire, a vascular filter attached near the distal end of the guidewire, and an emboli extraction catheter. The vascular filter has a porous covering, a smaller first diameter for insertion into the lumen, and a second larger diameter for expanding to substantially equal the diameter of the lumen and to be placed in generally sealing relationship with the lumen of the vessel. The system comprises actuating means for causing the vascular filter to move from the smaller first diameter to the larger second diameter and back. The emboli extraction catheter is a flexible catheter having an inner lumen, with the guidewire slidably insertable into the lumen. The catheter further comprises a radio-opaque tip near the distal end of the catheter, and a hub, with an inner lumen, attached to the proximal end of the catheter. The hub further comprises a sideport and means for maintaining a seal on the guidewire, with the lumen of the hub being in fluid communication with the lumen of the catheter. [0029] The vascular filter is inserted into the lumen of a vessel and is used to capture embolic particulates released during interventional procedures. Then, the emboli extraction catheter is inserted over the guidewire and is positioned as close as possible to, or into the filter. The catheter is then used to aspirate embolic particulates from the filter, so as to avoid their accidental release. It can also be used to empty full vascular filters of embolic particulates which may block distal flow. [0030] While the present invention may be realized in a number of exemplary embodiments, for ease of explanation, two exemplary embodiments will be described in detail. Referring to the figures wherein like numerals indicate the same element throughout the views, there is shown in FIG. 1, an emboli extraction catheter and vascular filter system made in accordance with the present invention. The vascular filter comprises a guidewire 22 and a basket-shaped filter 24, with a porous covering 23. The emboli extraction catheter comprises a catheter 12, with a radio-opaque tip 20 near the distal end of the catheter 12, and a hub 14 attached to the proximal end of the catheter 12, the hub comprising a sideport 16, and means for maintaining a seal on the guidewire 18. As illustrated in FIG. 1, the lumen of the catheter 12 is in fluid communication with the lumen of the hub 14. Therefore, as illustrated in FIG. 1, the distal end of the catheter 12 has been slidably inserted over the proximal end of the guidewire 22. As illustrated in FIG. 1, the guidewire 22 is now coaxially disposed within the catheter 12, and the radio-opaque tip 20 on the catheter 12 allows the operator to visualize when the distal end of the catheter 12 is as close as possible to the proximal end of the basket-shaped filter 24. [0031] [0031]FIG. 2 shows an exemplary embodiment of the emboli extraction catheter and vascular filter system made in accordance with the present invention. As illustrated in FIG. 2, when the radio-opaque tip 20 is positioned as close as possible to the basket-shaped filter 24, a syringe may be attached to the sideport 16 to aspirate the column of blood and embolic particulates from the filter 24. [0032] [0032]FIGS. 3A, 3B and 3C shows partial views of the distal end of an emboli extraction catheter made in accordance with the present invention. As illustrated in FIG. 3A, the distal end of the catheter may comprise a plurality of slits 56, to allow the emboli extraction catheter 12 to be positioned as close as possible to the basket-shaped filter 24, so as to avoid accidental release of embolic particulates during the aspiration step. As illustrated in FIG. 3B, the distal end of the catheter may be fluted 52, to allow the emboli extraction catheter 12 to be positioned as close as possible to the basket-shaped filter 24, so as to avoid accidental release of embolic particulates during the aspiration step. As illustrated in FIG. 3C, the distal end of the catheter may be serrated 54, to allow the emboli extraction catheter 12 to be positioned as close as possible to the basket-shaped filter 24, so as to avoid accidental release of embolic particulates during the aspiration step. [0033] The basket-shaped vascular filter 24 and the guidewire 22 may be made from any number of suitable materials, and are preferably made from a superelastic alloy such as Nickel-Titanium. The porous covering 23 on the basket-shaped filter 24 may be made from any number of suitable materials, and is preferably made from a flexible polymeric material with elastomeric properties chosen from a group consisting of polyurethane, polyethylene or a co-polymer thereof. The porous covering 23 on the filter 24 may comprise any number and configuration of pores and preferably comprises regularly-spacer laser-formed holes wherein the pore size is from about 20 to about 300 microns. The filter may be deployed by any suitable means, and is preferably deployed through the use of a sheath, which covers and restrains the filter during insertion into the lumen, is retracted thereafter to allow the filter to achieve its maximum diameter, then is advanced over the filter to cover and restrain it during removal of the guidewire and filter. The emboli extraction catheter 12 may be made from any number of suitable materials, and is preferably made from commercially available polymers, such as polyamide, high or low-density polyethylene, polyimide or polyurethane. The distal shaft of the emboli extraction catheter 12 may be constructed from any number of suitable materials, and is preferably constructed from lower durometer material than the proximal shaft of the emboli extraction catheter, to facilitate tracking and to avoid trauma to the artery. The distal shaft of the emboli extraction catheter 12 may also comprise a flexible coil to maintain flexibility and to prevent collapse of the catheter lumen during the aspiration step. The proximal shaft of the emboli extraction catheter 12 may be constructed from any number of suitable materials, and is preferably reinforced with braid wire to enhance pushability. [0034] The exemplary embodiment of the emboli extraction catheter, as illustrated in FIGS. 1, 2 and 3, can be used to aspirate embolic particulates, so as to avoid their accidental release after they are captured in a vascular filter, and can also be used to empty full vascular filters of embolic particulates which may block distal flow. Once the guidewire 22, comprising a filter 24, has been inserted into a vessel and has been used to collect embolic particulates which have been dislodged during angioplasty, stenting or other procedures, the emboli extraction catheter 12 can then be inserted over the guidewire. When the radio-opaque tip 20 of the catheter 12 is visualized to be as close as possible to the proximal end of the filter 24, the emboli extraction catheter 12 is in position. At this point, a syringe may be attached to the sideport 16 to aspirate the column of blood and embolic particulates from the filter 24. Once the embolic particulates have been aspirated, the syringe may be removed from the sideport 16, and the emboli extraction catheter 10 may be removed from the vessel. If the interventional procedure is complete, the guidewire 22 and filter 24 may also be removed at this point, without concern regarding accidental release of embolic particulates. If the interventional procedure is incomplete, the guidewire 22 and filter 24 may remain in position, and may collect additional embolic particulates, while still permitting distal flow. [0035] [0035]FIG. 4 shows another exemplary embodiment of the emboli extraction catheter and vascular filter system made in accordance with the present invention. The vascular filter device comprises a guidewire 33 and a windsock-shaped filter 35. The windsock-shaped filter 35 comprises at least one support hoop 39, having an articulation region 31, and a porous flexible sac 37 affixed to the at least one support hoop 39 at the greatest distance from the distal end of the guidewire 33, so that the support hoop 39 forms the mouth of the porous flexible sac 37. The emboli extraction catheter comprises a catheter 32, a radio-opaque tip 40 near the distal end of the catheter 32, and a hub 34 attached to the proximal end of the catheter 32, the hub comprising a sideport 36, and means for maintaining a seal on the guidewire 38. The catheter 32 further comprises a perforation 50 near the distal end of the catheter 32. The portion of the emboli extraction catheter 32 distal to the perforation 50 is positioned substantially parallel to but offset from the longitudinal axis of the catheter 32. As illustrated in FIG. 4, the lumen of the catheter 32 is in fluid communication with the lumen of the hub 34. Therefore, as illustrated in FIG. 4, the proximal end of the guidewire 33 has been slidably inserted into the perforation 50 near the distal end of the catheter. As illustrated in FIG. 4, the guidewire 33 is now coaxially disposed within the portion of the catheter proximal to the perforation 50, and the radio-opaque tip 40 on the catheter 32 allows the operator to visualize when the distal end of the catheter 32 has been inserted through the support hoop 39 and into the porous flexible sac 37 of the windsock-shaped filter 35. [0036] As illustrated in FIG. 4, when the radio-opaque tip 40 has been inserted into the filter 35, then the system is ready for the aspiration step. A syringe may then be attached to the sideport 36 to aspirate the column of blood and embolic particulates from the filter 35. [0037] The at least one support hoop 39 of the windsock-shaped filter 35, and the guidewire 33, may be made from any number of suitable materials, and are preferably made from a superelastic alloy such as Nickel-Titanium. The porous flexible sac 37 on the windsock-shaped filter 35 may be made from any number of suitable materials, and is preferably made from a flexible polymeric material with elastomeric properties chosen from a group consisting of polyurethane, polyethylene or a co-polymer thereof. The porous flexible sac 37 on the windsock-shaped filter 35 may comprise any number and configuration of pores and preferably comprises regularly-spacer laser-formed holes wherein the pore size is from about 20 to about 300 microns. The filter may be deployed by any suitable means, and is preferably deployed through the use of a sheath, which covers and restrains the filter during insertion into the lumen, is retracted thereafter to allow the filter to achieve its maximum diameter, then is advanced over the filter to cover and restrain it during removal of the guidewire and the filter. The emboli extraction catheter 32 may be made from any number of suitable materials, and is preferably made from commercially available polymers, such as polyamide, high or low density polyethylene, polyimide or polyurethane. The distal shaft of the emboli extraction catheter 32 may be constructed from any number of suitable materials, and is preferably constructed from lower durometer material than the proximal shaft of the emboli extraction catheter, to facilitate tracking and to avoid trauma to the artery. The distal shaft of the emboli extraction catheter 32 may also comprise a flexible coil to maintain flexibility and to prevent collapse of the catheter lumen during the aspiration step. The proximal shaft of the emboli extraction catheter 32 may be constructed from any number of suitable materials, and is preferably reinforced with braid wire to enhance-pushability. [0038] The exemplary embodiment of the emboli extraction catheter, as illustrated in FIG. 4, can be used to aspirate embolic particulates, so as to avoid their accidental release after they are captured in a vascular filter, and can also be used to empty full vascular filters of embolic particulates which may block distal flow. Once the guidewire 33, comprising a filter 35, has been inserted into a vessel and has been used to collect embolic particulates which have been dislodged during angioplasty, stenting or other procedures, the emboli extraction catheter 32 can then be inserted over the guidewire 33 by inserting the proximal end of the guidewire 33 into the perforation 50 near the distal end of the catheter 32. When the radio-opaque tip 40 is visualized to have been inserted into the filter 35, the emboli extraction catheter 32 is in position. At this point, a syringe may be attached to the sideport 36 to aspirate the column of blood and embolic particulates from the filter 35. Once the embolic particulates have been aspirated,- the syringe may be removed from the sideport 36, and the emboli extraction catheter 32 may be removed from the vessel. If the interventional procedure is complete, the guidewire 33 with filter 35 may also be removed at this point, without concern regarding accidental release of embolic particulates. If the interventional procedure is incomplete, the guidewire 33 with filter 35 may remain in position, and may collect additional embolic particulates, while still permitting distal flow. [0039] Although shown and described are what are believed to be the preferred embodiments, it is apparent that departures from specific designs and methods described and shown will suggest themselves to those skilled in the art and may be used without departing from the spirit and scope of the invention. The present invention is not restricted to the particular constructions described and illustrated, but should be constructed to include all modifications that may fall within the scope of the appended claims. 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Cardiovascular Systems, Inc.Filter device for embolic protection systemsUS20080172066 *Jul 27, 2006Jul 17, 2008Galdonik Jason AEmbolectomy procedures with a device comprising a polymer and devices with polymer matrices and supportsUS20080215084 *Apr 14, 2008Sep 4, 2008Advanced Cardiovascular Systems, Inc.Delivery systems for embolic filter devicesUS20080275498 *Apr 29, 2008Nov 6, 2008Endosvascular Technologies, Inc.Embolic basketUS20090012468 *Sep 18, 2008Jan 8, 2009Anderson Kent DDistal protection device with local drug infusion by physician to maintain patencyUS20090030445 *Aug 6, 2008Jan 29, 2009Advanced Cardiovascular Systems, Inc.Delivery sysems for embolic filter devicesUS20090062840 *Aug 31, 2007Mar 5, 2009Artificial Airways, Inc.Multi-lumen central access vena cava filter apparatus and method of using sameUS20090228036 *Apr 14, 2009Sep 10, 2009Advanced Cardiovascular Systems, Inc.Apparatus for capturing objects beyond an operative site utilizing a capture device delivered on a 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Classification606/200International ClassificationA61B17/22, A61F2/01Cooperative ClassificationA61F2/013, A61B17/22031European ClassificationA61B17/22ELegal EventsDateCodeEventDescriptionJun 29, 2011FPAYFee paymentYear of fee payment: 4Jul 15, 2015FPAYFee paymentYear of fee payment: 8RotateOriginal ImageGoogle Home - Sitemap - USPTO Bulk Downloads - Privacy Policy - Terms of Service - About Google Patents - Send FeedbackData provided by IFI CLAIMS Patent Services


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Childrens Play - Rustic - Kids - san francisco - by Keith Willig Landscape Services, Inc.
Keith Willig Landscape Services, Inc.Landscape Architects & Designers	Email	Save to Ideabook2k+Ask a Question1Print	Childrens Play
Kids Treehouse Playhouse	URL
nimitabhatt wrote:
How do I get high-res press images from Houzz? - I am the editorial at MoveTo and I needed a few high-res press images for a few tree houses I liked. Please would you e-mail me at n.bhatt@barrelfield.co.ukKind regards, Nimita Like Comment	Sign Up to comment	What Houzzers are commenting on:
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I woulike to see more about it.ruffyrex added this to Kids IdeasDecember 22, 2013why notJessica Havlir added this to jessica_havlir's ideasDecember 10, 2013idea for kidsLaurie Ruggiero added this to backyardNovember 15, 2013willow fencecglvsdesign added this to TreehouseNovember 4, 2013great bones/conceptjke28 added this to Kids' StuffNovember 3, 2013playhouse - rusticAlysha Parkkonen added this to clayton'sNovember 3, 2013Tree housetxmom22 added this to txmom22's ideasOctober 27, 2013Rusticjoe1933 added this to wooden fencesOctober 27, 2013naturaldellabean added this to Dream houseOctober 26, 2013Playhouse/fort with reclaimed materialsdarboy added this to darboy's IdeasOctober 26, 2013Tree housedaniellemcgrain added this to Mom and DadOctober 26, 2013Oliver would like to know if there is room for a fort?!jeannie_reas added this to Outdoor SpacesOctober 26, 2013Perfect--simple & rustic. Love the fence!!z1984 added this to playhousesOctober 12, 2013Lanthonymore added this to anthonymore's FavoritesOctober 8, 2013Play houselrvds added this to SeattleOctober 8, 2013playhouseMatt Lisner added this to lisnermatt's IdeasOctober 7, 2013Play house.Kelly Smith added this to kelly_smith4981's IdeasOctober 2, 2013Fortmamsa40 added this to Greenvalley LandscapeOctober 1, 2013children's play area with rustic fencelindagarcia719 added this to PlayhouseSeptember 27, 2013What I DON'T want it to look like!devine77 added this to devine77's ideasSeptember 21, 2013playhouseArmando Arce added this to armando_arce6240056's IdeasSeptember 20, 2013Edrymayarao added this to mayarao's ideasSeptember 19, 2013Under cordiaTiffany Davies added this to new yardSeptember 8, 2013Fortdawdeez added this to backyardSeptember 1, 2013Local landscaper architect. Very simpleKimberly Elwood added this to Landscape IdeasAugust 31, 2013private spacesanpatlin added this to sanpatlin's IdeasAugust 30, 2013shedyapsiewpeng added this to yapsiewpeng's IdeasAugust 27, 2013allhotflamerider added this to kid's fortAugust 26, 2013could use the pallet boards...also like the balconynicoleheroux added this to cabaneAugust 18, 2013Recyclagemamawithmoxie added this to boys backyardAugust 13, 2013Love the twig fence!gainesrya added this to gainesrya's IdeasAugust 8, 2013Create a boundary around children's play areajennkrejsa added this to jennkrejsa's ideasAugust 2, 2013bottom part of housekimsull4 added this to kimsull4's IdeasJuly 31, 2013Kids fortkellie1342 added this to outside projectsJuly 31, 2013This would be cool for kids/grandkids.nwduck added this to Kerri's GardenJuly 30, 2013Fort of reclaimed materialsflaggirl added this to Patio IdeasJuly 27, 2013for nateFujitsu Steffisaurus added this to fujitsu_steffisaurus's IdeasJuly 22, 2013Awesome treehouse/guesthouseanyajolie added this to YardJuly 19, 2013salvage fortarlinev added this to arlinev's IdeasJuly 12, 2013Treehouse, WHAT!nauston added this to house projectsJuly 11, 2013rustic fencing in front of play structurejamie7579 added this to jamie7579's ideasJuly 7, 2013my grands would love thisNancy's Garden Services added this to children's play areaJune 29, 2013natural wood structurekeithleen added this to keithleen's IdeasJune 29, 2013Treehousealyssajm added this to Back YardJune 28, 20132 story play housetraceyrowland added this to traceyrowland's IdeasJune 21, 2013Project for husbandpetpet added this to petpet's ideasJune 17, 2013Peut-être plus dans mes prix,
ça ressemble en gros à l'autremgdolfin added this to mgdolfin's IdeasJune 10, 2013for Michael--a real play houserealfruitgummie added this to Tree House ideasJune 6, 2013small 2 storystevebryant2013 added this to stevebryant2013's IdeasJune 2, 2013Neatpolllypigtails added this to Landscape IdeasJune 2, 2013rusticKelly McGrath added this to Yellow hiuseJune 1, 2013River hutamadinu added this to amadinu's ideasMay 22, 2013playjrissier added this to jrissier's ideasMay 21, 2013incorporates tree by same color groundzipzap added this to outsideMay 15, 2013love the "branch fence" in frontrayhogg added this to backyardMay 10, 2013Treehousejuliagrady added this to tree fortMay 5, 2013AlexBibette Prins added this to bibette_prins's IdeasMay 5, 2013Benn se boomhuischris5357 added this to chris5357's ideasMay 4, 2013Connorrugsland added this to rugsland's IdeasApril 30, 2013hytteColleen Hindman added this to exteriorApril 28, 2013Cool playhousekeeaton02 added this to keeaton02's IdeasApril 28, 2013Summer project with kids?katiecournoyer added this to katiecournoyer's IdeasApril 27, 2013Love the fun fence!borae95 added this to colin's fortApril 25, 2013forthottamolly00 added this to for next houseApril 24, 2013modkillercupcakez63 added this to killercupcakez63's ideasApril 23, 2013So cute!ajspeck added this to yardApril 19, 2013Fort-palletspboogaard added this to pboogaard's IdeasApril 13, 2013PlayhouseMelody Yesterday added this to rusticApril 12, 2013fencingNikki Filosa added this to treehousesApril 6, 2013coololdhousedream added this to TreehouseApril 5, 2013What I would like not to haveJake Peff added this to jake_peff's ideasMarch 31, 2013outsidetesadevina added this to tesadevina's IdeasMarch 24, 2013Tree housejessjacobs44 added this to treehouseMarch 20, 2013Treehouse in sandbox?khansen91 added this to khansen91's IdeasMarch 19, 2013Playhousenemesis2003 added this to nemesis2003's ideasMarch 19, 2013the tree houseandrewandariel added this to ExteriorMarch 13, 2013House in the treesdamae added this to damae's ideasMarch 8, 2013Kid's treehousealamilloperez added this to alamilloperez's ideasMarch 5, 2013cool kid housedrsrussett added this to drsrussett's IdeasMarch 2, 2013Treehousespitnut added this to spitnut's ideasFebruary 18, 2013someco ne brokw wimnd enewsd added this to newsd's ideasFebruary 17, 2013Casa sull'alberoStudio JPJ added this to exterior/yardFebruary 10, 2013Cool playhousebridgeburner added this to bridgeburner's ideasFebruary 8, 2013FenceAmber Ruggles added this to treehouseFebruary 3, 2013Woodtbeez added this to Backyard ideasJanuary 24, 2013funky fencescstrubbe added this to TreehousesJanuary 24, 2013like the simplicity, but this needs a finished lookpilitoro added this to pilitoro's IdeasJanuary 21, 2013Treehousejcscherie added this to jcscherie's ideasJanuary 20, 2013made of reclaimed woodkelly4lynch added this to outdoorsJanuary 11, 2013Playhouseelisej74 added this to elisej74's IdeasJanuary 9, 2013For kidsalaskangirl added this to Outside ideasJanuary 1, 2013Fortkvb121898 added this to kvb121898's IdeasDecember 28, 2012I would have this in my houseimwallace added this to W & V PlayhousesDecember 12, 2012Basic, privateGinger Albert added this to ginger_albert's ideasDecember 9, 2012johnnnericajsires added this to ericajsires's IdeasDecember 9, 2012Playhouse!annalouisedavis added this to outsideNovember 27, 2012Fencekaybeard added this to kaybeard's ideasNovember 25, 2012Guset houseastout123 added this to astout123's ideasNovember 9, 2012Fenceadamkyriacou added this to Cubby House IdeasNovember 5, 2012Rustic, 2 storey, use of reclaimed wood, sandpit underneatheugene28 added this to eugene28's ideasNovember 4, 2012Playhousekkblue33 added this to tree houseNovember 1, 2012cuteTudor Sri added this to tudorsri's IdeasOctober 28, 2012Hutsamanthacantwell added this to samanthacantwell's FavoritesOctober 27, 2012Treehousekimareej added this to kimareej's ideasOctober 24, 2012Rusticaslingit added this to gardenOctober 21, 2012big sandpit area under climbing frame?tiffanyglenn added this to tiffanyglenn's IdeasOctober 11, 2012Tree2Lori Anders added this to montecito ideasOctober 11, 2012playhousedustybiscuits added this to dustybiscuits's ideasOctober 1, 2012CubbyhouseBenjamin Darnell added this to benjamin_darnell's ideasOctober 1, 2012its looks fun and simpletymty77 added this to tymty77's ideasSeptember 26, 2012rustictowen added this to towen's IdeasSeptember 25, 2012Hideawaymohaid added this to mohaid's ideasSeptember 14, 2012fencemarcelagh added this to marcelagh's IdeasSeptember 9, 2012BardaJon Krouse added this to kidsSeptember 8, 2012Playhouselolirosner added this to lolirosner's IdeasSeptember 7, 2012Exterior. Casita chicosmesweat added this to mesweat's ideasAugust 26, 2012Grandkids would love this!!Christi Herber added this to christihope's ideasAugust 22, 2012OK Tim is this rustic enough???grsons2012 added this to grsons2012's ideasAugust 20, 2012small villa	Browse over 5 million home design photos on houzz	Related Products Villa Small Classic Beanbag, Vintage
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Simon Beresford, Teachers' Building Society: Profile & Biography - Bloomberg
Chief Executive Officer Teachers' Building Society, 2/2017-PRESENT
Mng Dir:Retail Business BlackRock Inc, UNKNOWN-2/2017
Branch Network Director Nationwide Building Society, FORMER
Managing Dir:Personal Loans Nationwide Building Society, FORMER

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Kevin HOWE Condolences | The Examiner
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