Use of magnetic implants to treat body tissue structures

Plural (at least two) magnetic devices are implanted in a patient so that magnetic interaction between those devices modifies the patient's body in one or more respects (e.g., by modifying the shape and/or performance of some part of the body) Prior to implantation, a location in the body may be marked for later reference during the implantation. The magnetism of one or more of the magnetic devices may be changed in vivo after implantation. One or more of the implanted devices may be subsequently removed from the patient if desired. Use of the magnetic devices inside tissue conduits (e.g., as a treatment for GERD) is especially considered by way of illustration.

Methods and apparatus for treating body tissue sphincters and the like

A plurality of structures that resiliently attract one another are provided for implanting in a patient around a body tissue structure of the patient. For example, the body tissue structure may be the esophagus, and the plurality of structures may be implanted in an annulus around the outside of the esophagus, the annulus being substantially coaxial with the esophagus. The attraction may be between annularly adjacent ones of the structures in the annulus, and it may be provided, for example, by magnets or springs. The array of structures is preferably self-limiting with respect to the smallest area that it can encompass, and this smallest area is preferably large enough to prevent the apparatus from applying excessive pressure to tissue passing through that area.

ENDOVASCULAR DEVICES AND METHODS

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion, inserting the device into the vascular lumen, positioning the distal portion in the vascular wall to at least partially surround the occlusion, and removing at least a portion of the surrounded occlusion from the lumen. 122-. (canceled)23. A medical device , comprising: a first tubular member defining a first lumen configured to receive a guidewire;', 'an expandable member located about the first tubular member; and', 'a second tubular member having a proximal end and a distal end, the second tubular member defining a second lumen having an outlet at the distal end of the second tubular member, the second tubular member adjacent an outer surface of the expandable member and configured to move radially away from a central axis of the first tubular member as the expandable member expands., 'a catheter including24. The medical device of claim 23 , wherein the expandable member has a proximal end and a distal end claim 23 , the expandable member claim 23 , upon inflation claim 23 , defining a first ramped surface near the proximal end of the expandable member claim 23 , a second ramped surface near the distal end of the expandable member claim 23 , and an intermediate surface joining the first ramped surface and the second ramped surface.25. The medical device of claim 24 , wherein the outlet of the second lumen is located approximately at a point where the second ramped surface meets the intermediate surface of the expandable member.26. The medical device of claim 23 , wherein the proximal end of the second tubular member includes a proximal opening configured to receive a subintimal device.27. The medical device of claim 23 , further including an infusion tube ...

ENDOVASCULAR DEVICES AND METHODS FOR EXPLOITING INTRAMURAL SPACE

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing a first intravascular device having a distal portion with a concave side, inserting the first device into the vascular lumen, positioning the distal portion in the vascular wall, and orienting the concave side of the distal portion toward the vascular lumen. 1. A method of facilitating vascular treatment via a vascular wall defining a vascular lumen having an occlusion disposed therein , the method comprising:providing an intravascular device having a distal intramural portion;inserting the intramural portion into the vascular lumen;passing the intramural portion from the vascular lumen into the vascular wall proximal of the occlusion;moving the intramural portion within the vascular wall in a longitudinal direction;moving the intramural portion within the vascular wall in a circumferential direction such that the intramural portion has a concave side facing the vascular lumen;providing a re-entry device having a tissue penetrating tip;orienting the tip as a function of the concave side of the intramural portion such that the tip is pointed toward the vascular lumen;causing the tip to penetrate tissue to pass from within the vascular wall to within the vascular lumen; andpassing the intramural portion from the vascular wall into the vascular lumen distal of the occlusion such that the intravascular device extends from the vascular lumen proximal of the occlusion, transmurally adjacent the occlusion, to the vascular lumen distal of the occlusion.263-. (canceled) This application claims the benefit of U.S. Provisional Application No. 60/716,287, filed Sep. 12, 2005, under 35 U.S.C. §119(e). In addition, this application also claims the benefit of U.S. Provisional Application No. 60/717,726, filed Sep. 15, 2005, ...

METHODS AND APPARATUS FOR TREATING BODY TISSUE SPHINCTERS AND THE LIKE

A plurality of structures that resiliently attract one another are provided for implanting in a patient around a body tissue structure of the patient. For example, the body tissue structure may be the esophagus, and the plurality of structures may be implanted in an annulus around the outside of the esophagus, the annulus being substantially coaxial with the esophagus. The attraction may be between annularly adjacent ones of the structures in the annulus, and it may be provided, for example, by magnets or springs. The array of structures is preferably self-limiting with respect to the smallest area that it can encompass, and this smallest area is preferably large enough to prevent the apparatus from applying excessive pressure to tissue passing through that area. 110-. (canceled)11. Apparatus for encompassing a patient's body tissue structure and for resiliently applying pressure to the encompassed tissue comprising:a band that can be disposed around the tissue structure; andmeans for resiliently producing a pleat in the band to reduce but not eliminate an area encompassed by the band.12. The apparatus defined in wherein the means for resiliently producing comprises:a pair of bodies adjacent to one another along the band that are magnetically attracted to one another.13. A method of treating a patient's body tissue structure comprising:surrounding the tissue structure with apparatus for applying resilient pressure to the tissue structure, the apparatus being self-limiting with respect to a smallest area that the apparatus encompasses, the smallest area being a non-zero area, the apparatus including a plurality of bodies in an array that can annularly surround the tissue structure so that each of the bodies contacts the tissue structure, each body in the array having a structural link connecting it to a next adjacent body in the array, each of the links allowing the bodies it connects to move apart from one another in a direction that is annular of the array, and ...

ENDOVASCULAR DEVICES AND METHODS FOR EXPLOITING INTRAMURAL SPACE

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes inserting an intramural crossing device into the vascular lumen, positioning at least the distal tip of the crossing device in the vascular wall, advancing an orienting device over the crossing device such that an orienting element of the orienting device resides in the vascular wall, inserting a re-entry device, and re-entering the true vascular lumen. 149-. (canceled)50. A method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein , the method comprising:inserting a guidewire or crossing device into the vascular lumen;positioning a distal portion of the guidewire or crossing device in the vascular wall;advancing an intravascular device over the guidewire or crossing device, the intravascular device defining a tubular body and a lumen, and having a distal portion including a side port and lateral projections, wherein each of the lateral projections includes a delivery configuration and a deployed configuration, wherein the lateral projections are completely external the lumen in both the delivery and the deployed configurations;positioning the distal portion of the intravascular device in the vascular wall;directing the lateral projections laterally within the vascular wall such that the lateral projections are in the deployed configuration;causing the intravascular device to assume an arbitrary one of two possible orientations relative to the vascular lumen, the two possible orientations comprising a first orientation in which the side port is directed toward the vascular lumen and a second orientation in which the side port is directed about 180 degrees away from the vascular lumen;advancing a distal end of a reentry device through the side port and determining which ...

ENDOVASCULAR DEVICE WITH A TISSUE PIERCING DISTAL PROBE AND ASSOCIATED METHODS

Devices, systems and methods for treating diseases and disorders effecting the cardiovascular system of the human body are disclosed. An exemplary blood vessel in accordance with this disclosure comprises a shaft, tip member fixed to the shaft, and a probe extending beyond a distal surface of the tip member. In some useful embodiments, the tip member is relatively atraumatic and the probe is shaped so as to be more likely to produce trauma than the tip member. 1. An elongate medical device for penetrating tissue , comprising:an elongate shaft having a proximal segment and a reduced diameter distal segment, the distal segment unitarily formed with the proximal segment;a coil positioned around the distal segment;a tip member securing a distal end of the coil to the distal segment; anda distal portion of the distal segment extending distal of the distal end of the coil and extending distal of a distalmost end of the tip member;wherein the distal portion of the distal segment defines a probe adapted and configured to pierce tissue.2. The elongate medical device of claim 1 , wherein the probe defines a distalmost end of the elongate medical device.3. The elongate medical device of claim 1 , wherein the probe is exposed from all other components of the elongate medical device.4. The elongate medical device of claim 1 , wherein the elongate shaft includes a tapered segment between the proximal segment and the distal segment.5. The elongate medical device of claim 4 , wherein a proximal end of the coil is secured to the tapered segment of the elongate shaft.6. The elongate medical device of claim 5 , wherein the proximal segment has a constant diameter.7. The elongate medical device of claim 6 , wherein the distal segment has a constant diameter.8. The elongate medical device of claim 1 , wherein the probe extends distally beyond all other components of the elongate medical device by a distance that is greater than about 0.003 inches.9. The elongate medical device of claim ...

SYSTEMS AND APPARATUS FOR TREATING BLOOD VESSELS AND RELATED METHODS

The present disclosure is directed to a system for treating a blood vessel including a blood vessel lumen defined by a blood vessel wall, the blood vessel lumen being at least partially obstructed. The system may include a shaft assembly including an orienting element. The system may also include a re-entry device extending into the central lumen. The re-entry device may comprise a core wire configured such that bending stresses created in the core wire during bending about a design bend radius are less than the elastic limit of the core wire so that the core wire will elastically recover from the bending upon release. 1. A system for treating a blood vessel including a blood vessel lumen defined by a blood vessel wall , the blood vessel lumen being at least partially obstructed , the system comprising:a shaft assembly including an orienting element, the orienting element having an expanded shape dimensioned such that, when the orienting element assumes the expanded shape within the blood vessel wall, the shaft assembly will assume an arbitrary one of two possible orientations relative to the blood vessel lumen, the two possible orientations comprising a first orientation and a second orientation;the shaft assembly defining a shaft lumen, a first aperture and a second aperture, the first aperture being positioned to face the blood vessel lumen when the shaft assembly assumes the first orientation and the second aperture being positioned to face the blood vessel lumen when the shaft assembly assumes the second orientation;a re-entry device extending into the central lumen, the re-entry device comprising a core wire, the core wire being configured such that bending stresses created in the core wire during bending of the core wire to follow a tortuous path are less than the elastic limit of the core wire so that the core wire will elastically recover from the bending upon release.2. The system of claim 1 , wherein the core wire comprises a strengthened region.3. The ...

Endovascular devices and methods for exploiting intramural space

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing a first intravascular device having a distal portion with a concave side, inserting the first device into the vascular lumen, positioning the distal portion in the vascular wall, and orienting the concave side of the distal portion toward the vascular lumen.

ENDOVASCULAR DEVICES AND METHODS FOR EXPLOITING INTRAMURAL SPACE

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes inserting an intramural crossing device into the vascular lumen, positioning at least the distal tip of the crossing device in the vascular wall, advancing an orienting device over the crossing device such that an orienting element of the orienting device resides in the vascular wall, inserting a reentry device, and re-entering the true vascular lumen. 1. A method of bypassing an occlusion in a blood vessel through a subintimal pathway , comprising:advancing a subintimal crossing device through a subintimal space between tissue layers of a vascular wall of the blood vessel adjacent to the occlusion;thereafter, advancing an orienting device into the subintimal space;expanding an orienting element of the orienting device in the subintimal space to orient a side port of the orienting device toward a lumen of the blood vessel distal of the occlusion; andadvancing a re-entry device out of the side port and into the true lumen of the blood vessel distal of the occlusion.2. The method of claim 1 , further comprising claim 1 , withdrawing the subintimal crossing device from the subintimal space prior to advancing the orienting device into the subintimal space.3. The method of claim 1 , wherein the orienting element expands in a planar orienting element.4. The method of claim 3 , wherein the planar orienting element is a preformed planar sinusoid.5. The method of claim 3 , wherein the planar orienting element is two wings that extend in opposite directions.6. The method of claim 3 , wherein the side port of the orienting device is oriented at a right angle to a plane of the planar orienting element.7. The method of claim 1 , wherein the subintimal crossing device includes a bulbous distal tip.8. The method of claim 1 , wherein the ...

ENDOVASCULAR DEVICES AND METHODS

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion, inserting the device into the vascular lumen, positioning the distal portion in the vascular wall to at least partially surround the occlusion, and removing at least a portion of the surrounded occlusion from the lumen. 1. A method of treating an occlusion in a blood vessel , the method comprising:advancing an elongate medical device through a lumen of a blood vessel to a location proximate an occlusion, the blood vessel including an intimal layer, a medial layer and an adventitial layer;passing a portion of the elongate medical device between the intimal layer and the adventitial layer proximate the occlusion; andremoving a portion of the intimal layer with the occlusion by withdrawing the elongate medical device from the blood vessel.2. The method of claim 1 , further comprising:positioning the portion of the elongate medical device around the occlusion radially outward of the intimal layer.3. The method of claim 2 , further comprising:reducing a diameter of the portion of the elongate medical device around the occlusion.4. The method of claim 1 , further comprising:positioning the portion of the elongate medical device helically around the occlusion radially outward of the intimal layer.5. The method of claim 4 , further comprising:reducing a diameter of the portion of the elongate medical device around the occlusion.6. The method of claim 5 , wherein the step of reducing the diameter of the portion of the elongate medical device around the occlusion includes rotating a distal end of the elongate medical device relative to a proximal end of the elongate medical device.7. The method of claim 1 , further comprising distally advancing a cutting element through the ...

ENDOVASCULAR DEVICES AND METHODS

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion, inserting the device into the vascular lumen, positioning the distal portion in the vascular wall to at least partially surround the occlusion, and removing at least a portion of the surrounded occlusion from the lumen. 1. A method of treating an occlusion in a vascular lumen defined by a vessel wall , comprising:inserting a guidewire into the vascular lumen and advancing a distal end of the guidewire to a position adjacent the occlusion;advancing a catheter over the guidewire into the vascular lumen to the position adjacent the occlusion, the catheter including a balloon proximate a distal end of the catheter, a guidewire lumen having the guidewire slidably disposed therein, and a device lumen extending to a distal opening;inflating the balloon to an inflated configuration against an intima of the vessel wall at the position adjacent the occlusion;advancing a distal portion of a subintimal device disposed within the device lumen out of the distal opening and through the intima into a subintimal space within the vessel wall.2. The method of claim 1 , further comprising:delaminating tissue layers of the vessel wall adjacent the occlusion.3. The method of claim 2 , wherein delaminating tissue layers of the vessel wall includes infusing a fluid into the subintimal space.4. The method of claim 3 , wherein the fluid is infused directly into the subintimal space from the device lumen.5. The method of claim 3 , wherein the fluid is infused into the subintimal space through the subintimal device.6. The method of claim 2 , wherein delaminating tissue layers of the vessel wall includes expanding the distal portion of the subintimal device from a collapsed configuration to ...

Systems, methods and apparatus for guiding and supporting catheters and methods of manufacture

A device for guiding and supporting a stent delivery catheter and other catheters is disclosed. The device may comprise a tubular guiding member and an elongated positioning member extending in a proximal direction beyond the tubular guiding member for advancing and retracting the tubular guiding member in distal and proximal directions. A distal portion of the elongate positioning member may be coupled to the proximal portion of the tubular guide. In embodiments, the device includes a ribbon having a distal portion and a proximal portion. In embodiments, the distal portion of the ribbon extends distally into the tubular guiding member and the proximal portion of the ribbon overlays an inner surface of the elongate positioning member. Methods for making medical devices and portions of medical devices (e.g., intravascular catheters, catheter shafts, and tubular guiding members) are also provided. Example methods may include providing a first ribbon comprising one or more thermoplastic materials and a piece of shrink tubing defining a shrink tube lumen and forming a first assembly by positioning the first ribbon inside the shrink tube lumen and urging the first ribbon to assume a tubular shape in which the first ribbon defines a ribbon lumen. A second assembly may be formed by loading an inner tubular member over a mandrel and forming or placing a support structure over an outer surface of the inner tubular member. A third assembly may be formed by inserting the second assembly into the ribbon lumen defined by the first ribbon of the first assembly. The third assembly may be heated to a process temperature.

ENDOVASCULAR DEVICES AND METHODS FOR EXPLOITING INTRAMURAL SPACE

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes inserting an intramural crossing device into the vascular lumen, positioning at least the distal tip of the crossing device in the vascular wall, advancing an orienting device over the crossing device such that an orienting element of the orienting device resides in the vascular wall, inserting a reentry device, and re-entering the true vascular lumen. 1. A system for facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein , the system comprising:an intramural orienting device defining a longitudinal axis and having an elongate shaft with a lumen extending therethrough to a distally facing opening transverse and intersecting the longitudinal axis, the elongate shaft being configured to be advanced over a guidewire positionable therein;wherein the elongate shaft includes a distal orienting element comprising one or more extensions configured to extend laterally from the longitudinal axis in a planar fashion, the one or more extensions formed as a part of the elongate shaft;wherein the elongate shaft further includes a distal side opening in communication with the lumen, the distal side opening facing orthogonally relative to the one or more extensions;wherein the one or more extensions each includes a collapsed delivery configuration and an expanded deployed configuration, and wherein a most proximal portion of each extension that is external the lumen of the elongate shaft in the deployed configuration is also external the lumen of the elongate shaft in the delivery configuration; anda re-entry device configured to penetrate vascular tissue, the reentry device sized and configured to be inserted into the lumen of the elongate shaft.2. A system of claim 1 , wherein the orienting ...

Endovascular devices and methods

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion with a lumen extending therein; inserting the device into the vascular lumen; positioning the distal portion in the vascular wall; and directing the distal portion within the vascular wall.

ENDOVASCULAR DEVICES AND METHODS

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion, inserting the device into the vascular lumen, positioning the distal portion in the vascular wall to at least partially surround the occlusion, and removing at least a portion of the surrounded occlusion from the lumen. 1. A subintimal device , comprising:an elongate device body including a proximal shaft portion, a distal coil portion, and an enlarged distal tip;wherein the distal coil portion is integrally formed with the proximal shaft portion;wherein each coil winding of the distal coil portion includes geometric features configured to engage with adjacent coil windings.2. The subintimal device of claim 1 , wherein the proximal shaft portion includes a tubular member.3. The subintimal device of claim 1 , wherein the distal coil portion is a single-layer coil.4. The subintimal device of claim 1 , wherein each geometric feature mechanically engages a geometric feature of an adjacent coil winding.5. The subintimal device of claim 1 , wherein the geometric features are arranged such that a peak of one coil winding falls within a valley of an adjacent coil winding.6. The subintimal device of claim 1 , wherein an outer extent of the distal tip is greater than an outer extent of the distal coil portion and the proximal shaft portion.7. A subintimal device claim 1 , comprising:an elongate device body having a tubular single-layer coil and an enlarged distal tip;wherein each coil winding of the tubular single-layer coil includes geometric features configured to engage with adjacent coil windings.8. The subintimal device of claim 7 , wherein each geometric feature mechanically engages a geometric feature of an adjacent coil winding.9. The subintimal device of claim 7 , ...

Methods for fabricating medical devices and portions of medical devices

Methods for making medical devices and portions of medical devices (e.g., intravascular catheters, catheter shafts, and tubular guiding members) are provided. Example methods may include providing a first ribbon comprising one or more thermoplastic materials and a piece of shrink tubing defining a shrink tube lumen and forming a first assembly by positioning the first ribbon inside the shrink tube lumen and urging the first ribbon to assume a tubular shape in which the first ribbon defines a ribbon lumen. A second assembly may be formed by loading an inner tubular member over a mandrel and forming or placing a support structure over an outer surface of the inner tubular member. A third assembly may be formed by inserting the second assembly into the ribbon lumen defined by the first ribbon of the first assembly. The third assembly may be heated to a process temperature.

SYSTEMS, METHODS AND APPARATUS FOR GUIDING AND SUPPORTING CATHETERS SUCH AS STENT DELIVERY CATHETERS

A device for guiding and supporting a stent delivery catheter and other catheters is disclosed. The device may comprise a tubular guiding member and an elongated positioning member extending in a proximal direction beyond the tubular guiding member for advancing and retracting the tubular guiding member in distal and proximal directions. A distal portion of the elongate positioning member may be coupled to the proximal portion of the tubular guide. In embodiments, the device includes a ribbon having a distal portion and a proximal portion. In embodiments, the distal portion of the ribbon extends distally into the tubular guiding member and the proximal portion of the ribbon overlays an inner surface of the elongate positioning member. 1. A device for guiding and supporting a stent delivery catheter and/or other catheters , the device comprising:a tubular guiding member and an elongated positioning member extending in a proximal direction beyond the tubular guiding member for advancing and retracting the tubular guiding member in distal and proximal directions;the tubular guiding member comprising an inner tubular member having an outer surface, an elongate support member disposed along a helical path around the outer surface, a saddle member at least partially encircling the inner tubular member at a location rearward of the elongate support member, and an encapsulation layer overlaying the support structure and the inner tubular member, the encapsulation layer being mechanically interlocked with and adhered to the elongate support member and the saddle member.2. The device of wherein the encapsulation layer comprises thermoplastic material from a sheet claim 1 , the thermoplastic material having melted claim 1 , mixed and solidified during a reflow process claim 1 , the inner tubular member having a wall thickness less than 0.0015 inch claim 1 , the encapsulation layer having a layer thickness less than 0.0020 inch claim 1 , and the tubular guiding member having a ...

CATHETERS AND RELATED DEVICES AND METHODS OF MANUFACTURE

Catheters incorporating a thin film polymeric layer or layers. The thin film may have a wall thickness of about 0.00025″ +/− less than 0.0001″ to about 0.0015″ +/−0.0002″, for example. The thin film may be formed by extruding a sheet and cutting the sheet into elongate ribbons, each having two opposing long edges. The ribbon may be rolled or wrapped to define a tubular shape with a gap between the long edges. Heat and pressure may be applied to close the gap, abut the edges and form a longitudinal joint. The joint may extend along a portion of the length of the tubular shaft or most of the length of the tubular shaft. The tubular-shaped thin film layer may have a uniform wall thickness around the circumference, and the uniform wall thickness may extend across the joint. 1. A catheter , comprising: an elongate tubular shaft having a proximal end , a distal end , a length , a longitudinal axis and a lumen extending therethrough , wherein the tubular shaft includes a thin film polymeric layer disposed about the longitudinal axis , wherein the thin film has two opposing long edges , and wherein the thin film extends around the longitudinal axis to define a tubular shape with the edges abutting each other to form a joint.2. A catheter as in claim 1 , wherein the joint extends along at least a portion of the length of the tubular shaft.3. A catheter as in claim 2 , wherein the joint extends along most of the length of the tubular shaft.4. A catheter as in claim 1 , wherein the tubular-shaped thin film layer has a uniform wall thickness around the longitudinal axis.5. A catheter as in claim 4 , wherein the uniform wall thickness extends across the joint.6. A catheter as in claim 1 , further comprising an inner liner claim 1 , wherein the tubular-shaped thin film layer is disposed about the inner liner.7. A catheter as in claim 6 , further comprising a reinforcement layer claim 6 , wherein the reinforcement layer is disposed between the inner liner and the thin film layer.8 ...

Endovascular devices and methods for exploiting intramural space

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing a first intravascular device having a distal portion with a concave side, inserting the first device into the vascular lumen, positioning the distal portion in the vascular wall, and orienting the concave side of the distal portion toward the vascular lumen.

CROSSING OCCLUSIONS IN BLOOD VESSELS

The present disclosure is directed a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method may include providing a first intravascular device having a distal portion and at least one aperture and positioning the distal portion of the first intravascular device in the vascular wall. The method may further include providing a reentry device having a body and a distal tip, the distal tip having a natural state and a compressed state and inserting the distal tip, in the compressed state, in the distal portion of the first intravascular device. The method may further include advancing the distal tip, in the natural state, through the at least one aperture of the first intravascular device. 1. A method of crossing an occlusion in a true lumen of a blood vessel via a vascular wall , comprising:advancing an orienting device into a subintimal space of the vascular wall until a distal end of the orienting device is positioned distal of the occlusion, the orienting device including a shaft having a wall defining a lumen having a longitudinal axis, a first aperture through the wall in communication with the lumen, and a second aperture through the wall in communication with the lumen;wherein the first aperture opens in a first direction away from the longitudinal axis of the lumen of the orienting device, and the second aperture opens in a second direction away from the longitudinal axis of the lumen of the orienting device;advancing a re-entry device through the lumen of the orienting device to a position adjacent the first aperture; andadvancing a distal end of the re-entry device out the first aperture until the distal end of the re-entry device is positioned within the true lumen.2. The method of claim 1 , further comprising:observing, via fluoroscopy, a position of the distal end of the re-entry device relative to the first aperture and the second aperture;confirming that the first aperture is facing the ...

Systems, apparatus and methods for treating blood vessels

A system and method for treating a blood vessel that is at least partially obstructed by an occlusion which divides the lumen into a proximal lumen segment and a distal lumen segment. The system includes an orienting catheter having an orientation element positionable in an intrawall space of the vessel and an occlusion catheter having an occlusion balloon inflatable in the proximal lumen segment so as to isolate a target volume including the intrawall space. The pressure inside the target volume is reduced to a pressure below the pressure of the distal lumen segment so that the intima presses against the orienting element of the orienting catheter. A distal end of a reentry device may be advanced from the orienting catheter through the intima and into the distal lumen segment.

ENDOVASCULAR DEVICES AND METHODS FOR EXPLOITING INTRAMURAL SPACE

The present disclosure is directed to a device. The device may include a distal shaft defining a central lumen and an orienting element comprising at least one inflatable member. Wherein a first portion of the orienting element extending from the shaft in a first direction and a second portion of the orienting element extending from the shaft in a second direction. Further, wherein the second direction is substantially opposite the first direction. 1. A method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein , comprising:advancing a crossing device within the vascular lumen to a location proximal of the occlusion;advancing a distal tip of the crossing device into the vascular wall;advancing the crossing device distally between an intima of the vascular wall and an adventitia of the vascular wall until the distal tip of the crossing device is disposed at a location distal of the occlusion;positioning a guidewire through a lumen of the crossing device to the location distal of the occlusion;withdrawing the crossing device from the vascular wall while maintaining a position of the guidewire within the vascular wall;advancing an orienting device over the guidewire and within the vascular wall until a first aperture of a shaft of the orienting device is disposed distal of the occlusion;withdrawing the guidewire from the orienting device;advancing a distal tip of a re-entry device through the orienting device and out the first aperture toward the vascular lumen distal of the occlusion.2. The method of claim 1 , further comprising advancing the distal tip of the re-entry device through the intima of the vascular wall and into the vascular lumen distal of the occlusion.3. The method of claim 1 , further comprising orienting the shaft of the orienting device between the intima and the adventitia of the vascular wall such that the first aperture is oriented toward the vascular lumen.4. The method of claim 3 , wherein the ...

ENDOVASCULAR DEVICES AND METHODS FOR EXPLOITING INTRAMURAL SPACE

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing a first intravascular device having a distal portion with a concave side, inserting the first device into the vascular lumen, positioning the distal portion in the vascular wall, and orienting the concave side of the distal portion toward the vascular lumen. 1. A method of bypassing an occlusion in a vascular lumen via a vascular wall defining the vascular lumen , comprising:advancing a guidewire within the vascular lumen to a position adjacent the occlusion;advancing the guidewire into a subintimal space within the vascular wall;inserting a subintimal device over the guidewire, the subintimal device comprising an elongate shaft having a fixed bulbous distal tip and a lumen extending within the elongate shaft and through the bulbous distal tip;advancing the bulbous distal tip over the guidewire and into the subintimal space;removing the guidewire from the lumen of the subintimal device;advancing the bulbous distal tip within the subintimal space to a position distal of the occlusion;orienting the bulbous distal tip within the subintimal space such that a re-entry device advanced through the lumen is directed toward the vascular lumen.2. The method of claim 1 , wherein orienting the bulbous distal tip is done without visualization of the distal portion of the elongate shaft within the subintimal space.3. The method of claim 1 , wherein the intravascular device further comprises an actuation member extending through the elongate shaft to the bulbous distal tip.4. The method of claim 3 , wherein orienting the bulbous distal tip includes pulling the actuation member proximally to bend a distal portion of the elongate shaft.5. The method of claim 4 , wherein after pulling the actuation member claim 4 , the distal ...

DEVICES AND METHODS FOR TREATING THE GASTROINTESTINAL SYSTEM

Devices and methods for less invasively treating the gastrointestinal system, such as the intestinal mucosa of the small bowel. Embodiments described herein may be used to reduce caloric absorption and effectuate weight loss, for example. 122.-. (canceled)23. A method for treating a patient , comprising:introducing a material into a vascular system of a patient, wherein the material is configured to occlude vasculature supplying the patient's gastrointestinal system.24. The method of claim 23 , wherein the material includes a plurality of occlusion beads.25. The method of claim 24 , wherein the occlusion beads include a polymeric material.26. The method of claim 24 , wherein the occlusion beads include at least one of polyethylene claim 24 , polymethyl methacrylate claim 24 , anadine butadiene styrene claim 24 , polycarbonate claim 24 , polyamide claim 24 , or pebax.27. The method of claim 24 , wherein the occlusion beads include at least one of ceramic claim 24 , glass claim 24 , or metal.28. The method of claim 23 , wherein introducing includes inserting a delivery device into an arterial system of the patient.29. The method of claim 23 , wherein introducing includes inserting a catheter into an arterial arcade of the patient.30. The method of claim 23 , wherein the material is configured to occlude vasculature supplying the patient's intestines.31. The method of claim 30 , wherein the material is configured to occlude vasculature supplying the patient's intestinal villi.32. A method for treating a patient claim 30 , comprising:introducing a material into a vascular system of a patient, wherein the material is configured to inhibit nutrient absorption by an intestine of the patient.33. The method of claim 32 , wherein the material includes a plurality of occlusion beads.34. The method of claim 33 , wherein the occlusion beads are suspended in a solution.35. The method of claim 32 , wherein introducing includes inserting a catheter into a superior mesenteric artery ...

ENDOVASCULAR DEVICES AND METHODS FOR EXPLOITING INTRAMURAL SPACE

Devices and methods for exploiting intramural (e.g., subintimal) space of a vascular wall to facilitate the treatment of vascular disease, particularly total occlusions. For example, the devices and methods disclosed herein may be used to visually define the vessel wall boundary, protect the vessel wall boundary from perforation, bypass an occlusion, and/or remove an occlusion. 1. An orienting device for exploiting intramural space , comprising:an elongate shaft having a distal end region and a lumen extending therethrough;an orienting element disposed at the distal end region of the elongate shaft, the orienting element including an expandable structure configured to expand from a first configuration to a second configuration;a deflectable distal tip disposed distal of the orienting element, the deflectable distal tip having a distal opening in communication with the lumen of the elongate shaft; anda tension member secured to the bi-deflectable distal tip and extending proximally through the elongate shaft, wherein manipulation of the tension member causes the deflectable distal tip to deflect the distal opening.2. The orienting device of claim 1 , wherein the elongate shaft includes an articulation zone located between the deflectable distal tip and the orienting element.3. The orienting device of claim 2 , wherein the articulation zone includes a plurality of slots.4. The orienting device of claim 1 , wherein the elongate shaft includes an outer tubular member and an inner tubular member extending axially through the outer tubular member.5. The orienting device of claim 4 , wherein the tension member extending along the elongate shaft between the inner tubular member and the outer tubular member.6. An orienting device for exploiting intramural space claim 4 , comprising:an elongate shaft comprising an outer tubular layer and an inner tubular layer extending axially through the outer tubular layer, the inner tubular layer defining a lumen extending therethrough;an ...

ENDOVASCULAR DEVICE WITH A TISSUE PIERCING DISTAL PROBE AND ASSOCIATED METHODS

Devices, systems and methods for treating diseases and disorders effecting the cardiovascular system of the human body are disclosed. An exemplary device in accordance with this disclosure comprises a shaft, tip member fixed to the shaft, and a probe extending beyond a distal surface of the tip member. In some useful embodiments, the tip member is relatively atraumatic and the probe is shaped so as to be more likely to produce trauma than the tip member. 1. An elongate medical device for penetrating tissue , comprising:an elongate shaft having a proximal portion having a first diameter and a distal portion having a second diameter less than the first diameter;a coil positioned around the distal portion; anda tip member fixedly attached to the distal portion;wherein the tip member comprises a distal surface and a probe extending distally beyond the distal surface.2. The elongate medical device of claim 1 , wherein the distal surface has a generally hemispherical shape.3. The elongate medical device of claim 1 , wherein the probe has a generally cylindrical shape.4. The elongate medical device of claim 1 , wherein a distal surface of the probe is substantially perpendicular to a longitudinal axis of the probe.5. The elongate medical device of claim 1 , wherein the probe is monolithically formed with the tip member.6. The elongate medical device of claim 1 , wherein the tip member is disposed distal of the coil.7. The elongate medical device of claim 1 , wherein the tip member fixedly secures a distal end of the coil to the distal portion.8. The elongate medical device of claim 1 , wherein the probe is adapted and configured to pierce tissue.9. The elongate medical device of claim 1 , wherein the probe has an outer diameter less than an outer diameter of the tip member.10. An elongate medical device for penetrating tissue claim 1 , comprising:a monolithic elongate shaft comprising a proximal segment, a distal segment having an outer diameter less than an outer diameter ...

METHODS AND APPARATUS FOR TREATING BODY TISSUE SPHINCTERS AND THE LIKE

A plurality of structures that resiliently attract one another are provided for implanting in a patient around a body tissue structure of the patient. For example, the body tissue structure may be the esophagus, and the plurality of structures may be implanted in an annulus around the outside of the esophagus, the annulus being substantially coaxial with the esophagus. The attraction may be between annularly adjacent ones of the structures in the annulus, and it may be provided, for example, by magnets or springs. The array of structures is preferably self-limiting with respect to the smallest area that it can encompass, and this smallest area is preferably large enough to prevent the apparatus from applying excessive pressure to tissue passing through that area. 131-. (canceled)32. A medical implant , the medical implant comprising: (i) a housing assembly defining a first hollow interior and a second hollow interior positioned concentrically around the first hollow interior, wherein the first hollow interior extends from a first aperture to a second aperture, and', '(ii) at least one magnet disposed within the second hollow interior; and, '(a) a plurality of beads, wherein each bead comprises(b) a plurality of links joining the beads together, wherein portions of the links are slidably disposed in corresponding first hollow interiors of the beads such that the plurality of beads are operable to transition between an constricted configuration and an expanded configuration, wherein the housing assembly of adjacent beads in the plurality of beads are configured to abut against each other in the constricted configuration.33. The medical implant of claim 32 , wherein the first hollow interior is isolated from the second hollow interior.34. The medical implant of claim 32 , wherein the housing assembly of each bead comprises a first housing component and a second housing component claim 32 , wherein the first housing component and the second housing component are ...

Endovascular devices and methods for exploiting intramural space

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing a first intravascular device having a distal portion with a concave side, inserting the first device into the vascular lumen, positioning the distal portion in the vascular wall, and orienting the concave side of the distal portion toward the vascular lumen.

SYSTEMS, APPARATUS AND METHODS FOR TREATING BLOOD VESSELS

A system and method for treating a blood vessel that is at least partially obstructed by an occlusion which divides the lumen into a proximal lumen segment and a distal lumen segment. The system includes an orienting catheter having an orientation element positionable in an intrawall space of the vessel and an occlusion catheter having an occlusion balloon inflatable in the proximal lumen segment so as to isolate a target volume including the intrawall space. The pressure inside the target volume is reduced to a pressure below the pressure of the distal lumen segment so that the intima presses against the orienting element of the orienting catheter. A distal end of a reentry device may be advanced from the orienting catheter through the intima and into the distal lumen segment. 1. A system for treating a blood vessel including a blood vessel wall defining a blood vessel lumen , the blood vessel lumen being at least partially obstructed by an occlusion , the occlusion dividing the lumen into a proximal lumen segment and a distal lumen segment , the system comprising:an orienting catheter including an orienting catheter shaft carrying an orienting element and a tracking element advanceable along the orienting catheter shaft;an occlusion catheter comprising a balloon and a coupling element configured to engage a complementary coupling element of the tracking element to form a connection therebetween;the occlusion catheter defining an inflation lumen disposed in fluid communication with an interior of the balloon so that the balloon can be selectively inflated by injecting an inflation fluid through the inflation lumen;the balloon, when in an inflated state, being sized so as to occlude the blood vessel lumen to isolate a target volume defined by blood vessel tissues;the occlusion catheter defining an aspiration lumen disposed in fluid communication with a distal port positioned so that fluid can be withdrawn from the target volume and into the aspiration lumen.2. The ...

Endovascular devices and methods for exploiting intramural space

The present disclosure is directed to a device. The device may include a distal shaft defining a central lumen and an orienting element comprising at least one inflatable member. Wherein a first portion of the orienting element extending from the shaft in a first direction and a second portion of the orienting element extending from the shaft in a second direction. Further, wherein the second direction is substantially opposite the first direction.

ENDOVASCULAR DEVICES AND METHODS

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion with a side port, inserting the device into the vascular lumen, positioning the distal portion in the vascular wall, directing the distal portion within the vascular wall such that the distal portion moves at least partially laterally, and directing the side port towards the vascular lumen. 1. A method of facilitating treatment of a blood vessel , comprising:advancing a guidewire within a vascular wall of the blood vessel past an occlusion disposed within a lumen of the blood vessel;advancing a balloon catheter over the guidewire until a balloon disposed on a distal portion of the balloon catheter is disposed adjacent a distal end of the occlusion;withdrawing the guidewire from the balloon catheter; andinflating the balloon within the vascular wall to orient a distal end of the balloon catheter towards the lumen of the blood vessel.2. The method of claim 1 , wherein the balloon catheter includes a lumen extending distally to a distal opening proximate the distal end of the balloon catheter.3. The method of claim 2 , wherein inflating the balloon within the vascular wall orients the distal opening towards the lumen of the blood vessel.4. The method of claim 1 , wherein at least a portion of an exterior surface of the balloon catheter is exposed between a proximal end of the balloon and a distal end of the balloon.5. The method of claim 1 , further comprising:advancing a sharpened stylet through the balloon catheter until a distal end of the sharpened stylet penetrates the vascular wall and is positioned within the lumen of the blood vessel.6. The method of claim 5 , wherein the distal end of the balloon catheter directs the distal end of the sharpened stylet toward ...

METHODS AND APPARATUS FOR TREATING BODY TISSUE SPHINCTERS AND THE LIKE

A plurality of structures that resiliently attract one another are provided for implanting in a patient around a body tissue structure of the patient. For example, the body tissue structure may be the esophagus, and the plurality of structures may be implanted in an annulus around the outside of the esophagus, the annulus being substantially coaxial with the esophagus. The attraction may be between annularly adjacent ones of the structures in the annulus, and it may be provided, for example, by magnets or springs. The array of structures is preferably self-limiting with respect to the smallest area that it can encompass, and this smallest area is preferably large enough to prevent the apparatus from applying excessive pressure to tissue passing through that area. 112-. (canceled)13. A method of treating a patient's body tissue structure comprising:surrounding the tissue structure with apparatus for applying resilient pressure to the tissue structure, the apparatus being self-limiting with respect to a smallest area that the apparatus encompasses, the smallest area being a non-zero area, the apparatus including a plurality of bodies in an array that can annularly surround the tissue structure so that each of the bodies contacts the tissue structure, each body in the array having a structural link connecting it to a next adjacent body in the array, each of the links allowing the bodies it connects to move apart from one another in a direction that is annular of the array, and each of the links including a stop that is trapped but movable inside one of the bodies it connects for stopping such movement apart of the bodies it connects when spacing between those bodies reaches a maximum spacing, each link being unconnected to any annularly adjacent link except by the body between that link and the annularly adjacent link.14. The method defined in wherein the surrounding comprises:implanting the apparatus inside the patient's body.15. The method defined in wherein the ...

Endovascular devices and methods

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion with a lumen extending therein; inserting the device into the vascular lumen; positioning the distal portion in the vascular wall; and directing the distal portion within the vascular wall.

ENDOVASCULAR DEVICES AND METHODS

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion with a side port, inserting the device into the vascular lumen, positioning the distal portion in the vascular wall, directing the distal portion within the vascular wall such that the distal portion moves at least partially laterally, and directing the side port towards the vascular lumen. 1. A method of facilitating treatment of a blood vessel having a vascular wall defining a vascular lumen , comprising: an elongate member defining a lumen extending distally to an opening; and', 'a balloon located on a distal end region of the elongate member;', 'wherein an exterior surface of the elongate member is exposed between a proximal end of the balloon and a distal end of the balloon;, 'advancing an intravascular device into the vascular wall adjacent an occlusion in the vascular lumen, wherein the intravascular device comprisespositioning the balloon within the vascular wall distal of the occlusion;inflating the balloon within the vascular wall in opposing directions from the elongate member to orient the opening toward the vascular lumen.2. The method of claim 1 , wherein the intravascular device further includes a re-entry device movably disposed within the lumen of the elongate member.3. The method of claim 2 , further comprising:advancing the re-entry device out of the opening and through a tissue layer of the vascular wall into the vascular lumen.4. The method of claim 1 , wherein the distal end region of the elongate member is oriented substantially parallel to the vascular lumen prior to inflating the balloon.5. The method of claim 1 , wherein at least a portion of the balloon is inflated in a direction away from the vascular lumen.6. The method of claim 1 , ...

Endovascular devices and methods for exploiting intramural space

The present disclosure is directed to a device. The device may include a distal shaft defining a central lumen and an orienting element comprising at least one inflatable member. Wherein a first portion of the orienting element extending from the shaft in a first direction and a second portion of the orienting element extending from the shaft in a second direction. Further, wherein the second direction is substantially opposite the first direction.

DEVICES AND METHODS FOR TREATING THE GASTROINTESTINAL SYSTEM

Devices and methods for less invasively treating the gastrointestinal system, such as the intestinal mucosa of the small bowel. Embodiments described herein may be used to reduce caloric absorption and effectuate weight loss, for example. 122.-. (canceled)23. A medical device , comprising: a reservoir configured to hold an agent;', 'a port coupled to the reservoir and configured to deliver the agent to the patient;', 'a pump; and', 'a power source., 'a capsule configured to be orally administered to a patient, the capsule including24. The medical device of claim 23 , wherein the reservoir is a first reservoir claim 23 , and the capsule further includes a second reservoir.25. The medical device of claim 24 , wherein the first reservoir contains a resin claim 24 , and the second reservoir contains a curing agent.26. The medical device of claim 23 , wherein the pump includes a piston.27. The medical device of claim 23 , wherein the capsule further includes a receiver configured to receive signals from an external device claim 23 , wherein the signals are configured to at least one of cause the capsule to release agent through the port or cause the capsule to stop releasing agent through the port.28. The medical device of claim 27 , wherein the external device is configured to be secured to the patient's skin.29. The medical device of claim 27 , wherein the external device is a hand-held wand.30. The medical device of claim 23 , wherein the reservoir contains the agent claim 23 , and the agent is configured to coat an intestinal lumen.31. A medical device claim 23 , comprising: a plurality of separate reservoirs; and', 'a pump;, 'a capsule configured to be positioned in a body of a patient, the capsule includingwherein the capsule is configured to deliver an agent to the patient upon receipt of a signal from an external transmitter.32. The medical device of claim 31 , wherein the signal is at least one of a magnetic claim 31 , radiofrequency claim 31 , or ultrasonic ...

ENDOVASCULAR DEVICES AND METHODS FOR EXPLOITING INTRAMURAL SPACE

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes inserting an intramural crossing device into the vascular lumen, positioning at least the distal tip of the crossing device in the vascular wall, advancing an orienting device over the crossing device such that an orienting element of the orienting device resides in the vascular wall, inserting a reentry device, and re-entering the true vascular lumen. 1. A method of bypassing an occlusion in a blood vessel through a subintimal pathway , comprising:advancing a subintimal crossing device having an expandable element at a distal end of the subintimal crossing device through a subintimal space between tissue layers of a vascular wall of the blood vessel adjacent to the occlusion, wherein the expandable element includes an atraumatic distal tip;thereafter, withdrawing the subintimal crossing device from the subintimal space;thereafter, advancing an orienting device into the subintimal space adjacent to the occlusion;expanding an orienting element of the orienting device in the subintimal space to orient a side port of the orienting device toward a lumen of the blood vessel distal of the occlusion; andadvancing a re-entry device out of the side port and into the lumen of the blood vessel distal of the occlusion.2. The method of claim 1 , wherein the expandable element is actuatable between a collapsed configuration and an expanded configuration.3. The method of claim 2 , wherein the expandable element is self-biased toward the expanded configuration.4. The method of claim 2 , wherein the subintimal crossing device is advanced within the subintimal space with the expandable element in the collapsed configuration.5. The method of claim 4 , wherein upon encountering resistance to advancement claim 4 , the expandable element is ...

Methods and apparatus for treating body tissue sphincters and the like

A plurality of structures that resiliently attract one another are provided for implanting in a patient around a body tissue structure of the patient. For example, the body tissue structure may be the esophagus, and the plurality of structures may be implanted in an annulus around the outside of the esophagus, the annulus being substantially coaxial with the esophagus. The attraction may be between annularly adjacent ones of the structures in the annulus, and it may be provided, for example, by magnets or springs. The array of structures is preferably self-limiting with respect to the smallest area that it can encompass, and this smallest area is preferably large enough to prevent the apparatus from applying excessive pressure to tissue passing through that area.

Methods and apparatus for treating body tissue sphincters and the like

A plurality of structures that resiliently attract one another are provided for implanting in a patient around a body tissue structure of the patient. For example, the body tissue structure may be the esophagus, and the plurality of structures may be implanted in an annulus around the outside of the esophagus, the annulus being substantially coaxial with the esophagus. The attraction may be between annularly adjacent ones of the structures in the annulus, and it may be provided, for example, by magnets or springs. The array of structures is preferably self-limiting with respect to the smallest area that it can encompass, and this smallest area is preferably large enough to prevent the apparatus from applying excessive pressure to tissue passing through that area.

Methods and apparatus for treating body tissue sphincters and the like

A plurality of structures that resiliently attract one another are provided for implanting in a patient around a body tissue structure of the patient. For example, the body tissue structure may be the esophagus, and the plurality of structures may be implanted in an annulus around the outside of the esophagus, the annulus being substantially coaxial with the esophagus. The attraction may be between annularly adjacent ones of the structures in the annulus, and it may be provided, for example, by magnets or springs. The array of structures is preferably self-limiting with respect to the smallest area that it can encompass, and this smallest area is preferably large enough to prevent the apparatus from applying excessive pressure to tissue passing through that area.

Medical compression devices and methods

Devices and methods for compressing a patient's limb or limbs (e.g., legs or arms) for treating or preventing ailments due to compromised venous or lymphatic circulation of the limb. Exemplary embodiments include, but are not limited to, sub-atmospheric compression, micro-pneumatic compression, and active fabric compression devices and methods.

Endovascular graft system

The invention provides an endovascular graft system for repair of aneurysms. The graft system includes a trunk component and first and second leg components. The graft components include graft material supported by a plurality of stents which are spaced apart and affixed to the graft material in a manner that allows articulation of the graft system without excessive wear of the graft material. The stents are formed by intersecting struts which may be tapered to relieve stress. A stabilizing mechanism is provided to stabilize the position of the legs with respect to the trunk when the graft system is deployed.

Systems, apparatus and methods for treating blood vessels

A system and method for treating a blood vessel that is at least partially obstructed by an occlusion which divides the lumen into a proximal lumen segment and a distal lumen segment. The system includes an orienting catheter having an orientation element positionable in an intrawall space of the vessel and an occlusion catheter having an occlusion balloon inflatable in the proximal lumen segment so as to isolate a target volume including the intrawall space. The pressure inside the target volume is reduced to a pressure below the pressure of the distal lumen segment so that the intima presses against the orienting element of the orienting catheter. A distal end of a reentry device may be advanced from the orienting catheter through the intima and into the distal lumen segment.

Catheters and related devices and methods of manufacture

Catheters incorporating a thin film polymeric layer or layers. The thin film may have a wall thickness of about 0.00025″ +/− less than 0.0001″ to about 0.0015″ +/−0.0002″, for example. The thin film may be formed by extruding a sheet and cutting the sheet into elongate ribbons, each having two opposing long edges. The ribbon may be rolled or wrapped to define a tubular shape with a gap between the long edges. Heat and pressure may be applied to close the gap, abut the edges and form a longitudinal joint. The joint may extend along a portion of the length of the tubular shaft or most of the length of the tubular shaft. The tubular-shaped thin film layer may have a uniform wall thickness around the circumference, and the uniform wall thickness may extend across the joint.

Systems, apparatus and methods for treating blood vessels

A system and method for treating a blood vessel that is at least partially obstructed by an occlusion which divides the lumen into a proximal lumen segment and a distal lumen segment. The system includes an orienting catheter having an orientation element positionable in an intrawall space of the vessel and an occlusion catheter having an occlusion balloon inflatable in the proximal lumen segment so as to isolate a target volume including the intrawall space. The pressure inside the target volume is reduced to a pressure below the pressure of the distal lumen segment so that the intima presses against the orienting element of the orienting catheter. A distal end of a reentry device may be advanced from the orienting catheter through the intima and into the distal lumen segment.

Endovascular devices and methods

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion, inserting the device into the vascular lumen, positioning the distal portion in the vascular wall to at least partially surround the occlusion, and removing at least a portion of the surrounded occlusion from the lumen.

Endovascular devices and methods

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion with a side port, inserting the device into the vascular lumen, positioning the distal portion in the vascular wall, directing the distal portion within the vascular wall such that the distal portion moves at least partially laterally, and directing the side port towards the vascular lumen.

Methods and apparatus for treating body tissue sphincters and the like

A plurality of structures (20) that resiliently attract one another are provided for implanting in a patient around a body tissue structure of the patient. For example, the body tissue structure may be the esophagus, and the plurality of structures may be implanted in an annulus around the outside of the esophagus, the annulus being substantially coaxial with the esophagus. The attraction may be between annularly adjacent ones of the structures in the annulus, and it may be provided, for example, by magnets or springs. The array of structures is preferably self-limiting with respect to the smallest area that it can encompass, and this smallest area is preferably large enough to prevent the apparatus from applying excessive pressure to tissue passing through that area.

Endovascular graft system

The invention provides an endovascular graft system for repair of aneurysms. The graft system includes a trunk component and first and second leg components. The graft components include graft material supported by a plurality of stents which are spaced apart and affixed to the graft material in a manner that allows articulation of the graft system without excessive wear of the graft material. The stents are formed by intersecting struts which may be tapered to relieve stress. A stabilizing mechanism is provided to stabilize the position of the legs with respect to the trunk when the graft system is deployed.

Apparatus for treating body tissue sphincters and the like

A plurality of structures (20) that resiliently attract one another are provided for implanting in a patient around a body tissue structure of the patient. For example, the body tissue structure may be the esophagus, and the plurality of structures may be implanted in an annulus around the outside of the esophagus, the annulus being substantially coaxial with the esophagus. The attraction may be between annularly adjacent ones of the structures in the annulus, and it may be provided, for example, by magnets or springs. The array of structures is preferably self-limiting with respect to the smallest area that it can encompass, and this smallest area is preferably large enough to prevent the apparatus from applying excessive pressure to tissue passing through that area.

System for treating blood vessels

The present disclosure is directed to a system for treating a blood vessel. The system may include a shaft assembly (202) including an orienting element (204). The system may also include a re-entry device (100) extending into the shaft lumen. The re-entry device may comprise a core wire (104) configured such that bending stresses created in the core wire during bending about a design bend radius are less than the elastic limit of the core wire so that the core wire will elastically recover from the bending upon release.

Endovascular devices and methods

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion with a side port, inserting the device into the vascular lumen, positioning the distal portion in the vascular wall, directing the distal portion within the vascular wall such that the distal portion moves at least partially laterally, and directing the side port towards the vascular lumen.

Endovascular devices and methods

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion with a lumen extending therein; inserting the device into the vascular lumen; positioning the distal portion in the vascular wall; and directing the distal portion within the vascular wall.

Endovascular devices and methods

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion with a lumen extending therein; inserting the device into the vascular lumen; positioning the distal portion in the vascular wall; and directing the distal portion within the vascular wall.

Systems, methods and apparatus for guiding and supporting catheters such as stent delivery catheters

Methods for fabricating medical devices and portions of medical devices

Methods for making medical devices and portions of medical devices (e.g., intravascular catheters, catheter shafts, and tubular guiding members) are provided. Example methods may include providing a first ribbon comprising one or more thermoplastic materials and a piece of shrink tubing defining a shrink tube lumen and forming a first assembly by positioning the first ribbon inside the shrink tube lumen and urging the first ribbon to assume a tubular shape in which the first ribbon defines a ribbon lumen. A second assembly may be formed by loading an inner tubular member over a mandrel and forming or placing a support structure over an outer surface of the inner tubular member. A third assembly may be formed by inserting the second assembly into the ribbon lumen defined by the first ribbon of the first assembly. The third assembly may be heated to a process temperature.

Endovascular devices and methods

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion with a lumen extending therein; inserting the device into the vascular lumen; positioning the distal portion in the vascular wall; and directing the distal portion within the vascular wall.

Methods for fabricating medical devices and portions of medical devices

Endovascular devices and methods for exploiting intramural space

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing a first intravascular device having a distal portion with a concave side, inserting the first device into the vascular lumen, positioning the distal portion in the vascular wall, and orienting the concave side of the distal portion toward the vascular lumen.

Endovascular devices and methods

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion with a side port, inserting the device into the vascular lumen, positioning the distal portion in the vascular wall, directing the distal portion within the vascular wall such that the distal portion moves at least partially laterally, and directing the side port towards the vascular lumen.

Métodos para elaborar dispositivos médicos y porciones de dispositivos médicos

Se proporcionan métodos para fabricar dispositivos médicos y partes de dispositivos médicos (por ejemplo, catéteres intravasculares, ejes de catéter y miembros guía tubulares). Los métodos de ejemplo pueden incluir proporcionar una primera cinta que comprende uno o más materiales termoplásticos y un trozo de tubo retráctil que define un lumen del tubo retráctil y formar un primer conjunto colocando la primera cinta dentro del lumen del tubo retráctil e instando a la primera cinta a asumir una forma tubular. en el que la primera cinta define un lumen de cinta. Se puede formar un segundo conjunto cargando un miembro tubular interior sobre un mandril y formando o colocando una estructura de soporte sobre una superficie exterior del miembro tubular interior. Se puede formar un tercer conjunto insertando el segundo conjunto en el lumen de la cinta definido por la primera cinta del primer conjunto. El tercer conjunto se puede calentar a una temperatura de proceso. (Traducción automática con Google Translate, sin valor legal)

Systems, methods and apparatus for guiding and supporting catheters such as stent delivery catheters

A device for guiding and supporting a stent delivery catheter and other catheters is disclosed. The device may comprise a tubular guiding member and an elongated positioning member extending in a proximal direction beyond the tubular guiding member for advancing and retracting the tubular guiding member in distal and proximal directions. A distal portion of the elongate positioning member may be coupled to the proximal portion of the tubular guide. In embodiments, the device includes a ribbon having a distal portion and a proximal portion. In embodiments, the distal portion of the ribbon extends distally into the tubular guiding member and the proximal portion of the ribbon overlays an inner surface of the elongate positioning member.

Endovascular devices and methods for exploiting intramural space

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing a first intravascular device having a distal portion with a concave side, inserting the first device into the vascular lumen, positioning the distal portion in the vascular wall, and orienting the concave side of the distal portion toward the vascular lumen.

Catheters and related devices and methods of manufacture

Catheters incorporating a thin film polymeric layer or layers. The thin film may have a wall thickness of about 0.00025″+/−less than 0.0001″ to about 0.0015″+/−0.0002″, for example. The thin film may be formed by extruding a sheet and cutting the sheet into elongate ribbons, each having two opposing long edges. The ribbon may be rolled or wrapped to define a tubular shape with a gap between the long edges. Heat and pressure may be applied to close the gap, abut the edges and form a longitudinal joint. The joint may extend along a portion of the length of the tubular shaft or most of the length of the tubular shaft. The tubular-shaped thin film layer may have a uniform wall thickness around the circumference, and the uniform wall thickness may extend across the joint.

Endovascular device with a tissue piercing distal probe and associated methods

Devices, systems and methods for treating diseases and disorders effecting the cardiovascular system of the human body are disclosed. An exemplary device in accordance with this disclosure comprises a shaft, tip member fixed to the shaft, and a probe extending beyond a distal surface of the tip member. In some useful embodiments, the tip member is relatively atraumatic and the probe is shaped so as to be more likely to produce trauma than the tip member.

Endovascular device with a tissue piercing distal probe and associated methods

Devices, systems and methods for treating diseases and disorders effecting the cardiovascular system of the human body are disclosed. An exemplary device in accordance with this disclosure comprises a shaft, tip member fixed to the shaft, and a probe extending beyond a distal surface of the tip member. In some useful embodiments, the tip member is relatively atraumatic and the probe is shaped so as to be more likely to produce trauma than the tip member.

Devices, systems and methods for improving suction in medical procedures

Systems and methods for removing material from a blood vessel or cavity inside a body by suction, wherein the magnitude of suction is increased by applying extracorporeal positive pressure. Positive pressure outside the body is increased such that the potential negative pressure inside the body may be increased. Methods include inserting a catheter into a blood vessel or cavity and positioning a distal opening of the catheter proximate the material to be removed. Extracorporeal positive pressure is applied to at least a portion of the body containing the material to be removed, and suction is simultaneously applied to the catheter to more effectively remove the material.

Systems, apparatus and methods for treating blood vessels

A system and method for treating a blood vessel that is at least partially obstructed by an occlusion which divides the lumen into a proximal lumen segment and a distal lumen segment. The system includes an orienting catheter having an orientation element positionable in an intrawall space of the vessel and an occlusion catheter having an occlusion balloon inflatable in the proximal lumen segment so as to isolate a target volume including the intrawall space. The pressure inside the target volume is reduced to a pressure below the pressure of the distal lumen segment so that the intima presses against the orienting element of the orienting catheter. A distal end of a reentry device may be advanced from the orienting catheter through the intima and into the distal lumen segment.

Endovascular devices and methods for exploiting intramural space

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes inserting an intramural crossing device into the vascular lumen, positioning at least the distal tip of the crossing device in the vascular wall, advancing an orienting device over the crossing device such that an orienting element of the orienting device resides in the vascular wall, inserting a reentry device, and re-entering the true vascular lumen.

Endovascular devices and methods for exploiting intramural space

The present disclosure is directed to a device. The device may include a distal shaft defining a central lumen and an orienting element comprising at least one inflatable member. Wherein a first portion of the orienting element extending from the shaft in a first direction and a second portion of the orienting element extending from the shaft in a second direction. Further, wherein the second direction is substantially opposite the first direction.