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.

Mechanical atherectomy and/or thrombectomy devices configured to remove obstructions (e.g., plaque material) of different consistencies and/or sizes from blood vessels. The devices may include a tractor comprising a flexible tube of material that inverts as it rolls over itself while being drawn into the open distal end of a catheter in a conveyor-like motion. The flexible tube can include features that facilitate engagement with the obstruction, enhance smooth tractor motion and/or promote movement control of the device within the blood vessel.

A device and method for establishing retrograde blood flow during recanalization of a vessel having a targeted blockage. While in a collapsed state an occluding component is introduced distally intravascularly traversing the targeted blockage to its distal side. Then, the occluding component transitions to an expanded state having an enlarged diameter forming a seal with an internal wall of the vessel prohibiting anterograde blood flow beyond the expanded occluding component. Retrograde blood flow is thereby established in a region of the vessel bound at one end by the occluding component and at an opposite end by the targeted blockage by dispensing a flushing fluid into the region of the vessel.

In embodiments of an obstruction removal device, system, and/or method, an expandable member is configured to be slidably coupled to a guide wire. The expandable member is configured to surround at least a portion of an obstruction captured by a stentriever as the expandable member transitions from the expanded state to the contracted state, i.e., when the guide wire is removed from a vasculature to remove the stentriever and the obstruction from the vasculature. A first locking member is located at a base of the expandable member. The first locking member is configured to engage a second locking member that is located on the guide wire, the stentriever, or an inner surface of a guide catheter, thereby coupling the expandable member to the guide wire, the stentriever, or the inner surface of the guide catheter when the expandable member is deployed within the vasculature.

A system for accessing a central pulmonary artery includes an elongate, flexible tubular catheter, having a proximal end, a distal end and a catheter hub on the proximal end. An elongate, flexible rail has a proximal end, a distal end and a rail hub on the proximal end. The rail has a distal advance segment which extends at least about 10 cm beyond the distal end of the catheter when the catheter hub is adjacent the rail hub.

A clot removal device for removing clot from a body vessel comprising an expandable structure and an elongate member. The elongate member can have a proximal end and a distal end, the elongate member being connected to the expandable structure at its distal end. The expandable structure can have a constrained delivery configuration, an expanded clot engaging deployed configuration, and an at least partially constrained clot pinching configuration. At least a portion of the expandable structure can be configured to engage clot in the expanded deployed configuration and to pinch clot on movement from the deployed configuration to the clot pinching configuration.

A handle assembly includes a drive wire coupled to an expandable end effector, the wire having a diameter of no more than 3 French and a handle cannula receiving the wire therethrough, rotation of the handle cannula transferring torque to rotate the wire. The assembly also includes a shaft receiving the handle cannula, rotation of the shaft transferring torque to rotate the handle cannula. The assembly further includes an actuation assembly receiving the shaft, the actuation assembly coupled to a sheath sized to receive the wire and end effector therethrough, the actuation assembly moveable between a proximal configuration in which the sheath is moved proximally to expand the end effector and a distal configuration in which the sheath is moved distally to retract the end effector, the actuation assembly including a rotation mechanism transferring torque to the shaft to rotate the shaft.

A medical device for cutting substances inside a body lumen includes a flexible and elongated drive shaft including a distal portion and a proximal portion, a cutting member connected to the distal portion of the drive shaft to be rotatable with the drive shaft, and a hub located at the proximal portion and supporting the drive shaft, the hub including a first bearing mounted on the drive shaft and an elastic ring that is made of an elastic material on an outer periphery of the first bearing.

A medical instrument, which is capable of holding a wire, includes: a sheath which has a center axis in a longitudinal direction from a distal end toward a proximal end thereof and includes in a distal end surface of the distal end a first contact area capable of being in contact with the wire and a second contact area coming in contact with the wire and provided on a proximal end side beyond the distal end with respect to the first contact area; and a holding portion which is advanceable and retractable in a lumen of the sheath and is retracted into the lumen of the sheath so that the wire is pressed to the first contact area and the second contact area and the holding portion holds the wire.

A system for endoscopic surgery within a body lumen of a patient including a flexible catheter having an expandable balloon at a distal portion and an access opening. The expandable balloon is expandable from a collapsed insertion configuration to an expanded configuration to provide an expanded chamber on a first side of the catheter. The access opening provides a window to access target tissue. The catheter includes a lumen dimensioned to receive an endoscopic instrument therethrough such that a distal end of the endoscopic instrument is positionable within the expanded chamber and angled laterally within the expanded chamber to access the target tissue through the window.