A guidewire for use in penetrating through complex and stenosed lesions. The distal tip of the guidewire has a roughened surface to increase frictional engagement with calcified and fibrous tissue to increase the penetration of the distal tip and the guidewire into and through the lesion and reduce the likelihood of deflection of the guidewire tip. The average surface roughness of the distal tip is in the range from 1 micron to 200 microns.

A thrombectomy system is provided that, in various embodiments, a rotating impeller that may be translated within limits along a guidewire and within a catheter. The rotating impeller is, during operation, either located entirely inside or outside of the distal end of the catheter's lumen or at least partially outside of the distal end of the catheter's lumen. In some cases, the impeller may be prevented from rotating if at least partially inside the catheter's lumen. The rotating impeller may achieve a working diameter that is greater than its resting diameter.

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.

Systems for providing access across a site of obstruction and methods for manufacturing and using such systems are provided. Such systems may include a cannula having a lumen, an everting member coupled to the cannula, and a push assembly having a pathway. The push assembly may be slidably disposed within the lumen of the cannula and connected to a proximal end of the everting member to move the everting member from an inverted position inside the cannula to an everted position outside the cannula. The systems may also include a hard tube having a passageway, the hard tube slidably disposed on or within the pathway of the push assembly. The hard tube being designed to create and opening within and traverse and obstruction within a structure.

Electrophysiology mapping and visualization systems are described herein where such devices may be used to visualize tissue regions as well as map the electrophysiological activity of the tissue. Such a system may include a deployment catheter and an attached hood deployable into an expanded configuration. In use, the imaging hood is placed against or adjacent to a region of tissue to be imaged in a body lumen that is normally filled with an opaque bodily fluid such as blood. A translucent or transparent fluid, such as saline, can be pumped into the imaging hood until the fluid displaces any blood, thereby leaving a clear region of tissue to be imaged via an imaging element in the deployment catheter. A position of the catheter and/or hood may be tracked and the hood may also be used to detect the electrophysiological activity of the visualized tissue for mapping.

Described herein is a shock wave device for the treatment of vascular occlusions. The shock wave device includes an outer covering and an inner member inner connected at a distal end of the device. First and second conductive wires extend along the length of the device within the volume between the outer covering and the inner member. A conductive emitter band circumscribes the ends of the first and second wires to form a first spark gap between the end of the first wire and the emitter band and a second spark gap between the end of the second wire and the emitter band. When the volume is filled with conductive fluid and a high voltage pulse is applied across the first and second wires, first and second shock waves can be initiated from the first and second spark gaps.

A combined system for diagnostic and therapeutic procedures includes a needle extending longitudinally from a proximal end to a distal end and including a lumen extending therethrough, the distal end including a sharp grind for cutting a tissue sample to be collected in the lumen of the needle and a protective sheath sized and shaped to be inserted through the lumen of the needle such that a distal end of the protective sheath extends distally past the distal end of the needle, the protective sheath extending longitudinally from a proximal end to the distal end and including a lumen extending therethrough.

An accessory device may be used in combination with a thrombectomy catheter. The accessory device may be configured to deflect a distal portion of the thrombectomy catheter and/or disrupt a lesion in a vessel.

The present specification is directed towards catheter devices having expandable and collapsible lumens. Air or fluid is pumped into the catheter wall to cause it to expand. Alternatively, wires are embedded within the wall and a direction of flow of electrical current through the wires is modulated to enable the catheter device to be in the collapsed or expanded state. For example, a first wire is embedded within the wall and is helically wound along a length of the catheter device. A second wire is provided that can be removably positioned within the lumen. The direction of flow of electric current through the first and second wires is modulated to enable the catheter device to be in the collapsed or expanded state.

The invention provides devices with integrated intravascular imaging and methods for crossing a CTO within the true lumen of a vessel. An interventional catheter with intravascular imaging capabilities can be guided into an affected vessel and to a CTO. An included intravascular imaging device captures a 3D image of the environment. The catheter includes a crossing member that can be extended out from a distal tip of the catheter, causing the crossing member to directly cross through the CTO creating a new channel through the CTO.