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.

A retriever device for removal of unwanted material from a vessel in a patient's body comprising a retriever sub-system and an aspiration sub-system. The retriever sub-system comprising a delivery catheter and a delivery wire having first and second expandable bodies disposed thereon that are adapted to expand from a pre-expansion configuration to an expanded configuration. The second expandable body is further adapted to slidably translate along the delivery wire in a distal direction toward the first expandable body when the second expandable body is released from the delivery wire, whereby, when the first expandable body is disposed on a distal side of at least a first portion of the unwanted material in the vessel and the second expandable body is disposed on a proximal side of the first portion of the unwanted material, the first expandable body and the second expandable body surround and contain the first portion of the unwanted material between the first expandable body and the second expandable body. The aspiration sub-system is adapted to remove at least a second portion of the unwanted material from the vessel. The aspiration sub-system also includes a pressure sensor adapted to monitor internal vessel pressure proximate an internal region of the vessel.

A percutaneous thrombus extraction device for removing a thrombus from within a blood vessel includes a flexible outer sheath defining a first passage between a proximal end and a distal end. An inner sheath is movably positionable within the first passage. The inner sheath defines a second passage between a proximal end and a distal end. The inner sheath is moveable in a radial direction between a collapsed configuration and an expanded configuration along a length of the inner sheath defined between the proximal end and the distal end. A catheter is movably positionable within the second passage, and has an expandable body at a distal end portion of the catheter. The expandable body is movable between a collapsed configuration and an expanded configuration.

The invention provides a system for treating an occlusion within a body lumen. The system may comprise an insulated outer sheath; an elongated conductive tube, wherein the insulated outer sheath is circumferentially mounted around the elongated conductive tube; and an insulated wire having a helically coiled portion at a distal end of the insulated wire. The coiled portion includes an exposed distal tip, and a distal portion of the elongated conductive tube is circumferentially mounted around the distal coiled portion of the insulated wire. When a voltage is applied across the insulated wire and the elongated conductive tube, a current is configured to flow from the exposed distal tip of the insulated wire to the elongated conductive tube to generate a plurality of cavitation bubbles. In an alternate embodiment, an elongated central electrode is used in place of the conductive tube.

A system of devices for treating an artery includes an arterial access sheath adapted to introduce an interventional catheter into an artery and an elongated dilator positionable within the internal lumen of the sheath body. The system also includes a catheter formed of an elongated catheter body sized and shaped to be introduced via a carotid artery access site into a common carotid artery through the internal lumen of the arterial access sheath. The catheter has an overall length and a distal most section length such that the distal most section can be positioned in an intracranial artery and at least a portion of the proximal most section is positioned in the common carotid artery during use.

An embolectomy device comprised of an expansion unit and a support unit is disclosed. The expansion unit can be actuated in response to one or more external stimuli, and the support unit, located proximately to the expansion unit, provides a force to hold the expansion unit in place and to further induce the expansion unit's radial expansion. The radial expansion of the expansion unit causes the expansion unit to physically contact a blood clot, enabling the blood clot to be removed. In some embodiments, the expansion unit can be fabricated from a shape memory polymer foam. In some embodiments the support unit can be fabricated from any elastic material including, without limitation, shape memory alloys.

A method for treating a patient having thrombus includes providing a manipulation device including a housing configured to be supported by the hand of a user and having a distal and proximal end, a drive system disposed within the housing, and configured to rotate a rotation member, an engagement member coupled to the rotation member and configured to be removably coupled to an elongate medical device, an activation member carried by the housing such that it can be operated by at least a portion of the hand of the user when the housing is supported by the hand of the user, the drive system configured to apply motive force to the engagement member, securing an elongate member to the engagement member, introducing at least the distal end of the elongate member into a blood vessel adjacent a thrombus, operating the activation member to cause at least some rotation of the rotation member, which in turn causes at least some rotation of the distal end of the elongate member at or near the thrombus, and aspirating at least some of the thrombus with an aspiration catheter.

A catheter system for accessing the central venous system through an occlusion in the neck region.

A device can detect and retrieve a blood clot by advancing a catheter with a clot sensing element through a patient’s vascular system. The catheter can map, using an electromagnetic sensor disposed at a distal end of the clot sensing element, the patient’s vascular system. A force sensor can generate a position signal indicating the clot sensing element contacted the clot in the patient’s vascular system. Once located, a blood clot retrieval device can be deployed through the catheter and a lumen in the clot sensing element to remove the clot from the patient’s vascular system.

An elongate endovascular element for crossing through an obstruction in a blood vessel comprises: a proximal section; a distal tip section of smaller diameter than the proximal section; and a distally-tapering intermediate section extending between the proximal and distal tip sections; wherein the tapered intermediate section has a length that is substantially λ/2 or a multiple of λ/2 , where λ is a wavelength of a driving frequency that will produce longitudinal resonance in the element.