A cryoablation device is provided herein which, in an embodiment, includes a catheter shaft; a cryogen return line disposed within the catheter shaft; and a cryogen supply line disposed within the cryogen return line, such that the cryogen supply line, the cryogen return line, and the catheter shaft are all substantially coaxial. A needle tip probe is disposed at a distal end of the cryogen return line. The cryogen supply line extends in a distal direction beyond a distal end of the cryogen return line and into the needle tip probe, and the catheter shaft is axially movable relative to the needle tip probe and the cryogen return line, and the catheter shaft is configured such that the catheter shaft is distally extended over the needle tip probe in an extended position.

A phototherapy method includes: introducing an ultrasound endoscope into a digestive tract; visualizing an irradiation target site in a body by means of the ultrasound endoscope introduced into the digestive tract; puncturing a vicinity of the irradiation target site with a distal-end section of a needle tube that is made to protrude from a distal-end section of the ultrasound endoscope introduced into the digestive tract; exposing an optical fiber from the distal-end section of the needle tube that has punctured the vicinity of the irradiation target site, by making the needle tube retreat with respect to the optical fiber accommodated inside the needle tube; and radiating light emitted from the exposed optical fiber onto the irradiation target site.

An intravascular catheter for peri-vascular nerve activity sensing or measurement includes multiple needles advanced through supported guide tubes (needle guiding elements) which expand with open ends around a central axis to contact the interior surface of the wall of the renal artery or other vessel of a human body allowing the needles to be advanced though the vessel wall into the perivascular space. The system also may include means to limit and/or adjust the depth of penetration of the needles. The catheter also includes structures which provide radial and lateral support to the guide tubes so that the guide tubes open uniformly and maintain their position against the interior surface of the vessel wall as the sharpened needles are advanced to penetrate into the vessel wall. The addition of an injection lumen at the proximal end of the catheter and openings in the needles adds the functionality of ablative fluid injection into the perivascular space for an integrated nerve sending and ablation capability.

An intravascular catheter for nerve activity ablation and/or sensing includes one or more needles advanced through supported guide tubes (needle guiding elements) which expand to contact the interior surface of the wall of the renal artery or other vessel of a human body allowing the needles to be advanced though the vessel wall into the extra-luminal tissue including the media, adventitia and periadvential space. The catheter also includes structures which provide radial and lateral support to the guide tubes so that the guide tubes open uniformly and maintain their position against the interior surface of the vessel wall as the sharpened needles are advanced to penetrate into the vessel wall. Electrodes near the distal ends of the needles allow sensing of nerve activity before and after attempted renal denervation. In a combination embodiment ablative energy or fluid is delivered from the needles in or near the adventitia to ablate nerves outside of the media while sparing nerves within the media.

Some of the present methods include, and some embodiments of the present systems are configured for gaining access to a patient's vessel by way of the vessel (i.e. from the inside out). Some embodiments facilitate gaining access to an occluded vessel, where part of the access path is through the occlusion.

Dual-access site catheter systems with a blade or scoring functionality entering through a first access site and a balloon functionality for manipulating or driving the blade or scoring functionality through a different site. The blade or scoring functionality also sometimes provides needle or fluid delivery functionality to an atherosclerotic lesion.

Methods and devices for trans-jugular carotid access are disclosed. Methods within the scope of this disclosure include methods of trans-jugular carotid access originating in the leg of a patient or other location remote to the jugular vein and carotid artery and methods originating at the neck of a patient. Devices used in connection with the disclosed methods may comprise access catheters, lumens, and stylets.

Delivery devices, systems, and methods for delivering implantable leadless pacing devices are disclosed. An example delivery device may include a tubular member and a distal holding section extending distally of a distal end of the tubular member and defining a cavity therein for receiving an implantable leadless pacing device. The delivery device may facilitate vascular delivery of the pacing device to a left side of a patient's heart. In one example, a distal tip portion may extend distal of the distal holding section and may be actuated between a closed and an opened position. When in the closed position, the distal tip portion may have a tip that can puncture or engage an opening in a septum between a left atrium and a right atrium of a patient's heart. Actuating the distal tip portion to an opened position may be utilized to dilate the puncture or opening in the septum.

A catheter, such as for use for total occlusion crossing and lumen reentry, incorporate a retractable long flexible nitinol curved needle at the catheter distal end. The needle is straight when withdrawn inside the catheter. When pushed forward, the needle is deployed by protruding axially out, directly from the distal tip, through a mechanism used to direct the curved needle into a specific radial direction. When pushed forward, the needle restores its curved shape and can penetrate the plaque or the media and intimal layers to reenter the true lumen.

An intravascular catheter for peri-vascular nerve activity sensing or measurement includes multiple needles advanced through supported guide tubes (needle guiding elements) which expand with open ends around a central axis to contact the interior surface of the wall of the renal artery or other vessel of a human body allowing the needles to be advanced though the vessel wall into the perivascular space. The system also may include means to limit and/or adjust the depth of penetration of the needles. The catheter also includes structures which provide radial and lateral support to the guide tubes so that the guide tubes open uniformly and maintain their position against the interior surface of the vessel wall as the sharpened needles are advanced to penetrate into the vessel wall. The addition of an injection lumen at the proximal end of the catheter and openings in the needles adds the functionality of ablative fluid injection into the perivascular space for an integrated nerve sending and ablation capability.