Methods and devices for performing transjugular carotid flow reversal are provided. A flow reversal sheath is advanced through a transjugular carotid fistula. An occlusion balloon is inflated, causing carotid inflow to be diverted through the sheath and through a flow reversal region positioned in the jugular vein. After reversal of blood flow, a carotid intervention is performed.

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.

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.

The present disclosure is directed to a medical device. Systems and methods are provided for accessing and visualizing the pancreatico-biliary system. The medical device may include a guide catheter with a first lumen and a second lumen. A first elevator may be disposed in the first lumen, wherein the first elevator is movable relative to the first lumen for elevating a first tool insertable into the first lumen. A second elevator may be disposed in the second lumen, wherein the second elevator is movable relative to the second lumen for elevating a second tool insertable into the second lumen.

The present disclosure relates generally to the field of medical devices. In particular, the present disclosure relates to medical systems and methods configured to shield the sharpened distal end of needles, such as exchangeable biopsy needles. The biopsy needles may be used for tissue biopsy and sampling under radial ultrasound guidance.

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.

Mechanisms are disclosed for securing a catheter in place to facilitate puncturing a hole through a vessel wall. The securing mechanisms include bubbles, meshes, flaps, or similar features that expand when activated to press against the wall of the vessel (e.g., coronary sinus). Activation of the securing mechanisms occurs through removal of a restraint (e.g., a cover) or by pushing or pulling a wire. The securing mechanisms activated by removal of a restraint may self-expand or may expand due to a spring within a mesh structure. The securing mechanisms activated by pushing or pulling a wire expand due to movement of the wire itself or due to movement of a component attached to the wire and to the anchor member.

A steerable surgical device includes a flexible joint positioned between first and second tubular elements, with multiple shape memory alloy wire elements extending across or through the joint being circumferentially spaced relative to one another and independently actuatable to effectuate pivotal movement between the first and second tubular elements (e.g., along at least two or at least three nonparallel planes) to provide enhanced maneuverability relative to single degree of freedom steerable devices. Longitudinal guide structures (e.g., channels or bores) and/or anchor points for shape memory alloy wire elements may be circumferentially spaced in or on the tubular elements to receive the shape memory alloy wire elements.

Some embodiments of an electrical stimulation system employ wireless electrode assemblies to provide pacing therapy, defibrillation therapy, or other stimulation therapy. In certain embodiments, the wireless electrode assemblies may include a guide wire channel so that each electrode assembly can be advanced over a guide wire instrument through the endocardium. For example, a distal tip portion of a guide wire instrument can penetrate through the endocardium and into the myocardial wall of a heart chamber, and the electrode assembly may then be advanced over the guide wire and into the heart chamber wall. In such circumstances, the guide wire instrument (and other portions of the delivery system) can be retracted from the heart chamber wall, thereby leaving the electrode assembly embedded in the heart tissue.

A device and method for performing a cricothyrotomy and/or a tracheotomy has an outer cannula. An inner cutting cannula is positioned within the outer cannula. An actuator is coupled to a proximate end of the inner cutting cannula. The actuator keeps the inner cutting cannula in a retracted position within the outer cannula when the actuator is not activated and an extended position where a distal end of the inner cutting cannula extends out of the outer cannula with a force for the distal end of the inner cutting cannula to penetrate one of a cricothyroid membrane or tracheal wall when the actuator is activated.