A device for creating intravascular access and guidewire placement includes a main body having a lumen and a piercing member disposed in the lumen. The piercing member moves distally out of the lumen and pierces tissue while moving. A needle guide is provided for guiding the piercing member, the needle guide having a distal end which comprises a first alignment member. A guidewire has a distal tip with a second alignment member disposed on the guidewire distal tip. The first alignment member may comprise a magnetic attachment, at least one magnetic implant, a proximity sensor, an ultrasonic sensor, or other suitable system for alignment of devices disposed on opposing sides of opaque tissue. Similarly, the second alignment member may comprise a magnetic attachment or implant, a proximity sensor, or an ultrasonic sensor.

Vascular access devices and methods of their use are provided. In one embodiment, a vascular access device includes a catheter (112) and at least one deployable wire (134). The catheter includes a primary lumen extending from a proximal end to a distal end of the catheter. The at least one deployable wire is secured to the catheter and configured to move relative to the catheter between a delivery configuration and a deployed configuration.

Disclosed are methods and systems for restoring patency across a vascular or non-vascular occlusion. The system may include a retrograde catheter, having a proximal end, a distal end, a first central lumen and a first side port spaced proximally apart from the distal end, the first central lumen extending at least as far as the first side port. An antegrade catheter is also provided, having a proximal end, a distal end, a second central lumen in communication with a second side port spaced proximally apart from the distal end. The catheters may have complementary surface configurations to facilitate alignment of the first and second side ports, so that a wire may be passed out of one of the side ports and into the other side port.

Disclosed are methods and devices for restoring patency across a vascular or non-vascular occlusion. A first catheter having a first side port is configured to advance in a first direction through a vessel from a vascular access site on a first side of the occlusion. A second catheter having a second side port is configured to advance in a second direction through the vessel from a vascular access site on a second side of the occlusion. The catheters may have complementary surface configurations to facilitate alignment of the first and second side ports, so that a wire may be passed through the catheters, out of one of the side ports and into the other side port, to bypass the occlusion.

A catheter has a guide-tip including at least one wing for crossing a CTO lesion in an artery via exploring the subintimal space. The catheter can includes one or more exit port(s) and radiopaque marker(s) for steering a re-entry wire through one of the exit ports. The catheter may include a number of spiral-cut sections with varying characteristics to provide different strength and flexibility along the axial direction.

Disclosed are methods and devices for bidirectional crossing of a vascular obstruction in a patient. The method includes the steps of advancing a first catheter transvascularly in a first (e.g., retrograde) direction towards a vascular obstruction, the first catheter having a first central lumen in communication with a first side port. A second catheter is advanced transvascularly in a second, opposite (e.g., antegrade) direction towards the obstruction, the second catheter having a second central lumen in communication with a second side port. The first and second side ports are aligned to place the first central lumen in communication with the second central lumen; and a wire is advanced through the first and second side ports such that a first end of the wire is on a first side of the obstruction and a second end of the wire is on a second side of the obstruction.

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 providing a first intravascular device having a distal portion with a concave side, inserting the first device into the vascular lumen, positioning the distal portion in the vascular wall, and orienting the concave side of the distal portion toward the vascular lumen.

Apparatuses and methods described herein relate to treating cancerous tumors using radiation therapy and chemotherapy. In some embodiments, a method of treatment includes administering radiation therapy targeting a tumor, isolating a segment of a vessel proximate to the tumor, and administering a dose of a chemotherapeutic agent to the segment of the vessel. The method can further include waiting a period of time after administering the radiation therapy before administering the dose of the chemotherapeutic agent. In some embodiments, a catheter device including first and second occluding elements can be used to isolate the segment of the vessel.

Methods and devices are disclosed for passing Chronic Total Occlusion (CTO) from subintimal location and re-entry into a true-lumen of the patient using transient fenestration approach. The transient fenestration is induced by balloon dilatation within the CTO, and a guidewire quickly trails into a true lumen.

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 providing an intravascular device having a distal portion with a side port, inserting the device into the vascular lumen, positioning the distal portion in the vascular wall, directing the distal portion within the vascular wall such that the distal portion moves at least partially laterally, and directing the side port towards the vascular lumen.