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 septostomy device 10 with a cutting structure or means 140 and tissue capture mechanisms 240, 250 is disclosed, along with a medical procedure for using the device. The system 10 is configured in such a way as to create a permanent interatrial aperture in the heart, including creating a permanent interatrial hole and/or removing tissue.

Devices and methods for occluding or promoting fluid flow through openings are disclosed. In one exemplary embodiment an occlusion device is provided having an expandable outer elongate tubular body, a guide member extending from a distal end of the outer body, and a slide tube disposed within the outer body, the proximal portions of the outer body and the slide tube being fixedly mated. The slide tube is configured to slide distally within the outer tubular body when the tubular body is expanded to form wings. A tether can be included as part of the device and it can be used to assist in positioning and locking a location of the device in an opening. Exemplary methods for delivering devices disclosed herein are also provided.

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.

Systems and methods can be used to retrieve and remove blood clots from blood vessels. For example, this document describes catheter-based cryogenic devices that are used to retrieve and remove blood clots. The systems and methods provided herein can be used to remove blood clots from all types of blood vessels including, but not limited to, peripheral vessels, coronary arteries, central veins, pulmonary arteries, cerebral arteries, and any other type of blood vessel that can contain blood clots.

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.

The disclosure provides various embodiments of catheters having articulable ends that can be used for various procedures. Embodiments of methods are also provided that can be performed with catheters in accordance with the present disclosure.

The present invention relates to a method for positioning a tip of a pacemaker lead that has passed through coronary sinus into an interventricular septum. More particularly, it relates to a method for positioning a tip of a pacemaker lead that has passed through a coronary sinus into an interventricular septum in order to more effectively transmit an electrical stimulus in a treatment using a pacemaker for patients with arrhythmia. A method of positioning a tip of a pacemaker lead, which has passed through a coronary sinus, into an interventricular septum, in order to effectively transmit electrical stimulus, includes: inserting into an intervention wire through a superior vena cava and a coronary sinus to pass through the interventricular septum and then guiding the intervention wire to an inferior vena cava; and positioning the tip of the lead into the interventricular septum by inserting the pacemaker lead along the intervention wire.