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.

Vascular treatment and methods include a plurality of self-expanding bulbs and a hypotube including interspersed patterns of longitudinally spaced rows of kerfs. Joints between woven structures and hypotubes include solder. Woven structures include patterns of radiopaque filaments measureable under x-ray. Structures are heat treated to include at least shapes at different temperatures. A catheter includes a hypotube including interspersed patterns of longitudinally spaced rows of kerfs. Heat treating systems include a detachable flange. Laser cutting systems include a fluid flow system.

A surgical access device includes a seal housing and a roller disposed in the housing and defining a working channel. The roller may be stationary or moveable within the seal housing to form both a zero seal in the absence of an instrument, and an instrument seal in the presence of an instrument. Rotation of the roller is contemplated and low-friction surfaces are discussed to reduce instrument insertion forces. Multiple rollers, wiper elements, low-friction braid, pivoting elements and idler rollers are contemplated. The rollers will typically be formed of a gel material in order to facilitate the desired compliance, stretchability and elongation desired.

The invention provides a filter assembly including a string or wire such that a lasso type cincture is effected, said filter being openable and closeable while in deployed within a bodily vessel. A string lengthen or shorting adjustment mechanism, such as a ratchet or reel allows more length of string into the device or alternatively to shorten the length of available string in the system. The described invention, when used to ameliorate venous clots and most arterio-venous dialysis grafts, a filter-tipped aspirator is used downstream from the clot to capture and remove dislocated emboli. A method of using same is disclosed.

A medical instrument for an endoscope according to the invention is the medical instrument to be used in the endoscope by being inserted therein, and the medical instrument includes: a flexible elongated sheath having a first lumen and a second lumen; a conductive wire which is inserted into the first lumen and of which a portion of a distal side is exposed to the outside of the sheath as an instrument unit; and a balloon which is attached to the sheath and is expandable with the supply of fluid from the second lumen. The balloon is configured such that an axial dimension thereof is larger than a radial dimension upon expansion and a distal end of the balloon upon expansion is located closer to a proximal side than the treatment unit exposed from the sheath.

An occlusion apparatus comprises inner and outer sheaths and an expandable flexible tubular sleeve. The occlusion apparatus is advanced to a target site in the blood vessel. A dilator having a soft, compressible tip may be advanced through a lumen of the inner sheath to facilitate the advancement of the occlusion apparatus. The sheaths are translated relative to one another to expand the flexible tubular sleeve to a funnel shape with a distal flush portion contacting the blood vessel inner wall and a proximal tapered portion. The proximal portion is fluid permeable so that blood can pass through to apply pressure on the vessel wall through the distal portion. A capture or traction device can be advanced out of the inner sheath lumen and retracted back therein to capture thrombus. The distal portion of the device may comprise an expandable mesh braid with a memory characteristic to limit expansion.

A thrombectomy device for removing thrombus from a body lumen comprises an elongated catheter member (2) having a distal part and a proximal part, a thrombus blocking body (5) disposed on the distal part of the catheter member and radially expansible between a contracted orientation and an expanded, thrombus-blocking, orientation, a thrombus capture body (3) disposed on the distal part of the catheter member in an axially spaced-apart relationship to the thrombus blocking body, and radially expansible between a contracted orientation and an expanded, thrombus-capture, orientation, deployment means actuable to deploy and retract the thrombus capture body and thrombus blocking body; and an elongated control arm operably connected to the thrombus capture body. The thrombus capture body is a cage having an inwardly tapering leading end, the elongated control arm is operably connected to the leading end of the cage, and a thrombus extractor or macerator mechanism is disposed within the cage.

A catheter is provided which includes an outer catheter and an extendable inner catheter. A sealing feature is positioned between the inner catheter and the outer catheter to seal the annular gap between the two while allowing axial translation. The seal may be a compliant protrusion surrounding the inner catheter and may have a chevron-shape for facilitating axial translation. The seal may be a one-way valve configured to allow antegrade flushing but prevent retrograde flow. The seal may be squeegee-like flange on the distal tip of the outer catheter. The seal may be an expandable bulge, which may be mechanically expandable or inflatable or which may be a photosensitive or electrosensitive hydrogel. The seal may include a spring that is radially compressed upon translation or rotation of the inner catheter to transiently break the seal. Also provided is a seal for sealing between the catheter and the vasculature.

Methods for removing blockages and preventing thromboembolic injuries, by advancing to a blockage a first tubular, endovascular device receiving irrigating fluid through a proximal opening, having a circumferential wall, lumen, at least one distal side hole oriented angularly to a distal opening; ejecting fluid from the side hole(s) to irrigate a blockage; introducing a second catheter for aspiration, comprising a circumferential wall having a proximal and distal opening, a flared, semi-permeable filter at the distal end for removal of emboli through the second lumen; advancing the second device to a blood vessel receiving blood from the blocked vessel, aspirating the blockage, axially rotating the first endovascular device having at least one half-loop to macerate an obstruction, capturing and removing emboli from the blockage through the second endovascular device which prevents emboli from causing further blockage of blood vessels. Variants of said method including a third rotatable device.

Filtration systems with integrated filter element(s) forming portions of the wall of the filtration catheter are disclosed. The filtration catheters disclosed herein are designed to be used alone or in conjunction with another filter device to provide embolic protection of both carotid arteries. Occlusive element such as balloon is placed on the exterior of the filtration catheter to redirect blood flow in the vessels during the filtration process as well as to help anchor the filtration catheter inside the vessel. The integrated filter element(s) does not require collapsing thus significantly reduces the complexity of the filtration system retrieval process and the chances of releasing emboli back into the blood stream. The compact design of the filtration systems makes them particularly suitable for embolic protection during endovascular procedures on or close to the heart.