An atherectomy system that utilizes an anchoring balloon with a rotary debulker and a crossing balloon to remove or debulk lesions formed on the interior wall surface of a body vessel. The system may include a first balloon coupled to a first tubular member, a rotary debulker coupled to a second tubular member, a second balloon coupled to both the third tubular member and the axially moveable fourth tubular member such that the second balloon is disposed inside the third tubular member. Methods for operating this device are also provided.

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.

The invention provides methods and devices for treating liver cirrhosis or portal hypertension by creating an intrahepatic shunt, or new passage, from a portal vein of a patient to a hepatic vein using a device with intravascular imaging capabilities and pressure sensing capabilities or positioning mechanisms. The integration of intravascular imaging aids in the precise placement of the shunt and pressure measurement may verify successful shunt creation. An apparatus may include a catheter with an extended body for insertion into a hepatic vein of a patient, an intravascular imaging device and a needle exit port on the distal portion of the extended body, and a needle disposed within a lumen in the catheter and configured to be pushed out of the exit port and extend away from a side of the extended body, in which the needle includes a pressure sensor.

Improved systems for diagnosing and/or treating arrhythmia of a heart makes use of an array of articulation balloons to control movement of a distal portion of a catheter inside the heart, and may be used to align a diagnostic or treatment tool with a target tissue surface region along or adjacent an inner surface of one of the chambers of the heart. The articulation balloons can generate articulation forces at the site of articulation, and the movement may provide greater dexterity than movements induced by transmitting articulation forces proximally along a catheter body that winds through a tortuous vascular pathway. One or more fluid channels may transmit pressure signals that can be used to determine engagement forces between an electrode or other surface near the distal and of an elongate flexible structure and a tissue or other surface, and those same channels may also be used to control inflation of a balloon articulation array, with the pressure signals optionally providing both force and engagement orientation information.

A surgical instrument for removing biological tissue during a surgical procedure comprises an elongate shaft and an end effector connected to the elongate shaft, the end effector including an edge configured to remove tissue, wherein curvature of one or both of the elongate shaft and end effector is adjustable to position the edge along a tissue surface when the curvature of the one or both of the elongate shaft and end effector is adjusted. A method of incising target tissue from an anatomic wall comprises inserting a shaft of a surgical instrument into an anatomic chamber of a patient, positioning a tissue-removal device connected to the shaft proximate the target tissue, deflecting an axis of the tissue-removal device relative to a central axis of the shaft, and shaving a surface of the anatomic wall by moving the tissue-removal device in a deflected state along the target tissue.

An atherectomy catheter includes an elongate flexible catheter body, a cutter near the distal end of the catheter body, a drive shaft connected to the cutter and extending within the catheter body, an imaging element near the distal end of the catheter body.

A system and associated method for manipulating tissues and anatomical or other structures in medical applications for the purpose of treating diseases or disorders or other purposes. In one aspect, the system includes a delivery device including a flexible portion that is suited to access target anatomy. The flexibility of an elongate portion of the delivery device can be varied. Additionally, the delivery device can include structure that maintains the positioning of the delivery device in patient anatomy.

This document describes minimally invasive surgical instruments and methods for their use. For example, this document describes devices and methods for transcatheter modification of mitral valve leaflets to reduce or prevent the potential for full or partial blockages of the left ventricular outflow tract by anterior displacement of the anterior leaflet of the native mitral valve.

Disclosed are access devices that can be used to safely guide instruments, such as EP ablation catheters, to a therapy site such one within the pericardial space of the heart. The access devices include integrated visualization, illumination, stabilization, and safety features in a single platform that can, for example, more safely and efficiently identify and ablate several ventricular tachycardia (VT) locations on the left ventricle of the heart.

MVO is treated by introducing injectate into blood vessels affected by MVO at precise flow rates, while blocking retrograde flow, such that the natural pumping of the heart aids in forcing the injectate into the affected microvessels. Monitoring pressure distal of an occlusion balloon is used to determine treatment effectiveness and heart health.