A device and method for treating a patient with total or near total occlusion is provided. The device can be positioned in a blood vessel at a treatment site. An occlusion at the treatment site is enlarged by a catheter. The catheter can be advanced over a guidewire into the occlusion. One or more of [a] compression or torsion applied to the guidewire or [b] compression or torsion applied to the catheter body expands or creates a path through the occlusion. The expansions or creation of the access path can be by cutting or abrading the occlusion or by a shoe-horn effect.

A steerable catheter device including a catheter, first and second steering wires, and a steering control unit. The steering wires are connected to and extend from the catheter. The steering control unit includes a first actuator member, a first output member, a second actuator member, and a second output member. The first output member is threadably connected to the first actuator member. The second output member is threadably connected to the second actuator member. A portion of the first actuator member is disposed within the second actuator member. The first output member translates with rotation of the first actuator member and the second output member translates with rotation of the second actuator member. The first steering wire is attached to the first output member and the second steering wire is attached to the second output member. Tension in the steering wires can be independently adjusted.

A catheter extension set may include a housing, which may include a distal end, a proximal end, and a lumen. The catheter extension set may include a distal connector coupled to the distal end of the housing and configured to couple to a catheter assembly. The catheter extension set may include a handle, an advancement element, and an instrument. The instrument may extend through a U-shaped channel of the advancement element and may include a fixed first end and a second end. A translation feature may be disposed between the handle and the housing and within a pocket of the advancement element such that in response to distal movement of the handle a first distance, the advancement element moves distally within the lumen the first distance and the second end of the instrument advances distally a second distance. The second distance may be at least twice the first distance.

An improved bi-directional steerable catheter is provided. The catheter generally comprises a catheter body, tip section and control handle. The catheter further comprises first and second puller wires extending from the control handle, through the catheter body and into the tip section. The control handle has deflection means for each puller wire that include a gear, and a carrier to which the proximal end of a puller wire is anchored. The gear is rotatably coupled to a lever controlled by an operator and the gear engages the carrier such that rotation of the gear by the lever results in longitudinal movement of the carrier, which results in deflection of the tip section.

A steering catheter includes an elongate shaft with an actively steerable distal part. An internal pull wire and an external pullwire extend through the shaft. The shaft has a first position in which the elongate shaft is generally straight and the external pullwire extends along the exterior of the distal portion of the shaft, a second position in which the shaft is curved and in which the external pullwire extends along the exterior of the distal portion of the shaft, and a third position in which the shaft is curved and in which the external pullwire extends laterally between laterally adjacent portions of the distal portion of the shaft, wherein the external pull wire locks the shaft in the curved position.

The disclosure of this application relates generally to medical devices and in particular to a steerable medical instrument applicable to guide interventional tools and instruments, such as percutaneous biopsy and ablations tools and endoscopes. The steerable medical instrument has an outer and an inner tube where the inner tube is movable at the proximal end and fixed at the distal end. At least one of the outer tube and inner tube has a plurality of openings, which creates deformable portions so that the outer and the inner tubes can bend by moving the inner tube at the proximal end.

For robotically operating a catheter, a medical catheter is controlled by rotation of the catheter as well as steering in one or more planes of a distal end of the catheter. To robotically rotate the catheter, a handle is rotated. The steering is performed separately using one or more knobs on the handle. The rotation of the handle complicates the robotic control of the knob. A mechanical decoupling is used so that rotation of the handle maintains the position of the knob relative to the handle. Gearing or transmission is used to avoid independent control of the knob and handle rotation. In an alternative or additional approach, the handle may be robotically controlled while also guiding the catheter shaft spaced away from the handle, allowing fine-tuned control of the catheter at the access point to the patient.

Apparatus for performing a minimally-invasive procedure, the apparatus comprising: a shaft having a distal end and a proximal end; a handle attached to the proximal end of the shaft; and an end effector attached to the distal end of the shaft; wherein the shaft comprises a flexible portion, a first articulating portion and a second articulating portion, wherein the flexible portion extends distally from the handle, the first articulating portion extends distally from the flexible portion, and the second articulating portion extends distally from the first articulating portion; wherein at least one articulation cable extends from the handle to the first articulating portion, such that when tension is applied to the at least one articulation cable, the first articulating portion deflects; wherein a plurality of articulation cables extend from the handle to the second articulating portion, such that when tension is applied to at least one of the plurality of articulation cables, the second articulating portion deflects.

A delivery device for delivering a pacing lead to the His bundle of a patient's heart includes an elongated sheath having a distal end, and a plurality of mapping electrodes positioned at the distal end. The distal end of the sheath may have a distal tip, and the mapping electrodes may include two electrodes that diametrically oppose one another at a position spaced from the distal tip of the sheath. The sheath includes a plurality of flexible sections spaced apart from one another, and a pull wire that causes the sheath to deflect from a straight configuration to a dual hinged curved configuration that positions the electrodes in the vicinity of the bundle of His.

A catheter including: an elongated body sized to traverse vasculature, defining a longitudinal axis, and including: an outer surface; and a proximal end and a distal end disposed on opposite sides thereof; an orientation lumen formed in the elongated body and defining a curved path extending proximally from the distal end towards the proximal end and about the longitudinal axis; an orientation insert disposed within the orientation lumen, the orientation insert including an oriented pull-wire attached to the distal end of the elongated body such that tightening the oriented pull-wire deflects the distal end to form a curve; and a flexible circuit disposed on the outer surface of the elongated body, the elongated body being substantially rotationally fixed about the longitudinal axis relative to the oriented pull-wire such that the flexible circuit is disposed toward an outer bend of the curve when the oriented pull-wire is tightened.