A catheter member for interacting with a circumferential tissue structure includes: an elongate primary catheter having at least one inner lumen and extending along a longitudinal axis; first and second elongate secondary catheters, each having an inner lumen, and each positionable in an inner lumen of the primary catheter to be moveable relatively thereto and exposable therefrom; and a first flexing mechanism to provide a distal end portion of the first and/or second secondary catheter with a tendency to assume a first secondary bent shape. The distal end portion of the first and/or second secondary catheters is provided so as to be able to be flexed by the first flexing mechanism to form an arm portion substantially transverse to the direction of the longitudinal axis of the primary catheter so as to assume the first secondary bent shape when exposed from a distal end portion of the primary catheter.

Described herein are various implementations of systems and methods for accessing and modulating tissue (for example, systems and methods for accessing and ablating nerves or other tissue within or surrounding a vertebral body to treat chronic lower back pain). Assessment of vertebral endplate degeneration or defects (e.g., pre-Modic changes) to facilitate identification of treatment sites and protocols are also provided in several embodiments. Several embodiments comprise the use of biomarkers to confirm or otherwise assess ablation, pain relief, efficacy of treatment, etc. Some embodiments include robotic elements for, as an example, facilitating robotically controlled access, navigation, imaging, and/or treatment.

An atherectomy device includes a catheter, and the catheter includes an outer sheath. The outer sheath includes a proximal portion coupled to and extending distally relative to a handle, and the proximal portion defines a longitudinal axis of the catheter. The outer sheath also includes a distal portion coupled to and extending distally relative to the proximal portion, and the distal portion normally has a curved configuration and is offset from the longitudinal axis. The catheter further includes a drive shaft carried within and rotatable relative to the outer sheath. A cutter assembly is coupled to and extends distally relative to the distal portion of the outer sheath. A cutter is coupled to the drive shaft and rotates about a cutter rotation axis upon rotation of the drive shaft relative to the outer sheath. The cutter rotation axis is normally disposed at an acute angle relative to the longitudinal axis.

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.

A cannula comprising a plastic tube having three longitudinal chambers, including a main chamber, a first lateral chamber and a second lateral chamber, and at least one reinforced section ensuring constant internal diameter, wherein the cannula is equipped from the distal side with a round end narrowing towards the end, in which there are longitudinal holes of a size enabling free venous blood flow, and a balloon. A fragment of the reinforced tube section located below the balloon is bent under an angle α of approximately 90°. From the proximal side, the tube ends with a flexible cone, sealing the cannula tightly, inside which there is a valve closing the main chamber and a port for inflating the balloon connected to the first lateral chamber.

An endoscope can include a substantially rigid elongate body. A visualization channel can extend through the elongate body. An elongate viewing instrument that can advance distally and retract proximally through a visualization channel of the elongate body. The elongate viewing instrument can include a distal portion that is pre-biased to assume a curved shape when the distal portion is unconfined. The distal portion can curve when the distal portion is advanced distally to exit the visualization channel and can straighten when the distal portion is retracted proximally to enter the visualization channel. A distal end of the elongate viewing instrument can further include a light port that is configured to illuminate a target and provide an image of the illuminated target.

Systems, methods, and devices are provided for assisting or performing guided interventional procedures using custom templates. The system uses pre-procedure scans of a patient's anatomy to identify targets and critical structures. A template is then manufactured containing guide elements. During a procedure, the template may be aligned to the patient and instruments passed though the guide elements and into various targets. The template may be aligned using one or more of, for example, a position sensing system or a live imaging modality to register the patient to the template. The system makes optional use of devices designed to immobilize or track an organ during therapy.

An approach is provided for delivering therapeutic materials to an intervertebral disc via a sub-ligamentous space. The approach includes positioning a tool at an interface of a longitudinal ligament and an outer surface of the intervertebral disc, in which the interface is the sub-ligamentous space. The tool may include a first needle and a second needle housed within the first needle. An insertion end of the first needle may include a shallow beveled end. The approach includes inserting the insertion end of the first needle into the sub-ligamentous space. The approach includes deploying the second needle from within the first needle into at least one of an annulus and a nucleus of the intervertebral disc. The approach includes delivering the therapeutic materials to the at least one of the annulus and the nucleus.

Systems and methods for augmenting a vertebral body. An introducer device includes a shaft having a flexible distal portion with a pre-set curve in an unconstrained state. An input provided to an actuator to tension a pulling element to move the pre-set curve to a constrained state in which the distal portion and a flexible sheath conforming to the shaft at least partially straighten. The introducer device is removable from the sheath remaining off-set from a longitudinal axis. A spacer hub facilitates proximal movement of the sheath relative to an access cannula expose a balloon through a syringe-style input. A hub of the access cannula may be adjustable to selectively adjust an interference surface relative to a datum. At least two radiopaque markers may be disposed on the sheath with relative positions between the markers viewable on lateral and A-P radiography to determine the location and/or curvature of the sheath.

Described herein are various implementations of systems and methods for accessing and modulating tissue (for example, systems and methods for accessing and ablating nerves or other tissue within or surrounding a vertebral body to treat chronic lower back pain). Assessment of vertebral endplate degeneration or defects (e.g., pre-Modic changes) to facilitate identification of treatment sites and protocols are also provided in several embodiments. Several embodiments comprise the use of biomarkers to confirm or otherwise assess ablation, pain relief, efficacy of treatment, etc. Some embodiments include robotic elements for, as an example, facilitating robotically-controlled access, navigation, imaging, and/or treatment.