A tissue-removing catheter for removing tissue from a body lumen during a cutting operation includes an elongate catheter body configured for insertion into the body lumen and a tissue-removing element. A motor is operably connected to the tissue-removing element for rotating the tissue-removing element. A sensor is configured to detect a parameter of the catheter body during the cutting operation. A motor control circuit is in electrical communication with the sensor and the motor. During an operational control function, the motor control circuit is configured to receive a signal from the sensor based at least in part on the detected parameter, determine whether the received signal is indicative of inefficient movement of the tissue-removing element, and adjust a rotational speed of the tissue-removing element to increase efficiency of the tissue-removing element if the received signal is indicative of inefficient movement of the tissue-removing element.

An endoluminal punch system including a sheath and dilator. The endoluminal punch may include energy delivery system capable of being transmitted from the proximal end to the distal end of the endoluminal punch to assist with tissue crossing and incisions. The dilator may include selectively deployable cutting mechanism to create incisions in tissue that are larger than their basic external diameter. The system may also be configured to reduce the risk of generating plastic emboli during insertion of the endoluminal punch.

A device for crossing a lesion in a tissue lumen includes a crossing wire configured to pass through a lumen of a catheter, the crossing wire including a loop at a distal end of the crossing wire. The loop can have a configuration that prevents a width of the loop from exceeding a width of the tissue lumen, and the loop having a pair of lateral opposing portions configured for alignment with a wall of the tissue lumen and a leading portion interconnecting the pair of lateral opposing portions, the leading portion being configured to interrogate the lesion. The loop has a length in an axial direction of the crossing wire extending from the leading portion to proximal ends of the pair of lateral opposing portions, the length being perpendicular to the width, and the length of the loop is at least twice the width of the loop.

A transseptal needle or punch. The transseptal punch includes a stylet with a tube with a side window and a cutting wire disposed within the tube, with a sharp cutting segment disposed proximate the window. The sharp cutting segment can be expanded radially outwardly from the window by translation of the cutting wire proximal end within the tube.

A tissue-removing catheter includes an elongate catheter body. The catheter body has a jogged portion that applies an urge force against a body lumen wall and urges a portion of the catheter body toward a portion of the body lumen wall. A tissue -removing element removes tissue from the body lumen during the cutting operation. The tissue-removing element is located generally adjacent the portion of the catheter body that is urged toward the body lumen wall by the logged portion. An urging mechanism selectively applies a compressive load to the catheter body to adjust the bending stiffness of the jogged portion and the urge force applied by the jogged portion.

A tissue-removing catheter for removing tissue from a body lumen includes a tissue-removing element. The tissue-removing element may be coupled to a first longitudinal body portion of the catheter body. The first longitudinal body portion may be rotatable along its length and relative to a second longitudinal body portion to adjust the angular position of the first longitudinal body portion relative to the second longitudinal body portion. An angular-positioning mechanism may be operatively connected to the tissue-removing element for rotating the tissue-removing element relative to the second longitudinal body portion about a rotational axis to adjust an angular tissue-removing position of the tissue-removing element, relative to the longitudinal axis of the body lumen, from a first angular tissue-removing position to a second angular tissue-removing position offset from the first angular tissue-removing position.

A catheter includes a tissue-removing element and a tissue-containment chamber configured to receive tissue removed by the tissue-removing element. The tissue-containment chamber has a tissue-removing opening for use in removing tissue from the chamber. A closure component is associated with the tissue-removing opening for selectively opening and closing the opening.

Methods and apparatuses for performing an orthopedic procedure in the sacroiliac region are disclosed. In one form, an aperture is formed that at least partially extends through at least one of an ilium and a sacrum. An undercutting system is inserted into the aperture. The undercutting system includes an insertion apparatus, a probe assembly and a cutting assembly. The probe assembly is moved with respect to the insertion apparatus from a retracted position to an extended position. The probe assembly is manipulated within a joint between the ilium and the sacrum while the probe assembly is in the extended position. The cutting assembly is moved with respect to the insertion apparatus from a retracted position to an extended position. The cutting assembly is manipulated within the joint between the ilium and the sacrum while the cutting assembly is in the extended position to form a fusion region.

Described herein are atherectomy catheters, systems and methods that include a distal tip region that may be moved laterally so that its long axis is parallel with the long axis of the main catheter body axis. Displacing the distal tip region laterally out of the main catheter body axis exposes an annular blade and opens a passageway for cut tissue to enter a storage region within the catheter. The annular blade may be internally coupled to a drive shaft that rotates the blade, and thus the exposed blade edge may have the same crossing profile (OD) as the rest of the distal end region of the catheter. Also described herein are gear-driven atherectomy devices that may use a cable drive shaft to actuate the annular blade. Both push-to-cut and pull-to-cut variations are described, as are methods for cutting tissue and systems including these atherectomy catheters.

A cleaning device for cleaning a catheter lumen of a tissue removal catheter has a flushing chamber with distal and proximal seals and an inlet port. The proximal seal is a duckbill seal that includes a pair of opposing duckbill members that slidingly accept the distal end portion of a catheter body to form a seal about the catheter body proximal to a proximal opening in of the catheter lumen. Fluid is directed in the inlet port, into the flushing chamber, into proximal opening in the catheter body, and through the catheter lumen to discharge tissue contained in the catheter lumen. In some embodiments, the cleaning device is preloaded on the catheter body. The cleaning device can have an internal stop that engages with an external stop on the catheter body when the cleaning device is positioned in an operative position.