A method and apparatus are disclosed for a needle for gaining access to the pericardial cavity of a heart. The needle includes an elongate member (e.g. a main shaft) defining a lumen and a side-port in communication with the lumen; a blunt atraumatic tip for delivering energy for puncturing tissue; and a guiding surface (e.g. a ramp) for directing a device (e.g. a guidewire) through the side-port. The method includes using the needle for tenting a pericardium and delivering energy for puncturing the pericardium, and advancing a guidewire or other device through the needle and into the pericardial cavity.

A method of removing material from a blood flow lumen generally includes providing a device having a cutting element and an opening, advancing the device through the blood flow lumen to a site where material is to be removed, forcing the opening toward a wall of the site where material is to be removed, and moving the cutting element and the opening so that material in the blood flow lumen is cut by the cutting element and directed into the opening for removal as the cutting element and opening are moved through the blood flow lumen. In some embodiments, the device may be deflected or bent to force the opening toward a wall to remove material. The cutting element may be rotatable and may have an axis that is movable, that is not parallel to the longitudinal axis of the device, or both.

A tissue cutting device includes a sizing element which detects the diameter of the vessel in which the cutting device is positioned. The sizing element is coupled to the cutting element so that the amount of the cutting element that is exposed varies in response to movement of the sizing element.

An atherectomy catheter directs particles generated by a cutting element into a collection chamber. A lumen configured to direct fluid into the tissue collection chamber.

A method of reducing blood flow within an aneurysm includes: injecting a contrast agent into a blood vessel including an aneurysm; expanding a stent, from a delivery device, across the aneurysm; and confirming that a stagnated area forms in the aneurysm. The stagnated area can form a crescent shape, a mushroom shape, a hemispherical shape, and/or a flat side. Upon confirming that the stagnated area forms in the aneurysm, the delivery device can be withdrawn from the blood vessel. The stagnated area can include the contrast agent. If the stagnated area does not form in the aneurysm, a second occluding device may be deployed. After withdrawing the delivery device, substantially all of the aneurysm progressively thromboses

A tissue-removing catheter includes a drive assembly operatively connected to a drive shaft to impart rotation and reciprocation to the drive shaft and thereby rotate and reciprocate a tissue-removing element of the catheter. The drive assembly includes a prime mover configured to generate a rotational drive force and a reciprocating rotor operatively connected to the prime mover to receive the rotational drive force. The rotor is also operatively connected to the drive shaft to impart rotation and reciprocation to the drive shaft. The drive assembly can include a stator configured to constrain rotation and reciprocation of the reciprocating rotor relative to an axis of the rotor. The rotor can define a race that extends around the rotor axis, and the stator can define one or more bearing projections that track through the race as the prime mover rotates the rotor about the rotor axis to drive reciprocation of the rotor.

A tissue-removing catheter for removing tissue from a body lumen includes an elongate catheter body configured for insertion into the body lumen and a tissue-removing element. A side opening in the distal portion of the catheter body is defined by opposite first and second side edges, a proximal edge extending between the first and second side edges, and a distal edge opposite the proximal edge and extending between the first and second side edges. The side opening window has a longitudinal axis extending between the distal and proximal edges. The tissue-removing element is configured to move between a tissue-removing position, in which the tissue-removing element is exposed through the side opening window, and a neutral position, in which the tissue-removing element is positioned inside the distal portion of the catheter. The distal edge is asymmetric about the longitudinal axis of the side opening window.

A tissue-removing catheter includes a cutting element. A radially innermost portion of the leading radial wall of a raised element of the cutting element may be spaced a radial distance from the longitudinal axis that is less than 66% of the radius of the annular cutting edge. The cutting element may be extendable through the window during operation such that as the cutting element is being rotated about its longitudinal axis, less than an entire radial portion of the leading radial wall passes through the window. A plurality of abrading members may be formed on at least the central portion of the inner surface of the cutting element to abrade hardened tissue as the cutting element is rotating about its longitudinal axis. A radially outermost portion of the leading radial edge of the raised element may be spaced apart radially from an inner surface of the cutting element.

A tissue-removing catheter includes a cutting element. A radially innermost portion of the leading radial wall of a raised element of the cutting element may be spaced a radial distance from the longitudinal axis that is less than 66% of the radius of the annular cutting edge. The cutting element may be extendable through the window during operation such that as the cutting element is being rotated about its longitudinal axis, less than an entire radial portion of the leading radial wall passes through the window. A plurality of abrading members may be formed on at least the central portion of the inner surface of the cutting element to abrade hardened tissue as the cutting element is rotating about its longitudinal axis. A radially outermost portion of the leading radial edge of the raised element may be spaced apart radially from an inner surface of the cutting element.

An atherectomy catheter directs particles generated by a cutting element into a collection chamber. A paddle attached to the cutting element propels fluid distally in the tissue collection chamber.