A method of removing material from a blood flow lumen includes providing a device having a cutting element and an opening, the cutting element being movable relative to the opening. The method then includes advancing the device through a patient's vascular system to the blood flow lumen. Finally, the method involves moving the cutting element and the opening relative to the blood flow lumen so that a continuous piece of material is severed by the cutting element and directed into the opening as the cutting element and opening move through the blood flow lumen, the continuous piece of severed material being directed into the device for removal from the patient. The method may include providing a device having a rotatable cutter that, in some embodiments, is not parallel to the longitudinal axis of the device, is movable, has retracted and deployed positions, or any combination thereof. The method may further include forcing the opening toward the wall of the vascular site after the advancing step and before the moving step.

A method of reducing blood flow within an aneurysm includes: injecting a contrast agent into a blood vessel including an aneurysm; deploying an occlusion device across the aneurysm; producing an image of the aneurysm including the contrast agent; and withdrawing the delivery device from the vessel after observing that the aneurysm has been stagnated by a desired amount. The image may be two-dimensional or three-dimensional. Observing that the aneurysm has been stagnated may include determining a degree of stagnation, for example by comparing an area or volume of the contrast agent in a first image and a second image. The desired amount may be a certain degree of stagnation, identification of a shape indicative of stasis such as a flat surface, an approximate hemisphere, a mushroom, or a crescent. If the occlusion device does not achieve the desired amount, a second occluding device may be deployed.

Described here are devices, systems and methods for forming a fistula between two blood vessels. Generally, the systems may comprise a first catheter which may comprise a fistula-forming element. The fistula-forming element may comprise one or more electrodes, mechanical cutting elements, laser sources, or combinations thereof, and may be used to assist in fistula formation. In some instances, a system may comprise a second catheter, which may comprise a fistula-forming element. One or more of the catheters may comprise one or more markers, magnetic alignment elements, and/or one shape-changing elements.

In one aspect, a system for endovascular treatment of a blood vessel includes a control unit, an ultrasound device, an actuator, and a catheter having a treatment portion. The ultrasound device is communicatively coupled to the control unit. The ultrasound device includes an ultrasound probe having a subject contact surface. The actuator is coupled to the ultrasound probe and is operable to move the subject contact surface of the ultrasound prove relative to a treatment zone of a subject. The control unit is configured to determine a position of the treatment portion of the catheter as the catheter is advanced through the blood vessel, and move the subject contact surface of the ultrasound probe relative to the treatment zone of the subject with the actuator to follow the position of the catheter as the catheter is advanced through the blood vessel.

The present disclosure is directed to a device. The device may include a distal shaft defining a central lumen and an orienting element comprising at least one inflatable member. Wherein a first portion of the orienting element extending from the shaft in a first direction and a second portion of the orienting element extending from the shaft in a second direction. Further, wherein the second direction is substantially opposite the first direction.

An atherectomy catheter for use in a vessel includes a catheter body, a nosecone and an annular cutter. The catheter body has a curved portion with a fixed jog section and an adjacent flexible section having a greater flexibility than a remainder of the catheter body. The fixed jog section and the flexible section include a frame having circumferential slits arranged in rows and in a circumferentially offset pattern. The circumferential slits of the flexible section are configured to allow the flexible section to passively bend in multiple directions during positioning of the catheter body within the vessel. The fixed jog section further includes a longitudinal spline having a pre-set curvature. The nosecone is attached to a distal end of the catheter body and includes a cutting window. The annular cutter configured to rotate with respect to the catheter body and positioned within the cutting window.

An articulating rotary cutting tool configured to articulate a distal cutting tip upon a trigger being operated. The trigger can be locked into various articulating positions. The velocity of rotation of a cutting bit is substantially constant in both articulating and non-articulating positions. An articulation joint is one of a hex ball joint or a flexible spring joint. A button is included to release a locking pressure holding the trigger in a locked position. The trigger may employ articulating sliding surfaces that provide constraint to a flexed head in both directions of articulation.

The present disclosure provides a tissue-removing catheter for removing tissue in a body lumen that includes an elongate body, a handle, tissue-removing element, liner assembly, and coupling assembly. The elongate body is sized and shaped to be received in the body lumen. The tissue-removing element is mounted on a distal end portion of the elongate body and removes tissue as rotated by the elongate body. The liner assembly defines a guidewire lumen. The coupling assembly is coupled to the liner assembly with a first orientation and a second orientation relative to the coupling assembly. The first orientation permits distal movement of the liner assembly relative to the coupling assembly prior to rotation of the elongate body to rotate the tissue-removing element. The second orientation is relative to the coupling assembly after rotation of the elongate body to prevent distal movement of the liner assembly relative to the coupling assembly.

An atherectomy catheter for use in a vessel includes a catheter and a rotatable cutter. The rotatable cutter can be translatable within the catheter to extend the cutter through a window of the catheter or retracted the cutter within the catheter. The catheter can have a fixed bend and/or have a shapeable portion configured to facilitate positioning and movement of the cutter. The shapeable portion may take on a pre-defined shape. The shapeable portion may be positioned against an inner wall of a blood vessel to provide leverage for the rotatable cutter. In some cases, a rotation limiter may limit the number of rotations that the catheter can rotate with respect to a guidewire to prevent twisting of the guidewire.

A catheter having a tubular body and a rotatable shaft disposed within a lumen of the tubular body. A cutting element is coupled to the rotatable shaft, the cutting element having a cutting edge, the cutting element and rotatable shaft being longitudinally moveable within the tubular body between a stored position in which the cutting element is positioned distal of a side opening and a cutting position in which the cutting element is contained within the lumen of the tubular body and longitudinally aligned with the side opening. The cutting element is configured to extend through the side opening and to cut material from the wall of a vessel at a treatment site as the catheter is pulled proximally through the treatment site. The catheter may optionally have a rotating distal tip with an abrasive surface. The catheter includes a collection chamber positioned proximally of the cutting window.