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 includes an apposition mechanism that selectively imparts an axially compressive load on the catheter body to bend the catheter and urge a tissue-removing element toward a blood vessel wall. The apposition mechanism can include one or more adjustment lines and an adjustment mechanism for selectively tensioning one of the adjustment lines to impart the compressive load on the catheter body. Two adjustment lines can have diametrically opposed positions and be wound onto a spool of the adjustment mechanism in opposite directions so that rotation of the spool simultaneously shortens one adjustment line and lengthens the other. The catheter body can have a more flexible bending segment adjacent the tissue-removing element to promote bending near the tissue-removing element operative to urge the tissue-removing element in apposition with the blood vessel.

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 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.

A medical device is disclosed for cutting an object in a living body lumen. The medical device includes a rotatable elongate member, rotating member having a cutting portion cutting the object and disposed on the distal end side of the elongate member for rotating together with rotation of the elongate member; and a distal member having a guide portion disposed on the distal end side of the rotating member with a space left from the rotating member and a supporting portion which supports the guide portion and defines a dimension of the space in an axial direction of the elongate member. The guide portion is disposed at a position at which the guide portion overlaps with part of the cutting portion and exposes part of the cutting portion as viewed from the distal end side of the distal member.

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 apparatus for cutting a wall of a vessel, such as scoring or slicing a lesion associated therewith. A catheter (10) includes a shaft (12) having a distal portion supporting a housing (20) including a first lateral passage (20a). A cutter (22) is adapted for moving from a retracted position within the housing (20) to a deployed position for at least partially projecting from the passage (20a). A expandable actuator (24) within the housing (20), such as an inflatable balloon (26), actuates the cutter (22) to move from the retracted position fully within the housing (20) to the deployed position at least partially projecting from the housing (20). More than one cutter (22′) may be provided, which cutters (22′) may be simultaneously actuated by the same actuator (26′).

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.

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.

An apparatus for treating a lesion in a vasculature has a catheter shaft (12) with a plurality of openings (16), which may be axially spaced. One or more cutters (18, 18′) are adapted for moving from a retracted position to a deployed position projecting from one of the plurality of openings for cutting the lesion, such as by being biased toward the opening and retracting upon engaging a leading edge thereof when the support is advanced proximally. A shaft forming part of the catheter may include a plurality of lateral openings and a plurality of cutters. The cutter(s) may be attached to a support adapted for moving independently within the shaft from a first position in which the cutter(s) move to a deployed position to project from a corresponding one of the plurality of openings for cutting the lesion. Related methods are also disclosed.