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 fluid 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.

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.

Described herein are atherectomy catheters, systems and methods of use. The atherectomy catheters may include a driveshaft within an elongate body. An optical fiber may run through the driveshaft and have a distal end that is attached to an opening of a cutter at distal end of the driveshaft. The cutter and the optical fiber may be rotated respect to the elongate body by rotating the driveshaft with respect to the elongate body. The driveshaft may be longitudinally displaced to expose a distal cutting edge of the cutter for cutting tissue or plaque from a vessel lumen. Images of the vessel lumen collected through the opening of the cutter may be captured in real time with the optical fiber.

A catheter for forming a fistula between two vessels. The catheter comprises a catheter body having a longitudinal axis, an electrode extending radially from the catheter body for contacting a vessel wall and forming the fistula, and a cutting unit disposed proximally or distally of the electrode for cutting a venous valve.

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 retraced 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.