An intravascular catheter for peri-vascular and/or peri-urethral tissue ablation includes multiple penetrators advanced through supported guide tubes which expand around a central axis to engage the interior surface of the wall of the renal artery or other vessel of a human body allowing the injection an ablative fluid for ablating tissue, nerve sensing, nerve stimulation, or ablation by application of energy. The catheter can include a proximal handle for the advancement of guide tubes and penetrators.

Described herein are methods and devices for selectively applying fluids (particularly anesthetics) to a target tissue from within a blood vessel while minimizing the amount of fluid applied to non-target tissue. The injection catheters described herein may include an elongate body, a directional injector, and one or more holdfasts for securing the catheter before extending the injector. The methods of selectively applying anesthetic to a target structure generally include the steps of inserting an injection catheter into a body vessel, positioning the injection catheter within the body vessel near the target structure, anchoring the injection catheter before extending a directional injector from the injection catheter, and applying anesthetic from the injection catheter to the target structure.

An injectate delivery device for expanding tissue is provided. The injectate delivery device comprises: at least one fluid delivery tube comprising a proximal end, a distal end and a lumen therebetween; at least one fluid delivery element in fluid communication with the at least one fluid delivery tube lumen; a radially expanding element comprising the at least one fluid delivery element; a supply of vacuum constructed and arranged to cause tissue to tend toward the at least one fluid delivery element; and at least one control constructed and arranged to perform a function. The at least one control can be constructed and arranged to expand the radially expandable element and activate the supply of vacuum. Systems and method of injectate delivery are also provided.

A catheter, such as for use for total occlusion crossing and lumen reentry, incorporate a retractable long flexible nitinol curved needle at the catheter distal end. The needle is straight when withdrawn inside the catheter. When pushed forward, the needle is deployed by protruding axially out, directly from the distal tip, through a mechanism used to direct the curved needle into a specific radial direction. When pushed forward, the needle restores its curved shape and can penetrate the plaque or the media and intimal layers to reenter the true lumen.

Disclosed herein is a lifting surgical instrument having a branch point, which is used to insert a thread without a cog and a barb into the skin. The lifting surgical instrument includes a sheath, including: a probe part formed in the tubular shape in which a through hole penetrating in a longitudinal direction is formed, and configured such that the front end thereof may be inserted into the skin; and a body configured to extend from the rear end of the probe part, to have a diameter larger than that of the through hole, to communicate with the through hole, and to include a sheath hole. In this case, a direction guidance portion is provided on the inner surface of the probe part, and the angle at which the needle travels is changed via the direction guidance portion when the needle passes through the through hole.

A catheter is disclosed for locating radiation tagged tissue within a mammalian body and treating tagged tissue or untagged tissue adjacent to the tagged tissue in a single procedure. The catheter includes in or on a distal end thereof one or more detectors for locating labeled tissue. A lumen extending from a proximal end of said tube to the distal end of said tube, includes a retractable and extendable needle positioned adjacent the distal end of said tube for delivering a liquid treatment modality. the alternative the injector for delivering the treatment modality may be placed adjacent to the catheter for delivery of the treatment.

The invention relates to an injection catheter for delivering a therapeutic agent into a substrate, comprising one or more lumens and a curved delivery element, said lumen serving as a guide for said curved delivery element outside of the substrate; said curved delivery element comprising openings on its distal tip, said distal tip comprising a distal zone and a proximal zone, said injection catheter being characterized in that the specific surface in said distal zone of said distal tip of said curved delivery element is higher than the specific surface in said proximal zone of said distal tip of said curved delivery element. The invention also relates to a process for delivering a therapeutic agent into a substrate.

Described herein are methods and devices for selectively applying fluids (particularly anesthetics) to a target tissue from within a blood vessel while minimizing the amount of fluid applied to non-target tissue. The injection catheters described herein may include an elongate body, a directional injector, and one or more holdfasts for securing the catheter before extending the injector. The methods of selectively applying anesthetic to a target structure generally include the steps of inserting an injection catheter into a body vessel, positioning the injection catheter within the body vessel near the target structure, anchoring the injection catheter before extending a directional injector from the injection catheter, and applying anesthetic from the injection catheter to the target structure.

Sympathetic nerves run through the adventitia surrounding renal arteries and are critical in the modulation of systemic hypertension. Hyperactivity of these nerves can cause renal hypertension, a disease prevalent in 30-40% of the adult population. Hypertension can be treated with neuromodulating agents (such as angiotensin converting enzyme inhibitors, angiotensin II inhibitors, or aldosterone receptor blockers), but requires adherence to strict regimens and often does not reach target blood pressure threshold to reduce risk of major cardiovascular events. A minimally invasive solution is presented here to reduce the activity of the sympathetic nerves surrounding the renal artery by locally delivering neurotoxic or sympathetic nerve-blocking agents into the adventitia. Extended elution of these agents may also be accomplished in order to tailor the therapy to the patient.

An intravascular catheter for peri-vascular and/or peri-urethral tissue ablation includes multiple penetrators advanced through supported guide tubes which expand around a central axis to engage the interior surface of the wall of the renal artery or other vessel of a human body allowing the injection an ablative fluid for ablating tissue, nerve sensing, nerve stimulation, or ablation by application of energy. The catheter can include a proximal handle for the advancement of guide tubes and penetrators.