Clot engagement element comprising bundle of unwoven fibers can be assembled to form an acute stroke treatment device. The device has the capability of forming a three dimensional filtration matrix comprising effective pores with a distribution of sizes. The bundle of fiber design allows the device to be effectively delivered into circuitous cerebral arteries to remove clot that causes stroke. The fiber bundle based filtration matrix offers the advantages of conforming to the changing inner perimeter of a blood vessel during a clot removal process and thus the capability to effectively retain and remove a clot in the vessel. The filtration matrix offers the additional advantage to trap any break-off of the clot during the removal process. A plurality of fiber bundles can be combined to form an effective clot engagement element. Supplemental engagement structure as well as mechanical treatment structure can be integrated into the stroke treatment device. The deployment of the fiber based elements can be facilitated by actuation tool. Aspiration can be employed during the clot removal process.

Medical guidewire assembly is movable through guidewire introducer positionable proximate to a biological wall located within the body of a patient. Medical guidewire assembly has flexible distal shaft section configured to extend along the guidewire introducer. Medical guidewire assembly has a predetermined spatial geometry once the flexible distal shaft section is removed from guidewire introducer. Medical guidewire assembly also has a piercing stylet device configured to puncture the biological wall in response to placement of guidewire introducer (in use) proximate to the biological wall, and movement of the flexible distal shaft section through the guidewire introducer. The predetermined spatial geometry is configured to prevent physical contact between the piercing stylet device and adjacently positioned tissue of the patient in response to formation of the predetermined spatial geometry.

A medical guidewire assembly is movable through an exit portal of a guidewire introducer. The guidewire introducer and the medical guidewire assembly are each insertable, at least in part, into a patient. The medical guidewire assembly is configured to reduce, at least in part, the hoop stress surrounding a puncture hole extending through the tissue of the patient. This is done in response to movement, at least in part, of the medical guidewire assembly relative to the puncture hole (after the puncture hole has been initially formed).

Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes inserting an intramural crossing device into the vascular lumen, positioning at least the distal tip of the crossing device in the vascular wall, advancing an orienting device over the crossing device such that an orienting element of the orienting device resides in the vascular wall, inserting a reentry device, and re-entering the true vascular lumen.

Apparatuses and methods are disclosed for the perforation of a communication between the aorta and left atrium. The method includes introducing the apparatus, positioning the apparatus at a location along the aorta, and energizing the apparatus to create a perforation. For example, one method may include: introducing a flexible wire into the left atrium, advancing a dilator along the flexible wire to position the flexible wire adjacent a selected location along the aorta and energizing the flexible wire to create a perforation from the left atrium into the aorta.

Apparatuses and methods are disclosed for the perforation of a communication between the aorta and left atrium. The method includes introducing the apparatus, positioning the apparatus at a location along the aorta, and energizing the apparatus to create a perforation. For example, one method may include: introducing a flexible wire into the left atrium, advancing a dilator along the flexible wire to position the flexible wire adjacent a selected location along the aorta and energizing the flexible wire to create a perforation from the left atrium into the aorta.

The disclosed invention provides a transseptal insertion device which is suitable for facilitating precise and safe transseptal puncture of a cardiac interatrial septum. The transseptal insertion device includes a sheath that defines at least one lumen therein, one or more positioning balloons that are connected to a distal end of the sheath, a puncture member movably positioned within the at least one lumen, and a puncture member balloon located on the puncture member. The sheath has one or more deflation ports to deflate the one or more positioning balloons. The puncture member balloon, when inflated, is capable of sealing the one or more deflation ports in the sheath, permitting the inflation of the one or more positioning balloons. When the puncture member moves toward fossa ovalis, the inflated puncture member balloon moves away from the deflation ports, allowing the positioning balloons to be deflated.

The medical device may comprise an elongate body having a proximal portion, a distal portion, and defining a lumen therethrough. Also, the medical device may include an expandable element coupled to the distal portion of the elongate body and in fluid communication with the lumen. The expandable element may define a first end and a second end, the second end being proximal to the first end. The medical device may further include a cannula surrounding at least a portion of the elongate body and the cannula may define a proximal end and a distal end. The distal end of the cannula may be disposed proximal and adjacent to the second end of the expandable element. An outer dimctcr diameter of the cannula may be substantially equal to or lesser than an outer diameter of the expandable element when inflated. The medical device may be maneuvered through a patient's body.

The present disclosure relates generally to medical devices and the use of medical devices for the treatment of vascular conditions. Particularly, the present disclosure provides devices and methods for using a vibrational wire guide to cut and/or core through a venous obstruction, such as a chronic clot.

An elongate endovascular element for crossing through an obstruction in a blood vessel comprises: a proximal section; a distal tip section of smaller diameter than the proximal section; and a distally-tapering intermediate section extending between the proximal and distal tip sections; wherein the tapered intermediate section has a length that is substantially λ/2 or a multiple of λ/2, where λ is a wavelength of a driving frequency that will produce longitudinal resonance in the element.