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.

A cannula apparatus (100) and method are provided for selective fluid flow in removal and return directions. An outer sheath (102) has proximal (104) and distal (106) outer sheath ends spaced apart by a longitudinal outer sheath body (108) defining an outer sheath lumen (110). At least one fluid removal aperture (112) extends through the outer sheath body. The outer sheath includes a side access aperture (114). An introducer (1534) has proximal (1536) and distal (1538) introducer ends spaced apart by a longitudinal introducer body (1540), which at least partially defines a guidewire channel (1542) longitudinally therealong. The introducer is configured for insertion into the outer sheath lumen with the guidewire channel in fluid communication with the side access aperture. An inner tube (218) has proximal (220) and distal (222) inner tube ends. At least one fluid return aperture (228) is located at least one of at and adjacent the distal inner tube end to place an inner tube lumen in fluid communication with an ambient space.

In some examples, a catheter includes an elongated body including a proximal portion and a distal portion. The elongated body includes an inner liner, an outer jacket, a structural support member positioned between at least a portion of the inner liner and at least a portion of the outer jacket, and an expandable member coupled to the structural support member at the distal portion of the elongated body. The expandable member may be configured to expand radially outward, e.g., to engage a clot within vasculature of a patient.

Systems and methods for positioning a wire for advancement through a vessel wall, and advancing it through one or more vessel walls, generally include a delivery catheter and an alignment catheter or a receiving catheter, and a guidewire. In some variations, the systems and methods may be used to bypass an occlusion or other barrier that may prevent advancement of a wire or tools through an endoluminal space. In these variations, the systems and methods include a delivery catheter, a bypass catheter, a receiving catheter, and a guidewire. The delivery and receiving catheters each generally include a side aperture, a deflection surface, and an alignment element, and the bypass catheter generally includes two side apertures, two deflectors, and two alignment elements. In some variations, the systems and methods may assist in treatment of a patient suffering from critical limb ischemia.

Methods and devices are disclosed for passing Chronic Total Occlusion (CTO) from subintimal location and re-entry into a true-lumen of the patient using transient fenestration approach. The transient fenestration is induced by balloon dilatation within the CTO, and a guidewire quickly trails into a true lumen.

A device for introduction into a body vessel includes a main elongated element, a balloon positioned at the main elongated element distal end, a distal connecting element positioned at the distal end of the balloon to receive a guidewire during use, and a longitudinally movable sheath positioned external to the main elongated element, a position of the sheath distal end with respect to the balloon defining an exposed portion of the balloon that expands when fluid is delivered to the balloon through the inflation lumen.

A delivery system can be provided with an ability to change its configurations to achieve both access to target anatomy and treatment thereof. Such treatments can include directing interventional devices around an occlusion. By providing different functionality at different stages, the need to exchange and replace tools at different stages can be reduced or eliminated. Accordingly, such operations can be completed more rapidly, efficiently, and safely.

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.

A retrieval catheter operable by a single clinician that will neither displace a deployed stent nor cause undue trauma to the vascular lumen or lesion. The retrieval catheter may be sized to accommodate both a guidewire and a balloon wire. The retrieval catheter is easy to navigate through tortuous passageways and will cross a previously deployed stent or stent-graft easily with minimal risk of snagging on the deployed stent or stent graft. The sheath and dilator are adapted to allow a guidewire or balloon wire to pass through the walls of both and to allow the sheath and dilator to move axially with respect to each other.

An endovascular catheter has an elongate catheter body having a distal portion, a proximal portion, a transition portion and a central lumen extending longitudinally through the catheter body, with the distal portion having a larger central lumen than the proximal portion. A guidewire tube extends through a hole in the transition portion from the proximal end of the distal portion through the central lumen of the distal portion to the distal end of the distal portion.