Three groups of guidewire embodiments are described with particularly suitable structures for navigating circuitous vessels, especially blood vessels of the brain. Some of the guidewires have a hyperbolic taper that provides desired flexibility. In some embodiments, an integrated guide structure provides for extension in the blood vessel of a corewire to provide for extended reach of the guidewire. In further embodiments, the guidewire has a flexible tip that can be guided directly by the flow in the vessel.

Guidewires useful for cooperating with catheters may be actively steered and/or provide adjustable stiffness. Angle or curvature of a guidewire, and/or flexural modulus of a guidewire, may be adjusted at one or more locations between ends thereof. Variable stiffness segments may include electrically operated compressible and/or extensible materials. Multiple tensile elements may terminate at different body elements to adjust angle or curvature at multiple locations. Multiple circumferentially and/or radially contractible fiber regions may be provided and distributed over a length of a guidewire. Adjustable flexure elements arranged in or along a guidewire may be electrically operated. A flexible core member may be centrally arranged in a tubular body. A flexible guide wire or track may cooperate with electrically operable motor units.

A flexible manipulator includes an insertion portion including a tubular flexible portion, a bending portion, and a distal end portion. The flexible manipulator includes an operating unit on a proximal end side of the insertion portion, the operating unit including a first operating portion. The flexible manipulator includes a tube inside the tubular flexible portion, the tube including a through-hole spirally extending along a longitudinal axis of the tube from a proximal end to a distal end. The flexible manipulator includes a wire extending through the through-hole, a first end of the wire connected to the distal end portion and a second end of the wire connected to the first operating portion. The flexible manipulator includes an adjustment mechanism. The bending portion is a tubular body between the distal end portion and a distal end side of the tube.

An elongate steerable medical device includes a shaft and a handle assembly that is removably securable to the shaft. The shaft includes an elongate outer member and an elongate inner member that is disposed within the elongate outer member. The handle assembly includes a proximal handle, a spool that is slidingly secured to the handle body and a collet that is removably secured to the handle body. The spool is adapted to releasable secure the elongate inner member and the collet is adapted to releasably secure the elongate outer member.

A detector-equipped treatment tool including: a distal-end treatment portion that applies a force to and treats biological tissue; a proximal-end portion that supports the distal-end treatment portion so as to be relatively movable; a detector that is disposed in a cavity provided inside of the distal-end treatment portion and detects the force; wiring that is connected to the detector; and a duct that is connected to the distal-end treatment portion and guides the wiring led out of the distal-end treatment portion from the detector in the cavity to the proximal-end portion.

A steerable guidewire. The steerable guidewire is fabricated includes an outer tube, an inner tube, a hub, and a distal articulating region. The steerable guidewire hub can be removed to permit advancement of catheters over its proximal end followed by re-attachment of the hub to permit deflection of the distal end of the steerable guidewire.

Guide wire apparatuses and methods. Guide wires may be utilized for guiding a delivery apparatus, for example a transcatheter mitral valve delivery apparatus to replace a native mitral valve. A guide wire may include a core body having a length, and an outer layer having a length and extending around the core body and along the length of the core body. A guide wire may include an intermediate layer positioned between the core body and the outer layer and configured to be retracted relative to the core body and the outer layer along the length of the core body and the length of the outer layer.

A catheter device for repositioning or explanting an implantable medical device comprises an outer catheter, and a steerable catheter extending through the outer catheter, wherein the outer catheter is axially movable with respect to the steerable catheter. A snare catheter extends through the steerable catheter, wherein the snare catheter is axially movable relative to the steerable catheter. A mandrel may extend through the snare catheter and comprising a distal end, wherein the mandrel is axially movable relative to the snare catheter. A snare may be arranged on the distal end of the mandrel for establishing a connection to the implantable medical device, wherein the snare, by moving the mandrel with respect to the snare catheter, is at least partially retractable into the snare catheter.

A steerable guidewire. The steerable guidewire is fabricated includes an outer tube, an inner tube, a hub, and a distal articulating region. The steerable guidewire hub can be removed to permit advancement of catheters over its proximal end followed by re-attachment of the hub to permit deflection of the distal end of the steerable guidewire.

Three groups of guidewire embodiments are described with particularly suitable structures for navigating circuitous vessels, especially blood vessels of the brain. Some of the guidewires have a hyperbolic taper that provides desired flexibility. In some embodiments, an integrated guide structure provides for extension in the blood vessel of a corewire to provide for extended reach of the guidewire. In further embodiments, the guidewire has a flexible tip that can be guided directly by the flow in the vessel.