Abstract: Vascular access devices, systems, and methods of their use are provided. In one embodiment, a vascular access device includes a catheter, a balloon, and an inflation lumen. The catheter includes an elongate flexible shaft having a proximal end and a distal end with a primary lumen therethrough. The balloon is disposed about the distal end of the catheter. The inflation lumen is in fluid communication with the balloon and extends toward the proximal end of the shaft of the catheter. The balloon is inflatable into a shape having a first open end, a second open end, a sidewall between the first and second open ends, and a passageway therethrough, which, when the balloon is deployed and inflated within a vessel, permits blood flowing in the vessel to flow through the passageway.

Abstract: A medical ultrasonic sensor array includes a plurality of ultrasonic sensors having a plurality of first electrode plates, a plurality of piezoelectric elements, and a second electrode plate. Each of the ultrasonic sensors has a first electrode plate and a piezoelectric element sandwiched between the second electrode plate and the first electrode plate. Each first electrode plate of each ultrasonic sensor is separated from each other first electrode plate of each other ultrasonic sensor. The second electrode plate is a single body electrode plate shared by the plurality of the ultrasonic sensors. The second electrode plate includes a plurality of cavities, each cavity being formed in a surface of the second electrode plate at which the piezoelectric elements connect to the second electrode plate at a position between connection regions connecting a respective pair of the piezoelectric elements to the second electrode plate.

Abstract: Sensor devices including dissolvable tissue-piercing tips are provided. The sensor devices can be used in conjunction with dissolvable needles configured for inserting the sensor devices into a host. Hardening agents for strengthening membranes on sensor devices are also provided. Methods of using and fabricating sensor devices are also provided.

Abstract: Methods and apparatus for accessing and repairing a vertebral disc include a pad with a central cut-out mounted to the skin of a patient or, alternatively, a pedicle-mounted support. An incision is made and then a corridor is created using an elongated guide and a series of dilating tubes. An access to the disc space is created through the superior articular process and the facet joint using the corridor defined by the dilating tubes. Nucleus material is removed from the disc space and the vertebral endplates are prepared. The disc space may be sized to select a suitable implant, which is advanced through the corridor and into the disc space following discectomy and endplate preparation. Bone graft material may be inserted into the disc space following installation of the implant and then posterior rigid fixation may be achieved using percutaneous pedicle screws, followed by closure of the site.

Abstract: The devices and methods shown provide for the minimization of extravasation during arthroscopic surgery. The extravasation minimization device allows a surgeon to drain excess fluids from the soft tissue surrounding the surgical field while also providing a stable surgical portal for arthroscopic surgical instruments.

Abstract: A biological fluid collection device that receives a sample and provides flow-through blood stabilization technology and a precise sample dispensing function for point-of-care and near patient testing applications is disclosed. A biological fluid collection device of the present disclosure is able to effectuate distributed mixing of a sample stabilizer within a blood sample and dispense the stabilized sample in a controlled manner. In this manner, a biological fluid collection device of the present disclosure enables blood micro-sample management, e.g., passive mixing with a sample stabilizer and controlled dispensing, for point-of-care and near patient testing applications.

Abstract: A flexible auger design for low-torque transmitting drive shafts, which allows effective tissue material transport through curved, flexible tubes and channels. A hollow auger has a hollow center, so that the helical member hugs the inner wall of the tube and material is transported along the center axis and the inner wall of the tube. The hollow flexible auger allows for transportation of material from an operative location in the patient (material removal) as well as to operative location in the patient (material delivery).

Abstract: A multi-cannula surgical instrument having an inner cannula movably disposed within an outer cannula, the inner cannula having a blunt distal tip, one or more first inner ducts and one or more first flow-through orifices arranged to allow one or more fluid flows therethrough, where the inner and the outer cannula at the proximal ends thereof are mounted onto a hub that includes a biasing mechanism coupled to the inner cannula and arranged to bias the inner cannula automatically from a retracted towards an advanced position in case of absence of resistance against the inner cannula, wherein the outer cannula comprises one or more second flow-through orifices that are in fluid communication with one or more second ducts arranged between the outer and the inner cannula, wherein the second flow-through orifices, the hub and the second ducts are configured to allow at least one fluid flow therethrough.

Abstract: An apparatus for delivering therapeutic agent to an eye comprises a body, a cannula, a hollow needle, and an actuation assembly. The cannula extends distally from the body and is sized and configured to be insertable between a choroid and a sclera of a patient's eye. The actuation assembly is operable to actuate the needle relative to the cannula to thereby drive a distal portion of the needle along an exit axis that is obliquely oriented relative to the longitudinal axis of the cannula. The cannula may be inserted through a sclerotomy incision to position a distal end of the cannula at a posterior region of the eye, between the choroid and sclera. The needle may be advanced through the choroid to deliver the therapeutic agent adjacent to the potential space between the neurosensory retina and the retinal pigment epithelium layer, adjacent to the area of geographic atrophy.

Abstract: Intramedullary nails, systems, and methods. The intramedullary nail may include a generally elongate body extending from a first, distal end to a second, proximal end. The distal end may include one or more openings configured to receive one or more bone anchors that extend transversely through the distal end of the intramedullary nail, and thereby configured to secure the distal end of the nail. The proximal end may also include one or more openings configured to receive one or more bone anchors that extend transversely through the proximal end of the intramedullary nail, and thereby configured to secure the proximal end of the nail.

Abstract: A cannula assembly for applying a flow cannula for the introduction, circulation or diversion of flow media, in particular blood, in the human or animal body. The flow cannula has a main portion and a tip portion. The tip portion is elastic and, in a functional position, is configured to protrude in an arc shape at an angle from the main portion, and in an application position, is held in the direction of the longitudinal extent of the main portion by a guide device. The flow cannula may be fitted for the indication of pulmonary hypertension and pulmonary insufficiency. The one of more flow cannulas so connected to the heart, for example, through an incision of the jugular vein or subclavian vein may be connected, on the outside, to a membrane ventilator, such as a Novalung®, with oxygen supply and/or additional pump support.

Abstract: 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 retracted 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.

Abstract: An assembly for radiofrequency ablation of tissue. A cannula includes a cannula hub and a cannula body including a cannula bend, a lumen, and side opening within an outer side of the cannula bend. An electrode includes an electrode hub and an electrode body dimensioned to be inserted within the lumen of the cannula body in at least first and second rotational orientations as indicated by registration of respective indicia on the cannula and electrode hubs. A distal section of the electrode body extends past the side opening of the cannula body in the first rotational orientation, and the distal section extends through the side opening in the second rotational orientation. The indicia of the cannula hub and the electrode hub may be indicative of the orientation of the cannula bend and an electrode bend, respectively. Methods of performing radiofrequency ablation of the tissue with the assembly are also disclosed.

Abstract: Embodiments of a cannula seal are disclosed. In some embodiments, a cannula seal can include a base portion that engages with a cannula; and a seal portion integrally formed with the base portion that slidebly engages with an instrument shaft such that an insertion frictional force between the seal portion and the instrument shaft for insertion of the instrument shaft is symmetrical and substantially equal with a retraction frictional force.

Abstract: A deformable seal for use together with a laparoscopic port has a deformable body with an upper region, a lower region, and a narrowed waist. A plurality of tool passing channels are individually formed in an axial direction through the deformable body, and each tool passing channel has a tool entrance on a surface of the upper region and a tool exit on a surface of the lower region. The tool passing channels are sufficiently elastic to conform to and seal about a shaft of a laparoscopic tool present in the channel and to close to inhibit leakage of an insufflation gases when the tool is removed from the tool passing channel.

Abstract: Cannula assemblies and methods of manufacturing cannula assemblies are provided. The cannula assembly includes a cannula and a pigtail extension coupled to the cannula. The pigtail extension includes a proximal section having a first stiffness and a distal section having a second stiffness, the first stiffness greater than the second stiffness. The proximal section of the pigtail extension is positioned between the cannula and at least a portion of the distal section.

Abstract: A cannula assembly is provided, the cannula assembly comprising a cannula, in particular a graft, for forming a flow channel for bodily fluids, in particular for blood, and a protective element for the cannula, wherein the protective element defines a channel for the cannula, wherein the cannula runs through the channel of the protective element at least in sections, wherein the protective element comprises a plurality of segments, wherein the segments are arranged next to one another in a sequence and wherein each segment defines a sub-section of the channel of the protective element. A blood pump assembly and a method for using the cannula assembly and the blood pump assembly are also provided.

Abstract: An activator attachment that can be attached to the proximal end of a catheter adapter and can activate a blood control valve within the catheter adapter.

Abstract: Methods and devices described for improved dynamic walled tubing and catheters.

Abstract: Devices and methods for locating sinus ostia and positioning a guide wire within the sinus ostia. The subject devices include a shaft having a distal end, a proximal end, a curved region located between the distal and proximal ends, and an interior channel, an extensible and retractable guide wire movably mounted within the interior channel and a probe tip joined to the guide wire. Certain devices further include expandable portions for engaging and treating body anatomy.

Abstract: Extravascular implant tools that utilize a bore-in mechanism to safely access extravascular locations and implant techniques utilizing these tools are described. The bore-in mechanism may include a handle and a helix extending from the handle. The bore-in mechanism is used, for example, in conjunction with a tunneling tool to traverse the diaphragmatic attachments to access a substernal location. The tunneling tool may be an open channel tunneling tool or a conventional tunneling tool (e.g., metal rod).

Abstract: A kit including a sheath having a tubular body with proximal and distal ends, an axis extending between the ends and a wall defining a bore extending along the axis to the distal end of the body. A delivery tube having proximal and distal ends and a lumen is adapted for disposition within the bore of the sheath in sealing engagement with the sheath, the delivery tube being slideable distally relative to the sheath. An elongated cannula having proximal and distal ends and a lumen is adapted for disposition inside the lumen of the delivery tube and an elongated dilator is adapted to fit within the lumen of the cannula with a proximal portion of the dilator extending proximally beyond the proximal ends of the cannula and delivery tube and in sealing engagement with the delivery tube proximal to the cannula.

Abstract: A coupling system is disclosed for connecting a tube set to a trocar that includes a multi-lumen trocar having a housing that has a connector extending outwardly from the housing, the connector having a plurality of coaxial flow passages defined therein by a plurality of concentric annular walls, a multi-lumen tube set including a plurality of tubes arranged in a parallel relationship, a coupling including a generally cylindrical body having a first end portion adapted and configured to selectively mate with the coaxial flow passages of the connector of the trocar and a second end portion adapted and configured for attachment to the parallel tubes of the tube set, and a latch assembly operatively associated with the cylindrical body of the coupling for selectively engaging the connector of the trocar housing when the coupling mates with the connector.

Abstract: A system, a method, and instruments for manipulating a surgical cord into spinal implants to assist in correcting a spinal deformity are described. The system may include a tensioner, a tensioner extension, and a counter tensioner. One of the instruments can include an elongate body, a dual coupler, and a nose member. The elongate body has a flexible cylindrical member adapted to carry tension along a longitudinal axis, where the flexible cylindrical member is sized to receive a surgical cord through a lumen within the flexible cylindrical member. The dual coupler is disposed on a proximal end of the elongate body, and include a bore for receiving a nose portion of a tensioner and for guiding the surgical cord into the tensioner. The nose member is disposed on a distal end of the elongate body, and be adapted to discharge the surgical cord from the elongate body.

Abstract: External fixation systems, and methods for immobilizing joints or fractured bones. An external fixation system may include one or more clamp assemblies connected to one or more rod assemblies at polyaxial joints. Each rod assembly may be length adjustable, and may include a one-way locking mechanism to provisionally lock the length of the rod assembly, and additional locking mechanisms to permanently lock the length of the rod assembly. The system may be deployed pre-assembled as a unit to immobilize a joint or fracture. Another external fixation system further includes a spanning member extending transverse to the rod assemblies. Two or more external fixation systems may be deployed in a stacked configuration on one set of bone pins to immobilize two joints and/or fractures. The systems may be provided in kits including guiding instrumentation, bone pins and pin clamping assemblies for connecting the bone pins to the external fixation systems.

Abstract: Adjacent tissue layers can be accessed using a catheter device with a distal tip having a conductive portion including a first cutting feature and one or more projections extending from the first cutting feature towards an outer diameter of the distal tip. Electrical energy can be supplied to the conductive portion of the device to cut tissue. A stent can be delivered to form a fluid communication between the adjacent tissue layers.

Abstract: A system for determining orientation of a guide sheath introduced by a bronchoscope or similar device. An example system includes a display device, a scope device and a guide sheath. The guide sheath includes a window occupying a predefined circumferential sector of a distal end of the guide sheath and a plurality of markings configured to visually indicate location/orientation and/or distance of the window. The plurality of markings includes a plurality of first markings located along a longitudinal center axis of the window and a plurality of second markings located along one or more other longitudinal axes that are radially separated from the longitudinal center axis of the window by more than 45°.

Abstract: In the case of an electrosurgical instrument, provision is made for a tool (16), for the operation of which at least one, preferably two pull/thrust elements (39, 40) and a sliding element (56) are required. The sliding element (56) is held between a pull/thrust element (39) and a thrust bearing, wherein the thrust bearing can be formed by means of a further pull/thrust element (40). This arrangement utilizes the fact that the sliding element must only be activated, when the pull/thrust element is tensioned tightly. This concept of guiding the sliding element at the pull/thrust element provides for the simple design of instruments comprising long shafts, wherein separate measures for laterally reinforcing the sliding elements do not need to be taken.

Abstract: The present disclosure relates to devices and methods for delivery of a ferrofluid to a targeted treatment site, such as delivery of a ferroadhesive to a pathological fistula to occlude the fistula. A device includes a catheter having a lumen and a distal opening. A hollow solenoid is coupled to a distal section of the catheter, and a hollow core of the solenoid allows passage of a ferrofluid through the catheter and through the hollow core so that it may exit past the distal end of the hollow solenoid. The solenoid may be selectively actuated to maintain or control the position of the delivered ferrofluid.

Abstract: Embodiments of the present invention provide devices, systems, and methods for implanting and using a connector in a tissue wall to establish, maintain, control, and close a fluid communication between opposing surfaces of the tissue wall. The connector may include an anchoring device, a port, and a coupler device. The anchoring device may be configured for advancing at least partially through the tissue wall. The port may be positioned about a proximal end of the anchoring device, and the port may define an aperture therethrough. The coupler device may be positioned about a proximal end of the port, and the coupler device may be configured for coupling to a medical device.

Abstract: There is provided an endoscope apparatus in which a forceps elevator can be operated according to the operator's intention even when a treatment tool has large bending stiffness. The forceps elevator is erectably provided in a distal end part of the insertion part of the endoscope apparatus and guides the treatment tool led out from the distal end part. The forceps elevator has an erecting motion range from a minimum angular position to a maximum angular position. If a state in which the treatment tool is not led out from the distal end part is assumed, the erecting operation lever for operating the movement of the forceps elevator has: a first operation range where the erecting operation lever is operated within the erecting motion range of the forceps elevator; and a second operation range where the erecting operation lever is operated beyond the first operation range.

Abstract: There is provided an endoscope apparatus in which a forceps elevator can be operated according to the operator's intention even when a treatment tool has large bending stiffness. The forceps elevator is erectably provided in a distal end part of the insertion part of the endoscope apparatus and guides the treatment tool led out from the distal end part. The forceps elevator has an erecting motion range from a minimum angular position to a maximum angular position. If a state in which the treatment tool is not led out from the distal end part is assumed, the erecting operation lever for operating the movement of the forceps elevator has: a first operation range where the erecting operation lever is operated within the erecting motion range of the forceps elevator; and a second operation range where the erecting operation lever is operated beyond the first operation range.

Abstract: An injection device for administering a substance, including a housing, a plunger rod which can be moved relative to the housing, at least one retaining element associated with the rod to hold the rod relative to the housing, and a displaceable locking sleeve which can be displaced relative to the housing from one position in which the sleeve holds the at least one retaining element in a retaining position to a second position in which the at least one retaining element is released.

Abstract: A surgical obturator comprising an elongate shaft extending along an axis between a proximal end and a distal end includes a bladeless tip disposed at the distal end of the shaft. The tip has a blunt point and a pair of shorter side surfaces separated by a relatively longer pair of opposing surfaces to form in radial cross-section a geometric shape that has a longer length and relatively narrower width. The side surfaces and opposing surfaces terminate in end surfaces located proximally from the blunt point. The end surfaces extend radially outwardly from opposite locations of the outer surface. A conical surface facilitates initial insertion of the obturator and the geometric shape facilitates separation of consecutive layers of muscle tissue having fibers oriented in different directions and provides proper alignment of the tip between the layers of muscle.

Abstract: Percutaneous access systems, including trocars, for accessing desired locations within a subject's body through the subject's skin or other tissues that are configured to minimize incision sizes are disclosed. Such a percutaneous access system includes a cannula and an obturator. The cannula includes a passageway with a tapered section and an expandable section at its distal end. The expandable section may include leaves that are configured to extend radially outward as an elongated instrument that has an outer diameter that exceeds a minimum relaxed inner diameter of the tapered section of the passageway is forced through the tapered section. Methods for using such a percutaneous access system, including medical procedures, are also disclosed.

Abstract: The endoscope is provided with the forceps elevator which is erectably provided in the distal end part of the insertion part of the endoscope and guides a treatment tool led out from the distal end part. The forceps elevator has an erecting motion range from a minimum angular position to a maximum angular position. If a state in which the treatment tool is not led out from the distal end part is assumed, the erecting operation lever for operating the movement of the forceps elevator has: a first operation range where the erecting operation lever is operated within the erecting motion range of the forceps elevator; and a second operation range where the erecting operation lever is operated beyond the first operation range. When the erecting operation lever is operated into the second operation range, the locking mechanism locks the movement of the erecting operation lever.

Abstract: Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues. In some embodiments, thermally-induced renal neuromodulation is achieved via delivery of a pulsed thermal therapy.

Abstract: An electrosurgical generator includes an RF output stage, a DC blocking capacitor, a measuring circuit, and a sensor circuit. The RF output stage generates electrosurgical energy for application to an active electrode. The DC blocking capacitor is electrically coupled between the RF output stage and the active electrode. The measuring circuit is coupled to the DC blocking capacitor and measures the voltage across the DC blocking capacitor. The sensor circuit determines the current of the electrosurgical energy as a function of the voltage across the DC blocking capacitor.

Abstract: External fixation systems, and methods for immobilizing joints or fractured bones. An external fixation system may include one or more clamp assemblies connected to one or more rod assemblies at polyaxial joints. Each rod assembly may be length adjustable, and may include a one-way locking mechanism to provisionally lock the length of the rod assembly, and additional locking mechanisms to permanently lock the length of the rod assembly. The system may be deployed pre-assembled as a unit to immobilize a joint or fracture. Another external fixation system further includes a spanning member extending transverse to the rod assemblies. Two or more external fixation systems may be deployed in a stacked configuration on one set of bone pins to immobilize two joints and/or fractures. The systems may be provided in kits including guiding instrumentation, bone pins and pin clamping assemblies for connecting the bone pins to the external fixation systems.

Abstract: An insertion tool for inserting a catheter into a patient's body is disclosed. The insertion tool unifies needle insertion, guidewire advancement, and catheter insertion in a single device. In one embodiment, the insertion tool comprises a housing in which at least a portion of the catheter is initially disposed, a hollow needle distally extending from the housing with at least a portion of the catheter pre-disposed over the needle, and a guidewire pre-disposed within the needle. A guidewire advancement assembly is also included for selectively advancing the guidewire distally past a distal end of the needle in preparation for distal advancement of the catheter. In one embodiment a catheter advancement assembly is also included for selectively advancing the catheter into the patient. Each advancement assembly can include a slide or other actuator that enables a user to selectively advance the desired component. Guidewire and catheter advancement assemblies are also disclosed.

Abstract: A needle assembly has a needle hub that has a body to which are formed two plates at opposite sides thereof in a parallel relationship. The plates have respective upper edges and lower edges that lie substantially along respective planes, so that the needle hub may be stably placed onto a surface by means of the respective edges. The plates also prevent the rolling of the needle between the fingers of the clinician when the clinician holds the needle assembly by means of the plates. A partition is formed orthogonally proximate to the front ends of the parallel plates. The connector at the proximal portion of the needle hub is configured to have a non-conventional configuration that allows it to mate only with a counterpart connector that has a complementary non-conventional configuration.

Abstract: A small diameter delivery device capable of delivering a tissue loaded scaffold arthroscopically to a tissue defect or injury site without reducing the pressure at the injury site is provided. The scaffold delivery device of the present invention comprises a plunger system that includes two main components: an insertion tube and an insertion rod. The insertion tube has a flared proximal end for holding a tissue scaffold prior to delivery. An elongate, hollow body extends from the flared proximal end to a distal end of the insertion tube, and defines a passageway that extends through the body for delivery of the tissue scaffold. The insertion rod has an elongate body that extends into a handle at a proximal end and a tip at a distal end. The insertion rod is configured to be removably disposed within the insertion tube for sliding along the passageway to effect delivery of the tissue scaffold through the insertion tube.

Abstract: Cannula assemblies and methods of manufacturing cannula assemblies are provided. The cannula assembly includes a cannula and a pigtail extension coupled to the cannula. The pigtail extension includes a proximal section having a first stiffness and a distal section having a second stiffness, the first stiffness greater than the second stiffness. The proximal section of the pigtail extension is positioned between the cannula and at least a portion of the distal section.

Abstract: Methods and devices described herein facilitate improved treatment of body organs. More specifically, devices and methods described herein are for minimally invasive surgery permit improved diaphragmatic access to a body cavity to perform a surgical procedure, for example ablation and/or coagulation of cardiac tissue during minimally invasive surgical access to the heart. The diaphragmatic access described provides direct visualization of anatomic structures within the thoracic cavity such as the posterior left atrium, the posterior side of pulmonary veins, or any other such anatomic structure.

Abstract: The present invention extends to a design of a needle hub and an actuator of a catheter assembly that allows the needle hub and actuator to interlock within the catheter hub. This interlocking allows the needle hub to be inserted into the catheter hub thereby increasing the rigidity of the catheter assembly. The interlocking can be accomplished by forming channels in the proximal end of the actuator and corresponding protrusions from the distal end of the needle hub. In some embodiments, the channels and protrusions can be formed at the top and bottom of the catheter hub and needle hub respectively to thereby increase the vertical rigidity of the catheter assembly. The increase in vertical rigidity can prevent flexing of the catheter hub with respect to the needle shield when a downward force is applied to the catheter assembly such as is common during insertion of the needle.

Abstract: A surgical apparatus for positioning within a tissue tract accessing an underlying body cavity is adapted to tissues having different thicknesses. The surgical apparatus is configured to have different lengths. In one embodiment, the surgical includes a seal anchor member having two ends, and one of which is adapted to fold resulting in a plurality of folded states. Each folded state corresponds to a different length of the seal anchor member. The seal anchor member includes a slot to facilitate transition within the plurality of folded states. The seal anchor member further includes an aperture and a pin configured to further facilitate transition within the plurality of folded states.

Abstract: A catheter for implantation into tissue, the catheter comprising a tubing having a lumen and defining an outer boundary between the catheter and the tissue when the catheter is implanted in the tissue, a healing dummy being insertable in the lumen with clearance so as to prevent tissue ingrowth from the tissue into the lumen when the healing dummy is within the lumen, wherein the healing dummy is removable from the lumen by pulling the healing dummy relative to the tubing out of the lumen, and a perfusion insert being insertable in the lumen when the healing dummy is removed from the lumen, being configured for supplying a perfusion fluid to the tissue so as to initiate interaction between the perfusion fluid and tissue, and being configured for collecting perfusion fluid after interaction with tissue.

Abstract: A system may include a catheter and a support cannula within the catheter. The catheter may include a tapered tip and a body extending proximally therefrom. The catheter tip may have a smaller inner diameter than the catheter body. The support cannula may include a tip disposed within the catheter tip such that the support cannula tip does not extend distally beyond the catheter distal end and a support segment extending proximally from the support cannula tip and disposed within the catheter body such that the catheter body remains in a non-stretched configuration. An outer diameter of the cannula tip may correspond to the inner diameter of the catheter tip. An outer diameter of the support segment may correspond to the inner diameter of the catheter body. The support segment may extend proximally to at least a proximal end of a perforated segment of the catheter body.

Abstract: The present invention provides methods and apparatuses for crossing or bypassing total or near total occlusions of vessels through the use of elongate members and specialized catheters that include a piercing catheter, a reentry catheter, a multi-lumen, reentry catheter, and combinations thereof. A piercing catheter comprises a distal tip used to pierce an occlusion in a crossing procedure and can be configured to microdissect the occlusion or provide support for an elongate member. A reentry catheter comprises a distal side port and ramp to facilitate the reentry or perforation of a vessel wall. A multi-lumen, reentry catheter comprises a tearable lumen divider and a distal side port and ramp.

Abstract: Implementations described and claimed herein provide controlled access into the intra-pericardial space. In one implementation, a medical device comprises an outer sheath, an inner sheath, and a nose shaft. The outer sheath comprises a proximal end, a distal end, and a lumen extending between the proximal end and the distal end. The inner sheath extends through the lumen of the outer sheath and comprises a distal portion adapted to pierce the pericardial sac. The nose shaft is adapted to displace relative to a distal edge of the distal portion of the inner sheath. Displacing the distal portion of the inner sheath relative to the outer sheath until the nose shaft displaces relative to the distal edge provides controlled penetration into the intra-pericardial space.