Abstract: Methods and devices for separating an implanted object, such as a pacemaker lead, from tissue surrounding such object in a patient's vasculature system. Specifically, the surgical device includes a handle, an elongate inner sheath and a circular cutting blade that extends from the distal end of the sheath upon actuating the handle. The circular cutting blade is configured to engage the tissue surrounding an implanted lead and cut such tissue in a coring fashion as the surgical device translates along the length of the lead, thereby allowing the lead, as well as any tissue remaining attached to the lead, to enter the device's elongate shaft. The surgical device has a barrel cam cylinder in the handle assembly that imparts rotation of the blade and a separate cam mechanism in the tip of outer sheath assembly that imparts and controls the extension and retraction of the blade.

Abstract: The present disclosure relates to methods and systems for removing a vascular obstruction in a subject using a combination of thrombolytic and laser ablation therapy. Treatment methods include positioning a catheter adjacent to an obstruction within a vessel of a subject. A portion of the obstruction may be ablated by delivering laser energy through the optical fibers to the distal end of the catheter, where the optical fibers are exposed, and circulating a fluid containing one or more thrombolytic agents to a remaining portion of the obstruction for a predetermined amount time. Fluid containing one or more thrombolytic agents capable of dissolving a remaining portion of the obstruction may be circulated through the fluid delivery lumen and removed through the fluid removal lumen.

Abstract: A light-diverting catheter tip is provided according to embodiments disclosed herein. The light-diverting catheter tip may be coupled with the distal tip of a laser catheter and divert at least a portion of the light exiting the distal tip of the laser catheter such that the spot size of the laser beam on an object after exiting the catheter tip is larger than the spot size of the light entering the catheter without the catheter tip. The catheter tip may be removably coupled with the catheter or constructed as part of the catheter. In other embodiment, the catheter tip may conduct fluid and/or divert fluid at the tip of the laser catheter.

Abstract: Embodiments of the invention are directed towards a rapid exchange catheter configured for insertion into a subintimal space and crossing an occlusion in a subintimal space. The catheter includes a proximal end, a distal end, a first lumen configured to receive a first wire, the first lumen extending longitudinally through a least a lateral port of the catheter, and a second lumen having at least a portion distal of the lateral port and extending through at least the distal end of the catheter. The catheter also includes an exchange port, arranged on an exterior portion of the catheter configured to receive a second wire and second rapid exchange port in communication with the second lumen. Moreover, other embodiments of the invention are directed towards methods for using the rapid exchange catheter to cross an obstruction in a vessel, e.g., a total or partial occlusion, in a subintimal space.

Abstract: Snaring systems and methods involve engaging objects such as pacemaker pacing leads within a patient. Physicians can use snaring systems having loops, tags, and roller mechanisms to remove a pacing leads from a patient. For example, snaring systems can be inserted through a jugular access site, engaged with a pacemaker pacing lead, and withdrawn through the jugular access site so as to remove a portion of the pacing lead. Lead extraction techniques can be employed to further dislodge the pacing lead from the patient.

Abstract: This disclosure discusses various methods and devices for providing multiple types of indicators to be used with a sheath set. One type of indicator indicates the linear position and alignment of each of the sheaths within the sheath set, and another type of indicator indicates the rotational position and alignment of the sheaths. Both types of indicators may be included on the ends of the sheath set proximal to the user outside the patient's vasculature, thereby informing the user of the sheath set of the linear and rotational position and alignment of the ends of the inner and outer sheaths within the vasculature.

Abstract: A method of delivering light energy to target matter in a mammalian body is described. The method may include inserting at least a portion of a catheter into a patient's vasculature, wherein the catheter comprises an open distal tip, a lumen extending proximally from the open distal tip, and at least one optical fiber within the lumen, wherein the at least one optical fiber has a distal end. The method may include flowing a liquid light guide medium through the open-ended catheter tip, wherein the liquid light guide medium flows beyond the distal end of the at least one optical fiber, wherein the liquid light guide medium comprises a magnesium chloride solution having an ion concentration that is isotonic with blood and tissue. The method may include forming a fluid optical channel with the liquid light guide medium between the catheter and the target matter. Other methods are described.

Abstract: The invention generally relates to method and apparatus for crossing an obstruction in a tubular member, and more particularly to a medical device method for crossing of a chronic occlusion in a subintimal or interstitial space of an artery.

Abstract: A device for extending a lead according to some embodiments includes a body, a tubular member coupled to the body, the tubular member comprising an outer surface, wherein the outer surface is sized to insert into an inner lumen of a lead, the tubular member is movable between a first configuration in which the tubular member slides into the lead, and a second configuration in which at least a portion of the tubular member expands to engage an inner surface of the lead; and, an actuation mechanism operatively coupled to the tubular member, the actuation mechanism configured to move the tubular member between the first configuration and second configuration.

Abstract: The present disclosure relates to a terahertz imaging system for imaging a lumen of a human, such as an intravascular space. A system may include a catheter and a terahertz transceiver device coupled to the catheter. The terahertz transceiver device may be operative to output terahertz radiation through a lumen of a human and to receive reflection signals based on the terahertz radiation. A power source may be coupled to the terahertz transceiver device. The system may further include a controller in communication with the terahertz transceiver device. The controller is operative to obtain an image of the lumen based on the reflection signals.

Abstract: The present disclosure relates to a system and method for providing laser energy through a catheter towards a second end portion of the catheter. Based on a characteristic of the laser energy multiple types of ablation therapy may be implemented. A first ablation therapy is directed at the target site when the laser energy at the second end portion of the laser energy delivery system has a first characteristic. A second ablation therapy is directed at the target site when the laser energy at the second end portion of the laser energy delivery system has a second characteristic. The first ablation therapy may be an optical ablation therapy wherein the laser energy is directed at the target site as optical energy and the second ablation therapy may be a pressure wave ablation therapy wherein pressure waves are directed at the target site as pressure wave energy.

Abstract: A method for detaching an object from a patient includes providing a tool having a sheath, and a separating assembly operably coupled to a distal end of the sheath. The separating assembly includes a separator moveably coupled to a tip via a threadable connection. The separating assembly is placed near patient tissue that is attached to the object, the sheath is rotated to move the separator distal to the tip, and the separator is applied to the patient tissue that is attached to the object, so as to separate the tissue. A separating system includes a sheath, and a separator threadably coupled with a distal end of the sheath. The separator is adapted to switch between a first configuration where a separating mechanism is deployed, and a second configuration where the separating mechanism is undeployed.

Abstract: Methods and systems for separating an object, such as a lead, from formed tissue are provided. Specifically, a tissue slitting device is configured to engage patient formed tissue at a slitting engagement point. While the object is subjected to a first traction force, the tissue slitting device is caused to move further into the engaged tissue and slit the tissue past the point of engagement. The slitting device causes the tissue to separate along an axial direction of the length of the formed tissue and releases at least some of the force containing the object. The methods and systems are well suited for use in cardiac pacing or defibrillator lead explant procedures.

Abstract: A device for removing an implanted object from a body vessel includes an actuator having an elongated sheath extending therefrom, the elongated sheath including a proximal portion and a distal portion. A tubular outer member has a proximal end attached to the distal portion of the elongated sheath, with a ramped surface at a distal end of the tubular outer member which constricts a diameter of a bore formed in the tubular outer member. A tubular inner member is located within the tubular outer member, the tubular inner member including a proximal end operably connected to the actuator and a distal end opposite the proximal end, the distal end of the tubular inner member including a plurality of resiliently flexible blades positioned to interact with the ramped surface of the tubular outer member such that the ramped surface is operable to deflect the resiliently flexible blades radially inwardly as the tubular inner member is advanced distally within the tubular outer member.

Abstract: The present disclosure is directed, in one embodiment, to a wire centering sheath system in which wires outwardly extend from a sheath to brace against a vessel wall. The wire centering sheath system may be used to center endovascular devices.

Abstract: A method and device for local delivery of a water-insoluble therapeutic agent to the tissue of a normal or diseased body lumen is disclosed. An expandable structure of a medical disposable device, such as a balloon of a balloon catheter, is coated with a non-durable coating which includes an amphiphilic polymer or copolymer, in embodiments polyethylene glycol, having a substantially water-insoluble therapeutic agent dispersed therein. In some embodiments, the coating may also include iodine. The medical disposable device is inserted into a body lumen, and expanded to contact the non-durable coating against the body lumen and deliver the substantially water-insoluble therapeutic agent to the body lumen tissue.

Abstract: A device suitable for removing material from a living being is provided, featuring at least an aspiration pump, powered by a motor. The aspiration pump and any optional infusate pump preferably feature a helical pumping mechanism, and operate at a high rate of rotation, thereby ensuring adequate pumping performance and flexibility. The helical pumping mechanism may be a helical coiled wire about a central core tube. The helical coil wire, whether together with, or independent of, the core tube, may be rotated to cause a pumping action. Additionally, a narrow crossing profile is maintained, ensuring that the device may reach more tortuous regions of the vasculature. In one embodiment, the system comprises a wire-guided mono-rail catheter with a working head mounted on a flexible portion of the catheter that can laterally displace away from the guide wire to facilitate thrombus removal.

Abstract: Laser energy delivery devices and methods are provided. A laser energy delivery device for providing treatment to a subject may include a coupling adapted to couple to a laser energy generator. A sheath is coupled to the coupling, the sheath including a distal end adapted to be disposed in the subject. A plurality of transport members are carried by the coupling and the sheath, the plurality of transport members being adapted to receive laser energy at the coupling, transmit laser energy through the sheath, and deliver laser energy to the subject. A sensor is adapted to detect transmission of laser energy through at least one of the plurality of transport members.

Abstract: A device for occluding a perforation in a blood vessel includes a catheter shaft that has a first lumen and a second lumen. The first lumen is adapted to receive at least one of a guidewire and an implanted cardiac lead, and the second lumen is adapted to receive an inflation fluid. The device further includes an inflatable balloon that is carried by the catheter shaft. The inflatable balloon is adapted to receive the inflation fluid from the second lumen. The inflatable balloon has a working length of about 65 mm to about 80 mm and an inflated diameter of about 20 mm to about 25 mm.

Abstract: Laser energy delivery devices and methods are provided. A laser energy delivery device may include a housing, and a coupling is carried by the housing and adapted to couple to a laser energy generator. A sheath is carried by the housing, and the sheath includes a distal end adapted to be disposed in the subject. A plurality of transport members are carried by the sheath, and the plurality of transport members are adapted to receive laser energy at the coupling, transmit laser energy through the sheath, and deliver laser energy to the subject. A fluid-driven motor is carried by the housing and adapted to be driven upon receiving a fluid from a fluid source. A drive wire is carried by the sheath and eccentrically coupled to the distal end of the sheath, and the drive wire is adapted to be rotatably driven by the fluid-driven motor and rotates to eccentrically rotate the distal end of the sheath.