Abstract: A suture anchor assembly includes a main suture strand, a plurality of suture arms, and a plurality of suture anchor elements connected to the main suture strand by a suture arm. The suture anchor elements are configured to rest against a cortex of a bone to provide an anchor when they are in a deployed configuration. The suture anchor assemblies can be employed in place of or in addition to traditional suture anchors. The assemblies, kits, and methods described herein can be utilized in a variety of procedures and locations in the body where anchoring a graft or tissue adjacent a bone is desired, including, for example, rotator cuff repair and ligament (e.g., the anterior cruciate ligament or ACL) reconstruction and/or repair.

Abstract: A method of implanting an occlusive device in a perforator vessel may include introducing a needle through skin of a patient, and advancing the needle into a perforator vessel, the perforator vessel extending between a superficial vein and a deep vein. The method may further include distally advancing a delivery component from within the needle until a distal end of the delivery component extends into the deep vein and releasing a distal portion of the occlusive device into the deep vein. The needle may then be proximally withdrawn from the perforator vessel such that the device is exposed within the vessel, and the proximal portion of the device may be released into the superficial vein such that the device blocks flow through the vessel.

Abstract: A method for occluding a blood vessel has steps for encasing a semi-rigid, circular plastic ring, open at one point, in silicon material, forming a bladder along an inside diameter of the silicon material, placing a mixture of sodium and potassium salts and polyacrylamide granules in the bladder, closing and sealing the bladder, forming a pair of opposed stirrups on an outside diameter of the silicon material, spreading the encased plastic ring by the stirrups accomplishing an opening through the ring of an extent enabling the ring to be placed over a blood vessel, placing the encased plastic ring over the blood vessel, releasing the stirrup, allowing the ring and bladder to close around the blood vessel, such that the bladder, constrained by the ring from expanding outward, absorbing moisture by osmosis over time, expands inward, and over a time t fully occludes the blood vessel.

Abstract: An occlusion device suitable for endovascular treatment of an aneurysm in a blood vessel in a patient, including a substantially tubular structure having a proximal end region and a distal end region, having a first, expanded condition and a second, collapsed condition. The device has dimensions in the second, collapsed condition suitable for insertion through vasculature of the patient and through a neck of the aneurysm. The device further includes a control ring having a substantially annular body disposed on the proximal end region of the structure and at least substantially circumscribing the proximal end region to prevent radial expansion of the proximal end region and to provide an engagement feature during manipulation of the occlusion device.

Abstract: A positioning and retrieval device manipulated by carrying element coupled to a handle and driven by an actuator that allows for axial movement and rotational movement of a capturing portion on the carrying element.

Abstract: Devices and methods for tissue and graft procedures are provided that are designed to fail under a certain amount of force, providing sensory feedback that a particular activity may be providing too much stress on a surgical implant. For example, a surgical implant can include a sacrificial element in the form of a filament designed to break when a certain threshold value of force is met or exceeded, while a second filament that has the ability to withstand higher values of force, is able to maintain the repair after the first filament fails. In other embodiments, the sacrificial element includes a filament engagement mechanism associated with a suture anchor configured to fail at a threshold value of force, and a second filament engagement mechanism of the anchor can maintain the repair after the first one fails. Many implants configurations are provided, as are various surgical methods incorporating sacrificial elements.

Abstract: Embodiments of the present disclosure provide an introducer device and method for introducing a delivery apparatus into a patient's vasculature. Disclosed methods can include positioning a sleeve of an introducer sheath in a blood vessel of a patient, the sleeve having a lattice layer with a lumen therethrough, inserting a distal end portion of the delivery apparatus and a prosthetic heart valve into the lumen, and advancing the distal end portion of the delivery apparatus through the lumen from the proximal end to the distal end. The method can then include expanding the lumen from a first diameter smaller to a second diameter at least equal to the diameter of the prosthetic heart valve to allow passage of the prosthetic heart valve through the lumen, and returning the lumen of the sleeve to a diameter smaller than the second diameter after advancing the prosthetic heart valve through the lumen.

Abstract: A stent delivery system includes a core member and a coupling assembly rotatably coupled to the core member distal segment. The coupling assembly includes first and second plates and first and second spacers. The first plate is rotatably coupled to the core member and includes an outer surface having three or more projections separated by recesses. The first spacer is coupled to the core member and disposed between the first plate and a proximal restraint. The second plate is rotatably coupled to the core member and includes an outer surface having three or more projections separated by recesses. The second spacer is coupled to the core member and disposed between the first plate and the second plate. A stent extends along the core member distal segment such that an inner surface of the stent is engaged by one or more projections of the first plate or the second plate.

Abstract: New methods for implanting a cardiac therapy system include implanting a lead of the system substernally anterior of the heart without attaching to the myocardium or pericardium. An illustration includes placement of an anchor beneath the sternum in the vicinity of one of the sternal angle, a location superior of the ventricles, the area bounded by the 2nd or 3rd ribs, and level with the aortic arch. A tension element or tether is attached to the anchor and a lead is introduced over the tension element or tether and secured in a desired position relative to the anchor. Other examples also include implantation, substernally, of a lead without the use of a pre-tunneling tool or sheath over the lead itself, for example by using an advancing tool for pushing the lead into position.

Abstract: Systems, devices, and methods for treating a glaucomatous eye are provided. An amount of pulsed laser energy is delivered to the pars plana of the eye by a hand-holdable device which comprises a hand-holdable elongate member and a contact member disposed on an end of the elongate member. A contact surface of the contact member is placed in direct contact with the eye so that a reference edge of the contact member aligns with the limbus and a treatment axis defined by the elongate member is angularly offset from the optical axis of the eye. The amount of pulsed laser energy delivered is insufficient to effect therapeutic photocoagulation but is sufficient to increase uveoscleral outflow so as to maintain a reduction from pre-laser treatment intraocular pressure. Amounts of pulsed laser energy will be transmitted to a circumferential series of tissue regions of the eye.

Abstract: An ultrasound catheter includes a catheter body, an ultrasound transmission member, a sonic connector, a constraining member, and a vibrational absorber. The vibrational absorber has an opening through which the ultrasonic transmission member extends. The vibrational absorber is located in a recessed portion of the constraining member. The vibrational absorber is both longitudinally interposed between the constraining member and the distal portion of the sonic connector and laterally interposed between the recessed portion of the constraining member and the ultrasound transmission member. The recessed portion of the constraining member overlaps a portion of an exterior of the distal portion of the sonic connector.

Abstract: A medical instrument includes: a metallic component on which a concave surface concaved with respect to a surface of the metallic component is formed; and a covering that covers the concave surface while receiving a compressive force from the concave surface of the metallic component.

Abstract: A bristle device (8) for delivery into a body lumen comprises a longitudinally extending stem and a plurality of bristles extending generally outwardly from the stem for anchoring the device in a body lumen. There may beat least two bristle segments (96) and there are flexible sections (95) between the segments (96). The flexible sections (95) articulate to enable the device to pass through a catheter placed in a tortuous anatomy or to be deployed in a curved vessel, or across a bifurcation. In some cases at least some of the bristle segments (96) are spaced-apart to accommodate bending of the bristles.

Abstract: An occlusion device suitable for endovasculature treatment of an aneurysm in a blood vessel in a patient, including a substantially tubular structure having a proximal end region and a distal end region, having a first, expanded condition and a second, collapsed condition. The device has dimensions in the second, collapsed condition suitable for insertion through vasculature of the patient and through a neck of the aneurysm. The device further includes a control ring having a substantially annular body disposed on the proximal end region of the structure and at least substantially circumscribing the proximal end region to prevent radial expansion of the proximal end region and to provide an engagement feature during manipulation of the occlusion device.

Abstract: An ultrasonic surgical apparatus including a first signal generator outputting a drive signal at a predetermined voltage and frequency, a first oscillating structure receiving the drive signal and oscillating at the frequency of the drive signal, and a bridge circuit, detecting the mechanical motion of the first oscillating structure and outputting a signal representative of the mechanical motion.

Abstract: Apparatus and methods are described herein for repositioning a tether attached to a prosthetic heart valve. In some embodiments, a method includes inserting a distal end portion of a snare device through an incision at a first location in a ventricular wall of a heart and within the left ventricle of the heart. A tether extending from a prosthetic mitral valve, through the left ventricle and out an incision at a second location on the ventricular wall of the heart is snared with the snare device. The tether is pulled with the snare device such that a proximal end of the tether is moved back through the incision at the second location on the ventricular wall and into the left ventricle. The snare device is pulled proximally such that the tether is pulled proximally through the incision at the first location in the ventricular wall of the heart.

Abstract: Described herein are shock wave devices and methods for the treatment of vascular plaques. One variation of a shock wave device may include a pair of elongated, flexible concentric tubes comprising an inner tube and an outer tube. The inner tube and the outer tube may be connected together at one end, and at least a portion of the volume between the inner tube and the outer tube may be filled with a conductive fluid via the other end. At least two electrodes may be positioned between the inner tube and the outer tube, the at least two electrodes being electrically connectable to a voltage source and configured to generate shock waves in the conductive fluid in response to voltage pulses.

Abstract: Adjuncts for use with surgical instruments, such as staplers, are provided. In one embodiment, an adjunct can include a plurality of suction members configured to attach the adjunct to an end effector jaw of a surgical stapler using a suction force. The suction members can be configured to generate the suction force when compressed. The suction members can be further configured to release the suction force to decouple the adjunct from the end effector jaw, permitting deployment of the adjunct at a treatment site. In certain embodiments, the suction members can include a plurality of air pockets formed in the bulk of the adjunct or within protrusions extending outward from a surface of the adjunct. The air pockets can be in communication with corresponding openings allowing air to escape the air pockets when compressed.

Abstract: Instruments and techniques to pass a suture are presented. The instruments and techniques are particularly useful where access to confined spaces and the ability to pass a suture through difficult to penetrate materials are needed. The instruments and techniques are particularly useful in surgery of the hands and feet.

Abstract: Devices for removing implanted objects from body vessels are provided. A device includes a sheath assembly having a cutting tip. The cutting tip includes a cutting surface that is adapted to cut tissue coupled to an implanted object as the cutting tip rotates. The sheath assembly further includes an outer shield carried outside of the cutting tip. The outer shield includes a distal opening, and the outer shield is translatable relative to the cutting tip from a first position to a second position and vice versa. In the first position the cutting surface of the cutting tip is disposed within the outer shield, and in the second position the cutting tip extends through the distal opening and the cutting surface is at least partially disposed outside of the outer shield.