Abstract: Configurations are described for conducting minimally invasive medical diagnoses and interventions utilizing elongate instruments and assemblies comprising one or more imaging devices, and one or more remote retraction and distraction devices. Retraction and distraction devices, such as balloons, mechanical retraction members, and/or trocar screw geometries may be utilized to access, investigate, and intervene at the joint capsule, or inside of the joint capsule. Imaging devices, such as optical image capture devices, ultrasound transducers, and optical coherence tomography fibers, may be utilized to assist with navigation of the pertinent tools during diagnostic and interventional steps.

Abstract: A system for laterally decompressing one or more spinal nerves comprises an access sheath, a tool guide, and a bone removal tool. The access sheath is percutaneously placed adjacent a facet joint using needle dilation or a small incision. The tool guide is then placed through the access sheath adjacent an anterior surface of the superior articular process of the facet joint. The bone removal tool is advanced over the guide track to remove bone from the anterior surface. Optionally, after bone removal has been completed, the cutting tool may be advanced through the access sheath in order to partially cut the ligamentum flavum to further relieve compression of the spinal nerve(s).

Abstract: An expandable medical device includes a plurality of elongated struts, forming a substantially cylindrical device which is expandable from a cylinder having a first diameter to a cylinder having a second diameter. A plurality of different beneficial agents can be loaded into different openings within the struts for delivery to the tissue. For treatment of conditions such as restenosis, different beneficial agents are loaded into different openings in the device to address different biological processes involved in restenosis and are delivered at different release kinetics matched to the biological process treated. The different beneficial agents may also be used to address different diseases, such as restenosis and acute myocardial infarction from the same drug delivery device.

Abstract: Methods and devices are provided for the delivery of therapeutic agents which reduce myocardial tissue damage due to ischemia and anti-restenotic agents which inhibit restenosis following a cardiac procedure such as stent implantation. The anti-ischemia agents are delivered to the myocardial tissue over an administration period sufficient to achieve reduction in ischemic or reperfusion injury of the myocardial tissue. The anti-restenotic agents are delivered over an administration period sufficient to reduce the re-narrowing of a blood vessel following a cardiac procedure such as implantation of a device. Preferred anti-restenotic drugs are those that do not reduce the beneficial effects provided by the anti-ischemic drug, such as drugs that do not act on the mammalian target of rapamycin (mTOR).

Abstract: Methods and devices are provided for the local delivery of anti-ischemic agents which reduce myocardial tissue damage due to ischemia or reperfusion, in combination with compounds that sensitize the response of the tissue to the anti-ischemic agent. The therapeutic agents are delivered to the myocardial tissue over an administration period sufficient to achieve reduction in ischemic or reperfusion injury of the tissue.

Abstract: A rapid exchange balloon catheter has a short rapid exchange length for faster catheter exchanges the balloon catheter includes a balloon structure having a balloon leg connected to a catheter shaft. Marker bands may be provided in the balloon leg for facilitating measurement of a dimension of physiological features. A stiffening wire extending longitudinally at least partially into the balloon leg may be provided to supplement and control the flexibility characteristics of the balloon leg.

Abstract: Methods and devices are provided for the delivery of therapeutic agents which reduce myocardial tissue damage due to ischemia and anti-restenotic agents which inhibit restenosis following a cardiac procedure such as stent implantation. The anti-ischemia agents are delivered to the myocardial tissue over an administration period sufficient to achieve reduction in ischemic or reperfusion injury of the myocardial tissue. The anti-restenotic agents are delivered over an administration period sufficient to reduce the re-narrowing of a blood vessel following a cardiac procedure such as implantation of a device. Preferred anti-restenotic drugs are those that do not reduce the beneficial effects provided by the anti-ischemic drug, such as drugs that do not act on the mammalian target of rapamycin (mTOR).

Abstract: A method for reducing the level of restenosis following a stent placement medical intervention involves the continuous administration of a dose of an anti-restenotic agent, such as paclitaxel, from the stent to vascular tissue in need of treatment in a controlled and extended drug release profile for a period of at least 60 days in vivo. The in vivo release profile is determined by in vivo animal experiments involving implanting a series of stents in animals, explanting the stents from the animals at selected time points, and extracting remaining drug from the explanted stents.

Abstract: Dipyridamole is an antithrombotic agent which also promotes the growth of endothelial cells. An endothelial cell lining within a stent is necessary for complete healing on the interior of the stent. A dual drug dipyridamole stent includes a first drug formulation of dipyridamole and polymer arranged in a first set of holes in the stent for primarily luminal delivery and a second drug formulation of an antirestenotic agent and polymer arranged in a second set of holes in the stent for primarily mural delivery. The delivery of dipyridamole luminally into the blood stream can involve a two phase release with the first phase being a burst to prevent initial clotting or thrombus formation followed by a second phase with a much slower and more sustained release to reduce thrombogenicity and promote the growth of the endothelial cell lining.

Abstract: A rapid exchange balloon catheter has a short rapid exchange length for faster catheter exchanges the balloon catheter includes a balloon structure having a balloon leg connected to a catheter shaft. Marker bands may be provided in the balloon leg for facilitating measurement of a dimension of physiological features. A stiffening wire extending longitudinally at least partially into the balloon leg may be provided to supplement and control the flexibility characteristics of the balloon leg.

Abstract: An advanceable, non-removable guide wire balloon catheter delivery system for a stent includes a balloon dilation catheter comprising a balloon defined by at least parts of an inner tubular element and an outer tubular element, a guidewire disposed in and having a limited range of longitudinal movement relative to the inner tubular element, and an expandable stent mounted on the balloon. A method of implanting a stent in a patient is also disclosed.

Abstract: A method for decreasing the level of restenosis following a stent placement medical intervention involves the continuous administration of a dose of an immunosuppressant or anti-inflammatory agent from reservoirs in a stent to vascular tissue in need of treatment in a controlled, two phase drug release profile. It is envisioned that the vascular tissue in need of treatment is arterial tissue, specifically coronary arterial tissue. The agent or drug can be the calcineurin inhibitor Pimecrolimus. The drug can be held within reservoirs in the stent in a drug delivery matrix comprised of the drug and a bioresorbable polymeric material and optionally additives to regulate the drug release.

Abstract: A method for decreasing the level of restenosis following a stent placement medical intervention involves the continuous administration of a dose of an anti-restenotic agent, such as Pimecrolimus, from the stent to vascular tissue in need of treatment in a controlled and extended drug release profile for a period of at least 45 days in vivo. The in vivo release profile is determined by in vivo animal experiments involving implanting a series of stents in animals, explanting the stents from the animals at selected time points, and extracting remaining drug from the explanted stents.

Abstract: A method for decreasing the level of restenosis following a stent placement medical intervention involves the continuous administration of a dose of an anti-restenotic agent, such as paclitaxel, from the stent to vascular tissue in need of treatment in a controlled, extended, and substantially linear drug release profile. The method of substantially linear extended release increases the therapeutic effectiveness of administration of a given dosage. In one example, a method of reducing restenosis includes delivering paclitaxel from a stent to an artery at a minimum release rate of 1 percent of the total dosage of paclitaxel on the stent per day throughout an entire administration period from the time of implantation of the stent until the time that substantially all the paclitaxel is released from the stent.

Abstract: A method for treating blood vessel occlusions in the heart delivers an angiogenic agent from an implantable device locally to the walls of the blood vessel over an extended administration period sufficient to establish self sustaining blood vessels. An expandable medical device for delivery of angiogenic agents includes openings in the expandable medical device struts to deliver one or more angiogenic agents to promote angiogenesis. The device can sequentially deliver a plurality of agents to promote angiogenesis to treat, for example, disorders and conditions associated with chronic total occlusions.

Abstract: An expandable medical device includes a plurality of elongated struts, forming a substantially cylindrical device which is expandable from a cylinder having a first diameter to a cylinder having a second diameter. A plurality of different beneficial agents can be loaded into different openings within the struts for delivery to the tissue. For treatment of conditions such as restenosis, different beneficial agents are loaded into different openings in the device to address different biological processes involved in restenosis and are delivered at different release kinetics matched to the biological process treated. The different beneficial agents may also be used to address different diseases, such as restenosis and acute myocardial infarction from the same drug delivery device.

Abstract: A bifurcation stent includes a first end which is deformable or crushable at a lower force than a second end. The crushable first end and more rigid second end of the bifurcation stent allow one end of the stent to remain expanded in tissue supporting configuration in a side branch of a vessel bifurcation while the other end is easily crushed against the side wall of the main vessel into which it extends. A method of supporting a bifurcated body lumen with the bifurcation stent involves delivering the bifurcation stent in an unexpanded configuration to a bifurcation in a body lumen, positioning the bifurcation stent with the distal portion substantially within a side branch vessel of the bifurcation and the proximal crushable portion substantially within the main vessel, expanding the bifurcation stent, and expanding a main vessel stent along side the bifurcation stent and thereby crushing at least a portion of the crushable proximal portion of the bifurcation stent against the main vessel wall.

Abstract: A method and apparatus for the local delivery of therapeutic agents reduces myocardial tissue damage due to ischemia. A local delivery device is used for delivery of the therapeutic agents into a coronary artery which feeds the ischemic myocardial tissue. According to one example, an implantable medical device for delivering insulin locally to myocardial tissue includes a therapeutic dosage of insulin in a biocompatible polymer affixed to a stent. The therapeutic dosage of insulin is released from the stent at a therapeutic dosage and over an administration period effective to reduce ischemic injury of the myocardial tissue.

Abstract: A method and apparatus for local delivery of growth factors which enhances stem cell regeneration of the heart is disclosed. In one example, a stent containing growth factor within openings in the stent delivers the growth factor into a coronary artery to improve effectiveness of the stem cell transplantation therapy. The stent may also be used to transplant stem cells and deliver other bioactive factors.

Abstract: A method and system for delivering a bioresorbable intravascular stent includes a delivery system or catheter having an expandable balloon. A guidewire lumen having a distal guidewire port and a proximal guidewire port spaced a relatively short distance from the distal end allows rapid exchange of the stent delivery system over a guidewire.