Abstract: Certain embodiments described herein relate to a system for use in analyzing neural activity of nerves surrounding a biological lumen. The system includes a probe body, electrodes, a stimulator, and an amplifier. The stimulator delivers electrical stimulation via a first pair of the electrodes, supported by the probe body, to test for an evoked neural response by nerves surrounding the biological lumen. The amplifier includes a pair of input terminals, an output terminal, and a ground reference terminal. A second pair of the electrodes is electrically coupled to the pair of input terminals of the amplifier, to thereby enable the amplifier to produce the sensed signal indicative of the evoked neural response. A remaining one of the electrodes, which is not included in the first and the second pairs of the electrodes, is electrically coupled to the ground reference terminal of the amplifier.

Abstract: A catheter having a shaft that has at least two spaced-apart lumens is disclosed. A retractable core wire is disposed within at least one of the lumens. The retractable core wire is manipulated by the user to impart variable stiffness to the shaft as the core wire is retracted and extended within the lumen. A catheter having substantially low profile bonds at the junctions where an inflatable balloon is attached to the catheter is also disclosed. The low profile bonds are created by recesses extending around the circumference of the distal end of the shaft, the proximal and distal ends of a stem, and the proximal end of a tip. The catheter having the low profile bond optionally has either a retractable or an embedded core wire. In examples, the catheter has at least one component formed from, co-extruded with, or coated with a lubricious material or a hydrophilic material.

Abstract: The tool for enhancing visualization during surgery includes a shaft having a balloon member at a distal end. A fluid conduit through the shaft permits passing and inflation fluid into the balloon to selectively inflate the balloon. The balloon is formed of a material transparent to a wavelength of interest. A waveguide extends within the shaft into the interior of the balloon to visualize anatomical features external to the balloon.

Abstract: A bifurcated stent includes a first stent section and a second stent section. The first stent section is balloon expandable, has an unexpanded configuration, an expanded configuration, and a tubular wall defining a secondary opening. The secondary stent section is self-expanding and an end of the secondary stent section is engaged to a portion of the tubular wall of the primary stent section defining the secondary opening. The secondary stent section has an unexpanded configuration with a first length and an expanded configuration with a second length where the first length is less than the second length. The secondary stent section is expanded to the expanded configuration after the primary stent section is expanded to the expanded configuration. The secondary stent section forms a portion of the tubular wall of the primary stent section in the unexpanded configuration.

Abstract: A catheter for use in introducing fluid into a vessel or other bodily structure. The catheter comprises a stem and a restrictor. The stem has approximate a distal end thereof a porous section that defines microholes distributed thereabout, which are inclined by a predetermined angle in the proximal direction. Affixed to the stem, the restrictor includes a conically-shaped valve with an apex thereof defining an opening and pointing in the proximal direction. The opening generally decreases in size as the conically-shaped valve flattens out distally as the pressure of the fluid within the tip increases. The forces of the fluid flowing out of the opening of the restrictor and out of the microholes of the stem substantially balance thereby substantially eliminating both recoil and whipping of the catheter, thus enabling its position to remain exceptionally stable while the fluid is finely dispersed therefrom in a cloud-like form.

Abstract: An apparatus for forming a lesion in tissue along a desired ablation path includes a guide member having a tissue-opposing surface for placement against a heart surface. A guide carriage is sized to be received within the guide member and moveable therein along a longitudinal axis. The carriage is configured to receive an optical fiber extending substantially axially within the carriage and bend the fiber for a discharge tip of the fiber to aim through a bottom wall of the guide member. The carriage is further configured to bend the fiber toward said discharge tip with a curved portion subject to mechanical stress and a straight portion at the fiber discharge tip. The straight portion is selected to have a length to dissipate thermal stress arising from reflectance of light from the tissue back into the discharge tip.

Abstract: An apparatus for forming a lesion in tissue along a desired ablation path includes a guide member having a tissue-opposing surface for placement against a heart surface. A guide carriage is sized to be received within the guide member and moveable therein along a longitudinal axis. A flexible tubular member extends from a proximal end of said carriage and through a length of the guide member with the tubular member adapted to move the carriage within the guide member upon application of a force to the tubular member. A system urges the carriage to move in a path along an axis of the guide member by amount substantially identical to a displacement of a force application location on the flexible tubular member.

Abstract: An apparatus for forming a lesion in tissue along a desired ablation path includes a guide member having a tissue-opposing surface for placement against a heart surface. A guide carriage is sized to be received within the guide member and moveable along a longitudinal axis of the guide member. A tubular member extends from a proximal end of the carriage and out a proximal end of the guide member. An ablation element is carried in the carriage for movement. The ablation member is connected to a source of ablation energy through the tubular member. A sensor is provided for sensing a safety condition. The sensor is connected to a monitor external the guide member.

Abstract: An apparatus for transmitting laser light and redirecting the light laterally relative to an axis of the apparatus includes an optical fiber having both a core and a cladding surrounding the core. The optical fiber terminates at a distal tip having a surface inclined relative to the axis of the optical fiber. A tubular member surrounds the optical fiber at its distal end. The distal end of the optical fiber has a portion opposing the tubular member for being united to the tubular member. The distal portion is joined to the tubular member by an intermediate material selected to have an index of refraction matching that of the core and the tubular member.

Abstract: An apparatus for transmitting laser light and redirecting the light laterally relative to an axis of the apparatus includes an optical fiber having a core and a cladding surrounding the core. The core terminates at a core end. The cladding terminates at a cladding end spaced from the core end to expose an exposed length of the core. A tubular member surrounds at least a distal portion of the fiber and has a closed distal end. The exposed length of the core is bent for the core end to oppose a side of said tubular member. The core end is bonded to the side of the tubular member. A seal creates a sealed volume of the tubular member surrounding said exposed length. The volume may contain a vacuum or a gas such as air.

Abstract: A method and apparatus for treating a body tissue in situ (e.g., an atrial tissue of a heart to treat atrial fibrillation) include a lesion formation tool is positioned against the heart surface. The apparatus includes a guide member having a tissue-opposing surface for placement against a heart surface. The guide member also has interior surfaces and a longitudinal axis. A guide carriage is sized to be received with the guide member and moveable therein along the longitudinal axis. An optical fiber is positioned within the guide carriage with the carriage retaining the fiber. The carriage receives the fiber with an axis substantially parallel to the longitudinal axis and bends the fiber to a distal tip with an axis of said fiber at said distal tip at least 45 degrees to the longitudinal axis and aligned for discharge of laser energy through the tissue opposing surface.

Abstract: A method and apparatus for treating a body tissue in situ (e.g., an atrial tissue of a heart to treat) atrial fibrillation include a lesion formation tool is positioned against the heart surface. The lesion formation tool includes a guide member having a tissue-opposing surface for placement against a heart surface. An ablation member is coupled to the guide member to move in a longitudinal path relative to the guide member. The ablation member has an ablation element for directing ablation energy in an emitting direction away from the tissue-opposing surface. The guide member may be flexible to adjust a shape of the guide member for the longitudinal path to approximate the desired ablation path while maintaining the tissue-opposing surface against the heart surface. In one embodiment, the ablation member includes at least one radiation-emitting member disposed to travel in the longitudinal pathway. Transmurality can be assessed to approximate a location of non-transmurality in a formed lesion.

Abstract: A method and apparatus for treating a body tissue in situ (e.g., an atrial tissue of a heart to treat) atrial fibrillation include a lesion formation tool is positioned against the heart surface. The lesion formation tool includes a guide member having a tissue-opposing surface for placement against a heart surface. An ablation member is coupled to the guide member to move in a longitudinal path relative to the guide member. The ablation member has an ablation element for directing ablation energy in an emitting direction away from the tissue-opposing surface. The guide member may be flexible to adjust a shape of the guide member for the longitudinal path to approximate the desired ablation path while maintaining the tissue-opposing surface against the heart surface. In one embodiment, the ablation member includes at least one radiation-emitting member disposed to travel in the longitudinal pathway.

Abstract: A method and apparatus for treating in situ biologic tissue include identifying a patient with a condition susceptible to treatment by forming a lesion in the tissue and accessing a surface of the tissue. A lesion formation tool is positioned against the accessed surface. The tool includes an optical fiber for guiding a coherent waveform of a selected wavelength to a fiber tip for discharge of light energy from the fiber tip. The wavelength is selected for the light energy to penetrate a full thickness of the tissue to form a volume of necrosed tissue through the thickness of the tissue. The tool further includes a guide tip coupled to the fiber tip. The guide tip is adapted to have a discharge bore aligned with the fiber tip to define an unobstructed light pathway from the fiber tip to the tissue surface.

Abstract: A method and apparatus for treating in situ biologic tissue include identifying a patient with a condition susceptible to treatment by forming a lesion in the tissue and accessing a surface of the tissue. A lesion formation tool is positioned against the accessed surface. The tool includes an optical fiber for guiding a coherent waveform of a selected wavelength to a fiber tip for discharge of light energy from the fiber tip. The wavelength is selected for the light energy to penetrate a full thickness of the tissue to form a volume of necrosed tissue through the thickness of the tissue. The tool further includes a guide tip coupled to the fiber tip. The guide tip is adapted to have a discharge bore aligned with the fiber tip to define an unobstructed light pathway from the fiber tip to the tissue surface.

Abstract: A method and apparatus for treating in situ biologic tissue include identifying a patient with a condition susceptible to treatment by forming a lesion in the tissue and accessing a surface of the tissue. A lesion formation tool is positioned against the accessed surface. The tool includes an optical fiber for guiding a coherent waveform of a selected wavelength to a fiber tip for discharge of light energy from the fiber tip. The wavelength is selected for the light energy to penetrate a full thickness of the tissue to form a volume of necrosed tissue through the thickness of the tissue. The tool further includes a guide tip coupled to the fiber tip. The guide tip is adapted to have a discharge bore aligned with the fiber tip to define an unobstructed light pathway from the fiber tip to the tissue surface.

Abstract: A method and apparatus for treating in situ biologic tissue include identifying a patient with a condition susceptible to treatment by forming a lesion in the tissue and accessing a surface of the tissue. A lesion formation tool is positioned against the accessed surface. The tool includes an optical fiber for guiding a coherent waveform of a selected wavelength to a fiber tip for discharge of light energy from the fiber tip. The wavelength is selected for the light energy to penetrate a full thickness of the tissue to form a volume of necrosed tissue through the thickness of the tissue. The tool further includes a guide tip coupled to the fiber tip. The guide tip is adapted to have a discharge bore aligned with the fiber tip to define an unobstructed light pathway from the fiber tip to the tissue surface.

Abstract: Systems for delivering a bifurcated stent to a bifurcation site comprise catheters and/or bifurcated stents delivered therefrom.

Abstract: A method and apparatus for treating in situ biologic tissue include identifying a patient with a condition susceptible to treatment by forming a lesion in the tissue and accessing a surface of the tissue. A lesion formation tool is positioned against the accessed surface. The tool includes an optical fiber for guiding a coherent waveform of a selected wavelength to a fiber tip for discharge of light energy from the fiber tip. The wavelength is selected for the light energy to penetrate a full thickness of the tissue to form a volume of necrosed tissue through the thickness of the tissue. The tool further includes a guide tip coupled to the fiber tip. The guide tip is adapted to have a discharge bore aligned with the fiber tip to define an unobstructed light pathway from the fiber tip to the tissue surface.

Abstract: The present invention provides an aortic valvuloplasty catheter which, in one preferred embodiment, has a tapered distal balloon segment that anchors within the left ventricle outflow track of the patient's heart and a rounded proximal segment which conforms to the aortic sinuses forcing the valve leaflets open. In addition, this embodiment of the valvuloplasty catheter includes a fiber-based balloon membrane, a distal pigtail end hole catheter tip, and a catheter sheath.