Abstract: A directional sheath for use in angiography, thrombectomy and/or chemotherapy procedures. The sheath includes a distal end and proximal end, defines aperture(s) between the ends, and includes an occlusion balloon adjacent the distal end. An inflation lumen is in fluid communication with the balloon, so the balloon can be inflated to occlude a blood vessel. The sheath can include a dilator. In one method, the sheath is inserted in a blood vessel, and the balloon is inflated to occlude it. A substance is introduced through the sheath, while the distal end remains occluded by a dilator distal end. The substance passes a dilator intermediate portion and exits the sheath through the apertures, whereby the substance is introduced retrograde in the blood vessel. In another method, the sheath is introduced into a vessel having a thrombus, the balloon is inflated to occlude it, and the thrombus is pulled into the sheath.