Abstract: Improved methods and apparatuses related to laser-assisted transmyocardial revascularization, and more particularly, to improved methods and apparatuses for precisely positioning a fiber-optic or other waveguide adjacent the area or areas to be lased, including at positions adjacent the posterior epicardial and endocardial surfaces of the heart and at trans-septal positions within the chambers of the heart, thereby making possible the creation of channels in myocardial tissue at precisely the positions in the heart where ischemia or infarction or other have rendered such treatment desirable or necessary. These methods and apparatuses can be adapted for use in surgical applications throughout the human body or in animals for transmitting laser energy precisely, at predetermined positions and to predetermined depths.

Abstract: A balloon end contact scope device for performing laser-assisted transmyocardial revascularization (TMR) or other surgical and catheter procedures, the device particularly adapted for delivery of laser energy via a laser delivery means and configured to reach inside a body cavity or organ chamber at a point not directly accessible, either visually or otherwise, such as in a lateral or posterior position, the device having a hollow outer lumen, a balloon scope portion with an internal guide tube extending through the balloon portion for directing a laser delivery means or other surgical or catheter device through the visualization balloon toward the area being visualized. The balloon scope portion may have a plurality of guide holes extending therethrough. On the essentially transparent contact viewing surface a friction surface may be applied to facilitate precise positioning and treatment therethrough.

Abstract: A catheter system is provided for accessing the coronary ostia transluminally from a peripheral arterial access site, such as the femoral artery, and for inducing cardioplegic arrest by direct infusion of cardioplegic solution into the coronary arteries. In a first embodiment, the catheter system is in the form of a single perfusion catheter with multiple distal branches for engaging the coronary ostia. In a second embodiment, multiple perfusion catheters are delivered to the coronary ostia through a single arterial cannula. In a third embodiment, multiple perfusion catheters are delivered to the coronary ostia through a single guiding catheter. In a fourth embodiment, multiple catheters are delivered to the coronary ostia through a single guiding catheter which has distal exit ports that are arranged to direct the perfusion catheters into the coronary ostia.

Abstract: A deployable clamp for clamping a patient's ascending aorta between the coronary arteries and the brachiocephalic artery. The clamp is detachably mounted to the distal end of an elongated clamp positioner and is manipulated and actuated from the proximal end of the clamp positioner at a location outside of the patient's thoracic cavity. When actuated, the clamp blocks blood flow through the ascending aorta.

Abstract: An atherectomy catheter includes a catheter body having a cylindrical housing at its distal end. The cylindrical housing includes an elongate cutting aperture on one side thereof and a mechanism for severing atheroma which enters within the opening. In a first embodiment, the cutting mechanism comprises a circular cutting blade which is advanced over an elongate guide member which defines a path for the blade. Use of the guide means helps assure that the cutting blade will not be lost from the housing during use. In a second embodiment, a rotatable helical cutting blade is mounted within the housing. In that particular embodiment, the helical cutting blade can serve as the guide member for the circular cutting blade.

Abstract: An atherectomy catheter includes a catheter body having a cylindrical housing at its distal end. The cylindrical housing includes an elongate cutting aperture on one side thereof and a mechanism for severing atheroma which enters within the opening. In a first embodiment, the cutting mechanism comprises a circular cutting blade which is advanced over an elongate guide member which defines a path for the blade. Use of the guide means helps assure that the cutting blade will not be lost from the housing during use. In a second embodiment, a rotatable helical cutting blade is mounted within the housing. In that particular embodiment, the helical cutting blade can serve as the guide member for the circular cutting blade.

Abstract: An atherectomy catheter includes a catheter body having a cylindrical housing at its distal end. The cylindrical housing includes an elongate cutting aperture on one side thereof and a mechanism for severing atheroma which enters within the opening. In a first embodiment, the cutting mechanism comprises a circular cutting blade which is advanced over an elongate guide member which defines a path for the blade. Use of the guide means helps assure that the cutting blade will not be lost from the housing during use. In a second embodiment, a rotatable helical cutting blade is mounted within the housing. In that particular embodiment, the helical cutting blade can serve as the guide member for the circular cutting blade.

Abstract: An improved trocar is provided which includes converters for adapting to different size surgical instruments while maintaining sealing. The invention also includes an improved trocar tube body seal design which accepts and accommodates surgical tool angulation while still maintaining sealing. Still further, the invention provides a trocar obturator with a snap-fit joint which permits the forward portion of the obturator to be detached from the trocar body and separately used with the trocar tube subassembly. With this option, a latch mechanism is configured opposite to a converter to retain the obturator fixed with the trocar tube subassembly.

Abstract: An atherectomy catheter includes a catheter body having a cylindrical housing at its distal end. The cylindrical housing includes an elongate cutting aperture on one side thereof and a mechanism for severing atheroma which enters within the opening. In a first embodiment, the cutting mechanism comprises a circular cutting blade which is advanced over an elongate guide member which defines a path for the blade. Use of the guide means helps assure that the cutting blade will not be lost from the housing during use. In a second embodiment, a rotatable helical cutting blade is mounted within the housing. In that particular embodiment, the helical cutting blade can serve as the guide member for the circular cutting blade.

Abstract: An atherectomy device for reducing stenosis material from a vascular vessel is provided. The atherectomy device includes an elongated flexible tubular member having at least one lumen extending therethrough and having proximal and distal extremities. A flexible drive means disposed within the tubular members is free to move both rotationally and axially therein. A cutting assembly is carried by the distal extremity of the flexible tubular member with a cutter being carried by the distal extremity of the flexible drive means for removing a portion of the stenosis from the vessel wall. An inflatable dilation balloon is carried by the tubular member proximally of the cutter for further reducing the stenosis after initial reduction by the cutter. A perfusion channel maintains blood flow past the dilation balloon. Methods of the present invention include cutting and dilating a stenosis, cutting then immediately dilating a stenosis, and dilating then immediately cutting a stenosis.

Abstract: A vascular catheter includes a flexible catheter body having proximal and distal ends and an elongate housing secured to the distal end of the catheter body. An interactional device is disposed on one side of the housing, and at least two spaced-apart inflatable chambers are located on the other side of the housing generally at its proximal and distal ends, respectively. The inflatable chambers may be expanded simutaneously or separately, and the spaced-apart positioning of the chambers provides for stable positioning of the housing during atherectomy procedures imaging procedures, and the like.

Abstract: A catheter system comprises a flexible catheter tube or body having a housing secured to its distal end. A plurality of structurally distinct terminal components are provided to attach to the forward end of the housing, while a plurality of interchangeable interventional elements are provided to attach to a drive member within the catheter. By properly selecting the terminal components and the interventional elements, a wide variety of specific therapeutic and diagnostic capabilities may be provided.

Abstract: An atherectomy device includes a transparent lumen for providing inflation medium to an inflatable balloon. A dual lumen flexible tube includes an opaque flexible torque member in a first lumen, while the second lumen serves as an inflation lumen. The distal end of the inflation lumen is expanded to define the balloon, and no seals are needed between the balloon and the inflation lumen.

Abstract: A vascular catheter includes a blade tip at its distal end. In the specific embodiments, a blade is mounted within the blade tip and a mechanism provided for extending the blade transversely when the blade tip is located within a region of stenosis. By extending the blade and axially translating the catheter so that the blade forms an incision within the region of stenosis, improved angioplastic treatment can be achieved.

Abstract: An atherectomy device for removing stenosis materials from a vascular vessel is provided. The atherectomy device includes a flexible tubular member, a flexible drive means disposed within the tubular member, and a cutting assembly carried by the distal extremity of the tubular member. The cutting assembly includes a collection chamber which receives a cutting bit carried by the drive means. The cutting bit is rotated to remove materials from the stenosis and cause the removed materials to be withdrawn into the collection chamber as the bit is advanced. A second embodiment of the atherectomy device includes an anchor member coaxially mounted within a tubular cutting blade at the distal end of the catheter. The anchor member is first advanced into a region of stenosis where it becomes embedded, and the tubular blade is subsequently advanced over the anchor member to sever the stenosis.

Abstract: An improved vascular dilation catheter comprises an involuted tubular structure including outer and inner tubular walls which extend the entire length of the catheter. The outer tubular wall is enlarged at a distal end of the catheter to form a dilation balloon, and extends back the remaining length of the flexible tube at a reduced diameter to define an annular lumen which is used to inflate the balloon. Alternatively, the outer tubular wall may conform to the exterior of the inner tubular wall and separate axial lumens may be provided for inflation. By providing means for heating inflation medium within the balloon, the catheter may be utilized for performing thermal ablation therapy.

Abstract: The invention is directed to a very low-profile dilatation catheter having an inner tubular member with an inner lumen with a diameter of not more than 0.003 inch (0.076 mm) greater than the diameter of a guidewire disposed therein. Preferably, the inner diameter of the tubular member is less than 0.015 inch (0.381 mm). The inner member may be formed of a thin-walled tubing such as polyimide tubing having a wall thickness less than 0.003 inch (0.076 mm). Polyimide tubing is also preferably employed as the tubular member in low-profile steerable dilatation catheters wherein the guide elements thereof are fixed within the catheter.

Abstract: Dilatation cathether, tip marker and method of manufacture wherein the tip marker comprises a split sleeve of radiopaque material having an arc length between 180.degree. and 360.degree.. In one disclosed embodiment, the tip marker is crimped in position about an inner tubular member, and an outer tubular member is bonded to the inner tubular member, with the tip marker being captured between the two members. In this particular embodiment, the outer tubular member comprises an inflatable balloon, and a vent opening extends from the balloon to the distal end of the catheter through the gap formed between the confronting edges of the marker sleeve.