Abstract: In vivo visualization systems are described which facilitate tissue treatment by a user in utilizing real time visualized tissue images with generated three-dimensional models of the tissue region of interest, such as the left atrial chamber of a subject's heart. Directional indicators on the visualized tissue as well as the imaging systems may be utilized while other variations may utilize image rotation or manipulation of visualized tissue regions to facilitate catheter control. Moreover, visualized tissue regions may be combined with imaged tissue regions as well as navigational information to further facilitate tissue treatments.

Abstract: Catheter control systems which facilitate the tracking of an angle of deflection of a catheter distal end can be used for any number of procedures where catheter orientation relative to the body is desirable, e.g., in transseptal access procedures where an accurate angle of puncture of the septal wall is desirable. Such control systems may comprise a steerable handle which is oriented relative to the catheter steerable section to provide for consistent catheter articulation upon corresponding manipulation of the steering ring. Another variation may utilize an orientation indicator to track the deflectable distal end. For instance, an orientation marker as visualized through an imaging hood on the distal end may correspond to identical orientation markers on the control handle such that articulation of a steering mechanism in a direction relative to the orientation markers deflects the catheter distal end in a corresponding direction relative to the visualized orientation markers.

Abstract: In vivo visualization systems are described which facilitate tissue treatment by a user in utilizing real time visualized tissue images with generated three-dimensional models of the tissue region of interest, such as the left atrial chamber of a subject's heart. Directional indicators on the visualized tissue as well as the imaging systems may be utilized while other variations may utilize image rotation or manipulation of visualized tissue regions to facilitate catheter control. Moreover, visualized tissue regions may be combined with imaged tissue regions as well as navigational information to further facilitate tissue treatments.

Abstract: The present technology relates generally to devices and methods for intravascular evaluation of blood vessels. Many embodiments of the technology relate to the intravascular evaluation of blood vessels before, during and after creation of autologous valves. In one embodiment, for example, the present technology is directed to a method comprising intravascularly delivering a delivery catheter to a target location adjacent a vessel wall and engaging the vessel wall along a portion of the delivery catheter. The method can further include determining the location of a first circumferential periphery of a dissection pouch formed within the vessel wall, determining the location of a second circumferential periphery of the dissection pouch, and determining an angular width of the dissection pouch based on the location of the first circumferential periphery and the second circumferential periphery.

Abstract: A method of ablating a tissue region within a blood-filled environment comprises restraining a fluid within a visualization field in a portion of the blood-filled environment and visualizing the tissue region through the fluid within the visualization field. The method also includes transmitting ablating electrical energy from the fluid into the visualized tissue region.

Abstract: Visual electrode ablation systems are described herein which include a deployment catheter and an attached imaging hood deployable into an expanded configuration. In use, the imaging hood is placed against or adjacent to a region of tissue to be imaged in a body lumen that is normally filled with an opaque bodily fluid such as blood. A translucent or transparent fluid, such as saline, can be pumped into the imaging hood until the fluid displaces any blood, thereby leaving a clear region of tissue to be imaged via an imaging element in the deployment catheter. An electric current may be passed through the fluid such that it passes directly to the tissue region being imaged and the electrical energy is conducted through the fluid without the need for a separate ablation probe or instrument to ablate the tissue being viewed.

Abstract: NMES systems and methods for stimulating muscle tissue, and in some embodiments deep muscle tissue. The impedance near the surface of the skin is controllably increased to increase the percentage of energy delivered to a subject that stimulates muscle tissue.

Abstract: In vivo visualization systems are described which facilitate tissue treatment by a user in utilizing real time visualized tissue images with generated three-dimensional models of the tissue region of interest, such as the left atrial chamber of a subject's heart. Directional indicators on the visualized tissue as well as the imaging systems may be utilized while other variations may utilize image rotation or manipulation of visualized tissue regions to facilitate catheter control. Moreover, visualized tissue regions may be combined with imaged tissue regions as well as navigational information to further facilitate tissue treatments.

Abstract: An expandable member for characterizing a three-dimensional space within a mammalian body is described. The expandable member is delivered to a target region in a deflated state where it is expanded by inflation of the member. Sensory transducers that contact the member relay sensory information generated when the member is in an expanded state to a microprocessor located outside the body. Using the sensory information, a data-driven picture that characterizes the three-dimensional space within the body is created with a microprocessor. The apparatus is useful in preparation for minimally invasive surgical therapy.

Abstract: Electrode placement and connection systems are described which allow for the electrical connection and maintenance of one or more electrodes positioned on a substrate which is subjected to a variety of mechanical stresses. Such a system may include an imaging hood having an aperture through which transparent fluid is flowed and one or more electrodes positioned along or about the hood. As the hood is configured between a low-profile and opened configuration, these electrodes may remain electrically coupled despite the mechanical stresses subjected to the electrodes and the connections thereto.

Abstract: Visualization and ablation system variations are described which utilize various tissue ablation arrangements. Such assemblies are configured to facilitate the application of bipolar energy delivery, such as RF ablation, to an underlying target tissue for treatment in a controlled manner while directly visualizing the tissue during the bipolar ablation process.

Abstract: An apparatus for accessing the epidural space in a mammal has a cutting sheath with a distal end adapted to transition from a closed cutting configuration to an open configuration. A tissue engagement device is in a hollow portion of the sheath. The tissue engagement device has a blunt distal end and an engagement feature. A method of accessing an epidural space includes the step of forming an opening to a position at or near the ligamentum flavum using the cutting sheath. Another step of the method is positioning a tissue engagement device within the hollow portion of the cutting sheath. Another step of the method is transitioning the cutting sheath from the closed cutting configuration to the open configuration. Another step of the method is manipulating the tissue engagement device to controllably advance the tissue engagement device at least partially through the ligamentum flavum.

Abstract: An apparatus for accessing the epidural space in a mammal has a cutting sheath with a distal end adapted to transition from a closed cutting configuration to an open configuration. A tissue engagement device is in a hollow portion of the sheath. The tissue engagement device has a blunt distal end and an engagement feature. A method of accessing an epidural space includes the step of forming an opening to a position at or near the ligamentum flavum using the cutting sheath. Another step of the method is positioning a tissue engagement device within the hollow portion of the cutting sheath. Another step of the method is transitioning the cutting sheath from the closed cutting configuration to the open configuration. Another step of the method is manipulating the tissue engagement device to controllably advance the tissue engagement device at least partially through the ligamentum flavum.

Abstract: In vivo visualization systems are described which facilitate tissue treatment by a user in utilizing real time visualized tissue images with generated three-dimensional models of the tissue region of interest, such as the left atrial chamber of a subject's heart. Directional indicators on the visualized tissue as well as the imaging systems may be utilized while other variations may utilize image rotation or manipulation of visualized tissue regions to facilitate catheter control. Moreover, visualized tissue regions may be combined with imaged tissue regions as well as navigational information to further facilitate tissue treatments.

Abstract: A device for use in a process that involves accessing an epidural space includes an elongated member having a distal end and a proximal end, a sensor located at the distal end of the elongated member, a handle coupled to the proximal end of the elongated member, and an indicator coupled to the sensor, wherein the indicator is configured to provide a sensory indication for assisting a user to identify a desired entry path to access an epidural space, wherein the indicator is configured to provide the sensory indication based at least in part on a signal received from the sensor.

Abstract: Methods and devices for treatment of the ostium are described herein. Examples of such devices include inflatable balloons which have one or more raised pores along a distal portion which act as conduits for providing saline flow from the balloon to facilitate visualization of the contacted tissue as well as providing for a conduction path for energy delivery. The balloon may be configured in various shapes to facilitate contact of the balloon in and against the ostium.

Abstract: Imaging catheters having irrigation capabilities are described herein. Generally, the device may include a first inner membrane which is sealed and serves to position the device within or relative to a lumen. This balloon structure, when filled with fluid, expands and is engaged in direct contact with the tissue. A second (outer) membrane is not completely sealed and instead provides a pathway for delivery of fluid at the treatment site for effecting various treatments. Imaging systems, optionally articulatable, may be positioned within the balloon as well as electrodes positionable upon the balloon may be utilized to facilitate tissue treatments.

Abstract: Image processing systems are described which utilize various methods and processing algorithms for enhancing or facilitating visual detection and/or sensing modalities for images captured in vivo by an intravascular visualization and treatment catheter. Such assemblies are configured to deliver energy, such as RF ablation, to an underlying target tissue for treatment in a controlled manner while directly visualizing the tissue during the ablation process.

Abstract: Electrode placement and connection systems are described which allow for the electrical connection and maintenance of one or more electrodes positioned on a substrate which is subjected to a variety of mechanical stresses. Such a system may include an imaging hood having an aperture through which transparent fluid is flowed and one or more electrodes positioned along or about the hood. As the hood is configured between a low-profile and opened configuration, these electrodes may remain electrically coupled despite the mechanical stresses subjected to the electrodes and the connections thereto.

Abstract: Methods and apparatus for efficient purging from an imaging hood are described which facilitate the visualization of tissue regions through a clear fluid. Such a system may include an imaging hood having one or more layers covering the distal opening and defines one or more apertures which control the infusion and controlled retention of the clearing fluid into the hood. In this manner, the amount of clearing fluid may be limited and the clarity of the imaging of the underlying tissue through the fluid within the hood may be maintained for relatively longer periods of time by inhibiting, delaying, or preventing the infusion of surrounding blood into the viewing field. The aperture size may be controlled to decrease or increase through selective inflation of the membrane or other mechanisms.