Abstract: A medical device for incising a substance inside a biological lumen. The medical device includes a tubular drive shaft that is rotatable, an intermediate portion connected to the drive shaft, at least one strut interlocked with the drive shaft, a tubular linear motion shaft inside of the drive shaft, and a tubular interlock portion. The strut is rotatable with the drive shaft and is expandable radially outward in response to outward expansion of the intermediate portion. The linear motion shaft is movable relative to the drive shaft in the axial direction to cause the strut to expand radially outward. The tubular interlock portion interlocks the drive shaft and the linear motion shaft while maintaining liquid-tight properties. The tubular interlock portion is stretchable in the axial direction.

Abstract: Embodiments of the invention provide a laparoscopic morcellating device and method for removing tissue from a body cavity. The morcellating device includes a containment mechanism having an aperture, a cutting mechanism designed to fit into an interior space of the containment mechanism and a retractor mechanism that is coupled to the cutting mechanism. The containment mechanism and cutting mechanism combination surrounds the tissue and the aperture of the containment mechanism is closed around the tissue. The morcellating device further includes a motor for actuating the retractor such that the cutting mechanism constricts and morcellates the tissue. The laparoscopic morcellating device further allows for torque balancing of the retractor mechanism, gas flow regulation of the body cavity, and safety feedback mechanisms that can alert the surgeon.

Abstract: An excisional device may comprise a sheath; a tubular element configured for rotation with the sheath; and an inner element configured for rotation and disposed at least partially within the tubular element. The inner element may comprise an articulable distal assembly configured to core through tissue in an open configuration and part-off cored tissue in a closed configuration. Differential rotation of the inner element with respect to the tubular element causes the articulable distal assembly to selectively assume the open and closed configurations. For example, lagging the rotation of the inner element relative to the rotation of the tubular element may control the articulable distal assembly to assume the open configuration whereas leading the rotation of the inner element relative to the rotation of the tubular element may control the articulable distal assembly to assume the closed configuration.

Abstract: An invasive instrument for treating a vessel, which possibly includes secondary vessels, has a tip formed for the dissection of tissue at the distal end of a shaft to be introduced into the body, with at least one functional unit. The tip includes vessel receptacle means, arranged and formed such that, in the operating condition of the instrument, the functional unit of the shaft is kept clear, so that working on the vessel, a secondary vessel and/or on the surrounding tissue is possible using or by means of the functional unit and with the vessel receiving means the vessel can be fixed in a spatial position. The tip is movable relative to the shaft by means of a guide element and the tip is shiftable in axial direction, so that during the procedure a vessel arranged in the vessel receiving means can be spaced selectively from the functional unit.

Abstract: A catheter is provided, which includes a cutting element having one or more raised elements. The cutting element has a cup-shaped surface at the distal end that may be smooth and continuous except for the raised elements.

Abstract: A tissue-removing catheter includes an elongate catheter body. The catheter body has a jogged portion that applies an urge force against a body lumen wall and urges a portion of the catheter body toward a portion of the body lumen wall. A tissue-removing element removes tissue from the body lumen during the cutting operation. The tissue-removing element is located generally adjacent the portion of the catheter body that is urged toward the body lumen wall by the jogged portion. An urging mechanism selectively applies a compressive load to the catheter body to adjust the bending stiffness of the jogged portion and the urge force applied by the jogged portion.

Abstract: A system for monitoring ablation size is provided and includes a power source including a microprocessor for executing at least one control algorithm. A microwave antenna is configured to deliver microwave energy from the power source to tissue to form an ablation zone. A radiation detection device is operably disposed on the microwave antenna. The radiation detection device is configured to generate a voltage corresponding to a radius of the ablation zone, wherein the radiation detection device is in operative communication with at least one module associated with the power source. The at least one module triggers a signal when a predetermined threshold voltage is measured corresponding to the radius of the ablation zone.

Abstract: A fluid pump includes a rotor with at least one rotatable impeller blade, the rotor having a compressed state and an expanded state, and a support device coupled to an outer radial edge of the at least one impeller blade. The support device is changeable between a first state in which the support device is radially compressed associated with the compressed state of the rotor, and a second state in which the support device is radially expanded associated with the expanded state of the rotor. In the expanded state of the rotor, the at least one impeller blade extends at least partly radially inward from the support device. The support device is a ring that at least partly surrounds the at least one impeller blade, the ring having a longitudinal axis parallel to an axis of rotation of the rotor.

Abstract: A method of increasing blood flow through an obstructed blood vessel includes providing an expandable member substantially made of a mesh having a plurality of interstices. The expandable member is inserted into the blood vessel, positioned within the blood vessel with the proximal member end upstream of the distal member end and the member body located radially adjacent at least a portion of an obstruction, and expanded to bring at least a portion of the member body into contact with the obstruction. An outward radial force is exerted on the obstruction to dislodge at least one fragment from the obstruction and to enhance blood flow through the blood vessel past the obstruction. The at least one fragment is passed through at least one interstice of the member body in the radial direction, and is selectively retained within the expandable member.

Abstract: In one illustrative embodiment, a thrombectomy device is disclosed. The thrombectomy device includes a treatment portion, comprising a reversibly-expandable framework configured to be deployed from within a microcatheter into a selected vasculature for removing thrombus or embolus. The thrombectomy device further includes a substantially tubular connection member disposed on a proximal end portion of the treatment portion configured to receive a terminal portion of a delivery member for positioning the treatment portion within the vasculature. The framework comprises structural features for engaging the thrombus or embolus including one or more of: framework peaks and valleys along a long axis of the treatment portion or a plurality of strut members.

Abstract: The devices and methods described herein relate to improved structures for removing obstructions from body lumens. Such devices have applicability in through-out the body, including clearing of blockages within the vasculature, by recanalizing or removing the obstruction within the body lumen.

Abstract: A veno-merse/harvester device having a handle portion, a hollow shaft portion, and a cutting portion. A fixed cannula system incorporated in the device improves the hydrostatic pressure, which allows efficient hydro-dissection with less retrograde leak of tumescent fluid and facilitates the separation of the vein from surrounding tissues with less bleeding. The veno-merse/harvester device may incorporate a camera system to allow direct visualization of the side branches to be ligated during a procedure. The self-adjustable cutting tip facilitates the forward advancement of the veno-merse/harvester device safely over a dilated portion of a vein.

Abstract: A method and dissecting device are disclosed for treating a stenotic vessel. The method including inserting a directional guide member of a dissecting device into a subintimal space of a blood vessel, the dissecting device including the directional guide member and a cutting member located proximally to a distal end of the directional guide member; and cutting a stenotic region within the blood vessel with the cutting member while advancing the distal end of the directional guide member through the subintimal space.

Abstract: The present invention provides a cerumen removal apparatus for mechanically removing cerumen from an ear canal, comprising: a device body having a distal end and a proximal end interconnected by a main longitudinal axis; said distal end comprising at least one collector head for amassing said cerumen; said proximal end comprising at least one rotating mechanism adapted to rotate said at least one collector head; wherein said rotation of said collector head amasses said cerumen and removes said cerumen from said ear canal.

Abstract: Catheter assemblies include a stabilization mechanism disposed at a distal end of the catheter assembly for stabilizing the catheter assembly within a subintimal space. The stabilization mechanism includes a self-expanding support structure that is slidably positionable within an inflatable balloon. The catheter assemblies include an outer shaft which has the balloon at a distal end thereof and an inner shaft which has the support structure mounted on a distal end thereof. The inner shaft is slidably disposed within a lumen of the outer shaft and has a first configuration in which the support structure is held in a compressed state within the outer shaft and a second configuration in which the support structure is permitted to return to an expanded state within the inflatable balloon. In the expanded state, the stabilization mechanism has a flattened laterally-extending profile.

Abstract: A catheter includes an elongate catheter body configured for insertion into a body lumen of a subject. A cutter is located generally at a distal end of the catheter body for rotation generally about a longitudinal axis of the cutter. An eccentric opening in a distal end portion of the cutter defines an angled cutting edge for cutting material from a wall of the body lumen. A center of the opening is offset from the longitudinal axis of the cutter. A cavity extends from the opening through the cutter from the distal end portion to a proximal end portion to allow material cut by the cutter to pass through the cutter into an interior passage of the catheter body for removal from the body lumen.

Abstract: A sheath comprises an elastomeric tube having a self-expanding scaffold coupled to a wall. The scaffold can expand to a diameter larger than the tube diameter to provide an enlarged distal opening. An aspiration catheter has a balloon and an aspiration port so that occlusive material can be removed from a blood vessel by drawing the balloon through the vessel while simultaneously aspirating through the port.

Abstract: A cutting device for performing a surgical procedure includes a cannula extending between a proximal end and a distal end, a first cutting element, and a second cutting element. The cannula of the cutting device includes an inner surface defining a passageway. The first cutting element extends from the distal end of the elongated shaft so as to contact tissue. The second cutting element also extends from the distal end of the elongated shaft. The second cutting element is configured for retractable extension beyond the distal end of the elongated shaft so as to contact tissue. The cutting device also includes a deployment mechanism disposed with the proximal end of the elongated shaft for actuating movement of the second cutting element.

Abstract: A resector balloon includes an outer wall having a resecting surface that resects biological material. The balloon also includes a woven sleeve including at least one woven thread disposed on at least a portion of the outer wall. The woven sleeve forms at least a portion of the resecting surface. In certain embodiments, the woven sleeve includes weft knit threads including crossover points where the threads overlap. In some embodiments, the woven sleeve includes electrically conductive threads.

Abstract: A retractor instrument for minimally invasive surgery may include a housing with a longitudinal axis, an arm extending from a distal end of the housing, and an actuation mechanism, wherein actuation of the actuation mechanism causes radial expansion of the arm relative to the longitudinal axis. The device may be adapted for use with an endoscope or arthroscope or may be an integral part of one such scope. A method of performing surgery in constrained areas within the body is also included and may be applicable to the carpal tunnel of a wrist and palm or the cubital tunnel of an elbow.

Abstract: Angioplasty and other dilatation devices are provided with scoring elements which incorporate a drug to be delivered to a body lumen, typically a blood vessel. The scoring elements have drugs and other active substances coated over a portion thereof or incorporated within internal structure of the element so that the drug is released into the luminal wall closely associated diseased regions of the body lumen as the scoring structure is radially expanded into the wall.

Abstract: A clot removal device has an expandable treatment member having a distal tip and a proximal end, a delivery wire having a distal end coupled to the proximal end of the expandable treatment member, and a flow restrictor carried along the delivery wire at a location that is separate and proximal from the expandable treatment member. The flow restrictor has a body with a distal section and a proximal section, the distal section being covered and the proximal section being uncovered. The expandable treatment member is moveable relative to the flow restrictor, and can be retracted into the distal section.

Abstract: A rotational atherectomy system is disclosed, comprising: an elongated, flexible spin-to-open drive shaft having a distal end for insertion into a vasculature of a patient and having a proximal end opposite the distal end remaining outside the vasculature of the patient; a concentric or eccentric abrasive element, preferably a solid crown, attached to the drive shaft proximate the distal end of the drive shaft; an electric motor rotatably coupled to the proximal end of the drive shaft, the electric motor being capable of rotating the drive shaft in a spin-to-open direction; and control electronics for monitoring and controlling the rotation of the electric motor. When an obstruction at the distal end is detected by the applied torque and/or current reaching a predetermined maximum allowed level and with the drive shaft opened to a maximum allowed outer diameter, power to the motor is eliminated.

Abstract: The invention provides a rotational atherectomy device having a flexible, elongated, rotatable drive shaft with a system of eccentric abrading heads attached thereto. The eccentric enlarged abrading heads may have centers of mass spaced radially from the rotational axis of the drive shaft, wherein adjacent eccentric abrading heads, and centers of mass thereof, are rotationally separated from each other on the drive shaft.

Abstract: Orthopedic device holder systems including a quick connect between an orthopedic device holder and an orthopedic tool are disclosed. The orthopedic device holder can include a shaft having a shaft connection end including at least three shaft engaging surfaces. The orthopedic tool can have a tool connection end including at least three tool engaging surfaces configured to couple with the three shaft engaging surfaces of the orthopedic device holder.

Abstract: A method of removing material from a blood flow lumen generally includes providing a device having a cutting element and an opening, advancing the device through the blood flow lumen to a site where material is to be removed, forcing the opening toward a wall of the site where material is to be removed, and moving the cutting element and the opening so that material in the blood flow lumen is cut by the cutting element and directed into the opening for removal as the cutting element and opening are moved through the blood flow lumen. In some embodiments, the device may be deflected or bent to force the opening toward a wall to remove material. The cutting element may be rotatable and may have an axis that is movable, that is not parallel to the longitudinal axis of the device, or both.

Abstract: An embodiment of the invention includes an expandable implant to endovascularly embolize an anatomical void or malformation, such as an aneurysm. An embodiment is comprised of a chain or linked sequence of expandable polymer foam elements. Another embodiment includes an elongated length of expandable polymer foam coupled to a backbone. Another embodiment includes a system for endovascular delivery of an expandable implant (e.g., shape memory polymer) to embolize an aneurysm. The system may include a microcatheter, a lumen-reducing collar coupled to the distal tip of the microcatheter, a flexible pushing element detachably coupled to an expandable implant, and a flexible tubular sheath inside of which the compressed implant and pushing element are pre-loaded. Other embodiments are described herein.

Abstract: A probe including a catheter sheath, a shaft inserted inside the catheter sheath, and an attachment portion detachably attached to a rotational drive unit, wherein the attachment portion includes an isolation member isolating the inside of the attachment portion into a first area in which a member for transmitting the drive force generated by the rotational drive unit to the shaft is rotatably held and a second area in which the catheter sheath is fixedly held; the isolation member includes: an insertion hole through which the shaft is inserted between the first area and the second area and an ejection hole provided in a surface to which an end portion on the rotational drive unit side of the catheter sheath is connected and which is approximately perpendicular to the rotation axis of the shaft; and the ejection hole defines a flow path extending to the outside of the isolation member.

Abstract: A membrane removing forceps may include a first forceps jaw having a first forceps jaw distal end and a first forceps jaw proximal end and a second forceps jaw having a second forceps jaw distal end and a second forceps jaw proximal end. The membrane removing forceps may include one or more abrasive surfaces configured to raise a portion of a membrane. A surgeon may raise a portion of a membrane by grazing the portion of the membrane with one or more abrasive surfaces of a membrane removing forceps. The surgeon may grasp the raised portion of the membrane with the first forceps jaw distal end and the second forceps jaw distal end. The surgeon may then remove the membrane by peeling the membrane apart from an underlying tissue.

Abstract: A membrane removing forceps may include a first forceps jaw having a first forceps jaw distal end and a first forceps jaw proximal end and a second forceps jaw having a second forceps jaw distal end and a second forceps jaw proximal end. The membrane removing forceps may include one or more abrasive surfaces configured to raise a portion of a membrane. A surgeon may raise a portion of a membrane by grazing the portion of the membrane with one or more abrasive surfaces of a membrane removing forceps. The surgeon may grasp the raised portion of the membrane with the first forceps jaw distal end and the second forceps jaw distal end. The surgeon may then remove the membrane by peeling the membrane apart from an underlying tissue.

Abstract: A delivery device usable to deliver an inverting implant is provided that includes a positioning mechanism that automatically initiates the inversion process once a predetermined length of the implant has exited a delivery catheter. The positioning mechanism allows the implant to be safely and accurately deployed with reduced operator experience and in a greater variety of target locations.

Abstract: The disclosure describes techniques and systems for delivering an implantable medical device. In one example, an implantable medical device (IMD) delivery system may include an elongated member comprising a first distal end configured to mate with the IMD, a resilient member disposed along at least a portion of the elongated member, a housing configured to accept a first proximal end of the elongated member and a second proximal end of the resilient member, a rotation control mechanism wherein user movement of the rotation control mechanism causes rotation of the elongated member with respect to the housing and a fixation element of the IMD into tissue, and a deflection control mechanism wherein user movement of the deflection control mechanism causes longitudinal displacement of the resilient member along a longitudinal axis of the elongated member and the housing resulting in angular deflection of the first distal end of the elongated member.

Abstract: An angioplasty catheter comprises a catheter body having a balloon or other radially expandable shell at its distal end. A non-axial external structure is carried over the shell and scores a stenosed region in a blood vessel when the balloon is inflated therein. The catheter has an attachment structure disposed between the catheter body and the balloon to accommodate foreshortening and rotation of the external structure as the balloon is expanded. The external structure may be part of a helical cage structure which floats over the balloon.

Abstract: An intravascular emboli capture and retrieval system for intravascular embolism protection and embolism removal or maceration. Guidewire mounted proximally and distally located multiple opening filters are deployed within the vasculature and used to part, divide and macerate embolic debris and to capture such embolic debris within the confines thereof. A deployable flexible preformed memory shaped capture sleeve is alternatively used to collapse one or more filters and embolic debris therein for subsequent proximal withdrawal from the vasculature.

Abstract: A tissue-removing catheter for removing tissue from a body lumen includes an elongate catheter body configured for insertion into the body lumen and a tissue-removing element. A side opening in the distal portion of the catheter body is defined by opposite first and second side edges, a proximal edge extending between the first and second side edges, and a distal edge opposite the proximal edge and extending between the first and second side edges. The side opening window has a longitudinal axis extending between the distal and proximal edges. The tissue-removing element is configured to move between a tissue-removing position, in which the tissue-removing element is exposed through the side opening window, and a neutral position, in which the tissue-removing element is positioned inside the distal portion of the catheter. The distal edge is asymmetric about the longitudinal axis of the side opening window.

Abstract: A balloon catheter is provided for dilating hardened stenoses. The balloon catheter has dilation elements integrally formed on the outer surface of the balloon. The dilation elements have cross-sectional shapes that improve the performance of the balloon catheter.

Abstract: In some embodiments, a medical device for recanalizing a vessel having a blockage and restoring blood flow through an obstructed blood vessel includes an expandable member coupled to a core wire and a hypotube that are movable relative to each other to manipulate the expandable member between various configurations. The expandable member having a capture structure in an expanded configuration. The expandable member can include multiple interstices formed by woven mesh filaments or braided strands through which the material blocking the vessel can pass. The capture structure can include a shape on its external surface that facilitates dislodgement and capture of the material within capture spaces created by the expandable member. Some embodiments include a capture sack or cap for capturing material and preventing material from migrating down stream of the blockage. Superoxygenated blood can be infused distal to the blockage to minimize loss of function during an ischemic event.

Abstract: The devices and methods described herein relate to improved structures for removing obstructions from body lumens. Such devices have applicability in through-out the body, including clearing of blockages within the vasculature, by addressing the frictional resistance on the obstruction prior to attempting to translate and/or mobilize the obstruction within the body lumen.

Abstract: A rotating cutting head catheter for passage through chronic total occlusions or other refractory atherosclerotic plaque from diseased arteries is disclosed. The catheter's rotating cutting head is designed to reside safely within an outer protective sheath when not in use. The outer protective sheath contains one or more helical grooves or slots, and the cutting head contains protruding blades or projections that fit into these helical grooves or slots. Application of torque to an inner catheter or wire attached to the cutting head applies spin to the cutting head, and the force of the sheath's helical grooves or slots against the cutting head's protruding blades or projections advances the cutting head outward from the protective sheath. Once extended, the cutting head may now rotate freely. The device may use a guidewire to direct the cutting head to the desired position.

Abstract: An atherectomy catheter directs particles generated by a cutting element into a collection chamber. A paddle attached to the cutting element propels fluid distally in the tissue collection chamber.

Abstract: An ablation catheter system is disclosed that comprises a channel and a tubular braided element having an outer circumferential surface and a lumen. The tubular braided element is sized and shaped to be placed in the channel when in a compressed configuration and to be expanded in a target area of a blood vessel in a manner that the outer circumferential surface touches the walls of the target blood vessel in the target area when in an expanded configuration. The system also includes a longitudinal maneuvering element which is mechanically connected to a distal end of the tubular braided element and set to pull the distal end into the lumen so as to curve radially and outwardly a plurality of annular segments of the expand tubular braided element in a sequential manner.

Abstract: A catheter pump assembly is provided that includes an elongate body assembly, a shaft, and an impeller. The assembly has a proximal end, a distal end and at least one lumen extending therebetween. The shaft is disposed at least partially within the elongate body, e.g., in the at least one lumen, and journaled for rotation. The impeller is coupled with a distal portion of the shaft. The impeller is configured to be rotated to induce flow of blood when the impeller is placed in fluid communication with a source of blood. An inflatable balloon brace is disposed on an outer surface of the catheter pump. The inflatable balloon brace is spaced proximally of the impeller and has a low profile configuration for delivery through the vasculature and an expanded configuration for disposing (e.g., position and/or orienting) the impeller within the source of blood.

Abstract: A rotary catheter comprising a motor-driven flexible shaft rotatably disposed in a flexible tube having a fluid channel between them, a distal portion of the flexible shaft extending out of the tube and being free to move radially relative to the tube enabling the fluid channel to ingest large particles eased by motions between the rotating flexible shaft and the flexible tube, and pump means containing a thrombolytic drug connected to the fluid channel for infusing the drug through the fluid channel to the obstruction. An asymmetrical tip that is affixed to a distal end of the shaft has a substantially narrower cross section than its effective diameter so that fluid can flow alongside the tip and reach the area that the tip impacts the obstruction with the side of the tip and the tube aspirates fluid and the resulting particles into the channel.

Abstract: A system and method for treating a blood vessel that is at least partially obstructed by an occlusion which divides the lumen into a proximal lumen segment and a distal lumen segment. The system includes an orienting catheter having an orientation element positionable in an intrawall space of the vessel and an occlusion catheter having an occlusion balloon inflatable in the proximal lumen segment so as to isolate a target volume including the intrawall space. The pressure inside the target volume is reduced to a pressure below the pressure of the distal lumen segment so that the intima presses against the orienting element of the orienting catheter. A distal end of a reentry device may be advanced from the orienting catheter through the intima and into the distal lumen segment.

Abstract: A venous valve incising cutter includes a cutting teeth head, a guide, a wire and a coupling rod that couples the guide and a cutting teeth head, all aligned in a rotation axis thereof. More than four pieces of cutting blades are formed on the outer surrounding surface of the cutting teeth head. Each cutting blade has a roughly triangular pyramid shape such that the three ridge lines are composed of the outer surrounding surface of the cutting teeth head and the two planes formed in the reverse side of the outer surrounding surface and the apex is a knife-point of the cutting blade.

Abstract: A minimally invasive laparoscopic tissue removal device, namely a morcellator. The device includes, from proximal end to distal end, a handle, handle guard, elongate sheath, and mouth, finally terminating in a safety tip. The elongate sheath and mouth are concentric, such that two elongate, rotating cutting/shredding blades/teeth and one elongate auger feed screw can be positioned along the length of the sheath and mouth. The teeth are opposingly disposed and staggered, such that contact with tissue mass grabs and pulls tissue inwards toward the auger, which transports the tissue proximally toward the outside of the patient's body. A motor unit and gear assembly can be coupled to the teeth and auger to drive rotation of the teeth and auger. A cup assembly can be disposed in overlying relation to the mouth for guiding the tissue mass towards the mouth. Various mechanisms of safely covering the mouth are contemplated as well.

Abstract: A matter elimination catheter includes a catheter body extending from a catheter proximal portion to a catheter distal portion. The catheter body includes an infusion lumen, an aspiration lumen fluidly isolated from the infusion lumen, and a septum interposed between the infusion and aspiration lumens. A drive shaft is within the infusion lumen and is configured to provide rotation near the catheter distal portion. A guide wire lumen is within the drive shaft, and the infusion lumen, the drive shaft and the guide wire lumen are fluidly separated from the aspiration lumen with the septum. In one example, fluid bearings are formed between one or more of the catheter body and drive shaft or the drive shaft and a guide wire or guide wire liner when supplied with infusion fluid through the infusion lumen.

Abstract: The invention being disclosed describes a medical device for removal of a thrombus or clot in a vascular setting by using a rotational, expandable basket structure in combination with drug infusion, blood/particle aspiration and clot isolation by distal and proximal occlusion.

Abstract: A device and system for providing a centered lumen within a catheter body. A coiled guide lumen (CGL) is composed of a length of wire forming a plurality of coils about the longitudinal axis of the CGL, the CGL including one or more first sections having a first diameter and one or more sections having a second diameter, the second diameter being greater than the first diameter, and a secondary guide lumen extending through the first sections. The CGL may include at least one pull wire extending through the secondary guide lumen and attached at the distal portion of the catheter body. A band may be coupled to an interior of the catheter body distal portion, each of the pull wires being coupled to the annular band. Alternatively, the system may further include a shim coupled to the band, each of the pulls wire being coupled to the shim.

Abstract: A device and method for treating a patient with total or near total occlusion is provided. The device can be positioned in a blood vessel at a treatment site. An occlusion at the treatment site is enlarged by a catheter. The catheter can be advanced over a guidewire into the occlusion. One or more of [a] compression or torsion applied to the guidewire or [b] compression or torsion applied to the catheter body expands or creates a path through the occlusion. The expansions or creation of the access path can be by cutting or abrading the occlusion or by a shoe-horn effect.