Abstract: The present embodiments provide systems and methods for deploying at least a portion of a stent. In one embodiment, the system comprises a cannula having an outer surface, and at least one coiled member having proximal and distal ends and a plurality of turns disposed therebetween. One of the proximal and distal ends of the coiled member is secured to the outer surface of the cannula, and the other of the proximal and distal ends of the coiled member is unsecured relative to the outer surface of the cannula. A portion of a stent is looped around the unsecured end of the coiled member and disposed within spacing between adjacent turns of the coiled member. Rotation of the cannula subsequently causes the portion of the stent to disengage from the coiled member.

Abstract: An delivery device including an inner tube having an inner tube proximal end region and an inner tube distal end region, the inner tube distal end region comprising a first retaining mechanism; a middle tube having a middle tube distal end region and a middle tube proximal end region and defining a middle tube lumen, the inner tube disposed within the middle tube lumen; and an outer tube having an outer tube proximal end region and an outer tube distal end region and defining an outer tube lumen, the middle tube disposed within the outer tube lumen, the outer tube distal end region comprising a second retaining mechanism; wherein the inner tube is structured and arranged to displace proximally and distally relative to the middle tube, and wherein the outer tube is structured and arranged to displace proximally and distally relative to the middle tube. A method of deploying an endoprosthesis is also disclosed.

Abstract: Stent delivery systems and methods for making and using the same are disclosed. An example stent delivery system may include an inner member having a proximal end. A sleeve may be coupled to the inner member adjacent to the proximal end. A deployment sheath may be disposed about the inner member. A gear rack assembly may be coupled to the deployment sheath. A stent may be disposed between the inner member and the deployment sheath. A handle may be coupled to the inner member and to the deployment sheath. The handle may include an actuation member. The actuation member may be coupled to the gear rack assembly so that actuation of the actuation to member shifts the longitudinal position of the gear rack assembly and the deployment sheath. An engagement mechanism may be coupled to the gear rack assembly. The engagement mechanism may be configured to engage the sleeve of the inner member so that proximal retraction of the gear rack assembly results in proximal retraction of the inner shaft.

Abstract: The present disclosure provides a stent graft comprising (a) a self-expandable stent structure having a first end and a second end, wherein the self-expandable stent structure defines a lumen, (b) at least one restraint configured to be coupled to an exterior surface of the stent graft in a compressed condition, and wherein the at least one restraint is configured to be broken to permit the stent graft to transition to an expanded condition, and (c) a first plurality of anchoring projections coupled to the exterior surface of the stent graft adjacent to the first end of the self-expandable stent-structure.

Abstract: A prosthesis delivery device and method of using the same is described. The delivery device comprises a rotatable inner cannula extending from a proximal end to a distal end with a prosthesis releasably coupled to the proximal end. A delivery handle assembly is disposed at the distal end of the delivery device. The handle comprises a first handle disposed about the inner cannula, a rotary dial rotatably disposed about a distal end of the first handle and a second handle disposed about at least a portion of the distal end of the first handle. The second handle is longitudinally moveable relative to the first handle between a first position wherein the sheath is coaxially disposed about the prosthesis and rotation of the rotary dial is prevented, and a second position wherein the sheath is retracted distally to expose at least a portion of the prosthesis and rotation of the dial is permitted.

Abstract: A reinforcing ring (10) for a fenestration (32) of a stent graft which can be surface treated such as by passivation and/or electropolishing. The reinforcing ring has several turns of a substantially inextensible resilient wire (12) in a circular two dimensional planar shape and terminal ends (14) at each end of the wire. The terminal ends each comprising a loop (14) and a tail (16). The tail is folded back and extends around the circular shape. Each of the tails of the terminal loops can have an enlarged end. The reinforcing ring can be straightened out for surface treatment such as passivation and/or electropolishing with substantially no part of the circular shape, the loops or tails touching each other.

Abstract: A vascular intervention device delivery system, such as for implanting a self expanding stent, includes a thumbwheel rotatably mounted in a handle. The thumbwheel includes a radially outward thumb surface. A catheter has a proximal end attached to the handle, and a distal carrier segment for mounting a vascular intervention device thereon. A retractable sheath is movable from a first position covering the distal carrier segment to a second position retracted proximally uncovering the distal carrier segment. A pull extends between the thumbwheel and the retractable sheath. A holding mechanism is operably positioned between the handle and the thumbwheel, and includes a wedge pin trapped to move in a wedge shaped cavity between a wedged position that prevents the thumb wheel from rotating, and an unwedged position that permits the thumbwheel to rotate to facilitate deployment of a self-expanding stent.

Abstract: A method includes coupling, at least temporarily, a support member adjacent to a target tissue. The support member is configured to support the target tissue and to define a path along which a cutting device can move. The method includes moving the cutting device along the path defined by the support member to cut and/or dilate the target tissue. In some embodiments, the method optionally includes disposing a cannula of a device within the cut defined in target tissue. The cannula is coupled to the target tissue such that a lumen defined by the cannula is in fluid communication with a volume defined at least in part by the target tissue.

Abstract: The described invention provides an endovascular stent device comprising a tubular structure comprising a circumference; wherein a flow-diverting portion of the circumference is covered by a flow-diverting material; a length (l) from a proximal end to a distal end; and an inner diameter (d); wherein the flow-diverting portion of the circumference comprises a length (l?); and the flow-diverting portion of the circumference covers at least 1% to at least 100% of the endovascular stent device. According to some embodiments, the flow-diverting material is adapted to increase blood vessel wall adherence and minimize risk of an endoleak.

Abstract: Described herein are devices and methods for treating eye conditions. Described is an ocular implant including an elongate member having an internal lumen forming a flow pathway, at least one inflow port communicating with the flow pathway, and at least one outflow port communicating with the flow pathway. The elongate member is adapted to be positioned in the eye such that at least one inflow port communicates with the anterior chamber, at least one outflow port communicates with the suprachoroidal space to provide a fluid pathway between the anterior chamber and the suprachoroidal space when the elongate member is implanted in the eye. The elongate member has a wall material imparting a stiffness to the elongate member. The stiffness is selected such that after implantation the elongate member deforms eye tissue surrounding the suprachoroidal space forming a tented volume.

Abstract: Devices, systems, and methods for inverting and closing the left atrial appendage. In at least one embodiment of a method for closing a left atrial appendage of the present disclosure, the method comprises the steps of inverting a distal portion of a left atrial appendage, and constraining the inverted distal portion of the left atrial appendage using a device configured to fit within an interior of the left atrial appendage.

Abstract: The invention relates to stent-grafts having a continuous anchoring machine stitching and methods of attachment of a stent to the graft material. The continuous anchoring machine stitching includes a series of loop points used to attach the stent to the graft material.

Abstract: The present disclosure is directed to a branched endoprosthesis comprising a graft component and at least one support component. In various embodiments, the branched endoprosthesis comprises a body portion and at least two leg portions, wherein at least two legs are in an aligned configuration for ease of cannulation. In various embodiments, at least one leg is in an open configuration for ease of cannulation. Cannulation methods are also taught.

Abstract: An anchor device to simplify catheterization procedures, particularly for insertion and maneuvering of large catheters in tortuous arteries, vessels, or other lumen is disclosed. In some embodiments, the anchor device includes an anchor stent formed from a plurality of zig-zag shaped wire elements that are coupled together. The device further includes a plurality of connector struts attached at a proximal end of the anchor stent, the connector struts coalescing to form a strut tip. A guide device, such as a guidewire, is attached to the anchor stent at the strut tip and may be used to guide the anchor stent into the arteries or other vessels and toward a target treatment site.

Abstract: Embolic implants delivery systems and methods of manufacture and delivery are disclosed. The devices can be used for aneurysm and/or fistula treatment. The designs offer low profile compressibility for delivery to neurovasculature, while maintaining advantageous delivery and implant detachment control features.

Abstract: An anchor device to simplify catheterization procedures, particularly for insertion and maneuvering of large catheters in tortuous arteries, vessels, or other lumen is disclosed. In some embodiments, the anchor device includes an anchor stent formed from a plurality of zig-zag shaped wire elements that are coupled together. The device further includes a plurality of connector struts attached at a proximal end of the anchor stent, the connector struts coalescing to form a strut tip. A guide device, such as a guidewire, is attached to the anchor stent at the strut tip and may be used to guide the anchor stent into the arteries or other vessels and toward a target treatment site.

Abstract: A medical device includes a polymer scaffold crimped to a catheter having an expansion balloon. The scaffold is crimped to the catheter by a multi-step process for increasing scaffold-catheter yield following a crimping sequence. Damage reduction during a crimping sequence includes modifying blades of a crimper, adopting a multi-step crimping sequence, and inflating a supporting balloon to support the scaffold during crimping.

Abstract: Apparatus and methods for facilitating deployment of an implantable medical device including a stent graft. A restraining device, such as cord or suture, holds at least the proximal end of the stent in a radially inwardly compressed configuration during delivery to a desired location within the lumen of a patient's vessel. Withdrawal of one or more trigger wires facilitates the release and removal of the restraining cord from the proximal end of the stent so as to allow the stent to become fully deployed within vessel.

Abstract: A prosthesis for implantation at a native semilunar valve includes a prosthetic distal valve, which includes a pliant material configured to collapse inwardly towards a longitudinal axis of the prosthesis during diastole, and to open outwardly during systole, and a distal fixation member configured to be positioned in a downstream artery of the subject. The apparatus also includes a proximal fixation member coupled to the distal fixation member, and configured to be positioned at least partially on a ventricular side of the native semilunar valve. The proximal fixation member is shaped so as to define a lattice that is shaped so as to define an intermediary portion that is coupled to the pliant material of the valve and diverges outwardly from the longitudinal axis, and a distal portion that is distal to the intermediary portion and diverges outwardly from the intermediary portion of the lattice. Other embodiments are also described.

Abstract: A valve retainer is connected to an elongate delivery member. The valve retainer is configured to releasably secure a prosthesis (e.g., a heart valve prosthesis) to the delivery member during delivery to a target site in a body (e.g., a native valve annulus). The valve retainer includes a rotational identifier that identifies the rotational orientation of the valve retainer when the valve retainer is positioned proximate to the target site. A heart valve prosthesis can include a commissural post that has a predetermined rotational position relative to the rotational identifier, such that the heart valve prosthesis can be rotationally aligned with the native commissures of the native valve by rotating the delivery member and the valve retainer until the commissural post is aligned with a native valve commissure and the rotational identifier is visible.

Abstract: Some embodiments are directed to methods and systems for percutaneously treating dissections in a patient's vasculature, such as, without limitation, the aorta. The method can include deploying a catheter containing a collapsed anchoring element, frame, and cover through a first vessel to an entry point of the dissection. The anchoring element can be secured to the second branch vessel. The frame can be expanded in the first branch vessel. The cover can be unfolded over at least a portion of the entry point. The cover then reduces blood flow into the entry point.

Abstract: Apparatus is provided for treating hypertension of a subject. The apparatus includes an implantable element which has a non-circular shape and which is configured to reduce the hypertension by facilitating an assumption of a non-circular shape by a blood vessel in a vicinity of a baroreceptor of the subject, during diastole of the subject. Other embodiments are also described.

Abstract: A low profile stepped delivery system for retracting trigger wires from a prosthesis to release the prosthesis from a delivery device. A rod is disposed within an axial bore of a handle. The rod has a first longitudinal surface and a second longitudinal surface. A first engagement mechanism is disposed on the first longitudinal surface and a second engagement mechanism disposed on the second longitudinal surface. A wire coiling assembly is disposed at an end of the of the handle and comprises a first rotary gear that is adapted to be rotated by the first engagement mechanism, a second rotary gear that is adapted to be rotated by the second engagement mechanism, a first wire spool that is coupled to a rotation of the first rotary gear, and a second wire spool that is coupled to the rotation of second rotary gear. The first wire spool is configured to secure a first trigger wire and the second wire spool is configured to secure a second trigger wire.

Abstract: An endoluminal prosthesis includes an expandable stent graft that includes a cannula extending through a lumen of the stent graft. A suture is threaded along the perimeter of the graft through openings therein, with an inner end of the suture mounted to the cannula. The cannula is rotatable relative to the graft to wind or unwind the suture around the cannula and cause the graft to become compressed when wound or allow the graft to expand when unwound. The cannula includes an attachment member for retaining an inner end of the suture, and the attachment member can release the inner end of the suture when adjustment of the graft diameter is no longer desired.

Abstract: A delivery device can provide sequential delivery of a plurality of intraluminal devices or tacks held in a compressed state on the delivery device. Delivery platforms on the delivery device can hold a tack in a compressed position and have a unique shape, such as a non-constant outer diameter, an hourglass shape, a tapered proximal half, ridges, dimples, etc. This unique shape can be positioned between annular pusher bands that may also be radiopaque markers. In some embodiments, the unique shape is provided by a sleeve of flexible material with the unique shape surrounding a harder inner shaft. Further, the annular pusher bands can be made of wire or sections of material to increase flexibility while remaining radiopacity. A tack deployment method can include alignment of radiopaque markers on the outer sheath and the tack to be deployed prior to deployment.

Abstract: The invention relates to an implantable stent which can be used in the region of an arterial constriction said region being expandable by a balloon catheter.

Abstract: A self-expandable mechanical clot retrieval device is designed variously to dislodge, engage and retract blood clot from extremely small and tortuous vasculature. The retrieval device comprises an elongate member and a plurality of ring elements. The ring elements may comprise a plurality of struts and crowns interconnected by a tether formed at a distal end of the elongate member or may be a separate component attached thereto. At least one tether may connect each ring element to the elongate member to restrain the ring element in a collapsed configuration during delivery of the retrieval device through an intravascular microcatheter. The tether connecting the ring element to the elongate member disengages when the retrieval device is positioned at the occluded site and the microcatheter is retracted to allow the self-expandable ring elements to reach an expanded configuration.

Abstract: A visceral double-barreled main body stent graft and methods for its use, the stent graft comprises, a main body stent graft having distal and proximal ends, the main body stent graft's length ranges from about 100-120 mm and diameter at the proximal end ranges from about 30-45 mm, first and second lumens defined at the main body stent graft's distal end, the first lumen's diameter ranges from about 18-20 mm, the second lumen's diameter ranges from about 16-18 mm, the first and second lumens have about the same length from about 50-70 mm, the first lumen is secured to the second lumen along a shared length, and the main body stent graft defines a tubular wall that is contiguous with the first and second lumens such that any fluid entering the main body must exit through one of the first or second lumens.

Abstract: Apparatus for actuating a delivery system are disclosed. The apparatus may comprise an adapter. The adapter may comprise an input, a first actuator, and a second actuator. The adapter may be configured to receive a portion of a delivery system. The adapter may be configured to impart translational motion to the delivery system. The adapter may be configured to impart translational motion to a catheter. The adapter may be configured to be actuated by a motorized device or a drill. The adapter may be configured to actuate multiple delivery systems. The adapter may be configured to at least partially compress a portion of an article such as a prosthetic heart valve.

Abstract: The present invention relates to a medical device, for pancreas, equipped with drainage feature. The medical device includes a stent having an exterior surface, a proximal end and a distal end. The medical device further includes a drainage tube helically wrapped around the stent. The drainage tube includes an external surface, an internal surface, a proximal end, and a distal end. The external surface of the drainage tube is designed with a plurality of holes. The pluralities of holes are connected to the internal surface via a lumen. The plurality of holes can be configured to direct the fluid from side walls of pancreas and bring it out through lumen to avoid occlusion of the side walls in pancreas.

Abstract: Implant in the form of an intraluminal endoprosthesis, having a tubular body containing metallic material, optionally iron, whereby in at least a portion of the implant body the following are present in the structure of a near-surface boundary layer in comparison to the respective concentration in the remaining structure: an increased carbon content in a concentration of approximately 0.5% by weight to approximately 2% by weight; or an increased carbon and nitrogen content, wherein a concentration of carbon is approximately 0.5% by weight to approximately 7% by weight, and a concentration of nitrogen is approximately 0.5% by weight to approximately 17% by weight.

Abstract: Methods and apparatus for treating bones, including, in one or more embodiments, methods and apparatus for treatment of vertebral fractures that include a containment assembly for cement containment and/or a balloon assembly for maintaining vertebral height. A containment assembly comprising a containment jacket adapted to be deployed inside bone; and a dividing wall that separates the interior of the containment jacket into a proximal region and a distal region, the dividing wall having an opening for providing access to the distal region from the proximal region.

Abstract: An implantable device system for controlling the dimensions of internal anatomic passages corrects physiologic dysfunctions resulting from a structural lumen which is either too large or too small. Implantable devices are disclosed which employ various mechanisms for adjusting and maintaining the size of an orifice to which they are attached. Systems permit the implants to be implanted using minimally invasive procedures and permit final adjustments to the dimensions of the implants after the resumption of normal flow of anatomic fluids in situ.

Abstract: A medical assembly for delivering an implant comprising a tubular resilient implant defining an inner lumen, the implant comprising a plurality of engaging members extending proximally an end thereof, the implant having a delivery configuration, and a released configuration, and a delivery assembly for delivering the implant, the delivery assembly comprising an outer tubular member extending through the inner lumen of the implant, the outer tubular member having a plurality of slots receiving therethrough the engaging members, with the implant being disposed in its delivery configuration on an outer surface of the outer tubular member, an inner tubular member coaxially disposed within the outer tubular member and movable relative to the outer tubular member, the inner tubular member having a first axial position that restrains the engaging members, and a second axial position to thereby release the implant from the delivery assembly.

Abstract: A prosthesis and a method of manufacturing the prosthesis for controlling flow through a bodily lumen are provided. The prosthesis includes a body having a proximal portion, a distal portion and a lumen extending therethrough. The prosthesis also includes a valve operably connected to the body. The valve has a proximal portion, a distal portion and a lumen extending through the valve, where the valve lumen is connected to the body lumen. The valve is configured to be closed in the absence of an antegrade pressure and a retrograde pressure, the retrograde pressure being greater than the antegrade pressure. The valve includes a material portion operably connected to the valve, the material portion providing increased stiffness to the valve relative to the valve alone, wherein the material portion is configured to facilitate self-reversion of the valve to the closed configuration.

Abstract: A deployment device for repair of a transected body vessel is described herein. Device can have a handle and one or more shafts coupled thereto. A prosthesis being retained by a sheath can be coupled to the delivery device. The sheath can have end portions coupled to one or more shafts. Rotation of a shaft can retract a sheath portion away from either end of the prosthesis for expansion thereof prior to the middle of the prosthesis. Continued rotation of a shaft can completely remove the sheath from the prosthesis, so that the prosthesis is fully expanded and couples the first and second vessel portions of the transected vessel together. Prosthesis may be retained by overlapping a tubular sheath and lacing a threading member therethrough. Prosthesis may be retained by a splittable sheath.

Abstract: Methods and apparatus for treating bones, including, in one or more embodiments, methods and apparatus for treatment of vertebral fractures that include a containment assembly for cement containment and/or a balloon assembly for maintaining vertebral height. Methods for treating a bone comprising: creating a cavity in the bone; inserting a containment jacket into the cavity; inserting a balloon into the containment jacket; inflating the balloon; and introducing a filler material into the containment jacket with isolation of the balloon from the filler material.

Abstract: A stent loading and delivery system, the delivery system comprising an inner elongate tubular member having a proximal end and a distal end, an intermediate elongate tubular member having a proximal end and a distal end in sliding relationship to said inner elongate tubular member and an external elongate tubular member having a proximal end and a distal end in sliding relationship to said intermediate elongate tubular member, said intermediate elongate tubular member comprising a stop mechanism at its proximal end, wherein the stop mechanism prevents the external elongate tubular member from being slid past the stop mechanism when the external elongate tubular member is slid in a proximal direction.

Abstract: This material comprises an annuloplasty member (12) able to be introduced using a catheter (2) through minimally invasive vascular access, then to be delivered by said catheter and fixed to the valve annulus (104).

Abstract: A delivery system for delivering and deploying stents with proximal and distal apices includes a guidewire catheter, a nose cone assembly, a proximal capture portion and a stent graft with proximal and distal stents. The nose cone assembly is at the distal end of the guidewire catheter and includes a nose cone and a distal capture portion. The proximal capture portion is proximal to the distal capture portion of the nose cone assembly. The proximal stent is releasably secured to the distal capture portion and the distal stent is releasably secured to the proximal capture portion. The stent graft can be deployed by releasing the proximal stent and the distal stent from proximal and distal capture portions of the delivery system.

Abstract: An intravascular medical device including an elongated member configured to be advanced along a vascular path of a patient, the elongated member having opposite first and second ends, the first end and second ends both being adapted for intravascular insertion, and the first end having a different structure than the second end. The elongated member has sufficient flexibility to be advanced through a human vasculature. Preferably, the first and second ends are adapted to have different operating characteristics. Depending on the operating characteristics needed for a particular procedure, a physician can insert either the first end portion or the second end portion of the elongated member into the patient's vasculature.

Abstract: A delivery system may include a stent-graft, a locking member, and one or more diameter reducing members. The stent-graft may include a tubular graft comprising first and second longitudinally extending sides disposed opposite each other and connected at a tangent line. When the locking member is in a locked position, the locking member restrains a surface of the graft against the cannula. The first diameter reducing member may be slidably connected to a first portion of the graft that is disposed proximate the tangent line and may be slidably connected to a second portion of the graft that is spaced circumferentially away from the tangent line. When the first diameter reducing member is in a restrained position, the second portion of the graft is drawn toward the first portion of the graft and the proximal portion of the stent-graft has a reduced diameter configuration with at least two lobes.

Abstract: Drug-eluting rotational spun coatings that include one or more therapeutic agents may be used to coat a medical device. The medical devices include, for example, balloon catheters, vascular grafts and stents, which are coated with drug-eluting rotational spun materials that may be used to deliver a therapeutic agent to a target tissue or body lumen.

Abstract: Systems and methods are disclosed for delivering a stent to a lumen internal to a body of a patient and for sheathing a stent just prior to an insertion procedure. One embodiment comprises a delivery device having a partially sheathed configuration, a fully sheathed delivery configuration, and a deployed configuration. A panchor (combination pusher and anchor) is configured to engage and limit proximal and distal movement of the implantable device. An outer sheath surrounds a distal portion of an inner member and retains the implantable device near the distal end. The outer sheath is slidably moveable relative to the inner member to deploy the implantable device. Proximal movement of a trigger results in movement of the outer sheath to deploy the implantable device. A sheathing mechanism is configured to crimp and fully sheathe the implantable device prior to a deployment procedure.

Abstract: A stent delivery system, a core assembly, and methods of operating the same are provided. The delivery system can comprise a catheter and the core assembly. The core assembly can comprise a constraining member, protruding member, a core member, and a stent extending along the core member. The tubular constraining member can be spaced apart from the core member and define a capture area. The protruding member can be disposed along the core member at least partially distal of the capture area. The stent can have a first portion disposed within the capture area and a second portion, distal to the first portion, extending across or over an outer surface of the protruding member so that the protruding member and the constraining member cooperate to inhibit expansion of the first portion of the stent.

Abstract: The present disclosure describes a system and method for forming a stent or stent-graft for use in the vasculature of a human patient. The system comprises a mandrel and a collar configured to slide and rotate in relation to the mandrel. The mandrel includes at least one groove that corresponds to the desired shape of a stent or stent-graft. The stent or stent-graft is formed by sliding and rotating the collar along the surface of the mandrel, which forces a wire to conform to the shape of the groove.

Abstract: Various improvements to inflatable membranes are disclosed. These improvements include, among other things, features on the membrane that can mitigate hazards such as bubble formation or frictional damage during inflation of the membrane.

Abstract: Flexible high-pressure angioplasty balloons are disclosed herein which utilize an inflatable balloon positioned upon the catheter and a supporting structure secured over or along the catheter at a first location proximal to the balloon and at a second location distal to the balloon. Inflation of the balloon reconfigures the supporting structure to urge the first location and the second location towards one another thereby inhibiting longitudinal elongation of the balloon relative to the catheter. The supporting structure may surround, support, or otherwise extend over the entire length of the balloon and allows for the balloon to retain increased flexibility which enables the balloon to bend or curve even at relatively high inflation pressures.

Abstract: A medical device for treating a heart valve insufficiency, with an endoprosthesis which can be introduced into a patient's body and expanded to secure a heart valve prosthesis in the patient's aorta with a catheter. In an embodiment, the endoprosthesis has a plurality of positioning arches configured to be positioned with respect to a patient's aorta and a plurality of retaining arches to support a heart valve prosthesis. The endoprosthesis includes a collapsed mode during the process of introducing it into the patient's body and an expanded mode when it is implanted. The endoprosthesis may be introduced into a patient's body and expanded via a catheter. In an embodiment, the catheter has first and second slide mechanisms configured to independently manipulate first and second sleeve elements to sequentially expand the endoprosthesis from the collapsed mode to the expanded mode.

Abstract: The invention provides for methods and catheter apparatus for passing one or more guidewires (via the use of one or more telescoping guidewire lumens) through a chronic total occlusion of a vasculature. The catheter apparatus may include: a catheter shaft having a distal end; one or more telescoping guidewire lumen catheters passing longitudinally through the shaft, wherein the one or more guidewire lumen catheters are capable of telescoping beyond the distal end of the catheter shaft; an expansible distal portion of the shaft; and a retractable sheath covering at least a portion of the expansible distal portion of the shaft, wherein retracting the retractable sheath from the expansible distal portion of the shaft directly activates the expansible distal portion of the shaft causing expansion of the expansible distal portion of the shaft.