Endovascular devices and methods
Devices and methods for the treatment of chronic total occlusions are provided. One disclosed embodiment comprises a method of facilitating treatment via a vascular wall defining a vascular lumen containing an occlusion therein. The method includes providing an intravascular device having a distal portion, inserting the device into the vascular lumen, positioning the distal portion in the vascular wall to at least partially surround the occlusion, and removing at least a portion of the surrounded occlusion from the lumen.
1. A method of treating an occlusion in a blood vessel, the method comprising:
advancing an elongate medical device through a lumen of a blood vessel to a location proximate an occlusion, the blood vessel including an intimal layer, a medial layer and an adventitial layer;
passing a portion of the elongate medical device between the intimal layer and the adventitial layer proximate the occlusion;
positioning the portion of the elongate medical device around the occlusion radially outward of the intimal layer;
reducing a diameter of the portion of the elongate medical device around the occlusion with the portion of the elongate medical device between the intimal layer and the adventitial layer; and
removing a portion of the intimal layer with the occlusion by withdrawing the elongate medical device from the blood vessel.
2. The method of claim 1 , wherein positioning the portion of the elongate medical device around the occlusion radially outward of the intimal layer includes:
positioning the portion of the elongate medical device helically around the occlusion radially outward of the intimal layer.
3. The method of claim 2 , wherein the step of reducing the diameter of the portion of the elongate medical device around the occlusion includes rotating a distal end of the elongate medical device relative to a proximal end of the elongate medical device.
4. The method of claim 1 , further comprising distally advancing a cutting element through the blood vessel to a location proximate the occlusion.
5. The method of claim 4 , further comprising:
cutting the intimal layer proximal of the occlusion with the cutting element.
6. The method of claim 5 , further comprising:
cutting the intimal layer distal of the occlusion with the cutting element.
7. The method of claim 6 , wherein the cutting element is advanced over the portion of the elongate medical device reduced in diameter around the occlusion with the portion of the elongate medical device between the intimal layer and the adventitial layer.
8. The method of claim 5 , wherein the cutting element is advanced over the portion of the elongate medical device reduced in diameter around the occlusion with the portion of the elongate medical device between the intimal layer and the adventitial layer.
9. The method of claim 1 , further comprising:
inflating a balloon in the lumen of the blood vessel proximal of the occlusion.
10. A method of treating an occlusion in a blood vessel, the method comprising:
advancing an elongate medical device through a lumen of a blood vessel to a location proximate an occlusion, the blood vessel including an intimal layer, a medial layer and an adventitial layer;
surrounding the occlusion and a portion of the intimal layer with a distal portion of the elongate medical device while a proximal portion of the elongate medical device is positioned in the lumen of the blood vessel;
wherein the distal portion of the elongate medical device is positioned between the intimal layer and the adventitial layer radially outward of the occlusion;
reducing a diameter of the distal portion of the elongate medical device around the occlusion and the portion of the intimal layer with the distal portion of the elongate medical device between the intimal layer and the adventitial layer; and
removing the occlusion with the portion of the intimal layer by withdrawing the elongate medical device from the blood vessel.
11. The method of claim 10 , further comprising distally advancing a cutting element through the blood vessel to a location proximate the occlusion.
12. The method of claim 11 , further comprising:
cutting the intimal layer proximal of the occlusion with the cutting element.
13. The method of claim 12 , further comprising:
cutting the intimal layer distal of the occlusion with the cutting element.
14. The method of claim 13 , wherein the cutting element is advanced over the distal portion of the elongate medical device reduced in diameter around the occlusion and the portion of the intimal layer with the distal portion of the elongate medical device between the intimal layer and the adventitial layer.
15. The method of claim 12 , wherein the cutting element is advanced over the distal portion of the elongate medical device reduced in diameter around the occlusion and the portion of the intimal layer with the distal portion of the elongate medical device between the intimal layer and the adventitial layer.
16. The method of claim 10 , wherein the distal portion of the elongate medical device extends helically around the occlusion.
17. The method of claim 16 , wherein the step of reducing the diameter of the distal portion of the elongate medical device around the occlusion includes rotating a distal end of the elongate medical device relative to a proximal end of the elongate medical device.