Guide catheter with steering mechanisms

1. An endovascular guide catheter comprising:

a flexible guide tube having a distal end portion configured to deflect via actuation of a pull wire; and

a handle coupled to the guide tube and comprising a steering assembly configured to actuate the pull wire to deflect the distal end portion of the guide tube, the steering assembly comprising:

a stationary rack;

a gear engaging the rack;

a reel coupled to and configured to rotate with the gear, the pull wire being coupled to the reel such that rotation of the reel causes the pull wire to wind or unwind around the reel;

a slider adapted for translation relative to the rack, wherein translation of the slider translates the reel relative to the rack and rotation of the gear along the rack rotates the reel; and

an actuator disposed at a distal end of the handle, the actuator is configured to rotate about a longitudinal axis of the guide catheter to drive the translation of the slider relative to the rack, wherein the actuator is externally disposed about and coupled to a threaded rod, and wherein the threaded rod is configured for translational movement and is coupled to the slider at a proximal end portion.

2. The guide catheter of claim 1 , wherein the gear is coupled to the slider and translation of the slider translates and rotates the gear along the rack.

3. The guide catheter of claim 1 , wherein the reel is integral with the gear such that the reel is directly coupled without further intermediate components to the gear.

4. The guide catheter of claim 1 , wherein the gear is directly coupled via only a pin to the slider.

5. The guide catheter of claim 1 , wherein the gear is adapted to engage with the rack to translate movement of the slider into rotation that rotates the reel.

6. The guide catheter of claim 1 , wherein the gear and the rack are adapted to be self-locking such that the reel cannot wind or unwind the pull wire without actuation by a user.

7. The guide catheter of claim 1 , wherein a travel distance of the pull wire comprises a combination of a linear travel of the slider and an amount of winding or unwinding due to rotation of the reel.

8. A system including the guide catheter of claim 1 , in combination with an operative tool that is configured to apply one or more fasteners to tissue.

9. A method comprising:

deploying a guide device comprising a handle with a steering assembly into an interior tissue region, wherein the steering assembly comprises:

a rack;

a gear engaging the rack;

a reel coupled to the gear for rotation and translation relative to the rack;

a slider adapted for translation relative to the rack, wherein translation of the slider translates the reel relative to the rack and rotation of the gear along the rack rotates the reel; and

an actuator disposed at a distal end of the handle, the actuator is configured to rotate about a longitudinal axis of the guide device to drive the translation of the slider relative to the rack, wherein the actuator is externally disposed about and coupled to a threaded rod, and wherein the threaded rod is configured for translational movement and is coupled to the slider at a proximal end portion; and

operating the steering assembly to deflect a distal end portion of a guide tube coupled to the guide device, the operating including rotating the reel to wind or unwind a pull wire about the reel to apply a force to deflect the distal end portion, wherein the force additionally comprises a tension on the pull wire due to a linear travel of the reel.

10. The method of claim 9 , further comprising:

passing an operative tool configured to apply one or more fasteners to tissue through the guide device; and

operating the operative tool while residing in the guide device to apply the one or more fasteners to tissue.