US20040167554A1 — Methods and devices for reentering a true lumen f…

Claim 1

Independent Claim 127 words

1 . A method of re-entering a lumen during an endovascular procedure when in a subintimal space, comprising the steps of: providing a device having a cutter, an opening, and an energy emitter coupled to the cutter, the cutter and energy emitter being coupled to a torque transmitting element which rotates the cutter and energy emitter together; advancing the device through a lumen into a subintimal space adjacent to the lumen; emitting energy from the energy emitter while in the subintimal space to locate the lumen after the advancing step; moving the energy emitter and cutting element together to expose the cutting element to tissue; and cutting through the wall using the rotating cutting element to provide an access path from the subintimal space to the lumen.

Claim 2

Dependent Claim 127 words

1 . A method of re-entering a lumen during an endovascular procedure when in a subintimal space, comprising the steps of: providing a device having a cutter, an opening, and an energy emitter coupled to the cutter, the cutter and energy emitter being coupled to a torque transmitting element which rotates the cutter and energy emitter together; advancing the device through a lumen into a subintimal space adjacent to the lumen; emitting energy from the energy emitter while in the subintimal space to locate the lumen after the advancing step; moving the energy emitter and cutting element together to expose the cutting element to tissue; and cutting through the wall using the rotating cutting element to provide an access path from the subintimal space to the lumen.

Claim 3

Dependent Claim 35 words

2 . The method of claim 1 , wherein: the cutting step is carried out while moving the cutter and opening together through the subintimal space to create the access path into the true lumen.

Claim 4

Dependent Claim 24 words

3 . The method of claim 1 , wherein: the providing step is carried out with the energy emitter being an ultrasound emitting element.

Claim 5

Dependent Claim 37 words

4 . The method of claim 1 , wherein: the moving step is carried out to move at least part of the cutting element through the opening to expose the at least part of the cutting element.

Claim 6

Dependent Claim 33 words

5 . The method of claim 1 , further comprising the step of: directing an element through the access path into the true lumen while maintaining the cutting element within the subintimal space

Claim 7

Dependent Claim 21 words

6 . The method of claim 1 , wherein: the directing step is carried out with the element being a guidewire.

Claim 8

Dependent Claim 22 words

7 . The method of claim 6 , wherein: the advancing step is carried out by advancing the device over the guidewire.

Claim 9

Dependent Claim 28 words

8 . The method of claim 1 , further comprising the step of: directing an element through the device and through the access path into the true lumen.

Claim 10

Dependent Claim 51 words

9 . The method of claim 1 , wherein: the providing step is carried out with the device having an open end; the moving step being carried out with the cutting element moving from a position within the device to a position outside the open end to expose the cutting element.

Claim 11

Dependent Claim 26 words

10 . The method of claim 1 , wherein: the moving step is carried out to move the cutting element to a position outside the opening.

Claim 12

Dependent Claim 33 words

11 . The method of claim 1 , wherein: the moving step is carried out to expose over 180 degrees of the cutting element through the opening relative to an axis of rotation.

Claim 13

Dependent Claim 30 words

12 . The method of claim 1 , wherein: the moving step is carried out to expose over 270 degrees of the cutting element relative to an axis of rotation.

Claim 14

Dependent Claim 23 words

13 . The method of claim 1 , wherein: the moving step is carried out by gradually exposing more of the cutting element.

Claim 15

Dependent Claim 24 words

14 . The method of claim 1 , further comprising the step of: bending a distal portion of the device before the cutting step.

Claim 16

Dependent Claim 32 words

15 . The method of claim 14 , wherein: the bending step is carried out with an axis of rotation maintaining the same orientation relative to a proximal portion of the device.

Claim 17

Dependent Claim 23 words

16 . The method of claim 1 , wherein: the cutting step is carried out while emitting energy with the energy emitting element.

Claim 18

Dependent Claim 21 words

17 . The method of claim 1 , further comprising the step of: positioning a sheath proximal to the subintimal space.

Claim 19

Dependent Claim 28 words

18 . The method of claim 17 , further comprising the step of: delivering a fluid through the sheath to determine whether the access path has been created.

Claim 20

Dependent Claim 25 words

19 . The method of claim 17 , further comprising: advancing a guidewire through the sheath and through the access path into the true lumen.

Claim 21

Dependent Claim 141 words

20 . A method of re-entering a lumen during an endovascular procedure, comprising the steps of: providing a device having a rotatable cutter and an opening, the cutter being movable from a first position to a second position, the cutter being positioned within the opening in the first position and extending out of the opening in the second position; advancing the device into a false lumen created during an endovascular procedure, the false lumen extending in a wall of a true lumen; orienting the opening toward the true lumen after the advancing step; moving the cutter into the second position so that the cutter extends out of the opening after the orienting step; cutting an opening from the false lumen to the true lumen after the moving step; and directing another endovascular device through the opening and into the true lumen.

Claim 22

Dependent Claim 141 words

20 . A method of re-entering a lumen during an endovascular procedure, comprising the steps of: providing a device having a rotatable cutter and an opening, the cutter being movable from a first position to a second position, the cutter being positioned within the opening in the first position and extending out of the opening in the second position; advancing the device into a false lumen created during an endovascular procedure, the false lumen extending in a wall of a true lumen; orienting the opening toward the true lumen after the advancing step; moving the cutter into the second position so that the cutter extends out of the opening after the orienting step; cutting an opening from the false lumen to the true lumen after the moving step; and directing another endovascular device through the opening and into the true lumen.

Claim 23

Dependent Claim 20 words

21 . The method of claim 20 , wherein: the orienting step is carried out using an energy emitting element.

Claim 24

Dependent Claim 25 words

22 . The method of claim 21 , wherein: the orienting step is carried out with the energy emitting element being an ultrasound emitting element.

Claim 25

Dependent Claim 27 words

23 . The method of claim 21 , wherein: the orienting step is carried out with the ultrasound emitting element rotating within a housing of the device.

Claim 26

Dependent Claim 31 words

24 . The method of claim 20 , wherein: the providing step is carried out with the cutter being rotatable; the cutting step is carried out while the cutter is rotating.

Claim 27

Dependent Claim 27 words

25 . The method of claim 24 , wherein: the orienting step is carried out with the device having an ultrasound emitting element coupled to the cutter.

Claim 28

Dependent Claim 28 words

26 . The method of claim 20 , wherein: the cutting step is carried out by moving the opening and the cutting element together within the false lumen.

Claim 29

Dependent Claim 36 words

27 . The method of claim 26 , wherein: the cutting step is carried out by moving the entire device longitudinally to move the opening and the cutter relative to the wall of the true lumen.

Claim 30

Dependent Claim 21 words

28 . The method of claim 20 , further comprising the step of: positioning a sheath proximal to the subintimal space.

Claim 31

Dependent Claim 28 words

29 . The method of claim 28 , further comprising the step of: delivering a fluid through the sheath to determine whether the access path has been created.

Claim 32

Dependent Claim 25 words

30 . The method of claim 28 , further comprising: advancing a guidewire through the sheath and through the access path into the true lumen.

Claim 33

Dependent Claim 33 words

31 . The method of claim 20 , wherein: the moving step is carried out to expose over 180 degrees of the cutting element through the opening relative to an axis of rotation.

Claim 34

Dependent Claim 30 words

32 . The method of claim 20 , wherein: the moving step is carried out to expose over 270 degrees of the cutting element relative to an axis of rotation.

Claim 35

Dependent Claim 23 words

33 . The method of claim 20 , wherein: the moving step is carried out by gradually exposing more of the cutting element.

Claim 36

Dependent Claim 24 words

34 . The method of claim 20 , further comprising the step of: bending a distal portion of the device before the cutting step.

Claim 37

Dependent Claim 32 words

35 . The method of claim 34 , wherein: the bending step is carried out with an axis of rotation maintaining the same orientation relative to a proximal portion of the device.

Claim 38

Dependent Claim 131 words

36 . A method of re-entering a lumen during an endovascular procedure, comprising the steps of: providing a device having a cutter, a distal portion and a proximal portion, the distal portion being movable from a first condition to a second condition, the distal portion being angled relative to the proximal portion in the second condition; advancing the device into a false lumen created during an endovascular procedure when the device is in the straightened condition; moving the distal portion to the second condition to angle the distal portion after the advancing step; orienting the opening toward a true lumen after the advancing step; cutting an opening from the false lumen to the true lumen using the cutter; and directing an endovascular device through the opening and into the true lumen.

Claim 39

Dependent Claim 131 words

36 . A method of re-entering a lumen during an endovascular procedure, comprising the steps of: providing a device having a cutter, a distal portion and a proximal portion, the distal portion being movable from a first condition to a second condition, the distal portion being angled relative to the proximal portion in the second condition; advancing the device into a false lumen created during an endovascular procedure when the device is in the straightened condition; moving the distal portion to the second condition to angle the distal portion after the advancing step; orienting the opening toward a true lumen after the advancing step; cutting an opening from the false lumen to the true lumen using the cutter; and directing an endovascular device through the opening and into the true lumen.

Claim 40

Dependent Claim 60 words

37 . The method of claim 36 , wherein: the directing step is carried out by directing the distal end of the device through the opening when in the second condition and then directing the endovascular device through the opening, the device being angled so that the distal portion is directed toward the access path cut during the cutting step.

Claim 41

Dependent Claim 36 words

38 . The method of claim 36 , wherein: the directing step is carried out with the endovascular device being advanced over the device which creates the opening from the false lumen to the true lumen.

Claim 42

Dependent Claim 19 words

39 . The method of claim 36 , wherein: the cutting step is carried out with the cutter rotating.

Claim 43

Dependent Claim 38 words

40 . The method of claim 39 , wherein: the moving step is carried out with the cutter rotating around an axis of rotation, the axis of rotation maintaining the same orientation with respect to the proximal portion.

Claim 44

Dependent Claim 31 words

41 . The method of claim 36 , wherein: the moving step is carried out by moving the cutter longitudinally which causes the distal portion to move to the second condition.

Claim 45

Dependent Claim 59 words

42 . The method of claim 36 , wherein: the cutting step is carried out with the device being in the second condition; and the directing step being carried out with the device also being in the second condition but with the device having an orientation which is about 180 degrees displaced from the orientation during the cutting step.

Claim 46

Dependent Claim 21 words

43 . The method of claim 36 , further comprising the step of: positioning a sheath proximal to the subintimal space.

Claim 47

Dependent Claim 28 words

44 . The method of claim 43 , further comprising the step of: delivering a fluid through the sheath to determine whether the access path has been created.

Claim 48

Dependent Claim 25 words

45 . The method of claim 43 , further comprising: advancing a guidewire through the sheath and through the access path into the true lumen.

Claim 49

Dependent Claim 33 words

46 . The method of claim 36 , wherein: the moving step is carried out to expose over 180 degrees of the cutting element through the opening relative to an axis of rotation.

Claim 50

Dependent Claim 30 words

47 . The method of claim 36 , wherein: the moving step is carried out to expose over 270 degrees of the cutting element relative to an axis of rotation.

Claim 51

Dependent Claim 23 words

48 . The method of claim 36 , wherein: the moving step is carried out by gradually exposing more of the cutting element.

Claim 52

Dependent Claim 24 words

49 . The method of claim 36 , further comprising the step of: bending a distal portion of the device before the cutting step.

Claim 53

Dependent Claim 32 words

50 . The method of claim 49 , wherein: the bending step is carried out with an axis of rotation maintaining the same orientation relative to a proximal portion of the device.

Claim 54

Dependent Claim 81 words

51 . A method of cutting tissue in a blood vessel, comprising the steps of: providing a device having a rotatable cutting element and an opening, the rotatable cutting element being movable from a stored position to a cutting position, the cutting element being exposed over at least 180 degrees in the cutting position; advancing the device through a blood vessel; moving the cutting element to the cutting position; cutting tissue with the cutting element while the cutting element is rotating.

Claim 55

Dependent Claim 81 words

51 . A method of cutting tissue in a blood vessel, comprising the steps of: providing a device having a rotatable cutting element and an opening, the rotatable cutting element being movable from a stored position to a cutting position, the cutting element being exposed over at least 180 degrees in the cutting position; advancing the device through a blood vessel; moving the cutting element to the cutting position; cutting tissue with the cutting element while the cutting element is rotating.

Claim 56

Dependent Claim 60 words

52 . The method of claim 51 , wherein: the providing step is carried out with the device having a proximal portion and a distal portion, the proximal portion and the distal portion being movable relative to one another between a straight position to a bent position; the cutting step being carried out with the device in the bent position.

Claim 57

Dependent Claim 34 words

53 . The method of claim 52 , wherein: the cutting step is carried out with the distal portion bending relative to the proximal portion and an axis of rotation of the cutting element.

Claim 58

Dependent Claim 40 words

54 . The method of claim 53 , wherein: the cutting step is carried out with the axis of rotation maintaining the same orientation with respect to the proximal portion when the device moves between the straight and bent positions.

Claim 59

Dependent Claim 26 words

55 . The method of claim 51 , wherein: the providing step is carried out with the cutting element being exposed over at least 270 degrees.

Claim 60

Dependent Claim 49 words

56 . The method of claim 51 , further comprising the step of: orienting the device so that the cutting element is exposed to cut tissue between a false lumen and a true lumen; the advancing step being carried out with the device being positioned in the false lumen.

Claim 61

Dependent Claim 40 words

57 . The method of claim 51 , wherein: the providing step is carried out with the device having an open end; the moving step being carried out with the device moving through the open end into the cutting position.

Claim 62

Dependent Claim 25 words

58 . The method of claim 51 , wherein: the providing step is carried out with the cutting element being gradually exposed from 220-240 degrees.

Claim 63

Dependent Claim 82 words

59 . An endovascular tissue cutting device, comprising: an elongate body having a lumen and an opening; a torque transmitting element extending through the lumen; and a rotatable cutter coupled to the torque transmitting element, the cutter being movable from a first position to a second position, the cutter being contained within the body in the first position and being exposed out of the opening in the second position, the rotatable cutter being exposed for over 180 degrees in the second position.

Claim 64

Dependent Claim 82 words

59 . An endovascular tissue cutting device, comprising: an elongate body having a lumen and an opening; a torque transmitting element extending through the lumen; and a rotatable cutter coupled to the torque transmitting element, the cutter being movable from a first position to a second position, the cutter being contained within the body in the first position and being exposed out of the opening in the second position, the rotatable cutter being exposed for over 180 degrees in the second position.

Claim 65

Dependent Claim 30 words

60 . The device of claim 59 , wherein: the rotatable cutter is movable to a third position, the cutter being exposed for over 220 degrees in the third position.

Claim 66

Dependent Claim 30 words

61 . The device of claim 59 , wherein: the rotatable cutter is movable to a third position, the cutter being exposed for over 270 degrees in the third position.

Claim 67

Dependent Claim 36 words

62 . The device of claim 59 , wherein: the rotatable cutter has a gradually increasing exposure when moving toward the second position so that a user may change the amount of exposure of the cutter.

Claim 68

Dependent Claim 25 words

63 . The device of claim 59 , wherein: the rotatable cutter gradually increases in exposure from 200-240 degrees when moving toward the second position.

Claim 69

Dependent Claim 136 words

64 . A method of entering a true lumen from a subintimal location, comprising the steps of: providing a device having an elongate body, a rotatable cutting element and an opening in the body, the rotatable cutting element being movable from a stored position to a cutting position, the cutting element being exposed through the opening when in the cutting position, the body being wider along a portion of the device where the cutting element is positioned in the cutting position to urge tissue toward the cutting element; advancing the device through a blood vessel; orienting the opening toward a true lumen; moving the cutting element to the cutting position, wherein the wider portion of the body urges tissue toward the cutting element; and cutting tissue with the cutting element while the cutting element is rotating.

Claim 70

Dependent Claim 136 words

64 . A method of entering a true lumen from a subintimal location, comprising the steps of: providing a device having an elongate body, a rotatable cutting element and an opening in the body, the rotatable cutting element being movable from a stored position to a cutting position, the cutting element being exposed through the opening when in the cutting position, the body being wider along a portion of the device where the cutting element is positioned in the cutting position to urge tissue toward the cutting element; advancing the device through a blood vessel; orienting the opening toward a true lumen; moving the cutting element to the cutting position, wherein the wider portion of the body urges tissue toward the cutting element; and cutting tissue with the cutting element while the cutting element is rotating.

Claim 71

Dependent Claim 39 words

65 . The method of claim 64 , wherein: the providing step is carried out with the portion of the device where the cutting element is positioned in the cutting position exposes over 180 degrees of the cutting element.

Claim 72

Dependent Claim 40 words

66 . The method of claim 65 , wherein: the providing step is carried out with the portion of the device where the cutting element is positioned in the cutting position exposes at least 270 degrees of the cutting element.

Claim 73

Dependent Claim 38 words

67 . The method of claim 64 , wherein: the providing step is carried out with the device tapering distally after the wider portion, wherein the cutting element becomes increasingly exposed as the cutting element is moved distally.

Claim 74

Dependent Claim 38 words

68 . The method of claim 64 , wherein: the providing step is carried out with the device having an open end which exposes substantially the entire cutting element when viewed along a longitudinal axis of the device.

Claim 75

Dependent Claim 21 words

69 . The method of claim 64 , further comprising the step of: positioning a sheath proximal to the subintimal space.

Claim 76

Dependent Claim 28 words

70 . The method of claim 69 , further comprising the step of: delivering a fluid through the sheath to determine whether the access path has been created.

Claim 77

Dependent Claim 25 words

71 . The method of claim 69 , further comprising: advancing a guidewire through the sheath and through the access path into the true lumen.

Claim 78

Dependent Claim 166 words

72 . A method of re-entering a lumen during an endovascular procedure, comprising the steps of: providing a device having a rotatable cutter and an opening, the cutter being movable from a first position to a second position, the opening have a proximal side, the rotatable cutter being partially exposed at all positions distal to the proximal side after the cutter is initially exposed; advancing the device into a false lumen created during an endovascular procedure, the false lumen extending through a wall of a true lumen, the cutter being positioned proximal to the proximal side of the opening; orienting the opening toward the true lumen after the advancing step; moving the cutter distally beyond the proximal side of the cutter so that the cutter extends out of the opening after the orienting step; cutting an opening from the false lumen to the true lumen using the rotating cutter after the moving step; and directing another endovascular device through the opening and into the true lumen.

Claim 79

Dependent Claim 166 words

72 . A method of re-entering a lumen during an endovascular procedure, comprising the steps of: providing a device having a rotatable cutter and an opening, the cutter being movable from a first position to a second position, the opening have a proximal side, the rotatable cutter being partially exposed at all positions distal to the proximal side after the cutter is initially exposed; advancing the device into a false lumen created during an endovascular procedure, the false lumen extending through a wall of a true lumen, the cutter being positioned proximal to the proximal side of the opening; orienting the opening toward the true lumen after the advancing step; moving the cutter distally beyond the proximal side of the cutter so that the cutter extends out of the opening after the orienting step; cutting an opening from the false lumen to the true lumen using the rotating cutter after the moving step; and directing another endovascular device through the opening and into the true lumen.

Claim 80

Dependent Claim 51 words

73 . The method of claim 72 , wherein: the providing step is carried out with the rotatable cutter being coupled to an energy emitting element which is coupled to the cutter; and the orienting step being carried out by emitting energy from the energy emitting element to orient the opening.

Claim 81

Dependent Claim 23 words

74 . The method of claim 73 , wherein: the moving step is carried out while emitting energy from the energy emitting element.

Claim 82

Dependent Claim 40 words

75 . The method of claim 72 , wherein: the cutting step is carried out by moving the entire device longitudinally so that the rotating cutter translates within the false lumen to cut through the wall to the true lumen.

Claim 83

Dependent Claim 26 words

76 . The method of claim 72 , wherein: the providing step is carried out with the device having a lumen in communication with the opening.

Claim 84

Dependent Claim 19 words

77 . The method of claim 76 , further comprising the step of: introducing a fluid through the lumen.

Claim 85

Dependent Claim 20 words

78 . The method of claim 76 , wherein: the introducing step is carried out with the fluid being contrast.

Claim 86

Dependent Claim 19 words

79 . The method of claim 76 , further comprising the step of: measuring a pressure through the lumen.

Claim 87

Dependent Claim 21 words

80 . The method of claim 72 , further comprising the step of: positioning a sheath proximal to the subintimal space.

Claim 88

Dependent Claim 29 words

81 . The method of claim A 80 , further comprising the step of: delivering a fluid through the sheath to determine whether the access path has been created.

Claim 89

Dependent Claim 25 words

82 . The method of claim 80 , further comprising: advancing a guidewire through the sheath and through the access path into the true lumen.

Claim 90

Dependent Claim 33 words

83 . The method of claim 72 , wherein: the moving step is carried out to expose over 180 degrees of the cutting element through the opening relative to an axis of rotation.

Claim 91

Dependent Claim 30 words

84 . The method of claim 72 , wherein: the moving step is carried out to expose over 270 degrees of the cutting element relative to an axis of rotation.

Claim 92

Dependent Claim 23 words

85 . The method of claim 72 , wherein: the moving step is carried out by gradually exposing more of the cutting element.

Claim 93

Dependent Claim 24 words

86 . The method of claim 72 , further comprising the step of: bending a distal portion of the device before the cutting step.

Claim 94

Dependent Claim 32 words

87 . The method of claim 86 , wherein: the bending step is carried out with an axis of rotation maintaining the same orientation relative to a proximal portion of the device.

Claim 95

Dependent Claim 153 words

88 . A method of re-entering a lumen during an endovascular procedure, comprising the steps of: providing a device having a rotatable cutter and an opening, the cutter being movable relative to the opening between a first position and a second position, the cutter being increasingly exposed when moving from the first position to the second position; advancing the device into a false lumen created during an endovascular procedure, the false lumen extending in a wall of a true lumen; orienting the opening toward the true lumen after the advancing step; moving the cutter from the first position toward the second position to expose part of the cutter; determining whether an access path has been created from the false lumen to the true lumen; increasing the amount of the cutter that is exposed until the access path has been created; and directing another endovascular device through the opening and into the true lumen.

Claim 96

Dependent Claim 153 words

88 . A method of re-entering a lumen during an endovascular procedure, comprising the steps of: providing a device having a rotatable cutter and an opening, the cutter being movable relative to the opening between a first position and a second position, the cutter being increasingly exposed when moving from the first position to the second position; advancing the device into a false lumen created during an endovascular procedure, the false lumen extending in a wall of a true lumen; orienting the opening toward the true lumen after the advancing step; moving the cutter from the first position toward the second position to expose part of the cutter; determining whether an access path has been created from the false lumen to the true lumen; increasing the amount of the cutter that is exposed until the access path has been created; and directing another endovascular device through the opening and into the true lumen.

Claim 97

Dependent Claim 29 words

89 . The method of claim 88 , wherein: the providing step is carried out with the cutter being exposed for over 180 degrees when in the second position.

Claim 98

Dependent Claim 29 words

90 . The method of claim 89 , wherein: the providing step is carried out with the cutter being exposed for over 220 degrees when in the second position.

Claim 99

Dependent Claim 30 words

91 . The method of claim 88 , wherein: the providing step is carried out with the cutter being having a gradually increasing exposure when moving toward the second position.

Claim 100

Dependent Claim 41 words

92 . The method of claim 91 , wherein: the providing step is carried out with the cutter being increasing exposed from at least 180 degrees to at least 220 degrees when moving from the first position to the second position.

Claim 101

Dependent Claim 21 words

93 . The method of claim 88 , further comprising the step of: positioning a sheath proximal to the subintimal space.

Claim 102

Dependent Claim 28 words

94 . The method of claim 93 , further comprising the step of: delivering a fluid through the sheath to determine whether the access path has been created.

Claim 103

Dependent Claim 25 words

95 . The method of claim 93 , further comprising: advancing a guidewire through the sheath and through the access path into the true lumen.

Claim 104

Dependent Claim 79 words

96 . An intravascular incising device, comprising: an elongate body, the body having at least one lumen and being sufficiently flexible to be advanced through a patient's vasculature to a treatment site; a torque transmitting element extending through the lumen; a cutting element coupled to the torque transmitting element, the cutting element being movable relative to the opening to a number of discrete positions to vary an amount of the cutting element which is exposed relative to the opening.

Claim 105

Dependent Claim 79 words

96 . An intravascular incising device, comprising: an elongate body, the body having at least one lumen and being sufficiently flexible to be advanced through a patient's vasculature to a treatment site; a torque transmitting element extending through the lumen; a cutting element coupled to the torque transmitting element, the cutting element being movable relative to the opening to a number of discrete positions to vary an amount of the cutting element which is exposed relative to the opening.

Claim 106

Dependent Claim 44 words

97 . The device of claim 96 , wherein: the cutting element is movable from a stored position in which the cutting element is not exposed to a working position where the cutting element is exposed at least 180 degrees relative to the opening.

Claim 107

Dependent Claim 44 words

98 . The device of claim 96 , wherein: the cutting element is movable from a stored position in which the cutting element is not exposed to a working position where the cutting element is exposed at least 180 degrees relative to the opening.

Claim 108

Dependent Claim 44 words

99 . The device of claim 96 , wherein: the cutting element is movable from a stored position in which the cutting element is not exposed to a working position where the cutting element is exposed at least 270 degrees relative to the opening.

Claim 109

Dependent Claim 19 words

100 . The device of claim 96 , wherein: the cutting element may be gradually exposed between 180-220 degrees.

Claim 110

Dependent Claim 19 words

101 . The device of claim 96 , wherein: the cutting element may be gradually exposed between 200-270 degrees.

Claim 111

Dependent Claim 31 words

102 . The device of claim 96 , wherein: the cutting element may be moved longitudinally relative to the body for moving the cutting element between the number of discrete positions.

Claim 112

Dependent Claim 70 words

103 . A method of entering a true lumen from a false lumen during an endovascular procedure, comprising the steps of: providing a guidewire and a reentry device; positioning the guidewire at a subintimal space; advancing the reentry device over the guidewire to the target location; cutting an access path from the subintimal space to a true lumen; and directing the guidewire through the access path into the true lumen.

Claim 113

Dependent Claim 70 words

103 . A method of entering a true lumen from a false lumen during an endovascular procedure, comprising the steps of: providing a guidewire and a reentry device; positioning the guidewire at a subintimal space; advancing the reentry device over the guidewire to the target location; cutting an access path from the subintimal space to a true lumen; and directing the guidewire through the access path into the true lumen.

Claim 114

Dependent Claim 25 words

104 . The method of claim 103 , further comprising the step of: advancing an endovascular device over the guidewire and through the access path.

Claim 115

Dependent Claim 29 words

105 . The method of claim 103 , wherein: the directing step is carried out by directing the guidewire through a different distal opening than during the advancing step.

Claim 116

Dependent Claim 61 words

106 . The method of claim 105 , wherein: the directing step is carried out with the device having a junction with a first arm and a second arm; the advancing step being carried out with the guidewire passing through the first arm; and the directing step is carried out with the guidewire passing through the second arm of the junction.

Claim 117

Dependent Claim 24 words

107 . The method of claim 103 , wherein: the directing step is carried out with a distal portion of the device being bent.

Claim 118

Dependent Claim 42 words

108 . The method of claim 103 , wherein: the directing step is carried out with the reentry device extending through the access path, the guidewire being advanced through the reentry device while the reentry device is positioned in the access path.

Claim 119

Dependent Claim 21 words

109 . The method of claim 103 , further comprising the step of: positioning a sheath proximal to the subintimal space.

Claim 120

Dependent Claim 28 words

110 . The method of claim 109 , further comprising the step of: delivering a fluid through the sheath to determine whether the access path has been created.

Claim 121

Dependent Claim 25 words

111 . The method of claim 109 , further comprising: advancing another guidewire through the sheath and through the access path into the true lumen.

Claim 122

Dependent Claim 25 words

112 . The method of claim 1 , further comprising the step of: measuring a pressure to determine when the access path has been created.

Claim 123

Dependent Claim 25 words

113 . The method of claim 20 , further comprising the step of: measuring a pressure to determine when an access path has been created.

Claim 124

Dependent Claim 28 words

114 . The method of claim 36 , further comprising the step of: measuring a pressure to determine when the opening into the true lumen has been created.

Claim 125

Dependent Claim 25 words

115 . The method of claim 88 , further comprising the step of: measuring a pressure to determine when the access path has been created.

Claim 126

Dependent Claim 25 words

116 . The method of claim 103 , further comprising the step of: measuring a pressure to determine when the access path has been created.

Methods and devices for reentering a true lumen from a subintimal space

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