Patent Publication Number: US-11660439-B2

Title: Modular medical device system

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of U.S. provisional patent application No. 62/803,208 filed on Feb. 8, 2019, and is a continuation-in-part of U.S. application Ser. No. 16/181,805 filed on Nov. 6, 2018 (claiming the benefit of U.S. provisional patent application No. 62/581,998 filed Nov. 6, 2017), which is a continuation-in-part of U.S. application Ser. No. 15/730,946 filed on Oct. 12, 2017 (claiming the benefit of U.S. provisional patent application Nos. 62/453,669 filed Feb. 2, 2017 and 62/407,557 filed Oct. 13, 2016), which is a continuation-in-part of U.S. application Ser. No. 15/196,952 filed on Jun. 29, 2016 (claiming the benefit of U.S. provisional patent application Nos. 62/325,700 filed Apr. 21, 2016; 62/279,858 filed Jan. 18, 2016; 62/249,482 filed Nov. 2, 2015; and 62/188,363 filed Jul. 2, 2015), the entireties of which applications are hereby incorporated by reference into this application. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates generally to a design of an adapter for a medical device for use in the body and more specifically to an adapter intended to convert or augment the medical device, for example a catheter, such that the purpose or configuration of the medical device is modified or expanded. 
     2. Description of the Related Art 
     Catheter type devices are typically long tubular structures with an inner lumen suitable for a guidewire used to navigate the vasculature, inject contrast or therapeutic materials, aspirate thrombus, or provide a means to deliver other devices or therapies to a target site within the vasculature or other body lumen. Catheter type devices are typically inserted through a small opening in the skin or another opening under visual guidance tracked to the target location within the body. Catheters for minimally invasive procedures are typically one-piece, unitary constructions combining structural, therapeutic and diagnostic elements at the distal end of the catheter. 
     U.S. Patent Application Publication No. 2007/0244440 discloses a medical device including a catheter with an expandable tip for use with at least two different sizes of wire guides. The catheter includes a wire guide lumen sized to receive a first wire guide of a first diameter. The catheter may also include a tip lumen that extends in a distal direction from a first opening in communication with the wire guide lumen to a second opening. The first opening is sized to receive the first wire guide, and the second opening is sized to receive a second wire guide of a smaller diameter than the first wire guide. The catheter also includes one or more longitudinal expansion features capable of radially expanding the tip lumen to receive a wire guide of a diameter up to the first diameter through the second opening. 
     U.S. Pat. No. 8,100,884 discloses an adapter assembly for connecting a catheter assembly to a tunneler having a generally tubular body having a first end, a second end and a longitudinal axis extending there through between the first end and the second end. The first end of the adapter is constructed to engage the proximal end of a trocar. The second end of the adapter is constructed to releasably engage at least one catheter lumen. A slider is disposed about the adapter and is longitudinally slidable along the adapter. When the slider is slid towards the second end of the adapter, the slider engages a plurality of legs on the adapter and biases the plurality of legs toward each other and the longitudinal axis of the adapter. 
     U.S. Pat. No. 8,523,840 discloses coupler assemblies to be used with a catheter to connect a proximal end of the catheter to extracorporeal medical equipment. An exemplary coupler assembly includes a spherical linkage coupler for a catheter. The coupler comprises a first cylinder portion for connecting to a structure, and a second cylinder portion for connecting to a distal end of a body of the catheter. The coupler also comprises a spherical linkage including at least two link arms. Each of the two link arms are connected on one end to the first cylinder portion and on the other end to the second cylinder portion. The two link arms connect a portion of the structure to the distal end of the catheter and enable the structure to move relative to the distal end of the catheter in response to an external force exerted on the structure. 
     U.S. Pat. Nos. 9,282,991; 9,808,276; 7,976,557; and U.S. Publication No. 2006/0259005 describe variations of a method of delivering a therapeutic agent, such as a drug, using a cutting balloon wherein the cutting or scoring members may comprise the therapeutic agent coated thereon. The cutting or scoring members are integral with the construction of the balloon and catheter system itself. 
     U.S. Publication No. 2008/0275427 describes a catheter connection system to connect catheter tubes together to form a secure and leak resistant connection. As described the connection system includes a threaded connector inserted into an end of a catheter lumen where an inner portion of the catheter lumen is elastically compliant to conform to the threaded structure of the connector. 
     It is desirable to provide an improved adapter and modular system designed with features that expand, augment, or modify the configuration or intended use of a medical device. The adapter including geometry, mechanical and/or thermal properties to expeditiously attach to the medical device, such as a catheter. 
     SUMMARY OF THE INVENTION 
     This summary is provided to introduce a selection of concepts that are further described below in the detailed description. This summary is not intended to identify key or essential features of the claimed subject matter, nor is it intended to be used as an aid in limiting the scope of the claimed subject matter. 
     In one aspect, a modular medical device system comprises a parent module with a proximal end configured to remain outside the body of a patient and a distal end configured to go inside the body of a patient, the distal end comprising an inner lumen; and an adapter module comprising a proximal portion and a distal portion, an attachment mechanism positioned at the proximal portion and comprising an interfacing element and an elongated element, wherein at least a portion of the interfacing element compresses to engage the inner lumen of the parent module, and wherein the elongated element connects the attachment mechanism to the distal portion of the adapter module. 
     In another aspect, a modular medical device system comprises an adapter module having an elongated element, an interfacing element, a conductor and an electrical connector electrically coupled to the conductor and configured to electrically connect a distal end of the adapter module to the outside of a patient, wherein the interfacing element is configured to couple to a distal end of a medical device. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The foregoing description, as well as further objects, features, and advantages of the present invention will be understood more completely from the following detailed description of presently preferred, but nonetheless illustrative embodiments in accordance with the present invention, with reference being had to the accompanying drawings, in which: 
         FIG.  1 A  is a schematic, longitudinal, cross-sectional view of an embodiment of an adapter in accordance with the teachings of the present invention and a partial schematic, longitudinal, cross-sectional view of a distal end of a medical device or parent. 
         FIG.  1 B  is an enlarged detail view of  FIG.  1 A , showing a proximal end of the adapter. 
         FIG.  1 C  is an enlarged detailed view of  FIG.  1 A , showing part of a distal portion of the adapter. 
         FIG.  2    is a schematic, longitudinal, cross-sectional view of the adapter where the coil of the adapter has been elongated in order to reduce the size of the coil prior to insertion into the target medical device or parent. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  3    is a schematic, longitudinal, cross-sectional view of the adapter where the coil of the adapter has been rotated or twisted in order to reduce the size of the coil prior to insertion into the target medical device. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  4    is a schematic, longitudinal, cross-sectional view of an alternate embodiment of an adapter, and a partial schematic, longitudinal, cross-sectional view of a distal end of a medical device or parent. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  5    is a schematic, longitudinal, cross-sectional view of an alternate embodiment of an adapter, and a partial schematic, longitudinal, cross-sectional view of a distal end of a medical device or parent. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  6    is a schematic, longitudinal, cross-sectional view of an alternate embodiment of an adapter, and a partial schematic, longitudinal, cross-sectional view of a distal end of a medical device or parent. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  7    is a schematic, longitudinal, cross-sectional view of an alternate embodiment of an adapter, where a coil of the adapter has been rotated or twisted in order to reduce the size of the coil prior to insertion into the medical device or parent. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  8 A  is a schematic, longitudinal, cross-sectional view of an adapter according an embodiment of the invention. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  8 B  is an enlarged detail view of  FIG.  8 A , showing a distal portion of the adapter. 
         FIG.  8 C  is an enlarged detail view of  FIG.  8 A , showing a proximal end of a distal portion of the adapter. 
         FIG.  8 D  is an enlarged detail view of  FIG.  8 A , showing a distal end of a distal portion of the adapter. 
         FIG.  8 E  is an enlarged detail view of  FIG.  8 A , showing a proximal portion of the adapter. 
         FIG.  8 F  is an enlarged detail view of  FIG.  8 A , showing a proximal end of a proximal portion of the adapter. 
         FIG.  9 A  is a schematic, longitudinal, cross-sectional view of an adapter according an embodiment of the invention. Break line symbols are utilized to reduce the size of the drawing or schematic for clarity. 
         FIG.  9 B  is an enlarged detail view of  FIG.  9 A , showing a distal portion of the adapter. 
         FIG.  9 C  is an enlarged detail view of  FIG.  9 A , showing a proximal portion of the adapter. 
         FIG.  9 D  is an enlarged detail view of  FIG.  9 A , showing a distal end of a distal portion of the adapter. 
         FIG.  9 E  is an enlarged detail view of  FIG.  9 A , showing a proximal end of a distal portion of the adapter. 
         FIG.  9 F  is an enlarged detail view of  FIG.  9 A , showing a proximal end of a proximal portion of the adapter. 
         FIG.  9 G  is an enlarged detail view of  FIG.  9 A , showing middle elements of a proximal portion of the adapter. 
         FIG.  9 H  is an enlarged detail view of  FIG.  9 A , showing a distal end of a proximal portion of the adapter. 
         FIG.  10 A  is a schematic, longitudinal, cross-sectional view of an adapter according to an embodiment of the invention having two coil elements in a proximal portion of the adapter. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  10 B  is an enlarged detail view of  FIG.  10 A , showing a distal portion of the adapter. 
         FIG.  10 C  is an enlarged detail view of  FIG.  10 A , showing a proximal portion of the adapter. 
         FIG.  10 D  is an enlarged detail view of  FIG.  10 A , showing a proximal end of a proximal portion of the adapter. 
         FIG.  10 E  is an enlarged detail view of  FIG.  10 A , showing a distal end of a distal portion of the adapter. 
         FIG.  10 F  is an enlarged detail view of  FIG.  10 A , showing the proximal coil element, coil located closer to the proximal end of the proximal portion of an adapter. 
         FIG.  10 G  is an enlarged detail view of  FIG.  10 A , showing the distal coil element, coil located closer to the distal end of the proximal portion of an adapter. 
         FIG.  11 A  is a schematic, longitudinal, cross-sectional view of an adapter according an embodiment of the invention where a distal coil element of the adapter has been rotated or twisted in order to reduce the size of the coil prior to insertion into the target catheter or device. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  11 B  is an enlarged detail view of  FIG.  11 A , showing a proximal portion of the adapter. 
         FIG.  11 C  is an enlarged detail view of  FIG.  11 A , showing a distal end of a proximal portion of the adapter. 
         FIG.  11 D  is an enlarged detail view of  FIG.  11 A , showing a distal end of a proximal portion of the adapter and a proximal end of a distal portion of the adapter. 
         FIG.  12 A  is a schematic, longitudinal, cross-sectional view of an adapter according to an embodiment of the invention and a partial schematic, longitudinal, cross-sectional view of a distal end of a medical device, where a distal coil element of the adapter has been rotated or twisted in order to reduce the size of the coil prior to insertion into the target medical device and the proximal coil element that has been inserted into the medical device causing the proximal coil element to elongate and reduce in diameter. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  12 B  is an enlarged detail view of  FIG.  12 A , showing a proximal portion of the adapter. 
         FIG.  12 C  is an enlarged detail view of  FIG.  12 A , showing a proximal end of a proximal portion of the adapter, including a proximal coil element. 
         FIG.  12 D  is an enlarged detail view of  FIG.  12 A , showing a distal end of a proximal portion of the adapter and a proximal end of a distal portion of the adapter. 
         FIG.  13 A  is a schematic, longitudinal, cross-sectional view of an adapter according to an embodiment of the invention and a partial schematic, longitudinal, cross-sectional view of a distal end of a medical device or parent, where a distal coil element of the adapter has been rotated or twisted in order to reduce the size of the coil prior to insertion into the medical device then subsequently released to expand to an inner lumen of the medical device, and a proximal coil element that has been inserted into the medical device causing the proximal coil element to elongate and reduce in diameter. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  13 B  is an enlarged detail view of  FIG.  13 A , showing a proximal portion of the adapter. 
         FIG.  13 C  is an enlarged detail view of  FIG.  13 A , showing a proximal end of a proximal portion of the adapter, including a proximal coil element. 
         FIG.  13 D  is an enlarged detail view of  FIG.  13 A , showing a distal end of a proximal portion of an adapter and a proximal end of a distal portion of the adapter. 
         FIG.  14 A  is a partial schematic, longitudinal, cross-sectional view of an adapter according to an embodiment of the invention and a partial schematic, longitudinal, cross-sectional view of a distal end of a medical device, where a coil element of the adapter has been rotated or twisted in order to reduce the size of the coil prior to insertion into a medical device then subsequently released to expand to an inner lumen of the medical device, and a transverse cross-sectional view Z-Z of a distal portion of the adapter. Break line symbols are utilized to reduce the size of the schematic for clarity. 
         FIG.  14 B  is an enlarged detail view of  FIG.  14 A , showing a proximal end of a distal portion of an adapter. 
         FIG.  14 C  is an enlarged detail view of  FIG.  14 A , showing a distal end of a distal portion of the adapter and a transverse cross-sectional view Z-Z of a distal portion of the adapter. 
         FIG.  15 A  is a partial schematic, longitudinal, cross-sectional view of an adapter according an embodiment of the invention and a partial schematic, longitudinal, cross-sectional view of a distal end of a medical device, where a coil element of the adapter has been rotated or twisted in order to reduce the size of the coil prior to insertion into the medical device then subsequently released to expand to an inner lumen of the medical device and a first and second wire, and a transverse cross-sectional view Z-Z of a distal portion of the adapter. Break line symbols are utilized to reduce the size of the schematic for clarity. 
         FIG.  15 B  is an enlarged detail view of  FIG.  15 A , showing a proximal end of a distal portion of the adapter. 
         FIG.  15 C  is an enlarged detail view of  FIG.  15 A , showing a distal end of a distal portion of the adapter and a transverse cross-sectional view Z-Z of a distal portion of the adapter. 
         FIG.  16 A  is a partial schematic, longitudinal, cross-sectional view of an adapter according to an embodiment of the present invention and a partial schematic, longitudinal, cross-sectional view of a distal end of a medical device, where a coil element of the adapter has been rotated or twisted in order to reduce the size of the coil prior to insertion into the medical device then subsequently released to expand to an inner lumen of the medical device, which also includes a first and second wire, and a transverse cross-sectional view Z-Z of a distal portion of the adapter. Break line symbols are utilized to reduce the size of the schematic for clarity. 
         FIG.  16 B  is an enlarged detail view of  FIG.  16 A , showing a proximal end of a distal portion of the adapter. 
         FIG.  16 C  is an enlarged detail view of  FIG.  16 A , showing a distal end of a distal portion of the adapter and a transverse cross-sectional view Z-Z of a distal portion of the adapter. 
         FIG.  17 A  is a partial schematic, longitudinal, cross-sectional view of an adapter according to an embodiment of the invention and a partial schematic, longitudinal, cross-sectional view of a distal end of a medical device, where a coil element of the adapter has been rotated or twisted in order to reduce the size of the coil prior to insertion into the target medical device then subsequently released to expand to an inner lumen of the medical device, and a transverse cross-sectional views Z-Z and Y-Y. 
         FIG.  17 B  is an enlarged detail view of  FIG.  17 A , showing a proximal end of a distal portion of the adapter. 
         FIG.  17 C  is an enlarged detail view of  FIG.  17 A , showing a distal end of a distal portion of the adapter and a transverse cross-sectional views Z-Z and Y-Y. 
         FIG.  18 A  is a partial schematic, longitudinal, cross-sectional view of a proximal portion of an adapter according to an embodiment of the invention. Break line symbols are utilized to reduce the size of the drawing or schematic for clarity. 
         FIG.  18 B  is a partial schematic, longitudinal, cross-sectional view of a proximal portion of the adapter shown in  FIG.  18 A , where the adapter and proximal portion has been inserted into a medical device. Break line symbols are utilized to reduce the size of the drawing or schematic for clarity. 
         FIG.  18 C  is a partial schematic, longitudinal, cross-sectional view of a proximal portion of the adapter shown in  FIG.  18 A , where the adapter and proximal portion has been inserted into a target medical device and a tensile force has been transmitted to a central tube axially compressing a portion of a coil. Break line symbols are utilized to reduce the size of the drawing or schematic for clarity. 
         FIG.  18 D  is a partial schematic, longitudinal, cross-sectional view of a proximal portion of the adapter, where the adapter and proximal portion has been inserted into a target medical device and a tensile force has been transmitted to a central tube axially compressing a portion of a coil. Break line symbols are utilized to reduce the size of the drawing or schematic for clarity. 
         FIG.  18 E  is an enlarged detail view of  FIG.  18 C  showing a compressed portion of the coil. 
         FIG.  18 F  is an enlarged detail view of  FIG.  18 D  showing a compressed portion of the coil. 
         FIG.  19    is a partial schematic, longitudinal, cross-sectional view of a proximal portion of an adapter according to an embodiment of the invention. Break line symbols are utilized to reduce the size of the drawing or schematic for clarity. 
         FIG.  20 A  is a partial schematic, longitudinal, cross-sectional view of a proximal portion of an adapter according to an embodiment of the invention. Break line symbols are utilized to reduce the size of the drawing or schematic for clarity. 
         FIG.  20 B  is an enlarged detail view of  FIG.  20 A . 
         FIG.  21 A  is a partial schematic, longitudinal, cross-sectional view of an adapter according to an embodiment of the invention, where the adapter has been inserted into a target medical device. Break line symbols are utilized to reduce the size of the drawing or schematic for clarity. 
         FIG.  21 B  is an enlarged detail view of  FIG.  21 A . 
         FIG.  22 A  is a schematic, longitudinal, view of an adapter according to an embodiment of the invention, and includes a schematic representation of a partial portion where the conductors embedded inside the central lumen wall are exposed, and a partial cross-section of the distal portion of the adapter showing the camera module. Break line symbols are utilized to reduce the size of the drawing for clarity 
         FIG.  22 B  is an enlarged detail view of a portion of  FIG.  22 A . 
         FIG.  22 C  is a schematic, longitudinal, view of an adapter according to an embodiment of the invention and includes a schematic representation of a partial portion where the conductors embedded inside the central lumen wall are exposed, and a schematic representation of a distal portion of the adapter including an electrically active element. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  23    is a partial schematic, longitudinal, view of a proximal end of an adapter according to an embodiment of the invention, where the adapter has been inserted into a target medical device. 
         FIG.  24    is a schematic, perspective, view of an adapter according to an embodiment of the invention where the balloon of the adapter is represented as inflated for the purposes of illustration. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  25 A  is a schematic, longitudinal, view of an adapter according to an embodiment of the invention where the balloon of the adapter is represented as inflated for the purposes of illustration, including a partial cross-section of the distal portion containing the balloon, and partial cross-section of the proximal portion containing the inflation connector. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  25 B  is an enlarged detail view of a portion of  FIG.  25 A . 
         FIG.  25 C  is an enlarged detail view of a portion of  FIG.  25 B . 
         FIG.  25 D  is an enlarged detail view of a portion of  FIG.  25 B . 
         FIG.  25 E  is an enlarged detail view of a portion of  FIG.  25 A . 
         FIG.  25 F  is an enlarged detail view of a portion of  FIG.  25 E . 
         FIG.  26    is a schematic, perspective, view of an adapter according to an embodiment of the invention, where the balloon of the adapter is represented as inflated for the purposes of illustration, attached to a target balloon medical device which also represented as inflated for the purposes of illustration. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  27    is a partial schematic, perspective, view of an adapter according to an embodiment of the invention, where the balloon of the adapter is represented as inflated for the purposes of illustration, attached to a target balloon medical device which also represented as inflated for the purposes of illustration, with fittings coupled to the proximal ends of both the adapter and target balloon medical device. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  28 A  is a partial, schematic, longitudinal, view of an adapter according to an embodiment of the invention, where the balloon of the adapter is represented as inflated for the purposes of illustration, attached to a target balloon medical device which also represented as inflated for the purposes of illustration, with fittings coupled to the proximal ends of both the adapter and target balloon medical device, and includes a partial cross-section view of the target balloon medical device and one of the fittings. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  28 B  is an enlarged detail view of a portion of  FIG.  28 A . 
         FIG.  29 A  is a schematic view of an adapter according to an embodiment of the invention, where the adapter includes slender elements running longitudinal from the distal end of the adapter. Break line symbols are utilized to reduce the size of the drawing for clarity. Some adapter elements are obscured by the slender elements. 
         FIG.  29 B  is a schematic view of an adapter according to an embodiment of the invention represented in  FIG.  29 A , where the slender elements running longitudinal from the distal end of the adapter are omitted to allow the obscured adapter elements to be visible. 
         FIG.  29 C  is an enlarged detail view of a portion of  FIG.  29 A , showing a distal end of a distal portion of the adapter. 
         FIG.  29 D  is a schematic longitudinal orthographic view of an adapter according to an embodiment of the invention, where the adapter includes slender elements running longitudinal from the distal end of the adapter.  FIG.  29 D  includes section arrows X-X and Z-Z. Break line symbols are utilized to reduce the size of the drawing for clarity. Some adapter elements are obscured by the slender elements. 
         FIG.  29 E  is a transverse cross-sectional view X-X of the adapter shown in  FIG.  29 D . View X-X includes a cross section through the slender elements and bonded portion of the slender elements of the adapter. 
         FIG.  29 F  is a transverse cross-sectional view Z-Z of the adapter shown in  FIG.  29 D . View Z-Z includes a cross section through the central tube and slender elements of the adapter. 
         FIG.  30 A  is a schematic view of an adapter according to an embodiment of the invention, where the adapter includes slender elements running longitudinal from the distal end of the adapter, and the adapter is attached to a target balloon catheter medical device which is represented as deflated for the purposes of illustration. Break line symbols are utilized to reduce the size of the drawing for clarity. Some adapter elements are obscured by the slender elements. 
         FIG.  30 B  is a schematic view of an adapter according to an embodiment of the invention, where the adapter includes slender elements running longitudinal from the distal end of the adapter, and the adapter is attached to a target balloon catheter medical device which is represented as inflated for the purposes of illustration. Break line symbols are utilized to reduce the size of the drawing for clarity. Some adapter elements are obscured by the slender elements. 
         FIG.  30 C  is an enlarged detail view of a portion of  FIG.  30 B , showing the distal end of the adapter and inflated balloon medical device. 
         FIG.  31 A  is a schematic longitudinal orthographic view of an adapter according to an embodiment of the invention, where the adapter includes slender elements running longitudinal from the distal end of the adapter. This view is an orthographic projection of the longitudinal orthographic view shown in  FIG.  31 B . Break line symbols are utilized to reduce the size of the drawing for clarity. Some adapter elements are obscured by the slender elements.  FIG.  31 B  is a schematic longitudinal orthographic view of an adapter according to an embodiment of the invention, where the adapter includes slender elements running longitudinal from the distal end of the adapter.  FIG.  31 B  includes section arrows V-V and W-W indicating cross sections through the slender elements and bonded portion of the slender elements of the adapter at different longitudinal points along the length of the adapter. Break line symbols are utilized to reduce the size of the drawing for clarity. Some adapter elements are obscured by the slender elements. 
         FIG.  31 C  is an enlarged detail view of a portion of  FIG.  31 B , showing distal end of the adapter. 
         FIG.  31 D  is a transverse cross-sectional view V-V of the adapter as shown in  FIG.  31 B . View V-V includes a cross section through the slender elements and bonded portion of the slender elements of the adapter. 
         FIG.  31 E  is a transverse cross-sectional view W-W of the adapter as shown in  FIG.  31 B . View W-W includes a cross section through the slender elements and bonded portion of the slender elements of the adapter. 
         FIG.  32    is a schematic, perspective, view of an adapter according to an embodiment of the invention, where the interfacing element includes a coil feature. 
         FIG.  33    is a schematic, perspective, view of an adapter according to an embodiment of the invention, where the interfacing element includes a leaf spring feature. The distal portion of the adapter has been truncated to reduce the size of the drawing for clarity. 
         FIG.  34    is a schematic, perspective, view of an adapter according to an embodiment of the invention, where the interfacing element includes a stent strut feature. The distal portion of the adapter has been truncated to reduce the size of the drawing for clarity. 
         FIG.  35    is a schematic, perspective, view of an adapter according to an embodiment of the invention, where the interfacing element includes a left hand and right hand coil features. The distal portion of the adapter has been truncated to reduce the size of the drawing for clarity. 
         FIG.  36    is a schematic, longitudinal orthographic top view, of an adapter according to an embodiment of the invention, where the interfacing element includes a left hand and right hand coil features. The distal portion of the adapter has been truncated to reduce the size of the drawing for clarity. 
         FIG.  37    is a schematic, longitudinal orthographic front view, of an adapter according to an embodiment of the invention, where the interfacing element includes a left hand and right hand coil features. The distal portion of the adapter has been truncated to reduce the size of the drawing for clarity. 
         FIG.  38    is a schematic, longitudinal orthographic front view, of an adapter according to an embodiment of the invention, where the interfacing element includes leaf spring features, and medical device. The adapter is shown being inserted into the distal end of the medical device before the compressible leaf spring elements interface with the lumen of the medical device to compress to a smaller size. The adapter and medical device have been truncated to reduce the size of the drawing for clarity and the medical device is shown in cross-section. 
         FIG.  39    is a schematic, longitudinal orthographic front view, of an adapter according to an embodiment of the invention, where the interfacing element includes leaf spring features, and medical device. The adapter is shown after inserted into the distal end of the medical device after the compressible leaf spring elements interface with the lumen of the medical device to compress to a smaller size. The adapter and medical device have been truncated to reduce the size of the drawing for clarity and the medical device is shown in cross-section. 
         FIG.  40    is a schematic, longitudinal orthographic front view, of an adapter according to an embodiment of the invention, where the interfacing element includes leaf spring features, and medical device. The adapter is shown being inserted into the distal end of the medical device before the compressible leaf spring elements interface with the lumen of the medical device to compress to a smaller size. The medical device is shown with a variable lumen size and the interfacing element engages the lumen and edge created by the change in lumen size. The adapter and medical device have been truncated to reduce the size of the drawing for clarity and the medical device is shown in cross-section. 
         FIG.  41    is a schematic, longitudinal orthographic front view, of an adapter according to an embodiment of the invention, where the interfacing element includes leaf spring features, and medical device. The medical device is shown with a variable lumen size and the interfacing element engages the edge created by the change in lumen size. The medical device adapter also includes a length that extends past the distal end of the medical device lumen. The adapter and medical device have been truncated to reduce the size of the drawing for clarity and the medical device is shown in cross-section. 
         FIG.  42    is partial schematic view of an interfacing element and elongated element embodiment of the invention. 
         FIG.  43 A  is a schematic, longitudinal view of an adapter according to an embodiment of the invention, and includes a schematic representation of a partial portion with optical fibers embedded inside the central lumen wall of the elongated element, and a transverse cross-sectional view Z-Z of the adapter showing the embedded optic fibers. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  43 B  is an enlarged detail view of transverse cross-sectional view Z-Z of the adapter of  FIG.  43 A . 
         FIG.  44    is a partial schematic, longitudinal view of a proximal end of an adapter according to an embodiment of the invention, where the adapter has been inserted into a target medical device. 
         FIG.  45 A  is a schematic, longitudinal view of an adapter according to an embodiment of the invention, and includes a schematic representation of a partial portion with steering wires within inside the central lumen wall of the elongated element, and a transverse cross-sectional view Z-Z of the adapter showing the steering wires within inside the central lumen wall of the elongated element. Break line symbols are utilized to reduce the size of the drawing for clarity. 
         FIG.  45 B  is an enlarged detail view of transverse cross-sectional view Z-Z of the adapter of  FIG.  45 A . 
         FIG.  45 C  is an enlarged detail schematic, longitudinal view of an adapter of  FIG.  45 A  showing the articulating element of the adapter and associated steering wires. 
         FIG.  46    is a partial schematic, longitudinal view of a proximal end of an adapter according to an embodiment of the invention, where the adapter has been inserted into a target medical device. 
     
    
    
     DETAILED DESCRIPTION 
     Reference will now be made in greater detail to various embodiments of the invention, examples of which are illustrated in the accompanying drawings. 
     In accordance with the present invention, an adapter is constructed to have a proximal portion that interfaces with a medical device and a distal portion that modifies, augments or extends the configuration or intended use of the medical device. As an example, the medical device can be a catheter. The proximal portion of the adapter interfaces with the internal lumen of the medical device in a manner to secure the adapter to the medical device during use. The distal portion of the adapter is generally outside the lumen of the catheter or device and is designed with features that expand, augment, or modify the configuration or intended use of the medical device. 
     The proximal portion of the adapter is designed to couple, such as through an interference fit, with an internal lumen of the medical device such that during subsequent use the adapter remains secure. The proximal portion is additionally designed to be easily inserted into the internal lumen of medical device. The proximal portion of the adapter includes an attachment mechanism, more completely described below, that provides securement between the adapter and medical device. The adapter and medical device comprise two modules of a modular medical device catheter system. The attachment mechanism allows an adapter module and a medical device module, also referred to as the parent module, to be combined as required by the physician or physician&#39;s staff in the operating room during a medical procedure to create a modular medical device catheter. Varying combinations of adapter modules, or adapters and parent modules or parents, allows multiple variants of a medical device catheter to be created. This modular medical device catheter system provides the physician with flexibility benefit to construct a medical device catheter, combining structural, therapeutic and diagnostic elements at the distal end for a specific procedural need and the hospital with inventory benefit, i.e. more medical device catheter variants from fewer inventory items or modules. The medical device or parent module typically has a proximal end that remains outside the body of the patient and a distal end that goes inside the body of the patient. Examples of parent modules include balloon catheters, stent delivery system catheters, transcatheter replacement valves, stent graft delivery catheters, dissection repair catheters, atherectomy catheters, ablation catheters, and thrombectomy catheters. 
     In one example, the proximal portion of the adapter includes a coil structure having geometry and mechanical/thermal properties such that the structure is slightly smaller than the internal lumen to fit within the internal lumen in the operating room environment temperature and then expands to a larger size to secure the adapter to the internal lumen of the medical device when it is in-vivo closer to body temperature. For example, the coil structure can be formed of nitinol at a predetermined austentic finish (AF) temperature less than body temperature but greater than the temperature typically expected in an operating room or catheter lab. Alternatively, the coil structure can be physically restrained to have a size smaller than the internal lumen in the operating room environment and then expands to interface with the internal lumen of the medical device once the adapter is seated with the medical device and the physical restraint is removed. Alternatively, the coil structure can be configured to compress as it is inserted into the internal lumen of the medical device and provide securement. 
     The proximal portion can include an internal lumen to preserve a path for a guidewire, or for contrast injection for example. The proximal portion can include a braided structure or slotted tube stent-like geometry which can be compressed to a smaller size and then expanded to secure the adapter to the internal lumen of the catheter or other device. 
     The distal portion of the adapter can be used to modify the configuration of the medical device, for example, to convert a medical device from a single guidewire device to a two (2) guidewire device. 
     In another example, the distal portion of the adapter can include one or more slender elements such as wires or fibers that extend proximally from the distal portion along the medical device or parent module. In one example, the adapter is attached to a balloon such that the slender elements external to the balloon create a scoring effect on a target tissue when inflated. In another example, the slender elements are coated or infused with a medical therapy or therapeutic agent, (pharmacological molecule, stem cell, or another therapeutic agent) to deliver the therapy to a body tissue. In another example, the slender elements include receptor sites to collect cells, tissue or molecules for diagnostic purposes. 
     If the adapter module of a modular medical device catheter includes an internal lumen, additional adapter modules can be added using this internal lumen to further add features, creating an enhanced modular medical device catheter, such as a parent plus a plurality of adapters. The modular arrangement allows a parent and adapter combination to become a parent in a new parent and adapter combination. 
       FIG.  1 A ,  FIG.  1 B , and  FIG.  1 C  illustrates one embodiment of adapter  10  coupled to distal end  213  of medical device  200 . An example of a suitable medical device  200  is a catheter. Medical device  200  can be referred to as a parent. Adapter  10  includes distal portion  20  and proximal portion  30 . Proximal portion  30  is predominately or entirely inside lumen  211  of target medical device  200 . Distal portion  20  of adapter  10  is predominately outside of target medical device  200 . Adapter  10  is co-axial with medical device  200  as shown by longitudinal axis  11 . Proximal portion  30  of adapter  10  includes coil  12 . Preferably coil  12  can be made of nitinol. Coil  12  can be comprised of wire with a cross-sectional size wound to form a general coil shape. 
     As an example of an interfacing element, coil  12  interfaces with lumen  211  of medical device  200  in a manner that secures adapter  10  to medical device  200 . Adapter  10  can be secured to medical device  200  by an interference fit of coil  12  with lumen  211 . Surface  220  of coil  12  can directly engage surface  212  of lumen  211 . Coil  12  can have an austenitic finish temperature (Af) less than body temperature, such as an average of 37° C. of normal body temperature, and greater than a temperature typically expected in an operating room or catheter lab, for example about 25 degrees to about 30 degrees C. Coil  12  can be twisted and or elongated to reduce a size or diameter of coil  12  such that coil  12  has a smaller size or diameter than a size or diameter of lumen  211  to facilitate positioning adapter  10  inside medical device  200 . As adapter  10  warms to body temperature during use in-vivo, coil  12  can expand to provide additional securement to medical device  200 . 
     Alternatively, coil  12  can be designed to be physically restrained or constrained to have a size or diameter smaller than internal lumen  211  of medical device  200  in an operating room environment and coil  12  can expand to interface with the internal lumen  211  of the target catheter or device  200  when the physical restraint is removed, once the adapter  10  is seated within medical device  200 . Coil  12  is shown with a constant round cross-section, alternatively the coil  12  can have a rectangular cross-section of a flat wire coil design. A flat wire design provides the benefit of a lower profile coil  12  but still provides sufficient securement through an interference fit with lumen  211 . The cross-section can be variable along the length of coil  12 . A variable cross-section coil  12  design provides the advantage of biased securement towards either one of the ends of adapter  10 . Coil  12  can have variable flexibility and bending about longitudinal axis  11 . 
     In one embodiment, coil  12  provides additional reinforcement of medical device  200  to improve the kink resistance. Adapter  10  includes tube  16 , coupled to distal portion  20  of adapter  10  and is co-axial with coil  12 . Tube  16  is an elongated element. Tube  16  has funnel portion  13  located at proximal end  30  of adapter  10 . Funnel portion  13  can facilitate tracking of a guide wire from a proximal end (not shown) of medical device  200  to distal portion  20  of adapter  10 . Tube  16  preferably is a polymer tube and can include braiding or other reinforcement. Coil  12  includes proximal end  15  that is coupled, bonded or otherwise attached near proximal end  19  of tube  16 . Proximal end  15  of coil  12  can be retained to a size smaller than a size of lumen  211  to facilitate loading of adapter  10  into medical device  200  in use. Distal end  14  of coil  12  can be retained to a size smaller than a size of lumen  211 . For example, proximal end  15  or distal end  14  can be heat shaped or formed to a smaller size than the size of lumen  211 . 
     Distal end  14  provides a location on coil  12  that can be grabbed or held in order to twist and or elongate coil  12  to make it smaller in size to facilitate positioning the adapter  10  inside medical device  200 . Distal portion  20  of adapter  10  is preferably made from a thermoplastic elastomer. Example thermoplastic elastomers or soft polymers include but are not limited to, polyether urethane and polyether block amide, such as for example ˜40 D PEBAX manufactured by Arkema. 
     In this embodiment, distal portion  20  is designed to modify medical device  200  that has a single guidewire access to have a two guidewire access. Distal portion  20  includes first lumen  21  for a first guidewire and second lumen  22 . Second lumen  22  connects to lumen  211  of medical device  200  by way of tube  16  of adapter  10 . This allows the user extra flexibility, for example to exchange guidewires, or to administer contrast or medications through the target catheter or device lumen  211 . The path of a first guidewire is illustrated by first lumen centerline  23  and the path of a second guidewire is illustrated by the second lumen centerline  24 . Accordingly, the path of lumen centerline  23  is outside of device  200 . 
     Distal portion  20  includes reduced size portion  17  at proximal end  26  of distal portion  20  which is designed through choice of materials, for example thermoplastic elastomers or soft polymers, and of a geometry to interface with lumen  211  of medical device  200 . A slight interference fit between reduced size portion  17  and lumen  211  provides a stable structure during introduction of the coupled adapter  10  and medical device  200  into a body cavity or vessel. Adapter  10  can include a tapered distal end  27  of distal portion  20  which facilitates tracking the medical device  200  with attached adapter  10  inside a body lumen. 
       FIG.  2    illustrates adapter  10  in a configuration where coil  12  has been reduced to a smaller size by elongating coil  12 .  FIG.  3    illustrates adapter  10  in a configuration where the coil  12  has been reduced to a smaller size by rotating or twisting coil  12 . An alternate embodiment of adapter  10  is where a combination of coil  12  twisting and elongating reduces the size of coil  10  such that it can fit within medical device  200 . Distance Ds 2  between distal end  14  of coil  12  and proximal end  26  of distal portion  20  in  FIG.  2    and  FIG.  3    is smaller than distance Ds 1  between distal end  14  of coil  12  and proximal end  26  of distal portion  20  as illustrated in  FIG.  1 C . In an alternate embodiment of adapter  10 , if the user twists and or elongates coil  12  such that distal end  14  of coil  12  is within a predetermined distance of proximal end  26  of distal portion  20 , then the user would know adapter  10  is safe to insert into medical device  200 . For example, tube  16  can be marked to indicate the appropriate location of distal end  14  of coil  12 . 
       FIG.  4    illustrates an alternate embodiment of the present invention shown as adapter  40 . Adapter  40  has distal portion  41  and proximal portion  42  similar to distal portion  20  and proximal portion  30  of adapter  10  as shown in  FIGS.  1 A,  1 B and  1 C . Adapter  40  includes tube  16  with funnel portion  13  located at proximal portion  42  of adapter  40 . Tube  16  is coupled to distal portion  41 . Coil  12  is also coupled to distal portion  41  and interfaces with lumen  211  of medical device  200  in a manner that secures adapter  40  to medical device  200 . Securement can be achieved in a similar manner as previously described for adapter  10 . 
       FIG.  5    illustrates an alternate embodiment of the present invention shown as adapter  50 . Adapter  50  has distal portion  51  and proximal portion  52  similar to distal portion  20  and proximal portion  30  of adapter  10  as shown in  FIGS.  1 A,  1 B and  1 C . Adapter  50  is similar to adapter  40 , except portion  53  of coil  12  that interfaces with lumen  211  has a larger pitch than that of adapter  40 . For example, the pitch can be in the range of about 2 to about 10 times the size of the coil-sectional size of the wire of coil  12 . Adapter  50  also includes proximal end  25  of coil  12  which is similar to distal end  14  of adapter  10  in both use and form, except coil  12  is elongated and or twisted toward the proximal portion  52  of adapter  50  to make the size of coil  12  smaller to facilitate insertion of adapter  50  into medical device  200 . 
       FIG.  6    illustrates an alternate embodiment of the present invention shown as adapter  60 . Adapter  60  has distal portion  61  and proximal portion  62  similar to distal portion  20  and proximal portion  30  of adapter  10  as shown in  FIGS.  1 A,  1 B and  1 C , as well as other similar features. Proximal portion  62  includes coil  12  which has a reduced sized portion  18  such that it grips tube  16 . Coil  12  can be heat shaped or formed with a portion that interfaces with lumen  211  of medical device  200 . Reduced sized portion  18  has an inside diameter dia 1  smaller than outside diameter dia 2  of tube  16  to contact and grip tube  16  during use. Reduced diameter portion  18  of coil  12  can be bonded, glued, or heat reflowed to tube  16 , for example, to further couple coil  12  to proximal portion  62 . 
       FIG.  7    illustrates an adapter  70  in a configuration where coil  12  has been reduced to a smaller size by elongating and or twisting coil  12 , similarly illustrated in  FIG.  2    and  FIG.  3   . Adapter  70  has distal portion  71  and proximal portion  72  similar to distal portion  20  and proximal portion  30  of adapter  10  as shown in  FIGS.  1 A,  1 B and  1 C . Distal portion  71  includes single lumen tip  73 , co-axial with longitudinal axis  11 . Single lumen tip  73  has been reinforced with reinforcement section  74 . For example, reinforcement section  74  can be a coil or braid. Reinforcement section  74  includes proximal coil portion  75  which extends past the proximal end of single lumen tip  73 . Proximal coil portion  75  provides a slight interference fit with lumen  211  and a stable interface during initial insertion of adapter  70  into medical device  200  by the user. Reinforcement section  74  reinforces distal portion  71  and can facilitate tracking medical device  200  through a tight lesion. 
       FIG.  8 A ,  FIG.  8 B ,  FIG.  8 C ,  FIG.  8 D ,  FIG.  8 E , and  FIG.  8 F  illustrate an alternate embodiment of the present invention shown as adapter  100 . Adapter  100  has distal portion  170  and proximal portion  110 . Proximal portion  110  includes coil  130 . Coil  130  is wound from wire  136  and has multiple diameters along its length. In one embodiment, wire  136  is flat with a rectangular or square cross-section. For example, coil  130  can have a wound length A  131  at a diameter øA  137  at proximal end of coil  130 . The wound pitch of wire  136  along wound length A  131  is variable, not constant, and changes from a pitch that is approximately twice the width  162  of flat wire  136  at proximal end of the wound length A  131 , to a pitch that is approximately equal to a width of flat wire  136 , such that wire  136  is close wrapped at distal end of wound length A  131 . A variable pitched wound length has advantages in that the farther spaced pitched coil can be more flexible, and the close wrapped coil can be stiffer and stronger in torsion or bending. A variable pitched wound length also has advantages in that the farther spaced pitched coil can also provide a better bonding geometry such that a bonding agent or adhesive can flow between wraps of coil  130 . As wire  136  is wound distally to form coil  130 , the diameter of the coil  130  transitions from a size øA  137  to a larger size øB  138  over length transition  132 . Wire  136  is wound over length B  133  at a size øB  138 . The wound pitch of wire  136  along wound length B  133  is variable, not constant, and changes from a pitch that is approximately equal to width  162  of wire  136 , such that wire  136  is close wrapped, to a significantly wider pitch that is approximately more than 5 times the close wrapped pitch. A dramatic or rapid change in pitch from close wrapped to more than 5 times width  162  of flat wire  136  is advantageous because it creates a wedge when coil  130  is constrained within internal lumen  211  of medical device  200  during use and can improve the interference fit and retention properties of adapter  100  within medical device  200 . Typically, øA  137  would be dimensionally smaller than lumen  211  of the target medical device  200  and øB  138  would be dimensionally larger than lumen  211  of the medical device  200 . As wire  136  is wound distally to form coil  130  the diameter of coil  130  transitions from a size øB  138  to a smaller size øD  139  over length transition  134 . The wound pitch of wire  136  along wound length transition  134  is approximately uniform. 
     In an alternate embodiment, the wound pitch of wire  136  along wound length transition  134  is variable. Wire  136  is wound distally from length transition  134  to continue to form coil  130  at a size øD  139  over a wound length D  135 . Typically, øD  139  would be dimensionally smaller than lumen  211  of medical device  200 . A portion of wound length D  135  of coil  130  at a size øD  139  is within cavities  178  and  177  of distal portion  170  of adapter  100 . Cavity  177  is sized to interface with a distal end of medical device  200  and cavity  178  is sized to accommodate the coil  130  at a size øD  139 . Cavity  178  is sized to allow wound length D  135  of coil  130  to move freely within cavity  178  when there is not an external mechanism gripping, pinching or clamping proximal end of distal portion  170  in the area of cavity  178 . When there is an external mechanism gripping, pinching or clamping the proximal end of distal portion  170  in the area of cavity  178 , cavity  178  is sized to prevent a portion of coil  130  in wound length D  135  from rotating or moving, holding coil  130 , which has been previously rotated/twisted to a smaller size state to facilitate insertion of proximal portion  110  of adapter  100  into medical device  200 . 
     Coil  130  can be made from Nitinol and have an austentic finish temperature (Af) approximately equal to or less than an ambient temperature of the operating room or catheter lab environment so coil  130  will expand when released from a smaller size state after insertion into medical device  200 . Alternatively, coil  130  can be made from Nitinol and have an austenitic finish temperature (Af) less than body temperature but greater than the temperature typically expected in an operating room or catheter lab, for example about 25 C-30 C, except in zone T  161  where coil  130  has been selectively heat treated to have an austentic finish temperature (Af) approximately equal to or less than an ambient temperature operating room or catheter lab environment, for example less than about ˜18 C, to enable zone T  161  of Nitinol coil  130  to expand when released from a smaller size state after insertion into medical device  200  in the catheter lab environment. Coil  130  having multi-zone or variable thermal properties has advantages in that it can be easier to insert adaptor  100  into medical device  200  with some of coil  130  having a higher Af temperature. The selectively heat treated portion of coil  130  in zone T  161  is biased to engage internal lumen  211  of medical device  200  more than the rest of coil  130  to facilitate creating the wedge, as described above, after coil  130  is released from a smaller size state and constrained within internal lumen  211  of medical device  200 . As adapter  100  warms to body temperature during use in-vivo the zone T is  161  of coil  130  provides additional securement and structure to adapter  100 . Zone T  161  as shown includes portion of length A  131 , transition  132  and portion of length B  133 . Alternatively, zone T  161  can include just a portion of transition  132  and a portion of length B  133  or other combinations. 
     Coil  130  is coupled to, bonded to or otherwise attached to central tube  182  of central lumen  183  of adapter  100  at part or all of the wound length A  131  at øA  137 . Proximal end  120  of proximal portion  110  of adapter  100  includes inner element  122  and outer element  121 . Inner element  122  and outer element  121  can form a funnel shape. Outer element  121  can be radiopaque or partially radiopaque to provide a landmark for proximal end  120  of adapter  100  when used in-vivo. The funnel shape of proximal end  120  of the adapter  100  can facilitate the back loading of a guidewire through the medical device  200  and adapter  100  during use. Proximal end  120  of adapter  100  is coupled, bonded or otherwise attached to the central tube  182 . In one embodiment, central tube  182  can be unitary with inner element  122 . 
     Central tube  182  connects proximal end of coil  130 , in the area of Length A  131  and proximal end  120  to distal portion  170 . Distal portion  170  of adapter  100  has an outer body  179  that is typically cylindrical or a revolved shape. Alternatively, outer body can have a non-revolved profile in portions or entirely. Outer body  179  can be made from a polymer. Outer body can be reinforced with metal, polymer or ceramic fibers, wire, laser cut hypotube and the like. Outer body  179  can be a laminated structure which can include multiple tube elements or materials. Outer body  179  can have a stepped tapered shape with first outside diameter  185  and second outside diameter  184  connected by tapered portions. Distal portion  170  has first exit lumen  186  of central lumen  183  and second exit lumen  187  of central lumen  183  at opposite each other in outer body  179 . First exit lumen  186  is angled at angle A 1  toward proximal portion  110  of adapter  100  from the central axis of central lumen  183 . An angle in a direction of angle A 1  can be advantageous when a guidewire is tracked through central lumen  183  starting at distal tip  181  of distal portion  170 , exiting through first exit lumen  186 . Second exit lumen  187  is angled at angle A 2  toward distal end of adapter  100  from the central axis of central lumen  183 . An angle in a direction of angle A 2  can be advantageous when a guidewire is tracked through central lumen  183  at proximal end  120  of proximal portion  110 , exiting through second exit lumen  187 . Central tube  182  terminates proximal to distal tip  181  such that a portion of central lumen  183  is formed only by outer body  179 . Alternatively, central tube  182  could extend to distal tip  181  or terminate at a more proximal location within outer body  179 . Central tube  182  can form central lumen  183  for a majority of the length of distal portion  170  to add strength and rigidity if required, for example if central tube  182  was a braided or wire reinforced structure. 
     In one embodiment, coil  130  has been rotated or twisted about the longitudinal axis of coil  130  and central tube  182 , while central tube  182  and a portion of wound length A  131  at øA  137  attached to central tube  182  are held fixed to decrease its size, specifically in transition  132 , length B  133 , and transition  134 . After coil  130  has been rotated or twisted to decrease the size of transition  132 , length B  133 , and transition  134 , a portion of distal end  198  of coil  130 , length D  135 , which is already at a small diameter, can be held and fixed relative to distal portion  170  and coupled central tube  182  such that the coil  130  will remain at a reduced diameter. When a portion of distal end  198  of coil  130 , length D  135  that was held is released, coil  130  will expand back from the small size state to its unconstrained size state and this expansion will tend to happen starting at unattached distal end  197 , length D  135  as coil  130  starts to expand/unwind from the distal end and progressively expands/unwinds moving proximal. In one embodiment, as coil  130  progressively expands/unwinds from distal end  197  to proximal end of coil  130 , distal elements of coil  130  do not substantially inhibit the expansion and engagement of the portion transition  132  and Length B  133  to internal lumen  211  of medical device  200 , to facilitate creating the wedge. 
       FIG.  9 A ,  FIG.  9 B ,  FIG.  9 C ,  FIG.  9 D ,  FIG.  9 E ,  FIG.  9 G  and  FIG.  9 H  illustrate an alternate embodiment of the present invention shown as adapter  101 . Adapter  101  is similar to Adapter  100  and has distal portion  171  and proximal portion  111 . Proximal portion  111  includes coil  140  which is similar to coil  130 . Coil  140  is wound from wire  136  and has multiple diameters along the length of coil  140 . Coil  140  as shown has a wound length A  141  at a diameter øA  137  at proximal end  157  of coil  140 . The wound pitch of wire  136  along wound length A  141  is variable, not constant, and changes from a pitch that is approximately twice the width  162  of flat wire  136  at the proximal end of the wound length A  141 , to a pitch that is approximately equal to the width  162  of wire  136 , such that wire  136  is close wrapped at the distal end of wound length A  141 . A variable pitched wound length has advantages that the farther spaced pitched coil can be more flexible, and the close wrapped coil can be stiffer and stronger in torsion or bending. A variable pitched wound length can have advantages in that the farther spaced pitched coil can also provide an improved bonding geometry such that a bonding agent or adhesive could flow between wraps of coil  140 . As wire  136  is wound distally to form coil  140 , the diameter of the coil  140  transitions from a size øA  137  to a larger size øB  138  over length transition  160 . Wire  136  is wound over a length B  133  at a size øB  138 . The wound pitch of wire  136  along wound length B  133  is variable, not constant, and changes from a pitch that is approximately equal to width  162  of wire  136 , such that wire  136  is close wrapped, to a significantly wider pitch that is approximately more than 5 times width  162  of the flat wire  136 . A dramatic or rapid change in pitch from close wrapped to more than 5 times the width  162  of wire  136  as shown is advantageous because it creates a wedge when coil  140  is constrained within internal lumen  211  of medical device  200  during use and can improve the interference fit and retention properties of adapter  101  within the catheter or device  200 . Typically, øA  137  would be dimensionally smaller than lumen  211  of medical device  200  and øB  138  would be dimensionally larger than lumen  211  of the medical device  200 . As wire  136  is wound distally to form coil  140  the diameter of coil  140  transitions from size øB  138  to a smaller size øC  144  over length transition  142 , the wound pitch of wire  136  along wound length transition  142  is substantially uniform. Alternatively, wound pitch of wire  136  along wound length transition  142  is variable. Wire  136  is wound distally from length transition  142  to continue to form coil  140  at a size øC  144  over wound length C  143 . øC  144  can be dimensionally similar to or slightly smaller than lumen  211  of medical device  200  so that as coil  140  was unconstrained from a small size state in use to secure adapter  101  to internal lumen  211 , wound length C  143  of coil  140  at size øC  144  would be less likely to inhibit wound length B  133  of coil  140  at size øB  138  from engaging and securing coil  140  to internal lumen  211  of medical device  200 . As wire  136  is wound distally to form coil  140  the diameter of coil  140  transitions from size øC  144  to a smaller size øD  139  over length transition  146 , the wound pitch of wire  136  along wound length transition  146  is substantially uniform. Alternatively, wound pitch of wire  136  along wound length transition  146  is variable. Wire  136  is wound distally from length transition  146  to continue to form coil  140  at a size øD  139  over wound length D  145 . Typically, øD  139  would be dimensionally smaller than lumen  211  of medical device  200 . A portion of the wound length D  145  of coil  140  at a size øD  139  is within cavities  178  and  177  at proximal end  199  of distal portion  171  of adapter  101 . Cavity  177  is sized to interface with distal end (not shown) of medical device  200  and cavity  178  is sized to accommodate coil  140  at a size øD  139 . 
     Cavity  178  is sized to allow wound length D  145  of coil  140  to move freely within cavity  178  when there is not an external mechanism gripping, pinching or clamping proximal end  199  of distal portion  171  in the area of cavity  178 . When there is an external mechanism gripping, pinching or clamping proximal end  199  of distal portion  170  in the area of cavity  178 , cavity  178  sized to prevent a portion of coil  140  in wound length D  145  from rotating or moving, holding coil  140 , which has been previously rotated/twisted to a smaller size state to facilitate insertion of proximal portion  111  of adapter  101  into medical device  200 . 
     Coil  140  is coupled to, bonded to or otherwise attached to second tube element  190  forming a portion of second lumen  191  of adapter  101  at or along part or all of the wound length  141  at øA  137 . It may be advantageous for wound length  141  to be attached to second tube element  190  predominately close to transition  160  such that an uncoupled portion of wound length  141  could extend proximally to add more structure and support to adapter  101  and medical device  200 . Proximal end  120  of adapter  101  is attached to second tube element  190  in a similar manner as proximal end  120  of adapter  100  is attached to central tube  182 . 
     Distal portion  171  of adapter  101  has outer body  179  that is typically cylindrical or a revolved shape. Alternatively, distal portion  171  of adapter  101  has outer body  179  that has a non-revolved profile in portions or throughout, similar to outer body  179  of adapter  100  shown in  FIG.  8 A . Second tube element  190  is attached or coupled to outer body  179 , thereby connecting proximal end of coil  140  in the area of Length A  141  and proximal end  120  to distal portion  171 . Distal portion  171  has first tube element  188  which forms a portion of first lumen  189 . As shown, first tube element  188  terminates proximal to distal tip  181  such that a portion of first lumen  189  is formed only by the outer body  179 . First tube element  188  could extend to distal tip  181  or terminate at a more proximal location within outer body  179 . Second lumen  191  and first lumen  189  exit outer body  179  in a manner similar to second exit lumen  187  and first exit lumen  186 . Second tube element  190  and first tube element  188  are shown extending to edge  230  of outer body  179  of distal portion  171 . Alternatively, second tube element  190  and first tube element  188  can terminate before edge  230  and such that a portion of second lumen  191  and first lumen  189  can be formed by outer body  179  of distal portion  171 . 
       FIG.  10 A ,  FIG.  10 B ,  FIG.  10 C ,  FIG.  10 D ,  FIG.  10 E ,  FIG.  10 F  and  FIG.  10 G  illustrate an alternate embodiment of the present invention, adapter  102 . Adapter  102  is similar to adapter  100  and has distal portion  172  and proximal portion  112 . Proximal portion  112  includes coil  130  located closer to distal portion  172  and coil  147  located closer to proximal end  123 . Coil  130  is a left handed helix and coil  147  is a right handed helix. Coil  130  has been described as part of adapter  100 . Coil  147  is similar to coil  130 . Coil  147  is wound from wire  153  and has multiple diameters along the length of the coil  147 . Wire  153  can be a flat wire. Coil  147  as shown has a wound length E  148  at a diameter (ø) øE  151  at the proximal end of coil  147 . As wire  153  is wound distally to form coil  147  the diameter of coil  147  transitions from a size øE  151  to a larger size øF  152  over a length transition  149 . Wire  153  is wound over a length F  150  at a size øF  152 . The wound pitch of  153  along wound length F  150  is variable, not constant, and changes from a pitch that is approximately equal to the width of wire  153 , such that wire  153  is close wrapped, to a significantly wider pitch that is approximately more than 5 times the width of wire  153 . A dramatic or rapid change in pitch from close wrapped to more than 5 times the width of wire  153  is advantageous because it creates a wedge when coil  147  is constrained within internal lumen  211  of medical device  200  during use and can improve the interference fit and retention properties of adapter  102  within medical device  200 . Typically, øE  151  would be dimensionally smaller than lumen  211  of medical device  200  and the øF  152  would be dimensionally larger than lumen  211  of medical device  200 . 
     Adapter  102  includes coaxial tube elements, central tube  192  and reinforcing tube member  194 . Central tube  192  forms a portion of central lumen  193  of adapter  102 . Proximal end  123  of adapter  102  is attached or coupled to the central tube  192 . Proximal end  123  is comprised of funnel element  124 . Central tube  192  and funnel element  124  can be unitary such that funnel element  124  is a flared end of central tube  192 . Funnel element  124  is advantageous in that it can facilitate back loading a guide wire through the medical device  200  and adapter  102 . Central tube  192  and reinforcing tube member  194  are both attached, bonded or coupled to distal portion  172  of adapter  102 . As shown, reinforcing tube member  194  terminates proximally to central tube  192  which terminates proximal to distal end  181  of proximal portion  172  of adapter  102 . An alternate embodiment or configuration can have reinforcing tube member  194  attached to distal portion  172  and central tube  192  attached to reinforcing tube member  194  to form adapter  102 . This embodiment has advantages if reinforcing tube member  194  were to terminate closer to distal tip  181  to include features to optimize the tip performance, for example as a crossing support device, while central tube  192  predominately provides a more optimized central lumen  193  for a guide wire as an example. In this embodiment, reinforcing tube member  194  and central tube  192  can terminate approximately together or central tube  192  can be more proximal than reinforcing tube member  194 . 
     Coil  147  is attached, bonded or otherwise coupled to the reinforcing tube member  194  at all or a portion of length E  148 . This could be accomplished using an adhesive to attach a portion of length E  148  to reinforcing tube member  194 . In a similar manner as previously described, a portion or all of the length A  131  of coil  130  is bonded or attached to reinforcing tube member  194 . The inside diameter of coil  130  at a size of øD  139  is typically larger than the outside diameter of second tube element  190  or central tube  182  or reinforcing tube member  194 . 
       FIG.  11 A ,  FIG.  11 B ,  FIG.  11 C , and  FIG.  11 D , illustrate adapter  102  while coil  130  has been rotated or twisted in a manner that wraps or winds it down to a smaller diameter a  155 . Coil  130  has been rotated or twisted such that transition  132 , wound length B  133  and transition  134  have been made to be held in a state at a smaller diameter a  155  over a combined wound length of transitions  132  and length B  154 . Diameter a  155  is approximately equal to or smaller than internal lumen  211  of medical device  200  to facilitate inserting adapter  102 . Temporary constraining element  195  is positioned around this portion of coil  130  to secure coil  130  at smaller diameter a  155 . Temporary constraining element  195  is advantageous to allow coil  130  to be held in smaller diameter a  155  without the need to hold or restrain from moving length D  135  section of coil  130 . Length D  135  is not attached or coupled to reinforcing tube member  194 . 
       FIG.  11 A ,  FIG.  11 B ,  FIG.  11 C , and  FIG.  11 D  show clamping element  196  pinching or holding a portion of Length D  135  from rotating such that temporary constraining element  195  can be removed and coil  130  would still be held in a state that includes smaller diameter a  155 . It may be advantageous to include a temporary constraining element  195  such that only temporary constraining element  195  holds coil  130  in a state at a smaller diameter a  155  in an adapter packaging suitable for terminal sterilization and or shipping, transportation and inventory at the customer site, which would minimize the amount of time the load at the attached portion of coil  130  in Length A  131  would need to be reacted. When the adapter is ready to be used in an operating room or catheter lab, clamping element  196  can be applied and temporary constraining element  195  can be removed to allow insertion into medical device  200 . 
       FIG.  12 A ,  FIG.  12 B ,  FIG.  12 C , and  FIG.  12 D , illustrate adapter  102  after it has been initially inserted into medical device  200  while coil  130  has been rotated or wound down to a smaller diameter a  155  and held in that position by clamping element  196 . Coil  147  is shown after it has been inserted in internal lumen  211  of medical device  200 . As coil  147  is inserted the portion of length F  150  and transition  149  as shown in  FIG.  11 A ,  FIG.  11 B ,  FIG.  11 C , and  FIG.  11 D  conforms to the size of inner lumen  211  of medical device  200  and becomes a smaller diameter ø″  159  by elongating and or rotating. Similarly to as described previously, a dramatic or rapid increase in pitch from close wrapped to more than 5 times the close wrap pitch, which is approximately the width of wire  153 , as shown, is advantageous because it creates a wedge with an angle A  127 , equal to or greater than approximately 15 degrees, when coil  147  is constrained within internal lumen  211  of medical device  200  during use, and can improve the interference fit and retention properties of adapter  100  within medical device  200 . In the embodiment of adapter  102 , coil  147  is the leading coil inserted into internal lumen  211  of medical device  200 . As coil  147  is inserted into internal lumen  211 , the wraps of wire  153  that are at a size approximately equal to internal lumen  211 , located within transition  149  and length F  150 , engage surface  212  of internal lumen  211  and reduce in size by elongating and rotating (predominately elongating) such that the transition and length F  158  is longer than the combination of transition  149  and length F  150 , and the entire coil  147  can be inserted into medical device  200 . This mode of action is different than that of coil  130 . 
     As shown in  FIG.  13 A ,  FIG.  13 B ,  FIG.  13 C , and  FIG.  13 D , after adapter  102  is inserted into target device or catheter  200  and clamping element  196  is removed, coil  130  will rotate and expand to the size of internal lumen  211  to engage surface  212  of internal lumen  211  over a combined wound length of length B  156 , which includes portions of transition  132 , length B  133 , and transition  134 . Coil  130  is designed such that, upon expansion to conform to internal lumen  211  as described, within coil  130  geometry there is a dramatic or rapid increase in pitch from close wrapped to more than 5 times the close wrap pitch, which is approximately the width of wire  136 , and which creates a wedge with an angle B  163  equal to or greater than approximately 15 degrees. An advantage to the mode of action of coil  130  versus the mode of action of coil  147  is that by predominantly rotating coil  130  to conform to the internal lumen  211  instead of predominately elongating coil  147  to conform to the internal lumen  211 , coil  130  will be less likely to have axial re-coil when allowed to expand, and the force to insert adapter is removed. Coil  147  can be pulled into the lumen  211  of medical device  200  as adapter  102  is inserted into medical device  200  via the bonded connection in Length A  131  to reinforcing tube member  194 . After adapter  102  has been inserted into medical device  200 , coil  147  will tend to axially re-coil toward distal end of adapter  102 , whereas coil  130  rotates into position without an external pulling force. Including both modes of action in one adapter is advantageous because it provides redundancy in case one mode is less effective than the other in retaining adapter  102  in medical device  200 . Additionally, coil  130  and coil  147  are wound in opposite directions such that if adapter  102  is placed under an external torsional load, adapter  102  optimally reacts in either direction of an external torsional load. 
       FIG.  14 A ,  FIG.  14 B , and  FIG.  14 C  illustrate adapter  103  after it has been inserted into medical device  200 , and coil  130  has been deployed to engage internal lumen  211  securing adapter  103 . Adapter  103  includes distal portion  173  and proximal portion  113  very similar to the previously described proximal portion  110  and proximal portion  111 . Distal portion  173  of adapter  103  has outer body  179  that is typically cylindrical or a revolved shape. Alternatively, distal portion  173  of adapter  103  can have a non-revolved profile in portions or throughout. Outer body  179  has a stepped tapered shape with first outside profile  185 , second outside profile  184  and third outside profile  180  connected by tapered portions. Distal portion  173  has first tube element  188  which forms a portion of first lumen  189 . First tube element  188  terminates proximal to distal tip  181  such that a portion of first lumen  189  is formed only by outer body  179 . First tube element  188  could extend to distal tip  181  or terminate at a more proximal location within outer body  179 . Second tube element  190 , which forms a portion of second lumen  191 , connects coil element  130  of proximal portion  113  to distal portion  173 . Second lumen  191  and first lumen  189  exit outer body  179  in a manner similar to second exit lumen  187  and first exit lumen  186 . Second tube element  190  and first tube element  188  are shown partially extending to edge  230  of outer body  179  of distal portion  173  where a portion of second tube element  190  and first tube element  188  terminate before  230  edge of outer body  179 , such that a portion of second lumen  191  and first lumen  189  are formed by outer body  179  of distal portion  173 . Third outside profile  180  of outer body  179  includes first cavity  166  and second cavity  169 , as shown in longitudinal cross section and transverse cross section Z-Z. First cavity  166  and second cavity  169  are shown as open cavities. Alternatively, first cavity  166  and second cavity  169  can be a closed cavity, such as a circle shaped cavity. First cavity  166  and second cavity  169  are shown to be 180 degrees opposite each other. Alternatively, first cavity  166  and second cavity  169  can have alternative orientations. 
       FIG.  15 A ,  FIG.  15 B , and  FIG.  15 C  illustrate adapter  103 , as shown in  FIG.  14 A ,  FIG.  14 B , and  FIG.  14 C  with the addition of first wire  167  and second wire  168 . Preferably, first wire  167  originates with a first end outside the patient (not shown) and extends distally along the outside of medical device  200 , then through first cavity  166  and first lumen  189 , exiting distal end  181  of distal portion  173  and extends to second end  231  of first wire  167 . Preferably, second wire  168  originates with a first end outside the patient (not shown) and extends distally through proximal end (not shown) of medical device  200  and continues inside lumen  211  of medical device  200 , through second lumen  191  then wrapping to extend back proximally through second cavity  169  extending proximally along the outside of medical device  200 , and extends to second end (not shown) of second wire  168 . Second end (not shown) of second wire  168  can terminate outside the patient body. Adapter  103  can be advantageous when medical device  200  is a percutaneous transluminal angioplasty balloon, for example. First wire  167  can act a guide wire to track medical device  200  which is a percutaneous transluminal angioplasty balloon to the site of an arterial lesion or blockage as well as provide a mechanism to induce a stress concentration into the wall of the artery and lesion, preferentially dissecting or disrupting the lesion to improve dilation performance of the balloon at the target lesion. Second end of second wire  168  can extend proximally past the balloon in medical device  200  such that second wire  168  also provides a mechanism to induce a stress concentration similar to first wire  167 . Second wire  168  can have curve  164 . For example, second wire  168  can be manufactured from Nitinol and be heat treated to set a shape with curve  164 . Alternately, second wire  168  can be designed to be readily shaped to curve  164 . For example, second wire  168  can be manufactured from Nitinol and be heat treated to have an Af temperature such that second wire  168  is easily bent to curve  164  and stays in that shape during use, for example at an Af temperature above body temperature ( 37 C). Second wire  168  can be positioned into adapter  103  and medical device  200  of a balloon prior to introduction of adapter  103  and medical device  200  into the patient. After the ballooning procedure is completed, second wire  168  can be withdrawn from proximal end (not shown) of medical device  200 . Alternatively, second wire  168  is tracked through medical device  200  and positioned in-vivo. 
       FIG.  16 A ,  FIG.  16 B , and  FIG.  16 C , illustrate adapter  104  which is similar to adapter  103 . Adapter  104  includes distal portion  174  which includes third outside profile  126  of outer body  179 . Second wire  125  includes first end  232  which is coupled or attached to outer body  179  at top or edge  233  of third outside profile  126 . Second wire  125  extends proximally from outer body  179  and distal portion  174  along the outside of medical device  200  and extends to second end (not shown) of second wire  125 . Second end (not shown) of second wire  125  can terminate within the artery or body vessel in a loop or fold to minimize any chance of incidental vessel trauma, or extend all the way proximally exiting the patient. As shown in transverse cross section view Z-Z of third outside profile  126 , there is no cavity in third outside portion  126  for first wire  167 . First wire  167  alternatively extends distally alongside third outside profile  126 . 
     The size of first outside profile  185 , second outside profile  184 , and third outside portion  126  generally increase in size from first outside profile  185  to third outside profile  126 . However, third outside profile  126  has a reduced size portion  165  which is approximately equal in size to second outside profile  184 . This can be advantageous in that there would be room for second wire  125  to fold back and extend distally as medical device  200  and adapter  104  is withdrawn from the artery and patient. 
       FIG.  17 A ,  FIG.  17 B , and  FIG.  17 C  illustrate adapter  105  which is similar to adapter  101 . Adapter  105  includes distal portion  175 . Distal portion  175  has outer body  179  that is typically made from a soft polymer or elastomeric polymer. Distal portion  175  incorporates first tube element  188  that forms a portion of first lumen  189  in outer body  179 . First lumen  189  exits outer body  179  distally at distal tip  181 . First lumen  189  is formed partially by first tube element  188  and outer body  179 . First lumen  189  exits outer body  179  proximally at exit  253  which is proximal to distal exit  254  of second lumen  191  from outer body  179 . Second lumen  191  is formed partially by second tube element  190  and outer body  179 . As shown in section Y-Y, second lumen  191  transitions from a closed section as it exits outer body  179 . Tube element  188  and tube element  190  are side by side and overlap for length  251  within outer body  179 . First lumens  189  and second lumen  191  overlap for length  255 . An alternate embodiment of distal portion  175  includes first lumen  189  formed entirely by outer body  179  without tube element  188 . Distal portion  179  also includes a hole or passage  252  into cavity  178  close to distal end  234  of cavity  178 . Hole  252  can be beneficial to facilitate flushing air out of cavity  178  prior to use. Hole  252  can also provide an additional conduit to deliver fluids or contrast through lumen  211  of medical device  200 . 
       FIG.  18 A ,  FIG.  18 B ,  FIG.  18 C ,  FIG.  18 D ,  FIG.  18 E , and  FIG.  18 F  illustrate alternate embodiments of coil  257  of proximal portion  113  of an adapter  105  of the present invention. Coil  257  has a variable diameter and pitch. Similar to the other coil embodiments, coil  257  has a proximal diameter (ø) øE  151  and a larger diameter (ø) øF  152  at distal end  270  of coil  257 . Coil  257  transitions in diameter from øE  151  to øF  152 . Coil  257  is bonded or otherwise attached to central tube  263  that forms a portion of a central lumen  271  similar to central tube  182  over a length G  258 . The unbonded distal portion, Length H 1   272 , of coil  257  includes a portion at a diameter øE  151 , a portion at diameter øF  152  and a portion where the diameter transitions between those two diameters. The unbonded distal portion, Length H 1   272 , of coil  257  is shown with a variable pitch that are not close wrapped, but could include close wrapped pitch. A close wrapped pitch in the unbonded distal portion  272  at the smaller diameter and in the transition to the larger diameter can be advantageous as there can be less axial movement of central tube  263  under an axial load after the adapter  105  is attached to a target medical device  200 .  FIG.  18 B  illustrates coil  257  of proximal portion  113  of an adapter  105  after adapter  105  has been inserted and seated into medical device  200  with lumen  211  as previously described. As coil  257  is inserted, the unbonded distal portion elongates to a length H 2   259 , such that a portion of coil  257  forms an angle A  127  as previously described. Proximal portion  113  also includes proximal end  120  and is comprised of inner element  122  that forms a funnel and outer element  256 . Outer element  256  is similar to outer element  121  and could be radiopaque or partially radiopaque to provide a landmark for the proximal end of the adapter in-vivo, but is shorter and doesn&#39;t fully cover inner element  122 , and is longitudinally shorter in length than inner element  122 . 
       FIG.  18 C  shows an embodiment of proximal portion  113  and coil  257  such that after inserting and seating into a target device  200  as described and the central tube  263  is placed under an axial load F  261 , the unbonded distal portion, Length H 3   260 , of coil  257  becomes shorter than the length H 2   259  prior to the axial load F  261 . Additionally, a portion of the unbonded coil wraps that formed unbonded distal portion length H 2  compress together axially under the axial load F  261  and touch each other, effectively completing the wedge formed by angle A  127 , as illustrated in the enlarged detail view  FIG.  18 E . 
       FIG.  18 D  shows yet another embodiment of the proximal portion  113  and coil  257  such that after inserting and seating into medical device  200  as described and the central tube  263  is placed under an axial load F  261 , the unbonded distal portion, Length H 4   262 , of coil  257  becomes shorter than the length H 2   259  prior to the axial load F  261 . Additionally, a portion of the unbonded coil wraps that formed unbonded distal portion length H 2   259  compress together axially under the axial load F  261  and touch each other as well as nest inside or invaginate, effectively completing the wedge formed by angle A  127 , as illustrated in the enlarged detail view  FIG.  18 F . Nested coil wraps as illustrated in  FIG.  18 D  and  FIG.  18 F  may be advantageous as it may increase the securement of the adapter. 
     It could be envisioned that multiple coils similar to coil  257  could be bonded to a central tube  263  in series to create proximal portion  113 . Proximal portion  113  of this design can increase the robustness of the securement of the adapter to medical device  200 . A multiple coil configuration of this nature can include both left and right hand coils as previously described to minimize a bias or potential securement issue when central tube  263  is place under a torsional load. 
       FIG.  19    illustrates an embodiment of proximal portion  114  of an adapter that includes a coil  264  similar to coil  257 . Coil  264  includes all the elements of coil  257  plus a section of unbonded length J  265  that transitions from a larger diameter øF  152  to a smaller diameter that is preferentially smaller than the diameter of the inner lumen  211  of medical device  200 , similar to a diameter øF  151 . A coil design of this nature can be advantageous as it allows proximal portion  114  to be removed from medical device  200 . Proximal portion  114  can be removed by a user gripping a coil wrap in length J  265  and pulling distally elongating and or rotating coil  264 , releasing the wedge securement at the inside diameter of lumen  211  of target device  200 . For example, if a proximal portion  114  were coupled to a distal portion similar to  102  to form an adapter, and a portion of length J  265  of coil  264  extended into cavity  178  after proximal portion  114  were inserted and seated into medical device  200 , similar to length D  135  as shown in  FIG.  13 D , effectively extending out the distal end  213  of medical device  200 , the user could cut distal portion  102  at a point along cavity  178 , effectively separating distal portion  102  from proximal portion  114  such that the user can grip and pull distally a coil wrap in length J  265 , removing proximal portion  114  from medical device  200 . It is understood that a length of wire  153  or an extension of wire  153  extending out of medical device  200  is gripped to remove proximal portion  114 . 
       FIG.  20 A  and  FIG.  20 B  show proximal portion  115  with coil  266  that is similar to coil  130 . Coil  266  includes a transition  267  that varies in diameter and pitch. Coil  266  also includes a length K  268  at a diameter øB  138  that is predominately a wider spaced pitch and a variable pitch transition to a diameter øD  139 . A design similar to this may have an advantage in securement when inserted into medical device  200  as described for coil  130 . It is understood that coils constructed similar to coil  130  and coil  266  can alternatively be inserted into medical device  200 , similarly to coil  257 , and still provide securement after insertion. 
       FIG.  21 A  and  FIG.  21 B  illustrate an alternate embodiment of a distal portion  176  of adapter  106 . Adapter  106  includes distal portion  176 . Adapter  106  has been inserted into medical device  200 . Distal portion  176  includes first lumen  273 , outer body  179 , and second tube element  190  forming a portion of second lumen  191  of adapter  106 . First lumen  273  exits outer body  179  proximally at exit  253  which is proximal to distal exit  254  of second lumen  191  from outer body  179 . Outer body  179  includes taper portion  274  to proximally interface and engage with surface  212  of distal inner lumen  211  of medical device  200 . Taper portion  274  interfaces and engages with medical device  200  and can reduce the overall size or profile of adapter  106 . Distal portion  176  includes reinforcing coil  275  which spans transition portion  276  between medical device  200  and distal portion  176 . Reinforcing coil  275  can reduce the chance of the medical device  200  or adapter  106  kinking at or near transition  276 . Reinforcing coil  275  is smaller in size or diameter than inner lumen  211  and is partially attached to outer body  179  and distal portion  176 . Distal portion  176  also includes distal tip  181 . When attached to a medical device  200 , the first lumen  273  can be used as a guide for a first guidewire, while the second lumen  191  can be used to introduce a second guidewire or other accessory into the patient. For example, an accessory with drill bit like features or characteristics that could be used to penetrate the cap of a completely occluded lesion may be advantageous. 
       FIG.  22 A ,  FIG.  22 B ,  FIG.  22 C , and  FIG.  23    illustrate adapter  107 . Adapter  107  includes distal portion  277 , which is similar to distal portion  176  as shown in  FIG.  21 A , but includes an embedded or incorporated camera module  280  in outer body  179  and a proximal portion  117 . Outer body  179  is typically made from a polymer or elastomeric polymer. Outer body  179  includes a portion with a diameter a  286  that is less than the diameter of inner lumen  211  such that a portion of the outer body  179  can fit within inner lumen  211 . Adapter  107  includes central tube  281  that forms central lumen  282 , similar to tube  190  and lumen  191  shown in  FIG.  21 A . Central tube  281  connects distal portion  277  and proximal portion  117  of adapter  107 . Proximal portion  117  is similar to the previously described proximal portions and includes a coil  283 , similar to coil  257  previously described with reference to  FIG.  18 A . Central tube  281  includes one or more electrical conductors  284  embedded in wall  285  of central tube  281 , for illustration purposes a portion of central tube  281  is shown with the conductors exposed. For example, electrical conductors  284  could be embedded in Polyimide or Polyimide and PEBAX to form central tube  281 . Electrical conductors  284  can also run longitudinal along the X axis of central tube  281  instead of spiraling as shown. In one embodiment six (6) conductors are shown embedded in wall  285  of central tube  281  and spiral around the x axis of central tube  281  connecting camera module  280  to connector  289  near proximal end  287  of central tube  281 . It will be appreciated that the numbers of conductors can include those required to supply power to camera module  280  and send signals from camera module  280  and could be more or less than six. As illustrated in  FIG.  23   , proximal end  287  of central tube  281  and adapter  107  extend out proximal end  292  of target medical device  200 . It is common for a proximal end of a medical device to terminate with a luer fitting. As shown, connector  289  has six (6) pads  293  that individually connect to six (6) conductors  284  that spiral along central tube  281 . Connector  289  can be designed such that a cable (not shown) with the appropriate mating connectors can couple camera module  280  to an appropriate viewing device or device that can interpret the electrical signals and interface with camera module  280 . The diameter øC  290  of connector  289  must be smaller than the lumen of the target medical device  200 . Also shown is proximal end  291  of adapter  107 . Proximal end  291  is designed to potentially interface with a syringe for flushing of liquids through the central lumen  282  and allow access of guidewires or other devices and equipment through the central lumen  282  as shown in  FIGS.  22 A and  22 B . Camera module  280  incorporates elements that allow visualization both distally through distal viewing port  279  and in the proximal direction through proximal viewing port  278 . In a similar manner as the described with regard to camera module  280  and adapter  107 , electrically activated element  294  could be embedded, incorporated or attached to distal portion  277  of adapter  107 . Electrically activated elements can be, for example, sensors or transducers. Connector  289  and conductors  284  electrically connect distal portion  277  of adapter  107  to the outside of the patient, proximal to the medical device, or parent  200 . For example, electrically activated element  294  can be one or more electrically activated elements including a sensor or transducer. For example, electrically activated element  294  can be an IntraVascular UltraSound (IVUS) sensor/transducer, Optical Coherence Tomography (OCT) sensor/transducer, pressure transducer, flow transducer, or other imaging or sensor technology could be attached and electrically coupled to a suitable interface device as described. An electrically activated element  294  that incorporates advanced imaging technology such as IVUS, would be advantageous when used with a stent delivery system catheter or similar as the parent module  200  for targeted treatment of vessel dissections. Therapeutic ablation electrodes are another electrically activated element  294  that could be used to create modular catheter solutions to treat a range of clinical conditions, including conditions of irregular heartbeat or denervation arterial tissue. Other ultrasonic or lithotripsy transducers could be incorporated into electrically activated elements  294  to create modular catheter solutions treating calcium deposits in the body. In an alternate embodiment, the conductors  284  could exit the outer body  179  and alternatively extend proximally along the outside of the parent module  200  to a position proximal to the body of the patient such that a proximal electrical connector could interface with electrical components or equipment outside the patient body. This would bypass at least some of the wall  285  of central tube  281 . 
       FIGS.  24 ,  25 A,  25 B,  25 C, and  25 D  illustrate adapter  108 . Adapter  108  includes distal portion  310  and proximal portion  118 . Adapter  108  includes central tube  315  that is co-axial with inside tube  322  where inside tube  322  forms central lumen  326  as shown in  FIG.  25 B , similar to tube  190  and lumen  191  as shown in  FIG.  21 A . Referring to  FIG.  24   , central tube  315  connects distal portion  310  and proximal portion  118  of adapter  108 . Proximal portion  118  is similar to the previously described proximal portions and includes coil  313 , similar to coils previously described, bonded, coupled or otherwise attached to central tube  315 . Distal portion  310  of adapter  108  includes balloon assembly  311 . Balloon assembly  311  includes balloon  312  coupled to central tube  315  and inside tube  322  through polymer body  316  at proximal end  320  of balloon  312  and polymer tip  330  at distal end  181  of adapter  108 . Polymer body  316  extends proximally from balloon  312  and includes channel  317  that runs longitudinally along the length of polymer body  316 . Polymer body  316 , balloon  312 , and central tube  315  are coupled, bonded or otherwise attached together to create sealed balloon assembly  311  at proximal end  320 . Distal end  339  of balloon  312  is similarly coupled, bonded or otherwise attached to inside tube  322  through distal tip  330 . In this embodiment, central tube  315  terminates proximally to inside tube  322 , and end  337  of central tube  315  can be plugged by seal element  329 . Seal element  329  being bonded, coupled or attached to outside surface of inside tube  322 . Seal element  329  could also be unitary with proximal end  338  of polymer body  316 , for plugging end  337  of central tube  315 . In an alternate embodiment, central tube  315  can extend to distal end of balloon  312  such that distal tip  330  also plugs and seals end  337  of central tube  315 . In this alternate embodiment, polymer body could extend distally and be unitary or joined with distal tip  330 . Space  327  between outside surface  351  of inside tube  322  and inside surface  352  of central tube  315  is a conduit to pressurize balloon  312 . Space  327  can form a lumen. Space  327  runs between balloon  312  and connector assembly  314 . Water, saline or other fluid/gas can be injected into space  327  at connector assembly  314  to pressurize balloon  312  through opening  328  in central tube  315  and polymer body  316 . In an alternate embodiment, polymer body  316  is optional or terminates proximal to opening  328  in central tube  315  which allows the pressurizing media into balloon  312 . Connector assembly  314  near proximal end of the adapter  108  is comprised of outer member  323  with a distal end  325  and a proximal end  324 . Inside tube  322  runs coaxial to outer member  323  and along the entire length of outer member  323 . Distal end  325  and proximal end  324  seal the ends of outer member  323 . Inside tube  322  is shown terminating distal to the proximal edge  344  of proximal end  324 . Alternately, inside tube  322  can extend to or beyond proximal edge  344  of proximal end  324 . Space  327  to inject the pressurizing media into balloon  312  connects to space  345  between outside surface of inside tube  322  and inside surface of outer member  323 . Opening  318  in outer member  323  allows the pressurizing media to be injected into space  345 , which is connected to space  327 , which is in turn connected to inside of balloon  312 , allowing balloon  312  to be inflated. Space  345  can be a lumen. In one embodiment, outer member  323  of connector assembly is metallic, such as stainless steel, where distal end  325  and proximal end  324  are polymers. Alternatively, outer member  323  and ends  324  and  325  could be of unitary construction, for example made of a polymer such as PEEK. The cross-sectional view illustrates central axis  347  of adapter  108 . 
       FIG.  26    illustrates adapter  108  after adapter  108  has been attached to target medical device  200  that has central lumen  211 . For the purposes of illustration,  FIG.  26    illustrates adapter  108  attached to balloon catheter  201  of medical device  200 . Balloon catheter  201  is comprised of balloon  214 , tubular member  218  that makes up the bulk length of balloon catheter  201 , and fitting assembly  215 . Fitting assembly  215  includes port  216  that connects to central lumen  211  in tubular member  218 , and port  217  that connects an inflation lumen (not shown) in tubular member  218  to balloon  214 . Fitting assembly  215  can be composed of a plastic or polymer with ports  217  and  216  terminated with a luer fitting for connection to a syringe or inflation device.  FIG.  26    shows adapter  108  attached to balloon catheter  201  such that there is gap  321  between distal end  319  of balloon catheter  201  and proximal end  320  of balloon  312 . In this illustration, polymer body  316  with channel  317  extends from balloon  312  into distal end  319  of central lumen  211  of balloon catheter  201 , spanning the gap  321 . Channel  317  is connected to central lumen  211 , which is connected to port  216 . Adapter  108  extends all the way through balloon catheter  201  such that opening  318  of connector assembly  314  is beyond proximal end  219  of balloon catheter port  216 . 
       FIGS.  27 ,  28 A and  28 B  illustrate adapter  108  attached to balloon catheter  201  as shown in  FIG.  26   , along with fitting  340  coupled to port  216  and fitting  331  coupled to connector assembly  314 . Fitting  340  includes port  341  to couple to port  216  of fitting assembly  215  (Y-fitting) of balloon catheter  201 . In one embodiment, port  341  can be a male luer fitting that is compatible with female luer fitting  216 . Fitting  340  also includes sealing mechanisms  343  at proximal end  342  of fitting  340 . Sealing mechanism  343  can be a Tuohy borst valve or hemostasis valve, O-ring, or other seal. Fitting  340  also includes a side port such that fluids can be introduced to the space (lumen)  346  between the outside surface of central tube  315  and lumen  211 . Fitting  340  can be available valve assemblies, such as a standard Hemostasis valve with locking seal described in U.S. Pat. No. 5,591,137. Fitting  331  includes side port  333  with distal sealing mechanism  336  and proximal sealing mechanism  335  on either side of side port  333 . Sealing mechanisms  335  and  336  seal on outer member  323 , effectively isolating opening  318 . Once opening  318  is isolated, side port  333  can be used to pressurize the balloon  312  via opening  318 , space  345 , space  327  and opening  328 . Sealing mechanisms  335  and  336  can be O-rings, hemostasis valves, Tuohy borst valves or other seals. Fitting  331  also includes end port  332  that connects to lumen  326  of inside tube  322 . As shown, fitting  331  is an assembly of two (2) seals, end port  332 , side port  333 , and end cap  334  to hold seal  336  in place. Fitting  331  in one embodiment can be manufactured from three (3) molded plastic components bonded, coupled or joined together holding sealing mechanism  336  and  335  in place. Adapter  108  effectively partitions lumen  211  of medical device  200 , shown as balloon catheter  201  into three lumens,  346 ,  326 , and  327 . Sealing mechanism  343  of fitting  340  is shown sealing around central tube  315 . Alternatively, sealing mechanism  343  can seal around outer member  323  of connector assembly  314 . 
       FIGS.  29 A,  29 B,  29 C,  29 D,  29 E and  29 F  illustrate an adapter  360  prior to being attached to balloon catheter  201 .  FIG.  29 A  illustrates adapter  360  which includes a plurality of slender elements  364  that extend proximally from the outer body  363  of the distal portion  361  past the proximal end  120  of proximal portion  362  of adapter  360 . Slender elements  364  obscure some of the elements of adapter  360 . Accordingly, for clarity,  FIG.  29 B  shows a view wherein the slender elements  364  are omitted, and illustrates the obscured elements not shown or visible in  FIG.  29 A .  FIG.  29 B  shows the proximal portion  362  which includes a right handed coil  370 , similar to coil  257  previously described with reference to  FIG.  18 A , and a left handed coil  371  also similar to coil  257  previously described with reference to  FIG.  18 A . Coils  370  and  371  are bonded or attached to central tube  365 . Adapter  360  includes central tube  365  that forms central lumen  366 , similar to tube  190  and lumen  191  shown in  FIG.  21 A . Outer body  363  is typically made from a polymer or elastomeric polymer, but may be manufactured from metallic elements or include metallic elements, such as a stainless steel braid, nitinol coil or similar material. Outer body  363  includes a portion  372  with a diameter that is less than the diameter of inner lumen  211  of medical device  201  such that a portion of the outer body  179  can fit within inner lumen  211 . Proximal portion  362  also includes a proximal end  120 . Distal portion  361  also includes a distal tip  181 . Slender elements  364  may be fibers or wires manufactured from metals such as stainless steel or Nitinol, or manufactured from a polymer such as PEEK or PVDF or other suitable material. Slender elements  364  may be a single constituent or a composite structure. As non-limiting examples, the slender elements  364  may include features or characteristics that improve scoring of the target artery or lesion, may include texture or features such as a reservoir for delivering a therapeutic agent, or may include receptors for gathering tissue, cells or other molecules for diagnostic purposes. 
       FIGS.  29 D,  29 E and  29 F  illustrate the cross section of adapter  360  to better illustrate the slender elements  364  and the central tube  365 , with coil  370  omitted for clarity. The cross section views show an example of thirty (30) individual slender elements  364  attached to outer body  363  and that traverse past the proximal portion  362  of adapter  360 . Slender elements  364  are shown in a circular pattern  368  and unconnected to each other except at the outer body  363  of the distal portion  361  and in the spiral bond portion  369 . In the spiral bond portion  369 , the side by side slender elements  364  may be welded, fused, bonded, glued or attached in a spiral configuration as shown, or other suitable organized configuration. As shown in cross section X-X of  FIG.  29 E , at any given cross section in the spiral bond portion  369 , three (3) of the side by side slender elements  364  are bonded together by a bonding element  367 . Bonding element  367  can be a composed of a different material than the slender element  364  or the same material as the slender element  364  as in a welded or fused junction or joint. The spiral bond portion  369  is shown progressing twice around and with a constant pitch. The spiral bond portion  369  could include a plurality of turns and a variable or constant pitch. Adapter  360  could also include a plurality of spiral bond portions  369 . The cross section of the slender elements  364  are shown circular but could also be other shapes, for example a triangular shape may be advantageous when scoring a lesion or artery. Additionally, the slender elements  364  may form a circular pattern  368  as shown or a non-circular pattern, and any number of slender elements  364  may be bonded together to form a suitably stable arrangement facilitating the joining of the adapter  360  with a balloon catheter  201 , as illustrated in  FIGS.  30 A,  30 B and  30 C  for example. 
       FIGS.  30 A,  30 B and  30 C  illustrate adapter  360  attached to balloon catheter  201 . As shown in  FIG.  30 A , the balloon  214  is not inflated, which would be the case while medical device  200  and adapter  360  would be tracked to and from the inflation site by the user. The parent module or medical device module, such as the balloon catheter  201 , is a physically separate module from the adapter  360 , and only the adapter  360  is physically integrated with slender elements  364  through attachment to outer body  363  of adapter  360  as described previously. When the parent module is attached to the adapter  360  of an adapter module, at least a portion of the parent module will reside inside and underneath a circumference defined by the slender elements  364 , and such that slender elements  364  are presented on the outside of the assembled parent and adapter  360  module. In an example where the parent module or medical device module is a balloon catheter  201 , once connected to adapter  360 , the balloon  214  is placed underneath or inside a circumference defined by the slender elements  364 , and while an inner lumen  211  of balloon  214  will be coupled to adapter  360  such as via coils  370 ,  371  or other mechanisms as described previously, the balloon&#39;s outer surface will not be physically joined or otherwise directly integrated with the slender elements  364 , though the elements may or may not be in physical contact or communication with the outer surface when the balloon  214  is in a deflated state. This enables, as shown in  FIGS.  30 B and  30 C , the slender elements  364  to flexibly and freely separate and space apart from each other equidistantly around the outer surface of balloon  214  when it is inflated, through the action of the outer surface of balloon  214  radially pushing against the slender elements  364  equally in all directions. In another example, depending on the number and positioning of the slender elements  364 , one or more of the slender elements  364  may flexibly but unevenly distribute around the outer surface of balloon  214  when it is inflated. Either configuration may have utility depending on the type of tissue scoring or cutting desired. 
       FIGS.  31 A,  31 B,  31 C,  31 D, and  31 E  illustrate an adapter  380  prior to being attached to balloon catheter  201 . Adapter  380  is similar to adapter  360  which includes distal portion  381 , similar to distal portion  361 , and proximal portion  362  (obscured/not shown) which is the same proximal portion of adapter  360 . As shown in  FIGS.  31 A and  31 B , adapter  380  includes a plurality of slender elements  382  that extend proximally from the outer body  363  of the distal portion  381  past the proximal end  120  of proximal portion  362  of adapter  380 . Slender elements  382  obscure some of the elements of adapter  380 , and in this example comprise a rectangular cross-sectional geometry as opposed to the circular geometry of slender elements  364 . For example, this rectangular cross-sectional geometry may further facilitate the cutting or scoring of target tissue. It may be appreciated that other cross-sectional geometries, including triangular, etc. are possible. 
     As shown in the orthographic views of  FIGS.  31 A,  31 B and  31 C  and cross sections V-V and W-W of  FIGS.  31 D and  31 E , slender elements  382  are attached to each other by a plurality of bonding elements  367 . As shown in  FIGS.  31 D and  31 E , the slender elements  382  are attached to each other by bonding elements  367  in a bond pattern  384  around the adapter  380 . As shown in  FIGS.  31 A,  31 B, and  31 C , a bond pattern  384  of bonding elements  367  connecting or attaching slender elements  382  around the adapter  380  occurs at different points along the length of the adapter  380 . As shown, the bond pattern  384  alternates along the length of the adapter  380  which encourages the slender elements  382  to remain approximately evenly disposed around the balloon as the balloon is inflated, i.e. not gathered on one side of the balloon, similar to as shown in  FIG.  30 C . 
     As shown in  FIGS.  31 A and  31 B , the slender elements  382  extend proximally from the outer body  363  in lengths that create a gradual reduction in the number of slender elements  382  extending proximally. Two pairs of orthogonal slender elements  382  extend completely proximal, such that they would extend out of the patient body. As shown, a slender element  382  extension stops at a bonding element  367 . This eliminates free proximal edges of the slender elements  382 , which could inhibit withdrawing the target medical device catheter  201  and attached adapter  380  from the patient body. In the illustrative embodiment of  FIGS.  31 A,  31 B,  31 C,  31 D, and  31 E , there are shown an example of sixteen (16) slender elements  382  disposed around the central tube  365  of the adapter  380 . As shown in  FIG.  31 E , every other slender element  382  is attached to a neighboring slender element  382  by a bonding element  367 , for a total of eight (8) bond joints for a full complement of slender elements to create a bond pattern  384 . The longitudinally adjacent bond pattern  384  of bonding elements  367 , or bond joints, have an alternating pattern of side by side slender element  382  connections or bonds via bonding element  367  around the adapter  380 . 
     In the longitudinal position along the adapter as depicted in  FIG.  31 D , Section V-V, there is shown an example of eight (8) slender elements  382  attached in pairs by four (4) bonding elements  367 . However, any suitable number of bonds is envisioned to optimize the functionality of adapter  380  with a balloon catheter  201  such that slender elements  382  are sufficiently stable and organized during use. In alternate embodiments, the slender elements  360 ,  382  could be replaced by a mesh structure or weave/braid of fibers. The described slender element  360 ,  382  bonding element  367  configuration could include varied bond patterns  384  organized along the length of the adapter  380 . 
       FIG.  32    show an adapter  390  similar to previous adapters, with a distal portion  399  and proximal portion  400 . Proximal portion  400  includes a central tube, or elongated element  398 , and an interfacing coil element  395 . Interfacing coil element  395  includes a length of coil element  396  that is coupled to, bonded to otherwise attached to central tube  398 , and a length of coil element  397  that is not attached or free from the central tube  398 . The length of coil element  397  not attached to the central tube  398  or characterized as free is positioned distal to the length of coil element  396  attached to central tube  398 . The central tube  398  has a proximal end  394  and connects the interfacing coil element  395  to the distal portion  399 . The length of coil element  397  that is not attached to or free from the central tube  398  compresses to a smaller size as it is inserted into a distal end  213  of the medical device  200  internal lumen  211 . A portion of the length of coil element  397  that is not attached to or free from the central tube  398  engages or interfaces an inner lumen  211  of the medical device module  200  to secure the adapter  390  to a distal end  213  of a medical device module  200  inner lumen  211 . 
       FIG.  33    show an adapter  391  similar to previous adapters, with a distal portion  399  and proximal portion  401 . Proximal portion  401  includes a central tube, or elongated element  398 , and an interfacing leaf spring element  405 . Interfacing leaf spring element  405  includes a length of leaf spring element  406  that is coupled to, bonded to otherwise attached to central tube  398 , and a length of leaf spring element  407  that is not attached or free from the central tube  398 . The length of leaf spring element  407  not attached to the central tube  398  or characterized as free is positioned distal to the length of leaf spring element  406  attached to central tube  398 . The central tube  398  has a proximal end  394  and connects the interfacing leaf spring element  405  to the distal portion  399 . The length of leaf spring element  407  that is not attached to or free from the central tube  398  compresses to a smaller size as it is inserted into a distal end  213  of the medical device  200  internal lumen  211 . A portion of the length of leaf spring element  407  that is not attached to or free from the central tube  398  engages or interfaces with an inner lumen  211  of the medical device  200  to secure the adapter  391  at the distal end  213  of a medical device  200  inner lumen  213 . Interfacing leaf spring element  405 , includes a plurality of leaf spring features  408 . The length of leaf spring element  406  that is coupled to, bonded to otherwise attached to central tube  398  is shown as a solid tube, this length could also include perforations, slots, a coil length, like element  395 , or other features to facilitate attaching to the central tube  398 . 
     In an alternate configuration, the interfacing element can be formed integral with the elongated element, for example, such that the interfacing element comprises the same material as the elongated element and is created therefrom, as shown for example in  FIG.  42   . As shown in  FIG.  42   , elongated element  377  includes integral leaf spring interfacing elements  378 . Elongated element  377  can be a tube. 
       FIG.  34    show an adapter  392  similar to previous adapters, with a distal portion  399  and proximal portion  402 . Proximal portion  402  includes a central tube, or elongated element  398 , and an interfacing stent strut element  410 . Interfacing stent strut element  410  includes a length of stent strut element  411  that is coupled to, bonded to otherwise attached to central tube  398 , and a length of stent strut element  412  that is not attached or free from the central tube  398 . The length of stent strut element  412  not attached to the central tube  398  or characterized as free is positioned distal to the length of stent strut element  411  attached to central tube  398 . The central tube  398  has a proximal end  394  and connects the interfacing stent strut element  410  to the distal portion  399 . The length of stent strut element  412  that is not attached to or free from the central tube  398  compresses to a smaller size as it is inserted into a distal end  213  of the medical device  200  internal lumen  211 . A portion of the length of stent strut element  412  that is not attached to or free from the central tube  398  engages or interfaces with an inner lumen  211  of the medical device  200  to secure the adapter  392  to a distal end  213  of a medical device  200  inner lumen  211 . Interfacing stent strut element  410 , includes a plurality of stent strut features  413  and connecting features  414  connecting to the length of stent strut element  412 . Connecting feature can be like the leaf spring features  408  of adapter  391 . 
       FIGS.  35 ,  36  and  37    show an adapter  393  similar to previous adapters, with a distal portion  399  and proximal portion  403 . Proximal portion  403  includes a central tube, or elongated element  398 , and an interfacing coil element  415 . Interfacing coil element  415  includes a length of coil element  416  that is coupled to, bonded to otherwise attached to central tube  398 , and a length of coil element  417  that is not attached or free from the central tube  398 . The length of coil element  417  not attached to the central tube  398  or characterized as free is positioned distal to the length of coil element  416  attached to central tube  398 . The central tube  398  has a proximal end  394  and connects or couples the interfacing coil element  415  to the distal portion  399 . The length of coil element  417  that is not attached to or free from the central tube  398  compresses to a smaller size as it is inserted into a distal end  213  of a medical device  200  internal lumen  211 . A portion of the length of coil element  417  that is not attached to or free from the central tube  398  engages or interfaces with an inner lumen  211  of the medical device  200  to secure the adapter  393  to a distal end  213  of a medical device  200  inner lumen  211 . The length of coil element  417 , includes left hand coil  418  and right hand coil  419  to form a bidirectional coil feature. 
       FIG.  38    shows adapter  391  as it is being inserted into a distal end  213  of a medical device  200  internal lumen  211 . As shown, leaf spring features  408  have not been compressed. 
       FIG.  39    shows adapter  391  after it has been inserted into a distal end  213  of a medical device  200  internal lumen  211 . As shown, leaf spring features  408  have been compressed and a portion of the length of leaf spring element  407  engages the lumen  211 . 
     Similar to  FIG.  39   ,  FIG.  40    shows adapter  391  after it has been inserted into a distal end  213  of a medical device  200  internal lumen  211 . As shown, leaf spring features  408  have been compressed and a portion of the length of leaf spring element  407  that engages the lumen  211 . In the case of  FIG.  401    a lumen  211  of medical device  200  has multiple and variable sizes, “2”  387  and “1”  386 . The leaf spring feature  408  engages an edge  389  created at the change in size of the lumen  211 . Lumen size “2”  387  is larger than lumen size “1”  386 . 
       FIG.  41    is similar to  FIG.  39   , also showing adapter  391 , however internal lumen  211  has a third size “3”  388  which is larger than the expanded size of the length of leaf spring element  407 . The leaf spring feature  408  engages an edge  389  created at the change in size of the lumen  211 . Lumen size “3”  388  is larger than lumen size “2”  387 . Lumen size “2”  387  is smaller than the expanded size of the length of leaf spring element  407 . The expanded size of the length of leaf spring element  407  is compressed to engage an inner lumen  211 . As shown in  FIG.  41   , a portion  376  of the medical device  200  extends past a distal end  213  of a medical device  200  internal lumen  211 . 
       FIG.  43 A ,  FIG.  43 B , and  FIG.  44    illustrate an example of adapter  420 . Adapter  420  includes distal portion  421 , which includes embedded or incorporated optically active elements  423  in outer body  179  and a proximal portion  422 . Outer body  179  is typically made from a polymer or elastomeric polymer. Outer body  179  includes a portion with a diameter a  429  that is less than the diameter of inner lumen  211  such that a portion of the outer body  179  can fit within inner lumen  211 . Adapter  420  includes central tube  424  that forms central lumen  425 , similar to tube  190  and lumen  191  shown in  FIG.  21 A . Central tube  424  connects distal portion  421  and proximal portion  422  of adapter  420 . Proximal portion  422  is similar to the previously described proximal portions and includes a coil  426 , similar to coil  257  previously described with reference to  FIG.  18 A . Central tube  424  includes one or more optical fibers  427  embedded in wall  428  of central tube  424 .  FIG.  43 B , which is a transverse cross-sectional view of adapter  420 , illustrates the optical fibers  427  embedded in wall  428  of central tube  424 . For example, optical fibers  427  could be embedded in Polyimide or Polyimide and PEBAX to form central tube  424 . In one embodiment, four (4) optical fibers  427  are shown embedded in wall  428  of central tube  424  connecting optical element  423  to optical connector  431  near proximal end  430  of central tube  424 . It will be appreciated that the numbers of optical fibers can include those required for optical element  423  and could be more or less than four. As illustrated in  FIG.  44   , proximal end  430  of central tube  424  and adapter  420  extend out proximal end  292  of target medical device  200 . It is common for a proximal end of a medical device to terminate with a luer fitting. Optical connector  431  can be designed such that an interface (not shown) with the appropriate mating elements can couple optical element  423  to an appropriate device that can interpret or transmit the optical signal or wavelengths. Optically active elements can be, for example, sensors, transducers, optics to direct light, elements to transmit laser light, etc. Connector  431  and optical fibers  427  optically connect distal portion  421  of adapter  420  to the outside of the patient, proximal to the medical device, or parent  200 . An optically activated element  423  that incorporates advanced imaging technology, would be advantageous when used with a stent delivery system catheter or similar as the parent module  200  for targeted treatment of vessel dissections. Therapeutic laser ablation is another area that could utilize optically activated element  423  to create modular catheter solutions to treat a range of clinical conditions. In an alternate embodiment, the optical fibers  427  could exit the outer body  179  and alternatively extend proximally along the outside of the parent module  200  to a position proximal to the body of the patient such that a proximal optical connector could interface with the optical equipment outside the patient body. This would bypass at least some of the wall  428  of central tube  424 . 
       FIG.  45 A ,  FIG.  45 B ,  FIG.  45 C , and  FIG.  46    illustrate an example of adapter  440 . Adapter  440  includes distal portion  441 , which includes articulating or steerable elements  443  in outer body  179  and a proximal portion  442 . Outer body  179  is typically made from a polymer or elastomeric polymer. Outer body  179  includes a portion with a diameter a  449  that is less than the diameter of inner lumen  211  such that a portion of the outer body  179  can fit within inner lumen  211 . Adapter  440  includes central tube  444  that forms central lumen  445 , similar to tube  190  and lumen  191  shown in  FIG.  21 A . Central tube  444  connects distal portion  441  and proximal portion  442  of adapter  440 . Proximal portion  442  is similar to the previously described proximal portions and includes a coil  446 , similar to coil  257  previously described with reference to  FIG.  18 A . Central tube  444  includes one or more steering wires  447 , housed in the lumen  452  in wall  448  of central tube  444 .  FIG.  45 B , which is a transverse cross-sectional view of adapter  440 , illustrates the steering wires  447  running through lumen  452  in wall  448  of central tube  444 . For example, steering wires  447  could extend through a lumen  452  within a Polyimide or Polyimide and PEBAX wall  448  to form central tube  444 . In one embodiment two (2) steering wires  447  are shown within lumen  452  of wall  448  of central tube  444  connecting steerable or articulating elements  443  to proximal end  451  of steering wires  447  near proximal end  450  of central tube  444 . It will be appreciated that the number of steering wires  447  can include those required for steerable or articulating elements  443  and could be more or less than two. As illustrated in  FIG.  46   , proximal end  450  of central tube  444  and adapter  440  extend out proximal end  292  of target medical device  200 . It is common for a proximal end of a medical device to terminate with a luer fitting. Proximal end  451  of steering wires  427  can be designed such that an interface (not shown) with the appropriate mating elements can couple steering wires  447  to an appropriate device that can transmit steering movements to steerable or articulating elements  443  at the distal portion  441 . Steerable or articulating elements  443  can include, for example, slots  453  that enable the steerable or articulating element  443  to bend as the steering wires  447  are put under tension at the proximal end  451  by the interface, not shown. It is appreciated that the steering wires  447  can move freely through lumens, not shown, in the outer body  179 . Steering wires  447  mechanically connect distal portion  441  of adapter  440  to the outside of the patient, proximal to the medical device, or parent module  200 . A steerable or articulating element  443  would be advantageous when used to guide a catheter or similar parent module  200  through tortuous anatomy. In an alternate embodiment, the steering wires  447  could exit the outer body  179  and alternatively extend proximally along the outside of the parent module  200  to a position proximal to the body of the patient such that the proximal ends  451  of steering wires  447  could engage an interface to mechanically manipulate the steering wires  447 , moving or steering the articulating or steerable elements  443 . This would bypass at least some of the lumen  452  of wall  448  of central tube  444 . 
     It is to be understood that the above-described embodiments are illustrative of only a few of the many possible specific embodiments, which can represent applications of the principles of the invention. Numerous and varied other arrangements can be readily devised in accordance with these principles by those skilled in the art without departing from the spirit and scope of the invention. 
     For example, the nitinol coil structure could be replaced by a braided wire structure as it could readily change size by elongating to facilitate insertion into medical device  200 . A braided wire structure can be manufactured from nitinol and have similar thermal-mechanical properties as the nitinol coil or can be made from a more traditional alloy, such as stainless steel and be designed to collapse to a smaller diameter as it is inserted or prior to insertion into medical device  200 . A braid structure could be designed to have a similar wedge geometry when inserted into the lumen of a target catheter. 
     Further, instead of the user reducing the size of the nitinol coil or similar, the adapter can be manufactured and delivered to the customer pre-constrained in that shape and ready to be inserted into the target catheter or device. This would remove some of the burden from the user and possibly make it easier to use. The coil could also be a more traditional alloy without shape memory or superelastic thermal-mechanical properties such as stainless steel. The coil could be manufactured from a polymer such as PEEK or polyimide. The coil itself could be coated with a polymer. 
     Additionally, for configurations where the nitinol coil is coupled to the distal portion of adapter, the tube could be optional. 
     Although the distal portion of the adapter described herein is generally shown to be a similar size as the target catheter or device, this is not required, but may be desired. Similarly, the distal portion of the adapter can be smaller than the inner lumen of the target medical device or parent and be inserted completely within the parent device, not extending distally from the target medical device or parent at all. 
     If a second lumen or central lumen is not required, the elongated element that the proximal portion of coil structure is attached to could be solid as in a wire or mandrel instead of a tube. The elongated element could include conductors to transmit electrical signals from outside the patient body to the distal end of the parent device. One application of this may be an adapter with a distal portion that includes electrodes powered or activated in a manner similar to an electrophysiology catheter. The conductor in electrophysiology catheters are sometimes fine scale copper magnet wire, e.g. 53 gauge, or other polymer coated wire conductors, and similar conductors could be used in an electrophysiology adapter. Conductors could be housed inside the central tube, electrically connecting the distal portion of the adapter to outside the patient. The tube, wire or mandrel could extend proximally all the way out the proximal end of the target catheter or device. Further, the outer body of the distal portion could have multiple and varied profiles. Lumens exiting outer body of the distal portion could be at varied angles instead of 180 degrees opposite each other, including on the same side of the outer body of the distal portion.