Patent Publication Number: US-10321932-B2

Title: Direct stream hydrodynamic catheter system

Description:
CROSS REFERENCES TO RELATED APPLICATIONS 
     This application is a divisional of U.S. patent application Ser. No. 14/176,814, filed Feb. 10, 2014, now U.S. Pat. No. 9,586,023; which is a divisional of U.S. patent application Ser. No. 12/933,520, filed Sep. 20, 2010, now U.S. Pat. No. 8,647,294, which is a 371 Application of PCT/US2009/037814, filed Mar. 20, 2009, which claims the benefit of U.S. Provisional Patent Application No. 61/070,095, filed Mar. 20, 2008, entitled “Direct Spray Disruption and Removal Catheter”, the entire disclosures of which are incorporated herein by reference. 
     This patent application is related to U.S. patent application Ser. No. 10/455,096 filed Jun. 5, 2003, entitled “Thrombectomy Catheter Device Having a Self-Sealing Hemostasis Valve”, now U.S. Pat. No. 7,226,433, which is a Continuation-In-Part (CIP) of application Ser. No. 10/198,264 filed Jul. 16, 2002, entitled “Rapid Exchange Fluid Jet Thrombectomy Device and Method”, now U.S. Pat. No. 6,875,193, which is a Continuation-In-Part (CIP) of application Ser. No. 09/888,455 filed Jun. 25, 2001, now U.S. Pat. No. 6,755,803, which is a Continuation-In-Part (CIP) of application Ser. No. 09/356,783 filed Jul. 16, 1999, now abandoned, which is a divisional of application Ser. No. 09/019,728 filed Feb. 6, 1998, now U.S. Pat. No. 5,989,210, and are hereby incorporated into this application by reference as if fully set forth herein. 
     This patent application is also related to application Ser. No. 11/096,592 filed Apr. 1, 2005, entitled “Rapid Exchange Fluid Jet Thrombectomy Device and Method”, which is pending now U.S. Pat. No. 7,879,022, and which is a Continuation-In-Part (CIP) of application Ser. No. 10/198,264 filed Jul. 16, 2002, entitled “Rapid Exchange Fluid Jet Thrombectomy Device and Method”, now U.S. Pat. No. 6,875,193, which is a Continuation-In-Part (CIP) of application Ser. No. 09/888,455 filed Jun. 25, 2001, now U.S. Pat. No. 6,755,803, which is a Continuation-In-Part (CIP) of application Ser. No. 09/356,783 filed Jul. 16, 1999, now abandoned, which is a divisional of application Ser. No. 09/019,728 filed Feb. 6, 1998, now U.S. Pat. No. 5,989,210, and are hereby incorporated into this application by reference as if fully set forth herein. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The general purpose of this disclosure is to provide a direct stream hydrodynamic catheter system for use in thrombectomies and associated procedures. More specifically is disclosed a direct stream hydrodynamic catheter system, preferably in the form of radially directed fluid jet streams, which uses controlled fluid jet streams to accomplish a thrombectomy of highly organized material or to accomplish infusion of drugs to a conduit wall, or as shown in alternative embodiments, to accomplish cell sampling of the conduit wall. The device is primarily intended for use as an enhanced thrombectomy device which can be beneficial for robust and aggressive removal of thrombus, lesions and the like from coronary arteries, peripheral arteries or veins, neurological arteries or veins, or arterial venous conduits. 
     2. Description of the Prior Art 
     Prior art thrombectomy devices provide structures for the removal of thrombus, lesions, gummous material and the like from the vasculature, but do little to address the control of fluid jet streams which are instrumental in accomplishing interventional procedures. Some prior art thrombectomy devices use indirect cross path fluid jet streams, the axial path of which can be diminished and of insufficient strength which do not utilize full strength, such as provided by the radially directed fluid jet streams disclosed here. Fluid jet streams produced by prior art devices, if not controlled effectively, may not accomplish a thrombectomy in a satisfactory manner or may cause undesirable damage. If the strength of the fluid jet streams is excessive, damage may occur to a blood vessel wall, and if the strength of the fluid jet stream is insufficient, then a satisfactory thrombectomy may not be accomplished. As presented in this disclosure, consideration is given to provide a catheter system for an aggressive and robust thrombectomy by controlling the volumetric flow rate which can be influenced by its structure and which may be controlled by a physician in its use. 
     SUMMARY OF THE INVENTION 
     The general purpose of this disclosure is to provide a direct stream hydrodynamic catheter system also referred to herein as the catheter system. This disclosure describes the use of a direct spray in the form of radially directed fluid jet streams emanating from an emanator at the distal end of a direct stream hydrodynamic catheter tube, synonymously referred to as a catheter tube, for purposes of, but not limited to, a thrombectomy of a highly organized material or the infusion of drugs into a vascular conduit. The direct stream hydrodynamic catheter system provides for a physician controlling a high pressure fluid pump and a high pressure fluid source for the purposes of delivering pressurized saline with or without medicaments to an emanator at the distal end of a catheter tube tip in order to provide for the emanation of radially directed fluid jet streams and to provide for a hydrodynamic action in the direct impingement of deposits in the vascular conduit. An inflow orifice is included near the distal end of the catheter tube proximal to a fluid jet emanator to receive freed thrombus or lesion particles which are evacuated through the catheter tube. There is also a collection chamber and an exhaust regulator in the form of a roller pump which can be operated by a physician and which is used to provide for the evacuation and control of the evacuation rate, i.e., aspiration of the catheter tube. The present disclosure provides for the structure of and use of a catheter tube whereby fluid jet streams are directed radially and outwardly from a fluid jet emanator or optionally at any other beneficial angle in a distal or proximal direction in order to directly impinge upon the vascular conduit unimpeded by any device structure. The inflow orifice is provided proximal to the fluid jet emanator to provide for the ingestion and entrainment of thrombus or lesion particles which are freed from the interior of the vasculature by radially directed fluid jet streams. The exhaust roller pump can be operated by a physician to control the rate to aspirate liberated thrombus or lesions or can be used, such as shown in an alternative embodiment, to assist in the aspiration of conduit wall cell samples. 
     The desired velocity and strength of the radially directed fluid jet streams can be controlled by using the fluid jet emanator in the distal end of the catheter tube which jet emanator has suitably sized radially directed jet orifices and by using the exhaust regulator for aspiration in coordination with the manipulation of the high pressure fluid pump to produce a desired operating pressure, volume and outflow. As disclosed herein, the catheter system is more robust and aggressive than traditional thrombectomy catheters and preferably is used in situations and in vessel segments which can tolerate aggressive direct stream hydrodynamic action. Another application of the disclosed catheter system is the treatment of venous valves which when embedded in an organized thrombus will lose their function. The devices of the present disclosure are intended to free these venous valves of adherent thrombus by using the radially directed fluid jet streams in order to prevent post phlebitic (post thrombotic) syndrome. Another application is to provide for a more robust thrombectomy of adherent and organized mural thrombus. The devices of the present disclosure can also use the strong radially directed jet streams to drive drugs into the vessel wall. 
     The preferred embodiment includes the use of nominal size high powered radially directed fluid jet streams emanating from a fluid jet emanator for the ablation of thrombus and lesions and uses aspiration to provide for an effluent flow. 
     A first alternative embodiment includes the use of nominal sized and high powered radially directed fluid jet streams emanating from a fluid jet emanator and the use of a proximally located balloon which is used to center the distal end of the catheter tube. Proximally directed fluid jet streams emanating from a fluid jet emanator are used to complement the evacuation of effluent flow and to complement the inflation of the proximally located balloon. 
     A second alternative embodiment includes the use of small sized high powered radially directed fluid jet streams emanating from a fluid jet emanator and also includes proximally directed fluid jet streams emanating from a fluid jet emanator which jet streams are used to complement the aspiration of effluent through the catheter tube. 
     A third alternative embodiment which can be used for cell harvesting includes the use of small sized high powered radially directed fluid jet streams emanating from a fluid jet emanator and also includes a distally located balloon which is used to center the distal end of the catheter tube. Distally directed fluid jet streams emanating from a fluid jet emanator are used to fill the distally located balloon. Proximally directed fluid jet streams emanating from a fluid jet emanator are optionally used to complement the aspiration of effluent flow. 
     A fourth alternative embodiment includes the use of distally directed fluid jet streams which emanate from the distally directed jet orifices of a fluid jet emanator and thence through one or more distally located small sized outflow orifices in the distal end of the catheter tube as low power cross stream jets used for thrombus ablation. Proximally directed fluid jet streams emanating from a fluid jet emanator are used to complement the aspiration of effluent through the catheter tube. 
     A fifth alternative embodiment provides for the use of nominally sized and high powered distally directed fluid jet streams emanating from a fluid jet emanator and proximally directed fluid jet streams emanating from a fluid jet emanator which complement the aspiration of effluent through the catheter tube. 
     According to an embodiment of the disclosure, there is provided a direct stream hydrodynamic catheter system for the removal of thrombus, lesions and the like including provisions for the infusion of drugs, lysing fluids and the like into the vasculature. A catheter tube having a coaxial high pressure tube and a coaxial distally positioned fluid jet emanator is provided for invasive use and treatment within the vasculature. The proximal end of the catheter tube including the high pressure tube is connected to and aligned within the distal end of a centrally located manifold. The manifold and other connected enabling components include, but are not limited to, a physician controlled high pressure pump and high pressure fluid source, a physician controlled exhaust regulator and a collection chamber provided for the operation of the catheter tube system, a high pressure tube and a fluid jet emanator provided for the emanation of radially directed fluid jet streams to accomplish the loosening and evacuation of loosened thrombus, lesions and fluid from within the vasculature or for dispensing of lysing agents or drugs into the vasculature. 
     One significant aspect and feature of devices of the present disclosure is the use of radially directed fluid jet streams for the purpose of enhanced thrombectomy of mural thrombus. 
     Another significant aspect and feature of devices of the present disclosure is the use of direct fluid jet streams which can operate in any desired direction and in multiple arrays, i.e., different points of emanation which can then also operate in any desired direction. 
     Another significant aspect and feature of devices of the present disclosure is the use of proximally directed fluid jet streams with radially directed fluid jet streams for the purpose of debris maceration along with a power provision. 
     Another significant aspect and feature of devices of the present disclosure is the use of radially directed fluid jet streams for the purpose of cell sampling. 
     Another significant aspect and feature of devices of the present disclosure is the use of direct fluid jet streams that have velocities which do not cause hemolysis. 
     Another significant aspect and feature of devices of the present disclosure is the use of fluid jet streams having enough momentum that can be delivered by a large non-hemolysing fluid jet stream which is equivalent in energy, via an increased flow rate, to a high velocity smaller fluid jet stream. 
     Yet another significant aspect and feature of devices of the present disclosure is the use of direct radially directed fluid jet streams which are physician controlled by a means of high pressure fuel pump. 
     Yet another significant aspect and feature of devices of the present disclosure is a direct fluid jet stream disruption, i.e., the erosion, breakup and reduction of thrombus or unwanted cellular matter into particulate by fluid jet streams of saline where effluent consisting of thrombus, and/or cellular particulate, and fluid saline is enhanced and driven, evacuated and removed by aspiration using a physician controlled exhaust regulator in the form of a roller pump. 
     Another significant aspect and feature of devices of the present disclosure is a direct fluid jet stream disruption, i.e., the erosion, breakup and reduction of thrombus or unwanted cellular matter into particulate by fluid jet streams of saline whereby the effluent consisting of thrombus and/or cellular particulate and the fluid saline is enhanced and driven, evacuated and removed by the use of directed fluid jet streams. 
     Another significant aspect and feature of devices of the present disclosure is a direct fluid jet stream disruption, i.e., the erosion, breakup and reduction of thrombus or unwanted cellular matter into particulate by fluid jet streams of saline whereby the effluent consisting of thrombus and/or cellular particulate and the fluid saline is enhanced and driven, evacuated and removed by manual aspiration using a syringe. 
     Another significant aspect and feature of devices of the present disclosure is a direct fluid jet stream disruption, i.e., the erosion, breakup and reduction of thrombus or unwanted cellular matter into particulate by fluid jet streams of saline whereby the effluent consisting of thrombus and/or cellular particulate and the fluid saline is enhanced and driven, evacuated and removed, and whereby the vacuum associated with devices of the present disclosure is controlled by varying the relationship between the inputted fluid jet stream pressure and an exhaust regulator, e.g., a bottled vacuum. 
     Another significant aspect and feature of devices of the present disclosure is the use of proximal or distal balloons inflated by proximally or distally directed fluid jet streams, respectively, for the purpose of centering the distal portion including the inflow orifice(s) of a catheter tube. 
     Another significant aspect and feature of devices of the present disclosure is the use of a cross stream type catheter tube which uses direct fluid jet streams as the outflow component. 
     Another significant aspect and feature of devices of the present disclosure is the use of direct fluid jet stream devices that operate with or without evacuation capabilities. 
     Another significant aspect and feature of devices of the present disclosure is the use of a catheter tube and a manifold that may be used with any sized guidewire. 
     Another significant aspect and feature of devices of the present disclosure is the use of direct fluid jet stream velocities ranging from 1 to 250 m/s. 
     Another significant aspect and feature of devices of the present disclosure is the use of direct fluid jet streams emanating from orifices of 0.001 inch to 0.040 inch in diameter. 
     Having thus briefly described one or more embodiments of this disclosure, and having mentioned some significant aspects and features, it is the principal object of this disclosure to provide a direct stream hydrodynamic catheter system. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Other objects of the disclosure and many of its attendant advantages will be readily appreciated as the same becomes better understood by reference to the following detailed description when considered in connection with the accompanying drawings, in which like reference numerals designate like parts throughout the figures thereof and wherein: 
         FIG. 1  is a plan view of the visible components of a direct stream hydrodynamic catheter system; 
         FIG. 2  generally is an isometric exploded and segmented view of a catheter tube and a manifold which are used with enabling components shown in  FIG. 1 ; 
         FIG. 3  is an assembled view, in partial cross section, of the components of the manifold and closely associated components and features thereof; 
         FIG. 4  illustrates the distal portion of the catheter tube and the relationships of radiopaque marker bands, a support ring, a high pressure tube, and a fluid jet emanator to each other and to the catheter tube; 
         FIG. 5  is an isometric view of the fluid jet emanator shown connected to and in communication with a high pressure tube; 
         FIG. 6  is a side view, in partial cross section, of the distal portion of the catheter tube in the performance of the method and use thereof which performance utilizes enabling connections and which utilizes functions of the accompanying components in a manner as shown in  FIG. 1 ; 
         FIG. 7 , a first alternative embodiment, generally is an isometric exploded and segmented view of a catheter tube and a manifold which are used with enabling components shown in  FIG. 1 ; 
         FIG. 8  is an illustration similar in many respects to  FIG. 4  showing the distal portion of the catheter tube and the relationships of radiopaque marker bands, a support ring, a high pressure tube, a fluid jet emanator, and a balloon to each other and to the catheter tube; 
         FIG. 9  is an illustration similar in many respects to  FIG. 5  and is an isometric view of another fluid jet emanator shown connected to and in communication with a high pressure tube; 
         FIG. 10  is similar in many respects to  FIG. 6  and is a side view, in partial cross section, of the distal portion of the catheter tube in the performance of the method and use thereof which performance utilizes enabling connections and which utilizes functions of the accompanying components in a manner as shown in  FIG. 1 ; 
         FIG. 11 , a second alternative embodiment, is an isometric exploded and segmented view of a catheter tube and a manifold which are used with enabling components shown in  FIG. 1 ; 
         FIG. 12  is an illustration similar in many respects to  FIG. 4  illustrating the distal portion of the catheter tube and the relationships of radiopaque marker bands, a support ring, a high pressure tube, and a fluid jet emanator to each other and to the catheter tube; 
         FIG. 13  is an illustration similar in many respects to  FIG. 5  and is an isometric view of another fluid jet emanator shown connected to and in communication with a high pressure tube; 
         FIG. 14  is similar in many respects to  FIG. 6  and is a side view, in partial cross section, of the distal portion of the catheter tube in the performance of the method and use thereof which performance utilizes enabling connections and which utilizes functions of the accompanying components in a manner as shown in  FIG. 1 ; 
         FIG. 15 , a third alternative embodiment, is an isometric exploded and segmented view of a catheter tube and a manifold which are used with enabling components shown in  FIG. 1 ; 
         FIG. 16  is an illustration similar in many respects to  FIG. 4  illustrating the distal portion of the catheter tube and the relationships of radiopaque marker bands, a support ring, a high pressure tube, a fluid jet emanator, and a balloon to each other and to the catheter tube; 
         FIG. 17  is an illustration similar in many respects to  FIG. 13  and is an isometric view of another fluid jet emanator shown connected to and in communication with a high pressure tube; 
         FIG. 18  is similar in many respects to  FIG. 6  and is a side view, in partial cross section, of the distal portion of the catheter tube in the performance of the method and use thereof which performance utilizes enabling connections and which utilizes functions of the accompanying components in a manner as shown in  FIG. 1 ; 
         FIG. 19 , a fourth alternative embodiment, is an isometric exploded and segmented view of a catheter tube and a manifold which are used with enabling components shown in  FIG. 1 ; 
         FIG. 20  is an illustration similar in many respects to  FIG. 4  illustrating the distal portion of the catheter tube and the relationships of radiopaque marker bands, a support ring, a high pressure tube, and a fluid jet emanator to each other and to the catheter tube; 
         FIG. 21  is an illustration similar in many respects to  FIG. 5  and is an isometric view of another fluid jet emanator shown connected to and in communication with a high pressure tube; 
         FIG. 22  is similar in many respects to  FIG. 6  and is a side view, in partial cross section, of the distal portion of the catheter tube in the performance of the method and use thereof which performance utilizes enabling connections and which utilizes functions of the accompanying components in a manner as shown in  FIG. 1 ; 
         FIG. 23 , a fifth alternative embodiment, is an isometric exploded and segmented view of a catheter tube and a manifold which are used with enabling components shown in  FIG. 1 ; 
         FIG. 24  is an illustration similar in many respects to  FIG. 4  illustrating the distal portion of the catheter tube and the relationships of radiopaque marker bands, a support ring, a high pressure tube, and a fluid jet emanator to each other and to the catheter tube; 
         FIG. 25  is an illustration similar in many respects to  FIG. 5  and is an isometric view of another fluid jet emanator shown connected to and in communication with a high pressure tube; and, 
         FIG. 26  is similar in many respects to  FIG. 6  and is a side view, in partial cross section, of the distal portion of the catheter tube in the performance of the method and use thereof which performance utilizes enabling connections and which utilizes functions of the accompanying components in a manner as shown in  FIG. 1 . 
     
    
    
     DETAILED DESCRIPTION 
       FIG. 1  is a plan view of the visible components of a direct stream hydrodynamic catheter system  10 , which can also be referred to for purposes of brevity as the catheter system  10 . The system includes a direct stream hydrodynamic catheter tube  12 , also referred to as the catheter tube  12 , in association with a one-piece manifold  14 , the latter having multiple structures extending therefrom or attached thereto including, but not limited to, the flexible multiple feature catheter tube  12 . The visible portion of the one-piece manifold  14  includes a central tubular body  16 , a threaded exhaust branch  18 , and a high pressure connection branch  20  extending angularly from the central tubular body  16 , a partially shown cavity body  22  extending proximally from the central tubular body  16  and a threaded connection port  24  extending distally from the central tubular body  16 . The proximal end of the catheter tube  12  is secured to the manifold  14  by the use of a Luer fitting  26  accommodated by the threaded connection port  24 . The proximal end of the catheter tube  12  extends through a strain relief tube  28  and through the Luer fitting  26  to communicate with the manifold  14 . Also shown is a hemostasis nut  30  in alignment with and threadingly engaged with the proximal region of the cavity body  22 . A threaded high pressure connection port  32  is secured to the high pressure connection branch  20  by a Luer connector  34 . An introducer  36  is shown in  FIG. 2 . A guidewire  37 , in association with the disclosure, is shown in  FIG. 3 . 
     The catheter tube  12  extends distally from the manifold  14  and includes an inflow orifice  38  at the distal section of the catheter tube  12 . In the alternative, an inflow gap could be provided in lieu of the inflow orifice  38 . A tapered flexible tip  40  extends distally from the distal section of the catheter tube  12  and is secured thereto and therein. The catheter tube  12  functions as an exhaust tube for the evacuation of thrombus or lesion particulate, fluids or other debris or effluent from the thrombus or lesion site. Preferably, the catheter tube  12  includes a hydrophilic coating to enhance deliverability along the vasculature or other structure. 
     Enabling components provide for the operation and utilization of the catheter tube  12 , the manifold  14  and components closely related thereto and therein include a high pressure fluid source  42  and a high pressure fluid pump  44  connected to the manifold  14  via the threaded high pressure connection port  32  and connector  46 . Also included are an exhaust regulator  47  in the form of a roller pump or other suitable device and a collection chamber  48  connected to the threaded exhaust branch  18  by a connector  49  as shown. 
       FIGS. 2 and 3  show portions of the disclosure.  FIG. 2  generally is an isometric exploded and segmented view of the catheter tube  12  and the manifold  14  which are used with the enabling components shown in  FIG. 1 .  FIG. 3  is an assembled view, in partial cross section, of the components of the manifold  14  and closely associated components and features thereof. Also included is a guidewire  37  incorporated into the use thereof. 
     A group of assembled components, including a high pressure tube  50  and a fluid jet emanator  52 , deliver pressurized saline or other suitable fluid to the distal section of the catheter tube  12  for producing fluid jet streams which are directed radially from the fluid jet emanator  52 , as later described in detail. The high pressure tube  50 , preferably of flexible stainless steel or other suitable material, extends within closely associated features or components attached to the manifold  14  and passes therethrough and is aligned with and distal to the strain relief tube  28 . The high pressure tube  50  extends along a greater portion of and within a lumen  53  of the catheter tube  12  to terminate at the fluid jet emanator  52 . The distal end of the high pressure tube  50 , including the fluid jet emanator  52 , is also shown in greater detail in  FIGS. 4 and 5 . 
     As provided in  FIGS. 2 and 3 , the manifold  14 , which is also used with reference to the alternative embodiments, has connected and communicating passageways and cavities ( FIG. 3 ) including a high pressure connection branch passageway  54 , an exhaust branch passageway  56 , a tapered central passageway  58  extending from and through the threaded connection port  24  and through the central tubular body  16  to and communicating with a multiple radius cavity  60 , which preferably is cylindrical and located central to the cavity body  22 . External threads  62  are located about the proximal portion of the cavity body  22  at the proximal region of the manifold  14  for accommodating the internal threads  64  of the hemostasis nut  30 . 
     Beneficial to devices of the disclosure is the use of a flexible self-sealing hemostasis valve  66  and the use of a washer  68  which is located distal to the self-sealing hemostasis valve  66 , the shape and function of which are described in referenced U.S. Pat. No. 7,226,433 which is incorporated herein in its entirety. The self-sealing hemostasis valve  66  and the washer  68  are aligned within the greater radius portion of the multiple radius cavity  60  of the cavity body  22 . The hemostasis nut  30  includes a centrally located cylindrical boss  70 . The washer  68  and the self-sealing hemostasis valve  66  are captured within the greater radius portion of the multiple radius cavity  60  by the threaded engagement of the hemostasis nut  30  to the threads  62  at the proximal end of the manifold  14 . The cylindrical boss  70  is brought to bear against the collective self-sealing hemostasis valve  66  and the washer  68  bringing pressure to bear, as required, against the self-sealing hemostasis valve  66  which pressure culminates in a forcible sealing of the self-sealing hemostasis valve  66  about the guidewire  37 . Although one method of sealing against a guidewire is briefly shown and described herein, it is appreciated that other methods can be incorporated into this and other forms of the present disclosure such as those methods referenced in U.S. Pat. No. 7,226,433. 
     Also shown is a ferrule  72  which is aligned within a passageway  74  of the threaded high pressure connection port  32 , the combination of which is partially aligned within an interior passageway  76  of the Luer connector  34 . The proximal end of the flexible high pressure tube  50 , shown in segmented form in  FIG. 2 , is used for the delivery of nominal or high pressure ablation liquids or for the delivery of drugs or other liquids and is suitably secured in a central passageway of the ferrule  72  to communicate with the interior passageway  74  of the threaded high pressure connection port  32 , as shown in  FIG. 3 . The proximal end of the high pressure tube  50  also extends through the high pressure connection branch passageway  54 , through part of the tapered central passageway  58 , through the strain relief tube  28  and Luer fitting  26 , and through the lumen  53  of the catheter tube  12 . 
     As shown in  FIG. 4 , the high pressure tube  50  extends through a support ring  78  and is suitably attached thereto to provide an anchoring and alignment structure for the high pressure tube  50  thereby affixing the distal portion of the high pressure tube  50  within the distal end of the catheter tube  12 . In addition, the high pressure tube  50  also extends indirectly through the radiopaque marker band  80 . The concentrically aligned radiopaque marker band  80  and the support ring  78  are shown forcibly contacting the full wall thickness of the catheter tube  12  at the distal end of the catheter tube  12 . The high pressure tube  50  is preferably attached to the support ring  78 , such as by welding or other suitable means, where the support ring  78  functions as a support for the catheter tube  12  in the region beneath the radiopaque marker band  80 . The high pressure tube  50  extends across the inflow orifice  38  and terminates within an internal annular manifold (not shown) of the fluid jet emanator  52  and is suitably attached thereto where the interior cavity (not shown) of the fluid jet emanatory  52  communicates with the lumen of the high pressure tube  50 , such as in the closely related fluid jet emanator described in the previously referenced U.S. Pat. No. 7,879,022 or other applications or patents assigned to the assignee. The fluid jet emanator  52 , also shown in  FIG. 5  as an isometric view, includes an annular groove  84  which is in coordinated use with a radiopaque marker band  82  to secure the fluid jet emanator  52  within the distal section of the catheter tube  12 . The distally located radiopaque marker band  82  is forcibly applied around the distal end of the catheter tube  12  to cause a frictional annular engagement with all or part of the annular grove  84  of the fluid jet emanator  52 . Such frictional engagement is sufficient to place the outer radial surface of the radiopaque marker band  82  (also  80 ) in a position lesser than the general and greater outer radial surface of the catheter tube  12 , thereby providing, in part, a catheter tube  12  having no elements protruding beyond the general outer radial surface thereof for an unimpeded and smooth distal or proximal transition of the catheter tube  12  within a vein, artery or the like. A passageway  86  ( FIG. 5 ) is shown central to the fluid jet emanator  52  to accommodate the passage of a guidewire  37  (shown in  FIG. 3 ). The tapered flexible tip  40  is shown suitably secured to the distal end of the distal section for the catheter tube  12 . The tapered flexible tip  40  includes a multiple radius inner passageway  88  for the accommodation of a guidewire  37 . In  FIG. 2 , the radiopaque marker band  80  is shown displaced a short distance distal to the support ring  78  and the fluid jet emanator  52  is shown displaced proximally a short distance from the radiopaque marker band  82  for the purpose of clarity, but are shown in frictional engagement in their actual positions along and with respect to the distal end of the catheter tube  12  in  FIG. 4 . The relationships of the radiopaque marker bands  80  and  82 , the support ring  78 , and the fluid jet emanator  52 , respectively, to each other and of the catheter tube  12 , are shown best in  FIG. 4 . 
     Structure is provided to nurture and aid the introduction and passage of the distal portion of the catheter tube  12  through blood vessels, arteries and the like to the sites of deposits of thrombus or lesions. The tapered flexible tip  40 , as opposed to a rounded and nontapered flexible tip, can part and more easily penetrate deposits of thrombus or lesions during its insertional travel in a distal direction instead of advancing or pushing such deposits of thrombus or lesions distally. The decreasing diameter in a distal direction of the tapered flexible tip  40  also allows for an increased flexibility in negotiating and passing through tortuous paths. 
     The exhaust tube support ring  78  in use with the radiopaque marker band  80  and the use of the fluid jet emanator  52  with the marker band  82  within and about the proximal and distal sections of the catheter tube  12 , respectively, are examples of structures offering support or reinforcement along the catheter tube  12 . Such a support ring  78 , marker bands  80  and  82 , and the external structure of the fluid jet emanator  52  provide for the use of a thinner wall thickness for the catheter tube  12  and allow for a larger and more effective and efficiently sized lumen  53  of the catheter tube  12 , as well as contributing to a reduced sized outer diameter. Such support rings and external structure of the fluid jet emanator  52  also contribute to supportively maintain the diameter and overall shape of the catheter tube  12  when the catheter tube  12  is pushed or advanced along a vein or artery, as well as aiding in torsional support. 
       FIG. 5  is an isometric view of the fluid jet emanator  52  shown connected to and in communication with the high pressure tube  50 . The fluid jet emanator  52  includes a plurality of like and nominal sized radially directed jet orifices  90   a - 90   n  located around the periphery of the fluid jet emanator as well as including the previously described annular groove  84  and passageway  86 . The plurality of radially directed jet orifices  90   a - 90   n  are in common and are pressurized in common by pressured saline provided through the high pressure tube  50 . 
     The high pressure tube  50  delivers high pressure saline or other suitable fluid to the fluid jet emanator  52  for producing and distributing high pressure and nominally sized radially directed fluid jet streams  92  of saline or other suitable fluids which emanate from the radially directed jet orifices  90   a - 90   n  of the fluid jet emanator  52  to perform functions, as described herein. A plurality of holes  94   a - 94   n  corresponding to and in alignment with the radially directed jet orifices  90   a - 90   n  are provided in the distal end of the catheter tube  12 , as shown in  FIG. 4 , or in alternative embodiments in order to allow the passage of the radially directed fluid jet streams  92  therethrough. Although the use of the particular style of fluid jet emanator  52  is shown, other fluid jet emanators having other configurations emanating radially directed fluid jet streams  92  can also be used in lieu of the fluid jet emanator  52  shown in  FIG. 5  and the use of other fluid jet emanators shall not be considered to be limiting to the scope of the disclosure. 
     Mode of Operation 
     Generally, a normal guidewire is deployed in a blood vessel  96  requiring treatment or, in the alternative, a filter guidewire or balloon occlusion guidewire could also be used. The catheter tube  12  and other closely associated and aligned components directly associated therewith consisting mainly of the high pressure tube  50  and the fluid jet emanator  52  are advanced over and along a guidewire ( 37 ) which is aligned within the blood vessel  96  for the purpose of debris/thrombus/lesion removal, drug infusion, or other procedures and maneuvered into an appropriate position for treatment. A generic guide catheter or sheath can be incorporated as necessary to offer assistance in placing the catheter tube  12  and closely aligned components in direct association therewith of the direct stream hydrodynamic catheter system  10  within the desired location of the blood vessel  96  in order that the tapered tip  40  of the catheter tube  12  can be extended through the thrombus or lesions  98  to position the fluid jet emanator in very close proximity to the thrombus or lesions  98 . The catheter tube  12  may be moved proximally or distally during the procedure to maximize the effect of the catheter system. Further interventions can be executed as normal over the remaining guidewire or guidewire device. 
     Moreover,  FIG. 6  is a side view, in partial cross section, of the catheter tube  12  in the performance of the method and use thereof which utilizes enabling connections and which utilizes functions of the accompanying components in a manner as shown in  FIG. 1  with particular attention given to the distal section of the catheter tube  12 , the flexible tapered tip  40 , the fluid jet emanator  52 , the inflow orifice  38 , and other closely associated components positioned in the blood vessel  96  containing deposits of thrombus or lesions  98 . More specifically and with reference to  FIGS. 1 and 6 , the mode of operation is further described in use. The direct stream hydrodynamic catheter tube  12  is engaged over and about a guidewire  37  wherein the guidewire  37  (previously inserted into a vein or artery) can first slideably pass through the passageway  88  of the tapered flexible tip  40 , into and through the lumen  53  of the catheter tube  12 , followed by transiting the passageway  86  of the fluid jet emanator  52 , past the inflow orifice  38 , followed by transiting the lumen  53  of the catheter tube  12 , the strain relief tube  28 , the tapered central passageway  58  of the manifold  14  ( FIG. 3 ) and slideably within and in sealed engagement with the hemostasis valve  66  ( FIG. 3 ) to finally exit from the hemostasis nut  30 . 
     The distal portion of the high pressure tube  50  delivers pressurized saline or other suitable fluid to the fluid jet emanator  52  to produce and distribute, preferably, non-hemolyzing radially directed fluid jet streams  92  of saline or other suitable fluids which emanate as direct fluid jet streams from the radially directed jet orifices  90   a - 90   n  of the fluid jet emanator  52  in order to accomplish thrombectomy functions, as described herein. Carefully generated operating pressure and fluid flows at values short of hemolysis can be provided primarily by controlling the input fluid pressure at the high pressure fluid pump  44  and/or by controlling the exhaust rate at the exhaust regulator  47 , whereby the exhaust regulator  47  is operated to provide a negative pressure for effluent aspiration. Other fluid jet emanators of appropriate size and/or configuration can also be incorporated in lieu of the fluid jet emanator  52  within the distal section of the catheter tube  12  to emanate or emit one or more radially directed fluid jet streams  92 . 
     The use of the radially directed fluid jet streams  92  from the radially directed jet orifices  90   a - 90   n  provides for the fluid jet impingement of the deposits of thrombus or lesions of  98  on the inner wall of the blood vessel  96  adjacent to or in close proximity to the radially directed jet orifices  90   a - 90   n  in order to impinge, ablate and loosen deposits of thrombus or lesions  98 , whereby such thrombus or lesion particulate and fluids can be entrained through one or more inflow orifices  38  by aspiration involving the use of an exhaust regulator  47  to be exhausted proximally through the catheter tube  12 . Alternatively, manual aspiration methods as well known in the art can be utilized as well. Additionally, drugs for treatment or for lysing of the thrombus or lesions  98  can also be delivered via the radially directed jet orifices  90   a - 90   n  and radially directed fluid jet streams  92  in order to soften the deposits of thrombus or lesions  98  in the region of the blood vessel  96  adjacent to or in close proximity to the radial jet orifices  90   a - 90   n , thereby benefiting and making use of the radially directed fluid jet streams  92  more effective. The drugs are delivered through the high pressure tube  50  to the sites of the deposits of thrombus or lesions  98  using the fluid jet emanator  52 . 
     One or more inflow orifices  38  receive, ingest and entrain thrombus or lesions  98  in the form of particulate and/or debris therethrough by fluidic flow and are entrained to be urged and carried along the lumen  53  of the catheter tube  12  by aspiration involving the exhaust regulator  47 , wherein the entrainment of thrombus or lesions  98  particulate and/or debris through the inflow orifice(s)  38  is influenced by and based on entrainment in association with aspiration in coordination with the exhaust regulator  47  through the catheter  12 . In such a device, the inflow orifice  38  is sufficiently sized for aspiration or multiple inflow orifices may be used in order to achieve a desired fluid inflow and aspiration. The outflow of fluid and thrombus or lesions is driven proximally through the catheter tube  12  by an internal pressure which results from the radially directed fluid jet streams  92  and the fluid entrained through the inflow orifice  38  and is assisted by aspiration by use of the exhaust regulator  47 . 
     As herein disclosed, the radially directed fluid jet streams  92  are driven by the same pressure source where the velocity is controllingly influenced by the high pressure pump  44  and the total area of all of the radially directed jet orifices  90   a - 90   n . By sizing the radially directed jet orifices  90   a - 90   n  and operating the high pressure pump  44  within suitable parameters, the velocity and strength of the radially directed jet streams  92  can be influenced and controlled. The use of nominally sized radially directed jet orifices  90   a - 90   n  provides for fluid jet streams having enough momentum which can be delivered by a large non-hemolysing fluid jet streams ( 92 ) which are equivalent in energy, via an increased flow rate, to a high velocity, smaller, fluid jet stream to be described later. The principle for an aggressive debris removal is dependent on the velocity of the radially directed jet streams  92 . Consider that there is some critical velocity for debris liberation. As the radially directed jet streams  92  travel through a fluid environment, the jet streams will entrain surrounding fluid whereby the velocity of the fluid jet streams will slow. There are empirical relationships for turbulent jet streams that show that velocity is proportional to the diameter of the jet streams and to the initial velocity of the jet streams. Thus, the velocity at a given distance would be increased by either increasing the initial jet stream velocity or increasing the jet orifice diameter. Note that if the jet orifice diameter is increased, the pump rate of the high pressure pump  44  would need to be increased in order to maintain the fluid jet stream velocity. In practice, the catheter system is designed with a given set of jet orifice diameters and the high pressure pump  44  pump rate is adjusted to achieve the proper efficacy. 
     In general, the structure and operation of embodiments disclosed herein provide for radially directed jet orifices in a size range from 0.001 inch to 0.040 inch for emanation of saline or other suitable fluid therefrom at a velocity range of 1 to 250 m/s. Proximally directed jet orifices can range in size from 0.001 inch to 0.040 inch for emanation of saline or other suitable fluid therefrom in a velocity range of 1 to 250 m/s. Distally directed jet orifices where used can range in size from 0.001 inch to 0.040 inch for emanation of saline or other suitable fluid therefrom in a velocity range of 1 to 250 m/s. By sizing the radially directed jet orifices and adjusting the high pressure fluid pump, the velocity and strength of the radially directed jet stream can be controlled. Also, the radially directed jet orifices can be sized such that the velocity of the jet streams is decreased to a point where no red blood cells are hemolysed, but the momentum of the jet streams can then be increased by means of an infused volume such that the efficacy of the catheter system is as high as that of the high velocity thrombectomy catheters disclosed in Applicant&#39;s related references as set forth above. The general operating pressure of the catheter system can range from 50 psi to 20,000 psi. Generally, those catheter systems of the embodiments disclosed herein use nominal sized radially directed jet orifices  90   a - 90   n  to emanate radially directed fluid jet streams  92 , and the fourth alternative embodiment utilizes cross stream jets  132  ( FIG. 22 ) where the occurrence of hemolysis is not desired or is to be minimized. Other embodiments can use smaller sized radially directed jet orifices  112   a - 112   n  (shown later) to emanate radially directed fluid jet streams  92  of greater strength and efficacy. 
       FIG. 7 , a first alternative embodiment, is an illustration similar in many respects to  FIG. 2  showing a direct stream hydrodynamic catheter tube  12   a , also referred to as the catheter tube  12   a , and the manifold  14  and components associated therewith and wherein each is connected to and utilizes functions of the accompanying enabling components in a manner similar to that shown in  FIG. 1  where all numerals correspond to those elements previously described or as otherwise described herein. The catheter tube  12  is reconfigured as a catheter tube  12   a  to additionally include a balloon  100 , which is self-inflating, located at the distal end thereof and at a position proximal to the inflow orifice  38 . A support ring  102  is additionally included and is secured to the high pressure tube  50 . A marker band  104  is also additionally included and is coaxially and indirectly aligned with the support ring  102 , as later described in detail. The components of  FIG. 7  are used with the enabling components referred to and shown in  FIG. 1  where such enabling components consist of the high pressure fluid source  42 , the high pressure fluid pump  44 , the threaded high pressure connection port  32  and connector  46 , the exhaust regulator  47 , the collection chamber  48  and the connector  49  which are used much in the same manner as previously described. Together, the referenced enabling components in combination with the catheter tube  12   a  and the manifold  14  and closely associated components thereof comprise a direct stream hydrodynamic catheter system  10   a  which is also referred to as the catheter system  10   a . Although the catheter tube  12   a , the manifold  14 , and closely associated components of each are shown referenced to the catheter system  10   a  in  FIG. 7 , it is understood that the previously referenced enabling components referred to and shown in  FIG. 1 , but not shown in  FIG. 7 , are also part of the catheter system  10   a.    
     As shown in  FIG. 8 , the high pressure tube  50  also extends through the support ring  102  and is suitably connected thereto to provide for an additional anchoring and alignment structure for the high pressure tube  50  in order to affix the distal portion of the high pressure tube  50  within the distal end of the catheter tube  12   a . In addition, the high pressure tube  50  also extends indirectly through the radiopaque marker band  104 . The concentrically aligned radiopaque marker band  104  and the support ring  102  are shown forcibly contacting the full wall thickness of the catheter tube  12   a  proximal to the balloon  100 . As previously described, the high pressure tube  50  preferably is attached to the support ring  78 , such as by welding or other suitable means, where the support ring  78  functions as a support for the catheter tube  12   a  in the region beneath the radiopaque marker band  80 . The high pressure tube  50  extends across the inflow orifice  38  and terminates within an internal annular manifold (not shown) of the fluid jet emanator  52   a  and is suitably attached thereto where the fluid jet emanator  52   a  communicates with the lumen of the high pressure tube  50 . The balloon  100  which is continuous with the catheter tube  12   a , preferably has a wall thickness less than that of the general wall thickness of the catheter tube  12   a , is aligned in a longitudinal orientation between the coaxially aligned marker band  104  and support ring  102  and the aligned marker band  80  and support ring  78 . The profile of the balloon  100  in the inflated mode is shown in dashed lines and referenced as the inflated balloon  100   a.    
       FIG. 9  is an illustration similar in many respects to  FIG. 5  showing an isometric view of an alternative fluid jet emanator  52   a  connected to and in communication with the high pressure tube  50 . In addition to the previously shown and described plurality of like and nominal sized radially directed jet orifices  90   a - 90   n , the fluid jet emanator  52   a  also includes a plurality of proximally (rearwardly) directed orifices  106   a - 106   n  located on and about a proximal face of the emanator  52   a  and in parallel alignment to the longitudinal axis of the fluid jet emanator  52   a , as well as including the previously described annular groove  84  and passageway  86 . The plurality of radially directed jet orifices  90   a - 90   n  and the plurality of proximally directed jet orifices  106   a - 106   n  are in common and are pressurized in common by pressured saline provided through the high pressure tube  50 . The high pressure tube  50  delivers a pressurized saline or other suitable fluid to the fluid jet emanator  52   a  for producing and distributing nominal sized radially directed fluid jet streams  92  of saline or other suitable fluids which emanate from the radially directed jet orifices  90   a - 90   n  of the fluid jet emanator  52   a  to perform functions, as described herein. The fluid jet emanator  52   a  also provides and distributes pressurized proximally directed fluid jet streams  108  of saline or other suitable fluids which are directed proximally from the proximally directed orifices  106   a - 106   n  to perform functions, as described herein. 
     Mode of Operation 
     In a closely related fashion and manner as previously described and with reference to  FIG. 10 , the method of operation of a first alternative embodiment is now described. Generally, a normal guidewire  37  is deployed in a blood vessel  96  requiring treatment, or in the alternative, a filter guidewire or balloon occlusion guidewire could also be used. The catheter tube  12   a  and other closely associated and aligned components directly associated therewith consisting mainly of the high pressure tube  50 , the fluid jet emanator  52   a , the distal section of the catheter tube  12   a , and the uninflated balloon  100  are advanced over and along the guidewire  37  and aligned within the blood vessel  96  for the purpose of debris/thrombus/lesion maceration and removal, drug infusion, or other procedures and maneuvered into an appropriate position within the blood vessel  96  for treatment. A generic guide catheter or sheath can be incorporated as necessary to offer assistance in placing the catheter tube  12   a  and closely aligned components in direct association therewith of the direct stream hydrodynamic catheter system  10   a  within the desired location of the blood vessel  96  in order that the tapered flexible tip  40  of the catheter tube  12   a  can be extended through and beyond the thrombus or lesions  98  to position the fluid jet emanator  52   a  in very close proximity to the thrombus or lesions  98  and to place the self-inflating balloon  100  proximal to the thrombus or lesions  98 . The direct stream thrombectomy catheter system  10   a  is then activated, wherein the balloon  100  is automatically and expandingly deployed reforming as an expanded balloon  100   a , and then thrombus, debris and the like are removed or drugs can be infused by a desired procedure. 
     Moreover,  FIG. 10  is a side view, in partial cross section, of the catheter tube  12   a  of the first alternative embodiment illustrating the performance of the method and use thereof which performance utilizes enabling connections and which performance utilizes functions of the accompanying components in a manner similar to that shown in  FIG. 1  with particular attention given to the distal section of the catheter tube  12   a , the flexible tapered tip  40 , the inflated self-inflated balloon  100   a , the fluid jet emanator  52   a , the inflow orifice(s)  38  (reoriented), and other closely associated components positioned in the blood vessel  96  containing deposits of thrombus or lesions  98 . For purposes of example and illustration, one or more inflow orifice(s)  38  are shown at the top and the bottom of the catheter tube  12   a . More specifically and with reference to  FIG. 10 , the mode of operation is further described. In use, the direct stream hydrodynamic catheter tube  12   a  can be engaged over and about the guidewire  37 , wherein the guidewire  37  (previously inserted into a vein or artery) can first slideably pass through the passageway  88  of the tapered flexible tip  40 , into and through the lumen  53  of the catheter tube  12   a , followed by transiting the passageway  86  of the fluid jet emanator  52   a , past the inflow orifice(s)  38 , through the balloon  100 , followed by additional transiting through the lumen  53  of the catheter tube  12   a , through the strain relief tube  28 , the tapered central passageway  58  ( FIG. 3 ), slideably within and in sealed engagement with the hemostasis valve  66  ( FIG. 3 ) to finally exit from the hemostasis nut  30 . 
     The distal portion of the high pressure tube  50  delivers pressured saline or other suitable fluid to the fluid jet emanator  52   a  to produce and distribute non-hemolyzing radially directed fluid jet streams  92  of saline or other suitable fluids which emanate as direct stream from the radially directed jet orifices  90   a - 90   n  of the fluid jet emanator  52   a  to accomplish thrombectomy functions in a manner as previously described. Carefully generated operating pressure and fluid flows at values short of hemolysis can be accomplished primarily by controlling the input fluid pressure at the high pressure fluid pump  44  and/or by controlling the exhaust rate at the exhaust regulator  47 , whereby the exhaust regulator  47  is operated to provide a negative pressure for effecting effluent aspiration. Additionally, the pressured saline, or other suitable fluid, is also delivered by the high pressure tube  50  to the fluid jet emanator  52   a  to produce and distribute proximally directed fluid jet streams  108  of saline or other suitable fluids which are directed proximally from the proximally directed jet orifices  106   a - 106   n  ( FIG. 9 ) of the fluid jet emanator  52   a , and to thence transit parallel to the inflow orifice(s)  38 , and finally into the distal section of the catheter tube  12   a  to flow proximally therethrough and provide for the inflation of the balloon  100  and to complement the aspiration of effluent flow. 
     The balloon  100  is automatically and expandingly deployed to reform as an inflated balloon  100   a  by the pressure exerted from the proximally directed high velocity fluid jet streams  108  emanating from the proximally directed jet orifices  106   a - 106   n  of the fluid jet emanator  52   a  and complemented by the pressurized effluent flow through the lumen  53  of the catheter tube  12   a . The pressurized inflation of the inflated balloon  100   a  or maintaining a state of inflation of the inflated balloon  100   a  is also assisted by utilizing back pressure along the length of the catheter tube  12   a . An operational advantage of the present catheter system is the utilization of an exhaust outflow and an internal pressure which are produced by the proximally directed fluid jet stream(s)  108  in combination with a restrictive control of the outflow, such as influenced by the exhaust regulator  47  in assisting an automatic expansion of the balloon  100  which forcibly impinges upon and seals against the inner walls of the blood vessel  96 . The reduced thickness of the material comprising the balloon  100  allows the balloon  100  to expand sufficiently to reform as the inflated balloon  100   a , the further expansion of which is restricted by its impingement on the wall of the blood vessel  96 . The operating pressure and fluid flows affecting the inflation of the balloon  100  can be affected primarily by controlling the input fluid pressure at the high pressure fluid pump  44  and/or by controlling the exhaust rate at the exhaust regulator  47  whereby the exhaust regulator  47  is operated to provide a negative pressure for effecting effluent aspiration. Other fluid jet emanators of appropriate size and/or configuration can also be incorporated in lieu of the fluid jet emanator  52   a  positioned within the distal section of the catheter tube  12   a  in order to emanate or emit one or more radially directed fluid jet streams  92  and to emanate or emit one or more proximally directed fluid jet streams  108  proximally along or near the longitudinal axis of the catheter tube  12   a ; the preceding alternatives shall not be considered to be limiting to the scope of the disclosure. 
     By inflating the balloon  100 , the peripheral circumference of the inflated balloon  100   a  impinges upon the wall of the blood vessel  96  in order to effect a fluid flow reduction or cessation within the blood vessel  96 . The inflated balloon  100   a , i.e., the balloon  100 , can be compliant, semi-compliant, or noncompliant according to the procedure performed. The inflated balloon  100   a  provides for the uniform centering and positioning of the distal section of the catheter tube  12   a  within the blood vessel  96 , thereby providing a substantially equal annular spacing between the wall of the blood vessel  96  and the inflow orifice  38  for uniform access and clearance thereto and thereabout. The inflated balloon  100   a  also provides for an annular spacing between the blood vessel  96  and the inflow orifice(s)  38  in order to provide for the access and clearance to and about the inflow orifice  38 . 
     The use of the radially directed fluid jet streams  92  from the radially directed jet orifices  90   a - 90   n  provides for the fluid jet impingement of the deposits of lesions or thrombus  98  on the inner wall of the blood vessel  96  adjacent to or in close proximity to the radially directed jet orifices  90   a - 90   n  in order to impinge, ablate and loosen deposits of lesions or thrombus  98 , whereby such thrombus or lesion particulate and fluids can be entrained through one or more inflow orifices  38  by aspiration involving the use of the exhaust regulator  47 , as previously described. The action and high velocity of the proximally directed fluid jet streams  108  of saline or other suitable fluids proximally through the catheter tube  12   a , in addition to causing the inflation of balloon  100 , provide a force for driving thrombus or lesions  98  and fluid flow proximally through the lumen  53  of the catheter tube  12   a . As previously described, drugs for treatment or for lysing of the thrombus deposits or lesions  98  can also be delivered via the high pressure tube  50  and the fluid jet emanator  52   a  and the radially directed jet orifices  90   a - 90   n  and radially directed fluid jet streams  92  in order to soften the deposits of lesions or thrombus  98  in the region of the blood vessel  96  adjacent to or in close proximity to the radial jet orifices  90   a - 90   n , thereby benefiting and making use of the radially directed fluid jet streams  92  more effective. 
     The proximally directed fluid jet streams  108  impinge upon, provide drag forces on, and break up or macerate such entrained thrombus or lesions  98  particulate and/or debris which have been ingested and entrained through the inflow orifice(s)  38 . Such debris is further entrained, urged and carried proximally along the lumen  53  of the catheter tube  12   a  by internal pressure and by aspiration involving the exhaust regulator  47 , as well as by the additional force provided by the action of the proximally directed fluid jet streams  108 . The entrainment of thrombus or lesions  98  particulate and/or debris through the inflow orifice(s)  38  is influenced by and based on coordinated association primarily involving the operation of the exhaust regulator  47  and the operation of the high pressure fluid pump  44  through the catheter  12   a . In such a catheter system, the inflow orifice  38  is sufficiently sized for aspiration or multiple inflow orifices may be used in order to achieve a desired fluid inflow and aspiration. The catheter tube  12   a  may be moved proximally or distally during the procedure to maximize the effect of the catheter system. The balloon  100  can be alternately pressurized and depressurized, whereby thrombus or lesions  98  can be compacted in order to enlarge a passage. When the procedure is complete, the inflated balloon  100   a  is generally deflated sufficiently under normal arterial pressure to be removed safely, or deflation can be aided with a manual syringe attached to the manifold, or deflation can be aided by means of the exhaust regulator  47 . Further interventions can be executed as normal over the remaining guidewire or guidewire device. Cessation of fluid flow in a blood vessel or other conduit maximizes the effect of the catheter system  10   a  in terms of debris or tissue removal. Use of devices of the present disclosure can also provide for the performance of a modified embolectomy by breaking up clots as the inflated balloon  100   a  is moved through a blocked vessel or can be used to minimize any distal or proximal embolization. 
     In the present disclosure, the radially directed fluid jet streams  92  are driven by the same pressure source as the proximally directed fluid jet streams  108 . The velocity of the fluid directed jet streams is controlled by the high pressure pump  44 , the total area of all of the radially directed jet orifices  90   a - 90   n  and the proximally directed jet orifices  106   a - 106   n . Debris removal is influenced by and accomplished by aspiration in coordination with the operation of the high pressure fluid pump  44  and the exhaust regulator  47  through the catheter tube  12   a . In such a catheter system, the inflow orifice  38  is sufficiently sized for aspiration. By sizing the radially directed jet orifices  90   a - 90   n  and the proximally directed jet orifices  106   a - 106   n  and operating the high pressure pump  44  within suitable parameters, the velocity and strength of the radially directed fluid jet streams  92  and the proximally directed fluid jet streams  108  can be influenced and controlled. The use of nominally sized radially directed jet orifices  90   a - 90   n  provides for the use of fluid jet streams having enough momentum that can be delivered by large non-hemolysing fluid jet streams ( 92 ) which are equivalent in energy, via increased flow rate, to high velocity smaller fluid jet streams described later. The principle for an aggressive debris removal is based on the velocity of the radially directed jet streams  92 . Consider that there is some critical velocity for debris liberation. As the radially directed fluid jet streams  92  travel through a fluid environment, the fluid jet streams will entrain surrounding fluid and the fluid jet streams will slow. There are empirical relationships for turbulent jet streams that show that velocity is proportional to the diameter of the jet streams and to the initial velocity of the jet streams. Thus, the velocity of the turbulent jet streams at a given distance could be increased by either increasing the initial fluid jet stream velocity or increasing the jet orifice diameters. Note that if the jet orifice diameters are increased, the high pressure pump rate of the pump  44  would need to be increased in order to maintain the fluid jet stream velocity. In practice, the present catheter system is designed with a given set of jet orifice diameters and with the high pressure pump  44  pump rate adjusted to achieve the proper efficacy. 
       FIG. 11 , a second alternative embodiment is shown as an illustration similar in many respects to  FIG. 2  showing a direct stream hydrodynamic catheter tube  12   b , also referred to as the catheter tube  12   b , and a manifold  14  and components associated therewith and wherein each is connected to and utilizes functions of the accompanying enabling components in a manner similar to that shown in  FIG. 1  where all numerals correspond to those elements previously described or as otherwise described herein. The components of  FIG. 11  are used with the enabling components referred to and shown in  FIG. 1  where such enabling components consist of the high pressure fluid source  42 , the high pressure fluid pump  44 , the threaded high pressure connection port  32  and connector  46 , the exhaust regulator  47 , the collection chamber  48 , and the connector  49  all which are used much in the same manner as previously described. Together, the referenced enabling components in combination with the catheter tube  12   b  and the manifold  14  and closely associated components thereof comprise a direct stream hydrodynamic catheter system  10   b  which is also referred to as the catheter system  10   b . The catheter system  10   b  of this embodiment provides for an increased fluid velocity with smaller sized radially projected fluid jet streams therefrom by using smaller radially directed jet orifices, as well as including the provision of and the use of the previously described proximally directed fluid jet streams  108 . Although the catheter tube  12   b , the manifold  14 , and closely associated components of each are shown referenced to the catheter system  10   b  in  FIG. 11 , it is understood that the previously referenced enabling components referred to and shown in  FIG. 1 , but not shown in  FIG. 11 , are also a significant part of the catheter system  10   b.    
       FIG. 12  is an illustration similar in many respects to  FIG. 4  showing the distal end of the catheter tube  12   b  used in lieu of the catheter tube  12  and shown in use with a fluid jet emanator  52   b  in lieu of the fluid jet emanator  52 , wherein the fluid jet emanator  52   b  includes additional structure, features and functionality such as described in  FIG. 13 . 
       FIG. 13  is an illustration similar in many respects to  FIG. 9  showing an isometric view of the alternative fluid jet emanator  52   b  connected to and in communication with the high pressure tube  50  alternatively including the plurality of small sized radially directed jet orifices  112   a - 112   n  in lieu of the nominally sized radially directed jet orifices  90   a - 90   n  of the previous embodiments. The fluid jet emanator  52   b  also includes the previously shown and described plurality of proximally (rearwardly) directed orifices  106   a - 106   n  located on and about a proximal face of the fluid jet emanator  52   b  in parallel alignment with the longitudinal axis of the fluid jet emanator  52   b , as well as including the previously described annular groove  84  and passageway  86 . The plurality of radially directed jet orifices  112   a - 112   n  and the plurality of proximally directed orifices  106   a - 106   n  are in common and are pressurized in common by the pressurized saline provided through the high pressure tube  50 . 
     The high pressure tube  50  delivers pressurized saline or other suitable fluid to the fluid jet emanator  52   b  for producing and distributing small sized radially directed fluid jet streams  114  at a high pressure which jet streams emanate from the radially directed jet orifices  112   a - 112   n  of the fluid jet emanator  52   b  to vigorously and more powerfully perform functions, as described herein. The fluid jet emanator  52   b  also produces and distributes pressurized proximally directed fluid jet streams  108  of saline or other suitable fluids which fluid jet streams are directed proximally from the proximally directed orifices  106   a - 106   n  to perform functions, as described herein. 
     Mode of Operation 
     Generally, a normal guidewire is deployed in a blood vessel  96  requiring treatment, or in the alternative, a filter guidewire or balloon occlusion guidewire could also be used. The catheter tube  12   b  and other closely associated and aligned components directly associated therewith consisting mainly of the high pressure tube  50  and the fluid jet emanator  52  are advanced over and along a guidewire ( 37 ) which is aligned within the blood vessel  96  for the purpose of debris/thrombus/lesion removal, drug infusion, or other procedures, and maneuvered into an appropriate position for treatment. A generic guide catheter or sheath can be incorporated as necessary to offer assistance in placing the catheter tube  12   b  and closely aligned components, in direct association therewith, of the direct stream hydrodynamic catheter system  10   b  within the desired location of the blood vessel  96  in order that the tapered tip  40  of the catheter tube  12   b  can be extended through and beyond the thrombus or lesions  98  and in order to position the fluid jet emanator in very close proximity to the thrombus or lesions  98 . The direct stream thrombectomy catheter  10   b  is then activated wherein thrombus, debris, lesions and the like can be infused by a desired procedure. The catheter tube  12   b  may be moved proximally or distally during the procedure to maximize the effect of the system. Further interventions can be executed as normal over the remaining guidewire or guidewire device. 
     Moreover,  FIG. 14  is a side view, in partial cross section, of the catheter tube  12   b  of the second alternative embodiment illustrating the performance of the method and use thereof which utilizes enabling connections and which performance utilizes functions of the accompanying components in a manner similar to that shown in  FIG. 1  with particular attention given to the distal section of the catheter tube  12   b , the flexible tapered tip  40 , the fluid jet emanator  52   b , the inflow orifice(s)  38  (reoriented), and other closely associated components positioned in the blood vessel  96  containing deposits of thrombus or lesions  98 . More specifically and with reference to  FIGS. 1 and 14 , the mode of operation is further described in use whereby the direct stream hydrodynamic catheter tube  12   b  is engaged over and about the guidewire  37  in a manner as previously described. 
     The distal portion of the high pressure tube  50  delivers pressurized saline or other suitable fluid to the fluid jet emanator  52   b  to produce and distribute small sized, high powered, radially directed fluid jet streams  114  of saline or other suitable fluids which emanate as direct stream from the radially directed jet orifices  112   a - 112   n  of the fluid jet emanator  52   b  to accomplish thrombectomy functions, as previously described. Carefully generated operating pressure and fluid flows can be influenced primarily by controlling the input pressure fluid at the high pressure fluid pump  44  and/or by controlling the exhaust rate at the exhaust regulator  47 , whereby the exhaust regulator  47  is operated to provide a negative pressure for effluent aspiration. Other fluid jet emanators of appropriate size and/or configuration can be incorporated in lieu of the fluid jet emanator  52   b  within the distal section of the catheter tube  12   b  in order to emanate or emit one or more radially directed fluid jet streams  114 . 
     The use of the high powered radially directed fluid jet streams  114  from the radially directed jet orifices  112   a - 112   n  provides for the fluid jet impingement of the deposits of thrombus or lesions  98  on the inner wall of the blood vessel  96  adjacent to or in close proximity to the radially directed jet orifices  112   a - 112   n  in order to impinge, ablate and loosen deposits of thrombus or lesions  98 , whereby such thrombus or lesion particulate and fluids can be entrained by the fluid inflow, as shown by the directed arrow  128  in  FIG. 14 , through one or more inflow orifices  38  by aspiration involving the use of the exhaust regulator  47  and exhausted proximally through the catheter tube  12   b . Additionally, drugs for treatment or for lysing of the thrombus or lesions  98  can also be delivered via the radially directed jet orifices  112   a - 112   n  and radially directed fluid jet streams  114  in order to soften the deposits of thrombus or lesions  98  in the region of the blood vessel  96  adjacent to or in close proximity to the radial jet orifices  112   a - 112   n , thereby making use of the radially directed fluid jet streams  114  more effective. The drugs are delivered through the high pressure tube  50  to the sites of the deposits of thrombus or lesions  98  using the fluid jet emanator  52   b.    
     One or more inflow orifices  38  receive, ingest and entrain thrombus or lesions  98  in the form of particulate and/or debris therethrough by fluidic flow and are entrained to be urged and carried along the lumen  53  of the catheter tube  12   b  by aspiration involving the exhaust regulator  47 , whereby the entrainment of thrombus or lesions  98  particulate and/or debris through the inflow orifice(s)  38  is influenced by and based on entrainment in association with aspiration in coordination with the exhaust regulator  47  through the catheter  12   b . In such a device, the inflow orifice  38  is sufficiently sized for aspiration or multiple inflow orifices may be used in order to achieve a desired fluid inflow and aspiration. The outflow of fluid and thrombus or lesions is driven proximally through the catheter tube  12   b  by an internal pressure which results from the radially directed fluid jet streams  92  and the fluid entrained through the inflow orifice  38  and is assisted by aspiration by the use of the exhaust regulator  47 . 
     In the present disclosure, the radially directed fluid jet streams  114  are driven by the same pressure source where the velocity is controllingly influenced by the high pressure pump  44  and the total area of all of the radially directed jet orifices  112   a - 112   n . By sizing the radially directed jet orifices  112   a - 112   n  and operating the high pressure pump  44  within suitable parameters, the velocity and strength of the radially directed fluid jet streams  114  can be influenced and controlled. The principle for an aggressive debris removal is dependent on the velocity of the radially directed fluid jet streams  114 . Consider that there is some critical velocity for debris liberation. As the radially directed fluid jet streams  114  travel through a fluid environment, the fluid jet streams will entrain surrounding fluid whereby the velocity of the fluid jet streams will slow. There are empirical relationships for turbulent fluid jet streams that show that velocity is proportional to the diameter of the fluid jet streams and to the initial velocity of the fluid jet streams. Thus, the velocity at a given distance could be increased by either increasing the initial fluid jet stream velocity or increasing the jet orifice diameter. As previously described, the pump flow rate must be adjusted depending on the size of the jet orifice diameter and the desired jet stream velocity. 
       FIG. 15 , a third alternative embodiment, is an illustration similar in many respects to  FIG. 2  showing a direct stream hydrodynamic catheter tube  12   c , also referred to as the catheter tube  12   c , and the manifold  14  and components associated therewith and wherein each is connected to and utilizes functions of the accompanying enabling components in a manner similar to that shown in  FIG. 1  where all numerals correspond to those elements previously described or as otherwise described herein. The catheter tube  12  is reconfigured as a catheter tube  12   c  to additionally include one or more balloon inflation inflow orifices  116  located distal to a fluid jet emanator  52   c , as best shown in  FIG. 16 , and a balloon  118  which is self-inflating and located at the distal end of the balloon inflation inflow orifice  116 . The components of  FIG. 15  are used with the enabling components referred to and shown in  FIG. 1  where such enabling components consist of the high pressure fluid source  42 , the high pressure fluid pump  44 , the threaded high pressure connection port  32  and connector  46 , the exhaust regulator  47 , the collection chamber  48 , and the connector  49  which are used much in the same manner as previously described. Together, the referenced enabling components in combination with the catheter tube  12   c  and the manifold  14  and closely associated components thereof comprise a direct stream hydrodynamic catheter system  10   c  which is also referred to as the catheter system  10   c , wherein the catheter system  10   c  provides for an increased velocity but smaller sized radially projected fluid jet streams therefrom by using small sized radially directed jet orifices. The catheter system  10   c  includes the provision of and the use of the previously described pressurized proximally directed fluid jet streams  108  and the previously described pressurized radially directed fluid jet streams  114 . Additionally, the catheter system  10   c  includes the provision of and the use of pressurized distally directed fluid jet streams  126  which emanate from the fluid jet emanator  52   c  ( FIG. 17 ) for the inflation of the distally located balloon  118  in cooperation with the balloon inflation inflow orifice  116 . Although the catheter tube  12   c , the manifold  14 , and closely associated components of each are shown referenced to the catheter system  10   c  in  FIG. 15 , it is understood that the previously referenced enabling components referred to and shown in  FIG. 1 , but not shown in  FIG. 15 , are also part of catheter system  10   c.    
       FIG. 16  is similar in many respects to  FIG. 4  illustrating the distal end of a catheter tube  12   c  reconfigured and used in lieu of the catheter tube  12  and shown in use with the fluid jet emanator  52   c  in lieu of the fluid jet emanator  52 , wherein the fluid jet emanator  52   c  includes additional structure, features and functionality such as described for  FIG. 17 . Shown more specifically is the relationship and arrangement of the inflow orifice  38  (reoriented), the proximally directed jet orifices  106   a - 106   n  of the fluid jet emanator  52   c , the radially directed jet orifices  112   a - 112   n  of the fluid jet emanator  52   c , the distally directed jet orifices  122   a - 122   n  of the fluid jet emanator  52   c , the balloon inflation inflow orifice(s)  116  (reoriented) and the self-inflating balloon  118 . Also shown is the plurality of holes  94   a - 94   n  extending through the wall of the catheter tube  12   c  in corresponding alignment with the radially directed jet orifices  112   a - 112   n . High velocity radially directed fluid jet streams  114  ( FIG. 17 ) emanate through the radially directed jet orifices  112   a - 112   n  and through the plurality of holes  94   a - 94   n  of the catheter tube  12   c  in order to provide treatment as shown and described in  FIG. 18 . The balloon  118  which is continuous with the catheter tube  12   c , preferably has a wall thickness less than that of the general wall thickness of the catheter tube  12   c , is generally aligned in longitudinal orientation along the catheter tube  12   c  between the balloon inflation inflow orifice  116  and the tapered flexible tip  40 . The profile of the balloon  118  in the inflated mode is shown in dashed lines and referenced as the inflated balloon  118   a.    
       FIG. 17  is an illustration similar in many respects to  FIG. 13  showing an isometric view of the alternative fluid jet emanator  52   c  connected to and in communication with the high pressure tube  50 . A plurality of distally (forwardly) directed jet orifices  122   a - 122   n  is additionally located on and about the distal face of the fluid jet emanator  52   c . As previously shown and described, the plurality of small sized radially directed jet orifices  112   a - 112   n  is also included about the periphery of the fluid jet emanator  52   c . The fluid jet emanator  52   c  also includes the plurality of proximally (rearwardly) directed jet orifices  106   a - 106   n  located on and about the proximal face of the fluid jet emanator  52   c , as well as including the previously described annular groove  84  and passageway  86 . The plurality of radially directed jet orifices  112   a - 112   n , the plurality of proximally directed orifices  106   a - 106   n  and the plurality of distally directed jet orifices  122   a - 122   n  are in common and are pressurized in common by pressurized saline provided through the high pressure tube  50 . 
     The high pressure tube  50  delivers pressurized saline or other suitable fluids to the fluid jet emanator  52   c  to produce and distribute high pressure distally directed fluid jet streams  126  which emanate from the distally directed jet orifices  122   a - 122   n  in order to provide for the automatic pressurization and inflation of the balloon  118  as shown in  FIG. 18 . In a manner as previously described, the high pressure tube  50  delivers pressurized saline or other suitable fluid to the fluid jet emanator  52   c  for producing and distributing high velocity but small sized radially directed fluid jet streams  114  of saline or other suitable fluids which emanate from the radially directed jet orifices  112   a - 112   n  of the fluid jet emanator  52   c  to vigorously and more powerfully perform functions, as described herein. As previously described, the fluid jet emanator  52   c  also produces and distributes pressurized proximally directed fluid jet streams  108  of saline or other suitable fluids which are directed proximally from the proximally directed orifices  106   a - 106   n  to perform functions, as described herein. 
     Mode of Operation 
     In a closely related manner as previously described herein and with reference to  FIG. 18 , the method of operation of a third alternative embodiment is now described. Generally, a normal guidewire  37  is deployed in a blood vessel  96  requiring treatment. The catheter tube  12   c  and other closely associated and aligned components directly associated therewith consisting mainly of the high pressure tube  50 , the fluid jet emanator  52   c , the distal section of the catheter tube  12   c , and the uninflated balloon  118  are advanced over and along the guidewire ( 37 ) and aligned within the blood vessel  96  for the purpose of cell harvesting, debris/thrombus/lesion maceration or removal, drug infusion, or other procedures; the catheter tube is maneuvered into an appropriate position within the blood vessel  96  for treatment. A generic guide catheter or sheath can be incorporated as necessary to offer assistance in placing the catheter tube  12   c  and closely aligned components in direct association therewith of the direct stream hydrodynamic catheter system  10   c  within the desired location of the blood vessel  96  in order that the tapered flexible tip  40  of the catheter tube  12   c  can be extended through the thrombus or lesions  98  to a position where the fluid jet emanator  52   c  is in very close proximity to the thrombus or lesions  98  and where the self-inflating balloon  118  is distal to the thrombus or lesions  98 . The direct stream thrombectomy catheter system  10   c  is then activated, whereby the balloon  118  is automatically and expandingly deployed reforming as an expanded balloon  118   a , and then cell from the thrombus or vessel, debris and the like can be harvested (removed) by aspiration or by liquid flows directed proximally along the lumen  53  of the catheter tube  12   c  and subsequently spun in a separation centrifuge for sampling or drugs can be infused by a desired procedure. 
     Moreover,  FIG. 18  is a side view, in partial cross section, of the catheter tube  12   c  of the third alternative embodiment of the present disclosure illustrating the performance of the method and use thereof which utilizes enabling connections and which utilizes functions of the accompanying components in a manner similar to that shown in  FIG. 1  with particular attention given to the distal section of the catheter tube  12   c , the flexible tapered tip  40 , the inflated self-inflated balloon  118 ( a ), the balloon inflation inflow orifice(s)  116  (reoriented), the fluid jet emanator  52   c , the inflow orifice(s)  38 , and other closely associated components positioned in the blood vessel  96  containing deposits of thrombus or lesions  98 . For purposes of example and illustration, one or more inflow orifice(s)  38  (reoriented) are shown at the top and the bottom of the catheter tube  12   c.    
     More specifically and with reference to  FIG. 18 , the mode of operation is further described. The distal portion of the high pressure tube  50  delivers pressured saline or other suitable fluid to the fluid jet emanator  52   c  to produce and distribute radially directed fluid jet streams  114  of saline or other suitable fluids which emanate as direct fluid jet streams from the radially directed jet orifices  112   a - 112   n  of the fluid jet emanator  52   c  to accomplish thrombectomy functions in a manner as previously described. Pressured saline, or other suitable fluid, is also delivered by the high pressure tube  50  to the fluid jet emanator  52   c  to produce and distribute proximally directed fluid jet streams  108  of saline or other suitable fluids which are directed proximally from the proximally directed jet orifices  106   a - 106   n  ( FIG. 17 ) of the fluid jet emanator  52   c , and to thence transit parallel to the inflow orifice(s)  38 , and finally into the distal section of the catheter tube  12   c  to flow proximally therethrough in a manner as previously described. Additionally and with particular reference to this third alternative embodiment, pressurized saline or other suitable fluid is also delivered by the high pressure tube  50  to the fluid jet emanator  52   c  to produce and distribute distally directed fluid jet streams  126  of saline or other suitable fluids which are directed distally from the distally directed jet orifices  122   a - 122   n  ( FIG. 17 ) in order to assist in the inflation of the balloon  118 . 
     The distally directed fluid jet streams  126  of saline or other suitable fluids which are directed distally from the orifices  122   a - 122   n  ( FIG. 17 ) of the fluid jet emanator  52   c  within and along the distal section of the catheter tube  12   c  in close proximity to the balloon inflation inflow orifice  116  and thence within the confines of the self-inflating balloon  118  result in the inflation of balloon  118   a  for the purposes of, but not limited to, impeding fluid flow within the blood vessel  96  to effect a stagnate fluid flow in the thrombus region, to provide centering of the distal section of the catheter tube  12   c , and to assist in the accomplishment of thrombectomy functions, as described herein. 
     The self-inflating balloon  118  is automatically and expandingly deployed to reform as an inflated balloon  118   a  primarily by the pressure of the distally directed fluid jet streams  126  emanating from the jet orifices  122   a - 122   n  of the fluid jet emanator  52   c . The fluid entrainment inflow, shown by the directed arrows  128  in  FIG. 18  assists in the inflation of the self-inflating balloon  118 . Pressurized inflation of the inflated balloon  118   a  or maintaining a state of inflation is also assisted by utilizing back pressure along the length of the catheter tube  12   c . An operational advantage of this third alternative embodiment is the utilization of the exhaust outflow and internal pressure which is produced by the proximally directed fluid jet stream(s)  108  in combination with the restriction of the outflow, such as caused by the exhaust regulator  47 , to assist in the automatic expansion of the balloon  118  which expanded balloon  118   a  forcibly impinges upon and seals against the inner wall of the blood vessel  96 . The reduced thickness of the material comprising the balloon  118  allows the balloon  118  to expand sufficiently to become an inflated balloon  118   a  restricted by its impingement upon the wall of the blood vessel  96 . The inflation pressure and fluid flows can be influenced by controlling the input fluid pressure at the high pressure fluid source  42  and/or by controlling the exhaust rate at the exhaust regulator  47 . Other fluid jet emanators of appropriate size and/or configuration can be incorporated in lieu of the fluid jet emanator  52   c  within the proximal end of the distal section of the catheter tube  12   c  in order to emanate or emit one or more distally directed fluid jet streams  126 , to emanate or emit one or more proximally directed fluid jet streams  108  along or near the longitudinal axis of the catheter tube  12   c , and to emanate or emit one or more radially directed fluid jet streams  114  therefrom. 
     Inflation of the balloon  118  to form the inflated balloon  118   a  positions the peripheral circumference of the inflated balloon  118  against the wall of the blood vessel  96  in order to effect a fluid flow reduction or cessation within the blood vessel  96 . The inflated balloon  118   a , i.e., the balloon  118 , can be compliant, semi-compliant, or noncompliant according to the procedure performed. The inflated balloon  118   a  provides uniform centering and positioning of the distal section of the catheter tube  12   c  within the blood vessel  96 , thereby providing a substantially equal annular spacing between the wall of the blood vessel  96  and the inflow orifice  38  for uniform access and clearance thereto and thereabout. The inflated balloon  118   a  also provides for an annular spacing between the blood vessel  96  and the balloon inflation inflow orifice  116  in order to provide access and clearance to and about the balloon inflation inflow orifice  116 . 
     The proximally directed fluid jet streams  108  provide a low pressure region at the inflow orifice  38  to ingest and entrain thrombotic particulate and/or debris  98  therethrough to impinge upon, provide drag forces on, and break up or macerate thrombotic particulate and/or debris  98 , and by entrainment to urge and carry along one or more particles of thrombotic particulate and/or debris or lesion particulate  98  along the lumen  53  of the catheter tube  12   c  by the action of the proximally directed fluid jet streams  108 . The entrainment of thrombotic particulate and/or debris  98  through the inflow orifice  38  is dependent on the high velocity fluid jet streams  108 . The outflow of fluid and thrombus is generally driven proximally through the catheter tube  12   c  by an internal pressure which is produced by the high velocity fluid jet streams  108  and the fluid entrained through the inflow orifice  38  but also uses the assistance of fluid pressure forces provided by the radially directed fluid jet streams  114 , the distally directed fluid jet streams  126  and assistance provided by aspiration. 
     The balloon  118  can be alternately pressurized and depressurized whereby the thrombus or lesions  98  can be compacted in order to enlarge a passage through the blood vessel  96 . The catheter tube  12   c  may be moved proximally or distally during the procedure to maximize the effect of the catheter system. When the procedure is complete, the inflated balloon  118   a  is generally deflated sufficiently under normal arterial pressure so that the balloon  118  can be removed safely, or deflation of the balloon  118  can be aided with a manual syringe attached to the manifold, or deflation of the balloon  118  can be aided by means of the exhaust regulator  47 . Other known interventions can be executed over the remaining guidewire or guidewire device. Cessation of fluid flow in a blood vessel or other conduit maximizes the effect of the catheter system  10   c  in terms of debris or tissue removal. Use of devices of the present disclosure can also provide for the performance of a modified embolectomy by breaking up clots as the inflated balloon  118   a  is moved through a blocked vessel or can be used to minimize any distal or proximal embolization. 
     In this alternative embodiment the radially directed fluid jet streams  114 , the proximally directed fluid jet streams  108  and the distally directed fluid jet streams  126  are driven by the same fluid pressure. The velocity of the fluid jet streams is controllingly influenced by the high pressure pump  44  and the total area of all of the radially directed jet orifices  112   a - 112   n , the proximally directed jet orifices  106   a - 106   n  and the distally directed jet orifices  122   a - 122   n . Debris and sample removal are influenced by and assisted by aspiration in coordination with the operation of the high pressure fluid pump  44  and the exhaust regulator  47  which simultaneously introduces pressurized radially, proximally and distally directed fluid jet streams into the distal end of the catheter tube  12   c . In such a catheter system, the inflow orifice  38  is sufficiently sized for aspiration to be effected. By sizing the radially directed jet orifices  112   a - 112   n , the proximally directed jet orifices  106   a - 106   n , the distally directed orifices  122   a - 122   n  and by operating the high pressure pump  44  within suitable parameters, the velocity and strength of the radially directed fluid jet streams  114 , the proximally directed fluid jet streams  108  and the distally directed fluid jet streams  126  can be influenced and controlled. The principle for aggressive debris removal is dependent upon the velocity of the radially directed fluid jet streams  114 . Consider that there is some critical velocity for debris liberation. As the radially directed fluid jet streams  114  travel through a fluid environment the fluid jet streams will entrain surrounding fluid whereby the fluid jet streams will slow. There are empirical relationships for turbulent jet streams that show that the velocity of the fluid jet streams is proportional to the diameter of the jet streams and to the initial velocity of the fluid jet streams. Thus, the velocity of the fluid jet streams, at a given distance, could be increased by either increasing the initial fluid jet stream velocity or increasing the jet orifice diameter. Note that if the jet orifice diameters are increased the high pressure pump  44  pump rate would need to be increased to maintain the fluid jet stream velocity. In practice, the catheter system is designed with a given set of jet orifice diameters and the high pressure pump  44  pump rate is adjusted to achieve the proper efficacy. In cases where cell sampling is desired, the velocity of the radially directed fluid jet streams  114  can be increased sufficiently to liberate microscopic rafts of cell clumps. The use of the distally located occlusion balloon  118   a  is helpful in ensuring that the liberated conduit cells do not migrate to distal vascular beds. For example, if the cells were cancerous ureter epithelial cells, the balloon  118   a  would minimize the chance for metastasizing. 
       FIG. 19 , a fourth alternative, is an illustration similar in many respects to  FIG. 2  showing a direct stream hydrodynamic catheter tube  12   d , also referred to as the catheter tube  12   d , and the manifold  14  and components associated therewith and wherein each is connected to and which utilizes functions of the accompanying enabling components in a manner similar to that shown in  FIG. 1  where all numerals correspond to those elements previously described or as otherwise described herein. The catheter tube  12  is reconfigured as a catheter tube  12   d  to additionally include one or more outflow orifice(s)  130  located in the distal portion of the catheter tube  12   d  at a location distal to a fluid jet emanator  52   d , as best shown in  FIG. 20 . The outflow orifices  130  are utilized to provide low power direct streams in the form of cross stream jets  132  referenced in  FIG. 22 . The radially directed jet orifices  112   a - 112   n  and the radially directed fluid jet streams  114  are not utilized in this alternative embodiment. The components of  FIG. 19  are used with the enabling components referred to and shown in  FIG. 1  where such enabling components consist of the high pressure fluid source  42 , the high pressure fluid pump  44 , the threaded high pressure connection port  32  and connector  46 , the exhaust regulator  47 , the collection chamber  48 , and the connector  49  which are used in much the same manner as previously described. Together, the referenced enabling components in combination with the catheter tube  12   d  and the manifold  14  and closely associated components thereof comprise a direct stream hydrodynamic catheter system  10   d  which is also referred to as the catheter system  10   d , wherein the catheter system  10   d  provides for the use of a decreased velocity but large sized cross stream jets  132  therefrom by using outflow orifice(s)  130 . The catheter system  10   d  includes the provision of and the use of the previously described pressurized proximally directed fluid jet streams  108  and the pressurized distally directed fluid jet streams  126  which emanate from the fluid jet emanator  52   d  ( FIG. 21 ), whereby the distally directed fluid jet streams  126  pass through and emerge from the outflow orifice(s)  130  as newly featured low powered cross stream jets  132  ( FIG. 22 ) to re-enter the catheter tube  12   d  at the inflow orifice  38 . Although the catheter tube  12   d , the manifold  14 , and closely associated components of each are shown referenced to the catheter system  10   d  in  FIG. 19 , it is understood that the previously referenced enabling components referred to and shown in  FIG. 1 , but not shown in  FIG. 19 , are also part of the catheter system  10   d.    
       FIG. 20  is an illustration similar in many respects to  FIG. 4  showing the distal end of a catheter tube  12   d  reconfigured and used in lieu of the catheter tube  12  and shown in use with the fluid jet emanator  52   d  in lieu of the fluid jet emanator  52 , wherein the fluid jet emanator  52   d  includes many of the structural features and much of the functionality such as described for  FIG. 21 . Shown more specifically is the relationship and arrangement of the inflow orifice  38  (reoriented), the proximally directed jet orifices  106   a - 106   n  of the fluid jet emanator  52   d , the distally directed jet orifices  122   a - 122   n  of the fluid jet emanator  52   d  and the outflow orifice(s)  130 . The plurality of radially directed jet orifices  112   a - 112   n  for the emanation of radially directed jet streams  114  is not included in the fluid jet emanator  52   d  and the plurality of holes  94   a - 94   n  of the previously shown catheter tubes  12   a - 12   c  is not included in the catheter tube  12   d.    
       FIG. 21  is an illustration similar in many respects to  FIG. 17  showing an isometric view of the alternative fluid jet emanator  52   d  connected to and in communication with the high pressure tube  50 . As previously described, the plurality of distally (forwardly) directed jet orifices  122   a - 122   n  is located on and about the distal face of the fluid jet emanator  52   d . Also included are the previously shown and described plurality of proximally (rearwardly) directed jet orifices  106   a - 106   n  located on and about the proximal face of the fluid jet emanator  52   d . The fluid jet emanator  52   d  also includes the previously described annular groove  84  and passageway  86 . The plurality of proximally directed orifices  106   a - 106   n  and the plurality of distally directed jet orifices  122   a - 122   n  are in common and are pressurized in common by pressurized saline provided through the high pressure tube  50 . 
     The high pressure tube  50  delivers high pressure saline or other suitable fluids to the fluid jet emanator  52   d  to produce and distribute pressurized distally directed fluid jet streams  126  which emanate from the distally directed jet orifices  122   a - 122   n  in order to provide for the generation of cross stream jets  132  used for thrombus or lesion treatment ( FIG. 22 ). In a manner as previously described, the high pressure tube  50  delivers pressurized saline or other suitable fluid to the fluid jet emanator  52   d  for producing and distributing pressurized proximally directed fluid jet streams  108  of saline or other suitable fluids which fluid jet streams are directed proximally from the proximally directed orifices  106   a - 106   n  to perform functions, as described herein. 
     Mode of Operation 
     In a closely related fashion and manner as previously described herein and with reference to  FIG. 22 , the method of operation of the fourth alternative embodiment is now described. Generally, a normal guidewire  37  is deployed in a blood vessel  96  requiring treatment, or in the alternative, a filter guidewire or balloon occlusion guidewire could also be used. The catheter tube  12   d  and other closely associated and aligned components directly associated therewith consisting mainly of the high pressure tube  50 , the fluid jet emanator  52   d  and the distal section of the catheter tube  12   d  are advanced over and along the guidewire ( 37 ) and aligned within the blood vessel  96  for the purpose of debris/thrombus/lesion maceration or removal, drug infusion, or other procedures; the catheter tube is maneuvered into an appropriate position within the blood vessel  96  for treatment. A generic guide catheter or sheath can be incorporated as necessary to offer assistance in placing the catheter tube  12   d  and closely aligned components in direct association therewith of the direct stream hydrodynamic catheter system  10   d  within the desired location of the blood vessel  96  in order that the tapered flexible tip  40  of the catheter tube  12   d  can be extended through the thrombus or lesions  98  to a position where the fluid jet emanator  52   d  is in very close proximity to the thrombus or lesions  98 . The direct stream thrombectomy catheter system  10   d  is then activated, whereby thrombus, debris and the like can be removed by action of the cross stream jet(s)  132  preferably in association with other methods previously described or drugs can be infused by a desired procedure. 
     Moreover,  FIG. 22  is a side view of the fourth alternative embodiment, in partial cross section, of the catheter tube  12   d  in the performance of the method and use thereof which utilizes enabling connections and which utilizes functions of the accompanying components in a manner similar to that shown in  FIG. 1  with particular attention given to the distal section of the catheter tube  12   d , the flexible tapered tip  40 , the outflow orifice(s)  130  (reoriented), the fluid jet emanator  52   d , the inflow orifice(s)  38 , and other closely associated components positioned in the blood vessel  96  containing deposits of thrombus or lesions  98 . For purposes of example and illustration, one or more inflow orifice(s)  38  (reoriented) and the outflow orifice  130  (reoriented) are shown at the top and the bottom of the catheter tube  12   d.    
     More specifically and with reference to  FIG. 22 , the mode of operation is further described. Pressured saline or other suitable fluid is delivered by the high pressure tube  50  to the fluid jet emanator  52   d  to produce and distribute proximally directed fluid jet streams  108  of saline or other suitable fluids which are directed proximally from the proximally directed jet orifices  106   a - 106   n  ( FIG. 21 ) of the fluid jet emanator  52   d , and to thence transit parallel to the inflow orifice(s)  38 , and finally into the distal section of the catheter tube  12   d  to flow proximally in a manner as previously described. In particular reference to this fourth alternative embodiment, pressurized saline or other suitable fluid is also delivered by the high pressure tube  50  to the fluid jet emanator  52   d  to produce and distribute distally directed fluid jet streams  126  of saline or other suitable fluids employed for a use different from the previously described embodiments, whereby the distally directed fluid jet streams  126  are directed distally from the distally directed jet orifices  122   a - 122   n  ( FIG. 21 ) in order to provide for the generation of the cross stream jets  132 . The distally directed fluid jet streams  126  of saline or other suitable fluids are directed toward the general location of the outflow orifice(s)  130  and within and along the co-located distal end of the catheter tube  12   d . The distally directed fluid jet streams  126  are pressurized at the distal end of the catheter tube  12   d  and exit the outflow orifice(s)  130  as cross stream jets  132  which re-enter the catheter tube  12   d  through the inflow orifice(s)  38 . The cross stream jets  132  serve to impinge upon the thrombus or lesion  98  in order to abrade, ablate, break up and entrain such thrombus or lesion  98  particulate and to entrain and carry such treated particulate into the inflow orifice(s)  38 . Other fluid jet emanators of appropriate size and/or configuration can be incorporated in lieu of the fluid jet emanator  52   d  within the proximal end of the distal section of the catheter tube  12   d  to emanate or emit one or more distally directed fluid jet streams  126  distally for the purpose of providing cross stream jets  132  and to emanate or emit one or more proximally directed fluid jet streams  108  along or near the longitudinal axis of the catheter tube  12   d.    
     The proximally directed fluid jet streams  108  provide for creating a low pressure region at the inflow orifice  38  for re-entry of the cross stream jet(s)  132  and, as before, provide for the ingestion and entrainment of thrombus or lesion  98  particulate and/or debris therethrough. The proximally directed fluid jet streams  108  impinge upon, provide drag forces on, and break up or macerate thrombus or lesion  98  particulate and/or debris and by entrainment urge and carry along one or more particles of thrombus or lesion  98  and/or debris along the lumen  53  of the catheter tube  12   d . The entrainment of thrombotic particulate and/or debris  98  through the inflow orifice  38  is dependent on the high velocity fluid jet streams  108 . The outflow of fluid and thrombus is generally driven proximally through the catheter tube  12   d  by an internal pressure which is produced by the high velocity fluid jet streams  108  and the fluid entrained through the inflow orifice  38 , but also uses the assistance of fluid pressure forces provided by the distally directed fluid jet streams  126  and closely associated cross stream jets  132 . 
     In this fourth alternative embodiment, the proximally directed jet streams  108  and the distally directed fluid jet streams  126  which produce the cross stream jets  132  are driven by the same fluid pressure. The velocity of the fluid jet streams is controllingly influenced by the high pressure pump  44  and the total area of all of the proximally directed jet orifices  106   a - 106   n  and the distally directed jet orifices  122   a - 122   n . Debris removal is influenced by and assisted by aspiration in coordination with the operation of the high pressure fluid pump  44  and the exhaust regulator  47  which simultaneously introduces pressurized proximally and distally directed fluid jet streams and cross jet streams into and from the distal end of the catheter tube  12   d . In such a catheter system, the inflow orifice  38  is sufficiently sized for aspiration. By sizing the proximally directed jet orifices  106   a - 106   n , the distally directed orifices  122   a - 122   n  and the outflow orifice(s)  130  and by operating the high pressure pump  44  within suitable parameters, the velocity and strength of the proximally directed fluid jet streams  108  and the distally directed fluid jet streams  126  and the cross stream jets  132  can be influenced and controlled. The principle for aggressive thrombus ablation and breakup, as well as for debris removal, is dependent on the velocity of the cross stream jets  132 . Consider that there is some critical velocity for debris liberation. As the cross stream jets  132  travel through a fluid environment within the blood vessel  96 , the cross stream jets  132  will entrain surrounding fluid whereby the cross stream jets  132  will slow. There are empirical relationships for turbulent jet streams that show that the velocity of the jet streams is proportional to the diameter of the fluid jet streams and to the initial velocity of the fluid jet streams. Thus, the velocity of the fluid jet streams at a given distance within the blood vessel  96  would be increased by either increasing the velocity of the distally directed fluid jet streams  126  or increasing the diameter of the distally directed jet orifice  122   a - 122   n . Note that if the jet orifice diameters are increased, the pump rate of the high pressure pump  44  would need to be increased in order to maintain the fluid jet stream velocity. In practice, the catheter system is designed with a given set of jet orifice diameters and with the pump rate of the high pressure pump  44  adjusted to achieve the proper efficacy. 
       FIG. 23 , a fifth alternative embodiment, is an illustration similar in many respects to  FIG. 2  showing a direct stream hydrodynamic catheter tube  12   e , also referred to as the catheter tube  12   e  and the manifold  14  and components associated therewith and wherein is connected to and which utilizes functions of the accompanying enabling components in a manner similar to that shown in  FIG. 1  where all numerals correspond to those elements previously described or as otherwise described herein. The catheter tube  12  is reconfigured as a catheter tube  12   e  excluding the tapered tip  40 , excluding the use of the radially directed jet orifices  112   a - 112   n  in the fluid jet emanator  52   e , excluding the use of high powered radially directed fluid jet streams  114 , and excluding the holes  94   a - 94   n  at the distal end of the catheter tube  12   e . This fifth alternative embodiment features the use of multiple distally directed jet streams  126  as a method of parting, projecting through and breaking up the thrombus or lesions  98 . The components of  FIG. 23  are used with the enabling components referred to and shown in  FIG. 1  where such enabling components consist of the high pressure fluid source  42 , the high pressure fluid pump  44 , the threaded high pressure connection port  32  and connector  46 , the exhaust regulator  47 , the collection chamber  48  and the connector  49  which are used in much the same manner as previously described. Together, the referenced enabling components in combination with the catheter tube  12   e  and the manifold  14  and closely associated components thereof comprise a direct stream hydrodynamic catheter system  10   e  which is also referred to as the catheter system  10   e , wherein the catheter system  10   e  provides for substantially the brute force of distally directed fluid jet streams  126  in combination. The catheter system  10   e  includes the provision of and the use of the previously described pressurized proximally directed fluid jet streams  108 , the pressurized distally directed fluid jet streams  126  which emanate from the fluid jet emanator  52   e  ( FIG. 25 ), wherein a numerically large number of distally directed fluid jet streams  126  part and disrupt thrombus or lesions  98  and pass therethrough generally in a tunneling manner. Although the catheter tube  12   e , the manifold  14 , and closely associated components of each are shown referenced to the catheter system  10   e  in  FIG. 23 , it is understood that the previously referenced enabling components referred to and shown in  FIG. 1 , but not shown in  FIG. 23 , are also part of the catheter system  10   e.    
       FIG. 24  is an illustration similar in many respects to  FIG. 4  showing the distal end of a catheter tube  12   e  reconfigured and used in lieu of the catheter tube  12  and shown with the fluid jet emanator  52   e  used in lieu of the fluid jet emanator  52 , wherein the fluid jet emanator  52   e  includes many of the structural features and much of the functionality such as described in  FIG. 25 . Shown more specifically is the relationship and arrangement of the inflow orifice  38  (reoriented), the proximally directed jet orifices  106   a - 106   n  of the fluid jet emanator  52   e , the distally directed jet orifices  122   a - 122   n  of the fluid jet emanator  52   e  and the open end  134  of the catheter tube  12   e . The plurality of radially directed jet orifices  112   a - 112   n  in the fluid jet emanator  52   e  and the plurality of holes  94   a - 94   n  of the previously shown catheter tubes  12   a - 12   c  are not included in the catheter tube  12   e.    
       FIG. 25  is an illustration similar in many respects to  FIG. 17  showing an isometric view of the alternative fluid jet emanator  52   e  connected to and in communication with the high pressure tube  50 . As previously described, the large number of distally (forwardly) directed jet orifices  122   a - 122   n  is located on and about the distal face of the fluid jet emanator  52   e . Also included is the previously shown and described plurality of proximally (rearwardly) directed jet orifices  106   a - 106   n  located on and about the proximal face of the fluid jet emanator  52   e . The fluid jet emanator  52   e  also includes the previously described annular groove  84  and passageway  86 . The plurality of proximally directed jet orifices  106   a - 106   n  and the plurality of distally directed jet orifices  122   a - 122   n  are in common and are pressurized in common by pressurized saline provided through the high pressure tube  50 . 
     The high pressure tube  50  delivers pressurized saline or other suitable fluids to the fluid jet emanator  52   e  to produce and distribute multiple high pressurize distally directed jet streams  126  which emanate from the distally directed jet orifices  122   a - 122   n  in order to provide for the direct fluid stream impingement of the thrombus or lesions  98  ( FIG. 22 ). In a manner as previously described, the high pressure tube  50  delivers pressurized saline or other suitable fluid to the fluid jet emanator  52   e  for producing and distributing pressurized, proximally directed, fluid jet streams  108  of saline or other suitable fluids which emanate from the proximally directed orifices  106   a - 106   n  of the fluid jet emanator  52   e  to perform functions, as described herein. 
     Mode of Operation 
     In a closely related fashion and manner as previously described herein and with reference to  FIG. 26 , the method of operation of the fifth alternative embodiment is now described. Generally, a normal guidewire  37  is deployed in a blood vessel  96  requiring treatment, or in the alternative, a filter guidewire or balloon occlusion guidewire could also be used. The catheter tube  12   e  and other closely associated and aligned components directly associated therewith consisting mainly of the high pressure tube  50 , the fluid jet emanator  52   e , and the distal section of the catheter tube  12   e  are advanced over and along the guidewire ( 37 ) and aligned within the blood vessel  96  for the purpose of debris/thrombus/lesion maceration or removal, drug infusion, or other procedures; the catheter system  12   e  is maneuvered into an appropriate position within the blood vessel  96  for treatment. A generic guide catheter or sheath can be incorporated as necessary to offer assistance in placing the catheter tube  12   e  and closely aligned components in direct association therewith of the direct stream hydrodynamic catheter system  10   e  within the desired location of the blood vessel  96  in order that the distally located open end  134  of the catheter tube  12   e  can be brought in close proximity or in intimate contact with the proximal end of the thrombus or lesions  98 , and then by operation of the catheter system, be extended through the thrombus or lesions  98 . The direct stream thrombectomy catheter system  10   e  is then activated, whereby thrombus, debris and the like can be removed by action of the low pressure region at the inflow orifice(s)  38 , preferably in association with other methods as previously described, or drugs can be infused by a desired procedure. 
     Moreover,  FIG. 26  is a side view, in partial cross section, of the catheter tube  12   e  of the fifth alternative embodiment of the present disclosure illustrating the performance of the method and use thereof which utilizes enabling connections and which performance utilizes functions of the accompanying components in a manner similar to that shown in  FIG. 1  with particular attention given to the distal section of the catheter tube  12   e , especially the open end  134  thereof, the fluid jet emanator  52   e , the inflow orifice(s)  38 , and other closely associated components positioned in the blood vessel  96  containing deposits of thrombus or lesions  98 . For purposes of example and illustration, one or more inflow orifice(s)  38  (reoriented) is shown at the top and the bottom of the catheter tube  12   e.    
     More specifically and with reference to  FIG. 26 , the mode of operation of the fifth alternative embodiment is further described. Pressured saline or other suitable fluid is delivered by the high pressure tube  50  to the fluid jet emanator  52   e  ( FIG. 25 ) to produce and distribute proximally directed fluid jet streams  108  of saline or other suitable fluids which are directed proximally from the proximally directed jet orifices  106   a - 106   n  ( FIG. 25 ) of the fluid jet emanator  52   e , and to thence transit parallel to the inflow orifice(s)  38 , and finally into the distal section of the catheter tube  12   e  to flow proximally in a manner as previously described. In particular reference to this fifth alternative embodiment, pressurized saline or other suitable fluid is also delivered by the high pressure tube  50  to the fluid jet emanator  52   e  to produce and distribute multiple distally directed fluid jet streams  126  of saline or other suitable fluids employed for a use different from uses of previously described embodiments, whereby the distally directed jet streams  126  in large numbers are directed distally from the distally directed jet orifices  122   a - 122   n  ( FIG. 21 ) in order to forcibly abrade, ablate, part, break up, tunnel and pass through the thrombus or lesion  98  and to make, provide and use a passage therethrough. In this alternative embodiment, the return of the flow created by the distally directed fluid jet streams in the form of cross stream jets  136  that ablate, abrade, breakup, dislodge or otherwise breakdown and carry thrombus or lesion  98  particulate proximally for entry into the inflow orifice(s)  38 . The pressurized distally directed jet streams  126  can re-enter the catheter tube  12   e  through the inflow orifice(s)  38 . Preferably, the thrombus or lesions  98  are entrained and carried into the inflow orifice(s)  38  by the low pressure region at the inflow orifice(s)  38 . Use of a guidewire having a distally deployed balloon can be beneficial in aiding in the flow of thrombus and lesion  98  proximally through the inflow orifice(s)  38 . Other fluid jet emanators of appropriate size and/or configuration can be used in lieu of the fluid jet emanator  52   e  within the distal section of the catheter tube  12   e  to emanate or emit multiple distally directed fluid jet streams  126  for the purpose of ablation, removal, breakup and the like of thrombus or lesions  98  and providing a path therethrough and for emanating or emitting one or more proximally directed fluid jet streams  108  along or near the longitudinal axis of the catheter tube  12   e.    
     The proximally directed fluid jet streams  108  provide a low pressure region at the inflow orifice  38  for re-entry of thrombus or lesion  98  particulate and, as before, to ingest and entrain such thrombotic or lesion particulate and/or debris  98  therethrough to impinge upon, provide drag forces on, and break up or macerate thrombotic particulate and/or debris  98 , and by entrainment to urge and carry along one or more particles of thrombotic particulate and/or debris  98  or lesion particulate along the lumen  53  of the catheter tube  12   e  by the action of the proximally directed fluid jet streams  108 . The entrainment of thrombotic particulate and/or debris  98  through the inflow orifice  38  is dependent on entrainment by the high velocity fluid jet streams  108 . The outflow of fluid and thrombus is generally driven proximally through the catheter tube  12   e  by an internal pressure which is produced by the high velocity fluid jet streams  108  and the fluid entrained through the inflow orifice  38 , but also uses the assistance of fluid pressure forces provided by the distally directed fluid jet streams  126 . 
     In this alternative embodiment, the proximally directed fluid jet streams  108  and the distally directed fluid jet streams  126  are driven by the same fluid pressure force. The velocity of the fluid jet streams is controllingly influenced by the high pressure pump  44  and the total area of all of the proximally directed jet orifices  106   a - 106   n  and the distally directed jet orifices  122   a - 122   n . Debris removal is influenced by and assisted by aspiration in coordination with the operation of the high pressure fluid pump  44  and the exhaust regulator  47  which simultaneously introduce pressurized proximally and distally directed fluid jet streams into the distal end of the catheter tube  12   e , as well as providing for the flow of the cross stream jets  136 . In such a catheter system, the inflow orifice  38  is sufficiently sized for aspiration. By sizing the proximally directed jet orifices  106   a - 106   n , the distally directed orifices  122   a - 122   n  and operating the high pressure pump  44  within suitable parameters, the velocity and strength of the proximally directed fluid jet streams  108  and the distally directed fluid jet streams  126  can be influenced and controlled. The principle for aggressive thrombus ablation and breakup, as well as for debris removal, is dependent on the velocity of the distally directed fluid jet streams  126 . Consider that there is some critical velocity for debris liberation. As the distally directed fluid jet streams  126  travel through a fluid environment, the distally directed fluid jet stream  126  will entrain surrounding fluid thus causing the distally directed fluid jet stream  126  to slow. There are empirical relationships for turbulent jet streams that show that velocity of the fluid jet streams is proportional to the diameter of the fluid jet streams and to the initial velocity of the fluid jet streams. Thus, the velocity of the fluid jet streams at a given distance could be increased by either increasing the initial velocity of the distally directed fluid jet streams  126  or increasing the jet orifice diameter. Note that if the jet orifice diameters are increased, the pump rate of the high pressure fluid pump  44  would need to be increased to maintain the jet stream velocity. In practice, the catheter system is designed with a given set of jet orifice diameters and the pump rate of the high pressure fluid pump  44  is adjusted to achieve the proper efficacy. 
     Various modifications can be made to the present disclosure without departing from the apparent scope thereof.