Patent Publication Number: US-11648139-B2

Title: Delivery systems for stents having protruding features

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of U.S. Provisional Application No. 62/742,852, entitled “DELIVERY SYSTEMS FOR STENTS HAVING PROTRUDING FEATURES,” filed Oct. 8, 2018, the entirety of which is incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     The present description relates generally to delivery systems for expandable elements, such as stents or scaffolds having spikes, flails, or other protruding features for penetrating target tissue and/or delivering drugs within a human patient. 
     BACKGROUND 
     A variety of devices can be used to deliver drugs at desired treatment locations within a patient. For example, a stent, such as a drug-eluting stent (DES), can be positioned at the location of a stenosis (arterial narrowing) caused by arteriosclerosis. DESs generally include a drug containing polymer coated over a metal stent or scaffold, or a bioresorbable stent or scaffold composed of a drug-containing polymer. After a DES is delivered to a treatment location within a body lumen (e.g., vessel), it is expanded against a wall of the body lumen (e.g., a vessel wall) and the drug is released via direct contact with the wall. Direct delivery of the drug to the vessel wall enables significantly lower doses than those required via other delivery means (e.g., pills or injections). 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    shows a partially schematic side view of an example of a delivery system. 
         FIG.  2    shows a cross-sectional view of an example region of the delivery system of  FIG.  1    taken along line  2 - 2 . 
         FIG.  3    shows an enlarged, partially schematic side view of a distal portion of the delivery system of  FIG.  1    with an unconstrained stent. 
         FIG.  4    shows a perspective view of an example of a stent. 
         FIG.  5    shows a side view of the stent of  FIG.  4   . 
         FIG.  6    shows a front view of the stent of  FIG.  4   . 
         FIG.  7    shows a perspective view of an example of a connector end of the stent of  FIG.  4   . 
         FIG.  8    shows a perspective view of another example of a connector end of the stent of  FIG.  4   . 
         FIG.  9    shows a perspective view of another example of a connector end of the stent of  FIG.  4   . 
         FIG.  10    shows a perspective view of another example of a connector end of the stent of  FIG.  4   . 
         FIG.  11    shows a side view of an example of a delivery system in a first stage of deployment. 
         FIG.  12    shows a side view of the delivery system of  FIG.  11    in a second stage of deployment. 
         FIG.  13    shows a side view of the delivery system of  FIG.  11    in a third stage of deployment. 
         FIG.  14    shows a side view of the delivery system of  FIG.  11    in a fourth stage of deployment. 
         FIG.  15    shows a cross-sectional view of an example region of a delivery system. 
         FIG.  16    shows a side view of another example of a delivery system in a first stage of deployment. 
         FIG.  17    shows a side view of the delivery system of  FIG.  16    in a second stage of deployment. 
         FIG.  18    shows a side view of the delivery system of  FIG.  16    in a third stage of deployment. 
         FIG.  19    shows a side view of the delivery system of  FIG.  16    in a fourth stage of deployment. 
         FIG.  20    shows a side view of the delivery system of  FIG.  16    in a fifth stage of deployment. 
         FIG.  21    shows a side view of another example of a delivery system in a first stage of deployment. 
         FIG.  22    shows a side view of the delivery system of  FIG.  21    in a second stage of deployment. 
         FIG.  23    shows a side view of the delivery system of  FIG.  21    in a third stage of deployment. 
         FIG.  24    shows a side view of the delivery system of  FIG.  21    in a fourth stage of deployment. 
         FIG.  25    shows a side view of an example of a delivery system in a first stage of deployment. 
         FIG.  26    shows a side view of the delivery system of  FIG.  25    in a second stage of deployment. 
         FIG.  27    shows a side view of the delivery system of  FIG.  25    in a third stage of deployment. 
         FIG.  28    shows a side view of the delivery system of  FIG.  25    in a fourth stage of deployment. 
         FIG.  29    shows a side view of an example of a delivery system in the delivery state within a body lumen. 
         FIG.  30    shows a cross-sectional view of the delivery system of  FIG.  29    in a deployed state. 
         FIG.  31    shows a cross-sectional view of the delivery system of  FIG.  29    with a balloon and a stent in an expanded state within a body lumen. 
         FIG.  32    shows a cross-sectional view of a region of the delivery system of  FIG.  29    with a stent in a treatment state and a balloon in a collapsed state that allows for fluid flow. 
     
    
    
     In one or more implementations, not all of the depicted components in each figure may be required, and one or more implementations may include additional components not shown in a figure. Variations in the arrangement and type of the components may be made without departing from the scope of the subject disclosure. Additional components, different components, or fewer components may be utilized within the scope of the subject disclosure. 
     DETAILED DESCRIPTION 
     The detailed description set forth below is intended as a description of various implementations and is not intended to represent the only implementations in which the subject technology may be practiced. As those skilled in the art would realize, the described implementations may be modified in various different ways, all without departing from the scope of the present disclosure. Accordingly, the drawings and description are to be regarded as illustrative in nature and not restrictive. 
     The following disclosure describes various embodiments of delivery systems for expandable structures, such as stents or scaffolds, having spikes, flails, or other protruding features for penetrating target tissue and/or delivering drugs within a human patient, and associated devices and methods. The delivery systems can be configured to deliver and position expandable structures within a body lumen (e.g., vessel). In addition, these delivery systems can also be configured to deploy and expand the expandable structures in the body lumen. The delivery systems can further be configured to engage with the expanded structure and collapse the structure for removal from the body lumen. In some embodiments, the delivery systems can be configured to deliver another expandable structure or the same expandable structure to another body lumen, or the same body lumen, in a single procedure or during a plurality of procedures. Such delivery systems are expected to simplify and expedite transluminal procedures to more effectively deliver and position expandable structures within target tissues. The delivery systems can be used with more than one procedure, such as deployment of an expandable structure, when configured to recapture the deployed expandable structure. 
     In particular, delivery systems described herein can be provided with a stent that is positioned over an inflatable balloon for expansion and delivery of the stent to a target delivery location. By positioning the stent over and about the inflatable balloon, the stent is ready to be expanded by the balloon immediately upon unsheathing with respect to the outer shaft. Additionally or alternatively, a stent can be positioned in an axially offset arrangement with respect to a balloon to reduce the need for space required by overlapping components. 
     Certain details are set forth in the following description and  FIGS.  1 - 32    to provide a thorough understanding of various embodiments of the disclosure. To avoid unnecessarily obscuring the description of the various embodiments of the disclosure, other details describing well-known structures and systems often associated with expandable structures, protruding features, and the components or devices associated with the manufacture of such structures are not set forth below. Moreover, many of the details and features shown in the figures are merely illustrative of particular embodiments of the disclosure. Accordingly, other embodiments can have other details and features without departing from the spirit and scope of the present disclosure. A person of ordinary skill in the relevant art will therefore understand that the present technology, which includes associated devices, systems, and procedures, may include other embodiments with additional elements or steps, and/or may include other embodiments without several of the features or steps shown and described below with reference to  FIGS.  1 - 32   . Furthermore, various embodiments of the disclosure can include structures other than those illustrated in the figures and are expressly not limited to the structures shown in the figures. 
       FIG.  1    shows a partially schematic side view of a delivery system  100  for a stent in a delivery state (e.g., low-profile or collapsed configuration). The delivery system  100  includes an outer shaft  120  (e.g., a catheter) having one or more lumens for containing an inner shaft  110  and/or a guidewire  162 . In some embodiments, the outer shaft  120  may also include one or more layers. In these embodiments, for example, the layers of the outer shaft  120  can include an inner layer, an outer layer, a liner, or a combination thereof. Each of the layers can be formed from materials including a polymer, high-density polyethylene (HDPE), polytetrafluoroethylene, silicone, Pebax® (polyether block amide) or a combination thereof. In some embodiments, each of the layers of the outer shaft  120  are formed from the same material. In other embodiments, however, one or more of the layers may be formed from different materials. 
     The inner shaft  110  can extend from a connector  150 , through the outer shaft  120 , and beyond the distal portion  120   b  of the outer shaft  120 . The inner shaft  110  can be formed as a tubular structure (with or without a slit), such as a coiled tube, a braided tube, a reinforced tube, or a combination thereof, and may be constructed of a polymer material, such as a polyimide. The delivery system  100  can include a guidewire within the inner shaft  110  and accessible at a proximal end of the delivery system  100 . 
     In the detailed view of the distal portion  100   b  of the delivery system  100 , a tip  115  (e.g., an atraumatic tip) is disposed on a distal terminal end of the inner shaft  110 . As illustrated, the tip  115  is adjacent to a distal terminal end of the outer shaft  120 . At least a portion of the tip  115  can have the same cross-sectional dimension as the outer shaft  120 , or the tip  115  may have a different cross-sectional dimension. In some embodiments, a distal end  115   b  of the tip  115  is tapered such that the distal end  115   b  has a smaller cross-sectional dimension compared to a proximal end  115   a  of the tip. Distal and/or proximal edges of the tip  115  may be curved/rounded so as to prevent the tip  115  from getting caught (e.g., stuck) on other portions of the delivery system  100  during delivery, positioning, deployment, etc. The tip  115  can be formed of the same material(s) as the outer shaft  120 . In other embodiments, however, the tip  115  can be formed from different material(s) than the outer shaft  120 . 
     The inner shaft  110  and the outer shaft  120  can be sized and shaped for intravascularly accessing a target site (e.g., treatment site) of the patient. In some embodiments, for example, the outer shaft  110  has a length of about 150 cm to about 180 cm and a suitable cross-sectional dimension for positioning within a subject&#39;s vasculature. The length of the inner shaft  110  can be a working length, such as a length that can be positioned within a subject&#39;s vasculature. In some embodiments, for example, the working length is about 70 cm to about 300 cm, about 150 cm to about 250 cm, or about 70 cm, about 80 cm, about 90 cm, about 100 cm, about 110 cm, about 120 cm, about 130 cm, about 140 cm, about 150 cm, about 160 cm, about 170 cm, about 180 cm, about 190 cm, about 200 cm, about 210 cm, about 220 cm, about 230 cm, about 240 cm, about 250 cm, about 260 cm, about 270 cm, about 280 cm, about 290 cm, or about 300 cm. In other embodiments, the outer shaft  120  has a length of about 130 centimeters (cm) to about 140 cm and a cross-sectional dimension of about 4 French, about 5 French, or about 6 French. The length of the outer shaft  120  can be a working length, such as a length that can be positioned within a subject&#39;s vasculature. In some embodiments, the working length is about 50 cm to about 200 cm, about 100 cm to about 150 cm, or about 50 cm, about 60 cm, about 70 cm, about 80 cm, about 90 cm, about 100 cm, about 110 cm, about 120 cm, about 125 cm, about 130 cm, about 135 cm, about 140 cm, about 145 cm, about 150 cm, about 155 cm, about 160 cm, about 170 cm, about 180 cm, about 190 cm, or about 200 cm. 
     In the detailed view of the proximal portion  100   a  of the delivery system  100  in  FIG.  1   , a proximal end  120   c  of the outer shaft is coupled to an outer shaft hub  140 . In the illustrated embodiment, the outer shaft hub  140  is coupled to the outer shaft  120  (e.g., via bonding). In other embodiments, however, the proximal end  120   c  of the outer shaft is directly coupled to the outer shaft hub  140 . 
     The outer shaft hub  140  is further coupled to a connector  150  (e.g., y-connector) having a lumen extending therethrough (not shown). In particular, a distal end  150   b  of the connector  150  can be coupled to the outer shaft hub  140  via a mating feature and a receiving feature (not shown). The mating and receiving features can be coupled to the proximal portion of the outer shaft  120  or the distal end  150   b  of the connector  150 . The connector  150  further includes a port  152  extending radially and/or longitudinally therefrom. The delivery system  100  can optionally include a hemostasis connector  170  coupled to a proximal end  150   a  of the y-connector  150 . While the proximal end  120   c  is illustrated with particular components in a particular arrangement, it will be understood that additional or fewer components can be included in similar or other arrangements to meet the needs of the system. 
     The delivery system  100  is configured to carry a stent, discussed further herein, in a delivery/collapsed state within a distal portion of the outer shaft  120 . The stent can be at least partially ensheathed by the outer shaft  120 . In some embodiments, the stent can be fixedly or removably coupled to the inner shaft  110 . Although the delivery system  100  is illustrated as a delivery system for stents, it will be appreciated that embodiments of the present technology can also include cages, meshes, balloons, membranes, tubular structures, circumferential bodies, expandable elements, expandable membranes, expandable structures, expandable tubular structures, and circumferentially expandable catheter tips with and without guidewire lumens. 
       FIG.  2    shows a cross-sectional view of a region of the delivery system  100  of  FIG.  1    taken along line  2 - 2 . As illustrated in  FIG.  2   , the inner shaft  110  can be at least partially disposed within a lumen of the outer shaft  120  and the guidewire  162  can be at least partially disposed within a lumen of the inner shaft  110 . In some embodiments, the outer shaft  120 , the inner shaft  110 , and/or the guidewire  162  each have a circular cross-sectional shape. In other embodiments, however, the outer shaft  120 , the inner shaft  110 , and/or the guidewire  162  can have other cross-sectional shapes, such as an ovoid shape, a “C” shape, a rectangular shape, a triangular shape, or the like. 
     The guidewire  162  and the inner shaft  110  can be positioned within the lumen of the outer shaft  120  in any configuration, such as anteriorly and posteriorly as illustrated, or medially and laterally. Furthermore, the guidewire  162  and the inner shaft  110  can be positioned in the lumen of the outer shaft  120  with respect to one another as illustrated, or the guidewire  162  can be positioned outside the inner shaft  110 . A fluid pathway can be defined within the lumen of the inner shaft  110 , for example along the length of the guidewire  162 . The fluid pathway can connect to and/or be accessible by the port  152  of the connector  150 . 
       FIG.  3    shows a side view of a distal portion  100   b  of the delivery system  100  of  FIG.  1    in a deployed state. In the illustrated embodiment, a stent  190  extends over a balloon  180  and is coupled to the delivery catheter shaft and has been unsheathed from the distal portion  120   b  of the outer shaft. A proximal visualization marker  192  is disposed on the stabilizing wire  160  near a proximal portion of the stent  190  and distal visualization markers  197  are disposed on a distal end  190   c  of the stent. In some embodiments, the proximal visualization marker  192  and/or the distal visualization marker  197  may be disposed on the stabilizing wire  160 . The visualization markers  192  and/or  197  can be formed from any material that can be visualized while the stent  190  is intravascularly positioned (e.g., within a target blood vessel). In one embodiment, for example, the visualization markers  192  and/or  197  are radiopaque markers. The stabilizing wire  160  can be connected to the inner shaft  110 , such that movement of the inner shaft  110  correspondingly urges the stent  190  via the stabilizing wire  160 , as discussed further herein. Alternatively, the stabilizing wire  160  can be independently movable relative to the inner shaft  110 , as discussed further herein. 
     The tip  115  is disposed on a terminal end  110   c  of the inner shaft  110  and can surround the terminal end  110   c  extending proximally along the distal portion  110   b  and/or distally from the terminal end  110   c . The inner shaft  110  extends distally from the distal portion  120   b  of the outer shaft  120 , through a lumen of the stent  190 , and, optionally, extends distally from the distal end of the stent  190 . In the deployed configuration, protruding features  194  extend radially from a longitudinal axis of the stent  190 , as discussed further herein. 
     The inner shaft  110  can also include an inflatable balloon (not shown), as discussed further herein. The inflatable balloon can be axially overlapping with the stent  190 , distal to the stent  190 , or proximal to the stent  190  while the stent  190  is in a delivery state (e.g., low-profile or collapsed configuration) within the outer shaft  120  and/or while the stent  190  is initially deployed from the delivery state. 
     The guidewire  162  can extend through the inner shaft  110  and beyond the tip  115 . Accordingly, the guidewire  162  can be advanced ahead of other portions of the delivery system  100 . The inner shaft  110 , the stent  190 , and the outer shaft  120  can be advanced over the guidewire  162  until the stent  190  is aligned with a desired target delivery location. The length of the guidewire  162  that overlaps other portions of the delivery system  100  can be within the inner shaft  110 , so that it does not interfere with any other components of the delivery system  100 . 
     As shown in  FIGS.  4 - 6   , the expandable stent  190  is provided with a frame  191  and multiple protruding features  194 . The frame  191  and the protruding features  194  can be configured to radially expand after the stent  190  has been unsheathed from the outer shaft  120 . The stent  190  can be self-expanding upon release from a constraint. Additionally or alternatively, the stent  190  can be expandable by radial forces applied from a balloon that is inflated while within the stent  190 . The frame  191  can include multiple struts  195  arranged in a pattern that supports compression, expansion, flexibility, and bendability of the stent  190 . The frame  191  can form a generally cylindrical shape along at least a portion of the stent  190 . At least a portion of each protruding feature  194  can extend at least partially distally from the frame  191  (e.g., towards the distal end  190   c ). For example, at least a portion of each protruding feature  194  can extend parallel to a longitudinal axis of the stent  190 . At least a portion (e.g., terminal end portion) of each protruding feature  194  can extend at least partially radially away from the frame  191 . For example, at least a portion of each protruding feature  194  can extend radially outwardly (e.g., perpendicular to) the longitudinal axis of the stent  190 . With at least a portion of each protruding feature  194  extending distally from the frame  191 , the protruding features  194  can be readily retracted into the outer shaft  120  by folding down and extending distally when the outer shaft  120  is advanced from a proximal side of the stent  190  in a distal direction over the stent  190 . The protruding features  194  can optionally include drugs for delivery to a target delivery location upon expansion of the stent  190 . However, it will be understood that a stent  190  can omit drugs for delivery and treat a target delivery location by penetrating tissue with the protruding features  194 . 
     The frame  191 , struts  195 , and/or protruding features  194  can be composed of or formed from a variety materials including, e.g., nitinol, cobalt chromium, stainless steel, any of a variety of other metals or metal alloys, or a combination thereof. The frame  191 , struts  195 , and/or protruding features  194  may also be composed of or formed from bioresorbable biodegradable, nanoporous or non-bioresorbable, non-biodegradable, non-nanopourous materials including, e.g., one or more polymers, nitinol, plastic materials, etc., or a combination thereof. In some embodiments, the frame  191  and the struts  195  can be formed from a bioresorbable material and the protruding features  194  can be formed from a non-bioresorbable material, such as nitinol. In these embodiments, the protruding features  194  can remain engaged with or penetrating a portion of the body lumen after the expanded frame  191  and struts  195  bio-resorb. After the expanded frame  191  and struts  195  bio-resorb, the body lumen where the stent  190  had been expanded is no longer partially occluded by the frame  191  and the struts  195  allowing for larger volumes of fluids, such as aqueous pharmaceutical compositions, to pass through the body lumen and contact the luminal wall. The protruding features  194  may also be formed of a bioresorbable material and, once the stent  190  has bio-resorbed, the spaces in the body lumen wall vacated by the protruding features  194  can be contacted by the fluids passing through the body lumen. In this way, the stent  190  can increase a surface area of the body lumen wall contacted by the fluid. 
     The protruding features  194  may also be carried by more than one strut  195 , the frame  191 , or a combination thereof. The protruding features  194  may be integrally formed with the struts  195 , for example by bending or twisting a portion of one or more struts and/or the frame  191  away from a longitudinal axis of the stent  190  or, alternatively, the protruding features  194  may be separate, discrete components that are attached to desired locations along the struts  195  and/or the frame  191 . 
     The stent  190  can include an anchor portion  196  that securely connects to a component for controlling, positioning, and/or adjusting the stent  190 . For example, the anchor portion  196  can securely connect the stent  190  to the inner shaft  110 . Alternatively, the anchor portion  196  can securely connect the stent  190  to the stabilizing wire  160 . The anchor portion  196  can be offset from a central axis of the stent  190 . For example, the anchor portion  196  can be radially aligned with, adjacent to, or near a portion of the frame  191  of the stent  190 . The frame  191  of the stent  190  can be connected to the anchor portion  196  by an intermediate portion  193 . The intermediate portion  193  can include multiple struts that may have varying widths to aide in column strength for deploying and retraction that extend from different portions of the frame  191 , for example connecting to different circumferential portions at an end of the frame  191 . The struts of the intermediate portion  193  can extend to the same or different axial locations along the anchor portion  196 . The arrangement of the struts of the intermediate portion  193  can maintain an open central space along the entire length of the stent  190 . 
     As shown in  FIGS.  7 - 10   , the anchor portion  196  can be formed with one or more of a variety of arrangements. As shown in  FIG.  7   , the anchor portion  196  can include multiple ribs  902  extending circumferentially from different axial locations along the anchor portion  196 . The ribs  902  can be positioned at different axial locations to provide multiple points of contact with a positioner, such as the inner shaft  110  and/or the stabilizing wire  160 . 
     As shown in  FIG.  8   , the anchor portion  196  can include different portions that extend in different directions. For example, the anchor portion  196  can include longitudinal portions  904  and circumferential portions  906 . Axially adjacent pairs of the longitudinal portions  904  can be connected together by a corresponding circumferential portion  906 . Likewise, axially adjacent pairs of the circumferential portions  906  can be connected together by a corresponding longitudinal portion  904 . Different longitudinal portions  904  can have different circumferential positions to surround a coupled positioned at different circumferential positions thereon. 
     As shown in  FIG.  9   , the anchor portion  196  can include a helical winding  908 . For example, the anchor portion  196  can wind helically about a central space configured to receive the positioner therein. The helical winding  908  can include multiple (e.g., 2, 3, 4, 5, 6, 7, 8, or more than 8) turns. The helical winding  908  can include, in cross-section, a shape that provides a flat inner side for engaging the positioner while maintaining a low profile. 
     As shown in  FIG.  10   , the anchor portion  196  can include an arrangement of multiple struts  910 . The struts  910  can define a generally cylindrical shape for receiving and coupling to a positioner. The struts  910  can extend longitudinally and/or circumferentially about the space for receiving the positioner. The struts  910  can form any number of cells, which can vary in length and/or width relative to each other. 
     The anchor portion  196  can securely connect the stent  190  to a positioner, such as the inner shaft  110  and/or the stabilizing wire  160 . For example, the anchor portion  196  can be pressed onto the positioner. By further example, the anchor portion  196  can be bonded to the positioner. Additionally or alternatively, a sleeve can be provided about at least a portion of the anchor portion  196  and/or the positioner. For example, a tube, such as shrink tubing molded from one or more flexible materials, including polyurethane and Pebex® (e.g., Pebex® 35D), can be provided as a sleeve over the anchor portion  196  and/or the positioner. Additionally or alternatively, the stabilizing wire  160  can be connected to the inner shaft  110  by one or more of a variety of methods, including laser welding, bonding, crimping, swaging, reflowing, etc. Additionally or alternatively, the anchor portion  196  can removably or reversibly connect the stent  190  to a positioner. For example, the anchor portion  196  can be provided with one or more detachment mechanisms (e.g., electrolytic, mechanical, or chemical) for controllably separating the stent  190  from the positioner. As such, the stent  190  can be controllably detached and left at a target delivery location. 
     Methods described herein provide delivery of the stent  190  to a target delivery location by operation of the delivery system  100 . While methods in their various stages are discussed and illustrated herein, it will be understood that multiple variations of each method are also contemplated. For example, the methods can be performed in various orders of operations, with additional operations, or with fewer operations. 
     As shown in  FIGS.  11 - 14   , a delivery system  100  can be provided with a stent  190  that is positioned over an inflatable balloon  180  for expansion and delivery of the stent  190  to a target delivery location. By positioning the stent  190  over and about the inflatable balloon  180 , the stent  190  is ready to be expanded by the balloon  180  immediately upon unsheathing with respect to the outer shaft  120 . 
     As shown in  FIG.  11   , the delivery system  100  is provided with the outer shaft  120  covering or ensheathing other components of the delivery system  100 . For example, the outer shaft  120  can extend to the tip  115  positioned at a distal end of the inner shaft  110 . The inner shaft  110  can extend within the outer shaft  120 , with a length thereof accessible proximal to a proximal end of the outer shaft  120  (e.g., at the outer shaft hub  140 ). Additionally or alternatively, the connector  150  can be accessible proximal to a proximal end of the outer shaft  120  (e.g., at the outer shaft hub  140 ). As discussed above, a guidewire can be advanced ahead of the tip  115  (e.g., through the inner shaft  110 ) to provide a pathway for advancement of other components of the delivery system  100 . 
     As shown in  FIGS.  12  and  13   , the outer shaft  120  can be moved to unsheath the stent  190  and other components of the delivery system  100 . For example, once the distal region of the delivery system  100  is positioned at a desired location, the outer shaft  120  is configured to be at least partially proximally retracted relative to the inner shaft  110  by retracting the outer shaft hub  140  relative to the connector  150 . Once the outer shaft  120  is partially retracted, at least a portion of the stent  190  and/or the balloon  180  is unsheathed and protruding features  194  of the stent  190  are configured to radially expand outwardly away from the inner shaft  110 . 
     As used herein, movement of various components can be relative to other components of the delivery system  100  and/or relative to a position apart from the delivery system  100  (e.g., a position within the anatomy of the patient, target delivery location, and/or tissue). The directions “proximal” and “distal” can be with respect to the delivery system  100 , a component thereof, and/or a position apart from the delivery system  100 . For example, movement of the guidewire  162  can be relative to the outer shaft  120 , the inner shaft  110 , the stent  190 , and/or the balloon  180 . It will be understood that while the guidewire  162  moves, the outer shaft  120 , the inner shaft  110 , the stent  190 , and/or the balloon  180  can be stationary, moving in the same direction (e.g., at a different speed), or moving in a different (e.g., opposite) direction. It will be further understood that while the outer shaft  120 , the inner shaft  110 , the stent  190 , and/or the balloon  180  moves, the guidewire  162  can be stationary, moving in the same direction (e.g., at a different speed), or moving in a different (e.g., opposite) direction. By further example, movement of the outer shaft  120  can be relative to the inner shaft  110 , the stent  190 , and/or the balloon  180 . It will be understood that while the outer shaft  120  moves, the inner shaft  110 , the stent  190 , and/or the balloon  180  can be stationary, moving in the same direction (e.g., at a different speed), or moving in a different (e.g., opposite) direction. By further example, movement of the inner shaft  110 , the stent  190 , and/or the balloon  180  can be relative to outer shaft  120 . It will be understood that while the inner shaft  110 , the stent  190 , and/or the balloon  180  move, the outer shaft  120  can be stationary, moving in the same direction (e.g., at a different speed), or moving in a different (e.g., opposite) direction. 
     As shown in  FIG.  14   , the outer shaft  120  has been retracted and the stent  190  is unsheathed. The stabilizing wire  160 , connected to the inner shaft  110  by the anchor portion  196 , is configured to engage with the proximal end of the stent  190  and control the position of the stent  190  during and after retraction of the outer shaft  120 . Accordingly, the position of the stent  190  is maintained with respect to the inner shaft  110 , including the balloon  180 . For example, while some adjustment of the length and/or axial position of the stent  190  may occur during radial expansion of the stent  190 , it will be understood that the stabilizing wire  160  can maintain the position of at least a portion of the stent  190  to be around and axially aligned with at least a portion of the balloon  180 . The balloon  180  can have an axial length that is greater than the axial length of the stent  190 , so that an entirety of the stent  190  is overlapping with the balloon  180 . As shown in  FIG.  14   , the stabilizing wire  160  can connect the stent  190  to a portion of the inner shaft  110  that is proximal to the balloon  180 . Additionally or alternatively, the stabilizing wire  160  can connect the stent  190  to a portion of the inner shaft  110  that is distal to the balloon  180 . 
     When both the stent  190  and the balloon  180  are unsheathed by the outer shaft  120  and exposed, the balloon  180  can be inflated to expand or further expand the stent  190 . For example, an interior region of the balloon can be fluidly connected, via the inner shaft  110 , to the port  152  of the connector  150 . By providing a fluid through the port  152 , the balloon  180  can be expanded, thereby expanding or further expanding the stent  190 . The expansion with respect to target anatomy will be further discussed herein. 
     Following one or more of the above-described operations, the balloon  180  can be deflated. The stent  190  can be maintained for any duration of time in an expanded state. For example, the stent  190  can be maintained for a duration of time effective to provide therapeutic treatment (e.g., remodeling and/or drug delivery) to target anatomy and allows fluid flow through the expanded stent and deflated balloon where there is no fluid blockage through the treated site. 
     Additionally or alternatively, the delivery system  100  can be deployed at multiple locations. The stent  190  can be collapsed by moving the outer shaft  120  over the stent  190 . The stent  190  and the balloon  180  can be moved to another target location, and one or more of the above-described operations can be repeated. 
     Additionally or alternatively, the delivery system  100  can be removed. The stent  190  can be collapsed by moving the outer shaft  120  over the stent  190 . Components of the delivery system  100  can be removed from the patient by retracting proximally over the guidewire. 
     Additionally or alternatively, the stent  190  can be detached from the inner shaft  110  and left as an implant within the patient. Following detachment, other components of the delivery system  100  can be removed from the patient by retracting proximally over the guidewire. 
     While the delivery system  100  is shown with a stent  190  positioned over a balloon  180  in a delivery state, it will be understood that other arrangements are contemplated. For example, a stent can be positioned in an axially offset arrangement with respect to a balloon to reduce the need for space required by overlapping components. Reference is made to a delivery system  200 , as shown in  FIGS.  16 - 20   , a delivery system  300 , as shown in  FIGS.  21 - 24   , and a delivery system  500 , as shown in  FIGS.  25 - 28   . While each of the delivery system  200  and the delivery system  300  is in some aspects different than the delivery system  100 , it will be understood that components and features of the delivery system  100  as described herein can apply to either or both of the delivery system  200  and the delivery system  300 . Similar or like items can perform the same function as those shown in the delivery system  100 , and the features of such items are not all discussed hereafter, for brevity. 
     Referring now to  FIG.  15   , with further reference to  FIG.  1   , a cross-sectional view of a region of a delivery system  200  is shown, wherein the delivery system  200  is similar in at least some aspects to the delivery system  100  shown in  FIG.  1   . For example, the sectional view of  FIG.  15    can be taken along a line that positioned similarly as the line  2 - 2  in  FIG.  1   . As illustrated in  FIG.  15   , an inner shaft  210  can be at least partially disposed within a lumen of an outer shaft  220 . Additionally, a stiffening wire  264  is provided between the outer shaft  220  and the inner shaft  210 . The stiffening wire  264  can be of stainless steel or another material and can influence the luminal space and shaft stiffness and/or flexibility without modifying the material thickness of the shaft. A guidewire  262  can be at least partially disposed within a lumen of the inner shaft  210 . A lumen defined between the outer shaft  220  and the inner shaft  210  or within the inner shaft  210  can provide fluid communication to a balloon for inflation and deflation of the balloon. In some embodiments, the outer shaft  220 , the inner shaft  210 , the guidewire  262 , and/or stiffening wire  264  each have a circular cross-sectional shape and a single lumen. In other embodiments, however, the outer shaft  220 , the inner shaft  210 , the guidewire  262 , and/or stiffening wire  264  can have other cross-sectional shapes, such as an ovoid shape, a “C” shape, a rectangular shape, a triangular shape, or the like, with multiple lumens. For example, the stiffening wire  264  can have a shape that fits within the space between the outer shaft  220  and the inner shaft  210 . For example, the cross-sectional shape of the stiffening wire  264  can be polygonal (e.g., rectangular) or crescent-shaped. The inner surface of the outer shaft  220  and/or the outer surface of the inner shaft  210  can have cross-sectional shapes that accommodate and/or guide the stiffening wire  264 . A support shaft  230  can also be placed circumferentially around the inner shaft  210  or outer shaft  220  to increase column strength and stiffness of the catheter region. In some embodiments, the support shaft  230  can have a larger inner diameter and be attached to the outer shaft  220  to extend the overall catheter length and accommodate a larger proximal segment of the inner catheter  210  or stiffening wire  264 . The support shaft placement can vary from the entire length of the inner shaft  210  to specific 10 cm, 20 cm, 30 cm, 40 cm segments of the inner shaft with varying gaps of 10 cm, 20 cm, 30 cm, 40 cm length to increase overall catheter stiffness. Attachment mechanisms may include bonding, reflowing, braiding, coiling, laser welding, etc. The support shaft  230  can also be made of high durometer plastics such as nylon, Pebax®, stainless steel, Nitinol, polyether ether ketone (PEEK), etc. 
     A stabilizing wire  260  can be coupled to a stent. The stabilizing wire  260  is slideably disposed within the outer shaft  220  and is sized and shaped to extend distally from the proximal end of the outer shaft and to extend proximally from a proximal end of a port. The stabilizing wire  260  can be formed of plastic, such as high durometer plastic including nylon, polyether ether ketone (PEEK), a metal, a metal alloy, such as nitinol, and/or combinations thereof. The stabilizing wire  260  can be configured to position the stent (not shown) at the desired treatment location and to at least generally maintain the position of the stent while the outer shaft  220  is withdrawn as described in greater detail below. 
     The stabilizing wire  260  can be sized and shaped to extend proximally from the proximal end of the port when the stent is positioned at the target site. For example, the stabilizing wire  260  can have a length of about 150 cm to about 180 cm and a suitable cross-sectional dimension for positioning within the patient&#39;s body lumen. The stabilizing wire  260  can have a working length (i.e., a length that can be positioned within the target body lumen) of about 70 cm to about 300 cm, about 150 cm to about 250 cm, or about 70 cm, about 80 cm, about 90 cm, about 100 cm, about 110 cm, about 120 cm, about 130 cm, about 140 cm, about 150 cm, about 160 cm, about 170 cm, about 180 cm, about 190 cm, about 200 cm, about 210 cm, about 220 cm, about 230 cm, about 240 cm, about 250 cm, about 260 cm, about 270 cm, about 280 cm, about 290 cm, or about 300 cm. 
     As shown in  FIGS.  16 - 20   , the delivery system  200  can be provided with a stent  290  that is positioned proximal to an inflatable balloon  280  for expansion and delivery of the stent  290  to a target delivery location. By positioning the stent  290  proximal to the inflatable balloon  280 , the stent  290  and the balloon  280  are not overlapping (e.g., are axially offset) while in a delivery state within the outer shaft  220 , and thereby reduce the space requirements within the outer shaft  220 . 
     As shown in  FIG.  16   , the delivery system  200  is provided with the outer shaft  220  covering or ensheathing other components of the delivery system  200 . For example, the outer shaft  220  can extend to a tip  215  positioned at a distal end of the inner shaft  210 . The inner shaft  210  can extend within the outer shaft  220 , with a length thereof accessible proximal to a proximal end of the outer shaft  220  (e.g., at the outer shaft hub  240 ). Additionally or alternatively, the connector  250  can be accessible proximal to a proximal end of the outer shaft  220  (e.g., at the outer shaft hub  240 ). A stabilizing wire  260  is also accessible proximal to a proximal end of the outer shaft  220  (e.g., at the outer shaft hub  240 ). A guidewire can be advanced ahead of the tip  215  (e.g., through the inner shaft  210 ) to provide a pathway for advancement of other components of the delivery system  200 . 
     As shown in  FIG.  17   , the outer shaft  220  can be moved to unsheath an inflatable balloon  280 . For example, once the distal region of the delivery system  200  is positioned at a desired location, the outer shaft  220  is configured to be at least partially proximally retracted relative to the inner shaft  210  by retracting the outer shaft hub  240  relative to the connector  250 . Once the outer shaft  220  is partially retracted, at least a portion of the balloon  280  is unsheathed. 
     As shown in  FIG.  18   , the outer shaft  220  can be further moved to unsheath a stent  290 . Once the outer shaft  220  is further retracted, a portion of the stent  290  is unsheathed and protruding features  294  of the stent  290  are configured to radially expand outwardly away from the inner shaft  210 . As shown, the balloon  280  is positioned at a distal portion  210   b  of the inner shaft  210 , and the stent  290  is positioned at a proximal portion  210   a  of the inner shaft  210 . The proximal portion  210   a  of the inner shaft  210  can have an outer cross-sectional dimension that is smaller than an outer cross-sectional dimension of the balloon  280 , thereby permitting the stent  290  to be collapsed onto the proximal portion  210   a  in a smaller profile than would be achieved if the stent  290  were collapsed onto the balloon  280 . 
     As shown in  FIG.  19   , the outer shaft  220  has been retracted and the stent  290  is unsheathed. The stabilizing wire  260 , accessible by a user, is configured engage with the proximal end of the stent  290  and control the position of the stent  290  during and after retraction of the outer shaft  220 . The user can secure the stabilizing wire  260  relative to the inner shaft  210  while the outer shaft  220  is retracted so that the position of the stent  290  can be maintained with respect to the inner shaft  210 , including the balloon  280 , during retraction of the outer shaft  220 . 
     As shown in  FIG.  20   , when both the stent  290  and the balloon  280  are unsheathed by the outer shaft  220  and exposed, the stent  290  can be axially aligned with the balloon  280 . Because the inner shaft  210  extends through the stent  290 , proximal retraction of the inner shaft  210  relative to the stent  290  can achieve axially alignment of the balloon  280  with the stent  290 . The balloon  280  can have an axial length that is greater than the axial length of the stent  290 , so that an entirety of the stent  290  is overlapping with the balloon  280  when axially aligned. Additionally or alternatively, the inner shaft  210  and the outer shaft  220  can be retracted together with respect to the stent  290 . 
     The balloon  280  can be inflated to expand or further expand the stent  290 . For example, an interior region of the balloon can be fluidly connected, via the inner shaft  210 , to the port  252  of the connector  250 . By providing a fluid through the port  252 , the balloon  280  can be expanded, thereby expanding or further expanding the stent  290 . The expansion with respect to target anatomy will be further discussed herein. 
     Following one or more of the above-described operations, the balloon  280  can be deflated. The stent  290  can be maintained for any duration of time in an expanded state. For example, the stent  290  can be maintained for a duration of time effective to provide therapeutic treatment (e.g., remodeling and/or drug delivery) to target anatomy. 
     Additionally or alternatively, the delivery system  200  can be deployed at multiple locations. The stent  290  can be collapsed by moving the outer shaft  220  over the stent  290 . Optionally, the stent  290  can be axially realigned with the proximal portion  210   a  of the inner shaft  210  prior to collapse by the outer shaft  220 . The stent  290  and the balloon  280  can be moved to another target location, and one or more of the above-described operations can be repeated. 
     Additionally or alternatively, the delivery system  200  can be removed. The stent  290  can be collapsed by moving the outer shaft  220  over the stent  290 . Optionally, the stent  290  can be axially realigned with the proximal portion  210   a  of the inner shaft  210  prior to collapse by the outer shaft  220 . Components of the delivery system  200  can be removed from the patient by retracting proximally over the guidewire. 
     Additionally or alternatively, the stent  290  can be detached from the stabilizing wire  260  and left as an implant within the patient. Following detachment, other components of the delivery system  200  can be removed from the patient by retracting proximally over the guidewire. 
     As shown in  FIGS.  21 - 24   , the delivery system  300  can be provided with a stent  390  that is positioned distal to an inflatable balloon  380  for expansion and delivery of the stent  390  to a target delivery location. By positioning the stent  390  distal to the inflatable balloon  380 , the stent  390  and the balloon  380  are not overlapping (e.g., are axially offset) while in a delivery state within the outer shaft  320 , and thereby reduce the space requirements within the outer shaft  320 . 
     As shown in  FIG.  21   , the delivery system  300  is provided with the outer shaft  320  covering or ensheathing other components of the delivery system  300 . For example, the outer shaft  320  can extend to a tip  315  positioned at a distal end of the inner shaft  310 . The inner shaft  310  can extend within the outer shaft  320 , with a length thereof accessible proximal to a proximal end of the outer shaft  320  (e.g., at the outer shaft hub  340 ). Additionally or alternatively, the connector  350  can be accessible proximal to a proximal end of the outer shaft  320  (e.g., at the outer shaft hub  340 ). A stabilizing wire  360  is also accessible proximal to a proximal end of the outer shaft  320  (e.g., at the outer shaft hub  340 ). A guidewire can be advanced ahead of the tip  315  (e.g., through the inner shaft  310 ) to provide a pathway for advancement of other components of the delivery system  300 . 
     As shown in  FIG.  22   , the outer shaft  320  can be moved to unsheath an inflatable balloon  380 . For example, once the distal region of the delivery system  300  is positioned at a desired location, the outer shaft  320  is configured to be at least partially proximally retracted relative to the inner shaft  310  by retracting the outer shaft hub  340  relative to the connector  350 . Once the outer shaft  320  is partially retracted, a portion of the stent  390  is unsheathed and protruding features  394  of the stent  390  are configured to radially expand outwardly away from the inner shaft  310 . The stabilizing wire  360 , accessible by a user, is configured engage with the proximal end of the stent  390  and control the position of the stent  390  during and after retraction of the outer shaft  320 . The user can secure the stabilizing wire  360  relative to the inner shaft  310  while the outer shaft  320  is retracted so that the position of the stent  390  can be maintained with respect to the inner shaft  310 , including the balloon  380 , during retraction of the outer shaft  320 . 
     As shown in  FIG.  23   , the outer shaft  320  can be further moved to unsheath a balloon  280 . Once the outer shaft  320  is further retracted, at least a portion of the balloon  380  is unsheathed. As shown, the balloon  380  is positioned at a proximal portion  310   a  of the inner shaft  310 , and the stent  390  is positioned at a distal portion  310   b  of the inner shaft  310 . The distal portion  310   b  of the inner shaft  310  can have an outer cross-sectional dimension that is smaller than an outer cross-sectional dimension of the balloon  380 , thereby permitting the stent  390  to be collapsed onto the distal portion  310   b  in a smaller profile than would be achieved if the stent  390  were collapsed onto the balloon  380 . 
     As shown in  FIG.  24   , when both the stent  390  and the balloon  380  are unsheathed by the outer shaft  320  and exposed, the stent  390  can be axially aligned with the balloon  380 . Because the inner shaft  310  extends through the stent  390 , distal movement of the inner shaft  310  relative to the stent  390  can achieve axially alignment of the balloon  380  with the stent  390 . The balloon  380  can have an axial length that is greater than the axial length of the stent  390 , so that an entirety of the stent  390  is overlapping with the balloon  380  when axially aligned. 
     The balloon  380  can be inflated to expand or further expand the stent  390 . For example, an interior region of the balloon can be fluidly connected, via the inner shaft  310 , to the port  352  of the connector  350 . By providing a fluid through the port  352 , the balloon  380  can be expanded, thereby expanding or further expanding the stent  390 . The expansion with respect to target anatomy will be further discussed herein. 
     Following one or more of the above-described operations, the balloon  380  can be deflated. The stent  390  can be maintained for any duration of time in an expanded state. For example, the stent  390  can be maintained for a duration of time effective to provide therapeutic treatment (e.g., remodeling and/or drug delivery) to target anatomy. 
     Additionally or alternatively, the delivery system  300  can be deployed at multiple locations. The stent  390  can be collapsed by moving the outer shaft  320  over the stent  390 . Optionally, the stent  390  can be axially realigned with the proximal portion  310   a  of the inner shaft  310  prior to collapse by the outer shaft  320 . The stent  390  and the balloon  380  can be moved to another target location, and one or more of the above-described operations can be repeated. 
     Additionally or alternatively, the delivery system  300  can be removed. The stent  390  can be collapsed by moving the outer shaft  320  over the stent  390 . Optionally, the stent  390  can be axially realigned with the proximal portion  310   a  of the inner shaft  310  prior to collapse by the outer shaft  320 . Components of the delivery system  300  can be removed from the patient by retracting proximally over the guidewire. 
     Additionally or alternatively, the stent  390  can be detached from the stabilizing wire  360  and left as an implant within the patient. Following detachment, other components of the delivery system  300  can be removed from the patient by retracting proximally over the guidewire. 
     As shown in  FIGS.  25 - 28   , a delivery system  500  can be provided with a stent  590  that is positioned over an inflatable balloon  580  for expansion and delivery of the stent  590  to a target delivery location. By positioning the stent  590  over and about the inflatable balloon  580 , the stent  590  is ready to be expanded by the balloon  580  immediately upon partial or complete unsheathing with respect to the outer shaft  520 . Any released portion of a stent  590  can be expanded by an underlying portion of a balloon  580  that is similarly released. 
     As shown in  FIG.  25   , the delivery system  500  is provided with the outer shaft  520  covering or ensheathing other components of the delivery system  500 . For example, the outer shaft  520  can extend to the tip  515  positioned at a distal end of the inner shaft  510 . The inner shaft  510  can extend within the outer shaft  520 , with a length thereof accessible proximal to a proximal end of the outer shaft  520  (e.g., at the outer shaft hub  540 ). Additionally or alternatively, the connector  550  can be accessible proximal to a proximal end of the outer shaft  520  (e.g., at the outer shaft hub  540 ). As discussed above, a guidewire can be advanced ahead of the tip  515  (e.g., through the inner shaft  510 ) to provide a pathway for advancement of other components of the delivery system  500 . 
     As shown in  FIG.  26   , the outer shaft  520  can be moved to unsheath a portion of the stent  590  and other components of the delivery system  500 . For example, once the distal region of the delivery system  500  is positioned at a desired location, the outer shaft  520  is configured to be at least partially proximally retracted relative to the inner shaft  510  by retracting the outer shaft hub  540  relative to the connector  550 . Once the outer shaft  520  is partially retracted, a portion of the stent  590  and/or the balloon  580  is unsheathed and protruding features  594  of the exposed portion of the stent  590  are configured to radially expand outwardly away from the inner shaft  510 . 
     The stent  590  can be fixedly attached to another component of the delivery system  500 , such as the inner shaft  510  (e.g., via an anchor portion). Alternatively, the stent  590  can be adjustably positioned relative to one or more other components of the delivery system  500 . For example, the stent  590  can be coupled to a stabilizing wire that is accessible to a user at a proximal end of the delivery system  500 , and the user can adjust a position of the stent  590  by operation of the stabilizing wire. 
     As shown in  FIG.  27   , the outer shaft  520  has been partially retracted and the stent  590  is partially unsheathed. The stent  590  can be connected to the inner shaft  510 , for example with a stabilizing wire (not shown), as described herein. Accordingly, the position of the stent  590  can be maintained with respect to the inner shaft  510 , including the balloon  580 . For example, while some adjustment of the length and/or axial position of the stent  590  may occur during radial expansion of the stent  590 , it will be understood that the stabilizing wire can maintain the position of at least a portion of the stent  590  to be around and axially aligned with at least a portion of the balloon  580 . Additionally or alternatively, the stent  590  can be secured relative to the outer shaft  520  by locking the outer shaft hub  540  relative to the inner shaft  510  at a proximal portion of the delivery system  500 . For example, a locking member can be controllably engaged and disengaged to selectively lock relative axial positions and/or movement of the outer shaft hub  540  and the inner shaft  510 . Such a locking member, when engaged can prevent proximal retraction of the outer shaft  520  when the balloon  580  is expanded, including portions of the balloon  580  that are within the outer shaft  520 . The balloon  580  can have an axial length that is greater than the axial length of the stent  590 , so that an entirety of the stent  590  is overlapping with the balloon  580 . 
     An extent to which the stent  590  and/or the balloon  580  are unsheathed (e.g., partially unsheathed) can be determined by one or more of a variety of mechanisms. For example, the stent  590 , the balloon  580 , the outer shaft  520 , and/or one or more other components coupled to one or more of the above can include a visualization marker, such as a radiopaque marker. The position of such components relative to each other and/or a target location can be determined visually, for example by an imaging technique (e.g., angiography). Additionally or alternatively, the relative positions of the stent  590 , the balloon  580 , and/or the outer shaft  520  can be determined and/or inferred by corresponding components at a proximal end of the delivery system  500 . For example, the positions the outer shaft hub  540 , the inner shaft  510 , and/or a stabilizing wire (not shown) can be compared to determine the relative positions of the outer shaft  520 , the balloon  580 , and/or the stent  590 , respectively. Appropriate markers, detents, or other indicators can be provided on the outer shaft hub  540 , the inner shaft  510 , and/or a stabilizing wire (not shown) at the proximal end of the delivery system  500  for reference by a user. For example, such markers, detents, or other indicators can be incrementally spaced apart from each other to indicate to the user a position of the outer shaft hub  540  with respect to the inner shaft  510 . Such an indication can be correlated with an extent to which the stent  590  is unsheathed. 
     When both the stent  590  and the balloon  580  are partially unsheathed by the outer shaft  520 , the initially exposed portion of the balloon  580  can be inflated to expand or further expand the stent  590 . For example, an interior region of the initially exposed portion of the balloon  580  can be fluidly connected, via the inner shaft  510 , to the port  552  of the connector  550 . By providing a fluid through the port  552 , the initially exposed portion of the balloon  580  can be expanded, thereby expanding or further expanding the initially exposed portion of the stent  590 . Other portions of the stent  590  and/or the balloon  580  can remain within the outer shaft  520 . Expansion can be performed, for example, while the outer shaft  520  is locked relative to the inner shaft  510  (e.g., with the outer shaft hub  540 ). Such locking can prevent the outer shaft  520  from further retracting in response to forces due to expansion of the partially exposed stent  590  and/or balloon  580 . The expansion with respect to target anatomy will be further discussed herein. 
     Following an initial deployment, additional operations can be performed to expand the stent  590  in a subsequent stage of the same procedure. For example, a different length and/or portion of the stent  590  can be utilized in a subsequent operation. As shown in  FIG.  28   , the outer shaft  520  has been further retracted and the stent  590  is further unsheathed. When both the stent  590  and the balloon  580  are more fully unsheathed by the outer shaft  520 , the more fully exposed portion of the balloon  580  can be inflated to expand or further expand the more fully exposed portion of the stent  590 , for example via the port  552 , as discussed herein. Other portions of the stent  590  and/or the balloon  580  can remain within the outer shaft  520 . As described above, expansion can be performed while the outer shaft  520  is locked relative to the inner shaft  510  (e.g., with the outer shaft hub  540 ) to stabilize the system during inflation of the balloon  580 . 
     An extent to which the stent  590  and/or the balloon  580  are unsheathed (e.g., further unsheathed) can again be determined by one or more of a variety of mechanisms, such as those described above with respect to determining an extent of partial unsheathing. 
     In some embodiments, the operating length of the stent  590  that is unsheathed, exposed, and/or expanded in the operations described above can be of different lengths. For example, the operating length can be shorter in an initial stage and longer in a subsequent stage. Alternatively, the operating length can be longer in an initial stage and shorter in a subsequent stage. 
     Where different operating lengths are desired, the balloon  580  can optionally include multiple segments that are independently inflatable. For example, the balloon  580  can include multiple segments that are aligned at different axial locations along the inner shaft  510 . The inner shaft  510  can provide multiple lumens each connecting to corresponding ports. A fluid can be provided through a selected number of the ports to inflate only the corresponding balloon segments. For example, only the balloon segments that are outside of the outer shaft  520  can be inflated to expand corresponding portions of the stent  590 . Additionally or alternatively, the balloon segments can be in fluid communication with each other such that they are inflated in a sequence. 
     Between an initial expansion (e.g., the expansion illustrated in  FIG.  27   ) and a subsequent expansion (e.g., the expansion illustrated in  FIG.  28   ), the stent  590  and/or the balloon  580  can be deflated, compressed, and/or at least partially retracted into the outer shaft  520 . Alternatively, the stent  590  and/or the balloon  580  can be further exposed by unlocking the outer shaft  520  from the inner shaft  510  and allowing the outer shaft  520  to further retract in response to forces from the inflated balloon  580 . 
     The transition from an initial expansion to a subsequent expansion can be performed to adjust an operating length of the stent  590  to more fully address a target region. For example, an initial operating length of the stent  590  can be exposed and expanded. The user can then evaluate the effectiveness of the operation (e.g., via imaging technique such as angiography). Where the initial operating length of the stent  590  is determined to be insufficient, the stent  590  and/or the balloon  580  can be further exposed to increase the operating length of the stent  590 . Such adjustments can be made as needed until an adequate operating length is provided. It will be recognized that the ability to perform such adjustments may avoid the need to remove a stent that is discovered to be inadequate and replace it with a different stent or other device that provides an adequate operating length. By eliminating these steps, total operation time can be reduced. Additionally, a user can desire to deploy a device with an operating length that is adequately long (e.g., to span a target region) without being longer than is required (e.g., to avoid operating on regions outside the target region). It will be recognized that the user can provide a single stent  590  with an adjustable operating length to adequately address a target region that has an initially uncertain length or where the required operating length of the stent is otherwise unknown or uncertain. Such capabilities reduce the burden on the user to accurately select the devices with the correct operating length at the beginning of an operation. Furthermore, the capabilities described herein also reduce the need to provide a wide array of devices that provide different performance characteristics, as a single device or reduced number of devices can be operated as described herein to provide a desirably wide range of performance characteristics. 
     The transition from an initial expansion to a subsequent expansion can be performed to address different operating length requirements of different target regions. Between an initial expansion and a subsequent expansion, the stent  590  and/or the balloon  580  can be repositioned to a different location. For example, the stent  590  can be repositioned to align with a different target region. Where the new target region has a different length or other feature relative to an initial target region, the operating length of the stent  590  can be selected and/or modified accordingly to adequately address each of the target regions. It will be recognized that the ability to perform such adjustments may avoid the need to remove a stent suitable for an initial target region and replace it with a different stent that is suitable for a different target region. By eliminating these steps, total procedure time can be reduced, thereby reducing risks associated with long procedure times. Additionally, it will be recognized that the user can provide a single stent  590  with an adjustable operating length to adequately address each of different target regions despite each target region having potentially different requirements for an operating length of the stent  590 . This allows a user with greater flexibility and options throughout a procedure with a single device. 
     Following one or more of the above-described operations, the balloon  580  can be deflated. The stent  590  can be maintained for any duration of time in an expanded state. For example, the stent  590  can be maintained for a duration of time effective to provide therapeutic treatment (e.g., remodeling and/or drug delivery) to target anatomy and allows fluid flow through the expanded stent and deflated balloon where there is no fluid blockage through the treated site. 
     Additionally or alternatively, the delivery system  500  can be deployed at multiple locations. The stent  590  can be collapsed by moving the outer shaft  520  over the stent  590 . The stent  590  and the balloon  580  can be moved to another target location, and one or more of the above-described operations can be repeated. 
     Additionally or alternatively, the delivery system  500  can be removed. The stent  590  can be collapsed by moving the outer shaft  520  over the stent  590 . Components of the delivery system  500  can be removed from the patient by retracting proximally over the guidewire. 
     Additionally or alternatively, the stent  590  can be detached from the inner shaft  510  and left as an implant within the patient. Following detachment, other components of the delivery system  500  can be removed from the patient by retracting proximally over the guidewire. 
     Referring now to  FIGS.  29 - 32   , an example of a delivery system  400  is shown in various configurations to deliver, position, deploy, and/or recapture a stent. The operations described with respect to the delivery system  400  can be applied to the delivery system  100 , the delivery system  200 , the delivery system  300 , and/or the delivery system  500 . As shown in  FIG.  29   , the delivery system  400  is in a delivery state within a body lumen  710  (e.g., a blood vessel) of a human patient. In this embodiment, the delivery system  400  is configured for intraluminal (e.g., intravascular) delivery through the blood vessel, (e.g., femoral artery) of a human patient. The femoral artery can be accessed by introducing a sheath (e.g., 5F or 6F) into the lumen of the femoral artery. The delivery system  400  is delivered into the body lumen by tracking the distal portion  410   b  of the inner sheath over the guidewire and distally advancing the delivery system  400  to a desired location  720  within the vessel. In some embodiments, an angioplasty procedure is performed at the desired location  720  before the delivery system  400  is advanced to the desired location  720 . 
     Once the delivery system  400  is positioned at the desired location  720 , the distal portion  420   b  of the outer sheath is proximally retracted to unsheath the stent  490 . In the illustrated embodiment, the body of the stent  490  is at least partially expanded when unsheathed and the protruding features  494  are collapsed. However, the protruding features  494  can be configured to expand once the distal portion  420   b  of the outer sheath is retracted. In other embodiments, the stabilizing wire (not shown) can be distally advanced and fixed, such as held or pinned, or fixed at the desired location to position the stent before, during, and/or after the outer sheath is proximally retracted to deploy the stent. As illustrated, the tip  415  of delivery system  400  is positioned distally from the distal end of the stent and the inner shaft  410  remains positioned within at least a portion of the lumen of the stent  190 . 
     In the deployed state, the protruding features  494  of the stent  490  are configured to expand radially and are further configured to pierce the lumen wall at the desired location once the deployed stent  490  is expanded into contact with the vessel wall (see  FIGS.  29  and  30   ). As will be explained in greater detail below, stents and other expandable structures can be configured to at least partially self-expand, such as expanding outwardly from the collapsed/delivery state to the deployed and/or expanded state when the stents and other expandable structures are at least partially unsheathed from the outer shaft. In some embodiments, stents and other expandable structures are configured to expand when operably coupled with an expandable element or mechanism, such as a balloon. In additional embodiments, self-expanding stents and other structures are configured to further expand when coupled to the expansion mechanism. Regardless of whether the stents and other expandable structures are self-expanding or expand when coupled to the expandable element, the stents and others expandable structures can be configured to expand radially (symmetrically or asymmetrically). In some embodiments, the at least partially expanded stents and other expandable structures can be configured to position at least some of the protruding features perpendicular to the vessel wall. 
     As shown in  FIGS.  29  and  30   , the delivery system  400  is configured for insertion of a balloon  480  coupled to the inner shaft  410 . The balloon  480  is further configured to be positioned within the stent lumen and expanded therein to further expand the stent  490  between the delivery state and the expanded, deployed state. In some embodiments, the balloon  480  can be coated with a drug-delivery coating and a drug, such as the coatings and drugs described herein. As further discussed elsewhere herein, the stent  490  can be operatively coupled to an actuation mechanism, such as a mechanical actuation mechanism (e.g., stabilizing wire, stent pull wire, pusher shaft, or a combination thereof), configured to position, expand, retract, re-position, and/or remove the stent  490  from the body lumen. 
       FIG.  30    shows a cross-sectional view of a region of the delivery system  400  in the deployed state within the body lumen. As shown in  FIG.  30   , the stent  490  is expanded within the vessel by a balloon  480 . To expand the deployed stent  490 , the balloon  480  is coupled to inner shaft  410  and distally advanced into a lumen of the deployed stent  490  until a distal tip  415  of the inner shaft  410  is positioned near a distal end  490   b  of the deployed stent  490 . As illustrated, the distal end  490   b  of the stent  490  can include radiopaque markers  490   c . Additionally or alternatively, radiopaque markers  490   c  may be located elsewhere in the delivery system  400 , or may be omitted from the delivery system  400 . 
       FIG.  31    shows a cross-sectional view of a portion of the delivery system  400  in a deployed state with the stent  490  having protruding features  494  expanded within and piercing a portion of the vessel wall. As illustrated in  FIG.  31   , the balloon  480  is deployed and radially expanded to engage with and further expand the stent  490  into contact with the lumen vessel. When the stent  490  is expanded, the protruding features  494  penetrate further into the wall. 
       FIG.  32    shows a cross-sectional view of the delivery system  400  in a treatment state. In the treatment state, the balloon  480  has been deflated. As illustrated, the distal portion  410   b  of the inner shaft  410  remains in the body lumen. Following deflation of the balloon  480 , the stent  490  remains expanded into contact with the lumen wall and the protruding features  494  remain penetrated into the wall. Any drugs carried by the protruding features  494  are at least partially released into the body lumen wall at the treatment state. Optionally, the stent  490  can be affixed to the balloon  480 , such as by crimping the stent  490  to at least partially surround the balloon  480 , such that the stent  490  is both expanded and collapsed by inflating and deflating the balloon  480 , respectively. 
     While the stents described herein have the features shown, it will be understood that a variety of different stents and other devices can be used with the delivery systems described herein. Various features are set forth below by way of example, and not by limitation. 
     Regarding such stents and other devices, the material(s) for forming the frame, struts, and/or protruding features described herein can be selected based on mechanical and/or thermal properties, such as strength, ductility, hardness, elasticity, flexibility, flexural modulus, flexural strength, plasticity, stiffness, emissivity, thermal conductivity, specific heat, thermal diffusivity, thermal expansion, any of a variety of other properties, or a combination thereof. If formed from a material having thermal properties, the material can be activated to deliver thermal treatment to the desired treatment site. Regardless of the material, the frame, struts, and/or protruding features can be formed from a tube or a wire, such as a solid wire, by laser cutting or other suitable techniques. When formed from the wire, a portion of the wire can be removed by chemical etching or another suitable method to create an inner dimension of the stent. 
     Stents (e.g., the frame and the struts) can be sized and shaped for placement within various body lumens, including blood vessels, while not rupturing the vessel. For example, several stents and other structures can have radial strength that allows for features of the body lumen (e.g., vessel wall) to receive drugs without dissection or damage thereto. Vessels in which the stents described herein may be sized and shaped for placement include arteries, such as coronary arteries, peripheral arteries, carotid arteries, circle of willis, anterior cerebral artery, middle cerebral artery, posterior cerebral artery, any of the lenticulostriate arteries, renal arteries, femoral arteries, veins, such as cerebral veins, saphenous veins, arteriovenous fistulas, or any other vessel that may contain a treatment site. Stents can have a variety of shapes, including a cube, a rectangular prism, a cylinder, a cone, a pyramid, or variations thereof. 
     Stents and other structures having protruding features can include a variety of dimensions (in both the low-profile delivery state and expanded deployed state). These embodiments can provide for expansion that enables usage in a variety of situations covering a wide range of dimensions, such as to treat and/or prevent dissection. Regardless of the shape, stents can have a length of about 0.25 mm, about 0.5 mm, about 1 mm, about 2 mm, about 3 mm, about 4 mm, about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 12 mm, about 14 mm, about 16 mm, about 18 mm, about 20 mm, about 30 mm, about 40 mm, about 50 mm, about 60 mm, about 70 mm, about 80 mm, about 90 mm, or about 100 mm. In addition, a stent shaped into a cube, a rectangular prism, or a pyramid can have a width of about 0.25 mm, about 0.5 mm, about 1 mm, about 2 mm, about 3 mm, about 4 mm, about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 12 mm, about 14 mm, about 16 mm, about 18 mm, about 20 mm, about 25 mm, or about 30 mm. Moreover, a stent shaped into a cylinder or a cone can have a diameter of about 0.25 mm, about 0.5 mm, about 1 mm, about 2 mm, about 3 mm, about 4 mm, about 5 mm, about 6 mm, about 7 mm, about 8 mm, about 9 mm, about 10 mm, about 12 mm, about 14 mm, about 16 mm, about 18 mm, about 20 mm, about 25 mm, about 30 mm, about 35 mm, about 40 mm, or about 50 mm. The width or the diameter of the stent can decrementally decrease along a length of the stent. In addition, the stent can be sized and shaped to prepare the body lumen for certain procedures, such as a stent placement procedure. 
     A stent and/nor other expandable structures in the expanded state can have a cross-sectional dimension of about 2 mm to about 10 mm, inclusive of the expanded protruding features. For example, a frame can have a cross-sectional dimension of about 1 mm to about 9 mm and the protruding features can each have a length from about 0.1 mm to about 1.5 mm. In some embodiments, the stent has an overall cross-sectional dimension of about 4 mm with the frame having a cross-sectional dimension of about 2 mm and the protruding features each having a length of about 1 mm. In some embodiments, the stent has an overall cross-sectional dimension of about 6 mm with the frame having a cross-sectional dimension of about 4 mm and the protruding features each having a length of about 1 mm. In further embodiments, the protruding features can have a plurality of lengths such that the length of the protruding features of a stent or other expandable structure differs. For example, a stent can include protruding features having a length of about 0.2 mm, about 0.5 mm, and about 1 mm. 
     Profiles of the stents or other structures can be sized such that the stents or other structures are compatible with a wide range of catheter sizes. Embodiments in accordance with the present technology can include stents or other structures designed to receive a guidewire, such as guidewires having a diameter of 0.010, 0.014, 0.018, 0.035, or 0.038 inch. In several embodiments, the stent or scaffold structure can be sized and designed for delivery via a micro-catheter that it is pushed through. In some embodiments, stents or structures can be incorporated into a delivery system, including modular or single unit delivery systems. 
     Stents and other structures described herein can include a marking for visualization of the stent within the body lumen, such as one or more radiopaque markers. The radiopaque markers can be formed from Clearfil Photo Core PLT®, tantalum, titanium, tungsten, barium sulfate, and zirconium oxide, or another suitable radiopaque marking. The markings can be formed on a proximal portion of the stent, a distal portion, an intermediate portion, or a combination thereof. The markings can be a band, a coil, a clip, filled into one or more portions of a tube in the stent, plated onto one or more portions of the stent, or a combination thereof. Regardless of the type of marking, the marking can be coined, swaged, wrapped, or encased along, or onto any portion of the stent. 
     Stents and other structures can be flexible enough to track through various anatomical features, including those having a curvature. The flexible properties of the stent and other structures can be provided by the material from they are formed. In addition, flexible properties can also be provided by fracturing one or more of the members engaging with and extending between two or more rows of struts. Additionally, the stent or other structure can be readily deployed and expanded, and retracted and contracted. The stent or other structure can also be readily repositioned within a vessel or other body lumen. 
     In several embodiments, a drug-eluting compound is coated onto at least a portion of the protruding features, the frame, the struts, and/or the balloon. The coating can be any suitable coating known to one of ordinary skill in the art suitable to deliver the drug to the wall. For example, suitable coatings include, but are not limited to a snow coating or a crystalline coating having edges configured to remain in the wall. The drug-eluting compound can be a synthetic or biological polymer coated into a variety of different patterns and thicknesses suitable for delivering the drug contained therein. In other embodiments, the protruding features themselves may be composed of drug-eluting materials. The drug carried by the drug-eluting compound and/or the protruding features in accordance with the present technology can be any drug suitable for treating the treatment site in which the stent will be placed and may or may not include an excipient. For example, the drug can be an anti-proliferative, an anti-neoplastic, a migration inhibitor, an enhanced healing factor, an immunosuppressive, an anti-thrombotic, a blood thinner, or a radioactive compound. Examples of anti-neoplastics include, but are not limited to, siroliums, tacrolimus, everolimus, leflunomide, M-prednisolone, dexamethasone, cyclosporine, mycophenolic acid, mizoribine, interferon, and tranilast. Examples of anti-proliferatives include, but are not limited to, taxol/paclitaxel, actinomycin, methotrexate, angiopeptin, vincristine, mitmycine, statins, c-myc antisense, Abbot ABT-578, RestinASE, 2-chloro-deoxyadenosine, and PCNA ribozyme. Examples of migration inhibitors, but are not limited to, include batimistat, prolyl hydrosylase, halofunginone, c-preteinase inhibitors, and probucol. Examples of enhanced healing factors include, but are not limited to, BCP 671, VEGF, estradiols, NO donor comounds, and EPC antibodies. Examples, of radioactive compounds include, but are not limited to, strontium-89 chloride (Metastron®), samarium-153 (Quadramet®), radium-223 dichloride (Xofigo®), yttrium-90, and iodine-131. In some embodiments, the drug-eluting compound and/or the protruding features can carry more than one drug. 
     In some embodiments, the protruding features can include textured (e.g., ribbed) surfaces which is expected to provide greater surface area for drug-delivery. Moreover, any protruding features can include a textured surface such as a ribbed surface (vertical, horizontal, radial, or circular relative to a longitudinal plane of the protruding feature), a cross-hatched surface, an isotropic surface, or other surface types suitable for providing greater surface area for drug-delivery. 
     The protruding features can be sized and shaped to engage with and/or penetrate an occlusion, a neointima, an intima, an internal elastic lamina (IEL) a media, an external elastic lamina (EEL), an adventitia, or a combination thereof. The protruding features can also be sized and shaped to engage with and/or penetrate a tissue and/or structure adjacent to the body lumen in which the stent is to be placed while not rupturing the body lumen. For example, the stent can include square protruding features sized and configured to penetrate into the intima and/or the media of a body lumen, pointed protruding features sized and configured to penetrate and extend into the media, and/or the IEL. In addition, protruding features can be configured to bend in one or more directions relative to a longitudinal axis of the stent to engage with and/or penetrate a portion of the body lumen described herein. In several embodiments, the protruding features can penetrate deeper into the wall of a diseased body lumen, such as a vessel, compared to a stent lacking protruding features. In addition, the stent can allow for blood to flow even while in the expanded position and with drug-eluting on-going. 
     Various protruding features described herein can deliver drugs deeper into a vessel wall than possible via angioplasty balloons or other existing devices. In addition to carrying one or more drugs for treatment of the site, the protruding features can also carry a molecule suitable for degrading a portion of the occlusion, neointima, and/or intima to allow the protruding features to penetrate deeper in to the vessel wall than without the molecule. For example, the molecule suitable for degradation can be an enzyme, such as elastase, collagenase, or a proteinase, such as, metalloproteinases, serine proteinases, cysteine proteinases, extracellular sulfatases, hyaluronidases, lysyl oxidases, lysyl hydroxylases, or a combination thereof. 
     Further, it will also be appreciated that stents can carry one or more protruding features on one or more portions of the stent. For example, the stents can carry about 5 protruding features, about 10 protruding features, about 15 protruding features, about 20 protruding features, about 30 protruding features, about 40 protruding features, about 50 protruding features, about 60 protruding features, about 70 protruding features, about 80 protruding features, about 90 protruding features, or about 100 protruding features. The protruding features can be carried by the frame, the struts, or a combination thereof. The number of protruding features can vary depending upon, for example, the target treatment site, the type of drug being delivered, and size of the stent, etc. In addition, the protruding features carried by the stent can be different types of the protruding features disclosed herein. 
     In some embodiments, once positioned against a body lumen wall (e.g., a vessel wall), tissue and/or fluid can interact with the protruding feature to dissolve the drug and selectively release it from the reservoir. In other embodiments, the protruding feature can be configured to deliver the drug via a variety of means once the stent is expanded. Protruding features are accordingly expected to provide an effective means for selectively delivering a drug to a desired location, while reducing inadvertent loss or release of drugs. In other embodiments, the stent can include more than one protruding feature, or a protruding feature having more than one reservoir. In several embodiments, the stent including protruding features can have the protruding feature, such as the coating or the reservoir, concealed (e.g., recessed) until the stent is positioned at the treatment site. Once positioned at the target site, the protruding feature can be revealed (e.g., expanded/projected, etc.) during and/or after expansion of the stent. This is expected to reduce any loss of the drug carried by the protruding feature during delivery to the treatment site. 
     In some embodiments, the stents can further include a material (e.g., PTFE, Dacron, polyamides, such as nylon and/or polyurethane based materials, silicone, etc.) positioned over a stent, scaffold or other structure having protruding features covering at least a portion of the outer surface area. In some embodiments, the material covers the entire outer surface area. The material can be a mesh or a braid. In some embodiments, the material can be configured to increase a surface area of the stent useful for providing additional surface area of the stent for coating with a drug. In other embodiments, the material can further be configured to allow blood flow through the inner diameter of the stent and/or limit blood flow to an outer dimension of the stent. In additional embodiments, the material can create a barrier between fluid flow (e.g., blood flow) and the drug-delivery locations. In addition, the material can be configured to prevent debris from the wall of the body lumen from entering the bloodstream. In such embodiments, the associated systems and devices can be used for temporary dissection tacking or coverage of a region that may have been perforated during a procedure. 
     The embodiments described herein provide delivery systems for one or more structures having a means for delivering drugs to a specific region within a body lumen, such as the vasculature, while still allowing fluid (e.g., blood) to flow through the treatment area where the structure has been placed and/or other devices or treatment means within the adjacent body lumen. In some embodiments, the fluid is temporary prevented from flowing through the treatment area while one or more regions of systems is delivered, deployed, positioned, and/or removed from the body lumen. In addition, the delivery systems can be configured to prepare the body lumen for treatment, by raking the stent, pulling the stent, turning the stent, or a combination thereof, proximal or distal to the treatment site. In other embodiments, the delivery systems can be configured to rotate the stent when mechanical force is applied. 
     The systems disclosed herein can provide for adjustment, recapture, and/or redeployment of the associated stents or other structures, and/or deployment of a different stent or other structure, allowing a practitioner to more effectively to treat a desired region more accurately and deliberately. In several embodiments, the stent or other delivery structure can be deployed for a temporary period (e.g., for less than 24 hours), and then retracted and removed. In these embodiments, the protruding features can engage with and/or pierce the lumen wall and remain therein after the stent or other delivery structure is removed, or can be retracted and removed with the stent or other delivery structure. The stent can be configured to self-expand, or partially self-expand, when deployed from the delivery system and also be configured to further expand within the body lumen when the balloon is expanded therein. The stent can also be configured to post-dilate when removed from the body lumen. In other embodiments, the stent or other delivery structure can be deployed for a long-term temporary period (e.g., for less than 2 weeks, less than one month, less than 6 months, less than one year), and then retracted and removed. In some embodiments, a different stent or delivery structure can be deployed after a first stent or delivery structure has been retraced and removed. The duration of deployment and duration after removal before deployment of the different stent or delivery structure can vary from minutes, to hours, to days, to weeks, to months, or to years. In these embodiments, removal of the first stent or delivery structure and deployment of a different stent or delivery structure can occur once, twice, three times, four times, five times, six times, seven times, eight times, nine times, or ten times. Moreover, the embodiments described herein can allow for a lower profile system than currently available systems. 
     In the embodiments described herein and other embodiments configured in accordance with the present technology, stents and other expandable structures may include non-protruding features, such as deployable and/or expandable features, that are not configured for delivering a drug to a target location. For example, stents and other expandable structures configured in accordance with the present technology can include one or more protruding features, one or more non-protruding features, or combinations thereof. 
     While many embodiments of the stents and/or structures described herein include stents, additional embodiments of the expandable elements, such as stents and/or structures, can include non drug-eluting stents and/or non drug-eluting structures. In these embodiments, the non drug-eluting stents may include one or more protruding members, such as spikes. The spikes can be configured to engage with and/or penetrate a portion of the body lumen or vessel. For example, the spikes can penetrate the vessel wall, thereby reducing and/or eliminating an elasticity of the vessel wall. In these embodiments, the protruding members can be configured to prevent the vessel wall from progressing inward toward the body lumen and restricting and/or constricting flow therein. The protruding members can be integrally formed with the struts, or disposed on the surface of the struts, extending radially outward from the struts toward the target tissue. 
     Various examples of aspects of the disclosure are described below as clauses for convenience. These are provided as examples, and do not limit the subject technology. 
     Clause A: a delivery system comprising: an outer shaft; an inner shaft slideably disposed within the outer shaft and comprising an inflatable balloon; a guidewire slideably disposed within the inner shaft; and a stent disposed around the balloon and fixedly coupled to the inner shaft. 
     Clause B: a method for delivering a stent within a body lumen of a patient, the method comprising: delivering an outer shaft ensheathing an inner shaft and a stent to a target treatment site within the body lumen of the patient, the stent being disposed around a balloon of the inner shaft and fixedly coupled to the inner shaft; proximally retracting the outer shaft to at least partially unsheath the stent; radially expanding the stent to an expanded state by expanding the balloon; and piercing through a portion of a wall of the body lumen with one or more protruding features of the stent. 
     Clause C: a delivery system comprising: an outer shaft; an inner shaft slideably disposed within the outer shaft and comprising an inflatable balloon on a distal portion of the inner shaft; a guidewire slideably disposed within the inner shaft; and a stent slideably disposed within the outer shaft and on a proximal portion of the inner shaft that is proximal to the balloon, the stent being connected to a stabilizing wire that is slideably disposed within the outer shaft. 
     Clause D: a method for delivering a stent within a body lumen of a patient, the method comprising: delivering an outer shaft ensheathing an inner shaft and a stent to a target treatment site within the body lumen of the patient, the stent being slideably disposed within the outer shaft and on a proximal portion of the inner shaft that is proximal to a balloon of the inner shaft; proximally retracting the outer shaft to at least partially unsheath the stent and the balloon; moving the inner shaft proximally relative to the stent until the stent is axially aligned with the balloon; radially expanding the stent to an expanded state by expanding the balloon; and piercing through a portion of a wall of the body lumen with one or more protruding features of the stent. 
     Clause E: a delivery system comprising: an outer shaft; an inner shaft slideably disposed within the outer shaft and comprising an inflatable balloon on a proximal portion of the inner shaft; a guidewire slideably disposed within the inner shaft; and a stent slideably disposed within the outer shaft and on a distal portion of the inner shaft that is distal to the balloon, the stent being connected to a stabilizing wire that is slideably disposed within the outer shaft. 
     Clause F: a method for delivering a stent within a body lumen of a patient, the method comprising: delivering an outer shaft ensheathing an inner shaft and a stent to a target treatment site within the body lumen of the patient, the stent being slideably disposed within the outer shaft and on a distal portion of the inner shaft that is distal to a balloon of the inner shaft; proximally retracting the outer shaft to at least partially unsheath the stent and the balloon; moving the inner shaft distally relative to the stent until the stent is axially aligned with the balloon; radially expanding the stent to an expanded state by expanding the balloon; and piercing through a portion of a wall of the body lumen with one or more protruding features of the stent. 
     Clause G: a method for delivering a stent within a body lumen of a patient, the method comprising: delivering an outer shaft ensheathing an inner shaft and a stent to a target treatment site within the body lumen of the patient, the stent being disposed around a balloon of the inner shaft and fixedly coupled to the inner shaft; proximally retracting the outer shaft to partially unsheath the stent; radially expanding a first length of the stent to an expanded state by expanding the balloon while a portion of the stent is within the outer shaft until one or more protruding features of the stent pierces through a first portion of a wall of the body lumen; proximally retracting the outer shaft to further unsheath the stent; and radially expanding a second length of the stent to an expanded state by expanding the balloon until one or more protruding features of the stent pierces through a second portion of the wall of the body lumen. 
     One or more of the above clauses can include one or more of the features described below. It is noted that any of the following clauses may be combined in any combination with each other, and placed into a respective independent clause, e.g., clause A, B, C, D, E, F, or G. 
     Clause 1: a connector at a proximal end of the inner shaft, the guidewire extending through the connector, the connector comprising a port in fluid communication with the balloon; and an outer shaft hub at a proximal end of the outer shaft, the inner shaft extending through the outer shaft hub. 
     Clause 2: incrementally spaced markers on a proximal portion of the inner shaft, wherein the outer shaft hub is slidable over the inner shaft along the proximal portion. 
     Clause 3: a locking member configured to lock the outer shaft hub to a proximal portion of the inner shaft such that a position of the outer shaft relative to the inner shaft is maintained when the balloon is inflated. 
     Clause 4: the balloon is inflatable through a lumen of the inner shaft that contains the guidewire. 
     Clause 5: a stiffening wire positioned radially between the inner shaft and the outer shaft. 
     Clause 6: the stent comprises: a radially expandable cylindrical frame comprising struts; and protruding features carried by one or more struts. 
     Clause 7: the stent is fixedly coupled to the inner shaft by an anchor portion that extends about at least a portion of the inner shaft. 
     Clause 8: the anchor portion is coupled to the inner shaft on a proximal side of the balloon. 
     Clause 9: the balloon comprises multiple segments at different axial positions along a length of the inner shaft, the multiple segments each being independently inflatable. 
     Clause 10: deflating the balloon; advancing the outer shaft over the stent; and removing the stent from the body lumen. 
     Clause 11: a connector at a proximal end of the inner shaft, the guidewire extending through the connector, the connector comprising a port in fluid communication with the balloon; and an outer shaft hub at a proximal end of the outer shaft, the inner shaft and the stabilizing wire extending through the outer shaft hub. 
     Clause 12: the target treatment site is a first target treatment site, the method further comprising before proximally retracting the outer shaft to further unsheath the stent, repositioning the stent to a second target treatment site. 
     Clause 13: the second length of the stent includes the first length of the stent. 
     Clause 14: before proximally retracting the outer shaft to further unsheath the stent, deflating the balloon and resheathing the stent. 
     Clause 15: before radially expanding the first length of the stent, locking the outer shaft relative to the inner shaft. 
     Clause 16: before radially expanding the second length of the stent, locking the outer shaft relative to the inner shaft. 
     A reference to an element in the singular is not intended to mean one and only one unless specifically so stated, but rather one or more. For example, “a” module may refer to one or more modules. An element proceeded by “a,” “an,” “the,” or “said” does not, without further constraints, preclude the existence of additional same elements. 
     Headings and subheadings, if any, are used for convenience only and do not limit the invention. The word exemplary is used to mean serving as an example or illustration. To the extent that the term include, have, or the like is used, such term is intended to be inclusive in a manner similar to the term comprise as comprise is interpreted when employed as a transitional word in a claim. Relational terms such as first and second and the like may be used to distinguish one entity or action from another without necessarily requiring or implying any actual such relationship or order between such entities or actions. 
     Phrases such as an aspect, the aspect, another aspect, some aspects, one or more aspects, an implementation, the implementation, another implementation, some implementations, one or more implementations, an embodiment, the embodiment, another embodiment, some embodiments, one or more embodiments, a configuration, the configuration, another configuration, some configurations, one or more configurations, the subject technology, the disclosure, the present disclosure, other variations thereof and alike are for convenience and do not imply that a disclosure relating to such phrase(s) is essential to the subject technology or that such disclosure applies to all configurations of the subject technology. A disclosure relating to such phrase(s) may apply to all configurations, or one or more configurations. A disclosure relating to such phrase(s) may provide one or more examples. A phrase such as an aspect or some aspects may refer to one or more aspects and vice versa, and this applies similarly to other foregoing phrases. 
     A phrase “at least one of” preceding a series of items, with the terms “and” or “or” to separate any of the items, modifies the list as a whole, rather than each member of the list. The phrase “at least one of” does not require selection of at least one item; rather, the phrase allows a meaning that includes at least one of any one of the items, and/or at least one of any combination of the items, and/or at least one of each of the items. By way of example, each of the phrases “at least one of A, B, and C” or “at least one of A, B, or C” refers to only A, only B, or only C; any combination of A, B, and C; and/or at least one of each of A, B, and C. 
     It is understood that the specific order or hierarchy of steps, operations, or processes disclosed is an illustration of exemplary approaches. Unless explicitly stated otherwise, it is understood that the specific order or hierarchy of steps, operations, or processes may be performed in different order. Some of the steps, operations, or processes may be performed simultaneously. The accompanying method claims, if any, present elements of the various steps, operations or processes in a sample order, and are not meant to be limited to the specific order or hierarchy presented. These may be performed in serial, linearly, in parallel or in different order. It should be understood that the described instructions, operations, and systems can generally be integrated together in a single software/hardware product or packaged into multiple software/hardware products. 
     In one aspect, a term coupled or the like may refer to being directly coupled. In another aspect, a term coupled or the like may refer to being indirectly coupled. 
     Terms such as top, bottom, front, rear, side, horizontal, vertical, and the like refer to an arbitrary frame of reference, rather than to the ordinary gravitational frame of reference. Thus, such a term may extend upwardly, downwardly, diagonally, or horizontally in a gravitational frame of reference. 
     The disclosure is provided to enable any person skilled in the art to practice the various aspects described herein. In some instances, well-known structures and components are shown in block diagram form in order to avoid obscuring the concepts of the subject technology. The disclosure provides various examples of the subject technology, and the subject technology is not limited to these examples. Various modifications to these aspects will be readily apparent to those skilled in the art, and the principles described herein may be applied to other aspects. 
     All structural and functional equivalents to the elements of the various aspects described throughout the disclosure that are known or later come to be known to those of ordinary skill in the art are expressly incorporated herein by reference and are intended to be encompassed by the claims. Moreover, nothing disclosed herein is intended to be dedicated to the public regardless of whether such disclosure is explicitly recited in the claims. No claim element is to be construed under the provisions of 35 U.S.C. § 112, sixth paragraph, unless the element is expressly recited using the phrase “means for” or, in the case of a method claim, the element is recited using the phrase “step for”. 
     The title, background, brief description of the drawings, abstract, and drawings are hereby incorporated into the disclosure and are provided as illustrative examples of the disclosure, not as restrictive descriptions. It is submitted with the understanding that they will not be used to limit the scope or meaning of the claims. In addition, in the detailed description, it can be seen that the description provides illustrative examples and the various features are grouped together in various implementations for the purpose of streamlining the disclosure. The method of disclosure is not to be interpreted as reflecting an intention that the claimed subject matter requires more features than are expressly recited in each claim. Rather, as the claims reflect, inventive subject matter lies in less than all features of a single disclosed configuration or operation. The claims are hereby incorporated into the detailed description, with each claim standing on its own as a separately claimed subject matter. 
     The claims are not intended to be limited to the aspects described herein, but are to be accorded the full scope consistent with the language of the claims and to encompass all legal equivalents. Notwithstanding, none of the claims are intended to embrace subject matter that fails to satisfy the requirements of the applicable patent law, nor should they be interpreted in such a way.