Patent Publication Number: US-2022218948-A1

Title: Dynamic curve access tool for complex arch anatomies and radial access

Description:
FIELD OF THE INVENTION 
     The present disclosure relates generally to medical devices and intravascular medical procedures and, more particularly, to devices and methods for controlling deflection at the distal end of a catheter. 
     BACKGROUND 
     Therapeutic or diagnostic catheters are commonly used to perform medical procedures within very small spaces in a patient&#39;s body. Most of these medical procedures mandate precise catheter navigation. To access a target site within the human body from a remote location, a catheter is typically passed through one or more body lumens, such as through the vascular system, to the target site. When the vascular system is used, the catheter is inserted into an artery or vein percutaneously or through a relatively small incision in the patient&#39;s body. The catheter is then threaded through the patient&#39;s system of blood vessels to reach the desired target site. Often a pathway is created through the vasculature to the target site with the use of a delivery device, such as a guide catheter or long sheath, through which a therapeutic or diagnostic catheter can be guided to the target site. 
     The usefulness of guide catheters is largely limited by their ability to successfully navigate through small vessels and around tight bends in the vasculature, such as around the aortic arch. Access of the great vessels off the aortic arch pose challenges, especially when anatomical features require devices to follow a highly tortured or a not well supported path. To overcome some of these challenges, pre-shaped selective catheters have been developed to direct guide catheters or long sheaths by providing an internal guide rail over which the guide catheter or long sheath may traverse a selected path to reach the intended target location for the guide catheter or long sheath. Such pre-shaped selective catheters may have multiple axially spaced curves that allow access to the great vessels which originate from the aortic arch. Often times a diagnostic catheter is used for the same purpose as the selective catheter, selective catheters generally are different only in length so that they will fit inside a guide catheter or long sheath. For example, diagnostic and selective catheters having various types of pre-shaped distal ends (e.g., Simmons, Headhunter, Vitek, Bentson, Newton, Berenstein shapes) have been developed to both assist in negotiating twists and branches common in a patient&#39;s arterial or venous system and to maintain a shape once positioned within a target cavity, e.g., a chamber in the heart. However, since the pre-shaped curve is fixed into the selective catheter at the time of manufacture, the radius, extent of the curvature, and overall shape generally cannot be altered in-situ. Due to anatomical variations, extensive pre-surgical planning would be necessary to determine an appropriate curvature of the selective catheter. Current practice requires guesswork to select an existing shape that is the closest approximation to the patient&#39;s anatomical geometry. 
     In one particular therapeutic procedure, a stent may be deployed in one or more carotid arteries or their branches with the use of a guide catheter to treat atherosclerosis. The disease processes that take place in these vessels cause deterioration of the interior vessel walls, and diseased material that detaches from the interior vessels can be swept through the arterial system with successively decreasing vessel diameter until it becomes lodged in a vessel construction, causing the cessation of blood flow in the block area, leading to tissue death from loss of oxygenation. This disease process is the leading cause of strokes, heart attacks, and other debilitating or fatal events. As atherosclerosis in the carotid artery progresses, the risk of stroke increases, and it becomes necessary to intervene to prevent stroke or death from clots or vessel debris that becomes lodged in the brain, specifically related to disease of the internal carotid artery branch, which serves the brain, or the common carotid artery, which preceded it in the circulatory path. It should be noted that stroke is the third leading cause in the developing nations. 85% of all strokes are ischemic (due to brain circulation compromise) in nature and 20-30% of all ischemic strokes are caused by carotid artery atherosclerotic occlusive disease. For atherosclerotic occlusive disease of the internal or common carotid artery, one procedure performed by interventionalists (interventional radiologists, vascular surgeons, or interventional cardiologists) is the installation of a stent, which is an expanding cylindrical wire or plastic mesh that supports and stabilizes the disease area of the artery, and reduces the stenosis (narrowing) of the artery through a treatment known as angioplasty, whereby an inflatable balloon is used to momentarily expand the sent across the inner diameter of the vessel in the stenotic region. 
     Stenting of a carotid artery is a challenging procedure because accessing the left or right carotid artery can be dependent on the anatomical disposition of the aortic arch. For example, referring to  FIG. 1A-1C , a typical human has an aortic arch  10  with three major arterial branches that leave aortic arch  10 , including a first arterial branch  12  that forms the left subclavian artery (LSA)  14  and left vertebral artery (LVA)  16 , a second arterial branch  18  that forms the left common carotid artery  20  (LCCA), and a third arterial branch (brachiocephalic trunk)  22  that forms the right subclavian artery (RSA)  24 , right vertebral artery (RVA)  26 , and right common carotid artery (RCCA)  28 . 
     There are three types of arches defined by the height h of the top of the aortic arch  10  from the base location where the brachiocephalic trunk  22  attaches to the aortic arch  10 . In a Type I arch, the height h is insignificant (h less than diameter of LCCA  20  or RCCA  28 ), as illustrated in  FIG. 1A . In a Type II arch, the height h significantly increases (h between one and two times the diameter of LCCA  20  or RCCA  28 ), as illustrated in  FIG. 1B , while in a Type III arch, the height h increases even more (h greater than two times diameter of LCCA  20  or RCCA  28 ), as illustrated in  FIG. 1C . As the height of the aortic arch  10  increases, the procedures within the carotid arteries become more and more difficult due to the tortuous nature of the arterial connections to the aortic arch  10 . For example, in Type III hostile aortic arches, as illustrated in  FIG. 1C , the angle of origin of the second arterial branch  18  or third arterial branch  22  can be very acute, thus making access to the LCCA  20  or RCCA  28  difficult. Bovine arches are another example of difficult anatomies, in which the origin of the LCCA ( 18 ) emanates from the brachiocephalic trunk ( 22 ). 
     For example, an interventionalist may select between a femoral approach or a radial approach when accessing one of the arterial branches from the aortic arch  10 . As illustrated in  FIG. 2A , during a femoral approach, a catheter  30  may be introduced within the femoral artery, up the abdominal aorta to the descending aorta, and around the aortic arch  10  to one of the three arterial branches of the aortic arch  10 . In contrast, as illustrated in  FIG. 2B , during a radial approach, a catheter  30  may be introduced into and through the radial artery, through the brachial and axillary arteries, then along the RSA  24 , and finally into the aortic arch  10 . In one method, the catheter  30  will be inserted into a selected one of the arterial branches from the aortic arch  10  to provide a stable platform through which the interventional device (e.g., a stent delivery device) is to be introduced into the diseased artery. In other methods, the catheter  30  may serve as a diagnostic catheter for injecting imaging dye within one of the major arterial branches extending from the aorta. Oftentimes, a selective catheter with a pre-bent or pre-shaped distal end may be used to facilitate proper orientation of the guide catheter within the aortic arch  10  and subsequent introduction of the guide catheter into the relevant arterial branch of the aortic arch  10 . 
     Interventional procedures in the neck or above the neck are challenging, particularly when confronted with hostile aortic arches, such as Type III or bovine arches or instances where the LCCA emanates from the arch at an acute angle. The interventional devices that are introduced through the guide catheter are often relatively stiff, and due to the tortuosity of the vessels originating from the aortic arch  10 , the catheter  30 , along with the interventional device, can become unstable and be pushed out into the aortic arch  10 . Thus, it is important that the catheter  30  be distally introduced as far into the arterial branches of the aortic arch as possible in order to provide a stable platform for interventional devices to travel to their intended treatment location. 
     However, stroke intervention devices are becoming larger and larger, and as a result, the guide sheaths that provide the support platform for these larger intervention devices must become larger and more supportive. While newer more supportive and flexible guide catheter designs have been, and are continuing, to be developed, the challenge of traversing unsupported anatomical bends remains. Even if a selective catheter is used to facilitate proper orientation of the guide catheter within the aortic arch  10 , the statically located curve at the distal end of the selective catheter prevents the selective catheter from being distally advanced deep into the selected arterial branch of the aortic arch  10  to achieve greater stability to additionally facilitate the advancement of a large supportive interventional device over the selective catheter. 
     There, thus, is an ongoing need to an improved means for manipulating a guide catheter within an anatomical vessel, such as one of the arterial branches from the aortic arch. 
     SUMMARY 
     In accordance with a first aspect of the present inventions, an intravascular device comprises an elongated outer catheter body having a proximal catheter end, a distal catheter end, and an inner lumen extending between the proximal catheter end and the distal catheter end. In one embodiment, the distal catheter end has one or more infusion openings. In another embodiment, the distal catheter end includes a distal wire tip. In still another embodiment, the distal catheter end is configured for being inserted into a branch of an aortic arch of a human. 
     The intravascular device further comprises an elongated inner articulating member slidably disposed within the inner lumen of the outer catheter body. The inner articulating member has a proximal member end and an articulatable distal member end. 
     The intravascular device further comprises a control assembly mechanically coupled to the proximal catheter end and the proximal member end. The control assembly configured for distally translating the outer catheter body over the inner articulating member, and for articulating the distal member end. In one embodiment, the control assembly is configured for articulating the distal member end into a single-curve planar shape. In another embodiment, the control assembly is configured for articulating the distal member end into a multi-curve shape. In still another embodiment, the control assembly is a manually operated control assembly. In yet another embodiment, the control assembly is releasably coupled to the proximal catheter end. In yet another embodiment, the intravascular device further comprises at least one pull wire operably connected between the distal member end and the control assembly, in which case, the control assembly is configured for articulating the distal member end by tensioning the pull wire(s). 
     In accordance with a second aspect of the present inventions, an intravascular device comprises an elongated inner articulating member configured for being slidably disposed within an inner lumen of the outer catheter body having a proximal catheter end, a distal catheter end, and an inner lumen extending between the proximal catheter end and the distal catheter end. In one embodiment, the distal catheter end is configured for being inserted into a branch of an aortic arch of a human. The inner articulating member has a proximal member end and an articulatable distal member end. 
     The intravascular device further comprises a control assembly mechanically coupled to the proximal member end. The control assembly is further configured for being releasably coupled to the proximal catheter end. The control assembly is further configured for distally translating the outer catheter body over the inner articulating member, and for articulating the distal member end. In one embodiment, the control assembly is configured for articulating the distal member end into a single-curve planar shape. In another embodiment, the control assembly is configured for articulating the distal member end into a multi-curve shape. In still another embodiment, the control assembly is a manually operated control assembly. In yet another embodiment, the control assembly is releasably coupled to the proximal catheter end. In yet another embodiment, the intravascular device further comprises at least one pull wire operably connected between the distal member end and the control assembly, in which case, the control assembly is configured for articulating the distal member end by tensioning the at least one pull wire. 
     In accordance with a third aspect of the present inventions, a method of performing a medical procedure on a patient using an intravascular device including an elongated outer catheter body having a distal catheter end and an inner catheter lumen, and an elongated inner member slidably disposed within the inner catheter lumen. The inner member has a distal member end. 
     The method comprises introducing the intravascular device within a vasculature of the patient (e.g., a femoral approach or a radial approach). The method further comprises distally advancing the intravascular device within the vasculature of the patient until the distal catheter end is adjacent an ostium of a blood vessel within the vasculature. In one method, the blood vessel is an arterial branch extending from an aortic arch (e.g., a Type III aortic arch) of the patient (e.g., one of a first arterial branch that forms a left subclavian artery (LSA) and a left vertebral artery (LVA) of the patient, a second arterial branch that forms a left common carotid artery (LCCA) of the patient, and a third arterial branch that forms a right subclavian artery (RSA), right vertebral artery (RVA), and right common carotid artery (RCCA) of the patient). If the arterial branch is the third arterial branch, further advancing the distal catheter end into the blood vessel may comprise advancing the distal catheter end into the RCCA. In another method, the distal catheter end is inserted into the ostium of the blood vessel by distally sliding the distal catheter end relative to the distal member end. 
     The method further comprises actively articulating the distal member end, such that the distal catheter end is pointed at the ostium of the blood vessel. The method further comprises inserting the distal catheter end into the ostium of the blood vessel, and distally sliding the distal catheter end relative to the distal member end, such that the distal catheter end is further advanced into the blood vessel. One method may further comprise advancing a guide catheter over the intravascular device, while the distal catheter end remains in the blood vessel, until the guide catheter reaches a target therapeutic site, and removing the intravascular device from the guide catheter while the guide catheter is at the target therapeutic site. This method may further comprise introducing a therapeutic device through the guide catheter until the therapeutic device is at the target therapeutic site, and performing a therapeutic procedure at the target therapeutic site using the therapeutic device. Another method may further comprise removing the inner member from the inner lumen of the outer catheter body, advancing a guide catheter through the inner lumen of the outer catheter body, while the distal catheter end remains in the blood vessel, until the guide catheter reaches a target therapeutic site, and removing the intravascular device from the guide catheter while the guide catheter is at the target therapeutic site. This other method may further comprise introducing a therapeutic device through the inner lumen of the outer catheter body until the therapeutic device is at the target therapeutic site, and performing a therapeutic procedure at the target therapeutic site using the therapeutic device. An optional method further comprises delivering an imaging dye within the blood vessel via the catheter assembly. 
     Other and further aspects and features of embodiments will become apparent from the ensuing detailed description in view of the accompanying figures. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The drawings illustrate the design and utility of preferred embodiments of the disclosed inventions, in which similar elements are referred to by common reference numerals. It should be noted that the figures are not drawn to scale and that elements of similar structures or functions are represented by like reference numerals throughout the figures. It should also be noted that the figures are only intended to facilitate the description of the embodiments. They are not intended as an exhaustive description of the invention or as a limitation on the scope of the invention, which is defined only by the appended claims and their equivalents. In addition, an illustrated embodiment of the disclosed inventions needs not have all the aspects or advantages shown. Further, an aspect or an advantage described in conjunction with a particular embodiment of the disclosed inventions is not necessarily limited to that embodiment and can be practiced in any other embodiments even if not so illustrated. 
       In order to better appreciate how the above-recited and other advantages and objects of the disclosed inventions are obtained, a more particular description of the disclosed inventions briefly described above will be rendered by reference to specific embodiments thereof, which are illustrated in the accompanying drawings. 
       Understanding that these drawings depict only typical embodiments of the invention and are not therefore to be considered limiting of its scope, the invention will be described and explained with additional specificity and detail through the use of the accompanying drawings in which: 
         FIG. 1A  is a plan view of an exemplary Type I aortic arch of a patient; 
         FIG. 1B  is a plan view of an exemplary Type II aortic arch of a patient; 
         FIG. 1C  is a plan view of an exemplary Type III aortic arch of a patient; 
         FIG. 2A  is a plan view of a catheter introduced into a Type III aortic arch of a patient via the femoral approach; 
         FIG. 2B  is a plan view of a catheter introduced into a Type III aortic arch of a patient via the right radial artery approach, including a plan view of the catheter of  FIG. 2A , particularly showing the distal end of the catheter in a curved configuration; 
         FIG. 3A  is a plan view of an intravascular device constructed in accordance with one exemplary embodiment of the present inventions, particularly shown in a straight configuration; 
         FIG. 3B  is a plan view of the intravascular device of  FIG. 3A , particularly shown in a curved configuration; 
         FIG. 3C  is a plan view of the intravascular device of  FIG. 3A , particularly shown in a curved, extended, configuration; 
         FIGS. 4A-4G  are plan views of different distal ends of the intravascular device of  FIG. 3A ; 
         FIG. 5  is a plan view of one exemplary distal end of the intravascular device that assumes a complex curve; 
         FIG. 6  is a plan view of an exemplary inner articulating member of the intravascular device of  FIG. 3A ; 
         FIG. 7  is a plan view of one specific construction of the distal end of the inner articulating member of  FIG. 6 ; 
         FIG. 8  is a perspective view of one exemplary embodiment of a control assembly that can be used by the intravascular device of  FIG. 3A ; 
         FIG. 9  is a longitudinal section of the control assembly of  FIG. 8 ; 
         FIG. 10  is a perspective view of another exemplary embodiment of a control assembly that can be used by the intravascular device of  FIG. 3A ; 
         FIG. 11  is a longitudinal section of the control assembly of  FIG. 10 ; 
         FIGS. 12A-12F  are plan views of the distal end of the intravascular device of  FIG. 3A , particularly shown in a sequence of different configurations; 
         FIG. 13  is a flow diagram illustrating one exemplary method of using the intravascular device of  FIG. 3  to perform a therapeutic procedure in a patient; 
         FIGS. 14A-14I  are plan views illustrating different steps used by the method of  FIG. 13  to perform the therapeutic procedure in the patient; 
         FIG. 15  is a flow diagram illustrating one exemplary method of using the intravascular device of  FIG. 3  to perform a diagnostic procedure in a patient; and 
         FIGS. 16A-16G  are plan views illustrating different steps used by the method of  FIG. 15  to perform the therapeutic procedure in the patient. 
     
    
    
     DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS 
     Referring to  FIGS. 3A-3C , one embodiment of an intravascular device  100  constructed in accordance with one embodiment of the present inventions will now be described. In the illustrated embodiment, the intravascular device  100  is described as a rail (especially used as an alternative to a traditional selective or diagnostic catheter) for subsequently advancing a guide catheter to a target therapeutic site within the body of a patient, which guide catheter can then be used to guide a therapeutic device (e.g., a catheter or other instrument) to the target therapeutic site. The intravascular device  100  lends itself well in facilitating the delivery of relatively stiff devices through unsupported curves, especially through Type III aortic arches via a femoral approach or any aortic arch configuration via a radial approach. However, it should be appreciated that the intravascular device  100  can take the form of any device, including a selective catheter, guidewire, or even a working catheter, itself, that is purposed to perform a medical procedure (therapeutic or diagnostic) that can benefit from accessing an ostium of a blood vessel, e.g., the ostium of an arterial branch off of the aortic arch of a patient. 
     In contrast to a selective catheter, which has a static curve that is in a static location on a catheter or even a conventional steerable catheter that would prevent the catheter from being distally advanced through an ostium and into the blood vessel, the intravascular device  100  can be shaped to direct the distal end of the intravascular device  100  towards or within the ostium of the blood vessel, and the distal end of the intravascular device  100  may be distally advanced relative to the shaped curve, thereby facilitating advancement of the distal end of the intravascular device  100  within the blood vessel, while the shaped curve remains in the location of the torturous anatomy for which the curve is facilitating transit therethrough. 
     To this end, the elongated intravascular device  100  generally comprises an outer catheter body  102 , an inner articulating member  104  slidably disposed within the outer catheter body  102 , and a control assembly  106 . The outer catheter body  102  generally has a proximal end  108 , a distal end  110 , and an inner lumen  112  in which the inner articulating member  104  is slidably disposed. The inner articulating member  104  generally has a proximal end  114  and a distal end  116 . The control assembly  106  is mechanically coupled to the proximal end  108  of the outer catheter body  102  and the proximal end  114  of the inner articulating member  104 , and is configured for both articulating the inner articulating member  104  to form a curve in the inner articulating member  104  via energy transmission elements (and in particular one or more pull wires), and thus the elongated intravascular device  100  (see  FIG. 3B ), and to translate the outer catheter body  102  relative to the inner articulating member  104  in an axial direction  120  along a longitudinal axis  118  (see  FIG. 3C ). In the embodiment illustrated in  FIG. 3B , the curve formed by the inner articulating member  104  is shown as a simple curve (a single bend), although as will be described in further detail below, the curve formed by the inner articulating member  104  may be a complex curve having multiple bends. Optionally, the control assembly  106  may be configured for translating the outer catheter body  102  relative to the inner articulating member  104  in a rotational direction  122  about the longitudinal axis  118 . 
     The outer catheter body  102  may be constructed in a manner similar to most endovascular catheter shafts, and can be composed of a variety of materials using a variety of construction processes. The outer catheter body  102  is substantially pliable or flexible, such that when it is advanced into a patient, the outer catheter body  102  will conform, adopt, or match the shape or curvatures of blood vessels of the patient. Alternatively, the outer catheter body  102  may be semi-rigid, i.e., by being made of a stiff material, or by being reinforced with a coating or coil, to limit the amount of flexing. 
     The outer catheter body  102  is preferably about 2 French to 9 French in diameter, and between 80 cm to 150 cm in length. The outer catheter body  102  preferably has a cross-sectional geometry that is circular. However, other cross-sectional shapes, such as elliptical, rectangular, triangular, and various customized shapes, may be used as well. The outer catheter body  102  is preferably preformed of an inert, resilient plastic material that retains its shape and does not soften significantly at body temperature; for example, Pebax®, polyethylene, polyurethane, polyamide or Hytrel® (polyester). Alternatively, the outer catheter body  102  may be made of a variety of materials, including, but not limited to, metals and polymers. 
     The outer catheter body  102  may be composed of multiple layers of materials and/or multiple tube structures that exhibit a low bending stiffness, while providing a high axial stiffness along the longitudinal axis of the outer catheter body  102 . Preferably, the outer catheter body  102  has adequate torsional rigidity, so that it can be rotated independently from the inner articulating member  104 . Typical designs include a nitinol spine encapsulated in braid and any flexible, pliable, or suitable polymer material, a laser cut hypotube, or bio-compatible polymer material or a braided plastic composite structure composed of low durometer plastics (e.g., nylon-12, Pebax®, polyurethanes, polyethylenes, etc.). 
     The inner lumen  112  is disposed through the entire length of the outer catheter body  102 . At least a portion of the inner lumen  112  of the outer catheter body  102  extending through the outer catheter body  102  may be formed by an inner polymer tube (e.g., 0.001″ thick polytetrafluoroethylene (PTFE)). The distal end  110  of the outer catheter body  102  terminates in an atraumatic distal tip  124 . In one embodiment illustrated in  FIG. 4A , the distal catheter end  100  has a pre-shaped curve. In other embodiments illustrated in  FIGS. 4B-4G , the distal catheter end  100  has a straight configuration. In the embodiments illustrated in  FIGS. 4A-4B and 4G , the atraumatic distal tip  124  is closed or sealed, while in the embodiments illustrated in  FIGS. 4C-4F , the atraumatic distal tip  124  has at least one infusion opening  126  that fluidly communicate with the inner lumen  112  of the outer catheter body  102  to allow for optional contrast injection. In the embodiments illustrated in  FIGS. 4F-4G , the intravascular device  100  includes a distal wire tip  128  to facilitate entry into the ostium of the blood vessel. 
     Referring to  FIG. 5 , the distal end  116  of the inner articulating member  104  (shown in  FIGS. 3A-3C ), and thus the distal end  110  of the outer catheter tube  102 , is configured for being gradually articulated from a straight configuration to a curved configuration into a multi-curve planar shape. In this embodiment, the distal end  116  of the inner articulating member  104  may be articulated into a Simmons-type shape, and in particular, a proximal curve  130  that bends in a plane to emulate the curvature of a typical aortic arch, and a distal curve  132  that bends in the same plane, but opposite the proximal curve  130 , such that the distal end  116  of the inner articulating member  104 , and thus the distal end  110  of the outer catheter body  102 , points towards the ostium of an arterial branch off of the aortic arch of the patient, as will be described in further detail below. It should be appreciated that the multiple curved configuration illustrated in  FIG. 5  is only exemplary, and alternative embodiments of the distal end  116  of the inner articulating member  104  may comprise only a single curve, or may comprise different types of compound curves having different shapes or different numbers of bends, including bends that are out-of-plane with each other, or even multiple compound curves. 
     Referring to  FIG. 6 , the inner articulating member  104  is functionality divided into three sections: a distal articulating section  134 , an intermediate transition section  136 , and a proximal shaft section  138 . 
     The distal articulating section  134  preferably allows for a moderate degree of axial compression and optimal lateral flexibility. The distal articulating section  134  has several portions of differing rigidities. In an exemplary embodiment illustrated in  FIG. 7 , the distal articulating section  134  comprises a relatively flexible distal articulating region  140 , which forms the distal curve  132 , a relatively flexible proximal articulating region  144 , which forms the proximal curve  130 , and a relatively inflexible non-articulating region  142  located between the proximal articulating region  144  and the distal articulating region  140 . 
     In the embodiment illustrated in  FIG. 7 , the distal articulating section  134  is formed of a slotted (e.g., micromachined or laser-cut) hypotube that tailors the flexibility, bending arc length, minimum bend radius and bending plane of the distal articulating section  134 . In particular, the slotted hypotube has slots  146  that are strategically sized and located in a manner such that the articulating section  134  forms the proximal curve  130  coincident with the proximal articulating region  144  and the distal curve  132  coincident with the distal articulating region  140 . The distal articulating section  134  further includes a pair of spiral struts  148  arranged in the non-articulating region  142  to add lateral rigidity thereto, such that the proximal articulating region  144  and distal articulating region  140  of the distal articulating section  134  predictably articulate about the non-articulating region  142  to form the proximal curve  130  and distal curve  132 . In an alternative embodiment, instead of a laser cut hypotube, the distal articulating section  134  may be formed by having different outer tubes composed of a suitable polymer material (e.g., Pebax®). In this alternative case, to increase its axial rigidity and elastic properties, the distal articulating section  134  may comprise a braided layer (e.g., sixteen 0.0005″×0.003″ spring temper 304V stainless steel wires braided at 68 picks per inch (ppi) in a 2-over-2 pattern) embedded within the outer polymer tubes, may comprise a coil with a varied pitch, or may comprise a slotted (e.g., micromachined) hypotube to tailor the flexibility and bending plane of the distal articulating section  134 . 
     As briefly discussed above, the energy transmission conduit(s) are mechanical energy transmission conduits, and in particular, take the form of one or more pull wires that extend within the inner articulating member  104 . In the illustrated embodiment, a single pull wire  150  is used. In the illustrated embodiment, the distal articulating section  134  comprises a distal tip ring  152  to which the distal end of the pull wire  150  is affixed, and a central lumen  153  through which the pull wire  150  extends back to the control assembly  106 . Tensioning of the pull wire  150  via manipulation of the control assembly  106  (as will be described in further detail below) transforms the distal articulating section  134  from the straight configuration to the curved configuration. 
     The pull wire  150  may be a metallic wire, cable or filament, or it may be a polymeric wire, cable or filament. The pull wire  150  may also be made of natural or organic materials or fibers. The pull wire  150  may be any type of suitable wire, cable or filament capable of supporting various kinds of loads without deformation, significant deformation, or breakage. Although mechanical energy transmission conduit(s) have been described as being a pull wire, it should be appreciated that the mechanical energy transmission conduits should not be limited to pull wires. For example, the mechanical transmission conduit(s) may take the form of small diameter tubes or rods that are axially rigid, but laterally flexible. Furthermore, in alternative embodiments of the intravascular device  100 , non-mechanical, e.g., fluid transmission conduits (e.g., hydraulic or pneumatic), electrical transmission conduits (i.e., electrical wires), electromagnetic energy (e.g., optical) transmission conduits, etc., may be used as energy transmission conduits. Essentially, any energy transmission conduit capable of transmitting any energy from the proximal end  114  to the distal end  116  of the inner articulating member  104  for articulating the distal articulating section  134  to form the proximal curve  130  and distal curve  132 . 
     In order to impart different forces along the distal end  116  of the inner articulating member  104  to create the proximal curve  130  and distal curve  132 , the pull wire  150  is slidably disposed, and floats, within, the central lumen  153  extending through the inner articulating member  104 . In an alternative embodiment, two pull wires may extend through two pull wire lumens (not shown) extending through the inner articulating member  104 . In this case, the pull wire lumens may be constructed of a low friction material or may simply be unsupported tubular cavities in which the pull wires respectively float, and may be provided in the inner articulating member  104  in a 180-degree circumferentially spaced apart relationship. 
     As will be described in further detail below, the proximal end of the pull wire  150  is operatively coupled to the control assembly  106 , while the distal end of the pull wire  150  is affixed to the distal end  116  of the inner articulating member  104 , such that operation of the pull wire  150  via manual actuation of the control assembly  106  applies or modifies a force or tension to the distal end  116  of the inner articulating member  104 , which may articulate to create the proximal curve  130  and distal curve  132 . In the illustrated embodiment, the portion of the outer catheter body  102  surrounding the distal articulating section  134  of the inner articulating member  104  is resilient, such that releasing the pull wire  150  via manual actuation of the control assembly  106  will release the internal force or tension on the distal articulating section  134  of the inner articulating member  104 , allowing the distal articulating section  134  to return to a straight configuration. 
     The intermediate transition section  136  resists axial compression to clearly define the proximal end of the distal articulating section  134  and transfer the motion of the pull wire  150  to the distal articulating section  134 , while maintaining lateral flexibility to allow the intravascular device  100  to track over tortuous anatomies. The intermediate transition section  136  may be formed of an outer tube composed of a slotted hypotube or a suitable polymer material (e.g., Pebax®). 
     The proximal shaft section  138  gradually transitions the inner articulating member  102  from the intermediate transition section  136  to the more rigid remaining portion of the inner articulating member  102  by having portions of differing rigidities formed by having different sections of slotted hypotube configurations or different outer tubes composed of a suitable polymer material (e.g., Pebax®). To increase its axial rigidity of any polymer tube segments, the proximal shaft section  138  may comprise a double braided layer (e.g., sixteen 0.0005″×0.003″ spring temper 304V stainless steel wires braided at 68 picks per inch (ppi) in a 2 over 2 pattern) embedded within the outer polymer tubes. 
     As briefly discussed above, the control assembly  106  is configured for articulating the distal end  116  of the inner articulating member  104  between a straight configuration and a curved configuration, translating the outer catheter body  102  over the inner articulating member  104  along the longitudinal axis  118 , and optionally for rotating the outer catheter body  102  relative to the inner articulating member  104  about the longitudinal axis  118 . In the illustrated embodiment, the control assembly  106  is a manually operated control assembly (i.e., an interventionalist manipulates the control assembly  106  via their hand or hands). In an alternative embodiment, the control assembly  106  may be automated, e.g., via a robotic device. 
     In the case where the intravascular device  100  serves as a rail for the subsequent introduction of a guide catheter or other device, at least a portion of the control assembly  106  may be releasably coupled to the outer catheter body  102 . Thus, the control assembly  106 , along with the inner articulating member  104  coupled thereto, can be pulled out of the inner lumen  112  of the outer catheter body  102 , leaving the outer catheter body  102  in the vasculature of the patient to be used as a rail for a subsequently introduced guide catheter. The inner articulating member  104 , along with the attached control assembly  106 , may be packaged and sold with the outer catheter body  102 , to form the intravascular device  100 , or the inner articulating member  104 , along with the attached control assembly  106 , may be packaged and sold as a stand-along device, and then subsequently coupled to the outer catheter body  102 , to form the intravascular device  100 . In an alternative embodiment, the outer catheter body  102  in the intravascular device  100  takes the form of a guide catheter. In this case, the inner articulating member  104 , along with the attached control assembly  106 , may be packaged and sold as an introducer, and then subsequently coupled to the guide catheter  102 , to form the intravascular device  100 . Thus, the control assembly  106 , along with the inner articulating member  104  coupled thereto, can be pulled out of the inner lumen  112  of the guide catheter  102 , leaving the guide catheter  102  in the vasculature of the patient for subsequent introduction of a therapeutic device therethrough. 
     Referring now to  FIGS. 8 and 9 , one exemplary embodiment of a control assembly  106   a  that can be used in the intravascular device  100  illustrated in  FIGS. 3A-3B  will be described. The control assembly  106  generally comprises a frame  154 , a rotation actuator  156  carried by the frame  154 , and a combined axial translation/articulation actuator  158  carried by the frame  154 . 
     The frame  154  comprises at least one slide rod  160  (and in this case, four slide rods), a proximal end cap  162  affixing the proximal ends of the slide rods  160  relative to each other, and a distal end cap  164  affixing the distal ends of the slide rods  160  relative to each other. As best shown in  FIG. 9 , the distal end cap  164  has a lumen  166  through which the proximal end  114  of the inner articulating member  104  is slidably disposed, and a reduced boss  168  having an annular ridge  170 . 
     The rotational actuator  156  comprises a nose  172  having a distal lumen  174  in which the proximal end  108  of the outer catheter body  102  is affixed, and a proximal annular cavity  176  in which the annular ridge  170  of the reduced boss  168  is rotationally disposed. Thus, the nose  172  may be rotated in a bi-directional direction  196  about a longitudinal axis  118  relative to the distal end cap  164 , thereby rotating the outer catheter body  102  about the longitudinal axis  118  relative to the frame  154 . In the case where at least a portion of the control assembly  106   a  is releasably coupled to the proximal end  108  of the outer catheter body  102 , the nose  172  may be releasably coupled to the proximal end  108  of the outer catheter body  102 , e.g., using a threaded arrangement (not shown). 
     The axial translation/articulation actuator  158  comprises a housing  180  having at least one lumen  182  (and in this case, four lumens) through which the slide rods  160  of the frame  154  are slidably disposed. The housing  180  further has a distal opening  184  in which the proximal end  114  of the inner articulating member  104  is affixed. Thus, the frame  154  may be axially translated along the longitudinal axis  118  in a bi-directional direction  198  relative to the housing  180  of the axial translation/articulation actuator  158 , thereby axially translating the outer catheter body  102  along the longitudinal axis  118  relative to the inner articulating member  104 . 
     As best shown in  FIG. 9 , the housing  180  also has a reduced diameter lumen  186  in communication with the distal opening  184 , and through which the pull wire  150  is slidably disposed. The axial translation/articulation actuator  158  further comprises a rotational gear in the form of a pinion collar  188 , which is rotatably slidable about the housing  180 , and a linear gear in the form of a rack  190 , which is axially slidable within the housing  180 . The pinion collar  188  has internal threads  192 , and the rack has a linear row of teeth  194  that engage the internal threads  192  of the pinion collar  188 . The rack  190  has a lumen  196  in which the proximal end of the pull wire  150  is affixed. 
     Thus, the pinion collar  188  may be rotated about the longitudinal axis  118  relative to the housing  180  in a bi-directional direction  199 , thereby either proximally translating the pull wire  150  within the inner articulating member  104  that increases the articulation of the distal end  116  of the inner articulating member  104 , or distally translating the pull wire  150  within the inner articulating member  104  that decreases the articulation of the distal end  116  of the inner articulating member  104 . 
     It should be appreciated that, although only one specific embodiment of a control assembly  106   a  has been described, any control assembly capable of distally translating the outer catheter body  102  over the inner articulating member  104  and articulating the distal end  116  of the inner articulating member  104  between a straight configuration and a curved configuration may be employed. 
     For example, referring to  FIGS. 10 and 11 , an alternative embodiment of a control assembly  106   b  will described. Like the control assembly  106   a  described above, the control assembly  106   b  is mechanically coupled to the proximal end  108  of the outer catheter body  102  and the proximal end  114  of the inner articulating member  104 . The control assembly  106   b  comprises a frame  202  and a combined axial translation/articulation actuator  204  carried by the frame  202 . 
     The frame  202  comprises at least one slide rod  206  (and in this case, two slide rods) and a distal end cap  208  affixing the distal ends of the slide rods  206  relative to each other. As best shown in  FIG. 11 , the distal end cap  208  has a distal opening  210  in which the proximal end  108  of the outer catheter body  102  is affixed, and a through lumen  212  through which the proximal end  114  of the inner articulating member  104  is slidably disposed. In the case where at least a portion of the control assembly  106   b  is releasably coupled to the proximal end  108  of the outer catheter body  102 , the nose distal end cap  208  may be releasably coupled to the proximal end  108  of the outer catheter body  102 , e.g., using a threaded arrangement (not shown). 
     The axial translation/articulation actuator  204  comprises a handle body  214  configured for being manually grasped by an operator, and ergonomically molded to allow an operator to more easily manipulate the outer catheter body  102  and inner articulating member  104 . In the illustrated embodiment, the handle body  214  has a fileted rectangular cross-section, although in alternative embodiments, the handle body  214  may have any cross-section that allows the operator to firmly grasp it, e.g., a circular or hexagonal cross-section. The handle body  214  has at least one blind lumen (not shown) (and in this case, two blind lumens) in which the slide rods  206  of the frame  202  are slidably disposed. The proximal end  114  of the inner articulating member  104  is affixed to the handle body  214  via a connector  216 . Thus, the distal end cap  208  and affixed frame  202  of may be axially translated along the longitudinal axis  118  in a bi-directional direction  222  relative to the axial translation/articulation actuator  204 , thereby axially translating the outer catheter body  102  along the longitudinal axis  118  relative to the inner articulating member  104 . 
     The handle body  214  has a lumen  218  in communication with the connector  216 , and through which the pull wire  150  is slidably disposed. The axial translation/articulation actuator  204  further comprises a slide mechanism  220  slidably disposed axially within an external slot  223  of the handle body  214 . The proximal end of the pull wire  150  is affixed to the slide mechanism  220 . Thus, the slide mechanism  220  may be slid along the longitudinal axis  118  in a bi-directional direction  224  relative to the handle body  214  in the proximal direction, thereby proximally translating the pull wire  150  within the inner articulating member  104  that increases the articulation of the distal articulating section  134  of the inner articulating member  104 , and may be slid along the longitudinal axis  118  relative to the handle body  214  in the distal direction, thereby distally translating the pull wire  150  within the inner articulating member  104  that decreases the articulation of the distal end  116  of the inner articulating member  104 . 
     Referring now to  FIGS. 12A-12F , one technique of manipulating the control assembly  106  to perform a sequence of articulation and axial translation maneuvers will be described. As illustrated in in  FIG. 12A , the distal end  110  of the outer catheter tube  102  is in its proximal-most position relative to the inner articulating member  104 , and the distal end  116  of the inner articulating member  104 , and thus the distal end  110  of the outer catheter tube  102 , is in a straight configuration. In this configuration, in the case where the intravascular device  100  comprises the control assembly  106   a  (see  FIGS. 8-9 ), the housing  180  of the axial translation/actuation actuator  158  is in its distal-most position relative to the frame  154 , and the pinion collar  188  is rotated about the longitudinal axis  118  in a neutral position relative to the housing  180  of the axial translation/articulation actuator  158 . In the case where the intravascular device  100  comprises the control assembly  106   b  (see  FIGS. 10-11 ), the handle body  214  of the axial translation/actuation actuator  204  is in its distal-most position relative to the frame  202 , and the slide mechanism  220  is at its distal-most position relative to the handle body  214  of the axial translation/articulation actuator  204 . 
     As illustrated in  FIGS. 12B-12D , the distal end  116  of the inner articulating member  104 , and thus the distal end  110  of the outer catheter tube  102 , of the intravascular device  100  may then be gradually transformed from the straight configuration into a curved configuration. In this specific embodiment, the curve configuration has a Simmons-like shape consisting of a proximal curve  130  and a distal curve  132  (see  FIG. 12D ). During transformation from the straight configuration to the curved configuration, in the case where the intravascular device  100  comprises the control assembly  106   a  (see  FIGS. 8-9 ), the pinion collar  188  is rotated about the longitudinal axis  118  from the neutral position to a curve actuation position relative to the housing  180  of the axial translation/articulation actuator  158 . In the case where the intravascular device  100  comprises the control assembly  106   b  (see  FIGS. 10-11 ), the slide mechanism  220  is moved from its distal-most position to its proximal-most position relative to the handle body  214  of the axial translation/articulation actuator  204 . 
     As illustrated in  FIGS. 12E-12F , the distal end  100  of the outer catheter tube  102  is gradually moved from its proximal-most position to its distal-most position relative to the inner articulating member  104 . In the case where the intravascular device  100  comprises the control assembly  106   a  (see  FIGS. 8-9 ), this is accomplished by translating the frame  154  distally and in doing so moving the housing  180  of the axial translation/actuation actuator  158  from its distal-most position to its proximal-most position relative to the frame  154 . In the case where the intravascular device  100  comprises the control assembly  106   b  (see  FIGS. 10-11 ), this is accomplished by translating the frame  202  distally and in doing so moving the handle body  214  of the axial translation/actuation actuator  204  from its distal-most position to its proximal-most position relative to the frame  202 . 
     Referring now to  FIGS. 13 and 14A-14H , one exemplary method  300  of performing a medical procedure on a patient using the intravascular device  100  will be described. In the method  300 , the medical procedure is a therapeutic procedure (e.g., the deployment of a stent) performed on one of the blood vessels  404  (namely one of the first arterial branch  404   a  that forms a left subclavian artery (LSA)  406  and a left vertebral artery (LVA)  408  extending from the aortic arch  402  of the patient, a second arterial branch  404   b  that forms a left common carotid artery (LCCA)  410  extending from the aortic arch  402  of the patient, and brachiocephalic trunk  404   c  that forms a right subclavian artery (RSA)  412 , right vertebral artery (RVA)  414 , and right common carotid artery (RCCA)  416  extending from the aortic arch  402  of the patient). Although the use of the intravascular device  100  lends itself well to the access of the second and third branches  404   b ,  404   c  extending from a Type III aortic arch, as illustrated in  FIGS. 14A-14I , the intravascular device  100  may be used to access the first branch  404   a  extending from a Type III aortic arch, or any of the branches extending from a Type I aortic arch or a Type II aortic arch. 
     The method  300  initially comprises introducing the intravascular device  100  within the vasculature of the patient, and in this case, via a femoral approach (step  302 ) (see  FIG. 14A ). The method  300  further comprises distally advancing the intravascular device  100  within the vasculature of the patient until the distal end  114  of the outer catheter body  102  is adjacent an ostium of a blood vessel within the vasculature of the patient, and in this case, around the aortic arch  402  of the patient and adjacent the ostium  418  of the third arterial branch  404   c  (step  304 ) (see  FIG. 14B ). In the illustrated method, intravascular device  100  is distally advanced until the distal end  114  of the outer catheter body  102  is proximal to the aortic valve  420  of the patient. 
     The method  300  further comprises manipulating the intravascular device  100 , such that the distal end  110  of the outer catheter body  102  points towards the ostium of the blood vessel, and in the illustrated method, the ostium of the third arterial branch  404   c  extending from the aortic arch  402  of the patient. In particular, the method  300  comprises actively articulating the distal end  116  of the inner articulating member  104  via manipulation of the control assembly  106  (step  306 ) (see  FIG. 14C ). 
     In one method, the articulated distal end  116  of the inner articulating member  104  is articulated into the proximal curve  126  that bends in a plane that emulates the curvature of the aortic arch  402  of the patient, and the distal curve  128  that bends in the same plane, but opposite the proximal curve  126 , such that the distal end  116  of the inner articulating member  104 , and thus the distal end  110  of the outer catheter body  102 , points towards the ostium of the third arterial branch  404   c  extending from the aortic arch  402  of the patient. In an alternative method, the articulated distal end  116  of the inner articulating member  104  is articulated into a single curve that points the distal end  116  of the inner articulating member  104 , and thus the distal end  110  of the outer catheter body  102 , toward the ostium of the third arterial branch  404   c  extending from the aortic arch  402  of the patient, while the portion of the inner articulating member  104  residing along the length of the aortic arch  402  of the patient is passively articulated by the pressure exerted on the inner articulating member  104  by the inner wall of the aortic arch  402 . 
     If the ostium of the third arterial branch  404   c  does not reside within the plane of the distal curve  128  of the articulated distal end  116  of the inner articulating member  104 , the method  30  may comprise actively rotating the distal end  110  of the outer catheter body  102  about the longitudinal axis  118  while the distal end  116  of the inner articulating member  104  is articulated, until the ostium of the third arterial branch  404   c  does reside within the plane of the distal curve  128  of the articulated distal end  116  of the inner articulating member  104  (step  308 ). 
     The method  300  further comprises inserting the distal end  110  of the outer catheter body  102  into the ostium of the blood vessel, and in the illustrated method, the ostium of the third arterial branch  404   c  extending from the aortic arch  402  of the patient. In particular, the distal end  110  of the outer catheter body  102  is inserted into the ostium of the third arterial branch  404   c  by distally translating the distal end  110  of the outer catheter body  102  relative to the distal end  116  of the inner articulating member  104  (step  310 ) (see  FIG. 14D ). 
     Significantly, as the distal end  110  of the outer catheter body  102  is translated distally relative to the distal end  116  of the inner articulating member  104 , the articulated distal end  116  of the inner articulating member  104  imposes a dynamic curve on the outer catheter body  102 . That is, as the outer catheter body  102  is translated distally relative to the inner articulating member  104 , the curve imposed on the outer catheter body  102  by the articulated distal end  116  of the inner articulating member  104  remains static relative to the aortic arch  402  of the patient, but moves relative to the outer catheter body  102  itself. Thus, in contrast to a selective catheter that has a static curve that cannot be moved relative to the body of the selective catheter, and thus may prevent or hinder the distal end of the selective catheter from being introduced into an ostium of a blood vessel, the dynamic curve imposed on the outer catheter body  102  by the articulated distal end  116  of the inner articulating member  104  does not hinder the introduction of the distal end  110  of the outer catheter body  102  into an ostium of a blood vessel, and in this case the ostium of the third arterial branch  404   c.    
     The method  300  further comprises pulling the intravascular device  100  in the proximal direction, such that the dynamic curve of the outer catheter body  102  is cinched up against the outer curvature of the aortic arch  402  of the patient (i.e., the portion of the wall of the aortic arch  402  from which the arterial branches  404  extend) (step  312 ) (see  FIG. 14E ). As a consequence, the aortic arch  402  supports, and thus, stabilizes the distal end of the intravascular device  100 , and the distal end  110  of the outer catheter body  102  is distally advanced further into the third arterial branch  404   c  extending from the aortic arch  402  of the patient, and in this case, into the RCCA  416 . 
     The method  300  further comprises distally translating the distal end  110  of the outer catheter body  102  relative to the distal end  116  of the inner articulating member  104 , such that the distal end  110  of the outer catheter body  102  is further advanced into the blood vessel, and in this case, further advanced into the RCCA  416  at a therapeutic target site  422  (step  314 ) (see  FIG. 14F ). In this manner, the distal end of the intravascular device  100  is further anchored within the aortic arch  402  of the patient, while also providing access to the therapeutic target site  422  in the RCCA  416 . 
     The method  300  further comprises advancing a guide catheter  424  over the intravascular device  100 , while the distal end  110  of the outer catheter body  102  remains in the RCCA  416 , until the distal end of the guide catheter  424  reaches the target therapeutic site  422  (step  316 ) (see  FIG. 14G ). In the illustrated method, this can be accomplished by detaching the control assembly  106   a  or control assembly  106   b  from the proximal end  108  of the outer catheter body  102 , removing the inner articulating member  104  from the inner lumen  112  of the outer catheter body  102  by pulling the detached control assembly  106   a  or detached control assembly  106   b , and threading the distal end of the guide catheter  424  over the proximal end  108  of the outer catheter body  102 . 
     The method  300  further comprises removing the intravascular device  100  (and in particular, the outer catheter body  102  of the intravascular device  100 ) from the guide catheter  424  while the distal end of the guide catheter  424  remains at the target therapeutic site  422  (step  318 ) (see  FIG. 14H ), and introducing a therapeutic device  426  (and in this case, a stent delivery catheter) through the guide catheter  424  until the distal end of the therapeutic device  426  is located at the target therapeutic site  422  (step  320 ) (see  FIG. 14I ). 
     In the alternative embodiment where the outer catheter body  102  of the intravascular device  100  takes the form of a guide catheter, instead of advancing the guide catheter  424  over the intravascular device  100  at step  316 , removing the intravascular device  100  from the guide catheter  424  at step  318 , and introducing the therapeutic device  426  through the guide catheter  424  at step  320 , the method  300  alternatively comprises removing the inner articulating member  104  from the inner lumen  112  of the outer catheter body  102  (step  322 ), and introducing the therapeutic device  426  (and in this case, a stent delivery catheter) through the inner lumen  112  of the outer catheter body  102  until the distal end of the therapeutic device  426  is located at the target therapeutic site  422 . 
     Lastly, the method  300  comprises performing a therapeutic procedure at the target therapeutic site  422  using the therapeutic device  426 , and in particular, deploying a stent in the RCCA  416  at the target therapeutic site  422  (step  326 ). 
     Referring now to  FIGS. 15 and 16A-16G , another exemplary method  350  of performing a medical procedure on a patient using the intravascular device  100  will be described. In the method  350 , the medical procedure is a diagnostic procedure (e.g., the introduction of an imaging (e.g., angiographic) dye) performed on one of the arterial branches  404 . Notably, in contrast to the method  300  described above with respect to  FIG. 13 , wherein the intravascular device  100  is used as a stable rail over which a guide catheter is introduced, and a separate therapeutic device is used to perform the medical procedure, the intravascular method  350  uses the intravascular device  100 , itself, to perform the medical procedure. 
     The method  350  initially comprises introducing the intravascular device  100  within the vasculature of the patient, and in this case, via a radial approach (step  352 ) (see  FIG. 16A ). The method  350  further comprises distally advancing the intravascular device  100  within the vasculature of the patient until the distal end  114  of the outer catheter body  102  is adjacent an ostium of a blood vessel within the vasculature of the patient, and in this case, through the RSA  410 , through the third arterial branch  404   c , and into the aortic arch  402  adjacent the ostium  428  of the second arterial branch  404   b  (step  354 ) (see  FIG. 16B ). In the illustrated method, intravascular device  100  is distally advanced until the distal end  114  of the outer catheter body  102  is proximal to the aortic valve  416  of the patient. 
     The method  350  further comprises manipulating the intravascular device  100 , such that the distal end  110  of the outer catheter body  102  points towards the ostium of the blood vessel, and in the illustrated method, the ostium of the second arterial branch  404   b  extending from the aortic arch  402  of the patient. 
     In particular, the method  350  comprises actively articulating the distal end  116  of the inner articulating member  104  (step  356 ) (see  FIG. 16C ). In the illustrated method, articulation of the distal end  116  of the inner articulating member  104  may be accomplished in the same manner described above with respect to step  306  of the method  300 . In this method, the articulated distal end  116  of the inner articulating member  104  is articulated into a single curve that points the distal end  116  of the inner articulating member  104 , and thus the distal end  110  of the outer catheter body  102 , toward the ostium of the second arterial branch  404   b  extending from the aortic arch  402  of the patient, while the portion of the inner articulating member  104  residing along the length of the RSA  410  and the second arterial branch  404   b  is passively articulated by the pressure exerted on the inner articulating member  104  by the inner wall of the RSA  410  and second arterial branch  404   b.    
     If the ostium of the second arterial branch  404   b  does not reside within the plane of the curve of the articulated distal end  116  of the inner articulating member  104 , the method  350  may comprise actively rotating the distal end  110  of the outer catheter body  102  about the longitudinal axis  118  while the distal end  116  of the inner articulating member  104  is articulated, until the ostium of the second arterial branch  404   b  does reside within the plane of the curve of the articulated distal end  116  of the inner articulating member  104  (step  358 ). In the illustrated method, rotation of the outer catheter body  102  about the longitudinal axis  118  in the same manner described above with respect to step  308  of the method  300 . 
     The method  350  further comprises inserting the distal end  110  of the outer catheter body  102  into the ostium of the blood vessel, and in the illustrated method, the ostium of the second arterial branch  404   b  extending from the aortic arch  402  of the patient. In particular, the distal end  110  of the outer catheter body  102  is inserted into the ostium of the second arterial branch  404   b  by distally translating the distal end  110  of the outer catheter body  102  relative to the distal end  116  of the inner articulating member  104  (step  360 ) (see  FIG. 16D ). Distal translation of the distal end  110  of the outer catheter body  102  relative to the distal end  116  of the inner articulating member  104  may be accomplished in the same manner described above with respect to step  310  of the method  300 , with the same result of imposing a dynamic curve on the outer catheter body  102  by the articulated distal end  116  of the inner articulating member  104  that does not hinder the introduction of the distal end  110  of the outer catheter body  102  into an ostium of a blood vessel, and in this case the ostium of the second arterial branch  404   b.    
     The method  350  further comprises pulling the intravascular device  100  in the proximal direction, such that the dynamic curve of the outer catheter body  102  is cinched up against the outer curvature of the aortic arch  402  of the patient (i.e., the portion of the wall of the aortic arch  402  from which the arterial branches  404  extend) (step  362 ) (see  FIG. 16E ). As a consequence, the aortic arch  402  supports, and thus, stabilizes the distal end of the intravascular device  100 , and the distal end  110  of the outer catheter body  102  is distally advanced further into the second arterial branch  404   c  extending from the aortic arch  402  of the patient, and in this case, into the LCCA  408 . 
     The method  350  further comprises distally translating the distal end  110  of the outer catheter body  102  relative to the distal end  116  of the inner articulating member  104 , such that the distal end  110  of the outer catheter body  102  is further advanced into the blood vessel, and in this case, further advanced into the LCCA  408  at a diagnostic target site  430  (step  364 ) (see  FIG. 16F ). In this manner, the distal end of the intravascular device  100  is further anchored within the aortic arch  402  of the patient, while also providing access to the diagnostic target site  430  in the LCCA  408 . Lastly, the method  350  comprises introducing an imaging dye within the LCCA  408  via the intravascular device  100  (step  366 ) (see  FIG. 16G ). 
     Although particular embodiments have been shown and described herein, it will be understood by those skilled in the art that they are not intended to limit the disclosed inventions, and it will be obvious to those skilled in the art that various changes, permutations, and modifications may be made (e.g., the dimensions of various parts, combinations of parts) without departing from the scope of the disclosed inventions, which is to be defined only by the following claims and their equivalents. The specification and drawings are, accordingly, to be regarded in an illustrative rather than restrictive sense. The various embodiments shown and described herein are intended to cover alternatives, modifications, and equivalents of the disclosed inventions, which may be included within the scope of the appended claims.