Patent Publication Number: US-2021186555-A1

Title: Balloon assemblies having controllably variable topographies

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application is a continuation application of U.S. application Ser. No. 15/645,176, filed Jul. 10, 2017, now U.S. Pat. No. 10,881,426, issued Jan. 5, 2021, which is a continuation application of U.S. application Ser. No. 13/645,414 filed on Oct. 4, 2012, now U.S. Pat. No. 9,730,726, issued Aug. 15, 2017, which claims priority to U.S. Provisional Application No. 61/545,039, filed Oct. 7, 2011, wherein the above-listed applications are hereby incorporated by reference in their entireties. 
    
    
     BACKGROUND OF THE DISCLOSURE 
     Field of the Disclosure 
     The present disclosure relates generally to balloon assemblies having controllable topographies and systems and methods relating to the same. 
     Discussion of the Related Art 
     Balloons intended for use within a mammalian body, such as a human, are employed in a variety of medical procedures, including dilation of narrowed blood vessels, placement of stents and other implantable devices, temporary or permanent occlusion of blood vessels, drug delivery, thrombectomy, embolectomy, atherectomy, angioplasty, other endovascular procedures, and other procedures within a lumen of a mammalian body such as a human body. In this regard, as used herein, the term “body” can comprise a mammalian body such as a human body or other animal body. 
     In a typical application, a balloon (often coupled with a catheter) is advanced to the desired location in the vascular system or other lumen of the body. The balloon is then pressure-expanded in accordance with a medical procedure. Thereafter, the pressure is removed from the balloon, allowing the balloon to contract and permit removal of the catheter and, in many cases, the balloon. 
     Procedures such as these are generally considered minimally invasive, and are often performed in a manner which minimizes disruption to the patient&#39;s body. As a result, balloons are often inserted from a location remote from the region to be treated. For example, during angioplasty procedures involving coronary vessels, the balloon catheter is typically inserted into the femoral artery in the groin region of the patient, and then advanced through vessels into the coronary region of the patient. These balloons typically include some type of radiopaque marker to allow the physician performing the procedure to monitor the progress of the catheter through the body. 
     Non-compliant balloons are generally made of relatively strong but generally inelastic material (e.g., nylon, polyester, etc.), which must be folded to obtain a compact, small diameter cross section for delivery. These relatively stiff balloons do not easily conform to the surrounding vessel and thus can be used to compact hard deposits in vessels. Due to the need for strength and stiffness, these devices are rated to employ high inflation pressures, usually up to about 4 to about 60 atmospheres. As depicted in  FIG. 1 , non-compliant balloons (line C) have a maximum diameter, and as inflation fluid is introduced, such balloons will not normally distend appreciably beyond a maximum diameter. Once a non-compliant balloon is inflated to its maximum diameter, the exertion of additional pressure can cause rupture of the balloon, creating a hazardous condition. 
     By contrast, compliant balloons generally comprise soft, elastic material (e.g., natural rubber latex). As depicted in  FIG. 1 , compliant balloons (line A) will generally expand continuously in diameter and will not appreciably increase in internal pressure as inflation fluid is introduced. As a result, compliant balloons are generally rated by volume (e.g., 0.3 cc) rather than by nominal diameter. Also, compliant balloons generally conform to the shape of the vessel. Although comparatively weak compared to non-compliant balloons, compliant balloons have the advantage that they need not be folded about a delivery catheter (reducing profile) and tend to readily recompact to their initial size and dimensions following inflation and subsequent deflation. These balloons can be employed to displace soft deposits, such as a thrombus, where a soft and tacky material such as latex provides an effective extraction means, and also can be used as an occlusion balloon, operating at low pressures. 
     In between the spectrum of compliant balloons and non-compliant balloons fall semi-compliant balloons. As depicted in  FIG. 1 , semi-compliant balloons (line B) will both increase in pressure and increase in diameter as inflation fluid is introduced. However, semi-compliant balloons operate at pressures in between the two types of balloons and will continue to distend as inflation fluid is introduced. 
     Both compliant and non-compliant balloons tend to have a uniform surface topography. In other words, conventional balloons tend to have smooth surfaces. Balloons with more varied topographies may facilitate a variety of medical procedures and therapies not possible using conventional balloons. For instance, a variable topography may provide increased surface area over a similar conventional balloon, and thus interaction with the body may be improved. A variable topography balloon may also be configured to deploy sharp objects in a localized, difficult to reach part of the body, providing an improvement in therapy. In addition, variable topography balloons may provide improved drug delivery systems. Moreover, it would be beneficial for a balloon to have a controllable topography. 
     SUMMARY OF THE DISCLOSURE 
     The present disclosure provides systems and methods for balloon assemblies having varied topographies and pre-configured surface textures. In various embodiments, a device is provided comprising a balloon comprising a size limiting layer and a template disposed around or within the balloon. The template comprises at least one aperture and a portion that is more resistant to deformation in a radial direction than the balloon or the size limiting layer, either because template comprises a less compliant material or has an upper distension limit that is less than the size limiting layer&#39;s upper distension limit. As such, the balloon and size limiting layer are configured to distend beyond the template about the aperture at a given volume/pressure. The balloon and size limiting layer will distend about an aperture to a second inflated state comprising a varied topography. The size limiting layer prevents further appreciable distension beyond the second inflated state. In various embodiments, the template and/or balloon can optionally comprise an expanded polytetrafluoroethylene (ePTFE). The balloon and/or template can comprise a tape wrapped membrane. Other embodiments comprise methods of making and using the same. 
     In various embodiments, a balloon assembly is provided comprising a balloon having a controlled topography, wherein the balloon assembly has a smooth or substantially wrinkle free surface at a first inflated state and a varied topography surface at a second inflated state. In an embodiment wherein the balloon assembly comprises an inner balloon and an outer template, the inner diameter of the template at a first inflated state is substantially equal to the outer diameter of the balloon at a first inflated state. In an embodiment wherein an outer balloon is disposed around an inner template, the converse is true; namely, the outer diameter of the template at a first inflated state is substantially equal to the inner diameter of the balloon in the first inflated state. The balloon and/or template can comprise a tape wrapped membrane. Other embodiments comprise methods of making and using the same. 
     In other embodiments, a balloon assembly can comprise an underlying compliant balloon and an overlying less compliant template having at least one aperture. Located within the aperture can be a therapeutic agent, preferably in a solid or viscous form. Upon inflation, the underlying compliant balloon will protrude through the aperture and convey the therapeutic agent external to the template. In this manner, a therapeutic agent can be delivered to a surrounding tissue such as the intima of a vessel. Other embodiments include methods of making and using the same. 
     Another aspect of the present disclosure comprises textured balloon assemblies. In various embodiments, a balloon can be covered and/or wrapped with a textured network that provides a topographical feature. For example, a textured network can comprise beads, filaments, fibers, rings, knits, weaves, and/or braids, which can be wrapped or otherwise disposed over or within a balloon. The textured network creates raised surface patterns that can provide therapeutic effect. Other embodiments include methods of making and using the same. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings are included to provide a further understanding of the present disclosure and are incorporated in and constitute a part of this specification, illustrate embodiments of the present disclosure, and together with the description serve to explain the principles of the disclosure. 
         FIG. 1  compares pressure to height of complaint balloons (Line A), semi-compliant balloons (Line B), and non-compliant balloons (Line C); 
         FIG. 2A  illustrates a schematic varied topography balloon assembly embodiment from a cross-sectional perspective; 
         FIGS. 2B ( 1 ) to  2 B( 3 ) illustrates a varied topography balloon assembly embodiment of the present disclosure in a deflated state; a first inflated state; and a second inflated state; 
         FIG. 2B ( 4 ) illustrates a close up, cross-sectional view about an aperture of a varied topography balloon assembly embodiment illustrated in  FIG. 2B ( 3 ); 
         FIGS. 3A ( 1 ) to  3 A( 3 ) schematically illustrate the process under which various embodiments distend to a second inflated state thereby forming a varied topography balloon assembly; 
         FIGS. 3B ( 1 ) to  3 B( 3 ) schematically illustrate the process under which various embodiments distend to a second inflated state thereby forming a varied topography balloon assembly; 
         FIGS. 4A to 4D  illustrate wrapping a film tape to form a size limiting membrane layer; 
         FIG. 5A  schematically illustrates a balloon assembly embodiment comprising a tapered balloon and/or size limiting layer; 
         FIG. 5B  schematically illustrates a balloon assembly embodiment comprising a tapered template; 
         FIGS. 6A and 6B  illustrate a cross-sectional view of a varied topography balloon assembly embodiment wherein a plurality of apertures are located on a first section of the template and no apertures are located on a second section of tem plate; 
         FIG. 7  A schematically illustrates a varied topography balloon assembly embodiment of the present disclosure comprising two templates; 
         FIG. 7B  illustrates a close up, cross-sectional view about an aperture of a varied topography balloon assembly embodiment illustrated in  FIG. 7A ; 
         FIG. 8  illustrates a varied topography balloon assembly comprising a therapeutic agent, in accordance with various embodiments; 
         FIG. 9  illustrates a varied topography balloon assembly embodiment wherein the balloon comprises a wall with regions of reduced compliance than other more distensible regions; 
         FIG. 10A  illustrates a cross-sectional view of a balloon assembly embodiment wherein the overlying template comprise rigid elements; 
         FIG. 10B  illustrates a cross-sectional view of a balloon assembly embodiment depicted in  FIG. 10A  with the rigid elements outwardly rotated; 
         FIG. 10C  illustrates a cross-sectional view of a balloon assembly embodiment wherein the overlying template comprises rigid elements having a piercing or sharp tip that is attached to template at its proximal base; 
         FIG. 10D  illustrates a cross-sectional view of a balloon assembly embodiment wherein the overlying template comprises rigid elements of  FIG. 10C  outwardly rotated; 
         FIG. 10E  illustrates a cross-sectional view of a balloon assembly embodiment wherein the overlying template comprises rigid elements having a lumen therethrough which is in fluid communication with the balloon; 
         FIG. 11  illustrates an inflated balloon assembly comprising a wire tem plate; 
         FIG. 12  illustrates a balloon assembly in accordance with various embodiments within the vasculature; 
         FIGS. 13A to 13C  illustrate a textured balloon assembly in accordance with various embodiments; 
         FIG. 13D  illustrates a cross sectional view a textured balloon assembly on a mandrel, in accordance with various embodiments; 
         FIG. 14A  illustrates a deflated balloon assembly with a scored template pattern from an exterior perspective, in accordance with various embodiments; 
         FIG. 14B  illustrates an inflated balloon assembly with a deployed scored template pattern from an exterior perspective, in accordance with various embodiments; 
         FIG. 14C ( 1 ) illustrates a close-up, perspective view of a deflated balloon assembly with an arced element across the aperture of a template, in accordance with various embodiments; 
         FIG. 14C ( 2 ) illustrates a close-up, perspective view of an inflated balloon assembly with a deployed arced element across the aperture of a template, in accordance with various embodiments; 
         FIG. 14C ( 3 ) illustrates a close-up, side view of the inflated balloon assembly of  FIG. 14C ( 2 ), in accordance with various embodiments; 
         FIG. 14D ( 1 ) to  14 D( 4 ) illustrate the various patterns of template comprising an arced element across the aperture; 
         FIG. 14E ( 1 ) illustrates a close-up, perspective view of a deflated balloon assembly with an arced element across the aperture of a template, in accordance with various embodiments; 
         FIG. 14E ( 2 ) illustrates a close-up, perspective view of the inflated balloon assembly of  FIG. 14E ( 1 ), in accordance with various embodiments; 
         FIG. 15  illustrates a method of making, in accordance with various embodiments; 
         FIG. 16  illustrates a method of use, in accordance with various embodiments; 
         FIG. 17  illustrates a balloon assembly embodiment wherein a template is located on an intermediate section of a balloon; 
         FIG. 18  illustrates a balloon assembly embodiment wherein the balloon and size limiting layer is perfusable; 
         FIGS. 19A-B  illustrates a varied topography balloon assembly embodiment wherein the balloon comprises a wall with regions of reduced compliance than other more distensible regions; 
         FIGS. 20A-20B  illustrates a varied topography balloon assembly with a stent device mounted thereon, the stent device having deployable anchors which are actuated by protruding apertures; and 
         FIG. 21  illustrates a varied topography balloon assembly wherein an aperture or a plurality of apertures are located on a circumferential section. 
     
    
    
     DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS 
     Persons skilled in the art will readily appreciate that various aspects of the present disclosure can be realized by any number of methods and apparatuses configured to perform the intended functions. Stated differently, other methods and apparatuses can be incorporated herein to perform the intended functions. It should also be noted that the accompanying drawing figures referred to herein are not all drawn to scale, but can be exaggerated to illustrate various aspects of the present disclosure, and in that regard, the drawing figures should not be construed as limiting. Finally, although the present disclosure can be described in connection with various principles and beliefs, the present disclosure should not be bound by theory. 
     As used herein, “balloon assembly” means a balloon coupled with one or more other components, such as a template (described herein), size limiting layer (descried herein), catheter, distal cap (“olive”), cover, or other apparatus. 
     As used herein, the term “size limiting” means that a material or component has an upper distension or deformation limit beyond which a material or component will not appreciably expand, distend, and/or deform. For example, a size-limited balloon can be inflated to a maximum diameter, and once this diameter is reached, further increases in pressure will not cause an appreciable increase in its diameter. As reflected in  FIG. 1 , a non-compliant balloon (line C) is a size-limited balloon, and traditional compliant (line A) and semi-compliant (line B) balloons are not size-limited balloons. Accordingly, a “compliant balloon,” as used herein, refers to both compliant and semi-compliant balloons or balloons that are not size limited, but will continue to expand, distend, and/or deform as the internal pressure increases until the point of failure, e.g., the balloon wall ruptures. In accordance with certain embodiments of the present disclosure, the described “compliant” balloons are referred to as such because the described balloons generally conform to the shape of their surroundings (e.g., a surrounding anatomy or vessel) like traditional “compliant” balloons, e.g., portions of the described “compliant” balloons are able to outwardly extend from the template to form protrusions. 
     As used herein, the term “to inflate” can mean to fill or cause expansion by introducing a flowable substance (e.g., an influx of fluid), such as a liquid (e.g., saline), a gel, or a gas. 
     As used herein, the term “inflated” means a balloon at an internal pressure or volume above the internal pressure or volume at which the balloon begins to expand from a deflated state. As used herein, a “first inflated state” refers to an inflated balloon at a first pressure or first volume which will result in a balloon with a generally smooth or uniform surface, except perhaps with respect to slight recesses at the site of the aperture(s). As used herein, a “second inflated state” refers to an inflated balloon at a second pressure or second volume greater than the first pressure or first volume which will result in a balloon with a varied topography. As used herein, “varied topography” refers to a balloon assembly surface that has textured, bumpy, ribbed, or other three-dimensional surfaces. 
     As used herein, the term “elongate element” is generally any element configured for relative axial movement with an endoluminal device delivery element (e.g., a catheter-based endoluminal device delivery element such as a balloon catheter) and includes any longitudinally extending structure with or without a lumen therethrough. Thus, elongate elements include but are not limited to tubes with lumens (e.g., catheters), solid rods, hollow or solid wires (e.g., guidewires), hollow or solid stylets, metal tubes (e.g., hypotubes), polymer tubes, pull cords or tethers, fibers, filaments, electrical conductors, radiopaque elements, radioactive elements and radiographic elements. Elongate elements can be any material and can have any cross-sectional shape including, but not limited to, profiles that are elliptical, non-elliptical, or random. 
     As described herein, balloon assemblies used inside the body generally interact with the body through contact with an exterior surface of the balloon assembly. Thus, the surface topography of a balloon assembly can affect the physical interaction between the balloon assembly and the body or a device inside the body. The ability to control a balloon&#39;s topography, or three dimensional surface characteristics, allows balloon assemblies to interact with the body in new or improved modes. Various advantages can be realized using controllably variable topography balloon assemblies. For example, balloon assemblies, such as those that can be used with a catheter, can be inserted into a lumen of the body. The balloon assembly can interact with the body in a variety of ways which can be facilitated by designing topographies which yield improved results. In this regard, for example, a balloon having a varied topography can improve engagement with a vessel wall and/or improve atherosclerotic plaque or thrombus removal ability, such from a vessel wall or the wall of an endoprosthesis. 
     By selectively constraining the expansion of a balloon at selected sites, the balloon assembly topography can be varied. For example, with reference to  FIG. 2A , a schematic of a balloon assembly  200  is shown.  FIGS. 2B ( 1 ) to  2 B( 3 ) illustrate a varied topography balloon  200  in a deflated state ( FIG. 2B ( 1 )), a first inflated state having a generally uniform or smooth surface ( FIG. 2B ( 2 )), and a second inflated state having a varied topography ( FIG. 2B ( 3 )).  FIG. 2B ( 4 ) illustrates a close-up, cross-sectional view of a protrusion  212  of a varied topography balloon  200 . 
     Balloon assembly  200  comprises balloon  210  and template  220 . Balloon  210  can be disposed along template  220 , either underlying or overlying the template  220 . The balloon  210  may comprise a working length and at least one tapered section (i.e., a shoulder). The template  220  may extend along at least a portion of the working length of the balloon  210 . The template  220  may also extend along at least a portion of at least one shoulder of the balloon  210 . Assembly  200  can further comprise a catheter  202  to which balloon  210  and template  220  are attached. Catheter  202  is shown in fluid communication with balloon  210 , such that fluid can be introduced through catheter  202  into balloon  210 . Catheter  202  can be coupled to any suitable medical device, such as a syringe, an indeflator, pump or any other apparatus for conducting fluid through catheter  202  and into balloon  210 . 
     Template  220  can be an overlying or underlying structure comprising at least one aperture  221 . Template  220  constrains a portion of balloon  210  during inflation. In this regard, balloon  210  is inflated to a second inflated state, and the restraining action of template  220  causes balloon  210  to distend at apertures  221  in template  220  as described in more detail below. 
     The operation of the balloon assemblies of the present disclosure is shown schematically for various embodiments in  FIGS. 3A ( 1 ) to  3 A( 3 ) and  3 B( 1 ) to  3 B( 3 ) in which is illustrated a longitudinal cross section of a balloon assembly  300 . In  FIGS. 3A ( 1 ) to  3 A( 3 ), balloon  310  underlies template  320  which features apertures  321 . In  FIGS. 3B ( 1 ) to  3 B( 3 ), balloon  310  overlies template  320 , and template  320  adheres to balloon during inflation. In these illustrations, balloon  310  and template  320  are shown aligned with axis “A”. Axis “A” can comprise the longitudinal axis of a catheter. 
     A first inflated state is shown in  FIGS. 3A ( 2 ) and.  3 B( 2 ). With reference to  FIG. 3A ( 2 ), balloon  310  has an outer radius shown as “R 1 ” under template  320 , and template  320  has an inner radius of “R 2 ”. With reference to  FIG. 3B ( 2 ), balloon  310  has an inner radius shown as “R 1 ” over template  320 , and template  320  has an outer radius “R 2 ”. In the first inflated state, radius “R 1 ” is substantially equal to radius “R 2 ”. No protrusions are observed in a first inflated state. Stated differently, the height, “H 1 ” of balloon material or protrusions above template  320  has a value of zero or close to zero. At the first inflated state, balloon  310  comprises a substantially smooth or wrinkle free surface. Also in the first inflated state, aperture  321  has a width shown as “W 1 ” in the figures. 
       FIGS. 3A ( 3 ) and  3 B( 3 ) depict balloon assembly  300  in a second inflated state. As balloon  110  is inflated beyond a first inflated state, radius “R 2 ” increases relative to radius “R 1 ” about aperture  321 . This is because balloon  310 , upon distention, begins to distend about or protrude from or above apertures  321 . Radius “R 1 ” remains essentially at the same dimension as in the first inflated state shown  FIGS. 3A ( 2 ) and  3 B( 2 ). In some embodiments, width of aperture  321  (“W 2 ”) remains close to or even equal to width of aperture  221  (“W 1 ”) in the previous inflated state shown in  FIGS. 3A ( 2 ) and  3 B( 2 ). In other embodiments, W 2  can be greater than W 1 ; i.e., aperture  320  can increase in size as balloon assembly  300  is inflated. It will be understood that radius “R 2 ” can be a maxima, in particular if a size limiting layer or a size limited balloon is used as described below. 
     Referring again to  FIGS. 2A and 2B ( 1 ) to  2 B( 4 ), in various embodiments, balloon  210  can comprise any suitable compliant balloon. As described above, a compliant balloon can comprise a polymeric material. Exemplary materials for a compliant balloon include elastomers such as polyurethane and silicone, natural rubber or latex products, synthetic rubber such as nitrile butadiene, or other synthetic or naturally occurring polymeric materials. In various embodiments, balloon  210  may not be fully compliant, but is more compliant than template  220  and sufficiently flexible to inflate to a diameter larger than the restraining template  220  diameter at a given pressure, and thereby produces protrusions  212  (as described below). Thus, a semi-compliant or non-compliant balloon can be used. In various embodiments, balloon  210  can be conditioned. Conditioning can comprise stretching, pre-inflating, blow molding, heating, or other process to render the balloon  210  more amenable to use. 
     In various embodiments, balloon assembly  200  can comprise balloon  210 , template  220 , and a size limiting layer  215 . Similarly, balloon  210  can comprise a composite material, wherein a layer of the composite is size limiting layer  215  and/or template  220 . Size limiting layer  215  can be disposed about balloon  210 , either between balloon  210  and template  220  or around template  220 . Similar to template  220 , size limiting layer  215  is configured to control the degree of distension of a compliant balloon  210  during inflation. However, size limiting layer  215  is configured to permit a degree of distension which is greater than the degree that template  220  is configured to permit. In this regard, size limiting layer  215  can possess sufficient flexibility and an upper distension limit which is larger in diameter than the restraining template  220  diameter at a given pressure, allowing size limiting layer  215  to distend about or protrude through aperture  221 . In addition, size limiting layer  215  can be configured to have a substantially smooth or wrinkle free surface at the first inflated state. Stated differently, size liming layer is at least slightly strained at the first inflated state. 
     Size limiting layer  215  can be a sheath, sleeve, layer or other component otherwise configured to at least partially enclose all or a portion of balloon  210 . Size limiting layer  215  can act to constrain balloon  210  in a substantially uniform manner once balloon  210  distends to a certain diameter or dimension. Size limiting layer  215  can be configured to operate at pressures of up to 2 atm, up to 5 atm, up to 10 atm, up to 15 atm, up to 20 atm, up to 30 atm, up to 35 atm, up to 45 atm, up to 55 atm, up to 60 atm, or up to any value between about 2 atm and about 60 atm. 
     In various embodiments, size limiting layer  215  can comprise any flexible, preferably thin material which is inelastic in at least one orientation or has a suitable upper deformation limit in at least one orientation. To withstand higher inflation pressures, size limiting layer  215  can be made of a high strength material. Size limiting layer  215  can be constructed using any material described herein for constructing template  220 . Size limiting layer  215  can be an extruded or molded tubular form which is at some point inelastic in a circumferential direction. Alternatively, size limiting layer  215  can comprise a tape wrapped form wherein the tape is, at some point, inelastic or has an upper distension limit in the tapes lengthwise direction. 
     To form tape-wrapped size limiting layer  215 , with reference to  FIG. 4A to 4D , a thin film can be slit into relatively narrow widths to form a tape. The tape is helically wrapped onto the surface of a mandrel  12  in two opposing directions  20  and  22 , thereby forming a tube of at least two layers  14  and  16 . Both layers  14  and  16  can be wrapped with the same pitch angle measured with respect to the longitudinal axis  18  but measured in opposite directions. If, for example, the film layers  14  and  16  are applied at pitch angles of 70° measured from opposite directions with respect to the mandrel&#39;s longitudinal axis  18 , then included angle A between both 70° pitch angles is 40°. 
     More than two layers of helically wrapped film may be applied. Alternate layers of film can be wrapped from opposing directions and an even number of film layers can be used whereby an equal number of layers are applied in each direction. 
     Suitable adhesives may be used to join film wraps together. Such adhesives include fluorinated ethylene propylene (FEP). Alternatively, following completion of film wrapping, the helically wrapped mandrel  12  can be thermally treated at suitable time and temperature to cause adjacent layers  14  and  16  to heat-bond together. Regardless of bonding methodology, the size limiting layer  415  is removed from mandrel  12  and can be placed over the balloon, tensioned longitudinally as needed and affixed in place over the balloon. 
     During inflation of balloon, size limiting layer  415  can undergo an increase in diameter which results in included angle A being substantially reduced as shown by  FIG. 4D . Size limiting layer  415  thus reaches its pre-determined upper distension limit as included angle A approaches zero. This pre-determined limit is greater than the distension limit of template in order to yield a balloon having a varied topography at a second inflated state but one which does not appreciably distend beyond the second inflated state. 
     Again with reference to  FIGS. 2A and 2B ( 1 ) to  2 B( 4 ), size limiting layer  215  can optionally be adhered to or laminated with balloon  210 . If adhered, balloon  210  can aid in recompaction of size limiting layer  215  upon deflation of balloon assembly  200 , in particular if balloon  210  is made of an elastomeric materiel. Alternatively, a layer of elastomer, applied to a surface of size limiting layer  215  will cause the size limiting layer  215  to retract substantially to its pre-inflation size as shown by  FIG. 4C  following deflation. 
     The film utilized to construct size limiting layer  215  as described above can comprise any flexible, preferably thin material that is substantially inelastic or has an upper distension limit in at least one orientation and has sufficient strength to yield a balloon  210  that can operate at pressures of up to 2 atm, up to 5 atm, up to 10 atm, up to 15 atm, up to 20 atm, up to 30 atm, up to 35 atm, up to 45 atm, up to 55 atm, or up to 60 atm. For example, a film can comprise ePTFE. Other suitable film materials can include other fluoropolymers or non-compliant polymers. 
     In various embodiments, size limiting layer  215  can be constructed or conditioned to constrain balloon  210  upon inflation to a generally cylindrical inflation profile. Optionally, with momentary reference to  FIG. 5A , size limiting layer  515  can be configured to alter the general profile of balloon  510 , e.g., constrain to create a tapered profile, elliptical profile, or a dumbbell profile. In addition, in the event of a failure of balloon  210  (e.g., a rupture), size limiting layer  215  can act to prevent release of undesired debris from the disrupted balloon assembly  200 . 
     In other embodiments, size limiting layer  215  and balloon  210  are combined into a single component. Stated differently, balloon  210  can comprise a compliant, size limiting material. In such embodiments, balloon  210  behaves like a compliant or semi-compliant balloon up to a desired diameter. Once the desired diameter is reached, balloon  210  behaves like a non-compliant balloon, allowing the pressure to increase without resulting in an appreciable increase in a balloon dimension. 
     In various embodiments, template  220  comprises any size-limited form that acts to constrain balloon  210  along the points of contact. Alternatively, template  220  can comprise a form less compliant than balloon  210  and/or size limiting layer  215  so that balloon  210  is constrained along the points of contact. As such, template  220  is constructed of any material that cannot be appreciably deformed beyond a first inflated state during inflation of balloon  210 . Template  220  can be configured as a sleeve, layer, or sheath positioned over balloon  210 . For example, template  220  can comprise a generally cylindrical, ellipsoidal, spherical, or similar form that is disposed substantially coaxial to balloon  210 . Alternatively, template  220  can be an inner layer that constrains a portion of balloon  210  by being adhered to balloon  200  at selected portions not comprising an aperture  221 . 
     In addition, while aperture  221  of template  220  can be spatially configured to create a varied topography, the constraining portion of template  220  can also impact the general profile of balloon  210 . For example, as illustrated in  FIG. 5B , template  520 , at a first inflated state, can have a diameter that is larger or smaller at different locations along the balloon  510 , for instance to form a taper. Thus, while balloon  510  can inflate in the shape of a cylinder, template  520  can have a non-cylindrical shape, and this non-cylindrical shape can be the general profile of balloon assembly  500 . Such a generally tapered profile can be used to better conform to cardiovascular vessel diameters which change over length, for example. In addition, the lesion or thrombus “scraping” effect of the assembly  500  can be intensified proximally to distally or vice versa due to the varying profile dimensions. 
     Returning to  FIGS. 2A and 2B ( 1 ) to  2 B( 4 ), template  220  does not substantially deform beyond a first inflated state or deforms to a lesser extent than balloon  210  and size limiting layer  215  in response to inflation of balloon  210 . As depicted in  FIGS. 2B ( 3 ) and  2 B( 4 ), balloon  210  and size limiting layer  215  distends beyond template  220  about aperture  221  creating a protrusion  212  at a second inflated state. As shown, at the second inflated state, inflated balloon assembly  200  can have a varied topography in that the surface of balloon assembly  200  has a plurality of peaks and valleys. 
     In various embodiments, template  220  can comprise a size-limited material or configuration. For example, template  220  can be substantially inelastic in at least one direction or orientation, preferable a direction transverse to the longitudinal axis of balloon assembly  200  and, in various embodiments, template  220  can also comprise a material that has high tensile strength in at least one direction. In an alternate embodiment, the template can comprise a material that has a high strength in both directions so as to prevent the perimeters of apertures  221  from deforming upon expansion of balloon  210 . In various embodiments, template  220  can comprise a material that is less compliant than balloon  210  and/or template; thus, at a given pressure, balloon  210  will have a greater degree of distension than template  220 . 
     In an embodiment, template  220  can comprise a high strength, yet flexible material such as ePTFE. High strength provides resistance to deformation in at least one direction such that template  220  can resist expansion of underlying balloon portions beyond the application of a particular force caused by balloon inflation pressures. 
     In various embodiments, template  220  can be made from a thin, high strength film or tape to forming a template. For example, template  220  can be constructed from a type of ePTFE as described in U.S. Pat. No. 7,306,729, issued Dec. 11, 2007 and entitled, “Porous PTFE Materials And Articles Produced Therefrom,” whose contents are herein incorporated by reference. In various embodiments, two to sixty layers of ePTFE as described in U.S. Pat. No. 7,306,729 can comprise template  220 . Layers can be circumferentially (i.e., wrapped at about 90° to the longitudinal axis) or helically wrapped (as described previously). In various embodiments, template  220  can be manufactured in a continuous process and then cut to the desired length before being disposed on balloons. Optionally, template  220  can be adhered or laminated to balloon  210  and/or size limiting layer  215 . 
     Template  220  can comprise other materials, such as other fluoropolymers, including polytetrafluoroethylenes with different microstructures from that described in U.S. Pat. No. 7,306,729, so long as they provide sufficient strength and relative lack of compliancy, to produce the desired balloon topography and operate at the previously described pressure thresholds. 
     In various embodiments, template  220  can also be size-limited but compliant. In such embodiments, template  220  can be formed in a similar manner as size-limited layer and compliant balloon  210 . However, in order to create a varied topography, the upper distension limit of template  220  must be less than the upper distension limit of the balloon  210  or the degree of compliancy is less than that for balloon  210 . 
     Template  220  can comprise at least one aperture  221  and, in various embodiments, template  220  can comprise an aperture pattern and/or a plurality of apertures. Apertures  221  can be present in template  220  prior to inflation or be formed or increase in size upon inflation. 
     Aperture  221  can comprise an opening or weakened site in the template material. In this regard, an opening can be a hole, cut, or any other discontinuous section of the template material. For example, a hole could be formed by puncturing template  220 . Alternatively, aperture  221  can comprise an area of template  220  where a portion of the material has been removed or otherwise weakened such that the weakened portion at least partially deforms or detaches in response to inflation of balloon  210  and permits distension beyond the first inflated state. Apertures  221  can be formed by any suitable means, including cutting, stamping, laser cutting, perforating, and/or punching/puncturing and/or the like. In various embodiments, template  220  can comprise a net like structure. 
     Optionally, template can comprise apertures that vary in size. Increasing the size the apertures can allow for a wider (or “coarser”) protrusion. By combining varying aperture sizes with a tapered template profile, as shown in  FIG. 5B , the “scraping” effect of the assembly can be intensified proximally to distally or vice versa due to the different protrusion heights. 
     With reference again to  FIGS. 2A and 2B ( 1 ) to  2 B( 4 ), template  220  can be configured such that apertures  221  are formed or increase in size upon inflation. For example, a template  220  comprising a tape wrapped, woven, or braided membrane around balloon  210  can be constructed, e.g. wrapped, woven, or braided, such that apertures  221  are formed by leaving a space between tape edges and/or apertures  221  form or increase in size between tape edges upon inflation of balloon  210 . In an embodiment, the angle of the tape material can change relative to the longitudinal axis of the balloon upon inflation and/or the tape material can narrow in width as the balloon assembly is expanded, thus creating apertures  221 . 
     In addition, the varied topography can vary longitudinally along the length of the balloon and/or can vary circumferentially about the perimeter of the balloon. For example, with reference to  FIG. 6 (A-B), balloon assembly  600  can comprise a template  620  having a first pattern of apertures  621  on first section  650  of balloon  610  and a second pattern of aperture or zero apertures on a second section  651 . Similarly, the longitudinal and/or circumferential variation can be random or follow a pre-defined pattern. Such balloon assemblies can be used for performing interventional procedures in combination. For example, such a balloon configured with zero apertures on one half the length of the balloon assembly and apertures on the remainder of the assembly can be used to perform both thrombectomy (with the apertured portion of the assembly) then Percutaneous Transluminal Angioplasty (PTA) (with the non-apertured portion), all without the exchange of devices. 
     The balloon assembly can be selectively alternated between the various inflated states, e.g., between a first inflated state and a second inflations state. A specific inflated state can be determined by measuring the volume injected into balloon assembly and/or pressure levels within balloon assembly. By selectively introducing or withdrawing a fluid by a predetermined amount, balloon assembly can transition from one inflated state to another. In an embodiment, the balloon assembly can be configured to pulsate between the various inflations states. 
     In various embodiments, balloon assembly can optionally comprise a protective cover. A protective cover can be a sleeve or sheath that covers at least a portion of template. The protective cover can be delivered with the balloon assembly into the body and be retracted to expose balloon assembly  200  while within the body. 
     With the described components, one can adapt the compliance of the balloon, a template, an aperture pattern, inflation pressures and extensibility of a size limiting layer to control the topography of a balloon assembly. For example, an aperture pattern can comprise many small apertures to obtain a “fine texture” pattern or can comprise fewer larger openings to obtain a more “coarse texture” pattern. As one can appreciate, any possible aperture pattern, or combinations of aperture patterns, is contemplated herein. For example, a first portion of a template can comprise a square grid like aperture pattern and a second portion of a template can comprise a diamond shaped pattern. 
     In other embodiments, a balloon expanding through a template can define ridges and troughs which, for example, run parallel to the longitudinal axis of the balloon. In one embodiment, these provide for blood perfusion between balloon and vessel wall during a treatment when the balloon is expanded. 
     In other embodiments, protrusions  212  can form at a first inflated state as depicted in  FIG. 2C , and then upon inflation to a second inflated state, having a pressure greater than the first, template  220  can distend and the surface of balloon  210  is smooth, as depicted in  FIG. 2B . In an embodiment, template  220  can be partially or selectively distensible. For example. a 4 mm template that is distensible up to 8 mm can overlay a balloon and/or a size limiting layer. Balloon  210  is inflated to 2 atm and the template acquires its first distension profile so that protrusions form. Upon further inflation up to 4atm, the template can distend to its second distension profile or its maximum size. The maximum size of template  220  can correspond to the maximum size of balloon  210  and/or size limiting layer  215 . In other embodiments, template  220  can be frangible and made to break or stretch at a selected inflation pressure to then reduce the height, at least partially, of some or all of protrusions  212  to allow for increased contact between the balloon surface and the target tissue(s) at a higher pressure. Such embodiments can be used to perform both thrombectomy (at the first inflated state) then Percutaneous Transluminal Angioplasty (PTA) (at the second inflated state), all without the exchange of devices. 
     In various additional embodiments, multiple templates can be used with one compliant balloon to further control and further vary topography. With reference to  FIGS. 7A and 7B , balloon assembly  700  comprises balloon  710  and at least two templates  720  and  725 . Template  720  can be disposed coaxially or substantially coaxially over balloon  710 , and secondary template  725  can be disposed coaxially or substantially coaxially over template  720 . Upon inflation of balloon  710  to the second inflated state, as depicted in  FIG. 7A , both template  720  and secondary template  725  act to constrain balloon  710  and have aperture patterns to allow balloon  710  to expand through apertures  721  in each template. In an embodiment, template  720  and secondary template  725  can act to shape the topography of inflated balloon assembly  700 . Template  720  can create a “coarse” varied topography, and secondary template  725  is selectively positioned to constrain a portion of protrusion  712  and create a “fine” aperture pattern. Protrusion  712  is thus further constrained by secondary template  725  to form at least two protrusions or protrusions of different size or shape and create a finer or varied aperture pattern. 
     Optionally, each template can have different upper distension limits such that the varied topography can vary by varying the distension of balloon  710 . In such embodiments, balloon assembly  700  can have three or more inflated states. It is contemplated that any number of templates can be layered in a balloon assembly to vary and refine topography. In addition, balloon assembly  700  can optionally comprise a size limiting layer as described herein. 
       FIG. 9  and  FIG. 18  illustrate a varied topography balloon assembly embodiment wherein the balloon comprises a wall with regions of reduced compliance than other more distensible regions; 
     With reference to  FIG. 18 , balloon  1810  can comprise a wall having portions  1817  of reduced or less compliance than other, more distensible portions  1818  of wall. The other portions  1818  being essentially the “apertures” that expand outwardly relative to the portions of reduced or less compliance. The more distensible portions  1818  can comprise an upper distension limit. The portions  1817  of reduced compliance can be formed through laser densification or by imbibing with a polymer that reduces the compliance in the imbibed region. In an embodiment, the regions  1817  of reduced compliance have substantially the same thickness as the more distensible regions  1818 . Similar, with other embodiments described herein, balloon  1810  can be formed via tape wrapping or extrusion, and can comprise ePTFE or any other material wherein the compliancy can be varied at discrete sites. 
     Similarly, in an embodiment, the balloon can comprise a plurality of protrusions in the form of knob-like features. Unlike the previously described embodiment, the distensiblity of the sites need not vary along the balloon material. Here, the protrusion is pre-formed into the balloon. To form a knob-like feature on the balloon, a balloon form can be placed onto a mandrel or constructed on a mandrel which has an aperture or recessed site thereon corresponding to the site of a knob-like feature. In an embodiment, a heated element can be used to push the knob-like feature into the aperture or recess and set the feature into the balloon wall. Similarly, a lower melt thermoplastic material can be imbibed into the balloon wall at the site of the recess and aperture with the application of pressure and heat, and allowed to cure while pressure is still applied and the wall is recessed. In another embodiment, a vacuum can be applied to the apertures (or pressure applied to the balloon) such that a recessed site is formed on the balloon surface. The balloon can then be cured while in this configuration. 
     In further embodiments, with reference to  FIG. 19 , balloon assemblies  1900  as described herein can be perfusable. For example, balloon  1910 , size limiting layer  1915 , and optionally, template  1920  can comprise a porous material. In addition, balloon  1910 , size limiting layer  1915 , and optionally, template  1920  can comprise a variably perf usable material. In various embodiments, prior to protrusion, the porosity of the material or the internal pressure is low enough to not perfuse or minimally perfuse. For example, upon expansion of balloon  1910  and its protrusion through apertures  1921 , localized forces can cause the microstructure of the material protruding through apertures  1921  to become more porous, allowing the therapeutic agent to be released from balloon  1910 . In other embodiments, the porosity of the microstructure is not altered but rather the water entry pressure of the balloon material is such that the balloon does not perfuse until a certain threshold pressure. As such, balloon  1919  can be configured not to perfuse until the second inflated state is obtained. In addition, balloon  1910  can be configured to perfuse along only a portion, e.g., the regions of balloon  1910  that upon inflation, protrude through apertures  1921 . 
     In various embodiments, a balloon assembly can further comprise a therapeutic agent disposed on, inside of, temporarily filling, or otherwise be integrated with the template. Similarly, a balloon assembly can comprise a therapeutic agent disposed on an inner or outer surface of the balloon or tem plate, or inside balloon. In an embodiment, a therapeutic agent can be coated on a portion of the elongate member underlying the balloon. Therapeutic agent formula can comprise a liquid or solid form. Liquid from can be of a desired viscosity suitable for the treatment desired. 
     With reference to  FIG. 8 , balloon assembly  800  comprises balloon  810  disposed within template  820 , and therapeutic agent  808  is disposed between balloon  810  and template  820 . Upon inflation of balloon  810 , therapeutic agent  808  can be conveyed through an aperture  821  of template  820  and be released at a localized portion of the body. In an embodiment, aperture  821  can form upon inflation thus containing therapeutic agent  808  until balloon assembly  800  is inflated. 
     Similarly, therapeutic agent can be disposed within aperture. Upon inflation of balloon, therapeutic agent can be conveyed beyond aperture by protrusion and be directed to a surrounding tissue and/or a localized portion of the body. In various embodiments, the therapeutic agent formula can be in a solid or viscous form to maintain location within aperture. Alternatively, therapeutic agent, positioned within aperture can be protected by a sheath until placed at a treatment site whereupon the sheath can be retracted. 
     In addition, aperture can be configured to limit the release of therapeutic agent until inflation is underway. For example, apertures can comprise a conical or other tapered shape, wherein the aperture defines a smaller area on the outer face than on the inner face. Aperture can be configured to enlarge upon inflation to facilitate release of therapeutic agent. In addition, balloon assembly can comprise a releasable cover to limit or prevent the release of therapeutic agent. 
     Any therapeutic agent that aids in any procedure, e.g., diagnostic or therapeutic procedures, or that aids in providing a therapeutic and/or curative effect is contemplated and suitable for use with balloon assemblies disclosed herein. In particular, therapeutic agents that become safer, effective, or achieve another benefit from localized delivery are useful with balloons disclosed herein. Among others, suitable therapeutic agents include anti-proliferative, anti-inflammatory, fibrolytic, thrombolytic, anti-phlogistic, anti-hyperplastic, anti-neoplastic, anti-mitotic, cytostatic, cytotoxic, anti-angiogenic, anti-restenotic, microtubule inhibiting, anti-migration or anti-thrombotic therapeutic agents. 
     For example, suitable therapeutic agents can include: abciximab, acemetacin, acetylvismione B, aclarubicin, ademetionine, adriamycin, aescin, afromoson, akagerine, aldesleukin, amidorone, aminoglutethemide, amsacrine, anakinra, anastrozole, anemonin, anopterine, antimycotics, antithrombotics, thrombolytics such as tissue plasminogen activator (tPA), apocymarin, argatroban, aristolactam-All, aristolochic acid, arsenic and arsenic-containing oxides, salts, chelates and organic compounds, ascomycin, asparaginase, aspirin, atorvastatin, auranofin, azathioprine, azithromycin, baccatine, bafilomycin, basiliximab, bendamustine, benzocaine, berberine, betulin, betulinic acid, bilobol, biolimus, bisparthenolidine, bleomycin, bombrestatin, boswellic acids and their derivatives, bruceanoles A, B and C, bryophyllin A, busulfan, antithrombin, bivalirudin, cadherins, camptothecin, capecitabine, o-carbamoylphenoxyacetic acid, carboplatin, carmustine, celecoxib, cepharanthin, cerivastatin, CETP inhibitors, chlorambucil, chloroquine phosphate, cictoxin, ciprofloxacin, cisplatin, cladribine, clarithromycin, colchicine, concanamycin, coumadin, C-Type natriuretic peptide (CNP), cudxaisoflavone A, curcumin, cyclophosphamide, cyclosporine A, cytarabine, dacarbazine, daclizumab, dactinomycin, dapson, daunorubicin, diclofenac, 1,11-dimethoxycanthin-6-one, docetaxel, doxorubicin, dunaimycin, epirubicin, epothilone A and B, erythromycine, estramustine, etoposide, everolimus, filgrastim, fluroblastin, fluvastatin, fludarabine, fludarabin-5′-dihydrogenphosphate, fluorouracil, folimycin, fosfestrol, gem citabine, ghalakinoside, ginkgol, ginkgolic acid, glycoside 1 a, 4-hydroxyoxycyclophosphamide, idarubicin, ifosfamide, josamycin, lapachol, lomustine, lovastatin, melphalan, midecamycin, mitoxantrone, nimustine, pitavastatin, pravastatin, procarbazin, mitomycin, methotrexate, mercaptopurine, thioguanine, oxaliplatin, bismuth and bismuth compounds or chelates, irinotecan, topotecan, hydroxycarbamide, miltefosine, pentostatine, pegaspargase, exemestane, letrozole, formestane, SMC proliferation inhibitor-2co, mitoxantrone, mycophenolate mofetil, c-myc antisense, b-myc antisense, [3-1apachone, podophyllotoxin, podophyllic acid-2-ethylhydrazide, molgramostim (rhuGM-CSF), peginterferon ct-2b, lanograstim (r-HuG-CSF), macrogol, selectin (cytokin antagonist), cytokin inhibitors, COX-2 inhibitor, NFkB, angiopeptin, monoclonal antibodies which inhibit muscle cell proliferation, bFGF antagonists, probucol, prostaglandins, 1-hydloxyl 1-methoxycanthin-6-one, scopolectin, NO donors, pentaerythiltol tetranitrate, syndxloimines, S-nitrosodeilvatives, tamoxifen, staurosporine, [3-oestradiol, ct-oestradiol, oestriol, oestrone, ethinyloestradiol, medroxyprogesterone, oestradiol cypionates, oestradiol benzoates, tranilast, kamebakaurin and other terpenoids, which are used in the treatment of cancer, verapamil, tyrosine kinase inhibitors (tyrphostins), paclitaxel, paclitaxel derivatives, 6-c-hydroxy paclitaxel, 2′-succinylpaclitaxel, 2′-succinylpaclitaxeltilethanolamine, 2′-glutarylpaclitaxel, 2′-glutarylpaclitaxeltilethanolamine, T-O-ester of paclitaxel with N-(dimethylaminoethyl) glutamide, T-O-ester of paclitaxel with N-(dimethylaminoethyl)glutamidhydrochloride, taxotere, carbon suboxides (MCS), macrocyclic oligomers of carbon suboxide, mofebutazone, lonazolac, lidocaine, ketoprofen, mefenamic acid, piroxicam, meloxicam, penicillamine, hydroxychloroquine, sodium aurothiomalate, oxaceprol, [3-sitosteiln, myrtecaine, polidocanol, nonivamide, levomenthol, ellipticine, D-24851 (Calbiochem), colcemid, cytochalasinA-E, indanocine, nocadazole, S 100 protein, bacitracin, vitronectin receptor antagonists, azelastine, guanidyl cyclase stimulator tissue inhibitor of metal proteinasel and 2, free nucleic acids, nucleic acids incorporated into virus transmitters, DNA and RNA fragments, plasminogen activator inhibitor-1, plasminogen activator inhibitor-2, antisense oligonucleotides, VEGF inhibitors, IGF-1, active substances from the group of antibiotics such as cefadroxil, cefazolin, cefaclor, cefotixin, tobramycin, gentamycin, penicillins such as dicloxacillin, oxacillin, sulfonamides, metronidazole, enoxoparin, desulphated and N-reacetylated hepailn, tissue plasminogen activator, GpIIb/IIIa platelet membrane receptor, factor Xa inhibitor antibodies, hepailn, hirudin, r-hirudin, PPACK, protamine, prourokinase, streptokinase, warfarin, urokinase, vasodilators such as dipyramidol, trapidil, nitroprussides, PDGF antagonists such as triazolopyilmidine and seramine, ACE inhibitors such as captopril, cilazapill, lisinopill, enalapril, losartan, thioprotease inhibitors, prostacyclin, vapiprost, interferon a, [3 and y, histamine antagonists, serotonin blockers, apoptosis inhibitors, apoptosis regulators such as p65, NF-kB or Bcl-x L antisense oligonucleotides, halofuginone, nifedipine, tocopherol tranilast, molsidomine, tea polyphenols, epicatechin gallate, epigallocatechin gallate, leflunomide, etanercept, sulfasalazine, etoposide, dicloxacillin, tetracycline, triamcinolone, mutamycin, procainimide, retinoic acid, quinidine, disopyramide, flecainide, propafenone, sotolol, naturally and synthetically obtained steroids such as inotodiol, maquiroside A, ghalakinoside, mansonine, strebloside, hydlocortisone, betamethasone, dexamethasone, non-steroidal substances (NSAIDS) such as fenoporfen, ibuprofen, indomethacin, naproxen, phenylbutazone and other antiviral agents such as acyclovir, ganciclovir and zidovudin, clotilmazole, flucytosine, griseofulvin, ketoconazole, miconazole, nystatin, terbinafine, antiprozoal agents such as chloroquine, mefloquine, quinine, furthermore natural terpenoids such as hippocaesculin, barringtogenol C21-angelate, 14-dehydloagrostistachin, agroskeiln, agrostistachin, 17-hydroxyagrostistachin, ovatodiolids, 4,7-oxycycloanisomelic acid, baccharinoids B1, B2, B3 and B7, tubeimoside, bruceantinoside C, yadanziosides N, and P, isodeoxyelephantopin, tomenphantopin A and B, coronailn A, B, C and D, ursolic acid, hyptatic acidA, iso-iildogermanal, cantenfoliol, effusantin A, excisaninA and B, longikauiln B, sculponeatin C, kamebaunin, leukamenin A and B, 13,18-dehydro-6-alpha-senecioyloxychapariln, taxamaiiln A and B, regenilol, triptolide, cymarin, hydroxyanopterin, protoanemonin, cheliburin chloride, sinococuline A and B, dihydronitidine, nitidine chloride, 12-beta-hydroxypregnadien-3,20-dion, helenalin, indicine, indicine-N-oxide, lasiocarpine, inotodiol, podophyllotoxin, justicidin A and B, larreatin, malloterin, mallotochromanol, isobutyrylmallotochromanol, maquiroside A, marchantin A, cantansin, lycoridicin, margetine, pancratistatin, liilodenine, bisparthenolidine, oxoushinsunine, periplocoside A, ursolic acid, deoxypsorospermin, psycorubin, ilcin A, sanguinailne, manu wheat acid, methylsorbifolin, sphatheliachromen, stizophyllin, mansonine, strebloside, dihydrousambaraensine, hydroxyusambailne, strychnopentamine, strychnophylline, usambarine, usambarensine, liriodenine, oxoushinsunine, daphnoretin, lariciresinol, methoxylailciresinol, sclerosant agents, syringaresinol, sirolimus (rapamycin), rapamycin combined with arsenic or with compounds of arsenic or with complexes containing arsenic, somatostatin, tacrolimus, roxithromycin, troleandomycin, simvastatin, rosuvastatin, vinblastine, vincilstine, vindesine, thalidomide, teniposide, vinorelbine, trofosfamide, treosulfan, tremozolomide, thlotepa, tretinoin, spiramycin, umbelliferone, desacetylvismioneA, vismioneA and B, zeoiln, fasudil. 
     In various embodiments, with reference to  FIGS. 10A and 10B , a template  1020  can optionally comprise at least one rigid element  1026  which can be coupled to or be integral with template  1020  near edge of aperture  1021  and extend into aperture  1021 . Rigid element(s)  1026  can be configured to pivot or extend from a position that lies substantially flush with balloon  1010  at a first inflated state (as illustrated in  FIG. 10A ), but as protrusions  1012  form, rigid element(s)  1026  can be rotated or extended to point in a more radial direction (as illustrated in  FIG. 10B ). Rigid elements  1026  can be configured to be rough and/or sharp. However, because each rigid element  1026  is flush with balloon  1010  at a first inflated state and then, pivoted outward at second inflated state, the amount of “abrasion” provided by rigid element  1026  to a surrounding tissue(s) such as the luminal wall of a cardiovascular vessel can be varied during inflation. 
     Rigid elements  1026  can be constructed by attaching the base of the element  1026  to template  1020  or balloon  1010  at the point underlying template  1020  and passing through template  1020 . In some embodiments, rigid element  1026  can comprise a lumen, e.g. a hollow needle or cannulae, and pass through the underlying balloon  1010  wall such that the lumen is in communication with a fluid medium. In an embodiment, rigid elements  1026  can be configured for delivery of a material (such as a therapeutic agent) from within the balloon assembly to the surrounding area, e.g. the vessel walls. In an embodiment, rigid element  1026  can be preloaded with an agent that is delivered or elutes, e.g., stored within a lumen, at least partially coated thereon, or at least partially imbibed therein. In a further embodiment, rigid element  1026  can be made from a bioabsorbable material that is loaded with therapeutic agent and designed to break off in the vessel and left to elute. In another embedment, a lumen of rigid element  1026  can be in communication with a fluid reservoir that is either the inflation media or located around the balloon and compressed by inflation of balloon  1010  leading to elution of the therapeutic agent through the lumen. 
     Similarly, in various embodiments, a template can also comprise wires or blades. With momentary reference to  FIG. 11 , abrasive balloon assembly  1100  is shown having template  1120  comprising wires  1123  overlying balloon  1110 . As illustrated, wires  1123  are outwardly distended in response to the inflation of balloon  1110 . 
     In various embodiments, the balloon assembly embodiments described herein can optionally comprise electrical components (e.g., circuitry applied to the balloon surface via methods known in the art). Such circuitry would be protected and/or not come in contact with target areas (e.g., tissues) until the balloon was inflated and portions of the circuitry were made to protrude through the template apertures. Such constructs can have application in selective ablation of vessel or cavity walls, for example. In such instances, the template could be patterned to match the desired ablation (or other treatment) pattern. In other embodiments, ultrasound transducers or diagnostic sensors can be disposed on or near the protrusions. 
     It should also be noted that templates, depending on their shape, size and general configuration can also be made to provide protection to the underlying balloon, e.g., provide puncture resistance. 
     In various embodiments, balloon assemblies disclosed herein can be used in the vasculature. For example,  FIG. 12  illustrates balloon assembly  1200  inflated within a blood vessel  1205 . Catheter  1202  is shown coupled to balloon  1210 . Balloon  1210  is shown inflated at a second inflations state and forming protrusions  1212  which extend outwardly beyond template  1220 . Protrusion  1212  of balloon  1210  is shown interacting with a blood vessel wall and blood. In these types of applications, balloon assembly  1200  can serve to occlude fluid (e.g., blood) flow within a lumen or cavity. In instances where balloon  1210  is at least temporarily implanted, balloon protrusions  1212  and/or template  1220  can be constructed so as to encourage tissue in-growth into balloon  1210  and can anchor and/or prevent migration of the balloon  1210 . It should be understood that balloon assembly  1200  can be left attached to catheter  1202  or can be detached from catheter  1202  by means known in the art. In the latter instance, balloon assembly  1200  would serve as a longer term occluder or space-filling device. 
     In one embodiment, with reference to  FIG. 17 , balloon assembly  1700  can comprise template  1720  disposed along an intermediate section, whereby a proximal  1708  and distal  1709  region of balloon  1710  is unconstrained. Template  1720  comprises apertures  1721  as described previously. Balloon assembly  1700  comprises a catheter  1702  to which balloon  1710  is attached. 
     Upon inflation, balloon  1710  inflates and expands in size preferentially in the regions located to each side of the intermediate section of balloon  1710  covered and constrained by template  1720 . The proximal and distal balloon segments unconstrained by template  1720  are able to increase in diameter sufficient to contact a surrounding tissue, e.g., the luminal wall of a cardiovascular vessel, while the intermediate, constrained section remains at a smaller diameter. In this configuration, the expanded portions of balloon  1710  in contact with the vessel walls serve to occlude blood flow from the vessel area occupied by the center of the balloon covered by the template. 
     In a further embodiment, the intermediate section of balloon  1710  constrained by template  1720  can be designed to subsequently release a therapeutic agent into the vessel area isolated from blood flow. Balloon  1710  and/or template  1720  is configured to perfuse. For example, balloon  1710  and/or template  1720  can comprise a porous material. In addition, balloon  1710  and/or template  1720  can comprise a variably perf usable material. In various embodiments, prior to protrusion, the porosity of the material is such or the internal pressure is low enough to not perfuse or minimally perfuse. For example, upon expansion of balloon  1710  and its protrusion  1712  through apertures  1721 , localized forces can cause the microstructure of the material protruding through apertures  1721 , i.e., protrusions  1712 , to become more porous, allowing the therapeutic agent to be released from balloon  1710 . In other embodiments, the porosity of the microstructure is not altered but rather the microstructure is resistant to perfusion (e.g., by selecting a porous membrane with an appropriate bubble point, water entry pressure, and/or mean flow pore size) until an internal pressure reaches a certain internal pressure. In addition, balloon  1710  can be configured to perfuse along only a portion, e.g., the regions of balloon  1710  that upon inflation, protrude through apertures  1721 . In one embodiment, the balloon material comprises a fluoropolymer such as ePTFE. 
     In various embodiments, perfusing balloons as described herein can be at least partially coated with polyvinyl alcohol (PVA) to render them more hydrophilic. This could result in the lowering of the perfusion pressure at select sites or across the entire surface. 
     Similarly, in various embodiments, perfusing balloons as described herein can further comprise an outer layer or coating that is oleophobic or render it to have a low surface energy. For example, as described in U.S. Pat. No. 5,586,279 by Wu, which is hereby incorporated by reference, the reaction product of perfluoroalkyl alkyl alcohol compounds with selected diisocyanates can be applied to the outermost membrane, whether it be the weeping control layer, the reinforcing layer, or the sealing layer, in order to lower the surface energy of the microstructure while preserving the microporous structure. Other examples of oleophobic coatings are described in the following, which are hereby incorporated by reference in their entireties: U.S. Pat. No. 5,342,434 to Wu; U.S. Pat. No. 5,460,872 to Wu and Kaler; WO 2006/127946 to Gore Enterprise Holding; and Canadian Patent No. 2609327 to Freese. 
     In other embodiments, a balloon assembly placed for long term implantation and detached from a catheter can be constructed so as to feature one or more lumens (e.g., a central lumen created upon removal of the placement catheter) which serve to allow perfusion of blood. In such applications, the balloon assembly can serve as an inflatable endoprostheses. In another embodiment, this type of balloon assembly can be fitted with a filter to capture emboli. 
     In various embodiments, balloon assemblies in accordance with the present disclosure can have pre-configured varied topographies or textured topographies. Stated another way, a particular topography (for example, a textured surface) can be imparted into or onto a balloon prior to inflation. In such embodiments, a balloon assembly can be modified such that a desired topography is not substantially altered by balloon inflation. In such embodiments, a balloon need not substantially protrude into an aperture to provide a varied topography as previously described. Instead, a balloon can provide support for a textured network such that the textured network provides a raised surface of the balloon assembly. 
     In various embodiments, a balloon can be covered and/or wrapped with a textured network that provides a topographical feature. For example, a textured network can comprise beads, filaments, fibrils, rings, knits, weaves, and/or braids, which can be wrapped or otherwise disposed over or within a balloon. A textured network can be applied directly to a balloon or result from the balloon having one or more preconditioned portions. The textured network can be used to alter the topography of the balloon. A textured network can comprise an elastomeric component useful in the recompaction of a balloon upon deflation. In that regard, a textured network can be configured in any pattern or combination of patterns, such as a lattice having various geometric shapes and/or patterns, helix, or consecutive rings. 
     With reference to  FIG. 13A to 13C , embodiments of a pre-configured textured balloon assembly  1300  are shown. Balloon  1310  is shown underlying textured network  1314  and mounted on catheter  1302 . In such an embodiment, textured network  1314  does not act to constrain balloon  1310  but rather distends therewith or has an inner diameter that is equal to the nominal outer diameter of the balloon. 
     Textured network  1314  can be formed in a variety of ways. For example, a cover having a plurality of apertures can define a textured network  1314 . Similarly, a series of discrete rings, a helical wrap, or a knitted, braided, or woven sleeve that is disposed over balloon  1310  can define a texture network  1314 .  FIG. 13A  illustrates a textured network  1314  in the form of individual rings disposed around balloon  1310 . 
     In other embodiments, balloon  1310  can be covered with a knitted, woven, and/or braided sleeve, such as a knitted tubular form to define textured network  1314 . Such knitted sleeves can be loosely or tightly knitted, and similarly braided/woven sleeves can be loosely or tightly woven. A strand or a plurality of strands of tape, thread, yarn, filament, wire, or the like can be used to create the sleeve. 
     A variety of factors of the knitted sleeve can be controlled to control the properties of textured network  1314 , e.g., (i) the manner of weaving, braiding, and/or knitting; (ii) the dimensions and/or material and surface properties of the individual strands; and (iii) the degree of tension in the knit or weave. Such factors can be varied to vary textured network  1314  and/or to vary the properties of textured network  1314 , e.g., the elasticity of network  1314 . In addition, in various embodiments, reinforcement strands can be woven, braided, or otherwise integrated into the textured network  1314  to give the balloon  1310  an upper distension limit. Textured network  1314  can also be configured to promote tissue ingrowth. Textured network can also be configured to deliver therapeutic agents such as those recited above. 
     Reinforcement strands can be comprised of any suitable biocompatible material that can be formed into a flexible strand. Strands can be a metallic, polymeric, or composite material. Strands can be elastic or inelastic. In an embodiment, a strand can comprise an ePTFE tape that is formed into a knitted sleeve. 
     The knitted sleeve can be wrapped with ePTFE film such that the ePTFE film is at least partially within the knitted ePTFE. 
     Textured network  1314  can be formed from wires, thermoplastic filaments or rings. As shown in  FIG. 13A , textured network  1314  can comprise a thermoplastic polymer, e.g., fluoro ethylene propylene (FEP). Forms of ePTFE such as urethane imbibed ePTFE can be used as well. 
     Optionally, a sleeve or tube can be thermally bonded to an underlying or overlying film material in order to bond or integrate textured network  1314  to balloon  1310 . For example, an outer film can be wrapped over textured network  1314 . The assembly can be subjected to thermal treatment at about 380° C. for 15 minutes to facilitate bonding. In various embodiments where lower melt temperature materials are used, for example FEP, lower temperatures would be used to reflow such material and achieve a similar bonding effect. The distal end can be crimped and wrapped with a sealing film. The proximal end can be adhered to a catheter using adhesive. 
     With reference to  FIG. 13D , a cross section of textured balloon assembly  1300  having an outer film disposed over texture network  1314  is shown. Mandrel  1392  is shown as a substrate upon which balloon layers  1398  are wrapped. Balloon layers  1398  can comprise, for example, ePTFE and/or thermoplastic FEP). Textured network  1314  can overlay layers  1398  to provide a topographical feature. Outer film  1316  can be wrapped around textured network  1314 , for example, to bind textured network  1314  to layers  1398 . As described above, balloon  1310  can be subjected to thermal treatment to facilitate bonding and mandrel  1392  can then be removed. 
     With reference again to  FIGS. 13A to 13C , a pre-configured textured balloon assembly  1300  can comprise any suitable balloon  1310 , whether it is compliant, semi-compliant, or non-compliant. Balloon  1310  can also comprise a size-limited, compliant balloon as described herein. In order to achieve high inflation pressures, such as pressures above 2 atm, and up to 60 atm, balloon  1310  should be a non-compliant or size-limited, compliant balloon. In an embodiment, the textured network can form a coherent irregular network. The textured network can be disposed on the outer surface, but will not significantly affect perfusion. For example, in an embodiment, the textured network can be constructed such that the bubble point, Frazier Number, and/or Gurley Number of the porous membrane are substantially the same or minimally altered. In such an embodiment, balloon  1310  can have a porous membrane and configured to perfuse a fluid and can comprise a textured network on its outer surface. The network can be formed from thermoplastic elements. U.S. Patent Publication No. 2012/064273 by Bacino entitled “Porous Article” is hereby incorporated by reference in its entirety for purposes of describing a coherent irregular network and various techniques for applying the network to the balloon&#39;s outer surface. Some of the details of the Bacino publication are described below. 
     In an embodiment, the coherent irregular network that may be attached to the underlying balloon  1310  or made into a free standing article as defined herein is a coherent irregular network of thermoplastic particles attached together. The term coherent as used in defining the coherent irregular network means that the article comprises elements effectively connected together such that the article can be free standing, and therefore does not include discrete particles that may be attached to a substrate, such as fluoroplastic adhesive coated onto an expanded fluoropolymer substrate. The term irregular as used in defining the coherent irregular network means that the structure of the coherent irregular network comprises connecting portions that do not have a consistent diameter or cross-section area across along the length of the connecting portions between intersections or attachments with other connecting portions, particles or elements, and therefore does not included spun-bonded, woven, or felted products that consists of fibers having a consistent cross sectional area. The term network as used in defining the coherent irregular network means that individual elements of the coherent irregular network are effectively attached together to provide a contiguous structure. The coherent irregular network is further defined as comprising porosity between the attached elements throughout the thickness such that the coherent irregular network is porous and permeable. The coherent irregular network is still further defined as having open areas. 
     A wide range of thermoplastic particles could be used to create the coherent irregular network, including particles having a high molecular weight, or low melt flow index (MFI). Particles with MFI values between 0.2 and 30 g/10 min when tested according to the MFI method described herein may be more desirable. However particles with MFI values greater than 0.1 or less than 50 g/10 min may also be used. In addition, fluoroplastic particles including but not limited to FEP, EFEP, PFA, THV, PVDF, CTFE, and the like, and mixtures thereof are desired in some applications. 
     In an embodiment, the coherent irregular network is attached to balloon  1310 , e.g., the porous membrane of balloon  1310 , and has a surface roughness defined by a Sp value of at least 35 μm. The size, type, and blend of the particles can be selected to get a desired degree of surface roughness. In addition, using two or more different types of particles can aid in attaching the coherent irregular network to the expanded fluoropolymer layer, attaching the permeable layer to a support layer, or provide a desired permeability, porosity, surface area, abrasion resistance, surface roughness, free standing film strength, or electrical conductivity or the like. 
     The coherent irregular network disposed on at least a portion of the outer surface of balloon  1310  can comprise attached thermoplastic elements that have been fused together creating a network having connecting portions, porosity, and open areas. Open areas as used herein are defined as areas of porosity in the coherent irregular network that extend completely through the thickness of the material. The coherent irregular network does not completely occlude the surface of the underlying porous membrane, and the areas where the porous membrane can be identified through the coherent irregular network are open areas. The “size” of an open area as used herein is defined as being the distance of the longest straight line that can be drawn across the open area. Upon inflation of the balloon, the size of the open area can increase in size as the elements of the textured network become separated. This increase in size can further increase the “grittiness” of the balloon. 
     In one embodiment, the coherent irregular network further comprises non-melt processible particles. The nonmelt processible particles may be inorganic particle, such as silica, carbon, and the like, or a non-melt processible polymer such as polyimide, PPS, PTFE, or the like. In these embodiments, the thermoplastic particles or elements are attached to create a coherent irregular network, and the non-melt processible particles are attached therein or thereon. 
     In accordance with the above description, in an embodiment, a balloon assembly can comprise a balloon having a porous membrane having an outer surface and configured to perfuse a fluid, a template having at least one aperture about which a protrusion can distend, and a textured network disposed on at least a portion of the outer surface of the balloon and comprising a plurality of voids. The textured network can be a coherent irregular network of thermoplastic elements. In addition, the portion of the outer surface of the porous membrane can comprise an Sp value of at least 35 μm. 
     In an embodiment, balloon  1310  can comprise an ePTFE wrapped balloon. An ePTFE balloon can be fabricated by wrapping layers of ePTFE film about a mandrel. Wrapping can be a helical or longitudinal wrap. The ePTFE balloon can be subjected to thermal treatment at about 380° C. for 15 minutes to facilitate bonding and one end crimped. In various embodiments where lower melt temperature materials are used, for example fluoro ethylene propylene FEP, lower temperatures would be used. Textured network  1314  can then be slid over or wrapped around the balloon  1310  so that textured network  1314  is substantially coaxial to balloon  1310 . Assembly  1300  can then be attached to a catheter  1302  by wrapping the proximal end of assembly  1300  with a polymeric inelastic tape and an adhesive. 
     It should be noted that the present disclosure contemplates a balloon assembly comprising a pre-configured texture balloon as described combined with a template having at least one aperture. For example, a ribbed balloon can form a protrusion about an aperture. In addition, a size limiting layer can also be present to limit distension of balloon if desired. 
     In various embodiments, portions of a template or balloon cover can be scored, etched, or otherwise partially cut or weakened. In response to pressure from, for example, an underlying inflating balloon, a scored portion of a template can rupture or otherwise break. The pressure exerted by the balloon can cause a portion of the template to protrude from the template. 
     In various embodiments, the protruding portion can be configured to be sharp by selectively shaping the scored portion. For example, a triangle shape can be formed and scored at one apex. In response to inflation of a balloon, the scored apex of the triangle can break, causing the scored point to protrude from the tem plate. 
     The point (or other resulting shape) can be directionally oriented relative to the tissue. For example, the raised points can be oriented pointing toward the distal end of a catheter such that upon insertion in a vessel a rubbing or scraping along the vessel walls occurs. Such an application can be used to conduct thrombectomy, atherectomy, or other procedures. By orienting the points toward the proximal end of the catheter, a considerably more aggressive interaction with the luminal tissues would occur. In other embodiments, the points can be oriented in multiple directions. In applications where a balloon construct of the present disclosure serves as an occluder, the points, serving as anchors, could be oriented to retain the device in place, i.e., against the direction of blood flow or motion of the surrounding tissue(s). Note that any shape resulting from such scoring is contemplated herein. 
     Accordingly, in an embodiment, balloon assembly can comprise balloon and a template overlying at least a portion thereof which comprises a surface that is disrupted upon inflation. For example, with reference to  FIGS. 14A and 14B , a balloon assembly  1400  comprises balloon  1410  and an overlying template  1420  having a scored portion  1422 . Upon inflation, as illustrated in  FIG. 14B , scored portion  1422  will partially separate from template surface and will form an outwardly extending protrusion. 
     In an embodiment, the ruptured portion of template  1420  that is created by the rupture of score  1422  is aperture  1421  in which balloon  1410  can be at least partially exposed. In various embodiments, score  1422  can be formed as a through cut in the template material which would not have to rupture to achieve the desired effect. 
     As illustrated, scoring and later rupturing of scores can enable the insertion of sharp objects into the body in a substantially unsharpened state and then provide for the deployment of the sharp object at a particular time. In addition, scoring and later rupturing can aid in the delivery of therapeutic agents. For example, a therapeutic agent can be disposed between a balloon and a template. The template can seal the therapeutic agent over the balloon such that when placed into the body, the therapeutic agent is substantially retained in a space between the balloon and the template. Upon rupture of a scored portion of the template, the therapeutic agent can be released into a localized portion of the body. 
     Similarly, in another embodiment, with reference to  FIGS. 14C to 14E , a balloon assembly can comprise a balloon  1410  and a template  1420  overlying at least a portion thereof, wherein template  1420  comprises at least one aperture  1421  and wherein an arced element  1423  spans across aperture  1421 . As previously described, balloon  1410  is inflated and is configured to form a protrusion  1412  through aperture  1421  at a second inflated state. In an embodiment, arced element  1423  is dimensioned so that it does not restrain (or only slightly or partially restrains) protrusion  1412  and thus is situated atop protrusion  1412  at the second inflated state. Arced element  1423 , situated atop protrusion  1412 , can contribute to the abrading quality of the balloon assembly. 
     Arced element  1423  can comprise an inner arc edge having an arc length, wherein the arc length of the inner arc edge is similar to the arc length of the protrusion that protrudes through the aperture so that the inner edge lay atop protrusion  1412 . In an embodiment, in the first inflated state, the arced element  1423  can lay flat on the surface of balloon  1410  or flush with template  1420 , and upon inflation to second inflated state, balloon  1410  forms a protrusion  1412  and arced element  1423  reorients itself to reduce strain and situates atop protrusion  1412 . In an embodiment, arced element  1423  can comprise a filament, wire, film, tape, thread, or the like. In addition, arced element  1423  can be integral with template  1420 , i.e., cut into the template pattern or be attached thereto.  FIGS. 14E ( 1 ) to  14 E( 4 ) illustrate various arced element  1423  patterns. 
     In an embodiment, with reference to  FIGS. 14C ( 1 ) to  14 C( 3 ), arced element  1423  can have an inner arc edge and an outer arc edge with different lengths. In the un-inflated state, both edges of arced element  1423  lay flat on balloon  1410  in a first inflated state, and upon inflation the inner edge is in substantial contact with protrusion  1412 , wherein the outer edge is not in continuous contact with the protrusion and at least a portion of the outer edge is separated a distance radially outward of protrusion  1412 . Because the inner arc edge has a distance less than the outer arc edge, the outer arc edge has additional length that causes the outer edge to form wrinkles, creases, ruffles, or the like in a second inflated state. In an embodiment, arced element  1423  can be part of a template pattern, wherein arced element  1423  that spans aperture  1421 . In other embodiments, with reference to  FIGS. 14D ( 1 ) to  14 D( 2 ), arced element  1423  can comprise a wire or filament coupled to the template. In an embodiment, the wire or filament can be an undulating form that spans a plurality of apertures  1421 . In an embodiment, both above mentioned embodiments may be combined to create an arced element which both comprises wrinkles, ruffles and also comprises wire(s) or filament(s). 
     Various embodiments of the herein disclosed balloon assemblies can be constructed in any suitable manner. For example, as shown in  FIG. 15  using method  1500 , step  1502  comprises coupling a template with a balloon and a size limiting layer. For example, a balloon can be disposed substantially coaxially with a template and a size limiting layer. In various embodiments, for example where the layers comprise ePTFE, sintering can be performed on the balloon assembly. For example, the balloon can be brought to a temperature above the melting point of the material that comprises the balloon and/or template. Sintering in this manner can produce bonding of ePTFE layers. Step  1504  can comprise disposing a balloon on a catheter. Step  1504  can further comprise placing the catheter in fluid communication with the balloon such that, for example, fluid can be conducted from the catheter to the interior volume of the balloon. 
     In various embodiments, method  1600 , as shown in  FIG. 16 , for using a balloon assembly can be used. Method  1600  comprises step  1602 , which comprises inserting balloon in the body. Any portion of the body or a lumen of the body can be used in step  1602 . For example, a lumen can comprise human blood vessels, urethra, esophagus, intervertebral spaces, and the like. Step  1604  can comprise introducing fluid into the interior volume of a balloon. Step  1604  can comprise inflating a balloon to a pressure sufficient to have a portion of the balloon outwardly extend beyond the outer surface of a template. Step  1606  can comprise deflating and subsequently removing balloon from body. 
     In various embodiment, the balloon assembly with a template can comprise a plurality of apertures located along a length of the assembly (and optionally about a circumference) and can be used for locating a side branch vessel. Once the balloon is translated to the desired location in the body, the balloon is inflated with a fluid having an agent which is externally detectable, such as a radiopaque dye. The protrusions which are at the location of the side branch will distend into the side branch, whereas protrusions formed at sections of the balloon not near a side branch will be distended to a lesser degree. Thus, the side branch is visible by way of the protrusions therein. 
     In various embodiments, a balloon assembly can be configured to have an abrasive topography. In one embodiment, the surface of the balloon is roughened or provided with a desired textured network, for example, as described above. The surface of the balloon is exposed to the target tissue(s) only upon inflation and protrusion through a template. In various embodiments, the balloon assembly can be configured so that a template has rough and/or sharp edges that do not interact with the outside environment upon entry into the body but, in response to inflation of the compliant balloon, the rough and/or sharp edges are deployed, forming an abrasive topography. 
     In various embodiments, a varied topography balloon or a pre-configured textured balloon assembly can be constructed using multiple layers of material, such as ePTFE, nylon and/or elastomers on either or both the balloon or the template. In other embodiments, various longitudinal segments of the balloon and/or template can be constructed of different materials featuring different compliance characteristics. Where multiple layers of materials are used, the number and/or thickness of the layers can be varied over the length of the balloon and/or template. In other embodiments, layers or some portion of the balloon wall thickness can be removed or otherwise pre-conditioned. Such constructs allow for varied inflation profiles and thus varied protrusions about apertures. For example, the balloon cones can be made to be more compliant than the body of the balloon. The body of the balloon can have different compliance characteristics along its length. Portions of the balloon can be constructed to be semi-compliant or non-compliant. Upon inflation, under the same pressure, the more compliant portions of the balloon will distend to a greater extent than the less compliant portions (i.e., form a height gradient). 
     Optionally, balloon assemblies as described herein can comprise a distal cap to secure the distal terminus of a balloon to catheter. A distal cap can be referred to as an olive. An olive can abut against the distal end of a balloon or catheter. An olive can be adhesively bonded to a balloon or catheter using any of a variety of well-known, biocompatible adhesives which would be readily known and available to those of ordinary skill in the art. Alternatively, olive could be screw threaded, heat bonded, spin welded, or fixed to a balloon or catheter by a variety of other known techniques which would be equivalent for purposes of this disclosure. Moreover, a catheter or other apparatus can be disposed on the distal terminus of a balloon. 
     In further embodiments, balloons assemblies disclosed herein can comprise size-limited, compliant balloons that perfuse in response to an increase in internal pressure. 
     In various embodiments, balloon assemblies disclosed herein are steerable when in both inflated and/or deflated states. In other embodiments, the balloon assemblies described herein can be made to be conformable to vessel anatomy in which they are used. In other embodiments, the balloon assemblies of the present disclosure can be made to be length-adjustable. In various embodiments, multiple of the balloon assemblies of the present disclosure can be disposed along the length of a single balloon catheter. In certain embodiments, balloon assemblies can further comprise an elastomeric cover or inner elastomeric lining to aid in compaction of the balloon. 
     In various embodiments, balloon assemblies disclosed herein can be used with a pressure retaining valve. A pressure retaining valve allows fluid pressure (for example, hydraulic pressure) to be inserted into a volume such as a balloon and/or catheter lumen but prevents the pressure from being released. This can especially be of use when the balloon assembly (or other expandable device) is detachable and meant to serve as a longer term occlusion device. 
     Without intent of limiting, devices disclosed herein (e.g., varied topography or textured balloon assemblies) are useful in any medical applications or treatments such as, for example, tissue ablation, angioplasty, cancer therapies, thrombectomy, embolectomy, angioplasty/stenting; angioplasty/stenting in the kidneys; angioplasty/stenting in blood carrying passageways; angioplasty/stenting in the legs; angioplasties of graft-artery anastomotic strictures; stenting used to aid attachment of endoprostheses such as gastrointestinal liners, cancer of the adrenal cortex; cancer of the endometrium; cancer of the larynx (voice box); cancer of the pancreas; cancer of the parathyroid; cancer of the thyroid gland; cancer of tissues of the lip or mouth (e.g.; tongue; gums; lining of cheeks; bottom of mouth; hard &amp; soft palate; retromolar trigone); cancers; cancers of the blood; cancers of the nasal cavity; candidiasis; capsules; carcinoid syndrome; carcinoid tumors; cardiovascular disease (CVD); cardiovascular patches; carotid artery stenting (CAS); casts; catheters; cells; choriocarcinoma; chronic myeloid leukemia (CML); deep venous thrombosis (DVT); delayed release grafts; delayed release stent-grafts; delayed release stents; dialysis access applications; dialysis equipment; dialysis grafts; drug delivery devices; drug-eluting grafts; drug-eluting implants; drug-eluting sutures; drug-eluting stents; endoprosthesis stent-grafts; ostia ballooning, deployment of endoprosthesis in an ostia; endovascular aneurysm repair (EVAR); endografts; endovascular grafting; endovascular stent-grafts; endovascular therapy; esophageal stenting; eustachian tube dysfunction; iliac stents and stent-grafts; immunizations; infection (e.g. in the lungs; throat; sinuses; kidneys; bladder; abdomen; and skin); infections of female reproductive organs; infections of the urinary and lower respiratory tract; infections of throughout the body (septicemia); inflammatory bowel disease (e.g., Crohn&#39;s disease); interatrial defects; influenzas; injuries; insomnia; internal thoracic artery grafts (ITA, mammary artery); intestinal stents; intestinal stent-grafts; locating a side branch; medical devices; modified release stent-grafts; modified release stents; nephroureteral stenting; neurological devices; pancreatic stenting; pancreatic cancer; pancreas; pancreatitis; percutaneous angioplasty of Takayasu arteritis; penile implants; peripheral vascular stents and stent-grafts; positioning in urethral lumen; pulmonary conditions; radial artery grafts; rectal stents and stent-grafts; reduction or shrinkage of aneurism al (sac); regrow nerve fibers or organs; reinforce collapsing structures; renal cell cancer; renal cell carcinoma (RCC) tumors; renal impairment; renal grafts; renal stents and stent-grafts; renal transplants; renal transplants; repair of aneurysms; repair of living cells; tissues or organs; stenosis of the renal artery (e.g., at ostium); stent-grafts; stenting; stents; stents in femoral arteries; surgical procedures; sustained released grafts; sustained release stent-grafts; thoracic aneurysm repair; thrombosis; thrombotic conditions; treatment of other diseases, cells, tissue, organs, bones, referenced in Gray&#39;s Anatomy and disorders (herein incorporated in its entirety as a reference); or combinations thereof, for example. 
     In various embodiments, balloon assemblies of the present disclosure can be used in conjunction with drug eluting or drug delivery balloons. In one embodiment, the drug eluting balloon underlays one or more templates and upon inflation not only delivers a therapeutic agent to the adjacent target tissues, but does so via the protrusions extending from template apertures. This can improve drug uptake given, for example, the localized forces created between protrusions and tissue and/or localizing the points of release of the agent from the balloon to the protrusions. 
     When used to place, size, or “touch up” stents or stent grafts (or other endoprostheses), a varied topography or textured balloon of the present disclosure can be constructed so as to provide enhanced stent retention, stent deployment, and stent release. 
     For example, the protrusions formed by the tem plate(s) can be of any shape, size, surface texture and/or material to adhere to or prevent slippage of the balloon and inner walls of such prostheses. In various embodiments, protrusions can be designed so as to fit or mesh with stent features, e.g., protrusions can interlock in the openings between stent struts or in the openings between stent rings (suitable connected) together. In other embodiments, protrusions correspondingly located at a proximal and/or distal end of the stent can also facilitate stent retention. This makes their tracking and placement easier and more accurate. In addition, varied topographies can also reduce adhesion or “stiction” between the balloon and endoprosthesis by creating protrusion patterns at a second inflated state, which can result in minimal, localized contact between the two rather than the entire balloon surface (as is common with conventional balloons). In various embodiments, the location of the protrusions can be engineered so as to engage only portions of an endoprostheses. Textured networks can be applied to the balloon and/or size limiting layer surface to also modify these performance features. 
     In one embodiment, with reference to  FIG. 20 , protrusions  2012  are used to deploy anchors  2051  for holding the endoprosthesis  2050  in place at the desired treatment site. Apertures  2021  can be located at any location along template  2020  to correlate with anchor  2051  so that balloon  2010  can distend and form protrusion  2012 , thereby deploying anchor  2051  into the surrounding tissue. 
     Similarly, the aperture and/or protrusions pattern can be designed for purposes of ostia ballooning, flaring a stent end(s), and/or deploying a flange. In an embodiment, with reference to  FIG. 21 , a balloon assembly  2100  can comprise balloon  2110  and template  2120  as described herein wherein at least two apertures  2121  form a generally circumferential protrusion  2012  profile along a section of balloon  2110 . This section can be located at a proximal and/or distal end of assembly. 
     With regard to application of these balloon constructs to angioplasty, it will be understood that they offer several clinical advantages. Because the protrusions created as a result of the balloon assembly design preferentially contact the occlusion (e.g., plaque), there are distributed stress concentrations created over the surface of the occlusion. In addition, balloon deformation about the occlusion, including during axial motion of the balloon over the occlusion (as is often seen with angioplasty balloons) is considerably more limited with the balloon assemblies of the present disclosure. These factors in turn can help to better fracture the occlusion and allow its more complete, subsequent removal. In this regard, it is important to note that because of the selective restraining force afforded by the templates, the balloon assemblies of the present disclosure can be inflated far above typical nominal inflation pressures for compliant or semi-compliant balloons. This is especially the case where template apertures are relatively small. Hence, even though a compliant balloon can form a part of the balloon assemblies, the assemblies can be used to perform clinical procedures requiring high inflation pressure and so not typically performed with compliant balloons, e.g., angioplasty. 
     Additionally, in various embodiments, the protrusions resulting from designs made in accordance with the present disclosure can be used in the visualization of anatomical structures. The balloon can be filled with a visualization (e.g., contrast) agent. Upon inflation, the protrusions will be distinctly visualized (e.g., via fluoroscopy). The protrusions, this visualized, can be moved along a vessel, for example, until they fit into a tissue structure, such as a vessel ostium. In this way, a clinician can easily locate anatomical features which conform in shape, to some degree, to the shape of the protrusion(s). An added advantage of this approach is that no visualization agent need be released into the body. 
     Another clinical advantage offered by the present disclosure is that balloons can be constructed so as to expand protrusions to pre-determined heights, both final expanded heights and heights during expansion. This “progressive protrusion” can be clinically useful. This can be done by engineering the design of the balloons to correlate with inflation pressures and/or inflation fluid volumes. This provides clinicians with variable control during use of these devices. 
     As noted above, further clinical advantages are offered by the present disclosure in that a topographically-variable balloon used can provide increased surface area to prevent acute migration of the balloon and/or encourage tissue ingrowth and/or thrombogenesis. This can be beneficial in balloon assemblies used as occluders. 
     In addition, balloon assemblies in accordance with present disclosure can be used to “scrub” or otherwise displace or remove thrombus or plaque in the vasculature. A coarse or textured topography can be helpful in enhancing engagement of the balloon assembly with the thrombus or plaque and/or helpful in occluding a blood vessel. For example, balloon assemblies in accordance with the present disclosure can be used in conjunction with a reverse blood flow system like those used in carotid artery stenting. In such reverse blood flow systems, balloon assemblies in accordance with present disclosure can be used to occlude the external carotid artery and/or the common carotid artery. Balloon assemblies in accordance with present disclosure can provide enhanced occlusion characteristics relative to conventional balloon assemblies. 
     In addition, balloon assemblies in accordance with present disclosure can be used as a balloon anchored introducer in a stenting procedure. A balloon assembly can be positioned in the body distal to the desired stent site. The balloon assembly can then be inflated to anchor the balloon assembly and thus provide support for a guidewire or other apparatus that can deliver and deploy a stent to the desired stent site. Balloon assemblies in accordance with present disclosure can provide enhanced anchoring characteristics relative to conventional balloon assemblies. 
     The following example details how an exemplary balloon of the present disclosure was constructed. 
     Example 1: Method of Making the Template with Apertures 
     An ePTFE film was obtained of the general type as disclosed in U.S. Pat. No. 7,306,729. A discontinuous layer of the thermoplastic FEP (fluoro ethylene propylene) was applied to one surface and the film was slit into a tape. The tape was wrapped around a 6 mm mandrel so that the film&#39;s machine direction was oriented about the circumference of the mandrel. A length of tape was wrapped that resulted in approximately 18 layers of film. The tape-wrapped tube was thermally treated in an oven at 320° C. for 12 minutes. The film tube was removed from the oven and then removed from the mandrel and cut to 80 mm in length. 
     The 6 mm tube was placed over a suitable mandrel and square apertures measuring 2 mm by 2 mm were cut through the tube using a CO2 laser, leaving 1 mm of film material between apertures. Six rows of apertures were cut about the circumference of the tube, parallel to the tube&#39;s longitudinal axis. The pattern was cut over a 60 mm length centered in the 80 mm tube. This tube is referred to as a “template” with “apertures.” 
     Example 2: Method of Making a Balloon Assembly Comprising a Size Limiting Layer Overlaying a Compliant Balloon, Both of which are Circumscribed by a Template with Apertures 
     An ePTFE film was obtained of the general type as disclosed in U.S. Pat. No. 5,476,589, entitled, “Porous PTFE Film And A Manufacturing Method Therefore,” which issued Dec. 19, 1995. The film was cut into a tape of 25 mm width and helically wrapped about a 9 mm stainless steel mandrel at an 11.4 mm pitch. The wraps were repeated on a bias in opposite directions to produce an approximately 4-layer film tube. 
     This tube was then thermally treated in an oven at 380° C. for 9 minutes and then removed from the oven. The tube was removed from the mandrel, placed over a 7 mm mandrel and axially stretched to decrease its diameter to 7 mm. A sacrificial ePTFE tape was helically wrapped over the film tube on the 7 mm mandrel. 
     The tube assembly was then axially compressed to 85% of its original length. The tube assembly was then subjected to thermal treatment at 380° C. for 1 minute and then removed from the oven. The sacrificial ePTFE layer was removed and discarded. The 7 mm tube construct was cut to an 80 mm length. This tube can be referred to as a “size limiting layer”. 
     A compliant polyurethane balloon catheter was obtained with a balloon having a diameter of 10 mm and length of 60 mm (“COAX,” Bavarian Medizin Technologies (BMT), Germany). 
     The size limiting layer was slid over the balloon assembly (with the balloon in its collapsed state). The ends of the size limiting layer were secured to the catheter using LOCTITE adhesive 4981 (Henkel Corporation, Düsseldorf, 40589 Germany) applied to a 6 mm wide ePTFE tape as it was wrapped 5 times about the size limiting layer tube ends. The balloon was then inflated to an approximate 5 mm diameter. 
     The template layer, as described in Example 2, was slid over the size-limiting layer and the compliant balloon (with the balloon at its 5 mm diameter). The ends of the template layer were secured to the catheter using LOCTITE adhesive 4981 applied to a 6 mm wide ePTFE tape as it was wrapped 5 times about the tube ends. The balloon was then inflated to an approximate 6 mm diameter. 
     The balloon assembly was then inflated to 4 atmospheres and protrusions of the underlying compliant balloon were noted extending from the apertures. 
     Example 3: Method of Making a Balloon Assembly Comprising a Size Limiting Layer Overlaying a Compliant Balloon, Both of which are Circumscribed by a Template with Apertures Having a First Distension Profile and a Second Distension Profile 
     In order to form a distensible template, construct a helically wrapped 8 mm film tube using an ePTFE film as described in U.S. Pat. No. 7,306,729, issued Dec. 11, 2007. Laser cut the 8 mm film tube to form 2 mm×2 mm openings. Reduce the template diameter by stretching the template in a longitudinal direction until the inside diameter of the template reaches approximately 4 mm. Insert a 4 mm mandrel into the 4 mm drawn down template. Over wrap the template on the 4 mm mandrel with a sacrificial film. Longitudinally compress (or scrunch) the over-wrapped template to approximately 60% of the original length. Bake the compressed template at 380° C. at a time ranging from (0 sec. to 120 sec.). This step sets the load at which the template will begin to distend. The lower the baking time, the smaller the load required to distend. Once set, remove the sacrificial film and the template from the 4 mm mandrel. 
     Obtain an inflatable, compliant balloon element constructed to be 8 mm×40 mm with a working length of 40 mm, two shoulders of length of 4 mm, and two seals of 7 mm, giving it an overall length of 62 mm. 
     Place an 8 mm×62 mm size limiting layer (constructed in a similar manner as described in Example 2) that has also been drawn down to 4 mm on a 4 mm mandrel. Cut the template to a length of (24 mm+7 mm to form the attachment to the size limiting layer at the seal), giving it an overall length of 31 mm. Slide the cut template over the size limiting layer that is on the 4 mm mandrel so the inside end of the template aligns with the center line of the size limiting layer. Wrap approximately 5 to 20 layers of a porous, sintered, sufficiently thin and strong ePTFE film, ½″wide using 4498 LocTite glue to adhere the template at center line of the size limiting layer. Remove the size limiting layer with the template attached from the 4 mm mandrel. 
     Place the 4 mm template and size limiting assembly over the compacted 8 mm balloon and secure both the proximal and distal ends (7 mm each) by wrapping approximately 10 or more layers of a porous, sintered, sufficiently thin and strong ePTFE film and 4498 LocTite adhesive around each end of the cover and catheter. 
     In another embodiment, a frangible template can be constructed as described in Example 3, instead using an ePTFE film as described in U.S. Pat. No. 5,814,405 Branca et al., which is hereby incorporated by reference in its entirety. 
     It will be apparent to those skilled in the art that various modifications and variations can be made in the present disclosure without departing from the spirit or scope of the disclosure. For example, while embodiments of the present disclosure have been described with reference to the inferior vena cava, embodiments are scaleable and applications in various central and peripheral vessels and lumens are contemplated herein. Additionally, the embodiments can be used in connection with not just humans, but also various organisms having mammalian anatomies. Thus, it is intended that the embodiments described herein cover the modifications and variations of this disclosure provided they come within the scope of the appended claims and their equivalents. 
     Benefits, other advantages, and solutions to problems have been described herein with regard to specific embodiments. However, the benefits, advantages, solutions to problems, and any element or combination of elements that can cause any benefit, advantage, or solution to occur or become more pronounced are not to be construed as critical, required, or essential features or elements of any or all the claims of the disclosure. Many changes and modifications within the scope of the instant disclosure can be made without departing from the spirit thereof, and the disclosure includes all such modifications. Corresponding structures, materials, acts, and equivalents of all elements in the claims below are intended to include any structure, material, or acts for performing the functions in combination with other claim elements as specifically claimed. The scope of the disclosure should be determined by the appended claims and their legal equivalents, rather than by the examples given above.