Patent Publication Number: US-2021186512-A1

Title: Devices, treatments and methods to restore tissue elastic recoil

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 16/444,849 (Attorney Docket No. 52086-703.302) filed Jun. 18, 2019, which is a continuation of PCT Application No. PCT/US18/67160, filed Dec. 21, 2018, (Attorney Docket No. 52086-703601), which claims priority to Provisional No. 62/609,761, filed Dec. 22, 2017, (Attorney Docket No. 52086-703.101); Provisional No. 62/651,573, filed Apr. 2, 2018, (Attorney Docket No. 52086-703.102); Provisional No. 62/714,411, filed Aug. 3, 2018, (Attorney Docket No. 52086-703.103); Provisional No. 62/720,004, filed Aug. 20, 2018, (Attorney Docket No. 52086-703.104); and 62/749,005, filed Oct. 22, 2018, (Attorney Docket No. 52086-703.105), the entire contents of which are incorporated herein by reference. 
    
    
     BACKGROUND OF THE INVENTION 
     Chronic obstructive pulmonary disease (COPD) is a common progressive, debilitating lung disease that is often fatal. COPD patients are diagnosed with either emphysema, chronic bronchitis or more commonly, a combination of both. The symptoms of COPD include a persistent cough, particularly one that produces excessive of mucus, shortness of breath (especially during exercise), a wheezing sound while breathing, a barrel-chest deformity, and tightness in the chest muscles due to expansion of the chest with the barrel-chest deformation. Late stages of COPD manifest in symptoms that relate more closely to slow persistent suffocation as the disease eventually nearly totally obstructs any outflow of gas from the lungs. Such symptoms may start as a minor impediment to daily life, but they often lead to difficulty in talking or basic breathing. COPD reduces oxygen and carbon dioxide gas exchange which leads to circulatory problems, such as low oxygen levels in the blood, brain and heart muscles. This negatively affects mental alertness and contributes to a very rapid heartbeat, due to increased strain on the heart. 
     According to the National Institutes of Health, COPD is the third leading cause of death in the United States. The American Lung Association reports that more than 11 million people in the United States have been diagnosed with COPD. However, about 24 million more people may have the disease and not know it. Globally, COPD affects approximately 65 million people. 
     COPD can occur in people suffering from an inherited genetic condition called Alpha-1 Antitrypsin Deficiency (A1AT Deficiency) and from breathing air in environmental conditions such as air pollution, contaminated air, in work environments that are not ideal etc. However, COPD most commonly occurs in people who are over age 40 and who have a history of smoking. Cigarette smoke is composed of over 4000 different chemicals, many of which are toxic. Both smoke that the smoker inhales (through the filter) and the smoke from the burning end are toxic. There are three main components that are hazardous to health: tar, nicotine and carbon monoxide. Tar settles in the lungs and stimulates a series of changes that lead to obstructive lung disease and lung cancer. Nicotine is an addictive element in cigarettes and also stimulates the nervous system to reduce arteriole diameter and release adrenaline, increasing heart rate and blood pressure. Nicotine also causes increased stickiness of blood platelets, which increases the risk of blood clotting. Carbon monoxide combines irreversibly with hemoglobin so that oxygen cannot bind effectively. This causes a strain on the heart muscle because it must pump more to provide the same amount of oxygen. 
     Tobacco smoke and secondhand smoke travel down through the windpipe and into the bronchial tubes. The toxic smoke then moves into the bronchioles, which contain the small clusters of air sacs known as alveoli. Within the alveoli are the capillaries. In a healthy person, oxygen moves through the alveoli and into the capillaries and bloodstream during inhalation, allowing oxygen rich blood to be distributed to the rest of the body via the arterial system. Simultaneously, carbon dioxide is transported from blood along venous pathways to the capillaries and into the alveoli so it can be removed from the body during exhalation. This process is known as gas exchange. The elasticity of healthy air sacs enables this exchange to occur during lung volume change with breathing cycles. However, the inhalation of smoke ultimately destroys this elasticity and lung tissue itself. 
     The effect of tobacco smoke on lung elastin is extremely complicated, affecting many facets of connective tissue metabolism. Inhalation of cigarette smoke causes an accumulation in the respiratory bronchi of alveolar macrophages, which appear to be filled with pigments and are metabolically and morphologically activated. The activated macrophage has the ability to secrete chemo attractants and secretagogues for neutrophils, as well as secrete a metalloprotease capable of digesting elastin and α 1  antiprotease. The end result is a clustering of large numbers of neutrophils and macrophages, poised to release considerable amounts of elastolytic enzymes at the site where the earliest signs of centrilobular emphysema are detected. This is seen, in X-ray images of the lung as small pockets of dissolved tissue known as blebs. In addition to this, the alveolar macrophages, as well as cigarette smoke, are rich sources of oxidizing agents. One potential action of these oxidants would be to oxidize the methionine residue found at the active site of α 1  proteinase inhibitor. This has been shown by selective chemical oxidation to yield a relatively ineffective inhibitor that associates with elastase some 2000 times more slowly than the native protein. This results in oxidant damage to lung cells and cellular components such as lipids, cofactors, and nucleic acids. Endogenous antioxidant systems within the lung, such as ceruloplasmin, vitamin C, or methionine sulphoxide-peptide reductase, are adversely affected by cigarette smoke, lowering the lung&#39;s defense against oxidants. The elastin maturation process is impaired by cigarette smoke. 
     Such damage affects the walls between the alveolar sacs. As the air sacs weaken, their walls break open or “melt”, creating one large air sac instead of many smaller ones. The total surface area of the air sacs is reduced, and this reduces that amount of gas that can be exchanged across the walls of the air sacs. These gasses are transported across the thin air sac membrane surfaces using a diffusion process. By reducing the majority of air sacs, the total surface area of the sacs is limited causing gas exchange to be reduced. This makes it more difficult for the capillaries to absorb enough oxygen and for the body to expel carbon dioxide, making it progressively harder to breathe. In addition, the air sacs lose their elasticity making it harder to recoil and expel air. The walls of the airways thicken and become swollen while making more mucus than normal which can clog the airways that lead to the air sacs. The thickening and mucus plugging are the chronic bronchitis component of COPD. All of these factors contribute to the symptoms of COPD. 
     Another common COPD symptom is air trapping which causes breathing disfunction as well as lobar and lung hyperinflation. The reduced volume reached by the lungs after exhalation is determined by the balance of forces between the inward elastic recoil pressure, or inward pulling tension of the lung tissue that lifts the diaphragm and the outward recoil pressure or outward pulling of the chest wall. The lung is suspended in an expanded state due to negative pressure or vacuum between the chest wall and the exterior lining of the lung. This vacuum keeps the lung expanded and pinned to the chest wall. Because the lungs are held in a generally expanded state, interior lung tissue (parenchyma) is stressed in tension (creating lung elastic resistance to stretching, commonly referred to as lung elastic recoil). This tension, throughout the lung, pulls radially outward on the airways to hold these airways open and the tension helps to allow air to be squeezed out of the lungs during the expiration breathing cycle. During expiration, the diaphragm muscle is relaxed, and the lung&#39;s internal elastic recoil lifts the diaphragm and lung floor up which reduces the lung volume and squeezes air out of the lung. During inspiration, the diaphragm muscle contracts to pull the diaphragm down which increase lung volume which draws air back into the lungs. Static hyperinflation occurs when the lungs exert less recoil pressure to counter the recoil pressure of the chest wall due to the destruction of elastin. This results in an equilibrium of recoil forces at a higher resting volume than normal. In other words, there is less recoil so the diaphragm cannot be lifted as far and the lungs ability to expel air is reduced. This creates a chronic increase in lung volume, also known as increased total lung capacity (TLC). Dynamic hyperinflation occurs when air is trapped within the lungs after each breath due to a disequilibrium between the volumes inhaled and exhaled. This most commonly occurs during exercise and inspiration is more efficient than expiration. With each breath, hyperinflation is increased. The ability to fully exhale depends on the degree of airflow limitation and the time available for exhalation. Both types of air trapping causes 1) lung gas congestion, preventing new oxygen from being inspired, 2) retainment of CO 2  in the lung and blood stream (hypoxemia) and 3) crushing of better functioning lobes making them incapable of inspiration or expiration. The last phenomenon occurs because the trapping often occurs in places with the most lung tissue destruction (regions with the greatest reduction of recoil). As more air is trapped in this area and the lobe hyperinflates, it expands into regions where tissue is better preserved and still performing well but the added pressure of the inflated tissue restricts air flow in and out of the healthier region. 
     Ultimately, enzymes destroy and eliminate airways and alveoli tissue. Large holes are formed in alveoli beds forming pulmonary blebs and bullae. Pulmonary blebs are small subpleural thin walled air pockets, not larger than 1-2 cm in diameter. Their walls are less than 1 mm thick. If they rupture, they allow air to escape into the pleural space between the lung and chest wall, which is normally holding the lungs expanded and pinned to the chest wall with vacuum, resulting in a spontaneous pneumothorax or collapse of the lung. Pulmonary bullae, like blebs, are cystic air spaces or pockets that have an imperceptible wall (less than 1 mm). The difference between blebs and bullae is generally considered to be their size, with the cross-over being around 2 cm in diameter. Blebs may, over time, coalesce to form bullae. 
     Smoking cessation continues to be an important therapeutic intervention for COPD. Approaches to management by stage include the following:
         Stage I (mild obstruction): Short-acting bronchodilator as needed;   Stage II (moderate obstruction): Short-acting bronchodilator as needed; long-acting bronchodilator(s); cardiopulmonary rehabilitation;   Stage III (severe obstruction): Short-acting bronchodilator as needed; long-acting bronchodilator(s); cardiopulmonary rehabilitation; inhaled glucocorticoids if repeated exacerbations;   Stage IV (very severe obstruction or moderate obstruction with evidence of chronic respiratory failure): Short-acting bronchodilator as needed; long-acting bronchodilator(s); cardiopulmonary rehabilitation; inhaled glucocorticoids if repeated exacerbation; long-term oxygen therapy (if criteria met); interventions such as lung transplantation, lung volume reduction surgery (LVRS), or implantable therapeutic devices.       

     Lung volume reduction surgery (LVRS) is a surgical procedure to remove diseased, emphysematous lung tissue. The surgery removes up to ⅓ of the lung to attempt to remove non-gas exchanging portions of lung. This is intended to remove sections of non-performing tissue that can no longer exchange gas to and from the blood stream. It is also intended to remove blood vessels that would otherwise shunt under oxygenated blood with high levels of CO2 (vessels traveling through portions of the lung where gas cannot be exchanged) back to the heart and blood circulatory system. However, this surgery presents patients with high risk of surgery related morbidity and mortality. Patients who already have distressed breathing due to the disease are further stressed with severe orthopedic trauma due to a sternotomy, which presents difficulty in reviving these patients from general anesthesia. LVRS related mortality and morbidity is a common result as was published in the National Emphysema Treatment Trial (NETT) report. NETT was a multicenter, randomized, controlled clinical trial, comparing the efficacy of lung volume reduction surgery (LVRS) plus medical management with rehabilitation to medical management with rehabilitation in 1,218 patients with severe emphysema. 
     LVRS is performed with a long simple excision to remove a large portion of lung volume. Thus, it is not discriminative in the tissue that is removed. LVRS also removes portions of remaining intact lung that would otherwise exchange gas. This reduces lung capacity that patients need to exchange gas. LVRS is also not effective for homogenous disease, which is the type that most COPD patients suffer from. In homogenous disease, the disease is spread evenly in all lobes without a discrete target lung volume that can be sacrificed to enhance lung elastic recoil. Homogenous patients need therapy because they suffer from an insufficient lung capacity to exchange gas. Removing more lung tissue only reduces their capacity. Therefore, the surgery actually degrades these patient&#39;s ability to breathe. 
     A variety of implantable therapeutic devices have been developed to assist in treating COPD sufferers. One such device is an endobronchial valve. An endobronchial valve is minimally invasive alternative to lung volume reduction surgery (LVRS). Endobronchial valves were designed to replicate the effects of that procedure without requiring incisions by allowing the most diseased lobe of a lung to be pneumatically blocked off so air can be evacuated to cause the treatment lobe to collapse. An endobronchial valve is a small, one-way valve that is typically implanted such that when a patient exhales, air is able to flow through the valve and out of the lobe, but when the patient inhales, the valve closes and blocks air from entering that lobe. Thus, a set of implanted endobronchial valves can help a lobe to empty itself of air. This has been shown to be beneficial in the treatment of a very small population of patients suffering from heterogenous emphysema, however such endobronchial valves suffer from some of the same limitations as LVRS. Endobronchial valves that succeed to collapse lobes in homogenous patients reduce their already insufficient lung capacity. Homogeneous disease is the type that most COPD patients suffer from. Thus, the valves may actually degrade these patient&#39;s ability to breathe. Another limitation with the valves is the fact that approximately 80% of patients present with additional flow paths that lead into the lobe in addition to the major airway tree that is typically shown in anatomy texts. The valves are designed to block flow in airways but in the majority of patients, total blockage or perfect pneumatic isolation can never be achieved and the lobe never collapses. Many times, the alternate flow paths are created by enzyme destruction due to the disease itself. This is particularly true in heterogenous patients where tissue damage is concentrated. 
     A similar type of therapy involves an endoscopic volume reduction using lung sealant. The lung sealant foam is instilled into the peripheral airways and alveoli where it polymerizes and functions as tissue glue on the lungs inner surfaces in order to seal the target region to cause durable irreversible absorption atelectasis or collapse of the lung tissue. Such treatment by a biological sealant produces an irreversible change in emphysematous tissue. The biological sealant is delivered to the alveolar compartment as separate liquid components via a dual lumen catheter passed through the instrument channel of a flexible bronchoscope. A common side effect is a systemic flu-like inflammatory reaction after the foam sealant application accompanied by transient fever, cough, bronchospasm, chest pain, leukocytosis, malaise, and elevated C-reactive protein levels. This side effect is sometimes self-limited and resolves within 24-96 h spontaneously. Other times, the inflammation can cause long term morbidity and even mortality. Other serious pulmonary side effects within 6 months after the procedure include repetitive COPD exacerbations, pneumonia, bronchitis, and hemoptysis. Over a period of several weeks, the treated lung region will start to shrink, reducing lung volume by atelectasis. However, such treatment again ultimately suffers from some of the same limitations as LVRS. In particular, lung sealants destroy lung tissue and reduce lung capacity so they are not effective for homogenous disease, which is the type that most COPD patients suffer from. Thus, these techniques actually degrade these patient&#39;s ability to breathe. 
     Endobronchial coils are another type of therapeutic device developed to assist in treating COPD sufferers and act as a minimally invasive alternative to lung volume reduction surgery (LVRS). Endobronchial coils are nitinol devices implanted bronchoscopically under fluoroscopic guidance. The coils are straightened so they can be passed through a bronchoscope and into airways for deployment and then they are pushed out of the catheter and allowed to recover to a programmed shape that bends the airway they are deployed into. The device bends the airway to compress adjacent tissue to cause a small lung volume reduction effect. As multiple coils revert to their original double-loop shape within the airways, targeted pockets of lung tissue are compressed between features of the coil to replicate the effects of the LVRS in a minimally invasive treatment. Multiple coils implanted throughout a lobe attempt to achieve mechanical volume reduction. However, such bending and folding of the airways increases resistance to gas flow which blocks the airways from flowing efficiently to exchange gas. The bending also compresses tissue by permanently freezing motion in portions of the lung volume and preventing those portions from efficiently contributing to exchanging gas. Thus, there is limited inspiration and expiration in those regions which reduces the patient&#39;s capacity to breathe. In addition, the coil design and dimensions provide a very small contact area which produces high pressure and compressive stress on the lung tissue. This potentially allows for a kind of “cheese wire” cutting effect that limits the effective time that a treatment remains effective, even if initial results are positive. The coils are strong enough to bend thick collagenous airways with substantial walls that would not be easily abraded or subject to device related tissue erosion or migration. However, due to the nature of the disease and the enzymatic destruction in COPD patients, substantial, thick walled airways are nearly absent beyond the 4th airway generation in patients with the requisite degree of disease that would require this type of intervention. The typical disease related tissue destruction leaves only fragile segments of thin tissue in areas in contact with the coils and this can only accelerate the “cheese wire” effect which may reduce the potential for treatment success substantially. In addition, blood vessels run parallel to most lung airways and they are of comparable size with respect to the airway. It is inadvisable to bend central airways (2nd-4th generation) as a blood vessel could easily be pinched closed or ruptured. Since the patient&#39;s entire cardiac pumping capacity is routed through the lungs and these vessels, the use of such coils on these airways would present the patient with extreme risk. 
     Devices such as the endobronchial coils and endobronchial valves that are mechanical structures suffer from fatigue related failure due to the high number of breathing cycles that these products endure and the nature of the flexure that lung airways present on these devices. In order to clear mucus, airways compress flat during coughing to reduce the cross-sectional area of the airway which increases the velocity of expelled gas and this increases the effectiveness of a cough event in clearing unwanted materials from the lung. In many cases, device failure occurs where metallic or stiff biocompatible materials are placed in the lungs where coughing presents the devices with repeated high force flexure and airway collapse. Another cause for device failure is tissue irritation and granular buildup of airway wall tissue and the formation of bacterial colonies that are commonly found on implanted polymers in the lung. Most devices that have been previously proposed to treat COPD in the past have included one or more design flaws to cause granulation tissue formations or bacterial colonization&#39;s which are nearly impossible to remove or otherwise treat. 
     Thus, additional treatment options are desired, particularly for treatment of homogenous COPD where LVRS is particularly ineffective and potentially harmful. Such treatment options should avoid blocking off, rendering non-functioning or removing segments of the lung in the manner of LVRS. In addition, such treatment options should avoid deleterious compression of tissue. Compression of lung tissue can compress and block blood vessels leading to tissue necrosis and cell death, which in turn causes chronic air leaks and eventual lung collapse due to breaching of the vacuum seal between the lungs and chest wall. Such treatment options should also be suitable for patients with late stage COPD. These patients typically do not have any anatomically normal airways past the 4 th  generation where the anatomy is comprised of extremely weak, destroyed alveoli tissue which continues to degrade. The ideal solution will be a device that treats COPD that is manufactured with a minimum number of joints or features that may present sharp edges, sharp and traumatic ends against soft tissues and that is made using materials and using methods that minimizes the potential for bacterial colonization and the formation of granulation tissue in airways. At least some of these objectives will be met by the present invention. 
     SUMMARY OF THE INVENTION 
     The present invention generally relates to medical systems, devices and methods, and more particularly relates to treatment of patients suffering from COPD. Likewise, the present invention relates to the following numbered clauses: 
     1. A pulmonary treatment device for treating a lung comprising: 
     a tissue gathering element having a shape configured to engage a portion of lung tissue within the lung by rotating the tissue gathering element around a rotational axis and wherein the tissue gathering element has a stiffness configured to move the portion of lung tissue around the rotational axis into a torqued configuration; and 
     an anchoring element configured to resist movement of the engaged portion of the lung from the torqued configuration once deployed. 
     2. A device as in claim  1 , wherein the pulmonary treatment device has a longitudinal axis, and wherein the rotational axis is concentric with the longitudinal axis. 
     3. A device as in claim  2 , wherein the anchoring element comprises at least one turn of a coil which is concentric with the longitudinal axis. 
     4. A device as in claim  2  or  3 , wherein the anchoring element comprises a shaft which forms an angle with the longitudinal axis. 
     5. A device as in any of the above claims, wherein the shape of the tissue gathering element includes at least one loop. 
     6. A device as in claim  5 , wherein the at least one loop comprises a single loop. 
     7. A device as in claim  5 , wherein the at least one loop comprises a pair of loops. 
     8. A device as in claim  7 , wherein the pair of loops extend in opposite directions. 
     9. A device as in claim  7 , wherein the pair of loops extend radially outwardly from a longitudinal axis along the pulmonary treatment device at an angle from each other that is less than 180 degrees. 
     10. A device as in any of claims  5 - 9 , wherein at least one of the at least one loop extends radially outwardly from a longitudinal axis along the pulmonary treatment device and curves at least partially back toward the longitudinal axis. 
     11. A device as in claim  10 , wherein the at least one of the at least one loop comprises a half loop. 
     12. A device as in claim  10 , wherein the at least one of the at least one loop extends radially outwardly from a longitudinal axis along the pulmonary treatment device and curves back toward the longitudinal axis crossing the longitudinal axis. 
     13. A device as in any of claims  5 - 12 , where each of the at least one loops has a diameter in the range of 10 mm to 50 mm. 
     14. A device as in any of the above claims, wherein the tissue gathering element has a width in a range of 0.25 to 3 inches. 
     15. A device as in any of the above claims, wherein the tissue gathering element is comprised of a wire ribbon having a width in the range of 0.040 and 0.100 inches. 
     16. A device as in claim  15 , wherein the wire ribbon is twisted along its length at at least one location so as to rotate at least one portion of a flat surface of the wire ribbon toward an edge of the wire ribbon. 
     17. A device as in claim  16 , wherein the wire ribbon is twisted along its length at multiple locations so as to rotate a series of portions of the flat surface of the wire ribbon toward the edge of the wire ribbon. 
     18. A device as in any of the above claims, wherein the tissue gathering element and the anchoring element are formed together from a single continuous shaft. 
     19. A device as in any of the above claims, wherein the tissue gathering element and/or the anchoring element are comprised of a wire. 
     20. A device as in claim  19 , wherein the wire is comprised of a metal, stainless steel, steel containing chromium, steel containing cobalt, steel containing chrome, a metal alloy with nickel and/or titanium, a biocompatible metal, nitinol or a shape-memory alloy. 
     21. A device as in any of the above claims, wherein the tissue gathering element and/or the anchoring element comprise a jacket configured increase surface area for engagement. 
     22. A device as in any of the above claims, further comprising an attachment feature configured for attachment with a tool. 
     23. A device as in claim  22 , wherein the tool comprises a torqueing tool. 
     24. A device as in claim  22 , wherein the tool comprises a deployment element. 
     25. A device as in any of claims  22 - 24 , wherein the attachment feature comprises a loop. 
     26. A device as in any of claims  22 - 24 , wherein the attachment feature comprises a hole, opening or slot. 
     27. A device as in any of claims  22 - 24 , wherein the attachment feature comprises an attachment element configured to hold the tissue gathering element and the anchoring element together while forming a desired shape for attachment. 
     28. A device as in claim  27 , wherein the desired shape is configured for torqueing. 
     29. A device as in any of the above claims, further comprising an extendable midsection. 
     30. A device as in claim  29 , wherein the extendable midsection has a shape of an elastic spring or coil. 
     31. A device as in any of claims  29 - 30 , wherein the extendable midsection has a length in the range of 5-75 mm in resting free space. 
     32. A device as in any of claims  29 - 31 , wherein the extendable midsection has a potential longitudinal elongation in the range of 10-200 mm. 
     33. A device as in any of the above claims, wherein the anchoring element is configured to apply radial force against a wall of an airway lumen. 
     34. A device as in any of the above claims, wherein the anchoring element is configured to extend into a secondary airway lumen adjacent to a primary airway lumen through which the tissue gathering element has entered. 
     35. A device as in any of the above claims, wherein the anchoring element comprises at least one loop. 
     36. A device as in any of the above claims, wherein the anchoring element comprises a stent. 
     37. A device as in any of the above claims, wherein the torqued configuration reduces an ability of the lung to trap air. 
     38. A device as in any of the above claims, wherein the torqued configuration increases tension within the lung. 
     39. A pulmonary treatment device having a longitudinal axis for treating a portion of a lung comprising: 
     a tissue gathering element disposed near a first end of the pulmonary treatment device, wherein the tissue gathering element has a shape configured to engage lung tissue within the lung during rotation of the tissue gathering element around the longitudinal axis so that the engaged lung tissue moves around the longitudinal axis into a torqued configuration; and 
     an anchoring element disposed near a second end of the pulmonary treatment device, wherein the anchoring element resists movement of the engaged lung tissue from the torqued configuration once deployed. 
     40. A pulmonary treatment device positionable at least partially within a lung passageway of a lung leading to compromised tissue, the device comprising: 
     a tissue gathering element disposed near a first end of the pulmonary treatment device, wherein the tissue gathering element is configured so that rotation of the pulmonary treatment device engages the tissue gathering element with a portion of the compromised tissue so as to move the portion of the compromised tissue into a torqued configuration; and 
     an anchoring element disposed near a second end of the pulmonary treatment device, wherein the anchoring element is configured to be deployed within the lung passageway so as to resist movement of the engaged compromised tissue from the torqued configuration while maintaining patency of the lung passageway. 
     41. A device as in claim  40 , wherein the compromised tissue comprises pulmonary blebs or bullae. 
     42. A device as in claim  40 , wherein the compromised tissue comprises loose parenchyma. 
     43. A device as in any of claims  40 - 42 , wherein the lung passageway comprises a fourth-generation airway. 
     44. A device as in any of claims  40 - 43 , wherein the tissue gathering element comprises at least one loop. 
     45. A device as in claim  44 , wherein the at least one loop comprises a single loop. 
     46. A device as in claim  44 , wherein at least one of the at least one loop extends radially outwardly from a longitudinal axis along the pulmonary treatment device and curves at least partially back toward the longitudinal axis. 
     47. A device as in any of claims  40 - 46 , wherein the tissue gathering element is comprised of a wire ribbon having a width in the range of 0.040 and 0.100 inches. 
     48. A device as in any of claims  40 - 47 , wherein the tissue gathering element includes a tip configured to pass through the compromised tissue. 
     49. A device as in any of claims  40 - 48 , wherein the tissue gathering element and the anchoring element are formed together from a single continuous shaft. 
     50. A device as in any of claims  40 - 49 , wherein the tissue gathering element and/or the anchoring element comprise a jacket configured increase surface area for engagement. 
     51. A device as in any of claims  40 - 50 , further comprising an attachment feature configured for attachment with a tool. 
     52. A device as in claim  51 , wherein the tool comprises a torqueing tool. 
     53. A device as in any of claims  40 - 52 , further comprising an extendable midsection. 
     54. A device as in claim  53 , wherein the extendable midsection has a shape of an elastic spring or coil. 
     55. A device as in any of claims  40 - 54 , wherein the anchoring element is configured to apply radial force against a wall of the lung passageway. 
     56. A device as in any of claims  40 - 55 , wherein the anchoring element comprises at least one loop. 
     57. A device as in any of claims  40 - 55 , wherein the anchoring element comprises a stent. 
     58. A device as in any of claims  40 - 57 , wherein the torqued configuration reduces an ability of the lung to trap air. 
     59. A device as in any of claims  40 - 58 , wherein the torqued configuration increases tension within the lung. 
     60. A system for treating a portion of a lung comprising: 
     a pulmonary treatment device comprising a tissue gathering element and an anchoring element, wherein the tissue gathering element is configured to receive torqueing force which rotates the tissue gathering element so as to engage tissue within the portion of the lung and move the tissue into a torqued configuration, and wherein the anchoring element is configured to resist rotation of the tissue gathering element once deployed; and 
     a torqueing tool configured to engage the pulmonary treatment device so as to impart the torqueing force to the tissue gathering element. 
     61. A system as in claim  60 , wherein the pulmonary treatment device comprises an attachment feature configured for releasably joining with the torqueing tool. 
     62. A system as in claim  61 , wherein the attachment feature comprises a loop, hole, opening or slot. 
     63. A system as in claim  62 , wherein the torqueing tool has a protrusion configured to pass through the loop, hole, opening or slot so as to releasably join the torqueing tool to the attachment feature. 
     64. A system as in any of claims  61 - 63 , further comprising a hitch wire configured to maintain joining of the torqueing tool with the attachment feature while in an engaged position. 
     65. A system as in claim  64 , wherein the hitch wire is configured to be moved to a disengaged position which releases joining of the torqueing tool to the attachment feature. 
     66. A system as in claim  65 , wherein the torqueing tool is comprised of a shape memory material and wherein the torqueing tool is configured to return toward a pre-set shape upon release by the hitch wire which withdraws the torqueing tool from the attachment feature. 
     67. A system as in any of claims  60 - 66 , further comprising a tether configured to attach to the pulmonary treatment device, wherein the tether is configured to move at least a portion of the pulmonary treatment device along a longitudinal axis around which the tissue gathering element is configured to rotate. 
     68. A system as in claim  67 , wherein the tether is configured to move to at least a portion of the pulmonary treatment device along the longitudinal axis in a proximal direction. 
     69. A system as in any of claims  67 - 68 , wherein the tether comprises a suture, a metallic wire, a monofilament or multifilament fiber, a braid, a polymer fiber, a ceramic, a glass fiber, a Kevlar® fiber, a carbon fiber, a nylon fiber, a polyurethane fiber, a polypropylene fiber or any combination of these. 
     70. A system as in any of claims  67 - 69 , wherein the pulmonary treatment device includes an additional attachment feature configured for attachment to the tether. 
     71. A system as in claim  70 , wherein the additional attachment feature comprises a loop, opening, hole or slot. 
     72. A system as in any of claims  60 - 71 , further comprising a catheter having a lumen at least partially therethrough, and wherein the pulmonary treatment device is transitionable to a collapsed configuration so as to pass through the lumen of the catheter. 
     73. A system as in claim  72 , wherein the pulmonary treatment device has a longitudinal axis alignable with a longitudinal axis of the lumen when in the collapsed configuration and wherein the pulmonary treatment device is transitionable from the collapsed configuration to an expanded configuration upon release from the lumen. 
     74. A system as in claim  73 , wherein the pulmonary treatment device is configured so that transition from the collapsed configuration to the expanded configuration includes bending of at least a portion of the tissue gathering element radially outwardly away from the longitudinal axis of the pulmonary treatment device. 
     75. A system as in claim  74 , wherein the tissue gathering element comprises at least one loop extending radially outwardly away from the longitudinal axis of the pulmonary treatment device and curving back toward the longitudinal axis of the pulmonary treatment device. 
     76. A system as in claim  73 , wherein the anchoring element comprises a coil and wherein the pulmonary treatment device is configured so that transition from the collapsed configuration to the expanded configuration includes expansion of the coil. 
     77. A system as in claim  73 , wherein the anchoring element comprises a shaft and wherein the pulmonary treatment device is configured so that transition from the collapsed configuration to the expanded configuration includes bowing of the shaft angularly outward from the longitudinal axis of the pulmonary treatment device. 
     78. A system as in any of claims  72 - 77 , wherein the catheter is sized and configured to enter a fourth-generation airway. 
     79. A system as in any of claims  72 - 78 , wherein the catheter includes at least one leverage element disposed near its proximal end, wherein the catheter is configured so that torqueing force applied to the at least one leverage element is transmitted to a distal end of the catheter. 
     80. A system as in any of claims  72 - 79 , wherein the catheter includes at least one leverage element disposed near its proximal end, wherein the catheter is configured so that longitudinal force applied to the at least one leverage element moves the catheter longitudinally along its length. 
     81. A system as in any of claims  72 - 80 , further comprising a delivery device having a working channel through which the catheter is configured to pass. 
     82. A system as in claim  81 , wherein the delivery device includes a mechanism for visualization within the lung. 
     83. A system as in claim  81 , wherein the delivery device comprises a bronchoscope. 
     84. A system as in claim  83 , wherein the bronchoscope comprises an insertion cord having an outer diameter in the range of 2 mm and 3 mm. 
     85. A system for treating a lung comprising: 
     a delivery device comprising an elongate shaft configured to extend through a lung passageway to a portion of the lung, wherein the elongate shaft has a lumen extending at least partially therethrough; 
     a pulmonary treatment device comprising a tissue gathering element having a first configuration shaped to pass through the lumen of the elongate shaft along a longitudinal axis and a second configuration wherein at least a portion of the tissue gathering element extends radially outwardly from the longitudinal axis and is configured to gather loose tissue within the portion of the lung. 
     86. A system as in claim  85 , wherein the loose tissue comprises blebs and/or bullae. 
     87. A system as in any of claims  85 - 86 , wherein the at least a portion of the tissue gathering element extending radially outwardly from the longitudinal axis has a loop shape extending at least partially around the longitudinal axis. 
     88. A system as in claim  87 , wherein the loop shape comprises a single loop concentric with the longitudinal axis. 
     89. A system as in claim  87 , wherein the loop shape comprises a plurality of loops extending around the longitudinal axis. 
     90. A system as in claim  87 , wherein the at least a portion of the tissue gathering element extending radially outwardly from the longitudinal axis has a loop shape extending at least partially around a parallel axis which is parallel to the longitudinal axis. 
     91. A system as in claim  90 , wherein the parallel axis is offset from the longitudinal axis by 3-30 mm. 
     92. A system as in any of claims  85 - 91 , wherein the pulmonary treatment device is configured to penetrate the loose tissue. 
     93. A system as in any of claims  85 - 92 , wherein the pulmonary treatment device comprises an anchoring element configured to anchor the pulmonary treatment device within the lung passageway. 
     94. A system as in claim  93 , wherein the anchoring element comprises at least one turn of a coil. 
     95. A system as in claim  94 , wherein the at least one turn of a coil is sized and configured to expand within an ostium. 
     96. A system as in any of claims  93 - 95 , wherein the pulmonary treatment device comprises an extendable midsection between the tissue gathering element and the anchoring element. 
     97. A system as in claim  96 , wherein the extendable midsection comprises a coil. 
     98. A system as in any of claims  96 - 97 , wherein the tissue gathering element, the extendable midsection and the anchoring element are formed together from a single continuous shaft. 
     99. A system as in any of claims  93 - 98 , wherein the tissue gathering element and/or the anchoring element comprise a jacket configured to increase surface area. 
     100. A system as in any of claims  85 - 99 , further comprising a deployment element configured to extend through the elongate shaft of the delivery device and to attach to the pulmonary treatment device. 
     101. A system as in claim  100 , wherein the deployment element comprises a tether, wherein the tether comprises a suture, a metallic wire, a monofilament or multifilament fiber, a braid, a polymer fiber, a ceramic, a glass fiber, a Kevlar® fiber, a carbon fiber, a nylon fiber, a polyurethane fiber, a polypropylene fiber or any combination of these. 
     102. A system as in any of claims  100 - 101 , wherein the deployment element has at attachment mechanism configured to attach to an attachment feature on the pulmonary treatment device. 
     103. A system as in any of claims  100 - 102 , wherein the deployment element is configured to move the pulmonary treatment device within the lumen of the elongate shaft of the delivery device. 
     104. A system as in claim  103 , wherein the pulmonary treatment device comprises an anchoring element configured to anchor the pulmonary treatment device within the lung passageway, and wherein the deployment element is configured to move the pulmonary treatment device within the lumen so that the tissue gathering element deploys while the anchoring element resides within the delivery device. 
     105. A system as in claim  104 , wherein the deployment element is configured to lock position in relation to the delivery device so that retraction of the delivery device pulls the loose tissue gathered by the tissue gathering element. 
     106. A system as in claim  105 , wherein the pulmonary treatment device comprises an extendible midsection configured to extend during retraction of the delivery device. 
     107. A system as in any of claims  85 - 106 , wherein the delivery device comprises a bronchoscope. 
     108. A system as in claim  107 , wherein the bronchoscope comprises an insertion cord having an outer diameter in the range of 2 mm and 3 mm. 
     109. A system as in any of claims  85 - 108 , wherein the tissue gathering element is configured to gather the loose tissue by rotation of the tissue gathering element around the longitudinal axis so as to move the loose tissue into a torqued configuration. 
     110. A system as in claim  109 , wherein the pulmonary treatment device further comprises an anchoring element configured to resist movement of the loose tissue from the torqued configuration once deployed. 
     111. A system as in claim  110 , wherein the anchoring element comprises at least one turn of a coil which is concentric with the longitudinal axis. 
     112. A system as in any of claims  110 - 111 , wherein the anchoring element comprises a shaft which forms an angle with the longitudinal axis. 
     113. A system as in any of claims  110 - 112 , wherein the shape of the tissue gathering element includes at least one loop. 
     114. A system as in any of claims  100 - 113 , further comprising a torqueing tool having an attachment feature configured for attachment with the pulmonary treatment device. 
     115. A system as in any of claims  85 - 114 , wherein the torqued configuration reduces an ability of the lung to trap air. 
     116. A system as in any of claims  85 - 115 , wherein the torqued configuration increases tension within the lung. 
     117. A method of treating a lung comprising: 
     inserting a tissue gathering element of a pulmonary treatment device into the lung so that the tissue gathering element engages lung tissue; 
     rotating the tissue gathering element of the pulmonary treatment device so that a portion of the lung tissue is moved around a rotational axis into a torqued configuration; and 
     anchoring the pulmonary treatment device so as to assist in maintaining the torqued configuration. 
     118. A method as in claim  117 , wherein the lung tissue comprises loose parenchyma. 
     119. A method as in claim  118 , wherein the loose parenchyma comprises blebs or bullae. 
     120. A method as in any of claims  117 - 119 , wherein the torqued configuration reduces lung volume of the lung. 
     121. A method as in any of claims  117 - 120 , wherein the tissue gathering element comprises at least one curved shaft and wherein inserting the tissue gathering element comprises extending the at least one curved shaft radially outwardly from a longitudinal axis along the pulmonary treatment device. 
     122. A method as in claim  121 , wherein inserting the tissue gathering element comprises extending at least one of the at least one curved shaft radially outwardly so as to form a loop shape extending at least partially around an axis perpendicular to the longitudinal axis. 
     123. A method as in claim  122 , wherein inserting the tissue gathering element comprises extending at least one of the at least one curved shaft radially outwardly so as to form the loop shape extending at least partially around the axis perpendicular to the longitudinal axis and crossing the longitudinal axis. 
     124. A method as in any of claims  121 - 123 , wherein inserting the tissue gathering element comprises extending at least one of the at least one curved shaft radially outwardly so as to form a loop shape extending at least partially around the longitudinal axis. 
     125. A method as in any of claims  121 - 124 , wherein inserting the tissue gathering element comprises extending at least one of the at least one curved shaft radially outwardly so as to form a loop shape extending at least partially around an axis parallel to the longitudinal axis. 
     126. A method as in any of claims  117 - 125 , wherein the pulmonary treatment device comprises an anchoring element and wherein anchoring the pulmonary treatment device comprises deploying the anchoring element. 
     127. A method as in claim  126 , wherein anchoring the pulmonary treatment device comprises deploying the anchoring element within an airway. 
     128. A method as in claim  127 , wherein the anchoring element comprises at least one turn of a coil and anchoring the pulmonary treatment device comprises deploying the anchoring element so that the coil expands and applies force to a wall within the airway. 
     129. A method as in claim  128 , wherein rotating the tissue gathering element comprises rotating the tissue gathering element in a direction opposite to the at least one turn of the coil. 
     130. A method as in any of claims  127 - 129 , wherein the anchoring element comprises at least one shaft which bows angularly away from the longitudinal axis, and wherein anchoring the pulmonary treatment device comprises positioning at least one of the at least one shaft into the airway. 
     131. A method as in claim  130 , wherein inserting the tissue gathering element of the pulmonary treatment device comprises passing the tissue gathering element through a first airway, and wherein anchoring the pulmonary treatment device comprises positioning at least one of the at least one shaft into a second airway. 
     132. A method as in any of claims  117 - 131 , wherein inserting comprises passing the tissue gathering element at least partially through a lumen of a delivery device. 
     133. A method as in claim  132 , wherein the delivery device comprises a bronchoscope. 
     134. A method as in claim  132 , wherein the delivery device comprises a catheter. 
     135. A method as in claim  134 , further comprising advancing the catheter through a bronchoscope. 
     136. A method as in any of claims  117 - 135 , wherein a torqueing tool is releasably attached to the pulmonary treatment device and wherein rotating the tissue gathering element comprises rotating the tissue gathering element with the use of the torqueing tool. 
     137. A method as in claim  136 , wherein the torqueing tool is releasably attached to the pulmonary treatment device by the insertion of a protrusion of the torqueing tool into a loop, opening, hole or slot on the pulmonary treatment device, further comprising releasing the torqueing tool by withdrawal of the protrusion. 
     138. A method as in claim  137 , wherein releasing the torqueing tool by withdrawal of the protrusion comprises manipulating a hitch wire so as to allow the protrusion to withdraw from the torqueing tool. 
     139. A method as in any of claims  117 - 138 , wherein a deployment element is releasably attached to the pulmonary treatment device, and wherein inserting the tissue gathering element comprises advancing the tissue gathering element through a delivery device with the use of the deployment element. 
     140. A method as in claim  139 , further comprising deploying the tissue gathering element while maintaining an anchoring element within the delivery device. 
     141. A method as in claim  140 , further comprising retracting the deployment element so as to apply longitudinal force to the portion of the lung tissue. 
     142. A method as in claim  140 , wherein anchoring the pulmonary treatment device comprises deploying the anchoring element after deploying the tissue gathering element. 
     143. A method as in claim any of claims  117 - 142 , further comprising inserting another pulmonary treatment device into the lung and joining the pulmonary treatment device with the another pulmonary treatment device. 
     144. A system for performing lung volume reduction on a lung comprising: 
     a delivery device comprising an elongate shaft; and 
     a pulmonary treatment device comprising a tissue gathering element and an anchoring element, wherein the tissue gathering element is configured to re-tension a slacked airway within the lung and so as to generate a reduced volume of the lung, and wherein the anchoring element is configured to hold the tissue gathering element in a manner that assists in maintaining the reduced volume of the lung. 
     145. A system as in claim  144 , wherein at least a portion of the pulmonary treatment device is mountable upon an exterior of the elongate shaft of the delivery device. 
     146. A system as in claim  145 , wherein the anchoring element is mountable upon the exterior of the elongate shaft of the delivery device. 
     147. A system as in claim  145 , further comprising a catheter advanceable at least partially through a lumen of the delivery device so as to extend beyond a distal end of the delivery device. 
     148. A system as in claim  147 , wherein the tissue gathering element is mountable upon an exterior of the catheter. 
     149. A system as in claim  148 , further comprising a guidewire positionable within a lumen in the catheter so as to extend beyond a distal end of the catheter. 
     150. A system as in claim  149 , wherein tissue gathering element further includes a guide element positionable around the guidewire in a manner which centers the pulmonary treatment device upon the delivery device. 
     151. A system as in claim  148 , wherein the pulmonary treatment device comprises an extendable midsection, wherein advancement of the catheter extends the extendable midsection within the slacked airway. 
     152. A system as claim  151 , wherein the tissue gathering element is configured to deploy radially outwardly upon retraction of the catheter from the tissue gathering element so as to create a hold on the slacked airway. 
     153. A system as in claim  152 , wherein the extendable midsection is configured apply force upon the tissue gathering element in the direction of the anchoring element upon removal of the delivery device which re-tensions the slacked airway. 
     154. A system as in any of claims  144 - 153 , wherein the delivery device comprises a bronchoscope. 
     155. A system as in claim  154 , wherein the bronchoscope has an insertion cord sized and configured to be insertable into a fourth-generation airway. 
     156. A pulmonary treatment device comprising: 
     an elongate shaft coiled into a helical shape around a longitudinal axis to form a tissue gathering end, an extendable midsection and a stabilizing end, 
     wherein the tissue gathering end includes at least one loop which curves at least partially around the longitudinal axis and is configured to engage loose damaged alveolar sac tissue, 
     wherein the stabilizing end includes at least one loop which curves at least partially around the longitudinal axis and is configured to engage a lung passageway proximal to the loose damaged alveolar sac tissue, and 
     wherein the extendable midsection is configured to extend along the longitudinal axis while the tissue gathering end engages the loose damaged alveolar sac tissue so that the loose damaged alveolar sac tissue is pulled toward the lung passageway and the stabilizing end seats in the lung passageway in a manner that maintains the loose damaged alveolar sac tissue in a pulled position. 
     157. A pulmonary treatment device comprising: 
     An elongate shaft having a longitudinal axis, wherein the elongate shaft curves around a transverse axis with respect to the longitudinal axis to form a tissue gathering end, and wherein the elongate shaft curves around a different transverse axis with respect to the longitudinal axis to form an anchoring end, and wherein the elongate shaft forms an extendable midsection between the tissue gathering end and the anchoring end, 
     wherein the tissue gathering end includes at least one loop which curves at least partially around the transverse axis and is configured to engage loose damaged alveolar sac tissue, 
     wherein the anchoring end is configured to engage a lung passageway proximal to the loose damaged alveolar sac tissue, and 
     wherein the extendable midsection is configured to extend along the longitudinal axis while the tissue gathering end engages the loose damaged alveolar sac tissue so that the loose damaged alveolar sac tissue is rotated about the longitudinal axis and pulled along the longitudinal axis and the anchoring end seats in the lung passageway in a manner that maintains the loose damaged alveolar sac tissue in a pulled condition. 
     158. A device for treating a lung comprising: 
     a tissue engaging end configured to engage loose damaged alveolar sac tissue; and 
     a stabilizing end configured to engage a lung passageway proximal to the loose damaged alveolar sac tissue, 
     wherein the device is configured to re-tension a portion of the lung by pulling the tissue engaging end toward the stabilizing end seated in the lung passageway and maintaining such pulling by recoil force. 
     159. A device for treating a lung comprising: 
     a tissue gathering end configured to engage loose damaged alveolar sac tissue; and 
     an anchoring end configured to engage a lung passageway proximal to the loose damaged alveolar sac tissue, 
     wherein the device is configured to re-tension a portion of the lung by rotating the tissue gathering end and pulling it toward the anchoring end seated in a lung passageway and maintaining such rotating and pulling by recoil force. 
     160. A method for treating a lung comprising: 
     deploying a tissue engaging end of a pulmonary treatment device into loose damaged alveolar sac tissue distal to a lung passageway; 
     pulling the tissue engaging end toward the lung passageway so that a portion of the lung associated with the loose damaged alveolar sac tissue is re-tensioned; and 
     seating a stabilizing end of the pulmonary treatment device into the lung passageway so as to maintain re-tensioning of the portion of the lung. 
     161. A method for treating a lung comprising: 
     deploying a tissue gathering end of a pulmonary treatment device into loose damaged alveolar sac tissue distal to a lung passageway; 
     rotating the tissue gathering end so that a portion of the lung associated with the loose damaged alveolar sac tissue is re-tensioned; and 
     seating an anchoring end of the pulmonary treatment device into a lung passageway so as to maintain re-tensioning of the portion of the lung. 
     162. A system for treating a lung comprising: 
     a delivery device having a proximal end, a distal end and lumen therethrough, wherein the distal end is configured to be advanced through a tracheobronchial tree of the lung to an area of loose damaged alveolar sac tissue; 
     a pulmonary treatment device advanceable through the lumen of the delivery device, wherein the pulmonary treatment device includes a tissue gathering end and a stabilizing end; and 
     a deployment element removably attached to the pulmonary treatment device and insertable into the lumen of the delivery device, 
     wherein together the delivery device and deployment element 
     1) deploy the tissue gathering end into the area of loose damaged alveolar sac tissue while maintaining attachment of the pulmonary treatment device to the deployment element, 
     2) pull the deployed tissue gathering end so as to re-tension the area of loose damaged alveolar sac tissue, and 
     3) deploy the stabilizing end within a lung passageway so as to maintain the re-tension of the area of loose damaged alveolar sac tissue. 
     163. A method for treating a lung of a patient, the method comprising: 
     introducing an elongate body of an implant system axially into a lung passageway system of the lung so that a proximal portion of the elongate body is disposed within a first region of the lung passageway system and so that a distal implant portion of the elongate body is disposed within a second region of the lung passageway system; and 
     tensioning a lung tissue volume of the lung by rotating the elongate body. 
     A system for treating a lung comprising: 
     a delivery device having a proximal end, a distal end and lumen therethrough, wherein the distal end is configured to be advanced through a tracheobronchial tree of the lung to an area of loose damaged alveolar sac tissue; 
     a pulmonary treatment device advanceable through the lumen of the delivery device, wherein the pulmonary treatment device includes a tissue gathering end and an anchoring end; 
     a deployment element removably attached to the pulmonary treatment device and insertable into the lumen of the delivery device, 
     wherein together the delivery device and deployment element 
     1) deploy the tissue gathering end into the area of loose damaged alveolar sac tissue while maintaining attachment of the pulmonary treatment device to the deployment element, 
     2) rotate the deployed tissue gathering end so as to re-tension the area of loose damaged alveolar sac tissue, and 
     3) deploy the anchoring end within a lung passageway so as to maintain the re-tension of the area of loose damaged alveolar sac tissue. 
     In addition, the present invention relates to the following aspects: 
     In an aspect of the present invention, the pulmonary treatment devices, methods and systems contained herein treat COPD and COPD symptoms by tensioning lung tissue in patients who have been diagnosed with emphysema whereas lung tissue destruction has been determined to present between zero and 70% volume of destroyed tissue, preferably at least 30% destruction, determined by calculating the percent of destroyed low density lung volume tissue that presents in CT images with a Hounsfield unit score at or higher than 850 (HU) Hounsfield units. 
     In another aspect of the present invention, the pulmonary treatment devices, methods and systems contained herein treat COPD and COPD symptoms by tensioning lung tissue in patients who have been diagnosed with emphysema whereas the patient has also been determined to be trapping air sufficiently so that retained residual volume is determined to be between 100% and 400% of normal but most preferably residual volume is determined to be in excess of 175% of normal for the patients gender, age and height. 
     In another aspect of the present invention, the pulmonary treatment devices, methods and systems contained herein treat COPD and COPD symptoms by tensioning lung tissue in patients who have been diagnosed with emphysema whereas the treatment may be performed in each of the four major lobes of the lungs, in a single or separate procedures, if the volume of damaged lung tissue in each lobe, defined as the volume of low density tissue greater that 850 (HU), falls within a range of zero to 70% but preferably is in excess of 30% in each lobe. 
     In another aspect of the present invention, the pulmonary treatment devices, methods and systems contained herein treat COPD and COPD symptoms by compressing lung tissue as the tissue is wrapped around an implant device that has been fixed to lung tissue and torqued to be rotated so lung tissue is drawn to the device and then anchored to another portion of lung tissue, to prevent the implant from counter-rotating which would allow lung tissue to be unwound from the implant. 
     In another aspect of the present invention, the pulmonary treatment devices, methods, systems and structures that may be considered implant systems contained herein treat COPD and COPD symptoms by tensioning lung tissue and reducing lung volume to make at least one of the following measurable physiologic changes to improve breathing in COPD patients: 
     1) Lift the diaphragm with respect to a reference rib location 
     2) Measure diaphragm lift with respect to a reference rib location while the patient maintains expiration, as a result of treatment 
     3) Elevate the base of at least one lung towards the patient&#39;s upper chest 
     4) Reduce coughing 
     5) Reduce mucus production 
     6) Reduce coughing caused by trapped air and mucus 
     7) Reduce glottis closure sensitivity 
     8) Increase the patient&#39;s ability to clear mucus from the lungs 
     9) Increase arterial blood oxygen levels in the blood stream 
     10) Increase arterial blood oxygen percent in the blood stream 
     11) Decrease arterial CO2 levels in the blood stream 
     12) Decrease arterial CO 2  percentage in the blood stream 
     13) Increase mobility as measured by the currently standard 6-minute walk test 
     14) Increase the number of meters a patient can walk in 6 minutes 
     15) Increase lung airway caliber as measured using high resolution CT 
     16) Increase airway diameter 
     17) Increase lung emptying volume during expiration 
     18) Increase airway lumen diameter 
     19) Provide radial outward support to airways 
     20) Assist reduction of lung volume during exhalation 
     21) Reduce the volume of at least one lung 
     22) Reduce the volume of a lobe 
     23) Reduce the volume of both lungs 
     24) Reduce the volume of a lung pair 
     25) Reduce TLC of a lung pair 
     26) Perform tissue compression 
     27) Compress tissue in a lobe 
     28) Remove slack in the lung tissue 
     29) Restore lung tissue elastic recoil back to a physiologic performance between 2 and 200 cm*H2O of pressure to expand the lung 
     30) Increase lung elastic recoil 
     31) Decrease lung compliance 
     32) Change the shape of the pressure volume curve generated by measuring patient breathing 
     33) Increase the area within a pressure vs. volume curve describing a patient&#39;s breathing 
     34) Displace fissures as seen using CT image post processed images comparing inspiration and expiration data 
     35) Delay airway closure during expiration, by using post processed CT image data to compare pre-treatment versus post treatment airway volumes of a similar region in the lung 
     36) Cause a volume of the lung to be reduced 
     37) Reduce airway resistance 
     38) Reduce the volume of one or more lungs in a patient 
     39) Reduce inspiratory effort using pulse transit time or respiratory inductance plethysmography methods 
     40) Reduce dynamic hyperinflation as measured by CT or 6-minute walk testing or plethysmography 
     41) Reduce end-expiratory lung volume 
     42) Reduce functional residual capacity 
     43) Reduce the incidence of respiratory failure 
     44) Increase time between COPD exacerbation events 
     45) Increase time that airways stay open during expiration 
     46) Increase the forced expiratory volume in the first second (FEV1) 
     47) Increase the forced vital capacity volume (FVC) 
     48) Increase the ratio FEV1/FVC 
     49) Reduce dysthymia 
     50) Reduce pressure on the heart 
     51) Reduce pressure on coronary arteries 
     52) Reduce blood hypertension 
     53) Reduce hypertension in the lungs 
     54) Reduce hypertension in blood vessels that supply the heart muscle 
     55) Reduce systolic and/or diastolic blood pressure 
     56) Reduce heart rate 
     57) Reduce systolic blood pressure 
     58) Increase the heart&#39;s ejection fraction 
     59) Reduce pulmonary artery pressure 
     60) Reduce lung tissue density (from 800 to 810-1000 HU, that&#39;s Hounsfield units) 
     61) Make lung tissue density more uniform (adjust the difference between lobes of average lobar density between 1-200 Hounsfield Units) 
     62) Increase forced expiratory volume during expiration 
     63) Reduce residual volume that is left in the lung during or after expiration (RV) 
     64) Reduce the volume of gas that is trapped in the lung during or after expiration 
     65) Reduce the volume of gas that is trapped in a lobe during or after expiration 
     66) Increase tidal expiratory volume change during tidal breathing at rest 
     67) Increase the inspiratory reserve volume during tidal breathing at rest 
     68) Decrease the patient&#39;s breathing rate 
     69) Decrease the patient&#39;s heart rate 
     70) Increase the patient&#39;s cardiac blood ejection fraction 
     71) Decrease the patient&#39;s total lung capacity 
     72) Decrease lung compliance 
     73) Decrease compliance in lobes or regions of lung tissue 
     74) Increase lung tissue compliance uniformity between upper versus lower lobes 
     75) Increase lung tissue compliance uniformity between lung lobes in a patient 
     76) Increase lung tissue compliance uniformity between lobar segments 
     77) Decrease inspiratory effort 
     78) Decrease the total lung capacity (TLC) 
     79) Reduce the RV/TLC ratio 
     80) Increase the volume of airways in a lobe during inspiration 
     81) Increase the volume of airways in a lobe during expiration 
     82) Reduce the difference in volume of lung airways in a lobe during breathing 
     83) Increase the total blood volume in a patient&#39;s lung or lobe by performing a treatment 
     84) Reduce regional blood volume in severely compromised lung tissue to reduce the volume of reduced oxygenated blood being mixed with normal blood in emphysema patients 
     85) Increase the change in lobar volume between an inspiration and expiration breathing cycle 
     86) Reduce the volume of trapped air in a lobe after expiration 
     87) Reduce expiratory volume of lungs after treatment 
     88) Increase volume of one or more lobes during inspiration 
     89) Increase the volume within distal airways in one or more lobes 
     90) Increase the volume within central airways in one or more lobes 
     91) Reduce impedance of central airways in one or more lobes 
     92) Reduce impedance in one or both lungs 
     93) Reduce resistance to flow in one or more lobes 
     94) Reduce resistance to flow in one or more lungs 
     95) Increase blood vessel density in one or more lobes 
     96) Increase the number of blood vessels per liter of lobar volume 
     97) Increase the volume of airway wall in one or more lobes 
     98) Increase the volume of airway wall in central airways of one or more lobes 
     99) Decrease the percentage of damaged tissue per liter of lung volume in one or more lobes 
     100) Hold airways open longer to increase the rate of aerosol transport in one or more lobes 
     101) Hold airways open longer to increase regional concentration of aerosol delivered drugs in one or more lobes 
     102) Measure one or more fissures that have moved more than 2 mm to indicate lobar volume has changed 
     103) Measure one or more fissures that have moved with respect to a chest wall rib more than 2 mm to indicate lung volume has changed 
     104) Reduce the percentage of low attenuation lung tissue in one lobe or more 
     105) Reduce the volume of low attenuation lung tissue in one lobe or more 
     106) Reduce the percentage of low-density tissue that is 950 HU or higher in one lobe or more 
     107) Reduce the volume of low-density tissue that is 950 HU or higher in one lobe or more. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising: a distal end that efficiently attaches to lung tissue that has been degraded by enzymatic destruction. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising: a pulmonary treatment device with proximal a distal end that anchors to an airway in the lung. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising: a pulmonary treatment device with a distal end that attaches to tissue primarily comprised of alveoli. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising: a treatment device, method or system that tensions lung tissue, parenchyma, alveoli, tissue with enzyme damage, distended, slackened or stretched tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising: a pulmonary treatment device that is produced from round wire shaft material that presents minimal sharp edges to soft tissues in the lung, that would otherwise cause the formulation of granulation tissue 
     In another aspect of the present invention, a COPD treatment device is provided comprising: a lung treatment device that is produced from round wire shaft material with a distal end and a proximal end, whereas at least the distal or proximal end is formed to make a blunt atraumatic end without the benefit of recasting material. 
     In another aspect of the present invention, a COPD treatment device is provided comprising: a lung treatment device that is produced from round wire shaft material with a distal end, a proximal end and a midsection whereas the distal end is connected to the midsection and the proximal end is connected to the midsection without the benefit of a connection to join components. 
     In another aspect of the present invention, a COPD treatment device is provided comprising: a lung treatment device that is produced and coated with an anti-bacterial coating such as silver or some other material that bacteria is repelled from. 
     In one aspect of the present invention, a pulmonary treatment device is provided comprising: an elongate shaft coiled into a helical shape around a longitudinal axis to form a tissue gathering end, an extendable midsection and a stabilizing end, wherein the tissue gathering end includes at least one loop which curves at least partially around the longitudinal axis and is configured to engage loose damaged alveolar sac tissue, wherein the stabilizing end includes at least one loop which curves at least partially around the longitudinal axis and is configured to engage a lung passageway proximal to the loose damaged alveolar sac tissue, and wherein the extendable midsection is configured to extend along the longitudinal axis while the tissue gathering end engages the loose damaged alveolar sac tissue so that the loose damaged alveolar sac tissue is pulled toward the lung passageway and the stabilizing end seats in the lung passageway in a manner that maintains the loose damaged alveolar sac tissue in a pulled position. 
     In another aspect of the present invention, a device is provided for treating a lung comprising: a tissue engaging end configured to engage loose damaged alveolar sac tissue; and a stabilizing end configured to engage a lung passageway proximal to the loose damaged alveolar sac tissue, wherein the device is configured to re-tension a portion of the lung by pulling the tissue engaging end toward the stabilizing end seated in the lung passageway and maintaining such pulling by recoil force. 
     In another aspect of the present invention, a lung treatment device is provided for treating a lung; comprising a tissue gathering distal end, a stabilizing proximal end and an elastic midsection whereas at least a portion of the device is configured to be positioned around the exterior of a bronchoscope in a configuration that is suitable for advancement into the lung. The device is configured so that at least a portion of the tissue gathering end or a portion of the mid-section or a portion of the stabilizing end is configured to circle at least partially around the longitudinal axis of the bronchoscope during advancement into the lung and is configured to displace lung tissue, wherein the extendable midsection is configured to be lengthened while the tissue gathering end is anchored to lung tissue in a way that allows lung tissue to be pulled toward the midsection of the device and the stabilizing end seats in lung tissue in a manner so lung tissue at the proximal end of the treatment device is pulled towards the midsection of the treatment device, after the bronchoscope is removed from the lung. 
     In another aspect of the present invention, a lung treatment device is provided for treating a lung comprising: a tissue gathering end configured to be fixed to lung tissue; a stabilizing proximal end configured to be fixed to lung tissue that is proximal to the tissue the tissue gathering end is fixed to, wherein the device is configured to re-tension a portion of the lung by pulling the tissue gathering end towards the stabilizing end seated in the lung. 
     In another aspect of the present invention, a lung treatment device is provided for treating a lung comprising: a tissue gathering end configured to be fixed to lung tissue; a stabilizing proximal end configured to be fixed to lung tissue that is proximal to the tissue the tissue gathering end is fixed to, wherein the device is configured to re-tension a portion of the lung by pulling the tissue that the tissue gathering end is fixed to toward the tissue that the stabilizing end is fixed to in the lung. 
     In another aspect of the present invention, a pulmonary treatment device is provided for treating a lung comprising: a tissue gathering end configured to be fixed to lung tissue; a stabilizing proximal end configured to be fixed to lung tissue that is proximal to the tissue the tissue gathering end is fixed to, wherein the device is configured to re-tension a portion of the lung by pulling the tissue that the tissue engaging end is fixed to toward the tissue that the stabilizing end is fixed to in the lung while the midsection of the lung treatment device is configured to maintain a patent lumen through the lung treatment device. 
     In another aspect of the present invention, a lung treatment device is provided for treating a lung comprising: a tissue gathering end configured to be fixed to lung tissue; a stabilizing proximal end configured to be fixed to lung tissue that is proximal to the tissue the tissue gathering end is fixed to, wherein the device is configured to be advanced into the lung and then stretched to a longer configuration before fixing the tissue gathering end to tissue and before fixing the proximal stabilizing end to tissue to more effectively re-tension a portion of the lung by pulling the tissue engaging end towards the stabilizing end which is fixed to tissue in the lung. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising: an elongate shaft coiled into a helical shape around a longitudinal axis to form a tissue gathering end, an extendable midsection and a stabilizing end, wherein the tissue gathering end includes at least one loop that is configured to engage loose damaged alveolar sac tissue or the wall of an airway, wherein the stabilizing end includes at least one loop which curves at least partially around the longitudinal axis and is configured to engage a lung passageway proximal to the loose damaged alveolar sac tissue, and wherein the extendable midsection is configured to extend along the longitudinal axis while the tissue gathering end engages the loose damaged alveolar sac tissue so that the loose damaged alveolar sac tissue is pulled toward the lung passageway and the stabilizing end seats in the lung passageway in a manner that maintains the loose damaged alveolar sac tissue in a pulled position. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising: an implant made from polymer or metal that behaves in at least a partially elastic manor that is shaped to form a tissue gathering anchor end, an extendable midsection and a stabilizing end, wherein the tissue gathering end can be advanced distally to cause the extendable midsection to be extended with increased length and strained elastically after which the tissue gathering end may be deployed to be fixed or anchored to the wall of the airway, wherein the stabilizing end includes at least one loop which curves at least partially around the longitudinal axis and is configured to engage a lung passageway proximal to the midsection, and wherein the extendable midsection is configured to provide elastic recoil force that tensions lung tissue and provides lumen patency maintaining support to stent the airway and prevent airway collapse while the tissue gathering end and the proximal stabilizing ends are pulled towards each other. 
     In another aspect of the present invention, a pulmonary treatment device is provided that reduces the length of airway segments to enhance lung elastic recoil. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is configured to be mounted to the outside of a bronchoscope while it is delivered to a location in the lung. 
     In another aspect of the present invention, a pulmonary treatment device is provided that configured to be advanced into the lung in a length unconstrained configuration. This allows the system to be flexible while being delivered along a tortuous path. Most of these devices are delivered to the upper lobes and that typically requires the scope and device to go through at least one small radius bend in the lungs. 
     In another aspect of the present invention, a pulmonary treatment device is provided that can be advanced into the lung in a condition that is unstressed to allow the delivery system to be flexible while the device is being delivered along a tortuous path. 
     In another aspect of the present invention, a pulmonary treatment device is provided for treating a lung that has not been stressed to lengthen or shorten the device length so as to allow the delivery system to be as flexible as possible while being delivered along a tortuous path. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is configured so that the length can be lengthened or shorted before deploying the device into the lung to stress lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided that can be advanced along a tortuous path to a treatment location in the lung and configured in a flexible unstressed condition that allows the length to be unconstrained but configured to be elongated at the treatment location before being deployed to distort lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided that can be advanced along a tortuous path to a treatment location in the lung, configured in a flexible unstressed condition, but configured to be strained to a longer configuration to store strain energy that may be applied to lung tissue after deployment of the treatment device. 
     In another aspect of the present invention, a pulmonary treatment device is provided that can be advanced into the lung and the device length can be adjusted to change length after a portion of the device is placed in contact with lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and spring coil midsection. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a central lumen and a constrained distal anchor feature that is unconstrained by retracting a delivery device component from the central lumen of the treatment device. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a central longitudinal axis, a distal end, a proximal end and a lumen running coaxial along the central longitudinal axis that is configured to be guided by a guidewire that is advanced through the lumen along the central longitudinal axis. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a central longitudinal axis, a distal end, a proximal end and a lumen running coaxial along the central longitudinal axis that is configured to be guided by a bronchoscope that is advanced through the lumen along the central longitudinal axis. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising distal and proximal anchors and a midsection that can be elongated to store fully elastic strain energy in the midsection. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising distal and proximal anchors and a midsection that can be elongated to store fully elastic strain energy in the treatment device before the device is coupled to lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a tissue gathering distal end, a stabilizing proximal end and a midsection that can be elongated to store fully elastic strain energy. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a tissue gathering distal end, a stabilizing proximal end and a midsection that can be elongated to store fully elastic strain energy before the device is coupled to lung tissue so the device causes length compression of the lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a tissue gathering distal end, a stabilizing proximal end and a midsection that can be elongated to store fully elastic strain energy after the stabilizing proximal end is seated in lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal end, a proximal end and a midsection that can be elongated to store fully elastic strain energy that can be deployed in a lung to restore tension in lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal end, a proximal end and a midsection that can be elongated to store fully elastic strain energy that can be deployed in a lung to restore lung elastic recoil in the lung. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a proximal end, a distal end and a midsection configured such that the midsection is cylindrical and the proximal end is flared. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a proximal end, a distal end and a midsection configured such that the midsection is tapered so the diameter varies along the length of the midsection of the device. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a proximal end, a distal end and a midsection configured such that the distal end comprises a spring element that can be constrained by the exterior surfaces of a bronchoscope. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a proximal end, a distal end and a midsection configured such that the device comprises a spring element that can be expanded to a larger diameter by a balloon. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is configured to be mounted around the outside of a bronchoscope while it is delivered to a location in the lung to increase tension in lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided having a distal anchor, a proximal anchor and a midsection that can be elongated to store elastic strain energy to tension lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided that can be advanced into the lung in a condition that is unstressed to allow the system to be flexible while being delivered along a tortuous path, configured with a distal anchor, a proximal anchor and a midsection that is made from single wire shaft. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and a midsection that is made from continuous wire shaft. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and a midsection that is made from single element with no connections to join features of the device. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and a midsection; the treatment device is configured in a way that may be elongated to store elastic strain energy to tension lung tissue comprising at least one weldment to connect features of the device. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and a midsection; the treatment device is configured in a way that may be elongated to store elastic strain energy to tension lung tissue comprising at least one crimped sleeve to connect features of the device. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and a midsection; the treatment device is configured in a way that may be elongated to store elastic strain energy to tension lung tissue comprising at least one glue bonded joint to connect features of the device. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is made from a continuous wire shaft whereas the wire shaft ends are terminated to be blunt atraumatic tips. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is made from a continuous wire shaft whereas at least one wire shaft end is recast to be shaped into a blunt atraumatic blunt end. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is made from a continuous wire shaft that may be delivered while at least partially encircling a bronchoscope and at least one wire shaft end is recast to be shaped into a ball shaped tip. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal end, a proximal end and a midsection; the treatment device is made from one or more wire shaft components and at least one proximal end or one distal end or both ends are recast to be shaped into ball shaped blunt tip. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal end, a proximal end and a midsection; the treatment device is configured to be delivered at least partially mounted to the outside of a bronchoscope and at least one proximal end or one distal end or both ends are recast to be shaped into ball shaped blunt tips. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and a midsection; the treatment device is configured in a way that may be elongated to store elastic strain energy to tension lung tissue whereas the distal end has been melted to form a blunt ball end. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is configured in a way that may be elongated to store elastic strain energy to tension lung tissue whereas the distal end has been melted to form a blunt ball end. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and a midsection; the treatment device is configured in a way that may be elongated to store elastic strain energy to tension lung tissue whereas the distal end has been melted to form a blunt end. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is configured in a way that may be elongated to store elastic strain energy to tension lung tissue whereas the distal end has been melted to form a blunt end. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and a midsection; the treatment device is configured in a way that may be elongated to store elastic strain energy to tension lung tissue whereas the distal end has had material joined to it to form an atraumatic end. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is configured in a way that may be elongated to store elastic strain energy to tension lung tissue whereas the distal end has had material joined to it to form an atraumatic end. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and a midsection; the device being configured so it can be advanced into the lung in a delivery configuration that has not been stressed to lengthen or shorten the device length and the device is configured in such a way that the device may be elongated to store elastic strain energy and anchored to lung tissue such that lung tissue is tensioned in a delivered treatment configuration. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and a midsection that may be delivered to a treatment site in a delivery configuration and made to perform work on lung tissue in a treatment configuration. In the delivery configuration, the device may be advanced into the lung free from stress that would otherwise lengthen or shorten the device; in the treatment configuration the device may be elongated to store elastic strain energy to beneficially tension lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and a midsection; the device being configured so it can be elongated to store elastic strain energy whereby the distal anchor is anchored to a location in a lung, the proximal anchor is anchored in a proximal location in the lung that is distant from the location of the distal anchor and the elastic strain energy is allowed to reduce the distance between the distal anchor and the proximal anchor to bring the distal and proximal anchors closer together in the lung. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and a midsection that may be delivered to a treatment site in a delivery configuration and made to perform work on lung tissue in a treatment configuration. In the delivery configuration, the device may be elongated to store elastic strain energy; in the treatment configuration the device may use the elastic strain energy to shorten the device to beneficially tension lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and a midsection that may be delivered to a treatment site in a delivery configuration and made to perform work on lung tissue in a treatment configuration. In the delivery configuration, the device may be mounted around the exterior of a bronchoscope; in the treatment configuration the device may benefit by the use of pneumatic pressure to shorten the device to beneficially tension lung tissue. Shortening may be accomplished by pneumatically expanding the device diameter, using a balloon, while allowing device foreshortening to shorten the device to cause lung tissue tensioning. 
     In another aspect of the present invention, a pulmonary treatment device is provided comprising a distal anchor, a proximal anchor and a midsection that may be delivered to a treatment site in a delivery configuration and made to perform work on lung tissue in a treatment configuration. In the delivery configuration, the device may be mounted around the exterior of a bronchoscope; in the treatment configuration the device may benefit by the use of hydraulic pressure to shorten the device to beneficially tension lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided that can be advanced along a tortuous path to a treatment location in the lung, configured in a flexible unstressed condition that allows the length to be unchanged from its unstressed state, but configured to be elongated at the treatment location before being deployed to distort lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided that can be advanced along a tortuous path to a treatment location in the lung, configured in a flexible condition whereas the length is unchanged from its unstressed state, but configured to be elongated at the treatment location before being deployed to distort lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided that can be advanced along a tortuous path to a treatment location in the lung, configured in a flexible condition whereas the length is unchanged from its unstressed state but configured to shorten in an unassisted way, after being deployed in tissue, to beneficially tension lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided that can be advanced along a tortuous path to a treatment location in the lung, configured in a flexible condition configured to shorten in an unassisted way, after being deployed in tissue, to beneficially tension lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured with a distal end, a proximal end and a midsection that can be advanced along a tortuous path to a treatment location in the lung, configured to shorten in an unassisted way, after being deployed in tissue, to beneficially tension lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured with a distal end, a proximal end and a midsection that can be advanced along a tortuous path to a treatment location in the lung, configured to shorten in an unassisted way, after being elongated to store elastic strain energy, to beneficially tension lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured with a distal anchor, a proximal anchor and a midsection that can be advanced along a tortuous path to a treatment location in the lung, configured to shorten in an unassisted way, after being elongated to store elastic strain energy, to beneficially tension lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured with a distal anchor that anchors a first location in a lung, a proximal anchor that anchors a second location in a lung that is distant to the first location and a midsection, connected to the proximal and distal anchors; the device is configured so it can be advanced along a tortuous path to a treatment location in the lung, the midsection is configured to be lengthened before the proximal and distal anchors are deployed to beneficially tension lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured with a distal anchor that anchors a first location in a lung, a proximal anchor that anchors a second location in a lung that is distant to the first location and a midsection, connected to the proximal and distal anchors; the device is configured so it can be advanced along a tortuous path to a treatment location in the lung, the midsection is configured to shorten after the proximal and distal anchors are deployed, to beneficially tension lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured with a distal anchor that anchors a first location in a lung, a proximal anchor that anchors a second location in a lung that is distant to the first location and a midsection, connected to the proximal and distal anchors; the device is configured to be mounted at least partially around the outside of a bronchoscope so it can be advanced along a tortuous path to a treatment location in the lung, the midsection is configured to shorten after the proximal and distal anchors are deployed, to beneficially tension lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured with a distal anchor that anchors a first location in a lung, a proximal anchor that anchors a second location in a lung that is distant to the first location and a midsection, connected to the proximal and distal anchors; the device is configured to be mounted at least partially around the outside of a bronchoscope so it can be advanced along a tortuous path to a treatment location in the lung, the midsection is configured to shorten after the proximal and distal anchors are deployed, to beneficially tension lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured with a distal anchor that anchors a first location in a lung, a proximal anchor that anchors a second location in a lung that is distant to the first location and a midsection, connected to the proximal and distal anchors; the device is configured to be mounted at least partially around the outside of a bronchoscope so it can be advanced along a tortuous path to a treatment location in the lung, the midsection is configured to be shortened after the proximal and distal anchors are deployed, to beneficially tension lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided that acts in a stent-like manner to maintain lung airway patency and straighten the airway path between its proximal and distal ends. 
     In another aspect of the present invention, a pulmonary treatment device is provided that acts in a stent-like manner that supports the airway to open the airway lumen and also to act as a tensioning device along the longitudinal axis of the airway. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is advanceable into the lung in a non-strained state. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is advanceable into the lung while maintaining an unstretched length. 
     In another aspect of the present invention, a pulmonary treatment device is provided that at least partially encircles the bronchoscope used to deliver the pulmonary treatment device. 
     In another aspect of the present invention, a pulmonary treatment device is provided with a distal anchor feature, configured to beneficially use a bronchoscope shaft to hold the distal anchor from being deployed while the device is being advanced into the lung. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to encircle the bronchoscope so the scope shaft strength is used to beneficially modify the treatment device dimensions. 
     In another aspect of the present invention, a pulmonary treatment device is provided that may be lengthened by advancing the bronchoscope. 
     In another aspect of the present invention, a pulmonary treatment device is provided that may be elongated by advancing the bronchoscope. 
     In another aspect of the present invention, a pulmonary treatment device is provided that may be elongated by retracting the bronchoscope. 
     In another aspect of the present invention, a pulmonary treatment device is provided that may be elongated by retracting a bronchoscope guide sleeve. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to deploy the proximal end to engage tissue first before being lengthened to enhance lung elastic recoil. 
     In another aspect of the present invention, a pulmonary treatment device is provided that may be advanced into the lung in a state whereby the device has not been strained to be lengthened or shortened from a zero-strain length, whereby the device length may be increased, using delivery system components at the treatment site before any portion of the device is released from the delivery system. 
     In another aspect of the present invention, a pulmonary treatment device is provided that can be pulled and lengthened after partial deployment. 
     In another aspect of the present invention, a pulmonary treatment device is provided that can be pulled and lengthened after deploying its distal end. 
     In another aspect of the present invention, a pulmonary treatment device is provided that may be tensioned along the longitudinal direction but the device length is maintained after deploying the distal end. 
     In another aspect of the present invention, a pulmonary treatment device is provided that can be longitudinally tensioned to pull distal end and adjacent lung tissue more proximally after deploying the distal end. 
     In another aspect of the present invention, a pulmonary treatment device is provided with flared ends for treating emphysema (end diameter is larger than midsection). 
     In another aspect of the present invention, a pulmonary treatment device is provided that acts in a stent-like manner with flared ends for treating emphysema (end diameter is larger than central body). 
     In another aspect of the present invention, a pulmonary treatment device is provided that tensions lung tissue that can be deployed in every anatomical lumen in lung that is either anatomical or made by disease or created by a device as shown as RB 1  through LB 10  on conventional airway charts. 
     In another aspect of the present invention, a pulmonary treatment device is provided that acts in a stent-like manner that is delivered by advancing a bronchoscope. 
     In another aspect of the present invention, a pulmonary treatment device is provided that stents lung tissue that is delivered by advancing a catheter (without the use of a scope). 
     In another aspect of the present invention, a pulmonary treatment device is provided to stent lung tissue wherein the device is delivered by guiding a bronchoscope in position using a guidewire. 
     In another aspect of the present invention, a pulmonary treatment device is provided to stent lung tissue wherein the device is delivered by guiding a catheter in position using a guidewire. 
     In another aspect of the present invention, a pulmonary treatment device is provided that straightens airways. 
     In another aspect of the present invention, a pulmonary treatment device is provided that straightens 2 or more airways at the same time. 
     In another aspect of the present invention, a pulmonary treatment device is provided that straightens 2 or more airways while laterally urging them closer together. 
     In another aspect of the present invention, a pulmonary treatment device is provided that urges 2 or more airways together to cause lung tissue tension. 
     In another aspect of the present invention, a pulmonary treatment device is provided that urges 2 or more airways together to cause any one of the beneficial changes listed above as items (1) through (107) above. 
     In another aspect of the present invention, a pulmonary treatment device is provided that straightens an airway while shortening the length of the airway. 
     In another aspect of the present invention, a pulmonary treatment device is provided that displaces lung tissue closer to the trachea. 
     In another aspect of the present invention, a pulmonary treatment device is provided that pulls tissue farther from the pleura. 
     In another aspect of the present invention, a pulmonary treatment device is provided that shifts lung tissue closer to the heart. 
     In another aspect of the present invention, a pulmonary treatment device is provided that urges 2 or more airways together to displaces lung tissue closer to the trachea. In another aspect of the present invention, a pulmonary treatment device is provided that urges 2 or more airways together to pull tissue farther from the pleura. 
     In another aspect of the present invention, a pulmonary treatment device is provided that urges 2 or more airways together to shift lung tissue closer to the heart. 
     In another aspect of the present invention, a pulmonary treatment device is provided that shortens an airway length while tensioning tissue that is distal to its distal end. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is tensioned while supporting airway patency. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is tensioned while supporting airway patency between its ends. 
     In another aspect of the present invention, a pulmonary treatment device is provided that stents lung tissue to provide support to keep airways open while also providing tension in the longitudinal axis of the airway. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is resilient enough to change dimension during breathing. 
     In another aspect of the present invention, a pulmonary treatment device is provided, comprising a curvilinear shape that maintains a fixed length as measured down the curvilinear path before and after deployment, that tensions lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided that straightens an airway while allowing gas to flow through in at least one direction. 
     In another aspect of the present invention, a pulmonary treatment device is provided that deploys into an airway while the device also straightens the gas flow path through the airway where the pulmonary treatment device is deployed. 
     In another aspect of the present invention, a pulmonary treatment device is provided, comprising a distal end designed to couple to low density lung tissue that is known to be greater than 800 HU in density. 
     In another aspect of the present invention, a pulmonary treatment device is provided, comprising an optimized design with high tissue contact area to reduce lung tissue stress, 
     In another aspect of the present invention, a pulmonary treatment device is provided that tensions lung tissue distal to the pulmonary treatment device and shortens the length of the airway the pulmonary treatment device occupies. 
     In another aspect of the present invention, a pulmonary treatment device is provided that tensions lung tissue distal to the pulmonary treatment device and shortens the length of the airway the pulmonary treatment device occupies and supports the airway wall to maintain airway patency. 
     In another aspect of the present invention, a pulmonary treatment device is provided that tensions lung tissue distal to the pulmonary treatment device whereas the device length is increased as tension is applied to the device. 
     In another aspect of the present invention, a pulmonary treatment device is provided, comprising an anchor that tensions lung tissue whereas the device length is increased as the proximal end of the device is moved closer to the trachea. 
     In another aspect of the present invention, a pulmonary treatment device is provided, comprising an anchor that tensions lung tissue whereas the device length is increased as a portion of the device is moved closer to the trachea. 
     In another aspect of the present invention, a pulmonary treatment device is provided that tensions lung tissue longitudinally along the axis the device occupies while also supporting the airway wall to maintain airway patency. 
     In another aspect of the present invention, a pulmonary treatment device is provided that tensions lung tissue and reduces elastic recoil adjacent the airway that the pulmonary treatment device occupies. 
     In another aspect of the present invention, a pulmonary treatment device is provided that tensions lung tissue distal or proximal to the pulmonary treatment device and supports the airway wall to maintain airway patency. 
     In another aspect of the present invention, a pulmonary treatment device is provided that straightens at least a portion of airway wall. 
     In another aspect of the present invention, a tensioning pulmonary treatment device is provided, comprising at least one end that forms a circular shape. 
     In another aspect of the present invention, a tensioning pulmonary treatment device is provided, comprising at least one end that forms a helical shape. 
     In another aspect of the present invention, a tensioning pulmonary treatment device is provided, comprising at least one end that penetrates lung tissue. 
     In another aspect of the present invention, a tensioning pulmonary treatment device is provided, comprising at least one end that deploys in a shape that contacts itself. 
     In another aspect of the present invention, a tensioning pulmonary treatment device is provided, comprising at least one end that does not compress tissue. 
     In another aspect of the present invention, a tensioning pulmonary treatment device is provided, comprising a design which is axisymmetric. 
     In another aspect of the present invention, a tensioning pulmonary treatment device is provided that changes the lung volume sufficiently to move the heart laterally. 
     In another aspect of the present invention, a pulmonary treatment device is provided that stents lung tissue to hold at least a portion of an airway lumen open while providing longitudinal tension. 
     In another aspect of the present invention, a pulmonary treatment device is provided, comprising a proximal or distal end that straightens as tension is applied to the device during deployment. 
     In another aspect of the present invention, a lung tissue tensioning pulmonary treatment device is provided that does not compress tissue. 
     In another aspect of the present invention, a lung tissue tensioning pulmonary treatment device is provided that selectively tensions tissue regions. 
     In another aspect of the present invention, a lung tissue tensioning pulmonary treatment device is provided that increases tension in lung tissue to a uniform magnitude. 
     In another aspect of the present invention, a pulmonary treatment device is provided that tensions lung tissue in a portion of a lung while relieving tension in another portion of the same lung. 
     In another aspect of the present invention, a pulmonary treatment device is provided that is delivered in a delivery configuration and deployed in a deployed configuration, comprising a proximal end; a distal end and a midsection which is connected to the proximal end and the distal end; configured to a delivery length in a delivery configuration and a deployed length that is longer than the delivery length. 
     In another aspect of the present invention, a pulmonary treatment device is provided that tensions lung tissue in a way that is compliant during breathing. 
     In another aspect of the present invention, a pulmonary treatment device is provided that tensions lung tissue and elongates during the inspiration portion of the breathing cycle. 
     In another aspect of the present invention, a pulmonary treatment device is provided that tensions lung tissue and contracts to a shorter length during the expiration portion of the breathing cycle. 
     In another aspect of the present invention, a COPD treatment device is provided that lengthens during the inspiration portion of the breathing cycle. 
     In another aspect of the present invention, a COPD treatment device is provided that shortens during the exhalation portion of the breathing cycle. 
     In another aspect of the present invention, a COPD treatment device is provided that acts as a stent device, comprising: a tubular shaped member having first and second open end and a lumen running therethrough, said member is sized for placement within a lung airway, said member is comprised of a shape memory material that exhibits a shape recovery transition temperature in a temperature range below normal body temperature such that after placement within the lung, having a temperature at or near normal body temperature, said member expands radially and contracts longitudinally so at least a portion of said member becomes firmly anchored to lung tissue. 
     In another aspect of the present invention, a COPD treatment device is provided that acts as a stent device, comprising: a tubular shaped member having first and second open end and a lumen running therethrough, said member is sized for placement within a lung airway, said member is comprised of a shape memory material that exhibits a shape recovery transition temperature in a temperature range below normal body temperature such that after placement within the lung, having a temperature at or near normal body temperature, said member expands radially and contracts longitudinally so at least a portion of said member straightens the lung airway. 
     In another aspect of the present invention, a COPD treatment device is provided comprising a helically wound coil spring, wherein the spring has a tubular shaped member having first and second open end and a lumen running therethrough, said member sized for placement within a lung airway, said member comprised of a shape memory material that exhibits a shape recovery transition temperature in a temperature range below normal body temperature such that after placement within the lung, having a temperature at or near normal body temperature, said member expands radially and contracts longitudinally so at least a portion of said member straightens the lung airway. 
     In another aspect of the present invention, a COPD treatment device is provided that acts as a stent device, comprising: a tubular shaped member having first and second open end and a lumen running therethrough, said member is sized for placement within a lung airway, said member is comprised of a shape memory material that exhibits a shape recovery transition temperature in a temperature range below normal body temperature such that after placement within the lung, having a temperature at or near normal body temperature, said member expands radially and contracts longitudinally so at least a portion of said member tensions the lung tissue. 
     In another aspect of the present invention, a COPD treatment device is provided that acts as a helically wound coil spring, comprising: a tubular shaped member having first and second open end and a lumen running therethrough, said member is sized for placement within a lung airway, said member is comprised of a shape memory material that exhibits a shape recovery transition temperature in a temperature range below normal body temperature such that after placement within the lung, having a temperature at or near normal body temperature, said member expands radially and contracts longitudinally so at least a portion of said member tensions lung tissue. 
     In another aspect of the present invention, a COPD treatment device is provided that acts as a stent device, comprising: a tubular shaped member having first and second open end and a lumen running therethrough, said member is sized for placement within a lung airway, said member is comprised of a nitinol material that exhibits a shape recovery transition temperature in a temperature range below normal body temperature such that after placement within the lung, having a temperature at or near normal body temperature, said member expands radially and contracts longitudinally so at least a portion of said member tensions the lung tissue. 
     In another aspect of the present invention, a COPD treatment device is provided that acts as a helically wound coil spring, comprising: a tubular shaped member having first and second open end and a lumen running therethrough, said member is sized for placement within a lung airway, said member is comprised of nitinol material that exhibits a shape recovery transition temperature in a temperature range below normal body temperature such that after placement within the lung, having a temperature at or near normal body temperature, said member expands radially and contracts longitudinally so at least a portion of said member tensions lung tissue. 
     In another aspect of the present invention, a COPD treatment device is provided that acts as a stent device, comprising a proximal end, a distal end and a midsection that joins the ends and a lumen running therethrough, said member is sized for placement within a lung airway, said member is comprised of a nitinol material that exhibits a shape recovery transition temperature in a temperature range below normal body temperature such that after placement within the lung, having a temperature at or near normal body temperature, said member contracts longitudinally so at least a portion of said member tensions the lung tissue. 
     In another aspect of the present invention, a COPD treatment device is provided that acts as a stent device, comprising a proximal end, a distal end and a midsection that joins the ends and a lumen running therethrough, said member is sized for placement within a lung airway, said member is comprised of a nitinol material that exhibits a shape recovery transition temperature in a temperature range below normal body temperature such that after placement within the lung, having a temperature at or near normal body temperature, said member contracts longitudinally so at least a portion of said member tensions the lung tissue; whereas the distal end is configured to anchor to loose lung tissue. 
     In another aspect of the present invention, a COPD treatment device is provided comprising a helically wound coil spring, comprising: a tubular shaped member having first and second open end and a lumen running therethrough, said member is sized for placement within a lung airway, said member is comprised of nitinol material that exhibits a shape recovery transition temperature in a temperature range below normal body temperature such that after placement within the lung, having a temperature at or near normal body temperature, said member contracts longitudinally so at least a portion of said member tensions lung tissue. 
     In another aspect of the present invention, a COPD treatment device is provided comprising a helically wound coil spring, comprising: a tubular shaped member having first and second open end and a lumen running therethrough, said member is sized for placement within a lung airway, said member is comprised of nitinol material that exhibits a shape recovery transition temperature in a temperature range below normal body temperature such that after placement within the lung, having a temperature at or near normal body temperature, said member contracts longitudinally so at least a portion of said member tensions lung tissue; whereas the distal end is configured to anchor in loose lung tissue. 
     In another aspect of the present invention, a COPD treatment device is provided comprising a helically wound coil spring, comprising: a tubular shaped member having first and second open end and a lumen running therethrough, said member is sized for placement within a lung airway, said member is comprised of nitinol material that exhibits a shape recovery transition temperature in a temperature range below normal body temperature such that after placement within the lung, having a temperature at or near normal body temperature, said member contracts longitudinally so at least a portion of said member tensions lung tissue; whereas the proximal end is configured to anchor in reinforced lung tissue. 
     In another aspect of the present invention, a COPD treatment device is provided comprising a first coil shaped end and second coil shaped end and a lumen running therethrough, said device is sized for placement within a lung airway, said device is comprised of nitinol material that exhibits a shape recovery transition temperature in a temperature range below normal body temperature such that after placement within the lung, having a temperature at or near normal body temperature, said device contracts longitudinally so at least a portion of said device tensions lung tissue. 
     In another aspect of the present invention, a COPD treatment device is provided that straightens the airway comprising a single helical component with an arc length that is not changed during deployment. 
     In another aspect of the present invention, a COPD treatment device is provided that does not cause lung volume reduction. 
     In another aspect of the present invention, a COPD treatment device is provided that causes minimal lung volume reduction. 
     In another aspect of the present invention, a COPD treatment device is provided that does not cause lung volume compression. 
     In another aspect of the present invention, a COPD treatment device is provided that causes minimal lung volume compression. 
     In another aspect of the present invention, a COPD treatment device is provided that does not cause lung tissue compression. 
     In another aspect of the present invention, a COPD treatment device is provided that causes minimal lung tissue compression. 
     In another aspect of the present invention, a COPD treatment device is provided comprising: a resilient stent device for straightening lung airways comprising a wire formed into a plurality of bends to generally form a helical shape having a longitudinal axis that is lengthened before being decoupled from a delivery system to apply longitudinal tension to lung tissue in a patient when said stent device is disposed within said airway. 
     In another aspect of the present invention, a COPD treatment device is provided comprising: a medical device for straightening a lung airway, comprising: a tissue gathering end, a stabilizing end, and a tether extending between the tissue gathering end and stabilizing end, the device configured so that the distance between the ends measured along the tether is fixed and maintained after being released from a delivery device but the distance between the ends can be lengthened by moving the delivery device before releasing the medical device from the delivery device. 
     In another aspect of the present invention, a COPD treatment device is provided that tensions lung tissue and a tension indicator feature. 
     In another aspect of the present invention, a COPD treatment device is provided that tensions lung tissue and a displacement indicator feature. 
     In another aspect of the present invention, a COPD treatment device is provided that straightens airways in the lung that includes a tension indicator feature. 
     In another aspect of the present invention, a COPD treatment device is provided that straightens airways in the lung and includes a displacement indicator feature. 
     In another aspect of the present invention, a COPD treatment device is provided that straightens airways in the lung when tension is applied to the lung tissue. 
     In another aspect of the present invention, a COPD treatment device is provided that dilates airways in the lung when the device is used to apply tension to lung tissue. 
     In another aspect of the present invention, a COPD treatment device is provided comprising: a medical device for straightening a lung airway, comprising: a tissue gathering end, a stabilizing end, and a tether extending between the tissue gathering end and stabilizing end, whereas the tether is shaped to form a coil and the coil is straightened as the distance between the tissue gathering end and the stabilizing end of the device is lengthened. 
     In another aspect of the present invention, a COPD treatment device is provided comprising: a medical device used to tension lung tissue; having a tissue gathering end, a stabilizing end and a tether joining the two ends that is made from a single continuous length of plastic, metal, tubing, wire, or extrusion. 
     In another aspect of the present invention, a COPD treatment device is provided comprising: a first portion having a first bearing surface and defining a first local axis, the first portion of the treatment device configured to engage a first portion of the airway with the first bearing surface; and the treatment device further comprising a second portion coupled to the first portion of the treatment device, the second portion of the treatment device having a second bearing surface and defining a second local axis, the second portion of the treatment device configured to engage a second portion of the airway with the second bearing surface, the second portion of the airway being axially spaced apart from the first portion of the airway; wherein, in a deployed configuration within the lung, the first portion of the treatment device presses against the first portion of the airway to urge it to a more coaxial orientation relative to the second local axis, and the second portion of the treatment device presses against the second portion of the airway to urge it to a more coaxial orientation relative to the first local axis, thereby straightening the path through the airway in contact with the first and second portions of the treatment device. 
     In another aspect of the present invention, a COPD treatment device is provided comprising: a first portion having a structure with a centroid defining a first local axis and a first bearing surface, the first portion of the treatment device configured to engage a first portion of the airway with the first bearing surface; and the treatment device further comprising a second portion coupled to the first portion of the treatment device, the second portion of the treatment device having a structure with a centroid defining a second local axis and a second bearing surface, the second portion of the treatment device configured to engage a second portion of the airway with the second bearing surface, the second portion of the airway being axially spaced apart from the first portion of the airway; wherein, in a deployed configuration within the lung, the first portion of the treatment device presses against the first portion of the airway to urge it to a more coaxial orientation relative to the second local axis, and the second portion of the treatment device presses against the second portion of the airway to urge it to a more coaxial orientation relative to the first local axis, thereby straightening the path through the airway in contact with the first and second portions of the treatment device 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within an airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: a first portion having a structure with a centroid defining a first local axis and a first bearing surface, the first portion of the treatment device configured to engage a first portion of the airway with the first bearing surface; and a second portion coupled to the first portion of the treatment device, the second portion of the treatment device having a structure with a centroid defining a second local axis and a second bearing surface, the second portion of the treatment device configured to engage a second portion of the airway with the second bearing surface, the second portion of the airway being axially spaced apart from the first portion of the airway; wherein, in a deployed configuration within the lung, the first portion of the treatment device presses against the first portion of the airway to urge it to a more coaxial orientation relative to the second local axis, and the second portion of the treatment device presses against the second portion of the airway to urge it to a more coaxial orientation relative to the first local axis, thereby straightening the path through the airway in contact with the first and second portions of the treatment device. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within more than one airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: a first portion having a first bearing surface and defining a first local axis, the first portion of the treatment device configured to engage a first portion of a first airway with the first bearing surface; and the treatment device further comprising a second portion (can be a portion of a proximal v clip) coupled to the first portion of the treatment device, a second portion of the treatment device having a second bearing surface and defining a second local axis, the second portion of the treatment device configured to engage a second portion of the first airway with the second bearing surface, the second portion of the airway being axially spaced apart from the first portion of the first airway; a third portion coupled to the second portion of the treatment device having a third bearing surface and defining a third local axis, the third portion of the treatment device configured to engage a first portion of a second airway with the third bearing surface; and a fourth portion (can be another tissue gathering end) coupled to the third portion of the treatment device, the fourth portion of the treatment device having a fourth bearing surface and defining a fourth local axis, the fourth portion of the treatment device configured to engage a second portion of the second airway with the fourth bearing surface, the second portion of the second airway being axially spaced apart from the first portion of the second airway; wherein, in a deployed configuration within the lung, the first portion of the treatment device presses against the first portion of the first airway to urge it to a more coaxial orientation relative to the second local axis in the first airway, and the second portion of the treatment device presses against the second portion of the first airway to urge it to more a coaxial orientation relative to the first local axis, thereby straightening the path through the first airway in contact with the first and second portions of the treatment device and the third portion of the treatment device presses against the first portion of the second airway to urge it to a more coaxial orientation relative to the fourth local axis in the second airway, and the fourth portion of the treatment device presses against the second portion of the second airway to urge it to more a coaxial orientation relative to the third local axis, thereby straightening the path through the second airway in contact with the third and fourth portions of the treatment device. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within more than one airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: a first portion having a first bearing surface having a structure with a centroid defining a first local axis, the first portion of the treatment device configured to engage a first portion of a first airway with the first bearing surface; a second portion (can be a portion of a proximal v clip) coupled to the first portion of the treatment device, the second portion of the treatment device having a second bearing surface having a structure with a centroid defining a second local axis, the second portion of the treatment device configured to engage a second portion of the first airway with the second bearing surface, the second portion of the first airway being axially spaced apart from the first portion of the first airway; a third portion coupled to the second portion of the treatment device having a third bearing surface having a structure with a centroid defining a third local axis, the third portion of the treatment device configured to engage a first portion of a second airway with the third bearing surface; and a fourth portion (can be another distal end) coupled to the third portion of the treatment device, the fourth portion of the treatment device having a fourth bearing surface having a structure with a centroid defining a fourth local axis, the fourth portion of the treatment device configured to engage a second portion of the second airway with the fourth bearing surface, the second portion of the second airway being axially spaced apart from the first portion of the second airway; wherein, in a deployed configuration within the lung, the first portion of the treatment device presses against the first portion of the first airway to urge it to a more coaxial orientation relative to the second local axis in the first airway, and the second portion of the treatment device presses against the second portion of the first airway to urge it to more a coaxial orientation relative to the first local axis, thereby straightening the path through the first airway in contact with the first and second portions of the treatment device and the third portion of the treatment device presses against the first portion of the second airway to urge it to a more coaxial orientation relative to the fourth local axis in the second airway, and the fourth portion of the treatment device presses against the second portion of the second airway to urge it to more a coaxial orientation relative to the third local axis, thereby straightening the path through the second airway in contact with the third and fourth portions of the treatment device. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within more than one airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: a first portion having a first bearing surface having a structure with a centroid defining a first local axis, the first portion of the treatment device configured to engage a first portion of a first airway with the first bearing surface; a second portion (can be a portion of a proximal v clip) coupled to the first portion of the treatment device, the second portion of the treatment device having a second bearing surface having a structure with a centroid defining a second local axis, the second portion of the treatment device configured to engage a second portion of the first airway with the second bearing surface, the second portion of the first airway being axially spaced apart from the first portion of the first airway; a third portion coupled to the second portion of the treatment device having a third bearing surface having a structure with a centroid defining a third local axis, the third portion of the treatment device configured to engage a first portion of a second airway with the third bearing surface; and a fourth portion (can be another distal end) coupled to the third portion of the treatment device, the fourth portion of the treatment device having a fourth bearing surface having a structure with a centroid defining a fourth local axis, the fourth portion of the treatment device configured to engage a second portion of the second airway with the fourth bearing surface, the second portion of the second airway being axially spaced apart from the first portion of the second airway; wherein, in a deployed configuration within the lung, the first portion of the treatment device presses against the first portion of the first airway to urge it to a more coaxial orientation relative to the second local axis in the first airway, and the second portion of the treatment device presses against the second portion of the first airway to urge it to more a coaxial orientation relative to the first local axis, thereby straightening the path through the first airway in contact with the first and second portions of the treatment device and the third portion of the treatment device presses against the first portion of the second airway to urge it to a more coaxial orientation relative to the fourth local axis in the second airway, and the fourth portion of the treatment device presses against the second portion of the second airway to urge it to more a coaxial orientation relative to the third local axis, thereby straightening the path through the second airway in contact with the third and fourth portions of the treatment device; whereas the first and second portions of the treatment device are urged closer to the third and fourth portions of the treatment device in a deployed configuration within the lung. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within more than one airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: a first portion having a first bearing surface having a structure with a centroid defining a first local axis, the first portion of the treatment device configured to engage a first portion of a first airway with the first bearing surface; a second portion (can be a portion of a proximal v clip) coupled to the first portion of the treatment device, the second portion of the treatment device having a second bearing surface having a structure with a centroid defining a second local axis, the second portion of the treatment device configured to engage a second portion of the first airway with the second bearing surface, the second portion of the first airway being axially spaced apart from the first portion of the first airway; a third portion coupled to the second portion of the treatment device having a third bearing surface having a structure with a centroid defining a third local axis, the third portion of the treatment device configured to engage a first portion of a second airway with the third bearing surface; and a fourth portion (can be another distal end) coupled to the third portion of the treatment device, the fourth portion of the treatment device having a fourth bearing surface having a structure with a centroid defining a fourth local axis, the fourth portion of the treatment device configured to engage a second portion of the second airway with the fourth bearing surface, the second portion of the second airway being axially spaced apart from the first portion of the second airway; wherein, in a deployed configuration within the lung, the first portion of the treatment device presses against the first portion of the first airway to urge it to a more coaxial orientation relative to the second local axis in the first airway, and the second portion of the treatment device presses against the second portion of the first airway to urge it to more a coaxial orientation relative to the first local axis, thereby straightening the path through the first airway in contact with the first and second portions of the treatment device and the third portion of the treatment device presses against the first portion of the second airway to urge it to a more coaxial orientation relative to the fourth local axis in the second airway, and the fourth portion of the treatment device presses against the second portion of the second airway to urge it to more a coaxial orientation relative to the third local axis, thereby straightening the path through the second airway in contact with the third and fourth portions of the treatment device; whereas the first and second portions of the treatment device are urged closer to the third and fourth portions of the treatment device in a deployed configuration within the lung; whereas the treatment device increases tension in lung tissue in a deployed configuration within the lung. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within more than one airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: a first portion having a first bearing surface having a structure with a centroid defining a first local axis, the first portion of the treatment device configured to engage a first portion of a first airway with the first bearing surface; a second portion (can be a portion of a proximal v clip) coupled to the first portion of the treatment device, the second portion of the treatment device having a second bearing surface having a structure with a centroid defining a second local axis, the second portion of the treatment device configured to engage a second portion of the first airway with the second bearing surface, the second portion of the first airway being axially spaced apart from the first portion of the first airway; a third portion coupled to the second portion of the treatment device having a third bearing surface having a structure with a centroid defining a third local axis, the third portion of the treatment device configured to engage a first portion of a second airway with the third bearing surface; and a fourth portion (can be another distal end) coupled to the third portion of the treatment device, the fourth portion of the treatment device having a fourth bearing surface having a structure with a centroid defining a fourth local axis, the fourth portion of the treatment device configured to engage a second portion of the second airway with the fourth bearing surface, the second portion of the second airway being axially spaced apart from the first portion of the second airway; wherein, in a deployed configuration within the lung, the first portion of the treatment device presses against the first portion of the first airway to urge it to a more coaxial orientation relative to the second local axis in the first airway, and the second portion of the treatment device presses against the second portion of the first airway to urge it to more a coaxial orientation relative to the first local axis, thereby straightening the path through the first airway in contact with the first and second portions of the treatment device and the third portion of the treatment device presses against the first portion of the second airway to urge it to a more coaxial orientation relative to the fourth local axis in the second airway, and the fourth portion of the treatment device presses against the second portion of the second airway to urge it to more a coaxial orientation relative to the third local axis, thereby straightening the path through the second airway in contact with the third and fourth portions of the treatment device; whereas the first and second portions of the treatment device are urged closer to the third and fourth portions of the treatment device in a deployed configuration within the lung; whereas the second and third portions of the treatment device are coupled by a resilient spring material. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within more than one airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: a first portion having a first bearing surface having a structure with a centroid defining a first local axis, the first portion of the treatment device configured to engage a first portion of a first airway with the first bearing surface; a second portion (can be a portion of a proximal v clip) coupled to the first portion of the treatment device, the second portion of the treatment device having a second bearing surface having a structure with a centroid defining a second local axis, the second portion of the treatment device configured to engage a second portion of the first airway with the second bearing surface, the second portion of the first airway being axially spaced apart from the first portion of the first airway; a third portion coupled to the second portion of the treatment device having a third bearing surface having a structure with a centroid defining a third local axis, the third portion of the treatment device configured to engage a first portion of a second airway with the third bearing surface; and a fourth portion (can be another distal end) coupled to the third portion of the treatment device, the fourth portion of the treatment device having a fourth bearing surface having a structure with a centroid defining a fourth local axis, the fourth portion of the treatment device configured to engage a second portion of the second airway with the fourth bearing surface, the second portion of the second airway being axially spaced apart from the first portion of the second airway; wherein, in a deployed configuration within the lung, the first portion of the treatment device presses against the first portion of the first airway to urge it to a more coaxial orientation relative to the second local axis in the first airway, and the second portion of the treatment device presses against the second portion of the first airway to urge it to more a coaxial orientation relative to the first local axis, thereby straightening the path through the first airway in contact with the first and second portions of the treatment device and the third portion of the treatment device presses against the first portion of the second airway to urge it to a more coaxial orientation relative to the fourth local axis in the second airway, and the fourth portion of the treatment device presses against the second portion of the second airway to urge it to more a coaxial orientation relative to the third local axis, thereby straightening the path through the second airway in contact with the third and fourth portions of the treatment device; whereas the first and second portions of the treatment device are urged closer to the third and fourth portions of the treatment device in a deployed configuration within the lung; whereas the second and third portions of the treatment device are coupled by a resilient spring material; whereas at least one of the portions of the treatment device is covered with a jacket to increase the area that is engaged with a portion of an airway. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within more than one airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: a first portion having a first bearing surface having a structure with a centroid defining a first local axis, the first portion of the treatment device configured to engage a first portion of a first airway with the first bearing surface; a second portion (can be a portion of a proximal v clip) coupled to the first portion of the treatment device, the second portion of the treatment device having a second bearing surface having a structure with a centroid defining a second local axis, the second portion of the treatment device configured to engage a second portion of the first airway with the second bearing surface, the second portion of the first airway being axially spaced apart from the first portion of the first airway; a third portion coupled to the second portion of the treatment device having a third bearing surface having a structure with a centroid defining a third local axis, the third portion of the treatment device configured to engage a first portion of a second airway with the third bearing surface; and a fourth portion (can be another distal end) coupled to the third portion of the treatment device, the fourth portion of the treatment device having a fourth bearing surface having a structure with a centroid defining a fourth local axis, the fourth portion of the treatment device configured to engage a second portion of the second airway with the fourth bearing surface, the second portion of the second airway being axially spaced apart from the first portion of the second airway; wherein, in a deployed configuration within the lung, the first portion of the treatment device presses against the first portion of the first airway to urge it to a more coaxial orientation relative to the second local axis in the first airway, and the second portion of the treatment device presses against the second portion of the first airway to urge it to more a coaxial orientation relative to the first local axis, thereby straightening the path through the first airway in contact with the first and second portions of the treatment device and the third portion of the treatment device presses against the first portion of the second airway to urge it to a more coaxial orientation relative to the fourth local axis in the second airway, and the fourth portion of the treatment device presses against the second portion of the second airway to urge it to more a coaxial orientation relative to the third local axis, thereby straightening the path through the second airway in contact with the third and fourth portions of the treatment device; whereas the first and second portions of the treatment device are urged closer to the third and fourth portions of the treatment device in a deployed configuration within the lung; whereas the second and third portions of the treatment device are coupled by a resilient spring material; whereas at least one of the portions of the treatment device is covered with a jacket to increase the area that is engaged with a portion of an airway; whereas the first and fourth portions of the treatment device are covered with a jacket to increase the area that is engaging the first portion of the first airway and second portion of the second airway. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within more than one airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: a first portion having a first bearing surface having a structure with a centroid defining a first local axis, the first portion of the treatment device configured to engage a first portion of a first airway with the first bearing surface; a second portion (can be a portion of a proximal v clip) coupled to the first portion of the treatment device, the second portion of the treatment device having a second bearing surface having a structure with a centroid defining a second local axis, the second portion of the treatment device configured to engage a second portion of the first airway with the second bearing surface, the second portion of the first airway being axially spaced apart from the first portion of the first airway; a third portion coupled to the second portion of the treatment device having a third bearing surface having a structure with a centroid defining a third local axis, the third portion of the treatment device configured to engage a first portion of a second airway with the third bearing surface; and a fourth portion (can be another distal end) coupled to the third portion of the treatment device, the fourth portion of the treatment device having a fourth bearing surface having a structure with a centroid defining a fourth local axis, the fourth portion of the treatment device configured to engage a second portion of the second airway with the fourth bearing surface, the second portion of the second airway being axially spaced apart from the first portion of the second airway; wherein, in a deployed configuration within the lung, the first portion of the treatment device presses against the first portion of the first airway to urge it to a more coaxial orientation relative to the second local axis in the first airway, and the second portion of the treatment device presses against the second portion of the first airway to urge it to more a coaxial orientation relative to the first local axis, thereby straightening the path through the first airway in contact with the first and second portions of the treatment device and the third portion of the treatment device presses against the first portion of the second airway to urge it to a more coaxial orientation relative to the fourth local axis in the second airway, and the fourth portion of the treatment device presses against the second portion of the second airway to urge it to more a coaxial orientation relative to the third local axis, thereby straightening the path through the second airway in contact with the third and fourth portions of the treatment device; whereas the first and second portions of the treatment device are urged closer to the third and fourth portions of the treatment device in a deployed configuration within the lung; whereas the second and third portions of the treatment device are coupled by a resilient spring material; whereas at least one of the portions of the treatment device is covered with a jacket, selected from the materials defined as jacket materials in this specification, to increase the area that is engaged with a portion of an airway; whereas the first and fourth portions of the treatment device are covered with a jacket to increase the area that is engaging the first portion of the first airway and second portion of the second airway. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured with a jacket to increase the area that is engaged with lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured with a jacket, made from material listed in this specification defined as jacket materials, to increase the area that is engaged with lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured with a jacket to increase the area that is engaged with lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured with a jacket, made from a polymer, to increase the area that is engaged with lung tissue. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured with a jacket, made from a polymer material, that regulates the rate of release of a therapeutic drug. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured with a jacket, made from a polymer material, that regulates the rate of release of a therapeutic drug; whereas the therapeutic drug reduces the rate of wound healing, tissue remodeling, inflammation, generation of granular tissue or a combination of these. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within an airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: an elongate body having a proximal end and a distal end; the elongate body configured to transition between a delivery configuration and a deployed configuration; and wherein the deployed configuration of the elongate body exerts force on the airway to straighten a portion of the airway that is axially spaced between the proximal and distal end of the treatment device for reducing air flow resistance in the lung; and wherein the elongate body is configured to increases tension in lung tissue to bring benefits related to increasing lung tension. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within an airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: an elongate body having a proximal end and a distal end; the elongate body configured to transition between a delivery configuration and a deployed configuration; and wherein the deployed configuration of the elongate body exerts force on the airway to straighten a portion of the airway that is axially spaced between the proximal and distal end of the treatment device for reducing air flow resistance in the lung; and wherein the elongate body is configured to increases tension in lung tissue to bring benefits related to increasing lung tension; and wherein the elongate body is configured to elute a therapeutic drug. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within an airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: an elongate body having a proximal end and a distal end; the elongate body configured to transition between a delivery configuration and a deployed configuration; and wherein the deployed configuration of the elongate body exerts force on the airway to straighten a portion of the airway that is axially spaced between the proximal and distal end of the treatment device for reducing air flow resistance in the lung; and wherein the elongate body is configured to increases tension in lung tissue to bring benefits related to increasing lung tension; and wherein the elongate body is configured to elute a therapeutic drug; wherein the therapeutic drug is configured to locally reduce a wound healing rate. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within an airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: an elongate body having a proximal end and a distal end; the elongate body configured to transition between a delivery configuration and a deployed configuration; and wherein the deployed configuration of the elongate body exerts force on the airway to straighten a portion of the airway that is axially spaced between the proximal and distal end of the treatment device for reducing air flow resistance in the lung; and wherein the elongate body is configured to increases tension in lung tissue to bring benefits related to increasing lung tension; and wherein the elongate body is configured to elute a therapeutic drug; wherein the therapeutic drug is configured to locally reduce tissue remodeling. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within an airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: an elongate body having a proximal end and a distal end; the elongate body configured to transition between a delivery configuration and a deployed configuration; and wherein the deployed configuration of the elongate body exerts force on the airway to straighten a portion of the airway that is axially spaced between the proximal and distal end of the treatment device for reducing air flow resistance in the lung; and wherein the elongate body is configured to increases tension in lung tissue to bring benefits related to increasing lung tension; and wherein the elongate body is configured to elute a therapeutic drug; wherein the therapeutic drug is configured to locally reduce inflammation. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within an airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: an elongate body having a proximal end and a distal end; the elongate body configured to transition between a delivery configuration and a deployed configuration; and wherein the deployed configuration of the elongate body exerts force on the airway to straighten a portion of the airway that is axially spaced between the proximal and distal end of the treatment device for reducing air flow resistance in the lung; and wherein the elongate body is configured to increases tension in lung tissue to bring benefits related to increasing lung tension; and wherein the elongate body is configured to elute a therapeutic drug; wherein the therapeutic drug is configured to reduce granular tissue formation. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within an airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: an elongate body having a proximal end and a distal end; the elongate body configured to transition between a delivery configuration and a deployed configuration; and wherein the deployed configuration of the elongate body exerts force on the airway to straighten a portion of the airway that is axially spaced between the proximal and distal end of the treatment device for reducing air flow resistance in the lung; and wherein the elongate body is configured to increases tension in lung tissue to bring benefits related to increasing lung tension; and wherein the elongate body is configured to elute a therapeutic drug; wherein the therapeutic drug is configured to reduce hyperplasia. 
     In another aspect of the present invention, a pulmonary treatment device is provided, configured to be deployed within an airway of a lung of a patient for treating the lung of the patient, the treatment device comprising: an elongate body having a proximal end and a distal end; the elongate body configured to transition between a delivery configuration and a deployed configuration; and wherein the deployed configuration of the elongate body exerts force on the airway to straighten a portion of the airway that is axially spaced between the proximal and distal end of the treatment device for reducing air flow resistance in the lung; and wherein the elongate body is configured to increases tension in lung tissue to bring benefits related to increasing lung tension; and wherein the elongate body is configured to elute a therapeutic drug; wherein the elongate body comprises a polymer material and wherein the polymer material regulates a release of the therapeutic drug. 
     In another aspect of the present invention, a method is provided for treating a lung comprising: deploying an implantable pulmonary treatment device to the airway of the lung, the treatment device comprising an elongate body having a proximal end and a distal end that can be repositioned; wherein the distal end of the elongate body is deployed to anchor to lung tissue, the proximal end of the elongate body is deployed to an initial position to anchor to lung tissue in a repositionable way, the proximal end is repositioned to a position farther from the distal end of the treatment device than the proximal end initial deployed position so that the elongate body and airway are urged to a more straight configuration. 
     In another aspect of the present invention, a method is provided for treating a lung comprising: deploying an implantable pulmonary treatment device to the airway of the lung, the treatment device comprising an elongate body having a proximal end and a distal end that can be repositioned; wherein the distal end of the elongate body is deployed to anchor to lung tissue, the proximal end of the elongate body is deployed to an initial position to anchor to lung tissue in a repositionable way, the proximal end is repositioned to a position farther from the distal end of the treatment device than the proximal end initial deployed position so that the elongate body and airway are urged to a more straight configuration; wherein the elongate body of the treatment device is configured to tension lung tissue to bring benefits related to increasing lung tension. 
     In another aspect of the present invention, a method is provided for treating a lung comprising: deploying an implantable pulmonary treatment device to the airway of the lung, the treatment device comprising an elongate body having a proximal end and a distal end that can be repositioned; wherein the distal end of the elongate body is deployed to anchor to lung tissue, the proximal end of the elongate body is deployed to an initial position to anchor to lung tissue in a repositionable way, the proximal end is repositioned to a position farther from the distal end of the treatment device than the proximal end initial deployed position so that the elongate body and airway are urged to a more straight configuration; wherein the elongate body of the treatment device is configured to increase tension of lung tissue that lie along directional vectors between the treatment device and chest wall. 
     In another aspect of the present invention, a method is provided for treating a lung comprising: deploying a pulmonary treatment device to the airway of the lung, the treatment device comprising an elongate body having a proximal end and a distal end that can be repositioned; wherein the distal end of the elongate body is deployed to anchor to lung tissue, the proximal end of the elongate body is deployed to an initial position to anchor to lung tissue in a repositionable way, the proximal end is repositioned to a position farther from the distal end of the treatment device than the proximal end initial deployed position so that the elongate body and airway are urged to a more straight configuration; wherein the elongate body of the treatment device is configured to increase tension of lung tissue that lies between the treatment device and the chest wall. 
     In another aspect of the present invention, a method is provided for treating a lung comprising: deploying a pulmonary treatment device to the airway of the lung, the treatment device comprising an elongate body having a proximal end and a distal end that can be repositioned; wherein the distal end of the elongate body is deployed to anchor to lung tissue, the proximal end of the elongate body is deployed to an initial position to anchor to lung tissue in a repositionable way, the proximal end is repositioned to a position farther from the distal end of the treatment device than the proximal end initial deployed position so that the elongate body and airway are urged to a more straight configuration; wherein the elongate body of the treatment device is configured to elute a therapeutic drug. 
     In another aspect of the present invention, a method is provided for treating a lung comprising: deploying a tissue engaging end of a pulmonary treatment device into loose damaged alveolar sac tissue distal to a lung passageway; pulling the tissue engaging end toward the lung passageway so that a portion of the lung associated with the loose damaged alveolar sac tissue is re-tensioned; and seating a stabilizing end of the pulmonary treatment device into the lung passageway so as to maintain re-tensioning of the portion of the lung. 
     In another aspect of the present invention, a method is provided to treat a lung comprising: providing a pulmonary treatment device with a proximal end configured to be a stabilizing end, a distal end configured to be a tissue gathering end and an elastic midsection that is connected to the stabilizing end and the tissue gathering ends and a delivery device configured to seat the stabilizing end of the pulmonary treatment device into the lung passageway; apply force to stress the elastic midsection of the treatment device so it is strained to a longer length and the distal tissue gathering end of the lung treatment device is advanced further within the lung; fix the tissue engaging end of the treatment device to the lung and then remove the delivery device to allow the elastic midsection to stent the lumen of the lung passageway while applying compressive stress on the lung tissue near the treatment device and to tension portions of the lung that are adjacent to the treatment device. 
     In another aspect of the present invention, a method is provided for reducing the distance between two locations in a lung to increase tension in locations in the lung that are not between the two locations. The method includes the steps of providing a device with at least two anchors and an elastic midsection that can be elongated to store elastic recoil strain energy, anchoring at a first location in the lung a first anchor, elongating the midsection to store elastic recoil strain energy, anchoring at a second location a second anchor where the second location is distant from the first location, allow the midsection with stored elastic recoil strain energy to reduce the distance between the anchored first location and the anchored second location to decrease the distance between the two locations to increase tension in locations in the lung that are not between the two anchored locations. 
     In another aspect of the present invention, a method is provided for reducing the distance between two locations in a lung to increase tension in locations in the lung that are not between the two locations. The method includes the steps of providing a device with at least two anchors and an elastic midsection that can store elastic recoil strain energy, anchoring at a first location in the lung a first anchor, anchoring at a second location a second anchor where the second location is distant from the first location, reducing the distance between the anchored first location and the anchored second location to decrease the distance between the two locations to increase tension in locations in the lung that are not between the two anchored locations. 
     In another aspect of the present invention, a method is provided for reducing the distance between two locations in a lung to increase tension in locations in the lung that are not between the two locations. The method includes the steps of providing a device with at least two anchors and an elastic midsection that can store elastic recoil strain energy, anchoring at a first location in the lung a first anchor, anchoring at a second location a second anchor where the second location is distant from the first location, reducing the distance between the anchored first location and the anchored second location to decrease the distance between the two locations to increase tension in locations in the lung that are not between the two anchored locations using stored elastic recoil strain energy. 
     In another aspect of the present invention, a method is provided for treating a lung comprising: advancing a lung treatment device comprising a tissue gathering distal end, a stabilizing proximal end, both connected to an elastic midsection; a delivery device comprising a bronchoscope, a deployment sleeve and a guidewire into a lung airway; advancing the treatment device through a lung airway until the stabilizing end or proximal end of the treatment device seats in the lung airway whereby the user continues to advance the non-stabilizing proximal end portion of the treatment device until the mid-section is extended or lengthened; deploying a tissue anchoring feature of the distal end of the pulmonary treatment device to allow the elastic midsection of the treatment device to pull lung tissue towards the center of the elastic midsection to increase tension in adjacent lung tissue. After removing the delivery system, the lung elastic recoil tension would be enhanced in the lung. By performing this method of treatment, one end of the treatment device is fixed to lung tissue, the treatment device is lengthened to store strain energy to fully elastically lengthen the device and the distal portion is then fixed to lung tissue. After removing the bronchoscope and related delivery system components such as a guidewire and deployment sleeve, the lung treatment device utilizes the stored strain energy to recover back to an original unstressed length and this pulls the tissue engaging end toward the lung passageway so that a portion of the lung associated with the distal or loose damaged alveolar sac tissue is re-tensioned and the seated stabilizing end of the pulmonary treatment device is pulled into the lung tissue so as to maintain re-tensioning of a large portion of the lung. The elastic midsection of the treatment device may be configured to stent the lung airway while enhancing lung tension as the airway tissue that is in contact with the elastic mid-section may be compressed over time and prone to allow lumen collapse during breathing. The elastic midsection of the treatment device may be made from a laser cut tube or a coiled or braided wire. 
     In another aspect of the invention, a method is provided to advance and deploy a pulmonary treatment device using a guidewire a deployment sleeve and a bronchoscope guide sleeve to 1) seat the proximal anchor of the treatment device which has been described as the stabilizing end of the treatment device, 2) advance the distal anchor structure that has been defined in as the tissue gathering end portion of the treatment device so that the midsection of the treatment device is elongated in a fully reversibly elastic way, 3) the deployment sleeve applies compressive force against the tissue gathering end portion of the treatment device to maintain the extended length of the mid-section while the bronchoscope is removed, 4) withdrawing the bronchoscope activates the anchor feature that is attached to the tissue gathering end so the distal portion of the treatment device is fixed to the lung tissue while 5) the guidewire, deployment sleeve and bronchoscope are fully removed from the lung to 6) allow the elastic recoil properties of the pulmonary treatment device to re-tension the area of loose damaged alveolar sac tissue, 7) pull the distal and proximal ends of the treatment device closer together 8) reduce compliance of the lung and 9) maintain the re-tension of the area of loose damaged alveolar sac tissue to enhance radial outward force to airways so symptoms of COPD are reduced or eliminated. 
     In another aspect of the present invention, a method is provided for treating a lung comprising the steps of: advancing a lung treatment system to a treatment location comprising a delivery system element with a distal end, a proximal end and a lung treatment device configured to at least partially encircle the delivery system element while the system is used to treat a patient, elongating the treatment device and deploying the device into the lung to tension lung tissue. 
     In another aspect of the present invention, a method is provided for treating a lung comprising the steps of: advancing a lung treatment system to a treatment location comprising a delivery system element with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of the element, a pulmonary treatment device configured to at least partially encircle the delivery system element while the system is advanced into a patient and elongating the treatment device and deploying the device into the lung to enhance lung elastic recoil. 
     In another aspect of the present invention, a method is provided for treating a lung comprising the steps of: advancing a lung treatment system comprising a delivery system element with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of the element, a pulmonary treatment device configured to at least partially encircle the delivery system element while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung, elongating the treatment device and deploying the device into the lung to pull lung tissue towards the treatment device centroid. 
     In another aspect of the present invention, a method is provided for treating a lung comprising the steps of: advancing a lung treatment system comprising a delivery system element with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of the element and an implantable pulmonary treatment device configured to at least partially encircle the delivery system element while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung, elongating the treatment device and deploying the treatment device in the lung to beneficially stress tissue in the lung. 
     In another aspect of the present invention, a method is provided for treating a lung comprising the steps of: advancing a lung treatment system comprising a delivery system canula with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of the canula, a pulmonary treatment device configured to at least partially encircle the delivery system canula while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung and implant the treatment device in the lung to enhance lung elastic recoil and reduce symptoms of COPD. 
     In another aspect of the present invention, a method is provided for treating a lung comprising the steps of: advancing a lung treatment system comprising a delivery system canula with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of the canula, a pulmonary treatment device configured to at least partially encircle the delivery system canula while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung, elongate the treatment device and deploy the treatment device in the lung to tension lung tissue. 
     In another aspect of the present invention, a method is provided for treating a lung comprising the steps of: advancing a lung treatment system comprising a bronchoscope with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of working length portion of the bronchoscope, a pulmonary treatment device configured to at least partially encircle the bronchoscope while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung, elongate the treatment device and implanted it in the lung to treat COPD. 
     In another aspect of the present invention, a lung treatment method is provided for treating a lung comprising the steps of; providing a bronchoscope with a distal end, a proximal end and a length which is longer than 5 inches and a pulmonary treatment device with a distal tissue gathering end, a proximal tissue stabilizing end and a midsection. The treatment device is configured to at least partially encircle the bronchoscope while the system is advanced into a patient to deliver the treatment device to a lung. The method includes anchoring the tissue gathering end at a first location, anchoring the tissue stabilizing end at a second location which is distant from the first location and reducing the distance between the first and second locations to increase tension in a portion of the lung that is not between the first and second locations. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of providing a bronchoscope with a distal end, a proximal end and a length which is longer than 5 inches, a pulmonary treatment device with a distal tissue gathering end, a proximal tissue stabilizing end and a midsection which is configured to be able to store elastic strain energy. Additionally, the treatment device is configured to at least partially encircle the bronchoscope while the system is advanced into a patient to deliver the treatment device to a lung. The method includes anchoring the tissue gathering end at a first location, anchoring the tissue stabilizing end at a second location which is distant from the first location and allowing stored elastic strain energy to reduce the distance between the first and second locations to increase tension in a portion of the lung that is not between the first and second locations. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of providing a bronchoscope with a distal end, a proximal end and a length which is longer than 5 inches, a lung treatment device with a distal tissue gathering end, a proximal tissue stabilizing end and a midsection which is configured to be able to store elastic strain energy. The method includes anchoring the tissue gathering end at a first location, anchoring the tissue stabilizing end at a second location which is distant from the first location and allowing stored elastic strain energy to reduce the distance between the first and second locations to increase tension in a portion of the lung that is not between the first and second locations. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of providing an elongate delivery system shaft with a distal end, a proximal end and a length which is longer than 5 inches, a lung treatment device with a distal tissue gathering end, a proximal tissue stabilizing end and a midsection which is configured to be able to store elastic strain energy. The method includes anchoring the tissue gathering end at a first location, anchoring the tissue stabilizing end at a second location which is distant from the first location and allowing stored elastic strain energy to reduce the distance between the first and second locations to increase tension in a portion of the lung that is not between the first and second locations. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of providing an elongate delivery system shaft with a distal end, a proximal end and a length which is longer than 5 inches, a pulmonary treatment device with a distal tissue gathering end, a proximal tissue stabilizing end and a midsection which is configured to be able to store elastic strain energy. Additionally, the pulmonary treatment device is configured to at least partially encircle the elongate delivery system shaft. The method includes anchoring the tissue gathering end at a first location, anchoring the tissue stabilizing end at a second location which is distant from the first location and allowing stored elastic strain energy to reduce the distance between the first and second locations to increase tension in a portion of the lung that is not between the first and second locations. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of providing an elongate delivery system shaft with a distal end, a proximal end and a length which is longer than 5 inches, a pulmonary treatment device with a distal tissue gathering end, a proximal tissue stabilizing end and a midsection which is configured to be able to store elastic strain energy. Additionally, the treatment device is configured to at least partially encircle the elongate delivery system shaft. The method includes anchoring the tissue gathering end at a first location, anchoring the tissue stabilizing end at a second location which is distant from the first location and reducing the distance between the first and second locations to increase tension in a portion of the lung that is not between the first and second locations. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of providing an elongate delivery system shaft with a distal end, a proximal end and a length which is longer than 5 inches, a pulmonary treatment device with a distal tissue gathering end, a proximal tissue stabilizing end and a midsection which is configured to be able to store elastic strain energy. The method includes anchoring the tissue gathering end at a first location, anchoring the tissue stabilizing end at a second location which is distant from the first location and reducing the distance between the first and second locations to increase tension in a portion of the lung that is not between the first and second locations. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of providing a pulmonary treatment device, a bronchoscope and a bronchoscope guide sleeve whereas the treatment device is configured with a proximal end, a distal end and a midsection that incorporates a lumen running through the treatment device proximal end and midsection along the central axis between the distal end and the proximal ends, a bronchoscope guide sleeve is configured with a proximal end, a distal end and a lumen running through the full length of the bronchoscope guide sleeve along the central axis between the distal end and proximal end; a bronchoscope that is configured to be advanced through the bronchoscope guide sleeve and through the proximal end and midsection of the treatment device in a way that allows the lung treatment device length to be lengthened or shortened by sliding the bronchoscope guide sleeve, which has been attached to the lung treatment device, along the axis of the coaxial bronchoscope. Further, the treatment device distal end is anchored to a first location in the lung, the treatment device proximal end is anchored to a second location in the lung which is distant from the first location and the treatment device is shortened to reduce the distance between the two locations in the lung to increase tension in areas in the lung that are not between the two locations. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of providing a pulmonary treatment device, a bronchoscope and a bronchoscope guide sleeve whereas the lung treatment device is configured with a proximal end, a distal end and a midsection. The treatment device can be elongated to store elastic strain energy. The treatment device may also be attached to the bronchoscope and the bronchoscope guide sleeve. The bronchoscope guide sleeve is configured with a proximal end, a distal end and a lumen running therethrough along its longitudinal axis. The bronchoscope is configured to be advanced through the bronchoscope guide sleeve and through the treatment device in a way that allows the lung treatment device length to be lengthened or shortened by sliding the bronchoscope guide sleeve along the axis of the coaxial bronchoscope. Further, the treatment device distal end is anchored to a first location in the lung, the treatment device proximal end is anchored to a second location in the lung which is distant from the first location and the treatment device is shortened to reduce the distance between the two locations in the lung to increase tension in areas in the lung that are not between the first or second anchored locations. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of providing a pulmonary treatment device, a bronchoscope and a bronchoscope guide sleeve whereas the treatment device is configured with a proximal end, a distal end and a midsection. The treatment device can be elongated to store elastic strain energy. The treatment device may also be attached to the bronchoscope and the bronchoscope guide sleeve. The bronchoscope guide sleeve is configured with a proximal end, a distal end and a lumen running therethrough along its longitudinal axis. The bronchoscope is configured to be advanced through the bronchoscope guide sleeve and through the treatment device in a way that allows the treatment device length to be lengthened or shortened by sliding the bronchoscope guide sleeve along the axis of the coaxial bronchoscope. Further, the treatment device is elongated to store elastic strain energy, distal end is anchored to a first location in the lung, the treatment device proximal end is anchored to a second location in the lung which is distant from the first location and the treatment device is shortened to reduce the distance between the two locations in the lung to increase tension in areas in the lung that are not between the first or second anchored locations. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of providing a pulmonary treatment device, a bronchoscope and a bronchoscope guide sleeve whereas the treatment device is configured with a proximal end, a distal end and a midsection. The treatment device can be elongated to store elastic strain energy. The treatment device may also be attached to the bronchoscope and the bronchoscope guide sleeve. The bronchoscope guide sleeve is configured with a proximal end, a distal end and a lumen running therethrough along its longitudinal axis. The bronchoscope is configured to be advanced through the bronchoscope guide sleeve and through the lung treatment device in a way that allows the lung treatment device length to be lengthened or shortened by sliding the bronchoscope guide sleeve along the axis of the coaxial bronchoscope. Further, the treatment device is elongated to store elastic strain energy, distal end is anchored to a first location in the lung, the lung treatment device proximal end is anchored to a second location in the lung which is distant from the first location and the stored elastic strain energy is allowed to shorten the lung treatment device to reduce the distance between the two locations in the lung to increase tension in areas in the lung that are not between the first or second anchored locations. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of deploying the tissue gathering end of a pulmonary treatment device in an airway at a location more distal from a bifurcation than the length of the pulmonary treatment device, pulling the undeployed portion of the device proximally and then deploying the stabilizing end at the bifurcation. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of deploying the tissue gathering end of a pulmonary treatment device in an airway at a location more distal from a stabilizing end target location than the length of the device, pulling the undeployed portion of the device proximally and then deploying the stabilizing end at the proximal stabilizing end target location. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of deploying the tissue gathering end of a pulmonary treatment device in an airway at a location more distal from a bifurcation than the length of the device, deploying the rest of the device and then tensioning the stabilizing end of the device to place the stabilizing end at the airway ostium or bifurcation. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of deploying the tissue gathering end of a pulmonary treatment device in an airway at a location more distal from a stabilizing end target location than the length of the device, deploying the rest of the device and then tensioning the stabilizing end of the device to place the stabilizing end at the stabilizing end target location. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of deploying the tissue gathering end of a pulmonary treatment device in an airway at a location more distal from a bifurcation than the length of the pulmonary treatment device, deploying the rest of the pulmonary treatment device and then tensioning a portion of the pulmonary treatment device to allow the stabilizing end to be placed at the airway ostium or bifurcation. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of deploying the tissue gathering end of a pulmonary treatment device in an airway at a location more distal from a stabilizing end target location than the length of the pulmonary treatment device, deploying the rest of the pulmonary treatment device and then tensioning a portion of the pulmonary treatment device to allow the stabilizing end to be placed at the stabilizing end target location. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of installing a shape-memory alloy medical device within a human lung so that the device is substantially at body temperature wherein the shape-memory alloy medical device displays reversible stress-induced or strain induced martensite at body temperature to straighten a lung airway, the method further comprising: deforming the medical device into a deformed shape different from a final shape; restraining the deformed shape of the medical device by the application of a restraining mechanism; positioning the medical device and restraining mechanism within the lung; and removing the restraining mechanism to allow the device to recover from the deformed shape into the final shape. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of installing a shape-memory alloy medical device within a human lung so that the device is substantially at body temperature wherein the shape-memory alloy medical device displays reversible stress-induced or strain induced martensite at body temperature to straighten a lung airway, the method further comprising: deforming the medical device into a deformed shape different from a final shape; restraining the deformed shape of the medical device by the application of a restraining mechanism; positioning the medical device and restraining mechanism within the lung; and removing the restraining mechanism to allow the device to recover from the deformed shape into the final shape; whereby the device tensions lung tissue. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of tensioning lung tissue by: delivering to the lung a resilient medical device with a distal end, a proximal end and a connected midsection; anchoring at least a portion of the distal end at a first position in the lung; displacing at least a portion of the proximal end to a position that is distant from the anchored at least portion of the distal end; anchoring at least a portion of the proximal end at a second position in the lung. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of tensioning lung tissue by: delivering to the lung a resilient medical device with a distal end, a proximal end and a connected midsection; anchoring at least a portion of the distal end at a first position in the lung; displacing at least a portion of the proximal end to a position that is distant from the anchored at least portion of the distal end; anchoring at least a portion of the proximal end at a second position in the lung, whereas displacing the proximal end lengthens the device. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of tensioning lung tissue by: delivering to the lung a resilient medical device with a distal end, a proximal end and a connected midsection; anchoring a at least portion of the distal end at a first position in the lung; displacing a at least portion of the proximal end to a position that is distant from the anchored at least portion of the distal end to tension the device; anchoring at least a portion of the proximal end at a second position in the lung. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of straightening a lung airway by: delivering to the lung a resilient medical device with a distal end, a proximal end and a connected midsection; anchoring at least a portion of the distal end at a first position in the lung; displacing at least a portion of the proximal end to a position that is distant from the anchored at least portion of the distal end in a way that straightens the lung airway; anchoring at least a portion of the proximal end at a second position in the lung. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of tensioning a lung airway by: delivering to the lung a resilient medical device a with distal end, a proximal end and a connected midsection; anchoring at least a portion of the distal end at a first position in a lung airway; displacing at least a portion of the proximal end to a position that is distant from the anchored at least portion of the distal end in a way that tensions the lung airway; anchoring at least at least a portion of the proximal end at a second position in another lung airway. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of tensioning a lung airway by: delivering to the lung a resilient medical device with a distal end, a proximal end and a connected midsection; anchoring at least a portion of the distal end at a first position in a lung airway; displacing at least a portion of the proximal end to a position that is distant from the anchored at least portion of the distal end in a way that tensions the lung airway; anchoring at least at least a portion of the proximal end at a second position in another at least portion of the same lung airway. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of tensioning lung tissue without causing lung volume reduction, the steps include: delivering to the lung a resilient medical device a with distal end, a proximal end and a connected midsection; anchoring at least a portion of the distal end at a first position in a lung; displacing at least a portion of the proximal end to a position in the lung that is distant from the anchored at least portion of the distal end to cause the midsection of the device to be elongated; anchoring at least a portion of the proximal end at the distant position in the lung, whereas all adjacent lung tissue has been tensioned and no lung tissue has been compressed to cause lung volume reduction. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of tensioning lung tissue without causing lung volume reduction, the steps include: delivering to the lung a resilient medical device with a distal end, a proximal end and a connected midsection; anchoring at least a portion of the proximal end at a first position in the lung; displacing a portion of the distal end to a position in the lung that is distant from the anchored at least portion of the proximal end to cause the midsection of the device to be elongated; anchoring at least a portion of the distal end at the distant position in the lung, whereas all adjacent lung tissue has been tensioned and no lung tissue has been compressed to cause lung volume reduction. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of deploying a resilient airway straightening medical device comprising an elongate body and at least one end that can be attached to lung tissue; attaching the end to at least a portion of a lung and; pulling the device to cause the attached end to pull on lung tissue to straighten a portion of a lung airway. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of deploying a resilient airway straightening medical device comprising an elongate body and at least one end that can be attached to lung tissue; attaching the end to at least a portion of a lung and; pulling the device to cause the attached end to pull on lung tissue to straighten a portion of a lung airway in a way that causes no lung volume reduction or tissue compression to occur. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of deploying a resilient airway straightening medical device comprising an elongate body and at least one end configured to be attached to lung tissue; attaching the end to at least a portion of a lung; and pulling the device to cause the attached end to pull on lung tissue to straighten a portion of a lung airway. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of deploying a pulmonary treatment device from a delivery device within a lung airway; the pulmonary treatment device comprising a tissue gathering end, a stabilizing end, and a resilient tether extending between the tissue gathering end and stabilizing end; the device configured such that the distance between the ends is increased then the ends are attached to lung tissue before releasing the pulmonary treatment device from a delivery device. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of deploying a pulmonary treatment device from a delivery device within a lung airway; the pulmonary treatment device comprising a tissue gathering end, a stabilizing end, and a resilient tether extending between the tissue gathering end and stabilizing end, the device configured such that the distance between the ends is increased and the ends are attached to a lung airway before releasing the pulmonary treatment device from a delivery device; thus straightening the lung airway. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of deploying a pulmonary treatment device from a delivery device within a lung airway; the pulmonary treatment device comprising a tissue gathering end, a stabilizing end, and a resilient tether extending between the tissue gathering end and stabilizing end, the device configured such that the distance between the ends is increased; the ends are attached to lung tissue; the pulmonary treatment device is released from the delivery device to increase tension between the ends. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of deploying a pulmonary treatment device from a delivery device within a lung airway; the pulmonary treatment device comprising a tissue gathering end, a stabilizing end, and a resilient tether extending between the tissue gathering end and stabilizing end, the device configured such that the distance between the ends is increased; and the ends are attached to lung tissue before releasing the pulmonary treatment device from a delivery device; allowing the tissue to maintain the increased distance. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of enhancing a breathing efficiency of a patient with a lung having an airway, the method comprising: advancing a treatment device distally through the airway to a portion of the lung of the patient while the treatment device is in a delivery configuration, the treatment device having a proximal end and a distal end; deploying the treatment device in a portion of the lung by transitioning the treatment device from the delivery configuration to a deployed configuration, the deployed configuration of the treatment device comprising at least two helical sections with a transition section disposed between the at least two helical sections; wherein the transition section is configured to straighten lung tissue disposed between the at least two helical sections when the device is in the second configuration. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of enhancing a breathing efficiency of a patient with a lung having an airway, the method comprising: advancing a treatment device distally through the airway to a portion of the lung of the patient while the treatment device is in a delivery configuration, the treatment device having a proximal end and a distal end; deploying the treatment device in a portion of the lung by transitioning the treatment device from the delivery configuration to a deployed configuration, the deployed configuration of the treatment device comprising at least two helical sections with a transition section disposed between the at least two helical sections; wherein the distal end is configured to straighten lung tissue disposed more distal to the at least two helical sections when the treatment device is transitioned to the deployed configuration. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of enhancing a breathing efficiency of a patient with a lung having an airway, the method comprising: advancing a treatment device distally through the airway to a portion of the lung of the patient while the treatment device is in a delivery configuration, the treatment device having a proximal end and a distal end; deploying the treatment device in a portion of the lung by transitioning the treatment device from the delivery configuration to a deployed configuration, the deployed configuration of the treatment device comprising at least two helical sections with a transition section disposed between the at least two helical sections; wherein the distal end is configured to straighten lung tissue disposed more distal to the at least two helical sections when the treatment device is transitioned to the deployed configuration. 
     In another aspect of the present invention, a lung treatment method is provided, comprising the steps of enhancing a breathing efficiency of a patient with a lung having an airway, the method comprising: advancing a treatment device distally through the airway to a portion of the lung of the patient while the treatment device is in a delivery configuration, the treatment device having a proximal end and a distal end; deploying the treatment device in a portion of the lung by transitioning the treatment device from the delivery configuration to a deployed configuration, the deployed configuration of the treatment device comprising at least two helical sections with a transition section disposed between the at least two helical sections; wherein the distal end is configured to straighten lung tissue disposed more distal to the distal end when the treatment device is transitioned to the deployed configuration and the proximal end is repositioned more proximally, relative to the deployed distal end. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: a delivery device having a proximal end, a distal end and lumen therethrough, wherein the distal end is configured to be advanced through a tracheobronchial tree of the lung to an area of loose damaged alveolar sac tissue; a pulmonary treatment device advanceable through the lumen of the delivery device, wherein the pulmonary treatment device includes a tissue gathering end and a stabilizing end; a deployment element removably attached to the pulmonary treatment device and insertable into the lumen of the delivery device, wherein together the delivery device and deployment element 1) deploy the tissue gathering end into the area of loose damaged alveolar sac tissue while maintaining attachment of the pulmonary treatment device to the deployment element, 2) pull the deployed tissue gathering end so as to re-tension the area of loose damaged alveolar sac tissue, and 3) deploy the stabilizing end within a lung passageway so as to maintain the re-tension of the area of loose damaged alveolar sac tissue. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: a delivery device having a proximal end, a distal end and lumen therethrough, wherein the distal end is configured to be advanced through a tracheobronchial tree of the lung to an airway in the lung; a deployment sleeve comprising a distal end and a proximal end and a lumen therethrough which is sized to be advanced through the delivery device lumen, a guidewire which may be passed through the lumen of the deployment sleeve; a pulmonary treatment device having a distal tissue gathering end, a proximal stabilizing end and a midsection spring element that is mounted around the outside of the delivery device in a configuration that allows the system to be advanceable through the trachea and into lung airways and lung passageways, wherein the pulmonary treatment device is configured to be advanced so that the proximal stabilizing end is wedged into lung tissue; the delivery device is configured to continue to advance the non-stabilizing portion of the treatment device so that the midsection spring element is strained to a longer state; the deployment sleeve is configured to be advanced and held against distal end of the treatment device to hold it in place in the patient while the delivery device is removed. The system includes a guidewire which is configured to hold the treatment device aligned in the same axis as the delivery device lumen. The delivery device may be a bronchoscope. 
     In another aspect of the present invention, a system is provided for treating a COPD patient&#39;s lung comprising: a delivery system element with a distal end, a proximal end and a lung treatment device configured to at least partially encircle the delivery system element while the system is used to treat a patient. 
     In another aspect of the present invention, a system is provided for treating a COPD patient&#39;s lung comprising: a delivery system element with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of the element, a lung treatment device configured to at least partially encircle the delivery system element while the system is advanced into a patient. 
     In another aspect of the present invention, a system is provided for treating a COPD patient&#39;s lung comprising: a delivery system element with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of the element, a lung treatment device configured to at least partially encircle the delivery system element while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung. 
     In another aspect of the present invention, a system is provided for treating a COPD patient&#39;s lung comprising: a delivery system element with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of the element, a lung treatment device configured to at least partially encircle the delivery system element while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung. 
     In another aspect of the present invention, a system is provided for treating a COPD patient&#39;s lung comprising: a delivery system canula with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of the canula, a lung treatment device configured to at least partially encircle the delivery system canula while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung, whereas the lung treatment device is implanted in the lung to enhance lung elastic recoil. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: a delivery system canula with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of the canula, a pulmonary treatment device configured to at least partially encircle the delivery system canula while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung, whereas the treatment device is implanted in the lung to tension lung tissue. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: a bronchoscope with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of working length portion of the bronchoscope, a pulmonary treatment device configured to at least partially encircle the bronchoscope while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung, whereas the treatment device is implanted in the lung to treat COPD. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: a bronchoscope with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of working length portion of the bronchoscope, a pulmonary treatment device configured to at least partially encircle the bronchoscope while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung, whereas the treatment device is implanted in the lung to treat the symptoms relating to COPD. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: a bronchoscope with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of working length portion of the bronchoscope, a pulmonary treatment device configured to at least partially encircle the bronchoscope while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung, whereas the treatment device is implanted in the lung to by making one or more of the beneficial changes in the patient that are listed herein above. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: a bronchoscope with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of working length portion of the bronchoscope, a pulmonary treatment device configured to at least partially encircle the bronchoscope while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung, whereas the treatment device is elongated before it is implanted in the lung to make one or more of the beneficial changes in the patient that are listed herein above. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: a bronchoscope with a distal end, a proximal end and a length which is longer than 2 times the largest transverse dimension of working length portion of the bronchoscope, a pulmonary treatment device configured to at least partially encircle the bronchoscope while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung, whereas the treatment device is elongated to store elastic strain energy to be released in tissue to make one or more of the beneficial changes in the patient that are listed herein above. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: a bronchoscope with a distal end, a proximal end and a lumen running therethrough, a pulmonary treatment device configured to at least partially encircle the bronchoscope while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung, whereas the treatment device is elongated to store elastic strain energy to be released in tissue to make one or more of the beneficial changes in the patient that are listed herein above. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: a bronchoscope with a distal end, a proximal end and a lumen running therethrough, a pulmonary treatment device configured to at least partially encircle the bronchoscope while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung, whereas the treatment device is elongated to store elastic strain energy to be used to tension lung tissue. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: a bronchoscope with a distal end, a proximal end and a lumen running therethrough, a pulmonary treatment device configured to at least partially encircle the bronchoscope while the system is advanced into a patient to deliver the treatment device to a treatment location in the lung and a bronchoscope guide sleeve with a distal end, a proximal end and a lumen configured to allow the bronchoscope to be advanced through the bronchoscope guide sleeve; whereas the treatment device is elongated by the bronchoscope guide sleeve and the bronchoscope to store elastic strain energy in the treatment device to be used to tension lung tissue. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: a pulmonary treatment device, a bronchoscope and a bronchoscope guide sleeve whereas the treatment device is configured with a proximal end, a distal end and a midsection and a lumen running through the treatment device proximal end and midsection along the central axis between the distal end and the proximal ends, the bronchoscope guide sleeve is configured with a proximal end, a distal end and an open lumen running through the full length of the bronchoscope guide sleeve along the central axis between the distal end and proximal end; the bronchoscope is configured to be advanced through the bronchoscope guide sleeve and through the proximal end and midsection of the lung treatment device so the treatment device length may be adjusted by sliding the bronchoscope guide sleeve along the axis of the coaxial bronchoscope. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: an assembly for straightening a portion of a lung airway, the assembly comprising: a straightening element; a first end configured for fixing to a first portion of the lung, the straightening element attached to the first end; a second end configured for fixing to a second portion of the lung, the straightening element being attached to the second end; a delivery device for delivering the first end to the first portion of the lung and for delivering the second end to the second portion of the lung. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: an assembly for straightening a portion of a lung airway, the assembly comprising: a straightening element; a first end configured for fixing to a first portion of the lung, the straightening element attached to the first end; a second end configured for fixing to a second portion of the lung, the straightening element being attached to the second end; a delivery device for delivering the first end to the first portion of the lung and for delivering the second end to the second portion of the lung; whereas the delivery device is a bronchoscope. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: an assembly for straightening a portion of a lung airway, the assembly comprising: a straightening element; a first end configured for fixing to a first portion of the lung, the straightening element attached to the first end; a second end configured for fixing to a second portion of the lung, the straightening element being attached to the second end; a delivery device for delivering the first end to the first portion of the lung and for delivering the second end to the second portion of the lung; whereas the delivery device is a tube. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: an assembly for straightening a portion of a lung airway, the assembly comprising: a straightening element; a first end configured for fixing to a first portion of the lung, the straightening element attached to the first end; a second end configured for fixing to a second portion of the lung, the straightening element being attached to the second end; a delivery device for delivering the first end to the first portion of the lung and for delivering the second end to the second portion of the lung; whereas the straightening element is tensioned after at least one end is deployed. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: an assembly for straightening a portion of a lung airway, the assembly comprising: a straightening element; a first end configured for fixing to a first portion of the lung, the straightening element attached to the first end; a second end configured for fixing to a second portion of the lung, the straightening element being attached to the second end; a delivery device for delivering the first end to the first portion of the lung and for delivering the second end to the second portion of the lung; whereas the straightening element and ends are made more co-axial before being released from the delivery device than they are while being delivered to the airway. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: an assembly for straightening a portion of a lung airway, the assembly comprising: a straightening element; a first end configured for fixing to a first portion of the lung, the straightening element attached to the first end; a second end configured for fixing to a second portion of the lung, the straightening element being attached to the second end; a delivery device for delivering the first end to the first portion of the lung and for delivering the second end to the second portion of the lung; whereas the first end is a deformable spring. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: an assembly for straightening a portion of a lung airway, the assembly comprising: a straightening element; a first end configured for fixing to a first portion of the lung, the straightening element attached to the first end; a second end configured for fixing to a second portion of the lung, the straightening element being attached to the second end; a delivery device for delivering the first end to the first portion of the lung and for delivering the second end to the second portion of the lung; whereas the second end is a deformable spring. 
     In another aspect of the present invention, a system is provided for treating a lung comprising: an assembly for straightening a portion of a lung airway, the assembly comprising: a straightening element; a first end configured for fixing to a first portion of the lung, the straightening element attached to the first end; a second end configured for fixing to a second portion of the lung, the straightening element being attached to the second end; a delivery device for delivering the first end to the first portion of the lung and for delivering the second end to the second portion of the lung; whereas the straightening element is a helix. 
     In another aspect of the present invention, a system is provided for straightening more than one lung airway, the assembly comprising: a first straightening element having a first end for attaching to a first airway in the lung; a second straightening element having a second end for attaching to a second airway in the lung; a connector that connects the first straightening element to the second straightening element; and a delivery device for delivering the first end to the first airway in the lung and for delivering the second end to the second airway in the lung. 
     In another aspect of the present invention, a system is provided for straightening more than one lung airway, the assembly comprising: a first straightening element having a first end for attaching to a first airway in the lung; a second straightening element having a second end for attaching to a second airway in the lung; a connector that connects the first straightening element to the second straightening element; and a delivery device for delivering the first end to the first airway in the lung and for delivering the second end to the second airway in the lung; whereas the delivery device is a bronchoscope 
     In another aspect of the present invention, a system is provided for straightening more than one lung airway, the assembly comprising: a first straightening element having a first end for attaching to a first airway in the lung; a second straightening element having a second end for attaching to a second airway in the lung; a connector that connects the first straightening element to the second straightening element; and a delivery device for delivering the first end to the first airway in the lung and for delivering the second end to the second airway in the lung; whereas the delivery device is a tube. 
     In another aspect of the present invention, a system is provided for straightening more than one lung airway, the assembly comprising: a first straightening element having a first end for attaching to a first airway in the lung; a second straightening element having a second end for attaching to a second airway in the lung; a connector that connects the first straightening element to the second straightening element; and a delivery device for delivering the first end to the first airway in the lung and for delivering the second end to the second airway in the lung; whereas the first straightening element is tensioned after at least one end is deployed. 
     In another aspect of the present invention, a system is provided for straightening more than one lung airway, the assembly comprising: a first straightening element having a first end for attaching to a first airway in the lung; a second straightening element having a second end for attaching to a second airway in the lung; a connector that connects the first straightening element to the second straightening element; and a delivery device for delivering the first end to the first airway in the lung and for delivering the second end to the second airway in the lung; whereas the first straightening element and first end is made more co-axial before being released from the delivery system than they are while being delivered to the airway. 
     In another aspect of the present invention, a system is provided for straightening more than one lung airway, the assembly comprising: a first straightening element having a first end for attaching to a first airway in the lung; a second straightening element having a second end for attaching to a second airway in the lung; a connector that connects the first straightening element to the second straightening element; and a delivery device for delivering the first end to the first airway in the lung and for delivering the second end to the second airway in the lung; whereas the second straightening element and second end is made more co-axial before being released from the delivery device than they are while being delivered to the airway. 
     In another aspect of the present invention, a system is provided for straightening more than one lung airway, the assembly comprising: a first straightening element having a first end for attaching to a first airway in the lung; a second straightening element having a second end for attaching to a second airway in the lung; a connector that connects the first straightening element to the second straightening element; and a delivery device for delivering the first end to the first airway in the lung and for delivering the second end to the second airway in the lung; whereas the first tissue gathering end is a deformable spring. 
     In another aspect of the present invention, a system is provided for straightening more than one lung airway, the assembly comprising: a first straightening element having a first end for attaching to a first airway in the lung; a second straightening element having a second end for attaching to a second airway in the lung; a connector that connects the first straightening element to the second straightening element; and a delivery device for delivering the first end to the first airway in the lung and for delivering the second end to the second airway in the lung; whereas the first straightening element is a helix. 
     In another aspect of the present invention, a system is provided for straightening more than one lung airway, the assembly comprising: a first straightening element having a first end for attaching to a first airway in the lung; a second straightening element having a second end for attaching to a second airway in the lung; a connector that connects the first straightening element to the second straightening element; and a delivery device for delivering the first end to the first airway in the lung and for delivering the second end to the second airway in the lung; whereas the second straightening element is a helix. 
     In another aspect of the present invention, a system is provided for straightening more than one lung airway, the assembly comprising: a first straightening element having a first end for attaching to a first airway in the lung; a second straightening element having a second end for attaching to a second airway in the lung; a connector that connects the first straightening element to the second straightening element; and a delivery device for delivering the first end to the first airway in the lung and for delivering the second end to the second airway in the lung; whereas the connector that connects the first straightening element to the second straightening element is a v shaped spring. 
     In another aspect of the present invention, a system is provided for straightening more than one lung airway, the assembly comprising: a first straightening element having a first end for attaching to a first airway in the lung; a second straightening element having a second end for attaching to a second airway in the lung; a connector that connects the first straightening element to the second straightening element; and a delivery device for delivering the first end to the first airway in the lung and for delivering the second end to the second airway in the lung; whereas the connector that connects the first straightening element to the second straightening element is a v shaped spring. 
     In another aspect of the present invention, a system is provided for straightening more than one lung airway, the assembly comprising: a first straightening element having a first end for attaching to a first airway in the lung; a second straightening element having a second end for attaching to a second airway in the lung; a connector that connects the first straightening element to the second straightening element; and a delivery device for delivering the first end to the first airway in the lung and for delivering the second end to the second airway in the lung; additionally, more components may be included to be used to straighten a 3rd or 4th, 5th or 6th airway with a single device. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart a straightening force on a lung airway, the implantable device including a proximal end, and a distal end with a transition section connecting the two ends that includes at least one helical loop structure; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable length constrained condition, the second configuration is configured so the distance between the start and end of at least one of the helical loop structurer can be increased to straighten the airway. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein at least one of the ends comprise a circular helical section when the implantable device is in the second configuration. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein both of the ends comprise a circular helical section when the implantable device is in the second configuration. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein the implantable device further comprises a jacket (jacket can be metallic, plastic, coating, coil or extrusion made from a variety of materials, such as metals (e.g. stainless steel, titanium, nitinol, nickel, cobalt chrome, or a combination of these) or polymers (e.g. polycarbonate urethane, polytetrafluoroethylene (PTFE), ethylene tetrafluoroethylene (ETFE). fluorinated ethylene propylene (FEP), polyimide film (e.g. Kapton®), polyimide, polyether ether ketone (PEEK), polyethylene, ethylene-vinyl acetate (EVA) (also known as poly (ethylene-vinyl acetate) (PEVA)), polypropylene, polyvinyl alcohol (PVA), polyurethane, nylon, polyether block amides (PEBA), acrylonitrile butadiene styrene (ABS), polybutyrate, butyrate, polyethylene terephthalate (PET), polysulfone (PES), ethylene tetrafluoroethylene (ETFE), polyvinylidene fluoride (PVDF), thermoplastic polyurethane elastomers (e.g. Pellethane®), aliphatic polyether-based thermoplastic polyurethanes (TPUs) (e.g. Tecoflex®), metallocenes or a combination of these) which covers a portion of the implantable device, the jacket configured to reduce erosion into the airway by a deployed implantable device (by maximizing the bearing area in contact with the tissue to be greater than 9.81E-7 inches squared of bearing area per linear inch of the implantable device). 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein a jacket covers the at least one helical sections. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein a jacket covers the distal end of the implantable device. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein the distal end of the implantable device is configured to couple with the airway. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein the proximal end of the implantable device is atraumatic. 
     A method for treating a lung of a patient, the lung including a lung passageway system having a first lung passageway elongate axial region with an associated first local lung passageway central axis and a second lung passageway elongate axial region with an associated second local lung passageway central axis, the method comprising: introducing an elongate body of an implant system axially into the lung passageway system so that a proximal portion of the elongate body is disposed within the first axial lung passageway region and so that a distal implant portion of the elongate body is disposed within the second axial lung passageway region; tensioning a lung tissue volume disposed at least in part distal to at least one of the lung passageway axial regions by bending the elongate body between the proximal and distal portions so as to urge the first local lung passageway axis of the first lung passageway axial region laterally toward the second lung passageway axial region while the proximal and distal portions of the elongate body extend axially within the first and second lung passageway axial regions, respectively. 
     A method for treating a lung of a patient, the lung including a lung passageway system having a first lung passageway elongate axial region with an associated first local lung passageway central axis, and a second lung passageway elongate axial region with an associated second local lung passageway central axis, the method comprising: introducing an elongate body of an implant system axially into the lung passageway system so that a proximal portion of the elongate body is disposed within the first axial lung passageway region and so that a distal implant portion of the elongate body is disposed within the second axial lung passageway region; tensioning a lung tissue volume disposed at least in part distal to at least one of the lung passageway axial regions by releasing strain energy that has been previously stored in the elongate body to compress the elongate body between the proximal and distal portions so as to urge the first local lung passageway axis of the first lung passageway axial region laterally toward the second lung passageway axial region while the proximal and distal portions of the elongate body extend within the first and second lung passageway axial regions, respectively. 
     A method for treating a lung of a patient, the lung including a lung passageway system having a first lung passageway elongate axial region with an associated first local lung passageway central axis, and a second lung passageway elongate axial region with an associated second local lung passageway central axis, the method comprising: introducing an elongate body of an implant system axially into the lung passageway system so that a proximal portion of the elongate body is disposed within the first axial lung passageway region and so that a distal implant portion of the elongate body is disposed within the second axial lung passageway region; tensioning a lung tissue volume by releasing strain energy that has been previously stored in the elongate body so as to urge the first local lung passageway axis of the first lung passageway axial region laterally toward the second lung passageway axial region while the proximal and distal portions of the elongate body extend axially within the first and second lung passageway axial regions, respectively. 
     A method for treating a lung of a patient, the lung including an lung passageway system having a first lung passageway elongate axial region with an associated first local lung passageway central axis, and a second lung passageway elongate axial region with an associated second local lung passageway central axis, the method comprising: introducing an elongate body of an implant system axially into the lung passageway system so that a proximal portion of the elongate body is disposed within the first axial lung passageway region and so that a distal implant portion of the elongate body is disposed within the second axial lung passageway region; tensioning a lung tissue volume by rotating the elongate body. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein the proximal end of the implantable device comprising one or more features selected from the following: a ball, loop, break away link, threaded hole or shaft, friction fit taper or hole, that is reversibly coupled to a delivery system. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein the implantable device is made of a metal alloy that contains nickel and titanium. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein the implantable device is made from a stainless-steel alloy. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein the implantable device is made from a steel alloy containing chromium. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein the implantable device is made from an alloy containing cobalt. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein the stabilizing end comprises more helical loops than the tissue gathering end when the implantable device is in the second configuration. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein the tissue gathering end comprises less than one loop when the implantable device is in the second configuration. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein the helical section transitions into the proximal end via a bend that is disposed between the proximal portion of the helical section and the proximal end such that the helical section is straightened when proximal end is repositioned more proximally relative to the proximal portion of the helical section when the device is in the second configuration. 
     In another aspect of the present invention, a lung airway straightening system is provided for enhancing breathing efficiency of a patient with an airway, the system comprising: an implantable device configured to impart tension on lung tissue, the implantable device including a proximal stabilizing end, and a distal tissue gathering end with a transition section connecting the two ends that includes at least one helical loop structure with a start and an end to the helical loop; furthermore, the device has a first delivery configuration and a second deployed configuration, the first configuration of the implantable device corresponds to a deliverable condition and a finite distance between the start and end of at least one of the helical loop structures, the second configuration is configured so the distance between the start and end of the same helical loop structures may be elastically strained longer to apply tension to lung tissue; wherein the implant comprises a spring element and wherein the implant is constrained to the delivery configuration during delivery and wherein the implant is configured to naturally recover from the constrained delivery configuration to the deployed configuration during deployment. 
     In another aspect of the present invention, a lung tensioning device is provided that tensions lung tissue with the application of a rotating motion to turn the implant after a portion of the implant has engaged tissue. 
     In another aspect of the present invention, a lung tensioning device is provided that tensions lung tissue with the application of a combination of rotating motion and longitudinal translation motion to turn the implant and to apply longitudinal translation of the implant after a portion of the implant has engaged tissue. 
     These and other embodiments are described in further detail in the following description related to the appended drawing figures. 
     INCORPORATION BY REFERENCE 
     All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which: 
         FIG. 1  illustrates a healthy lung of a patient. 
         FIGS. 2-3  illustrates damaged lung tissue. 
         FIG. 4  illustrates a cross-sectional slice under computed tomography (CT) of the lungs of a patient suffering from COPD. 
         FIG. 5  illustrates a lung of a patient suffering from advanced COPD. 
         FIG. 6  illustrates an embodiment of a pulmonary treatment device comprising an elongate shaft coiled into a helical shape to form a tissue gathering end, a stabilizing end and an extendable midsection therebetween. 
         FIG. 7  illustrates an embodiment of the pulmonary treatment device expanding along its longitudinal axis. 
         FIG. 8  illustrates a pulmonary treatment device delivered by a delivery device configured to be advanced to an area of loose damaged alveolar sac tissue. 
         FIG. 9  illustrates retraction of the deployment element which straightens and extends the surrounding airway. 
         FIG. 10  illustrates the pulmonary treatment device left in place to maintain re-tensioning of the lung. 
         FIG. 11  illustrates the positioning of three pulmonary treatment devices within the lung of a patient. 
         FIG. 12  illustrates a plurality of pulmonary treatment devices positioned in both lungs of a patient. 
         FIG. 13  illustrates an embodiment of a tissue gathering end of a pulmonary treatment device. 
         FIG. 14  illustrates a top view of the embodiment of  FIG. 13 . 
         FIG. 15  illustrates another embodiment of a tissue gathering end of a pulmonary treatment device. 
         FIG. 16  illustrates a top view of the embodiment of  FIG. 15 . 
         FIG. 17  illustrates an embodiment of a tissue gathering end of a pulmonary treatment device having multiple loops. 
         FIG. 18  illustrates a top view of the embodiment of  FIG. 17 . 
         FIG. 19  illustrates another embodiment of a tissue gathering end of a pulmonary treatment device. 
         FIG. 20  illustrates a top view of the embodiment of  FIG. 19 . 
         FIG. 21  illustrates an embodiment of a tissue gathering end wherein the shaft extends along the longitudinal axis through the extendible midsection and then gradually bends radially outwardly distal to the extendible midsection. 
         FIG. 22  illustrates a top view of the embodiment of  FIG. 21 . 
         FIG. 23  illustrates an embodiment of a tissue gathering end wherein at least one of the loops of the tissue gathering end cross at least a portion of another loop. 
         FIG. 24  illustrates a top view of the embodiment of  FIG. 23 . 
         FIG. 25  illustrates an embodiment of a pulmonary treatment device having an extendible midsection connecting the tissue gathering end with the stabilizing end. 
         FIG. 26  illustrates an embodiment of a pulmonary treatment device having an attachment feature located distally of the stabilizing end. 
         FIGS. 27A-27D  illustrate example tips suitable for either the distal tip or proximal tip. 
         FIGS. 28A-28D  illustrate example methods of forming the tips of  FIGS. 27A-27D . 
         FIGS. 29A-29D  illustrate example tips having an attachment feature. 
         FIG. 30  illustrates an embodiment of a device configured from a shaft comprising a hollow tube. 
         FIGS. 31A-31B  illustrate an embodiment of a bronchoscope used as a delivery device for delivering the pulmonary treatment device. 
         FIG. 32  illustrates an embodiment of an introducer having a pre-loaded pulmonary treatment device. 
         FIG. 33  illustrates another embodiment of an introducer having a pre-loaded pulmonary treatment device. 
         FIG. 34  illustrates a pre-loaded introducer advanceable into the working channel port of a bronchoscope. 
         FIG. 35  illustrates the insertion cord tip of the bronchoscope positioned in the damaged tissue of the patient&#39;s lung. 
         FIGS. 36-37  illustrate an embodiment wherein two devices are joined with the use of a joining device. 
         FIG. 38  illustrates an embodiment of a delivery system for delivering a pulmonary treatment device of the present invention. 
         FIG. 39  illustrates an embodiment of a pulmonary treatment device that is deliverable by the system of  FIG. 38  and has a flared stabilizing end. 
         FIG. 40  illustrates the treatment device of  FIG. 39  mounted on the delivery system of  FIG. 38 . 
         FIG. 41  illustrates deployment of the treatment device within the target airway by advancing the delivery system so as to push the tissue gathering end further along the target airway while the extendible midsection expands, elongating the treatment device. 
         FIG. 42  illustrates the beginning stages of decoupling the device from the delivery system wherein the tissue gathering end is unmounted from the bronchoscope. 
         FIG. 43  illustrates further steps of decoupling the device from the delivery system, wherein the deployment sleeve and guidewire have been removed from the bronchoscope allowing the tissue gathering end to fully engage with the wall of the airway. 
         FIG. 44  illustrates retraction and removal of the delivery device from the lung anatomy, leaving the treatment device behind. 
         FIG. 45  illustrates the treatment device after the stored elastic strain energy that has been stored in at least the midsection of the treatment device has urged the device to shorten and recover elastically more closely to its original pre-elongated length. 
         FIG. 46  illustrates another embodiment of a delivery system for delivery of a treatment device, the delivery system comprises a bronchoscope having a bronchoscope body and an insertion cord, a guidewire, a deployment sleeve and a guide sleeve. 
         FIG. 47  illustrates an embodiment of a treatment device releasably mounted on the delivery system of  FIG. 46 . 
         FIG. 48  illustrates elongation of the extendible midsection due to retraction of the stabilizing end by the guide sleeve and catch feature. 
         FIG. 49  illustrates another embodiment of a treatment device, wherein the treatment device has a tissue gathering end and extendible midsection which is similar to the device of  FIG. 39 , however in this embodiment the stabilizing end differs. 
         FIG. 50  illustrates the treatment device of  FIG. 49  loaded onto a delivery system. 
         FIG. 51  illustrates deployment of the tissue gathering end of the treatment device of  FIG. 49  within an airway. 
         FIG. 52  illustrates extension of the midsection of the treatment device of  FIG. 49  by retracting the guide sleeve which has a tether extending therethrough removably attached to the extension loop of the device. 
         FIG. 53  illustrates anchoring of the stabilizing end of the treatment device of  FIG. 49  by retracting the bronchoscope from the device. 
         FIG. 54  illustrates the treatment device of  FIG. 49  after the tether has been cut and removed, thereby allowing the midsection to recoil toward its natural configuration over time. 
         FIG. 55  illustrates the elastic recoil of the treatment device of  FIG. 54  supporting the airway tree A, B, C, D, E and F in tension. 
         FIG. 56  illustrates an alternative method of treating a patient wherein the pulmonary treatment device is deployed in the lung anatomy and then expanded thereafter. 
         FIG. 57  illustrates an embodiment of a treatment device that is collapsible into a small profile for optional delivery through a lumen in a delivery device. 
         FIG. 58  illustrates the treatment device of  FIG. 57  in a collapsed configuration mounted on a guidewire. 
         FIG. 59A  illustrates the treatment device in a non-stressed configuration 
         FIG. 59B  illustrates the treatment device and delivery system in a lung with the treatment device partially deployed in the lung 
         FIG. 60  illustrates a treatment device and delivery system whereas the treatment device is partially deployed in the lung and the tissue gathering end of the treatment device is being rotated to apply torque to lung tissue to tension the lung tissue 
         FIG. 61  illustrates the treatment device deployed in the lung after the tissue gathering end has been rotated to apply toque to tension lung tissue and the anchoring end has been deployed in another airway branch to maintain the torsion and lung tissue tension 
         FIGS. 62A-62D  illustrate the treatment device and delivery system with sequential deployment steps including rotation motions applied to the tissue gathering end and deployment of the anchoring end to maintain the tissue gathering, rotation and tensioning. 
         FIG. 63A-63C  illustrates embodiments of treatment devices with a variety of tissue gathering and anchoring element shapes. 
         FIG. 64  illustrates an embodiment of a treatment device with a tissue gathering element that crosses over the longitudinal axis of the device. 
         FIG. 65  illustrates an embodiment of a treatment device made from two ribbon strips that have been bonded together. 
         FIG. 66  illustrates an embodiment of a treatment device that has been crimped together. 
         FIG. 67  illustrates an embodiment of a treatment device with a curvilinear tissue gathering element. 
         FIG. 68  illustrates an embodiment of a treatment device with matching tissue gathering and anchoring elements. 
         FIG. 69  illustrates an embodiment of a treatment device with strain relief sections that store energy during deployment. 
         FIGS. 70A-70B  illustrates an embodiment of a treatment device comprised of a tube having slots or cuts along at least a portion of its length to increase bearing area against tissue. 
         FIG. 71A-71C  illustrates alternative designs to increase device bearing area on tissue. 
         FIG. 72  illustrates an embodiment of a treatment device with a expandable anchoring element design. 
         FIG. 73  illustrates an embodiment of a treatment device with hooks as anchoring elements. 
         FIG. 74  illustrates an embodiment of a treatment device with a stent as an anchoring element. 
         FIG. 75  illustrates an embodiment of a treatment device section made from two joined wires. 
         FIG. 76A-76B  illustrates embodiments of treatment device attachment end configurations. 
         FIG. 77  illustrates an embodiment of a treatment device socketing attachment end. 
         FIG. 78  illustrates an embodiment of a treatment device threaded attachment end. 
         FIG. 79  illustrates an embodiment of a treatment device with an interlocking attachment end. 
         FIG. 80  illustrates an embodiment of a treatment device attachment end that is controlled by forceps. 
         FIG. 81  illustrates an embodiment of a treatment device with a stent anchoring element. 
         FIGS. 82A-82B  illustrates an embodiment of a treatment device made from a single wire shaft. 
         FIGS. 82C-82D  illustrate additional embodiments of a pulmonary treatment device having a tissue gathering element and an anchoring element. 
         FIGS. 82E-82G  illustrate steps in an example method of deploying a torque-based pulmonary treatment device such as illustrated in  FIGS. 82A-82D . 
         FIGS. 83A-83I  illustrates an embodiment of a treatment device being deployed in lung tissue. 
         FIG. 84A-84E  illustrates an embodiment of a dual tissue gathering element treatment device and components. 
         FIG. 85  illustrates an embodiment of a treatment device and delivery system inserted into an airway. 
         FIG. 86  illustrates an embodiment of a treatment device tissue gathering elements deployed through the airway wall. 
         FIG. 87  illustrates an embodiment of a treatment device being rotated to rotate and tension tissue. 
         FIG. 88  illustrates an embodiment of a treatment device middle section being deployed from the catheter. 
         FIG. 89  illustrates an embodiment of a treatment device anchoring end being deployed to the airway ostium. 
         FIG. 90  illustrates an embodiment of a treatment device being decoupled from the delivery system control devices. 
         FIGS. 91A-91D  illustrate design details of an embodiment of a torqueing tool and connection. 
         FIG. 92  illustrates steps of an embodiment of a method that includes basic treatment steps that utilize torque to affect tissue. 
         FIG. 93  illustrates an example of two treatment devices deployed into adjacent airways. 
         FIG. 94  illustrates steps of an embodiment of a method to deploy two treatment devices in branching airways. 
         FIG. 95  illustrates steps of an embodiment of a method to deploy a treatment device while seeking anatomical feedback. 
         FIG. 96  illustrates steps of an embodiment of a method to deploy a treatment device while seeking physiologic feedback. 
         FIGS. 97A-97C  illustrates an embodiment of a torsion-based treatment device that is surgically installed. 
         FIG. 98  illustrates the treatment device of  FIG. 97A  surgically installed. 
         FIGS. 99A-99D  illustrate embodiments of distal tips having twisted ends. 
         FIG. 100  illustrates an embodiment of a torque-based pulmonary treatment device prepared for pre-loading in an introducer. 
         FIG. 101  illustrates the device of  FIG. 100  preloaded into the introducer and prepared for advancement into a catheter. 
         FIG. 102  illustrates the distal tip of the catheter of  FIG. 101  advanced beyond the distal tip of the bronchoscope and the beginning steps of deployment of the device. 
         FIG. 103  illustrates exposure of the anchoring element for anchoring of the device. 
         FIG. 104  illustrates expansion of the anchoring element. 
         FIG. 105  illustrates release of the device to be left behind as an implant. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Specific embodiments of the disclosed device, delivery system, and method will now be described with reference to the drawings. Nothing in this detailed description is intended to imply that any particular component, feature, or step is essential to the invention. 
     Anatomical Changes in COPD 
       FIG. 1  illustrates a healthy lung L of a patient. As shown, the lung L includes a tracheobronchial tree which is the anatomical and functional segment of the respiratory system that conducts air from the larger upper airways to the lung parenchyma. It is comprised of the trachea T and various intrapulmonary airways, including the bronchi, bronchioles and terminal bronchioles. The trachea and bronchi have cartilaginous walls which makes them thick, fibrous and this allows them to maintain patency during breathing. Bronchi undergo multiple divisions and eventually give rise to the terminal bronchioles, which by definition, lack cartilage. The most distal respiratory bronchioles and alveoli are where gas exchanges into and out of the blood stream. 
     The trachea T is also referred to as the zero-generation airway and it extends distally 10-12 cm and it then divides into the right and left mainstem bronchi MB, commonly referred to as the first-generation airways. The left mainstem bronchus MB (shown in  FIG. 1 ) is about 5 cm in length. The mainstem bronchus MB divides into the lobar bronchi LB (secondary or second-generation airways) and subsequently into the segmental bronchi SB (tertiary or third generation). Subsegmental airways (fourth generation airways) branch off from the segmental airways and they lead to the numerous subsegmental portions that are found in each lobar segment. Bronchi undergo multiple divisions (on average 23) along the bronchial tree. The initial 16-17 generations of bronchi make up the conducting zone of the airways and these do not normally participate in gas exchange in healthy lungs. However, with the progression of COPD and particularly with Emphysema, many of the traditional pathways beyond about the fourth generation commonly get destroyed and collateral pathways are formed that allow gas to communicate and get trapped in places in the lung that can no longer exchange gas as well as alveolar tissue in the lung that can exchange gas. 
     As bronchi divide into smaller airways, the respiratory epithelium undergoes histological changes and gives rise to terminal bronchioles. The 17th to 19th generations of bronchioles constitute the transitional zone. These bronchioles enter pyramid-shaped pulmonary lobules separated from one another by a thin septum, with the apex directed toward the hilum, comprising 5-7 terminal bronchioles. The last 2-3 generations of bronchioles have some alveoli in their walls and make up the respiratory zone. The area of the lung that is distal to a terminal bronchiole is termed the acinus. The final division is called the respiratory bronchiole, which further branches into multiple alveolar ducts. Alveoli, the functional units of the respiratory system, start appearing at the level of the respiratory bronchioles. This is where the majority of gas is exchanged. It is important to note that the majority of the healthy lung volume is comprised of alveoli tissue. The airway network branches from the trachea through the various portions of the lung to supply a volume of oxygen and to expel carbon dioxide from alveoli that are positioned almost everywhere within the lung. Only a small volume of the lung is occupied by the airway tree and the arterial network that transports blood from the right side of the heart through the lung to the left side of the heart. 
     In a healthy lung L, the intrapulmonary airways are held open by tension t (indicated by lines with facing arrows) between the airways and the chest wall CW. The elastic nature of healthy connective lung tissue and alveoli tissue communicates the tension. The tension is required to hold airways open during normal breathing as the airways experience higher external pressure, relative to the internal air pressure, during exhalation breathing cycles. Without this radial outward lung elastic recoil tension holding the airways open, the airways would collapse during exhalation which would not allow air to exit the lung. The lung L is suspended in an expanded state due to negative pressure or vacuum between the chest wall CW and the exterior lining of the lung, or pleura PL, of the lung L. As a person inhales, the chest wall CW and ribs R are expanded by the chest wall muscle CWM and the diaphragm muscle D contracts to lower the diaphragm and reduce the diaphragm arch DA which expands the lung L and its volume. By expanding the volume, a negative pressure is created in the alveoli which draws fresh oxygen into the airways and alveoli. Such expansion causes the interior lung tissue to be stressed with increased tension which dilates the airways and increases lung elastic recoil. This increased lung elastic recoil greatly enhances alveoli and airway contraction during exhalation. This ability to stretch and undergo extreme elastic strain elongation with the ability to fully recoil back to an original shape is made possible by a fibrous protein called elastin. Elastin fibers are present in virtually all vertebrate tissues, although it is only found in abundance within a few structures, such as arteries, some ligaments, and the lung. In these organs, elastin comprises an appreciable percentage of the total protein. 
     In many respects, elastin is a perfectly designed protein for its role in normal lung function. The unusual amino acid composition and lysine derived crosslinks provide the elastin fiber with great distensibility and recoil properties. They also lend chemical stability to the fiber, which is susceptible to few proteolytic enzymes and chemical injuries. Complications arise in conjunction with this inherent stability. Mature elastin has an extremely low turnover rate. Once the delicate architecture of the alveolar walls has been constructed and the continuum of connective tissue fibers is established, the components are meant to remain in that configuration. After the fetal and early perinatal stages of lung development there is no ability to initiate a new and architecturally correct alveolus if the original structure has been destroyed. 
     The introduction of tobacco smoke and other pollutants signals macrophages and neutrophils to respond. As the neutrophils degranulate and release their enzymes there is disparity between the finely tuned ratio of elastase to antiprotease which perpetuates destruction of the lung tissue and lung elastic properties. Every injury sustained by alveolar elastin that is not repaired hastens the inevitable cleavage of the alveolar wall. If the injury is perpetuated, as is the case with cigarette smoke, alveolar walls are slowly cleaved, leaving greatly enlarged air spaces and a lung without elastic recoil properties. Coalescence of damage leaves structural gaps in the tissue that further reduces the lungs ability to maintain tissue integrity and lung elastic recoil properties. 
       FIGS. 2-3  illustrate this change in lung composition. As the alveolar sacs are destroyed, large open spaces form called pulmonary blebs, bullae and giant bullae which can exceed several centimeters in length, width or length. Pulmonary blebs are small subpleural thin walled air containing spaces, not larger than 1-2 cm in diameter. Their walls are less than 1 mm thick. Pulmonary bullae are, like blebs, cystic air spaces that have an imperceptible wall (less than 1 mm) The difference between blebs and bullae is generally considered to be their size, with the cross-over being around 2 cm in diameter. Blebs may, over time, coalesce to form bullae or giant bullae.  FIG. 2  illustrates damage that is typically seen in patients with early stage of severe emphysema while  FIG. 3  is more typical of tissue that would be seen in a late stage emphysema patient who would typically present with 30% annual mortality rate.  FIG. 4  illustrates a cross-sectional slice acquired using computed tomography (CT) of the lungs of a patient suffering from COPD. CT is a noninvasive, painless procedure that uses low-dose x-ray images to visualize the lung tissue. As shown, a large portion of the lung parenchyma has been destroyed and the majority of the lungs are now mostly air pockets, consisting of blebs and bullae. 
       FIG. 5  illustrates a lung L of a patient suffering from advanced COPD. As in most COPD sufferers, this example shows homogenous destruction of the lung parenchyma. This can be easily identified by the fact that there is a similar amount of damage in the upper, middle and lower portion of the lung. If only the upper most portion of the lung was damaged, it would be considered a lung with heterogeneous upper lobe predominant damage. Predominant damage in the lower portion would be heterogeneous lower lobe predominant. Some patients present with heterogeneous disease but it may be upper lobe predominant in one lung and lower lobe predominant in the other lung but the vast majority of heterogenous patients present with upper lobe damage in both lungs or lower lobe damage in both lungs. Over 60% to 75% of all patients present with homogenous disease with a generally even distribution of damage throughout the lung volumes. Visible damage in some patients may be not be easily visible, even utilizing high resolution CT images where the image slice thickness is less than 1.0 mm thick. However, most patients present with damage that can be easily seen in these images such as the pockets BU shown in  FIG. 5 . There is vast tissue destruction beyond the 4 th  generation airways wherein diffuse blebs BL and bullae BU fill the area of the lung L. Thus, late stage COPD sufferers often do not have any anatomically normal airways past the 4 th  generation. This is a discovery based on the review of thousands of three-dimensionally reconstructed computed tomography files that were acquired to study severe emphysema patient&#39;s lungs. Basic medical and specialized pulmonology education teachings indicate that medium to small collagenous walled airways are preserved in late stage emphysema patients and this is simply not true. CT reconstructions are typically referred to as post processed CT files that show more than just two-dimensional visual images of cross-sectional slices of the lung. These detailed images of the inner structures of the body can be reconstructed (post-processed) in a three-dimensional format so tissue density and changes of density can reveal lung tissue condition, anatomical boundaries as well as physiologic data and dimensions. This data can be analyzed to summarize anatomical and physiologic changes such as airway lumen diameter change during breathing and airway volume change. Post processing can also be used to measure the volume and density of blood vessels that remain intact in damaged lungs. This is particularly useful to determine the over-all gas exchange activity in lobes or regions of the lung. Regions of lung tissue that trap gas or otherwise don&#39;t exchange oxygen and CO 2  efficiently experience accommodation which is vascular contraction that prevents the flow of blood that is not being properly prepared to be sent back into the vascular system. By using post processing software, it&#39;s possible to measure dynamic and static blood volumes in lungs, lobes and segments to evaluate where to treat the patient, recommended dose and to determine if additional treatments may be required later to maintain the patients breathing mechanics. Effective treatment recruits additional blood volume where it is otherwise insufficient or lower than typically physiologically normal. Post processing can also measure airway volume within areas of the lung during the respiration cycle. The volume during inspiration can be compared to the volume during expiration and the magnitude of airway collapse can be calculated by subtracting the difference. This is a good indicator of where air trapping occurs and it also indicates where lung elastic recoil is suboptimal as the elastic recoil is what normally holds the airways patent with volume. Areas with a greater difference in airway volume during the breathing cycle need treatment more than areas with less. 
     Emphysema related destruction severely reduces lung elastic recoil and it eliminates or dramatically reduces gas exchanging tissue surface area. The reduction of lung elastic recoil leads to airway collapse during exhalation, air trapping and hyperinflation. As previously mentioned, lung elastic recoil and its associated outward radial pulling is necessary to hold airways open during exhalation as the external pressure on and around the airways are higher than the internal airway pressure. With reduced lung elastic recoil, the outward radial pulling on the airway is reduced and the airway collapses during exhalation. Air is still allowed to enter the lungs during inhalation but no air is allowed to flow out during exhalation. This leads to classic air trapping and hyperinflation. The lung volume may increase but the patients breathing capacity is reduced due to the lack of flow of fresh oxygen. With these patients undergoing any form of exercise, the airways collapse and trap air in the lung due to diminished tension t (indicated by wavy lines with facing arrows) between the airways and the chest wall CW. The air trapping and resulting increase in lung volume increases pressure on the heart H and the coronary arteries C. This in turn can lead to increased blood pressure, increased heart rate and decreased blood ejection fraction from the heart to the patient&#39;s arterial system. 
     It may be appreciated that in some instances there is no obvious visual sign of tissue destruction in low or high-resolution CT images, however there may still be numerous uniform small pockets of damage throughout the parenchyma which can reduce the surface area of the alveoli and therefor reduce gas exchange by as much as 50% or sometimes more. In addition, there can be severe damage to the elastin and loss of lung elastic recoil without the presence of destruction that can be seen in CT images in the form of blebs, bullae or other visual indicators of bulk enzymatic tissue destruction. This renders a normal looking lung dysfunctional due to airway collapse during breathing, etc. Most patients, however, present with a combination of symptoms that indicate a reduction of lung elastic recoil and also present with lung tissue damage that can be seen in CT image reconstructions. 
     Treatment Overview 
     Methods, systems and devices are provided which take into account the vast tissue damage of advanced COPD sufferers and provides treatment designed specifically to treat the particularly compromised lung tissues that are present in these patients. Such tissue damage has not been identified or acknowledged by previous treatment plans which has led to insufficient treatment and undesired outcomes in many cases. In particular, in some embodiments, the degree of tissue damage is assessed and the locations that the damage manifests in a lobe or lobes is utilized in the determination of the treatment plan. Thus, the extent and distribution of tissue damage is utilized in determining the number of devices that may be desired to treat the patient and the most optimal locations that the devices should be placed. These same data may also be used to assess the patient over time to determine if more devices should be implanted at the same locations as was targeted in a previous procedure to enhance or restore the improvement brought on in the first procedure or if implants might be best deployed in new locations that were not previously treated in order to restore the benefit brought on by an original treatment. In some embodiments, damage that can be seen by looking at CT image file reconstructions or post-processed CT image files is used as an indicator for loss of tissue recoil properties, compromised blood vessel communication or perfusion, hyper-inflation, air trapping, airway lumen collapse, clogged or congested airways. The extent and distribution of such tissue loss is determined by a variety of comparisons, such as comparisons between upper and lower lobes, comparisons between volumes of affected tissue per lobe, and comparisons of areas of destruction per CT slice integrated across number of slices. In some embodiments, damage is quantified by analyzing CT files (CT post-processing) and used to plan treatment or dose of therapeutic implant. For example, in some embodiments, such analysis of CT files utilizes software that analyzes and compares CT scans and summarized detailed physiologic data that is acquired during a patient&#39;s inspiration portion of a breath versus data acquired during expiration, to measure the change in density and additional metrics which indicate degree of airway collapse, blood flow patterns through the breathing cycle, locations of trapped air, regional lung volume changes, lobar lung volume changes, total lung volume changes, diaphragm motion, vectors of motion and displacement of motion of various regions of the lung which can be used to evaluate levels of compliance in the lungs or regions of the lungs. Areas with high compliance (large magnitudes of tissue displacement during breathing) need treatment to restore elastic recoil force that reduces compliance. 
     Blood vessel volume and total blood volume within a lung, lobe, segment and sub-segments can be calculated using CT data files and post-processing technology. Since blood vessels contract where oxygen transfer is less than normal (below physiologic levels, commonly called blood vessel accommodation) blood volume reduction or signals such as data indicating that blood volume is lower than normal can be used to determine where lung elastic recoil needs to be improved, where the airways are collapsing and trapping air, where lung elastic recoil is suboptimal, where enzymatic activity is high and many other things that would indicate that the devices should be placed in those regions. Differences between lobes of more than 10% blood volume is significant and less blood volume indicates more damage has been done by the disease. Changes of more than 10% of lobar blood volume over time indicates significant ongoing destruction and this signals a target for minimally invasive therapy such as the treatment described herein. Successful treatment increases the lobar blood volume in most cases. Pre-treatment versus post treatment CT analysis that indicates an increase of lobar blood volume of 5% or more is considered significant. 
     In some instances, CT images that are acquired during inhalation and others acquired during exhalation can be compared to determine what regions or lobes experience the greatest amount of volume expansion and contraction. High levels of motion and relative volume change indicates that these regions perform with a high level of compliance. Again, areas with high compliance is a target where treatment can benefit the patient. Computational CT analysis may be performed to measure the relative change in position of thousands of easily identifiable points in the lungs such as the many Corina branch points of the blood vessels and airways during inhalation versus exhalation. If the distance between 2 points moves more than the rest of the points in the lung (on % basis or gross length change), the region between the points is more compliant than other regions in the lung. Additionally, the compliant regions may comprise elongated and slack tissue so the distance between the two points move freely during chest expansion. It may be appreciated that slack tissue is typically referred to as high compliance or high compliance tissue. High compliance is a strong indicator of slack tissue with low tissue elasticity and patients will benefit from placement of devices that incorporate strong spring elements where the compliance is highest. Thus, devices may be deployed in parts of the lung that are the most compliant as these devices are designed to reduce compliance to bring the patients lung breathing mechanics closer to physiologic breathing performance. 
     In some instances, CT images are acquired while the patient inhales and others acquired while the patient exhales wherein they are compared to determine what regions or lobes experience air trapping. The volume of the lungs, lobes, segments or even sub-segments of a lobe may be measured using CT quantitative analysis to measure these volumes during inhalation and compare to the same region during exhalation. If the volume of a region, as measured while the patient exhales, is less than 40% of the measured volume of the same region while the patient inhales, the region is considered to be not trapping air. However, if the exhale volume is more than 40% of the volume of the same region while the patient inhales, the region is considered to be trapping air. This is a strong indicator that the lung elastic recoil in the region has been compromised and the tissue requires therapy to increased tissue tensioning. The total volume of lung that is measured that traps air indicates how much dose the patient needs. For instance, therapy is recommended if the patient is found to trap air in 50 cc&#39;s of lung volume or more. Therapy that reduces more than 50 cc&#39;s of lung volume improves breathing and this can be measured using any of the measurable outcomes listed herein. The therapy devices described herein provide lung volume reduction of at least 50 cc. The therapies described herein may provide at least a 50 cc reduction of lung volume that traps air, as measured by quantitative CT analysis. The device embodiments described herein are typically designed to provide at least 10 cc of volume reduction or reduction of lung that traps air. Again, areas with high compliance trap air during exhale and present a measurable and quantitative parameter to use as a threshold to indicate treatment, to recommend therapy dose and such areas also provide a target to determine where treatment should be placed to most beneficially treat the patient. 
     If the patient presents with homogenous destruction, the pulmonary treatment devices can be delivered to the most severely damaged regions, if they can be identified, or the devices can be delivered to every major lobe so as to tension the entire lung system uniformly. If the patient presents with strongly heterogenous destruction, the pulmonary treatment devices can be delivered to low attenuation (low density) or high compliance areas of the lung, commonly the two upper lobes only. These areas exchange gas less efficiently and therefore present as lower risk locations to place implants rather than always placing devices in all lobes, in order to preserve maximum lung and breathing capacity. Devices may also be placed in high attenuation portions of the lung (high density tissue) to gain additional traction if the low attenuation portions are so destroyed that there is minimal to no tissue for the device to engage. This is possible because the devices restore the airway lumens and minimal tissue is being compromised with device placement. If this is done, the high-density tissue that has a significant amount of preserved elastic recoil will not easily expand or elongate with tension but the entire region of relatively preserved tissue will simply be pulled to a new location and the adjacent low attenuation tissue with low elastic recoil properties will still be tensioned. Sometimes this involves pulling an entire lobe to a new position and using the negative pressure in the fissure that separate the lobes to communicate the tension to another lobe. This allows tension and lung elastic recoil to be enhanced or created in places that may not be ideal for implant placement. Device placement and tensioning also lifts the diaphragm to restore basic diaphragm movement to enhance breathing mechanics. By deploying the device in a lung to cause tensioning, the lowest compliance tissues that are connected in a serial fashion will be strained more than the higher compliance areas and the lung tissue will be brought to equilibrium with more uniform compliance and elastic recoil performance. This strain also pulls airways radially outward and holds them open so they cannot collapse during exhale events. This reduces air trapping in the lung tissue. 
     Once the type and extent of damage has been accessed, the treatment plan is devised, including choice and placement of various treatment devices of the present invention designed specifically for use in damaged lung tissue. 
       FIG. 6  illustrates an embodiment of a pulmonary treatment device  10  of the present invention. In this embodiment, the device  10  comprises an elongate shaft  12  coiled into a helical shape to form a tissue gathering element or tissue gathering end  14 , an anchoring element or stabilizing end  16  and an extendable midsection  18  therebetween. Typically, each end  14 ,  16  is comprised of 1-2 coil turns, however any suitable number of turns may be used. The pulmonary treatment device  10  is configured to expand along a longitudinal axis  19 , as illustrated in  FIG. 7 , wherein the bulk of the expansion occurs along the extendable midsection  18 . In some embodiments, the device  10  has a diameter of 2-50 mm and a length of 0.25-10 inches, preferably 0.5-1 inch, in resting free space. In such embodiments, the device  10  typically has a potential longitudinal elongation of between 0.25 and 10 inches, but most preferably 2-4 inches of potential elongation beyond the devices original length. However, the dimensions of the device  10  after deployment in the body may vary due to constraints of the airways and pattern of disease. Devices  10  deployed into smaller airways will have smaller diameters due to anatomical constraints. Likewise, the extension of the midsection  18  may vary depending on the location of the target treatment site within the tracheobronchial tree. A brief overview of deployment will be provided followed by a more detailed description of various elements and features. 
     The pulmonary treatment device  10  is sized and configured to be delivered by a delivery device configured to be inserted into the lung, such as a steerable scope (e.g. bronchoscope  20 ), such as illustrated in  FIG. 8 . In some embodiments, the pulmonary treatment device  10  is configured to be delivered through a lumen in the delivery device, such as by pushing the treatment device through a lumen of a scope, catheter, introducer, sheath, sleeve or similar device. In other embodiments, the pulmonary treatment device  10  is configured to be delivered by mounting it on the outside of a delivery device, such as on the outside of a scope, catheter (e.g. a balloon catheter), introducer, sheath, sleeve, guidewire or similar device. In some embodiments, when mounting on the outside of a delivery device, the treatment device  10  freely slide along the length of the delivery device. It may be appreciated that the pulmonary treatment device  10  may be configured to be delivered using a combination of these delivery device components such as mounting the treatment device  10  on a guidewire or balloon catheter shaft and delivering the assembly through the channel of the bronchoscope. It may be appreciated that when using a guidewire, the delivery system may be configured to be Over-The-Wire (OTW) or Rapid Exchange (RX) wherein the guidewire exits the delivery system at a particular location for the configuration. For example, in an OTW design, the guidewire exits the delivery system at its proximal end so that the guidewire that tracks along the full length of the delivery device. In contrast, in the RX design, the guidewire only tracks along a short section (about 25 cm) of the delivery device and then exists at a side port. This design saves time compared with advancing a guidewire through the full length of the delivery device. 
     In some embodiments, the device  10  is loaded into a bronchoscope port  22  and the bronchoscope  20  is advanced through the tracheobronchial tree to a target location within the lung. In patients with advanced COPD, lung tissue and airways are inflamed, bleed easily and react to even slight trauma, such as by advancement of a guidewire or catheter. Therefore, unlike conventional endobronchial valves and coils, in these embodiments, the device  10  may be deliverable without the use of a guidewire and/or catheter. In this embodiment, the device  10  is loaded within the bronchoscope port  22  so that the tissue gathering end  14  is directed distally. The bronchoscope  20  is then steered through the airways AW atraumatically, without digging its distal tip into the airway walls W. Typically, the distal end of the bronchoscope  20  is advanced into or well beyond the 4 th  generation airways, often into the areas of the lung containing highly damaged tissue DT. This is easily accomplished when the bronchoscope outer diameter is less than 4.5 mm diameter. This is typically a bronchoscope with a 2.0 mm diameter channel and port. In these areas of damaged tissue, large portions of parenchyma are often loose or missing, forming coalesced blebs and bullae. Thus, normal lung passageways with supportive walls are typically not available, and any existing tissue is sponge-like and very weak. The tissue gathering end  14  of the pulmonary treatment device  10  is deployed in this damaged tissue DT, as illustrated in  FIG. 8 . This is typically achieved by advancement of a deployment element  30  that extends through the bronchoscope port  22  or by retraction of the bronchoscope  20  while the deployment element  30  maintains its position relative to the damaged tissue DT. The deployment element  30  comprises an elongate shaft  32  having an attachment mechanism  36  near its distal end. The attachment mechanism  36  engages an attachment feature  38  on the device  10  so as to maintain connection between the deployment element  30  and the device  10  during deployment. In this embodiment, the attachment feature  38  comprises a loop  40  formed by the shaft  12  of the device  10 . The loop  40  is disposed near or within the stabilizing end  16 , as more clearly illustrated in  FIGS. 6-7 . Referring back to  FIG. 8 , in this embodiment, the attachment mechanism  36  comprises a tether  42  (e.g. suture, metallic wire (such as comprised of stainless steel, titanium, nitinol or other nickel based alloy), monofilament or multifilament fiber, braid, polymer or ceramic or glass fiber (such as comprised of Kevlar®, carbon fiber, nylon, polyurethane, polypropylene or other durable material)) and a support rod  44  (such as comprised of polymer, metal, ceramic or another durable material). The tether  42  extends through the loop  40  and around the support rod  44  so as to secure the loop  40  to the support rod  44 . Thus, the stabilizing end  16  of the device  10  is able to remain attached to the deployment element  30  during deployment by the attachment mechanism  36 . It may be appreciated that other attachment features  38  include a ball, a breakaway link, a threaded hole or shaft, or a friction fit taper or hole, to name a few. 
     In some embodiments, as the tissue gathering end  14  is released into the area of loose damaged DT, the tissue gathering end  14  expands and rotates, gathering up the loose, damaged tissue in a manner that fixedly engages the end  14  with the damaged tissue DT. In other embodiments, the tissue gathering end  14  expands and dilates the airway or passageway through the damaged tissue DT so as to be effective in gathering tissue when the tissue gathering end  14  is pushed or pulled longitudinally along the axis  19 . Once the tissue gathering end  14  has fixedly engaged within the damaged tissue DT, the deployment element  30  is retracted into the bronchoscope port  22 . Since the deployment element  30  is attached to the attachment feature  38  of the device  10 , such retraction tugs the device  10 . This causes extension of the midsection  18  and pulling of the damaged tissue DT engaged by the tissue gathering end  14 . Such pulling continues until a desired level of resistance occurs or the damaged tissue DT has been pulled a desired amount. This retraction may be observed using an integrated bronchoscope camera or using one of many possible forms of X-ray imaging and equipment such as real time fluoroscopic imaging, fluoroscopic CT (computed tomography), biplane X-ray or other methods. The retraction and tissue gathering magnitude may be measured by observing the distance that the tissue gathering feature is moved. In some embodiments, movement in a range of 1 cm to 25 cm, preferably 7-8 cm, indicates substantial and adequate gathering of tissue and axial pulling to cause lung tissue tensioning to increase lung elastic recoil. Pulling force of 0.005 to 0.30 pounds force are beneficial to the patient but preferably 0.01-0.20 pounds force are applied to the tissues of the lung. The deployment element  30  is then additionally retracted which further extends the midsection  18 . This straightens and extends the surrounding airway AW, as illustrated in  FIG. 9 . By observing the increased length of the midsection  18 , using imaging methods, the user can observe and adjust the amount of length change imparted on the midsection which will ensure adequate recoil energy is stored in the midsection  18  of the device  10 . It is important to store potential energy in the device  10  so it remains in tension to continue to enhance lung elastic recoil, even if the lung tissue relaxes and elongates over time. Retraction of the deployment element  30  continues until the stabilizing end  16  reaches a suitable airway for holding and maintaining the stabilizing end  16 . Typically, the deployment element  30  is retracted until the stabilizing end  16  is positioned within an ostium OS or point of branching within the tracheobronchial tree. The larger diameter of the ostium OS allows the stabilizing end  16  to expand and exert stabilizing radial force against the walls W of the ostium OS, holding the expanded device  10  in place. If the midsection  18  is not desirably elongated, such as 1-5 cm longer than it presents prior to retraction of the stabilizing end  16 , the device may be recaptured and redeployed more distally so the midsection  18  may be elongated enough to preserve the treatment effect over time. Once the stabilizing end  16  is secured within the airway AW, the attachment mechanism  36  is released from the attachment feature  38 . In this embodiment, the tether  42  is severed which allows removal from the support rod  44 . The tether  42  is then removed along with the support rod  44 . The bronchoscope  20  is then removed, along with the deployment element  30 , leaving the device  10  in place, as illustrated in  FIG. 10 . 
     Since the device  10  remains in an expanded configuration, the coiled configuration holds potential energy and creates tension between the damaged tissue DT and the ostium OS. This newly acquired tension replaces the loss of tension caused by COPD. Thus, the airway AW and tissue that is more distal and more proximal to the device  10  is re-tensioned, providing renewed recoil strength. This improves breathing and reduces air trapping and resultant hyperinflation which is common in advanced COPD. In addition, the stored potential energy provides continued tension as the damaged tissue DT and/or airway AW naturally relaxes due to progression of COPD. Thus, such re-tensioning continues even during disease progression. 
     Thus, the pulmonary treatment device  10  provides a variety of features which improve lung function and quality of life for COPD sufferers, particularly those in advanced stages with few treatment options. Since the device  10  has a coiled configuration with an open central lumen, the device  10  does not obstruct airflow when implanted. This is in contrast to many of the existing implantable devices used to treat COPD, such as endobronchial valves. Such valves are intended to obstruct the airway, blocking off a portion of the lung so as to mimic LVRS. Thus, any functioning alveolar sacs are obstructed and are unable to be used. In contrast, the pulmonary treatment device  10  maintains access to the damaged tissue DT so that remaining functioning alveolar sacs can be utilized. The ends  14 ,  16  of the device  10  are coaxially biased so that positioning of the device  10  within a tortuous airway naturally straightens the airway AW along the longitudinal axis  19  of the device  10 . In addition, the elongation of the midsection  18  of the device  10 , elongates the airway AW providing a more direct pathway with less resistance to airflow. This is in contrast to endobronchial coils which are intended to bend and fold airways, compressing tissue and creating resistance to airflow. This blocks off regions of the lung so as to mimic LVRS. 
     In addition, at least some portions of the coiled configuration are radially expandable. Thus, the pulmonary treatment device  10  acts in a stent-like manner, supporting airway walls W and improving airflow. In addition to providing tensioning of the lung tissues to radially pull on airways to maintain patency during exhalation (when airway collapse is common in these patients), the stenting feature of the pulmonary treatment device internally supports the inside diameter of the airways to maintain patency during breathing. The act of deploying the device  10  (thereby re-tensioning the airways) holds the small airways, that are smaller than 2.0 mm in diameter, open, further increasing airflow. This act also displaces lung tissue closer to the trachea and pulls tissue farther from the pleura, shifting lung tissue closer to the heart. The trachea and central airways, such as the first, second, third and fourth generation airways, are much better reinforced by a pulmonary treatment device configured to be anchored in airways comprising mostly cartilage as compared to airways beyond the 4 th  generation so the tissues closer to the heart function as a foundational support for device  10 . As the device  10  is elongated and anchored in the reinforced support region, the distal tissue gathering end  14  can efficiently pull and tension tissue that lies between the tissue gathering end  14  and the chest wall. Most of the lung volume adjacent to the chest wall comprises small airways and alveoli. This is a particularly fertile region to retention in order to improve breathing mechanics as a large percentage of air trapping happens in the beds of small airways (commonly referred to as small airways disease). The coiled configuration provides a spring-like or resilient quality to the device  10  during breathing. During inhalation, the device  10  lengthens or elongates, and, during exhalation, the device  10  shortens or contracts. This ability to change dimension during breathing while maintaining relatively uniform tension levels in the lung allows device  10  to behave similar to normal healthy lung tissue. The tension does not dramatically change during the breath cycle. 
     It is important to point out that this type of lung elastic recoil enhancing treatment device  10  can beneficially be made from a single continuous element such as a single length of wire or fiber. This single element design enjoys the benefit of not comprising joints or links that may fail due to strain or bending during the high number of breathing cycles the device may encounter during the remainder of the patient&#39;s life. The single element may be made with varying diameter sections or it can be made from tapered diameter material as well as material that has totally non-uniform size or cross section along its length. A single component implant design is ideal. The treatment device  10  may also be made from a number of components if different diameter shaft material or if different materials are desired in the different sections such as the mid-section versus the stabilizing end or the mid-section versus the tissue gathering end. The mid-section is most ideal if it&#39;s made from resilient material whereas the tissue gathering distal end  14  and the stabilizing proximal end  16  may be made from more rigid material. The difference in modulus between the two portions may be as much as 500% or more different and they would still be suitable. A single component structure may be configured with tuned material properties in different locations of the single element. Nitinol material may be adjusted by using local heat treatment techniques to increase or decrease the stiffness or modulus of elasticity in local portions of the wire. This is beneficial in that the tissue gathering ends may be tuned to be stiff to be most effective to engage tissue and the central spring portion may be tuned to be less stiff to be ideally matched with the stiffness of healthy lung tissue. 
     It may be appreciated that any number of pulmonary treatment devices  10  may be positioned within a lung of a patient.  FIG. 11  illustrates the positioning of three pulmonary treatment devices  10   a ,  10   b ,  10   c  within the lung L of a patient P. As shown, a bronchoscope  20  is advanced down the trachea T and into the bronchial tree of the lung L. A first pulmonary treatment device  10   a  is loaded within a port  22  and the bronchoscope  20  is advanced through the airways of the bronchial tree to a first area of damaged tissue DT 1 . The first pulmonary treatment device  10   a  is deployed as described above so that the first area of damaged tissue DT 1  is drawn toward the trachea T and lung tissue in the vicinity is re-tensioned. The bronchoscope  20  may then be retracted and removed from the patient P. This allows the bronchoscope  20  to be cleansed so as to avoid transferring bacteria and contaminating other airways when re-introducing the bronchoscope  20 . The second pulmonary treatment device  10   b  is then loaded within the port  22  and the bronchoscope  20  is advanced through the airways of the bronchial tree to a second area of damaged tissue DT 2 . The second pulmonary treatment device  10   b  is deployed as described above so that the second area of damaged tissue DT 2  is drawn toward the trachea T and lung tissue in the vicinity is re-tensioned. The bronchoscope  20  may then again be retracted and removed from the patient P. Again, the bronchoscope  20  may be cleansed and third pulmonary treatment device  10   c  is loaded within the port  22  and the bronchoscope  20  is advanced through the airways of the bronchial tree to a third area of damaged tissue DT 3 . The third pulmonary treatment device  10   c  is deployed as described above so that the third area of damaged tissue DT 3  is drawn toward the trachea T and lung tissue in the vicinity is re-tensioned. The bronchoscope  20  is then retracted and removed from the patient P. Alternatively, the bronchoscope  20  may be left in the lung throughout the delivery of the three devices  10   a ,  10   b ,  10   c  through the bronchoscope channel to the locations shown in  FIG. 11 . Or, the devices  10   a ,  10   b ,  10   c  may be delivered into the lung via a catheter that has been advanced through the bronchoscope channel. As many as 25 devices may be placed within each lobe. Pulmonary treatment devices may be placed in a single lobe during a single procedure, in two or more lobes during a single procedure or in all 4 major lobes during a single procedure. Alternatively, one, two, three or 4 of the major lobes may be treated over a sequence of several procedures with typically 1-4 weeks of recovery time between procedures. Lastly, one or more pulmonary treatment devices may be placed in one or more lobes during a single procedure and additional pulmonary treatment devices may be implanted in sequential additional procedures. 
       FIG. 12  illustrates a plurality of pulmonary treatment devices  10  positioned in both lungs L. The devices  10  are preferably delivered into regions of the lung with the most tissue destruction. If the patient suffers from upper lobe predominant heterogenous disease, the upper lobes in the left and right lungs are preferably treated. If the patient suffers from homogeneous disease where the tissue destruction is diffuse throughout every major lobe of both lungs, devices  10  are preferably placed in all five lobes of the lung. This “total lung” treatment is ideal because each device  10  is designed to restore and preserve lung elastic recoil. Homogeneous patients need this enhancement in all major lobes of the lung and unlike nearly every alternative treatment, the devices  10  will not block or otherwise render lung tissue non-functioning. By simply pulling tissue sufficiently to eliminate slack in the lung tissue and restoring lung elastic recoil without compromising gas exchange function of the tissue, the devices  10  can be placed in locations throughout the lungs to additively enhance breathing mechanics in these patients. 
     It may be appreciated that each pulmonary treatment device  10  may impart differing levels of re-tensioning in a lung L. But, overall, the impact on the lung L is such that a variety of clinical goals have been achieved. Such goals include returning physiologic tension to make the lung perform in a more physiologic way. The human lung normally behaves in a fully elastic manner in which it expands between approximately 200 milliliters with the application of pressure relating to approximately 20 centimeters of H 2 O or 0.02 Bar or 0.02 atmospheres and 1200 milliliters with the application of 40 centimeters of H 2 O pressure. The pulmonary treatment device removes slack in the tissue, minimizes tissue compression, restores lung elastic recoil, enhances breathing mechanics by providing an elastic link to enhance spring properties in the tissue, radially outwardly supports airways to maintain airway lumen patency, internally stents airways to maintain lumen patency and lifts the diaphragm to restore diaphragm motion. This also increases the lumen diameter or caliber of the airways and increases the radial outward support to the airways so that the support is sufficient to hold the airways open. Airway closure during expiration is delayed and the time that airways stay open during expiration is increased. Likewise, airway resistance is reduced along with air trapping in the lung. Such tensioning reduces hyperinflation and the related increase in lung volume. This has a variety of beneficial effects on the heart and circulation, including reducing pressure on the heart because hyperinflated lungs push on the heart, reducing pressure on coronary arteries, reducing pulmonary artery pressure, reducing systolic and/or diastolic blood pressure, reducing blood hypertension, reducing heart rate, increasing blood oxygen percent, decreasing CO 2  levels in blood stream and increasing blood ejection fraction as relieving lung inflation related pressure on the heart allows it to contract and refile more efficiently. Additionally, treating patients with the pulmonary treatment device will reduce the amount of Dyspnea, otherwise known as shortness of breath, and quality of life is improved. Quality of life is normally measured using validated patient surveys such as SGRQ scoring surveys. As the patient&#39;s quality of life is improved, the SGRQ survey score is decreased. Appropriate patients who a have been treated with the pulmonary treatment devices described herein will typically survey with reduced SGRQ scores of at least 1 point but more preferably a reduction of 4 or more points will be experienced. 
     In addition, beneficial effects of pulmonary treatment in the lung can be measured by monitoring one or more of a number of possible pulmonary indicators, including measuring benefit by measuring increased forced expiratory volume during expiration, increased lung emptying during expiration, reduced end-expiratory lung volume, reduced functional residual capacity, reduced residual volume left in the lung during or after expiration (RV), reduced volume of gas that is trapped in the lung during or after expiration reduced volume of gas that is trapped in a lobe during or after expiration, reduced dynamic hyperinflation, decrease total lung capacity, reduce RV/TLC ratio, increased tidal expiratory volume change during tidal breathing at rest, increased inspiratory reserve volume during tidal breathing at rest, increased forced expiratory volume in the first second (FEV1), increased forced vital capacity volume (FVC), and increase ratio FEV1/FVC, to name a few. 
     Additionally, the beneficial effects of pulmonary treatment in the lung can be measured by monitoring one or more of the following measures, including reduced lung tissue density (e.g. more than 5 HU (Hounsfield units) change in average lung tissue density due to a treatment procedure), measuring lobar lung tissue density in which more than 2% change is measured, measuring the difference between lobes of lobar damage volume using a 950 HU filter in which the volume difference between lobes is reduced and a reduction of more than 3% volume of damaged tissue due to the treatment is significant, measuring displacement of more than 2 mm of fissure shift during the same portion of the breathing cycle is significant, or reduction of folds of pleura that demarcate the lobes in the lung, decreased lung compliance, decreased compliance in lobes or regions of lung tissue, increased lung tissue compliance uniformity between upper versus lower lobes, increased lung tissue compliance uniformity between lung lobes in a patient, and increased lung tissue compliance uniformity between lobar segments, to name a few. 
     Overall, the patient typically has a variety of symptomatic improvements, including reduced coughing (e.g. due to trapped air and mucus), increased ability to clear mucus due to passageways opening larger and for longer periods of time, increased mobility (e.g. as measured by currently standard 6-min walk test), reduced inspiratory effort, reduced dysthymia, decreased breathing rate, reduced glottis closure sensitivity (by clearing mucus, inflammation is reduced and coughing is reduced), reduced incidence of respiratory failure and increase time between COPD exacerbation events, to name a few. 
     Pulmonary Treatment Device Embodiments 
     Embodiments of the pulmonary treatment device  10  have various features and design elements to achieve the above described treatment effects and clinical goals. In addition, such features and design elements may have varying alternatives, a variety of which will be set forth herein. 
     Overall, the pulmonary treatment device  10  has a relatively short length of between approximately 1 cm and 20 cm but preferably 2-3 cm in an unstrained condition so as to minimize its length within the bronchoscope  20 . This allows the bronchoscope  20  to be advanced to or as close to the target area within the lung L for deployment of the tissue gathering end  14 . In some embodiments, the distal end of the bronchoscope  20  positioned at the target area and the tissue gathering end  14  is deployed by retraction of the bronchoscope  20 . Delivering the tissue gathering end  14  and allowing it to recover to its deployed configuration at the target area avoids pushing of the device  10  forward within the lung tissue which causes tissue trauma. 
     Herein various aspects of the pulmonary treatment device  10  are described in more detail. It may be appreciated that although a variety of aspects and features are described, embodiments of the device  10  may include any combination of these aspects and features. Likewise, some embodiments may not include all of the aspects and features described. For example, in some embodiments, the device  10  comprises a tissue gathering end  14  and a stabilizing end  16  without an extendible midsection  18  therebetween. 
     A. Tissue Gathering End 
     As described previously, the tissue gathering end  14  of the pulmonary treatment device  10  is designed to be deployed into intact airways or the damaged tissue DT, comprised of loose, sponge-like, weakened tissue and open areas of blebs and bullae, so as to effectively engage the damaged tissue DT while minimizing any trauma. A variety of design features are provided to achieve these goals. In some embodiments, the tissue gathering end  14  expands and is rotatable so as to gather up the loose, damaged tissue in a manner that fixedly engages the end  14  with the damaged tissue DT. Thus, the tissue gathering end  14  is configured to gather, connect or hook into as much damaged soft tissue as possible. In some embodiments, this involves rotating the tissue gathering end  14  which threads the end  14  into place, such as through existing holes in the tissue. Due to the specialized design of the tissue gathering end  14 , such rotation does not twist or bend airways in the lung. 
       FIG. 13  illustrates an embodiment of a tissue gathering end  14  of a pulmonary treatment device  10  of the present invention. In this embodiment, the tissue gathering end  14  comprises a portion of the elongate shaft  12  coiled into a helical shape, particularly having a single coil turn to form a loop shape. In this embodiment, the shaft  12  extends along the longitudinal axis  19  through the extendible midsection  18  and then bends radially outwardly distal to the extendible midsection  18 , such as perpendicularly or at a 90 degree angle to the longitudinal axis, forming a loop  50  in the same plane. Thus, the loop  50  has an opening  52  perpendicular to the longitudinal axis  19 .  FIG. 14  illustrates a top view of the embodiment of  FIG. 13 . Thus, as illustrated, the opening of the loop  50  is perpendicular to the longitudinal axis  19 , having a circular shape. Likewise, in this embodiment, the loop extends nearly 360 degrees around the longitudinal axis  19 . In this embodiment, the shaft  12  has a distal tip  54  which is “turned-up” or facing in the distal direction. In some embodiments, the distal tip  54  is aligned with the longitudinal axis  19  and in other embodiments the distal tip  54  is offset from the longitudinal axis  19 . In any case, the turned-up configuration aligns the distal tip  54  with or parallel with the direction of tension so as to avoid or reduce any trauma to the surrounding tissue. The distal tip  54  may have a variety of shapes including an end loop, coil, ball, bullet, tear drop, cone or taper shape to minimize tissue trauma. 
     In this embodiment, the tissue gathering end  14  comprises a single loop  50 . However, it may be appreciated that the tissue gathering end  14  may comprise any suitable number of loops  50  or partial loops, including a quarter loop, a half loop, a three-quarter loop, one loop, two loops, three loops, four loops, five loops, six loops, more than six loops or any combination of these. The loops  50  may have any suitable diameter, typically in the range of 10 mm to 50 mm. Each of the loops  50  may have the same diameter or differing diameters. In some embodiments, the loop diameters taper, such as in a funnel or cone shape, wherein loop diameters incrementally decrease in size along the tissue gathering end  14 . In such embodiments, the taper may be in the distal direction or the proximal direction. In some embodiments, the tissue gathering end  14  comprises a series of loops  50  having the same diameter and then transitions into a taper, typically in the distal direction, to the distal tip  54  or to a series of loops  50  having the same diameter which is smaller than the loops  50  disposed proximally. In some situations, these arrangements reduce trauma to the tissue. 
     In some embodiments the tissue gathering end  14  comprises more than one loop  50  to act as a spring that limits peak tensioning force on the fragile lung tissue, like a tension fuse between the tissue and the user. Typically, total pull force applied to the tissue gathering end  14  during placement of the device  10  is less than or equal to 9 Newtons. In preferred embodiments, the total pull force is less than or equal to 0.9 Newtons but patients may utilize a range of force between 0.005 and 10 Newtons but preferably near 0.07 Newtons, depending on the density of the tissue that is to be re-tensioned. The lower forces are required for low density tissue and more force is required in tissue that is denser and better preserved with more lung elastic recoil. In any case, the tissue gathering end  14  is shaped to optimize contact area to reduce lung tissue stress or pressure. 
     In some embodiments, the tissue gathering end  14  is comprised of heavy gage core wire, such as core wire having a diameter of 0.10-2.5 mm but most preferably between 0.25 mm and 0.30 mm. In some instances, the preferred diameter depends on the shape and configuration of the tissue gathering end  14 . For example, if the tissue gathering end  14  comprises a loop shape having a diameter of less than 25 mm, the preferred core wire diameter may be 1 mm. If the tissue gathering end  14  comprises a loop shape having a diameter of greater than or equal to 25 mm, the preferred core wire diameter may be 1-2 mm. 
       FIG. 15  illustrates a similar embodiment of a tissue gathering end  14  of a pulmonary treatment device  10 . In this embodiment, the shaft  12  extends along the longitudinal axis  19  through the extendible midsection  18  and then gradually bends radially outwardly distal to the extendible midsection  18 . Rather than bending at a 90 degree angle to the longitudinal axis  19 , the shaft  12  bends at an angle less than 90 degrees, such as a 30-45 degree angle to the longitudinal axis  19 . This creates an arch  56 , wherein the shaft  12  then bends downward at a distance from the longitudinal axis  19  and ultimately forms a loop  50  in a plane perpendicular to the longitudinal axis  19 . Thus, the tissue gathering end  14  comprises a distal facing arch  56  with a loop  50  extending around the longitudinal axis  19  proximal of the arch  56 . As the shaft  12  is retracted to tension lung tissue, arch  56  pulls loop  50  down against distal tip  54  to create a shape that emulates a concentric ring that gathers tissue.  FIG. 16  illustrates a top view of the embodiment of  FIG. 15 . As shown, the opening  52  of the loop  50  is perpendicular to the longitudinal axis  19  having a circular shape. Likewise, in this embodiment, the loop  50  extends nearly 360 degrees around the longitudinal axis  19 . In this embodiment, the shaft  12  has a distal tip  54  which is not “turned-up”; rather the distal tip  54  is disposed in the plane of the loop  50 . 
       FIG. 17  illustrates an embodiment of a tissue gathering end  14  of a pulmonary treatment device  10  having multiple loops  50 . In this embodiment, the shaft  12  extends along the longitudinal axis  19  through the extendible midsection  18  and then gradually bends radially outwardly distal to the extendible midsection  18 . Again, rather than bending at a 90 degree angle to the longitudinal axis  19 , the shaft  12  bends at an angle less than 90 degrees, such as a 30-45 degree angle to the longitudinal axis  19 . This creates an arch  56 , wherein the shaft  12  then bends downward at a distance from the longitudinal axis  19  and ultimately forms a first loop  50   a  in a plane perpendicular to the longitudinal axis  19 . The shaft  12  then bends to form additional loops, such as a second loop  50   b  and a third loop  50   b , each in a plane perpendicular to the longitudinal axis  19  and parallel to each other. Thus, the tissue gathering end  14  comprises a distal facing arch  56  with a plurality of loops  50   a ,  50   b ,  50   c  extending around the longitudinal axis  19  proximal of the arch  56 . In some instances, the plurality of loops  50   a ,  50   b ,  50   c  allows the grabbing of more damaged tissue DT and the entire anchor may be pulled together to bind the tissue and trap tissue between the loops to cause tissue traction that wouldn&#39;t otherwise be achievable with a single loop shape. This configuration also stores potential energy in the plurality of loops  50   a ,  50   b ,  50   c  that acts to maintain tissue tension even after the lung disease continues with elongation of tissue over time. 
       FIG. 18  illustrates a top view of the embodiment of  FIG. 17 . Since the loops  50   a ,  50   b ,  50   c  have the same diameter, they are not individually visible from the top view as they are overlaid. As shown, the opening  52  of the loops  50   a ,  50   b ,  50   c  are perpendicular to the longitudinal axis  19  and have a circular shape. Likewise, in this embodiment, the loops  50   a ,  50   b ,  50   c  extend nearly 360 degrees around the longitudinal axis  19 . Again, in this embodiment, the shaft  12  has a distal tip  54  which is not “turned-up”; rather the distal tip  54  is disposed in a plane parallel to the planes of the loops  50   a ,  50   b ,  50   c.    
       FIG. 19  illustrates another embodiment of a tissue gathering end  14  of a pulmonary treatment device  10  having multiple loops  50 . In this embodiment, the shaft  12  extends along the longitudinal axis  19  through the extendible midsection  18  and then gradually bends radially outwardly distal to the extendible midsection  18 . In this embodiment, the bending is in a first direction at a 90 degree or lesser angle to the longitudinal axis  19 . The shaft  12  then bends in a second direction which is opposite to the first direction and ultimately bends downward at a distance from the longitudinal axis  19  on the opposite side of the extendible midsection  18 . This creates an arch  56  which straddles the extendible midsection  18 . The shaft  12  then forms a first loop  50   a  in a plane perpendicular to the longitudinal axis  19  and bends to form additional loops, such as a second loop  50   b  and a third loop  50   b , each in a plane perpendicular to the longitudinal axis  19  and parallel to each other. Thus, the tissue gathering end  14  comprises a distal facing arch  56  with a plurality of loops  50   a ,  50   b ,  50   c  extending around the longitudinal axis  19  proximal of the arch  56 . In this embodiment, the radius of the arch  56  is such that the arch  56  extends beyond the diameter of the loops  50   a ,  50   b ,  50   c . This configuration resists movement of the arch  56  through the loops  50   a ,  50   b ,  50   c  while positioning the device  10 , such as when tugging on the device  10  to re-tension the lung tissue. 
       FIG. 20  illustrates a top view of the embodiment of  FIG. 19 . Since the loops  50   a ,  50   b ,  50   c  have the same diameter, they are not individually visible from the top view as they are overlaid. As shown, the opening  52  of the loops  50   a ,  50   b ,  50   c  are perpendicular to the longitudinal axis  19  and have a circular shape. Likewise, in this embodiment, the loops  50   a ,  50   b ,  50   c  extend nearly 360 degrees around the longitudinal axis  19 . This top view also illustrates that the arch  56  extends beyond the diameters of the loops  50   a ,  50   b ,  50   c . Again, in this embodiment, the shaft  12  has a distal tip  54  which is not “turned-up”; rather the distal tip  54  is disposed in a plane parallel to the planes of the loops  50   a ,  50   b ,  50   c.    
     In each of the above embodiments, the openings  52  of the one or more loops  50  of the tissue gathering end  14  are substantially concentric with the longitudinal axis  19 . However, in other embodiments, the openings  52  of the one or more loops  50  are not substantially concentric with the longitudinal axis  19  and are offset from the longitudinal axis  19 . For example,  FIG. 21  illustrates an embodiment wherein the shaft  12  extends along the longitudinal axis  19  through the extendible midsection  18  and then gradually bends radially outwardly distal to the extendible midsection  18 . Rather than bending at a 90 degree angle to the longitudinal axis  19 , the shaft  12  bends at an angle less than 90 degrees, such as a 30-45 degree angle to the longitudinal axis  19 . This creates an arch  56 , wherein the shaft  12  then bends downward at a distance from the longitudinal axis  19  and ultimately forms a loop  50  in a plane perpendicular to the longitudinal axis  19 . In this embodiment, the loop  50  is extends over 360 degrees but does not encircle the longitudinal axis  19 . Instead, the loop  50  is concentric with an axis  60  which is parallel to the longitudinal axis  19  and offset by 3-30 mm, preferably 13 mm  FIG. 22  illustrates a top view of the embodiment of  FIG. 21 . As shown, the opening  52  of the loop  50  is perpendicular to the longitudinal axis  19  and shifted to one side of the extendable midsection  18 . Likewise, in this embodiment, the loop  50  extends more than 360 degrees. In this embodiment, the shaft  12  has a distal tip  54  which is not “turned-up”; rather the distal tip  54  is disposed in the plane of the loop  50 . 
     This offset configuration allows the extendable midsection  18  to be positioned against the wall of a lung passageway rather than extending through the center of the lung passageway lumen. This may reduce any potential accumulation of mucus within the lung passageway lumen, providing an open pathway for airflow. It may be appreciated that when the tissue gathering end  14  is positioned within damaged tissue DT, the loop  50  is not disposed within a natural lung passageway having structured walls. Therefore, contact between the loop  50  and the shaft  12  above the extendable midsection  18  is not problematic as the tissue gathering end  14  is not compressing the walls of a lung passageway. 
     In some embodiments, at least one of the loops  50  of the tissue gathering end  14  crosses at least a portion of another loop as illustrated in  FIGS. 23-24 . In particular,  FIG. 23  illustrates an embodiment wherein the shaft  12  extends along the longitudinal axis  19  through the extendible midsection  18  and then bends radially outwardly distal to the extendible midsection  18 , such as perpendicularly or at a 90 degree angle to the longitudinal axis, forming a first loop  50   a  in the same plane. Thus, the first loop  50   a  has an opening  52  perpendicular to the longitudinal axis  19 . In this embodiment, the shaft  12  continues bending circumferentially to form at least a portion of a second loop  50   b , wherein the second loop  50   b  has a smaller diameter than the first loop  50   a . In addition, the second loop  50   b  is disposed proximally to the first loop  50   a .  FIG. 24  illustrates a top view of the embodiment of  FIG. 23 . Thus, as illustrated, the opening of the loops  50   a ,  50   b  are perpendicular to the longitudinal axis  19 . Likewise, in this embodiment, the second loop  50   b  portion extends under the first loop  50   a . Thus, when the device  10  is tugged in the proximal direction, during the re-tensioning step, the first loop  50   a  captures the second loop  50   b , applying the total area of the combined length of both coils times the width of the shaft  12  material to present a broad efficient tissue gathering anchor to be pulled in the proximal direction. This large area of contact reduces the bearing pressure that is imparted on the tissue which minimizes or eliminates the tendency for the device to grow through or migrate through the tissue over time. With minimal migration, the advantageous effect of the treatment is prolonged. It may be appreciated that any number of loops  50  may be present, the distal-most loop applying force to the more proximal loops. 
     B. Extendable Midsection 
     The extendible midsection  18  connects the tissue gathering end  14  with the stabilizing end  16 , as illustrated in  FIG. 25 . In some embodiments, the tissue gathering end  14 , extendible midsection  18  and stabilizing end  16  are formed by shaping a single shaft to form the desired configurations. However, it may be appreciated that each or some of the parts may be formed individually and joined together. In any case, the midsection  18  is configured to be extendible from at least a relaxed state to an extended state, wherein the midsection  18  stores potential energy. As described previously, once the tissue gathering end  14  has fixedly engaged the damaged tissue DT, the deployment element  30  is retracted into the bronchoscope port  22  which tugs the device  10  in the proximal direction. This causes extension of the midsection  18  and pulling of the damaged tissue DT engaged by the tissue gathering end  14 . Such pulling continues until a desired level of resistance occurs or the damaged tissue DT has been pulled a desired amount. The deployment element  30  is then additionally retracted which further extends the midsection  18 . This straightens and extends the surrounding airway AW. Retraction of the deployment element  30  continues until the stabilizing end  16  reaches a suitable airway for holding and maintaining the stabilizing end  16 . Thus, the bulk of the expansion occurs along the extendable midsection  18 . 
     In some embodiments, the extendible midsection  18  has the shape of an elastic spring or coil. Typically, the shaft  12  is coiled into a helical shape to form the elastic spring or coil. In some embodiments, the midsection  18  has a length in the range of 5-75 mm but preferably a length of less than 25 mm in resting free space and a potential longitudinal elongation in the range of 10-200 mm but preferably more than 75 mm. However, the extension of the midsection  18  while the device  10  is in use depends on the location of the target treatment site within the tracheobronchial tree, the extent of damage to the tissue and the desired level of re-tensioning. In any event, in some embodiments the midsection  18  comprises at least 3 complete coils. 
     In some embodiments, the coiled extendible midsection  18  has a diameter in the range of 0.5-10 mm, such as 2.5 mm, particularly when the shaft  12  is comprised of a wire having a diameter in the range of 0.10-0.75 mm, preferably 0.25-0.3 mm. It may be appreciated that in some embodiments, the diameter of the shaft  12  forming the extendible midsection  18  is smaller than the diameter of the shaft  12  forming the tissue gathering end  14  or the stabilizing end  16 . This may be achieved by necking down the shaft  12  in the area of the extendible midsection  18 , such as by grinding. In any case, the overall diameter of the extendible midsection  18  is typically smaller than both the tissue gathering end  14  and the stabilizing end  16 . 
     In some embodiments, the extendible midsection  18  additionally supports the airway wall. In use, the device  10  draws the loose damaged tissue DT inward toward the lung passageways that have a maintained structure. Therefore, the extendible midsection  18  is located within an airway having structured walls when the device  10  is implanted. However, such walls are often weakened and benefit from the additional internal support offered by the extendible midsection  18 , particularly under the new level of lung tensioning. As the midsection  18  of device  10  is elongated to store energy, the adjacent airway wall, along the length of the midsection, may be longitudinally compressed which will weaken it and possibly allow it to collapse more easily. This is more than offset by the coil of the midsection providing radial strength and radial stenting support enough to prevent the airway, along this midsection  18  length from collapsing. Likewise, the extendible midsection  18  straightens the airway or the general path of the overall airway system. 
     In some embodiments, the extendible midsection  18  is axisymmetric with the tissue gathering end  14  and/or the stabilizing end  16 , such as illustrated in  FIGS. 6-7 . In such embodiments, the midsection  18  typically has an open lumen forming a tunnel to allow passage of air therethrough. However, it may be appreciated that in some embodiments the extendible midsection  18  may not be axisymmetric and is disposed to one side of the tissue gathering end  14 , such as illustrated in  FIG. 21 , and/or the stabilizing end  16 . Thus, in these embodiments, the midsection  18  extends along the side of the airway (e.g. adjacent to the wall). 
     In some embodiments, the extendible midsection  18  is joined to a feature along the tissue gathering end  14  to keep the tissue gathering end  14  from rotating. 
     C. Stabilizing End 
     As described previously, the stabilizing end  16  of the pulmonary treatment device  10  is designed to hold the device  10 , and therefore the lung tissue, in tension by seating in an appropriate portion of the tracheobronchial tree. As mentioned, after the tissue gathering end  14  has been desirably positioned, the deployment element  30  retracts and pulls the stabilizing end  16 , which in turn pulls the extendable midsection  18  and tissue gathering end  14 . Such pulling continues and increasingly applies tension to the lung, along with other physical benefits such as straightening the airway and increasing airflow. Once the stabilizing end  16  reaches a suitable airway for holding and maintaining the stabilizing end  16 , the stabilizing end  16  is seated and released. Typically, the stabilizing end  16  is positioned within an airway or ostium OS or point of branching within the tracheobronchial tree. The larger diameter of the ostium OS allows the stabilizing end  16  to expand and exert stabilizing radial force against the walls W of the ostium OS, holding the expanded device  10  in place. The end  16  stabilizes the device  10 , providing a base or anchor for the applied tension which is then maintained throughout treatment of the patient as the device  10  is left behind. 
     In some embodiments, the stabilizing end  16  comprises a portion of the elongate shaft  12  coiled into a helical shape, particularly having multiple coil turns, each having a loop shape. In some embodiments, the stabilizing end  16  comprises single loop  70 , as illustrated in  FIG. 25 . However, the stabilizing end  16  may have additional loops, such as two loops, three loops, four loops or any combination with partial loops, such as a half loop, one and a half loops, two and a half loops or three and a half loops, to name a few. The wire end at the far proximal end of the stabilizing end  16  may be terminated using a crimp, compression sleeve, weld, glue joint or tether to connect it to the previous loop. By connecting the proximal loose end of the stabilizing end to the previous loop, the hoop strength of the stability end is greatly enhanced. This brings benefit in two ways. It reduces the likeliness that the stabilizing end will be forced into a smaller diameter and be pulled into the airway. By preventing this, the odds of bringing long term benefit for the patient are greatly increased. Also, there are circumstances in which the treatment devices may need to be removed, such as times when the patient may have severe lung infection or lung cancer. In order to recapture and remove a device, large bronchoscope must be utilized to provide a large bore channel and lumen for a forceps or other instrument that will be used to connect to the treatment device. These scopes typically provide a 2.0 mm channel and the scope outside diameter normally exceeds 6 mm Large scopes such as the one we are describing cannot be guided past the 3 rd  generation airways so it is ideal that the stabilizing end of the treatment device can be reliably fixed at the ostium that joins 3rd generation airways. Most other devices that intend to treat these patients tend to migrate deeper in the lung and they present the physician who is charged to remove them with great difficulties. 
     In one embodiment, the shaft  12  forms the extendible midsection  18  along the longitudinal axis  19  and then bends radially outwardly distal to the extendible midsection  18 , such as perpendicularly or at a 90 degree angle to the longitudinal axis  19 , forming a loop  70  in the same plane. Thus, the loop  70  has an opening  72  perpendicular to the longitudinal axis  19  and has a circular shape. Likewise, in this embodiment, the loop  70  extends nearly 360 degrees around the longitudinal axis  19 . 
     The loops  70  may have any suitable diameter, typically in the range of 10 mm to 12 mm, particularly when formed from a shaft  12  having a diameter of 0.3 mm. Thus, the overall diameter of the stabilizing end  16  is typically smaller than the diameter of the tissue gathering end  14 . When the stabilizing end  16  comprises a plurality of loops  70 , each of the loops  70  may have the same diameter or differing diameters. Typically, the loops  70  are expandable so as to enlarge within an ostium OS or other suitable portion of the tracheobronchial tree. 
     Typically, the stabilizing end  16  is the portion of the device  10  which is pulled to re-tension the lung and locate the final placement of the device  10  for implantation. Therefore, in such embodiments, the stabilizing end  16  includes an attachment feature  38  to which the deployment element  30  of the bronchoscope  20  is coupled. In the embodiment of  FIG. 25 , the attachment feature  38  comprises a loop  40  formed by the proximal tip of the shaft  12  of the device  10 . Such a loop-shaped attachment feature  38  may be utilized with a compatible attachment mechanism  36  on the deployment element  30 , such as a tether  42  and a support rod  44 , as previously illustrated in  FIGS. 8-9 . The tether  42  extends through the loop  40  and around the support  42  so as to secure the loop  40  to the support rod  44 . Thus, the stabilizing end  16  of the device  10  is able to remain attached to the deployment element  30  during deployment by the attachment mechanism  36 . 
     In other embodiments, the attachment feature  38  is located distally of the stabilizing end  16 , such as illustrated in  FIG. 26 . Here, the attachment feature  38  comprises a loop  40  formed by the shaft  12  between the extendible midsection  18  and the stabilizing end  16 . Again, such a loop-shaped attachment feature  38  may be utilized with a compatible attachment mechanism  36  on the deployment element  30 , such as a tether  42  and a support rod  44 , as previously illustrated in  FIGS. 8-9 . Since the attachment feature  38  is distal to the stabilizing end  16 , the attachment feature  38  may be pulled proximally in a way that allows the stabilizing end  16  to expand and anchor freely in the ostium. Thus, the stabilizing end  16  will be free to expand into the ostium OS while pulling on the device  10  in the proximal direction during delivery. 
     It may be appreciated that other types of attachment features  38  may be used, such as threaded couplers, hook like wire forms, snap lock connections etc. 
     In some embodiments, the shaft  12  has a separate proximal tip which is “turned-down” or facing in the proximal direction. In some embodiments, the proximal tip is aligned with the longitudinal axis  19  and in other embodiments the proximal tip is offset from the longitudinal axis  19 . In any case, the turned-down configuration aligns the proximal tip  76  with or parallel with the direction of tension so as to avoid or reduce any trauma to the surrounding tissue, such as blunt end agitation on the airway wall or bleeding or coughing that this brings. The proximal tip  76  may have a variety of shapes including a coil, ball, end loop, cone shape or other blunt end shape that will minimize tissue agitation during breathing related motion. 
     D. Shaft Materials 
     The pulmonary treatment device  10  may be formed from a single element, such as a continuous shaft  12 , or from individual parts that are joined together. When parts are joined together, they may ultimately appear as a continuous shaft  12 , however the device  10  will include various transition zones where the parts are joined. In some embodiments, the parts are comprised of differing materials, etc. Thus, the shaft  12  will be described herein and may refer to a single continuous shaft forming the tissue gathering end  14 , extendible midsection  18  and stabilizing end  16 , or a shaft forming any one or more of these parts. 
     In some embodiments, the shaft  12  is comprised of a shape-memory alloy, such as nickel titanium (nitinol). Nitinol alloys exhibit two closely related and unique properties: shape memory effect and super-elasticity or pseudo-elasticity. Shape memory is the ability of nitinol to undergo deformation at one temperature, then recover its original, undeformed shape upon heating above its “transformation temperature”. Super-elasticity occurs at a temperature range above its transformation temperature; in this case, the transformation temperature should be set under that of body temperature so no heating is necessary to cause the undeformed shape to recover, and the material exhibits enormous elasticity, some 10-30 times that of ordinary metal. 
     Thus, the desired configuration of the shaft  12  (e.g. bends, loops, etc.) is set during manufacturing of the device  10 . The device  10  is then able to be elongated, restrained, compressed or deformed, such that when loaded within the delivery device, the pulmonary treatment device recovers to its original shape in free space. When the device  10  is delivered to a confined space, the device  10  is able to recover toward its original shape, with modifications according to the confined space. Recovery force is tuned by adjusting Austenite final (A f ) temperature using heat treating of the alloy during manufacturing. An A f  temperature closer to body temperature (37° C.) lowers recovering force. An A f  temperature farther below body temperature increases recovery force. Thus, in some embodiments, an A f  temperature that is 5-50 degrees below body temperature is preferred. In other embodiments, the pulmonary treatment device my beneficially be produced with a gradation of A f  temperatures. For instance, a large wire may be used to produce the device so the distal and proximal structures are strong, tuned with an A f  of 15 degrees C. to allow them to anchor into tissue reliably but the extendable midsection, also constructed using the same large wire, may be thermally tuned so the A f  is 30 degrees C. (closer to 37 degrees C., typical body temperature) so the extendable midsection is weaker and the spring stress versus strain ratio is lower. Any number of A f  temperatures may be set at any location on the implant in order to enhance performance. 
     In some embodiments, the metallic surface of the nitinol is stripped of contaminants and oxides to native metal. The nitinol is then passivated to form a thin layer of titanium dioxide on the surface for optimal biocompatibility. In some embodiments, the thin layer is 0.5-10 μm thick, preferably 2 μm thick. 
     In some embodiments, the shaft  12  is comprised of a metal, such as stainless steel, steel containing chromium, steel containing cobalt, steel containing chrome, a metal alloy with nickel and/or titanium, a biocompatible metal that is fully elastic after being strained, or a combination of these, to name a few. In some embodiments, the metallic surface of the metal is stripped of contaminants and oxides to native metal. The metal is then passivated to form a thin layer of chromium oxide (when the metal is steel-based) on the surface for optimal biocompatibility. In some embodiments, the thin layer is 0.5-10 μm thick, preferably 2 μm thick. 
     In some embodiments, the shaft  12  is comprised of other materials, such as composites (e.g. carbon fiber) or ceramics, polymers, polyimide film (e.g. Kapton®), para-aramid synthetic fiber (e.g. Kevlar®), nylons, polyimides, metals such as titanium, nickel alloys, nitinol, memory shape alloys such as martensite nitinol or super-elastic forms of nitinol. 
     In some embodiments, the shaft  12  is comprised of wire, such as round-section wire, or square or rectangular section ribbon. The shaft  12  may be solid or hollow, such as comprised of tubing. All edges of the shaft  12  are free of sharp edges to minimize inflammation and the related granulation tissue that is formed from cyclic agitation of the soft tissues in the lung. 
     In some embodiments, the shaft  12  has a diameter between 0.010 inches-0.080 inches, but preferably between 0.009 and 0.023 inches. 
     E. Shaft Tips 
     As mentioned, the shaft  12  has a distal tip  54  and a proximal tip  76 . In some embodiments, such tips  54 ,  76  are optimized to assist in advancement of the device  10  from the delivery device. Typically, the tips  54 ,  76  have a blunt surface to reduce any potential injury or inflammation of tissue due to delivery. In addition, in some embodiments, the tips  54 ,  76  include a feature which assists in resisting relative motion between the tips  54 ,  76  and the surrounding tissue. This helps to resist sliding or movement of the tips  54 ,  76  towards the center of the implant, such as toward the extendible midsection  18 . Such resistance to tip migration bolsters storage of potential energy in the device  10  rather than losing energy during migration. Thus, for example, the distal tip  54  can advance but resists moving backwards, in the proximal direction, and the proximal tip  76  can be pulled proximally but resists moving in the distal direction. 
       FIGS. 27A-27D  illustrate example tips  90  suitable for either the distal tip  54  or proximal tip  76 . Each of the tips  90  are formed at the end of the shaft  12 .  FIGS. 28A-28B  illustrate example methods of forming such tips  90 . To begin,  FIG. 27A  illustrates an embodiment of a tip  90  having a ball shape. Such a ball shape may be formed by melting the distal-most portion  92  of the shaft  12 , as illustrated in  FIG. 28A . Here, a forming tool, such as a copper mold  96  is positioned a distance d from the end of the shaft  12 . The copper mold  96  serves as a heat sink. The distal-most portion  92  of the shaft  12  is then melted while the copper mold  96  stops the melt-back, forming the ball. Thus, the length of distance d determines the size of the ball shaped tip  90 . 
       FIG. 27B  illustrates an embodiment of a tip  90  having a cylindrical shape. Such a cylindrical shape may be formed by melting the distal-most portion  92  of the shaft  12 , as illustrated in  FIG. 28B . Here, a forming tool, such as a copper casting tool  98  or welding arc, is positioned a distance d from the end of the shaft  12 . The copper casting tool  98  serves as a heat sink and a mold. The distal-most portion  92  of the shaft  12  is then melted into the casting tool  98  forming a cylindrical shape. Again, the length of distance d determines the size of the cylindrical shaped tip  90 . 
       FIG. 27C  illustrates an embodiment of a tip  90  having a blunt large bore shape. A tube is placed over wire and the wire and tube are welded together, to yield a hemisphere tip and tube with a chamfer or straight cut back edge to grab tissue. 
       FIG. 27D  illustrates an embodiment of a tip  90  having a coil spring and spherical end shape. By placing a coil over the wire, positioning the coil end coincident with the wire end and striking a welding arch at the end, a hemispherical weldment is created that joins the coil and wire that is blunt and larger diameter than the bare wire would be without the benefit of the coil. The wire coil or tube used to make the tips can be made from titanium, nitinol or a more radiopaque material such as tungsten, tantalum, gold or platinum. 
     In each of these embodiments, the tip  90  is smooth to allow removal of the device  10  if desired, but the increase in diameter compared to the shaft  12  allows the tip  90  to catch on a portion of tissue, particularly in an area of damaged tissue DT, which assists in anchoring the tip the place. 
     It may be appreciated that in some embodiments, the tip  90  functions as an attachment feature  38 . In such embodiments, the tip  90  includes a hole or opening  120 , as illustrated in  FIGS. 29A-29D , which is used to connect with an attachment mechanism  36 . Thus, a tether  42  can be passed through the opening  120  and around a support rod  44 , so as to secure the tip  90  to the support rod  44 . This allows the device  10  to be attached to the deployment element during delivery, as described previously. 
     F. Jacket 
     In some embodiments, the pulmonary treatment device  10  includes one or more jackets  80 . A jacket  80  is a covering that extends over the shaft  12 , such as to increase the diameter of the shaft  12 , increase engagement quality with surrounding tissue, increase surface area of the shaft  12 , and/or to provide drug delivery, to name a few. The jacket  80  may be formed from a variety of materials, such as metals (e.g. stainless steel, titanium, nitinol, nickel, cobalt chrome, or a combination of these) or polymers (e.g. polycarbonate urethane, polytetrafluoroethylene (PTFE), fluorinated ethylene propylene (FEP), polyimide film (e.g. Kapton®), polyimide, polyether ether ketone (PEEK), polyethylene, ethylene-vinyl acetate (EVA) (also known as poly (ethylene-vinyl acetate) (PEVA)), polypropylene, polyvinyl alcohol (PVA), polyurethane, nylon, polyether block amides (PEBA), acrylonitrile butadiene styrene (ABS), polybutyrate, polyethylene terephthalate (PET), polysulfone (PES), ethylene tetrafluoroethylene (ETFE), polyvinylidene fluoride (PVDF), thermoplastic polyurethane elastomers (e.g. Pellethane®), aliphatic polyether-based thermoplastic polyurethanes (TPUs) (e.g. Tecoflex®), or a combination of these). Likewise, the jacket  80  may be formed from a metallocene. A metallocene is a compound typically comprising two cyclopentadienyl anions (Cp, which is C 5 H −   5 ) bound to a metal center (M) in the oxidation state II, with the resulting general formula (C 5 H 5 ) 2 M. 
     The jacket  80  may take a variety of forms. In some embodiments, the jacket  80  comprises a wire, extrusion or sleeve that is welded to, over-molded, shrunk to, glued to, adhered to, compression fit to or otherwise joined with the shaft  12 . In some embodiments, the jacket  80  has the form of a coil which is advanced over the shaft  12  in the desired area. In such embodiments, a ball or other feature may be welded to the shaft  12  to hold the jacket  80  on the shaft  12 . In other embodiments, the jacket  80  comprises a coating. 
     Both  FIG. 25  and  FIG. 26  illustrate a pulmonary treatment device  10  having a plurality of jackets  80 . For example, the device  10  includes a first jacket  80   a  positioned over the tissue gathering end  14 . In some embodiments, the first jacket  80   a  covers the entire tissue gathering end  14 , as shown, and in other embodiments, the first jacket  80   a  covers a portion of the tissue gathering end  14 . An example of such a first jacket  80   a  is a 20 mm diameter nitinol coil; such a jacket may be suitable for positioning over, for example, a shaft  12  comprising a 1.0 mm diameter wire. This allows passage of the tissue gathering end  14  through a 2.0 mm channel of a bronchoscope  20 . However, it may be appreciated that other sized jackets may be used, particularly in the range of 0.5-3.0 mm diameter. For example, if a therapeutic scope is used as a delivery device (having a 2.8 mm channel), a jacket having a 2.8 mm diameter may be used. Increasing the cross sectional area of the tissue gathering end increases the bearing area imparted on the tissue which reduces the pressure imparted on the tissue and this reduces implant migration or implant ingrowth through the tissue. These benefits are important as they increase the durability of the treatment. 
     In  FIG. 25  and  FIG. 26 , the device  10  includes also includes a second jacket  80   b  positioned over the stabilizing end  16 . In some embodiments, the second jacket  80   b  covers the entire stabilizing end  16  ( FIG. 25 ), and in other embodiments, the second jacket  80   b  covers a portion of the stabilizing end  16  ( FIG. 26 ). An example of such a second jacket  80   b  is a 0.50-4 mm diameter nitinol coil but most preferably a 2.5-2.8 mm diameter coil; such a jacket may be suitable for positioning over, for example, a shaft  12  comprising a 0.2-0.3 mm diameter wire. This also allows passage of the stabilizing end  16  through a 2.8 mm channel of a bronchoscope  20 . Again, it may be appreciated that other sized jackets may be used, particularly in the range of 0.5-4.0 mm diameter. For example, if a therapeutic scope is used as a delivery device (having a 2.8 mm channel), a jacket having a 2.8 mm diameter may be used. 
     The second jacket  80   b  increases the area that is engaging tissue. By maximizing the bearing area in contact with the tissue to be greater than 9.81E-8 square inches but preferably more than 10E-7 square inches of bearing area per linear inch along the implantable device centroid+, the potential for device migration through tissue is nearly eliminated. This reduces erosion into the airway by the device  10  to increase treatment effect durability. In addition, the second jacket  80   b  prevents the stabilizing end  16  from “cheese wiring” or cutting through the soft ostium tissue. 
     In some embodiments, the jacket  80  provides controlled delivery of an agent, such as a drug. In some instances, such delivery reduces the rate of wound healing, tissue remodeling, inflammation, generation of granular tissue, and hyperplasia, to name a few. 
     Alternative Embodiments 
     It may be appreciated that the pulmonary treatment device  10  may take a variety of alternative forms. In such embodiments, the device  10  may include elements similar in function but differing in form. Or, the embodiments may include features which function differently but still satisfactorily treat the lung.  FIG. 30  illustrates an embodiment of a device  10  configured from a shaft  12  comprising a hollow tube. In this embodiment, the device  10  includes a tissue engaging end  14 , an extendible midsection  18 , and a stabilizing end  16 , each laser cut from the hollow tube. Here, the tissue engaging end  14  includes one or more wings  100  which extend radially outwardly from the longitudinal axis  19  when deployed. Each wing  100  has an elongate shape formed from the shaft  12 , such as by laser cutting longitudinal slits in the shaft  12  from the extendible midsection  18  to the distal tip  54 . Thus, the tissue engaging end  14  is configured to have a slim profile, wherein the wings  100  extend in parallel to the longitudinal axis  19 , while the tissue engaging end  14  is disposed within the delivery device. Each wing  100  also has a predetermined bend location  102 , typically midway along the length of the wing  100 . Upon deployment, each wing  100  juts radially outwardly, perpendicular to the longitudinal axis  19 , by bending at its bend location  102 . This creates an expanded profile which allows the end  14  to engage the damaged tissue DT of the lung. As each wing  100  bends radially outwardly, the expandable midsection  18  and distal tip  54  are drawn toward each other. 
     In this embodiment, the extendible midsection  18  is also laser cut from the hollow tube shaft  12 . Here, the hollow tube is cut in a helical or spiral shape to form a spring or coil. Further, in this embodiment, the stabilizing end  16  is also cut from the hollow tube shaft  12 . Here, the stabilizing end  16  includes at least one prong  104  cut from the shaft  12 . Each prong  104  may have any suitable shape but is typically elongate having a free end with an atraumatic tip  106 . The stabilizing end  16  is configured to have a slim profile, wherein the prongs  104  extend in parallel to the longitudinal axis  19 , while the stabilizing end  16  is disposed within the delivery device. Each prong  104  also has a pre-curvature which causes the prong  104  to bend radially outwardly, away from the longitudinal axis, upon deployment. This allows the stabilizing end  16  to expand in a desired lung area, such as an ostium, to stabilize the position of the device  10  when implanted. In this embodiment, the stabilizing end  16  also includes an attachment feature  38  for attaching to an attachment mechanism  36  on the deployment element  30  during deployment. In this embodiment, the attachment feature  38  comprises a hole cut into the tubular shaft  12 . 
     Delivery Device Embodiments 
     As mentioned previously, the pulmonary treatment device  10  is sized and configured to be delivered by a delivery device that is insertable into the lung, such as a steerable scope (e.g. bronchoscope  20 ), catheter or other delivery system. The delivery device is configured to be advanced within any anatomical lumen in the lung that is either innate or created within the lung, either by disease or with the use of an instrument. An example delivery device is a bronchoscope  20 , an embodiment of which is illustrated in  FIG. 31A-31B . In this example, the bronchoscope  20  includes a bronchoscope body  200  and an insertion cord  202 . The insertion cord  202  is advanced into the endobronchial tree of the patient and the bronchoscope body  200  remains outside of the patient, typically grasped by the operator&#39;s non-dominant hand. The insertion cord  202  contains a fiberoptic bundle for light and image transmission, tip bending control wires and a working channel. The average length of the insertion cord  202  is 600 mm (range 500-650 mm). The working channel continues into the bronchoscope body  200 , exiting at the working channel port  204 . The bronchoscope body  200  also includes an eye piece (which can be attached to a camera for display on a screen-fiberoptic scopes have an eye piece; video scopes do not), diopter ring (for focusing), and control lever. The control lever is used to control the distal tip of the insertion cord  202 . Typically, the control lever is used to move the insertion cord tip  208  up/down and/or side-to-side, whereas rotation is typically achieved by rotation of the bronchoscope body  200  with the operator&#39;s wrist and shoulder. The bronchoscope  20  also includes a light source which can be supplied via a cable  206  or a portable battery powered source. The light source may be halogen, incandescent or LED, to name a few.  FIG. 31B  illustrates an end view of the insertion cord tip  208 . As shown, the working channel  210  extends through the tip  208 , allowing delivery of the pulmonary treatment device  10  therefrom. 
     As mentioned previously, in some embodiments, the pulmonary treatment device  10  is configured to be delivered through a lumen in the delivery device, such as by pushing the treatment device through a lumen of a scope, catheter, introducer, sheath, sleeve or similar device. For example, in some embodiments, the pulmonary treatment device  10  is loaded directly into the working channel port  204  and advanced through the working channel  210  for delivery from the insertion cord tip  208 . However, in other embodiments, the device  10  is pre-loaded into an introducer which is advanceable into the working channel  210  for delivery therefrom. In other embodiments, the treatment device  10  is mounted on a guidewire which constrains portions of the device  10 , preventing these portions from expanding radially. The device  10  and guidewire are advanced together into the working channel  210  for delivery therefrom. In another embodiment, the device is pre-loaded on the guidewire which is advanceable into the working channel  210  for delivery therefrom. 
       FIG. 32  illustrates an embodiment of an introducer  220  having a pre-loaded pulmonary treatment device  10 . In this embodiment, the introducer  220  comprises an elongate tube  222  having a first end  224  and a second end  226 . The elongate tube  222  is comprised of any suitable material, such as metal, stainless steel, polymer or composite tubing. Typically, the elongate tube  222  has a bend to assist in insertion into the working channel port  204  or is bendable to both assist in insertion and to allow for compact packaging (such as positioning into round track or square track packaging without kinking) In any case, the introducer  220  should be strong enough to keep the device  10  from distorting from a straight configuration and hard enough that the device  10  cannot indent into the wall of the introducer  220 , particularly during the sterilization process that involves heating to 130-180° C. The introducer  220  can be any suitable length, such as a minimum of 2 inches longer than the device  10  therein and a maximum of half the length of the deployment element  30 . In some embodiments, the introducer  220  has a length of 4 to 20 inches, preferably 10 inches. 
       FIG. 32  illustrates the stabilizing end  16  and the extendible midsection  18  loaded within the introducer  220 . Here, the tissue gathering end  14  is disposed outside of the introducer  220  and allowed to coil into its expanded state. In some embodiments, the tissue gathering end  14  is packaged in this configuration to reduce stress on the end  14  during transport and sterilization. In such embodiments, the tissue gathering end  14  is then retracted into the introducer  220  prior to use. In this embodiment, the first end  224  of the introducer  220  is removably joined with a funnel  230  to assist in retracting the tissue gathering end  14  into the introducer  220 . Thus, the funnel  230  has a tapered shape which gradually draws the tissue gathering end  14  radially inward toward the interior lumen of the introducer  220 . Once the tissue gathering end  14  resides within the introducer  220 , the funnel  230  is removed. 
     In this embodiment, the device  10  is attached to a deployment element  30  by tether  42 . The deployment element  30  comprises an elongate shaft  32 , typically having an interior lumen extending therethrough. The elongate shaft  32  may take various forms, including a coiled shape, as shown and may be comprised of a variety of materials, such as metal or polymer. In some embodiments, the shaft  32  is comprised of a wire or polymer coil having a flexible exterior sheath or liner that minimizes kinking as it is advanced through the working channel  210  of the bronchoscope  20 . Likewise, in some embodiments, the shaft  32  includes an interior liner, such as of polytetrafluoroethylene or other polymer, to protect the tether  42  passing therethrough from breaking. In other embodiments shaft  32  is comprised of a braided frame with a liner (such as comprised of polytetrafluoroethylene) and an outer jacket (such as comprised of thermoplastic elastomer or flexible polyamide). It may be appreciated that in some embodiments, the elongate shaft  32  has a solid center rather than a hollow center. It may also be appreciated that the deployment element  30  may have any suitable length, such as 13-45 inches, preferably 34 inches. 
     When the elongate shaft  32  is hollow or has an interior lumen, the tether  42  passes through the interior lumen, through the attachment feature  38  and then back through the interior lumen of the deployment element  30  creating two free ends  240  of the tether  42 . The tether  42  may be comprised of any suitable material such as a monofilament or braided high strength polymer, a carbon fiber, or a thread or braid comprising metal, stainless steel, nitinol, titanium, steel alloyed with chrome or cobalt, polytetrafluoroethylene, and/or material from a family of ultra-high molecular weight polymers, to name a few. 
     In this embodiment, the deployment element  30  extends out of the second end  226  of the introducer  220  and culminates in a hub  242  which holds the free ends  240  of the tether  42 . Thus, the device  10  is able to remain attached to the deployment element  30  by tether  42  during deployment. In this embodiment, the hub  242  of the deployment element  30  comprises a base  244  and a top  246 . Here, each of the base  244  and top  246  are thumb knob shaped for ease of use. In this embodiment, the base  244  is crimped, glued or welded to the shaft  32  of the deployment element  30 . The free ends  240  of the tether  42  extend from the shaft  32  and then pass through the base  244 , typically within a cavity  248  therein. Such passage through the cavity  248  ensures that the tether  42  is not abraded by the base  244 . In this embodiment, the cavity  248  has tapered walls leading to the shaft  32  so as to minimize the size of the cavity  248  while ensuring adequate space for the tether  42 . The free ends  240  then pass through the top  246  where they are separated into individual lumens  230 . The lumens  230  are spaced apart to impart a moment while twisting to make length reduction related tightening more effective. In this embodiment, the free ends  240  then wrap around a support  250  which reduces stress on the tether  42 . Typically, the support  250  has an atraumatic shape, such as a cylinder or ball. The free ends  240  are then held together with a clip  252 . 
       FIG. 33  illustrates another embodiment of an introducer  220  having a pre-loaded pulmonary treatment device  10 . In this embodiment, the introducer  220  again comprises an elongate tube  222  having a first end  224  and a second end  226 . The elongate tube  222  is comprised of any suitable material, such as metal or polymer. In this embodiment, the device  10  comprises a tissue gathering end  14  and a stabilizing end  16 , without an extendible midsection  18 .  FIG. 33  illustrates the tissue gathering end  14  and stabilizing end  16  loaded within the introducer  220 . 
     In this embodiment, the deployment element  30  is attached to the attachment feature  38  of the device  10  by tether  42 . The deployment element comprises an elongate shaft  32  having an interior lumen extending therethrough. The elongate shaft  32  may take various forms, including a coiled shape, as shown. The tether  42  passes through the interior lumen of the deployment element  30 , through the attachment feature  38  and then back through the interior lumen of the deployment element  30  creating two free ends  240  of the tether  42 . In this embodiment, the deployment element  30  extends out of the second end  226  of the introducer  220  and culminates in a hub  242  which holds the free ends  240  of the tether  42 . Thus, the device  10  is able to remain attached to the deployment element  30  by tether  42  during deployment. In this embodiment, the hub  242  of the deployment element  30  comprises a base  244 . In this embodiment, the base  244  is crimped, glued or welded to the shaft  32  of the deployment element  30 . In this embodiment, the free ends  240  then wrap around a support  250  which reduces stress on the tether  42 . Typically, the support  250  has an atraumatic shape, such as a cylinder or ball. The free ends  240  are then held together with a clip  252 . 
     In any case, the use of a pre-loaded introducer  220  allows for ease in loading of the bronchoscope  20  for delivery of the device  10  therethrough. The introducer  220  holds the device  20  in a relatively straight configuration so it can easily be introduced into the bronchoscope  20 . In some embodiments, the introducer  220  also holds the device  20  in a radially compressed configuration so that it can be advanced through the working channel  210  of a bronchoscope  20  having a conventional inner diameter (e.g. 2.0 mm) Thus, the operator is relieved from any manipulation of the device  10  during loading of the bronchoscope  20  and is ensured proper orientation and delivery. 
     As illustrated in  FIG. 34 , the pre-loaded introducer  220  is advanceable into the working channel port  204  of the bronchoscope  20 , typically once the bronchoscope  20  has been desirably positioned within the lung. In some embodiments, the introducer  220  has a shape, such as a male luer taper, that sockets into the working channel port  204 . Such advancement into the port  204  relieves the operator from holding the device  10  during delivery. As shown, the device  10  is advanced from the first end  224  of the introducer  220  and into the working channel  210  by advancement of the deployment element  30 . Thus, the deployment element  30  pushes the device  10  through the introducer  220  and through the working channel  210  of the bronchoscope  20 . 
       FIG. 35  illustrates the insertion cord tip  208  of the bronchoscope  20  positioned in the damaged tissue DT of the patient&#39;s lung. The position of the insertion cord tip  208  indicates the delivery location of the tissue gathering end  14 . The tissue gathering end  14  is deployed at this delivery location by retraction of the bronchoscope  20  while holding the deployment element  30  fixed. Thus, the deployment element  30  and attached device  10  remain fixed in relation to the anatomy while the bronchoscope  20  is retracted. This exposes the tissue gathering end  14 , allowing the tissue gathering end  14  to expand into a deployed configuration. In this embodiment, the tissue gathering end  14  comprises a loop  50  deployed in a plane perpendicular to the longitudinal axis  19  of the device  10 . 
     Once the tissue gathering end  14  is deployed, the lung is ready for re-tensioning. This can be achieved by a variety of methods. In one embodiment, the deployment element  30  is fixed relative to the bronchoscope  20  and together the deployment element  30  and bronchoscope  20  are retracted. Such retraction pulls the tissue gathering end  14  toward the larger bronchioles and trachea, which in turn pulls the damaged tissue DT, because the device  10  is connected to the deployment element  30 . This is continued until a desired level of re-tensioning of the lung, has been achieved. It may be appreciated that the deployment element  30  and bronchoscope  20  can be advanced and retracted together as needed to adjust the level of re-tensioning, if desired. 
     As mentioned, other methods of delivery and re-tensioning can be achieved with the pulmonary treatment device  10 . In some embodiments, the tissue gathering end  14 , optional midsection  18 , and stabilizing end  16  are all deployed prior to the re-tensioning step. Thus, once the device  10  has been deployed, re-tensioning can be achieved by retracting the deployment element  30  and bronchoscope  20  together as described previously. The retraction pulls the device  10  toward the larger bronchioles and trachea, which in turn pulls the damaged tissue DT. Retraction continues until the stabilizing end  16  is seated in a desired portion of the airway. Once the operator is satisfied with the placement of the device  10 , the device  10  is detached from the deployment element  30 . 
     It may be appreciated that the device  10  may alternatively be deployed from the bronchoscope  20  by advancing the deployment element  30 , thereby pushing the device  10  out of the working channel  210  of the bronchoscope  20 . In such embodiments, the deployment element  30  typically has a low compressibility. Such deployment of the device  10  can be achieved all at once or in separate steps. Since the deployment element  30  is attached to the device  10 , re-tensioning can be achieved by the same methods as described above (i.e. retraction of the deployment element  30  and bronchoscope  20 ). Once the operator is satisfied with the placement of the device  10 , the device  10  is detached from the deployment element  30 . 
     It may be appreciated that in some embodiments, the device  10  is delivered to the desired location within the lung with the use of a guidewire and/or catheter, passed through the working channel  210  of a bronchoscope  20  or alone. 
     When more than one device  10  is to be implanted into the patient during a procedure with the use of a bronchoscope  20 , the bronchoscope  20  is typically exchanged or cleaned before implanting the next device  10 . Since bronchoscopes  20  typically not disposable, they are designed for such cleaning protocols. The ability to easily exchange or clean the delivery device between uses reduces any risk of cross-contamination from one portion of the lung to another and/or from one lung to another. Previously, when using conventional devices and treatment protocols, both lungs of a patient could not be treated during the same procedure due to risks of cross contamination between both lungs which could prove fatal to the patient. However, the delivery methods and devices of the present invention reduce or eliminate this risk. 
     It may be appreciated that an additional device  10 ′ can be implanted into the same airway as a previous implanted device  10 . In some embodiments, the additional device  10 ′ is passed through the previously implanted device  10  to reach a more distally located area of the lung. 
     In some embodiments, the device  10 , attached deployment element  30  and introducer  220  are packaged or pouched as a single unit. Each unit is used to treat a particular target location in the lung. In some embodiments, the units are sold individually since the number of devices  10  implanted in a single lung will vary depending on the patient&#39;s disease state and a variety of other features. In other embodiments, the units are sold by the box wherein each box contains a plurality of units. In some embodiments, 6-14 devices are delivered to a single lung during a treatment session. If two lungs are treated during a single treatment session, upwards of 30 devices may be used. It may be appreciated that in some embodiments, the procedure has a flat cost wherein an unlimited number of devices  10  may be used during the procedure for the same cost. This allows the operator to focus on the technical aspects of the procedure rather than on the cost of using additional units. 
     It may be appreciated that in some embodiments, two or more devices  10  are joined or fixed together within the lung anatomy.  FIGS. 36-37  illustrate an embodiment wherein two devices  10  are joined with the use of a joining device  300 .  FIG. 36  illustrates a first device  10   a  implanted at a first location within a lung L and a second device  10   b  implanted at a second location within lung L. In this embodiment, the first and second locations are along lung passageways branching from the same ostium OS. As shown, the tissue gathering ends  14  are disposed in damaged tissue DT and the stabilizing ends  16  are located more proximal along the respective lung passageways. In addition, each device  10   a ,  10   b  has a respective tether  42   a ,  42   b  attached to its attachment feature  38 . The tethers  42   a ,  42   b  extend from the devices  10   a ,  10   b  to the exterior of the patient. The delivery device is not shown in  FIG. 36  for clarity, however the tethers  42   a ,  42   b  extend through the delivery device to the exterior of the patient. The joining device  300  is then advanced over the free ends  240   a ,  240   b  of the tethers  42   a ,  42   b . In this embodiment, the joining device  300  comprises a clip having a first arm  302   a  and a second arm  302   b , wherein the arms  302   a ,  302   b  are connected by a connector  304 . Each arm  302   a ,  302   b  has a respective lumen  306   a ,  306   b  through which an individual tether passes. Thus, joining device  300  is advanced over the free ends  240   a ,  240   b  so that the first tether  42   a  passes through the lumen  306   a  of the first arm  302   a  and the second tether  42   b  passes through the lumen  306   b  of the second arm  302   b . The joining element  300  is then advanced along the tethers  42   a ,  42   b  until the arms  302   a ,  302   b  reach the devices  10   a ,  10   b . As illustrated in  FIG. 37 , the joining device  300  is then advanced so as to attach the first arm  240   a  to the first device  10  and the second arm  240   b  to the second device  10   b . In this embodiment, the joining device  300  resides within the ostium OS, each arm  302   a ,  302   b  extending toward a separate lung passageway, thereby creating a V or U shape. The tethers  42   a ,  42   b  are removed and the joining device  300  is left in place. 
     In other embodiments of the invention, the pulmonary treatment device  10  is mounted on the outside of the bronchoscope  20 . Mounting the device  10  on the outside of the bronchoscope  20  avoids packing the device  10  within a bronchoscope working channel  210  or catheter within a bronchoscope channel which involves restraining the device  10  in a high strain configuration. Once restrained, the device  10  would then transition to a more relaxed configuration upon deployment. However, by mounting the device  10  on the outside of the bronchoscope  20 , device  10  can be delivered into the patient in a non-stressed and non-strained state. This configuration provides the benefit of reliably delivering the treatment device  10  along the delivery path in substantially the same shape as it will be when it is inserted into the target airway. In addition, the device  10  may be comprised of a broader selection of materials, including high strength materials that would typically be unsuitable for such restraint and relaxation. In some embodiments, the treatment device  10  may be comprised of titanium, steel, a stainless-steel alloy, one or more ferrous metals, one or more non-ferrous metals, metals that contain nickel, iron, and/or manganese, or any combination of these listed materials. In other embodiments, the treatment device  10  may also be comprised of a polymer material, a ceramic material or a composite material that is made from any combination of plastic, metal, carbon, carbon fiber or any other material that exhibits resilience and biocompatibility performance, such as nitinol or an alloy made from nickel and titanium. It may be appreciated that, in some embodiments, materials that can perform in a fully reversible elastic way up to a minimum of 1% strain are very suitable. 
       FIG. 38  illustrates an embodiment of a delivery system  301  for delivering a treatment device  10 . In this embodiment, the system  301  includes a bronchoscope  20  having a bronchoscope body  200  and an insertion cord  202  with an insertion cord tip  208 . Suitable bronchoscope outer diameters may be as large as 10 mm in diameter but they may also be as small as 1 mm diameter. More typically, the bronchoscope is between 2 mm and 3 mm outer diameter. In this embodiment, the delivery system  301  further includes a deployment sleeve  311  and a guidewire  313 , both of which may be utilized in delivering particular embodiments of the treatment device  10 . As shown, the deployment sleeve  311  includes a proximal end  310  and a distal end  312 . The deployment sleeve  311  is advanceable through the working channel  210  of the bronchoscope  20 , such as extending through the working channel port  204  and beyond the insertion cord tip  208 , as shown. In some embodiments, the deployment sleeve  311  is comprised of a polymer tube, a polymer or metallic round wire coil, a ribbon coil, a braid reinforced sleeve, an extrusion or any combination of these. In some embodiments, the deployment sleeve  311  has an outer diameter of up to 5 mm but preferably its outer diameter is between 2 mm and 4 mm with an inside diameter as small as 0.010″, but more preferably it has an inside diameter of 0.018-0.040 inches. Additionally, in some embodiments, a guidewire  313  is advanceable through the deployment sleeve  311 , as illustrated in  FIG. 38 . In some embodiments, the guidewire  313  is comprised of a stainless steel or nitinol core wire with a stainless-steel or nitinol wound coil outer jacket. The guidewire diameter may be as small as 0.010″ and as large as 3 mm, ideally but it&#39;s ideally between 0.025-0.040 inches in diameter. In some embodiments, the guidewire  313  and deployment sleeve  311  are longer than 60 cm, preferably 90 to 110 cm. Other embodiments include a much longer guidewire that is 90 cm to 250 cm long, with sufficient length so that pulmonary treatment devices may be removed from the patient or exchanged on and off of the guidewire with enough excess guidewire length to allow the maneuvers to be accomplished without ever needing to let go of the guidewire. This insures that the guidewire stays in an appropriate position while exchanges are being made  FIG. 39  illustrates an embodiment of a pulmonary treatment device  10  that is deliverable by the system  301  of  FIG. 38 . In this embodiment, the pulmonary treatment device  10  comprises a tissue gathering end  14 , an extendible midsection  18  and a stabilizing end  16 . In this embodiment, the stabilizing end  16  comprises a coil having a flared configuration, as illustrated in  FIG. 39 . Here, the outer diameter of the stabilizing end  16  generally matches that of the extendible midsection  18  and then gradually expands moving away from the midsection  18  forming the flared configuration. The flared configuration can assist in seating the stabilizing end  16  within the airway, particularly within an ostium. In this embodiment, the stabilizing end  16  also includes a connector  326  which assists in maintaining the shape of the stabilizing end  16 . When the stabilizing end  16  is comprised of a coil, the free end of the coil is connected with the remainder of the coil by the connector  326  to ensure that the free end does not cause trauma to tissue, such as during delivery and deployment. Such connection of the free end to the remainder of the coil forms a complete hoop which increases the hoop strength of the most proximal portion of the stabilizing end  16 . In some instances, the increased hoop strength assists in anchoring the stabilizing end  16  in a portion of the lung airway. 
     In this embodiment, the extendible midsection  18  also comprises a coil, however the midsection  18  typically has a uniform diameter. The diameter is typically chosen so as to be mountable on a bronchoscope  20  or other delivery device, such as a guidewire. The extendible midsection  18  is able to be elongated to store elastic strain energy which urges the treatment device  10  to recover back to a non-elongated length. 
     In this embodiment, the tissue gathering end  14  comprises an anchor strut  322  which is extendable radially outwardly from the longitudinal axis  19  to assist in anchoring the device  10  within a lung passageway or within damaged tissue. Anchor strut  322  may extend 1 mm to more than 30 mm but 6-12 mm is preferable. The anchor strut  322  terminates in an anchor strut end  321 , which may have a variety of shapes including a coil, ball, sharp end barb, L shaped pad, strain relief long coil or tapered coil. The anchor strut  322  is configured to extend radially outwardly upon deployment so at least the anchor strut end  321  engages an airway wall W or damaged tissue DT, such as in the area of the alveolar sacs. However, in some instances, the anchor strut  322  itself additionally engages the airway wall W or damaged tissue DT. 
     During delivery and prior to deployment, the anchor strut  322  is held in a retracted or un-extended position so as to avoid dragging along the airway walls W or traumatizing tissue. Such retraction is maintained by an alignment element  320 . In this embodiment, the alignment element  320  has the form of a loop, however it may be appreciated that the element  320  may have the form of a partial loop or snap locking structure, partial loop, hook shaped lock or spring lock mechanism. When the center of the loop is aligned with the longitudinal axis  19 , the anchor strut  322  is held parallel to or at a small angle in relation to the longitudinal axis  19 . Such alignment may be maintained by passing a device, such as the bronchoscope  20  or guidewire, catheter, balloon catheter, hitch lock wire, or other accessories related thereto, through the center of the treatment device  10  and through the alignment element  320  (as will be illustrated in later sections). The tissue gathering end  14  is configured so as to bias the alignment element  320  and attached anchor strut  322  radially outwardly. Therefore, withdrawal of devices from the alignment element  320  frees the alignment element  320  and allows the alignment element  320  to rotate away from alignment with the longitudinal axis  19 . This, in turn, causes the anchor strut  322  to extend radially outwardly, as illustrated in  FIG. 39 . Thus, in the extended position, the alignment element  320  has an axis  19  which is at an angle θ to the longitudinal axis  19 . Typically, the angle θ is in the range of 1 to 90 degrees but it&#39;s preferably 20-65 degrees. In some embodiments, additional portions of the tissue gathering end  14  are also biased to assist in extension of the anchor strut  322  radially outwardly. For example, in some embodiments, the tissue gathering end  14  includes a body strut  323  which is connected to the anchor strut  322 . In such embodiments, the body strut  323  is biased so as to further extend the anchor strut  322  radially outwardly. In the embodiment of  FIG. 39 , the body strut  323  is disposed opposite the anchor strut  322  so that the alignment element  320  is disposed therebetween. Thus, when the center of the alignment element  320  is aligned with the longitudinal axis  19 , the body strut  323  and anchor strut  322  reside on opposite sides of the longitudinal axis  19 . In some instances, release of the alignment element  320  allows both the body strut  323  and anchor strut  322  to bias toward their relaxed configurations (such as pushing both the body strut  323  and anchor strut  322  outwardly in the same radial direction). This can allow the body strut  323  and anchor strut  322  to spread fully elastically at least 5 degrees but up to 90 degrees, and preferably 20 to 65 degrees, to push the anchor strut end  321  into or through the wall of an airway or the diseased tissue to anchor the tissue gathering end  14  in the lung tissue. 
     In some embodiments, the tissue gathering end  14  further includes a guide element  319 , such as illustrated in  FIG. 39 . In this embodiment, the guide element  319  comprises a coil, however the element  319  may have any suitable shape including a single loop. In some embodiments, the guide element  319  helps keep the device  10  centered on the end of the bronchoscope  20  or other delivery device such as a guidewire, catheter or balloon catheter. In some embodiments, the guide element  319  is arranged so that a guidewire emerging from the insertion cord tip  208  of the bronchoscope  20  passes through the guide element  319 . This assists in aligning the tissue gathering end  14  with the longitudinal axis  19  and holding the body strut  323  and anchor strut  322  in its retracted position during delivery, prior to deployment. In some embodiments, the guide element  319  comprises a coil partial coil, hook, hitch lock system or snap lock geometry. In some instances, the coil dictates the strength of the spreading force of the anchor strut  322  radially outwardly. 
       FIG. 40  illustrates the treatment device  10  of  FIG. 39  mounted on the delivery system  301  of  FIG. 38 . As shown, the treatment device  10  is mountable on the bronchoscope  20 , deployment sleeve  311  and guidewire  313 . In particular, the most distal portion of the system  301  is advanced through the central lumen of the treatment device  10 , from the stabilizing end  16  toward the tissue gathering end  14 . Thus, the tissue gathering end  14  of the treatment device  10  faces distally. In some embodiments, the stabilizing end  16  and midsection  18  are mounted on the exterior of the bronchoscope  20 . In some embodiments, portions of the tissue gathering end  14  are also mounted on the exterior of the bronchoscope  20 . For example, in some embodiments the alignment element  320  is mounted on the bronchoscope  20 , as shown in  FIG. 40 . In this embodiment, portions of the tissue gathering end  14  extend beyond the insertion cord tip  208  of the bronchoscope  20 . In particular, the guide element  319  is mounted on the guidewire  313  and held in place by the deployment sleeve  311 . This is achieved by having the inner diameter of the guide element  319  smaller than the outer diameter of the deployment sleeve  311  so that the guide element  319  abuts the deployment sleeve  311 . 
     The delivery system  301  and mounted treatment device  10  are then advanceable into the lung anatomy, the guidewire  313  guiding the system  301  through the lung passageways. Once the target location has been reached, the delivery system  301  is positioned so as to seat the stabilizing end  16  at a desired location, such as within an ostium OS.  FIG. 40  illustrates the tissue stabilizing end  16  within an ostium OS at a bifurcation of two lung airways AW. Here, at least a portion of the stabilizing end  16  resides in the ostium OS while the midsection  18  and tissue gathering end  14  extend into the target airway AW. Thus, the flared configuration of the stabilizing end  16  anchors the stabilizing end  16  within the ostium OS by pressing against the walls W of the airway AW. 
     The treatment device  10  is then deployed within the target airway AW by advancing the delivery system  301 , as illustrated in  FIG. 41 . Since the stabilizing end  16  is anchored within the ostium OS and the treatment device  10  has a structure which allows elongation along its longitudinal axis  19 , advancement of the delivery system  301  pushes the tissue gathering end  14  further along the target airway AW while the treatment device  10  expands. In particular, the extendible midsection  18  length elongates and stores elastic recoil strain energy in its helix structure; the elastic strain energy will be used to urge the treatment device  10  to recover to its original shorter length after the device  10  has been fully deployed and the delivery system  301  has been decoupled from the device  10 . 
       FIG. 42  illustrates the beginning stages of decoupling the device  10  from the delivery system  301 . To begin, the tissue gathering end  14  is unmounted from the bronchoscope  20 . In particular, the alignment element  320  is released from the bronchoscope  20 , such as by retracting the bronchoscope  20  or by advancing the deployment sleeve  311  which in turn advances the anchor strut  322  which pulls the alignment element  320  off the insertion cord tip  208 . The guidewire  313 , and optionally the deployment sleeve  311 , are held in a fixed position within the airway AW so as to maintain the elongated configuration of the treatment device  10 . Release of the alignment element  320  allows the anchor strut  322  to extend radially outwardly toward its biased configuration. Thus, as shown in  FIG. 42 , the anchor strut end  321  engages with the wall W of the airway AW in an anchoring manner. In this embodiment, at least the anchor strut end  321  deforms a portion of the wall W to make purchase at a location that is distant from the stabilizing end  16 . 
       FIG. 43  illustrates further steps of decoupling the device  10  from the delivery system  301 . Here, the deployment sleeve  311  and guidewire  313  have been removed from the bronchoscope  20  allowing the tissue gathering end  14  to fully engage with the wall W of the airway AW. Thus, the tissue gathering end  14  is fixed to lung tissue within the target airway at a position distant from the stabilizing end  16  within the ostium OS. The bronchoscope  20  can then be fully retracted and removed from the lung anatomy, leaving the treatment device  10  behind, as illustrated in  FIG. 44 . 
     The stored elastic strain energy of the extendible midsection  18 , and optionally any stored energy in the stabilizing end  16  and/or tissue gathering end  14 , creates an urging force to recoil and shorten the treatment device  10  toward its original configuration and length. Since the strength of the airway AW is compromised, the walls W are unable to overcome this urging force. Thus, the wall W, at least at the point of purchase or engagement by the tissue gathering end  14 , is carried with the tissue gathering end  14  toward the stabilizing end  16 . This retensions the airway distal to the treatment device  10 .  FIG. 45  illustrates the treatment device  10  after the stored elastic strain energy that has been stored in at least the midsection  18  of the treatment device  10  has urged the device  10  to shorten and recover elastically more closely to its original pre-elongated length. As described, this shortens the length of the airway along the treatment device  10  yet elongates the length of the airway distal to the treatment device  10  to cause restoration of lung tissue tension and elastic recoil in the tissue that is distal, proximal and adjacent to the treatment device  10 . By tensioning the lung tissue, the device  10  has tensioned the entire bronchial tree that is distal to this single airway which in turn expands the associated alveoli tissue. By tensioning the airways and alveoli, the involved airways are held in a dilated arrangement. In some instances, this simulates the effects of bronchodilator drugs in patients who still respond to this family of drugs (unfortunately, these late stage severe emphysema and COPD patients typically no longer respond to these drugs). 
     It may be appreciated that the delivery system  301  of  FIG. 38  may be used to deliver treatment devices  10  in a variety of ways. One such way, which was illustrated in  FIGS. 40-43 , involves seating the stabilizing end  16  in an ostium, or other stable portion of the lung anatomy, and advancing the stabilizing end  14  further along the airway. It may be appreciated that the treatment devices  10  may be delivered by alternative methods. For example, the tissue gathering end  14  may be positioned at a target location and the stabilizing end  16  retracted to an ostium, or other stable portion of the lung anatomy. This may be achieved with the use another embodiment of the delivery system  301 , such as illustrated in  FIG. 46 . 
       FIG. 46  illustrates another embodiment of a delivery system  301  for delivery of a treatment device  10 . In this embodiment, the delivery system comprises a bronchoscope  20  (having a bronchoscope body  200  and an insertion cord  202 ), a guidewire  313 , a deployment sleeve  311  and a guide sleeve  327 . In some embodiments, the guide sleeve  327  has a proximal end  328 , a distal end  330  and length extender catch feature  329  near its distal end  330 . In this embodiment, the catch feature  329  comprises a protrusion which extends radially outwardly from the guide sleeve  327 . The protrusion may have a variety of shapes including a flap, a hook, a knob, a nub, a clasp or any suitable shape for attaching to the treatment device  10  itself or a corresponding feature on the treatment device  10 . The guide sleeve  327  is position able over the insertion cord  202  of the bronchoscope  20  as shown and is able to slide longitudinally over the insertion cord  202 . In addition, the catch feature  329  is configured to removably attach to the treatment device  10 , such as the stabilizing end  16  of the treatment device  10 , so that translation of the guide sleeve  327  along the insertion cord  202  of the bronchoscope  20  adjusts the treatment device  10  length. For example, retraction of the guide sleeve  327  (toward the proximal end of the bronchoscope  20 ) increases the length of the device  10  by pulling the stabilizing end  16  proximally. This in turn increases the stress and strain on the treatment device  10 . Such retraction can be undertaken to achieve any desired treatment device stress, strain and length configurations before advancing the treatment device  10  into the lung, while advancing the treatment device  10  in the lung, just before deployment of the treatment device  10  in the lung, after anchoring the stabilizing end  16 , after anchoring the tissue gathering end  14 , after anchoring both the stabilizing end  16  and the tissue gathering end  14 , or before or after any combination of these actions to deploy the treatment device  10  in lung tissue. It may be appreciated that in other embodiments the guide sleeve  327  may be advanced to push the treatment device  10  off of the insertion cord  202  or the guide sleeve  327  may be held fixed to support the stabilizing end  16  of the treatment device  10  to keep the treatment device  10  from binding with the insertion cord  202 . Further, it may be appreciated that the guide sleeve  327  may be used to pull the treatment device  10  out of the airway while the insertion cord  202  is being withdrawn from the treatment device. 
       FIG. 47  illustrates an embodiment of a treatment device  10  releasably mounted on the delivery system of  FIG. 46 . As shown, the guide sleeve  327  is advanced over the insertion cord  202  and disposed proximal to the insertion cord tip  208 . The treatment device  10  is mounted on the bronchoscope  20  so that the tissue gathering end  14  is disposed over the insertion cord tip  208  and the stabilizing end  16  is disposed over a portion of the guide sleeve  327 . Here, the catch feature  329  engages the stabilizing end  16 , such as by hooking on to one or more turns of the coil forming the stabilizing end  16 . This constrains the stabilizing end  16  so it cannot use stored elastic spring energy to open and increase the longitudinal dimension of the treatment device  10 . In addition, a guidewire  313  has been advanced through the working channel port  204  of the bronchoscope  20  and through the guide coil  319  to guide the advancement of the system  301 . Likewise, the deployment sleeve  311  has been advanced through the working channel  210  of the bronchoscope  20  and it is butted against the guide coil  319 . As mentioned, the guide sleeve  327  and catch feature  329  has been connected to the stabilizing end  16  and adjusted relative to the bronchoscope  20  so the midsection  18  is fixed in an unstressed and unstrained configuration to allow the delivery system  301  and the treatment device  10  to remain unstressed and flexible during delivery for easy advancement to a treatment location. 
     Once the delivery system  301  has been advanced to the treatment location within the lung anatomy, the tissue gathering end  14  is desirably positioned within the treatment location. The tissue gathering end  14  will substantially remain in this desired position while the stabilizing end  16  is retracted. To accomplish this, the tissue gathering end  14  is unmounted or deployed from the bronchoscope  20 . In particular, the alignment element  320  is released from the bronchoscope  20 , such as by retracting the bronchoscope  20  or by advancing the deployment sleeve  311  which in turn advances the anchor strut  322  which pulls the alignment element  320  off the insertion cord tip  208 . The guidewire  313 , and optionally the deployment sleeve  311 , are held in a fixed position within the airway AW so as to maintain the elongated configuration of the treatment device  10 . Release of the alignment element  320  allows the anchor strut  322  to extend radially outwardly toward its biased configuration. Thus, the anchor strut end  321  engages with the wall W of the airway AW in an anchoring manner. In this embodiment, at least the anchor strut end  321  deforms a portion of the wall W to make purchase at the desired location. 
     The stabilizing end  16  is then retracted, as illustrated in  FIG. 48 . Here, the guide sleeve  327  and catch feature  329  has been retracted relative to the insertion cord  202 , pulling the stabilizing end  16  proximally so that the extendible midsection  18  is elongated. This allows the stabilizing end  16  to be positioned within an ostium or other stable area within the airway. The treatment device  10  is then released from the delivery system  301 . The stored elastic strain energy of the extendible midsection  18 , and optionally any stored energy in the stabilizing end  16  and/or tissue gathering end  14 , creates an urging force to recoil and shorten the treatment device  10  toward its original configuration and length. Since the strength of the airway AW is compromised, the walls W are unable to overcome this urging force. Thus, the wall W at least the point of purchase or engagement by the tissue gathering end  14  is carried with the tissue gathering end  14  toward the stabilizing end  16 . This retensions the airway distal to the treatment device  10 . By tensioning the lung tissue, the device  10  has tensioned the entire bronchial tree that is distal to this single airway which in turn expands the associated alveoli tissue. 
       FIG. 49  illustrates another embodiment of a treatment device  10 . In this embodiment, the treatment device  10  has a tissue gathering end  14  and extendible midsection  18  which is similar to the device  10  of  FIG. 39 , however in this embodiment the stabilizing end  16  differs. In this embodiment, the stabilizing end  16  is configured to resist movement relative to the lung tissue in the distal direction. The stabilizing end  16  is comprised of elastic material that is capable of storing elastic strain energy and recovering to its initial stable shape. In this embodiment, the initial shape of the stabilizing end  16 , illustrated in  FIG. 49 , comprises a plurality of loops which splay or deploy radially outwardly due to stored elastic strain energy. In this embodiment, the stabilizing end  16  comprises a body strut  331 , an extension loop  336 , a spring loop  335 , an anchor strut  334 , an actuation loop  333 , and an anchor strut end  332 . The body strut  331  is generally aligned with the longitudinal axis  19  of the device  10 . The extension loop  336  is used to tether the device  10  to the delivery device  301 . Alternatively, the delivery device may be a guidewire. The anchor strut  334  is joined with the body strut  331  by the spring loop  335  which biases the anchor strut  334  radially outward at an angle θ, such as between 5 and 90 degrees, preferably about 45 degrees. The stabilizing end  16  is strained, against its stable shape configuration, during delivery with the delivery device  301  retaining the spring loop  335  and the actuation loop  333  in a condition that is coaxial with the longitudinal axis  19 . This keeps the anchor strut end  332  from being forced against lung tissue until the user is ready to deploy the stabilizing end  16 . 
       FIG. 50  illustrates the treatment device  10  of  FIG. 49  loaded onto a delivery system  301 . In this embodiment, the delivery system  301  comprises a bronchoscope  20  (including a bronchoscope body  200  and an insertion cord  202 ), a guidewire  313 , a deployment sleeve  311  and a guide sleeve  346 . The guide sleeve  346  has a proximal end  342  and a distal end  343 . The guide sleeve  346  is position able over the insertion cord  202  of the bronchoscope  20  as shown and is able to slide longitudinally over the insertion cord  202 .  FIG. 50  illustrates the delivery system  301  advanced into lung anatomy so that the treatment device  10  has been advanced through airway A and into airway B via a bifurcation BF which also leads to airway C. The tissue gathering end  14  and stabilizing end  16  are constrained from actuating by the insertion cord  202  which is holding the alignment element  320  and the actuation loop  333  coaxial with the longitudinal axis  19 . 
       FIG. 51  illustrates deployment of the tissue gathering end  14  within airway B. In this embodiment, deployment is achieved by advancing the deployment sleeve  311  so as to contact the guide coil  319 . Additional advancement causes guide coil  319  and attached anchor strut  322  to pull the alignment element  320  off of the insertion cord tip  208  of the bronchoscope  20 . Alternatively, in other embodiments, deployment is achieved by retracting the insertion cord tip  208  while maintaining position of the deployment sleeve  311  so that the alignment element  320  is pulled off of the insertion cord tip  208 . In either situation, this releases the stored elastic strain energy in the tissue gathering end  14  driving the anchor strut end  321  into the airway wall W to anchor the distal end of the treatment device  10  at the desired location in airway B, as described previously in relation to the embodiment of  FIG. 39 . It may be appreciated that in some embodiments the alignment element  320  is configured as a structure that only partially encircles the bronchoscope shaft  202  as shown in  FIG. 51  wherein the anchor loop  320  has an opening  354  and the loop  320  is then turned back around to form a blunt partial loop termination  355 . It may be appreciated that the proximal anchor spring loop  335  and the proximal anchor actuation loop  333  may be similarly formed so as to not fully encircle the bronchoscope and still be effective. This allows for a bronchoscope or other delivery cannula or delivery device shaft, such as a guidewire, that may have diameter variation down the length to be translated to activate or unlock these anchor assemblies without actually removing the bronchoscope or delivery canula or delivery element. The proximal extension loop  336  is utilized for connection to a wire, link or tether  344  which may be pulled to move the device  10  or the stabilizing end  16  more proximally so as to extend the length of the midsection  18  while the device  10  is anchored into the lung tissue. The tissue gathering end  14  is configured to resist moving proximally in relation to the airway wall W, but it is configured to easily be moved more distally relative to the airway wall W. The stabilizing end  16  is configured to resist being advanced distally in relation to the airway wall W but it is configured to be able to be moved proximally relative to the airway wall W thereby extending the midsection  18 . 
     The midsection  18  is extended, as illustrated in  FIG. 52 . In some embodiments, such extension is achieved by retracting the guide sleeve  346  which has a tether  344  extending therethrough. The tether  344  is removably attached to the extension loop  336  of the device  10 , as mentioned previously. Retraction of the guide sleeve  346  pulls the tether  344  which in turn pulls the stabilizing end  16  of the device  10 . In other embodiments, the guide sleeve  346  remains in place and the tether  344  is retracted into or through the guide sleeve  346 . In some embodiments, this is achieved by pulling a handle  351  which is attached to the tether  344 .  FIG. 52  illustrates an embodiment of such a handle  351 . Here, the handle  351  comprises a shaft  353  having a hole  352  therethrough. The tether  344  has two free ends which extend through or along the guide sleeve  346 , exiting the proximal end  342  of the guide sleeve  346 . The free ends wrap around the shaft  353  of the handle  351  and through the hole  352  to increase traction and efficiency when pulling the tether  344 . Thus, as the handle  351  is pulled away from the patient, the tether  344  is tensioned and pulls on the extension loop  336  of the device  10 . By tensioning the tether  344 , the tether  344 , treatment device  10  and airway wall W become a tensile member which straightens the tether  344 , the treatment device  10  and the airway wall W. 
     The pulling force is translated through the device  10  to the tissue gathering end  14 . If the tissue gathering end  14  is anchored in stable lung tissue, the tissue gathering end  14  will remain in place and the midsection  18  will expand longitudinally as the stabilizing end  16  moves in the proximal direction. If the tissue gathering end  14  is anchored in unstable or weakened lung tissue, the tissue gathering end  14  will pull the weakened airway wall W along with it in the proximal direction as the stabilizing end  16  moves in the proximal direction. This will continue until stronger lung tissue is reached wherein the tissue gathering end  14  will cease movement and the midsection  18  will expand longitudinally as the stabilizing end  16  moves in the proximal direction. The midsection  18  is extended until the stabilizing end  16  is desirably positioned within the airway. The stabilizing end  16  is then released and anchored in place. 
       FIG. 53  illustrates anchoring of the stabilizing end  16  within the airway B, just beyond the branch to airway C. This is achieved by retracting the bronchoscope  20  from the device  10 . Such retraction releases the spring loop  335  of the device  10 . As mentioned previously, the spring loop  335  joins the body strut  331  with the anchor strut  334  which is biased radially outward. Thus, release of the spring loop  335  allows the anchor strut  334  to extend radially outwardly, toward the airway wall W, such as shown. The anchor strut end  332  engages the airway wall W, anchoring the stabilizing end  16  in place. 
       FIG. 54  illustrates the treatment device  10  after the tether  344  has been cut and removed. Removal of the pulling force from the tether  344  allows the midsection  18  to recoil toward its natural configuration over time. Since the stabilizing end  16  and the tissue gathering end  14  are engaged with the airway walls W, the engaged portions of the airway walls W travel along with the ends  14 ,  16 . In some embodiments, both ends  14 ,  16  travel toward each other as the longitudinal length of the midsection  18  shortens. Thus, the lung tissue along the airway between the ends  14 ,  16  becomes minimally compressed, as illustrated in  FIG. 54 , and the volume of the lung along the airway B becomes minimally reduced. The airway between the ends  14 ,  16  is supported by the helical structure of the midsection  18 , acting as a stent to keep the airway patent. Thus, COPD symptoms are reduced rather than increased, which is the result when the airways are compressed without internal support, exasperating the original problem in the lung particularly during expiration breathing cycles. In addition, the more proximal airway A structure and the proximal end of airway B structure is now stronger and provides a better foundation and base to stabilize lung tissue and lung treatment devices than the distal end of airway B. 
     It may be appreciated that in some embodiments the ends  14 ,  16  travel equal distance toward the center of the midsection  18 . In other embodiments, the ends  14 ,  16  travel differing distances, such as influenced by the stability of the portions of the airway wall W engaged by the ends  14 ,  16 . For example, the stabilizing end  16  is typically positioned more proximally than the tissue gathering end  14 , within a portion of the airway that is stronger and more stable. In such instances, the stabilizing end  16  would travel a smaller distance than the tissue gathering end  14  which is engaged with weaker tissue. It may also be appreciated that in some embodiments, only one of the ends  14 ,  16  moves while the other remains stationary. In such instances, typically the tissue gathering end  14  moves toward the stabilizing end  16 . However, the outcome would vary depending on the characteristics of the airway and the treatment device  10 . It may also be appreciated that as the health of the patient changes over time, such as a progression of the disease state, the device  10  will continue to shorten so as to maintain tension in the lung. 
       FIG. 55  illustrates the elastic recoil of the treatment device  10  causing midsection  18  shortening as has been previously discussed.  FIG. 55  also illustrates the branching of the distal portion of airway B into an attached network of airways D, E (F is the cross-section of the distal portion of airway B). The airways B, D, E that are longitudinally tensioned and affected by the deployment, elongation and tensioning of the treatment device  10 . The distal portion of airway B is shown to be supported and made to remain round and patent as the patient successfully expires air as connective tissue between the distal airways D and E connect to the distal portion of airway B to hold the distal portion of airway B more open and round (as shown in F) as tension is applied to the entire lung airway system. By tensioning the lung tissue to support the airway tree A, B, C, D, and E in tension, the symptoms listed herein are reduced and one or more of the physiologic changes that are listed in herein are changed to beneficially affect and treat COPD patients who may suffer from emphysema.  FIG. 56  illustrates an alternative method to treating the patient wherein the device  10  is deployed in the lung anatomy and then expanded thereafter. In this embodiment, the treatment device  10  is similar to that of  FIG. 49  and is deployable by a delivery device  301  into an airway of the lung. In this embodiment, the device  10  is partially deployed according to  FIGS. 50-51 , wherein the tissue engaging end  14  is deployed and engaged with the airway wall W. However, in this embodiment, the stabilizing end  16  is also deployed without extending the midsection  18 . This may be achieved by retracting the bronchoscope  20  while the guide sleeve  346  is held against the stabilizing end  16  so that the stabilizing end  16  is released and deployed. Thus, the device  10  is deployed into the airway in a substantially relaxed configuration, as illustrated in  FIG. 56 . 
     The device  10  maintains connection with the tether  344  which extends through or along the guide sleeve  346 . It may be appreciated that the configuration of the tissue gathering end  14  and its engagement with the wall W creates resistance to movement of the device  10  along the airway in the proximal direction. In particular, the anchor strut  322  extends radially outwardly from the longitudinal axis  19  forming an angle θ which faces the proximal direction or midsection  18 . Likewise, anchor strut end  321  faces the proximal direction or midsection  18  as it engages the wall W. This creates an indent in the wall W and a tissue ledge which impedes movement of the anchor strut end  321  along the wall W in the proximal direction. Likewise, the configuration of the stabilizing end  16  and its engagement with the wall W creates resistance to movement of the device  10  along the airway in the distal direction. In particular, the anchor strut  334  extends radially outwardly from the longitudinal axis  19  forming an angle θ which faces the distal direction or midsection  18 . Likewise, anchor strut end  332  faces the distal direction or midsection  18  as it engages the wall W. This creates an indent in the wall W and a tissue ledge which impedes movement of the anchor strut end  332  along the wall W in the distal direction. However, it may be appreciated that either or both of the tissue gathering end  14  and stabilizing end  16  are able to move along the airway away from the midsection  18 . In this embodiment, the stabilizing end  16  is tethered to the delivery device  301 , particularly the guide sleeve  346 . Therefore, the stabilizing end  16  is able to be pulled in the proximal direction by pulling the tether  344 . However, the tissue gathering end  14  resists movement along the wall W in the proximal direction at least due to the tissue ledge impeding the anchor strut end  321 . If the wall W is weak, the wall W itself moves in the proximal direction, being pulled by the anchor strut end  321 . This continues until a stronger portion of the wall W is reached which is able to resist longitudinal compression. At that point, the tissue gathering end  14  anchors in place and the midsection  18  expands, increasing the overall longitudinal length of the device  10 . This continues incrementally as the stabilizing end  16  is pulled along the airway. At any time, pulling may cease and the stabilizing end  16  remains engaged at the new location along the wall W due to resistance in the distal direction at least due to the tissue ledge impeding the anchor strut end  332 . Such extension of the midsection  18  stores elastic strain energy in the device  10 . Since the wall W has compressed and adjusted during positioning of the stabilizing end  16 , the device  10  will likely maintain its length and position upon release of pulling force. However, over time, the stored elastic strain energy may cause the midsection to contract, along with movement of the tissue gathering end  14  and/or stabilizing end  16  toward the midsection  18 . 
     It may be appreciated that such capability may allow the length of the device  10  to be adjusted throughout the procedure to achieve the desired re-tensioning of the airway. Once this has been achieved, the tether  344  is removed along with the delivery device  301 . It may be appreciated that in some embodiments the device  10  may be re-accessed and repositioned. This may be achieved by re-tethering or re-connecting a device, such as a delivery device  301 , to the stabilizing end  16  and further pulling the stabilizing end so as to position the stabilizing end  16  at a new more proximal location. This pulling motion further tensions the airway. Again, once the desired effect has been achieved, the delivery device  301  is removed leaving the device  10  in place. 
     It may be appreciated that the pulmonary treatment devices  10  may be removed from the lung anatomy either during the procedure, for repositioning or replacement, or at a later time during a secondary procedure. Removal may be achieved by threading a delivery device through the appropriate portions of the device  10 , such as through the actuation loop  333  and/or alignment element  320 , so as to re-engage the device  10 . The device  10  is then pulled proximally by the delivery device and extracted from the body. It may also be appreciated that the device  10  may be pulled from the anatomy by attachment to any suitable portion, such as the stabilizing end  16 , and applying sufficient force in the proximal direction to withdraw the device  10 . The same device  10  can then be sanitized and reloaded on the delivery device for re-delivery to the target treatment area or a new device  10  may be utilized. 
     Likewise, it may be appreciated that previously positioned devices  10  may be adjusted at a later time during a secondary procedure. This may be achieved by accessing a previously positioned device  10  with a delivery device and attaching thereto. This can be achieved by threading a delivery device through the appropriate portions of the device  10 , such as through the actuation loop  333  and/or alignment element  320 , so as to re-engage the device  10 . Typically, the actuation loop  333  is re-engaged so as to attach to the stabilizing end  16  of the device  10 . Or, the stabilizing end  16  is grasped such as with the use of a catch feature  329 . In such instances, the stabilizing end  16  is pulled proximally so as to further re-tension the airway AW. This may be desired if the disease has progressed over time beyond the ability of the device  10  to compensate. The stabilizing end  16  is then secured in a new location to maintain the re-tensioning. The delivery device is then disengaged from the pulmonary treatment device  10  which is left behind as an implant. 
     It may be appreciated that a variety of approaches have been described herein, including treatment devices  10  which are introduced through a lumen in a delivery device (including being pushed or pulled through the lumen by itself, within an introducer or mounted on an additional device such as a catheter or guidewire which is advanceable within the lumen), and treatment devices  10  which are introduced by mounting on an exterior portion of a delivery device, such as the insertion cord tip  208  of a bronchoscope  20  or on a catheter, wherein the treatment device  10  is pushed or pulled from the mounted position by an external or internal sleeve or device. It may be appreciated that in some embodiments the treatment device  10  is deployed as it is released from the delivery device and in other embodiments, the treatment device  10  is released from the delivery device and then deployed, such as by the removal of an element or device which holds the treatment device  10  in a constrained configuration (e.g. a guidewire or sleeve). It may be appreciated that in some embodiments, a single treatment device  10  is deliverable from a delivery device at a time and in other embodiments multiple treatment devices  10  (including two, three, four, five, six or more) are deliverable from the delivery device at a time. It may be appreciated that the treatment devices  10  may be pre-loaded on or within the delivery device or may be loaded by the user. It may also be appreciated that in some embodiments the tissue gathering end  14  is anchored initially in the lung passageway and the stabilizing end  16  is pulled so as to re-tension the airway. In other embodiments, the stabilizing end  16  is anchored initially in the lung passageway and the tissue gathering end  14  is pushed so as to re-tension the airway. It may be appreciated that pulling of the stabilizing end  16  or pushing of the tissue gathering end  14  may be achieved while the end  14 ,  16  is held in a contracted state for ease of movement or after the end  14 ,  16  has been deployed (wherein the end  14 , 16  has been specially designed to allow such movement). 
       FIG. 57  illustrates another embodiment of a treatment device  10 . In this embodiment, the treatment device  10  is optionally introduce able through a lumen in a delivery device. Thus, it is collapsible into a small profile. It is held in the collapsed or constrained configuration by the use of a catheter or guidewire which holds the treatment device  10  in the constrained configuration. In some embodiments, a guidewire is preferred due to its small diameter and ability to be advanced into distant branches of the lung passageways. Once the treatment device  10  is desirably positioned within the lung passageway, the guidewire is removed, thereby allowing the device  10  to deploy either at once or in stages. 
       FIG. 57  illustrates the treatment device  10  in its deployed or expanded state. In this embodiment, the treatment device  10  has a tissue gathering end  14 , unextendible midsection  18  and a stabilizing end  16 . The treatment device  10  may have a single component structure or may be comprised of a number of components. In any case, individual stiffnesses of the tissue gathering end  14 , extendible midsection  18  and stabilizing end  16  may be tuned to maximize effectiveness of both anchoring and supporting likeness to healthy lung tissue. Likewise, the tissue gathering end  14  and stabilizing end  16  are flexible so as to collapse along longitudinal axis  19  and deploy or expand to the relaxed configuration shown in  FIG. 57 . Such expansion is typically achieved by self-expansion due to spring loading. 
       FIG. 58  illustrates the treatment device  10  of  FIG. 57  in a collapsed configuration. Here, the device  10  is mounted on a guidewire  313 . Thus, each of the tissue gathering end  14 , midsection  18  and stabilizing end  16  form at least one loop or partial loop through which the guidewire  313  is passable so that the treatment device  10  is mountable on the guidewire  313  and the tissue gathering end  14  and stabilizing end  16  are held in a constrained configuration (storing elastic strain energy). In this collapsed or constrained configuration, the guidewire  313  and treatment device  10  are passable through a lumen in a delivery device, such as a working channel  210  of a bronchoscope  20 . In some embodiments, the guidewire  313  and treatment device  10  are passable through a working channel  210  having an inner diameter that is sized between 1.3 and 3.2 mm. In this embodiment, the extendible midsection  18  comprises a coil wherein the guidewire  313  is passable therethrough. Thus, the extendible midsection  18  is able to be elongated to store elastic strain energy which urges the treatment device  10  to recover back to a non-elongated length. In some embodiments, the midsection  18  has a uniform diameter. However, in other embodiments, the midsection  18  has a tapering diameter, particularly tapering downward toward the stabilizing end  14  of the treatment device  10 . Such tapering may mimic the tapering diameter of a lung passageway within which the device  10  is implanted. 
     As more easily visualized in  FIG. 58 , the tissue gathering end  14  comprises a body strut  323 , a guide element  319 , an anchor strut  322 , an alignment element  320  and an anchor strut end  321 . In this embodiment, the body strut  323  extends from the flexible midsection  18  and is generally parallel to the longitudinal axis  19 . The body strut  323  is connected with a guide element  319  which typically forms the distal-most portion of the treatment device  10 . In this embodiment, the guide element  319  comprises a coil, however the element  319  may have any suitable shape including a single loop. In this embodiment, the guide element  319  is arranged so that the guidewire  313  coaxially passes through the guide element  319 . The guide element  319  also stores the strain energy which allows the anchor strut  322  to deploy and extend outwardly. In some instances, the coil dictates the strength of the spreading force of the anchor strut  322  radially outwardly. During delivery and prior to deployment, the anchor strut  322  is held in a retracted or un-extended position so as to avoid dragging along the airway walls W or traumatizing tissue. Such retraction is maintained by alignment element  320 . In this embodiment, the alignment element  320  has the form of a coil, however it may be appreciated that the element  320  may have the form of a single loop, a partial loop or snap locking structure, a hook shaped lock or spring lock mechanism, to name a few. When the center of the element  320  is aligned with the longitudinal axis  19 , the anchor strut  322  is held parallel to or at a small angle in relation to the longitudinal axis  19 . Such alignment is maintained by passing the guidewire  313  or similar device through the center of the treatment device  10  and through the alignment element  320  (as illustrated in  FIG. 58 ). The tissue gathering end  14  is configured so as to bias the alignment element  320  and attached anchor strut  322  radially outwardly. Therefore, withdrawal of guidewire  313  from the alignment element  320  frees the alignment element  320  and allows the alignment element  320  to rotate away from alignment with the longitudinal axis  19 . This, in turn, causes the anchor strut  322  to extend radially outwardly. In some embodiments, the anchor strut  322  extends 1 mm to more than 30 mm but 6-12 mm is preferable. The anchor strut  322  terminates in an anchor strut end  321 , which may have a variety of shapes including a coil, ball, sharp end barb, L shaped pad, strain relief long coil or tapered coil, to name a few. The anchor strut  322  is configured to extend radially outwardly upon deployment so at least the anchor strut end  321  engages an airway wall W or damaged tissue DT, such as in the area of the alveolar sacs. However, in some instances, the anchor strut  322  itself additionally engages the airway wall W or damaged tissue DT. 
     In the extended position, the alignment element  320  has an axis which is at an angle θ to the longitudinal axis  19 . Typically, the angle θ is in the range of 1 to 90 degrees, preferably 20-65 degrees. In some embodiments, additional portions of the tissue gathering end  14  are also biased to assist in extension of the anchor strut  322  radially outwardly. For example, in some embodiments, the body strut  323  is biased so as to further extend the anchor strut  322  radially outwardly. In the embodiment of  FIG. 39 , the body strut  323  is disposed opposite the anchor strut  322  so that the alignment element  320  is disposed therebetween. Thus, when the center of the alignment element  320  is aligned with the longitudinal axis  19 , the body strut  323  and anchor strut  322  reside on opposite sides of the longitudinal axis  19 . In some instances, release of the alignment element  320  allows both the body strut  323  and anchor strut  322  to bias toward their relaxed configurations (such as pushing both the body strut  323  and anchor strut  322  outwardly in the same radial direction). This can allow the body strut  323  and anchor strut  322  to spread fully elastically at least 5 degrees but up to 90 degrees, and preferably 20 to 65 degrees, to push the anchor strut end  321  into or through the wall of an airway or the diseased tissue to anchor the tissue gathering end  14  in the lung tissue. 
     In this embodiment, the stabilizing end  16  comprises a body strut  331 , a spring loop  335 , an extension loop  336 , an anchor strut  334 , an actuation loop  333 , and an anchor strut end  332 . The body strut  331  and spring loop  335  are generally aligned with the longitudinal axis  19  of the device  10  in both the relaxed and constrained configurations. The anchor strut  334  is joined with the body strut  331  by the spring loop  335  which biases the anchor strut  334  radially outward at an angle θ, such as between 5 and 90 degrees, preferably about 45 degrees. The spring loop  335  also allows the anchor strut  334  to be moved toward the longitudinal axis  19  so that the actuation loop  333  is aligned coaxially with the longitudinal axis  19  for passage of the guidewire  313  therethrough. This keeps the anchor strut end  332  from being forced against lung tissue until the user is ready to deploy the stabilizing end  16 . 
     Referring again to  FIG. 58 , the treatment device  10  of  FIG. 57  is shown loaded onto a guidewire  313 . In this embodiment, the delivery system comprises the guidewire  313 , a pusher coil  370  and a tether  344  that is looped, tied, attached (such as with a hitch knot) or otherwise removably attached to the pulmonary treatment device  10 , such as to extension loop  336 . The pusher coil  370  has a proximal end  372  and a distal end  373 . The coil shape allows the pusher coil  370  to bend and flex easily through the anatomy. The pusher coil  370  Is typically comprised of a metal material to assist in cleaning and steam sterilization however other materials may be used such as polymers. The pusher coil  370  is positionable over the guidewire  313 , proximal to the treatment device  10 , as shown, and is able to slide longitudinally over the guidewire  313 . To deploy the treatment device  10 , the pusher coil  370  is advanced over the guidewire  313  so as to push the treatment device  10  in the distal direction while the guidewire  313  remains in place. Consequently, the treatment device  10  is pushed off of the guidewire  313  wherein it deploys to its relaxed and expanded configuration. This may be achieved in stages or all at once. For example, in some embodiments, the tissue gathering end  14  is pushed off the distal end of the guidewire  313  with the use of the pusher coil  370  so that the anchor strut  322  expands and at least the anchor strut end  321  engages the lung passageway wall. This is achieved while the remainder of the treatment device  10  remains mounted on the guidewire  313 . The proximal end of the treatment device  10  is then pulled in the proximal direction by applying pulling force to the tether  344 . Since the tissue anchoring end  14  is anchored in the lung passageway, the lung passageway is pulled proximally, re-tensioning the airway, while the midsection  18  also expands. Once airway is desirably re-tensioned, the stabilizing end  16  is deployed by advancing the pusher coil  370 , thereby pushing the stabilizing end  16  off of the guidewire  313 . This allows the stabilizing end  16  to anchor in place. The guidewire  313  and pusher coil  370  are then removed from the patient. In addition, the tether  344  is removed from the treatment device  10 . 
     It may be appreciated that the delivery system of  FIG. 58  and treatment device  10  mounted thereon may be passed through a lumen of a scope or other instrument, particularly through a working lumen of a bronchoscope  20 . Or, the delivery system of  FIG. 58  and treatment device  10  mounted thereon can be advanced through the trachea and into the lung by itself, without the use of a bronchoscope. 
     Torque-Based Pulmonary Treatment Device Embodiments 
     Torque-Based Treatment Overview 
     The above described embodiments rely primarily on linear or curvilinear pulling and pushing of lung tissue to re-tension the lung in patients suffering from COPD, particularly advanced COPD where tissue is highly damaged. Here, methods and devices are provided which rely primarily on torque, twisting and rotation to re-tension the lung, optionally in addition to linear or curvilinear pulling and pushing. Such embodiments are particularly suitable for patients with advanced emphysema, such as patients who are diagnosed as GOLD stage II, III, and IV, where the lung contains highly damaged tissue, particularly into and well beyond the lobar airways and typically beyond the bifurcations that lead to regions of the lung that would normally contain the 3rd generation airways or more distal generations of airways in a healthy person. Lung airways and bronchi are comprised of smooth muscle, submucosa, mucosa, connective tissue made of collagen, a subepithelial basement membrane and epithelium. Among other things, the COPD disease progresses to allow enzymes to dissolve bronchi, airway components and complete airways. The disease also destroys elastin in tissue that survives the enzymatic bulk reduction of airways and lung tissue. Late stage Emphysema patient lungs are compromised to the point that these patients commonly communicate gases through paths or passageways that are largely without airways. In these areas of damaged tissue, large portions of parenchyma are often loose or missing, forming coalesced blebs and bullae. Thus, normal lung passageways with supportive walls are typically not available, and any existing tissue is sponge-like. These pulmonary treatment devices and methods consider the vast tissue damage of advanced COPD sufferers and are designed specifically to treat these patients. It may be appreciated that although the previously described pulmonary treatment devices rely primarily on linear or curvilinear pulling and pushing of lung tissue to treat the lung, particular embodiments may also be used to apply torque to the lung tissue in such treatment. 
       FIG. 59A  illustrates an example of a torque-based pulmonary treatment device  400  and  FIG. 59B  illustrates the treatment device  400  deployed into a lung L. Referring to  FIG. 59A , in this embodiment the device  400  comprises a tissue gathering element  402  and an anchoring element  404 , both of which join with an attachment end  406 . The attachment end  406  may be used to attach a delivery device thereto, such as a torqueing tool  408 . Thus, the attachment end  406  typically has a non-round cross-section shape, such as a square, rectangular, polygonal or oval shape, to assist in maintaining rotational torque coupling and torque transmission during rotational or torqueing motion of the torqueing tool  408 . It may be appreciated that in some embodiments the attachment end  406  is formed from portions of the tissue gathering element  402  and anchoring element  404  themselves, such the joining of their respective proximal ends. In other embodiments, the attachment end  406  includes an attachment element  410  to assist in joining the elements  402 ,  404  and forming a desired shape for attachment and torqueing. And yet in other embodiments, the attachment end  406  resides at the proximal end of the tissue gathering element  402  or the anchoring element  404  and the elements  402 ,  404  are joined to each other distally of the attachment end  406 . 
     In this embodiment, the tissue gathering element  402  is comprised of a shaft  412  extending in a first direction from the attachment end  406  and then bending laterally outwardly in a second direction to form a circular, inwardly spiraled shape. The shaft  412  may reside in a single plane (e.g. x-y plane) or may pass through additional planes throughout the spiral shape (e.g. in the z direction) so that portions of the shaft  412  reside out of the x-y plane. Typically, the tissue gathering element  402  has a shape which is approximately 0.25 to 3 inches in diameter, preferably approximately 0.5 to 1.5 inches in diameter. In this embodiment, the shaft  412  is comprised of wire, such as metal (e.g. nitinol, austenite or martensite nitinol, spring steel, stainless steel, cobalt steel alloys, titanium etc.) or polymeric compounds, ceramic, carbon fiber and/or other biocompatible materials. Such wire is typically extruded, drawn or sintered into near net shapes or wire form shapes, wherein the wire has a constant diameter between 0.005 inches up to 0.200 inches but preferably round wire between 0.013 and 0.070 inches in diameter or ribbon wire that is 0.005 to 0.040 inches thick and 0.010 to 0.100 wide. The ribbon width or thickness may be different at the distal tissue gathering element  402  as compared to the proximal anchoring element  404 . In some embodiments, the distal tissue gathering element  402  is made from ribbon that is 0.015 to 0.030 inches thick and 0.045 to 0.080 inches wide while the and the proximal anchoring element  404  is made from ribbon that is 0.010 to 0.030 inches thick and 0.010 to 0.030 wide. In some embodiments, the shaft  412  is comprised of a single wire and in other embodiments, the shaft  412  is comprised of more than one wire (such as twisted together) and/or includes additional features and/or elements to increase its diameter and/or increase its ability to gather lung tissue, as will be described in later sections. It may be appreciated that the one or more wires may have any suitable cross-sectional shape including round, oval, square, rectangular, etc. Further, the one or more wires may have a cross-sectional shape which changes along the length of the shaft  412 . Likewise, the one or more wires may be made from tapered wire or wire that varies in diameter at different locations along the tissue gathering element  402 . It may be appreciated that the tissue gathering element  402  may be comprised of any combination of these materials and geometries. In other embodiments, the shaft  412  includes additional features and/or elements to increase its diameter and/or increase its ability to gather lung L tissue, as will be described in later sections. 
     In this embodiment, the anchoring element  404  is comprised of a shaft  412  which extends from the attachment end  406 , as shown in  FIG. 59A , in the same direction as the tissue gathering element  402 , generally along a longitudinal axis  411 . In this embodiment, the shaft  420  of the anchoring element  404  bows outwardly, away from the longitudinal axis  411  and tissue gathering element  404 , such as to form the shape of a bifurcation. This bifurcation typically mimics the bifurcations found in the airway network branches from the trachea through the various portions of the lung L. In some embodiments, this aspect allows the anchoring element  404  to anchor the device  400  in the lung anatomy. 
     Referring to  FIG. 59B , the treatment device  400  is sized and configured to be delivered through a delivery device which is insertable into the lung L, such as a steerable scope (e.g. bronchoscope  20 ). In this embodiment, the device  400  is loaded within a catheter  430  or similar delivery device which is advanceable through a lumen in the bronchoscope  20 . During such advancement, the device  400  is constrained within the catheter  430  to allow for ease of movement. In this embodiment, such constraint is achieved by retraction of the device  400  of  FIG. 59A  into a lumen in the catheter  430  so that the anchoring element  404  and tissue gathering element  402  are drawn together and the tissue gathering element  402  is uncoiled and straightened. The device  400  remains within the catheter  430  until the distal tip of the catheter  430  is desirably positioned within the lung L. 
     In some embodiments, the distal tip of the catheter  430  is advanced beyond the distal tip of the bronchoscope  20 . This allows the catheter  430  to reach locations that are beyond the reach of the bronchoscope  20  due to size constraints (i.e. the smaller diameter of the catheter  430  can pass through small diameter or contorted passageways that the larger diameter bronchoscope is restricted from entering). Thus, in some instances, the catheter  430  is able to reach far distal portions of the lung L, such as the apical portions of the upper lobes and the lateral corners of the lower lobes, which are typically unreachable by the bronchoscope alone. 
     In some embodiments, the catheter  430  is advanced with the use of a guidewire. This may be within an airway or beyond the natural airways into damaged tissue, parenchyma, alveoli, artificially created passageways or other types of lung tissue. In such instances, the device  400  is not pre-loaded into the catheter  430 , rather the device  400  is inserted at a later time once the catheter  430  is desirably positioned. This is because the guidewire typically fills the catheter lumen. The guidewire fills the catheter lumen so as to minimize digging of the catheter leading edge into tissue during advancement and to provide a flexible, blunt, atraumatic tip. The guidewire then acts as a rail or support shaft to further advance the catheter  430 . Alternating advancement of the guidewire and catheter in blood vessels is known as the Seldinger Wire Technique. In some embodiments, the guidewire and catheter  430  are advanced within the lung using a modified Seldinger Wire Technique. It may be appreciated that when using a guidewire, the delivery system components may be configured to be delivered Over-The-Wire (OTW) or Rapid Exchange (RX). In an OTW design, the guidewire exits the delivery system at its proximal end so that the guidewire that tracks along the full length of the delivery device. In contrast, in the RX design, the guidewire exits the delivery system at a side port. Thus, the guidewire only tracks along a short section (about 25 cm) of the delivery device and then exists at the side port. This design saves time compared with advancing a guidewire through the full length of the delivery device. 
     It may be appreciated that the guidewire is configured to be compatible with advancement within lung tissue, particularly to contact lung tissue with minimal or no incident or injury. In some embodiments, the guidewire is comprised of a wire cable, wire bundles, continuous braid, twisted wire, or twisted wire bundle shaft structure with blunt tip (typically formed by crimping, gluing or welding the tip of the guidewire shaft structure). In some embodiments, the guidewire has a diameter in a range of 0.005 to 0.100 inches, preferably in a range of 0.018 to 0.070 inches. Typically, the guidewire fills the catheter lumen in a way that presents no gaps or very minimal gapping while the guidewire is curved or bent during delivery. In some embodiments, the guidewire is configured so that no portion of the guidewire which contacts tissue creates a gap which opens more than 0.030 inches, preferably in a range of 0 and 0.020 inches during bending around a radius that is 0.5 inches or smaller, to minimize catching tissue in the gaps. This is in contrast to conventional vascular guidewires made with a central core wire and a coiled spring outer jacket. When such vascular guidewires are used in the lung, the adjacent coils in the coil spring jacket tend to separate more than 0.030 inches which creates gaps that allow lung tissue to intrude and be caught during bending through lung passageways. Thus, when the vascular guidewire is retracted, the pulling/withdrawing motion straightens the wire and closes the gaps more than 0.001 inches smaller which causes the lung tissue to be pinched or caught in the coil spring jacket. Such outcomes are avoided with the specially configured guidewire embodiments described herein. 
     Once the distal tip of the catheter  430  is positioned near a target location for placement of the treatment device  400 , the device  400  is deployed. If a guidewire was used, the guidewire is removed and the device  400  is inserted and advanced through the catheter  430  using a pusher, cable, or link, such as torqueing tool  408 . In some embodiments, the torqueing tool  408  is attachable to the device  400  near the attachment end  406 , and in other embodiments the torqueing tool  408  is attachable at a location between the tissue gathering element  402  and the attachment end  406 . 
     Deployment from the catheter  430  may be achieved by a variety of methods or a combination of multiple methods. In some embodiments, the device  400  is self-expanding. In such instances, the catheter  430  may be retracted to expose the device  400 . Once exposed, the device  400  self-expands, tending toward its pre-formed or natural configuration. Alternatively, the device  400  may be advanced beyond the distal tip of the catheter  430  allowing self-expansion, again due to release of tension or compression. In either case, the self-expanding device  400  is recovered to a programmed or pre-bent curved shape. When the device  400  is comprised of nitinol, the super-elastic or pseudo-elastic properties of nitinol force the curved shape to recover. When the device  400  is comprised of a memory shape alloy, the heat energy provided by the body temperature of the patient causes the device  400  to resume a pre-programmed curved shape. In other embodiments, the device  400  is not self-expanding. For example, in some embodiments the tissue gathering element  402  is bent into a deployed shape within the lung L by the user or the tissue gathering element is actuated into a deployed shape by use of a mechanical mechanism, such as a mechanism that bows the tissue gathering element  402  (e.g. by retracting a suture that is attached to the distal most tip of the tissue gathering element  402 ). 
     Deployment allows the distal tip of the tissue gathering element  402  to engage the surrounding tissue, curving through and/or against the tissue. Such deployment may be in an airway or beyond the natural airways into damaged tissue, parenchyma, alveoli, artificially created passageways, disease created passageways or other types of lung tissue. It may be appreciated that the distal tip of the tissue gathering element  402  may be sharp or blunt, including a ball tip or other shapes. The ability to pierce the tissue may be due to a combination of factors, including tissue type, tissue condition and tip shape, to name a few. Thus, in some embodiments, the tissue gathering element  402  pierces through lung tissue during deployment from the catheter  430  and in other embodiments the tissue gathering element  402  deploys within the tissue without piercing. And, in some embodiments, the tissue gathering element  402  pierces some tissue and not other tissue. In any case, the deployed tissue gathering element  402  has an expanded configuration within the lung L. 
     The device  400  is then rotated, as illustrated in  FIG. 60 . Rotation is achieved by applying torqueing, twisting or rotational force to at least a portion of the device  400  with the use of the torqueing tool  408  or other such device. In some embodiments, the torqueing tool  408  includes a handle  435  which is graspable by a user so as to manually applying the rotational force. Since the torqueing tool  408  is attached to the device  400 , the device  400  (and therefore tissue gathering element  402 ) rotates as well. The arrows indicating rotation of the proximal and distal end of the torqueing tool  408  in  FIG. 60  indicate that the torqueing tool  408  may be rotated both clock-wise or counter clock-wise directions. This gathers up the surrounding lung tissue onto and around the tissue gathering element  402  as the element  402  rotates, such as like twisting a fork in spaghetti to gather the spaghetti onto the fork. Thus, loose parenchyma, portions of blebs and bullae, damaged alveolar sacs and other distended, slackened or stretched tissue is pulled inwardly, twisted and/or gathered up by the tissue gathering element  402 . Rotation continues, gathering the loose, slackened tissue, until tension is achieved in the tissue. With each additional rotation, the lung tissue will be increasingly strained or tensioned. Likewise, the diameter of tissue that is spooled up around the tissue gathering element  402  will grow to further improve the effectiveness of the device  400 . In some instances, as lung parenchyma is gathered around the tissue gathering element  402 , it is compressed around the tissue gathering element  402  and/or compressed between layers of tissue that is wrapped around the tissue gathering element  402 . It may be appreciated that the device  400  may be effective at gathering, tensioning or compressing lung tissue even if there is no compression of tissue or lung volume reduction that is performed within the center of the distal tissue gathering element  402  or within coils of a helix shape. 
     Recall, it is the inward pulling tension of the lung tissue that lifts the diaphragm and is balanced by the outward recoil pressure or outward pulling of the chest wall. The lung is suspended in an expanded state due to negative pressure or vacuum between the chest wall and the exterior lining of the lung. This vacuum keeps the lung expanded and pinned to the chest wall. Because the lungs are held in a generally expanded state, applying torque with the device  400  in the interior of the lung L stresses and tensions diseased lung tissue (restoring lung elastic resistance to elongation, commonly referred to as lung elastic recoil). This tension, throughout the lung, pulls radially outward on the airways to hold these airways open and the tension helps to allow air to be squeezed out of the lungs during the expiration breathing cycle. Thus, the tissue gathering element  402  is rotated until re-tensioning of the lung is achieved to mimic the natural, healthy state of the lung. 
     In some embodiments, the device  400  is rotationally rigid so that rotational force that is applied to by the torqueing tool  408  is transmitted directly to the lung tissue. However, in other embodiments, at least a portion of the device  400  is designed to be intentionally less torque transmissive. This allows the portion to twist more easily so as to store rotational energy within the structure of the device  400 . In some embodiments, the proximal end of the device  400  is rotatable up to 1000 degrees more than the tissue gathering element  402 , preferably up to 720 degrees more than the tissue gathering element  402 . In some embodiments, the tissue gathering element  402  and/or other portions of the device  400  are torqued sufficiently to be distorted and strained in a way that stores elastic spring energy. By storing this potential elastic energy using torque forces (e.g. rotation and twisting), the resulting lung tissue tensioning and lung elastic recoil restoration effects may be prolonged because chronic tensioning force is maintained on the lung tissue even if continued effects from the disease allow the tissue to elongate over time. As the tissue elongates, portions of the device  400  may be allowed to incrementally recover a small amount over a time period of months or years in a rotational recovery or strain relaxing orientation. However, if sufficient elastic strain energy is stored in the device  400 , some residual chronic tension and restoration of lung elastic recoil will be maintained throughout this period and possibly for the remainder of the patient&#39;s lifetime. Thus, the stored elastic strain energy in the device  400  enhances the acute and chronic benefits to the patient. For example, the stored elastic strain energy provides chronic tension that is maintained even if the lung tissue continues to degrade and elongate. Thus, the stored rotational strain energy continues to provide benefit to the patient over time as the patient progresses with complications relating to COPD, even as the lung tissue slowly elongates into the future. In some embodiments, this time period is up to 10 years or up to a lifetime, but even a period of 3 years is considered a very acceptable time period. 
     Once the lung L is desirably re-tensioned, the device  400  is anchored to maintain the rotated arrangement. This is achieved by deployment of the anchoring element  404 . In this embodiment, the anchoring element  404  is comprised of a shaft  420  which extends from the attachment end  406  in the same direction as the tissue gathering element  402 , generally along a longitudinal axis  411 . Thus, upon deployment, the shaft  420  of the anchoring element  420  bows outwardly, away from the longitudinal axis  411  and tissue gathering element  420 , such as to form the shape of a bifurcation. The anchoring element  404  is then advanced into an adjacent or nearby airway, as illustrated in  FIG. 61 . In some embodiments, deployment is achieved by retracting the catheter  430  to expose the anchoring element  404 , thereby allowing its deployment. Thus, the catheter  430  and device  400  are positioned so that such deployment of the anchoring element  404  is possible, such as in an airway, proximal to a bifurcation. This may involve pulling the proximal end of the device  400  in the proximal direction prior to deployment of the anchoring element  404 . Likewise, in some embodiments, the device  400  is rotated an additional amount so that the anchoring element  404  is aligned with the direction that the bifurcation branches off. Visualization may be achieved with a variety of methods, including fluoroscopy and/or imaging through the bronchoscope camera. Once desirably positioned, the anchoring element  404  is deployed and advanced into an airway. For example, the tissue gathering element  402  resides in a first airway while the anchoring element is deployed and advanced into a second airway, adjacent or nearby the first airway. The rigidity and robustness of the airways minimizes or prevents rotation or unwinding of the device  400 . This is maintained even after the torqueing tool  408  is removed. 
     The torque that is applied to the lung tissue is a function of the diameter of the distal tissue gathering element  402  or the width of any shape that is used as the tissue gathering element  402 . If the tissue gathering element  402  is less than 0.5 inches wide or in diameter, a range of 0 to 2.0 inch-pounds of torque will be typically applied. If the width or diameter is greater than 0.5 inches, a range of torque between 0.3 and 3.0 inch-pounds is typically applied. It is advantageous that any loss of stored energy due to relaxation of the lung tissue after removing the torqueing tool  408  will be stored in the lung tissue through counter rotation and contact between the anchoring element  404  and the adjacent airway or other lung parenchyma or lung structure that the anchoring element  404  has been deployed into. As an example, if the torqueing tool  408 , tissue gathering end  402 , remainder of device  400  and the catheter is rotated 180 degrees in a clockwise direction to apply 1.0 inch ounce of torque to the distal tissue gathering element  402 , while the remaining portion of the device  400  is still inside the catheter  430 , the torque may be communicated to tissue effectively through portions of the tissue gathering element  402  bearing on the tissue and the tissue may present resistance and a propensity to unwind the device  400  with an equal amount of torque in the opposite counter clockwise direction. This unwinding may happen if the torqueing tool  408  were to be uncoupled and removed. To counter this, the anchoring element  404  is deployed and coupled to tissue to prevent this from happening in a gross way. However, after deploying the anchoring element  404 , it is simply wedged against the tissue to hold the device fixed with respect to the airway or lung tissue it has been deployed into. The anchoring element  404  may not have been rotated to rotationally load the anchoring element  404  against the bifurcation branch or ostium it has been placed into to resist counter rotation of the device  400 , as the torqueing tool  408  is removed. Also, the tissue may not have been conditioned to resist rotation such as being loaded in a rotated way to gather loose tissue to create rotational resistance. As such, removal of the torqueing tool  408  may allow up to 90 degrees of counter-rotation or unwinding of the entire device  400  in a counter clockwise direction until the anchoring element  404  rotationally loads the lung tissue it has been deployed into in this same counter clockwise direction. In this example, as much as 0.5 inch-pounds of torque may have been lost at the distal end when the tissue gathering element  404  was allowed to unwind 90 degrees in the counter clockwise direction. However, the tissue anchoring element  404  will be rotated 90 degrees in the counter clockwise direction which loads proximal lung tissue in a rotational direction which improves lung mechanics as previously described herein. The amount of rotational work energy that is potentially lost at the distal end of the device will be gained at the proximal end of the device, as the torqueing tool  408  is removed. It is possible that the 90 degrees that the tissue anchoring element  404  is counter rotated may apply as much as 0.5 inch-pounds of torque to tissue that is adjacent to the proximal end of the device  400  and adjacent to the anchoring element  404 . The force rotational applied to tissue by the distal tissue gathering element  402  will be balanced by the forces that are applied by the anchoring element  404  to rotate the proximal lung tissue. The anchoring element  404  will be anchored into lung tissue that is structurally stiffer than the tissue that the tissue gathering element  402  will be anchored into because lung tissue that is closer to the trachea is normally reinforced by cartilage. As a result, the rotational torqueing loads that are applied to the tissue may be balanced but the angle of rotation experienced by the tissue may not be the same between the two regions of lung tissue. 
     It may be appreciated that the anchoring element  404  may be deployed to anchor the device  400  in many possible structures of the lung L to maintain the lung tension but it is often beneficial to deploy the anchoring element  404  in a bifurcation that can be accessed by a bronchoscope. This provides support to prevent the continued recovery of the tissue gathering element  402  from pulling the device into a more distal position, over time. By hooking the attachment end  406  of the device  400  around the carina of the airway bifurcation, there is strong support to keep the device  400  in a position to be later accessed, such as by using a bronchoscope, to remove the device  400  if the need arises. This is very advantageous to be nearly guaranteed that the implanted device  400  can be accessed with a bronchoscope, such with the use of a bronchoscope camera alone. This is in contrast to conventional lung volume reduction coils which tend to migrate so far distally that bronchoscopes, appropriately sized to guide recapture instrumentation, cannot be advanced far enough and cannot fit in the portion of the lung that the proximal coil eventually resides within. 
     In some instances, the device  400  is rotated further in the same direction that the torqueing tool  408  rotated the device  400  while the anchoring element  404  is being deployed from the bronchoscope  20  or delivery system catheter  430  or other delivery system component. If the anchoring element  404  is shaped in the form of a helix, removal of the constraining device, such as by retracting a catheter  430 , in the proximal direction will drive rotation of device  400 . The direction of spiral of the helix shape will dictate the direction that the device  400  will be rotated. Thus, the helix may be configured to add rotation and torque in the same direction that the torqueing tool  408  has been used to rotate device  400  further or the helix may be configured in the opposite direction to remove some rotation or torque to relieve some of the torque force during deployment of the anchoring element. 
     In some instances, the device  400  is pulled proximally (along its longitudinal axis) to further tension the lung tissue distal to the device  400  and/or to position the anchoring element  404  at a more proximal location. Thus, in some embodiments, the device  400  applies both radial re-tensioning within the lung and linear re-tensioning toward the trachea T. In some embodiments, the proximal pulling of the device  400  may be as much as 5 inches, but more preferably it will be 0.5 to 3 inches of linear proximal displacement. In these embodiments, the tissue gathering element  402  is strategically positioned within the lung L so that such pulling in the proximal direction is at least partially maintained after the anchoring element  404  is deployed so that the device  400  applies both radial re-tensioning within the lung and linear re-tensioning toward the trachea T. 
     Once desirably positioned and anchored, the device  400  is left in place as an implant. Thus, the torqueing tool  408  is detached from the attachment end  406  of the device  400  and withdrawn along with the catheter  430  and bronchoscope  20 . Chronic tension is maintained on the tissue to restore lung elastic recoil. In some instances, the patient&#39;s COPD will progress and the device  400  may gradually unwind, releasing increments of stored energy, to maintain tensioning of the lung. And, in some advanced cases, the device  400  may ultimately fully untwist so that the device  400  has recovered to a zero-strain state due to continued elongation of tissue because of the progressive nature of the COPD disease. This can be easily detected, using common medical imaging techniques, by comparing the rotational position of the tissue gathering element  402  relative to the anchoring element  404  to determine if they are similar to an unconstrained device  400  before it is deployed in the patient. If the tissue has relaxed sufficiently that the twist in the device  400  has been substantially eliminated, additional devices  400  may be deployed to restore lung function back to the patient or the existing previously implanted device  400  may be accessed again with a torqueing system that can rotate the device  400  again to energize and restore the rotational strain back into the previously implanted device  400 . Additionally, the anchoring element  404  may be pulled from its anchored position so rotation can be applied and then the anchoring element  404  may be advanced back into the same airway branch, a new airway branch or it may be anchored at another anatomical location in the lung to resist unwinding of the device  400 . 
     Medical imaging techniques may be used to visualize device  400  delivery, the deployment of the device  400  from delivery system constraints, rotation or torqueing of device  400 , deployment of the anchoring element  404 , deployment of the tissue gathering element  402 , decoupling of the torqueing tool  408  from the device  400 , reattachment of the torqueing tool  408  to device  400 , recapture of device  400  by attaching a recapture tool (e.g. a forceps instrument or suture or specialized recapture tool designed to couple to a feature of device  400 ), attaching a guide tool to device  400  to guide a catheter to be advanced to recapture device  400 , to name a few. Likewise, other maneuvers may be used to visualize any of the measurable physiologic changes listed herein to improve breathing in COPD patients during the implantation procedure or after the procedure or in comparison to determine change in breathing function by comparing the physiologic difference in the patient as a result of placing one or more device  400  in the patient. Medical imaging may be used to assist in selecting a device  400  size before implantation and any other maneuver that would benefit from visualization while delivering device  400 , recapturing device  400  or evaluating any of the outcome parameters. Medical imaging includes the use of all forms of equipment that allows for real time imaging, recording or computer processing that outputs an image of devices, organs or tissue within the human body without needing to expose the devices, organs or tissue to be visualized using a direct line of site by the human eye. These medical imaging techniques may typically benefit by the emission of low to high frequency electro-magnetic energy or sound energy which may include the use of one or more video cameras such as the ones bronchoscopes are equipped with, computed tomography, biplane imaging, fluoroscopy, ultrasound or standard planar x-ray machines. 
       FIGS. 62A-62D  additionally illustrate an embodiment of delivering a torque-based pulmonary treatment device  400 .  FIG. 62A  illustrates the device  400  loaded within the catheter  430  which is advanceable through a lumen of a delivery device, such as a bronchoscope. Thus, the device  400  is constrained within the catheter  430  to allow for ease of movement. The anchoring element  404  and tissue gathering element  402  are drawn together and the tissue gathering element  402  is uncoiled and straightened. The device  400  remains within the catheter  430  until the distal tip of the catheter  430  is desirably positioned within the lung L. In this embodiment, the catheter  430  is then retracted, as illustrated in  FIG. 62B , while the torqueing tool  408  remains in place. This exposes the tissue gathering element  402 , allowing the element  402  to deploy. In this embodiment, the tissue gathering element  402  has a curved shape, particularly an S-shape, wherein a first wing  440  extends in a first direction (radially outwardly from a longitudinal axis  442  of the device  400  and joined torqueing tool  408 ) and a second wing  444  extends in a second direction (radially outwardly from the longitudinal axis  411 ). In this embodiment, the first and second directions are directly opposite to each other. However, it may be appreciated that the first and second directions may be at an angle to each other. Referring to  FIG. 62C , the handle  435  is then twisted to rotate the tissue gathering element  402 . This causes at least the wings  440 ,  444  to rotate around the longitudinal axis  411 . This rotation draws the surrounding tissue toward the longitudinal axis  411 , as the wings  440 ,  444  capture and pull the tissue. The tissue gathering element  402  is then anchored in place by deployment of the anchoring element  404 , as illustrated in  FIG. 62D . Here, the catheter  430  is further retracted exposing the more proximally positioned anchoring element  404  which curves or bows radially outwardly, away from the longitudinal axis  411 . As mentioned, in some embodiments, additional torque is applied to the torqueing tool  408  in order to align the anchoring element  404  with an available airway branch so that the anchoring element  404  is advanceable into the airway branch so as to keep the device  400  from unwinding upon release of the torqueing tool  408 . The torqueing tool  408  is then removed from the attachment end  406  and the device  400  is left behind. 
     A. Tissue Gathering Element 
     It may be appreciated that the tissue gathering element  402  may be comprised of a variety of materials, may take a variety of forms or shapes, and may include a variety of features. 
     In some embodiments, device  400  is formed from a single shaft (e.g. wire, cable, braid), wherein the shaft is curved or bent to form the tissue gathering element  402  and an anchoring element  404 . In such embodiments, the attachment end  406  is created by a loop, bend, U shaped bend, coil or other feature of the shaft that allows for grasping or other mechanisms of attachment to a suitable delivery system. Examples of attachment include attachment to a pusher, grasper, forceps, suture, or catheter, to name a few. 
       FIGS. 63A-63C  illustrate a variety of embodiments of torque-based pulmonary treatment devices  400 . As illustrated, each device  400  includes at least one tissue gathering element  402  and at least one anchoring element  404  which meet at an attachment end  406 . More than one tissue gathering elements  402  may be attached to a single device  400  to improve lung function. More than one anchoring element  404  may be attached to a single device  400  to improve lung function. It may also be appreciated that the embodiments illustrated in  FIGS. 63A-63C  may be formed from a single shaft to create the tissue gathering element  402  and anchoring element  404 , as described above, or may be formed from multiple shafts, etc. It may also be appreciated that the tissue gathering elements  402  may include a distal tip  405 , and the tip  405  is often not the distal-most portion of the tissue gathering element  402 . For example,  FIGS. 63A-63C  illustrate devices  400  having tissue gathering elements  402  comprising a partial loop which curves radially outwardly from the longitudinal axis  411 . In some embodiments, the loop extends such that the distal tip  405  is directed back toward the longitudinal axis  411  (e.g.  FIG. 63A-63B ). In other embodiments, the distal tip  405  is directed substantially parallel to the longitudinal axis  411  in the distal direction, such as extending around a full circle (e.g.  FIG. 63C ). In such embodiments, the tissue gathering element  402  may be described as having a radius R. As the radius R of the tissue gathering end is increased, the circumference of the loop is increased by a factor of 2π (i.e. 2×3.1415). Thus, increasing the size of the loop increases the volume of tissue that can be gathered, particularly by πR 2  (i.e. the area of a circle; the square of R times 3.1415). In some instances, it is desirable for the loop to extend as far as feasibly possible to create a maximum radius to increase effectiveness in gathering tissue. Such feasibility depends on a variety of factors, including shaft construction, loop design, and desired function, to name a few. In some instances, it is desired that the loop has increased torsional strength so as to more efficiently gather tissue. 
     In other embodiments, the tissue gathering element  402  may not be circular so the effective dimension may be described as having a width W. Looking at  FIG. 63A , if the tissue gathering element  402  was not circular, what is shown as R would be described as W. Stated another way, W is the extreme maximum width of a non-circular tissue gathering element shape. As the width W of the tissue gathering element  402  is increased, the path length around the tissue gathering element  402  is increased by a factor of 2×W to describe the length of lung tissue that is pulled towards the longitudinal axis  411  by rotating the tissue gathering element 360 degrees. Thus, increasing the width W of the tissue gathering element  402  increases the length of tissue that can be gathered, particularly by 2 times the width W. In some instances, it is desirable for the tissue gathering element  402  width W to extend as far as feasibly possible to create a maximum width to increase effectiveness in gathering tissue. Such feasibility depends on a variety of factors, including shaft construction, tissue gathering element  402  design, and desired function, to name a few. In some instances, it is desired that the loop has increased torsional strength so as to more efficiently gather tissue. The tissue gathering width W may be produced in a range between 0.25 and 3 inches but a range between 0.5 and 1.0 inches is preferable. If ribbon is used to make the tissue gathering element  402 , it&#39;s preferable to use ribbon between 0.005 and 0.030 inches thick if it&#39;s made from metallic material. The width of the ribbon is typically between 0.005 and 0.100 inches but preferably between 0.040 and 0.075 inches wide to withstand the torqueing forces and to resist deforming to such a degree that it no longer effectively gathers tissue. 
     In some embodiments, the loop shape is designed to increase strength during torsion. For example, in some embodiments, the loop has a “D” or “P” shape wherein the loop extends over the longitudinal axis  411 , crossing the portion of the tissue gathering element  402  that extends along the longitudinal axis  411  (e.g.  FIG. 64 ). By forming a shape in the shaft  412  that crosses over itself, the circular section of the “D” or “P” shape or other looping shape is stiffened to resist twist or torsional deformation. Stiffening is provided because the free end (distal tip  405 ) is stabilized at the crossing point, against the portion of the shaft that it crosses. These crossing points or points of contact may optionally be held together with a reinforcing element, such as a crimped tube connector, or they may be joined together, such as by brazing or welding (e.g. with an arc or using laser light or any combination), to geometrically stiffen the attachment end  406 , the anchoring element  404  or the tissue gathering element  402 . 
     When rotating the tissue gathering element  402  around the longitudinal axis  411  the direction of the cross-over, so that the tissue presses the shaft  412  against itself at the cross-over point, the cross-over resists deformation of the loop. By arresting the deformation in this way, the looped portion of the tissue gathering element  402  is made more effective to transmit torque or rotation energy directly to the tissue. When rotating the tissue gathering element  402  in the opposite direction, the tissue gathering element  402  will deform because the free distal tip  405  is not supported to prevent the deformation. In some instances, this may be beneficial because the deformation stores elastic strain energy in the device  400  that can continue to perform work on the lung L after the delivery system has been removed (like loading a spring and leaving it in the body to continue pulling on tissue). 
     It may be appreciated that the distal tip  405  may have a variety of forms. In some embodiments, the distal tip  405  is atraumatic and has a blunt shape, such as a ball or other rounded shape (e.g.  FIG. 63A ). In this configuration, the tissue gathering element  402  may be more inclined to track along the inside lumen of an airway if the airways are still preserved. However, in nearly all cases, they are not. If the distal tip includes a ball that is smaller than 0.060 inches diameter, it will still be capable of penetrating the wall of an airway to engage connective alveoli instead of manipulating airways alone. In other embodiments, the distal tip  405  has a sharp shape, configured to pierce and/or penetrate tissue (e.g.  FIG. 63B ). In other embodiments, the distal tip  405  has an anchoring shape, such as a fish-hook or other shape which is configured for piercing or penetrating tissue while resisting withdrawal from the tissue ( FIG. 63C ). 
     In some embodiments, the device  400  is made from round wire. It may be appreciated that in some embodiments the round wire has been flattened at the distal tip or any other portion of the tissue gathering element  402  to add bearing area. For example,  FIG. 65  illustrates an embodiment of a device  400  formed from flattened wire. In this embodiment, the tissue gathering element  402  is formed from a shaft  412  and the anchoring element  404  is formed from a shaft  420 , wherein the shafts  412 ,  420  are fixed together to form the attachment end  406 . Each shaft  412 ,  420  has a flattened, broader surface, such as a ribbon, wherein the flattened surfaces are mated so as to increase contact for fixing to each other. Fixing the elements together may be accomplished by welding, gluing, thermally friction bonding, crimping, locking together using puzzle lock patterns, locking extrusion sections within each other, wrapping with a spring, riveting, locking together with threaded fasteners, by joining using locking hardware that is known in the art. In some embodiments, the flattened or broader surface is arranged to be perpendicular to the direction the shaft  412  contacts tissue to prevent the tissue gathering element  402  from cutting or migrating through tissue over time. Thus, the flattened or broader surface serves as the bearing area. In some instances, this is particularly useful along curved portions of the tissue gathering element  402  so as to prevent the curved portion of the tissue gathering element  402  from cutting or migrating through tissue over time. 
       FIG. 66  illustrates an embodiment of a device  400  formed from oval wire. In this embodiment, the tissue gathering element  402  is formed from a shaft  412  and the anchoring element  404  is formed from a shaft  420 , wherein the shafts  412 ,  420  are fixed together with the use of an attachment element  410 . The attachment element  410  assists in joining the shafts  412 ,  420  and forming a desired shape for attachment and torqueing. In this embodiment, the broader side of the oval wire is arranged to be perpendicular to the direction the shaft  412  contacts tissue to prevent the tissue gathering element  402  from cutting or migrating through tissue over time. 
       FIGS. 65-66  also illustrate tissue gathering elements  402  having a shape which is more similar to an arc or arch than a loop. In  FIG. 65 , the shaft  412  bends radially outwardly from the longitudinal axis  411  to form a curved arch wherein the distal tip  405  is parallel to the longitudinal axis  411  facing the proximal direction. In  FIG. 66 , the shaft  412  bends radially outwardly from the longitudinal axis  411  to form a curved arc wherein the distal tip  405  parallel to the longitudinal axis  411  facing the radially outwardly from the longitudinal axis  411 . 
     It may be appreciated that the tissue gathering element  402  may have irregular shapes or compound curvatures. For example,  FIG. 67  illustrates a tissue gathering element  402  having a shape formed by the shaft  412  curving radially outwardly from the longitudinal axis  411  and forming a first curvature  450 , a second curvature  452  and then a third curvature  454 . The first curvature  450  has an arc shape which then transitions into an inverse arc shape for the second curvature  452 . This then transitions into a semi-circle or arch shape which directs the distal tip  405  toward the longitudinal axis  411 . This compound curvature (combination of curvatures  450 ,  452 ,  454 ) creates a hook shape which may be particularly beneficial for gathering tissue in both a twisting fashion and a pulling fashion. The partial loop shape extending radially outwardly from the longitudinal axis  411  assists in gathering tissue during torqueing, as described above. And, the hooking shape (distal tip  405  facing the longitudinal axis  411 ) assists in holding the tissue when pulling the device  400  in the proximal direction, such as along the longitudinal axis  411 . 
     It may also be appreciated that the tissue gathering element  402  may have a variety of other shapes, including bends and arcs which are rounded or angular, in the same direction or opposite directions, and in a variety of configurations.  FIG. 68  illustrates a tissue gathering element  402  similar to that illustrated in  FIGS. 62A-62D . In this embodiment, the tissue gathering element  402  has a curved shape, particularly an S-shape, wherein a first wing  440  extends in a first direction (radially outwardly from a longitudinal axis  411 ) and a second wing  444  extends in a second direction (radially outwardly from the longitudinal axis  411 ). In this embodiment, the first and second directions are directly opposite to each other. However, it may be appreciated that the first and second directions may be at an angle to each other. In addition, this embodiment illustrates the distal tip  405  aligned with the longitudinal axis  411 , particularly facing in the distal direction. 
     It may be appreciated that the shaft  412  may include various additional bends or curvatures to provide particular features. For example,  FIG. 69  illustrates an embodiment wherein the shaft  412  is configured to provide strain relief. Here, the shaft  412  has one or more bends, switchbacks or wings in succession configured to act as a strain relief while manipulating the device  400 . In this embodiment, the strain relief portion  460  is disposed proximal to the tissue gathering end  404 . Thus, pulling in the proximal direction, such as along the longitudinal axis  411 , would expand the strain relief portion  460  leaving the tissue gathering end  404  in position. This may be desired in situations wherein it is preferred to maintain position of the tissue gathering end  404  when pulling the attachment end  406 , such as when positioning the anchoring element  404 . 
     It may be appreciated the shaft  412  of the tissue gathering end  404  may vary in terms of construction and materials so as to provide various features. In some embodiments, as illustrated in  FIGS. 70A-70B , the shaft  412  is comprised of a tube  461  having slots or cuts  462  along at least a portion of its length. Such cuts  462  may be fabricated by laser cutting of the tube  461 . In addition, a pull cord  464  is positioned within or along the tube  461  extending distal to the cuts  462 . The cuts  462  are aligned along the tube  461  so as to allow flexibility of the tube  461  while the pull cord  464  is slack ( FIG. 70A ), and to allow curvature along a predetermined arc or arch when the pull cord  464  is pulled ( FIG. 70B ). Such pulling closes the slots or cuts  462 , holding the shaft  412  in the curved formation. This construction provides increased torque strength and allows the tissue gathering end  404  to transmit higher levels of torque. It may be appreciated that although the shaft  412  is illustrated with a needle tip, any suitable tip shape may be used. 
     In other embodiments, the shaft  412  is comprised of a twisted pair of wires or a combination of more than 2 wires. In other embodiments, the shaft may be pressure cast or made from powder metal to form a near net shape that varies in dimension along its length. Near net shapes are limited only to the shape of a mold that is used to forge the powder metal together to form a high performance metalized composite material of nearly any shape. In another embodiment, the shaft  412  is made from a twisted pair of wires, the preferable direction of rotation that the user should use to rotate the tissue gathering element  402  within the lung is the same direction that was used to produce the twist in the twisted pair of wires. This same direction will further tighten the twist to maintain a reasonably small diameter of the tissue gathering element  402 . This will also transmit the greatest amount of torque through the delivery system and the device  400  to the tissue. This is the direction that will transmit the maximum torque force to the lung tissue. 
     In some embodiments, the tissue gathering element  402  comprises a jacket which extends over at least a portion of the shaft  412  so as to increase gripping of the lung tissue and reduce cutting through lung tissue (i.e. “cheese wiring”).  FIGS. 71A-71C  illustrate example embodiments of jackets  470 .  FIG. 71A  illustrates a jacket  470  comprising a coil  472  which extends over a portion of the shaft  412  to increase bearing area on the tissue. In some embodiments, the coil  472  comprises a spring coil that is tight wound to grip the shaft  412 . In some embodiments, gaps between coil turns are spaced between 0.003 and 0.100 inches so as to increase friction between the tissue gathering element  402  and the tissue, therefore enhancing tissue gathering. In some embodiments, a suitable coil  472  outer diameter would be larger than 0.018″ and smaller than 0.130″ to be suitable to fit in a typical bronchoscope.  FIG. 71B  illustrates a jacket  470  comprising a flexible sleeve  474 . In some embodiments, the flexible sleeve  474  comprises a woven material, such as Dacron or polyester. In other embodiments, the flexible sleeve  474  comprises a braided tube. In either case, the flexible sleeve  474  increases bearing area on the tissue and increases friction or gripping. In other embodiments, the flexible sleeve  474  comprises silicone. In other embodiments, the flexible sleeve  474  comprises shrink fit tubing.  FIG. 71C  illustrates a jacket  470  comprising a combination of a coil  472  and a sleeve  474 . In this embodiment, the coil  472  extends over the shaft  412  and the sleeve  474  extends over the coil  472 . Thus, the jacket  470  may be comprised of a coil  472  having shrink fit tubing thereover. 
     In some embodiments, the distal tip of the tissue gathering element  402  comprises a balloon expandable or self-expanding stent structure that grips an airway wall or that grips to lung tissue as the stent is dilated to minimize the distal tip from being pulled out of the tissue as the device  400  is rotated, to further increase the effectiveness of the tissue gathering. 
     B. Anchoring Element 
     It may be appreciated that the anchoring element  404  may be comprised of a variety of materials, may take a variety of forms or shapes, and may include a variety of features. 
     As mentioned previously, in some embodiments, the device  400  is formed from a single shaft (e.g. wire, ribbon, cable, braid), wherein the shaft is curved or bent to form the tissue gathering element  402  and the anchoring element  404 . In such embodiments, the attachment end  406  is created by a loop, bend, U shaped bend, coil or other feature of the shaft that allows for grasping or other mechanisms of attachment to a suitable delivery system. Examples of attachment include attachment to a pusher, grasper, forceps, suture, or catheter, to name a few. 
     As mentioned previously,  FIGS. 63A-63C  illustrate a variety of embodiments of torque-based pulmonary treatment devices  400 . As illustrated, each device  400  includes a tissue gathering element  402  and an anchoring element  404  which meet at an attachment end  406 . It may be appreciated that the embodiments illustrated in  FIGS. 63A-63C  may be formed from a single shaft to create the tissue gathering element  402  and anchoring element  404  or may be formed from multiple shafts, etc. As shown in these embodiments, the anchoring element  404  is typically comprised of a shaft  420  which extends from the attachment end  406  in the same direction as the tissue gathering element  402 , generally along a longitudinal axis  411 . Thus, upon deployment, the shaft  420  of the anchoring element  420  bows outwardly, away from the longitudinal axis  411  and tissue gathering element  420 , such as to form the shape of a bifurcation. The anchoring element  404  is then advanced into an adjacent or nearby airway to anchor the device  400 . 
       FIG. 63A  illustrates an anchoring element  404  comprising a loop which curves radially outwardly from the longitudinal axis  411 . In some embodiments, the loop extends such that its distal tip  407  is directed back toward the longitudinal axis  411 . In some embodiments, the distal tip  405  is directed so that the loop extends substantially around a full circle. In such embodiments, the anchoring element  404  may be described as having a radius R. Increasing R increases the moment on fixing the proximal end of the device  400 . Torque resistance=R×F (friction in the tissue). By increasing R, less friction is needed to hold the device  400  from counter rotating. Some embodiments may include barbs or hooks that penetrate the airway wall and increase the R dimension to reinforce anchoring and resistance to counter rotating with respect to the torqueing force that had been applied to the tissue gathering element  402  and tissue. 
       FIG. 63B  illustrates an anchoring element  404  which bows radially outwardly away from the longitudinal axis  411  and then curves back toward the longitudinal axis  411  and extends along the longitudinal axis  411  in the distal direction. In this embodiment, the proximal end of the tissue gathering element  402  similarly bows radially outwardly from the longitudinal axis  411 , substantially symmetrical to the anchoring element  404 . 
       FIG. 63C  illustrates a plurality of anchoring elements  404  on a single device  400 . In this embodiment, three anchoring elements  404  extend from the attachment end  406 , however any number may be present including one, two, three, four, five, or more. In this embodiment, each anchoring element  404  extends in a different radial direction from the longitudinal axis. This provides the user with a variety of options when anchoring the device  400 . In particular, the anchoring element  404  most suitably positioned for anchoring within the particular anatomy may be used to anchor the device  400 . Or, more than one anchoring element  404  may be used in the same or differing airways for additional anchoring support. 
     It may be appreciated that in some embodiments, such as illustrated in  FIGS. 65-66 , the anchoring element  404  has a shape which is more similar to an arc or arch than a loop. In  FIG. 65 , the shaft  420  bends radially outwardly from the longitudinal axis  411  to form a curved arch wherein the distal tip  407  is parallel to the longitudinal axis  411  facing the proximal direction. In  FIG. 66 , the shaft  420  bends radially outwardly from the longitudinal axis  411  to form a curved arc wherein the distal tip  407  parallel to the longitudinal axis  411  facing the radially outwardly from the longitudinal axis  411 . 
     It may also be appreciated that the anchoring element  404  may have a variety of other shapes, including bends and arcs which are rounded or angular, in the same direction or opposite directions, and in a variety of configurations.  FIG. 68  illustrates an anchoring element  404  having a curved shape, particularly an S-shape, wherein a first wing  441  extends in a first direction (radially outwardly from a longitudinal axis  411 ) and a second wing  445  extends in a second direction (radially outwardly from the longitudinal axis  411 ). In this embodiment, the first and second directions are directly opposite to each other. However, it may be appreciated that the first and second directions may be at an angle to each other. In addition, this embodiment illustrates the distal tip  407  aligned with the longitudinal axis  411 , particularly facing in the distal direction. 
     It may be appreciated that in any of the embodiments, the tissue gathering element  402  and anchoring element  404  may extend radially outwardly from the longitudinal axis  411  in the same or different directions. Likewise, it may be appreciated that in any of the embodiments, the tissue gathering element  402  and anchoring element  404  may have the same or similar shapes or different shapes. 
     It may be appreciated that in some embodiments the anchoring element  404  maintains position in an airway or area of the lung anatomy by simple entrapment of the anchoring element  404 , such as insertion into an airway that is separate from the pathway to the tissue gathering element  402 . In such instances, the anchoring element  404  may be “loose” within the airway yet pressed against a portion of the airway due to forces applied via the attachment end  406  so as to anchor the device  400 . Such anchoring elements  404  may be easily removable by releasing the forces applied via the attachment end  406  or applying sufficient pulling force in the proximal direction. In other embodiments, the anchoring element  404  is actively anchored within the airway so as to maintain anchoring without relying on forces applied via the attachment end  406  for anchoring.  FIG. 72  illustrates an embodiment of an anchoring element  404  comprising an expandable basket  480 . In this embodiment, the expandable basket  480  is insertable into an airway or other anatomy and expandable so as to apply radial outward force upon the airway. This holds the basket  480  within the airway resisting movement within the airway. This, in turn, anchors the device  400  and holds the tissue gathering element  402  in place.  FIG. 73  illustrates an embodiment of an anchoring element  404  comprising one or more anchoring hooks  486 . In this embodiment, the one or more anchoring hooks  486  are insertable into an airway or other anatomy and expandable so as to puncture or penetrate the wall of the airway. This holds the one or more anchoring hooks  486  within the airway resisting movement within the airway. This, in turn, anchors the device  400  and holds the tissue gathering element  402  in place.  FIG. 74  illustrates an embodiment of an anchoring element  404  comprising an expandable stent  490 . The stent  490  may be comprised of a variety of materials, such as nitinol, steel, etc. Likewise, the stent  490  may be braided or laser cut, to name a few. In this embodiment, the expandable stent  490  is insertable into an airway or other anatomy (such as alone or with the use of a guidewire) and expandable so as to circumferentially expand against the inner walls of the airway. In some embodiments, the stent  490  is self-expanding and in other embodiments the stent  490  is expandable with assistance, such as by balloon inflation. This holds the stent  490  within the airway resisting movement within the airway. This, in turn, anchors the device  400  and holds the tissue gathering element  402  in place. 
     C. Attachment End 
     As mentioned previously, the torque-based pulmonary treatment device  400  typically comprises an attachment end  406  where the tissue gathering element  402  and an anchoring element  404  join. The attachment end  406  may be used to attach a delivery device thereto, such as a torqueing tool  408 . Thus, the attachment end  406  typically has a non-round cross-section shape, such as a square, rectangular, polygonal or oval shape, to assist in maintaining rotational toque coupling and torque transmission during rotational or torqueing motion of the torqueing tool  408 . It may be appreciated that in some embodiments the attachment end  406  is formed from portions of the tissue gathering element  402  and anchoring element  404  themselves, such the joining of their respective proximal ends. In other embodiments, the tissue gathering element  402  and anchoring element  404  are formed from a continuous shaft and the attachment end  406  is formed from a bend or crimp in the shaft therebetween. In some embodiments, the attachment end  406  includes an attachment element  410  to assist in joining and/or holding the elements  402 ,  404  and forming a desired shape for attachment and torqueing. And yet in other embodiments, the attachment end  406  resides at the proximal end of the tissue gathering element  402  or the anchoring element  404  and the elements  402 ,  404  are joined to each other distally of the attachment end  406 . 
     As mentioned, in some embodiments, the attachment end  406  is formed from portions of the tissue gathering element  402  and anchoring element  404  themselves, such the joining of their respective proximal ends.  FIG. 75  illustrates such an embodiment wherein the proximal ends of the tissue gathering element  402  and anchoring element  404  are bonded together by gluing or welding but they may also be joined by riveting, using threaded fasteners, crimping using a tubing or spring coupler, press fit together using a coupler or interlocking features such as threading a hitch pin, it may also be sutured together or tied using metal or plastic wire, cable, fibers, string, or they may be fused together by congealing biologic material they may be held adjacent to each other using magnetic attraction force with magnetic materials. Thus,  FIG. 75  illustrates bonding material  510  between and optionally covering outer portions of the tissue gathering element  402  and anchoring element  404 . 
     As mentioned, in some embodiments, the tissue gathering element  402  and anchoring element  404  are formed from a continuous shaft  412  and the attachment end  406  is formed from a bend or crimp in the shaft therebetween.  FIG. 76A  illustrates such an embodiment wherein the attachment end  406  has the form of a bend, in particular a loop-shaped bend.  FIG. 76B  illustrates an example of usage of the embodiment of  FIG. 76A . Here, the attachment end  406  is connected with another device, such as a torqueing tool  408  or removal tool, using a hitch pin  503  with a ball end  505 . The hitch pin  503  releasably attaches the devices together. Removal of the hitch pin  503  detaches the devices from each other. It may be appreciated that this design may also be used to pin the tissue gathering element  402  and the anchor element  404  together. 
       FIG. 77  illustrates a portion of an attachment end  406  of a device  400  having torqueing tool socket  507  that has been slipped thereover. The torqueing tool socket  507  has a shape that allows for a slip fit over the portion of the attachment end  406 . The socket  507  is attached to or part of a torqueing tool  408  so that rotation of the torqueing tool  408  is transmitted through the torqueing tool socket  507  and translated to the attachment end  406 . Likewise, the torqueing tool  408  is able to be translated longitudinally to be released from the device  400  without requiring any actuation of any mechanism to release the slip fit connection. 
     In some embodiments, the attachment end  406  is configured to mate with a torqueing tool  408  in a manner which temporarily locks the device  400  and tool  408  together. In some instances, this assists in positioning the device  400  wherein the device  400  can be easily advanced and retracted with the use of the tool  408 . For example, in  FIG. 78  the attachment end  406  has a threaded outer surface and the torqueing tool  408  includes threaded inner surface. This allows the attachment end  406  to join with a torqueing tool  408  in a screw-type manner. In this embodiment, the torqueing tool  408  has a threaded receptacle  550  configured to receive the attachment end  406  so as to mate the threading surfaces together. It may be appreciated that such joining may be achieved by rotation of the torqueing tool  408 , wherein continued rotation in the same direction then rotates or torques the tissue gathering element  402 . Once desired rotation has been achieved, the anchoring element  404  is actuated and the torqueing tool  408  is then unscrewed from the attachment end  406 .  FIG. 79  illustrates an attachment end  406  which keys into the torqueing tool  408 . In this embodiment, the attachment end  406  includes an extension  570  which extends away from the longitudinal axis  411  of the device  400 . The extension  570  may have any suitable shape including a rod, protrusion, bump, etc. In this embodiment, the torqueing tool  408  includes a receptacle  580  having a groove or cutaway  582  configured to receive the extension  570  upon mating of the attachment end  406  with the receptacle  580 . Typically, the cutaway  582  extends along a first direction, such as along the longitudinal axis  411  and then extends along a second direction, such as angular or perpendicular to the longitudinal axis  411 . As the attachment end  406  is joined with the torqueing tool  408 , the extension  570  is advanced along the cutaway  582  (along the first and second directions) which typically involves rotating the torqueing tool  408  to allow advancement of the extension along the second direction. Positioning of the extension  570  within the cutaway  582  along the second direction temporarily locks the attachment end  406  to the torqueing tool  408  during pulling or pushing along the longitudinal axis  411 . It may be appreciated that continued rotation of the torqueing tool  408  in the same direction rotates or torques the device  400 . since the extension  570  is unable to slide out of the cutaway  582 . Once desired rotation has been achieved, the anchoring element  404  is actuated and the torqueing tool  408  is then rotated in the reverse direction to release the extension  570  from the receptacle  580 . 
     In other embodiments, the attachment end  406  includes one or more accessories configured to assist in rotation of the device  400 . For example,  FIG. 80  illustrates an embodiment of an attachment end  406  having at least one protrusion  590  which extends radially outwardly from the longitudinal axis  411 . The at least one protrusion  590  provides a larger surface area for attachment to the torqueing tool  408 . In this embodiment, the torqueing tool  408  comprises a grasper which grasps the at least one protrusion  590 . Rotation of the torqueing tool  408  thus rotates the device  400 . The torqueing tool  408  is then disengaged from the device  400  by releasing the grasper. 
     In some embodiments, the anchoring element  404  is positionable within the same airway or passageway as the tissue gathering element  402  or within an airway or passageway which is proximal to that of the tissue gathering element  402 .  FIG. 81  illustrates an embodiment of such a device  400 . Here, the anchoring element  404  is disposed in the opposite direction as the tissue gathering element  402 , along the longitudinal axis  411 . Here, the anchoring element  404  comprises an expandable stent  490 . Thus, the tissue gathering element  402  may be advanced into an airway and desirably positioned. The device  400  is then anchored in place by expanding the stent  490  proximally of the tissue gathering element  402 . This may be particularly useful in situations wherein a nearby airway is not available for anchoring due to anatomical configuration or lack of strength. 
       FIGS. 82A-82B  illustrate another embodiment wherein the anchoring element  404  is positionable within the same airway or passageway as the tissue gathering element  402 . Here, the anchoring element  404  is disposed in the opposite direction as the tissue gathering element  402 , along the longitudinal axis  411 . Here, the anchoring element  404  comprises a coil  491 . Thus, the tissue gathering element  402  may be advanced into an airway or through the wall of the airway into destroyed fragile lung tissue and desirably positioned. The device  400  is then anchored in place by deploying the coil  491  which expands within a luminal passageway or airway proximally of the tissue gathering element  402 . In this embodiment, the device  400  includes an attachment feature  610  near the proximal end of the coil  491  and an additional attachment feature  610 ′ disposed between the tissue gathering element  402  and the anchoring element  404 . Thus, the torqueing tool  408  may be attached to either attachment feature  610 ,  610 ′ for the most desirable outcome. Alternatively, more than one torqueing tool  408  may be attached to device  400  to apply torque and to help deploy the anchoring element  404 . One or both of the torqueing tools may also be used to remove the device  400  from the lung in a coordinated way if this is desirable.  FIG. 82B  illustrates the device  400  of  FIG. 82A  rotated 90 degrees about the longitudinal axis  411 . In this embodiment, the tissue gathering element  402  has a hook or loop shape. It may be appreciated that the loop of the tissue gathering element  402  may curve within a single plane. However, in this embodiment, the loop of the tissue gathering element  402  curves within multiple planes, as illustrated in  FIG. 82B . This may be beneficial when the tissue gathering element  402  is less rigid and therefore less capable of moving tissue. The out-of-plane curvature accounts for such flexibility wherein rotation of the tissue gathering element  402  causes the tissue to align the loop toward a single plane. The tissue gathering element  402  then has increased ability to move tissue. 
       FIG. 82C  illustrates another embodiment of a pulmonary treatment device  400  having a tissue gathering element  402  and an anchoring element  404 . In this embodiment, the device  400  is formed from a continuous shaft  412  which bends to form the elements  402 ,  404 . Here, the device  400  generally extends along a longitudinal axis  411 . The tissue gathering element  402  is formed by the shaft  412  bending radially outwardly away from the longitudinal axis  411  forming a loop around an axis  413  that is perpendicular to the longitudinal axis  411 . In some embodiments, the outer diameter of the loop that is formed around the axis  413  in the range of 0.400 inches to 3.0 inches in diameter or any size between. Most preferably, the loop may have an outer diameter in the range of 0.75 inches and 1.25 inches. In this embodiment, the loop continues into a full loop shape around the axis  413 , however it may be appreciated that in other embodiments the loop is a partial loop forming an arc shape. In this embodiment, the anchoring element  404  is formed by the shaft  412  bending into a coiled shape, wherein each turn of the coil extends at least partially around the longitudinal axis  411 . In this embodiment, the shaft  412  has a flattened, ribbon shape. In some embodiments, the ribbon shape is between 0.005 and 0.030 inches wide and between 0.005 and 0.030 inches thick in dimension. The ribbon may be blasted or tumbled in abrasive media to round the edges so it more closely appears like a round cross-section wire. Alternatively, the anchoring element  404  may be made from round cross section wire, for example having a diameter between 0.003 and 0.050 inches. The coiled shape may be configured to form a coil shaped stent or helix with an outer diameter of the helix that is between 5 mm and 17 mm in diameter but more preferably it is between 6 mm and 10 mm in diameter. Thus, the tissue gathering element  402  has a stiffness sufficient to move lung tissue, particularly to move lung tissue around the longitudinal axis  411 . Thus, in such a situation the longitudinal axis  411  becomes a rotational axis. 
       FIG. 82D  illustrates another embodiment of a pulmonary treatment device  400  having a tissue gathering element  402  and an anchoring element  404 . In this embodiment, the device  400  is formed from a continuous shaft  412  which bends to form the elements  402 ,  404  in a shape similar to that of  FIG. 82C . Likewise, the tissue gathering element  402  has a flattened, ribbon shape. However, in this embodiment, the ribbon is twisted along its length in at least one location  415  so as to rotate at least one portion of a flat surface of the ribbon  417  toward an edge of the ribbon, as shown. In particular, the ribbon is twisted along its length at multiple locations  415  so as to rotate a series of portions of the flat surface  417  of the ribbon toward the edge of the ribbon. Thus, when the device  400  is rotated about the longitudinal axis  411 , the series of portions of the flat surface of the ribbon are posed to engage the surrounding tissue. This adds 300-500% more bearing area against the tissue for engagement. This reduces the stress on the tissue to less than 20% compared to when the edge of the ribbon engages the tissue. 
     It may be appreciated that the anchoring elements  404  described herein may be positioned within an airway, lung passageway, blood vessel, parenchyma, or destroyed tissue, to name a few. The choice of design used for the anchoring element  404  is typically chosen based on the anatomy or environment within which the element  404  is to be positioned. For example, a stent  490  design may be more suitable for a luminal passageway while an anchoring hook  486  design may be more suitable for damaged tissue. 
       FIGS. 82E-82G  illustrate steps in an example method of deploying a torque-based pulmonary treatment device  400  such as illustrated in  FIGS. 82A-82D . In this embodiment, deployment begins ( FIG. 82E ) by pushing the device  400  through a catheter  430  and out its distal end so that the tissue gathering element  402  extends from the distal end of the catheter  430  and curves radially outwardly from the longitudinal axis  411 . As the tissue gathering element  402  is further advanced additional portions of the tissue gathering element  402  extend from the distal end of the catheter  430 , curving around into a loop shape, as shown.  FIG. 83F  illustrates rotation of the device  400 , such as by rotation of the catheter  430  around the longitudinal axis  411 . The forces on the tissue adjacent the tissue gathering element  402  move the tissue around the longitudinal axis  411  into a torqued configuration. This tensions the surrounding tissue. Once the lung has been desirably tensioned, the device  400  is then anchored to maintain the tensioning or resist unwinding of the device from the torqued configuration. In this embodiment, this is achieved by deploying the anchoring element  404 , as illustrated in  FIG. 82G . In this embodiment, the anchoring element  404  had a coil shape and is concentrically aligned with the longitudinal axis  411 . In this embodiment, deployment of the anchoring element  404  is achieved by retracting the catheter  430  so as to allow the coils of the anchoring element  404  to expand. In this embodiment, a torqueing tool  108  remains attached to the device  400  at this stage of delivery. The torqueing tool  408  is then removed from the device  400 . The device  400  is then left in place as an implant while the catheter  430  is removed. 
       FIGS. 83A-83J  provide a more detailed illustration of steps in an example method of deploying a torque-based pulmonary treatment device  400  such as illustrated in  FIGS. 82A-82D . To begin ( FIG. 83A ), the device  400  is loaded within a catheter  430  or similar delivery device which is configured to be advanceable through a lumen in an endoscope, such as a bronchoscope  20 . The device  400  is constrained within the catheter  430  (along longitudinal axis  411 ) to allow for ease of placement. The device  400  is attached to a torqueing tool  408  which extends from the distal end of the catheter  430 . In this embodiment, the torqueing tool  408  includes a handle  435 . In this embodiment, deployment begins by advancing the torqueing tool  408  into the catheter  430  so as to begin pushing the device  400  through the catheter  430  and out its distal end.  FIG. 83A  illustrates the distal tip  405  of the tissue gathering element  402  extending from the distal end of the catheter  430  along the longitudinal axis  411 . As the torqueing tool  408  is additionally advanced, as illustrated in  FIG. 83B , additional portions of the tissue gathering element  402  extend from the distal end of the catheter  430 . Due to pre-curves set into the tissue gathering element  402  the distal tip  405  begins curving radially outwardly from the longitudinal axis  411 . As the torqueing tool  408  is yet further advanced, as illustrated in  FIG. 83C , additional portions of the tissue gathering element  402  extend from the distal end of the catheter  430 , curving around into a loop shape. Here, the distal tip  405  is directed toward a sample tissue area  600  located off-set from the longitudinal axis  411 . The sample tissue area  600  is demarked to illustrate how the sample tissue area  600  may move in response to torqueing the device  400 . However, it may be appreciated that a larger mass of tissue surrounding the sample tissue area  600  is moved by rotation of the device  400 . 
       FIG. 83D  illustrates the start of rotating the torqueing tool  408 ; as indicated by arrow  602 , the torqueing tool  408  is rotated in the counter-clockwise direction in this embodiment. It may be appreciated that in other embodiments, the torqueing tool  408  may be rotated in the clockwise direction. In this embodiment, slight resistance of the tissue is illustrated wherein the torqueing tool  408  rotates while the tissue gathering element  402  flexes. The forces on the sample tissue area  600  begin to pull the surrounding tissue creating tension, as illustrated by arrow  604 .  FIG. 83E  illustrates further rotation of the torqueing tool  408 . At this point the curved portion of the tissue gathering element  402  has rotated around the longitudinal axis  411  pulling the sample tissue area  600  along with it. This further tensions the surrounding tissue as illustrated by arrow  606 . Additionally, in this embodiment, the torqueing tool  408  is pulled back, in the proximal direction along the longitudinal axis  411 , as indicated by arrow  608 . This additionally applies longitudinal force to the sample tissue area  600  as indicated by arrow  611 . As illustrated in  FIG. 83F , the torqueing tool  408  is then retracted further in this embodiment, as illustrated by arrow  608 . Because the tissue gathering element  402  has been distorted due to the rotational and longitudinal motions illustrated in  FIG. 83E , the tissue gathering element  402  has been interlocked into tissue to allow additional rotation and translation motions and applied forces to tissue that would not normally have been possible without pulling the tissue gathering element  402  out of tissue. Designing the tissue gathering element in a way that allows it to be rotated and translated so it is distorted to converge more closely to occupy a plane that is periductular to axis  411  locks it into tissue to allow more extreme torsion and translational forces to be applied to tissue. In this embodiment, the device  400  is then additionally rotated, as illustrated in  FIG. 83G , so as to further wrap the surrounding tissue around the tissue gathering element  402 . Thus, the sample tissue area  600  continues rotating around the longitudinal axis  411 , applying further radial and longitudinal tension on the surrounding lung. Once the lung has been desirably tensioned, the device  400  is then anchored to maintain the tensioning. In this embodiment, this is achieved by deploying the anchoring element  404 . In this embodiment, the anchoring element  404  had a coil shape and is concentrically aligned with the longitudinal axis  411 .  FIG. 83H  illustrates deployment of the anchoring element  404  wherein the catheter  430  is retracted to allow the coils of the anchoring element  404  to expand. In this embodiment, the torqueing tool  108  remains attached to the device  400  at this stage of delivery. In particular, in this embodiment, the torqueing tool  408  has a curved distal tip (e.g. a 90 degree curvature away from the longitudinal axis) which passes through an attachment feature  610  (e.g. a loop) on the device  400 , maintaining attachment. The torqueing tool  408  is then removed from the attachment feature  610  by retracting the torqueing tool with sufficient force as to straighten the curved end of the torqueing tool  408  to pull it out of the attachment feature  610 , as illustrated in  FIG. 83I . The device  400  is then left in place as an implant while the catheter  430  is removed. In some embodiments, the torqueing tool  408  is be made from a resilient material such as Nitinol or titanium in which the modulus of elasticity is less than 30E6 pounds per square inch. In other embodiments, the torqueing tool  408  is made from ferrous or non-ferrous metals with a cross section area less than 0.005 square inches. These dimensions allow for the wire to be deformed. In some embodiments, the torqueing tool  408  is made from stainless steel wire that has a dimension between 0.010 and 0.030 inches in diameter. 
     D. Alternative Embodiment 
     It may be appreciated that the torque-based pulmonary treatment device  400  may take a variety of forms and include a variety of features, such as those of the pulmonary treatment devices  10  described herein above which are applicable to torque-based methods and treatments.  FIGS. 84A-84E  illustrate another embodiment of a torque-based pulmonary treatment device  400 . Here, the device  400  includes a plurality of tissue gathering elements  402 . In particular, two tissue gathering elements  402  are shown, however it may be appreciated that additional tissue gathering elements  402  may be present including three, four, five, six or more. In this embodiment, the tissue gathering elements  402  extend radially outwardly away from the longitudinal axis  411 , particularly in opposite directions from each other. Thus, in this embodiment, the device  400  includes a first tissue gathering element  402 ′ and a second tissue gathering element  402 ″, each extending outwardly from the longitudinal axis  411  and then curving around and back toward the longitudinal axis  411  in a loop shape. In this embodiment, each loop forms half of the diameter of the distal end of the device  400  which rotates within the tissue. Therefore, each loop may be considered as forming a radius R as indicated in  FIG. 84A . In this embodiment, each loop forms a radius R wherein R=0.5 inches. It may be appreciated that in other embodiments radius R may vary including R values in the range of 0.3 to 3.0 inches. 
     Each tissue gathering element  402 ′,  402 ″ is comprised of shaft  412  made from a suitable material, such as nitinol wire, stainless steel wire, etc.). In this embodiment, the tissue gathering elements  402 ′,  402 ″ are comprised of 0.020 inch thick ribbon that is 0.020 to 0.100 inches wide. In particular, in this embodiment, each tissue gathering element  402 ′,  402 ″ is comprised of a wire ribbon. In addition, here each tissue gathering element  402 ′,  402 ″ terminates in a distal tip  405  which is formed by bending back and overlapping the ribbon to form a blunt end.  FIG. 84B  provides a closer view of a distal tip  405  of  FIG. 84A . In this embodiment, the ribbon material is curved back upon itself forming a bend having an outer thickness of approximately 0.065 inches at its thickest location.  FIG. 84C  provides another embodiment of a distal tip  405  wherein the ribbon material is curved back upon itself forming a bullet-nose shape. In this embodiment, the folded material creates an opening  620  within the distal tip  405  that has a length l and width w. In some embodiments, the opening  620  has a length of 1=5 mm. Likewise, in some embodiments, the distal tip  405  has a thickness th wherein the thickness has a maximum of 0.065 inches. It may be appreciated that the tissue gathering elements  402 ′,  402 ″ may be formed from separate shafts or from one continuous shaft. 
     Referring back to  FIG. 84A , in this embodiment, the device  400  also includes an anchoring element  404 . Here, the anchoring element  404  is disposed in the opposite direction as the tissue gathering element  402 , concentrically along the longitudinal axis  411 . Here, the anchoring element  404  comprises a coil  491 . Thus, the tissue gathering element  402  may be advanced into an airway and desirably positioned. The device  400  is then anchored in place by deploying the coil  491  which expands within a luminal passageway or airway proximally of the tissue gathering element  402 . In this embodiment, tissue gathering elements  402 ′,  402 ″ are joined therebetween by a crimp, weld, glue joint, rivet, threaded fastener, spring element that is wrapped around parts to clamp components together. In this embodiment, the device  400  includes an attachment feature  610 . Thus, the torqueing tool  408  is attached to the attachment feature  610  as will be described in more detail herein below. 
       FIG. 84D  illustrates a possible position of the tissue gathering elements  402 ′,  402 ″ during rotation and torqueing of the device  400 . As shown, the resistance of the surrounding lung tissue may initially bend the elements  402 ′,  402 ″ as the device  400  rotates within the lung. Thus, the elements  402 ′,  402 ″ are somewhat flexible while imparting force on the tissue. The tissue gathering elements  402 ′ and  402 ″ are shaped with a twist so that the resistance of surrounding tissue deforms them to be more in-plane with respect to each other and along axis  411 . If the tissue gathering elements  402 ′ and  402 ″ are shaped so they deform to a more vertical structure along axis  411 , the tissue gathering elements  402 ′ and  402 ″ will present the greatest amount of contact and the greatest amount of bearing area on effected tissue possible as the device  400  is rotated. 
       FIG. 84E  provides a top view of this embodiment of the device  400  as produced or once implanted. In this embodiment, the elements  402 ′,  402 ″ both curve downward toward the proximal end of the device  400 . However, this view shows the elements  402 ′,  402 ″ out of plane (i.e. not in the same plane) which is a common position when advanced into tissue, particularly after rotation of the device  400 . Thus, the first tissue gathering element  402 ′ is shown set back from the second tissue gathering element  402 ″.  FIG. 84E  also illustrates that the coil design of the anchoring element  404  leaves an open passageway therethrough once deployed. Thus, anchoring of the device  400  does not impinge upon or block airflow through the airway within which the device  400  is anchored. 
       FIGS. 85-90  illustrate example method steps of delivering a device  400  having double tissue gathering elements  402 ′,  402 ″, such as in the device of  FIG. 84A . Referring to  FIG. 85 , the device  400  is loaded within the catheter  430  or other suitable delivery device such as a loading cartridge so that the tissue gathering elements  402 ′,  402 ″ are positioned near the distal end of the catheter  430 , ready for deployment. In this embodiment, the portion of device  400  that protrudes from the catheter forms a blunt tip that allows the catheter to be advanced through fragile airways or fragile lung tissue without causing trauma. In this embodiment, the catheter  430  includes at least one leverage element  700  which resides outside of the body when the distal end of the catheter  430  is positioned within the patient&#39;s body. The at least one leverage element  700  assist the user in manipulating the catheter  430 , such as applying torque to the catheter  430  or moving the catheter  430  longitudinally in the proximal or distal direction. In this embodiment, the device  400  is attached to a torqueing tool  408  which extends through the catheter  430  and exits the proximal end of the catheter  430 . In this embodiment, the torqueing tool  408  includes a torqueing handle  704  disposed near its proximal end to assist the user in grasping and applying torque to the torqueing tool  408 . In this embodiment, the device  400  is also attached to a tether  702  (e.g. suture, metallic wire (such as comprised of stainless steel, titanium, nitinol or other nickel based alloy), monofilament or multifilament fiber, braid, polymer or ceramic or glass fiber (such as comprised of Kevlar®, carbon fiber, nylon, polyurethane, polypropylene or other durable material)). The tether  702  may be used to manipulate portions of the device  400 , typically other than torqueing, such as pulling the anchoring element  404  in the proximal direction or removing the device  400 , to name a few. Thus, in this embodiment, the tether  702  includes a tether handle  706  disposed near its proximal end to assist the user in grasping and manipulating the tether  702 . The manipulating tether may also be a second torqueing tool that is located at proximal end of the anchoring element  404 .  FIG. 85  illustrates advancement of the distal end of the catheter  430  through at least one airway AW to a target location within a lung L. Thus, in this example, the distal-most end of the catheter  430  is disposed within an airway AW. Likewise, a blood vessel BV is shown residing nearby the airway AW along with alveolar or connective lung tissue surrounding the airway AW. It may be appreciated that  FIGS. 85-90  are not drawn to scale; rather, the distal and proximal ends of the delivery devices are prominent for focus and detail. It may be appreciated that the catheter  430  is much longer than depicted to allow for advancement through the trachea to various airways, including advancement along airways past the 4 th  generation. Likewise, it may be appreciated that the airway AW is illustrated as bisected for the purpose of clear viewing of the device  400  and delivery devices disposed therein. 
       FIG. 86  illustrates delivery of the tissue gathering elements  402 ′,  402 ″. Here, the tissue gathering elements  402 ′,  402 ″ are deployed by pushing the torqueing tool  408  in the distal direction which in turn pushes the device  400  toward the distal end of the catheter  430 , revealing the tissue gathering elements  402 ′,  402 ″. This allows each element  402 ′,  402 ″ to extend radially outwardly, through the airway wall W, and curve around through the tissue surrounding the airway AW. In this example, the tissue gathering element  402 ″ passes in front of the blood vessel BV. 
       FIG. 87  illustrates torqueing steps of the method. In this embodiment, the catheter  430  and device  400  together are rotated or torqued, such as by grasping the at least one leverage element  700  and applying a torqueing force. As the device  400  rotates, the tissue gathering elements  402 ′,  402 ″ gather up the tissue surrounding the airway AW, along with the blood vessel BV which is now shown wrapping around the airway AW. This step tensions the tissue, as indicated by the diagonal orientation of the lines depicting the tissue, by drawing in the surrounding tissue toward the device  400 .  FIG. 88  illustrates further withdrawal of the catheter  430 , such as by pulling the at least one leverage element  700  in the distal direction. Torque is maintained or adjusted with the use of the torqueing tool  408 . The torqueing tool  408  is attached to device  400  at the location such as the attachment feature  610 . 
     The device  400  is then anchored within the airway W, as illustrated in  FIG. 89 . In this embodiment, this is achieved by retracting the catheter  430  so as the expose the anchoring element  404  while maintaining position of the device  400  or pushing the anchoring element  404  in the distal direction by manipulation of the tether handle  706  to actuate the tether  702 . In this embodiment, the anchoring element  404  comprises a coil which expands against the inner surface of the airway AW. It may be appreciated that in some embodiments the coil is wound in the opposite direction as the torqueing applied to the tissue gathering elements  402 ′,  402 ″. Thus, over time, any unwinding of the device  400  will cause the coil to expand, further anchoring the device  400 . Referring to  FIG. 90 , the torqueing tool  408  and tether  702  are then disengaged from the device  400  and removed along with the catheter  430 . Thus, the device  400  is left behind as an implant. It may be appreciated that the implant is typically so securely positioned that it is unable to move around sufficiently to cause coughing and other uncomfortable symptoms for the patient. 
     It may be appreciated that in some embodiments, the torqueing tool  408  is configured to assist in detachment from the device  400 .  FIGS. 91A-91C  illustrate an embodiment of such a torqueing tool  408 .  FIG. 91A  illustrates a torqueing tool  408  comprising a shaft  720  having a hooked end  722 . The hooked end  722  is formed from an approximately 90 degree bend in the shaft  720  adjacent to its distal tip but the bend can range from 10 to 90 degrees to allow the hook to be easily pulled off the device  400  or it may range from 90 to 180 degrees to hook through and around the attachment end  406  (shown in  FIG. 91C ) of device  400  so traction is maintained. In addition, the shaft  720  has a curvature  724  set a distance proximally from the hooked end  722 . In some embodiments, the curvature  724  is disposed 0.05 to 1.0 inches from the hooked end  722  of the tool  408 . The curvature  724  bends the shaft  720  radially outwardly from a longitudinal axis  726  extending through the proximal end of the shaft  720 . In some embodiments, the curvature  724  bends the shaft  720  radially outwards by 0 degrees, wherein 0 is in the range of 1 to 90 degrees. The torqueing tool  408  is comprised of a flexible or resilient material which allows the curvature  724  to straighten when retracted into a tube or catheter  430 .  FIG. 91B  illustrates the tool  408  retracted within a catheter  430 . The hooked end  722  is sized to maintain its hooked shape while retracted within the catheter  430 . Thus, the length of the hooked end  722  (and therefore, overall width of the distal end of the torqueing tool  408 ) typically does not exceed 0.070 inches. Consequently, the torqueing tool  408  is able to remain attached to an attachment end  406  of a torque-based pulmonary treatment device  400  while the hooked end  722  resides within the catheter  430 . This allows the tool  408  to torque the device  400  as desired. Once the desired torqueing has been achieved, the torqueing tool  408  may be removed from the attachment end  406  by simply advancing the tool  408 . This allows the hooked end  722  to spring radially outwardly due to the preset curvature  724 , as illustrated in  FIG. 91C . This disengages the hooked end  722  from the attachment end  406 . The tool  408  can then be retracted into the catheter  430  once again and removed, leaving the device  400  behind. 
     In some embodiments, as illustrated in  FIG. 91D , the torqueing tool  408  includes a cross drilled end hole  725  which passes through the hooked end  722  of shaft  720 , so a hitch wire  727  can be threaded through the hole  725 . This holds the torqueing tool  408  in engagement with the device  400 , such as to the attachment end  406  or to an attachment fixation feature  610 . The end hole  725  may be drilled through the torqueing tool  408  in any orientation, relative to the axis along the length of the shaft  720  of the torqueing tool  408 .  FIG. 91D  illustrates the torqueing tool  408  that has been inserted through hole or slot of an attachment feature  610 . The hitch wire  727  has been threaded through the torqueing tool  408  end hole  725  to connect the torqueing tool  408  to the device  400 . In some embodiments, the hitch wire  727  is made from metallic wire, nitinol, suture, polymer, monofilament line, braided material, glass, organic fiber or shape memory NiTi wire. The distal end of the hitch wire  727  is typically shaped to form a non-straight end shape, such as a curl or loop, that is designed to create drag or pulling resistance as it is pulled through the torqueing tool  408  end hole  725 . This prevents the hitch wire  727  from accidentally being pulled out prematurely. In some embodiments, the hitch wire  727  is a suture that is threaded through the end hole  725  and tied to form a complete loop that is exposed outside the delivery system so as to be accessible to the user. By forming a loop, the hitch wire  727  cannot be accidentally removed. Alternatively, the user can easily cut the loop and withdraw the hitch wire  727  at any time the torqueing tool  408  needs to be removed from device  400 . 
       FIG. 92  outlines steps of an example method of treating a patient with a torque-based pulmonary treatment device  400 . To begin, the first step  800  describes that the device  400  is advanced into a lung. It may be appreciated that in some embodiments such advancement is through the mediastinum, through the trachea, through an airway, through the chest wall, through an opening in the chest, through blood vessels, through wall or barriers that define the previously described structures in the body or between ribs, to name a few. Likewise, in some embodiments, such advancement is with the use of a trocar, guide introducer, catheter, endoscope or bronchoscope. The second step  802  describes coupling the device  400  to lung tissue. In some embodiments, such coupling includes pulling back to engage the lung tissue, advancing to engage the lung tissue, rotating to engage the lung tissue, unsheathing at least a portion of the device  400  to allow expansion of the device  400 , unsheathing at least a portion of the device  400  to allow bending of the device  400 , advancing at least a portion of the device  400  through an airway wall, removing a constraint to allow expansion of the device  400  (such as removing a sleeve, removing a pin, removing a hitch wire, cable or knot, melting a polymer, unzipping a seam, splitting a sheath wall, applying a current to melt a metal connection, etc.), deploying a balloon to expand at least a portion of the device  400 , pulling a draw string to actuate at least a portion of the device  400 , pushing a push rod to actuate at least a portion of the device  400 , shortening a structure to radially expand at least a portion of the device  400 , pulling a tether to pull at least a portion of device  400 , bending or rotating a torqueing tool to rotate at least a portion or feature of device  400 , barbing at least a portion of the device  400  into tissue, or allowing self-expansion of at least a portion of the device  400 , to name a few. The third step  804  describes rotating the device  400  to apply torque to lung tissue. In some embodiments, such rotation includes twisting to apply torque, pulling tissue along tangent, pulling tissue in an arc direction, curvilinear pulling, creating tension along a perpendicular plane relative to a longitudinal axis of the device, non-uniaxial tensioning of tissue, lung volume reduction by rolling tissue around a hub or tissue gathering element  402  spooling tissue on the device, winding tissue around the device, shortening tissue in the lung by winding, compressing lung volume or reducing lung volume by compressing tissue around a tissue gathering element  402  or by compressing tissue by wrapping tissue over itself as it&#39;s wound around a tissue gathering element  402  to name a few. Optionally, a fourth step  806  is included which describes pulling the device  400  to create a uni-axial displacement, translation, stress, strain or tension in the lung. And the fifth step  808  describes anchoring the device  400  within the lung. In some embodiments, this includes releasing stored elastic energy to engage an anchoring element  404 , hooking an anchoring element  404  into tissue, expanding the anchoring element  404  against lung tissue or otherwise coupling the anchoring element  404  to lung tissue so counter rotation of device  400  is resisted by the tissue the anchoring element  404  is coupled to. 
       FIG. 93  illustrates an embodiment of the placement of two torque-related pulmonary treatment devices (a first torque-related pulmonary treatment device  400 ′ and a second torque-related pulmonary treatment device  400 ″). In this embodiment, each device  400 ′,  400 ″ is comprised of a tissue gathering element  402   a  and another tissue gathering element  402   b , each extending outwardly and then curving around and back in a loop shape, such as illustrated in  FIG. 84A . Likewise, the first device  400 ′ includes a first anchoring element  404 ′ and the second device  400 ″ includes a second anchoring element  404 ″. Referring back to  FIG. 93 , the first torque-related pulmonary treatment device  400 ′ is positioned so that its tissue gathering elements  402   a ,  402   b  are disposed within a first airway AW 1 . Similarly, the second torque-related pulmonary treatment device  400 ″ is positioned so that its tissue gathering elements  402   a ,  402   b  are disposed within a second airway AW 2 . Torque is applied to each device  400 ′,  400 ″ either simultaneously or in series, so that their tissue gathering elements  402   a ,  402   b  to gather up the surrounding tissue (as indicated by the twisted configuration of the blood vessels BV). In some embodiments, torque is applied to the first device  400 ′ in a first direction and torque is applied to the second device  400 ″ in an opposite direction. In any case, torqueing re-tensions the lung, as described hereinabove. In this embodiment, the devices  400 ′,  400 ″ are then both anchored within a common airway proximal to the first and second airways AW 1 , AW 2 , such as in an ostium OS. In this embodiment, each anchoring element  404 ′,  404 ″ has the shape of a coil. In such embodiments, it is desirable that the coil is wound in a direction opposite to the direction of the torque/rotation of the tissue gathering elements  402   a ,  402   b . Thus, any unwinding of the torque would further expand the corresponding anchoring element. In  FIG. 93 , the anchoring elements  404 ′,  404 ″ are positioned within the ostium OS so as to overlap with each other. In some embodiments, the anchoring elements  404 ′,  404 ″ are positionable so as to overlap and in other embodiments, the anchoring elements  404 ′,  404 ″ are manufactured as intertwined so as to be delivered in an intertwined configuration. In any case, the anchoring elements  404 ′,  404 ″ take up minimal space when positioned in the same or overlapping portions of the ostium OS or airway. Likewise, when the devices  400 ′,  400 ″ are torqued in opposite directions, the devices  400 ′,  400 ″ are able to counterbalance each other, thereby placing less load on the ostium OS or airway at the point of anchoring. 
       FIG. 94  outlines steps of an example method of treating a patient with two pulmonary treatment devices. The pulmonary treatment devices may be torque based or linear so as to lead to the following combinations: two linear pulmonary treatment devices  10 , two torque-based pulmonary treatment devices  400  or one linear pulmonary treatment device  10  and one torque-based pulmonary treatment device  400 . To begin, the first step  820  describes advancing a first pulmonary treatment device (torque-based on linear) into a lung at a first target location. The second step  822  describes advancing a second pulmonary treatment device (torque-based on linear) into the lung at a second target location. The third step  824  describes actuating the first and/or second pulmonary treatment devices to tension the lung. And, the fourth step  826  describes coupling the pulmonary treatment devices together to maintain tensioning of the lung. 
       FIG. 95  outlines steps of an example method of treating a patient with a pulmonary treatment device while monitoring with imaging. The pulmonary treatment device may be linear or torque-based. To begin, the first step  828  describes advancing the pulmonary treatment device into a lung. The second step  830  describes coupling a first portion of the pulmonary treatment device to lung tissue. The third step  832  describes manipulating the pulmonary treatment device to cause lung volume reduction. The fourth step  834  describes acquiring a chest image, such as via computed tomography (CT), fluoroscopy or any other imaging method or modality that has been described herein or other data may be assessed such as any of the measurable physiologic changes listed herein that indicate improved breathing in COPD patients. The chest image or data is then analyzed to determine if the diaphragm is desirably elevated (as described in the fifth step  836 ) or to determine if any of the measurable physiologic changes listed herein that indicate improved breathing in COPD patients has been shown. If not, the method is then repeated from the third step  832  wherein the pulmonary treatment device is further manipulated. If so, then manipulation ceases, as indicated in the sixth step  838 . The device is then anchored in place, as indicated in the seventh step  840 . 
       FIG. 96  outlines steps of an example method of treating a patient with a pulmonary treatment device while monitoring with the use of a ventilator. The pulmonary treatment device may be linear or torque-based. To begin, the first step  842  describes attaching the patient to the ventilator. The ventilator should be set to provide breathable gas into the patient until a constant peak pressure is achieved during each breathing cycle. The required volume of delivered breathable gas to achieve the constant peak pressure should be noted. The second step  843  describes advancing the pulmonary treatment device into a lung. The third step  844  describes coupling a first portion of the pulmonary treatment device to lung tissue. The fourth step  845  describes manipulating the pulmonary treatment device to cause lung volume reduction. The fifth step  846  describes monitoring a decrease in ventilation volume of breathable gas that is required to achieve the constant peak pressure. In some instances, a volume reduction of 20-1500 cc is desired, however, a volume reduction of 300-500 cc is typically considered desirable. The volume reduction is then analyzed to determine if it is sufficiently reduced (as described in the sixth step  847 ). If not, the method is then repeated from the fourth step  845  wherein the pulmonary treatment device is further manipulated. Alternatively, an additional device  400  may be installed to further reduce the volume of breathable gas that must be ventilated into the patient to achieve the constant peak pressure during each breathing cycle. If the volume reduction is sufficiently reduced (as described in the sixth step  847 ), then manipulation ceases, as indicated in the seventh step  848 . The device is then anchored in place, as indicated in the eighth step  849 . 
     In some embodiments, the torque-based pulmonary treatment device  400  is positioned in the lung by a surgical procedure, such as a minimally invasive video assisted portal procedure or an open procedure. In such embodiments, the device  400  is not anchored in place by stabilization within an ostium or airway. Rather, the device  400  is anchored within lung tissue by suturing or balancing torque forces.  FIGS. 97A-97C  illustrate an embodiment of a device  400  which may be positioned in the lung by a surgical procedure. Here, the device  400  has a first pair of tissue gathering elements  402   a ,  402   b , each tissue gathering element  402   a ,  402   b  extending outwardly radially outwardly from a longitudinal axis  411  and then curving around and back toward the longitudinal axis  411  in a loop shape, such as illustrated in  FIG. 84A . The device  400  also has a second pair of tissue gathering elements  402   c ,  402   d . In this embodiment, these tissue gathering elements  402   c ,  402   d  mirror the first pair of tissue gathering elements  402   a ,  402   b  around an axis  850  which is perpendicular to the longitudinal axis  411 . Thus, in this embodiment, both pairs of tissue gathering elements ( 402   a ,  402   b ) ( 402   c ,  402   d ) extend radially outwardly from the longitudinal axis  411  and then curve toward the axis  850  before curving back toward the longitudinal axis  411 . In some embodiments, the device  400  includes a coupler  852  to connect the tissue gathering elements  401   a  and  402   b  and possibly the anchoring elements  402   c  and  402   d . In some embodiments, the device  400  includes an attachment feature  854  which is used to attach a torqueing tool  408  to the device  400  to rotate the distal end of device  400  to apply torqueing loads to the surrounding lung tissue. A suture or other fixation device may be used to attach the attachment feature  854  to the lung tissue within the lung L. 
       FIG. 98  illustrates the device  400  of  FIGS. 97A-97C  in use.  FIG. 96  shows access to lung tissue of the lung L with the use of a trocar or cannula  860 . The device  400  loaded within a distal end of delivery catheter  430  and the distal end of the catheter  430  is advanced through the cannula  860  to a target location within the lung L. The first pair of tissue gathering elements  402   a ,  402   b  are then deployed and torqued so as to gather up a first portion of lung tissue LT 1 . The second pair of tissue gathering elements  402   c ,  402   d  are then deployed and torqued so as to gather up a second portion of lung tissue LT 2 . In this embodiment, the first portion of lung tissue LT 1  and the second portion of lung tissue LT 2  are torqued in opposite directions. Such torqueing in opposite directions creates a counter-balance, anchoring the device  400  in place. Alternatively or in addition, the device  400  may be anchored in place by joining the fixation feature  854  to the lung tissue with the use of a fixation element, such as a suture, staple, tissue glue, coagulated blood or by using other devices that are sufficiently biocompatible and designed to connect tissue and device components to tissue. 
     It may be appreciated that in some embodiments, one or more torque-based pulmonary treatment devices  400  may be used to “wad up” tissue, so as to close off airways, close communication of gas in diseased tissue or close off gas exchange in the lung. This may be utilized to tune where preferential filling occurs. Thus, it may be desired to block flow to severely diseased parts of the lung so that filling preferentially occurs in the less severe parts of the lung. Any devices described herein may be used to block the flow of gas in one or both directions to cause atelectasis or shrinkage of volumes of the lung. Ideally, portions of the lung can be completely blocked off to cause atelectasis. Such methods may also may be used to stop chronic air leaks in lung fistulas that are currently very difficult to treat effectively. Such small leaks in the pleura typically cause repeated pneumothorax incidents. Thus, the torque-based pulmonary treatment devices may be a minimally invasive treatment to block the leak by twisting tissue to block air flow. 
     Additionally, these devices and methods may be used to block, reduce or generally regulate the flow of blood through the lung so as to minimize the flow of insufficiently or minimally oxygenated blood that flows through areas of lung with severe damage. Patients will benefit by reducing the flow of blood that is under-oxygenated because mixing this blood with fully oxygenated blood, as the blood streams exit the lungs, allows for oxygen dilution that leads to reduced oxygen as a percentage of blood volume in the patient&#39;s vascular system. Blocking the flow of under-oxygenated blood before the blood exits the lungs actually increases the percentage of blood oxygen in the patient&#39;s system. The other benefit to blocking the flow of blood through areas in the lung that are severely damaged by emphysema is that the CO2 that is normally not sufficiently transported out of the blood in these damage regions so it should not be allowed to be mixed with low CO2 or normally conditioned blood where the blood streams combine and exit the lungs. By blocking blood flow in severe areas of the lung, the blood that does exit the lungs carries a higher percentage of oxygen and a lower percentage of CO2 than the levels of these gases that would otherwise be present in typical emphysema or COPD patients. 
     E. Placement 
     Many of the pulmonary treatment devices (torque-based and linear) described herein may be placed in any lung, lobe, mainstem segment, segment, sub-segment or even farther down the airway tree. Likewise, many of the devices may be placed directly through the chest wall into the lung or through the wall of the main bronchi to access pockets of destroyed parenchyma. Many of the devices may be implanted via open chest procedure or with the use of any type of endoscope. 
     The number, type and placement location of the devices are chosen to best treat the disease type and disease state of the patient. Restoring tension and lung elastic recoil in the lung with these devices mitigates the symptoms typically experienced by COPD patients and patients suffering from other lung conditions. The devices described herein are capable of producing a tremendous amount of work to tension lung tissue. These lung treatments have been shown to induce biologic feedback in the lungs that further enhances the reduction of symptoms, restoration of lung elastic recoil, enhancement of the lifting displacement of the diaphragm and general restoration of breathing mechanics in patients. Treatment magnitude, during each device deployment, is controlled by controlling the amount of force that is placed on the tissue, the linear distance that the proximal or distal end of the device is translated or the amount of rotation that is applied to a treatment device that acts upon tissue with the application of torque. Additionally, linear force and linear translation as well as the application of torque may be combined with any of the embodiments provided herein to enhance the amount of work performed on the lung tissue. By controlling these forces, a patient may be treated with one or more devices in a single major lobe of the patient&#39;s lung, more than one major lobe or all of the major lobes. It may be appreciated that a patient has four major lobes in the lung. It may also be appreciated that major lobes may also include the middle lobe in the right lung and the Lingula in the left lung of a patient. 
     In some embodiments, the first treatments target the lobes with the maximum amount of tissue damage, as can be determined using quantitative computed tomography (CT) analysis (CT image file post processing) that analyzes the least dense portions of the lung. Any number of CT analyses may be studied to determine the most severe portions of each lobe and the magnitude and nature of the damage. Patients with heterogeneous lung damage typically present with severely damaged upper lobes and generally preserved lower lobes. These patients should be treated with implantation in the upper lobes and possibly not in the lower lobes during the initial treatments. If the patient doesn&#39;t respond adequately, additional devices may be implanted and those may be added to the upper lobes or they may be implanted in the lower lobes to balance the tensioning forces in the lungs. 
     Homogeneous patients generally present with mild to severe damage in all four major lobes. It is preferable to treat one, two or three lobes in a single lung during a single intervention or implantation event so that mucus, bacteria, fungus or other infectious contaminants are not transferred from one lung to the other during a treatment. That way bilateral infections are avoided. If all major lobes are to be treated, it is preferable to treat each lung during one of two total procedures. A single lobe may be treated during a single procedure or a combination of lobes may be treated during a series of treatments. If the delivery methods described herein may be used to deliver into a patient each device  400  in less than 10 minutes or with the use of 10 or less minutes of energized fluoroscope time, patient risk to x-ray exposure and risk of hypoxemia will be reduced. In homogeneous patients, it is important to treat at least all four major lobes. In order to uniformly lift the diaphragm, all patients preferably benefit by receiving treatment in at least one lobe in each of the patient&#39;s two lungs. Treatment success requires that the treatment gathers a threshold amount of relatively loose tissue to a slightly tightened condition that is approximately physiologically normal. If a patient does not respond positively to a treatment, this only indicates that the dose was not sufficient and more devices should be placed to transcend the threshold minimum tissue displacement to tension the loose elongated tissue, hold airways open to allow expiration of gas during exhale events and to lift the diaphragm enough to restore diaphragm pumping motion. The pulmonary function tests listed herein are excellent indicators of positive and adequate response. 
     It may be appreciated that the more severely affected patients may require treatments that are delivered in stages that progressively build a dose level to accomplish several possible outcomes. For these patients, low doses may result in some elimination of slack in the lung tissue but inadequate tensioning to lift the diaphragm enough or it may provide an inadequate dose to delay airway closure during exhalation. With implantation of additional devices, the patient may experience sufficient tensioning to lift the diaphragm and hold airways open enough to show positive reduction of symptoms described herein but not enough of a dose to adequately tension the majority of the lung volume. With implantation of additional devices, the patient may show positive reduction of symptoms on a large number of the symptoms listed herein. At this stage, the treatment may be successful, but the duration of the benefit may still be improved. Implantation of a larger number of devices or implantation with a higher degree of displacement, force, or torque (or higher level of a combination of displacement, force, and torque) will present such a high degree of stress and strain on the lung tissue that it responds in the same way that tissue responds to typical tissue injury. This can be quite beneficial to the patient. 
     The lung tissue is quite radio transparent using typical medical imaging such as fluoroscopy, computed tomography (CT), and X-ray imaging. However, if the lung tissue is stressed sufficiently, the tissue hydrates and this presents in images as consolidation with opacities that sometime present with local consolidates. The tissue goes into a wound healing cascade that manifests as opacities in the tissue between devices, between devices and the pleura, and between anatomical features of the lung. Wherever the tissue is stressed and strained sufficiently, bands of opaque shades present in the images that indicate that the treatment dose has been applied sufficiently to yield a maximum effect that is possible in these severe COPD and emphysema patients. As the wound healing cascade progresses, the end stage presents as tissue healing and contraction which further enhances the lifting of the diaphragm and tensioning of the lung tissue throughout the patient&#39;s lung. This contraction adds a high impact to boost the benefit of the treatment and the combination of slight scaring in the contracted tissue seems to reinforce the tissue in a way that allows the effect to be maintained for long periods of time such as 1 to 10 years but normally 3-5 years. The wound healing cascade can be managed using steroidal treatments to control the rate of healing, slightly alleviate contraction and the magnitude of effect. This also manages the pain that is sometime associated with the high degree of tensioning that this presents. In addition, this minimizes symptoms that often lead the attending physicians into erroneously believing that the patient suffers from pneumonia, such as elevated body temperature and flu symptoms. Additionally, because these patients already present with compromised immune mechanisms, they are more susceptible to the effects of infection and colonization of inherent fungus in the lung, so the use of steroid treatment to manage stress induced opacity, is recommended. Normally antibiotic treatments tend to mitigate the effect of steroids so a mix of antibiotic treatments may be prescribed but the major drug regimen should be dominated by steroids or some nonsteroidal anti-inflammatory drug such as the (NSAID) class that is commonly referred to as Ibuprofen. 
     After straining lung tissue, airway walls, blood vessels, pulmonary arteries, pulmonary veins, alveoli, alveolar ducts, smooth muscle, interstitial connective tissue, capillary beds, elastic fibers and collagen fibrils sufficiently to cause a wound healing response, the inflammatory phase is the first phase of healing and is characterized by hemostasis and inflammation. Hemostasis is initiated during the exposure of collagen during wound formation that activates the intrinsic and extrinsic clotting cascade in the available vasculature. In addition, the injury to tissue causes a release of thromboxane A2 and prostaglandin 2-alpha to the wound bed causing a potent vasoconstrictor response. Furthermore, the extravasation of blood constituents provides the formation of the blood clot reinforcing the hemostatic plug. This initial response helps to limit hemorrhage and provides an initial extracellular matrix for cell migration. Platelets are among the first response cells that play a key role in the formation of the hemostatic plug. They secrete several chemokines such as epidermal growth factor (EGF), fibronectin, fibrinogen, histamine, platelet-derived growth factor (PDGF), serotonin, and von Willebrand factor. These factors help stabilize the wound through clot formation and also attract and activate macrophages and fibroblasts. They also act to control bleeding and limit the extent of injury. Platelet degranulation activates the complement cascade, specifically C5, a potent neutrophils chemotactic protein. Vasoactive mediators and chemokines are released by the activated coagulation cascade, complement pathways, and parenchymal cells which play a key role in the recruitment of inflammatory leukocytes to injured skin. 
     After hemostasis is achieved, capillary vasodilatation and leakage result secondary to local histamine release by the activated complement cascade. The increased blood flow and altered vascular permeability allow for the migration of inflammatory cells to the wound bed. The presence of foreign organisms further stimulates the activation of the alternate complement pathway. Complement C3 activation results in a cascade of non-enzymatic protein cleavage and interactions that eventually stimulate inflammatory cells and the lysis of bacteria. 
     The second response cell to migrate to the wound after complement activation and platelet recruitment is the neutrophil. It is responsible for debris scavenging, complement-mediated opsonization and lysis of foreign organisms, and bacterial destruction via oxidative burst mechanisms (i.e., superoxide and hydrogen peroxide formation). Neutrophils kill bacteria and decontaminate the wound from foreign debris. These wastes are later extruded with the eschar or phagocytosed by macrophages. Macrophages are important phagocytic cells that play a key role in wound healing. They are formed from monocytes stimulated by fragments of the extracellular matrix protein, transforming growth factors and monocyte chemoattractant protein 1. In addition to direct phagocytosis of bacteria and foreign materials, macrophages secrete numerous enzymes and cytokines; collagenases, which debride the wound; interleukins and tumor necrosis factor (TNF), which stimulate fibroblasts and promote angiogenesis; and transforming growth factor (TGF), which stimulates keratinocytes. Macrophages also secrete platelet-derived growth factor and vascular endothelial growth factor which initiate the formation of granulation tissue and thus initiate the transition into the proliferative phase and tissue regeneration. 
     The proliferative phase is the second phase of wound healing and it is marked by epithelialization, angiogenesis, granulation tissue formation, and collagen deposition. Epithelialization occurs within hours after injury in wound repair. With an intact basement membrane, the epithelial cells migrate upwards in the normal pattern as occurs in a first-degree skin burn whereby the epithelial progenitor cells remain intact below the wound and the normal layers of epidermis are restored in 2-3 days. If the basement membrane has been damaged, then the wound periphery re-epithelializes the wound. Neovascularization is necessary to deliver nutrients to the wound and help maintain the granulation tissue bed. Angiogenesis has been attributed to many molecules including fibroblast growth factor, vascular endothelial growth factor, transforming growth factors, angiogenin, angiotropin, angiopoietin  1 , tumor necrosis factor alpha, and thrombospondin. In emphysematous lung tissue where there is little to no vascularization, this critical nutrient supply by capillaries is insufficient to sustain the tissue deposition in the granulation phase and may result in a chronically unhealed wound in some portions of the patient&#39;s lungs. The proliferative phase ends with granulation tissue formation. This new stroma begins to invade the wound space close to four days after injury. The new blood vessels at this time have provided a facilitated entry point into the wound to cells such as macrophages and fibroblasts. Macrophages continue to supply growth factors stimulating further angiogenesis and fibroplasia. The secreted platelet-derived growth factor and transforming growth factors along with the extracellular matrix molecules stimulate fibroblasts differentiation to produce ground substance and then collagen. Fibroblasts are the key players in the synthesis, deposition, and remodeling of the extracellular matrix providing strength and substance to the wound. 
     The third and final phase of wound healing is the maturational phase. This is characterized by the transition from granulation tissue to scar formation. Close to two weeks after injury, the wound undergoes contraction, ultimately resulting in a smaller amount of apparent scar tissue. Collagen deposition by fibroblasts continues for a prolonged period with a net increase in collagen deposition reached after three weeks from tissue injury. The entire process is a dynamic continuum dictated by numerous growth factors and cells with an overlap of each of the three phases of wound healing to provide continued remodeling. The wound is estimated to reach its maximal strength at one year, with a maximal tensile strength that is 70% of normal lung parenchyma. 
     F. Implant Removal 
     It may be appreciated that in some instances the device  400  may need to be removed. It may be determined that the device  400  may need to be removed to be repositioned if the initial deployment isn&#39;t ideal or this may be determined after the deployment has been performed. If the initial deployment has been misplaced or too much torque has been applied to the tissue, it may be desired to recapture and adjust the device  400  to remove torque based stress on the lung tissue. Or it may be desired to recapture and adjust the device  400  to reduce linear or uniaxial tension that the device  400  is imparting on the lung tissue. It may also be appreciated that a torqueing tool  408  may be releasably coupled to the far proximal end of the device  400  at an attachment feature  610  near the proximal end that allows the user to control the deployment of the anchoring element  404  and to allow for the possibility of removing the device  400  in an orderly manner. 
     G. Torqueing Tool 
     It may be appreciated that in some instances the torqueing tool  408  is provided to the end user already attached to device  400 . In some embodiments, one or more torqueing tools  408  are releasably attached to the device  400  during a manufacturing step to spare the end user from making the attachments during the procedure. In other embodiments, the tool  408  is attached by the user, such as just before delivering device  400  to the patient or while delivering device  400  to the patient. In some embodiments, the torqueing tool  408  is made from metal or organic materials such as carbon fiber, ceramic, plastic, glass or a combination of these materials. In some embodiments, the torqueing tool  408  is terminated with a handle or a wire form loop that can accommodate a finger or thumb to facilitate rotation. The distal end section of the torqueing tool  408  is resilient so as to pass through bends in human anatomy or common bends in a typical endoscope or bronchoscope. However, stiffness of the shaft  720  may vary to reliably transmit torque efficiently. 
     In some embodiments, torque transmission is such that a single turn at the control or user actuated end results in at least 1/10 th  of a rotation or more at the device  400  end. The torqueing tool  408  may be inserted through a hole, slot or loop in the device  400  to retain the torqueing tool  408  so torque transmission may be communicated to device  400 . The torqueing tool  408  may be snap fit, interference fit, or loosely fit through the device  400  attachment feature  6104  so that it may be easily removed during a desired time. As described previously, the distal tip of the torqueing tool  408  may be cross drilled to accept a hitch pin, wire or thread that locks the torqueing tool  408  engaged in the attachment feature  610  of device  400  until such time as the hitch pin, wire or thread has been pulled out or broken to allow the release of the torqueing tool  408 . 
     H. Distal Tip 
     As mentioned previously, the distal tip  405  of the tissue gathering elements  402  may have a variety of forms. As previously shown in  FIG. 63A , in some embodiments, the distal tip  405  is atraumatic and has a blunt shape, such as a ball or other rounded shape. In this configuration, the tissue gathering element  402  may be more inclined to track along the inside lumen of an airway if the airways are still preserved. However, in nearly all cases, they are not. If the distal tip includes a ball that is smaller than 0.060 inches diameter, it will still be capable of penetrating the wall of an airway to engage connective alveoli instead of manipulating airways alone. In other embodiments, as previously shown in  FIG. 63B , the distal tip  405  has a sharp shape, configured to pierce and/or penetrate tissue. In other embodiments, as previously shown in  FIG. 63C , the distal tip  405  has an anchoring shape, such as a fish-hook or other shape which is configured for piercing or penetrating tissue while resisting withdrawal from the tissue. 
     As mentioned previously, in some embodiments, the device  400  is made from round wire and in some embodiments the round wire has been flattened at the distal tip or any other portion of the tissue gathering element  402  to add bearing area. Likewise, in other embodiments, the device  400  is made from ribbon which already has a flattened shape. In such instances, the ribbon can optionally be twisted so as to form the distal tip  405 .  FIG. 99A  illustrates such twisting of a ribbon  900 . Here, the ribbon  900  is shown extending in a plane wherein its free end  902  is twisted 90 degrees so as to reside in a perpendicular plane. 
       FIGS. 99B-99D  illustrate additional embodiments of distal tips  405  having twisted ends.  FIG. 99B  illustrates a portion of a tissue gathering element  402 , particularly its distal tip  405 . Here, the distal tip  405  is formed from a ribbon  900  that is twisted so that its free end  902  is flat forming a planar surface  903  that resides in a plane configured to maximize contact area with tissue when engaging the tissue gathering elements  402  with the tissue, such as during torqueing. In some embodiments, the twist is approximately 90 degrees, however it may be appreciated that any amount of twist may be used including various degrees up to 90 degrees or in a range of 1 to 90 degrees. In other embodiments, the twist is beyond 90 degrees. In addition, in this embodiment, the edge  904  of the free end  902  is blunt or rounded. This assists in smooth advancement of the distal tip  405  through delivery devices.  FIG. 99C  illustrates another embodiment of the distal tip  405  formed from a ribbon  900  that is twisted so that its free end  902  is flat forming a planar surface  903  that resides in a plane configured to maximize contact area with tissue when engaging the tissue gathering elements  402  with the tissue, such as during torqueing. In this embodiment, the edge  904  of the free end  902  has a point  906  to assist in forward penetration but has angled corners  908  straddling the point  906  so as to reduce any friction or digging into delivery devices during advancement.  FIG. 99D  illustrates another embodiment of the distal tip  405  formed from a ribbon  900  that is twisted so that its free end  902  is flat forming a planar surface  903  that resides in a plane configured to maximize contact area with tissue when engaging the tissue gathering elements  402  with the tissue, such as during torqueing. In this embodiment, the edge  904  of the free end  902  has an elongate taper ending in a ball  914 . In some embodiments, this distal tip  405  is formed by putting a very slow long taper on the ribbon  900  and melting its tip back to form the ball  914 . 
     Example System for Torque-Based Treatment 
     Both the pulmonary treatment device  10  and the torque-based pulmonary treatment device  400  are sized and configured to be delivered by a delivery device that is insertable into the lung, such as a steerable scope (e.g. bronchoscope  20 ), catheter or other delivery system. As described previously, such as in relation to  FIGS. 31A-31B , an example delivery device is a bronchoscope  20 . In this example, the bronchoscope  20  includes a bronchoscope body  200  and an insertion cord  202 . The insertion cord  202  is advanced into the endobronchial tree of the patient and the bronchoscope body  200  remains outside of the patient, typically grasped by the operator&#39;s non-dominant hand. The insertion cord  202  contains a fiberoptic bundle for light and image transmission, tip bending control wires and a working channel. The working channel continues into the bronchoscope body  200 , exiting at the working channel port  204 . The working channel  210  extends through the tip  208 , allowing delivery of the pulmonary treatment devices  10 ,  400  therefrom. 
     In some embodiments, the pulmonary treatment device  10  is loaded directly into the working channel port  204  and advanced through the working channel  210  for delivery from the insertion cord tip  208 . However, in other embodiments, the device  10  is pre-loaded into an introducer which is advanceable into the working channel  210  for delivery therefrom. 
       FIG. 32  previously illustrated an embodiment of an introducer  220  having a pre-loaded pulmonary treatment device  10 . In this embodiment, the introducer  220  comprises an elongate tube  222  having a first end  224  and a second end  226 . The introducer  220  is typically strong enough to keep the device  10  from distorting from a straight configuration and hard enough that the device  10  cannot indent into the wall of the introducer  220 , particularly during the sterilization process that involves heating to 130-180° C. 
       FIG. 100  illustrates an embodiment of a torque-based pulmonary treatment device  400  prepared for pre-loading in an introducer  220 . Here, the device  400  is prepared for pre-loading by having the torqueing tool  408 , hitch wire  727  and tether  702  attached thereto. In particular, the torqueing tool  408  is attached to an attachment feature  610  on the device  400 . Thus, the torqueing tool  408  is able to torque the device  400  by rotation of its handle. In this embodiment, its handle has a loop shape for easy grasping and rotational leverage. The hitch wire  727  is attached to the torqueing tool  408  to maintain its engagement as previously described in relation to  FIG. 91D . In this embodiment, its handle has a T shape for ease of pulling and pushing the hitch wire  727 . The tether  702  is attached to the anchoring element  404  and its handle is shaped for ease of use and to distinguish from the other handles. These tools (i.e. torqueing tool  408 , hitch wire  727 , tether  702 ) extend through the introducer  220  so that the device  400  resides beyond the first end  224  of the introducer  220  and the handles of the tools reside proximal to the second end  226  of the introducer  220 . Thus, in this arrangement, the device  400  is not confined within the introducer  220  in a straightened configuration. In some instances, implantable materials, such as nitinol, can be damaged if they are stressed in packaging and then exposed to heat that exceeds 25 degrees C. during shipment as the stress on the device is elevated with the additional heat. In some embodiments, the device  400  is packaged in this manner so that any heating due to transit or sterilization will not introduce any potential damage or inadvertent shape setting while the device  400  is constrained in a straightened configuration. It is advantageous to ship the device  400  in an unstressed configuration. It is also advantageous to ship the device  400  in an unstressed configuration but already attached to the torqueing tool  408 , tether  702  and the hitch wire  727  so the assembly does not have to be attached by the user and the device  400  may be quickly and easily be retracted into the introducer  220  by simply pulling on one or more of the attached tools to pull device  400  into the introducer  220  through the first end  224 . 
       FIG. 101  illustrates the device  400  preloaded into the introducer  220 . This can be achieved by retracting the device  400  into the introducer  220  by pulling the tether  702 . Alternatively, or in addition, the introducer may be advanced over the device  400 . Finally, device  400  may be advanced into the introducer  220  by advancing the tissue gathering element  402  into the introducer  220  by inserting it into the second end  226  of the introducer  220 . Thus, the device itself is disposed within the introducer  220  while the handles of the torqueing tool  408 , hitch wire  727 , tether  702  extend from the second end  226  of the introducer  220 . The introducer  220  is then ready to be advanced into or coupled to a bronchoscope  20  working channel or a catheter  430  or similar delivery device which is advanceable through a lumen in the bronchoscope  20 . The device  400  is constrained within the catheter  430  to allow for ease of advancement through the bronchoscope. The device  400  remains within the catheter  430  until the distal tip of the catheter  430  is desirably positioned within the lung L. Alternatively, a guidewire  313  may be used to guide the catheter  430  through and distal to the bronchoscope  20  to an optimal position within the lung L before the introducer  220  is coupled to it. 
     As illustrated in  FIG. 102 , the distal tip of the catheter  430  is advanced beyond the distal tip of the bronchoscope  20 . This allows the catheter  430  to reach locations that are beyond the reach of the bronchoscope  20  due to size constraints (i.e. the smaller diameter of the catheter  430  can pass through small diameter or contorted passageways that the larger diameter bronchoscope is restricted from entering). Thus, in some instances, the catheter  430  is able to reach far distal portions of the lung L, such as the apical portions of the upper lobes and the lateral corners of the lower lobes, which are typically unreachable by the bronchoscope alone. 
     Once the distal tip of the catheter  430  is positioned near a target location for placement of the treatment device  400 , the device  400  is deployed. Deployment from the catheter  430  may be achieved by a variety of methods or a combination of multiple methods. In this embodiment, the device  400  is pushed beyond the catheter  430 , such as with the use of the torqueing tool  408 , to allow the tissue gathering element  402  bend toward its pre-formed or natural configuration (e.g. radially outwardly and around into a loop shape as illustrated in  FIG. 102 ). In this embodiment, the tissue gathering element  402  has a distal tip  405  having a free end  902  shaped as an elongate taper ending in a ball  914 . Thus, deployment allows the distal tip of the tissue gathering element  402  to engage the surrounding tissue, curving through and/or against the tissue. Such deployment may be in an airway or beyond the natural airways into damaged tissue, parenchyma, alveoli, artificially created passageways, disease created passageways or other types of lung tissue. 
     The device  400  is then rotated by applying torqueing, twisting or rotational force to at least a portion of the device  400  with the use of the torqueing tool  408 . As shown, the torqueing tool  408  includes a handle which is graspable by a user so as to manually applying the rotational force. Since the torqueing tool  408  is attached to the device  400 , the device  400  (and therefore tissue gathering element  402 ) rotates as well. This gathers up the surrounding lung tissue onto and around the tissue gathering element  402  as the element  402  rotates. Thus, loose parenchyma, portions of blebs and bullae, damaged alveolar sacs and other distended, slackened or stretched tissue is pulled inwardly, twisted and/or gathered up by the tissue gathering element  402 . Rotation continues, gathering the loose, slackened tissue, until desired tension is achieved in the tissue. 
     It may be appreciated that although such rotation is applied around the longitudinal axis  411 , such rotation may occur in the tissue around other axes. Such other axes may be at a variety of angles to the longitudinal axis  411  and on either side of the longitudinal axis. This may occur due to bending of portions of the device  400 , such as bending of the tissue gathering element  402 , during advancement of the tissue gathering element  402  or during rotation itself. Such bending may cause the torque applied around the longitudinal axis  411  to be transmitted around one or more different axes. Such other axes are typically in the range of 1 to 90 degrees from the longitudinal axis  411 . 
     It may be appreciated that the desired amount of torque imposed by the device may vary depending on the patient anatomy and disease state, to name a few. In some embodiments, the desired level of torque is determined by tactile feedback to the user. For example, in some instances, torque is applied until the user encounters desired resistance to rotation, ranging from minimal resistance to complete obstruction of further rotation. Such resistance may simply be felt by the user as manual rotation is attempted. Typically, torque is applied quite easily while slack tissue is gathered until a sudden increase in tension is reached. In some patients, a minimal amount of tension is desired wherein torque application is ceased as soon as the increase in tension is reached. In other embodiments, torque is measured by a torque measurement mechanism, such as a torque sensor, torque transducer or torque meter attached to or incorporated within the torqueing tool  408 . In some instances, torque sensors or torque transducers use strain gauges applied to a rotating shaft. With this method, a mechanism to power a strain gauge bridge is present as well as a means to receive the signal from the rotating shaft. This can be accomplished using slip rings, wireless telemetry, or rotary transformers, to name a few. In some embodiments, SAW devices are attached to the shaft and remotely interrogated. The strain on these tiny devices as the shaft flexes are read remotely and output without the need for attached electronics on the shaft. In other embodiments, torque is measured by way of twist angle measurement or phase shift measurement, whereby the angle of twist resulting from applied torque is measured by using two angular position sensors and measuring the phase angle between them. In some embodiments, a predetermined level of torque is established wherein the torque measurement mechanism indicates when the predetermined level of torque has been reached, such as by a visual or auditory signal or by obstruction of further rotation. In some embodiments, the predetermined amount of torque is approximately 0 to 3 in-oz, preferably approximately 0.1 to 0.5 in-oz, more preferably approximately 0.1 to 0.3 in-oz. 
     In other embodiments, torque is applied until a predetermined amount of rotation has been achieved. In some instances, the amount of rotation is visually monitored such as by watching rotation of the tissue gathering element  402  by visualization with a variety of methods, including fluoroscopy and/or imaging through a bronchoscope camera. Typically, when the desired amount of rotation is observed, the user ceases rotation. In other instances, the amount of rotation is measured by a rotational measurement mechanism, such as attached to or incorporated within the torqueing tool  408 . In some embodiments, a predetermined amount of rotation is established wherein the rotation measurement mechanism indicates when the predetermined level of rotation has been reached, such as by a visual or auditory signal or by obstruction of further rotation. In some embodiments, the predetermined amount of rotation is up to 10 degrees, up to 20 degrees, up to 30 degrees, up to 40 degrees, up to 45 degrees, up to 50 degrees, up to 60 degrees, up to 70 degrees, up to 80 degrees, up to 90 degrees, up to 100 degrees, up to 110 degrees, up to 120 degrees, up to 130 degrees, up to 135 degrees, up to 140 degrees, up to 150 degrees, up to 160 degrees, up to 170 degrees, up to 180 degrees, up to 225 degrees, up to 270 degrees, up to 315 degrees, up to 360 degrees, or over 360 degrees. 
     Once the lung L is desirably re-tensioned, the device  400  is anchored to maintain the rotated arrangement. This is achieved by deployment of the anchoring element  404 .  FIG. 103  illustrates such deployment. Here the catheter  430  is retracted to expose the anchoring element  404 . Here, the tether  702  is still attached to proximal end of the device  400 , particularly to the anchoring element  404 , and holds the anchoring element  404  in a stretched configuration. The anchoring element  404  is then expanded, such as by advancement of the tether  702  in relation to the torqueing tool  408 . Alternatively, or in addition, the torqueing tool  408  may be retracted. This assists in shortening the anchoring element  404 , allowing the coils to reform as illustrated in  FIG. 104 . It may be appreciated that anchoring may be verified by observation of any unwinding of the device  400 . Typically, any unwinding of the device  400  pulls on the airway until the airway is unable to rotate any further. Thus, anchoring is established. 
     The device  400  is then released, as illustrated in  FIG. 105 . The torqueing tool  408  is released from the device  400  by removal of the hitch wire  727 . Removal of the hitch wire  727  allows the hooked end  722  the torqueing tool  408  withdraw from the attachment feature  610 . Likewise, the tether  702  is removed from the anchoring element  404 . The tools (torqueing tool  408 , hitch wire  727 , tether  702 ) are then removed and the device  400  is left behind as an implant. 
     Patients suffering from severe COPD typically have a high chance of having an inflammatory response to implantation of the device  400 . In such instances, the inflammatory response can be beneficial to implantation since it typically causes higher volume contraction, lung volume reduction and lung tensioning. For such patients, a lower level of torque may be applied in anticipation of the effects of the inflammatory response. 
     It may be appreciated that in some embodiments, a similar inflammatory response is actively induced in a patient so as to obtain similar benefits. In some embodiments, the tissue gathering element  402 , or other portions of the device  400 , includes sharp edges which cause a fibrotic reaction or thickening of the tissue. This in turn causes increased contraction. In other embodiments, fibrosis is achieved by increasing tissue tension because the wound healing and the formation of scar tissue is accelerated. In some embodiments, the tissue gathering element  402 , or other portions of the device  400 , are texturized to enhance epithelium adhesion and fibrotic reaction around the implanted device  400 . For example, in some embodiments, the device  400  is texturized by etching lines along its surface, such as lines that are spaced 2-30 micrometers apart to help drive macrophage propulsion along the surface and to preserve macrophage health that minimizes collateral tissue growth formations that may occur in the airway. It may be appreciated that the tissue gathering element  402 , or other portions of the device  400 , may be coated to reduce infection. Examples of coating include silver plating, which is known to inhibit bacteria. Other coatings, coverings or plating materials may be applied to the device to inhibit colonization of bacteria, inhibit growth of granulation tissue, random collagen or other foreign growths that would compromise breathing. Coatings, coverings or plating materials may be provided to enhance epithelium attachment and health, cause fibrosis formation to enhance the structure of the emphysema lung tissue and to reduce friction between the device and delivery system components during delivery into the patient. It may be appreciated that any reduction of coating over time may be inconsequential since it may be most desired during and shortly after implantation. 
     In some embodiments, natural and/or induced inflammatory and wound healing responses are controlled with the use of agents, such as steroidal drugs. Coatings may be applied to the device to efficiently carry anti-inflammatory drugs to the lung airway in the form of a gel that rubs into the airway wall or lung tissue, in the form of a resorbable polymer that releases the drugs over time or in the form of film on the surface of the device. These drugs may include, for example, Sirolimus, Rapamune, Rapamycin, Paclitaxel, Taxol or a combination thereof. In some instances, such control may allow for more precise treatments, such as more precise levels of torque application depending on patient condition and anatomy. 
     In some embodiments, various therapies are used in combination with implantation of one or more devices  400 . For example, in some instances, radiotherapy is used in combination with implantation of one or more devices  400 . Radiotherapy or X-ray therapy cross-links and shrinks lung tissue so as to cause additional tissue contraction, tensioning the lung tissue which adds more elastic recoil and reduced compliance. 
     It may be appreciated that the methods, devices and systems provided herein may be used in combination with a variety of conventional treatments for COPD and other lung conditions. For example, in some instances, the methods, devices and systems provided herein may be used in combination with lung volume reduction surgery (LVRS). Likewise, in some instances, the methods, devices and systems provided herein may be used in combination with conventional implantable therapeutic devices, such as conventional endobronchial valves and conventional endobronchial coils. Example conventional endobronchial valves include those developed by Emphasys Medical (now Pulmonx—Redwood City, Calif.) as a minimally invasive alternative to lung volume reduction surgery for emphysema. Emphasys was purchased by Pulmonx in 2009, and Pulmonx currently markets the Zephyr® endobronchial valve (developed by Emphasys). Other example conventional endobronchial valves include those developed by Spiration (Seattle, Wash.) which was acquired by Olympus in 2010. Example conventional endobronchial coils include those developed by PnemRx (Mountain View, Calif.) which has been acquired by BTG. Based in London, BTG is an international specialist healthcare company that is active in interventional medicine and specialty pharmaceuticals. BTG has since been acquired by Boston Scientific. 
     Likewise, the methods, devices and systems provided herein may be used in combination with conventional lung airway bypass products that cause venting of trapped air, such as conventional pulmonary stents. Example conventional pulmonary stents include the Ultraflex™ Tracheobronchial Stent System (Boston Scientific), the Polyflex™ Self-Expanding Silicone Airway Stent (Boston Scientific) and the Dynamic™ (Y) Stent Bifurcated Tracheobronchial Stent (Boston Scientific). 
     Likewise, the methods, devices and systems provided herein may be used in combination with conventional devices that inject steam to cause tissue trauma, scarring and cell death, such as the InterVapor® Bronchoscopic Thermal Vapor Ablation (BTVA®) system which has returned to the market after a brief hiatus as the asset sale of Uptake Medical Corporation was being completed to Broncus Holding Co. A new company, Uptake Medical Technology, Inc was formed in Seattle, Wash., USA and has received a new CE Mark for the technology. Likewise, the methods, devices and systems provided herein may be used in combination with conventional sealants, such as the AeriSeal® System. The AeriSeal® System is foam-based lung sealant system wherein polymers are mixed and blown with air to create foam in the damaged regions of lung. The foam turns to a state like hard rubber blocking holes and damages in the lung and stays for several months while the lung shrinks in its normal size. The AeriSeal® System was developed by Aeris Therapeutics and was later acquired by Pulmonx®. 
     While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the scope of these claims and their equivalents be covered thereby.