Patent Publication Number: US-2021178134-A1

Title: Anchored dilator system and methods for same

Description:
PRIORITY APPLICATIONS 
     This application claims the benefit of priority to U.S. Provisional Patent Application Ser. No. 62/949,024, filed Dec. 17, 2019, the content of which is incorporated herein by reference in its entirety. 
    
    
     COPYRIGHT NOTICE 
     A portion of the disclosure of this patent document contains material that is subject to copyright protection. The copyright owner has no objection to the facsimile reproduction by anyone of the patent document or the patent disclosure, as it appears in the Patent and Trademark Office patent files or records, but otherwise reserves all copyright rights whatsoever. The following notice applies to the software and data as described below and in the drawings that form a part of this document: Copyright Surmodics, Inc. of Eden Prairie, Minn. All Rights Reserved. 
     TECHNICAL FIELD 
     This document pertains generally, but not by way of limitation, to medical devices for vascular access and navigation. 
     BACKGROUND 
     Catheters and other vascular accessing medical devices are introduced to vasculature and delivered to target locations within the vasculature with a variety of instruments. In one example, a catheter is delivered to a specified location in the vasculature with a collection of instruments including a needle, guidewire, dilator, introducer, guide catheter, catheter based instruments or the like. 
     The Seldinger technique is one example of a method that uses these instruments to introduce a catheter to the vasculature. A vessel is first penetrated through the skin with a needle. A guidewire is passed into the vessel through a lumen of the needle. The needle is withdrawn, leaving the guidewire in place. A dilator is fed over the guidewire, and an introducer sheath is fed over the dilator. The dilator and the introducer sheath are pushed along the guidewire and into the vessel. The dilator extends from the tip of the introducer sheath, and provides a transition from the guidewire diameter to the inner diameter of the introducer sheath. The dilator is removed leaving the introducer sheath and the guidewire in the vessel and extending from the penetration through the skin. A catheter is fed through the introducer sheath and over the guidewire to the specified location in the vasculature. 
     In other examples, after penetration and introduction of an introducer sheath, the vasculature is dilated with one or more dilators delivered along the guidewire to the specified target location. After dilation, the guide sheath is navigated through the dilated vasculature to the specified target location. The guide sheath includes a delivery lumen having an inner diameter that permits delivery of a therapeutic catheter, diagnostic catheter or other medical device (having an outer diameter smaller than the inner diameter of the guide sheath) to the specified target. 
     OVERVIEW 
     The present inventors have recognized, among other things, that a problem to be solved can include minimizing the devices and steps used for vascular access and delivery, and increasing the profile (e.g., diameter) available for medical devices delivered through the vasculature. The Seldinger technique for vascular introduction and similar techniques for navigation to specified vascular locations are example methods for accessing a specified vascular location. Multiple instruments are used in successive steps to provide access to a vessel and improve access through vasculature to a vascular location. For example, during introduction a needle penetrates the skin and vessel; a guidewire is delivered through the needle to the specified vascular location; the needle is withdrawn; one or more dilators dilate the penetration; and an introducer sheath is delivered over the guidewire (optionally with an intermediate catheter between the guidewire and the sheath inner diameter) to introduce the sheath through the penetration. 
     The intermediate catheter or dilator is removed, and a guide sheath or guide catheter is delivered over the guidewire, through the introducer sheath, and navigated to the specified vascular location. In a similar manner to the introducer sheath for introduction, in delivery one or more dilators are navigated along the guidewire to the specified vascular location to dilate the vessel. The dilator has a profile proximate to the outer diameter of the guide catheter or guide sheath. The dilator is removed, and the guide catheter (or sheath) is delivered along the guidewire and navigated through the dilated vessels to the specified vascular location. The guide catheter (or sheath) includes its own associated delivery lumen. One or more of therapeutic catheters, diagnostic catheters or other medical devices (collectively medical device), having a device profile smaller than the inner diameter of the guide catheter or sheath, are delivered through the delivery lumen to the specified vascular location. Accordingly, the guide catheter or guide sheath fills a portion of the vessel profile (e.g., based on its wall thickness) and the device profile of the medical device is thereby smaller than a corresponding guide profile of the guide catheter or guide sheath. 
     Each of these steps and the corresponding instruments are introduced in a staged method to achieve vascular introduction and delivery to the specified vascular location. The number of steps, instruments and staged introduction and removal of instruments are labor and time intensive. Additionally, the introduction of multiple instruments provides multiple vectors for infection. Further still, the delivery and placement of an introducer sheath and one or more of a guide catheter or guide sheath consumes space in the vessel otherwise available for medical devices. In some examples, for instance, with a transradial access (through the wrist) introducer sheath, guide catheter or sheath, or both fill a relatively large portion of the vessel diameter, and accordingly limit the profile of catheters and instruments (herein medical devices) delivered to the specified vascular location. 
     Further, introducer sheaths, guide catheters or guide sheaths or the like have corresponding profiles larger than the guidewire to facilitate the eventual passage and delivery of medical devices through delivery lumens. Introduction and delivery of the introducer sheath, guide catheter or guide sheath in a procedure over the narrower guidewire provides a steep transition that exposes the edge of the sheath or catheter. In some examples, the exposed edges engage with vessel walls (especially at bends) and increase the risk of trauma to the vessel, an effect sometimes referred to as ‘razoring’. An intermediate catheter is optionally provided between the guidewire and the guide catheter or guide sheath to provide a stepped interface. In at least some examples, the stepped interface continues to provide a relatively sharp edge at the end of the guide catheter or guide sheath having the increased risk of trauma. 
     The present subject matter helps provide a solution to these problems, such as with an anchored dilator system that marries the dilator with medical devices, such as a guide catheter, guide sheath or medical device (e.g., therapeutic or diagnostic catheter) for delivery to the specified vascular location. The intervening introducer sheath, guide catheter or guide sheath used in other methods is thereby optionally eliminated. The dilator of the system includes a dilator tip having an anchor cuff that transitions between a shuttle configuration and an anchored configuration. In the shuttle configuration, the anchor cuff is (relatively) compact, and the distal tip readily passes through the catheter lumen of the guide catheter. A distal nose of the distal tip is delivered through the catheter lumen and projects from the distal catheter portion. The anchor cuff, proximal to the distal nose, is received and remains within the catheter lumen. The anchor cuff is transitioned (e.g., expanded or deployed) to the anchored configuration. The anchored profile of the anchor cuff is larger than in the shuttle configuration, and engages with the catheter, for instance with an interior surface surrounding the catheter lumen. The distal tip of the anchored dilator is thereby anchored to the medical device in the anchored configuration. Optionally, a dilator transition of the dilator tip is deployed with operation of the anchor cuff. The dilator transition provides a flush (including near flush) transition between the tapered dilator nose and the catheter exterior surface of the medical device that conceals (at least partially) the otherwise exposed edge of the medical device, such as the guide catheter. Accordingly, snagging, trauma to the vessel or the like are minimized. Instead, the anchored dilator and the catheter (collectively medical devices) are a composite assembly having a consistent graduated profile. 
     The anchored dilator system of the medical device, such as a guide catheter, guide sheath, introducer sheath or medical device and the distal tip anchored to the guide catheter are delivered together. For example, manipulation of a push tube of the dilator navigates the dilator tip and the medical device anchored to the dilator tip through the vasculature (e.g., over a guidewire) to the specified vascular location. 
     By consolidating the dilator and the medical device (including a guide catheter, guide sheath, introducer sheath, therapeutic catheter, or other instrument) together with the anchor cuff both components are navigated to the specified vascular location at the same time. Additionally, time consuming and labor intensive steps, such as delivery of dilators, an introducer sheath, delivery of a guide catheter or guide sheath, and delivery of a catheter over a guidewire and through the guide catheter are minimized or eliminated. Instead, the anchored dilator described herein is anchored to the medical device (e.g., guide catheter, guide sheath, therapeutic or diagnostic catheter) and optionally directly delivered over the guidewire to the specified vascular location as a composite assembly. After the catheter is delivered, the dilator tip is transitioned to the shuttle configuration (e.g., the anchor cuff is compressed or relaxed) having a shuttle profile less than the lumen profile of the catheter. The dilator is readily withdrawn through the catheter delivery lumen, and optionally sterilized for future procedures. Further, because the anchored dilator is coupled to the medical device (either of the sheaths, catheters or the like described herein) for delivery to the specified vascular location the full profile of the vessel is available for the instrument without an intervening introducer sheath or the like that otherwise subtracts at least some of the vessel profile for later delivery of medical devices through a delivery lumen. Accordingly, access through smaller vessels, for instance in transradial approaches, is permitted with instruments that are otherwise too large when used with an introducer sheath and guide catheter and guide sheath. In some examples, instruments, catheters or the like typically used in femoral approach procedures are available for use in transradial approaches (e.g., through the wrist) with the anchored dilator system described herein. 
     This overview is intended to provide an overview of subject matter of the present patent application. It is not intended to provide an exclusive or exhaustive explanation of the invention. The detailed description is included to provide further information about the present patent application. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       In the drawings, which are not necessarily drawn to scale, like numerals may describe similar components in different views. Like numerals having different letter suffixes may represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document. 
         FIG. 1  is a perspective view of one example of one example of an anchored dilator system. 
         FIG. 2  is a sectional view of one example of an anchored dilator. 
         FIG. 3A  is a sectional view of one example of a dilator tip in a shuttle configuration. 
         FIG. 3B  is a sectional view of the dilator tip of  FIG. 3A  in an anchored configuration. 
         FIG. 4  is a sectional view of one example of an operator drive. 
         FIG. 5  is a schematic view of one example method of device delivery including an anchored dilator. 
         FIG. 6  is a schematic view of another example method of device delivery. 
     
    
    
     DETAILED DESCRIPTION 
       FIG. 1  is a perspective view of one example of an anchored dilator system  100 . As shown, the system  100  includes a guide catheter  102  (e.g., including a guide catheter or other medical device having a lumen, such as a therapeutic instrument, diagnostic instrument or the like) connected with a hub assembly  106  proximate to a proximal catheter portion  108  of the guide catheter  102 . The anchored dilator system  100  includes an anchored dilator  104  within a catheter lumen  112  (e.g., a delivery lumen) of the guide catheter  102 . In this example, the anchored dilator  104  includes a dilator hub assembly  114  at a proximal portion of the dilator  104  and proximate to the hub assembly  106  of the guide catheter  102 . 
     As shown in  FIG. 1 , the guide catheter  102  extends from the hub assembly  106 . The anchored dilator  104  extends from the dilator hub assembly  114  through the catheter lumen  112  of the guide catheter  102 , for instance, to a distal tip described herein. In one example, the distal tip is stored within the guide catheter  102  prior to use. For example, the distal tip of the anchored dilator  106  is held in a shuttle configuration (described herein) within a distal catheter portion  110  of the guide catheter  102  prior to use. 
     As described herein, the anchored dilator  104  is configured to transition between shuttle and anchored configurations to provide a tapered transition between the guide catheter  102  (including other medical devices) and the dilator  104 . As described herein the anchored dilator  104  in combination with the guide catheter  102  is a unitary assembly that eliminates a separate introducer or introducer sheath, for instance, to provide an intermediate passage for one or more of the dilator, guide catheter or the like. Instead, the anchored dilator  104  directly positions the guide catheter  102  or other medical device at a specified target location within a vessel, cavity or the like through manipulation of the anchored dilator  104  to navigate the dilator and the guide catheter  102  attached to the dilator to the specified target location. 
       FIG. 2  shows a cross sectional view of one example of an anchored dilator  104 , such as the anchored dilator shown in  FIG. 1 . In this example, the anchored dilator  104  extends from the dilator hub assembly  114  to the dilator tip  200 . The dilator hub assembly  114  includes a dilator hub  232  and an operator hub  234 . The anchored dilator  104  includes a push tube  204  extending from the dilator hub  232  to the dilator tip  200 . For instance, in this example, the push tube  204  is an interior element relative to an operator shaft  208  that surrounds the push tube  204 . As shown in  FIG. 2 , the push tube  204 , in this example, is coupled with the dilator hub  232  with an adhesive, mechanical interfit, interference fit or the like. The push tube  204  extends from the dilator hub  232  to the dilator tip  200 , and in an example includes a push tube lumen  222  to facilitate the passage of a guidewire, stylet or the like through the anchored dilator  104 . The push tube  204  extends through a cuff operator  206  of the operator shaft  208  and extends through a portion of the dilator nose  210  of the dilator tip  200 . For instance, a distal push tube portion  207  of the push tube  204  extends through the operator cavity  212  and is coupled with the dilator tip  200 . Conversely, the proximal push tube portion  205  is coupled with the dilator hub  232  (e.g., with an adhesive, mechanical interfit, interference fit or the like). 
     Referring again to  FIG. 2 , the dilator tip  200  in this example includes an operator cavity  212  surrounded by a cavity surface  213 . As described herein, in one example, the cavity surface  213  includes a tapered portion, for instance a portion of the cavity surface  213  proximate to the cuff operator  206 , to facilitate deflection of one or more components of the dilator tip  200  such as the anchor cuff  202 . Deformation of the anchor cuff  202  transitions the dilator tip  200  from the shuttle configuration shown in  FIG. 2  to the deployed or anchored configuration shown, for instance, in  FIG. 3B . Additionally, deployment of the anchor cuff  202  provides an affirmative anchoring engagement between the dilator tip  200  and the guide catheter  102  (or other medical device) to unify the anchored dilator  104  with the guide catheter  102  and facilitate navigation of vessels, cavities or the like as a composite unified assembly. 
     As further shown in  FIG. 2 , the dilator tip  200  further includes a pliable cuff interface  216  providing an interface between the anchor cuff  202  and the remainder of the dilator tip  200 . In one example, the pliable cuff interface  216  is constructed with or includes a pliable or deformable material configured expand or outwardly deploy relative to the configuration shown in  FIG. 2 . The anchor cuff  202  is proximate to the pliable cuff interface  216  and the dilator transition  214 . Optionally, the anchor cuff  202  includes a pliable or deformable material like the cuff interface. Pliable or deformable materials for one or more of the anchor cuff  202 , dilator transition  214  and the pliable cuff interface  216  include, but are not limited to, polymers, elastomers or the like, such as rubber, silicone, polyvinyl chloride. 
     Referring again to  FIG. 2 , the anchor cuff  202  includes a cuff inner wall  220  extending around the push tube  204  and the operator shaft  208 . The anchor cuff  202  further includes a cuff outer wall  218  providing the exterior surface, perimeter, profile or the like of the anchor cuff  202 . As described herein, transitioning of the anchor cuff  202  from the shuttle to the anchored configuration biases the pliable cuff interface  216  from the shuttle configuration shown in  FIG. 2  to the anchored configuration shown in  FIG. 3B . Accordingly, at least a portion of the cuff outer wall  218  proximate to the pliable cuff interface  216  is deployed outwardly into engagement with one or more surfaces, features or the like of a catheter or other medical device, such as the guide catheter  102 . In the deployed configuration, the dilator transition  214 , in one example, provides a flush (including near flush, smooth or the like) transition from the dilator tip  200  to the medical device. For example, the dilator transition  214  provides a smooth transition from the tapered profile of the dilator nose  210  to the corresponding exterior surface of the medical device coupled with the anchored dilator  104  in the anchored configuration, such as the guide catheter  102 . The smooth transition from the dilator nose  210  to the guide catheter  102  minimizes sharp corners, terraces, recesses or the like, and thereby facilitates navigation through vessels and cavities without engagement or snagging of tissues. 
     As further shown in  FIG. 2 , a cuff operator  206  is coupled with the dilator tip  200 . The cuff operator  206  is moveable relative to the dilator tip  200 , for instance through actuation of the operator shaft  208 . In the example shown in  FIG. 2 , the cuff operator  206  includes an operator bulb, collet, jack or the like configured to deform a portion of the dilator tip  200 , such as the pliable cuff interface  216 , and deploy the anchor cuff  202  into the anchored configuration. The shape of the cuff operator  206  is tapered in one example and engages with a converse taper of the cavity surface  213 . Engagement between the opposed tapers biases the pliable cuff interface  216  and the anchor cuff  202  into the anchored configuration with proximal movement of the cuff operator  206  from the position shown in  FIGS. 2  (and  3 A) to a position shown in  FIG. 3B . 
     In one example, movement of the cuff operator  206  is remotely conducted by way of an operator drive  236  and the interposed operator shaft  208  extending from the operator hub  234  of the drive  236  to the cuff operator  206 . As shown in  FIG. 2 , the operator drive  236  is optionally provided as a component of the dilator hub assembly  114 . The operator drive  236  moveably interfits each of the dilator hub  232  and the operator hub  234  to facilitate movement of the cuff operator  206  relative to the dilator tip  200 . In one example, the operator drive includes, but is not limited to, one or more of a ratchet engagement, threaded engagement or the like optionally providing one or more of haptic or audible feedback. The operator drive  236  includes haptic or audible feedback to indicated movement of the operator drive  236  and the cuff operator  206  and corresponding transition of the anchor cuff  202  between the shuttle and anchored configurations. In another example, the operator drive  236  includes one or more bearings to facilitate the movement of one or more of the operator hub  234  relative to the dilator hub  232 . In one example, bearings interposed between the dilator hub  232  and the operator hub  234  include thrust bearings, roller bearings or the like. 
     As further shown in  FIG. 2 , a luer fitting  230  is, in one example, coupled with and in communication with the push tube lumen  222  of the push tube  204 . The luer fitting  230  facilitates the delivery of one or more instruments such as guidewires, stylets or the like through the luer fitting  230  and into the push tube lumen  222 . The dilator tip  200  is delivered over the guidewire, stylets or the like, for instance, by back loading of the dilator tip  200  onto the guidewire or stylet. The guidewire or stylet passes through the distal push tube portion  207  into the push tube lumen  222  and exits the anchored dilator  104  through the luer fitting  230 . 
       FIGS. 3A and 3B  show two examples of the anchored dilator system  100  including the anchored dilator  104  and a medical device, such as a guide catheter  102 . As shown in  FIG. 3A , the anchor cuff  202  has a shuttle profile (e.g., a shuttle configuration) configured to pass through the guide catheter  102 . Conversely,  FIG. 3B  shows the anchor cuff  202  of the anchor dilator  104  in a deployed or anchored configuration with the dilator tip  200  anchored with the catheter  102 , for instance, a guide catheter  102  or other medical device, such as a guide sheath, therapeutic or diagnostic medical device or the like. 
     Referring first to  FIG. 3A , as previously described, the dilator tip  200  having the anchor cuff  202  is in a shuttle configuration with a shuttle profile  300  smaller than an anchored profile  310  shown in  FIG. 3B . The shuttle profile  300 , in this example, is smaller than an interior surface  304  of the catheter  102  (e.g., a lumen profile). The dilator tip  200 , push tube  204  and the operator shaft  208  are readily moved through the catheter  102 , for instance, through proximal or distal loading of the dilator tip  200 . As further shown in  FIG. 3A , the dilator transition  214 , cuff interface  216  and cuff outer wall  218  are recessed relative to the interior surface  304  of the catheter  102 . The cuff operator  206  in the operator cavity  212  is spaced from one or more portions of the cavity surface  213  including, for instance, a proximal tapered portion of the cavity surface  213 . 
     Referring now to  FIG. 3B , the anchored dilator system  100  is in an anchored configuration, for instance, with the anchor cuff  202  deployed and engaged with the catheter  102 . As shown, the cuff operator  206  is withdrawn or moved proximally relative to the position shown in  FIG. 3A . The operator drive  236  shown in  FIG. 2  is operated to move the cuff operator  206 . For instance, the operator hub  234  is moved relative to the dilator hub  232 . In an example including a threaded engagement between the hubs  232 ,  234 , rotation of the operator hub  234  moves the hub  234  proximally, and also moves the operator shaft  208  and the cuff operator  206  proximally. The moved cuff operator  206  engages with the cavity surface  213  and deforms the cavity surface  213  and corresponding portions of the anchor cuff  202 . For instance, as shown in  FIG. 3B , the cuff interface  216  as well as the cuff outer wall  218  proximate to the interface  216  are biased outwardly and accordingly engage with the interior surface  304  of the catheter  102 . The anchor cuff  202  has an anchored profile  310  larger than the shuttle profile  300  previously shown in  FIG. 3A . One or more of the cuff interface  216  or the cuff outer wall  218  engage with the interior surface  304  of the guide catheter  102  to accordingly join the dilator tip  200  with the catheter  102  and form a unitary composite device. 
     Optionally, the anchor cuff  202  includes one or more features configured to enhance anchoring with the guide catheter  102  or other medical device. For instance, the cuff outer wall  218  includes one or more of a roughened texture, knurling, studs, ridges or the like that enhance engagement of the anchor cuff  202  with the interior surface  304  of the guide catheter  102 . In another example, the anchor cuff  202  includes a tacky interface (e.g., in the manner of a rubber like surface, adhesive or the like) that enhances engagement between the anchor cuff  202  and the interior surface  304  of the guide catheter. 
     As further shown in  FIG. 3B , the dilator transition  214  is proximate to an end of the catheter  102  (e.g., a distal catheter portion  110  as shown in  FIGS. 1 and 3B ). As shown, the dilator transition  214 , when deployed in the anchored configuration, smoothly transitions the dilator nose  210  to the exterior surface  302  of the catheter  102 . For example, the dilator transition  214  provides a flush (including near flush) transition between the exterior surface  302  of the catheter  102  and the dilator nose  210 . The dilator transition  214  in the anchored configuration provides a continuous interface from the dilator nose to the catheter  102  to facilitate delivery of the dilator  104  and catheter  102  through vasculature. Additionally, the dilator transition  214  conceals and isolates the edge of the catheter  102  (e.g., a distal edge of the guide catheter) to minimize risk of trauma through razoring of a vessel or collision with tissues. Accordingly, the dilator transition  214  of the dilator tip  200  minimizes snags, sharp corners, exposed edges or the like that otherwise, in some examples, snag or roughly engage with tissues. 
     The anchored dilator system  100  including the catheter  102  (e.g., a guide catheter, guide sheath or other medical device) and the deployed anchored dilator  104  are a unitary device that facilitates the navigation of the system  100  through vasculature and to a specified location. In one example, the operator navigates the system  100  through the vasculature through manipulation (e.g., pushing, pulling, rotation or the like) of one or more of the catheter  102  or the anchored dilator  104 . For instance, the system  100  is moved in a unitary manner through manipulation of the catheter  102  and corresponding movement of the deployed anchored dilator  104 . In another example, the push tube  204  of the anchored dilator  104  is manipulated (e.g., pushed, pulled, rotated or the like) and navigates both of the dilator tip  200  and the deployed anchor cuff  202 . The catheter  102  is coupled with the anchored dilator  104  with the deployed anchor cuff  202  and thereby correspondingly moves with manipulation through the push tube  204 . 
     In an example, the catheter  102  is a guide catheter including one or more bracing features such as a braid, coil, structural wall or the like in comparison to more pliable devices, such as guide sheaths. A guide catheter  102  is in some examples specified for access to a vascular location. In other procedures an intermediate sheath, such as a guide sheath, introducer sheath or guide sheath in combination with an introducer sheath, are previously navigated through vasculature to provide a conduit for the guide catheter. The sheaths facilitate the passage of the guide catheter and minimize risks including razoring of vessel walls, tissues or the like through engagement of the edge of the guide catheter with the walls or tissues. The introducer sheath, guide sheath or combination of sheaths subtracts from vascular space otherwise available for the guide catheter or other medical device. In an example including the anchor dilator  104 , the system  100  of the anchored dilator and the guide catheter  102  is readily navigated through the vasculature without an intervening sheath (introducer sheath, guide sheath or the like). Instead, the deployed anchor cuff  202  engages with the surfaces of the guide catheter  102  proximate to the distal end and conceals and isolates edges of the guide catheter  102  that may, in some examples, increase the risk of trauma to organs, tissues, vessel walls or the like. The anchored dilator system  100  including the anchored dilator  104  provides a tapered, smooth composite assembly that is readily navigated by itself through the vasculature. 
     After delivery of the anchored dilator system  100 , for instance, to a specified location of the vasculature, the anchored dilator  104  is optionally decoupled from the catheter  102  (including one or more of a guide catheter, therapeutic medical device or the like) and removed, for instance, through the catheter lumen  112  shown in  FIG. 3B . In this example, the operator drive  236  ( FIG. 2 ) is operated in reverse to transition the anchor cuff  202  from the anchored configuration to the shuttle configuration. Rotation or movement of the operator drive  236  moves the operator hub  234  relative to the dilator hub  232 . In this example, the operator hub  234  is moved distally. The operator shaft  208  connected to the operator hub  234  moves distally and thereby distally moves the cuff operator  206  from the position shown in  FIG. 3B  to the position shown in  FIG. 3A  with the operator  206  decoupled (including a relaxed engagement) with the cavity surface  213 . Decoupling of the cuff operator  206  (including relaxed engagement) relative to the cavity surface  213  relaxes the anchor cuff  202  and allows the anchor cuff  202  to compress to the shuttle configuration shown in  FIG. 3A . As the anchor cuff  202  relaxes and resumes the shuttle configuration, the dilator transition  214  as well as the cuff outer wall  218  withdraw relative to the interior surface  304  of the catheter  102  thereby reducing the profile of the anchor cuff  202  to the shuttle profile  300  and facilitating the withdrawal of the dilator tip  200  through the catheter  102 . 
       FIG. 4  is a cross sectional view of one example of the operator drive  236 . In this example, the operator drive  236  includes a threaded engagement between the dilator hub  232  and the operator hub  234 . Movement of the operator drive  236  transitions the operator, such as the cuff operator  206  shown in  FIGS. 3A, 3B , between proximal and distal positions that correspond to the anchored and shuttle configurations previously described herein. 
     In the example shown in  FIG. 4 , the dilator hub  232  is coupled along an interior portion of the operator hub  234 . The dilator hub  232  is connected with the push tube  204  extending toward the distal push tube portion  207  shown, for instance, in  FIG. 2 . The distal push tube portion  207  is coupled with the dilator nose  210  of the dilator tip  200 . The push tube  204  extending between the dilator nose  210  and the dilator hub  232  accordingly provides a relatively robust component for the anchor dilator  104  to facilitate the pushing movement of the dilator nose  210  as well as one or more components anchored to the dilator tip  200 , such as the catheter  102  described herein. Pushing movement delivered along the push tube  204  to the dilator nose  210  correspondingly pulls the anchored instrument coupled with the dilator tip  200  into the vasculature. As further shown in  FIG. 4 , the push tube  204  is provided, in this example, along an interior of the operator shaft  208 . The push tube lumen  222  is provided along an interior of the push tube  204  for delivery or passage of guidewires, stylets or the like. 
     As further shown in  FIG. 4 , the operator drive  236  includes an operator hub  234  movably coupled (e.g., a threaded, ratchet coupling or the like) with the dilator hub  232 . The operator hub  234  is, in turn, coupled with the operator shaft  208  extending, in this example, around the push tube  204 . Movement of the operator hub  234  moves the operator shaft  208  and cuff operator  206  and transitions the cuff operator between the shuttle and anchored configurations shown in  FIGS. 3A, 3B . Accordingly, movement of the cuff operator  206  by the operator hub  234  remotely transitions the dilator tip  200  including its anchor cuff  202  between the shuttle and anchored configurations. 
     In the example shown in  FIG. 4 , the operator drive  236  includes a threaded interface between the dilator hub  232  and the operator hub  234 . In other examples, the operator drive  236  includes a ratchet engagement, rack and pinion type engagement or the like configured to provide predictable graduated movement of the operator hub  234  and the cuff operator  206 . In the example shown in  FIG. 4 , rotation of the operator hub  234  moves the operator hub proximally or distally (depending on the direction of rotation) and correspondingly moves the operator shaft  208  and the associated cuff operator  206 . Rotation of the operator hub  234  in a clockwise direction, in one example moves the operator shaft  208  and the cuff operator  206  proximally thereby engaging the cuff operator with the cavity surface  213  of the dilator tip  200  and deforming the anchor cuff  202  into the anchored configuration shown in  FIG. 3B . Conversely, rotation in an opposed direction, such as the counterclockwise direction, moves the operator hub  234 , the operator shaft  208  and the cuff operator  206  distally. The cuff operator  206  relaxes its engagement or disengages from the cavity surface  213 . Accordingly, the anchor cuff  202  transitions from the anchored configuration shown in  FIG. 3B  to the shuttle configuration shown in  FIG. 3A . 
     In still other examples, the operator drive  236  includes one or more features configured to provide haptic (tactile) or audible feedback to a clinician, technician or the like. For instance, as the operator drive  236  is actuated the cuff operator  206  moves and the drive generates ticks, clicking or the like in one or more of a tactile or audible manner. The feedback provides notification to the clinician or technician of the graduated movement, and the magnitude of the movement (e.g., based on the number of ticks or clicks heard or felt). 
     In still other examples, the operator drive  236  includes one or more features such as bearings, lubricants or lubricious coatings or materials configured to constrain movement of the operator hub  234 , dilator hub  232  and the associated operator shaft  208  and push tube  204  to rotational movement without axial loading. For instance, in one example, bearings, lubricants or the like are provided between one or more of the push tube  204  and operator shaft  208  to limit twisting motion otherwise applied to the push tube  204 , for instance with rotation of the operator shaft  208 . Conversely, one or more of thrust bearings, rotational bearings, lubricants or the like, in another example, are configured to limit or constrain movement between the operator hub  234  and the dilator hub  232  (as well as the associated shaft and tube  208 ,  204 ) to rotation and specified axial movement to actuate the anchor cuff  202 , and thereby limit additional axial movement transmitted between the components. 
       FIG. 5  shows one example of a device delivery method  501  including the anchored dilator  104  previously described herein.  FIG. 5  is divided into six portions (denoted with roman numerals) each corresponding to an example step for the delivery of a medical device, such as the guide catheter  102  or other medical device, to a specified target location in a vessel  500 . As shown in  FIG. 5 , the anchored dilator system  100  is navigated to the specified vascular location without an introducer sheath, guide sheath or the like. Instead, the anchored dilator  104  is deployed and engages with the guide catheter  102  for navigation of the system  100  to the location. Referring first to step I, a needle  502  penetrates the vessel  500  to provide access to the interior of the vessel  500 . As shown in portion  11 , the needle  502  remains within the vessel  500  and a guidewire  504  is fed through the needle  502 , for instance, to the specified location of the vessel  500  shown in  FIG. 5  as the leftmost portion of the vessel. 
     As further shown in  FIG. 5 , for instance, in portion III, the anchored dilator system  100  including the anchored dilator  104  coupled with the guide catheter  102  is administered through the penetration of the vessel  500 . For example, the anchored dilator  104  is loaded into the guide catheter  102  or other medical device, for instance through the catheter lumen  112 , as previously described herein. The anchored dilator  104  is transitioned to the anchored configuration through actuation of the anchor cuff  202 , to anchor the dilator tip  200  to a corresponding portion of the guide catheter  102  (e.g., proximate to a distal end of the catheter). In this arrangement, the anchored dilator  104  and the guide catheter  102  are a unified composite body that is delivered along the guidewire  502  and into the vessel  500 . Additionally, the anchored dilator  104  conceals and isolates the edge of the guide catheter  102  (e.g., the edge surrounding the distal opening of the catheter) and thereby minimizes the risk of trauma from the edge while at the same time provide a tapered and smooth profile for the system  100 . 
     As shown in portion IV, the composite assembly of the guide catheter  102  and the anchored dilator  104  (one example of an anchored dilator system  100 ) is delivered through the vessel  500  with the dilator  104  leading the guide catheter  102  through the vessel  500 . As previously described, the anchored dilator  104  includes a dilator tip  200  that tapers toward the dilator nose  210  to facilitate passage of the guide catheter  102  through the vessel  500 . The cuff operator  206  expands the anchor cuff  202  and an associated optional dilator transition  214 . The expanded dilator transition  214  is in close correspondence with a proximate portion of the guide catheter  102 . As shown in  FIG. 3B , the deployment of the anchor cuff  202  and the dilator transition  214  into the anchored configuration provides a flush (including near flush) transition from the dilator tip  200  to the exterior surface  302  of the guide catheter  102 . Accordingly, one or more of steep transitions, corners, steps or the like are accordingly minimized at the interface between the dilator tip  200  and the exterior surface  302  of the guide catheter  102  to provide a smooth transition between the dilator tip  200  and the guide catheter  102  and minimize snagging, rough engagement or the like with the tissues of the vessel  500 . 
     Referring now to portion IV of  FIG. 5 , the dilator  104  in the anchored configuration is delivered through the vessel  500 , for instance, by way of axial force applied to the dilator  104  by way of the push tube  204  shown in  FIG. 2 . The push tube  204  is not shown in  FIG. 5  to facilitate viewing of other components of the anchored dilator system  100 . Axial force applied along the push tube  204  is delivered to the dilator tip  200 . The axially pushed dilator tip  200  coupled with the proximate portion of the guide catheter  102  or other medical device accordingly pulls the guide catheter  102  through the vessel  500  to the specified vessel location. 
     As further shown in portion IV of  FIG. 5 , the guide catheter  102  or other medical device has a device profile  508 . As shown, the device profile  508  is a shape, size or the like of the guide catheter  102 . In this example, the device profile  508  of the guide catheter  102  substantially corresponds with a vessel profile  506  (e.g., shape, size or the like) of the vessel  500 . For instance, the diameter, shape or the like of the guide catheter  102  or other medical device substantially matches that of the vessel  500 . Accordingly as shown in portions IV, V and VI, the guide catheter  102  having the device profile  508  readily delivered to the specified location within the vessel  500 . 
     Referring now to portion V of  FIG. 5 , the guide catheter  102  or other medical device is delivered to the specified location as previously shown in portion IV. After delivery of the guide catheter  102  to the specified location, the anchored dilator  104  is retracted to the shuttle configuration shown in  FIG. 3A  to facilitate its extraction from the vessel  500 . For instance, as shown in portion V the anchored dilator  104  in the shuttle configuration has a smaller profile relative to the dilator  104  shown in portions III and IV in the anchored configuration. The cuff operator  206  is actuated to transition the anchor cuff  202  between the anchored configuration shown in  FIG. 3B  to the shuttle configuration shown in  FIG. 3A . In the shuttle configuration the anchored dilator  104  is withdrawn along the guidewire  504  and (as shown in portion VI) removed from the guide catheter  102 . 
     The guide catheter  102  or other medical device delivered with the anchored dilator  104  remains within the vessel  500 . As shown, the catheter  102  has a device profile  508  substantially corresponding to the vessel profile  506 . For example, the medical device having the device profile  508  fit to the vessel profile  506  is delivered to the specified location and left in place for one or more procedures. Because an introducer sheath or other intermediate device is not used with the anchored dilator  104  in the device delivery  501  minimal space in the vessel  500 , otherwise used by an introducer sheath or the like, is instead available for larger guide catheters  102  or other medical devices. 
       FIG. 6  shows another series of examples of a device delivery  601  including an introducer sheath  602 . As described herein, in some example the delivery  601  further includes additional sheaths, such as guide sheaths or the like used alone or in combination with the introducer sheath  602 . As shown, the device delivery  601  provided in  FIG. 6  includes at least seven portions or steps. Referring first to portion I, the vessel  500  is shown with a needle  502  inserted through the vessel wall to provide access into the vessel  500  for delivery of one or more instruments therein. As shown in portion II, a guidewire  504  is inserted through the needle  502  and into the vessel  500 , and navigated to a specified location within the vessel  500 . 
     As shown in portion III, the guidewire  504  remains within the vessel  500 . A dilator  600  is fed through an introducer sheath  602  and both the introducer sheath  602  and the dilator  600  are back loaded onto the guidewire  504  and introduced through the penetration of the needle into the vessel  500 . As further shown in portion III, the dilator  600  is recessed from the interior wall of the introducer sheath  602  to allow for delivery through a delivery lumen of the sheath  602 . Accordingly, an exposed edge  603  of the introducer sheath  602  is revealed. In other examples, multiple dilators  600  having gradually increasing sizes are navigated through the vessel  500  for dilation of the vessel in preparation for delivery of the introducer sheath  602 . 
     As further shown in portion IV, the dilator  600  and introducer sheath  602  are moved together, for instance, through translation of corresponding hubs through the vessel  504 . The dilator  600  provides an intermediate component between the guidewire  504  and the introducer sheath  602  to facilitate navigation through the vessel  500  and attempts to minimize trauma, such as razoring. However, as shown in portion IV the exposed edge  603  extends away from the dilator  600  and is revealed and proximate to the vessel walls. As shown in portion IV, the introducer sheath  602  has an introducer profile  604  substantially matching the vessel profile  506  of the vessel  500 . As further shown in portion IV, the dilator  600  provides a transition to the introducer sheath  602  from the guidewire  504 . In contrast to the anchored dilator  104  previously described herein, the dilator  600  extends through a lumen of the introducer sheath  602  and provides a stepped interface from the dilator  600  to the proximate distal portion of the introducer sheath  602 . 
     Accordingly, the dilator  600  shown in  FIG. 6 , does not include the dilator transition  214 , for instance, provided in the anchored configuration with the anchored dilator system  100  and the anchored dilator  104 . The dilator transition  214  shown in  FIG. 3B , for instance, provides a smooth transition from the dilator tip  200  to the proximate portion of the guide catheter  102  shown in  FIG. 3B  and thereby conceals the otherwise exposed edge of the guide catheter. For instance, the cuff operator  206  deploys or expands a portion of the dilator tip  200  such as the anchor cuff  202  in a close intimate engagement with an interior surface  304  of the guide catheter such as the guide catheter  102  shown in  FIG. 3B . Additionally, the operation of the cuff operator  206  expands the anchor cuff  202  and correspondingly expands the dilator transition  214  to provide a flush or near flush transition from the dilator tip to the corresponding proximate portion of the guide catheter  102  that covers and isolates the edge of the guide catheter  102 . In contrast to the smooth transition provided in  FIG. 3B , the dilator  600  and introducer sheath  602  shown in  FIG. 6  provide a stepped or staggered profile having the exposed edge  603  that may, in some circumstance, provide a rough engagement between the dilator  600 , introducer sheath  602  and the corresponding portions of the vessel  500  that increases the risk of trauma, such as razoring. 
     As further shown in  FIG. 6 , for instance, in portion V, after deployment of the introducer sheath  602  to the specified target location, the dilator  600  is removed, for instance, by sliding movement of the dilator through the introducer sheath  602  and out of the penetration previously provided by the needle  502 . As further shown in portion VI of  FIG. 6 , the introducer sheath  602  remains within the vessel  500  and one or more guide catheters, medical devices  102 ′ or the like are delivered through the introducer sheath  602  to the specified location within the vessel  500 . As shown in portion VI, the guide catheter or medical device  102 ′ includes a device profile  508 ′ configured to fit within the introducer sheath  602 . The device profile  508 ′ is accordingly smaller than the vessel profile  506  to facilitate delivery through the introducer sheath  602 . 
     Referring now to portion VII of the device delivery  601  shown in  FIG. 6 , after delivery of the guide catheter or medical device  102 ′ to the specified target location within the vessel  500 , the introducer sheath  602  is, in one example, removed from the vessel  500 , for instance, by drawing of the introducer sheath  602  over along the guidewire  504  and the medical device  102 ′ and through the penetration previously provided in the vessel  500 . The guide catheter or other medical device  102 ′ remains within the vessel  500 . 
     As shown, the guide catheter or medical device  102 ′ includes the device profile  508 ′ and the device profile  508 ′ is smaller than the vessel profile  506  because of the previously interposed introducer sheath  602 . Accordingly, in the example shown in  FIG. 6 , the device delivery  601  provides a smaller device  102 ′ having a corresponding smaller device profile  508 ′ in comparison to the device profile  508  shown, for instance, in  FIG. 5  more closely corresponding to the vessel profile  506 . As shown in  FIG. 5 , the anchored dilator  104  facilitates the delivery of the guide catheter or medical device  102  having the larger device profile  508  because the anchored dilator  104  is mated to and anchors with the guide catheter or medical device  102  and facilitates its delivery through the vessel  500  without a previously installed introducer sheath such as the introducer sheath  602  used in the device delivery  601  shown in  FIG. 6 . Instead, the guide catheter or medical device  102  shown in  FIG. 5  is mated with the anchored dilator  104  and delivered as a unitary assembly through the vessel  500  to the specified target location. Additionally, the deployed anchor cuff  202  isolates otherwise exposed edges and minimizes the risk of trauma (e.g., razoring) through vessel navigation. After positioning of the guide catheter or medical device  102  at the specified target location, the dilator  104  is readily contracted into the shuttle configuration shown in  FIG. 5  and previously shown and described in  FIG. 3A . The contracted dilator  104  is withdrawn over the guidewire  504 . 
     VARIOUS NOTES AND ASPECTS 
     Aspect 1 can include subject matter such as an anchored dilator system comprising: a guide catheter having proximal and distal catheter end portions and a catheter lumen extending therebetween; an anchored dilator received in the catheter lumen, the anchored dilator includes: a dilator tip having an anchor cuff; a push tube coupled with the dilator tip and extending toward the proximal catheter end portion; a cuff operator proximate the dilator tip; and an operator shaft coupled with the cuff operator, the operator shaft extends from the dilator tip toward the proximal catheter end portion; and wherein the anchor cuff is configured to transition between the anchored and shuttle configurations: in the anchored configuration actuation of the cuff operator with the operator shaft deploys the anchor cuff into engagement with the distal catheter end portion, and in the shuttle configuration the anchor cuff is withdrawn and disengaged with the distal catheter end portion. 
     Aspect 2 can include, or can optionally be combined with the subject matter of Aspect 1, to optionally include wherein the dilator tip includes a dilator nose distal to the anchor cuff, the dilator nose tapers distally from the anchor cuff toward the push tube. 
     Aspect 3 can include, or can optionally be combined with the subject matter of one or any combination of Aspects 1 or 2 to optionally include wherein the dilator includes a dilator transition proximate the anchor cuff, and in the anchored configuration the dilator transition is flush with an exterior surface of the guide catheter. 
     Aspect 4 can include, or can optionally be combined with the subject matter of one or any combination of Aspects 1-3 to optionally include wherein in the shuttle configuration the anchor cuff includes a shuttle profile, and in the anchored configuration the anchor cuff includes an anchored profile larger than the shuttle profile. 
     Aspect 5 can include, or can optionally be combined with the subject matter of one or any combination of Aspects 1-4 to optionally include wherein the shuttle profile is smaller than a lumen profile of the guide catheter, and the anchored profile is equal to or greater than the lumen profile. 
     Aspect 6 can include, or can optionally be combined with the subject matter of Aspects 1-5 to optionally include wherein the anchor cuff is a pliable anchor cuff, and the deployed anchor cuff in the anchored configuration includes an expanded anchor cuff. 
     Aspect 7 can include, or can optionally be combined with the subject matter of Aspects 1-6 to optionally include wherein the cuff operator includes an operator bulb coupled with the operator shaft. 
     Aspect 8 can include, or can optionally be combined with the subject matter of Aspects 1-7 to optionally include wherein the distal tip includes a cavity surface surrounding an operator cavity, and the cuff operator is received in the operator cavity. 
     Aspect 9 can include, or can optionally be combined with the subject matter of Aspects 1-8 to optionally include wherein at least a portion of the anchor cuff is proximate the cuff operator and the cavity surface, and the cavity surface includes a tapered interface. 
     Aspect 10 can include, or can optionally be combined with the subject matter of Aspects 1-9 to optionally include wherein in the anchored configuration the cuff operator is configured to engage the tapered interface and expandably deploy the tapered interface and the anchor cuff into engagement with an interior surface of the guide catheter. 
     Aspect 11 can include, or can optionally be combined with the subject matter of Aspects 1-10 to optionally include an anchored dilator comprising: a push tube having proximal and distal push tube portions; a dilator tip coupled with the distal push tube portion, the dilator tip is configured for selectable coupling with a catheter, the dilator tip includes: an anchor cuff having a cuff interface, the anchor cuff is configured to transition between a shuttle configuration having a shuttle profile and an anchored configuration having an anchored profile larger than the shuttle profile; and a dilator nose distal to the anchor cuff; and a cuff operator assembly configured to transition the anchor cuff between the anchored and shuttle configurations, the cuff operator assembly includes: a cuff operator movably coupled with the dilator tip; an operator shaft coupled with the cuff operator, the operator shaft extends toward the proximal push tube portion; and wherein actuation of the cuff operator with the operator shaft transitions the anchor cuff between the shuttle configuration and the anchored configuration. 
     Aspect 12 can include, or can optionally be combined with the subject matter of Aspects 1-11 to optionally include wherein the dilator nose tapers distally from the anchor cuff toward the push tube. 
     Aspect 13 can include, or can optionally be combined with the subject matter of Aspects 1-12 to optionally include wherein the dilator tip includes a dilator transition proximate the anchor cuff, in the shuttle configuration the dilator transition is proximate to the push tube, and in the anchored configuration the dilator transition is remote to the push tube relative to the shuttle configuration. 
     Aspect 14 can include, or can optionally be combined with the subject matter of Aspects 1-13 to optionally include wherein the anchor cuff is a pliable anchor cuff, and the anchor cuff in the anchored configuration includes an expanded anchor cuff. 
     Aspect 15 can include, or can optionally be combined with the subject matter of Aspects 1-14 to optionally include wherein the cuff operator includes an operator bulb coupled with the operator shaft. 
     Aspect 16 can include, or can optionally be combined with the subject matter of Aspects 1-15 to optionally include wherein the distal tip includes a cavity surface surrounding an operator cavity, and the cuff operator is received in the operator cavity. 
     Aspect 17 can include, or can optionally be combined with the subject matter of Aspects 1-16 to optionally include wherein the cavity surface includes a tapered interface, and in the anchored configuration the cuff operator is configured to deform the tapered interface and expand the anchor cuff to the anchored profile. 
     Aspect 18 can include, or can optionally be combined with the subject matter of Aspects 1-17 to optionally include wherein the cuff operator is in a distal position in the shuttle configuration, and in a proximal position in the anchored configuration. 
     Aspect 19 can include, or can optionally be combined with the subject matter of Aspects 1-18 to optionally include wherein the cuff operator is slidably coupled along the push tube. 
     Aspect 20 can include, or can optionally be combined with the subject matter of Aspects 1-19 to optionally include wherein the operator shaft is slidably coupled along the push tube. 
     Aspect 21 can include, or can optionally be combined with the subject matter of Aspects 1-20 to optionally include a hub assembly proximate the proximal push tube portion, the hub assembly includes: a dilator hub coupled with the proximal push tube portion; and an operator hub coupled with a proximal shaft portion of the operator shaft. 
     Aspect 22 can include, or can optionally be combined with the subject matter of Aspects 1-21 to optionally include wherein the hub assembly includes an operator drive interposed between the dilator hub and the operator hub, and the operator drive is configured to actuate the operator shaft, move the cuff operator and transition the anchor cuff between the shuttle and anchored configurations. 
     Aspect 23 can include, or can optionally be combined with the subject matter of Aspects 1-22 to optionally include wherein the operator drive includes a threaded interface between the dilator hub and the operator hub. 
     Aspect 24 can include, or can optionally be combined with the subject matter of Aspects 1-23 to optionally include a method for using an anchored dilator system comprising: passing a dilator having a dilator tip coupled with a push tube through a catheter lumen of a catheter, an interior surface of the catheter surrounds the catheter lumen; and anchoring the dilator tip with the catheter with an anchor cuff, anchoring the dilator tip includes: passing a dilator nose of the dilator tip past a distal catheter portion of the catheter; delivering the anchor cuff of the dilator tip toward the distal catheter portion through the catheter lumen, the anchor cuff in a shuttle configuration having a shuttle profile smaller than a lumen profile of the catheter; transitioning the anchor cuff from the shuttle configuration to an anchored configuration, the anchor cuff in the anchored configuration having an anchored profile larger than the shuttle profile; and engaging the anchor cuff in the anchored configuration with the interior surface of the catheter. 
     Aspect 25 can include, or can optionally be combined with the subject matter of Aspects 1-24 to optionally include delivering the catheter and the dilator tip to a specified vascular location. 
     Aspect 26 can include, or can optionally be combined with the subject matter of Aspects 1-25 to optionally include wherein delivering the catheter and the dilator tip includes: manipulating the dilator tip with the push tube; and guiding movement of the catheter with the dilator tip having the anchor cuff in the anchored configuration and engaged with the interior surface of the catheter. 
     Aspect 27 can include, or can optionally be combined with the subject matter of Aspects 1-26 to optionally include wherein transitioning the anchor cuff from the shuttle configuration to the anchored configuration includes expanding the anchor cuff. 
     Aspect 28 can include, or can optionally be combined with the subject matter of Aspects 1-27 to optionally include wherein the anchor cuff includes a pliable anchor cuff, and transitioning the anchor cuff from the shuttle configuration to the anchored configuration includes deforming the anchor cuff. 
     Aspect 29 can include, or can optionally be combined with the subject matter of Aspects 1-28 to optionally include wherein the distal tip includes a cuff operator coupled with an operator shaft, and transitioning the anchor cuff from the shuttle configuration to the anchored configuration includes: moving the cuff operator toward the anchor cuff with the operator shaft; and biasing the anchor cuff into the anchored configuration with the cuff operator. 
     Aspect 30 can include, or can optionally be combined with the subject matter of Aspects 1-29 to optionally include wherein engaging the anchor cuff with the interior surface of the catheter includes engaging the anchor cuff in surface to surface contact with the interior surface of the catheter proximate to the distal catheter portion. 
     Aspect 31 can include, or can optionally be combined with the subject matter of Aspects 1-30 to optionally include wherein transitioning the anchor cuff from the shuttle configuration to the anchored configuration includes blending a dilator nose of the dilator tip with an exterior surface of the guide catheter. 
     Each of these non-limiting aspects can stand on its own, or can be combined in various permutations or combinations with one or more of the other aspects. 
     The above description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “aspects” or “examples.” Such aspects or example can include elements in addition to those shown or described. However, the present inventors also contemplate aspects or examples in which only those elements shown or described are provided. Moreover, the present inventors also contemplate aspects or examples using any combination or permutation of those elements shown or described (or one or more features thereof), either with respect to a particular aspects or examples (or one or more features thereof), or with respect to other Aspects (or one or more features thereof) shown or described herein. 
     In the event of inconsistent usages between this document and any documents so incorporated by reference, the usage in this document controls. 
     In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects. 
     Geometric terms, such as “parallel”, “perpendicular”, “round”, or “square”, are not intended to require absolute mathematical precision, unless the context indicates otherwise. Instead, such geometric terms allow for variations due to manufacturing or equivalent functions. For example, if an element is described as “round” or “generally round,” a component that is not precisely circular (e.g., one that is slightly oblong or is a many-sided polygon) is still encompassed by this description. 
     The above description is intended to be illustrative, and not restrictive. For example, the above-described aspects or examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.F.R. § 1.72(b), to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description as aspects, examples or embodiments, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.