Patent Description:
Thrombectomy is a medical procedure that removes a blood clot (e.g., thrombus) from a vessel, such as an artery or vein. Left untreated thrombus may occlude a vessel or break free and preclude blood flow to one or more organs.

One technique to perform a thrombectomy includes a catheter having an infusion lumen that delivers lytic solutions that can breakdown or dissolve the thrombus. The catheter or a second catheter includes an aspiration lumen that aspirates the broken down or dissolved thrombus particulate.

Thrombectomy devices (e.g., thrombectomy catheters) can use fluid jet streams to ablate thrombus. In an example, a catheter used during a thrombectomy procedure is fed over a guidewire such that the catheter is concentric with the guidewire. In that instance, the catheter body performing the thrombectomy is positioned within a lumen of the catheter. In order to facilitate delivery and navigate through vasculature of a patient, the diameter of the catheter is relatively small compared to a vessel being treated. The catheter provides a treatment delivery footprint within the vessel that is equal to the diameter of the catheter body (e.g., as the guidewire is coincident with the guidewire).

<CIT> Al relates to an enhanced cross stream mechanical thrombectomy catheter with backloading manifold. The catheter has a distal end with outflow and inflow orifices at one side for producing concentrated cross stream jet flow for selective and concentrated thrombus ablation during thrombectomy procedures. The invention provides for suitable distancing of high powered ablation or suction forces from the near walls of the vasculature. Cross stream flow emanating from the one side of the distal end of the catheter resultantly urges the distal end of the catheter and thus the opposing non-orificed side of the distal end of the catheter toward and against the vascular wall to inhibit contact of the inflow orifice with the vascular wall. Features of the invention include a geometrically configured insert to facilitate the backloading or exchange of guidewires. The catheter comprises a smooth catheter tube assembly having a smooth catheter tube. A flexible tapered tip is located distally at the end of the smooth catheter tube. A support ring is attached to a high pressure tube and is located within the smooth catheter tube. A fluid jet emanator including terminated loop at a distal end of the high pressure tube and a circular support ring is located distal of the inflow orifice within the distal end of the smooth catheter tube. The terminated loop includes a plurality of proximally directing jet orifices. A center void of the terminated loop allows for passage of the guidewire. The support ring, a tubular device, includes a central passageway corresponding in use to that of the center void of the terminated loop for passage of the guidewire.

<CIT>relates to a device suitable for removing material from a living being, featuring an infusate pump, and an aspiration pump, both powered by a motor. The aspiration pump and infusate pump preferably feature a helical pumping mechanism, and operate at a high rate of rotation, thereby ensuring adequate pumping performance and flexibility. Additionally, a narrow crossing profile is maintained, ensuring that the device may reach more tortuous regions of the vasculature. The system comprises a wire-guided mono-rail catheter with a working head mounted on a flexible portion of the catheter that can laterally displace away from the guide wire to facilitate thrombus removal. The working head may be operated to separate and move away from the guide wire to come within a closer proximity of the obstructive material to more effectively remove it from the vessel.

<CIT>relates to catheters including guidewire tubes having a limited length and methods of using the catheters. The catheters may be delivered over guidewires in procedures that are commonly referred to as rapid-exchange delivery. In some embodiments, the catheters may be miniature flexible thrombectomy catheters that may be used to remove thrombus or other unwanted material from a body blood vessel or other small regions of body cavities in which the distal portion of the catheter has smaller external dimensions than the larger proximal portion.

<CIT>relates to a single operator exchange fluid jet thrombectomy device having an outer catheter assembly and separable and exchangeable components in the form of an inner catheter assembly allowing functioning as a rheolytic thrombectomy catheter or as a crossflow thrombectomy catheter. Embodiments include an outer catheter assembly common to any mode of usage having a guide catheter having a lumen through which a guidewire and the greater portion of a hypo-tube carrying a flow director are passed and advanced. For use as a rheolytic thrombectomy catheter, thrombus is dislodged, entrained, and broken into pieces by jets and evacuated through the lumen of the guide catheter. For use as a crossflow thrombectomy catheter, a flow director having an outflow orifice and an inflow orifice is provided.

The present inventors have recognized, among other things, that a problem to be solved includes increasing a treatment delivery footprint of a catheter body (e.g., a hydrodynamic catheter used to perform a thrombectomy procedure) within a vessel without increasing the diameter of the catheter body. Increasing the treatment delivery footprint of the catheter body (e.g., the proximity of the treatment features of a catheter to the targeted thrombus) increases the efficiency of the thrombectomy procedure while maintaining a minimal catheter perimeter minimizing damage to the vessel. Additionally, another problem to be solved includes the removal of structural obstructions within a catheter lumen, for instance an infusion lumen or aspiration lumen. Removing structural obstructions from the catheter interior, especially while maintaining a relatively small catheter perimeter, increases the area available for energy transfer (e.g., the maintenance of delivery pressure and aspirating pressure between the catheter proximal and distal ends).

Existing thrombectomy devices (e.g., a catheter) can include a guidewire that is concentric with a lumen of the catheter. Therefore, rotation of the catheter about the guidewire provides a footprint within the vessel that is equal to the diameter of the catheter body. As the thrombectomy procedure continues and the thrombus is broken down, the existing devices can be inefficient at obtaining intimate contact between the thrombus and an inlet and outlet orifice of the catheter. Additionally, having the guidewire positioned in the path of the indirect cross-path fluid jet streams can diminish and or decrease the strength of the thrombectomy procedure, thereby decreasing the effectiveness of the procedure.

The present subject matter provides a solution to these problems, by providing a hydrodynamic catheter and system that provides a treatment delivery footprint of the catheter within a vessel that is larger than the actual diameter of the catheter. The larger treatment delivery footprint of the hydrodynamic catheter described herein in effect creates a virtual perimeter for the treatment features of the catheter larger than perimeter of the catheter. In an example, a guidewire extends along a catheter body external surface at least between the inflow and outflow orifice (e.g., the treatment features of the catheter). Providing the guidewire along the catheter body external surface provides the catheter body to be eccentric in its path of travel as the device is rotated about the guidewire. Thus, the treatment delivery footprint of the catheter body within the vessel is increased as compared to a guidewire positioned concentrically with a catheter body having an equal diameter. For example, the portions of the catheter positioned opposite of the guidewire and guidewire lumen, when rotated, are moved into intimate proximity relative to the vessel wall. Accordingly, any catheter treatment features provided at those portions are similarly positioned in intimate proximity to the thrombus and vessel wall. In an example using the catheter for a thrombectomy including introducing fluid jets (e.g., of lytic solution) allows for the penetrating delivery of the fluid into the thrombus interior as opposed to the exterior where it may quickly dilute or flow downstream.

Additionally, the present subject matter clears the catheter lumen from structural obstructions (e.g., a guidewire) between at least inflow and outflow orifices. Energy (e.g., the maintenance of pressurization in the delivery fluid) is conserved allowing enhanced thrombectomy procedures, for instance by high pressure delivery and aspiration of fluids and entrained particulate from the area of interest in the vessel. For example, by removing the guidewire from the catheter lumen, at least between the inflow and outflow orifices, the area within the catheter lumen available for energy transfer increases thereby also increasing the efficiency of the device while maintaining a relatively small catheter perimeter, as compared to the vessel.

In an example, the present subject matter provides a hydrodynamic catheter for use in a thrombectomy procedure. The hydrodynamic catheter includes a catheter body with a catheter lumen extending from a proximal catheter portion to a distal catheter portion. The hydrodynamic catheter includes an inflow orifice at a first location along a catheter body perimeter and an outflow orifice at a second location along the catheter body perimeter spaced from the first location. A fluid jet emanator includes one or more jet orifices configured to direct one or more fluid jets through the catheter lumen from near the inflow orifice toward the outflow orifice. The hydrodynamic catheter includes a pivot cylinder at a third location along the catheter body perimeter, the third location distal relative to one or more of the fluid jet emanator, the inflow orifice, or the outflow orifice. At least a portion of the catheter body including the inflow and outflow orifices is rotatable around the pivot cylinder between at least first and second rotated positions. In the first rotated position the inflow and outflow orifices are directed in a first direction, and the inflow and outflow orifices are positioned in close proximity to a first portion of a vessel. In the second rotated position the inflow and outflow orifices are directed in a second direction different from the first direction, and the inflow and outflow orifices are positioned in close proximity to a second portion of a vessel different from the first portion of the vessel.

The following non SI-units are employed by the detailed description:.

<FIG> illustrates a hydrodynamic catheter system <NUM>, in accordance with one embodiment of the present disclosure. As will be described in detail herein, the hydrodynamic catheter system <NUM> is configured to provide a pressurized fluid at a catheter distal portion <NUM> for removal of thrombus from a vessel. Additionally, the hydrodynamic catheter system <NUM> is optionally configured to provide a vacuum source (aspiration) at the catheter distal portion <NUM> for removal of thrombus with the pressurized fluid.

In an example, the hydrodynamic catheter system <NUM> includes a hydrodynamic catheter <NUM> in association with a manifold <NUM>. The hydrodynamic catheter <NUM> is coupled to and extends distally from the manifold <NUM>. The hydrodynamic catheter <NUM> includes a catheter body <NUM> having a catheter lumen <NUM> extending along a length of the catheter body <NUM> (e.g., from a catheter proximal portion <NUM> to a catheter distal portion <NUM>). The hydrodynamic catheter <NUM> also includes an infusion tube <NUM> including an infusion lumen <NUM> extending along a length of the catheter lumen <NUM>. The infusion tube <NUM> extends within the catheter body <NUM> from a catheter proximal portion <NUM> towards the catheter distal portion <NUM> and is configured to deliver fluid under pressure to the catheter distal portion <NUM> for removal of thrombus.

The hydrodynamic catheter <NUM> includes a treatment portion <NUM> positioned along a portion of the catheter body <NUM>. In an example, the catheter distal portion <NUM> includes the treatment portion <NUM>. The treatment portion <NUM> includes at least one inflow orifice <NUM> and at least one outflow orifice <NUM>. In an example, the inflow and outflow orifices <NUM>, <NUM> cooperate with fluid jets to provide a cross stream effect where fluid is projected from the catheter body <NUM> through the outflow orifice <NUM> and is recirculated to the catheter body <NUM> through the inflow orifice <NUM>. The fluid entering and exiting the catheter body <NUM> thereby develops a circular or cross stream flow that engages with thrombus within a vessel, dislodges and macerates the thrombus, and entrains the thrombus particles in the fluid flow returned to the catheter body <NUM> through the inflow orifice <NUM>.

In an example, the infusion tube <NUM> is coupled to an injection side port <NUM> such that the infusion lumen <NUM> is coupled to a fluid delivery device <NUM>, such as an injector or pumping device. The infusion lumen <NUM> delivers fluid under pressure to the catheter distal portion <NUM>, for example, to a jet orifice used in a thrombectomy procedure. In one example, the jet orifice provides a fluid jet at pressures of around <NUM> pounds per square inch (psi) for hydrodynamic engagement with thrombus (although other pressures may be obtained with the same or differing fluid delivery devices <NUM>). As illustrated in <FIG>, the hydrodynamic catheter system <NUM> includes a strain relief fitting <NUM> coupled between to the catheter body <NUM> (at the catheter proximal portion <NUM>) and the manifold <NUM>. In an example, the strain relief fitting <NUM> extends around the catheter body <NUM> and is engaged with the manifold <NUM>. In another example, the catheter lumen <NUM> communicates with an aspiration side port <NUM> that is coupled to an aspirator <NUM>, such as a vacuum source. The vacuum source includes, but is not limited to, a syringe, vacuum bottle, roller pump, vacuum pump or the like.

The hydrodynamic catheter <NUM> includes a pivot cylinder <NUM>. In an example, the pivot cylinder <NUM> is adjacent to the treatment portion <NUM>. The pivot cylinder <NUM> is eccentric relative to a longitudinal axis <NUM> of the hydrodynamic catheter <NUM>. As illustrated in <FIG>, the pivot cylinder <NUM> is positioned along the catheter distal portion <NUM> at a position that is distal relative to one or more of the fluid jet emanator <NUM> (as illustrated in <FIG>), the inflow orifice <NUM>, or the outflow orifice <NUM>. In an example, the treatment portion <NUM> is positioned proximal relative to the pivot cylinder <NUM> and is rotatable around the pivot cylinder <NUM> between at least a first rotated positioned and a second rotated position. In one example, the pivot cylinder <NUM> can include, but is not limited to a guidewire lumen extending therein that is configured to receive a guidewire <NUM>. The treatment portion <NUM> of the catheter body <NUM> is rotatable around the pivot cylinder <NUM>, in one example <NUM> degrees. In an example, the guidewire <NUM> is positioned through the guidewire lumen of the pivot cylinder <NUM> and along a catheter body external surface <NUM> along at least the treatment portion <NUM>. Providing the guidewire <NUM> along the catheter body external surface <NUM> positions the catheter body <NUM> eccentrically relative to the guidewire <NUM> and the pivot cylinder <NUM> in a rotating path of travel as the hydrodynamic catheter <NUM> rotates about the guidewire <NUM>.

By rotating the treatment portion <NUM> of the catheter body <NUM> about the pivot cylinder <NUM>, the portions of the catheter positioned opposite of the guidewire <NUM> are moved into intimate proximity relative to the vessel wall. Accordingly, any catheter treatment features (e. g, the inlet and outlet orifices <NUM>, <NUM>) are similarly positioned in intimate proximity to the thrombus and vessel wall. As the catheter body <NUM> rotates about the guidewire <NUM>, a treatment delivery footprint creates a virtual perimeter for the treatment features that is greater than a perimeter of the catheter body <NUM>. The eccentric positioning of the pivot cylinder relative to the longitudinal axis increases the treatment delivery footprint while maintaining a minimal actual catheter perimeter that is more easily delivered and navigated through the vasculature. Furthermore, positioning the guidewire <NUM> along the catheter body external surface <NUM> at least between the inflow and outflow orifices <NUM>, <NUM>, clears the catheter lumen <NUM> from structural obstructions (e.g., a guidewire <NUM>) between at least the inflow and outflow orifices <NUM>, <NUM> and thereby conserves energy (fluid velocity and pressure) and provides enhanced thrombectomy effectiveness.

In operation, the hydrodynamic catheter <NUM> is inserted into a vessel, such as a vein or artery, and fluid is delivered to the catheter distal portion <NUM> via the infusion lumen <NUM>. The fluid is delivered through one or more fluid jets and hydrodynamically engages and dislodges thrombus within the vessel (e.g., through concentrated fluid pressure, fluid velocity, and fluid flow volume). For instance, the one or more fluid jets provided through the outflow orifice <NUM> (or orifices) impact the thrombus and mechanically macerate the thrombus. As discussed herein, the catheter lumen <NUM> receives the dislodged thrombus particulate, through the inlet orifice <NUM>, and delivers the thrombus particulate along the catheter lumen <NUM> through an aspiration side port <NUM> to a waste unit such as a collection bag, vial, chute and the like.

<FIG> illustrates an exploded view of a hydrodynamic catheter <NUM>, in accordance with one embodiment of the present disclosure. As illustrated in <FIG>, the infusion tube <NUM> is in fluid communication with a fluid jet emanator <NUM>. The catheter body <NUM> includes the treatment portion <NUM> positioned at the catheter distal portion <NUM>. The treatment portion <NUM> includes the inflow and outflow orifices <NUM>, <NUM> that are in fluid communication with the catheter lumen <NUM>. As discussed herein, the inflow and outflow orifices <NUM>, <NUM> generate a cross stream flow that removes deposited thrombus within a vessel. In an example, the catheter body <NUM> includes radiopaque collars positioned on each side of the treatment portion <NUM>. That is, a first radiopaque collar is positioned adjacent to the inflow orifice <NUM> and a second radiopaque collar is positioned adjacent to the outflow orifice <NUM>. The radiopaque collars assist with imaging of the catheter distal portion <NUM> during insertion and navigation through a vessel, under fluoroscopic viewing.

The pivot cylinder <NUM> includes a pivot cylinder inlet <NUM> and a pivot cylinder outlet <NUM>. In an example, the pivot cylinder outlet <NUM> is in a non-parallel orientation (e.g., is angled) to the pivot cylinder inlet (or <NUM>. In one example, the pivot cylinder outlet <NUM> is substantially perpendicular to the pivot cylinder inlet <NUM>. In an example, the pivot cylinder includes a guidewire lumen, such that a guidewire can be positioned through the guidewire lumen. For example, the guidewire lumen <NUM> extends between the pivot cylinder inlet <NUM> and the pivot cylinder outlet <NUM> and a guidewire inlet can correspond to the pivot cylinder inlet <NUM> and a guidewire outlet can correspond to a pivot cylinder outlet <NUM>. The pivot cylinder <NUM> and corresponding guidewire lumen are eccentric relative to the longitudinal axis <NUM> of the hydrodynamic catheter <NUM> (e.g., non-coincident or spaced from the longitudinal axis <NUM>).

As illustrated in <FIG>, the pivot cylinder inlet <NUM> is radially spaced around the catheter body <NUM> from the inflow orifice <NUM> and the outflow orifice <NUM>. In one example, the portions of the catheter body <NUM> positioned opposite of pivot cylinder <NUM> (e.g., the treatment portion <NUM> including the inlet and outlet orifices <NUM>, <NUM>), when rotated, are moved into intimate proximity relative to the vessel wall. Positioning the treatment portion <NUM> opposite the pivot cylinder inlet <NUM> ensures that the largest treatment delivery footprint is created during operation. For example, the inlet and outlet orifices <NUM>, <NUM> are positioned in intimate proximity to the thrombus and vessel wall when the catheter body <NUM> is rotated about the pivot cylinder <NUM>. As discussed herein, a diameter of the treatment delivery footprint is greater than a diameter of the catheter body <NUM>. Thus, the hydrodynamic catheter <NUM> including the pivot cylinder <NUM> increases the effectiveness of thrombectomy (e.g., by positioning the treatment portion <NUM> of the hydrodynamic catheter <NUM> in intimate contact with thrombus and the vessel wall) without increasing the size (e.g., diameter) the hydrodynamic catheter <NUM>.

In an example, the catheter body <NUM> has a diameter within a range of from about <NUM> French (Fr) to about <NUM> Fr and uses a <NUM> inch to a <NUM> inch guidewire for insertion. In another example, the catheter body <NUM> has a diameter within a range of from about <NUM> Fr to about <NUM> Fr and is inserted using a <NUM> inch guidewire. In yet another example, the catheter body <NUM> has a diameter within a range of from about <NUM> Fr to about <NUM> Fr and is inserted using a <NUM> inch guidewire Optionally, the catheter body <NUM> includes other diameters and is accordingly usable with corresponding guidewires for delivery.

As further illustrated in <FIG>, the infusion tube <NUM> extends within the catheter lumen <NUM> toward the catheter distal portion <NUM>. The infusion tube <NUM> is coupled with and in fluid communication with the fluid emanator <NUM>. For example, the infusion lumen <NUM> is in fluid communication with the jet orifices <NUM> through an interior of the fluid emanator <NUM> by way of a fluid passage <NUM> extending around the fluid emanator <NUM> and providing high pressure fluid to each of the jet orifices <NUM>. When assembled, the fluid emanator <NUM> is optionally positioned distal relative to the inflow orifice <NUM>. In an example, the fluid emanator <NUM> is positioned distal relative to the inflow orifice <NUM> and proximal relative to the pivot cylinder <NUM>.

As discussed herein, the fluid emanator <NUM> includes one or more jet orifices <NUM> configured to direct one or more fluid jets through the catheter lumen <NUM> from near the inflow orifice <NUM> toward the outflow orifice <NUM>. As shown in <FIG>, the fluid emanator <NUM> includes one or more jet orifices <NUM> directed in a proximal direction toward the catheter proximal portion <NUM> (as shown in <FIG>). Stated another way, the jet orifices <NUM> are positioned on a proximal face <NUM> of the fluid emanator <NUM> and are directed within the catheter lumen <NUM> along the longitudinal axis <NUM> of the catheter body <NUM> toward the catheter proximal portion <NUM> (as shown in <FIG>).

In an example, the fluid jet emanator <NUM> is a circular or semi-circular fixture within the catheter body <NUM>. For example, the fluid jet emanator <NUM> extends around a catheter body interior wall <NUM> and is engaged with a catheter body interior wall <NUM> along a fluid emanator perimeter surface <NUM>. The fluid jet emanator <NUM> produces fluid jets to create the cross stream flow, as discussed herein, and thereby remove and exhaust thrombus from the vessel. The fluid jet emanator <NUM> includes one or more jet orifices <NUM> that direct the one or more fluid jets through the catheter lumen <NUM>. The infusion tube <NUM> and the fluid jet emanator <NUM> deliver the pressurized fluid to the distal portion <NUM> of the catheter body <NUM> for creation of high velocity fluid jet streams which are directed distally from the fluid jet emanator <NUM>, as discussed herein. In another example, the high velocity fluid jet streams are directed both distally and radially. In yet another example, the high velocity fluid jet streams are directed radially from the emanator and into the vessel directly (e.g., without the inflow and outflow orifices). In one example, the jet orifices <NUM> are configured to provide a jet flow velocity of within a range of from about <NUM> to about <NUM> meters per second (m/s). In another example, the jet orifices <NUM> are configured to provide the jet flow velocity within a range of from about <NUM>/s to about <NUM>/s.

In the example shown in <FIG>, the treatment portion <NUM> of the catheter body <NUM> includes a single outflow orifice <NUM> that is configured to direct a fluid jet radially away from a longitudinal axis <NUM> of the catheter body <NUM> and a single inflow orifice <NUM> that is configured to direct fluid with thrombus entrained into the catheter lumen <NUM>. For instance, the outflow orifice <NUM> ensures the fluid jet generated impinges upon thrombus in a vessel surrounding the catheter body <NUM> and the inflow orifice <NUM> ensures that the fluid including entrained thrombus is delivered downstream through the catheter lumen <NUM>. As the catheter body <NUM> is rotated (e.g., the treatment portion <NUM> rotates about the pivot cylinder <NUM>), the cross stream flow between the inflow and outflow orifices <NUM>, <NUM> travel the full measure of the vessel and remove the thrombus around the catheter distal portion <NUM> (or over some portion of the vessel if rotated over an arc less than <NUM> degrees).

In the example illustrated in <FIG>, the treatment portion <NUM> includes a single outflow orifice <NUM> and a single inflow orifice <NUM>. In other examples, a plurality of outflow orifices <NUM> and a plurality of inflow orifices <NUM> are provided at one or more locations on the catheter body <NUM> (e.g., radially around the catheter distal portion <NUM>, and the like). A single outflow orifice <NUM>, as shown in <FIG>, concentrates the hydrodynamic energy of the infusion fluid to better break up the thrombus.

As illustrated in <FIG>, the fluid emanator <NUM> include one or more jet orifices <NUM> on a proximal face <NUM> of the fluid emanator <NUM>. In an example, the fluid emanator <NUM> includes one or more jet orifices <NUM> on a radial surface, such that the fluid jets generated flow away from the longitudinal axis <NUM> of the catheter body <NUM>. In that example, the catheter body <NUM> includes corresponding outflow orifices to deliver the fluid jets directly to the vessel.

In the example illustrated in <FIG>, the infusion tube <NUM> is positioned within the catheter lumen <NUM>. In another example, the infusion tube <NUM> is positioned within a sidewall of the catheter lumen <NUM>. That is, the infusion tube <NUM> is positioned between the catheter body external surface <NUM> and the catheter body internal surface <NUM>. The infusion tube <NUM> is formed from a material such as, but not limited to, stainless steel, a polymer, a Nitinol tube or the like.

<FIG> illustrates a partial cross-section of the hydrodynamic catheter <NUM> in <FIG> and <FIG>. As illustrated in <FIG>, the fluid emanator <NUM> is positioned distal relative to the inlet orifice <NUM>, which is spaced from the outlet orifice <NUM>. In an example, the catheter lumen <NUM> terminates at a termination point <NUM>. The termination point <NUM> is proximal relative to a distal tip <NUM> of the catheter body <NUM>. In an example, the distal tip <NUM> is a solid structure and includes the pivot cylinder <NUM> extending from the pivot cylinder inlet <NUM> to the pivot cylinder outlet <NUM>. The pivot cylinder <NUM> is eccentrically positioned relative to the longitudinal axis <NUM> of the catheter body <NUM>. In an example, the pivot cylinder outlet <NUM> is positioned at the distal end <NUM> of the distal tip <NUM>.

The infusion lumen <NUM> is in fluid communication with the jet orifices <NUM> through the fluid passage <NUM>. A pressurized fluid <NUM> travels through the infusion lumen <NUM>, to the fluid passage <NUM>, and through the jet orifices <NUM> to generate fluid jets <NUM>. In an example, the fluid jets <NUM> are directed proximally within the catheter lumen <NUM> and form the cross stream, as discussed herein. In an example, the infusion tube <NUM> is formed within a sidewall <NUM> of the catheter body <NUM> such that along the treatment portion <NUM> of the catheter body <NUM> the catheter lumen <NUM> is free from structural obstructions. As illustrated in <FIG>, the guidewire <NUM> is positioned within the pivot cylinder <NUM> extending from the pivot cylinder inlet <NUM> to the pivot cylinder outlet <NUM>. In an example, the pivot cylinder <NUM> is isolated from the catheter lumen <NUM>. Isolating the pivot cylinder <NUM> from the catheter lumen <NUM> ensures that the largest overall profile is available for aspiration of thrombus materials through the catheter lumen <NUM> without interference by a guidewire being positioned within the catheter lumen <NUM> (e.g., a guidewire being positioned centrally or along a perimeter and within the catheter lumen <NUM>.

As illustrated in <FIG>, a portion of the guidewire <NUM> is adjacent to the catheter external surface <NUM>. As discussed herein, the treatment portion <NUM> of the catheter body <NUM>, including the inlet and outlet orifices <NUM>, <NUM> is rotatable around the pivot cylinder <NUM> between at least a first rotated position and a second rotated position. In the first rotated position, the inflow and outflow orifices <NUM>, <NUM> are directed in a first direction and the inflow and outflow orifices <NUM>, <NUM> are positioned in close proximity to a first portion of a vessel. In the second rotated position, the inflow and outflow orifices <NUM>, <NUM> are directed in a second direction different from the first direction, and the inflow and outflow orifices <NUM>, <NUM> are positioned in close proximity to a second portion of a vessel different from the first portion of the vessel. Positioning the pivot cylinder <NUM> eccentrically relative to the longitudinal axis <NUM> allows for a cross-section area of the treatment delivery footprint that is greater than a cross-section area of the catheter body <NUM>. In other words, a virtual perimeter for the treatment portion <NUM> of the catheter body <NUM> is greater than a perimeter of the catheter body <NUM>. Thus, the treatment delivery footprint is increased, which increases the efficiency of the thrombectomy, without increasing the diameter of the catheter.

<FIG> illustrates a cross-section of the hydrodynamic catheter <NUM> in <FIG> along lines 3B-3B. As illustrated in <FIG>, the guidewire <NUM> is positioned externally to the catheter lumen <NUM> and eccentrically with respect to the longitudinal axis <NUM>. In an example, the guidewire <NUM> is positioned adjacent to the catheter external surface <NUM> along at least the treatment portion <NUM> of the catheter body <NUM>. Minimizing the structural obstructions (e.g., a guidewire) between at least inflow and outflow orifices <NUM>, <NUM> conserves energy (fluid velocity, pressure and the like) allowing for enhanced thrombectomy procedures. For example, by removing the guidewire <NUM> from the center of the catheter lumen <NUM>, at least adjacent to the inflow and outflow orifices <NUM>, <NUM> the area within the catheter lumen <NUM> available for fluid flow during thrombectomy increases thereby enhancing the effectiveness of the hydrodynamic catheter <NUM>. Additionally, providing the guidewire <NUM> along the catheter body external surface <NUM> facilitates eccentric rotation of the catheter body <NUM> (e.g., the treatment portion <NUM>) as the hydrodynamic catheter <NUM> rotates about the pivot cylinder <NUM>. The eccentric path of the catheter body <NUM> positions the treatment features (e.g., inlet and outlet orifices <NUM>, <NUM>) in intimate proximity to the thrombus and vessel wall and creates a treatment delivery footprint that is greater than the catheter body <NUM>. Positioning the treatment features in intimate proximity allows the fluid jets to penetrate to the thrombus interior instead of impacting along the exterior of the thrombus and diffusing within the remainder of the vessel.

<FIG> illustrates a partial cross-section of another example of a hydrodynamic catheter <NUM> in accordance with one embodiment of the present disclosure. As illustrated in <FIG>, the pivot cylinder <NUM> is positioned within a sidewall <NUM> of the catheter body <NUM>. For simplicity, the guidewire <NUM> is not shown positioned within the pivot cylinder <NUM>. The pivot cylinder <NUM> is positioned eccentrically relative to the longitudinal axis <NUM>. For example, the pivot cylinder <NUM> as shown in <FIG> is positioned opposite of the inlet and outlet orifices <NUM>, <NUM> such that an optional maximized distance is formed between the pivot cylinder <NUM> and the inlet and outlet orifices <NUM>, <NUM>. The maximized spacing facilitates the positioning of the treatment portion <NUM> intimately with the vessel wall, as the treatment portion <NUM> rotates about the pivot cylinder <NUM>. In the example illustrated in <FIG>, the distal tip <NUM> of the catheter body <NUM> includes the catheter lumen <NUM>. That catheter lumen <NUM> terminates at a termination point <NUM>. However, in other examples, the catheter lumen <NUM> is open at the distal end of the catheter body <NUM>.

The infusion lumen <NUM> is in fluid communication with the jet orifices <NUM> of an emanator <NUM> through the fluid passage <NUM>. As discussed herein, a pressurized fluid <NUM> travels through the infusion lumen <NUM>, to the fluid passage <NUM>, and through the jet orifices <NUM> to generate fluid jets <NUM> that are directed proximally within the catheter lumen <NUM> and form the recirculating cross stream with the inflow and outflow orifices <NUM>, <NUM>.

<FIG> illustrates a cross-section of the hydrodynamic catheter <NUM> in <FIG> along lines 4B-4B. As illustrated in <FIG>, the pivot cylinder <NUM> including the guidewire lumen is positioned within a wall <NUM> of the catheter body <NUM>. The pivot cylinder <NUM> is eccentric relative to the longitudinal axis <NUM>. The hydrodynamic catheter <NUM> minimizes the structural obstructions (e.g., a guidewire) between at least the inflow and outflow orifices <NUM>, <NUM> and conserves hydrodynamic energy dedicated to a thrombectomy procedure conducted with the catheter <NUM>. Additionally, positioning the guidewire <NUM> within the wall <NUM> of the catheter body <NUM> allows eccentric rotation of the catheter body <NUM> as the hydrodynamic catheter <NUM> rotates about the pivot cylinder <NUM>. The eccentric path of the catheter body <NUM> positions the treatment features (e.g., inlet and outlet orifices <NUM>, <NUM>) in intimate proximity to the thrombus and vessel wall. In the example illustrated in <FIG>, the infusion tube <NUM> is positioned within the catheter lumen <NUM>. In another example, the infusion tube <NUM> is positioned within the sidewall <NUM> of the catheter body <NUM>.

<FIG> illustrates a partial cross-section of a portion of another example of a hydrodynamic catheter <NUM>, in accordance with one embodiment of the present disclosure. As illustrated in <FIG>, the pivot cylinder <NUM> is positioned within the sidewall <NUM> of the catheter body <NUM> along a portion of the catheter body <NUM> that is distal relative to at least the inflow orifice <NUM>. In an example, the pivot cylinder <NUM> is positioned within the sidewall <NUM> of the catheter body <NUM> along a portion of the catheter body <NUM> that is distal relative to the fluid emanator <NUM>. The guidewire <NUM> extends through the pivot cylinder <NUM> and is positioned adjacent a catheter body external surface <NUM> along the portion of the catheter body <NUM> proximal to the pivot cylinder <NUM>. As illustrated in <FIG>, the catheter lumen <NUM> extends to a catheter lumen opening <NUM>. However, in other examples, the catheter lumen <NUM> is closed at the distal end of the catheter body <NUM>, as discussed herein.

<FIG> illustrates a partial cross-section of a portion of another hydrodynamic catheter <NUM>, in accordance with one embodiment of the present disclosure. As illustrated in <FIG>, the pivot cylinder <NUM> is a virtual pivot cylinder that is formed between the pivot cylinder opening <NUM> and the pivot cylinder outlet <NUM>. The pivot cylinder inlet <NUM> includes a ramped surface <NUM> to facilitate the insertion of the guidewire <NUM>. In the example illustrated in <FIG>, the pivot cylinder outlet <NUM> corresponds to the catheter lumen opening <NUM>.

The hydrodynamic catheters <NUM>, <NUM>, <NUM>, and <NUM> illustrated in <FIG> minimize structural obstructions (e.g., the guidewire) within the catheter lumen <NUM> between at least the inflow and outflow orifices <NUM>, <NUM> by positioning the pivot cylinder inlet <NUM> distal relative to at least one of the inflow orifice <NUM> and the fluid emanator <NUM>.

<FIG> illustrates a partial cross-section of a portion of a hydrodynamic catheter <NUM>, in accordance with the present invention. The hydrodynamic catheter <NUM> illustrated in <FIG> minimizes structural obstructions (e.g., the guidewire) within the catheter lumen <NUM> between at least the inflow and outflow orifices <NUM>, <NUM>. As shown in <FIG>, the pivot cylinder <NUM> is positioned proximal relative to the outlet orifice <NUM>. The pivot cylinder <NUM> includes the guidewire lumen and extends through the sidewall <NUM> of the catheter body <NUM>. As illustrated in <FIG>, the guidewire <NUM> extends along the catheter body external surface <NUM> between at least the inlet and outlet orifices <NUM>, <NUM> thereby minimizing the structural obstructions between the inflow and outflow orifices. The guidewire <NUM> extends within the catheter lumen <NUM> at a position proximal to at least the outlet orifice <NUM>.

Minimizing the structural obstructions (e.g., between the inflow and outflow orifices <NUM>, <NUM>) conserves energy and allows for enhanced thrombectomy procedures. Additionally, removing the guidewire <NUM> from the catheter lumen <NUM> at least between the inflow and outflow orifices <NUM>, <NUM> allows the hydrodynamic catheters <NUM>, <NUM>, <NUM>, <NUM>, and <NUM> to be eccentric in their path of travel when rotated about the pivot cylinder <NUM> including the guidewire <NUM>. The eccentric path of the catheter body <NUM> positions the treatment features (e.g., inlet and outlet orifices <NUM>, <NUM>) in intimate proximity to the thrombus and vessel wall continuously as the catheter body <NUM> rotates about the pivot cylinder <NUM>.

<FIG> illustrates a footprint <NUM> (in broken line) of a traditional hydrodynamic catheter <NUM> where a guidewire <NUM> is substantially concentric with a catheter body <NUM>. As the catheter body <NUM> rotates about the guidewire <NUM>, the cross-sectional footprint <NUM> is substantially the same as the cross-sectional area of the catheter body <NUM>. As such, a diameter <NUM> of the catheter body <NUM> equals a diameter <NUM> of the cross-sectional footprint area <NUM>. Rotation of the catheter body <NUM> about the guidewire <NUM> during a thrombectomy procedure provides a treatment delivery footprint within the vessel <NUM> that is substantially similar to the diameter of the catheter body <NUM>. As the thrombectomy is conducted and thrombus is dislodged, remaining organized thrombus is positioned further away from the centrally located catheter body <NUM>. The catheter body <NUM> illustrated in <FIG> is accordingly repeatedly reciprocated and translated laterally as best able with the catheter to further remove thrombus. Accordingly, intimate contact if at all possible requires extensive movement and traversing of the catheter. Additionally, having the guidewire <NUM> positioned in the path of the indirect cross-path fluid jet streams diminishes and or decreases the strength of the thrombectomy procedure, thereby decreasing the effectiveness of the procedure.

<FIG> illustrates a cross-section treatment delivery footprint <NUM> of the hydrodynamic catheter <NUM> of <FIG>, in accordance with one embodiment of the present disclosure. The cross-section treatment delivery footprint <NUM> is taken at a point between the inflow and outflow orifices <NUM>, <NUM> in <FIG>. As illustrated in <FIG>, the guidewire <NUM> is positioned along an external surface <NUM> of the catheter body <NUM> and is eccentric relative to the catheter lumen <NUM>. As the catheter body <NUM> rotates about the guidewire <NUM>, a cross-section treatment delivery footprint <NUM> area formed by the rotation is greater than the cross-sectional area of the catheter body <NUM>. The eccentric positioning of the guidewire <NUM> provides a cross-sectional footprint area diameter <NUM> that is approximately twice as large as a catheter body diameter <NUM>. In the example where the guidewire <NUM> is positioned adjacent the catheter external surface <NUM>, the cross-sectional footprint area diameter <NUM> is greater than twice the catheter body diameter <NUM>. Accordingly, the treatment delivery footprint <NUM> of the catheter body <NUM> within the vessel <NUM> is increased relative to the configuration shown in <FIG> with the guidewire <NUM> positioned concentrically with a catheter body <NUM> having an equal diameter (that is the diameter <NUM> shown in <FIG> equals the diameter <NUM> shown in <FIG>). In the example illustrated in <FIG>, the guidewire <NUM> is positioned along the catheter body external surface <NUM>. In the embodiments described herein with the guidewire <NUM> positioned within the wall <NUM> of the catheter body <NUM> (as illustrated in <FIG>) a cross-sectional footprint area of those embodiments is greater than the cross-sectional area of the catheter body.

The treatment delivery footprint of the catheter body <NUM> within the vessel is increased (as illustrated in <FIG>) with the pivot cylinder <NUM> as previously described herein relative to the configuration including a guidewire positioned concentrically with a catheter body (as illustrated in <FIG>). Rotation of the catheter body16 about the guidewire <NUM> (positioned within the pivot cylinder <NUM>) during a thrombectomy procedure provides a treatment delivery footprint diameter <NUM> within the vessel <NUM> that is greater than the diameter <NUM> of the catheter body <NUM>. As the thrombectomy procedure is conducted and thrombus is dislodged, the catheter body <NUM> (e.g., the treatment portion) as illustrated in <FIG> maintains intimate contact between the remaining thrombus along the vessel wall and the inlet and outlet orifices of the treatment portion. For example, the portions of the catheter positioned radially away from the guidewire <NUM>, when rotated, are moved into intimate proximity relative to the thrombus and the vessel wall. Accordingly, any catheter treatment features provided at the treatment portions are similarly positioned in intimate proximity to the thrombus and vessel wall. During rotation, the treatment features maintain their intimate proximity to the thrombus and vessel wall.

<FIG> is a flow chart of a method <NUM>, in accordance with one embodiment of the present disclosure. At <NUM>, a treatment portion of a catheter is positioned adjacent to a thrombus location along a vessel wall. For example, any of the hydrodynamic catheters <NUM>, <NUM>, <NUM>, <NUM>, and <NUM> as shown in <FIG>, are used in the method <NUM>. In an example, the hydrodynamic catheter <NUM> includes a treatment portion <NUM> including an inflow orifice <NUM> and an outflow orifice <NUM>, where the outflow orifice <NUM> is spaced from the inflow orifice <NUM>. The hydrodynamic catheter <NUM> includes a pivot cylinder <NUM> eccentrically mounted relative to a catheter longitudinal axis <NUM>, where the pivot cylinder includes a guidewire lumen.

At <NUM>, the thrombus at a first vessel position along the vessel wall is treated. At <NUM>, treating the thrombus at the first vessel position includes rotating a treatment portion of the catheter including the inflow and outflow orifices about the pivot cylinder to a first rotated positioned corresponding to the fist vessel position, where the inflow and outflow orifices are positioned in close proximity to the first vessel portion and directed in a first direction. For example, the treatment portion <NUM> (including the inflow and outflow orifices <NUM>, <NUM>) of the catheter body <NUM> is rotated about the pivot cylinder <NUM> to the first vessel position. In an example, rotating the treatment portion <NUM> of the catheter body <NUM> to the first rotated position includes rotating the treatment portion <NUM> of the catheter body <NUM> about the guidewire <NUM> received within the pivot cylinder <NUM>. The treatment portion <NUM> of the catheter body <NUM> is in intimate proximity to the thrombus deposit along the first vessel wall as the inlet and outlet orifices <NUM>, <NUM> are positioned opposite from the pivot cylinder <NUM>.

As <NUM>, treating the thrombus at the first vessel position includes delivering treatment in the first direction to the first vessel portion through the inflow and outflow orifices <NUM>, <NUM> at the first rotated position. In an example, delivering treatment includes moving a fluid under pressure through an infusion tube into a fluid jet emanator. For example, the fluid <NUM> is moved under pressure through the infusion tube <NUM> (e.g., within the infusion lumen <NUM>) into the fluid jet emanator <NUM>. The one or more jet orifices <NUM> generates fluid jets <NUM> and direct the fluid jets <NUM> through the catheter lumen <NUM> from near the inflow orifices <NUM> toward the outflow orifice <NUM>. The fluid jets <NUM> generate the cross stream flow that is able to deliver fluid to the vessel through the outlet orifice <NUM> and draw fluid with thrombus entrained therein into the catheter lumen <NUM> through the inflow orifice <NUM>.

At <NUM>, the thrombus at a second vessel position along the vessel wall radially spaced from the first vessel position is treated. At <NUM>, treating the thrombus at the second vessel position includes rotating the treatment portion of the catheter (including the inflow and outflow orifices) about the pivot cylinder to a second rotated position corresponding to the second vessel position. For example, the treatment portion <NUM> including the inflow and outflow orifices <NUM>, <NUM> is rotated about the pivot cylinder <NUM> to a second vessel position. The inflow and outflow orifices <NUM>, <NUM> are positioned in close proximity to the second vessel portion and directed in a second direction different from the first direction.

In an example, rotating the treatment portion <NUM> of the catheter body <NUM> to the first and second rotated positions generates a cross-sectional footprint area <NUM> larger than a cross-sectional area of the catheter body, as shown in <FIG>. Additionally, rotating the treatment portion <NUM> of the catheter body <NUM> to the first and second rotated positions generates a circular cross-sectional footprint area having a footprint diameter <NUM> approximately twice as large as a catheter body diameter <NUM>. Therefore the cross-sectional treatment delivery footprint area is increased, while maintaining the relatively small diameter of the catheter, as compared to the vessel.

At <NUM>, treating the thrombus at the second vessel position includes delivering treatment in the second direction to the second vessel portion through the inflow and outflow orifices at the second rotated position. In an example, fluid <NUM> is moved under pressure through the infusion tube <NUM> (e.g., within the infusion lumen <NUM>) into the fluid jet emanator <NUM>. The one or more jet orifices <NUM> generates fluid jets <NUM> and direct the fluid jets <NUM> through the catheter lumen <NUM> from near the inflow orifices <NUM> toward the outflow orifice <NUM> at the second vessel portion. The fluid jets <NUM> generate the cross stream flow that is able to deliver fluid to the vessel at the second vessel position through the outlet orifice <NUM> and draw fluid with thrombus entrained therein into the catheter lumen <NUM> through the inflow orifice <NUM>. In an example, the second vessel position is approximately <NUM> degrees from the first vessel position. In another example, the catheter <NUM> is rotated approximately <NUM> degrees within the vessel.

During use, the hydrodynamic catheters described herein are inserted into a vessel using a guidewire, for example. The catheter distal portion <NUM> is navigated through the vasculature and placed adjacent to a thrombus location. The fluid delivery device <NUM> (as illustrated in <FIG>) is set to deliver pressurized fluid within a range of from about <NUM> pounds per square inch (psi) to about <NUM> psi. Examples of the fluid delivery device <NUM> are described in<CIT>, entitled "THROMBECTOMY CATHETER DEPLOYMENT SYSTEM" and <CIT>, entitled "CROSSFLOW THROMBECTOMY CATHETER AND SYSTEM", which are hereby incorporated herein by reference in their entirety.

As discussed herein, the outlet orifice <NUM> and the one or more fluid orifices <NUM> are configured by way of shape and size to provide a fluid jet having desired flow characteristics (e.g., velocity and flow rate) configured to remove and macerate thrombus. The fluid control module is associated with the fluid delivery source for controlling fluid flows delivered by the fluid delivery system. In an example, the fluid delivery system includes a user-input control section for interfacing with computer hardware/software (i.e., electronic memory) of the fluid control module.

In an example, the aspirator <NUM> is coupled to the catheter body <NUM> and configured to apply a vacuum to remove the fluid and entrained thrombus in the catheter lumen <NUM>. When the aspirator <NUM> is turned on, the fluid with entrained thrombus enters the catheter lumen through the inlet orifice <NUM> and is directed toward the catheter proximal end <NUM> (as shown in <FIG>) and into a collection container of the aspirator.

In an example, method <NUM> includes positioning the treatment portion of the catheter within an interior cavity of a filter. For example, the treatment portion <NUM> of catheter <NUM> (illustrated in <FIG>) is positioned distal relative to the pivot cylinder <NUM>. In other words, the pivot cylinder <NUM> is positioned proximal to at least the outlet orifice <NUM>. In an example, the catheter <NUM> is combined with a filter and positioned within the interior of the filter such that the treatment portion <NUM> of the catheter <NUM> removes material caught within the filer. For example, the hydrodynamic catheter <NUM> is fed onto a guidewire used for a filter system. As discussed herein, the hydrodynamic catheter <NUM> is able to rotate about the guidewire and the treatment portion <NUM> of the hydrodynamic catheter <NUM> is able to remove material caught within the filter.

<FIG> illustrates a partial cross-section of the hydrodynamic catheter <NUM> in <FIG> positioned within a lumen <NUM> of a vessel <NUM> including thrombus <NUM>. The hydrodynamic catheter <NUM> includes the catheter body <NUM> having the pivot cylinder <NUM> positioned distal relative to at least one of the fluid jet emanator <NUM>, the outflow orifice <NUM>, and the inflow orifice <NUM>. As shown in <FIG>, the inflow and outflow orifices <NUM>, <NUM> (e.g., the treatment portion <NUM>) is in a first rotated position within the vessel <NUM> such that the inflow and outflow orifices <NUM>, <NUM> are directed in a first direction <NUM>. The inflow and outflow orifices <NUM>, <NUM> are positioned in close proximity to a first portion of a vessel including the thrombus. The first portion of the vessel is treated by delivering the fluid jets via the outflow orifice <NUM> and having the fluid with entrained thrombus <NUM> enter the catheter lumen <NUM> via the inflow orifice <NUM>.

<FIG> illustrates a partial cross-section of the hydrodynamic catheter <NUM> in <FIG> positioned within the lumen <NUM> of the vessel <NUM> including the thrombus <NUM>. The hydrodynamic catheter <NUM> in <FIG> is positioned at a second rotated position such that the inflow and outflow orifices <NUM>, <NUM> are directed in a second direction <NUM> different from the first direction. As illustrated in <FIG>, by rotating the inflow and outflow orifices <NUM>, <NUM> (e.g., the treatment portion <NUM>) about the pivot cylinder <NUM> ensures that the inflow and outflow orifices are readily maintained in intimate contact with the thrombus at the second (and first) rotated position. As discussed herein, the treatment delivery footprint generated by the hydrodynamic catheter <NUM> having the guidewire positioned eccentrically relative to a longitudinal axis of the catheter body, is greater than the footprint of the catheter body <NUM>. Thus, the treatment portion <NUM> of the catheter body is in intimate contact with the thrombus and vessel wall throughout the thrombectomy procedure, thereby increasing the efficiency of the procedure while at the same time using a relatively small diameter catheter body. Additionally, isolating the guidewire <NUM> from at least the catheter lumen <NUM> between the inflow and outflow orifices <NUM>, <NUM> increases the area within the catheter lumen <NUM> available for energy transfer thereby increasing the efficiency of the device while maintaining a relatively small catheter perimeter, as compared to the vessel.

<FIG> illustrates a hydrodynamic catheter of <FIG> in combination with a filter <NUM>, in accordance with one embodiment of the present disclosure. In an example, a filter catheter <NUM> and a filter <NUM> are deployed in a vessel for collection of material within the filter <NUM>. In an example, the filter <NUM> is a collapsible filter having expanded and retracted configurations. As illustrated in <FIG>, the filter <NUM> is in the expanded configuration. The filter <NUM> includes a filter cavity <NUM> and a plurality of extension legs <NUM>. The extension legs <NUM> are coupled to a filter catheter external surface <NUM>. A guidewire <NUM> through the filter catheter lumen <NUM> and through a distal end <NUM> of the filter <NUM>. In an example, the filter <NUM> is also coupled to the guidewire at the distal end <NUM>. During operation, the filter catheter <NUM>, filter <NUM>, and guidewire <NUM> are introduced to the vasculature. In one example, the filter catheter <NUM>, filter <NUM>, and guidewire <NUM> are introduced via a delivery sheath. While the filter catheter <NUM>, filter <NUM>, and guidewire <NUM> are introduced into the vessel or extended from the delivery catheter, the guidewire <NUM> and filter catheter <NUM> move together to maintain the filter <NUM> in the retracted configuration. When the filter <NUM> is at a desired location, the guidewire <NUM> is pulled proximally relative to the filter catheter <NUM> to transition the filter <NUM> from the retracted configuration to the expanded configuration (as shown in <FIG>).

The filter <NUM> is used to capture material (e.g., thrombus, plaque particulate or the like) and prevent the material from flowing downstream (e.g., past the filter) within the vessel. Over time as the filter mesh <NUM> collects material, the filter mesh <NUM> becomes clogged with material such that blood flow is unable to pass through the filter <NUM>. In that instance, it is beneficial to remove the material from the filter mesh <NUM> without having to remove the entire filter <NUM>. In an example, the hydrodynamic catheter <NUM> is used to remove the material caught within the filter <NUM>. In an example, the hydrodynamic catheter, as described in <FIG>, is inserted over the guidewire <NUM>. The catheter body <NUM> includes the treatment portion <NUM> having the inflow and outflow orifices <NUM>, <NUM>. In an example, the guidewire <NUM> enters the catheter body <NUM> at the pivot cylinder <NUM>, which is positioned proximal relative to at least the outflow orifice <NUM>. The treatment portion <NUM> of the catheter body <NUM> is positioned within the filter cavity <NUM>. As discussed herein, the catheter body <NUM> cooperates with the infusion tube <NUM> and the fluid emanator <NUM> (as shown in <FIG>) to generate a cross stream recirculating flow between the inflow and outflow orifices <NUM>, <NUM>. The recirculating flow enters the vessel and the filter cavity <NUM> and engages and dislodges the particulate material caught in the filter <NUM>. Fluid with entrained material enters the catheter lumen <NUM> through the inflow orifice <NUM> (described above) and is directed toward a proximal end of a catheter. As the catheter body <NUM> rotates about the guidewire <NUM>, the treatment portion <NUM> of the catheter body <NUM> is positioned in intimate contact with, in this example, an interior filter surface <NUM> over any arc as desired (e.g., through <NUM> degrees) to remove the material collected by the filter mesh <NUM>.

Claim 1:
A hydrodynamic catheter (<NUM>) comprising:
a catheter body (<NUM>) having a catheter lumen (<NUM>) extending along a length of the catheter body from a catheter proximal portion (<NUM>) to a catheter distal portion (<NUM>),
an infusion tube (<NUM>) including an infusion lumen (<NUM>) extending along a length of the catheter lumen (<NUM>), the infusion tube (<NUM>) extending within the catheter body (<NUM>) from the catheter proximal portion (<NUM>) towards the catheter distal portion (<NUM>) and being configured to deliver fluid under pressure to the catheter distal portion (<NUM>) for removal of thrombus,
the catheter distal portion (<NUM>) including a treatment portion (<NUM>), the treatment portion including at least one inflow orifice (<NUM>) and at least one outflow orifice (<NUM>),
a pivot cylinder (<NUM>) extending through a sidewall (<NUM>) of the catheter body (<NUM>) and including a pivot cylinder inlet (<NUM>), a pivot cylinder outlet (<NUM>) and a guidewire lumen extending therebetween, the pivot cylinder (<NUM>) being radially spaced around the catheter body (<NUM>) from the at least one inflow orifice (<NUM>) and the at least one outflow orifice (<NUM>),
wherein the pivot cylinder (<NUM>) and the guidewire lumen are eccentric relative to a longitudinal axis (<NUM>) of the catheter (<NUM>), and wherein the treatment portion (<NUM>) is positioned distal relative to the pivot cylinder (<NUM>),
a guidewire (<NUM>) positioned through the guidewire lumen and extending along a catheter body external surface (<NUM>) at least between the at least one inflow orifice (<NUM>) and the at least one outflow orifice (<NUM>), wherein the guidewire (<NUM>) extends within the catheter lumen (<NUM>) at a position proximal to at least the outlet orifice (<NUM>), and
a fluid jet emanator (<NUM>) in fluid communication with the infusion tube (<NUM>), wherein the fluid emanator (<NUM>) includes one or more jet orifices (<NUM>) directed in a proximal direction toward the catheter proximal portion (<NUM>).