Shunting catheters and methods for tissual removal

A method of creating a shunt, comprising:

• deploying a tissue-removal assembly in a shaft lumen of a catheter shaft at a first state, the tissue-removal assembly comprising a shunting shaft having an opening at a distal end thereof, and the shunting shaft comprising a cutting component disposed at a distal end of the shunting shaft, the cutting component extending along a circumferential direction of the opening at the distal end of the shunting shaft;
• operating the tissue-removal assembly to a second state, wherein the distal end of the shunting shaft extends from a side opening of the catheter shaft with a curved shape;
• disposing the cutting component approximate to a tissue wall of a patient;
• extending a puncture element from the distal end of the shunting shaft;
• cutting, using the cutting component, the tissue wall;
• and
• removing an area of tissue from the tissue wall to form an opening in the tissue wall using the tissue-removal assembly,
• wherein a puncture element shaft connects the puncture element to the distal end of the shunting shaft, the puncture element shaft is configured to mechanically support the puncture element when the puncture element is extended from the shunting shaft at an extended state;
• and
• wherein:
• the puncture element includes a rear surface that is coupled to the puncture element shaft;
• the rear surface of the puncture element has a first diameter;
• the puncture element shaft has a second diameter;
• and
• the first diameter is greater than the second diameter.