A guide catheter assembly includes an outer sheath and an inner catheter disposed, at least partially, within the outer sheath. A tether tethers the inner catheter to the outer sheath. The guide catheter assembly has a first configuration where the tether is untensioned and distal ends of the outer sheath and inner catheter are pointing in a first direction. In a second configuration of the guide catheter assembly, the tether is tensioned, the distal end of the outer sheath is pointing in the first direction, the distal end of the inner catheter is pointing in a second direction that is different from the first direction, and the tether is oriented at an angle different from both the first direction and the second direction.
