JP7029019B2 - アンケージングステント - Google Patents
アンケージングステント Download PDFInfo
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- JP7029019B2 JP7029019B2 JP2021179301A JP2021179301A JP7029019B2 JP 7029019 B2 JP7029019 B2 JP 7029019B2 JP 2021179301 A JP2021179301 A JP 2021179301A JP 2021179301 A JP2021179301 A JP 2021179301A JP 7029019 B2 JP7029019 B2 JP 7029019B2
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- stent
- scaffold
- degradable
- expansion
- circumferential
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Landscapes
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- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Cardiology (AREA)
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- Transplantation (AREA)
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- General Health & Medical Sciences (AREA)
- Optics & Photonics (AREA)
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- Pulmonology (AREA)
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Description
本願は、2017年3月31日に出願された仮特許出願番号第62/480,121号(代理人書類番号32016-714.106);2016年12月06日に出願された第62/430,843号(代理人書類番号32016-714.105);2016年11月21日に出願された第62/424,994号(代理人書類番号32016-714.104);2016年10月28日に出願された第62/414,593号(代理人書類番号32016-714.103);2016年8月12日に出願された第62/374,689号(代理人書類番号32016-714.102);および2016年5月16日に出願された第62/337、255号(代理人書類番号32016-714.101)の利益を主張しており、これら全体の開示は、参考として本明細書中に援用される。
Bond、またはその他からの紫外線硬化性物質、アクリル、シリコーン、熱溶融物、ポリウレタン、ゴリラグルー、TissueGlu、Sylys外科用封止剤、またはその他等のリシンベースの接着剤、フィブリン接着剤、蜜ろう等の接着剤、封止剤、およびポッティング化合物を含む。Sn97Cu3、Sn50Zn49Cu1、Sn95.5Cu4Ag0.5、Sn90Zn7Cu3、Sn98Ag2、Sn96.5Ag3Cu0.5、Sn91Zn9、Sn85Zn15、Sn70Zn30、Sn89Zn8Bi3、Sn83.6Zn7.6In8.8、Sn86.9In10Ag3.1、Sn95Ag3.5Zn1Cu0.5、Sn86.5Zn5.5In4.5Bi3.5、Sn95Sb5、Sn96.2Ag2.5Cu0.8Sb0.6、Sn90Au10、またはその他等のスズもしくはその合金、In97Ag3、In90Ag10、In50Sn50、In52Sn48、またはその他等のインジウムもしくはその合金、Zn95Al5、Zn60Sn40、Zn95Sn5、またはその他等の亜鉛もしくはその合金、B57Sn42Ag1、Bi58Sn52、またはその他等のビスマスもしくはその合金、Au80Sn20、Au98Si2、Au87.5Ge12.5、Au82In18等の金もしくはその合金等のはんだまたは可融合金材料等の他の固定材料もまた、使用されてもよい。固定のための他の手段は、レーザ接合または溶接もしくは融合、またはエネルギー固定の他の手段(接合および継合を含む)、ポリアルキル-2-シアノアクリレート、メチル-2-シアノアクリレート、エチル-2-アクリレート、n-ブチルシアノアクリレート、2-オクチルシアノアクリレート、またはその他等のシアノアクリレート、エポキシ、エポキシアミン、Loctite、Dymax、Master Bond、Henkel、またはその他からの紫外線硬化性物質、アクリル、シリコーン、熱溶融物、ポリウレタン、ゴリラグルー、ポリエステル、ポリラクチドおよびそれらのコポリマーならびにブレンド、ポリトリメチレンカーボネートおよびそれらのコポリマーならびにブレンド、ポリビニルアルコール、ポリ酢酸ビニル、エチレン-酢酸ビニル(熱溶融性接着剤)、フェノールホルムアルデヒド樹脂、ポリアミド、ポリエステル樹脂、ポリエチレン(熱溶融性接着剤)、ポリプロピレン、ポリスチレン、ポリカーボネート、ポリクロロプレン、天然ゴム、シリコーンゴム、TissueGlu、Sylys外科用封止剤、またはその他等のリシンベースの接着剤、フィブリン接着剤、蜜ろう、カゼイン、イガイ接着タンパク質、およびコラーゲン等の生体接着剤、それらの組み合わせ、または同等物等の溶剤ベースのポリマー分散もしくは純接着剤、封止剤、およびポッティング化合物、Sn97Cu3、Sn50Zn49Cu1、Sn95.5Cu4Ag0.5、Sn90Zn7Cu3、Sn98Ag2、Sn96.5Ag3Cu0.5、Sn91Zn9、Sn85Zn15、Sn70Zn30、Sn89Zn8Bi3、Sn83.6Zn7.6In8.8、Sn86.9In10Ag3.1、Sn95Ag3.5Zn1Cu0.5、Sn86.5Zn5.5In4.5Bi3.5、Sn95Sb5、Sn96.2Ag2.5Cu0.8Sb0.6、Sn90Au10、またはその他等のスズもしくはその合金、In97Ag3、In90Ag10、In50Sn50、In52Sn48またはその他等のインジウムもしくはその合金、Zn95Al5、Zn60Sn40、Zn95Sn5、またはその他等の亜鉛もしくはその合金、B57Sn42Ag1、Bi58Sn52、またはその他等のビスマスもしくはその合金、Au80Sn20、Au98Si2、Au87.5Ge12.5、Au82In18等の金もしくはその合金、それらの組み合わせ、または同等物等のはんだまたは可融合金材料等を含む。血管または他の生理学的環境内で非分解性の好適なステント材料は、限定されないが、304V、304L、および316LVステンレス鋼等のステンレス鋼、軟鋼等の合金鋼、コバルトクロム等のコバルトベースの合金、L605、Elgiloy(登録商標)、Phynox(登録商標)、白金クロム、白金イリジウム、および白金ロジウム等の白金ベースの合金、スズベースの合金、ロジウム、ロジウムベースの合金、パラジウム、パラジウムベースの合金、アルミニウムベースの合金、チタンまたはそれらの合金、50:50レニウムモリブデン等のレニウムベースの合金、モリブデンベースの合金、タンタル、金および金合金、銀および銀合金、形状記憶金属または合金、クロムベースの合金、線形弾性および/または超弾性ニチノール等のニッケルチタン合金、ニッケル・クロム・モリブデン合金(例えば、INCONEL 625、Hastelloy C-22、Hatelloy C276、Monel 400、Nickelvac 400、および同等物)等のニッケル合金、MP35-N等のニッケル・コバルト・クロム・モリブデン合金、ニッケルモリブデン合金、白金濃縮ステンレス鋼、それらの組み合わせ、もしくは同等物、ならびにステントおよび補綴具製造で一般的に採用されるタイプの他の可鍛性金属等の金属および金属合金を含む。他の実施例では、非分解性材料は、ポリアリールエーテルケトン、ポリエーテルエーテルケトン、ポリイミド、UHMW、HDPE、LDPE、またはその他等のポリエチレン、ポリプロピレン、ポリエステル、ポリエチレンテレフタレート、ポリカーボネート、ポリスルホン、ポリフェニルスルホン、ポリエーテルスルホン、Ultem、ポリエーテルイミド、ポリウレタン、ポリアミド、ナイロン12、ナイロン6、ナイロン6-6、またはその他等のナイロン、ポリ塩化ビニル、PTFE、FEP、ETFE、PFA、PVDF、ポリ塩化ビニル、アクリロブタジエンスチレン、デルリン、ポリメチルメタクリレート、ポリスチレン、ポリアクリルアミド、ポリフェニルスルフィド、PEBAX、または他の材料等の非分解性ポリマーを備えてもよい。なおも他の実施例では、非分解性材料は、形状もしくは熱記憶合金、形状記憶ポリマー、または超弾性材料、典型的には、ニッケルチタン合金、ばねステンレス鋼、Ni50-Mn28-Ga22、銅・アルミニウム・ニッケル、亜鉛、銅、金、および鉄の合金、Fe-Mn-Si等の鉄ベースの合金、Cu-Zn-AlおよびCu-Al-Ni等の銅ベースの合金、ポリ(ε-カプロラクトン)ジメタクリレート、PVDF/PMMA、PVDF/PVA、PLA/PVAc、またはその他、もしくは同等物等の弾性金属を備えてもよい。分解性ポリマー材料等の分解性材料の実施例は、ラクチド、カプロラクトン、トリメチレンカーボネート、グリコリド、ポリ(L-ラクチド)、ポリ-DL-ラクチド、ポリラクチド-co-グリコリド(例えば、ポリ(L-ラクチド-co-グリコリド)、ポリ(L-ラクチド-co-イプシロン-カプロラクトン)のコポリマー(例えば、約50~約95%L-ラクチド対約50~約5%カプロラクトンの重量比)、ポリ(L-ラクチド-co-トリメチレンカーボネート)、ポリトリメチレンカーボネート、ポリ-カプロラクトン、ポリ(グリコリド-トリメチレンカーボネート)、ポリ(ラクチド-グリコリド-トリメチレンカーボネート)、または同等物、ポリ(3-ヒドロキシ酪酸)およびポリ(4-ヒドロキシ酪酸)等のポリヒドロキシ酪酸、ポリヒドロキシ吉草酸、ポリヒドロキシ酪酸/ポリヒドロキシ吉草酸コポリマー(PHV/PHB)、ポリヒドロキシアルカノエート、ポリオルトエステル、ポリ酸無水物、ポリイミノカーボネート、チロシン由来ポリカーボネート、チロシン由来ポリアクリレート、ヨウ化および/または臭素化チロシン由来ポリカーボネート、ヨウ化および/または臭素化チロシン由来ポリアクリレートポリエステルアミド、ポリカーボネートコポリマー、ポリ(フマル酸プロピレン-co-エチエレングリコール)コポリマー(別名フマル酸無水物)等のラクトンベースのポリマー、ポリ酸無水物エステル、ポリオルトエステル、シルクエラスチンポリマー、ポリホスファゼン、脂肪族ポリウレタン、ポリヒドロキシ酸、ポリエーテルエステル、ポリエステル、ポリデプシペプチド、ポリ(アルキレンオキサラート)、ポリアスパラギン酸、ポリグルタル酸ポリマー、ポリ-p-ジオキサノン、ポリ-ベータジオキサノン、非対称3,6-置換ポリ-1,4-ジオキサン-2,5-ジオノン、ポリアルキル-2-シアノアクリレート、ポリデプシペプチド(グリシン-DL-ラクチドコポリマー)、ポリジヒドロピラン、ポリアルキル-2-シアノアクリレート、ポリ-ベータ-マレイン酸(PMLA)、ポリアルカノエート、ポリ-ベータ-アルカン酸、ポリマー、ブレンド、および/またはコポリマー、もしくはそれらの組み合わせのうちの1つまたはそれを上回るものを備える。
Nickelvac 400、および同等物)等のニッケル合金、MP35-N等のニッケル・コバルト・クロム・モリブデン合金、Ni21Cr17MoまたはHaynes 230等のニッケル合金、もしくはその他、ニッケルモリブデン合金、白金濃縮ステンレス鋼、それらの組み合わせ、または同等物等の非腐食性(非分解性)金属もしくは金属合金。腐食性金属または金属合金(分解性)は、ニッケル、コバルト、タングステン、レニウム、コバルト、鉄、ジルコニウム、亜鉛、チタンのタングステン合金、マグネシウム、マグネシウム合金、マグネシウム合金AZ31、20重量%未満の亜鉛またはアルミニウムを伴い、3%未満の鉄、シリコーン、マンガン、コバルト、ニッケル、イットリウム、スカンジウム、または他の希土類金属の1つもしくはそれを上回る不純物を伴わない、または伴うマグネシウム合金、AZ31BもしくはMG11li5Al1Zn0.034Sc(LAZ1151)、亜鉛またはZn5al、Zn10Al、Zn18Al、Zn30Al等の亜鉛合金等のその合金、ビスマスまたはその合金、インジウムまたはその合金、スズまたはスズ鉛、Sn3.9Ag0.6Cu、Sn-3.8Ag-0.7Cu、SnPb、もしくはSnPbAt等のその合金、銀または銀スズ合金等のその合金、コバルト鉄合金、鉄または80-55-06グレード延性鋳鉄、他の延性鋳鉄、AISI 1010鋼、AISI 1015鋼、AISI 1430鋼、AISI 8620鋼、AISI 5140鋼、Fe29.7Mn8.7Al1C、30HGSA合金鋼、4140、C45鋼、Fe36Ni、低炭素鋼、もしくは他の鋼鉄等のその合金、溶融可融合金(40%ビスマス-60%スズ、58%ビスマス-42%スズ、ビスマス・スズ・インジウム合金等)、ビスマス、インジウム、コバルト、タングステン、ビスマス、銀、銅、鉄、亜鉛、マグネシウム、ジルコニウム、モリブデン、インジウム、スズのうちの1つまたはそれを上回るものを含む合金、もしくは他の材料、または同等物を含む。
および/または管内で、ならびに/もしくは1.5psi~5psiにおいて、圧力下で、脈動圧力下でステントを加圧して、および/または加速された疲労、ならびに/もしくは加速された条件のうちのいずれか、および/またはそれらの組み合わせで、修正を受ける。
構造は、展開後および/または展開後かつ修正後のステントが、管腔もしくは血管がさらに拡大する、および/または離脱する、ならびに/もしくは分離することを可能にするように、少なくとも1つの支柱の上および/または少なくとも1つのクラウンの上に、キーおよびロック、当接、2つのプレート、圧入、ラチェット、リベット、挿入物、磁石、もしくはその他等の分離領域不連続性を有する。
本発明は、例えば、以下を提供する。
(項目1)
非分解性材料からパターン化される複数の円周方向リングを有する、足場であって、圧着構成から拡張構成まで拡張するように構成される、足場を備え、
前記円周方向リングのうちの少なくともいくつかは、生理学的環境内の拡張後に前記円周方向リングに少なくとも1つの不連続性を形成するように構成される、少なくとも1つの分離領域を有し、前記円周方向リングのうちの2つの少なくとも一部は、不連続性が形成された後に軸方向に継合されたままである、管腔内補綴具。
(項目2)
全ての円周方向リングは、全ての不連続性が形成された後に軸方向に継合されたままである、項目1に記載の管腔内補綴具。
(項目3)
任意の不連続性の形成に先立って、各円周方向リングは、初期半径方向コンプライアンスを有し、不連続性の形成後に、少なくともいくつかの円周方向リングは、増加した半径方向コンプライアンスを有する、項目1に記載の管腔内補綴具。
(項目4)
前記足場は、全ての不連続性が形成された後に、区画に分離しない、項目1に記載の管腔内補綴具。
(項目5)
前記足場は、全ての不連続性が形成された後に、2つまたはそれを上回る区画に分離する、項目1に記載の管腔内補綴具。
(項目6)
前記2つまたはそれを上回る区画のうちの少なくともいくつかは、円周方向リングを備える、項目5に記載の管腔内補綴具。
(項目7)
前記2つまたはそれを上回る区画のうちの少なくともいくつかは、閉鎖セル区画を備える、項目5に記載の管腔内補綴具。
(項目8)
前記2つまたはそれを上回る区画のうちの少なくともいくつかは、前記足場の第1の端部から前記足場の第2の端部まで延在する分離線に沿って、円周方向に分離する、項目5に記載の管腔内補綴具。
(項目9)
前記分離線は、軸方向または渦巻状幾何学形状を有する、項目8に記載の管腔内補綴具。
(項目10)
前記円周方向リングのうちの少なくともいくつかは、連続円形周囲を有し、隣接する連続リングは、軸方向に継合される、項目1に記載の管腔内補綴具。
(項目11)
前記円周方向リングのうちの少なくともいくつかは、継合して螺旋足場を形成する端部領域を伴う不連続周囲を有する、項目1に記載の管腔内補綴具。
(項目12)
前記円周方向リングのうちの少なくともいくつかは、クラウンによって継合される複数の支柱を備える、項目1に記載の管腔内補綴具。
(項目13)
少なくとも1つの分離領域は、円周方向リングの支柱の中に位置する、項目12に記載の管腔内補綴具。
(項目14)
各円周方向リングは、分離領域を有する1~5つの支柱を有する、項目13に記載の管腔内補綴具。
(項目15)
少なくとも1つの分離領域は、円周方向リングのクラウンの中に位置する、項目12に記載の管腔内補綴具。
(項目16)
円周方向リングの少なくとも1つのクラウンは、分離領域を含まない、項目12に記載の管腔内補綴具。
(項目17)
前記円周方向リングのうちの少なくともいくつかの前記支柱およびクラウンは、連続円周方向経路を形成し、前記分離領域は、全ての不連続性が形成された後に、前記経路に不連続性を形成するように位置する、項目12に記載の管腔内補綴具。
(項目18)
前記材料は、スリーブ、はんだ、および/または接着剤として形成される生分解性ポリマーを含む、項目17に記載の管腔内補綴具。
(項目19)
前記分離領域は、前記リングに形成される間隙の中に、それにわたって、および/またはそれに隣接して配置される、弾性材料を含み、前記弾性材料は、生理学的環境内の拡張後に無傷のままである、項目1に記載の管腔内補綴具。
(項目20)
前記分離領域は、拡張中に固定化されるが、前記生理学的環境内の前記初期拡張後に分離するように構成される、キーおよびロック接合点を備える、項目1に記載の管腔内補綴具。
(項目21)
前記キーおよびロック接合点は、円周方向ならびに/または半径方向への分離を可能にするが、軸方向への分離を阻止する、くし状もしくは鋸歯状表面を有する、項目20に記載の管腔内補綴具。
(項目22)
前記キーおよびロック接合点は、円周方向、半径方向ならびに/または軸方向への分離を可能にする、平滑表面を有する、項目20に記載の管腔内補綴具。
(項目23)
前記分離領域は、前記生理学的環境内で分解する材料によって継合されるか、それによって被覆されるか、またはそれに埋め込まれる、突き合わせ継手を備える、項目1に記載の管腔内補綴具。
(項目24)
非分解性材料は、金属または金属合金材料を含む、項目1に記載の管腔内補綴具。
(項目25)
前記不連続性は、前記足場が初期拡張からの反跳後にさらに拡張することを可能にするように構成される、項目1に記載の管腔内補綴具。
(項目26)
前記不連続性は、前記足場が初期拡張直径よりも大きい拡張直径まで拡張することを可能にするように構成される、項目1に記載の管腔内補綴具。
(項目27)
前記円周方向リングは、前記圧着構成における前記足場の長手軸と実質的に垂直に整合される、項目1に記載の管腔内補綴具。
(項目28)
前記円周方向リングは、前記圧着構成における前記足場の長手軸に対する角度で傾斜している、項目1に記載の管腔内補綴具。
(項目29)
前記足場は、管状または平坦基板からパターン化される、項目1に記載の管腔内補綴具。
(項目30)
前記足場は、屈曲ワイヤから形成される、項目1に記載の管腔内補綴具。
ここで図4-9を参照すると、本発明の管腔内補綴具は、任意の従来のステントパターンで生分解性ポリマー材料(または生分解性金属材料)からパターン化されてもよい。例えば、支柱21、ヒンジ22、およびリンク23ならびに24のパターンを有する、蛇行管腔内補綴具16は、具体的には図4Aおよび4Bに示されるように、補強要素26を提供されてもよい。図4Aでは、補綴具は、その圧着または小直径構成であり、典型的には、曲線または三日月形として形成されるが、種々の形状、サイズ、および幾何学形状を有し得る、第1のタイプの補強要素26が、ヒンジ22のうちの選択されるもの中で提供される。ヒンジが、図4Bに示されるように、ステントの開放中に応力を加えられ、拡張されたヒンジが血管または他の身体管腔内の初期拡張後に存在し得る圧縮力への降伏に抵抗することに補強が役立つであろうため、ヒンジ内に補強を提供することが特に望ましい。
ここで図10を参照すると、部分リング14を示す拡張可能ジグザグが、軸方向リンク44によって相互に取り付けられたヒンジ42および隣接するリングによって継合された複数の支柱40とともに詳細に図示されている。以下の議論および実施例の目的のために、ジグザグリング14は、金属または他の非分解性材料から形成され(但し、ステントの拡張に応じて高い剛性を有する金属またはポリマー材料等の分解性材料から形成されることもできる)、材料は、経時的に、および/または拡張後に、これらの場所(分離領域)において、もしくはこれらの領域中に、不連続性または分離を形成するように、材料を脆弱化するために(もしくは接合点を形成するために)特定の場所または領域において修正されるであろう。ある場合には、不連続性または転位は、補綴具が埋め込まれている管腔環境の結果として生じるであろう。例えば、血管系に埋め込まれたとき、血管は、自然に脈動し、連続機械的応力を、管腔内補綴具、または心臓の鼓動中に収縮および拡張する(もしくは広がる)弁輪に提供するであろう。特定の場所または分離領域における円周方向足場の物理的性質を修正することによって、これらの場所は、経時的に優先的に破損(崩壊および/または分離)し、展開後ならびに/もしくは血管壁に組み込まれた後に、円周方向足場が離脱および/またはさらに拡張することを可能にするであろう。このように、血管または他の身体管腔もしくはステント留置区画の望ましくない閉じ込めまたは拘束が、防止されることができる。他の事例では、円周方向足場上のある場所または分離領域の優先的破損は、磁性、超音波エネルギー、熱、高周波数エネルギー、血管拡張剤もしくは血管収縮剤等の後続の治療薬、身体管腔内のバルーン拡張、または同等物を含む、種々の源のうちのいずれか1つからの外部エネルギーの印加によって誘発または増進されることができる。以下の議論では、円周方向足場への特定の構造または物理的修正の殆どもしくは全てが、身体管腔内の生理学的環境および/または外部エネルギーの印加のいずれかに応答するように構成もしくは適合され得ることを理解されたい。
52の部分リングおよび54の部分リングは、本実施例では、望ましい時間周期後または展開後に、破損して、52の2つの隣接する部分リングを完全に分離し、リング54の2つの隣接する部分リングを完全に分離するように構成されることができる、中心区分62のみによって保持されたままである。具体的には、中心部分の幅および厚さは、脈動応力、他の管腔内条件、および/または外部エネルギーの印加、ならびにそれらの組み合わせに応答して、破損もしくは分離するように選定されることができる。典型的には、中心区分62の破損は、52の2つの部分リングの間および54の2つの部分リングの間の分離領域の存在がないと、リング52および54に不連続性を形成しないであろう。
ここで図22を参照すると、蛇行リング14の隣接する支柱40は、スリーブ118または類似生分解性束縛具によって束縛されてもよい。生分解性束縛具は、円周方向足場の拡張中に隣接する支柱区画をともに保持するであろう。埋込後、スリーブ118または他の束縛具は、経時的に浸食もしくは分解し、支柱42は、拡張するように解放され、したがって、補綴具を離脱させる、または非拘束するであろう。別の実施例では、接着剤は、2つの隣接する要素を継合して、ステントの展開後にそれらをともに保持し、次いで、接着剤は、分解して2つの隣接する要素を解放し、さらに拡張して、血管を離脱させる。
ここで図23Aおよび23Bを参照すると、枢動ピン126上で支柱124を継合する能動ヒンジ122が、形成されてもよい。枢動部126は、下部ポート支柱区画の一方の端部にパターン化され、上部支柱区画内のスロット128の中に受容される。スロットは、非対称であり、枢動ピン126に隣接して形成される下面132に対して角度を成す面130を有する。そのような能動継手を含む円周方向足場が拡張された後、継手は、図23Aの構成を成すことができるように、身体管腔によって圧縮されるであろう。しかしながら、経時的に、管腔再形成が管腔直径を拡張すると、継手は、図23Bに図示されるように、開放し、したがって、補綴具の結果として、任意の拘束または閉じ込めを減少させることができるであろう。一実施例では、能動ヒンジは、ポリマー材料で、または展開に応じて定位置でヒンジを保持する接着剤材料でコーティングされる。能動ヒンジ材料はまた、または代わりに、支柱上のリングの直線状区分の中に設置されることもできる。
典型的には、一実施例では、非分解性材料は、304V、304L、および316LVステンレス鋼等のステンレス鋼、軟鋼等の鋼合金、コバルトクロム等のコバルトベースの合金、L605、Elgiloy(登録商標)、Phynox(登録商標)、白金クロム、白金イリジウム、および白金ロジウム等の白金ベースの合金、スズベースの合金、ロジウム、ロジウムベースの合金、パラジウム、パラジウムベースの合金、アルミニウムベースの合金、チタンまたはそれらの合金、50:50レニウムモリブデン等のレニウムベースの合金、モリブデンベースの合金、タンタル、金またはそれらの合金、形状記憶金属または合金、クロムベースの合金、線形弾性および/または超弾性ニチノール等のニッケルチタン合金、ニッケル・クロム・モリブデン合金(例えば、INCONEL 625、Hastelloy C-22、Hatelloy C276、Monel 400、Nickelvac 400、および同等物)等のニッケル合金、MP35-N等のニッケル・コバルト・クロム・モリブデン合金、ニッケルモリブデン合金、白金濃縮ステンレス鋼、それらの組み合わせ、もしくは同等物、ならびにステントおよび補綴具製造で一般的に採用されるタイプの他の可鍛性金属、または圧着構成から拡張構成まで拡張されたときに塑性的に変形可能な金属等の金属および金属合金を含むか、またはそれらから形成される。しかしながら、他の実施例では、非分解性材料は、ポリアリールエーテルケトン、ポリエーテルエーテルケトン、ポリイミド、UHMW、HDPE、LDPE、またはその他等のポリエチレン、ポリプロピレン、ポリエステル、ポリエチレンテレフタレート、ポリカーボネート、ポリスルホン、ポリフェニルスルホン、ポリエーテルスルホン、Ultem、ポリエーテルイミド、ポリウレタン、ポリアミド、ナイロン12、ナイロン6、ナイロン6-6、またはその他等のナイロン、ポリ塩化ビニル、PTFE、FEP、ETFE、PFA、PVDF、ポリ塩化ビニル、アクリロブタジエンスチレン、デルリン、ポリメチルメタクリレート、ポリスチレン、ポリアクリルアミド、ポリフェニルスルフィド、PEBAX、または他の材料等の非分解性ポリマーを含んでもよい。なおも他の実施例では、非分解性材料は、形状もしくは熱記憶合金、形状記憶ポリマー、または超弾性材料、典型的には、ニッケルチタン合金、ばねステンレス鋼、Ni50-Mn28-Ga22、銅・アルミニウム・ニッケル、亜鉛、銅、金、および鉄の合金、Fe-Mn-Si等の鉄ベースの合金、Cu-Zn-AlおよびCu-Al-Ni等の銅ベースの合金、ポリ(ε-カプロラクトン)ジメタクリレート、PVDF/PMMA、PVDF/PVA、PLA/PVAc、またはその他、もしくは同等物等の弾性金属を含んでもよい。
6、Monel 400、Nickelvac 400、および同等物)等のニッケル合金、MP35-N等のニッケル・コバルト・クロム・モリブデン合金、Ni21Cr17MoまたはHaynes 230等のニッケル合金、もしくはその他、ニッケルモリブデン合金、白金濃縮ステンレス鋼、それらの組み合わせ、または同等物等の非腐食性(非分解性)金属もしくは金属合金。腐食性金属または金属合金(分解性)は、ニッケル、コバルト、タングステン、レニウム、コバルト、鉄、ジルコニウム、亜鉛、チタンのタングステン合金、マグネシウム、マグネシウム合金、マグネシウム合金AZ31、20重量%未満の亜鉛またはアルミニウムを伴い、3%未満の鉄、シリコーン、マンガン、コバルト、ニッケル、イットリウム、スカンジウム、または他の希土類金属の1つもしくはそれを上回る不純物を伴わない、または伴うマグネシウム合金、AZ31BもしくはMG11li5Al1Zn0.034Sc(LAZ1151)、亜鉛またはZn5al、Zn10Al、Zn18Al、Zn30Al等の亜鉛合金等のその合金、ビスマスまたはその合金、インジウムまたはその合金、スズまたはスズ鉛、Sn3.9Ag0.6Cu、Sn-3.8Ag-0.7Cu、SnPb、もしくはSnPbAt等のその合金、銀または銀スズ合金等のその合金、コバルト鉄合金、鉄または80-55-06グレード延性鋳鉄、他の延性鋳鉄、AISI 1010鋼、AISI 1015鋼、AISI 1430鋼、AISI 8620鋼、AISI 5140鋼、Fe29.7Mn8.7Al1C、30HGSA合金鋼、4140、C45鋼、Fe36Ni、低炭素鋼、もしくは他の鋼鉄等のその合金、溶融可融合金(40%ビスマス-60%スズ、58%ビスマス-42%スズ、ビスマス・スズ・インジウム合金等)、ビスマス、インジウム、コバルト、タングステン、ビスマス、銀、銅、鉄、亜鉛、マグネシウム、ジルコニウム、モリブデン、インジウム、スズのうちの1つまたはそれを上回るものを含む合金、もしくは他の材料、または同等物を含む。他の非分解性ポリマー材料は、パリレンおよびC-フレックス材料を含む。
ここで図36を参照すると、従来技術の螺旋ステント1300は、螺旋骨格1302を有する足場を備える。螺旋骨格1302は、個々の巻目が支柱1308によって継合されるクラウン1306を備える、複数の隣接する巻目(リング)1304を備える。従来技術のステントでは、そのような螺旋ステントの中の隣接する巻目のうちの少なくともいくつかは、恒久軸方向コネクタ1310によって継合されてもよい。螺旋骨格は、典型的には、マンドレルの周囲にワイヤを屈曲することによって形成され、軸方向コネクタ1310は、典型的には、対向クラウン1306が相互に直接隣接して位置する点において、隣接する巻目をともに溶接または別様に融合することによって形成される。
本発明の分離領域技術はまた、ステントおよび他の管腔補綴具上の閉鎖セル足場に適用されてもよい。例えば、図43に示されるように、閉鎖セルステント足場1400は、複数の円周方向リング1402を備える。各リングは、軸方向リンク1406によって継合される、いくつかの四角形閉鎖セル1404を備える。各円周方向リング1402内の四角形閉鎖セル1404は、円周方向コネクタ1408によって継合される。
図49は、支柱のうちの2つが、本発明の原理に従って構築される円周方向変位領域1710等の変位領域を有する、支柱1704およびクラウン1706から形成されたステント補綴具1700の単一の部分円周方向リング1702を図示する。円周方向部分リング1702は、軸方向リンク1708によって軸方向に隣接する円周方向リング(完全には示されていない)に接続される。前述で説明された分離領域とは対照的に、これらの変位領域1710は、前述で説明されたような分離だけではなく、円周方向リングの円周方向寸法を拡張および/または収縮するための弾性領域を提供するように構成されてもよい。
溶剤の部分的蒸発を可能にする数秒後、はんだごての先端は、キーおよびロックとロックの上部との間にポリマーを再流動させる要素に隣接して設置される。ステントは、次いで、ポリマー管類を溶融するように10分にわたって120℃のオーブンにおいて加熱され、それがキーおよびロック要素に隣接する要素の中へ、かつそれにわたって流動することを可能にした(図27B)。キーおよびロックに加えて、キーおよびロック構成要素は、ロックによって突き刺されることから隣接する組織を保護するとともにポリマーとの接合後に取付を改良するスタブ、ウィング、アンカ、または同等物を有した。キーおよびロックの間にあり、かつこれらの構成要素の表面に隣接する本ポリマーは、それがもはやキーおよびロックをともに保持することができなくなり、または分解するポリマー接着が生理学的条件下で牽引力によって克服され、それらの取外ならびにステントおよび/または血管の離脱をもたらす、ならびに/もしくは取外後に血管運動を可能にする、および/またはステントがさらに拡張することを可能にする時点まで、ポリマーが1~3ヶ月で分解するまで、効果的にキーをロックにともに係止し、分離領域を形成する。ステントは、十分な強度を有し、拡張の直後に動脈を支持することができる。ステントは、組織狭窄および/または再狭窄を低減させる免疫抑制剤である、ノボリムスを含有する薬物ポリマー基質でコーティングされる。切断された際の3×14mmステントは、0.063インチ外径を有する(図28)。切断されたステントは、3.0mmバルーン上に圧着され、包装され、電子ビームを使用して滅菌された。ステントは、3mmバルーンカテーテルを用いて拡張され、平坦プレート圧縮強度に関して試験された(図29Bおよび30)。圧縮後、ステントは、拡張後に3mm直径に戻り、生分解性50:50ポリ(DL-ラクチド-co-グリコリド)を溶解し、生理学的条件をシミュレーションして不連続性を形成するようにジクロロメタンに浸された(表1参照)。これは、ステント上のロックから全てのキーを効果的に取り外した。ステントは、平坦プレート圧縮強度に関して再試験された(表1参照)。ステントは、別個に、または細い管の内壁の中へ細い管内で拡張され(細い管の内壁の中へ埋め込むように十分に拡張され)、いずれかで試験される。細い管の使用は、ステントが2つまたはそれを上回る縦方向区画に分離するように構成されるときに特に重要であり、管は、したがって、ステント留置区画の複合コンプライアンスを模倣する、ステント留置管の複合強度または複合(ステントおよび管一緒の)コンプライアンスを試験することによって、強度もしくはコンプライアンス試験を実施する含有手段を提供する。
FEAモデル結果は、不連続性を有していない「従来技術」(対照)のステントおよび不連続性ならびに軸方向リンクを有していないサンプル2が、本実施例で評価される全てのパラメータに関して実質的に同一であることを示した。中間リング結果の分析を図示する目的のために、「従来技術」(対照)のステント対4つの不連続性を有するステントが選定された。対照(0の不連続性)と4つの不連続性のグラフとの間の変位の差を図式的に見ると、図78において定性的ならびに定量的の両方で、隣接するリングの間(隣接するクラウンの間)でとられる区分と中間リング区画との間の差を示す。
Claims (29)
- 管腔内補綴具であって、
非分解性材料からパターン化される複数の円周方向リングを有する足場を備え、前記足場は、圧着構成から展開構成まで拡張するように構成され、
前記円周方向リングのうちの少なくともいくつかは、クラウンによって継合される支柱を備え、前記円周方向リングのうちの少なくともいくつかは、隣接する円周方向リングに軸方向に継合され、前記円周方向リングのうちの少なくともいくつかは、少なくとも1つの分離領域を有し、
前記少なくとも1つの分離領域は、ロックおよびキー接合点を備え、前記ロックおよびキーは、非分解性材料であり、
前記少なくとも1つの分離領域は、前記円周方向リングの支柱内にあり、前記少なくとも1つの分離領域は、前記円周方向リングの前記支柱内に事前形成された切れ目を備え、前記ロックは、前記切れ目の一端上にあり、前記キーは、前記切れ目の他端上にあり、前記ロックおよびキーは、生分解性ポリマーおよび/または接着剤によって継合され、前記生分解性ポリマーおよび/または接着剤によって被覆され、または、前記生分解性ポリマーおよび/または接着剤に埋め込まれ、前記生分解性ポリマーおよび/または接着剤は、前記ロックおよびキーを拡張中にともに保持するが生理学的環境内で前記展開構成への前記足場の拡張後に分解して前記ロックおよびキーが分離するのを可能にする、管腔内補綴具。 - 前記分離領域を含む前記少なくとも1つの支柱は、円周方向リング上で2つのクラウンを継合する、請求項1に記載の管腔内補綴具。
- 前記展開構成への拡張後、前記少なくともいくつかの円周方向リングは、軸方向に継合されたままである2つ以上の区画に分離する、請求項1に記載の管腔内補綴具。
- 前記展開構成への拡張後、前記足場は、軸方向に継合される2つまたは3つの区画に分離する、請求項3に記載の管腔内補綴具。
- 前記足場は、蛇行、ジグザグ、螺旋、開放セル設計、または閉鎖セル設計を含むパターンを有する、請求項1に記載の管腔内補綴具。
- 前記少なくとも1つのロックおよびキー接合点は、オス型部分とメス型部分とを備える、請求項1に記載の管腔内補綴具。
- 少なくともいくつかの円周方向リングの全てのクラウンは、分離領域を含まない、請求項1に記載の管腔内補綴具。
- 拡張に応じて、前記分離領域は、展開後の前記分離領域の分離前に、いくつかの移動を可能にする、請求項1に記載の管腔内補綴具。
- 前記少なくともいくつかの円周方向リングは、各々、1~4つの分離領域を含む、請求項1に記載の管腔内補綴具。
- 少なくとも1つの円周方向リングは、支柱内に位置する少なくとも1つの分離領域を含み、前記支柱は、同一のリング上でクラウンを継合し、前記支柱およびクラウンは、隣接する円周方向リングに継合されない、請求項1に記載の管腔内補綴具。
- 少なくとも1つの円周方向リングは、支柱内に位置する少なくとも1つの分離領域を含み、前記支柱は、同一のリング上でクラウンを継合し、前記支柱およびクラウンは、軸方向リンクを介して、隣接する円周方向リングに継合されない、請求項1に記載の管腔内補綴具。
- 少なくとも1つの円周方向リングは、支柱内に位置する少なくとも1つの分離領域を含み、前記支柱は、同一のリング上でクラウンを継合し、前記支柱またはクラウンは、隣接する円周方向リングに継合される、請求項1に記載の管腔内補綴具。
- 少なくとも1つの円周方向リングは、各々が支柱内に位置する1~4つの分離領域を含み、前記支柱は、同一のリング上でクラウンを継合し、前記支柱またはクラウンは、軸方向リンクによって、隣接する円周方向リングに継合される、請求項1に記載の管腔内補綴具。
- 1つまたは複数の分離領域を含む前記少なくともいくつかの円周方向リングは、隣接する円周方向リングに軸方向に継合され、前記円周方向リングは、生理学的環境内で前記足場の展開後、軸方向に継合されたままである、請求項1に記載の管腔内補綴具。
- 前記少なくともいくつかの円周方向リングは、リンクによって軸方向に継合される、請求項14に記載の管腔内補綴具。
- 生理学的環境内での圧着構成から展開構成への拡張の後の前記補綴具は、身体管腔を支持するための十分な強度および前記拡張構成からの低い反跳を有する、請求項1に記載の管腔内補綴具。
- 前記足場は、ポリマーコーティングを備え、前記ポリマーコーティングは、ポリラクチド、ポリ-L-乳酸、ポリ-DL-ラクチド、ポリラクチド-co-グリコリド、ポリ(乳酸-co-グリコリド)、ポリ(n-ブチルメタクリレート)、エチレン酢酸ビニル、ポリ(エチレン-co-酢酸ビニル)、ポリビニルピロリドン、パリレン、PVDF-HFPポリ(フッ化ビニリデンヘキサフルオロプロピレン)、ポリスチレン、ポリ(L-ラクチド-co-イプシロン-カプロラクトン)、または、ポリ(スチレン-b-イソブチレン-b-スチレン)を含む、請求項1に記載の管腔内補綴具。
- 管腔内補綴具であって、
非分解性材料からパターン化される複数の円周方向リングを有する足場を備え、前記足場は、圧着構成から展開構成まで拡張するように構成され、
前記円周方向リングのうちの少なくともいくつかは、クラウンによって継合される支柱を備え、前記円周方向リングのうちの少なくともいくつかは、隣接する円周方向リングに軸方向に継合され、前記円周方向リングのうちの少なくともいくつかは、少なくとも1つの分離領域を有し、
前記少なくとも1つの分離領域は、1対の構造を備え、前記1対の構造は、ボールおよびソケット、円盤およびキャップ、スロット内凸部、相互係止コーム、相互係止歯、適した対向形状を伴う溝またはV字型またはU字型、あるいは、波形または起伏相互係止表面のうちの1つまたは複数を備え、各対の構造は、非分解性材料であり、
前記分離領域のうちの少なくともいくつかは、前記円周方向リングの支柱内にあり、前記1対の構造は、各々、前記支柱の一部であり、分解性材料を用いて拡張中にともに保持され、生理学的環境内で前記展開構成への前記足場の拡張後に分離するように構成されている、管腔内補綴具。 - 前記少なくとも1つの分離領域は、スロット接合点内で凸部を備える、請求項18に記載の管腔内補綴具。
- 管腔内補綴具であって、
非分解性材料からパターン化される複数の円周方向リングを有する足場を備え、前記足場は、圧着構成から展開構成まで拡張するように構成され、
前記円周方向リングのうちの少なくともいくつかは、クラウンによって継合される支柱を備え、前記円周方向リングのうちの少なくともいくつかは、隣接する円周方向リングに軸方向に継合され、前記円周方向リングのうちの少なくともいくつかは、少なくとも2つの分離領域を有し、
前記分離領域のうちの少なくともいくつかは、前記円周方向リングの支柱内にあり、
前記分離領域を伴う前記補綴具は、少なくとも2つの区画に分離するように構成され、各いくつかの前記円周方向リングは、隣接する円周方向リングに軸方向に継合され、
前記分離領域は、前記円周方向リングの前記支柱内に事前形成された切れ目または間隙を備え、前記切れ目または間隙の一端上の前記支柱は、非分解性オス型部分を備え、前記切れ目または間隙の他端上の前記支柱は、非分解性メス型部分を備え、前記分離領域は、生理学的環境内で分解する生分解性ポリマーおよび/または接着剤によって継合され、前記生分解性ポリマーおよび/または接着剤によって被覆され、または、前記生分解性ポリマーおよび/または接着剤に埋め込まれ、前記分離領域は、拡張中にともに保持され、生理学的環境内で前記展開構成への前記足場の拡張後に分離するように構成されている、管腔内補綴具。 - 前記足場は、管、平坦基板、または、屈曲ワイヤからパターン化される、請求項1、18、または20に記載の管腔内補綴具。
- 前記生分解性ポリマーおよび/または接着剤は、ポリラクチド、ポリ-L-ラクチド、ポリ-DL-ラクチド、ポリラクチド-co-グリコリド、ポリ(L-乳酸-co-グリコリド)、ポリ(エチレン-co-酢酸ビニル)、ポリ(L-ラクチド-co-イプシロン-カプロラクトン)、ポリ(DL-ラクチド-co-グリコリド)、ポリ(ラクチド-co-カプロラクトン)、ポリ(D-ラクチド)、ポリグリコリド、ポリカプロラクトン、ポリヒドロキシアルカノエート、ポリビニルアルコール、ポリ酢酸ビニル、または、シアノアクリレートを含む、請求項1または20に記載の管腔内補綴具。
- 前記足場は、シロリムス、ノボリムス、バイオリムス、エベロリムス、リダフォロリムス、テムシロリムス、またはゾタロリムスを含むm-TOR阻害剤を含む少なくとも1つの薬物をさらに備える、請求項1、18、または20に記載の管腔内補綴具。
- 前記非分解性材料は、金属または金属合金を含む、請求項1、18、または20に記載の管腔内補綴具。
- 前記金属または金属合金は、ステンレス鋼、コバルト合金、コバルトクロム、白金、白金イリジウム、白金クロム、白金ロジウム、または、ニッケルチタンを含む、請求項24に記載の管腔内補綴具。
- 各円周方向リングは、3つの分離領域を有する、請求項20に記載の管腔内補綴具。
- 全ての円周方向リングは、隣接するリングに継合される、請求項20に記載の管腔内補綴具。
- 前記分離領域は、前記分離領域を被覆しかつ/または前記補綴具の少なくとも1つの表面を被覆するコーティングによって、ともに保持される、請求項1、18、または20に記載の管腔内補綴具。
- 前記補綴具は、展開構成への拡張の後に2つまたは3つの区画を形成するように構成されている、請求項20に記載の管腔内補綴具。
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| JP2009530060A (ja) | 2006-03-20 | 2009-08-27 | エックステント・インコーポレーテッド | 連結されたプロテーゼセグメントの展開装置及び方法 |
| WO2009041664A1 (ja) | 2007-09-27 | 2009-04-02 | Terumo Kabushiki Kaisha | ステントおよび生体器官拡張器具 |
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