WO2013118352A1 - Stent graft delivery device - Google Patents

Description

Stent graft delivery device

The present invention relates to a stent graft delivery device for delivering a stent graft having a skeleton to a tube-shaped graft into a living body lumen, and more specifically, centering a shaft with respect to a living body lumen before deployment of the stent graft. The present invention relates to a possible stent graft delivery device.

Conventionally, surgery using an artificial blood vessel has been performed for the treatment of aortic aneurysm and aortic dissection, but in recent years, percutaneous artificial blood vessel placement using a stent graft (hereinafter also referred to as “stent graft technique”) has been performed. (See, for example, Japanese Patent Publication No. 2000-512863). A general stent graft is formed by forming a wire such as nickel titanium alloy or stainless steel in a Z shape or a ring shape on the inner surface or outer surface of a graft made of a woven fabric (fabric) woven with resin yarn such as polyester. A skeleton (stent) is configured by being sutured and fixed, and is deployed and expanded in a body cavity to be placed in a desired blood vessel or the like.

In the placement of the so-called body graft, which is placed on the central side in the abdominal stent graft procedure, positioning is one of the major points that determines the outcome of the operation. It is necessary to place the central seal portion of the graft in the normal blood vessel portion (so-called landing zone) from the renal artery bifurcation of the aorta to the central end of the aneurysm. This is because the renal artery is occluded when the central seal portion is placed centrally by the landing zone, and into the aneurysm when the central seal portion is placed distal to the landing zone. This is because a blood leak occurs. In view of this, various approaches have been made so that the surgeon can easily position the graft at an appropriate position.

The initial stent graft delivery device (hereinafter also simply referred to as “delivery device”) is a self-expanding stent graft folded into a small diameter within a sheath (outer tube), and an X-ray opaque marker provided on a shaft. An apparatus having a structure in which the stent graft is expanded at a stretch and brought into close contact with the blood vessel by delivering to the indwelling target position with reference and retracting (lowering) the sheath with respect to the shaft has been the mainstream. Hereinafter, such a delivery device is referred to as a delivery device according to a first conventional example. In the delivery device according to the first conventional example, it is difficult to place the central seal portion in the landing zone well in the intense blood flow of the aorta. When this occurs, there is a problem that the entire graft is pushed by the blood flow and the position of the central seal portion shifts.

As a delivery device for solving such problems, the central portion is expanded after the remaining peripheral portion is expanded in a state where only the central-side seal portion maintains a small diameter (half-opened state), and sufficient positioning is performed in that state. The type that expands the side seal part is increasing. Some types can gradually expand the central seal portion, and there are delivery devices that can adjust the position until the final central seal portion is almost expanded. Hereinafter, a delivery device that can maintain the central seal portion in a half-open state with respect to the first conventional example is referred to as a delivery device according to the second conventional example.

In the delivery device according to the second conventional example, the half-open stent graft is not located in the radial center of the blood vessel in most cases, but is eccentric with respect to the blood vessel, and a part thereof is in contact with the blood vessel wall. ing. The outer surface of the stent graft is not as smooth as the outer surface of the sheath, and the wrinkles of the base material, the stent skeleton, etc. are exposed, and rubbing the inner wall of the blood vessel in that state may damage the blood vessel It will be.

Also, in a state where the stent graft is eccentric from the radial center of the blood vessel, the moving distance when the stent graft is expanded varies depending on the circumferential position of the stent graft. That is, in the eccentric stent graft before diameter expansion, the axial position deviation before and after deployment is small in the portion close to the vascular wall, while in the portion far from the vascular wall, the influence of the inclination of the shaft and blood flow during deployment is small. As a result, a large shift occurs in the axial position before and after deployment.

The present invention has been made in consideration of such problems, and in the case of adjusting the axial position of the stent graft, it is possible to reduce the possibility of damaging the inner wall of the blood vessel and to shift the axial position when the stent graft is expanded. An object of the present invention is to provide a stent graft delivery device capable of suppressing the above.

In order to achieve the above object, a stent graft delivery device according to the present invention includes a stent graft, a shaft on which the stent graft is placed, a tubular shape that is slidable in the axial direction with respect to the shaft and can store the stent graft. A sheath and a centering mechanism disposed on a distal end side of the stent graft in the shaft so as to be displaceable in an axial direction of the shaft, wherein the centering mechanism displaces the sheath in the proximal direction with respect to the shaft. An expansion body that expands when the expansion body is expanded, and the shaft is centered in a radial direction with respect to the living body lumen by expansion of the expansion body.

According to the above-described configuration of the present invention, the shaft can be centered in the radial direction while being displaceable in the axial direction of the living body lumen. Therefore, even when the position of the stent graft in the half-open state is adjusted in the axial direction. The possibility of damaging the inner wall of the biological lumen can be reduced. Moreover, the position shift of the axial direction at the time of expanding a stent graft can be suppressed suitably.

In the above-described stent graft delivery device, the expansion body is preferably made of an elastic skeleton and configured in a tubular shape as a whole.

According to the above configuration, the expansion body is expanded by being released from the sheath, whereby the outer surface of the expansion body is in close contact with the inner wall of the living body lumen, so that the shaft is more reliably placed in the radial direction of the living body lumen. Can be centered.

In the stent graft delivery device, the centering mechanism includes a first slider provided to be slidable in an axial direction with respect to the shaft on a distal end side with respect to the expansion body, and the shaft on a proximal end side with respect to the expansion body. A second slider provided so as to be slidable in the axial direction, a first flexible member stretched between the extension body and the first slider, the extension body and the second slider, It is good to have the 2nd flexible member stretched | interposed between, and the 1st elastic member arrange | positioned between the said 1st slider and the said 2nd slider.

According to the above configuration, tension is applied to the first flexible member and the second flexible member by the elastic action of the first elastic member disposed between the first slider and the second slider. The shaft is centered at the radial center of the living body lumen regardless of the extent of expansion of the expanding body according to the living body lumen diameter. In addition, since the shaft is centered by supporting the expansion body at two locations (first slider and second slider) spaced apart in the axial direction on the shaft, the centering mechanism is not limited to the portion provided with the centering mechanism. The eccentricity of the portion of the shaft that is distant from the location where the is provided in the proximal direction can also be relatively suppressed.

In the above stent graft delivery device, a detachment mechanism for detaching the expansion body from the shaft may be provided.

According to the above configuration, the expanded body can be placed in the living body lumen, and the components other than the stent graft and the expanded body in the stent graft delivery device can be reliably recovered from the living body.

In the stent graft delivery device, the disengagement mechanism is disposed so as to be capable of advancing and retreating in the axial direction with respect to the first slider, and elastically biases the actuating member in the distal direction with a plurality of hook portions. And when the operating member is in the advanced position, the engagement between the first flexible member and the second flexible member and the hook portion is maintained. When the operating member is displaced to the retracted position by connecting the shaft and the expansion body and being pressed by a nose portion provided at the tip of the shaft, the first flexible member and the first flexible member 2 The engagement between the flexible member and the hook portion may be released.

According to the above configuration, the connection state between the shaft and the expansion body can be reliably maintained until the disengagement operation is performed, and the operation member is moved backward by displacing the shaft in the proximal direction. When the mating release operation is performed, the first flexible member and the second flexible member are released from the hook portion, so that the expansion body can be reliably detached from the shaft.

In the stent graft delivery device, the elastic force of the second elastic member may be smaller than the elastic force of the first elastic member.

According to the above configuration, when the operating member is pressed in the proximal direction, the first slider is biased in the distal direction by the elastic force of the first elastic member. It is displaced in the proximal direction in the first slider against the elastic force. Therefore, the first flexible member and the second flexible member can be reliably released from the hook portion.

The stent graft delivery device may include a fixing mechanism that fixes the first slider and the second slider to the shaft at arbitrary axial positions.

According to the above configuration, the outer surface of the stent graft and the inner wall of the biological lumen can be rubbed when the position of the stent graft is adjusted in the axial direction with the end portion of the stent graft being half-opened even when the meandering of the biological lumen is large Therefore, the axial displacement of the stent graft can be suppressed, and the stent graft can be stably placed in the living body lumen in an appropriate direction. In addition, since the entire centering mechanism including the expansion body can be accommodated again in the sheath after the stent graft is expanded, only the stent graft is placed in the body, and the remaining components of the stent graft delivery device Can be recovered completely.

In the above-described stent graft delivery device, the first slider and the second slider have a first shape in which axial displacement with respect to the shaft is allowed and a second shape in which axial displacement with respect to the shaft is restricted. It is elastically deformable, and the fixing mechanism includes a flexible driving member that spans between the first slider and the second slider, and the first slider and the second slider are moved by the driving member. The first slider and the second slider may be deformed from the first shape to the second shape by being pressed toward the shaft.

According to said structure, the drive member which can switch the movement permission state and movement restriction state to the axial direction with respect to the shaft of a centering mechanism according to a deformation | transformation of a 1st slider and a 2nd slider, and has flexibility. Since the first slider and the second slider are deformed by the above, the fixing mechanism can be configured compactly at the distal end portion of the stent graft delivery device.

In the stent graft delivery device, the fixing mechanism includes a first convex portion provided on an inner peripheral portion of the first slider, a second convex portion provided on an inner peripheral portion of the second slider, and the shaft. First recesses provided at a plurality of positions in the axial direction in the outer periphery of the first recess, and second recesses provided at a plurality of positions in the axial direction at the outer periphery of the shaft on the proximal side from the first recess, With the first slider and the second slider deformed to the second shape, the first convex portion and the first concave portion are engaged, and the second convex portion and the second concave portion are engaged. Also good.

According to the above configuration, since the first slider, the second slider, and the shaft are engaged through the concavo-convex structure, the centering mechanism can be more securely fixed to the shaft.

In the stent graft delivery device, the first slider is provided with a pair of first insertion holes penetrating in the axial direction at circumferential positions opposite to each other, and the second slider has a circumferential direction opposite to each other. A pair of second insertion holes penetrating in the axial direction is provided at the position, and the pair of first insertion holes are displaced in a direction in which the pair of first insertion holes approach each other with the operation of the driving member. The first slider and the second slider may be deformed from the first shape to the second shape by displacing in a direction approaching each other.

According to the above configuration, the first slider and the second slider can be reliably deformed from the first shape to the second shape in accordance with the operation of the driving member.

In the above-described stent graft delivery device, a portion of the drive member that spans between the first slider and the second slider may be inserted inside the first elastic member.

According to the above configuration, since the first elastic member and the drive member do not interfere with each other, tension is reliably applied to the first flexible member and the second flexible member based on the elastic force of the first elastic member. And the drive member can be operated reliably.

According to the stent graft delivery device of the present invention, when adjusting the axial position of the stent graft, it is possible to reduce the possibility of damaging the inner wall of the blood vessel, and to suppress positional deviation in the axial direction when the stent graft is expanded.

1 is a partially omitted side view (partially sectional view) of a stent graft delivery device according to a first embodiment of the present invention. It is a perspective view which shows the centering mechanism of the apparatus shown in FIG. 3A is a schematic cross-sectional view showing the centering mechanism (contracted state) of the apparatus shown in FIG. 1, and FIG. 3B is a schematic cross-sectional view showing the centering mechanism (expanded state) of the apparatus shown in FIG. is there. It is sectional drawing which shows the structure of a separation mechanism in relation to a 1st flexible member. It is sectional drawing which shows the structure of a removal mechanism in relation to a 2nd flexible member. FIG. 6A is a cross-sectional view illustrating the structure of the separation mechanism according to the modification in relation to the first flexible member, and FIG. 6B illustrates the structure of the separation mechanism according to the modification in relation to the second flexible member. It is sectional drawing which shows a structure. 7A is a first diagram for explaining how to use the device shown in FIG. 1, and FIG. 7B is a second diagram for explaining how to use the device shown in FIG. 8A is a third diagram for explaining how to use the device shown in FIG. 1, and FIG. 8B is a fourth diagram for explaining how to use the device shown in FIG. FIG. 7 is a partially omitted cross-sectional view of a centering mechanism in a movement-permitted state of a stent graft delivery device according to a second embodiment of the present invention and its peripheral portion. It is a partially omitted sectional view of the centering mechanism in the movement restricted state of the stent graft delivery device according to the second embodiment of the present invention and its peripheral portion. 11A is a cross-sectional view taken along the line XIA-XIA in FIG. 9, and FIG. 11B is a cross-sectional view taken along the line XIB-XIB in FIG. FIG. 12A is a diagram for explaining the positional relationship between the blood vessel and the stent graft delivery device when the centering mechanism is not fixed to the shaft, and FIG. 12B is a diagram illustrating the blood vessel and the stent graft delivery when the centering mechanism is solid with respect to the shaft. It is a figure explaining the positional relationship with an apparatus. 13A is a first state diagram for explaining a method for housing the centering mechanism in the sheath, and FIG. 13B is a second state diagram for explaining a method for housing the centering mechanism in the sheath. These are 3rd state diagrams explaining the method of accommodating a centering mechanism in a sheath.

Hereinafter, preferred embodiments of the stent graft delivery device according to the present invention will be described with reference to the accompanying drawings.

[First Embodiment]
FIG. 1 is a partially omitted sectional view of a stent graft delivery device 10A (hereinafter also simply referred to as “delivery device 10A”) according to a first embodiment of the present invention. In FIG. 1, for easy understanding, the distal end portion of the delivery device 10 </ b> A is enlarged, and a middle portion in the longitudinal direction is partially omitted.

The delivery device 10 </ b> A allows the stent graft 12 placed and stored (mounted) on the distal end side to reach a lesion (treatment site) such as an aortic aneurysm through a blood vessel, and treats the lesion by deploying and placing the stent graft 12. It is a medical device for performing. In the following description, the right side (handle 18 side) of the delivery device 10A in FIG. 1 is referred to as the “base end (rear end)” side, and the left side of the delivery device 10A (stent graft 12 side) is referred to as the “front end” side. To do.

10A of delivery apparatuses are the stent graft 12, the elongate shaft 14 in which the stent graft 12 was mounted, the tubular sheath 16 which can be slid to an axial direction with respect to the shaft 14, and can accommodate the stent graft 12, The delivery apparatus A handle 18 constituting the base end portion of 10A, a centering mechanism 20 for centering the shaft 14 with respect to a blood vessel (biological lumen), and a detaching mechanism 22 for detaching the expansion body 32 from the shaft 14 are provided.

The stent graft 12 to be delivered and placed in the living body has a self-expanding function, and generally has a configuration in which a stent 12b (see FIG. 8B), which is a metal skeleton for expansion, is fixed to the inner or outer surface of a tubular graft 12a. A typical stent graft 12 can be used. In FIG. 1, the stent graft 12 is housed in a space formed by a mount portion 13 and a sheath 16 provided on the shaft 14, and is in a state of being expanded with its expansion restricted (contracted state). When the sheath 16 moves backward with respect to the shaft 14 and the stent graft 12 accommodated therein is released from the restriction by the sheath 16, the stent graft 12 is expanded and deployed by the self-expanding function.

For example, the graft 12a may be configured by forming a woven fabric (fabric) woven with resin threads such as polyester or a film of ePTFE (stretched polytetrafluoroethylene) into a tube shape. The stent 12b has a structure in which a plurality of skeletons formed of a superelastic alloy such as a Ti—Ni alloy in a ring shape or a Z shape are arranged in the axial direction of the graft 12a, or a wire made of a superelastic alloy or the like in a mesh shape. A knitted structure may be used.

The shaft 14 is a flexible tubular member having a flexibility in which a guide wire lumen 14a through which a guide wire (not shown) is inserted is formed through the entire length. A tapered nose portion 15 (nose cone) is provided at the tip of the shaft 14. A mount portion 13 for mounting (mounting) the stent graft 12 is provided in the vicinity of the distal end portion of the shaft 14, that is, on the proximal end side of the nose portion 15. The mount portion 13 is a portion having a diameter smaller than the front and rear portions thereof. In the present embodiment, the centering mechanism 20 is disposed in addition to the stent graft 12, and therefore, the mount portion 13 is longer than the entire length of the stent graft 12 in the natural state. The mount portion 13 can position and hold the proximal end edge portion of the stent graft 12 in a reduced diameter state by the sheath 16 by a rear stage portion provided on the proximal end side.

The sheath 16 is a flexible thin-walled and flexible tubular member that is slidably disposed on the outer surface side of the shaft 14. In the initial state, the sheath 16 is in a position completely covering the mount portion 13 and the centering mechanism 20 with respect to the shaft 14, and the stent graft 12 is accommodated and the centering mechanism 20 is disposed in the mount portion 13. A sheath hub 26 that expands toward the base end is connected to the base end of the sheath 16, and a sheath driving pipe 28 is connected to the base end of the sheath hub 26. The sheath 16, the sheath hub 26, and the sheath driving pipe 28 can be integrally displaced with respect to the shaft 14 in the axial direction.

The handle 18 that constitutes the base end portion of the delivery device 10A is a portion that is gripped by the user, and is a cylindrical member having an appropriate length and outer diameter so that it can be easily gripped. The shaft 14 described above is connected and fixed to the handle 18 on the proximal end side. The above-described sheath driving pipe 28 is inserted on the distal end side of the handle 18 so as to be slidable in the axial direction. Accordingly, the assembly including the sheath 16, the sheath hub 26, and the sheath driving pipe 28 moves from the initial position (before use) shown in FIG. 1 to the proximal direction (proximal direction) with reference to the position of the handle 18. Is possible.

In the initial position shown in FIG. 1, the sheath 16 is disposed on the most distal end side of the movable range with reference to the position of the handle 18. In the delivery device 10A, at this initial position, the sheath 16 completely covers the mount portion 13 of the shaft 14 and compresses and stores the stent graft 12 disposed on the mount portion 13 over the entire length. The possible range of the sheath 16 with respect to the shaft 14 is that when the sheath 16 is displaced to the most proximal side, the most distal end portion of the sheath 16 is located on the proximal side with respect to the mount portion 13 provided on the shaft 14, and the stent graft 12 Is set so that it can be completely released.

The handle 18 is provided with an operation unit 30 for controlling (manipulating) the stent graft 12. In the present embodiment, the operation unit 30 has a ring shape and is provided so as to be rotatable relative to the handle 18 and movable in the axial direction. The operation unit 30 and the stent graft 12 are connected by a control wire (not shown). By performing a predetermined operation (rotating operation or advancing / retreating operation) on the operation unit 30, the diameter expansion of the end portion (end portion on the nose cone side) of the stent graft 12 can be controlled.

The centering mechanism 20 is for centering the shaft 14 with respect to the living body lumen, and is disposed at a position on the distal end side of the shaft 14 relative to the stent graft 12 so as to be displaceable in the axial direction with respect to the shaft 14. Specifically, the centering mechanism 20 is disposed on the distal end side of the mount portion 13 provided on the shaft 14 with respect to the place where the stent graft 12 is placed. The mount portion 13 has a portion longer than the entire length of the contracted centering mechanism 20 on the tip side of the space for placing the stent graft 12, and the centering mechanism 20 is displaced in the axial direction with the portion as a movable range. It is possible.

As shown in FIG. 2, the centering mechanism 20 includes an expansion body 32 having at least a self-expanding function, a first slider 34 and a second slider 36 provided on both sides of the expansion body 32 in the axial direction, and a first slider 34. And a plurality of first flexible members 38 and a plurality of second flexible members 40 respectively stretched between the second slider 36 and the expansion body 32, and the first slider 34 and the second slider 36. And a compression spring 42 (first elastic member) disposed therebetween.

The expansion body 32 is an elastic body made of a wire material such as a superelastic alloy, and has an overall cylindrical shape (cylindrical shape in the illustrated example) and is disposed so as to surround the shaft 14. In addition to the configuration in which the wire 32 is bent into a zigzag shape (Z shape) to form a cylindrical shape, the extended body 32 has a configuration in which a plurality of ring bodies made of wire materials are connected in the axial direction to form a cylindrical shape as a whole. Alternatively, it is possible to adopt a configuration in which the wire is knitted into a mesh shape to form a cylindrical shape as a whole.

The first slider 34 is disposed so as to be slidable in the axial direction with respect to the shaft 14 on the distal end side of the shaft 14 with respect to the expansion body 32. In this embodiment, the first slider 34 is a hollow cylindrical member through which the shaft 14 is inserted. Consists of. The second slider 36 is disposed so as to be slidable in the axial direction with respect to the shaft 14 on the proximal end side of the shaft 14 relative to the expansion body 32. In the present embodiment, the second slider 36 has a hollow cylindrical shape through which the shaft 14 is inserted. It consists of members.

The first flexible member 38 is stretched between a distal end portion of the expansion body 32 and the first slider 34 at a plurality of positions in the circumferential direction. The second flexible member 40 is stretched between a proximal end portion of the expansion body 32 and the second slider 36 at a plurality of positions in the circumferential direction. The 1st flexible member 38 and the 2nd flexible member 40 are comprised by the cable-shaped body (wire material) which has flexibility, for example, a metallic or resin wire, a thread | yarn, etc. The tension structure of the first flexible member 38 and the second flexible member 40 will be described in relation to the separation mechanism 22.

The compression spring 42 has a distal end in contact with the first slider 34, a proximal end in contact with the second slider 36, and the first slider 34 and the second slider 34 in a direction in which the distance between the first slider 34 and the second slider 36 is increased. The slider 36 is always urged elastically. The compression spring 42 acts to widen the distance between the first slider 34 and the second slider 36, and always applies tension to the first flexible member 38 and the second flexible member 40. Even when the diameter of the first flexible member 38 changes, the first flexible member 38 and the second flexible member 40 do not loosen. The elastic force of the compression spring 42 is set so as not to prevent the expansion of the expansion body 32.

In the centering mechanism 20 configured as described above, in the state where the centering mechanism 20 is housed in the sheath 16 as shown in FIG. On the other hand, when the sheath 16 is displaced in the proximal direction with respect to the shaft 14 as shown in FIG. 3B, the restriction on the expansion body 32 by the sheath 16 is released, so that the expansion body 32 is expanded (expanded diameter) by its elastic force. ) At this time, the expansion body 32 is connected to the first slider 34 and the second slider 36 via the first flexible member 38 and the second flexible member 40, respectively, and the elastic body 32 is moved by the elastic action of the compression spring 42. The state where tension is applied to the first flexible member 38 and the second flexible member 40 is maintained. As a result, the expansion body 32 expands in a state where the central axis of the shaft 14 and the central axis of the expansion body 32 substantially coincide with each other. In other words, the shaft 14 is positioned substantially at the center of the expansion body 32 in a state where the expansion body 32 is expanded. 3A and 3B mainly explain the expansion function of the expansion body 32 of the centering mechanism 20, the centering mechanism 20 schematically shows the configuration shown in FIG.

As will be described later, in the procedure using the delivery device 10A according to this embodiment, after the stent graft 12 is expanded and placed in the blood vessel, the expanded body 32 is detached from the shaft 14 and the expanded body 32 is placed in the blood vessel. Then, the remaining device is recovered from the living body. Therefore, the delivery device 10 </ b> A is provided with a detachment mechanism 22 for detaching the expansion body 32 from the shaft 14. As shown in FIGS. 4 and 5, the detachment mechanism 22 in the present embodiment includes an operating member 44 provided on the first slider 34 and a compression spring 46 (a first spring that elastically biases the operating member 44 in the distal direction. 2 elastic members).

The first slider 34 is provided with an annular housing recess 34a that opens in the distal direction, and the operating member 44 is disposed in the housing recess 34a so as to be displaceable in the axial direction. A compression spring 46 is disposed between the bottom of the housing recess 34 a and the base end surface of the operating member 44. The elastic force of the compression spring 46 is smaller than the elastic force of the compression spring 42 disposed between the first slider 34 and the second slider 36. Although not shown, the actuating member 44 and the first slider 34 are provided with a retaining structure that prevents the actuating member 44 from coming out of the first slider 34.

The actuating member 44 includes a cylindrical abutting portion 48 and a plurality of hook portions 50 protruding in the distal direction outside the abutting portion 48. The contact portion 48 protrudes in the distal direction from the hook portion 50. As shown in FIG. 2, the plurality of hook portions 50 are provided at intervals in the circumferential direction. The plurality of hook portions 50 include a first hook portion 50a with which the first flexible member 38 is engaged and a second hook portion 50b with which the second flexible member 40 is engaged.

As shown in FIG. 4, one end of the first flexible member 38 is fixed to the first slider 34, and an intermediate portion of the first flexible member 38 is provided at the distal end portion of the expansion body 32. The first guide ring 52 is passed through. A first engagement ring 54 is provided at the other end of the first flexible member 38, and the first engagement ring 54 is hooked on the first hook portion 50 a of the operation member 44. Tension is applied to the first flexible member 38 by the elastic action of the expansion body 32 and the elastic action of the compression spring 42.

As shown in FIG. 5, one end of the second flexible member 40 is fixed to the first slider 34, extends in the proximal direction from the fixed position, and is inserted into a guide hole 37 provided in the second slider 36. Then, it is folded back at the base end side of the second slider 36 and further passed through a second guide ring 56 provided at the base end of the expansion body 32. The second flexible member 40 folded back by the second guide ring 56 is again inserted from the proximal end side of the second slider 36 into the guide hole 37 and extends toward the first slider 34. A second engagement ring 58 is provided at the other end of the second flexible member 40, and the second engagement ring 58 is hooked on the second hook portion 50 b of the operation member 44. Tension is applied to the second flexible member 40 by the elastic action of the expansion body 32 and the elastic action of the compression spring 42.

The detachment mechanism 22 operates as follows. When the shaft 14 moves backward with respect to the first slider 34 and the nose portion 15 of the shaft 14 presses the operating member 44 in the proximal direction, the operating member 44 is displaced in the proximal direction with respect to the first slider 34. When the actuating member 44 is accommodated in the accommodating recess 34a of the first slider 34 and the actuating member 44 is retracted to a position where the tip of the hook portion 50 is in the accommodating recess 34a, the first flexible member 38 and the second flexible member 38 are provided. The engagement rings 54 and 58 of the flexible member 40 are detached from the hook portion 50. That is, the first flexible member 38 and the second flexible member 40 are disengaged from the operating member 44, respectively. Then, the first flexible member 38 and the second flexible member 40 can come out of the first guide ring 52 and the second guide ring 56 provided in the expansion body 32, respectively. Accordingly, the extension body 32 can be detached from the shaft 14 by moving the first slider 34 and the second slider 36 together with the shaft 14 away from the extension body 32.

In the delivery device 10A, a detachment mechanism 22a according to the modification shown in FIGS. 6A and 6B may be employed instead of the detachment mechanism 22 described above. FIG. 6A is a cross-sectional view showing the structure of the separation mechanism 22a according to the modification in relation to the first flexible member 38. FIG. In FIG. 6A, one end of the first flexible member 38 is fixed to the first slider 34, and an intermediate portion of the first flexible member 38 is passed through the first guide ring 52, so that the first flexible member 38. The other end of the first slider 34 is fixed to the front end surface of the first slider 34. An annular groove 60 is formed outside the fixed portion of the first flexible member 38 at the tip of the first slider 34.

FIG. 6B is a cross-sectional view showing the structure of the separation mechanism 22a according to the modification in relation to the second flexible member 40, and shows a cross section at a phase shifted in the circumferential direction from the phase shown in FIG. 6A. . In FIG. 6B, one end of the second flexible member 40 is fixed to the first slider 34, and the other end of the second flexible member 40 is fixed to the tip surface of the first slider 34. Although not shown, a midway portion of the second flexible member 40 is inserted through the second slider 36 and the second guide ring 56 as in the structure shown in FIG.

An annular cutter 62 is provided on the base end surface of the nose portion 15 of the shaft 14. When the nose portion 15 is retracted to some extent as the shaft 14 is retracted relative to the first slider 34, the cutter 62 provided in the nose portion 15 cuts the first flexible member 38 and the second flexible member 40. To do. At this time, the cutter 62 is inserted into the annular groove 60.

By cutting the first flexible member 38 and the second flexible member 40, the first flexible member 38 and the second flexible member 40 are provided with the first guide ring provided in the expansion body 32. 52 and the second guide ring 56 can be removed. Accordingly, the extension body 32 can be detached from the shaft 14 by moving the first slider 34 and the second slider 36 together with the shaft 14 away from the extension body 32.

The mechanism for detaching the expansion body 32 from the shaft 14 is not limited to the above-described detachment mechanisms 22 and 22a. For example, the first flexible member 38 and the second flexible member 40 are connected via a release wire. A configuration may be adopted in which the expansion body 32 is detached from the shaft 14 by being connected to the first slider 34 and extracting the release wire.

The delivery device 10A according to the present embodiment is basically configured as described above, and the operation and effect will be described below.

In this example, a case will be described in which the delivery device 10A is used to perform a procedure of placing the stent graft 12 in a blood vessel including a site where an aortic aneurysm has occurred. First, the form of a lesion occurring in a living body is specified by an intravascular imaging method or an intravascular ultrasonic diagnostic method. Next, a guide wire (not shown) is introduced into the blood vessel from the thigh or the like by, for example, the Seldinger method, and the guide wire is inserted from the distal end of the guide wire lumen 14a of the shaft 14 to the proximal end. 14 and sheath 16 are inserted into the aorta. Then, under X-ray imaging using a radiopaque marker (not shown) provided on the distal end side of the shaft 14 or the sheath 16, the stent graft 12 accommodated on the distal end side of the sheath 16 is placed on the central side as shown in FIG. 7A. Insert until the seal portion 12c (the end portion on the side of the nose portion 15) reaches an approximate target indwelling position (landing zone S). Here, the target indwelling position is a portion between the branch portion of the renal artery 74 from the aorta 70 and the central end of the aneurysm 72.

Next, as shown in FIG. 7B, the sheath 16 is displaced in the proximal direction while the position of the shaft 14 is maintained, and the centering mechanism 20 is exposed in the blood vessel while the stent graft 12 is housed in the sheath 16. . Then, the expansion body 32 of the centering mechanism 20 is expanded by being released from the restriction by the sheath 16 and closely contacts the inner peripheral wall in the blood vessel. When the sheath 16 is displaced in the proximal direction, the centering mechanism 20 is pulled in the proximal direction by the frictional force between the inner peripheral surface of the sheath 16 and the outer peripheral surface of the expansion body 32, but the second slider 36 is Since it abuts against the end of the stent graft 12 disposed on the proximal side, the movement of the centering mechanism 20 in the proximal direction is prevented at that time.

In a state in which the expansion body 32 is expanded, the first slider 34 and the second slider 36 are centered at a substantially central position of the expansion body 32, whereby the shaft 14 is centered in the radial direction of the blood vessel (aorta 70). . When the shaft 14 is centered in this way, as shown in FIG. 8A, the axial direction of the stent graft 12 is arranged so that the central seal portion 12 c of the stent graft 12 comes to the landing zone S by displacing the shaft 14 in the axial direction. Adjust the position. In this case, since the stent graft 12 is accommodated in the sheath 16 and not exposed in the blood vessel, the outer surface of the stent graft 12 does not rub against the inner wall of the blood vessel when adjusting the axial position of the stent graft 12. As a method different from FIG. 8A, even when the central seal portion 12c is in a half-open state, the shaft 14 is centered, so that the stent graft 12 may rub against the inner wall of the blood vessel when adjusting the axial position. Absent.

When the position of the stent graft 12 in the axial direction is adjusted, as shown in FIG. 8B, the sheath 16 is displaced in the proximal direction, and the stent graft 12 is expanded and deployed. When the entire length of the stent graft 12 is expanded in the blood vessel, the expansion body 32 is detached from the shaft 14. Specifically, the shaft 14 is displaced in the proximal direction. Then, in the case of the detachment mechanism 22 shown in FIGS. 4 and 5, the first flexible member 38 and the second flexible member 40 are detached from the hook portion 50, so that the expansion body 32 is removed from the shaft 14. Can be withdrawn. In the case of the separation mechanism 22a shown in FIGS. 6A and 6B, the first flexible member 38 and the second flexible member 40 are cut by the cutter 62, whereby the expansion body 32 is detached from the shaft 14. Can be made.

As described above, according to the delivery device 10A, since the shaft 14 can be centered in the radial direction of the blood vessel, the outer side of the stent graft 12 can be adjusted even when the position of the stent graft 12 in the half-open state is adjusted in the axial direction. The chance that the surface rubs the inner wall of the blood vessel can be reduced. Moreover, the magnitude of the positional deviation in the axial direction when the stent graft 12 is expanded can be suppressed as compared with the case where the shaft 14 is not centered and eccentric.

In the case of the present embodiment, the expansion body 32 is made of an elastic skeleton and is configured in a tubular shape as a whole. For this reason, the expansion body 32 expands by being released from the sheath 16, and the outer surface of the expansion body 32 thereby adheres to the inner wall of the blood vessel, so that the shaft 14 can be more reliably centered in the radial direction of the blood vessel. it can.

In this embodiment, tension is applied to the first flexible member 38 and the second flexible member 40 by the elastic action of the compression spring 42 disposed between the first slider 34 and the second slider 36. Therefore, the shaft 14 is centered in the radial direction of the blood vessel regardless of the degree of expansion of the expansion body 32 according to the blood vessel diameter. Further, since the shaft 14 is centered by supporting the expansion body 32 at two locations (first slider 34 and second slider 36) spaced apart in the axial direction on the shaft 14, the portion provided with the centering mechanism 20 is provided. In addition, the eccentricity of the portion of the shaft 14 away from the location where the centering mechanism 20 is provided in the proximal direction can be relatively suppressed.

In the case of the present embodiment, the delivery device 10A includes the detachment mechanism 22 that detaches the expansion body 32 from the shaft 14, so that the expansion body 32 is placed in the blood vessel, and the delivery device 10A other than the stent graft 12 and the expansion body 32 is placed. The component can be reliably recovered from the living body.

In the case of this embodiment, the detachment mechanism 22 includes an operating member 44 that is provided so as to be able to advance and retract in the axial direction with respect to the first slider 34, and a compression spring 46 that is disposed between the first slider 34 and the operating member 44. The first flexible member 38 and the second flexible member 40 are hooked on the hook portion 50 of the actuating member 44. Therefore, the connection state between the shaft 14 and the expansion body 32 can be reliably maintained until the engagement is released, and the operating member 44 is moved backward by displacing the shaft 14 in the proximal direction. When the mating / releasing operation is performed, the first flexible member 38 and the second flexible member 40 are released from the hook portion 50, so that the expansion body 32 can be reliably detached from the shaft 14.

In the present embodiment, the elastic force of the compression spring 46 disposed on the first slider 34 is smaller than the elastic force of the compression spring 42 disposed between the first slider 34 and the second slider 36. Therefore, when the operating member 44 is pressed in the proximal direction, the first slider 34 is urged in the distal direction by the elastic force of the compression spring 42, so that the operating member 44 is affected by the elastic force of the compression spring 46. In contrast, the first slider 34 is displaced in the proximal direction. Therefore, the engagement between the hook portion 50 and the first flexible member 38 can be reliably released.

[Second Embodiment]
FIG. 9 is a partially omitted cross-sectional view of the centering mechanism 80 of the stent-graft delivery device 10B (hereinafter, also simply referred to as “delivery device 10B”) according to the second embodiment and its peripheral portion. The delivery device 10B differs from the delivery device 10A according to the first embodiment mainly in that it does not include the above-described detachment mechanism 22 and includes a fixing mechanism 82. The configuration of the delivery device 10B is the same as that of the delivery device 10A unless otherwise specified below.

The fixing mechanism 82 has a function of fixing the first slider 34 and the second slider 36 to the shaft 14 at an arbitrary axial position. In the present embodiment, the fixing mechanism 82 includes a first convex portion 84 provided on the inner peripheral portion of the first slider 34, a second convex portion 86 provided on the inner peripheral portion of the second slider 36, and the shaft 14. First recesses 88 provided at a plurality of positions in the axial direction on the outer periphery of the first recess 88, and second recesses 90 provided at a plurality of positions in the axial direction on the outer periphery of the shaft 14 on the proximal end side of the first recess 88. Prepare.

The first slider 34 and the second slider 36 have a first shape in which displacement in the axial direction relative to the shaft 14 is allowed (see FIG. 11A) and a second shape in which displacement in the axial direction relative to the shaft 14 is restricted (see FIG. 11B). Can be elastically deformed. Specifically, the first slider 34, the second slider 36, and the shaft 14 are configured as follows.

The first slider 34 is configured to be elastically deformable in the radial direction, and a first convex portion 84 is provided at a position opposite to each other in the inner peripheral portion thereof. The second slider 36 is configured to be elastically deformable in the radial direction, and a second convex portion 86 is provided at a position opposite to each other in the inner peripheral portion thereof. The first recess 88 is provided corresponding to the movable range of the first slider 34, and in the present embodiment, the first recess 88 is formed to face the first protrusion 84 at a circumferential position on the opposite side of the shaft 14. ing. The second concave portion 90 is provided corresponding to the movable range of the second slider 36, and in the present embodiment, the second concave portion 90 is formed to face the second convex portion 86 at opposite circumferential positions on the shaft 14. ing. The first recess 88 and the second recess 90 may be provided in a range that goes around the shaft 14.

FIG. 11A is a cross-sectional view taken along line XIA-XIA in FIG. FIG. 11B is a cross-sectional view taken along line XIB-XIB in FIG. As shown in FIGS. 9 and 11A, in a natural state (a state where no load is applied), the inner diameters of the first slider 34 and the second slider 36 are larger than the outer diameter of the shaft 14, and the first slider 34. The second slider 36 is movable on the shaft 14 in the axial direction. On the other hand, when the first slider 34 and the second slider 36 are compressed in the radial direction under the action of a drive member 92 described later, and elastically deformed as shown in FIGS. 10 and 11B, a flat shape (second shape) is obtained. The first convex portion 84 and the first concave portion 88 are engaged with each other when the first convex portion 84 enters the first concave portion 88, and the second convex portion is formed when the second convex portion 86 enters the second concave portion 90. The portion 86 and the second recess 90 are engaged. In this engaged state, the first slider 34 and the second slider 36 are prevented from moving on the shaft 14 in the axial direction.

The drive member 92 is a flexible linear member that spans between the first slider 34 and the second slider 36, and is made of, for example, a metal or resin wire, a thread, or the like. Specifically, in the present embodiment, the driving member 92 is provided in the first insertion hole 94 provided in the first slider 34, the second insertion hole 96 provided in the second slider 36, and the shaft 14. Inserted through the insertion holes 98, 100 a, 100 b, 102, one end is fixed to the shaft 14. A portion of the driving member 92 that extends between the first slider 34 and the second slider 36 is inserted inside the compression spring 42.

A pair of first insertion holes 94 are provided penetrating in the axial direction at circumferential positions on opposite sides of the first slider 34. Specifically, the first insertion hole 94 is provided in the first slider 34 so as to penetrate in the axial direction at circumferential positions (two locations) corresponding to the first convex portion 84. A pair of second insertion holes 96 are provided penetrating in the axial direction at circumferential positions on opposite sides of the second slider 36. Specifically, the second insertion hole 96 is provided in the second slider 36 so as to penetrate in the axial direction at circumferential positions (two locations) corresponding to the second convex portion 86. The insertion hole 102 of the shaft 14 is provided slightly on the tip side from the first recess 88, and the insertion holes 100 a and 100 b are provided between the first recess 88 and the second recess 90 at circumferential positions on the opposite sides of the shaft 14. The insertion hole 98 is provided slightly on the proximal end side with respect to the second recess 90. The proximal end side of the drive member 92 extends to the handle 18 (see FIG. 1), and the drive member 92 can be moved forward and backward by operating an operation unit (not shown) provided on the handle 18. ing.

In a state where the driving member 92 is not pulled in the proximal direction, as shown in FIGS. 9 and 11A, the first slider 34 and the second slider 36 maintain the above-described first shape and are not in relation to the shaft 14. Since it is in the engaged state, it can move in the axial direction of the shaft 14. On the other hand, when the driving member 92 is pulled in the proximal direction, the pair of first insertion holes 94 are displaced in a direction approaching each other along with the operation of the driving member 92, and the pair of second insertion holes 96 are in a direction approaching each other. It is displaced to. That is, as shown in FIGS. 10 and 11B, the first slider 34 and the second slider 36 are pressed toward the shaft 14 by the driving member 92, whereby the first slider 34 and the second slider 36 are moved from the first shape. Since it deforms into the second shape and engages with the shaft 14, the movement of the shaft 14 in the axial direction is restricted.

9 and 10, one linear drive member 92 extends from the proximal end side to the distal end side of the delivery device 10 </ b> B, and the second insertion hole 96 of the second slider 36 and the insertion hole of the shaft 14. 100a, the first slider 34 is turned back in the reverse direction (proximal direction) through the first insertion hole 94 of the first slider 34 through the insertion hole 102 provided on the distal end side of the first slider 34, and the first slider 34 is turned back again. The configuration in which the shaft 14 is fixed to the shaft 14 on the proximal end side with respect to the second slider 36 via the insertion hole 94, the insertion hole 100b of the shaft 14 and the second insertion hole 96 of the second slider 36 is shown. The driving member 92 may be used so that the driving member 92 does not fold back on the tip side of the first slider 34.

In this case, one drive member 92 extends from the proximal end side of the delivery device 10B to the distal end side, and is connected to one of the second insertion holes 96 on one side (for example, the upper side in FIG. 9) of the second slider 36 and one of the shafts 14. The first insertion hole 94 is fixed to the shaft 14 on the tip side of the first slider 34 via the first insertion hole 94 of one of the first sliders 34 (for example, the upper side in FIG. 9). The other drive member 92 extends from the proximal end side to the distal end side of the delivery device 10B, and the second insertion hole 96 on the other side (for example, the lower side in FIG. 9) of the second slider 36 and the other insertion of the shaft 14. It is fixed to the shaft 14 on the tip side of the first slider 34 via the hole 100b and the first insertion hole 94 on the other side of the first slider 34 (for example, the lower side in FIG. 9).

The delivery device 10B does not include the detachment mechanism 22 shown in FIG. Therefore, unlike the first embodiment (FIG. 2 and the like), the first flexible member 38 has one end fixed to the first slider 34 and the other end is not folded back, and the other end is the tip of the expansion body 32. In this state, the first slider 34 and the expansion body 32 are stretched. A plurality of first flexible members 38 stretched in this way are provided at intervals in the circumferential direction.

One end of the second flexible member 40 is fixed to the first slider 34, the middle portion is folded back by the second slider 36, and the other end is fixed to the base end of the expansion body 32. In this state, the first slider 34 and the second slider 36 and between the expansion body 32 and the second slider 36. A plurality of second flexible members 40 stretched in this way are provided at intervals in the circumferential direction.
According to the delivery device 10B according to the present embodiment, the following functions and effects can be obtained by providing the above-described configuration.

As shown in FIG. 12A, the meandering of normal blood vessels on the central side of the aneurysm 72 may be large. When the delivery device 10A according to the first embodiment is inserted into such a meandering blood vessel, in the delivery device 10A that does not have the fixing mechanism 82, as shown in FIG. Although centered radially, the portion where the stent graft 12 is placed may be eccentric with respect to the blood vessel. In this case, if position adjustment in the axial direction is performed in a state where the central seal portion 12c of the stent graft 12 is half open, the outer surface of the stent graft 12 rubs against the inner wall of the blood vessel. Further, when the stent graft 12 is expanded after positioning in the axial direction, the stent graft 12 is expanded from a state of being eccentric in the radial direction, and therefore, the axial position may be greatly shifted on the counter electrode side of the eccentricity. Furthermore, in the landing zone S, since the shaft 14 is inclined with respect to the axis of the blood vessel, the stent graft 12 is inclined with respect to the blood vessel, and in some cases, the stent graft 12 may fall within the blood vessel.

On the other hand, according to the delivery device 10B according to the present embodiment, since the shaft 14 and the centering mechanism 80 can be fixed in the axial direction, as shown in FIG. 12B, the shaft 14 is in a state where the expansion body 32 is solid in the blood vessel. By pushing and bending the sheath 16 in the distal direction, the portion of the shaft 14 on which the stent graft 12 is placed can be made close to the axis of the blood vessel. As a result, in the case where the meandering of the blood vessel is large, the outer surface of the stent graft 12 and the inner wall of the blood vessel may be rubbed even when the axial position adjustment is performed with the central seal portion 12c of the stent graft 12 being half-opened. It can be effectively reduced. Moreover, even when the meandering of the blood vessel is large, the positional deviation in the axial direction when the stent graft 12 is expanded can be suppressed, and the stent graft 12 can be stably placed in the blood vessel in an appropriate direction.

According to the delivery device 10B according to the second embodiment, the following operational effects can be obtained as compared with the delivery device 10A according to the first embodiment. In the case of the delivery device 10A according to the first embodiment, when the sheath 16 is pushed in the distal direction after the stent graft 12 is expanded, the distal end of the sheath 16 eventually hits the second flexible member 40, and thereby the second possible member. While the flexible member 40 is bent, the second slider 36 is displaced in the distal direction. If the sheath 16 is forcibly pushed further in the distal direction, the force by which the compression spring 42 pushes the first slider 34 eventually exceeds the expansion force of the expansion body 32 and moves the expansion body 32 while rubbing the inner wall of the blood vessel. It will be. For this reason, in the delivery device 10A, the centering mechanism 20 cannot be accommodated in the sheath 16 again even if the sheath 16 is displaced in the distal direction after the stent graft 12 is expanded.

On the other hand, the delivery device 10B includes the fixing mechanism 82, thereby displacing the sheath 16 in the proximal direction and expanding the centering mechanism 80, and then displacing the sheath 16 in the distal direction again, thereby providing a centering mechanism. 80 can be housed within the sheath 16. That is, when the sheath 16 is displaced in the distal direction in a state where the centering mechanism 80 is fixed in the axial direction with respect to the shaft 14 under the action of the fixing mechanism 82 from a state where the centering mechanism 80 is expanded (see FIG. 13A), As shown in FIG. 13B, the second flexible member 40 is moved toward the shaft 14 by the distal end of the sheath 16, and the second slider 36 is accommodated in the sheath 16 to maintain the position in the axial direction with respect to the shaft 14. Is done.

When the sheath 16 is further displaced in the distal direction, the second flexible member 40 and the expansion body 32 are sequentially accommodated in the sheath 16 as shown in FIG. 13C. By further displacing the sheath 16 in the distal direction, the first slider 34 and the first flexible member 38 are also accommodated in the sheath 16, whereby the centering mechanism 80 is completely accommodated in the sheath 16.

Thus, according to the delivery device 10B, after the stent graft 12 is expanded, the entire centering mechanism 80 including the expansion body 32 can be accommodated again in the sheath 16, so that only the stent graft 12 is placed in the body. Thus, the remaining components of the delivery device 10B can be completely recovered from the body.

In the case of the present embodiment, the fixing mechanism 82 permits the axial movement of the centering mechanism 80 relative to the shaft 14 according to the deformation of the first slider 34 and the second slider 36, and restricts the movement. Since the first slider 34 and the second slider 36 are deformed by the flexible drive member 92, the fixing mechanism 82 is configured compactly at the distal end portion of the delivery device 10B. be able to.

Furthermore, in the case of the present embodiment, the first slider 34 and the second slider 36 and the shaft 14 are engaged via the concavo-convex structure, so that the position in the axial direction of the centering mechanism 80 with respect to the shaft 14 can be more reliably fixed. Can do.

The fixing mechanism 82 shown in FIG. 9 and the like includes a first convex portion 84 of the first slider 34 and a second convex portion 86 of the second slider 36, a first concave portion 88 and a second concave portion 90 provided on the shaft 14. Engaging the first slider 34 and the second slider 36 with respect to the shaft 14 in the axial direction. However, the first concave portion 88 and the second concave portion 90 of the shaft 14 are eliminated, and the first convex portion The first slider 34 and the second slider 36 may be fixed in the axial direction with respect to the shaft 14 by the frictional force between the portion 84 and the second convex portion 86 and the outer peripheral surface of the shaft 14.

As a modified example of the fixing mechanism 82, the inner peripheral shape of the first slider 34, the inner peripheral shape of the second slider 36, and the outer peripheral shape of the shaft 14 are each formed in a non-circular shape, and the first slider 34, the second slider 36, A state in which the first slider 34 and the second slider 36 are allowed to move in the axial direction with respect to the shaft 14 according to the relative rotational position with respect to the shaft 14, and the first slider 34 and the second slider 36 with respect to the shaft 14. You may employ | adopt the structure which switches to the state in which the movement of an axial direction is blocked | prevented.

As another modification of the fixing mechanism 82, a balloon that can be expanded and contracted is provided at a position corresponding to the movable range in the axial direction of the first slider 34 and the second slider 36 on the shaft 14, and the balloon is contracted. In this state, the first slider 34 and the second slider 36 are allowed to move in the axial direction with respect to the shaft 14, and the axis of the first slider 34 and the second slider 36 with respect to the shaft 14 in a state where the balloon is expanded. You may employ | adopt the structure by which the movement of a direction is blocked | prevented.

In the second embodiment, as for the respective components common to the first embodiment, the same operations and effects as those provided by the respective common components in the first embodiment can be obtained. is there.

Claims (11)

A stent graft (12);
A shaft (14) on which the stent graft (12) is mounted;
A tubular sheath (16) slidable axially relative to the shaft (14) and capable of accommodating the stent graft (12);
A centering mechanism (20, 80) disposed on the shaft (14) on the distal side of the stent graft (12) so as to be displaceable in the axial direction of the shaft (14);
The centering mechanism (20, 80) has an expansion body (32) that expands when the sheath (16) is displaced in the proximal direction with respect to the shaft (14), and the expansion body (32) Centering the shaft (14) in a radial direction relative to the body lumen by expansion of
A stent-graft delivery device (10A, 10B). The stent graft delivery device (10A, 10B) according to claim 1,
The expansion body (32) is composed of a skeleton having elasticity, and is configured in a tubular shape as a whole.
A stent-graft delivery device (10A, 10B). The stent graft delivery device (10A, 10B) according to claim 2,
The centering mechanism (20, 80) includes a first slider (34) that is slidable in an axial direction with respect to the shaft (14) on the tip side of the expansion body (32), and the expansion body ( 32) between the second slider (36) provided to be slidable in the axial direction with respect to the shaft (14) on the base end side, and between the expansion body (32) and the first slider (34). A first flexible member (38) stretched on the second flexible member (40), a second flexible member (40) stretched between the expansion body (32) and the second slider (36), A first elastic member (42) disposed between the first slider (34) and the second slider (36);
A stent-graft delivery device (10A, 10B). The stent graft delivery device (10A) according to claim 3,
A detachment mechanism (22) for detaching the expansion body (32) from the shaft (14);
A stent graft delivery device (10A). The stent graft delivery device (10A) according to claim 4,
The release mechanism (22)
An actuating member (44) arranged to be movable back and forth in the axial direction with respect to the first slider (34) and having a plurality of hook portions (50);
A second elastic member (46) for elastically urging the actuating member (44) in the distal direction;
When the actuating member (44) is in the advanced position, the engagement between the first flexible member (38) and the second flexible member (40) and the hook portion (50) is maintained. Thus, the shaft (14) and the expansion body (32) are coupled,
When the actuating member (44) is displaced to the retracted position by being pressed by a nose part (15) provided at the tip of the shaft (14), the first flexible member (38) and the first flexible member (38) 2 The engagement between the flexible member (40) and the hook part (50) is released,
A stent graft delivery device (10A). The stent graft delivery device (10A) according to claim 5,
The elastic force of the second elastic member (46) is smaller than the elastic force of the first elastic member (42).
A stent graft delivery device (10A). The stent graft delivery device (10B) according to claim 3,
A fixing mechanism (82) for fixing the first slider (34) and the second slider (36) to the shaft (14) at an arbitrary axial position;
A stent graft delivery device (10B) characterized by the above. The stent-graft delivery device (10B) according to claim 7,
The first slider (34) and the second slider (36) have a first shape in which displacement in the axial direction relative to the shaft (14) is allowed, and displacement in the axial direction relative to the shaft (14) is restricted. Elastically deformable to the second shape,
The fixing mechanism (82) includes a flexible driving member (92) that spans between the first slider (34) and the second slider (36). When the first slider (34) and the second slider (36) are pressed toward the shaft (14), the first slider (34) and the second slider (36) are moved from the first shape to the first shape. Transforms into two shapes,
A stent graft delivery device (10B) characterized by the above. The stent graft delivery device (10B) according to claim 8,
The fixing mechanism (82)
A first protrusion (84) provided on the inner periphery of the first slider (34);
A second protrusion (86) provided on the inner periphery of the second slider (36);
First recesses (88) provided at a plurality of positions in the axial direction on the outer periphery of the shaft (14);
A second recess (90) provided at a plurality of positions in the axial direction on the outer peripheral portion of the shaft (14) on the proximal side from the first recess (88),
With the first slider (34) and the second slider (36) deformed to the second shape, the first convex portion (84) and the first concave portion (88) are engaged, and the second The convex part (86) and the second concave part (90) are engaged,
A stent graft delivery device (10B) characterized by the above. The stent graft delivery device (10B) according to claim 8,
The first slider (34) is provided with a pair of first insertion holes (94) penetrating in the axial direction at circumferential positions opposite to each other,
The second slider (36) is provided with a pair of second insertion holes (96) penetrating in the axial direction at circumferential positions opposite to each other,
With the operation of the drive member (92), the pair of first insertion holes (94) are displaced in a direction approaching each other, and the pair of second insertion holes (96) are displaced in a direction approaching each other. The first slider (34) and the second slider (36) are deformed from the first shape to the second shape.
A stent graft delivery device (10B) characterized by the above. The stent graft delivery device (10B) according to claim 10,
Of the driving member (92), a portion spanned between the first slider (34) and the second slider (36) is inserted inside the first elastic member (42).
A stent graft delivery device (10B) characterized by the above.

Images