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WO2014006737A1 - Dispositif de traitement destiné à traiter l'intérieur de la lumière d'un organisme - Google Patents

Dispositif de traitement destiné à traiter l'intérieur de la lumière d'un organisme Download PDF

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Publication number
WO2014006737A1
WO2014006737A1 PCT/JP2012/067290 JP2012067290W WO2014006737A1 WO 2014006737 A1 WO2014006737 A1 WO 2014006737A1 JP 2012067290 W JP2012067290 W JP 2012067290W WO 2014006737 A1 WO2014006737 A1 WO 2014006737A1
Authority
WO
WIPO (PCT)
Prior art keywords
shaft
treatment device
lumen
rotating member
substance
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2012/067290
Other languages
English (en)
Japanese (ja)
Inventor
西田香織
柴田秀彬
石井直樹
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Terumo Corp
Original Assignee
Terumo Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Terumo Corp filed Critical Terumo Corp
Priority to PCT/JP2012/067290 priority Critical patent/WO2014006737A1/fr
Publication of WO2014006737A1 publication Critical patent/WO2014006737A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0082—Catheter tip comprising a tool
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0068—Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0068—Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
    • A61M25/0069—Tip not integral with tube
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0074—Dynamic characteristics of the catheter tip, e.g. openable, closable, expandable or deformable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00491—Surgical glue applicators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00893—Material properties pharmaceutically effective
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0068—Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
    • A61M25/007—Side holes, e.g. their profiles or arrangements; Provisions to keep side holes unblocked

Definitions

  • the present invention relates to a treatment device for a living body lumen that applies a substance to be coated on the inner surface of a living body lumen.
  • a technique for delivering a therapeutic device to a lesion in a living organ for example, a blood vessel, a bile duct, a trachea, an esophagus, a urethra, a nasal cavity, or other organs
  • a therapeutic device for treating a stenosis that is a lesion of a blood vessel includes a stent (including a drug eluting stent: DES), a drug eluting balloon catheter (DEB), or other prosthesis that pushes the blood vessel wall from the inside. Things are used.
  • an ablation device that can be delivered via a blood vessel is used as a therapeutic device, and a treatment for cutting (ablation) a nerve inside a blood vessel (for example, a renal artery) is sometimes performed.
  • the treatment device contacts or expands on the thickened blood vessel wall (intima), whereby the elastic plate in the intima is cracked or ruptured, or the blood vessel with the contact of the treatment device It has been confirmed that the walls are inflamed and damaged.
  • a thrombus is generated in the blood vessel to embolize the peripheral blood vessel, or restenosis occurs at the treatment site.
  • improvement of the treatment of lesions has been attempted by applying the composition disclosed in US Patent Application Publication No. 2011/0077216 to the treated blood vessel wall.
  • US Patent Application Publication No. 2011/0077216 discloses a gel adhesive called alginate-catechol.
  • the catechol group reacts with the blood vessel wall, and the alginate is cross-linked by Ca 2+ present at a high concentration at the inflammatory site. For this reason, an adhesive agent will gelatinize in a short time and can coat the blood vessel wall after a treatment favorably.
  • US Patent Application Publication No. 2011/0077216 discloses a tubular member (catheter) that can be delivered into a blood vessel.
  • This therapeutic device has a discharge port on the side surface of the distal end portion, and is configured to apply an adhesive to the blood vessel wall from the discharge port after being delivered to a treatment position in the blood vessel by an operator.
  • the treatment device disclosed in U.S. Patent Application Publication No. 2011/0077216 is configured to discharge adhesive from the side surface of a catheter formed in a long and thin shape, and the influence of blood flowing in the blood vessel is reduced. Receive a lot.
  • blood near the center flows faster than blood near the blood vessel wall, so when a solution containing an adhesive substance is discharged from the side of the treatment device located on the axis of the blood vessel, The solution containing the adhesive substance is poured, and it becomes difficult to attach a sufficient amount of the adhesive substance to the treatment target.
  • the adhesive substance since the adhesive substance is discharged only from the discharge port formed at a predetermined position of the catheter, it tends to adhere nonuniformly to the blood vessel wall.
  • the present invention has been made in order to solve the above-described problem, and can apply a substance to be applied to a desired treatment target in a living body lumen uniformly and reliably, thereby improving the living body lumen. It is an object of the present invention to provide a biological intraluminal treatment device capable of being treated.
  • an intraluminal treatment device is capable of rotating along a long shaft that is inserted into a living body lumen so as to advance and retreat, and about the axis of the shaft. And a rotating member having a discharge port provided on the shaft and capable of discharging a substance to be coated in a substantially centrifugal direction of rotation.
  • the rotating member provided on the shaft is rotatable along the shaft axis and has the discharge port capable of discharging the substance to be coated, thereby rotating the rotating member in the living body lumen.
  • the material to be coated can be discharged while the operation is performed. Therefore, the substance to be coated can be uniformly attached to the wall portion in the living body lumen.
  • the substance to be coated can be discharged at a position in the vicinity of the wall in the living body lumen by discharging the substance to be coated from the discharge port in the substantially centrifugal direction of rotation. For this reason, the discharged substance to be applied is substantially affected by the fluid flowing in the living body lumen in the substantially centrifugal direction, and is reliably attached to a desired location in the living body lumen.
  • the rotating member includes a first form in which the discharge port is positioned in the vicinity of the outer surface of the shaft, and the discharge port is spaced from the position in the vicinity of the outer surface of the shaft to cover the inner surface of the living body lumen. It is preferable to be able to be deformed to the second form that is faced.
  • the rotating member can be deformed into the first and second forms, when the treatment device in the living body lumen is delivered, the rotating member is used as the first form so that the inside of the living body lumen can be smoothly performed. Can be moved. Then, by deforming the rotating member into the second form at the position where the rotating member overlaps the treatment target in the living body lumen, the substance to be coated can be discharged with the discharge port facing the inner surface of the living body lumen. .
  • the rotating member has a plurality of wings that bend in the extending direction of the shaft in the first form and expand outward in the radial direction of the shaft in the second form.
  • the rotating member is formed around the axis of the shaft when the wing part in the second form receives the flow of fluid in the living body lumen. It can be set as the structure which rotates.
  • the wing portion of the rotating member in the second embodiment rotates by receiving the flow of fluid in the living body lumen, so that the delivered rotating member can be easily rotated in the living body lumen.
  • the substance to be coated can be satisfactorily applied from the discharge port formed on the radially outer side of the wing portion.
  • the wing portion may be configured as a balloon having an internal space, and the development fluid may be supplied to the internal space to shift from the first form to the second form.
  • the wing as a balloon having an internal space, the first and second forms of the wing can be easily deformed.
  • the rotating member may include a rotating body that surrounds the shaft and rotates integrally with the wing portion, and the rotating body may include a flow passage through which the deployment fluid can flow into the internal space. .
  • the rotating body that rotates integrally with the wing portion has the flow passage through which the deployment fluid flows, the deployment fluid can easily flow in or out of the internal space of the wing portion.
  • an outer tube that surrounds the shaft and is movable back and forth with respect to the shaft is disposed in the proximal direction of the rotating body, and the rotating body and the outer tube include the outer tube.
  • a connection mechanism may be provided that is connected to the rotating body as the advancing movement is performed and restricts the rotation of the rotating body, and is detached from the rotating body as the outer tube moves backward and allows the rotation of the rotating body.
  • connection mechanism that is connected to the rotating body to restrict the rotation of the rotating body and separates from the rotating body as the outer tube moves backward is provided. And the stop can be easily switched, and the substance to be coated can be efficiently applied.
  • the shaft has a lumen for a substance to be coated that extends in the axial direction and can flow the substance to be coated, and the rotating member rotates on a bearing portion provided in the lumen for the substance to be coated. It is good to have the rotating shaft part in which the hollow part which was supported freely and in which the said lumen
  • the hollow portion communicating with the lumen for the substance to be coated of the shaft is formed in the rotating shaft portion of the rotating member, so that the substance to be coated can be easily guided from the lumen for the substance to be coated to the discharge port. A sufficient amount of the substance to be coated can be discharged to the wall in the living body lumen.
  • the following method can be adopted as a treatment method for a biological intraluminal treatment device. That is, a long shaft that is inserted into a living body lumen so as to be movable back and forth, and a shaft that is provided on the shaft so as to be rotatable around the axis of the shaft, and a substance to be coated is applied in a substantially centrifugal direction of rotation.
  • the substance to be applied can be uniformly and reliably attached to a desired treatment target in the living body lumen, and thus the living body lumen can be treated well.
  • FIG. 2A is a partial side sectional view showing a distal end portion of the treatment device of FIG. 1
  • FIG. 2B is a sectional view taken along line IIB-IIB in FIG. 2A
  • FIG. 2C is a sectional view taken along line IIC-IIC in FIG. It is.
  • FIG. 3A is a first explanatory diagram showing an operation procedure using the treatment device of FIG. 1
  • FIG. 3B is a second explanatory diagram showing an operation procedure of the treatment device following FIG. 3A
  • FIG. 4A is a third explanatory diagram illustrating an operation procedure of the treatment device following FIG. 3B
  • FIG. 4B is a fourth explanatory diagram illustrating an operation procedure of the treatment device following FIG. 4A.
  • FIG. 5A is a fifth explanatory diagram illustrating an operation procedure of the treatment device following FIG. 4B
  • FIG. 5B is a sixth explanatory diagram illustrating an operation procedure of the treatment device following FIG. 5A.
  • 6A is a main part front view showing a treatment device according to a first modification
  • FIG. 6B is a main part perspective view showing a treatment device according to a second modification
  • FIG. 6C is a third modification.
  • FIG. 6D is a side sectional view of an essential part showing a treatment device according to a fourth modified example.
  • FIG. 7A is a first explanatory diagram illustrating a treatment device according to a fifth modification
  • FIG. 7B is a second explanatory diagram illustrating a treatment device according to the fifth modification.
  • FIG. 1 is a partially omitted perspective view schematically showing a biological intraluminal treatment device according to the present embodiment.
  • This intraluminal treatment device 10 (hereinafter, also simply referred to as the treatment device 10) is used to treat a lesion in a blood vessel by a treatment method (intervention) in which a catheter is inserted into a blood vessel through a small hole opened in the skin.
  • the present therapeutic device 10 is used not only for single use, but also for treatment of a lesioned portion (a narrowed portion or a portion where a blood vessel wall is weakened) by a balloon catheter, a stent or an atherectomy device, or a blood vessel treatment by an ablation device, etc. It is used to apply a substance to be applied to a lesioned part or a blood vessel wall after treatment.
  • the treatment device 10 is delivered and the substance to be applied is applied to the treatment site.
  • the treatment device 10 is delivered to apply the substance to be coated around the placement site of the stent.
  • the therapeutic device 10 is delivered and the substance to be applied is applied to the treatment site.
  • the sympathetic ablation treatment after the treatment for cutting the sympathetic nerve passing through the inside of the blood vessel wall is performed, the therapeutic device 10 is delivered and the substance to be applied is applied to the blood vessel wall at the treatment site.
  • the treatment device 10 that applies a substance to be applied to the treatment target X in the blood vessel A (blood vessel wall B) that has been expanded by balloon angioplasty will be described as a representative example.
  • the treatment device 10 is not limited to the above procedure and can be used for various procedures, and various biological lumens (for example, bile duct, trachea, esophagus, urethra, nasal cavity, other organs, etc.). Of course, it can be applied to internal therapy.
  • the treatment device 10 surrounds the shaft 12 inserted into the blood vessel A, the rotating member 14 provided at the distal end portion of the shaft 12, and the outer surface of the shaft 12 on the proximal end side of the rotating member 14. And an outer tube 16.
  • the therapeutic device 10 is delivered from the discharge port 18 formed in the rotating member 14 while the rotating member 14 is rotated at a position (or a nearby position) that is delivered to the treatment target X by being delivered through the blood vessel A by the operator.
  • the material to be applied is attached to the treatment target X by discharging the material.
  • the shaft 12 is formed into a long tubular body having a sufficient length so that the distal end portion can be delivered to the treatment target X. Further, the outer shape of the shaft 12 is formed narrower than the inner surface of the blood vessel A to be delivered. Inside the shaft 12, a hollow coated material distribution lumen 20 (coated material lumen) extends along the axial direction.
  • the shaft 12 is preferably formed of a material having flexibility that can be deformed following the shape of the blood vessel A meandering in the living body and a rigidity that can support the rotation of the rotating member 14.
  • the material constituting the shaft 12 include metals and resins.
  • the metal include pseudoelastic alloys (including superelastic alloys) such as Ni—Ti alloys (naitinol), shape memory alloys, stainless steel (for example, SUS304, SUS303, SUS316, SUS316L, SUS316J1, SUS316J1L, SUS405).
  • the resin examples include polyolefin (for example, polyethylene, polypropylene, polybutene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, ionomer, or a mixture of two or more thereof), polyvinyl chloride, polyamide, polyamide.
  • polyolefin for example, polyethylene, polypropylene, polybutene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, ionomer, or a mixture of two or more thereof
  • polyvinyl chloride for example, polyethylene, polypropylene, polybutene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, ionomer, or a mixture of two or more thereof
  • polyvinyl chloride for example, polyethylene, polypropylene, polybutene, ethylene-propylene copolymer, ethylene-vinyl acetate copoly
  • Examples thereof include polymer materials such as elastomers, polyesters, polyester elastomers, polyurethanes, polyurethane elastomers, polyimides, fluororesins, mixtures thereof, and the above-described two or more polymer materials.
  • the shaft 12 can also be applied to a composite of these metals and resins (for example, a multilayer tube in which a metal and a resin are laminated).
  • an X-ray impermeable marker that can be recognized under X-ray fluoroscopy may be provided near the tip of the shaft 12.
  • a hub 22 having a diameter larger than that of the shaft 12 is provided at the proximal end portion of the shaft 12 so that the operator can easily grasp it.
  • the hub 22 can be mounted on an actuator 24 (see FIG. 3A), and the treatment device 10 is configured to be moved forward and backward by the actuator 24 in addition to the operator.
  • an actuator 24 for example, an external drive device disclosed in Japanese Patent Application Laid-Open No. 2011-152274 filed earlier by the present applicant can be suitably applied.
  • a first port 26 is connected to the base end portion of the hub 22 so as to be able to supply physiological saline and the substance to be coated, communicating with the substance distribution lumen 20 (see FIG. 3A and the like).
  • a three-way stopcock (not shown) is attached to the proximal end of the first port 26, and a physiological saline syringe (not shown) is connected to one upstream side of the three-way stopcock to supply the substance to be coated.
  • a possible substance supply device (not shown) is connected to the other upstream side of the three-way cock.
  • physiological saline or a substance to be coated is selectively supplied to the substance to be coated circulation lumen 20 while air is prevented from being mixed therein.
  • the base end structure of the shaft 12 is not limited to the above-described configuration.
  • a plurality of ports are connected to the hub 22 to supply physiological saline and a substance to be coated separately. Also good.
  • the coated substance distribution lumen 20 is formed to have an inner diameter that allows the physiological saline and the coated substance supplied from the first port 26 to smoothly flow to the tip of the shaft 12.
  • the substance to be applied is guided to the discharge port 18 of the rotating member 14 via the material distribution lumen 20 and discharged from the discharge port 18 to the treatment target X in the blood vessel A.
  • the substance to be coated examples include alginate-catechol that exhibits a strong adhesive force to the blood vessel wall B.
  • the alginate-catechol gels in the blood vessel A in a short time, and well coats the blood vessel wall B after the treatment. For this reason, it is possible to prevent the restenosis and the thrombus from occurring in the treatment target X while protecting the inflammation and the like generated in the treatment target X.
  • the material to be applied is not limited to alginate-catechol, and examples thereof include polysaccharides such as heparin and hyaluronic acid, betaine-based polymers, and catechol-modified products of polyethylene glycol.
  • various drugs including biological and physiologically active substances can be applied simultaneously.
  • a biological physiologically active substance that suppresses restenosis by adhering to a treatment site in the blood vessel A may be applied.
  • biologically bioactive substances include anticancer agents, immunosuppressive agents, antibiotics, anti-rheumatic agents, antithrombotic agents, antihyperlipidemic agents, ACE inhibitors, calcium antagonists, integrin inhibitors, antiallergies.
  • Agents antioxidants, GPIIbIIIa antagonists, retinoids, flavonoids, carotenoids, lipid improvers, DNA synthesis inhibitors, tyrosine kinase inhibitors, antiplatelet agents, vascular smooth muscle growth inhibitors, anti-inflammatory agents, lipoprotein-related phospholipase inhibition Agents, biological materials, interferons, NO production promoting substances, and the like.
  • anticancer agent for example, vincristine sulfate, vinblastine sulfate, vindesine sulfate, irinotecan hydrochloride, paclitaxel, docetaxel hydrate, methotrexate, cyclophosphamide and the like are preferable.
  • immunosuppressive agent for example, sirolimus (rapamycin), tacrolimus hydrate, azathioprine, cyclosporine, mycophenolate mofetil, gusperimus hydrochloride, mizoribine and the like are preferable.
  • antibiotic for example, mitomycin C, doxorubicin hydrochloride, actinomycin D, daunorubicin hydrochloride, idarubicin hydrochloride, pirarubicin hydrochloride, aclarubicin hydrochloride, epirubicin hydrochloride, pepromycin sulfate, dinostatin styramer and the like are preferable.
  • antirheumatic agent for example, sodium gold thiomalate, penicillamine, lobenzalit disodium and the like are preferable.
  • antithrombotic agent for example, heparin, ticlopidine hydrochloride, hirudin and the like are preferable.
  • an HMG-CoA reductase inhibitor or probe is preferable.
  • the HMG-CoA reductase inhibitor for example, cerivastatin sodium, atorvastatin, nisvastatin, pitavastatin, fluvastatin sodium, simvastatin, lovastatin, pravastatin sodium and the like are preferable.
  • ACE inhibitor for example, quinapril hydrochloride, perindopril erbumine, trandolapril, cilazapril, temocapril hydrochloride, delapril hydrochloride, enalapril maleate, lisinopril, captopril and the like are preferable.
  • calcium antagonist for example, nifedipine, nilvadipine, diltiazem hydrochloride, benidipine hydrochloride, nisoldipine and the like are preferable. More specifically, for example, tranilast is preferable as the antiallergic agent.
  • the retinoid for example, all-trans retinoic acid is preferable.
  • the antioxidant for example, catechins, anthocyanins, proanthocyanidins, lycopene, ⁇ -carotene and the like are preferable.
  • catechins epigallocatechin gallate is particularly preferable.
  • the tyrosine kinase inhibitor for example, genistein, tyrphostin, arbustatin and the like are preferable.
  • the anti-inflammatory agent for example, steroids such as dexamethasone and prednisolone and aspirin are preferable.
  • the bio-derived material include EGF (epidemal growth factor), VEGF (basic endowment growth factor), HGF (hepatocyte growth factor), PDGF (platelet gender, etc.).
  • the physiologically active substance may include only one type of the biologically physiologically active substances exemplified above, or may include two or more different biologically physiologically active substances. When two or more kinds of biological physiologically active substances are included, the combination may be appropriately selected from the biologically physiologically active substances exemplified above as necessary.
  • the discharge port 18 for discharging the substance to be coated is provided in the rotating member 14, and the substance to be coated is uniformly applied to the treatment target X (blood vessel wall B) by discharging the substance to be coated during rotation. It has become. For this reason, a bearing portion 30 that protrudes radially inward is provided near the tip of the inner surface of the shaft 12 that constitutes the coated substance distribution lumen 20, and the rotating member 14 is rotatably supported by the bearing portion 30.
  • FIG. 2A is a partial side sectional view showing the distal end portion of the treatment device 10 of FIG. 1
  • FIG. 2B is a sectional view taken along line IIB-IIB in FIG. 2A
  • FIG. 2C is a sectional view taken along line IIC-IIC in FIG. FIG.
  • the rotating member 14 includes a pair of wings 32 positioned at the distal end of the treatment device 10, a flow tube 34 extending inside each wing 32, and a roll shaft member 36 (to which the pair of flow tubes 34 are connected. (Rotating shaft portion) and a rotating body 38 connected to the base end face side of the wing portion 32.
  • the pair of wing portions 32 extend in opposite directions with the axis of the shaft 12 as a base point, and discharge ports 18 for discharging the substance to be coated are formed on the outer ends. Further, the pair of wing portions 32 are curved so as to be along the axial direction of the shaft 12, and the discharge port 18 is positioned in the vicinity of the rotating body 38 (see FIGS. 3A and 3B), and the discharge port. 18 is configured to be able to take a second form (see FIGS. 1 and 2A) that faces the blood vessel wall B away from the vicinity of the rotating body 38.
  • the interior of the wing part 32 is formed as a cavity 40 (internal space) having a predetermined volume, and a developing fluid (for example, physiological saline or contrast medium) can flow into the cavity 40. ing.
  • a developing fluid for example, physiological saline or contrast medium
  • the deformation of the first form and the second form is realized by supplying and discharging the development fluid. That is, the wing portion 32 is configured as a balloon that can be expanded and contracted, and in a state where the deployment fluid is not present in the cavity portion 40 (in a state where the fluid is discharged), the wing portion 32 is deflated and becomes the first form. Is in the cavity 40 (the supplied state), the wing 32 expands to the second form.
  • the wing portion 32 has a shape in which the body portion from the center portion toward the outer end portion is curved and contacts the outer surface of the rotating body 38. This shape is preferably stored in advance (shaped). As a result, after the wing portion 32 is deformed to the second configuration in response to the inflow of the deployment fluid, when the deployment fluid is discharged, the body portion is automatically restored to the first configuration in contact with the outer surface of the rotating body 38. Is done.
  • the wing portion 32 in the second embodiment has a predetermined thickness and is formed to have a distal end surface 32a and a proximal end surface 32b having a narrow end portion at the center and a wide outer end portion.
  • the distal end surface 32a and the proximal end surface 32b are formed as inclined surfaces that receive the blood flow in the blood vessel A from the front or rear and flow obliquely. Therefore, when the wing 32 receives a blood flow flowing in the blood vessel A (in the axial direction of the treatment device 10), the wing 32 rotates around the axis.
  • the degree of deployment of the wings 32 in the second embodiment can be adjusted according to the inflow amount of the deployment fluid. Thereby, blood vessels of various thicknesses can be treated with one therapeutic device 10.
  • a silicon rubber that can easily adjust the degree of expansion of the wing portion 32 in the blood vessel A can be suitably used.
  • the material is not particularly limited as long as it can be deformed into the first and second forms by supplying and discharging the development fluid, and can be rotated by the blood flow in the second form.
  • the pair of flow pipes 34 provided in the hollow portion 40 is configured as a tube body extending radially outward from the center portion.
  • Each flow pipe 34 has a flow passage 42 therein, and an outer end portion of the flow passage 42 communicates with the discharge port 18.
  • an end portion on the center side of the flow pipe 34 is connected to the roll shaft member 36.
  • the material which comprises the flow pipe 34 is not specifically limited, For example, the same material as the wing
  • the roll shaft member 36 is a substantially T-shaped tubular member, and extends in the proximal direction by connecting to a pair of branch portions 44 protruding radially outward at the distal end portion and an intermediate portion of the pair of branch portions 44.
  • Main shaft portion 46 Main shaft portion 46.
  • a guide path 48 (hollow part) is formed in the pair of branch parts 44 and the main shaft part 46 so that the flow path 42 and the material to be coated circulation lumen 20 can be conducted.
  • the pair of branch portions 44 are located on the distal end side of the distal end of the shaft 12, are inserted into the pair of wing portions 32 (hollow portion 40), and project in the same direction as the pair of wing portions 32. Further, the branch portion 44 is fitted and connected to the flow pipe 34, and the flow passage 42 and the guide passage 48 are communicated with each other.
  • the main shaft portion 46 connected to the branching portion 44 is inserted from the outside of the shaft 12 into the inside (the substance to be coated circulation lumen 20), and extends within the length of the coating substance circulation lumen 20 beyond the bearing portion 30. Yes. Further, the outer shape of the main shaft portion 46 is formed to have a thickness that is supported by the bearing portion 30. The axis of the main shaft portion 46 is disposed so as to coincide with the axis of the shaft 12.
  • a flange portion 50 having a diameter increased outward in the radial direction is formed.
  • the flange portion 50 is configured to be caught on the base end surface of the bearing portion 30, and prevents the roll shaft member 36 from falling off the shaft 12.
  • the roll shaft member 36 functions as a rotating shaft of the pair of wing portions 32 by being rotatable with respect to the bearing portion 30. Thereby, the rotating member 14 rotates around the axis of the shaft 12.
  • the rotating body 38 connected to the wing portion 32 is formed in a substantially bullet-shaped container having an accommodation space 52 in which the shaft 12 can be accommodated.
  • the wall 38a constituting the rotating body 38 has a distal end joined to the pair of wings 32, extends from the distal end in the proximal direction, and further axially extends from the curved portion toward the proximal direction. Extends in parallel with.
  • the inner surface of the curved portion of the wall portion 38 a is an abutting portion 54 that abuts on the curved portion of the tip portion of the shaft 12.
  • a pair of rotating body-side fluid passages 56 are formed in the wall portion 38a of the rotating body 38.
  • the rotating body-side fluid passages 56 are formed of elongated holes through which the developing fluid can flow.
  • the rotating body side fluid passage 56 extends from the distal end portion to the proximal end portion along the substantially bullet-shaped wall portion 38 a, and the distal end opening communicates with the cavity portion 40 of the pair of wing portions 32.
  • a valve body 58 that blocks outflow of the developing fluid is provided at the proximal end opening of the rotor-side fluid passage 56.
  • a connection mechanism 60 is provided on the base end surface of the rotating body 38 so that the rotating body 38 and the outer tube 16 can be easily connected. The connection mechanism 60 will be described later.
  • the rotating member 14 configured as described above is rotatable relative to the shaft 12.
  • the rotating member 14 according to the present embodiment automatically rotates when the wing portion 32 receives blood flow.
  • the rotation state (rotation and stop) of the rotation member 14 is switched by an outer tube 16 disposed on the base end side.
  • the outer tube 16 is a tubular body that extends along the axial direction of the shaft 12 and is slightly shorter than the shaft 12.
  • the outer tube 16 is exposed to the outside of the living body with the rotating member 14 delivered to the treatment target X.
  • a through lumen 62 having an inner diameter larger than the outer diameter of the shaft 12 is formed inside the outer tube 16, and the shaft 12 is inserted into the through lumen 62. That is, the shaft centers of the shaft 12 and the outer tube 16 are substantially coaxial.
  • a flange 64 (operation part) that expands radially outward is formed at the proximal end of the outer tube 16.
  • the flange portion 64 is located in front of the hub 22, and a fluid passage port 66 is formed at a predetermined position on the side surface thereof.
  • a second port 68 (see FIG. 3A and the like) is connected to the fluid passage port 66, and a developing fluid can be supplied by a pressure application device such as an indeflator (not shown).
  • the outer tube 16 is moved forward and backward relative to the shaft 12 and the rotating member 14 by the forward and backward movement of the collar portion 64.
  • An outer tube side fluid passage 70 extending from the distal end to the proximal end is formed inside the wall portion 16a constituting the outer tube 16.
  • the outer pipe side fluid passage 70 extends in a pair inside the outer pipe 16, joins at the flange 64 on the base end side, and communicates with the fluid passage port 66.
  • a projecting portion 72 that protrudes in the distal direction is formed at the distal end portion of the outer tube 16, and the outer tube side fluid passage 70 passes through the projecting portion 72.
  • the protrusion 72 is inserted into the valve body 58 in a state where the rotating member 14 and the outer tube 16 are connected, thereby realizing communication between the rotating body-side fluid passage 56 and the outer tube-side fluid passage 70.
  • connection mechanism 60 that connects the rotating member 14 and the outer tube 16 switches between a connection state and a detached state with the rotating member 14 as the outer tube 16 moves forward and backward. Yes.
  • the connection mechanism 60 includes the above-described valve body 58 of the rotating body 38 and the protrusion 72 of the outer tube 16, a magnet 74 (magnetic body) embedded in the rotating body 38, and a metal material 76 embedded in the outer tube 16. (For example, iron).
  • a pair of magnets 74 is provided on the base end surface of the rotating body 38 at a position shifted by 90 ° in the circumferential direction with respect to the pair of valve bodies 58.
  • a pair of metal members 76 are provided on the distal end surface of the outer tube 16 at positions shifted by 90 ° in the circumferential direction with respect to the pair of protrusions 72.
  • the magnet 74 acts to attract the metal material 76, and when the distal end surface of the outer tube 16 approaches the base end surface of the rotator 38, the rotator 38 is guided so that the magnet 74 and the metal material 76 coincide with each other in the circumferential direction.
  • the valve body 58 and the projection 72 are opposed to each other, and when the rotary body 38 and the outer tube 16 are to be connected, the projection 72 is easily inserted into the valve body 58 and the rotary body-side fluid passage 56 The pipe side fluid passage 70 is communicated. Further, since the magnet 74 and the metal material 76 are brought into close contact with each other by magnetic force, the rotating body 38 and the outer tube 16 are fixed, and the rotation of the rotating member 14 can be stopped.
  • the outer tube 16 is moved in the proximal direction beyond the magnetic force of the magnet 74 with the rotating body 38 and the outer tube 16 connected, the outer tube 16 is detached from the rotating member 14.
  • the protrusion 72 is removed from the valve body 58, and the valve body 58 is self-closed. Therefore, even if the developing fluid is present in the rotor-side fluid passage 56, the valve body 58 prevents leakage. Further, the rotating member 14 can be rotated by blood flow as the outer tube 16 is detached.
  • the treatment device 10 is preferably provided so as to cover the periphery with a sheath 78 in a state where the pair of wings 32 are folded inward (see FIG. 3A). .
  • blade part 32 does not expand
  • the treatment device 10 according to the present embodiment is basically configured as described above, and the operation and effect will be described below.
  • Priming is performed on the treatment device 10 according to the present embodiment to fill the inside of the treatment device 10 with physiological saline before introduction into the living body (priming step).
  • physiological saline is supplied through the first port 26 while the sheath 78 is attached to the distal end portion of the treatment device 10, and physiological saline is supplied through the substance distribution lumen 20. Lead to the tip side of the shaft 12.
  • the physiological saline flows into the guide path 48 of the roll shaft member 36 and is discharged from the discharge port 18 through the flow path 42 of the flow pipe 34.
  • air is extracted from the coated substance distribution lumen 20, the guide path 48, and the flow path 42 and filled with physiological saline.
  • a developing fluid (physiological saline) is supplied through the second port 68, and the developing fluid is supplied to the cavity 40 of the wing 32 through the outer tube side fluid passage 70 and the rotating body side fluid passage 56. Inflow. At this time, the rotating member 14 and the outer tube 16 are connected by the connection mechanism 60, and the developing fluid is easily guided to the cavity 40.
  • the supply amount of the deployment fluid at the time of priming is an amount sufficient to maintain the first form, and since the sheath 78 exists around the wing portion 32, the deployment of the wing portion 32 is restricted. In this way, by filling the wing 32 with the deployment fluid before insertion into the living body, the subsequent operation of the treatment device 10 (deployment of the wing 32) can be performed efficiently.
  • the primed treatment device 10 is used for applying a substance to be applied to a treatment site (treatment target X) in balloon angioplasty. Therefore, before the treatment device 10 is used, a treatment for expanding a stenosis, which is a lesion in the blood vessel A or the like, with a balloon catheter (not shown) is performed.
  • the surgeon first identifies the form of the lesion by an intravascular imaging method or an intravascular ultrasonic diagnostic method.
  • a guide wire is introduced into the blood vessel percutaneously from the thigh or the like, for example, by the Seldinger method, and the balloon catheter is advanced along the guide wire.
  • the stenosis is pushed outward in the radial direction of the blood vessel.
  • the balloon is deflated and the balloon catheter is withdrawn from the blood vessel. Thereby, the treatment by the balloon catheter is completed.
  • a delivery step of delivering the therapeutic device 10 to the treatment target X whose stenosis portion is pushed and expanded is performed.
  • this delivery step as shown in FIG. 3B, the sheath 78 attached to the distal end portion of the treatment device 10 is removed, and the treatment device 10 is inserted from the same insertion site as the balloon catheter.
  • the wing portion 32 of the treatment device 10 is maintained in the first form in contact with the rotating body 38, and the rotating member 14 is sufficiently thinner than the inner surface of the blood vessel A. Therefore, the treatment device 10 is smoothly delivered to the treatment target X without damaging the inner surface of the blood vessel A.
  • the delivery is stopped.
  • the wing 32 of the rotating member 14 is shifted to the second form. That is, the expansion
  • a deployment fluid is supplied to the outer tube side fluid passage 70 via the second port 68.
  • the developing fluid is guided to the rotating body side fluid passage 56 through the outer tube side fluid passage 70 and further flows into the cavity portion 40 of the wing portion 32.
  • blade part 32 transfers to a 2nd form from a 1st form.
  • the pair of wings 32 are expanded with a predetermined internal pressure to form the shape of the second form. Since the form of the treatment target X is specified before the treatment of the treatment device 10, the supply amount of the deployment fluid can be appropriately adjusted. That is, the supply amount is set so that the radial length of the pair of wings 32 is shorter than the diameter of the blood vessel wall B, and the pair of wings 32 is expanded.
  • the wings 32 are expanded so as to be orthogonal to the axis of the shaft 12.
  • the discharge port 18 is made to face the blood vessel wall B.
  • the pair of wing parts can be obtained by reducing the supply amount of the developing fluid. 32 is tilted and deployed, so that the discharge port 18 faces the blood vessel wall B. That is, the treatment device 10 can appropriately arrange the discharge port 18 in the vicinity of the treatment target X by adjusting the degree of expansion of the wing 32 according to the thickness of the blood vessel A.
  • the outer ends of the pair of wings 32 are brought into contact with the blood vessel wall B, and then the deployment fluid is somewhat removed from the cavity 40.
  • the work of adjusting the length of the wing portion 32 in the radial direction may be shortened.
  • the axial center of the shaft 12 can be easily matched (centered) with the axial center in the blood vessel A.
  • a rotating step for rotating the rotating member 14 is performed.
  • the outer tube 16 is moved in the proximal direction, and the outer tube 16 is detached from the rotating body 38.
  • the developing fluid supplied to the cavity 40 remains on the rotating member 14 side by closing the valve body 58.
  • blade part 32 is maintained in the state of a 2nd form. Then, when the pair of wing portions 32 receives blood flowing in the blood vessel A, the rotating member 14 automatically rotates.
  • an application step of applying a substance to be applied to the treatment target X is performed.
  • the material to be coated is supplied to the material circulation lumen 20 through the first port 26, and the material to be coated is guided to the tip of the shaft 12 through the material circulation lumen 20.
  • the material to be coated is discharged from the discharge port 18 through the guide path 48 of the rotating roll shaft member 36 and the flow path 42 of the flow pipe 34.
  • the treatment device 10 is a treatment target X It is possible to apply the substance to be applied more accurately.
  • the treatment device 10 does not cause uneven application or coating failure of the substance to be applied.
  • the rotating member 14 rotates, the blood in the blood vessel A acts in the centrifugal direction (radial direction) of the wing portion 32 based on the shape of the wing portion 32. Thereby, since the rotating member 14 is guided so as to be positioned at the axial center of the blood vessel A, the pair of wing portions 32 can be prevented from contacting the blood vessel wall B.
  • a moving step is performed in which the treatment device 10 is moved by the actuator 24 while applying the substance to be applied.
  • the treatment device 10 is moved backward at a constant speed by the actuator 24 connected to the hub 22. Therefore, the distal end portion of the shaft 12 and the rotating member 14 that are in a position overlapping the treatment target X also move backward at a constant speed.
  • the therapeutic device 10 can apply
  • the rotating member 14 In the moving step, after the rotating member 14 is moved backward, it can be moved again to apply the substance to be coated more reliably. That is, in the procedure using the treatment device 10, the rotation member 14 may move back and forth in the blood vessel A any number of times.
  • a backward movement step for contracting the pair of wings 32 and moving the treatment device 10 backward from the blood vessel A is performed as shown in FIG. 5B.
  • the rotation of the rotating member 14 is stopped by moving the outer tube 16 forward and reconnecting the rotating body 38 and the outer tube 16.
  • the magnet 74 and the metal material 76 of the connection mechanism 60 are attracted.
  • the valve body 58 of the rotating body 38 and the protruding portion 72 of the outer tube 16 face each other, and the protruding portion 72 is inserted into the valve body 58 as the rotating body 38 and the outer tube 16 are connected. Accordingly, the rotor-side fluid passage 56 and the outer tube-side fluid passage 70 communicate with each other.
  • the outer tube 16 After the outer tube 16 is connected to the rotating member 14, an operation of discharging the deployment fluid through the second port 68 is performed. As a result, the deployment fluid that has deployed the pair of wings 32 is discharged, and the pair of wings 32 contracts. As described above, since the pair of wing portions 32 is preliminarily stored in the first form, the pair of wing portions 32 can be easily bent so as to come into contact with the outer surface of the rotating body 38. Therefore, the treatment device 10 can be removed from the living body by smoothly moving the rotating member 14 backward from the blood vessel A.
  • the treatment device 10 is not limited to the above-described embodiment, and various modifications and application examples can be taken. Hereinafter, some modifications of the treatment device 10 according to the present invention will be described. In addition, in the following description, about the structure same as the treatment device 10 concerning this Embodiment, or the structure which has the same function, the same code
  • the treatment device 10 ⁇ / b> A according to the first modification is provided with eight wings 33 along the circumferential direction at the distal end portion of the rotation member 15, and the eight wings 33 allow the rotation member to rotate. 15 is configured to rotate.
  • the discharge port 18 for the substance to be coated may be provided in all the wing parts 33, or may be provided only in a part of the wing parts 33.
  • the number of the wings 32 and 33 provided on the rotating members 14 and 15 is not limited, and the shape of the wings 32 and 33 may be appropriately formed according to the number of sheets.
  • the number of wings 32 and 33 that can achieve both smooth delivery of the treatment device 10 (first form) and rotation of the rotating members 14 and 15 (second form) includes 2 to 8.
  • the treatment device 10 ⁇ / b> B according to the second modification includes a valley portion 80 in which the connection mechanism 61 is provided at the proximal end portion of the rotating body 38 and a mountain portion provided at the distal end portion of the outer tube 16. 82.
  • the valley portion 80 and the mountain portion 82 are connected to each other without any gap by engaging with each other. Therefore, the engagement state between the valley portion 80 and the mountain portion 82 can be switched in accordance with the forward / backward operation of the outer tube 16, and the rotation and rotation stop of the rotating member 14 can be switched.
  • the rotating body side fluid passage 56 and the outer tube side fluid passage 70 are provided in the valley portion 80 and the mountain portion 82, respectively, so that they can be easily communicated in the connected state. That is, the structure of the connection mechanism 61 can employ various structures that connect the rotating member 14 and the outer tube 16.
  • the guide path 48 of the roll shaft member 36 is in direct communication with the cavity 40 of the pair of wings 32, and the pair of coated devices is supplied by supplying the substance to be coated.
  • the wing portion 32 is expanded.
  • the discharge port 18 for discharging the substance to be coated is provided sufficiently small at the outer ends of the pair of wings 32 and communicates with the cavity 40, and is applied from the wings 32 expanded by a predetermined internal pressure.
  • the coating material can be discharged.
  • the treatment device 10 ⁇ / b> D includes an outer roll shaft member 84 coupled to the wing portion 32 and an inner roll shaft member 86 that passes through the inside of the outer roll shaft member 84.
  • a roll shaft member 37 having a double structure is provided.
  • the shaft 12 is comprised by the double tube body by which the inner tube
  • the outer roll shaft member 84 is formed therein with a fluid passage 90 through which a developing fluid can flow, and is rotatably supported by a bearing portion 30a provided in the shaft 12 (the developing fluid flow lumen 92). Is done.
  • the inner roll shaft member 86 is provided with a material flow passage 94 through which the material to be coated can flow, and this material flow passage 94 is connected to the material flow lumen 21 of the inner pipe 88 and discharged.
  • the outlet 18 is in communication.
  • the inner roll shaft member 86 is rotatably supported by a bearing portion 30b provided in the coated material distribution lumen 21.
  • the treatment device 10D according to the fourth modification can obtain the same effect as the treatment device 10 according to the present embodiment.
  • the treatment device 10E according to the fifth modification is configured to be inserted into the blood vessel A while being accommodated in the sheath 78.
  • the pair of wing portions 32 is formed in a shape (second form) extending in a direction orthogonal to the axial direction of the shaft 12 in a natural state, and is elastically deformed by being accommodated in the sheath 78. And it becomes the 1st form.
  • the treatment device 10 ⁇ / b> E may be configured to be positioned (centered) along the axis of the blood vessel A by being supported by the sheath 78 via the support member 96.
  • the rotating member 14 is automatically rotated by the blood flow in the state of transition to the second form, and discharges the substance to be coated from the discharge port 18. After the application, it is accommodated again in the sheath 78 and removed.
  • the rotating member 14 can be rotated by various means regardless of the blood flow.
  • the rotating member 14 may be rotated using the flow of the material to be coated.
  • the core material connected to the rotation member 14 is exposed at the proximal end portion of the treatment device 10, the core material is rotated by a driving source such as an operator's manual or a motor, and the rotation member 14 at the distal end portion is rotated. Also good.
  • the rotating member 14 provided on the shaft 12 is rotatable along the axis of the shaft 12 and is coated.
  • the discharge port 18 capable of discharging the substance
  • the substance to be coated can be discharged while rotating the rotating member 14 in the blood vessel A. Therefore, the substance to be coated can be uniformly attached to the treatment target X (blood vessel wall B).
  • the discharge port 18 is located in the substantially centrifugal direction of the wing part 32, the substance to be coated can be discharged near the treatment target X. For this reason, the discharged substance to be applied is directed substantially in the centrifugal direction without being substantially affected by the blood flowing in the blood vessel A, and is reliably attached to the treatment target X.
  • the rotating member 14 can be deformed into the first and second forms, when the therapeutic device 10 is delivered, the rotating member 14 can be smoothly moved in the blood vessel A as the first form. it can. And in the position which overlaps with the treatment target X, by deform
  • the pair of wings 32 is configured as a balloon, the radial length of the pair of wings 32 can be easily adjusted, and the contact between the wings 32 and the blood vessel wall B is suppressed and rotated. The member 14 can be rotated.
  • the coated substance can be easily transferred from the coated substance distribution lumen 20 to the discharge port 18. Therefore, a sufficient amount of the substance to be coated can be discharged to the treatment target X.
  • the substance to be coated has a high viscosity (a solution in which a high-molecular substance that expresses adhesiveness, such as sugars, betaine-based polymers, and polyethylene glycol) is dissolved) Is supplied, it is assumed that clogging is relatively easy in the flow path in the process of injecting the material to be coated.
  • the flow path of the substance to be applied extends substantially linearly to the roll shaft member 36, and the discharge port 18 is provided in the centrifugal direction in which the roll shaft member 36 rotates. Since it is formed, even a high-viscosity material can be smoothly guided to the discharge port 18 without clogging.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biophysics (AREA)
  • Pulmonology (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Media Introduction/Drainage Providing Device (AREA)
PCT/JP2012/067290 2012-07-06 2012-07-06 Dispositif de traitement destiné à traiter l'intérieur de la lumière d'un organisme Ceased WO2014006737A1 (fr)

Priority Applications (1)

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PCT/JP2012/067290 WO2014006737A1 (fr) 2012-07-06 2012-07-06 Dispositif de traitement destiné à traiter l'intérieur de la lumière d'un organisme

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2000501632A (ja) * 1995-12-13 2000-02-15 ニーコメド・アルツナイミッテル・ゲゼルシャフト・ミット・ベシュレンクテル・ハフツング 外科手術用具の使用のための器具
JP2004500175A (ja) * 1999-12-14 2004-01-08 リンバテック・コーポレーション 固定システムおよび方法
JP2009082727A (ja) * 2004-10-18 2009-04-23 Tyco Healthcare Group Lp スプレー可能な創傷処置材料を付与するための構造物

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2000501632A (ja) * 1995-12-13 2000-02-15 ニーコメド・アルツナイミッテル・ゲゼルシャフト・ミット・ベシュレンクテル・ハフツング 外科手術用具の使用のための器具
JP2004500175A (ja) * 1999-12-14 2004-01-08 リンバテック・コーポレーション 固定システムおよび方法
JP2009082727A (ja) * 2004-10-18 2009-04-23 Tyco Healthcare Group Lp スプレー可能な創傷処置材料を付与するための構造物

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