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WO2014178197A1 - Instrument creux et allongé - Google Patents

Instrument creux et allongé Download PDF

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Publication number
WO2014178197A1
WO2014178197A1 PCT/JP2014/002411 JP2014002411W WO2014178197A1 WO 2014178197 A1 WO2014178197 A1 WO 2014178197A1 JP 2014002411 W JP2014002411 W JP 2014002411W WO 2014178197 A1 WO2014178197 A1 WO 2014178197A1
Authority
WO
WIPO (PCT)
Prior art keywords
hollow
thrombus
long body
hollow long
expanded
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/JP2014/002411
Other languages
English (en)
Japanese (ja)
Inventor
克彦 清水
祐貴 伊藤
陽一郎 桑野
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
Publication of WO2014178197A1 publication Critical patent/WO2014178197A1/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
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320758—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with a rotating cutting instrument, e.g. motor driven
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/22031—Gripping instruments, e.g. forceps, for removing or smashing calculi
    • A61B17/22032—Gripping instruments, e.g. forceps, for removing or smashing calculi having inflatable gripping elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320725—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with radially expandable cutting or abrading elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22079—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with suction of debris
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A61B2017/32004—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes having a laterally movable cutting member at its most distal end which remains within the contours of said end
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320758—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with a rotating cutting instrument, e.g. motor driven
    • A61B2017/320775—Morcellators, impeller or propeller like means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2217/00—General characteristics of surgical instruments
    • A61B2217/002—Auxiliary appliance
    • A61B2217/005—Auxiliary appliance with suction drainage system

Definitions

  • the present invention relates to a hollow long body, and more particularly, to a hollow long body capable of removing a relatively large thrombus.
  • (A) is the schematic of the catheter containing the hollow elongate body which concerns on 1st embodiment of this invention
  • (b) is the hollow elongate body which concerns on 1st embodiment of this invention shown to (a).
  • the cross section of the hollow long body in a state in which the expansion part included in is not expanded (hereinafter also referred to as “non-expanded state”) along the extending direction of the hollow long body is represented by one end of the hollow long body.
  • (C) is a state in which the extended portion of the hollow elongated body according to the first embodiment of the present invention shown in (a) is expanded (hereinafter also referred to as “expanded state”).
  • (A), (b) is a figure which shows the cross section by the surface in alignment with the extension direction of a hollow elongate body of the balloon 55B which concerns on 2nd embodiment in a contracted state
  • (c) It is a figure which shows the cross section by the surface in alignment with the extension direction of a hollow elongate body of the balloon 55B which concerns on 2nd embodiment in an expanded state
  • (A) is a figure which shows the cross section by the surface in alignment with the extension direction of a hollow elongate body of the balloon 55C which concerns on 3rd embodiment in a contracted state
  • (b) is 3rd embodiment in an expanded state.
  • Examples of the fiber member 18 used in the extension portion 1epC according to the third embodiment include monofilament yarn, multifilament yarn, twisted yarn, braided string, and the like.
  • the flexible material 20 used for the expansion part 1epC according to the third embodiment can be the same as the flexible material 13 used for the expansion part 1epA according to the first embodiment.
  • As the balloon 21 used for the expansion part 1epC according to the third embodiment a normal one in the medical field can be used.
  • the thrombus cutting member 2B has a radial shape centered on the point O in the projection view.
  • the thrombus cutting member according to the embodiment of the present invention is not limited to this, and can have any shape as long as it does not hinder folding.
  • the projection may have a spider web shape (see FIG. 6A) or a star shape (see FIG. 6B). It is good.
  • the foldable member 35 ′ another member (for example, a long body having a balloon coupled to the tip) is inserted into the ring-shaped member 38 in both the unexpanded state and the expanded state of the expansion portion 1ep. Can do.
  • the diameter X of the thrombus cutting member 2 increases as the expanded portion 1ep is expanded.
  • the thrombus cutting member 2 is preferably expandable in the radial direction. According to the above configuration, the thrombus can be cut in both the expanded state and the unexpanded state of the expanded portion 1ep.
  • FIG. 9 (a) shows a cross section of the thrombus cutting member 2C according to the third embodiment in the non-expanded state of the expanded portion, along a surface along the extending direction of the hollow elongated body, and FIG.
  • the cross section by the surface in alignment with the extension direction of a hollow elongate body of 2 C of thrombus cutting members which concern on 3rd embodiment in the expanded state of a part is shown.
  • a thrombus cutting member 2 ⁇ / b> C according to the third embodiment shown in FIG. 9 is an openable / closable member 40 fixed on the inner peripheral surface of the hollow portion 1 t of the hollow long body 1.
  • the openable / closable member 40 includes a blade 41 composed of a first blade to a fourth blade 41a to 41d.
  • the blade 41 has a blade portion 42 having an action of cutting a thrombus, and the blade portion 42 is connected to the hollow elongated body 1. It consists of the connection part 43 fixed on the internal peripheral surface of the expansion part 1ep.
  • points R1 to R4 are defined on the inner peripheral surface of the extended portion 1ep of the hollow long body 1, and a first connection portion 43a fixed to the point R1 and one end thereof are connected to the first connection portion 43a.
  • a first blade 41a composed of a first blade 41a, a second connection portion 43b fixed to the point R2, and a second blade portion 42b having one end coupled to the second connection portion 43b.
  • An openable / closable member 40 including a fourth blade 41d including 43d and a fourth blade portion 42d having one end coupled to the fourth connection portion 43d is provided.
  • the points R1 to R4 are on a plane perpendicular to the extending direction of the hollow long body 1, and are arranged in this order on the inner peripheral surface of the hollow long body 1 at equal intervals.
  • the first blade to the fourth blades 41a to 41d have a direction from one end to the other end of the blade portion 42 in the non-expanded state of the expanded portion 1ep.
  • the blade portion 42 is positioned along the extending direction of the hollow elongated body 1 so as to be in the direction from the one end 1a to the other end 1b.
  • the direction from one end to the other end of the hollow long body 1 is positioned so as to be the direction from the radially outer side to the inner side of the hollow portion 1t of the hollow long body 1.
  • the venous blood taken from the one end 1 a of the hollow elongated body 1 passes through the openable member 40, and the thrombus in the venous blood is severed by receiving strong force from the openable member 40. Is done.
  • the openable member 40 included in the hollow long body 1 according to the first embodiment of the present invention is not limited to the above configuration, and may have any configuration as long as it has an action of cutting a thrombus.
  • the number of each blade 41 (the first blade to the fourth blade 41a to 41d in FIG. 9) forming the openable member 40 and the position where each blade 41 is fixed are not limited to the above.
  • Each projection 46 has a projection main body portion 47 having an action of cutting a thrombus, and the projection main body portion 47 is formed into a hollow long shape. It consists of the coupling
  • bond part 48 fixed on the internal peripheral surface of the expansion part 1ep of the body 1.
  • the protrusion main body portion 47 of each protrusion 46 is fixed by the restraining portion 49 so that the protrusion main body portion 47 is along the inner peripheral surface of the hollow portion 1t of the hollow long body 1. Has been.
  • the points T1 to T8 are on a plane perpendicular to the extending direction of the hollow elongated body 1 located on the other end 1b side of the hollow elongated body 1 with respect to the points S1 to S4.
  • the first protrusion 46a to the fourth protrusion 46d are formed in a hollow elongated body in the direction from one end to the other end of the protrusion main body portion 47 as shown by a dotted line in FIG. Since the other end portion is restrained by the restraining portion 49 as shown by a solid line in FIG. The other end of the portion 47 is fixed so as to be positioned near the inner peripheral surface of the hollow elongated body 1.
  • the distance between one end and the other end of the restricting portion 49 for example, between the point T1 and the point T2 in the case of the first hind foot portion 49a). Distance
  • the restraining portion 49 breaks, and the other end of the projection main body portion 47 stands up from the position near the inner peripheral surface of the hollow long body 1 toward the radially inner side of the hollow long body 1. To do.
  • the stand-up member 45 including the protrusion 46 including the first protrusion 46a to the fourth protrusion 46d does not function to cut the thrombus in the non-expanded state of the expansion part 1ep, but is hollow in the expansion state of the expansion part 1ep.
  • the thrombus cutting member 2 has a diameter X larger than the inner diameter rm of the long body 1mp.
  • FIG. 11 (a) shows a cross section of the thrombus cutting member 2E according to the fifth embodiment in a non-expanded state of the expanded portion, along a surface along the extending direction of the hollow elongated body, and FIG.
  • the cross section by the surface in alignment with the extending direction of a hollow elongate body of the thrombus cutting member 2E which concerns on 5th embodiment in the expanded state of a part is shown.
  • the thrombus cutting member 2E according to the fifth embodiment shown in FIG. 11 is an umbrella-shaped member 50 that opens from the radially inner side to the radially outer side of the hollow elongated body 1 in the hollow portion 1t of the hollow elongated body 1. is there.
  • the umbrella-shaped member 50 is connected to one shaft portion 51 extending in the extending direction of the hollow long body 1 and one end of the shaft portion 51, and can be expanded and contracted in a direction perpendicular to the extending direction of the hollow long body 1.
  • Four arm portions 52 first arm portion to fourth arm portions 52a to 52d
  • the arm portion 52 is moved to the hollow long body by giving displacement to the shaft portion 51 from the other end 1 b side to the one end 1 a side in the expanded state of the expansion portion 1 ep. 1 can be extended outward in the radial direction, and the end portion 53 can be expanded outward in the radial direction of the hollow elongated body 1 as the arm portion 52 extends.
  • the umbrella-shaped member 50 including the four arm portions 52 that can be expanded and contracted in the direction perpendicular to the extending direction of the hollow long body 1 does not exhibit the action of cutting the thrombus in the non-expanded state of the expanded portion 1ep
  • the thrombus cutting member 2 has a larger diameter X than the inner diameter rm of the hollow long body main body 1mp.
  • the venous blood taken from one end 1a of the hollow elongated body 1 passes through the umbrella-shaped member 50, and the thrombus in the venous blood is removed from the umbrella-shaped member 50 (particularly, the arm portion 52). It is cut by receiving power.
  • the umbrella-shaped member 50 with which the hollow elongate body 1 which concerns on 1st embodiment of this invention is provided is not limited to the said structure, As long as it has the effect
  • the number of arm portions 52 (first arm portion to fourth arm portions 52a to 52d in FIG. 11) constituting the umbrella-shaped member 50 and the position where each arm portion 52 is fixed are not limited to the above.
  • the thrombus cutting member 2 is preferably formed in a state where the expanded portion 1ep is expanded. According to the said structure, the clot cutting member 2 can be prepared only when performing operation which removes a thrombus.
  • Such thrombus cutting members 2A to 2E can be used in appropriate combination.
  • FIG. 12 shows a hollow long body according to the second embodiment of the present invention.
  • FIG. 12 (a) shows a cross section of the hollow long body according to the second embodiment of the present invention in a non-expanded state of the hollow long body according to the surface along the extending direction of the hollow long body.
  • FIG. 12B is an enlarged view of one end portion
  • FIG. 12B is a cross section of the hollow long body according to the second embodiment of the present invention in the expanded state, along a surface along the extending direction of the hollow long body. Is shown enlarged for one end of the hollow elongated body. 12 (a) and 12 (b), the same elements as those of the hollow long body 1 according to the first embodiment of the present invention shown in FIG.
  • the thrombus cutting member 2y is provided between the point A of the expansion portion 1ep and the other end 1epb, and the thrombus cutting member 2z is not the expansion portion 1ep. It is provided in the hollow long body main body 1mp. According to this configuration, the thrombus can be cut in stages.
  • the size of the particles that can be passed by the thrombus cutting member 2y on the other end 1b side is allowed to pass by the thrombus cutting member 2x on the one end 1a side.
  • the thrombus can be cut (subdivided) stepwise, so that when the thrombus in venous blood is removed, the thrombus is prevented from clogging the hollow long body. The effect of the long body can be further enhanced.
  • FIG. 13 shows a hollow long body according to the third embodiment of the present invention.
  • FIG. 13A shows a cross-section of the hollow long body 1 ′′ according to the third embodiment of the present invention in a non-expanded state by a surface along the extending direction of the hollow long body.
  • FIG. 13B is an enlarged view of one end portion of the scale, and FIG. 13B shows the extension of the hollow long body of the hollow long body 1 ′′ according to the third embodiment of the present invention in the expanded state.
  • the cross section by the surface along a direction is expanded and shown about the one end part of a hollow elongate body.
  • the hatched portion indicates only the presence of the expanded portion 1ep and the thrombus cutting member 2, and the details thereof are omitted.
  • the hollow long body 1 '' according to the third embodiment of the present invention is a balloon as an expansion body that expands in the radial direction of the hollow long body 1 outside the one end 1a in the extending direction of the hollow long body 1.
  • 55 is further provided.
  • the balloon 55 can be, for example, a balloon used for a Fogarty catheter for removing an arterial embolus.
  • the deflated balloon 55 is inflated on the outer side in the extending direction of the hollow elongated body 1 than the one end 1a of the hollow elongated body 1, and the inflated balloon 55 is expanded from the one end 1a side to the other end 1b.
  • the venous blood located on the outer side in the extending direction of the hollow long body 1 than the one end 1 a of the hollow long body 1 can be taken into the hollow portion 1 t of the hollow long body 1.
  • the taken venous blood passes through the thrombus cutting member 2, and the thrombus in the venous blood is cut (subdivided) by the thrombus cutting member 2. Therefore, if the balloon 55 is provided, thrombi in venous blood can be efficiently removed.
  • FIG. 14 (a) and 14 (b) show a cross section of the balloon 55A as the expansion body according to the first embodiment in the contracted state along the surface along the extending direction of the hollow long body
  • FIG. 14 (c) shows a cross section by the surface in alignment with the extension direction of a hollow elongate body of the balloon 55A which concerns on 1st embodiment in an expanded state
  • the balloon 55A according to the first embodiment shown in FIG. 14 is fixed to the end of one rail 56 passing through the hollow portion 1t of the hollow long body 1 ''.
  • the hollow elongate body 1 '' shown in FIG. 14 uses the expansion portion 1epA according to the first embodiment shown in FIG.
  • the method of using the balloon 55A is as follows. That is, by displacing the rail 56 in the extending direction of the hollow elongated body 1 ′′, the balloon 55A is allowed to pass through the ring-shaped member 38 of the thrombus cutting member 2B ′ (FIG. 14A), and the balloon 55A is moved to the other. The balloon 55A is displaced from the end 1b side toward the one end 1a side so that the balloon 55A is positioned on the outer side in the extending direction of the hollow elongated body 1 with respect to the one end 1a of the hollow elongated body 1 (FIG.
  • one end 1 a of the hollow long body 1 ′′ preferably has a tapered shape that extends from the radially inner side to the outer side of the hollow long body. According to this configuration, when the balloon 55A is pressed against the one end 1a, the balloon 55 can easily bite into the expanded portion 1ep. Therefore, the effect that the thrombi in venous blood can be efficiently removed can be enhanced.
  • FIG. 15 (a) and 15 (b) show a cross section of the balloon 55B as the expansion body according to the second embodiment in the contracted state along a surface along the extending direction of the hollow long body
  • FIG. (D) shows the cross section by the surface in alignment with the extension direction of a hollow elongate body of the balloon 55B which concerns on 2nd embodiment in an expanded state.
  • the balloon 55B according to the second embodiment is fixed to the ends of four rails 56 (56a to 56d, only 56a and 56c are shown in FIG. 15) passing through the hollow portion 1t of the hollow long body 1 ''. It is a thing.
  • the hollow elongate body 1 '' shown in FIG. 15 uses the expanded portion 1epA according to the first embodiment shown in FIG. 2, and the thrombus cutting member 2C (opening / closing member) according to the third embodiment shown in FIG. 40).
  • the method of using the balloon 55B is the same as that of the balloon 55A shown in FIG.
  • the outer diameter Rb of the balloon 55 (55A, 55B) in the inflated state is expanded. It is preferable that it is larger than the inner diameter re of the expanded portion 1ep in the above state. According to this configuration, when the inflated balloon 55 is moved from the one end 1a side toward the other end 1b side, the balloon 55 enters the hollow portion 1t in the expansion portion 1ep of the hollow long body 1 ''. The contact with the thrombus cutting member 2 can be prevented. Therefore, possibility that the hollow elongate body of this invention will be damaged can be reduced.
  • FIG. 16 (a) shows a cross section of the balloon 55C as the expansion body according to the third embodiment in the contracted state by a surface along the extending direction of the hollow elongated body
  • FIG. 16 (b) shows in the expanded state.
  • the cross section by the surface in alignment with the extension direction of a hollow elongate body of the balloon 55C which concerns on 3rd embodiment is shown.
  • the balloon 55C according to the third embodiment has a stopper 60 that protrudes in the radial direction of the balloon 55C on the outer surface of the balloon 55C.
  • the outer diameter (not shown) of the balloon 55C main body not including the stopper in the inflated state is smaller than the inner diameter re of the expanded portion 1ep in the expanded state, but the outer diameter of the balloon 55C in the expanded state.
  • the diameter Rb is larger than the inner diameter re of the expanded portion 1ep in the expanded state. Therefore, it is possible to obtain an effect of reducing the possibility that the hollow long body of the present invention is damaged.
  • FIG. 17 shows a hollow long body according to the fourth embodiment of the present invention.
  • FIG. 17 shows a cross-section of the hollow long body 1 ′ ′′ according to the fourth embodiment of the present invention in the expanded state by a surface along the extending direction of the hollow long body. One end and the other end are shown enlarged.
  • elements similar to those of the hollow long body 1 according to the first embodiment of the present invention shown in FIG. in the hollow elongated body 1 ′ ′′ according to the fourth embodiment of the present invention, the thrombus cutting member 2 is provided on the inner side of the expanded portion 1ep so as to be rotatable relative to the expanded portion 1ep.
  • the thrombus cutting member 2 is formed in a form having a radial net portion intersecting at the center of the cross section of the hollow elongated body 1 ′ ′′, and its outer peripheral edge portion is fixed to the inner peripheral surface of the expansion portion 1ep.
  • the thrombus cutting member 2 can rotate about the center of the mesh portion as an axis.
  • a distal end of an operation shaft 70 for rotation operation made of a flexible wire material capable of transmitting rotational power, such as a metal wire, is fixed to the axis of the thrombus cutting member 2.
  • the operation shaft 70 is disposed through the hollow portion 1t, and its end portion projects outward from the other end 1b of the hollow long body 1 ′ ′′.
  • the expansion portions 1epA to 1epC shown in FIGS. 2 to 4 are appropriately used as the expansion portion 1ep on which the thrombus cutting member 2 is provided so as to be relatively rotatable. be able to.
  • the thrombus cutting member 2 provided in the expanded portion 1ep so as to be relatively rotatable with respect to the expanded portion 1ep is of the above-described form.
  • the present invention can be used in various forms.
  • the thrombus cutting member 2 provided inside the expansion portion 1ep so as to be rotatable relative to the expansion portion 1ep is similar to the thrombus cutting member 2E, that is, the umbrella-shaped member 50 according to the fifth embodiment shown in FIG. It can also have.
  • the end portion 53 is configured to be relatively rotatable with respect to the expansion portion 1ep, so that the umbrella-shaped member 50 (thrombus cutting member 2E) is expanded inside the expansion portion 1ep in the expansion state of the expansion portion 1ep. It can be set as the structure relatively rotatable with respect to.
  • the shaft portion 51 is configured to function as an operation shaft for rotating operation.
  • the hollow long body 1 ′ ′′ is expanded outside the one end 1a in the extending direction of the hollow long body 1 in the radial direction of the hollow long body 1.
  • a balloon 55 as a body is further provided.
  • the thrombus cutting member 2 is provided on the surface of the balloon 55 facing the expansion portion 1ep.
  • the thrombus cutting member 2 is constituted by a plate-like cutter blade 71 having a sharp tip, and is fixed to the balloon 55 at the root portion thereof.
  • the balloon 55 for example, the balloon 55A according to the first embodiment shown in FIGS. 14 to 16, the balloon 55B according to the second embodiment, or the balloon 55C according to the third embodiment can be used.
  • the rail 56 is configured to function as an operation shaft for rotating operation.
  • the inflated balloon 55 removes the venous blood thrombus on the outer side in the extending direction of the hollow long body 1 ′′ ′′ from the one end 1a of the hollow long body 1 ′ ′′.
  • the cutter blade 71 (thrombus cutting member 2) can be rotated inside the expansion portion 1ep together with the balloon 55 by being able to be taken in and rotating the end portion of the rail 56 manually or using a rotary drive device or the like.
  • the thrombus taken into the expanded portion 1ep can be further finely cut by the cutter blade 71 that rotates.
  • the thrombus taken into the expanded portion 1ep is sealed in the expanded portion 1ep. Can be cut in a state. Therefore, the thrombus finely cut by the rotating cutter blade 71 can be prevented from scattering to the distal side.
  • the thrombus cutting member 2 is provided on the surface of the balloon 55 facing the expansion portion 1ep (proximal side).
  • the thrombus cutting member 2 may be provided on the rail 56 to which the balloon 55 is fixed.
  • the thrombus cutting member 2 can be configured as a plate-like cutter blade 71 having a sharp tip and fixed to the rail 56 at the root portion.
  • the cutter blade 71 is preferably fixed to the rail 56 so that the balloon 55 is positioned inside the extended portion 1ep when the balloon 55 is pressed against the one end 1a of the hollow long body 1 "". Also with this configuration, the same effect as that shown in FIG. 18A can be obtained by rotating the cutter blade 71 (thrombus cutting member 2) together with the rail 56 inside the extended portion 1ep.
  • the thrombus cutting member 2 is configured as a plate-like cutter blade 71 having a sharp tip, but rotates with the balloon 55 or the rail 56 to cut the thrombus. If possible, it can be of other shapes.
  • FIG. 19 shows a hollow long body according to the fifth embodiment of the present invention.
  • FIG. 19A shows a hollow long body 1 ′′ ′′ according to the fifth embodiment of the present invention in a state before the spring-like portion provided at the tip of the extension portion abuts against the object.
  • the cross section by the surface along the extending direction of a long body is expanded and shown about the one end part and other end part of a hollow elongate body, and the spring-like part provided in the front-end
  • a cross-section of the hollow long body 1 '''' according to the fifth embodiment of the present invention in a state of being in contact with the object along a surface along the extending direction of the hollow long body is shown as one end of the hollow long body.
  • the enlarged portion and the other end portion are shown. 19, the same code
  • the hollow long body 1 '''' according to the fifth embodiment of the present invention has a spring-like portion 72 at the tip portion of the expansion portion 1ep.
  • the spring-like part provided at the tip of the extension part 1ep is not limited to the above-described configuration.
  • a coil-like form can be used as long as it can be expanded together with the extension part 1ep in the radial direction and elastically deformed in the axial direction.
  • Various forms can be adopted.
  • the thrombus cutting member 2 is positioned relative to the expanded portion 1ep and the spring-shaped portion 72 inside the spring-shaped portion 72 of the expanded portion 1ep. It is provided rotatably.
  • the thrombus cutting member 2 is configured as a plate-like cutter blade 74.
  • the cutter blade 74 has an elongated plate shape extending in the axial direction and has a shape bent at the intermediate portion in the longitudinal direction.
  • the cutter shaft 74 is rotated along the operation shaft 70 at both ends in the longitudinal direction. 70 is fixed to the outer peripheral surface.
  • the pair of thrombus cutting members 2 are provided at symmetrical positions with the operation shaft 70 interposed therebetween, but a configuration in which only one thrombus cutting member 2 is provided or two or more thrombus cutting members 2 are provided. It can also be configured.
  • the operation shaft 70 can be the same as that shown in FIG. 17 and is made of a wire material that can transmit rotational power, such as a metal wire, and has a hollow end portion 1 ′ ′′. It protrudes outside from the other end 1b of '.
  • the spring-like portion 72 contracts in the axial direction, and the cutter blade 74 is exposed to the outside of the spring-like portion 72 and comes into contact with the thrombus.
  • the distal end portion of the operation shaft 70 is rotated manually or using a rotary drive device or the like, so that the thrombus outside the expanded portion 1ep is finely cut by the rotating cutter blade 74, and the expanded portion 1ep has a hollow length. It can be taken into the scale 1 ''''.
  • the configuration shown in FIGS. 2 to 4 can be appropriately used as the configuration for expanding the expansion portion 1ep.
  • FIG. 20 shows a hollow long body according to the sixth embodiment of the present invention.
  • the cross section by the surface in alignment with the extension direction of a hollow long body of the hollow long body which concerns on 6th embodiment of this invention in the expansion state of an expansion part is expanded about the one end part of a hollow long body
  • FIGS. 21A to 21D are cross-sectional views of modifications of the sliding contact edge shown in FIG. 20 and 21, elements similar to those of the hollow elongated body according to the above-described embodiment are denoted by the same reference numerals, and description thereof is omitted.
  • the hollow long body 1 ′ ′′ ′′ according to the sixth embodiment of the present invention has a spatula member 82 as an expansion body.
  • the spatula member 82 is fixed to the tip of the rail 56, opened from the contracted state folded along the rail 56 toward the radially outer side, and is a circular shape perpendicular to the axial direction of the rail portion 56. It is configured to be deformable into a spatula-like expanded diameter state.
  • the outer diameter dimension, that is, the outer diameter Rs, of the spatula member 82 in the diameter-expanded state is made smaller than the inner diameter re of the expanded portion 1ep, and the outer peripheral portion of the spatula member 82 is slidable in contact with the inner peripheral surface of the expanded diameter portion 1ep.
  • a contact edge 83 is formed.
  • the expanded portion 1ep can be configured to have the stent portion 80 at the distal end portion.
  • This stent part 80 can be made into the structure formed by cross
  • the stent portion 80 can be expanded in the radial direction together with the expanded portion 1ep.
  • the spatula member 82 in the contracted state is more extended than the one end 1a of the hollow elongate body 1.
  • the spatula member 82 By moving the spatula member 82 that is opened in a circular spatula shape on the outer side in the present direction and opened and expanded in diameter from the one end 1a side (distal side) toward the other end 1b side (proximal side), The thrombus located on the outer side in the extending direction of the hollow long body 1 than the one end 1 a of the hollow long body 1 can be taken into the hollow portion 1 t of the hollow long body 1. Further, by expanding the stent portion 80 in the blood vessel, the thrombus adhering to the inner wall of the blood vessel is pushed out from the rhombus space of the stent portion 80 toward the inside of the expanded portion 1ep, but the spatula member 82 is hollow in the stent portion 80.
  • a spatula member that reaches the inside of the stent portion 80 from the outside in the extending direction from one end 1a of the long body 1 and moves inside the stent portion 80 to push the thrombus pushed out from the rhombus space toward the inside of the expanded portion 1ep. It can cut
  • FIG. The thrombus thus taken up is cut (subdivided) by the thrombus cutting member 2. Therefore, by providing the spatula member 82, the thrombus can be removed more efficiently.
  • the spatula member 82 shown in FIG. 20 can be configured as shown in FIGS. 21 (a) to 21 (d), for example.
  • the spatula member 82 is provided with a protrusion 84 having a wedge-shaped cross section that protrudes from the distal side toward the proximal side on the sliding contact edge 83 provided on the outer peripheral portion thereof. Can be configured.
  • the sliding contact edge 83 having the wedge-shaped protrusion 84 moves from the one end 1a side (distal side) to the other end 1b side (proximal side) along the inner peripheral surface of the stent portion 80, whereby the stent portion
  • the thrombus pushed out from the 80 rhombus space toward the inside of the extended portion 1ep can be easily cut by the sharp blade at the tip of the wedge-shaped projection 84. Thereby, thrombus can be removed more efficiently.
  • the spatula member 82 can also be set as the structure by which the brush part 85 was provided in the sliding contact edge 83 provided in the outer peripheral part.
  • the spatula member 82 may have a conical shape in which the outer peripheral portion is located on the proximal side with respect to the axial center portion (center portion).
  • the sliding contact edge portion 83 has an obtuse angle on the distal side and an acute angle on the proximal side. Therefore, when the spatula member 82 moves from the proximal side to the distal side, the sliding contact edge portion 83 is formed. Straddles the thrombus pushed out from the rhombus space of the stent portion 80 toward the inside of the expansion portion 1ep at the obtuse angle portion, while the spatula member 82 moves from the distal side to the proximal side.
  • the thrombus pushed out from the rhombus space of the stent portion 80 toward the inside of the expansion portion 1ep at the acute angle portion of the sliding contact edge portion 83 can be cut and taken into the hollow elongated body 1. Therefore, by moving the spatula member 82 back and forth inside the stent portion 80, the thrombus pushed out from the rhombus space of the stent portion 80 toward the inside of the expanded portion 1ep can be surely removed.
  • the spatula member 82 may be attached to the rail 56 so as to be tiltable. With this configuration, the spatula member 82 can be inclined at an angle according to the inner diameter of the expansion portion 1ep. Therefore, the spatula member 82 can be adapted to changes in the inner diameter of the expansion portion 1ep and various expansion portions 1ep having different inner diameters. Can be made.
  • the spatula member 82 as an expansion body is fixed to the tip of the operation shaft 70, and is in a contracted state folded into a shape along the operation shaft 70. Further, it is configured to be deformable into a diameter-expanded state that is opened toward the outside in the radial direction and has a rectangular spatula shape that is arranged along the operation shaft 70 and parallel to the operation shaft 70.
  • the radial dimension of the spatula member 82 in the expanded state in a rectangular shape, that is, the outer diameter Rs is made smaller than the inner diameter re of the expanded portion 1ep, and its outer peripheral edge can be slidably contacted with the inner peripheral surface of the expanded diameter portion 1ep.
  • the entire space of the inner peripheral surface of the stent portion 80 is directed from the rhombus space toward the inside of the expanded portion 1 ep.
  • the extruded thrombus can be cut and removed.
  • the spatula member 82 shown in FIG. 22 may be configured as shown in FIGS. 23 (a) to (c), for example.
  • the spatula member 82 is directed to a pair of sliding contact edges 83 provided on the outer peripheral portion thereof toward one side in the circumferential direction around the axis of the operation shaft 70.
  • a protrusion 86 having a wedge-shaped projecting cross section may be provided.
  • the sliding contact edge 83 having the wedge-shaped protrusion 86 is moved in the circumferential direction along the inner peripheral surface of the stent portion 80, so that the expanded portion 1 ep from the rhombus space of the stent portion 80.
  • the spatula member 82 can also be set as the structure by which the brush part 87 was provided in the sliding contact edge 83 provided in the outer peripheral part. In this case, by rotating the spatula member 82, the sliding contact edge 83 having the brush portion 87 moves in the circumferential direction along the inner peripheral surface of the stent portion 80, so that the expanded portion 1 ep from the rhombus space of the stent portion 80.
  • the spatula member 82 may be configured such that a plurality of spatula members 82 are radially arranged on the operation shaft 70 around the operation shaft 70. Although the case where three spatula members 82 are arranged on the operation shaft 70 is shown in the drawing, it is also possible to adopt a configuration in which a larger number of spatula members 82 are arranged on the operation shaft 70.
  • the outer diameter Rs of the spatula member 82 is smaller than the inner diameter re of the expanded portion 1ep, but the outer diameter Rs is larger than the inner diameter re of the expanded portion 1ep.
  • the spatula member 82 is opened in a diameter-expanded state on the outer side in the extending direction of the hollow long body 1 than the one end 1a of the hollow long body 1, and the open spatula member 82 is opened from the one end 1a side in the blood vessel.
  • the thrombus adhering to the inner wall of the blood vessel is cut off at the sliding contact edge 83 on the outer side in the extending direction of the hollow elongated body 1 than the one end 1a of the hollow elongated body 1, Thrombus at the site can be taken into the hollow portion 1t of the hollow long body 1 and these thrombus can be cut (subdivided) through the thrombus cutting member 2.
  • the spatula member 82 will contact
  • the stent portion 80 is provided in the extension portion 1ep.
  • the extension portion 1ep in which the stent portion 80 is not provided can also be applied to the hollow elongated body 1 having the above.
  • members having various configurations such as those shown in FIGS. 5 to 12 can be used.
  • the size of the particles that can pass through the thrombus cutting member 2 is preferably 0.6 to 30 mm, and more preferably 2.7 to 22 mm. Within this range, the thrombus can be sufficiently subdivided, so that it is easy to obtain the effect of the hollow elongated body of the present invention that removes a relatively large thrombus.
  • the outer diameter Rb of the balloon 55 is preferably 1 to 31 mm, and more preferably 3 to 23 mm. When the outer diameter Rb is within the above range, thrombus can be sufficiently captured, and the possibility of damage to the hollow long body due to contact with the hollow long body can be reduced.
  • the other end side of the Y-type connector 102 is closed by a valve (not shown) provided on the other end side of the Y-type connector 102 connected to the catheter hub 101 of the catheter tube.
  • a valve (not shown) provided on the other end side of the Y-type connector 102 connected to the catheter hub 101 of the catheter tube.
  • the hollow elongated body of the present invention has been illustrated and described with reference to the drawings.
  • the hollow elongated body of the present invention is not limited to the above-described example, and the above embodiment is appropriately modified. Can be added.

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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
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  • Surgical Instruments (AREA)

Abstract

L'invention concerne un instrument creux et allongé (1) s'insérant à l'intérieur du corps. Plus précisément, cet instrument creux et allongé (1) est caractéristique en ce qu'il est équipé : au niveau d'une partie extrémité (1ap), d'une partie dilatation (1ep) qui se dilate dans sa direction radiale ; et au niveau de cette partie dilatation (1ep), d'un élément d'ablation de caillot (2) destiné à l'ablation d'un caillot.
PCT/JP2014/002411 2013-05-02 2014-05-02 Instrument creux et allongé Ceased WO2014178197A1 (fr)

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JP2013097044 2013-05-02
JP2013-097044 2013-05-02

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Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN107261223A (zh) * 2017-07-19 2017-10-20 宁波市第医院 一种胃内血凝块抽引装置
CN113974769A (zh) * 2021-11-19 2022-01-28 心凯诺医疗科技(上海)有限公司 一种血栓抽吸导管
JP2022053391A (ja) * 2020-09-24 2022-04-05 テルモ株式会社 血栓除去デバイス
JP2023538106A (ja) * 2020-08-21 2023-09-06 マイクロベンション インコーポレイテッド 動的吸引カテーテル及び方法
WO2024130075A1 (fr) * 2022-12-15 2024-06-20 W. L. Gore & Associates, Inc. Dispositifs et systèmes de traitement de thrombus
WO2024205785A1 (fr) * 2023-03-24 2024-10-03 Edwards Lifesciences Corporation Gaine d'introduction gonflable

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH07227427A (ja) * 1994-02-18 1995-08-29 Nippon Zeon Co Ltd 医療用カテーテルセット
JP2007289394A (ja) * 2006-04-25 2007-11-08 Terumo Corp 血栓吸引カテーテル
JP2010022566A (ja) * 2008-07-18 2010-02-04 Norikata Taguma 吸引カテーテル、及び吸引カテーテルシステム
US20120197277A1 (en) * 2011-02-01 2012-08-02 Stinis Curtiss T Vascular plaque removal systems, devices, and methods

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH07227427A (ja) * 1994-02-18 1995-08-29 Nippon Zeon Co Ltd 医療用カテーテルセット
JP2007289394A (ja) * 2006-04-25 2007-11-08 Terumo Corp 血栓吸引カテーテル
JP2010022566A (ja) * 2008-07-18 2010-02-04 Norikata Taguma 吸引カテーテル、及び吸引カテーテルシステム
US20120197277A1 (en) * 2011-02-01 2012-08-02 Stinis Curtiss T Vascular plaque removal systems, devices, and methods

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN107261223A (zh) * 2017-07-19 2017-10-20 宁波市第医院 一种胃内血凝块抽引装置
CN107261223B (zh) * 2017-07-19 2023-08-29 宁波市第一医院 一种胃内血凝块抽引装置
JP2023538106A (ja) * 2020-08-21 2023-09-06 マイクロベンション インコーポレイテッド 動的吸引カテーテル及び方法
JP7667253B2 (ja) 2020-08-21 2025-04-22 マイクロベンション インコーポレイテッド 動的吸引カテーテル及び方法
JP2022053391A (ja) * 2020-09-24 2022-04-05 テルモ株式会社 血栓除去デバイス
JP7607424B2 (ja) 2020-09-24 2024-12-27 テルモ株式会社 血栓除去デバイス
CN113974769A (zh) * 2021-11-19 2022-01-28 心凯诺医疗科技(上海)有限公司 一种血栓抽吸导管
CN113974769B (zh) * 2021-11-19 2022-12-20 心凯诺医疗科技(上海)有限公司 一种血栓抽吸导管
WO2024130075A1 (fr) * 2022-12-15 2024-06-20 W. L. Gore & Associates, Inc. Dispositifs et systèmes de traitement de thrombus
WO2024205785A1 (fr) * 2023-03-24 2024-10-03 Edwards Lifesciences Corporation Gaine d'introduction gonflable

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