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WO2014188300A1 - Dispositif de gaine introductrice avec extrémité dilatable - Google Patents

Dispositif de gaine introductrice avec extrémité dilatable Download PDF

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Publication number
WO2014188300A1
WO2014188300A1 PCT/IB2014/061374 IB2014061374W WO2014188300A1 WO 2014188300 A1 WO2014188300 A1 WO 2014188300A1 IB 2014061374 W IB2014061374 W IB 2014061374W WO 2014188300 A1 WO2014188300 A1 WO 2014188300A1
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WO
WIPO (PCT)
Prior art keywords
distal end
condition
introducer
fingers
tube
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/IB2014/061374
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English (en)
Inventor
Fabio Melchiorre
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Individual
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Individual
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Filing date
Publication date
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Publication of WO2014188300A1 publication Critical patent/WO2014188300A1/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
    • A61M25/0074—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
    • A61B17/22—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
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3415—Trocars; Puncturing needles for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters
    • 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
    • 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

Definitions

  • the present invention relates to an introducer device, in particular for the percutaneous introduction of catheters into blood vessels and other ducts and for the removal of materials such as clots and other obstructing material.
  • Vascular catheters by means of which it is possible to pass through the blood vessels from an insertion point to a section of vessel on which it is desired to operate are wel ! known in the medical field.
  • catheters used to remove embol isms (embolectomies) and similar obstructions in a blood vessel are known.
  • the access route to the vessel may be surgical ( in the overwhelming majority of cases this is the treatment of primary intent) or via mini -invasive percutaneous access without surgical incisions.
  • surgical embo!ectomy comprises a surgical incision in the vicinity of the area which must be treated (for example a lower l imb or upper l imb ). T he surgeon then proceeds to isolate the vessel requiring treatment by separati ng it I rom the overlying cuianeous and subcutaneous layers and then from the fascial and muscular 1 avers above and beneath the vessel. He then proceeds to make an incision in the vessel and introduces a small balloon catheter (Fogarty catheter ) into it. When the Fogarty catheter has passed beyond the embolism, the bal loon is inflated and drawn back towards the access point . In this way the fresh clot is removed owing to the mechanical action of the bal loon.
  • Fogarty catheter Fogarty catheter
  • the procedure via the percutaneous route instead requires only local anaesthesia, w ithout any superficial or deep surgical incisions, drastically reducing the risk of local vascular, infection and scarring complications.
  • the procedure normally comprises access to the vascular system via a first needle which i s used to puncture the skin and the subcutaneous layers down to the selected blood vessel (for example an artery).
  • a guide wire which is used to sl idably guide a device known as an introducer comprising a hollow cannula and a fascial di lator projecting from the distal end of the cannula with a tapering tip, is introduced into the vessel through the needle, which is then removed.
  • the fascia! dilator slides on the guide wire and is used to widen the passage through the tissues, following the guide wire so as to move the introducer inside the vessel together with the distal end which is positioned axially w ithin the vessel.
  • the introducer may be of variable length and is moved within the vessel by the operator to a predetermined point. After the di lator has been removed, via the lumen of the introducer (provided with a suitable valve at the proximal end ) a eatheter is inserted inside the vessel and slid to the vessel section which must be operated on.
  • a eatheter is inserted inside the vessel and slid to the vessel section which must be operated on.
  • the mini-invasive percutaneous approach offers undoubted advantages, but also includes some limitations when accessing the blood vessel, which often leads surgeons to prefer the surgical approach, even though it is more complex and in some respects more risky.
  • the main obstacle is that because of the percutaneous access there are limitations on the maximum diameter of the instruments which can be inserted.
  • the catheter will be selected from various possible types.
  • US 4,729,763 describes a catheter comprising two concentric tubes, with the inner tube rotating axiallv to drive a mi ll at the distal end of the catheter.
  • Thi s catheter is relatively large and a surgical operation is required in order to introduce it into the blood vessel that is to be treated.
  • US 4.61 0.662 describes a treatment catheter which is inserted into a guide catheter coaxial ly.
  • the treatment catheter comprises two inflatable bal loons located at the distal end of the catheter to trap and isolate the obstructing material in the section between the balloons.
  • Ducts present in the catheter allow liquid to be circulated in the isolated section between the balloons with a view to attempting to dissolve and remove the obstructing material in small steps.
  • the lumen of the catheter may thus be smal l, but the guide catheter must necessarily have a relatively large diameter because of the structure required to isolate the stenosis, and for circulation of the liquid.
  • US 2009/0.054.91 8 describes a removal catheter constructed to have a smal l diameter with a form-memory wire which slides axiallv within the catheter so as to exit with its tip from the distal end of the catheter and contract in the form of one or two coils when suitable energy is applied, in this way the end of the wire can move the clot by dragging it towards the outlet when the entire catheter is withdrawn, in one of the embodiments described tiie catheter has a distal end which can enlarge under control so as to trap the clot within it together with the expanded end of the wire, livery time anything is removed the whole catheter must be taken out to remove the clot trapped in the tip before it is possible to perform a second pass i f necessary.
  • US 5.01 1 .488 describes a catheter comprising three concentric flexible tubes.
  • the intermediate tube has a distal end which opens against a spring when it leaves the distal end of the outer tube.
  • the innermost tube instead has an inflatable bal loon at its distal end.
  • the catheter can be introduced by means of a percutaneous introducer and pushed as far as the region of the clot which must be removed.
  • the intermediate tube is then moved forward so that it projects and opens its end in the manner of a funnel, and the innermost tube is pushed beyond the clot and then inflated.
  • By withdrawing the innermost tube the clot is drawn in towards the open end of the intermediate lube by the balloon and is trapped.
  • US 5, 1 02,41 5 describes a device comprising three concentric catheters - the outermost acts as an introducer and into this there is inserted an intermediate catheter provided with a distal end which can be controllabiv expanded into a funnel shape.
  • the innermost catheter instead has a distal end on which a balloon can be inflated to draw the embolism which is to be removed into the expanded funnel-shaped end of the intermediate catheter.
  • the external catheter protects the expandable lip as far as the region where the clot to be removed is located.
  • the external catheter which acts as an introducer does however l imit the diameter of the intermediate catheter and the lumen of the passage w 7 ilhin it.
  • the general object of this invention is to provide a more satisfactory system for percutaneous introduction into a duct of the body and a system for removing material from a duct (for example clots in a blood vessel ) which is simpler, faster and more efficient.
  • FIG. 1 shows a diagrammatic view- in partial cross-section of an introducer device according to the invention
  • FIG. 2 shows a diagrammatic view of a distal end of the introducer in Figure 1 close to the area of entry into a duct, for example a blood vessel;
  • FIG. 3 and 4 show diagrammatic views of the distal end of the introducer according to the invention close to the material to be removed (for example a clot) and during removal of the material respectively;
  • FIG. 5 shows a diagrammatic view in transverse cross-section (along the l ine V-V in Figure 4) o f a possible embodiment of the distal end of an introducer according to the invention
  • FIG. 8 and 9 show diagrammatic perspective view s of a further possible embodiment of the distal end of an introducer according to the invention in the closed and open condition respectively.
  • Figure 1 illustrates an introducer device according to the invention generically indicated by 1 0, comprising an outermost cannula or tube 1 1 with a distal end 1 2 that is intended to be introduced into a duct in the body (for example in particular a blood vessel ) through percutaneous access, as will be clear below.
  • the device may vary in length according to need (for example it may have a length of between 1 0 and 90 cm).
  • the introducer will be of cyl indrical shape so that it can be introduced into ducts such as an artery, like a conventional vascular introducer.
  • the introducer will have the generic structure of a tubular body which is substantially known to match the path within the ducts without crushing.
  • it may have a core of variable/resilient shape made of a suitable known material (e.g. nitinol) and covered with a known resilient biocompatible and noivthrombogenic material (e.g. PVA. PIPE, etc.).
  • the introducer comprises a body 1 9 which is useful for gripping and manoeuvring and which is provided with an axial passage 20 towards the tube 1 1 .
  • the passage 20 is lilted with a known lcaktight passage valve element 1 4 (for example with a pierced resi lient membrane) to avoid the loss of fluid to the exterior once the introducer has been inserted in the duct of the body, but which allows the introduction of catheters and instruments through the passage 36 and into the lumen of the introducer.
  • the introducer also comprises a fascial di lator 1 3 which is axially inserted into the cannula 1 1 through the passage of the valve element 1 4 present at the proximal end 1 5 of the device.
  • the fascial dilator is constructed so as to slide (preferably with minimum play) within the tube 1 1 and project from the distal end 1 2 with its tapering end 1 6.
  • the fascial dilator 1 3 advantageously has an axial passage so that it can slide on a guide wire 1 7.
  • the distal end 1 2 o f the introducer can be controllably di lated so as to pass from its closed rest condition to a radially expanded condition, advantageously of conical shape with a distal base.
  • the tip In the closed condition the tip preferably has a diameter which is substantially the same as the diameter of the cannula so that it substantial ly adopts the shape of a cyl i nder, such that the introducer can be introduced, retracted and removed without trauma.
  • the (manual) control device for the movement is arranged so that it can be operated from the exterior once the introducer has been placed in position.
  • this control device comprises operating means 1 8 located at the proximal end 1 5 ( preferably on the body 1 9 or connected to the body 1 9), as will be clearly apparent below.
  • the distal end 1 5 may also comprise a connector 35 which is connected to the lumen of the cannula 1 1 and to which a flexible tube 36 for the introduction, where necessary, of l iquids into a blood vessel/duct is connected.
  • the device according to the invention which is suitable for percutaneous introduction into a blood vessel .
  • the principles of the invention can be adapted to other ducts in the body (such as for example the bi le ducts, those in the urinary system, the ducts in the digestive system, etc .).
  • Figure 2 shows a diagrammatic illustration of percutaneous entry of the introducer into a blood vessel 21 .
  • the insertion manoeuvres may be the same as those performed with an introducer of the known art and will not therefore be described and il l ustrated in detail here, as they can be easily imagined by those skil led in the art.
  • the tube 1 1 of the introducer is the outermost element of the device, in direct contact with the walls of the passage in the patient's body and the interior of the blood vessel.
  • a needle (not show n) may be fi rst introduced until it is inserted into the vessel 21 and the guide wire 1 7 can be inserted into the blood vessel/duct through this needle.
  • the introducer complete with the fascial di lator may ⁇ be slid along guide wire 1 7.
  • the introducer penetrates the subcutaneous, fascial and muscular tissues perculaneously and then enters the blood vessel/duct.
  • the introducer complete with di lator is made of a sufficiently ilexible material for it to be able to follow the wire and position itself with the end of the tip parallel to the axis of the vessel .
  • FIG. 3 shows the introducer with its distal end (after the fascial dilator has been removed) lying c lose to material 22 which has to be removed (for example a clot).
  • the distal end is set to its radially dilated condition (show in dashed l ines in Figure 3 ) so that the edge of its free end is close to the walls of the vessel and forms a kind of funnel which will intercept the material which will be removed.
  • the device may advantageously comprise a sl iding element ( indicated diagrammatically by a line at 35 ) with an expandable end 23.
  • this sliding element may be a suitable catheter which is in itself known. The element is introduced via the introducer until it passes beyond the material which has to be removed and when expanded can be drawn back within the lumen of the introducer, pull ing the material along the entire length of the introducer to the proximal end until i t comes out of the leaktight valve 14 (which may be designed with a known screw mechanism so that it can be unscrewed and screwed up again and thus allow the obstructing material to leave the introducer freely). It is thus possible to perform for example several cleaning operations and/or introduce sequentially other types of catheters or instruments without having to remove the introducer.
  • the expandable end 23 wil l advantageously be selected from a type which is capable of being sufficiently compressible, even when in the expanded or partly expanded condition, so as to deform as the material passes into the funnel-shaped end 1 2 and so that it can travel along the introducer to the proximal exit. In this way it can carry the clot through the introducer to the exterior, minimising the risk of loss of the material which has to be removed along (he way.
  • the funnel shape of the distal end of the introducer assists insertion and compression of the part 23 inside the lumen of the introducer.
  • the element 35 with expandable end is a "Fogarly type” balloon catheter.
  • this type of catheter is used for surgical embolectomy. but thanks to the innovative characteristics of the introducer according to the invention it may also be advantageously used percutaneously (when for example it is decided to use the abovementioned Fogarty catheter sliding on a guide wi re ).
  • the balloon 23 is placed in a position beyond the material or clot 22. passing through introducer and material 22 in the unintlated state, then being inflated so that the material is confined between the balloon and the funnel of the expanded distal end 1 2. Retraction of the balloon along the introducer draws the material to the exit 1 5. again as il lustrated in Figure 4.
  • the distal end 1 2 may be returned to its rest condition and the introducer can finally be removed from the duct.
  • a known haemostatic procedure may then also be applied if this is necessary or appropriate.
  • Figure 5 shows a possible structure of end 1 2 which permits movement between its two conditions.
  • This structure advantageously comprises a plurality of fingers or blades 24 extending longitudinally at the distal end of the introducer.
  • the fingers may advantageously comprise a form-memory material such as nilinol.
  • a flexible membrane 25 with a resilience and/or a size selected so that end 1 2 can expand between the closed cond ition and the expanded condition in an "umbrella" movement, as is clear from Figure 5.
  • Use o f the membrane allows the tip 1 2 to safely intercept the material which is to be removed also avoiding the latter becoming lodged between the open blades.
  • the membrane may for example be of made PTFE. a porous and strong material, or the l ike.
  • the membranes When the device is in its closed state the membranes advantageously fold inw ards.
  • the mechanism for opening/closing the tip may be constructed in various ways.
  • FIG. 6 an embodiment operated by a pull-wire is il lustrated diagrammatical ly.
  • the lingers are constructed so as to open resilientiy towards the cone condilion, preferably as a result of their natural resil ience.
  • a loop 26 of suitable wire is arranged circumferential))' on the fingers.
  • suitable passages and/or grooves may be provided to prevent the loop from sliding along the axis of the introducer.
  • a pull-wire 27 extends, advantageously within a passage made withi n the thickness of the wall of the introducer, as far as the device 1 8 (for example comprising a simple handle for pulling the pull-wire).
  • a known Socking system may advantageously be provided in the device 1 8. so that it is possible to keep the pull-wire under tension and the end 1 2 is in the rest condition shown in Figure 3 during the operations of introducing, moving and extracting the introducer.
  • Figure 7 shows a second possible embodiment of the mechanism for moving the end 1 2.
  • a fluid system is used to inflate the distal end into its expanded condition.
  • an inflatable chamber placed in the distal end w hich expands the distal end radially on command is advantageously provided.
  • This inflatable chamber is advantageously shaped in the manner of an in flatable ring 28 located coaxial ly on the end 1 2.
  • the end preferably again comprises lingers 24 (for example agai n made of nitinol ) constructed so that they are normally resilient!y pushed into the closed-up rest condition (for example as a result of their natural resi l ience) when the ring 28 is deflated.
  • lingers 24 for example agai n made of nitinol
  • inflating the ring increases the d iameter in such a way that it moves the edge of the distal end away (and in particular the extremities of the fingers, if present) and produces the conical shape of the funnel .
  • the end 12 of the introducer returns to its cylindrical rest condition.
  • the membranes for closing off the space between the open fingers may be present between lingers 24.
  • the ring can be inflated and deflated by means of a condui t 29 w hich is advantageousl y made in the thickness of the wall of the introducer and extends as far as device 1 8. which is constructed as an inflation/deflation system (for example comprising a simple known small pump with a deactivalable one-way valve or a known syringe system ).
  • the ring is inflated or deflated by the operating device 1 8.
  • the deflating operation may also possibly comprise a suction force.
  • Advantageously inflation may take place using a physiological solution as fluid.
  • Figure 8 shows a third possible embodiment of the mechanism for moving the end 12.
  • the expandable end 1 2 comprises a foil element 30 wound along the axis of the introducer in tube form.
  • An edge 3 1 of the foil may be pushed in a direction (advantageously substantially axially to the extension of the tip ) so as to move the overlapping lateral edges of the foil in such a way that it is arranged from the cylindrieally rolled form into a conically rolled form, as is clear from Figure 9.
  • a resilient force acts on the foi l element so as to press it towards the conical condition in Figure 9. while a pull-wire 33 (similar to pull-wire 27 in Figure 6 ) can be operated to draw the tip back against the resilient force into the condition in Figure 8.
  • the resilient force which pushes towards the condition in Figure 9 may be for example provided by means of a spring 32.
  • a resilient force produced by foil 30 may also be used direct! ⁇ ' instead of the spring.
  • the foi l may be formed w ith a resilient and suitably shaped thin sheet of suitable material (such as nitinol ).
  • the pul l-wire may also be constructed using a wire which is sufficiently axially rigid so that it can be used to both push and pull. In this case the resilient action on the foi l may no longer be necessary.
  • a membrane (not shown) which seals the spaces for sliding of the foil sides may also be provided so as to prevent the clot formation from entering the sliding spaces during pulling inside the device.
  • the introducer with the innovative capacity to widen progressively from the distal end and thus come into contact with the walls of a duct, in the body, adopting a cone/funnel shape, allows for example the use of a " Fogarty on guide" type balloon catheter, ' i his balloon catheter may channel the material to be removed within the i nnovative introducer and therefore remove it wholly outside, even in several passes, without unnecessarily stressing the site of percutaneous insertion.
  • the appl ications of the device according to the invention are not l imited to the removal of clots but, owing to the innovative funnel concept, the device may be used for other purposes (such as the treatment of pre-angioplasty and pre-stenting arterial stenoses, the removal of foreign bodies, or the like) and be used in other ducts in the human body - for example in the system of the liver's bile ducts, for the removal of fonnations within the ducts such as calculi or removable stents, or in the urinary system in ducts such as the renal pelvis, the ureter and the bladder, and again in the ducts and conduits of the digestive system.
  • the device may be used for other purposes (such as the treatment of pre-angioplasty and pre-stenting arterial stenoses, the removal of foreign bodies, or the like) and be used in other ducts in the human body - for example in the system of the liver's bile ducts, for the removal of fonn
  • the device to which the invention relates offers another important aid and characteristic as a result of the funnel-shaped opening of the introducer.
  • the walls of the distal end of the introducer may be dimensioned so as to come into contact with the walls of the duct in which it is placed ( venous or arterial blood vessel, bile duct, duct in the urinary system, etc. ) .
  • Contact with the wal l of the duct makes it possible to slow the passage of fluids in the duct, in particular, contact with the wall of a vessel, for example an arterial vessel, significantly reduces the passage of blood beyond the introducer.
  • This special feature offers for example the advantage of being able to carry out all the stages of removal (of a clot for example) with virtual blockage of the flow, significantly reducing the risk of the migration of micro-embol isms and embolisms carried into more distal vessels by the blood flow.
  • drugs may be administered through the introducer itself in order to achieve a high concentration and selectivity o f the drug in the area of the vessel/duct undergoing treatment.
  • a thrombolytic/fibrinolytic drug may for example be injected into the area between the distal end of the introducer with an open tip and the removing device (in particular the Fogartv balloon inflated downstream of the clot formation ). I n this condition the thrombolytic drug may act in high concentrations within the vessel in which the clot has formed, reducing systemic dispersion of the thrombolytic drug, as well as possible systemic complications associated therewith.
  • the device according to the invention there is better selective treatment of the pathological section of the duct, fewer complications at the access site, fewer infectious complications, shorter hospitalisation times for the healing of wounds, fewer surgical complications in general, increased selectivity of treatment, increased control i n handl ing of the removal system, with the possibility of visualising and monitoring it over its entire path, and the possibility of also approaching smal l ducts and vessels ⁇ for example the distal vessels of the leg or the forearm) and more tortuous vessels (e.g. the anterior tibial, the splachnic vessels, etc.).
  • tortuous vessels e.g. the anterior tibial, the splachnic vessels, etc.
  • an inner space which is greater than what is normal when in the closed condition may be occupied in its distal part (for example because of the folded membranes and/or the opening/closing mechanisms).
  • the fascial dilator may be thinner (for example hol!owed-out) in its distal part corresponding to the distal section of the opening funnel (as shown diagrammatical ! ⁇ ' in dashed l ines with 37 in Figure 1 ) so as to leave space within the introducer for parts o f the end 1 2 in the rest condition (in particular for the membranes).
  • a hol lovved-oui form of the dilator before its conicallv tapered part may also be useful for axially constraining the fascial dilator to the introducer until the moment when the conical end of the introducer is opened.

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Abstract

L'invention concerne un dispositif introducteur (10) pour l'introduction percutanée dans des vaisseaux sanguins et d'autres conduits dans le corps, qui comprend un tube plus à l'extérieur (11) ayant une extrémité distale (12) destinée à entrer de manière percutanée et en glissant à l'intérieur d'un conduit, et une extrémité proximale (15) pourvue d'un élément de valve (14) avec un passage axial étanche aux fuites (20). Le tube externe héberge de manière amovible un dilatateur aponévrotique (13) inséré de manière axiale dans le tube (11) par le passage de l'élément de la valve de manière à faire saillie à partir de l'extrémité distale (12) avec l'extrémité effilée (16). L'extrémité distale (12) peut être bougée de manière contrôlable entre une condition de repos et une condition de dilatation radiale de manière à former un entonnoir contre les parois du récipient. Avantageusement, un élément avec une extrémité dilatable (avantageusement un cathéter à ballonnet de type "Fogarty") peut glisser à l'intérieur du tube (11) et être utilisé pour éliminer un matériau présent dans le conduit (comme un caillot, des corps étrangers, des calculs, des matériaux d'obstruction) en l'aspirant le long du tube (11) et en dehors de son extrémité proximale.
PCT/IB2014/061374 2013-05-20 2014-05-12 Dispositif de gaine introductrice avec extrémité dilatable Ceased WO2014188300A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
ITMI2013A000816 2013-05-20
IT000816A ITMI20130816A1 (it) 2013-05-20 2013-05-20 Dispositivo introduttore con estremita' espandibile

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WO2014188300A1 true WO2014188300A1 (fr) 2014-11-27

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CN109152585A (zh) * 2016-03-04 2019-01-04 万肖蓬 负压吸引鞘
CN112057729A (zh) * 2015-07-13 2020-12-11 Cti血管公司 用于治疗血管和非血管疾病的机械驱动且可功能集成的导管系统
CN112717269A (zh) * 2021-01-07 2021-04-30 上海翰凌医疗器械有限公司 血管鞘装置、血管鞘装置与预扩张器的配合结构
CN113143346A (zh) * 2020-07-08 2021-07-23 郑州大学第一附属医院 人体腔道多功能抗折活检鞘套装
US11351346B2 (en) 2017-10-24 2022-06-07 Venkat Tummala Balloon sheath and associated methods
US11622781B2 (en) 2020-01-30 2023-04-11 Julier Medical AG Apparatus and method for neurovascular endoluminal intervention
EP4115935A3 (fr) * 2021-06-14 2023-04-12 Neuravi Limited Cathéter à pointe évasée en polymère extensible et ses procédés de fabrication
US11633198B2 (en) 2020-03-05 2023-04-25 Neuravi Limited Catheter proximal joint
US11737767B2 (en) 2022-01-21 2023-08-29 Julier Medical AG Neurovascular catheter and method of use
US11759217B2 (en) 2020-04-07 2023-09-19 Neuravi Limited Catheter tubular support
US11779364B2 (en) 2019-11-27 2023-10-10 Neuravi Limited Actuated expandable mouth thrombectomy catheter
US11839725B2 (en) 2019-11-27 2023-12-12 Neuravi Limited Clot retrieval device with outer sheath and inner catheter
US11872354B2 (en) 2021-02-24 2024-01-16 Neuravi Limited Flexible catheter shaft frame with seam
US11883043B2 (en) 2020-03-31 2024-01-30 DePuy Synthes Products, Inc. Catheter funnel extension
US11937839B2 (en) 2021-09-28 2024-03-26 Neuravi Limited Catheter with electrically actuated expandable mouth
US11944333B2 (en) 2014-06-30 2024-04-02 Neuravi Limited System for removing a clot from a blood vessel
US11944327B2 (en) 2020-03-05 2024-04-02 Neuravi Limited Expandable mouth aspirating clot retrieval catheter
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US11944333B2 (en) 2014-06-30 2024-04-02 Neuravi Limited System for removing a clot from a blood vessel
CN112057729A (zh) * 2015-07-13 2020-12-11 Cti血管公司 用于治疗血管和非血管疾病的机械驱动且可功能集成的导管系统
US12171962B2 (en) 2015-07-13 2024-12-24 Biotronik Ag Mechanically actuated and functionally integratable catheter system for treating vascular and non-vascular diseases and related methods
CN109152585A (zh) * 2016-03-04 2019-01-04 万肖蓬 负压吸引鞘
US11351346B2 (en) 2017-10-24 2022-06-07 Venkat Tummala Balloon sheath and associated methods
US11969180B2 (en) 2019-03-04 2024-04-30 Neuravi Limited Actuated clot retrieval catheter
US12029864B2 (en) 2019-09-11 2024-07-09 Neuravi Limited Expandable mouth catheter
US11779364B2 (en) 2019-11-27 2023-10-10 Neuravi Limited Actuated expandable mouth thrombectomy catheter
US11839725B2 (en) 2019-11-27 2023-12-12 Neuravi Limited Clot retrieval device with outer sheath and inner catheter
US11622781B2 (en) 2020-01-30 2023-04-11 Julier Medical AG Apparatus and method for neurovascular endoluminal intervention
US11911057B2 (en) 2020-01-30 2024-02-27 Julier Medical AG Catheter apparatus and methods for endoluminal intervention
US11766272B2 (en) 2020-01-30 2023-09-26 Julier Medical AG Apparatus and methods for neurovascular endoluminal intervention
US11633198B2 (en) 2020-03-05 2023-04-25 Neuravi Limited Catheter proximal joint
US11944327B2 (en) 2020-03-05 2024-04-02 Neuravi Limited Expandable mouth aspirating clot retrieval catheter
US11883043B2 (en) 2020-03-31 2024-01-30 DePuy Synthes Products, Inc. Catheter funnel extension
US11759217B2 (en) 2020-04-07 2023-09-19 Neuravi Limited Catheter tubular support
CN113143346B (zh) * 2020-07-08 2023-09-05 郑州大学第一附属医院 人体腔道多功能抗折活检鞘套装
CN113143346A (zh) * 2020-07-08 2021-07-23 郑州大学第一附属医院 人体腔道多功能抗折活检鞘套装
CN112717269A (zh) * 2021-01-07 2021-04-30 上海翰凌医疗器械有限公司 血管鞘装置、血管鞘装置与预扩张器的配合结构
US11872354B2 (en) 2021-02-24 2024-01-16 Neuravi Limited Flexible catheter shaft frame with seam
EP4115935A3 (fr) * 2021-06-14 2023-04-12 Neuravi Limited Cathéter à pointe évasée en polymère extensible et ses procédés de fabrication
US11937839B2 (en) 2021-09-28 2024-03-26 Neuravi Limited Catheter with electrically actuated expandable mouth
US12011186B2 (en) 2021-10-28 2024-06-18 Neuravi Limited Bevel tip expandable mouth catheter with reinforcing ring
US11737767B2 (en) 2022-01-21 2023-08-29 Julier Medical AG Neurovascular catheter and method of use
US12004758B2 (en) 2022-01-21 2024-06-11 Julier Medical AG Catheter for accessing the vasculature including the neurovasculature, and methods of use

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