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WO2023223370A1 - Simulateur de mouvement d'artère coronaire et modèle de vaisseau sanguin - Google Patents

Simulateur de mouvement d'artère coronaire et modèle de vaisseau sanguin Download PDF

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Publication number
WO2023223370A1
WO2023223370A1 PCT/JP2022/020300 JP2022020300W WO2023223370A1 WO 2023223370 A1 WO2023223370 A1 WO 2023223370A1 JP 2022020300 W JP2022020300 W JP 2022020300W WO 2023223370 A1 WO2023223370 A1 WO 2023223370A1
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WO
WIPO (PCT)
Prior art keywords
coronary artery
blood vessel
model
motion simulator
vessel model
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/JP2022/020300
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English (en)
Japanese (ja)
Inventor
清隆 岩▲崎▼
洪澤 陸
紀香 北場
誉之 岡村
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Waseda University
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Waseda University
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Publication date
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Priority to PCT/JP2022/020300 priority Critical patent/WO2023223370A1/fr
Priority to JP2024521387A priority patent/JPWO2023223370A1/ja
Publication of WO2023223370A1 publication Critical patent/WO2023223370A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • G—PHYSICS
    • G09—EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09B—EDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B23/00—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes
    • G09B23/28—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine
    • G—PHYSICS
    • G09—EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09B—EDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B9/00—Simulators for teaching or training purposes

Definitions

  • the present invention relates to a coronary artery motion simulator that simulates the movement of coronary arteries associated with heart beats, and a blood vessel model used therein.
  • Coronary arteries are blood vessels that send blood to the surface of the heart in order to move the myocardium, and are made up of two branches, the left and right coronary arteries, which branch from the root of the aorta to the left and right.
  • the left coronary artery is a very important blood vessel that supplies blood containing oxygen and nutrients to move the left ventricular myocardium, which plays a role in pumping blood throughout the body.
  • This left coronary artery along the way from the main trunk (LMT: Left main truck) that connects to the aorta, has an anterior descending artery (LAD: Left anterior descending coronary artery) and a circumflex artery (LCx: Left circumflex artery). flex coronary artery).
  • the anterior descending artery is primarily responsible for supplying blood to the anterior wall of the left ventricle and the myocardial septum, and the circumflex artery (LCx) is responsible for supplying blood from the lateral wall to the posterior wall of the left ventricle.
  • LAD anterior descending artery
  • LCx circumflex artery
  • the main treatments for ischemic heart disease include drug therapy, coronary artery bypass surgery, which involves creating a detour blood vessel before and after the narrowing, and percutaneous coronary angioplasty using a catheter.
  • coronary artery bypass surgery which involves creating a detour blood vessel before and after the narrowing
  • percutaneous coronary angioplasty using a catheter are known.
  • Coronary artery intervention using a stent is one type of percutaneous coronary angioplasty.
  • a metal mesh stent crimped onto a thin polymer film balloon is inserted through a blood vessel at the base of the thigh or wrist using a catheter.
  • the stenotic lesion is expanded by the stent and compressed into the blood vessel, ensuring blood flow.
  • left main branch branch lesion is a condition in which stenosis or occlusion occurs in the blood vessels at the base of the anterior descending artery (LAD) and circumflex artery (LCx), which branch from the main trunk (LMT).
  • LAD anterior descending artery
  • LCx circumflex artery
  • LMT main trunk
  • stent treatment for lesions at the main bifurcation of the left coronary artery has poor long-term results, and many clinical techniques are being considered to improve treatment results.
  • advances in drug-eluting stents have improved treatment outcomes, and coronary artery intervention has become acceptable for the treatment of relatively simple left main coronary artery bifurcation lesions that can be treated with a single stent. became.
  • Clinical treatment of the main branch of the left coronary artery is performed while the heart is beating, so it is difficult to identify the structure of the stent within the coronary artery on an X-ray fluoroscopic screen.
  • the anterior descending artery (LAD) and circumflex artery (LCx) may appear to overlap due to the limited movement of the X-ray angiography equipment used in conjunction with the X-ray angiography system. Treatment is performed while observing from a substitute perspective that reduces the length of the .
  • the present inventors have previously conducted research and development on stent treatment methods using an elastic blood vessel model that imitates the diameter and angle of the main branch branch vessel of the left coronary artery, and research on stent selection using the blood vessel model. (Refer to Non-Patent Document 1).
  • the present invention was devised based on the above-mentioned problems and the knowledge of the inventor, and its purpose is to create a system with a relatively simple structure that simulates a coronary artery that moves with the heartbeat.
  • the object of the present invention is to provide a coronary artery motion simulator and a blood vessel model that can test and evaluate medical devices such as stents and treatment methods.
  • the present invention mainly provides a coronary artery movement simulator that simulates the movement of a coronary artery associated with heart beats, which includes a blood vessel model that simulates a predetermined portion of the coronary artery, and a blood vessel model that supports the blood vessel model.
  • a model support unit holds the blood vessel model arranged at an angle with respect to its installation surface so as to be rotatable along a predetermined plane, and repeatedly performs the rotation motion in forward and reverse directions. Thereby, the displacement state of the blood vessel model accompanying the pulsation can be simulated.
  • the present invention it is possible to simulate the movement of coronary arteries associated with contraction and expansion of a patient's heart using a simple mechanism and a simple drive system, and it is possible to more effectively treat coronary arteries in an environment that matches actual clinical conditions than before. This makes it possible to evaluate safety and safety.
  • FIG. 2 is a conceptual diagram of the coronary artery motion simulator according to the present embodiment in a side view.
  • FIG. 3 is a schematic front view of a simulated blood vessel unit.
  • FIG. 2 is a schematic side view of a simulated blood vessel unit.
  • FIG. 3 is a schematic plan view of the movable device. It is a schematic perspective view of a support body.
  • FIG. 3 is a schematic perspective view of the fixing portion viewed from the top side.
  • FIG. 3 is a schematic front view of the fixing part.
  • FIG. 3 is a schematic perspective view of the operating section viewed from the back side.
  • FIG. 3 is a schematic front view of the operating section.
  • FIG. 5 is a schematic plan view of the movable device for explaining a state in which the operating section rotates from the state shown in FIG. 4;
  • FIG. 1 shows a conceptual diagram of the coronary artery motion simulator according to the present embodiment in a side view.
  • the coronary artery motion simulator 10 supports a simulated blood vessel unit 11 including a part simulating the left main trunk branch of the coronary artery, which is a predetermined part of the coronary artery, and supports the simulated blood vessel unit 11.
  • the model support unit 12 is configured to be able to simulate the operation of the left coronary artery main trunk branch.
  • the simulated blood vessel unit 11 includes a Y-shaped blood vessel model 14 in a plan view that simulates a blood vessel near the main branch of the left coronary artery, and a blood vessel model 14 that is integrally fixed. It consists of a block-shaped base 15.
  • the blood vessel model 14 is formed into an elastic tube shape from a material such as silicone, and has an elliptical cross section (lumen cross section) perpendicular to the direction in which the blood vessel extends in its inner lumen.
  • This blood vessel model 14 has a main part 14A corresponding to the main trunk (LMT) of the left coronary artery, and branches from the main part 14A to correspond to the anterior descending artery (LAD) and circumflex artery (LCx) of the left coronary artery. It consists of branch parts 14B and 14C. Note that the intersection of the blood vessel axes of the main portion 14A and the branch portions 14B and 14C is referred to as a branch center 14D.
  • the branch portions 14B and 14C branch into two branches from the main portion 14A in a plan view of FIG. 2, and are arranged so as to be bent from a branch center 14D with respect to the main portion 14A in a side view of FIG. Therefore, the blood vessel model 14 has a three-dimensional shape in which the blood vessel portion extends three-dimensionally.
  • the ends of the main part 14A and the branch parts 14B and 14C are connected to another tube, and a part of the test circuit filled with liquid etc. will be placed in
  • the base 15 has a bent shape corresponding to the bent state of the blood vessel model 14, and a part of the surface of the blood vessel model 14 is embedded therein.
  • the part where the main part 14A is buried becomes a mounting part 15A that is attached to the model support unit 12.
  • the model support unit 12 has a structure capable of simulating the displacement and rotational conditions of the coronary arteries associated with heart beats. As shown in FIG. 1, this model support unit 12 includes a tilting table 17 installed on a predetermined installation surface B, and a tilting arrangement placed on the top surface of the tilting table 17, and holding the simulated blood vessel unit 11.
  • the movable device 18 has a mechanism for performing rotational operation in the state.
  • the inclined table 17 is arranged at a predetermined inclination angle (for example, 35 degrees) from the distal end side of the installed part 20, which is the left side in FIG. It consists of a flat plate-shaped inclined surface part 21 that is arranged to be inclined upward in the figure toward the right side in the figure, and a side part 22 that stands up from the right end of the installation part 20 in the figure and supports the inclined surface part 21 from below. .
  • a predetermined inclination angle for example, 35 degrees
  • the movable device 18 has a structure capable of simulating the displacement of the blood vessel model 14 due to heart beats by rotating the simulated blood vessel unit 11 while being fixed to the inclined surface portion 21 of the inclined table 17. There is.
  • this movable device 18 includes a support body 24 that is configured to be able to perform a predetermined rotational movement while supporting the simulated blood vessel unit 11, and a drive device 25 that operates the support body 24. It is equipped with
  • the support body 24 includes a fixing portion 27 located at the lower side in the figure and fixed to the inclined table 17 (see FIG. 1), and a surface (predetermined surface) of the fixing portion 27.
  • the operating part 28 is connected to the fixed part 27 so as to be relatively rotatable along the movement axis.
  • the fixing section 27 includes a substantially rectangular plate-shaped main body 30 whose back surface is fixed to the inclined surface section 21 (see FIG. 1) with screws (not shown), and an inclined surface section.
  • the rail 31 protrudes near the center of the upper surface of the main body 30 opposite to the rail 31 and extends in an arc shape.
  • the operating section 28 includes a pedestal 33 having a substantially rectangular plate shape, and is arranged upright on the upper surface of the pedestal 33, and also includes a pedestal 33 having a substantially rectangular plate shape. ), a guide 35 protruding from the lower surface of the pedestal 33, and a drive device 25 (see FIG. 1, etc.) standing up from the outer edge of one corner on the upper surface of the pedestal 33. It is provided with a connecting part 36 to be connected.
  • the model holding parts 34 have the same trapezoidal shape when viewed from the side and are arranged in parallel in the same direction.
  • Each model holding section 34 is arranged such that the upper mounting surface 34A is inclined vertically at a predetermined inclination angle with respect to the upper surface of the pedestal 33.
  • a base 15 (see FIG. 1, etc.) is detachably attached using screws (not shown) or the like.
  • the blood vessel model 14 is arranged facing the pedestal 33, as shown in FIGS. 1 and 4.
  • the model holding section 34 is fixed to the pedestal 33 in an oblique direction so that the back surface 34B, which is the short side thereof, faces the direction of the connecting section 36.
  • the arrangement angle in plan view between the axis of the main part 14A of the attached blood vessel model 14 and the reference edge 33A (reference line) of the pedestal 33 is set at a predetermined angle. value (for example, 33 degrees).
  • the pedestal 33 is arranged such that the reference edge 33A runs along the inclination direction of the inclined surface portion 21 (see FIG. 1).
  • the guide 35 is made up of two large and small arc-shaped members arranged apart from each other with different diameters from the same center, and a fixed part is provided in the space S between these arc-shaped members. 27 rails 31 (see FIG. 6) are fitted together. Further, the guide 35 is capable of sliding along the rail 31, and due to the sliding, the surface of the main body 30 of the fixed part 27 is rotated about the center of the guide 35, as shown in FIG. The operating section 28 can be rotated along. As a result, the model holding section 34 and the simulated blood vessel unit 11 rotate with respect to the fixed section 27 together with the pedestal 33 .
  • the shape and position of the rail 31 and the guide 35 are set to enable rotational oscillation that reciprocates the branch center 14D of the blood vessel model 14 attached to the model holder 34 within a predetermined angular range and movement amount range.
  • Ru a range of a predetermined rotation angle (for example, 7.4 degrees) and a range of a predetermined movement amount (for example, 3.7 mm) from the initial position.
  • the blood vessel model 14 is set to rotate and swing along the surface of the fixed part 27.
  • the drive device 25 includes an actuator 38 that applies an external force to the support 24, and a control section 39 that includes a computer that controls the operation of the actuator 38.
  • the actuator 38 is a linear actuator capable of linear reciprocating motion using a motor, and as shown in FIGS. It is connected to a connecting portion 36 near an end remote from the center of rotation of 28. Therefore, by driving the actuator 38, an external force is applied to the base 33 of the operating portion 28 while repeatedly pushing and pulling, thereby causing the operating portion 28 to move relative to the fixed portion 27 while the universal joint 40 is bent. That is, as shown in FIGS. 4 and 10, the actuator 38 reciprocates in one direction, and the operating section 28 rotates in forward and reverse directions along the surface of the main body 30 of the fixing section 27, and the simulated blood vessel unit 11 will swing within a predetermined range.
  • the control unit 39 sets a drive time corresponding to the time from the diastole to the systole of the heart and a predetermined stop so that the blood vessel model 14 is displaced in accordance with the pulsation state of the heart, based on conditions specified by the user.
  • the actuator 38 is driven in the forward direction at the same time, and the actuator 38 is repeatedly driven in a cycle that also includes driving in the opposite direction.
  • the drive time is set in accordance with the assumed heart rate.
  • the inclination angle of the tilting table 17, the inclination angle of the mounting surface 34A of the model holding part 34, and the arrangement angle of the model holding part 34 with respect to the reference edge 33A of the pedestal 33 are determined at the time of actual surgery.
  • the angles are set to match the position and condition of the patient's left main trunk bifurcation.
  • the displacement status of the left main trunk branch of the left coronary artery due to pulsation that is, the movement vector in the displacement direction in the predetermined reference coordinates, and the displacement amount.
  • the rotation amount and the arrangement state at the initial position at the reference time are simulated.
  • reciprocating motion in only one direction is performed without using a device such as a simulated heart that reproduces the motion of the heart in the six-axis directions, which requires a complicated mechanism or drive system.
  • a device such as a simulated heart that reproduces the motion of the heart in the six-axis directions, which requires a complicated mechanism or drive system.
  • the coronary artery motion simulator 10 of the present embodiment makes it possible to evaluate the effectiveness and safety of left coronary artery main branch bifurcation treatment in an environment that matches actual clinical practice.
  • the displacement situation of the left coronary artery main branch is simulated, but the design values of each part of the model support unit 12 can be adjusted as appropriate by using a blood vessel model simulating other coronary artery parts. This allows evaluation at other sites as well.
  • model support unit 12 in the present invention performs various movements of the coronary artery associated with heart beats, that is, displacement movements that imitate the movement vector and displacement amount of the coronary artery, and/or, depending on the region of the target coronary artery.
  • Various structures can be adopted as long as they can simulate a rotational motion that mimics the amount and range of rotation of a coronary artery.
  • each part of the device according to the present invention is not limited to the illustrated configuration example, and various changes can be made as long as substantially the same effect is achieved.
  • Coronary artery motion simulator 11 Simulated blood vessel unit 12 Model support unit 14 Blood vessel model 17 Inclined table 18 Movable device 21 Inclined surface portion 24 Support body 25 Drive device 27 Fixed portion 28 Operating portion 33 Pedestal 34 Model holding portion 38 Actuator 39 Control portion 40 Universal joint

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Abstract

La présente invention est un simulateur de mouvement d'artère coronaire qui simule le mouvement d'une artère coronaire qui se produit en tandem avec le battement cardiaque, et comprend : une unité de vaisseau sanguin simulé (11) comprenant un modèle de vaisseau sanguin (14) qui simule une partie prédéterminée d'une artère coronaire ; et une unité de support de modèle (12) qui supporte l'unité de vaisseau sanguin simulé (11). L'unité de support de modèle (12) est configurée pour maintenir le modèle de vaisseau sanguin (14) qui est disposé de façon à être incliné par rapport à une surface d'installation B de l'unité de support de modèle, d'une manière permettant au modèle de vaisseau sanguin (14) de tourner le long d'une surface prédéterminée, et est configuré de telle sorte que la répétition dudit mouvement rotatif dans les directions avant et arrière permet la simulation de la manière dont le modèle de vaisseau sanguin (14) est déplacé en tandem avec le battement de cœur. L'unité de support de modèle (12) est pourvue : d'une base inclinée (17) installée sur la surface d'installation B ; et d'un dispositif mobile (18) ayant un mécanisme pour effectuer un mouvement rotatif pendant que le modèle de vaisseau sanguin (14) est maintenu. La base inclinée (17) a une partie de surface inclinée (21) disposée à un angle prédéterminé par rapport à la surface d'installation B, et le dispositif mobile (18) est disposé de façon à être incliné le long de la partie de surface inclinée (21).
PCT/JP2022/020300 2022-05-15 2022-05-15 Simulateur de mouvement d'artère coronaire et modèle de vaisseau sanguin Ceased WO2023223370A1 (fr)

Priority Applications (2)

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PCT/JP2022/020300 WO2023223370A1 (fr) 2022-05-15 2022-05-15 Simulateur de mouvement d'artère coronaire et modèle de vaisseau sanguin
JP2024521387A JPWO2023223370A1 (fr) 2022-05-15 2022-05-15

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2009122130A (ja) * 2006-03-03 2009-06-04 Univ Waseda 冠動脈バイパス手術用の訓練評価システム
JP2009133878A (ja) * 2006-03-03 2009-06-18 Univ Waseda 外科手術訓練装置
JP2013083786A (ja) * 2011-10-10 2013-05-09 Nagoya Univ 血管吻合トレーニング装置
JP2019086759A (ja) * 2017-11-07 2019-06-06 豊田合成株式会社 手術訓練装置
JP2020091307A (ja) * 2018-12-03 2020-06-11 朝日インテック株式会社 血管モデル及び臓器シミュレータ

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2009122130A (ja) * 2006-03-03 2009-06-04 Univ Waseda 冠動脈バイパス手術用の訓練評価システム
JP2009133878A (ja) * 2006-03-03 2009-06-18 Univ Waseda 外科手術訓練装置
JP2013083786A (ja) * 2011-10-10 2013-05-09 Nagoya Univ 血管吻合トレーニング装置
JP2019086759A (ja) * 2017-11-07 2019-06-06 豊田合成株式会社 手術訓練装置
JP2020091307A (ja) * 2018-12-03 2020-06-11 朝日インテック株式会社 血管モデル及び臓器シミュレータ

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