CN111672009A

CN111672009A - Multi-functional coronary artery of radial artery route guides pipe

Info

Publication number: CN111672009A
Application number: CN202010470904.6A
Authority: CN
Inventors: 雷新军; 师睿; 张葳
Original assignee: First Affiliated Hospital of Medical College of Xian Jiaotong University
Current assignee: First Affiliated Hospital of Medical College of Xian Jiaotong University
Priority date: 2020-05-28
Filing date: 2020-05-28
Publication date: 2020-09-18

Abstract

The invention provides a multi-functional coronary artery guide catheter through a radial artery path, which comprises a twisting controller, an anti-bending protector, a push rod, a composite tube and a nested catheter, wherein the twisting controller is arranged on the outer side of the composite tube; the push steel wire and the first annular steel ring and the second annular steel ring at the two ends play a role in mechanical transmission, when the guide catheter is used, the nested catheter can freely enter and exit the guide catheter under the action of the mechanical transmission of the push steel wire, and the longer the depth of the nested catheter inserted into a coronary artery is, the stronger the supporting force obtained by the guide catheter is, so that the supporting force of the guide catheter is actively enhanced; the whole operation is simple and convenient, the operation is safe and reliable, the supporting force can be enhanced step by step, and the operation safety is improved.

Description

Multi-functional coronary artery of radial artery route guides pipe

Technical Field

The utility model belongs to the field of medical equipment, and relates to a multifunctional coronary artery guiding catheter through a radial artery path.

Background

Complicated coronary artery lesions including multiple, diffuse, tortuous, calcified or chronic total occlusion cto (chronic total occlusion) lesions are the difficulties in percutaneous coronary intervention (pci), and the difficulty in reaching target lesions due to insufficient support force of a guide catheter by devices such as balloons and stents is the most common reason for operation failure. Therefore, the guiding catheter capable of providing super-strong supporting force is the first guarantee for the success of the interventional treatment of complex coronary artery lesion.

In 2005, with the increasingly mature coronary intervention technology and the improvement of instruments, the tri (transradial intervention) technology for coronary intervention became popular. Clinical practice shows that: the radial artery path has the advantages of small puncture injury, few vascular complications, convenient hemostasis after operation, no restriction of body position, no influence on continuous use of anticoagulant drugs and the like, does not prolong the time of a door-balloon (door to balloon) and the reperfusion time, and really realizes minimally invasive treatment of coronary artery. The TRI meets the era requirement of minimally invasive coronary intervention treatment development, is also an important embodiment of the human-oriented idea of the minimally invasive coronary intervention treatment development, and is a milestone of the minimally invasive coronary intervention treatment development.

At present, the radial artery route not only serves as a main routine approach for coronary angiography and coronary intervention, but also deepens into the intervention of complex, multiple branches, bifurcations, CTOs and other lesions and acute myocardial infarction ami (acute myocardial infarction). In China, TRI is currently in the front of Europe and America, and the characteristics and advantages of the Chinese PCI technology are reflected to a certain extent.

Referring to fig. 1, TRI is becoming more and more widely used. However, in the case of PCI via the radial approach, the support force of the JL guiding catheter is reduced by about 60% and the support force of long-tip guiding catheters (e.g., EBU, BL, XB, and Q-curve, etc.) is reduced by about 8% compared to the case of PCI via the femoral approach. Since the complicated coronary lesions are mostly circuitous, calcified or CTO lesions, even if a guiding catheter with strong supporting force is selected, the guiding guide wire, the balloon or the stent can still be difficult to pass through the lesions due to insufficient supporting force; especially, when the lesion site is expanded, the dissection and blood flow of the lesion site are slowed down, and the stent cannot reach the lesion site due to insufficient support force of the system, the operator is difficult to advance and retreat, and the patient is exposed to life risks, which finally results in the failure of the operation. Meanwhile, the operation time is prolonged, the X-ray exposure dose is increased, the dosage of the contrast agent is increased, the complication risk is increased, and the like. How to further enhance the supporting force of the guiding catheter on the basis of the original guiding steel wire to successfully complete the PCI is a hot spot and a difficult point of TRI discussion.

Currently, the most common techniques and methods for enhancing the support of guide catheters are: the double-guide-wire technology, the balloon anchoring technology, the primary and secondary catheter technology, the Guidezilla extension catheter technology and the like are simple and convenient to operate, other technical operations are complex, and the risks of complications such as myocardial ischemia, guide wire winding, instrument damage, coronary artery injury, dissection or even perforation, cardiac tamponade, aortic dissection or even sudden cardiac death and the like are also inevitably increased.

The Guidezilla extension catheter technique, although simple to operate, has significant drawbacks: firstly, a single push rod is used for pushing and guiding a catheter section to enter the diffuse, tortuous and calpain coronary artery, so that the force is obviously insufficient and the catheter section is difficult to advance; secondly, the pushing rod is easy to kink or break; when the conveying appliance enters the guide conduit section, complications such as folding and even damage of the guide steel wire, damage of the balloon, tilting of the steel beam of the bracket, longitudinal compression or unloading and the like are easy to occur; block coronary blood flow, inevitably increase the risk of complications such as myocardial ischemia, malignant arrhythmia (ventricular tachycardia, ventricular fibrillation, third degree atrioventricular block), even sudden death and the like; fifthly, the covered stent can not pass through, the rescue time of coronary perforation and cardiac tamponade is delayed; sixthly, the rotary grinding operation cannot be carried out.

The existing guide catheter has the following defects:

firstly, the supporting force can not be adjusted, and even gradually decreases along with the extension of the operation time;

secondly, according to the difference of the internal diameter of the ascending aorta and the opening position of the coronary artery, the guide catheters with different specifications need to be replaced;

and thirdly, the blood flow of the coronary artery is inevitably blocked by applying a 5in 6 technology (a son-mother catheter technology) or a Guidezilla extension catheter technology, and a huge risk is faced particularly when the bifurcation lesion at the left trunk end of the coronary artery is treated.

Disclosure of Invention

The invention aims to solve the defects in the prior art, and provides the multifunctional coronary artery guiding catheter through the radial artery path, which is simple and convenient to operate, safe and reliable, can enhance the supporting force step by step, and has the advantages of avoiding myocardial ischemia, being difficult to damage the coronary artery and the like.

A multifunctional coronary artery guiding catheter through a radial artery path comprises a twisting controller, an anti-bending protector, a pushing rod, a composite tube and a nested catheter;

the push rod consists of a push section and a blood vessel section, the push section of the push rod extends into the composite tube from the front end of the composite tube and can move back and forth in the composite tube, the blood vessel section of the push rod is connected to the rear end of the composite tube, the torsion controller is connected with the anti-bending protector and then connected with the push section of the push rod, the blood vessel section of the push rod comprises a straight tube, a first bent tube and a second bent tube, the first bent tube and the second bent tube are sequentially connected to the rear end of the straight tube, and the tail end of the second bent tube is connected with an end;

a nested catheter is arranged in the blood vessel section of the push rod, can move back and forth in the blood vessel section of the push rod and can extend out of the end head;

the push steel wire is placed in the vascular section of compound pipe and propelling movement pole, and first annular steel ring and second annular steel ring are connected respectively to the propelling movement steel wire both ends, and the first annular steel ring that the propelling movement steel wire front end is connected with the propelling movement section tip of propelling movement pole, and the second annular steel ring that the propelling movement steel wire rear end is connected with nested pipe.

Further, the push rod is made of soft materials and comprises an outer layer, a middle layer and an inner layer, the outer layer is made of polyethylene plastics, the middle layer is made of metal steel wires in a woven mode, and the inner layer is made of a PTFE coating.

Furthermore, the push steel wire is exposed on the composite tube, a micro pore channel extending along the radial direction is arranged between the middle layer and the inner layer of the blood vessel section of the push rod, and the push steel wire is positioned in the micro pore channel of the blood vessel section of the push rod.

Furthermore, three pushing steel wires are arranged in the blood vessel sections of the composite tube and the pushing rod, and the three pushing steel wires are arranged along the circumference at an angle of 120 degrees.

Furthermore, side holes are symmetrically formed in the side wall of the blood vessel section of the push rod.

Further, the end head adopts an X-ray end head.

Further, the composite pipe material is made of biocompatible plastics or metal.

Further, the length of the composite pipe is 50 mm.

Further, the push rod has an inner diameter of 6Fr corresponding to an outer diameter of 7Fr, or an inner diameter of 5Fr corresponding to an outer diameter of 6 Fr.

Further, the nested catheter is a wire mesh/polymer structure.

The invention relates to a multi-functional coronary artery guiding catheter through a radial artery path, which comprises a twisting controller, an anti-bending protector, a push rod, a composite tube and a nested catheter; the pushing steel wire and the first annular steel ring and the second annular steel ring at two ends play a mechanical transmission role. When the guiding catheter is used, the nested catheter can freely enter and exit the guiding catheter under the mechanical transmission action of the push steel wire 10, and the longer the nested catheter is inserted into a coronary artery, the stronger the supporting force obtained by the guiding catheter is, so that the supporting force of the guiding catheter is actively enhanced. Provides a smooth path for the subsequent instrument to enter, and successfully completes the assisted surgery. The invention has simple and convenient integral operation, safety and reliability, and the supporting force can be enhanced step by step.

Furthermore, the side holes are symmetrically formed in the side wall of the blood vessel section of the push rod, when the nested catheter extends out for 5mm, the blood can be supplied to the myocardium by the guide catheter, myocardial ischemia caused by incarceration and complications such as angina, malignant arrhythmia, sudden death and the like caused by the incarceration can be avoided, and the safety of the operation is improved.

The invention also has the following advantages:

1. the guide catheter has inherent super strong supporting force different from the prior guide catheter, and can also gradually enhance the supporting force of the guide catheter according to the complexity of coronary lesion, thereby ensuring the smooth completion of the operation.

2. After the catheter is guided to enter the ascending aorta, the left coronary artery intervention and the right coronary artery intervention can be selected or respectively carried out according to the actual disease condition; meanwhile, according to the diameter of ascending aorta and the opening position of coronary artery, the length of the guide catheter section extending out of the guide catheter is adjusted to obtain good coaxiality, and the optimal radiography result is ensured.

3. According to the actual pathological change condition, the depth of the nested catheter segment entering the coronary artery is accurately adjusted, so that not only can the required superstrong supporting force be provided for the instrument through pathological change, but also a smooth channel can be provided for the conveying of the instrument, and the assisting operation is smoothly completed.

4. Can actively supply blood to myocardium at a far position with coronary artery stenosis, improve operation safety, and avoid complication such as myocardial ischemia, angina pectoris attack, malignant arrhythmia, and even sudden death induced by incarceration.

5. The head incarceration can be handled.

6. When the CTO lesion is reversely opened, an Active greetingTechnique (Active greetingTechnique) can be directly used.

7. Avoids replacing different types of guide catheters, not only can effectively avoid complications such as vasospasm, injury, even bleeding and the like of the approach, but also can save the operation time of the operation, reduce the use of contrast medium, lighten the radiation exposure of the medical care patients and the like.

8. The economic cost is reduced.

Drawings

FIG. 1 is a schematic view of a conventional JL guiding catheter structure

FIG. 2 is a schematic view of the present invention

FIG. 3a is a schematic partial cross-sectional view of the present invention

FIG. 3b is a cross-sectional view taken at A in FIG. 3a

FIG. 3c is a cross-sectional view taken at B in FIG. 3a

FIG. 3d is a cross-sectional view taken at C in FIG. 3a

FIG. 4 is a diagram showing the operation effect of the present invention

In the figure: 1-a torsion controller, 2-a bending-resistant protector, 3-a pushing rod, 4-a composite pipe, 5-a side hole, 6-a first bent pipe, 7-a second bent pipe, 8-a tip, 9-a first annular steel ring, 10-a pushing steel wire, 11-a second annular steel ring and 12-a nested conduit.

Detailed Description

In order to make the objects, technical solutions and advantages of the present invention more apparent, the technical solutions of the present invention are described clearly and completely below, and it is obvious that the described embodiments are some, not all embodiments of the present invention. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.

As shown in fig. 2 and fig. 3a, the multifunctional coronary guiding catheter through radial artery path of the invention comprises a twist controller 1, an anti-folding protector 2, a push rod 3, a composite tube 4 and a nested catheter 12.

Propelling movement pole 3 comprises propelling movement section and vascular section two parts, the propelling movement section of propelling movement pole 3 stretches into in the compound pipe 4 from compound pipe 4 front end, and can be in compound pipe 4 back-and-forth movement, the vascular section of propelling movement pole 3 is connected in compound pipe 4 rear end, twist controller 1 is connected with the propelling movement section of propelling movement pole 3 after linking to each other with anti protector 2 of breaking over, the vascular section of propelling movement pole 3 includes the straight tube, and connect gradually first return bend 6 and the second return bend 7 at the straight tube rear end, 7 end-to-end connections of second return bend have end 8.

The material of the composite tube can be selected from proper biocompatible plastics or metals. The pusher section may advance or retract within the composite pipe 4. The length of the composite pipe 4 is 50 mm.

The nested catheter 12 is arranged in the blood vessel section of the push rod 3, and the nested catheter 12 can move back and forth in the blood vessel section of the push rod 3 and can extend out of the end head 8.

Nested catheter 12 is a wire mesh/polymer construction.

Push steel wires 10 are placed in the blood vessel sections of the composite tube 4 and the push rod 3, two ends of each push steel wire 10 are respectively connected with a first annular steel ring 9 and a second annular steel ring 11, the first annular steel ring 9 connected with the front end of each push steel wire 10 is connected with the tail end of the push section of the push rod 3, and the second annular steel ring 11 connected with the rear end of each push steel wire 10 is connected with a nested guide tube 12.

The hardness of the multifunctional coronary artery guiding catheter passing through the radial artery path is enhanced section by section from the torsion controller 1 to the end head 8, and the end head 8 adopts an X-ray end head; the push rod 3 is made of soft materials and comprises an outer layer, a middle layer and an inner layer, the outer layer is made of polyethylene plastic materials (Pebax modified nylon), the middle layer is made of metal steel wires in a woven mode, and the inner layer is made of a PTFE coating serving as a lubricating material.

The outer diameter of the push rod 3 is 7Fr or 6Fr, the corresponding inner diameter is 6Fr or 5Fr, and the side holes 5 are symmetrically arranged on the side wall of the blood vessel section of the push rod 3.

As shown in fig. 3 b-3 d, the push steel wire 10 is exposed in the composite tube 4, a micro-channel extending along the radial direction is provided between the middle layer and the inner layer of the blood vessel section of the push rod 3, the push steel wire 10 is located in the micro-channel of the blood vessel section of the push rod 3, and the push steel wire 10 runs in the micro-channel between the inner layer and the middle layer of the push rod 3.

Three pushing steel wires 10 are arranged in the blood vessel sections of the composite tube 4 and the pushing rod 3, the three pushing steel wires 10 are arranged at an angle of 120 degrees along the circumference, are dissociated in the composite tube, and can freely advance and retreat in a pore passage between the inner layer and the middle layer of the pushing section.

As shown in FIG. 4, the push wire 10 and the first and second annular steel rings 9 and 11 at both ends are mechanically driven in the present invention. The nested catheter 12 is free to move into and out of the guide catheter under the mechanical drive of the push wire 10.

The torque controller is controlled to make the pushing section of the pushing rod 3 advance in the composite tube 4, and correspondingly, the nested catheter also extends out of the end head 8 by the same length, so that the supporting force of the guide catheter is actively strengthened. The longer the nested catheter is inserted into the coronary artery, the stronger the support force achieved by the guiding catheter. The maximum length of the nested catheter extending into the coronary artery is 50 mm. In the same way, the control twist controller is withdrawn from the push section in the composite tube, and the nested catheter is correspondingly withdrawn from the coronary artery to the finger guide tube.

The longer the nested catheter 12 is pushed by the push wire 10 into the coronary artery, the stronger the support force obtained by the guide catheter, and the smooth passage is provided for the subsequent instruments to enter, so that the assisted surgery can be completed smoothly. Meanwhile, when the nested catheter extends out by 5mm, the guide catheter can supply blood to the myocardium, so that myocardial ischemia caused by incarceration and complications such as angina, malignant arrhythmia, sudden death and the like caused by the incarceration can be avoided, and the safety of the operation is improved.

The steps of the operation by adopting the invention are as follows:

1. after the radial artery puncture is successful, a 6F or 7F artery sheath is placed.

2. The guiding catheter is sent into the ascending aorta (normal diameter 3.0-3.5 cm) along the radiography guide wire, and the position and the direction of the guiding catheter are adjusted to be coaxial with the coronary artery opening.

If the ascending aorta is widened or the coronary opening is abnormal, the guide catheter twist controller can be pushed to enable the nested catheter to extend out of the guide catheter to a proper length, and the guide catheter is coaxial directly or by means of a guide steel wire.

3. When diffuse, tortuosity, calsium or CTO lesion is treated and the instrument is difficult to pass through, the guide catheter twister is directly pushed or pushed by anchoring the saccule, so that the nested catheter extends out of the guide catheter and enters the coronary artery to a proper depth.

The longer the nested catheter extends into the coronary artery, the stronger the supporting force obtained by the guiding catheter is, and a smooth passage is provided for the subsequent instruments to enter, so that the assisting operation is completed smoothly.

4. After the nested catheter extends out of the guide catheter and enters the coronary artery by 5mm, the two side holes which are symmetrical up and down are exposed, and blood supply to cardiac muscle is started; when the nested catheter further extends out of the guide catheter and enters the coronary artery by 15mm, the second pair of the side holes which are symmetrical up and down are exposed, and the blood supply of the cardiac muscle is effectively increased.

The active myocardial blood supply is particularly important in treating coronary artery left trunk bifurcation lesion and diffuse coronary artery lesion, can effectively avoid complications such as myocardial ischemia, malignant arrhythmia, even cardiogenic sudden death and the like induced by incarceration, and improves the safety and success rate of the operation.

5. And after the coronary lesion treatment is finished, withdrawing the guide catheter twist controller and withdrawing the nested catheter.

6. The guiding catheter is withdrawn out of the body directly or by means of a contrast guide wire, and the operation is finished.

Finally, it should be noted that: the above examples are only intended to illustrate the technical solution of the present invention, but not to limit it; although the present invention has been described in detail with reference to the foregoing embodiments, it will be understood by those of ordinary skill in the art that: the technical solutions described in the foregoing embodiments may still be modified, or some technical features may be equivalently replaced; and such modifications or substitutions do not depart from the spirit and scope of the corresponding technical solutions of the embodiments of the present invention.

Claims

1. A multifunctional coronary artery guiding catheter through a radial artery path is characterized by comprising a twisting controller (1), an anti-bending protector (2), a pushing rod (3), a composite tube (4) and a nested catheter (12);

the push rod (3) consists of a push section and a blood vessel section, the push section of the push rod (3) extends into the composite pipe (4) from the front end of the composite pipe (4) and can move back and forth in the composite pipe (4), the blood vessel section of the push rod (3) is connected to the rear end of the composite pipe (4), the twist controller (1) is connected with the push section of the push rod (3) after being connected with the anti-bending protector (2), the blood vessel section of the push rod (3) comprises a straight pipe, a first bent pipe (6) and a second bent pipe (7) which are sequentially connected to the rear end of the straight pipe, and the tail end of the second bent pipe (7) is connected with an end head (8);

a nested guide pipe (12) is arranged in the blood vessel section of the push rod (3), and the nested guide pipe (12) can move back and forth in the blood vessel section of the push rod (3) and can extend out of the end head (8);

push steel wire (10) have been placed in the vascular section of compound pipe (4) and push rod (3), first annular steel ring (9) and second annular steel ring (11) are connected respectively at push steel wire (10) both ends, and first annular steel ring (9) that push steel wire (10) front end is connected with the push section end of push rod (3), and second annular steel ring (11) that push steel wire (10) rear end is connected are connected with nested pipe (12).

2. The multifunctional coronary artery guiding catheter through the radial artery path is characterized in that the pushing rod (3) is made of a soft material and comprises an outer layer, a middle layer and an inner layer, the outer layer is made of polyethylene plastic, the middle layer is made of metal steel wires in a braided mode, and the inner layer is made of a PTFE coating.

3. The multifunctional coronary guiding catheter through the radial artery path is characterized in that the push steel wire (10) is exposed out of the composite tube (4), a micro-hole extending along the radial direction is arranged between the middle layer and the inner layer of the blood vessel section of the push rod (3), and the push steel wire (10) is positioned in the micro-hole of the blood vessel section of the push rod (3).

4. The multifunctional coronary guiding catheter through the radial artery path according to claim 3, characterized in that three push steel wires (10) are placed in the blood vessel section of the composite tube (4) and the push rod (3), and the three push steel wires (10) are arranged at 120 degrees along the circumference.

5. The multifunctional coronary guiding catheter through the radial artery route according to any one of claims 1 to 4, characterized in that the side holes (5) are symmetrically arranged on the side wall of the vessel section of the pushing rod (3).

6. The multifunctional transradial coronary guiding catheter according to claim 5, characterized in that the tip (8) is an X-ray tip.

7. The multifunctional transradial coronary guidance catheter according to claim 5, wherein the composite tubing is made of biocompatible plastic or metal.

8. The multifunctional transradial coronary guidance catheter according to claim 5, characterized in that the length of the composite tube (4) is 50 mm.

9. The multifunctional trans-radial-artery-route coronary guiding catheter according to claim 5, characterized in that the pushing rod (3) has an outer diameter of 7Fr corresponding to an inner diameter of 6Fr or an outer diameter of 6Fr corresponding to an inner diameter of 5 Fr.

10. The multifunctional transradial coronary guiding catheter according to claim 5, characterized in that the nested catheter (12) is a wire mesh/polymer structure.