JP2000279524A - Catheter - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a catheter capable of recovering thrombus dissolved by an administered drug and discharging it outside the body. SOLUTION: This catheter 1 is provided with a first baloon 11 which can expand and shrink and closes a blood vessel when expanded, a second baloon 12 which can be expanded and shrunk, closes a blood vessel when expanded, and is arranged on a basic end side at a predetermined interval from the first baloon 11, a drug supply lumen supplying a drug into the blood vessel closed by both baloons 11 and 12 through a drug release port 19 formed between both baloons 11 and 12, and a dissolved substance recovery lumen recovering a dissolved substance in the blood vessel closed by both baloons 11 and 12 through a dissolved substance recovery port 20 formed between both baloons 11 and 12.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a catheter for administering a drug to a desired portion in a blood vessel and removing a thrombus or the like formed in the blood vessel.

[0002]

2. Description of the Related Art A balloon catheter has been conventionally used as a medical device for treating a blood vessel. Various examples of the balloon catheter include an infusion catheter mainly used for administering a drug to a local part of a blood vessel and a perfusion catheter mainly used in PTCA (percutaneous coronary angioplasty). There are forms.

[0003] Conventional infusion catheters include, for example, Japanese Patent Application Laid-Open Nos.
Japanese Patent Application Laid-Open Nos. 0-179747 and 10-179755.

[0004] As a conventional perfusion catheter, there is one disclosed in Japanese Patent Application Laid-Open No. 9-70441.

[0005]

SUMMARY OF THE INVENTION Acute myocardial infarction (AM)
The thrombus seen in I) is generally in a state of floating in a blood vessel. The treatment of this AMI includes P
In many cases, TCA is performed. In PTCA, a thrombus is pressed against a blood vessel wall, but it is considered that the thrombus is partially spread to peripheral blood vessels to cause thromboembolism, thereby expanding the disorder.

[0006] Using a conventional infusion catheter, a drug is administered into a blood vessel having a thrombus formed therein,
Even when the thrombus is dissolved, the partially dissolved fragmented thrombus cannot be positively collected, and the fragmented thrombus is also scattered to the periphery.

An object of the present invention is to solve such a conventional problem, and it is possible to collect a thrombus which has been partially dissolved and fragmented by an administered drug and can be discharged outside the body. It is intended to provide a catheter.

[0008]

SUMMARY OF THE INVENTION To achieve this object, the present invention provides a first balloon which is inflatable and deflateable and closes a blood vessel when dilated; A second balloon that is closed and disposed at a proximal end spaced from the first balloon by a predetermined distance; and a drug discharge port formed between the first balloon and the second balloon. And a drug supply lumen for supplying a drug into a blood vessel closed by the balloons, and a lysate recovery port formed between the first balloon and the second balloon. And a lysate collection lumen for collecting lysates in a blood vessel closed by a balloon.

In the catheter having this configuration, the dissolved substance dissolved by the drug can be collected from the dissolved substance collecting port into the dissolved substance collecting lumen and discharged out of the body. Specifically, when a drug such as a thrombolytic agent is released from the drug release port into the blood vessel closed by the balloons, the thrombus formed in the blood vessel is dissolved (fragmented). Here, the portion from which the drug is released is closed by both balloons, and thus this portion is filled with the drug. Therefore, the speed at which the thrombus dissolves can be increased. Further, the pressure in the blood vessel increases due to the released drug. For this reason, a dissolved substance in which a dissolved thrombus, a drug after release, blood and the like are mixed (hereinafter, referred to as a dissolved substance)
These are simply referred to as “lysate”) are efficiently collected (aspirated) from the lysate collection port to the lysate collection lumen by a force that attempts to restore the elevated pressure in the blood vessel,
Excreted outside the body.

[0010] The plurality of drug release ports can be formed. In this way, the medicine can be more efficiently supplied (injected) into the blood vessel closed by the balloons.

Further, the catheter according to the present invention can be configured so that the total area of the drug release port is equal to the area of the dissolved substance recovery port.

By doing so, the amount of the drug per unit time released from the drug release port can be made equal to the amount of the dissolved substance recovered from the dissolved substance recovery port per unit time. The lysate can be recovered more smoothly.

[0013] A suction mechanism for sucking the melt may be connected to the melt recovery lumen.

[0014] By doing so, the dissolved substance can be more efficiently collected outside the body.

The catheter according to the present invention may further include a blood inlet disposed closer to the proximal end than the second balloon, a blood outlet disposed distal to the first balloon, A blood passage lumen communicating between the blood inlet and the blood outlet, and discharging the blood flowing in from the blood inlet from the blood outlet.

According to this configuration, in addition to the above-mentioned advantages, during treatment using the catheter, blood can be taken from the blood inlet into the blood passage lumen, and then can be flowed to the blood outlet through the blood inlet. Therefore, even if the treatment takes a long time, the blood flow is not interrupted by the two balloons, so that it is possible to prevent the ischemic state.

Further, in the catheter according to the present invention, marks can be provided on the distal end portion, the proximal end side of the first balloon, and the distal end side of the second balloon.

By providing this mark, it is possible to easily confirm the treatment site (the site where the catheter is applied).

Further, the catheter according to the present invention comprises:
The blood passage lumen can also be used as a guide wire insertion lumen.

By using the blood passage lumen and the guide wire insertion lumen in this way, if the diameter of the catheter is the same, the diameter of each of the remaining lumens can be increased.

Further, the diameter of the above-mentioned dissolved product recovery lumen can be made larger than the diameter of other lumens. Further, the area of the melt collection port can be equal to or larger than the cross-sectional area perpendicular to the longitudinal direction of the melt collection lumen.

Thus, the diameter of the lysate recovery lumen,
By making the area of the lysate collection port as large as possible, even if a relatively large volume of small thrombus is mixed in the lysate, it can be collected.

Further, the catheter according to the present invention comprises:
The first balloon and the second balloon may be provided with an endoscope capable of observing a closed blood vessel.

By doing so, in addition to the above-mentioned advantages, the state of the treatment can be confirmed from the outside.

[0025]

Next, a catheter according to an embodiment of the present invention will be described with reference to the drawings.

FIG. 1 is a side view showing an outline of a catheter according to an embodiment of the present invention, FIG. 2 is a sectional view taken along the line II-II of FIG. 1, and FIG. FIG. 4 is a cross-sectional view taken along the line IV-IV of FIG. 2, and FIG.
FIG. 6 is a cross-sectional view taken along line VV of FIG. 2, FIG. 6 is a cross-sectional view showing a state where the catheter shown in FIG. 4 is inserted into a blood vessel, and FIG.
FIG. 6 is a cross-sectional view showing a state where the catheter shown in FIG. 5 is inserted into a blood vessel.

[0027] The catheter 1 according to the present embodiment is shown in FIG.
As shown in FIG. 5, a main body 10, a first balloon 11 disposed on the distal end side of the main body 10, and a first balloon 11
And a second balloon 12 arranged on the base end side of the main body 10 at a predetermined interval.

First balloon 11 and second balloon 1
2 has a structure that can be expanded by supplying gas and contractable by discharging the gas. These two balloons 11 and 12 expand when the catheter 1 is inserted into the blood vessel, and abut against the inner wall of the blood vessel. Both balloons 1
It is configured to close the area in the blood vessel that is between 1 and 12.

The main body 10 has a guide wire insertion lumen 14 into which the guide wire 13 is inserted, at the center thereof,
A drug supply lumen 15 and a gas supply lumen 16 formed at positions 180 degrees out of phase with respect to the guidewire insertion lumen 14, and the guidewire insertion lumen 1
A lysate recovery lumen 17 and a blood passage lumen 18 are respectively provided at positions that are 180 degrees out of phase with respect to 4 and that are 90 degrees out of phase with the drug supply lumen 15 and the gas supply lumen 16.

The drug supply lumen 15 is, for example, a lumen for supplying a drug for dissolving a thrombus or the like formed in a blood vessel. The drug supply lumen 15 extends from the proximal end side of the catheter 1 to the proximal end side of the first balloon 11, and a plurality of medicine supply lumens 15 are provided at positions corresponding to between the first balloon 11 and the second balloon 12. Drug release ports (five in this embodiment) 19 are formed. This drug release port 1
9 communicates with the outside of the main body 10 so that the medicine supplied from the medicine supply lumen 15 can be released to the outside of the main body 10. That is, the medicine can be released into the blood vessel closed by the first balloon 11 and the second balloon 12.

The gas supply lumen 16 supplies gas to the first balloon 11 and the second balloon 12 to expand both balloons 11 and 12, and exhausts the gas from both expanded balloons 11 and 12. Hand balloon 11
And 12 are lumens for contracting. The gas supply lumen 16 communicates from the proximal end side of the catheter 1 to the gas inlet / outlet 11A of the first balloon 11, further extends to the second balloon 12, and extends to the gas inlet / outlet 1 of the second balloon 12.
It communicates with 2A.

The lysate collecting lumen 17 is a lumen for collecting the lysate dissolved by the drug. The lysate collection lumen 17 extends from the proximal end of the catheter 1 to the proximal end of the first balloon 11,
At a position corresponding to a position between the first balloon 11 and the second balloon 12, a melt collection port 20 for collecting the melt is formed. The melt recovery port 20 is connected to the first
The lysate dissolved by the drug released into the blood vessel closed by the balloon 11 and the second balloon 12 is inhaled and communicated with the outside of the main body 10 so as to be collected in the lysate collection lumen 17. I have.

In this embodiment, the medicine discharge port 19
And the area of the dissolved matter recovery port 20 were set to be equal. In addition, since small thrombi may be mixed in the lysate, the area of the lysate collection port 20 and the diameter of the lysate collection lumen 17 are preferably set as large as possible so that the small thrombus can be collected smoothly.

The blood passage lumen 18 is a lumen for bypassing the blood in order to prevent the blood flow from being stopped and causing an ischemic condition during the treatment using the catheter 1. The blood passage lumen 18 extends from near the proximal end of the second balloon 12 to near the distal end of the first balloon 11. A blood inlet 21 through which blood flows into the blood passage lumen 18 is formed on the proximal end side of the blood passage lumen 18, and the blood passage lumen 18 is formed on the distal end side.
A blood outlet 22 for discharging blood passing through the blood vessel into the blood vessel is formed. The blood inlet 21 and the blood outlet 22
Also communicates with the outside of the main body 10.

The tip of the main body 10 and the first balloon 11
Markers (markers) 23, 24, and 25 are formed along the outer periphery of the main body 10 at a position where the main body 10 is in contact with the base end and a position where the second balloon 12 is in contact with the distal end. These markers 23, 24 and 25 are provided so that the treatment site (the site where the catheter 1 is applied) can be easily confirmed.

The size of the catheter according to the present invention, such as the diameter of the main body, the diameter of the balloon at the time of expansion, the length of the balloon, the distance between the two balloons, etc., may be arbitrarily determined depending on the treatment site, the condition of the patient, and the like. Can be. In the present embodiment,
As an example, the diameter of the main body 10 is 4 Fr (French),
The diameter of the first balloon 11 and the second balloon 12 at the time of expansion is 2.0 mm to 3.5 mm, the length of the first balloon 11 and the second balloon 12 is 10 mm, and The interval was about 10 mm to 30 mm.

Next, a specific operation of the catheter 1 according to the present embodiment will be described with reference to the drawings. In the present embodiment, a case where the thrombus of a patient with acute myocardial infarction (AMI) is removed using the catheter 1 will be described.

First, the catheter 1 in a state where the first balloon 11 and the second balloon 12 are deflated is inserted into a blood vessel 25 by an ordinary method, and the thrombus 26 is inserted into the first balloon 11 and the second balloon 12. The catheter 1 is guided so as to be located between the two. At this time, the position can be easily confirmed by the markers 23, 24, and 25 formed on the main body 10.

Next, a gas such as air is supplied from the gas supply lumen 16, and the first balloon 11 and the second balloon 12 are expanded through the gas ports 11A and 12A. By this operation, the first balloon 11 and the second balloon 11
Of the balloon 12 abuts on the inner wall of the blood vessel 25 to close between the balloons 11 and 12.

At the same time, the blood flowing through the blood vessel 25 flows from the blood inlet 21 into the blood passage lumen 18 as shown by the arrow X in FIG. Spill as shown. That is,
Since the blood flows by bypassing through the blood passage lumen 18, the first balloon 11 and the second balloon 12
Never be blocked. Therefore, even if the treatment takes a long time, the patient does not become ischemic, so that the treatment can be performed without imposing a burden on the patient.

Next, a thrombolytic agent (eg, urokinase) is supplied from the drug supply lumen 15, and the first balloon 1 is supplied from the drug release port 19 as shown by the arrow Z in FIG.
The thrombolytic agent is released into the blood vessel 25 closed by the first and second balloons 12.

At this time, the thrombolytic agent is released into the blood vessel 25 closed by the first balloon 11 and the second balloon 12, so that this portion is filled with the thrombolytic agent. Accordingly, the speed at which the thrombus 26 dissolves can be increased. In addition, since the pressure in the blood vessel 25 increases due to the released thrombolytic agent, the lysate is moved from the lysate recovery port 20 to FIG. It is collected (sucked) by the melt collection lumen 17 as shown by the arrow Y, and is discharged outside the body. Thus, the thrombus 26 can be removed in a short time.

Thereafter, when the removal of the thrombus 26 is completed, the first balloon 11 and the second balloon 12 are deflated,
The catheter 1 is withdrawn from the blood vessel in a usual manner.

In the catheter according to the present invention, a suction device (not shown) for efficiently sucking the lysate collected in the lysate collection lumen 17 is connected to the proximal end side of the lysate collection lumen 17. You can also. By doing so, the dissolved substance can be more efficiently discharged out of the body.

If an endoscope is provided between the first balloon 11 and the second balloon 12, the state of thrombus dissolution and removal can be observed from the outside.

In the case of a rapid exchange type (monorail type) catheter, the blood passage lumen can be used also as a guide wire insertion lumen. In this case, the diameter of each lumen can be relatively increased.

In the present embodiment, the case where five drug outlets 19 are arranged in the horizontal direction has been described. However, the present invention is not limited to this, and a plurality of drug outlets may be spirally arranged.
In addition, the number of drug outlets may be arbitrarily determined.

[0048]

As described above, the catheter according to the present invention can release a drug into a blood vessel closed by the first balloon and the second balloon, so that this portion is filled with the drug. be able to. Therefore, thrombus and the like formed in this portion can be efficiently dissolved. As a result, the treatment time can be significantly reduced. Further, since the dissolved substance dissolved by the drug can be collected and discharged out of the body, the thrombus can be surely removed.

[Brief description of the drawings]

FIG. 1 is a side view showing an outline of a catheter according to an embodiment of the present invention.

FIG. 2 is a sectional view taken along the line II-II in FIG.

FIG. 3 is a sectional view taken along the line III-III in FIG. 1;

FIG. 4 is a sectional view taken along the line IV-IV in FIG. 2;

FIG. 5 is a sectional view taken along the line VV of FIG. 2;

6 is a cross-sectional view showing a state where the catheter shown in FIG. 4 is inserted into a blood vessel.

FIG. 7 is a cross-sectional view showing a state where the catheter shown in FIG. 5 is inserted into a blood vessel.

[Explanation of symbols]

 Reference Signs List 1 catheter 10 main body 11 first balloon 12 second balloon 13 guide wire 14 guide wire insertion lumen 15 drug supply lumen 16 gas supply lumen 17 lysate recovery lumen 18 blood passage lumen 19 drug elution port 20 lysate recovery port 21 Blood inlet 22 Blood outlet 23, 24, 25 Marker

 ──────────────────────────────────────────────────続 き Continuing on the front page (72) Inventor: Suo Miyoshi 10-18-216, Koshien, Nishinomiya City, Hyogo Prefecture

Claims (10)

[Claims] 1. A first balloon which is expandable and deflateable and closes a blood vessel when inflated, and a dilatable and deflateable blood vessel which closes the blood vessel when inflated and at a predetermined distance from the first balloon. A second balloon disposed on the proximal side, and a drug release port formed between the first balloon and the second balloon into a blood vessel closed by the two balloons. A lysate for collecting a lysate in a blood vessel closed by the two balloons via a lysate collection port formed between the first balloon and the second balloon; A catheter having a collection lumen; 2. The apparatus according to claim 2, wherein a plurality of the drug release ports are formed.
The catheter as described. 3. The catheter according to claim 1, wherein the total area of the drug discharge port is equal to the area of the lysate recovery port. 4. A suction mechanism for suctioning the melt is connected to the melt recovery lumen.
The catheter according to any one of claims 1 to 4. 5. A blood inlet disposed closer to the proximal end than the second balloon, a blood outlet disposed distal to the first balloon, the blood inlet and the blood outlet. The catheter according to any one of claims 1 to 4, further comprising: a blood passage lumen communicating between the blood inlet and the blood flowing out of the blood inlet through the blood outlet. 6. The catheter according to claim 1, wherein a mark is provided on a distal end portion, a proximal end side of the first balloon, and a distal end side of the second balloon. . 7. The catheter according to claim 5, wherein the blood passage lumen doubles as a guidewire insertion lumen. 8. The catheter according to claim 1, wherein a diameter of the lysate collection lumen is larger than diameters of other lumens. 9. The catheter according to claim 1, wherein an area of the lysate collection port is not less than a cross-sectional area perpendicular to a longitudinal direction of the lysate collection lumen. 10. The catheter according to claim 1, further comprising an endoscope provided in the first balloon and the second balloon, the endoscope being capable of observing a closed blood vessel.