JP2015029652A - Guiding catheter for renal artery, and using method of the same - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a guiding catheter for a renal artery, hardly being affected by pulsation of a heart, a pulsation flow of blood, or expansion/contraction of the abdominal aorta, and to provide a using method of the same.SOLUTION: A catheter body 12 of a guiding catheter 10A for a renal artery has: a first abutment part 16 abutting on an inner wall on the renal artery 50 side disposed with a tip part 30 of the inner wall of the aorta 42 when the tip part 30 is disposed inside the objective renal artery 50; and a second abutment part 18 abutting on the inner wall on the side opposite to the renal artery 50 side disposed with the tip part 30 of the inner wall of the aorta 42 when the tip part 30 is disposed inside the objective renal artery 50. The first abutment part 16 is positioned on the most tip part 30 side of a plurality of abutment portions abutting on the inner wall of the aorta 42.

Description

  The present invention relates to a guiding catheter for a renal artery that is inserted into a blood vessel from an artery of an arm and introduces a distal end portion into a renal artery via an aorta and a method of using the same.

  For example, for patients with refractory hypertension where it is difficult to improve hypertension even after taking antihypertensive agents, expect to lower blood pressure by cutting or damaging the sympathetic nerves surrounding the renal arteries and blocking the transmission There is knowledge that it is possible.

  As a procedure for percutaneously cutting the sympathetic nerve of the renal artery, it has been proposed to use an ablation device. This type of ablation device has an electrode part at the end of a long shaft, contacts the electrode part with the inner wall of the renal artery, applies heat energy to the sympathetic nerve around the renal artery, Cauterize (see, for example, Patent Document 1 below).

  When performing treatment on the renal artery using an ablation device, in order to guide the ablation device to the target renal artery safely and efficiently, the reaction caused by the insertion is alleviated and sufficient backup force is provided to assist smooth introduction. A guiding catheter is needed. In addition, although it does not design for guidance of an ablation device, there exist the following patent documents 2 and 3 as literature which discloses the prior art of a guiding catheter, for example.

  In a conventional procedure for treating the renal artery using an ablation device, a guiding catheter is inserted from the femoral artery close to the renal artery, and the distal end portion is placed in the target renal artery. It is common to insert an ablation device into the catheter.

Special table 2012-513873 gazette JP 2009-273640 A JP 2011-83596 A

  By the way, about 90% of human renal arteries branch downward or perpendicularly from the aorta. When the guiding catheter is introduced from the femoral artery, in order to insert the leading end of the guiding catheter into the downward-facing renal artery, the direction of the leading end is opposite to the advancing direction in the aorta. Need to change. On the other hand, introduction from an arm artery (for example, radial artery or brachial artery) is considered to be more advantageous than introduction from a femoral artery because it is easy to approach the downward renal artery.

  In addition, when a guiding catheter is introduced from an artery in the thigh, since the puncture part is hemostasis after the operation, absolute rest is required in the supine position, which is a burden on the patient. On the other hand, when the guiding catheter is introduced from the artery of the arm, walking immediately after the operation is possible, and there is an advantage that the burden on the patient is small.

  However, when a guiding catheter is introduced from the artery of the arm, the guiding catheter and the ablation device inserted in the thoracic aorta to the abdominal aorta are affected by the pulsation of the heart and blood. Shaking. As a result, vibration is transmitted to the electrode portion provided at the tip of the ablation device.

  Further, the guiding catheter is in contact with the inner wall of the abdominal aorta opposite to the target renal artery in a state where the distal end portion of the guiding catheter is inserted into the target renal artery. The blood vessel repeatedly expands and contracts due to blood pressure fluctuations generated from the heartbeat, and the same applies to the abdominal aorta. During the operation, the abdominal aorta repeatedly expands and contracts in the radial direction. At this time, since the guiding catheter moves in synchronization with the movement of the abdominal aorta that expands and contracts, the distal end portion of the guiding catheter inserted into the target renal artery moves relative to the renal artery. As a result, the electrode portion of the ablation device inserted into the guiding catheter moves relative to the renal artery in synchronization with the expansion / contraction of the abdominal aorta.

  As described above, if the electrode part of the ablation device moves relative to the target renal artery due to the influence of the pulsation of the heart, the pulsatile flow of blood, or the expansion / contraction of the abdominal aorta, There is a concern that the impedance is not stable, making it difficult to perform the procedure. In addition, when the electrode portion moves as described above, thermal energy is applied in a wider range than intended, and there is a concern that the range of damage is widened. Furthermore, when the electrode portion moves as described above, the applied thermal energy per unit area of the blood vessel inner surface is reduced, and there is a concern that the intended ablation effect cannot be obtained.

  The present invention has been made in view of such problems, and is a renal artery guiding catheter that is less susceptible to the effects of heart pulsation, blood pulsatile flow, and abdominal aortic dilatation and contraction, and uses thereof. It aims to provide a method.

  To achieve the above object, the present invention provides a guiding catheter for a renal artery that is inserted into a blood vessel from an artery of an arm and introduces the distal end portion into the renal artery via the aorta, and the distal end portion is provided. A catheter body having flexibility, and the catheter body is configured such that when the distal end portion is disposed in the target renal artery, the renal artery where the distal end portion is disposed among the inner walls of the aorta is disposed. A first abutting portion that abuts on the inner wall of the side, and when the distal end portion is disposed in the target renal artery, the side of the renal artery on the inner wall of the aorta where the distal end portion is disposed is opposite A second abutting portion that abuts against the inner wall on the side, wherein the first abutting portion is located closest to the distal end portion among a plurality of abutting portions that abut against the inner wall of the aorta. And

  According to said structure, the 1st contact part which is the contact part nearest to a front-end | tip part in the inner wall of the aorta on the same side as the target renal artery in the state which the front-end | tip part has been arrange | positioned in the target renal artery Comes into contact with each other, and the second contact portion comes into contact with the inner wall of the aorta on the opposite side. For this reason, it is possible to suppress the movement of the catheter tip due to the influence of dilatation / contraction of the aorta caused by blood pressure fluctuations generated by the pulsation of the heart. Accordingly, when the ablation device is inserted into the guiding catheter and the ablation treatment is performed on the living tissue by the electrode portion at the tip, vibration of the electrode portion can be suppressed and stabilized.

  In the above renal artery guiding catheter, the first contact portion and the second contact portion may contact the inner wall of the abdominal aorta. According to this configuration, since the first abutting portion and the second abutting portion abut on the inner wall of the aorta away from the heart, it is difficult for the heart beat to be transmitted to the catheter body, and the vibration of the catheter body is further reduced. Can be suppressed.

  In the above renal artery guiding catheter, the first contact portion and the second contact portion may contact the caudal side of the inner wall of the aorta rather than the left and right renal artery openings. With this configuration, the catheter body is stably supported. Therefore, the vibration of the catheter tip can be effectively suppressed.

  In the above-mentioned guiding catheter for renal artery, the catheter body may further include a third contact portion that contacts the head side of the inner wall of the aorta with respect to the renal artery opening. With this configuration, the catheter body is stably fixed to the aorta. Therefore, the vibration of the catheter tip can be more effectively suppressed.

  In the above guiding catheter for renal arteries, the catheter main body includes the first contact portion, the second contact portion, and a shape portion that connects the first contact portion and the second contact portion. The width of the shape portion in the natural state with respect to the direction orthogonal to the longitudinal direction of the renal artery guiding catheter is such that the shape portion is disposed when the distal end portion is disposed in the renal artery. It may be larger than the inner diameter of the aorta. According to this structure, the shape part in a catheter main body can be reliably contact | abutted to the mutually opposing inner wall of an aorta, and a catheter main body is stably fixed with respect to an aorta.

  The above guiding catheter for a renal artery may further include a shape control mechanism that makes the shape portion in a desired curved state. According to this configuration, even when the ablation device is inserted into the guiding catheter for the renal artery, the shape part is moved within the aorta by the repulsive force of the ablation device by regulating the deformation of the shape part by the action of the shape control mechanism. It can be prevented from spreading too much. As a result, the load on the aorta can be reduced while obtaining an appropriate backup force.

  In the above guiding catheter for renal artery, the shape control mechanism is disposed along the catheter body at a distal end thereof fixed to the first contact portion and at a proximal end side with respect to the second contact portion. When the puller wire is pulled in the proximal direction, the width of the shape portion decreases as the puller wire moves in the proximal direction with respect to the catheter body. May be. According to this configuration, the bending state of the shape portion can be controlled with a simple structure using the pulling wire.

  Further, the present invention provides a method for using a guiding catheter for renal artery, the providing step of providing the guiding catheter for renal artery provided with a catheter body capable of contacting a plurality of locations on the inner wall of the aorta, A step of inserting a guiding catheter for a renal artery from an artery of an arm and disposing the distal end portion in the renal artery via the aorta; and the renal artery having the distal end portion disposed on the inner wall of the aorta The first abutting portion of the catheter body is brought into contact with the inner wall on the side, and the second wall of the catheter body is disposed on the inner wall of the aorta opposite to the side of the renal artery where the distal end portion is disposed. An abutting step for abutting the abutting portion, wherein the first abutting portion is located closest to the distal end portion among a plurality of abutting portions that abut against the inner wall of the aorta. .

  According to this method, it is possible to suppress the movement of the catheter tip due to the influence of dilatation / contraction of the aorta caused by blood pressure fluctuations generated by the pulsation of the heart. Accordingly, when the ablation device is inserted into the guiding catheter and the ablation treatment is performed on the living tissue by the electrode portion at the tip, vibration of the electrode portion can be suppressed and stabilized.

  In the above-described method for using a guiding catheter for a renal artery, in the contact step, the first contact portion and the second contact portion may be contacted to the inner wall of the abdominal aorta. In this way, since the first contact portion and the second contact portion are in contact with the inner wall of the aorta away from the heart, it is difficult for the heart beat to be transmitted to the catheter body, further suppressing the vibration of the catheter body. can do.

  In the above-described method for using a guiding catheter for a renal artery, in the abutting step, the first abutting portion and the second abutting portion are placed closer to the caudal side of the inner wall of the aorta than the left and right renal artery openings. You may contact. If it does in this way, a catheter main part will be supported stably. Therefore, the vibration of the catheter tip can be effectively suppressed.

  In the above-described method for using a guiding catheter for a renal artery, in the abutting step, the third abutting portion of the catheter body may be abutted on the head side of the inner wall of the aorta with respect to the renal artery opening. . In this way, the catheter body is stably fixed to the aorta. Therefore, the vibration of the catheter tip can be more effectively suppressed.

  ADVANTAGE OF THE INVENTION According to this invention, the guiding catheter for renal arteries which is hard to receive the influence of the pulsation of the heart and the pulsatile flow of blood, and the expansion / contraction of the abdominal aorta, and its usage method are provided.

1 is a partially omitted plan view showing a guiding catheter for a renal artery according to a first embodiment of the present invention. It is a 1st figure explaining the usage method of the guiding catheter for renal arteries shown in FIG. FIG. 6 is a second view for explaining a method of using the guiding catheter for renal artery shown in FIG. 1. FIG. 6 is a third diagram for explaining a method of using the renal artery guiding catheter shown in FIG. 1. FIG. 10 is a fourth diagram for explaining a method of using the renal artery guiding catheter shown in FIG. 1. FIG. 6 is a partially omitted plan view showing a renal artery guiding catheter according to a second embodiment of the present invention. FIG. 7A is a diagram illustrating a configuration of the bending portion according to the first modification, and FIG. 7B is a diagram illustrating a configuration of the bending portion according to the second modification. FIG. 8A is a diagram illustrating a configuration of a bending portion according to a third modification, and FIG. 8B is a diagram illustrating a configuration of the bending portion according to a fourth modification.

  Hereinafter, preferred embodiments of a guiding catheter for a renal artery and a method for using the same according to the present invention will be described with reference to the accompanying drawings.

[First Embodiment]
FIG. 1 is a partially omitted plan view showing the configuration of a renal artery guiding catheter 10A (hereinafter referred to as “guiding catheter 10A”) according to the first embodiment of the present invention. This guiding catheter 10A is inserted into a patient's blood vessel from an arm artery (eg, brachial artery or radial artery), and the distal end 30 is introduced into the renal artery 50 (see FIG. 2) via the aorta 42. The catheter. In addition, the guiding catheter 10A can reach the renal artery 50 when it is introduced from either the left or right arm artery. Furthermore, the distal end portion 30 of the guiding catheter 10A can be selectively engaged with the mouth portions (the renal artery mouth 51) of the left and right renal arteries 50.

  As shown in FIG. 1, the guiding catheter 10 </ b> A has a flexible hollow catheter body 12 and a hub 14 connected to the proximal end of the catheter body 12.

  The catheter body 12 has a lumen 13 that extends from the distal end to the proximal end of the catheter body 12. The outer diameter of the catheter body 12 is set to 2.7 mm or less (preferably 2.1 mm or less) over its entire length so that the guiding catheter 10A can be introduced from the human brachial artery, preferably the radial artery.

  The catheter body 12 includes a first contact portion 16 and a second contact portion that contact the inner wall of the aorta 42 on the abdomen side (caudal side) of the heart 52 when the distal end portion 30 is disposed in the target renal artery 50. The unit 18 is provided. When the distal end portion 30 is disposed in the target renal artery 50, the first abutting portion 16 contacts the inner wall of the aorta 42 on the same side as the renal artery 50 where the distal end portion 30 is disposed. The first contact portion 16 is positioned closest to the distal end portion 30 among the plurality of contact portions that contact the inner wall of the aorta 42. When the distal end portion 30 is disposed in the target renal artery 50, the second abutting portion 18 contacts the inner wall of the aorta 42 opposite to the renal artery 50 side where the distal end portion 30 is disposed. Touch.

  Specifically, when the distal end portion 30 is disposed in the target renal artery 50, the first contact portion 16 and the second contact portion 18 are in contact with the inner wall of the abdominal aorta 48. In particular, in the present embodiment, the first contact portion 16 and the second contact portion 18 are in contact with the caudal side of the inner wall of the aorta 42 with respect to the left and right renal artery openings 51.

  In the present embodiment, the catheter body 12 includes a long body portion 20 that extends from the hub 14 and constitutes the major portion of the catheter body 12, and a portion extending from the body portion 20 to the forefront to form a natural portion. And a curved portion 22 having a curved shape in the state. The main body 20 in the illustrated example is substantially linear (substantially linear) in a natural state. The length of the main body 20 is, for example, about 1000 to 1500 mm, and preferably about 1100 to 1300 mm. Here, the “natural state” means a state in which no external force is applied, and the same meaning is used in the following description.

  The bending portion 22 includes an extension portion 24 extending from the main body portion 20, a second contact portion 18 extending from the extension portion 24, an intermediate portion 28 bending and extending from the second contact portion 18, and an intermediate portion. It has the 1st contact part 16 extended | stretched from the part 28, and the front-end | tip part 30 which extends from the 1st contact part 16 and comprises to the forefront. The entire bending portion 22 exists in the same plane. However, it is not limited to that. The extending portion 24 in the illustrated example extends linearly via the curve 25 and continues to the second contact portion 18. The extending part 24 may be omitted, and the main body part 20 may be directly connected to the second contact part 18.

  The second contact portion 18 in the illustrated example is slightly curved in the opposite direction to the curve 25 in the natural state, but may be configured in a straight line. The intermediate portion 28 is a portion that connects the first contact portion 16 and the second contact portion 18, and is curved in an arc shape in the illustrated example. The first contact portion 16 in the illustrated example is substantially linear in a natural state, but may be curved. The first contact part 16 and the second contact part 18 connected via the arcuately curved intermediate part 28 extend opposite to each other. The curved portion 22 has a shape extending from the main body portion 20 to the second contact portion 18 in the distal direction, reversed at the intermediate portion 28 and extended in the proximal direction at the first contact portion 16.

  In the catheter body 12, the first abutting portion 16, the intermediate portion 28, and the second abutting portion 18 constitute a substantially U-shaped shape portion 32. The width W of the shape portion 32 in the natural state with respect to the direction orthogonal to the longitudinal direction of the guiding catheter 10A (the direction of arrow A in FIG. 1) is the shape portion 32 when the distal end portion 30 is disposed in the renal artery 50. Is larger than the inner diameter of the aorta 42 in which is disposed. Accordingly, the width W of the shape portion 32 is set to, for example, about 12 to 40 mm, preferably set to about 14 to 30 mm, and more preferably set to about 15 to 26 mm. By setting the width W in this way, when the distal end portion 30 is disposed in the target renal artery 50, the first abutting portion 16 and the second abutting portion 18 are connected to the inner walls of the aorta 42 facing each other. It can be made to contact.

  The distal end portion 30 is curved from the first contact portion 16 and extends in a direction opposite to the second contact portion 18. It is preferable that the distal end portion 30 is more flexible than the catheter main body 12 at the proximal end side of the distal end portion 30. Since the distal end portion 30 is a portion that is inserted and arranged in the renal artery 50, the distal end portion 30 is highly flexible, so that it is difficult to damage the inner wall of the renal artery 50. Further, in the catheter body 12, the portion of the proximal end side with respect to the distal end portion 30 is preferably improved in flexibility toward the distal end direction. With this configuration, it is possible to improve blood vessel followability when passing a blood vessel having a large curvature and to obtain good torque transmission.

  The catheter body 12 may have an inner layer and an outer layer formed outside the inner layer. In this case, the inner layer can be made of a synthetic resin having appropriate flexibility. Examples of the constituent material of the inner layer include fluorine resins such as PFA (a copolymer of tetrafluoroethylene and perfluoroalkoxyethylene) and PTFE (polytetrafluoroethylene). Examples of the constituent material of the outer layer include polyolefin (for example, polyethylene, polypropylene, polybutene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, ionomer, or a mixture of two or more thereof), polyvinyl chloride, Examples thereof include a polymer material such as polyamide, polyester, polyester elastomer, polyamide elastomer, polyurethane, polyurethane elastomer, polyimide, fluorine resin, or a mixture thereof. A reinforcing layer may be provided between the inner layer and the outer layer. In this case, the reinforcing layer may be configured by a mesh-like blade in which fine wires made of metal or resin are interwoven.

  The guiding catheter 10A is inserted into the blood vessel while confirming its position under fluoroscopy. For this reason, it is preferable to mix | blend the radiopaque material like barium sulfate, bismuth oxide, tungsten, etc. with the material which comprises the said catheter main body 12, for example.

  The guiding catheter 10A according to the present embodiment is basically configured as described above. Next, the operation and effect will be described. Hereinafter, a procedure for reducing blood pressure by partially damaging the sympathetic nerve around the renal artery 50 in relation to the method of using the guiding catheter 10A will be described. In the following description, right (right side) and left (left side) mean the right (right side) and left (left side) of the patient.

  In this procedure, first, a guiding catheter 10A configured as described above is provided (providing step). Next, the guiding catheter 10A is inserted from the artery of the arm, and the distal end portion 30 is placed in the renal artery 50 via the aorta 42 (placement step). Specifically, in the placement step, a catheter introducer (introducer sheath) (not shown) is inserted into the artery of the patient's arm prior to introducing the guiding catheter 10A into the artery (brachial artery or radial artery) of the patient's arm. Puncture into.

  Next, the guide wire 39 is inserted into the guiding catheter 10A, and the guiding catheter 10A with the guide wire 39 inserted is inserted into the catheter introducer. Then, the distal end of the catheter body 12 is inserted into the blood vessel with the guide wire 39 preceding the distal end of the catheter body 12.

  Next, while performing imaging under X-ray fluoroscopy, the guiding catheter 10A and the guide wire 39 are run in the blood vessel, and as shown in FIG. 2, the brachiocephalic artery 40 passes through the aortic arch 44 and descending aorta 45. Thus, the distal end portion 30 of the guiding catheter 10A is made to reach the vicinity of the left and right renal arteries 50 (50R, 50L). Note that when the distal end of the catheter body 12 passes through the bent portion of the blood vessel, an operation in which the guide wire 39 is put in and out and the guiding catheter 10A is advanced and retracted and rotated is appropriately combined. Reference numeral 54 denotes left and right kidneys.

  In FIG. 2, the bending portion 22 of the guiding catheter 10A is stretched by the guide wire 39 inserted into the guiding catheter 10A, and thus has a substantially linear shape. Then, the tip of the guide wire 39 is directed to the renal artery opening 51 of the target renal artery 50R, the guide wire 39 is inserted into the target renal artery 50R, and the guide wire 39 is guided along the guide wire 39 as shown in FIG. The ding catheter 10A is inserted into the renal artery 50R.

  Next, the first contact portion 16 and the second contact portion 18 are brought into contact with the inner wall of the aorta 42 on the abdomen side of the heart 52 (contact step). Specifically, when the guide wire 39 is pulled out from the catheter body 12, the bending portion 22 attempts to return to the original curved shape shown in FIG. As shown in FIG. 4, the first contact portion 16 and the second contact portion 18 are formed on the inner wall of the aorta 42 in a state where the distal end portion 30 is disposed in the renal artery 50R as shown in FIG. Abut.

  Specifically, the first contact portion 16 and the second contact portion 18 are located in the abdominal aorta 48, and the inner wall of the aorta 42 on the same side as the renal artery 50R into which the distal end portion 30 is inserted (see FIG. In the illustrated example, the first abutting portion 16 abuts on the right inner wall) and the second inner wall of the aorta 42 (on the left inner wall in the illustrated example) located on the opposite side of the renal artery 50R into which the distal end portion 30 is inserted. The contact part 18 contacts. In the case of this embodiment, more specifically, both the first contact portion 16 and the second contact portion 18 are in contact with the caudal side of the left and right renal artery openings 51.

  As a result, backup support is provided at the first contact portion 16 and the second contact portion 18. That is, the first abutting portion 16 and the second abutting portion 18 are connected to each other by the shape portion 32 configured in a substantially U shape trying to expand in the abdominal aorta 48 based on the elastic restoring force. Abutting against the mutually opposing inner walls of the aorta 48, a high backup force is generated. Due to this backup force, the curved portion 22 of the catheter body 12 is well fixed to the abdominal aorta 48, so that the distal end portion 30 is unlikely to come off from the renal artery opening 51.

  After the distal end portion 30 is placed in the renal artery 50R by the above operation, the guide wire 39 is completely removed from the guiding catheter 10A, and a Y connector (not shown) attached to the rear end of the hub 14 is removed. A contrast medium is injected through. The injected contrast medium passes through the lumen 13 and is ejected from the distal end opening into the renal artery 50R, which is the target site. Thereby, the insertion position of the distal end portion 30 into the renal artery 50R can be confirmed, and the renal artery 50R can be imaged.

  Next, as shown in FIG. 5, the ablation device 56 is inserted into the renal artery 50R via the rear end portion of the Y connector and the lumen 13. The ablation device 56 has a long and flexible shaft 58 and an electrode portion 60 provided at the tip of the shaft 58. The ablation device 56 is connected to a high-frequency power source (not shown) outside the body, and can apply a high-frequency voltage to the electrode unit 60 under the action of the high-frequency power source.

  Then, the electrode portion 60 is brought into contact with the inner wall of the renal artery 50R, and energy by a high frequency voltage is applied to the electrode portion 60, so that the region where the electrode portion 60 is in contact and the peripheral region are around the renal artery 50R. Cauterize the sympathetic nerve. The cauterized sympathetic nerve is damaged and its transmission function is blocked.

  In this way, a treatment for applying energy to the sympathetic nerve and cauterizing and damaging it is performed at a plurality of locations in the renal artery 50R. Thereafter, the ablation device 56 and the guiding catheter 10A are pulled out from the patient's blood vessel to the outside of the body, and a treatment for closing the wound of the arm is performed, and the procedure is finished.

  In this case, according to the guiding catheter 10A according to the present embodiment, the first contact portion 16 and the second contact portion 18 are connected to the abdominal aorta 48 in a state where the distal end portion 30 is disposed in the target renal artery 50. Contact the inner wall. For this reason, the vibration of the catheter body 12 due to the influence of the pulsation of the heart 52 and the pulsating flow of blood can be suppressed.

  In particular, in the case of a guiding catheter, the same side as the target renal artery 50 in a state where the distal end portion 30 is disposed in the target renal artery 50 and the distal end portion 30 is disposed in the target renal artery 50. The first contact portion 16, which is the contact portion closest to the tip portion 30, contacts the inner wall of the aorta 42, and the second contact portion 18 contacts the inner wall of the aorta 42 on the opposite side.

  Thus, since the first contact portion 16 closest to the distal end portion 30 disposed in the target renal artery 50 contacts the inner wall of the aorta 42 on the same side as the renal artery 50, the heart beats. Even under the situation where the aorta 42 repeatedly expands and contracts due to the generated blood pressure fluctuation, the distal end portion 30 hardly moves relative to the renal artery 50 where the distal end portion 30 is disposed. That is, when the aorta 42 is expanded and contracted in the radial direction, the renal artery 50 where the distal end portion 30 is disposed moves by approximately the same distance in substantially the same direction as the inner wall of the aorta 42 with which the first contact portion 16 contacts. Relative movement hardly occurs between the distal end portion 30 and the renal artery 50. Therefore, it is possible to suppress the movement of the catheter tip due to the expansion / contraction of the aorta 42 caused by the blood pressure fluctuation generated by the heartbeat.

  Thus, when the ablation device 56 is inserted into the guiding catheter 10A and the ablation treatment is performed on the living tissue (sympathetic nerve) by the electrode part 60 at the tip, the vibration of the electrode part 60 with respect to the target renal artery 50 is caused. It can be suppressed and stabilized. Therefore, the impedance at the time of application of thermal energy is stabilized, and the thermal energy can be applied in the intended range. Further, desired heat energy per unit area can be given to the inner surface of the blood vessel, and the intended effect is easily obtained.

  In the case of this embodiment, the first contact portion 16 and the second contact portion 18 are in the abdominal aorta 48 with the distal end portion 30 disposed in the target renal artery 50. Accordingly, the first abutting portion 16 and the second abutting portion 18 abut on a portion of the aorta 42 away from the heart 52. For this reason, it is difficult for the pulsation of the heart 52 to be transmitted to the catheter body 12, and the vibration of the catheter body 12 can be further suppressed.

  Furthermore, in the case of the present embodiment, the first abutment portion 16 and the second abutment portion 18 abut on the caudal side of the inner wall of the aorta 42 rather than the left and right renal artery openings 51, so that the catheter body 12 is stabilized. Supported. Therefore, the vibration of the catheter tip can be effectively suppressed.

  As shown in FIG. 5, the catheter body 12 may further include a third contact portion 34 that contacts the head side of the inner wall of the aorta 42 with respect to the renal artery opening 51. When such a third contact portion 34 is provided, the catheter body 12 is stably fixed to the aorta 42, and vibration of the catheter tip can be more effectively suppressed.

  As described above, the width W (see FIG. 1) of the shape portion 32 in the natural state in the direction orthogonal to the longitudinal direction of the guiding catheter is the shape when the distal end portion 30 is disposed in the target renal artery 50. It is larger than the inner diameter of the aorta 42 where the portion 32 is disposed. For this reason, the shape part 32 in the catheter main body 12 can be reliably brought into contact with the mutually opposing inner walls of the aorta 42, and the catheter main body 12 is stably fixed to the aorta 42.

  The distal end portion 30 of the guiding catheter 10A is disposed in the left renal artery 50L, and the ablation device 56 is inserted into the left renal artery 50L via the guiding catheter 10A, and energy is applied from the electrode portion 60. Thus, the sympathetic nerve around the renal artery 50L may be damaged. In this case, the first contact portion 16 and the second contact portion 18 are located in the abdominal aorta 48 and are located on the inner wall (left inner wall) of the aorta 42 on the same side as the renal artery 50L into which the distal end portion 30 is inserted. The first contact portion 16 contacts, and the second contact portion 18 contacts the inner wall (right inner wall) of the aorta 42 located on the opposite side of the renal artery 50L into which the distal end portion 30 is inserted.

  In the above description, the procedure for introducing the guiding catheter 10A from the artery of the right arm has been described. However, the guiding catheter 10A may be introduced from the artery of the left arm. Even when the guiding catheter 10A is introduced from the left arm artery, the distal end portion 30 can be disposed with respect to both the right and left renal arteries 50.

[Second Embodiment]
FIG. 6 is a partially omitted plan view of a renal artery guiding catheter 10B (hereinafter referred to as “guiding catheter 10B”) according to a second embodiment of the present invention. In the guiding catheter 10B according to the second embodiment, elements having the same or similar functions and effects as those of the guiding catheter 10A according to the first embodiment are denoted by the same reference numerals, and detailed description thereof is omitted. To do.

  A guiding catheter 10B according to the second embodiment includes a shape control mechanism 64 and differs from the guiding catheter 10A according to the first embodiment in that a structure related to the shape control mechanism 64 is provided in the catheter body 12. . The shape control mechanism 64 is a mechanism for bringing the shape portion 32 into a desired curved state.

  The shape control mechanism 64 includes a pulling wire 66 having a distal end connected to the shape portion 32 and disposed at least partially along the catheter body 12. Specifically, the pulling wire 66 has a distal end 66 a fixed to the first contact portion 16 and is disposed along the catheter body 12 on the proximal end side with respect to the second contact portion 18. The pulling wire 66 is a flexible linear member, and can be made of, for example, a metal material, a resin material, or the like.

  A middle portion of the pulling wire 66 is slidably inserted into a wire lumen 68 provided in the main body portion 20 of the catheter main body 12. A proximal end side 66 b of the pulling wire 66 is drawn from a proximal end opening of a wire lumen 68 provided in the vicinity of the proximal end of the catheter body 12. Thereby, in a state where the guiding catheter 10B is inserted into the blood vessel of the patient, the operator (user) grasps and pulls the proximal end side of the pulling wire 66 to pull the pulling wire 66 in the proximal direction. And move operation.

  In the guiding catheter 10B including the shape control mechanism 64 configured as described above, the pulling wire 66 moves in the proximal direction with respect to the catheter body 12 when the pulling wire 66 is pulled in the proximal direction. Accordingly, the width W (see FIG. 1) of the shape portion 32 becomes smaller. Thus, even when the ablation device 56 is inserted into the guiding catheter 10B, the shape portion 32 can be brought into a desired curved state by the action of the shape control mechanism 64.

  Although the ablation device 56 is flexible, it has a certain degree of rigidity (rigidity). Therefore, when the ablation device 56 is inserted into the guiding catheter 10B, the shape portion 32 tends to expand. The aorta 42 receives this force of spreading. When the force for spreading is large, the load on the aorta 42 increases. Therefore, the first contact portion 16 is pulled by pulling the pulling wire 66 outside the patient's body. If it does so, the width W of the shape part 32 will become small, and the shape part 32 can be made into a desired curved state.

  As described above, even when the ablation device 56 is inserted into the guiding catheter 10B, the shape part 32 is deformed by the repulsive force of the ablation device 56 by restricting the deformation of the shape part 32 by the action of the shape control mechanism 64. It can be prevented from spreading too much. As a result, the load on the aorta 42 can be reduced while obtaining an appropriate backup force. In particular, in the case of this embodiment, the bending state of the shape portion 32 can be controlled with a simple structure using the pulling wire 66.

  The method of using the guiding catheter 10B according to the second embodiment is the same as the method of using the guiding catheter 10A according to the first embodiment, except for the part related to the operation of the shape control mechanism 64 described above.

  In the second embodiment, as for the respective components common to the first embodiment, the same operations and effects as those provided by the respective common components in the first embodiment can be obtained. is there.

[Modification]
In the guiding catheter 10A according to the first embodiment or the guiding catheter 10B according to the second embodiment, instead of the bending portion 22, the bending portions 22a to 22a according to the first to fourth modifications shown in FIGS. 7A to 8B. Any configuration of 22d may be provided.

  The bending portion 22a according to the first modification shown in FIG. 7A includes a first contact portion 16a and a second contact portion 18a. The first contact portion 16a is located on the same side as the renal artery 50 where the distal end portion 30 is disposed in a state where the distal end portion 30 is disposed in the target renal artery 50 (the right renal artery 50R in the case of FIG. 7A). The inner wall contacts the caudal part of the renal artery opening 51. The second abutting portion 18a has an inner wall opposite to the side on which the distal end portion 30 is disposed in a state where the distal end portion 30 is disposed in the target renal artery 50 (in the case of FIG. 7A, the right renal artery 50R). Among these, it contacts the part of the head side from the renal artery opening 51.

  7A, the first contact portion 16a closest to the distal end portion 30 disposed in the target renal artery 50 is also on the same side as the renal artery 50, as in the above-described embodiments. It contacts the inner wall of the aorta 42. For this reason, it is possible to suppress the movement of the distal end of the catheter due to the expansion / contraction of the aorta 42 caused by the blood pressure fluctuation generated by the pulsation of the heart.

  The bending portion 22b according to the second modification shown in FIG. 7B includes a first contact portion 16b and a second contact portion 18b. The first contact portion 16b is located on the same side as the renal artery 50 where the distal end portion 30 is disposed in a state where the distal end portion 30 is disposed in the target renal artery 50 (in the case of FIG. 7B, the right renal artery 50R). The inner wall of the abdominal aorta 48 abuts on a portion of the inner wall of the abdominal aorta 48 that is more cranial than the renal artery opening 51. The second contact portion 18b is an abdomen opposite to the side on which the distal end portion 30 is disposed in a state where the distal end portion 30 is disposed in the target renal artery 50 (in the case of FIG. 7B, the right renal artery 50R). It has the 2nd contact part 18b contact | abutted to the caudal part rather than the renal artery opening 51 among the inner walls of the aorta 48.

  7B, the first contact portion 16b closest to the distal end portion 30 disposed in the target renal artery 50 is also on the same side as the renal artery 50, as in the above-described embodiments. It contacts the inner wall of the aorta 42. For this reason, it is possible to suppress the movement of the distal end of the catheter due to the expansion / contraction of the aorta 42 caused by the blood pressure fluctuation generated by the pulsation of the heart.

  The bending portion 22c according to the third modification shown in FIG. 8A includes a first contact portion 16c and a second contact portion 18c. The first contact portion 16c is located on the same side as the renal artery 50 where the distal end portion 30 is disposed in a state where the distal end portion 30 is disposed in the target renal artery 50 (the right renal artery 50R in the case of FIG. 8A). The inner wall of the abdominal aorta 48 abuts on a portion of the inner wall of the abdominal aorta 48 that is more cranial than the renal artery opening 51. The second abutting portion 18c is abdomen opposite to the side on which the distal end portion 30 is disposed in a state where the distal end portion 30 is disposed in the target renal artery 50 (the right renal artery 50R in the case of FIG. 8A). Of the inner wall of the aorta 48, it abuts on the head side of the renal artery opening 51.

  8A, the first contact portion 16c closest to the distal end portion 30 disposed in the target renal artery 50 is also on the same side as the renal artery 50, as in the above-described embodiments. It contacts the inner wall of the aorta 42. For this reason, it is possible to suppress the movement of the distal end of the catheter due to the expansion / contraction of the aorta 42 caused by the blood pressure fluctuation generated by the pulsation of the heart.

  The bending portion 22d according to the fourth modification shown in FIG. 8B includes a first contact portion 16d and a second contact portion 18d. The first contact portion 16d is located on the same side as the renal artery 50 where the distal end portion 30 is disposed in a state where the distal end portion 30 is disposed in the target renal artery 50 (in the case of FIG. 8B, the right renal artery 50R). The inner wall of the abdominal aorta 48 abuts on a portion of the inner wall of the abdominal aorta 48 that is more cranial than the renal artery opening 51. The second abutting portion 18d has a second abutting portion 18d that abuts against a portion of the inner wall of the abdominal aorta 48 opposite to the side on which the distal end portion 30 is disposed, on the head side of the renal artery opening 51. . The curved portion 22 has a loop, and the second contact portion 18 constitutes a part of the loop.

  8B, the first contact portion 16d closest to the distal end portion 30 disposed in the target renal artery 50 is located on the same side as the renal artery 50, as in the above-described embodiments. It contacts the inner wall of the aorta 42. For this reason, it is possible to suppress the movement of the distal end of the catheter due to the expansion / contraction of the aorta 42 caused by the blood pressure fluctuation generated by the pulsation of the heart.

  In addition, in each curved part 22a-22d which concerns on a 1st-4th modification, the 3rd contact part 34 shown in FIG. 5 may be provided.

  In the above description, the present invention has been described with reference to preferred embodiments and modifications. However, the present invention is not limited to the above embodiments and modifications, and various modifications can be made without departing from the scope of the present invention. Needless to say, it is possible.

DESCRIPTION OF SYMBOLS 10A, 10B ... Renal artery guiding catheter 12 ... Catheter body 16, 16a-16d ... 1st contact part 18, 18a-18d ... 2nd contact part 22, 22a-22d ... Curved part 28 ... Middle part 32 ... Shape portion 34 ... third contact portion 64 ... shape control mechanism 66 ... pulling wire

Claims (11)

A guiding catheter for a renal artery that is inserted into a blood vessel from an artery of an arm and introduces the distal end portion into the renal artery via the aorta,
The distal end portion is provided, and includes a flexible catheter body,
The catheter body is
A first abutting portion that abuts an inner wall of the aorta on the side of the renal artery when the distal end portion is disposed in the target renal artery;
A second abutting portion that abuts against an inner wall of the aorta opposite to the side of the renal artery on the inner wall of the aorta when the distal end is disposed in the target renal artery; Have
The first contact portion is located closest to the distal end portion among a plurality of contact portions that contact the inner wall of the aorta,
A guiding catheter for renal arteries. The guiding catheter for renal artery according to claim 1,
The first contact portion and the second contact portion contact the inner wall of the abdominal aorta,
A guiding catheter for renal arteries. In the renal artery guiding catheter according to claim 1 or 2,
The first contact portion and the second contact portion contact the caudal side of the inner wall of the aorta rather than the right and left renal artery openings;
A guiding catheter for renal arteries. The guiding catheter for renal artery according to claim 3,
The catheter body further includes a third contact portion that contacts the head side of the inner wall of the aorta with respect to the renal artery mouth,
A guiding catheter for renal arteries. In the guiding catheter for renal artery according to any one of claims 1 to 4,
The catheter body has a shape portion including the first contact portion, the second contact portion, and an intermediate portion connecting the first contact portion and the second contact portion,
The width of the shape portion in the natural state with respect to the direction perpendicular to the longitudinal direction of the guiding catheter for the renal artery is the width of the aorta where the shape portion is disposed when the distal end portion is disposed in the renal artery. Larger than the inner diameter,
A guiding catheter for renal arteries. In the renal artery guiding catheter according to claim 5,
A shape control mechanism for bringing the shape portion into a desired bending state;
A guiding catheter for renal arteries. The guiding catheter for renal artery according to claim 6,
The shape control mechanism includes a pulling wire that is fixed along the catheter main body on the proximal end side with respect to the second contact portion while a distal end is fixed to the first contact portion.
When the puller wire is pulled in the proximal direction, the width of the shape portion decreases as the puller wire moves in the proximal direction with respect to the catheter body.
A guiding catheter for renal arteries. A method for using a guiding catheter for a renal artery,
Providing the renal artery guiding catheter with a catheter body capable of contacting a plurality of locations on the inner wall of the aorta;
Placing the guiding catheter for the renal artery from the artery of the arm, and placing the distal end portion in the renal artery via the aorta; and
The first abutting portion of the catheter body is brought into contact with the inner wall of the aorta on the side of the renal artery on which the distal end portion is disposed, and the distal end portion is disposed on the inner wall of the aorta. Abutting step of abutting the second abutting portion of the catheter body on the inner wall opposite to the side of the renal artery,
The first contact portion is located closest to the distal end portion among a plurality of contact portions that contact the inner wall of the aorta,
A method for using a guiding catheter for a renal artery. The method of using a guiding catheter for renal artery according to claim 8,
In the contact step, the first contact portion and the second contact portion are contacted to the inner wall of the abdominal aorta,
A method for using a guiding catheter for a renal artery. The method of using a guiding catheter for renal artery according to claim 8 or 9,
In the abutting step, the first abutting part and the second abutting part are brought into contact with the caudal side of the inner wall of the aorta rather than the left and right renal artery openings,
A method for using a guiding catheter for a renal artery. The method of using a guiding catheter for renal artery according to claim 10,
In the abutting step, the third abutting portion of the catheter body is abutted on the head side of the inner wall of the aorta with respect to the renal artery opening.
A method for using a guiding catheter for a renal artery.

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