JP2016049267A - Vascular endoscope catheter and vascular endoscope using the same - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a vascular endoscope catheter, which has an outer diameter insertable into various types of blood vessels and which allows a guide wire to be inserted into a blood vessel without requiring experience and extremely advanced technique of an operator, and provide a vascular endoscope using the same.SOLUTION: A vascular endoscope catheter and a vascular endoscope using the same are disclosed. The vascular endoscope catheter comprises a flexible lumen body. The lumen body comprises: a flexible guide wire which is disposed so as to become an eccentric shaft in an axial cross section of the lumen body at a distal end of the lumen body, and can extend in a distal direction from the distal end of the lumen body along an axial direction of the lumen body; and a fiber bundle which consists of a plurality of glass fibers accommodated in the lumen body, and in which distal ends of the glass fibers are oriented along the axial direction of the lumen body, respectively. The outer diameter of the lumen body is between 0.1 mm and 2 mm.SELECTED DRAWING: Figure 2

Description

  The present invention relates to a vascular endoscope catheter and a vascular endoscope using the same, and more specifically, a vascular endoscope catheter with improved operator operability and reduced risk of vascular perforation, and the like. The present invention relates to a blood vessel endoscope using the above.

  It is desirable that angioscopes and bronchial endoscopes have a smaller diameter catheter than gastrointestinal endoscopes, depending on the size of the lumen used. For this reason, these small-diameter endoscopes have limitations in incorporating a system for driving the distal end of the catheter, so that only the distal end is driven by itself as in a so-called stomach camera or colonic fiber. It is difficult to point in the direction. In this regard, vascular endoscopes and bronchial endoscopes have been developed under the same technical idea that is completely different from gastrointestinal endoscopes.

  For example, in a conventional endovascular operation, a guide wire having flexibility with respect to a blood vessel is first inserted to reach a desired position, and then another catheter including an endoscope is provided along the guide wire. There are known ways to reach it.

However, the guide wire is inserted by such a method using only a two-dimensional image obtained by fluoroscopy from the outside with respect to the target blood vessel, and is performed under the experience and extremely high skill of the operator. For this reason, in this way,
(1) Since a guide wire is inserted while estimating a desired location, it takes a long time, and it takes time to insert and remove a guide wire, so that the burden on the patient is great and the fluoroscopic time is required. The amount of exposure will inevitably increase;
(2) When inserting into a blood vessel, guidewire insertion must rely on the operator's “sense”, and it is not possible to objectively predict whether the guidewire is oriented in an appropriate direction. Is possible;
(3) Even if it is performed by an operator with advanced skills and experience, this method leaves the risk that the distal end of the guide wire may perforate the inner wall of the blood vessel and cause serious complications. ing.

  In recent years, intravascular ultrasonic catheters having several ultrasonic probes have been developed.

  For example, as shown in FIG. 16A, a blood vessel including a guide wire 714 that can be extended from the distal end 712 and an ultrasonic probe 716 provided around the axis of the catheter at the distal end 712. An inner ultrasound catheter 710 is known.

  The intravascular ultrasound catheter 710 shown in FIG. 16A senses the presence or absence of the stenosis 812 in the blood vessel 810 and the surface condition by detecting the reflected wave of the ultrasound oscillated from the ultrasound probe 716. It can be imaged as a dimensional image. However, this catheter 710 can only image the surface conditions around the axis of the catheter. That is, since the ultrasonic wave from the ultrasonic probe 716 is not oscillated in the traveling (extending) direction of the guide wire 714 inserted into the blood vessel 810, the forward direction of the catheter distal end 712 (that is, the guide wire 714) The state of progress or extension) is not visualized through the image, and insertion of the guidewire 714 still relies on the operator's experience and very high skill.

  On the other hand, a new technique called “intravascular forward vision ultrasound catheter” has also been proposed. This is because, as shown in FIG. 16B, in the intravascular ultrasound catheter 720, the ultrasound probe 726 is configured in the distal end 722 so as to be directed in the direction in which the guide wire 724 advances or extends. Yes. Since the ultrasonic wave from the ultrasonic probe 726 is oscillated in the forward direction of the catheter distal end 722 (that is, in the direction of advancement or extension of the guide wire 724), the stenosis 812 or the like is forward in the forward direction of the catheter distal end 722. Is present, the reflected wave can be visualized through the image. Furthermore, by using such an image, the danger of perforating the narrowed portion 812 at the distal end of the guide wire 724 can be avoided. However, such an intravascular ultrasound catheter 720 cannot form an image when there is no portion that generates a reflected wave such as the stenosis in the blood vessel 810 (FIG. 16C), Insertion of the guide wire 724 still relies on the operator's experience and very high skill.

  On the other hand, a vascular endoscope catheter is known that includes an image fiber oriented in the direction of catheter movement and a light guide at the distal end without providing a guide wire as described above (patent) References 1 and 2). The catheters described in Patent Documents 1 and 2 also include a flush channel for introducing flush liquid.

  However, the catheters described in Patent Documents 1 and 2 must have an outer diameter with a certain thickness due to their configuration, and the size of a blood vessel that can be practically inserted is limited. Further, by not using the guide rail, the tip of the blood vessel endoscope may damage the blood vessel wall, and it is difficult to carry the blood vessel endoscope to the target blood vessel. Damaged blood vessel walls cause thrombus formation and stenosis, and it is important to deliver a blood vessel endoscope to a target site without applying frictional stimulation to the blood vessel wall. Even with such a configuration, a separate guide wire is required, and even if it is not necessary to damage the blood vessel wall, insertion of the blood vessel endoscope still requires extremely high skill of the operator. Furthermore, there is a possibility that the procedure time, the amount of exposure due to X-ray transmission increase, and the use of a large amount of contrast agent may result.

JP-A-2-124127 JP-A-2-124128

  An object of the present invention is to solve the above-mentioned problems. The object of the present invention is to have an outer diameter that can be inserted into a variety of blood vessels, and experience and extremely high skill of the operator. It is an object of the present invention to provide a vascular endoscope catheter and a vascular endoscope using the same, in which a guide wire can be inserted into a blood vessel without the need for a blood vessel.

The present invention is a vascular endoscope catheter comprising a flexible lumen body,
Where the lumen body is:
A guide wire having flexibility, which is arranged to be an eccentric shaft in an axial section of the lumen body at the distal end of the lumen body, and from the distal end of the lumen body A guide wire capable of extending in a distal direction along an axial direction of the lumen body; and a fiber bundle composed of a plurality of glass fibers housed in the lumen body, the glass fiber And a bundle of fibers, each of which is oriented along the axial direction of the lumen body, and wherein the outer diameter of the lumen body is 0.1 mm to 2 mm.

  In one embodiment, the outer diameter of the glass fiber constituting the fiber bundle is 5 μm to 500 μm.

  In one embodiment, the fiber bundle is composed of 3000 to 30000 glass fibers.

  In one embodiment, the vascular endoscopic catheter of the present invention further includes a flexible cylindrical cover portion, and the lumen body is slidable within the cover portion and It is provided so that it can extend in the distal direction along the axial direction.

  In a further embodiment, the cover part is transparent.

  In a further embodiment, the outer diameter of the cover part is 0.3 mm to 3 mm.

  In one embodiment, a gap capable of supplying fluid is provided between the cover portion and the lumen body.

  In one embodiment, the lumen body integrally includes an auxiliary lumen for inserting the guide wire therein.

  In a further embodiment, the auxiliary lumen has an inner diameter of 0.25 mm to 1 mm.

  In one embodiment, the lumen body has a plurality of side holes at positions within 50 mm on the proximal end side along the axial direction from the distal end of the lumen body.

  The present invention is also a blood vessel endoscope including a hollow handle portion including a fluid supply port and the catheter slidably disposed in the handle portion.

  According to the present invention, it is possible to insert into a wider variety of blood vessels without necessarily requiring an extremely high level of skill in performing the operation, and the risk of perforation of the blood vessel wall during insertion of the guide wire is reduced. Further reduction can be achieved. Thereby, occurrence of complications in endovascular surgery can be prevented. Furthermore, according to the present invention, dependence on X-ray fluoroscopy can be reduced or eliminated when inserting a guide wire. Thereby, a patient's X-ray exposure amount can be reduced significantly.

It is the figure which represented typically an example of the blood vessel endoscope containing the blood vessel endoscope catheter of this invention. It is a figure for demonstrating an example of the vascular endoscope catheter of this invention shown in FIG. 1, Comprising: It is a figure which represents typically the distal end vicinity of the said catheter. It is a figure showing the axial cross section of the cover part which comprises the blood vessel endoscope catheter of this invention, and a luminal body, Comprising: It is a figure which shows typically the cross section of the luminal body in A-A 'of FIG. It is a figure showing the axial cross section of the lumen main body which comprises the vascular endoscope catheter of this invention, Comprising: It is a figure which shows typically the cross section of the lumen main body in B-B 'of FIG. It is sectional drawing of the axial direction of the said catheter in the vicinity of the distal end of the vascular endoscope catheter of this invention shown in FIG. It is the figure which represented typically the other example of the vascular endoscope containing the vascular endoscope catheter of this invention, Comprising: (a) is the axis | shaft of the said catheter in the distal end vicinity of the vascular endoscope catheter, It is sectional drawing of the orthogonal direction, and (b) is an axial sectional view of the catheter in the vicinity of the distal end of the vascular endoscope catheter. It is the figure which represented typically the other example of the vascular endoscope containing the vascular endoscope catheter of this invention, Comprising: (a) is the axis | shaft of the said catheter in the distal end vicinity of the vascular endoscope catheter, It is sectional drawing of the orthogonal direction, and (b) is an axial sectional view of the catheter in the vicinity of the distal end of the vascular endoscope catheter. It is the figure which represented typically the other example of the vascular endoscope containing the vascular endoscope catheter of this invention. It is the figure which represented typically another example of the blood vessel endoscope containing the blood vessel endoscope catheter of this invention. It is a figure for demonstrating an example of the vascular endoscope catheter of this invention shown in FIG. 9, Comprising: It is a figure which represents typically the distal end vicinity of the said catheter. It is a figure showing the axial cross section of the cover part which comprises the blood vessel endoscope catheter of this invention, and a luminal body, Comprising: It is a figure which shows typically the cross section of the luminal body in C-C 'of FIG. It is sectional drawing of the axial direction of the said catheter in the vicinity of the distal end of the vascular endoscope catheter 320 of this invention shown in FIG. It is the figure which represented typically another example of the blood vessel endoscope containing the blood vessel endoscope catheter of this invention. It is a figure for demonstrating an example of the vascular endoscope catheter of this invention shown in FIG. 13, Comprising: It is a figure which represents typically the distal end vicinity of the said catheter. FIG. 11 is a diagram schematically showing a state in which a vascular endoscope catheter (corresponding to the catheter of the present invention shown in FIG. 10) is inserted into a blood vessel by using the vascular endoscope of the present invention. It is a figure explaining the state which the catheter of invention reached | attained the branch part in the blood vessel, (b) is an example of the two-dimensional image displayed on the monitor when the catheter of this invention exists in the position of (a) (C) is a figure explaining the state which extends the guide wire from the catheter of this invention, and makes the said wire approach into a desired blood vessel, and (d) is a figure explaining the state to (c) position. It is a figure which shows an example of the two-dimensional image displayed on a monitor in case the catheter of invention exists. It is a schematic diagram explaining the state in which the conventional intravascular ultrasonic catheter passes in the blood vessel, (a) is an intravascular ultrasonic catheter in which an ultrasonic probe is arranged around the axis of the catheter at the distal end of the catheter. It is a figure which shows the state which passes the inside of a blood vessel, (b) is the state which passes the inside of the blood vessel which has the stenosis part in the intravascular ultrasonic catheter by which the ultrasonic probe was arrange | positioned in the catheter forward direction in the catheter distal end. (C) is a diagram showing a state in which an intravascular ultrasonic catheter in which an ultrasonic probe is arranged in the forward direction of the catheter at the distal end of the catheter passes through a blood vessel not having a stenosis. .

  Hereinafter, the present invention will be described with reference to the drawings.

  FIG. 1 is a diagram schematically showing an example of a vascular endoscope including the vascular endoscope catheter of the present invention.

  As shown in FIG. 1, the vascular endoscope 100 includes a catheter 120 that is slidably disposed within a handle portion 102.

  The handle portion 102 is a hollow component including the fluid supply port 104, and is made of, for example, a resin or metal material. The outer diameter of the handle portion 102 is not particularly limited, but is designed to have a size (for example, 5 mm to 20 mm) suitable for the operator to grasp. The outer shape does not necessarily have a columnar shape, and may have an arbitrary shape with excellent grip.

  The inner diameter of the handle portion 102 is designed to a size that matches the outer diameter of a vascular endoscope catheter described later. The fluid supply port 104 communicates with a hollow portion of the handle portion 102, and various fluids commonly used for intravascular surgery provided as a flush solution (e.g., physiological saline, Ringer's solution, low molecular weight dextran, contrast agent), The handle 104 and subsequent catheter 120 can be fed through the port 104. Although the internal diameter of the fluid supply port 104 is not specifically limited, For example, they are 2 mm-10 mm. The handle portion 102 may be, for example, a commercially available Y connector or T connector.

  In the vascular endoscopic catheter 120 of the present invention, the proximal end of the catheter communicates with the distal end of the handle portion 102. Here, in the present invention, the vascular endoscope catheter 120 and the handle portion 102 may be integrally formed, or may be appropriately combined with each other.

  Here, the term “proximal” used in the present specification is a term representing the position of the instrument and the device, and when the operator uses the instrument or the device, The term “distal” refers to the part near the surgeon, and the term “distal” refers to the position of the instrument and the device, and when the instrument or device is used by the surgeon, , Point to the operator on the far side. Further, as used herein, the term “proximal end” refers to the proximal end of such instruments and devices, and the term “distal end” refers to such instruments and devices. Point to the distal end.

  The vascular endoscope catheter 120 of the present invention shown in FIG. 1 includes, for example, a flexible cylindrical cover portion 122, a flexible lumen main body 124 and a guide wire accommodated in the cover portion 122. 126.

  FIG. 2 is a view for explaining an example of the vascular endoscopic catheter 120 of the present invention shown in FIG. 1 and schematically showing the vicinity of the distal end of the catheter.

  In FIG. 2, in the vascular endoscope catheter 120, the lumen main body 124 slidably passes through the cylindrical cover portion 122 and can extend in the distal direction along the axial direction of the cover portion 122. . Here, the cover portion 122 has a length from the distal end to the proximal end (that is, the connecting portion with the distal end of the handle portion 102 shown in FIG. 1), for example, 100 cm to 250 cm, preferably 120 cm to Designed to be 230 cm. In the vascular endoscope catheter 120 shown in FIG. 2, both the lumen main body 124 and the cylindrical cover portion 122 have a substantially circular cross-sectional shape. The cross-sectional shape is not necessarily a perfect circle shape, and may be, for example, an elliptical shape.

  The outer diameter of the cover portion 122 can be designed to have an arbitrary size that can pass through the blood vessel according to the inner diameter of the blood vessel in which the vascular endoscope catheter of the present invention is used. The outer diameter of the cover part is preferably 0.3 mm to 3 mm, more preferably 0.5 mm to 1.8 mm. The inner diameter of the cover part 122 is designed to a size that allows the lumen main body 124 to be inserted, and is not necessarily limited, but is, for example, 0.2 mm to 2.5 mm, more preferably 0.4 mm to 1.6 mm. . The cover portion may be, for example, a commercially available guiding catheter or sheathless catheter.

  For example, the cover portion 122 can directly observe the blood vessel wall through the cover portion while passing through the cover portion, and can be safely covered without damaging the blood vessel wall when the endoscope is moved back and forth. It is preferable that it is transparent because the blood vessel wall can be observed in a state where the endoscope is housed in the inside, and a flexible material such as polyurethane, vinyl chloride, or fluorine resin is used. It is configured.

  The lumen body 124 is designed so that the length from the distal end to the proximal end is, for example, 101 cm to 280 cm, preferably 140 cm to 250 cm. The proximal end of the lumen body 124 protrudes from the proximal end of the handle portion 102 as shown in FIG. The operator grasps the lumen body 124 protruding from the handle portion 102 and pushes or pulls the lumen body 124 distally or proximally, thereby sliding the lumen body 124 within the cover portion 122 and the cover portion 122. The extension of the lumen body 124 from the distal end can be controlled.

  Referring to FIG. 2 again, the outer diameter of the lumen main body 124 may be designed to have any size that can pass through the cover portion 122 according to the inner diameter of the cover portion 122. The outer diameter of the lumen main body 124 is 0.1 mm to 3 mm, preferably 0.5 mm to 2 mm.

  FIG. 3 is a diagram showing an axial cross section of the cover portion and the lumen main body constituting the vascular endoscope catheter of the present invention, and schematically showing a cross section of the lumen main body at AA ′ in FIG. 2. It is. In this embodiment, the inner diameter of the cover portion 122 and the outer diameter of the lumen body 124 are the fluid supplied from the port of the handle portion between the inner surface 123 of the cover portion 122 and the outer surface 125 of the lumen body 124. It is preferable that the gap is designed to form a gap that can pass through. For example, a fluid such as flush liquid is allowed to pass between the handle portion 102 and the lumen main body 124 at the handle portion 102 from the fluid supply port 104 of the handle portion 102 shown in FIG. This is because the fluid passes through the body 124 and flows out from the distal end of the cover portion 122.

  Referring to FIG. 2 again, the inner diameter of the lumen main body 124 is not necessarily limited, but is, for example, 0.1 mm to 3 mm, more preferably 0.3 mm to 1.8 mm. Furthermore, the lumen main body 124 is made of a flexible material, for example, a material such as polyimide or a fluorine resin.

  In the vascular endoscopic catheter 120 of the present invention, the lumen body 124 includes a guide wire 126 that can extend from the distal end of the lumen body 124 in the distal direction along the axial direction of the lumen body 124; And a fiber bundle 130 composed of a plurality of glass fibers 132 accommodated in the lumen main body 124. The distal end of the fiber bundle 130 is connected to a lens 133 provided on the lens guide 131. Light from the outside can be transmitted to each glass fiber 132 in the fiber bundle 130 through the lens 133. In FIG. 2, the lens guide 131 includes a ring-shaped guide 136 at the lower end, and a guide wire 126 passes through the guide 136.

  The blood vessel endoscope catheter 120 of the present invention is also preferably within 50 mm on the proximal end side along the axial direction from the distal end (distal end) of the lumen body 124 for the purpose of increasing the efficiency of blood removal during use. More preferably, a plurality of side holes 129 are provided on the outer periphery at a position within 30 mm. The side holes are preferably, for example, elliptical from the viewpoint of flush liquid injection efficiency and durability of the cover, and have a shape in which the axial direction of the catheter coincides with the long axis of the ellipse. As a result, a transparent layer made of a flush liquid is formed between the flowing blood and the observation part, and the inside of the blood vessel can be observed more clearly without obstructing the visual field by the blood.

  The size of the side hole 129 is not necessarily limited because it depends on the outer diameter of the lumen main body 124, but may be designed such that the inscribed radius is, for example, 0.05 mm to 0.3 mm. The number of the side holes 129 is not necessarily limited, but in order to appropriately maintain the strength of the lumen body 124, for example, 1 to 5 per circumference on the outer circumference of the lumen body 124, preferably 2 per circumference. ~ 4 pieces are provided. Alternatively, the side holes 129 are provided at substantially equal intervals so as to have, for example, an angle of 180 °, 120 °, 90 °, or 75 ° per circumference in the circular cross section of the lumen main body 124. Such side holes 129 are provided on the outer periphery of the lumen main body 124, for example, for one to three turns, preferably one to two turns. When the side holes 129 are provided on the outer periphery of the lumen main body 124 over a plurality of circumferences, the side holes 129 arranged on each circumference are not necessarily provided in alignment along the axial direction of the lumen main body 124. It may be provided at random or shifted in position. For example, a side hole in an adjacent circumference (for example, the second round) is arranged at a position corresponding to between two adjacent side holes provided in a certain circumference (for example, the first round). It may be provided.

  4 is a diagram showing an axial cross section of the lumen main body 124 constituting the vascular endoscopic catheter 120 of the present invention, and schematically showing a cross section of the lumen main body 124 at BB ′ in FIG. It is.

  As shown in FIG. 4, the guide wire 126 is disposed at a position that is an eccentric axis in this axial section (that is, a position that deviates from the central axis in the axial section of the lumen main body 124). By arranging the guide wire 126 at such a position in the axial cross section, an image indicating the further distal side from the distal end of the lumen main body 124 created through the glass fiber described later is blocked by the guide wire 126. Therefore, it is possible to ensure a good field of view.

  The guide wire 126 is designed so that the length from the distal end to the proximal end is, for example, 150 cm to 300 cm, preferably 170 cm to 190 cm. Moreover, the axial cross section of the guide wire 126 has a substantially circular shape, and the diameter is designed to have, for example, 0.2 mm to 0.9 mm, preferably 0.35 mm to 0.46 mm. Further, the guide wire 126 is made of a flexible material such as stainless steel, polyimide, or platinum.

  In the present invention, the guide wire 126 is slidable back and forth (in the direction from the distal end to the proximal end and / or from the proximal end to the distal end) along the axial direction of the lumen body 124. Further, it can be arbitrarily rotated around the axis of the lumen main body 124. The guide wire 126 also extends to the outside of the lumen body 124 on the proximal side, and the surgeon can grasp this portion to insert and move the guide wire 126. In addition, the guidewire 126 may extend from the lumen body 124 to prevent excessive insertion into the blood vessel, for example, at a suitable location on the proximal side of the guidewire that extends from the proximal end of the handle portion 102. A stopper (for example, a protrusion) (not shown) may be provided on. An X-ray opaque marker for determining the length inserted into the blood vessel may be provided near the distal end of the lumen main body 124 or the guide wire 126. Alternatively, a scale may be provided near the proximal end of the guide wire 126.

  In the fiber bundle 130, each glass fiber 132 is preferably arranged so as to form one bundle in the lumen main body 124 and to be distributed substantially evenly in the bundle. The glass fiber 132 constituting the fiber bundle 130 has a length from the distal end to the proximal end substantially the same as that of the lumen main body 124, that is, for example, 101 cm to 280 cm, preferably 140 cm to 250 cm. Designed to be. The axial cross section of the glass fiber 132 has a substantially circular shape, and the outer diameter is, for example, 5 μm to 500 μm, preferably 20 μm to 350 μm. In the present invention, the fiber bundle is composed of a plurality of glass fibers, preferably 3000 to 30000, more preferably 6000 to 20000 glass fibers. In the present invention, by using a plurality of glass fibers in this way, the light collection rate is improved, and a two-dimensional image in the blood vessel obtained through the fiber bundle can be displayed more clearly. By increasing the number, the image quality becomes clearer and the quality of examination treatment can be improved. The glass fibers are preferably multicomponent glass fibers.

  FIG. 5 is a sectional view in the axial direction of the catheter in the vicinity of the distal end of the vascular endoscope catheter 120 of the present invention shown in FIG.

In FIG. 5, the distal end of a fiber bundle 130 composed of a plurality of glass fibers is optically connected to a lens 133 in a lens guide 131 provided at the distal end of the lumen body 124. Thereby, the distal end of each glass fiber in the fiber bundle 130 is oriented along the axial direction of the lumen body 124. On the other hand, the guide wire 126 can extend and be accommodated along the axial direction of the lumen main body 124 from the distal end of the lumen main body 124 through the guide 136 provided in the lens guide 131. The maximum length that the guide wire 126 can extend from the lumen body 124 (ie, the maximum length L1 _max from the distal end of the guide wire 126 to the distal end of the lumen body 124) is the guide wire 126. Although not necessarily limited because it varies depending on the length of the lumen main body 124, for example, 0.5 cm to 20 cm, preferably 1 cm to 10 cm. Such a maximum length L1 _max is preferably designed to be longer than the horizontal visibility in the blood vessel through the fiber bundle 130 composed of a plurality of glass fibers.

Further, the lumen body 124 itself can also extend from the distal end of the cover portion 122. The maximum length that the lumen main body 124 can extend from the cover portion 122 (that is, the maximum length L2 _max from the distal end of the lumen main body 124 to the distal end of the cover portion 122) is the guide wire tube. Although it is not necessarily limited because it varies depending on the lengths of the cavity main body 124 and the cover portion 122, it is, for example, 0 mm to 200 mm, preferably 2 mm to 150 mm.

  In the present invention, the distal ends of the guide wire 126, the lumen body 124, and the cover portion 122 are also rounded so as not to damage tissue in the blood vessel when inserted into the blood vessel. It is preferably processed so as to have a different shape. Furthermore, it is preferable that surface treatment such as hydrophilic coating is performed in order to improve slippage in the blood vessel. A fastener (not shown) for moving the cover portion 122 and the lumen main body 124 in an integrated manner so as to increase the efficiency of blood removal and not damage the blood vessel wall is provided in front of the handle portion. Also good. At this time, it is preferable that the fastener can be easily fixed and released.

  In FIG. 5, the fiber bundle 130 and the guide wire 126 are arranged together in the lumen main body 124, but the present invention is not limited to this form. For example, even if the section in which the fiber bundle 130 made of glass fiber is disposed in the lumen main body 124 and the section in which the guide wire 126 is disposed are completely separated by a partition wall (not shown). Good.

  FIG. 6 is a view schematically showing another example of a vascular endoscope including the vascular endoscope catheter of the present invention.

  As shown in FIG. 6 (a), the vascular endoscope catheter 160 of the present invention has a lumen main body 124 penetrating through the cover portion 122, similar to the vascular endoscope catheter 120 shown in FIG. Yes. Furthermore, in the vascular endoscopic catheter 160 of the present invention, an auxiliary guide tube 162 made of a flexible material such as polyimide or fluorine-based resin is provided in the lumen main body 124.

  The auxiliary guide tube 162 is preferably integrally formed to have a fiber lumen 164 that accommodates a fiber bundle 130 similar to that shown in FIG. 4 and a wire lumen 166 that accommodates the guide wire 126. ing.

  As shown in FIG. 6B, the vascular endoscope catheter 160 of the present invention is provided with a lens 133 on the fiber lumen 164 side at the distal end of the auxiliary guide tube 162, and through the lens 133. Light from the outside can be transmitted to each glass fiber in the fiber bundle 130.

  The inner diameter of the fiber lumen 164 constituting the auxiliary guide tube 162 is, for example, 0.1 mm to 3 mm, preferably 0.3 mm to 0.8 mm. The inner diameter of the wire lumen 166 constituting the auxiliary guide tube 162 is, for example, 0.25 mm to 1 mm, preferably 0.4 mm to 0.5 mm. The length from the distal end to the proximal end of the auxiliary guide tube 162 is designed to be substantially the same as that of the lumen main body 124, that is, for example, 101 cm to 280 cm, preferably 140 cm to 250 cm. Yes. However, the length of the wire lumen 166 is desirably designed to be, for example, 1 mm to 300 mm, more preferably 3 mm to 50 mm, in order to improve the operability of the wire.

  In the vascular endoscope catheter 160 of the present invention shown in FIGS. 6A and 6B, fluid such as blood or flush fluid passes through a gap between the lumen main body 124 and the auxiliary guide tube 162, for example. can do. Therefore, the fiber bundle 130 and the guide wire 126 can be appropriately separated from these fluids via the auxiliary guide tube 162.

  By having such a configuration, the blood vessel endoscope catheter 160 of the present invention can be used even if blood or the like in the blood vessel enters the lumen main body 124 as the guide wire 126 extends and is accommodated. It is possible to prevent intrusion into the arranged section where the bundle 130 is arranged. In the vascular endoscopic catheter 160 of the present invention shown in FIGS. 6A and 6B, the lumen main body 124 and the auxiliary guide tube 162 can be slid independently from each other. For example, the auxiliary guide The tube 162 can extend from the distal end of the lumen body 124.

  FIG. 7 is a diagram schematically showing another example of a blood vessel endoscope including the blood vessel endoscope catheter of the present invention.

  As shown in FIG. 7 (a), the vascular endoscope catheter 180 of the present invention has a lumen main body 182 passing through the cover portion 122, similar to the vascular endoscope catheter 120 shown in FIG. Yes.

  The lumen main body 182 accommodates a fiber bundle 130 similar to that shown in FIG. Lumen body 182 is also integrally formed with an auxiliary lumen 184 extending axially therein. The auxiliary lumen 184 includes a guide 186 for receiving the guide wire 126 therein.

  As shown in FIG. 7B, the vascular endoscope catheter 180 of the present invention is provided with a lens 133 via a lens guide 188 at the distal end of the fiber bundle 130, and externally passes through the lens 133. Can be transmitted to each glass fiber in the fiber bundle 130.

  The inner diameter of the guide 186 in the auxiliary lumen 184 provided in the lumen main body 182 (that is, the inner diameter of the auxiliary lumen 184) is, for example, 0.25 mm to 1 mm, preferably 0.4 mm to 0.5 mm. is there. The length from the distal end to the proximal end of the lumen body 182 is designed to be substantially the same as that of the lumen body 124, that is, for example, 101 cm to 280 cm, preferably 140 cm to 250 cm. Yes. However, regarding the length of the auxiliary lumen 184, in order to improve the operability of the wire, for example, it is desirable that the length is designed to be 1 mm to 300 mm, preferably 3 mm to 50 mm.

  In the vascular endoscopic catheter 180 of the present invention shown in FIGS. 7A and 7B, the fluid such as blood and flush fluid is, for example, a gap inside the lumen main body 124 and outside the auxiliary lumen 184. Can pass through. This allows the guidewire 126 to be properly isolated from these fluids via the auxiliary lumen 184.

  By having such a configuration, the vascular endoscopic catheter 180 of the present invention extends and accommodates the guide wire 126 in a state where it is separated from the blood and flush fluid flowing in the lumen main body 182. Can do. Further, in the vascular endoscope catheter 180 of the present invention shown in FIGS. 7A and 7B, the lumen main body 182 and the fiber bundle 130 can be slid independently of each other. It is also possible to extend from the distal end of the lumen body 182 as long as the blood vessels are not damaged.

  FIG. 8 is a diagram schematically showing another example of a vascular endoscope including the vascular endoscope catheter of the present invention.

  In the vascular endoscope 200 shown in FIG. 8, the vascular endoscope catheter 220 includes a cover portion 222, a flexible lumen main body 224 and a guide wire 226 accommodated in the cover portion 222. In the vascular endoscopic catheter 200 shown in FIG. 8, other configurations are shown in FIG. 1 except that the distal end of the guide wire 226 provided in the lumen body 224 is curved with an arbitrary curvature. It is the same as what is there.

  By having the guide wire 226 having such a curved distal end, for example, when the guide wire 226 is inserted into one lumen of a branched blood vessel using the vascular endoscope catheter 220 of the present invention, the guide wire 226 is guided. By rotating wire 226 about the axis of lumen body 224, it can be more easily inserted into the desired branch vessel.

  FIG. 9 is a diagram schematically showing still another example of the vascular endoscope including the vascular endoscope catheter of the present invention.

  As shown in FIG. 9, the blood vessel endoscope 300 includes a blood vessel endoscope catheter 320 that is slidably disposed in the handle portion 302.

  The handle portion 302 is the same as the handle portion 102 shown in FIG. Furthermore, it is also provided with a fluid supply port 304 for supplying fluid to the distal end of the cover part 322 and the vicinity of the distal end of the lumen body 324 through the gap between the cover part 322 and the lumen body 324. 1 is the same as the fluid supply port 104 shown in FIG.

  In the vascular endoscopic catheter 320 of the present invention, the proximal end of the catheter communicates with the distal end of the handle portion 302. Further, the vascular endoscope catheter 320 includes a cylindrical cover portion 322 having flexibility similar to the cover portion 122 shown in FIG. 1 and a flexible lumen main body 324 accommodated in the cover portion 322. And a guide wire 326.

  FIG. 10 is a view for explaining an example of the vascular endoscope catheter 320 of the present invention shown in FIG. 9, and schematically shows the vicinity of the distal end of the catheter.

  In FIG. 10, in the vascular endoscope catheter 320, the lumen main body 324 can slidably pass through the cylindrical cover portion 322, and can extend in the distal direction along the axial direction of the cover portion 322. . Here, the length, the outer diameter, the inner diameter, and the material from the distal end to the proximal end of the cover portion 322 are all the same as those of the cover portion 122 shown in FIG.

  The lumen body 324 has a guide rail portion 340 that penetrates the guide wire 326 at a portion of the distal end. Further, the fiber bundle 330 is fixed in the lens guide 331 and is optically connected to a lens 333 provided in the lens guide 331. In the guide rail portion 340, the guide wire 326 penetrates at a position that becomes an eccentric axis in the axial cross section near the distal end of the lumen main body 324 (that is, the axial cross section of the guide rail portion 340). By arranging the guide wire 326 at such a position in the axial cross section, an image indicating the distal side further from the distal end of the lumen body 324 created through the glass fiber constituting the fiber bundle 330 is a guide. A good visual field can be ensured without being blocked by the wire 326.

  The lumen main body 324 has a cylindrical shape only in a predetermined length from the distal end to the proximal direction of the lumen main body 324 corresponding to the guide rail portion 340, and the guide wire 326 is exposed at other portions. The cylinder has a structure in which a part of the cylinder is cut out in the axial direction. The length (axial length) of the guide rail portion 340 in the lumen main body 324 is not necessarily limited, but is, for example, 5 mm to 300 mm, preferably 1 mm to 50 mm. In the configuration shown in FIG. 10, the length of the guide wire 326 penetrating through the lumen body 324 is significantly shorter than the length of the guide wire 126 shown in FIG. ing. This reduces the contact area between the guide wire 326 and the lumen body 324 and makes it easier to move the lumen body 324 along the guide wire 326 in the distal and / or proximal directions. In the present invention, the guide wire 326 is also slidable back and forth (in the direction from the distal end to the proximal end and / or from the proximal end to the distal end) along the axial direction of the lumen body 324. . Further, it can be arbitrarily rotated around the axis of the lumen body 324.

  Note that the length, the outer diameter (corresponding to the outer diameter of the guide rail portion 326), the inner diameter, and the material from the distal end to the proximal end of the lumen main body 324 are all shown in FIG. The same as that of the main body 124. Further, the length, axial cross-sectional shape, diameter and material of the guide wire 326 are the same as those of the guide wire 126 shown in FIG.

  The vascular endoscopic catheter 320 of the present invention is also preferably within 50 mm from the distal end (distal end) of the lumen main body 324 to the proximal end side along the axial direction for the purpose of increasing the efficiency of blood removal during use. More preferably, a plurality of side holes 329 are provided on the outer periphery within 30 mm. The shape, size, arrangement mode, and number of the side holes 329 are the same as those of the side holes 129 shown in FIG.

  FIG. 11 is a diagram illustrating an axial cross section of a cover portion and a lumen main body constituting the vascular endoscope catheter of the present invention, and schematically showing a cross section of the lumen main body at CC ′ in FIG. 10. It is. In this embodiment, the inner diameter of the cover portion 322 and the outer diameter of the lumen body 324 are the fluid supplied from the port of the handle portion between the inner surface 323 of the cover portion 322 and the outer surface 325 of the lumen body 324. It is preferable that the gap is designed to form a gap that can pass through.

  In the vascular endoscopic catheter 320 of the present invention, the lumen body 324 extends from the distal end of the lumen body 324 in the distal direction along the axial direction of the lumen body 324; A fiber bundle 330 including a plurality of glass fibers 332 housed in the lumen body 324.

  In the fiber bundle 330, each glass fiber 332 is preferably arranged so that each glass fiber 332 forms one bundle within the lumen body 324 and is distributed substantially evenly within the bundle. The length and diameter from the distal end to the proximal end of the glass fiber 332 constituting the fiber bundle 330 are the same as those of the glass fiber 132 shown in FIG.

  12 is a cross-sectional view in the axial direction of the catheter in the vicinity of the distal end of the vascular endoscopic catheter 320 of the present invention shown in FIG.

In FIG. 12, the distal end of a fiber bundle 330 composed of a plurality of glass fibers is optically connected to a lens 333 in a lens guide 331 provided at the distal end of the lumen body 324. Thereby, the distal end of each glass fiber in the fiber bundle 330 is directed along the axial direction of the lumen body 324, respectively. On the other hand, the guide wire 326 can extend and be accommodated along the axial direction of the lumen body 324 from the distal end of the lumen body 324 through the guide 336 provided on the distal end side of the guide rail portion 340. . The maximum length that the guide wire 326 can extend from the lumen body 324 is the same as the maximum length L1 _max that the guide wire 126 can extend from the lumen body 124.

Further, the lumen body 324 itself can also extend from the distal end of the cover portion 322. The maximum length that the lumen main body 324 can extend from the cover portion 322 is the same as the maximum length L2 _max that the lumen main body 124 can extend from the cover portion 122.

  FIG. 13 is a diagram schematically showing still another example of a blood vessel endoscope including the blood vessel endoscope catheter of the present invention.

  As shown in FIG. 13, the blood vessel endoscope 400 includes a catheter 420 that is slidably disposed in the handle portion 402.

  The handle portion 402 is the same as the handle portion 102 shown in FIG. On the other hand, in the vascular endoscopic catheter 420 of the present invention shown in FIG. 13, the proximal end of the catheter communicates with the distal end of the handle portion 402. Further, the vascular endoscopic catheter 420 includes a flexible lumen main body 424 and a guide wire 426 without providing a cover portion.

  FIG. 14 is a view for explaining an example of the vascular endoscopic catheter 420 of the present invention shown in FIG. 13, and schematically showing the vicinity of the distal end of the catheter.

  In FIG. 14, in the vascular endoscope catheter 420, the lumen main body 424 has a guide rail portion 440 through which the guide wire 426 penetrates at a part of the distal end. Further, the fiber bundle 430 is fixed in the lens guide 431 and optically connected to a lens 433 provided in the lens guide 431. In the guide rail portion 440, the guide wire 426 penetrates at a position serving as an eccentric axis in the axial cross section near the distal end of the lumen main body 424 (that is, the axial cross section of the guide rail portion 440). By arranging the guide wire 426 at such a position in the axial cross section, an image indicating the distal side further from the distal end of the lumen body 424 created through the glass fiber constituting the fiber bundle 430 is guided. A good visual field can be secured without being blocked by the wire 426.

  The lumen main body 424 has a cylindrical shape only in a predetermined length from the distal end to the proximal direction of the lumen main body 424 corresponding to the guide rail portion 440, and the guide wire 426 is exposed at other portions. For example, it has a structure in which a part of a cylinder is cut out in the axial direction. The length (axial length) of the guide rail portion 440 in the lumen body 424 is not necessarily limited, but is, for example, 3 mm to 230 mm, preferably 30 mm to 100 mm. In the configuration shown in FIG. 14, the length of the guide wire 426 penetrating through the lumen main body 424 is significantly shorter than the length of the guide wire 126 shown in FIG. 2 penetrating through the lumen main body 124, for example. Yes. This reduces the contact area between the guidewire 426 and the lumen body 424, making it easier to move the lumen body 424 along the guidewire 426 in the distal and / or proximal directions. In the present invention, the guide wire 426 is also slidable back and forth (in the direction from the distal end to the proximal end and / or from the proximal end to the distal end) along the axial direction of the lumen body 424. . Further, it can be arbitrarily rotated around the axis of the lumen body 424.

  The length, the outer diameter (corresponding to the outer diameter of the guide rail portion 426), the inner diameter, and the material from the distal end to the proximal end of the lumen main body 424 are all shown in FIG. The same as that of the main body 124. Further, the length, axial cross-sectional shape, diameter, and material of the guide wire 426 are the same as those of the guide wire 126 shown in FIG.

  The vascular endoscope catheter 420 of the present invention is also preferably within 50 mm from the distal end (distal end) of the lumen body 424 to the proximal end side along the axial direction for the purpose of enhancing the efficiency of blood removal during use. More preferably, a plurality of side holes 429 are provided on the outer periphery within 30 mm. The shape, size, arrangement mode, and number of the side holes 429 are the same as those of the side holes 129 shown in FIG.

  In the vascular endoscopic catheter 420 of the present invention, the lumen body 424 includes a guide wire 426 that can extend from the distal end of the lumen body 424 in the distal direction along the axial direction of the lumen body 424; And a fiber bundle 430 composed of a plurality of glass fibers accommodated in the lumen main body 424.

  In the fiber bundle 430, each glass fiber is preferably arranged so as to form one bundle in the lumen body 424 and to be distributed substantially evenly in the bundle. The length and diameter from the distal end to the proximal end of the glass fibers constituting the fiber bundle 430 are the same as those of the glass fibers 132 shown in FIG.

In the vascular endoscope catheter 420 shown in FIG. 14, the distal end of the glass fiber is optically connected to a lens 433 in a lens guide 431 provided at the distal end of the lumen body 424. As a result, the distal ends of the glass fibers are oriented along the axial direction of the lumen body 424, respectively. On the other hand, the guide wire 426 can extend and be accommodated along the axial direction of the lumen main body 424 from the distal end of the lumen main body 424 through the guide 436 provided on the distal end side of the guide rail portion 440. . The maximum length that the guide wire 426 can extend from the lumen body 424 is the same as the maximum length L1 _max that the guide wire 126 can extend from the lumen body 124.

  The vascular endoscope catheter of the present invention is slidably disposed in the hollow handle portion having the fluid supply port as described above, and can be used as a vascular endoscope.

  In the blood vessel endoscope thus obtained, the proximal end of the glass fiber is connected to an image display device (not shown) or the like by a method known to those skilled in the art. Thereby, the visual field at the distal end of the glass fiber can be displayed as a two-dimensional image.

  As described above, the vascular endoscopic catheter of the present invention uses a plurality of glass fibers, but the fiber is used for purposes other than image formation (for example, a light guide for vascular endoscope insertion and intravascular observation). ) Can be used. When the glass fiber is used as a light guide, a glass fiber having a diameter larger than that of the image fiber may be mounted in order to improve the light transmission efficiency and the durability of the endoscope.

  Next, an example of how to use the vascular endoscope of the present invention will be described.

  FIG. 15 is a diagram schematically showing a state in which a vascular endoscope catheter (corresponding to the catheter of the present invention shown in FIG. 10) is inserted into a blood vessel using the vascular endoscope of the present invention.

  With respect to the catheter 320 inserted into the blood vessel, the operator carefully pushes the guide wire 326 while preserving the trajectory of the lumen body 324 in advance while viewing the two-dimensional image displayed through the glass fiber. Here, for example, when the catheter 320 reaches the branching portion in the blood vessel 610 as shown in FIG. 15A, the operator images the branched blood vessels 612 and 614 displayed on the monitor through the glass fiber. The tip 327 of the guide wire 326 can be directed in a target direction by pushing and pulling the guide wire 326 back and forth and / or rotating around the axis while viewing (FIG. 15B). Thereafter, the guide wire 326 is further extended ((c) in FIG. 15), and it is confirmed that the guide wire 326 has entered in a desired direction ((d) in FIG. 15). Move along 326.

  In this way, the surgeon can move the vascular endoscope catheter of the present invention to a desired position without relying on conventional sensations or X-ray fluoroscopy means. The vascular endoscopic catheter of the present invention can reduce the amount of exposure for patients and medical workers, and can also suppress the amount of contrast medium used. This is useful, for example, in cases with renal dysfunction or allergic predisposition.

  Furthermore, the above method is particularly useful when the vessel wall surface is dissociated, highly calcified or stenotic due to arteriosclerosis, or completely obstructed. . In highly stenotic lesions, the guide wire is advanced slightly, and then the vascular endoscope is followed to provide a good back-up (reaction force) for the guide wire as well as the forward visual field. Thus, the vascular endoscope can follow the guide wire and pass through the stenotic region in a progressive manner without damaging the blood vessel wall. In such an application, in order to stably operate the guide wire in the blood vessel, it is desirable that the length of the guide through which the guide wire passes is 30 mm or more.

  The vascular endoscope catheter of the present invention does not necessarily require an extremely high level of skill from the operator, and further reduces the risk of piercing the blood vessel wall during the insertion of the guide wire, thereby allowing more various blood vessels. Can be inserted. In addition to being useful for vascular endoscopy, the catheter of the present invention has other lumens (eg, oral cavity, nostril, esophagus, gastrointestinal tract, bile duct, gallbladder, spleen, rectum, colon, bronchi and the like) It is also useful as an endoscopic catheter for the periphery, fallopian tube, uterus, vagina, urethra, ureter, bladder).

100, 200, 300, 400 Vascular endoscope 102, 302, 402 Handle portion 104, 304 Fluid supply port 120, 220, 320, 420 Catheter 122, 222, 322 Cover portion 124, 224, 324, 424 Lumen body 126 , 226, 326, 426 Guide wire 130, 330, 430 Fiber bundle 131 Lens guide 132, 332 Glass fiber 133, 333, 433 Lens 340, 440 Guide rail

Claims (11)

A vascular endoscopic catheter comprising a flexible lumen body;
Where the lumen body is:
A guide wire having flexibility, which is arranged to be an eccentric shaft in an axial section of the lumen body at the distal end of the lumen body, and from the distal end of the lumen body A guide wire capable of extending in a distal direction along an axial direction of the lumen body; and a fiber bundle composed of a plurality of glass fibers housed in the lumen body, the glass fiber A fiber bundle, each distal end of which is oriented along the axial direction of the lumen body, and the outer diameter of the lumen body is 0.1 mm to 2 mm.   The vascular endoscope catheter according to claim 1, wherein an outer diameter of the glass fiber constituting the fiber bundle is 5 µm to 500 µm.   The vascular endoscope catheter according to claim 1 or 2, wherein the fiber bundle is composed of 3000 to 30,000 glass fibers.   Further, a cylindrical cover portion having flexibility is provided, and the lumen main body is slidable in the cover portion and can extend in the distal direction along the axial direction of the cover portion. The vascular endoscopic catheter according to any one of claims 1 to 3, which is provided.   The vascular endoscope catheter according to claim 4, wherein the cover portion is transparent.   The vascular endoscope catheter according to claim 4 or 5, wherein an outer diameter of the cover portion is 0.3 mm to 3 mm.   The vascular endoscope catheter according to any one of claims 4 to 6, wherein a gap capable of supplying a fluid is provided between the cover portion and the lumen main body.   The vascular endoscope catheter according to any one of claims 1 to 7, wherein the lumen body integrally includes an auxiliary lumen for inserting the guide wire therein.   The vascular endoscopic catheter according to claim 8, wherein the auxiliary lumen has an inner diameter of 0.25 mm to 1 mm.   The intravascular body according to any one of claims 1 to 9, wherein the lumen body has a plurality of side holes at positions within 50 mm on the proximal end side along the axial direction from the distal end of the lumen body. Endoscopic catheter. A hollow handle with a fluid supply port;
A blood vessel endoscope comprising: the catheter according to claim 1 slidably disposed in the handle portion.

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