JPH09285546A - Catheter - Google Patents

Abstract

PROBLEM TO BE SOLVED: To dispense with the lateral replacing operation of a catheter by putting a slidable outer jacket on a Judkins type contrast catheter, and changing the angle form by the movement of the outer jacket. SOLUTION: An outer jacket (outer cylinder) 20 is put on a Judkins type contrast catheter 1, and an expanding and contracting mechanism for the outer jacket 20 is provided between a reinforcing tube 21 and the catheter body 1. The angle 1c in the housing of the catheter body 1 has the same form as the angle of left cornary artery Judkins type contrast catheter, and since the bent part of the catheter lis gradually housed in the outer jacket 20 and extended as the outer jacket 20 is fed out, the angle 1c has the same form as the angle of right cornary artery Judkins type contrast catheter.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a catheter, more specifically, for example, Coronary Angiography (hereinafter referred to as CAG), Percutaneous Transluminal Corona.
The present invention relates to a catheter used in ry angioplasty (percutaneous coronary angioplasty, hereinafter abbreviated as PTCA) and the like.

[0002]

2. Description of the Related Art FIG. 6 shows a conventional Judkins-type contrast catheter used for CAG. FIG. 6 (A) is for the left coronary artery (referred to as JL catheter), and FIG. 6 (B) is for the right coronary artery (JR catheter). Referred to (usually 100 in length
cm × outer diameter 4 Fr to 6 Fr × angle length 4 cm is used). In the figure, 1 is a catheter body, 2 is a reinforcing tube for preventing kink when operating a catheter (usually a tube that is 2 Fr thicker than a catheter is used), and 3 is a manifold connecting to a rotating adapter (described later). It is a screw tightening type connection connector that is possible, and it is a wing type for easy attachment and detachment. Reference numeral 1a is a left coronary artery-specific angle for guiding the catheter tip to the left coronary artery ostium, and 1b is a right coronary artery-specific angle for guiding the catheter tip to the right coronary artery ostium. To be distinguished.

FIG. 7 is a diagram for explaining a guide wire / kid used for CAG (usually, for CAG, a 135 cm length × 0.035 ″ diameter with a J-shaped tip is used. In the figure, 4 is a J-type guide wire, 5 is a straightener (introduction tube), and 6 is a guide wire holder .. The guide wire 4 is inserted into the catheter 1 so that it has its own angle (1a, 1b). )
The purpose of the catheter 1 is to straighten the tip of the catheter 1 and to smoothly guide the catheter 1 from the small blood vessel to the aorta, or vice versa. The J-shaped portion at the tip is provided for smoother running in the blood vessel.

The straightener 5 is provided for the purpose of smoothing the J-shaped guide wire 4 by inserting the J-shaped guide wire 4 into the catheter 1. Also, a spiral type guide wire holder 6
Is for accommodating the guide wire 4 in order to facilitate handling of the guide wire 4 having a length of about 135 cm.

FIG. 8 is a view for explaining a manifold (three-way three-way stopcock with a rotating adapter). In the figure, 7 is a three-way three-way stopcock, and 8 is attached to the tip of the three-way three-way stopcock 7. This adapter 8 and the connector 3 for connection shown in FIG. 6 are connected by a rotating adapter, but in order to prevent twisting during insertion operation of the catheter 1, it is configured to rotate integrally with the catheter 1. There is. The three-way three-way stopcock 7 can be used for injecting a drug solution through a syringe, bleeding air from the catheter 1, and measuring blood pressure transmitted from the catheter 1 without having to reattach the catheter 1 while switching individual stopcocks. It can be done.

Next, a method of operating the contrast catheter in CAG will be described. 9 to 18 are diagrams for explaining the operation from the left coronary angiography to the end of the right coronary angiography, in which the same reference numerals as those in FIGS. 6 to 8 denote the same or corresponding portions. First, in order to perform left coronary angiography, FIG.
The J-type guide wire 4 is inserted into the left coronary artery Judkins-type contrast catheter (JL catheter) shown in (A). This operation is performed by the straightener 5 as shown in FIG.
Take out the guide wire 4 and the holder 6 a little,
This is performed by straightening the J-shaped portion at the tip of the guide wire 4 with the straightener 5, inserting it from the connector 3, and sending out the inside of the catheter 1.

Then, the catheter 1 guided by the guide wire 4 is guided to the aorta, and when the catheter 1 reaches the aorta, the guide wire 4 is pulled out all at once as shown in FIG. It is dipped into the tray 9 containing heparin-added saline as shown in FIG.

Then, as shown in FIG. 12, the adapter 3 of the three-way three-way stopcock 7 is connected to the connector 3 to operate the stopcock, and the air in the catheter 1 is sucked and removed using a syringe. When the guide wire 4 is pulled out from the catheter 1 guided into the aorta, the tip of the catheter 1 is automatically restored to the shape shown in the left-only coronary artery angle 1a of FIG. 6A by the restoring force of the tip-shaped portion. However, since it is guided to the vicinity of the left coronary artery port for implantation, it is possible to simply insert and implant the catheter in the left coronary artery port 10 as shown in FIG. 13 only by finely adjusting the position of the catheter 1. And
Although a contrast agent is injected from the left coronary artery port 10 to image the left coronary artery, this operation is omitted because it is not directly related to the present invention.

When the left coronary angiography is completed, FIG.
After removing the connector 3 for connection of the catheter 1 from the adapter 8 as shown in FIG. 15, taking out the guide wire 4 and the straightener 5 that had been washed with the tray 9 as shown in FIG. 15, after wiping the guide wire 4 with gauze 11. ,
As shown in FIG. 16, a straightener (introduction tube) 5 is inserted from the rear of the guide wire 4 and fed into the catheter 1 from the connector 3 for connection as shown in FIG. After confirming that the catheter 1 has been stretched, the catheter 1 is pulled out of the blood vessel, and the guide wire 4 is pulled out from the catheter 1 in the same manner as in FIG. 10, and in the tray 9 containing heparinized saline as in FIG. Soak in.

Next, right coronary angiography is performed. For right coronary angiography, a right Judkins type contrast catheter (JR catheter) for coronary arteries is taken out, and the above-described operations of FIGS. 9 to 12 are performed to insert the tip of the catheter 1 into the aorta. And pulling out the J-shaped guide wire 4 from the catheter 1, the angle of the distal end of the catheter 1 is automatically changed by the restoring force of the distal end shape portion as described above, and the angle 1b for the right coronary artery in FIG. Since it can be restored to the shape shown in Fig. 1 and can be guided to the vicinity of the left coronary artery ostium and landed, the tip of the catheter 1 is inserted into the right coronary artery ostium as shown in Fig. 18 by rotating the catheter by 180 degrees. Can be landed.

FIG. 19 shows a conventional Judkins type guiding catheter with a side hole used in PCTA.
9 (A) shows the one for the left coronary artery, and FIG. 19 (B) shows the one for the right coronary artery (usually, a length of about 100 cm × outside diameter of 6 Fr to 8 Fr × angle length of about 4 cm is used). In the figure,
The same reference numerals as those in FIG. 6 indicate the same or corresponding portions, and 100 is a side hole, which is provided to promote blood from the aorta to the coronary artery via the catheter during the operation.

A guiding catheter with a side hole is a PC
Various types of surgery for the purpose of predicting ischemic (insufficient inflow of blood) shock during TA surgery (severe cases, stenosis of the main coronary artery, and narrow coronary artery ostium as its entrance) When a device (not shown) is inserted, blood can be guided into the coronary artery through the side hole opening 100 to prevent the shock, and safer and more stable PCTA can be performed.

[0013]

The conventional Judkins type contrast catheter for the left and right coronary arteries as described above is easy to handle and has excellent insertion stability, but when performing left and right coronary angiography, the L / R catheter mutual It is necessary to replace the guide wire, and the guide wire attached to the operation is complicated and requires an assistant to handle it.
The burden on the operator is heavy. Especially, in a case where a drug solution load test (check for a patient with a possibility of vasoconstriction attack) that requires replacement operation twice is performed, the burden is doubled.

Further, the conventional guiding catheter with a side hole has the safety indispensable for PCTA since blood can be guided into the coronary artery through the side hole opening and the shock can be prevented. However, a clear image cannot be obtained during contrast enhancement. For this reason, especially during postoperative confirmatory contrast where a clear image is required,
There is a problem that the burden on the operator is heavy, because the method such as reconfirmation imaging is performed again after replacing with another catheter without a side hole.

The present invention has been made in order to solve the above problems, and in the Judkins-type imaging catheter, it is not necessary to replace the left and right catheters, and the guide wire accompanying the operation is complicatedly handled. It is an object of the present invention to provide a contrast catheter capable of reducing the number of times. Another object of the present invention is to provide a guiding catheter which can guide blood into the coronary arteries and prevent its shock while eliminating the need to replace it with another catheter, and which can obtain a clear image during contrast enhancement.

[0016]

According to a first aspect of the present invention, there is provided a catheter according to claim 1, wherein:
Based on the JL catheter, cover the JL catheter with a slidable outer jacket (outer cylinder), and change the angle shape by moving the outer jacket so that it has the functions of both the JL catheter and the JR catheter. It is characterized by having done.

A guiding catheter according to a second aspect is based on a guiding catheter with a side hole, and a guiding sleeve with a side hole is covered with a slidable outer jacket (outer cylinder). It is characterized in that the side holes are opened and closed by expanding and contracting the outer jacket.

[0018]

BEST MODE FOR CARRYING OUT THE INVENTION

Embodiment 1 FIG. Hereinafter, embodiments of the present invention will be described with reference to the drawings. FIG. 1 is a diagram for explaining a first embodiment of the present invention. In the figure, 1 is a catheter, 1c is its angle, and J in the free state is shown in FIG. 6 (A).
It has the same angle shape as the L catheter. 3 is a connector for connection similar to the conventional one, 20 is an outer jacket (outer cylinder) covered by the catheter 1, 21 is a reinforcing tube according to the present embodiment, and is 2 from the catheter body 1.
A tube as thick as Fr is used, and a telescopic mechanism of the outer jacket 20 is provided between the catheter body 1 and the inner diameter of the tube. The size of the outer jacket 20 is set such that the outer diameter thereof is about the main body 1 of the catheter +1 Fr (for example, 6 Fr when the catheter 1 is 5 Fr), and the length thereof is just before the acgle 1c when stored.

FIG. 2 shows the outer jacket 2 shown in FIG.
It is a figure for demonstrating the expansion-contraction mechanism of 0, FIG.2 (A) shows the form at the time of accommodation, FIG.
In the figure, the same reference numerals as those in FIG. 1 indicate the same or corresponding parts, 200 is a stopper for fixing when stored in the outer jacket 20, 201 is a stopper for fixing during delivery, and 211 is a stopper provided for the reinforcing tube 21. It is a holding unit. Although the catheter 1 is omitted in FIG. 2 for easy understanding of the drawing, the rear end of the catheter 1 has a reinforcing tube 21 and a connector 3 for connection.
Needless to say, it is fixed to. As shown in FIG. 2, the outer jacket 20 is stretched over the catheter 1 by an expansion / contraction mechanism having a simple structure that utilizes the difference between the outer diameter of the outer jacket 20 and the inner diameter of the reinforcing tube 21.
It is configured so that it can slide about a cm to expand and contract.

FIG. 3 is a diagram showing a change in the angle 1c due to the movement of the tip of the outer jacket 20 as the outer jacket 20 expands and contracts.
Shows the state when stored, and FIG. 3B shows the operation state when delivered. As shown in FIG. 3, at the time of storage (A), the angle 1c is basically the same as the angle 1a of the JL catheter, but as the outer jacket 20 is sent out, the bent portion of the catheter 1 gradually increases. Since the outer jacket 20 is accommodated in the outer jacket 20 and is stretched, the angle 1c has the same shape as the angle 1b of the JR catheter as shown in FIG. 6B.

That is, the present invention focuses on the fact that the tip shape of the JR catheter basically corresponds to the stretched shape of the JL catheter, and the stretching is performed by moving (extending and contracting) the outer jacket 20. By feeding the outer jacket 20 about 3 cm, the U-shaped portion of the tip of the JL catheter is housed in the outer jacket 20 and stretched to have a shape similar to that of the JR catheter. As a result, it is possible to perform CAG on the left and right without the need to perform a replacement operation.

That is, in the CAG, first, the guide wire 4 is fed from the connecting connector 3 into the catheter 1 as in the case of FIG. 9, and is guided to the aorta. Then, as shown in FIGS.
After the operation of FIG. 12, the left coronary angiography is performed in the same manner as in FIG. After the left coronary angiography is completed, the rear end of the outer jacket 20 is pulled out from the reinforcing tube 21 to change the angle 1c into a shape like the angle 1b. Therefore, the subsequent replacement operation, that is, FIGS. 14 to 17 and FIGS.
1. The operation in each of the 12 steps shown in FIGS. 15 to 17 and 10 to 12 accompanying the insertion of the JR catheter can be eliminated, and the right coronary ostium 11 shown in FIG. 18 can be immediately approached.

Embodiment 2 FIG. Embodiment 2 of the present invention will be described below with reference to the drawings. FIG. 4 is a diagram for explaining the second embodiment of the present invention and corresponds to FIG. 19 of a conventional Judkins type guiding catheter. In the figure, FIG.
The same reference numerals as 9 indicate the same or corresponding parts, 20 is an outer jacket (outer cylinder), 21 is a reinforcing tube, and the outer jacket 20 is expandable and contractable (movable) as in the first embodiment. The expansion / contraction mechanism is provided in the reinforcing tube 21 as in the first embodiment. The guiding catheter according to the second embodiment has a structure in which the side hole 100 is opened and closed instead of changing the shape of the angle by expanding and contracting the outer jacket 20, and as shown in FIG. The outer jacket 20 is accommodated in the inner side of the side hole 100 to open the side hole 100 to guide blood into the coronary arteries to prevent shock. At the time of contrast enhancement, as shown in FIG. 5B, the outer jacket 20 is pulled out to close the side hole 100. Then, a clear image can be obtained by performing contrast.

For this reason, the outer jacket 20 according to the second embodiment is made of a supple and flexible material so that only the side hole 100 can be opened and closed without changing the angle shape. The guiding catheter according to the second embodiment can have both safety during operation and easiness of confirmation after operation by adopting the above-described configuration, and does not require catheter replacement operation during postoperative imaging. Then, simple PTCA can be performed.

That is, in PTCA, the guiding catheter shown in FIG. 5 (A) is inserted into the left coronary artery ostium 10 as described with reference to FIG. 13, and a desired device (not shown) is fed to the target intravascular site. PC in stenosis
Enforce TA. After the PCTA is finished, the outer jacket 20 is pulled out from the reinforcing tube 21, so that the side hole 100 is taken into the outer jacket 20, and the side hole 100 is closed as shown in FIG. It is possible to obtain a clear image by performing confirmation contrast without the need for.

[0026]

The catheter of the present invention, in the contrast catheter according to the first aspect, does not require catheter replacement work in left and right coronary angiography, and can be performed 2-3 times during surgery.
There is an effect that the operator can be relieved from the replacement operation repeatedly performed from 5 times to 6 times, and the operation of handling the guide wire incidental to the operation.

In the guiding catheter according to the second aspect of the present invention, one catheter can be provided with the contradictory functions of safety required during PCTA operation and easiness of confirmation required after surgery. There is an effect that the operator can be freed from the trouble of replacing the catheter and reading the used catheter due to preoperative symptoms.

[Brief description of drawings]

FIG. 1 is a diagram for explaining a contrast catheter according to a first embodiment of the present invention.

FIG. 2 is a diagram for explaining an expansion / contraction mechanism of the outer jacket 20 shown in FIG.

FIG. 3 is a diagram showing how the angle of the catheter shown in FIG. 1 changes.

FIG. 4 is a diagram for explaining a guiding catheter according to a second embodiment of the present invention.

FIG. 5 is a diagram for explaining the operation of the second embodiment of the present invention.

FIG. 6 is a diagram for explaining a configuration of a JL catheter and a JR catheter used in a conventional CAG.

FIG. 7 is a diagram for explaining an operation and a problem when performing CAG using the catheter shown in FIG.

FIG. 8 is a diagram for explaining an operation and a problem when performing CAG using the catheter shown in FIG.

FIG. 9 is a diagram for explaining an operation and a problem when performing CAG using the catheter shown in FIG.

FIG. 10 is a diagram for explaining an operation and a problem when performing CAG using the catheter shown in FIG.

FIG. 11 is a diagram for explaining an operation and a problem when performing CAG using the catheter shown in FIG.

FIG. 12 is a diagram for explaining an operation and a problem when performing CAG using the catheter shown in FIG.

FIG. 13 is a diagram for explaining an operation and a problem when performing CAG using the catheter shown in FIG.

FIG. 14 is a diagram for explaining an operation and a problem when performing CAG using the catheter shown in FIG.

FIG. 15 is a diagram for explaining an operation and a problem when performing CAG using the catheter shown in FIG.

16 is a diagram for explaining an operation and a problem when performing CAG using the catheter shown in FIG.

FIG. 17 is a diagram for explaining an operation and a problem when performing CAG using the catheter shown in FIG.

FIG. 18 is a diagram for explaining an operation and a problem when performing CAG using the catheter shown in FIG. 6.

FIG. 19 is a diagram for explaining the configuration of a guiding catheter used in a conventional PCTA.

[Explanation of symbols]

 1 Catheter 1a, 1b, c Angle 3 Connector for connection 20 Outer jacket (outer cylinder) 21 Reinforcement tube 100 Side hole 200 Fixing stopper for storing 201 Fixing stopper for sending 211 211 Stopper holding part

Claims (2)

[Claims] 1. A contrasting catheter having a plurality of bent portions at its tip and having a predetermined angle formed, by covering an outer circumference of the catheter body with an outer jacket (outer cylinder) slidably movable in the longitudinal direction of the catheter. A catheter for contrast enhancement comprising: a means for changing the angle shape by taking in and bending the bent portion into the outer jacket by moving the jacket. 2. In a guiding catheter having a side hole at its tip, an outer jacket (outer cylinder) which is slidably movable in the catheter longitudinal direction is covered on the outer circumference of the catheter body, and the outer hole is moved by moving the outer jacket. A guiding catheter comprising: means for opening and closing.