CA2213291A1 - Device for removing an implanted endoprosthesis - Google Patents
Device for removing an implanted endoprosthesisInfo
- Publication number
- CA2213291A1 CA2213291A1 CA 2213291 CA2213291A CA2213291A1 CA 2213291 A1 CA2213291 A1 CA 2213291A1 CA 2213291 CA2213291 CA 2213291 CA 2213291 A CA2213291 A CA 2213291A CA 2213291 A1 CA2213291 A1 CA 2213291A1
- Authority
- CA
- Canada
- Prior art keywords
- endoprosthesis
- catheter
- gripping
- internal
- tension element
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/22031—Gripping instruments, e.g. forceps, for removing or smashing calculi
- A61B2017/22035—Gripping instruments, e.g. forceps, for removing or smashing calculi for retrieving or repositioning foreign objects
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
- A61B2017/2215—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having an open distal end
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2002/9528—Instruments specially adapted for placement or removal of stents or stent-grafts for retrieval of stents
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Cardiology (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Transplantation (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Media Introduction/Drainage Providing Device (AREA)
Abstract
A device comprising a conveying catheter (30) and a compression system (50) which is arranged axially displaceably therein is proposed for removing an endoprosthesis (5) which is implanted in a hollow organ in a living being and is self-expanding in design. The individual elements of the compression system (50) are designed and arranged relative to one another such that, during an axially orientated relative movement, the endoprosthesis (5) gripped by a gripping system (15) brought into the radially spread gripping position can be tapered roughly in the form of a so-called envelope curve (8) successively radially and can be pulled into the conveying catheter (30) designed as a receiving tube. The gripping system (15) arranged at the distal end of a tension element (10) can be repeatedly brought into engagement with the implanted endoprosthesis (5) and can be completely released therefrom between engagements.
Description
Device for removing an implanted ~n~or~osthesis The invention relates to a device for removing an endoprosthesis implanted in a hollow organ in a living being, in particular an endoprosthesis which is self-expanding in design, with a conveying catheter which can be introduced into the hollow organ and a compression system which is arranged axially displaceably therein and by means of which the endoprosthesis can be tapered radially and, in the substantially compressed state, can be drawn into the conveying catheter and removed from the hollow organ therewith.
For correcting the positlon of an endoprosthesis implanted in a blood vessel or the like, EP-A 0 575 719 discloses a device in which a tension element designed in the form of an elongate piece of wire is arranged in an inlet tube, the tension element having, at the distal end, wire portions which can be raised radially at the distal end substantially to form a basket, which can be brought into engagement with the endoprosthesis by means of hooks arranged thereon for pulling (proximal). This device comprises no means for the radial compression of the endoprosthesis and no conveying catheter for holding and removing it and for protecting the internal vessel wall.
The device is designed exclusively for making a minor correction in the position of the endoprosthesis within the blood vessel.
US-A 5,098,440 discloses a device for positioning and/or removing an endoprosthesis (stent) which is implanted in a blood vessel or the like and comprises a conveying catheter, an internal catheter arranged coaxially therein and two tension elements which are arranged axially displaceably separately from one another therein and are each provided at the distal end with a gripping member designed as a loop. This device has the drawback that the endoprosthesis to be removed is merely locally constricted by the loops and is therefore pulled in the substantially expanded state along the easily injured internal vessel wall into the conveying catheter which should be correspondingly great in size and consequently cannot be brought right up to the endoprosthesis. The conveying catheter also requires a relatively great perforation for the introduction thereof, so the sphere of application of this device is relatively limited.
For removing an endoprosthesis which is implanted in a hollow organ of a living being and is self-expanding in design, EP-A 0 423 916 discloses a device which comprises a conveying catheter, an internal catheter which is arranged coaxially therein, is axially displaceable relative thereto and in which there are arranged at least two axially orientated tension elements, constantly cooperating with the endoprosthesis and designed with different lengths depending on the application, in the form of threads or the like, by means of which, by proximal pulling, the endoprosthesis formed, for example, from wires in a zigzag arrangement is compressed, for example by folding together in a radially tapering manner and is pulled into the conveying catheter for removal together with the internal catheter and is removed from the hollow organ therewith.
In this device, the individual tension elements have to be permanently connected to the endoprosthesis both during implantation and expansion of the endoprosthesis and during the entire engagement, the sphere of application of the endoprosthesis thus being relatively restricted and, furthermore, only suitable for temporary usage.
The object of the invention is to improve a device of the type mentioned in the preamble of claim 1 such that, in particular, the permanent connection between the tension elements and the implanted endoprosthesis which is found to be undesirable during engagement is not necessary and the endoprosthesis can be removed from the hollow body using relatively simple means without injuring the internal vessel wall.
According to the invention, this object is achieved in that, for removing an implanted endoprosthesis, the compression system can be repeatedly brought into engagement therewith and can be completely released therefrom between engagements.
This allows an endoprosthesis implanted into a hollow organ or the like, in particular an endoprosthesis which is enlarged in a self-expanding manner until it makes positive contact with the internal wall of the hollow organ to be successively released from the internal wall of the hollow organ in an advantageous manner before removal owing to the relative movements of the individual functional elements and to be radially reduced and simultaneously drawn into the conveying catheter which can then be removed from the hollow organ together with tension element and internal catheter.
The construction of the compression system allows relatively simple handling during engagement and reliable grasping of the endoprosthesis to be removed. In the context of the invention it has been found that the elements (conveying catheter, internal catheter and tension element) to be introduced into the hollow organ can preferably be produced from flexible material, for example from a suitable plastics material, even with relatively long distances from the orifice, so they can adapt themselves appropriately to the internal shape of the hollow organ during introduction without injuring the internal wall. With shorter distances from the orifice, the individual elements can also be produced from relatively rigid material.
Further features of the invention will emerge from the following description given in conjunction with the embodiment illustrated in the drawings and the claims.
The invention is described hereinafter with reference to the drawings.
Figure 1 shows the distal end of a device according to the invention illustrated on a larger scale and in a sectional view, with a gripping system shown in the closed position.
Figure 2 shows the distal end of the device according to figure 1 with the gripping system shown in the radially spread engagement position.
Figure 3 shows the gripping system illustrated in elevation in the direction of the arrow X in figure 2 with the individual gripping elements spread radially outwardly.
Figure 4 shows a portion, illustrated in part and on an enlarged scale, of an individual gripping element for the gripping system.
Figure 5 shows the compression system according to figure 1 introduced in part into the proximal end of an endoprosthesis with the gripping system shown in the closed position.
Figure 6 shows the compression system introduced further axially into the proximal end of the endoprosthesis with the gripping system shown in the radially spread engagement position.
Figure 7 shows the compression system according to figure 6 arranged in the proximal end of the endoprosthesis with the gripping elements of the gripping system shown hooked on filaments.
Figure 8 shows the proximal end of the endoprosthesis which is radially tapered in the form of a theoretical envelope by means of the hooked gripping elements and is drawn in part into a conveying catheter.
To illustrate the invention, figure 1 shows a distal end, illustrated in a sectional view, of a compression system designed substantially in the form of an elongate surgical instrument for introduction into a hollow organ, for example for introduction into a blood vessel of a living being. In the embodiment illustrated, the compression system is designed, in particular, for removing a self-expanding endoprosthesis (stent) implanted in a hollow organ, without the endoprosthesis being attached to the internal wall during removal (extraction) and therefore causing undesirable injury. However, the compression system according to the invention can also be used for the proximal re-positioning of the endoprosthesis inserted into a hollow organ or the like while maintaining the foregoing conditions without additional aids.
The compression system which is designated in its entirety by 50 and is illustrated on an enlarged scale essentially comprises a tension element 10 with a distally arranged gripping system 15 and an internal catheter 20. In the assembled state, the tension element 10 is arranged substantially coaxially in the internal catheter 20 and the internal catheter 20 together with the tension element 10 substantially coaxially in a conveying catheter 30. The elements 10, 15, 20 and 30 which cooperate with an actuating system not shown in detail and are axially displaceable relative to one another are described in detail hereinafter in conjunction with figures 1 to 4.
The tension element 10 is provided at its proximal end, for example, with a grip part not shown (actuating device) for the axially orientated movement. At the distal end, the gripping system 15 shown in the closed position in figure 1 is arranged on the end face 12. The gripping system 15 comprises at least two, but preferably several gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' uniformly distributed on the end face 12 and fastened in a manner not shown (figure 2). The tension element 10 can also be produced from a hollow cylindrical tube. In this variation, not shown, a plate is arranged and fastened on the distal end of the tension element 10 for fastening the gripping system 15.
The hollow cylindrical internal catheter 20 is provided with a bevelled or rounded circular contact edge 23 at the distal end face 22. When the gripping system 15 is opened the contact edge 23 which is inwardly bevelled or rounded from the outer end face 22 guarantees that the individual gripping elements 16, 16'; 17, 17'i 18, 18' and 19, 19' slide along the contact edge 23 and are spread uniformly radially outwardly by the radially outwardly directed spring force (figure 2). When being pulled in, the individual gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' slide along the contact edge 23 and are uniformly radially folded together against the spring force and are pulled into the internal catheter 20. In the pulled-in state, the individual gripping elements 16, 16'; 17, 17'i 18, 18' and 19, 19' rest firmly substantially in the distal region of the internal wall 21 of the internal catheter 20 and the shaped hooks 14 (designated only once) are pulled against the annular end face 22 of the internal catheter 20 in the closed position (figure 1).
For better introduction of the endoprosthesis to be removed, the hollow cylindrical conveying catheter 30 is provided with a bevelled end face 32 at the distal end.
The bevel of the end face 32 is inclined backwardly in the direction of the lower front edge 32" starting from the upper front edge 32' lying closest to the endoprosthesis 5 during introduction into the internal space 2 of the hollow organ 1 (figures 5 to 8). The bevel of the annular end face 32 is preferably at an acute angle of about 10~ to 25~.
Figure 2 shows the compression system 50 in which the internal catheter 20 is shown axially displaced relative to the conveying catheter 30 and the tension element 10 axially displaced relative to the internal catheter 20.
During displacement of the tension element 10 relative to the internal catheter 20, the individual gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' slide along the bevelled contact edge 23 of the internal catheter 20 to the maximum engagement position owing to the predetermined spring force. In this position, the gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' arranged on the end face of the tension element 10 are no longer tensioned against the bevelled edge 23 of the internal catheter 20.
As shown in figure 1 and figure 2, the internal catheter 20 is preferably arranged coaxially in the conveying catheter 30 so a substantially hollow cylindrical internal space 30' is formed between the internal wall 31 of the conveying catheter 30 and the internal catheter 20. In the internal space 30', the proximal end of the endoprosthesis 5 can penetrate into the conveying catheter 30' when the endoprosthesis 5 to be removed from the hollow organ 1 is being pulled in (figure 8).
Figure 3 shows the gripping system 15 arranged on the end face 12 of the tension element 10 in the direction of the arrow X in figure 2, and the individual, peripherally distributed gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' which are each provided with a hook 14 at the outer ends and, with respect to the longitudinal axis of the tension element 10 not shown in detail, are directed obliquely outwardly and arranged on the end face 12 thereof and are fastened by means not shown can be seen.
Figure 4 shows an embodiment of the portion of the gripping element 16 designed as a hook 14 on an enlarged scale.
With respect to the straight portion 16" of the rod-shaped gripping element 16, the shaped hook 14 is provided with a curved arcuate part 14' having an angle of at least 90~, but preferably an angle of about 120~ to 180~. The free end 14" of the arcuate part 14' is roùnded in a manner not shown in detail to avoid injury. The distance 13 provided between the straight portion 16" and the arcuate part 14' is dimensioned so as to guarantee secure grasping and holding of the individual filament 6 of the endoprosthesis 5 (figure 7) and release of the caught gripping elements from the filaments 6. The hooks shaped on the individual gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' and not described in detail are similar in design to the above-described hook 14.
The mode of operation of the device according to the invention is described in detail hereinafter in conjunction with figures 5 to 8.
Figure 5 shows the first phase in which the compression system 50 together with the conveying catheter 30 is introduced into the internal space 2 of the hollow organ 1 and is pushed substantially into the front region of the implanted endoprosthesis 5 using means not shown. In this phase, the gripping device 15 is arranged, still in the radially folded together state, in the internal catheter 20 pushed in part into the internal space 7 of the endoprosthesis 5 relative to the conveying catheter 30 in the direction of the arrow Z.
In a second phase, as shown schematically in figure 6, the tension element 10 is displaced in the direction of the arrow Z relative to the internal catheter 20. The gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' successively released from the internal catheter 20 are spread radially outwardly by the spring force against the internal wall, not shown, of the endoprosthesis 5 such that the individual gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' engage with the hooks 14 shaped thereon between two axially spaced filaments 6 of the endoprosthesis 5 (figure 6).
As shown schematically in figure 7, the tension element 10 is drawn into the internal catheter 20 in the direction of the arrow Z' in order to grasp the filaments 6 allocated to the individual gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19'. The leading filaments 6 grasped by the individual gripper elements 16, 16'; 17, 17'; 18, 18' and 19, 19' are released from the internal wall 1' of the hollow organ 1 in a manner not shown in detail.
In the phase shown in figure 8, the front end 5' of the endoprosthesis 5 grasped by the individual gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' is pulled in the form of a successively radially tapering envelope portrayed by a theoretical line 8 along the bevelled end face 32 into the conveying catheter 30. It is possible for the conveying catheter 30 with the distal end face 32 to be pushed forward in the direction of the endoprosthesis 5 relative to the internal catheter 20 and the tension element 10 in the direction of the arrow Z or for the internal catheter 20 to be pulled back with the tension element 10 relative to the conveying catheter 30 in the direction of the arrow Z'. As soon as the endoprosthesis 5 is pulled into the conveying catheter 30 with its entire length, the compression system 50 can be removed from the hollow organ 1 with the drawn in endoprosthesis 5.
The construction of the entire compression system 50 allows relatively simple handling and manipulation during engagement and reliable grasping and removal (extraction) of the endoprosthesis 5. The advance, orientated in the direction of the arrow Z, of the conveying catheter 30 designed as a so-called collecting tube releases the endoprosthesis 5 from the internal wall 1' of the hollow organ 1 in the front region and relaxes the substantially radially outwardly acting tensioning force against the internal wall 1' in the rear region thereof. The gripping system 15 provided with the individual gripping elements can repeatedly be brought into engagement with the implanted endoprosthesis 5 without additional aids and can be completely released from the endoprosthesis 5 between engagements.
The tension element 10 and the two catheters 20 and 30 are produced, for example, from suitable plastics material or from a plastics material reinforced with a mesh, so they are flexible with respect to their longitudinal axis and can be introduced without difficulty and in an adapted manner into the internal space 2 of the hollow organ 1 of a living being for grasping an implanted endoprosthesis 5.
The endoprosthesis 5 consists, for example, of groups of helically wound filaments 6 of wire or the like which are interlaced with one another in opposite directions and is designed such that it can be automatically radially reduced by a low tensile force acting axially thereon and can therefore be pulled without difficulty into the internal space of the conveying catheter 30 designed as a collecting tube. This invention does not relate to the endoprosthesis 5 which is therefore illustrated only schematically in figures 5 to 8 and is not described in detail.
For correcting the positlon of an endoprosthesis implanted in a blood vessel or the like, EP-A 0 575 719 discloses a device in which a tension element designed in the form of an elongate piece of wire is arranged in an inlet tube, the tension element having, at the distal end, wire portions which can be raised radially at the distal end substantially to form a basket, which can be brought into engagement with the endoprosthesis by means of hooks arranged thereon for pulling (proximal). This device comprises no means for the radial compression of the endoprosthesis and no conveying catheter for holding and removing it and for protecting the internal vessel wall.
The device is designed exclusively for making a minor correction in the position of the endoprosthesis within the blood vessel.
US-A 5,098,440 discloses a device for positioning and/or removing an endoprosthesis (stent) which is implanted in a blood vessel or the like and comprises a conveying catheter, an internal catheter arranged coaxially therein and two tension elements which are arranged axially displaceably separately from one another therein and are each provided at the distal end with a gripping member designed as a loop. This device has the drawback that the endoprosthesis to be removed is merely locally constricted by the loops and is therefore pulled in the substantially expanded state along the easily injured internal vessel wall into the conveying catheter which should be correspondingly great in size and consequently cannot be brought right up to the endoprosthesis. The conveying catheter also requires a relatively great perforation for the introduction thereof, so the sphere of application of this device is relatively limited.
For removing an endoprosthesis which is implanted in a hollow organ of a living being and is self-expanding in design, EP-A 0 423 916 discloses a device which comprises a conveying catheter, an internal catheter which is arranged coaxially therein, is axially displaceable relative thereto and in which there are arranged at least two axially orientated tension elements, constantly cooperating with the endoprosthesis and designed with different lengths depending on the application, in the form of threads or the like, by means of which, by proximal pulling, the endoprosthesis formed, for example, from wires in a zigzag arrangement is compressed, for example by folding together in a radially tapering manner and is pulled into the conveying catheter for removal together with the internal catheter and is removed from the hollow organ therewith.
In this device, the individual tension elements have to be permanently connected to the endoprosthesis both during implantation and expansion of the endoprosthesis and during the entire engagement, the sphere of application of the endoprosthesis thus being relatively restricted and, furthermore, only suitable for temporary usage.
The object of the invention is to improve a device of the type mentioned in the preamble of claim 1 such that, in particular, the permanent connection between the tension elements and the implanted endoprosthesis which is found to be undesirable during engagement is not necessary and the endoprosthesis can be removed from the hollow body using relatively simple means without injuring the internal vessel wall.
According to the invention, this object is achieved in that, for removing an implanted endoprosthesis, the compression system can be repeatedly brought into engagement therewith and can be completely released therefrom between engagements.
This allows an endoprosthesis implanted into a hollow organ or the like, in particular an endoprosthesis which is enlarged in a self-expanding manner until it makes positive contact with the internal wall of the hollow organ to be successively released from the internal wall of the hollow organ in an advantageous manner before removal owing to the relative movements of the individual functional elements and to be radially reduced and simultaneously drawn into the conveying catheter which can then be removed from the hollow organ together with tension element and internal catheter.
The construction of the compression system allows relatively simple handling during engagement and reliable grasping of the endoprosthesis to be removed. In the context of the invention it has been found that the elements (conveying catheter, internal catheter and tension element) to be introduced into the hollow organ can preferably be produced from flexible material, for example from a suitable plastics material, even with relatively long distances from the orifice, so they can adapt themselves appropriately to the internal shape of the hollow organ during introduction without injuring the internal wall. With shorter distances from the orifice, the individual elements can also be produced from relatively rigid material.
Further features of the invention will emerge from the following description given in conjunction with the embodiment illustrated in the drawings and the claims.
The invention is described hereinafter with reference to the drawings.
Figure 1 shows the distal end of a device according to the invention illustrated on a larger scale and in a sectional view, with a gripping system shown in the closed position.
Figure 2 shows the distal end of the device according to figure 1 with the gripping system shown in the radially spread engagement position.
Figure 3 shows the gripping system illustrated in elevation in the direction of the arrow X in figure 2 with the individual gripping elements spread radially outwardly.
Figure 4 shows a portion, illustrated in part and on an enlarged scale, of an individual gripping element for the gripping system.
Figure 5 shows the compression system according to figure 1 introduced in part into the proximal end of an endoprosthesis with the gripping system shown in the closed position.
Figure 6 shows the compression system introduced further axially into the proximal end of the endoprosthesis with the gripping system shown in the radially spread engagement position.
Figure 7 shows the compression system according to figure 6 arranged in the proximal end of the endoprosthesis with the gripping elements of the gripping system shown hooked on filaments.
Figure 8 shows the proximal end of the endoprosthesis which is radially tapered in the form of a theoretical envelope by means of the hooked gripping elements and is drawn in part into a conveying catheter.
To illustrate the invention, figure 1 shows a distal end, illustrated in a sectional view, of a compression system designed substantially in the form of an elongate surgical instrument for introduction into a hollow organ, for example for introduction into a blood vessel of a living being. In the embodiment illustrated, the compression system is designed, in particular, for removing a self-expanding endoprosthesis (stent) implanted in a hollow organ, without the endoprosthesis being attached to the internal wall during removal (extraction) and therefore causing undesirable injury. However, the compression system according to the invention can also be used for the proximal re-positioning of the endoprosthesis inserted into a hollow organ or the like while maintaining the foregoing conditions without additional aids.
The compression system which is designated in its entirety by 50 and is illustrated on an enlarged scale essentially comprises a tension element 10 with a distally arranged gripping system 15 and an internal catheter 20. In the assembled state, the tension element 10 is arranged substantially coaxially in the internal catheter 20 and the internal catheter 20 together with the tension element 10 substantially coaxially in a conveying catheter 30. The elements 10, 15, 20 and 30 which cooperate with an actuating system not shown in detail and are axially displaceable relative to one another are described in detail hereinafter in conjunction with figures 1 to 4.
The tension element 10 is provided at its proximal end, for example, with a grip part not shown (actuating device) for the axially orientated movement. At the distal end, the gripping system 15 shown in the closed position in figure 1 is arranged on the end face 12. The gripping system 15 comprises at least two, but preferably several gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' uniformly distributed on the end face 12 and fastened in a manner not shown (figure 2). The tension element 10 can also be produced from a hollow cylindrical tube. In this variation, not shown, a plate is arranged and fastened on the distal end of the tension element 10 for fastening the gripping system 15.
The hollow cylindrical internal catheter 20 is provided with a bevelled or rounded circular contact edge 23 at the distal end face 22. When the gripping system 15 is opened the contact edge 23 which is inwardly bevelled or rounded from the outer end face 22 guarantees that the individual gripping elements 16, 16'; 17, 17'i 18, 18' and 19, 19' slide along the contact edge 23 and are spread uniformly radially outwardly by the radially outwardly directed spring force (figure 2). When being pulled in, the individual gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' slide along the contact edge 23 and are uniformly radially folded together against the spring force and are pulled into the internal catheter 20. In the pulled-in state, the individual gripping elements 16, 16'; 17, 17'i 18, 18' and 19, 19' rest firmly substantially in the distal region of the internal wall 21 of the internal catheter 20 and the shaped hooks 14 (designated only once) are pulled against the annular end face 22 of the internal catheter 20 in the closed position (figure 1).
For better introduction of the endoprosthesis to be removed, the hollow cylindrical conveying catheter 30 is provided with a bevelled end face 32 at the distal end.
The bevel of the end face 32 is inclined backwardly in the direction of the lower front edge 32" starting from the upper front edge 32' lying closest to the endoprosthesis 5 during introduction into the internal space 2 of the hollow organ 1 (figures 5 to 8). The bevel of the annular end face 32 is preferably at an acute angle of about 10~ to 25~.
Figure 2 shows the compression system 50 in which the internal catheter 20 is shown axially displaced relative to the conveying catheter 30 and the tension element 10 axially displaced relative to the internal catheter 20.
During displacement of the tension element 10 relative to the internal catheter 20, the individual gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' slide along the bevelled contact edge 23 of the internal catheter 20 to the maximum engagement position owing to the predetermined spring force. In this position, the gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' arranged on the end face of the tension element 10 are no longer tensioned against the bevelled edge 23 of the internal catheter 20.
As shown in figure 1 and figure 2, the internal catheter 20 is preferably arranged coaxially in the conveying catheter 30 so a substantially hollow cylindrical internal space 30' is formed between the internal wall 31 of the conveying catheter 30 and the internal catheter 20. In the internal space 30', the proximal end of the endoprosthesis 5 can penetrate into the conveying catheter 30' when the endoprosthesis 5 to be removed from the hollow organ 1 is being pulled in (figure 8).
Figure 3 shows the gripping system 15 arranged on the end face 12 of the tension element 10 in the direction of the arrow X in figure 2, and the individual, peripherally distributed gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' which are each provided with a hook 14 at the outer ends and, with respect to the longitudinal axis of the tension element 10 not shown in detail, are directed obliquely outwardly and arranged on the end face 12 thereof and are fastened by means not shown can be seen.
Figure 4 shows an embodiment of the portion of the gripping element 16 designed as a hook 14 on an enlarged scale.
With respect to the straight portion 16" of the rod-shaped gripping element 16, the shaped hook 14 is provided with a curved arcuate part 14' having an angle of at least 90~, but preferably an angle of about 120~ to 180~. The free end 14" of the arcuate part 14' is roùnded in a manner not shown in detail to avoid injury. The distance 13 provided between the straight portion 16" and the arcuate part 14' is dimensioned so as to guarantee secure grasping and holding of the individual filament 6 of the endoprosthesis 5 (figure 7) and release of the caught gripping elements from the filaments 6. The hooks shaped on the individual gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' and not described in detail are similar in design to the above-described hook 14.
The mode of operation of the device according to the invention is described in detail hereinafter in conjunction with figures 5 to 8.
Figure 5 shows the first phase in which the compression system 50 together with the conveying catheter 30 is introduced into the internal space 2 of the hollow organ 1 and is pushed substantially into the front region of the implanted endoprosthesis 5 using means not shown. In this phase, the gripping device 15 is arranged, still in the radially folded together state, in the internal catheter 20 pushed in part into the internal space 7 of the endoprosthesis 5 relative to the conveying catheter 30 in the direction of the arrow Z.
In a second phase, as shown schematically in figure 6, the tension element 10 is displaced in the direction of the arrow Z relative to the internal catheter 20. The gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' successively released from the internal catheter 20 are spread radially outwardly by the spring force against the internal wall, not shown, of the endoprosthesis 5 such that the individual gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' engage with the hooks 14 shaped thereon between two axially spaced filaments 6 of the endoprosthesis 5 (figure 6).
As shown schematically in figure 7, the tension element 10 is drawn into the internal catheter 20 in the direction of the arrow Z' in order to grasp the filaments 6 allocated to the individual gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19'. The leading filaments 6 grasped by the individual gripper elements 16, 16'; 17, 17'; 18, 18' and 19, 19' are released from the internal wall 1' of the hollow organ 1 in a manner not shown in detail.
In the phase shown in figure 8, the front end 5' of the endoprosthesis 5 grasped by the individual gripping elements 16, 16'; 17, 17'; 18, 18' and 19, 19' is pulled in the form of a successively radially tapering envelope portrayed by a theoretical line 8 along the bevelled end face 32 into the conveying catheter 30. It is possible for the conveying catheter 30 with the distal end face 32 to be pushed forward in the direction of the endoprosthesis 5 relative to the internal catheter 20 and the tension element 10 in the direction of the arrow Z or for the internal catheter 20 to be pulled back with the tension element 10 relative to the conveying catheter 30 in the direction of the arrow Z'. As soon as the endoprosthesis 5 is pulled into the conveying catheter 30 with its entire length, the compression system 50 can be removed from the hollow organ 1 with the drawn in endoprosthesis 5.
The construction of the entire compression system 50 allows relatively simple handling and manipulation during engagement and reliable grasping and removal (extraction) of the endoprosthesis 5. The advance, orientated in the direction of the arrow Z, of the conveying catheter 30 designed as a so-called collecting tube releases the endoprosthesis 5 from the internal wall 1' of the hollow organ 1 in the front region and relaxes the substantially radially outwardly acting tensioning force against the internal wall 1' in the rear region thereof. The gripping system 15 provided with the individual gripping elements can repeatedly be brought into engagement with the implanted endoprosthesis 5 without additional aids and can be completely released from the endoprosthesis 5 between engagements.
The tension element 10 and the two catheters 20 and 30 are produced, for example, from suitable plastics material or from a plastics material reinforced with a mesh, so they are flexible with respect to their longitudinal axis and can be introduced without difficulty and in an adapted manner into the internal space 2 of the hollow organ 1 of a living being for grasping an implanted endoprosthesis 5.
The endoprosthesis 5 consists, for example, of groups of helically wound filaments 6 of wire or the like which are interlaced with one another in opposite directions and is designed such that it can be automatically radially reduced by a low tensile force acting axially thereon and can therefore be pulled without difficulty into the internal space of the conveying catheter 30 designed as a collecting tube. This invention does not relate to the endoprosthesis 5 which is therefore illustrated only schematically in figures 5 to 8 and is not described in detail.
Claims (7)
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:
1. Device for removing an endoprosthesis implanted in a hollow organ in a living being, in particular an endoprosthesis which is self-expanding in design, with a conveying catheter which can be introduced into the hollow organ and a compression system which is arranged axially displaceably therein and by means of which the endoprosthesis can be tapered radially and, in the substantially compressed state, can be drawn into the conveying catheter and removed from the hollow organ therewith, characterised in that, for removing an implanted endoprosthesis (5), the compression system (50) can be repeatedly brought into engagement therewith and can be completely released therefrom between engagements.
2. Device according to claim 1, characterised in that the compressing system (50) comprises an internal catheter (20) arranged in the conveying catheter (30), a tension element (10) arranged therein and a gripping system (15) which is arranged at the distal end (12) of the tension element (10), is held in the folded together closed position by the internal catheter (20) and can be brought into a radially spread engagement position owing to an axial sliding movement of the tension element (10) relative to the internal catheter (20) or vice versa.
3. Device according to claim 2, characterised in that the gripping system (15) has several gripping elements (16, 16'; 17, 17'; 18, 18'; 19, 19') which are tensioned against the internal wall (21) of the internal catheter (20) by a radially outwardly directed spring force, are each provided with a hook (14), can be spread from the closed position into the engagement position by axial displacement of the tension element (10) relative to the internal catheter (20) and, by hanging of the hooks (14) in the endoprosthesis (5), can be brought into engagement therewith.
4. Device according to claims 2 and 3, characterised in that the distal end of the internal catheter (20) is provided internally with a bevelled or rounded contact edge (23) for the sliding contact and guidance of the gripping elements (16, 16'; 17, 17'; 18, 18'; 19, 19').
5. Device according to claim 3, characterised in that the hook (14) shaped on the individual gripping element (16, 16'; 17, 17'; 18, 18'; 19, 19') is provided with an arcuate part (14') which at least has an angle of 90°, preferably an angle substantially between 120° and 180°.
6. Device according to claim 3, characterised in that the hook (14) shaped on the individual gripping element (16, 16'; 17, 17'; 18, 18'; 19, 19') is rounded in design at the end (14") of the arcuate part (14').
7. Device according to claim 1, characterised in that the conveying catheter (30) is bevelled at the distal end.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| EP96113229A EP0829242A1 (en) | 1996-08-19 | 1996-08-19 | Removal device for an implanted endoprothesis |
| EP96113229.7 | 1996-08-19 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2213291A1 true CA2213291A1 (en) | 1998-02-19 |
Family
ID=8223117
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA 2213291 Abandoned CA2213291A1 (en) | 1996-08-19 | 1997-08-18 | Device for removing an implanted endoprosthesis |
Country Status (4)
| Country | Link |
|---|---|
| EP (1) | EP0829242A1 (en) |
| JP (1) | JP3466432B2 (en) |
| AU (1) | AU2560997A (en) |
| CA (1) | CA2213291A1 (en) |
Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| WO2001035861A1 (en) | 1999-10-29 | 2001-05-25 | C.R. Bard, Inc. | Method of, and device for, installing a stent in a sleeve |
| US8048139B2 (en) | 2006-07-24 | 2011-11-01 | Cardiatis, S.A. | Reversible applicator for an intraluminal endoprosthesis |
| US9427317B2 (en) | 2006-04-04 | 2016-08-30 | Cormove | Device for treating a blood circulation canal and process for preparing this device |
Families Citing this family (12)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US6143021A (en) | 1998-07-10 | 2000-11-07 | American Medical Systems, Inc. | Stent placement instrument and method of assembly |
| US6802846B2 (en) | 2001-02-12 | 2004-10-12 | Ams Research Corporation | Foreign body retrieval device and method |
| US6926732B2 (en) | 2001-06-01 | 2005-08-09 | Ams Research Corporation | Stent delivery device and method |
| US6821291B2 (en) | 2001-06-01 | 2004-11-23 | Ams Research Corporation | Retrievable stent and method of use thereof |
| US7758589B2 (en) * | 2005-05-03 | 2010-07-20 | Ethicon Endo-Surgery, Inc. | Surgical instrument for extracting an anastomotic ring device |
| US20070198032A1 (en) * | 2006-02-22 | 2007-08-23 | Ethicon Endo-Surgery, Inc. | Methods and devices for fastener removal |
| US8852112B2 (en) | 2007-06-28 | 2014-10-07 | W. L. Gore & Associates, Inc. | Catheter with deflectable imaging device and bendable electrical conductor |
| US8864675B2 (en) | 2007-06-28 | 2014-10-21 | W. L. Gore & Associates, Inc. | Catheter |
| JP5078462B2 (en) * | 2007-06-29 | 2012-11-21 | オリンパスメディカルシステムズ株式会社 | Stent system |
| US8157853B2 (en) * | 2008-01-24 | 2012-04-17 | Medtronic, Inc. | Delivery systems and methods of implantation for prosthetic heart valves |
| EP3028679A1 (en) * | 2014-12-04 | 2016-06-08 | Rheinisch-Westfälische Technische Hochschule Aachen | Stent removal device |
| CN109199660B (en) * | 2017-06-29 | 2020-12-01 | 先健科技(深圳)有限公司 | Medical conveying device and conveying system thereof |
Family Cites Families (7)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| GB2200848B (en) * | 1987-02-25 | 1991-02-13 | Mo Med Inst Pirogova | Intravenous filter, and apparatus and method for preoperative preparation thereof |
| SE8803444D0 (en) * | 1988-09-28 | 1988-09-28 | Medinvent Sa | A DEVICE FOR TRANSLUMINAL IMPLANTATION OR EXTRACTION |
| FR2655839B2 (en) * | 1989-10-09 | 1994-03-04 | Fondation Avenir Rech Medical | ANTI-EMBOLISED PULMONARY FILTER AND ITS PRESENTATION AND FITTING KIT. |
| US5098440A (en) * | 1990-08-14 | 1992-03-24 | Cordis Corporation | Object retrieval method and apparatus |
| JP2573612Y2 (en) * | 1991-12-30 | 1998-06-04 | ハナコメディカル株式会社 | Filter for thrombus filtration |
| US5474563A (en) * | 1993-03-25 | 1995-12-12 | Myler; Richard | Cardiovascular stent and retrieval apparatus |
| US5480423A (en) * | 1993-05-20 | 1996-01-02 | Boston Scientific Corporation | Prosthesis delivery |
-
1996
- 1996-08-19 EP EP96113229A patent/EP0829242A1/en not_active Withdrawn
-
1997
- 1997-06-19 AU AU25609/97A patent/AU2560997A/en not_active Abandoned
- 1997-08-18 JP JP22152497A patent/JP3466432B2/en not_active Expired - Lifetime
- 1997-08-18 CA CA 2213291 patent/CA2213291A1/en not_active Abandoned
Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| WO2001035861A1 (en) | 1999-10-29 | 2001-05-25 | C.R. Bard, Inc. | Method of, and device for, installing a stent in a sleeve |
| US9427317B2 (en) | 2006-04-04 | 2016-08-30 | Cormove | Device for treating a blood circulation canal and process for preparing this device |
| US8048139B2 (en) | 2006-07-24 | 2011-11-01 | Cardiatis, S.A. | Reversible applicator for an intraluminal endoprosthesis |
Also Published As
| Publication number | Publication date |
|---|---|
| EP0829242A1 (en) | 1998-03-18 |
| JP3466432B2 (en) | 2003-11-10 |
| AU2560997A (en) | 1998-02-26 |
| JPH1076015A (en) | 1998-03-24 |
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| FZDE | Dead |