CN100534392C - Method and apparatus for treating a carotid artery - Google Patents
Method and apparatus for treating a carotid artery Download PDFInfo
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- CN100534392C CN100534392C CNB2004800407173A CN200480040717A CN100534392C CN 100534392 C CN100534392 C CN 100534392C CN B2004800407173 A CNB2004800407173 A CN B2004800407173A CN 200480040717 A CN200480040717 A CN 200480040717A CN 100534392 C CN100534392 C CN 100534392C
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Abstract
One disclosed embodiment comprises a method for treating lesions in the carotid artery of a mammalian body. The method comprises transcervical access and blocking of blood flow through the common carotid artery (with or without blocking of blood flow through the external carotid artery), shunting blood from the internal carotid artery and treating the lesion in the carotid artery.
Description
Technical field
The present invention relates to treat carotid artery.For example, the carotid artery that can use method and apparatus treatment disclosed herein may have damage or partial occlusion.
Background technology
Carotid artery is shaped and Stent (CAS) is the minimally-invasive treatment that is used for the treatment of carotid artery stenosis.Introduced before 20 years since the method, the use of CAS increases steadily, and calendar year 2001 8% has been used CAS in the 107000 routine carotid artery operations that carry out in Europe.Because the sense of discomfort that do not have sizable cervical incision to bring, the prospect of outpatient operation makes the patient determine to abandon carotid endarterectomy, and carotid endarterectomy is the first operation that is used for the treatment of carotid bifuracation portion disease in the past 50 years.
Summary of the invention
A disclosed embodiment comprises the apparatus that is used for the carotid artery plasty.This apparatus comprises: have the conduit of far-end and the near-end relative with this far-end, and first obstruction piece and second obstruction piece, wherein, at least the first obstruction piece is positioned on this conduit.First obstruction piece and second obstruction piece are configured to make the normal direction of the blood flow in the internal carotid artery reverse when first obstruction piece is blocked common carotid artery and second obstruction piece obstruction external carotid artery.This conduit has from the first axle part of first obstruction piece to proximal extension.The first axle part has the maximum cross-section that can be inserted in the common carotid artery.The first axle part has and is suitable for entering Carotid shorter length through neck.This conduit has the blood inlet that is positioned at the first obstruction piece far-end.This apparatus also comprises collection reservoir, and this bin is configured to be connected on this conduit and is communicated with the blood passive fluid that enters the mouth.
Another disclosed embodiment comprises the method for the injury of carotid artery that is used for the treatment of the patient.This method comprises: use and through the neck method conduit is inserted into carotid artery system, and block the blood flow of common carotid artery and external carotid artery so that the normal direction of the blood flow in the internal carotid artery is reverse.This method comprises that also the blood that blood is flow in the conduit enters the mouth, and collects blood in the bin passively.
Another disclosed embodiment comprises the apparatus that is used for the carotid artery plasty, and this apparatus comprises: have the conduit of far-end and the near-end relative with this far-end, and first obstruction piece and second obstruction piece, wherein, at least the first obstruction piece is positioned on this conduit.First obstruction piece and second obstruction piece are configured to make the normal direction of the blood flow in the internal carotid artery reverse when first obstruction piece is blocked common carotid artery and second obstruction piece obstruction external carotid artery.This conduit has the first axle part that comes out to proximal extension from first obstruction piece.The first axle part has the maximum cross-section that can be inserted in the common carotid artery.The first axle part has and is suitable for entering Carotid shorter length through neck.This conduit has the blood inlet that is positioned at the first obstruction piece far-end.This apparatus also comprises passive fluid line and collection reservoir.This collection reservoir is configured to be connected on the described conduit via passive fluid line.
Another disclosed embodiment comprises the method that is used for the treatment of the intravital injury of carotid artery of mammal.This method comprises: enters through neck, blocks, blood is diverted to Venous system from the intravital internal carotid artery of mammal by Carotid blood flow, and the treatment injury of carotid artery.This method also comprises the blood flow of obstruction by external carotid artery alternatively.
In the method, enter carotid artery alternatively by through skin, via little otch or use any suitable technique to obtain.The treatment step of this method comprises alternatively with balloon expandable to be damaged.The treatment step of this method is included in the injury region of expansion alternatively and puts into support.The branch flow step of this method comprises the fragment in the filtering blood alternatively.The retardance step of this method comprises alternatively with sacculus blocks external carotid artery.The retardance step of this method comprises alternatively with sacculus blocks common carotid artery.The retardance step of this method comprises alternatively clamps common carotid artery.The importing step of this method comprises alternatively: the location has the single conduit of sacculus with obstruction common carotid artery and external carotid artery, and the oriented side mouth is to launch angioplasty sacculus or support.The retardance step of this method comprises alternatively at least one conduit is directly imported in the common carotid artery.The importing step of this method comprises that alternatively the first importing sheath and second is imported sheath directly to import in the common carotid artery.The importing step of this method comprises alternatively first foley's tube and second foley's tube is directly imported in the common carotid artery.
Another disclosed embodiment comprises the method that is used for the treatment of injury of carotid artery.This method comprises: enter through neck, block by Carotid blood flow and damage to treat safely, and make blood turn back to carotid artery.This method also comprises the blood flow of obstruction by external carotid artery.
In the method, can initiatively regain intracarotid blood and make it turn back to carotid artery.In the method, enter carotid artery alternatively through skin, via little otch or use any suitable technique to obtain.The treatment step of this method comprises alternatively with balloon expandable to be damaged.The treatment step of this method is included in the injury region of expansion alternatively and puts into support.The branch flow step of this method comprises the fragment in the filtering blood alternatively.The retardance step of this method comprises alternatively with sacculus blocks external carotid artery.The retardance step of this method comprises alternatively with sacculus blocks common carotid artery.The retardance step of this method comprises alternatively clamps common carotid artery.The importing step of this method comprises alternatively: the location has the single conduit of sacculus with obstruction common carotid artery and external carotid artery, and the oriented side mouth is to launch angioplasty sacculus or support.The retardance step of this method comprises alternatively at least one conduit is directly imported in the common carotid artery.The importing step of this method comprises that alternatively the first importing sheath and second is imported sheath directly to import in the common carotid artery.The importing step of this method comprises alternatively first foley's tube and second foley's tube is directly imported in the common carotid artery.
Another disclosed embodiment comprises the method that is used for the treatment of injury of carotid artery.This method comprises: enter through neck, block by Carotid blood flow, collect blood and fragment passively, and next filtering blood is turned back to carotid artery.This method also comprises the blood flow of obstruction by external carotid artery.
In the method, enter carotid artery alternatively by through skin, via little otch or use any suitable technique to obtain.The treatment step of this method comprises alternatively with balloon expandable to be damaged.The treatment step of this method is included in the injury region of expansion alternatively and puts into support.The branch flow step of this method comprises the fragment in the filtering blood alternatively.The retardance step of this method comprises alternatively with sacculus blocks external carotid artery.The retardance step of this method comprises alternatively with sacculus blocks common carotid artery.The retardance step of this method comprises alternatively clamps common carotid artery.The importing step of this method comprises alternatively: the location has the single conduit of sacculus with obstruction common carotid artery and external carotid artery, and the oriented side mouth is to launch angioplasty sacculus or support.The retardance step of this method comprises alternatively at least one conduit is directly imported in the common carotid artery.The importing step of this method comprises that alternatively the first importing sheath and second is imported sheath directly to import in the common carotid artery.The importing step of this method comprises alternatively first foley's tube and second foley's tube is directly imported in the common carotid artery.
This paper has described some purpose of the present invention and advantage.Certainly, should be appreciated that any specific embodiment according to the present invention there is no need to realize all purposes and advantage.Therefore, for example, it will be appreciated by those skilled in the art that and to specialize or implement the present invention in the mode that realizes or optimize a advantage that this paper was said or one group of advantage, and there is no need to realize other purpose or advantage that this paper says or that advised.
Top all embodiment that sum up are in scope of the present invention disclosed herein.Yet,, have only appended claim (rather than this summary) to limit scope of the present invention though top some embodiment is discussed.From below with reference to the specific descriptions of accompanying drawing to preferred embodiment, the embodiment that is summed up and other embodiments of the invention are conspicuous to those skilled in the art, the invention is not restricted to disclosed any specific embodiment.
Description of drawings
Fig. 1 is the sketch map that is used for the treatment of an embodiment of carotid method and apparatus;
Fig. 2 is the sketch map that is used for the treatment of another embodiment of carotid method and apparatus;
Fig. 2 A is with apparatus disclosed herein and method-the comprise side view of the dilator end that apparatus shown in Figure 2 and method one are used;
Fig. 3 is the sketch map that is used for the treatment of another embodiment of carotid method and apparatus;
Fig. 3 A is with apparatus disclosed herein and method-the comprise blocker of apparatus shown in Figure 3 and method-use and the side view of push rod;
Fig. 3 B is the enlarged drawing of another embodiment of conduit shown in Figure 3;
Fig. 4 is the sketch map that is used for the treatment of another embodiment of carotid method and apparatus;
Fig. 4 A is the sketch map of another embodiment of the pump bin shown in Fig. 4;
Fig. 5 is the sketch map of another embodiment of the pump bin shown in Fig. 4.
The specific embodiment
Can be used for the carotid artery plasty through neck Blocking Method (CCA) and near-end shunting (TOPS).
In an embodiment shown in Figure 1, a kind ofly be used for the treatment of carotid method and can in operating room, carry out.After patient's mild sedation, with the skin of 2 centimeters above the mixed liquor paralysis clavicle of 1% lignocaine and 0.5% marcain.Form the cross sections of 2cm in the center of sternocleidomastoid medical border (medical border).Side direction retracts this muscle, thereby common carotid artery (CCA) 12 is exposed in the circumference of 2 centimeter length.
, with after increasing activated clotting time (for example) the pin (not shown) is introduced directly in the CCA 12 above the position of operating forceps 14 in heparin (for example, approximately 70IU/kg is to about 100IU/kg) greater than 250 seconds.Injecting contrast medium under the perspective in suitable front bevel locates carotid bifuracation portion and damage 16 " the difference images " that are in the contrastographic picture of amplification.The seal wire (not shown) is advanced in distal carotid artery bulb 22 or the external carotid artery 20.Advance first sheath 24, the end of seal wire is stretched, continue then to advance this sheath, make it cross dilator and arrive distal CCA 13 or external carotid artery (ECA) 20 up to dilator (parts of this sheath, not shown).Carry out intracranial carotid artery plasty (Tang Shi position, front and back (AP Towne) and side position), with the proof preexist intracranial carotid artery pathology and estimate side Zhi Xunhuan.
The side arm 30 of first sheath 24 is connected on the filter 34 by the fixture (not shown), and this fixture is installed on the side arm 38 of the 3rd sheath 28 that is communicated with internal jugular vein 40 fluids.This structure forms isocon 32.Because operating forceps 14 is clipped on the CCA 12, can use perspective or the ultrasonic affirmation contrast medium of two merit to blow back into internal jugular vein 40 through isocon 32 from internal carotid artery (ICA) 42.The seal wire 27 that comes out from second sheath 26 passes injury of carotid artery 16 under the flow inversion brain protection, and this damages 16 with sacculus 29 expansions.
If do not see when enabling isocon 32 that contrast medium flows backwards rapidly, then use syringe (for example syringe of 20cc) by first sheath, 24 powerful ground sucking-off blood, for example, after each plasty.Therefore, the refluence passage of embolism materials can be provided.Blood turns back to patient's (in body) by threeway pipe close (stopcock) (for example pipe close 44 and pipe close 46) or the filter 34 that is installed on the isocon 32.Stent (for example, 8 or the support of 10mmx241nm) makes it stride across damage 16, enters CCA 12.This support can be expanded continuously and healthily by shaping sacculus (for example, 5 or the shaping sacculus of 6mmx2cm).
After discharging external carotid artery occlusion balloon 25 and common carotid artery pincers 14, finish carotid artery and intracranial carotid artery plasty.In case it is satisfactory to observe the treatment of damage 16, then removes first arterial sheath 24 and second arterial sheath 26, use the previous exit position suture of placing to repair the tremulous pulse acanthopore simultaneously.
In certain embodiments, one or two in the sheath 24,26 has and inserts length or from the far-end of the sheath the first axle part to proximal extension.On whole insertion length, sheath 24,26 has the sectional dimension (for example, about 6-8 French) that is suitable for being inserted among the CCA 12.Though (this sectional dimension there is no need identical along insertion length, should be suitable for being inserted among the CCA along the largest cross-sectional sized of inserting length.) in some such embodiment, this inserts length less than about 75cm, less than about 50cm, less than about 30cm, perhaps less than about 15cm.In other embodiment, this inserts length between about 2cm and about 25cm, perhaps between about 2cm and about 15cm.More generally, because can be suitable for entering CCA through neck, can be shorter so insert length.
In certain embodiments, one or two among axle 24a, the 26a of sheath 24,26 are configured to inflexible substantially.Advantageously, not needing to make sheath 24/26 " to ride " on seal wire just can be inserted into rigidity sheath 24,26 among the CCA 12.Perhaps, axle 24a/26a can make inflexible substantially, but can be fully crooked, with permission user " prebuckling " axle 24a/26a, thus this curved shape that can keep user to give.By this flexible axle 24a/26a, the shape that user can self-defined sheath 24/26 being fit to patient's vascular system, thereby and more easily is placed into sheath 24/26 the correct position place of CCA 12.Described prebuckling can be carried out the observation of patient's carotid artery system according to user.Above-mentioned inflexible and/or flexible sheath 24/26 can be made with rustless steel, suitable soft metal or any suitable polymeric material.
In another embodiment shown in Fig. 2 and the 2A, used the device 210 that has only an arterial sheath or conduit 224.The dilator 250 (seeing Fig. 2 A) that is used for arterial sheath 224 has the tapering shorter than the arterial sheath of routine, and can turn to or bend towards the end, to help preventing damage or cutting the tremulous pulse rear wall.Support/ICA shaping sacculus 229 and ECA occlusion balloon 225 are passed single sheath 224, and this sheath is preferred enough big, so that launch sacculus 225,229 and the inner chamber of sufficient size is provided, thereby are convenient to embolism materials by sheath 224 refluences.This sheath can have prevent that conduit 224 from moving and can be enough greatly blocking the sacculus 252 of CCA 212, thereby replaced the operating forceps 14 of the embodiment among Fig. 1 effectively.The side arm 230 of arterial sheath 224 has opening 256, and this opening preferably opening than sheath commonly used is big, thereby can prevent to form the bottleneck of the blood flow that carries very big embolic debris.Flow transducer 258 (for example, doppler sensor) is the part of flow path, can carry out in real time and verification incessantly mobile and flow direction.Contrast medium injection/blood aspiration device 260 and contrast reservoir 264 can be installed near the side mouth 256 the side arm 230, are used to prevent form because of carelessness air embolism.Can use pipe close 244 at the connecting portion place between side arm 230 and the injection/aspiration device 260.When pipe close 244 was opened, the passage of opening preferably had very big cavity.Filter 268 also can be installed on the side arm 230.Filter can be made one with device 210, with the member of simplification device 210.Shown in flow arrow 272, side arm 230 can lead to the venous sheath (not shown), for example the sheath 28 among the embodiment of Fig. 1.
In certain embodiments, sheath 224 has and inserts length or from the first axle part of sacculus 252 to proximal extension.On whole insertion length, sheath 224 has the sectional dimension (for example, about 6-8 French) that is suitable for being inserted among the CCA 12.Though (this sectional dimension there is no need identical along insertion length, should be suitable for being inserted among the CCA along the largest cross-sectional sized of inserting length.) in some such embodiment, this inserts length less than about 75cm, less than about 50cm, less than about 30cm, perhaps less than about 15cm.In other embodiment, this inserts length between about 2cm and about 25cm, perhaps between about 2cm and about 15cm.More generally, because can be suitable for entering CCA through neck, can be shorter so insert length.
In certain embodiments, the axle 224a of sheath 224 is configured to inflexible substantially.Advantageously, not needing to make sheath 224 " to ride " on seal wire just can be inserted into rigidity sheath 224 among the CCA 12.Perhaps, axle 224a can make inflexible substantially, but can be fully crooked, so that allow user " prebuckling " axle 224a, thus this curved shape that can keep user to give.By this flexible axle 224a, the shape that user can self-defined sheath 224 is to be fit to patient's vascular system.Thereby and more easily sheath 224 is placed into the correct position place of CCA 12.Described prebuckling can be carried out the observation of patient's carotid artery system according to user.Above-mentioned inflexible and/or flexible sheath 224 can be made with rustless steel, suitable soft metal or any suitable polymeric material.
In another embodiment shown in Fig. 3,3A and the 3B, the ductus arteriosus/sheath 324 of this apparatus has opening 374 in a side of the sheath distal of first expanded film or sacculus 352, and described first expanded film or sacculus are positioned at the outside of this sheath 324.Second expanded film or sacculus 325 are positioned at the outside of sheath 324, the far-end of opening 374.Balloon sheath 324 is for example crossed the seal wire (not shown) and is inserted in the ECA 320.After removing the seal wire (not shown) from sheath 324, blocker 378 (also shown in Fig. 3 A) is passed sheath 324, to block the distal lumen 373 of sheath 324.This blocker 378 can be sent into by knock-down push rod 380.Perhaps, after removing seal wire, can use valve (not shown) or other mechanism to seal the inner chamber 373 of the sheath 324 that leads to ECA 320.Then, second sacculus 325 expands and seals to form, thereby has prevented flowing in ECA 320.First sacculus 352 can expand to block CCA 312.Then, no matter having does not have pre-expansion-molded damage 316, and shaping sacculus and support 329 can be crossed seal wire 376, the side opening 374 by arterial sheath 324 and enter internal carotid artery 342.
In one embodiment, first sacculus 352 has the swell diameter up to about 13mm, and second sacculus 325 has the swell diameter up to 6mm.Described air bag preferably on sheath 324 at a distance of about 2-6cm.
Can comprise slip or movably overlap 382 (seeing Fig. 3 B), covering the side opening 374 on the arterial sheath 324, thereby allow two conduit (not shown) to pass sheath 324, and blood is leaked in the external operating space of patient from sheath 324.Flexible or movably overlap 382 and can perhaps can make by plastics of suitable material-for example-form by any suitable strippable band.
For example, when ECA got clogged, for treatment injury of common carotid artery (not shown) or treatment injury of internal carotid artery, it was useful being equipped with the sheath of cover 382.In these situations, this sheath can not extend among the ECA of obstruction, and the end that therefore only has a sheath 324 of far-end second sacculus 325 is placed in the CCA 312 and blocks CCA 312.If ECA has got clogged or because disease and narrow does not especially then need independent ECA occlusion balloon.Placing sheath like this can make side opening 374 or hole on the sheath external the patient.Therefore, use cover 382 to cover opening 374, to suppress or to prevent that blood is sprayed onto on the operating space from sheath 324.
The ECA of not shown obstruction in Fig. 3, but there is the ECA that blocks in following description hypothesis, and second sacculus 325 is positioned at CCA 312 and blocks CCA 312.Be used to implement the end that the unfolded conduit of angioplasty and support (for example, conduit 329) passes sheath, to be positioned at ICA 342.In this case, the sheath 324 among Fig. 3 with Fig. 2 in sheath 224 similar modes work, second sacculus 325 is used to block CCA 312.Unexpanded first sacculus 352 of sheath 324 is external the patient, and is therefore inoperative.Note, in this example, do not use blocker 378.
If ECA does not get clogged, the cover 382 of then peelling off or slip so that sheath 324 continued to be pushed away and to enter the hole of tremulous pulse to far-end from otch, thereby makes second sacculus 325 be arranged in ECA 320.Placing sheath 324 as mentioned above allows support 329 to launch by side opening (side opening) 374 rather than by the end hole 373 of sheath 324.About the decision of where placing the end of sheath is to make at initial angiography.What be worth appreciation is that this sheath also can be used to carry out operation shown in Figure 2.
Shown in flow arrow 372, the side arm 330 of sheath 324 can lead to the sheath 28 of Fig. 1 of the bin 264, pipe close, venous sheath of the device 260, contrast reservoir of the isocon 32, filter, contrast medium injection/blood aspiration device of isocon-for example above-mentioned-for example above-mentioned-for example above-mentioned-for example or above-mentioned combination.
In another embodiment, the sheath 324 among Fig. 3-4 can have the far-end (rather than the open end shown in Fig. 3-4 and blocker) of sealing.The far-end of this sealing preferably has structure taper, atraumatic.Far-end by sealing does not use seal wire just this sheath 324 can be inserted in CCA312 and the ECA 320.
In certain embodiments, sheath 324 has and inserts length or from the first axle part of first sacculus 352 to proximal extension.On whole insertion length, sheath 324 has the sectional dimension (for example, about 6-8 French) that is suitable for being inserted among the CCA 12.Though (this sectional dimension there is no need identical along insertion length, should be suitable for being inserted among the CCA along the largest cross-sectional sized of inserting length.) in some such embodiment, this inserts length less than about 75cm, less than about 50cm, less than about 30cm, perhaps less than about 15cm.In other embodiment, this inserts length between about 2cm and about 25cm, perhaps between about 2cm and about 15cm.More generally, because can be suitable for entering CCA through neck, can be shorter so insert length.
In certain embodiments, the axle 324a of sheath 324 is configured to inflexible substantially.Advantageously, not needing to make sheath 324 " to ride " on seal wire just can be inserted into rigidity sheath 324 among the CCA 12.Perhaps, axle 324a can make inflexible substantially, but can be fully crooked, with permission user " prebuckling " axle 324a, thus this curved shape that can keep user to give.By this flexible axle 324a, the shape that user can self-defined sheath 324 being fit to patient's vascular system, thereby and more easily is placed into sheath 324 the correct position place of CCA 12.Described prebuckling can be carried out the observation of patient's carotid artery system according to user.Above-mentioned inflexible and/or flexible sheath 324 can be made with rustless steel, suitable soft metal or any suitable polymeric material.
Some embodiment does not use venous shunt.Fig. 4 illustrates such enforcement.Arterial sheath-sidearm 330 is communicated with pump 484 fluids of control and checking flow.Blood turns back to carotid sheath 324 after flowing through filter (can comprise pump 484).Blood returns and can finish or by blood being flow in the pump bin 488 (seeing Fig. 4 A) and finishing the back in brain protection's phase and return by same side arm mouth 330a and finish by independent carotid artery path 486.A kind of method in back can be used the valve 490 and 491 of valve-for example.
Fig. 5 illustrates the embodiment that can be used for collecting passively from the storage device 588 of the blood of the side arm 30/230/330 of sheath 24/224/324.This device 588 comprises: filter 568, valve 590,591 and 597, blood inlet 592, blood outlet 593, plunger 594, bin 598 and air outlet slit 596.This side arm 30/230/330 is connected to blood inlet 592, and valve 591 is initially set to permission and 592 flows into bins 598 from the effusive blood of side arm from entering the mouth, and valve 590 is initially set to and prevents from bin 598 effusive fluids through valves 590.In addition, blood outlet is connected on the arterial passageway 486-of tremulous pulse or vein loop-for example.(when artery blood flow is reverse by above-mentioned sacculus and/or clamp) during the brain protection; this initial setting up allows arterial blood sheath 24/224/324 of at first flowing through " passive " under normal arterial pressure power; the side arm 30/230/330 of flowing through then; finally enter bin 598, and do not need additonal pressure source or external pressure source.Therefore, arterial blood is collected in the storage device 588 passively; When blood was collected in the bin 598, air was discharged from (for this reason, valve 597 is opened) by air outlet slit 596.
Finish and the normal direction of blood flow is recovered back (for example, by shrinking sacculus and/or discharging clamp) in brain protection's phase, the blood of collection turns back to patient's vascular system, for example, and by CCA 12 and the sheath 24/224/324 implanted.For this reason, shut off valve 591 and 597, and open valve 590.Then, depression of plunger 594, with the blood that forces collection flow out bin 598, flow through filter 568 and valve 590 and flow out from blood outlet 593.If use the arterial passageway 486 of loop-for example, then blood flow is crossed path 486 and the sheath of implanting and is turned back in the CCA 12.
If wish, can on air outlet slit 596, connect nonrigid overflow chamber (bag for example ventilates), to collect the blood that overflows from bin 598.Perhaps, can the control valve (not shown) be installed, regulating, thereby solve the difference of the normal arterial flow speed between the patient to bin 598 mobile velocity of blood flow at (perhaps between side arm and bin 598) on the side arm 30/230/330.
Perhaps, can export at blood on the loop/arterial passageway in 593 downstreams by T-shape joint etc. and connect the contrast reservoir (not shown), add desirable contrast fluid to blood when returning in patient's body when blood.
Additional embodiments comprises tool kit.First tool kit comprises the apparatus among Fig. 1; Second tool kit comprises the apparatus among Fig. 2-2A; The 3rd tool kit comprises the apparatus among Fig. 3-3B; The 4th tool kit comprises the apparatus among Fig. 4; The 5th tool kit comprises the apparatus among Fig. 4, and wherein the apparatus among Fig. 4 A replaces the corresponding apparatus among Fig. 4.The 6th tool kit comprises the apparatus among Fig. 4, and wherein the apparatus among Fig. 5 replaces the corresponding apparatus among Fig. 4.Tool kit above-mentioned can also comprise (for example, the 15-45cm) seal wire that is suitable for through the weak point of the special use of neck method.These short-length guidewires can be configured to curved shape flexible and that keep user to give, and are similar with above-mentioned flexible sheath.This seal wire can be made with rustless steel or suitable soft metal, and can be thicker than seal wire commonly used.
Replace or except these short-length guidewires, any tool kit above-mentioned comprises " crooked " implanting needle, and this implanting needle has suitable angle, to reduce the probability of tremulous pulse rear wall perforation.This implanting needle can have contrast medium and inject the side mouth.
Though in contextual some preferred embodiment and example, disclose these inventions, but those skilled in the art should be understood that, the present invention is not limited in concrete disclosed embodiment, also comprise other interchangeable embodiment and/or use of the present invention, and to conspicuous modification of the present invention etc.In addition, though illustrate and described a plurality of modification of the present invention with different the level of details, according to the disclosure, other modification of being made within the scope of the invention is conspicuous to those skilled in the art.It is also conceivable that various combinations or son combination and these combinations or sub in conjunction with still being within the scope of the present invention are carried out in the concrete feature and the aspect of present embodiment.Therefore, should be appreciated that in order to form the variation pattern of disclosed invention, different characteristic of the disclosed embodiments and aspect can mutually combine or replace.Therefore, scope of the present invention disclosed herein should not be limited to above-mentioned disclosed specific embodiment, but should only determine by clearly reading claims.
Claims (11)
1. apparatus that is used for the carotid artery plasty, described apparatus comprises:
Conduit with far-end and near-end relative with described far-end;
First obstruction piece and second obstruction piece, at least described first obstruction piece is positioned on the described conduit, and described first obstruction piece and second obstruction piece are configured to make the normal direction of the blood flow in the internal carotid artery reverse when described first obstruction piece is blocked common carotid artery and described second obstruction piece obstruction external carotid artery;
Wherein, described conduit has from the first axle part of described first obstruction piece to proximal extension, described the first axle part has the maximum cross-section that can be inserted in the common carotid artery, and described the first axle part has the length less than 15 centimetres, enters common carotid artery so that be suitable for through neck;
Wherein, described conduit has the blood inlet that is positioned at the described first obstruction piece far-end;
Described apparatus also comprises collection reservoir, and described collection reservoir is configured to be connected on the described conduit and is communicated with the described blood passive fluid that enters the mouth;
Described catheter fluid is connected to isocon on the described collection reservoir; And
The flow transducer of the blood flow of described isocon is flow through in perception.
2. apparatus according to claim 1 is characterized in that, passive fluid is communicated with under the assistance that is included in the fluid pressure source except that arterial blood pressure not via fluid flow path from the enter the mouth connection of described collection reservoir of described blood.
3. apparatus according to claim 1 is characterized in that, described second obstruction piece is positioned at the described distal end of catheter of described first obstruction piece.
4. apparatus according to claim 1 is characterized in that, also comprises being configured to filter the filter that is collected in the blood in the described collection reservoir.
5. apparatus according to claim 1 is characterized in that, also comprises the tremulous pulse loop that is communicated with described collection reservoir fluid.
6. apparatus according to claim 1 is characterized in that the direction of the blood flow of described isocon is flow through in described flow transducer perception.
7. apparatus according to claim 1 is characterized in that described collection reservoir comprises air outlet slit, and when blood was collected in the described collection reservoir, air was discharged from described collection reservoir by described air outlet slit.
8. apparatus according to claim 1, it is characterized in that, described collection reservoir comprises blood inlet that has first valve and the blood outlet that has second valve, described first valve is opened to allow blood to flow into described collection reservoir, and described second valve is opened to allow blood to flow out described collection reservoir.
9. apparatus according to claim 8 is characterized in that described collection reservoir also comprises air outlet slit, and when blood was collected in the described collection reservoir, air was discharged from described collection reservoir by described air outlet slit.
10. apparatus according to claim 8 is characterized in that described collection reservoir also comprises plunger, and described plunger is used to force the blood of collection to discharge described collection reservoir by described blood outlet.
11. tool kit that comprises the apparatus described in the claim 1.
Applications Claiming Priority (4)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US52406903P | 2003-11-21 | 2003-11-21 | |
| US60/524,069 | 2003-11-21 | ||
| US60/569,843 | 2004-05-10 | ||
| US60/587,067 | 2004-07-12 |
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| Publication Number | Publication Date |
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| CN1905841A CN1905841A (en) | 2007-01-31 |
| CN100534392C true CN100534392C (en) | 2009-09-02 |
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| CNB2004800407173A Active CN100534392C (en) | 2003-11-21 | 2004-11-22 | Method and apparatus for treating a carotid artery |
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| US11844893B2 (en) | 2021-01-17 | 2023-12-19 | Inspire M.D Ltd. | Shunts with blood-flow indicators |
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| WO2010019481A1 (en) | 2008-08-11 | 2010-02-18 | Conceptx Medical, Inc. | Systems and methods for treating dyspnea, including via electrical afferent signal blocking |
| DE112013002175T5 (en) * | 2012-04-24 | 2015-01-22 | Cibiem, Inc. | Endovascular catheters and procedures for ablation of the carotid body |
| US9402677B2 (en) | 2012-06-01 | 2016-08-02 | Cibiem, Inc. | Methods and devices for cryogenic carotid body ablation |
| EP3116408B1 (en) | 2014-03-12 | 2018-12-19 | Cibiem, Inc. | Ultrasound ablation catheter |
| US9241699B1 (en) * | 2014-09-04 | 2016-01-26 | Silk Road Medical, Inc. | Methods and devices for transcarotid access |
| EP3622981A1 (en) * | 2015-04-10 | 2020-03-18 | Silk Road Medical, Inc. | Methods and systems for establishing retrograde carotid arterial blood flow |
| CN110151295A (en) * | 2017-11-15 | 2019-08-23 | 林斌 | A kind of vena cave bypass blood perfusion Cryoablation system |
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2004
- 2004-11-22 CN CNB2004800407173A patent/CN100534392C/en active Active
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US11844893B2 (en) | 2021-01-17 | 2023-12-19 | Inspire M.D Ltd. | Shunts with blood-flow indicators |
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| Publication number | Publication date |
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| CN1905841A (en) | 2007-01-31 |
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