CN103349575A - Windowing method for covered stent in vascular cavity - Google Patents
Windowing method for covered stent in vascular cavity Download PDFInfo
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- CN103349575A CN103349575A CN 201310225012 CN201310225012A CN103349575A CN 103349575 A CN103349575 A CN 103349575A CN 201310225012 CN201310225012 CN 201310225012 CN 201310225012 A CN201310225012 A CN 201310225012A CN 103349575 A CN103349575 A CN 103349575A
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- overlay film
- film frame
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- covered stent
- vessel lumen
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Abstract
The invention discloses a windowing method for a covered stent in a vascular cavity. The windowing method comprises the following steps: firstly, a covered stent is placed in a vascular cavity, then an x-ray mark is placed in the covered stent, and the blocked vascular opening is preliminarily located through x-ray; the three-dimensional space of the blocked vascular opening is accurately located through ultrasonic sound; finally, a laser emission element is placed in the covered stent and moved to the accurately located vascular opening to trigger a laser beam after a laser emission opening approaches the pipe wall of the covered stent so as to achieve windowing of the covered stent, and blood recirculation of the blocked vascular opening is realized. When the windowing method is adopted, an operation bottleneck problem that in present clinic practice, many related vessel diseases cannot be treated by stenting is solved, extracorporeal visible operation positioning is accurate, and the specific laser frequency windowing is safe and cannot injure vessels, thereby greatly lowering the operation risk for patients.
Description
Technical field
The present invention relates to overlay film frame technical field in the vessel lumen, refer to particularly overlay film frame windowing method in a kind of vessel lumen.
Background technology
Aortic aneurysm is modal aneurysm, is a kind of serious threat human life's trunk disease.Along with hypertension, arteriosclerotic sickness rate increase and aged tendency of population, the sickness rate of aortic aneurysm also increases year by year in recent years, becomes one of common cause of middle-aged and elderly people sudden death.Its cause of disease mainly is that degeneration appears in the aorta middle level, and then causes the aorta wall ball sample expansion weak, the aorta tube chamber that becomes.Can be divided into according to pathological anatomy: true aneurysm (the holostrome Ectasia of blood vessel wall), false aneurysm (how by being wrapped up by connective tissue afterwards with the wound angiorrhexis is hemorrhage), dissecting aneurysm (because the inner membrance part tears, aorta forms the expansion in false chamber behind true and false two chambeies).This disease is very dangerous, the fatality rate height of disabling, and according to relevant report aortic aneurysm such as untimely treatment, five year survival rate only is 17%.Wherein in a single day dissection of aorta occurs, and as not taking active treatment, mortality rate can reach and reach 49%, one year Nei Keda 93%(Anagnostopoulos CE, Elefteriades JA, Doroghazi RM in 21%, four day in first 24 hours of morbidity).Along with the progress of Imaging Technology with to the not short intensification of the understanding of arotic disease, the surgical intervention means of this type of disease are constantly innovation also.
Before the nineties, surgical operation is the primary treatment means of arotic disease.Main modus operandi has: 1. aortic aneurysm excision artificial blood vessel transplants the reconstruction aorta; 2. aortic aneurysm wraps up art; 3. aortic aneurysm sidewall tumor Corpectomy.Not only wound is large for above-mentioned three kinds of operative treatments, operating time is long, complication is many, mortality rate is high, could carry out under the measure support that needs the circulation of extracorporeal circulation support and dark hypothermia to stop, so the requirement to patient's overall health of patients and medical skill is high, and even experienced surgeon the good patient who chooses date for operation of cardiac function is carried out surgical intervention, its operative mortality is still 12 ~ 15%, (DeBakey ME, Moreno-Cabral CE) patient the incidence rate of paraplegia occurs 5 ~ 12%.Especially aortic aneurysm is mainly in elderly patient, often merges the patient of the complete and emergency operation of the multi-organ functions such as the heart, liver, lung, kidney, and operative mortality is especially up to 50% or higher (Moreno-Cabral CE).
Interventional therapy is the treatment means of the arotic disease that grows up after the nineties in last century, constantly be applied in the various difficult miscellaneous diseases, mainly contain: 1. percutaneous inner membrance windowing, its mentality of designing is to window at the interlayer far-end, make parallel blood flow is arranged between the true and false chamber, purpose is to make the blood flow in the false chamber of dissecting aneurysm return true chamber, enlarge for alleviating false chamber, acute abdominal viscera and lower limb ischemia that true chamber pressurized causes play a role, but be after all a kind of palliative operation, for fundamentally eliminating false chamber and inner membrance breach, be that further interventional therapy is striven for operating time as emergency treatment only, at present less employing.2. overlay film frame endovascular graft.The conventional open surgery of this technology has that wound is little, post-operative recovery fast, few intercurrent disease, obviously shorten the advantage such as hospital stays, has especially given to merge the high-order elderly patient that chronic disease can not tolerate traditional operation the therapy apparatus meeting is provided.From Parodi doctor in 1991, Dake doctor in 1994 and Nienaber doctor in 1999 respectively application and abdominal aortic aneurysm, convex chest main aneurysm and dissection of aorta treatment and succeed after, the overlay film frame graft exclusion has become the aneurysmal optimum selection for the treatment of in the aorta lumen now, has started the milestone of aortectasia disease therapeutic.Now, replaced traditional operation in the treatment of the diseases such as part dissection of aorta, aorta true aneurysm, aortic pseudoaneurysm.
But intracavity overlay film frame implantation remains at present in a lot of technical bottlenecks, is mainly reflected in following three kinds of situations: 1. the curvature of near-end tumor neck, bore are excessive; 2. tumor neck place exists mural thrombus or speckle; 3. the length of tumor neck is larger.For Stanford Type B Thoracic Aortic Dissection endovascular graft, it requires aorta breach position to exceed left subclavian artery opening 15mm, for abdominal aortic aneurysm, requires distance between tumor body near-end and the low renal artery greater than 15mm.For the patient that can not satisfy the requirement of above-mentioned tumor neck such as routinely treatment, can be shorter for the zone of overlay film frame grappling, then in the art, as easy as rolling off a log displacement or the near-end I type internal hemorrhage due to trauma that support occurs of postoperative.But, in order to obtain enough anchor region, often need left subclavian artery or renal artery, superior mesenteric artery, coeliac trunk artery are sealed in the lump, further cause the fatal complication such as relevant important organ ischemia.Therefore, have approximately 25 ~ 40% patient can not use conventional overlay film frame method for implantation treatment, the difficult problem that section's aortic aneurysm, nearly renal aorta tumor and thoracoabdominal aortic aneurysm become present overlay film frame endovascular graft falls in bow.
Solution to this problem has at present: 1. overlay film frame implantation+surgical operation is rebuild and is closed tremulous pulse, the method not only before the art, postoperative repeatedly the radiography assessment relate to arterial blood and supply, and, open surgery to rebuild axillary artery, subclavian artery, internal carotid artery, renal artery, coeliac trunk artery, superior mesenteric artery.Only be only applicable to the part state of an illness steadily, ordinary circumstance still can patients undergoing elective surgery, have not yet to see appropriate authority successful surgery report for the emergency treatment critically ill patient, operating difficulty, operation risk, operating time and wound have some idea of, be difficult to carry out in the popularization of middle level medical institutions, and the medium-term and long-term prognosis of patient is not still not certainly.2. overlay film frame is windowed, it is exactly to punch in the position of overlay film frame over against important Visceral artery openings such as renal artery exactly that what is called is windowed, can make like this overlay film frame cross over important tremulous pulse and carry out grappling, fully isolated interlayer breach and prevention internal hemorrhage due to trauma can guarantee again the unobstructed of above-mentioned vitals artery blood flow perfusion.But windowing stent manufacturing technology difficult point is windowed to overlay film frame in advance external, is difficult to accurately be positioned the opening part of above-mentioned important branch, customizes on the basis that needs accurately to measure in conjunction with CTA imaging (bed thickness 1mm).Medical very long to the rack making success time from the patient, a lot of patient aggravation even sudden deaths in wait have increased greatly this type of patient and have enclosed operative mortality.Moreover the domestic not yet listing, expensive of this type of support.Moreover, because individual variation, the position of the opening of everyone aorta and each branch, size, direction differ greatly, and are difficult to realize individualized treatment.With regard to present image technology, three-dimensional accurate location in the external very difficult acquisition vessel lumen.Moreover, this type of support implant need with method the methods such as silver brain clip labelling, left subclavian artery, renal artery labelling, multi-angle perspective are arranged, operation easier is very large.Therefore, how to realize bending and fall windowing of refractory aneurysms patient's overlay film frames such as section's aortic aneurysm, nearly renal aorta tumor and thoracoabdominal aortic aneurysm, become the international headache of interventional therapy.
Summary of the invention
The object of the invention is to overcome the technical barrier that overlay film frame is windowed in the existing vessel lumen, overlay film frame windowing method in a kind of vessel lumen is provided, can accurately locate the important arterial branch opening part that is covered by overlay film frame and window, open and be blocked tremulous pulse, thereby realized refractory aneurysms patient's interventional therapy.
For achieving the above object, the interior overlay film frame windowing method of vessel lumen that the present invention is designed comprises the steps:
1) with in the stent inserting vessel lumen, make the tube wall outside of overlay film frame block at least a vascular mouth;
2) the x ray markers is inserted in the overlay film frame, by the x ray Primary Location is carried out in the position of the vascular mouth that is blocked;
3) insert ultrasonic parts in the overlay film frame and move to by the vascular mouth position of Primary Location, carry out ultrasonic to gather local vessel chamber parameter, image, and transmit, store, analyze the data that gather, finish the three-dimensional reconstruction of ultrasonic place vessel lumen and the identification of structural pipe wall, the three-dimensional space position that is blocked the vascular mouth is accurately located;
4) insert the Laser emission element in the overlay film frame and move to the vascular mouth position of accurately having been located, make the Laser emission mouth trigger laser beam near behind the tube wall of overlay film frame, overlay film frame is windowed, the blood flow of realizing being blocked the vascular mouth is logical again.
Preferably, the distance of the tube wall of the close overlay film frame of Laser emission mouth is 5 ~ 10mm in the described step 4).
Preferably, the power of laser beam is that 10 ~ 300MW, wavelength are that 500 ~ 10000nm, frequency are 3.846 ~ 7.895 * 10 in the described step 4)
14Hz.
More preferably, the power of described laser beam is that 50 ~ 100MW, wavelength are that 3000 ~ 7000nm, frequency are 4.568 ~ 6.755 * 10
14Hz.
Beneficial effect of the present invention: utilize the interior overlay film frame windowing method of vessel lumen to carry out the interior overlay film frame of body and window with solving the many operation bottleneck problems that can't carry out clinically the sufferer of implant frame treatment related vascular diseases now, for numerous patients provide more leases of life; External visual operation accurate positioning, the specific laser frequency safety of windowing adopts specific laser frequency to window, can injured blood vessel, can greatly reduce patient's operation risk.
The specific embodiment
The present invention is described in further detail below in conjunction with specific embodiment.
Behind the complicated Endovascular Graft Exclusion for Abdominal Aortic Aneurysm that involves bilateral renal arteries, the vessel lumen inwardly opened window reparation that the bilateral renal arteries that causes is blocked is example.
Overlay film frame windowing method in a kind of vessel lumen comprises the steps:
1) with stent inserting abdominal aortic aneurysm intracavity, there is left renal artery and the right renal artery vascular mouth that is blocked in the tube wall of the overlay film frame outside;
2) the x ray markers is inserted in the overlay film frame, by the x ray Primary Location is carried out in the position of the left renal artery vascular mouth that is blocked;
3) insert ultrasonic parts in the overlay film frame and move to by the left renal artery vascular mouth position of Primary Location, carry out ultrasonic to gather local vessel chamber parameter, image, and transmit, store, analyze the data that gather, finish the three-dimensional reconstruction of ultrasonic place vessel lumen and the identification of structural pipe wall, the three-dimensional space position of left renal artery vascular mouth is accurately located;
4) insert the Laser emission element in the overlay film frame and move to the left renal artery vascular mouth position of accurately having been located, make the Laser emission mouth near the tube wall of overlay film frame, keeping at a distance is 5 ~ 10mm, then trigger laser beam, overlay film frame is windowed, realize that the blood flow of left renal artery vascular mouth is logical again.The power of described laser beam is that 70MW, wavelength are that 50000nm, frequency are 5.436 * 10
14Hz.
Repeat above-mentioned steps 2) ~ 4), realize that the blood flow of right renal artery is logical again.
At last, under X-ray examination, beat contrast agent, check is by left renal artery and the right renal artery originally blocked by vessel lumen, if radiography finds that the vessel lumen opening at left renal artery or right renal artery place is less, can also again utilize localization by ultrasonic after, in vessel lumen again with laser will be less opening enlarge, simultaneously, also can insert band film small rack in left renal artery or right renal artery, thoroughly shutoff is leaked the blood flow of people in aneurysm or in the interlayer from the laser opening part.
Claims (4)
1. the interior overlay film frame windowing method of vessel lumen comprises the steps:
1) with in the stent inserting vessel lumen, make the tube wall outside of overlay film frame block at least a vascular mouth;
2) the x ray markers is inserted in the overlay film frame, by the x ray Primary Location is carried out in the position of the vascular mouth that is blocked;
3) insert ultrasonic parts in the overlay film frame and move to by the vascular mouth position of Primary Location, carry out ultrasonic to gather local vessel chamber parameter, image, and transmit, store, analyze the data that gather, finish the three-dimensional reconstruction of ultrasonic place vessel lumen and the identification of structural pipe wall, the three-dimensional space position that is blocked the vascular mouth is accurately located;
4) insert the Laser emission element in the overlay film frame and move to the vascular mouth position of accurately having been located, make the Laser emission mouth trigger laser beam near behind the tube wall of overlay film frame, overlay film frame is windowed, the blood flow of realizing being blocked the vascular mouth is logical again.
2. overlay film frame windowing method in the vessel lumen according to claim 1, it is characterized in that: the Laser emission mouth is 5 ~ 10mm near the distance of the tube wall of overlay film frame in the described step 4).
3. overlay film frame windowing method in the vessel lumen according to claim 1 and 2, it is characterized in that: the power of laser beam is that 10 ~ 300MW, wavelength are that 500 ~ 10000nm, frequency are 3.846 ~ 7.895 * 10 in the described step 4)
14Hz.
4. overlay film frame windowing method in the vessel lumen according to claim 3, it is characterized in that: the power of described laser beam is that 50 ~ 100MW, wavelength are that 3000 ~ 7000nm, frequency are 4.568 ~ 6.755 * 10
14Hz.
Priority Applications (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN 201310225012 CN103349575A (en) | 2013-06-06 | 2013-06-06 | Windowing method for covered stent in vascular cavity |
| PCT/CN2014/070695 WO2014194675A1 (en) | 2013-06-06 | 2014-01-16 | Windowing method for covered stent in vascular cavity and windowing device for covered stent in vascular cavity |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN 201310225012 CN103349575A (en) | 2013-06-06 | 2013-06-06 | Windowing method for covered stent in vascular cavity |
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| CN103349575A true CN103349575A (en) | 2013-10-16 |
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Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN105902326A (en) * | 2016-06-29 | 2016-08-31 | 黄连军 | Windowing method and device of covered stent |
| CN107374779A (en) * | 2016-05-16 | 2017-11-24 | 上海交通大学医学院附属第九人民医院 | A kind of local laser artery windowing facility and application thereof |
| WO2018145518A1 (en) * | 2017-02-07 | 2018-08-16 | 先健科技(深圳)有限公司 | Puncturing device and anchoring device |
-
2013
- 2013-06-06 CN CN 201310225012 patent/CN103349575A/en active Pending
Cited By (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN107374779A (en) * | 2016-05-16 | 2017-11-24 | 上海交通大学医学院附属第九人民医院 | A kind of local laser artery windowing facility and application thereof |
| CN105902326A (en) * | 2016-06-29 | 2016-08-31 | 黄连军 | Windowing method and device of covered stent |
| CN105902326B (en) * | 2016-06-29 | 2018-05-22 | 黄连军 | A kind of overlay film frame windowing facility |
| WO2018145518A1 (en) * | 2017-02-07 | 2018-08-16 | 先健科技(深圳)有限公司 | Puncturing device and anchoring device |
| US11413067B2 (en) | 2017-02-07 | 2022-08-16 | Lifetech Scientific (Shenzhen) Co., Ltd | Puncturing device and anchoring device |
| US11950807B2 (en) | 2017-02-07 | 2024-04-09 | Lifetech Scientific (Shenzhen) Co., Ltd | Puncturing device and anchoring device |
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Application publication date: 20131016 |