CN116327464B - Delivery microcatheter integrated with brain protection device and stent placement method - Google Patents
Delivery microcatheter integrated with brain protection device and stent placement method Download PDFInfo
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- CN116327464B CN116327464B CN202310243846.7A CN202310243846A CN116327464B CN 116327464 B CN116327464 B CN 116327464B CN 202310243846 A CN202310243846 A CN 202310243846A CN 116327464 B CN116327464 B CN 116327464B
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- 238000000034 method Methods 0.000 title claims abstract description 27
- 230000001681 protective effect Effects 0.000 claims abstract description 65
- 230000000149 penetrating effect Effects 0.000 claims description 13
- 239000012528 membrane Substances 0.000 claims description 10
- 229910001000 nickel titanium Inorganic materials 0.000 claims description 5
- 239000000956 alloy Substances 0.000 claims description 3
- 230000001050 lubricating effect Effects 0.000 claims description 3
- 239000002861 polymer material Substances 0.000 claims description 3
- 230000006378 damage Effects 0.000 abstract description 4
- 208000027418 Wounds and injury Diseases 0.000 abstract description 3
- 208000014674 injury Diseases 0.000 abstract description 3
- 230000008569 process Effects 0.000 description 15
- 208000031481 Pathologic Constriction Diseases 0.000 description 13
- 230000010339 dilation Effects 0.000 description 10
- 230000002792 vascular Effects 0.000 description 9
- 230000003902 lesion Effects 0.000 description 6
- 210000004204 blood vessel Anatomy 0.000 description 5
- 230000036262 stenosis Effects 0.000 description 5
- 208000037804 stenosis Diseases 0.000 description 5
- 238000002583 angiography Methods 0.000 description 4
- 230000000694 effects Effects 0.000 description 4
- 238000002627 tracheal intubation Methods 0.000 description 4
- 208000005189 Embolism Diseases 0.000 description 3
- 238000013172 carotid endarterectomy Methods 0.000 description 3
- 238000003780 insertion Methods 0.000 description 3
- 230000037431 insertion Effects 0.000 description 3
- 238000011084 recovery Methods 0.000 description 3
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 3
- 230000002411 adverse Effects 0.000 description 2
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- 230000003073 embolic effect Effects 0.000 description 2
- 239000010935 stainless steel Substances 0.000 description 2
- 229910001220 stainless steel Inorganic materials 0.000 description 2
- 238000001356 surgical procedure Methods 0.000 description 2
- 206010057469 Vascular stenosis Diseases 0.000 description 1
- 206010047163 Vasospasm Diseases 0.000 description 1
- 230000009471 action Effects 0.000 description 1
- 230000009286 beneficial effect Effects 0.000 description 1
- 210000005013 brain tissue Anatomy 0.000 description 1
- 210000001715 carotid artery Anatomy 0.000 description 1
- 208000006170 carotid stenosis Diseases 0.000 description 1
- 230000008602 contraction Effects 0.000 description 1
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- 238000004393 prognosis Methods 0.000 description 1
- 230000002035 prolonged effect Effects 0.000 description 1
- 230000001012 protector Effects 0.000 description 1
- 210000005077 saccule Anatomy 0.000 description 1
- 230000000638 stimulation Effects 0.000 description 1
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Classifications
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- 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
- A61F2/962—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
-
- 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
- A61F2/962—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
- A61F2/97—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve the outer sleeve being splittable
-
- 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
- A61B2017/22038—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 with a guide wire
-
- 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
- A61B2017/2212—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having a closed distal end, e.g. a loop
-
- 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
- A61F2/958—Inflatable balloons for placing stents or stent-grafts
- A61F2002/9583—Means for holding the stent on the balloon, e.g. using protrusions, adhesives or an outer sleeve
Abstract
The application discloses a delivery microcatheter integrated with a brain protection device and a stent placement method. The catheter body comprises a catheter outer layer and a catheter inner layer; the balloon is fixed on the circumferential surface of the front end of the catheter body; the inner layer of the catheter is provided with an eccentric conveying large cavity and an eccentric exchange small cavity which are arranged separately; at the front end of the catheter body, the exchange small cavity is communicated with the conveying large cavity through an inclined channel; a conveying guide wire is penetrated in the conveying large cavity; the front end of the conveying guide wire is provided with a protective umbrella and a bracket which are contracted in the conveying large cavity; the exchange small cavity is internally penetrated with a guide wire and a control guide wire. The application realizes the placement of the protective umbrella and the bracket by utilizing the single tube to match with three guide wires, and has simple structure and smaller radial dimension; the brain protection device is passed and released before the passage is expanded, the stent delivery can be completed without exchanging a guide wire, the frequency of instrument exchange and operation steps are reduced, and the potential injury caused by operation is reduced.
Description
Technical Field
The application relates to the technical field of interventional medical instruments, in particular to a delivery microcatheter integrated with a brain protection device and a stent placement method. The application is mainly applied to the treatment of carotid artery vascular stenosis, and realizes the distal embolic brain protection effect while delivering a stent or other instruments through only one cannula.
Background
Carotid Endarterectomy (CEA) is the gold standard for carotid stenosis treatment. However, in recent years, a plurality of international multicenter prospective random control results show that carotid stenting (CAS) has similar curative effects to CEA, and has no statistical difference in incidence rate of disabling stroke, and CAS has advantages of minimally invasive, good prognosis, fast recovery of patients, high tolerance level and the like, and is favored by doctors and patients. However, the biggest factor limiting the widespread development of CAS is its ischemic complications, which occur at about 5% to 10%. Mainly plaque fragments fall off, resulting in brain tissue damage caused by distal vessel blockage. Each step in CAS surgery is likely to produce a micro-embolic event, and pre-and post-expansion are the two stages of embolic events that are most likely to fall off, as found by intracranial doppler (TCD).
At present, the conventional stent implantation method comprises the following steps: percutaneous puncture, placement of a vascular sheath, angiography, and establishment of a vascular access; the microcatheter passes through the stricture along the microcatheter; withdrawing the microcatheter and replacing the guide wire along the microcatheter; withdrawing the microcatheter along the guide wire; introducing a balloon dilation catheter along the guide wire and allowing the balloon to reach the stricture; slowly inflating the balloon to dilate the stricture; the balloon is depressurized; the balloon dilation catheter is withdrawn from the body along the guide wire; loading a rapid exchange channel of a brain protection device (protective umbrella) delivery device to the proximal end of a guide wire and pushing the rapid exchange channel to a proper position at the distal end of a stenosis along the guide wire; retracting the sheath of the brain protecting device to release the brain protecting device; withdrawing the sheath from the body; taking a guide wire attached to the brain protector as a guide wire for subsequent interventional operation, wherein the guide wire needs to be kept fixed in the whole operation process; the stent conveying system is conveyed to a narrow place along a guide wire of a brain protecting device, the guide wire is pushed by a fixed stent, and a stent conveying sheath tube is retracted to finish stent release; after the operation is finished, the recovery sheath is loaded on a guide wire of a brain protection device, pushed to a filter screen and recovered; the recovery sheath and the brain protection device and the wire are taken out.
The surgical procedure described above can be seen:
(1) Since the release position of the protective umbrella is distal to the lesion, this indicates that the release of the protective umbrella must first pass through the stricture. Clinically, the balloon dilation catheter is conveyed along a guide wire to a lesion position, the balloon dilation catheter is withdrawn after passing through the lesion to pre-dilate a narrow position, then the protective umbrella conveying catheter and the protective umbrella are pushed along the guide wire to reach a proper position at the far end of a blood vessel through lesion tissues, and the conveying catheter is retracted to finish the release of the protective umbrella; the process has no protection of the protective umbrella, and performs multiple expansion stimulation on the lesion position, which is easy to cause the drop of the embolus;
(2) The whole operation process comprises a plurality of steps of expanding catheter insertion, retracting, protecting umbrella conveying catheter insertion, retracting, stent conveying catheter insertion, retracting and the like, and has complex operation and prolonged operation time; each exchange of the instrument can generate risks, carotid blood vessels are distorted, the operation difficulty is high, and the blood vessels are easy to cause vasospasm and even damage due to slight carelessness.
Disclosure of Invention
In order to solve the defects in the prior art, the application provides a delivery microcatheter integrated with a brain protection device and a stent placement method. According to the application, the stent, the brain protection device conveying system and the balloon dilation catheter are combined, so that the number of times of dilation and exchange of instruments in operation is reduced, the risk of embolic falling is reduced, and the operation time is shortened.
The application adopts the following technical scheme: a delivery microcatheter incorporating a brain protection device,
the catheter body comprises a catheter outer layer and a catheter inner layer, and an annular balloon control cavity is formed between the catheter outer layer and the catheter inner layer; the balloon is fixed on the circumferential surface of the front end of the catheter body, the inner side of the balloon is communicated with the balloon control cavity, and the balloon control cavity of the rear end of the catheter body is connected with a pressure control device;
the inner layer of the catheter is provided with an eccentric conveying large cavity and an eccentric exchange small cavity which are arranged separately; at the front end of the catheter body, the exchange small cavity is communicated with the conveying large cavity through an inclined channel;
a conveying guide wire is arranged in the conveying large cavity in a penetrating way; the front end of the conveying guide wire is provided with a protective umbrella contracted in the conveying large cavity, and the rear part of the protective umbrella is provided with a front baffle ring and a rear baffle ring which are arranged on the conveying guide wire; a bracket penetrating through the conveying guide wire is arranged between the front baffle ring and the rear baffle ring;
a guide wire and a control guide wire are arranged in the small exchange cavity in a penetrating way; the front end of the control guide wire penetrates through the inclined channel to enter the conveying large cavity, and the front end of the control guide wire sequentially penetrates through the rear baffle ring, the support and the middle part of the front baffle ring and then is connected with the protective umbrella.
It is further: the rear end of the protective umbrella is connected with a slip ring which is connected to the conveying guide wire in a sliding way; the rear end of the slip ring is connected with a thrust spring, and the rear end of the thrust spring is fixedly connected with the conveying guide wire.
The front baffle ring and the rear baffle ring are symmetrical; the front baffle ring is respectively provided with a through hole for the conveying guide wire and the control guide wire to pass through; one side of the front baffle ring is also provided with a sinking groove, a fixing knot is embedded in the sinking groove, and the fixing knot is fixed on the conveying guide wire.
And developing rings for positioning are arranged on the saccule, the protective umbrella, the front baffle ring and the rear baffle ring.
The front ends of the conveying guide wire and the guiding guide wire are welded or bonded with flexible sections; the flexible section is a micro-elastic lubricating piece made of nickel-titanium alloy materials or high polymer materials.
The protective umbrella comprises an umbrella rib, a filter membrane is arranged outside the umbrella rib, and the filter membrane or a filter membrane filter screen is arranged outside the umbrella rib; the filter membrane adopts a high molecular semipermeable membrane; the filter screen adopts nickel-titanium alloy or stainless steel woven mesh.
The rear end of the catheter body is connected with a fixed sleeve; the fixed sleeve is provided with a waterway joint which is communicated with the balloon control cavity and is connected with the pressure control device; the fixed sleeve is provided with three locking nuts through threaded connection; wedge grooves are formed in the inner walls of the locking nuts, and the conveying guide wires, the guiding guide wires and the control guide wires correspondingly penetrate through the wedge grooves in the three locking nuts one by one.
A stent placement method comprising the steps of:
A. percutaneous puncture, placement of a vascular sheath, angiography, and establishment of a vascular access;
B. inserting a guide wire, and then controlling the delivery microcatheter to pass through the stenosis along the guide wire, wherein the balloon is opposite to the stenosis; then retracting the guide wire for a certain distance, and keeping the front end of the guide wire in the exchange small cavity;
C. pulling the control guide wire backwards, and pulling the support and the protective umbrella towards the front end of the conveying microcatheter until the protective umbrella stretches out of the conveying microcatheter to a position 2-5cm in front of the narrow section; in the process, the advancing speed of the protective umbrella is controlled by matching with the conveying guide wire; after the protective umbrella reaches a preset position, the control guide wire is slowly loosened, and the protective umbrella is automatically unfolded;
D. slowly filling the balloon through the pressure control device and the balloon control cavity to dilate the narrow section, and collecting the dropped emboli to the protective umbrella in the process;
E. the pressure of the balloon is relieved through the pressure control device and the balloon control cavity; then, the delivery microcatheter is retracted until the stent is exposed, the stent is expanded and supported at the stenosis, and in the process, the dropped emboli are collected to the protective umbrella;
F. the balloon of the conveying microcatheter is controlled to reach the narrow section by taking the conveying guide wire as a guide, the stent is expanded again by slowly filling the balloon through a pressure control device and a balloon control cavity, and then the balloon is decompressed; in the process, the dropped emboli are collected to the protective umbrella;
G. controlling the control guide wire, pulling the conveying guide wire backwards, and slowly shrinking and entering the conveying microcatheter while protecting the umbrella to retreat;
H. pushing the guide wire forwards, and enabling the guide wire to enter the conveying large cavity again through the inclined channel until the guide wire stretches out of the conveying microcatheter; and then taking the guide wire as a support, withdrawing the delivery microcatheter, and finally withdrawing the guide wire to complete the stent placement operation.
The application has the beneficial effects that:
the placement of the protective umbrella and the bracket is realized by utilizing the single tube to match with three guide wires, the structure is simple, the radial size is smaller, and the intubation operation is convenient; the catheter is not required to be retracted when the protective umbrella is placed, and is retracted once in a short distance when the bracket is placed, so that adverse effects on blood vessels caused by operating the catheter are avoided;
the brain protection device is passed and released before the passage is expanded, and the stent delivery can be completed without exchanging a guide wire, so that the frequency of instrument exchange and operation steps are reduced, and the potential injury caused by operation is reduced;
in the operation processes of intubation, tube withdrawal and placement, the guide wire is used for supporting the catheter all the time, so that the catheter is prevented from larger fluctuation; the waterway is arranged between the outer layer of the catheter and the inner layer of the catheter, so that the outer layer can be made thinner, and the flexibility of the outer layer is improved; thereby improving the safety of the operation.
Drawings
In order to more clearly illustrate the embodiments of the application or the technical solutions in the prior art, the drawings that are required in the embodiments or the description of the prior art will be briefly described, it being obvious that the drawings in the following description are only some embodiments of the application, and that other drawings may be obtained according to these drawings without inventive effort for a person skilled in the art.
FIG. 1 is a schematic diagram of the structure of the present application;
FIG. 2 is an enlarged view at A in FIG. 1;
FIG. 3 is a view in the direction B-B of FIG. 1;
FIG. 4 is a view in the direction C-C of FIG. 1;
FIGS. 5 to 10 are schematic views illustrating the operation of the present application;
fig. 11 is a schematic structural diagram of another embodiment of the present application.
Reference numerals illustrate: 1. a catheter body; 101. an outer layer of the catheter; 102. an inner layer of the catheter; 2. a balloon control lumen; 3. a balloon; 4. conveying the large cavity; 5. exchanging the small cavity; 6. an inclined channel; 7. delivering a guidewire; 8. a guide wire; 9. controlling the guide wire; 10. a protective umbrella; 1001. umbrella ribs; 1002. a filter membrane; 1003. a filter screen; 11. a front baffle ring; 12. a rear baffle ring; 13. a bracket; 14. a slip ring; 15. a thrust spring; 16. a fixed knot; 17. a fixed sleeve; 18. a waterway joint; 19. a lock nut.
Detailed Description
The following description of the embodiments of the present application will be made clearly and completely with reference to the accompanying drawings, in which it is apparent that the embodiments described are only some embodiments of the present application, but not all embodiments. All other embodiments, which can be made by those skilled in the art based on the embodiments of the application without making any inventive effort, are intended to be within the scope of the application.
Example 1
Referring to fig. 1 to 3, a delivery microcatheter integrated with a brain protection device is shown, wherein a catheter body 1 comprises an outer catheter layer 101 and an inner catheter layer 102, and an annular balloon control lumen 2 is formed between the outer catheter layer 101 and the inner catheter layer 102. The balloon 3 is fixed on the circumferential surface of the front end of the catheter body 1, and the inner side of the balloon 3 is communicated with the balloon control cavity 2. The catheter body 1 rear end is connected with fixed cover 17, is provided with water route joint 18 on the fixed cover 17, and water route joint 18 and sacculus control chamber 2 intercommunication, water route joint 18 are connected with pressure control device. During operation, the expansion and contraction of the balloon 3 are controlled by the pressure control device, which is the prior art, and the embodiment is not further described.
The inner layer 102 of the catheter is provided with an eccentric conveying large cavity 4 and an exchange small cavity 5 which are arranged separately, and the exchange small cavity 5 is communicated with the conveying large cavity 4 through an inclined channel 6 at the front end of the catheter body 1. The conveying large cavity 4 is penetrated with a conveying guide wire 7, and the front end of the conveying guide wire 7 is provided with a protective umbrella 10 and a bracket 13 which are contracted in the conveying large cavity 4. A guide wire 8 and a control guide wire 9 are arranged in the exchange small cavity 5 in a penetrating way. The front end of the guide wire 8 enters the large conveying cavity 4 through the inclined channel 6 and extends out of the catheter body 1. The control guide wire 9 is matched with the conveying guide wire 7 to place the protective umbrella 10 and the bracket 13. The inclined channel 6 may be located before the stent 13 or after the stent 13 in the initial state of delivering the microcatheter.
The rear end of the protective umbrella 10 is connected with a slip ring 14, and the slip ring 14 is connected on the conveying guide wire 7 in a sliding way. The rear end of the slip ring 14 is connected with a thrust spring 15, and the rear end of the thrust spring 15 is fixedly connected with the conveying guide wire 7. In the free state, the thrust spring 15 pushes the slip ring 14 forward, and the slip ring 14 drives the protective umbrella 10 to open. As shown in fig. 6, in the present embodiment, the protective umbrella 10 includes ribs 1001, and the ribs 1001 are fixed to the delivery guide wire 7 at one end and connected to the slip ring 14 at one end. A filter membrane 1002 or a filter screen 1003 is arranged outside the umbrella rib 1001. The filter membrane 1002 is a high molecular semipermeable membrane, and the filter screen 1003 is a nickel-titanium alloy or stainless steel woven mesh. As another preferred mode: a thrust spring 15 may be placed on the front side of the slip ring 14, the thrust spring 15 being subject to a tendency to retract.
The rear part of the protective umbrella 10 is provided with a front baffle ring 11 and a rear baffle ring 12 which are arranged on the conveying guide wire 7, and the front baffle ring 11 and the rear baffle ring 12 are symmetrical. Taking the previous baffle ring 11 as an example: the front baffle ring 11 is respectively provided with a through hole for the transmission guide wire 7 and the control guide wire 9 to pass through, the transmission guide wire 7 is arranged at the center of the front baffle ring 11 in a penetrating way, and the control guide wire 9 is arranged at the periphery of the front baffle ring 11 in a penetrating way. A sinking groove is formed in one side of the front baffle ring 11, a fixing knot 16 is embedded in the sinking groove, and the fixing knot 16 is fixed on the conveying guide wire 7, so that the front baffle ring 11 is fixed. The support 13 is contracted at the front baffle ring 11 and the rear baffle ring 12, and the delivery guide wire 7 passes through the center of the support 13. The front end of the control guide wire 9 passes through the inclined channel 6 to enter the large conveying cavity 4, and then the front end of the control guide wire 9 sequentially passes through the rear baffle ring 12, the bracket 13 and the front baffle ring 11 and is connected with the slip ring 14 behind the protective umbrella 10.
Preferably: developing rings for positioning are arranged on the balloon 3, the protective umbrella 10, the front baffle ring 11 and the rear baffle ring 12. The front ends of the conveying guide wire 7 and the guide wire 8 are welded or bonded with flexible sections, and the flexible sections are micro-elastic lubricating pieces made of nickel-titanium alloy materials or high polymer materials.
Referring to fig. 4, the fixing sleeve 17 is provided with three locking nuts 19 by screw connection. Wedge grooves are formed in the inner wall of the locking nut 19, and the conveying guide wire 7, the guide wire 8 and the control guide wire 9 correspondingly penetrate through the wedge grooves in the three locking nuts 19 one by one. The corresponding guide wire is pressed by the rotation of the locking nut 19, so that the guide wire is positioned conveniently. In addition, two avoidance grooves for penetrating other guide wires are formed in each locking nut 19, so that interference with control of other guide wires is avoided.
Example two
A stent placement method, a delivery microcatheter incorporating a brain protection device according to the first embodiment described above,
the method comprises the following steps:
A. percutaneous puncture, placement of a vascular sheath, angiography, and establishment of a vascular access;
B. as shown in fig. 5, a guide wire 8 is inserted, and then the delivery microcatheter is controlled to pass along the guide wire 8 through the stricture with the balloon 3 opposite the stricture; the guide wire 8 is then withdrawn a distance, passing over the delivery lumen 4 and the inclined channel 6, but the front end of the guide wire 8 remains in the exchange lumen 5;
C. as shown in fig. 6, the control guide wire 9 is pulled back, the bracket 13 and the protective umbrella 10 are pulled towards the front end of the conveying micro-catheter until the protective umbrella 10 stretches out of the conveying micro-catheter to the position 2 cm to 5cm in front of the narrow section; in the process, the advancing speed of the protective umbrella 10 is controlled by matching with the conveying guide wire 7, so that the bracket 13 and the protective umbrella 10 slowly advance, and the phenomenon that the rear tension of the control guide wire 9 is too large to cause sudden advance is avoided; after the protective umbrella 10 reaches a preset position, the control guide wire 9 is slowly loosened, the slip ring 14 slides forwards under the thrust action of the thrust spring 15, and the protective umbrella 10 is automatically opened to finish release;
D. slowly filling the balloon 3 through the pressure control device and the balloon control cavity 2 to dilate the narrow section, wherein the dropped emboli are collected to the protective umbrella 10;
E. as shown in fig. 7, the pressure of the balloon 3 is relieved through the pressure control device and the balloon control cavity 2; then, the delivery microcatheter is retracted until the stent 13 is exposed, the stent 13 is expanded and supported in the stricture, and during this process, the dropped emboli are collected in the protective umbrella 10;
F. as shown in fig. 8, the balloon 3 of the micro-catheter is controlled to be conveyed to a narrow section by taking the conveying guide wire 7 as a guide, the stent 13 is expanded again by slowly filling the balloon 3 through the pressure control device and the balloon control cavity 2, and then the pressure of the balloon 3 is relieved; during this process, the dropped emboli collect into the protective umbrella 10;
G. as shown in fig. 9, the control guide wire 9 is controlled, the conveying guide wire 7 is pulled backwards, and the protective umbrella 10 is retracted and slowly contracted and enters the conveying microcatheter;
H. as shown in fig. 10, the guide wire 8 is advanced forward, and the guide wire 8 is again advanced into the delivery lumen 4 through the inclined channel 6 until the delivery microcatheter is extended; then taking the guide wire 8 as a support, withdrawing the delivery microcatheter, and finally withdrawing the guide wire 8 to complete the stent 13 placement operation.
The embodiment can be seen that the application realizes the placement of the protective umbrella and the bracket by utilizing the single tube to match with three guide wires, has simple structure and smaller radial dimension, and is convenient for intubation operation; the catheter is not required to be retracted when the protective umbrella is placed, and is retracted once in a short distance when the stent is placed, so that adverse effects on blood vessels caused by operating the catheter are avoided. In the operation processes of intubation, tube withdrawal and placement, the guide wire is used for supporting the catheter all the time, so that the catheter is prevented from larger fluctuation; the waterway is arranged between the outer layer of the catheter and the inner layer of the catheter, the outer layer can be made thinner, and the flexibility of the outer layer is improved, so that the safety of an operation is improved. When the application is used for CAS operation, the use of a balloon dilation catheter is avoided, pre-dilation is directly carried out, and a brain protection device is conveyed by a guide wire to pass through a stenosis before dilation, so that the release of a protection umbrella is completed; after the stent is released, the balloon can be used for expanding the stent, so that the stent can be completely expanded. The application avoids the use of a balloon dilation catheter in CAS operation, places a brain protection device faster and safer, and simultaneously avoids the use of a stent conveying system, so that the whole operation process is more convenient and faster, and the potential injury caused by the operation is reduced.
Example III
The third embodiment differs from the first embodiment in that:
in connection with fig. 11, the delivery microcatheter of this embodiment has the control guidewire 9 removed and the protective umbrella 10 is a self-expanding protective umbrella of the prior art.
The operation method comprises the following steps:
A. percutaneous puncture, placement of a vascular sheath, angiography, and establishment of a vascular access;
B. inserting a guide wire 8, and controlling the delivery microcatheter to pass through the narrow section along the guide wire 8, wherein the balloon 3 passes a certain distance over the narrow section; the guide wire 8 is then withdrawn a distance, passing over the delivery lumen 4 and the inclined channel 6, but the front end of the guide wire 8 remains in the exchange lumen 5;
C. the conveying microcatheter is retracted, the protective umbrella 10 slowly exposes out of the conveying microcatheter and then automatically expands, and the balloon 3 is opposite to the narrow section;
D. slowly filling the balloon 3 through the pressure control device and the balloon control cavity 2 to dilate the narrow section, wherein the dropped emboli are collected to the protective umbrella 10;
E. the pressure of the balloon 3 is relieved through the pressure control device and the balloon control cavity 2; then, the delivery microcatheter is retracted until the stent 13 is exposed, the stent 13 is expanded and supported in the stricture, and during this process, the dropped emboli are collected in the protective umbrella 10;
F. the balloon 3 of the conveying microcatheter is controlled to return to the narrow section again by taking the conveying guide wire 7 as a guide, the stent 13 is expanded again by slowly filling the balloon 3 through the pressure control device and the balloon control cavity 2, and then the pressure of the balloon 3 is relieved; during this process, the dropped emboli collect into the protective umbrella 10;
G. the conveying guide wire 7 is controlled, the conveying microcatheter is pushed forward, the front end of the conveying microcatheter abuts against the protective umbrella 10 and extrudes the protective umbrella 10, so that the protective umbrella 10 is contracted until the protective umbrella 10 is completely retracted into the conveying microcatheter;
H. advancing the guide wire 8 forward, the guide wire 8 re-entering the delivery lumen 4 through the inclined channel 6 until extending out of the delivery microcatheter; then taking the guide wire 8 as a support, withdrawing the delivery microcatheter, and finally withdrawing the guide wire 8 to complete the stent 13 placement operation.
The third embodiment simplifies the structure of the conveying microcatheter in the first embodiment, removes the control guide wire 9, reduces the control precision of the protective umbrella 10 to a certain extent and increases the movement times of the conveying microcatheter; but the operation steps are simpler and the operation is simpler. The three delivery microcatheters of this embodiment are suitable for stent placement at vascular sites where the lesion site is less complex, requiring a somewhat relaxed surgical environment.
The preferred embodiments of the application disclosed above are intended only to assist in the explanation of the application. The preferred embodiments are not exhaustive or to limit the application to the precise form disclosed. Obviously, many modifications and variations are possible in light of the above teaching. The embodiments were chosen and described in order to best explain the principles of the application and the practical application, to thereby enable others skilled in the art to best understand and utilize the application. The application is limited only by the claims and the full scope and equivalents thereof.
Claims (8)
1. A delivery microcatheter incorporating a brain protection device,
the method is characterized in that:
the catheter body (1) comprises a catheter outer layer (101) and a catheter inner layer (102), and an annular balloon control cavity (2) is formed between the catheter outer layer (101) and the catheter inner layer (102); the balloon (3) is fixed on the circumferential surface of the front end of the catheter body (1), the inner side of the balloon (3) is communicated with the balloon control cavity (2), and the balloon control cavity (2) at the rear end of the catheter body (1) is connected with a pressure control device;
the inner layer (102) of the catheter is provided with an eccentric conveying large cavity (4) and an exchange small cavity (5) which are arranged separately; at the front end of the catheter body (1), the exchange small cavity (5) is communicated with the conveying large cavity (4) through an inclined channel (6);
a conveying guide wire (7) is arranged in the conveying large cavity (4) in a penetrating way; the front end of the conveying guide wire (7) is provided with a protective umbrella (10) contracted in the conveying large cavity (4), and the rear part of the protective umbrella (10) is provided with a front baffle ring (11) and a rear baffle ring (12) which are arranged on the conveying guide wire (7); a bracket (13) penetrating through the conveying guide wire (7) is arranged between the front baffle ring (11) and the rear baffle ring (12);
a guide wire (8) and a control guide wire (9) are arranged in the small exchange cavity (5) in a penetrating way; the front end of the control guide wire (9) passes through the inclined channel (6) to enter the large conveying cavity (4), and the front end of the control guide wire (9) sequentially passes through the rear baffle ring (12), the bracket (13) and the middle part of the front baffle ring (11) and then is connected with the protective umbrella (10).
2. A delivery microcatheter incorporating a brain protection device according to claim 1, wherein: the rear end of the protective umbrella (10) is connected with a slip ring (14), and the slip ring (14) is connected to the conveying guide wire (7) in a sliding manner; the rear end of the slip ring (14) is connected with a thrust spring (15), and the rear end of the thrust spring (15) is fixedly connected with the conveying guide wire (7).
3. A delivery microcatheter incorporating a brain protection device according to claim 1, wherein: the front baffle ring (11) and the rear baffle ring (12) are symmetrical; the front baffle ring (11) is respectively provided with a through hole for the conveying guide wire (7) and the control guide wire (9) to pass through; one side of the front baffle ring (11) is also provided with a sinking groove, a fixing knot (16) is embedded in the sinking groove, and the fixing knot (16) is fixed on the conveying guide wire (7).
4. A delivery microcatheter incorporating a brain protection device according to claim 1, wherein: the balloon (3), the protective umbrella (10), the front baffle ring (11) and the rear baffle ring (12) are respectively provided with a developing ring for positioning.
5. A delivery microcatheter incorporating a brain protection device according to claim 1, wherein: the front ends of the conveying guide wire (7) and the guide wire (8) are welded or bonded with flexible sections; the flexible section is a micro-elastic lubricating piece made of nickel-titanium alloy materials or high polymer materials.
6. A delivery microcatheter incorporating a brain protection device according to claim 1, wherein: the protective umbrella (10) comprises umbrella ribs (1001), and a filter membrane (1002) or a filter screen (1003) is arranged outside the umbrella ribs (1001).
7. A delivery microcatheter incorporating a brain protection device according to claim 1, wherein: the rear end of the catheter body (1) is connected with a fixed sleeve (17); the fixed sleeve (17) is provided with a waterway joint (18), the waterway joint (18) is communicated with the balloon control cavity (2), and the waterway joint (18) is connected with the pressure control device; the fixed sleeve (17) is provided with three locking nuts (19) through threaded connection; wedge grooves are formed in the inner wall of the locking screw caps (19), and the conveying guide wire (7), the guiding guide wire (8) and the control guide wire (9) correspondingly penetrate through the wedge grooves in the three locking screw caps (19) one by one.
8. A delivery microcatheter incorporating a brain protection device,
the method is characterized in that:
the catheter body (1) comprises a catheter outer layer (101) and a catheter inner layer (102), and an annular balloon control cavity (2) is formed between the catheter outer layer (101) and the catheter inner layer (102); the balloon (3) is fixed on the circumferential surface of the front end of the catheter body (1), the inner side of the balloon (3) is communicated with the balloon control cavity (2), and the balloon control cavity (2) at the rear end of the catheter body (1) is connected with a pressure control device;
the inner layer (102) of the catheter is provided with an eccentric conveying large cavity (4) and an exchange small cavity (5) which are arranged separately; at the front end of the catheter body (1), the exchange small cavity (5) is communicated with the conveying large cavity (4) through an inclined channel (6);
a conveying guide wire (7) is arranged in the conveying large cavity (4) in a penetrating way; the front end of the conveying guide wire (7) is provided with a protective umbrella (10) contracted in the conveying large cavity (4), and the rear part of the protective umbrella (10) is provided with a front baffle ring (11) and a rear baffle ring (12) which are arranged on the conveying guide wire (7); a bracket (13) penetrating through the conveying guide wire (7) is arranged between the front baffle ring (11) and the rear baffle ring (12);
a guide wire (8) is arranged in the small exchange cavity (5) in a penetrating way.
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| CN114305588A (en) * | 2022-01-05 | 2022-04-12 | 复旦大学附属中山医院 | Low limbs artery two-chamber sacculus negative pressure suction umbrella device |
| CN114831787A (en) * | 2022-03-01 | 2022-08-02 | 北京大学第一医院 | Blood vessel stent conveying device |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN108289731B (en) * | 2015-10-27 | 2020-11-06 | 康特戈医疗股份有限公司 | Intraluminal angioplasty device and method of use |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US6264672B1 (en) * | 1999-10-25 | 2001-07-24 | Biopsy Sciences, Llc | Emboli capturing device |
| US6716237B1 (en) * | 2000-09-18 | 2004-04-06 | Inflow Dynamics, Inc. | Interventional shielded stent delivery system and method |
| CN109009592A (en) * | 2018-06-19 | 2018-12-18 | 西安交通大学医学院第二附属医院 | Internal carotid integral type discharges umbrella protective cradle |
| CN213588618U (en) * | 2020-09-16 | 2021-07-02 | 北京美迪微科技有限责任公司 | Carotid artery stent implanting apparatus with blood filtering device |
| CN114305588A (en) * | 2022-01-05 | 2022-04-12 | 复旦大学附属中山医院 | Low limbs artery two-chamber sacculus negative pressure suction umbrella device |
| CN114831787A (en) * | 2022-03-01 | 2022-08-02 | 北京大学第一医院 | Blood vessel stent conveying device |
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| CN116327464A (en) | 2023-06-27 |
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Denomination of invention: A delivery microcatheter and stent placement method for integrated brain protection devices Granted publication date: 20231103 Pledgee: Bank of Nanjing Jiangbei District branch of Limited by Share Ltd. Pledgor: Pugao medical technology (Nanjing) Co.,Ltd. Registration number: Y2024980011129 |