CN116616846A - 一种带可回收支架的双层导引导管 - Google Patents

一种带可回收支架的双层导引导管 Download PDF

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CN116616846A
CN116616846A CN202310146025.1A CN202310146025A CN116616846A CN 116616846 A CN116616846 A CN 116616846A CN 202310146025 A CN202310146025 A CN 202310146025A CN 116616846 A CN116616846 A CN 116616846A
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高斌
任啸宇
黎浩然
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Beijing University of Technology
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12027—Type of occlusion
    • A61B17/12031—Type of occlusion complete occlusion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
    • A61B17/12109—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel
    • A61B17/12113—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel within an aneurysm
    • A61B17/12118—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel within an aneurysm for positioning in conjunction with a stent
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
    • A61B17/12168—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a mesh structure
    • 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
    • A61F2/966—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M25/0026—Multi-lumen catheters with stationary elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0043—Catheters; Hollow probes characterised by structural features
    • A61M25/0045—Catheters; Hollow probes characterised by structural features multi-layered, e.g. coated
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
    • A61B2017/1205—Introduction devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2002/9528—Instruments specially adapted for placement or removal of stents or stent-grafts for retrieval of stents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M25/0026—Multi-lumen catheters with stationary elements
    • A61M2025/0039—Multi-lumen catheters with stationary elements characterized by lumina being arranged coaxially

Abstract

一种带可回收支架的双层导引导管，属于生物医学工程领域。采用双层导引导管，双层导引导管分为内外两层，即外层的外管同轴套在内层的内管外，将支架折叠同轴放置于外管和内管之间，支架后端融(前端指的是指向病灶的一端)在内管内壁上，内管内腔通行释放弹簧圈的微导管。综合了支架与可释放弹簧圈的导管，具有体积小、可在术中释放支架与微导管，术后可将支架收回等优势。

Description

一种带可回收支架的双层导引导管
技术领域
本发明属于生物医学工程领域，涉及一种新型双层导引导管，主要用于动脉瘤介入治疗弹簧圈的释放。
背景技术
脑动脉瘤是因脑动脉管壁局部的先天性缺陷和腔内压力增高引起的动脉局部异常扩张。看上去就像血管上长了一颗气球，里面充盈着血液，是一种脑血管病，形态如图1所示。脑动脉瘤壁非常脆弱，易于破裂出血，即发生蛛网膜下腔出血。如破裂出血，致残率高达33％，致死率高达40％，未经治疗的患者，如果再次发生破裂出血，其死亡率更可高达60％。对于已经破裂动脉瘤，需要急诊手术，对于未破裂动脉瘤，由于远期破裂风险很高，需要手术治疗，防范远期破裂风险。
动脉瘤栓塞术是目前主要的治疗手段。主要步骤为：右侧股动脉穿刺(脑动脉瘤治疗穿刺一般为颈部位置)，置入导引导管(粗导管)，将导引导管送入载瘤动脉(生长动脉瘤的脑动脉)内。将一根微导管(细导管，头端比缝纫线粗不了多少)经导引导管送入载瘤动脉，并将微导管头端小心送入动脉瘤腔内，经微导管向动脉瘤腔内送入弹簧圈，利用弹簧圈的机械闭塞作用以及继发的血栓闭塞作用，将动脉瘤隔绝于载瘤动脉的血循环之外，从而达到防止动脉瘤再破裂的目的。
其中，弹簧圈为一根极细的铂钨合金，质地柔软。在释放前的形态一般可分为两种：成蓝圈，填塞圈，如图2，图3所示。
成蓝圈形态在被拉入微导管之前为球形，释放之后由于自身弹性，依然会偏向于球形形态在动脉瘤内分布，总体起定形、建立框架的作用。填塞圈形态偏弹簧圈形态，相比与成蓝圈，一般长度较短，主要起填补已填入弹簧圈之间的空隙的作用。二者的大小选择一般由动脉瘤的(长轴+短轴)/2来决定。
弹簧圈在选好形态之后，通过一根导丝链接弹簧圈的一端，将其拉入到微导管当中，导丝长于微导管，医生可在体外控制导丝的推入与拉出，进而控制弹簧圈的撤回与释放。
弹簧圈治疗动脉瘤示意图如图4，图5所示。
但弹簧圈治疗动脉瘤除了术后会发生再通以外，对某些宽颈或不规则动脉瘤，术中易发生弹簧圈会发生脱出动脉瘤掉入载流动脉的情况，对于这种动脉瘤，医生往往会在弹簧圈填入前，先填入支架，放置于动脉瘤颈口，以防止术中弹簧圈的脱出。但这种支架属于永久性支架，放入血管中后便无法取出。且支架的使用也会带来一系列问题。如发生在早期支架内血栓，常见原因于支架贴壁不良、支架扩张不全、支架过长(>30mm)等；支架过长、置入多个串联支架，导致血管内皮损伤，内膜下组织和胶原暴露过多，激活血小板和纤维蛋白附着及沉积形成血栓和血栓瀑布效应。支架辅助弹簧圈栓塞示意图如图6，图7所示。
发明内容
为了解决以上现有技术的问题，本发明提供了一种双层导引导管，该导管综合了上述提到的支架与可释放弹簧圈的导管，具有体积小、可在术中释放支架与微导管，术后可将支架收回等优势。
为了实现上述目的，本发明采用的一个技术方案是：
采用双层导引导管，双层导引导管分为内外两层，即外层的外管同轴套在内层的内管外，将支架折叠同轴放置于外管和内管之间，支架后端融(前端指的是指向病灶的一端)在内管内壁上，内管内腔通行释放弹簧圈的微导管。
具体使用方法，在将双层导引导管沿着血管到达病灶区域后，将外管单独向后撤回一段距离，内管和支架不后撤，由于支架自身弹性作用，折叠在外管和内管间的支架会自己膨胀，形成一个荷叶结构支撑在动脉瘤颈口，防止弹簧圈释放过程中的弹簧脱出，然后通行释放弹簧圈的微导管；在弹簧圈释放完毕后，先将内管撤回一部分缩回到外管，由于支架下端融在内管上，在撤回的过程中会将已经展开的支架重新折叠，拉回到内管与外管之间，起到支架的回收效果，后便可将双层导引导管、微导管、支架一并撤出体外。
附图说明
图1、为动脉瘤大致形态及其破裂的示意图。
图2、为弹簧圈栓塞治疗术中所用的成篮圈，是弹簧圈的一种类型。
图3、为弹簧圈栓塞治疗术中所用的填塞圈刚刚从微导管释放出来后的形态。
图4-图5、为弹簧圈栓塞治疗术的过程示意图。
图6-图7、为支架辅助弹簧圈栓塞治疗术的示意图。
图8-图11、为本发明提供的一种新型双层导引导管结构示意图。
图中：1-微导管(释放弹簧圈)；2-内层导引导管；3-外层导引导管；4-支架(网状结构)；5-弹簧圈；6-动脉瘤。
具体实施方式
为了令本发明的目的、特征、优点更加明显易懂，下面结合附图中涉及的具体实施方式对本发明的实施例进行清楚地描述。基于本发明的实施例，本领域技术人员在未进行创造性劳动前提下获得的所有其它实施例，如只改变用途而不改变权利要求涉及基本原理的实施例，都属于本发明保护的范围。
实施例1
如图8中1和2所示，本发明所提供的一种新型双层导引导管，包括外管，内管，内外管之间的支架。
本发明工作时，先将双层导引导管沿病人血管穿行，使导管口到达病灶区域。然后将外管撤回一段距离，使得折叠在内管与外管间的支架释放出来，如图9所示。支架与血管壁间可形成一个较为封闭的结构，防止弹簧圈释放时的脱出，掉入载流动脉。同时使得弹簧圈更易停留在瘤内与瘤颈部区域。而后微导管便可沿着导引导管进入血管到达病灶区域释放弹簧圈。待弹簧圈释放完毕后，先将内管中的微导管拉回到内管中，后再将内管向后撤回，由于支架下口与内管相连，在内管撤回的同时，支架会随着内管重新折叠进入到外管当中，起到回收支架的作用。
说明书未详细描述的部件组合特征属于公知技术轻易想到或者实施本发明时容易确定且无异议的内容。上述方案所描述的实施例仅为本发明的一部分实施例，而不是全部实施例，但本申请的保护范围不仅限于此，本申请保护范围应以权利要求保护范围为准。

Claims (3)

1.一种带可回收支架的双层导引导管，其特征在于，采用双层导引导管，双层导引导管分为内外两层，即外层的外管同轴套在内层的内管外，将支架折叠同轴放置于外管和内管之间，支架后端融(前端指的是指向病灶的一端)在内管内壁上，内管内腔通行释放弹簧圈的微导管。
2.权利要求1所述的一种带可回收支架的双层导引导管具体使用方法，其特征在于，在将双层导引导管沿着血管到达病灶区域后，将外管单独向后撤回一段距离，内管和支架不后撤，由于支架自身弹性作用，折叠在外管和内管间的支架会自己膨胀，形成一个荷叶结构支撑在动脉瘤颈口，防止弹簧圈释放过程中的弹簧脱出，然后通行释放弹簧圈的微导管；在弹簧圈释放完毕后，先将内管撤回一部分缩回到外管，由于支架下端融在内管上，在撤回的过程中会将已经展开的支架重新折叠，拉回到内管与外管之间，起到支架的回收效果，后便可将双层导引导管、微导管、支架一并撤出体外。
3.权利要求1所述的一种带可回收支架的双层导引导管的应用，用于动脉瘤。
CN202310146025.1A 2023-02-21 2023-02-21 一种带可回收支架的双层导引导管 Pending CN116616846A (zh)

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