DE102004023559A1 - Catheters and stents especially of shape-memory plastics are used in kits for a wide variety of procedures, including chemotherapy, emergency thrombolysis and vertebral column treatment - Google Patents

Abstract

Catheters and stents especially of shape-memory plastics and kits containing them, are new. Catheters and stents especially of shape-memory plastics and kits containing them, are new. The stents are useful as transmyocardial stents (26) and/or conventional stents for use in plaque dialysis and/or emergency thrombolysis as well as in other applications such as cardial catheterization, central tumor irradiation or localized chemotherapy of malignant tumors, particular attention being paid to the pilot catheter control (1, 1>) and the use of shape-memory plastics.

Description

With The subject of the present patent applications is cardiac catheterization preferred for implantation of transmyocardial or "conventional" stents, the subject the catheter control for the implantation of a stent in other vascular areas, the catheter-assisted Plaque removal (plaque removal) or the emergency lysis or thrombolysis worked off under new aspects. This at the same time considering the fact that newly developed plastics with shape memory properties or so-called shape memory materials in general increasing importance win. For this reason, these were now in the consideration the design and application of catheters and stents included.

there becomes the catheter-assisted Plaque removal in rheologically significant bottlenecks or the catheter-assisted Plaque removal at risk of rupture, over Cardio-CT, a multi-slice spiral CT or via ultrasound methods and the like Like. Detected soft plaque and the catheter-assisted lysis for emergency treatment of a fresh myocardial infarction or emergency, catheter-assisted vascular recanalization particular attention in other tissue areas, wherein the vascular plaque preferred by risk factors such as diabetes mellitus and / or nicotine abuse and / or Hypertension and / or the like. Induced. If at the plaque elimination and in embolism-induced lysis predominantly arterial vessels are treated, concerns the catheter-assisted Thrombolysis, mostly venous vascular areas (deep vein thrombosis and the like).

there shall be described in the following with the description of the prior art With respect to cardiac catheterization, wherein the applicant catheter kits for Plaque removal (Plaqueremovel) or for localized lysis not are known. This applies in particular to embolism-induced pulmonary infarctions to.

At the Linksherzkatheter is the so-called "large" heart catheter from the question or the task this can over the Groin (Judkins technique) or over the right crook of the arm (Sones technique) is introduced under local anesthesia.

Prefers is used in cardiac catheterization both in the Judkins- as even with the Sones technique still the basic idea of the Method according to Seldinger applied.

there is exemplified in the Judkins technique in the groin Femoral artery punctured and over a pushed lock a flexurally elastic guide probe, preferably in the form of a wire spiral with core wire and atraumatic Top, as a scout for advanced the preferred Judkins catheter, wherein the guide probe naturally longer and compared to the catheter thinner is formed. After positioning the Judkins catheter and after Removal of the guide probe can the radiopaque Judkins catheter for coronary vessel imaging via contrast medium be used.

With the representation of the coronary arteries, the the sinus aortae in the area of the right and left pocket flap spring up and in the coronary sinus (coronary artery) of the right End of the atrial, the coronary catheter thus serves on the one hand diagnostic Purposes over the detection of possibly preferred plaque-related bottlenecks (usually hard plaque); on the other hand therapeutic tasks by these Bottlenecks z. B. over a guidewire with atraumatic tip and another catheter to preferred balloon dilatation is placed. After or instead of one Balloon dilatation is usually another catheter for the preferred stent implantation for use.

Yourself self-deploying stents are just as well-known as coated ones and uncoated stents, in particular absorbable stents Plastic or special metal alloys (magnesium alloys) special attention is paid.

Of the Process of balloon dilatation but also of stent implantation The so-called angioplasty can be subsumed during ablative therapy like the rotablation compared to the described angioplasty barely apply today.

there these are diagnostic or therapeutic elements (Catheter, Driver, etc.) except the stents for disposable items. And Stents often become ineffective through reclosure.

So is for uncoated stents with a restenosis rate of 30% Coated stents with controlled drug release (DESs = drug eluting stents) already reduce this proportion considerably below 10%.

It is therefore understandable that of the surface coating Stents paid the most attention becomes.

As a last resort, the By remains at the heart Surgery or heart transplantation. Both procedures leave deep scars, at least in the subconscious of the corresponding patients.

Begrudge is still that especially on cardiac catheters from diagnostic side the Judkins catheter is given preference while Sones catheter and others only in exceptional cases Find use.

• 1. In Zusammenarbeit mit der Firma Siemens AG wurde oder wird am St. Georg Krankenhaus, Hamburg, ein Verfahren entwickelt, das es ermöglicht, über ein rotierendes Magnetfeld mit 0,1 Tesla einen Herzkatheter mit bevorzugt magnetversehener Spitze unterstützend ins Zielgebiet zu lenken, womit es gelingt, etliche diagnostische und therapeutische Schritte mittels einer Art Joy-Stick außerhalb des eigentlichen Katheterlabors abzuarbeiten. Einer der Vorteile ist dabei z. B. die fehlende Strahlenbelastung des mitwirkenden Personals. Diesem Verfahren wird in vorliegenden Anmeldung deshalb besondere Bedeutung geschenkt, da es in der Lage ist, ggf. unterstützend zur Implantation eines transmyokardialen Stents eingesetzt zu werden. Hierzu weiter unten.
• 2. Es werden kritische Stimmen laut, die die Plaque (Ablagerung) der Herzkranzgefäße zur Diskussionsgrundlage nehmen und insbesondere in der wei chen Plaque mit ihrem gallertartigen Kern, die rheologisch oft unbedeutend ist, die eigentliche Gefahr für ein Infarktgeschehen sehen. Von Vorteil ist, dass diese Plaqueform über ein Cardio-CT bzw. über Ultraschallverfahren erkennbar ist, womit ihr eine entsprechende Indikationsstufe zum therapeutischen Eingreifen zuzuordnen ist.

In addition, two more information is important:

• 1. In cooperation with the company Siemens AG, a procedure was developed at the St. Georg Hospital, Hamburg, which makes it possible to steer a cardiac catheter with a magnetically preferred tip into the target area via a rotating magnetic field of 0.1 Tesla It is possible to process a number of diagnostic and therapeutic steps by means of a kind of joy stick outside the actual catheter laboratory. One of the advantages is z. B. the lack of radiation exposure of the contributing staff. This method is therefore given particular importance in the present application, since it is able to be used if necessary supporting the implantation of a transmyocardial stent. See below.
• 2. Critical voices are raised, which take the plaque (deposition) of the coronary arteries as a basis for discussion and, especially in the white plaque with its gelatinous core, which is often rheologically insignificant, see the actual danger for an infarct event. It is advantageous that this form of plaque can be recognized by means of cardio-CT or ultrasound procedures, with which a corresponding indication level can be assigned to therapeutic intervention.

With The present application is with the preferred implantation of a transmyocardial stent on the dilatation of a coronary Bottleneck dispensed and over a bypass from the left ventricle to the transmyocardial stent Coronary area following the plaque-induced bottleneck created. In order to deleted largely the conventional bypass operation, which is ultimately the same objective, although not all of the left ventricle Coronary artery areas are reachable. It should be emphasized that the design and material issues of the transmyocardial stent in this Registration not dealt with or only peripherally striped. And it should be emphasized that the procedure described in essence also transferable to the general use of stents is.

Of the The transmyocardial stent is related to the strength of the heart wall in all contractile ones Phases, as well as all other cardiac stent variants the respective coronary diameter or the recognizable plaque expansion are matched and mounted with their respective catheter selected.

stents for others vascular areas are analogously the same Procedural pattern applied.

Basically However, the question of the described angioplasty in principle, if it succeeds, the plaque through a modified dialysis procedure dissolve, with which a gentle revascularization is possible, which is completely new therapeutic approaches for the Heart, the extremity arteries and possibly also for the brain and other vascular areas to conclude. Not to mention the possible uses in emergency therapy a heart attack or a vascular embolism in other parts of the body (eg, pulmonary infarction) by localized lysis or thrombolysis.

cardiac catheterization for the implantation of transmyocardial stents and / or for implantation Stents in general are discussed below in particular at least partially using shape memory plastics, which is also for stents applies, although these preferably exclusively a material composition are assigned.

starting point for the implantation of a transmyocardial stent bypassing a Sternotomy is a cardiac catheterization system that is capable of using a steerable cardiac pilot catheter over contrast agent imaging the coronary vessels the correct To reach the target site, there to be redirected to the myocardium Perforations wire on direct way to propel to the left ventricle, the in a second step is suitable as a guide rail for the actual stent-mounted heart balloon catheter, which in turn preferred laser-assisted is suitable to provide a corresponding "stent bed", wherein laser light fibers already be considered with the pilot catheter.

In Correct stent position this is conventional, metallic transmyocardial stents over the expandable balloon unfolded. It turns out differently the situation with self-unfolding transmyocardial metal stents or in shape memory plastic stents in which the used cardiac catheter in a corresponding modification of the preferred balloon catheter optionally dispensed with the balloon or balloon when using an original balloon catheter only supportive Significance to stent unfolding plays.

The preferred pilot catheter used here is as well as the guidewire due to its shape high torqueblastbar and with its dimensions, its possibility of vascular presentation and its control option even in marginally small vessel areas used. At the same time, using shape memory resins, it offers the option of placing a transmyocardial stent far beyond a perforation catheter, making 0.55 mm pilot catheter outside diameter feasible.

Although these dimensions are not achieved, are different from previous applications as an alternative in the present application the catheter tubes of all subsequent catheter variants in their inner lumen with preferably four longitudinal ribs provided (which of course also for Pilot catheter is conceivable), with its dimension suitable on the one hand are, an introduced guidewire seal longitudinally and use it for guidance and possibly steering, on the other hand in exchange a perforation wire analogous to the above To use pilot catheter, in particular via a peripheral myocardial perforation to realize the implantation of a transmyocardial stent, Preferably, each pilot catheter also preferably on the Advantages of shape memory plastics recourse.

Around simultaneously with a required rotation of the pilot catheter This is to guarantee a sufficient Torqueaufastbarkeit is the catheter base material preferably with at least one helical arranged and preferably polyfilen, possibly sealed polyaramid tightly wrapped around it by its longitudinal extent allow the catheter tip area to remain flexurally flexible. Alternatively, of course also an additional or exclusively used or on-polymerized metal coil in preferred tightest winding conceivable and possibly more meaningful.

Thereby arise diagonal, separate flow paths, on the one hand catheter tip side open a vessel representation enable and on the other hand in closed form with at least one near the catheter tip lateral fenestration and / or perforation are able to especially with pilot catheters depending on the flow control one preferred short - term resulting propulsion and lateral impulse of the respective catheter tip area Catheter steering up to a desired deflection at the appropriate Destination with alignment of the catheter tip on the myocardium to the preferred Implantation of a transmyocardial stent to reach by means of an exchanged, preferably spring-hard perforated wire for this Indication to perform myocardial perforation and around the perforation wire for the Position stent catheter as scout. That this for a possibly necessary Rotation of the catheter the Torquestabilität already mentioned required is, lights up.

The diagonal flow paths are further used for temperature control used the catheter tube material. This is at least one Processor controlled thermoaggregate with the preferred Multifunction pump with its pump modules to a preferred Unity is / are united.

Especially in this formation and orientation of the preferred pilot catheter for the implantation of a transmyocardial stent are shape memory plastics Helpful in controlling temperature-controlled catheter tip area stabilize the perforation wire without the risk of catheter perforation to advance to the left ventricle and to him over there preferred wire feed mechanism to fix. It is conceivable that the preferred pilot catheter a permanent catheter tip radius or a permanent catheter tip orientation as part of catheter fabrication and temporarily programmed is present in stretched form or that the desired orientation in a permanently stretched catheter temperature controlled over the appropriate flow control with correct catheter rotation temporarily programmable and by cooling down of the catheter tip material is freezable.

Of the subsequently placed (balloon) stent catheter, the balloon modified in self-unfolding preferred metal stents deleted, at conventional stents whose elongation allows and in shape memory plastic stents whose expansion is supported by the set fluid temperature is selected according to the preferred stent variant.

That each optimized catheter adapter with transition elements to Konnex With the appropriate pump modules required, no one needs further explanation and is in the claims or the following description of the figures sufficiently appreciated.

There high pressures have to be absorbed in balloon stent distension the catheter tube alone therefore into the catheter base material introduced carbon and / or Glass and / or polyaramid and / or PTFE filaments and / or others filamentary materials are stabilized. And there an extra Improvement of the sliding properties, especially for the perforation and / or guidewire useful is, the respective Katheterschlauchlumen preferably inside coated become.

A control device of cardiac catheters By means of a magnetized and / or ferromagnetic catheter tip over a rotatable about the patient and preferably longitudinally displaceable permanent magnet with high magnetic flux density and preferably combined X-ray device is already described above as essentially known and is optionally used to support in particular the final deflection movement for implantation of transmyocardial stents.

Logically, is the multifunctional pump with its pump modules designed and stored over a preferred servomotor, any necessary rotation of the Accompanying pilot catheter. The catheter end of the assigned Balloon catheter (but possibly also that of the pilot catheter) as a preferred laser extension passed through the pump bearing and is in balloon catheters for the application of a transmyocardial Stents or perforated organized thrombi preferred over a rotatable laser coupling preferably connected to an excimer laser.

It should be noted remains that every pump module over preferred disposable devices is suitable, a nearly continuous Intake or ejection phase by means of a respective independently controllable Servomotor to ensure.

All Flow paths (both of pilot catheters and associated ones Stent balloon catheters etc.) are about lateral bypass access by means of Adapter reached and via transition elements connected to the appropriate, preferred pump modules, while the have only one access perforation at each catheter end, which is suitable, in turn, over an adapter a preferred guide and / or perforation wire to enclose sealing or optimally automated by means of a corresponding device to exchange for each other.

a supportive Catheter advance and the advance of the preferred perforation and / or Support guide wires or get corresponding devices that simultaneously, at least are also suitable for rotation in the catheter feed.

Of course it would be absurd to initiate a material change in stents only because this at a corresponding transition temperature its permanent form receives from its temporary, which is a conventional one Stent by known balloon expansion already in a proven way occupies. Also the possibility the absorbability is already more appropriate for metal stents Alloy (magnesium alloy (s)) realized and controlled drug release from the material itself is already realized.

insofar remains to be seen if a stent made of shape memory plastic with his considerable properties can be maintained on the market per se, in particular as a transmyocardial stent or with its potential, drug-effective Diffuse substances directly into its surface structure like rapamycin, paclitaxel, sirolism, cyclosporin u. a. are capable of restenosis by controlled release to prevent or halt. At the same time, it makes sense that the polymers used z. B. by hydrolysis or by the body's own Enzymes are biodegradable. That this and already mentioned or still the following requirements of a corresponding creativity and the necessary laboratory tests, goes without saying. At the short-term feasibility exist however basically no concerns.

A Another generation of catheters serves to dissolve hard and / or softer ones Plaque, the z. Radiologically, by ultrasound o. The like. As a rheologically significant vascular constriction or at risk of rupture were detected.

• 1. Sie müssen insbesondere in ihrem Außendurchmesser auf die entsprechende Gefäßstrecke abgestimmt sein.
• 2. Sie müssen in der Lage sein, eine Plaquestrecke proximal und distal bevorzugt über einen entsprechend gestalteten Ballon abzudichten.
• 3. Sie müssen dennoch in der Lage sein, während der bevorzugten Dialyse den dem distalen Gefäßverschlussballon folgenden Gefäßbezirk ausreichend zu oxigenieren.
• 4. Sie müssen in der Lage sein, Zu- und Abflussbahnen für ein geeignetes Dialysefluid auszubilden.
• 5. Sie müssen geeignet sein, den jeweiligen Gefäßverschlussballondruck so steuerbar zu machen, dass eine Endothelschädigung zumindest wesentlich eingeschränkt oder optimal ausgeschlossen ist.
• 6. Sie müssen daher über entsprechende Zusatzvorrichtungen wie Pumpenmodule, einen Dialysator, einen Oxigenator, eine Wiederaufbereitungsanlage, ggf. einen Ultraschallgenerator, ggf. ein Thermoaggregat und Vorratsbehältnisse verfügen, die alle über mindestens einen Steuer- und Zentralprozessor mit Timer und entsprechenden Sensoren in Form einer kybernetischen Rückkopplung gesteuert werden.
• 7. Sie müssen durch eine hohe Gewebsverträglichkeit aller inkorporierten Anteile ausgezeichnet sein.
• 8. Sie müssen mit Hilfe eines Pilotkatheters und bevorzugt über einen Führungsdraht platzierbar sein.
• 9. Sie müssen alternativ geeignet sein, selbständig gesteuert zu werden, indem dreidimensionale Gefäßkoordinaten gewonnen werden und mindestens ein dreidimensionaler Steuer- und Zentralprozessor diese in entsprechende Steuerbefehle umwandelt.
• 10. Die verwendete Schleuse muss geeignet sein, ohne Gefäß-Leckage über längere Zeit (ggf. Tage) platziert zu bleiben.
• 11. Die verwendete Schleuse sollte geeignet sein, durch die Abgabe sterilisierender Substanzen, die Gefäß-Eintrittsperforation keimfrei zu halten.
• 12. Die Katheter dürfen in der Dialysezeit die Herzaktivität keinesfalls beeinträchtigen.
• 13. Alle Baukomponenten müssen sicher sein.

These catheter forms must meet the following conditions:

• 1. They must be tuned in particular in their outer diameter to the appropriate vessel route.
• 2. You must be able to seal a plaque course proximally and distally, preferably via a properly designed balloon.
• 3. Nevertheless, during the preferred dialysis, you must be able to adequately oxygenate the vascular area following the distal vessel occlusion balloon.
• 4. You must be able to design inflow and outflow trajectories for a suitable dialysis fluid.
• 5. They must be capable of making the respective vascular occlusion balloon pressure controllable such that endothelial damage is at least substantially restricted or optimally ruled out.
• 6. You must therefore have appropriate additional devices such as pump modules, a dialyzer, an oxygenator, a reprocessing system, possibly an ultrasonic generator, possibly a thermoaggregate and storage containers, all via at least one control and central processor with timer and corresponding sensors in the form of a be controlled by cybernetic feedback.
• 7. They must be characterized by a high tissue compatibility of all incorporated proportions.
• 8. They must be placeable using a pilot catheter and preferably over a guidewire.
• 9. Alternatively, they must be capable of being independently controlled by obtaining three-dimensional vessel coordinates and having at least one three-dimensional control and central processor convert them into corresponding control commands.
• 10. The lock used must be able to remain placed without long-term vascular leakage (possibly days).
• 11. The lock used should be capable, by delivering sterilizing substances, to keep the vessel entry perforation sterile.
• 12. The catheters should not interfere with cardiac activity during dialysis.
• 13. All construction components must be safe.

The Dialysis fluid preferably consists of a physiological carrier substance, the cholesterol binding additives such as pectin and / or ezetimibe in a balanced amount, preferably matrix metalloproteases (MMP) in optimal concentration and so on. (Calcium binder, ASS or the like, Vitamin C u. a. Vitamins or pharmaceuticals such. B. fibrinolytics) are added, so that ultimately an isotonic fluid is suitable, possibly in systemically unusable form or not realizable Concentration of the individual components of the enclosed plaque area (s) to be regenerated in order to ultimately regenerate them, wherein the loaded fluid is suitable, largely recycled with fresh fluid to be reused and ultimately the fluid preferably artificial Blood (eg fluorosol from fluorocarbons or a bacterial, the hemoglobin Comparable derivative o. The like.) Is added to the separated vessel section yourself and possibly dependent on it Tissue prefers over a separate oxygenator module constantly to supply oxygen. It is especially important that the individual dialysis fluid components are not mutually negative influence.

That here in cooperation the pharmaceutical industry is in demand, seems plausible.

Further The application should serve to catheter indication areas open, as possible through one now appearing short-term, d. H. emergency lysis in the restricted Closure area of a coronary artery, an extremity artery or -vene, a cerebral vessel or other vessels appear possible. This includes also the use in particular of a pilot catheter and / or a preferred Einballonkatheters preferred as Rechtsherzkatheter for emergency treatment a pulmonary embolism.

Reached We prefer this by the detection of three-dimensional vascular coordinates (see above), which is preferred in the heart via a cardiac CT Today, multilayer spiral CT is often preferred becomes, with which the vessel representation possibly under contrast medium gives excellent results. Of course, there is the option, the preferred lysis catheter via a conventional X-ray device by means of a preferred vessel contrast agent representation to place.

By adopting the obtained information (see also the claims) into the memory units of at least one preferred three-dimensional control and central processor, the latter is able to direct the catheter tip of pilot and / or balloon catheters to the destination, where they take on differentiated tasks:
Streptokinase, urokinase, t-PA, rt-PA, human plasmin and other plasminogen activators are preferably used as fibrinolytic agents.

In any case it seems possible a heart attack, acute peripheral vascular occlusion and other acute vascular Events on an emergency basis and to treat with a high chance of success; z. B. also as Rechtsherzkatheter in a pulmonary embolism.

To Lastly, it should be noted that modified Pilot catheter with special arrangement of conductor fibers for preferred electromagnetic waves in and / or on the catheter tube suitable are, a tumor over its incoming or outgoing To reach vessels a targeted chemotherapy in addition to a central tumor irradiation to enable. For this purpose, especially IR rays, laser light, radio waves in the Sense of radiofrequency ablation, x-rays and the like more.

These Conductor fiber assembly also allows modified, preferred To create a balloon catheter, which also allows a largely localized chemotherapy of malignant tumors with the possibility to combine the central tumor radiation. Ultimately, it works it about it In addition, tumor-specific vessels through selectively close a thermocoagulation to nutrient supply to prevent the respective tumors.

Also are further indication areas conceivable, with exemplified the Closed fracture treatment with bone adhesive, stabilization The spine with cartilage and / or Bone substitutes and the like are mentioned more.

And It should be noted that the respective target area not exclusively via selective Vessels accessible is, by way of example to the bronchial tree, the spinal canal, etc. thought is.

The invention will now be described with reference to claims 1-76 and 1 - 11 explained in more detail, was dispensed with the catheter presentation with optical fibers for tumor therapy as a possible variant.

there shows:

1 in a schematic representation of the plan view of the tip of a preferred pilot catheter,

2 in a schematic, perspective side view of the catheter tip region of a preferred pilot catheter,

3 in a schematic sectional view "A" of 4 the tip area of a balloon catheter with mounted transmyocardial stent equal to the balloon filling and emptying perforation.

4 in a schematic, perspective side view of the tip area of a balloon catheter with mounted transmyocardial stent and lateral steering fenestrations,

5 in a schematic sectional view of the detail area of a plaque-afflicted (hard plaque) vessel section with introduced two-balloon catheter in its catheter tip area,

6 in a schematic representation of the top view of the catheter tip of a preferred Einballonlysekatheters,

7 a schematic, perspective side view of the catheter tip region of a preferred Einballonlysekatheters,

8th in a schematic representation of a possible complete kit variant for stent application or for thrombolysis,

9 in a schematic sectional view of a possible alternative pilot catheter with integrated guide wire,

10 in a schematic plan view of the tip portion of a pilot catheter with a modified catheter deflection fenestration,

11 in the same schematic representation of a possible catheter Umlenkperforation.

1 shows a schematic representation of the top view of the tip ( 5 ) of a preferred pilot catheter ( 1 ).

We recognize its catheter tip ( 5 ) with its catheter tube ( 4 ) (shown only as a circle) with its beginning, the catheter course just following longitudinal ribs ( 6 ) with their respective inner, longitudinal sealing surface ( 9 ) for sealing against a guidewire symbolized here ( 10 ) are suitable. After replacement of the displayed guidewire ( 10 ) against perforation wire ( 15 ) the sealing function ( 9 ) of the longitudinal ribs ( 6 ), provided that ( 15 ) rounded end ( 28 ) the catheter tip ( 5 ) has overcome.

Thereby they are ( 6 . 10 . 15 ) able to with the pilot catheter ( 1 ) preferably each two diagonal flow paths ( 11 . 11 ' and ( 27 . 27 ' ), of which the river flow paths ( 11 . 11 ' ) (not directly visible in plan view) sealing in the region of the catheter tip ( 23 ) to ( 10 ) locked ( 8th ) and which each have their own pump module ( 12 . 12 ' , ...) and a retropulsive partial exit perforation ( 13 ) (Fenestration) is assigned.

These ( 13 ) are preferably realized so that the catheter tube ( 4 ) is cut as a door-shaped opening (open to the distal end), so that when the pressure builds up via the separately controllable ( 16 ) Pump modules ( 12 . 12 ' , ....) within one or both flow stream (s) ( 11 . 11 ' ) this partial / perforation (s) ( 13 ) distally opens / open and a side pulse and a propulsion of the catheter tip area ( 14 ) with the integrated guide wire ( 10 initiate / initiate. In the case of a pure perforation, only one side pulse each comes about, in both variants the actual catheter thrust with a possibly necessary catheter rotation of the catheter advancing device (FIG. 34 ) is reserved.

The guide wire ( 10 ) with its atraumatic tip optimized Shore hardness closes in the illustrated variant preferably with the catheter tube closure ( 8th ) of the river flow paths ( 11 . 11 ' ) here flush ( 23 ), although it is considered advantageous if it ( 10 ) this ( 8th ) surmounted in optimal length.

The longitudinal recesses ( 27 . 27 ' , ...) are used in the pilot catheter ( 1 ) is used in order to display the vessel situation via a suitable radiopaque fluid by means of the used X-ray device. The preferred pump modules ( 47 . 47 ' , ...). Another indication of the river flow paths ( 27 . 27 ' ) is seen to ideally temper the preferred shape memory plastic and to assist the steering of the catheter tip.

It should be noted explicitly that the be preferred torquestabilizing metal and / or plastic winding / s preferably after the catheter tip area ( 14 ) starts / starts.

2 shows a schematic, perspective side view of the catheter tip region ( 14 ) of a preferred pilot catheter ( 1 ).

The reference numerals of 2 can be largely from the 1 be removed; However, it is expressly to the abstracted representation of the longitudinal ribs ( 6 ) provided with closure ( 8th ) the actually invisible diagonal flow paths ( 11 . 11 ' ) train.

In addition, in particular, the door-shaped, partial outlet opening ( 13 ) of flow stream ( 11 ), which on the unrecognizable opposite side also here for Flussstrombahn ( 11 ' ) is present in the same way. Depending on the activation of the corresponding, preferred pump modules ( 12 . 12 ' , ...) via control and central processor ( 16 ) (please refer 8th ), the preferred pilot catheter ( 1 ) with its integrated guide wire ( 10 ) as needed (bent to the required direction), while the possibly required catheter rotation and the actual propulsion over catheter advancing device ( 34 ) preferably in synchronism with wire feed mechanism ( 37 ) is accomplished.

At the same time it should be pointed out and clarified that the guidewire ( 10 ) here with the catheter tip ( 5 ) ends flush or that this ( 10 ) for target activation the catheter tip ( 5 ) optimally surmounted.

When using shape memory plastics for pilot catheters ( 1 ) can be a realizable curvature ( 83 ) in the form of a resulting circle segment of max. 90 degrees with alignment to the myocardium ( 20 ) as a preferably temporary shape with optimized Shore hardness quasi "frozen" to ensure a safe placement of the guidewire ( 10 ) exchanged perforation wire ( 15 ) after myocardial perforation to the left ventricle ( 41 ) succeeds in him ( 15 ) as Boy Scout for after removing the pilot catheter ( 1 ) used Einballonstentkatheter ( 2 ) to use preferably transmyocardial stent implantation.

The curvature of the catheter tip region of pilot catheter ( 1 ) is via X-ray marking ( 17 ) and possibly correctable, whereby X-ray marking ( 17 ) preferably in the form of a 90-degree angle with a longitudinal leg ( 18 ) or horizontal leg ( 19 ) into the catheter tubing of catheter tubing ( 4 ) of the pilot catheter ( 1 ) in its catheter tip region ( 14 ) is integrated.

The orientation of the horizontal leg ( 19 ) provides information about its ( 14 ) Direction of rotation, that of the longitudinal leg ( 18 ) Information about his ( 14 ) Tilt or bend to the remaining catheter ( 1 ). Of course, preferably also have the Einlononkatheter ( 2 ) and other catheter forms ( 3 . 70 , ...) over comparable X-ray markings. On the representation of reinforcing elements in the catheter tube ( 4 ) can not be entered.

3 shows in a schematic sectional view "A" of 4 the top area ( 14 ) of a balloon catheter ( 2 ) with mounted transmyocardial stent ( 26 ) at the level of the balloon filling ( 42 ) and emptying ( 42 ' ).

The longitudinal ribs ( 6 ) of catheter tube ( 4 ) nestle sealingly against the perforation wire ( 15 ) and form the respective diagonal flow paths ( 11 . 11 ' ), which are ultimately in the fenestrations ( 13 ) find their exit, while the river flow paths ( 27 . 27 ' ) about the balloon filling ( 42 ) and the ballon empty perforation ( 42 ' ) a preferred flow rate for balloon ( 35 ), wherein the balloon pressure on the preferred pump modules ( 47 . 47 ' , ...) controllable ( 16 ).

The preferred balloon ( 35 ) is presented here without any special folding and is produced by the stent likewise made without crimp technology (US Pat. 26 ) enclosed.

4 shows a schematic, perspective side view of the tip area ( 14 ) of a balloon catheter ( 2 ) with mounted transmyocardial stent ( 26 ) and side steering fenestrations ( 13 ) according to 2 ,

Perforation wire ( 15 ) with its optimally rounded end ( 28 ) is clearly visible and is from the sealing area ( 23 . 24 ) of the catheter tip ( 5 ) closure ( 8th ) of the river flow paths ( 11 . 11 ' . 27 . 27 ' ) enclosing sealing. The catheter tip ( 5 ) itself shows the longitudinal longitudinal ribs ( 6 ) only indicated in their position, with the longitudinal ribs ( 6 ) flow streams ( 11 . 11 ' . 27 . 27 ' ) is only indicated by their reference numerals.

The flow streams ( 11 . 11 ' ) about the fenestrations ( 13 ) of catheter tube ( 4 ) with integrated guide wire ( 10 ) (here perforation wire ( 15 )) only if necessary directing on Einballonkatheter ( 2 ), which also works without a pilot catheter ( 1 ) with the indication of the implantation of conventional stents or stents of shape memory plastics over guide wire ( 10 ) by means of the feed devices ( 34 . 37 ) is navigable to the destination by following temporary withdrawal of guidewire ( 10 ) via the sealing perforation ( 23 . 24 ) the corresponding vessel areas can be displayed via contrast agent. And with sufficient catheter tip length ( 14 ) before applying balloon ( 35 ) succeeds after the replacement of guidewire ( 10 ) against perforation wire ( 15 ) even the implantation of a transmyocardial stent ( 26 ).

The river flow paths ( 27 . 27 ' ) allow a flow through the balloon ( 35 ) about the respective balloon filling ( 42 ) and emptying ( 42 ' ). With the preferred pump modules ( 47 . 47 ' , ...) and the thermal aggregate ( 39 ) achieves an optimal flow flow, in particular for shape memory plastic stents ( 26 , ...), here for the preferred transmyocardial stent ( 26 ), which is preferably present during introduction in temporary form (preferably folded) and temperature-controlled ( 16 . 39 . 47 . 47 ' ) goes into its preferred permanent form and the ( 26 ) preferably at body core temperature assumes a sufficient Shore hardness for stabilization.

Particularly noteworthy is the presented stent ( 26 ), which symbolizes a transmyocardial stent ( 26 ) with v-shaped bridges ( 81 ) and longitudinal struts ( 82 ) without crimping technology the balloon shown without folding ( 35 ) is mounted. Stent is on both sides ( 26 ) of circularly arranged bridge segments ( 77 ), each with a longitudinal bracing ( 82 ) are connected.

Balloon ( 35 ) is about the adhesive and / or welding areas ( 50 ) with the catheter tube ( 4 ) sealed sealing and pressure resistant.

On the representation of preferred lasers ( 44 ) Light Conductors in Catheter Tubing ( 4 ) can be discussed as well as the representation of reinforcing elements o. The like ..

5 shows a schematic sectional view of the detail area of a plaque-containing vessel section ( 52 ) with inserted two-balloon catheter ( 3 ) in its catheter tip area ( 14 ), preferably a hard plaque ( 56 ) attention was paid to rheologically not yet significant vasoconstriction. Of course, the two-balloon dialysis catheter ( 3 ) can also be used mutatis mutandis for evaluated soft plaque areas.

It should first on anatomical or pathological features of the vessel section ( 52 ) To be received:
In the layered examination of the vessel wall, we recognize endothelium from the inside out ( 65 ), the membrana elastica interna ( 84 ) as a windowed membrane for the passage of metabolic products and as a limit to the media ( 85 ), the ( 84 ) The subendothelial stratum, not shown, rests as a fine, loose connective tissue with occasional smooth muscle cells. The Media or Muscularis ( 85 ) consists mainly of annularly arranged muscle cells, between which occur in varying amounts of elastin, collagen and proteoglycans. It is also the myocytes that determine the level of metabolism of the vessel wall. They are either nourished by the vascular lumen or by vasa vasorum. The Membrana elastica externa ( 86 ) separates the Media or Muscularis ( 85 ) of the adventitia or tunica externa ( 87 ). This consists mainly of connective tissue with elastic fibers. The Adventitia ( 87 ) is connected to the connective tissue of the organ, through which the respective vessel section runs.

From a pathological point of view, it should be pointed out that the plaque shown here ( 56 ) is to be regarded as hard plaque, which via an endothelium transformation ( 88 ) and connective tissue-like portions is encapsulated.

In order to address the indication of the so-called plaque epithelium, the heart first of all needs to be clarified as to whether plaque dialysis or a transmyocardial bypass should be attempted. It is with the described 5 the Plaqueremoval preferred.

The 5 makes it clear that the two-balloon catheter ( 3 ) with its vascular occlusion balloons ( 51 . 51 ' ) and their actually not visible on average balloon filling and emptying perforations ( 53 . 53 ' ) the vessel route ( 52 ) gently separated by the vascular occlusion balloons ( 51 . 51 ' ) to the vascular endothelium ( 65 ) the largest possible contact surface ( 89 ) exhibit. In addition, it is possible by the preferred strain limitation of the elastic sheath ( 48 ) the pressures in the vascular occlusion balloons ( 51 . 51 ' ) via pressure sensors so ( 16 ), that on the one hand an optimal closure of the vessel route ( 52 ) is ensured and on the other hand, the vessel wall is not or not permanently damaged. Preferably, both vascular occlusion balloons ( 51 . 51 ' ) exclusively from the dialysis inflow ( 49 ) is filled and emptied to allow a possible valve-like closure of the balloon filling and emptying perforation ( 53 ' ) of the proximal vascular occlusion balloon ( 51 ' ) in the influx phase of the dialysis fluid ( 63 ) to prevent ( 51 ' ) otherwise might not unfold.

The proximal vascular occlusion balloon ( 51 ' ) by its shape ( 54 ) in addition, that over the elastic envelope ( 48 ) resulting dialysis drainage path ( 49 ' ) in the course of their drainage perforation ( 55 ' ) proximal preferably to the vessel occlusion balloon ( 51 ' ), fluid ( 63 ) inflow via the inflow perforation ( 55 ) open remains. Optimal are the Zu- ( 55 ) or outflow ( 55 ' ) perforations offset by 90 degrees from each other.

It should also be noted that the dialysis inlets and outlets ( 49 . 49 ' ) end distally blindly ( 90 . 90 ' ) and that the preferred catheter tube ( 4 ) is shown physically opposite to the other figures and with its lumen ( 7 ) is suitable, on the one hand via the perforation wire shown here abstractly ( 15 ) ( 34 . 37 ), on the other hand after removal of ( 15 ) the distal vascular occlusion balloon ( 51 ) to oxygenate the following vessel section with natural blood ( 58 . 59 . 79 ) (s. 8th ).

That the vessel route ( 52 ) and in particular the myocytes whose vascular wall are separately oxygenated, has been mentioned in particular in the claims and the above general description. It is important to note that the fluid ( 63 ), whose preferred composition has also already been set forth, preferably with grafted ultrasonic vibration (generated by means of an ultrasound generator ( 67 )) is used (s symbolic 8th which prefers locally via a piezopolymer foil connected and contacted with the catheter segment via a clock generator of the ultrasound generator (US Pat. 67 ) is generated). Otherwise, the presentation of a dialysis pendulum method was dispensed with. It still remains to be discussed whether the lysis process achieves the best possible temperature over the thermoaggregate ( 39 ) is sought.

Again, on the representation of preferred laser ( 44 ) Light Conductors in Catheter Tubing ( 4 ) as well as on how to the representation of reinforcing elements o. The like ..

6 shows a schematic representation of the top view of the catheter tip ( 5 ) of a preferred balloon-lysis catheter ( 70 ).

We recognize the catheter shown as a circle ( 70 )tube ( 4 ) in the region of its catheter tip ( 5 ), which partially to the perforation wire shown here ( 15 ) sealing ( 24 ) locked ( 8th ) and thus the balloon filling and emptying flow streams ( 73 . 73 ' ) over the abstracted catheter luminal longitudinal ribs ( 6 ) trains.

The remaining lysis flow streams ( 72 . 72 ' ) contribute to blocking blocked vascular balloon ( 71 ) and thus after proximal vessel closure by means of appropriate pump modules ( 12 . 12 ' , ...) to ensure a continuous lysis flow in Durchströmungsvertahren.

Incidentally, the balloon filling and emptying flow paths ( 73 . 73 ' ) by means of at least one pump module ( 47 . 47 ' , ...) to be operated in the flow process, which ensures a constant pressure in the vascular occlusion balloon ( 71 ) guaranteed ( 16 ). Here, too, it remains to be discussed whether the optimal temperature of the lysis process via the thermoaggregate ( 39 ) is sought.

7 shows a schematic, perspective side view of the catheter tip area ( 14 ) of a preferred balloon-lysis catheter ( 70 ).

From distal to proximal is the guide ( 10 ) and perforation wire ( 15 ) with its rounded end ( 28 ), the catheter tip ( 5 ) with its catheter tube ( 4 ) end and the open lysis flow streams ( 72 . 72 ' ) or the locked ( 8th ) Balloon filling and emptying flow paths ( 73 . 73 ' ), which, via the abstracted longitudinal ribs (FIG. 6 ) be generated.

In the continuation of the catheter tube ( 4 ) adhered distally and proximally and / or welded ( 50 ) Vascular occlusion balloon ( 71 ) with its balloon filling and emptying perforations ( 80 . 80 ' ). Of course it will be useful to also use the catheter tube ( 4 )

On the representation of preferred lasers ( 44 ) Light Conductors in Catheter Tubing ( 4 ) can be discussed as well as the representation of reinforcing elements o. The like ..

8th shows a schematic representation of a possible complete kit variant for stent application or for thrombolysis, without going into each kit component in detail. The use of different catheters ( 1 . 1' . 2 . 3 . 70 , ...) is dealt with simultaneously.

We recognize indicated the essential vascular system with the preferred femoral artery ( 91 ) and puncture site ( 92 ) with lock ( 93 ) and yours ( 91 ) Continuation of the Art. Iliaca ( 94 ) into the aorta ( 95 ) with her aortic valve ( 96 ) in the left ventricle ( 41 ) of heart ( 25 ).

Distal from this ( 95 ), the portal of entry into the coronary artery system is via the sinus aortae ( 97 ). The preferred catheter ( 1 . 1' . 2 . 3 . 70 ) is in a selected coronary artery ( 31 ) under the control of the preferred cardio-CT ( 29 ) and the control and / or central processor ( 16 ) with its catheter tip ( 5 ) or its catheter tip region ( 14 ) to the destination (B) or is in a variant (A) of the placed perforation wire ( 15 ) following balloon catheter ( 2 ) for implantation of a transmyocardial stent ( 26 ) already in the left ventricle ( 41 ) preferably using laser light ( 44 ) penetrated. That, then also the catheters ( 3 . 70 ) achieve a target laser assisted if necessary, is traceable, the indication in the plaque dialysis or the emergency plaque must be sought. And catheters ( 2 ) is also suitable for implantation of a conventional stent or a shape memory plastic stent.

By means of at least one controlled ( 16 ) Flows of the flow streams ( 11 ) and or ( 11 ' ) arise from at least one lateral fenestration ( 13 ) or via at least one lateral perforation of the catheter tip region ( 14 ) of pilot catheter ( 1 ) via the appropriate pump module (s) ( 12 . 12 ' , ...) control impulses that are appropriate to the catheter tip ( 5 ) to steer. The controlled ( 16 ) Catheter Advance Device ( 34 ) with the wire feed mechanism ( 37 ) in a meaningful supplement and is ( 34 ) additionally, preferably the pilot catheter ( 1 . 1' ) with little Torqueverlust to turn.

Cardio-CT ( 29 ) is usually designed as a tube and provides, among other things, heart cuts that represent the entire coronary artery when assembled. Thus, almost all essential target points in reproducible contraction phases of the heart ( 25 ) three-dimensional coordinates in preferred relation to a three-dimensionally defined point of the heart ( 25 ), such. B. the anterior entry into the sinus aortae ( 97 ), with which the control and / or central processor ( 16 ) can fulfill its tasks.

The reproducible contractile cardiac phases are preferred via ECG ( 66 ) or via its current waveform ( 98 ) additionally secured or stored taking into account a preferred interpolation value, wherein an easily transportable storage medium is useful.

This makes it possible to perform the actual minimally invasive intervention elsewhere preferably also via a conventional x-ray device, in each case by an identical, via the ECG current waveform ( 98 ) defined heart contraction phase is to go out.

Continue doing 8th clearly that the preferred catheters ( 1 . 2 . 3 . 70 , ...) with the catheter tube ( 4 ) in each case via preferred bypasses ( 38 ) and adapters ( 64 ) by means of preferred transition elements ( 40 ) with the optimally usable pump modules ( 12 . 12 ' . 47 . 47 ' . 59 . 60 . 60 ' , ...) via adapter ( 79 ), whereby preferably pump adapters ( 79 ) are meant. In addition, preferred pump modules ( 12 . 12 ' . 47 . 47 ' , ...) each with at least one thermal aggregate ( 39 ) and it becomes clear that the pump modules ( 12 . 12 ' . 47 . 47 ' , ...) to the multifunction pump ( 30 ), which are preferably circular about that for the reception of catheter-laser process ( 2 . 3 . 70 . 76 ) suitable pump bearings ( 74 ) via the preferred servomotor ( 75 ) is rotatably arranged, wherein ( 76 ) preferably after the pump bearing ( 74 ) via laser coupling ( 45 ) also rotatable ( 46 ) with the preferred excimer laser or the like ( 44 ) is coupled.

Noteworthy is the pilot catheter ( 1 . 1' ) with its X-ray marking ( 17 ) especially the guidewire ( 10 ) or the perforation wire ( 15 ) with its optimally rounded end ( 28 ), in particular the perforation catheter ( 15 ), because it ( 15 ) over the catheter end ( 32 ) with its catheter access ( 36 ) Adapter ( 33 ) in exchange for the guidewire useful for targeting ( 10 ) in the preferably coated catheter lumen ( 7 ) to over the myocardium ( 20 ) entering curved ( 13 . 83 ) and cooled ( 39 ) cured catheter tip region ( 14 ) the myocardium ( 20 ) preferably until just before entering the left ventricle ( 41 ) predominantly by means of wire feed mechanism ( 37 ) perforated, which via control processor ( 16 ) is monitored. Here is the wire feed mechanism ( 37 ) also suitable for the synchronized feed of guidewire ( 10 ) with the respective catheter ( 1 . 1' . 2 , ...) to serve or if necessary ( 10 ) versus ( 15 ) preferably automatically exchange.

Especially with pilot catheter ( 1 ) is of particular importance that the catheter tube ( 4 ), made as a plastic compound and is suitable by at least one preferably aufpolymerisierten and preferably sealed polyaramid fiber in a narrow spiral arrangement, a high torque from the catheter end ( 32 ) to the catheter tip area ( 14 ) and that in the tubing of other catheter forms ( 2 . 3 . 70 , ...) preferably filamentary reinforcing elements such as carbon and / or glass fibers and / or polyaramid fibers and / or textures are incorporated, in particular polyaramid (known as Kevlar ^® ) has an outstanding position.

The catheter tube ( 4 ) of pilot catheter ( 1' ) is in the illustrated variant by a tightly wound wire ( 102 ) torquestabilisiert, it is conceivable that the pilot catheter variant ( 1 ) for Torquestabilisierung such a winding wire ( 102 ) requirement.

Also considered to be valuable, the possibility of the catheter tube ( 4 ) especially of pilot catheters ( 1 . 1' ) from shape memory plastic / s produce.

It remains to be added at this point that the catheter tube ( 4 ) in a variant preferred in a transparent design for lasers ( 44 ) as the preferred clocked excimer laser itself serves as a light guide or preferably contains at least one polymerized light guide.

It is also worth noting that the catheter tip area ( 14 ) of pilot catheter ( 1 . 1' ) optionally contains a magnet and initiated by a rotatable magnetic field, preferably from two diagonally arranged magnet poles, is additionally steerable and in this way the preferred deflection ( 13 . 83 ) of his ( 1 . 1' ) Catheter tip area ( 14 ), apart from the advantages of temperature-controlled shape memory plastics.

Furthermore, it should be noted that the control processor ( 16 ) via the fragmentary data bus system ( 57 ) is involved in all essential control processes and that all parts of the kit constitute a cybernetic system.

It is also worth noting that most catheters ( 1 . 1' . 2 . 3 . 70 , ...) have a sufficient length, which is in 8th through loop ( 21 ) symbolizes the representation comes.

And it should be noted that in the overall kit preferably the dialyzer ( 61 ) with its reprocessing plant ( 62 ) and its storage compartment ( 69 ) as well as the Oxigenator ( 58 ) with its storage compartment ( 68 ) and its associated pump modules ( 59 . 78 , ...), where pump module ( 59 ) almost continuously oxygenated blood via the corresponding catheter lumen ( 7 ) of catheters ( 3 ), resulting in venous access ( 22 ) via pump module ( 78 ) was won. That in addition the oxigenator ( 58 ) or another oxygenator module is used to oxygenate artificial blood, is noted on the edge.

Finally, it only remains to be noted that the pump modules ( 12 . 12 ' . 47 . 47 ' . 59 . 60 . 60 ' . 78 , ...) preferably each have their own drive mechanism, wherein the preferred ejection or Ansaugkompartimente are preferably designed as disposables.

9 shows a schematic sectional view of a possible pilot catheter ( 1' ) with integrated guide wire ( 10 ).

This consists in the illustrated variant of a flattened (here oval) core wire ( 99 ) with its surrounding, peripheral winding wire ( 100 ). However, such an arrangement can only lead to Torquestabilisierung when the winding wire ( 100 ) with the core wire ( 99 ), which is achieved by a preferred cylindrical PTFE seal ( 101 ) has been achieved.

In 9 Now this guidewire ( 10 ) in the catheter tube ( 4 ) of pilot catheter ( 1' ), which ( 1' . 4 ) again by winding wire ( 102 ) is torquestabilized. As the catheter tube material, a shape-memory plastic that is suitable for the needs is composed, and via the longitudinal welding tracks (FIG. 50 ) so with the elastic membrane ( 103 ) welded (or glued), that in a corresponding flow the flow paths ( 104 ) and ( 104 ' ), whereby the one ( 104 ) or ( 104 ' ) is suitable for representing the respective vessel area over a red-leak-tight fluid, while the other one ( 104 ' ) or ( 104 ) is used to pass through a catheter tip-side perforation ( 105 , ...) the catheter tip area ( 14 ) to steer.

10 shows a schematic plan view of the tip area ( 14 ) of a pilot catheter ( 1 ) with a modified catheter deflection fenestration ( 13 ). The catheter tips ( 14 ) tube ( 4 ) area of fenestration ( 13 ) of pilot catheter ( 1 ) so with an elastic sheath ( 106 ) ( 50 ) that fenestration ( 13 ) can only be opened above a defined minimum pressure in order to generate a suitable control pulse.

11 shows in the same schematic representation as an alternative to fenestration ( 13 ) a possible catheter Umlenkperforation ( 105 ), in turn, with the glued ( 50 ) elastic envelope ( 106 ) only over a defined minimum pressure the desired control effect on the catheter tip area ( 14 ) of pilot catheter ( 1 ) guaranteed.

1

pilot catheter

1'

pilot catheter

2

Einballonkatheter

3

Two balloon catheter / dialysis catheters

4

catheter tube

5

catheter tip

6

longitudinal ribs (Catheter tube)

7

inner lumen (Catheter tube)

8th

catheter occlusion

9

Inner, longitudinal sealing surface of 6

10

guidewire

11

River flow path

11 '

River flow path

12

pump module

12 '

pump module

13

fenestration

14

Catheter tip section

15

Perforationsdraht

16

Tax- and central processor

17

radiopaque marker

18

Longitudinal leg of 17

19

Horizontal thigh of 17

20

myocardium

21

loop (Catheter tube excess)

22

venous access

23

Sealing area of 8th . 11 . 11 ' For 10 . 15 (Catheter 1 . 2 , ...)

24

Sealing area of 8th . 27 . 27 ' . 73 . 73 ' For 15 (Catheter 2 . 70 , ...)

25

heart

26

transmyocardial stent

27

River flow path

27 '

River flow path

28

Rounded end of 15

29

Cardio-CT

30

Multifunction pump

31

coronary artery

32

catheter end

33

adapter 32

34

feed device

35

Balloon of 2

36

Catheter ( 1 ) access from 32

37

Wire feed mechanism

38

Bypasses to river flow paths

39

thermal unit

40

Transition elements

41

left ventricles

42

Ballonfüllperforation

42 '

Ballonentleerperforation

43

free

44

Excimer laser

45

Laser coupling

46

Turning range of 45

47

pump module

47 '

pump module

48

elastic wrapping

49

Dialysis inlet path

49 '

Dialysis outflow path

50

sticking- and / or welding area

51

Vascular occlusion balloon

51 '

Vascular occlusion balloon

52

plaque route

53

Balloon filling and entleerperforation

53 '

Balloon filling and entleerperforation

54

Shaping terminal balloon of 51

55

Dialysezuflussperforation

55 '

Dialyseabflussperforaration

56

plaque (hard)

57

data bus system

58

oxygenator

59

pump module

60

pump module

60 '

pump module

61

dialyzer

62

Reprocessing plant

63

fluid

64

River power adapter

65

endothelium

66

ECG

67

ultrasonic generator

68

Storage jar

69

Storage jar

70

Einballon-Lysekatheter

71

Vascular occlusion balloon

72

Lyse river current path (Inflow)

72 '

Lyse river current path (Outflow)

73

Ballonfüllflussstrombahn

73 '

Ballonentleerflussstrombahn

74

pump bearings

75

servomotor

76

Catheter-laser projection

77

Stent bridge segment

78

pump module

79

pump adapter

80

Balloon filling and / or -entleerperforation

80 '

Balloon filling and / or -entleerperforation

81

Circular stent bridges

82

longitudinal stent struts

83

Pilot catheter bending radius

84

Membrana elastica interna

85

Media or muscularis

86

Membrana elastica externa

87

Tunica externa (Adventitia)

88

Endetheltransformation

89

Gefäßverschlussballonendothelauflagefläche

90

Distal end of 49

90 '

Distal end of 49 '

91

artery femoral

92

Puncture site

93

lock

94

artery iliac

95

aorta

96

aortic valve

97

Sine aorta

98

ECG current curve

99

core wire

100

Winding wire too 99

101

Guidewire ( 10 )-Sealing

102

Wire (pilot catheter 1' )

103

Membrane (pilot catheter 1' )

104

River flow path

104 '

River flow path

105

Katheterschlauchperforation

106

Catheter tube wrapping

Claims (76)

Catheters and / or stents, in particular using shape memory plastics and adapted kit devices or elements, characterized in that heart and / or other catheters ( 1 . 1' . 2 . 3 . 70 , ...) and / or stents ( 26 , ...) are suitable as kit elements with further kit devices or elements ( 29 . 30 . 34 . 37 . 44 . 58 . 61 . 67 ...) be applied to a transmyocardial stent ( 26 ) and / or conventional stents, perform plaque dialysis and / or emergency thrombolysis, and other applications (eg Right heart catheterization or central tumor irradiation or localized chemotherapy of malignant tumors and the like), the pilot catheter control ( 1 . 1' . 13 . 16 , ...) and the use of shape memory plastics is to pay particular attention. Catheter and / or stent according to claim 1, characterized in that the respective catheters ( 1 . 1' . 2 . 3 . 70 , ...) or stents ( 26 , ...) are available in various dimensions and that all dimensions are suitable, to the same or the same kit elements or additional devices ( 29 . 30 . 34 . 37 . 44 . 58 . 61 . 67 , ...) to be adapted. Catheter and / or stent according to at least one of claims 1 to 2, characterized in that for the preferred positioning of the catheter ( 2 . 3 . 70 , ...) the respective pilot catheter ( 1 . 1' ) is three-dimensionally controlled (16) to reach the target site with three-dimensional vessel path coordinates in order to obtain a guide wire ( 10 ) or a perforation wire ( 15 ) with optimally rounded end ( 28 ) for the following catheter ( 2 . 3 . 70 , ...) as a guide rail to place. Catheter and / or stent according to at least one of claims 1-3, characterized in that the preferred control and central processor ( 16 ) with appropriate software and with suitable storage units as a central processor ( 16 ) is also suitable for all ancillary equipment ( 29 . 30 . 34 . 37 . 44 . 58 . 61 . 67 , ...), which are selectively preferably combined to form at least one unit, or to control the respective preferred catheter function without x-ray exposure of the staff preferably telemetrically taking into account cybernetic requirements (..., 57 ), wherein pressure sensors and / or limiters as well as valves and other control elements is assigned a significant role. Catheter and / or stent according to at least one of claims 1-4, characterized in that the necessary three-dimensional vessel path coordinates in preferred relation to a defined "0" coordinate and the heart ( 25 ) of the coronary arteries ( 31 ) with respect to a defined "0" coordinate, preferably via a cardiac CT ( 29 ) and / or a comparable device (multilayer spiral CT), possibly after contrast injection ( 30 . 16 , ...) through a preferred pilot catheter ( 1 . 1' ) and, if necessary, with the associated current waveform of an ECG ( 66 ) to be stored preferably via a suitable, preferably even easily transportable storage medium, so that it is possible to use these coordinates and additional information also elsewhere and also via a conventional X-ray device, wherein in the heart of each of the same, over the ECG current waveform ( 98 ) defined heart contraction phase is to go out. Catheter and / or stent according to at least one of claims 1-5, characterized in that the catheter tip ( 5 ) of the preferred pilot catheter ( 1 . 1' ) is additionally magnetically shaped and is thus able to move over a magnet of high magnetic flux density (a device which is operated with 0.1 Tesla (SI unit: 1T = 1N / Am), rotatable around the patient and preferably longitudinally displaceable known) to be steered with a coupled X-ray device supportive, whereby an additional assurance is given to the correct position feed of the guide wire ( 10 ) to realize. Catheter and / or stent according to at least one of claims 1-6, characterized in that all catheters ( 1 . 1' . 2 . 3 . 70 , ...) are suitable via preferred guidewires ( 10 ), which are also suitable for special indications on the part of their form with preferred perforated wires ( 15 ) with optimally rounded tip ( 28 ) to correspond. Catheter and / or stent according to at least one of claims 1-7, characterized in that the guide wire ( 10 ) of the preferred catheters ( 1 . 1' . 2 . 3 . 70 , ...), preferably an oval-shaped, high-strength core wire ( 99 ) with a peripheral, optimized winding wire ( 100 ) to combine also high-strength material, both of which are designed and suitable in particular for high tensile loads, in their combination the guide wire ( 10 ) with preferred PTFE sealant ( 101 ) either a round shape or an oval shape with the smallest possible diameter (favorable for the pilot catheter ( 1 . 1' ) for implantation of a transmyocardial stent ( 26 )), whereby ( 10 ) each have a high Torqueaufastbarkeit and good sliding properties compared to the catheter ( 1 . 1' . 2 . 3 . 70 , ...) - inner lumina ( 7 ) is own and he ( 10 ) Preferably in the peak portion by the / a preferred (PTFE) plastic or plastic compound, if necessary, with shape memory properties on a defined length flexible and preferably designed atraumatic. Catheter and / or stent according to at least one of claims 1-8, characterized in that preferably the catheter tube ( 4 ) of the pilot catheter ( 1 . 1' ) for implantation of a transmyocardial stent ( 26 ) the guidewire ( 10 ) adjoins flush and slightly slidable, except for the catheter tip area ( 14 ) the catheter tube ( 4 preferably made of shape memory plastic also preferably with a high-strength optimized wound wire ( 102 ) is torquebastbar stabilized. Catheter and / or stent according to at least one of claims 1-9, characterized in that the pilot catheter ( 1' ) for implantation of a transmyocardial stent ( 26 ) preferably with an ultrathin, flexible and yet tear-resistant membrane ( 103 ), which is provided with two longitudinal adhesive and / or welding tracks ( 50 ), two outer flow paths ( 104 . 104 ' ), of which one, to the catheter tip ( 5 ) open, is suitable, by means of contrast media at the heart ( 25 ) the coronary arteries ( 31 ) ( 30 ), while the other in the area of the catheter tip ( 5 ) ends blindly and with a catheter-near perforation, the pilot catheter ( 1 ) in combination with a possible rotational movement preferred by the catheter advancing device ( 34 ) to steer ( 16 . 30 . 10 . 37 , ...). Catheter and / or stent according to claim 10, characterized in that the generated outer flow paths of pilot catheter ( 1' ) via adapter ( 64 , ...) and transition elements ( 40 ) with corresponding pump modules ( 12 . 12 ' . 47 . 47 ' , ...) connected ( 79 ) are, after they by means of a suitable auxiliary element sealing the lock ( 93 ) have happened. Catheter and / or stent according to at least one of claims 10, 11, characterized in that the named flow paths ( 104 . 104 ' ) are suitable, by a meaningful temperature control ( 30 . 39 ) the catheter tube ( 4 ) of the preferred pilot catheter ( 1' ) of shape memory plastic with its catheter tip area ( 14 ) for myocardial perforation via a preferred perforated wire ( 15 ) with optimally rounded tip ( 28 ) on the myocardium ( 20 ) to redirect ( 16 . 34 . 17 . 83 , ...), as a scout for the perforation wire ( 15 ) to serve. Catheter and / or stent according to at least one of claims 1-12, characterized in that the deflection ( 83 ) of the catheter tip area ( 14 ) the catheter ( 1 . 1' ) shape memory plastic material has been entered as permanent "information" during manufacture or that it ( 83 ) according to the controlled ( 16 . 30 . 34 . 39 , ...) deflection process the catheter tip area ( 14 ) can be programmed as temporary "information" ( 16 . 30 . 39 , ...) is. Catheter and / or stent according to at least one of claims 1-13, characterized in that the respective catheter tubes ( 4 ) the catheter ( 1 . 2 . 3 . 70 , ...) in cross-section are preferably designed circular and in the catheter course preferably aligned, the same shape inner longitudinal ribs ( 6 ) with their longitudinal sealing surfaces ( 9 ) are adapted to a preferably from the catheter end ago introduced preferred guide wire ( 10 ) and / or in exchange with a cross-sectionally identical perforation wire ( 15 ) in a sealing manner, wherein at least one, but preferably at least two separated flow streams ( 11 . 11 ' . 27 . 27 ' . 72 . 72 ' . 73 . 73 ' , ...) in a preferably diagonally comparable embodiment to the vessel representation ( 27 . 27 ' . 72 . 72 ' , ...) by means of contrast media, for catheter control ( 11 . 11 ' . 13 . 105 . 16 , ...), for balloon filling and emptying ( 27 . 27 ' . 73 . 73 ' ) as well as for lysis ( 72 . 72 ' ) can be designed by additionally preferably the catheter end ( 32 ) except for the actual recording perforation for ( 10 . 15 ) is closed so that the recording perforation is suitable, the guidewire ( 10 ) or the perforation wire ( 15 ) sealingly. Catheter and / or stent according to at least one of claims 1-14, characterized in that the respective pilot catheter ( 1 ) of preferred shape memory plastic the Flußstrombahnen ( 11 . 11 ' ) in the region of the catheter tip ( 5 ) sealing ( 23 ) to ( 10 ) and or ( 15 ) locked ( 8th ) and that the flow streams ( 11 . 11 ' ) preferably immediately after this closure ( 8th ) at least one to the catheter end ( 32 ) optimally hinged ( 106 , ...), partial catheter tube ( 4 ) fenestration ( 13 ) suitable longitudinal extension and / or at least one optimally configured catheter tube ( 4 ) perforation ( 105 . 106 , ...) to generate a controlled ( 16 ) Have forward and transverse pulses, while the catheter tip side open, diagonal flow paths ( 27 . 27 ' ) are suitable, for. B. in addition to the vessel representation preferably optional and preferably in particular with ( 11 . 11 ' ) for defined temperature control ( 16 . 12 . 12 ' . 47 . 47 ' . 30 . 39 , ...) of the catheter tube material to be used, these ( 27 . 27 ' ) are open through catheter recesses open recesses (not shown) are suitable, an additional supporting steering movement of the catheter tip region ( 14 ). Catheter and / or stent according to at least one of claims 1-15, characterized in that the catheter tube ( 4 ) especially in pilot catheters ( 1 ) in the catheter tip area ( 14 ) its fenestration (s) ( 13 ) and / or perforation (s) ( 105 ) preferably with at least one ultrathin, elastic sheath ( 106 ), an ultra-thin, elastic film ( 106 ) o. The like. Glued and / or welded ( 50 ) is that thus the function of Fenestrierung / en ( 13 ) and / or the perforation (s) ( 105 ) Optimized by pressure-controlled overcoming of the elastic envelope or foil resistance can be used. Catheter and / or stent according to at least one of claims 1-16, characterized in that for all achievable vascular targets (not only the heart) the catheter tip area ( 14 ) of the respective pilot catheter ( 1 . 1' ) via at least one radiopaque marker ( 17 . 18 . 19 , ...), which makes it possible to recognize ( 18 . 19 , ...), like the catheter tip ( 5 ) is aligned. Catheter and / or stent according to at least one of claims 1-17, characterized in that for the implantation of a preferably transmyocardial stent ( 26 ) the pilot catheter ( 1 . 1' ) with its catheter tip area ( 14 ) is controlled to the destination ( 16 , ...) to get an alignment ( 83 ) of the catheter tip ( 5 ) on the myocardium ( 20 ) about the corresponding resulting pulse ( 13 . 105 , ...) at least one preferred flow stream ( 11 . 11 ' . 104 . 104 ' , ...) to initiate or bring about this (or 11 . 11 ' . 104 . 104 ' , ...) and possibly further flow paths ( 27 . 27 ' . 104 . 104 ' , ...) to a suitable temperature control ( 16 . 39 ) when using preferred shape memory plastics, wherein the flow paths ( 27 . 27 ' ) in addition to the supporting orientation ( 83 ) of the catheter tip ( 5 ) and that the catheter tube ( 4 ), possibly a preferred rotation ( 34 ) of the catheter ( 1 . 1' ) with sufficient torque transmission ( 102 ) to the catheter tip ( 5 ). Catheter and / or stent according to at least one of claims 1-18, characterized in that the catheter tube ( 4 ) of the preferred pilot catheter ( 1 . 1' ) or Einballonkatheters ( 2 ) and others ( 3 , ...) is suitable, preferably via carbon and / or glass and / or PTFE and / or polyaramid fibers and / or other preferably filamentary materials of high resistance biologically harmless form-stabilized for higher internal pressures, without thereby its predetermined bending flexibility to lose. Catheter and / or stent according to at least one of claims 1-19, characterized in that the catheter tube ( 4 ) of the preferred pilot catheter ( 1 . 1' ) or Einballonkatheters ( 2 ) and others ( 3 . 70 , ...) in a preferably defined area, in each case instead of or in addition to at least one metal coil (if appropriate polymerized into the preferred shape memory plastic material and / or preferably coated) ( 102 , ...) in preferably narrowest helical arrangement to prevent kinking or for increased strength increase in terms of Torquestabilisierung preferably has polymerized and / or applied polyaramid fibers in preferably also densest spiral arrangement and / or that also a polymerized and / or applied Polyaramidtextur alone or in combination is suitable. Catheter and / or stent according to at least one of claims 1-20, characterized in that the preferred pilot catheter ( 1 . 1' ) is suitable when using shape memory plastics with optimized, preferably stretched starting shape and optimized ( 16 . 39 , ...) Shore hardness steered to the destination ( 16 . 11 . 11 ' . 12 . 12 ' . 27 . 27 ' . 104 . 104 ' . 13 . 105 , ...) to be there at the heart pilot catheter ( 1 . 1' ) for the preferred implantation of a transmyocardial stent ( 26 ) by a suitable temperature control ( 16 . 30 , ...) by means of at least one preferred thermal aggregate ( 39 ) a controlled ( 16 . 11 . 11 ' . 12 . 12 ' . 27 . 27 ' . 104 . 104 ' . 13 . 105 , ...) achieved catheter tip alignment ( 83 ) at short notice to place a preferred perforated wire ( 15 ) (in exchange for guidewire ( 10 )) to keep ( 16 . 30 . 39 , ...) or this ( 83 ) then again temperature-controlled ( 16 . 30 . 39 , ...) to remove the heart pilot catheter ( 1 . 1' ) to be removed again. Catheter and / or stent according to at least one of claims 1-21, characterized in that in the case of a shape memory plastic stent ( 26 , ...) in general, preferably via a balloon catheter ( 2 ) by means of perforation wire ( 15 ), this ( 2 ), whose ( 26 , ...) permanent shape that was temporarily transformed for implantation ( 16 . 11 . 11 ' . 27 . 27 ' . 12 . 12 ' . 47 . 47 ' . 30 . 39 , ...) and preferably at body temperature with sufficient or optimized Shore hardness to fix, for which control tasks at least one preferred fluid is suitable to be used. Catheter and / or stent according to at least one of claims 1-22, characterized in that the catheter tube ( 4 ) a priori of different plastics, preferably distributed over different areas, is formed and / or preferably by different plasticizer concentrations in different segments has different Shore (initial) hardness. Catheter and / or stent according to at least one of claims 1-23, characterized in that under catheter tip alignment ( 83 ) at least one optimized pilot catheter bending radius ( 83 ) of the catheter tip area ( 14 ), the ( 83 ) is suitable, this ( 14 ) with its catheter tip ( 5 ) on the myocardium ( 20 ) and that placing the preferred perforated wire ( 15 ) whose fixed ( 37 ) Location after myocardial perforation up to the left ventricle ( 41 ) is to be understood. Catheter and / or stent according to at least one of claims 1-24, characterized in that self-deploying stents ( 26 , ...) preferably a modified stent catheter ( 2 ) is suitable to be used, wherein preferably no ne balloon elongation is required but preferably supportively meaningful and where the stent ( 26 , ...) unfolding is suitable, preferably to be realized only on the retraction of a plastic sheath, as the catheter base material, at least in certain areas shape memory plastics are considered useful. Catheter and / or stent according to at least one of claims 1-25, characterized in that metal stents ( 26 , ...) with shape memory properties are suitable, with appropriate temperature control ( 16 . 30 . 39 , ...) to be used. Catheter and / or stent according to at least one of claims 1-26, characterized in that for the preferred perforation wires ( 15 ) with its optimally rounded end ( 28 ) to prevent catheter tube perforation, preferably spring-hard steel alloys are suitable to be used. Catheter and / or stent according to at least one of claims 1-27, characterized in that at least the preferred pilot catheter ( 1 . 1' ) with a durable catheter tube ( 4 ) Inner coating is provided. Catheter and / or stent according to at least one of claims 1-28, characterized in that the terminal catheter access ( 36 ) of the preferred pilot catheter ( 1 ) preferably with an adapter ( 33 ), which is suitable, via a corresponding device, both the guide wire ( 10 ) as well as the perforation wire ( 15 ) prefers automated recording and ( 10 ) versus ( 15 ) and both ( 10 . 15 ) ( 16 ) via a suitable feed mechanism ( 37 ) to advance or fix ( 15 ), whereby the adapter ( 33 ) is further suitable as a sealing element for the flow paths ( 11 . 11 ' . 27 . 27 ' , ...) and where both the guidewire ( 10 ) as well as the pertortation wire ( 15 ) is suitable in each case with the adapter ( 33 ) sealing accordingly. Catheter and / or stent according to at least one of claims 1-29, characterized in that the catheter tube ( 4 ) of the corresponding stent ( 26 , ...) - balloon catheter ( 2 ) of the internal structure of the preferred used pilot catheter ( 1 ), with two diagonally arranged, catheter tip-side sealing ( 23 ) closed ( 8th ) Flow streams ( 11 . 11 ' ), the catheter ( 2 ) ( 16 . 13 , ...) (preferably using guidewire ( 10 )), while the two remaining diagonally arranged flow paths ( 27 . 27 ' ), also catheter-side sealing ( 24 ) locked ( 8th ), with appropriately arranged and shaped balloon filling and emptying perforations ( 42 . 42 ' ) especially in shape memory plastic stents ( 26 , ...) these ( 26 , ...) via an optimized temperature profile ( 16 . 27 . 27 ' . 47 . 47 ' . 30 . 39 , ...) of the preferably used radiopaque fluid via balloon ( 35 ) in the preferred flow-through process and by active stretching into its preferred permanent form, which is preferably fixable by the body temperature with preferably increased Shore hardness. Catheter and / or stent according to at least one of claims 1-30, characterized in that the preferred pilot catheter ( 1 ) and the associated balloon catheter ( 2 ) with his on catheter tube ( 4 ) glued and / or welded ( 50 ) Balloon ( 35 ) with mounted transmyocardial stent ( 26 ) is suitable in each case, preferably lateral bypasses ( 38 ) to the river flow paths ( 11 . 11 ' . 27 . 27 ' ) with the corresponding pump modules ( 12 . 12 ' . 47 . 47 ' , ...) of a multifunctional liquid pump ( 30 ) with at least one preferably assigned thermal aggregate ( 39 ) via preferred adapters ( 64 ) by means of preferred transition elements ( 40 ) through adapters ( 79 ) are connectable. Catheter and / or stent according to at least one of claims 1-31, characterized in that the catheter tube ( 4 ) of the preferred balloon balloon stent catheter ( 2 ) is suitable for a preferred laser perforation extension of the myocardium ( 20 ) to receive preferred optical fibers. Catheter and / or stent according to at least one of claims 1-32, characterized in that preferably a pulsed-working excimer laser o. The like. ( 44 ), with the catheter tube ( 4 ) from ( 2 , ...) preferably rotatable ( 46 ) ( 45 ) to become. Catheter and / or stent according to at least one of claims 1-33, characterized in that the balloon balloon stent catheter ( 2 ) with adequately sized catheter tip area ( 14 ) and at least one catheter tip side integrated steering fenestration ( 13 ) or perforation ( 105 ), per se with the replacement of guidewire ( 10 ) against perforation wire ( 15 ) laser assisted stents ( 26 , ...), whereby the catheter tube ( 4 ) torqueable ( 102 ) and configured with the known features according to the above-mentioned claims, so that the vessel situation can be detected radiographically with it, inter alia via a radiopaque fluid ( 27 . 27 ' , ...) and kit elements ( 16 . 10 . 30 . 34 . 37 ,) are suitable to take over the required control tasks. Catheters and / or stents after at least one of claims 1-34, characterized in that instead of a preferred stent coating corresponding Pharmacomponents such as rapamycin, paclitaxel, sirolism, cyclosporin u. a. in the superficial preferred shape memory plastic stent material actively diffusible and are therefore suitable in a given Period to be released. Catheter and / or stent according to at least one of claims 1-35, characterized in that for plaque removal in vessels and in particular in coronary arteries ( 31 ) the preferred two-balloon catheter ( 3 ) via an elastic, stretch-limited tear-resistant, blind-ending ( 90 . 90 ' ) Serving ( 48 ), preferably two further preferred dialysis flow streams ( 49 . 49 ' ) by wrapping the envelope ( 48 ) preferably with the catheter tube ( 4 ) glued diagonally and / or welded ( 50 ) and to increase the strain limitation also preferably reinforced with carbon and / or glass and / or polyaramid and / or PTFE fibers and / or other preferably filamentous materials of high strength biologically harmless, without up to a certain degree their ( 48) negatively affecting elasticity, with catheters ( 3 ) with its external dialysis flow paths ( 49 . 49 ' ) is suitable, via a modified lock ( 93 ) to be placed and to remain. Catheter and / or stent according to at least one of claims 1-36, characterized in that the elastic sheath ( 48 ) or the dialysis flow streams ( 49 . 49 ' ) forming adhesive and / or welding tracks ( 50 ) with two balloons (vascular occlusion balloons) ( 51 . 51 ' ), which ( 51 . 51 ' ), the plaque route ( 52 ) and the ( 51 . 51 ' ) prefers both from the dialysis inflow path ( 49 ) with suitable perforations ( 53 . 53 ' ) can be filled and emptied. Catheter and / or stent according to at least one of claims 1-37, characterized in that the terminal balloon ( 51 ' ) by its shape ( 54 ), the dialysis drainage path ( 49 ' ), the shaping ( 54 ) is preferably realized by appropriately arranged material reinforcements. Catheter and / or stent according to at least one of claims 1-38, characterized in that the dialysis flow streams ( 49 . 49 ' ) with preferably large-sized and optimally positioned perforations ( 55 . 55 ' ) to the plaque route ( 52 ), in the form of a modified dialysis preferably soft or organized, hard ( 56 ) Ablate plaque via a preferred flow-through method, while preferably catheter catheter-side open catheter tube lumen ( 7 ) is suitable, first the two-balloon catheter ( 3 ) preferably via a pilot catheter ( 1 . 1' ) inserted guidewire ( 10 ) and then after removal of ( 10 ) by means of a corresponding valve circuit o. The like. Via a pump module ( 59 , ...) with associated oxygenator ( 58 ) the vascular occlusion balloon arranged on the catheter tip side ( 51 ) following tissue district with oxygenated ( 58 ) and preferably to supply heparinized blood, which is preferably suitable via pump module ( 78 , ...) taken from a preferably large vein ( 22 ) to become. Catheter and / or stent according to at least one of claims 1-39, characterized in that for the modified plaque dialysis additionally at least one further pump module ( 60 . 60 ' , ...), a dialyzer ( 61 ), possibly a reprocessing plant ( 62 ) and a suitable fluid ( 63 ) are necessary. Catheter and / or stent according to at least one of claims 1-40, characterized in that the external flow paths ( 49 . 49 ' ) are catheter-endseitig with an external (to catheter tube 4 ) second tube portion connected via two longitudinal longitudinal ribs with catheter tube ( 4 ) is suitable, on the one hand, the flow paths ( 49 . 49 ' ) and on the other hand extracorporeal preferred adapters ( 64 ) with transition elements ( 40 ) to the assigned pump modules ( 60 . 60 ' , ...) with their adapters ( 79 ) to realize. Catheter and / or stent according to at least one of claims 1-41, characterized in that the vascular occlusion balloons ( 51 . 51 ' ) a large endothelial surface ( 89 ) and that the flow is chosen such that the claimed endothelium ( 65 ) is exposed to the lowest possible pressure load. Catheter and / or stent according to at least one of claims 1-42, characterized in that the vascular occlusion balloons ( 51 . 51 ' ) processor-controlled ( 16 ) are suitable via a timer, at defined intervals, in which the dialysis process rests, to be deblocked together or separately at least partially, to avoid Gefäßendothelschäden by pressure. Catheter and / or stent according to at least one of claims 1-43, characterized in that the pressurization of the vessel closure balloons ( 51 . 51 ' ) in the dialysis phase cardiac (ECG) ( 66 ) and / or pressure sensor controlled (..., 16 ) is capable of being kept constant at the lowest level. Catheter and / or stent according to at least one of claims 1-44, characterized in that the vascular occlusion balloons ( 51 . 51 ' ) are preferably suitable at intervals, to be presented with a radiopaque marker for presentation. Catheter and / or stent according to at least one of claims 1-45, characterized in that the pump module ( 60 , ...) for the dialysis inflow ( 49 ) preferably with an ultrasonic generator ( 67 ), so that the plaque-laden vascular route ( 52 ) preferably a fluid ( 63 ), to which an optimized ultrasonic oscillation, preferably via at least one of the relevant catheter path applied, contacted piezopolymerfolie is grafted. Catheter and / or stent according to at least one of claims 1-46, characterized in that the preferred ultrasonic vibration is suitable, via the preferred ultrasonic generator ( 67 ) preferably by means of a suitable clock generator to be generated. Catheter and / or stent according to at least one of claims 1-47, characterized in that the dialyzer module ( 61 ) is preferably to act as a plate and / or Kapillardialysator, wherein the dialyzer Gesamtbausatz ( 3 . 61 . 62 . 67 . 58 , ...) via appropriate storage compartments ( 68 . 69 ). Catheter and / or stent according to at least one of claims 1-48, characterized in that the dialysis fluid preferably consists of a physiological carrier, the cholesterol binding additives such as pectin and / or ezetimibe in a balanced amount, preferably matrix metalloproteases (MMP) in optimal concentration etc (calcium binders, ASA or the like, vitamin C, etc. vitamins or pharmaceuticals such as fibrinolytics) are added, so that ultimately an isotonic fluid is suitable, possibly in systemically unusable form or in unrealizable concentration of Individual constituents may be supplied to the enclosed plaque area (s) to ultimately regenerate the same, the contaminated fluid being capable of being reused for the most part reconditioned with fresh fluid, and ultimately, the fluid being preferably oxygenated ( 58 ) artificial blood (eg fluosol from fluorocarbons or a bacterially produced hemoglobin-like derivative or the like) is added to the separated vessel section ( 52 ) and possibly dependent tissue preferably via a separate oxygenator module ( 58 ) constantly supplied with oxygen, whereby it is ensured that the individual dialysis fluid components do not influence each other negatively. Catheter and / or stent according to at least one of claims 1-49, characterized in that a preferred balloon catheter ( 70 ) is capable of lysing an unorganized vaso-occlusive thrombus such that its vascular occlusion balloon ( 71 ) is suitable to block in front of the thrombus the corresponding vessel in the inflow, and then with the guidewire ( 10 ) (placed by pilot catheter ( 1 . 1' )) preferably in the flow-through method ( 72 . 72 ' , ...) the thrombus via at least one corresponding pump module ( 60 . 60 ' , ...) dissolve. Catheter and / or stent according to at least one of claims 1-50, characterized in that the preferred four longitudinal ribs ( 6 ) of the catheter tube ( 4 ) of catheters ( 70 ) are symmetrically offset so that each two diagonally arranged larger flow paths ( 72 . 72 ' ) which are open to the thrombus or embolus and which 72 . 72 ' ) as with all registered catheter variants ( 1 . 2 . 3 ), via adapters ( 64 ) and transition elements ( 40 ) with the preferred pump modules ( 60 . 60 ' , ...) via adapter ( 79 ) to be connected. Catheter and / or stent according to at least one of claims 1-51, characterized in that the vascular occlusion balloon ( 71 ) with the guidewire left ( 10 ) is suitable, over the preferred two smaller, catheter top side sealed ( 8th ) Flow streams ( 73 . 73 ' ) is optimally controlled with preferably radiopaque solution ( 16 ) to be stretched and emptied ( 73 . 73 ' ) via an additional adapter ( 64 ) by means of a preferred transition element ( 40 ) with preferred pump modules ( 47 . 47 ' , ...) via adapter ( 79 ) are connected. Catheters and / or stents after at least one of claims 1-52, characterized in that as fibrinolytic agents streptokinase, urokinase, t-PA, rt-PA, human plasmin, and other plasminogen activators Discussion. Catheter and / or stent according to at least one of claims 1-53, characterized in that preferably all catheters ( 1 . 1' . 2 . 3 . 70 , ...) of a modifiable feed device ( 34 ) are associated with integrated possibility of rotation. Catheters and / or stents after at least one of claims 1-54, characterized in that as catheter tube base materials Polyamides and / or comparable materials from application technology and preferably those having shape memory properties are suitable to be used. Catheters and / or stents after at least one of claims 1-55, characterized in that preferably the pilot catheter ( 1 . 1' ) is also suitable for use in conventional Seldinger technique. Catheter and / or stent according to at least one of claims 1-56, characterized in that alternatively in the preferred pilot catheter ( 1 ) also the river flow paths ( 11 . 11 ' ) are open on the catheter tip side and preferably all flow paths ( 11 . 11 ' . 27 . 27 ' ) one to the catheter tip ( 5 ) have an open recess (not shown) which is suitable for a respective controlled ( 16 . 12 . 12 ' . 47 . 47 ' , ...) to generate preferred side pulse results. Catheter and / or stent according to at least one of claims 1-57, characterized in that the preferred pump modules ( 12 . 12 ' . 47 . 47 ' , ...) preferably to a circular pump ( 30 ), which is capable of being stored ( 74 ) each rotational movement, in particular of the pilot catheter ( 1 ) (but also ( 1' )) with its adapters ( 64 ) and transition elements ( 40 ) via a preferred servomotor ( 75 ), with the respective catheter end ( 32 ) or the laser extension ( 76 ) of the preferred balloon catheter ( 2 ) is suitable, through the warehouse ( 74 ) of the pump ( 30 ) to be guided to the clutch ( 45 ) to the downstream laser ( 44 ) preferably rotatable ( 46 ) or ultimately to the pilot catheter ( 1 . 1' ) the preferably round guidewire ( 10 ) and later replaced therefor perforation wire ( 15 ) by the laser coupling ( 45 ) which ( 10 . 15 ) preferably in Einlongonkatheter ( 2 ) also for stretching ( 27 . 27 ' . 35 . 42 . 42 ' , ...) of preferred shape memory plastic stents ( 26 , ...) are suitable for use and that other or differently used pump modules ( 60 ' . 60 . 59 . 78 , ...), with the dialysis catheter ( 3 , ...) and the dialyzer ( 61 ), the preferably used ultrasonic generator ( 67 ), the oxigenator ( 58 ) or with other kit devices or venous access ( 22 ) via appropriate adapters ( 79 ) or corresponding transition elements ( 40 ) to be connected. Catheter and / or stent according to at least one of claims 1-58, characterized in that the pump modules ( 12 . 12 ' . 47 . 47 ' , ...) depending on the preferred valve circuit via preferably independently operating, separately controllable preferred servomotors are suitable to eject almost permanently or suck. Catheter and / or stent according to at least one of claims 1-59, characterized in that the suction and ejection preferably suitable cylinder and piston of the individual pump modules ( 12 . 12 ' . 47 . 47 ' , ...) are preferably designed as disposables. Catheter and / or stent according to at least one of claims 1-60, characterized in that in particular the preferred transmyocardial stent ( 26 ) has a high bending flexibility with optimized dimensional stability in the unfolded state, which is achieved by preformed circular bridges ( 81 ) with longitudinal braces ( 82 ) is reachable. Catheter and / or stent according to at least one of claims 1-61, characterized in that the preferably used shape memory plastic stents ( 26 , ...) for implanting are preferably folded in crimp technology and preferably constructed of biocompatible and preferably biodegradable polymers and that preferred transmyocardial shape memory plastic stents ( 26 ) in the folded state even over a small radius ( 83 ) are bendable and ultimately at the destination in their final shape to bring. Catheter and / or stent according to at least one of claims 1-62, characterized in that preferably the catheters ( 1 . 1' . 2 . 70 , ...) if appropriate in a slightly modified form are also suitable for use as a right-heart catheter, whereby in particular the catheter ( 70 ) is suitable as an emergency lysis catheter in its indication, preferably in combination with a suitable pilot catheter ( 1 . 1' ) to treat an acute pulmonary embolism emergency. Catheter and / or stent according to at least one of claims 1-63, characterized in that the lysis or thrombolysis catheter is preferably a modified two-balloon catheter ( 3 ), with which it is possible to separate an embolus or thrombus by two expanded balloons during lysis or thrombolysis. Catheter and / or stent according to at least one of claims 1-64, characterized in that in particular a modified lock ( 93 ) preferably to the appropriate dialysis catheter ( 3 ) is tuned with its external tube portion and is capable of timed release preferably at least one sterilizing substance, which is suitable, biologically harmless the vascular access ( 92 ) to keep unappealing. Catheter and / or stent according to at least one of claims 1-65, characterized in that a modified pilot catheter ( 1 . 1' ) in and / or on its catheter tube ( 4 ) arranged conductor fibers for preferred electromagnetic waves, in the catheter tip region ( 14 ) are arranged at least partially helically so that they are individually or in groups circular in optimally small angle segments suitable for each other, virtually quasi tangent and emerge at an optimized angle to the catheter orientation, so that an optimal irradiation space can be generated, preferably separate conductor fibers are suitable in the region of the catheter tip ( 5 ) exit. Catheter and / or stent according to claim 66, characterized in that the conductor fibers for preferred electromagnetic waves preferably at the same angle to the catheter alignment of the catheter tube ( 4 ), wherein the different refraction at the exit point with the catheter tip-exiting conductor fibers are sufficient to produce a sufficient irradiation space. Catheter and / or stent according to at least one of claims 66, 67, characterized in that the modified pilot catheters ( 1 . 1' ) are available in various thicknesses and dimensions and with different exit angles of the conductor fibers, preferably in relation to the catheter orientation. Catheters and / or stents after at least one of claims 66-68, characterized in that the conductor fibers for the preferred electromagnetic Shaft spectrum consist of optimal / optimized material and / or provided with an optimal / optimized coating. Catheter and / or stent according to at least one of claims 66-69, characterized in that the preferred modified pilot catheter ( 1 . 1' ) is suitable, according to the obtained target coordinates, which were obtained via a suitable CT, MRI or the like. Preferably under contrast administration and / or the administration of signal or recognition molecules to be placed so controlled in a tumor via the vascular system that over his ( 1 . 1' ) preferred and possibly different conductor fibers a preferably central tumor irradiation with preferably electromagnetic radiation such as IR-rays and / or laser light and / or radio waves and / or X-rays and / or the like. Catheter and / or stent according to at least one of claims 66-70, characterized in that the introduction of the modified pilot catheter (s) (s) ( 1 . 1' ) in a tumor via a conventional rotating X-ray system, as is common in cardiac catheterization laboratories, preferably using a joy stick is feasible. Catheter and / or stent according to at least one of claims 66-71, characterized in that the preferred conductor fibers before their splitting into the respective catheter tube ( 4 ) at least simply bundled with at least one "beam generator" are connectable. Catheter and / or stent according to at least one of claims 66-72, characterized in that the modified pilot catheter (s) ( 1 . 1' ) itself and / or at least one preferred balloon catheter ( 2 ) after placement via a described pilot catheter ( 1 . 1' ) or a guide wire ( 10 , ...) is suitable to carry out both a largely separated chemotherapy and / or a preferably central tumor irradiation in order ultimately to prevent the blood supply to a tumor by selective vascular coagulation. Catheter and / or stent according to claim 73, characterized in that modified Einballonkatheter ( 2 ) are preferably to block nourishing (arteries) as well as laxative (vein) vessels of a tumor in order to carry out a localized chemotherapy with preferably supporting, preferably central tumor irradiation, which in the case of several balloon catheters ( 2 ) is selectively controllable. Catheter and / or stent according to at least one of claims 73, 74, characterized in that the modified balloon ( 2 ) are preferably available in different diameters and dimensions. Catheter and / or stent according to at least one of claims 1-75, characterized in that pilot catheter ( 1 ), Guide wires ( 10 ) and matched balloon catheters ( 2 ) are suitable for other indications, such. B. the closed fracture, the spinal stabilization and the like more z. B. on the application of bone adhesives, cartilage and / or bone substitutes, etc via their catheter lumen ( 7 ), wherein the target finding is not exclusively coupled to the vascular pathway (see bronchial tree, spinal canal, etc.).