DE102005053434A1 - Thromboses removal device e.g. for removal of foreign bodies and thromboses from body cavities and blood vessels, has guide wire with far element which is provided with orthogonal structure which is made from fiber bristles - Google Patents

Abstract

The device has a guide wire (2), with a far element (3), which is provided with an orthogonal structure (4). The orthogonal structure (4) is made from fiber bristles. The fibers or bristles are made from a polymer material. The fibers are PU, PP, Polyacryl, Polyester, Polytetrafluoroethylen or Polyalkylen. The fibers or bristles are made of metal.

Description

The The invention relates to a device with a guidewire for removal of foreign bodies and thrombi from body cavities and Blood vessels.

thromboembolic Diseases such as myocardial infarction, pulmonary embolism, peripheral thrombosis, organ embolism, etc. are typically caused by a thromboembolus (hereinafter short thrombus), ie a viscoelastic blood clot of platelets, Fibrinogen, coagulation factors, etc., triggered, which settled in a blood vessel has and completely or partially closes this. The occlusion of organ arteries leads to interrupt the supply of dependent tissue with oxygen and nutrients. The disorder Functional metabolism with loss of function follows within short time the subsidence of the structural change with the sinking of affected tissue (infarction). The most common in humans affected Organs are the heart and the brain. However, such changes also affect the extremity arteries and the pulmonary arteries. Venous thrombosis and thromboembolic occlusions are coming heaped in the leg and Pelvic veins before. The clinical picture of the thrombotic occlusion of a Intracranial sinus may be due to the disruption of venous drainage of the brain tissue lead to severe cerebral hemorrhage.

in view of the severity of diseases caused by thromboembolism and the frequency These disorders are different resolution techniques or Removal of thrombi known.

So It is known to treat such patients with thrombolytic agents Treat streptokinase or urokinase or with anticoagulants, what to thrombolysis or to control thrombus growth to lead should. Since these treatments are usually time consuming, will be they are often combined with interventions that are mechanical Shredding or removal of the thrombus or embolus serve.

In addition to open surgical procedures, transluminal or endovascular, catheter-guided interventional therapy forms are increasingly being used in the prior art since they are less invasive. It is thus known to remove the thrombus from the patient's body by means of suction catheters producing negative pressure or mechanically with catheters provided with collecting baskets, spirals, hooks or the like US Pat. No. 6,245,089 B1 . US 5 171 233 A1 , Thomas E. Mayer et al., Stroke 2002 (9), 2232.

Of the Disadvantage of the known transluminal devices is that these too often thrombus not completely can remove, and there is a risk that the thrombus or fragments of it become release and move on in the bloodstream to smaller-volume vessels, which are harder to reach and to treat. Furthermore The devices known in the art are suitable due to their dimensions and / or low flexibility insufficient to remove thrombi from particularly kleinlumigen or strongly tortuous vessels, such as those of the brain.

So is from US 2002/0049452 a device with a catheter For the removal of thrombi known at the distal end tentacles from a shape memory material are attached, which rest in the compressed state on the catheter and in the expanded configuration radially from the catheter Outside extend. After the body temperature triggered Intake of the expanded configuration should be the tentacles in the thrombus and this when returning the catheter into a pull another catheter out of the blood vessel. The disadvantage this device is that they either for cooling the Tentacles below the transformation temperature until these enter the bloodstream in a secondary catheter, the this cooling allows maneuvered past the thrombus must become; or the catheter provided with the tentacles must be inside carry a heater that is heating to the transformation temperature after reaching the thrombus allows. This constructive Requirements are on the one hand very expensive and thus prone to failure and make the treatment solely because of their physical extent especially small-lumen vessels impossible.

in view of the disadvantages associated with the prior art is the Object of the invention thus in the provision of a device for Removal of foreign bodies and thrombi from body cavities and Blood vessels, which reduces the surgical risk of removing thrombi and the treatment of particularly small-lumen vessels allowed.

This object is achieved by a device with a guidewire for removing foreign bodies and thrombi from body cavities and blood vessels with a guide wire, wherein the device has a cage structure at the distal end of the guide wire, the is composed of individual struts and is adapted to fold tight under the external constraint of a microcatheter and transported within the microcatheter, and unfolds to the full basket structure when eliminating the external constraint through the microcatheter, wherein the basket structure at least two longitudinally arranged one behind the other Includes baskets.

A Such device for removal of thrombi with basket structure is basically intended to receive thrombi inside and in this way to allow the removal of thrombi. In the folded Condition is going through the basket structure within a microcatheter the blood vessels up to brought to the destination and there finally distal to be removed Thrombus pushed out of the microcatheter, whereupon the Device for full basket structure unfolds. The basket structure The thrombi to be removed may be whole or crushed Take shape. Subsequently the device becomes in the blood vessel system withdrawn and finally, optionally after insertion into a catheter in which it is for an additional guide catheter (guide catheter) can act, which has a larger inner diameter as the microcatheter, through which the basket structure to its destination was brought, together with the thrombus wholly from the blood vessel system away.

The Basketry generally has an elongated, ship-like shape Structure with a length from 5 to 50 mm and a diameter of 2 to 6 mm in expanded State on. The basket structure is made of peripheral, in particular longitudinal struts educated. These struts are usually on a regular basis Scope distributed.

According to the invention this basket structure at least two longitudinally one behind the other arranged baskets on, so that it is a Doppelkorbstruktur. Two or more baskets arranged one behind the other have the advantage that these ultimately serve different purposes. So For example, the proximally arranged basket as a separating tool for the Thrombus or formed in the vessel Clot act while the distal basket can accommodate the thrombus or fragments of the thrombus can. Such a fragmentation of the clot has particular significance, if the clot is too big overall, as a whole can be absorbed by the basket structure, or else hardened so hard is that he has difficulty getting into the basket structure. A such a strong hardening of the clot is probably to be found especially in older thrombi.

in the In connection with this invention, the terms "distal" and "proximal" refer to the view of treating doctor. The distal end is thus each the treating the doctor facing away from the end, which advanced further into the blood vessel system Components of the device corresponds while proximal to the treating Physician-facing means d. H. the proximally arranged components The device is advanced less far into the blood vessel system.

So far in this application of longitudinal direction the speech is, this is ultimately the feed direction of the device to understand, d. H. the longitudinal axis the device also corresponds to the longitudinal axis of the blood vessel, within the device is advanced.

The Basket structure is, as already mentioned, formed from struts, which preferably extend at least partially in the longitudinal direction. in this connection It should be noted that under longitudinal direction ongoing striving not only those are understood that exactly parallel to the longitudinal axis are aligned, but also those which are at a certain angle <90 ° to the longitudinal axis in the direction of distal or proximal. To be from a real one Basket structure to speak, this is preferably at least three, but better still four formed to eight struts.

Farther it is useful if the basket structure and thus the struts of a shape memory material, Nitinol, preferably, so that they are in the folded Condition in a microcatheter and after pushing out automatically unfolds from the microcatheter.

The Unfolding to the full basket structure in the absence of external constraint however, the microcathode does not always have to be self-acting, but can also be brought about manually. For example could on the basket structure an additional guidewire be attached, which causes a deployment of the basket structure during advancement.

Central through the basket structure runs expediently a core filament. This core filament is the distal portion of the guidewire or even a separate core filament containing the guidewire continues towards distal.

The folding of the basket structure under the external constraint of a catheter is generally associated with an extension of the basket structure. In order to absorb this stretch, or to facilitate the radial expansion associated with longitudinal contraction upon release of the basket structure from the catheter, it makes sense to use the basket structure so flexible that it can follow this extension / contraction. Therefore, at least at its proximal end, the basket structure should be displaceable relative to the core filament. This can be achieved by the basket structure converging at its proximal end in a sleeve through which the core filament is movable in the longitudinal direction.

There in the Doppelkorbstruktur invention the further proximally arranged basket primarily as a parting tool for the The clot to be removed is intended to be removed while the distal basket is to be picked up of the clot is provided, it makes sense to baskets their specific tasks to design accordingly. For example, the distally arranged basket longer be formed so as to accommodate enough space for the thrombus to disposal to deliver. The separation of the thrombus serving proximal Basket, however, can be longitudinal shorter be designed.

There forces are ultimately to be exerted on the thrombus with the basket arranged proximally, which lead to the crushing of the thrombus, it is beyond makes sense to design this basket harder as the distally arranged basket. A harder embodiment is in Understand this relationship so that the required for deformation radial forces are bigger as the radial forces, which are needed to deform the distally arranged basket. By a correspondingly hard configuration of the proximally arranged Korbs can even very old, already strongly hardened thrombi crushed so far or scraped off the vessel walls be that afterwards removed from the blood vessel after being collected in the distally located basket can be.

Around the proximal and distal basket to their respective Can customize tasks they are made of different materials, where, like stated above for the proximal basket a harder Material should be used. For example, here different nitinol materials be used, d. H. in particular different alloys.

alternative or additionally can also the struts that make up the proximally arranged basket is, a larger diameter exhibit as the struts that make up the distally arranged basket consists. Also in this way it is achieved that the proximal Basket to withstand greater radial forces capable and thus ultimately harder.

A another possibility consists in the choice of the angle in which the struts to the longitudinal axis stand. So can the struts that make up the proximal basket at least partially at a greater angle to the longitudinal axis run as the struts of the distally located basket, which causes that the proximal basket due to radial forces less easily collapsible. Altogether thus has the distally arranged Basket a slightly flatter structure, especially in the eye falls if in addition the distal basket designed longer is considered the proximal basket.

In cases in which a lot of clot material is to be included, for example because the thrombus is especially big, can Also basket structures are used, which include more than two baskets. In this case, all serve Baskets distal of the proximal basket for receiving the clot material.

As already mentioned, can the baskets made up of different numbers of struts, ultimately the basket is denser, the more struts the basket structure has. Depending on the intended use, however, it has turned out that it makes sense may not be too many struts to use the proximal opening of the Basket structure through which the thrombus penetrate into the basket structure should, not to shrink too much. So ultimately those between the struts lying partial openings viewed in the proximal cross section of the basket structure, the larger the less struts are used. This is especially important when the thrombus is very old and therefore firm and connected, so that it is difficult to get into the opening of the basket structure. For such Thrombus has become a number of aspirations from four to six as special advantageously proved.

Of course they are Here also combinations conceivable, approximately in the form that the proximal one Basket in which the thrombus while retracting the basket structure in Vascular system first must penetrate a smaller number of struts than the distally located Basket that for the inclusion of the already crushed by the proximal basket Thrombus is provided.

Usually The struts of each basket run at the distal and proximal ends, respectively End of the basket in one point together, this point preferably is centrally located. At the points where the struts converge, the Struts directly or indirectly via a connecting element be connected to each other. Optionally, the connecting element as Sleeve formed be opposite a centrally extending core filament is longitudinally movable to this Way stretching and contraction of the basket structure at Pushing out of the catheter to facilitate.

One another approach, the proximal opening of the Basket structure to enlarge exists besides the possibility described above reducing the number of aspirations in that between the Strive for resulting partial openings at least partially to enlarge in this way the intrusion of a firmly connected To facilitate thrombus. For this, the between the struts existing large ones partial openings enlarged, with what at the same time a reduction of the small partial openings results. This is achieved by the struts at least a basket, preferably the proximal basket at unfolded basket structure from the point where the struts on converge towards the proximal end of the basket, along a first section grouped, z. B. in pairs closely adjacent to run distally, distally this first section diverge and move in one second section distal to the first section along the circumference of the basket evenly distributed extend distally. In other words, they are lost Do not strut along the entire basket evenly distributed over the circumference, rather this even distribution will be the first one piece distal to the proximal opening produced. Because of the struts at the proximal end of the basket first grouped closely adjacent, partial openings are created, which are approximately are so big as would only half or a third of the number of struts used came. When using a total of four struts run about about two strut pairs together at the proximal opening, so that there are two significantly enlarged partial openings, the almost semicircular are while the remaining small partial openings between the closely adjacent struts are negligible. In a similar way would result in a total of six struts and pairwise course of the first Aspiration partial openings, almost the size of one Third circle have. If along the first section respectively three struts closely adjacent run in the direction of distal even with the use of six struts, there are two nearly semicircular openings. in principle is such an approach for partial enlargement of the partial openings Of course also conceivable with basket structures, which consist only of a basket.

The the baskets forming struts can for the proximal and for be identical to the distal basket. In this case extend the struts from the proximal end of the proximal basket to to the distal end of the distally arranged basket. So the struts thereby forming a Doppelkorbstruktur and not just a strong extended Form basket, the struts are preferably at least partly cross over, so that ultimately the node where the struts meet the distal end of the proximal basket and simultaneously represent the proximal end of the distally arranged basket. A such embodiment has the advantage of being on the distal basket and on the influence the radial forces acting on the proximal basket, because radial forces be transferred to the other basket in the pursuit. To this Way, the device can maintain its clamped shape, too if the nominal diameter in a vessel can not be realized. This is especially true if the precautions described above for length adjustment the basket structure are given.

in the Node can the struts are interconnected and / or connected to the core filament. Advantageously, however, there is no connection because of this Way the radial force influencing is not disturbed.

Furthermore can the radial forces through not completely complete Pushing out the device from the microcatheter. If For example, only the distal basket is ejected while the proximal remains in the micro catheter, the radial force of the catheter increases distally arranged basket. This can be especially strong during salvage Clots / thrombi be beneficial.

Especially good is the mutual influence of the radial forces then, when the struts from the proximal basket to the nearest distally arranged basket on the opposite side of the basket structure run, d. h., If there is an offset of 180 ° from one basket to the next.

The furthest distal basket may expediently have a network structure at least distally, in order to thus ensure improved safety against slippage of thrombus fragments out of the basket when the device is returned from the blood vessel. This network structure may be composed in particular of intertwined wire, for which, as well as for the struts, Nitinol can be used. Such a network structure of a basket is particularly useful at the distal end, as ultimately the basket structure is pulled proximally to remove the thrombus, while a network structure at the proximal end of the basket is less helpful, as otherwise under certain circumstances, the penetration of the thrombus in the basket could prevent. Accordingly, the network structure should only be at the distal end of the basket or be compressed from proximal to distal. In addition, a larger mesh size in the proximal area of the basket facilitates retraction of the basket into the catheter under collapse of the structures at the inclusion of the thrombus.

A similar Function, like the described network structure, can also be a stringing of the distally arranged basket on its distal side with a Apply polymer skin. Such a polymer skin, for example made of expanded PTFE (polytetrafluoroethylene) can exist, practically, that the distal end of the basket becomes a bag. The polymer skin extends from the distal tip of the basket along the struts to a desired one Position, for example, in the middle of the basket. The polymer skin may have one or more openings at the distal end of the basket, that are so big that liquid, In particular, blood can pass through unhindered during the thrombus or thrombus fragments captured with the basket structure retained become. This is especially true when retracting the basket structure of Advantage, since in this way the blood flow does not hinder itself but the thrombus is still completely out of the blood vessel system Will get removed.

According to one further advantageous embodiment The struts of the basket structure are helical, d. H. distal end and proximal end are up to 45 to each other 180 ° offset, preferably about 90 °. Such a helical course allows, when advancing the Basket structure a thrombus adhering to the vessel wall to shear off or cut off without the device rotated would have to be.

According to one In another variant, the struts run along a wavy line with a lateral deflection of 45 to 90 °, d. H. the struts are moving first laterally until, for example, you have reached a point that by 90 ° against is offset from the starting point, and then move on the second half their length back to the starting point. In this case, the proximal end and the distal end are not offset against each other.

According to one particularly preferred embodiment the device not only consists of a basket structure at the distal end End of the guidewire, but additionally in the basket structure radially outwardly standing fibers or bristles on, individually or in bundles can be arranged.

These Fibers or bristles are suitable for holding a thrombus and to stabilize, especially if they are made from thrombogenic materials exist or equipped with it are.

The Fibers or bristles can in addition to Korbstruktur serve to capture a thrombus by get caught in the thrombus and thus facilitate its return. simultaneously the fibers / bristles are flexible so that they move forward the device due to the mechanical resistance in proximate Apply direction to the distal element. Accordingly, they must have one have sufficient rigidity, to fulfill their purpose of arresting the thrombus, at the same time but also be flexible enough to be flexible by one Catheter guided to be able to and the vessel walls not to hurt.

The Fibers / bristles can also of a natural material, polymer material, metal, ceramic material, Glass or combinations thereof. Particularly preferred Polymer materials.

When Materials are especially suitable here polyurethane, polyacrylic, polyester, Polytetrafluoroethylene, polyamide or polyethylene, due to its peptide-like Bonding structure mainly polyurethane and polyamide, z. Nylon, which allows a particularly good anchoring ("growth") of the thrombus to the fibers.

Next Polymer materials are mainly metallic materials in question. Suitable metals are all metals without harm to the patients can be used for treatment. Particularly suitable are for the above purpose, stainless steel fibers of metal alloys having shape memory properties, such as nitinol lasers. Have fibers of shape memory materials the advantage of being under external compulsion a microcatheter in a first, tight-fitting form can and after release from the microcatheter in a second orthogonal Shape with freely projecting fibers. Furthermore, gold and platinum suitable materials. Also suitable are ceramic materials, Glass fibers and carbon fibers.

The used according to the invention incoming fibers or bristles are preferably at an angle from 70 ° to 110 °, preferably at an angle of 80 ° to 90 ° from the longitudinal axis of the device. These angles should be understood to mean that Angle <90 ° a proximal Alignment of the fibers, angle> 90 ° a distal Designate orientation of the fibers. Embodiments with an angle, which is slightly smaller than 90 ° particularly atraumatic when advancing into the vessel or through The thrombus and at the same time cause a particularly good anchorage in the thrombus when retracting from the blood vessel.

The fibers or bristles are connected in a manner known per se to a distal element of the guide wire, as for example wise from the production of fiber-reinforced embolization spirals is known. This can be done by interlacing with the distal element, by gluing, welding or any other suitable method of attachment.

to Treatment of particularly small-lumen vessels are particularly suitable Fibers of a length of 0.5 to 6 mm and preferably 0.5 to 3 mm, so that even with radial Arrangement of fibers an outer diameter of the fiber-carrying part of the distal element from 1 to maximum 12 mm is reached. For particularly atraumatic treatment should this outside diameter be dimensioned slightly smaller than the inner diameter of the relevant Blood vessel.

The Fibers extend expediently over one Length of the distal element, which makes up 0.5 to 5 cm. To guarantee A sufficiently good anchoring of the thrombus, it is useful if the fibers at a density of 20 to 100 per cm at the distal Element of the guidewire are arranged.

Conveniently, is the guidewire off a medical grade stainless steel or shape memory material, preferably Nitinol, manufactured. It is expedient if the guide wire an outer diameter from 0.2 to 0.4, preferably 0.22 to 0.27 mm. A typical one Length of one guidewire is between 50 to 180 cm.

According to one particularly preferred embodiment The device is coated on the fibers. This can be, for example a neutral coating of parylene or polytetrafluoroethylene (teflon) be, but also one with collagen or with a blood clot promoting Material, preferably one or more coagulation factors. These embodiment serves the reinforced Anchoring the fibers in the thrombus and reduces the risk that the thrombus disintegrates so far that parts of the thrombus remain in the blood vessel or in the bloodstream can release.

It was surprising found that thrombogenic equipment of the fibers / bristles too a significant stabilization of the thrombus on the device according to the invention to lead. It is up to the surgeon the device according to the invention so to contact with the thrombus and leave that over one certain exposure time of the thrombogenic elements to a "festering" of the thrombus promoted the device becomes. This festering occurs in a relatively short time thrombogenic Fibers / bristles, sometimes within a few minutes. This bows not just a decay of the thrombus, as he did with many, commercially available Devices is observed, but also facilitates the collection of the thrombus into a catheter and its extraction from the vascular system. The most suitable thrombogenic materials and coatings are known to those skilled in the literature. Especially suitable about one or more of the factors fibrin, thrombin, factor XIII and / or factor VIII.

advantageously, the device has one or more radiopaque (radiopaque) Markers on. these can made of platinum or a platinum alloy, for example be. Such radiopaque Brands can are located in both the areas of which the fibers or Brems go out, but also on the basket structure, so that the treating Physician with appropriate imaging procedures the progress of Can observe treatment.

It is further advantageous when the tip of the entire device atraumatic, z. B. rounded, is formed.

The The distal element of the device that has the fiberization is expedient centrally in the basket structure, d. H. the element with its fiber is ultimately centrally located within the baskets. That way the beneficial effects of the basket structure on the one hand and the On the other hand, fibers on the distal element are combined with each other. this makes possible a particularly secure capture of the captured thrombus both through the basket structure as well as through the fibering and also allows retreating of the thrombus in a catheter.

The Fibers or bristles can in particular one or more on the through the basket structure extending core filament slidable filaments be located and fixed so that the fibers / bristles practically from Center of the basket structure from jet-shaped radially projecting. alternative or additionally can also fibers or bristles fixed to struts of the basket structure be.

According to one alternative embodiment the device for removing foreign bodies and thrombi from body cavities and With blood vessels a guidewire one or more distal elements that are at least two together twisted soul wires comprise, between which fibers inserted transversely to the course of the core wires and with the soul wires are twisted so that the fibers from the distal element project radially outward.

The distal element thus has the shape of a brush, from the bristle-like fibers to the outside stand. As previously described in the embodiment in combination with a basket structure, the fibers serve to capture and stabilize a thrombus so that it can ultimately be removed from the blood vessel system. The procedure is as follows:
The device is brought to the site using a small-lumen microcatheter. It is equally possible to maneuver the device in the microcatheter 1) first distally of the thrombus and then retract 2) in the area of the thrombus from the microcatheter, 3) push it out of the microcatheter proximally of the thrombus and then anterograde to penetrate the thrombus. When advancing the device, the flexible fibers attach themselves to the distal element due to the mechanical resistance in the proximal direction, but on retraction, they stand up, get caught in the thrombus and thus support the return to a larger than the originally used microcatheter. This is usually a guide catheter. Such a guiding catheter can coaxially introduce a microcatheter, which in turn forces the device into the target region. The thrombus fixed with the device is preferably pulled back into the guiding catheter and then removed together with it from the body.

at the preparation of the device according to the invention is done this way before that the fibers that later the brush form, side by side and possibly additionally superimposed between two core wires with the fibers orthogonal to the core wires. In this context, it should be noted that under an orthogonal Course according to the invention not just an angle of exactly 90 ° is understood, but any transverse course the fibers to the soul wires, d. H. the fibers are substantially transverse to the core wires, not parallel. Correspondingly, too Angle of for example 70 ° in still be regarded as orthogonal in this context. If the fibers are inserted between the core wires are, these are twisted together, for example by a End is arrested while the other is twisted to give a plastic deformation the soul wires to create a spiral structure. After the twist the soul wires the fibers stand as it were on a helix from the twisted soul wires Outside out. The main advantage of such a device is in that relatively few soulwire needs to be used at the same time a very high fiber content of serving as a brush distal element to reach. The use of little soul wire is advantageous in that as the system remains very flexible. Furthermore is the fixing of the fibers to the core wires in this embodiment especially easy and the distribution of fibers on the brush is very evenly.

The Fiber amount or density leaves controlling themselves by the number of twists of the soul wires, what related to different degrees of hardness on the radial force of the brush leads, because by more twists also more fibers per unit length the brush be generated. About that lets out the bending stiffness of the soul u. a. by the number of soul wires and adjust the twists. Thus, for example, by a high number of twists of two soul wires a double helix out of these formed both soul wires, which is less rigid than in a version with fewer turns.

Possibly can usually two soul wires also be connected to each other at the distal end and a loop form. Ultimately, it is therefore just a soul wire, the first is returned to the distal end and then back again, finally the two parallel sections of the soul wire with in between to twist lying fibers.

At the proximal end can the soul wires over one Coil with other, proximal components of the device be connected. In these more proximal components in particular, it may be a guidewire or even more as a brush act trained distal elements. The connection over such Coils is used in medical technology in particular from the field of Occlusion coils for Aneurysms sufficient known. The connection of the coil with the soul wires can doing so by welding, Gluing, soldering or mechanical (i.e., force and / or positive) joining methods respectively.

The core wires can of platinum or its alloys, in particular of a platinum-iridium alloy, Stainless steel, nickel-titanium alloys such as Nitinol or tungsten and tungsten alloys exist.

The core wires and with it the whole brush can just executed be wavy or helical, d. H. with each other twisted soul wires again form a wave or helix shape of the soul itself. The difference between wave and helix is in this context to understand that a wave is a purely two-dimensional, one Helix, however, forms a three-dimensional shape. The waves- or helix shape of the brush has advantages insofar as hereby a better cleaning effect connected is.

in the Trap formed by the twisted core wires helix can additionally run through the interior of the helix stretch protection filament, which prevents axial stretching of the device over the nominal length. Such stretch protection filaments can be made from polymer materials (eg, nylon) or metal, such as nylon. B. Nickel Titanium Alloys (Nitinol) be prepared. They are both distal and proximal with the through the soul wires trained helix connected. Also the stretch protection filament itself can turn straight, wavy or helical be designed, the latter variants a certain leeway longitudinal in terms of a possible allow axial stretching. To still have sufficient protection against stretching bring about, However, if such a helix has a very high slope, so that the scope of the axial extension holds within certain limits.

The mentioned core wires have to not always classic, cross-section round wires, it may also be cut or shaped fittings, for example, when the soul wires be cut out of a plate. In this case, the Cross section of the core wires not round but square or square.

According to one further advantageous embodiment the device has a plurality of distal elements, one of which Fibers project radially outward. Such a system consisting of several brushes, for example, benefits have, if particularly large Thrombi or multiple thrombi from the blood vessel system should be removed. About that In addition, a brush located further distal, if necessary, fragments of a thrombus, that of the proximal brush fall off, intercept and remove with.

Around despite the length of such a system of several brush parts still one sufficient flexibility to reach it, it makes sense to connect the individual distal elements via fasteners, especially joints to connect with each other. At this joint can bend the device to some extent and thus the Follow the course of the blood vessels.

Possibly can also several a brush forming distal elements, preferably two or three brushes, im Cross-section of the device considered juxtaposed be, preferably in parallel. Proximal and distal, these brushes are again connected to each other, for example by the soul wires of the to brush converge centrally again proximally and distally. Such an embodiment This has the advantage that every single brush has shorter fibers feature can not because the fibers from the center of the device to the Inner vessel wall have to extend but only from the individual distal elements, which in an arrangement next to each other get closer to the vessel walls. Since shorter or Ultimately, fibers protruding less far from the distal element harder are, the cleaning effect can be further improved in this way become. If necessary, you can the individual brushes even further twisted into a helix.

Of Further can provide the distal elements with struts (suitably at least 3) which emanate from the distal end of the distal element, radial outward emerge and reappear at the proximal end of the distal element converge centrally. The radial extent of the struts corresponds preferably in about the radial extent of the fibers. in the In the middle region, the struts thus run essentially parallel to the inner soul of the distal element. The provision of Struts on the distal element serve to provide additional guidance of the system in the blood vessel. In a certain way Measures the pursuit a resemblance to the basket structures described in the first part of the invention on, however, must these struts are not so dense, so u. Not from a real basket structure can be spoken.

In cases in which the device has several distal elements with outward Fibers may have the struts each span a distal element or several distal elements. For example, with two distal elements the struts from the distal end of the most distal go out of the distal element and only at the proximal end of the proximal Brush again converge. In this case, it makes sense to additional Zwischenstreben between the struts and the central running To provide soul wires, for an additional stability to create the strut structure.

According to a further advantageous embodiment of the invention, the brushes have a conical structure, ie the radial extent of the fibers, which ultimately corresponds to the brush diameter, increases from proximal to distal. The essential advantage of such a conical brush shape is that, irrespective of the width of the blood vessel to be specifically cleaned, there are always at least some brush areas in which the fibers have the optimum length. An optimal length for a particular blood vessel will have fibers just when the fibers abut the walls of the blood vessel without being bent in the distal direction when the device is moved proximally. In this case, the Cleaning effect of the fibers particularly good. Longer fibers, on the other hand, are deflected distally in the proximal direction in the backward movement and therefore do not clean as effectively, short fibers in turn reach u. U. not at all the vessel inner wall and therefore do not cause any cleaning effect anyway. Because not all fibers are the same length in a conical brush shape, therefore, even with different blood vessels always at least some fibers are present, which develop the optimal cleaning effect.

The conical brushes can have different shapes, for example, can be relatively few conical brushes be provided over a joint are connected to each other, but it can also be many short conical sections formed on a single distal element become.

Additionally or alternatively you can also the fibers in the proximal region of a distal element harder be as in the distal area. The harder fibers in the proximal Area serve more the scraping of an adhering to the vessel wall Thrombus, while the softer fibers in the distal area more the clinging of the Thrombus or thrombus fragments serve. Another possibility, to ensure, that the fibers have different lengths and thus always at least some fibers the optimal length have, is the individual fibers so on the two sides let the twisted soul wires stand out, that the fiber is a shorter and a longer one Side has. This can be achieved by using the fibers before twisting the soul wires not exactly centered between the core wires, but irregular.

Further Options, to produce fibers of different lengths on the distal element are to use fibers of different lengths while twisting which ultimately has an irregular brush structure produced, or conical brushes in which the brush diameter increases from distal to proximal. More advantageous, however, is the previously described variant of an increase in the radial extent fibers from proximal to distal, in this case the longer fibers when retiring lie in the proximal direction of the device behind and possibly Thrombusfragmente can catch.

Around To facilitate the uptake of a clot (thrombus), the brush of the distal element along the soul be designed differently. For example, you can some areas, especially the middle area of a brush, with be occupied softer fibers, the fibers of the recording of the Serve clots. The harder ones Fibers occupy further proximal or distal areas on the other hand, they are more likely to be reinforced Cause cleaning effect.

A similar one It has an effect if the density of the fiber composition in some areas, smaller, especially in the middle region of the distal element is as in other areas. Again, this has the effect that the more densely packed proximal and distal areas of the brush rather serve to improve the cleaning effect on the vessel walls, while the middle, thinner occupied area should accommodate the clot.

The Fibers are inserted between the twisted core wires in held primarily by being pinched while twisting. additionally or alternatively, however, a further fixing by gluing, Knotting and / or melting take place.

The radially outboard Ends of the fibers advantageously have thickenings, for example spherical Thickening, so the clot mass more surface and hold available put. Another advantage of this embodiment is that the fiber ends can be designed atraumatic in this way. The thickenings At the fiber ends can be achieved, for example, that the separation of the fibers by microlaser cutting, electron beam cutting etc. he follows.

According to one another embodiment are the radially outside lying ends of the fibers at least partially connected to each other via loops. Ultimately, it is the interconnected fibers thus not by two but only by a fiber with a loop-shaped course. The fiber emerges from the soul, runs to the outer brush edge, forms a loop and runs back to the soul. Total results thus an elliptical course of the fiber. This embodiment has the advantage that, much like at the thickening at the fiber end, the Clotmasse more surface to disposal in this way, the capture effect for the thrombus to improve. About that In addition, the loop is rounded and thus atraumatic. Another advantage is that the fibers are stiffer because the loop-shaped Fiber ultimately behave like two juxtaposed Shows fibers.

According to a further embodiment, the core wires extend in the cross section of the distal element outside the center, ie eccentrically. Such a brush with eccentrically arranged soul causes ver on one side of the brush short fibers, on the other side of the soul long fibers are present. Because of their short distance to the soul, the short ends of the fibers behave much harder, the long ends of the fibers behave much softer, again the harder fibers tend to improve the cleaning effect, the softer fibers rather clinging to the thrombus. A further advantage of a brush with an eccentrically arranged core can be that such a brush can be guided more easily laterally past a clot in order subsequently to receive it during the backward movement in the proximal direction through the brush.

The described brush-like Devices can also basically for backfilling used by aneurysms. In this case, it should be the brushes around helical to brush Act that compared to such brushes, the thrombus removal serve, are comparatively short. To place the brushes in the aneurysm to be able to the distal element (s) must be separable from the guidewire be. To further fill the aneurysm, the bristles can also be used with a Be provided adhesive or have a thrombogenic coating.

Of It should also be noted that also with regard to the embodiment of the invention with brush-shaped distal Element to the fibers all versions apply, previously related to a basket structure having embodiment were made with fibers, in particular with regard to the material, that for the fibers used, the angular orientation, the length of the Fibers, the coating of fibers, the use of radiopaque Markers etc.

Furthermore are all described embodiments of the invention can be combined with each other. In particular, the embodiment with the Doppelkorbstruktur additional Fibers, conversely, the embodiment of the distal Element outgoing fibers in addition have a basket structure. In particular, it is also a combination of Doppelkorbstruktur and distal element of twisted together core wires with outward above fibers possible.

The Invention finally relates also the combination of the device with a guide and / or microcatheter, in which the device maneuvered to the site and with the thrombus loaded again from the blood vessel system can be removed. It may be useful to additionally use the catheter Aspiration catheter designed to be taken with the micro catheter can be.

Special Significance has the previously described invention for the removal of thrombi from particularly kleinlumigen vessels, in particular intracranial. Of course let yourself However, the invention also in the removal of thrombi from others Areas of the body use, for example, from the heart, the lungs, the legs etc. Also conceivable is the use for removing other foreign bodies the blood vessels, for example of embolization spirals and stents.

The The invention will now be described by way of example with reference to the accompanying drawings explained in more detail. It demonstrate:

1a a representation of a Doppelkorbstruktur in the side view;

1b the Doppelkorbstruktur 1a in a view from distal;

2a another side view of a Doppelkorbstruktur;

2 B the view of the double basket structure 2a from distal;

3a the proximal view of a basket structure according to an embodiment;

3b the proximal view of a basket structure according to an alternative embodiment;

4a the proximal view of a basket structure according to another embodiment;

4b the proximal view of a basket structure according to another embodiment;

4c the proximal view of a basket structure according to another embodiment;

5 the side view of the basket structure 4a ;

6 the side view of another embodiment of the invention;

7 the production of a brush-like distal element;

8a the distal element in longitudinal section;

8b the distal element in longitudinal section;

8c the distal element in cross section;

9 a further embodiment of the distal element in longitudinal section;

10 a distal element with a wavy soul;

11 a helical soul;

12 a helical soul with outwardly protruding fibers;

13 an embodiment with two consecutively arranged distal elements;

14 an embodiment with two consecutively arranged distal elements and additional struts;

15 a further embodiment with two consecutively arranged distal elements with additional struts;

16 an embodiment with conical brush elements;

17 a further embodiment with conical brush elements;

18 an embodiment with fibers of different hardness;

19 an embodiment with different dense Faserbesatz;

20a an embodiment with eccentrically arranged soul in longitudinal section;

20b an embodiment with eccentrically arranged soul in cross section;

21 an embodiment with basket structure and brush element.

In 1a is a basket structure 1 consisting of a proximal basket 2 and a distal basket 3 represented according to the invention. The two single baskets 2 . 3 are formed here by the baskets 2 . 3 training aspirations 4 crossing over in the middle, with an offset of the struts from the proximal basket 2 to the distal basket 3 every 180 ° takes place. Central through the basket structure 1 runs a core filament 5 that at the distal end with the struts 4 is connected while the struts 4 at the proximal end opposite the core filament 5 are mobile. In this way, a certain displaceability of the basket structure 1 ensured in the longitudinal direction, which is important when inserting and deploying the basket structure 1 in or out of a microcatheter.

By doing that the two baskets 2 . 3 through the same pursuits 4 are formed, it is ensured that radial forces are transmitted from one basket to the next and, for example, on the proximal basket 2 acting radial forces from the distal basket 3 Increase outgoing, outward-acting radial forces. For example, only the distal basket can be used to recover particularly solid thrombi 3 be pushed out of a microcatheter, while the proximal basket 2 remains in the microcatheter, so by the external constraint, passing through the microcatheter on the proximal basket 2 is applied, the outward-acting radial force of the distal basket 3 is greatly increased.

In addition, it should be noted that it is in the 1a is only a schematic representation in which only two struts 4 are shown. Usually, however, to form the basket structure 1 more striving 4 for example, three to six struts 4 used.

1b shows the basket structure 1 out 1a in a view from distal. The core filament runs in the middle 5 while the pursuit 4 Seen in the longitudinal direction of a clockwise screw corresponding to the longitudinal axis forming core filament 5 around squirm.

In 2a is another basket structure 1 shown in a side view, here on the left of the proximal basket 2 and right the distal basket 3 can be seen. Shown here are four struts each 4 , in turn, both baskets 2 . 3 train and become in a node 8th between the two baskets 2 . 3 to cut. Through the basket structure 1 in turn passes through a core filament 5 , on which in each case longitudinally displaceable filaments 7 which are a reinforcement of radially outward standing fibers 6 exhibit. These fibers 6 are so flexible that they invest in advancing the device through a micro-catheter in the direction of the longitudinal axis, but put up after deployment of the device from the microcatheter. The fibers 6 serve to further capture a trapped thrombus and, moreover, provide stabilization due to the thrombogenic coating of the fibers 6 is due. Both at the distal end and at the proximal end of the basket structure 1 There are radiopaque markers 9 , which serve the visualization of the system by means of imaging techniques. The core filament 5 is interrupted at the point marked with a circle, so that when contraction or unfolding of the basket structure 1 the proximal part of the core filament 5 longitudinally movable in the filament 7 can slide back and forth. In this way, the longitudinal expansion and contraction of the basket structure 1 much easier. The radiopaque marker 9 at the distal end of the device has a rounded tip which acts atraumatically.

In 2 B is the basket structure 1 out 2a in a view of distal, in which six evenly distributed around the circumference struts 4 recognizes. In addition, there are fibers 6 Bulk radially outward. The longitudinal axis is again through the core filament 5 educated.

In the 3a and 3b can be seen views of proximal openings of a basket structure, wherein the basket structure in 3a itself out of four, the basket structure in 3b out of six struts 4 composed. On the one hand, the use of six struts causes 4 a closed basket structure 1 On the other hand, however, the proximal openings of the basket structure 1 between the struts 4 when using only four struts 4 significantly larger. The latter may be advantageous when the thrombus is particularly strong and continuous, as it thus becomes easier to insert the thrombus through the proximal opening into the cage structure 1 hineinzubefördern.

In the 4a . 4b and 4c an alternative possibility is shown between the struts 4 located partial openings 12 . 13 to enlarge. This is where the struts go 4 at the proximal end of the basket structure 1 from a common point and initially grouped closely adjacent and parallel towards distal, before diverge slightly farther distally of a first section to finally reach their final position in which the struts 4 evenly distributed over the circumference of the basket. When using four struts you get, as already in 3a four partial openings, however, the new course of the struts, the large partial openings 12 greatly enlarged, while the small part openings 13 be significantly reduced. Due to the pairwise parallel, closely adjacent course of the struts 4 in the initial phase are partial openings 12 . 13 created, which correspond almost to the partial openings, as they are when using half of the struts 4 would result, ie in 4a the proximal opening is essentially halved, in 4b when using six struts 4 roughly in thirds. In 4c after all, there are three struts each 4 grouped closely adjacent, so despite the use of a total of six struts 4 two approximately habkreisförmige partial openings 12 arise.

In 5 is the basket structure 1 out 4a Once again shown in the side view, in which one recognizes again that the struts 4 from the marker 9 from initially parallel in pairs, before they diverge to diverge evenly over the perimeter of the basket structure 1 to distribute. It should be noted that in 5 only a basket of basket structure 1 is shown and beyond the middle part has been omitted.

In 6 Finally, you recognize another basket structure 1 , here only the distal basket 3 can be seen. This in turn consists of four struts 4 put together between two radiopaque markers 9 run. Central through the basket structure 1 the core filament extends 5 , The peculiarity of the embodiment of 6 lies in the polymer skin 10 located at the distal end of the basket structure 1 located. Cross to the struts 4 are also cross struts 11 to recognize, respectively, the completion of the polymer skin 10 to represent proximal. In this way, so to speak, at the distal end of the basket structure 1 a pocket formed, which serves to receive a thrombus. The transverse connecting struts 11 serve to stabilize the edge structure of the polymer skin 10 and an additional fixation of the struts 4 opposite each other.

In 7 a second embodiment of the invention is shown in which two core wires 14 be arranged parallel to each other, wherein between the two core wires 14 orthogonal fibers 6 run. Then the soul wires 14 at the point 15 held and twisted together by a torsional motion T. In this way, a brush-like distal element is obtained 27 from which fibers 6 protrude radially outward.

After twisting the soul wires 14 each other has the distal element 27 a look like it from the 8a to 8c which is the case with the 8a and 8b to longitudinal sections, in the 8c is a consideration of proximal or distal. It can be seen that the fibers 6 evenly along the circumference of the distal element 27 are distributed and stand radially outward.

In the 9 is another embodiment of the distal element according to the invention 27 shown, in which case the fibers 6 be represented as a uniform surface, as it results from the density of the fiber composition. In this case, the soul wires 14 at the distal end of the distal element via a loop 16 connected together so that ultimately a single soul wire 14 is present, which runs from proximal to distal, a loop 16 forms and goes back to proximal. There is thus a twist of the two ends of the core wire 14 ,

Furthermore, from the 9 to recognize how the distal element 27 over a coil 17 with further proximal components of the device, in particular with a guide wire 28 can be connected.

In 10 is a wave or sinusoidal course of the soul wire 14 shown. this Wavy course also follow the fibers 6 , so that there is a wave-shaped course of the entire distal element 27 results. Compared to straight soul wires 14 This is associated with an improved cleaning effect.

In 11 is a helical secondary structure of the soul 14 to recognize, where the fiber structure is not shown here for simplicity of illustration. It should also be noted that the soul 14 Again, from at least two twisted soul wires 14 which is a primary helix of the twisted soul wires 14 form. In the 11 therefore, the secondary helix represented may not be combined with the twisting of the core wires 14 resulting primary helix. A helical structure of the distal element is on the one hand due to the better cleaning action on the vessel inner walls of advantage, on the other hand, such an embodiment can serve to place shorter brushes in an aneurysm to close it.

Another illustration of a helical distal element is shown in FIG 12 can be seen, in which case a longitudinal section is shown, in which schematically the fiber composition 6 can be seen.

13 shows an embodiment of the invention consisting of several distal elements 27 , Every distal element 27 is made up of twisted soul wires 14 and a fiber trimming 6 together. Here are the distal elements 27 with each other via a joint 20 connected so that a certain flexibility in pushing back and forth within the vessels is given. At the proximal end, the distal element is via a helix 17 with a push or guide wire 18 connected. At the distal end, the device has a rounded tip 19 on. Because in this example the fibers 6 of the two distal elements 27 are formed differently, the color shade is chosen differently here.

In 14 another embodiment is shown with a plurality of distal elements, which are largely according to the embodiment 13 equivalent. In addition, however, the device includes struts 21 that from the distal end of the distal element 27 go out, radially outward emerge and at the proximal end of the distal element 27 again run together centrally. The radial extent of the struts 21 corresponds to the radial extent of the fibers 6 , Such an embodiment with additional struts 21 serves to improve the management of the system in the vessel.

Another embodiment with struts is in the 15 to recognize, here are the struts 21 over all distal elements 27 extend. For additional stabilization, however, are intermediate struts 22 intended.

In 16 is an embodiment with two distal elements to recognize, wherein each distal element 27 has a conical structure. At the same time, the radial extent of the fibers of the distal elements decreases 27 from proximal to distal, ie the distal elements 27 are each wider in the distal region than in the proximal region. Such an embodiment has the advantage that regardless of the width of the blood vessels always fibers 6 are present, which have an optimal length.

In 17 is another embodiment to recognize, in each case within a distal element 27 increases the radial extent of the fibers from proximal to distal several times. Accordingly, there is every distal element 27 from several cone-shaped brushes.

In 18 shows an embodiment in which the middle region 27 of the distal element 27 softer fibers, the proximal as well as the distal area 23 on the other hand shows harder fibers. In this case, the middle area serves 24 First and foremost, take a clot while the proximal and distal areas 23 serve to enhance the cleaning effect.

The situation is similar in the case of 19 illustrated embodiment, in which case the same effect is achieved in that the fiber composition in the area 26 thinner than in the proximal and distal areas 25 ,

In the 20a and 20b is a distal element 27 in longitudinal section and in a proximal / distal view, in which the twisted core wires 14 run eccentric. Accordingly, the fibers are 6 to one side considerably further than the other side. This is particularly advantageous when the distal element 27 should be guided laterally past a thrombus.

In 21 an embodiment is shown in which a basket structure 3 was combined with a brush structure. The distal element 27 consists in turn of twisted soul wires 14 and radially outwardly protruding fibers 6 and is proximal to the basket 3 arranged. The basket 3 has a polymer skin 10 on, with cross struts 11 the polymer skin 10 with the struts 4 connect. Furthermore, the device has radiopaque marks 9 and a guidewire 18 on. Upon retraction of the device proximally, a thrombus first becomes from the distal element 27 with the fibers 6 recorded and recorded. Should individual thrombus fragments be split off, they will be separated by the basket structure located distally 3 with her polymer skin 10 captured, because the polymer skin 10 ultimately training a bag. The combination of brush structure and basket structure creates a particularly advantageous apparatus for removing thrombi.

Claims (61)

Device comprising a guide wire for removing foreign bodies and thrombi from body cavities and blood vessels, characterized by a basket structure ( 1 ) at the distal end of the guidewire, which consist of individual struts ( 4 ) and is adapted to fold tightly under the external constraint of a microcatheter and to be transported within the microcatheter and, when the microcatheter eliminates the external constraint, results in the full basket structure ( 1 ), the basket structure ( 1 ) at least two longitudinally successively arranged baskets ( 2 . 3 ). Device according to claim 1, characterized in that the basket structure ( 1 ) three or more aspirations ( 4 ) having. Device according to claim 1 or 2, characterized in that the struts ( 4 ) consist of shape memory material. Device according to claim 3, characterized in that the struts ( 4 ) consist of nitinol. Device according to one of claims 1 to 4, characterized in that centrally through the basket structure ( 1 ) a core filament ( 5 ) runs. Device according to one of claims 1 to 5, characterized in that the proximally arranged basket ( 2 ) is shorter in the longitudinal direction than the distally arranged basket ( 3 ). Device according to one of claims 1 to 6, characterized in that for the deformation of the proximally arranged basket ( 2 ) are greater than those required to deform the distally arranged basket ( 3 ) required radial forces. Apparatus according to claim 7, characterized in that the proximally arranged basket ( 2 ) and the distally arranged basket ( 3 ) are made of different materials. Device according to claim 7 or 8, characterized in that the struts ( 4 ), from which the proximal basket ( 2 ) is formed, have a larger diameter than the struts ( 4 ), from which the distally arranged basket ( 3 ) is formed. Device according to one of claims 7 to 9, characterized in that the struts ( 4 ), from which the proximal basket ( 2 ) is formed, at least partially run at a greater angle to the longitudinal axis than the struts ( 4 ), from which the distally arranged basket ( 3 ) is formed. Device according to one of claims 1 to 10, characterized in that the device more than two baskets ( 2 . 3 ). Device according to one of claims 2 to 11, characterized in that the number of struts ( 4 ) per basket ( 2 . 3 ) is four to six. Device according to one of claims 1 to 12, characterized in that the struts ( 4 ) of each basket ( 2 . 3 ) at the distal and proximal ends of the basket ( 2 . 3 ) converge in one point. Apparatus according to claim 13, characterized in that the struts of at least one basket ( 2 . 3 ) with unfolded basket structure ( 1 ) from the point where the struts at the proximal end of the basket ( 2 . 3 ), grouped together along a first section, in particular in pairs closely adjacent in a distal direction, distanced distally of the first section and in a second section distal to the first section along the circumference of the basket ( 2 . 3 ) evenly distributed continue to extend distally. Device according to one of claims 1 to 14, characterized in that the baskets ( 2 . 3 ) from the same aspiration ( 4 ) and the struts ( 4 ) from the proximal end of the proximal basket ( 2 ) to the distal end of the distally arranged basket ( 3 ). Device according to claim 15, characterized in that the struts ( 4 ) from the proximal basket ( 2 ) to the nearest distally arranged basket ( 3 ) on the opposite side of the basket structure ( 1 ). Device according to claim 15 or 16, characterized in that the struts ( 4 ) in the course of the proximally arranged basket ( 2 ) to the distally arranged basket ( 3 ) a common node ( 8th ) happen. Device according to one of claims 1 to 17, characterized in that the furthest distal basket ( 3 ) distally a network structure having. Device according to one of claims 1 to 17, characterized in that the furthest distal basket ( 3 ) distally with a polymer skin ( 10 ) is covered. Apparatus according to claim 19, characterized in that the polymer skin at the distal end of the basket ( 3 ) has one or more apertures of a size which allows blood to pass and retains thrombus fragments. Device according to one of claims 1 to 20, characterized in that the struts ( 4 ) so that their distal end is offset from their proximal end by 45 ° to 180 °. Device according to one of claims 1 to 20, characterized in that the struts ( 4 ) along a wavy line with a lateral deflection of 45 ° to 90 °, wherein the proximal end and the distal end are not offset from each other. Device according to one of claims 1 to 22, characterized in that in the region of the basket structure ( 1 ) radially outward standing fibers ( 6 ) are located. Device according to claim 23, characterized in that the fibers ( 6 ) on one or more of which through the basket structure ( 1 ) core filament ( 5 ) slidable filaments ( 7 ). Device according to claim 24, characterized in that the displaceable filament ( 7 ) is a helically wound wire. Device according to one of claims 23 to 25, characterized in that the fibers ( 6 ) at least partially to aspiration ( 4 ) of the basket structure ( 1 ). Device for removing foreign bodies and thrombi from body cavities and blood vessels with a guide wire ( 18 ) containing one or more distal elements ( 27 ), characterized in that the distal element ( 27 ) at least two twisted core wires ( 14 ) between which fibers ( 6 ) transverse to the course of the core wires ( 14 ) are inserted and twisted with the core wires, so that the fibers ( 6 ) from the distal element ( 27 ) protrude radially outward. Device according to claim 27, characterized in that the core wires ( 14 ) are connected together at the distal end and a loop ( 16 ) form. Apparatus according to claim 27 or 28, characterized in that the core wires ( 14 ) at its proximal end via a helix ( 17 ) are connected to further, proximal components of the device. Device according to one of claims 27 to 29, characterized in that the core wires ( 14 ) of platinum, a platinum alloy, platinum-iridium, a nickel-titanium alloy, tungsten, a tungsten alloy or stainless steel. Device according to one of claims 27 to 30, characterized in that the twisted core wires ( 14 ) run straight. Apparatus according to claim 27 to 30, characterized in that the twisted core wires ( 14 ) wavy. Device according to one of claims 27 to 30, characterized in that the twisted core wires ( 14 ) form a helix. Device according to claim 33, characterized in that that through the interior of the helix extends a stretch protection filament. Device according to claim 34, characterized in that that the stretch protection filament as straight, wavy or helical Wire is formed. Device according to claim 34, characterized in that that the stretch protection filament consists of a polymer material. Device according to one of Claims 27 to 36, characterized by a plurality of distal elements ( 27 ), from which fibers ( 6 ) protrude radially outward. Device according to claim 37, characterized in that the distal elements ( 27 ) over joints ( 20 ) are interconnected. Device according to claim 37, characterized in that the distal elements ( 27 ) are juxtaposed viewed in cross-section. Device according to claim 39, characterized in that the distal elements ( 27 ) are twisted together to form a helix. Device according to one of claims 27 to 40, characterized in that the distal Ele elements ( 27 ) Aspiration ( 21 ) extending from the distal end of the distal element (FIG. 27 ), protrude radially outward and at the proximal end of the distal element (FIG. 27 ) converge again centrally. Device according to claim 41, characterized in that the struts ( 21 ) several distal elements ( 27 span). Device according to claim 41 or 42, characterized in that between the struts ( 21 ) and the central soul wires ( 14 ) of the distal element ( 27 ) additional intermediate struts ( 22 ). Device according to one of claims 27 to 43, characterized in that the radial extent of the fibers ( 6 ) of the distal element ( 27 ) increases from proximal to distal. Device according to one of claims 27 to 44, characterized in that the fibers ( 6 ) in the proximal region of the distal element ( 27 ) are harder than in the distal region of the distal element ( 27 ). Device according to one of claims 27 to 44, characterized in that the fibers ( 6 ) in the middle region of the distal element ( 27 ) are softer than in the proximal and distal regions of the distal element ( 27 ). Device according to one of claims 27 to 46, characterized in that the density of the fiber composition in the central region of the distal element ( 27 ) is smaller than in the proximal and distal regions of the distal element ( 27 ). Device according to one of claims 27 to 47, characterized in that the fibers ( 6 ) by clamping, gluing, knotting and / or melting on the core wires ( 14 ). Device according to one of claims 23 to 48, characterized in that the radially outer ends of the fibers ( 6 ) Have thickening. Device according to one of claims 23 to 49, characterized in that the radially outer ends of the fibers ( 6 ) are at least partially connected to each other via loops. Device according to one of claims 27 to 50, characterized in that the fibers ( 6 ) at least partially differently far to both sides of the distal element ( 27 ) protrude radially outward. Device according to one of claims 27 to 51, characterized in that the core wires ( 14 ) in the cross section of the distal element ( 27 ) run outside the center. Device according to one of claims 27 to 52, characterized in that the distal elements ( 27 ) from the guide wire ( 18 ) are formed detachable. Device according to one of claims 27 to 52, characterized that the device is an elongated Basket structure, which is suitable under the external constraint of a microcatheter to fold tightly around within the microcatheter to be transported and in the absence of external coercion deployed through the microcatheter to the full basket structure. Device according to one of claims 23 to 53, characterized in that the fibers ( 6 ) form an angle of 70 ° to 110 °, preferably an angle of 80 ° to 90 °, to the longitudinal axis of the device. Device according to one of claims 23 to 55, characterized in that the fibers ( 6 ) are provided with a coating. Device according to one of claims 1 to 56, characterized by one or more radiopaque markers ( 9 ). Device with a guide wire ( 18 ) for removing foreign bodies and thrombi from body cavities and blood vessels, characterized by a basket structure according to one of claims 1 to 26 and at least one distal element ( 27 ) according to any one of claims 27 to 52. Device according to one of claims 1 to 58 in combination with a guide catheter and / or Microcatheter. Device according to claim 59, characterized in that that the leadership or microcatheter is an aspiration catheter. Method for producing a distal element ( 27 ) as part of a device according to claim 27, characterized in that at least two core wires ( 14 ) are arranged parallel to one another, between which transversely to the course of the core wires ( 14 ) Fibers ( 6 ), and the core wires ( 14 ) are twisted together.