DE3941949A1 - Method of removal of blood clots - uses catheter into which saline solution is pumped at pressure - Google Patents

Method of removal of blood clots - uses catheter into which saline solution is pumped at pressure

Info

Publication number
DE3941949A1
DE3941949A1 DE19893941949 DE3941949A DE3941949A1 DE 3941949 A1 DE3941949 A1 DE 3941949A1 DE 19893941949 DE19893941949 DE 19893941949 DE 3941949 A DE3941949 A DE 3941949A DE 3941949 A1 DE3941949 A1 DE 3941949A1
Authority
DE
Germany
Prior art keywords
catheter
characterized
pressure
saline solution
multi
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
DE19893941949
Other languages
German (de)
Inventor
Hans-Juergen Dr Med Rupprecht
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
RUPPRECHT HANS JUERGEN
Original Assignee
RUPPRECHT HANS JUERGEN
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by RUPPRECHT HANS JUERGEN filed Critical RUPPRECHT HANS JUERGEN
Priority to DE19893941949 priority Critical patent/DE3941949A1/en
Publication of DE3941949A1 publication Critical patent/DE3941949A1/en
Application status is Withdrawn legal-status Critical

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/0067Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0068Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
    • A61M25/007Side holes, e.g. their profiles or arrangements; Provisions to keep side holes unblocked
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A61B2017/22047Means for immobilising the guide wire in the patient
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A61B2017/22047Means for immobilising the guide wire in the patient
    • A61B2017/22048Balloons
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22082Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for after introduction of a substance
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22082Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for after introduction of a substance
    • A61B2017/22084Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for after introduction of a substance stone- or thrombus-dissolving

Abstract

The method is for removing a blood clot or embolism by using a catheter. The catheter is inserted into the affected blood vessel and then filled with a saline solution. The saline solution is pumped under pressure into the catheter which has a nozzle at its distal end. The nozzle has holes arranged in the form of a spiral so that the saline solution is sprayed onto the clot. The catheter may be fitted with a guide wire which can be moved in the longitudinal direction. USE - Removal of blood clots.

Description

Die Erfindung betrifft einen Katheter zur Behebung einer Blutgefäßverstopfung (Thrombose) oder Embolie. The invention relates to a catheter to remedy a blood vessel blockage (thrombosis) or embolism.

Bei der Thrombose handelt es sich um eine abnorme lokalisier te Gerinnung von Blutbestandteilen in einem Blutgefäß (Vene oder Arterie), die zur Bildung eines Gerinnsels (Thrombus) führt. In thrombosis is an abnormal Locating te coagulation of blood constituents in a blood vessel (vein or artery) leading to the formation of a clot (thrombus) leads.

Durch Verlegung des Gefäßes kommt es zu einer örtlichen Stö rung des vor- und/oder nachgeschalteten Kreislaufabschnitts. By laying the vessel there is a local Symptom of the upstream and / or downstream circuit section.

Löst der Thrombus sich von der Gefäßwand am Ort der Entstehung, so kann er mit dem Blutstrom in einen anderen Kreislaufabschnitt fortgeschleppt werden und dort erneut zur Verstopfung lebens wichtiger Blutgefäße führen. Solves the thrombus, so it can be carried away by the bloodstream to another circuit section and perform there again clogs life important blood vessels from the vessel wall at the site of origin. Dieser Vorgang wird als Embolie bezeichnet. This process is called embolism.

Für die Behebung von Blutgefäßverstopfungen (Thrombosen) stehen im wesentlichen die nachfolgend geschilderten drei Verfahren zur Verfügung: For the elimination of blood vessel blockages (thromboses) the below-described three methods are generally available:

  • 1) Chemisch-medikamentöse Verfahren. 1) Chemical-drug methods.
    Durch sogenannte thrombolytische Substanzen, z. By so-called thrombolytic substances such. B. Strepto kinase, Urokinase, rt-PA und andere Plasmogenaktivatoren wird das in einem Thrombus gebundene Fibrin in Bruchstücke zerlegt und dadurch der Thrombus zur Auflösung gebracht. B. Strepto kinase, urokinase, rt-PA and other Plasmogenaktivatoren is decomposed in thrombus fibrin bound in fragments, thereby bringing the thrombus dissolution. Dieser Prozeß schreitet zeitabhängig nur langsam fort. This process proceeds time-dependent continued slowly. Die Auflösung eines Thrombus in Coronar-Arterien (Herzkranz- Arterien) nimmt in der Regel etwa eine Stunde, in anderen Gefäßen oft mehrere Stunden bis Tage in Anspruch. The resolution of a thrombus in coronary arteries (coronary arteries) usually takes about an hour, in other vessels often several hours to days to complete. Die Ischämietolerenz der meisten Organe ist jedoch wesentlich kürzer, dh häufig tritt eine irreversible Schädigung des Organs ein, bevor das Gerinnsel durch Thrombolyse zur Auf lösung gebracht werden kann. However, the Ischämietolerenz of most organs is much shorter, that often does irreversible damage to the organ one before the clot can be brought by thrombolysis for On solution.
  • 2) Operative Verfahren. 2) Operational method.
    Bei einer massiven Lungen-Embolie, bei der die Haupt stämme der Pulmonalarterien verlegt werden, mußte bisher Brustkorb und Pulmonalarterie (Lungen-Arterie) eröffnet werden, um das Gerinnsel direkt entfernen zu können (Tren delenburg-Operation). In a massive pulmonary embolism, wherein the main stems of the pulmonary arteries are laid, thorax and pulmonary artery (pulmonary artery) previously had to be opened in order to remove the clot directly (Tren Trendelenburg operation). Dieser Eingriff wird nur von etwa 50% der Patienten überlebt. This intervention is survived only about 50% of patients. Viele Patienten versterben darüberhinaus,bevor sie eine Klinik erreichen, in der eine solche Operation durchgeführt werden kann. Many patients die beyond, before they reach a hospital where such an operation can be performed. Selbst in günstig gelagerten Fällen, in denen der Patient sich bereits in einer entsprechend ausgerüsteten Klinik befindet, ist die Zeitspanne vom Eintritt des Ereignisses (z. B. Lungenembolie) bis zur definitiven Entfernung des Gerinnsels zu lang, um den Patienten vor einer irreversiblen Organschädigung zu bewahren. Even in low-mounted cases where the patient is already in a suitably equipped hospital, the time period from the occurrence of the event (eg. As pulmonary embolism) until the final removal of the clot is too long to the patient before irreversible organ damage preserve.
  • 3) Katheter-Verfahren. 3) catheter method.
    • a) Pulmonalarterien-Saug-Katheter: a) pulmonary artery suction catheter:
      Bei Einsatz eines Katheters ist es in der Regel nicht möglich, ein größeres Gerinnsel durch einen englumigen Katheter unter Sog aus dem Körper zu entfernen. When using a catheter, it is not usually possible to remove a larger clot by a narrow-lumen catheter under suction from the body.
    • b) Fogarty-Katheter: b) Fogarty catheter:
      Dieser Katheter wird durch das Gerinnsel hindurchgeführt. This catheter is passed through the clot.

Dann wird ein am Katheterende befindlicher Ballon aufge blasen und der Katheter zurückgezogen. Then, a befindlicher at the end of the catheter balloon is blown, and the catheter withdrawn. Nach operativer Eröffnung des Gefäßes (z. B. Beckenvene) kann so das Gerinnsel in toto entfernt werden. After surgical opening of the vessel (z. B. Iliac) can so the clot to be removed in toto. Der wesentlichste Nachteil dieser Methode ist ihre begrenzte Anwendbarkeit. The most significant drawback of this method is its limited applicability.

Bei Lungenembolien oder Coronarthrombosen ist diese Methode z. In pulmonary embolisms or Coronarthrombosen this method is for. B. nicht anwendbar. As not applicable.

Der Erfindung liegt die Aufgabe zugrunde, einen Katheter vorzuschlagen, welcher die dargelegten Nachteile der be kannten Verfahren vermeidet und das Gerinnsel schnellst möglich zur Auflösung bringt. The invention has the object of providing a catheter which avoids the disadvantages of the known processes be set forth and the clot as soon as possible to the dissolution brings.

Die Erfindung geht von der Erkenntnis aus, daß es zweck mäßiger ist, nicht den gesamten Thrombus als Einheit zu entfernen, sondern in fraktionierten Einzelteilen, so daß die Gefäßverlegung so rasch wie möglich beseitigt wird. The invention is based on the recognition that it is more convenient not to remove all of the thrombus as a unit, but so that the vessel laying is eliminated as soon as possible in fractional parts.

Gelöst wird diese Aufgabe nach der Erfindung durch einen Katheter, bei dem im Innenraum des Katheters ein flüssiges Medium -beispielsweise Wasser oder physiologische Kochsalz lösung- untergebracht ist, das mittels einer am freien, hinteren Ende des Katheters angeschlossenen Vorrichtung wie Pumpe oder Drucktank auf Überdruck gebracht werden kann und das durch eine Mehrloch-Düse am vorderen Ende des Katheters aus diesem austritt. This object is achieved according to the invention by a catheter in which the interior of the catheter -beispielsweise water or physiological saline is housed solution- a liquid medium brought to pressure by means of a connected at the free rear end of the catheter device, such as a pump or pressure tank can be and exiting through a multi-hole nozzle at the front end of the catheter therefrom.

Zweckmäßig sind die Austrittskanäle in der Mehrloch-Düse auf einer um die Katheter-Längsachse umlaufenden Spirale verteilt angeordnet. Suitably, the outlet channels are arranged distributed in the multi-hole nozzle on a circumferential around the catheter longitudinal axis of the spiral.

Vorteilhaft schließen die Längsachsen der Austrittskanäle der Mehrloch-Düse unterschiedliche Winkel mit der Katheter- Längsachse ein. Advantageously, the longitudinal axes of the outlet channels of the multi-hole nozzle include different angles with the longitudinal axis of the catheter.

In einem solchen Katheter kann auch ein längsverschieblicher Führungsdraht untergebracht sein,der an seinem vorderen Ende als Widerlager für den Thrombus einen Bürstenkopf oder einen aufblasbaren Ballon tragen kann. In such a catheter, a longitudinally displaceable guide wire can be accommodated, which can carry at its front end as an abutment for the thrombus a brush head or an inflatable balloon.

Das flüssige Druckmedium kann ganz oder teilweise aus thrombolytischen Substanzen bestehen, so daß die hydrau lisch fraktionierten Thromboseteile mit ihren vergrößer ten Oberflächen durch diese thrombolytischen Substanzen schneller angegriffen und aufgelöst werden können. The liquid pressure medium may entirely or partly consist of thrombolytic agents, so that the hydrau lisch thrombosis fractional parts can be with their Enlarge th surfaces attacked more quickly by these thrombolytic agents and dissolved.

Claims (5)

1. Katheter zur Behebung einer Blutgefäßverstopfung (Thrombose) oder Embolie, dadurch gekennzeichnet , daß 1. catheter to remedy a blood vessel blockage (thrombosis) or embolism, characterized in that
  • - im Innenraum des Katheters ein flüssiges Medium -beispielsweise Wasser oder physiologische Kochsalz lösung- untergebracht ist, - in the interior of the catheter a liquid medium is housed solution- -beispielsweise water or physiological saline,
  • - das mittels einer am freien, hinteren Ende des Katheters angeschlossenen Vorrichtung wie Pumpe oder Drucktank auf Überdruck gebracht werden kann, und das - which can be brought to pressure by means of a connected at the free rear end of the catheter device, such as a pump or pressure tank, and that
  • - durch eine Mehrloch-Düse am vorderen Ende des Katheters aus diesem austritt. - by a multi-hole nozzle at the front end of the catheter emerges from the latter.
2. Katheter nach Anspruch 1, dadurch gekennzeichnet, daß die Austrittskanäle in der Mehrloch-Düse auf einer um die Katheterlängsachse umlaufenden Spirale verteilt angeordnet sind. 2. The catheter of claim 1, characterized in that the outlet channels are arranged distributed in the multi-hole nozzle on a circumferential around the catheter longitudinal axis of the spiral.
3. Katheter nach Anspruch 2, dadurch gekennzeichnet, daß die Längsachsen der Austrittskanäle der Mehrloch-Düse unterschiedliche Winkel mit der Katheterlängsachse ein schließen. 3. A catheter according to claim 2, characterized in that the longitudinal axes of the outlet channels of the multi-hole nozzle include different angles with the catheter longitudinal axis a.
4. Katheter nach Anspruch 3, dadurch gekennzeichnet, daß 4. A catheter according to claim 3, characterized in that
  • - in dem Katheter ein längsverschieblicher Führungs draht untergebracht ist, - a longitudinally displaceable in the catheter guide wire is housed,
  • - der an seinem vorderen Ende als Widerlager für den Thrombus einen Bürstenkopf oder einen aufblasbaren Ballon tragen kann. - which can carry at its front end as an abutment for the thrombus a brush head or an inflatable balloon.
5. Katheter nach Anspruch 1, dadurch gekennzeichnet, daß das flüssige Druckmedium ganz oder teilweise aus thrombolytischen Substanzen besteht. 5. The catheter of claim 1, characterized in that the liquid pressure medium consists of thrombolytic agents in whole or in part.
DE19893941949 1989-12-20 1989-12-20 Method of removal of blood clots - uses catheter into which saline solution is pumped at pressure Withdrawn DE3941949A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
DE19893941949 DE3941949A1 (en) 1989-12-20 1989-12-20 Method of removal of blood clots - uses catheter into which saline solution is pumped at pressure

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
DE19893941949 DE3941949A1 (en) 1989-12-20 1989-12-20 Method of removal of blood clots - uses catheter into which saline solution is pumped at pressure

Publications (1)

Publication Number Publication Date
DE3941949A1 true DE3941949A1 (en) 1991-06-27

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0879578A1 (en) * 1997-05-19 1998-11-25 Micro Therapeutics, Inc. Apparatus for power lysis of a thrombus
US6635027B1 (en) 1997-05-19 2003-10-21 Micro Therepeutics, Inc. Method and apparatus for intramural delivery of a substance

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0879578A1 (en) * 1997-05-19 1998-11-25 Micro Therapeutics, Inc. Apparatus for power lysis of a thrombus
US6063069A (en) * 1997-05-19 2000-05-16 Micro Therapeutics Inc. Method and apparatus for power lysis of a thrombus
US6635027B1 (en) 1997-05-19 2003-10-21 Micro Therepeutics, Inc. Method and apparatus for intramural delivery of a substance

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