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

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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
saline solution
pressure
removal
hole nozzle
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Withdrawn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.)
Individual
Original Assignee
Individual
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 Individual filed Critical Individual
Priority to DE19893941949 priority Critical patent/DE3941949A1/en
Publication of DE3941949A1 publication Critical patent/DE3941949A1/en
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0068—Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
    • A61M25/007—Side holes, e.g. their profiles or arrangements; Provisions to keep side holes unblocked
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A61B2017/22047—Means for immobilising the guide wire in the patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A61B2017/22047—Means for immobilising the guide wire in the patient
    • A61B2017/22048—Balloons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22082—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for after introduction of a substance
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22082—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for after introduction of a substance
    • A61B2017/22084—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for after introduction of a substance stone- or thrombus-dissolving

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Public Health (AREA)
  • Animal Behavior & Ethology (AREA)
  • Anesthesiology (AREA)
  • Hematology (AREA)
  • Pulmonology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Vascular Medicine (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Biophysics (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Surgical Instruments (AREA)
  • Media Introduction/Drainage Providing Device (AREA)

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 for eliminating a Blockage of blood vessels (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.Thrombosis is an abnormal localization coagulation of blood components in a blood vessel (vein or artery) that form a clot (thrombus) leads.

Durch Verlegung des Gefäßes kommt es zu einer örtlichen Stö­ rung des vor- und/oder nachgeschalteten Kreislaufabschnitts.A local disruption occurs when the vessel is moved tion 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. Dieser Vorgang wird als Embolie bezeichnet.If the thrombus detaches from the vessel wall at the point of origin, so he can move the bloodstream to another section of the circulation be dragged away and live there again for constipation important blood vessels. This process is called an embolism designated.

Für die Behebung von Blutgefäßverstopfungen (Thrombosen) stehen im wesentlichen die nachfolgend geschilderten drei Verfahren zur Verfügung:For the removal of blood vessel blockages (thrombosis) are essentially the three described below Procedures available:

  • 1) Chemisch-medikamentöse Verfahren.
    Durch sogenannte thrombolytische Substanzen, z. 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. Dieser Prozeß schreitet zeitabhängig nur langsam fort. 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. Die Ischämietolerenz der meisten Organe ist jedoch wesentlich kürzer, d. h. häufig tritt eine irreversible Schädigung des Organs ein, bevor das Gerinnsel durch Thrombolyse zur Auf­ lösung gebracht werden kann.     1) Chemical-drug procedures.
    Through so-called thrombolytic substances, e.g. B. Streptokinase, urokinase, rt-PA and other plasmogen activators, the fibrin bound in a thrombus is broken down into fragments and the thrombus is thereby dissolved. This process only proceeds slowly depending on the time. The dissolution of a thrombus in coronary arteries (coronary arteries) usually takes about an hour, in other vessels it often takes several hours to days. However, the ischemia tolerance of most organs is much shorter, ie irreversible damage to the organ often occurs before the clot can be resolved by thrombolysis.
  • 2) Operative Verfahren.
    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). Dieser Eingriff wird nur von etwa 50% der Patienten überlebt. Viele Patienten versterben darüberhinaus,bevor sie eine Klinik erreichen, in der eine solche Operation durchgeführt werden kann. 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.    2) Operative procedures.
    In the case of a massive pulmonary embolism, in which the main strains of the pulmonary arteries are relocated, the chest and pulmonary artery (pulmonary artery) had to be opened in order to be able to remove the clot directly (Tren delenburg operation). Only 50% of patients survive this procedure. Many patients also die before reaching a clinic where such an operation can be performed. Even in favorable cases, where the patient is already in a suitably equipped clinic, the time from the occurrence of the event (e.g. pulmonary embolism) to the definitive removal of the clot is too long to prevent the patient from irreversible organ damage preserve.
  • 3) Katheter-Verfahren.
    • a) Pulmonalarterien-Saug-Katheter:
      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.
    • b) Fogarty-Katheter:
      Dieser Katheter wird durch das Gerinnsel hindurchgeführt.
    3) Catheter procedure.
    • a) Pulmonary artery suction catheter:
      When using a catheter, it is usually not possible to remove a larger clot from the body with suction through a narrow-bore catheter.
    • b) Fogarty catheter:
      This catheter is passed through the clot.

Dann wird ein am Katheterende befindlicher Ballon aufge­ blasen und der Katheter zurückgezogen. Nach operativer Eröffnung des Gefäßes (z. B. Beckenvene) kann so das Gerinnsel in toto entfernt werden. Der wesentlichste Nachteil dieser Methode ist ihre begrenzte Anwendbarkeit.Then a balloon located at the end of the catheter is opened blow and the catheter is withdrawn. After operative Opening the vessel (e.g. pelvic vein) can do this Clots can be removed in toto. The most essential The disadvantage of this method is its limited applicability.

Bei Lungenembolien oder Coronarthrombosen ist diese Methode z. B. nicht anwendbar.This method is used for pulmonary embolism or coronary thrombosis e.g. B. 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 for its object a catheter to propose which the disadvantages of the be known procedures avoided and the clot as quickly as possible possible resolution.

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 knowledge that it is useful is more moderate, not the entire thrombus as a unit remove, but in fractional parts, so that vascular removal is eliminated as soon as possible.

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 with a liquid inside the catheter Medium - for example water or physiological table salt solution- is housed, which by means of an outdoor, rear end of the catheter connected device like Pump or pressure tank can be brought to positive pressure and through a multi-hole nozzle at the front end of the catheter exits from this.

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

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

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 can also be a longitudinally displaceable Guide wire housed at its front end as an abutment for the thrombus a brush head or can carry 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 can be made up entirely or partially thrombolytic substances exist, so that the hydrau lisch fractionated thrombosis parts with their enlarger th surfaces by these thrombolytic substances can be attacked and resolved more quickly.

Claims (5)

1. Katheter zur Behebung einer Blutgefäßverstopfung (Thrombose) oder Embolie, dadurch gekennzeichnet, daß
  • - 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.
1. Catheter to remedy a blood vessel obstruction (thrombosis) or embolism, characterized in that
  • a liquid medium — for example water or physiological saline solution — is accommodated in the interior of the catheter,
  • - That can be brought to positive pressure by means of a device connected to the free, rear end of the catheter, such as a pump or pressure tank, and that
  • - Leaves the catheter through a multi-hole nozzle at the front end.
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. Catheter according to claim 1, characterized in that the outlet channels in the multi-hole nozzle on one distributed around the spiral longitudinal axis of the catheter are arranged. 3. Katheter nach Anspruch 2, dadurch gekennzeichnet, daß die Längsachsen der Austrittskanäle der Mehrloch-Düse unterschiedliche Winkel mit der Katheterlängsachse ein­ schließen.3. Catheter according to claim 2, characterized in that the longitudinal axes of the outlet channels of the multi-hole nozzle different angles with the longitudinal axis of the catheter shut down. 4. Katheter nach Anspruch 3, dadurch gekennzeichnet, daß
  • - in dem Katheter ein längsverschieblicher Führungs­ draht untergebracht ist,
  • - der an seinem vorderen Ende als Widerlager für den Thrombus einen Bürstenkopf oder einen aufblasbaren Ballon tragen kann.
4. Catheter according to claim 3, characterized in that
  • - In the catheter a longitudinally movable guide wire is housed,
  • - Who can wear a brush head or an inflatable balloon at its front end as an abutment for the thrombus.
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 all or part of the liquid pressure medium thrombolytic substances.
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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