JP2003290238A - Medical treatment appliance - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a medical treatment appliance in which a diameter of a rotary cutter is expanded on a guide wire while remaining the guide wire in a blood vessel without detaching the rotary cutter from the guide wire in the case of medical treatment of further expanding a diameter of an intravascular angiostenosis continuously to the initial medical treatment of the relevant intravascular angiostenosis. <P>SOLUTION: The medical treatment appliance is provided with a rotary cutter 3 and another rotary cutter for treatment having an outer diameter of a cutting face larger than the maximum outer diameter of the cutting face of the rotary cutter 3 (rotary cutter for initial ablation. When further expanding the diameter of an intravascular angiostenosis part 2, the rotary cutter 7 for initial ablation is temporarily pulled out of the body along with a guide wire 1 together with a drive shaft 4 and an anchoring sheath 5, the rotary cutter for treatment is integrated with the rotary cutter 7 for initial ablation pulled out of the body on the guide wire 1, and the outer diameter of the cutter is expanded. Afterwards, the integrated cutters (unit cutters) are inserted into the body again and the medical treatment of expanding the diameter of the intravascular angiostenosis part 2 is continued. <P>COPYRIGHT: (C)2004,JPO

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a therapeutic instrument (catheter device) for performing rotational cutting of a deposit on a coronary artery stenosis or other vascular stenosis to penetrate or expand the stenosis.
Regarding

[0002]

2. Description of the Related Art When treating a disease in which a deposit adheres to the inner wall of a blood vessel, the catheter device is inserted up to the treated part in the blood vessel to remove the deposit or to expand the narrowed portion narrowed by the deposit. It is often opened.

FIG. 11 is a diagram schematically illustrating a method for cutting deposits. First, a thin guide wire 10
5 is inserted into the blood vessel 101 until it passes the narrowed portion 27, and a catheter device 125 having a small diameter is inserted along the guide wire 105. The catheter device 125 includes a shell-shaped grindstone 127 and a drive shaft 129 composed of a coiled wire.
Have. Then, the grindstone 127 of the catheter device 125
Is rotated at a high speed (about 200,000 rpm in one example) to scrape off the deposit 103, and first, the diameter of the inlet of the narrowed portion 27 is 1 mm.
The entire grindstone 127 is inserted after it is spread to some extent to facilitate centering.

Next, the catheter device 125 is pulled out while leaving the guide wire 105, and then the catheter device equipped with a grindstone with a slightly larger diameter is inserted along the guide wire, and the catheter device is similarly rotated. The deposit 103 is scraped off. This operation is repeated while gradually increasing the diameters of the guide wire and the grindstone of the catheter device, and finally the diameter of the narrowed portion 27 of the blood vessel is 2.5 m.
Spread to about m.

As described above, in the catheter device, the rotary cutting bar (grinding stone 127) is rotatably and slidably held with respect to the guide wire 105 passing through the narrowed portion, and the rotary cutting bar is driven to rotate at a high speed so that the lime is removed. The deposit in the converted blood vessel is excised.

[0006]

The above-mentioned conventional rotary cutting bar (rotator, grindstone 127 in FIG. 11) has a strong structure whose surface is a grinding surface to which abrasive grains are adhered,
Does not have a diameter expansion mechanism. Therefore, in the case where it is desired to expand the calcified intravascular stenosis to a diameter larger than the diameter at which it penetrates first, the rotary cutting bar (grinding stone 127) together with the drive shaft (driving shaft 129) is completely removed from the guide wire (105). It is necessary to pull it out and replace it with a larger one. In the past, nearly 40% of the cases used a rotating cutting bar (grinding stone) and a drive shaft (drive shaft 129), one with a large diameter and one with a small diameter (average per case). The number used is 1.4), and it was necessary to replace it in a clean area in the operating room.

Here, since the conventional rotary cutting bar (rotabrader, grindstone) is integrated with the drive shaft (drive shaft), it is necessary to perform the following steps to replace it, which is complicated. There was a problem. The drive shaft (drive shaft 129 in FIG. 11) is separated from the drive control unit. Pull out the drive control from the guide wire. The rotary cutting bar and the drive shaft (the grindstone 127 and the drive shaft 129) are once completely pulled out of the body and also pulled out from the guide wire. A large diameter rotary cutting bar and drive shaft (grinding stone 127 and drive shaft 129) are passed through the guide wire. A rotary cutting bar (grinding stone 127) is made to reach the affected part of the coronary artery. Thread the drive control through the guide wire. The drive control unit is connected to the rotary cutting bar having a large diameter and the drive shaft (the grindstone 127 and the drive shaft 129).

Another problem is that the abrasive grains on the cutting surface of the rotary cutter fall off. In other words, the cutting surface of the rotary cutter is configured by chrome-plating diamond abrasive grains on a metal surface as a base material and adhering it (diamond electrodeposition). However, the diamond reaction particles may fall off due to the cutting reaction force from the calcified hard deposits and may flow into the downstream of the blood vessel to clog the peripheral blood vessel. Further, the diamond electrodeposition grindstone in the conventional rotabrator has a problem that when the diameter of the grindstone part is deformed to increase the diameter, the electrodeposited diamond abrasive grain layer is likely to peel off from the base material and fall off.

The present invention has been made in view of the above problems, and when the intravascular stenosis is further expanded after the initial treatment of the intravascular stenosis, the guide wire is inserted into the blood vessel. It is an object of the present invention to provide a treatment instrument capable of expanding the diameter of a rotary cutter on a guide wire without removing the rotary cutter from the guide wire while leaving it as it is.

It is another object of the present invention to provide a therapeutic instrument capable of easily expanding the diameter of a rotary cutter, which is once pulled out of the body along the guide wire left in the blood vessel, on the guide wire.

It is another object of the present invention to provide a therapeutic instrument capable of rapidly and effectively excising an intravascular stenosis with a rotary cutter.

[0012]

In order to solve the above-mentioned problems, the therapeutic device of the present invention has a guide wire for passing a stenosis portion in which a deposit is accumulated in a blood vessel and extending it out of the body. A rotary cutter that is rotatably and slidably guided to rotate and cut the deposit in the intravascular stenosis; a hollow drive shaft that is continuous with the rotary cutter and has the guide wire inserted therein; A therapeutic instrument comprising: a fixed sheath inserted through; and a controller having a rotation drive section of the drive shaft, wherein the rotary cutter performs treatment such as penetration and diameter expansion of the intravascular stenosis. For another medical treatment with a cutting surface outer diameter larger than the cutting surface maximum outer diameter of the rotating cutter (rotating cutter for initial cutting) A rotary cutter is provided in the body extension portion on the guide wire, and when the diameter of the intravascular stenosis is further expanded after cutting treatment of the intravascular stenosis with the rotary cutter for initial resection, the rotary cutter for initial resection is used. Both the drive shaft and the fixed sheath are once pulled out of the body along the guide wire, and the rotary cutter for initial resection is pulled out to the outside of the body by combining the rotary cutter for medical treatment on the guide wire and integrating it. After the diameter is expanded, a cutter (unit cutter) integrated with the diameter is reinserted into the body to enable continuous diameter expansion treatment of the intravascular stenosis.

In the treatment instrument of the present invention, the medical treatment rotary cutter can be combined and integrated with the initial resection rotary cutter by fitting locking or press fitting. In this case, both cutters are not likely to come off during the dilation treatment of the intravascular stenosis and can be used safely.

In the therapeutic instrument of the present invention, the medical treatment rotary cutter can cover the rotary cutter for cutting by plastically deforming along the outer circumference of the cutting curved surface of the rotary cutter for initial cutting. In this case, both cutters can be integrated with sufficient bonding strength so as not to come off.

In the treatment instrument of the present invention, the medical treatment rotary cutter may be preliminarily arranged coaxially with or close to the drive shaft. When further expanding the intravascular stenosis after the initial resection treatment,
The rotary cutter for medical treatment can be quickly coupled to the rotary cutter for initial resection once pulled out of the body along the guide wire. Therefore, the stepwise excision treatment of the intravascular stenosis can be promptly continued.

In the therapeutic instrument of the present invention, the medical treatment rotary cutter is set on the initial excision rotary cutter by a jig which is pre-arranged coaxially with or close to the drive shaft. can do. In this case, since the jig is always in the vicinity, it is possible to quickly and effectively connect both cutters by the jig.

In the treatment instrument of the present invention, the jig may have a grasping action type lever mechanism which can be operated by one hand and which applies a boosting mechanism by a lever or a cam. In this case, the initial cutting rotary cutter and the medical treatment rotary cutter can be easily combined.

In the treatment instrument of the present invention, it is assumed that the initial cutting rotary cutter and the medical treatment rotary cutter each have a cutting surface formed by a groove or cutting edge provided on the outer peripheral surface thereof. You can In the conventional cutting bar, diamond particles were attached to the surface of the base metal of the rotating grindstone by chrome plating or electrodeposition, so the diamond particles fell off due to the cutting reaction force from the calcified hard constriction, etc. Occasionally, diamond particles cause clogging of peripheral blood vessels. On the other hand, in the rotary cutter of the present invention, since the cutting surface is formed by the cutting edge, there is no danger of such particles falling off.

In the therapeutic instrument of the present invention, the controller has a mechanism for pushing the rotary cutter for initial resection from the distal end of the fixed sheath to the front side of the affected area and a mechanism for pulling back to the front side. However, it can be operated by a grasping operation type operating lever having an automatic return mechanism and a position holding mechanism. In this case, the operation of pushing or pulling the rotary cutter from the distal end of the fixed sheath to the front side of the affected area can be easily performed.

In the treatment instrument of the present invention, the controller may be provided with a vibration imparting mechanism for applying a reciprocating vibration motion to the initial cutting rotary cutter in a direction along the guide wire. In this case, since the cutting force due to the rotation and the cutting force due to the reciprocating motion can be applied to the rotary cutter in a superimposed manner, the cutting force of the intravascular stenosis portion due to the rotary cutter can be increased or stabilized. In addition, it is possible to reduce friction when inserting the rotary cutter and the fixed sheath into the guiding catheter and to facilitate the insertion.

In the therapeutic instrument of the present invention, the drive unit of the controller for applying a rotational force to the drive shaft may include a motor having a hollow rotary shaft through which the drive shaft can be inserted. In this case, the drive shaft can be easily pulled out of the body along the guide wire without completely pulling out the drive shaft from the guide wire.

In the therapeutic instrument of the present invention, the controller may have a chucking mechanism for the drive shaft and a detachable mechanism for the soft sheath. In this case, the rotation driving force can be reliably transmitted to the drive shaft by the chucking mechanism. Further, the fixed sheath can be easily removed from the controller at the time of maintenance inside the controller.

[0023]

DETAILED DESCRIPTION OF THE INVENTION A description will be given below with reference to the drawings. [First Embodiment] FIG. 1 is a perspective view illustrating a usage state of a therapeutic instrument according to a first embodiment of the present invention. In the lower left part of FIG. 1, an intravascular stenosis 2 which is a target site for treatment is shown. In the state shown in this figure, the distal end portion of the therapeutic instrument is inserted in the same portion 10.

This treatment instrument has a guide wire 1. The guide wire 1 allows the intravascular stenosis 2 to pass through and extends outside the body. A rotary cutter (rotary cutter for initial cutting) 3 is held on the guide wire 1. The initial cutting rotary cutter 3 rotates about the guide wire 1 as a central axis and is slidable along the wire 1. The details of the rotary cutter 3 will be described later.

The rear end of the rotary cutter 3 is connected to the drive shaft 4. The drive shaft 4 is a hollow member made of a soft and flexible material. The drive shaft 4 is slidably inserted in a fixed sheath 5 which is a flexible cover tube. The fixed sheath 5 is inserted into the guiding catheter 6.
At the rear end of the guiding catheter 6, the controller 1
0 is connected. The controller 10 has a built-in drive mechanism that drives the drive shaft 4 to rotate at high speed and reciprocally vibrates.

The controller 10 will be described in detail below with reference to FIGS. 2 and 3. FIG. 2 is an enlarged perspective view showing a controller of the treatment instrument of FIG. 1. Figure 3
FIG. 3 is a partial perspective view showing the controller of FIG. 2 with a part thereof broken away. As shown in FIGS. 2 and 3, the controller 1
A rotary cutter (rotating cutter for medical treatment) 7 is provided at 0. The rotary cutter 7 is a rotary cutter different from the rotary cutter 3 for initial cutting described above. The medical treatment rotary cutter 7 is rotatably and slidably held on the externally extending portion of the drive shaft 4. The rotary cutter 7 is detachably fitted and held in a pedestal hole portion 12 provided in the front end wall portion of the housing 11 of the controller 10.

A jig 13 is slidably attached to the front end of the housing 11 of the controller 10.
The jig 13 is a jig for fitting and coupling the initial cutting rotary cutter 3 and the medical treatment rotary cutter 7. The jig 13 has a tip bending piece 13a. The tip bending piece 13a is bent and formed at the tip of the jig 13 (a portion extending forward from the front end of the housing 11).
A notch slit 13b is formed in the tip bending piece 13a. On the other hand, a cam engagement piece 13c (see FIG. 3) is bent and formed at the rear end of the jig 13 (a portion located inside the housing 11). Although not shown in FIGS. 2 and 3, a cutter fitting recess 13d (see FIGS. 4 and 5) facing the pedestal hole 12 is formed in the tip bending piece 13a.

In the housing 11 of the controller 10,
The jig operating lever 14 is pivotally supported. A cam 15 is connected to the rotating shaft of the operating lever 14. The cam 15 is engaged with a cam engagement piece 13c at the rear end of the jig 13. The engagement between the cam 15 and the cam engaging piece 13c enables the jig 13 to move back and forth in accordance with the operation of the jig operating lever 14.

Next, the rotary cutter 3 for initial cutting and the rotary cutter 7 for medical treatment will be described in detail with reference to FIG. FIG. 4 (A) is a cross-sectional view showing a state before coupling the rotary cutter for initial cutting and the rotary cutter for medical treatment in association with a jig, and FIG. 4 (B) shows a state where both cutters in FIG. 4 (A) are coupled. It is sectional drawing shown. The initial cutting rotary cutter 3 has a cutting surface portion (cutting surface body portion) 3a. The cutting surface portion 3a is formed into a tapered curved surface having a minimum diameter at the front end in the insertion direction into the body and a maximum diameter at the rear end. The middle shaft part 3b is integrally coupled to the rear end of the cutting surface part 3a.
The middle shaft portion 3b is a shaft portion for another cutter fitting, and is formed with a diameter smaller than the maximum diameter portion of the cutting surface portion 3a. A small-diameter shaft portion 3c is integrally connected to the rear end of the middle shaft portion 3b. The drive shaft 4 is attached to the small-diameter shaft portion 3c.
The tip of is attached. An engagement recess 3e that engages with the medical treatment rotary cutter 7 is formed on the outer periphery of the middle shaft portion 3b. Further, a central hole 3d through which the guide wire 1 is inserted is formed in the axial center of the initial cutting rotary cutter 3.

The medical treatment rotary cutter 7 has a substantially circular cross section. The rotary cutter 7 has a cutting surface portion 7a formed in a curved surface having a diameter larger than the maximum diameter of the rotary cutter 3 for initial cutting. The outer diameter of the tip of the medical treatment rotary cutter 7 is set to be substantially the same as the maximum diameter of the rear end of the initial cutting rotary cutter 3, and both of these cutters 3,
The cutting surface portions 3a and 7a are connected to each other without a gap when they are connected to each other. An annular locking claw 7b is integrally formed on the inner circumference of the medical treatment rotary cutter 7. The locking claw 7b engages with the engagement recess 3e of the initial cutting rotary cutter 3. The locking claw 7b is formed in a tapered shape having a large diameter at its tip, and is easily fitted into the middle shaft portion 3b.

Next, the operation of excising the intravascular stenosis 2 using the therapeutic instrument of the first embodiment will be described. First, in the initial excision treatment, the guide wire 1 is inserted into a blood vessel, and the tip of the guide wire 1 is passed over the intravascular narrowed portion 2. And the rotary cutter 3 for initial cutting
Is rotated at a low speed and is advanced to the intravascular stenosis 2 along the guide wire 1. When the rotary cutter 3 reaches the intravascular stenosis 2, the cutter 3 is rotated at a high speed at that time. Then, the cutting surface portion 3a of the rotary cutter 3 initially cuts the intravascular narrowing portion 2.

Following this initial resection, the intravascular stenosis 2
When the diameter of the guide wire 1 is further expanded, the rotary cutter 3 together with the drive shaft 4 and the sheath 5 is pulled out of the body along the wire 1 while the guide wire 1 is left inside the body (in the blood vessel). The rotary cutter 3 pulled out of the body should not be pulled out from the guide wire 1,
As shown in (A), the cutter fitting recess 13d of the jig 13
To fit and hold.

Here, the housing 1 of the controller 10
The medical treatment rotary cutter 7 is fitted and held in advance in the first pedestal hole 12. Therefore, the jig 13 in the state of FIG.
When it is moved backward to the side, the middle stage shaft portion 3b of the initial cutting rotary cutter 3 is press-fitted into the medical treatment rotary cutter 7 as shown in FIG. 4B. When the rear end step of the cutting surface 3a of the initial cutting rotary cutter 3 comes into contact with the front end of the medical treatment rotary cutter 7, the medical treatment rotary cutter 7 is inserted into the engaging recess 3e of the initial cutting rotary cutter 3. The engaging claw 7b is engaged. Thereby, both cutters 3 and 7 are combined and integrated, and the rotary cutter 3 for initial cutting is expanded by the rotary cutter 7 for medical treatment.

After the cutters 3 and 7 are integrated in this way, the jig 13 is opened to remove the integrated cutters 3 and 7 (unit cutter) from the pedestal hole 12 and the cutter fitting recess 13d. The unit cutter is moved on the guide wire 1 to the patient side of the tip bending piece 13a of the jig 13. In this state, while rotating the unit cutter at a low speed, the unit is inserted along the guide wire 1 still inserted in the blood vessel to the intravascular narrowed portion 2 after the initial resection. Then, the unit cutter is rotated at a high speed, and this time, the remaining intravascular narrowing portion is cut by the cutting surface portion 7a of the medical treatment rotary cutter 7.

According to the first embodiment described above, when the diameter re-expansion treatment is performed again after the initial excision treatment of the intravascular stenosis 2,
It is not necessary to completely remove the controller 10, the rotary cutter 3, the drive shaft 4 and the fixed sheath 5 and replace the rotary cutter 3 itself with a new one as in the conventional case. In the treatment instrument according to the first embodiment, the diameter of the cutter cutting surface can be easily increased by simply fitting another rotary rotary cutter 7 to the rotary cutter 3 on the guide wire 1 extending outside the body. it can. For this reason, the stepwise resection treatment of the intravascular stenosis can be performed quickly and efficiently.

[Second Embodiment] FIG. 5 is a partial cross-sectional side view of a rotary cutter diameter-expanding jig of a therapeutic instrument according to a second embodiment of the present invention. The jig 16 shown in FIG. 5 has a lever mechanism that can be operated with one hand. The jig 16 includes a pair of lever-type operation levers 16A that are rotatably connected by an axis P,
It is equipped with 16B. A pedestal 17 is integrally connected to the tip of one operation lever 16A. The pedestal 17 is formed with a hole 17a, a pedestal hole 17b for fitting and holding the medical treatment rotary cutter 7, and a notch slit 17c for fitting the fixed sheath 5.

The pressing member 18 is provided in the hole 17a of the pedestal 17.
Is slidably inserted. This pressurizing member 18
Has a substantially L-shaped cross section, and the other operating lever 16
An engaging piece portion 18a that engages with the tip of B is provided. Further, the pressurizing member 18 is formed with a cutter fitting recess 18b for fitting the initial cutting rotary cutter 3 and a notch slit 18c for fitting the guide wire 1.

When using the jig of the second embodiment, as shown in FIG. 5 (A), the medical treatment rotary cutter 7 is previously fitted and held in the pedestal hole portion 17b of the pedestal 17. The rotary cutter 3 for initial cutting is fitted in the cutter fitting recess 18b of the pressing member 18 in advance. When the operation levers 16A and 16B are gripped in this state, the middle stage shaft portion 3b of the initial cutting rotary cutter 3 is press-fitted into the annular medical treatment rotary cutter 7. As a result, the cutters 3 and 7 are integrally joined as shown in FIG. 5 (B), and the diameter of the cutter cutting surface is expanded.

[Third Embodiment] FIGS. 6A to 6D show
It is sectional drawing which links | relates with the jig | tool and shows the rotary cutter of the medical treatment instrument which concerns on 3rd Embodiment of this invention. In addition, this FIG.
Also serves as a description of the diameter expansion process of the rotary cutter. Further, in FIG. 6, the same or corresponding parts as those in FIGS.

In the first embodiment shown in FIG. 4, the initial cutting rotary cutter 3 and the medical treatment rotary cutter 7 are integrally coupled by engaging the engaging recesses 3e and the engaging claws 7b of the two. I decided. On the other hand, in the third embodiment, the cutting surface portion 3a and the middle shaft portion 3b of the initial cutting rotary cutter 3 are formed in a stepped reverse taper shape, and the large diameter hole portion in the front stage of the medical treatment rotary cutter 7 is formed. 7c and the small-diameter taper hole portion 7d in the subsequent stage are formed coaxially. Then, the medical treatment rotary cutter 7 is fitted and pressure-bonded to the initial cutting rotary cutter 3 by using the jig 21. The jig 21 is provided with a jig pedestal 22 paired therewith.

The jig 21 and the jig pedestal 22 will be described in detail below. The jig pedestal 22 has a pedestal hole 22a. The pedestal hole 22a has a curved concave shape, and the rear half from the axial middle of the cutting surface 7a of the medical treatment rotary cutter 7 to the rear end is fitted and aligned.

The jig 21 has a cutter fitting recess 21a (see FIG. 6C). This cutter fitting recess 2
1a is fitted with the front half of the cutting surface 7a of the medical treatment rotary cutter 7 from the axial center to the front end.
The front half of a is the cutting surface portion 3 of the rotary cutter 3 for initial cutting.
It is for plastically deforming in the crimping direction with respect to a. Further, the jig 21 has a notch slit 21b. Using the notch slits 21b, the guide wire 1 is moved from outside the jig 21 to inside the cutter fitting recess 21.
It is possible to pass up to a. The cutter fitting recess 21a is formed into a curved surface that is substantially symmetrical to the pedestal hole 22a.

Next, the operation of the therapeutic instrument of the third embodiment will be described. First, in the initial excision treatment of the intravascular stenosis 2 shown in FIG. 1, as shown in FIG. 6 (A), the treatment rotary cutter 7 is preliminarily fitted and held in the pedestal hole 22a of the jig pedestal 22. Keep it. In this state, the first
Similar to the embodiment, the initial cutting of the intravascular stenosis 2 is performed by the initial cutting rotary cutter 3.

When the intravascular stenosis 2 is further expanded after the initial excision, the rotary cutter 3 is once pulled out of the body along the wire 1 while the guide wire 1 is left inside the body (in the blood vessel). . Then, as shown in FIG. 6B, on the guide wire 1, the rotary cutter 3 pulled out of the body is fitted into the medical treatment rotary cutter 7. In this state, there is a gap between the cutting surface portion 3a of the initial cutting rotary cutter 3 and the medical treatment rotary cutter 7.

Therefore, as shown in FIG. 6C, the jig 21 is positioned on the guide wire 1 extending forward from the rotary cutter 3 for initial cutting, and the jig pedestal 22 is formed along the guide wire 1. Press and move in the joining direction. Then, the extending portion of the medical treatment rotary cutter 7 extending forward from the jig pedestal 22 is the cutter fitting recess 2 of the jig 21.
It is plastically deformed in the direction along the surface 1a. With this, the extending portion of the medical treatment rotary cutter 7 is changed to the initial cutting rotary cutter 3.
Are bonded by pressing onto the cutting surface portion 3a.

When both cutters 3 and 7 are combined and integrated in this way, the rotary cutter 3 for initial cutting is expanded in diameter by the rotary cutter 7 for medical treatment. Then, the integrated cutters 3 and 7 (unit cutters) are returned along the guide wire 1 to the intravascular constriction 2 after the initial resection, the unit cutters are rotated at high speed, and this time the medical treatment rotary cutter 7 is rotated. The remaining intravascular narrowing portion is cut by the cutting surface portion 7a.

The jig 21 and the jig pedestal 22 of the third embodiment are similar to those of the jig 13 shown in FIGS.
The controller 10 may be equipped. Alternatively, FIG.
Similar to the case of the jig 16 shown in FIG. 3, a grip type operation handle structure may be used to hold the fixed sheath 5 near the controller 10. In short, it suffices that the medical treatment rotary cutter 7 is plastically deformed and pressure-bonded to and covers the outer periphery of the initial cutting rotary cutter 3. Also according to the above-described third embodiment, it is possible to obtain the same effect as that of the above-described first embodiment.

[Fourth Embodiment] FIG. 7 is a perspective view showing a rotary cutter for initial cutting and a rotary cutter for medical treatment of a therapeutic instrument according to a fourth embodiment of the present invention. The rotary cutter 3 for initial cutting shown in FIG. 7 has a plurality of grooves 23 formed on the outer peripheral surface. The rotary cutter 3 has these grooves 23.
Thereby forming a plurality of cutting edges 24. The cutting surface 3a of the initial cutting rotary cutter 3 is formed by the plurality of cutting edges 24 (cutting edge group).

A plurality of grooves 25 are formed on the outer peripheral surface of the medical treatment rotary cutter 7. A plurality of cutting edges 26 are formed by these grooves 25. The cutting surface 26a of the medical treatment rotary cutter 7 is formed by the plurality of cutting edges 26 (cutting edge group).

That is, in the fourth embodiment, the grooves 2 are formed on the outer peripheral surfaces of the initial cutting rotary cutter 3 and the medical treatment rotary cutter 7, for example, by laser machining.
3, 25 are engraved, and the open end edges of the grooves 23, 25 are used as cutting edges 24, 26. The cutting edges 24 and 26 may be integrally formed on the outer peripheral surfaces of both cutters 3 and 7 in a protruding shape.

According to the fourth embodiment, as in the conventional cutting bar in which diamond particles are attached to the base metal surface of the rotary grindstone structure by chrome plating, electrodeposition or the like, the intravascular constriction 2 is formed. The diamond particles do not fall off due to a cutting reaction force from a hard calcified affected part.

[Fifth Embodiment] FIG. 8 is a side sectional view showing a structure of a controller of a therapeutic instrument according to a fifth embodiment of the present invention. FIG. 9 is an enlarged side sectional view showing the structure of the main part of the controller of the treatment instrument of FIG. FIG. 10 is a side sectional view showing a state in which the sheath connector of the controller of the treatment instrument of FIG. 8 is removed. As shown in FIG. 8, the controller 10 has a housing 11. The housing 11 is integrally molded so that the grip 11A rises. A grip lever 30 is attached to the grip 11A. This grip lever 30 has a built-in lever core metal 31,
The lever core metal 31 is pivotally supported by the grip 11A via a shaft P1.

A lock lever 32 is connected to the shaft P1. Lower part 31a of the lever core metal 31 in the housing 11
The motor holder 3 at a position below the axis P1.
3 is attached. A guide slit 34 is formed on a portion of the motor holder 33 that is attached to the lever core metal 31. A guide pin 35 protruding from the lower end of the lever core metal 31 is slidably fitted into the guide slit 34. A motor 36 is held in the motor holder 33. An eccentric cam 37 is fitted on the output shaft of the motor 36. The bearing holder 3 is attached to the outer periphery of the eccentric cam 37 via a bearing 38.
9 is fitted. At the center of the bottom of the bearing holder 39, a hanging shaft 39a is integrally provided.

The housing 11 includes a cylindrical slider 40.
Is built in. This slider 40 has a structure in which the drive shaft 4
Are connected so that they can reciprocate in the axial direction. Slider 4
0 is urged by the spring 41 in the backward direction (the direction in which the drive shaft 3 is pulled out from the body). An armature iron core 42 is arranged on the inner circumference of the slider 40. Inside the armature iron core 42, the armature coil 43
A rotor magnet 44 is arranged via the. A Hall sensor 45 is built in the slider 40.
Here, the slider 40, the armature iron core 42, the armature coil 43, the rotor magnet 44, and the hall sensor 45 are
A brushless motor section 46 for driving the drive shaft is formed in the housing 11.

Inside the rotor magnet 44, a sleeve-shaped hollow rotary shaft 47 is rotatably arranged. A sleeve-shaped chuck member 48 is inserted into the hollow rotary shaft 47 so as to be movable in the axial direction. Chuck member 48
A chuck claw 48a for chucking the drive shaft 4 is integrally formed at one end (front end) in the axial direction of. The chuck claw 48a is engaged with one end of the hollow rotary shaft 47 in the axial direction to reduce the diameter and chuck the drive shaft 4. Further, the chucking of the drive shaft 4 is released by moving in the direction away from the engagement position with the axial end of the hollow rotary shaft 47.
A chuck claw coupling body 49 is screwed on the other end (rear end) of the chuck member 48 in the axial direction. These chuck members 4
8 and the chuck claw combination 49 are urged by the spring 50 in the direction in which the chuck claw 48a chucks the drive shaft 4. With such a structure, the hollow rotary shaft 47, the chuck member 48, the chuck claw coupling body 49, and the spring 50 constitute a chucking mechanism for the drive shaft 4. It should be noted that the chuck member 48 and the chuck claw combination 49 may be made of a single sleeve integrally formed with the chuck claw 48a at one end in the axial direction, and may be any member that allows the drive shaft 4 to be inserted therethrough.

A cylinder knob 51 for releasing chucking is arranged behind the chuck claw combination 49. The cylinder knob 51 is held in the housing 11 by a cylinder holder 52 so as to be movable in the axial direction, and can come into contact with the rear end of the chuck claw combination 49. The cylinder knob 51 is biased by a spring 53 in a direction away from the chuck claw coupling 49.

A sheath connector 54 is detachably attached to the front end of the housing 11 so as to surround the drive shaft 4. The soft fixed sheath 5 is fitted to the sheath connector 54. Sheath connector 54
A mechanical seal 55 is fitted inside, and the mechanical seal 55 is in sliding contact with the drive shaft 4. The sheath connector 54 includes a physiological saline supply tube 56.
Are in communication.

Next, the operation of the controller 10 will be described. A brushless motor 46 for driving the drive shaft in a state in which the rotary cutter 3 is moved along the guide wire 1 to the intravascular narrowing 2 as shown in FIG.
To operate. Then, the drive shaft 4, the chuck claw 48 a chucking the drive shaft 4, and the chuck claw combination 49 connected to the rear end of the chuck member 48 rotate together with the rotor magnet 44.
As a result, the rotary cutter 3 at the tip of the drive shaft 4 rotates to cut off the intravascular narrowing 2.

When the motor 36 is operated while the rotary cutter 3 is rotating, the eccentric cam 37 rotates, and the bearing holder 39 also eccentrically rotates together with the eccentric cam 37.
Then, the slider 40 connected to the hanging shaft 39a of the bearing holder 39 reciprocates in the axial direction. As a result, the drive shaft 4 reciprocates in the axial direction via the drive shaft drive motor portion 46 and the chuck member 48 that are integrally provided on the slider 40. Therefore, in the rotary cutter 3 at the tip of the drive shaft 4,
A reciprocating motion in the direction along the guide wire 1 is given together with the rotating force. Therefore, it is possible to increase or stabilize the cutting force of the intravascular narrowing 2 by the rotary cutter 3.

After the initial resection of the intravascular stenosis 2 by the rotary cutter 3, when the diameter of the intravascular stenosis 2 is further expanded, the rotary cutter 3 and the drive shaft 4 are once pulled out of the body along the guide wire 1. . At this time, the chucking of the drive shaft 4 by the chuck claw 48a is released. In this case, when the chucking release cylinder knob 51 is pushed in the direction against the spring 53, the chuck claw combination 49 and the chuck member 48 are advanced by the cylinder knob 51 against the spring 50, and the chuck claw 48a rotates in the hollow direction. Open away from the front end of shaft 47.
As a result, the chucking of the drive shaft 4 by the chuck claw 48a is released, and the drive shaft 4 can be easily pulled out of the body along the guide wire 1.

The rotary cutter 3 or the rotary cutter 3
When the intravascular stenosis 2 is cut off by the unit including the medical treatment rotary cutter 7 and the medical treatment rotary cutter 7, the tube 56 to the sheath connector 5 are removed.
A physiological saline solution is supplied to the inside of 4. The physiological saline flows through the fixed sheath 5 and is ejected toward the rotary cutter 3.

According to this method, since the vibration motor 36 having the eccentric cam 37 and the brushless motor 46 for rotating the drive shaft are combined to constitute the mechanical drive unit of the controller 10, the rotary cutter is used. 3 can have both a cutting force by rotation and a cutting force by reciprocating motion. Therefore, it is possible to increase or stabilize the cutting force of the intravascular stenosis 2 by the rotary cutter 3. Further, friction when inserting the rotary cutter 3 and the sheath 5 into the guiding catheter 6 can be reduced to facilitate the insertion.

[0063]

As is apparent from the above description, according to the present invention, when the diameter of the rotary cutter is further expanded after the initial cutting of the intravascular stenosis, the guide wire is left inside the body and the fixing is performed. It is possible to pull out the rotary cutter along the guide wire together with the sheath to the outside of the body, and to expand the diameter of the pulled rotary cutter on the guide wire. Therefore, when expanding the diameter of the intravascular stenosis, it is not necessary to completely remove the rotary cutter including the controller from the guide wire and replace the rotary cutter itself. Therefore, there is an effect such that it is possible to rapidly perform the dilation cutting of the intravascular stenosis.

[Brief description of drawings]

FIG. 1 is a perspective view illustrating a usage state of a therapeutic instrument according to a first embodiment of the present invention.

2 is an enlarged perspective view showing a controller of the treatment instrument of FIG. 1. FIG.

FIG. 3 is a partial perspective view showing the controller of FIG. 2 partially broken away.

4 (A) is a cross-sectional view showing a state before connection of the initial cutting rotary cutter and the medical treatment rotary cutter in association with a jig, and FIG. 4 (B) is a cross-sectional view of FIG. 4 (A). It is sectional drawing which shows a cutter connection state.

FIG. 5 is a partial cross-sectional side view of a rotary cutter diameter-expanding jig of a therapeutic instrument according to a second embodiment of the present invention.

6 (A) to 6 (D) are cross-sectional views showing a rotary cutter of a therapeutic instrument according to a third embodiment of the present invention in association with a jig.

FIG. 7 is a perspective view showing a rotary cutter for initial resection and a rotary cutter for medical treatment of a therapeutic instrument according to a fourth embodiment of the present invention.

FIG. 8 is a side sectional view showing the structure of the controller of the therapeutic instrument according to the fifth embodiment of the present invention.

9 is an enlarged side sectional view showing a structure of a main part of a controller of the treatment instrument of FIG. 8. FIG.

10 is a side cross-sectional view showing a state in which the sheath connector of the controller of the treatment instrument of FIG. 8 is removed.

FIG. 11 is a diagram schematically illustrating a method of cutting a deposit.

[Explanation of symbols]

1 Guide Wire 2 Intravascular Constriction 3 Rotating Cutter for Initial Excision Treatment 3a Cutting Surface 3b Middle Shaft 3c Small Diameter Shaft 3d Center Hole 3e Engagement Recess 4 Drive Shaft 5 Fixed Sheath 6 Guiding Catheter 7 Treatment Rotating Cutter 7a Cutting Surface 7b Engaging claw 10 Controller 11 Housing 11A Grip 12 Base hole 13 Jig 13a Tip bending piece 13b Notch slit 13c Cam engaging piece 13d Cutter fitting recess 14 Jig operating lever 15 Cam 16 Jig 16A, 16B Operating lever 17 Pedestal 17a Hole 17b Pedestal Hole 17c Notch Slit 18 Pressing Member 18a Engagement Piece 18b Cutter Fitting Recess 18c Notch Slit 21 Jig 21a Cutter Fitting Recess 21b Notch Slit 22 Jig Pedestal 22a Pedestal Hole 23 Groove 24 cutting edge 5 groove 26 cutting edge 30 grip lever 31 lever core 31a lower part of lever core 32 lock lever 33 motor holder 34 guide slit 35 guide pin 36 motor 37 eccentric cam 38 bearing 39 bearing holder 39a hanging shaft 40 slider 41 spring 42 armature Iron core 43 Armature coil 44 Rotor magnet 45 Hall sensor 46 Brushless motor part 47 Hollow rotating shaft 48 Chuck member 48a Chuck claw 49 Chuck claw combination 50 Spring 51 Cylinder knob 52 Cylinder holder 53 Spring 54 Sheath connector 55 Mechanical seal 56 Tube

Claims (11)

[Claims] 1. A guide wire for passing a stenosis in which a deposit is deposited in a blood vessel and extending it out of the body, and a guide wire which is rotatably and slidably guided by the guide wire to remove the deposit in the stenosis in the blood vessel. A rotary cutter for rotary cutting, a hollow drive shaft connected to the rotary cutter and having the guide wire inserted therein, a fixed sheath having the drive shaft inserted therein, and a controller having a rotary drive unit for the drive shaft. And a rotary cutter (a rotary cutter for initial resection) for treating the penetration / expansion of the intravascular stenosis by the rotary cutter.
Is provided with another medical treatment rotary cutter having a larger cutting surface outer diameter than the cutting surface maximum outer diameter on the body extension part on the guide wire, and cutting of the intravascular narrowing part by the initial cutting rotary cutter. When the diameter of the intravascular stenosis is further expanded after treatment, the rotary cutter for initial resection is temporarily pulled out of the body along the guide wire together with the drive shaft and the fixed sheath, and the rotary cutter for initial resection is pulled out of the body. Then, after the medical treatment rotary cutter is integrally connected on the guide wire to expand the outer diameter of the cutter, the combined cutter (unit cutter) is re-inserted into the body to perform the intravascular stenosis. A treatment instrument capable of continuously expanding the diameter of a part. 2. The treatment according to claim 1, wherein the medical treatment rotary cutter is adapted to be coupled and integrated with the initial excision rotary cutter by fitting locking or press fitting. Equipment. 3. The therapeutic instrument according to claim 1, wherein the medical treatment rotary cutter covers the rotary cutter for cutting by plastically deforming along the outer circumference of the cutting curved surface of the rotary cutter for initial cutting. 4. The therapeutic instrument according to claim 1, wherein the medical treatment rotary cutter is pre-arranged coaxially with or on the side of the drive shaft. 5. The rotary cutter for medical treatment is set on the rotary cutter for initial cutting by a jig that is pre-arranged coaxially with or close to the drive shaft. 4. The therapeutic device according to any one of 4 to 4. 6. The treatment instrument according to claim 5, wherein the jig has a grasping action type lever mechanism which can be operated by one hand and which applies a boosting mechanism using a lever or a cam. 7. The cutting surface of each of the initial cutting rotary cutter and the medical treatment rotary cutter is formed by a groove or a cutting edge provided on an outer peripheral surface thereof. The treatment instrument according to any one of claims. 8. The controller has a mechanism for pushing the rotary cutter for initial resection from the distal end of the fixed sheath to the front side of the affected area and a mechanism for pulling back to the front side, and these mechanisms include an automatic return mechanism and The therapeutic instrument according to claim 1, wherein the therapeutic instrument is operated by a grasping operation type operating lever having a position holding mechanism. 9. The treatment according to claim 1, wherein the controller includes a vibration applying mechanism that applies a reciprocal vibration motion to the initial cutting rotary cutter in a direction along the guide wire. Equipment. 10. The drive unit for applying a rotational force to the drive shaft in the controller has a motor having a hollow rotary shaft through which the drive shaft can be inserted. Therapeutic instrument. 11. The therapeutic instrument according to claim 1, wherein the controller has a chucking mechanism for the drive shaft and a detachable mechanism for a soft sheath.