JP2007531600A - 迅速交換式介入デバイスおよび方法 - Google Patents
迅速交換式介入デバイスおよび方法 Download PDFInfo
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- 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
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/0169—Exchanging a catheter while keeping the guidewire in place
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2/958—Inflatable balloons for placing stents or stent-grafts
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- 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
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M2025/0183—Rapid exchange or monorail catheters
-
- 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
- A61M25/10—Balloon catheters
Abstract
Description
Claims (49)
- 血管貫入部を通って脈管内の処置部位に導入するための介入デバイスであって、
近位端、遠位端、前記遠位端に結合した介入要素を有するカテーテル軸と、
近位末端、遠位末端、ガイドワイヤを摺動可能に受け取るように構成され、前記近位末端と前記遠位末端の間のガイドワイヤ内腔を有するガイドワイヤ管とを備え、前記遠位末端は前記カテーテル軸の前記遠位端に結合し、前記近位末端は前記カテーテル軸から分離しており、
前記カテーテル軸の前記近位端と前記ガイドワイヤ管は、それぞれ、介入デバイスが前記処置部位に位置決めされる時に、前記血管貫入部へ延びるのに十分な長さを有する介入デバイス。 - 前記血管貫入部内に位置決め可能な、かつ、内部に少なくとも1つの通路を有するカラーであって、前記少なくとも1つの通路は、実質的な血液の漏れが無い状態で、前記カテーテル軸の前記近位端と前記ガイドワイヤを摺動可能に受け取るように構成されたカラーをさらに備える請求項1に記載の介入デバイス。
- 前記カラーは、止血デバイスを通して前記血管貫入部内に位置決め可能であり、前記カラーは、前記止血デバイス内でシールするように構成された外部表面を有する請求項2に記載の介入デバイス。
- 前記カラーは、前記近位端の周りでの血液の漏れを阻止するための、前記少なくとも1つの通路と連通するシールを備える請求項2に記載の介入デバイス。
- 前記カラーは、前記カテーテル軸を受け取る第1通路と、前記ガイドワイヤ管を受け取る第2通路を備える請求項2に記載の介入デバイス。
- 前記ガイドワイヤ管は、前記遠位末端から約50cm未満の遠位点から、前記遠位末端から前記ガイドワイヤ管の少なくとも約半分の長さの近位点まで、内部に長手方向に配設されたスリットを備える請求項1に記載の介入デバイス。
- 前記近位点は前記近位末端から約20cm以内である請求項6に記載の介入デバイス。
- 前記近位点は前記近位末端である請求項6に記載の介入デバイス。
- 前記スリットを通して位置決め可能な、かつ、前記ガイドワイヤに対して動作可能なワイヤ・ガイドをさらに備え、それによって、前記ガイドワイヤは、前記ワイヤ・ガイドの遠位で前記ガイドワイヤ内腔内に配設され、前記ワイヤ・ガイドの近位で前記ガイドワイヤ内腔の外に配設される請求項6に記載の介入デバイス。
- 前記カテーテル軸の前記近位端と前記ガイドワイヤ管を摺動可能に受け取るように構成された少なくとも1つの通路を有する前記カラーをさらに備える請求項9に記載の介入デバイス。
- 前記ワイヤ・ガイドは前記カラーに結合する請求項9に記載の介入デバイス。
- 前記カラーは、前記カテーテル軸を受け取る第1通路と、前記ガイドワイヤ管を受け取る第2通路を備える請求項10に記載の介入デバイス。
- 前記ワイヤ・ガイドは、遠位開口、近位開口、前記遠位開口と前記近位開口の間のガイド通路を備え、前記ワイヤ・ガイドが前記スリットを通して位置決めされると、前記遠位開口は前記ガイドワイヤ内腔と位置合わせされ、前記近位開口は前記ガイドワイヤ管の外にある請求項9に記載の介入デバイス。
- 前記ワイヤ・ガイドは、前記ガイドワイヤ管内で前記スリットを広げるように構成された丸い、または、テーパ付き遠位縁部を備える請求項9に記載の介入デバイス。
- 前記ガイドワイヤ管は少なくとも約100cmの長さを有する請求項1に記載の介入デバイス。
- 前記ガイドワイヤ管は延びた長さから折り畳まれた長さまで折畳み可能である請求項1に記載の介入デバイス。
- 前記ガイドワイヤ管はアコーデオンに似た壁を有する請求項16に記載の介入デバイス。
- 前記ガイドワイヤ管は、ヒンジによって接続される一連の全体が円錐のセグメントを備え、隣接する円錐セグメントは、前記ヒンジを中心として互いの方に、また、互いから離れるように回動可能である請求項16に記載の介入デバイス。
- 前記ガイドワイヤ管はジグザグ断面を有する壁を有する請求項16に記載の介入デバイス。
- 前記カテーテル軸の前記近位端を摺動可能に受け取るように構成された少なくとも1つの通路を有するカラーをさらに備える請求項16に記載の介入デバイス。
- 前記ガイドワイヤ管の前記近位末端は、前記カラーに対して前記カテーテル軸を移動させることによって、前記ガイドワイヤ管が延びるか、または、引っ込むように前記カラーに結合される請求項20に記載の介入デバイス。
- 前記折り畳まれた長さは前記延びた長さの約50%未満である請求項16に記載の介入デバイス。
- 前記介入要素はステントを備える請求項1に記載の介入デバイス。
- 前記介入要素は複数のステント・セグメントを備える請求項23に記載の介入デバイス。
- 前記ステント・セグメントを覆って摺動可能に配設されるシースをさらに備える請求項24に記載の介入デバイス。
- 前記シースは、前記カテーテル軸上に第2の選択された数のステント・セグメントを保持しながら、前記カテーテル軸から第1の選択された数のステント・セグメントを展開するように選択的に位置決めされる請求項25に記載の介入デバイス。
- 前記介入要素はバルーンである請求項1に記載の介入デバイス。
- 前記バルーンを覆って摺動可能に配設されるシースをさらに備える請求項27に記載の介入デバイス。
- 前記シースは、前記バルーンの第2の部分を拘束しながら、前記バルーンの第1の部分を拡張するように選択的に位置決めされる請求項28に記載の介入デバイス。
- 前記ガイドワイヤ管は、前記介入要素の近位で前記カテーテル軸に結合し、前記介入要素の遠位の点まで延びる請求項1に記載の介入デバイス。
- 脈管内で、血管貫入部を通して処置部位で介入を実施する方法であって、
カテーテル軸、前記カテーテル軸の遠位端に結合した介入要素、前記カテーテル軸の前記遠位端に結合した遠位部分と前記カテーテル軸から分離した近位部分を有するガイドワイヤ管を有する介入デバイスを用意するステップと、
前記血管貫入部を通して前記脈管内にガイドワイヤの遠位末端を配置するステップと、
前記ガイドワイヤ管の少なくとも一部を通して前記ガイドワイヤの近位末端を挿入するステップと、
前記血管貫入部を通して前記介入デバイスを位置決めするステップと、
前記脈管を通して前記介入デバイスを進め、前記介入要素を前記処置部位に位置決めするステップを含み、前記ガイドワイヤは、前記介入要素が前記処置部位にある時に、前記血管貫入部と前記介入要素の間で前記ガイドワイヤ管内に配設される方法。 - 前記ガイドワイヤの前記近位末端は、前記ガイドワイヤ管の壁のスリットの外に延びる請求項31に記載の方法。
- 前記スリットは、前記介入要素が前記処置部位にある時に、前記介入要素の近位の50cm以下の点から前記血管貫入部の近位の点まで延びる請求項32に記載の方法。
- 前記血管貫入部にカラーを位置決めするステップをさらに含み、前記カラーは、カテーテル軸と前記ガイドワイヤ管を覆って摺動可能に配設され、前記介入デバイスを進めるステップは、前記カラーに対して前記カテーテル軸とガイドワイヤ管を移動させるステップを含む請求項31に記載の方法。
- 前記カラーは、前記ガイドワイヤ管のスリットを通して延びるワイヤ・ガイドを有し、前記カラーに対して前記ガイドワイヤ管を移動させるステップは、前記ガイドワイヤ管の内または外に前記ガイドワイヤを誘導する請求項34に記載の方法。
- 前記血管貫入部に止血デバイスを位置決めするステップをさらに含み、前記カラーは、前記止血デバイス内に位置決めされる請求項34に記載の方法。
- 前記止血デバイスと前記カラーの間に止血シールを設けるステップをさらに含む請求項36に記載の方法。
- 前記カテーテル軸とガイドワイヤ管の周りの前記脈管からの血液漏れを阻止するために、前記カラー内にシールを設けるステップをさらに含む請求項34に記載の方法。
- 前記ガイドワイヤ管は、延びた長さから折り畳まれた長さまで折畳み可能であり、前記ガイドワイヤ管は、前記ガイドワイヤが前記ガイドワイヤ管内に挿入される時に、前記折り畳まれた長さを有し、前記介入要素が前記処置部位にある時に、前記延びた長さを有する請求項31に記載の方法。
- 前記血管貫入部にカラーを位置決めするステップをさらに含み、前記カラーは、カテーテル軸を覆って摺動可能に配設され、前記介入デバイスを進めるステップは、前記カラーに対して前記カテーテル軸を移動させるステップを含む請求項39に記載の方法。
- 前記ガイドワイヤ管は、前記カラーに対して前記介入デバイスを進めると、前記ガイドワイヤ管の長さが延びるように、前記カラーに結合される請求項40に記載の方法。
- 前記血管貫入部に止血デバイスを位置決めするステップをさらに含み、前記カラーは、前記止血デバイス内に位置決めされる請求項40に記載の方法。
- 前記止血デバイスと前記カラーの間に止血シールを設けるステップをさらに含む請求項42に記載の方法。
- 前記介入要素がステントを備え、前記処置部位において前記ステントを展開するステップをさらに含む請求項31に記載の方法。
- 前記介入要素が複数のステント・セグメントを備え、前記カテーテル軸上に第2の選択された数のステント・セグメントを保持しながら、前記処置部位において第1の選択された数のステント・セグメントを展開するステップをさらに含む請求項31に記載の方法。
- 前記介入要素がバルーンであり、前記処置部位において前記バルーンを拡張するステップをさらに含む請求項31に記載の方法。
- 前記バルーンの第2の選択された部分を拘束しながら、前記バルーンの第1の選択された部分を拡張するステップをさらに含む請求項46に記載の方法。
- 前記脈管から前記介入デバイスを引き抜くステップをさらに含み、前記ガイドワイヤは、前記介入デバイスが引き抜かれるにつれて、前記介入要素に徐々に近くなる場所において前記ガイドワイヤ管を出る請求項31に記載の方法。
- 脈管内で、血管貫入部を通して処置部位で介入を実施する方法であって、
カテーテル軸、前記カテーテル軸の遠位端に結合した介入要素、前記カテーテル軸の前記遠位端に結合した遠位部分を有するガイドワイヤ管を有する介入デバイスを用意するステップと、
前記血管貫入部を通して前記脈管内にガイドワイヤの遠位末端を配置するステップと、
前記ガイドワイヤ管の少なくとも一部分を通って前記ガイドワイヤの近位末端を位置決めし、それによって、前記ガイドワイヤの近位末端が、前記介入デバイスの前記近位末端より、前記介入デバイスの前記遠位末端に近い点で前記ガイドワイヤ管を出るステップと、
前記血管貫入部を通して前記介入デバイスを位置決めするステップと、
前記脈管を通して前記介入デバイスを進め、前記介入要素を前記処置部位に位置決めするステップを含み、前記ガイドワイヤは、前記介入要素が前記処置部位にある時に、前記介入デバイスの前記遠位末端より、前記介入デバイスの前記近位末端に近い点で前記ガイドワイヤ管を出る方法。
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US10/814,581 | 2004-03-30 | ||
US10/814,581 US7323006B2 (en) | 2004-03-30 | 2004-03-30 | Rapid exchange interventional devices and methods |
PCT/US2005/010961 WO2006065262A2 (en) | 2004-03-30 | 2005-03-30 | Rapid exchange interventional devices and methods |
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Also Published As
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US20050222603A1 (en) | 2005-10-06 |
CA2560993A1 (en) | 2006-06-22 |
US8460358B2 (en) | 2013-06-11 |
WO2006065262A2 (en) | 2006-06-22 |
WO2006065262A3 (en) | 2007-03-22 |
US20080097299A1 (en) | 2008-04-24 |
EP1742699A2 (en) | 2007-01-17 |
JP4762228B2 (ja) | 2011-08-31 |
AU2005317254A1 (en) | 2006-06-22 |
EP1742699A4 (en) | 2012-10-17 |
US7323006B2 (en) | 2008-01-29 |
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