JP2011056117A - Guide wire insertion device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To introduce a guide wire into an intended vein branch simply in a short time by shortening the guide wire. <P>SOLUTION: This guide wire insertion device includes: an ultrasonic probe 2 having an elongated insert part 2a inserted in a blood vessel A, an ultrasonic vibrator 7 provided at the tip of the insert part 2a and rocked around a predetermined axis 6 to obtain an ultrasonic image within a rocking plane, and a through hole 8 partially provided at least at the tip of the insert part 2a along the longitudinal direction; and the guide wire 3 inserted in the through hole 8 of the ultrasonic probe 2 to rise and set from the tip opening of the through hole 8. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to a guide wire insertion device.

Conventionally, in order to insert the left ventricular lead of ventricular resynchronization therapy into the target venous branch, the coronary sinus and the target venous branch branching from the coronary sinus are confirmed by X-ray photography or the like in a state where a contrast medium is administered. A guide wire was placed after the inner catheter introduced from No. 1 was inserted into the target vein branch. Then, after the inner catheter is extracted, the left ventricular lead is introduced into the target vein branch along the indwelling guide wire, and the guide wire is extracted.
On the other hand, an ultrasonic probe is known as an apparatus that includes an insertion portion with a small diameter and observes the state of a blood vessel (see, for example, Patent Document 1).

US Pat. No. 5,379,772

However, it is difficult to place a guide wire in the target vein branch while inserting the inner catheter while confirming the position of the target vein branch of the coronary sinus from outside the body by X-ray imaging or the like. For this reason, it takes a considerable amount of time to insert the guide wire, and it is necessary to administer a large amount of contrast medium. In addition, since the operation of extracting the inner catheter after inserting the guide wire needs to be performed outside the body while the guide wire is supported, the length of the guide wire is required to be more than twice the total length of the inner catheter. There is inconvenience that it is bad. In particular, once the guide wire is inserted, if it is determined that the insertion location is not appropriate, it is necessary to reinsert the long guide wire into the through hole of the inner catheter, and a considerable amount of time is required for the insertion work. In other words, there is a disadvantage that the burden on the patient is large.
Further, if a guide wire and an inner catheter can be inserted without using X-rays such as an ultrasonic probe, a large-scale X-ray apparatus or the like is not necessary, and the influence on the human body is reduced.

  The present invention has been made in view of the circumstances described above, and provides a guide wire insertion device that can shorten the guide wire and can easily introduce the guide wire into the target vein branch in a short time. The purpose is that.

In order to achieve the above object, the present invention provides the following means.
The present invention relates to an elongated insertion portion that is inserted into a blood vessel, and an ultrasonic transducer that is provided at the distal end of the insertion portion and that is swung around a predetermined axis to acquire an ultrasonic image within the swinging surface. An ultrasonic probe provided with a through-hole partially provided along the longitudinal direction at least at the distal end of the insertion portion, and can protrude from the distal opening of the through-hole into the through-hole of the ultrasonic probe A guide wire insertion device comprising a guide wire inserted into the guide wire.

  In order to insert a guide wire using the guide wire insertion device according to the present invention, the insertion portion of the ultrasonic probe is inserted into the blood vessel in a state where the guide wire is inserted into the through hole provided in the ultrasonic probe. Then, by oscillating the ultrasonic transducer provided at the distal end of the insertion portion around a predetermined axis line, an ultrasonic image within the oscillating surface was acquired, and the branch of the blood vessel was confirmed on the ultrasonic image. At that point, the guidewire can be pushed forward against the ultrasound probe to insert the tip of the guidewire into the target branch.

In this case, since the through hole is provided at least at the distal end portion of the ultrasonic probe, the ultrasonic probe simply supports the guide wire with respect to the distal end portion by inserting the guide wire into the through hole. Can be stably introduced to the vicinity of the branch of the blood vessel.
After the guide wire is introduced, the guide wire exposed outside the body is supported, and the ultrasonic probe is extracted from the blood vessel. At this time, since the through-hole through which the guide wire penetrates is not provided in the entire length of the ultrasonic probe but only partially, the length of the guide wire is set to the length inserted in the blood vessel, It is sufficient to add the length of each through-hole and the exposure length necessary for gripping. As a result, it is not necessary to prepare a guide wire having a length twice as long as that of the ultrasonic probe, and the operability can be greatly improved.
In addition, when changing the guide wire placement position, it is possible to reinsert the ultrasonic probe along the guide wire having the length of the guide wire, and the operability can be greatly improved.

In the said invention, the support part provided with the said through-hole may be multiply arranged by the longitudinal direction of the said insertion part at intervals.
In this way, when the ultrasonic probe is extracted from the blood vessel after insertion of the guide wire, the guide wire exposed between the plurality of support portions can be supported, and the guide wire is not extracted. Thus, the ultrasonic probe can be extracted. In addition, when the guide wire is inserted into the ultrasonic probe and inserted, the guide wire can be integrated with the ultrasonic probe at the plurality of support portions in which the guide wire is inserted into the through hole, and the insertion work can be performed. Can be easily.

  According to the present invention, the guide wire can be shortened, and the guide wire can be easily introduced into the target vein branch in a short time.

It is a whole lineblock diagram showing the guide wire insertion device concerning one embodiment of the present invention. It is a longitudinal cross-sectional view explaining insertion of the guide wire from the coronary sinus to the target vein branch by the guide wire insertion apparatus of FIG. It is a perspective view which shows the bending part provided in the guide wire front-end | tip of the guide wire insertion apparatus of FIG. It is a longitudinal cross-sectional view explaining the shape of the front-end | tip opening part of the through-hole which makes the curved part of FIG. 3 protrude. It is a figure which shows the example of an ultrasonic image detected by the ultrasonic probe in the state of FIG. It is a figure explaining the length of the guide wire exposed outside the body in the guide wire insertion apparatus of FIG.

A guide wire insertion device 1 according to an embodiment of the present invention will be described below with reference to the drawings.
As shown in FIG. 1, the guide wire insertion device 1 according to this embodiment includes an ultrasonic probe 2 inserted into a patient's coronary sinus A (see FIG. 2), and a patient together with the ultrasonic probe 2. A guide wire 3 inserted into the coronary sinus A, an image processing unit 4 that processes a signal detected by the ultrasonic probe 2 to generate an image signal, and an image generated by the image processing unit 4 And a monitor 5 for display.

  As shown in FIG. 2, the ultrasonic probe 2 includes an elongated insertion portion 2 a having a small diameter that can be inserted into the coronary sinus A, and is orthogonal to the longitudinal direction of the insertion portion 2 a in the insertion portion 2 a. An ultrasonic transducer (ultrasonic transducer) 7 provided so as to be swingable around the axis 6 is provided. The ultrasonic transducer 7 oscillates ultrasonic waves toward the front, detects echoes that are reflected and returned from boundary surfaces such as the inner surface of blood vessels, and converts them into electrical signals.

  As a result, the ultrasonic transducer 7 is swung around the axis 6, thereby generating an image signal of a tomographic tissue around the blood vessel along the rocking surface. By displaying this on the monitor 5, A tomographic image in which a blood vessel is vertically divided in the longitudinal direction can be observed. That is, the monitor 5 can display the coronary sinus A and the target vein branch B branched from the coronary sinus A.

  In the ultrasonic probe 2, a plurality of cylindrical support portions 9 having through holes 8 formed along the longitudinal direction of the insertion portion 2 a in the oscillation surface of the ultrasonic transducer 7 are spaced apart in the longitudinal direction. Is provided. The through-hole 8 has a cross-sectional shape slightly larger than the cross-section of the guide wire 3 so that the guide wire 3 described later can be freely moved in the longitudinal direction. Further, as shown in FIG. 4, a guide surface 8 b that bends in the bending direction of the guide wire 3 is provided at the tip opening 8 a of the through hole 8.

  The guide wire 3 is made of, for example, an elastic metal material such as titanium or stainless steel or a superelastic material such as a nickel titanium alloy, and has a short side and a long side at its tip as shown in FIG. A curved portion 3a having a flat rectangular cross-sectional shape having sides is provided. The bending portion 3a is preliminarily shaped so as to bend in one direction along the short side.

  The bending portion 3 a is elastically deformed following the shape of the through hole 8 when inserted into the through hole 8 of the ultrasonic probe 2. For example, when the ultrasonic probe 2 is in a linear form, the through hole 8 is also in a linear form, and the curved portion 3a is elastically shaped into a linear form following the shape of the through hole 8. It has been deformed. On the other hand, when the bending portion 3a is pushed out from the distal end opening portion 8a of the through hole 8 and is in a released free state, the bending portion 3a is bent in the direction along the short side by the elastic restoring force, and the original form is obtained. It has come to take.

A method for inserting the guide wire 3 using the guide wire inserting apparatus 1 according to the present embodiment configured as described above will be described below.
In order to insert the guide wire 3 into the target vein branch B using the guide wire insertion device 1 according to the present embodiment, the guide wire 3 is passed through the through holes 8 of all the support portions 9 provided in the ultrasonic probe 2. By inserting the ultrasonic probe 2 and the guide wire 3 into the coronary sinus A, the ultrasonic transducer 7 is operated to oscillate the ultrasonic wave, and the ultrasonic transducer 7 is swung around the axis 6. Let

  As a result, an ultrasonic image along the rocking surface of the ultrasonic transducer 7 is acquired and displayed on the monitor 5. The ultrasonic image includes a tomographic image obtained by vertically dividing the coronary sinus A in which the ultrasonic probe 2 is inserted. When the ultrasonic probe 2 is advanced, an image obtained by vertically dividing the coronary sinus A and the target vein branch B branching from the coronary sinus A is displayed on the monitor 5 as shown in FIG. Will be included.

  In this state, the guide wire 3 accommodated in the through-hole 8 is pushed forward with respect to the ultrasonic probe 2, and the curved portion 3a at the tip of the guide wire 3 is projected from the tip opening 8a. Since the through hole 8 is provided on the rocking surface of the ultrasonic transducer 7, the curved portion 3a of the guide wire 3 protruding from the tip opening 8a of the through hole 8 is an ultrasonic image as shown in FIG. Appears on top.

  When the guide wire 3 is pushed out of the through hole 8 and becomes free, the guide wire 3 is bent so as to return to its original curved shape by its elastic restoring force. The ultrasound image on the monitor 5 displays the trajectory of the guide wire 3 together with the image of the target vein branch B branched from the coronary sinus A as described above. The guide wire 3 can be surely inserted into the target vein branch B by adjusting the position of.

  According to the guide wire insertion device 1 according to the present embodiment, since the distal end of the guide wire 3 includes the flat curved portion 3a, the curved portion 3a is easily bent in the direction along the short side, but is long. It is difficult to bend in the direction along the side. Therefore, the curved portion 3 a projected from the tip opening 8 a of the through hole 8 is advanced more stably while being curved on the rocking surface of the ultrasonic transducer 7. As a result, the distal end of the guide wire 3 can be inserted into the target vein branch B more reliably.

  Further, according to the guide wire insertion device 1 according to the present embodiment, since the guide surface 8b for guiding the guide wire 3 is provided in the distal end opening 8a of the through hole 8, the guide wire 3 is brought into the bending direction at an early stage. Led. Therefore, the guide wire 3 is pushed out in a state in which the distal end portion of the ultrasonic probe 2 is brought closer to the vicinity of the branch point between the coronary sinus A and the target vein branch B, and is inserted into the target vein branch B more securely. Can do.

  Furthermore, according to the guide wire insertion device 1 according to the present embodiment, the ultrasonic probe 2 in which the guide wire 3 is accommodated in the through hole 8 is brought closer to the vicinity of the branch point between the coronary sinus A and the target vein branch B. Since the guide wire 3 is pushed out in a state in which the distal end of the ultrasonic probe 2 has been twisted or curved with a small curvature, the distal end of the guide wire 3 is not affected by the distal end. There is an advantage that the guide wire 3 projected from the opening 8a can be stably advanced in a desired direction.

  Then, after the guide wire 3 is inserted into the target vein branch B in this way, the ultrasonic probe 2 is extracted from the coronary sinus A while the guide wire 3 remains in place. In this case, it is necessary to extract the ultrasonic probe 2 while supporting the guide wire 3 exposed outside the body so that the guide wire 3 is not extracted. According to the present embodiment, since the support portion 9 provided with the through hole 8 that penetrates the guide wire 3 is provided at an interval in the longitudinal direction of the ultrasonic probe 2, the guide wire 3 is interposed between the support portions 9. Can be exposed.

Therefore, the ultrasonic probe 2 can be extracted while supporting the guide wire 3 exposed between the support portions 9 so that the guide wire 3 is not extracted from the target vein branch B.
When the ultrasonic probe 2 is extracted with the guide wire 3 in place, if the through hole 8 is provided over the entire length of the ultrasonic probe 2, the entire length of the ultrasonic probe 2 is extracted from the body. Until then, the end portion of the guide wire 3 must be supported, and the guide wire 3 needs to be at least twice as long as the ultrasonic probe 2. On the other hand, according to the present embodiment, the guide wire 3 exposed between the support portions 9 can be supported. Therefore, the length of the guide wire 3 is as short as possible in the body as shown in FIG. A length obtained by adding the length L1 of one support portion 9 and the length L2 necessary for support to the length to be provided is sufficient, and can be sufficiently shortened.

  In particular, after the guide wire 3 is once inserted into the target vein branch B and the ultrasonic probe 2 is removed, if it is determined that the insertion position of the guide wire 3 is not appropriate, the guide wire 3 is removed from the body again. It is necessary to insert the arranged end into the through hole 8 at the tip of the ultrasonic probe 2 and sequentially reinsert the ultrasonic probe 2 into the coronary sinus A. In this case, if the guide wire 3 is long, the operability is poor, and it takes time to reinsert the guide wire 3 and the burden on the patient increases. In the present embodiment, there is no such inconvenience, and it is only necessary to sequentially insert the guide wire 3 exposed to the outside of the body into the through holes 8 of the plurality of support portions 9, so that the time required for reinsertion can be shortened. it can.

  When the guide wire 3 is inserted at an appropriate position, the guide wire 3 is placed and the ultrasonic probe 2 is extracted from the coronary sinus A. Instead, for example, the left ventricle of cardiac resynchronization therapy A lead (not shown) can be easily guided to a target position along the guide wire 3. After the left ventricular lead is placed at the target position, the left ventricular lead can be placed in the target vein branch B by removing the guide wire 3.

  According to the guide wire insertion device 1 and the insertion method according to the present embodiment, conventionally, after administering a large amount of contrast agent, the guide wire is observed by observing the locus of the inner catheter from the outside using a large-scale X-ray imaging device. Compared with the method in which 3 is introduced, a large-scale device can be eliminated. And there is an advantage that the burden on the patient can be greatly reduced by inserting the guide wire 3 simply and quickly without administering a large amount of contrast agent and without being exposed to radiation.

  In the present embodiment, the curved portion 3a having a flat rectangular cross-sectional shape is provided at the tip of the guide wire 3, but instead, the shape is given so as to be curved while maintaining a circular cross-section. It is good. Moreover, it is good also as shape giving so that it may curve in the direction in alignment with a minor axis by elliptical cross-sectional shape.

  Moreover, in this embodiment, although the guide surface 8b was provided in the front-end | tip opening part 8a of the through-hole 8, it is good also as not providing the guide surface 8b. In this case, since the curved shape of the curved portion 3a of the guide wire 3 is restored after protruding from the distal end opening portion 8a, the distal end of the ultrasonic probe 2 is slightly away from the branch to the target vein branch B. The guide wire 3 may be started to protrude.

The first vein branch (first vein branch) in which the guide wire is inserted and placed is found to be unsuitable for left ventricular lead placement by examination, and the target vein branch is moved from the first vein branch to another vein branch (second vein). If it is necessary to change to the branch), the proximal end of the guide wire inserted into the blood vessel is inserted into at least the through hole provided in the distal end portion of the ultrasonic probe of this embodiment. Then, the ultrasonic probe is inserted again into the blood vessel along the guide wire, and when it comes near the first vein branch, the guide wire is slowly pulled out and accommodated in the through hole of the distal end portion of the ultrasonic probe. Thereafter, the ultrasonic probe is moved to the vicinity of the second venous branch, which is the next target venous branch, with the guide wire stored in the distal end through-hole, in the same manner as when the guide wire is inserted into the first venous branch. The second vein branch is depicted in the ultrasound image, the position of the ultrasound probe is adjusted so that the second vein branch is located in the projecting trajectory of the guide wire, the guide wire is projected, and the guide wire is projected into the second vein branch. Can be detained.
According to the above, the length of the guide wire does not need to be the entire length of the ultrasonic probe outside the body, and it is sufficient that a guide wire having a length equal to or longer than the length of the distal end through-hole is left outside the living body. Therefore, even when changing the indwelling vein branch of the guide wire, the ultrasonic probe and the guide wire can be easily operated with a short guide wire with good operability.

A Coronary sinus (blood vessel)
B Purpose vein branch (branch of blood vessel)
DESCRIPTION OF SYMBOLS 1 Guide wire insertion apparatus 2 Ultrasonic probe 2a Insertion part 3 Guide wire 6 Axis 7 Ultrasonic transducer (ultrasonic transducer)
8 Through-hole 8a Tip opening 8b Guide surface 9 Support

Claims (2)

An elongated insertion portion to be inserted into a blood vessel, an ultrasonic transducer provided at the distal end of the insertion portion, swung around a predetermined axis, and acquiring an ultrasonic image within a rocking plane, and the insertion portion An ultrasonic probe comprising a through-hole partially provided along the longitudinal direction at least at the tip of
A guide wire insertion device comprising: a guide wire inserted into the through hole of the ultrasonic probe so as to be able to protrude and retract from a tip opening of the through hole.   The guide wire insertion device according to claim 1, wherein a plurality of support portions provided with the through holes are arranged at intervals in a longitudinal direction of the insertion portion.

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