JP2011147580A - Guide wire - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To make it hard to damage blood vessels, to allow size, shape, or the like of a prescribed part in a living body to be obtained precisely in a state where a guide wire is inserted in the living body, thus to more safely and reliably perform manual treatment, and to perform new medical examination and treatment. <P>SOLUTION: Disclosed is the guide wire 1 used when inserting a catheter into the living body, wherein a pigtail-shaped part 10 formed into a curve to draw an almost circle is provided on a distal position side. When the guide wire 1 is inserted into the blood vessel, the pigtail-shaped part 10 is abutted to an inner wall of the blood vessel. Under imaging, size and shape of a prescribed position in the body are estimated and obtained on the basis of the pigtail-shaped part 10. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to a guide wire used when a catheter is introduced into a living body.

  The heart has an atrial septum between the right and left atria, and a ventricular septum between the right and left ventricles. As a disease caused by the formation failure of the atrial septum, there is an atrial septal defect (ASD) in which the right atrium and the left atrium communicate with each other through a hole in the atrial septum. Further, as a disease caused by dysplasia of the ventricular septum, there is a ventricular septal defect (VSD) in which the right ventricle and the left ventricle communicate with each other through a hole in the ventricular septum.

  As a treatment method for these diseases, a medical treatment method using a catheter that is less invasive than surgical treatment is known (for example, see Patent Document 1). In general, when a catheter is used, a guide wire for guiding the catheter to the heart is used.

JP 2009-213900 A

  By the way, the medical treatment for the heart disease as described above may be performed on an infant or a child. Infants and infants have softer and weaker blood vessels than adults, so when the guidewire is advanced toward the center of the blood vessel, the blood vessel is damaged when the distal end of the guide wire hits the inner wall of the blood vessel. There is a risk of giving.

  In the treatment of ASD and VSD, the holes formed in the atrial septum and the ventricular septum are closed, but in order to ensure the treatment, the size of the hole is obtained as accurately as possible. There is a demand for it. However, when trying to obtain the size of the pores of the atrial septum and ventricular septum in medical treatment, it must be performed based on the image displayed on the monitor by ultrasonic echo etc., and it is difficult to obtain accurately .

  The present invention has been made in view of such a point, and the object of the present invention is to prevent damage to blood vessels and to determine the size and shape of a predetermined part in the living body while being inserted into the living body. It is to be able to obtain accurately, thereby enabling the procedure to be performed more safely and reliably.

  A first invention is a guide wire used when a catheter is introduced into a living body, and is characterized in that a distal end is provided with a pigtail-shaped portion that is curved so as to draw a substantially circle. To do.

  According to this configuration, since there is a pigtail-shaped portion on the distal side of the guide wire, when the guidewire is inserted into the blood vessel of the living body and advanced toward the central side, the pigtail-shaped portion hits the inner wall of the blood vessel. It will be. Since the pigtail-shaped part has a substantially circular shape, the force is distributed and acts over a wide range of the blood vessel, and it is difficult to damage the blood vessel.

  In addition, since the size of the pigtail shape portion is known in advance, the pigtail shape portion and a predetermined part in the body (for example, a hole in the atrial septum) are displayed under the image of the monitor with the guide wire inserted into the living body. By comparison, the size and shape of the predetermined part can be estimated and obtained based on the size of the pigtail shape portion.

  Further, an obstacle that is easily encountered in the process of introducing a guide wire into the heart, for example, is that the tip of the guide wire gets into a thin branch blood vessel. Since the guide wire according to the present invention has a pigtail shape on the tip side (distal side), it is difficult to get into a thin branch blood vessel on the way and can be easily introduced into the heart. Therefore, if it is used for insertion of a catheter for auxiliary circulation in an emergency, the catheter can be easily placed in the blood vessel without using an X-ray device or the like.

  According to a second invention, in the first invention, a marker portion that can be confirmed under contrast is provided on the distal side.

  According to this configuration, the distal position of the guide wire can be confirmed from outside the body.

  In a third aspect based on the second aspect, the marker portion includes indocyanine green.

  According to this configuration, by irradiating near-infrared light from the body surface side of the living body into which the guide wire is inserted and observing with a near-infrared camera, the guide is used without using a contrast agent and without using an X-ray device. It becomes possible to confirm the position of the wire. Since no contrast medium is used, it is possible to avoid nephropathy from developing due to the contrast medium. Moreover, since it can observe with a near-infrared camera, even if it is not an X-ray imaging X-ray room, it can observe in a general treatment room.

  According to a fourth invention, in any one of the first to third inventions, a bent portion is provided on the proximal side of the pigtail-shaped portion.

  According to this configuration, when the surgeon rotates the proximal end of the guide wire around its center line, the position of the distal pigtail-shaped portion changes due to the bent portion in the middle portion. This makes it possible to change the direction of the distal side of the guide wire in the living body.

  The fifth invention is characterized in that, in any one of the first to fourth inventions, the proximal side has a tapered shape that becomes narrower as it approaches the end.

  According to this configuration, when the guide wire is inserted into the catheter, the proximal side is tapered so that the insertion operation from the proximal side can be easily performed.

  A sixth invention is characterized in that in any one of the first to fifth inventions, a hydrophilic coating is applied to the surface.

  According to this configuration, the surface is easily slipped when the guide wire touches the blood.

  According to the first invention, since the pigtail-shaped portion is provided on the distal side of the guide wire, it is difficult to damage the blood vessel, and the size of the predetermined site in the body is determined based on the pigtail-shaped portion under the monitor image. The shape can be estimated and obtained. Thereby, the procedure using a guide wire can be performed more safely and reliably.

  According to the second invention, since the marker portion that can be confirmed under contrast is provided on the distal side of the guide wire, the safety of the procedure can be further improved.

  According to the third invention, since the marker portion contains indocyanine green, the position of the guide wire can be confirmed without using an X-ray device, and thus the patient can be prevented from being exposed to X-rays. Nephropathy can also be avoided by contrast agents. Further, for example, observation in an emergency room can be performed.

  According to the fourth invention, since the bent portion is provided more proximally than the pigtail-shaped portion, the traveling direction of the guide wire can be easily changed by rotating the proximal end of the guide wire. .

  According to the fifth aspect, since the proximal side is tapered, the guide wire can be easily inserted into the catheter, and the procedure can be facilitated.

  According to the sixth aspect, the guide wire can be operated with a small force by applying the hydrophilic coating to the surface of the guide wire.

It is a side view of the guide wire concerning an embodiment. It is a side view of a catheter. It is sectional drawing of the distal side of the guide wire before shape | molding a pigtail shape part. It is an enlarged view of the proximal side of a guide wire. It is a figure explaining the state which the distal side of the guide wire contacted the blood vessel inner wall. It is a figure explaining the case where the advancing direction of a guide wire is changed. It is a figure which shows the state which pulled in the guide wire in the catheter. It is a figure which shows the state which pulled in the guide wire largely in the catheter. FIG. 6 is a diagram corresponding to FIG. 4 according to a modified example.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. It should be noted that the following description of the preferred embodiment is merely illustrative in nature, and is not intended to limit the present invention, its application, or its use.

  FIG. 1 shows a guide wire 1 according to an embodiment of the present invention. This guide wire 1 is used when medically treating an atrial septal defect or a ventricular septal defect, and guides a catheter 20 (shown in FIG. 2) from an artery or vein to the heart. Target patients are infants and children. It can also be used when inserting a catheter for auxiliary circulation in an emergency.

  The diameter of the wire constituting the guide wire 1 is set to 0.010 inch or more and 0.038 inch or less. The diameter of the wire can be arbitrarily set as long as it is within this range. For example, 0.010 inch, 0.014 inch, 0.018 inch, 0.021 inch, 0.025 inch, 0.035 It is good also as an inch and 0.038 inch. The diameter of the wire is not limited to the above. What is necessary is just to select a wire according to a patient's physique and technique.

  As shown in FIG. 3, the guide wire 1 has a double structure of a resin core portion 1a and a resin coating portion 1b that covers the core portion 1a. The resin material constituting the core portion 1a and the covering portion 1b has elasticity that can be restored when deformed by receiving an external force during normal operation or handling of the guide wire 1.

  The core portion 1a has higher rigidity than the covering portion 1b. The distal end side (distal side of the guide wire 1) of the core portion 1a is tapered. Thereby, the distal side of the guide wire 1 becomes flexible and easily bent as it approaches the distal end.

  Further, the surface of the guide wire 1 is provided with a coating for imparting hydrophilicity. A conventionally well-known thing can be used as a coating material. By imparting hydrophilicity to the surface of the guide wire 1, it becomes easy to slip when touching blood, and the force required to operate the guide wire 1 can be reduced. The surface of the guide wire 1 may be subjected to Teflon (registered trademark) coating or titanium oxide coating.

  As shown in FIG. 1, a pigtail-shaped portion 10 is provided on the distal side of the guide wire 1. The pigtail-shaped portion 10 is formed by bending the wire constituting the guide wire 1 so as to draw a substantially circle, and is integrally formed with other portions of the guide wire 1. By providing the pigtail-shaped portion 10, the distal end of the guide wire 1 has a curved shape and no sharp shape.

  The outer diameter d of the pigtail shape portion 10 is set to 8 mm or more and 12 mm or less. The outer diameter d can be arbitrarily set as long as it is within this range, but may be 8 mm, 10 mm, or 12 mm, for example. If the outer diameter d of the pigtail-shaped portion 10 is larger than 12 mm, it will be difficult to slide smoothly into the inner wall when proceeding in an artery such as an infant, and if it is smaller than 8 mm, the inner wall of the blood vessel will be difficult. Therefore, it is preferable to set the value within the above-mentioned range.

  The pigtail-shaped portion 10 is provided with a plurality of marker portions 10a that can be confirmed under the image of the monitor. The marker part 10a is arrange | positioned at intervals in the circumferential direction of the pigtail-shaped part 10. FIG. The marker portion 10a includes indocyanine green (ICG). Indocyanine green is a well-known substance that emits fluorescence when irradiated with near-infrared light. Moreover, the marker part 10a contains the radiopaque material. As the X-ray opaque material, it is sufficient that the X-ray transmission degree is lower than other portions of the guide wire 1, and a known material can be used. The marker portion 10a may be provided on the entire pigtail shape portion 10.

  A side closer to the proximal end than the pigtail-shaped portion 10 of the guide wire 1 is a straight-shaped portion 11 formed so as to extend substantially linearly.

  A bent portion 12 is provided on the proximal side of the linear portion 11 of the guide wire 1. A proximal side of the bent portion 12 of the guide wire 1 extends substantially linearly. The bent portion 12 is formed such that an angle α formed by the linear shape portion 11 and a portion closer to the proximal side than the bent portion 12 is not less than 145 ° and not more than 155 °. The angle α can be arbitrarily set as long as it is within this range, but may be set to 145 °, 155 °, for example. If the angle α is smaller than 145 °, the degree of bending of the guide wire 1 may be too tight, which may hinder the progress in the blood vessel. If the angle α is larger than 155 °, the degree of bending of the guide wire 1 may be reduced. Since it is too small and it becomes difficult to change the direction of travel by a turning operation described later, it is preferable to set the value in the above range.

  A dimension L1 from the bent portion 12 to the distal end of the pigtail-shaped portion 10 is set to 45 mm or more and 65 mm or less. The dimension L1 can be arbitrarily set within this range, but may be 45 mm, 55 mm, 65 mm, for example. The dimension L1 may be selected according to the patient's physique and procedure.

  On the proximal side of the guide wire 1, a tapered portion 14 is provided that becomes thinner as it approaches the proximal end. The length L2 of the tapered portion 14 is set to 10 mm or more and 30 mm or less. The length L2 can be arbitrarily set as long as it is within this range, but may be, for example, 10 mm, 20 mm, and 30 mm.

  The dimension L3 from the proximal end to the distal end of the guide wire 1 is set to 400 mm or more and 3000 mm or less. The dimension L3 can be arbitrarily set as long as it is within this range. For example, the dimension L3 may be 400 mm, 500 mm, 600 mm, 1250 mm, 1500 mm, 1800 mm, or 3000 mm. The dimension L3 may be selected according to the patient's physique and procedure. For example, the one of 3000 mm is suitable for progressing from the vein to the heart.

  The catheter 20 guided by the guide wire 1 is for infants and children, and is thinner and softer than that for adults. The material of the catheter 20 is preferably, for example, urethane or silicone.

  Next, the case where the guide wire 1 configured as described above is used will be described.

  First, the guide wire 1 is inserted into a patient's blood vessel. The insertion start site is the wrist artery, femoral vein, or the like.

  Then, the catheter 20 is moved so that the proximal side of the guide wire 1 is inserted into the catheter 20, and the catheter 20 is inserted into the blood vessel along the guide wire 1. When the guide wire 1 is inserted into the catheter 20, since the tapered portion 14 is provided on the proximal side of the guide wire 1, the insertion operation can be easily performed. As shown in FIG. 5, the guide wire 1 is protruded from the distal end of the catheter 20. The protruding amount is set such that the bent portion 12 protrudes from the distal end of the catheter 20.

  When the guide wire 1 is advanced to the central side of the blood vessel, for example, as shown in FIG. 5, the pigtail-shaped portion 10 is formed on the distal side of the guide wire 1 when reaching the bent portion of the blood vessel. The pigtail shape portion 10 hits the inner wall of the blood vessel. Since the pigtail-shaped portion 10 is formed by bending a wire, the force is distributed and acts over a wide range of blood vessels, and the blood vessels are hardly damaged.

  Also, as shown in FIG. 6, when the surgeon reaches the branching portion of the blood vessel, when the surgeon rotates the proximal side of the guide wire 1 around its center line, a bent portion 12 is formed in the middle portion. As a result, the position of the pigtail-shaped portion 10 changes from the position indicated by the solid line to the position indicated by the phantom line in the figure, and the traveling direction of the guide wire 1 changes. Thereby, the guide wire 1 can be directed toward the blood vessel to be advanced.

  In addition, as shown in FIG. 7, when the distal side of the guide wire 1 is drawn into the catheter 20, the pigtail-shaped portion 10 is caught on the opening peripheral edge portion of the distal end of the catheter 20. When the wire is further pulled in this state, the wire constituting the pigtail-shaped portion 10 enters the catheter 20, and the size of the pigtail-shaped portion 10 is reduced. Thereby, the guide wire 1 can be advanced also to a thin blood vessel. In addition, the magnitude | size of the pigtail shape part 10 can be made small as shown in FIG. 8, and can be changed freely.

  When the guide wire 1 is inserted into the body, near-infrared light is irradiated from the outside of the body, and further photographing with a camera having high sensitivity in the near-infrared region, the fluorescence emitted from the marker portion 10a is captured and displayed on the monitor screen. Projected. Thereby, the position of the pigtail shape part 10 can be confirmed. Near-infrared light can be irradiated with LED etc., for example. A known camera can be used.

  Moreover, since the size of the hole can be estimated and obtained by comparing the size of the pigtail-shaped portion 10 with, for example, a hole in the atrial septum, an appropriate treatment is performed when the subsequent hole is closed. be able to.

  As described above, according to the guide wire 1 according to this embodiment, since the pigtail-shaped portion 10 is provided on the distal side, it is difficult to damage the blood vessel, and a predetermined amount in the body is determined based on the pigtail-shaped portion 10. It can be obtained by estimating the size of the part. Thereby, the procedure using the guide wire 1 can be performed more safely and reliably.

  Further, since the marker portion 10a is provided on the distal side of the guide wire 1, the position on the distal side can be confirmed under the monitor image, and the safety of the procedure can be further enhanced.

  Moreover, since the marker part 10a contains indocyanine green, the position of the distal side of the guide wire 1 can be confirmed without using an X-ray device, and the patient can be prevented from being exposed to X-rays. The onset of nephropathy due to the drug can be avoided. Furthermore, since observation can be performed without using the X-ray room, for example, observation in an emergency room can also be performed.

  Further, by providing the bent portion 12 closer to the proximal side than the pigtail-shaped portion 10, the traveling direction of the guide wire 1 can be easily changed by rotating the proximal end.

  In addition, by providing the tapered portion 14 on the proximal side, the guide wire 1 can be easily inserted into the catheter 20, and the procedure can be facilitated.

  In addition, when used for insertion of a catheter for auxiliary circulation in an emergency, the catheter can be easily placed in a blood vessel without using an X-ray device or the like.

  In addition, you may curve the taper-shaped part 14 of the guide wire 1 like the modification shown in FIG.

  Moreover, you may provide a marker part in the front end side of the core part 1a. The marker portion preferably contains indocyanine green.

  Moreover, the marker part 10a may be comprised only with a radiopaque material, and it can confirm the position of the guide wire 1 in the deep place from a patient's body surface under X-ray imaging by doing in this way. .

  Moreover, in the said embodiment, although the guide wire 1 is made from resin, it may not be restricted to this but may be made from metal. In this case, it is preferable that a thin wire is wound around the outer peripheral surface of the core portion in the circumferential direction.

  Moreover, if indocyanine green diluted with physiological saline is introduced into the heart or blood vessel into which the guide wire 1 is inserted, it is possible to irradiate near infrared light from the outside and photograph it with a dedicated camera. The position of the guide wire 1 can be confirmed from the outside.

  As described above, the guide wire according to the present invention can be used, for example, for the treatment of atrial septal defect or ventricular septal defect.

DESCRIPTION OF SYMBOLS 1 Guide wire 10 Pigtail shape part 10a Marker part 11 Linear shape part 12 Bending part 14 Taper shape part 20 Catheter

Claims (6)

A guide wire used when introducing a catheter into a living body,
A guide wire characterized in that a pigtail-shaped portion curved to form a substantially circle is provided on the distal side. The guidewire according to claim 1, wherein
A guide wire characterized in that a marker portion that can be confirmed under contrast is provided on the distal side. The guide wire according to claim 2,
A guide wire characterized in that the marker portion contains indocyanine green. The guide wire according to any one of claims 1 to 3,
A guide wire, wherein a bent portion is provided closer to the proximal side than the pigtail-shaped portion. The guide wire according to any one of claims 1 to 4,
A guide wire characterized in that the proximal side has a tapered shape that becomes thinner toward the end. The guide wire according to any one of claims 1 to 5,
A guide wire having a hydrophilic coating on the surface.

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