JP2011512900A - 血流回復のための方法及び装置 - Google Patents
血流回復のための方法及び装置 Download PDFInfo
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- JP2011512900A JP2011512900A JP2010547816A JP2010547816A JP2011512900A JP 2011512900 A JP2011512900 A JP 2011512900A JP 2010547816 A JP2010547816 A JP 2010547816A JP 2010547816 A JP2010547816 A JP 2010547816A JP 2011512900 A JP2011512900 A JP 2011512900A
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- thrombus
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- distal segment
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- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
- A61B2017/2215—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having an open distal end
-
- 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
- A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/92—Stents in the form of a rolled-up sheet expanding after insertion into the vessel, e.g. with a spiral shape in cross-section
Abstract
Description
発明は閉塞された血管部位に局所血流を回復させる方法に向けられる。血管部位、すなわち血管は、血栓によって閉塞され得る。本発明の方法に用いられる装置は、マイクロカテーテル及び、必要に応じて、誘導カテーテルにより、血管部位に配置することができる。本発明の方法は完全に引戻し可能な装置を用いることができ、これは方法が永久的に患者に埋め込まれる装置を必要とする技術に優る改善である。装置が永久的に患者に埋め込まれる場合、患者には生涯続く抗血液凝固治療が必要となる。したがって、引き戻し可能な装置を用いることで、生涯続く抗血液凝固治療を回避できると考えられる。
X線不透過性マイクロカテーテル遠位マーカー17をX線不透過性遠位セグメント近端マーカー18にまたはその近傍に残すことができ、あるいは患者から完全に取り出すことができる;
遠位セグメント1に対するあらかじめ定められた位置までマイクロカテーテル8を前進させることができ、これは、X線不透過性マイクロカテーテル遠位マーカー17がX線不透過性遠位セグメント近端マーカー18と所望通りに位置合せされた場合、X線不透過性マイクロカテーテル遠位マーカー17がX線不透過性遠位セグメント近端マーカー18の遠端と所望通りに、例えば約0.5mmから約10mmまたは約5mmから約10mmの範囲で、位置合せされた場合、マイクロカテーテル8の座屈によって明らかになるようにマイクロカテーテル8の前進に対してかなりの抵抗を受けた場合の、所望の位置合わせまたはかなりの抵抗のいずれが初めにおころうとも、その場合とすることができる。展開されて非拘束状態13にある遠位セグメント1を誘導カテーテルに向けてまたは誘導カテーテル内に移動させている間、以下のいずれかがおこり得る:
誘導カテーテル内腔近端が加圧バッグまたはその他の陽圧流体源と通じる;または
誘導カテーテル内腔近端が吸引源またはその他の陰圧源と通じる。
(A・P)+C・f
で表すことができる。
(a・p)+c・f
で表すことができ、既知の方法による元の血栓12の引剥し及び可動化に必要な力よりもかなり小さくなるであろう(図5)。
上述したように、本発明の方法によっていずれか適する自動展開式装置を用いることができる。装置の様々な実施形態を米国特許第7300458号明細書に見ることができる。この明細書はその全体が本明細書に参照として含まれる。
本発明では抗血液凝固性及び/または抗血小板性の薬剤で装置をコーティングすることも考えられる。薬剤は単独でまたは別の薬剤と組み合わせて用いることができると考えられる。
4-カルボン酸のようなP-セレクチン阻害薬、及び、アセチルサリチル酸(アスピリン(登録商標))、レスベラトール、イブプロフェン(Advil(登録商標),Motrin(登録商標))、ナプロキセン(Aleve(登録商標),Naprosyn(登録商標))、スリンダク(Clinoril(登録商標))、インドメタシン(Indocin(登録商標))、メフェナム酸、ドロキシカム、ジクロフェナク(Cataflam(登録商標),Voltaren(登録商標))、スルフィンピラゾン(Anturane(登録商標))及びピロキシカム(Feldene(登録商標))のような非ステロイド性抗炎症薬(NSAIDS)を含む、それぞれの作用に基づく、抗血小板剤のいくつかの種別がある。NSAIDSの中では、アセチルサリチル酸(ASA)、レスベラトール及びピロキシカムが好ましい。アスピリン及びイブプロフェンのようないくつかのNSAIDSは、シクロオキシゲナーゼ-1(cox-1)及びシクロオキシゲナーゼ-2(cox-2)のいずれをも阻害する。cox-2を弱くしか阻害しない可逆的cox-1阻害薬である、レスベラトールのようないくつかのNSAIDSは、cox-1を選択的に阻害する。
2 遠位セグメント遠端
3 遠位セグメント近端
4 本体部分
5 重畳構造
6 体積縮小形態
7 押出ワイア
8 マイクロカテーテル
9 連結点
10 取付機構
11 大脳動脈
12,12' 血栓
13 非拘束状態
14 血流
15 X線不透過性遠位セグメント遠端マーカー
16 マイクロカテーテル遠位先端
17 X線不透過性マイクロカテーテル遠位マーカー
18 X線不透過性遠位セグメント近端マーカー
19 引張力
Claims (11)
- 血管内の血栓の除去のための自動展開式装置において、
第1の複数のメッシュセルを有するメッシュ構造であって、前記メッシュ構造が近端及び遠端を有し、前記メッシュ構造の前記遠端が前記血栓の少なくとも一部分に絡み付いて除去可能な一体化された装置−血栓複合体を形成するように構成された、メッシュ構造、
第2の複数のメッシュ構造を有する先細り部分であって、前記先細り部分が前記メッシュ構造の前記近端に向けて配置される、先細り部分、及び
前記先細り部分が収斂する、前記先細り部分の近端に配置された、連結点、
を有し、
前記装置が、体積拡大形態をとるようにあらかじめ形成され、前記体積拡大形態において前記連結点に向けて先細りになる、軸方向開放管の形態をとる、
ことを特徴とする装置。 - 前記メッシュ構造の前記遠端がコイルまたはアイレットの形状をもつX線不透過性マーカーを有することを特徴とする請求項1に記載の装置。
- 前記メッシュ構造の前記遠端が、前記体積拡大形態において前記体積拡大形態における前記メッシュ構造の前記近端より大きな直径を有することを特徴とする請求項1に記載の装置。
- 前記メッシュ構造の前記遠端が第3の複数のメッシュセルを有し、前記第3の複数のメッシュセルが前記第2の複数のメッシュセルより小さいセル寸法を有することを特徴とする請求項1に記載の装置。
- 前記メッシュ構造の前記遠端が1つ以上のペグ及び/またはフックを有することを特徴とする請求項1に記載の装置。
- 前記メッシュ構造の前記遠端がファイバを有することを特徴とする請求項1に記載の装置。
- 前記メッシュ構造の前記遠端が強められた径方向力を与えるに十分な時間加熱されることを特徴とする請求項1に記載の装置。
- 前記メッシュ構造が抗血液凝固性または抗血小板性の薬剤でコーティングされることを特徴とする請求項1に記載の装置。
- 前記メッシュ構造がさらに生分解性/生体適合性の高分子材でコーティングされて前記抗血液凝固性または抗血小板性の薬剤の徐放を提供することを特徴とする請求項8に記載の装置。
- 前記メッシュ構造が抗血液凝固性または抗血小板性の薬剤を保持するための貯槽を有することを特徴とする請求項1に記載の装置。
- 装置に少なくともある程度絡み付かれた血栓を含む、除去可能な一体化された装置−血栓複合体において、前記装置が、
第1の複数のメッシュセルを有するメッシュ構造であって、前記メッシュ構造が近端及び遠端を有し、前記メッシュ構造の前記遠端が前記血栓の少なくとも一部分に絡み付いて除去可能な一体化された装置−血栓複合体を形成するように構成された、メッシュ構造、
第2の複数のメッシュ構造を有する先細り部分であって、前記先細り部分が前記メッシュ構造の前記近端に向けて配置される、先細り部分、及び
前記先細り部分が収斂する、前記先細り部分の近端に配置された、連結点、
を有し、
前記装置が、体積拡大形態をとるようにあらかじめ形成され、前記体積拡大形態において前記連結点に向けて先細りになる、軸方向開放管の形態をとる、
ことを特徴とする装置−血栓複合体。
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