JP2013183803A - Bump treating device assembly and bump treating method - Google Patents

Abstract

PROBLEM TO BE SOLVED: To effectively suppress rise of the internal pressure in a bump and to reduce an influence on the peripheral tissue.SOLUTION: A bump treating device assembly 10 includes: a clip 18 which has a prescribed elasticity and which can be inserted into a bump 102 formed in a blood vessel 100; and a shaft 12 which supports the clip 18 and which is relatively retractable to the clip 18. The clip 18 has a plurality of extensions 30 extending toward the proximal end and a distal end connecting part 28 for connecting and supporting the distal ends of the plurality of extensions 30. The plurality of extensions 30 in a natural state are formed in such a shape that proximal end opposing parts 36a of the plurality of extensions 30 are approximate to each other. The plurality of extensions 30 are elastically deformed and opened as the shaft 12 moves forward and abuts to the extensions. Then, the extensions 30 are restored to the natural state from the opened sate as the shaft 12 moves backward, and the extensions 30 are removed from the shaft 12 with the proximal end opposing parts 36a holding a wall 102a of the bump 102.

Description

  The present invention relates to an aneurysm treatment device assembly and an aneurysm treatment method for treating an aneurysm generated in a living organ.

  A portion where a part of a blood vessel is swollen and weakened is called an aneurysm, and particularly, a portion occurring in a cerebral artery is called a cerebral aneurysm. Subarachnoid hemorrhage occurs when a cerebral aneurysm ruptures. There are several methods for treating such rupture. One is a “neck clip technique” in which a neurosurgical craniotomy is performed, and a clip is attached between the cerebral aneurysm and the parent artery (the root portion of the aneurysm) with a clip. In another treatment method, treatment is performed without craniotomy. A catheter is inserted into the cerebral aneurysm through the blood vessel, and a flexible coil made of a metal such as platinum is implanted into the cerebral aneurysm through the catheter. This is a method called “embolization” (Patent Document 1 below).

Special table 2008-510594 gazette

  The present invention has been made in connection with a method for treating an aneurysm via a blood vessel (by an intravascular interventional procedure), and can effectively suppress an increase in the intraluminal pressure and An object of the present invention is to provide an aneurysm treatment device assembly and an aneurysm treatment method capable of reducing an influence on a tissue.

  In order to achieve the above object, the present invention provides an indwelling portion that has a predetermined elastic force and can be inserted into an aneurysm formed in a living body lumen, supports the indwelling portion, and is relative to the indwelling portion. And the indwelling portion has a plurality of extending portions extending in the proximal direction and a distal end connecting portion for connecting and supporting the distal ends of the plurality of extending portions. In a natural state, at least the opposing portions positioned on the base end side of the plurality of extending portions have a shape close to each other, and the plurality of extending portions are elastically deformed in accordance with the contact due to the advance movement of the shaft. The opposite portion sandwiches the wall portion of the knob and is detached from the shaft while sandwiching the knob. And

  According to the above, the indwelling portion has a plurality of extending portions extending in the proximal direction, and in a natural state, the opposing portions positioned on the proximal end sides of the plurality of extending portions have shapes close to each other. By doing so, after expanding the extension part by the advance movement of the shaft in the aneurysm, when the shaft is moved backward, the extension part acts to restore to the natural state, and the plurality of extension parts The aneurysm can be easily sandwiched between the opposing portions. At this time, the indwelling portion can be sandwiched so that the wall portion in the vicinity of the neck portion of the aneurysm connected to the living body lumen is folded, and can close the neck portion of the aneurysm in a contracted state. Then, after the treatment with the aneurysm treatment device assembly, the indwelling portion is indwelled in the aneurysm, so that the closed state of the neck of the aneurysm is maintained. it can.

  In this case, it is preferable that the plurality of extending portions include an engaging portion that is continuous with the facing portion and extends obliquely outward in the proximal direction.

  As described above, the engaging portion extends obliquely outward in the proximal direction from the opposing portion, so that the tip of the engaging portion comes into contact with the engaging portion as the shaft moves forward. Thereby, an engaging part is guided to the front-end | tip, and it displaces outside, and can extend a some extension part smoothly.

  The shaft has a hollow portion extending in the axial direction, and the distal end continuous portion is connected to a long body inserted through the hollow portion, and is placed in the aneurysm by separation of the long body. It is good to be done.

  In this way, by separating the long body having the continuous connection portion at the distal end of the indwelling portion, the indwelling portion in which the aneurysm is sandwiched can be easily placed in the aneurysm.

  Furthermore, the tip of the shaft is provided with an abutting portion that has an outer diameter that is larger than the outer diameter of the shaft, moves forward along the axial direction of the elongated body, and abuts on the extending portion. It is preferable.

  In this way, the contact portion that is larger than the outer diameter of the shaft is provided at the tip of the shaft, so that when the contact portion is moved forward and brought into contact with the extension portion, the opposing portion of the extension portion (Or the engaging portion) can be expanded sufficiently wider than the neck portion of the aneurysm. Accordingly, the extended portion in the expanded state can be reliably brought into contact with the wall portion of the aneurysm, and when restoring the indwelling portion, the wall portion of the aneurysm with which the plurality of extension portions are in contact is smoothly sandwiched. Can do.

  Furthermore, the contact portion may be provided with a separation mechanism that separates the long body and allows the separated long body on the distal end side to be detached from the shaft.

  As described above, by providing the separation mechanism, the indwelling portion can be easily detached and placed in the aneurysm by separating the long body on the distal end side. Further, since the detachment mechanism is provided at the contact portion whose diameter is larger than that of the shaft, the structure of the detachment mechanism can be easily accommodated, and there is no need to provide another detachment mechanism on the shaft. Therefore, the shaft can be formed thin.

  In order to achieve the above object, the present invention includes a plurality of extending portions that have a predetermined elastic force and can be inserted into an aneurysm formed in a living body lumen and extend in the proximal direction. And a distal end connecting portion for connecting and supporting the distal ends of the plurality of extending portions, and in a natural state, a detention in which at least opposing portions positioned on the base end sides of the plurality of extending portions are close to each other. An aneurysm treatment method using an aneurysm treatment device assembly comprising: a support portion; and a shaft that supports the indwelling portion and is relatively movable relative to the indwelling portion, wherein the indwelling portion and the shaft are placed in a catheter. And a delivery step of positioning the catheter opening in the opening of the aneurysm, and after the delivery step, the indwelling portion is advanced from the opening of the catheter and the indwelling portion is inserted into the aneurysm Inserting step, and the inserting step And then expanding the shaft by advancing and moving the shaft and abutting the ends of the shaft against the plurality of extending portions to elastically deform the extending portions, and the expanding step. Thereafter, the abutment step in which both the indwelling portion and the shaft are moved backward to bring the opposed portion into contact with the wall portion of the knob, and the shaft is moved backward after the contacting step to be in an expanded state. Elastically restoring the extension part of the step, sandwiching the wall portion of the knob by the plurality of extension parts, and after the sandwiching step, the detention part is detached from the shaft And a detachment step for placing in the aneurysm.

  According to the above, in the insertion step, the indwelling portion having a shape in which the opposing portions of the extending portions are close to each other in a natural state is easily inserted into the aneurysm. In the expanding step and the sandwiching step, the wall portion of the knob can be easily sandwiched by the plurality of extending portions. At this time, the indwelling part can be sandwiched so that the wall part near the neck part of the aneurysm connected to the living body lumen is folded, and can close the neck part of the aneurysm in a contracted state. And, since the indwelling portion is placed in the aneurysm by the detachment step, the closed state of the neck portion of the aneurysm is maintained after the treatment with the aneurysm treatment device assembly, so that the compression of the living tissue by the aneurysm is surely suppressed. be able to.

  According to the present invention, an increase in the pressure inside the aneurysm can be effectively suppressed and the influence on the surrounding tissue can be reduced.

It is a schematic perspective view which shows the whole structure of the aneurysm treatment device assembly which concerns on this Embodiment. 2A is an enlarged perspective view of a main part showing the distal end portion of the aneurysm treatment device assembly of FIG. 1, and FIG. 2B is a schematic side view showing the distal end portion of the aneurysm treatment device assembly of FIG. 2A. FIG. 2B is a schematic side view showing a state in which the clip portion of FIG. 2B is expanded, FIG. 2D is a schematic side view showing the vicinity of the aneurysm into which the clip portion of FIG. 2B is inserted, and FIG. 2E is FIG. It is a principal part side view which shows the state which pinched the knob by the clip part. 3A is a main part side view showing a first configuration example of the extension part of the clip part, and FIG. 3B is a main part side view showing a second example of the extension part of the clip part, and FIG. These are principal part side views which show the 3rd structural example of the extension part of a clip part, and FIG. 3D is a principal part side view which shows the 4th structural example of the extension part of a clip part. 4A is a partial perspective view showing a detachment mechanism of the aneurysm treatment device assembly of FIG. 1, and FIG. 4B is a first side cross-sectional view for explaining the operation of the detachment mechanism of FIG. 4A. FIG. 4B is a second side cross-sectional view for explaining the operation of the release mechanism of FIG. 4A, and FIG. 4D is a configuration diagram of the release mechanism according to the first configuration example. FIG. 5A is a configuration diagram of the detachment mechanism according to the second configuration example, FIG. 5B is a configuration diagram of the detachment mechanism according to the third configuration example, and FIG. 5C is a configuration of the detachment mechanism according to the fourth configuration example. FIG. 5D is a configuration diagram of a detachment mechanism according to a fifth configuration example, and FIG. 5E is a configuration diagram of a detachment mechanism according to a sixth configuration example. FIG. 6A is a first diagram illustrating a method of using the aneurysm treatment device assembly, and FIG. 6B is a second diagram illustrating a method of using the aneurysm treatment device assembly. FIG. 7A is a third diagram for explaining how to use the aneurysm treatment device assembly, and FIG. 7B is a fourth diagram for explaining how to use the aneurysm treatment device assembly. FIG. 8A is a fifth diagram for explaining how to use the aneurysm treatment device assembly, and FIG. 8B is a sixth diagram for explaining how to use the aneurysm treatment device assembly. 9A is a perspective view of a main part showing a first modification of the clip part, FIG. 9B is a side view of a main part showing a second modification of the clip part, and FIG. 9C is a third modification of the clip part. FIG. 9D is a side cross-sectional view of a main part showing a fourth modification of the clip part.

  Hereinafter, preferred embodiments of an aneurysm treatment device assembly according to the present invention will be described in detail in relation to an aneurysm treatment method with reference to the accompanying drawings.

  An aneurysm treatment device assembly 10 according to the present embodiment is generated in a living body lumen (blood vessel 100) by an interventional technique (a technique for delivering a device to an abnormal site through the blood vessel) in a blood vessel (living body lumen). FIG. 2D is a device assembly for treating the aneurysm 102 (see FIG. 2D). Examples of the lumen in which the aneurysm 102 is generated include a blood vessel, a digestive tract, an organ, a bile duct, a lymph vessel, an otonasal cavity, and a lacrimal gland. Examples of the blood vessel 100 in which the aneurysm 102 is generated include an artery, a vein, and a peripheral blood vessel. Hereinafter, the case where the lumen is the blood vessel 100 will be described. When the aneurysm 102 is generated in the artery, for example, the aneurysm 102 (aneurysm) is formed to have a neck 104 connected to the blood vessel 100 and a bag-like reservoir 106 connected to the neck 104. Blood flows into the reservoir 106 from the opening 108 of 104. The aneurysm treatment device assembly 10 can be suitably used for the treatment of such an aneurysm 102.

  FIG. 1 is a schematic perspective view showing the overall configuration of an aneurysm treatment device assembly 10 according to the present embodiment. The aneurysm treatment device assembly 10 includes a shaft 12 that extends in the axial direction, and a treatment portion main body 14 that can move forward and backward with respect to the shaft 12. The treatment portion main body 14 includes a long body 16 inserted into the shaft 12 and a clip portion 18 (an indwelling portion) provided at a distal end portion of the long body 16. The shaft 12 is configured as a long member having a hollow portion (lumen) at least in part. Specifically, a lumen into which the elongated body 16 can be inserted is extended to the distal end side of the shaft 12. This lumen may not extend to the proximal end side of the shaft 12. In this case, the proximal end side of the long body 16 inserted into the lumen is exposed from the middle of the shaft 12 to the outer surface. What is necessary is just to arrange | position so that it may extend to a base end side. In the following description, the shaft 12 having a lumen formed therethrough will be described in detail, and this lumen will be referred to as an insertion lumen 26.

  The user (operator) of the aneurysm treatment device assembly 10 delivers and positions the distal end opening 20a of the catheter 20 so as to face the aneurysm 102, and then advances and moves the treatment portion main body 14 so that the clip portion 18 is moved. Insert into the aneurysm 102. Further, the clip portion 18 is elastically deformed by the forward / backward movement of the shaft 12 to sandwich the wall portion 102a of the aneurysm 102 (see FIG. 2E), thereby closing the neck portion 104 of the aneurysm 102. As a result, the aneurysm 102 is treated. Hereinafter, each configuration of the aneurysm treatment device assembly 10 will be specifically described.

  As shown in FIG. 1, the shaft 12 of the aneurysm treatment device assembly 10 is a long and flexible tubular member (tubular body), and a hub 22 is connected to the proximal end side and the distal end side is contacted. A contact portion 24 is provided. Further, an insertion lumen 26 (hollow portion) penetrating in the axial direction is formed inside the shaft 12 and the hub 22.

  The insertion lumen 26 is formed to have an inner diameter that can accommodate the elongated body 16 of the treatment portion main body 14 to be described later. The treatment portion main body 14 is accommodated in the insertion lumen 26 so that the distal end portion (the distal end side of the elongated body 16 and the clip portion 18) is supported by the shaft 12, and the distal end side of the shaft 12 is supported. To be exposed.

  The shaft 12 preferably has a flexibility (flexibility) that can easily follow the curve of the catheter 20 inserted into the meandering blood vessel 100 and a rigidity that can easily move forward and backward with respect to the catheter 20. . In this case, examples of the material constituting the shaft 12 include metals and resins. Examples of the metal include pseudo-elastic alloys (including superelastic alloys) such as Ni-Ti alloys, shape memory alloys, stainless steel (for example, SUS304, SUS303, SUS316, SUS316L, SUS316J1, SUS316J1L, SUS405, SUS430, SUS434, SUS444, SUS429, SUS430F, SUS302, etc.), cobalt-based alloys, noble metals such as gold and platinum, tungsten-based alloys, carbon-based materials (including piano wires), and the like. Examples of the resin include polyolefin (for example, polyethylene, polypropylene, polybutene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, ionomer, or a mixture of two or more thereof), polyvinyl chloride, polyamide, polyamide. Examples thereof include polymer materials such as elastomers, polyesters, polyester elastomers, polyurethanes, polyurethane elastomers, polyimides, fluororesins, mixtures thereof, and the above two or more polymer materials. The shaft 12 can also be applied to a composite of these metals and resins (for example, a multilayer tube in which a metal and a resin are laminated). Furthermore, an X-ray impermeable marker that can be recognized under X-ray fluoroscopy may be provided near the tip of the shaft 12.

  The dimension of the shaft 12 is appropriately selected according to the site to be treated (aneurysm 102). For example, when the aneurysm treatment device assembly 10 is used for the treatment of a cerebral aneurysm, the overall length is about 800 to 1500 mm. The diameter is set to about 0.6 to 3 mm.

  The hub 22 connected to the proximal end side of the shaft 12 is formed to have a larger diameter than the shaft 12 so that the operator can easily grasp it. A proximal end opening 26 a communicating with the insertion lumen 26 is formed on the proximal end surface of the hub 22. The operator can perform forward / backward movement and rotation of the entire shaft 12 by grasping the hub 22 and arbitrarily operating (advancing / retracting operation or rotating operation).

  On the other hand, the contact portion 24 provided at the tip of the shaft 12 is formed in a cylindrical shape whose diameter is increased outward in the radial direction from the outer diameter of the shaft 12. The abutting portion 24 moves integrally with the advance movement of the shaft 12 and abuts against the clip portion 18, thereby elastically expanding an extension portion 30 of the clip portion 18 described later. In addition, a main part structure (see FIG. 4B) of the detachment mechanism 50 that cuts the treatment portion main body 14 (the long body 16) is accommodated in the contact portion 24.

  The treatment portion main body 14 of the aneurysm treatment device assembly 10 includes the long body 16 and the clip portion 18 as described above. The long body 16 and the clip portion 18 are integrally formed of an elastic material having a shape restoring property. Thereby, the treatment portion main body 14 is configured to have a predetermined elastic force, and can easily follow the catheter 20 (or the shaft 12) accommodated therein.

  Although the material (elastic material) which comprises the treatment part main body 14 is not specifically limited, The metal quoted by the shaft 12 can be used. In particular, since the superelastic alloy is rich in flexibility and difficult to bend, it is possible to obtain a high followability to a blood vessel that is curved and bent in a complicated manner by configuring the treatment body 14 with a superelastic alloy. Excellent resilience is obtained when elastically deformed. The preferred composition of the superelastic alloy is Ni-Ti alloy such as Ni-Ti alloy of 49-52 atomic% Ni, Cu-Zn alloy of 38.5-41.5 wt% Zn, 1-10 wt% X Cu-Zn-X alloy (X is at least one of Be, Si, Sn, Al, and Ga), 36-38 atomic% Al-Ni-Al alloy, and the like. Of these, the Ni-Ti alloy is particularly preferable. Hereinafter, the treatment portion main body 14 will be specifically described.

  The elongated body 16 of the treatment portion main body 14 has a longer axial length than the shaft 12 and extends linearly. When the elongated body 16 is accommodated in the insertion lumen 26, both end portions of the shaft 12 (the hub 22 and the contact portion 14). It can be exposed from the contact portion 24). The surgeon pushes and moves the long body 16 extending from the proximal end opening 26a of the hub 22 in the advance direction, thereby moving the clip portion 18 connected to the distal end side of the long body 16 to advance. Moreover, the clip part 18 is moved backward by pulling back the long body 16 in the backward direction.

  The clip portion 18 of the treatment portion main body 14 is provided at the distal end of the long body 16 and is set to a size that can be inserted into the aneurysm 102 (reservoir portion 106) (see also FIG. 6B). That is, the entire clip portion 18 is formed to have an axial length that is narrower than the inner diameter of the opening portion 108 of the knob 102 and shorter than the inner diameter of the reservoir portion 106 (the dimension from the root portion connected to the neck portion 104 to the opposite back portion). ing.

  2A is an enlarged perspective view of a main part showing the distal end portion of the aneurysm treatment device assembly 10 of FIG. 1, and FIG. 2B is a schematic side view showing the distal end portion of the aneurysm treatment device assembly 10 of FIG. 2A. 2C is a schematic side view showing a state in which the clip portion 18 of FIG. 2B is expanded, and FIG. 2D is a schematic side view showing the vicinity of the knob 102 into which the clip portion 18 of FIG. 2B is inserted. 2E is a side view of the main part showing a state in which the knob 102 is sandwiched by the clip part 18 of FIG. 2B.

  As shown in FIGS. 2A and 2B, the clip portion 18 includes a distal end continuous portion 28 that is continuous with the elongated body 16, and a plurality (four in FIG. 2A) extending in the proximal direction from the distal end continuous portion 28. The extending part 30 is provided. Here, the base end direction (base end side) is the base end direction (base end side) with respect to the major axis of the aneurysm treatment device assembly 10 of the present invention.

  The distal end continuous portion 28 is located at the distal end of the long body 16 and is configured as a connecting portion that connects the four extending portions 30. The four extending portions 30 are connected at intervals of 90 ° along the circumferential direction of the distal end connecting portion 28 (the axis of the long body 16) serving as a base point (center). Accordingly, when the clip portion 18 is viewed from the front, the four extending portions 30 are connected in a cross shape and protrude outward in the radial direction of the tip continuous portion 28.

  Each extending portion 30 includes a root portion 32 that protrudes from the distal end continuous portion 28 in a short direction radially outward, and a trunk portion that extends a predetermined length in the proximal direction via a curved portion 34 that continues to the root portion 32. 36 and an engaging portion 38 connected to the base end side of the body portion 36. Each extending portion 30 is formed in a bar shape (round bar shape) having a circular cross section, and is set to a thickness that can be elastically deformed in the radial direction of the long body 16 with the root portion 32 as a fulcrum. In addition, the shape of the extension part 30 is not limited to a round bar shape, and, of course, various shapes such as a square bar shape and a cylindrical shape can be taken.

  The body portion 36 of each extension portion 30 is supported by the root portion 32 so as to be elastically deformable in a natural state, and extends substantially parallel to the axial direction of the long body 16. A narrow gap 40 is interposed between the portion 36. That is, the four extending portions 30 extend from the distal end to the proximal end of the trunk portion 36 in a state of being close to each other to the extent that the narrow gap 40 is interposed. The contact portion 24 enters the gap 40 by the advancing movement of the shaft 12, whereby the extension portion 30 is elastically expanded (see FIG. 2C). The inner side surfaces (base-end facing portions 36 a) facing the elongated body 16 on the base end side of the body portions 36 are separated from each other by the expansion of the extension portion 30, and close to each other by the restoration of the extension portion 30.

  Further, the engaging portion 38 connected to the trunk portion 36 is formed so as to extend obliquely outward with respect to the trunk portion 36 extending substantially in parallel. When the engaging part 38 moves the abutting part 24 forward, its base end surface comes into contact with the outer surface (corner part) of the abutting part 24, and when the abutting part 24 further moves forward. The extending portion 30 is smoothly expanded along the inclined shape. For this reason, the contact portion 24 can easily advance and move to the vicinity of the distal end continuous portion 28 without being caught by the extending portion 30. Further, the engaging portion 38 is formed shorter than the extending length of the extending portion 30 so that the outer diameter of the clip portion 18 does not increase. Furthermore, the end of the engaging portion 38 is formed in a smooth arc shape, and is configured so as not to inadvertently damage the knob 102.

  The clip portion 18 is inserted into the knob 102 and is subjected to a predetermined operation (the operation shown in FIGS. 6A to 7B), thereby partially sandwiching the wall 102 a of the knob 102 as shown in FIG. 2E. In other words, the clip portion 18 is sandwiched by the four extending portions 30 so that the wall portion 104 a near the neck portion 104 of the aneurysm 102 and the wall portion 106 a of the root portion of the reservoir portion 106 connected to the neck portion 104 are folded. The neck 104 of the aneurysm 102 can be closed. Thereby, the inflow of blood into the aneurysm 102 is blocked.

  In addition, the extension part 30 of the clip part 18 is not limited to said structure, It can take a various structure. Hereinafter, other configuration examples (first to fourth configuration examples) of the clip unit 18 will be described with reference to FIGS. 3A to 3D.

  The clip portion 18a according to the first configuration example shown in FIG. 3A has a configuration in which the proximal-side facing portions 36a of the plurality of extending portions 30a are in contact with the side surfaces of the long body 16. That is, the trunk portion 36 that is continuous with the curved portion 34 is inclined so as to be close to the elongated body 16 and extends in the proximal direction, and the engaging portion 38 a that is continuous with the trunk portion 36 is connected to the contact portion 24. It extends longer than the outer diameter. Even when the extending portion 30a is formed in this way, when the abutting portion 24 abuts on the engaging portion 38a, the engaging portion 38a is guided to expand. Further, the wall portion 102a of the knob 102 can be sandwiched more firmly at the contact portion between the proximal-side facing portion 36a of the extending portion 30a and the elongated body 16. In short, the extension angle, extension length, and the like of the extension part 30 are not particularly limited, and may be designed in an appropriate shape according to the shape of the knob 102 or the like.

  The clip portion 18b according to the second configuration example shown in FIG. 3B has a configuration in which an uneven portion 42 is formed on the proximal end side of the engaging portion 38 of the plurality of extending portions 30b. Thus, by having the uneven part 42, when the extended part 30b pinches | interposes the wall part 102a of the knob 102, the uneven part 42 will be caught by the wall part 102a. Therefore, the clip portion 18b can firmly sandwich the wall portion 102a of the knob 102.

  In the clip portion 18c (extension portion 30c) according to the third configuration example shown in FIG. 3C, the end portion of the engagement portion 38c is formed in a tapered shape (sharp), and the wall portion 102a of the knob 102 can be punctured. The puncture unit 44 is configured. Further, a reverse puncture portion 46 (return) is provided on the opposite side of the puncture portion 44, and the reverse puncture portion 46 is hooked when the puncture portion 44 punctures the wall portion 102 a of the aneurysm 102. ing. As described above, the clip portion 18c has the puncture portion 44 and the reverse puncture portion 46, whereby the engagement between the wall portion 102a of the knob 102 and the engagement portion 38c can be further ensured. Therefore, the clip part 18c can pinch | interpose the wall part 102a of the knob 102 more firmly. Note that a hemostatic agent (blood coagulant) that stops the puncture portion of the aneurysm 102 may be applied to the engaging portion 38c.

  The clip portion 18d (extension portion 30d) according to the fourth configuration example illustrated in FIG. 3D has a configuration in which an adhesive 48 is applied to the engagement portion 38d that contacts the wall portion 102a of the knob 102. That is, the engaging portion 38d and the wall portion 102a can be bonded together with the wall portion 102a of the knob 102 sandwiched between the clip portions 18d. Therefore, the clip portion 18 d can firmly maintain the sandwiched state of the wall portion 102 a of the knob 102 with the adhesive 48. Examples of the adhesive applied to the engaging portion 38d include hydrophilic polymers such as hydrogel, bioadhesives (fibrin glue), and instantaneous adhesives.

  The treatment portion main body 14 configured as described above is formed by cutting a desired portion of the long body 16 so that the clip portion 18 and the long body 16 on the distal end side are long on the proximal end (shaft 12) side. Separated from the body 16 and placed in the aneurysm 102. For this reason, in the aneurysm treatment device assembly 10 according to the present exemplary embodiment, a detachment mechanism 50 is provided in the contact portion 24 as a mechanism for cutting the long body 16. Hereinafter, the separation mechanism 50 will be specifically described.

  4A is a partial perspective view showing the detachment mechanism 50 of the aneurysm treatment device assembly 10 of FIG. 1, and FIG. 4B is a first side sectional view for explaining the operation of the detachment mechanism 50 of FIG. 4A. 4C is a second side sectional view for explaining the operation of the separation mechanism 50 of FIG. 4A, and FIG. 4D is a configuration diagram of the separation mechanism 50 according to the first configuration example.

  The detachment mechanism 50 includes an operating element 52 (see FIG. 1) operated by an operator, a driving mechanism 56 connected to the operating element 52 via an operating line 54, and a long length under the driving action of the driving mechanism 56. A cutting blade 58 for cutting the body 16, and configured to cut the long body 16 based on the operation of the operator.

  The operation element 52 is provided so as to be exposed on the side peripheral surface of the hub 22 and is movable in the proximal direction, and one end of the operation line 54 is connected thereto. The surgeon moves the operation element 52 in the proximal direction at a desired timing. As a result, the operating force of the operator 52 is transmitted to the drive mechanism 56.

  The drive mechanism 56 is built in the abutting portion 24 at the distal end of the shaft 12 and mechanically converts the operating force (force pulled in the proximal direction) of the operating element 52 received via the operating line 54 to convert a pair of the driving mechanism 56 into a pair. The cutting blade 58 is moved inward. The drive mechanism 56 is configured to return the pair of cutting blades 58 to their original positions based on the operation cancellation of the operation element 52. The drive mechanism 56 is not limited to such a configuration, and may adopt other mechanical mechanisms or electrical mechanisms. For example, a motor (not shown) may be provided inside the drive mechanism 56 as an electrical mechanism, and the cutting blade 58 may be driven by supplying electric power to the motor. In this case, the operation element 52 may be a switch for switching on / off the power supply.

  The pair of cutting blades 58 are sandwiched by the long body 16 by being brought close to each other by the drive mechanism 56. When the operation element 52 is not operated normally, as shown in FIG. 4B, the pair of cutting blades 58 are at positions sufficiently separated from each other, and the longitudinal movement of the long body 16 is ensured. When cutting the long body 16, the operator 52 is operated, and as shown in FIG. 4C, the pair of cutting blades 58 move close to each other to cut the long body 16. As a result, the clip portion 18 sandwiching the wall portion 102 a of the knob 102 is detached from the shaft 12 and is left in the knob 102.

  The separation mechanism 50 may employ various configurations other than the above configuration. For example, as shown in FIG. 4D, a detachment mechanism 50 </ b> A may be provided in the catheter 20 that accommodates the shaft 12 and the treatment portion main body 14 and performs delivery. That is, the detachment mechanism 50A according to the first configuration example is provided in the catheter 20, and the drive mechanism 56a and the cutting blade 58a for cutting the long body 16 are disposed on the inner wall 60a constituting the housing lumen 60 of the catheter 20. Yes. When cutting the long body 16, the shaft 12 and the long body 16 delivered from the distal end opening 20a of the catheter 20 are moved backward in the proximal direction so that the cutting portion of the long body 16 is cut with the cutting blade 58a. Arrange them so that they overlap. Then, by operating an operation element (not shown) (for example, provided on the proximal end side of the catheter 20), the long blade 16 can be cut by operating the cutting blade 58a via the drive mechanism 56a. Thus, even if the catheter 20 is provided with the detachment mechanism 50A, the long body 16 can be cut and the clip portion 18 can be separated.

  Further, the separation mechanism 50 has a structure in which the long body 16 is composed of two members, which are physically engaged (fitted, hooked, etc.) and removably connected, or the long body 16 has some physical action ( It is possible to adopt a configuration in which the parts are separated so as to be separated by thermal action, chemical action, or the like. Hereinafter, some configuration examples of other separation mechanisms for separating the long body 16 will be described.

  In the detachment mechanism 51a according to the second configuration example shown in FIG. 5A, the long body 16 includes two members (a first long body 16a and a second long body 16b), and a base 62 of the first long body 16a. And the front-end | tip of the 2nd elongate body 16b which has the hollow part 64 becomes a structure which fits. The fitting force (coupling force) between the base portion 62 and the second elongated body 16b is fitted and maintained in a connected state until the force for separating them is less than a predetermined value, but when a force exceeding a predetermined value is applied. Is set to such a fitting force that the first elongate body 16a and the second elongate body 16b are detached by disengaging the fitting. According to the detachment mechanism 51a configured as described above, the first long body 16a is moved to the second position by moving the second long body 16b backward after the wall portion 102a of the knob 102 is sandwiched between the clip portions 18. The long body 16b can be automatically detached. In FIG. 5A, the base 62 is inserted into the hollow portion 64 and the two are fitted together, but a configuration in which the male and female relationships of fitting are reversed may be used.

  The detachment mechanism 51b according to the third configuration example shown in FIG. 5B is configured such that the base 62 of the first long body 16c and the tip of the second long body 16d are screwed together. Specifically, a male screw 66 is formed on the outer peripheral portion of the base 62, and a female screw 68 is formed on the inner peripheral portion of the second elongated body 16d. The male screw 66 and the female screw 68 are formed so as to be disengaged by rotating the second elongated body 16d when performing a procedure for treating the aneurysm 102. According to the detachment mechanism 51b configured as described above, the first elongated body 16c is moved to the second elongated length by rotating the second elongated body 16d after the wall portion 102a of the knob 102 is sandwiched between the clip portions 18. It can be automatically detached from the scale 16d. In FIG. 5B, the male screw 66 provided on the base 62 is connected to the female screw 68 provided on the second elongate body 16d so that the two are connected. A configuration in which the relationship between the male and female is reversed may be used.

  The detachment mechanism 51c according to the fourth configuration example shown in FIG. 5C is formed in a coil shape on the outer periphery of the connecting portion 70, which connects the base 62 of the first long body 16e and the tip of the second long body 16f. A wound heater 72 and first and second conducting wires 74 and 76 connected to the heater 72 are provided. The connecting portion 70 is made of a material (for example, resin, low melting point metal, or the like) that can be melted and broken when heated. The first conducting wire 74 is connected to one end of the heater 72, the second conducting wire 76 is connected to the other end of the heater 72, and the first and second conducting wires 74, 76 are the hollow portion 64 of the second elongated body 16f. It is connected to the power source at the end opposite to the side inserted into the heater 72 and connected to the heater 72. The power source may be either DC or AC. According to the detachment mechanism 51c configured in this manner, the wall portion 102a of the knob 102 is sandwiched between the clip portions 18, and then the heater 72 is energized through the first and second conducting wires 74 and 76 to generate heat. Thus, the first elongated body 16e can be detached from the second elongated body 16f by melting and breaking the connecting portion 70.

  The disengagement mechanism 51d according to the fifth configuration example shown in FIG. 5D is engaged with the hook portion 78 provided at the base of the first long body 16g and the hook portion 78 provided at the tip of the second long body 16h. And an engaging portion 80. Since the hook part 78 and the engaging part 80 are disengaged by pushing the second long body 16h slightly toward the distal end side with the wall part 102a of the knob 102 sandwiched between the clip parts 18, the first long body 16g can be detached from the second elongated body 16h. According to the detachment mechanism 51d configured as described above, the first elongated body is obtained by disengaging the hook portion 78 and the engaging portion 80 after the wall portion 102a of the knob 102 is sandwiched between the clip portions 18. 16g can be detached from the second elongated body 16h.

  A separation mechanism 51e according to the sixth configuration example shown in FIG. 5E includes an interposition member 84 having a ball-shaped portion 82, a tension member 86 that pulls the interposition member 84 into the base portion 62 of the first elongated body 16i, The holding ring 88 provided in the front-end | tip part of 2 long body 16j and the release wire 90 penetrated by the 2nd long body 16j are provided. For example, the release wire 90 is connected to an operation element 52 provided on the hub 22, and is pulled back in the proximal direction by the operation of the operation element 52. In a state where the release wire 90 is sandwiched between the holding ring 88 and the ball-shaped portion 82 (a state where the ball-shaped portion 82 and the release wire 90 are fixed), the ball-shaped portion 82 passes through the holding ring 88. Since the movement into the base 62 is prevented, the connected state of the first elongated body 16i and the second elongated body 16j is maintained. On the other hand, when the operating element 52 is operated and the release wire 90 is pulled in the proximal direction, the release wire 90 is detached from between the holding ring 88 and the ball-shaped portion 82, so that the ball-shaped portion 82 moves inside the holding ring 88. The ball-shaped portion 82 moves into the base portion 62 under the tension action of the tension member 86. Thereby, the 1st elongate body 16i can be made to detach | leave from the 2nd elongate body 16j.

  Other configurations of the detachment mechanism 50 include a configuration in which a portion to be cut of the long body 16 is separated by electrolysis, or a fluid pressure is applied to the portion of the long body 16 to be cut, and the tip of the long body 16 A configuration in which the side and the base end side are cut and separated can be employed.

  The aneurysm treatment device assembly 10 according to the present embodiment is basically configured as described above, and the operation and effect thereof will be described below. 6A is a first diagram illustrating how to use the aneurysm treatment device assembly 10, FIG. 6B is a second diagram illustrating how to use the aneurysm treatment device assembly 10, and FIG. FIG. 7B is a fourth diagram illustrating a method of using the aneurysm treatment device assembly 10, and FIG. 8B is a fourth diagram illustrating a method of using the aneurysm treatment device assembly 10. FIG. FIG. 8B is a fifth diagram illustrating a method of using the solid body 10, and FIG. 8B is a sixth diagram illustrating a method of using the aneurysm treatment device assembly 10.

  As described above, the aneurysm treatment device assembly 10 is suitably used for the treatment of the aneurysm 102 including the reservoir 106 into which blood flows and the neck 104 that communicates the reservoir 106 with the blood vessel 100. Such an aneurysm 102 is formed by weakening the wall portion (blood vessel wall) of the blood vessel 100 (artery) due to arteriosclerosis or the like, and the blood gradually presses against the wall portion of the blood vessel 100 to swell. Examples of the aneurysm 102 occurring in the blood vessel 100 include a cerebral aneurysm, an abdominal aneurysm, a thoracic aneurysm, a coronary aneurysm, a popliteal aneurysm, a femoral aneurysm, a carotid aneurysm, and a varicose vein. Needless to say, the aneurysm treatment device assembly 10 according to the present embodiment may be applied to an aneurysm that does not have the neck 104.

  Here, the aneurysm treatment method using the aneurysm treatment device assembly 10 will be schematically described. In the aneurysm treatment method, the shaft 12 and the treatment portion main body 14 are accommodated in the accommodation lumen 60 of the catheter 20, and the opening of the aneurysm 102 is obtained. 108, a first step (positioning step) for positioning the distal end opening 20a of the catheter 20; a second step (insertion step) for moving the treatment portion main body 14 from the distal end opening 20a of the catheter 20 and inserting the clip portion 18 into the aneurysm 102; ), Moving the shaft 12 forward, a third step (expansion step) in which the abutting portion 24 of the shaft 12 abuts on the clip portion 18 and the extending portion 30 is expanded outward, and the clip portion 18 is moved backward. The fourth step (contact step) in which the clip portion 18 is brought into contact with the wall portion 102a of the knob 102, the shaft 12 is moved backward. Then, the extended portion 30 in the expanded state is elastically restored, and a fifth step (a sandwiching step) in which the wall portion 102a of the knob 102 is sandwiched by the four extending portions 30, and the clip portion 18 is detached from the shaft 12. Thus, the sixth step (removal step) for placing the clip portion 18 in the aneurysm 102 and the seventh step (retraction step) for extracting the aneurysm treatment device assembly 10 and the catheter 20 from the blood vessel 100 are sequentially performed. As a result, the knob 102 can be closed in a contracted state. Hereinafter, each step will be described in detail.

[Delivery step]
In the delivery step, a guiding catheter (not shown) is inserted into the blood vessel 100 percutaneously from a predetermined position (for example, a thigh), and the guide wire is inserted into the blood vessel 100 in advance. (Not shown) is moved to a position close to the location where the bump 102 is generated. After the guide wire is removed, the catheter 20 configured as a microcatheter is inserted through the lumen of the guiding catheter, and the catheter 20 is delivered to the site where the aneurysm 102 is generated. The catheter 20 is guided in the blood vessel 100 based on the operation of the operator, and is disposed at an opposing position where the distal end opening 20 a overlaps the opening 108 of the aneurysm 102. At the time of delivery of the catheter 20, the clip portion 18, the contact portion 24, and the like may be arranged in advance at the distal end position of the housing lumen 60.

  For example, the distal end portion of the catheter 20 has a gently curved shape (for example, the right shape of Judkins) with respect to the axial direction of the blood vessel 100, or the shape thereof is brazed so as to be bent approximately 90 °. . When the distal end of the catheter 20 is delivered from the opening of the guiding catheter, as shown in FIG. 6A, the distal end 20b bends 90 ° from the linear shape on the proximal end side, and the distal end opening 20a passes through the wall of the blood vessel 100. Deformed to face. Note that the distal end portion of the catheter 20 may be configured to bend with a wire or the like, for example.

  Moreover, the catheter 20 shown to FIG. 6A becomes a suitable shape when treating the aneurysm 102 formed in the side surface of the blood vessel 100 extended linearly. In addition to this, in the aneurysm treatment method, it is preferable to select a catheter having an appropriate shape in accordance with the treatment site (where the aneurysm 102 is generated). For example, in the case where an aneurysm is formed at the connection portion of the blood vessel that branches in a substantially Y shape, the distal end opening may be opposed to the opening of the aneurysm using a linear catheter.

[Insert step]
After the delivery step, an insertion step is performed as shown in FIG. 6B. In the insertion step, the elongate body 16 is advanced while the distal end opening 20 a of the catheter 20 is positioned and fixed to the opening 108 of the aneurysm 102. As a result, the distal end side of the treatment portion main body 14 (the distal end side of the long body 16 and the clip portion 18) is delivered from the distal end opening 20a of the catheter 20 and inserted into the aneurysm 102. This advancement movement is performed until the entire clip portion 18 enters the pool portion 106 of the knob 102.

  As described above, in the natural state, the clip portion 18 has the four extending portions 30 extending in parallel with each other, and has an outer diameter smaller than that of the neck portion 104 of the knob 102. Therefore, as the elongated body 16 moves forward, the clip portion 18 can be smoothly delivered from the housing lumen 60 of the catheter 20, and the clip portion 18 can be easily inserted into the pool portion 106 of the aneurysm 102. I can go. At the time of the insertion step, the shaft 12 and the treatment portion main body 14 may be moved forward and a little so that the corresponding contact portion 24 is disposed at a position where the tip surface of the contact portion 24 faces the inside of the aneurysm 102. Thereby, since the advancing direction of the treatment portion main body 14 is linearly guided by the contact portion 24, the clip portion 18 can be more smoothly entered into the knob 102.

[Expansion step]
After the insertion step, an expansion step is performed as shown in FIG. 7A. In the expanding step, only the shaft 12 is moved forward while the movement of the treatment portion main body 14 inserted into the aneurysm 102 is stopped (fixed). As a result, the contact portion 24 at the tip of the shaft 12 enters the knob 102. In the vicinity of the contact portion 24 passing through the neck portion 104, the outer surface (corner portion) of the contact portion 24 comes into contact with the proximal end surface of the engaging portion 38, and is inclined and extended in the proximal direction. The engaging portion 38 is pushed by the contact portion 24 and guided in the expanding direction. Thereby, the contact part 24 enters the inside of the extension part 30.

  When the contact part 24 is further moved forward, the outer surface of the contact part 24 is brought into sliding contact with the inner side surface (opposing part) of the extension part 30, and the extension part 30 is expanded so as to be pushed outward. Go. When the abutting portion 24 is brought close to the distal end continuous portion 28, the engaging portion 38 is elastically deformed to a state where the engaging portion 38 is sufficiently expanded more than the neck portion 104.

[Contact step]
After the expansion step, as shown in FIG. 7B, the contact step is performed. In the contact step, the shaft 12 and the treatment portion main body 14 (long body 16) are simultaneously moved backward. That is, the clip portion 18 and the contact portion 24 are integrally formed in a state where the contact portion 24 is close to the tip continuous portion 28 of the clip portion 18 and the extending portion 30 is greatly expanded (the state shown in FIG. 7A). By moving backward, the engaging portion 38 of the clip portion 18 comes into contact with the wall portion 106 a in the vicinity of the root portion of the reservoir portion 106 connected to the neck portion 104.

  When the shaft 12 and the treatment portion main body 14 are further moved backward, the engaging portion 38 acts to push down the wall portion 106a at the base portion of the reservoir portion 106 and bring the reservoir portion 106 toward the blood vessel 100 side. With this depression, the blood flowing into the reservoir 106 flows out into the blood vessel 100, and the volume in the aneurysm 102 (reservoir 106) becomes smaller and contracts. Further, the wall portion 106 a of the root portion of the reservoir portion 106 is bent with respect to the neck portion 104 of the knob 102, and the proximal-side facing portion 36 a continuous with the engaging portion 38 is in close contact with the wall portion 106 a of the reservoir portion 106.

(Pinch step)
After the contact step, as shown in FIG. 8A, the sandwiching step is performed. In the sandwiching step, only the shaft 12 is moved backward while the movement of the treatment portion body 14 is stopped. As a result, the contact portion 24 that has expanded (elastically deformed) the extended portion 30 retreats from the clip portion 18 and acts so that the extended portion 30 is restored to a natural state. That is, the diameter is reduced so that the proximal-side facing portions 36a of the extending portions 30 are close to each other.

  For this reason, the wall 102a of the aneurysm 102 in which the proximal end facing portion 36a and the engaging portion 38 are in contact (contacted) is subjected to stress due to restoration, and the wall 104a and the reservoir 106 of the neck 104 are attracted. The wall portion 106a is sandwiched so as to be folded. In a state in which the contact portion 24 is moved backward from the neck portion 104 of the aneurysm 102, the wall portion 104 a is in close contact with the elongated body 16 inserted into the neck portion 104, and the neck portion 104 is occluded with respect to the blood vessel 100. . Thereby, the inflow of blood into the aneurysm 102 is blocked. In addition, even if the abutting portion 24 is retracted, the clip portion 18 is not completely restored to the natural state, so the four extending portions 30 continue to push the wall portion 102a of the knob 102 toward the long body 16 (inside). Acts as follows. That is, the sandwiching by the four extending portions 30 is continued.

[Leaving step]
After the sandwiching step, the detachment step is performed as shown in FIG. 8B. In the detachment step, the detachment mechanism 50 is operated in a state where the neck portion 104 of the aneurysm 102 is swallowed by the distal end side of the long body 16 and the clip portion 18. That is, by operating the operating element 52 of the hub 22, the cutting blade 58 of the detachment mechanism 50 is moved forward to cut the long body 16 (see also FIG. 4C). As a result, the distal end side of the long body 16 and the clip portion 18 are detached from the proximal end side of the long body 16.

[Backward step]
After the departure step, the reverse step is performed. In the retreating step, the proximal end side of the shaft 12 and the treatment portion main body 14 (elongate body 16) is retreated to accommodate the treatment portion main body 14 in the catheter 20, and then the treatment portion main body 14 and the catheter 20 are moved. The blood vessel 100 is moved backward and removed from the blood vessel 100. As a result, the distal end side of the long body 16 and the clip portion 18 are left in the knob 102. In this indwelling state, the neck portion 104 of the aneurysm 102 is blocked and the inflow of blood into the aneurysm 102 is continuously blocked. Harden.

  As described above, according to the aneurysm treatment method using the aneurysm treatment device assembly 10 according to the present exemplary embodiment, the neck 104 is closed while the aneurysm 102 is contracted. It should be noted that the aneurysm treatment device assembly 10 (clip portion 18) according to the present invention is not limited to the above-described configuration, and can have various configurations that can sandwich the aneurysm 102 from the inside. Hereinafter, another form (modification) of the clip portion will be described with reference to FIGS. 9A to 9D.

  The clip portion 19A according to the first modification shown in FIG. 9A is different from the clip portion 18 according to the present embodiment in that the engaging portions 38 of the adjacent extending portions 31a are connected by the bridging portion 94. Different. That is, the bridging portion 94 is continuously provided on the base end side of the two engaging portions 38, so that the two extending portions 31a are integrally elastically deformable. In this way, by connecting the two extending portions 31a, the base end side facing portion 36a, the engaging portion 38 and the bridging portion 94 of the extending portion 31a are connected to the wall portion 102a (wall portion) of the knob 102 (reservoir portion 106). Can be stably pressed against the portion 106a). Therefore, the knob 102 can be more firmly sandwiched from the inside by the clip portion 19A.

  The clip portion 19B according to the second modification shown in FIG. 9B is different from the embodiment and the first embodiment in that one extending portion 31b extends from the distal end portion (the distal end continuous portion 28) of the elongated body 16. It is different from the clip portions 18 and 19A according to one modification. Thus, even in the configuration including the long body 16 and the one extending portion 31b, the wall portion 102a of the knob 102 can be sandwiched between them. That is, the distal end side of the long body 16 can be grasped as another extension part having a function of sandwiching the wall part 102a of the knob 102 by cooperating with the extension part 31b. That is, it is sufficient that two or more extending portions 30 (including the long body 16) constituting the clip portion 18 are provided so as to be able to sandwich the wall portion 102a of the knob 102, and the number thereof is limited. Not.

  In the clip portion 19C according to the third modification shown in FIG. 9C, an arc portion 96 that is once curved outward is formed at a midpoint position of the trunk portion 36 of the extending portion 31c (the distal end side of the proximal-side facing portion 36a). This is different from the clip portions 18, 19A and 19B according to the present embodiment and the first and second modifications. Thus, when the circular arc part 96 is provided in the extension part 31c, in the state where the extension part 31c sandwiches the wall part 102a of the knob 102, the proximal-side facing part that contacts the wall part 102a of the knob 102 The restoring force (stress) of the extending portion 31c can be concentrated on 36a. Therefore, the sandwiching of the wall 102a of the knob 102 by the proximal end facing portion 36a can be further strengthened.

  The aneurysm treatment device assembly 10A according to the fourth modified example shown in FIG. 9D uses the clip portion 18 according to the present embodiment, but the abutment portion 24a is detached and placed in the neck portion 104 of the aneurysm 102. This is different from the aneurysm treatment device assembly 10 according to the present embodiment in that it is configured as described above. In this way, by removing the abutting portion 24a together with the clip portion 18, the aneurysm 102 is formed between the abutting portion 24a whose diameter is larger than that of the long body 16 and the extending portion 31d (base end side facing portion 36a). It is possible to sandwich the wall portion 102a. In addition, since the contact portion 24a is placed in the neck portion 104, the contact portion 24a serves as a blocking member that blocks the blood flow path, and the neck portion 104 of the aneurysm 102 is more reliably secured. Can be occluded. In addition, as a removal mechanism of the contact part 24a, the structure which screws together the front-end | tip of the shaft 12, and the contact part 24a is mentioned, for example. That is, in a state where the contact portion 24a is disposed on the neck portion 104, the shaft 12 can be rotated to release the contact portion 24a.

  As described above, according to the aneurysm treatment device assembly 10 according to the present exemplary embodiment, the clip portion 18 has the plurality of extending portions 30 extending in the proximal direction, and the plurality of extending portions in the natural state. By forming the proximal-side facing portions 36a of the projecting portion 30 close to each other, the treatment portion main body 14 can be easily accommodated so as to be able to advance and retract even with respect to a microcatheter or the like having a small diameter. That is, when treating the aneurysm 102 generated in a thin blood vessel, the aneurysm treatment device assembly 10 can be suitably used.

  Further, the clip portion 18 can be easily inserted into the aneurysm 102 during treatment using the aneurysm treatment device assembly 10. And in the knob 102, after extending the extension part 30 by the advance movement of the shaft 12, the extension part 30 acts so that the extension part 30 may be restored to the natural state by moving the shaft 12 backward. The wall portion 102a of the knob 102 can be easily sandwiched by the proximal-side facing portion 36a of the extended portion 30. At this time, the clip portion 18 sandwiches the wall portions 104 a and 106 a near the neck portion 104 of the aneurysm 102 connected to the blood vessel 100 so as to be folded, and closes the neck portion 104 of the aneurysm 102 in a contracted state. After the treatment with the aneurysm treatment device assembly 10, the clip portion 18 is placed in the aneurysm 102, so that the closed state of the neck 104 of the aneurysm 102 is maintained. It can be surely deterred.

  Further, since the engaging portion 38 extends from the proximal-side facing portion 36a obliquely outward in the proximal direction, the engaging portion 38 is moved when the clip portion 18 in the expanded state is moved to the proximal side. Can be brought into close contact with the wall portion 106 a of the root portion of the reservoir portion 106. Therefore, when the plurality of engaging portions 38 are brought close to each other when the clip portion 18 is restored, the wall portion 106a follows the engaging portion 38, and the neck portion 104 vicinity of the aneurysm 102 is further improved. Can be pinched.

  Further, since the contact portion 24 having a diameter larger than the outer diameter of the shaft 12 is provided at the tip of the shaft 12, when the contact portion 24 is moved forward and contacted with the extension portion 30, the extension portion It is possible to expand the base end side facing portion 36 a and the engaging portion 38 of 30 sufficiently wider than the neck portion 104 of the knob 102. Therefore, the extended portion 30 in the expanded state easily comes into contact with the wall portion 106a, and when the clip portion 18 is restored, the knob 102 can be more reliably sandwiched by the plurality of extended portions 30.

  Further, since the separation mechanism 50 is provided in the contact portion 24 whose diameter is larger than that of the shaft 12, the main structure (the drive mechanism 56 and the cutting blade 58) of the separation mechanism 50 can be easily accommodated. There is no need to provide a separate release mechanism. Therefore, the shaft 12 can be formed thin.

  In the above description, the present invention has been described with reference to preferred embodiments. However, the present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the scope of the present invention. Needless to say. For example, the length that the extending portion 30 extends (the axial length of the clip portion 18) may be longer than the inner diameter of the reservoir portion 106. In this case, when the abutting part 24 moves forward to the tip part and the clip part 18 expands in the pool part 106, the engaging part 38 abuts on the inner surface of the knob 102 and deforms its shape to expand the diameter. can do. As a result, the deformed aneurysm 102 can be sandwiched between the clip portions 18.

DESCRIPTION OF SYMBOLS 10, 10A ... Aneurysm treatment device assembly 12 ... Shaft 14 ... Treatment part main body 16 ... Long body 18, 18a-18d, 19A-19C ... Clip part 20 ... Catheter 24, 24a ... Contact part 28 ... Tip connection part 30, 30a-30d, 31a-31d ... extension part 36 ... body part 36a ... proximal end facing part 38, 38a-38d ... engagement part 50, 50A, 51a-51e ... detachment mechanism 100 ... blood vessel 102 ... lumbar 104 ... Neck 106 ... Reservoir 108 ... Opening

Claims (6)

An indwelling portion that has a predetermined elastic force and can be inserted into an aneurysm formed in a living body lumen;
A shaft that supports the indwelling part and is relatively movable relative to the indwelling part, and
The indwelling portion includes a plurality of extending portions extending in the proximal direction and a distal end connecting portion for connecting and supporting distal ends of the plurality of extending portions, and at least the plurality of extending portions in a natural state. The opposing parts located on the base end side of the part have a shape close to each other,
The plurality of extending portions are elastically deformed and expanded as a result of contact by the advance movement of the shaft, and are elastically restored from the expanded state as the shaft is retracted, and the opposing portions are An aneurysm treatment device assembly characterized in that a wall portion is sandwiched and detached from the shaft in a state where the aneurysm is sandwiched. The aneurysm treatment device assembly according to claim 1.
The plurality of extending portions include an engaging portion that is continuous with the opposing portion and extends obliquely outward in the proximal direction. An aneurysm treatment device assembly. The aneurysm treatment device assembly according to claim 1 or 2,
The shaft has a hollow portion extending in the axial direction;
The aneurysm treatment device assembly, wherein the distal end continuous portion is connected to a long body inserted through the hollow portion, and is detained in the aneurysm by separation of the long body. The aneurysm treatment device assembly according to claim 3.
The tip portion of the shaft is provided with an abutting portion that has an outer diameter larger than the outer diameter of the shaft, moves forward along the axial direction of the elongated body, and abuts on the extending portion. An aneurysm treatment device assembly. The aneurysm treatment device assembly according to claim 4.
An aneurysm treatment device assembly, wherein the contact portion is provided with a separation mechanism that separates the long body and allows the separated long body on the distal end side to be detached from the shaft. A plurality of extending portions extending in the proximal direction and having a predetermined elastic force and being inserted into the aneurysm formed in the body lumen, and a distal end link for connecting and supporting the distal ends of the plurality of extending portions. An indwelling portion having a configuration in which at least a facing portion located on a proximal end side of the plurality of extending portions is close to each other in a natural state, and supporting the indwelling portion and the indwelling portion An aneurysm treatment method using an aneurysm treatment device assembly comprising a relatively movable shaft,
A delivery step of accommodating the indwelling portion and the shaft in a catheter and positioning the opening of the catheter in the opening of the aneurysm;
After the delivery step, an insertion step of advancing and moving the indwelling portion from the opening of the catheter and inserting the indwelling portion into the aneurysm;
After the inserting step, the shaft is advanced and moved, and the extending portion is elastically deformed and expanded by contacting the ends of the shaft with the plurality of extending portions; and
After the expanding step, an abutting step in which the indwelling portion and the shaft are moved backward together to bring the facing portion into contact with the wall portion of the knob.
After the abutting step, the shaft is retracted to elastically restore the extended portion in the expanded state, thereby sandwiching the wall portion of the knob by the plurality of extended portions; and
A method of treating aneurysm, comprising: a detaching step of detaching the indwelling portion from the shaft and indwelling in the aneurysm after the sandwiching step.

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