JP2016523135A - 標的神経線維の調節 - Google Patents
標的神経線維の調節 Download PDFInfo
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- JP2016523135A JP2016523135A JP2016517972A JP2016517972A JP2016523135A JP 2016523135 A JP2016523135 A JP 2016523135A JP 2016517972 A JP2016517972 A JP 2016517972A JP 2016517972 A JP2016517972 A JP 2016517972A JP 2016523135 A JP2016523135 A JP 2016523135A
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Abstract
Description
II.神経調節の種類
A.機械的神経調節
B.装置ベースの神経調節
C.エネルギーベースの神経調節
1.高周波
1.4ミリメートルの直径の動脈
2.中膜の厚さは2ミリメートルである
3.外部血管冷却はなし(電極冷却が電極近傍の反応を支配するため、この仮定は適切である)
4.1〜2ミリメートルの電極直径
5.電極は冷却され、その表面は約37℃に維持される
2.超音波
3.レーザ
4.外部からの開始
D.蒸気/熱湯による神経調節
E.化学的神経調節
F.冷凍調節
III.画像誘導、マッピング、および選択的位置決め
IV.別のカテーテル送達方法
V.刺激
VI.実施例
A.実施例1
B.実施例2
3.実施例3
D.実施例4
E.実施例5
F.実施例6
G.実施例7
電力=K1-K2e(−K 3 *流量)
上記式中、K1=11.27、K2=10.28、K3=151.59である。
H.実施例8
1)血液の抵抗(R血液)
2)組織塊の「バックグラウンド」または「リモート」抵抗(Rリモート)
3)単極電極近傍組織(目標組織)の抵抗、R組織
Claims (49)
- 肝臓神経調節用装置であって、
近位端および遠位端を有するカテーテル本体であって、肝動脈分岐部内への経皮的血管内留置用として構成されたカテーテル本体と、
該カテーテル本体の遠位端の操作可能な部分と、
該操作可能な部分に配置された少なくとも1つの電極とを備え、
該操作可能な部分が、該肝動脈分岐部内で該カテーテルの安定化を可能とし、該少なくとも1つの電極と該肝動脈分岐部の動脈内壁との接触を容易にするように構成され、
該少なくとも1つの電極が、該肝動脈分岐部の少なくとも一部の除神経を行うのに充分な熱エネルギーを送出するために作動されるよう構成され、
該操作可能な部分が、1つまたは複数の引張りワイヤにより作動されて1つまたは複数の屈曲形状を形成して、該肝動脈分岐部内で解剖学的屈曲部に適合するようにまたは該肝動脈分岐部へのアクセスを容易にするように構成された1つまたは複数の可撓性屈曲セグメントを備え、
第1の可撓性屈曲セグメントが作動時に第1の動脈屈曲部に適合するように構成され、第2の可撓性屈曲セグメントが作動時に第2の動脈屈曲部に適合するように構成され、
該第1の可撓性屈曲セグメントおよび該第2の可撓性屈曲セグメントが、作動時にS形状を形成する、装置。 - 該少なくとも1つの電極に隣接して位置決めされ、該電極を通る動脈流を増やし、それにより該少なくとも1つの電極の冷却を容易にするように構成された閉塞要素をさらに備える、請求項1に記載の装置。
- 該少なくとも1つの電極が、熱エネルギーを該肝動脈分岐部内の複数の位置に同時にまたは順次に送出するように構成された複数の電極を備える、請求項1に記載の装置。
- 該第1の可撓性屈曲セグメントの関節が、第1の引張りワイヤにより制御され、該第2の可撓性屈曲セグメントの関節が第2の引張りワイヤにより制御される、請求項1〜3のいずれかに記載の装置。
- 外側シースをさらに含み、該カテーテル本体が該外側シースの管腔内に送達されるように構成され、該外側シースに対して移動可能である、請求項1〜3のいずれかに記載の装置。
- 該第1の可撓性屈曲セグメントが該カテーテル本体長さの遠位20%に配置または形成され、該第2の可撓性屈曲セグメントが該カテーテル本体長さの遠位5%に配置または形成される、請求項1〜3のいずれかに記載の装置。
- 該カテーテル本体が、該肝動脈分岐部内の位置への該装置の送達の間にガイドワイヤに追従するように構成された管腔を備える、請求項1〜3のいずれかに記載の装置。
- 第3の屈曲部さらに備える、請求項1〜3のいずれかに記載の装置。
- 該カテーテル本体が、力センサをさらに含む、請求項1〜3のいずれかに記載の装置。
- 第1の可撓性屈曲セグメントの関節が第1の引張りワイヤで制御され、
第2の可撓性屈曲セグメントの関節が第2の引張りワイヤで制御され、
該カテーテル本体が、外側シースの管腔内に送達されるように構成され、該外側シースに対して移動可能であり、および
該カテーテル本体が、該肝動脈分岐部内への位置への該装置の送達の間に、ガイドワイヤに追随するように構成された管腔を備える、請求項1に記載の装置。 - 肝臓神経調節用装置であって、
近位端および遠位端を有するカテーテル本体であって、肝動脈分岐部内への経皮的血管内留置用として構成されたカテーテル本体と、
該カテーテル本体の遠位端の操作可能な部分と、
該操作可能な部分に配置された少なくとも1つの電極とを備え、
該操作可能な部分が、該肝動脈分岐部内で該カテーテルの安定化を可能とし、該少なくとも1つの電極と該肝動脈分岐部の動脈内壁との接触を容易にするように構成され、
該少なくとも1つの電極が、該肝動脈分岐部の少なくとも一部の除神経を行うのに充分な熱エネルギーを送出するために作動されるように構成され、
該操作可能な部分が、標的位置で外側に拡張して該肝動脈分岐部の該動脈内壁と接触するように構成された1つまたは複数の可撓性リボンワイヤまたはケーブルを備え、
該少なくとも1つの電極が前記1つまたは複数の可撓性リボンワイヤまたはケーブルの内の少なくとも1つに配置される、装置。 - 外側シースをさらに含み、該カテーテル本体が、該外側シースの管腔内に送達されるように構成され、該外側シースに対して移動可能である、請求項11に記載の装置。
- 該少なくとも1つの電極に近接して位置決めされ、該電極を通る動脈流を増やすことにより、該少なくとも1つの電極の冷却を容易にするように構成された閉塞要素をさらに備える、請求項11に記載の装置。
- 該少なくとも1つの電極が、熱エネルギーを該肝動脈分岐部内の複数の位置に同時にまたは順次に送出するように構成された複数の電極を備える、請求項11〜13のいずれかに記載の装置。
- 該1つまたは複数の可撓性リボンワイヤまたはケーブルが、フレキシブル機構に対し反力を加えるように構成される、請求項11〜13のいずれかに記載の装置。
- 血管管腔周辺の神経の神経調節に適した装置であって、
第1の末端、第2の末端および該第1の末端から該第2の末端へ伸びる管腔を含む中空シャフトと、
該シャフトの遠位端に位置決めされたバルーンであって、該シャフトの管腔を通る流体の導入により、収縮形状から膨張形状に移行するように構成され、該膨張形状にある場合には、該シャフトの周囲の85%から95%周辺に配置されるバルーンと、
該バルーンで覆われていない該シャフトの位置に位置決めされた電極とを備え、
該膨張形状では、該バルーンが血管の断面積の一部を閉塞することにより該電極周辺の血流速度を高める、装置。 - 該電極が、該血管周辺の1つまたは複数の交感神経の除神経を生じさせるのに充分なエネルギーを送出するように構成される、請求項16に記載の装置。
- 該バルーンにより覆われていない該シャフトの長さに沿って配置された複数の電極をさらに備える、請求項16または17に記載の装置。
- 肝臓神経調節用装置であって、
近位端、遠位端および管腔を備えるシャフトと、
該シャフトの遠位端の遠位先端部に位置決めされた電極であって、該シャフトが、第1の領域、第2の領域および第3の領域を含み、該第1の領域が、該電極の近位にある弾力的に変形可能な領域を含み、該第2の領域が、該弾力的に変形可能な領域の近位にある関節運動可能な領域を含み、該第3の領域が、該関節運動可能な領域の近位にあるねじり剛性領域を含み、該第1の領域、該第2の領域および該第3の領域の内の少なくとも1つの領域が、肝動脈のねじれを通り抜けるように構成された電極と、
該関節運動可能な領域の遠位端から該シャフトの近位端まで伸びる引張りワイヤであって、該遠位先端部の電極を関節を使って該肝動脈の内壁に向け、該内壁に対する該電極の均一な接触力を維持するように構成された引張りワイヤとを備え、
該電極が、該肝動脈の少なくとも一部の除神経を行うのに充分な熱エネルギーを送出するために作動されるように構成される、装置。 - 該電極の直径が、該電極の長さに等しい、請求項19に記載の装置。
- 該ねじり剛性領域が可撓性であり、該ねじり剛性領域が少なくとも1方向でねじり剛性を有する、請求項19に記載の装置。
- 該関節運動可能な領域が、該均一な電極接触力の維持を容易にするためにカンチレバー支持を可能とするように構成される、請求項19に記載の装置。
- 該関節運動可能な領域の長さが、0.5から2cmである、請求項19〜22のいずれかに記載の装置。
- 該シャフトがハイポチューブを含み、該ねじり剛性領域が、該ねじり剛性領域の長さに沿って変化する断続スパイラルカットパターンを備える、請求項19〜22のいずれかに記載の装置。
- 該関節運動可能な領域がスパインカットパターンを備える、請求項19〜22のいずれかに記載の装置。
- 該関節運動可能な領域が、180°関節を可能とするように構成される、請求項19〜22のいずれかに記載の装置。
- 該ねじり剛性領域が可撓性であり、該ねじり剛性領域が少なくとも1方向でねじり剛性を有し、
該関節運動可能な領域が、該均一な電極接触力の維持を容易にするためにカンチレバー支持を可能とするように構成され、
該シャフトがハイポチューブを含み、該ねじり剛性領域が、該ねじり剛性領域の長さに沿って変化する断続スパイラルカットパターンを備え、
該関節運動可能な領域がスパインカットパターンを備える、請求項19に記載の装置。 - 動脈内壁周辺の神経の神経調節方法であって、
対象の脈管構造中に高周波(RF)アブレーションカテーテルを挿入することであって、該RFアブレーションカテーテルが、第1の動脈部分の第1の解剖学的屈曲部に適合する第1の屈曲部を形成するように構成され、第2の動脈部分の第2の解剖学的屈曲部に適合する第2の屈曲部を形成するように構成され、該第1の屈曲部および該第2の屈曲部が一緒にS形状を形成する、高周波アブレーションカテーテルを挿入すること、
該RFアブレーションカテーテルに該第1の屈曲部および該第2の屈曲部を形成させて、該RFアブレーションカテーテルの少なくとも1つの電極を該動脈の内壁と接触して位置決めすること、および
該RFアブレーションカテーテルに治療有効量のRFエネルギーを該動脈の内壁に向けて血管内送出させて、該動脈の内壁周辺の1つまたは複数の交感神経をアブレーションすることを含み、
該RFアブレーションカテーテルが、該RFエネルギーが送出されている間に、該動脈の内壁に対し該少なくとも1つの電極の接触を維持するように構成される、方法。 - 該RFアブレーションカテーテルが、該RFアブレーションカテーテルの肝動脈に隣接した位置または肝動脈内の位置への前記前進の間に、該第1の解剖学的屈曲部および該第2の解剖学的屈曲部に適合するように構成された操作可能な遠位部を備える、請求項28に記載の方法。
- 該操作可能な遠位部が、該第1の屈曲部および該第2の屈曲部を形成するように構成された形状記憶材料を含む、請求項29に記載の方法。
- 該操作可能な遠位部が、1つまたは複数の引張りワイヤにより機械的に拡張されて該第1の屈曲部および該第2の屈曲部を形成するように構成される、請求項29に記載の方法。
- 該治療有効量のRFエネルギーが、約300Jから約1kJの範囲である、請求項28〜31のいずれかに記載の方法。
- 該治療有効量のRFエネルギーが、約0.1Wから約10Wの出力レベルを有する、請求項28〜31のいずれかに記載の方法。
- 該RFエネルギーが、約3Wから約8Wの出力レベルを有する、請求項33に記載の方法。
- 該RFエネルギーにより標的にされていない該総肝動脈の一部に冷却を付与することをさらに含む、請求項28〜31のいずれかに記載の方法。
- 該少なくとも1つの電極に冷却を付与することをさらに含む、請求項28〜31のいずれかに記載の方法。
- 前記冷却が、該カテーテル内または該少なくとも1つの電極に隣接する血流内に生理食塩水を注入することを含む、請求項35または36に記載の方法。
- 前記冷却が、該少なくとも1つの電極の上流の流れを妨害して、該少なくとも1つの電極を通る該動脈血流速度を高めることにより、増加した血流による対流冷却を付与することを含む、請求項35または36に記載の方法。
- 第1の屈曲部が該カテーテル長さの20%遠位に位置しまたは形成され、第2の屈曲部が該カテーテル長さの5%遠位に位置しまたは形成される、請求項28〜31のいずれかに記載の方法。
- 該少なくとも1つの電極が該内壁と接触しているかどうかに関してフィードバックを受けることをさらに含む、請求項28〜31のいずれかに記載の方法。
- 該1つまたは複数の交感神経の長さに沿って伝導を測定することにより、該1つまたは複数の交感神経のアブレーションをリアルタイムで確認することをさらに含む、請求項28〜31のいずれかに記載の方法。
- 肝臓を神経支配する神経を調節するための、請求項1〜27のいずれかに記載の装置の使用。
- 肝動脈周辺の神経を調節するための、請求項1〜27のいずれかに記載の装置の使用。
- 糖尿病に関連する症状を治療するための、請求項1〜27のいずれかに記載の装置の使用。
- 神経調節用装置であって、
近位端および遠位端を有する細長い本体であって、蛇行動脈内への経皮的血管内留置用として構成される細長い本体と、
該細長い本体の遠位端の操作可能な部分と、
該操作可能な部分に配置された少なくとも1つの電極とを備え、
該操作可能な部分が、該蛇行動脈内で安定化を可能とするように構成され、および該少なくとも1つの電極と該蛇行動脈の内壁との接触を容易にするように構成され、
該少なくとも1つの電極が、該蛇行動脈の少なくとも一部の除神経を行うのに充分な熱エネルギーを送出するために作動されるよう構成され、
該操作可能な部分が、1つまたは複数の引張りワイヤにより作動されて1つまたは複数の屈曲形状を形成して、該動脈内で解剖学的屈曲部に適合するようにまたは該蛇行動脈へのアクセスを容易にするように構成された1つまたは複数の可撓性屈曲セグメントを備え、
第1の可撓性屈曲セグメントが作動時に第1の動脈屈曲部に適合するように構成され、第2の可撓性屈曲セグメントが作動時に第2の動脈屈曲部に適合するように構成される、装置。 - 該第1の可撓性屈曲セグメントの関節が第1の引張りワイヤにより制御され、該第2の可撓性屈曲セグメントの関節が第2の引張りワイヤにより制御される、請求項45に記載の装置。
- 外側シースをさらに含み、該細長い本体が該外側シースの管腔内に送達されるように構成され、該外側シースに対して移動可能である、請求項45に記載の装置。
- 該細長い本体が、ガイドワイヤに追従するように構成された管腔を備える、請求項45〜47のいずれかに記載の装置。
- 該細長い本体が、予め形成されている屈曲形状をさらに備える、請求項45〜47のいずれかに記載の装置。
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EP3003191A4 (en) | 2017-02-08 |
US20160128767A1 (en) | 2016-05-12 |
EP3003191A1 (en) | 2016-04-13 |
CN105473089A (zh) | 2016-04-06 |
CA2913346A1 (en) | 2014-12-11 |
AU2014274903B2 (en) | 2019-03-07 |
AU2014274903A1 (en) | 2015-12-17 |
US20200197086A1 (en) | 2020-06-25 |
WO2014197625A1 (en) | 2014-12-11 |
JP6580034B2 (ja) | 2019-09-25 |
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