JP2020048605A - Catheter and treatment method using the same - Google Patents

Abstract

To provide a catheter and a treatment method using the same capable of easily performing catheter replacement work and effectively supporting a guide wire.SOLUTION: The shaft 12 of a catheter 10A comprises: a tip shaft part 16 having a tip side lumen 20; and a base end shaft part 18 which has a base end side lumen 24 and extends from the base end of the tip shaft part 16 to a hub 14 to be coaxial with the tip shaft part 16. An insertion part 26 for leading a guide wire GW out of the base end shaft part 18 from the base end side lumen 24 is provided in a lumen formation wall part 25 which forms the base end side lumen 24.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a catheter provided with a shaft portion for supporting a guidewire when a guidewire is passed through a stenosis portion or an occlusion portion formed in a living body lumen, and a treatment method using the catheter.

  As this kind of catheter, a so-called over-the-wire catheter in which a lumen through which a guide wire is inserted is formed over the entire length of the catheter is used. In such a catheter, since the guide wire and the catheter can be coaxially arranged over the entire length of the catheter, the pushability (pushability) of the guide wire when passing the guide wire through the stenosis or occlusion is reduced. Are better.

  However, in the case of an over-the-wire catheter, when exchanging the catheter while the guide wire is indwelled in the body lumen, it is necessary to expose the guide wire to the outside of the living body by at least the entire length of the catheter. is there. That is, the length of the guide wire is twice or more the total length of the catheter. In addition, the replacement operation of the catheter becomes complicated, and the operation time is lengthened.

  On the other hand, Patent Literature 1 discloses a so-called rapid exchange type catheter that can shorten the length of a guide wire and facilitate the operation of replacing a catheter. This catheter has a tubular distal shaft portion through which a guide wire is inserted, and a proximal shaft portion made of a solid wire connected to a proximal end portion of the distal shaft portion.

JP 2004-275435 A

  In the above-described catheter, the lumen through which the guide wire is inserted is formed only in the distal shaft portion. Therefore, depending on the position, size, shape, and the like of the stenotic portion or the closed portion, the wall surface forming the lumen when passing the guide wire sufficiently suppresses the deflection of the guide wire in the direction orthogonal to the axial direction (the guide wire is Support).

  The present invention has been made in view of such problems, and a catheter and a treatment method using the catheter, which can easily perform a catheter replacement operation and can effectively support a guide wire. The purpose is to provide.

  One embodiment of the present invention is a catheter including a flexible shaft that supports a guidewire, and a hub provided at a proximal end of the shaft, wherein the shaft is inserted with the guidewire. A distal shaft portion having a distal lumen, and a proximal lumen communicating with the distal lumen, and extending from the proximal end of the distal shaft portion to the hub so as to be coaxial with the distal shaft portion. A proximal shaft portion, and a lumen forming wall portion forming the proximal side lumen, the insertion portion for leading the guide wire from the proximal side lumen to the outside of the proximal end shaft portion. Is a catheter.

  Another aspect of the present invention is a flexible shaft that supports the guidewire when the guidewire is passed through a stenosis or occlusion in a lower limb blood vessel, and a hub provided at a proximal end of the shaft. A treatment method using a catheter comprising: a distal end shaft portion having a distal side lumen through which the guide wire is inserted, and a proximal end side through which the guide wire is inserted in communication with the distal side lumen. A proximal shaft portion having a lumen and extending from the proximal end of the distal shaft portion to the hub so as to be coaxial with the distal shaft portion; and forming a proximal lumen. The wall portion is provided with a plurality of insertion portions for guiding the guide wire from the proximal lumen to the outside of the proximal shaft portion. Introducing from a pulse, guiding catheter placement step of placing the distal end of the guiding catheter in the lower limb artery, preparing step of preparing the catheter, and part of the proximal lumen and the distal lumen An insertion for inserting the guide wire through the entire length of the guiding catheter and passing the catheter through the lumen of the guiding catheter in a state where the catheter is led out of the proximal shaft portion via any one of the plurality of insertion portions. Step, a guide wire passing step of passing the guide wire through the stenotic portion or the closing portion with the catheter protruding from the distal end of the guiding catheter, and passing the guide wire through the stenotic portion or the closing portion. Removing the catheter out of the body while remaining in place over the body. Wherein in the inserting step, the constriction or in response to constriction of the closed portion, changing the insertion portion for leading out the guide wire, a treatment method using the catheter.

  According to one aspect of the present invention, since the insertion portion is provided in the lumen forming wall portion of the proximal shaft portion, the entire length of the guide wire can be shortened as compared with an over-the-wire type catheter, and the guide wire can be used as a living body. The replacement operation of the catheter can be easily performed in a state where the catheter is kept in the lumen. Further, since the guide wire can be inserted through only the entire length of the distal side lumen and a part of the proximal side lumen, the guide wire can be effectively supported.

  According to another aspect of the present invention, the length of the monorail portion where the shaft and the guide wire are coaxially arranged can be adjusted according to the degree of stenosis of the stenotic portion or the closed portion. The guide wire can be effectively supported when the guide wire is passed through.

It is a schematic diagram of a catheter according to a first embodiment of the present invention. FIG. 2 is a partially omitted longitudinal sectional view of the shaft of FIG. 1. FIG. 3A is a perspective explanatory view of the insertion portion of FIG. 1, and FIG. 3B is a plan view of the insertion portion of FIG. 3A. 2 is a flowchart illustrating a treatment method using the catheter of FIG. 1. FIG. 5A is a first operation explanatory view of the catheter of FIG. 1, and FIG. 5B is a second operation explanatory view of the catheter of FIG. 6A is a perspective explanatory view showing a modified example of the insertion portion, FIG. 6B is a first operation explanatory diagram of the insertion portion of FIG. 6A, and FIG. 6C is a second operation of the insertion portion of FIG. 6A. FIG. FIG. 7 is a partially omitted longitudinal sectional view of a shaft of a catheter according to a second embodiment of the present invention. FIG. 8 is a sectional view taken along the line VIII-VIII in FIG. 7. It is operation | movement explanatory drawing of the catheter of FIG.

  Hereinafter, preferred embodiments of a catheter and a treatment method using the catheter according to the present invention will be described with reference to the accompanying drawings.

(1st Embodiment)
The catheter 10A according to the first embodiment of the present invention shown in FIG. 1 is used when a guidewire GW is passed through a stenosis or occlusion in a blood vessel in percutaneous transluminal angioplasty (PTA). A medical instrument used to support the guidewire GW. Therefore, the catheter 10A can be used to improve a stenosis or occlusion of a blood vessel such as a peripheral blood vessel of a lower limb.

  However, the present invention is not limited to the catheter 10A used for percutaneous angioplasty. The present invention is also applicable to a catheter that supports the guidewire GW when passing the guidewire GW through a stenosis or an obstruction created in a body lumen such as a bile duct, an esophagus, and a urethra. In the following description of the catheter 10A, the direction of arrow X1 (left side) in FIG. 1 is referred to as “distal end”, and the direction of arrow X2 (right side) is referred to as “proximal end”.

  The catheter 10A includes a flexible shaft 12, and a hub 14 provided at a proximal end of the shaft 12. As shown in FIGS. 1 and 2, the shaft 12 is formed to be long and small in diameter. The total length of the shaft 12 is not particularly limited, but is set to be 600 mm to 2500 mm. In particular, when the catheter 10A is introduced from the radial artery and guided to the lower limb artery to treat the peripheral blood vessels of the lower limb, the total length of the shaft 12 is preferably 1500 mm to 2500 mm.

  The outer peripheral surface of the shaft 12 is preferably coated with a hydrophilic material (hydrophilic polymer). Examples of the hydrophilic material include, but are not particularly limited to, a copolymer of methyl vinyl ether and maleic anhydride, and a copolymer of dimethylacrylamide and glycidyl methacrylate. Thus, the shaft 12 can be smoothly and easily inserted into the body lumen.

  The shaft 12 has a tubular distal shaft portion 16 and a tubular proximal shaft portion 18 extending from the proximal end of the distal shaft portion 16 to the hub 14. The length of the distal shaft portion 16 is not particularly limited, but is set to 400 mm to 2300 mm. The length of the proximal shaft portion 18 is not particularly limited, but is set to 200 mm to 2100 mm.

  Examples of the constituent material of the tip shaft portion 16 include polyolefin (for example, polyethylene, polypropylene, polybutene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, ionomer, or a mixture of two or more of these), Examples thereof include polymer materials such as vinyl chloride, polyamide, polyamide elastomer, polyurethane, polyurethane elastomer, polyimide, and fluororesin, and mixtures thereof, and two or more polymer materials described above.

  A tapered surface 19 (see FIG. 2) whose diameter decreases toward the tip (in the direction of arrow X1) is formed on the outer peripheral surface of the tip of the tip shaft portion 16. A reinforcing member (not shown) may be embedded in the wall of the distal shaft portion 16. The reinforcing member is not particularly limited, but a reinforcing member formed in a spiral coil shape or a rod shape using tungsten, stainless steel, or the like is preferably used. The tip shaft section 16 may be provided with a contrast marker (not shown) made of a substance having radiopaque properties.

  In FIG. 2, the distal shaft section 16 is a flexible tube having a distal lumen 20 through which the guide wire GW is inserted. The distal lumen 20 extends from the distal end to the proximal end of the distal shaft portion 16 with a constant diameter D1. The diameter D1 of the distal lumen 20 (the inner diameter of the distal shaft portion 16) is not particularly limited, but is set to 0.4 mm to 1 mm. That is, the guide wire GW protrudes in the distal direction from the distal opening 22 of the distal shaft portion 16 (catheter 10A).

  The proximal shaft portion 18 is provided coaxially and integrally with the proximal end of the distal shaft portion 16. The constituent material of the proximal shaft portion 18 may be the same as the constituent material of the distal shaft portion 16 described above. The proximal shaft portion 18 is made of a material different from that of the distal shaft portion 16 and is connected to the proximal end of the distal shaft portion 16. However, the proximal shaft portion 18 may be made of the same material as the distal shaft portion 16 and may be provided integrally with the proximal end of the distal shaft portion 16.

  For example, the distal shaft section 16 may be a tubular body having a reinforcing body, and the proximal shaft section 18 may be a PEEK tube body.

  The proximal shaft portion 18 has a proximal lumen 24 which communicates with the distal lumen 20 and through which the guide wire GW is inserted. The proximal lumen 24 extends from the distal end of the proximal shaft portion 18 to the proximal end with a constant diameter D2. The diameter D2 of the proximal lumen 24 (the inner diameter of the proximal shaft portion 18) is the same as the diameter D1 of the distal lumen 20. However, the diameter D1 and the diameter D2 may be different from each other.

  A plurality of insertion portions 26 for guiding the guide wire GW from the proximal side lumen 24 to the outside of the proximal end shaft portion 18 are provided in the lumen forming wall portion 25 that forms the proximal side lumen 24. The plurality of insertion portions 26 are provided at equal intervals along the axial direction of the proximal shaft portion 18.

  Specifically, the plurality of insertion portions 26 are substantially aligned in a direction in which the proximal shaft portion 18 extends. In other words, the plurality of insertion portions 26 are provided so as not to overlap in the circumferential direction of the proximal shaft portion 18. This can prevent the rigidity of the portion where the insertion portion 26 is provided from being excessively reduced in the axial direction of the proximal shaft portion 18. The interval L1 (see FIG. 1) between the plurality of insertion portions 26 is not particularly limited, but is preferably set to 100 mm to 300 mm, more preferably 150 mm to 250 mm.

  As shown in FIGS. 2 to 3B, the insertion portion 26 is a side hole 28 that opens in a direction orthogonal to the axial direction of the proximal shaft portion 18. The side hole 28 is a long hole extending along the axial direction of the proximal shaft portion 18. The side hole 28 has a semicircular distal opening 30 oriented in the proximal direction (the direction of the arrow X2) of the proximal shaft portion 18, and a rectangular shape (rectangular shape) extending in the proximal direction from the distal opening 30. ), And a triangular base-side opening 34 extending from the middle opening 32 to the base end from the extension end.

  3A and 3B, the distal opening 30 extends in a direction perpendicular to the axis of the proximal shaft portion 18. The width dimension W (the dimension in the direction orthogonal to the axial direction of the proximal shaft portion 18) of the intermediate opening portion 32 is constant over the entire length of the proximal shaft portion 18 along the axial direction. The width W of the intermediate opening 32 is equal to or slightly smaller than the diameter D2 (see FIG. 2) of the proximal-side lumen 24. The intermediate opening 32 extends parallel to the axis of the proximal shaft portion 18.

  As shown in FIG. 3A, the proximal opening 34 is inclined in a direction away from the axis of the proximal shaft 18 toward the proximal direction of the proximal shaft 18. The proximal opening 34 is formed narrower toward the proximal direction of the proximal shaft portion 18. In FIG. 3B, the length L2 of the side hole 28 is not particularly limited, but is set to 1 mm to 3 mm.

  The intermediate opening 32 may be inclined in a direction away from the axis of the proximal shaft portion 18 toward the proximal direction of the proximal shaft portion 18. The proximal opening 34 may extend parallel to the axis of the proximal shaft portion 18.

  As shown in FIG. 1, the hub 14 is integrally formed in a hollow shape with a resin material. The hub 14 is formed in a size that can be easily grasped manually. The hub 14 has higher rigidity than the shaft 12.

  The guide wire GW used with such a catheter 10A is a long linear member having appropriate rigidity and appropriate flexibility, and has a diameter D1 of the distal lumen 20 and a proximal lumen 24. Has an outer diameter slightly smaller than the diameter D2. The entire length of the guidewire GW is longer than the entire length of the catheter 10A, but may be relatively short because it may be inserted only through a part of the shaft 12 of the catheter 10A.

  The operation of passing the guidewire GW through the stenosis 100 formed in the blood vessel 104 such as a peripheral blood vessel of the lower limb using the catheter 10A thus configured will be described below.

  First, in the guiding catheter placement step (step S1) in FIG. 4, the operator punctures a sheath introducer into a blood vessel (for example, a radial artery) by the Seldinger method, and attaches the guide wire GW as shown in FIG. 5A. The guiding catheter 102 is introduced in advance, and the guiding catheter 102 is placed at a predetermined position in a blood vessel 105 (for example, a lower limb artery, for example, a superficial femoral artery (SFA)).

  In the catheter preparation step (step S2) in FIG. 4, the operator prepares the above-described catheter 10. Then, the operator inserts the guide wire GW into the blood vessel 104 up to a position just before the stenosis 100.

  Thereafter, in the insertion step (step S3), the operator allows the guide wire GW to be inserted over a part of the proximal-side lumen 24 and the entire length of the distal-side lumen 20, and via any of the plurality of insertion portions 26. The catheter 10 is inserted into the lumen of the guiding catheter 102 in a state where the catheter 10 is led out of the proximal shaft portion 18.

  Specifically, the operator passes the guide wire GW from the distal opening 22 of the catheter 10A to the distal lumen 20 and the proximal lumen 24, and passes the guidewire GW from the side hole 28 on the proximal side in FIG. Let it go outside. As a result, the guide wire GW is inserted only through the entire length of the distal lumen 20 and a part of the proximal lumen 24. That is, the range from the tip of the shaft 12 to the side hole 28 through which the guide wire GW is inserted (the monorail portion 36 in which the shaft 12 and the guide wire GW are coaxially arranged) allows the guide wire GW to pass through the constriction portion 100. In this case, the support portion receives a reaction force acting on the guide wire GW.

  At this time, the surgeon selects the side hole 28 through which the guide wire GW passes from the plurality of side holes 28 according to the position, size, shape, and the like of the stenosis portion 100. In other words, the surgeon needs a longer pushing distance as the distance from the guide wire GW introduction position into the blood vessel to the stenosis portion 100 is higher and the degree of stenosis is higher. The side hole 28 is selected. On the other hand, the surgeon selects the side hole 28 at a position where the shorter the distance from the guide wire GW introduction position into the blood vessel to the stenosis portion 100 and the lower the degree of stenosis, the shorter the monorail portion 36 becomes.

  Subsequently, the surgeon advances the catheter 10A through the lumen of the guiding catheter 102, and positions the distal end thereof slightly proximal to the distal end of the guide wire GW. Then, in the guide wire passing step (step S4), the operator holds the proximal end side of the guide wire GW and pushes the guide wire GW toward the distal end in a state where the catheter 10 is projected from the distal end of the guiding catheter 102, The distal end of the guide wire GW is passed through the constriction 100 (see FIG. 5B).

  At this time, a reaction force from the constriction 100 acts on the guide wire GW, but since the monorail portion 36 of the shaft 12 is in contact with and supports the guide wire GW, the guide wire GW is in a direction orthogonal to its axis. Can be suppressed. Thereby, the pushing force of the operator can be efficiently transmitted to the distal end portion of the guide wire GW. Therefore, the guide wire GW can be easily passed through the stenosis portion 100.

  Next, in a removal step (step S5), the operator removes the catheter 10 from the body while leaving the guide wire GW over the stenosis 100. At this time, since the guide wire GW is inserted only through a part of the shaft 12 (the entire length of the distal lumen 20 and a part of the proximal lumen 24), the catheter 10A can be easily removed from the guide wire GW. .

  After that, various catheters for treatment, for example, an atherectomy catheter, a balloon catheter, a stent delivery catheter, a drug-coated balloon catheter, a drug-coated stent delivery catheter, etc. are inserted along the guide wire GW to remove calcified lesions in the stenosis part 100, Perform expansion, drug application, stent placement, etc. Two or more therapeutic catheters may be used. After the completion of the treatment, the operator removes the treatment catheter and the guiding catheter 102 from the body.

  The guidewire GW and the catheter 10 may be replaced with ones having different hardness and thickness depending on the need for the hardness of the stenosis or occlusion, the size of the guidewire lumen of the treatment catheter, or the meandering of the blood vessel to the lesion. Is also good.

  In this case, the catheter 10A according to the present embodiment has the following effects.

  According to the present embodiment, since the insertion portion 26 is provided in the proximal shaft portion 18, the entire length of the guide wire GW can be shortened as compared with an over-the-wire type catheter, and the replacement operation of the catheter 10A can be easily performed. It can be carried out. In addition, since the guide wire GW can be inserted only through the entire length of the distal lumen 20 and a part of the proximal lumen 24, the guide wire GW can be reliably supported.

  A plurality of insertion portions 26 are provided along the axial direction of the proximal shaft portion 18. According to such a configuration, the length of the portion (monorail portion 36) of the shaft 12 that is arranged coaxially with the guide wire GW is adjusted according to the position, size, shape, and the like of the constricted portion or the closed portion. be able to. Thus, the guide wire GW can be more effectively supported while facilitating the replacement operation of the catheter 10A.

  The insertion portion 26 is a side hole 28 that opens in a direction orthogonal to the axial direction of the proximal shaft portion 18. According to such a configuration, the guide wire GW can be easily inserted into the side hole 28.

  The side hole 28 extends along the axial direction of the proximal shaft portion 18. According to such a configuration, it is possible to suppress the guide wire GW from being excessively bent when the guide wire GW is passed through the side hole 28.

  The catheter 10 supports a guide wire GW used when the guide wire GW is passed through a stenosis part or an occlusion part generated in a living body lumen. In this case, the guide wire GW can be effectively passed through a stenotic part or a closed part in the body lumen.

  In the treatment method using the catheter 10, the guiding catheter 102 is introduced from the arm artery, and the guiding catheter placement step of placing the distal end of the guiding catheter 102 in the lower limb artery, and the preparation step of preparing the catheter 10 The guide wire GW is inserted through a part of the proximal-side lumen 24 and the entire length of the distal-side lumen 20, and is led out of the proximal shaft portion 18 through one of the plurality of insertion portions 26. An insertion step of inserting the catheter 10 into the lumen of the guiding catheter 102 in a state, and a guide wire passing the guide wire GW to a stenosis part or an occlusion part with the catheter 10 protruding from the tip of the guiding catheter 102. Step and indwell guidewire GW beyond stenosis or occlusion The remains catheter 10 has a removal step for removal from the body, the. In the insertion step, the insertion portion 26 for leading out the guide wire GW is changed according to the degree of stenosis of the stenotic portion or the closed portion.

  According to such a method, the length of the monorail portion 36 in which the shaft 12 and the guide wire GW are coaxially arranged can be adjusted according to the degree of stenosis of the stenotic portion or the closed portion. When passing the guide wire GW through the portion, the guide wire GW can be effectively supported.

  The insertion section 26 is not limited to the configuration described above. As shown in FIG. 6A, the insertion portion 26 may be a slit 40 provided in the lumen forming wall portion 25. The slit 40 extends along the circumferential direction of the lumen forming wall 25. Specifically, the slit 40 extends in the circumferential direction of the lumen forming wall portion 25 in a range of 30 to 140 °, preferably 60 to 120 °. Such a slit 40 is opened by deforming the lumen forming wall 25.

  Specifically, as shown in FIG. 6B, for example, the slit 40 is formed by connecting a portion 42 of the lumen forming wall portion 25 adjacent to the slit 40 in the proximal direction (the direction of the arrow X2) to the inner side of the proximal lumen 24. It is opened by pressing toward. As shown in FIG. 6C, the slit 40 is opened by bending the lumen forming wall 25 in a direction orthogonal to the axial direction.

  In this modification, the insertion portion 26 is a slit 40 provided in the lumen forming wall portion 25, and the slit 40 opens by deforming the lumen forming wall portion 25. According to such a configuration, the guide wire GW can be inserted by deforming the lumen forming wall portion 25 to open the slit 40.

  The slit 40 extends along the circumferential direction of the lumen forming wall 25. According to such a configuration, the slit 40 can be easily opened.

(2nd Embodiment)
Next, a catheter 10B according to a second embodiment will be described. In the catheter 10B according to the second embodiment, the same components as those of the catheter 10A according to the above-described first embodiment are denoted by the same reference numerals, and detailed description is omitted.

  As shown in FIG. 7, the shaft 12a of the catheter 10B includes a distal shaft portion 16 and a proximal shaft portion 18a. The proximal shaft portion 18a is provided coaxially and integrally with the proximal end of the distal shaft portion 16. The proximal shaft portion 18a is provided with four side holes 28 (insertion portions 26) for inserting the guide wire GW into the proximal lumen 24. The four side holes 28 are provided at equal intervals along the axial direction of the proximal shaft portion 18a. The four side holes 28 are positioned with a phase shift of 90 ° in the circumferential direction of the proximal shaft portion 18a.

  As shown in FIGS. 7 and 8, the catheter 10B is provided with four introduction portions 50 for guiding the guide wire GW to the side hole 28 in the proximal shaft portion 18a. Specifically, the four introduction parts 50 are located so as to correspond to each of the four side holes 28.

  The introduction portion 50 is a tubular portion that protrudes radially outward from the outer peripheral surface of the proximal shaft portion 18a. In FIG. 7, an introduction hole 52 communicating with the side hole 28 is formed in the introduction portion 50. The opening 54 of the introduction hole 52 opposite to the side hole 28 is oriented in the proximal direction of the proximal shaft portion 18a (see FIG. 8). An inclined surface 56 that is inclined in the proximal direction from the proximal shaft portion 18a outward in the radial direction is provided in a portion of the wall surface that forms the introduction hole 52, facing the opening 54.

  According to the catheter 10B according to the present embodiment, as shown in FIG. 9, the guide wire GW can be easily replaced while the shaft 12a is indwelled in the blood vessel 105 (in the body lumen). Specifically, the guide wire GW is withdrawn while the catheter 10B is placed in the blood vessel 105, and another guide wire GW1 is inserted between the inner peripheral surface of the guiding catheter 102 and the outer peripheral surface of the proximal shaft portion 18a. It is inserted into the gap and advanced in the direction of the tip of the catheter 10B (the direction of arrow X1).

  Then, the distal end of the guide wire GW1 is inserted into the opening 54 of the introduction portion 50, and the guide wire GW1 is introduced into the proximal end lumen 24 through the introduction hole 52 while contacting the inclined surface 56. When the guide wire GW1 is further advanced, the distal end of the guide wire GW1 protrudes from the distal opening 22 of the catheter 10B. Thus, the replacement of the guide wire GW is completed.

  According to the present embodiment, the same operation and effect as those of the above-described catheter 10A can be obtained. In addition, the lumen forming wall portion 25 is provided with an introduction portion 50 for guiding the replaced guide wire GW1 to the side hole 28 when replacing the guide wire GW with the shaft 12a indwelled in the living body lumen. The introduction portion 50 is formed with an introduction hole 52 that opens in the proximal direction of the proximal shaft portion 18 a and communicates with the side hole 28. According to such a configuration, the guide wire GW can be easily exchanged while the shaft 12a is indwelled in the living body lumen.

  The present invention is not limited to the configuration described above. In the catheters 10A and 10B, the proximal end side of the proximal end portion of the proximal shaft portion 18, 18a with respect to the insertion portion 26 located at the proximal end may be formed solid.

  The catheter according to the present invention and the treatment method using the catheter are not limited to the above-described embodiment, and may adopt various configurations without departing from the gist of the present invention.

10A, 10B ... catheter 12, 12a ... shaft 14 ... hub 16 ... distal shaft portion 18, 18a ... proximal shaft portion 20 ... distal side lumen 24 ... proximal side lumen 26 ... insertion portion 28 ... side hole 40 ... slit 50 ... Introducing part 52 ... Introducing hole GW, GW1 ... Guide wire

Claims (9)

A catheter having a flexible shaft that supports a guide wire, and a hub provided at a proximal end of the shaft,
The shaft is
A distal shaft portion having a distal lumen through which the guide wire is inserted,
A proximal shaft having a proximal lumen communicating with the distal lumen and through which the guidewire is inserted, and extending from the proximal end of the distal shaft portion to the hub so as to be coaxial with the distal shaft portion; And a part,
A catheter, in which a lumen forming wall portion forming the proximal side lumen is provided with an insertion portion for leading the guide wire from the proximal side lumen to the outside of the proximal end shaft portion. The catheter according to claim 1, wherein
The catheter, wherein a plurality of the insertion portions are provided along an axial direction of the proximal shaft portion. The catheter according to claim 1 or 2,
The catheter, wherein the insertion portion is a side hole that opens in a direction orthogonal to an axial direction of the proximal shaft portion. The catheter according to claim 3,
The catheter, wherein the side hole extends along an axial direction of the proximal shaft portion. The catheter according to claim 1 or 2,
The insertion portion is a slit formed in the lumen forming wall portion,
The catheter, wherein the slit is opened by deforming the lumen forming wall. The catheter according to claim 5, wherein
The catheter, wherein the slit extends along a circumferential direction of the lumen forming wall. The catheter according to claim 3 or 4, wherein
The lumen forming wall portion is provided with an introduction portion for guiding the replaced guide wire to the side hole when replacing the guide wire with the shaft placed in the living body lumen,
A catheter, wherein the introduction portion is formed with an introduction hole which opens in a proximal direction of the proximal shaft portion and communicates with the side hole. The catheter according to any one of claims 1 to 7,
A catheter for supporting the guidewire used when passing the guidewire through a stenosis or an obstruction created in a body lumen. Treatment using a catheter having a flexible shaft that supports the guidewire when passing the guidewire through a stenosis or occlusion in the lower limb blood vessel and a hub provided at the proximal end of the shaft The method
The shaft is
A distal shaft portion having a distal lumen through which the guide wire is inserted,
A proximal shaft having a proximal lumen communicating with the distal lumen and through which the guidewire is inserted, and extending from the proximal end of the distal shaft portion to the hub so as to be coaxial with the distal shaft portion; And a part,
A plurality of insertion portions for guiding the guide wire from the proximal lumen to the outside of the proximal shaft portion are provided on a lumen forming wall portion forming the proximal lumen,
A guiding catheter placement step of introducing a guiding catheter from the artery of the arm and placing the tip of the guiding catheter in the lower limb artery,
A preparation step of preparing the catheter,
In a state where the guide wire is inserted through a part of the proximal-side lumen and the entire length of the distal-side lumen, and the guide wire is led out of the proximal shaft portion through any one of the plurality of insertion portions. An insertion step of inserting the catheter into the lumen of the guiding catheter,
In a state where the catheter is protruded from the tip of the guiding catheter, a guide wire passing step of passing the guide wire through the stenotic part or the closed part,
Withdrawal step of removing the catheter from the body while leaving the guide wire in place beyond the stenosis or the occlusion,
In the insertion step, a treatment method using a catheter, wherein the insertion portion through which the guide wire is led out is changed according to the degree of stenosis of the stenotic portion or the closed portion.

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