JP2022054769A - Guide wire holding assembly - Google Patents

Abstract

To provide a guide wire holding assembly which allows replacement of a guide wire and insertion of another catheter without a need of separately preparing an inserter and a torque device and without being removed from the guide wire.SOLUTION: A guide wire holding assembly 10 comprises: a cylindrical body 20 which has a lumen through which a guide wire 110 can be inserted; a holding part 30 which is provided on a base end part 22 of the cylindrical body 20 and can hold the guide wire 110; an engagement part 40 which is provided on a tip 21 of the cylindrical body 20 and can engage the cylindrical body 20 with the base end part 22 of a Y connector 100 arranged on the tip side of the cylindrical body 20; and an inserter 50 which is provided on the tip 21 of the cylindrical body 20.SELECTED DRAWING: Figure 1

Description

The present invention relates to a guide wire holder for holding a guide wire.

Long guide wires are used to diagnose and treat lesions in blood vessels. In inserting the guide wire into the blood vessel and reaching the lesion, the surgeon uses various assistive devices. When inserting the guide wire into the blood vessel, the surgeon may use a tubular inserter. The inserter is inserted into the Y connector connected to the guiding catheter to guide the guide wire in the desired direction to facilitate the insertion operation and prevent damage to the guide wire due to entry into the side tube opening. ..

Also, when the guidewire reaches the lesion, the surgeon may use a torque device to improve the operability of the guidewire. The torque device is coupled to the proximal end of the guidewire exposed outside the body to facilitate anterior-posterior or rotational manipulation of the distal end of the guidewire inserted into the blood vessel.

Further, Patent Document 1 describes a catheter capable of holding and fixing a guide wire inserted therein.

Japanese Unexamined Patent Publication No. 2014-39613

In the procedure using the guide wire, the inserter and the torque device need to be prepared separately. Furthermore, since both the inserter and the torque device are small in size, they are easily lost or dropped. Further, when the guide wire is replaced or a therapeutic catheter such as a balloon catheter is inserted along the guide wire, the guide wire must be removed from the torque device, which is complicated.

The present invention has been made to solve the above problems, and it is not necessary to prepare the inserter and the torque device separately, and the guide wire can be replaced or other catheters can be used without removing the guide wire. It is an object of the present invention to provide a guide wire holder that can be inserted.

The guide wire holder according to the present invention that achieves the above object is provided at a tubular body having a cavity through which a guide wire can be inserted and at a base end portion of the tubular body, and is provided at a base end portion of the tubular body to hold the guide wire. A portion, an engaging portion provided at the tip end portion of the tubular body, and an engaging portion capable of engaging the tubular body with a base end portion of another device arranged on the tip end side of the tubular body, and the said portion. It is characterized by having an inserter provided at the tip of a tubular body.

The guide wire holder configured as described above has the function of a torque device that improves the operability of the guide wire by the holding portion and the inserter, and the function of the inserter that assists the insertion of the guide wire into another device. Therefore, the operator does not need to prepare the torque device and the inserter separately. In addition, since the guide wire holder can be connected to the connector by the engaging portion, another catheter can be inserted along the guide wire without removing the guide wire holder from the guide wire to the proximal end side. The guide wire can be replaced.

The inserter may be expandable and contractible along the long axis direction of the cylindrical body. This allows the surgeon to extend the inserter only when necessary and to contract the inserter only when necessary. Therefore, the guide wire holder can improve the operability when used as a torque device and can suppress damage to the inserter.

The inserter may be dispositionable in the lumen of the tip of the cylinder. This allows the inserter to be housed in the lumen of the cylinder except when necessary. Therefore, the guide wire holder can improve the operability when used as a torque device and can suppress damage to the inserter.

The inserter may have an arc shape in a cross section perpendicular to the long axis direction of the cylindrical body. As a result, the inserter can effectively cover the side tube opening of the connector when inserted into the lumen of the connector, and it is easy to secure the passage of the guide wire in the lumen of the connector.

The inserter may be formed of a plurality of sliding members that are relatively slidable in the long axis direction of the cylindrical body. As a result, since a plurality of sliding members can be stacked and arranged, the length of the guide wire holder in the long axis direction can be shortened. Therefore, the guide wire holder can be miniaturized, and the operability when used as a torque device is improved.

The holding portion is movable with respect to a plate-shaped member made of an elastic body arranged in the lumen of the tubular body and the tubular body, and by moving, the plate-shaped member is pressed and deformed. You may have a pressing member to make it. The pressing member can apply pressing force to the guide wire by deforming the plate-shaped member and bringing it into contact with the guide wire. As a result, the guide wire can be held between the plate-shaped member and the inner peripheral surface of the tubular body. Further, since the plate-shaped member is an elastic body, it can be deformed along the shape of the guide wire to increase the contact area between the plate-shaped member and the guide wire. As a result, the guide wire holder can satisfactorily hold even a guide wire having a small outer diameter, and thus has a high function as a torque device. Further, by increasing the contact area between the plate-shaped member and the guide wire, the pressing force acting on the guide wire from the pressing member can be dispersed, so that damage to the guide wire can be suppressed.

The plate-shaped member may have a notch formed on the surface side defining the lumen into which the guide wire can be inserted. As a result, the pressing force acting on the plate-shaped member from the pressing member is efficiently dispersed. Therefore, the plate-shaped member can suppress damage due to the local load of the guide wire. Further, since the contact area between the plate-shaped member and the guide wire is increased, it is possible to prevent the guide wire from being displaced from the plate-shaped member. Therefore, the guide wire holder can effectively hold the guide wire.

The notch may be formed along the long axis direction of the tubular body. As a result, the plate-shaped member tends to bend along the guide wire. Therefore, the pressing force acting on the guide wire from the plate-shaped member can be effectively dispersed. As a result, the plate-shaped member can hold the guide wire well and can effectively suppress the damage of the guide wire.

The plate-like member may have at least a layer containing a viscous material on the surface side defining a lumen into which a guide wire can be inserted. As a result, the plate-shaped member is easily deformed into a shape along the guide wire. As a result, the plate-shaped member can increase the contact area with the guide wire, so that the guide wire can be prevented from being displaced from the plate-shaped member. Further, since the plate-shaped member can disperse the pressing force acting on the guide wire, damage to the guide wire can be suppressed.

It is a figure which shows the guide wire holder which concerns on 1st Embodiment, (A) is a side view, (B) is a plan view. It is a vertical sectional view of the guide wire holder which concerns on 1st Embodiment, which passes through the long axis of the tip portion, (A) shows the open state, (B) shows the closed state. It is a cross-sectional view which is orthogonal to the long axis of the tip part of the guide wire holder which concerns on 1st Embodiment, (A) is the cross-sectional view along the line AA of FIG. 2, (B) is B of FIG. A cross-sectional view taken along line B, FIG. 2C is a cross-sectional view taken along line CC of FIG. It is a vertical sectional view of the tip portion of the guide wire holder and the inserter according to the first embodiment that pass through the long axis of the tip portion, (A) shows a contracted state, and (B) shows an extended state. It is a side view for demonstrating the usage of the guide wire holder which concerns on 1st Embodiment, (A) is the state which extended the inserter, (B) is the state which the guide wire holder is connected to a Y connector, (C) shows a state in which the guide wire is inserted into the Y connector. It is a side view for demonstrating the usage of the guide wire holder which concerns on 1st Embodiment, (A) is the state which the guide wire holder was removed from the Y connector, (B) is the guide wire by the guide wire holder. (C) shows a state when another device is inserted into the Y connector via the guide wire holder. It is a vertical sectional view through the long axis of the tip portion which shows the modification of the guide wire holder which concerns on 1st Embodiment. It is a vertical sectional view which passes through the long axis of the tip portion of the guide wire holder which concerns on 2nd Embodiment. 8 is a cross-sectional view taken along the line DD, where FIG. 8A shows a first example and FIG. 8B shows a second example. It is a side view for demonstrating the usage of the guide wire holder which concerns on 2nd Embodiment, (A) is the state which the guide wire holder is connected to the Y connector, (B) is the state which extended the inserter. (C) shows a state in which the guide wire is inserted into the Y connector. It is a front view which shows the operation part, the plate-shaped member and the guide wire of the 1st modification. It is a figure which shows the plate-shaped member of the 2nd modification, (A) is a sectional view, (B) is a plan view. It is a figure which shows the operation part, the plate-like member and the guide wire of the 3rd modification, (A) is a plan view, (B) is a front view. It is a figure which shows the plate-shaped member of the 4th modification, (A) is a sectional view, (B) is a plan view.

Hereinafter, embodiments of the present invention will be described with reference to the drawings. The dimensions of the drawings may be exaggerated and differ from the actual dimensions for convenience of explanation, and in the present specification and the drawings, the same reference numerals are used for the components having substantially the same functions. The duplicate explanation is omitted by adding. In the present specification, the side of the guide wire holder 10 connected to the Y connector 100 is referred to as the "tip side", and the opposite side thereof is referred to as the "base end side".

<First Embodiment>
As shown in FIGS. 1 to 4, the guide wire holder 10 according to the first embodiment assists the function of the torque device for improving the operability of the guide wire 110 and the insertion of the guide wire 110 into the Y connector 100. It has the function of the inserter 50.

The guide wire holder 10 includes a tubular body 20 having a cavity through which the guide wire 110 can be inserted, a holding portion 30 capable of holding the guide wire 110, and an engaging portion 40 capable of engaging with the Y connector 100. It includes an inserter 50 that assists in inserting the guide wire 110 into the Y connector 100.

The tubular body 20 includes a tip end portion 21 arranged on the tip end side and a proximal end portion 22 arranged on the proximal end side. The tip portion 21 is provided with an engaging portion 40 and an inserter 50. The base end portion 22 is provided with a holding portion 30.

The tip portion 21 has a tip lumen 23 formed inside. Further, the tip portion 21 includes a tip opening 24 at which the tip lumen 23 opens at the tip, and an inserter slit hole 25 formed along the long axis direction X of the cylindrical body 20.

The tip lumen 23 is formed with two holding walls 23A that slidably hold the inserter 50 along the long axis direction X of the cylindrical body 20. The two holding walls 23A project inward (toward the lumen side) of the tubular body 20 from the substantially opposite inner peripheral surfaces of the tip lumen 23.

The tip opening 24 is formed with a tip convex portion 29 that protrudes inward in the radial direction of the tubular body 20. The tip convex portion 29 is formed on the tip side of the tip of the inserter 50 housed in the tip lumen 23 of the tubular body 20. The tip convex portion 29 limits the inserter 50 from unintentionally extending toward the tip.

In the slit hole 25 for the inserter, the operation protrusion 54 of the inserter 50, which will be described later, is accommodated so as to be movable along the long axis direction X of the tubular body 20. The inserter slit hole 25 is formed with a limiting protrusion 27 for limiting the movement of the operating protrusion 54 along the long axis direction X on the tip end side of the base end of the inserter slit hole 25. The limiting protrusion 27 limits the unintentional movement of the operating protrusion 54 arranged at the base end of the slit hole 25 for the inserter to the tip end side. When the operator strongly pushes the operating protrusion 54 toward the tip side, the operating protrusion 54 and / or the limiting protrusion 27 is deformed, and the operating protrusion 54 moves beyond the limiting protrusion 27 to the tip side. Can be done.

The proximal end lumen 26 is formed inside the proximal end portion 22. The proximal lumen 26 includes a first lumen 26A and a second lumen 26B. The second lumen 26B communicates with the distal lumen 23. The second lumen 26B and the tip lumen 23 form a lumen through which the guide wire 110 is inserted. The proximal end portion 22 includes a proximal end opening 27 at which the second lumen 26B opens at the proximal end, and a slit hole 28 for a holding portion formed along the longitudinal direction X of the cylindrical body 20. There is.

The holding portion 30 includes a plate-shaped member 31 made of an elastic body, a pressing member 32 that presses and deforms the plate-shaped member 31, and two guide rails 33 that guide the movement of the pressing member 32.

The plate-shaped member 31 is formed of an elastic body and extends in the proximal lumen 26 along the long axis direction X of the tubular body 20. The plate-shaped member 31 is a substantially quadrangular flat plate, and the main plane of the flat plate is arranged substantially parallel to the major axis direction X. The plate-shaped member 31 has two edges along the major axis direction X fixed to the inner peripheral surface of the tubular body 20. The other edge portion of the plate-shaped member 31 may be fixed to the tubular body 20. The plate-shaped member 31 divides the proximal end lumen 26 into a first lumen 26A and a second lumen 26B. The elastic body forming the plate-shaped member 31 may be, for example, various rubbers such as silicone rubber, fluororubber, isoprene, and natural rubber, various resins such as polyurethane, polyamide elastomer, polybutadiene, and soft vinyl chloride, or two or more of them. Examples include combinations.

The pressing member 32 includes a disk-shaped operating portion 34 operated by an operator with a finger, and two shafts 35 that project coaxially with the operating portion 34 from the centers of both sides of the operating portion 34. The central axis of the operation unit 34 and the shaft 35 is perpendicular to the long axis direction X of the cylindrical body 20. A part of the operation part 34 is arranged in the first lumen 26A, and the other part of the operation part 34 protrudes from the slit hole 28 for the holding part to the outside of the tubular body 20. The portion of the operating portion 34 that protrudes to the outside of the tubular body 20 is a portion that can be operated by the operator with a finger.

As shown in FIGS. 2 and 3 (C), the two guide rails 33 are arranged so as to face each other with the operation unit 34 interposed therebetween, and a groove 36 is formed on the opposing surfaces. The groove 36 accommodates the shaft 35 of the pressing member 32 so as to be rotatable and movable in the extending direction of the groove 36. The two guide rails 33 may form a part of the slit hole 28 for the holding portion. Each guide rail 33 has a rail inclined portion 37 having a groove 36 formed with a groove 36 inclined with respect to the major axis direction X so as to approach the plate-shaped member 31 toward the proximal end side of the tubular body 20, and a rail inclined portion. A rail base end portion 38 extending in parallel with the main plane of the plate-shaped member 31 is provided from the base end of the 37 to the base end side of the tubular body 20. The groove 36 of the rail inclined portion 37 and the groove 36 of the rail base end portion 38 communicate with each other.

In the open state where the shaft 35 is arranged on the tip end side of the groove 36, the outer peripheral surface of the operation unit 34 is separated from the plate-shaped member 31. At this time, since the second lumen 26B is widely secured, it is easy to pass the guide wire 110 through the second lumen 26B and the tip lumen 23. Since a part of the operation unit 34 protrudes from the slit hole 28 for the holding portion to the outside of the tubular body 20, the operator can operate the operation unit 34 with his / her fingers. As shown in FIG. 2B, when the operator operates the operation unit 34 with his / her finger to rotate it and moves it toward the base end side, the shaft 35 connected to the operation unit 34 moves with respect to the long axis direction X. Guided by the inclined groove 36, it gradually moves toward the plate-shaped member 31. As a result, the outer peripheral surface of the operating portion 34 gradually presses the plate-shaped member 31, and the plate-shaped member 31, which is an elastic body, is gradually deformed. The deformed plate-shaped member 31 narrows the second lumen 26B through which the guide wire 110 can be inserted and comes into contact with the guide wire 110. The plate-shaped member 31 can apply a pressing force to the guide wire 110 to hold the guide wire 110 between the plate-shaped member 31 and the inner peripheral surface of the tubular body 20. The guide wire holder 10 holding the guide wire 110 functions as a torque device. Since the rail inclined portion 37 has the groove 36 inclined with respect to the major axis direction X, the plate-shaped member 31 gradually narrows the second lumen 26B, so that the guide wire holder 10 has various diameters. The guide wire 110 can be held. The guide wire holder 10 can hold the guide wire 110 having a diameter of, for example, about 0.3 to 1.0 mm.

When the shaft 35 exceeds the rail inclined portion 37, the shaft 35 moves toward the proximal end side of the tubular body 20 along the rail proximal end portion 38. Since the rail base end portion 38 extends parallel to the long axis direction X of the tubular body 20, the operation portion 34 moves toward the base end side along the long axis direction X. As a result, the guide wire holder 10 is in a closed state in which the guide wire 110 can be held between the plate-shaped member 31 and the inner peripheral surface of the tubular body 20. The diameter of the operating portion 34 is such that a pressing force can be applied to the plate-shaped member 31 so that the plate-shaped member 31 can narrow the second lumen 26B and hold the guide wire 110 in the closed state. Is preferable.

The rail base end portion 38 extends parallel to the major axis direction X of the tubular body 20. Therefore, the shaft 35 is prevented from returning to the tip side along the inclination of the rail inclined portion 37 due to the restoring force of the elastically deformed plate-shaped member 31. As a result, the guide wire holder 10 can prevent the guide wire 110 from being unintentionally released due to the natural loosening of the guide wire 110 held by the plate-shaped member 31. In the closed state of the guide wire holder 10, it is preferable that a part of the tubular body 20 protrudes from the holding portion slit hole 28 to the outside of the tubular body 20. The amount of protrusion is not particularly limited, but is, for example, 0.5 mm. As a result, the operator can operate the operation unit 34 in the closed state with a finger to move it toward the tip end, and return the guide wire holder 10 to the open state.

As shown in FIGS. 2, 3 (A), 3 (B) and 4, the inserter 50 is arranged in the tip lumen 23 and can extend from the tip opening 24 toward the tip side. The inserter 50 has a three-layer structure including a first sliding member 51, a second sliding member 52, and a third sliding member 53. The inserter 50 may have a two-layer structure or a structure having four or more layers. The first sliding member 51, the second sliding member 52, and the third sliding member 53 have an arcuate cross-sectional shape perpendicular to the long axis direction X of the cylindrical body 20. The second sliding member 52 is arranged on the convex side of the arc of the first sliding member 51, and the third sliding member 53 is arranged on the convex side of the arc of the second sliding member 52. .. Then, the inner peripheral surface of the tip portion 21 is arranged on the convex side of the arc of the third sliding member 53.

The first sliding member 51 defines a lumen through which the guide wire 110 can be inserted on the concave side of the arc of the first sliding member 51. The first sliding member 51 has a lumen through which the guide wire 110 defined by the first sliding member 51 can be inserted because the shape of the cross section perpendicular to the long axis direction X of the tubular body 20 is an arc. Can be widely secured. The first sliding member 51 includes two first guide convex portions 55, an operation protrusion 54, and a first tip stopper 56. The first guide convex portion 55 folds both ends of the arc of the first sliding member 51 toward the side where the second sliding member 52 is provided (the side where the arc of the first sliding member 51 becomes convex). It is formed. The operation protrusion 54 protrudes from the surface on the side where the second sliding member 52 is arranged (the side where the arc of the first sliding member 51 becomes convex) at the base end of the first sliding member 51, and is used for the inserter. It reaches the outside of the tubular body 20 through the slit hole 25. The first tip stopper 56 projects from the tip of the first sliding member 51 to the side where the second sliding member 52 is arranged (the side where the arc of the first sliding member 51 becomes convex). In a state in which the inserter 50 contracts without extending in the major axis direction X (hereinafter referred to as a contracted state), as shown in FIGS. 3A and 4A, the first tip stopper 56 has a second tip stopper 56. The tip of the sliding member 52 is held, and the second sliding member 52 is restricted from unintentionally extending toward the tip.

As shown in FIGS. 2, 3 (A), 3 (B) and 4, the second sliding member 52 has a second guide rail 57 and a second guide convex portion 58 at both ends of the arc. And are formed. The second guide rail 57 is a concave portion extending along the long axis direction X, and as shown in FIGS. 3 (A) and 3 (B), the first guide convex portion of the first sliding member 51. The 55 is slidably accommodated. The second guide rail 57 allows the second sliding member 52 to move in the long axis direction X with respect to the first sliding member 51, while the second sliding member 52 moves from the first sliding member 51 in the long axis direction. Prevents the vehicle from leaving in the direction intersecting with X. The second guide convex portion 58 is formed by folding both sides of the arc of the second sliding member 52 to the side where the third sliding member 53 is provided (the side where the arc of the second sliding member 52 becomes convex). Will be done. Further, the second sliding member 52 includes a second base end stopper 59 and a second tip stopper 60. The second base end stopper 59 projects from the base end of the second sliding member 52 to the side where the first sliding member 51 is arranged (the side where the arc of the second sliding member 52 is concave). In a state where the inserter 50 is extended in the major axis direction X (hereinafter referred to as an extended state), the second base end stopper 59 is a first tip stopper of the first sliding member 51 as shown in FIG. 4 (B). It is engageable with 56. That is, when the second sliding member 52 moves by a predetermined length in the tip direction with respect to the first sliding member 51, the second base end stopper 59 abuts on the first tip stopper 56 and the tip of the second sliding member 52. Movement in the direction is restricted. The second tip stopper 60 is from the tip of the second sliding member 52 to the side where the first sliding member 51 is arranged (the side where the arc of the second sliding member 52 is concave) and the third sliding member. It projects to both sides on which the 53 is arranged (the convex side of the arc of the second sliding member 52). In the contracted state, as shown in FIGS. 3A and 4A, the second tip stopper 60 is held by the first tip stopper 56 of the first sliding member 51, and the second sliding member 52 is held. Is restricted from unintentionally extending toward the tip.

In the third sliding member 53, as shown in FIGS. 2, 3 (A), 3 (B) and 4, the third guide rail 61 is formed at both ends of the arc. The third guide rail 61 is a concave portion extending along the major axis direction X, and as shown in FIGS. 3A and 3B, a convex portion for a second guide of the second sliding member 52. 58 is slidably accommodated. The third guide rail 61 allows the third sliding member 53 to move in the long axis direction X with respect to the second sliding member 52, while the third sliding member 53 moves from the second sliding member 52 in the long axis direction. Prevents the vehicle from leaving in the direction intersecting with X. Further, the third sliding member 53 includes a third base end stopper 62 and a third tip stopper 63. The third base end stopper 62 projects from the base end of the third sliding member 53 to the side where the second sliding member 52 is arranged (the side where the arc of the third sliding member 52 is concave). In the extended state, the third base end stopper 62 can engage with the second tip stopper 60 of the second sliding member 52, as shown in FIG. 4 (B). That is, when the third sliding member 53 moves by a predetermined length in the tip direction with respect to the second sliding member 52, the third base end stopper 62 abuts on the second tip stopper 60, and the tip of the third sliding member 53 Movement in the direction is restricted. The third tip stopper 63 moves from the tip of the third sliding member 53 to the inner surface side of the cylindrical body 20 facing the third sliding member 53 (the side where the arc of the third sliding member 53 becomes convex). It stands out. In the contracted state, as shown in FIGS. 3A and 4A, the third tip stopper 63 is held by the tip convex portion 29 of the tubular body 20, and the third sliding member 53 is in the tip direction. Unintentional extension is restricted.

As shown in FIGS. 3 (A), 3 (B) and 4, there are a first tip stopper 56 and a second base end stopper 59 between the first sliding member 51 and the second sliding member 52. A passable gap is formed. A gap through which the second tip stopper 60 and the third base end stopper 62 can pass is formed between the second sliding member 52 and the third sliding member 53. A gap through which the third tip stopper 63 can pass is formed between the third sliding member 53 and the tubular body 20.

As shown in FIG. 4B, the length L from the tip of the tubular body 20 to the tip of the inserter 50 in the extended state is not particularly limited, but is preferably 50 mm or more. The length L is a length along the long axis direction X of the portion of the inserter 50 that can be inserted into the Y connector 100, and may cover the side tube opening 102 (see FIG. 5B) of the Y connector 100. It is a length that can be done. The Y connector 100 has a main pipe 104 in which a linear lumen of the Y connector 100 is formed, and a side pipe 103 that branches from the main pipe 104. The side tube opening 102 is a portion of the lumen of the main tube 104 where the lumen of the side tube 103 is open.

The second sliding member 52 is arranged radially outside the first sliding member 51, and the third sliding member 53 is arranged radially outside the second sliding member 52. Therefore, as shown in FIG. 4B, when the inserter 50 is inserted into the Y connector 100 in the extended state, the lumen of the Y connector 100 expands toward the tip end side. Therefore, the step generated between the first sliding member 51 and the second sliding member 52 of the inserter 50 and between the second sliding member 52 and the third sliding member 53 is Y of the guide wire 110. It is difficult to prevent insertion into the connector 100.

The inserter 50 is preferably thin as long as the strength can be maintained so that the guide wire 110 can be inserted into the Y connector 100 with the inserter 50 inserted into the Y connector 100. The total thickness W of the inserter 50 is, for example, 1.4 mm or less. The total thickness W of the inserter 50 is from the reference surface M where the inner peripheral surface of the first sliding member 51 is located in the extended state to the farthest position of the third sliding member 53 in the normal direction of the reference surface M. It can be defined as a distance. When an inserter 50 having a total thickness W of 1.4 mm or less is inserted into a Y connector 100 having an inner diameter of 2.33 mm, a gap of 0.93 mm remains, so 0.035 inches (diameter about 0.9 mm). The guide wire 110 can be inserted into the Y connector 100.

As shown in FIGS. 1 and 2, the engaging portion 40 is provided so as to extend from the tip end portion of the tubular body 20 toward the tip end portion of the tubular body 20. The engaging portions 40 are provided at two opposite positions on the outer peripheral surface of the tubular body 20, and have claw portions 41 protruding inward in the radial direction of the tubular body 20 at the tips thereof. The claw portion 41 can be engaged with the adapter 101 on the base end side of the Y connector 100. The shape, number, and position of the engaging portions 40 are not particularly limited as long as they can be connected to the Y connector 100. The position where the claw portion 41 of the Y connector 100 engages is not limited to the adapter 101. Further, the engaging portion 40 is not limited to the form having the claw portion 41, and may be a rubber cap that can be attached so as to cover the outer peripheral surface of the adapter 101.

The material forming the tubular body 20, the pressing member 32, the guide rail 33, the engaging portion 40, and the inserter 50 is not particularly limited, but is preferably a material that is somewhat rigid, for example, polycarbonate, polyethylene, polypropylene, or ABS resin. Alternatively, a combination of two or more of these may be mentioned.

Next, the operation of the guide wire holder 10 according to the first embodiment will be described by taking the case of treating the coronary artery of the heart as an example.

First, the surgeon inserts the tip of the guiding catheter 120 (see FIG. 5B) to the entrance of the coronary artery and connects the Y connector 100 to the proximal end of the guiding catheter 120.

Next, as shown in FIG. 5A, the operator moves the operation protrusion 54 of the guide wire holder 10 toward the tip with a finger, and inserts the inserter 50 from the tip opening 24 of the tubular body 20. Stretch. Further, the operator moves the third sliding member 53 toward the tip end side with a finger to bring the inserter 50 into an extended state.

Next, the operator inserts the inserter 50 into the Y connector 100. The operator adjusts the position of the inserter 50 so that the inserter 50 covers the side tube opening 102 of the Y connector 100, and engages the engaging portion 40 with the Y connector 100 as shown in FIG. 5 (B). Then, the guide wire holder 10 is connected to the Y connector 100.

Next, as shown in FIG. 5C, the operator inserts the guide wire 110 from the base end opening 27 of the guide wire holder 10 and passes it through the Y connector 100. At this time, since the inserter 50 covers the side pipe opening 102, it is possible to prevent the guide wire 110 from entering the side pipe 103 side. After this, the operator inserts the guide wire 110 to the entrance of the coronary artery.

Next, the operator moves the operation protrusion 54 toward the proximal end side, and accommodates the first sliding member 51 of the inserter 50 in the tip lumen 23 of the tubular body 20. Next, the operator disengages the engaging portion 40 from the Y connector 100 and separates the guide wire holder 10 from the Y connector 100. Subsequently, as shown in FIG. 6A, the operator can push the third sliding member 53 toward the proximal end side to accommodate the entire inserter 50 in the distal lumen 23 of the tubular body 20. .. The operator may operate the operation protrusion 54 after separating the guide wire holder 10 from the Y connector 100.

Next, the operator moves the guide wire holder 10 on the guide wire 110, and at an appropriate position of the guide wire 110, the operation unit 34 is cylinderd as shown in FIGS. 2 (B) and 6 (B). It is moved to the base end side while being rotated with respect to the shape 20. As a result, the operating portion 34 that moves along the guide rail 33 gradually moves toward the plate-shaped member 31, and the outer peripheral surface of the operating portion 34 deforms the plate-shaped member 31. The deformed plate-shaped member 31 narrows the second lumen 26B and comes into contact with the guide wire 110 to hold the guide wire 110 passing through the second lumen 26B. As a result, the guide wire holder 10 is in a closed state in which the guide wire 110 is held.

Next, the operator operates the guide wire holder 10 to rotate the guide wire 110 back and forth (tip direction and proximal direction) and pass the guide wire 110 through the lesion.

Next, the operator moves the operation unit 34 toward the tip side with respect to the tubular body 20. As a result, as shown in FIG. 2A, the operation unit 34 moving along the guide rail 33 is separated from the plate-shaped member 31, and the plate-shaped member 31 returns to its original shape by its own restoring force. As a result, the plate-shaped member 31 is separated from the guide wire 110 passing through the second lumen 26B, and the guide wire holder 10 is opened.

Next, as shown in FIG. 6C, the operator engages the engaging portion 40 with the Y connector 100 and connects the guide wire holder 10 to the Y connector 100. Next, the operator inserts the proximal end of the guide wire 110 into the lumen of the catheter 130 (eg, balloon catheter, microcatheter, penetrating catheter, etc.) from the distal end side. The guide wire 110 penetrates the lumen of the catheter 130. Subsequently, the surgeon advances the catheter 130 toward the distal end side along the guide wire 110 and projects it from the guiding catheter 120 to treat the lesion. After this, the operator removes all guide wires and catheters from the body and completes the procedure.

As described above, the guide wire holder 10 according to the first embodiment is provided at the tubular body 20 having a cavity through which the guide wire 110 can be inserted and at the base end portion 22 of the tubular body 20. With respect to the holding portion 30 capable of holding the 110 and the base end portion 22 of another device (for example, the Y connector 100) provided at the tip end portion 21 of the tubular body 20 and arranged on the tip end side of the tubular body 20. It has an engaging portion 40 to which the tubular body 20 can be engaged, and an inserter 50 provided at the tip end portion 21 of the tubular body 20.

The guide wire holder 10 configured as described above has a torque device function that improves the operability of the guide wire 110 by the holding portion 30 and the inserter 50, and an inserter that assists the insertion of the guide wire 110 into the Y connector 100. It has 50 functions. Therefore, the operator does not need to prepare the torque device and the inserter 50 separately. Further, since the guide wire holder 10 can be connected to the Y connector 100 by the engaging portion 40, the catheter 130 can be moved along the guide wire 110 without completely removing the guide wire holder 10 from the guide wire 110. It can be inserted or the guide wire 110 can be replaced. This simplifies the procedure and prevents the guide wire holder 10 from falling or being lost. Further, in the guide wire holder 10, the inserter 50 can cover the side tube opening 102 of the Y connector 100 in a state where the engaging portion 40 is engaged with the Y connector 100. As a result, when the guide wire 110 is inserted into the lumen of the Y connector 100 from the base end of the Y connector 100, it is possible to prevent the tip of the guide wire 110 from being caught in the side tube opening 102. The other device arranged on the tip end side of the tubular body 20 is not limited to the Y connector 100.

Further, the inserter 50 can be expanded and contracted along the long axis direction X of the tubular body 20. As a result, the operator can extend the inserter 50 only when necessary, and can contract the inserter 50 only when necessary. Therefore, the guide wire holder 10 can improve the operability when used as a torque device and can suppress damage to the inserter 50.

Further, the inserter 50 can be arranged in the tip lumen 23 of the tip portion 21 of the tubular body 20. Thereby, the inserter 50 can be accommodated in the lumen of the tubular body 20 except when necessary. Therefore, the guide wire holder 10 can improve the operability when used as a torque device and can suppress damage to the inserter 50.

Further, the inserter 50 has an arc shape in a cross section perpendicular to the long axis direction X of the cylindrical body 20. Thereby, when the inserter 50 is inserted into the lumen of the Y connector 100, the side tube opening 102 of the Y connector 100 can be effectively covered, and the guide wire 110 can be inserted into the lumen of the Y connector 100. Easy to secure a passage.

Further, the inserter 50 is a plurality of sliding members (first sliding member 51, second sliding member 52, and second sliding member 53) that are relatively slidable in the major axis direction X of the tubular body 20. Is formed by. As a result, since a plurality of sliding members can be stacked and arranged, the length of the guide wire holder 10 in the major axis direction X can be shortened. Therefore, the guide wire holder 10 can be miniaturized, and the operability when used as a torque device is improved.

Further, the holding portion 30 is movable with respect to the plate-shaped member 31 made of an elastic body arranged in the lumen of the tubular body 20 and the tubular body 20, and presses the plate-shaped member 31 by moving. It has a pressing member 32 and which is deformed. The pressing member 32 can apply pressing force to the guide wire 110 by deforming the plate-shaped member 31 and bringing it into contact with the guide wire 110. As a result, the guide wire 110 can be held between the plate-shaped member 31 and the inner peripheral surface of the tubular body 20. Further, since the plate-shaped member 31 is an elastic body, it can be deformed along the shape of the guide wire 110 to increase the contact area between the plate-shaped member 31 and the guide wire 110. As a result, the guide wire holder 10 can hold the guide wire 110 having a small outer diameter satisfactorily, so that the guide wire holder 10 has a high function as a torque device. Further, by increasing the contact area between the plate-shaped member 31 and the guide wire 110, the pressing force acting on the guide wire 110 from the pressing member 32 can be dispersed, so that damage to the guide wire 110 can be suppressed. For example, in the case of a torque device having a holding mechanism by a metal chuck, the pressing force is concentrated on the contact portion between the chuck and the guide wire 110, so that the coating applied to the guide wire 110 may be peeled off at the contact portion. be.

The inserter 50 may be arranged on the outer peripheral surface of the tip portion 21 of the tubular body 20 as in the modified example of the first embodiment shown in FIG. 7. The first sliding member 51 is slidably arranged in the long axis direction X with respect to the outer peripheral surface of the tip portion 21, and the second sliding member 52 is arranged with respect to the outer peripheral surface of the first sliding member 51. , Slidably arranged in the long axis direction X. As a result, in the guide wire holder 10, since the inserter 50 is not arranged in the lumen of the tubular body 21, the tip lumen 23 can be widely secured.

<Second Embodiment>
As shown in FIG. 8, the guide wire holder 10 according to the second embodiment is different from the first embodiment in that the inserter 50 is formed of a single layer.

The guide wire holder 10 has a single layer inserter 50. As shown in FIG. 9A, the operating protrusion 54 of the inserter 50 is formed with a guide groove 70 extending in the long axis direction X. The slit hole 25 for the inserter of the tubular body 20 is formed with a convex portion 71 for a guide that is slidable in the guide groove 70. The guide groove 70 makes the inserter 50 movable with respect to the tubular body 20 in the long axis direction X, and prevents the inserter 50 from detaching from the tubular body 20 in the direction intersecting the long axis direction X. As in another example shown in FIG. 9B, the guide groove 70 may be formed in the slit hole 25 for the inserter of the tubular body 20, and the convex portion 71 for the guide may be formed in the operation protrusion 54. .. As in the first embodiment, if the holding wall 23A (see FIGS. 2 and 4) is provided in the tip lumen 23, the guide groove 70 and the guide convex portion 71 may not be provided. Further, the guide wire holder 10 according to the first embodiment may have a guide groove 70 and a guide convex portion 71, and may not have a holding wall 23A.

The length L (see FIG. 4B) from the tip of the tubular body 20 to the tip of the inserter 50 in the extended state is determined by the length of one layer of the inserter 50 in the second embodiment. Therefore, the length of the tip portion 21 of the tubular body 20 accommodating the inserter 50 along the major axis direction X may be longer than that of the first embodiment.

Next, the operation of the guide wire holder 10 according to the second embodiment will be described by taking the case of treating the coronary artery of the heart as an example.

First, the surgeon inserts the tip of the guiding catheter 120 to the entrance of the coronary artery and connects the Y connector 100 to the proximal end of the guiding catheter 120.

Next, as shown in FIG. 10A, the operator aligns the circumferential position of the operation protrusion 54 in the guide wire holder 10 with the circumferential position of the side tube opening 102 in the Y connector 100. , The engaging portion 40 of the guide wire holder 10 is engaged with the Y connector 100.

Next, as shown in FIG. 10B, the operator moves the operation protrusion 54 of the guide wire holder 10 toward the tip with a finger, and inserts the inserter 50 from the tip opening 24 of the tubular body 20. Stretch. That is, the operator needs to operate the operation protrusion 54 and the third sliding member 53 in the first embodiment in order to bring the inserter 50 into the extended state, but in the second embodiment, the operation protrusion All you have to do is operate 54. Therefore, the operator can insert the inserter 50 into the Y connector 100 after connecting the guide wire holder 10 to the Y connector 100. The guide wire holder 10 may be connected to the Y connector 100 after the inserter 50 is extended from the tip opening 24.

Next, as shown in FIG. 10C, the operator inserts the guide wire 110 from the base end opening 27 of the guide wire holder 10 and passes the Y connector 100 through the guide wire 110. At this time, since the inserter 50 covers the side pipe opening 102, it is possible to prevent the guide wire 110 from entering the side pipe 103. After this, the operator inserts the guide wire 110 to the entrance of the coronary artery.

Next, as shown in FIG. 8, the operator moves the operation protrusion 54 toward the proximal end side to accommodate the inserter 50 in the tip lumen 23 of the tubular body 20, and the engaging portion 40 is the Y connector 100. The guide wire holder 10 is separated from the Y connector 100. The operator may operate the operation protrusion 54 after separating the guide wire holder 10 from the Y connector 100. After that, the operator moves the guide wire holder 10 on the guide wire 110, and holds the guide wire 110 by the guide wire holder 10 at an appropriate position of the guide wire 110 in a closed state. Since the procedure after this is the same as the procedure described in the first embodiment, the description thereof will be omitted.

As described above, the guide wire holder 10 according to the second embodiment can insert the inserter 50 into the Y connector 100 after connecting to the Y connector 100. Therefore, the chance that the inserter 50 comes into contact with the Y connector 100 is reduced, and damage to the inserter 50 can be suppressed.

The present invention is not limited to the above embodiment, and various modifications can be made by those skilled in the art within the technical idea of the present invention. For example, as in the first modification shown in FIG. 11, the operating portion 34 of the pressing member 32 may have a groove-shaped constricted portion 39 extending in the circumferential direction on the outer peripheral surface. As a result, the plate-shaped member 31 that receives the pressing force from the outer peripheral surface of the operating portion 34 is easily deformed along the guide wire 110, can be in contact with the guide wire 110 over a wide area, and the guide wire 110 is a plate-shaped member. It is possible to suppress the deviation from 31. Therefore, the guide wire holder 10 can effectively hold the guide wire 110. The size of the constricted portion 39 is, for example, 0.3 mm in depth and 0.3 mm in width.

Further, as in the second modification shown in FIG. 12, the plate-shaped member 31 may have a notch 80 formed on the surface in contact with the pressing member 32 and / or on the surface side in contact with the guide wire 110. The notch 80 is formed so that a plurality of hexagonal columns 81 are lined up without gaps. The notch 80 is formed between adjacent hexagonal columns 81. As a result, the pressing force acting on the plate-shaped member 31 from the pressing member 32 is efficiently dispersed from the side of the hexagonal column 81 to the side of the other hexagonal column 81. Therefore, the plate-shaped member 31 can suppress damage to the guide wire 110 due to a local load. Further, since the contact area between the plate-shaped member 31 and the guide wire 110 increases, it is possible to prevent the guide wire 110 from being displaced from the plate-shaped member 31. Therefore, the guide wire holder 10 can effectively hold the guide wire 110. The length of the diagonal line of each hexagon on the surface of the plate-shaped member 31 is preferably not more than the diameter of the guide wire 110, and is, for example, 0.3 mm to 1 mm or less. The depth of the notch 80 (height of the hexagonal column 81) may be set so that the thickness of the portion of the plate-shaped member 31 without the notch 80 is 1 mm or more from the viewpoint of durability against multiple deformations. preferable. Therefore, the depth of the notch 80 is set depending on the thickness of the plate-shaped member 31. The thickness of the plate-shaped member 31 (the length of the plate-shaped member 31 in the cross section perpendicular to the long axis direction X of the guide wire holder 10) is a guide from the viewpoint of operability of the guide wire holder 10 as a torque device. The maximum outer diameter of the wire holder 10 in the cross section perpendicular to the long axis direction X is set within a range of 20 mm or less.

Further, as in the third modification shown in FIG. 13, the plate-shaped member 31 is arranged in parallel along the guide wire 110 on the surface in contact with the pressing member 32 and / or on the surface side in contact with the guide wire 110. A notch 80 may be formed. The plate-shaped member 31 is easily deformed into a shape along the guide wire 110. As a result, the plate-shaped member 31 can increase the contact area with the guide wire 110, so that the guide wire 110 can be prevented from being displaced from the plate-shaped member 31. Further, since the plate-shaped member 31 can disperse the pressing force acting on the guide wire 110, damage to the guide wire 110 can be suppressed. The notch 80 may not be formed in a portion other than the portion assumed to be in contact with the guide wire 110 of the plate-shaped member 31.

Further, as in the fourth modification shown in FIG. 14, the plate-shaped member 31 is formed from an elastic body forming an elastic layer 90 which is an elastic body and a surface in contact with the pressing member 32 and / or a surface in contact with the guide wire 110. A surface layer 91 and an intermediate layer 92 arranged between the elastic layer 90 and the surface layer 91 are provided. The intermediate layer 92 includes a honeycomb structure 93 formed of an elastic body like the surface layer 91, and a flow portion 94 made of a viscous material housed in each room divided by the honeycomb structure 93. The elastic body forming the elastic layer 90 can effectively propagate the pressing force. The viscous material contained in the intermediate layer 92 can effectively disperse the pressing force. The viscous material preferably has high fluidity, and is, for example, a gel or a gel. The plate-shaped member 31 can prevent the viscous material of the flowing portion 94 from flowing out due to the surface layer 91. Since the plate-shaped member 31 has a flowing portion 94 made of a viscous material, the plate-shaped member 31 is easily deformed so as to follow the shape along the guide wire 110. As a result, the plate-shaped member 31 can increase the contact area with the guide wire 110, so that the guide wire 110 can be prevented from being displaced from the plate-shaped member 31. Further, since the plate-shaped member 31 can disperse the pressing force acting on the guide wire 110, damage to the guide wire 110 can be suppressed.

In the above-mentioned second to fourth modifications, it is preferable that the notch 80 or the intermediate layer 92 containing the viscous material is formed on the surface side of the plate-shaped member 31 in contact with the guide wire 110.

On the other hand, in the above-mentioned second to fourth modifications, the surface of the plate-shaped member 31 in contact with the pressing member 32 may or may not have the notch 80 or the intermediate layer 92 containing the viscous material. .. When the surface of the plate-shaped member 31 in contact with the pressing member 32 has a notch 80 or an intermediate layer 92 containing a viscous material, the pressing force acting on the plate-shaped member 31 from the pressing member 32 is dispersed, so that the plate-shaped member 31 has a plate-like shape. The wear of the member 31 can be reduced. Further, since the plate-shaped member 31 is easily deformed along the shape along the guide wire 110, it is possible to prevent the guide wire 110 from being displaced from the plate-shaped member 31, and it is possible to suppress damage to the guide wire 110.

In the above-mentioned second to fourth modifications, when the surface side of the plate-shaped member 31 in contact with the pressing member 32 is not provided with the notch 80 or the intermediate layer 92 containing the viscous material, the notch 80 or the intermediate containing the viscous material is provided. As compared with the case where the layer 92 is not provided, the dispersion of the pressing force acting on the plate-shaped member 31 from the pressing member 32 is suppressed, so that sufficient pressing force can be easily applied to the plate-shaped member 31. Further, since the notch 80 is not provided at the position where the pressing force directly acts from the pressing member 32, the surface of the plate-shaped member 31 is less likely to be damaged.

Further, the inserter 50 may have a structure fixed to the tubular body 20 instead of a structure that can be expanded and contracted with respect to the tubular body 20. Further, the inserter 50 may have a structure that can be folded by having a hinge structure or the like, instead of a structure that can be expanded and contracted with respect to the tubular body 20.

Further, the shape of the inserter 50 may be a rod-shaped body, a tube body, or a flat plate. Further, the inserter 50 may be formed by at least one tube having a nested structure. The tubular body is rotatable from the tubular body 20 and has a fixing mechanism fixed to the other tubular body or the tubular body 20 on the proximal end side by rotating the tubular body 20 in the circumferential direction. ..

Further, the structure of the holding portion 30 for holding the guide wire 110 is not particularly limited, and a holding mechanism using a metal chuck may be used.

Further, in the first and second embodiments described above, a marker indicating the circumferential position of the inserter 50 may be provided on the surface of the guide wire holder 10. The marker may be formed in a visually identifiable color or shape.

10 Guide wire holder 20 Cylindrical body 21 Tip 22 Tip end 23 Tip lumen 26 Base lumen 26A First lumen 26B Second lumen 30 Holding part 31 Plate-shaped member 32 Pressing member 40 Engaging part 50 Inserter 51 1st sliding member (sliding member)
52 Second sliding member (sliding member)
53 Third sliding member (sliding member)
80 Notch 92 Intermediate layer (layer containing viscous material)
100 Y connector (other devices)
102 Side tube opening 110 Guide wire X Long axis direction

Claims (9)

A cylindrical body with a lumen through which a guide wire can be inserted,
A holding portion provided at the base end portion of the tubular body and capable of holding the guide wire, and a holding portion.
An engaging portion provided at the tip end portion of the tubular body and capable of engaging the tubular body with a base end portion of another device arranged on the tip end side of the tubular body.
A guide wire holder having an inserter provided at the tip of the tubular body. The guide wire holder according to claim 1, wherein the inserter can be expanded and contracted along a long axis direction of the cylindrical body. The guide wire holder according to claim 2, wherein the inserter can be arranged in a lumen at the tip of the tubular body. The guide wire holder according to any one of claims 1 to 3, wherein the inserter has an arc shape in a cross section perpendicular to the long axis direction of the cylindrical body. The guide wire holding according to any one of claims 1 to 4, wherein the inserter is formed of a plurality of sliding members that are relatively slidable in the long axis direction of the cylindrical body. Ingredients. The holding portion is movable with respect to a plate-shaped member made of an elastic body arranged in the lumen of the tubular body and the tubular body, and by moving, the plate-shaped member is pressed and deformed. The guide wire holder according to any one of claims 1 to 5, further comprising a pressing member. The guide wire holder according to any one of claims 1 to 6, wherein the plate-shaped member has a notch formed on a surface side defining a lumen into which a guide wire can be inserted. The guide wire holder according to claim 7, wherein the notch is formed along the long axis direction of the tubular body. The guide wire according to any one of claims 1 to 6, wherein the plate-shaped member has at least a layer containing a viscous material on a surface side defining a lumen into which a guide wire can be inserted. Holder.

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