JP2022080007A - Medical material - Google Patents

Abstract

To provide a defect hole closing material which realizes noninvasive treatment of an atrial septal defect with few risks of malfunction in a remote period.SOLUTION: A defect hole closing material 100 has a shape of a sandglass formed of two tubular bodies (a first tube on a root side and a second tube on a tip side) of net-like tissue made of bioabsorbable material and comprises a joint part for joining a cable body 510 of a delivery cable inserted from a first end side on a root side through generally the center part to a second end side on a tip side, at the second end side. The cable body 510 is put through to the outside of the defect hole closing material 100 from the first end side, and the delivery cable comprises the cable body 510 and an outer tube 550 covering the cable body 510 to the outside of a living body so as to be slidable along the cable body 510, so that the first end can be pressed against the second end side through operation of pressing the outer tube 550 from the outside of the living body.SELECTED DRAWING: Figure 6

Description

The present invention relates to a medical material for treating a defect formed in a living tissue, and more particularly to a medical material which is set in a catheter and sent to a treatment site through a blood vessel and indwelled in the living body.

The human heart is divided into left and right chambers by a tissue called the septum, and each has a ventricle and a ventricle on the left and right, and is composed of two ventricles, a right ventricle, a right ventricle, a left ventricle, and a left ventricle. In a heart with such a structure, atrial septal defect (ASD: Atrial Septal), in which a hole congenitally called a defect hole opens in the atrial septum that separates the right and left atrium due to developmental disorders during the fetal period. There is a disease called Defect).

There are the following two methods for treating this atrial septal defect. One is surgery performed by cutting the chest, and the other is catheter treatment using a closure plug without cutting the chest.
Surgery (patch surgery) uses an artificial heart-lung machine, opens the chest, and closes the defect hole with a patch. In catheter treatment, a closing plug is set in the catheter, the catheter is inserted into a blood vessel, delivered to a target position (defective hole), and then the closing plug is released and placed in the body. In this catheter treatment, a small jig (device) called an elongated folded closure plug is sent from the vein at the base of the foot (femoral vein) to the position of the hole opened in the atrial septum without incising the chest to close the hole. It is a thing. The advantage of this catheter treatment is that it can be treated with a tiny skin incision (several millimeters) from an inconspicuous place at the base of the foot (stomach) without performing thoracotomy that requires general anesthesia. ..

Japanese Patent Application Laid-Open No. 2008-512139 (Patent Document 1) discloses an assembly (closing plug) used for catheter treatment of atrial septal defect. This assembly seals the passage (defective hole) of the heart. This assembly extends through a first anchor used to be located proximal to the first end of the aisle, a second anchor used to be located proximal to the second end of the aisle, and a passage. The second anchor consists of a closure device that seals the passage of the heart, including the flexible extension used to connect to the first and second anchors, the second anchor being movable with respect to the flexible extension. It consists of a supply system that modifies the length of the flexible extension between the second anchor and supplies the closure device to the passage of the heart, and the supply device is set to move through the lumen of the guide catheter. Includes wires that control movement along the flexible extension of the second anchor.

Further, in Patent Document 1, the patent foramen ovale (PFO) closing device (closing plug) includes a left atrium anchor, a right atrium anchor, a tether and a lock, and is via the left atrium anchor and the tether. It is disclosed that the right atrial anchor and lock that bind to the left atrial anchor remain in the heart and seal the PFO.

Japanese Patent Publication No. 2008-512139

In the case of patch surgery, there is a problem that an artificial heart-lung machine is used and the length of hospital stay is long due to its high invasiveness. In the case of catheter treatment, artificial heart-lung machine is not used, and since it is less invasive, the length of hospital stay is short and preferable.
As disclosed in Patent Document 1, the left atrium anchor and the right atrium anchor remain in the heart. The left atrium anchor and the right atrium anchor include one or more arms, which extend outward radially from the hub, which is preferably formed from a rolled sheet of two-component nickel-titanium alloy. Has been done. Then, these left atrium anchors and right atrium anchors are expanded in vivo to close the defect hole, but once the anchor expansion is started, it cannot be easily restored. The anchor is folded using a dedicated take-out device having a complicated structure and difficult to operate from outside the living body as disclosed in Patent Document 1.

However, for example, when the anchor is caught in a living tissue in the atrium and damaged, there may be no time to fold the anchor with such a dedicated extraction device. In such a case, there is no choice but to immediately switch to open chest surgery. This has the problem of eventually undergoing highly invasive thoracotomy.
Furthermore, since the metal defect hole closure plug remains in the body for a lifetime, there is a problem that there is a concern about problems in the remote period.

The present invention has been developed in view of the above-mentioned problems of the prior art, and an object of the present invention is to provide a minimally invasive catheter treatment that can be released and indwelled at a treatment site in a living body, and has a complicated structure. The purpose is to provide medical materials that can be operated easily and reliably without preparation, and that there is almost no possibility of malfunction in the remote period even if they remain in the body.

In order to achieve the above object, the medical material according to the present invention takes the following technical measures.
That is, the medical material according to the present invention is a medical material including a tubular body of a stitch-like structure using a wire rod having bioabsorbability and a delivery cable removably joined to the tubular body. It has a shape in which the diameter of the substantially central portion of the cylinder is smaller than the diameter of the cylinders of other portions, and the first end side of the cylinder, which is one end in the longitudinal direction of the cylinder with the substantially center as the center. A tubular portion of 1 and a second tubular portion on the second end side, which is the other end, are formed, and the first end portion and the second end portion are separated from each other with the substantially central portion as the center. When the diameter of the other portion is reduced and the medical material is housed in the catheter, the second end side becomes the tip end side of the catheter, and the medical material is the first end. The second end side is provided with a joint for joining the delivery cable passed from the portion side to the second end side via the substantially central portion, and the delivery cable is provided on the first end side. The delivery cable can be operated from outside the living body to press the first end portion toward the second end portion side. It is characterized by having a various configurations.

Preferably, the delivery cable includes a cable body and an outer cylinder that covers the cable body from the medical material to the outside of the living body so as to be slidable along the cable body. It can be configured to push the first end portion toward the second end portion side by an operation of pushing from the outside.
More preferably, when the medical material to which the delivery cable is joined is stored in the catheter, the inner end of the outer cylinder is exposed to the outside of the living body. The portion can be configured to abut on the first end.

More preferably, the joint portion is a hollow cylindrical object provided with a female screw, and the male screw provided on the tip end side of the delivery cable is screwed into the female screw to be joined. The delivery cable is operated so that the defect hole closing material advances toward the opening of the catheter while the entire medical material joined to the delivery cable by the portion is housed in the catheter. By ejecting the first cylinder portion from the tip of the catheter to the outside of the catheter following the second cylinder portion, the first end portion and the second end portion form the substantially central portion. In vitro, the outside end of the delivery cable is said to be in vitro when the diameter of the other portion is expanded to a size corresponding to a defect hole that is close to the center and closed by the medical material. The male screw and the female screw are screwed by rotating the delivery cable toward the outer end of the delivery cable, which is longer than the outer end of the outer cylinder and is exposed from the outer cylinder. It can be configured so that a hand operation jig that is released to disconnect the delivery cable from the cylinder is connected.

According to the medical material of the present invention, minimally invasive catheter treatment that can be released and indwelled at a treatment site in a living body can be performed easily and reliably without having a complicated structure. Furthermore, according to the medical material of the present invention, even if it remains in the body, there is almost no possibility of a defect in a remote period.

It is an overall view of the defect hole closing material 100 which is an example of the medical material which concerns on this invention (the distance between the 1st end and the 2nd end is close). It is an overall view of the defect hole closing material 100 (the distance between the first end portion and the second end portion is an intermediate state). It is an overall view of the defect hole closing material 100 (the entire defect hole closing material is housed in the catheter 300, and the distance between the first end portion and the second end portion is separated). It is an overall view of the defect hole closing material 100 (a state in which the second tubular portion is taken out of the catheter 300 and the first tubular portion is housed in the catheter 300). (A) is a partial side view of the defect hole closing material 100 in the state of FIG. 2, and (B) is a cross-sectional view taken along the line AA. It is a conceptual diagram when the defect hole closing material 100 is used for the catheter treatment of the atrial septal defect. It is an enlarged view (the 1) of the part B of FIG. 6 which shows the procedure of catheter treatment. It is an enlarged view (2) of the part B of FIG. 6 which shows the procedure of catheter treatment. It is an enlarged view (3) of the part B of FIG. 6 which shows the procedure of catheter treatment. It is an enlarged view of the joint portion 422 provided at the distal end side end portion of the defect hole closing material 100 and the delivery cable 500 joined to the joint portion 422 by screwing. Top view (second end 122) and hand side end (first end 112) of the defect hole closing material 100, and a plan view of the catheter 300 including the delivery cable 500 and the hand operation jig 560. (Top view). It is a perspective view of FIG.

Hereinafter, the medical material according to the present invention will be described in detail with reference to the drawings. In the following, as an example of the medical material according to the present invention, a fistula closing material used for catheter treatment will be described, but other openings or passages, such as a ventricular septal defect and a heart such as a patency of an arterial duct, will be described. It is also suitable for opening or closing passages in other parts of the body (eg, stomach) such as arteriovenous fistulas. Therefore, the defect hole closing material according to the embodiment of the present invention is not limited to the use for closing the hole of the atrial septal defect. Further, the medical material according to the present invention includes a tubular body of a stitch-like tissue (a first tubular portion 110 on the hand side arranged on the right atrium side) and a second tubular body on the distal end side arranged on the left atrium side, which will be described later. In addition to the cylinder portion 120 connected to the cylinder portion 120 via a substantially central portion 130, a delivery cable 500 detachably joined to the cylinder portion may be included.

Further, in the following embodiment, the knitted structure of the defect hole closing material (closing plug) 100 (hereinafter, may be referred to as medical material 100), which is an example of the medical material according to the present invention, is a living body. Although the description will be made assuming that an absorbent fiber (an example of a wire rod) is knitted, the present invention is not limited thereto. Any material that can be used for catheter treatment to close the defect formed in the living body may be used, and the knitted structure and the material thereof have the first feature to the second feature described later and the first action to the first. The material is not limited as long as it exhibits the action of 3, and for example, the material may be knitted with a wire rod other than the bioabsorbable fiber. As such a wire, it is preferable that the wire has a certain degree of hardness in order to have the shape-retaining property of the defect hole closing material (different from the shape-retaining property by the shape-retaining member described later).

[Basic configuration]
FIG. 1 shows an overall view of the defective hole closing material 100 according to the present embodiment (a state in which the distance between the first end 112 and the second end 122 is close), and FIG. 2 shows the defective hole closing material 100. Another overall view (the distance between the first end 112 and the second end 122 is in the middle state) is shown in FIG. 3 and yet another overall view of the defective hole closing material 100 (overall of the defective hole closing material 100). Is housed in the catheter 300 and the distance between the first end 112 and the second end 122 is separated). A state in which the portion 120 is taken out of the catheter 300 and the first tubular portion 110 is housed in the catheter 300) is shown respectively. Regarding the storage relationship of the defect hole closing material 100 in the catheter 300, FIG. 3 shows a state in which the entire defect hole closing material 100 is housed in the catheter 300, and FIG. 4 shows the state in which the defect hole closing material 100 is stored in the catheter 300. It is a figure which shows the state in which the half (the side of the 1st cylinder 110) is housed in a catheter 300, respectively.

In terms of time transition, the defect hole closing material 100, which is entirely housed inside the catheter 300 shown in FIG. 3 (the space formed by the inner wall 310), and the second tubular portion 120 are the openings of the catheter 300. When the 320 is extended in the Y direction of the arrow, the state shown in FIG. 4 is obtained, and when the first tubular portion 110 is further extended in the Y direction of the arrow, the state shown in FIG. 1 is obtained. Here, the state of the defect hole closing material 100 shown in FIG. 2 is a virtual state in which the distance between the first end portion 112 and the second end portion 122 is an intermediate state. In addition, "hand" and "root" are synonymous.

As shown in these figures, the defect hole closing material 100 is generally formed of a tubular body having a stitch-like structure using a wire rod, and the diameter of the substantially central portion 130 of the tubular body is the other portion. The first tubular portion 110 and the other end portion (the first) on the side of the first end 112 in the longitudinal direction of the tubular body in the defect hole closing material 100, which has a shape smaller than the diameter of the tubular portion 130. A second tubular portion 120 on the end portion 122) side of 2 is formed.

What is characteristic is that the first end 112 and the second end 122 are separated from each other with the central portion 130 as the center, and the diameter of the other portion is reduced to close the defect hole in the catheter 300. When the material 100 is stored (state shown in FIG. 3), the second end 122 side becomes the tip side of the catheter 300. In this case, the defect hole closing material 100 is referred to as an operation wire 500 (hereinafter referred to as a delivery cable 500) passed from the first end 112 side to the second end 122 side via the substantially central portion 130. A joint portion 422 for joining (may be) is provided on the second end portion 122 side. Further, the defective hole closing material 100 allows the delivery cable 500 to be passed from the first end 112 side to the outside of the defective hole closing material 100 (for example, the delivery cable to the first end 112). A hole through which the 500 cable body 510 passes) is formed.

Here, as shown in FIGS. 10 to 12, the joint portion 422 is a hollow cylindrical object (for example, made of metal) provided with a female screw 424, and is located on the tip end side of the cable body 510 of the delivery cable 500. The provided male screw 514 is joined by screwing it into the female screw 424. In the living body, by rotating (rotating) the cable body 510 in the direction opposite to the direction in which the male screw 514 is screwed into the female screw 424, the joint by this screwing is opened, and the defect hole closing material 100 is opened. And the delivery cable 500 can be separated.

Here, as shown in FIGS. 10 to 12, in the hollow cylindrical object forming the joint portion 422, the first tubular portion 110 side is opened and the female screw 424 is provided, and the cable main body of the delivery cable 500 is provided. It can be screwed with the male screw 514 provided on the tip end side of the 510, and the opposite side of the first cylinder portion 110 side is closed.
When the opposite side of the first tubular portion 110 side is closed in this way, the delivery cable can be easily operated when pushing the defective hole closing material in the sheath so that the defective hole closing material is not twisted. It is preferable in that it can be.

As will be described in detail in [Usage] described later, the defect hole closing material 100 is in a state where the entire defect hole closing material 100 joined to the delivery cable 500 by the joint portion 422 is housed in the catheter 300. , The delivery cable 500 is manipulated (so that the defect hole closure 100 travels towards the opening 320 of the catheter 300) so that the first tube 110 follows the second tube 120 from the tip of the catheter 300. By being brought out of the 300, the first end 112 and the second end 122 approach each other around the substantially central portion 130, corresponding to the defect hole closed by the defect hole closing material 100. The cylinder diameter of other parts is expanded to the size.

At this time, since the joint portion 422 is provided on the second end portion 122 side and the tip end portion of the delivery cable 500 is joined to this joint portion 422, (the joint portion 422 joined to the tip end portion of the delivery cable 500). The second tube 120 and the first tube 110 are pulled out of the catheter 300 so that they are pushed out (as if they were provided on the side of the first end 122). Is taken out of the catheter 300. When extruded, the defect hole closing material 100 is twisted, and the first end portion 112 and the second end portion 122 cannot be appropriately approached with respect to the substantially central portion 130 and are closed by the defect hole closing material 100. The cylinder diameter of other parts may not be appropriately expanded to the size corresponding to the defective hole, but when pulled, the defect hole closing material 100 is suppressed from twisting and the first end 112 And the second end 122 are appropriately close to each other around the central portion 130, and the diameter of the other portion is appropriately expanded to a size corresponding to the defect hole closed by the defect hole closing material 100. Can be done.

Further, FIG. 5A shows a partial side view of the defect hole closing material 100, and FIG. 5B shows a cross-sectional view taken along the line AA of FIGS. 2 and 5A, respectively. Note that FIG. 5B is a cross-sectional view of the defect hole closing material 100 (more specifically, the second tubular portion 120), but the cross section of the cable body 510 of the delivery cable 500 is shown in the direction of arrow A. The stitches of the bioabsorbable fiber 150 that can be visually recognized from the above are not shown. Further, in FIGS. 1 to 5, they are arranged on the back side of the paper surface in order to facilitate understanding of the existence of the cable body 510 of the delivery cable 500 located inside the defect hole closing material 100 and the stitches of the bioabsorbable fiber 150. The bioabsorbable fiber 150 is not shown, and there is a portion where the appearance shape of the defect hole closing material 100 is shown by a dotted line in order to facilitate understanding of the appearance shape of the defect hole closing material 100. ..

As shown in these figures (particularly FIG. 2), the defect hole closing material 100 has two cylinders (first cylinder 110 and second cylinder 120) of a stitch-like structure using a bioabsorbable material. ), And its shape is composed of such two cylinders, for example, an hourglass type, a figure eight shape, and a double spindle type (a long and narrow rod-shaped object with a thick center and thin ends). It has a shape called (two consecutive shapes) or a peanut shape (the appearance shape of a peanut shell containing two fruits). The defect hole closing material 100 having such a shape has a shape in which the substantially central portion 130 is narrowed so that the diameter of the substantially central portion 130 of the tubular body is smaller than the diameter of the other portions. That is, the first tubular portion 110 on the first end 112 side and the second tubular portion 120 on the second end 122 side are formed around the substantially central portion 130.

Although not limited, the defect hole closing material 100 has a first cylinder portion 110 and a second cylinder portion 110 so that the cylinder diameter of the substantially central portion 130 is smaller than the cylinder diameter of the other portion. The tubular portion 120 of the above is integrally knitted, and the overall shape of the defect hole closing material 100 is formed into an hourglass type, a figure eight shape, a double spindle type, or a peanut shape composed of two cylinders. To.
In this case, using such an hourglass-shaped, figure-eight-shaped, double-spindle-shaped or peanut-shaped formwork (three-dimensional paper pattern), one bioabsorbable fiber 150 is formed according to the formwork. By knitting, the entire shape of the defect hole closing material 100 is formed. Further, but not limited to, the defect hole closing material 100 is heat-set after the first tubular portion 110 and the second tubular portion 120 are integrally knitted to form a tubular body having substantially the same diameter. By doing so, the substantially central portion 130 in which the diameter of the substantially central portion 130 is smaller than the diameter of the other portions and the diameter of the substantially central portion 130 is larger than the diameter of the cable body 510 of the delivery cable 500 is provided. The defect hole closing material 100 may be formed into an hourglass shape composed of two cylinders, a figure eight shape, a double spindle shape, or a peanut shape as the whole shape of the defect hole closing material 100.

Then, as will be described in detail later, by realizing such a shape by knitting, the defect hole closing material 100 in which the entire catheter 300 is housed inside (the space formed by the inner wall 310) shown in FIG. 3 is stored. The delivery cable 500, whose tip is joined to the joint 422 on the second end 122 side, is operated (so that the defect hole closing material 100 advances toward the opening 320 of the catheter 300) to operate the catheter 300. A space in which the second tubular portion 120 is formed by the inner wall 310 of the catheter 300 by extending the second tubular portion 120 from the opening 320 at the tip of the catheter 300 in the Y direction so as to be pulled out of the catheter 300. The second tubular portion 120 is in the state shown in FIG. 4, and the delivery cable 500 is further operated (so that the defect hole closing material 100 advances (further) toward the opening 320 of the catheter 300). Then, the first tubular portion 110 is pulled out from the opening 320 at the tip of the catheter 300 in the Y direction of the arrow so as to be pulled out of the catheter 300, so that the first tubular portion follows the second tubular portion 120. The shape change (time transition shape) that the portion 110 is also released from the space formed by the inner wall 310 of the catheter 300 and the first tubular portion 110 (and the second tubular portion 120) is in the state shown in FIG. (Change) can be realized.

As shown in FIG. 1, when the defect hole closing material 100 is not housed in the catheter 300 and exists isolated in the space, the first end portion 112 and the second end portion 122 are formed. The cylinder diameters of the first cylinder portion 110 and the second cylinder portion 120, which are other portions other than the substantially central portion 130, are expanded by approaching the center of the substantially central portion 130. Regarding the expanded cylinder diameter, the first cylinder portion 110 and the second cylinder portion (which are other parts other than the substantially central portion 130) up to the size corresponding to the defect hole closed by the defect hole closing material 100. It is particularly preferable that the cylinder diameter of 120 is expanded.

Then, as shown in FIG. 3, when the defect hole closing material 100 is housed in the catheter 300 and the like, the defect hole closing material 100 is not isolated in the space but the freedom in the radial direction is restricted. The end portion 112 of 1 and the second end portion 122 are separated from each other around the substantially central portion 130, and the cylinder diameters of the first cylinder portion 110 and the second cylinder portion 120, which are other portions, are reduced. ing. Regarding the reduced cylinder diameter, the first cylinder portion 110 and the second cylinder portion 120 (which are other parts other than the substantially central portion 130) up to the size corresponding to the catheter 300 in which the defect hole closing material 100 is housed. It is particularly preferable that the diameter of the cylinder is reduced.

The diameter of the cable body 510 of the delivery cable 500 is smaller than the diameter of the cylinder of the central portion 130.
In this way, the defect hole closing material 100 is not stored in the catheter 300, for example, to limit the radial freedom, or is pulled out from the catheter 300 to be taken out of the catheter 300 to limit the radial freedom. In this way, the first end 112 in the longitudinal direction of the cylinder in the defect hole closing material 100 and the second end 122, which is the other end, are separated from each other (stored in the catheter 300). It can be brought closer (pulled out of the catheter 300). The first end 112 and the second end do not limit the radial freedom by pulling the defect closure material 100 out of the catheter 300, for example, by pulling it out of the catheter 300. The diameter of the other part of the central portion 130 (the diameter of the body portion in the first tubular portion 110 and the second tubular portion 120) is expanded by approaching the 122, and the diameter is accommodated in the catheter 300. When the freedom of direction is restricted, as shown in FIG. 3, the first end 112 and the second end 122 are separated from each other, and the diameter of the other portion of the substantially central portion 130 (first cylinder 110). And the cylinder diameter of the body portion in the second cylinder portion 120) is reduced.

Further, as shown in FIG. 4, when the second tubular portion 120 was pulled out from the catheter 300 in the arrow Y direction, the shape was restricted by the inner wall 310 of the catheter 300 (the radial freedom was restricted). The shape of the cylinder portion 120 of 2 can be freely changed, and only the diameter of the cylinder portion of the body portion of the second cylinder portion 120 is expanded. Further, when the first tubular portion 110 is pulled out from the catheter 300 in the Y direction indicated by the arrow, the shape of the first tubular portion 110 is restricted by the inner wall 310 of the catheter 300 (the radial freedom is restricted). The shape can be freely changed, and the diameter of the body portion of the first cylinder portion 110 is also expanded.

In the defect hole closing material 100, the first tubular portion 110 and the second tubular portion 120 are woven fabrics (coarse ones) of bioabsorbable fibers 150, knitted fabrics, braided fabrics, or tubular knitted fabrics. It is composed of knitted fabric, and the whole is a stitch-like structure. As confirmed here, this stitch-like structure is not limited to the knitting formed by knitting, and as described above, the mesh-like structure is formed by a coarse woven structure such as a screen door. including. That is, it may be a structure called a stitch-like structure or a structure called a mesh-like structure.

As described above, basically, except for the joint portion 422 made of a metal piece made of metal (for example, stainless steel), the first tubular portion 110 and the second tubular portion 120 are all made of a bioabsorbable material. Therefore, the entire defect hole closing material 100 except for the joint portion 422 has bioabsorbability (the delivery cable 500 does not constitute the medical material according to the present invention and does not remain in the living body. So the material is not particularly limited). Further, the treatment for closing the defect hole is performed by changing the shape of the defect hole closing material 100. A defect hole closing material 100 is formed in the material, stitch shape, fibrous structure and fiber cross section so as not to be damaged, including the joint 422.

Normally, stainless steel or the like is used for the joint portion 422 and does not have bioabsorbability, but a magnesium-based alloy described later may be used to provide bioabsorbability. It is advantageous to use a bioabsorbable alloy for the joint 422 in that it reacts to X-ray imaging, and if a bioabsorbable alloy is used, the metal member will not remain in the body for a lifetime, so it is remote. It is advantageous in that it does not cause the problem of concern about defects in the period.

The bioabsorbable fiber 150 constituting the first tubular portion 110 and the second tubular portion 120 is, for example, polyglycolic acid, polylactide (D, L, DL polymer), polycaprolactone, glycolic acid-lactide (D). , L, DL polymer), glycolic acid-ε-caprolactone copolymer, lactide (D, L, DL polymer) -ε-caprolactone copolymer, poly (p-dioxanone), glycolic acid-lactide (D) , L, DL form) -ε-caprolactone, which is at least one selected from copolymers and the like, and is used in a form processed into any one of monofilament yarn, multifilament yarn, twisted yarn, braided cord, etc., but monofilament yarn. It is preferably used in the form of.

Further, the material of the bioabsorbable fiber 150 may be a bioabsorbable alloy. An example of such a bioabsorbable alloy is a magnesium-based alloy as a raw material.
The diameter of the bioabsorbable fiber 150 is about 0.001 mm to 1.5 mm, and the fiber diameter and type suitable for the catheter treatment to be applied are selected. Further, the cross section of the bioabsorbable fiber 150 may be any of a circle, an ellipse, and other irregular shapes (for example, a star shape), provided that the tissue in the living body is not damaged. Further, the surface of the bioabsorbable fiber 150 may be hydrophilized by plasma discharge, electron beam treatment, corona discharge, ultraviolet irradiation, ozone treatment or the like. Further, the bioabsorbable fiber 150 is a drug suitable for coating or impregnating an X-ray impermeable material (for example, barium sulfate, gold chip, platinum chip, etc.) or a drug (for example, catheter treatment for atrial septal defect). ) Adhesion treatment, or coating treatment with a natural polymer such as collagen or gelatin or a synthetic polymer such as polyvinyl alcohol or polyethylene glycol may be used.

The first tubular portion 110 and the second tubular portion 120 have a plurality of bioabsorbable fibers 150 (for example, eight ports) around a silicone rubber tube (not shown) having an outer diameter desired as a monofilament yarn, for example. Alternatively, it is manufactured into a braided woven fabric using a braiding machine having a yarn feeding port (or 12), or is knitted into a knitted structure of a cylinder having substantially the same diameter by a circular knitting machine (not shown). After knitting, as described above, it is formed into an hourglass-shaped, figure-eight-shaped, double-spindle-shaped or peanut-shaped body composed of two cylinders, a first cylinder 110 and a second cylinder 120. To. The diameters of the first cylinder 110 and the second cylinder 120 are smaller than the inner diameter of the catheter 300 when the diameter is reduced, and the diameter is suitable for catheter treatment of atrial septal defect when the diameter is expanded. Be prepared. For example, when the diameter is expanded, the cylinder diameters of the first cylinder portion 110 and the second cylinder portion 120 are about 5 mm to 80 mm, preferably about 15 mm to 25 mm. Further, the lengths of the first tubular portion 110 and the second tubular portion 120, and the density of the stitch-like tissue of the defect hole closing material 100 also have a density suitable for catheter treatment of atrial septal defect. The diameter and length of the first cylinder 110 and the second cylinder 120 do not have to be the same, and may be changed so as to be suitable for catheter treatment of atrial septal defect.

As described above, the defect hole closing material 100 according to the present embodiment has the following features.
(First feature) Formed into an hourglass-shaped, figure-eight-shaped, double-spindle-shaped or peanut-shaped composed of a first tubular portion 110 and a second tubular portion 120 squeezed in a substantially central portion 130. ing.
(Second feature) The joint portion 422 that joins the operation wire 500 passed from the first end portion 112 side to the second end portion 122 side via the substantially central portion 130 is joined to the second end portion 122 side (second end portion 122 side). The delivery cable 500 is provided so as to be provided on the distal end side of the catheter 300) so that the delivery cable 500 can be passed from the first end 112 side to the outside of the defect hole closing material 100.

Then, according to the first feature and the second feature, when the second tubular portion 120 is extended from the catheter 300 to the outside of the catheter 300 with respect to the defect hole closing material 100 housed in the catheter 300, the inner wall of the catheter 300 is formed. The second tubular portion 120 whose shape was restricted by 310 can freely change its shape, and only the diameter of the tubular portion in the second tubular portion 120 is expanded, and further, the catheter 300 to the first tubular portion 110 When the catheter 300 is taken out of the catheter 300, the shape of the first tubular portion 110 whose shape is restricted by the inner wall 310 of the catheter 300 can be freely changed, and the tubular portion of the body portion of the first tubular portion 110 is also expanded. .. Then, the cylinder diameter of the trunk portion is expanded to the size corresponding to the defect hole closed by the defect hole closing material 100. In particular, the defect hole closing material 100 exhibits the following effects, and the atrial septum. Suitable for catheter treatment of defects.

(First action) The first end 112 and the second end 122 are separated from each other with the central portion 130 as the center (the first end 112 and the second end 122 are separated from each other). By pulling in opposite directions so as to reduce the diameters of the other parts, the first cylinder 110 and the second cylinder 120, the diameter of the defect hole closing material 100 is reduced to the inner diameter of the catheter 300. It can be made thinner and set in the catheter 300.
(Second action) Since the joint portion 422 is provided on the side of the second end portion 122 and the tip end portion of the delivery cable 500 is joined to this joint portion 422, the second cylinder portion 120 is also the first cylinder portion. Since the portion 110 is not pushed out of the catheter 300 so as to be pushed out, but is pushed out of the catheter 300 so as to be pulled out, the defect hole closing material 100 is twisted when pushed out, and the first end portion The cylinder diameter of the other portion is appropriately expanded to a size corresponding to the defect hole in which the 112 and the second end portion 122 cannot be appropriately approached with respect to the substantially central portion 130 and are closed by the defect hole closing material 100. It is suppressed that the defect hole closing material 100 is not twisted in this way by pulling it, and the first end portion 112 and the second end portion 122 are centered on the substantially central portion 130. The diameter of the other portion can be appropriately expanded to a size corresponding to the defect hole that is appropriately approached and closed by the defect hole closing material 100. As a result, the first tubular portion 110 arranged on the right atrium side and the second tubular portion 120 arranged on the left atrium side approach each other around the substantially central portion 130 and open to the atrial septum. You can close the hole.

(Third action) Since all the materials constituting the defect hole closing material 100 (the joint portion 422 may be excluded) are bioabsorbable materials, they are finally absorbed into the living body, which is a problem in the remote period. The possibility of is almost eliminated.
Further, a preferred embodiment of the present invention will be described below.
As described above, the defect hole closing material 100 is formed on a tubular body of a stitch-like tissue using a wire rod having bioabsorbability (on the first tubular portion 110 on the hand side and the left atrium side arranged on the right atrium side). In addition to the delivery cable 500 (more specifically, the cable) detachably joined to the second cylinder 120 on the tip side to be arranged, in addition to the cylinder itself connected via the substantially central 130. It is preferable that the main body 510 and the outer cylinder 550) are included. The delivery cable 500 has a configuration capable of pressing the first end 112 on the hand side toward the second end 122 on the tip side by operating from outside the living body.

More specifically, the delivery cable 500 includes a cable body 510 and an outer cylinder covered with the cable body 510 from the cylinder itself of the defect hole closing material 100 so as to be slidable along the cable body 510 to the outside of the living body. It is preferably configured to include 550 and the like. Then, by pushing the outer cylinder 550 from outside the living body, the first end 112 on the hand side can be pressed toward the second end 122 on the tip side.

The length of the outer cylinder 550 is as shown in FIG. 6 when the cylinder itself of the defect hole closing material 100 to which the delivery cable 500 is joined is housed in the catheter 300 (in the state shown in FIG. 3). In a state where the outer end of the outer cylinder 550 is outside the living body, the inner end 552 of the outer cylinder 550 comes into contact with the first end 112. This will be described in detail with reference to FIGS. 1 to 4 and FIG. The distance from the end face of the joint portion 422 on the tip side (the joint portion 412 side on the hand side) of the cable body 510 of the delivery cable 500 inside the living body to the end face inside the living body of the outer cylinder 550 (hereinafter simply referred to as a distance). Is L (2) in the state of FIG. 1 showing the shortest case, and L (1) (> L (2)) in the state of FIG. 3 showing the longest state. In the state shown in FIGS. 2 and 4, the distance is L (1) to L (2). In either case, the inner end 552 of the outer cylinder 550 can abut on the first end 112, and in any case, the outer side as shown in FIG. The outer end of the cylinder 550 is outside the living body. Then, in order to provide such a distance and positional relationship and a change in the shape of the cylinder itself, the end portion 552 inside the living body of the outer cylinder 550 abuts on the first end portion 112 in any state. Therefore, by pushing the outer cylinder 550 from outside the living body, the first end 112 on the hand side can be pressed toward the second end 122 on the tip side.

Here, as shown in FIG. 10A, the inner end portion 552 of the outer cylinder 550 is in contact with the first end portion 112, and the outer cylinder 550 is pushed from outside the living body to the hand side. Instead of being able to press the first end portion 112 toward the second end portion 122 on the tip side, the configuration shown in FIG. 10B may be used. As shown in FIG. 10B, a collar 556 is provided at the inner end of the outer cylinder 550, and the end surface 554 of the collar 556 is in contact with the first end 112, and the outer cylinder is in contact with the first end 112. By pushing the 550 from outside the living body, the first end 112 on the hand side may be pressed toward the second end 122 on the tip side. With this configuration, the end face 554 of the collar 556 inside the living body is in contact with the first end 112, and the end face 554 of the collar 556 is on the hand side by the operation of pushing the outer cylinder 550 from outside the living body. The first end 112 can be suitably pressed toward the second end 122 on the tip side (the first end 112 is preferably pressed by the end face instead of the end). It should be noted that the maximum outer diameter of the collar 556 is confirmed to be smaller than the inner diameter d of the catheter 300.

Here, the remarkable action and effect by such a configuration will be described. The biodegradable material particularly preferably adopted as the material of the cylinder itself of the medical material 100 may be slower to expand or have poor expandability as compared with a shape memory alloy such as a nickel titanium alloy. could be. In such a case, as shown in FIG. 4, when the second tubular portion 120 on the tip side is expanded and then the first tubular portion 110 on the root side is expanded (delivery cable from the state shown in FIG. 4). 500 is manipulated (so that the defect closure material 100 advances (further) towards the opening 320 of the catheter 300) so that the first tube 110 pulls out of the catheter 300 from the opening 320 at the tip of the catheter 300. Following the second tubular portion 120, the first tubular portion 110 is also released from the space formed by the inner wall 310 of the catheter 300 so as to be ejected in the Y direction, and the first tubular portion 110 (and the first tubular portion 110) is released. (In the case of realizing the change in shape (change in shape in a time transition) that the cylinder portion 120) of 2 is in the state shown in FIG. 1), the first operation on the hand side by pushing the outer cylinder 550 from outside the living body. Since the end portion 112 is pressed toward the second end portion 122 on the distal end side, even if a biodegradable material is adopted for the first tubular portion 110, the first tubular portion 110 can be preferably deployed. can.

Here, in the present invention, pressing the first end 112 on the hand side toward the second end 122 on the tip side by operating from outside the living body is the case shown in FIG. 4 (timing) described above. Not limited to.
Although the outer cylinder 550 is not limited, for example, when the outer diameter of the cable body of the delivery cable 500 is 1.5 mm, the outer cylinder 550 has an inner diameter larger than the outer diameter of 1.5 mm. It is preferably possible to cover with a fluorine tube having an inner diameter of 1.93 mm (outer diameter of 2.53 mm).

Further, it is also preferable to have the following configuration. FIGS. 1 and 9 in which the diameter of the other part is expanded to the size corresponding to the defect hole closed by the cylinder itself (for example, the defect hole 252 in the atrioventricular septum 250 separating the right atrium 210 and the left atrium 230). In the case shown in the above case, as shown in FIG. 6, the end of the cable body 510 of the delivery cable 500 outside the living body is longer than the end of the outside of the living body of the outer cylinder 550 (from the outer cylinder 550 to the cable body 510). Is exposed), and the delivery cable 50 is released from the cylinder by releasing the screw between the male screw 514 and the female screw 424 that rotate the cable body 510 on the outer end side of the exposed cable body 510.
It is also preferable that a hand operation jig 560 for detaching 0 is connected. Here, when the direction in which the male screw 514 is screwed into the female screw 424 is a right-handed screw (rotating clockwise and advancing and screwing), the hand operation jig 560 is used in the opposite direction. By rotating (rotating) the cable body 510 in the counterclockwise direction, the connection by screwing can be released and the cylinder itself and the delivery cable 500 can be separated from each other.

As shown in FIGS. 6, 11 and 12, the hand operation jig 560 includes a jig body 562 having an octagonal cross section and having a through hole corresponding to the outer diameter of the cable body 510. The cable body 510 inserted through the through hole is provided with a set screw 564 to prevent the cable body 510 from idling in the jig body 562, and the cable body 510 is suitably rotated (rotated) by rotating (rotating) the jig body 562. ) Is provided. The through hole may not be penetrated as long as it is provided at least up to the position of the set screw 564.
The case where the defect hole closing material 100 is used for catheter treatment of atrial septal defect will be described with reference to FIGS. 6 to 9.

[Usage mode]
FIG. 6 is a conceptual diagram when the defect hole closing material 100 is used for catheter treatment of atrial septal defect, and FIGS. 7 to 9 are enlarged views of part B of FIG. 6 showing the procedure of this catheter treatment. show. In the following, only the matters peculiar to the usage mode of the defect hole closing material 100 according to the present embodiment will be described, and the general matters will be described in the same manner as the known catheter treatment for atrial septal defect. Since there is, I will not repeat the detailed explanation here.

As shown in FIG. 6, the human heart 200 is connected to the right atrium 210 via the right atrium 210, which is connected to the superior and inferior aorta and receives venous blood from the whole body, the pulmonary artery and the tricuspid valve 260, and to the lung. Two atriums of the right ventricle 220 that pumps venous blood, the left atrium 230 that is connected to the pulmonary vein and receives arterial blood from the lung, and the left ventricle 240 that is connected to the left atrium 230 via the aorta and mitral valve 270 and pumps arterial blood throughout the body. It is composed of ventricles. Atrial septal defect is a disease in which a defect hole 252 is opened in the atrial septum 250 that separates the right atrium 210 and the left atrium 230. In FIG. 6, for easy understanding, the distal end side of the catheter 300 (the distal end side from the break line in the B portion) is shown by a virtual line so that the defect hole closing material 100 housed in the catheter 300 is shown as a solid line. Is shown.

First, in vitro, the defect hole closing material 100 is pulled in a direction in which the first end 112 and the second end 122 of the defect closing material 100 that expands to an appropriate size with respect to the defect hole 252 are separated from each other. The diameter of the cylinder is smaller than the inner diameter of the catheter 300, and the catheter 300 is set. Insert the catheter 300 containing the defect hole closing material 100 from the femoral vein (see FIG. 3), and insert the catheter 300 (containing the defect hole closing material 100) into the catheter 300 (along with the stored defect hole closing material 100). The catheter 300 containing the defect hole closing material 100 is brought closer to the left atrium 230 side through the defect hole 252 from the right atrium 210 side by moving in the direction X (1).

As shown in FIGS. 6 and 7, the catheter 300 containing the defect hole closing material 100 is stopped at a position such that the substantially central portion 130 of the defect hole closing material 100 corresponds to the vicinity of the defect hole 252. The delivery cable 500 is operated (so that the defect hole closing material 100 advances toward the opening 320 of the catheter 300), and in the living body, the tip of the delivery cable 500 is joined to the junction 422 on the distal end side. Therefore, the second tubular portion 120 is not pushed out of the catheter 300 so as to be pushed out from the catheter 300, but the second tubular portion 120 is pulled so that the arrow is outward from the catheter 300 to the catheter 300. It is issued in the indicated Y direction. Then, the second tubular portion 120 whose shape is regulated by the inner wall 310 of the catheter 300 can freely change its shape, and only the tubular portion diameter of the body portion in the second tubular portion 120 is shown in FIG. It is extended as shown in.

Further, the delivery cable 500 is operated (so that the defect hole closing material 100 advances (further) toward the opening 320 of the catheter 300), and in the living body, the delivery cable 500 is connected to the joint portion 422 on the distal end side. Since the tip of the catheter 300 is joined, the first tubular portion 110 is not pushed out of the catheter 300 so that the first tubular portion 110 is pushed out from the catheter 300, but the first tubular portion 110 follows the second tubular portion 120. It is pulled out from the catheter 300 in the direction Y indicated by the outside of the catheter 300. Then, the shape of the first tubular portion 110 whose shape is regulated by the inner wall 310 of the catheter 300 can be freely changed, and only the tubular portion of the body portion in the first tubular portion 110 is shown in FIG. It is extended as shown in.

That is, at a position where the substantially central portion 130 of the defect hole closing material 100 corresponds to the vicinity of the defect hole 252, the delivery cable 500 is inserted (so that the defect hole closing material 100 advances toward the opening 320 of the catheter 300). When operated, the second tubular portion 120 arranged on the left atrium side expands first, and then the first tubular portion 110 arranged on the right atrium side expands later. As a result, the first tubular portion 110 arranged on the right atrium 210 side and the second tubular portion 120 arranged on the left atrium 230 side approach each other around the substantially central portion 130 (defective hole 252). , The first tubular portion 110 and the second tubular portion 120 are expanded. Finally, as shown in FIG. 9, the atrial septum 250 was sandwiched from both sides by the first tubular portion 110 and the second tubular portion 120, and opened to the atrial septum 250 by the defect hole closing material 100. The defect hole 252 can be closed.

Here, at a position where the substantially central portion 130 of the defect hole closing material 100 corresponds to the vicinity of the defect hole 252, the delivery cable 500 is inserted (so that the defect hole closing material 100 advances in the direction of the opening 320 of the catheter 300). ) In the case where the second tube 120 located on the left atrium side expands first and then the first tube 110 placed on the right atrium side expands later (ie, the tip). (In the case where the first cylinder portion 110 on the root side is expanded after the second cylinder portion 120 on the side is expanded), the outer cylinder 550 covered with the cable body 510 of the delivery cable 500 is pushed from outside the living body. Since the first end 112 on the hand side is pressed toward the second end 122 on the tip side by this operation, even if a biodegradable material is adopted for the first cylinder 110, it is deployed first. Following the second tubular portion 120, the first tubular portion 110 can be preferably deployed.

Then, in the body, the cable body 510 is rotated (rotated) so that the male screw 514 rotates (rotates) in the direction opposite to the direction in which the male screw 514 is screwed into the female screw 424, and the defect hole due to this screwing is performed. The joint between the closing material 100 and the delivery cable 500 is opened. At this time, the defect hole closing material 100 provided so as to close the defect hole 252 does not rotate (rotate).

At this time, outside the living body, as shown in FIG. 6, the end of the cable body 510 of the delivery cable 500 outside the living body is longer than the end of the outside of the living body of the outer cylinder 550 (from the outer cylinder 550 to the cable body 510). (Exposed), and the hand operation jig 560 is connected to the end side of the exposed cable body 510 on the outside of the living body. If the direction in which the male screw 514 is screwed into the female screw 424 is a right-hand screw (rotating clockwise and advancing and screwing), this hand-operated jig 560 rotates counterclockwise in the opposite direction. By rotating (rotating) the cable body 510, the screwed joint can be suitably opened, and the cylinder itself and the delivery cable 500 can be suitably separated from each other.

Then, the catheter 300 (which houses the delivery cable 500) is moved in the direction of arrow X (2), and the catheter 300 (and the delivery cable 500) is taken out of the living body to complete the treatment. As a result, a defect hole closing material 100 (may exclude the joint portion 422) made entirely of a bioabsorbable material is placed in the living body (to be exact, in the vicinity of the defect hole 252). Since all the materials of the defect hole closing material 100 placed in the living body in this way are bioabsorbable materials (the joint portion 422 may be excluded), they are finally absorbed in the living body, which is a problem in the remote period. There is almost no possibility of.

Then, in such a usage mode, when the first tubular portion 110 is pushed out from the catheter 300 to the second tubular portion 120 in the arrow Y direction with the operation wire 500, the defect hole closing material 100 is twisted. The cylinder of the other portion to the size corresponding to the defect hole in which the first end portion 112 and the second end portion 122 cannot be appropriately approached with respect to the substantially central portion 130 and are closed by the defect hole closing material 100. The diameter may not expand properly, but when pulled, the defect hole closing material 100 is suppressed from twisting, and the first end 112 and the second end 122 are substantially central 130. The diameter of the cylinder of the other portion can be appropriately expanded to a size corresponding to the defect hole closed by the defect hole closing material 100 so as to be appropriately close to the center.

In particular, even if a biodegradable material, which is inferior in expandability to a shape memory alloy, is used as the material of the cylinder itself of the medical material 100, the root side is used after the second cylinder 120 on the tip side is expanded. When the first cylinder portion 110 of the above is deployed, the first end portion 112 on the hand side is pressed toward the second end portion 122 side on the tip side by the operation of pushing the outer cylinder 550 from outside the living body. , The first tubular portion 110 can be preferably deployed. Further, by rotating the hand operation jig 560 on the female screw 424 in the direction opposite to the direction in which the male screw 514 is screwed to rotate (rotate) the cable body 510, the connection by this screwing is suitably released. , The cylinder itself and the delivery cable 500 can be suitably separated.

As described above, the defective hole closing material 100 according to the present embodiment (here, the defective hole closing material includes the cable main body 510, the outer cylinder 550 covered on the cable main body 510, and the outer cylinder 550. According to the hand-operated jig 560 provided on the cable body 510 exposed from (including the hand-operated jig 560), all of which are made of bioabsorbable material (except for the joint 422), which is finally absorbed into the body. Therefore, there is almost no possibility of a malfunction in the remote period. Further, when the defect hole closing material 100 is extruded from the catheter 300, the defect hole closing material 100 is twisted, and the first end portion 112 and the second end portion 122 appropriately approach each other with the substantially central portion 130 as the center. The cylinder diameters of other parts (first cylinder portion 110 and second cylinder portion 120) may not be appropriately expanded to the size corresponding to the defect hole that cannot be closed by the defect hole closing material 100. Such a case where a joint portion 422 is provided on the side of the second end portion 122, and the tip portion of the delivery cable 500 is joined to the joint portion 422 and pulled to pull out the defect hole closing material 100 from the catheter 300. The defect hole closing material 100 is suppressed from twisting, and the first end portion 112 and the second end portion 122 appropriately approach each other around the substantially central portion 130 and are closed by the defect hole closing material 100. The diameter of the other portions (first tubular portion 110 and second tubular portion 120) can be appropriately expanded to a size corresponding to the defect hole. Further, when the first cylinder portion 110 on the root side is expanded after the second cylinder portion 120 on the tip side is expanded, the first end portion on the hand side is operated by pushing the outer cylinder 550 from outside the living body. Since the 112 is pressed toward the second end 122 on the distal end side, the first tubular portion 110 can be preferably deployed. Further, by rotating the hand operation jig 560 on the female screw 424 in the direction opposite to the direction in which the male screw 514 is screwed to rotate (rotate) the cable body 510, the connection by this screwing is suitably released. , The cylinder itself and the delivery cable 500 can be suitably separated. As a result, by simply operating the delivery cable 500 so that the defect hole closing material 100 advances in the direction of the opening 320 of the catheter 300 at the position of the defect hole, the cylinder diameter of the defect hole closing material 100 can be changed to two cylinders. (1st tubular portion 110 and 2nd tubular portion 120) can be easily changed so as to approach each other, and its morphology can be easily fixed, and a defect hole opened in the atrial septum. Can be closed.

It should be noted that the embodiments disclosed this time are exemplary in all respects and are not restrictive. The scope of the present invention is shown by the scope of claims rather than the above description, and is intended to include all modifications within the meaning and scope equivalent to the scope of claims.

INDUSTRIAL APPLICABILITY The present invention is suitable for a medical material set on a catheter for treating a defect formed in a living tissue, and can be released and indwelled at a treatment site to enable minimally invasive treatment, and is a medical material. It is particularly preferable in that there is almost no possibility of malfunction in the remote period even if it remains in the body, and that operability is preferable.

100 Medical materials (closing plugs)
110 First cylinder 112 First end 120 Second cylinder 122 Second end 130 Approximately central 150 Bioabsorbable fiber 200 Heart 250 Atrial septum 252 Defect hole 300 Catheter 500 Delivery cable (operation wire) )
510 Cable body 550 Outer cylinder (Fluorine tube)
560 Hand operation jig

Claims (4)

A medical material including a cylinder of a stitch-like tissue using a bioabsorbable wire and a delivery cable removably joined to the cylinder.
It has a shape in which the diameter of the substantially central portion of the cylinder is smaller than the diameter of other portions.
A first tubular portion on the first end side, which is one end in the longitudinal direction of the tubular body, and a second tubular portion on the second end side, which is the other end, are formed around the substantially central portion. Being done
When the first end and the second end are separated from each other around the substantially central portion and the diameter of the other portion is reduced to accommodate the medical material in the catheter. The second end side is the tip side of the catheter,
The medical material is
The second end side is provided with a joint portion for joining the delivery cable that is passed from the first end side to the second end side via the substantially central portion.
The delivery cable is formed so as to be able to pass from the first end side to the outside of the medical material.
The delivery cable is a medical material having a structure capable of pressing the first end portion toward the second end portion side by operating from outside the living body. The delivery cable is
With the cable body
Including an outer cylinder covered with the cable body from the medical material to the outside of the living body so as to be slidable along the cable body.
The medical material according to claim 1, wherein the first end portion is pressed toward the second end portion by an operation of pushing the outer cylinder from outside the living body. When the medical material to which the delivery cable is joined is stored in the catheter, the inner end of the outer cylinder is the first end of the outer cylinder while the outer end of the outer cylinder is outside the living body. The medical material according to claim 2, wherein the medical material abuts on the end portion of 1. The joint is a hollow cylindrical object provided with a female screw.
A male screw provided on the tip side of the delivery cable is joined by screwing it into the female screw.
The delivery cable is operated so that the defect hole closing material advances toward the opening of the catheter while the entire medical material bonded to the delivery cable by the joint is housed in the catheter. By ejecting the first tubular portion from the tip of the catheter to the outside of the catheter following the second tubular portion, the first end portion and the second end portion are substantially centered. The outside end of the delivery cable in vitro when the diameter of the other portion is expanded to a size corresponding to the defect hole closed by the medical material in close proximity to the portion. Is longer than the outer end of the outer cylinder,
By rotating the delivery cable to the outer end side of the living body of the delivery cable exposed from the outer cylinder, the screw between the male screw and the female screw is released, and the delivery cable is detached from the cylinder. The medical material according to claim 2 or 3, wherein a hand-operated jig to be used is connected.

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