JP2022529761A - オクルーダ挿入システム - Google Patents
オクルーダ挿入システム Download PDFInfo
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- 238000003780 insertion Methods 0.000 title claims abstract description 95
- 230000037431 insertion Effects 0.000 title claims abstract description 95
- 210000005248 left atrial appendage Anatomy 0.000 claims abstract description 52
- 230000005540 biological transmission Effects 0.000 claims description 55
- 230000008878 coupling Effects 0.000 claims description 14
- 238000010168 coupling process Methods 0.000 claims description 14
- 238000005859 coupling reaction Methods 0.000 claims description 14
- 238000010586 diagram Methods 0.000 abstract 1
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- 238000000034 method Methods 0.000 description 11
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- 230000007704 transition Effects 0.000 description 6
- 239000007943 implant Substances 0.000 description 4
- 241001088162 Primula auricula Species 0.000 description 3
- 235000006894 Primula auricula Nutrition 0.000 description 3
- 208000007536 Thrombosis Diseases 0.000 description 3
- 230000015572 biosynthetic process Effects 0.000 description 3
- 238000011161 development Methods 0.000 description 3
- 230000018109 developmental process Effects 0.000 description 3
- 238000013459 approach Methods 0.000 description 2
- 210000004204 blood vessel Anatomy 0.000 description 2
- 230000002349 favourable effect Effects 0.000 description 2
- 210000002837 heart atrium Anatomy 0.000 description 2
- 239000003550 marker Substances 0.000 description 2
- 239000000463 material Substances 0.000 description 2
- 229910001285 shape-memory alloy Inorganic materials 0.000 description 2
- 206010003658 Atrial Fibrillation Diseases 0.000 description 1
- 208000035478 Interatrial communication Diseases 0.000 description 1
- 239000004809 Teflon Substances 0.000 description 1
- 229920006362 Teflon® Polymers 0.000 description 1
- 229910045601 alloy Inorganic materials 0.000 description 1
- 239000000956 alloy Substances 0.000 description 1
- 238000004873 anchoring Methods 0.000 description 1
- 208000013914 atrial heart septal defect Diseases 0.000 description 1
- 206010003664 atrial septal defect Diseases 0.000 description 1
- 230000023555 blood coagulation Effects 0.000 description 1
- 230000003247 decreasing effect Effects 0.000 description 1
- 210000005069 ears Anatomy 0.000 description 1
- 230000005489 elastic deformation Effects 0.000 description 1
- 239000012530 fluid Substances 0.000 description 1
- 239000006260 foam Substances 0.000 description 1
- 210000004379 membrane Anatomy 0.000 description 1
- 239000012528 membrane Substances 0.000 description 1
- 229910001000 nickel titanium Inorganic materials 0.000 description 1
- HLXZNVUGXRDIFK-UHFFFAOYSA-N nickel titanium Chemical compound [Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni] HLXZNVUGXRDIFK-UHFFFAOYSA-N 0.000 description 1
- 210000003516 pericardium Anatomy 0.000 description 1
- 229920001343 polytetrafluoroethylene Polymers 0.000 description 1
- 239000004810 polytetrafluoroethylene Substances 0.000 description 1
- 238000011321 prophylaxis Methods 0.000 description 1
- 210000001147 pulmonary artery Anatomy 0.000 description 1
- 230000000284 resting effect Effects 0.000 description 1
- 238000011477 surgical intervention Methods 0.000 description 1
- 238000012546 transfer Methods 0.000 description 1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
- A61B17/12122—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder within the heart
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12027—Type of occlusion
- A61B17/12031—Type of occlusion complete occlusion
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12168—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a mesh structure
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12168—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a mesh structure
- A61B17/12172—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a mesh structure having a pre-set deployed three-dimensional shape
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12168—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a mesh structure
- A61B17/12177—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device having a mesh structure comprising additional materials, e.g. thrombogenic, having filaments, having fibers or being coated
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/00867—Material properties shape memory effect
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B2017/1205—Introduction devices
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B2017/1205—Introduction devices
- A61B2017/12054—Details concerning the detachment of the occluding device from the introduction device
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
- A61B2090/3966—Radiopaque markers visible in an X-ray image
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- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Heart & Thoracic Surgery (AREA)
- Molecular Biology (AREA)
- Vascular Medicine (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Reproductive Health (AREA)
- Medical Informatics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Cardiology (AREA)
- Surgical Instruments (AREA)
- Media Introduction/Drainage Providing Device (AREA)
Abstract
【選択図】なし
Description
Claims (15)
- 自己拡張可能なオクルーダ(12)を患者に挿入し、前記オクルーダ(12)を前記患者の左心耳(10)で解放するためのシステムであって、
前記システムは、駆動ユニット(102)を有するとともに、外側チューブ(110)と前記外側チューブ(110)内を延在する内側チューブ(108)とを有する挿入カテーテル(104)を有する挿入ユニット(100)を備え、
前記オクルーダ(12)の近位端領域(16)が前記外側チューブ(110)に運動結合され、前記オクルーダ(12)の遠位端領域(18)が前記内側チューブ(108)に運動結合され、
前記駆動ユニット(102)は、前記オクルーダ(12)を解放するために前記内側チューブ(108)及び前記外側チューブ(110)と相互作用し、これによって前記駆動ユニット(102)が作動すると、前記内側チューブ(108)は、遠位方向または近位方向に移動せられ、前記外側チューブ(110)は近位方向(27)または遠位方向(29)に移動せられ得、これによってオクルーダ(12)の遠位端(140)及び近位端(142)が互いに離間し、または近接し得る、
システム。 - 前記外側チューブ(110)は、遠位方向(29)において、前記内側チューブ(108)の前方で終端する、請求項1に記載のシステム。
- 前記オクルーダ(12)は、前記挿入カテーテル(104)が前記オクルーダ(12)に挿入される近位管状端部(16)を有するフレーム(14)を備える、請求項1または請求項2に記載のシステム。
- 前記オクルーダ(12)は、挿入カテーテル(104)の内側チューブ(108)が配置されるポット形状の遠位端領域(18)を備える、請求項1~3の何れか1項に記載のシステム。
- オクルーダ(12)は、患者に挿入するために、内側チューブ(108)の遠位端(138)と外側チューブ(110)の遠位端(137)とを互いに相対的に、かつ互いに離れるように移動させることによって、挿入ポジションに遷移させることができ、これにより、オクルーダ(12)の近位端(142)と遠位端(140)とを互いに離間させることができる、請求項1~4の何れか1項に記載のシステム。
- 前記内側チューブ(108)及び前記外側チューブ(110)の遠位端(137、138)は、前記オクルーダ(12)を解放するために、前記オクルーダ(12)の前記近位端(142)及び前記遠位端(140)を互いに向かって移動させることができ、好ましくは、前記オクルーダ(12)の解放中、前記近位端(142)と前記遠位端(140)との間の前記オクルーダ(12)の中央部(144)は、その位置を実質的に変化させない、請求項5に記載のシステム。
- 前記駆動ユニット(102)は、第1の伝動ねじ(126)を有する第1の伝動要素(122)と、第2の伝動ねじ(130)を有する第2の伝動要素(124)と、オペレータによって作動可能であり、第1の駆動ねじ(118)および第2の駆動ねじ(120)を有する作動要素(116)と、を有し、前記第1の伝動要素(122)は、前記内側チューブ(108)に運動結合され、前記第2の伝動要素は、前記外側チューブ(110)に運動結合され、前記第1の駆動ねじ(118)は、前記第1の伝動ねじ(126)と相互作用し、前記第2の駆動ねじ(120)は、前記外側チューブ(110)および前記内側チューブ(108)の遠位端(137、138)を互いに接近または離間させるために、前記第2の伝動ねじ(130)と相互作用する請求項1~6の何れか1項に記載のシステム。
- 第1の駆動ねじ(118)は、外部ねじとして設計された第1の伝動ねじ(126)と相互作用する第1の雌ねじとして設計され、前記第2の駆動ねじ(120)は、外部ねじとして設計された第2の伝動ねじ(130)と相互作用する第2の雌ねじとして設計されている、請求項1~7の何れか1項に記載のシステム。
- 前記外側チューブ(110)は、その遠位端領域に、少なくとも1つのラッチングフィンガ状部分(136)、特に2つ以上を有し、これらは、運動結合の目的で、前記オクルーダ(12)の前記近位端領域と相互作用する、請求項1~8のいずれか1項に記載のシステム。
- 前記第1の伝動要素は、内側チューブ(108)への運動結合を目的として、内側チューブ(108)上に配置されたルアーコネクタ(134)と相互作用する、請求項7、8または9に記載のシステム。
- 内側チューブ(108)がオクルーダ(12)内に配置されるときに、ラッチングフィンガ状部分(136)は、オクルーダ(12)の近位端領域(16)と形状嵌め方式で相互作用する、請求項9または請求項10に記載のシステム。
- オクルーダ(12)から挿入カテーテルを取り外すために、内側チューブ(108)をまずオクルーダ(12)から引き出すことができ、次いで、外側チューブ(110)を通してオクルーダ(12)から内側チューブ(108)を引き出した直後に、外側チューブ(110)をオクルーダ(12)から引き出すことができる、請求項11に記載のシステム。
- 前記挿入ユニット(102)は、オペレータが保持することができるハウジング(114)を有し、前記伝動要素及び前記作動要素は、前記ハウジング(114)内または上に配置される、請求項1~12の何れか1項に記載のシステム。
- 前記作動要素(116)は、前記ハウジング上に回転可能に配置される、請求項13に記載のシステム。
- 請求項1~14の何れか1項に記載のシステム用の挿入ユニット(100)。
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JP2022136468A JP7367150B2 (ja) | 2019-01-10 | 2022-08-30 | オクルーダ挿入システム |
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DE102019100531.0 | 2019-01-10 | ||
DE102019100531.0A DE102019100531B4 (de) | 2019-01-10 | 2019-01-10 | Okkludereinführsystem und Einführeinheit |
PCT/EP2020/050432 WO2020144283A1 (de) | 2019-01-10 | 2020-01-09 | Okkludereinführsystem |
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US (2) | US11690630B2 (ja) |
EP (2) | EP3908204A1 (ja) |
JP (2) | JP7342130B2 (ja) |
CN (2) | CN115252037B (ja) |
BR (1) | BR112021013203A2 (ja) |
DE (1) | DE102019100531B4 (ja) |
WO (1) | WO2020144283A1 (ja) |
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JP6423851B2 (ja) | 2013-03-13 | 2018-11-14 | アーロン・ヴィ・カプラン | 左心耳に空置術を行うためのデバイス |
EP3531926A2 (en) | 2016-10-27 | 2019-09-04 | Conformal Medical, Inc. | Devices and methods for excluding the left atrial appendage |
Citations (2)
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JP2008514291A (ja) * | 2004-09-24 | 2008-05-08 | エヌエムティー メディカル, インコーポレイティッド | オクルーダデバイスのデリバリ/回収用二重固定システム |
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JP2003529410A (ja) * | 1999-10-27 | 2003-10-07 | アトリテック インコーポレイテッド | 左心耳の小孔用のフィルター装置 |
JP2008514291A (ja) * | 2004-09-24 | 2008-05-08 | エヌエムティー メディカル, インコーポレイティッド | オクルーダデバイスのデリバリ/回収用二重固定システム |
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CN115252037B (zh) | 2023-10-31 |
US11890019B2 (en) | 2024-02-06 |
US20220096093A1 (en) | 2022-03-31 |
JP7342130B2 (ja) | 2023-09-11 |
EP4101397A2 (de) | 2022-12-14 |
DE102019100531A1 (de) | 2020-07-16 |
EP3908204A1 (de) | 2021-11-17 |
CN113286550B (zh) | 2024-06-11 |
JP2022164758A (ja) | 2022-10-27 |
BR112021013203A2 (pt) | 2021-09-28 |
WO2020144283A1 (de) | 2020-07-16 |
CN115252037A (zh) | 2022-11-01 |
DE102019100531B4 (de) | 2021-08-19 |
US11690630B2 (en) | 2023-07-04 |
CN113286550A (zh) | 2021-08-20 |
US20220387043A1 (en) | 2022-12-08 |
EP4101397A3 (de) | 2023-01-11 |
JP7367150B2 (ja) | 2023-10-23 |
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