JP2750118B2 - Angioplasty catheters and methods of use - Google Patents

Description

Description: TECHNICAL FIELD This patent application is filed on Mar. 1, 1984, US patent application Ser.
This is a continuation-in-part application of No. 12. The present invention is useful in blood vessels, including body conduits, passageways, and arterial veins.
Insertion to remove emboli, stenosis, obstruction, etc. from inside the conduit
About the Internet. In particular, the present invention relates to laser angioplasty.
The laser coronary artery and femoral artery
Decompose or vaporize lesions in the arteries. Laser angioplasty
Surgery puts a laser energy transmitting catheter into the blood vessel
To introduce the free end of the catheter into the vessel
Reach the site of obstruction or atherosclerotic lesions within. catheter
Radiates laser energy to the site to break up the obstruction
Alternatively, the stenotic blood vessel is opened by vaporization. Intense energy of laser in a part of the body such as blood vessels
Use of lugi can cause perforation of blood vessels or damage to surrounding tissue
is there. Therefore, catheters that use laser energy
Need to limit this energy to obstacles to be removed.
You. BACKGROUND ART Conventional catheters for laser angioplasty are placed inside blood vessels.
It has an insertable flexible outer tube. Of the optical fiber in the outer tube
The bundle extends to the distal end of the outer tube. Connect the laser to the bundle,
Transmits laser energy to occlusions in blood vessels. laser
The residue generated by the vaporization of the blockage by the
To remove. U.S. Pat. No. 4,207,874 (Choy, June 17, 1980)
Laser tunneling device ”is a category with a bundle of optical fibers.
This is an example of a satellite. Catheter travels through blood vessel and becomes occluded
Laser energy is applied to the part or near the calcified lesion
I do. Suction is applied to the laser and the residual
Remove the residue. US Patent No. 4,224,929 (Hurihata, September 30, 1980)
Disclosed in “Endoscope with inflatable cuff member and working suction”
The endoscope is positioned within the blood vessel. Near the distal end of the endoscope
The two cuff members are inflated and brought into contact with the inner wall of the blood vessel, and the cuff is
A chamber is formed between the members. Formed by cuff members and blood vessels
Observation, surgical procedures, etc. are performed in the room. U.S. Pat. No. 4,240,431 (Komiya, December 23, 1980)
Laser knives use laser energy to
Incision or resection of the metamorphosis. The laser energy is
To prevent unwanted cauterization or perforation of stationary tissue
To receive laser energy when the cutting process is complete.
Cut off by face. Soviet Patent No. 938977 (Zaizev, March 12, 1980)
JP) discloses a device for separating the wall of a blood vessel. This device
Using a balloon, press against the wall of the aorta and bend it.
Makes an incision through the window into the central casing of the aorta. U.S. Pat. No. 4,458,892 (Hussein, May 1, 1985)
A dual balloon catheter device is disclosed, comprising two spaced apart inflatables.
An expandable balloon ligates a portion of the blood vessel. This patent is
Further, a laser emitting device is shown. International Patent No. PCT / US82 / 01669 (Gullet June 9, 1983
JP) discloses a catheter assembly comprising a first catheter.
And a second catheter positioned within the first catheter
Including ter. First and second inflatable balloons
Stick to one outer surface of the tell. When inflated, the balloon
Sealing engagement within the body conduit. In addition, this patent discloses intravascular
Discloses use of laser beam to remove obstacles
I do. U.S. Pat. No. 4,040,413 (Oshiro, August 9, 1977)
One or more balloons disclosed are mounted on the outer surface of the endoscope tube
The optical transmission bundle of the optical fiber is accommodated in the endoscope. Disclosure of the Invention Removal of Unwanted Substances from Patient Body Conduit According to the Invention
The catheter device used for
A catheter and blood attached to the catheter near its distal end
A conduit that traverses unwanted material, such as the volume of a stenosis or lesion in the vessel
And the distal end of the catheter to the inner surface of the conduit
An inflatable bladder positioned in contact with the inflatable bag. According to an embodiment of the present invention, an optical fiber in a catheter
Transmits laser energy to the distal end of the catheter and
Act on essential substances. According to another embodiment of the invention, the distal end of the catheter
Includes a pair of protrusions, forming a chamber near the inner surface of the blood vessel, unnecessary
Prevents laser energy acting on the material from escaping. According to another embodiment, the catheter is provided with a projection to provide a catheter.
Laser energy by deforming the distal end of the vessel
Turn outside. According to another embodiment of the present invention, a catheter with a distal end
Constriction of lesion, including elongated element extending between nearby protrusions
Or remove the pile. According to another embodiment, the catheter reflects off the distal end or
A second optical fiber is provided when unnecessary substances including the fluorescent layer are removed.
Returns light along the bar. According to another embodiment, the catheter has two lumens
One of which is a rotatable and slidable filament such as a guide wire.
The other contains optical fibers and guidewires
Unnecessary object that has rotated around the center and almost completely occluded the blood vessel
Drill a hole in the quality. According to another embodiment of the present invention, a vessel is
The present invention includes a catheter for piercing without damage.
Of catheters according to other embodiments
Remove. According to another embodiment of the invention, a ligating valve is attached to the catheter.
Block the blood flow with respect to the catheter
A relatively bloodless environment is created during the tell operation. According to another embodiment of the present invention, one or more catheters
Radio opaque band and catheter near occlusion
To guide. According to another embodiment of the invention, the catheter is a soft cone
Shaped nose to minimize damage to blood vessels. According to another embodiment of the invention, the catheter is integral
Guide the catheter through the blood vessel
You. According to another embodiment of the invention, at least a catheter is provided.
Also has a conical distal end with one opening to minimize occlusion
I do. Therefore, it is an object of the present invention to connect the distal end of the catheter to the patient.
Effect of laser energy by a catheter in a body conduit
Before positioning by remote control. Another object of the present invention is to use laser energy to affect lesions.
Laser energy from acting on the inner surface of the blood vessel
There is. Another object of the invention is to rotate a catheter device within a blood vessel.
And place it in all parts of the blood vessel near the distal end of the catheter.
To apply user energy. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 shows a laser angioplasty catheter according to the present invention.
Perspective view showing two protrusions, a suction port and an inflatable bladder
Fig. 2 and Fig. 2 show the catheter of Fig. 1 in the vicinity of a lesion in a blood vessel.
FIG. 3 is a partial cross-sectional view of the catheter, and FIG.
Fig. 4 is a partial cross-sectional view of the sac inflated in contact with the skin.
Acts on stalks and removes lesion residue by suction lumen
5 is a partial cross-sectional view, and FIG.
FIG. 6 is a cross-sectional view showing the catheter positioned according to FIG.
FIG. 7 is a sectional view of the laser angioplasty catheter of the present invention.
The catheter at the distal end of the catheter of
FIG. 8 is a partial perspective view showing a projection to be positioned. FIG. 8 shows the catheter of FIG. 7 in a position near a lesion in a blood vessel.
FIG. 9 is a partial cross-sectional view of the catheter shown in FIG.
FIG. 10 is a partial cross-sectional view of the catheter pressed against the inner surface of the blood vessel, and FIG. 10 is a catheter of FIG. 7 along the line 10-10 in FIG.
FIG. 11 is a cross-sectional view showing a state of the sac before inflation, and FIG. 11 is a view showing a catheter heated by another embodiment of the present invention.
FIG. 12 is a partial cross-sectional view of a blood vessel having an element for removing unnecessary substances from a blood vessel, and FIG. 12 shows a catheter according to another embodiment of the present invention.
FIG. 13 is a partial perspective view of a catheter having a catheter for removing unnecessary substances from a blood vessel.
Sectional view positioned within the tube, FIG. 14 similar to FIG. 13, with catheter in FIG.
FIG. 15 is a cross-sectional view rotated in a tube, and FIG.
16 is a partial perspective view of a catheter for opening a passage in the product, and FIG. 16 shows a catheter of FIG.
FIG. 17 is a partial perspective view of a filament passed through a passage opened in the product. FIG. 17 shows the catheter of FIG.
Rotate and apply laser energy to drill holes
FIG. 18 is a sectional view taken along the line 18-18 in FIG. 15, and FIG. 19 is a laser angioplasty machine according to another embodiment of the present invention.
Blood flow in the blood vessel when Teether sets the catheter in the blood vessel
Block the ligature balloon and catheter between the approach to the vessel
FIG. 20 is a perspective view including a soft nose for preventing damage, and FIG. 20 is a laser energy at the distal end of the catheter shown in FIG.
Radiate the lugi into the room formed between the protrusions of the catheter
FIG. 21 is a sectional view taken along the line 21-21 in FIG. 20, and FIG. 22 is a laser energy view at the distal end of the catheter in FIG.
Fig. 23 is a partial cross-sectional view of the lugi acting on the deposition in the blood vessel.
When the object is removed, the laser energy is projected to the far end
Reflected from the optical fiber toward the receiving fiber in the protruding part on the near end side
FIG. 24 is a partial sectional view of a laser angioplasty machine according to another embodiment of the present invention.
Laser energy is emitted from the far end of the catheter
Fig. 25 is a partial perspective view of the catheter facing the obstructed obstacle. Fig. 25 is the distal end of the catheter along the line 25-25 in Fig. 24.
Rotation of the catheter in the blood vessel, showing the positioning balloon
FIG. 26 is a cross-sectional view showing a flexible tubular member of a catheter according to another embodiment of the present invention.
Movement of the catheter in the vessel by the conical distal end made of material
FIG. 27 is a cross-sectional view of the catheter shown in FIG.
FIG. 28 is a partial cross-sectional view of a catheter having a helical coil guide wire at a distal end of the catheter according to another embodiment of the present invention.
FIG. 29 is an end view of the catheter of FIG. 28, and FIG. 30 is a view of the distal end of the catheter of another embodiment of the present invention.
Partial side view to prevent obstruction of the opening by forming a long hole opening. FIG. 31 is an end view of the catheter shown in FIG. 30, and FIG.
FIG. 33 is an end view of the catheter shown in FIG. 32. BEST MODE FOR CARRYING OUT THE INVENTION The embodiment of the catheter device of the present invention shown in FIG.
The angioplasty catheter device 20 is provided. catheter
The catheter 21 of the device 20 has a distal end 21a and a near end (not shown).
And The diameter of the catheter should be
It can be introduced into the artery or femoral artery and easily proceed along the blood vessel
I do. Thus, the distal end of the catheter device is
Stenosis or platelet accumulation that should progress
Reach nearby. Stenosis in blood vessels using a catheter or
The proximal end of the catheter remains outside the patient while destroying other lesions.
Stay in the department. Catheter near the distal end 21a of the catheter
A pair of protrusions 22, 23 are arranged on the outer surface. The gap between the protrusions
The pace is determined by positioning the catheter in the blood vessel and
Form a working room in contact with the substance. As shown in FIG.
To position the catheter device in the blood vessel.
It has a lumen through which the lament 24 passes. Filament 24
The inside of the catheter 21 is extended to be relatively slidable and rotatable. H
The filament guides the catheter to the position of the stenosis
First, a stenosis to first treat the distal end 24a of the filament
Part. After that, the catheter is
The distal end 21a of the catheter into the stenosis
Near. The filament in the catheter is the catheter
The catheter inside the vessel.
It rotates with respect to the filament when it is applied. In addition, as shown in FIG.
Connect the near end (not shown) to the laser energy source and
25a is inside the projection 23. Typical optical fiber is glass
Fiber bundle or single fiber
It is configured to transmit light including energy. For example, a laser
-Energy source is blue / green argon laser, power range
Is approximately up to 20 watts. Optical fiber far end 25a
The laser energy emitted from the
Across the formed chamber 26, the laser energy
Therefore, it is blocked and absorbed. Thus, laser energy
The heating effect due to the use of teeth is limited to the chamber 26 by the projection 22.
Defined, traveling along a blood vessel, or entering a blood vessel 19
Is prevented. In order to focus the laser energy in the room 26, an optical fiber
A refractive device or lens is provided in the projection 23 at the distal end 25a of the fiber.
Install the 27 The lens transfers the laser energy inside the room 26
Focus and focus to ensure that energy crossing the chamber is projected
Cut off at 22. The catheter device 20 shown in FIG. 2 advances in the direction of the arrow.
Then, it goes to the lesion 28 attached to the inner surface 19a of the blood vessel 19. Kate
The distal end 21a of the teller has a sac 29 in the contracted state in FIG.
It is in. The distal end of the lumen 30 extending inside the catheter 21
The sac 29 has an opening near the inner surface. Diagram of lumen 30
To the required fluid pressure source, for example, an air pressure source.
Supply pressure to expand the sac 29 to the position shown in FIG.
I do. Further, as shown in FIG.
Form one. Connect the far end 32a of the lumen 32 to the suction port 31
The proximal end (not shown) of the lumen 32 is connected to a vacuum source or the like.
Can be connected to a pressure source lower than atmospheric pressure. Thus, suction
The port 31 receives the fluid flow from inside the blood vessel, and
The body flow can be transmitted by the lumen 32. The catheter device 20 shown in FIG.
The projections 22 and 23 are the lesions 28 to be removed from the inner surface 19a of the blood vessel.
Are positioned in the blood vessels on both sides of the body. The sac 29 is inflated and the sac is
Expands the distal end 21a of the catheter by contacting the inner surface of the blood vessel.
Presses against the inner surface of the blood vessel opposite the bladder, resulting in protrusions 22,2
3 comes into contact with the inner surface of the blood vessel on both sides of the lesion 28. Thus, the disease
The spots are substantially contained within the chamber 26 formed by the protrusion. Next, the laser energy is supplied to the optical fiber 25,
The laser beam is emitted from the far end 25a of the fiber into the chamber 26,
Energy is applied to the lesion 28. Laser energy
The lesions are heated and decomposed, and the lesions evaporate in response to heating
Tend to The distal end of the catheter during lesion resolution
Laser energy is released into the blood vessel beyond the end of section 21a.
The protrusion 22 prevents the protrusion from being caused. The laser can be pulsed or
The intensity and level of energy acting on the lesion as switchable
Control files. During the action of the laser energy, the capsule 29 expands
Maintain condition and keep in contact with the inner surface of blood vessels. In FIG. 4, the laser beam 33 indicated by the dotted line is
It extends across the room 26 with the change. Laser beam chamber
After crossing the road, it is blocked by the projection 22 and the projection is
Energy is transferred into the blood vessel by absorbing the remaining level of energy
Prevention. As shown in Fig. 4, the residue is in the direction of the arrow
Through the port in response to the negative pressure in lumen 32
Enters the lumen 32 and removes residue from near the lesion on the inner surface of the blood vessel.
Remove. FIG. 5 shows the positioning of the catheter device in the blood vessel 19 and the
And the lesion 28 is on one side of the chamber 26 formed between the protrusions.
Deviate to In FIG. 6, the catheter device 20 is rotated in the
The spot 28 is inside the room 26. The rotational movement of the device
Acts on rotational torque. The catheter device is a filament
It can rotate around 24 and sweeps the entire inner circumference of blood vessels.
All the lesions inside can be removed. FIG. 7 is a laser angioplasty according to another embodiment of the present invention.
6 shows a surgical catheter 35. Catheter for catheter device 35
The distal end 36a of 36 is partially closed by a wall 37. 8th
As shown in the figure, the outer surface of the catheter 36 near the distal end 36a
It has a projection 38, which has a top 38a and a plate 38b.
An optical fiber 39 is placed in the catheter 36. Optical fi
The far end 39a of the bar is the near end (not shown) of the optical fiber 39.
Inside the blood vessel when connected to a laser energy source outside the patient
Emits laser energy. Catheter device 35 is
Included within the catheter 36 is a lumen 40 having a distal end 40a.
The distal end of the lumen should be half-moon shaped, as shown in Figure 7.
Can also be. The catheter device 35 is placed near the distal end 36a of the catheter.
Includes 1 and is almost opposite to the projection 38. Capsule port 42
The port communicates with the lumen 43. Lumen 43
Is connected to a pressure source to inflate the sac as shown in FIG.
You. The inflation of the sac is due to the protrusion 38 and the outer surface of the catheter near the protrusion
Is pressed against the inner surface 19a of the blood vessel. As a result, the catheter
The distal end 36a has a curved shape as shown in FIG.
Distal end 39a faces the center line of the blood vessel. Position shown in Fig. 9
Then, the laser energy is directed to the lesion 28. Lumen 40
Residue from the lesions due to negative pressure acts as a half-moon opening of the lumen 40
Enters 40a and is removed from blood vessels. As shown in FIG. 10, the catheter 35 has a filament 44
The ray radiated from optical fiber 39
The energy is substantially matched to the lesion 28. Furthermore, Fira
The catheter device rotates the catheter device 35 around the entire inner
The entire inner surface of the tube can be swept with laser energy. FIG. 11 shows a catheter device 50 according to another embodiment of the present invention.
No need for the interior of the patient's lumen, eg inside the bile duct communicating with the gallbladder
A device that arrives at and removes the substance. Catheter device 50
Includes a heating element 51 made of a resistance wire such as a nichrome wire. Guidance
Line 52 supplies electrical energy to heating element 51. In Figure 13
Rotation of catheter 50 shown reaches heating element to unwanted material 53
To allow removal from the inner surface of the lumen 54. FIG. 12 shows a catheter device according to another embodiment of the present invention.
The device 60 has a blade 62, and arrives at the unnecessary substance 63 to receive a lumen 64.
Removed from the inner surface of The blade 62 is shown in FIG.
a, 62b, the catheter device 60 rotates in the lumen 64
Sometimes it cuts off unwanted substances. 15-18 show another embodiment of the catheter device of the present invention.
Show. The catheter device 70 has a housing 71, and a figure eight
A double barrel, the first lumen 72 and the second lumen
73. The first lumen 72 has a length of filament
Through the wire or guide wire 74, as shown in Fig. 15-17.
The housing 71 goes straight and rotates around the filament 74
Make it possible. The lumen 73 in FIG.
You. In a preferred example, the lumens 72, 73 have a predetermined inner diameter and
The filament 74 easily passes through the first lumen 72 and
A fiber 75 may pass through the second lumen 73. Good examples
The distal end 75a of the optical fiber 75 is the second lumen 73
It is the same plane as the far end 73a. The diameter of the housing 71 is
Can easily be guided along blood vessels 19 such as the coronary or femoral arteries of the elderly.
And be able to proceed. Using an X-ray fluoroscope
Observe the movement of the catheter in the blood vessel. Thus, c
The distal end 71a of the housing 71 advances along the blood vessel and
That is, it reaches the vicinity of the platelet accumulation 28. FIG. 16 shows that the catheter device 70 of FIG.
% In a stenotic blood vessel. Unwanted substance 28 on the inner surface of blood vessel 19
There is no room for the catheter device to pass through. The first roux
The filament 74 advanced to the men 72 is the housing 71
Projecting from the far end portion 71a of the undesired substance 28. Fi
The diameter of the lament 74 can pass through the passage 28a in the unnecessary substance 28.
Wear. If the vessel is not completely occluded, it is usually unnecessary
There is a passage 28a extending therethrough. If the filament 74 passes through the unnecessary substance passage 28a,
Align the end 71a of the housing 71 with the axis of the filament 74
To advance to the vicinity of the unnecessary substance 28. To the second lumen 73
The near end of the housed optical fiber 75 is a laser (not shown)
Connect to an energy source. Laser energy is optical fiber
The direction of the unnecessary substance 28 is radiated at the far end portion 75a of the negative 75.
In a preferred example, the distal end 75a of the optical fiber 75 is a polished convex.
Surface to direct laser energy to unwanted substances 28 over short distances
Focus. Thus, the laser energy is deposited
Ability to decompose laser energy deposits, focusing on 28
Increase. In FIG. 17, the far end of the housing 71 is not required inside the blood vessel 19.
Proximity to substance 28. Optical fiber with laser energy 76
Communicate via 75. The far end 71a of the housing 71 is a filler
Going straight along the element 74 and close to the sediment 28,
The optical fiber 75 rotates around the
Rotate around the lament 74 to sequentially decompose unnecessary substances
To This rotation is indicated by the chain line in FIG. FIG. 19 shows laser angioplasty according to another embodiment of the present invention.
1 shows a surgical catheter device. Catheter device 80 catheter
The lever 81 has a far end 81a and a near end 81b. Catheter 81
Diameter is introduced into patient's blood vessel 19 such as coronary artery or femoral artery
And can easily proceed. X-ray movement of catheter in artery
Observe and control using a fluoroscope. Catheter far
The end 81a is narrow along the vessel to be removed from the vessel.
It reaches the constriction or near platelet accumulation. Proximal end of catheter
Portion 81b is outside the patient during use of the catheter. Near end
A plurality of tubes 91, 93, 94, 95 are connected to the proximal end 81b by a connector 82.
Fluid, gas, and solids into multiple lumens of the catheter.
Passes body and laser energy. As shown in FIGS. 19, 20, and 21, the distal end 81a of the catheter 81
An open chamber 83 is formed by the bottom wall 83a and the projections 83b and 83c.
You. Attach positioning balloon 84 to outer surface 83d of bottom wall 83a
You. As shown in FIG. 21, the projection 83c has a lumen 81c, 81d, 81
e, 81f, 81g, 81h open. The lumen 81c communicates with the inside of the balloon 84, and the lumen 8c
The balloon expands and contracts in response to the pressure condition of the fluid in 1c.
Let Lumen 81d slidably engages guide wire 85
You. Using a guide wire, the chamber 83 is stenosis 28 shown in FIG.
Close to. Remove guidewire from lumen 81d
For example, lumen 81d may be used for other purposes, such as
It can be used for the passage for inhaling from. The lumen 81e is used as a passage communicating with the chamber 83.
For example, using the lumen 81e, the chamber 83 and the inside of the blood vessel near the chamber
The solution to be irrigated is supplied to the chamber 83. The lumen 81f houses the optical fiber 86, and the optical fiber
The distal end 86a of the mirror is exposed at the projection 83c. Optical fiber 86
Radiates laser energy into room 83 and unwanted material 28 in the room
To decompose and remove unnecessary substances. The lumen 81g passes through the optical fiber 87 and the optical fiber 8
7 transmits the reflected light from the chamber 83 as described later. The lumen 81h is a preliminary fluid passage communicating with the chamber 83. As shown in FIGS. 19 and 20, the catheter device 80 is provided with a chamber 83.
Includes a ligating balloon 88 that surrounds the catheter 81 nearby. Baru
The inside of the valve 88 communicates with the lumen 81i in the catheter 81.
Supply a controlled fluid pressure to the interior 88a of the balloon 88
You. When inflated by fluid pressure, the outer periphery of balloon 88
Is pressed against the inner wall of the blood vessel 19 and blocks the blood flow in the blood vessel.
For example, when inflated, the balloon 88 moves from the left in FIG.
Blocks blood movement toward 83. Thus, the room is
During use of the catheter device 80, it is isolated from the inflow of blood. A plurality of passages (not shown) are formed in the near-end connector 82.
Each passage leads to a respective lumen 81c-81i in catheter 81.
Pass. Multiple fixtures 82 extending from proximal end connector 82
a communicates with each of the lumens 81c-81i. Note as a fluid pressure source to inflate the positioning balloon 84
It has a projectile 89. Syringe is piped through unidirectional stopcock 90
Communicate with 91. Operate the plunger 89a of the syringe
Fluid pressure, stopcock 90, pipe 91, near end connector 82,
The positioning balloon 84 is inflated via the body 81c. Rank
If the positioning balloon 84 is inflated, the open chamber 83 is shown in FIG.
Move up the street and make the stack 28 indoors. Unidirectional stop
The lock 90 acts as a check valve and operates the plunger 89a.
After stopping, maintain the fluid pressure at the value in the pipe 91 and lumen 81c.
One. To release this pressure, handle 90 of stopcock 90
The pressure is discharged by operating a, and the balloon 83 is deflated. The syringe 92 smaller than the syringe 89 is connected to the unidirectional stopcock 92a,
Ligation balloon through tube 93, proximal end connector 82, lumen 81i
Connect to terminal 84. Ligation balloon by operation of syringe 92
When the blood swells, the catheter 81 and the blood
Fills the space between the pipe inner wall. Thus, in room 83
Incoming blood flow is cut off, and at the same time a ligated balloon is
The flow toward the air is also blocked. Thus, catheterization
The part of the room where the device 80 operates to remove the accumulation of unnecessary substances
Blood flow is shut off. The position of the balloon 84 is shown in FIG.
Near room 83 or from room 83 along catheter 81
The distance is important. As shown in FIGS. 19 and 20, the pipe 94 passes through the near-end connector 82.
To the lumen 81d of the catheter 81. Connector connection
The end of the tube 94 opposite the continuation is connected to the luer fitting 94a.
To the negative pressure source. This allows lumen 81d
Discharge material from chamber 83. As another example, guide inside pipe 94
Through the wire 95, through the lumen 81d, to the vicinity of the chamber 83
You. X-ray fluorescence of catheter device 80 using guide wire
Proceed along the blood vessel while observing with a fluoroscope,
83 is near the stenosis to be removed. Tube 94 and lumen 81d
The guide wire passing through tube 94 and lumen 81d
, The catheter 81 can slide and rotate. The tube 95 shown in FIG. 19 extends from the near-end connector 82 and stops.
The blood Y reaches the optical Y connector 98 via the blood valve assembly 97. Tube of 95
The light contains a bundle 96 of optical fiber elements 96a, 96b. Element 9
6a and 96b are connected to the proximal end connector 82 through the tube 95 and the hemostasis valve assembly 97.
To be extended. Connector 82 has optical fiber elements 96a and 96b.
The optical fibers 86 and 85 of the catheter 81 are respectively coupled. Connector 100c is a laser not shown with optical fiber 96a
-Connects to an energy source and transmits laser energy to room 83
The free end of the optical fiber 96b is
When the laser energy is supplied to the chamber,
Detect the light returned. The tube 101 is connected to the hemostasis valve 97 to bundle the optical fibers 96a and 96b.
Enters tube 95 containing 96. Pipe luer fitting 101a
Connect to 101 free end. Irrigation of fixture 101a with sarin etc.
When connected to the fluid source, the irrigation solution passes through tube 101, tube 95, and lumen 81e.
Is supplied to the chamber 83. From the irrigation tubing 101 by valve 97
Control cut off the supply of As shown in FIG. 20, at the distal end 81c of the catheter device 80,
Conical nose 103 is made of soft or flexible resin or elastomer
The catheter device is attached along the blood vessel.
To facilitate passage and prevent trauma to blood vessels.
The nose also joins a single branch of multiple vessels at the junction of the vessels
Make it easy to enter. Thus, the soft nose is
At the junction, it smoothly enters the required branch vessel, damaging the blood vessels.
To prevent The radio opaque bands 104 and 105 shown in FIGS.
When guiding the room 83 to the stenosis 28 using a fluoroscope,
Absorbs or blocks radiation. The band blocks X-rays and is nearby
Because the members are transparent to the radiation, the catheter is
The band can be easily recognized when observing with
Indicates the position of. The radio opaque band is
It can be near. The protrusion 83b is inserted into the chamber 83 from the far end 86a of the optical fiber 86.
Made of a material that can absorb the emitted laser energy
You. Thus, the laser energy is shut off and the vicinity of room 83
Prevent contact with blood vessels. As shown in Fig. 20, this material
The material layer 106 is attached to the protrusion 83b. This layer of material is
Laser energy, and some laser energy
Head to fiber 87. Optical fiber 87 is a reflected laser
Energy is transmitted to the optical fiber 96b. Laser energy
Lugi or light response sensor 102 connected to optical fiber 96b,
The laser energy reflected from layer 106 of protrusion 83b,
Sense the presence of light. Laser beam from optical fiber 86
If it penetrates and disassembles the stenosis 28 in the Nergie room 83, it will gradually increase
Of laser energy is applied to the layer 106 of the protrusion 83b,
The light is reflected toward the optical fiber 87. Optical fiber 96b
The connected optical response sensor 102 reflects the reflected laser energy.
To detect. Stenosis is sequentially decomposed by laser energy
If this is done, the reflected laser energy will increase to the maximum
Level, at which point the laser energy is
Not be cut off. Thus, the catheter device worker
Know the disassembly process of the stenosis and the completion of the work. Layer 106 fluoresces when exposed to laser energy.
It can also be formed of a material such as This fluorescent material is reflective
The level of light that is transmitted and the reflection transmitted by the optical fiber 87
Facilitates light detection. Phosphorous material as fluorescent material of layer 106
Is most easily detected under the working conditions of the room 83
Get the color of light. In addition, the phosphor layer is reflective due to the choice of phosphor material.
The fluorescence has a predetermined wavelength determined by the laser energy.
This facilitates the detection of the reflected light from the chamber 83. Laser energy source 100d is a preferred example of a pulsed laser
-Energy. Further, for example, a repetition rate of 5 pulses per second
And The laser pulse is at the far end of the catheter device 80
Unnecessary substances extend across the room when entering room 83
Also, the fluorescent layer 106 responds to the laser pulse. Therefore,
The fluorescent layer reflects the transmitted light pulse, and the optical fiber
Photodetector 1 via 87, optical fiber 95, optical fiber 96b
Reach 02. The detection device 102 is a silicon photodiode
And the like. Optical pal from photodetector 102
Is counted by the pulse counter 102a,
The pulse of energy is actually delivered to chamber 83.
I can see. Thus, for example, the counter 102a is a pulse
Is counted for a predetermined time, for example, 2 seconds. Within a predetermined time
When the predetermined number of pulses are not counted, the laser
Indicates a device failure with respect to the delivery of energy pulses
You. Connect the output of the photodetector to the pulse amplitude detector 102b
Measure the pulse amplitude. The room is almost full of unwanted substances
When most of the laser energy does not reach the phosphor layer 106
The amplitude is at a minimum level. If unnecessary substances are decomposed,
The amount of laser energy striking target 106 increases sequentially.
You. Once all the unwanted substances are decomposed and removed from the chamber,
The pulse amplitude detector 102b detects the maximum amplitude. Hide
Therefore, the process of removing unnecessary substances from the room should be monitored and controlled.
Can be. The illustrated catheter device 80 is inserted into the blood vessel 19 in the upper part of FIG.
To press against the wall, the positioning sac 84 is inflated. Ligature bar
The shaft 88 is in an expanded state. Intravascular catheter device 80
The optical fiber can be rotated around the filament 85.
-86 Laser energy radiated from 86 touches constriction 28
Let it. Irrigation lumen 81e as irrigation fluid source via tubes 95 and 101
Connect and irrigate chamber 83 to facilitate decomposition of unwanted material 28
You. The irrigation solution or solution may be, for example, sarin and a guide wire 85.
After being removed, it is discharged through the lumen 81d. The catheter device 80 shown in FIG.
And press the projections 83b and 83c against the inner surface of the blood vessel 19,
The constriction 28 to be removed from is between the protrusions. Laser d
Nergie 107 radiates from optical fiber 86 and contacts constriction 28
However, the laser energy is limited in the chamber 83 by the protrusion.
It is. In FIG. 23, the laser energy 107
Disintegrates and discharges from chamber 83 by suction lumen 81d
You. The constriction 28 is sequentially removed from the path of the laser energy 107.
If removed, the laser energy is applied to the reflective layer 106 of the protrusion 83b.
The laser energy that comes into contact with and is reflected by the receiving optical fiber
-87, the reflected energy is transmitted to the sensor 102.
You. FIG. 24 shows a laser angioplasty according to another embodiment of the present invention.
Laser drilling catheter 110 shown as a surgical catheter
You. Catheter 110 has a relatively flat distal end 110a,
Open distal end of suction lumen 111 and irrigation lumen 112 at the end
End of optical fiber 113 and balloon lumen with plug
114. Suction lumen for guide wire (not shown)
11 and connect the laser drilling catheter device 110 to the blood vessel 119
For the introduction. Balloon lumen with plug
114 communicates with the inside of the positioning balloon 115,
And push the catheter against the vessel wall as shown in FIG.
Press. When using, the laser drilling catheter device 110
Stenosis guided by X-ray monitor, eg fluoroscopy
Reach the desired position in the vessel completely occluded by part 28
You. If the sac 115 is inflated, the laser drilling catheter 1
10 is a guide (not shown) in any of the lumens 111, 112, and 113
Rotate around the wire to reach the desired position in the blood vessel 19
The fiber 113 is positioned. Far end of optical fiber 113
Attach a refraction device or lens 113a to the
Energy is emitted from the optical fiber
Converge on the stenosis 28. Laser drilling catheter
The device 110 is used for drilling of the complete occlusion stenosis,
Catheter removed close to residual stenosis material 28 for effective removal
I do. Example of irrigation fluid during or before the action of laser energy 114
For example, sarin may be delivered through the irrigation lumen 112 to the stenosis.
Feeding, laser drilling catheter 110 distal end 110a and stenosis
To fill the space between
It is discharged through the inlet lumen 111. In FIG. 25, the laser drilling catheter device 110 is
Position in tube 19. Raw by inflation of balloon 115
Laser piercing catheter 110 responds to the
It is located at the position where it is pressed against the inner wall of 9. As shown in Fig. 25,
Laser piercing catheter 110 along the inner wall of blood vessel 19
Rotate to narrow the laser energy 114 in a circular pattern
Turn to different parts of section 28. FIG. 26 shows another embodiment of a laser piercing catheter.
The catheter 120 is shown. Catheter 120 has tapered end 12
1 is extended beyond the positioning balloon 122 and the chamber 123. Plan
The inner wire lumen 124 extends inside the tapered portion. Soft
Tubular material 125 covers the taper and at least the taper
Laser drilling cassette extending beyond far end 121a
Cover almost all the holes 120. The distal end 125a of the soft tubular material 125 is
It does not damage blood vessels during catheter 120 entry. The laser drilling catheter 130 shown in FIG.
Guides catheter 130 through vessel with spring wire end 131
I do. The end 131 is flexible, so that the end is
The fork allows easy entry into the desired vessel of the plurality of vessels.
Thus, the catheter tip can be used without damaging the blood vessel.
Guide 0. FIGS. 28 and 29 show laser drilling according to another embodiment of the present invention.
FIG. Laser drilling catheter 140
Has a conical shape with a reduced radius and an oval opening 14
It has 2,143,144,145. Opening 142 communicates with optical fiber
The opening 145 communicates with the irrigation lumen. The opening 144 sucks
And communicate with the guidewire lumen. Opening 143 is plug
And communicate with the balloon inflation lumen. Laser hole
The oval opening of this embodiment of the dawn catheter is laser
Blood or debris from obstacles to be broken down by energy
Prevents the opening from being damaged or closed. Good examples
And the conical distal end 141 is made of soft resin or elastomer material
And prevent damage to blood vessels. The laser drilling catheter 150 shown in FIGS.
It is the same as the Tel 140. Opening 151 is a guide wire lumen
Communicate with Opening 152 communicates with the irrigation fluid lumen. Open
Mouth 153 has a plug to inflate the ligating balloon
(Not shown). Aperture 155 is laser
Connects to lumen (not shown) for receiving optical fiber
I do. The laser drilling catheter device 160 shown in FIG.
It has an end 161a. Optical fiber housed in lumen 161b
-162 has a distal end 161a as a terminal. Irrigation lumen 161c
Similarly ends at the far end 161a. Lumen 161d with far end 161a
With a plug nearby to inflate the positioning balloon 163
Supply pressurized fluid. The lumen 161c ends at the far end 161a,
Inhalation into nearby blood vessels. The distal end 161a may contact obstacles or deposits in the blood vessel.
In order to prevent
Attach and extend from the far end to the positioning balloon
You. Thus, the shape of the catheter 163 before the distal end 161a
An open chamber 163a is formed. Color 163 is metal or
It is formed of a rigid resin material. Rigid collar 163 is cut
To avoid damaging the lining of the vessel during tellur
Protective sheath made of resin or elastomeric material with collar 163
Extend above and over a portion of catheter 161. Sheath end
The part 164a projects from the end 163a of the collar.
Does not contact the inner surface of the blood vessel. The operation will be described. Before using the catheter device according to the invention, the patient
Stenosis in ducts such as blood vessels, accumulation of lesions, or other lesions
Unnecessary substance locations can be determined using existing methods, including vascular scans, X-rays, and tomography.
The first is determined by the technique of knowledge. After this, for example,
An incision is made in the femoral artery and filament 24 is advanced through the artery.
To reach the vicinity of the stenosis or lesion accumulation shown in FIG. other
In some cases, it may be necessary to reach the occlusion during surgery, for example,
At the time of surgery. Known techniques after dissection of required vessels, eg
For example, using techniques such as fluoroscopy and vascular fluoroscopy,
The intravascular conditions to be treated by using the Tetra device
Observe. Thus, by controlling the catheter device,
Blood has already been extended to reach the site to be treated.
Allow to enter the pipe. Supply and remove fluid pressure to the balloon or bladder 29 of the device.
Position with respect to the lesion to be done. Place of catheter device 20
In this case, the sac 29 presses the protrusions 22, 23 against the inner surface of the blood vessel,
Prepare for laser energy emission. Catheter device 35
In the case of, the protrusion 38 and the vicinity of the protrusion are
The catheter outer surface 36b is pressed against the inner surface of the blood vessel,
The distal end of the device 35 forms a curved surface within the blood vessel. If the blood vessel is completely occluded, the laser shown in Figs.
Use drilling catheter 110 to drill holes in unwanted materials.
It will be clear that other catheter devices of the present invention can be used.
Can be. Blood vessels almost completely due to obstructions such as lesions
If it is closed but at least the narrow passage 28a remains, the first
Use the catheter device 70 shown in FIG.
Drill holes. The larger the passage, the larger the invention
Decompose residual unnecessary substances by bringing other catheters close to obstacles
I do. For this purpose, a guide wire such as a filament
74 through the narrow passage 28a of unnecessary material, and then the optical fiber 7
3 with a catheter device 70 centered on a guide wire 74
And rotate. For laser drilling catheter 161, see Figs.
Put the protective sheath 164 shown on
Minimize damage to blood vessels by the catheter device. No. 28, 30
Conical distal end of laser drilling catheter device 140 shown
Slot 141 end was broken down by laser energy
Openings damaged or obstructed by obstruction residue or blood
To prevent To use negative pressure when using a catheter device
In addition, the suction port 31 and the catheter
Orifice 40a for the catheter device 35, and for the catheter device 80
There is 81d. Pulse, burst, and cycle formats
Laser energy on the catheter devices 20, 35, 80
You. In the case of the device 20, the laser energy is
The interstitial lesion 28 is vaporized. If the lesion evaporates, the protrusion 2
Nos. 2 and 23 indicate that the laser energy is
Prevents laser energy from escaping into the tube. In the case of the catheter device 35, the
The curved shape of the teller device converts the laser energy into the blood shown in FIG.
Aim at the tube centerline. As a result, the laser
-Energy is dissipated in the center of the blood vessel,
From accidentally contacting the inner surface 19a of the blood vessel. Unnecessary substances are vaporized when using the catheter device 80
Can detect when it is removed from the blood vessel. laser
If unnecessary substances in the path of energy 107 are removed,
The energy of the reflection layer 106 of the projection 83b shown in FIGS.
Collide with The laser energy that hits the reflective layer is fluorescent
And return to the receiving fiber 87 to reduce the reflected energy.
Transmitted to the sensor 102, the laser energy 1
The signal indicates that the obstacle in the route of 07 has been removed. other
As an example, the operator of the catheter device of the present invention may
Indicates the time of completion of the lesion removal process by fluoroscopy or
Observed by observing the fluid pressure gradient between upstream and downstream. The present invention
During use of the catheter, blood vessels during processing can be
For continuous observation, endoscope, vascular scanning, tomography, X-ray
Use a fluoroscope or the like. The catheter device of the present invention
During use, it is rotated around the filament by the operator.
And sweep the inside of the blood vessel. In the case of the catheter device 50, use the electric heating element 51 to protrude
Unnecessary substances between the parts 55 and 56 are cut. Catheter device 54
If not, use the blade 62 to remove unnecessary objects between the protrusions 65 and 66.
Cut off the quality. The soft-conical nose 103 shown in FIGS.
Helps guide the tel device through blood vessels
Any catheter of the present invention, such as a catheter,
20, 35, 50, 80, ie unnecessary substances at the distal end of the catheter
A cassette utilizing a chamber between the first and second protrusions for removal
Can be used for tell. The ligation balloon 84 shown in FIGS.
Catheter devices, eg catheter devices 20, 35, 50, 70, 8
0,110 for efficient removal of unwanted substances in blood vessels
It can be used when a relatively blood-free environment is desired.
Similarly, the radio opaque bands 104 and 105 correspond to any of the present invention.
Of the catheter device
Can be facilitated. For use of any of the catheter devices of the present invention, the 27th
The integrated spring wire tip 131 shown in the figure
It guides the inside of the vessel and is especially effective at the bifurcation of the blood vessel.
The integrated guide wire tip 131 is shown in FIG.
Can be used instead of a wire or guide wire. According to the invention, in particular, the catheter is
The catheter is designed to rotate
There is a real benefit that performance can be demonstrated more efficiently.

Continuation of front page    (56) Reference US Pat. No. 4,266,547 (US, A)                 US Patent 4,627,436 (US, A)                 US Patent 4865458 (US, A)                 US release 4747405 (US, A)                 European publication 163502 (EP, A2)

Claims (1)

(57) [Claims] A laser angioplasty catheter device for use in removing unwanted material from a blood vessel in a human body that occludes the blood vessel, the device having a distal end and a proximal end and adapted to be inserted into the blood vessel. And a catheter having a first lumen and a second lumen, an optical fiber disposed in the second lumen, and a filament disposed in the first lumen, the first and the second The second lumen extends in the longitudinal direction of the catheter, the catheter adapted to receive a filament and adapted to receive an optical fiber, wherein the optical fiber is at a distal end adjacent the distal end of the catheter. And a proximal end adapted to pass laser energy to the optical fiber,
The filament extends along the length of the catheter and beyond the distal end of the catheter to unwanted material;
The catheter is adapted to move linearly and rotationally with respect to the filament when placed in the blood vessel, emitting laser energy from the optical fiber to form a hole in the unwanted material, and the optical fiber is remote. The end is provided with a polished radius to focus the light emitted from the optical fiber, causing significant damage to unwanted material adjacent the distal end of the catheter when laser energy is emitted from the catheter A laser angioplasty catheter device, characterized in that: