JP4194852B2 - Indwelling device for internal neck clipping, in-vivo detachment device, and in-vivo detachment device with relocation or recovery - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
  The present invention uses internal neck clipping.DetainerFurther, regarding the in-vivo detachment device, in more detail, it is possible to treat an aneurysm, an aneurysm, an arteriovenous malformation, an arteriovenous fistula and the like, particularly an aneurysm having a neck diameter of 30 mm or less. Internal neck clippingDetainerAnd the internal neck clippingDetainerThe present invention relates to an in-vivo detachment device using a lipstick. In the present invention, neck clipping refers to the part of the cerebral aneurysm that opens to the parent artery as the neck (neck) of the aneurysm. It means surgery that prevents the aneurysm from rupturing by using a clip (a tool for pinching) from the outside. Also, internal neck clippingDetainerIn the blood vessel (internal), the neck of the aneurysm is pinched from the inside in the same manner as the neck clipping.DetainerMeans that.
[0002]
[Prior art]
  Conventionally, various methods for treating an aneurysm that is a local extension, dilation or dissection of an artery due to fragility of a blood vessel wall or the like have been proposed. For example, conventional craniotomy is a procedure in which an aneurysm is located and treated outside the blood vessel. This type of procedure has significant disadvantages. For example, patients undergoing craniotomy must undergo general anesthesia. Furthermore, because the surgeon has to cut various tissues in order to reach the aneurysm, the patient suffers a considerable trauma in the area of the aneurysm. For example, when treating a cerebral aneurysm extravascularly, a surgeon typically must remove a portion of the patient's skull and further damage brain tissue to reach the aneurysm. There is a risk that.
[0003]
  On the other hand, as an intravascular (internal) treatment, there is typically a method of forming an embolus in an aneurysm. For the embolization, for example, a microcatheter is used to access the aneurysm, the distal end of the microcatheter is inserted into the aneurysm, and the embolus is inserted into the aneurysm using the microcatheter. Injected. Examples of the embolic material include a removable coil and a liquid polymer.
[0004]
  However, the injection of these types of embolic materials has the following disadvantages. For example, if a detachable coil is used to occlude a wide neck aneurysm without a clearly defined neck region, the detachable coil may leave the aneurysm and move into the parent artery. is there. Also, sometimes, when a removable coil is injected, it is difficult to accurately measure how much the aneurysm is filled. For this reason, there is a risk of overfilling the aneurysm, in which case the releasable coil may also overflow into the parent artery, or the aneurysm may be ruptured by over-emphasis of the coil. is there.
[0005]
  Another drawback of the detachable coil is coil compression over time. After filling the aneurysm, a space remains between the coils, and sustained hemodynamic forces from the circulation act to compress the mass of the coil and cause a neck remnant in the neck of the aneurysm. Can cause the aneurysm to regress or recanalize. In the literature, it is known that the frequency of recurrence and resumption increases in proportion to the size of the neck.
[0006]
  Furthermore, when a liquid polymer that is an embolic material is injected into an aneurysm, the liquid polymer may move out of the aneurysm and cause irreversible occlusion of the parent artery due to vascular hemodynamics. .
[0007]
  Another intravascular technique for treating an aneurysm includes inserting a detachable balloon into the aneurysm using a microcatheter. The detachable balloon is inflated with saline and / or contrast media. The balloon is then removed from the microcatheter and left in the aneurysm for the purpose of filling the aneurysm.
[0008]
  However, when the balloon is inflated, it is typically unable to adapt to the internal shape within the aneurysm, increasing the risk that the balloon will rupture the aneurysm. Also, the detachable balloon may rupture and move out of the aneurysm.
[0009]
  Further, as shown in FIGS. 1 (A) to (C), an aneurysm formed in a fine blood vessel having a diameter of 30 mm or less at the branch portion of the artery or the neck portion of the aneurysm 1 is placed with a stent up to that position. There is a problem that even if it cannot be induced, or even if it can be placed, endothelial cells proliferate inside the stent and cause vascular occlusion. 1A shows the vertebrobasilar artery, FIG. 1B shows the middle cerebral artery, and FIG. 1C shows the aneurysm of the superior cerebellar artery.
[0010]
  On the other hand, various proposals have been made for a catheter and a guide wire for carrying an indwelling member such as a stent to a target site and detaching it, but minute blood vessels and urine in which the target site is complicated and twisted are proposed. In the case of a tube or the like, it is difficult to smoothly insert it to the target site. In particular, an aneurysm is likely to occur in a bent blood vessel site, and in such a case, the stent and the internal that can reliably carry and place the stent to the target site. There has been a strong demand for the development of a Lunek clipping detainer.
[0011]
[Problems to be solved by the invention]
  An object of the present invention is to meet such demands, solve the above-described problems, and achieve the following objects. That is, the present invention can treat an aneurysm, an arteriovenous malformation, an arteriovenous malformation site, and the like, and more specifically, a parent blood vessel can be guided to a thin blood vessel of 2 mm or less. Internal neck clipping that can be placed in an aneurysm with a diameter of 30mm or lessDetainerAnd the internal neck clippingDetainerAn object of the present invention is to provide an in-vivo detachment device that uses the above.
[0012]
[Means for Solving the Problems]
  Means for solving the problems are as follows. That is,
  <1> substantially short cylindrical shape or substantially short rod shapebook ofBody,The bookFormed at the front and rear ends of the body, when leaving the target positionThe bookProvided with a first foot and a second foot that can be rewound in the body directionAn indwelling device for internal neck clipping that can be placed in an aneurysm having an aneurysm neck diameter of 30 mm or less,
  Internal neck clippingDetainerBefore the aneurysm is removedBookThe body is inserted into the neck of the aneurysm, the first foot is rolled back and comes in contact with the vicinity of the neck of the aneurysm from the inside of the aneurysm, and the second foot is rolled back and the neck of the aneurysm Locking the vicinity from the outside (parent artery side), the internal neck clippingDetainerInternal neck clipping, characterized in that it can be placed in an aneurysmDetainerIt is.
  <2> About a short cylinder or a short barbook ofBody,The bookFormed at the front and rear ends of the body, when leaving the target positionThe bookA first foot that can be rewound in the body direction and a second foot that can be expanded outward at the time of separation at the target position.An indwelling device for internal neck clipping that can be placed in an aneurysm having an aneurysm neck diameter of 30 mm or less,
  Internal neck clippingDetainerHowever, when the body is disengaged at the position of the aneurysm, the main body is inserted into the neck of the aneurysm, the first foot is rolled back and comes into contact with the vicinity of the neck of the aneurysm from the inside of the aneurysm, and the second The internal neck clipping is achieved by radially expanding the foot and locking the vicinity of the neck of the aneurysm from the outside (parent artery side).DetainerInternal neck clipping, characterized in that it can be placed in an aneurysmDetainerIt is.
  <3> The internal neck clipping according to any one of <1> to <2>, wherein one or more first and second foot portions are provided.DetainerIt is.
  <4> At least one of the first foot and the second foot,BookThe internal neck clipping according to any one of <1> to <3>, wherein the internal neck clipping is formed integrally with the body.DetainerIt is.
  <5> From <1> to <1> above, which has an umbrella-shaped membrane portion that extends from the vicinity of the root of at least one of the first foot and the second foot and covers the first and second feet from the inside and / or the outside 4> Internal neck clipping according to any one ofDetainerIt is.
  <6> The internal neck according to any one of <1> to <4>, further including at least one arm portion that expands in a substantially ring shape when detached from at least one of the first foot portion and the second foot portion. clippingDetainerIt is.
  <7>BookAt least one of the body, the first foot, the second foot, the umbrella-shaped membrane, and the arm is molded from any one of a metal material, a metal alloy, a shape memory alloy, a synthetic resin, and a superconducting material. The internal neck clipping according to any one of <1> to <6>DetainerIt is.
  <8> The internal neck clipping according to <7>, wherein the synthetic resin is one of a silicone resin and an acrylic resin.DetainerIt is.
  <9> PreviousBookThe internal neck clipping according to any one of <1> to <8>, wherein a recovery or rearrangement protrusion is provided on either the central part or the peripheral part of the bodyDetainerIt is.
  <10>Book<1> to <9>, wherein at least one of the body, the first foot, the second foot, the umbrella membrane, the arm, and the recovery or rearrangement protrusion includes a radiopaque material. Internal neck clipping described in anyDetainerIt is.
  <11> Internal neck clippingDetainerAn in-vivo detachment device comprising a child catheter capable of accommodating a distal end portion, a parent catheter for accommodating the child catheter therein and carrying it to a target site, and a guide wire,
  From <1> to <10> Internal neck clipping according to any ofDetainerIs inserted into the distal end of the child catheter with the first and second legs extended, and the guide wire is pushed out at the target position, or the child catheter is pulled forward, so that the indwelling device for internal neck clipping This is an in-vivo detachment device that is configured so that it can be detached and placed in an aneurysm.
  <12> Guide wire and internal neck clipping attached to the tip of the guide wireDetainerAnd guide wire and internal neck clippingDetainerAn in-vivo detachment tool equipped with a catheter that carries it to a target position while being housed inside,
  From <1> to <10> Internal neck clipping according to any ofDetainerClipping the neck of the guide wire and / or the catheter at the target position by attaching it to the tip of the guide wire in a detachable manner with the first and second feet extended or detached.DetainerIt is an in-vivo detachment device characterized in that it is configured to be detached from the catheter alone or from the catheter so as to be placed in the aneurysm.
  <13> Internal neck clippingDetainerAn in-vivo detachment device comprising a child catheter capable of accommodating a distal end portion, a parent catheter for accommodating the child catheter therein and carrying it to a target site, and a guide wire,
  <9> to <10> Internal neck clipping according to any ofDetainerIs inserted into the distal end of the child catheter with the first and second legs extended, and the guide wire is pushed out at the target position, or the child catheter is pulled toward the front, thereby clipping the internal neck.Detainer, And internal neck clipping after leavingDetainerGrip the recovery or rearrangement protrusion at the tip of the guide wire and clip the internal neckDetainerIt is the in-vivo detachment tool provided with the rearrangement or collection | recovery function characterized by being comprised so that rearrangement or collection | recovery was possible.
  <14> Internal neck clipping at guide wire tipDetainerProvided with an extruding member capable of extruding at a target position11> To <13> The in-vivo release tool according to any one of the above.
[0013]
  Internal neck clipping of the present inventionDetainerIs a substantially short cylindrical shape or a substantially short rod shape as a first aspect.book ofBody,The bookFormed at the front and rear ends of the body, when leaving the target positionThe bookIt comprises a first foot and a second foot that can be rewound in the body direction.
  Also, the internal neck clipping of the present inventionDetainerAs a second aspect, a substantially short cylindrical shape or a substantially short rod shapebook ofBody,The bookFormed at the front and rear ends of the body, when leaving the target positionThe bookA first foot that can be rewound in the body direction and a second foot that can be expanded outward at the time of separation at the target position are provided.
  Internal neck clipping according to the first and second aspectsDetainerAre the first and second feetAnd bookClipping the neck of the aneurysm from the parent artery side and the anterior-posterior direction from inside the aneurysm through interaction with the body and the umbrella membrane, and internal neck clipping in the aneurysm safely and reliablyDetainerCan be detained.
  In this case, the internal neck clippingDetainerBy selecting the most suitable material for the target, internal neck clipping can be applied to thin blood vessels where the target site has been difficult with conventional technology.DetainerCan be induced.
[0014]
  According to the in vivo release device of the present invention, the internal neck clipping is performed.DetainerCan be removed safely and reliably at the target site,DetainerIncorrect size,DetainerWhen I was not able to place it wellDetainerCollect orDetainerAfter detentionDetainerThe position of can be changed.
  Also, the internal neck clippingDetainerBy selecting the most suitable material and in-vivo removal tool, internal neck clipping is possible even if the target site is a thin, tortuous blood vessel that was difficult with conventional technology.DetainerCan be placed safely and reliably.
[0015]
BEST MODE FOR CARRYING OUT THE INVENTION
(Internal neck clippingDetainer)
  Internal neck clipping of the present inventionDetainerIs a substantially short cylindrical shape or a substantially short rod shape as a first aspect.book ofBody,The bookFormed at the front and rear ends of the body, when leaving the target positionThe bookIt comprises a first foot portion and a second foot portion that can be rewound in the body direction, and if necessary, an umbrella-shaped membrane portion, an arm portion, a recovery or rearrangement projection, and other members. Have.
[0016]
  Internal neck clippingDetainer2 to 4, as shown in FIGS.BookA body 4 is inserted into the neck of the aneurysm, the first foot 2 is unwound and comes into contact with the vicinity of the neck of the aneurysm from the inside of the aneurysm, and the second foot 3 is unwound and unrolled. The neck of the neck is locked from the outside (parent artery side) and the internal neck clipping is performed.Detainer10 can be placed in the aneurysm.
  It is preferable that one or more first legs and second legs are provided, more preferably 1 to 10, more preferably 2 to 6, respectively.
  At least one of the first foot and the second foot is,BookIt is preferable in terms of moldability and molding cost that it is molded integrally with the body.
[0017]
  Also, the internal neck clipping of the present inventionDetainer5 and 6, as shown in FIGS. 5 and 6, the first and second feet are extended from the vicinity of at least one of the first foot 2 and the second foot 3 so that the first and second feet are at least one of the inside and the outside. It is preferable to have the umbrella-shaped film part 7 which covers from above. The umbrella-shaped film part 7 can be formed from at least one of the inside and the outside of the first foot part 2 and the second foot part 3, and is particularly preferably formed from the second foot part 3. That is, the umbrella-shaped film part 7 may be covered from the outside, or may be covered from both the inside and the outside.
  Although illustration is omitted,,BookIt is preferable to form a recovery or rearrangement protrusion on either the center or the periphery of the body.
[0018]
  The umbrella-shaped film part 7 is not particularly limited and can be appropriately selected according to the purpose.DetainerIn the state that is accommodated in the child catheter, a hydrophilic polymer is applied in order to have a slip on the surface (in the state accommodated in the child catheter, it hits the inner surface of the umbrella membrane 7), Internal neck clippingDetainerAfter the detachment, the umbrella membrane is opened and can be placed in the neck of the aneurysm.
[0019]
  In this first embodiment, although not shown, it is preferable to have at least one arm portion that expands in a substantially ring shape when detached from at least one of the first foot portion and the second foot portion. More preferably, the arm portion is formed from the second foot portion.
[0020]
  In the present invention,BookAt least one of the body, the first foot, the second foot, the umbrella-shaped membrane, and the arm is molded from any one of a metal material, a metal alloy, a shape memory alloy, a synthetic resin, and a superconducting material. It is preferable. Details of each material will be described later.
  in frontBookIt is preferable that at least one of the body, the first foot, the second foot, the umbrella membrane, the arm, and the recovery or rearrangement protrusion contains a radiopaque material. Examples of the radiopaque material include barium sulfate, bismuth oxide, and tungsten.
[0021]
  Internal neck clipping of the present inventionDetainerAs a second aspect, a substantially short cylindrical shape or a substantially short rod shapebook ofBody,The bookFormed at the front and rear ends of the body, when leaving the target positionThe bookIt comprises a first foot that can be rolled back in the body direction and a second foot that can be expanded outward when it is detached at the target position. An arm, a recovery or rearrangement protrusion, and other members.
[0022]
  Internal neck clippingDetainerBefore the withdrawal at the aneurysm positionBookThe body is inserted into the neck of the aneurysm, the first foot is rolled back and comes into contact with the vicinity of the neck of the aneurysm from the inside of the aneurysm, and the second foot is radially expanded to expand the aneurysm. The neck of the neck is locked from the outside (parent artery side) and the internal neck clipping is performed.DetainerIs configured to be placed in the aneurysm.
[0023]
  Internal neck clipping of the present inventionDetainer10 is substantially cylindrical as shown in FIG.book ofBody 4 andThe bookFormed on the front and rear ends of the body 4 when detachedBookA first foot 2 that can be rolled back in the body direction and at least one second foot 3 that can be opened outward are provided. This first foot 2 is the wholeIs a bookIt is configured to be able to rewind in the body direction and come into contact with the neck of the aneurysm from the inside.
  in frontBookThe shape of the body 4 is not particularly limited and can be appropriately selected according to the purpose. In addition to a substantially short cylindrical shape or a substantially short rod shape, the shape may be a quadrangular shape, and several cylinders are bundled. It doesn't matter. In FIG. 7, reference numeral 5 denotes a recovery and rearrangement projection.
[0024]
  Also, the internal neck clippingDetainer10, the first foot 2 is divided into four parts as shown in FIG.BookIt is configured to be able to rewind in the body direction.
  Internal neck clippingDetainerAs shown in FIGS. 9 and 10, 10 is formed in a substantially ring shape extending from the four first foot portions 2, 2, 2, 2 and the two second foot portions 3, 3 at the time of detachment. The arm part 6 which spreads is provided. Accordingly, the four first leg portions 2, 2, 2, 2, the two second leg portions 3, 3 and the two ring-shaped arm portions 6, 6 are provided.BookThe body 4 can be placed firmly in the aneurysm and internal neck clippingDetainerIt is also easy when manufacturing. In addition, although illustration is abbreviate | omitted, the umbrella-shaped film | membrane part 7 can be formed from either the inner side of the 1st leg part 2 and the 2nd leg part 3, or the outer side.
[0025]
  Internal neck clippingDetainerAs shown in FIGS. 11 and 12, 10 is an arm that extends from the four first leg portions 2, 2, 2, 2 and the one second foot portion 3 in a substantially ring shape when detached. Part 6. As a result, the four first legs 2, 2, 2, 2, the one second leg 3, and the ring-shaped arm 6BookThe body 4 can be placed firmly in the aneurysm and internal neck clippingDetainerIt is also easy when manufacturing. In addition, although illustration is abbreviate | omitted, the umbrella-shaped film | membrane part 7 can be formed from either the inner side of the 1st leg part 2 and the 2nd leg part 3, or the outer side.
[0026]
  Internal neck clippingDetainer10, when the second foot 3 is disengaged at the target position, as shown in FIG. 13, the second leg 3 expands radially and locks the neck of the aneurysm from the outside (the parent artery side). On the other hand, the first foot 2 is wound back into a substantially spiral shape and comes into contact with the neck of the aneurysm from the inside of the aneurysm, and the internal neck clipping is performed.Detainer10 is configured to be reliably placed in the aneurysm.
[0027]
  in frontBookThe body 4 is not particularly limited and can be appropriately selected according to the purpose, but is preferably molded from any of various metal materials, shape memory alloys, synthetic resins, and superconducting materials. Examples of the metal material include stainless steel.
[0028]
  The shape memory alloy is not particularly limited and may be appropriately selected depending on the purpose. For example, Ni—Ti alloy, Ni—Ti—Co alloy, Ni—Ti—Fe alloy, Ni—Ti—Mn alloy Ni-Ti-Cr alloy, Ni-Ti-V alloy, Ni-Ti-Al alloy, Ni-Ti-Nb alloy, Cu-Zn alloy, Cu-Zn-Be alloy, Cu-Zn-Si alloy, Cu -Zn-Sn alloy, Cu-Zn-Ga alloy, Cu-Al-Ni-based alloy, Cu-Al-Zn-based alloy, etc., and the alloy concentration is changed according to the degree of use, shape memory property, etc. Can be used. In particular, a Ni—Ti alloy having a Ni concentration of 49 to 58 atomic%, preferably 50 to 51 atomic%, more preferably 50.3 to 50.7 atomic% is preferable.
[0029]
  There is no restriction | limiting in particular as said synthetic resin, According to the objective, it can select suitably, For example, a polyvinyl chloride resin, a polystyrene resin, ABS resin, an acrylic resin, a polyethylene resin, a polypropylene resin, a polyethylene terephthalate resin, nylon Resins, fluororesins, polyurethane resins, silicone resins, etc., among these, acrylic resins (PAMA (polymethyl acrylate), PMMA (polymethyl methacrylate), PEMA (polyethyl methacrylate), etc.), Silicone resins are desirable from the viewpoints of in vivo compatibility, strength, moldability, and the like.
[0030]
  There is no restriction | limiting in particular as said superconducting material, According to the objective, it can select suitably, For example, Nb-Ti, Nb-Zr, Nb₃Sn, Nb₃Ge, Nb₃Ga, Nb₃(Al, Ge), V₃Ga, V₃Si, NbN, etc. are mentioned.
[0031]
  in frontBookThe size (length) of the body is not particularly limited and can be appropriately selected according to the size of the aneurysm to be placed, but is preferably 10 to 50000 μm, and more preferably 100 to 5000 μm.
[0032]
  The first foot and the second foot are,BookMade separately from the body,BookAlthough it can be attached to the body, it is preferable from the viewpoint of moldability to form integrally with a mold using a synthetic resin.
  In this case, the first foot 2 is not particularly limited and can be appropriately selected according to the purpose. However, it is preferable to have at least one, particularly two or more. It contacts the neck of the aneurysm from the inside.
  The second leg 3 is not particularly limited and can be appropriately selected according to the purpose. However, the second leg 3 is at least one, preferably 2 to 10, and radially expands to the neck of the aneurysm 1. Can be locked from the outside (parent artery side).
  The lengths of the first leg and the second leg can be appropriately selected according to the size, shape, etc. of the target aneurysm.
[0033]
  The first foot portion and the second foot portion are not particularly limited and can be appropriately selected according to the purpose. However, the first foot portion and the second foot portion can be produced by forming a cut portion in a shape memory material tube. As the shape memory material, the shape memory alloy, the shape memory polymer, or the like can be appropriately used.
  The first leg and the second leg are preferably made by bundling wires made of shape memory material and storing an appropriate shape. As the shape memory material,BookThe same body can be used.
[0034]
  in frontBookAs shown in FIGS. 7 and 17, a recovery or rearrangement projection 5 is formed on the front of the body 4, and the recovery or rearrangement projection 5 is X-ray opaque. clippingDetainerThis is convenient for finding the position of the recovery or rearrangement protrusion 5 when rearranging or recovering the head.
  In this case, in the in-vivo detachment tool to be described later, the internal neck clipping is achieved by engaging the distal end portion of the guide wire G with the recovery or rearrangement protrusion 5.Detainer10 can be rearranged or retrievable.
[0035]
  Internal neck clipping of the present inventionDetainerIs not particularly limited and can be appropriately selected according to the purpose, but can be reliably positioned and placed in the aneurysm under a blood pressure of 50 dynes or more, preferably 200 dynes or more, more preferably 500 dynes or more. It is preferable that it is a thing.
[0036]
  Internal neck clipping of the present inventionDetainerFor example, hydrophilic polymers such as polyurethanes, nylons, and polyolefins that impart antithrombotic properties, thromboresistant substances, antiangiogenic substances such as hyaluronic acid or taxol, or angiogenic substances or growth factors It can be coated with a suitable material. In particular, the umbrella-like membrane portion 7 is coated with a hydrophilic polymer that imparts antithrombogenic properties in order to have a slip on the surface in an inverted state in the child catheter. In the open state, the inner surface is reversed, and coating with an appropriate substance such as angiogenic substances or growth factors promotes thrombus formation and can be locked firmly after thrombus formation at the aneurysm neck. .
[0037]
  The growth factors are not particularly limited and can be appropriately selected according to the purpose. For example, vascular endothelial cell growth factor (VEGF), platelet-derived growth factor (PDGF), vascular permeability update factor (VPF) , Basic fibroblast growth factor (BFGF), conversion growth factor β (TGF-β), and the like.
[0038]
  Internal neck clipping of the present inventionDetainerIs not particularly limited and can be appropriately selected according to the purpose, but treatment of vascular lesions such as aneurysms, arteriovenous malformations and arteriovenous fistulas, the diameter of the neck of the aneurysm is preferably 30 mm or less, In particular, 10 mm or less is more preferable. Internal neck clipping of the present inventionDetainerCan be applied to any of the vertebrobasilar artery as shown in FIG. 1A, the middle cerebral artery as shown in FIG. 1B, and the aneurysm of the superior cerebellar artery as shown in FIG.
[0039]
(In vivo removal tool)
  The in-vivo detachment device of the present invention has internal neck clipping.DetainerA child catheter that can be accommodated in the distal end portion, a parent catheter for accommodating the child catheter inside and carrying it to a target site, and a guide wire.
  The in-vivo detachment tool is the internal neck clipping of the present invention.DetainerIs inserted into the distal end of the child catheter with the first and second legs extended, and the guide wire is pushed out at the target position, or the child catheter is pulled toward the front, thereby clipping the internal neck.DetainerAnd can be configured to be placed in the aneurysm.
[0040]
  Further, the in-vivo detachment tool is the internal neck clipping device of the present invention.DetainerIs inserted into the distal end of the child catheter with the first and second legs extended, and the guide wire is pushed out at the target position, or the child catheter is pulled toward the front, thereby clipping the internal neck.Detainer, And internal neck clipping after leavingDetainerGrip the recovery or rearrangement protrusion at the tip of the guide wire and clip the internal neckDetainerCan be repositioned or retrievable.
[0041]
  The in-vivo detachment device of the present invention includes a guide wire and an internal neck clipping attached to the tip of the guide wire.DetainerAnd guide wire and internal neck clippingDetainerThe internal neck clipping of the inventionDetainerClipping the neck of the guide wire and / or the catheter at the target position by attaching it to the tip of the guide wire in a detachable manner with the first and second feet extended or detached.DetainerCan be detached alone or detached from the catheter and placed in the aneurysm.
  According to this in-vivo detachment device, particularly in an aneurysm having a neck diameter of 30 mm or less, the internal neck clipping can be placed in the aneurysm with the guide wire separated from the catheter.
[0042]
  Specifically, as shown in FIGS. 14 to 16, the internal neck clipping is performed.DetainerA child catheter 15 detachably attached to the distal end portion, a parent catheter 20 for carrying the child catheter 15 to a target site, and a guide wire G, and the internal neck clippingDetainer10 is used with the first foot 2 and the second foot 3 extended, and the guide wire G is pushed out at the target site, or the child catheter 15 is pulled forward, so that the internal neck is removed from the distal end of the child catheter. clippingDetainer10 is separated and can be placed at the target site.
  This allows internal neck clippingDetainerCan be rearranged or recovered efficiently, safely and reliably.
[0043]
  In addition, as shown in FIGS. 14 to 16, the internal neck clipping with the first and second legs extended.DetainerA repositioning / recovering function comprising a child catheter 15 detachably attached to the distal end portion, a parent catheter 20 for carrying the child catheter 15 to a target site, and a guide wire G; clippingDetainer10 with the first and second legs extended, and by pushing out the guide wire G at the target site or pulling the child catheter 15 forward, the internal neck clipping from the distal end of the child catheterDetainer10 at the target site and the internal neck clippingDetainerThe recovery or rearrangement projection 5 is gripped by the distal end portion of the guide wire G so that it can be rearranged or recovered.
  This allows internal neck clippingDetainerCan be efficiently and safely rearranged or recovered.
[0044]
  The recovery or relocation projection 5 isBookOne or more can be provided at either the central part or the peripheral part of the body 4. Further, the recovery or rearrangement protrusion 5 has a rod-like shape with a bulging tip as shown in FIG. 17A, and has a hook-like tip as shown in FIGS. 17B to 17D. The protrusion 5 for collecting or rearranging engages with the distal end portion of the guide wire G and internal neck clipping.DetainerGrip 10 and work wellDetainerCan be recovered when it cannot be placed, or can be rearranged after it has left.
[0045]
  As shown in FIG. 14, the internal neck clipping is applied to the distal end of the guide wire G.DetainerIt is possible to provide an extrusion member 17 capable of extruding 10 at a target position at a target site.DetainerIs preferable for extruding and indwelling.
[0046]
  Thus, the internal neck clipping of the present inventionDetainerAlthough one embodiment of the in-vivo detachment tool has been described in detail, the present invention is not limited to the above-described embodiment, and various modifications may be made without departing from the gist of the present invention.
[0047]
【The invention's effect】
  As described above, according to the present invention, internal neck clipping is performed.DetainerAnd the first and second feet inBookClipping the neck of the aneurysm from the front and back of the aneurysm side and the aneurysm inside through the interaction with the body, arm, and umbrella membrane, and internal neck clippingDetainerCan be safely and reliably placed in the aneurysm.
[0048]
  According to the present invention, the internal neck clipping is performed.DetainerCan be removed safely and reliably with an aneurysm,DetainerWrong or wrong sizeDetainerCan be recovered when it cannot be placed, or can be rearranged after it has left.
[Brief description of the drawings]
FIG. 1 is a schematic diagram showing an example of an aneurysm configuration, FIG. 1 (A) is a vertebral basilar artery, FIG. 1 (B) is a middle cerebral artery, and FIG. 1 (C) is a superior cerebellar artery. An aneurysm is shown.
FIG. 2 shows internal neck clipping according to the first aspect of the present invention.DetainerIt is a perspective view which shows an example.
FIG. 3 shows another example of internal neck clipping according to the first aspect of the present invention.DetainerIt is a perspective view which shows an example.
FIG. 4 shows still another internal neck clipping according to the first aspect of the present invention;DetainerIt is a perspective view which shows an example.
FIG. 5 is an internal neck clipping provided with an umbrella-shaped membrane part.DetainerIt is a perspective view which shows an example.
FIG. 6 is an internal neck clipping provided with another umbrella-shaped membrane part.DetainerIt is a perspective view which shows an example.
FIG. 7 shows internal neck clipping according to the second aspect of the present invention.DetainerIt is a side view which shows an example.
FIG. 8 shows another example of internal neck clipping according to the second aspect of the present invention;DetainerIt is a perspective view which shows an example.
FIG. 9 is an internal neck clipping having an arm that expands in a ring shape.DetainerIt is a perspective view which shows an example.
FIG. 10 shows the internal neck clipping of FIG.DetainerFIG.
FIG. 11 is an internal neck clipping with arms extending into another ring.DetainerIt is a perspective view which shows an example.
12 is an internal neck clipping of FIG. 11; FIG.DetainerFIG.
FIG. 13 shows internal neck clipping.DetainerFIG.
FIG. 14 is a schematic view showing an example of the in-vivo detachment device of the present invention.
FIG. 15 shows internal neck clipping using a catheter.DetainerIt is a schematic side view which shows the state which indwells in an aneurysm.
FIG. 16 shows internal neck clipping.DetainerIt is a schematic side view which shows the state which indwelled in the aneurysm.
FIG. 17 shows,BookIt is explanatory drawing for demonstrating the protrusion for collection | recovery or rearrangement provided in the body.
[Explanation of symbols]
      1 Aneurysm
      2 First foot
      3 Second foot
      4Bookbody
      5 Protrusion for recovery or relocation
      6 arms
      7 Umbrella-shaped membrane
    10 Internal neck clippingDetainer
    15 child catheter
    17 Extruded member
    20 Parent catheter
  100 In vivo removal tool
      G Guide wire

Claims (14)

Substantially and the body of the short cylindrical or substantially short rod-shaped, is formed at the front end and the rear end of the body, the first leg portion and a capable back around the body direction when disengaged at the target position An indwelling device for internal neck clipping, comprising two legs , and capable of being placed in an aneurysm having a neck diameter of 30 mm or less.
The internal neck clipping for retaining device is, aneurysms located before upon leaving in Symbol present body is interposed neck of the aneurysm, the neck of the aneurysm first foot portion wound back from the interior aneurysm The internal neck clipping indwelling device can be placed in the aneurysm by abutting the vicinity and rewinding the second foot and locking the vicinity of the neck of the aneurysm from the outside (the parent artery side). An indwelling device for internal neck clipping characterized by the above. Substantially and the body of the short cylindrical or substantially short rod-shaped, is formed at the front end and the rear end of the body, a first leg portion that can be back around the body direction when disengaged at the target position, An internal neck clipping indwelling device comprising a second foot that can be expanded outward at the target position when disengaged , and can be placed in an aneurysm having a neck diameter of 30 mm or less;
When the internal neck clipping indwelling device is disengaged at the position of the aneurysm, the main body is inserted into the neck of the aneurysm, and the first foot is rolled back from the inside of the aneurysm to the vicinity of the neck of the aneurysm. In addition to abutting, the second leg portion expands radially to lock the vicinity of the neck of the aneurysm from the outside (the parent artery side) so that the internal neck clipping indwelling device can be placed in the aneurysm An indwelling device for internal neck clipping characterized by comprising. The indwelling device for internal neck clipping according to any one of claims 1 to 2, wherein one or more first and second foot portions are provided. At least one of the first foot portion and the second foot part, the internal neck clipping for indwelling device according to any one of claims 1, which is molded into the body and integrally 3. 5. The apparatus according to claim 1, further comprising an umbrella-shaped film portion that extends from the vicinity of a root of at least one of the first foot portion and the second foot portion and covers the first and second foot portions from the inside and / or the outside. internal neck clipping for indwelling device according. The indwelling device for internal neck clipping according to any one of claims 1 to 4 , further comprising at least one arm portion that expands in a substantially ring shape when detached from at least one of the first foot portion and the second foot portion. This body, first foot portion, a second foot portion, at least one of the umbrella-shaped film portion and the arm portion, a metal material, a metal alloy, a shape memory alloy, is formed of any material of synthetic resin and the superconducting material The indwelling device for internal neck clipping according to any one of claims 1 to 6. The indwelling device for internal neck clipping according to claim 7, wherein the synthetic resin is one of a silicone resin and an acrylic resin. Before SL Body center and the internal neck clipping for indwelling device according to any one of claims 1 to 8 in which a recovery or relocation projections on either of the peripheral portion of the. This body, first foot portion, a second foot portion, umbrella film unit, at least one of the arms and the recovery or re-arranging projections, claim 1 containing an X-ray opaque material 9 The indwelling device for internal neck clipping described in 1. An in vivo detachment device comprising a child catheter capable of accommodating an indwelling device for internal neck clipping at the tip, a parent catheter for accommodating the child catheter inside and carrying it to a target site, and a guide wire,
The internal neck clipping indwelling device according to any one of claims 1 to 10 is accommodated in the distal end portion of the child catheter with the first foot portion and the second foot portion extended, and the guide wire is pushed out at a target position. Alternatively, the in-vivo detachment device is configured such that by pulling the child catheter forward, the internal neck clipping indwelling device is disengaged and can be placed in the aneurysm. An in-vivo detachment device comprising a guide wire, an internal neck clipping indwelling device attached to the distal end of the guide wire, and a catheter that carries the guide wire and the internal neck clipping indwelling device to a target position while being accommodated therein. There,
11. The indwelling device for internal neck clipping according to any one of claims 1 to 10 is detachably attached to the distal end of a guide wire in a state where the first and second feet are extended or detached, and the guide wire at a target position. And / or an in-vivo detachment device wherein the internal neck clipping indwelling device can be detached alone or detached from the catheter by manipulating the catheter and placed in the aneurysm. An in vivo detachment device comprising a child catheter capable of accommodating an indwelling device for internal neck clipping at the tip, a parent catheter for accommodating the child catheter inside and carrying it to a target site, and a guide wire,
Whether the internal neck clipping indwelling device according to any one of claims 9 to 10 is accommodated in the distal end portion of the child catheter with the first foot portion and the second foot portion extended, and the guide wire is pushed out at a target position. Or by pulling the child catheter forward, the internal neck clipping indwelling device is detached, and the recovery or repositioning protrusion of the internal neck clipping indwelling device after the disengagement is gripped by the distal end portion of the guide wire, An in-vivo detachment device having a rearrangement or recovery function, wherein the internal neck clipping indwelling device is configured to be rearranged or recovered. The in-vivo detachment device according to any one of claims 11 to 13 , wherein an extruding member capable of extruding the internal neck clipping indwelling device at a target position is provided at a tip portion of the guide wire.

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