JP4611991B2 - 固着装置、組織に係合するための装置および方法 - Google Patents
固着装置、組織に係合するための装置および方法 Download PDFInfo
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- JP4611991B2 JP4611991B2 JP2006533201A JP2006533201A JP4611991B2 JP 4611991 B2 JP4611991 B2 JP 4611991B2 JP 2006533201 A JP2006533201 A JP 2006533201A JP 2006533201 A JP2006533201 A JP 2006533201A JP 4611991 B2 JP4611991 B2 JP 4611991B2
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Description
本願は、37CFR§1.78(a)下で1999年4月9日に出願された先行予備出願第60/128,690号の恩典を請求している2000年4月7日に出願された共同出願中の米国特許出願第09/544,930号の一部継続である2001年6月27日に出願された共同出願中の米国特許出願第09/894463号の一部継続であり、その出願からの優先権の恩典を請求する(これらの出願の全開示は、出典を明示することにより本願明細書の開示の一部とされる)。本願は、米国特許出願第 (代理人ドケットNo.020489−001200US)、米国特許出願第 (代理人ドケットNo.020489−001500US)および米国特許出願第 (代理人ドケットNo.020489−001700US)(これらのすべては本願と同じ日に出願されており、それらの開示は出典を明示することにより本願明細書の開示の一部とされる)に関連されている。
連邦国家支援研究または開発の下で行なわれた発明に関する陳述
コンパクトディスクに受けられた「シーケンス一覧表」、
表、またはコンピュータプログラム一覧付録に対する関連
発明の背景
1.発明の分野
背景技術の説明
I.心臓生理機能
収縮中の正常な心臓Hの左心室LVが図1に示されている。左心室LVは収縮しており、血液は矢印の方向に三尖(大動脈)弁AVを通って外方に流れる。僧帽弁MVは左心室内の圧力が左心房LA内の圧力より高いときに逆流を防ぐ「逆止弁」として構成されているので、僧帽弁MVを通る血液の逆流が防がれる。僧帽弁MVは、図1に示すように、閉じるように平らに交わる自由縁部FEを有する一対の弁膜を備えている。弁膜LFの両端部は環帯ANと称される環状領域に沿って周囲の心臓構造体に付設されている。弁膜LFの自由縁部FEは、左心室LVの各々の下面に固着された複数の分岐腱を有する索腱(以後、索と称する)CTを介して左心室LVの下部分に固着されている。索CTは、左心室および心室内隔膜IVSの下部分から上方に延びている乳頭筋PMに付設されている。
本発明は、心臓弁逆流、特に、僧帽弁逆流を治療するために弁膜のような組織を把持し、接近し、そして固着させるための方法および装置を提供する。また、本発明は、特に、取出しが索CTのような解剖学的特徴により妨げられるような領域において、望まれるなら、装置の再位置決めおよび取出しを許容する特徴を提供する。このような取出しによれば、外科医は、望まれるなら、新規な方法で弁に再接近し得る。
A.固着装置の導入および設置
固着装置14は、送出し装置を使用して弁または所望の組織に送出される。送出し装置は用途に応じて剛性でも可撓性でもよい。血管内用途では、送出し装置は後の段落で述べる可撓性送出しカテーテルよりなる。しかしながら、代表的には、このようなカテーテルは、近位端部および遠位端部を有するシャフトと、その遠位端部に解放可能に取付けられた固着装置とを備えている。シャフトは、通常、細長く、可撓性であり、血管内導入に適している。変更例として、送出し装置は心臓の壁部を通る経胸外科導入用に使用されるもっと短く且つさほど可撓性でない介入器具よりなってもよいが、いくらかの可撓性および最小の輪郭が一般に望ましい。固着装置は、図3Aに示すように送出し装置と解放可能に連結可能である。固着装置は様々な形態を有してもよく、その幾つかの実施形態をここに述べる。
近位要素16は組織におけるグリップを高めるために複数の開口部63および波形側縁部61を有している。近位要素16は、任意には、弁膜を把持したり、および/または保持したりするのを助けるために摩擦付属品、摩擦特徴またはグリップ向上要素を有している。好適な実施形態では、摩擦付属品は係合表面50に向かって延びているテーパ状の尖った先端部を有する刺部60よりなる。プロング、巻き部、バンド、バー、溝、チャンネル、バンプ、表面凹凸、焼結部、高摩擦パッド、覆い体、コーティングまたはそれらの組合せのような任意の適当な摩擦付属品を使用してもよいことはわかるであろう。任意に、近位および/または遠位要素に磁石が存在してもよい。合せ表面が、磁力による吸引を引起こすために反対磁荷の材料から作成されるか、或いはその材料を有することはわかるであろう。例えば、近位要素および遠位要素は、各々、組織の速い回復および内部成長を容易にするために組織が近位要素と遠位要素との間に一定の圧縮下で保持されるように、反対磁荷の磁気材料を有してもよい。また、遠位要素に向けての近位要素の付勢に加えて、或いはその代わりに、近位要素16を遠位要素18に引きつけるために磁力を使用してもよい。これは近位要素16の展開を助成し得る。他の例では、遠位要素17は、各々、遠位要素18間に位置決めされた組織が磁力によりそれらの間に保持されるように、反対磁荷の磁気材料を有している。
固着装置14は、任意に、覆い体を有してもよい。この覆い体は組織を把持するのを助成し、後で組織の内部成長のための表面をなす。弁膜のような周囲の組織の内部成長は、装置14が更に適所に固定されるときに装置14に安定性をもたらし、そして自生の組織で装置を覆い、かくして免疫反応の可能性を低減する。覆い体は、ポリエチレンテレフタレート、ポリエステル、コットン、ポリウレタン、発泡ポリテトラフルオロエチレン(ePTFE)、シリコンまたは種々のポリマーのような任意の生物適合性材料で構成されてもよく、布、メッシュ、織物、フェルト、ループ状または多孔性構造体のような任意の適当な形態を有してもよい。一般に、覆い体は導入シースを通しての送出し、または弁膜または組織の把持または癒合に干渉しないように低い輪郭を有している。
先に述べたように、固着装置14は、任意に、開放位置、閉鎖位置または逆転位置またはそれらの間の任意に位置のような特定の位置に装置14を係止するための係止機構を有している。係止機構が、装置を係止したり離脱したり両方を行なえる離脱機構を有することはわかるであろう。図18ないし図21は係止機構106の具体例を示している。図18を参照すると、この具体例では、係止機構106は連結部材19と作動機構58の基部69との間に配置されている。基部69は係止機構106を通って延びているスタッド74に固定的に取付けられている。スタッド74は介入器具10の連結部材19およびシャフト12を通っているアクチェータロッド64に解放可能に取付けられている。また、基部69は遠位要素18に連結されている作動機構58の脚部68に連結されている。
図22Aおよび図22Bは前述の固着装置14の変形例を示しており、この変形例では、固着装置の各側における遠位および近位要素16、18は広く離れた弁膜または他の組織弁の捕獲を容易にするために互いに対して近づいたり遠ざかったり横方向の移動化膿である。連結部材19は弾性で可撓性の枝部19A、19Bに分岐されており、これらの枝部は図22Aに示される位置へ外方に付勢されているが、図22Bに示される位置まで移動化膿である。変更例として、互いに対して近づいたり遠ざかったり枢動可能であるようにピンまたはヒンジにより連結部材19に連結されたより剛性の部材であってもよい。近位要素16および遠位要素18の各々はそれらの近位端部が連結部材19の一方の枝部19Aまたは19Bに連結されて前述のように、脚部68が、それらの近位端部のところで基部69、従ってスタッド74に連結され、それらの遠位端部のところで遠位要素18に連結されている。連結部材19に対するスタッド74の遠位方向または近位方向の並進により、前述の実施形態におけるように、遠位要素18を開放したり、閉鎖したりする。連結部材19上には、カラー131が摺動可能の配置されており、このカラー131は、摺動し、そして枝部19A、19B上の戻り止め135に摩擦係合するように構成された環状の溝133をその内壁部に有している。シャフト12上には、シース137が同軸に位置決めされており、このシース137はカラー131を連結部材19上で遠位方向に押し易くするためにシャフト12に対して摺動可能である。
更なる実施形態では、近位要素は把持を高めるために操られてもよい。例えば、弁膜または組織を近位要素と遠位要素との間に把持するために近位要素を降下させてもよく、弁膜または組織を固着装置に引きずり込むために近位要素を移動させてもよい。他の例では、弁膜または組織を把持するために近位要素を独立して降下させてもよい。これは、順次的な把持のためには有用である。順次的な把持では、一方の近位要素を降下させて弁膜または組織を近位要素と遠位要素との間に捕獲する。次いで、固着装置を、他の弁膜または組織部分を他の組の近位および遠位要素間に把持するための位置へ移動させ、調整し、或いは操縦する。次いで、この位置で、第2近位要素を降下させてこの他の弁膜または組織部分を把持する。
A.送出し装置の大要
図47は、前述のように固着装置を導入し、そして位置決めするのに使用し得る送出し装置または送出しカテーテル300の具体例の斜視図を示している。この送出しカテーテル300は、近位端部322および遠位端部324を有するシャフト302と、近位端部322に取付けられた取っ手304とを有している。固着装置(図示せず)は、代表的には僧帽弁への血管内送出しのための身体内の部位への送出しのために遠位端部324に取外し可能に連結可能である。かくして、固着装置との連結用の連結構造体320が遠位端部324から延びている。アクチェエータロッド64もまた遠位端部324から延びている。アクチェエータロッド64は固着装置と連結可能であって、代表的には遠位要素を開閉するために固着装置を操るように作用する。固着装置へのこのような連結が図48に示されている。
図50は図47の送出しカテーテルのシャフト302の横断面図を示している。この実施形態では、シャフト302は内腔348を有する管状の形状を有しており、可撓性および耐もつれ性を維持しながら、フープ強度を与える材料、例えば、編組積層材料で構成されている。このような材料としては、ほんの少しの例を挙げると、ポリウレタン、ポリエステル、ペバックス、グリラミドTR55およびAESNOのようなポリマーに埋設されたステンレス鋼編組またはコイル状ワイヤがある。更なる支持およびフープ強度を与えるために、図50に示すように、支持コイルがシャフト302の腔348内に配置されている。
先に述べたように、係止線92が存在する場合、これらの線92は係止線取っ手310と係止機構106との間で少なくとも1つの係止線腔340を通っている。係止線92は係止機構106の解放ハーネス108に係合して前述のように係止機構106を係止したり脱係止したりする。係止線92は、例が図53Aないし図53Cに示される種々の構成で解放ハーネス108に係合し得る。各実施形態では、2つの係止線腔340が、ノーズ318のところで終わっている送出しカテーテル300のシャフト302内に存在している。これらの腔340は、各腔340が解放ハーネス108の方に向けられるように、アクチュエータロッド64の交互の側に配置されている。
先に述べたように、近位要素線90が存在する場合、これらの線90は近位要素線取っ手312と少なくとも1つの近位要素16との間で少なくとも1つの近位要素線腔342を通っている。近位要素線90は先に説明したように近位要素16に係合して要素16を上昇させるか或いは降下させる。近位要素線90は、例が図54Aおよび図54Bに示される種々の配置で近位要素16に係合し得る。各実施形態では、2つの近位要素線腔342がノーズ318のところで終わっている送出しカテーテル300のシャフト302内に存在している。これらの腔342は、それらの各々が近位要素16の方に向けられるように、アクチュエータロッド64(このアクチュエータロッド64は明確のために連結部材のような取り囲みハウジングなしで示されている)の交互側に配置されている。
図55は送出しカテーテル300の取っ手304の具体例を示している。先に述べたように、アクチュエータロッド取っ手316、アクチュエータロッドつまみ314、近位要素線取っ手312および係止線取っ手310はすべて主ボディ318と接合されている。更に、取っ手304は主ボディ308と連結された支持基部306を有している。主ボディ308はシャフト302の並進を行なうために支持基部306に沿って摺動可能であり、また主ボディ308はシャフトを回転させるために支持基部306のまわりに回転可能である。
先に述べたように、係止線92は、種々の量の張力が掛けられて伸ばされたり、引込められたりされ得るか、或いは係止線取っ手310を使用して取出され得る。同様に、近位要素線90は、種々の量の張力が掛けられて伸ばされたり、引込められたりされ得るか、或いは近位要素線取っ手312を使用して取出され得る。これらの取っ手310、312の両方はこれらを通る適切な線90、92を操るように同様に設計されてもよい。
図57は係止線92が通っている係止線取っ手310の具体例を示している。この係止線取っ手310は遠位端部384と、近位端部382と、これらの端部間の細長いシャフト383とを有している。遠位端部382は、近位端部382が主ボディ308を超えて密封室370内から延び出るように密封室370内に位置決め可能である。係止線92の自由端部はねじ付き結節390の近くで取っ手310の壁部を通って近位端部382の近くに配置されている。取っ手310は、更に、結節390に位置決め可能であるキャップ388を有している。キャップ388の雌ねじ部はねじ付き結節390のねじ部と噛合って、キャップ388が係止線92の自由端部をキャップ388と結節390および/またはとって310の他の部分との間に摩擦により保持するようになっている。係止線92は細長いシャフト383の中央腔(図示せず)を通り、(図56に示すように)密封室370を通って延び、そしてシャフト302を通って係止機構106まで延びている。
アクチュエータロッド64はアクチュエータロッドつまみ314およびアクチュエータロッド取っ手316を使用して操られてもよい。図59はアクチュエータロッドつまみ314およびアクチュエータロッド取っ手316を有する取っ手04の一部の横断面図を示している。アクチュエータロッド取っ手316は取っ手314の近位端部に位置決めされている。アクチュエータロッド取っ手316はアクチュエータロッド64の近位端部に固定的に取付けられている。アクチュエータロッド64は図示のようにホルダ428内に配置されているコレット426に挿通されている。ホルダ428はアクチュエータロッドつまみ314の雌ねじ部432と噛合う雄ねじ部434を有している。かくして、アクチュエータロッドつまみ314の回転により、以下により詳細に説明するように、ホルダ428をねじの作用によりアクチュエータロッドつまみ314に沿って並進させる。アクチュエータロッドつまみ314は取っ手304の主ボディ308と回転可能に連結され、リップ430により適所に保持されている。
A.案内装置の大要
図60を参照すると、本発明の多カテーテル案内装置1の実施形態が示されている。この案内装置1は、近位端部1014、遠位端部1016および貫通する中央腔1018を有する外側ガイドカテーテル1000と、近位端部1024、遠位端部1026および貫通する中央腔1028を有する内側ガイドカテーテル1020とを備えており、内側ガイドカテーテル1020は、図示のように、外側ガイドカテーテル1000の中央腔1018内に同軸に位置決めされている。カテーテル1000、1020の遠位端部1016、1026は、それぞれ、代表的には血管内腔のような身体内腔を通って身体の空腔へ通ることが可能であるように寸法決めされている。かくして、遠位端部1016は、好ましくは、0.102cmないし1.270cm(0.040インチないし0.500インチ)の範囲、より好ましくは、0.330cmないし0.813cm(0.130インチないし0.320インチ)の範囲の外径を有している。中央腔1018は内側ガイドカテーテル1020の通過のために寸法決めされており、遠位端部1026は、好ましくは、ほぼ0.089cmないし0.711cm(0.035インチないし0.280インチ)、より好ましくは、0.305ないし0.508cmの範囲の外径を有している。中央腔1028は様々な装置がこれを通るために寸法決めされている。従って、中央腔1028は、好ましくは、ほぼ0.066cmないし1.143cm(0.026インチないし0.450インチ)の範囲、より好ましくは、0.254cmないし0.457cm(0.100インチないし0.180インチ)の範囲の内径を有している。
図61Aないし図61Dはカテーテル1000、1020が保持し得る位置の例を示している。図61Aを参照して説明すると、外側ガイドカテーテル1000は予め湾曲されており、および/または一次曲線1100を含む位置へ操向され得る。一次曲線1100は、代表的には、0.318cmないし2.540cm(0.125インチないし1.000インチ)の範囲、好ましくは、ほぼ0.635cmないし1.127cm(0.250インチないし0.500インチ)の範囲の曲率半径を有しており、或いはほぼ0°ないし120°の範囲の曲線を形成している。図示のように、この位置が一次曲線1100のみを含む場合、遠位端部16は単一の平面Xにある。遠位端部16のところの中央腔18の中心を通って横切る軸線xは平面X内にある。
先に説明したように、湾曲は予備湾曲、操向または任意の手段によりカテーテル1000、1020に形成し得る。予備湾曲は、例えば、ポリマーを熱硬化することにより、或いは計上記憶合金を利用することにより、使用前に特定の湾曲をカテーテルに設定することを含む。カテーテルが概ね可撓性であるので、ガイドワイヤ、拡張器栓子または他の導入装置へのカテーテルの装填により、湾曲領域全体にわたってカテーテルをまっすぐにする。カテーテルが解剖学的に位置決めされたら、導入装置を取出し、カテーテルを緩めて予備湾曲設定に戻す。
外側ガイドカテーテル1000および内側ガイドカテーテル1020は、前記の湾曲を生じるために任意の適当な材料または材料の組合せを含む同じまたは異なる構成を有してもよい。明確のために、示した例は外側ガイドカテーテルについてであるが、このような例が内側ガイドカテーテル1020にも当てはまることはわかるであろう。
カテーテルが操向可能であるのではなく、或いは操向可能であるのに加えて予め湾曲されている実施形態では、カテーテル1000は、例えば熱硬化により所望の湾曲に硬化されることができるポリマーまたはコポリマーで構成されてもよい。同様に、カテーテル1000は形状記憶合金で構成されてもよい。
先に述べたように、ガイドカテーテル1000、1020の操りはカテーテル1000、1020の近位端部に取付けられた取っ手1056、1057を使用して達成される。図68は取っ手1056、1057好適な具体例を示している。図示のように、取っ手1056は外側ガイドカテーテル1000の近位端部1014に取付けられており、取っ手1057は内側ガイドカテーテル1020の近位端部1024に取付けられている。内側ガイドカテーテル1020取っ手1056に挿通され、外側ガイドカテーテル1000内に同軸に位置決めされている。この実施形態では、取っ手1056、1057は図60に示される実施形態に示されるようには互いに連結されていない。変更例として、かかる取っ手1056、1057が外部のロッド、バーまたはプレートにより、或いは追加の外部安定化基部により連結されてもよいことはわかるであろう。安定化基部の具体例は後の段落で説明する。図68に戻って説明すると、介入カテーテルが取っ手1057に挿通され、内側ガイドカテーテル1020および外側ガイドカテーテル1000内に同軸に位置決めされている。
図70は明確のためにハウジング1302が取除かれている取っ手内の操向機構を示している。ここでは、操向ノブ1300aがハードストップギア組立体1304に取付けられており、摩擦組立体(図示せず)および操向ノブ1300bが別体のハードストップギア組立体1304および摩擦組立体1306に取付けられている。基部1308を通ってノブギアホイール1310で終わっているノブポスト1318に、操向ノブ1300aが取付けられている。ノブギアホイール1310はハードストップギア組立体1304を作動し、それにより張力を1つまたはそれ以上のプルワイヤ1120に加える。
図76は本発明の介入装置3の実施形態を示している。本発明の多カテーテル案内装置1の実施形態は、近位端部1014および遠位端部1016を有する外側ガイドカテーテル1000と、近位端部1024および遠位端部1026を有する内側ガイドカテーテル1020とを備えて示されており、内側ガイドカテーテル1020は、図示のように、外側ガイドカテーテル1000内に同軸に位置決めされている。また、内側ガイドカテーテル1020と共に或いはこれ無しに漏れ無し密封を適所にもたらすために、取っ手1056内に、或いは図示のように取っ手1056の外側には、止血弁1090が配置されている。この弁1090は、また、逆流出を防ぎ、且つ内側ガイドカテーテル1020を外側ガイドカテーテル1000に挿通するときの空気の導入の可能性を減じる。止血弁1090の例が図76Aに示されているが、同様な機能を与えるために任意の適当な弁または止血弁を使用してもよい。図76Aでは、弁1090は第1端部1091と、第2端部1092と、この弁を通る腔1093とを有している。腔1093の内壁部は、好ましくは、端部1091に向けてテーパになっており、更に、内側ガイドカテーテル1020における突出部1400を受入れるように構成された複数のテーパ状軸方向チャンネルを有している。第1端部1091は外側ガイドカテーテル1000に取付けられており、第2端部1092は自由である。図76を参照して説明すると、カテーテル1000、1020の遠位端部1016、1026は、それぞれ、代表的には、血管腔のような身体の腔を通して身体の空洞に通れるように寸法決めされている。
また、装置3の構成部品のうちの多くは1つまたはそれ以上の親水性塗膜を有してもよい。親水性塗膜は、濡れると、つるつるになり、別の潤滑剤の必要性を無くしている。かくして、このような塗膜は、少しの例を挙げると、近位要素および遠位要素を含めて、多カテーテル案内装置、送出しカテーテルおよび固着装置に存在してもよい。
図81を参照して説明すると、本発明によるキット1500は本発明について説明した構成部品のうちのいずれも備えている。キット1500は、取っ手1056を有する外側ガイドカテーテル1000、取っ手1057を有する内側ガイドカテーテル1020、送出しカテーテルおよび固着装置14、および使用IFCのための取扱説明書のような前記構成部品のうちのいずれをも有してもよい。任意に、キットのうちのいずれも更に、種々の介入器具1040のような前記の任意の他の装置構成部品、またはガイドワイヤ1202、拡張器1206またはニードル1204のような身体内腔における装置の位置決めと関連された構成部品を有してもよい。使用IFCのための取扱説明書は前記のような方法のうちのいずれをも説明し、すべてのキット構成部品が、通常、ポーチ1505または他の在来の医療装置包装体に一緒に包装される。通常、患者に対して手順を行なうのに使用されるこれらのキット構成部品は安定化され、キット内に維持される。任意に、別体のポーチ、バッグ、トレーまたは他の包装体が大きな包装箱に設けられてもよく、構成部品を無菌状態に別々に維持するように、小さいパックが別々に開けられてもよい。
Claims (24)
- 各々が第1端部、この第1端部と反対側の自由端部、および組織に係合するための両端部間の係合表面を有する一対の固着要素を備えており、前記第1端部は、固着要素が、係合表面が互いに向い合う閉鎖位置と、係合表面が互いからそむけて向いている逆転位置との間で移動可能であるように、互いに移動可能に連結されており、
固着要素に連結されていて、閉鎖位置と逆転位置との間で固着要素を移動させるようになっている作動機構と、
一対の把持要素と、を更に備えており、各把持要素は、固着要素のうちの一方に対して移動可能であり、組織を捕獲するように係合表面のうちの一方に対向して配置されており、
各把持要素は、展開形状において固着要素の凹所内に少なくとも部分的に配置され、
把持要素は、それらの各々が対向している係合表面から離されている未展開形状から、把持要素が対向している係合表面により接近した展開形状まで移動可能である、組織に係合するための固着装置。 - 固着要素は閉鎖位置と逆転位置との間の開放位置まで更に移動可能である、請求項1に記載の固着装置。
- 開放位置では、一方の固着要素の係合表面は他方の固着要素の係合表面と5°より大きく、90°より小さい角度を形成する、請求項2に記載の固着装置。
- 把持要素はこれらにより係合された組織に対するグリップを高めるように構成された摩擦特徴を有している、請求項1乃至3のいずれか1項に記載の固着装置。
- 把持要素は固着要素と関係なく移動可能である、請求項1乃至4のいずれか1項に記載の固着装置。
- 把持要素は係合表面に向けて付勢されている、請求項1乃至4のいずれか1項に記載の固着装置。
- 各固着要素は少なくとも部分的に凹形である、請求項1乃至6のいずれか1項に記載の固着装置。
- 把持要素は未展開形状において互いにほぼ平行である、請求項1乃至6のいずれか1項に記載の固着装置。
- 作動機構は第1および第2固着要素に連結された一対のリンク部材を備えており、それにより、リンク部材の移動によって第1および第2固着要素を移動させる、請求項1乃至8のいずれか1項に記載の固着装置。
- 作動機構は更に、連結部材と、この連結部材に摺動可能に連結されたスタッドとを備えており、第1端部は連結部材およびスタッドの一方に連結されており、リンク部材は連結部材およびスタッドの他方に連結されている、請求項9に記載の固着装置。
- リンク部材はヒンジにより連結部材およびスタッドの一方に連結されており、リンク部材はヒンジにより固着要素に連結されている、請求項10に記載の固着装置。
- 固着要素を所望の位置に係止するようになっている係止機構を更に備えている、請求項1ないし11のいずれか1項に記載の固着装置。
- 作動機構は固着要素に連結された移動可能なスタッドを備えており、係止機構はスタッドの移動を防ぐためにスタッドに摩擦係合するように構成されている、請求項12に記載の固着装置。
- 係止機構はスタッドに摩擦係合するための楔留め要素を備えており、一対の側壁部を有する連結部材を更に備えており、側壁部の少なくとも一方は他方の側壁部に向かって傾斜しており、スタッドは側壁部間で摺動可能であり、楔留め要素はスタッドと少なくとも一方の側壁部との間に移動可能に配置されている、請求項13に記載の固着装置。
- 楔留め要素はスタッドとの係合において少なくとも一方の側壁部に沿って転動するように構成された転動要素よりなり、転動要素は一対の概ね円筒形のキャップと、それらの間のシャフトとを有するバーベルよりなり、シャフトはキャップ間でスタッドに係合するように構成されている、請求項14に記載の固着装置。
- 所望の位置から移動可能であるように固着要素を離脱するようになっている離脱機構を更に備えており、所望の位置から移動可能であるように固着要素を離脱するようになっている離脱機構を更に備えており、この離脱機構は楔留め要素に連結されたハーネスを備えており、このハーネスはスタッドの摩擦係合を減じるために楔留め要素を移動させるようになっている、請求項12乃至15のいずれか1項に記載の固着装置。
- 固着装置を送出し装置に取外し可能に連結するための連結部材を更に備えている、請求項1乃至16のいずれか1項に記載の固着装置。
- 連結部材は、固着要素および作動機構のうちの一方に連結されていて、軸方向チャンネルを有する外側部材と、軸方向チャンネルを通って摺動可能に延びていて、固着要素および作動機構のうちの他方に連結されている内側部材とよりなり、外側部材は送出し装置と係合するための合せ表面を有しており、この合せ表面はS字形の形状を有している、請求項17に記載の固着装置。
- 組織の成長を促進するようになっている覆い体を固着要素上に更に備えている、請求項1乃至18のいずれか1項に記載の固着装置。
- 治療剤を送出すようになっている覆い体を固着要素上に更に備えている、請求項1乃至19のいずれか1項に記載の固着装置。
- 固着要素は第1端部と自由端部との間に長さ方向の縁部を有しており、これらの長さ方向の縁部は係合表面から離れる方向に長さ方向軸線のまわりに湾曲されている、請求項1乃至20のいずれか1項に記載の固着装置。
- 固着要素の自由端部は係合表面と概ね平行な横方向軸線のまわりに係合表面から離れる方向に湾曲しており、固着要素の自由端部は横方向軸線と平行でない第2軸線のまわりに湾曲されている、請求項1乃至21のいずれか1項に記載の固着装置。
- 近位端部および遠位端部を有しており、患者の遠い血管系から組織に近い患者の身体内の位置まで通るように構成されたカテーテルと、
請求項1乃至22のいずれか1項に記載の固定装置と、を有するシステム。 - 開放位置では、一方の固着要素の係合表面は他方の固着要素の係合表面と90°より大きく、180°より小さい角度を形成する、請求項2に記載の固着装置。
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JP2006533201A Active JP4611991B2 (ja) | 1999-04-09 | 2004-05-18 | 固着装置、組織に係合するための装置および方法 |
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