JP4932854B2 - カテーテルシステム - Google Patents
カテーテルシステム Download PDFInfo
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- JP4932854B2 JP4932854B2 JP2008554416A JP2008554416A JP4932854B2 JP 4932854 B2 JP4932854 B2 JP 4932854B2 JP 2008554416 A JP2008554416 A JP 2008554416A JP 2008554416 A JP2008554416 A JP 2008554416A JP 4932854 B2 JP4932854 B2 JP 4932854B2
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Images
Classifications
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- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
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- A61B17/22031—Gripping instruments, e.g. forceps, for removing or smashing calculi
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- A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
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- A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
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- A61B2017/22051—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
- A61B2017/22061—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation for spreading elements apart
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- A61B2017/22094—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for for crossing total occlusions, i.e. piercing
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- A—HUMAN NECESSITIES
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- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
- A61B2017/2212—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having a closed distal end, e.g. a loop
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Description
Melchior JP, Doriot PA, Chatelain P, et al. Improvement of left ventricular contraction and relaxation synchronism after recanalization of chronic total coronary occlusion by angioplasty. JAm Coll Cardiol. 1987; 9(4): 763-768 Olivari Z, Rubartelli P, Piscione F, et al. Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE). JAm Coll Cardiol. 2003; 41(10): 1672- 1678 Suero JA, Marso SP, Jones PG, et al. Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol. 2001; 38(2): 409-414) Bourassa MG, Roubin GS, Detre KM, et al. Bypass Angioplasty Revascularization Investigation: patient screening, selection, and recruitment. Am J Cardiol. 1995; 75(9): 3C-8C King SB, 3rd, Lembo NJ, Weintraub WS, et al. A randomized trial comparing coronary angioplasty with coronary bypass surgery. Emory Angioplasty versus Surgery Trial (EAST). N Engl J Med. 1994; 331(16): 1044-1050 Kinoshita I, Katoh O, Nariyama J, et al. Coronary angioplasty of chronic total occlusions with bridging collateral vessels: immediate and follow-up outcome from a large single-center experience. J Am Coll Cardiol. 1995; 26(2): 409-415 Colombo A, Mikhail GW, Michev I, et al. Treating chronic total occlusions using subintimal tracking and reentry: the STAR technique. Catheter Cardiovasc Interv. 2005; 64(4): 407-41 1; discussion 412 Ito S, Suzuki T, Ito T, et al. Novel technique using intravascular ultrasound-guided guidewire cross in coronary intervention for uncrossable chronic total occlusions. Circ J. 2004; 68(11): 1088-1092 Kimura BJ, Tsimikas S, Bhargava V, et al. Subintimal wire position during angioplasty of a chronic total coronary occlusion: detection and subsequent procedural guidance by intravascular ultrasound. Cathet Cardiovasc Diagii. 1995; 35(3): 262-265 Matsubara T5 Murata A, Kanyama H, et al. IVUS-guided wiring technique: promising approach for the chronic total occlusion. Catheter Cardiovasc Interv. 2004; 61(3): 381-386
登録された全患者は、第1の選択肢としてまたは同じまたは先の処置中に従来のワイヤまたは専用のワイヤを用いて失敗した順行性の試みの後にCART技術を用いて治療された。CTO脈管再生についての指示は、狭心症の症状または確認されたストレスによる虚血だった。閉塞の期間は、以前の血管造影によるデータから、あるいは臨床情報(急性心筋梗塞または狭心症パターンの急変)または閉塞の位置に整合するECG(心電図)の変化から推定された。
冠動脈の慢性完全閉塞は、心筋梗塞(TIMI:thrombolysis in myocardial infarction)における血栓溶解がグレード0の流れであった場合に真の完全閉塞として定義される。3ヵ月を超える期間の完全閉塞は、慢性的とみなされた。
記述的分析を使用した。結果は、カテゴリーデータについてのパーセンテージとして、または連続変数についての平均±標準偏差として引き合いに出される。
ネイティブ冠状動脈のCTOを有する10名の患者(男性9名、女性1名)が、CART技術を用いて治療された。患者特性を表2にまとめる。基本病巣特性(Baseline lesion characteristics)を表3中に示す。CTOの期間は、7ヵ月から84ヵ月までさまざまであった。全てのCTOは、TIMI 0の流れの完全閉塞であった。10症例のうちの8症例において、それは、反復治療の試みだった。
40 スライド可能なスリーブ、スリーブ、インナーシャフト、デバイス
41 近位端、アウターシャフト
42 遠位端
43 複数のリブ
500 デバイス
510 カテーテルシャフト
515 ガイドワイヤ管腔
520 捕獲管腔
530 止め具
540 テンションワイヤ
550 遠位先端部、係留位置
560 バスケット
600 カテーテル
610 ワイヤ
620 バルーン
630 コイル
650 トリガが引き戻される位置、トリガ
651 トリガの前方位置
710 順行性ガイドワイヤ
720 逆行性ガイドワイヤ
730 バルーン
800 プラスチックチューブ
805 螺旋状の溝
810 先細になった拡大された部分
850 拡張デバイス
851 大きいワイヤ、ワイヤ
852 小さいワイヤ、ワイヤ
855 ポリマーの先端部領域、先端部
860 ポリマーのジャケット
865 中央のPTFEライナー、PTFEライナー
900 可撓性ガイドワイヤ、ガイドワイヤ
910 近位部
920 部分
930 部分
940 先細の遠位部、部分
945 円錐部
946 リボン
950 螺旋コイル、放射線不透過性部、放射線不透過性コイル部、放射線不透過性部
955 ポリマーの外装またはジャケット、外装
960 親水性皮膜
970 遠位先端部、先端部
975 遠位先端部、先端部構成
980 遠位先端部、先端部構成
1200 カテーテル、注入カテーテル
1210 カテーテルシャフト、カテーテル、シャフト
1220 カテーテルシャフト、シャフト
1230 カテーテルシャフト、インナーシャフト、シャフト
1240 注入ポート
1245 壁
1250 ガイドワイヤ管腔
1251 薄壁、壁
1255 PTFE内層
1260 マーカー、網状の内層
Claims (14)
- 閉塞の近位端を貫いて進めることができる遠位端を有する順行性縦部材と、
前記閉塞の遠位端を貫いて進めることができる遠位端を有する逆行性縦部材と
を備え、
前記順行性縦部材の前記遠位端及び前記逆行性縦部材の前記遠位端が協働して前記閉塞した血管内で連続的なチャンネルを形成する
閉塞した血管を再疎通するカテーテルシステム。 - 前記縦部材のうちの少なくとも1つが、拡張及び回収できる、請求項1に記載のカテーテルシステム。
- 前記順行性縦部材が、次に示すもの、すなわちガイドワイヤ、拡張デバイス、注入デバイス及び捕獲デバイスのうちの1つまたは複数を備える、請求項1に記載のカテーテルシステム。
- 前記逆行性縦部材が、次に示すもの、すなわちガイドワイヤ、拡張デバイス、注入デバイス及び捕獲デバイスのうちの1つまたは複数を備える、請求項1に記載のカテーテルシステム。
- 前記閉塞内の開いたスペースを維持し、連続的なチャンネルを生成するために前記逆行性縦部材と前記順行性縦部材を対合する手段を含む、請求項1に記載のカテーテルシステム。
- 前記逆行性縦部材の前記遠位端が、側副チャンネルを貫いて進めることができる、請求項1に記載のカテーテルシステム。
- 前記側副チャンネルが、心外膜のチャンネル、心房間のチャンネル、中隔間のチャンネルまたはバイパスグラフトから選択される、請求項6に記載のカテーテルシステム。
- a.閉塞の近位端を貫いて進めることができる遠位端を有する順行性縦部材と、
b.前記閉塞の遠位端を貫いて進めることができる遠位端を有する逆行性縦部材と
を備え、
c.前記逆行性部材の前記遠位端が、圧縮性要素によって接続される近位先端部及び遠位先端部を有し、該遠位先端部に向って該近位先端部を進めること、または前記近位先端部に向って前記遠位先端部を進めることにより前記圧縮性要素が張り出し、捕獲機構を形成することを可能にする
閉塞した血管を再疎通するカテーテルシステム。 - 前記逆行性部材の前記遠位端の前記圧縮性要素を展開し前記順行性部材を進めると、その結果、前記順行性部材の前記遠位端が前記捕獲機構の中で係合されることになり、前記逆行性の遠位端の前記近位先端部または遠位先端部を引くことにより前記圧縮性要素を引っ込め、結合した前記順行性部材及び前記逆行性部材を前記閉塞を貫いて動かすことを可能にする、
請求項8に記載のカテーテルシステム。 - a.閉塞の近位端を貫いて進めることができる遠位端を有する順行性縦部材と、
b.前記閉塞の遠位端を貫いて進めることができる遠位端を有する逆行性縦部材と、
を備え、
c.前記順行性部材の前記遠位端が、圧縮性要素によって接続される近位先端部及び遠位先端部を有し、該遠位先端部に向って該近位先端部を進め、または前記近位先端部に向って前記遠位先端部を進めることにより前記圧縮性要素が張り出し、捕獲機構を形成することを可能にする
閉塞した血管を再疎通するカテーテルシステム。 - 前記順行性部材の前記遠位端の前記圧縮性要素を展開し前記逆行性部材を進めると、その結果、前記逆行性部材の前記遠位端が前記捕獲機構の中で係合されることになり、前記順行性の遠位端の前記近位先端部または遠位先端部を引くことにより前記圧縮性要素を引っ込め、結合した前記順行性部材及び前記逆行性部材を前記閉塞を貫いて動かすことを可能にする、
請求項10に記載のカテーテルシステム。 - a.閉塞の近位端を貫いて進めることができる遠位端を有する順行性縦部材と、
b.前記閉塞の遠位端を貫いて進めることができる遠位端を有する逆行性縦部材と、
を備え、
c.前記逆行性部材の前記遠位端が、コイルを張り出させ捕獲要素を形成させるように作動できる該コイルの設計を含む
閉塞した血管を再疎通するカテーテルシステム。 - 前記逆行性部材の前記遠位端の前記コイルを作動し前記順行性部材を進めると、その結果、前記順行性部材の前記遠位端が展開された前記コイルの中で係合される、請求項12に記載のカテーテルシステム。
- a.閉塞の近位端を貫いて進めることができる遠位端を有する順行性縦部材と、
b.前記閉塞の遠位端を貫いて進めることができる遠位端を有する逆行性縦部材と、
を備え、
c.前記逆行性縦部材の前記遠位端が、前記順行性縦部材を受容できる圧縮性バスケット状捕獲機構を有する
閉塞した血管を再疎通するカテーテルシステム。
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WO2008022077A2 (en) * | 2006-08-14 | 2008-02-21 | Buch Wally S | Methods and apparatus for mitral valve repair |
US9283034B2 (en) * | 2007-09-26 | 2016-03-15 | Retrovascular, Inc. | Recanalization system using radiofrequency energy |
KR101228879B1 (ko) * | 2007-09-26 | 2013-02-05 | 레트로배스큘러, 아이엔씨. | 고주파 에너지를 이용한 폐색된 혈관의 재관류 |
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JP2004500171A (ja) * | 1999-12-06 | 2004-01-08 | バッカス バスキュラー, インコーポレイテッド | 血餅の破壊および回収のためのシステムおよび方法 |
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RU2753143C1 (ru) * | 2020-05-27 | 2021-08-12 | Олег Сергеевич Белоконь | Коронарный буж для реканализации окклюзии коронарной артерии |
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WO2007095191A2 (en) | 2007-08-23 |
CA2641729C (en) | 2014-05-20 |
KR20090003212A (ko) | 2009-01-09 |
KR101074876B1 (ko) | 2011-10-19 |
US20110166591A1 (en) | 2011-07-07 |
EP3391934B1 (en) | 2023-06-21 |
AU2007215224A1 (en) | 2007-08-23 |
EP3075332A1 (en) | 2016-10-05 |
EP1984062A2 (en) | 2008-10-29 |
AU2007215224B2 (en) | 2011-05-12 |
JP2009526570A (ja) | 2009-07-23 |
WO2007095191A3 (en) | 2008-11-20 |
EP3391934A1 (en) | 2018-10-24 |
US20070208368A1 (en) | 2007-09-06 |
EP1984062A4 (en) | 2013-05-22 |
US7918859B2 (en) | 2011-04-05 |
EP1984062B1 (en) | 2016-05-11 |
CA2641729A1 (en) | 2007-08-23 |
EP3075332B1 (en) | 2018-05-16 |
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