JP5133235B2 - 血管構造内の完全閉塞を横断するためのカテーテルシステム - Google Patents
血管構造内の完全閉塞を横断するためのカテーテルシステム Download PDFInfo
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Description
本願は、2005年3月30日出願の米国特許出願第60/666,896号の利益を主張するものである。米国特許出願第60/666,896号は、2004年4月12日出願の米国特許出願第10/823,416号の一部継続出願であり、米国特許出願第10/823,416号は、2002年12月3日出願の米国特許出願第10/308,568号の一部継続出願であり、米国特許出願第10/308,568号は、現在は米国特許第6,511,458号である2001年1月19日出願の米国特許出願第09/765,777号の継続出願であり、米国特許出願第09/765,777号は、現在は米国特許第6,235,000号である1999年11月17日出願の米国特許出願第09/440,308号の継続出願であり、米国特許出願第09/440,308号は、現在は米国特許第6,231,546号である1998年1月13日出願の米国特許出願第09/006,563号の分割出願である。
本明細書の開示は、概して、医療機器および方法に関するものである。具体的には、本開示は、血管構造内の慢性完全閉塞を横断する(crossing chronic total occlusions)ためのシステム、方法および手技に関するものである。
心血管疾患は、世界における主要死因である。心血管疾患は、様々な形態を取りうるものであり、多様な特別介入治療(specific interventional treatments)および薬物治療が長年にわたって考案され、その成功の度合いはさまざまであった。
本明細書で言及した各々の特許、特許出願および/または刊行物は、それぞれの個々の特許、特許出願および/または刊行物が具体的かつ個別に参照により組み込まれることが示された場合と同じ範囲で、その全体が参照により本明細書に組み込まれる。
以下に示す装置および方法には、血管構造内の完全閉塞部を横断する(crossing total occlusions in vasculature)際に用いられるカテーテル、ガイドおよび/または他の器具が含まれる。完全閉塞は、完全血管閉塞あるいは慢性完全閉塞(CTOs)とも呼ばれる。装置および方法には、従来のガイドワイヤーおよび/または特殊なガイドワイヤーを持った医師/ユーザが、ガイドワイヤーが内膜下空間(subintimal space)に入った後に、ガイドワイヤーを内膜下空間から血管腔へ戻るように導く、あるいは向け直す(redirect)ことを目的として使用する医療装置が含まれる。これらの装置および方法は、他の血管と同様に、冠動脈における冠動脈疾患の治療にも有効であり、画像化の有無に関わらず実行可能であるべきである。この装置/方法は、末梢血管疾患の治療などの他の動脈および静脈における応用にも有用である。
(1)血管構造に使用するためのカテーテルシステムにおいて、
本体内腔部を含むカテーテル本体と、
前記カテーテル本体の遠位端に連結されたノーズコーンであって、
前記ノーズコーンは、ノーズコーン内腔部、側面口、および遠位口を含み、
前記ノーズコーン内腔部の近位部分は、前記本体内腔部とつながっており、
前記ノーズコーン内腔部の中間部分は、前記側面口および前記近位部分とつながっている受動的偏向領域を含むように構成されており、
前記ノーズコーン内腔部の遠位部分は、前記遠位口および前記近位部分とつながっている、
ノーズコーンと、
前記ノーズコーンに設けられたマーカーであって、前記血管構造における対象部位に対する前記側面口の相対的な向きを示す複数のシンボルとして現れるように構成された、マーカーと、
を備える、カテーテルシステム。
前記遠位部分の断面積は、前記近位部分および前記中間部分の断面積より比較的小さい、カテーテルシステム。
(3)実施態様1に記載のカテーテルシステムにおいて、
前記中間部分は、カニューレが前記側面口まで通るように構成されている、カテーテルシステム。
(4)実施態様1に記載のカテーテルシステムにおいて、
前記遠位部分は、ガイドワイヤーが前記遠位口まで通るように構成されている、カテーテルシステム。
(5)実施態様1に記載のカテーテルシステムにおいて、
前記マーカーは、前記側面口に対し遠位に位置しており、
前記複数のシンボルは、第1のシンボル、および第2のシンボルを含む、カテーテルシステム。
遠位端を有する作用要素、
をさらに備えており、
前記遠位端は、前記作用要素が前記側面口を通って前進した場合に、内膜下空間内の第1血管場所から前記血管構造の真腔内の第2血管場所へ送達されるように、前記側面口を通って展開するように構成されている、カテーテルシステム。
(7)実施態様6に記載のカテーテルシステムにおいて、
前記作用要素は、前記カテーテル本体にキー固定されている、カテーテルシステム。
(8)実施態様6に記載のカテーテルシステムにおいて、
前記作用要素は、少なくとも1つの内腔部を有するカニューレを含む、カテーテルシステム。
(9)実施態様6に記載のカテーテルシステムにおいて、
前記作用要素は、
カニューレと、
前記カニューレ内にスライド可能に配置された少なくとも1つのガイドワイヤーと、
を含む、カテーテルシステム。
前記作用要素の前記遠位端は、予め形成された、弾性のある先端部を含む、カテーテルシステム。
(11)実施態様6に記載のカテーテルシステムにおいて、
前記作用要素の前記遠位端は、前記作用要素が前記カテーテル本体内に引っ込められたときに第1の構成をとり、前記作用要素が前記側面口を通って伸ばされたときに第2の構成をとる、カテーテルシステム。
(12)内膜下空間から血管構造の真腔に再入するための方法において、
カテーテルをワイヤー上で前進させて前記内膜下空間に入れ、前記ワイヤーを後退させることと、
可視化をしている間に、前記カテーテルの遠位領域にあるマーカーにより示された複数のシンボルの情報を用いて、前記カテーテルの側面口の位置を特定し、前記真腔の対象の再入部位にほぼ隣接するように位置付けることと、
前記ワイヤーを前記側面口に通して前記真腔に入れるように前進させることであって、前記真腔は、前記ワイヤーにより再入される、前進させることと、
を含む、方法。
前記位置を特定し、位置付けることは、第1のシンボルを表す位置まで前記カテーテルを回転させることにより、前記側面口を前記真腔にほぼ隣接するように位置付けることを含む、方法。
(14)実施態様13に記載の方法において、
前記位置を特定し、位置付けることは、第2のシンボルを表す位置まで前記カテーテルを回転させることにより、前記側面口の前記位置付けを調整することを含む、方法。
(15)実施態様14に記載の方法において、
結果として前記第2のシンボルを示す可視化中の撮像装置の位置は、結果として前記第1のシンボルを示す可視化中の前記撮像装置の位置に対してほぼ直交している、方法。
(16)実施態様12に記載の方法において、
前記対象の再入部位に向けて前記側面口を通してカニューレを前進させること、
をさらに含む、方法。
前記前進させることは、前記カテーテルから前記カニューレを偏向させることを含む、方法。
(18)実施態様16に記載の方法において、
前記前進させることは、前記ワイヤーを前記カニューレに通して前進させることを含む、方法。
(19)実施態様12に記載の方法において、
前記可視化は、透視を含む、方法。
(20)実施態様12に記載の方法において、
前記内膜下空間は、前記血管構造のびまん性疾患内に位置する、方法。
(21)実施態様12に記載の方法において、
前記内膜下空間は、前記血管構造の外膜層と内膜層との間に位置する、方法。
Claims (11)
- 血管構造に使用するためのカテーテルシステムにおいて、
本体内腔部を含むカテーテル本体と、
前記カテーテル本体の遠位端に連結されたノーズコーンであって、
前記ノーズコーンは、ノーズコーン内腔部、側面口、および遠位口を含み、
前記ノーズコーン内腔部の近位部分は、前記本体内腔部とつながっており、
前記ノーズコーン内腔部の中間部分は、前記側面口および前記近位部分とつながっている受動的偏向領域を含むように構成されており、
前記ノーズコーン内腔部の遠位部分は、前記遠位口および前記近位部分とつながっている、
ノーズコーンと、
前記ノーズコーンにおける前記側面口よりも遠位側に設けられたマーカーであって、前記血管構造における対象部位に対する前記側面口の相対的な向きを示す複数のシンボルとして現れるように構成された、マーカーと、
を備え、
前記マーカーは、LT指向マーカーであって、前記ノーズコーンが回転することによって、L字形状またはT字形状に見えるものであり、前記マーカーは、前記長手方向に延びる第1部分、及び、該第1部分の遠位端に接触していて前記長手方向に対し直交方向に延びる第2部分から構成されている、カテーテルシステム。 - 請求項1に記載のカテーテルシステムにおいて、
前記遠位部分の断面積は、前記近位部分および前記中間部分の断面積より比較的小さい、カテーテルシステム。 - 請求項1に記載のカテーテルシステムにおいて、
前記中間部分は、カニューレが前記側面口まで通るように構成されている、カテーテルシステム。 - 請求項1に記載のカテーテルシステムにおいて、
前記遠位部分は、ガイドワイヤーが前記遠位口まで通るように構成されている、カテーテルシステム。 - 請求項1に記載のカテーテルシステムにおいて、
前記マーカーは、前記側面口に対し遠位に位置しており、
前記複数のシンボルは、第1のシンボル、および第2のシンボルを含む、カテーテルシステム。 - 請求項1に記載のカテーテルシステムにおいて、
遠位端を有する作用要素、
をさらに備えており、
前記遠位端は、前記作用要素が前記側面口を通って前進した場合に、内膜下空間内の第1血管場所から前記血管構造の真腔内の第2血管場所へ送達されるように、前記側面口を通って展開するように構成されている、カテーテルシステム。 - 請求項6に記載のカテーテルシステムにおいて、
前記作用要素は、前記カテーテル本体にキー固定されている、カテーテルシステム。 - 請求項6に記載のカテーテルシステムにおいて、
前記作用要素は、少なくとも1つの内腔部を有するカニューレを含む、カテーテルシステム。 - 請求項6に記載のカテーテルシステムにおいて、
前記作用要素は、
カニューレと、
前記カニューレ内にスライド可能に配置された少なくとも1つのガイドワイヤーと、
を含む、カテーテルシステム。 - 請求項6に記載のカテーテルシステムにおいて、
前記作用要素の前記遠位端は、予め形成された、弾性のある先端部を含む、カテーテルシステム。 - 請求項6に記載のカテーテルシステムにおいて、
前記作用要素の前記遠位端は、前記作用要素が前記カテーテル本体内に引っ込められたときに第1の構成をとり、前記作用要素が前記側面口を通って伸ばされたときに第2の構成をとる、カテーテルシステム。
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-
2006
- 2006-03-30 CN CNA2006800176746A patent/CN101495171A/zh active Pending
- 2006-03-30 EP EP06739991A patent/EP1868754A2/en not_active Withdrawn
- 2006-03-30 CA CA002602662A patent/CA2602662A1/en not_active Abandoned
- 2006-03-30 JP JP2008504328A patent/JP5133235B2/ja active Active
- 2006-03-30 WO PCT/US2006/011547 patent/WO2006105244A2/en active Application Filing
- 2006-03-30 US US11/393,623 patent/US20060276749A1/en not_active Abandoned
-
2012
- 2012-06-28 JP JP2012145189A patent/JP5356580B2/ja active Active
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2013
- 2013-04-26 US US13/871,801 patent/US20130245430A1/en not_active Abandoned
Also Published As
Publication number | Publication date |
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JP2012192209A (ja) | 2012-10-11 |
US20130245430A1 (en) | 2013-09-19 |
JP2008538190A (ja) | 2008-10-16 |
US20060276749A1 (en) | 2006-12-07 |
WO2006105244A2 (en) | 2006-10-05 |
EP1868754A2 (en) | 2007-12-26 |
JP5356580B2 (ja) | 2013-12-04 |
CA2602662A1 (en) | 2006-10-05 |
WO2006105244A3 (en) | 2009-04-16 |
CN101495171A (zh) | 2009-07-29 |
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