JP5836590B2 - 弧状末端部分を有するカテーテル - Google Patents
弧状末端部分を有するカテーテル Download PDFInfo
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Description
上述のラッソーカテーテルは、肺静脈口などの解剖学的構造を取り囲む弧に沿って組織の焼灼を行うために使用することができる。ラッソーは、操縦性を目的として概して薄く可撓性に作られ、電気抵抗を最小限にするために大きい環状電極を伴う。その開示は参照により本明細書に組み込まれる、本特許出願の出願人に譲渡された2008年12月30日付出願の米国特許出願第12/345,720号は、より厚く堅いラッソーを代替設計として開示している。しかしながら、オペレータはしばしば、心臓内でラッソーカテーテルを操縦すること、並びに、特に、例えば、効果的な肺静脈隔離のために望ましいとされるように、ラッソーの全周辺を組織と接触させるように、心臓内で位置づけることが、困難であると実感する。
図1は、本発明の一実施形態による、患者28の心臓26の組織の焼灼のためのシステム20を概略的に絵図で示したものである。例えば心臓専門医のようなオペレータ22は、カテーテルの遠位端が患者の心臓の室に入るように、カテーテル24を患者28の血管系を通して挿入する。オペレータ22は、次の図に示されるように、カテーテルの末端部分が(1つ又は複数の)所望の位置で心臓内組織と係合するように、カテーテルを前進させる。カテーテル24はその近位端の好適なコネクタによってコンソール30に接続される。コンソールは、遠位部分が接触する組織を焼灼するために、カテーテルの末端部分の電極を介してRFエネルギーを付加するためのRF発振器36を備える。あるいは、又は加えて、カテーテル24を他の診断及び/又は治療機能、例えば心臓膜電気マッピング又は他のタイプの焼灼療法に使用してもよい。
ここで、本発明の実施形態によるカテーテル24の遠位部分の詳細を概略的に示す図3A及び3Bを参照する。図3Aは側面図であり、図3Bは図3Aの線IIIB〜IIIBに沿って取られた断面図である。カテーテルは挿入シャフト54を備え、この挿入シャフトはその遠位端で末端部分52のベースに接続している。これらの図のZ軸は、図3Aの破線が図示するように、挿入シャフトの長手方向軸になるように切り取られている。末端部分52は、ほぼX−Y平面に配向されているが、螺旋形を有するので、部分52の遠位先端は軸方向に(Z軸に沿って)遠位方向に(図3Aでは右へ)突出する。
(1) 長手方向軸を有し、患者の身体内への挿入に適応された遠位端を有する、挿入シャフトと、
前記挿入シャフトの前記遠位端に固定され、非拘束状態のときに、前記軸に対して斜めに配向され、前記軸上に曲率中心を有する弧を画定するように形成される、弾力的な末端部分と、
前記末端部分に沿ってそれぞれの位置に配置される、1つまたは2つ以上の電極と、を備える、医療装置。
(2) 前記弧が300度を超える範囲を定める、実施態様1に記載の装置。
(3) 前記弧が270度未満の範囲を定める、実施態様1に記載の装置。
(4) 前記弧が180度の範囲を定める、実施態様3に記載の装置。
(5) 前記末端部分が、前記挿入シャフトの前記遠位端に接続されたベースと、先端とを備え、前記先端が前記ベースに対して遠位方向に軸方向に突出するような螺旋形を有する、実施態様1に記載の装置。
(6) 前記末端部分が、前記挿入シャフトの前記遠位端に接続されるベースと、先端とを備え、前記1つまたは2つ以上の電極が、前記先端を越えて延びる先端電極と、前記末端部分に沿って分布される複数の近位電極とを備える、実施態様1に記載の装置。
(7) 前記非拘束状態の末端部分が前記身体の組織表面に対して軸方向に前進したときに、前記末端部分が前記弧に沿って前記組織表面を係合することにより前記先端電極、及び前記近位電極の少なくともいくつかが前記組織表面に同時に接触するように、前記末端部分が構成される、実施態様6に記載の装置。
(8) 前記末端部分が、真っ直ぐにして進めて前記先端電極のみを前記組織表面と接触させることができる、1つまたは2つ以上の接合部を備える、実施態様7に記載の装置。
(9) 少なくとも1つの位置検出器を備える、実施態様1に記載の装置。
(10) 前記少なくとも1つの位置検出器が、前記末端部分の内部に分布された複数の位置検出器を備える、実施態様9に記載の装置。
前記挿入シャフトの前記遠位端に接続されたベースと、先端とを備え、非拘束状態のときに前記軸に対して斜めに配向され、前記先端が前記ベースに対して遠位方向に軸方向に突出するように螺旋形を有する弧を画定するように形成される、弾力的な末端部分と、
前記末端部分に沿ってそれぞれの位置に配置される、1つまたは2つ以上の電極と、を備える、医療装置。
(12) 患者の身体内に挿入するためのプローブを備え、前記プローブが、
長手方向軸を有し、前記身体内に挿入されるように適応された遠位端を有する、挿入シャフトと、
前記挿入シャフトの前記遠位端に固定され、非拘束状態のときに、前記軸に対して斜めに配向され、前記軸上に曲率中心を有する弧を画定するように形成される、弾力的な末端部分と、
前記末端部分に沿ってそれぞれの位置に配置され、前記身体内の組織に接触するように構成される1つまたは2つ以上の電極と、
前記組織を焼灼するように前記プローブを通して無線周波数(RF)エネルギーを前記電極の少なくとも1つに供給するために連結される、無線周波数(RF)発振器と、を備える、医療器具。
(13) 前記プローブが、前記末端部分に位置検出器を備え、前記器具が、前記身体内における前記末端部分の位置を決定するために前記位置検出器と通信するように構成される位置検出システムを備える、実施態様12に記載の器具。
(14) 身体通路を通して前記身体内部の腔内に挿入されるように構成されるシースを備え、前記シースを通して前記腔内に挿入されるように前記プローブが構成される、実施態様12に記載の器具。
(15) 前記シースが血管を通して心臓の室に挿入されるように構成され、前記末端部分が前記弧に沿って前記室内の組織を係合するように構成される、実施態様14に記載の器具。
(16) 前記挿入シャフトが、前記弧が前記組織上に環状の道筋を描くように前記シース内で前記軸を中心に回転されるように構成される、実施態様15に記載の器具。
(17) 前記末端部分が、前記挿入シャフトの前記遠位端に接続されたベースと、先端とを備え、前記先端が前記ベースに対して遠位方向に軸方向に突出するように螺旋形を有する、実施態様12に記載の器具。
(18) 患者の身体内にプローブを挿入することであり、前記プローブが、長手方向軸及び遠位端を有する挿入シャフトと、弾力的な末端部分とを備え、前記末端部分が、前記挿入シャフトの前記遠位端に固定され、非拘束状態のときに前記軸に対して斜めに配向されて、前記軸上に曲率中心を有する弧を画定するように形成され、電極が、前記末端部分に沿ってそれぞれの位置に配置されている、挿入することと、
前記末端部分が前記弧に沿って前記身体内の組織を係合して、前記電極の少なくともいくつかが前記組織に同時に接触するように、前記プローブを軸方向に前進させることと、
前記弧が前記組織上に環状の道筋を描くようにする一方で、前記電極の前記少なくともいくつかが前記組織と接触するように、前記軸を中心に前記挿入シャフトを回転させることと、を含む、医療処置のための方法。
(19) 前記環状の道筋に沿って前記組織を焼灼するように前記電極を介してエネルギーを付加することを備える、実施態様18に記載の方法。
(20) 前記プローブを挿入することが、血管を通して心臓の室内に前記プローブを通過させることを含む、実施態様18に記載の方法。
Claims (12)
- シース内を通って患者の身体内へ挿入される医療装置であって、
長手方向軸を有し、患者の身体内への挿入に適応された遠位端を有する、挿入シャフトと、
前記挿入シャフトの前記遠位端に固定され、前記長手方向軸に対して斜めに配向され、前記長手方向軸上に中心を有する弧を画定するように形成される、弾力的な末端部分と、
前記末端部分に沿ってそれぞれの位置に配置される、1つまたは2つ以上の電極と、を備え、
前記挿入シャフトの前記遠位端が患者の身体内に挿入されている状態で、前記挿入シャフトが回転した際に、前記弧は前記長手方向軸を中心として環状の道筋を描いて移動し、
前記末端部分は、前記シース内を通って移動している際に略直線状であり、前記末端部分は、前記シースから出て、前記シースによる拘束が解除された際に、前記弧を画定し、該弧が270度未満の範囲を定め、前記挿入シャフトが回転した際に、前記弧は前記長手方向軸を中心として前記環状の道筋を描いて移動し、
前記末端部分が、前記挿入シャフトの前記遠位端に接続されたベースと、先端とを備え、前記先端が前記ベースに対して遠位方向に長手方向軸方向に突出するような螺旋形を有する、医療装置。 - 前記弧が180度の範囲を定める、請求項1に記載の装置。
- 前記1つまたは2つ以上の電極が、前記先端を越えて延びる先端電極と、前記末端部分に沿って分布される複数の近位電極とを備える、請求項1に記載の装置。
- 前記末端部分が前記身体の組織表面に対して長手方向軸方向に前進したときに、前記末端部分が前記弧に沿って前記組織表面を係合することにより前記先端電極、及び前記近位電極の内の少なくとも1つが前記組織表面に同時に接触するように、前記末端部分が構成される、請求項3に記載の装置。
- 前記末端部分が、真っ直ぐにして進めて前記先端電極のみを前記組織表面と接触させることができる、1つまたは2つ以上の接合部を備える、請求項4に記載の装置。
- 少なくとも1つの位置検出器を備える、請求項1に記載の装置。
- 前記少なくとも1つの位置検出器が、前記末端部分の内部に分布された複数の位置検出器を備える、請求項6に記載の装置。
- シース内を通って患者の身体内へ挿入される医療装置であって、
長手方向軸を有し、患者の身体内部の腔に身体通路を介して挿入されるように適応された遠位端を有する、挿入シャフトと、
前記挿入シャフトの前記遠位端に接続されたベースと、先端とを備え、前記長手方向軸に対して斜めに配向され、前記先端が前記ベースに対して遠位方向に長手方向軸方向に突出するように螺旋形を有し、前記長手方向軸上に中心を有する弧を画定するように形成される、弾力的な末端部分と、
前記末端部分に沿ってそれぞれの位置に配置される、1つまたは2つ以上の電極と、を備え、
前記挿入シャフトの前記遠位端が患者の身体内部の腔に挿入されている状態で、前記挿入シャフトが回転した際に、前記弧は前記長手方向軸を中心として環状の道筋を描いて移動し、
前記末端部分は、前記シース内を通って移動している際に略直線状であり、前記末端部分は、前記シースから出て、前記シースによる拘束が解除された際に、前記弧を画定し、該弧が270度未満の範囲を定め、前記挿入シャフトが回転した際に、前記弧は前記長手方向軸を中心として前記環状の道筋を描いて移動する、医療装置。 - シース内を通って患者の身体内に挿入するためのプローブを備え、前記プローブが、
長手方向軸を有し、前記身体内に挿入されるように適応された遠位端を有する、挿入シャフトと、
前記挿入シャフトの前記遠位端に固定され、前記長手方向軸に対して斜めに配向され、前記長手方向軸上に中心を有する弧を画定するように形成される、弾力的な末端部分と、
前記末端部分に沿ってそれぞれの位置に配置され、前記身体内の組織に接触するように構成される1つまたは2つ以上の電極と、
前記組織を焼灼するように前記プローブを通して無線周波数(RF)エネルギーを前記電極の少なくとも1つに供給するために連結される、無線周波数(RF)発振器と、を備え、
前記挿入シャフトの前記遠位端が患者の身体内に挿入されている状態で、前記挿入シャフトが回転した際に、前記弧は前記長手方向軸を中心として環状の道筋を描いて移動し、
前記末端部分は、前記シース内を通って移動している際に略直線状であり、前記末端部分は、前記シースから出て、前記シースによる拘束が解除された際に、前記弧を画定し、該弧が270度未満の範囲を定め、前記挿入シャフトが回転した際に、前記弧は前記長手方向軸を中心として前記環状の道筋を描いて移動し、
前記末端部分が、前記挿入シャフトの前記遠位端に接続されたベースと、先端とを備え、前記先端が前記ベースに対して遠位方向に長手方向軸方向に突出するような螺旋形を有する、医療器具。 - 前記プローブが、前記末端部分に位置検出器を備え、前記器具が、前記身体内における前記末端部分の位置を決定するために前記位置検出器と通信するように構成される位置検出システムを備える、請求項9に記載の器具。
- 前記シースが血管を通して心臓の室に挿入されるように構成され、前記末端部分が前記弧に沿って前記室内の組織を係合するように構成される、請求項9に記載の器具。
- 前記末端部分が、前記挿入シャフトの前記遠位端に接続されたベースと、先端とを備え、前記先端が前記ベースに対して遠位方向に長手方向軸方向に突出するように螺旋形を有する、請求項9に記載の器具。
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CN102113907A (zh) | 2011-07-06 |
EP2340765A1 (en) | 2011-07-06 |
AU2010257390B2 (en) | 2015-05-14 |
EP3111839B1 (en) | 2021-03-31 |
CA2726334C (en) | 2016-10-25 |
EP2537465A1 (en) | 2012-12-26 |
IL227721A (en) | 2017-01-31 |
IL227721A0 (en) | 2013-09-30 |
US20110160719A1 (en) | 2011-06-30 |
JP2011136172A (ja) | 2011-07-14 |
AU2010257390A1 (en) | 2011-07-14 |
IL210131A (en) | 2013-08-29 |
CA2726334A1 (en) | 2011-06-30 |
IL245262A0 (en) | 2016-06-30 |
US8608735B2 (en) | 2013-12-17 |
IL210131A0 (en) | 2011-02-28 |
IL245262A (en) | 2017-10-31 |
EP3111839A1 (en) | 2017-01-04 |
EP2340765B1 (en) | 2017-07-12 |
CN102113907B (zh) | 2016-06-08 |
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