JP6183134B2 - Ablation device - Google Patents

Description

  The present invention relates to an ablation device that performs ablation on tissue around the lumen of a living body.

  It is known that when nerves existing in the adventitia of the renal arteries are cauterized, blood pressure is lowered for a long time, and application to the treatment of hypertension is expected. Such a technique of cauterizing nerves in the renal arteries is called renal artery sympathetic nerve ablation or renal denavigation. As one of renal artery sympathetic nerve ablation, a balloon catheter with electrodes is inserted into the left and right renal arteries, the electrodes are heated, and heated from the lumen side of the renal arteries, and the heat is transferred to the adventitia of the renal arteries. There is a technique to reach and cauterize nerves.

  However, when the heat of about 60-70 ° C. necessary for cauterizing the nerves reaches the outer membrane from the lumen side of the renal artery, side effects such as edema and thrombus are frequently caused by the heat applied to the inner membrane. There is concern about the problem of In addition, several minutes pass to reach the necessary heat from the lumen side to the outer membrane, and during that time, the patient may be given heat and pain.

  To solve the above-mentioned problem, the pulse laser is guided to the renal artery using a catheter, the pulse laser is focused on the outer membrane of the renal artery by a condensing lens, and multiphoton absorption is caused at the focal position, thereby focusing. An apparatus for ablating the outer membrane at a position has been proposed (Patent Document 1).

International Publication No. 2013/017261

  However, the apparatus described in Patent Document 1 has a problem that the structure of the catheter becomes complicated by arranging a condensing lens or the like in the catheter. In addition, since the focal position of the pulse laser depends on the thickness of the blood vessel wall and the position of the catheter in the blood vessel, there is a problem that it is difficult to accurately position the focal position of the pulse laser at a desired position. For example, there are individual differences in the thickness of the blood vessel wall, so it is necessary to measure the thickness of the blood vessel wall of the individual to be ablated in advance and adjust the focal position of the condenser lens to the thickness of the blood vessel wall. If the catheter is positioned out of the center of the blood vessel, there may be a problem that the focal position of the pulse laser is not uniform in the thickness direction of the blood vessel wall in the circumferential direction of the blood vessel.

  The present invention has been made in view of the above-described circumstances, and an object of the present invention is to heat a deep tissue around the lumen of a living body and suppress thermal damage to the lumen lumen. It is to provide an ablation device capable of performing the above.

  An ablation device according to the present invention is provided on a shaft, a distal end side of the shaft, is formed along an elastically inflatable balloon, and the shaft, and allows fluid to flow into the balloon. A first lumen, a second lumen for flowing a fluid from the balloon, and a light guide material provided along the shaft for guiding laser light into the balloon. And a diffusing member that reflects or diffuses laser light emitted from the light guide material in the balloon in a direction intersecting the first direction in which the light guide material is extended, and provided in the balloon, Surrounding the diffusing member, has a reflection layer for reflecting or blocking the laser beam reflected or diffused by the diffusing member on the inner surface side, and applies the laser beam to the diffusing member. Comprising a tubular member having a transmission window for transmitting to the outside of the reflective layer.

  In the ablation device inserted into the lumen of the living body, the balloon is inflated at a desired position, and the fluid is returned to the internal space of the balloon through the first lumen and the second lumen. The laser light applied to the light guide material is guided into the balloon, and reflected or diffused in the direction intersecting the first direction by the diffusion member. The reflected or diffused laser light is reflected by the reflective layer of the tubular member. On the other hand, the reflected or diffused laser light travels from the transmission window of the tubular member toward the outside of the tubular member, that is, the tissue around the lumen. The balloon is in contact with the inner surface of the lumen, and the heating of the inner surface by the laser light is suppressed by being cooled by the fluid circulating in the balloon.

  The tubular member may be movable in a direction in which at least one of a position in the circumferential direction with the first direction of the transmission window as an axis or a position in the first direction is displaced.

  Since the position of the transmission window is displaced by moving the tubular member, the laser light is uniformly applied to the tissue around the lumen.

  The diffusion member and the tubular member may be provided integrally with the light guide material.

  The movement of the tubular member can be controlled by operating the proximal end side of the light guide material.

  The transmission window may have a spiral shape extending in the first direction.

  As a result, the laser light is uniformly applied to the tissue around the lumen.

  A plurality of the transmission windows may be provided at different positions with respect to the first direction.

  As a result, the laser light is uniformly applied to the tissue around the lumen.

  The plurality of transmission windows may be arranged at different positions with respect to a circumferential direction having the first direction as an axis.

  Since the direction of the laser beam traveling in the circumferential direction is different in the first direction, the laser beam is not concentrated at a specific position in the first direction. Thereby, the heating to the inner surface of the lumen can be suppressed.

  The plurality of transmission windows may be such that each transmission range partially overlaps in the first direction.

  Thereby, the unirradiated part of the laser beam does not occur in the first direction of the lumen.

  ADVANTAGE OF THE INVENTION According to this invention, while heating with respect to the structure | tissue of the deep part around the lumen | bore of a biological body, the thermal damage to a lumen inner membrane can be suppressed.

FIG. 1 is a diagram illustrating a configuration of an ablation system 10 including an ablation device 11 in a state where a balloon 21 is in a contracted posture. FIG. 2 is a partial cross section of the ablation device 11. FIG. 3 is a side view of the tubular member 34. FIG. 4 is a cross-sectional view showing the ablation device 11 in the state where the renal artery 40 is ablated. FIG. 5 is a side view of a tubular member 34 according to a modification.

  Hereinafter, preferred embodiments of the present invention will be described. In addition, this embodiment is only one embodiment of this invention, and it cannot be overemphasized that an embodiment can be changed in the range which does not change the summary of this invention.

[Ablation system 10]
As shown in FIG. 1, the ablation system 10 includes an ablation device 11, a laser light generation unit 12, a fluid reflux unit 13, a drive mechanism 14, and a control unit 15.

[Ablation device 11]
As shown in FIGS. 1 and 2, the ablation device 11 has a shaft 22 provided with a balloon 21 on the distal end side. The shaft 22 is a member that is long in the axial direction 101. The shaft 22 is a tubular body that can be elastically bent so as to be bent with respect to the axial direction 101. The direction in which the shaft 22 in the uncurved state extends is referred to as the axial direction 101 in this specification. The axial direction 101 corresponds to the first direction.

  An in-side tube 27 and an optical fiber 29 are inserted through the shaft 22. The outer diameter and inner diameter of the shaft 22 are not necessarily constant with respect to the axial direction 101, but from the viewpoint of operability, it is preferable that the rigidity on the base end side is higher than the tip end side. The shaft 22 can be made of a known material used for a balloon catheter, such as synthetic resin or stainless steel, and is not necessarily composed of only one type of material, and a plurality of parts made of other materials are assembled. It may be configured.

  In the present embodiment, the proximal end side refers to the rear side (right side in FIG. 1) with respect to the direction in which the ablation device 11 is inserted into the blood vessel. The distal end side refers to the front side (left side in FIG. 1) with respect to the direction in which the ablation device 11 is inserted into the blood vessel.

  A balloon 21 is provided on the distal end side of the shaft 22. The balloon 21 expands elastically when fluid (liquid, gas) flows into the internal space and contracts when fluid flows out of the internal space. 1 and 2, the balloon 21 in a deflated state is shown. The internal space of the balloon 21 is in communication with the internal space of the shaft 22 and the internal space of the in-side tube 27. When fluid flows into the inner space of the balloon 21 through the in-side tube 27, the balloon 21 expands in a radial direction orthogonal to the axial direction 101 so that the center of the axial direction 101 becomes the maximum diameter. While a fluid having a flow rate sufficient to maintain the pressure of the fluid that maintains the inflation of the balloon 21 flows into the balloon 21, the fluid flows out from the balloon 21 through the internal space of the shaft 22, whereby the fluid is recirculated in the balloon 21. The As the material of the balloon 21 and the method for fixing the balloon 21 and the shaft 22, known materials and methods used in balloon catheters can be used. The internal space of the in-side tube 27 corresponds to the first lumen, and the internal space of the shaft 22 corresponds to the second lumen.

  An out port 28 is provided on the proximal end side of the shaft 22. The out port 28 is continuous with the internal space of the shaft 22. The fluid recirculated to the balloon 21 flows out from the out port 28 through the internal space of the shaft 22.

  A hub 23 is provided at the proximal end of the shaft 22. An optical fiber 29 is inserted through the hub 23. The hub 23 is provided with an in-port 26 separately from the insertion port of the optical fiber 29. The in port 26 is continuous with the internal space of the in side tube 27. Through the inner space of the in-side tube 27, the fluid recirculated to the balloon 21 flows from the in-port 26.

  As shown in FIG. 2, a guide wire tube 24 is provided outside the shaft 22. The guide wire tube 24 is sufficiently shorter than the length of the shaft 22 in the axial direction 101. The guide wire tube 24 is not necessarily provided outside the shaft 22. For example, instead of the rapid exchange type as in the present embodiment, the guide wire tube 24 may be inserted into the inner space of the shaft 22 if a monorail type is adopted.

  The in-side tube 27 inserted into the shaft 22 has a distal end side reaching the internal space of the balloon 21 and a proximal end side connected to the in-port 26. The distal end of the in-side tube 27 is connected to the distal tip 25 provided on the distal end side of the balloon 21. In the vicinity of the tip 25 of the in-side tube 27, openings 30 and 31 that penetrate the peripheral wall of the in-side tube 27 are provided. The openings 30 and 31 are for fluid flowing through the inner space of the in-side tube 27 to flow into the balloon 21, and are arranged at different positions with respect to the circumferential direction of the axial direction 101.

  The tip 25 is provided with a marker made of a contrast medium. Examples of the contrast agent include barium sulfate, bismuth oxide, and bismuth subcarbonate.

  The optical fiber 29 is inserted from the hub 23 into the inside tube 27 and extends to the inside of the balloon 21. The optical fiber 29 transmits laser light generated by the laser light generating means 12 and applied to the proximal end of the optical fiber 29 to the distal end side. As the optical fiber 29, a fiber having a refractive index that totally reflects at the wavelength of the laser light is appropriately applied. Specific examples include a single mode fiber, a polarization maintaining fiber, a multimode fiber, and a bundle fiber for image transmission. . The optical fiber 29 corresponds to a light guide material.

  As shown in FIGS. 2 and 3, a diffusion member 33 is provided inside the in-side tube 27 adjacent to the tip surface 32 of the optical fiber 29. The diffusion member 33 is a cylindrical member, and the length in the axial direction 101 is shorter than the length in the axial direction 101 of the balloon 21. The diffusing member 33 transmits the laser light emitted from the distal end surface 32 of the optical fiber 29 and diffuses it so that the traveling direction of the laser light changes, that is, from the axial direction 101 to the direction intersecting the axial direction 101. It is. For example, quartz-based glass or the like is employed as the diffusion member 33, but the material is not particularly limited. The diffusing member 33 is connected to and integrated with the optical fiber 29, and can rotate or slide together with the optical fiber 29 in the inner space of the in-side tube 27. Note that the diffusing member 33 may not only change the traveling direction of the laser light by refraction, but may also change the traveling direction of the laser light by reflection.

  As shown in FIGS. 2 and 3, a tubular member 34 is provided inside the in-side tube 27 so as to surround the outside of the diffusion member 33. The tubular member 34 is a tube-shaped member in which the distal end side and the proximal end side, that is, the distal tip 25 side and the hub 23 side are sealed, and covers the distal end surface 32 of the optical fiber 29 and the outer side of the diffusion member 33. . The length of the tubular member 34 in the axial direction 101 is shorter than the length of the balloon 21 in the axial direction 101. The tubular member 34 is connected to and integrated with the optical fiber 29 inserted on the proximal end side, and can rotate or slide together with the optical fiber 29 in the inner space of the in-side tube 27. That is, the optical fiber 29, the diffusing member 33, and the tubular member 34 can be rotated or slid integrally in the inner space of the in-side tube 27.

  The tubular member 34 is obtained by laminating a reflective layer 36 inside a resin layer 35 that can transmit laser light. The resin layer 35 is a synthetic resin such as polyimide. The reflection layer 36 is a metal that reflects laser light, and is formed, for example, by applying gold plating to the inner surface side of the resin layer 35. The reflection layer 36 exists on the inner surface side facing the diffusion member 33 and the sealed tip side. The reflective layer 36 does not necessarily need to totally reflect the laser light, and may absorb part or all of the laser light.

  The tubular member 34 has a transmission window 37 formed on a circular tube-shaped peripheral wall. The transmission window 37 is formed by removing a part of the reflection layer 36. For example, it is formed by masking the inner surface of the resin layer 35 corresponding to the transmission window 37 when gold plating as the reflection layer 36 is performed. The transmission window 37 has an elongated spiral shape extending along the axial direction 101. In the transmission window 37, laser light can be transmitted from the inner space side of the tubular member 34 to the outside.

  The optical fiber 29, the diffusion member 33, and the tubular member 34 can rotate about the axial direction 101 as a unit with respect to the in-side tube 27, and can slide in the axial direction 101. The rotation and sliding of the optical fiber 29, the diffusing member 33, and the tubular member 34 are controlled by directly or indirectly operating the proximal end side of the optical fiber 29 extended from the hub 23. Specifically, the optical fiber 29 is rotated and slid by applying a driving force from the driving mechanism 14 to the proximal end side of the optical fiber 29. Thereby, the position in the circumferential direction with respect to the axial direction 101 of the transmission window 37 of the tubular member 34 and the position in the axial direction 101 are displaced.

  Although not shown in each drawing, a temperature sensor may be provided on the outer wall of the in-side tube 27 in the balloon 21. As the temperature sensor, a known sensor such as a thermocouple can be used as long as it can be installed inside the balloon 21. The temperature of the fluid in the balloon 21 can be monitored by guiding the cable extended from the temperature sensor to the outside. Further, a third lumen may be provided on the shaft 22 and an imaging member such as an endoscope, IVUS, or OCT may be inserted.

  As the laser light generating means 12, a known laser light generating device can be used. The laser light generation means 12 is, for example, one in which light from an excitation source is given to a laser medium, and is oscillated and output by reflection of an optical resonator. The laser light output from the laser light generating means 12 is preferably a continuous wave, and the wavelength of the laser light is preferably in the range of 400 to 2000 nm. In particular, when the wavelength of the laser beam is in the range of 800 to 1500 nm (915 nm, 980 nm, 1470 nm), a local temperature increase can be confirmed, and the intima of the renal artery can be appropriately heated. The laser light generating means 12 is connected to the base end of the optical fiber 29, and the laser light output from the laser light generating means 12 is irradiated on the base end face of the optical fiber 29.

  As the fluid reflux means 13, a known apparatus having a roller pump or a syringe pump can be used. The fluid return means 13 is connected to the in port 26 and the out port 28 of the ablation device 11 through a flow path such as a tube. The fluid recirculation means 13 has a tank for storing fluid, and supplies the fluid from the tank to the in port 26 at a desired flow rate and pressure by the driving force of the pump. Further, the fluid flowing out from the out port 28 may be returned to the tank or discarded as a waste liquid. Moreover, the fluid recirculation | reflux means 13 may be provided with the cooling device for cooling the fluid in a tank. The fluid is not particularly limited, but for the purpose of ablation of the renal artery, a mixed solution of physiological saline and contrast medium is preferable.

  The drive mechanism 14 applies a driving force for rotating and sliding the proximal end side of the optical fiber 29 with respect to the axial direction 101, and a mechanism in which a motor, a slider, or the like is combined may be employed. The drive mechanism 14 is not essential, and the optical fiber 29 may be rotated and slid with respect to the axial direction 101 by the operator handling the proximal end side of the optical fiber 29.

  The control means 15 generates, for example, laser light from the laser light generation means 12 at a predetermined light intensity and time based on a pre-programmed protocol, controls the flow rate and pressure of the fluid reflux means 13, and is driven. The drive amount and timing of the mechanism 14 are controlled. The control means 15 includes an arithmetic device for performing these operation controls.

[How to use the ablation device 11]
In the following, a method of using the ablation system 10 for cutting the nerve 41 of the renal artery 40 will be described.

  As shown in FIG. 1, the ablation device 11 is connected to a laser light generation unit 12, a fluid reflux unit 13, and a drive mechanism 14. Further, the laser light generating means 12, the fluid reflux means 13, and the drive mechanism 14 are connected to the control means 15. The control means 15 is preset with a program suitable for performing ablation on the renal artery 40.

  The ablation device 11 is inserted into the renal artery 40 from the distal end side. In the renal artery 40, a guide wire is inserted in advance and reaches the target portion while performing imaging under fluoroscopy. Such insertion of the guide wire is performed by a known method disclosed in, for example, Japanese Patent Application Laid-Open No. 2006-326226 and Japanese Patent Application Laid-Open No. 2006-230442.

  When the ablation device 11 is inserted into the renal artery 40, no fluid is pressed into the balloon 21, and the balloon 21 is in a deflated state. A guide wire is inserted into the guide wire tube 24 from the tip of the ablation device 11 in this state. Then, the ablation device 11 is inserted into the renal artery 40 along the guide wire. The insertion position of the ablation device 11 in the renal artery 40 is grasped by, for example, confirming a marker placed on the distal tip 25 under the X-ray.

  As shown in FIG. 4, when the ablation device 11 is inserted up to the target portion of the renal artery 40, the fluid return means 13 is driven by the control means 15, and the fluid flows from the fluid return means 13 through the in-side tube 27 to the balloon 21. And the balloon 21 is expanded. Further, the fluid is recirculated from the balloon 21 through the shaft 22 to the fluid recirculation means 13 from the out port 28. The return of the fluid to the balloon 21 is controlled so that the fluid return means 13 is controlled by the control means 15 so that a desired flow velocity and pressure are obtained. The fluid stored in the fluid return means 13 is managed at a temperature suitable for cooling the intima of the renal artery 40.

  Subsequently, the laser light generating means 12 and the drive mechanism 14 are driven by the control means 15, and the laser light 42 generated from the laser light generating means 12 is transmitted into the balloon 21 through the optical fiber 20 and is diffused by the diffusion member 33. Diffused in a plurality of directions intersecting the axial direction 101. The diffused laser light 42 is reflected in the internal space of the tubular member 34 by the reflective layer 36 of the tubular member 34. Then, the laser beam 42 that has reached the transmission window 37 of the tubular member 34 passes through the transmission window 37, further passes through the in-side tube 27 and the balloon 21, is irradiated onto the blood vessel wall of the renal artery 40, and passes through the blood vessel wall. The nerve 41 is reached. Thereby, the nerve 41 is ablated by irradiating the nerve 41 with the laser beam 42 in a spiral shape by the transmission window 37 of the tubular member 34. The intensity and irradiation time of the laser beam are managed by the control means 15.

  Further, when the drive mechanism 14 is driven by the control means 15, the optical fiber 29 that transmits the laser light 42 is slid while being rotated with respect to the axial direction 101. Since the optical fiber 29 is rotated and the diffusing member 33 and the tubular member 34 are also rotated, the direction of the laser light 42 transmitted through the spiral transmission window 37 is displaced in the circumferential direction of the axial direction 101. Thereby, it is possible to uniformly ablate the nerve 41 existing in the circumferential direction of the renal artery 40. Further, since the optical fiber 29 is slid and the transmission window 37 is also slid, the laser light 42 transmitted through the transmission window 37 is displaced in the axial direction 101. Thereby, it is possible to uniformly ablate the nerve 41 existing in the direction in which the renal artery 40 extends (the same direction as the axial direction 101).

  The rotation and slide pattern of the optical fiber 29 can be arbitrarily set by programming in the control means 15. In addition, when the rotation or slide of the optical fiber 29 is temporarily stopped, the laser light 42 is irradiated from the laser light generating means 12 so that the nerve 41 of the renal artery 40 is irradiated with the laser light 42 in a spot shape. it can. In other words, the timing and order of irradiating the laser beam 42 to the nerves 41 existing all around the predetermined range in the direction in which the renal artery 40 extends can be arbitrarily set.

  On the other hand, the laser light 42 transmitted through the transmission window 37 is also irradiated to the tissue on the intima side of the renal artery 40 before reaching the nerve 41 of the renal artery 40. The inflated balloon 21 is in contact with the intima of the renal artery 40, and fluid is circulated in the balloon 21. Due to the cooling effect of the fluid, heating of the intima side of the renal artery 40 is suppressed. Therefore, it is preferable that the slide range of the optical fiber 29 is a range in which the balloon 21 is in contact with the intima of the renal artery 40.

[Operational effects of this embodiment]
According to the above-described embodiment, the nerve 41 of the renal artery 40 can be ablated, and heating to the intima of the renal artery 40 can be suppressed to suppress thermal damage to the intima.

  Further, since the position of the transmission window 37 is displaced by rotating and sliding the tubular member 34, the laser beam 42 is uniformly applied to the nerve 41 of the renal artery 40.

  In addition, the diffusing member 33 and the tubular member 34 are integrally provided on the distal end side of the optical fiber 29, and the optical fiber 29 can move and rotate along the axial direction 101 with respect to the shaft 22. Realized with a simple configuration. Further, the movement and rotation of the diffusing member 33 and the tubular member 34 can be operated via the optical fiber 29 on the proximal end side of the shaft 22.

[Modification]
In the above-described embodiment, the transmission window 37 of the tubular member 34 has a spiral shape extending in the axial direction 101, but the shape of the transmission window 37 may be changed as appropriate. For example, as shown in FIG. 5, a plurality of circular transmission windows 38 may be provided at different positions in the axial direction 101. Each transmission range D1, D2, D3, D4 of each transmission window 38 partially overlaps with the transmission window 38 adjacent in the axial direction 101. Further, each transmission window 38 has a different position with respect to the circumferential direction in the axial direction 101.

  Also by such a plurality of transmission windows 38, the tubular member 34 is rotated and slid, whereby the nerve 41 of the renal artery 40 is uniformly irradiated with laser light.

  Further, since the direction of the laser light 42 that travels through each transmission window 38 is different from the circumferential direction of the axial direction 101, the laser light 42 does not concentrate in a specific circumferential direction of the axial direction 101. . Thereby, the heating to the inner surface of the renal artery 40 can be suppressed.

  Further, in each transmission window 38, the transmission ranges D 1, D 2, D 3, and D 4 partially overlap in the axial direction 101, so that an unirradiated portion of the laser light 42 is hardly generated in the axial direction 101 of the renal artery 40.

  In the embodiment and the modification described above, the diffusion member 33 and the tubular member 34 are integrally provided at the tip of the optical fiber 29. However, only the tubular member 34 is configured to be rotatable and slidable, and the tubular member An operation unit for operating 34 may be extended to the hub 23. For example, the tubular member 34 and the in-side tube 27 may be connected, and the tubular member 34 may be configured to interlock with the rotation and slide of the in-side tube 27.

  In the above-described embodiment and modification, the optical fiber 29 is inserted through the in-side tube 27. However, the insertion path of the optical fiber 29 is not limited as long as the distal end side reaches the balloon 21. . Therefore, for example, it may be inserted into the internal space of the shaft 22 or may be inserted into the balloon 21 from the outside of the shaft 22.

  Further, in the above-described embodiment and modification, the tubular member 34 is rotated and slid, but the tubular member 34 may be configured to be rotatable or slidable only. For example, if the tubular member 34 having the spiral-shaped transmission window 37 is provided to the same extent as the length in the axial direction 101 of the balloon 21, when the tubular member 34 is rotated, the renal artery 40 is within the range of the balloon 21. It is possible to uniformly irradiate the nerve 41 with the laser beam 42.

  In the above-described embodiments and modifications, the transmission windows 37 and 38 are configured by the resin layer 35. However, the transmission windows may be configured as holes that penetrate the resin layer 35 and the reflection layer 36. .

11 Ablation device 21 Balloon 22 Shaft (second lumen)
27 Inner tube (first lumen)
29 Optical fiber (light guide material)
33 Diffusion member 34 Tubular member 36 Reflective layers 37 and 38 Transmission window

Claims (7)

A shaft,
Provided on the tip side of the shaft, and an elastically inflatable balloon;
A first lumen formed along the shaft for injecting fluid into the balloon;
A second lumen formed along the shaft for allowing fluid to flow out of the balloon;
A light guide provided along the shaft for guiding laser light into the balloon;
A diffusing member that reflects or diffuses laser light emitted from the light guide material in the balloon in a direction intersecting the first direction in which the light guide material is extended;
A reflection layer provided in the balloon, surrounding the diffusion member, having a reflection layer for reflecting or blocking the laser beam reflected or diffused by the diffusion member on the inner surface thereof; And a tubular member having a transmission window that allows the light to pass outside .
The tubular member is movable in a direction in which at least one of a position in the circumferential direction having the first direction of the transmission window as an axis or a position in the first direction is displaced,
The ablation device in which the diffusion member and the tubular member are provided integrally with the light guide material .   The ablation device according to claim 1, wherein the tubular member has a length in the first direction shorter than a length in the first direction of the balloon, and a distal end and a proximal end thereof are sealed.   The length of the tubular member along the first direction is longer than the length of the diffusion member along the first direction,
  The ablation device according to claim 1, wherein a space along the first direction is provided between a distal end of the tubular member and the diffusion member.   The ablation device according to claim 1, wherein the transmission window has a spiral shape extending in the first direction.   The ablation device according to claim 1, wherein a plurality of the transmission windows are provided at different positions with respect to the first direction.   The ablation device according to claim 5, wherein the plurality of transmission windows are arranged at positions different from each other with respect to a circumferential direction having the first direction as an axis. The ablation device according to claim 6, wherein the plurality of transmission windows partially overlap each other in the first direction.

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