JP6461891B2 - 高周波エネルギを用いた閉塞血管再疎通術 - Google Patents
高周波エネルギを用いた閉塞血管再疎通術 Download PDFInfo
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- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
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Description
〔1〕第一長手方向部材を閉塞の近位端へ順行性方式で進める工程と、
第二長手方向部材を前記閉塞の遠位端へ逆行性方式で進める工程と、
前記第一および第二長手方向部材との間にエネルギを適用する工程と、
前記閉塞を再疎通する工程と、
を備えている閉塞血管再疎通方法。
〔2〕前記エネルギは、高周波エネルギである実施形態1に記載の閉塞血管再疎通方法。
〔3〕前記エネルギは、レーザエネルギである実施形態1に記載の閉塞血管再疎通方法。
〔4〕前記エネルギは、マイクロ波エネルギである実施形態1に記載の閉塞血管再疎通方法。
〔5〕前記エネルギは、超音波エネルギである実施形態1に記載の閉塞血管再疎通方法。
〔6〕さらに、血流が最大となるときに前記適用を起こすタイミングをはかる工程を備えており、それによって血流の冷却効果を最大にするとともに前記血管への熱の暴露を最小にする実施形態1に記載の閉塞血管再疎通方法。
〔7〕さらに、心電図(EKG)信号を用いて前記適用のタイミングをはかる工程を備えている実施形態1に記載の閉塞血管再疎通方法。
〔8〕前記タイミングをはかる工程は、前記心電図(EKG)信号のR波を検出する工程を備えている実施形態7に記載の閉塞血管再疎通方法。
〔9〕さらに、破片を捕獲および回収する工程を備えている実施形態1に記載の閉塞血管再疎通方法。
〔10〕高周波発生器を備えており、
近位端および遠位端を有する順行性長手方向部材を備えており、前記順行性長手方向部材の遠位端が第一導電性電極を備え且つ前記順行性長手方向部材の近位端が前記高周波発生器と結合されるように構成されており、かつ、
近位端および遠位端を有する逆行性長手方向部材を備えており、前記逆行性長手方向部材の遠位端が第二の導電性電極を備え且つ前記逆行性長手方向部材の近位端が前記高周波発生器と結合されるように構成されている再疎通システム。
〔11〕前記長手方向部材は、ガイドワイヤまたはカテーテルまたはマイクロカテーテルまたは拡張カテーテルである実施形態10に記載の再疎通システム。
〔12〕前記長手方向部材は、内側ガイドワイヤ内腔を備えている実施形態10に記載の再疎通システム。
〔13〕前記長手方向部材は、十分なねじれ剛性および長手方向柔軟性を有して、閉塞を通して進むと共に、前記電極を前記血管壁から離隔および互いに対向するように配置する実施形態10に記載の再疎通システム。
〔14〕前記電極は、前記長手方向部材の片側に取り付けられている実施形態10に記載の再疎通システム。
〔15〕前記電極は、アレイ状に配列されている実施形態10に記載の再疎通システム。
〔16〕前記長手方向部材は、放射線不透過性マーカを備えている実施形態10に記載の再疎通システム。
〔17〕少なくとも一つの前記長手方向部材は、破片を捕獲および回収する塞栓保護機構を備えている実施形態10に記載の再疎通システム。
〔18〕前記塞栓保護機構は、フィルタである実施形態17に記載の再疎通システム。
〔19〕前記塞栓保護機構は、バルーンを備えている実施形態17に記載の再疎通システム。
〔20〕前記塞栓保護機構は、前記長手方向部材の一方を通して吸引ができる管腔を備えている実施形態17に記載の再疎通システム。
〔21〕前記長手方向部材は、カテーテルまたはガイドシース内に配置されるように構成されている実施形態10に記載の再疎通システム。
〔22〕さらに、高周波エネルギを制御および発生する回路を備えている実施形態10に記載の再疎通システム。
〔23〕さらに、EKGに接続して、エネルギ放出のタイミングをはかるように構成された接続ポートを備えている実施形態10に記載の再疎通システム。
〔24〕遠位端、近位端、及びガイドワイヤ管腔を構成しているガイドワイヤシャフトを有している長手方向部材を備えており、前記長手方向部材をねじることにより、狭い内径の血管を通して進めることができるように、前記長手方向部材が少なくともその長さ部分に沿って構成されており、
前記長手方向部材の遠位端に電極を備え、
エネルギを前記電極から外部エネルギ源に伝える一つ以上の導線を備え、かつ
絶縁シースを備えている焼灼カテーテル。
〔25〕前記長手方向部材は、らせん状の外部を有するように構成されている実施形態24に記載の焼灼カテーテル。
〔26〕前記長手方向部材は、ライナに巻かれた複数のワイヤを備えている実施形態24に記載の焼灼カテーテル。
〔27〕前記複数のワイヤは、少なくとも二つの異なる直径を有している実施形態26に記載の焼灼カテーテル。
〔28〕前記複数のワイヤは、電極または導線であるように構成されている実施形態26に記載の焼灼カテーテル。
20 ピグテール
30 コネクタ
100a、100b、400、500、550 ガイドワイヤ(長手方向部材)
105a、105b 導電性電極
Claims (14)
- 閉塞血管を再疎通させるために超音波発生器とともに用いるための再疎通システムであって、
前記閉塞血管内の閉塞まで順行方向に前進させられるように構成された第一の長手方向部材であって、前記第一の長手方向部材が近位端および遠位端を有し、前記第一の長手方向部材の遠位端が第一の超音波トランスデューサーを備える、第一の長手方向部材と、
前記閉塞血管内の閉塞まで逆行方向に前進させられるように構成された第二の長手方向部材であって、前記第二の長手方向部材が近位端および遠位端を有し、前記第二の長手方向部材の遠位端が第二の超音波トランスデューサーを備える、第二の長手方向部材と、
を備え、前記第一の長手方向部材および前記第二の長手方向部材は、前記第一の超音波トランスデューサーと前記第二の超音波トランスデューサーとの間の前記閉塞に超音波エネルギを加えるように構成された、再疎通システム。 - 前記長手方向部材が、ガイドワイヤまたはカテーテルまたはマイクロカテーテルまたは拡張カテーテルである請求項1記載の再疎通システム。
- 前記長手方向部材が、内側ガイドワイヤルーメンを有する請求項1に記載の再疎通システム。
- 閉塞を通して進めるのに及びトランスデューサーを血管壁から離してかつ互いに向けて配置するのに十分なねじり剛性および長手方向フレキシビリティを前記長手方向部材が有する請求項1に記載の再疎通システム。
- 前記トランスデューサーが、前記長手方向部材の遠位端の一部のみに取り付けられた請求項1に記載の再疎通システム。
- 前記トランスデューサーが、アレイ状に配置された請求項1に記載の再疎通システム。
- 前記長手方向部材が、X線不透過性マーカーを有する請求項1に記載の再疎通システム。
- 前記長手方向部材のうちの少なくとも1つが、デブリを捕獲および回収する塞栓保護機構を備える請求項1に記載の再疎通システム。
- 前記塞栓保護機構が、フィルタである請求項8に記載の再疎通システム。
- 前記塞栓保護機構が、バルーンである請求項8に記載の再疎通システム。
- 前記塞栓保護機構がルーメンを有し、前記ルーメンが前記長手方向部材の一方を通して吸引を可能にする請求項8に記載の再疎通システム。
- 前記長手方向部材が、カテーテルまたはガイドシース内に配置されるように構成された請求項1に記載の再疎通システム。
- 超音波エネルギを制御および発生する回路をさらに備える請求項1に記載の再疎通システム。
- 前記超音波エネルギの伝送タイミングを計るために、前記再疎通システムは、心電図装置に接続された請求項1に記載の再疎通システム。
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