JP6557944B2 - Tip deflection movable catheter - Google Patents

Description

  The present invention relates to a tip deflection movable catheter that can freely deflect a tip portion.

  For catheters (including electrode catheters, ablation catheters, and catheter sheaths) that are inserted through blood vessels, body cavities, or body lumens to target tissues such as various organs (for example, the heart). In order to facilitate access to the tissue, etc., the direction of the distal end (tip) of the catheter to be inserted into the body is set to the operation portion provided at the proximal end (base end) of the catheter arranged outside the body. A distal deflection movable catheter that can be deflected by operation is known (see Patent Document 1 and Patent Document 2).

  The portion to be deflected of the distal end portion of the catheter tube is set to have a stepwise lower hardness, for example, as it goes to the distal end. The distal ends of the pair of wires are connected to each other at 180 ° opposite positions, and at the proximal ends of the pair of wires, one wire (first wire) is pulled, and the other wire (second wire) is connected. By slackening, the direction of the tube tip can be controlled.

  In the operation portion provided at the proximal end of such a catheter tube, when the proximal ends of the first wire and the second wire are connected to the rotary knob and the rotary knob is rotated in the first direction. The first wire is pulled and the second wire is slackened. When the second wire is rotated in the second direction opposite to the first direction, the second wire is pulled and the first wire is slackened. Can be controlled.

  However, in the prior art, the wire connected to the rotary knob hits the wall surface of the fixed portion and the proximal end portion of the catheter tube constituting the operation portion, and between the wire and the wall surface of the fixed portion and the proximal end portion of the catheter tube. Thus, there is a problem in that friction occurs, the operability is poor, and the wire is damaged. Moreover, it is desired that the distal end of the catheter can be deflected at a large deflection angle with a light operating force at the operating portion.

JP 2005-230471 A Special table 2009-537244 gazette

  The present invention has been made in view of such a situation, and an object of the present invention is to provide a tip deflection movable catheter that has good operability, can deflect the distal end of the catheter greatly, and causes little damage to the wire. Is to provide.

In order to achieve the above object, a tip deflection movable catheter according to the present invention includes:
A catheter tube;
A ring member provided at the distal end of the catheter tube;
A first wire and a second wire having respective distal ends connected to the ring member;
A tip deflection movable catheter having an operation portion provided at a proximal end of the catheter tube,
The operation unit is
A securing portion secured to the proximal end of the catheter tube;
A first rotating piece that is provided so as to be rotatable with respect to the fixed portion, and a proximal end of the first wire is attached to an outer peripheral portion of a first rotating radius;
Synchronously with the first rotating piece on the opposite side of the first rotating piece, the second wire is provided so that the proximal end of the second wire can rotate freely. A second rotating piece attached to the
The first wire and the first wire are rotatably provided at predetermined arrangement intervals with respect to the fixed portion in the operation portion, and are drawn substantially parallel from the proximal end of the catheter tube along the axial direction of the catheter tube. And a pair of guide pulleys for guiding the proximal ends of the two wires to the outer peripheral portion of the first rotating piece and the outer peripheral portion of the second rotating piece, respectively.

  In the tip deflection movable catheter according to the present invention, the pair of guide pulleys rotate by themselves, whereby the first wire and the first wire that are drawn substantially in parallel along the axial direction of the catheter tube from the proximal end of the catheter tube. The proximal ends of the two wires are led to the outer peripheral part of the first rotating piece and the outer peripheral part of the second rotating piece, respectively. Therefore, the operation | movement which pulls out a wire from a catheter, and the operation | movement to push in can be performed smoothly, without rubbing a wire and a guide pulley.

  Further, by increasing the first turning radius and the second turning radius, the wire can be moved greatly in the longitudinal direction by the turning movement of the first turning piece and the second turning piece. The distal end can be greatly deflected. That is, according to the present invention, it is possible to realize a tip deflection movable catheter that has good operability, can largely deflect the distal end of the catheter, and causes little damage to the wire.

  Preferably, the pair of guide pulleys are rotated by movement along the longitudinal direction of the first wire and the second wire according to the rotational movement of the first rotational piece and the second rotational piece. It is attached to the fixed part. By comprising in this way, it becomes possible to reduce the friction between a wire and a pulley, and operativity improves.

  Preferably, the arrangement interval of the pair of guide pulleys is such that the proximal ends of the first wire and the second wire are drawn from the proximal end of the catheter tube substantially in parallel along the axial direction of the catheter tube. Is slightly larger than the outer diameter of the catheter tube. With this configuration, the proximal ends of the first wire and the second wire can be easily drawn from the proximal end of the catheter tube substantially in parallel along the axial direction of the catheter tube. The frictional force between the two can be reduced and the operability is improved.

  Preferably, the first turning radius and the second turning radius are substantially equal, and the first turning piece and the second turning piece are movable in the same turning direction at the same turning angle. ing. With this configuration, the distal end of the catheter tube can be deflected in the same manner in the first direction and the second direction opposite to each other. The first turning radius and the second turning radius are made different so that the distal end of the catheter tube can be deflected at different deflection angles in the first direction and the second direction opposite to each other. Also good.

  In the present invention, the distal end is an end portion on the opposite side to the operation side and can also be referred to as the distal end side, and is used in a concept including the vicinity of the distal end. Further, the proximal end is an end opposite to the distal end, and is an end close to the operation side, and can be rephrased as a proximal end, and is used in a concept including the vicinity of the proximal end. The distal and proximal ends are relative concepts and include not only the ends in the strict sense, but also near the ends.

FIG. 1 is a plan view showing an external configuration of a tip deflection movable catheter according to an embodiment of the present invention. 2 is a cross-sectional view taken along line II-II shown in FIG. FIG. 3 is a sectional view taken along line III-III shown in FIG. 4 is a cross-sectional view taken along line IV-IV shown in FIG. FIG. 5 is a sectional view taken along line VV shown in FIG. 6A is a schematic cross-sectional view showing the internal structure of the operation portion of the distal deflection movable catheter shown in FIG. 6B is a schematic cross-sectional view showing the internal structure of the operation portion of the distal deflection movable catheter shown in FIG. 1, and shows a state where the operation portion is operated in the first direction. 6C is a schematic cross-sectional view showing the internal structure of the operation portion of the distal deflection movable catheter shown in FIG. 1, and shows a state where the operation portion is operated in the second direction. FIG. 7 is a schematic sectional view of the guide pulley shown in FIGS. 6A to 6C. FIG. 8 is an exploded perspective view of the operation unit of the distal deflection movable catheter shown in FIG.

Hereinafter, the present invention will be described based on embodiments shown in the drawings.
The catheter sheath (tip deflectable movable catheter) as the tip deflection movable catheter of this embodiment is, for example, a sheath for guiding an electrode catheter for detecting an electrocardiogram when performing arrhythmia treatment or an ablation catheter for ablating myocardium. And other uses. Other applications include a sheath for guiding a catheter (stent delivery catheter) for introducing a stent into the bile duct.

  As shown in FIG. 1, the catheter sheath 1 of the present embodiment includes a sheath body 2 as a catheter tube, and an operation portion 3 and a grip portion 4 provided at the proximal end of the sheath body 2.

  As shown in FIGS. 2 and 3, the sheath body 2 includes a hollow tube 20 having a main lumen 21. The hollow tube 20 of the present embodiment is configured by a multilayer tube having an inner tube 22 and an outer tube 24. A blade layer 26 made of a net-like reinforcing wire (for example, a metal wire such as stainless steel) is embedded in the outer tube 24 to impart kink resistance to the sheath body 2.

  Inside the blade layer 26 of the outer tube 24, wire lumen tubes 28, 29 in which wire lumens are formed along the axial direction are embedded at positions facing about 180 ° with respect to the central axis of the sheath body 2. Yes. A first wire 30 and a second wire 31 are inserted into the wire lumens of the tubes 28 and 29 so as to be movable in the axial direction.

  As shown in FIG. 2, the blade layer 26 is embedded in the outer tube 24 so as to have an elliptical cross section, and the first wire 30 and the first wire 30 are arranged in the major axis direction of the elliptical blade layer 26. Two wires 31 are arranged. In the minor axis direction of the elliptical blade layer 26, the blade layer 26 is embedded in the outer tube 24 near the inner tube 22, and in the major axis direction of the elliptical blade layer 26, the blade layer 26 is embedded. Is embedded in the outer tube 24 close to the outer periphery.

  The main lumen 21 formed along the axial direction on the inner peripheral surface of the inner tube 22 includes an electrode catheter, an ablation catheter, a stent delivery catheter, a catheter for other uses, a guide wire, and other medical devices. It can be inserted freely in the direction. The inner peripheral surface of the main lumen 21 preferably has good sliding characteristics, and the inner tube 22 is made of, for example, polytetrafluoroethylene (PTFE), tetrafluoroethylene / perfluoroalkyl vinyl ether copolymer (PFA), tetrafluoroethylene · It is made of a fluororesin such as hexafluoropropylene copolymer (FEP), tetrafluoroethylene / ethylene copolymer (ETFE), and polyvinylidene fluoride (PVDF).

  The outer tube 24 is preferably formed of a resin. For example, a polyamide-based elastomer such as a polyether block amide copolymer, polyamide, polyimide, polyamideimide, polyethylene terephthalate, polyethylene, polypropylene, polyurethane, ethylene / vinyl acetate copolymer It is composed of coalesced or polyvinyl chloride. The wire lumen tubes 28 and 29 are preferably formed of a resin having good sliding characteristics. For example, polytetrafluoroethylene (PTFE), tetrafluoroethylene / perfluoroalkyl vinyl ether copolymer (PFA), tetrafluoro It is made of a fluororesin such as ethylene / hexafluoropropylene copolymer (FEP), tetrafluoroethylene / ethylene copolymer (ETFE), or polyvinylidene fluoride (PVDF). The first wire 30 and the second wire 31 are made of a metal such as stainless steel, and may be a stranded wire or a single wire.

  As shown in FIG. 1, the distal end of the sheath body 2 is a deflecting portion 2a that can be arbitrarily deflected in directions opposite to each other by 180 °, as indicated by arrows α and β. The deflection directions α and β of the deflection unit 2a correspond to the mounting positions of the wire lumen tubes 28 and 29 facing each other at 180 °. In the deflection part 2a, it is preferable that the hardness is set lower (softer) than the remaining part, and further, in the deflection part, the hardness is set to be gradually or stepwise reduced toward the tip. May be.

  As shown in FIG. 4, a ring 35 with a wire having an annular pull ring (ring member) 32 is embedded in the distal end of the sheath body 2 (near the tip of the deflecting portion 2 a). The distal ends 30 a and 31 a of the first wire 30 and the second wire 31 are connected and fixed at positions 180 ° opposite to the central axis of the sheath body 2 on the inner peripheral surface of the pull ring 32.

  The method for connecting and fixing the distal ends 30a, 31a of the first wire 30 and the second wire 31 to the inner peripheral surface of the pull ring 32 is not particularly limited, and brazing using a brazing material such as silver brazing, laser Examples include welding, ultrasonic welding, arc welding, and soldering.

  In order to embed the wire ring 35 at the distal end of the sheath body 2, the distal end of the outer tube 24 has a stepped tip inserted into the through-hole of the pull ring 32, as shown in FIGS. The part 24a is formed by means such as cutting. The outer peripheral surface of the stepped tip portion 24 a is cut into a cylindrical outer peripheral surface shape in accordance with the inner peripheral surface shape of the through hole of the pull ring 32. Therefore, as shown in FIGS. 3 and 5, the blade layer 26 may remain inside the ring 32 in the minor axis direction of the blade layer 26 having an elliptical cross section.

  Further, as shown in FIGS. 3 and 4, in the major axis direction of the blade layer 26 having an elliptical cross section, a part of the blade layer 26 is also removed, and part of the wire lumen tubes 28 and 29 are also removed. Removed, the wire lumen is open inside the ring 32. At the position where the wire lumen is opened inside the ring 32, the distal ends of the wires 30 and 31 are connected and fixed to the inner peripheral surface of the ring 32.

  4 and 5, at the distal end of the deflecting portion 2a, the outer periphery of the ring 32, the outer periphery of the stepped tip 24a, the outer periphery of the inner tube 22, and the distal end of the inner tube 22 are distal. It is covered and integrated by the end coating resin 34. The distal end coating resin 34 may partially enter the distal end lumen of the wire lumen tubes 28, 29, but does not prevent the wires 30, 31 from moving in the axial direction in the wire lumen. It has become.

  The distal end coating resin 34 is formed by, for example, a dipping method. For example, a polyamide-based elastomer such as a polyether block amide copolymer, polyamide, polyethylene, polypropylene, polyurethane, an ethylene / vinyl acetate copolymer, polyvinyl chloride, or the like. It is made of resin.

  The ring 32 is made of, for example, a metal such as stainless steel, and a contrast ring may be attached to the distal end thereof. The contrast ring is made of a metal that can be easily detected by X-rays, for example, gold, platinum, iridium, tungsten, or the like. In addition, you may comprise the whole ring 32 with a contrast ring.

  The wire-attached ring 35 is formed by inserting the wires 30 and 31 into the lumens of the wire lumen tubes 28 and 29 before the distal end coating resin 34 shown in FIGS. The stepped tip 24a shown in FIG. 5 is passed through the through hole. Thereafter, a distal end coating resin 34 is formed, and at the distal end of the deflecting portion 2a, the outer periphery of the ring 32, the outer periphery of the stepped tip 24a, the outer periphery of the inner tube 22, and the distal end of the inner tube 22 Are covered and integrated by the distal end coating resin 34.

  Proximal ends of the first wire 30 and the second wire 31 are connected to an operation unit 3 provided at the proximal end of the sheath body 2 shown in FIG. The operation unit 3 is provided on the tip (distal end) side of the grip unit 4.

  The operation part 3 has the fixing | fixed part 50 fixed to the proximal end of the sheath main body 2, as shown to FIG. 6A-FIG. 6C. The fixing portion 50 includes a disc-shaped fixing portion main body 51, a grip connecting portion 52 that is inserted and connected to the distal end 4a of the grip portion 4, and a sheath retracting portion 54 that is positioned on the opposite side of the grip connecting portion 52 by 180 °. And have. The fixing portion main body 51, the grip connecting portion 52, and the sheath retracting portion 52 that constitute the fixing portion 50 are integrally formed of plastic or the like.

  A cover 56 is attached to the outer periphery of the sheath retracting portion 54 of the fixed portion 50. The proximal end 2 b of the sheath body 2 passes through the inside of the cover 56, passes through the inside of the sheath retracting portion 54, the center portion of the fixing portion main body 51, and the inside of the grip connecting portion 52, and reaches the inside of the grip portion 4. Yes.

  On the outer peripheral portion of the sheath body 2 located inside the cover 56, a lead-out portion 2c for taking out the first wire 30 and the second wire 31 is formed. The lead-out portion 2c is a hole formed in the outer peripheral portion of the sheath body 2 and communicates with the inside of the wire lumen tubes 28 and 29 shown in FIG. 30 b and 31 b are taken out of the sheath body 2.

  The proximal ends 30b and 31b of the wires 30 and 31 drawn out from the lead-out part 2c are guided to the inside of the operation part 3 through the inside of the cover 56 and the inside of the sheath drawing-in part 54. A rotation cover 45 is attached to the fixed portion 50 so as to be rotatable (pivotally rotated) around the center of the disk-shaped fixed portion main body 51. A rotary knob 58 is fixed to the rotary cover 45, and the rotary cover 45 can be rotated with respect to the fixed portion 50 by operating the rotary knob 58.

  6A to 6C, only the rotary cover 45 disposed on the lower side of the fixing unit 50 is illustrated, but actually, as shown in FIG. A rotating cover 45a is disposed. Similarly to the rotary cover 45, the rotary knob 58 a is fixed to the upper rotary cover 45 a, and the rotary knob 58 a is connected to the rotary knob 58 so that the upper rotary cover 45 a, the rotary cover 45, and the The 1 rotation piece 40 and the 2nd rotation piece 41 are united, and can rotate with respect to the fixing | fixed part 50. FIG.

  A first rotation piece 40 and a second rotation piece 41 are attached to the rotation cover 45 with screws or the like along the circumferential direction of the disk-shaped fixing portion main body 51. And the second rotation piece 41 are configured to rotate simultaneously in the same direction. The first rotating piece 40 and the second rotating piece 41 are provided at predetermined intervals along the circumferential direction of the disk-shaped fixing portion main body 51, and are opposed to each other inside the operation portion 3 with the sheath main body 2 interposed therebetween. It is designed to be located on the side.

  The proximal end 30b of the first wire 30 is wound around the arcuate outer peripheral portion 40a having the first radius R1 from the rotation center of the first rotation piece 40, and is fixed to the rotation piece 40 with a screw 42 or the like. The rotation piece 40 is rotated around the rotation center, whereby the proximal end 30b of the wire 30 is drawn out or returned from the drawing portion 2c. Similarly, the proximal end 31b of the second wire 31 is wound around the arcuate outer peripheral portion 41a having the second radius R2 from the rotation center of the second rotation piece 41, and the rotation piece 41 is provided by a screw 43 or the like. The proximal end 31b of the wire 31 is pulled out or returned from the lead-out portion 2c by rotating the rotating piece 41 around the rotation center.

  A pair of guide pulleys 60 are attached to the sheath retracting portion 54 of the fixed portion 50 so as to be rotatable around the axis of each pulley 60 at a predetermined arrangement interval D2 with the sheath body 2 interposed therebetween. As shown in FIG. 7, each guide pulley 60 may have a locking groove 62 that locks the proximal ends 30 b and 31 b of the wires 30 and 31. Each guide pulley 60 may be integrally formed with a rotating shaft 64, and the rotating shaft 64 is inserted into a bearing hole 50 a formed in the bottom wall of the sheath retracting portion 54 of the fixed portion 50. Thus, each pulley 60 may be configured to rotate.

  The arrangement interval D2 between the pair of pulleys 60 is preferably slightly larger than the outer diameter D1 of the sheath body 2, and the proximal ends 30b and 31b of the wires 30 and 31 drawn from the drawing portion 2 are in the axial direction of the sheath body 2. Are directed to the pulley 60 substantially in parallel. The pulley 60 guides the proximal ends 30b and 31b of the respective wires 30 and 31 drawn from the drawing portion 2c to the outer peripheral portion 40a of the first rotating piece 40 and the outer peripheral portion 41a of the second rotating piece 41, respectively. It is like that.

  As shown in FIGS. 6B and 6C, the pair of guide pulleys 60 includes the longitudinal lengths of the first wire 30 and the second wire 31 according to the rotational movement of the first rotational piece 40 and the second rotational piece 41. It is attached to the fixed part 50 so as to rotate by movement along the direction. In addition, as for the relationship between arrangement | positioning space | interval D2 and the outer diameter D1 of the sheath main body 2, D2 / D1 becomes like this. Preferably it is 1.05-1.60. If D2 / D1 is too large, it tends to be difficult to pull out the wires 30, 31 from the lead-out portion 2c in a substantially parallel manner along the axial direction. If it is too small, the wires 30, 31 and the outer peripheral surface of the sheath body 2 The friction tends to increase. By pulling out the proximal ends 30b and 31b of the first wire 30 and the second wire 31 from the proximal end 2b of the sheath body 2 in a substantially parallel manner along the axial direction of the sheath body 2, the sheath body 2 and the wires 30, The frictional force with 31 can be reduced and the operability is improved.

  In the present embodiment, the first radius R1 and the second radius R2 are preferably substantially equal. In addition, the relationship between the outer diameter D1 of the sheath body 2 and the first radius R1 or the second radius R2 is preferably R1 / D1 or R2 / D1 of 8.0 to 12.0, and increases R1 and R2. As a result, the longitudinal movement amount of the wires 30 and 31 per rotation angle of the rotary knob 58 can be increased. However, if R1 and R2 are too large, the outer diameter of the operation unit 3 becomes large, and the operation with one hand tends to be difficult. In this embodiment, as shown to FIG. 6B and FIG. 6C, the 1st rotation piece 40 and the 2nd rotation piece 41 are movable at the same rotation angle in the same rotation direction.

  The plastic constituting the fixing portion 50 is not particularly limited, and examples thereof include polycarbonate resin, acrylonitrile / butadiene / styrene copolymer resin, polyamide resin, and polyethylene resin. The rotating cover 45 and the cover 56 may be made of the same plastic as that of the fixed portion 50.

  In the present embodiment, as shown in FIG. 6B, the first wire 30 shown in FIGS. 2 to 5 is pulled in the direction of the operation unit 3 by operating the knob 58 in the first rotation direction (for example, counterclockwise). The second wire 31 is returned to the deflecting unit 2a, and the deflecting unit 2a is deflected as indicated by an arrow α. Further, as shown in FIG. 6C, by operating the knob 58 in a second rotation direction (for example, clockwise) opposite to the first rotation direction, the second wire 31 shown in FIGS. The first wire 30 is returned to the deflecting portion 2a side, and the leading deflecting portion 2a is deflected as indicated by an arrow β.

  In the present embodiment, the pair of guide pulleys 60 rotate by themselves, whereby the first wire 30 and the second wire that are drawn substantially in parallel along the axial direction of the sheath body 2 from the proximal end 2 b of the sheath body 2. The proximal ends 30b and 31b of the wire 31 are led to the outer peripheral portion 40a of the first rotating piece 40 and the outer peripheral portion 41a of the second rotating piece 41, respectively. Therefore, the operation | movement which pulls out the wire 30, 31 from the drawer | drawing-out part 2c of the sheath main body 2, and the operation to push in can be performed smoothly, without rubbing the wire 30, 31 and the guide pulley 60. That is, the friction between the wires 30 and 31 and the pulley 60 can be reduced, and the operability is improved.

  Further, in the present embodiment, by increasing the first turning radius R1 and the second turning radius R2, the wires 30, 31 are enlarged by the turning movement of the first turning piece 40 and the second turning piece 41. It is possible to move in the longitudinal direction and greatly deflect the distal end of the catheter. That is, in the present embodiment, the distal deflection movable catheter sheath 1 is realized that has good operability, can deflect the deflection portion 2a of the sheath body 2 greatly, and causes little damage to the wires 30 and 31. can do.

  The present invention is not limited to the above-described embodiment, and can be variously modified within the scope of the present invention.

  For example, in the above-described embodiment, the tip deflection movable catheter is used as a catheter sheath having the main lumen 21, but the present invention can also be applied to a catheter having no main lumen 21 and other catheters. In the above-described embodiment, the wire lumen is formed by the wire lumen tubes 28, 29. However, the present invention is not limited to this, and the wire lumen is formed on the outer tube 24 itself without providing the tubes 28, 29. Also good. Further, in the embodiment described above, the sheath body 2 is configured by a multilayer tube, but may be configured by a single layer tube.

  In the above-described embodiment, the first turning radius R1 and the second turning radius R2 are configured to be the same. However, the first turning radius R1 and the second turning radius R2 may be different. In that case, the deflecting portion 2a of the sheath body 2 can be deflected at different deflection angles in the first direction α and the second direction β on the opposite sides.

1 ... tip deflection movable catheter (catheter sheath)
DESCRIPTION OF SYMBOLS 2 ... Sheath main body 2a ... Deflection part 3 ... Operation part 4 ... Grip part 20 ... Hollow tube 21 ... Main lumen 22 ... Inner tube 24 ... Outer tube 26 ... Blade layer 28, 29 ... Wire lumen tube 30 ... First wire 31 ... 2nd wire 32 ... Pull ring 34 ... Distal end covering resin 35 ... Ring 40 with wire ... 1st rotating piece 40a ... Outer peripheral part 41 ... Second rotating piece 41a ... Outer peripheral part 45 ... Rotary cover 50 ... Fixed part 51 ... fixed part main body 52 ... grip connecting part 54 ... sheath drawing-in part 56 ... cover 58 ... knob 60 ... guide pulley

Claims (3)

A catheter tube;
A ring member provided at the distal end of the catheter tube;
A first wire and a second wire having respective distal ends connected to the ring member;
A tip deflection movable catheter having an operation portion provided at a proximal end of the catheter tube,
The operation unit is
A securing portion secured to the proximal end of the catheter tube;
A first rotating piece that is provided so as to be rotatable with respect to the fixed portion, and a proximal end of the first wire is attached to an outer peripheral portion of a first rotating radius;
Synchronously with the first rotating piece on the opposite side of the first rotating piece, the second wire is provided so that the proximal end of the second wire can rotate freely. A second rotating piece attached to the
The operation portion the catheter relationship D2 / D1 between the outer diameter D1 and the arrangement interval D2 of the tube is provided rotatably respectively in a predetermined arrangement interval D2 to be 1.05 to 1.60 with respect to the fixed part, the The proximal ends of the first wire and the second wire, which are drawn out substantially in parallel with the axial direction of the catheter tube from the hole formed in the outer peripheral portion of the catheter tube, are respectively the outer periphery of the first rotating piece. To the outer periphery of the first rotating piece and the second rotating piece, and is rotated by movement along the longitudinal direction of the first wire and the second wire according to the turning movement of the first rotating piece and the second rotating piece. A tip deflection movable catheter having a pair of guide pulleys.   The distal deflection movable catheter according to claim 1, wherein each guide pulley of the pair of guide pulleys is formed with a locking groove for locking a proximal end of the first wire or the second wire. The substantially equal to the first pivot radius to the second pivot radius, wherein the first rotation piece and the second rotation piece, claims and is movable in the same rotational direction at the same rotation angle Item 3. The distal deflection movable catheter according to Item 1 or 2 .

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