JP6785832B2 - 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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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
- A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- 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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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- 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
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/1815—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 microwaves
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—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
- 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
- A61B18/24—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 with a catheter
- A61B18/245—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 with a catheter for removing obstructions in blood vessels or calculi
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/1815—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 microwaves
- A61B2018/1861—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 microwaves with an instrument inserted into a body lumen or cavity, e.g. a catheter
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- Health & Medical Sciences (AREA)
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- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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- Heart & Thoracic Surgery (AREA)
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- Physics & Mathematics (AREA)
- Electromagnetism (AREA)
- Plasma & Fusion (AREA)
- Vascular Medicine (AREA)
- Cardiology (AREA)
- Surgical Instruments (AREA)
- Electrotherapy Devices (AREA)
- Ultra Sonic Daignosis Equipment (AREA)
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)
- 閉塞した血管を再疎通するためにマイクロ波発生器とともに使用するための再疎通システムであって、
閉塞した血管内の閉塞まで順行方向に進むように構成された第1の長手方向部材であって、前記第1の長手方向部材は、近位端および遠位端を有し、前記第1の長手方向部材の遠位端は第1のアンテナを備え、前記第1の長手方向部材の近位端は前記マイクロ波発生器と結合するように構成されている、第1の長手方向部材と、
前記閉塞した血管内の閉塞まで逆行方向に進むように構成された第2の長手方向部材であって、前記第2の長手方向部材は、近位端および遠位端を有し、前記第2の長手方向部材の遠位端は第2のアンテナを備え、前記第2の長手方向部材の近位端は前記マイクロ波発生器と結合するように構成されている、第2の長手方向部材と、
を備え、前記第1の長手方向部材および前記第2の長手方向部材は、前記第1のアンテナと前記第2のアンテナとの間に位置する前記閉塞にマイクロ波エネルギを加えるように構成されている再疎通システム。 - 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に記載の再疎通システム。
- 長手方向部材が、内部ガイドワイヤルーメンを備える請求項1に記載の再疎通システム。
- 長手方向部材が、閉塞部を通って進み、アンテナを血管壁から離れて互いに向かって位置合わせするのに十分なねじり剛性および長手方向の可撓性を有する請求項1に記載の再疎通システム。
- アンテナが、長手方向部材の片側に取り付けられている請求項1に記載の再疎通システム。
- アンテナが、アレイ状に構成されている請求項1に記載の再疎通システム。
- 長手方向部材が、放射線不透過性マーカを備える請求項1に記載の再疎通システム。
- 長手方向部材の少なくとも1つが、破片を捕獲および回収するための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。
- 前記塞栓保護機構は、フィルタである請求項8に記載の再疎通システム。
- 前記塞栓保護機構は、バルーンを備える請求項8に記載の再疎通システム。
- 前記塞栓保護機構は、前記長手方向部材のうちの1つを通して吸引を可能にするルーメンを備える請求項8に記載の再疎通システム。
- 長手方向部材が、カテーテル内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請求項1に記載の再疎通システム。
- マイクロ波エネルギを制御および生成するための回路をさらに備える請求項1に記載の再疎通システム。
- エネルギの伝送タイミングをはかるためにEKGに接続するように構成された接続ポートをさらに備える請求項1に記載の再疎通システム。
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US97547307P | 2007-09-26 | 2007-09-26 | |
US60/975,473 | 2007-09-26 |
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JP2016227657A Division JP6461891B2 (ja) | 2007-09-26 | 2016-11-24 | 高周波エネルギを用いた閉塞血管再疎通術 |
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JP2010527088A Active JP5618332B2 (ja) | 2007-09-26 | 2008-09-23 | 高周波エネルギを用いた閉塞血管再疎通術 |
JP2014124232A Active JP6050283B2 (ja) | 2007-09-26 | 2014-06-17 | 高周波エネルギを用いた閉塞血管再疎通術 |
JP2016227657A Active JP6461891B2 (ja) | 2007-09-26 | 2016-11-24 | 高周波エネルギを用いた閉塞血管再疎通術 |
JP2018240919A Active JP6785832B2 (ja) | 2007-09-26 | 2018-12-25 | 高周波エネルギを用いた閉塞血管再疎通術 |
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JP2010527088A Active JP5618332B2 (ja) | 2007-09-26 | 2008-09-23 | 高周波エネルギを用いた閉塞血管再疎通術 |
JP2014124232A Active JP6050283B2 (ja) | 2007-09-26 | 2014-06-17 | 高周波エネルギを用いた閉塞血管再疎通術 |
JP2016227657A Active JP6461891B2 (ja) | 2007-09-26 | 2016-11-24 | 高周波エネルギを用いた閉塞血管再疎通術 |
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US (1) | US8911435B2 (ja) |
EP (2) | EP3348221A1 (ja) |
JP (4) | JP5618332B2 (ja) |
KR (1) | KR101228879B1 (ja) |
AU (1) | AU2008304599B2 (ja) |
CA (2) | CA2700968C (ja) |
WO (1) | WO2009042614A1 (ja) |
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