JP7133057B2 - 血管から閉塞性血餅を除去するための血餅回収デバイス - Google Patents
血管から閉塞性血餅を除去するための血餅回収デバイス Download PDFInfo
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Description
一事例では、デバイスが少なくとも2つの波パターンを有する。これらの波パターンが互いに重ね合わされ得る。一事例では、第1のパターンが1つの波長および1つの振幅を有し、第2のパターンが、第1のパターンの波長および振幅より大きい1つの波長および1つの振幅を有する。
一実施形態では、拘束構成で、血餅係合区間が実質的に平坦である。
拡張構成で、血餅係合区間が曲線状であってよい。
一実施形態では、拘束構成および拡張構成で、血餅係合区間が実質的に曲線状である。
一事例では、拡張構成で、血餅係合区間が螺旋形態または渦巻き形態である。
一実施形態では、血餅係合要素が概略反対方向を向く2つの表面を有し、一方または両方の表面が拡張配備構成で血餅に係合可能である。
一事例では、デバイスが、近位側区間と、遠位側区間と、近位側区間と遠位側区間との間にある血餅係合区間とを備え、ここでは、近位側区間が血餅係合区間を基準として摺動可能に移動可能である。近位側区間が、カラーなどの摺動可能要素と、カラーから延在する近位側ストラットとを備えることができ、血餅係合区間が近位側シャフトを備え、カラーが近位側シャフトを基準として摺動可能に移動可能である。近位側区間のストラットのうちの少なくともいくつかのストラットが、近位側シャフトを基準としてカラーが近位方向に移動するときに血餅係合区間と近位側ストラットとの間で血餅を少なくとも部分的に捕捉するために遠位方向に延在してよい。
一実施形態では、血餅係合区間が、ストラットおよびクラウンによって画定される複数のセルを備え、ストラットおよび/またはクラウンの少なくとも一部が波状の形態に位置合わせされ、それにより血餅の埋め込みが改善される。
一実施形態では、拡張構成で、デバイスの血餅係合区間の少なくとも一部分が長手方向軸を中心とした概略渦巻きまたは螺旋構成である。血餅係合区間が遠位側管状区間をさらに備えることができる。血餅分断部分(clot fragment portion)が管状区間の遠位端のところに設けられ得る。
本発明は血管から閉塞性血餅を除去するための方法をさらに提供し、この方法が、
長手方向に延在する起伏状形態を有する血餅係合区間を有する血餅回収デバイスを提供するステップであって、このデバイスが拘束送達構成および拡張配備構成を有する、ステップと、
閉塞性血餅の方に向かうように且つ閉塞性血餅を横切るようにマイクロカテーテルを前進させるステップと、
マイクロカテーテルの中にデバイスを装填してデバイスをマイクロカテーテルの遠位側部分まで前進させるステップと、
血餅を埋め込ませるためにデバイスを配備するステップと、
デバイスの少なくとも一部分および捕捉された血餅を回収カテーテルの中に回収する
ステップと、
を含む。
いくつかの事例では、この方法が、血餅と血餅を囲む血管壁の一部分との間にデバイスの一部分を配備することを含む。
この方法が、デバイスおよび血餅を近位側に引っ張る前に血餅内にさらに埋め込ませるために、配備後にデバイスを近位側に引っ張るのを遅延させることを含むことができる。
いくつかの事例では、この方法が血餅の中にデバイスを埋め込むためにデバイスを捻じることを含む。
一事例では、拡張構成で、血餅係合区間が曲線状である。
別の事例では、拡張構成で、血餅係合区間が実質的に平坦である。
一事例では、拡張構成で、血餅係合区間が螺旋形態または渦巻き形態である。
別の事例では、拡張構成で、血餅係合区間が概略s形である。
一事例では、デバイスが、デバイスが拡張配備構成にあるときに血液の流れのための流れチャンネルを画定する部分を備える。
一事例では、デバイスが、重ね合わされ得る少なくとも2つの波パターンを有する。第1のパターンが1つの波長および1つの振幅を有し、第2のパターンが、第1のパターンの波長および振幅より大きい1つの波長および1つの振幅を有する。
一事例では、血餅係合要素が1つまたは複数の血餅握持特徴部分を備える。
一事例では、デバイスが、Nitinolなどの形状記憶材料の平坦シートから形成される。
本発明の血餅回収デバイスを提供することと、
マイクロカテーテルの中にデバイスを装填することであって、ここでは、デバイスが拘束送達構成である、ことと、
マイクロカテーテルを閉塞性血餅まで前進させることと、
血餅を捕捉するためにデバイスを配備することと、
捕捉された血餅と共にデバイスを回収カテーテルの中に回収することと
を含む。
かまたはチューブからレーザ切断され得てその後で平坦になるように加工されてもよい。
続され、それによりデバイスを導入および回収することが容易になる。平坦区間154が、血餅に係合されて血餅の中に埋め込まれるストラット158とセル159とのパターンで構成される。平坦なデバイスを使用することにより、血餅の長手方向に沿って径方向の力を作用させる管状デバイスとは異なり血餅がデバイスによって大きく圧縮されないことから、脈管から血餅を握持および除去することの性能を向上させることができる。
guide catheter)、標準的なガイドカテーテルまたはシースに戻るように後退させられる。別法として、中間カテーテルまたは遠位側アクセスカテーテルが遠位側の吸引を適用するのに使用され得、デバイスがカテーテルの中に完全にまたは部分的に再装填され得る。再装填中、「S」プロフィールの一方側の中に突出する血餅がS形の腕部によって挟まれて握持され得、それにより血餅に対してのデバイスの握持が改善される。血餅を挟むことは、マイクロカテーテルの中にデバイスを部分的に再装填することによっても達成され得る。
血餅をより突出させるような特殊な形状を有することができるか、またはそのために曲線状であってよい。
デバイス700が、近位側細長部材(図示せず)に接続され得る近位側ストラット706および707を備える。これらの近位側ストラットが遠位側においてストラットの要素のネットワークに接続され、このネットワークが、側方レール701および702と、フローティングセル705と、接続アーム703とを備える。
パターンが頂点761を備え、これらの頂点761が、前記頂点に隣接する示される領域760などの個別の領域において血餅を局部的に圧縮するが、血餅の集まりの大部分に対する全体の圧縮を最小にする。したがって、血餅の全体の特性は配備時のデバイスの作用によってもあまり変化しないが、個別の領域760がデバイスによって圧縮されて握持される。このように圧縮することにより、血餅が局部的にいくらか脱水され、それによりその摩擦係数が増大し、さらにそれによりその握持およびデバイスとの係合が強化される。しかし、血餅の大部分がデバイスによって圧縮されない状態を維持することから、血餅と脈管との摩擦係合が大きくは強化されない。
として近位側に移動する。次いで、血管系からの除去のために、デバイスおよび血餅が近位側カテーテルまで後退させられ得る。
シャフト931を含むデバイスの側面図を示す。図27bがデバイスの平面図を示し、対して、図27dが同じデバイスの等角図を示す。図27cが図27aで詳説されるA-Aの断面図を示す。デバイスが平坦シートから形成され得、平坦な断面を維持しながら一連の波形状としてヒートセットされ得る。別の実施形態では、デバイスが曲線状の断面もしくは特殊な形状の断面を有することができるか、または、切断されたチューブを平坦化することによっても形成され得るか、または、脈管の軸に沿って見る場合に長円もしくは楕円の断面形状チューブを使用しても形成され得る。示されるすべての実施形態と同様に、このデバイスは、例えば図23aおよび23bで示されるような、断片保護特徴部分を組み込むことができる。
る。デバイスの外側縁部971が曲線状であってよく、それにより脈管の接触圧力が最小となる。
がガイドカテーテルまたはシースへの回収中に血餅を良好に後退させるのを実現する。示されるすべての実施形態と同様に、デバイスは挿入ツールの中に再び装填される前にすすぎ洗いされて緩やかに掃除され得る。デバイスは、必要である場合に、閉塞性血餅の追加のセグメントの中に再配備されるようにマイクロカテーテルの中に再導入され得る。
Claims (4)
- 血管(756)から閉塞性血餅(757)を除去するための血餅回収デバイス(700,750)であって、
拘束送達構成を有し、小径の血管において拡張配備構成を有し、前記小径の血管から前記小径の血管の近位側の大径の血管に後退させられたときに追加自由拡張構成を有する血餅係合要素を備え、
前記血餅係合要素が、第1側方レール(701)と、第2側方レール(702)と、前記第1側方レール(701)と前記第2側方レール(702)との間を延在する血餅係合区間とを有し、
(i)前記拡張配備構成では、縁部が長手方向に延在する起伏状であり、前記第1側方レール(701)および前記第2側方レール(702)が横方向に離間され、前記血餅係合区間が前記第1側方レール(701)および前記第2側方レール(702)の間を延在し、前記血餅係合区間の少なくとも一部分が、血餅と係合及び血餅を握持するように構成され且つ長手方向に延在する第1の起伏状の波パターンを有し、
(ii)前記追加自由拡張構成では、前記縁部が長手方向に延在する起伏状であり、前記第1側方レール(701)および前記第2側方レール(702)が横方向に離間され、前記血餅係合区間が前記第1側方レール(701)および前記第2側方レール(702)の間を延在し、前記血餅係合区間の少なくとも一部分が、血餅と係合及び血餅を握持するように構成され、前記デバイスが拡大した脈管(758)の直径を通って後退されるときに、血餅と血管壁との間の付着状態を維持し、前記拡張配備構成の前記デバイスの有効直径を超えて、前記デバイスの有効直径を増加させるために、前記血餅係合区間、前記第1側方レール(701)および前記第2側方レール(702)は、互いに重ね合わされる少なくとも2つの波パターンを有し、前記少なくとも2つの波パターンは、1つの波長および1つの振幅を有する前記第1の起伏状の波パターンと、前記第1の起伏状の波パターンの波長および振幅より大きい1つの波長および1つの振幅とを有する第2の波パターンを有する、
血餅回収デバイス。 - 前記血餅係合要素が1つまたは複数の血餅握持特徴部分(705)を備える、請求項1に記載の血餅回収デバイス(700,750)。
- 前記血餅係合要素が概略反対方向を向く2つの表面を有し、一方または両方の表面が前記拡張配備構成で血餅に係合可能である、請求項1または2に記載の血餅回収デバイス(700,750)。
- 遠位側血餅断片保護区間(751)を備える、請求項1から3までのいずれか一項に記載の血餅回収デバイス(700,750)。
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