JPH02167178A - 圧縮形ステント及びその付与装置 - Google Patents

圧縮形ステント及びその付与装置

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Publication number
JPH02167178A
JPH02167178A JP1062324A JP6232489A JPH02167178A JP H02167178 A JPH02167178 A JP H02167178A JP 1062324 A JP1062324 A JP 1062324A JP 6232489 A JP6232489 A JP 6232489A JP H02167178 A JPH02167178 A JP H02167178A
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JP
Japan
Prior art keywords
stent
catheter
wire
wires
inner catheter
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
JP1062324A
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English (en)
Other versions
JP2814261B2 (ja
Inventor
Creg W Dance
クレッグ ダヴリュ.ダンス
Rodney W Wolff
ロドニー ダヴリュ.ウルフ
Brice M D Letac
ブライス レタ エム.デイー.
Alain M D Cribier
アラン クリビエ エム.デイー.
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Medtronic Inc
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Medtronic Inc
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Publication of JPH02167178A publication Critical patent/JPH02167178A/ja
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Publication of JP2814261B2 publication Critical patent/JP2814261B2/ja
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/9522Means for mounting a stent or stent-graft onto or into a placement instrument
    • A61F2/9525Means for mounting a stent or stent-graft onto or into a placement instrument using a funnel
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3933Liquid markers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/9522Means for mounting a stent or stent-graft onto or into a placement instrument
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/962Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
    • A61F2/966Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30003Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/3006Properties of materials and coating materials
    • A61F2002/3008Properties of materials and coating materials radio-opaque, e.g. radio-opaque markers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30451Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements soldered or brazed or welded
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0058Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements soldered or brazed or welded
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0096Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
    • A61F2250/0098Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers radio-opaque, e.g. radio-opaque markers

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Media Introduction/Drainage Providing Device (AREA)

Abstract

(57)【要約】本公報は電子出願前の出願データであるた
め要約のデータは記録されません。

Description

【発明の詳細な説明】 く産業上の利用分野〉 本発明は、血管内ステラ1・に係り、経皮的、透視式脈
管形成術(PCTAl法あるいは経皮的脈管形成術(P
TA)法いずれかにJ:るバルーン式脈管形成術の後に
動物あるいは人類の末梢血管あるいは冠状動脈内に適用
して血管の通過性を維持しておく血管内ステ.ノ1・に
係る。
本ステノj一は1本1本のワイヤを一緒に溶接し、外側
カテーテル内に入れろようにその筒型の直径を小さくす
るようその軸方向に沿一,て圧縮しこの圧縮状態を保ち
得ろステラ1−であって、又バ4 −シ式脈管形成後に
内側カテーテル及び案内ワイヤを用いてステントを脈管
形成領域に永久的に挿入配置、そして固定して急性の脈
管再閉塞及び爾後の再狭窄を防I1ニするものである。
本ステノl・の構造はその寸法及びその装置の材質は動
脈の内部に所与のラレアル方向の力を与えて血管を閉塞
しようとする力に抗してその形状を保持するように選ば
れろ。この閉塞力は血管内膜切開片、その垂れ下がり、
けいれんによる急性再閉塞ばかりでなく血小板による再
狭窄に基因する力も含まれろ。こわらはステ./)・自
体の上に新hに成長する血管内膜により防止乃至は発症
を遅らせ得ろ。ステラ1・の長さは種々変えられたり1
 4r所に1本以上のステラ1−を用いて血管の曲がり
に対処しtコりその他持殊な血管の性質に対処する事が
出来ろ。内側及び外側カテーテルの端末にある放射線不
透過性マーカ物質により外部からの監視により所望のと
ころにステラ1〜を置くことの出渠るようにしt二り、
或いはステラ1・自体を放射線不透過に作ることも出来
ろ。
・く従来の技術〉 米国特許第4,553,545号明細河及び図1石には
ワイヤコイルをその長さ方向の回りに回転し、巻回数を
減らして直径を太くするような血管内に挿入した後拡張
できろ装置が示されている。
米国特許第4,503,569号明細書及び図面にはぜ
旋巻きコイルが115゜F乃至125’ Fの範囲に転
移温度をイイする形状記憶ニチ、ノル(N I T I
NOL)a金で作られたものが示されている。血管内に
置いた後このコイルが加熱されてもとの人きさ及び形状
を取戻すように加熱される。これら従来例に示された解
決策では装置に熱か機織力かを加え、ステントをその場
で拡張する結果人体を傷つけることになる。
米国特許第4,580,568号明細書及び図面に示す
ものにおいてはステントが細かいジグザグ模様にした0
、 45mm (0,018インチ)のステルススチー
ル・ワイヤより作られている。このステントを血管系内
にステントを配置するのに用いろンース内にこのステン
トを取付けるため圧縮してその寸法を減少する。ステン
トをその通路内に置いて保持するためこのンース内を通
ず平らな端末をもったカテーテルが用いられるがこのシ
ースが引き抜かれている同にステントを原型まで拡張し
通路を拡張できろようにする。仕様書によればこのステ
ントが原型に復するtコめのエネルギー分のみが曲げら
れたス子ント内に貯えられていたことになる。
この装置及びその付与装置は多数の制約及び問題点に悩
まされていた。
一連のワイヤをジグザグ模様に折り曲げるようステッド
を格好付けるにはステントの両端でワイヤを極端に曲げ
て格好を付けなければならない。
このワイヤはワイヤ径の数倍の割合でのみ曲げ得る。正
確な倍数は材料の性質によって変わる。
この公知例の特許では、0.04572センチメートル
(0,018インチ)径のワイヤを用いており、その曲
げ程度は、02センチメ−1、ル以下である。
この曲げ率はおよそ1から437となる。ワイヤが曲げ
られてジグザグ模様となるので隣の脚との間にある程度
の角度があり、これが脚間の最小スペースを限定するこ
とになる。ステントが短い時はステンj・を圧縮するに
大きい力を必要とする。と言うのはエネルギーが曲がり
のみに貯えられるからである。ステントがその直径に比
し比較的短い時にはワイヤを曲げてステッドを圧縮する
に要するに力は大きい。これまた、曲がり部分のみがエ
ネルギーの貯わえられろ場所t!からてある。ステン!
・がその直径に比し比較的長く作られた時には血管を開
いて保持しておくに必要な力は減る。
クレームには完全拡張で長さ5.5cmX径4 cm及
び長さ3.0cm X径2.5cmのステン!・を特に
取り上げている。この比較的大きい長さ及び直径は力が
管器官に広く兼用できることになるが非常に大きい末梢
動脈・静脈のみにしか適用できないことは明らかである
。もう1つの作用はステンI・が圧縮し得る絶対的の最
小寸法にある。前述したように端末における隣接ワイヤ
間の角度関係はその隣接ワイヤ間の最低間隔を限界し、
これ(よステントの最小寸法を冠状動脈及びこれと同等
な寸法の血管には兼用できない寸法に限定してしまう。
更に加えて、ワイヤの直径と材料組成はその長さにわた
り連続であるから、これらのパラメータは変わらずジグ
ザグの曲がり部と直線部との間に異なった特性を与λる
。材料の曲がり部分のみが貯又られるエネルギーに関与
するので、曲がり部対直線部との特性はすべての要求、
特に生体適応性材料使用の必要性が加わった時(よ当然
に兼用できることtζはならない。更に1本のワイヤで
ジグザグ模様を縁密に完成させるにはスリーブを2っの
末端におき、ワイヤを一緒に接続するがこれはこの点に
おいて異質性を生ずる。
く課題を解決するための手段〉 本発明においては従来のこれらの本来的の制約を回避す
るのに全〈従来と異なる解決手段を採り、個々の部分を
一緒に溶接し、材料の曲げ部の必要性を完全に排除した
この手段は上述に列挙した制限・制約すべてを解決する
本発明によるステッドは他の解決手段としてワイヤの本
数を少なくして用いない限り必要とする脈管寸法までは
縮径出来ないような特に小直径の冠状動脈でも用い得る
もし本数の少ないワイヤが用いられたとすると、血管壁
にかかる力も血し′壁を覆う力も甚だしく限定されろこ
とになる。
このステンj・の付与装置は人体の外部から狭窄領域に
対するステン1−の位置決め手段はもたない。
案内ワイヤも用いられず、ステンl−がカテーテルの近
位端から挿入されて用いられる。
〈発明の概要〉 本発明は病変した冠状動脈あるいはその他太い脈管の紅
皮的透視弐MFc管形成術(PCTA)あるいは経皮的
脈管形成術(PTA)がどちらかであるバルーン式脈管
形成術に関連して用い、−術後の脈管の急性の再閉塞と
か再狭窄を防止する予防ステントを特徴とする。
本ステン1−は手術の延長として、バルーン式形成手術
後直ちに施す。本ステントは末端が開放しているチュー
ブ形状であ快これはワイヤの組がその端末で最終的に軸
に対し斜め方向になろLうに一緒に溶接され、次いでこ
れが筒状に成型され端末ワイヤが一緒に溶接される。こ
の構成を採ることにより、ワイヤは一端から反対端へと
斜めに接続される。このワイヤは曲げて密にまとめ得る
ようなスプリング材であって小直径チューブに変形でき
、直球セグメントにエネノ1ギーを貯えるが圧縮力が除
去されろとワイヤが斜めのワイヤから自己拡張して元の
筒状体直径への力を発する。この回復力は動脈を拡張し
た位置に保持しておきlっ動脈を閉止しようとする他の
すべての力に抵抗するに適当である。この選ばれたステ
ント構造は動脈を支持する乙の構造体の若干割合部分が
新面管内膜層の組織成長を与え、プラーク (平滑班)
あるいはその他のta維成長を防止し又再狭窄を遅らせ
tl:りもする。本ステントはステッドを取り囲み圧縮
する外側カテーテルを用いて経皮的に挿入され、その圧
縮されたステン!−と同等の直径を有し同等の寸法を有
する内側カテーテルを用いて該ステシトを外す。内側カ
テーテルを通る案内ワイヤが患部へステントを置く助け
をし、一方、外側カテーテル上のイプンヨナルな案内カ
テーテルが動脈内への内・外カテーテルの挿入の助けを
する。
この案内ワイヤは従来のバルーン式形成術に用いt二案
内ワイヤと同じものでよい。
ステッド自体の位置はフレオロスコープあるいは同様の
装置を用いてカテーテル端上のjli射、線不透過性マ
ーカを監視し決定しステン1−を適正な場所に置くこと
ができるようにする。ステッド自体はプラチナあるいは
プラチナイリジウムのような放射線不透過性材ネ4上り
作ることもでき、同しフレオロスコープ技術を用いてス
テッドを狭窄部位に容易に配置できろようにする。本ス
テントは開通状態を確保しこの部位における急性の再閉
塞及び再狭窄を防止する。
〈実施例〉 第1図は、本装置を構成する個々のワイヤ10がまだ曲
げられず成形もさtEない状態を示す。第2図において
は溶接部12がワイヤ10の末端を1本おきに接続して
いる状態を示す。ここに使われたワイヤは生体適応金属
のいずれかである。この生体適応金属は316LSSの
ような3(10シリーズステンレススチー゛ル、7°ラ
ヂナ及びプラチナイリジウムo金、M P 35 Nの
ようなコバルI−−−クロミウム合金及び非合金チタン
等を含む。溶接部は冠状動脈に適用するためには代表的
な長さ1ない1ノ2ミリメー1−ルの範囲にある。例え
ばNd/YAG+、−ザがJ/、15ワツlの出力で用
いられこの溶接を達成するが、抵抗溶接のような溶接工
程を用いる事もできろ。
第3図においてはワイヤlOの曲がり部14は各溶接部
12において“V′°形態をとる。これら12本のワイ
ヤ10は第3図に示すように一緒に溶接され、第4図に
おいては、筒状ステント1(10の形態に成形されるが
この筒体形状はワイヤ端末を一緒に溶接することで達成
されろ。曲がり部14はワイヤ10が第3図に示すよう
に一緒に溶接された後に成形されてもあるいは溶接前に
成形されてもよいが、何れの場合でもワイヤは曲がり部
により離間され筒状体全表面積の若干バー・セント、例
えば10〜25%程度だけが金属より成る。この金属部
面積が小さいことについての利点は後で説明する。
ステンI・1(10を形成するこの方法はワイヤ端末が
単に溶接されろのみであるから所要とする特性をもった
所望するワイヤを利用できる。例えば変型としてワイヤ
10を所望とする角度に曲げて、この曲げられたワイヤ
を筒状に成形保持させ、里純なジグ及び固定具を用いて
全構成体を溶接で閉じ合わせてもよい。
この手法で変更できろものはワイヤ寸法、利用金属、ワ
イヤ長さ、溶接長、曲げ角度及び筒体直径である。冠状
動脈に対しては直径約1/l0XI(0,(104イン
チ)程度のワイヤで長さ4〜15m1ステント直径で2
〜5ffiI+のものが用い得ろ。このような冠状動脈
ステントに用いられるワイヤの本数はステントの直径に
より8〜16本にわたり変更できる。乙のように冠状動
脈に適用するに必要な特に小寸法のものなど、ど/しな
所要とする冠状動脈の要求にも応えられるように容易に
製造調製できる。
これら範囲のワイヤ寸法及びステル)・寸法は上述した
ように筒状体全表面積に対する金属外部表面積を代表的
に10〜25%となし得る。
より太い末梢動脈については直径0.15n+m(0,
(106インチ)ないし0.4mm (0,016イン
チ)、長さ10ないし25m11のワイヤであって、ス
テント径が5〜15關のものが利用できる。ここに用い
られたワイヤの本数はステル)・の直径により8〜16
本と変更される。
第4図にはステント1(10の側面図を示す。この図は
個々のワイヤで形成した筒状体を示す。第5図はワイヤ
が一緒に溶接された端末におけるワイヤ10の1対間の
間隔が均一であることを示し、第6図はステントの半分
長のところの個々のワイヤ間が均一の間隔であることを
示す。
第4.5.6図においては、ステント1(10はワイヤ
10が最大限度に離れてエネルギーを貯えず、完全な不
拘束状態にある。第7図においては、ステッド1(10
は外側カテーテル16内に包囲圧縮され、ステルl−1
(10の長手軸方向に案内ワイヤ18が通されている。
このステント1(10の大きさはこれが圧縮された時に
ワイヤ18をステントに容易に通すことのできる寸法で
ある。内側カテーテル20の大きさは外側カテーテル1
6内に嵌合する大きさであるが内側カテーテルが外側カ
テーテル内を容易に滑ることのできる材質のものである
。内・外側カテーテル20.1Bの両方の端末には放射
線不透過性マーカ22があり、これは装置本体外部のX
線励起及びフレオロスコープ監視装置の利用により、こ
れらカテーテルの位置を測定可能とする。特別な案内カ
テーテル21が外部カテーテル16を包囲する。
これら以上の部材すべてが動脈28内に挿入されるがこ
れについては後述する。動脈28は狭窄部位30を有し
、これが動脈を一循する。第8図においてステルl−1
(10が外側カテーテル16から外され、これが狭窄部
位30を支える。狭窄部位30でのステル1−iooの
取り外しを達成する装置及び手順については後述する。
第9図においては、内・外カテーテル20.16、案内
ワイヤ18及び案内カテーテル21が示されている。標
準Y−コネクタ止血弁24.26は夫々のバルブ調節キ
ャップ25.27と一緒になって出血を制御する。止血
弁24は中央孔を有しこれは内側カテーテル20が滑り
挿通出来るような寸法である。止血弁26も中央孔を有
しこれは外側カテーテル16が滑り挿通出来るような寸
法である。
ハブ23は中央孔を有しこの寸法は案内ワイヤ18が滑
り挿通出来る大きさである。この構成はキャップ25.
27が締まっている位置からゆるめられ図示していない
0リングを夫々自由ぼこして隣接部品が滑り得るように
した時に内・外カテーテル20゜16が互いに滑り動け
るようにする。調節ができた後はキャップ25,27が
再び締められ、隣接部品に対し、0リングを締め付けそ
の相対的動きを止め、血液の流出を封止する。案内カテ
ーテル21は外側カテーテル16を取り囲み、近位端へ
ブ26人により止血バルブ26に固定される。
r!JJ脈28に対してバルーン式形成手術を施すには
第7図に示すようにしてなされ、狭窄部位30にわtコ
リ血管内腔を伸張、変形あるいは拡張する。案内ワイヤ
18及び案内カテーテル21はバルーン式形成術に用い
たものと同じものであり、外側カテーテル16を案内す
るためその場に残される。バルーン式形成施術の後、内
・外カテーテル20,16及びステルl−1(10は、
第7.9図に示すようjζ組み立てられ、動脈28内に
置かれるが、外側カテーテルの末端にステントが予め装
着されており、このステントを圧接して内側カテーテル
があり、そして外側カテーテルは第9図に示すように案
内カテーテル21内に包囲されている。このようなステ
ント1(10を装填する方法は後述する。これらの部品
は全部予め消毒され、バルーン式形成施術に用いられた
と同じ経路を通り同じやり方で血管内に挿入されていく
が、患部をX線照射して患部付近を7レイロスコープで
観察L7放射線不透過のマーカ22の位置を監視する。
ステツl−1(10が放射線不透過性材料の1って作ら
t’t t:、場合(rはこれも又位置監視される。
案内ワイヤ18は内側カテーテル20の内部に挿通され
、内・外カテーテルはステ、、、1・1(10の患部へ
、の挿入及び位置決めの間、第9図について前述したよ
うにバルブキャップ25.27を締めろことにより、近
位端(ζおいて共に係止せられろ。内側カテーテル20
は第7図に示すようにステツI・1(10の近位端を押
圧するので、これはステツl−1(10の狭窄部位30
内への挿入位置決定中、固定されt二カテーテル1日及
び20に関してステントが同0相対位置に保持されるこ
とを保証するものである。内・外力子−テ3.2Q、1
6の端末からステツ+1(10へ至る距離は分かってい
るので、ステ′:/1−の遠位端の位置は決定できろ。
前述17たようにステッド1(10自体が放射綿不a過
性にさハA(ば、−ルオロスニ」−ブーCその位置は賽
易に決定できろ。案内ワイヤ18はカテーテル16及び
20より6可撓性大きく、カテーテルを動脈内に持って
いくのに用いられる。案内カテーテル法ルが予め動脈に
ぴったりと隣接し′Cおかれ、残りの組を体の寮内カデ
ー°−:y−ルを通っτ滑り込まさね、この手順が完了
する。小者の体に接しておかれろフレ4t1スコープが
ステント1(10が第7図に示すように狭窄部位に置か
第1た時を指示する。次にバルブキャップ25がゆるめ
られ、ハシ23及びバルブ24により位置保持されてい
る内6!IJカテーテル20が近位方向に動かさ第1ス
ー?ントが第8図に示すように外されるまで外側カテー
テル16を内側カテー”チルより引き抜く。外側カテー
テル16が引き抜かれるこの経過において、内側カテー
テル20はステツl−1(10をその場所に保持−する
。7.チット1(10が外側力t−チルI6から外され
た時このステツ1−は図示しであるように自分で拡張し
、狭窄部位30の領域に対しこれを支え且つ固定する。
ステント+(10が外された後は全組立体が引き扱かれ
ステントのみが血管中に残る。
この簡単な手続はバルーン式形成術のような一最のカテ
ーテル法のみを必要としてステツl−1(10を狭窄部
位に配置することができろ。
ステッド1(10の設置はバルーン式形成術のa ?+
tl的手順であ、って同じカテーテル法中としてなさオ
’t 。
このカテーテル法に要する時間が若干長くなるに過ぎな
い。乙の手順の結果によるこの若干の時間延長は人体が
十分耐え得るものである。ステント1(10が拡張され
るとこtlは全方向外方に向いたラジアル力を発揮する
ようにして狭窄部位の血管内壁を支える。
この力は2つの重要な作用をなす。1つの作用はけいれ
ん等による血管内方への力に抗して血管を開いr二状態
に保持し、前もってなさ第1だバルーン式形成術によっ
て生じた血管内股″フラップあるいは切片を本質的に添
着し血管の通りをよくする。
この力は前述したパラメータの選択により調節できろ。
乙の力の第2の作用は血管28の内壁内にワイヤを強固
に固定することである。この第2作用はステント1(1
0の・ノイ1゛10の1−に組織の発芽あるいは新しい
内膜の早期再生を助け、再狭窄が滅多に生1ニないよう
にする。前述したように金7嘱表面積のυ1合が小さい
ことはこの早期再生ができるようにし、かっ血栓による
急性の閉塞の防止にも役立つ。
前述したように、ワイヤ10によって生ずるスフ。
リノゲカは所与の手順に」、て調節できる。このスゴリ
ノグカは動脈28を完全に開いて保持−孝ろに十分な力
でなげi]ばならないし、また血管収縮力、けいれん及
び狭窄部位30に生してくろ5またなプ′ノークの逐次
発生に対抗できなければならない。また、と言ってこの
力は血管壁の損錫を避けろため上記要求以」−〕の力で
あってはならない。
ステッド+(10の直径は、外側力士−テル1G内に嵌
着させるために圧縮される時はその寸法が2−6分の1
まで縮径されろ。この寸法調節の範囲及びスプリング定
数の変化範囲は拡張力の調節を所望とする大きさに変え
られろようにする。
11M述したLうに、ステツl−1(10の代表的寸法
は外側カテーテル16内に嵌め込むために圧縮した時の
最小外径寸法2〜4uua、太い動脈血管内で外した時
の5〜151III11から、外側カテーテル16内に
嵌めこむために圧縮した時の1〜1磯闘、冠状動脈内に
外した時の2〜5omの範囲である。
ステッド1(10の長さは場合によって甚だ差があり、
狭窄部位の長さに適合できる程度のものであるが、狭窄
部分の長さより常に長くなければならない。プラークあ
るいは病変部位の前後の血管の曲がりくねりとか曲がり
角がある場合、ステント1(10の適用に融通性をもた
せるため、ステントの長さを狭窄部の長さより短くし曲
がった血管部分あるいは外側カテーテル16において1
つ以上のステノ1−をたてに並べ、カテー′チルの曲が
りがステJ1・の端末同志の間の点で得られるようにす
ることができろ。
ステッド1(10を外側カテーテル16に装着するに総
体的に筒状をした特殊な道具32が用いられる。
この道具32の断面を第10図に示すがこれは筒状体の
一端から内方へ延びるフレア付開口34及び外側端から
の円形ボア36とを有し、これら2つの部分の間のフラ
ット部38を有する。外側カテーテル16が道具32の
中にボア36の底まで挿入され、そして内側カテーテル
20がボア36に入る一寸手前にもってこられると共に
一方案内ワイヤ18はこのボア及びフレア付き開口両方
共貫通して本道具を完全に貫通する。外側カテーテル1
6、内側カテーテル及び案内ワイヤ18は前述した方法
でバルブキャップ25.27を用いてこの関係で固定せ
られる。
次に、ステン1−tooはフレア付開口を通して押し込
まれるがこの間口34はステントがフラット38を越え
てボア36に至るのを案内し、ボア36ではステント1
(10がスプリング力で開く。これを第11図に示しこ
れでステント装填作業が完了する。道具32は次にカテ
ーテル16の周りから取り除かれる。
〈発明の効果〉 ステントは組立容易であり、ワイヤは溶接により接合さ
れるのであるからワイヤ寸法及び材質は所望とするラジ
アル力及び対象血管寸法のみに基づき選ぶことができる
。溶接はワイヤ接点におけるワイヤ間間隔が0であるか
らどんなワイヤでも溶接できる。冠状動脈に必要とする
特に細いステントでもこの技術を用いれば容易に作るこ
とができろ。
内・外カテーテルの端末にあるマーカとじての放射線不
透過材料の利用は、ステント自体に放射線不透過材料を
用いたのと同様に7しオロスコープを用いろだけでステ
ントを正確に位置づけろことができる。ステッドを外側
カテーテル内部に積極的に係止するため円形断面を有す
る内側カテーテルの利用はステントが容易に外れ易くす
ることになる。と言うのは、圧縮されたステントの拡張
しようとする力が外側カテーテルの内壁を押しつけ支え
るようにしているからである。この装置はどんな要求に
も容易に応え得ろパラメータをもった簡単な構造である
Y−コネクタ止血バルブ24及び26の利用はステンl
−1(10の位置における動脈の形状寸法を測定するこ
とが必要な時に放射線不透過の薬用1を含ませた液体を
注入もできろようにする。必要ならばステンl−1(1
0を設置した後に案内ワイヤを除去してこのスペースを
液体注入に利用できる。
本発明は図示された実施例について説明されたが、この
説明は発明を限定する意味で説明しようとするものでは
ない。図示された実施例の種々変型並びに本発明の他の
実施例は本明細書を参考にすれば当業者にとって明白で
あろう。従って請求範囲は以上のような変型あるいは他
の実施例をすへてその範囲に含まれるものとして記載さ
れている。
【図面の簡単な説明】
第1図はアタッチメントに整列された個々のワイヤの前
面図、第2図は個々のワイヤが一緒に溶接された場合の
前面図、第3図は溶接されたワイヤの曲がり部が筒状に
成形されない前の前面図、第4図はステントの側面図、
第5図は第4図55綿で切った略図、第6図は第4図6
−6線で切った略図、第7図はステントが動脈内に置か
れる前の状態を示し、内側カテーテル、外側カテーテル
、案内ワイヤ及び装着さfまたステントと共に動脈の縦
方向断面を示した図、第8図はステントを外側カテーテ
ルを引き抜くことによりステントを外し動脈中に置いた
後の状態を示す図、第9図はY−コネクタ止血バルブ及
び案内カテーテルと一緒に組込んだ内・外カテーテル及
び案内ワイヤを示す図、第10図はステン1−を外側カ
テーテルの適正位置に装填する道具の断面図、第11図
は外側カテーテル内にステントが装填された状態の第1
0図の断面を示す図である。 ステントワイヤ。 曲げ部。 案内ワイヤ。 案内カテーテル。 狭窄部。 ステン1− 溶接部 外側カチーチル。 内側力・【−チルP II+脈。 ステント装着道A。 FIG、8

Claims (10)

    【特許請求の範囲】
  1. (1)ワイヤで形成された全体的に筒状型式の血管ステ
    ントにおいて、 (a)本質的に真直な中央セグメントを各々が有する多
    数本の等寸・等形のワイヤであって、端末セグメントが
    上記中央セグメントに対し斜めに曲げられ、上記ワイヤ
    各々の端末セグメントは本質的に他の端末セグメントに
    対し平行とし、 (b)上記曲げた端末セグメントを平行に方向づけした
    各ワイヤの互いに隣接するワイヤ同志が重なり相接する
    ようにして上記ワイヤが筒状を形成するように方向づけ
    及び等間隔とし、 その結果、各隣接対ワイヤの上記中央セグメント同志の
    なす角が鋭角となり、総ての端末セグメントにおいてワ
    イヤ同志が固着されており、 (c)上記ワイヤはスプリング金属で生体適応性物質で
    形成され、上記ワイヤは上記ワイヤセグメント内にエネ
    ルギーを貯えるように曲げて上記ステントの直径が細く
    出来るようにし、且つこのステントを経皮的に生体内に
    設置し得るべく圧縮した時にこのステントを受け入れる
    大きさの外側カテーテル内に挿入出来るようにした ことを特徴とする圧縮可能の血管ステント。
  2. (2)上記外側カテーテル内に滑り嵌合出来るような寸
    法の内側カテーテルを更に具備し、上記内側カテーテル
    が上記外側カテーテル内に嵌合され、上記ステントが圧
    縮されて該外側カテーテル内に嵌着された時に上記内側
    カテーテルの壁が上記ステントの端末に当たるような寸
    法にされていることを特徴とする前記請求項1記載のス
    テントの付与装置。
  3. (3)上記内側カテーテル、外側カテーテルの端末であ
    って上記ステント付近に放射線不透過のマーカを貼付し
    たことを特徴とする前記請求項2記載の付与装置。
  4. (4)上記内側カテーテルと上記ステントとを同軸に貫
    通して案内ワイヤを通し、該内側カテーテルとステント
    との寸法は該案内ワイヤが中心を滑り通り得る寸法にし
    、循環系に上記カテーテルを挿通する助けとすることを
    特徴とする前記請求項2記載の付与装置。
  5. (5)上記外側カテーテルを滑り挿通せしめる寸法の案
    内カテーテルに該外側カテーテルを同軸的に挿通し、上
    記内・外カテーテルの循環系への案内手段となすことを
    特徴とする前記請求項4記載の付与装置。
  6. (6)上記内側カテーテルが第1Y−コネクタ止血バル
    ブにより上記外側カテーテルに対し係止・封止され、上
    記案内ワイヤが近位端において外部に露出されており上
    記内側カテーテルに対し上記案内ワイヤを抜き差し調節
    出来るようにしたことを特徴とする前記請求項4記載の
    付与装置。
  7. (7)上記内側カテーテルが第1Y−コネクタ止血バル
    ブにより上記外側カテーテルに対し係止・封止可能であ
    り、上記外側カテーテルが第2Y−コネクタ止血バルブ
    により上記管内カテーテルに対し係止・封止可能であり
    、上記案内ワイヤが近位端において露出され、上記内側
    カテーテルに対する上記案内ワイヤの抜き差し調節が出
    来るようにしたことを特徴とする前記請求項4記載の付
    与装置。
  8. (8)上記ワイヤが溶接により共に固定されていること
    を特徴とする前記請求項1記載のステント組立体。
  9. (9)総体的に筒状の道具であって、第1端からの軸方
    向のボア及び同軸セグメントに連接した第2端からの軸
    方向のフレア付開口とを有し、該道具は上記外側カテー
    テル内に上記ステントを装填する手段を設ける寸法にし
    たことを特徴とするステント付与道具。
  10. (10)上記ワイヤが放射線不透過材料で作られること
    を特徴とする前記第1項記載のステント。
JP1062324A 1988-06-17 1989-03-16 圧縮形ステント及びその付与装置 Expired - Fee Related JP2814261B2 (ja)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US208,252 1988-06-17
US07/208,252 US4830003A (en) 1988-06-17 1988-06-17 Compressive stent and delivery system

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JPH02167178A true JPH02167178A (ja) 1990-06-27
JP2814261B2 JP2814261B2 (ja) 1998-10-22

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DE68900599D1 (de) 1992-02-06
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US4830003A (en) 1989-05-16
EP0346564B1 (en) 1991-12-27
CA1306161C (en) 1992-08-11

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