JPH02191467A - 操縦―調節可能の先端を有するガイドワイヤ組立体 - Google Patents

操縦―調節可能の先端を有するガイドワイヤ組立体

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Publication number
JPH02191467A
JPH02191467A JP1238331A JP23833189A JPH02191467A JP H02191467 A JPH02191467 A JP H02191467A JP 1238331 A JP1238331 A JP 1238331A JP 23833189 A JP23833189 A JP 23833189A JP H02191467 A JPH02191467 A JP H02191467A
Authority
JP
Japan
Prior art keywords
guidewire
outer tubular
core
tubular member
guide wire
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.)
Pending
Application number
JP1238331A
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English (en)
Inventor
Gary H Miller
ゲイリー、エイチ、ミラー
Jeffrey L Kraus
ジエフリー、エル、クラウス
Linda T Guthrie
リンダ、ティー、ガスリー
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Abbott Cardiovascular Systems Inc
Original Assignee
Advanced Cardiovascular Systems Inc
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Filing date
Publication date
Application filed by Advanced Cardiovascular Systems Inc filed Critical Advanced Cardiovascular Systems Inc
Publication of JPH02191467A publication Critical patent/JPH02191467A/ja
Pending legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/09—Guide wires
    • A61M25/09016—Guide wires with mandrils
    • A61M25/09025—Guide wires with mandrils with sliding mandrils
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00778—Operations on blood vessels
    • A61B2017/00783—Valvuloplasty
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/09—Guide wires
    • A61M2025/09175—Guide wires having specific characteristics at the distal tip

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biophysics (AREA)
  • Pulmonology (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Media Introduction/Drainage Providing Device (AREA)
  • Prostheses (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】 ［産業上の利用分野コ 本開明は一般に弁形成術において拡張カテーテルと共に
使用されるガイドワイヤ組立体に関するものである。
［従来技術と問題点］ バルーン型拡張カテーテルは、冠状動脈および末梢動脈
中の狭窄８変部を治療するために広く使用されている０
代表的にはこれらのカテーテルは。
その遠位端に取り付けられた膨張性バルーンが拡張され
る狭窄部を横断するまで、ガイドワイヤ組立体に沿って
患者の血管内部を前進させられる。
つぎにバルーン要素を膨張させて開口または内股を拡張
させる。
また狭窄は心臓弁において、特に大動脈弁および僧帽弁
において生じるケースがある。従来特に重症の狭窄症に
ついては弁交換が好ましい治療法であったが、最近にな
って、弁形成術または文運切開として知られる手術にお
いて拡張バルーンカテーテルによって弁狭窄部が効果的
に治療されている。しかしこれらの手術において、膨張
性バルーンは通常の冠状動脈拡張と末ｍ動脈拡張に使用
されるものよりもはるかに大である。さらに、心臓弁を
効果的に拡張するためには、複数のバルーン要素が狭窄
弁の中にｌ！ｉａ！されて同時に膨張される事が多い。
大動脈弁または僧帽弁を通して比較的大ｉＩ！径のバル
ーンカテーテルを挿入するためには、まず比較的剛性の
ガイドワイヤを弁の中に通さなければならない、しかし
、比較的剛性のガイドワイヤが弁を通過した時、ガイド
ワイヤの遠位端が心臓の内側膜に係合して外傷を与えな
いように注意しなけ九ばならない。
これまで必要でしかも存在しなかったものは、大動脈弁
または僧帽弁を容易に通過する事のできるように比較的
剛性であるが、弁を通過させられた時に心臓の内側面に
外傷を与えないような可撓性形状を取る事のできる弁形
成術用ガイドワイヤ組立体である。
〔発明の概要コ 本発明は、患者の血管を通してカテーテルを案内するガ
イドワイヤにおいて、遠位端に丸いプラグを有する可撓
性外側管状部材と、前記外側管状部材の中に配置されそ
の内部に固着された成形可能の第１コア部材と、前記外
側管状部材の内部に配置され、この外側管状部材の実質
的に全長に沿って延在し、その内部を軸方向に可動の比
較的剛性の第２コア部材と、前記外側管状部材の内部に
おいて第１コア部材に対して第２コア部材を軸方向に移
動させるため第２コア部材の近位端に備えられた手段と
を含むガイドワイヤが提供される。
以下、本発明を図面に示す実施例について詳細に説明す
る。
［実施例コ 第１図は本発明による多バルーン式弁形成用拡張カテー
テル−ガイドワイヤ組立体１ｏに関するものである。第
１３に図示のように、組立体１０は六本の心臓１３の左
心房１１を通して、左心室１２の中に９置さ九る。この
組立体１０は、全体としてガイドワイヤ１４と、３個の
バルーン拡張カテーテル１５．１６、１７とを有し、こ
れらのカテーテルの遠位端のスリーブ１８，１９．２０
がガイドワイヤ１４上に摺動自在に取り付けられている
。カテーテル１５，１６．１７のバルーン要素２１．２
２．２３はそれぞれ大動脈弁２４を通過するように図示
されている。ガイドワイヤ１４とカテーテル１５．１８
．１７は経皮的に大腿動脈（図示されず）の中に導入さ
れ、この大腿動脈と大動脈弓２５とを通り、最後に大動
脈弁２４を通されて、そのノ＜バルーン要素２１　、２
２．２３が適当にこの弁２４の中に配置される。ガイド
ワイヤはまず大動脈弁２４の中を押し通され、つぎに各
拡張カテーテル１５．１８．１７カ（ガイドワイヤ１４
に沿って弁２４の中を前進させられる。）＜ルーン要素
２１，２２．２３は狭窄大動脈弁２４の中番こ入ると、
膨張されてこの弁２４を拡張させる。カテーテル構造の
詳細とその動作は、同時係属特願米国特ａ第１９９，９
４０号、　「案内カテーテルを備えた血管カテーテル組
立体」に記載され、これを引例として加える。
第２図は、本発明によるガイドワイヤ１４の細部を示す
０図示のように、ガイドワイヤ１４は全体として可撓性
外側管状部材３０と、この管状部材３０の内部に実質的
に全長に沿って延在し軸方向に移動するために近位端に
ハンドル３２を備えた比較的剛性の内側可動コア３１と
、外側管状部材３０の内部に固着された比較的可撓性の
内側コア部材３３とから成る。前記の可動コア３１と固
定コア３３はステンレス銅またはニチノールなどの適当
素材によって構成する事ができる。
第２図に図示の外側管状部材３０はガイドワイヤ１４の
遠位端のプラグ３５から近位ａ側に延在するコイルバネ
３４から成る。このコイルバネ３４の遠位端部分３６と
プラグ３５は、弁形成手術中の遠位端の蛍光観察を容易
に成し、しかも使用目的に適した機械的特性を有するよ
うに、好ましくはチタン、白金、およびその合金などの
放射線不透過性材料によって構成される。バネの遠位端
部分３６の近位端はバネの近位＠部分３７の遠位端の中
にねじ込まれ。
この近位端部分３７は好ましくはステンレス網から成り
、このねじ込み部分は溶接、ロウ付け、ハンダ付けなど
の適当手段によって相互に接合される。
コイル近位端部分３７はその全長に沿って、゛ガイドワ
イヤ１４の近位端まで延在する支持管３８によって支持
される。好ましくは、この支持管３８の全部または大部
分はポリイミドなどのプラスチック管とする。
固定コア３３はその遠位端によってプラグ３５に固着さ
れ、固定コア３３の近位端は溶接、ロウ付け、ハンダ付
けなどの適当手段によって、短いハイポチューブ部分４
０に固着され、このハイポチューブ部分は前記管状支持
管３８に対してＬｏｋｔｉｔ、ｅ　４０Ｓなどの適当接
着剤によって接着されている。
可動コア３１はその軸方向移動を容易に実施するために
その近位端に固着されたハンドル３２を有する。可動コ
ア３１の遠位端３９はガイドワイヤ１４の遠位端の中ま
で延在するが、プラグ３５または外側管状部材３０に対
して固着されていない、可動コアの遠位端３９は図示の
ように丸く形成さ九で、コイル部分３６．３７のコイル
を通る事を防止される。さらに、可動コア３１は、固定
コア３３の回りに延在するツバ（図示されず）を備える
事ができる。
可動コア３１の先細遠位端部分４１は固定コア３３より
　かに剛性であるので、固定コア３３が予成形されてい
る時、この可動コア３１の遠位＠部分４１の剛性により
、予成形された固定コア３３がガイドワイヤ１４の遠位
端部分の全体形状に大きな影響を与える事を防止する。
しかし第３図と第４図に図示のように、可動コア３１が
軸方向に近位端方向に引っ張られる時、固定コア３３が
その所定の形状をとる。
好ましくは、固定コア３３は二重湾曲形状を有し、その
最も遠位端の湾曲部分４４は、その手前の湾曲部分４２
よりも実質的に７４％さい曲率半径を有する。
第１図と第４図に図示のように、ガイドワイヤが大動脈
弁２４を通過した後に心Ｆｊａ１３の左心室１２と係合
して外傷を生じる事を防止するため、固定コア部材３３
の二重湾曲形状が好ましい。
ガイドワイヤが狭窄弁２３を通される除に、可動コア部
材３１の遠位＠部分は一般に予成形さ九た固定コア３３
と同延長であって、ガイドワイヤの押し込み特性を増大
し、狭窄弁２３を通過させる。しかし、ガイドワイヤが
大動脈弁２４を通過した時、可動コア３１が軸方向に近
位端方向に引き出されて、予成形された固定コア３３に
二重湾曲形状をとらせる。固定コアの遠位端曲率４４が
小である程、ガイドワイヤ１４の遠位端が左心室の壁に
係合する事を防止する。ガイドワイヤをさらに壁に向か
って前進させ可動コア３１をさらに近位端側に引き出す
と。
ガイドワイヤの大湾曲部分４２が第１図に図示のように
左心室の壁体に当接する。またこのようなガイドワイヤ
の形状は、弁２４を通過したガイドワイヤ部分を支持し
て、拡張カテーテルＩｓ、　１６．１７をガイドワイヤ
１４に治って前進させ、バルーン要素２１．２２．２３
を大＠脈弁２４の中に入らせる。これらのバルーン要素
を比較的高圧まで膨張させると、大動脈弁の開口を拡張
させ、従ってこの弁を通してより多＝の血液を通過させ
る事ができる。
可動コア３１の直径は、近位端における約０．０１８〜
約０．０３５インチ（０，４６−０，８９ｍｍ）から、
遠位端における約０．００７〜約０．０１５インチ（０
，１８−０，３８ａ＋ｃ）まで変動する。その全長は約
１３０−１６０ｃｍの範囲とする事ができる。可動コア
３工のテーパ部分４工の全長は約１５−２５ｃＩｉｌで
ある。固定コア３３の近位端の直径は約０．００６〜約
０．０１２インチ（０，１５−０，３０ｍｍ）の範囲内
とし、中央部分は約０．００７〜約０．０１５インチ（
０，０３−０，３８ｍｍ）の範囲内とし、遠位端部分は
厚さ約０．００１〜約０．００フインチ（０，０２５−
０，１０１）の平坦部分を成す、固定コア３３の長さは
約８ｃｍ〜約２０ｃ口である。
本発明は大動脈弁の拡張の場合について説明したが、こ
のガイドワイヤは僧＠弁に使用する事もできる。しかし
僧帽弁文運切開の場合、心房中隔横断技術が使用され、
この場合ガイドワイヤおよび拡張カテーテルが大腿血管
を通して患者の脈管系の中に経皮的に導入さ九、右心房
の中まで前進させる。心房中隔の中に小開口作り、ガイ
ドワイヤと拡張カテーテルを左心房の中に導入し、つぎ
にガイドワイヤとカテーテルを僧帽弁を横断して前進さ
せる１通常ガイドワイヤはさらに大動脈弁を通して大動
脈の中まで前進される。つぎにこの弁形成カテーテルは
ガイドワイヤに沿って前進させられて僧帽弁を横断し、
そこでバルーン要素が膨張されて僧帽弁を拡張させ、つ
ぎに除去されて血行を容易する。僧帽弁文運切開の詳細
は、Ｒ，Ｇ。
ＭｃＫａｙ　ほか、、ｅ’　　　　　　　　ｅ。
、　Ｖｏｌ、７．　Ｎｏ、６．　Ｊｕｎｅ　１９８６に
記載されている。また、Ｊ、Ｅ、Ｌｏｃｋａ　ほか、　
　ｖ　　　　　　　Ｊｏｕ虹ムエム１■Ｖｏｌ、３１３
．　ｐｐ　１５１５−８１．１９８５参照、これら両方
の資料を３１例として加える。
本発明のガイドワイヤ組立体は弁形成術において広範囲
の弁手術に使用する事ができる。さらに。
本発明はその好ましい実施態様について説明したのであ
るが１種々の変形が可能である。例えば、外側管状部材
はガイドワイヤの長さの大部分に沿って延在するコイル
バネとしたのであるが、このコイルバネの一部または全
部の代わりに比較的厚い壁体の可撓性プラメヂン々管を
使用する事ができる。本発明の主旨の範囲内においてそ
の他の変形が可能である。
【図面の簡単な説明】
第１図は人体の心臓の前部の破断図であって、本発明の
多バルーン式弁形成カテーテル組立体を大動脈弁の中に
起案した状態を示す図、第２図は本発明のガイドワイヤ
組立体の長手方断面図、第３図は可動部材を軸方向に引
き戻してガイドワイヤの先端部分の第１湾曲を生じた状
態を示す長手方断面図、また９４図は、可動部材を軸方
同番こざらに引き出して、ガイドワイヤの遠位端の二重
湾曲を生じた状態を示す長手方断面図である。 １４、、、ガイドワイヤ、３０．、、バネ管、３１．、
、可動コア、３２、、、ハンドル、３３．、、固定コア
、３５．、、プラグ、３８、、、支持管、４０．、、ハ
イポチューブ、４２，４４．、、？Ｒ曲部分。 出願人代理人　　佐　　藤　−雄

Claims (1)

  1. 【特許請求の範囲】 １、患者の血管を通してカテーテルを案内するガイドワ
    イヤにおいて、 ａ）遠位端に丸いプラグを有する可撓性外側管状部材と
    、 ｂ）前記外側管状部材の中に配置されその内部に固着さ
    れた成形可能の第１コア部材と、 ｃ）前記外側管状部材の内部に配置され、この外側管状
    部材の実質的に全長に沿って延在し、その内部を軸方向
    に可動の比較的剛性の第２コア部材と、 ｄ）前記外側管状部材の内部において第１コア部材に対
    して第２コア部材を軸方向に移動させるため第２コア部
    材の近位端に備えられた手段とを含む操縦−調節可能先
    端部を有するガイドワイヤ組立体。 ２、第１コア部材の遠位端は外側管状部材の遠位端のプ
    ラグに対して固着される事を特徴とする請求項１に記載
    のガイドワイヤ。 ３、第１コア部材の近位端は前記外側管状部材に対して
    固着される事を特徴とする請求項１または２に記載のガ
    イドワイヤ。 ４、前記外側管状部材はその大部分に沿って延在するコ
    イルを含む事を特徴とする請求項１乃至３のいずれかに
    記載のガイドワイヤ。 ５、外側管状部材を成すコイルバネが支持管の回りに嵌
    着される事を特徴とする請求項４に記載のガイドワイヤ
    。 ６、前記支持管はポリイミドから成る事を特徴とする請
    求項５に記載のガイドワイヤ。 ７、ガイドワイヤが患者の血管の中に導入される前に第
    １コア部材が予成形されている事を特徴とする請求項１
    乃至６のいずれかに記載のガイドワイヤ。 ８、第１コア部材が２つの湾曲部分を有する事を特徴と
    する請求項７に記載のガイドワイヤ。 ９、もっとも遠位端の湾曲部分はこれより近位側の湾曲
    部分より小さい曲率半径を有する事を特徴とする請求項
    ８に記載のガイドワイヤ。 １０、前記第１コア部材の近位端は短い管状部材に固着
    されている事を特徴とする請求項１乃至９のいずれかに
    記載のガイドワイヤ。
JP1238331A 1988-09-14 1989-09-13 操縦―調節可能の先端を有するガイドワイヤ組立体 Pending JPH02191467A (ja)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US07/244,817 US4917102A (en) 1988-09-14 1988-09-14 Guidewire assembly with steerable adjustable tip
US244817 1988-09-14

Publications (1)

Publication Number Publication Date
JPH02191467A true JPH02191467A (ja) 1990-07-27

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JP1238331A Pending JPH02191467A (ja) 1988-09-14 1989-09-13 操縦―調節可能の先端を有するガイドワイヤ組立体

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US (1) US4917102A (ja)
EP (1) EP0363661A1 (ja)
JP (1) JPH02191467A (ja)

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