JPH0630943A - Embolectomy catheter - Google Patents
Embolectomy catheterInfo
- Publication number
- JPH0630943A JPH0630943A JP20729992A JP20729992A JPH0630943A JP H0630943 A JPH0630943 A JP H0630943A JP 20729992 A JP20729992 A JP 20729992A JP 20729992 A JP20729992 A JP 20729992A JP H0630943 A JPH0630943 A JP H0630943A
- Authority
- JP
- Japan
- Prior art keywords
- embolus
- tube
- opening
- tip
- 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.)
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Abstract
Description
【0001】[0001]
【産業上の利用分野】本発明は血管内壁に付着した塞栓
を切除するためのカテ−テルに関する。BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a catheter for removing an embolus attached to the inner wall of a blood vessel.
【0002】[0002]
【従来の技術】血管内壁に凝固血液(血栓)またはカル
シウムとコレステロ−ルからなる粥腫等(以下塞栓と総
称する)が付着すると血流が阻害される。例えば冠動脈
内の血流が塞栓によって閉塞すると心筋梗塞が起こり、
また肢抹消血管が閉塞すると壊疽となる。そのために、
早期にこのような塞栓を切除することが要求され、従来
から種々の切除方法が行われている。2. Description of the Related Art Blood flow is inhibited when coagulated blood (thrombus) or atheroma and the like consisting of calcium and cholesterol (hereinafter collectively referred to as emboli) adheres to the inner wall of a blood vessel. For example, if the blood flow in the coronary artery is blocked by an embolus, myocardial infarction occurs,
In addition, gangrene occurs when the limb peripheral blood vessels are occluded. for that reason,
It is required to remove such an embolus at an early stage, and various cutting methods have been conventionally performed.
【0003】例えば、特表昭57−501167号公報には、バ
ル−ンカテ−テルを血管内に挿入し、血管内でカテ−テ
ルのバル−ンを膨張させ、細くなった血管の内径を拡大
させるこ3によって血流を確保する方法が紹介されてい
る。しかし、この方法は単に細くなった血管の内径を拡
大して血流を確保するものであるから、一時的に血流が
確保できても再狭窄の恐れがある。かかるバル−ンカテ
−テルの欠点を克服したものとして米国特許第 4994067
号明細書に、血管内にカテ−テルを挿入し、カテ−テル
の側壁に設けられた開口部を血管内壁の塞栓の位置に配
置し、カテ−テルに内挿された金属製のカッタ−を回転
前進させて導入塞栓を切除する、いわゆるアテレクトミ
−血管形成方法が紹介され注目を浴びている。For example, in Japanese Patent Publication No. 57-501167, a balloon catheter is inserted into a blood vessel and the balloon of the catheter is expanded in the blood vessel to enlarge the inner diameter of the thinned blood vessel. A method of securing blood flow by using Sako 3 is introduced. However, since this method simply enlarges the inner diameter of the thinned blood vessel to secure blood flow, there is a risk of restenosis even if blood flow is temporarily secured. US Pat. No. 4,940,067 claims that such a balloon catheter has been overcome.
In the specification, a catheter is inserted into a blood vessel, an opening provided in the side wall of the catheter is arranged at the position of the embolus on the inner wall of the blood vessel, and a metal cutter inserted in the catheter. A so-called atherectomy-angiogenesis method of rotating and advancing to remove the introduced embolus has been introduced and has been attracting attention.
【0004】この塞栓切除カテ−テルは図5に示すよう
に、内側チュ−ブ32を内挿した外側チュ−ブ31の先端は
塞栓を切除するためのカッタ−36が接続され、内側チュ
−ブ32には駆動軸33が内挿され、その先端はカッタ−36
の滑受部35が設置されてなる。駆動軸33は内側チュ−ブ
32から突出し、先端は血管内を先導するヘッド34が形成
され、駆動軸33を回転前進させることによって外側チュ
−ブ31と共にカッタ−36が滑受部35の方向へ回転前進さ
れ血管内の塞栓が切除されるようになっている。そし
て、血管内塞栓の切除方法は、図6に示すように先ずカ
テ−テルの開口部40を塞栓37のある位置に設置する(図
6A)。次いで、ワイヤ−38を伸ばして外側チュ−ブ31の
外壁を血管内壁に押しつける(図6B)。その後、カッタ
−36を回転させながら前進させることによって開口部35
内にある塞栓37が切除される(図6C)。切除された塞栓
小片39は除去される(図6D)。次に、カテ−テルの開口
部40を反対方向に向ける(図6E)。そして図6B〜図6Dの
操作を繰り返すことによって血管内の塞栓は除去される
(図6F)。また特開昭62−266046号公報には図5のワイ
ヤ−38の代わりに、膨張可能なバル−ンを設けてカテ−
テルの開口部を塞栓の位置に押しつけて血管壁に付着し
た塞栓を切除する装置が紹介されている。As shown in FIG. 5, this embolus-cutting catheter is connected to a cutter 36 for cutting off an embolus at the tip of an outer tube 31 in which an inner tube 32 is inserted, and an inner tube. The drive shaft 33 is inserted in the hub 32, and the tip of the drive shaft 33 is a cutter 36.
The sliding portion 35 of is installed. Drive shaft 33 is an inner tube
A head 34 projecting from 32 and leading inside the blood vessel is formed at the tip, and by rotating the drive shaft 33 forward, the cutter 36 together with the outer tube 31 is rotated forward toward the sliding portion 35 to embolize the blood vessel. Are to be excised. Then, in the method of removing the embolus in the blood vessel, as shown in FIG. 6, first, the opening 40 of the catheter is installed at the position where the embolus 37 is present (see
6A). The wire 38 is then stretched to press the outer wall of the outer tube 31 against the inner wall of the blood vessel (Fig. 6B). Then, the cutter 36 is rotated and moved forward to open the opening 35.
The internal embolus 37 is excised (Fig. 6C). The excised embolic piece 39 is removed (FIG. 6D). The catheter opening 40 is then oriented in the opposite direction (FIG. 6E). Then, the embolism in the blood vessel is removed by repeating the operations of FIGS. 6B to 6D (FIG. 6F). Further, in JP-A-62-266046, an inflatable balloon is provided in place of the wire 38 shown in FIG.
A device that presses the opening of the tell at the position of the embolus to remove the embolus attached to the blood vessel wall has been introduced.
【0005】[0005]
【発明が解決しょうとする課題】しかしながら、かかる
カテ−テル開口部の反対側に設けたワイヤ−の伸縮やバ
ル−ンの膨張によって、カテ−テル開口部を塞栓の位置
に押しつけて血管壁に付着した塞栓を切除する装置は、
ワイヤ−の伸縮やバル−ンの膨張がカテ−テル開口部の
反対側付近だけで行われるために、カテ−テル開口部が
塞栓と完全に密着せず、そこから血液がカテ−テル先端
側に流れて切除された塞栓片が飛散する恐れがある。本
発明の目的は、血管内壁に付着した塞栓を効率よく切除
し、切除された塞栓片をカテ−テルの外側に飛散させな
いで収集し排出する塞栓切除カテ−テルを提供すること
である。However, due to the expansion and contraction of the wire provided on the opposite side of the catheter opening and the expansion of the balloon, the catheter opening is pressed to the position of the embolus to the vessel wall. The device to remove the attached embolus is
Since the expansion and contraction of the wire and the expansion of the balloon are performed only near the opposite side of the catheter opening, the catheter opening does not completely adhere to the embolus, and the blood comes from the catheter tip side. There is a risk that the removed embolic pieces will flow to the ground and scatter. An object of the present invention is to provide an embolus excision catheter which efficiently excises an embolus attached to the inner wall of a blood vessel and collects and ejects the excised embolus piece without scattering it outside the catheter.
【0006】[0006]
【課題を解決するための手段】すなわち、本発明は側壁
に開口部を有し、先端部にフイルタ−を収容した先端が
開口した細長いチュ−ブと;該チュ−ブの外側にほぼ全
長にわたって設けられた膨張可能な外管と;該チュ−ブ
内に内挿され先端側で該チュ−ブの開口部に対応する位
置に配置された切除部材と;前記フイルタ−をチュ−ブ
先端開口部から外方に押し出すための押出手段とからな
る塞栓切除カテ−テルである。また、本発明は前記塞栓
切除カテ−テルにおいて、外管が開口部付近より先端方
向のチュ−ブの開口部側の側壁を除くチュ−ブ全長にわ
たって設けられてなる塞栓切除カテ−テルである。更
に、本発明は前記塞栓切除カテ−テルにおいて、造影剤
を血管に注出するための孔がチュ−ブ内に設けられてな
る塞栓切除カテ−テルである。更に、本発明は前記塞栓
切除カテ−テルにおいて、切除部材が塞栓を切除するた
めのカッタ−からなり、その後方に螺施状のノッチが装
備された回転部材が設けられてなる塞栓切除カテ−テル
である。更にまた、本発明は前記塞栓切除カテ−テルに
おいて、切除部材が細長い円筒形の回転部材からなり、
その先端に塞栓を切除するためのカッタ−が装備されて
おり、切除された塞栓が回転部材の内部から排出される
ように形成された塞栓切除カテ−テルである。また、本
発明は前記塞栓切除カテ−テルにおいて、チュ−ブの後
方側に内径が拡大した塞栓収集室が設けられてなる塞栓
切除カテ−テルである。SUMMARY OF THE INVENTION That is, according to the present invention, there is provided an elongated tube having an opening at a side wall and an opening at an end thereof, the housing accommodating a filter; An inflatable outer tube provided; a cutting member inserted into the tube and disposed at a position corresponding to an opening portion of the tube at a tip side; a tube tip opening of the filter; The embolus cutting catheter comprises a pushing means for pushing the portion outward. Further, the present invention is the embolus excision catheter in which the outer tube is provided over the entire length of the tube excluding the side wall on the opening side of the tube in the distal direction from the vicinity of the opening. . Further, the present invention is the embolus excision catheter, wherein the embolus excision catheter is provided with a hole for pouring a contrast medium into a blood vessel in the tube. Further, according to the present invention, in the embolus cutting catheter, the cutting member comprises a cutter for cutting the embolus, and an embolus cutting catheter provided with a rotating member equipped with a screw-shaped notch behind the cutter. It is tell. Furthermore, the present invention is the embolus cutting catheter, wherein the cutting member comprises an elongated cylindrical rotating member,
A cutter for cutting off an embolus is provided at its tip, and the embolus cutting catheter is formed so that the cut embolus is discharged from the inside of the rotating member. Further, the present invention is the embolus excision catheter, wherein the embolus excision catheter is provided with an embolus collection chamber having an enlarged inner diameter on the rear side of the tube.
【0007】[0007]
【作用】本発明は塞栓切除カテ−テルを血管に挿入し、
チュ−ブ先端部に収納されたフイルタ−を先端開口部か
ら押し出すことによって、フイルタ−は血管内部で膨張
する。フイルタ−方向に飛散した切除された塞栓片はフ
イルタ−面で捕捉されるとともにフイルタ−より先端側
の血管の方向に飛散するのを防止する。血管の塞栓部に
チュ−ブの開口部を配置し、外管に液体を注入すること
によってチュ−ブ開口部は塞栓箇所に押し当てられると
ともに、塞栓の後方にある健状血管箇所で血液は殆ど止
血される。次いで、スイッチを押すことによってモ−タ
−と接続された回転部材が前後に移動しながら回転し、
その先端に設けられた切除部材も回転移動されることに
よって、血管内壁に付着した塞栓は切除部材の刃面で切
除される。切除された塞栓片は切除された後、例えば螺
施状のノッチの谷部を経て後方に移動され、塞栓収集室
に集められ、吸引ポンプと連結した排出ポ−トから排出
される。The present invention inserts an embolized catheter into a blood vessel,
By pushing the filter housed in the tube tip through the tip opening, the filter expands inside the vessel. The removed embolus pieces scattered in the direction of the filter are captured by the surface of the filter and are prevented from scattering in the direction of the blood vessel on the tip side of the filter. The tube opening is placed in the embolus of the blood vessel, and the tube opening is pressed against the embolus site by injecting the liquid into the outer tube, while blood is collected at the healthy blood vessel site behind the embolus. Mostly hemostasis. Then, by pressing the switch, the rotating member connected to the motor rotates while moving back and forth,
The embolus attached to the inner wall of the blood vessel is excised by the blade surface of the excision member by rotationally moving the excision member provided at the tip thereof. After the excised embolic piece is excised, it is moved rearward, for example, through the troughs of the screw-shaped notch, is collected in the embolic collection chamber, and is discharged from the discharge port connected to the suction pump.
【0008】[0008]
【実施例】以下実施例にて本発明の一例を説明する。図
1は本発明の一例を示す塞栓切除カテ−テルの説明図で
あり、図2は図1の塞栓切除カテ−テルの要部を示す一
部切欠断面図であり、図3は図2の塞栓切除カテ−テル
のX−X線断面図であり、図4は図2の塞栓切除カテ−
テルのY−Y線断面図であり、図5は従来の塞栓切除カ
テ−テルの一部切欠断面図であり、図6は図5の塞栓切
除カテ−テル使用方法の説明図であり、図7は本発明の
他の実施例を示す塞栓切除カテ−テルの要部を示す一部
切欠断面図であり、図8は図7の塞栓切除カテ−テルの
突起物の斜視図である。図中、1は切除部材、2はチュ
−ブ、3は回転部材、4は外管、5は排出ポ−ト、6は
フイルタ−、7は造影剤注入管、8は切除部材の刃面、
9は隔壁、10はモ−タ−、11はバッテリ−、12はスイッ
チ、13は塞栓収集室、14は側壁開口部、15は先端開口
部、16および26はワイヤ−操作治具、17は液体注入ポ−
ト、18は造影剤用孔部、19は押出手段、20は隔室、21は
先端室、22はノッチ、23は造影剤注入口、24は血管壁、
25は塞栓、27はワイヤ−、28は突起物、29は塞栓排出小
孔、30は接続部材を示す。EXAMPLES An example of the present invention will be described below with reference to examples. 1 is an explanatory view of an embolus excision catheter showing an example of the present invention, FIG. 2 is a partially cutaway sectional view showing an essential part of the embolus excision catheter, and FIG. 3 is FIG. FIG. 4 is a sectional view taken along line XX of the embolus excision catheter, and FIG. 4 is the embolus excision catheter of FIG.
FIG. 6 is a sectional view taken along line YY of FIG. 5, FIG. 5 is a partially cutaway sectional view of a conventional embolus excision catheter, and FIG. 6 is an explanatory view of a method of using the embolus excision catheter of FIG. 7 is a partially cutaway sectional view showing an essential part of an embolus excision catheter according to another embodiment of the present invention, and FIG. 8 is a perspective view of a projection of the embolus excision catheter of FIG. In the figure, 1 is a cutting member, 2 is a tube, 3 is a rotating member, 4 is an outer tube, 5 is a discharge port, 6 is a filter, 7 is a contrast agent injection tube, and 8 is a blade surface of the cutting member. ,
9 is a partition wall, 10 is a motor, 11 is a battery, 12 is a switch, 13 is an embolus collection chamber, 14 is a side wall opening, 15 is a tip opening, 16 and 26 are wire manipulation jigs, 17 is a Liquid injection port
G, 18 is a hole for contrast agent, 19 is extrusion means, 20 is a compartment, 21 is a distal chamber, 22 is a notch, 23 is a contrast agent injection port, 24 is a blood vessel wall,
25 is an embolus, 27 is a wire, 28 is a protrusion, 29 is an embolus discharge small hole, and 30 is a connecting member.
【0009】図1〜図4に基づいて、本発明の塞栓切除
カテ−テルの一例を説明する。チュ−ブ2の先端は図2
に示すように先端開口部15からなり、隔壁9によって先
端室21を形成する。先端室21には図1に示すようにフイ
ルタ−6が収納されている。図2のフイルタ−6は押出
手段であるワイヤ−19によって、先端開口部15から押し
出されて血管壁24の内壁にまで膨張した状態を示してい
る。フイルタ−6はカテ−テル先端側に飛散した塞栓片
を捕捉し、塞栓片がフイルタ−より前方の血管方向へ流
入するのを防止している。フイルタ−6は先端室21では
圧縮されたような状態で収納され、先端室21から押し出
されると血管壁24を圧迫するような状態で膨張される。
塞栓切除終了後、フイルタ−6は先端室21に挿入され、
カテ−テルは血管から抜去される。従って、フイルタ−
6は先端室21に容易に圧縮されて挿入され、先端室21か
ら押し出されると血管壁24にまで膨張する伸縮可能な材
料、例えばナイロンメッシュが好ましく、その他に発泡
プラスチック、スポンジゴム、編織物、不織布等が挙げ
られる。フイルタ−6の先端室21からの出入は、フイル
タ−6に取りつけられた押出手段19、例えばワイヤ−の
操作によって行われる。図1では、ワイヤ−19はワイヤ
−操作治具16を操作することによってワイヤ−19がフイ
ルタ−6を押し出したり、引っ込めたりするようになっ
ている。隔室20の先端側の隔壁には、造影剤を血管内に
注出するための造影剤用孔部18が設けられており、造影
剤注入口23から注入された造影剤は造影剤注入管7を経
て隔室20に入り、造影剤用孔部18から造影剤が血管内に
流出され血管内の塞栓位置の確認に使用される。An example of the embolus excision catheter of the present invention will be described with reference to FIGS. The tip of the tube 2 is shown in FIG.
As shown in FIG. 3, the partition wall 9 forms a distal end chamber 21 with the distal end opening 15. A filter 6 is housed in the tip chamber 21 as shown in FIG. The filter 6 in FIG. 2 is in a state in which it is pushed out from the distal end opening portion 15 and expanded to the inner wall of the blood vessel wall 24 by the wire 19 as the pushing means. The filter 6 captures the embolic pieces scattered on the tip side of the catheter and prevents the embolic pieces from flowing in the blood vessel direction in front of the filter. The filter 6 is stored in the distal chamber 21 in a compressed state, and when pushed out of the distal chamber 21, the filter 6 is expanded in a state of pressing the blood vessel wall 24.
After the embolization, the filter 6 was inserted into the distal chamber 21 and
The catheter is removed from the blood vessel. Therefore, the filter
6 is preferably a stretchable material that is easily compressed and inserted into the distal chamber 21 and expands to the blood vessel wall 24 when pushed out from the distal chamber 21, for example, nylon mesh, and in addition, foamed plastic, sponge rubber, knitted fabric, Examples include non-woven fabrics. The filter 6 is moved in and out of the front end chamber 21 by the operation of the pushing means 19, for example, a wire attached to the filter 6. In FIG. 1, the wire 19 is adapted to push or pull the filter 6 by operating the wire operating jig 16. The partition wall on the tip side of the compartment 20 is provided with a contrast agent hole portion 18 for pouring the contrast agent into the blood vessel, and the contrast agent injected from the contrast agent injection port 23 is a contrast agent injection tube. After entering the compartment 20 via 7, the contrast agent is discharged from the contrast agent hole 18 into the blood vessel and is used to confirm the embolization position in the blood vessel.
【0010】先端室21に隣接した側壁には開口部14が設
けられ、チュ−ブ2の後端は螺合状の接続部材30を介し
てモ−タ−10およびバッテリ−11を内蔵した駆動部本体
と接続されている。チュ−ブ2の後端側には、内径が拡
大した塞栓収集室13があり、該収集室13の側壁から分岐
して塞栓片を排出するためのチュ−ブ(図示せず)と接
続するための排出ポ−ト5が設置される。排出ポ−ト5
は真空装置と連結され切除された塞栓が真空吸引によっ
て塞栓収集室13に集められ排出される。回転部材3はチ
ュ−ブ2内に内挿され、その先端には切除部材1が接続
される。切除部材1はチュ−ブ2の開口部14に設置さ
れ、その刃面8は図1では金属製カッタ−、例えば円柱
状の外面の表面にカッタ−が設けられたもの等からなっ
ている。刃面8の外径はチュ−ブ2の外径を超えない範
囲内に形成されており、それによって血管壁24を切除部
材1の回転によって傷つけるのを防止している。図1の
回転部材3は円柱状の外面に螺施状のノッチ22が形成さ
れており、切除部材1の回転によって塞栓25が切除さ
れ、切除された塞栓片がノッチ22の谷間を経て塞栓収集
室13に集められ、真空源によって塞栓片は排出ポ−ト5
および塞栓排出チュ−ブを経て除去される。回転部材3
の後端は接続部品を介して回転駆動部本体のモ−タ−10
と接続され、モ−タ−10の回転と連動して回転部材3が
チュ−ブ2内で回転するとともに、前後に移動しうるよ
うになっており、切除部材1は側壁開口部14内を回転し
ながら前後に移動して血管壁24に付着した塞栓25を切除
する。チュ−ブ2が熱可塑性樹脂で成形されている場
合、切除部材1の回転によって熱が発生しチュ−ブ2が
軟化変形したり、切除部材1が回転移動する際にチュ−
ブ2の内壁を削除したりする危険を防止するために、チ
ュ−ブ2の内壁に金属製の円筒体が設けられていてもよ
い。An opening 14 is provided in the side wall adjacent to the front end chamber 21, and the rear end of the tube 2 has a motor 10 and a battery 11 built therein via a screw-shaped connecting member 30. It is connected to the main unit. At the rear end side of the tube 2, there is an embolus collection chamber 13 having an enlarged inner diameter, which is connected to a tube (not shown) for branching from the side wall of the collection chamber 13 and discharging the embolus piece. A discharge port 5 is installed for this purpose. Discharge port 5
Is connected to a vacuum device, and the excised embolus is collected in the embolus collection chamber 13 by vacuum suction and discharged. The rotating member 3 is inserted into the tube 2 and the cutting member 1 is connected to the tip thereof. The cutting member 1 is installed in the opening 14 of the tube 2, and its blade surface 8 is made up of a metal cutter in FIG. 1, for example, one having a cylindrical outer surface provided with a cutter. The outer diameter of the blade surface 8 is formed within the range that does not exceed the outer diameter of the tube 2, thereby preventing the blood vessel wall 24 from being damaged by the rotation of the cutting member 1. The rotating member 3 in FIG. 1 has a threaded notch 22 formed on a cylindrical outer surface, and the embolus 25 is cut by the rotation of the cutting member 1. The embolus pieces are collected in the chamber 13 and the embolus pieces are discharged by the vacuum source.
And removed via the embolus evacuation tube. Rotating member 3
The rear end is connected to the motor 10
The rotating member 3 rotates in the tube 2 in conjunction with the rotation of the motor 10 and can move back and forth. The embolus 25 attached to the blood vessel wall 24 is excised by moving forward and backward while rotating. When the tube 2 is formed of a thermoplastic resin, heat is generated by the rotation of the cutting member 1 to soften and deform the tube 2, or when the cutting member 1 is rotationally moved.
In order to prevent the risk of removing the inner wall of the tube 2, a metal cylindrical body may be provided on the inner wall of the tube 2.
【0011】チュ−ブ2の外面には該チュ−ブのほぼ全
長にわたって外管4が設けられている。外管4は塞栓切
除カテ−テルを血管内に挿入するときには、チュ−ブ2
の外壁に皮膜状態に密着しているが、チュ−ブ2の開口
部14が血管内の塞栓位置に設置されると、液体注入ポ−
ト17から液体が外管4内に注入されて外管4が膨張しチ
ュ−ブ2の開口部14面が血管内壁側に移行し、チュ−ブ
2の開口部付近の外壁は血管内壁と接するとともに、開
口部14の後方にあるチュ−ブ2の外壁は健状血管とも密
接し、血液が開口部14へ流れるのを防止する。液体とし
ては生理食塩水、造影剤混入生理食塩水等が使用され
る。図3および図4は外管4が膨張したときの図2の塞
栓切除カテ−テルの断面図であり、図3は側壁開口部14
の箇所での断面図、図4は側壁開口部14より後方での断
面図である。図1では外管4は側壁開口部14付近より先
端方向の側壁開口部14側のチュ−ブ側壁を除くチュ−ブ
全長にわたって設けられている。その他に、外管4は側
壁開口部14の開口部側の側壁付近だけを除き、先端室2
1、側壁開口部の反対側の側壁および側壁開口部14より
後方のチュ−ブ全長にわたって設けられていてもよい。
外管4は液体の注入によって膨張するものが好ましく、
例えばシリコ−ンゴム、SEBS、SIS などの合成ゴム、ポ
リウレタン、ポリ塩化ビニル、ポリオレフインなどの熱
可塑性樹脂、天然ゴムなどが挙げられる。開口部14内に
は塞栓25が導入され、スイッチ12を作動させることによ
って回転部材3が回転し、それによって切除部材1が回
転し開口部14内の塞栓25が切除される。チュ−ブ2はテ
フロン、ポリエチレン、ポリプロピレン、ポリイミド、
ポリ塩化ビニル、ABS樹脂、ポリウレタンのようなプ
ラスチック製が好ましく、回転部材3はステンレス鋼等
の金属、ポリイミド、ポリウレタン、ポリ塩化ビニル、
ポリオレフィン、ポリエステル、ポリアミド等のプラス
チック、セラミック等からなるのが好ましい。また、切
除部材1は金属、セラミック、硬質プラスチック等から
なるのが好ましい。An outer tube 4 is provided on the outer surface of the tube 2 over substantially the entire length of the tube. The outer tube 4 is a tube 2 when the embolization catheter is inserted into the blood vessel.
When the opening 14 of the tube 2 is placed at the embolization position in the blood vessel, the liquid injection port
A liquid is injected into the outer tube 4 from the valve 17, the outer tube 4 expands, the surface of the opening 14 of the tube 2 moves to the inner wall side of the blood vessel, and the outer wall near the opening of the tube 2 becomes the inner wall of the blood vessel. While contacting, the outer wall of the tube 2 behind the opening 14 also comes into close contact with a healthy blood vessel to prevent blood from flowing into the opening 14. As the liquid, physiological saline, physiological saline mixed with a contrast agent, or the like is used. 3 and 4 are cross-sectional views of the embolus cutting catheter of FIG. 2 when the outer tube 4 is expanded, and FIG.
FIG. 4 is a cross-sectional view at the location of FIG. In FIG. 1, the outer tube 4 is provided over the entire length of the tube excluding the tube side wall on the side wall opening 14 side in the distal direction from the vicinity of the side wall opening 14. In addition, the outer tube 4 is provided only in the vicinity of the side wall on the opening side of the side wall opening 14 except for the distal end chamber 2
1, the side wall on the side opposite to the side wall opening and the entire side of the tube rearward of the side wall opening 14 may be provided.
It is preferable that the outer tube 4 expands when liquid is injected,
Examples thereof include synthetic rubbers such as silicone rubber, SEBS and SIS, thermoplastic resins such as polyurethane, polyvinyl chloride and polyolefin, and natural rubber. The embolus 25 is introduced into the opening 14, and the rotary member 3 is rotated by operating the switch 12, whereby the cutting member 1 is rotated and the embolus 25 in the opening 14 is cut. Tube 2 is Teflon, polyethylene, polypropylene, polyimide,
A plastic such as polyvinyl chloride, ABS resin or polyurethane is preferable, and the rotating member 3 is made of metal such as stainless steel, polyimide, polyurethane, polyvinyl chloride,
It is preferably made of a plastic such as polyolefin, polyester or polyamide, or ceramic. Further, the cutting member 1 is preferably made of metal, ceramic, hard plastic or the like.
【0012】図1〜図4の塞栓切除カテ−テルを操作す
るには、先ず血管内に挿入されたカテ−テルは造影剤注
入口23から注入された造影剤を隔室20の先端に設けられ
た造影剤用孔部18から血管内に分散して血管内の塞栓25
の位置を確認する。次いで塞栓25の方向に側壁開口部14
を設置し、流体注入ポ−ト17から生理食塩水を注入して
外管4を膨張させて側壁開口部14を塞栓25に接するよう
に配置するとともに、側壁開口部14の後方にあるチュ−
ブ外壁は健状血管とも密接するようる配置される。。そ
の後ワイヤ−操作治具16を操作して先端室21内のフイル
タ−6を先端室21の先端開口部15から押出し、フイルタ
−6を血管壁24に圧迫させるように膨張させる。次い
で、スイッチ12を作動させることによって、モ−タ−10
が回転しそれと連動して回転部材3がチュ−ブ2内で回
転する。そして回転部材3の先端にある切除部材1も回
転しカッタ−8によって塞栓25が切除される。切除され
た塞栓片は回転部材3のノッチ22と真空吸引によって後
方の塞栓収集室13に集められ、排出ポ−ト5から排出さ
れる。In order to operate the embolus excision catheter of FIGS. 1 to 4, first, the catheter inserted into the blood vessel is provided with the contrast agent injected from the contrast agent injection port 23 at the tip of the compartment 20. The embolus 25 in the blood vessel is dispersed from the hole 18 for the contrast medium that is dispersed in the blood vessel.
Check the position of. Then the side wall opening 14 in the direction of the embolus 25
Is installed and physiological saline is injected from the fluid injection port 17 to inflate the outer tube 4 so that the side wall opening 14 is in contact with the embolus 25, and the tube behind the side wall opening 14 is placed.
The outer wall of the bulge is placed in close contact with healthy blood vessels. . Thereafter, the wire operating jig 16 is operated to push the filter 6 in the tip chamber 21 through the tip opening portion 15 of the tip chamber 21 and expand the filter 6 so that the filter 6 is pressed against the blood vessel wall 24. Then, by activating the switch 12, the motor 10
Rotates and the rotating member 3 rotates in the tube 2 in conjunction therewith. Then, the cutting member 1 at the tip of the rotating member 3 is also rotated and the embolus 25 is cut by the cutter 8. The cut embolic pieces are collected by the notch 22 of the rotary member 3 and the vacuum suction in the rear embolic collection chamber 13 and discharged from the discharge port 5.
【0013】図7は本発明の他の実施例を示す塞栓切除
カテ−テルの要部を示す一部切欠断面図であり、図1の
塞栓切除カテ−テルの回転部材3が円筒形状をし、切除
部材1が突起形状をした塞栓切除カテ−テルである。先
端部に圧縮されたフイルタ−6を収納し、後端側には内
径が拡大した塞栓収集室13からなるカテ−テルであり、
該収集室13の側壁から本体と分岐して塞栓を排出するた
めの排出ポ−ト5が設置される。回転部材3の側壁には
少なくとも1の小孔が設けられるが、小孔は図7に示す
ように塞栓収集室13の回転部材3の側壁のみに形成され
るのが好ましい。そして、切除部材1の小孔28から回転
部材3の中空部を通過した塞栓片、およびチュ−ブ2の
内腔を通過した塞栓片が塞栓収集室13に集められ、真空
源によって塞栓片は排出ポ−ト5および塞栓排出チュ−
ブを経て除去される。また、塞栓収集室13の先端側にフ
イルタ−6をチュ−ブ2の先端開口から押し出すための
ワイヤ−27とそれを操作するワイヤ−操作治具26がチュ
−ブ側壁から分岐して設けられている。FIG. 7 is a partially cutaway sectional view showing an essential part of an embolus excision catheter according to another embodiment of the present invention, in which the rotary member 3 of the embolus excision catheter of FIG. 1 has a cylindrical shape. The cutting member 1 is an embolization cutting catheter having a projection shape. A catheter having a compressed filter 6 housed at the front end and an embolus collection chamber 13 having an enlarged inner diameter on the rear end side.
A discharge port 5 for discharging the emboli is installed by branching from the side wall of the collecting chamber 13 to the main body. At least one small hole is provided on the side wall of the rotary member 3, but it is preferable that the small hole is formed only on the side wall of the rotary member 3 of the embolus collection chamber 13 as shown in FIG. 7. Then, the embolus piece that has passed through the hollow portion of the rotary member 3 from the small hole 28 of the cutting member 1 and the embolus piece that has passed through the inner cavity of the tube 2 are collected in the embolus collection chamber 13, and the embolus piece is removed by the vacuum source. Discharge port 5 and embolus discharge tube
It is removed after passing through. Further, a wire 27 for pushing the filter 6 out of the tip opening of the tube 2 and a wire operating jig 26 for operating the same are provided on the tip side of the embolus collecting chamber 13 while branching from the side wall of the tube. ing.
【0014】回転部材3はチュ−ブ2内に内挿され、そ
の先端には切除部材1が接続される。後端は接続部品を
介して回転駆動部本体のモ−タ−と接続され、モ−タ−
の回転と連動して回転部材3がチュ−ブ2内で回転する
ようになっている。切除部材1は回転部材3の先端側に
設けられ、チュ−ブ2の開口部14に設置されるととも
に、その刃面28は切除部材1が回転した際チュ−ブ2の
外径を超えない範囲内に形成される。すなわち切除部材
1の回転する刃がチュ−ブ2の外周の内側にあることに
よって、血管内壁を切除部材1の回転によって傷つける
のを防止することができる。切除部材1は図8に示すよ
うに円筒状部材の外面に、少なくとも1の突起物20が設
けられて形成される。図8は突起物20の斜視図であり、
突起物20の開口した先端面は刃面8からなり、内部が湾
曲空洞化した猫の耳のような形をし、かつ内部が湾曲空
洞化した突起物20の円筒状部材の側壁である基面は小孔
18からなり、刃面8で切除した塞栓片を円筒状の切除部
材1の中空部に吸引する作用をする。図7では突起物20
は猫の耳のような形状をしているが、内部が湾曲空洞化
した四半球形状でもよい。刃面8の刃先は円筒状部材外
線と直角に直立していてもよいが、刃面8の刃先が切除
部材1の回転方向に曲がったものが血管内壁を傷つけな
くて好ましい。切除部材1は例えば金属製シ−トに少な
くとも1の小孔18を形成することによって、肉盛りされ
た厚肉部を突起物に形成し、次いで該シ−トを円筒状に
して製造される。切除部材1の先端側は円柱状の有底部
17と連結しており、回転部材3の支軸が回転の際移動し
ないように支持される。The rotating member 3 is inserted into the tube 2, and the cutting member 1 is connected to the tip of the rotating member 3. The rear end is connected to the motor of the main body of the rotary drive through a connecting part,
The rotating member 3 rotates in the tube 2 in conjunction with the rotation of the. The cutting member 1 is provided on the tip side of the rotating member 3 and is installed in the opening 14 of the tube 2, and its blade surface 28 does not exceed the outer diameter of the tube 2 when the cutting member 1 rotates. It is formed within the range. That is, since the rotating blade of the cutting member 1 is inside the outer circumference of the tube 2, it is possible to prevent the inner wall of the blood vessel from being damaged by the rotation of the cutting member 1. The cutting member 1 is formed by providing at least one protrusion 20 on the outer surface of a cylindrical member as shown in FIG. FIG. 8 is a perspective view of the protrusion 20,
The opening end surface of the protrusion 20 is composed of the blade surface 8, has a shape like a cat's ear with a curved hollow inside, and is a side wall of the cylindrical member of the protrusion 20 with a curved hollow inside. The surface is a small hole
It has a function of suctioning the embolus piece cut by the blade surface 8 into the hollow portion of the cylindrical cutting member 1. In FIG. 7, the protrusion 20
Has a shape like a cat's ear, but may have a semi-hemispherical shape with a curved hollow inside. The blade edge of the blade surface 8 may be upright at a right angle to the outer line of the cylindrical member, but it is preferable that the blade edge of the blade surface 8 is bent in the rotation direction of the cutting member 1 because it does not damage the inner wall of the blood vessel. The cutting member 1 is manufactured, for example, by forming at least one small hole 18 in a metal sheet to form a thickened portion which is built up into a protrusion, and then forming the sheet into a cylindrical shape. . The tip side of the cutting member 1 has a cylindrical bottomed portion.
It is connected to 17 and is supported so that the spindle of the rotating member 3 does not move during rotation.
【0015】チュ−ブ2の外側には、チュ−ブのほぼ全
長に亘って外管4が設置されている。図7はチュ−ブ2
の後端側に設けられた液体注入ポ−ト17から生理食塩水
が注入されて外管4が膨張した状態を示している。。チ
ュ−ブ2を血管内に挿入する際には、外管4はチュ−ブ
2の外面に密接しているが、チュ−ブ2の開口部14が血
管内の塞栓位置に設置され、流体注入ポ−ト17から生理
食塩水が注入されることによってチュ−ブ2の開口部14
付近の外壁が血管内壁側に移行するとともに、チュ−ブ
2の開口部14より後方の外壁も血管内壁と密接するよう
になる。開口部14内には塞栓があり、回転部材3が回転
することによって切除部材1が回転し開口部14内の塞栓
が切除される。An outer tube 4 is installed outside the tube 2 over substantially the entire length of the tube. Figure 7 shows tube 2
The state where the outer tube 4 is expanded by injecting physiological saline from the liquid injection port 17 provided on the rear end side is shown. . When inserting the tube 2 into a blood vessel, the outer tube 4 is in close contact with the outer surface of the tube 2, but the opening 14 of the tube 2 is placed at the embolization position in the blood vessel, By injecting physiological saline from the injection port 17, the opening 14 of the tube 2 is opened.
The outer wall in the vicinity moves to the inner wall side of the blood vessel, and the outer wall behind the opening 14 of the tube 2 comes into close contact with the inner wall of the blood vessel. There is an embolus in the opening 14, and the rotating member 3 rotates to rotate the cutting member 1 to cut off the embolus in the opening 14.
【0016】切除部材1は先端が有底の円筒形で、同様
に円筒形の回転部材3と円筒箇所で連結している。チュ
−ブ2の後端側には内径が拡大した塞栓収集室13があ
り、塞栓を排出する排出ポ−ト5と接続されている。塞
栓収集室13の回転部材3の側壁には少なくとも1の小孔
が設けられていて、切除された塞栓片はチュ−ブ2内だ
けでなく円筒形の回転部材3の中空部からも除去され
る。特に、小孔を切除部材1と塞栓収集室13のみに設け
ると回転部材3内部の塞栓除去位置が固定され、塞栓片
の大部分は回転部材3の中空部を通過して排出されるの
で好ましい。回転部材3の円筒形の後端は塞栓収集室13
までであって、それより後方の回転部材3は円柱形にな
っている。切除部材1の側壁には少なくとも1の小孔28
が設けられる。塞栓収集室13の回転部材3の側壁には少
なくとも1の小孔29が設けられ、回転部材3の円筒内を
通過した塞栓片が小孔29から除去される。塞栓収集室13
では小孔29からの塞栓だけでなく、チュ−ブ2の内腔の
塞栓片も排出ポ−ト5を経て排出される。The cutting member 1 has a cylindrical shape with a bottom end, and is similarly connected to a cylindrical rotating member 3 at a cylindrical portion. At the rear end side of the tube 2, there is an embolus collection chamber 13 having an enlarged inner diameter, which is connected to a discharge port 5 for discharging the embolus. At least one small hole is provided in the side wall of the rotating member 3 of the embolus collecting chamber 13, and the cut embolus pieces are removed not only in the tube 2 but also in the hollow portion of the cylindrical rotating member 3. It In particular, if small holes are provided only in the excision member 1 and the embolus collection chamber 13, the embolus removal position inside the rotary member 3 is fixed, and most of the embolus pieces pass through the hollow portion of the rotary member 3 and are discharged. . The cylindrical rear end of the rotating member 3 has an embolus collection chamber 13
Up to and behind the rotary member 3, the rotary member 3 has a cylindrical shape. The side wall of the cutting member 1 has at least one small hole 28
Is provided. At least one small hole 29 is provided in the side wall of the rotary member 3 of the embolus collection chamber 13, and the plug piece passing through the cylinder of the rotary member 3 is removed from the small hole 29. Embolus collection room 13
Then, not only the embolus from the small hole 29 but also the embolus piece in the inner cavity of the tube 2 is discharged through the discharge port 5.
【0017】[0017]
【発明の効果】本発明塞栓切除カテ−テルは、チュ−ブ
のほぼ全長に亘って設けられた外管1膨張することによ
って、チュ−ブの側壁開放部を塞栓箇所に押しあてると
ともに塞栓箇所より後方にある健状血管内壁をも押しあ
てるので、血液は殆ど健状血管で止血され、血管内壁に
付着した塞栓はチュ−ブの側壁開放部で殆ど止血状態で
切除される。また、チュ−ブ先端方向に飛散した塞栓片
は、チュ−ブ先端から押し出されて膨張したフイルタ−
に吸着されるので、塞栓片がチュ−ブの先端より外方に
飛散することはなく、管内壁に付着した塞栓は効率よく
切除され、カテ−テル内で収集され排出される。The catheter for embolization according to the present invention expands the outer tube 1 provided over substantially the entire length of the tube to push the side wall open portion of the tube to the embolized portion and the embolized portion. Since the inner wall of the healthy blood vessel located further behind is also pressed, the blood is almost hemostasised in the healthy blood vessel, and the embolus attached to the inner wall of the blood vessel is excised in the hemostasis state at the side wall open portion of the tube. Also, the embolic pieces scattered toward the tip of the tube are expanded by being pushed out from the tip of the tube.
Since the emboli are not adsorbed on the tube, the emboli attached to the inner wall of the tube are efficiently excised, collected and discharged in the catheter.
【図1】本発明の一例を示す塞栓切除カテ−テルの説明
図である。FIG. 1 is an explanatory view of an embolus excision catheter showing an example of the present invention.
【図2】図1の塞栓切除カテ−テルの要部を示す一部切
欠断面図である。FIG. 2 is a partially cutaway sectional view showing a main part of the embolus excision catheter of FIG.
【図3】図2の塞栓切除カテ−テルのX−X線断面図で
ある。FIG. 3 is a cross-sectional view taken along line XX of the embolization catheter of FIG.
【図4】図2の塞栓切除カテ−テルのY−Y線断面図で
ある。4 is a cross-sectional view taken along the line YY of the embolization catheter of FIG.
【図5】従来の塞栓切除カテ−テルの一部切欠断面図で
ある。FIG. 5 is a partially cutaway cross-sectional view of a conventional embolization catheter.
【図6】図5の塞栓切除カテ−テル使用方法の説明図で
ある。6 is an explanatory view of a method of using the embolus excision catheter of FIG. 5. FIG.
【図7】本発明の他の実施例を示す塞栓切除カテ−テル
の要部を示す一部切欠断面図である。FIG. 7 is a partially cutaway sectional view showing an essential part of an embolus excision catheter showing another embodiment of the present invention.
【図8】図7の塞栓切除カテ−テルの突起物の斜視図で
ある。8 is a perspective view of a protrusion of the embolus excision catheter of FIG. 7. FIG.
1 切除部材 2 チュ−ブ 3 回転部材 4 外管 5 排出ポ−ト 6 フイルタ− 7 造影剤注入管 8 切除部材の刃面 9 隔壁 10 モ−タ− 11 バッテリ− 12 スイッチ 13 塞栓収集室 14 側壁開口部 15 先端開口部 16、26 ワイヤ−操作治具 17 液体注入ポ−ト 18 造影剤用孔部 19 押出手段 20 隔室 21 先端室 23 造影剤注入口 24 血管壁 25 塞栓 1 cutting member 2 tube 3 rotating member 4 outer tube 5 discharge port 6 filter 7 contrast agent injection tube 8 cutting surface of cutting member 9 partition wall 10 motor 11 battery 12 switch 13 embolus collection chamber 14 sidewall Opening 15 Tip opening 16, 26 Wire-manipulating jig 17 Liquid injection port 18 Contrast medium hole 19 Extrusion means 20 Separation chamber 21 End chamber 23 Contrast medium injection port 24 Blood vessel wall 25 Embolus
Claims (6)
−を収容した先端が開口した細長いチュ−ブと;該チュ
−ブの外側にほぼ全長にわたって設けられた膨張可能な
外管と;該チュ−ブ内に内挿され先端側で該チュ−ブの
開口部に対応する位置に配置された切除部材と;前記フ
イルタ−をチュ−ブ先端開口部から外方に押し出すため
の押出手段とからなる塞栓切除カテ−テル。1. An elongate tube having an opening on a side wall and having an opening at a tip end thereof and containing a filter; and an inflatable outer tube provided on the outside of the tube over substantially the entire length. A cutting member inserted into the tube and located at a position corresponding to the opening of the tube on the tip side; and an extrusion for pushing the filter outward from the tube tip opening. An embolization catheter comprising means.
ブの開口部側の側壁を除くチュ−ブ全長にわたって設け
られてなる請求項1記載の塞栓切除カテ−テル。2. The outer tube has a tube extending from the vicinity of the opening toward the tip.
The embolus cutting catheter according to claim 1, which is provided over the entire length of the tube excluding the side wall on the opening side of the tube.
ュ−ブ内に設けられてなる請求項1記載の塞栓切除カテ
−テル。3. The embolus excision catheter according to claim 1, wherein a hole for pouring a contrast medium into a blood vessel is provided in the tube.
−からなり、その後方に螺施状のノッチが装備された回
転部材が設けられてなる請求項1または2記載の塞栓切
除カテ−テル。4. The embolus cutting catheter according to claim 1, wherein the cutting member is a cutter for cutting an embolus, and a rotating member provided with a threaded notch is provided behind the cutter. .
なり、その先端に塞栓を切除するためのカッタ−が装備
されており、切除された塞栓が回転部材の内部から排出
されるように形成された請求項1〜3記載の塞栓切除カ
テ−テル。5. The cutting member is composed of an elongated cylindrical rotary member, and a cutter for cutting the emboli is provided at the tip of the rotary member so that the cut embolus is discharged from the inside of the rotary member. The embolization catheter according to claims 1 to 3.
収集室が設けられてなる請求項1〜4記載の塞栓切除カ
テ−テル。6. The embolus resection catheter according to claim 1, wherein an embolus collection chamber having an enlarged inner diameter is provided on the rear side of the tube.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP20729992A JPH0630943A (en) | 1992-07-10 | 1992-07-10 | Embolectomy catheter |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP20729992A JPH0630943A (en) | 1992-07-10 | 1992-07-10 | Embolectomy catheter |
Publications (1)
Publication Number | Publication Date |
---|---|
JPH0630943A true JPH0630943A (en) | 1994-02-08 |
Family
ID=16537486
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP20729992A Pending JPH0630943A (en) | 1992-07-10 | 1992-07-10 | Embolectomy catheter |
Country Status (1)
Country | Link |
---|---|
JP (1) | JPH0630943A (en) |
Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2008086180A1 (en) * | 2007-01-05 | 2008-07-17 | Baylor College Of Medicine | Embolectomy catheter |
JP2013513442A (en) * | 2009-12-11 | 2013-04-22 | タイコ ヘルスケア グループ リミテッド パートナーシップ | Substance removal device and method with improved substance capture efficiency |
WO2013080729A1 (en) | 2011-11-28 | 2013-06-06 | ニプロ株式会社 | Atherectomy catheter |
JP2013521897A (en) * | 2010-03-11 | 2013-06-13 | アドバンスド・カテーテル・セラピーズ・インコーポレーテツド | Atherectomy device |
WO2015119153A1 (en) | 2014-02-06 | 2015-08-13 | ニプロ株式会社 | Catheter |
WO2017141923A1 (en) * | 2016-02-15 | 2017-08-24 | テルモ株式会社 | Medical device and treatment method |
-
1992
- 1992-07-10 JP JP20729992A patent/JPH0630943A/en active Pending
Cited By (13)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7914549B2 (en) | 2007-01-05 | 2011-03-29 | Hesham Morsi | Mechanical embolectomy and suction catheter |
WO2008086180A1 (en) * | 2007-01-05 | 2008-07-17 | Baylor College Of Medicine | Embolectomy catheter |
JP2013513442A (en) * | 2009-12-11 | 2013-04-22 | タイコ ヘルスケア グループ リミテッド パートナーシップ | Substance removal device and method with improved substance capture efficiency |
US9254145B2 (en) | 2010-03-11 | 2016-02-09 | Advanced Catheter Therapies, Inc. | Atherectomy device |
JP2013521897A (en) * | 2010-03-11 | 2013-06-13 | アドバンスド・カテーテル・セラピーズ・インコーポレーテツド | Atherectomy device |
WO2013080729A1 (en) | 2011-11-28 | 2013-06-06 | ニプロ株式会社 | Atherectomy catheter |
US9572594B2 (en) | 2011-11-28 | 2017-02-21 | Nipro Corporation | Atherectomy catheter |
WO2015119153A1 (en) | 2014-02-06 | 2015-08-13 | ニプロ株式会社 | Catheter |
US10405881B2 (en) | 2014-02-06 | 2019-09-10 | Nipro Corporation | Catheter |
EP3753502A1 (en) | 2014-02-06 | 2020-12-23 | Nipro Corporation | Catheter having cutter with torque shaft |
US11529165B2 (en) | 2014-02-06 | 2022-12-20 | Nipro Corporation | Catheter |
WO2017141923A1 (en) * | 2016-02-15 | 2017-08-24 | テルモ株式会社 | Medical device and treatment method |
US11090077B2 (en) | 2016-02-15 | 2021-08-17 | Terumo Kabushiki Kaisha | Medical device and treatment method |
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