JPWO2018193598A1 - catheter - Google Patents

Abstract

An object of the present invention is to provide a catheter capable of reliably receiving a retrograde guide wire through an opening. The catheter 3 of the present invention includes a tubular mesh member 110 that can be expanded and contracted in the radial direction, a first hollow shaft 120, a distal tip 130, and a portion of which is arranged in a space inside the mesh member 110. A second hollow shaft 340 having a proximal end located outside the mesh member 110 and a distal end connected to the distal end and / or the distal end tip 130 of the mesh member 110, the proximal end being the first hollow shaft. The mesh member 110 and the core wire extending through the inside of the first hollow shaft 120 are provided so as to be located closer to the base end side than the base end of 120.

Description

  The present invention relates to catheters.

  As a medical device for improving blood flow by removing an obstruction that blocks a blood vessel such as chronic total occlusion (CTO), for example, the obstruction part is removed at a site where the obstruction exists in the blood vessel. To expand the mesh-shaped braided wire in the radial direction (see, for example, Patent Document 1), or to provide a cover in the mesh-shaped self-expandable area so that the removed blockage can be collected (for example, Patent Document 2) is known.

  On the other hand, in many cases, it is difficult to remove the occluder with the above-mentioned medical instruments because the occluder is extremely hard. In such a case, the pseudoluminal dilation is performed using the antegrade guide wire. After performing the technique, a technique of conducting a retrograde guide wire through the expanded false cavity, and a technique of expanding a mesh-shaped member and receiving the guide wire through its openings have also been proposed (for example, non-patent document). Reference 1).

Japanese Patent No. 36555920 Special table 2011-517424 gazette

Shinsuke Nanto, “Revised Edition: Basics and Tips for Securely Wearing PCI,” Yodosha, February 25, 2016, p. 222-227

  However, in the conventional technique as described above, the antegrade guide wire and the retrograde guidewire cannot coexist, and the retrograde guidewire is received after the antegrade guidewire is pulled out of the body. However, it is not always efficient because it becomes complicated.

  The present invention has been made based on the above circumstances, and an object thereof is to allow a antegrade guide wire and a retrograde guidewire to coexist, and to perform an operation efficiently and easily. To provide a catheter.

The present invention is
(1) A tubular mesh member that can be expanded and contracted in the radial direction,
A first hollow shaft connected to the proximal end of the mesh member;
A tip tip connected to the tip of the mesh member,
A second hollow shaft, a part of which is arranged in a space inside the mesh member, penetrates through the mesh member, and has a proximal end located outside the mesh member;
The tip of the mesh member and / or the first hollow shaft is connected to the tip of the mesh member and / or the tip, and the base end of the mesh member and the first hollow shaft are located closer to the base end side than the base end of the first hollow shaft. A core wire extending therethrough,
(2) Whether the tip of the second hollow shaft is connected to the tip and the base end of the second hollow shaft is a free end,
The tip of the second hollow shaft is a free end, and the outer circumference of the base end portion of the second hollow shaft is connected to the outer circumference of the mesh member or the first hollow shaft. And (3) the catheter according to (1) or (2), in which the base end of the second hollow shaft is open toward the base end side.

  In the present specification, the “tip side” refers to the direction along the longitudinal direction of the catheter and the direction in which the tip is positioned with respect to the mesh member. The “proximal end side” refers to a direction along the longitudinal direction, which is opposite to the distal end side. The “tip” refers to the end on the tip side in each member that constitutes the catheter. The “proximal end” refers to the end portion on the proximal end side of each member that constitutes the catheter. The “maximum expanded diameter” means the outer diameter of a portion of the mesh member that is orthogonal to the axial direction and has the largest outer diameter when the mesh member is expanded.

  INDUSTRIAL APPLICABILITY The present invention can provide a catheter that can coexist with an antegrade guide wire and a retrograde guide wire and can perform a procedure efficiently and easily.

It is a schematic front view which shows the 1st Embodiment of this invention, Comprising: It is a figure which shows the state which the mesh member reduced in diameter. It is a schematic front view which shows the state which the mesh member of FIG. 1 expanded in diameter. It is a schematic perspective view which shows an example of each strand. It is a schematic perspective view which shows the other example of each strand. It is a schematic sectional drawing which shows the state which joined the strands of FIG. It is a schematic sectional drawing which shows the state which joined the strand of FIG. 3 and the strand of FIG. It is a schematic sectional drawing which shows the other example of a sealing member, (a) has a curved end surface, (b) has a flat end surface, respectively. It is a schematic front view which shows an example of the state in which the 2nd hollow shaft of FIG. 1 was tilted. It is the schematic which shows the joining part of a core wire and a mesh member, (a) the joining part of a core wire is a substantially annular shape, (b) the joining part of a core wire is a substantially C shape, (c)-(. In e), the joint portions are each formed of a substantially annular part. It is a schematic diagram showing other examples of joining of a core wire and a mesh member. FIG. 7 is a schematic view showing a positional relationship between the core wire and the center of gravity of the tip, and is a view showing a cross section of a portion taken along line VII-VII in FIG. 1. It is a schematic front view which shows an example of an induction membrane. It is a schematic sectional drawing cut | disconnected by the IX-IX line of FIG. It is the schematic which shows one suitable aspect of an induction | guidance | derivation membrane. It is the schematic which shows the other suitable aspect of an induction | guidance | derivation membrane. It is a schematic sectional drawing which shows an example of the front-end | tip part of the guidance film of FIG. It is a schematic front view which shows the other example of the front-end | tip part of the guidance film of FIG. It is a schematic sectional drawing cut | disconnected by the XIV-XIV line of FIG. It is a schematic front view which showed the modification of FIG. 1, and is a figure which shows the state which the mesh member reduced in diameter. It is a schematic front view which shows the state which the mesh member of FIG. 19 expanded. It is a schematic front view which shows the use condition of FIG. It is a schematic front view which shows the 2nd Embodiment of this invention, Comprising: It is a figure which shows the state which the mesh member reduced in diameter. It is a schematic sectional drawing which shows a holding member, (a) is an example and (b) has shown the other example, respectively. FIG. 23 is a schematic front view showing another example of FIG. 22, showing a state in which the mesh member has a reduced diameter. It is a schematic front view which shows the state which the mesh member of FIG. 24 expanded. FIG. 23 is a schematic front view showing a modified example of FIG. 22, showing a state in which the mesh member has a reduced diameter. It is a schematic front view which shows the state which the mesh member of FIG. 26 expanded. It is a schematic front view which shows the state which the mesh member of FIG. 22 expanded. It is a schematic front view which shows the 3rd Embodiment of this invention, Comprising: It is a figure which shows the state which the mesh member reduced in diameter. It is a schematic front view which shows the other example of FIG. 29, and is a figure which shows the state which the mesh member reduced in diameter. It is a schematic front view which shows the state which the mesh member of FIG. 30 expanded. It is a schematic front view which shows the state which the mesh member of FIG. 29 expanded in diameter, and is a figure of the state which the antegrade guide wire and the retrograde guide wire have penetrated. FIG. 2 is a schematic front view showing a catheter in which the second hollow shaft of FIG. 1 is not provided, and is a view showing a state in which the mesh member has a reduced diameter. It is a schematic front view which shows the state which the mesh member of FIG. 33 expanded.

  Hereinafter, first to third embodiments of the catheter according to the present invention will be described with reference to the drawings, but the present invention is not limited to the embodiments described in the drawings.

  In the present specification, the term “antegrade guide wire” means, among the guide wires, a guide wire that is pushed forward to a surgical site such as a blockage site in a blood vessel prior to the catheter, and a “retrograde guide wire”. “Of the guide wires, for example, is meant a guide wire coming from the distal end side of the catheter in the blood vessel.

[First Embodiment]
FIG. 1 is a schematic front view showing a first embodiment of the present invention, and is a view showing a state in which a mesh member has a reduced diameter. As shown in FIG. 1, the catheter 1 schematically includes a mesh member 110, a first hollow shaft 120, a distal tip 130, a second hollow shaft 140, a core wire 150, and a guide membrane 160. , Connector 170.

  The mesh member 110 is a tubular member that can be expanded and contracted in the radial direction. When the core wire 150 to be described later is pulled toward the proximal end side, the mesh member 110 expands in diameter by, for example, deforming out-of-plane and expanding outward in the radial direction as shown in FIG. The retrograde guide wire is received in the catheter 1 through the opening m of the member 110.

  In the present embodiment, the mesh member 110 has a plurality of first strands 111 and a plurality of second strands 112, and the first strands 111 and the second strands 112 are knitted in a lattice shape. And is formed into a tubular shape as a whole. Further, the mesh member 110 has a mesh opening m between the adjacent knitted strands, and receives the retrograde guide wire through the expanded mesh opening m when the diameter is expanded. In addition, a tip chip 130 and a first hollow shaft 120, which will be described later, are joined to the tip end and the base end of each element wire that constitutes the mesh member 110.

  Here, each of the strands (the first strand 111 and the second strand 112) forming the mesh member 110 can employ either the single strand a shown in FIG. 3 or a plurality of strands. However, for example, as shown in FIG. 4, a plurality of strands having different wire diameters are twisted, such as a core wire b1 arranged in the central portion and a plurality of side wires b2 arranged so as to surround the core wire b1. It may be formed from the twisted wires b combined (hereinafter, when the twisted wires b as shown in FIG. 4 are used as the first element wires 111 and the second element wires 112, the first twisted wires 111 are respectively formed. , Second twisted wire 112). In such a case, as shown in FIG. 5, at some intersections 110a of the intersections 110a between the first twisted wires 111 and the second twisted wires 112, as shown in FIG. It is preferable that a part of them and a part of some of the plurality of strands forming the second stranded wire 112 (some side wires b2 in the present embodiment) are joined. Further, as shown in FIG. 6, the wires forming the mesh member 110 may be a combination of a single wire a and a twisted wire b. In this case, at some of the intersections 110a of the intersections 110a, the single wire a and some of the plurality of strands of the twisted wire b (some side wires b2 in the present embodiment) are joined. Is preferably provided.

  As described above, since the first element wire 111 and the second element wire 112 are formed of the stranded wire b, the tubular mesh member 110 can be deformable (flexible), and the mesh member 110 The expandability can be improved, and since only some of the strands are joined as described above, unraveling of the first strand 111 and the second strand 112 due to excessive expansion of the mesh member 110 can be prevented. And the mesh member 110 can be safely expanded.

  In addition, the mesh member 110 has a maximum expanded diameter when expanded as shown in FIG. 2, and the joint 110b provided at the intersection 110a between the first twisted wire 111 and the second twisted wire 112 has a maximum expanded diameter. It is more preferable that the number of joints is minimized in the area where Specifically, in the mesh member 110, the number of joints 110b in the circumferential direction of the cross section of the portion having the maximum expansion diameter is smaller than the number of joints 110b in the circumferential direction of the cross section of the remaining portion. Is formed in. Thereby, the expandability of the mesh member 110 can be further improved.

  In addition, the number of joints 110b in the circumferential direction provided at the intersecting portion 110a of the first twisted wire 111 and the second twisted wire 112 is directed to both ends of the mesh member 110 (the front end and the base end of the mesh member 110). It is also preferable that it is increased according to. Accordingly, it is possible to prevent the mesh member 110 from being loosened from both ends, and as a result, it is possible to improve expandability and robustness of the mesh member 110.

  A metal material or a resin material can be used as a material forming each element wire of the mesh member 110. Examples of the metal material include stainless steel such as SUS304, nickel titanium alloy, and cobalt chrome alloy. Examples of the resin material include polyamide, polyester, polyacrylate, and polyether ether ketone. Among these, a metal material is preferable from the viewpoint of improving strength and flexibility. The first strand 111 and the second strand 112 described above, and the core wire b1 and the side wire b2 may be formed of the same material or different materials.

  In addition, the material forming each strand of the mesh member 110 is preferably a radiopaque material from the viewpoint of improving the visibility of the mesh member 110. Examples of the radiopaque material include gold, platinum, tungsten, and alloys containing these elements (eg, platinum-nickel alloy). The radiopaque material may be a combination of the radiopaque material and a material other than this material, such as a material coated on the surface of a material that is not radiopaque.

  The first hollow shaft 120 is a member connected to the base end of the mesh member 110. In the present embodiment, as shown in FIG. 1, the first hollow shaft 120 includes a hollow distal shaft 121 whose distal end is connected to the proximal end of the mesh member 110, and a distal end which is the proximal end of the distal shaft 121. And a hollow proximal shaft 123 connected to the.

  The distal shaft 121 has a lumen 122 therein so that a retrograde guide wire and a core wire 150, which will be described later, can be inserted therethrough. The proximal shaft 123 has a lumen 124 therein so that the core wire 150 can be inserted therethrough. In addition, at the connecting portion 125 between the distal shaft 121 and the proximal shaft 123, the proximal end of the distal shaft 121 is formed with an opening 126 that opens toward the proximal side. A retrograde guide wire is delivered to the outside of the catheter 1 via the.

  Here, in the connecting portion 125 between the distal end side shaft 121 and the proximal end side shaft 123 described above, inside the distal end of the proximal end side shaft 123, as shown in FIG. It is preferable that a cylindrical sealing member 127 on which the core wire 150 is slidable in the axial direction is arranged. As a result, the gap between the outer circumference of the core wire 150 and the inner circumference of the sealing member 127 can be reduced, and the end portion of the retrograde guide wire (not shown) can be prevented from entering the proximal shaft 123. As a result, damage to the first hollow shaft 120 and the retrograde guide wire can be prevented.

  Further, it is preferable that the above-mentioned sealing member 127 has a volume that increases from the distal end toward the proximal end side, and that the end surface 127 a on the distal end side of the sealing member 127 is inclined so as to approach the opening 126. Specifically, the end surface 127 a of the sealing member 127 is exposed to the lumen 122, and the end surface 127 a is inclined toward the opening 126 so that the retrograde guide wire can smoothly pass through the opening 126. Has been formed. This can prevent the end of the retrograde guidewire from catching on the tip of the proximal shaft 123 and easily guide the retrograde guidewire to the opening 126. As a result, damage to the first hollow shaft 120 and the retrograde guide wire can be prevented. As the sealing member, as shown in FIG. 7 (a), the shape of the end surface 128a on the tip side is a curved shape, and the shape of the end surface 129a on the tip side as shown in FIG. 7 (b). May be a sealing member 129 or the like having a planar shape perpendicular to the axial direction.

  The sealing member 127 may be made of any material as long as the core wire 150 is slidable. For example, polyamide resin, polyolefin resin, polyester resin, polyurethane resin, silicone resin, fluororesin, polyamide elastomer, polyolefin elastomer, polyester elastomer. , Resins such as polyurethane elastomers.

  As the material forming the first hollow shaft 120, since the first hollow shaft 120 is inserted into a blood vessel, it is preferable that the material has antithrombogenicity, flexibility, and biocompatibility. A resin material or a metal material can be adopted. Since flexibility is required for the distal shaft 121, it is preferable to employ a resin material such as polyamide resin, polyolefin resin, polyester resin, polyurethane resin, silicone resin, or fluororesin. Since pushability is required for the proximal shaft 123, it is preferable to use a metal tube such as a hypotube.

  The tip chip 130 is a member connected to the tip of the mesh member 110. Specifically, the distal tip 130 is formed in a sharp shape toward the distal end side so that the catheter 1 can easily move through the blood vessel, and the proximal end of the distal tip 130 is provided with the mesh member 110. The tip of each strand and the tip of a second hollow shaft 140, which will be described later, are buried.

  The material forming the distal tip 130 is preferably flexible because the catheter 1 advances in the blood vessel. Examples of the material having the flexibility include resin materials such as polyurethane and polyurethane elastomer.

  The second hollow shaft 140 is connected to the distal end tip 130, and protrudes toward the proximal end side in the space inside the mesh member 110. As shown in FIG. 1, the proximal end of the second hollow shaft 140 is located between the distal end of the first hollow shaft 120 and the proximal end of the distal tip 130 in the space inside the mesh member 110. In addition, the base end of the second hollow shaft 140 can be separated from the core wire 150 without being restricted by the core wire 150. Therefore, when pulling the core wire 150 toward the base end side, as shown in FIG. 2, the second hollow shaft 140 is tilted with respect to the axial direction of the mesh member 110, and the base of the second hollow shaft 140 is pulled. The ends press the inner circumference of the mesh member 110 toward the radially outer side to promote the expansion of the diameter of the mesh member 110. On the other hand, even when the second hollow shaft 140 is tilted but its base end does not contact the inner circumference of the mesh member 110, as shown in FIG. It can be expanded asymmetrically, making retrograde guidewires more acceptable.

  As the material forming the second hollow shaft 140, since the second hollow shaft 140 is also inserted into the blood vessel like the first hollow shaft 120 described above, the anti-thrombogenicity, flexibility, and living body It is preferably compatible. Examples of the material include the same materials as those exemplified in the description of the first hollow shaft 120, but a resin material is preferable from the viewpoint of flexibility.

  The core wire 150 is connected at its tip to the tip of the mesh member 110 and / or the tip 130, and its proximal end is positioned closer to the proximal side than the proximal end of the first hollow shaft 120 is. It is a member extending through the inside of the hollow shaft 120. Specifically, the core wire 150 includes a space outside the second hollow shaft 140 inside the mesh member 110, an inside of the first hollow shaft 120, and an outside through a through hole 171 of a connector 170 (described later). Extends to. By operating the core wire 150 outside the connector 170, the core wire 150 advances and retracts in the axial direction, and the mesh member 110 expands and contracts in the radial direction.

  The material forming the core wire 150 preferably has sufficient tensile strength and rigidity from the viewpoint of preventing the core wire 150 itself from being cut and reliably expanding and contracting the mesh member 110. Examples of the above-mentioned material include stainless steel such as SUS304, metallic materials such as nickel-titanium alloy, cobalt-chromium alloy, and the like.

  Here, the mesh member 110 and the core wire 150 are formed of a metal material, and as shown in FIG. 9, the tip of the core wire 150 is located at the tip of the mesh member 110 in the axial direction, and the tip portion of the core wire 150 is located. It is preferable that the joint portion d is formed by joining the end portion of the mesh member 110 with the joint portion d. Since the joint part d is formed in this way, the mesh member 110 and the core wire 150 can be strongly connected, and the core wire 150 is prevented from coming off from the mesh member 110 when the mesh member 110 is expanded. can do.

  The cross-sectional shape of the joint portion d is not particularly limited, but from the viewpoint of improving the joint strength between the mesh member 110 and the core wire 150, a substantially annular shape obtained by joining the cylindrical member 153 to the core wire 150 (see FIG. )) Or a substantially C shape integrally formed with the core wire 151 (see FIG. 9B). The shape of the joint portion d is, for example, the core wire 152 from the viewpoint of improving flexibility of the tip chip 130 in a state of being joined to the tip chip 130 and improving joint strength between the core wire 150 and the tip chip 130. An integrally formed shape (see FIG. 9C), a shape in which a plurality of cylindrical members 154 are joined to the core wire 150 (see FIG. 9D), and a member 155 in which a part of the cylindrical shape is cut out are provided. A shape (see FIG. 9E) joined to the core wire 150 may be adopted. Further, the joint portion d may be arranged on either the outer circumference of the tip portion of the mesh member 110 (see FIG. 9A) or the inner circumference of the tip portion (see FIG. 10). Thereby, when pulling the mesh member 110 toward the base end side, a force can be more uniformly applied to the tip end portion of the mesh member 110, and the mesh member 110 and the core wire 150 can be connected more strongly without breaking. You can

  Note that, as shown in FIG. 11, at a portion where the core wire 150 is connected to the tip chip 130 and / or the mesh member 110, the projection position p1 on the transverse plane orthogonal to the axial direction is the center of gravity of the tip chip 130. Is preferably eccentric with respect to the projected position p2 on the cross-section, but may be eccentric with respect to the projected position (not shown) on the cross-section of the center of gravity of the second hollow shaft 140. Accordingly, when the core wire 150 is pulled toward the proximal end side to expand the diameter of the mesh member 110, the second hollow shaft 140 is easily tilted with respect to the axial direction of the mesh member 110 (second with respect to the center of gravity). The hollow shaft 140 can be rotated). As a result, the proximal end of the second hollow shaft 140 can be easily brought into contact with the mesh member 110 to reliably press the inner periphery of the mesh member 110, and the diameter expansion of the mesh member 110 can be promoted.

  As shown in FIGS. 1 and 12, the guiding film 160 is disposed on the mesh member 110, and the leading end of the guiding film 160 is located between the proximal end of the distal tip 130 and the leading end of the first hollow shaft 120. There is. The guide film 160 smoothly guides the retrograde guide wire received through the opening m of the mesh member 110 toward the first hollow shaft 120. The guide membrane 160 of the present embodiment is shown in FIG. 13 in a region extending from the substantially central portion in the axial direction of the mesh member 110 where the tip is located to the tip of the first hollow shaft 120 where the base end of the guide membrane 160 is located. As described above, it is formed on the mesh member 110 so as to bridge the adjacent element wires 111 and 112. Here, the retrograde guide wire is guided into the first hollow shaft 120 through the mesh member 110 by expanding the guide film 160 in a funnel shape when the diameter of the mesh member 110 is expanded. At least a part of the guide film 160 (for example, the outer circumference of the tip of the guide film 160) may be bonded to the mesh member 110, and may be, for example, a film (not shown).

  Examples of the material forming the induction film 160 include polyethylene, polyurethane, polyamide, polyamide elastomer, polyolefin, polyester, polyester elastomer and the like. Among these, polyurethane is preferable as the above material from the viewpoint of improving the sliding property of the surface.

  The method of forming the guiding film 160 is not particularly limited, and for example, a dipping method is used for the guiding film arranged on the mesh member 110, and a method of fusing the tip of the film to the mesh member 110 for the film-shaped guiding film. be able to.

  Here, the guide film 160 is formed of a stretchable material, is disposed on the mesh member 110, and has a tip positioned between the base end of the tip tip 130 and the tip of the first hollow shaft 120. As shown in FIG. 14, it is preferable that the film thickness at the base end of the guide film 160 is thicker than the film thickness at the tip of the guide film 160 (the guide film having this configuration is hereinafter also referred to as “guide film A”). Such a guiding film A is formed by, for example, using the above-mentioned dipping method, by lifting the mesh member from the immersion bath, and then curing the mesh member 110 with the base end side thereof facing vertically downward. You can This allows the mesh member 110 to be easily expanded by the amount that the thickness of the leading end of the guiding film A is smaller than the thickness of the proximal end, and the thickness of the proximal end of the guiding film A is thicker than the thickness of the leading end. Accordingly, it is possible to reduce damage to the guide film A due to contact with the retrograde guide wire.

  Note that, as shown in FIG. 2, it is also preferable that the tip of the guiding film A is located at a portion where the mesh member 110 has the maximum expansion diameter when the mesh member 110 expands. As a result, the funnel-shaped guiding membrane 160 can be expanded to the maximum extent, and the received retrograde guide wire can be easily guided to the first hollow shaft 120.

  It is also preferable that the film thickness of the guide film A increases from the distal end to the proximal end (see the solid line and the broken line in FIG. 14), and the expanded diameter of the mesh member 110 is from the maximum expanded diameter. It decreases toward the base end (see the alternate long and short dash line in FIG. 14), and the film thickness of the guide film 160 increases from the front end to the base end in inverse proportion to the decrease in the expanded diameter of the mesh member 110 (FIG. 14). 14) is also preferable. Accordingly, the mesh member 110 can be easily expanded, and the guide film 160 can be prevented from being broken even when the retrograde guide wire comes into contact with the proximal end portion of the guide film 160 with a high load.

  On the other hand, the guide membrane 160 is arranged on the mesh member 110 and has its tip located between the base end of the tip tip 130 and the tip of the first hollow shaft 120, as shown by the solid line and the broken line in FIG. It is also preferable that the film thickness at the tip of the guide film 160 is thicker than the film thickness of the part where the film thickness of the guide film 160 is the smallest (the guide film having this structure is also referred to as “guide film B” hereinafter). As shown in FIG. 16, such a guide film B is formed by forming a guide film 160a having a uniform thickness and then forming a guide film on the tip of the guide film 160a having a uniform thickness by a coating method. It is possible to form the guiding film 160 by applying the padding 160b of the material or by forming the guiding film using the dipping method described above and then applying the padding 160b in the same manner as above. Thereby, even if the retrograde guide wire contacts the tip of the guide film 160 by the amount that the tip of the guide film 160 is thicker than the thinnest portion, damage to the guide film 160 is suppressed. be able to. Further, the same effect can be obtained by making the thickness of the leading end of the guiding film 160 thicker than the thickness of other portions of the guiding film 160.

  As shown in FIG. 17, the guide film B closes some openings m of the plurality of openings m formed between the first element wire 111 and the second element wire 112. The leading end of the guide film 161 is located at the intersection 110a between the first element wire 111 and the second element wire 112, and the openings m1 and m2 adjacent to each other in the circumferential direction of the intersection part 110a are opened. It is also preferable. In the guide film B of such an aspect, all the ends of the guide film 161 existing in the opening m are framed by the wires (the first wire 111 and the second wire 112) (the end of the guide film 161). All parts are joined to the wire). Accordingly, even when the retrograde guide wire comes into contact with the tip of the guiding film 161, damage of the guiding film 161 can be further suppressed, and the guiding film 161 is prevented from peeling from the mesh member 110. be able to.

  It is also preferable that the thickness of the guide film B is thickest at the intersection 110a between the wires 111 and 112, as shown in FIG. Thereby, even when the retrograde guide wire comes into contact with the tip of the guiding film 161, it is possible to suppress damage to the guiding film 161.

  It is also preferable that the outer periphery of the intersection 110a of the first element wire 111 and the second element wire 112 at the tip of the guide film B is covered with a guide film 161 as shown in FIG. 18 (b). Accordingly, even when the retrograde guide wire comes into contact with the tip of the guiding film 161, damage of the guiding film 161 can be further suppressed, and the guiding film 161 is prevented from peeling from the mesh member 110. be able to.

  As described above, in the catheter 1, by disposing the guide membrane 160 on the mesh member 110, the retrograde guide wire can be easily and reliably guided to the first hollow shaft 120 along the guide membrane 160.

  The connector 170 is a member by which an operator holds the catheter 1. As shown in FIG. 1, the connector 170 is connected to the proximal end of the first hollow shaft 120 and communicates with the lumens 122, 124 of the first hollow shaft 120 so that the core wire 150 can be exposed to the outside. It has a through hole 171 and an opening 172 formed at the base end of this through hole 171. The shape of the connector 170 is not particularly limited and may be any shape as long as it is easy for the operator to grip.

  As shown in FIGS. 19 and 20, the catheter 1 has a core wire positioned inside the tip of the guide membrane 160 when the diameter of the mesh member 110 is expanded, and more preferably when the diameter of the mesh member 110 is optimally expanded. It is preferable to have a marker 180 formed of a radiopaque material at 150 sites, and the marker 180 and the radiation formed of a radiopaque material provided at the tip of the guiding film 160. It is more preferable to have the impermeable part 160a. When a resin material is used, the marker 180 is formed by mixing, for example, a polyamide resin, a polyolefin resin, a polyester resin, a polyurethane resin, a silicone resin, or a fluororesin with a radiopaque material such as bismuth trioxide, tungsten, or barium sulfate. When a metal material is used, it is preferably formed of, for example, a radiopaque material such as gold, platinum, tungsten, or an alloy containing these elements (for example, a platinum nickel alloy or the like). When a resin material is used as the radiation opaque material, the radiation opaque portion 160a is preferably formed by mixing a radiation opaque material such as bismuth trioxide, tungsten, or barium sulfate at the tip of the guiding film 160, and a metal material. When using, a radiopaque material such as gold, platinum, tungsten, or an alloy containing these elements (for example, a platinum nickel alloy) is preferably joined to the tip end portion of the induction film 160. This allows the marker 180 and the tip of the guide film 160 to be easily recognized under the perspective of radiation such as X-rays, so that the marker 180 is positioned inside the radiopaque portion 160a at the tip of the guide film 160. By pulling the core wire 150 to the inner side, the diameter of the mesh member 110 can be optimally expanded, and the retrograde guide wire can be easily guided to the inside of the guide film 160 by using the radiopaque portion 160a as a clue. The guide film 160 can be prevented from being damaged by preventing contact between the guide film 160 and the retrograde guide wire. In the present specification, “optimum diameter expansion” means maximally expanding the diameter of the mesh member 110 so as to easily receive the retrograde guide wire within a range in which the guide membrane 160 is not damaged due to excessive expansion. Means that.

  Next, a usage mode of the catheter 1 described above will be described. The catheter 1 can be used not only for receiving the retrograde guide wire W2 (usage mode 1) but also for removing an occlusion (usage mode 2). Hereinafter, usage modes 1 and 2 will be described.

(Use mode 1)
In the usage mode 1, the catheter 1 is used to receive the retrograde guide wire W2. In this usage mode 1, first, the antegrade guide wire W1 (not shown) is inserted into, for example, a blood vessel, and then pushed along the blood vessel to a site where an occluded object exists (hereinafter, also referred to as “occlusion site”).

  Next, after the distal end of the antegrade guide wire W1 reaches the occlusion site, the proximal end of the antegrade guide wire W1 is inserted into the through hole at the distal end of the second hollow shaft 140, and the antegrade guide wire W1 is inserted. As a guide, the tip of the catheter 1 is pushed into the blood vessel to the occluded site. At this time, the catheter 1 is inserted into a blood vessel in a state where the mesh member 110 has a reduced diameter, and the reduced diameter state is maintained until the tip of the catheter 1 reaches the occlusion site.

  Next, as described above, after the distal end of the catheter 1 reaches the occlusion site, the antegrade guidewire W1 is pulled toward the proximal side with respect to the catheter 1 so that the antegrade guidewire W1 is removed. Pull out from. Next, by pulling the core wire 150 exposed to the outside of the connector 170 toward the proximal end side, the distance between the tip of the mesh member 110 and the tip of the first hollow shaft 120 is narrowed, and as a result, the mesh member 110 is reduced in diameter. It expands out-of-plane and expands in diameter. At this time, since the mesh opening m is expanded as the diameter of the mesh member 110 is expanded, it becomes easy to receive the retrograde guide wire W2. Further, the inner circumference of the mesh member 110 is pressed outward in the radial direction due to the tilting of the second hollow shaft 140, whereby the diameter expansion of the mesh member 110 is promoted. In addition, in the present embodiment, since the leading end of the guiding film 160 is joined to the substantially central portion in the axial direction of the mesh member 110, the guiding film 160 is expanded in diameter in accordance with the expansion of the mesh member 110, and the guiding film 160. Becomes funnel shape as a whole.

  Next, as shown in FIG. 21, the retrograde guide wire W2 coming from the distal end side is received in the catheter 1. As the route through which the retrograde guide wire W2 goes, for example, a false cavity in the blood vessel wall surrounding the occlusion site, a through hole penetrating the occlusion site, or the like is assumed. It may be the wire W2. The retrograde guide wire W2 is received in the space inside the mesh member 110 through the opening m of the expanded mesh member 110, and then inserted through the opening 120a of the first hollow shaft 120 into the distal shaft 121. , Is delivered to the outside of the catheter 1 through the opening 126. Next, the retrograde guide wire W2 delivered from the opening 126 passes through the blood vessel, and then the end portion is delivered outside the body. As a result, it is possible to create a state in which the retrograde guide wire W2 penetrates the closed site and both ends of the retrograde guide wire W2 are exposed outside the body.

  As described above, the catheter 1 can receive the retrograde guide wire W2 and guide the end portion to the outside of the body, and thus can be suitably used as a medical device combined with the retrograde guide wire W2.

(Use mode 2)
In the usage mode 2, the catheter 1 is used to remove the occluded material with the antegrade guide wire W1 and the like. In the usage mode 2, the method of inserting the antegrade guide wire W1 and the catheter 1 and the method of expanding the diameter of the mesh member 110 are the same as the above-described methods, and therefore the description thereof is omitted here. In this usage mode 2, first, the same operation as in usage mode 1 is performed to make the antegrade guide wire W1 and the catheter 1 reach the occlusion site. Next, the core wire 150 is operated to expand the diameter of the mesh member 110. The antegrade guide wire W1 is not pulled out from the catheter 1.

  Next, the occluded material is crushed using the antegrade guide wire W1 and the like. At this time, the crushed occluded matter is taken into the space inside the mesh member 110 through the opening m of the expanded mesh member 110 and then guided into the first hollow shaft 120 through the opening 120a. , Passes through the first hollow shaft 120 and is discharged outside the body.

  As described above, the catheter 1 can crush the occluded substance in the blood vessel and remove the occluded substance to the outside of the body, and thus can be suitably used as a medical instrument for removing the occluded substance.

  As described above, since the catheter 1 has the above-described configuration, when the diameter of the mesh member 110 is expanded by pulling the core wire 150 toward the base end side, the base end of the second hollow shaft 140 is separated from the core wire 150. Since they can be separated from each other, the mesh member 110 can be easily expanded in diameter by pressing the inner circumference of the mesh member 110. Even when the base end of the second hollow shaft 140 does not contact the inner circumference of the mesh member 110, the space inside the expanded mesh member 110 can be expanded asymmetrically, and the retrograde guide can be used. The wire may be more receptive.

[Second Embodiment]
FIG. 22 is a schematic front view showing the second embodiment of the present invention, and is a view showing a state where the mesh member has a reduced diameter. As shown in FIG. 22, the catheter 2 includes a mesh member 110, a first hollow shaft 120, a distal tip 130, a second hollow shaft 240, a core wire 250, and a holding member 280. , A guide film 160 and a connector 170 (not shown). The second embodiment is different from the first embodiment in that the second hollow shaft 240, the core wire 250, and the holding member 280 are provided. Since the configurations of the mesh member 110, the first hollow shaft 120, the tip tip 130, the guiding film 160 and the connector 170 are the same as those of the first embodiment, the same parts are designated by the same reference numerals. The detailed description thereof will be omitted. Further, the materials of the second hollow shaft 240 and the core wire 250 are the same as those of the first embodiment, so the description of the first embodiment is cited and the detailed description thereof is omitted.

  The second hollow shaft 240 is connected to the distal end tip 130 and protrudes toward the proximal end side in the space inside the mesh member 110, and the proximal end has the distal end of the first hollow shaft 120 and the proximal end of the distal end tip 130. It is a member located between and.

  The core wire 250 has a distal end connected to the distal end of the mesh member 110 and / or the distal end tip 130, a proximal end located closer to the proximal end side than a proximal end of the first hollow shaft 120, and an outer circumference of the second hollow shaft 240. Is a member that extends along and through the interior of the mesh member 110 and the first hollow shaft 120.

  The holding member 280 is a member that is provided in the core wire 250 and covers the second hollow shaft 240, and has a substantially annular shape or a substantially C shape in cross-sectional view (see FIGS. 23A and 23B). The holding member 280 covers the outer periphery of the second hollow shaft 240, and the second hollow shaft 240 can move relative to the holding member 280 in the axial direction. Note that, in the present embodiment, as shown in FIG. 22, the holding member 280 is provided so as to cover the base end of the second hollow shaft 240, but the base end of the second hollow shaft 240 is held by the holding member 280. The holding member moved from the proximal end to the distal end side of the second hollow shaft 240, as shown in FIGS. 24 and 25, as long as they can move together without being separated from the core wire 250. It may be provided so as to cover the portion.

  Examples of the material forming the holding member 280 include resin materials such as polyamide resin, polyolefin resin, polyester resin, polyurethane resin, silicone resin, and fluororesin, stainless steel such as SUS304, nickel titanium alloy, and cobalt chromium alloy. The metal material of can be adopted.

  In the catheter 2, the holding member 280 preferably contains a radiopaque material, and as shown in FIGS. 26 and 27, the holding member 280 containing the radiopaque material and the guiding film 160. It is more preferable to have a radiopaque portion 160a provided at the tip portion and formed of a radiopaque material. When the holding member 280 is made of the above resin material, it is preferable to mix the holding member 280 with a radiopaque material such as bismuth trioxide, tungsten or barium sulfate. When the holding member 280 is made of a metal material. For example, it is preferably formed of a radiopaque material such as gold, platinum, tungsten, or an alloy containing these elements (for example, a platinum nickel alloy). As for the configuration of the radiation opaque portion 160a, when a resin material is used as the radiation opaque material, it is preferable to mix a radiation opaque material such as bismuth trioxide, tungsten, or barium sulfate at the tip portion of the induction film 160, and a metal material. When using, a radiopaque material such as gold, platinum, tungsten, or an alloy containing these elements (for example, a platinum nickel alloy) is preferably joined to the tip end portion of the induction film 160. In the catheter 2, as shown in FIGS. 26 and 27, the holding member 280 is placed inside the tip of the guide membrane 160 when the diameter of the mesh member 110 is expanded, and more preferably when the diameter of the mesh member 110 is optimally expanded. It is preferably located. This allows the holding member 280 and the leading end of the guiding film 160 to be easily recognized under the perspective of radiation such as X-rays, so that the holding member 280 is positioned inside the radiation opaque portion 160a at the leading end of the guiding film 160. By pulling the core wire 250 as described above, the mesh member 110 can be optimally expanded in diameter, and the retrograde guide wire can be easily guided to the inside of the guide film 160 by using the radiopaque portion 160a as a clue. It is possible to prevent contact between the guide film 160 and the retrograde guide wire and prevent damage to the guide film 160.

  Next, the operation of the catheter 2 in use will be described. For example, after operating the catheter 2 in the same manner as in the usage mode 1 described above to reach the closed site, the core wire 250 is operated to expand the diameter of the mesh member 110 as shown in FIG. 28. At this time, since the base end of the second hollow shaft 240 is covered with the holding member 280, the second hollow shaft 240 does not tilt and the base end of the second hollow shaft 240 and the mesh member are not tilted. The mesh member 110 is expanded in the axial direction by being pulled toward the base end side without making contact with 110. As a result, it becomes possible to receive the retrograde guide wire W2 through the opening m of the mesh member 110.

  As described above, in the catheter 2, since the second hollow shaft 240, the core wire 250, and the holding member 280 have the above-described configurations, the holding member 280 does not separate the proximal end of the second hollow shaft 240 from the core wire 250. In addition, these can be integrally moved, and the second hollow shaft 240 can be prevented from breaking through the guiding film 160 because the base end of the second hollow shaft 240 is not separated from the core wire 250. When the outer periphery of the second hollow shaft 240 is covered with the holding member 280, the core wire 250 at the base end of the second hollow shaft 240 does not come in contact with the guiding membrane 160 so that the base end of the second hollow shaft 240 does not contact the guide wire 250. May be configured so that the separation between the two is limited.

[Third Embodiment]
FIG. 29 is a schematic front view showing the third embodiment of the present invention, and is a view showing a state in which the mesh member has a reduced diameter. As shown in FIG. 29, the catheter 3 includes a mesh member 110, a first hollow shaft 120, a distal tip 130, a second hollow shaft 340, a core wire 150, and a guide membrane 160. , And a connector 170 (not shown). The third embodiment is different from the first embodiment in that the second hollow shaft 340 is provided. Since the configurations of the mesh member 110, the first hollow shaft 120, the tip chip 130, the core wire 150, the guiding film 160 and the connector 170 are the same as those of the first embodiment, the same parts are designated by the same reference numerals. The detailed description is omitted. Moreover, since the material of the second hollow shaft 340 is the same as that of the first embodiment, the description of the first embodiment is applied and the detailed description thereof is omitted.

  The second hollow shaft 340 is a member that is partially disposed in the space inside the mesh member 110, penetrates the mesh member 110, and has a proximal end located outside the mesh member 110. Note that the above-mentioned "the base end is located outside the mesh member" means that the base end 341a of the second hollow shaft 341 is located on the outer periphery of the mesh member 110, as shown in FIGS. 30 and 31. It is a concept that includes.

  Here, as for the 2nd hollow shaft 340, both ends of the 2nd hollow shaft 340 may be being fixed to other members (for example, tip tip 130, mesh member 110, the 1st hollow shaft 120, etc.). However, the distal end of the second hollow shaft is connected to the distal end tip 130 and the proximal end of the second hollow shaft is the free end, or the distal end of the second hollow shaft is the free end, and the second hollow shaft is It is preferable that the outer periphery of the base end portion of the above is connected to the outer periphery of the mesh member 110 or the first hollow shaft 120. Accordingly, since only one of the distal end and the proximal end of the second hollow shaft 340 is connected to the other member, it is possible to prevent the second hollow shaft 340 from being broken when the mesh member 110 is expanded. Therefore, the passability of the antegrade guide wire W1 can be secured and the procedure can be performed stably and efficiently.

  Further, it is preferable that the base end of the second hollow shaft 340 is open toward the base end side. Accordingly, when the proximal end of the antegrade guide wire W1 is inserted into the distal end of the second hollow shaft 340 by a technique, the proximal end of the antegrade guide wire W1 is opened at the proximal end of the second hollow shaft 340. The operator quickly recognizes the position of the proximal end of the antegrade guide wire W1 by an amount corresponding to the distance from the catheter 3 to the proximal end side of the catheter 3, and easily and reliably grasps the proximal end of the antegrade guide wire W1. You can As a result, it is possible to efficiently perform the procedure using the catheter 3.

  In the present embodiment, as shown in FIG. 29, in the catheter 3, the distal end of the second hollow shaft 340 is a free end and the distal end side of the second hollow shaft 340 is arranged in the space inside the mesh member 110. ing. The second hollow shaft 340 penetrates the mesh opening m of the mesh member 110 in the middle of the axial direction, and the base end of the second hollow shaft 340 is located outside the mesh member 110 and the base end portion thereof is located. Is joined to the outer circumference of the first hollow shaft 120. The second hollow shaft 340 is provided at its base end with an opening 340a that opens toward the base end.

  As shown in FIGS. 29 to 32, the catheter 3 has a core wire positioned inside the tip of the guide membrane 160 when the mesh member 110 is expanded, more preferably when the mesh member 110 is optimally expanded. It is preferable to have a marker 180 formed of a radiopaque material at 150 sites, and the marker 180 and the radiation formed of a radiopaque material provided at the tip of the guiding film 160. It is more preferable to have the impermeable part 160a. As the configurations of the marker 180 and the radiopaque portion 160a, for example, the same configurations as those described in the first embodiment can be adopted. This allows the marker 180 and the tip of the guide film 160 to be easily recognized under the perspective of radiation such as X-rays, so that the marker 180 is positioned inside the radiopaque portion 160a at the tip of the guide film 160. By pulling the core wire 150 to the inner side, the diameter of the mesh member 110 can be optimally expanded, and the retrograde guide wire can be easily guided to the inside of the guide film 160 by using the radiopaque portion 160a as a clue. The guide film 160 can be prevented from being damaged by preventing contact between the guide film 160 and the retrograde guide wire.

  Next, the operation of the catheter 3 in use will be described. For example, after operating the catheter 3 in the same manner as in the usage mode 1 described above to reach the occlusion site, as shown in FIG. 32, the antegrade guide wire W1 is not pulled out from the second hollow shaft 340, but the core wire is pulled out. The diameter of the mesh member 110 is expanded by operating 150. At this time, since the proximal end of the second hollow shaft 340 is located outside the mesh member 110, the antegrade guide wire W1 does not exist inside the first hollow shaft 120. Therefore, the retrograde guidewire W2 received through the opening m of the mesh member 110 and inserted into the first hollow shaft 120 coexists with the antegrade guidewire W1 in the first hollow shaft 120. It can be smoothly delivered from the opening 126 without performing.

  As described above, in the catheter 3, since the mesh member 110, the distal tip 130, the second hollow shaft 340, and the guiding membrane 160 have the above-described configurations, the antegrade guidewire W1 moves the first hollow shaft 120. Since it does not pass, the retrograde guidewire W2 can be guided to the first hollow shaft 120 while the antegrade guidewire W1 is passed through the second hollow shaft 340, and the procedure can be performed efficiently and easily. .

  It should be noted that the present invention is not limited to the configurations of the above-described embodiments, and is shown by the scope of the claims, and is intended to include all modifications within the scope and meaning equivalent to the scope of the claims. To be done. Part of the configuration of the above-described embodiment may be deleted, replaced with another configuration, or another configuration may be added to the configuration of the above-described embodiment.

  For example, in the first embodiment, the catheter 1 provided with the second hollow shaft 140 has been described, but for example, the catheter 4 not provided with the second hollow shaft 140 as shown in FIGS. 33 and 34 is also applicable. It is within the intended scope of the invention.

1, 2, 3, 4 Catheter p1, p2 Projection position W1 Prograde guide wire W2 Retrograde guide wire 110 Mesh member 111 First strand 112 Second strand 110a Intersection 110b Joint m, m1, m2 Opening of openings 120 1st hollow shaft 121 Tip side shaft 123 Base end side shaft 126 Opening 127, 128, 129 Sealing member 130 Tip tip 140, 240, 340, 341 2nd hollow shaft 150, 250 Core wire 280 Holding member 160, 161 Induction membrane

Claims (3)

A tubular mesh member that can be expanded and contracted in the radial direction,
A first hollow shaft connected to the proximal end of the mesh member;
A tip tip connected to the tip of the mesh member,
A second hollow shaft, a part of which is arranged in a space inside the mesh member, penetrates through the mesh member, and has a proximal end located outside the mesh member;
A tip of the mesh member and the first hollow shaft is connected to a tip of the mesh member and / or the tip, and a base end of the mesh member and the first hollow shaft is located closer to the base end than the base end of the first hollow shaft. A core wire extending therethrough. A distal end of the second hollow shaft is connected to the distal tip, and a proximal end of the second hollow shaft is a free end,
The distal end of the second hollow shaft is a free end, and the outer periphery of the base end portion of the second hollow shaft is connected to the mesh member or the outer periphery of the first hollow shaft. catheter.   The catheter according to claim 1 or 2, wherein the base end of the second hollow shaft is open toward the base end side.

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