JPWO2018193604A1 - catheter - Google Patents

Abstract

An object of the present invention is to provide a catheter capable of preventing a core wire from coming off from a mesh member when the mesh member is expanded. The catheter 1 of the present invention is made of a metal material and has a tubular mesh member 110 that can be radially expanded and contracted, a first hollow shaft 120, a distal tip 130 connected to the distal end of the mesh member 110, The mesh member 110 and the first hollow shaft 120 are formed of a material such that the distal end is located at the distal end of the mesh member 110 and the proximal end is located closer to the proximal end than the proximal end of the first hollow shaft 120. A core wire 150 extending through the inside thereof, and a joining portion is formed by joining a tip portion of the core wire 150 and a tip portion of the mesh member 110.

Description

  The present invention relates to catheters.

  As a medical device for improving blood flow by removing an obstruction obstructing a blood vessel such as chronic total occlusion (CTO), for example, removing the obstruction at a site where an obstruction exists in a blood vessel. For example, a mesh-shaped braided wire is expanded in the radial direction (for example, see Patent Document 1), or a mesh-shaped self-expandable area is provided with a cover so as to be able to collect the removed obstruction (for example, Patent Document 2) is known.

  On the other hand, since the obstruction is very hard, it is often difficult to remove the obstruction with the medical device as described above, and in such a case, the false lumen dilation is performed using a antegrade guide wire. After that, a technique of conducting a retrograde guide wire through the expanded false lumen, and a technique of expanding a mesh-like member to receive the guide wire through an opening thereof have been proposed (for example, non-patented). Reference 1).

Japanese Patent No. 3655920 JP 2011-517424 A

Shinsuke Minato, “Revised Edition: Basics and Tips for PCI to Be Surely Acquired,” Yodosha, February 25, 2016, p. 222-227

  However, when expanding the mesh-like member as described above, there is a possibility that the mesh-like member cannot be sufficiently expanded in a narrow blood vessel, and it cannot always be said that the retrograde guidewire can be reliably received. It is also required that the core wire can be prevented from coming off from the mesh member when the mesh member is expanded.

  The present invention has been made based on the above circumstances, and an object of the present invention is to provide a catheter capable of preventing a core wire from coming off from a mesh member when the mesh member is expanded.

The present invention
(1) a tubular mesh member formed of a metal material and expandable and contractable in a radial direction;
A first hollow shaft connected to a proximal end of the mesh member;
A tip tip connected to the tip of the mesh member,
The mesh member and the first hollow shaft such that the mesh member and the first hollow shaft are formed of a metal material, and a distal end is located at a distal end of the mesh member, and a proximal end is located closer to a proximal end than a proximal end of the first hollow shaft. A core wire extending through the interior of the
A catheter having a joint formed by joining a distal end of the core wire and a distal end of the mesh member; and (2) the joint has a substantially annular or substantially C-shaped cross-sectional shape, and The catheter according to the above (1), which is arranged on the outer periphery or the inner periphery of a distal end portion of the mesh member.

  In this specification, the “distal end side” refers to a direction along the longitudinal direction of the catheter and a direction in which the distal end tip is positioned with respect to the mesh member. The term "proximal side" refers to a direction along the longitudinal direction and opposite to the distal side. The “tip” refers to an end on the tip side of each member constituting the catheter. The “proximal end” refers to the proximal end of each member constituting the catheter. The “maximum expanded diameter” means the outer diameter of a portion where the outer diameter of the mesh member, which is orthogonal to the axial direction, is maximized when the mesh member is expanded.

  The present invention can provide a catheter capable of preventing a core wire from being detached from a mesh member when the mesh member is expanded.

It is a schematic front view showing a 1st embodiment of the present invention, and is a figure showing the state where the diameter of the mesh member was reduced. FIG. 2 is a schematic front view showing a state where the diameter of the mesh member of FIG. 1 is expanded. 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. FIG. 5 is a schematic cross-sectional view showing a state where the strands of FIG. 4 are joined together. FIG. 5 is a schematic sectional view showing a state where the strand of FIG. 3 and the strand of FIG. 4 are joined. It is the schematic sectional drawing which shows the other example of a sealing member, (a) has a curved end surface, (b) has shown the flat end surface, respectively. FIG. 2 is a schematic front view illustrating an example of a state in which a second hollow shaft in FIG. 1 is tilted. It is the schematic which shows the joint part of a core wire and a mesh member, (a) The joint part of a core wire is a substantially annular thing, (b) The joint part of a core wire is a substantially C shape, (c)-( e) shows the case where the joining portion is constituted by a substantially annular part. It is the schematic which shows the other example of joining of a core wire and a mesh member. FIG. 7 is a schematic diagram illustrating a positional relationship between a core wire and a center of gravity of a tip tip, and is a diagram illustrating a cross section taken along a line VII-VII in FIG. 1. It is a schematic front view which shows an example of a guide film. It is the schematic sectional drawing cut | disconnected by the IX-IX line of FIG. It is the schematic which shows one suitable embodiment of a guide film. It is the schematic which shows the other preferable aspect of a guide film. FIG. 16 is a schematic cross-sectional view illustrating an example of a tip portion of the guide film of FIG. 15. FIG. 16 is a schematic front view showing another example of the distal end portion of the guide film of FIG. 15. It is the schematic sectional drawing cut | disconnected by the XIV-XIV line of FIG. FIG. 6 is a schematic front view showing a modification of FIG. 1, and is a view showing a state where a mesh member is reduced in diameter. FIG. 20 is a schematic front view showing a state where the diameter of the mesh member in FIG. 19 is expanded. FIG. 3 is a schematic front view showing a use state of FIG. 2. It is a schematic front view showing a 2nd embodiment of the present invention, and is a figure showing the state where the diameter of the mesh member was reduced. It is the schematic sectional drawing which shows a holding member, (a) has shown an example and (b) has shown another example, respectively. FIG. 23 is a schematic front view showing another example of FIG. 22, showing a state in which the diameter of the mesh member is reduced. FIG. 25 is a schematic front view showing a state where the diameter of the mesh member of FIG. 24 is expanded. FIG. 23 is a schematic front view showing a modification of FIG. 22, showing a state where the mesh member has been reduced in diameter. FIG. 27 is a schematic front view showing a state where the diameter of the mesh member of FIG. 26 is expanded. FIG. 23 is a schematic front view showing a state where the diameter of the mesh member in FIG. 22 is expanded. It is a schematic front view showing a 3rd embodiment of the present invention, and is a figure showing the state where the diameter of the mesh member was reduced. FIG. 30 is a schematic front view showing another example of FIG. 29, showing a state where the diameter of the mesh member is reduced. FIG. 31 is a schematic front view showing a state where the diameter of the mesh member in FIG. 30 is expanded. FIG. 30 is a schematic front view showing a state where the diameter of the mesh member in FIG. 29 is expanded, and a state in which a antegrade guidewire and a retrograde guidewire are inserted. 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 where a mesh member is reduced in diameter. FIG. 34 is a schematic front view showing a state where the diameter of the mesh member in FIG. 33 is 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 only the embodiments described in the drawings.

  In this specification, the term "antegrade guidewire" refers to a guidewire that is pushed into an operation site such as an occluded site in a blood vessel prior to the catheter, and a "retrograde guidewire". Means a guide wire coming from a distal end side of the catheter in a blood vessel, for example.

[First Embodiment]
FIG. 1 is a schematic front view showing the first embodiment of the present invention, and is a view showing a state where a mesh member is reduced in 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 guiding film 160. , And a connector 170.

  The mesh member 110 is a tubular member that can expand and contract in the radial direction. When the core member 150 described later is pulled toward the base end side, the mesh member 110 expands by, for example, out-of-plane deformation and bulging radially outward as shown in FIG. A retrograde guidewire is received by the catheter 1 through the aperture m of the member 110.

  In the present embodiment, the mesh member 110 has a plurality of first wires 111 and a plurality of second wires 112, and the first wires 111 and the second wires 112 are knitted in a lattice shape. All are formed so as to have a tubular shape as a whole. In addition, the mesh member 110 has an opening m between adjacent woven wires, and receives a retrograde guidewire through the enlarged opening m when the diameter is increased. In addition, a distal tip 130 and a first hollow shaft 120, which will be described later, are joined to the distal end and the proximal end of each of the strands constituting the mesh member 110, respectively.

  Here, each of the strands (the first strand 111 and the second strand 112) constituting the mesh member 110 can adopt any of the single strand a shown in FIG. 3 and a plurality of strands. However, a plurality of strands having different wire diameters and the like are twisted, for example, a core wire b1 disposed at a central portion as shown in FIG. 4 and a plurality of side wires b2 disposed so as to surround the core wire b1. 4 may be used as the first strand 111 and the second strand 112. In the case where the strands b as shown in FIG. , The second stranded wire 112). In such a case, at a part of the intersections 110a between the first stranded wire 111 and the second stranded wire 112, as shown in FIG. It is preferable that a part of them and a part (a part of the side wire b2 in the present embodiment) of the plurality of strands forming the second stranded wire 112 are joined. Further, as shown in FIG. 6, the element wires constituting the mesh member 110 may be a combination of a single wire a and a stranded wire b. In this case, at a part of the intersections 110a among the intersections 110a, the single wire a and a part (a part of the side wire b2 in the present embodiment) of the plurality of strands forming the stranded wire b are joined. It is preferred that

  As described above, since the first strand 111 and the second strand 112 are formed of the stranded wire b, the tubular mesh member 110 can be formed in a deformable (flexible) manner. The expandability can be improved, and since only a part of the wires is joined as described above, the first wires 111 and the second wires 112 due to the excessive expansion of the mesh member 110 can be unraveled. To prevent the mesh member 110 from expanding safely.

  The mesh member 110 has a maximum expanded diameter when expanded as shown in FIG. 2, and a joint 110 b provided at an intersection 110 a between the first stranded wire 111 and the second stranded wire 112 has a maximum expanded diameter. It is more preferable that the number of joints be minimized in the portion where Specifically, the mesh member 110 is configured such that 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. Thereby, the expandability of the mesh member 110 can be further improved.

  Further, the number of joints 110b in the circumferential direction provided at the intersection 110a between the first stranded wire 111 and the second stranded wire 112 is directed to both ends (the distal end and the proximal end of the mesh member 110) of the mesh member 110. It is also preferred that it increases in accordance with Accordingly, it is possible to prevent the mesh member 110 from being released from both ends, and as a result, it is possible to improve the expandability and robustness of the mesh member 110.

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

  Further, as a material constituting each element wire of the mesh member 110, a radiopaque material is also preferable 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 (for example, a platinum-nickel alloy). Note that 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 this embodiment, as shown in FIG. 1, the first hollow shaft 120 has a hollow distal shaft 121 having a distal end connected to the proximal end of the mesh member 110, and a proximal end of the distal shaft 121 having a distal end connected to the mesh member 110. And a hollow proximal shaft 123 connected to the shaft.

  The distal side shaft 121 has a lumen 122 so that a retrograde guide wire and a core wire 150 described later can be inserted therein. The proximal shaft 123 has a lumen 124 so that the core wire 150 can be inserted therein. Further, at a connection portion 125 between the distal shaft 121 and the proximal shaft 123, an opening 126 that opens toward the proximal end is formed at the proximal end of the distal shaft 121. The retrograde guidewire is sent out of the catheter 1 via the.

  Here, in the connection portion 125 between the distal shaft 121 and the proximal shaft 123, as shown in FIG. 1, the inside of the distal end of the proximal shaft 123 covers and surrounds the outer periphery of the core wire 150. It is preferable that a cylindrical sealing member 127 in which the core wire 150 can slide in the axial direction is disposed. Thereby, the gap between the outer periphery of the core wire 150 and the inner periphery of the sealing member 127 can be reduced, and the end of the retrograde guide wire (not shown) can be prevented from entering the proximal shaft 123. As a result, breakage of the first hollow shaft 120 and the retrograde guide wire can be prevented.

  Further, it is preferable that the above-mentioned sealing member 127 increases in volume 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 127a of the sealing member 127 is exposed to the lumen 122, and the end surface 127a is inclined toward the opening 126 so that the retrograde guide wire smoothly passes through the opening 126. Is formed. Thereby, the end of the retrograde guide wire can be prevented from being caught on the distal end of the proximal shaft 123, and the retrograde guide wire can be easily guided to the opening 126. As a result, breakage of the first hollow shaft 120 and the retrograde guide wire can be prevented. As the sealing member, a sealing member 128 having a curved end surface 128a as shown in FIG. 7A and a shape of a distal end surface 129a as shown in FIG. 7B are used. May be a sealing member 129 or the like having a planar shape perpendicular to the axial direction.

  The material constituting the sealing member 127 may be any material as long as the core wire 150 is slidable. For example, polyamide resin, polyolefin resin, polyester resin, polyurethane resin, silicone resin, fluorine resin, polyamide elastomer, polyolefin elastomer, polyester elastomer And resins such as polyurethane elastomers.

  As a material constituting the first hollow shaft 120, since the first hollow shaft 120 is inserted into a blood vessel, the material preferably has antithrombotic properties, flexibility, and biocompatibility, Resin material and metal material can be adopted. Since flexibility is required for the distal end side shaft 121, it is preferable to use a resin material such as a polyamide resin, a polyolefin resin, a polyester resin, a polyurethane resin, a silicone resin, and a fluororesin. As the proximal shaft 123 is required to be pushable, it is preferable to use a metal tube such as a hypotube, for example.

  The tip 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 so that the catheter 1 can easily advance in a blood vessel. A distal end of each of the strands and a distal end of a second hollow shaft 140 described later are embedded.

  As a material constituting the distal end tip 130, it is preferable that the catheter 1 has flexibility since the catheter 1 proceeds in a 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 from the base 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. At the same time, 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. For this reason, when the core wire 150 is pulled toward the base end side, as shown in FIG. 2, the second hollow shaft 140 is inclined with respect to the axial direction of the mesh member 110 and the base of the second hollow shaft 140 is tilted. The edges press the inner periphery of the mesh member 110 radially outward to promote the mesh member 110 to expand in diameter. On the other hand, even when the second hollow shaft 140 is tilted but its base end does not abut against the inner periphery of the mesh member 110, as shown in FIG. It can be spread asymmetrically, making it easier to accept a retrograde guidewire.

  As a material constituting the second hollow shaft 140, the second hollow shaft 140 is also inserted into the blood vessel similarly to the first hollow shaft 120 described above. Preferably, it is compatible. Examples of the material include the same materials as those exemplified in the description of the first hollow shaft 120, and a resin material is preferable from the viewpoint of flexibility.

  The core wire 150 has the distal end connected to the distal end of the mesh member 110 and / or the distal end tip 130, and has the proximal end located closer to the proximal end than the proximal end of the first hollow shaft 120. The member extends through the inside of the hollow shaft 120. The core wire 150 is, specifically, a space outside the second hollow shaft 140 inside the mesh member 110, inside the first hollow shaft 120, and outside through a through hole 171 of a connector 170 (described later). Extends to. When the core wire 150 is operated outside the connector 170, the core wire 150 advances and retreats 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 cutting of the core wire 150 itself and reliably expanding and contracting the mesh member 110. Examples of the material include stainless steel such as SUS304, and metal materials such as a nickel titanium alloy and a cobalt chromium alloy.

  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 It is preferable that a joining portion d is formed by joining the tip of the mesh member 110 with the mesh member 110. By forming the joint d in this manner, the mesh member 110 and the core wire 150 can be strongly connected to each other, and the core wire 150 is prevented from coming off from the mesh member 110 when the mesh member 110 is expanded. can do.

  Note that the cross-sectional shape of the joint 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 in which the cylindrical member 153 is joined 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 d may be, for example, a core wire 152 from the viewpoint of improving the flexibility of the tip 130 in a state of being joined to the tip 130 and improving the joining strength between the core wire 150 and the tip 130. An integrally formed shape (see FIG. 9 (c)), a shape in which a plurality of cylindrical members 154 are joined to the core wire 150 (see FIG. 9 (d)), and a cylindrically cut-out member 155 A shape joined to the core wire 150 (see FIG. 9E) or the like can also be adopted. Further, the joint d may be arranged on either the outer periphery of the distal end portion of the mesh member 110 (see FIG. 9A) or the inner periphery of the distal end portion (see FIG. 10). Thereby, when the mesh member 110 is pulled to the base end side, a force can be more uniformly applied to the distal end portion of the mesh member 110, and the mesh member 110 and the core wire 150 can be more strongly connected without breaking. Can be.

  As shown in FIG. 11, the position where the core wire 150 is connected to the distal tip 130 and / or the mesh member 110 is such that the projection position p1 on the cross section orthogonal to the axial direction is the center of gravity of the distal tip 130. Is preferably eccentric with respect to the projection position p2 on the cross section of the second hollow shaft 140, but may be eccentric with respect to the projection position (not shown) of the center of gravity of the second hollow shaft 140 on the cross section. Accordingly, when the core member 150 is pulled toward the base end 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 (the second hollow shaft 140 is tilted with respect to the center of gravity). Of the hollow shaft 140 can be rotated). As a result, the base end of the second hollow shaft 140 can be easily brought into contact with the mesh member 110, and the inner periphery of the mesh member 110 can be reliably pressed, thereby promoting the diameter expansion of the mesh member 110.

  The guiding film 160 is disposed on the mesh member 110 as shown in FIGS. 1 and 12, and the distal end of the guiding film 160 is located between the base end of the distal tip 130 and the distal end of the first hollow shaft 120. I have. The guiding 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 film 160 of the present embodiment is shown in FIG. 13 in a region from a substantially central portion in the axial direction of the mesh member 110 where the distal end is located to a distal end of the first hollow shaft 120 where the proximal end of the guide film 160 is located. As described above, the adjacent wires 111 and 112 are formed on the mesh member 110 so as to bridge each other. Here, the retrograde guidewire is guided into the first hollow shaft 120 through the mesh member 110 when the guiding film 160 is developed in a funnel shape when the diameter of the mesh member 110 is expanded. It is sufficient that at least a part (for example, the outer periphery of the leading end of the guiding film 160) of the guiding film 160 is joined to the mesh member 110, and may be, for example, a film (not shown).

  Examples of the material forming the guide film 160 include polyethylene, polyurethane, polyamide, polyamide elastomer, polyolefin, polyester, and polyester elastomer. Among these, it is preferable that the material be polyurethane from the viewpoint of improving the surface slidability.

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

  Here, the guide film 160 is formed of a material having elasticity, is disposed on the mesh member 110, and has a tip located 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 base film thickness of the guide film 160 is larger than the film thickness of the distal end of the guide film 160 (the guide film having this configuration is also referred to as “guide film A” hereinafter). Such a guide film A is formed by, for example, using the above-described dip method, by lifting the mesh member from the immersion bath, and then curing the mesh member 110 with the base end side of the mesh member 110 facing vertically downward. Can be. Accordingly, the mesh member 110 can be easily expanded by the thickness of the leading end of the guide film A that is smaller than the base end, and the thickness of the base end of the guide film A is larger than the tip end. Accordingly, it is possible to reduce the damage of the guide film A due to the contact of the retrograde guide wire.

  In addition, as shown in FIG. 2, it is also preferable that the distal end of the guide film A is located at a position where the mesh member 110 has a maximum expanded diameter when the mesh member 110 expands. Thereby, the funnel-shaped guiding membrane 160 can be expanded to the maximum, 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 from the position where the expanded diameter of the mesh member 110 becomes the maximum expanded diameter. The thickness decreases toward the proximal end (see the dashed line in FIG. 14), and the thickness of the guiding film 160 increases from the distal end toward the proximal end in inverse proportion to the decrease in the expanded diameter of the mesh member 110 (FIG. 14). 14 (see solid line). Thus, the mesh member 110 can be easily expanded, and even if the retrograde guide wire contacts the base end of the guide film 160 with a high load, the breakage of the guide film 160 can be prevented.

  On the other hand, the guide film 160 is disposed on the mesh member 110 and has a distal end located between the proximal end of the distal tip 130 and the distal end of the first hollow shaft 120, as shown by the solid and broken lines in FIG. It is also preferable that the thickness of the leading end of the guide film 160 is larger than the thickness of the portion where the guide film 160 is the thinnest (the guide film having this configuration is also referred to as “guide film B” hereinafter). As shown in FIG. 16, for example, as shown in FIG. 16, after forming a guide film 160a having a uniform thickness, such a guide film B is formed on the tip of the guide film 160a having a uniform thickness by using a coating method. The guide film 160 can be formed by forming the induction film 160 by applying the buildup 160b of the material, or by forming the induction film using the above-described dipping method, and then applying the buildup 160b in the same manner as described above. Accordingly, the guide film 160 is prevented from being damaged even when the retrograde guide wire comes into contact with the front end of the guide film 160 by the thickness of the guide film 160 that is thicker than the thinnest portion. be able to. The same effect can be obtained by making the thickness of the leading end of the guiding film 160 larger than the thickness of other parts of the guiding film 160.

  In addition, as shown in FIG. 17, the guide film B closes some of the openings m among the plurality of openings m formed between the first strand 111 and the second strand 112. The leading end of the guide film 161 is located at the intersection 110a between the first strand 111 and the second strand 112, and the openings m1 and m2 adjacent to the intersection 110a in the circumferential direction are opened. Is also preferable. In the guide film B of such an embodiment, all the ends of the guide film 161 existing in the opening m are bordered by the wires (the first wires 111 and the second wires 112) (the ends of the guide film 161). All parts are joined to the strand). Accordingly, even when the retrograde guide wire comes into contact with the distal end of the guide film 161, breakage of the guide film 161 can be further suppressed, and peeling of the guide film 161 from the mesh member 110 is prevented. be able to.

  It is also preferable that the thickness of the guide film B is the largest 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 distal end of the guide film 161, the breakage of the guide film 161 can be suppressed.

  Further, it is also preferable that the outer periphery of the intersection 110a of the first strand 111 and the second strand 112 at the tip of the guiding film B is covered with the guiding film 161 as shown in FIG. Accordingly, even when the retrograde guide wire comes into contact with the distal end of the guide film 161, breakage of the guide film 161 can be further suppressed, and peeling of the guide film 161 from the mesh member 110 is prevented. be able to.

  In this way, by arranging the guide membrane 160 on the mesh member 110, the catheter 1 can easily and reliably guide the retrograde guidewire to the first hollow shaft 120 along the guide membrane 160.

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

  As shown in FIGS. 19 and 20, the catheter 1 has a core wire positioned inside the distal end of the guiding membrane 160 when the mesh member 110 is expanded, more preferably, when the mesh member 110 is expanded optimally. It is preferable to have a marker 180 provided at a portion 150 and formed of a radiopaque material, and the marker 180 and a radiation provided at a distal end portion of the guide film 160 and formed of a radiopaque material. It is more preferable to have the non-transmissive part 160a. When a resin material is used, the marker 180 is formed, for example, by mixing a radiopaque material such as bismuth trioxide, tungsten, and barium sulfate with a polyamide resin, a polyolefin resin, a polyester resin, a polyurethane resin, a silicone resin, a fluororesin, or the like. When a metal material is used, it is preferable to use, for example, a radiopaque material such as gold, platinum, tungsten, or an alloy containing these elements (for example, a platinum-nickel alloy). When a resin material is used as the radiopaque material, the radiopaque portion 160a is preferably formed by mixing a radiopaque material such as bismuth trioxide, tungsten, or barium sulfate at the tip of the guide film 160. In the case where is used, it is preferable to bond a radiopaque material such as gold, platinum, tungsten, or an alloy containing these elements (for example, a platinum-nickel alloy) to the leading end of the induction film 160. This makes it possible to easily recognize the marker 180 and the leading end of the guide film 160 under fluoroscopy of radiation such as X-rays, so that the marker 180 is positioned inside the radiopaque portion 160a at the leading end of the guide film 160. By pulling the core wire 150, the mesh member 110 can be optimally enlarged 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. 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, “optimally expanding” means that the mesh member 110 is expanded to the maximum size so as to easily receive a retrograde guide wire within a range in which the guide film 160 is not damaged by excessive expansion. Means that.

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

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

  Next, after the distal end of the antegrade guidewire W1 reaches the obstruction site, the proximal end of the antegrade guidewire W1 is inserted into the through hole at the distal end of the second hollow shaft 140, and the antegrade guidewire W1 is inserted. As a guide, the distal end of the catheter 1 is pushed to the obstruction site in the blood vessel. At this time, the catheter 1 is inserted into a blood vessel with the mesh member 110 reduced in diameter, and maintains the reduced diameter until the distal end 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 end side of the catheter 1 so that the antegrade guidewire W1 is connected to the catheter 1. Pull out from. Next, by pulling the core wire 150 exposed to the outside of the connector 170 toward the base end side, the distance between the distal end of the mesh member 110 and the distal end of the first hollow shaft 120 is reduced, and as a result, the diameter of the mesh member 110 becomes smaller. Outwardly out-of-plane deformation expands the diameter. At this time, since the aperture m is expanded with the diameter expansion of the mesh member 110, a state in which the retrograde guide wire W2 can be easily received is provided. Further, the inner periphery of the mesh member 110 is pressed radially outward due to the inclination of the second hollow shaft 140, so that the diameter of the mesh member 110 is increased. In the present embodiment, since the leading end of the guiding film 160 is joined to a substantially central portion of the mesh member 110 in the axial direction, the guiding film 160 is expanded following the diameter expansion of the mesh member 110, and the guiding film 160 is expanded. Has a funnel shape as a whole.

  Next, as shown in FIG. 21, the retrograde guide wire W2 coming from the distal end side is received by the catheter 1. As a path through which the retrograde guide wire W2 is directed, for example, a false lumen in a blood vessel wall surrounding the occlusion site, a through-hole penetrating the occlusion site, and the like are assumed. The wire W2 may be used. The retrograde guide wire W2 is received in the space inside the mesh member 110 through the aperture m of the mesh member 110 whose diameter has been increased, and is then inserted through the opening 120a of the first hollow shaft 120 into the distal shaft 121. , Through the opening 126 to the outside of the catheter 1. Next, the retrograde guide wire W2 sent out from the opening 126 passes through the inside of the blood vessel, and then the end is sent out of the body. Thereby, a state can be created in which the retrograde guidewire W2 penetrates the obstruction site and both ends of the retrograde guidewire W2 are exposed outside the body.

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

(Use mode 2)
In the usage mode 2, the obstruction is removed by using the catheter 1 and the antegrade guide wire W1 or the like. In the usage mode 2, the method of inserting the antegrade guidewire 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 a description thereof will be omitted. In this usage mode 2, first, the operation is performed in the same manner as in usage mode 1, so that the antegrade guidewire W1 and the catheter 1 reach the occlusion site. Next, the diameter of the mesh member 110 is expanded by operating the core wire 150. The antegrade guide wire W1 is not pulled out of the catheter 1.

  Next, the obstruction is crushed using the antegrade guide wire W1 or the like. At this time, the crushed obstruction is taken into the space inside the mesh member 110 through the opening m of the mesh member 110 whose diameter has been increased, and then guided into the first hollow shaft 120 through the opening 120a. After passing through the first hollow shaft 120, it is discharged outside the body.

  As described above, the catheter 1 can pulverize an obstruction in a blood vessel and remove the obstruction outside the body, so that the catheter 1 can be suitably used as a medical instrument for removing the obstruction.

  As described above, since the catheter 1 has the above-described configuration, when the diameter of the mesh member 110 is increased by pulling the core wire 150 toward the base end, the base end of the second hollow shaft 140 is moved away from the core wire 150. Because the mesh member 110 can be separated, the inner diameter of the mesh member 110 can be easily expanded by pressing the inner periphery of the mesh member 110. Further, even when the base end of the second hollow shaft 140 does not abut on the inner periphery of the mesh member 110, the space inside the mesh member 110 whose diameter has been increased can be asymmetrically expanded, and the retrograde guide The wire can be more easily accepted.

[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 diameter of the mesh member is reduced. As shown in FIG. 22, the catheter 2 schematically 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. , An induction film 160 and a connector 170 (not shown). The second embodiment is different from the first embodiment in that a second hollow shaft 240, a core wire 250, and a holding member 280 are provided. Note that the configurations of the mesh member 110, the first hollow shaft 120, the distal tip 130, the guide film 160, and the connector 170 are the same as those of the first embodiment, and therefore, the same portions are denoted by the same reference numerals. A detailed description of the lever is omitted. Further, since the materials of the second hollow shaft 240 and the core wire 250 are the same as those of the first embodiment, detailed description thereof will be omitted with reference to the description of the first embodiment.

  The second hollow shaft 240 is connected to the distal tip 130 and protrudes from the proximal end in a space inside the mesh member 110, and the proximal ends are the distal end of the first hollow shaft 120 and the proximal end of the distal tip 130. This is a member located between.

  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 than the proximal end of the first hollow shaft 120, and an outer periphery of the second hollow shaft 240. Along the mesh member 110 and the inside of the first hollow shaft 120.

  The holding member 280 is a member having a substantially annular shape or a substantially C shape in a cross-sectional view (see FIGS. 23A and 23B), provided on the core wire 250, and covering the second hollow shaft 240. 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. 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. However, the base member of the second hollow shaft 240 is provided by the holding member 280. 24 and 25, the holding member has moved from the proximal end to the distal end of the second hollow shaft 240 as long as they can be moved together without separating from the core wire 250. It may be provided so as to cover the portion.

  In addition, as a material forming the holding member 280, for example, a resin material such as a polyamide resin, a polyolefin resin, a polyester resin, a polyurethane resin, a silicone resin, and a fluororesin; stainless steel such as SUS304; a nickel titanium alloy; Metal material can be adopted.

  In the catheter 2, the holding member 280 preferably contains a radiopaque material. 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 distal end portion and formed of a radiopaque material. When the holding member 280 is formed of the above-described resin material, it is preferable that the holding member 280 be mixed with a radiopaque material such as bismuth trioxide, tungsten, barium sulfate or the like, and when the holding member 280 is formed of a metal material. For example, it is preferable to use a radiopaque material such as gold, platinum, or tungsten, or an alloy containing these elements (for example, a platinum-nickel alloy). When a resin material is used as the radiopaque material, it is preferable to mix a radiopaque material such as bismuth trioxide, tungsten, barium sulfate or the like at the tip of the guide film 160. In the case where is used, it is preferable to bond a radiopaque material such as gold, platinum, tungsten, or an alloy containing these elements (for example, a platinum-nickel alloy) to the leading end of the induction film 160. In the catheter 2, as shown in FIG. 26 and FIG. 27, when the diameter of the mesh member 110 is expanded, more preferably, when the diameter of the mesh member 110 is optimally expanded, the holding member 280 is placed inside the distal end of the guiding film 160. Preferably, it is located. Accordingly, the holding member 280 and the leading end of the guide film 160 can be easily recognized under fluoroscopy of radiation such as X-rays, so that the holding member 280 is positioned inside the radiopaque portion 160a at the leading end of the guide film 160. By pulling the core wire 250 so that the mesh member 110 can be optimally enlarged, 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 contact between the guide film 160 and the retrograde guide wire can be prevented, so that the breakage of the guide film 160 can be prevented.

  Next, an operation at the time of using the catheter 2 will be described. For example, after the catheter 2 reaches the occlusion site by operating in the same manner as in the usage mode 1 described above, the core member 250 is operated to expand the mesh member 110 as shown in FIG. 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 The mesh member 110 is pulled toward the base end along the axial direction without contact with the mesh member 110, and the mesh member 110 expands in diameter. Thereby, 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 configuration, the base end of the second hollow shaft 240 is not separated from the core wire 250 by the holding member 280. These members can be integrally moved, and the second hollow shaft 240 can be prevented from breaking through the guiding film 160 by the amount that 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 is moved to the extent that the base end of the second hollow shaft 240 does not contact the guiding film 160. May be limited.

[Third Embodiment]
FIG. 29 is a schematic front view illustrating the third embodiment of the present invention, and is a diagram illustrating a state where the diameter of the mesh member is reduced. As shown in FIG. 29, the catheter 3 schematically 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 guiding film 160. , And a connector 170 (not shown). The third embodiment differs from the first embodiment in that a second hollow shaft 340 is provided. Note that the configurations of the mesh member 110, the first hollow shaft 120, the tip 130, the core wire 150, the guide film 160, and the connector 170 are the same as those of the first embodiment. And a detailed description thereof will be omitted. Further, since the material of the second hollow shaft 340 is the same as that of the first embodiment, the detailed description thereof will be omitted by referring to the description of the first embodiment.

  The second hollow shaft 340 is a member partially disposed in the space inside the mesh member 110, penetrating through the mesh member 110, and having a base end located outside the mesh member 110. Note that “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. It is a concept that includes.

  Here, in the second hollow shaft 340, both ends of the second hollow shaft 340 may be fixed to another member (for example, the tip 130, the mesh member 110, the first hollow shaft 120, and the like). However, the distal end of the second hollow shaft is connected to the distal tip 130, and the proximal end of the second hollow shaft is a free end, or the distal end of the second hollow shaft is a free end, and the second hollow shaft Is preferably 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 another member, the second hollow shaft 340 is prevented from being broken when the mesh member 110 is expanded. Thus, it is possible to secure the passage of the antegrade guide wire W1 and perform the procedure 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 guidewire W1 is inserted into the distal end of the second hollow shaft 340 by a procedure, the proximal end of the antegrade guidewire 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 guidewire W1 by the distance from the head to the proximal end side of the catheter 3, and grasps the proximal end of the antegrade guidewire W1 easily and reliably. Can be. As a result, the procedure can be performed efficiently using the catheter 3.

  In the present embodiment, as shown in FIG. 29, 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 disposed in the space inside the mesh member 110, as shown in FIG. ing. The second hollow shaft 340 penetrates the opening m of the mesh member 110 at an intermediate position in the axial direction, the base end of the second hollow shaft 340 is located outside the mesh member 110, and the base end Is joined to the outer periphery of the first hollow shaft 120. An opening 340a that opens toward the base end is provided at the base end of the second hollow shaft 340.

  In addition, as shown in FIGS. 29 to 32, when the diameter of the mesh member 110 is expanded, more preferably, when the diameter of the mesh member 110 is optimally expanded, the core wire positioned inside the distal end of the guiding film 160 is used as shown in FIGS. It is preferable to have a marker 180 provided at a portion 150 and formed of a radiopaque material, and the marker 180 and a radiation provided at a distal end portion of the guide film 160 and formed of a radiopaque material. It is more preferable to have the non-transmissive part 160a. As the configuration of the marker 180 and the radiopaque portion 160a, for example, the same configuration as that described in the first embodiment can be adopted. This makes it possible to easily recognize the marker 180 and the leading end of the guide film 160 under fluoroscopy of radiation such as X-rays, so that the marker 180 is positioned inside the radiopaque portion 160a at the leading end of the guide film 160. By pulling the core wire 150, the mesh member 110 can be optimally enlarged 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. The guide film 160 can be prevented from being damaged by preventing contact between the guide film 160 and the retrograde guide wire.

  Next, an operation at the time of using the catheter 3 will be described. For example, after the catheter 3 reaches the occlusion site by operating in the same manner as in the usage mode 1 described above, as shown in FIG. 32, the core wire without pulling out the antegrade guide wire W1 from the second hollow shaft 340. By operating 150, the diameter of the mesh member 110 is increased. At this time, since the base end of the second hollow shaft 340 is located outside the mesh member 110, the antegrade guide wire W1 does not exist in the first hollow shaft 120. Therefore, the retrograde guide wire W2 received through the aperture m of the mesh member 110 and inserted into the first hollow shaft 120 coexists with the antegrade guide wire W1 in the first hollow shaft 120. It is possible to smoothly send out from the opening 126 without performing.

  As described above, in the catheter 3, the mesh member 110, the distal end tip 130, the second hollow shaft 340, and the guiding membrane 160 have the above-described configuration, so that the antegrade guide wire W1 connects the first hollow shaft 120 to the first hollow shaft 120. 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 configuration of the above-described embodiment, but is indicated by the appended claims, and is intended to include all modifications within the scope and meaning equivalent to the appended claims. Is done. A 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 including the second hollow shaft 140 has been described. However, for example, the catheter 4 not including the second hollow shaft 140 as illustrated in FIGS. It is within the intended scope of the present invention.

1, 2, 3, 4 Catheter p1, p2 Projection position W1 Anterior guidewire W2 Retrograde guidewire 110 Mesh member 111 First strand 112 Second strand 110a Intersection 110b Joint m, m1, m2 Aperture 120 first hollow shaft 121 distal shaft 123 proximal shaft 126 opening 127, 128, 129 sealing member 130 distal tip 140, 240, 340, 341 second hollow shaft 150, 250 core wire 280 holding member 160, 161 Induction membrane

Claims (2)

A tubular mesh member formed of a metal material and expandable and contractable in the radial direction,
A first hollow shaft connected to a proximal end of the mesh member;
A tip tip connected to the tip of the mesh member,
The mesh member and the first hollow shaft such that the mesh member and the first hollow shaft are formed of a metal material, and a distal end is located at a distal end of the mesh member, and a proximal end is located closer to a proximal end than a proximal end of the first hollow shaft. A core wire extending through the interior of the
A catheter having a joint formed by joining a distal end of the core wire and a distal end of the mesh member.   The catheter according to claim 1, wherein a cross-sectional shape of the joint is substantially annular or substantially C-shaped, and the joint is disposed on an outer periphery or an inner periphery of a distal end portion of the mesh member.

Images