KR20100001342A - Catheter for ablating vascular chronic total occlusion - Google Patents

Abstract

PURPOSE: A catheter for ablating vascular chronic total occlusion is provided to reduce heat due to friction between a lesion removal tool and a lesion by supplying the cooling fluid. CONSTITUTION: A first port is formed in a proximal end of an external conduit(10). The expandable fluid is supplied to the external conduit through the first port. A longitudinal axis of an internal conduit is extended in parallel to the longitudinal axis of the external conduit. A balloon(30) is attached to a distal end of the catheter and swells in the blood vessel with the expandable fluid. A guide wire(40) is extended through the internal conduit. A lesion removal tool(50) is arranged in the distal end of the guide wire. A driver(60) supplies the driving force or energy to the lesion removal tool.

Description

CATHETER FOR ABLATING VASCULAR CHRONIC TOTAL OCCLUSION

The present invention relates to a catheter used for the removal of chronic stenosis lesions in blood vessels, and more particularly chronic complete in blood vessels that can effectively remove the lesions causing chronic stenosis in the vessels while preventing damage to the inner wall of the vessels A catheter for removing stenosis lesions.

Among cardiovascular diseases, chronic total stenosis (CTO), in which the vascular lumen is completely closed by deposits and prevents blood flow, is found in 52% of patients with severe coronary artery disease.

In general, chronic complete stenosis is caused by the deposition of lipid-rich cholesterol on the inner wall of the blood vessels, resulting in occlusion of the lumen of the vessels. The multilayer lipid and thrombosis complex constituting the stenosis lesion thus formed is replaced with collagen, etc., over time, and these collagen form a multi-molecule mass from a single molecule, crosslinking reaction and calciumation (calcification). ) To form a mechanically stable phosphorylated layer that prevents blood circulation.

As a treatment method for such chronic complete stenosis, a method of reperfusion by physically decomposing the fibrin-collagen complex of the stenosis part and a method of physical puncturing are used.

Looking at the conventional example for the physical puncture of chronic stenosis lesion, CROSSER ^TM which drills the chronic stenosis lesion with mechanical shock and cavitation effect using 20,000 vibration energy per second, and thread the wire end of the catheter There is an ASAHI Tornus Specialty Catheter that perforates chronic complete stenosis lesions by shaping and rotating the shape. There are also laser angioplasty that instantaneously vaporizes and removes material from the constriction site, and rotational antherectomy penetrates the constriction site using a high-speed rotating diamond burr. . Rotational cutting is known to be particularly useful for hard stenosis lesions with advanced calcium.

However, the above-mentioned physical perforation methods are difficult to penetrate the center of the lesion along the center of the blood vessel in the process of penetrating hard calcium lesions, and also angiography agent is injected into the direction of blood flow through the blockage of the blood vessel. Since it is difficult to obtain, it is difficult to secure a form of vascular development after crossing the chronic perfect stenosis site, which may cause damage and perforation of the inner wall of the blood vessel during the physical procedure.

Therefore, in the case of chronic stenosis, the success rate of vascular intervention is 95%, whereas in the case of chronic stenosis, the success rate is only about 70%.

The present invention has been made to solve the above problems, to remove the lesions while maintaining the centering in the blood vessels during chronic stenosis lesion removal by the lesion removal tool, blood vessels that can prevent damage to the inner wall of the vessels and perforation An object of the present invention is to provide a catheter for removing chronic stenosis lesions.

The present invention effectively reduces the heat generated when the lesion removal tool removes a chronic perfect stenosis lesion by supplying a cooling fluid to prevent the damage of the blood vessel inner wall caused by heat, so that the lesion can be removed completely. It is an object to provide a catheter for removal.

In order to achieve the above object, the present invention provides a catheter for removing chronic stenosis lesions in blood vessels for removing lesions of the stenosis or occlusion of the vascular lumen, having a proximal end and a distal end and for supplying an expansion fluid to the proximal end. An outer conduit with one port; An inner conduit extending through the interior of the outer conduit such that a longitudinal axis extends parallel to the longitudinal axis of the outer conduit and the distal end is positioned at a position corresponding to the distal end of the outer conduit or at a position past the distal end of the outer conduit ; A balloon bonded to the distal end of the catheter, the balloon being expanded in the vessel by the expansion fluid supplied through the first port in the folded state and supported by the vessel inner wall; A guidewire extending through the inner conduit and extending so that its distal end is positioned beyond the distal end of the inner conduit; A lesion removal tool provided at the distal end of the guidewire; And a driving unit connected to the proximal end of the guide wire and supplying driving force or energy to the lesion removal tool.

According to the invention, the proximal end of the inner conduit is provided with a second port for supplying cooling fluid into the inner conduit.

According to one embodiment of the invention, the inner conduit extends beyond the distal end of the outer conduit, the balloon having a proximal end joined to the distal end of the outer conduit and the distal end of the balloon distal of the inner conduit Bonded and molded at the end, the inflation fluid supplied through the first port is discharged into the balloon to the distal end of the outer conduit to inflate the balloon.

According to another embodiment of the invention, at the distal end of the catheter, the balloon has a proximal end and distal end bonded to the outer circumferential surface of the distal end side of the outer conduit, the outer circumferential surface of the outer conduit located inward of the balloon The portion is provided with a through hole for introducing the expansion fluid into the balloon.

According to the present invention, an end cap is provided at the distal end of the inner conduit, the guide wire penetrates through the center opening of the end cap, and the end cap is formed with a port for fluid discharge around the center opening.

According to the present invention, the lesion removal tool is formed of a rotary cutting tool for physically puncturing the contact lesion while rotating and moving forward, the guide wire is rotated for the operation of the lesion removal tool receiving the operation of the drive unit; Provide longitudinal motion.

According to the present invention, the lesion removal tool is formed of any one of a vibration tool for crushing a lesion by repeated impact, a cutting tool for cutting the lesion, and a laser radiation tool for radiating and removing a laser to the lesion.

According to the present invention, the lesion can be removed while maintaining the centering in the blood vessel during the removal of the chronic complete stenosis lesion by the lesion removal tool. Thus, blood vessel wall damage and perforation can be prevented. In addition, according to the present invention, the heat generated when the lesion removal tool removes the chronic stenosis lesion by the cooling fluid can be effectively reduced. Therefore, the lesion may be removed while preventing damage to the inner wall of the blood vessel by heat generated when the lesion is removed.

Hereinafter, exemplary embodiments of the present invention will be described in detail with reference to the accompanying drawings.

1 and 2 are views illustrating a catheter for removing chronic stenosis lesions in blood vessels according to an embodiment of the present invention.

Referring to the drawings, the catheter for chronic perfect stenosis lesion removal in the blood vessel according to the present invention is the outer conduit 10, the inner conduit 20, balloon 30, guidewire 40, lesion removal tool 50 and drive unit (60).

According to the invention, the outer conduit 10 of the catheter is formed from a material which has a proximal end 11 and a distal end 12 as a tubular member and which does not damage the inner wall of the blood vessel. As the material of the outer conduit 10, a known catheter's conduit, a tube material is used and need not be particularly limited. In the present specification, the proximal end 11 and the distal end 12 are terms used as a criterion for the operator. The end of the side inserted through the blood vessel is the distal end 12 and the end located at the operator's side is the proximal end ( 11).

At the proximal end 11 of the outer conduit 10 is formed a first port 14 for supplying expansion fluid. An expansion fluid supply means 13 is connected to the first port 14 to supply the expansion fluid 15 into the outer conduit 10. In addition, the outer conduit 10 is formed with a knob (not shown) used to introduce the catheter into the vessel, these configurations are the same as the configuration of a general catheter.

According to one embodiment of the invention, an inner conduit 20 is provided to extend through the interior of the outer conduit 10, wherein the longitudinal axis of the inner conduit 20 extends parallel to the longitudinal axis of the outer conduit 10. do. The inner conduit 20 extends through the outer conduit 10 so that the distal end 22 is disposed beyond the distal end 12 of the outer conduit 10.

According to the invention, the inner conduit 20 extends through the distal end of the proximal end 11 of the outer conduit 10, and the distal end of the proximal end 11 of the outer conduit 10 leaks out of the expansion fluid. It is sealed so that it is prevented.

As a variation of this embodiment, a port for introducing the inner conduit 20 is formed at the proximal end 11 of the outer conduit 10, and the inner conduit 20 is introduced into the outer conduit 10 through the port. It is possible to configure. However, in terms of ensuring centering of the inner conduit 20 with respect to the outer conduit 10, the inner conduit 20 passes through the distal end of the proximal end 11 of the outer conduit 10 and thus the entire length of the outer conduit 10. More preferably coaxially along.

According to the invention, the proximal end 21 of the inner conduit 20 is provided with a second port 24 for supplying cooling fluid. The cooling fluid 25 supplied from the cooling fluid supply means 23 through the second port 24 functions to cool the heat generated when the lesion removal tool 50 removes the lesion. The heat generated when the lesion is removed by the lesion removal tool 50 by the cooling fluid is cooled to prevent damage to the inner wall of the blood vessel by the heat generated during the physical removal of the lesion.

As the cooling fluid 25, saline (physiological saline) may be used, and in addition, 5% glucose injection solution, 5% glucose saline injection solution, 5% fructose injection solution may be used, antithrombotic agent, anticoagulant agent, antiplatelet agent, thrombolytic agent, Anti-inflammatory agents, antibiotics and the like may further be included, such as aspirin, ticlopidine, clopidogrel, heparin, enoxaparin and the like.

According to an embodiment of the present invention, the guidewire 40 extends along the inner conduit 20. 3 is a cross-sectional view taken along the line AA ′ of FIG. 2, in which the outer conduit 10, the inner conduit 20, and the guidewire 40 extend coaxially.

An expansion fluid 15 is filled in the outer conduit 10 and a cooling fluid 25 is filled in the inner conduit 20.

The proximal end 41 of the guidewire 40 extends through the distal end of the proximal end 21 of the inner conduit 20 and is connected to the drive 60, the distal end of the proximal end 21 of the inner conduit 20. Is sealed to prevent leakage of the cooling fluid 25. As another example of the present invention, the guide wire 40 may be introduced through a guide wire introduction port formed at the proximal end 21 of the inner conduit 20, but the guide wire 40 is connected to the inner conduit 20. In order to be coaxially extended in parallel, the guidewire 40 preferably extends coaxially through the entire length of the inner conduit 20 through the end of the inner conduit 20.

The guidewire 40 is a means for providing the operation or energy provided by the drive unit 60 to the lesion removal tool 50 provided at the distal end 42 of the guidewire 40, the distal end of the guidewire 40. The end 42 extends beyond the distal end 22 of the inner conduit 20, and at the distal end 42 of the guidewire 40, a lesion removal tool 50 for removing the lesion occluding the blood vessel. This is provided.

Referring to FIG. 5, an end cap 45 is provided at the distal end of the distal end 22 of the inner conduit 20. The guidewire 40 extends through the central opening 46 of the end cap 45. The end cap 45 is provided with a port 47 for fluid discharge around the central opening 46. Since the guidewire 40 extends through the central opening 46 located at the center of the end cap 45, the guidewire 40 is defined by the end cap 45 so that the center of the guide wire 40 coincides with the inner conduit 20. Since it is subjected to physical support, the guidewire 40 is more advantageous for maintaining centering with respect to the inner conduit 20.

However, according to the present invention, the distal shape of the distal end 22 of the inner conduit 20 is not limited to the form in which the end cap is attached. It may be supported in the form of reducing the diameter of the distal end at the end of the inner conduit 20, it is also possible not to provide a separate diameter reduction depending on the design of the diameter difference between the inner conduit 20 and the guide wire (40). Do. The distal end 22 of the inner conduit 20 is formed in the form of an opening, through which the guidewire 40 can pass, and through the space between the outer circumferential surface of the guide wire 40 and the inner circumferential surface of the opening. Cooling fluid 25 may be designed to be supplied. The force exerted by the guide wires by the cooling fluid 25 is uniform along the outer circumference of the guide wire so that the guide wire 40 extends in parallel with the inner conduit 20.

According to the invention, a balloon 30 is provided at the distal end of the catheter. The balloon 30 is attached to the catheter and inserted into the vessel in a folded state, and is inflated by the swelling fluid 15 provided at the procedure position where the chronic stenosis lesion is to be removed. After the location selection for chronic perfect stenosis lesion removal is made, the operator supplies the inflation fluid 15 to inflate the balloon 30 and the balloon 30 is inflated so that the outer circumferential surface is in contact with the blood vessel inner wall.

By inflation of the balloon 30, the inner conduit 20 or the outer conduit 10 through which the inner conduit 20 passes is pressurized by the inflation fluid to secure centering in relation to the vessel. The lesion removal tool 50 located at the distal end 42 of the guidewire 40 also ensures centering in relation to the vessel. Therefore, the lesion removal operation by the lesion removal tool 50 in the expanded state of the balloon 30 may be performed toward the center of the vessel, thereby preventing the lesion removal tool 50 from damaging or puncturing the vessel inner wall. You can do it.

2, the proximal end 31 of the balloon 30 is joined to the outer circumferential surface of the distal end 12 of the outer conduit 10 and the distal end 32 The outer circumferential surface of the distal end 22 of the inner conduit 20 is joined. At this time, the joining method of the conduit and the balloon is not particularly limited, and known techniques, that is, bonding by fusion, fusion, and the like may be used. In addition, the composition, chemical structure, and curing type of the adhesive used are not limited. Balloon catheter is already known as a stand delivery means for vasodilation of blood vessels, the technique of known balloon catheter can be applied in the present invention. The balloon 30 is designed to have a cylindrical shape at least partially during inflation so that it can be supported in the longitudinal direction on the inner wall of the blood vessel.

According to one embodiment of the invention shown in FIG. 2, the proximal end 31 of the balloon 30 is joined to the distal end 11 of the outer conduit 10 and the distal end 32 of the balloon 30. Is bonded to the distal end 22 of the inner conduit 20, so that when the expansion fluid is supplied through the outer conduit 10, through the end of the distal end 11 of the outer conduit 10 inside the balloon 30. In this way, the balloon 30 in the folded state is inflated so that the outer circumferential surface is in contact with the inner wall of the blood vessel.

According to an embodiment of the present invention, since the balloon 30 is expanded in the blood vessel, the inner conduit 20 is supported at the center thereof, and thus, the lesion removal tool attached to the distal end 42 of the guide wire 40. Centering of 50 can be secured effectively.

6 is a cross-sectional view illustrating a bonding structure of the balloon according to another embodiment of the present invention, FIG. 7 is a cross-sectional view taken along the line D-D 'of FIG. 6, and FIG. 8 is a perspective view of part F of FIG. 6. .

Another embodiment of the present invention will be described with reference to the drawings, wherein both the proximal end 31 and the distal end 32 of the balloon 30 are joined to the outer circumferential surface of the distal end 12 side of the outer conduit 10 and the balloon ( On the outer circumferential surface of the outer conduit 10 positioned inward of the 30, a plurality of through holes 17 for introducing the expansion fluid 15 inside the outer conduit 10 into the balloon 30 are provided. The through-holes 17 are provided in a rectangular shape and four are provided at equal intervals along the outer conduit 10.

According to another embodiment of the present invention, the distal end 42 of the guidewire 40 is supported together by the outer conduit 10 as well as the inner conduit 20 so that the centering of the guidewire 40 can be maintained more effectively. There are advantages to it.

9 is a cross-sectional view showing a bonding structure of a balloon according to another embodiment of the present invention.

Referring to FIG. 9, another embodiment of the present invention is provided with four through-holes 17 of rectangular shape at equal intervals along the periphery of the distal end 12 side of the outer conduit 10. Corresponding to each through hole 17 presents a structure in which balloons 30 'of the same size and shape are individually bonded.

According to the embodiment shown in FIG. 9, the expansion fluid 15 supplied to the outer conduit 10 is supplied to each balloon 30 ′ through each through hole 17, and each balloon ( 30 ') expand and close to the vessel inner wall 1 to maintain centering of the outer conduit 10, the inner conduit 20 and the guidewire 40 inside the inner conduit 20.

As described above, in the catheter structure having a plurality of balloons separated along the circumference, blood flow may flow between the balloons, and thus, the flow of blood is not completely blocked during the procedure. In particular, according to the catheter structure according to the present embodiment, it is advantageous because the flow of blood flow is not completely blocked by the balloon during the lesion removal procedure when the lesion is not completely occluded. The embodiment of the present invention is not limited by the number of balloons and various modifications are possible.

According to the present invention, the lesion removal tool 50 removes the lesion while the centering of the guide wire 40 in the blood vessel 1 is secured by the expansion of the balloons 30 and 30 'as in the above-described embodiments. I'm trying to.

The lesion removal tool 50 may be used in various examples. Referring to the drawings, FIG. 1 shows an example in which a drill-shaped member (hereinafter referred to as a “drill”), which is an example of a rotary cutting tool, is provided as the lesion removal tool 50.

The drill 51 removes chronic stenosis lesions through rotational and longitudinal movements. The drive unit connected to the proximal end 41 of the guide wire 40 generates a rotational motion and provides the drill 51 through the guide wire 40. The drive 60 providing rotation to the drill 51 may be a motor or an air turbine. For example, air turbines used in Rotabltor ^™ , available through Boston Scientific Corporation, can provide high speed rotations of 140,000 to 160,000 rpm. The operator removes the lesion through the rotation and longitudinal movement of the drill 51 while moving the guide wire 40 in the longitudinal axis direction when removing the lesion. At this time, the cooling fluid 25 is supplied to cool the heat generated by the friction between the drill 51 and the lesion, thereby preventing the blood vessel from being damaged by the heat generated when the lesion is removed.

According to the invention the rotary cutting tool is not limited to a drill. As an example of a tool for rotationally cutting a lesion, not only a drill, but also a polishing tool coated with diamond particles, for example, can be used. In addition, a drill formed by processing the distal end of the guide wire in the form of a drill, rather than attaching a separate lesion removal tool, may be used.

Further, according to another embodiment of the present invention, various means other than a rotary cutting tool such as a drill may be used as the lesion removal tool for lesion removal. For example, a vibrating tool may be used that removes the lesion by applying a physical impact to the lesion by repeated movement in the longitudinal axis. The drive unit provides the driving force for the vibration tool to physically impact the lesion. Flowcardia, inc. The CROSSER ^TM vibration tool developed by is known to be able to remove lesions by mechanical shock and cavitation effects using 20,000 vibration energy per second. In the present invention, it is possible to use such a conventionally known lesion removal tool. As another example, the lesion removal tool can be an incision tool that incisions the lesion. Cordis endovascular division offers a tool to cut and remove lesions. As another example the lesion removal tool may be a laser radiation tool. The lesion is removed by an Excimer laser provided to the laser radiation tool.

The drive unit 60 provides power or energy through the guidewire 40 so that the lesion can be removed by the lesion removal tool 50.

Hereinafter, referring to FIGS. 1 and 2, an operation for removing chronic stenosis lesions causing vascular occlusion using a catheter for removing stenosis lesions in blood vessels according to the present invention will be described.

The operator incise a portion of the vessel connected to the site in need of the procedure and inserts the catheter according to the present invention, and then the catheter until the distal end of the lesion removal tool 50 of the catheter reaches the lesion occluding the vessel. Advance If it is determined that the lesion removal tool 50 will reach a predetermined site, the expansion fluid 15 is supplied through the first port 14 of the outer conduit 10. The balloon 30 is inflated by the expansion fluid 15, the outer circumferential surface of the balloon 30 comes into contact with the blood vessel inner wall, and the inner conduit or the outer conduit and the inner conduit passing through the balloon 30 are pressurized. Centering is ensured, thereby ensuring centering of the lesion removal tool 50 attached to the guidewire 40 and its distal end 42. That is, the lesion removal tool 50 is located at the center of the blood vessel.

The operator supplies the cooling fluid 25 through the second port 24 and drives the drive unit 60 to operate the drill 51, which is the lesion removal tool 50. The operator removes the lesion while advancing the drill 51 rotating by a set length using a knob (not shown) formed on the guide wire. That is, the drill 51 is to remove the lesion while moving forward while receiving the rotational force and the longitudinal axis force through the guide wire (40). The advance length of the drill 51 is previously designed in a range in which the centering can be maintained in consideration of the bending stiffness of the guide wire 40 and the like. The lesion is removed while moving to the set forward distance, and the drill 51 returns to its original position.

Thereafter, after the cooling fluid 15 is discharged to retract the balloon 30, the catheter is advanced again, and the lesion is removed while repeating the above-described process.

Through this process, chronic complete stenosis lesions in the blood vessels are removed, and the lesions are removed with the centering of the lesion removal tool 50 such as the drill 51 secured by the balloon 30, such as the drill 51. The lesion removal tool 50 can be minimized to damage the blood vessel inner wall.

The present invention has been described with reference to some embodiments. The presented embodiments are presented to aid the understanding of the present invention, and the present invention is not limited by the detailed description. Although the name of the present invention is a catheter for removing chronic stenosis lesions, the present invention can be used for the removal of lesions forming partial stenosis and occlusion of vascular lumen rather than chronic stenosis lesions. Is not. The technical scope or protection scope of the present invention is limited only by the appended claims, and includes all modifications and changes within the scope of the appended claims and their equivalents.

1 is a perspective view of a catheter for removing chronic stenosis lesions in blood vessels according to an embodiment of the present invention.

Figure 2 is a cross-sectional view of the catheter for removing chronic stenosis lesions in the blood vessel according to an embodiment of the present invention.

3 is a cross-sectional view taken along line AA ′ of FIG. 2.

4 is a cross-sectional view taken along line BB ′ of FIG. 2.

5 is a partially enlarged perspective view of a portion C of FIG. 2.

6 is a partial cross-sectional view of the catheter for removing chronic stenosis lesions in the blood vessel according to another embodiment of the present invention.

FIG. 7 is a cross-sectional view taken along the line D-D 'of FIG. 6.

8 is a perspective view of a portion F of FIG. 6.

9 is a partial cross-sectional view of a catheter for removing chronic stenosis lesions in blood vessels according to another embodiment of the present invention.

Claims (10)

A catheter for removing chronic stenosis lesions in blood vessels for removing lesions of the stenosis or occlusion of the vascular lumen, An outer conduit having a proximal end and a distal end and having a first port at the proximal end for supplying expansion fluid; An inner conduit extending through the interior of the outer conduit such that a longitudinal axis extends parallel to the longitudinal axis of the outer conduit and the distal end is positioned at a position corresponding to the distal end of the outer conduit or at a position past the distal end of the outer conduit ; A balloon bonded adjacent to the distal end of the catheter and inflated in the vessel by the expansion fluid supplied through the first port in the folded state and supported by the vessel inner wall; A guidewire extending through the inner conduit and extending so that its distal end is positioned beyond the distal end of the inner conduit; And A lesion removal tool provided at the distal end of the guidewire; And And a drive unit connected to the proximal end of the guide wire and configured to supply driving force or energy to the lesion removal tool. The method of claim 1, And a proximal end of the medial conduit is provided with a second port for supplying a cooling fluid into the medial conduit. The method of claim 2, The inner conduit extends beyond the distal end of the outer conduit, The balloon having a proximal end bonded to the distal end of the outer conduit and the distal end of the balloon bonded to the distal end of the inner conduit, A catheter for chronically constricted lesion removal in blood vessels, wherein the expansion fluid supplied through the first port is discharged into the balloon at the distal end of the outer conduit to expand the balloon. The method of claim 2, At the distal end of the catheter, the balloon is proximal and distal end bonded to the distal end side peripheral surface of the outer conduit, A catheter for removing chronic stenosis lesions in a blood vessel, characterized in that a through-hole is provided at the outer circumferential surface portion of the outer conduit positioned inwardly of the balloon to allow the inflation fluid to flow into the balloon. The method of claim 2, On the distal end side of the catheter At least two through-holes formed through the outer circumference along the circumference of the outer conduit and serving as a passage for the expansion fluid, are provided at equal intervals, Corresponding to each of the through hole formed in the outer circumferential surface of the outer conduit, the chronic complete stenosis lesion removal in the blood vessels, characterized in that it comprises a balloon that is expanded by the expansion fluid provided through the through hole to support the inner wall of the vessel Catheters. The method according to any one of claims 2 to 5, An end cap is provided at the distal end of the inner conduit, The guide wire penetrates through the central opening of the end cap, and the end cap is formed in the periphery of the central opening for the discharge of a chronic complete stenosis lesion in the vessel, characterized in that the catheter. The method according to any one of claims 2 to 5, The lesion removal tool is formed as a rotary cutting tool for physically drilling the contact lesion while rotating and moving forward, The guidewire is catheters for chronic stenosis lesion removal in the vessel, characterized in that for receiving the movement of the drive unit provides a rotational and longitudinal direction for the operation of the lesion removal tool. The method according to any one of claims 2 to 5, The lesion removal tool, A catheter for chronic stenosis lesion removal in blood vessels, which is formed by any one of a vibration tool for crushing a lesion by a repetitive impact, an incision tool for cutting a lesion, and a laser radiation tool for radiating and removing a laser to the lesion. The method according to any one of claims 2 to 5, The medial conduit extends outwardly through the proximal end of the outer conduit, and the proximal end of the outer conduit is sealed to prevent swelling fluid leakage. Catheter. The method of claim 9, The guidewire extends outward through the distal end of the proximal end of the inner conduit, and the distal end of the proximal end of the inner conduit is sealed to prevent cooling fluid leakage.

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