WO2005018729A1

WO2005018729A1 - Catheter with elastically flexible or directed end

Info

Publication number: WO2005018729A1
Application number: PCT/EP2004/009009
Authority: WO
Inventors: Peter Osypka
Original assignee: Dr. Osypka Gmbh
Priority date: 2003-08-16
Filing date: 2004-08-12
Publication date: 2005-03-03
Also published as: DE10337580A1; DE10337580B4

Abstract

A catheter (1) comprises a region (6), which is flexible and directed by means of a drawing element (8), as an extension of the catheter shaft (9), and which may be directed in opposing directions, whereby the drawing element is arranged to run eccentrically within the catheter (1), guided such as to avoid kinking and which may thus make adjustments in the drawing direction and the opposing pushing direction. The catheter (1) can thus be produced with a smaller cross-section then when provided with a drawing element for each opposing deformation.

Description

Catheter with an elastically bendable or steerable end

The invention relates to a catheter with at least one channel or lumen extending over part of its length in its interior, which catheter is essentially formed by a flexible plastic tube, the distal end of the catheter being arranged eccentrically with respect to the essential by means of an eccentrically arranged relative to the axial center Length of the catheter to its attachment point at the distal end within the outline or cross section of the catheter traction element is elastically bendable or steerable relative to the catheter shaft and the traction element is enclosed up to the flexible region by a guide element or guide tube, to which a guide part is attached the tension element connects in the flexible area, which is also flexible.

Such a catheter is known from EP 0 630 657 B1 and has proven itself. With the aid of a traction element running inside it, at least in the flexible area arranged eccentrically, the flexible area can be deflected in order to control and align the tip of the catheter, for example for entry into branches of the body cavity system, for example blood vessels. Due to the tensile force acting on the pulling element relative to the rest of the catheter, due to the eccentric arrangement, the flexible region is pivoted in the direction in which the guide part is also offset eccentrically relative to the center of the flexible region of the catheter. The tensile force practically shortens the tensile element relative to the central axis of the catheter, which results in a corresponding bend in the direction of the eccentricity. The tension element is movable between two end positions and assumes one end position when the flexible region is in a straight position and the other end position when the flexible region is deflected to the maximum.

In order to be able to take into account an opposite change in direction with this known and proven catheter, it must therefore be rotated through 180 ° about its longitudinal axis. This can be difficult or even impossible, especially during an operation.

Such catheters with several eccentrically arranged pulling wires are also known, the eccentricities of which are spaced apart from one another in order to be able to cause a deflection in different directions depending on the actuation of one or the other pulling wire. These multiple pull wires, together with their guides, then require a correspondingly large amount of space inside the catheter, so that, at least for some applications, the overall dimension is too large, in particular the cross-sectional dimension is too large. Such large catheters are unusable, especially when treating children.

The object is therefore to create a catheter of the type mentioned at the outset which allows its flexible end to be deflected in opposite directions, the overall dimension, in particular the cross-sectional dimension of the catheter shaft and also the deflectable region, nevertheless being small.

To achieve this object, the catheter of the type defined at the outset is characterized in that the tension element is arranged eccentrically, at least in its flexible region, in that the pulling element which serves to deflect the flexible area is also displaceably mounted in the guide element or guide tube and in the flexible guide part against its pulling direction and that the pulling element can be adjusted in a pulling direction and in the opposite direction in the pushing direction from a central position in which the flexible area runs approximately rectilinearly is.

If the entire axial extension of the pulling element is shifted against the pulling movement serving to deflect in one direction, the flexible area of the catheter is pivoted and deflected in the opposite direction, because instead of being shortened by a pulling movement, the pushing movement now within the flexible area Compared to the axial center, an extension of this tension element is created, which the flexible area with the tension element running eccentrically therein must dodge by an opposite adjustment movement. It is therefore possible in a simple manner that the pulling element is assigned adjustment movements in its two axial directions of extension beyond a central position, without an additional pulling element allowing deflection of the flexible region of the catheter to two opposite sides, so that despite the deflectability to opposite sides the cross section of the catheter need not be enlarged.

It is particularly advantageous if the pulling element can be moved or adjusted in both directions by approximately the same amount from its central position. This then leads to adjustment movements of approximately the same size towards the opposite sides.

To be able to do this with a relatively thin one To be able to get by the tension element and to be able to operate it with the required thrust force, it is expedient if the tension element is tightly enclosed in the guide element and in the guide part to prevent it from buckling under shear load. If the displaceable tension element is sufficiently closely enclosed by its guide, buckling cannot take place even with increased pushing force, so that the pushing force can be transmitted to the distal fastening end. Even a relatively simple wire can have sufficient rigidity and strength to transmit the necessary pushing force for deflecting the flexible area despite its particularly elastic flexibility in a guide surrounding it. Such a tensile element can absorb the oppositely directed deflection force even more under tensile load.

To adjust the pulling element, an actuating element, in particular a slider which can be rotated, pivoted and / or adjusted relative to the catheter and to which the pulling element is connected directly or indirectly, can be provided, and the actuating element can be moved from a central position in which the flexible region runs straight and approximately flush with the catheter, can be moved in two opposite directions. With the aid of this actuating element, the surgeon can thus determine which side the flexible region of the catheter is to be deflected during the operation by moving the actuating element in one direction or the other from the approximately middle rest position.

In a particularly simple embodiment of the invention, the actuating element can be a slide which is adjustable in the longitudinal direction of the catheter relative to an abutment - at the proximal end and which can be designed in particular as a pull and push handle. In the proximal end area of the catheter, where the user grasps the catheter, the pulling and pushing handle for actuating the pulling element can be conveniently arranged in different directions. For example, the user can use one or two fingers to support the abutment and use the remaining part of the hand to adjust this push handle relative to the abutment that is firmly connected to the catheter shaft. However, if necessary, he can also grasp the abutment with one hand and the pull and push handle with the other hand in order to carry out the mutual relative movement.

The tension element between its two end positions can in particular be continuously adjustable in intermediate positions. Any deflection movements up to the greatest deflection can thus be carried out.

A particularly advantageous embodiment of the invention can consist in that the tension element has a flattened cross-section, at least near or at the transition from the substantially straight catheter shaft into the flexible region of the catheter, the larger cross-sectional dimension of this flattened tension element being arranged transversely to the bending plane. As a result, the curvature in the bending plane is facilitated, while a transverse deflection is made more difficult or prevented. The respective bending or deflection movement of the flexible region is correspondingly precise, so that it cannot be deflected or can be deflected unintentionally with respect to the bending plane.

It is particularly advantageous if the flattened cross section of the tension element is an oval or elliptical cross section or a cross section with two close to each other parallel outsides or surfaces.

So that the tension element cannot be twisted or twisted, it is expedient if the guide element and / or guide part for the tension element at least before and / or at the beginning of the flexible area or in the transition from the catheter shaft to its flexible area corresponds to the cross section of the tension element and is flattened tightly around it. The guide thus contributes to the fact that the flattened part of the tension element is practically only bent in the bending plane and deflection with respect to this plane can be largely prevented.

It is particularly favorable and expedient for simple manufacture if the tension element has a flat - in particular constant - cross section over its entire length and is in particular designed as a band, for example made of stainless steel.

This easily results in a larger cross-sectional dimension transversely to the bending plane, and such a metal or stainless steel band can also be accommodated in a corresponding guide within the catheter in a good and space-saving manner, the smaller cross-sectional dimension advantageously extending in the radial direction and thereby contributes to keeping the overall cross section of the catheter in the area of the pulling element and its guide small.

For fastening the guide element within the tube for the catheter shaft, at least two spaced sleeves can be provided, which are fastened with their outer circumference to the inside of the tube and on the inside of which the guide element, guide tube or a guide cannula, is in particular welded on, preferably one of the sleeves at or near the proximal end of the catheter and the other sleeve near or at the distal end of the catheter shaft in front of its flexible part. As a result, the guide element is held securely and prevented from undesired deformations over the entire length of the catheter shaft up to the flexible area.

For good dimensional stability, it is helpful if the sleeves inside the tube of the catheter shaft have a closed outer circumference.

A further embodiment and modification of the invention with independent meaning worthy of protection can be characterized in the case of a catheter of the type defined in the introduction in that the flexible region can be deflected differently or asymmetrically on the opposite sides, this being in particular the greatest deflection in each case on the opposite sides means. This allows the user to best adapt the catheter to different anatomical conditions. Depending on the change in direction, either a deflection on one side with a narrow radius of curvature or an opposite deflection with a larger radius of curvature may be required, whereby the user has the option of rotating the catheter about its longitudinal axis, in order to thereby move the catheter to the respective spatial Adapt direction change. This does not mean only a partial deflection that leads to intermediate positions, which is also possible, but it is about the greatest possible deflection to one side or the other.

A particularly expedient embodiment of the modified catheter with an asymmetrically deflectable area can be stand that the deflectable area has at least two continuing parts and a first part of the area which is directly adjacent to the catheter shaft is stiffened in such a way that this first part is less or not after one of the two deflection directions and the subsequent second part in this direction can be deflected unhindered and that the first part and the second part of the deflectable region can be deflected unhindered in the opposite direction. "Unhindered" here means the normal deflectability in contrast to that of the first part of the flexible region, which is difficult or blocked in one direction. This arrangement means that when only the second part is deflected and the deflection of the first part is blocked, deflection also occurs narrower radius of curvature can be achieved and achieved, while in the opposite direction, in which the entire flexible region remains deflectable, this occurs with a larger radius of curvature, which facilitates adaptation to different anatomical conditions.

In the first part of the deflectable area, a stiffening element can extend eccentrically to the center thereof and within the deflection plane up to the end of the first part of the deflectable area and can be fixed there. In this first part of the deflectable area there is therefore an element which, due to its eccentricity, has a similar effect to the tension element, but this stiffening element does not itself have to be movable in the longitudinal direction. Because of the eccentricity, it prevents the bend in one direction where it would be on the outside of that bend, while an opposite bend and deflection is possible due to the flexibility of this stiffening element, in which this stiffening but flexible element is on the inside of the Bend runs. The stiffening element can be arranged on the same side as the tension element eccentrically to the longitudinal central axis and in particular can be in the form of a band, thread or wire. It therefore takes up little space and can be arranged immediately adjacent to the longitudinally movable tension element.

The stiffening element can be displaceable at its proximal end relative to a stop when the first and second parts of the flexible element are deflected to the side of this stiffening element and, in the case of opposite deformation, can bear against the stop under tensile load when the first part of the deflectable region runs approximately in a straight line. The stiffening element or stiffening element is thus passively adjusted with its proximal end relative to the stop during the deflection, in which the first part of the flexible region can also be deflected, because the bending in this direction means a shortening of the region with this stiffening element , This shortening is taken into account by the fact that the stiffening element can retract in the axial direction compared to the abovementioned stop. In the opposite direction, however, the stiffening element is prevented by the abovementioned stop from following the deformation and bending by means of a corresponding relative adjustment, so that a corresponding bending is prevented.

Although this stiffening element could run on the outside of the catheter and the first part of its deflectable region, this stiffening element is also expediently accommodated within the catheter and the catheter tube. A further modification of the catheter according to the invention can consist in that it has a second axially adjustable tension element on the side of its longitudinal center or longitudinal axis facing away from or opposite the tension element, which ends at the distal end of a first part of the deflectable region. Instead of a passive stiffening element, a second adjustable tension element can also be provided, with which the first deflectable area can under certain circumstances even be adjusted opposite to the deflection of the second part of the deflectable area, if the anatomical conditions so require. However, this second tension element can also be used to prevent the first part of the deflectable region from deflecting when the second part is deflected. But it can also support the deflection and thus bring about a correspondingly strong deflection of the entire flexible area.

The pulling element stiffening the first part of the deflectable area to one side can thus be adjusted in opposite directions in the axial direction of the catheter and the catheter shaft and the first part of the deflectable area in the opposite direction to the second part of the deflectable area or in the same direction or even cannot be deflected and for actuating the second pulling element a second actuating part at the proximal end of the catheter shaft, in particular a slide, can be connected to this second pulling element. Thus, the two pulling elements can be actuated separately from each other in an analogous manner.

The second tension element can have a flat cross section, in particular be a tension band, that is to say correspond to a preferred embodiment of the first tension element. Thereby NEN the flat cross sections of the first and second tension element parallel to each other, but be arranged on different sides of the longitudinal central axis.

Especially when combining one or more of the features and measures described above, a catheter with a deflectable end results, in which a single pulling element is sufficient to be able to perform opposite deflections of this flexible end, in which the pulling element can also be used and adjusted as a pushing element ,

Further features and measures with a passive or an adjustable further tension element allow different deflections of the flexible end and thus, due to the axial adjustability of at least the first tension element in two opposite directions, a considerably improved adaptation to different anatomical conditions.

Exemplary embodiments of the invention are described in more detail below with reference to the drawing. It shows in a partially schematic representation:

1 shows a catheter according to the invention with an area arranged at its distal end and deflectable or flexible relative to the rest of the catheter shaft in an unbent or non-deflected position,

FIG. 2 shows a view of the catheter according to the invention corresponding to FIG. 1, the flexible region being deflected to the right, as viewed by the viewer, in that a push handle provided at the proximal end is opposite the arrangement in FIG. 1 in the direction towards the distal end an abutment is moved there.

3 shows a representation corresponding to FIGS. 1 and 2, the flexible end being deflected in the opposite direction in relation to FIG. 2 in that the pulling and pushing handle is in the proximal direction in relation to the catheter shaft and the abutment firmly connected thereto 1 is moved further away from the abutment,

Fig. 4 on an enlarged scale, a longitudinal section through the catheter shaft and the transition into the flexible area, wherein a pulling element runs in the guide tube within the catheter shaft, which element enters a further guide part in the flexible area and up to the distal end of the catheter and the flexible one Area where the electrodes of the catheter are also arranged,

5 shows a cross section of the catheter according to section line V-V in FIG. 4 in the region of a sleeve arranged in the catheter shaft and the tube forming it, to which the proximal end of the guide tube for the pulling element is fixed,

Fig. 6 shows a cross section of the catheter at the transition to the flexible region according to section line VI-VI in Fig. 4 adjacent to a distal sleeve no longer covered by this section, to which the guide tube for the pulling element is also fastened, in particular welded, wherein this guide tube still protrudes somewhat into the flexible area and is flattened according to the cross section in FIG. 6, since the tension element also has a flat or ribbon-shaped cross section in this area,

FIG. 7 shows a modified longitudinal section according to the illustration in FIG. 4, the electrical feed lines to the electrodes arranged at the end of the flexible region being shown, which in this exemplary embodiment extend helically around the guide tube for the tension element,

8 is a cross section corresponding to FIG. 5 showing the helically arranged electrical leads of the arrangement according to FIG. 7,

9 shows a cross section corresponding to FIG. 6 with the electrical leads of the arrangement according to FIG. 7 lying next to one another in this area, FIG.

10 shows a further longitudinal section analogous to the representations according to FIGS. 4 and 7, the electrical leads inside the catheter shaft running essentially parallel to one another,

11 shows a cross section corresponding to FIG. 5 of the catheter according to FIG. 10,

12 shows a cross section corresponding to FIG. 6 of the catheter according to FIG. 10,

13 shows a longitudinal section of a again modified catheter analogous to the representation according to FIG. 4, a cannula for a cooling medium running in the interior of the catheter shaft, which extends to the distal end of the catheter Leads the catheter and the flexible area so that the area of the electrodes can be cooled,

14 is a cross section of the catheter of FIG. 13 analogous to that of FIG. 5,

15 shows a cross section of the catheter according to FIG. 13 analogous to the representation in FIG. 6,

16 is a view of the flexible area of a modified catheter with a stiffening element looking in the bending plane,

17 is a view of the flexible region with a stiffening element which, due to the bend to the right and due to its arrangement to the right, is displaced with its proximal end relative to a stop from the center of this catheter, that is to say does not obstruct this bend,

18 shows a view corresponding to FIG. 16, in which the flexible region is arched in the opposite direction and the stiffening element with its proximal end is prevented from "going along" with the corresponding opposite curvature,

Fig. 19 is a side view of the opposite to 17, partially prevented by the stiffening element, which thus has a narrower radius of curvature than that of Fig. 17, wherein the stiffening element is designed as a flexible tension element and is shown on the outside of the catheter for better clarity , in reality but is preferably placed inside

20 shows a side view of the distal end of the catheter with its flexible region, the flexible region being deflected as a pulling element by an eccentrically extending tension band,

21 shows an enlarged cross section of the catheter shown in FIG. 20 with a tube, an outer tube surrounding the latter and the guide for the pulling element and an outer braid,

22 shows a modified embodiment with two tension elements arranged eccentrically on different sides to the longitudinal center and running inside the catheter, one of which extends to the end of the deflectable area, while the second tension element only extends to the end of a first part of the deflectable area and there ends, so that the first part of the deflectable region can also be bent in the opposite direction to the second part by different tensile and / or shear stresses, and

FIG. 23 shows a cross section of the catheter according to FIG. 22 in an area in which the two tension elements run, the structure of the catheter corresponding to that according to FIG. 21.

In the following description of various exemplary embodiments, reference numbers that correspond to one another in terms of their function, but have differently designed parts, are given the same reference numbers. A catheter, designated as a whole by 1, in particular largely fully illustrated in FIGS. 1 to 3, has in its interior a channel 2, which can also be referred to as a lumen, and, according to FIGS. 7 to 13, electrical leads 3 in particular contains or receives the electrodes 4 arranged at its distal end.

The catheter 1 is essentially formed by a flexible plastic tube 5 and, according to FIGS. 2 and 3 and also according to other figures, has at its distal end a generally designated 6 flexible region, which according to FIG. 1 is also in a non-deflected position or 4 can be used in only a slightly deflected position.

This flexible region 6, that is to say the distal end of the catheter 1, is by means of a tension element 8 which is arranged eccentrically with respect to the axial center of the catheter 1 and runs over the essential length of the catheter up to a fastening point 7 at the distal end within the outline or cross section of the catheter relative to the catheter shaft 9, that is to say the part of the catheter 1 which extends to the beginning of the flexible region 6, can be elastically bent and deflected. The tension element 8 is enclosed up to the deflectable area 6 by a guide element or guide tube 10, which is followed by a guide part 11 for the tension element 8 in the interior of the flexible area 6, which is flexible together with the latter. If, as indicated in FIG. 4, a pulling force is exerted on the pulling element 8, that is to say the pulling element 8 in the interior of the catheter 1 is adjusted towards its proximal end, this leads to a “shortening” in the flexible region due to the eccentric arrangement affects the desired increasing bend in a known manner. This pulling element 8, which serves to deflect the flexible area 6, is also displaceably mounted in the guide element or guide tube 10 and in the flexible guide part 11 against its pulling direction and can be moved from a central axial position according to FIG. 1, in which the flexible area 6 is approximately rectilinear runs, on the one hand in the pulling direction according to FIG. 4 and on the other hand in the pushing direction, which then leads to an opposite curvature. The flexible region 6 can thus be deflected in two opposite directions with the aid of a single eccentrically arranged pulling element 8. The catheter cross-section can be correspondingly small compared to a solution in which two eccentric tension elements are required for an opposite deflection.

In the exemplary embodiment according to FIGS. 1 to 3 and also according to FIGS. 4 to 15, the tension element 8 can be adjusted in both directions by approximately the same amount from a central position (FIG. 1), that is to say the deflectable region 6 can be moved according to the two opposite sides by the one tension element 8 are each curved by the same amount, as the comparison of FIGS. 2 and 3 illustrates.

Especially in FIGS. 4 to 15 and also in FIGS. 21 and 23, it can clearly be seen that the tension element 8 in the guide element 10 and in the guide part 11 is tightly enclosed to prevent it from buckling under shear loading, the ones that can be seen in the figures Distances between the tension element 8 and this guide element 0 or guide part 11 are shown somewhat exaggerated for better clarity. This prevents and when a pushing force is exerted on the tension element 8, this force leads to a buckling of the tension element 8 and can prevent the deflection of the flexible region 6.

An actuating element, in the exemplary embodiment a slide or push handle 12, is used to adjust the pulling element 8, with which the pulling element 8 is connected directly or indirectly in the interior of the catheter 1 and from a central position according to FIG. 1, in which the flexible region 6 is straight and runs approximately in alignment with the catheter 1 or the catheter shaft 9 and can be moved in two opposite directions.

1 to 3, it becomes clear that the actuating element is a slide which is adjustable in the longitudinal direction of the catheter 1 with respect to an abutment 13 and which is designed as a pull and push handle 12.

The user can therefore grasp this handle 12 by hand and, for example, support himself on the abutment 13 with his thumb, in order then to move the handle 12 from the position according to FIG. 1 to that according to FIG. 3. Conversely, it can include the slide handle 12 and also, for example, overlap the abutment 13 with the index finger and then move the push handle in the opposite direction to the abutment 13, as shown in FIG. 2. The opposite adjustment can be carried out in a similar manner from these respective end positions according to FIGS. 2 and 3. Furthermore, it is possible to grasp the abutment 13 with one hand and the pulling and pushing handle 12 with the other hand and to perform an opposite movement to selectively deflect the pivotable area 6 in one direction or the other.

The operation is very simple and the pulling element 8 can also between its two end positions be infinitely adjustable in intermediate positions if the complete deflection of the flexible region 6 is not desired or necessary.

6, 9, 12, 15, 21 and 23, the tension element 8 has a flattened cross-section, at least near or at the transition from the essentially straight catheter shaft 9 into the flexible region 6, the larger cross-sectional dimension of this flattened tension element 8 is arranged transversely to the bending plane and can thus largely prevent deflections of the flexible region 6 from the desired bending plane. In the above-mentioned exemplary embodiments, this flattened cross-section of the tension element 8 is band-shaped, that is to say that the tension element 8 could also have such a flat cross-section, possibly over its entire length, and be designed as a band, for example made of stainless steel. 6, 9, 12, 15, 21 and 23 also show that the guide tube 10 for this tension element 8 can be flattened at least in this transition region from the catheter shaft 9 to the flexible region 6 in accordance with the cross section of the tension element 8. and is to give good guidance and to improve the stiffening transverse to the desired bending plane for the deflection of the flexible region 6.

4, 7, 10 and 13 it is shown that two spaced sleeves 14 are provided for fastening the guide element or guide tube 10 within the tube 5 for the catheter shaft 9, with their outer circumference on the inside of the tube 5 or of the catheter shaft 9 are fastened, for example glued, and to which the guide element or guide tube 10 or a guide cannula is in turn fastened, in particular welded, to the inside. Corresponding figures are shown in the figures Welding points 15, which can be formed by laser welding, are indicated. One sleeve 14 is located at or near the proximal end of catheter 1 or catheter shaft 9, while the other sleeve 14 is located near or at the distal end of catheter shaft 9 directly in front of flexible region 6, so that catheter shaft 9 is good on the one hand is stiffened and stabilized and on the other hand the flexible region 6 can be deformed independently of it.

The sleeves 14 inside the tube 5 or the catheter shaft 9 have a closed outer circumference in order to distribute their holding forces evenly.

16 to 23 show exemplary embodiments in which the flexible region 6 can be deflected differently or asymmetrically on the opposite sides, as shown on the one hand by the comparison between FIGS. 17 and 19 and on the other hand by the comparison between FIGS. 20 and 22 is explained in more detail below.

This is achieved in that the deflectable region 6 has two continuing parts 6a and 6b and a first part 6a of the region 6 which can be deflected towards two opposite sides and which is directly adjacent to the catheter shaft 9 is stiffened such that this first part 6a according to one of the two deflection directions less or not, and the second part 6b adjoining the distal end of the keter 1 can be deflected in this direction without hindrance, as is shown above all in FIG. 19. "Unhindered" means that this second part 6b can be deformed in this direction as is the case for the deflectable region 6 according to FIGS. 2 and 3. The first part 6a and the second part 6b of this exemplary embodiment, on the other hand, can be deflected freely in the direction opposite to FIG. 19, as shown in FIG. 17. This results in a larger radius of curvature for the deflection according to FIG. 17, in which both parts 6a and 6b are bent, than in the case in which only the second part 6b is bent with opposite bending, as is the comparison of FIG. 17 and 19 shows.

The already mentioned one-sided or one-way stiffening of the first part 6a is brought about by the fact that in the first part 6a of the deflectable area 6 an eccentric element 16 eccentrically to its center and in the deflection plane, hereinafter also referred to as “stiffening element 16” , which extends and is fixed there to the distal end of the first part 6 of the deflectable region 6. However, this stiffening element 16 is flexible. The only important thing is that the length of the stiffening element 16 is practically unchangeable same side as the tension element 8 eccentric to the longitudinal central axis and is in the form of a ribbon or thread or wire, in any case also like a tension element.

The proximal end 16a of the stiffening element 16 can be displaced with respect to a stop 17 according to FIG. 17 in the direction of the proximal end of the catheter 1 when the first and the second part of the flexible region 6 are deflected to the side on which the latter Stiffening element 16 is located. Since it is then located to a certain extent on the “inner curve”, the corresponding deflection actually leads to a shortening of the distance between the distal attachment point 16b of this stiffening element 16 and the eyelet-shaped stop 17 mentioned, so that the proximal end is located 16 must be adjusted accordingly relative to this stop 17.

In the opposite deformation, on the other hand, the proximal end 16a reaches the stop 17 and comes to bear against it under tensile load, and can therefore prevent deformation of the first part 6a in the bending direction according to FIG. 19. The proximal end 16a is provided with a corresponding projection or the like, which comes to rest against the stop 17 in one direction (FIG. 19), but can be moved away from this stop 17 in the opposite direction (FIG. 17).

This stiffening element 16 is shown in FIGS. 16 to 19 on the outside of the first part 6a of the deflectable region 6. In reality, however, this stiffening element 16 is located inside this first part 6a, as is the stop 17 and the corresponding anchoring and fastening points. The illustration in FIGS. 16 to 19 on the outside was chosen for the sake of clarity.

22 and 23 show another modified embodiment. Accordingly, the catheter 1 of this exemplary embodiment has a second, also axially adjustable pulling element 18 on the side of its longitudinal center or longitudinal axis facing away from the pulling element 8, which pulling element 18 is also axially adjustable and is located at the distal end of a first part 6a of the deflectable region 6, that is to say at a considerable distance from the distal end of the catheter 1 or its deflectable region 6 and thus ends much earlier than the first pulling element 8. With this second tension element 18, only the first part 6a of the flexible region 6 can be curved, as is indicated in FIG. 22. This curvature can even be opposite to the curvature extend, which can be carried out with the actual tension element 8, which extends to the distal end of the deflectable region 6. However, the second tension element 18 can also be used to keep this first part 6a of the area 6 straight or to support its curvature - in the case of FIG. 22 - to the left and, if necessary, to reinforce it.

The pulling element 18 stiffening the first part 6a of the deflectable region 6 to one side is thus adjustable in the axial direction of the catheter 1 and the catheter shaft 9 and this first part 6a of the deflectable region 6 is therefore in the opposite direction to the second part 6b of the deflectable area 6 or in the same direction or not deflectable at all, which can be accomplished by actuating this second pulling element 18 with a corresponding actuating element or handle on the proximal end of the catheter shaft 9. In particular, a slide or the like can be connected to this second tension element 18.

23, this second tension element 18 can likewise have a flat cross section and preferably be a tension band. 23 also shows that the flat cross sections of the first tension element 8 and of the second tension element 18 are arranged parallel to one another and at the same time are arranged transversely to the bending plane of the deflectable region 6.

It should also be mentioned that a wide variety of lines can run in the inner channel 2 or lumen of the catheter 1, including measuring lines, so that the corresponding catheter 1 can be used in a variety of ways.

The catheter 1 has a continuation of its catheter shaft 9 a region 6 which is flexible and deflectable with the aid of a pulling element 8 and which can be deflected in opposite directions in that the pulling element which runs eccentrically inside the catheter 1 and is guided against buckling is displaceably mounted in two opposite directions and both in the pulling direction and also is adjustable in the opposite direction. The catheter 1 can thus be manufactured with a smaller cross section than if tensile elements were provided for the opposite deformations.

A second tension element 18 or a stiffening element 16 can be provided in order to be able to design the deflection of the flexible region differently in one or the other direction, so that better adaptation to different anatomical conditions is possible.

/Expectations

Claims

Expectations

1. Catheter (1) with at least one channel (2) or lumen running over part of its length in its interior, which catheter is essentially formed by a flexible plastic tube (5), the distal end of the catheter (1) being formed by means of a with respect to the axial center eccentrically arranged, over the substantial length of the catheter up to its attachment point (7) at the distal end within the outline or cross section of the catheter, traction element (8), is elastically bendable or deflectable relative to the catheter shaft (9) and wherein the tension element (8) up to the area (6) is enclosed by a guide element or guide tube (10), which is followed by a guide part (11) for the tension element (8) in the flexible area (6), which is also flexible, characterized in that the pulling element (8) serving to deflect the flexible region (6) in the guide element or guide tube (10) and in the flexible guide part (11) is displaceably mounted counter to its pulling direction and that the pulling element can be adjusted from a middle position, in which the flexible region (6) runs approximately rectilinearly, in the pulling direction and in the opposite direction in the pushing direction.

2. Catheter according to claim 1, characterized in that the tension element (8) is adjustable from a central position in both directions by approximately the same amount.

3. Catheter according to claim 1 or 2, characterized in that the tension element (8) in the guide element (9) and in the guide part (11) is tightly enclosed to prevent it from buckling under shear loading.

4. Catheter according to one of claims 1 to 3, characterized in that for adjusting the pulling element (8) there is an actuating element, in particular a rotatable, pivotable and / or adjustable slide (12) relative to the catheter, with which the Tension element (8) is connected directly or indirectly, and that the actuating element can be moved in two opposite directions from a central position in which the flexible region (6) runs straight and approximately flush with the catheter.

5. Catheter according to claim 4, characterized in that the actuating element is a in the longitudinal direction of the catheter (1) relative to an abutment (13) adjustable slide, which is designed in particular as a pull and push handle (12).

6. Catheter according to one of claims 1 to 5, characterized in that the tension element (8) between its two end positions, in particular, is also continuously adjustable in intermediate positions.

7. Catheter according to one of claims 1 to 6, characterized in that the pulling element (8) has a flattened cross section at least near or at the transition from the essentially straight catheter shaft (9) into the flexible region (6) of the catheter, the larger cross-sectional dimension of this flattened tension element (8) being arranged transversely to the bending plane.

8. Catheter according to claim 7, characterized in that the flattened cross section of the tension element (8) is an oval or elliptical cross section or a cross section with two closely spaced parallel outer sides or surfaces.

9. Catheter according to one of the preceding claims, characterized in that the guide element and / or guide part (11) for the tension element (8) at least before and / or at the beginning of the flexible region or in the transition from the catheter shaft (9) to it flexible area (6) corresponding to the cross section of the tension element (8) and this is flattened tightly surrounding.

10. Catheter according to one of claims 1 to 9, characterized in that the tension element (8) has a flat cross section over its entire length and is in particular formed as a band, for example made of stainless steel.

11. Catheter according to one of claims 1 to 10, characterized in that for fastening the guide element (10) within the tube (5) for the catheter shaft (9) at least two spaced sleeves (14) are provided, which with their outer circumference on the Are attached to the inside of the tube (5) and to which the guide element, guide tube (10) or a guide cannula is attached, in particular welded, preferably one of the sleeves (14) at or near the proximal end of the catheter (1) and the other Sleeve (14) near or at the distal end of the catheter shaft (9) in front of its flexible region (6) are arranged.

12 - Catheter according to one of claims 1 to 11, characterized in that the sleeves (14) in the interior of the tube (5) of the catheter shaft (9) are closed Have outer circumference.

13. Catheter in particular according to one of the preceding claims or according to the preamble of claim 1, characterized in that the flexible region (6) can be deflected differently or asymmetrically on the opposite sides.

14. The catheter according to claim 13, characterized in that the deflectable region (6) has at least two continuing parts (6a, 6b) and that the first part (6a) of the deflectable region (6) which is directly adjacent to the catheter shaft (9) It is stiffened that this first part (6a) can be deflected less or not after one of the two deflection directions and that the subsequent second part (6b) can be deflected unhindered in this direction and that the first part (6a) and the second part (6b) of the deflectable part Area (6) in the opposite direction are both freely deflectable.

15. Catheter according to claim 13 or 14, characterized in that in the first part (6a) of the deflectable region (6) eccentrically to the center thereof and within the deflection plane, a stiffening element (16) up to the end of the first part (6a) of the deflectable area runs and is fixed there and is flexible.

16. Catheter according to one of claims 13 to 15, characterized in that the stiffening element (16) on the same side as the tension element (8) is arranged eccentrically to the longitudinal central axis and in particular is in the form of a band or thread or wire.

17. Catheter according to one of claims 13 to 16, characterized in that the stiffening element (16) at its proximal end (16a) with respect to a stop (17) when deflecting the first and second part of the flexible region (6) to the side of this stiffening element (16) displaceable and, in the case of opposite deformation, rests against the stop under tensile load with the first part of the deflectable region running approximately in a straight line.

18. Catheter according to one of claims 1 to 17, characterized in that it has a second axially adjustable tension element (18) on the side of its longitudinal center or longitudinal axis facing away from the tension element (8), which tension element (18) is located at the distal end of a first part ( 6a) of the deflectable area (6) ends.

19. Catheter according to one of claims 1 to 18, characterized in that the first part (6a) of the deflectable region (6) on one side stiffening tension element (18) in the axial direction of the catheter (1) and catheter shaft (9) adjustable and the first part (6a) of the deflectable region (6) in the opposite direction to the second part (6b) of the deflectable region (6) or in the same direction or not deflectable and for actuating the second pulling element a second confirmation part at the proximal end of the catheter shaft (9), in particular a slide is connected to this second tension element (18).

20. Catheter according to one of claims 1 to 19, characterized in that the second tension element (16; 18) has a flat cross section, in particular a tension band is

21. Catheter according to one of the preceding claims, characterized in that the flat cross sections of the first tension element (8) and the second tension element (18) or stiffening element (16) are arranged parallel to one another.

/ Summary