WO2005030061A1 - Instrument de traitement medical - Google Patents

Instrument de traitement medical Download PDF

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Publication number
WO2005030061A1
WO2005030061A1 PCT/JP2003/012365 JP0312365W WO2005030061A1 WO 2005030061 A1 WO2005030061 A1 WO 2005030061A1 JP 0312365 W JP0312365 W JP 0312365W WO 2005030061 A1 WO2005030061 A1 WO 2005030061A1
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WO
WIPO (PCT)
Prior art keywords
rotary cutter
drive shaft
guide wire
cutter
diameter
Prior art date
Application number
PCT/JP2003/012365
Other languages
English (en)
Japanese (ja)
Inventor
Masayuki Nakao
Original Assignee
Johnson And Johnson Kabushiki Kaisha
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Johnson And Johnson Kabushiki Kaisha filed Critical Johnson And Johnson Kabushiki Kaisha
Priority to PCT/JP2003/012365 priority Critical patent/WO2005030061A1/fr
Publication of WO2005030061A1 publication Critical patent/WO2005030061A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320758—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with a rotating cutting instrument, e.g. motor driven
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320725—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with radially expandable cutting or abrading elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320004—Surgical cutting instruments abrasive

Definitions

  • the present invention relates to a therapeutic device (catheter device) for performing rotary cutting of a deposit in a coronary artery stenosis or other stenosis in a blood vessel to penetrate or expand the stenosis.
  • FIG. 15 is a diagram schematically illustrating a method of cutting a sediment.
  • the small-diameter guide wire 105 is passed through the blood vessel 101 until it passes over the stenosis 107, and the small-diameter catheter device 125 is passed along the guide wire 105.
  • the catheter device 125 has a bullet-shaped whetstone 127 and a drive shaft 125 formed of a coiled wire. Then, the grindstone 127 of the catheter device 125 is rotated at a high speed (about 200,000 rpm in one example) to scrape off the sediment 103, and the diameter of the entrance of the constricted part 107 is first reduced to lmm. Spread it to the center and reduce the center ring, then let the whole grindstone 127 pass through.
  • the force catheter device 125 is pulled out.
  • the catheter device provided with a grindstone having a slightly larger diameter is passed along the guide wire, and the catheter device is similarly drawn. Is turned to scrape off the deposit 103. This operation is performed using a guide wire and a catheter device. The process is repeated while gradually increasing the diameter of the grindstone, and finally the diameter of the stenotic part 107 of the blood vessel is increased to about 2.5 mm.
  • the catheter device allows the rotary cutting bar (grinding wheel 127) to rotate freely and slide itself with respect to the guide wire 105 passing through the constriction, thereby driving the rotary cutting bar to rotate at high speed.
  • the rotary cutting bar grinding wheel 1257
  • the above-mentioned conventional rotary cutting bar (rotator, grinding wheel 127 in FIG. 15) has a strong structure whose surface is a ground surface to which abrasive grains are attached, and does not have a diameter expanding mechanism. Therefore, in cases where it is desired to expand the diameter of the calcified intravascular stenosis to a diameter larger than the diameter that first penetrated it, the rotary cutting par (grinding wheel 127) is driven by the drive shaft (drive shaft 127). It must be completely removed from the guidewire (105) and replaced with a larger diameter one. In the past, nearly 40% of cases used a rotary cutting bar (grinding wheel) and a drive shaft (drive shaft 1229), one with a large diameter and one with a small diameter (1 case). The average number used per unit was 1.4), which had to be replaced in a clean area in the operating room.
  • the rotating cutting bar (grinding wheel 127) reaches the affected area of the coronary artery.
  • the present invention has been made in view of the above-described problems, and when performing a diameter-increasing treatment of the intravascular stenosis following the initial treatment of the intravascular stenosis, the guide wire is left in the blood vessel. Accordingly, it is an object of the present invention to provide a treatment instrument capable of expanding the rotational force cutter on the guide wire without removing the rotary cutter from the guide wire.
  • Another object of the present invention is to provide a therapeutic instrument that can easily expand the diameter of a rotary cutter drawn out of a body along a guide wire left in a blood vessel.
  • Another object of the present invention is to provide a therapeutic instrument capable of rapidly and effectively resecting a stenosis in a blood vessel using a rotary cutter. Disclosure of the invention
  • a therapeutic device of the present invention includes a guide wire that passes through a stenosis portion where a deposit is accumulated in a blood vessel and extends outside the body.
  • a rotary force cutter that is rotatably and slideably guided by the guide wire and rotatably cuts deposits in the intravascular stenosis
  • a hollow drive shaft connected to the rotary cutter and through which the guide wire passes;
  • a fixed sheath through which the drive shaft is passed;
  • a controller having a rotation drive unit of the drive shaft, wherein treatment such as penetration and enlargement of the intravascular stenosis is performed by the rotation force cutter.
  • both the drive shaft and the fixed sheath can be pulled out of the body along the guide wire.
  • the rotary cutter has a deformable portion that can be deformed in the radially expanding direction on the guide wire after being pulled out.
  • the deformable portion of the rotary cutter is composed of a plurality of force-setting blades that are circumferentially adjacent on the rotary cutter.
  • the radially enlarged resection of the intravascular stenosis can be performed quickly.
  • the rotating force cutter can be held in the radially expanded state.
  • the force-setting blade can be deformed in a radially expanding direction of the rotary cutter by a todal mechanism. Preferably, it is deformed in the direction.
  • the rotary cutter includes a heat-shrinking member or a heat-expanding member that deforms the deformable portion in the radial direction of the rotating force cutter.
  • the deformable portion of the rotating force meter is made of a heat deformable material such as a shape memory alloy.
  • the deformable portion can be deformed in the radially expanding direction only by thermal deformation.
  • a jig for deforming the deformable portion of the rotary force meter in a radially expanding direction is provided, and the jig is preferably arranged coaxially with or near the drive shaft.
  • the deformable portion can be deformed in the direction of the diameter expansion easily.
  • the controller has a mechanism for pushing out the rotary cutter from a distal side of the fixed sheath to a diseased area in front of the fixed sheath and a mechanism for pulling back the rotary cutter, and these mechanisms include an automatic return mechanism and a position holding mechanism. It is preferable to be operated by a grasping operation type operation lever. '' The rotating cutter can be easily pushed and pulled back from the distal end of the fixed sheath to the front of the affected area. .
  • a jig for deforming the deformable portion of the rotating force meter in a radially expanding direction is a grasping operation type lever which can be operated by one hand using a lever or a boosting mechanism using a cam. It preferably comprises a mechanism.
  • the deformable portion of the rotary force meter can be easily deformed in the radially expanding direction by the jig.
  • the controller includes a vibration imparting mechanism that reciprocates the rotary cutter along the guide wire.
  • the cutting force due to the rotating force and the cutting force due to the reciprocating motion can be superimposed on the rotating cutter, the cutting force of the rotating cutter can be increased or stabilized. In addition, friction when inserting the rotary cutter and the sheath into the guiding catheter can be reduced to facilitate insertion.
  • the controller is connected to the drive shaft. It is preferable that a drive unit for transmitting the rolling force is built in, and the drive unit has a motor whose hollow shaft is hollow so that the drive shaft can pass therethrough.
  • the drive shaft can be easily pulled out of the body along the guide wire left inside the body without completely pulling out the drive shaft from the guide wire.
  • the controller has a mechanism for chucking the drive shaft and a mechanism for attaching and detaching the soft sheath.
  • the chucking mechanism ensures that the driving force of the motor is transmitted to the drive shaft.
  • the sheath can be easily removed from the controller during internal maintenance of the controller.
  • FIG. 1 is a perspective view for explaining a use state of the treatment instrument according to the first embodiment of the present invention.
  • FIG. 2 is an enlarged view of the rotary cutter of the treatment instrument of FIG. 1, wherein FIG. 2 (A) shows a state before diameter expansion and FIG. 2 (B) shows a state where diameter expansion is performed.
  • FIG. 3 is a view for explaining the structure of the front part of the controller of the treatment instrument of FIG. 1 and a method of expanding the diameter of the rotary cutter.
  • FIGS. 4A and 4B are diagrams showing a rotary power meter diameter increasing jig of a treatment instrument according to a second embodiment of the present invention, wherein FIG. 4A shows a state before diameter expansion, and FIG. Indicates the state.
  • FIG. 5 is a partial side cross-sectional view showing the structure of a turning force meter of a treatment instrument according to a third embodiment of the present invention, wherein FIG. 5 (A) is before expansion and FIG. 5 (B) is an expansion. This shows a state where the diameter is increased.
  • FIG. 6 is a partial side cross-sectional view showing the structure of a turning force meter of a treatment instrument according to a fourth embodiment of the present invention, where FIG. 6 (A) is before expansion and FIG. 6 (B) is This shows a state where the diameter is expanded.
  • FIG. 7 is a partial side cross-sectional view showing the structure of a jig for enlarging the rotational force of a therapeutic instrument according to a fifth embodiment of the present invention, and FIG. (B) shows an expanded state.
  • FIG. 8 is a perspective view of the entire diameter expanding jig of FIG.
  • FIG. 9 is a partial side cross-sectional view showing the structure of a turning force meter of a treatment instrument according to a sixth embodiment of the present invention, where FIG. 9 (A) is before expansion and FIG. 9 (B) is expansion. This shows a state where the diameter is increased.
  • FIG. 10 is a partial side cross-sectional view showing the structure of a turning force meter of a treatment instrument according to a seventh embodiment of the present invention.
  • FIG. ) Indicates an expanded state.
  • FIG. 11 is a partial side sectional view showing the structure of the turning force meter of the treatment instrument according to the eighth embodiment of the present invention, and
  • FIG. B) shows the expanded state.
  • FIG. 12 is a side sectional view showing a structure of a controller of a treatment instrument according to a ninth embodiment of the present invention.
  • FIG. 13 is an enlarged side sectional view showing the structure of the main part of the controller of the treatment instrument shown in FIG.
  • FIG. 14 is a side sectional view showing a state where the sheath connector of the controller of the treatment instrument in FIG. 12 is removed.
  • FIG. 15 is a diagram schematically illustrating a method of cutting a sediment.
  • FIG. 1 illustrates a use state of the treatment instrument according to the first embodiment of the present invention.
  • FIG. 2 is an enlarged view of the rotary cutter of the treatment instrument of FIG. 1, wherein FIG. 2 (A) shows a state before diameter expansion and FIG. 2 (B) shows a state where diameter expansion is performed.
  • FIG. 3 is a view for explaining the structure of the front part of the controller of the treatment instrument of FIG.
  • an intravascular stenosis part 10 which is a target part of the treatment is shown.
  • the distal end of the treatment instrument is inserted into the part 10.
  • the treatment instrument includes a guide wire 1 that passes through the intravascular stenosis 10, and a rotary cutter 2 that rotates around the guide wire 1 and slides in the axial direction of the wire 1.
  • the turning force 2 is integrally connected to the drive shaft 3.
  • the drive shaft 3 is a hollow member made of a soft flexible material.
  • the drive shaft 3 is passed through a fixed sheath 4 which is a flexible cover tube.
  • the fixed sheath 4 is passed through the guiding catheter 5.
  • the turning force cutter 2 has a plurality of deformable portions 2a.
  • the deformable portion 2a is composed of a plurality of cutting blades arranged in a circumferential direction.
  • the deformable portion 2a is integrally joined at the tip portion to form a gun-shaped tip head portion 2b of the rotating force cutter 2, and the end portion is integrally joined by a ring member 2c.
  • drive shaft 3 is connected to controller 20. ing.
  • the controller 20 controls the drive shaft 3 to rotate and reciprocally oscillate at a high speed ⁇ (described later in detail).
  • a fitting recess 21 into which the rear end of the rotary cutter 2 fits is formed on the front end face of the controller 20.
  • the fitting recess 21 has a center hole through which the drive shaft 3 can slide freely.
  • the controller 20 further includes a movable jig 2 for compressing the rotary cutter 2 fitted in the fitting recess 21 1 in the axial direction of the guide wire 1 to expand the diameter. 2 and an operation lever 23 for moving the movable jig 22 in the compression direction and the compression release direction of the rotary cutter 2.
  • the movable jig 22 has an L-shaped cross section and extends in the direction of the controller 20 by extending the front part 22 a perpendicular to the direction of the guide wire and the front part 22 a. And a shaft part 2 2b to be pulled out. A notch 22c is formed in the front part 22a.
  • the operation lever 23 is fixed to the operation shaft 23a, and rotates along the operation shaft 23a.
  • the operation shaft 23 a is connected to one end of the shaft portion 22 b of the movable shaft 22 in the controller 20.
  • the operating lever 23 When the operating lever 23 is rotated in one direction (counterclockwise), the operating shaft 23a is also rotated, and the shaft 22b of the movable jig 22 is pulled out of the controller 20 force.
  • a space is formed between 22 a and the front end face of the main body of the controller 20.
  • the operation shaft 23a also rotates, and the shaft 22b of the movable jig 22 is pulled into the controller 20 and the front part. The space between 22 a and the front end face of controller 20 is reduced.
  • the guide wire 1 is inserted into a blood vessel, and the distal end of the guide wire 1 is passed over the intravascular stenosis 10.
  • rotary cutter 2 The diameter is not expanded as shown in FIG. 2 (A).
  • the rotating cutter 2 is advanced along the guide wire 1 to the intravascular stenosis 10 while rotating the rotating cutter 2 at a low speed.
  • the cutter 2 is rotated at a high speed.
  • the intravascular stenosis 10 is initially resected by the cutting blade of the rotary cutter 2.
  • the intravascular stenosis 10 is not completely resected, and if further resection is necessary, the rotating cutter 2 is moved along the wire 1 while leaving the guide wire 1 in the blood vessel. Pull it out together with drive shaft 3 and sheath 4 as soon as possible. The diameter of the rotary cutter 2 drawn out of the body is expanded as shown below.
  • the operation lever 23 is rotated counterclockwise (from the dotted line position to the solid line position in the figure), and the shaft 22b of the movable jig 22 is moved inside the controller body.
  • the rotating cutter 2 pulled out of the body is inserted into this space, and the rear end of the cutter 2 is fitted into the fitting recess 21 (see FIG. 3 (B)).
  • the guide wire 1 is located at the notch 22c of the front part 22a.
  • the rotary cutter 2 After the diameter of the rotary cutter 2 is expanded, the rotary cutter 2 is inserted into the intravascular stenosis portion 10 again along the guide wire 1. Then, the rotary cutter 2 is rotated at a high speed, and the remaining intravascular stenosis is cut by the enlarged force-setting blade.
  • FIGS. 4A and 4B are diagrams showing a rotary force-taper expanding jig of a treatment instrument according to a second embodiment of the present invention, wherein FIG. 4A shows a state before expanding, and FIG. Indicates the state.
  • the diameter expanding jig of this example has a lever mechanism that can be operated with one hand.
  • the expanding jig is a pair of lever-type levers 6 rotatably connected by the axis P, a fixed base 7 fixed to the end of one lever 16A, and a free-slidable bottom of the fixed base 7. And a movable base 8 attached to the vehicle.
  • the fixing pedestal 7 has an L-shaped cross section, and has a bottom 7a fixed to the tip of the lever 6A and an upright portion 7b standing upright from the bottom 7a.
  • the movable pedestal 8 also has an L-shaped cross section, and includes a bottom 7 a of the fixed pedestal 7, a bottom 8 a slidably attached thereto, and an upright portion 8 b standing upright from the bottom 8 a.
  • the upright portion 7b of the fixed pedestal 7 and the upright portion 8b of the movable pedestal 8 are located to face each other with the bottom portions 7a and 8a of both pedestals interposed therebetween.
  • the upright portion 7b of the fixed base 7 has a cutout in which the guide wire is placed.
  • the rear surface of the upright portion 8b of the movable base 8 is in contact with the tip of the other operation lever 6B.
  • the inner surface of the upright portion 8b is formed with a concave portion 8d and a cut in which the fixed sheath is placed.
  • FIG. 5 is a partial side cross-sectional view showing the structure of a turning force meter of a treatment instrument according to a third embodiment of the present invention, where FIG. 5 (A) is before expansion and FIG. 5 (B) is an expansion. This shows a state where the diameter is increased.
  • the rotary cutter 2 of this example has a hollow central shaft portion 2 ⁇ , and a plurality of concave portions 2d are formed on the back surface of the cutting blade of the deformable portion 2a. .
  • the recess 2d is formed on the back surface of the cutting blade so as to extend in the circumferential direction.
  • the recess 2d provides the cutting blade with a trigger mechanism.
  • the end of the cutting blade is fixed to the central shaft portion 2f by a fastening member 2e.
  • the diameter of the rotary force meter 2 is minimized without increasing the diameter of the cutting blade. Then, when expanding the diameter of the rotary cutter 2, as shown in FIG. 5 (B), loosen the fastening member 2e and move the end of the cutting blade toward the tip of the rotary cutter 12 (to the left in the figure). Press to compress rotary cutter 2. Then, the cutting blade spreads outward while bending locally by the todal mechanism, and the rotary cutter 2 expands in diameter. Then, with the diameter increased, the end of the cutting blade is fastened with the fastening member 2e.
  • the rotating cutter 2 can be quickly expanded to an arbitrary diameter by selecting the moving distance of the fastening member 2e.
  • FIG. 6 is a partial side cross-sectional view showing the structure of a turning force meter of a treatment instrument according to a fourth embodiment of the present invention, where FIG. 6 (A) is before expansion and FIG. 6 (B) is expansion. This shows a state where the diameter is increased.
  • the rotary cutter 2 of this example has a hollow central shaft portion 2f and a sleep-shaped wedge 9 inserted between the central shaft portion 2f and the cutting blade.
  • a wedge 9 a having a tapered convex shape is formed on the outer periphery of the wedge 9 on the distal end side.
  • a wedge-shaped engaging portion 2g is formed on the inner surface of the tip of the cutting blade of the rotary cutter 2.
  • FIG. 7 is a partial side cross-sectional view showing a structure of a rotating force turret expanding jig of a treatment instrument according to a fifth embodiment of the present invention.
  • FIG. 8 is a perspective view of the entire diameter expanding jig of FIG.
  • the diameter increasing jig of this example includes a pair of columnar pressing members 11.
  • One pressing member 11B fits into the other pressing member 11A.
  • a concave surface 11a of a predetermined shape is formed, and on the surface of the pressing member 11B facing the pressing member 11A.
  • a concave surface lib of a predetermined shape is formed.
  • the concave surfaces 11a and 11b form a space surrounded by a curved surface facing each other.
  • the pressing members 11A and 11B are formed with cuts 11c and lid extending in the axial direction. From these cuts, pass the drive shaft ⁇ fixed sheath.
  • the rotary cutter 2 has a deformable portion 2 a (cutting plate) having a solid front half portion and a rear half portion that branches off near the center of the rotary cutter 2 to the terminal side.
  • a groove 2h extending in the circumferential direction is formed near the center of the outer surface of the deformable portion 2a.
  • the rotary cutter 2 When using this diameter increasing jig, the rotary cutter 2 is positioned within the concave surface of both pressing members 11 with both pressing members 11 separated. At this time, the guide wire and the like are passed through the cuts 11 c and the lid of each pressing member 11. Then, the pressing members 11 are fitted and pressed against each other. Then, the cutting blade of the rotary cutter 2 is pressurized in the axial direction and spreads outwardly along the concave surfaces lla and 11b of both pressing members 11. This allows the rotary cut Tar 2 expands.
  • FIGS. 9A and 9B are partial side sectional views showing the structure of a rotary cutter of a treatment instrument according to a sixth embodiment of the present invention.
  • FIG. 9A shows a state before diameter expansion
  • FIG. It shows the state where it was done.
  • a thermal expansion member 12 is disposed between a central shaft portion 2f and a deformable portion 2a.
  • the thermal expansion member 12 has an annular shape, and the direction of thermal expansion is outward.
  • FIG. 10 is a partial side cross-sectional view showing the structure of a turning force meter of a treatment instrument according to a seventh embodiment of the present invention.
  • FIG. 10 Indicates an expanded state.
  • a heat-shrinkable member 14 is arranged at a part of the end of the deformable portion 2a (cutting blade).
  • the outer surface at the end of the cutting blade 2a is a tapered surface 2i.
  • An outwardly extending flange 2j is formed at the end of the central shaft portion 2f.
  • the inner surface of the flange 2 j (rotary cutter side) has a tapered surface 2 k.
  • an annular groove 13 is formed between the tapered surface 2i of the cutting blade and the tapered surface 2k of the flange 2j.
  • the side wall of the groove 13 has a tapered shape inclined inward, and the area of the open surface of the groove is larger than the area of the bottom surface of the groove.
  • the heat-shrinkable member 14 has an annular shape and the heat-shrinkage direction is the center direction. In the state before the diameter expansion shown in FIG. 10 (A), the heat-shrinkable member 14 is arranged on the open surface of the groove 13. When expanding the diameter of this rotary cutter 2, heat shrink The member 14 is heated and contracted by heat. The heat-shrinkable member 14 shrinks in the direction of the central shaft portion 2 f along the tapered surfaces 2 j and 2 k of the groove 13 and enters the groove 13 until it contacts the bottom surface of the groove 13. Then, the side wall of the groove 13 is separated in the axial direction, and the cutting blade 2a is compressed against the flange 2k of the central shaft portion 2f.
  • FIG. 11 is a partial side sectional view showing the structure of the rotary cutter of the treatment instrument according to the eighth embodiment of the present invention.
  • FIG. 11 (A) shows the state before the diameter expansion
  • FIG. 11 (B) shows the state after the diameter expansion.
  • the cutting blade 2a is made of a shape memory alloy. In a normal environment, the shape is shown so as to be transformed into a state shown in FIG. 11 (A), and in a high temperature environment, it is transformed into a state shown in FIG. 11 (B). Further, a large diameter step 2n is integrally formed at the end of the central shaft 2f. Before the diameter of the rotary cutter 2 is increased as shown in FIG. 11 (A), the end of the cutting blade 2a is held on the step 2n.
  • the ring member 2 for fastening the end of the cutting blade 2a is made of a contractible material.
  • the rotating force cutter 2 When expanding the diameter of the rotating force cutter 2, the rotating force cutter 2 is heated outside the blood vessel. Then, the cutting blade 2a expands in diameter to the state shown in FIG. 11 (B) as the shape memory is initially stored, and the end of the cutting blade 2a moves forward away from the step 2n. In this state, when the temperature drops and the cutting blade 2a tries to return to the state shown in FIG. 11 (A), the end of the cutting blade 2a is hooked on the front surface 2q of the step 2n, and the cutting blade 2a is cut. The towing blade 2a is maintained in the expanded state.
  • FIG. 12 is a side sectional view showing a structure of a controller of a treatment instrument according to a ninth embodiment of the present invention.
  • FIG. 13 is a side cross-sectional view showing an enlarged structure of a main part of a controller of the treatment instrument of FIG.
  • FIG. 14 is a side sectional view showing a state where the sheath connector of the controller of the treatment instrument in FIG. 12 is removed.
  • the controller 20 has a housing 30.
  • a rising grip 31 is formed in the housing 30.
  • a grip lever 32 is rotatably supported on the grip 31 via a shaft 33.
  • the grip lever 32 has a lever core 34, and a lock lever 35 is attached to the lever core 34 via a shaft 33.
  • a motor holder 36 is attached to the lower end of the lever core 34.
  • a guide slit 37 is formed on the mounting piece of the motor holder 36 to the lever core 34.
  • a guide bin 38 protruding from the lower end of the lever core 34 is fitted into the guide slit 37.
  • the motor holder 36 holds a motor 3′9. .
  • An eccentric cam 40 is fitted on the rotating shaft of the motor 39.
  • a bearing 41 is fitted on the outer periphery of the eccentric cam 40 via a bearing 42.
  • the bearing holder 41 is integrally provided with a hanging shaft 41a.
  • a cylindrical slider 43 is built in the housing 30. The slider 43 is connected to the hanging shaft 41a of the bearing holder 41 so as to be able to reciprocate in the axial direction.
  • an armature iron core 44 is arranged on the inner periphery of the slider 43, and an armature coil 45 is arranged inside the armature iron core 44.
  • a rotor magnet 46 is arranged inside the armature coil 45.
  • Armature core 44, armature coil 45, rotor magnet 46 It constitutes a motor section 47 for driving the drive shaft.
  • the motor section 47 has a built-in Hall sensor 48.
  • a chuck claw assembly 50 movably arranged in the axial direction is arranged inside the rotor magnet 46.
  • a chuck claw 51 is screwed and connected to the front end of the chuck claw assembly 51.
  • the drive shaft 3 is passed through the inside of the chuck claw combination 50 and the chuck claw 51.
  • the chuck pawl 51 is biased in the axial direction of the drive shaft 3 by a spring 52 and a chuck pawl assembly 50.
  • a cylinder knob 53 for canceling the chucking is held via a cylinder holder 54 so as to be movable in the axial direction. It is urged in the opposite direction to the chuck jaw assembly 50 by 55.
  • a sheath connector 60 is detachably attached to the front end of the housing 30 so as to surround the drive shaft 3.
  • a soft fixed sheath 4 is fitted to 60 to make the inside of the sheath connector 60 and the inside of the fixed sheath 4 communicate with each other, and a mechanical seal 61 is fitted in the sheath connector 60.
  • the mechanical seal 61 is in sliding contact with the drive shaft 3.
  • the sheath connector 60 communicates with a saline solution supply tube 62.
  • the drive shaft 3 reciprocates in the axial direction via the drive shaft driving motor unit 47 provided integrally with the slider 43 and the check claws 51. Accordingly, the rotary cutter 2 at the end of the drive shaft 3 is reciprocated in the direction along the guide 1 together with the rotational force, so that the blood vessel generated by the rotational force The cutting force of the inner constriction 10 can be increased or stabilized.
  • the rotational force meter 2 and the drive shaft 3 are connected to the guide wire 1. Pull out along the body. At this time, the chucking of the drive shaft 3 by the chuck claws 51 needs to be released. In this case, when the chucking release cylinder knob 53 is pushed and moved in a direction against the spring 55, the chuck jaw assembly 50 moves forward against the spring 52. Then, the chuck claws 51 are opened to release the chucking of the drive shaft 3, and the drive shaft 3 can be easily pulled out of the body along the guide wire 1.
  • the mechanical drive unit of the controller 20 is configured to give the rotary cutter 2 a reciprocating motion by the drive shaft driving motor unit 47 and a rotary motion by the motor 39. Therefore, the cutting force of the intravascular stenosis 10 can be superimposed by a combination of the reciprocating motion and the rotating motion. For this reason, the cutting force of the intravascular stenosis 10 by the rotary cutter 2 can be increased or stabilized. Furthermore, the friction when the rotary cutter 2 and the sheath 4 are introduced into the guiding catheter 5 is reduced to be introduced. I can crouch. Industrial applicability
  • the guide shaft is fixed together with the drive shaft and the fixed sheath while leaving the guide wire in the body. It can be pulled out of the body along the guide wire and the rotating cutter can be expanded on the guide wire. Therefore, it is not necessary to completely remove the rotary cutter including the controller from the guide wire and replace the rotary cutter itself when expanding the diameter of the intravascular stenosis. Therefore, it is possible to rapidly perform diameter-increasing cutting of a stenosis part in a blood vessel.
  • a plurality of force-setting blades that are adjacent in the circumferential direction of the rotary cutter are integrally formed so as to be deformable in the radially expanding direction of the rotary cutter.

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Abstract

L'invention concerne un instrument de traitement médical, dans lequel un élément coupant (3) rotatif est formé de manière à pouvoir être extrait temporairement d'un corps en même temps qu'une tige (3) d'entraînement et une gaine fixe (4) le long d'un fil-guide, au moment où le diamètre d'un site (10) sténosé de vaisseau sanguin est accru, après l'application du traitement consistant à couper le site (10) sténosé. L'élément coupant (2) rotatif comprend une partie (2a) déformable, constituée d'une pluralité de lames adjacentes dans une direction périphérique et qui se déforme dans le sens de l'accroissement du diamètre sur le fil-guide (1), après l'extraction de l'élément coupant.
PCT/JP2003/012365 2003-09-26 2003-09-26 Instrument de traitement medical WO2005030061A1 (fr)

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PCT/JP2003/012365 WO2005030061A1 (fr) 2003-09-26 2003-09-26 Instrument de traitement medical

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Application Number Priority Date Filing Date Title
PCT/JP2003/012365 WO2005030061A1 (fr) 2003-09-26 2003-09-26 Instrument de traitement medical

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WO2005030061A1 true WO2005030061A1 (fr) 2005-04-07

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2016210167A1 (fr) * 2015-06-25 2016-12-29 Covidien Lp Cathéter d'ablation de tissus à section transversale de dimension réglable

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH0488919U (fr) * 1990-02-14 1992-08-03
WO1994010919A1 (fr) * 1992-11-13 1994-05-26 Scimed Life Systems, Inc. Dispositif et procede de suppression d'une occlusion intravasculaire
JP2003088530A (ja) * 2001-09-19 2003-03-25 Masayuki Nakao カテーテル装置
JP2003290235A (ja) * 2002-03-29 2003-10-14 Masayuki Nakao 治療器具

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH0488919U (fr) * 1990-02-14 1992-08-03
WO1994010919A1 (fr) * 1992-11-13 1994-05-26 Scimed Life Systems, Inc. Dispositif et procede de suppression d'une occlusion intravasculaire
JP2003088530A (ja) * 2001-09-19 2003-03-25 Masayuki Nakao カテーテル装置
JP2003290235A (ja) * 2002-03-29 2003-10-14 Masayuki Nakao 治療器具

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2016210167A1 (fr) * 2015-06-25 2016-12-29 Covidien Lp Cathéter d'ablation de tissus à section transversale de dimension réglable
CN107735038A (zh) * 2015-06-25 2018-02-23 柯惠有限合伙公司 具有可调节横截面尺寸的组织去除导管
JP2018519035A (ja) * 2015-06-25 2018-07-19 コヴィディエン リミテッド パートナーシップ 調節可能な断面形状を有する組織除去カテーテル
US10478213B2 (en) 2015-06-25 2019-11-19 Covidien Lp Tissue-removing catheter with adjustable cross-sectional dimension
CN107735038B (zh) * 2015-06-25 2020-07-17 柯惠有限合伙公司 具有可调节横截面尺寸的组织去除导管

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