WO2006089517A1 - Implanting a self-expanding stent by means of hydraulic power - Google Patents

Implanting a self-expanding stent by means of hydraulic power Download PDF

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Publication number
WO2006089517A1
WO2006089517A1 PCT/DE2006/000276 DE2006000276W WO2006089517A1 WO 2006089517 A1 WO2006089517 A1 WO 2006089517A1 DE 2006000276 W DE2006000276 W DE 2006000276W WO 2006089517 A1 WO2006089517 A1 WO 2006089517A1
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WO
WIPO (PCT)
Prior art keywords
stent
catheter
piston
system
pressure
Prior art date
Application number
PCT/DE2006/000276
Other languages
German (de)
French (fr)
Inventor
Ernst-Peter Strecker
Original Assignee
Ernst-Peter Strecker
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
Priority to DE200510008682 priority Critical patent/DE102005008682B4/en
Priority to DE102005008682.9 priority
Priority to DE102005048181.7 priority
Priority to DE102005048181 priority
Application filed by Ernst-Peter Strecker filed Critical Ernst-Peter Strecker
Priority claimed from DE200611001056 external-priority patent/DE112006001056A5/en
Publication of WO2006089517A1 publication Critical patent/WO2006089517A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/962Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
    • A61F2/966Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/88Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure the wire-like elements formed as helical or spiral coils

Abstract

Selbst expandierende Stents werden zur Platzierung des Stents vom in den Patienten eingeführten Katheter (1) durch ein Druckmedium aus dem Katheterlumen in das zu behandelnde Hohlorgan wie z.B. ein Blutgefäß (3) herausgeschoben. Der Druck (p) wirkt entweder direkt auf den Stent, oder auf Kolben (4) , die durch den von proximal eingebrachten Druck (p) den Stent aus dem Katheter (1) herausbefördern.

Description

Description:

Implantation of a self-expanding stent by means of hydraulic force

Introduction:

Stents have become established as a means for treating pathological body vessels and hollow organs, opening up new treatment options. Compared with balloon-expandable stents have self-expanding stents some technical advantages such as a smaller introducer and more flexibility and elasticity of the stent. The systems currently in use to release a self-expanding stent consist of a shell, in which the stent is held in the non-expanded state and a pusher system that drives the stent out of the sheath into the vessel to be treated. This pusher includes a channel for angiographic guide wire. The disadvantages of this system are that the pusher for expelling the stent must be loaded with a high force to expel the stent or to pull the cover back. Therefore, the pusher is usually made of a relatively rigid material. When driving out of the stent a large friction not only between stent and sheath, but additionally between pusher and sheath is formed. Therefore this system is poorly suited for tortuous vessels. It happens that the introduced catheter-stent assembly fails in patients and that the pusher can not advance or sheath can not pull back, especially in cases of implantation of gastrointestinal stents. Self-expanding stents are therefore used in said technical reasons for coronary arteries. Another technical problem with currently available stent delivery systems is the so-called "Jump" effect that can be observed when the still remaining in the application system after almost complete release residual portion of the stent leaves the outer wrapper, namely abruptly because at the outlet of the stent of the surrounding casing, the energies within the application system, consisting of compression of the pusher and train on the shell, are suddenly released, this occurring at the end of the release process, uncontrolled release of the last portion of the stent can lead to misplacement of the stent and / or injury of the inner vessel wall . lead, thus greatly reducing the technical and clinical success of stenting solution to the problem:

The force for expelling the stent from the catheter (sheath) is not transferred by a pusher, but by a liquid or gas column. Applicable would be the principle of the hydraulic or pneumatic, that is, the force for expelling the stent from the sheath is transmitted through a liquid or gas column. The hydraulic principle ensures a smoother, more controlled and metered power transmission to the stent to be released from the surrounding envelope. The principle of the hydraulic system is rudimentary, applied in connection with a commercial product, the Embolisatioπsspirale: which is integrated in a catheter filamentary wire structure is flushed out by flushing liquid from the catheter and then transferred to the vessel to be treated, where it into a ball unfolded and occludes the vessel lumen. However, because is in the embolization a small, thin and weak thread-like structure having only a small radial expansion force, small force is only required to transport the coil from the catheter addition, since no significant friction forces. In the said application it is not necessary to provide the balls for implanting a certain form and controlled this and let batches come out of the catheter. Power is transmitted by a piston has not been applied. However, the application of such guarantees more accurate placement.

The embolization is in contrast to self-expanding stents, which have a very strong radial force and thus cause high frictional forces in the catheter. The technology (system for the release of a stent by means of hydraulic or pneumatic principle) described here transmits a stronger effect than the prior art technique described above and is therefore not comparable with the latter.

Description of the principle of the invention:

The following models are useful in the hydraulic or pneumatic:

The stent is to be placed, a spiral stent, for example a Doppelcoil-stent, a stent meander or helical stent, which do not completely fill the lumen of the catheter prior to release in its stretched state (Fig.1,2). The print medium, such as liquid or gas partly flows past the coil stent and serves as a lubricant to reduce the friction forces between the stent and catheter.

The tip of the coil stent, so the wire is formed like a piston. The piston has a diameter so large that it fills the inner lumen of the catheter (Fig.3,4). Liquid which is pushed from the proximal end to the catheter applies to the piston and presses it out of the catheter beyond (Figure 3). The piston seals the clearance (gap) down so that the pressure medium can not flow past between the piston surface and the catheter inside wall. The attached at the front end of the stent proportion piston then pulls the stent behind it and out of the catheter (Figure 4). Thus, the helical coil is not compressed by proximal, whereby the resulting frictional energy is lower. In another embodiment, other pistons are attached to the stent wire (Fig.5,6), the rear end of the stent or in the middle, which then act themselves as an additional force transmitter. The pistons are fitted by a somewhat smaller diameter than the inner diameter of the surrounding catheter or with holes, with which a leak is created, so that at the beginning of the release of the pressure medium, for example a liquid, can penetrate as far as the first piston.

With a smaller piston diameter of the piston may be adapted in its dimensions so that the piston may rotate together with the wire located in the catheter portion within the surrounding catheter about its longitudinal axis while the stretched helical wire stent is expelled. The already implanted in the vessel portion of the helix stent no longer moves, but only the portion of the stent which is still in the catheter. In this way, a proper placement of the stent is achieved in its predetermined shape. In this case, damage to the vessel wall is avoided, which might be caused by a moving vessel in the stent portion. should be avoided, undesired adverse rejection of the helix shape. In another embodiment, however, the additional piston could also be the same size and all fill the lumen of the catheter.

At least the front piston disappears after implantation of the stent flat against the vessel wall to, so that no turbulence occur (Figure 6). The stent wire attached to the piston may be made of biodegradable material and dissolve in the blood so that they do not impede the flow of blood (Fig.4).

The front tip of the stent is formed as a ball which is received in a fork wire. The fork wire is firmly connected with a piston, which together form the stent support (carrier); the piston is located behind the proximal end of the stent (Fig.7,8). Liquid which is pushed from the proximal end to the catheter applies to the piston and moves the stent is held on the fork wire together with the fork wire from the catheter out. The stent disengages from the fork and the fork wire wire is then removed along with the catheter and the inliegenden flask.

In the case of the conventional self-expanding, slotted tube stents, for example, from Nitinol, or braided and knitted tubular stent, the catheter is provided in its interior with a piston which pushes the stent through the catheter and out of the catheter pushes (Fig.9,10) , The piston remains in the catheter, it is guaranteed a thread by a fuse, for example, which is anchored in the catheter. In order to prevent the piston terminal exits the catheter to release the stent, a lateral orifice located in the wall of the catheter (Figure 10). As long as the stent or portions of the stent are still, in the catheter, the lateral orifice is closed by the piston. After release of the stent when the piston is at the catheter tip and the lateral orifice is open, so that serves as a print medium, inflowing fluid can now escape through the lateral orifice. Thus, the reduced pressure on the piston so that the piston does not move further (Figure 10). The distance of the Seitlochs of the catheter tip must be at least as great as the length of the piston (Fig.9,10).

Such a piston has a central slot-shaped channel, through which the guide wire is inserted. The hole is so large that the guidewire it completely fills and seals, so that no pressure loss may arise. Such a piston has as piston in an engine via additional seals such as sealing rings (Fig.11,12).

The total piston is flexible and pliable, so that the system can be pushed through tortuous arteries and may also be released in an arterial curve.

In a further embodiment, the tubular or hose-shaped stent in its small diameter in the catheter the piston itself. The opening of the tubular stent in the small diameter is filled by the guide wire so that no pressure loss occurs when the stent is forced out. The distal tip of the catheter is designed to be elastic and conical, so that the step between the guidewire and the catheter containing the stent is equalized (Figure 13). Step out of the stent, the cone is further and allows the passage without a drop in pressure (Fig.14).

In another embodiment, the gap between the guide wire and the lumen of the collapsed stent is filled with a biodegradable substance. Also, the gaps between the stent struts on the rear end of the stent are filled with the polymer, so that the compressed stent end gets the action of a piston. Upon deployment of the stent in the vessel, these polymer-like substance ruptures and releases the stent completely free (Figure 15 and 16).

In the catheter is located at the distal end of an elongated plunger which is provided with a conical tip. Through the tip of first coaxial leads a channel which then leads obliquely to the outer surface of the piston and the guide wire receiving (Fig.17). The system shown is a fast-exchange system. At the distal portion of this piston, a carrier is provided with a notch (stent bed), in which the stent in the low-profile state is inserted and is held by the sheath of the delivery catheter in its small diameter, the stent is resiliently self-expanding. The delivery catheter has an elongated slot. This slot is greater than the side opening of the piston. The guide wire is inserted prior to the introduction of the catheter-stent Assembiies in the distal opening of the cutlery and retrograde pushed by the piston until it protrudes from the side opening of the piston and from the overlying longitudinal slot of the catheter. The catheter is introduced in this state into a hollow vessel, for example artery in the body until the non-deployed stent ranging site to be treated. Then, the pressure is applied with the printing medium in the catheter, whereby the piston is pushed forward.

In another case, the pressure causes the piston remains in its position while the catheter is withdrawn. So there must be withdrawn to the same extent in driving out the piston of the catheter with the expanding stent to take the in the artery to be treated. Upon movement of the piston relative to the catheter of the piston, the guide wire slides comprising, distally, with the guide wire also moves in the elongated slot in the distal direction. Thus, the stent is released for expansion. This is the case when the distal end of the catheter is no longer covered the bed of the stent. Slipping out of the plunger is prevented by the wire as it emerges from the lateral hole of the piston, a further sliding of the piston blocks (Fig.18).

Such a fuse effect which prevents leakage of the piston out of the catheter, can also be through a lateral orifice in the catheter itself, as described in Figure 9 and Figure 10 can be obtained. When the piston is slid forward, it opens the lateral orifice and the pressure in the system is degraded.

The system described in Figure 17 (without lateral orifice in the catheter, through which the pressure can escape) can also be used as a closed system (Fig.18), ie, that the pressure medium must not be introduced by the user, but before use in catheter is installed. The doctor then takes the system only to apply the pressure, the pressure sprayer or pressure vessel is connected already fixed to the catheter. produced by the doctor connections between hoses thus be omitted. The advantage of the closed for the pressure medium system is, among other things, that it is avoided that inadvertently air can get in the system.

A likewise closed for the hydraulic pressure transmission embodiments, as described in Figure 19, a catheter-stent system in which the hydraulic fluid is not introduced by the physician, but has already been filled by the producer beforehand. The so produced and the catheter-stent assembly is not inserted over a guide wire, but by the closure of a catheter lock, which is provided at the proximal end, outside the patient, with a hemostatic valve.

First, then, the assembly is inserted through the previously introduced lock. Then, it is acted upon by the pump pressure, being forced out by pressure on the plunger of the stent from the catheter. Previously, the lock was withdrawn and that at least the length of the not yet deployed stent. When driving out of the stent, the catheter is withdrawn to ensure accurate placement of the deploying stents.

The advantage of the closed hydraulic system is that the system for applying air to the attending physician or gas-free and thus the stent release can be better controlled.

The piston and the stent can advance best if the system does not contain air, but is filled with liquid. Previously air enters the system, it must be vented. A doppellumiges catheter-stent assembly is shown in FIGS. 20 and 21 In the catheter, there is a thinner and a thicker lumens. the system is vented prior to the introduction of the system in the treated hollow organ and also before the introduction of the guide wire, through the dünnlumigen portion of the system. The dünnlumige share later serves also to pressurize. The advantage of the dünnlumigen tube is in this case is that it is more rigid, in principle, the wall voltage is here less than for a wide tube (Figure 22). With a rigid pipe, the pressure can be better dosed because the walls with increased pressure dilating less. For venting the system is flushed to carry out remaining air. For this purpose, the print medium first runs from the proximal end outside the catheter via a syringe through the dünnlumige pipe in the main pressure chamber. The seals are now, when no guide wire is still introduced> so that the air from the pressure chamber can escape via the non-closing valve open, after proximally. The rinsing liquid exits the stent support system, namely from its peak. After discharge of the rinsing liquid, the tip of the system is closed, with the finger, until the liquid is then, leaked through the second valve, which is located further proximally from the proximal end of the catheter, for example. Then the stopcock is closed at the proximal end of the catheter opening dünnlumigen. The guide wire is introduced through the tip of the stent-carrier system and guided through the catheter. Only then the vented system is inserted into the hollow organ to be treated. The pressure for the purpose of advancing the stent support to the stent release takes place over the thin lumen of the system, the pressure chamber increases its volume and the carrier from the surrounding stent catheter is fed out. The volume of the syringe (pump) for pressurizing at least as great as that of the pressure chamber in the state after release of the stent. In the piston area of ​​the stent support for better sealing two seals are mounted. The smaller is located between the guide wire and inner wall of the stent support, the second consists of a disc made of elastic Kunsttoff as silicone and seals the gap between the guide wire and the catheter. Upon bending of the catheter it is oval in cross-section, the discs shaped seal will adapt this circumstance.

In the double-lumen catheter stent system is the small lumen which is used for pushing, with relatively thick walls as compared to the lumen for the guide wire. The small lumen is thus surrounded by a large amount of wall material (Figure 22). This guarantees that the wall of the small lumen can not dilating upon pressurization and thus well controlled release of the stent from the carrier system is carried out. A second variation is that instead of a double catheter is only one lumen. In this lumen is a hollow wire (tube) is introduced via a valve, is pushed out by the air during rinsing with liquid (Figure 23). This system can be introduced over a guidewire into the body. The guide wire is guided coaxially through the opening of the stent support through the system and passes proximally through the hemostatic valve then outward (Figure 24). However, before the catheter is inserted, the system via a thin tube which extends into the channel of the stent support, rinsed (Figure 23), said rinsing liquid will have been run through the tube. This is done for. For example, by a small syringe. The proximal end is raised, with the air in the system can escape from the distal tip of the stent support. Then the tube through the valve is slow and also retracted under injection of the liquid. The guide wire may now be introduced into the catheter (Figure 24), which has become completely free of air. Here fluid back into the pump occurs via the pump approach. If the guide wire is stepped out of the hemostasis valve, the hydraulic pump, which is also vented, is carried out and driven by pressure of the stent support, wherein the catheter is withdrawn accordingly.

When the system is pressurized, there is first a jerky sliding ahead of the piston. This is avoided by a special bulb shape, for example by a bellows (Figs 25 and 26), with which the stent discharge can be better dosed. The bellows consists of a tube with transverse to the longitudinal axis wrinkles, which serves as a piston. This tube is enclosed by the catheter.

The collapsed tube has transverse folds, which are pushed together in the non-expanded state, characterized the hose is shortened. Is introduced at the end of the hose outside the patient's fluid pressure, the hose extends in the longitudinal direction when the other, opposite opening is closed by a piston. The pfropfenförmige flask is then driving the stent out. The advantage of this system is that the folded and upset tubing is connected directly to the hose that conveys the print medium. Thereby, the liquid is trapped in a closed space, so the liquid can not escape between the piston and cylinder, or in the body. This would be an advantage when using a so-called closed system. Furthermore, it can be dispensed with seals between the piston and catheter inner wall and between the piston and guide wire.

Also, the product could be air-free from the start, so a vent as described above, would not be necessary. In a further embodiment (Figure 27) of the guide wire is inserted distally into the system, through the stent, or as shown in Figure 18 the stent support, through, and then slides into the central opening of the connected to the bellows slide of piston or a stent carrier. The wire then continues through a located in the slide, obliquely outwardly extending channel and from there to the bellows by, between the bladder surface and inner catheter wall to the outside. At the end of the catheter is a hemostasis valve. The pressure is applied as described above. An advantage of this embodiment is that the guide wire extends within the catheter.

The catheter-stent device is longitudinally flexible in order to be able to insert the catheter through tortuous vessels or vessel outlets. When pressure is applied, however, the inner diameter of the catheter does not change. This can be achieved by lecht located in the catheter wall reinforcements, for example in the form of wire rings or -gef. Between the wall reinforcements there is stretchable plastic to ensure flexibility.

In another embodiment (Figures 27 and 28) which remains the stent-carrying system during the release of the stent in its position, since only the system moves the stent surrounding sheath and the stent support is held by a holding tube. The system is particularly advantageous also because for the exact positioning of the stent, because during withdrawal of the surrounding sheath the stent, this does not have to be moved through the hemostatic valve of the catheter lock. The stent sheath surrounding therefore does not interfere with the hemostatic valve of the introducer sheath into contact, reducing the frictional force and can slide on the stabilization of the catheter within the vessel, the end of the sheath rather.

Advantage of this embodiment is further that, for example, it is possible in the event of incorrect placement, not yet fully expanded-to-do stent about to push the stent enveloping catheter manually from the outside and again back, wherein the holding tube outside of the patient is held in its position and the Pusher catheter is advanced into the patient; the sheath catheter is pushed over the not yet fully expanded stent.

The system described in Figures 27 and 28 could also be designed so that the holding tube and the stabilizing catheters are made in one piece, wherein the distal portion of the holding tube located in the piston is made smaller in its diameter. In a further development, the catheter-stent system is also vented, but has only a single lumen instead of a double, and therefore can be very kleinkalibrig applied. In this embodiment, the stent supporting carrier system remains during stent release in position, as only the stent system surrounding sheath moves (Figures 30 and 31).

Prior to the introduction of the guide wire in the catheter system, the lumen of the catheter is flushed by fluid introduced through the proximal end located at the tap. Air is removed from the catheter system. The rinsing fluid can on the distal end of the catheter to flow out because the seal situated here does not close tightly as long as no guide wire is inserted; the gasket located at the proximal end of the catheter prevents the outflow of the irrigation fluid proximally.

Then introducing a guide wire into the system and the catheter system is inserted over the guidewire into the body. The seal valve at the distal end of the catheter includes completely sealed with inserted guide wire and is additionally secured by two metal rings. Since this sealing valve is located distally of the pressure chamber, the inner lumen of the catheter is operatively incorporated with the pressure chamber and is pressurized.

there are three series-connected shells which are supported together in the system: - a surrounding the stent movable and equipped with an annular piston sleeve, - a sheath surrounding the catheter shaft, and - a proximally located annular slitted removable cover. After placement of the catheter system to the site to be treated, the annular shell is manually removed; While this annular sheath is the system, it prevents the premature accidental sliding back surrounding the catheter shaft sleeve and the sleeve surrounding the stent.

Then, before the pressure is applied, the catheter shaft surrounding sheath is withdrawn proximally.

can be dispensed with the sheath surrounding the catheter shaft when the sheath surrounding the stent is held by the pressure of the compressed stent during insertion mechanically in position that it can not slide back before the pressure is applied.

The print medium P input through the catheter located at the proximal end tap runs within the inner lumen of the catheter system to the distal end, between the guide wire and catheter inner wall through the side opening in the pressure chamber. Where it causes the print medium, because all of the seals are closed at the proximal and distal end of the catheter, that the sheath surrounding the stent is pushed back by the attached at the proximal end of the sheath annular, surrounding the catheter shaft by piston proximally.

After stent release the entire catheter system in this state from the

body of the patient are removed, leaving the guidewire remains in position to be able to perform more endovascular treatments.

The advantage of this design is that it can be vented, but only a lumen instead of a double. Thus, the outer diameter can be kept very small. The stent can be positioned very precisely, as not the main catheter, but only the surrounding casing moves him. In this embodiment, the attack surface of the pressure (p), so the piston area, ring-shaped and relatively large, as opposed to the piston, the inside of the

There catheter; characterized a favorable force transfer is achieved.

The system shown in Fig. 32 is made without the valve, when a so-called. Closed system is used, as described in Fig.17 and Fig.18. In the manner described in Figure 32 embodiment, the proximal portion of the catheter has a smaller diameter than the stent support. This ensures that the pressure medium can act compared to the previously described embodiments over a larger area. Characterized a relatively lower pressure in the hydraulic system is necessary. In addition, this version also includes a device for flushing and venting of the stent bed. A leading from outside to the stent bed channel, a flushing fluid may be introduced through a syringe with a needle. By flushing the stent bed disturbing air is removed from the stent bed, which can be located in the space between the catheter sheath and stent support and between the stent struts. The removal of air improves positionability the stent because existing air would cause the stent bed that the stent or portions of the stent pop out uncontrollably from the stent bed. Furthermore, the removal of air from the stent bed prevents the escape of air into the artery. The leakage of air into the artery would lead to an air embolism, which is especially important in treatment supraaortaler arteries such as the carotid artery, as air embolism have serious effects on the patient in the brain. causes the flushing of the stent bed außerdem.daß the individual components that move against each other, are lubricated and the movement in order to facilitate and controllable.

Fig. 33 also shows a hydraulic stent delivery system, in which slides back, the stent holds together the small radius envelope. In contrast to the two previous figures, this system is designed as a "exchange Fast System", wherein the guide wire is pushed in beyond the distal tip and then laterally behind the piston system, so proximally, leads out of the catheter. The lateral orifice for the guide wire is placed so far proximally that the piston gives the stent bed for the collapsed stent in its maximum position zurückgeglittenen completely free. Through a channel in the catheter is flushed to the patient, the pressure channel and the pressure chamber in order to flush out disturbing air before the start of the procedure. There is a connection between the is used for pressurizing the channel, the pressure chamber and the channel which receives the guidewire. The liquid runs from the proximal direction through the catheter up to the pressure chamber and from there via an inclined channel in the channel which receives the guidewire. The liquid can take place over the sealing valve distally, since this valve is open as long as no guide wire has been inserted; said second sealing valve which is placed in close proximity in front of the mouth of the oblique passage, is closed even if no guide wire has been introduced. The rinsing liquid thus takes place only through the distal opening of the catheter stent system. For the treatment, the patient's system over the guide wire to the site to be treated is then placed in the body, wherein the guide wire now closes the front seal; the rear, that is proximal seal is also sealed by the wire. Now the pressure can commence, the liquid pushes the annular piston according proximally, whereby the stent is released; the pressure is not escapes through the sealing valves.

In the embodiment shown in Fig. 34 embodiment, no sealing rings in the pressure-conducting or the guide wire receiving channel are necessary because of the guide wire-receiving channel is not in communication with the pressurized system. Also in this embodiment, the pressurization causes as described in Fig.33 that the stent cohesive catheter sheath from sliding proximally. Previously the system but vented. For this the double lumen catheter afferent, ie provided with two channels which open into the pressure chamber. For venting of the system liquid is over the introduced catheter lumen and pushed out the air through the second catheter lumen. For pressurizing a lumen of the catheter is closed then proximally, while on the other lumen, the pressure is applied to urge the annular piston back. The guide wire is as in the process described in Fig.33 system obliquely from the catheter tip by the stent carrier, in order to leave this through a lateral orifice.

The embodiment shown in Figure 35 is a further development of the imaged in Fig. 34 catheter stent system. The feeding catheter is provided with only one lumen. In this lumen there is a further thin catheter or a tube which extends out through a seal valve at the proximal end of the system from the catheter lumen. The catheter lumen is provided by a Seithahn at the outermost end of the catheter with the pressurizing pump or syringe. the pressurization system is vented prior to inserting the catheter stent system in the patient by the rinsing liquid is introduced via the catheter lumen into the pressure chamber via the Seithahn. From there, the air escaping to or liquid passes through the chamber until the pressure reaching, second, coaxial with tube back to the outside. When the user observes that liquid escapes through the Koaxialkatheter outwardly, it can be concluded that the system is vented. The Koaxialröhrchen can then be withdrawn either in order to improve the flexibility of the system, or can be left in place. If the tube is entirely withdrawn, the sealing valve closes the proximal end of the catheter from perfectly to prevent escape of pressure. As with the method described in FIG. 34 system of inclined by the stent carrier channel has no connection to the printing system, seal valves within the channels are therefore not necessary.

The embodiments described in FIGS. 32, 33, 34 and 35 also have the advantage that the stent bed may be purged. This facilitates stent release, as any air can be removed from the stent bed and the stent bed can be made slippery. For this, the stent bed is provided with a leading outwards, dot-shaped channel, introduced via the rinsing liquid. The flushing fluid then exits the existing between the stent and stent bed boundary interstices again.

The embodiment described in Fig.36 shows another technique for flushing the stent bed.

The catheter has, as described in Fig.35, a large lumen contains a Koaxialkatheter. This extends beyond the pressure chamber out and even into the stent bed. -Pressure compartments and rinsing fluid conducting channels are separated by a sealing valve in the distal portion of the main lumen of the catheter from one another, which seals the inserted Koaxialkatheter opposite the main lumen. First, the Koaxialkatheter is inserted so far distally by that the stent bed is purged. Then the Koaxialkatheter the stent bed is purged. Then, it is pulled back through the valve, that the distal sealing valve closes as shown in Fig. 37. The distal opening of the coaxial catheter is then in the pressure chamber. The further procedure of the vent and purge the pressure chamber is then described in Fig.35.

legends

Figure 1:

1 shows a longitudinally stretched, the catheter (1) located spiral stent (2 ') prior to placement in a hollow organ to be treated (3), for example an artery. The spiral stent filled with its transverse diameter, the inner lumen of the catheter located in the patient almost entirely. the spiral stent (2 ') through the catheter (1) from proximally (1') to the distal opening (1 ') conveyed by pressure p by means of a pressure medium Here, the pressure medium flowing to the stent wire past as a lubricant is used. thus, the friction between the elongate resilient wire and the inner wall of the catheter is reduced. Due to the pressure differential between the pressure medium proximally of the spiral stent, and the distal portion in the catheter is of the helical stent in the direction of the opening located in the patient (1 ") promoted.

Figure 2:

Fig. 2 represents the partial implantation of the spiral stent (2!) Is in the vessel to be treated (3).

A portion of the spiral stent is still in the stretched state in delivery catheter

(1), this percentage will be carried out, nor of the printing medium P from the catheter. a liquid having good compatibility with the body, for example, physiological saline solution, or even a high viscosity liquid such as serving as a pressure medium, a

X-ray contrast agent.

Figure 3:

In this embodiment, the distal end of a catheter located in the elongated spiral stent (1: 2) with a piston (4) is provided which is adapted to the diameter of the lumen of the patient catheter (1). This creates a better seal between the printing medium and the inner wall of the catheter when the printing medium conveys the stent through the catheter. By the piston (4), the spiral stent through the catheter; because the stent is thus not compressed, less friction.

Figure 4:

Fig. 4 shows the helical stent (2 ') with piston (4) in partially implanted state. The piston is now in size has become smaller, since it is agbebaut after reaching the body vessel (3) by the body fluids or by a fluid introduced through the catheter and decreases in size, thus melts.

Figure 5:

Fig. 5 shows a the catheter (1) elongated spiral stent (2 ') having a plurality of pistons (4).

The distal piston (4 ') may have a larger diameter than the downstream piston, but is in any case so great that it fills the lumen of the catheter.

Figure 6:

The pressure medium, which is introduced from the proximal direction, flows past the proximal piston (4), whereby the distal (4 J) is driven out of the stent. Then the next

Piston which conveys the remaining portion of the catheter. This guarantees that the pressure medium acts on the end of the stent and transported this out.

In a case in which the sections are completely filled with fluid between the pistons, it is not necessary that the pistons allow Lekage, since a liquid is not compressible and therefore the pressure is propagated.

The distal piston (4 J) is mounted on the wire / coil stent so as to adhere to the

Vessel wall of the vessel to be treated (3) applies to maintain flow turbulence to a minimum.

Figure 7:

The stretched spiral stent (2 ') by a support (5) (carrier) through the catheter (1) transported. The carrier consists of a piston (4 "), on the perpendicular in the direction of the distal catheter opening (1 'is mounted) a rod having a Y-shaped end. The stretched spiral stent with a ball head (2 '') which is locked into the Y-shaped extension of the carrier bar (5). The support carrying the stent, is conveyed by the printing medium P through the catheter.

Figure 8:

Fig. 8 shows the support (5) with partially implanted spiral stent (2 '). The spiral stent has now solved with its head out of the Y-shaped pliers, and by the piston (4 ") further expelled.

Figure 9: Fig. 9 shows a longitudinal section through the catheter flask stent system. A piston (4) is in the in-patient catheter (1) as placed in a cylinder and is pushed by the print medium P from proximally toward the distal catheter opening (1 ") in the patient. The stent is in front of the piston (2 ) in its not yet deployed state (low profile). pistons and stent including catheters are flexible so that the system can also be used in tortuous arteries. in the catheter (1) there is a lateral orifice (6), from which the pressure medium can also escape into the catheter from the hollow organ in order to brake the advance of the piston. This is to prevent, that is transported by pushing the stent of the piston out of the catheter into the patient's vessel to be treated.

Figure 10: The pressure medium conveyed to the stent (2) as long as the catheter (1) according to distally until the piston has passed through the lateral orifice in the catheter (1) (6) located. Thereby the outflow of pressure medium, whereby a further advance of the piston is omitted and the piston can not leave the catheter.

Figure 11:

The stent (2) is in the distal end of the catheter located in the patient (1) loaded behind the catheter opening in its small, unexpanded state. The catheter is here of smaller lumen at the proximal end of the stent chamber is a step which prevents the piston (4) after the stent has been conveyed from its chamber may slip out of the catheter. The stent is not fed out in this case directly by the piston but through an upstream the piston slide (4 " ') which has at its distal end the diameter of the stent chamber and thus is smaller in diameter than the rear part of the piston. Central in the piston and slider is a bore (7!) for receiving the guide wire (7). the bore is provided with a sealing ring (8), which seals the guide wire relative to the piston. a further sealing ring is found on the surface of the piston, in order to avoid leakage of pressure medium between the piston and inner surface of the catheter. the proximal end of the piston (4) and the distal end of the slide (4 " ') are funnel-shaped hollowed out to facilitate an exploratory with the guide wire.

Figure 12:

The stent (2) has been pushed out by the piston here. The slider portion (4 ') of the piston (4) is located as far as possible distally, wherein a further advance of the piston is prevented by the rear portion of the piston with its shoulder having a larger diameter, not in the front, in its diameter may occur reduced portion of the catheter (1).

Figure 13: An in-small-diameter stent (2) is loaded in the catheter (1). The inside diameter (lumen) of this stent is equal to the outer diameter of the guide wire (7). The tip of the catheter (1 ') is pulled distally tapered and covered the step forming between the guide wire and stent. The catheter is elastically movable in the region of its tip (hatched portion). The stent (2) is conveyed from the printing medium P within the catheter to distally.

Figure 14: Step out of the stent (2) expands the existing catheter tip made of elastic material (1 ').

Figure 15:

Longitudinal section through the catheter / piston / stent system.

A self-expanding stent (2) is loaded into its small diameter in the catheter (1). The proximal end of such a stent (2) serves as a piston, over a certain distance, the spaces between the stent struts and the space between the stent and guide wire (7) by a in the blood rapidly dissolving substance, for example, a polymer (9), sealed are. During exit the stent from the distal

Catheter opening (1 "), the polymer from the pressure medium such as gas or a particular

Liquid, dissolved, and thus the stent deploys.

In another embodiment, it is also possible that the print medium, for example, do not dissolve a gas or certain liquids, this polymer. The polymer is in this case in the vascular system dissolved only after exit of the stent by the body fluids, including blood or intestinal juices, in which case the stent reaches its use size.

Figure 16:

A self-expanding stent implanted in FIG. 15, on the stent struts (2 ") or

adhering residues of the polymer (9).

Figure 17:

Longitudinal section through a catheter / piston / stent system according to the rapid exchange system

(Fast insertable system, also called monorail).

The angiographic guide wire (7) not here extends centrally through the entire catheter

(1), but only in the distal portion of the catheter. The guide wire is at the top of

Vehicle system (11) containing the stent bed (11 1) and a downstream Kolbenantei! (11 ") includes, first introduced centrally and laterally from the piston moiety through a lateral orifice (11" ') is executed, and then runs alongside the catheter (1) over the Kathetereinführschleuse outward. Opposite the for the guide wire (7) provided for the lateral opening in the piston (11 " ') is a longitudinal slot (10) provided in the catheter that allows a forward sliding of the piston within the catheter while the guidewire emerges laterally The piston is relative to the catheter lumen. sealing rings (8) sealed. the stent transporting piston is advanced through the print medium p.

Figure 18:

Unlocked stent (2) of FIG 17th

The flask was advanced through the printing medium P completely to the distal direction toward the distal end of the catheter (1 ") until the now in the hollow organ (3) exposed stent bed (11 ') releases the stent for deployment. Another leakage of the piston is prevented by the guide wire (J) at the distal edge of the longitudinal slit in the catheter (10 ') is turned off. in this state, the carrier system (11) is so far moved out of the catheter, that the stent bed (11 J) is located outside the catheter (1 ) located in the hollow organ (3) and the stent (2) can swell to its use size. the rear part of the support (11 "), which acts as a piston, but remains in the catheter. The catheter / piston system can be withdrawn in its entirety over the guide wire to release the stent, wherein the guide wire (7) can be left in the deployed stent to possibly take other therapeutic measures.

19 shows a closed system for hydraulic pressure transmission. The hydraulic fluid is already in the system. The catheter-stent assembly is introduced through the sheath of a catheter sheath (12) having a hemostatic valve (8 ') at the proximal end. From the pump (13) is applied pressure, by pressure on the piston (4) of the stent (2) from the catheter (1) is expelled. Previously, the sheath (12) has been withdrawn and that at least the length of the not yet deployed stent. When driving out of the stent, the catheter is withdrawn to ensure accurate placement of the deploying stents. For this purpose, the platform (18) is fixed on the patient and the catheter (1) is pushed into the platform cover, wherein the piston of the platform (18 ") is pushed into the catheter to release the stent. The plunger of the platform (18" ) has the same diameter as the piston on the stent support (4 ') Figure 20:. doppellumiges catheter-stent assembly (15), with dünnlumigem (15 1) and dicklumigem (15 ") portion before the guide wire has been introduced. About the dünnlumigen portion (15 ') of the system is vented by the pressure medium via a syringe (pump) (13) is passed through the dünnlumige pipe in the main pressure chamber (16) and on the remaining seals (8, 8') can escape. After discharge of the rinsing liquid, the closure valve (17) is sealed and placed the guide wire across the top of the stent support system (5).

Fig. 21: process of stent release by the method described in Figure 20 system following the introduction of the guide wire (7) in the large lumen (15 ") The system is then transported to the destination and on the dünnlumigen portion (15 ') of the system. the pressurization carried out for the purpose of stent release. here, the stent (2) is partially deployed. the stent support (5) has at its distal part, two gaskets (8). the first seal seals the intermediate space between the guide wire and the channel in the stent support. the second seal on the other hand seals the outer space between the stent support and the outer catheter (1). the hemostasis valve at the distal end of the catheter seals the large lumen (15 ") from at introduced wire (7).

Fig. 22 shows the cross section of the catheter system (15), which is described in Fig. 20 and 21. The small lumen (15 ') for pressurizing is compared with the lumen (15 ") thick wall for the guide wire, that is surrounded by a large amount of wall material.

Figure 23: catheter stent system with a venting system for feeding the printing medium. Before the catheter (1) to be treated hollow organ (3) is inserted, the system via a thin tube (7 ") which extends into the channel of the stent support (5), rinsed, rinsing liquid is a hypodermic syringe (14) introduced via the tube into the system. After the exit of the irrigation fluid from the tip of the stent support the entire system is free of air after retraction of the hollow wire (7 ") via the valve (8 ')., the guide wire (7) is introduced into the now fully air-free catheter (Figure 24).

Figure 24: catheter stent system with vent system of Figure 23, upon exiting the guide wire (7) of the hemostatic valve (8 1) is used which also vented hydraulic pump (13) for the purpose of pressurizing and expelling the stent support from the catheter wherein the catheter must be withdrawn accordingly. Fig. 25: illustration of another closed hydraulic system in the stent (2) carrying the catheter (1) another catheter is inserted coaxially, whose distal end is forged together by cross folds (19). At the end of this catheter (19) is closed the opening of which by the hydraulic piston (4). By pressurizing the inner catheter proximally of the folded end of the inner catheter extends and thus pushes the piston forward to lead out the stent (2) from the main catheter (1). These are a completely closed system. The hydraulic fluid can not pass between the piston and catheter inner wall also in the blood here.

Figure 26 shows the stretched by applying pressure to the distal portion of the bellows-like inner catheter (19). The stent (2) has come out of the catheter (1) and has in the hollow organ (3) dilated.

Figure 27 shows the in figure 25 and 26 illustrated bellows system, in which the guide wire (7) between the bellows-like inner catheter (19) and the surrounding catheter (1) extends outwardly. In the distal portion of the system, the guidewire passes through the piston (4) upstream and connected to it slide of the piston (4 ' ") and the stent (2), or alternatively by a not in this figure, but for example, in Figure 18 illustrated stent support (11).

Figure 28 shows an embodiment in which the stent (2) carrying system (5) remains in its position during the release of the stent, as only the stent system surrounding envelope (1) moves. For exact positioning of the stent (2) at the site to be treated in the artery holder (20), the stent support (5) from the outside, that is, outside of the patient, through a coaxially through the tunneled catheter (1) extending maintained. This holder consists of a thin tube (20) having its proximal end outside the patient, for example, is fixedly positioned on the body of the patient and whose distal end is fixedly connected to the stent support (5). Upon retraction of the enveloping the stent support catheter (sheath) (1) remains the stent support are constant at the desired location and the sleeve moves relative to the stent support proximally away, whereby the stent (2) is released.

The rearward movement of the sleeve (1) is caused by the fact that on the described tube (20), the pressure medium is introduced into the pressure chamber (16). Here, the volume of the pressure chamber is increased and the piston (4) is pushed back together with the enveloping the stent delivery catheter (1). Piston (4) and enveloping the catheter (1) are fixedly interconnected. Stent support (5) and piston (4) thus move away from each other, the piston with the shell (1) is moved; the stent support (5) itself is maintained through the tube (20) in position. The holding tube (20) passes through an aperture in the piston (4); in order to avoid a pressure drop, there is an additional seal (8) herein. A further seal (8) is found between the proximal end of the stent support (5) and the surrounding sheath (1). The Führungsraht (7) runs according to the above-described rapid-exchange system from the stent support side (5) off. In order to support the inner support tube (20) during advancement of the catheter-stent cutlery into the patient, this by a stabilization tube (21) is surrounded. This stabilization tube extends into the proximal piston portion; However, there is a gap provided on the magnification in the pressure chamber (16) of the inner portion of the piston (4) slides over the stabilizing catheter (21).

The pressure chamber must be able to enlarge in length at least to such an extent that it corresponds at least to the length of the stent bed (11 '), which houses the unexpanded stent (2).

The piston part (4) encloses at its proximal end the stabilizing catheter (21); Thus, the coaxial displacement between stabilization catheter and piston (4) is ensured.

The stabilizing catheter is further surrounded by a pusher catheter (22). During insertion of the catheter-stent cutlery the Stentträger- piston system over the guide wire (7) is advanced with the pusher catheter. Since the pusher catheter then abuts the stent support-piston system is that by the pressure of Pusher- catheter proximally of the stent enveloping the catheter (1) is not pushed back, and thus the stent is not released prematurely is guaranteed.

Figure 29 shows the system described in Figure 28 at a time at which the stent (2) has been partially released.

Prior to release of the stent (2) of the pusher catheter (22) (11 ') first has at least the length of the stent (2) harboring stent bed withdrawn. After positioning of the stent-transporting system in the body to be treated arteries the holding tube (20) outside of the patient is held in position. Then, the application of pressure, wherein the pressure chamber (16) increases and the piston portion (4) with the attached sheath catheter (1) slides proximally and the stent (2) are free. An unwanted displacement of the stent support (5) as this by the holding tube (20) is held in position from the outside is avoided. After the stent is placed, the system is pulled out by train on the holding tube over the guide wire and through a catheter lock.

Fig. 30: Single lumen, entlüftbares catheter stent system in the supporting the stent (2) support system (5) remains during stent release to its position, since only the catheter shaft of the stent system surrounding sheath (23) moves. Before the guide wire is inserted into the catheter system, the lumen of the catheter (1) located on the proximal end tap (17) is flushed to purge air from the catheter system. The seal at the proximal end of the catheter (T) located (8) prevents the outflow of the irrigation fluid proximally, while the rinsing fluid at the distal end of the catheter (1 ") can flow out because the seal located here (8"), the distal to the to the pressure chamber (16) leading side opening (24) is located, not tightly closes as long as no guide wire is inserted. For the introduction of the catheter system into the body, a guide wire (7) is inserted into the catheter system. The sealing valve (8 ") at the distal end of the catheter includes completely sealed with inserted guide wire (7). It is additionally secured by two metal rings (8 W). Since this sealing valve is located distally of the pressure chamber (16), the inner lumen of the catheter is operatively included with the pressure chamber and is pressurized.

After placement of the catheter system to the site to be treated at a proximal end of the catheter (T) befindlicher, the main catheter (1) surrounding sleeve-like ring (25) is removed; This ring has a slit designed so flexible, the component that it can be manually removed from the catheter system. As long as this ring is located at the system, it prevents premature accidental sliding back of the surrounding the catheter shaft (23) and surrounding the stent sheath (26), as the shells are supported to each other.

Then, before the pressure is applied, the sheath surrounding the catheter shaft (23) is retracted proximally.

The faucet located above the proximal catheter end (T) (17) input print medium P passes within the inner lumen of the catheter system to the distal end, between the guide wire (7) and the catheter inner wall (1) through the side opening (24) (in the pressure chamber 16 ). Where it causes the print medium, because all of the seals are closed at the proximal and distal end of the catheter, that the surrounding the stent sheath (26) is pushed back enclosing by the attached at the proximal end of the sheath annular, the catheter shaft (1) piston (26 ') according to proximalward , During stent release, the carrier catheter is not moved but only the surrounding the stent sheath (26) when attached thereto annular piston surface (26 ') is pushed back by the engaging pressure (p) on the outside of the catheter (1).

Figure 31: Single lumen, entlüftbares catheter stent system, in which the stent (2) carrying the support system (5) remains during stent release to its position, since only the catheter shaft of the stent system surrounding sheath (23) moves. The proximal end of the catheter (1!) Located annular sheath has been removed. The surrounding the stent sheath (26) is slid back to proximally, as is the proximally located, the catheter shaft surrounding sheath (23). The stent (2) has reached the site to be treated its desired expansion diameter. The whole catheter system can be removed in this state from the body of the patient, wherein the guide wire (7) remains in position in order to perform further endovascular treatments.

Fig. 32: Single lumen, entlüftbares catheter stent system, in which the piston-shaped end (26 ') is sliding in the surrounding said stent sheath (26) on said catheter shaft (1) when pressure (p) is applied. Because the catheter shaft (1) has a smaller diameter than the stent support (5), this piston (26 ') is particularly large. The system is vented before the guide wire (7) is introduced. The seal (8 ") at the distal end of the catheter does not, when no guide wire is inserted. The seal (8) always closes tightly. Rinsing liquid via the tap (17) is introduced, removes air from the system and leaves it through the open seal (8 ") at the distal end of the catheter. After introduction of the guide wire (7), the system is pressure-tight, the seal (8 ") is then sealed. About the valve (17) acted upon pressure (p) is the leading into the pressure chamber channel (16 ') to the piston (26' ) passed, whereby it is moved. the stent bed (11 ') is flushed by using a cannula (27' rinsing liquid is introduced into the channel (27)).

Fig. 33: Rapid-exchange system in which the guidewire exits the catheter through a lateral orifice. The stent support (5) is provided with two channels, whereby a compound (28) is formed leading from the pressure channel of the catheter (1) and said receiving the guide wire (7) channel.

The distal valve (8 ") of the catheter is open as long as no guide wire was inserted. Another, namely sealing valve (8) is found in the guide wire receiving channel immediately poximal the point of entry of the thin scavenging passage. This valve is always tight closing. the thin connecting channel (28) has such a small diameter, that the guide wire (7) can not accidentally pass into this, but only in the channel provided with the side opening (6 1).

Fig. 34: Rapid-exchange system with doppellumigem catheter (1) which can be vented, wherein pressure or flushing fluid conducting channels (29) which up to the pressure chamber (16) extend, and the guide wire (7) receiving channel are separated.

Fig. 35: Rapid-exchange system with einlumigem catheter (1) which can be vented. Pressure, and irrigation fluid conducting channels and the said guide wire (7) receiving channel are separated. Pressure, and irrigation fluid to be introduced through the main lumen of the catheter (1) or by a coaxially inserted tube (30) into the system; Rinsing liquid is derived accordingly.

Fig 36: Entlüftbares wherein the stent bed (11 1) is not rinsed from the outside but from the main lumen of the catheter (1) into which a Koaxialkatheter (30) is inserted rapid-exchange system. Pressure, and irrigation fluid conducting channels and the said guide wire (7) receiving channel are separated. Rinsing liquid is introduced into the system via a Koaxialkatheter (30). The Koaxialkatheter is initially pushed completely distally. The stent bed (11 ') and the stent (2) is flushed and purged of air. Then, the Koaxialkatheter (30) past the seal (8) is withdrawn. The sealing valve (8) always closes tight, even if the Koaxialkatheter (30) is removed. About the Koaxialkatheter introduced (30) rinsing fluid is rinsed and then vents the pressure chamber (16), wherein the rinsing liquid located on the on the catheter (1) valve (17) is derived. Pressurization is then over the main catheter, wherein the Koaxialkatheter (30) can also be entirely removed.

Fig. 37: Entlüftbares rapid exchange system, as shown in Figure 36, here in the state after venting and purging of the stent bed (11 '):. The Koaxialröhrchen (30) has been withdrawn through the sealing gasket valve (8) also, so that the proximal opening of the coaxial catheter (30) is in the pressure chamber (16). The sealing valve (8) is so closed, that the pressure medium is not to be filled in the direction of stent bed (11 ') can pass. The application of pressure (p) can be effected via the tap of the catheter (17) or the Koaxialröhrchen (30). Number key to the drawings

1 catheter

V Proximal portion of the catheter

1 "distal opening of the catheter

2 stent

2 'spiral stent

2 "slotted tube stent

Spherical head of the spiral stent

3 hollow organ

4 piston

4 'Distal piston

4 "of the support plunger (carrier)

4 '' of the piston slide

5 carrier (Carrier)

6 lateral orifice in the catheter 1

6 'side opening for the guide wire 7

7 guidewire

7! Bore for receiving the guidewire

7 "hollow wire

8 seal

8 'hemostasis valve

8 "sealing valve at the distal end of the catheter

8 '', the sealing valve 8 "locking rings

9 polymer

10 longitudinal slot in the catheter 1

11-carrier system

11 'stent bed

11 "piston proportion of the carrier system

11 ' "lateral orifice in the piston portion of the support system

12 introducer

13 pump for pressurizing

14 syringe to flush the system

14 'endpiece for injection syringe or pump

15 doppellumiges catheter system

15 'thin (small) Lumen

15 "thick (large) lumen pressure chamber 'for the pressure chamber leading channel

stopcock

Platform 'platform sleeve "piston of the bellows-like platform pleated catheter

Holding tube for stent support

Stabilization tube

Pusher catheter sheath surrounding the catheter shaft in the pressure chamber leading side opening in the catheter 1 of removable covers like ring surrounding the stent envelope 'of annular piston 26 in leading into the stent bed 5 rinse-channel' cannula for rinsing the stent bed 5

connecting channel

double lumen

Koaxialkatheter

Claims

claims:
1. The catheter-stent apparatus for application and implantation of a stent for the treatment of body vessels and body hollow organs, characterized in that the stent by a pressure differential between the proximal, exterior to the body end and the distal, situated in the body end, in relation to surrounding tunneled catheter is moved, this being effected by a pressure medium, with the result that the stent is placed purposefully.
2. The catheter-stent device according to claim 1, characterized in that the stent by pistons which are adapted to the lumen of the catheter is pushed out.
3. The catheter-stent device according to claim 1, which is used for the release of an elongated thread-like elastic Drahtfilamentes (spiral stent, meander-stent) which is conveyed by the pressure difference as a piston through the catheter into the tubular body, wherein the filament in the organ formed because of its elasticity into a tubular structure.
4. The catheter-stent assembly of claim 1, which serves for the release of a tubular self-expanding stent, whereby the pressure of the pressure medium acts on the unexpanded stent and presses piston-like manner out of the surrounding catheter.
5. The catheter-stent assembly which is formed like a piston according to claim 1, wherein the difference in pressure in the catheter directly acts on an end of the freely eluting stents.
6. The catheter-stent assembly of claim 1, in which the printing medium against one or suppressed several series-arranged form piston-shaped extensions of the stent and drives it gradually from the surrounding catheter addition, only the front-mounted on the stent piston the lumen in the catheter completely fills, while the following piston allow a small flow past the print medium, so that the subsequent stent sections are pushed out by the more rearward piston after emergence of the front piston.
7. catheter stent system according Anspruchi, wherein the piston-shaped extensions of the stent are made of material which dissolves in the body fluids.
8. catheter stent system according to claim 1, in which the piston is flexible.
9. catheter stent system according to claim 1, wherein the proximal end of the piston is extended in its diameter and the corresponding carrier catheter is narrowed in accordance with at its distal end to prevent a sliding out of the piston.
10. The catheter-stent system according to claim 1, in which the stent is to be placed being driven by a piston in the catheter by means of the pressure medium through the catheter and pushed out of the catheter.
11. The catheter-stent system in which the piston has according to claim ^ a central channel to receive a guide wire.
12. The catheter stent system according to claim 1, in which the wall of the surrounding piston catheter having a lateral orifice which is opened by sliding past the piston by distally and after release of the stent, and by which then the pressurized medium can escape, for a further advance of the piston from sliding out of the piston from the catheter to prevent the vessel.
13. The catheter-stent system according to claim 1, which is a closed for the pressure medium system, in which a self-expanding stent is mounted on a tubular support having a stent receiving sink, and whose front end is formed into a tip, and the rear end is provided with a sliding piston, and which is provided with a channel for a guide wire, which extends centrally in the carrier portion and then obliquely in the piston extends and opens into a lateral orifice to the outside, wherein the guide wire extends through the piston and then the lateral orifice addition occurs, and being released by pushing the carrier of the stent, but the piston remains in the catheter portion, as a further sliding out of the piston is prevented by blocking of the laterally emerging from the lateral orifice guidewire.
14. The stent catheter system of claim 1, wherein the end face of the piston of the injection pump is kept equal to the time available for applying pressure surface of the piston located in the catheter.
15. The stent catheter system of claim 1, wherein the end face of the piston of the injection pump is a different size than the end face of the available for pressurizing the piston in the catheter.
16. The catheter-stent system according to claim 1, whose shaft has two lumens for carrying out a flushing and venting of the catheter system.
17, catheter-stent system according to claim 1, in which a smaller lumen is preferably used for pressurizing, and a larger lumen for receiving the guide wire.
18, catheter-stent system according to claim 1, which is located in the catheter and a filled with compressed medium containing bellows-shaped tube, which changes due to pressurization in shape and moves the stent.
19, catheter-stent system of claim 1, wherein the stent carrying portion after placement in the target vessel remains in a fixed position and the stent is released, said sliding back by pressurizing the piston together with the surrounding the stent support tunneled catheter.
20, catheter-stent system of claim 1, wherein the sheath surrounding the stent can be moved back with not yet fully expanded stent back over the stent away in the starting position.
21, catheter-stent system according to claim 1, wherein the pressure medium in the pressure chamber and the channels connected with it is filled before use and completed (sealed).
22, catheter-stent system of claim 1, wherein the stent remains proportion supporting after placement of the stent in the organ to be treated in a fixed position and the stent is released, and by applying pressure on the inner lumen of the catheter in inserted guidewire and distally and proximal the pressure chamber sealing valves, an annular, connected to the stent sheath piston is pushed back on the outer surface of the support catheter.
23: catheter stent system, which serves for flushing and Luftentleeren of the printing system according to claim 1, wherein said shaft includes a longitudinally mounted, to the piston reaching catheter for pressurization. 24: catheter stent system according to claim 1, wherein the guide wire coaxially received in the pressure chamber with which is provided with proximal and distal sealing valves.
25: catheter stent system of claim 1, wherein the stent enveloping Katheteram proximal end is provided with an annular piston sliding on a delivery catheter with a smaller diameter after pressurization by proximally backward to stent deployment, wherein the stent support for receiving the guidewire according to the "Fast Exchange system" with an inclined, is provided in the proximal channel leading from the catheter tip from the side of the catheter beyond the pressure chamber system, ends.
26: catheter stent system according to claim 1, with a device for filling and venting of the stent chamber and the hydraulic portion by means of a catheter.
27: catheter stent system according to claim 1, wherein said surrounding the stent catheter sheath is provided with a slot-like side opening which is connected with a leading into the stent bed and located in the stent carrier channel, is introduced above the liquid for rinsing the stent bed and evacuating of air as well as for lubrication of the mutually moving parts.
PCT/DE2006/000276 2005-02-25 2006-02-16 Implanting a self-expanding stent by means of hydraulic power WO2006089517A1 (en)

Priority Applications (4)

Application Number Priority Date Filing Date Title
DE200510008682 DE102005008682B4 (en) 2005-02-25 2005-02-25 Catheter-stent device for implantation of self-expanding stents by means of hydraulic force
DE102005008682.9 2005-02-25
DE102005048181.7 2005-09-29
DE102005048181 2005-09-29

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
DE200611001056 DE112006001056A5 (en) 2005-02-25 2006-02-16 Implantation of a self-expanding stents by means of force hydraulishcer

Publications (1)

Publication Number Publication Date
WO2006089517A1 true WO2006089517A1 (en) 2006-08-31

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Cited By (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1779818A3 (en) * 2005-11-01 2007-09-12 Cordis Corporation Implant delivery apparatus
EP1891914A1 (en) 2006-08-25 2008-02-27 Strecker, Ernst Peter, Dr.-med.Prof. Catheter-sent device
WO2011035318A1 (en) * 2009-09-21 2011-03-24 Boston Scientific Scimed, Inc. Rapid exchange stent delivery system
EP2387977A1 (en) * 2010-05-20 2011-11-23 JenaValve Technology Inc. Catheter system for introducing an expandable heart valve stent into the body of a patient
WO2011144351A3 (en) * 2010-05-20 2012-06-21 Jenavalve Technology Inc. Catheter system for introducing an expandable heart valve stent into the body of a patient, insertion system with a catheter system and medical device for treatment of a heart valve defect
WO2013056898A1 (en) * 2011-10-21 2013-04-25 Jenavalve Technology Inc. Catheter system for introducing an expandable heart valve stent into the body of a patient, insertion system with a catheter system and medical device for treatment of a heart valve defect
EP2839815A1 (en) 2013-08-20 2015-02-25 Biotronik AG Catheter system with movable sleeve
JP2015515911A (en) * 2012-05-09 2015-06-04 アボット カーディオバスキュラー システムズ インコーポレイテッド Catheter with hydraulic actuator with tandem chamber
US9056008B2 (en) 2006-12-19 2015-06-16 Sorin Group Italia S.R.L. Instrument and method for in situ development of cardiac valve prostheses
US9168105B2 (en) 2009-05-13 2015-10-27 Sorin Group Italia S.R.L. Device for surgical interventions
WO2017072592A1 (en) * 2015-10-28 2017-05-04 Tilo Kolbel Systems and methods for removing air from stent-grafts and other medical devices
US9867694B2 (en) 2013-08-30 2018-01-16 Jenavalve Technology Inc. Radially collapsible frame for a prosthetic valve and method for manufacturing such a frame
US9878127B2 (en) 2012-05-16 2018-01-30 Jenavalve Technology, Inc. Catheter delivery system for heart valve prosthesis
US10058313B2 (en) 2011-05-24 2018-08-28 Sorin Group Italia S.R.L. Transapical valve replacement
US10278847B2 (en) 2015-08-11 2019-05-07 Mokita Medical Gmbh I.Gr. Systems and methods for removing air from medical devices

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5817101A (en) * 1997-03-13 1998-10-06 Schneider (Usa) Inc Fluid actuated stent delivery system
WO1998052496A1 (en) * 1997-05-20 1998-11-26 Biocompatibles Limited Stent deployment device
US6004328A (en) * 1997-06-19 1999-12-21 Solar; Ronald J. Radially expandable intraluminal stent and delivery catheter therefore and method of using the same
US6254612B1 (en) * 1998-10-22 2001-07-03 Cordis Neurovascular, Inc. Hydraulic stent deployment system
US6607538B1 (en) * 2000-10-18 2003-08-19 Microvention, Inc. Mechanism for the deployment of endovascular implants
EP1500382A1 (en) * 2003-07-22 2005-01-26 Medtronic Vascular Connaught Stents and stent delivery devices
WO2005117758A1 (en) * 2004-05-28 2005-12-15 Cook Incorporated Exchangeable delivery system for expandable prosthetic devices

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5817101A (en) * 1997-03-13 1998-10-06 Schneider (Usa) Inc Fluid actuated stent delivery system
WO1998052496A1 (en) * 1997-05-20 1998-11-26 Biocompatibles Limited Stent deployment device
US6004328A (en) * 1997-06-19 1999-12-21 Solar; Ronald J. Radially expandable intraluminal stent and delivery catheter therefore and method of using the same
US6254612B1 (en) * 1998-10-22 2001-07-03 Cordis Neurovascular, Inc. Hydraulic stent deployment system
US6607538B1 (en) * 2000-10-18 2003-08-19 Microvention, Inc. Mechanism for the deployment of endovascular implants
EP1500382A1 (en) * 2003-07-22 2005-01-26 Medtronic Vascular Connaught Stents and stent delivery devices
WO2005117758A1 (en) * 2004-05-28 2005-12-15 Cook Incorporated Exchangeable delivery system for expandable prosthetic devices

Cited By (28)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1779819A3 (en) * 2005-11-01 2007-09-12 Cordis Corporation Method for preparing and employing an implant delivery apparatus
US7637933B2 (en) 2005-11-01 2009-12-29 Cordis Corporation Method for preparing and employing an implant delivery apparatus
US7780714B2 (en) 2005-11-01 2010-08-24 Cordis Corporation Implant delivery apparatus
EP1779818A3 (en) * 2005-11-01 2007-09-12 Cordis Corporation Implant delivery apparatus
EP1891914A1 (en) 2006-08-25 2008-02-27 Strecker, Ernst Peter, Dr.-med.Prof. Catheter-sent device
US9056008B2 (en) 2006-12-19 2015-06-16 Sorin Group Italia S.R.L. Instrument and method for in situ development of cardiac valve prostheses
US9168105B2 (en) 2009-05-13 2015-10-27 Sorin Group Italia S.R.L. Device for surgical interventions
WO2011035318A1 (en) * 2009-09-21 2011-03-24 Boston Scientific Scimed, Inc. Rapid exchange stent delivery system
US9814613B2 (en) 2009-09-21 2017-11-14 Boston Scientific Scimed, Inc. Rapid exchange stent delivery system
US8771335B2 (en) 2009-09-21 2014-07-08 Boston Scientific Scimed, Inc. Rapid exchange stent delivery system
WO2011144351A3 (en) * 2010-05-20 2012-06-21 Jenavalve Technology Inc. Catheter system for introducing an expandable heart valve stent into the body of a patient, insertion system with a catheter system and medical device for treatment of a heart valve defect
JP2013526935A (en) * 2010-05-20 2013-06-27 イエナバルブ テクノロジー インク Catheter system for introducing an expandable heart valve stent into a patient's body, insertion system having a catheter system, and medical device for treating heart valve abnormalities
AU2011254893B2 (en) * 2010-05-20 2014-08-21 Jenavalve Technology Inc. Catheter system for introducing an expandable heart valve stent into the body of a patient, insertion system with a catheter system and medical device for treatment of a heart valve defect
US9597182B2 (en) 2010-05-20 2017-03-21 Jenavalve Technology Inc. Catheter system for introducing an expandable stent into the body of a patient
EP2387977A1 (en) * 2010-05-20 2011-11-23 JenaValve Technology Inc. Catheter system for introducing an expandable heart valve stent into the body of a patient
CN103096844A (en) * 2010-05-20 2013-05-08 耶拿阀门科技公司 Catheter system for introducing an expandable heart valve stent into the body of a patient, insertion system with a catheter system and medical device for treatment of a heart valve defect
US10307251B2 (en) 2010-05-20 2019-06-04 Jenavalve Technology, Inc. Catheter system for introducing an expandable stent into the body of a patient
US10058313B2 (en) 2011-05-24 2018-08-28 Sorin Group Italia S.R.L. Transapical valve replacement
CN104159543B (en) * 2011-10-21 2016-10-12 耶拿阀门科技公司 The catheter system for the introduction of an expandable heart valve stent patient
CN104159543A (en) * 2011-10-21 2014-11-19 耶拿阀门科技公司 Catheter system for introducing an expandable heart valve stent into the body of a patient, insertion system with a catheter system and medical device for treatment of a heart valve defect
WO2013056898A1 (en) * 2011-10-21 2013-04-25 Jenavalve Technology Inc. Catheter system for introducing an expandable heart valve stent into the body of a patient, insertion system with a catheter system and medical device for treatment of a heart valve defect
US9510947B2 (en) 2011-10-21 2016-12-06 Jenavalve Technology, Inc. Catheter system for introducing an expandable heart valve stent into the body of a patient
JP2015515911A (en) * 2012-05-09 2015-06-04 アボット カーディオバスキュラー システムズ インコーポレイテッド Catheter with hydraulic actuator with tandem chamber
US9878127B2 (en) 2012-05-16 2018-01-30 Jenavalve Technology, Inc. Catheter delivery system for heart valve prosthesis
EP2839815A1 (en) 2013-08-20 2015-02-25 Biotronik AG Catheter system with movable sleeve
US9867694B2 (en) 2013-08-30 2018-01-16 Jenavalve Technology Inc. Radially collapsible frame for a prosthetic valve and method for manufacturing such a frame
US10278847B2 (en) 2015-08-11 2019-05-07 Mokita Medical Gmbh I.Gr. Systems and methods for removing air from medical devices
WO2017072592A1 (en) * 2015-10-28 2017-05-04 Tilo Kolbel Systems and methods for removing air from stent-grafts and other medical devices

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