WO2011007444A1 - Endoprothèse coaxiale multicouches - Google Patents

Endoprothèse coaxiale multicouches Download PDF

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Publication number
WO2011007444A1
WO2011007444A1 PCT/JP2009/062955 JP2009062955W WO2011007444A1 WO 2011007444 A1 WO2011007444 A1 WO 2011007444A1 JP 2009062955 W JP2009062955 W JP 2009062955W WO 2011007444 A1 WO2011007444 A1 WO 2011007444A1
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WIPO (PCT)
Prior art keywords
stent
component
struts
strut
csb
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PCT/JP2009/062955
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English (en)
Japanese (ja)
Inventor
浩二 森
Original Assignee
株式会社メドバン・アイ・ピー
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Priority to PCT/JP2009/062955 priority Critical patent/WO2011007444A1/fr
Publication of WO2011007444A1 publication Critical patent/WO2011007444A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—Filters 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
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/856—Single tubular stent with a side portal passage
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—Filters 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
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/90—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
    • A61F2/91—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheet material or tubes, e.g. perforated by laser cuts or etched holes
    • A61F2/915—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheet material or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—Filters 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
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/852—Two or more distinct overlapping stents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—Filters 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
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2002/826—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents more than one stent being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0076—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof multilayered, e.g. laminated structures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0018—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in elasticity, stiffness or compressibility
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0036—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in thickness
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/006—Additional features; Implant or prostheses properties not otherwise provided for modular
    • A61F2250/0063—Nested prosthetic parts

Definitions

  • the present invention relates to coaxial multi-layer stents and to intraluminal endoprostheses and endoprostheses having similar or similar support structures.
  • a stent that has been attracting attention in recent years in order to enable non-invasive treatment.
  • This is a cylindrical structure with open ends or a coiled type, and is composed of a metal material that can be plastically deformed, such as stainless steel, and has properties such as shape memory and superelasticity.
  • Nitinol (Ni-Ti) alloy etc.
  • metal materials biopolymer materials, ceramics, biodegradable plastics, etc. that have superplasticity and melting characteristics in vivo. is there.
  • stents made of a plastically deformable metal material such as stainless steel are most frequently used, and will be described below by taking this as an example. It should be noted that those skilled in the art can easily guess that the same applies to stents made of other materials.
  • the stent is attached to the balloon part at the tip of the catheter, which is called a balloon catheter and a delivery device called a catheter together with a small radius so that it can be placed in a tubular organ inside the body in advance. It has been. If the radius of the stent can be reduced when attached to the balloon catheter, it can be very easily transported to the lesion during and after insertion into the body.
  • the stent is delivered to the lesion site, where the tip of the balloon catheter is expanded.
  • a stent is attached to the distal end portion of the balloon catheter, but the portion to which the stent is attached has a balloon shape and can be expanded.
  • the stent is also expanded in the body by the expansion of the balloon catheter.
  • the stent is a plastic material, the stent is expanded to cause plastic deformation and the deformation is retained permanently.
  • the balloon catheter is removed after the balloon portion is deflated after the stent is expanded, only the plastically deformed stent remains in a state where the lesion site where the stenosis or the like has occurred is expanded.
  • stents General requirements for stents
  • Many functions are required for a stent.
  • the most basic required functions are expansion of a tubular organ, radial rigidity that supports the tubular organ from the inside, and tubular organ that runs in the long axis direction. It is flexible enough to follow complex shapes.
  • the stent is basically constituted by repeating the same shape in the circumferential direction and the major axis direction.
  • a typical stent structure includes a portion called a “cell” 2 that expands a tubular organ and supports the organ, and a “link” 3 that gives the stent flexibility in the longitudinal direction.
  • a stent having a structured structure see, for example, Patent Document 14).
  • Such a stent is called a closed cell structure and is characterized in that a portion called a link has an S-shape or an N-shape.
  • Non-Patent Document 1 since the coil stent has a relatively low radial rigidity (see, for example, Non-Patent Document 1), the blood vessel cannot be sufficiently expanded, and the treatment results are inferior. Such a problem also exists in the stent of Patent Document 13. Therefore, at present, stents such as Patent Documents 12 and 14 are often used. Such stents are typically fabricated from a single material hollow tube, referred to herein as a single-layer stent.
  • Patent Document 1 and Patent Document 2 propose a stent including an inner layer and an outer layer. These are a shape memory alloy superelastic material and a malleable material (elastic plastic material) such as stainless steel, which are processed into one tube shape and then processed into a stent shape.
  • the basic characteristics of these stents are the same as those of the single layer stent described above, and do not solve the essential problems caused by the structural reasons of the single layer stent.
  • single-layer stents mainly have a structure called a closed cell structure and an open cell structure.
  • the closed cell structure and the open cell structure are characterized by the difference in the size of the repeating structural unit, in addition to the above-described characteristics.
  • the closed cell structure has a smaller size of the repeating structural unit.
  • the closed cell structure and the open cell structure have advantages and disadvantages.
  • the closed cell structure has a preferable characteristic that it can expand and support a tubular organ with a uniform stress distribution while it has little change in shape when bent, but has a problem that it is difficult to use in a portion where the tubular organ is branched.
  • the open cell structure is suitable for use in a branched part of a tubular organ, and is highly flexible, but when bent, a part of the stent may be unexpectedly deformed excessively. Therefore, there is a problem that uneven stress distribution may be given to the tubular organ.
  • a conventional single-layer stent has a structure in which cells and links (or connectors) are alternately arranged in a row when viewed in the longitudinal direction, and the tubular organ is expanded and supported in the link or connector portion.
  • cells and links or connectors
  • the tubular organ is expanded and supported in the link or connector portion.
  • the stent is required to have followability to the shape of the tubular organ to be applied (shape followability).
  • This followability means that a stent placed in a tubular organ that meanders in the long axis direction can faithfully follow the organ shape even after expansion and placement.
  • the stent has insufficient ability to follow the shape of the tubular organ, when the stent is expanded and placed in the tubular organ, there is a problem that the expandability of the tubular organ becomes non-uniform with respect to the long axis direction. It develops into the problem of non-uniformity of stress distribution in the organ and damage of the tubular organ at the stress concentration site and the occurrence of restenosis.
  • FIGS. 2 (i)-(iv) illustrate this state, and thus a high therapeutic effect can be expected.
  • Patent Document 3 and Patent Document 4 disclose a stent applied to a portion having a side branch and a dedicated balloon catheter.
  • This balloon catheter is provided with a special side branch discriminating device and can specify the position of the side branch in the long axis direction and the angle in the circumferential direction.
  • the stent has a structure that allows easy opening of one portion outward so that the balloon catheter can be easily introduced into the side branch.
  • a stent intended to improve flexibility and transportability to a lesion site by providing an engagement portion capable of connecting and separating two stents in the longitudinal direction.
  • Patent Document 7 proposes a stent intended to improve flexibility and transportability to a lesion site by providing an engagement portion capable of connecting and separating two stents in the longitudinal direction.
  • Patent Document 5 a stent (“coil stent”) in which metal wires of a single material are formed in a spiral shape are overlapped, and the overlapping strut portions are joined by welding or the like.
  • a method of enhancing the radial rigidity which is a weak point of a coil stent, is disclosed.
  • the thinner the stent struts the lower the restenosis rate.
  • superimposing stents in the radial direction in order to enhance the radial rigidity is rational in engineering, but medically, on the contrary, it does not provide useful results. This is because, as shown in Non-Patent Document 3, the restenosis rate is reduced as the struts of the stent are thinner.
  • Patent Document 11 a stent having a plurality of thin struts having slightly different radii (hereinafter referred to as “thin stent”) is prepared, and the other thin stent is inserted into one thin stent in the long axis direction.
  • a multi-layered stent suitable for treatment of a side branch or the like is disclosed by superimposing them on the same axis and joining a part of struts at both ends (see FIG. 3 of Patent Document 11).
  • joining utilizing resistance welding or thermocompression bonding is assumed (refer to paragraph [0040] and FIG. 5 (b) of Patent Document 11 for this).
  • the two thin stents have the same position and direction of the central axis (long axis) of each stent when they are joined, and the outer diameter (ri_out) of the inner thin stent is There was a need to match the inner diameter (ro_in) of the outer thin stent. Since the dimensions of the joining struts are about 0.1-0.5 mm, the required accuracy is the precision below this strut, specifically, the precision is 0.1 mm or less. In order to achieve this, alignment under a microscope is necessary. For resistance welding and thermocompression bonding, it is necessary to prepare a dedicated machine for development.
  • Patent Document 11 a joining method by fitting is also disclosed.
  • the details are not specifically disclosed, and there is only a description that “a concave portion and a convex portion are formed, and both are press-fitted and fitted”. From this description, it is only presumed that a support column for fitting is provided in addition to the cell and the link.
  • a support column for fitting is provided in addition to the cell and the link.
  • precise alignment using a microscope is required.
  • the support column in order to complete the fitting, the support column must be deformed (to press fit), and the operation amount (deformation amount) is assumed to be a very fine operation amount from the thickness and width of the support column. Is done. To achieve this, it is necessary to support a special device under a microscope. The manufacturer also needs special training. There is a problem that these constraints lead to an increase in manufacturing cost, and it is difficult to actually realize them.
  • stents are folded to a small diameter and transported to a lesion site such as a luminal organ. Therefore, the designer designs the stent by assuming a small folded state. For this reason, as disclosed in Patent Document 11, if a support column that is not necessary for treatment and is merely used for conjugation is provided, there is a restriction on the design of the support column that has a function essential for the treatment of cells and links. Or, due to the presence of the extra struts, smooth folding (warping) is hindered, and the stent does not fold sufficiently small.
  • An object of the present invention is to provide a thin, coaxial multi-layered stent that eliminates such constraints and does not require a dedicated machine such as a welding machine and does not require precise alignment. It is what.
  • the radial rigidity is almost the same as that of a conventional single-layer stent, and it can be easily assembled by a doctor without any special struts at a medical site and inserted into the body.
  • a planar structure consisting of multiple struts (Supporting Strut Members (SSM or Just SM)) arranged to form a mesh structure is rolled into a cylindrical shape, and consists of a cylindrical body with a long axis at the center.
  • Coaxial multi-layer stent that forms two component stents A and B (hereinafter sometimes referred to as CSA and CSB) that can be reduced and expanded, and is arranged and configured coaxially with the CSA as the inner layer and CSB as the outer layer.
  • CMLS Coaxial Multi-Layered Stent
  • the column is composed of a plurality of cells, each of which has a bent portion, and at least one link connecting the cells in the long axis direction.
  • the CSA and CSB are each composed of a main body part (Main Body Portion (MBP) occupying most of the center and both side (left and right) ends (LEP, REP) of the main body part,
  • the radii of the body portions are Ra and Rb (where Ra ⁇ Rb)
  • the component stent A (CSA) and the component stent B (CSB) are composed of the component stent A (CSA) strut (SSM) and the component stent B at least at the left end (LEP) of the both ends of the CMLS.
  • the radius (Ra, in) of the cylindrical body of the component stent A (CSA) is the same as the radius Ra of the main body portion, and the struts can receive the struts of other component stents.
  • the component stent B is (A) A support column arranged at the same radial position (Rb, in) as the radius (Rb) of the main body, (A) a strut disposed at a radius position (Rb, df) smaller than the main body radius (Ra) of the component stent A; and (C) A strut (Radially-running SM (RRSM)) (running or disposed in the radial direction of the cylindrical body connecting the two struts arranged at the two radial positions (Rb, in Rb, df). Or Radially-disposed SM (RDSM), Radially-arranged SM (RASM))
  • the component stent A (CSA) is inserted in the longitudinal direction of the cylindrical body of the component stent B with respect to the component stent B (CSB), and the strut (RRSM) of the component stent B (CSB) is inserted into the component stent B (CSB).
  • CSA component stent A
  • CSB component stent B
  • RRSM strut of the component stent B
  • CSB component stent B
  • a coaxial multi-layer stent characterized in that the two component stents A and B are engaged with each other by inserting and fitting the stent A (CSA) into the receiving portion (AP) so as to penetrate the radial direction. Is provided.
  • a planar structure consisting of multiple struts (Supporting Strut Members (SSM or Just SM)) arranged to form a mesh structure is rolled into a cylindrical shape, and consists of a cylindrical body with a long axis at the center.
  • a coaxial multi-layered stent in which two component stents A and B (hereinafter sometimes referred to as CSA and CSB) that can be contracted and expanded are formed and arranged coaxially with the CSA as an inner layer and the CSB as an outer layer.
  • CMLS Coaxial Multi-Layered Stent
  • the column is composed of a plurality of cells, each of which has a bent portion, and at least one link connecting the cells in the long axis direction.
  • the CSA and CSB are each composed of a main body part (Main Body Portion (MBP) occupying most of the center and both side (left and right) ends (LEP, REP) of the main body part.
  • the radii of the body portions are Ra and Rb (where Ra ⁇ Rb),
  • the component stent A (CSA) and the component stent B (CSB) intersect the strut (SSM) of the component stent A (CSA) and the strut (CSB) of the component stent B at the right end (REP) of the CMLS. Is performed,
  • the component stent A is (A) A support column arranged at the same radial position (Ra, in) as the radius (Ra) of the main body, (A) a strut disposed at a radius position (Ra, df) larger than the main body radius (Rb) of the component stent B; and (C) A strut (Radially-running SM (RRSM)) running or arranged in the radial direction of the cylinder connecting the two struts arranged at the two radial positions (Ra, in Ra, df) (Or Radially-disposed SM (RDSM), Radially-arranged SM (RASM))
  • the radius (Rb, in) of the cylindrical body of the component stent B (CSB) is the same as the radius Rb of the main body portion, and the struts are capable of receiving struts of other component stents.
  • Department Accommodation Port Portion (AP)
  • the component stent A is inserted into the component stent B (CSB) in the longitudinal direction of the cylindrical body of the component stent B, and the RRSM of the component stent A (CSA) is inserted into the component stent B (CSB).
  • a coaxial multi-layer stent is provided in which the two component stents A and B are engaged with each other by inserting and fitting the receiving portion so as to penetrate the receiving portion in the radial direction.
  • the strut (SSM) and the component stent B strut (CSB) of the component stent A (CSA) are crossed, respectively, and the coaxial stent in which the two component stents A and B are engaged.
  • a coaxial multi-layer stent is provided.
  • a part of the strut of the component stent A or B partially surrounds the long axis by connecting a plurality of cells having bent portions capable of reducing and extending the circumferential length of the cylindrical body in the vertical direction. It is composed of a ring-shaped support (Ring-shaped SM) configured by arranging a plurality of the same and at least one link connecting the adjacent ring-shaped support in the major axis direction [ [1]
  • the coaxial multilayer stent according to any one of [3].
  • the receiving portion AP of the component stent A or B is provided as a part of the cell having the bent portion, and a part thereof is opened in the direction of the left end portion (LEP) and / or the right end portion (REP),
  • LEP left end portion
  • REP right end portion
  • the receiving portion AP of the component stent A or B includes the passage and a locking holder (Latch Holder) having a circular opening (Round-Rectangular Aperture) communicating with the passage.
  • the radius of curvature of the column that forms the opening located at a position opposite to the passage is longer than the radius of the bent portion of the cell, and forms the passage of the passage communicating with the holder.
  • the distance between the two opposing struts (SM) is narrower than the strut width forming the bent portion of the holder or cell, according to any one of [1]-[5] A layer stent is provided.
  • the holder In the receiving portion AP of the component stent A or B, the holder is symmetrical with respect to a straight vertical bisector connecting the cell bent portions in the circumferential direction, but the opposing struts forming the passage are The coaxial multilayer stent according to [6], which is disposed at a position shifted in the circumferential direction from the perpendicular bisector thereof.
  • the receiving portion AP of the component stent A or B is provided as a part of a cell having a bent portion, and at least two of the receiving portions (AP) are part of at least two or more cells.
  • the coaxial multilayer stent according to any one of [1] to [7], characterized in that each is provided.
  • the receiving portion AP of the component stent A or B is characterized in that at least one receiving portion (AP) has a mirror image relationship with the other receiving portion (AP) with respect to the major axis of the stent A or B [ 8] is provided.
  • the component stent A or B has a radially running or arranged strut (Radially-running SM (RRSM)) (or Radially-disposed SM (RDSM), Radially-arranged SM (RASM)).
  • RRSM Radially-running SM
  • RDSM Radially-disposed SM
  • RASM Radially-arranged SM
  • Struts (Radially-running SM (RRSM), Radially-arranged, Radially-running SM (RRSM)) provided in the link portion of the component stent A or B. SM (RASM))
  • the length in the major axis direction of the link part is longer than the length in the major axis direction of the link part of the pillar without the strut (RRSM) traveling in the radial direction.
  • the coaxial multilayer stent according to [10] is provided.
  • a gap in the main body between the two component stents A and B (CSA, CSB)
  • the drug elution is characterized by the fact that the part can be preferably used as a site for storing or holding a drug reservoir (Drug Reserver or Holder) (Said space is favorably used for, or serves as, a DR)
  • a coaxial multi-layer stent is provided.
  • [13] According to the present invention, [1] In the coaxial multi-layered stent (CMLS) according to any one of [11], a gap in the main body between the two component stents A and B (CSA, CSB) A drug-eluting coaxial multi-layer stent (DE-CMLS) is provided in which the drug to be eluted is accommodated or accommodated in a part as a drug reservoir.
  • CMLS coaxial multi-layered stent
  • DE-CMLS drug-eluting coaxial multi-layer stent
  • the present invention has the following advantageous effects.
  • the coaxial multilayer stent of the present invention it is possible to assemble the coaxial multilayer stent without using a dedicated machine such as a welding machine and without requiring precise alignment.
  • the cells located at the end of the stent have a wide interval between the opposing struts, and the cell struts are formed so as to gradually narrow toward the struts for engagement. This eliminates the need for an assembly machine (manufacturer) or a dedicated joining machine, and enables engagement by simply moving and sliding a plurality of thin stents (component stents) in the longitudinal direction.
  • the coaxial multilayer stent of the present invention can be assembled.
  • the coaxial multi-layer stent of the present invention can be easily assembled, even if the circumferential position is inappropriate before joining, only the length of the long axis of the cell in the long axis direction ( If it slides about 1.0mm-2.5mm), as will be described later, the struts that run in the radial direction are guided to an appropriate position.
  • the moving length slide amount is the long axis length of the cell (or the long axis length of the receiving part receiving the column) (approximately 1.0mm-2.5mm), so the joining operation is performed manually without using a special machine. it can.
  • the struts that run in the radial direction are engaged with the struts (receiving portions) for engaging the component stent A constituting the inner layer.
  • the positions of the central axes of the two component stents A and B do not have to coincide with each other.
  • the thickness of the struts radially running in the outer component stent B is different from the thickness radius difference of the struts of the inner component stent A.
  • a gap error is allowed as much as the thickness is subtracted.
  • the two stent central axes are in sharp contrast to the fact that they had to be exactly coincident.
  • the coaxial multilayer stent of this invention was mounted in the balloon, and it was overlapped on the way of conveying to a lesioned part.
  • a force to pull the struts often acts.
  • This force is a force in the r direction in the stent coordinate system. For example, it occurs when the stent passes through a bend in a blood vessel.
  • the struts involved in the engagement of the inner component stent A and the outer component stent B intersect with each other at the radial positions in the engaging portions as will be described later. is doing.
  • a radial force r-force
  • the strut of the component stent B is arranged on the outer side of the component stent A by the strut of the component stent A. Prevent separation from the column.
  • the strut of the component stent B is disposed outside the component stent B, so that the strut of the component stent B becomes the component stent. Prevents from leaving the A column.
  • the coaxial multi-layer stent of the present invention has a novel engagement mechanism in which struts that run in the radial direction are formed in each of the inner component stent A and the outer component stent B, thereby engaging with each other. Therefore, the problem of dropping off the outer component stent during transportation, which is one of the biggest problems in the conventional coaxial multilayer stent, has been essentially solved.
  • the foldability of the stent it is not necessary to newly provide struts for engagement formed on both ends of the component stents A and B as elements different from the cells as in the prior art. Since it is fused with the cell and is provided as a part of the cell, it is possible to fold the stent after joining, for example, in a contraction time without being disturbed.
  • the number of links affecting the flexibility is the same as the total number of inner layers and outer layers.
  • the thickness of the struts at the link site is thinner than that of a conventional stent, so that it has excellent flexibility.
  • the thickness of the stacked struts is designed to be the same as that of the conventional stent, so that the radial rigidity is comparable to that of the conventional stent.
  • Each component stent before overlapping has a large mesh (pattern consisting of cells and links).
  • Each stent has a strut joined at its end, but the other portions do not affect the deformation of the stent struts. Therefore, the coaxial multilayer stent of the present invention can make a large hole in the side surface.
  • the component stent constituting the present invention is provided with a connector fused with a cell or a link, and is thereby joined.
  • work such as welding can be omitted for the joining, it is expected that productivity can be improved by facilitating assembly work and preventing assembly errors.
  • the design method equivalent to the conventional single layer stent can be applied. Therefore, the coaxial multilayer stent of the present invention can be realized without complicating the design process.
  • the coaxial multi-layer stent of the present invention has a function of holding such a drug. If it mentions, since the said stent of this invention is the state in which the some component stent was piled up, the space exists in the radial direction between each component stent. It is possible to store a drug reservoir formed in a spiral shape or the like that is stored in the shape of the space with a polymer mixed with the drug. The drug reservoir (shape and capacity) is formed regardless of the shape and structure of each component stent. Therefore, the shape and structure of the component stent and the multi-layer stent do not affect the amount of drug mixed in the drug reservoir. This means that the drug loading can be set independently from the shape and structure of the component stent and the multilayer stent.
  • the drug is applied to the surface of the stent cell or link as it is or together with a binder, and the amount of the drug is regulated by the surface area and can be changed (increased) significantly. It was difficult.
  • the degree of freedom is extremely large, and the drug can be eluted for a long time. The effect is very great.
  • the configuration of the drug reservoir by the coaxial multilayer stent of the present invention and the accommodation mechanism thereof will be described in detail later.
  • FIG. 1 is a developed view of a general stent.
  • FIG. 2 is a schematic view of a bifurcation treatment.
  • FIG. 3 is a conceptual diagram showing a method for assembling a coaxial stent.
  • FIG. 4 is an explanatory diagram showing the definition of the coordinate system.
  • FIG. 5 is a development view of the cell.
  • FIG. 6 is a photograph showing a state before and after expansion of the stent.
  • FIG. 7 is a photograph showing a state when the stent is expanded when there is no cell bent portion on the cell central axis.
  • FIG. 8 is an explanatory view of a receiving portion (female connector FC).
  • FIG. 9 is an explanatory view showing the receiving portion and the locking holder.
  • FIG. 10 is a diagram illustrating the passage portion in detail.
  • FIG. 11 is a diagram illustrating the definition of the angle of the passage portion and another embodiment of the passage portion.
  • FIG. 12 is an explanatory diagram showing a receiving portion and a receiving portion that is in a mirror image relationship with the receiving portion.
  • FIG. 13 is a schematic view showing a cell and a receiving portion.
  • FIG. 14 is a conceptual diagram showing a radial traveling strut in the mail connector MC.
  • FIG. 15 is a conceptual diagram showing a component stent in which a mail connector MC is formed on a part of a link.
  • FIG. 16 is a conceptual diagram showing a component stent in which both a receiving portion and a mail connector are formed.
  • FIG. 17 is a cross-sectional view of component stents A and B.
  • FIG. 18 is a cross-sectional view showing a state where the end portions of the component stents A and B are deformed for joining.
  • FIG. 19 is a cross-sectional view showing a state where the end portions of the component stents A and B are deformed for joining.
  • FIG. 20 is a diagram showing a state in the middle of the crossing of the component stents, where (i) is a cross-sectional view and (ii) is a development view.
  • FIG. 21 is a diagram showing a state where the crossing process of the component stent has further progressed (immediately before joining), where (i) is a sectional view and (ii) is a developed view.
  • FIG. 22 is a diagram illustrating a state where the crossing of the component stents is completed (after joining), where (i) is a cross-sectional view and (ii) is a developed view.
  • FIG. 23 is an enlarged view showing the receiving portion and the radial traveling strut in a state where the intersection is completed and joined.
  • FIG. 24 is a developed view showing the positions of the struts when the joined component stents are displaced in the circumferential direction.
  • FIG. 25 is a cross-sectional view of a coaxial multilayer stent mounted on a balloon catheter.
  • FIG. 26 is a development view showing stents having the same shape and different strut thicknesses t.
  • FIG. 27 is a developed view showing stents that differ only in the number n of links in the circumferential direction.
  • FIG. 28 is a graph showing a change in radius during pressurization of a coaxial multilayer stent and a conventional single layer stent.
  • FIG. 29 is a developed view showing two coarse component stents A and B. (However, the connector is omitted.)
  • FIG. 30 shows a development view (i) when the component stents A and B of FIG. 29 are joined, and a development view (ii) when a hole is made in the side wall thereof. (However, the connector is omitted.)
  • FIG. 31 is an explanatory view showing a preferable shape of the medicine reservoir.
  • Planar structure of a stent A composed of a plurality of struts arranged so as to form an A 0 network structure
  • Planar structure of a stent B composed of a plurality of struts arranged so as to form a A 0 network structure
  • a component stent B forming an inner layer Component stent forming the outer layer MBP (Main Body Portion))
  • LEP Left side end of main body part REP Left side end part of main body part Ra Radius of main part of stent A Ra, in Radius of cylindrical body of stent A (before forming a step) Ra, df Radius of cylindrical body of stent A (after forming a step) Rb
  • Radius of stent B main body radius Rb in Radius of cylindrical body of stent B (before forming a step) Rb
  • df Radius of the stent B cylinder (after forming the step)
  • joining refers to bringing two struts into contact with each other.
  • Fixation refers to a state where two struts are in contact and the two struts do not change their relative position and angle at the contacted portion.
  • a fixed state can be created by joining the struts by welding.
  • Attachment refers to a state in which two struts are in contact with each other and the relative position of the two struts does not change, but the relative angle changes.
  • a joined state can be created by joining the struts by engagement.
  • (C) Engagement means that in two parts or elements, a claw part, a projecting part, or a convex part (hereinafter referred to as a claw part or the like) of one part or element is formed. Other parts or elements are provided with a locking part or a hook-like part (hereinafter referred to as a locking part or the like) having a space part for fixing the claw part or the like corresponding to the claw part or the like. When the or element is brought close to each other, the claw portion or the like is received by the space portion such as the locking portion, the two engage with each other, and the two parts or elements are connected. In the present specification, engagement and fitting are used interchangeably.
  • the coordinate system used in the present invention will be described with reference to FIG.
  • the global coordinate system Og-XYZ is a general three-dimensional coordinate system.
  • the stent coordinate system Os-r ⁇ z (FIG. 4 (i)) is a coordinate system used to represent the position and orientation of the stent, and is the same as the cylindrical coordinate system, and has a radius r, a circumferential angle ⁇ , and a length. It consists of an axis z. The long axis z coincides with the central axis of the stent.
  • Reference numeral 7 denotes a central axis of the stent.
  • the stent development coordinate system Oe- ⁇ z (FIG. 4 (ii)) is a two-dimensional coordinate system. It is used to describe the shape of the struts that are placed at any radius of the stent when it is deployed. The direction perpendicular to the plane of the paper coincides with the radius r in the stent coordinate system. FIG. 4 also shows the relationship between the coordinate systems.
  • the multi-layer stent of the present invention is configured by stacking two stents.
  • the basic configuration of each stent (component stent) is schematically shown in FIG.
  • a planar structure 01 composed of a plurality of support columns arranged so as to form a mesh structure is rolled into a cylindrical shape, has a long axis at the center, and its circumferential length can be reduced and expanded as shown in FIG. It consists of a cylindrical stent 1 as shown in c).
  • FIG. 1B is an enlarged view of a part of the column, and shows that the cell 2 and the link 3 connecting the cells are included as elements.
  • FIGS. 17 to 22 are diagrams showing the process of assembling the laminated stent of the present invention.
  • FIGS. 19A and 19B show planar structures A 0 and B 0 composed of a plurality of support columns arranged so as to form a mesh structure, and FIGS. 19A and 19B show this structure.
  • Two component stents A and B (hereinafter referred to as CSA and CSB, respectively), each of which is formed by a cylindrical body having a long axis at the center, and whose circumferential length can be reduced and expanded, Yes.) (The figure is a longitudinal sectional view.)
  • the component stent A (CSA) is used as an inner layer, and the component stent B (CSB) is used as an outer layer to be coaxially disposed and configured to form a coaxial multi-layered stent (CMLS) as follows.
  • component stent A may be simply referred to as stent A, and component stent B may be referred to as stent B.
  • CMLS coaxial multi-layered stent
  • the CSA and CSB each have a main body portion (Main Body Portion (MBP)) that occupies most of the center. And end portions on both sides (left and right) of the main body, that is, a left end portion (LEP) and a right end portion (REP).
  • the radii of the main body portions are Ra and Rb (where Ra ⁇ Rb), respectively. (Of course, this means that the radius of the body portion of the component stent B forming the outer layer is larger than the radius of the body portion of the component stent A forming the inner layer.)
  • the component stent A (CSA) and the component stent (B) (CSB) are at least the left end (LEP) or the right end (REP) of the both ends of the CMLS.
  • the strut (SSM) of the component stent A (CSA) and the strut (CSB) of the component stent B are configured to be crossed.
  • the most characteristic point of the present invention is that the stent A and the stent B are connected by performing the “crossing of the struts”.
  • stents A and B as shown in FIG. 17 are used as starting stents, and as shown in FIG. 18 (i), the stent A (main body radius Ra) is directed outward at the right end thereof.
  • the radius (Ra, in) of the cylindrical body of the component stent A (CSA) constituting the inner layer is the same as the radius Ra of the main body at the left end. (That is, the component stent A is not particularly provided with a “step” at the left end portion thereof, and the left end portion and the main body portion are on the same plane.)
  • a receiving port (Accommodation Port or Portion (AP (A))) that can receive the column is formed.
  • the receiving unit AP (A) consists of a passage for introducing the column and an opening for holding the introduced column.
  • An example of a typical shape is as shown in the left side view of Fig. 20 (ii), which will be described in detail later.
  • the component stent B (CSB) constituting the outer layer is formed with a “step” that extends downward from the main body at the left end thereof. That is, the step is (A) A column 10B arranged at the same radial position (Rb, in) as the radius (Rb) of the main body, (A) a strut 12B disposed at a radius position (Rb, df) smaller than the main body radius (Ra) of the component stent A; and (C) A strut 14B (Radially-running SM (RRSM)) running or arranged in the radial direction of the cylindrical body connecting the two struts arranged at the two radial positions (Rb, in Rb, df). (Or also referred to as Radially-disposed SM (RDSM) or Radially-arranged SM (RASM)).
  • RDSM Radially-disposed SM
  • RASM Radially-arranged SM
  • the component stent A constituting the inner layer is inserted into the component stent B constituting the outer layer in the direction indicated by IN along the long axis Ld.
  • the figure shows a state in which the receiving portion AP (A) at the left end of the inner component stent A is approaching the “step” of the component stent B, that is, the strut 14B that runs in the radial direction, at the left end LEP. Show. (The left view of FIG. 20 (ii) shows the support 14B and the receiving portion AP (A) in this state as seen from the radial direction.)
  • FIG. 21 shows a stage where the component stents A and B are in the middle of crossing at the left end thereof. That is, as shown in FIG. 21 (i), the supporting portion AP (A) (the supporting strut) at the left end portion of the inner component stent A intersects the strut 14B traveling in the radial direction. (In other words, it is understood that the columns cross in a cross section.)
  • the receiving portion AP (A) is composed of a passage 16A for introducing a support column and an opening 18A for holding the introduced support column. The state where the column 14B is entering the passage is shown.
  • FIG. 22 shows a state in which the component stents A and B have completed the crossing process at the left end thereof. That is, as shown in the left end of FIG. 22 (i), the intersection of the strut 14B traveling in the radial direction and the receiving portion AP (A) (the strut constituting the left end of the inner component stent) is completed. Thereafter, the intersection cannot be solved (that is, this state does not return to the state of FIG. 21 or FIG. 20).
  • the column 14B introduced from the passage 16A is trapped in the opening 18A of the receiving portion AP (A). Because it is.
  • the column 14B is movable in the opening (in other words, in a loosely fitted state), but is configured not to run backward to the passage. The mechanism by which the receiving portion traps the support will be described in detail later.
  • the component stent A (CSA) that forms the inner layer is arranged in the major axis direction of the cylindrical body of the component stent B with respect to the component stent B (CSB) that forms the outer layer. Inserting and fitting the strut (RRSM) of the component stent B (CSB) into the receiving portion AP of the component stent A (CSA) so as to penetrate the component stent A (CSA) in the radial direction. , B are formed into a coaxial multilayer stent.
  • the radius (Rb, in) of the cylindrical body of the component stent B (CSB) constituting the outer layer is the same as the radius Rb of the main body. (That is, the component stent B is not particularly provided with a “step” at the right end thereof, and the left end portion and the main body portion are on the same plane.)
  • a receiving portion (Accommodation Port or Portion (AP (B))) capable of receiving the support is formed (the receiving portion AP (B) includes a passage for introducing the support and an opening for holding the introduced support.
  • An example of a typical shape is as shown in the right diagram of Fig. 20 (ii), which will be described in detail later.
  • the component stent A (CSA) constituting the inner layer is formed with a “step” toward the upper side from the main body at the right end thereof. That is, the step is (A) A support 10A disposed at the same radial position (Ra, in) as the radius (Ra) of the main body, (A) a column 12A disposed at a radial position (Ra, df) larger than the main body radius (Ra) of the component stent (A); and (C) A strut 14A (Radially-running SM (RRSM)) that travels or is arranged in the radial direction of the cylindrical body connecting the two struts arranged at the two radial positions (Ra, in Ra, df). , (Or Radially-disposed SM (RDSM), Radially-arranged SM (RASM)).
  • RDSM Radially-disposed SM
  • RASM Radially-arranged SM
  • the component stent A constituting the inner layer is inserted into the component stent B constituting the outer layer in the direction indicated by IN along the long axis Ld.
  • the figure shows a state in which the receiving portion AP (B) at the right end portion of the outer component stent is approaching the “step” of the component stent A, that is, the strut 14A running in the radial direction at the right end portion thereof. .
  • the right side view of FIG. 20 (ii) is a view of the column 14A and the receiving portion AP (B) in this state from the radial direction.
  • FIG. 21 shows a stage in which the component stents A and B are in the middle of crossing at the right end thereof. That is, in the right end portion of FIG. 21 (i), the receiving portion AP (B) (the supporting strut) of the right end portion of the outer layer component stent B is disposed on the strut 14A running in the radial direction of the inner layer component stent A. Crossed. (In other words, it is understood that the columns cross in a cross section.) Specifically, as shown in the right diagram of FIG. 21 (ii), the receiving portion AP (B) is composed of a passage 16B for introducing a support column and an opening 18B for holding the introduced support column. However, a state in which the column 14A is entering the passage is shown.
  • FIG. 22 shows a state in which the crossing process of the component stents A and B is completed at the right end portion thereof. That is, as shown in the right end portion of FIG. 22 (i), the struts constituting the struts 14A that run in the radial direction of the inner layer component stent A and the receiving portions AP (B) (at the right end portion of the outer layer component stents). ) Is completed and the intersection cannot be solved (that is, this state does not return to the state of FIG. 21 or FIG. 20).
  • the column 14A introduced from the passage 16B is trapped in the opening 18B of the receiving portion AP (B). Because it is.
  • the support column 14A is movable in the opening, but is configured not to run backward to the passage.
  • the component stent A (CSA) is inserted into the major axis direction of the cylindrical body of the component stent B with respect to the component stent B (CSB).
  • CSB component stent B
  • the left end or the right end is crossed, but preferably both the left end and the right end. In Fig. 3, the intersection is performed.
  • the coaxial multilayer stent of the present invention can be defined as follows. That is, a component stent A that forms an inner layer having a strut (receiving portion) that can engage a strut that is configured in the radial direction of struts of other stents and that has a uniform strut radius, and a stent Outer layer having struts arranged at larger radial positions, struts arranged at smaller radii, and struts (struts running in the radial direction) for connecting the struts arranged at the two radii as compared to A
  • the stent A is inserted in the longitudinal direction relative to the stent B, and the struts of the stent B are arranged at three radial positions formed by engaging the receiving portion of the stent A.
  • a coaxial multi-layer stent having a strut and a strut having a continuously changing radius.
  • FIG. 5 (a) shows a state in which a plurality of cells 30 having bent portions are connected in a waveform in the radial direction (circumferential direction). A ring is formed that surrounds the long axis.
  • FIG. 5B is an enlarged view of the shape of the one cell.
  • the cell has a cell center axis ld, two above the cell center axis (J side), Two cell bent portions (cell bent portion 31j, cell bent portion 31k, cell bent portion 32j, cell bent 32k) and two cell central long side portions 34j, 34k are formed on the side (K side).
  • a straight bisector of a straight line connecting the cell bent portion 31j and the cell bent portion 31k in the circumferential direction is the cell center axis ld. (That is, in one cell, the elements constituting it extend from 31j ⁇ 34j ⁇ 32j ⁇ 32k ⁇ 34k ⁇ 31k to form one cell. In this case, the cell bent portion 32j and the cell bent 32k are directly Are connected to form one arc 36 as a whole.)
  • the cell bending portions 32j and 32k that continuously form an arc are deformed, so that the circumferential distance between the cell bending portions 31i-31k is increased. Since the distance between the bent portions 31i-31k is a part of the circumference of the stent having a cylindrical shape, the longer distance between the cell bent portions 31i-31k means that the circumference of the stent becomes longer, in other words, This means that the radius of the stent is increased.
  • FIGS. 6A and 6B show photographs of the stent actually produced by the present inventors.
  • the arc formed by the cell bent portion 31i and the cell bent portion 31k is offset in the circumferential direction from the cell central axis ld, the stent is twisted during expansion. It was found that this phenomenon was observed.
  • FIGS. 7 (i)-(iii) are photographs showing the result of expanding an actually produced stent based on the drawing disclosed in Patent Document 15 (FIG. (Iv)).
  • the arc formed by the cell bent portion 32j and the cell bent portion 32k is preferably located on the cell center axis ld that passes through the midpoint between the cell bent portion 31i and the cell bent portion 31k. It is understood that a symmetrical shape with respect to the axis is preferred.
  • the radial stiffness of the stent is largely governed by the length of the cell in the long axis direction. Therefore, the shape of the strut of the cell central long side portion (also simply referred to as the cell central portion) other than the cell bent portion forming the corrugation hardly affects the radial rigidity of the stent (for example, Stent design using sensitivity analysis, see Koji Mori, Ken Ikeuchi, Kazuaki Mitsudo, Journal of Japanese Society for Clinical Biomechanics, 22, 381-387, 2001). Therefore, it is possible to change the shape of the column in the central part of the cell so that the column in the central part of the cell plays the role of a claw or protrusion necessary for realizing the engagement mechanism by crossing as described above. preferable.
  • the radius of the stent is usually further reduced from an unexpanded state (for example, FIG. 6A). This is because the smaller the radius of the stent, the easier it is to pass through the blood vessel. In such a case, as for the shape of the cell, the circumferential distance between the cell bent portion 31j and the cell bent portion 31k is reduced, but the curvature radius of the bent portion is hardly reduced.
  • the receiving portion (AP (A), AP (B), etc.) for receiving the struts that run in the radial direction in a part of the cell, but by forming the receiving portion, From the above-mentioned knowledge, in order to maintain or achieve the function as the original link without obstructing the function required as the link (also referred to as a connector), the shape as shown in the developed view of FIG. It is preferable to form.
  • the receiving portion is also referred to as a “female connector” (FC) from the viewpoint that it is an element that receives a strut that travels in the radial direction and functions as a link.
  • the receiving portion AP is composed of the cell bending portions 31 j and 31 k, the cell center long side portions 34 j and 34 k, the passage portion 16, and the locking holder 38 having the opening 18.
  • the opening 18 is divided into a J-side opening 18j and a K-side opening 18k.
  • the struts of the component stent moving in the radial direction moving from the left are already assembled at the time of assembling (in the crossing process), It is smoothly guided to the opening 18.
  • the opening 18 is preferably circular.
  • FIG. 10 shows the passage portion 16 divided according to the function.
  • the entrance portion Inlet Port j, k) ((i)), the taxiway (Guide Path j, k) ((ii) ), Outlet part (Outlet Port j, k) ((iii)), and locking part (Locking Port j, k) ((iv)).
  • the cell center long side portions 34j, 34k and the entrance portion 16 of the passage portion are smoothly connected to each other.
  • FIGS. 11 (a)-(c) the angle formed between the J-side inlet and the cell center axis ld in the support of the inlet (Inlet Port) (j, k) and outlet (Outlet Port) (j, k)
  • the relationship between ⁇ and the angle ⁇ between the J-side outlet portion (Outlet Port) (j) and the cell center axis ld is formed such that ⁇ ⁇ .
  • the relationship between the angle ⁇ formed by the other K-side inlet (Inlet Port) and the cell center axis ld and the angle K between the K-side outlet (Otelet Port) (k) and the cell center axis ld is ⁇ ⁇ . It forms so that it may become.
  • the passage 16 is preferably formed at a position offset in either of the circumferential directions with respect to the cell center axis ld. Therefore, the relationship between the angle ⁇ and the angle ⁇ in FIG. 11A is preferably ⁇ ⁇ ⁇ .
  • ⁇ ⁇
  • the major axis direction interval of the square portion of the circular opening shown in FIG. 9 is close to the thickness of the struts of the component stent to be joined.
  • the fixing mechanism of the strut running in the radial direction by the receiving portion or the locking holder in the present invention a long-axis direction (friction with living tissue) force generated when the stent is transported to the lesioned part.
  • the stent can be prevented from shifting in the long axis direction.
  • shaft ld is near the width
  • the passage portion is formed by a column having a constant thickness.
  • the passage portion is formed by locally changing the thickness of the column.
  • the same function can be achieved by maintaining the relationship of the angles ⁇ , ⁇ , ⁇ , and ⁇ .
  • FIG. 11C it is obvious that the same function can be exhibited even if the passage is formed by branching the support.
  • the opening 18 in the locking holder reduces its expansion strain and allows its radius of curvature to be received by the receiving portion (or locking holder) in order to secure space for holding another component stent strut. It is preferable to form the cell larger than the bent portions 32j and 32k of the cell in which no is formed. The larger the opening 18, the greater the tolerance in the assembly process when manufacturing the stent including the locking holder (or receiving part), and the ease of assembly and the yield are improved. However, if the radius of curvature is too large, restrictions on the cell shape and the link shape, which are other structural parts of the stent, are not preferable.
  • One of the objects of the present invention is to prevent the overlapped stent from falling off due to frictional force with the living tissue generated in the longitudinal direction when the stent is transported to the lesion.
  • the shape is preferably short in the long axis direction and long in the circumferential direction. (This is why it is preferable that the opening 18 has a circular shape.) By adopting such a shape, the radius of curvature at the center of the opening is increased, and strain concentration during expansion can be reduced. The following effects can also be expected. Also, the opening 18 plays the same role as the cell bent portions 32j and 32k in the cell (where no receiving portion or locking holder is formed) when the stent is expanded. A symmetrical shape is preferred, which can prevent twisting during expansion.
  • the receiving portion AP female connector
  • the portion is preferably formed to be AP and AP * (AP having a mirror image relationship with respect to the cell center axis ld).
  • the cell 2 in which the receiving portion AP having such a shape is formed with at least two or more of the cells arranged at the end of the stent.
  • the receiving parts AP * that is, a mirror image of the AP
  • the struts of the component stent inserted into the opening of the receiving portion AP are the struts having the configuration described below, whereby the stent forming the inner layer and the two struts forming the outer layer are formed.
  • the binding force of the stent can be further increased.
  • the strut RRSM that travels in the radial direction may be referred to as a “mail connector” (MC), focusing on its function.
  • a mail connector MC is preferably formed in the portion of the link 3, and more preferably, the link shape thereof is formed in such a shape that the engagement with the receiving portion is more reliably performed. desirable.
  • the link portion 3 as a support is connected in series with a function as a radial traveling support RRSM (mail connector MC). That is, at the time of assembling the stent, preferably, a connecting portion 14 ′ is provided at a position (corresponding) to the opening 18 of the receiving portion AP, and this is connected to the link 3 in series.
  • the connecting portion 14 ′ is an element that finally constitutes the radial traveling strut RRSM, and is also a portion that constitutes a mail connector.
  • the post of the mail connector MC that is, the radial running post RRSM is located on the cell center axis of the adjacent cell, and when the coaxial multi-layer stent described above is assembled, the mail connector MC The post is deformed in the radial direction so that the radially deformed portion (RDP) 14 ′′ is positioned between the link 3 and the connecting portion 14 ′. Further, it is understood that the connecting portion 14 ′ is connected to the cell 2 through another radial deformation portion 14 ′′ ′′.
  • the struts of the mail connector are preferably wider than the interval (circumferential direction) of the passage portion of the receiving portion.
  • the link portion 3 is typically narrower than the cell portion 2.
  • a part or all of the struts be formed wider than the other ordinary link portions 3 as shown by 14 'in the figure.
  • pillar width is wider than another link part.
  • the portion indicated by the dotted line S has the same width as the normal link portion 3. Basically, as shown in the dotted line S, it is essential to form the link portion 3 to be long (L) as the post of the mail connector. However, in order to ensure a more reliable engagement with the AP, it is preferable not only to make it as long as L but also to have a wide configuration as shown in FIG. Note that the radially deforming portions 14 ′′, 14 ′ ′′ in the struts that run in the radial direction bend greatly when the mail connector is deformed in the radial direction. Therefore, it is preferable that this portion has a relatively narrow column width compared to the connecting portion, and it is preferable to make this column the same as the column width of the other link 3.
  • the struts 14A, 14B are configured to run radially (RRSM).
  • the mail connector MC is preferably configured to be replaced with some of the links 3 in the stent, like the receiving portion AP.
  • the part L of the mail connector MC that forms the struts that run in the radial direction is preferably longer than the other links. That is, the length of the component stent in this case is such that the length of the component stent can be easily understood by changing the radius of part of the component stent for joining and forming struts that run in the radial direction. Since the length of the component stent without the connector is approached, it is desirable that the length of the two component stents be equal when the component stents are joined.
  • a conventional single-layer stent is composed of cells 2 and links 3.
  • a stent in addition to the cell 2 and the link 3, it is composed of a stent to which a mail connector MC and / or a female connector FC is added.
  • a stent is a component stent, and in the above-described one, the component stent A forms the inner layer and the component stent B forms the outer layer, and forms a coaxial bilayer stent.
  • the component stent A, the component stent B, the component stent C,... Are formed as coaxial multilayer (coaxial multilayer) stents.
  • the coaxial multi-layer stent of the present invention is configured by coaxially laminating a plurality of component stents as described above in the assembly section.
  • the strut thickness of one component stent is about 1/2 to 1/4 of the strut thickness of a single layer stent.
  • the radial stiffness of the component stent is greatly affected by the strut thickness.
  • a single component stent alone does not reach the radial stiffness of a single layer stent. This suggests that the component stent alone is incomplete as a therapeutic device.
  • the present invention by combining (combining) a plurality of component stents as coaxial multi-layer stents, the present invention provides a therapeutic instrument that exhibits strength in the radial direction equivalent to that of a conventional single-layer stent. It is.
  • FIG. 23 is an enlarged view three-dimensionally showing how the female connector (that is, the receiving portion AP) and the male connector (radial travel strut 14 thereof) thus joined are locked.
  • the component stent B forming the outer layer is determined in the major axis direction and the circumferential direction by the openings of the component stent B constituting the inner layer.
  • the radial position of the stent B is determined by the radial position of the struts of the component stent A.
  • the tolerance of these positions can be controlled by the size of the opening 18 and the amount of deformation of the mail connector in the radial direction (that is, the size of the “step”). If these are reduced, the tolerance is reduced and the relative position of the two component stents can be determined precisely. On the other hand, if these are increased, the accuracy of the relative positions of the two component stents is lowered. Maintaining low positioning accuracy allows for relative movement of the two component stent struts.
  • the coaxial multi-layer stent of the present invention allows treatment impossible with a conventional single-layer stent by preventing deformation of one layer of struts from interfering with struts of other layers. Therefore, allowing low positioning accuracy contributes to stronger properties of the coaxial multilayer stent.
  • ⁇ Sliding amount in the long axis direction for engaging and joining the component stent is almost equal to the long axis length of the cell or the female connector. Specifically, it is about 1.0 mm-2.5 mm. This slide amount can be realized manually without the assistance of a special device. If the state shown in FIG. 22 or FIG. 23 is realized, when the component stent is moved in either of the circumferential directions relatively, as shown in FIG. It should be noted that the mail connector post 14 is not located at the exit of the AP) passage.
  • the struts of the joined component stent have moved away from the outlet (in the circumferential direction) and are in contact with the lock. Accordingly, the two component stents once joined are less likely to be released when they are relatively displaced in the circumferential direction. This is because, when the coaxial multi-layer stent of the present invention is transported in a blood vessel, even if the component stent is displaced in the circumferential direction due to a frictional force with a living tissue, the component stent does not easily fall off.
  • the multi-layer stent of the present invention is composed of two component stents in which two component stents are joined (engaged) at this position. At this time, the radius of the component stent strut is, for example, as shown in FIG. As shown, there are four different radii (Ra, Ra, df, Rb, Rb, df).
  • the two component stents (coaxial multi-layer stent) connected to each other are placed on a balloon catheter, and the two components are utilized by utilizing the device disclosed in, for example, Patent Document 16.
  • the stent (multi-layer stent) is compressed radially. This force causes the two component stents (multilayer stent) to be mounted on the balloon catheter 50.
  • FIG. 25 shows the mounted state.
  • the radius of the struts of the component stent (multi-layer stent) at this time becomes two, Ra_mount and Rb_mount.
  • the component stent strut (which forms part of the cell or link) straddles (intersects) the other component stent strut, so that the radial force in the stent coordinate system is reduced.
  • it has the effect that the struts of the two component stents are difficult to separate.
  • the compressed multilayer stent needs to pass through the bent part of the blood vessel.
  • a stent is bent, it tries to return to a straight state.
  • this force is expressed in the stent coordinate system in the radial direction and bent, the struts located on the outside try to separate from each other.
  • the component stent A when a radial (r direction) force is applied to the inner component stent A, the component stent A is supported by the struts of the component stent B arranged on the outer side. Acts to prevent it from leaving the strut of the component stent B.
  • a force in the r direction acts on the component stent B of the outer layer, the strut of the component stent A is separated from the strut of the component stent A by the strut of the component stent A arranged outside the component stent B. Acts to prevent separation.
  • the coaxial multi-layer stent according to the present invention is bonded to the component stent as described above even if a force is generated in the major axis direction, the circumferential direction, or the radial direction of the stent at the time of transportation to the lesioned part. Will not separate.
  • a strong connection can be achieved by simply inserting the two component stents from the longitudinal direction and intersecting them, as described above in detail in the assembly section. ing.
  • the manufacturer can easily perform this simple operation manually without the assistance of a microscope.
  • the coaxial multilayer stent of the present invention has further advantages over conventional single layer stents. As shown in FIG. 29, the meshes of the component stents A and B in the present invention are large. Thus, it is essentially understood that it can be used to treat side branches as shown in FIG.
  • the positions of the meshes of the two component stents can be slid in the circumferential direction and joined.
  • the mesh of the composite stent after assembly is small. This means that blood vessels can be expanded uniformly.
  • the central portions of the two component stents can be deformed independently of each other. Therefore, large holes can be drilled in the side walls of the combined multilayer stent to ensure side branch blood flow.
  • the mesh size is the same as that of the closed cell structure, and as described above, as shown in FIG. 30 (ii), a large hole is formed in the side wall of the composite stent. I can open it.
  • the side branch can be treated without precisely controlling the indwelling position in the lesion.
  • a device for examining the indwelling position is not required as in Patent Document 3 and Patent Document 4.
  • the coaxial multi-layer stent of the present invention differs from the conventional multi-layer stent in that most of the struts overlap each other, but the overlapping struts are not joined. Alternatively, even when the struts of each layer intersect, bonding at the intersecting portion is not performed. As already mentioned in the assembly section, it is characterized in that only specific struts of specific parts of the stent end are joined.
  • This configuration has the great advantage that the struts of each layer in the central part (in the longitudinal direction) of the stent used for treatment can be deformed without being interfered with the struts of the other layers. Since such deformation is possible, a therapeutic effect that is impossible with a normal stent can be exhibited. For example, in the side branch treatment at the bifurcation as described above, it is possible to make a large hole on the side wall of the stent as compared with a normal stent.
  • the coaxial multi-layer stent of the present invention has a high degree of freedom in the struts of each layer with respect to the overlapping portion, so that a treatment function that cannot be realized by a single-layer stent or other conventional multi-layer stents Can be expressed.
  • the coaxial multilayer stent of the present invention has a greater degree of freedom of deformation of the struts, specifically, in the treatment of the bifurcation, a larger hole can be formed in the side wall as needed. This greatly contributes to further reducing the influence of the inhibition of the blood flow of the branched blood vessels as a result of the treatment.
  • FIG. 3 shows an example of a coaxial multilayer stent of the present invention as a three-dimensional view.
  • FIG. 3 (i) shows a case where the stent A constituting the inner layer is inserted into the component stent B constituting the outer layer.
  • FIG. 3 is an explanatory view showing an assembling process constituting a laminated stent
  • FIG. 3 (ii) is an enlarged view of a part of the constructed multilayer stent.
  • each component stent is composed of component stents having half the number of links in the circumferential direction and half the strut thickness as compared with a general stent (single-layer stent).
  • the mechanical properties of the coaxial multilayer stent composed of such component stents will be considered.
  • Stent flexibility can be evaluated by bending stiffness.
  • Small bending stiffness means high flexibility.
  • Such bending stiffness can be measured by a bending test.
  • the present inventors measured the bending rigidity of stents having two same stent shapes and different thicknesses t as shown in FIG. That is, the bending stiffness of a stent having a thickness of 0.100 mm (FIG. 26 (i)) and a stent having a thickness t of 0.080 mm (FIG. 26 (ii)) was measured.
  • This result shows that the thinner the stent is, the more the bending rigidity of the stent can be reduced and the flexibility is improved.
  • the number n of links in the circumferential direction affects the flexibility of the stent.
  • the bending stiffness of two stents as shown in FIG. 27 was measured.
  • the stent with 8 links n (FIG. 27 (ii)) had a flexural rigidity of 80.9 Nmm2, and the stent with 6 links n (FIG. 27 (i)) had 43.6 Nmm2.
  • This result shows that a stent having a smaller number of links n has higher flexibility.
  • a stent having a small number of links means a stent having a large mesh. From the above results, it was shown that a stent having a small thickness and a small number of links in the circumferential direction has excellent flexibility.
  • the coaxial multi-layered stent of the present invention is made by connecting two male and female stents A and B having thin struts and connecting the male connector and the female connector. To do.
  • the assembly method has already been described in detail.
  • Each component stent has a large mesh, that is, a component stent with a small number of links. Therefore, in the assembled coaxial multilayer stent of the present invention, the number of links (the total number of links of the inner layer and the outer layer) is equal to that of the conventional single layer stent, but the thickness t of the link strut is thin. Thus, it is clear that the flexibility is superior to that of single layer stents.
  • the radial stiffness of the coaxial multilayer stent of the present invention was examined by numerical analysis.
  • a pressure p of 0.5 atm was applied via Each stent was pressurized after expanding to a radius of about 1.5 mm.
  • the material constituting the stent may be known per se and is not particularly limited, but is basically a metal material that can be plastically deformed, preferably stainless steel such as SUS316L,
  • shape memory alloys such as Ni-Ti alloys and Cu-Al-Mn alloys already described, Cu-Zn alloys, Ni-Al alloys, titanium, titanium alloys, tantalum, tantalum alloys, platinum, platinum alloys, tungsten, tungsten Alloys can be appropriately employed depending on the purpose.
  • a mesh pattern before the stent is expanded from a tube or pipe (substantially tubular body) of the metal base by a laser or the like. Cut out and made. Further, the flat plate of the metal material may be laser-processed to form a mesh pattern, which is subsequently rounded into a tubular shape.
  • the stent of the present invention is a very fine and complicated structure, and the struts constituting the stent are generally strut widths of 0.050 mm-0.300 mm, The strut thickness is about 0.050 mm-0.300 mm, and the diameter is about 1.0 mm-1.5 mm (before expansion) and the length is about 10.0 mm-30.0 mm for coronary arteries, although there are individual differences.
  • a mesh pattern before expansion of a stent is cut out from a metal tube or the like with a laser or the like.
  • the coaxial multilayer stent of the present invention described in detail above can be suitably used as a drug-eluting coaxial multilayer stent.
  • the gap Vab in the main body between the two component stents A and B is a reservoir for storing a drug such as a thrombolytic agent (see FIG. 21-22).
  • Drug Reserver, DR can be preferably used as a site for accommodating.
  • An eluting coaxial multi-layer stent (DE-CMLS) can be formed.
  • Patent Document 8 it is disclosed that a therapeutic effect is enhanced when a stent is placed in a blood vessel by applying a drug to the stent by application or the like. Therefore, in Patent Document 8, the drug is fixed to the stent by applying a biodegradable polymer mixed with the drug to the stent strut.
  • Non-patent document 2 shows that the rate of restenosis is significantly reduced in a drug-eluting stent compared to a stent (Bare Stent) in which no drug is applied and the drug is not eluted. In this way, the therapeutic effect can be enhanced by the drug-eluting stent, so that it is expected to be applied to the treatment of restenosis of blood vessels and the like, which are conventionally considered difficult to treat, and the treatment of blood vessels with narrow occlusions and branches. ing.
  • the stent used for the drug-eluting stent is a conventional single-layer stent, the above structural problem remains.
  • Another problem of the drug eluting stent is a method of loading the drug on the stent as the base material. Since the loading of the drug is performed by application (coating) to the stent strut, the loading amount of the drug is physically limited by the surface area of the stent strut. Therefore, only drugs that exhibit a therapeutic effect with a limited loading amount can be used, or treatment must be performed with an insufficient amount of loading agent, which narrows treatment options.
  • Patent Document 9 discloses a method in which a number of holes for storing a drug are formed in a stent column and the drug is stored there. This is a technique intended to enhance the therapeutic effect by controlling the sustained release speed of the drug. In addition, this method has an advantage that, unlike the coating, there is no possibility of the drug falling off during transportation. However, this method still has the problem that the loading amount is limited by the surface area of the stent strut.
  • Patent Document 10 discloses a method for enhancing a therapeutic effect by forming a stent itself with a biodegradable polymer and mixing a drug with the polymer in advance. Compared with Patent Document 8 and Patent Document 9, this method determines the loading amount of drug (content in the volume of the stent) not by the surface area of the stent but by the volume of the stent. Can be installed.
  • biodegradable polymers are significantly inferior in material properties such as Young's modulus compared to metals, and the stent has a mechanical problem in that the radial rigidity is reduced.
  • Non-Patent Document 4 discloses a treatment result of a stent using a biodegradable polymer in which a drug is premixed. Even in this case, the restenosis rate is inferior to that of a stent made by the method as described in Patent Document 8.
  • the gap Vab in the main body between the two component stents A and B more specifically, most of the center, not the end where the struts intersect.
  • the struts of the two stents are arranged in a separated state, and this portion forms a void portion Vab.
  • a drug-eluting coaxial multi-layer stent (DE-CMLS) can be formed in which the drug to be eluted is preferably accommodated as a drug reservoir (Drug Rseaver, DR).
  • the drug reservoir DR is formed in advance so as to mix the drug to be eluted and the polymer (preferably, those having biocompatibility) and to match the shape of the cavity of the coaxial multilayer stent. ⁇ Processed. For example, it is preferably processed into a spiral shape as shown in FIG.
  • one method is based on a thin film. This is because a base material (polymer composition containing a biodegradable material such as polylactic acid and containing a drug) placed on a flat plate (because the base material on the flat plate has low viscosity) When the temperature is high), the flat plate is rotated at a high speed, and when the base material temperature decreases, a thin and uniform film can be formed. This is a method called spin coating (or double spin coating) and is one of the manufacturing methods generally used in the semiconductor field.
  • spin coating or double spin coating
  • the used thin film may be formed.
  • the thin film formed by the above method is cut out with a certain width (about 0.05 to 1.0 mm).
  • the length is appropriately determined depending on the length of the stent used as the carrier.
  • a rectangular thin film having a determined width and length is wound around the component stent (in the middle) of the coaxial multilayer stent so as to be spiral in the long axis direction.
  • it may be directly wound around the component stent, or separately wound around a rod having the same circular cross section as that of the component stent, spirally formed, and then combined with the component stent.
  • Other methods include substances produced in human bodies (substances such as hyaluronic acid and collagen) themselves, or polymeric substances to which a thickener is added to increase the viscosity (preferably biocompatible). It is also possible to use a technique in which a drug or the like is contained in a thin sheet processed and sandwiched between coaxial multilayer stents. Furthermore, a polymer or the like (preferably biocompatible material is desirable) is processed into a sheet shape by containing a drug or the like, but a microneedle is formed on one surface of the sheet and this is directly inserted into the inner wall of the blood vessel. However, it is also possible to create a shape in which the drug contained in the sheet main body is injected into the blood vessel wall from the micro needle just like the function of the syringe.
  • the drug reservoir does not become a deformation resistance when the stent is expanded, and does not overlap in the radial direction in the contracted state.
  • a shape even if it is basically a cylindrical shape, a plurality of incisions are made in the circumferential direction and the long axis direction, and cracks progress from there in the expansion direction.
  • a shape that can lower the thickness is preferable. That is, at the time of expansion, a plurality of holes and cuts are opened in the drug reservoir. Therefore, it can be said that the above-described spiral shape is one of preferable shapes.
  • this drug reservoir is a structure for actively leaking sufficient blood from the side wall of the stent (for blood flowing in the stent). Is fundamentally different. This is because the stent graft is a kind of artificial blood vessel and blood should not leak through the side wall of the stent.
  • drugs in the drug reservoir of the present invention include, for example, anticoagulants, antithrombotic agents, antiplatelet agents, cytokines, steroids and nonsteroids, antibiotics, anticancer agents, anticholesterol agents, anticholesterol agents, Immunity agent, antiallergic agent, regeneration promoting or inhibiting factor substance in the field of regenerative medicine, intracellular substance, extracellular matrix, drug such as cell growth or inhibiting factor or gene in the field of gene therapy, genetic factor or gene, inhibitor or more Derivatives such as drugs, analogs, metabolites, by-products, etc., or combinations of these drugs and the like, heparin which is a substance that effectively reduces the degree of intimal hyperplasia in animal models and Heparin fragment, colchicine taxol, angiotensin converting enzyme (ACE) inhibitor, angiopeptin, chic Includes rosporin A, goat-anti-rabbit PDGF antibody, terbinafine, trapidil, tranilast, interferon- gamm
  • Heparin and heparin conjugates that have antiproliferative effects on smooth muscle cells in vitro, taxol, tranilast, colchicine, ACE inhibitors, fusiontoxins, antisense oligonucleotides, rapamycin And a substance containing ionizing radiation.
  • These drugs are dispersed and held in the polymer molded in the above-mentioned form as DR, and when the outer surface comes into contact with the bloodstream in the living body, diffusion, dissolution, and other mass transfer mechanisms, It is gradually released (released) from the surface of the reservoir, and functions to suppress the formation of thrombus and the like in the vicinity of the stent and to exert other desired effects.
  • the stent As a polymer mixed with a drug to form a reservoir (preferably, a biocompatible polymer is desirable), the stent is compressed, expanded, bent or deformed while being accommodated in a coaxial multilayer stent.
  • the polymer material preferably having biocompatibility
  • an effective amount of an anticoagulant or the like that is a polymer that is not soluble in blood or physiological saline (preferably having biocompatibility is desirable) and that can inhibit blood coagulation is obtained in vivo. There is no particular limitation as long as it can be gradually eluted (slow release) from the surface of the coating layer.
  • polymers examples include polyvinyl acetate, (meth) acrylic ester polymers, polyester elastomers, polyamide elastomers, polyurethane elastomers, poly (ethylene-vinyl alcohol) copolymers, and 2-methacryloyloxy.
  • Ethyl phosphorylcholine (MPC) (2-hydroxyethyl-methacrylate) -styrene block copolymer is exemplified as a preferable one.
  • a biodegradable polymer is more preferable.
  • Such polymers include PLA (polylactic acid), PLGA (lactic acid / glycolic acid copolymer), PLGAC (lactic acid / glycolic acid / ⁇ -caprolactone copolymer), and in-vivo products, which are usually used for DDS.
  • PLA polylactic acid
  • PLGA lactic acid / glycolic acid copolymer
  • PLGAC lactic acid / glycolic acid / ⁇ -caprolactone copolymer
  • in-vivo products which are usually used for DDS.
  • Hyaluronic acid, collagen, extracellular matrix, etc. and inorganic substances for example, magnesium, calcium, etc.
  • this pre-formed drug reservoir is sandwiched in a void Vab formed by the inner component stent A and the outer component stent B, and is narrowed by both component stents.
  • the drug reservoir DR is formed in a spiral shape, and is formed of a polymer that can follow the deformation of the stent. Can follow deformation (expansion).
  • the shape and structure of the coaxial multilayer stent and the drug reservoir are basically separate elements and are independent of each other. Therefore, the amount of medicine loaded in the medicine reservoir depends only on the shape and structure of the medicine reservoir. Thus, if the volume of the medicine reservoir is increased, the amount of medicine loaded can be easily increased.
  • the concentration of the drug in the drug reservoir can be appropriately selected. For example, in the drug reservoir (based on the total mass), 0.01-80% by mass, preferably 0.1-60% by mass, more preferably 1. It is about 0-50% by mass.
  • the method for forming the drug reservoir (molded body) DR has been described in detail above. However, the method is not limited to this.
  • the shape of the void Vab formed by the target component stent A and the component stent B is used.
  • a mold is prepared as a split mold, and in the split mold, a resin composition composed of a drug and a polymer (preferably those having biocompatibility is desirable) is melted in an injection molding machine, It is injected into the mold and cured, or a solvent of at least the polymer (preferably biocompatible) is added to the composition to obtain a resin solution containing a drug, This may be poured into the split mold, and then the solvent may be removed by drying.
  • the drug and the monomer of the resin can be injected into a split mold together with a polymerization initiator or the like, and polymerized in the mold.
  • the volume of the drug reservoir is not affected by the structural characteristics of the stent.
  • the volume of the drug reservoir can be increased or decreased independently of the stent structure.
  • a large volume drug reservoir is combined with a coaxial multilayer stent using an open cell component stent, or a small volume drug reservoir is combined with a coaxial multilayer stent composed of a closed cell structure component stent.
  • the drug reservoir of the present invention is also housed in the void portion Vab of the coaxial multilayer stent composed of the two component stents A and B, and is guided to the lesioned portion in a sandwiched state. Therefore, it is unlikely that the drug reservoir comes into contact with the blood vessel wall or the like during transportation and a part of the drug reservoir falls off.
  • the coaxial multilayer stent protects the drug reservoir held by it.
  • the present invention has the following industrial applicability.
  • the coaxial multilayer stent of the present invention it is possible to assemble the coaxial multilayer stent without using a dedicated machine such as a welding machine and without requiring precise alignment. That is, engagement can be realized by simply moving and sliding a plurality of thin stents (component stents) in the long axis direction, and the coaxial multilayer stent of the present invention can be assembled. Further, since the moving amount of the component stent in the major axis direction is about 1.0 mm-2.5 mm, it can be easily assembled without using a microscope.
  • the inner component stent A and the outer stent One of the biggest problems in the conventional coaxial multi-layer stent is that it has a new engagement mechanism that forms struts that run in the radial direction in each of the component stents B, and thereby performs engagement. The problem of falling out of the outer component stent during transportation is essentially solved.
  • each component stent before overlapping has a large mesh (pattern composed of cells and links).
  • Each stent has a strut joined at its end, but the other portions do not affect the deformation of the stent struts. Therefore, the coaxial multilayer stent of the present invention can make a large hole in the side surface and can be effectively applied to the treatment of a blood vessel portion having a side branch.
  • a drug eluting stent can be formed by having a space part that can suitably store a drug reservoir between component stents. That is, in the drug-eluting coaxial multi-layer stent of the present invention, since the drug is stored in the space between the layers, the degree of freedom is extremely large, and the drug can be eluted for a long time. The availability is very large.

Abstract

La présente invention concerne une endoprothèse coaxiale multicouches dont la rigidité radiale est presque équivalente à celle d'une endoprothèse monocouche, qui peut être fabriquée par un médecin lui-même en pratique clinique sans avoir à fabriquer un élément de type entretoise de soutien particulier, qui ne se disloque pas lors de la mise en place au niveau du site d'une lésion, qui permet de traiter une ramification latérale et qui dispose d'un espace suffisant pour le stockage d'une grande quantité de médicament. L'invention concerne donc l'utilisation d'une endoprothèse coaxiale multicouches comprenant une première endoprothèse A constituant la couche interne et dans laquelle un élément constitutif de type entretoise de soutien présente un diamètre uniforme, qui est également dotée d'un élément de type entretoise de soutien (orifice d'accueil) pouvant se loger dans un élément de type entretoise de soutien radial d'un élément de type entretoise de soutien d'une autre endoprothèse, et une seconde endoprothèse B constituant la couche extérieure et comportant un élément de type entretoise de soutien situé au niveau d'une position radiale de plus grande taille que celle de l'endoprothèse A, un élément de type entretoise de soutien situé au niveau d'une position radiale de plus petite taille et un élément de type entretoise de soutien (élément de type entretoise de soutien radial) reliant les deux éléments de type entretoise de soutien décrits plus haut, l'endoprothèse A étant introduite dans le sens longitudinal dans l'endoprothèse B de façon à avoir des éléments de type entretoise de soutien disposés au niveau de trois positions radiales obtenues en introduisant l'élément de type entretoise de soutien de l'endoprothèse B dans l'orifice d'accueil de l'endoprothèse A, ainsi qu'un unique élément de type entretoise de soutien dont le rayon varie constamment.
PCT/JP2009/062955 2009-07-17 2009-07-17 Endoprothèse coaxiale multicouches WO2011007444A1 (fr)

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JP2003533270A (ja) * 2000-05-17 2003-11-11 ゲーバー，ベニー 選択的に拡張及び解放可能なステント
WO2007109621A2 (fr) * 2006-03-20 2007-09-27 Xtent, Inc. Appareil et procédés destinés à la mise en place de segments prothétiques reliés entre eux

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JPH05507215A (ja) * 1990-06-28 1993-10-21 シュナイダー・（ユーエスエイ）・インコーポレーテッド 体腔内への固定装置
JP2003533270A (ja) * 2000-05-17 2003-11-11 ゲーバー，ベニー 選択的に拡張及び解放可能なステント
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Publication number Priority date Publication date Assignee Title
CN102415925A (zh) * 2011-09-15 2012-04-18 中国人民解放军第三军医大学第一附属医院 一种可贮存药物的医用腔道支架

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