WO2013150776A1 - Dispositif de traitement du type à introduction dans un vaisseau sanguin - Google Patents

Dispositif de traitement du type à introduction dans un vaisseau sanguin Download PDF

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Publication number
WO2013150776A1
WO2013150776A1 PCT/JP2013/002275 JP2013002275W WO2013150776A1 WO 2013150776 A1 WO2013150776 A1 WO 2013150776A1 JP 2013002275 W JP2013002275 W JP 2013002275W WO 2013150776 A1 WO2013150776 A1 WO 2013150776A1
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WO
WIPO (PCT)
Prior art keywords
blood vessel
treatment device
ultrasonic
type treatment
insertion type
Prior art date
Application number
PCT/JP2013/002275
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English (en)
Japanese (ja)
Inventor
吏悟 小林
小林　淳一
杉本　良太
平原　一郎
Original Assignee
テルモ株式会社
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Publication of WO2013150776A1 publication Critical patent/WO2013150776A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/12—Diagnosis using ultrasonic, sonic or infrasonic waves in body cavities or body tracts, e.g. by using catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N7/00—Ultrasound therapy
    • A61N7/02—Localised ultrasound hyperthermia
    • A61N7/022—Localised ultrasound hyperthermia intracavitary
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22051—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A61B2017/22065—Functions of balloons
    • A61B2017/22071—Steering
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00214—Expandable means emitting energy, e.g. by elements carried thereon
    • A61B2018/0022—Balloons
    • A61B2018/0025—Multiple balloons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00434—Neural system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00595—Cauterization
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
    • A61B2090/3782—Surgical systems with images on a monitor during operation using ultrasound transmitter or receiver in catheter or minimal invasive instrument
    • A61B2090/3784—Surgical systems with images on a monitor during operation using ultrasound transmitter or receiver in catheter or minimal invasive instrument both receiver and transmitter being in the instrument or receiver being also transmitter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/42—Details of probe positioning or probe attachment to the patient
    • A61B8/4245—Details of probe positioning or probe attachment to the patient involving determining the position of the probe, e.g. with respect to an external reference frame or to the patient
    • A61B8/4254—Details of probe positioning or probe attachment to the patient involving determining the position of the probe, e.g. with respect to an external reference frame or to the patient using sensors mounted on the probe
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
    • A61B8/4444—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device related to the probe
    • A61B8/445—Details of catheter construction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M2025/1043—Balloon catheters with special features or adapted for special applications
    • A61M2025/1047—Balloon catheters with special features or adapted for special applications having centering means, e.g. balloons having an appropriate shape
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M2025/1043—Balloon catheters with special features or adapted for special applications
    • A61M2025/1084—Balloon catheters with special features or adapted for special applications having features for increasing the shape stability, the reproducibility or for limiting expansion, e.g. containments, wrapped around fibres, yarns or strands
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M2025/1043—Balloon catheters with special features or adapted for special applications
    • A61M2025/1097—Balloon catheters with special features or adapted for special applications with perfusion means for enabling blood circulation only while the balloon is in an inflated state, e.g. temporary by-pass within balloon
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02—Holding devices, e.g. on the body
    • A61M25/04—Holding devices, e.g. on the body in the body, e.g. expansible
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M25/1002—Balloon catheters characterised by balloon shape
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M25/1011—Multiple balloon catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N7/00—Ultrasound therapy
    • A61N2007/0056—Beam shaping elements
    • A61N2007/006—Lenses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N7/00—Ultrasound therapy
    • A61N2007/0056—Beam shaping elements
    • A61N2007/0065—Concave transducers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N7/00—Ultrasound therapy
    • A61N2007/0078—Ultrasound therapy with multiple treatment transducers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N7/00—Ultrasound therapy
    • A61N2007/0086—Beam steering
    • A61N2007/0091—Beam steering with moving parts, e.g. transducers, lenses, reflectors

Definitions

  • the present invention relates to a blood vessel insertion type treatment device, and particularly to a blood vessel insertion type treatment device that can be inserted into a blood vessel and cauterize a living tissue around the blood vessel from inside the blood vessel.
  • a blood vessel insertion type treatment device capable of cauterizing a living tissue around a blood vessel such as a renal artery sympathetic nerve around the renal artery while suppressing damage to the blood vessel is provided. With the goal.
  • a blood vessel insertion type treatment device includes: An ultrasonic generator that emits ultrasonic waves that converge at a convergence position; Position adjusting means for adjusting the convergence position; It has a longitudinal shape having a base end and an insertion end at both ends, and an insert body provided with an ultrasonic generator in the vicinity of the insertion end.
  • the ultrasonic wave emitted from the ultrasonic generator converges at the convergence position, a large amount of thermal energy is generated in the biological tissue at the convergence position without causing a large damage to the biological tissue up to the convergence position. Can be generated.
  • the convergence position can be adjusted, the living tissue can be cauterized regardless of the distance from the blood vessel to the living tissue.
  • the blood vessel insertion type treatment device configured as described above, it is possible to cauterize the living tissue around the blood vessel while suppressing damage to the blood vessel.
  • FIG. 2 is an enlarged view of the vicinity of a renal artery in which a guiding catheter is inserted in FIG. 1. It is sectional drawing along the longitudinal direction of the insertion end vicinity of the blood vessel insertion type treatment device of 1st Embodiment. It is a figure for demonstrating adjustment of the convergence position in the blood vessel insertion type treatment device of 1st Embodiment. It is sectional drawing along the longitudinal direction of the insertion end vicinity of the blood vessel insertion type treatment device of 2nd Embodiment.
  • FIG. 10 is a cross-sectional view taken along line XX in FIG. 9. It is a figure which shows the 2nd modification of a mesh balloon.
  • FIG. 12 is a cross-sectional view taken along line XII-XII in FIG.
  • FIG. 1 is a diagram for explaining a technique for removing a renal artery sympathetic nerve using the blood vessel insertion type treatment device according to the first embodiment of the present invention.
  • the operator inserts the guiding catheter 200 from the patient's thigh into the femoral artery FA in advance and allows the distal end of the guiding catheter 200 to reach the renal artery RA.
  • a guide wire (not shown) is used for reaching the guiding artery 200 to the renal artery RA.
  • the guiding catheter 200 is tubular, and a device for diagnosis and treatment can be inserted.
  • the blood vessel insertion type treatment device 100 is generally string-shaped, has an insertion end and a proximal end, and can be inserted into the lumen of the guiding catheter 200 from the insertion end.
  • the surgeon inserts the blood vessel insertion type treatment device 100 into the guiding catheter 200 and causes the insertion end to protrude from the guiding catheter 200 (see FIG. 2).
  • the mesh balloon 101 provided in the vicinity of the insertion end of the blood vessel insertion type treatment device 100 is inflated to fix the blood vessel insertion type treatment device 100 in the renal artery RA.
  • the blood vessel insertion type treatment device 100 has an imaging function and an ablation function.
  • the blood vessel insertion type treatment device 100 can emit ultrasonic waves for imaging (see IUS in FIG. 2).
  • the surgeon executes an imaging function of the inserted blood vessel insertion type treatment device 100 to acquire an image around the renal artery from the renal artery RA.
  • the surgeon discriminates the sympathetic nerve SN to be cauterized based on the acquired image and irradiates the discriminated sympathetic nerve SN with ultrasonic waves for cauterization (see CUS in FIG. 2). Adjust the position of the device 100. After the position adjustment, the surgeon performs the cauterization function of the blood vessel insertion type treatment device 100 to cauterize the desired sympathetic nerve.
  • the blood vessel insertion type treatment device 100 includes a sheath 102, an insert 103, an ultrasonic generator 104, an image acquisition unit 105, a mesh balloon 101 (see FIG. 2), and the like.
  • the sheath 102 is formed into a tubular shape by a member having acoustic properties and flexibility.
  • the end of the sheath 102 on the insertion end side is open. Further, at the start of use, the inside is filled with the acoustic transmission body from the base end.
  • the insert 103 is formed by a flexible member so as to extend from the proximal end of the sheath 102 to the insertion end. With the insertion end of the insertion body 103 reaching the insertion end of the sheath 102, the proximal end of the insertion body 103 protrudes from the proximal end of the sheath 102.
  • the outer diameter of the insert 103 is determined to be smaller than the inner diameter of the sheath 102, and the insert 103 is rotatable within the sheath 102 about the longitudinal direction. Therefore, when a torque for rotating the longitudinal direction about the axis is supplied at the proximal end of the insertion body 103, the supplied torque is transmitted to the insertion end of the insertion body 103, and the entire insertion body 103 rotates within the sheath 102. Further, the insert 103 can be displaced along the longitudinal direction within the sheath 102.
  • a recess C is formed in the vicinity of the insertion end of the insertion body 103.
  • the depth of the recess C is formed to be longer than the height of the ultrasonic generator 104.
  • An actuator 109 and an ultrasonic generator 104 are embedded in the recess C.
  • the actuator 109 can be expanded and contracted in a direction perpendicular to the longitudinal direction of the insert 103.
  • the depth position of the ultrasonic generator 104 in the recess C is adjusted by expanding and contracting in the direction perpendicular to the longitudinal direction. Expansion and contraction of the actuator 109 is controlled by a convergence position control unit (not shown).
  • the ultrasonic generator 104 has a single first ultrasonic transducer 106 and an acoustic lens 107.
  • the first ultrasonic transducer 106 is arranged so as to emit ultrasonic waves in a direction perpendicular to the longitudinal direction of the insert 103.
  • the first ultrasonic transducer 106 emits an ablation ultrasonic wave CUS having a frequency suitable for ablation.
  • the distance for transmitting ultrasonic waves and the amount of heat generated at the position where the ultrasonic waves converge are determined by the frequency. Therefore, the frequency of the ultrasound CUS for cauterization is determined in advance based on the approximate interval from the inside of the renal artery RA to the renal artery sympathetic nerve SN and the amount of heat generated for cauterization of the sympathetic nerve SN.
  • a signal line extending from the first ultrasonic transducer 106 to the proximal end is connected to an ablation control unit (not shown).
  • the ablation control unit supplies a drive signal to the first ultrasonic transducer 106 so as to generate the ablation ultrasonic wave CUS at the above-described frequency.
  • the acoustic lens 107 is provided on the surface of the first ultrasonic transducer 106.
  • the acoustic lens 107 converges the ultrasonic wave at a convergence position away from the acoustic lens 107 by a predetermined distance, and maximizes the heat generation energy in the vicinity of the convergence position.
  • a desired convergence position is determined based on an average distance from the renal artery to the renal artery sympathetic nerve, and the focal length of the acoustic lens 107 is determined and formed so that the ultrasonic wave can be converged to the determined convergence position. Is done.
  • the image acquisition unit 105 is provided on the back side of the ultrasonic generator 104 in the insert 103.
  • the image acquisition unit 105 has a single imaging ultrasonic transducer 108.
  • the imaging ultrasonic transducer 108 is arranged so as to emit ultrasonic waves in a direction perpendicular to the longitudinal direction of the insert 103. From the imaging ultrasonic transducer 108, it is possible to generate imaging ultrasonic IUS suitable for image acquisition. The imaging ultrasonic transducer 108 generates a pixel signal corresponding to the reflected wave of the imaging ultrasonic IUS.
  • the imaging ultrasonic transducer 108 can observe not only tissue image creation but also temperature changes and tissue state changes during irradiation of cauterization ultrasonic waves.
  • the reflection of ultrasonic waves occurs at the boundary where the acoustic impedance represented by the product of the density of the medium and the sound speed of the medium changes.
  • the acoustic impedance represented by the product of the density of the medium and the sound speed of the medium changes.
  • the ultrasonic signal reflected from the tissue changes, and it becomes possible to diagnose the cauterization status of the tissue.
  • the resolution due to the reflected wave of the ultrasonic wave varies depending on the frequency.
  • the frequency of the imaging ultrasound IUS is determined in advance based on the resolution necessary for confirmation and diagnosis of the position of a specific sympathetic nerve.
  • a signal line extending from the imaging ultrasonic transducer 108 to the base end is connected to the imaging control unit.
  • the imaging control unit (not shown) supplies a drive signal to the imaging ultrasonic transducer 108 so as to generate the imaging ultrasonic IUS at the above-described frequency.
  • the imaging control unit receives a pixel signal generated by the imaging ultrasonic transducer 108.
  • the imaging control unit creates an image based on pixel signals corresponding to a number of locations irradiated with imaging ultrasonic waves.
  • the irradiation position of the imaging ultrasonic wave can be determined by detecting the rotational position of the insertion end 103 and the displacement position along the longitudinal direction using an encoder or a position sensor, and is used for creating an image.
  • the mesh balloon 101 is provided on the sheath 102 (see FIG. 2).
  • the blood vessel insertion type treatment device 100 can be fixed in the blood vessel.
  • the heat generation energy can be maximized at the convergence position of the ultrasound for ablation. Therefore, while it is possible to cauterize living tissue distributed from the inside of the blood vessel to the outside of the blood vessel, it is possible to suppress damage to the blood vessel interposed between the living tissue.
  • the depth position in the recessed portion C of the ultrasonic generator 104 can be adjusted, the convergence that maximizes the heat generation energy of the cauterization ultrasonic wave CUS is achieved. It is possible to adjust the position.
  • the blood vessel insertion type treatment device 100 of the first embodiment it is possible to change the irradiation position of the ultrasonic wave CUS for cauterization using the insert 103.
  • the ultrasonic wave In ablation of a living tissue using an ultrasonic transducer, the ultrasonic wave is converged to a convergence position, so that the causative region is only near the convergence position.
  • it is possible to rotate the entire blood vessel insertion type treatment device 100 it is necessary to release the fixation by the mesh balloon 101, which requires a complicated procedure.
  • the image acquisition unit 105 is provided in the vicinity of the ultrasonic generator 104, confirmation of a living tissue to be ablated, confirmation of ablation status, and the like. Easy.
  • the vicinity of the insertion end of the blood vessel insertion type treatment device 100 can be temporarily fixed in the blood vessel using the mesh balloon 101.
  • fixing the blood vessel insertion type treatment device 100 it is possible to reduce the blurring of the reproduced image and to reduce the blurring that occurs at the irradiation position of the ultrasonic wave CUS for cauterization.
  • the mesh balloon 101 since the mesh balloon 101 is used, blood flow can be secured, and overheating of the inner wall of the blood vessel that irradiates the ultrasound CUS for cauterization while fixing the blood vessel insertion type treatment device 100 in the blood vessel can be prevented. is there.
  • the convergence position adjusting means is different from that of the first embodiment.
  • the second embodiment will be described below with a focus on differences from the first embodiment.
  • symbol is attached
  • the blood vessel insertion type treatment device 1000 in the second embodiment includes a sheath 102, an insert 103, an ultrasonic generator 1040, an image acquisition unit 105, a mesh balloon 101 (see FIG. 2), and the like. Consists of including.
  • the configurations and functions of the sheath 102, the insert 103, the image acquisition unit 105, and the mesh balloon 101 are the same as those in the first embodiment.
  • an actuator is not provided in the recessed portion C of the insert 103, and an ultrasonic generator 1040 is embedded and fixed.
  • the ultrasonic generator 1040 has a single ultrasonic transducer 106 and a variable acoustic lens 1070.
  • the configuration and function of the ultrasonic transducer 106 are the same as those in the first embodiment.
  • the variable acoustic lens 1070 is provided on the surface of the first ultrasonic transducer 106.
  • the variable acoustic lens 1070 converges the ultrasonic wave at the convergence position and maximizes the heat generation energy in the vicinity of the convergence position.
  • the variable acoustic lens 1070 can be deformed, and the convergence position is changed by the deformation.
  • variable acoustic lens 1070 can be deformed so that the radius of curvature of the concave surface changes, and the convergence position can be adjusted by changing the radius of curvature.
  • the radius of curvature of the variable acoustic lens 1070 is controlled by a convergence position control unit (not shown) connected to the blood vessel insertion type treatment device 1000.
  • the ultrasonic convergence position CP can be moved away from the blood vessel insertion type treatment device 1000.
  • the living tissue can be cauterized, while the damage of the blood vessel interposed between the living tissue can be suppressed. .
  • the blood vessel insertion type treatment device 1000 can also adjust the convergence position, and can efficiently cauterize the living tissue regardless of the distance from the blood vessel.
  • the blood vessel insertion type treatment device 1000 can also cauterize biological tissue distributed at various positions near the insertion end of the sheath 102.
  • the blood vessel insertion type treatment device 1000 can also reduce the blurring of the reproduced image and the blurring generated at the irradiation position of the cauterizing ultrasonic wave.
  • the blood vessel insertion type treatment device 1000 can prevent overheating of the blood vessel inner wall while fixing the blood vessel insertion type treatment device 1000 in the blood vessel.
  • the convergence position adjusting means is different from that of the first embodiment.
  • the third embodiment will be described below with a focus on differences from the first embodiment.
  • symbol is attached
  • the blood vessel insertion type treatment device 1001 in the third embodiment includes a sheath 102, an insert 103, an ultrasonic generator 1041, an image acquisition unit 105, a mesh balloon 101 (see FIG. 2), and the like. Consists of including.
  • the configurations and functions of the sheath 102, the insert 103, the image acquisition unit 105, and the mesh balloon 101 are the same as those in the first embodiment.
  • the ultrasonic generator 1041 includes a base 1101 and a plurality of first ultrasonic transducers 1061. Further, unlike the first embodiment, the ultrasonic generator 1041 is not provided with an acoustic lens.
  • the base 1101 is formed by an elastic member into a shape having a curved surface CS whose center is recessed.
  • the plurality of first ultrasonic transducers 1061 are fixed in a state of being aligned along the longitudinal direction of the insertion body 103 on the curved surface CS.
  • the first ultrasonic transducers 1061 are all driven so as to generate the cauterization ultrasonic waves CUS with the same phase and the same cycle.
  • the ultrasonic generator 1041 is embedded in the recess C of the insert 103. However, only the vicinity of the center of the base 1101 is fixed to the bottom surface of the recessed portion C, and the end portion EP of the base 1101 is not fixed. An actuator 1111 is provided between the bottom surface of the recessed portion C and both end portions EP of the base 1101.
  • Actuator 1111 can expand and contract in a direction perpendicular to the longitudinal direction.
  • the radius of curvature of the curved surface CS can be adjusted by extending / contracting the actuator 1111 provided at both ends EP.
  • the convergence position CP can be brought closer to the blood vessel insertion type treatment device 1001.
  • the blood vessel insertion type treatment device 1001 of the third embodiment configured as described above, it is possible to cauterize the living tissue, while suppressing damage to the blood vessels interposed between the living tissue. .
  • the blood vessel insertion type treatment device 1001 can adjust the convergence position and can efficiently cauterize the living tissue regardless of the distance from the blood vessel.
  • the blood vessel insertion type treatment device 1001 can also cauterize living tissue distributed at various positions near the insertion end of the sheath 102.
  • the blood vessel insertion type treatment device 1001 can also reduce the blurring of the reproduced image and the blurring generated at the irradiation position of the cauterizing ultrasonic wave.
  • the blood vessel insertion type treatment device 1001 can also prevent overheating of the blood vessel inner wall while fixing the blood vessel insertion type treatment device 1001 in the blood vessel.
  • the mesh balloon 101 is provided in the blood vessel insertion type treatment devices 100, 1000, 1001 of the first to third embodiments.
  • the structure which can be temporarily fixed to may be sufficient.
  • a balloon that prevents overheating of the inner wall of the blood vessel is preferable.
  • the same overheating prevention effect as that of the mesh balloon 101 can be obtained by a configuration having a plurality of balloons 112 that can be expanded in different directions around the sheath 102.
  • the mesh balloon 101 and the mesh balloon 101 can also be inflated around the sheath 102 and have a balloon 113 formed with a hole OH penetrating in the longitudinal direction. It is possible to obtain the same overheating prevention effect.
  • the same overheating prevention effect as that of the mesh balloon 101 can be obtained by the configuration having the balloon 114 formed so that the cross section along the plane perpendicular to the longitudinal direction has a star shape. Is possible. Further, for example, as shown in FIG. 14, the same overheating prevention effect as that of the mesh balloon 101 can be obtained by a configuration in which the balloon 116 is partially inflated using a plurality of wires 115.
  • the image acquisition unit 105 is configured to acquire an image using ultrasonic waves, but acquires an image based on optical information such as TD-OCT and HUD-OCT. It may be a configuration.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Radiology & Medical Imaging (AREA)
  • Biomedical Technology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Physics & Mathematics (AREA)
  • Biophysics (AREA)
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  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un dispositif du type à introduction dans un vaisseau sanguin (100) qui a un générateur d'ondes ultrasonores (104), un actionneur (109) et un corps d'introduction (103). Le générateur d'ondes ultrasonores (104) émet des ondes ultrasonores qui convergent vers une position de convergence. L'actionneur (109) ajuste la position de convergence. Le corps d'introduction (103) a une forme longitudinale ayant une extrémité de base et une extrémité d'introduction à l'une ou l'autre de ses extrémités. Le générateur d'ondes ultrasonores (104) est agencé près de l'extrémité d'introduction du corps d'introduction (103).
PCT/JP2013/002275 2012-04-06 2013-04-02 Dispositif de traitement du type à introduction dans un vaisseau sanguin WO2013150776A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP2012087009 2012-04-06
JP2012-087009 2012-04-06

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US10293190B2 (en) 2002-04-08 2019-05-21 Medtronic Ardian Luxembourg S.A.R.L. Thermally-induced renal neuromodulation and associated systems and methods
US10335280B2 (en) 2000-01-19 2019-07-02 Medtronic, Inc. Method for ablating target tissue of a patient
US10589130B2 (en) 2006-05-25 2020-03-17 Medtronic, Inc. Methods of using high intensity focused ultrasound to form an ablated tissue area containing a plurality of lesions

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10335280B2 (en) 2000-01-19 2019-07-02 Medtronic, Inc. Method for ablating target tissue of a patient
US10293190B2 (en) 2002-04-08 2019-05-21 Medtronic Ardian Luxembourg S.A.R.L. Thermally-induced renal neuromodulation and associated systems and methods
US10589130B2 (en) 2006-05-25 2020-03-17 Medtronic, Inc. Methods of using high intensity focused ultrasound to form an ablated tissue area containing a plurality of lesions

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