WO2017097742A1

WO2017097742A1 - Catheter system

Info

Publication number: WO2017097742A1
Application number: PCT/EP2016/079850
Authority: WO
Inventors: Viktor Heit; Manuel Müller; David KLOPP
Original assignee: Acandis Gmbh & Co. Kg
Priority date: 2015-12-10
Filing date: 2016-12-06
Publication date: 2017-06-15
Also published as: DE102015121545B4; DE102015121545A1

Abstract

The invention relates to a catheter system for delivering and releasing an implant (10) in the area of a vessel bifurcation, in particular for the treatment of an aneurysm in the area of the vessel bifurcation, with a first guide element (11) for delivering and releasing the implant (10). The invention is characterized in that a second guide element (12), or at least part of the second guide element (12), and the first guide element (11) form a Y-shaped fork (14) at least when the implant (10) is released, wherein the first guide element (11) can be manipulated through the second guide element (12) or through at least part of the second guide element (12).

Description

catheter system

description

The invention relates to a catheter system for supplying and discharging an implant having the features of the preamble of claim 1. Such a catheter system is known for example from DE 10 2011 054 907 AI, which is due to the applicant.

Endovascular implants or devices we use stents, flow diverter,

Thrombectomy systems, etc. are used to treat vascular lesions such as aneurysms or stenoses, which implants or devices can be combined with embolic materials. Lesions in the area of bifurcations, ie in the area of vascular branches, such as bifurcation aneurysms, present a particular challenge. Conventional catheter systems place implants in the main feeding vessel as well as in one of the outgoing side vessels.

For the treatment of cerebral blood vessels, two implantation procedures for implant delivery have been established. These are the so called "By the Wire

Procedure ", which is also called Rapid Exchange RX method, and the so-called" Over the Wire method "(OTW method).

An example of the OTW method is shown in Figures 1-3, which represent the prior art.

As shown in Figure 1, is located in the region of a bifurcation

Aneurysm formed in the vessel wall on the opposite side of the main feeding vessel. Side vessels drain on both sides of the aneurysm.

For the treatment of the bifurcation aneurysm, in the first step according to FIG. 1, a delivery catheter is positioned distal to the lesion in one of the two departing secondary vessels (here in the right secondary vessel). The implant is transferred in the second step into the delivery catheter and through it into the area of the lesion transported. As seen in Figures 2 and 3, the implant is released from distal to proximal by retracting the delivery catheter. One end of the implant, ie the distal end, is anchored next to the vessel. Since the delivery catheter is located in the main vessel upon deflation of the implant, the implant will inevitably be discharged into the main vessel with the proximal end, so that the implant is anchored on the one hand always outgoing side vessel and on the other hand in the feeding main vessel. The arrangement of the implant in the vessel is thus predetermined by the implantation process. This results in the implant not having a full neck cover

Aneurysm allows, as shown in Figure 3 to recognize. A treatment of

Aneurysms with coils or other embolic materials is just with

Restrictions possible because of the risk of coil dislocation and coils can not be safely retained in the aneurysm.

The invention is based on the object to provide a catheter system for supplying and discharging an implant in the region of a vessel bifurcation, in particular for the treatment of an aneurysm in the region of the vessel bifurcation, which allows a better neck coverage, than with conventional

Catheter systems is the case.

This object is achieved by a catheter system with the

Characteristics of claim 1 solved. In the invention therefore relates to a catheter system for feeding and

Discharge of an implant in the region of a vessel bifurcation, in particular for the treatment of an aneurysm in the region of the vessel bifurcation, which has a first guide element for feeding and discharging the implant. The catheter system has a second guide element, wherein the second

Guide element or at least a portion of the second guide member and the first guide element at least when dismissing the implant form a Y-shaped fork. The first guide element is through the second

Guide element or through at least a part of the second

Manipulated guide element.

The invention has the advantage that an implant or other medical device can be released in the area of the lesion such that it has a greater size Neck coverage of an aneurysm, in particular a complete as a cover of an aneurysm, allows, even if the aneurysm is formed in the region of a bifurcation. This is achieved in that the implant with the help of the catheter system according to the invention with both ends in the

Ancillary vessels can be anchored. In other words, the implant can be anchored on either side of the lesion or aneurysm so that the implant wall substantially completely covers the aneurysm neck.

This has the advantage that a better decoupling of the aneurysm from the blood flow is possible because the aneurysm is directly completely or almost completely completed. So that the aneurysm can also be treated with embolic materials, which can be held back by the implant resting directly on the aneurysm. This was not possible with the previous treatment methods.

The improved positioning of implants in the area of a

Gefäßbifurkation is inventively achieved in that the

Catheter system has two guide elements, wherein a first

Guide element at least during implantation contains the implant and together with a second guide member or at least a part thereof, at least when dismissing the implant forms a Y-shaped fork. The Y-shaped bifurcation makes it possible to place a first implant end in one of the two outgoing side vessels laterally of the bifurcation aneurysm. The second guide element may due to the Y-shaped bifurcation in the other outgoing side vessel, i. on the other side of the

Bifurcation aneurysms are arranged. Since the catheter system is adapted so that the first guide element can be manipulated by the second guide element or by a part of the second guide element, the first guide element can thus into the other by the second guide element

Be moved secondary vessel in that the other implant end is anchored in the other side vessel.

In other words, the geometry of the catheter system is at least in the

At the time the implant is discharged, it approximates the vessel geometry in the region of a bifurcation in which the main feeding vessel and the two outgoing secondary vessels form approximately a Y shape or T shape. It is not about the geometry of the catheter system being exactly the same Vessel geometry maps. The invention works when the geometry of the catheter system and the vessel geometry match so far that a guide of the first guide member by the second guide member is possible in that the first guide member in the two

Side vessels can be placed successively. This is at the

Y-shaped bifurcation according to the invention.

Preferred embodiments of the invention are specified in the subclaims.

For example, the first guide element and the second

Guide element be different flexible. It is particularly preferred if the second guide element less flexible, ie. stiffer than the first guide element containing the implant at least during implantation. Due to the different flexibility, the manipulability of the

Catheter system improved.

The first guide element and the second guide element can be firmly connected. The tight connection results in a robust catheter assembly that is easy to use. The fixed connection can be made user-specific in the delivery state, so that a certain amount of leeway for the user is given, the catheter system to the special patient needs

adapt. In a further preferred embodiment, the first form

Guide member and the second guide member each have a branch of the Y-shaped bifurcation, wherein the first branch formed by the first guide member is longer than the second branch formed by the second guide member. This improves the navigability of the catheter system because the longer branch formed by the first guide element can first be positioned in one of the two side vessels for the purpose of releasing the first end of the implant. After that, with the shorter second branch, i. H. manipulated with the second guide member, the first guide member so that this in the other next vessel, d. H. the opposite side of the vessel comes to rest there completely the implant. In the further preferred embodiment, the first guide element and the second guide element are movable relative to each other. By the

Relative movement between the two guide elements can be the first

Guide element are particularly precisely manipulated during the discharge, so that an atraumatic movement of the first guide member is possible. This design allows a particularly gentle discharge of the implant.

Preferably, the second guide element is curved. In a particularly preferred embodiment, the second guide element and the first

Guide element curved in opposite directions. The curvature of the guide element allows a particularly good adaptation of the second guide element to the vessel shape of the outgoing secondary vessel. This effect is improved if both guide elements are curved and curved in opposite directions, so that the two guide elements can follow the vessel shape particularly well.

Preferably, the first guide element comprises a microcatheter. This design allows the use of known components, whereby the

Reliability and safety of the system is improved. The second guide element may consist of a deflection catheter or comprise a deflection catheter and at least one functional element. The first variant, in which the second guide element consists of a deflection catheter is particularly easy to manufacture and easy to use because of

Deflection catheter directly manipulated the first guide element or the microcatheter. The second variant, in which the second guide element comprises a deflection catheter and at least one functional element, allows a particularly flexible and adapted to the respective patient leadership of the catheter system, so that more complicated procedures are possible. Preferably, the functional element comprises a driver, which in the

Deflection catheter arranged longitudinally movable and connected to the first guide element. The driver allows manipulation of the first

Guide element and is very smooth and therefore very precise to use. The driver may comprise a wire.

Preferably, the wire forms a loop through which the first

Guide element is guided. Using the loop, the wire or general the driver is connected to the first guide element, so that the manipulation forces can be transmitted to the first guide element via the wire. The connection through a loop is easy and secure. The first guide element can be arranged coaxially in the deflection catheter, wherein the deflection catheter has an opening for the first guide element, which is arranged in the region of the fork. Through the opening, the first guide member for discharging the implant can be moved out of the Umlenkkatheter so that when you release the implant, the Y-shaped

Crotch forms. Other ways to form the Y-crotch are conceivable.

The first guide element can be arranged loosely in the deflection catheter. This design is particularly easy to manufacture. Alternatively, the

Umlenkkatheter be formed mehrlumig, wherein the first guide element is arranged in a first lumen of the deflection catheter. The second lumen of the deflection catheter can for other functions, eg. To receive a

Guidewire, be used.

According to the independent claim 15, the invention relates to a

Catheter system for delivering and discharging an implant in the region of a vessel bifurcation for treating an aneurysm between a first and second side vessel portion of the bifurcation with a microcatheter for delivering and discharging the implant. The microcatheter is in one

Deflection catheter arranged and positioned in the first side vessel section adjacent to the bifurcation. The deflection catheter is curved such that the microcatheter for complete release of the implant in the second

Nebengefäßabschnitt is positioned next to the bifurcation.

The invention will be explained in more detail below with further details with reference to the attached schematic drawings.

In these show:

Fig. 1-3 the discharge of an implant with a conventional catheter; Fig. 2a-i the discharge of an implant with a catheter system according to an embodiment of the invention; Fig. Fig. 3 is a longitudinal section of a catheter system with a coaxial arrangement

Guide elements; Fig. 4 shows a longitudinal section of a catheter system with a multi-lumen second guide element;

Fig. 5a, b, a catheter system arranged side by side

Guide elements;

Fig. 6 a catheter system with a second guide element and a

carrier; a second guide member having an opening for the first

Guide member;

Fig. 8a, b, a catheter system with a driver, which is connected by a loop with the first guide member; and Fig. 9a, b, a catheter system according to another invention

Embodiment.

Figures 2a to 2i show the various steps in the delivery and discharge of an implant, such as a stent or a flow diverter using a catheter system according to an embodiment of the invention.

The catheter system used in FIGS. 2a to 2b is explained in greater detail in FIGS. Catheter systems according to other invention

Embodiments can be used according to the same scheme as shown in FIGS. 2a to 2b.

The catheter systems according to FIGS. 3, 4 are two technically related, similar examples. As can be seen in FIG. 3, the catheter system has a first guide element 11 and a second guide element 12. The first guide element 11 is designed as a microcatheter 17 in the example according to FIG. 3. The microcatheter 17 is in the second

Guide element 12 is arranged, in particular arranged coaxially. In which second guide member 12 is a single lumen deflection catheter 18 in which the microcatheter 17 is loosely and coaxially disposed. Alternatively, the deflection catheter 18, as shown in FIG. 4, formed mehrlumig. The microcatheter 17 is arranged in the first lumen 22. The second lumen 23 can be used elsewhere, for example for receiving a guide wire 24. The microcatheter 17 and the deflection catheter 18 are movable relative to each other. Both the microcatheter 17 and the deflection catheter 18 each have a guide wire 24.

In both embodiments according to Figures 3, 4, the second

Guide element 12 and der Umlenkkatheter 18 each have an opening 21 which is formed in the wall of the guide member 12 and der Umlenkkatheters 18 and the lumen of the guide member 12 and des

Deflection catheter 18 connects with the environment. The opening 21 is a lateral opening. The microcatheter 17 is guided from the inside to the outside through the opening 21 during use of the catheter system, resulting in a Y-shaped bifurcation 14 of the catheter system. The Y-shaped fork 14 has two branches 15, 16. The first branch 15 is formed by the microcatheter 17 and the second branch 16 by the deflection catheter 18. The two branches 15, 16 form the Y-shaped fork 14. The length of one of the two branches 15, 16 is adjustable, depending on how far the microcatheter 17 is pushed out of the opening 21.

The microcatheter 17 and the deflection catheter 18 have different flexibility. Specifically, the microcatheter 17 is more flexible than the deflection catheter 18. The greater stability of the deflection catheter 18 ensures that it can manipulate the softer catheter 17 when the stent or the implant is discharged. The manipulation of the microcatheter 17 is generally carried out in that the deflection catheter 18 is moved in a desired direction and thereby entrains the microcatheter 17, so that the microcatheter 17 is moved in substantially the same direction as the deflection catheter 18. The manipulation of the microcatheter 17 can take place by direct transfer of force from the deflection catheter 18 to the microcatheter 17. Alternatively, an indirect power transmission can take place by means of further components or concretely by at least one functional element 19, which is arranged between the deflection catheter 18 and the microcatheter 17. In other words, the second guide element 12 can consist of the deflection catheter 18 as the only component for the direct transmission of force (see Fig. 3, 4). Alternatively, the second guide member 12 may comprise a plurality of components, namely the

Deflection catheter 18 and at least one further functional element 19, which is provided for the indirect power transmission (see Fig. 6 and Fig. 8a, 8b).

The manipulation of the microcatheter 17 or, in general, the handling of the catheter system according to FIG. 3 or of the catheter system according to FIG. 4 is shown in FIGS. 2 a to 2 i.

In the first step according to FIG. 2a, the deflection catheter 18 is navigated with the aid of the guide wire 24 into a side branch or a secondary vessel in the region of the bifurcation. In this case, as shown in Figure 2b, the opening 21 of the deflection catheter 18 is positioned so that first the guide wire 24 of the

Microcatheter 17 and then the microcatheter 17 itself through the opening 21 in the other side branch, the other side vessel can be advanced (Fig. 2c). In this case, the microcatheter 17 is so far in the other side vessel

advanced that the micro-catheter 17 and the deflection catheter 18 together form a Y-shaped bifurcation 14. The microcatheter 17 and the deflection catheter 18 form the two branches 15, 16 of the Y-shaped bifurcation 14. As can be seen in Fig. 2d, the Y-shaped geometry of the catheter system corresponds approximately to the vessel geometry in the region of the bifurcation consisting of the main feeding vessel and the two outgoing side vessels. In the next step begins, as seen in Figure 2e, the dismissal of

Implant 10, for example, a flow diverter. The catheter system has a Y-shaped bifurcation 14 at the time the implant 10 is discharged.

Discharge of the implant 10 takes place by retracting the microcatheter 17 into the deflection catheter 18. As a result, the compressed implant located in the microcatheter 17 unfolds and attaches itself to the vessel wall of the (right-hand) secondary vessel and is anchored there. The dismissal of the Implant 10 can also be made by a combined push-pull movement of the

Implant 10 and the microcatheter 17 done.

After the implant 10 is anchored in the secondary vessel, as shown in FIG. 2f, the microcatheter 17 is withdrawn into the deflection catheter 18 so far that the microcatheter 17 forms a shorter branch 15 than the branch 16 of the deflection catheter 18. In this case, the microcatheter 17 or the shorter branch 15 projects so far out of the opening 21 of the deflection catheter 18 that the microcatheter 17 can be folded over by an external force acting in the longitudinal direction of the deflection catheter 18.

Then, as shown in Figure 2g, the deflection catheter 18, together with the microcatheter 17 into the other side vessel, d. H. moved into the secondary vessel in which the deflection catheter 18 is already located. In this case, the microcatheter 17 is taken and folded, as seen in Figures 2g and 2h. The force required for folding over the microcatheter 17 is applied through the wall of the auxiliary vessel and the deflection catheter 18, which presses the microcatheter 17 against the wall of the auxiliary vessel. By manipulating the deflection catheter 18, the microcatheter 17 is drawn into the secondary vessel, in which the other, d .h. the not yet anchored end of the implant 10 is to be placed. Since the implant 10 is anchored in the (right-hand) secondary vessel, the implant 10 is released in the other secondary vessel by the movement of the deflection catheter 18 together with the microcatheter 17 (FIG. 2h). After complete release of the implant 10, the microcatheter 17 is first completely drawn into the deflection catheter 18 so that it disappears through the opening 21. The deflection catheter 18 is then withdrawn past the discharged implant 10 through the main vessel. As can be clearly seen in FIG. 2i, the implant 10 is then located in the two outgoing secondary vessels to the right and left of the aneurysm or respectively laterally of the aneurysm

Aneurysm arranged and anchored.

Thus, a complete or at least almost complete neck coverage of the aneurysm is achieved. The implant 10 is therefore not anchored in the main vessel, but is transverse to the main vessel in the two side vessels. In the other figures, various embodiments of the catheter system are shown, which operate on the same principle, as explained with reference to the figures 2a to 2i. These embodiments have in common that the catheter system forms a Y-shaped bifurcation, which is either fixedly arranged or at least can be formed when discharging or before the implant 10 is discharged.

In the micro-catheter 17 is disposed outside of the deflection catheter 18. The microcatheter 17 is in the longitudinal direction of the deflection catheter 18 and that in the region of the Y-shaped bifurcation 14 substantially parallel to

Deflection catheter 18 is arranged. From the Y-shaped fork 14, the two catheters 17, 18 extend in different directions.

In the example of FIG. 5a, the deflection catheter 18 or generally the second guide element 12 and the microcatheter 17 or the first

Guide element 11 firmly connected. The firm connection takes place via two interconnected rings 25, through which he the two catheters 17, 18 are guided. The two catheters 17, 18 are each firmly connected to the associated ring 25.

Since the two catheters 17, 18 are curved in opposite directions, the Y-shaped fork 14 is formed in the region of the rings 25, which is for the manipulation of

Microcatheter 17 is used. The Y-shaped bifurcation 14 comprises two branches 15, 16, which are formed by the microcatheter 17 and the deflection catheter 18, respectively. In this case, the branch 16, which is formed by the deflection catheter 18, longer than the branch 15, which is formed by the micro-catheter 17.

It is also possible to form the two branches 15, 16 of equal length. Particularly preferred is an embodiment in which the branch 15 of the microcatheter 17 is longer than the branch 16 of the deflection catheter 18. This has the advantage that when

Discharge of the implant 10 in the microcatheter 17 is first positioned in one of the two outgoing side vessels. The deflection catheter or the branch 16 of the deflection catheter 18 serves to manipulate the microcatheter 17 or to guide it into the other, still free side vessel. This is facilitated by the branch 16 of the deflection catheter 18 being shorter than the branch 15 of the microcatheter 17. The starting example according to FIG. 5b differs from that according to FIG. 5a in that the two rings 25 hold the deflection catheter firmly and the microcatheter 17 loosely, so that a relative movement in the longitudinal direction is possible between the two catheters 17, 18. Incidentally, the catheter systems according to FIG. 5a, 5b the same structure.

6, the second guide element 12 comprises the deflection catheter 18 and a further component, namely the functional element 19. The functional element 19 serves as a driver, for example as a wire

is formed and with the first guide member 11, specifically with the

Microcatheter 17 is connected.

The microcatheter 17 is disposed outside of the deflection catheter 18 and forms together with this the Y-shaped fork 14. The two catheters 17, 18 are curved in opposite directions. The wire 19 is passed through the deflection catheter 18 and can be operated by a user. By pulling the

Wire 19, the micro-catheter 17 is moved in the direction of the deflection catheter 18. For this purpose, the wire 19 is attached to the tip or in the region of the tip of the microcatheter 17. As a result of the pulling movement of the wire 19, the microcatheter 17 works similarly as shown in FIGS. 2g and 2h, so that the direction in which the implant 10 is released is changed.

The changes in direction when dismantling the implant by manipulation of the first guide member 11 by the second guide member 12 is generally a property that in all embodiments or generally in

Associated with the invention. The change of direction refers to the position of the proximal part of the deflection catheter 18 and the

Microcatheter 17 in the main vessel. Due to the possibility of manipulation of the microcatheter 17, the implant 10 does not necessarily have to be discharged in the main vessel, but can be completely discharged by the forced change of direction in another vessel, specifically in the desired secondary vessel.

Figure 7a and Figure 7b shows the deflection catheter 18 without microcatheter 17. Here is good to see that the opening 21 for the micro-catheter 17 in the region of

Curvature of the deflection catheter 18 is arranged so that when dismissing the Implant when the microcatheter 17 is passed through the opening 21, the Y-shaped bifurcation 14 results.

A further exemplary embodiment, in which the second guide element 12 has a functional element in addition to the deflection catheter 18, is shown in FIG. 8a. The two catheters 17, 18 are side by side, d. H. not coaxial with each other. The manipulation of the microcatheter 17 by the deflection catheter 18 takes place with the aid of the functional element 19, which serves as a

Driver, specifically designed as a wire. The wire has a loop or loop 20, which is firmly connected on the one hand to the deflection catheter 18 and on the other hand through the opening 21 into the interior of the deflection catheter 18, so that the loop 20 can be reduced by tightening the wire 19.

The microcatheter 17 is guided through the loop 20 and is held by the latter on the deflection catheter 18. Thus, the relative movement of the microcatheter 17 is possible, namely, the loop 20 is somewhat solved. For folding or for the change in direction when dismissing the implant 10, the loop 20 is tightened, so that the microcatheter 17 fixed to the

Deflection catheter 18 is connected. The microcatheter 17 performs the movements illustrated in FIGS. 2a to 2i, with the result that the implant 10 is completely released in the two secondary vessels. In other words, the deflection catheter 18 takes the microcatheter 17 by a movement from proximal to distal in the side vessel into which the tip of the

Umlenkkathers 18 protrudes.

The exemplary embodiment according to FIG. 8b is constructed similarly to the exemplary embodiment according to FIG. 8a, the difference being that the deflection catheter 18 does not have a lateral opening 21, but rather that

Functional element 19, specifically the wire protrudes with the loop 20 through the distal end opening on the catheter tip. The microcatheter 17 is passed through the loop 20. By pulling the wire 19 in the

Deflection catheter 20, the micro-catheter 17 is connected to the deflection catheter 18, so that it can manipulate the micro-catheter 17 when dismissing the implant.

Again, when dismissing the implant from the microcatheter 17, a Y-shaped bifurcation 14 is formed in the interaction of the Mikrokatheters 17 with the guide member 19 and the wire 19, the part of the Umlenkkatheters 18 and generally the second guide member 12 forms. The wire 19 protrudes into the side vessel in which the implant is to be released. The deflection catheter 18 or its wire 19 takes the microcatheter 17 by a movement from proximal to distal in the side vessel with it.

FIGS. 9a, 9b show an embodiment of the catheter system which corresponds to independent claim 15. This embodiment can be considered to be the simplest form of catheter system in which the microcatheter can be manipulated by a diverter catheter 18 to change the release direction for the implant so that the implant 10 can be released in the lateral collateral vessels adjacent to the aneurysm. It is primarily important that the microcatheter 17 is so flexible that it can fold down when the implant 10 is released when the

Deflection catheter 18 entrains the microcatheter 17 in the other side vessel.

As regards the stiffnesses of the catheter elements, in particular the deflection catheter 18 and the microcatheter 17, the following should be stated: The catheter elements have different mechanical properties which are adapted to the respective function.

The rigid element, specifically the deflection catheter 18, serves to entrain the flexible element, specifically the catheter 17, during the stent delivery and should be made axially stable. The stability can be created by influencing the following parameters: Large diameter, large bending moment, stable material, composite structure with stiffening elements, internal wire, guide wire.

The flexible element, specifically the microcatheter 17, should respond flexibly to flexing to create low loads in the vessel. For optimum flexibility, the following design measures can be taken: small diameter, flexible material, composite construction with coil or braiding elements.

Claims

claims

Catheter system for feeding and discharging an implant (10) in the region of a vessel bifurcation, in particular for treating an aneurysm in the region of the vessel bifurcation, with a first one

Guide element (11) for feeding and discharging the implant (10), as it indicates that

a second guide element (12) or at least a part of the second guide element (12) and the first guide element (11) form a Y-shaped fork (14) at least when the implant (10) is discharged, wherein the first guide element (11) passes through the second guide element (12) or by at least a part of the second guide element (12) can be manipulated.

System according to claim 1,

That's why that is

the first guide element (11) and the second guide element (12) are differently flexible.

System according to claim 1 or 2,

That's why that is

the first guide element (11) and the second guide element (12) are firmly connected.

System according to one of the preceding claims,

That's why that is

the first guide element (11) and the second guide element (12) each form a branch (15, 16) of the Y-shaped bifurcation (14), wherein the first branch (15) formed by the first guide element (11) longer than that by the second guide element (12) formed second branch (16).

System according to one of the preceding claims,

That's why that is

the first guide element (11) and the second guide element (12) are movable relative to each other.

6. System according to any one of the preceding claims, da u rch nected net, that

the second guide element (12) is curved, in particular the second guide element (12) and the first guide element (11) are curved in opposite directions.

7. System according to one of the preceding claims,

That's why that is

the first guide element (11) comprises a microcatheter (17).

8. System according to one of the preceding claims,

That's why that is

the second guide element (12) consists of a deflection catheter (18) or comprises a deflection catheter (18) and at least one functional element (19).

9. System according to claim 8,

That's why that is

the functional element (19) comprises a driver, which in the

Deflection catheter arranged longitudinally movable and with the first

Guide element (11) is connected.

10. System according to claim 9,

That's why that is

the driver comprises a wire.

11. System according to claim 10

That's why that is

the wire forms a loop (20) through which the first guide element (11) is guided.

12. System according to claim 8,

That's why that is

the first guide element (11) is arranged coaxially in the deflection catheter (18), wherein the deflection catheter (18) has an opening (21) for the first guide element (11), which is arranged in the region of the fork (14).

13. System according to claim 12,

That's why that is

the first guide element (11) is arranged loosely in the deflection catheter (18).

14. System according to claim 12,

That's why that is

the deflection catheter (18) is designed with several lumens, wherein the first guide element (11) is arranged in a first lumen (22) of the deflection catheter (18).

15. A catheter system for delivering and discharging an implant (10) in the region of a vessel bifurcation for treating an aneurysm between a first and a second auxiliary vessel section

Vascular bifurcation, with a microcatheter (17) for delivering and discharging the implant (10),

That's why that is

the microcatheter (17) is arranged in a deflection catheter (18) and can be positioned in the first auxiliary vessel section next to the bifurcation, wherein the deflection catheter (18) is curved in such a way that the

Microcatheter (17) for complete discharge of the implant (10) in the second auxiliary vessel portion is positioned next to the bifurcation.