WO2022073441A1 - 植入式医疗器械的输送系统及其控制手柄、植入式医疗器械及其固定方法、装载方法、释放方法 - Google Patents

植入式医疗器械的输送系统及其控制手柄、植入式医疗器械及其固定方法、装载方法、释放方法 Download PDF

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Publication number
WO2022073441A1
WO2022073441A1 PCT/CN2021/121154 CN2021121154W WO2022073441A1 WO 2022073441 A1 WO2022073441 A1 WO 2022073441A1 CN 2021121154 W CN2021121154 W CN 2021121154W WO 2022073441 A1 WO2022073441 A1 WO 2022073441A1
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WO
WIPO (PCT)
Prior art keywords
implantable medical
medical device
wire
delivery system
balloon catheter
Prior art date
Application number
PCT/CN2021/121154
Other languages
English (en)
French (fr)
Inventor
范郑·万
曾·艾希莉·雷切尔
王翔
王健
周斌
Original Assignee
杭州启明医疗器械股份有限公司
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by 杭州启明医疗器械股份有限公司 filed Critical 杭州启明医疗器械股份有限公司
Priority to EP21876959.4A priority Critical patent/EP4226896A1/en
Priority to CN202180029856.XA priority patent/CN115426981A/zh
Publication of WO2022073441A1 publication Critical patent/WO2022073441A1/zh
Priority to US18/120,386 priority patent/US20230225864A1/en

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/9522Means for mounting a stent or stent-graft onto or into a placement instrument
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/24Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2412Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves
    • A61F2/2418Scaffolds therefor, e.g. support stents
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/24Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2427Devices for manipulating or deploying heart valves during implantation
    • A61F2/2436Deployment by retracting a sheath
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/962Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
    • A61F2/966Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
    • A61F2/9662Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod the middle portion of the stent or stent-graft is released first
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/24Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2427Devices for manipulating or deploying heart valves during implantation
    • A61F2/243Deployment by mechanical expansion
    • A61F2/2433Deployment by mechanical expansion using balloon catheter
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/958Inflatable balloons for placing stents or stent-grafts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2002/9505Instruments specially adapted for placement or removal of stents or stent-grafts having retaining means other than an outer sleeve, e.g. male-female connector between stent and instrument
    • A61F2002/9511Instruments specially adapted for placement or removal of stents or stent-grafts having retaining means other than an outer sleeve, e.g. male-female connector between stent and instrument the retaining means being filaments or wires
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/958Inflatable balloons for placing stents or stent-grafts
    • A61F2002/9583Means for holding the stent on the balloon, e.g. using protrusions, adhesives or an outer sleeve
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • A61F2/962Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
    • A61F2/966Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
    • A61F2002/9665Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod with additional retaining means

Definitions

  • the present application relates to the field of medical equipment, and in particular, to a delivery system of an implantable medical device and a control handle thereof, an implantable medical device and a fixing method, a loading method, and a releasing method thereof.
  • stents and prosthetic heart valves are now delivered to treatment sites within blood vessels and within the heart through a transcatheter procedure that avoids invasive procedures.
  • implantable medical devices such as stents and prosthetic heart valves
  • stents and prosthetic heart valves are loaded onto a balloon catheter in a compressed state and then passed through a catheter or sheath inserted into the vascular system to reach the target site.
  • the implanted medical device is then inflated to its intended size through the balloon body in the balloon catheter and secured in the desired treatment location, and finally the balloon body is deflated to a collapsed state and the balloon is withdrawn from the body catheter.
  • the fixation of the implantable medical device on the balloon body is usually accomplished by friction, or shoulders are provided on the balloon catheter to prevent the implantable medical device from moving during insertion and delivery.
  • the balloon body is inflated/liquid, the two ends of the balloon body are usually inflated/liquid first to play a blocking role and prevent the implantable medical device from moving on the balloon body.
  • the implanted medical device in a compressed state is exposed to the surrounding environment (eg, conventional sheaths, blood vessels, etc.), which may cause the implantable medical device to experience movement during insertion.
  • the surrounding environment eg, conventional sheaths, blood vessels, etc.
  • exposed implantable medical devices tend to expand outward on their distal outer surface, which can be hazardous to the artery.
  • the shoulders used to hold the implantable medical device on the balloon body can hold the implanted medical device in place, but the implanted medical device moves and presses against the shoulder, so the shoulder will There is a risk of puncturing the balloon body.
  • a delivery system for an implantable medical device including a balloon catheter, and also includes:
  • a sheath which is slidably fitted on the outer periphery of the balloon catheter and used to wrap the implantable medical device;
  • An adjustment wire is used to releasably fix the implantable medical device on the balloon catheter, one end of the adjustment wire can be kept fixed with the balloon catheter, and the other end can pass through the implantable medical device and be fixed on the balloon catheter. with keyhole;
  • the locking wire has a relative locked state and an unlocked state. In the locked state, the locking wire penetrates each locking hole to restrict the implantable medical device, and in the unlocked state, the locking wire is separated from each locking hole to release the implantation. type medical device.
  • each optional method can be independently implemented for the above-mentioned overall solution.
  • the combination can also be a combination between multiple optional ways.
  • the delivery system further includes a control handle, the balloon catheter, the sheath and the locking wire all extend to the control handle, and the balloon catheter, the sheath and the locking wire can move relatively.
  • the balloon catheter includes:
  • the guide head is provided with an insertion hole, and the end portion of the lock wire in the locked state extends into the insertion hole;
  • a balloon body adjacent to the guide head and located on the proximal end side of the guide head, the outer periphery of the balloon body is a loading area of the implantable medical device;
  • a catheter body communicates with the balloon body and extends toward the proximal end side of the delivery system.
  • the balloon catheter further includes:
  • the central tube is inserted through the catheter body, one end of the central tube extends toward the proximal side of the delivery system, and the other end penetrates the balloon body and is connected with the guide head.
  • the locking wire extends from a lumen defined between the sheath and the catheter body toward the proximal side of the delivery system.
  • the locking wire extends from a lumen defined inside the catheter body toward the proximal side of the delivery system.
  • the tube wall of the catheter body is provided with a through hole, and the distal end of the locking wire extends to the outside of the catheter body through the through hole, so as to cooperate with the adjustment wire.
  • the tube wall of the catheter body is provided with a radially inward concave area, and the through hole is opened at a proximal end side portion of the radially inwardly concave area.
  • At least two joints between the adjusting wire and the locking wire wherein at least one joint restricts the movement of the implantable medical device in the distal direction, and at least one joint restricts the implantable medical device.
  • the instrument moves in the proximal direction.
  • one or more adjustment wires there are one or more adjustment wires, and one or more locking holes may be provided for the same adjustment wire.
  • the lock holes are arranged in pairs, and in the same pair of lock holes, one of them is close to the distal end of the balloon catheter, and the other is close to the proximal end of the balloon catheter.
  • the end of the adjustment wire is wound into a wire loop structure, and the inside of the wire loop structure is the lock hole.
  • the adjustment line includes:
  • the first adjustment wire is connected to the balloon catheter and is adjacent to the distal end of the balloon catheter;
  • the second adjustment wire is connected to the balloon catheter and is adjacent to the proximal end of the balloon catheter;
  • the locking wire passes through the first locking hole and the second locking hole at the same time.
  • the distance between the end of the locking wire and the first locking hole satisfies a size range of at least 5 mm, for example, 8-30 mm.
  • the first adjustment wire and the second adjustment wire are respectively fixedly connected to the balloon catheter.
  • the first adjustment wire is fixed to the guide head.
  • the second adjustment wire is fixedly sleeved on the outer circumference of the catheter body.
  • the outer circumference of the catheter body is provided with a limit step, and the second adjustment wire is limited by the limit step.
  • both the first adjustment wire and the second adjustment wire are movably connected to the balloon catheter.
  • the first adjustment line and the second adjustment line are connected by a connecting line.
  • At least one of the first adjustment wire and the second adjustment wire is integrally formed with the connecting wire.
  • the connecting wire extends toward the proximal side of the delivery system.
  • the connecting wire extends toward the proximal side of the delivery system in the central tube, and can be pulled and moved relative to the balloon catheter.
  • one of the first adjustment line and the second adjustment line is a fixed adjustment line that is fixedly connected to the balloon catheter, and the other is a movable adjustment line that can be pulled relative to the balloon catheter.
  • a middle sheath is movably passed through the lumen defined between the sheath and the catheter body, and the movable adjustment wire is connected with the middle sheath.
  • the central tube has multiple lumens, and the movable adjustment line extends along one of the lumens.
  • one of them is a central lumen, and at least the other is an eccentrically arranged second lumen, and the movable adjustment wire extends through the second lumen.
  • the cavity wall of the second cavity is provided with two openings, and the first adjustment line and the second adjustment line extend out of the central tube through the corresponding openings.
  • the implantable medical device is provided with a ring body, and in the locked state, the end of the adjustment wire with the locking hole passes through the corresponding ring body, and then cooperates with the locking wire.
  • ring bodies which are respectively located at two opposite ends of the implantable medical device.
  • the configuration mode of the ring body is at least one of the following modes:
  • the implantable medical device has a tubular device body, and one end of the adjustment wire with a locking hole is guided radially from the inside of the device body toward the outside of the device body.
  • ring bodies which are located at two axial ends of the instrument body respectively.
  • the locking wire is a metal rod.
  • the delivery system further includes a bend adjustment member, the bend adjustment member is located on the inner side, the outer side of the catheter body, or in the interlayer of the pipe wall, the distal end of the bend adjustment member and the catheter body. Site interaction causes the balloon catheter to flex at the distal site.
  • the proximal end of the bending member is connected to and controlled by the control handle.
  • the bend adjustment member is a bend adjustment wire or a bend adjustment tube
  • the distal ends of the bend adjustment member and the catheter body are fixed, and the proximal end slides and fits to make the balloon catheter bend at the distal end.
  • the bend adjustment piece includes an inner bend adjustment pipe and an outer bend adjustment pipe that are nested in each other, the inner bend adjustment pipe and the outer bend adjustment pipe are fixed at their distal ends, and the proximal ends are slidably matched to make the bend adjustment pipe.
  • a piece deflects at the distal end and acts on the catheter body.
  • the bending member is fixedly connected or movably matched with the distal ends of the catheter body.
  • At least one of the inner bending tube and the outer bending tube is movably connected to a control handle.
  • a first mounting seat slidably arranged on the support body
  • a first driving member movably mounted on the support body, and in driving cooperation with the first mounting seat;
  • the first mounting seat includes a body with an inner cavity, and is opened on the body and communicated with the inner cavity:
  • Proximal port for threading the guide wire.
  • control handle further includes a second drive assembly mounted on the support body, the second drive assembly is located on the proximal side of the first drive assembly, and the second drive assembly includes:
  • the second mounting seat is slidably arranged on the support body
  • the second driving member is movably mounted on the support body and is in driving cooperation with the second mounting seat.
  • control handle further includes a third drive assembly mounted on the support body, the third drive assembly is located between the first and second drive assemblies, and the third drive assembly includes :
  • the third mounting seat is slidably arranged on the support body
  • a third driving member is movably mounted on the support body and is in driving cooperation with the third mounting seat.
  • the support body has an axial direction in space
  • the support body is provided with a guide groove extending along its own axial direction
  • each mounting seat is slidably arranged in the corresponding guide groove; each driving member is rotated and sleeved respectively.
  • the distal port and the proximal port are aligned with each other.
  • the proximal end of the catheter body is sealingly connected to the distal interface, and the proximal end of the central tube extends out of the catheter body and then extends in the lumen of the first mounting seat and is sealingly connected to the proximal interface;
  • the drive interface communicates to the radial gap between the conduit body and the central tube.
  • the proximal end of the locking wire extends into the inner cavity of the first mounting seat, it directly passes through the first mounting seat through the limit interface, or passes through the side wall of the branch pipe where the limit interface is located. first mount.
  • the branch pipe where the limiting interface is located extends obliquely toward the proximal end of the support body, and the included angle ⁇ with the axis of the support body satisfies 0° ⁇ 60°. For example, 10 degrees ⁇ 45 degrees, and for example, 15 degrees ⁇ 30 degrees.
  • the present application discloses a delivery system for an implantable medical device, including a balloon catheter, and also includes:
  • a sheath which is slidably fitted on the outer periphery of the balloon catheter and used to wrap the implantable medical device;
  • An adjustment wire for releasably fixing the implantable medical device on the balloon catheter one end of the adjustment wire can be kept fixed with the balloon catheter, and the other end is provided with a key hole and is implanted Type medical devices pass through;
  • the locking wire has a relative locked state and an unlocked state.
  • the locked state the locking wire passes through the implantable medical device to restrict the separation of the implantable medical device from the adjustment wire.
  • the unlocked state the locking wire is separated from the implant. The implantable medical device is allowed to disengage and release the implantable medical device.
  • a ring body is provided on the implantable medical device, and in a locked state, the ring body passes through the end of the corresponding adjustment wire with a locking hole, and cooperates with the locking wire.
  • the present application also discloses an implantable medical device, comprising a stent and valve leaflets connected to the stent, the stent is a radially deformable structure and has a relatively compressed state and an expanded state, the implantable medical device
  • the apparatus also includes a tethered ring connected to the stent circumferentially around the stent, the tethered ring limiting the magnitude of radial deformation of the stent as the stent enters the expanded state.
  • the position of the bundle ring is located in the middle of the stent or adjacent to the inflow side of the stent.
  • the position of the bundle ring is adjacent to the position of the inflow side of the valve leaflet.
  • the width of the bundle ring is 2-30 mm.
  • 5 to 20 mm and another example of 5 to 15 mm.
  • Another example is 8mm.
  • the bundle ring is a flexible material that can be compressed with the stent.
  • the beam ring is stitched to the stent.
  • the bundle ring is a metal wire.
  • the stent along the axial direction of the stent, includes a bundle-shaped segment corresponding to the position of the bundle-shaped ring, and a free segment on both sides of the bundle-shaped segment.
  • the segments have a smaller outer diameter.
  • the stent is in the shape of a mesh cylinder with a hollow structure and has an axial direction in space. According to the direction of blood flow, one end of the axial direction of the stent is the inflow side, the other end is the outflow side, and the inside of the stent is the axis.
  • the valve leaflets For the through-flow channel, the valve leaflets have 2, 3 or 4 valves, and each valve leaflet cooperates with each other to open or close the blood flow channel.
  • the implantable medical device further includes a first covering connected to the inner side of the stent, and the first covering is butted on the inflow side of the valve leaflet.
  • the implantable medical device further includes a second covering film connected to the outside of the stent, the second covering film is butted on the inflow side of the beam-shaped ring.
  • the first covering film and the second covering film are integral structures.
  • both the first covering film and the second covering film extend to the inflow side of the stent, and they are butted against each other to wrap the inflow side edge of the stent.
  • one of the first covering film and the second covering film extends to the inflow side of the stent and then is folded to wrap the inflow side edge of the stent, and is further extended and docked to the other after being folded. the outflow side of the user.
  • the first covering film and/or the second covering film is provided with an incision at an edge portion adjacent to the inflow side of the stent, and the position of the incision matches the shape of the inflow side edge of the stent.
  • the inflow side of the support includes a plurality of cells arranged in the circumferential direction, adjacent cells are provided with structural gaps facing the inflow side, and the incisions are matched with the corresponding structural gaps.
  • the first coating and/or the second coating is serrated at the edge portion adjacent to the inflow side of the stent, the incision is between the adjacent teeth, and the positions on both sides of the incision are corresponding to the stent. Stitch connection.
  • the present application provides an implantable system, including an implantable medical device and a delivery system matched with the implantable medical device.
  • the present application discloses a release method for an implantable medical device, wherein the implantable medical device is pre-fixed on the delivery system, and the release method includes:
  • the balloon body is deflated, and the balloon catheter is moved toward the proximal side of the delivery system to separate from the implantable medical device.
  • the present application provides a method for loading an implantable medical device, which is used to fix the implantable medical device to the delivery system, and the loading method includes:
  • the application provides a method for fixing an implantable medical device on a balloon catheter, comprising the following steps:
  • An implantable medical device has a tubular device body, the tubular device body has a first end and a second end, the first end is provided with a first ring body, the second end A second ring body is provided;
  • a balloon catheter comprising:
  • balloon body adjacent to and at a proximal end of the guide head, the balloon body having opposite distal and proximal ends;
  • first adjustment wire having a first locking hole
  • the first adjustment wire is adjacent to the distal end of the balloon catheter and fixed to the balloon catheter
  • the second adjustment wire is at a position adjacent to the proximal end of the balloon catheter, and is fixed to the balloon catheter;
  • the sheath for sliding movement over the catheter body and the balloon, the sheath having a distal end;
  • the sheath is slid over the implanted medical device in a compressed state until it is advanced to the guide head to completely cover the implantable medical device.
  • the step of advancing the locking wire includes the step of advancing the locking wire through a lumen defined between the sheath and the catheter body to extend beyond the distal end of the sheath.
  • the step of passing through the first and second locking holes includes the step of locking the first and second locking holes on the first and second ring bodies, respectively.
  • each of the first ring body and the second ring body is provided as a separate ring body and is connected to the first and second ends of the implantable medical device, respectively.
  • each of the first and second loops are provided as rounded tips at the first and second ends of the implantable medical device, respectively.
  • each of the first and second loops are provided as openings in vertices of the first and second ends of the implantable medical device, respectively.
  • a connecting line connecting the first and second adjustment lines is further provided.
  • it also includes providing a central lumen extending through the balloon body, wherein the connecting line extends through the central lumen.
  • it also includes providing an intermediate sheath extending through a lumen defined between the sheath and the catheter body, the second adjustment wire being connected to the distal end of the intermediate sheath.
  • a method for implanting an implantable medical device into a human organ comprising the following steps:
  • the balloon body is deflated; the balloon catheter is withdrawn directly at the proximal end.
  • the present application accordingly provides an implantable artificial heart valve, a delivery system for the implantable artificial heart valve, and an implantable system for the artificial heart valve.
  • the related methods are the same as the method for releasing the implantable artificial heart valve, the method for loading the implantable artificial heart valve, and the method for fixing the implantable artificial heart valve on the balloon catheter.
  • the present application effectively secures the implantable medical device to the delivery system for delivery to the treatment site, and for deployment at the treatment site, the improved locking method can lock the medical device on the deflated balloon body to avoid displacement; further End expansion of the implantable medical device is also prevented by the covering of the sheath, thereby minimizing the risk of puncturing the balloon body.
  • FIG. 1A is an exploded schematic diagram of an implantable medical device and a balloon catheter according to an embodiment of the application;
  • Fig. 1B is a schematic diagram of the implantable medical device in Fig. 1A being positioned around a balloon body;
  • FIG. 2 is a schematic view of the implantable medical device in FIG. 1A in a compressed state and surrounding a balloon body;
  • 3A is a schematic view of the adjustment wire after passing through the loop on the end of the implantable medical device
  • Fig. 4 is the schematic diagram after pushing the sheath on the periphery of the implantable medical device
  • FIG. 5 is a schematic diagram of withdrawing the sheath to expose the implantable medical device
  • Fig. 6 is the schematic diagram after balloon body is unfolded
  • Figure 7 is a schematic diagram of the process of pulling out the lock wire from the lock hole and entering the sheath
  • FIG. 8 is a schematic diagram of the balloon body being deflated and entering a contracted state
  • Figure 9 is a schematic diagram of the balloon catheter being pulled out from the implantable medical device.
  • 10-12B are schematic diagrams of different embodiments of the implantable medical device in FIG. 1A after changing different ring structures;
  • Figure 13B is a partial cross-sectional view of Figure 13A;
  • Figure 14A is a schematic view of the adjustment wire in Figure 13A after it is tightened
  • Figure 14B is a partial cross-sectional view of Figure 14A;
  • FIG. 15A is a schematic diagram of another embodiment of the present application configured with an intermediate sheath
  • Figure 15B is a schematic illustration of the intermediate sheath of Figure 15A retracted and the locking wire tensioned.
  • 16 is a schematic structural diagram of a conveying system according to an embodiment of the present application.
  • 17 is a schematic view of the ring body at the end of the implantable medical device passing through the locking hole of the adjustment wire;
  • 18 is a schematic view of the locking wire extending to the guide head after passing through the loop body on the implantable medical device;
  • Figure 19 is a schematic view of the balloon body in Figure 18 after expansion
  • 20 is a schematic diagram of the connection between the bending member and the distal end portion of the catheter body in an embodiment of the application;
  • Figure 21 is an enlarged view of the K part in the state in which the bending member and the catheter body are fixedly connected in Figure 20;
  • Fig. 22 is a schematic diagram of the bending adjustment of the acting guide body after the bending member in Fig. 21 is moved;
  • Fig. 23 is an enlarged view of the K portion in the state where the bending member and the catheter body are movably connected in Fig. 20;
  • Figure 24 is a schematic diagram of the bending adjustment of the guide body after the bending part in Figure 23 is moved;
  • FIG. 25 is a schematic structural diagram of a part of a balloon catheter in an embodiment of the application.
  • Figure 26 is an enlarged view of the J part in Figure 25;
  • FIG. 27 is a schematic diagram of the matching structure of the limit step between the second adjustment wire and the catheter body according to an embodiment of the application;
  • Figure 28 is the exploded view of Figure 16;
  • Figure 29 is a cross-sectional view of the control handle in Figure 16.
  • Figure 30 is a cross-sectional view at the balloon catheter in Figure 16.
  • Figure 31 is an enlarged view of part A in Figure 28;
  • Figure 32 is an enlarged view of part B in Figure 28;
  • Figure 33 is an enlarged view of G part in Figure 29;
  • Fig. 34 is the enlarged view of C part in Fig. 28;
  • Figure 35 is an enlarged view of part D in Figure 28;
  • Figure 36 is an enlarged view of part H in Figure 29;
  • Fig. 37 is the enlarged view of E part in Fig. 28;
  • Figure 38 is an enlarged view of part F in Figure 28;
  • Figure 39 is an enlarged view of part I in Figure 29;
  • Fig. 40 is a partial enlarged view of the guide head in Fig. 30;
  • Figure 41 is a schematic structural diagram of the first mounting seat in Figure 28;
  • Figure 42 is a cross-sectional view of the first driving member in Figure 16;
  • FIG. 43 is a schematic diagram of the implantable medical device in a compressed state after being loaded with a beam ring according to an embodiment of the application;
  • 44 is a schematic diagram of an implantable medical device in an expanded state after being loaded with a beam ring according to an embodiment of the application;
  • FIG. 45 is a perspective view of the implantable medical device in an expanded state after being loaded with a beam ring according to an embodiment of the application;
  • 46 is a partial structural schematic diagram of a first covering film in an implantable medical device according to an embodiment of the application.
  • FIG. 47 is a partial structural schematic diagram of the first coating film and the second coating film in the implantable medical device according to an embodiment of the application.
  • FIG. 48 is a partial structural schematic diagram of the first covering film and the second covering film in the implantable medical device according to another embodiment of the present application.
  • FIG. 49 is a schematic structural diagram of an exhaust assembly in a control handle according to an embodiment of the application.
  • 100 implantable medical device; 102, cell; 103, stent; 104, heart valve assembly; 105, ring body; 105a, ring body; 105b, tip; 105c, tip; 105d, ring body; 105e, ring body ; 106, distal end; 107, proximal end; 108, leaflet; 109, beam ring; 111, first covering; 112, second covering; 113, inflow side; 114, outflow side; 115, through hole ;
  • 140 connecting wire; 8a, locking area; 8b, locking area; LK, locking area; 11a, locking knot; 11b, locking knot; 141, central lumen; 142, second lumen; 143, second opening; 144, the first opening; 150, the middle sheath;
  • control handle 210, support body; 211, guide groove; 212, guide surface; 220, first drive assembly; 221, first mounting seat; 222, first drive member; 230, second drive assembly; 231, 232, the second driving member; 240, the exhaust assembly; 241, the connecting head; 242, the liquid injection pipe; 250, the third driving member; 251, the third mounting seat; 252, the third driving member; 253, fixed mount; 261, remote interface; 262, drive interface; 263, limit interface; 264, proximal interface; 265, operating part;
  • Adjustable bending parts 301. Inner adjustment bend pipe; 302, Outer adjustment bend pipe.
  • a component when referred to as being "connected" to another component, it can be directly connected to the other component or an intervening component may also exist. When a component is considered to be “set on” another component, it may be directly set on the other component or there may be a co-existing centered component.
  • the implantable medical device 100 can be any implantable medical device implanted in the human body, such as stents, transcatheter heart valves, stent-graft assemblies, Closures and stoppers, etc.
  • the figures in this application are illustrated in conjunction with an expandable stented transcatheter heart valve assembly 104 or a stent frame for a transcatheter heart valve.
  • a heart valve as an example, it can be specifically applied to aortic valve, mitral valve, tricuspid valve, pulmonary valve, etc.
  • the heart valve assembly 104 has a tubular instrument body, such as a hollow cylindrical stent 103, the stent 103 is braided or engraved with a frame structure, for example, can be braided from a single wire or multiple wires, or Can be laser cut from metal (eg Nitinol) tubes.
  • a plurality of cells 102 are defined by the frame strip structure.
  • the delivery system for an implantable medical device of the present application includes a balloon catheter 120 and further includes:
  • the sheath 123 is slidably fitted on the outer periphery of the balloon catheter 120 for wrapping the implantable medical device 100;
  • the adjustment wire is used for releasably fixing the implantable medical device 100 on the balloon catheter 120, one end of the adjustment wire can keep the fixation with the balloon catheter 120, and the other end can pass through the implantable medical device 100 and be fixed on the balloon catheter 120. with keyhole;
  • the locking wire 126 has a relative locked state and an unlocked state. In the locked state, the locking wire 126 penetrates each locking hole to restrict the implantable medical device. In the unlocked state, the locking wire 126 is separated from each locking hole to release the implantable medical device. Medical device 100 .
  • the balloon catheter 120 has an axial length and has a corresponding proximal end 132 and a distal end 128.
  • the distal end 128 is the end of the balloon catheter 120 that first extends into the human body, and the proximal end 132 is the same as the one.
  • the delivery system has proximal and distal ends in the same orientation as the balloon catheter 120 . That is, the remaining components within the delivery system, eg, sheath 123 , locking wire 126 , etc., have a distal end 128 and a proximal end 132 with balloon catheter 120 .
  • the implantable medical device 100 can be separated from the delivery system.
  • the implantable medical device 100 has a distal end 106 and a proximal end 107 .
  • the balloon catheter 120 is made of an elastic material and is disposed at the distal end of the delivery system, capable of bending and allowing the implantable medical device 100 disposed thereon to reach the lesion site. Referring to 1B and FIG. 6 , the balloon catheter 120 can also be inflated/fluid to expand itself, driving the implantable medical device 100 to switch to the expanded state. Of course, after deflation/fluid, the balloon catheter 120 switches to the deflated state.
  • the implantable medical device 100 has a compressed state and an expanded state, and can switch between the expanded and compressed states.
  • the sheath 123 is a hollow tubular shape, which is slidably mounted on the delivery system and slides axially along the balloon catheter, thereby changing the restraint state of the implantable medical device 100.
  • the implantable medical device 100 can be restrained inside the implantable medical device 100 at the periphery to limit the expansion of the implantable medical device 100.
  • the sheath 123 slides relative to the balloon catheter 120 and completely withdraws from the expansion path of the implantable medical device 100, it makes Implantable medical device 100 is exposed, allowing implantable medical device 100 to expand.
  • the adjustment wire is used to limit the misalignment between the implantable medical device 100 and the balloon catheter 120 (especially in the axial direction of the balloon catheter 120 ) during the operation, which may affect the implantable medical device.
  • the three-dimensional shape of the device 100 after entering the inflated state may even pose a safety hazard.
  • the adjustment line to releasably fix the implantable medical device 100 on the balloon catheter 120 can be understood as the premise of avoiding axial dislocation as much as possible. Affect the release of the implantable medical device 100 .
  • one end of the adjustment wire can be kept fixed with the balloon catheter 120, and in some cases, this end can also be controllably moved relative to the balloon catheter 120, which can flexibly adjust the position of the implantable medical device 100. position, but also to avoid interference with its release.
  • the elastic deformation of the adjusting wire itself can be used within a predictable range, or the adjusting wire can be operated by using a transmission component, and so on.
  • the other end of the adjustment wire is bound by the locking wire 126 after passing through the implantable medical device 100.
  • the specific threading method of the adjusting wire and the implantable medical device 100 is not strictly limited.
  • the combination of the locking hole and the locking wire on the adjustment wire The position can be regarded as a limit point; as far as a limit point is concerned, at least the movement of the implantable medical device in a certain direction in the axial direction of the balloon catheter can be restricted or interfered to reduce mutual misalignment.
  • the adjustment wire itself is a rigid part, even one joint part can limit the dislocation of the implantable medical device in two directions. If the adjustment wire is flexible and the length of the deformable part is short, it can basically meet the above requirements. .
  • the same adjustment wire can provide one or more lock holes.
  • the keyholes are arranged in pairs, such as one or more pairs, in the same pair of keyholes, one of the keyholes is near the distal end of the balloon catheter (in use), and the other is near the proximal end of the balloon catheter.
  • the combination of the locking hole and the locking wire near the distal end of the balloon catheter can restrict the proximal movement of the implantable medical device
  • the combination of the locking hole and the locking wire near the proximal end of the balloon catheter can restrict the movement of the implantable medical device to the distal end.
  • the implantable medical device 100 is provided with a ring body 105 .
  • the ring body 105 cooperates with the locking wire 126 after passing through the end of the corresponding adjustment wire with the locking hole.
  • the locking wire 126 is used to restrict the adjustment wire from leaving the ring body 105, so that the adjustment wire cannot be separated from the implantable medical device 100, which is mainly reflected in the implantable medical device.
  • 100 slides over the balloon catheter 120 and is eventually restricted from further sliding at the keyhole. The axial sliding of the implantable medical device 100 relative to the balloon catheter in the compressed/expanded state is restricted.
  • the ring body 105 passes through the locking hole, and the locking wire 126 restricts the ring body 105 from being separated from the adjustment wire.
  • the operation of inserting the lock hole through the ring body 105 or the ring body 105 through the lock hole, and the operation of inserting the lock wire through the lock hole or the ring body 105 can be done manually or in other ways.
  • the locking wire 126 is movably passed through the delivery system.
  • the locked state after passing through all the locking holes or the ring body 105 in sequence, the two ends are fixed, and the interaction between the three limits the separation of the adjusting wire from the implantable medical device 100 .
  • the locking wire 126 can be disengaged from the delivery system at its distal end. After the locking wire 126 is disengaged from the operation and completely withdraws from all the locking holes or the ring body 105 , the lock wire 126 is correspondingly switched to the unlocked state.
  • the delivery system further includes a control handle 200, the balloon catheter 120, the sheath 123 and the locking wire 126 all extend to the control handle 200, and the balloon catheter 120, the sheath 123 and the locking wire 126 can relative motion.
  • the balloon catheter 120 includes:
  • the guide head 127 is provided with an insertion hole 138, and the end portion of the locking wire 126 in the locked state extends into the insertion hole;
  • the balloon body 122 adjacent to the guide head 127 and located at the proximal end side of the guide head 127, the outer periphery of the balloon body 122 is the loading area of the implantable medical device 100;
  • the catheter body 124 communicates with the balloon body 122 and extends toward the proximal side of the delivery system.
  • the distal end of the balloon catheter 120 is the guide head 127, and the locking wire 126 is inserted into the insertion hole to be fixed, so as to avoid the unintended release of the adjustment wire.
  • the balloon body 122 is provided near the guide head 127 and on the proximal end side of the guide head 127 .
  • the introducer head 127 may have a tapered configuration that tapers from its proximal end 128 to its most distal end to facilitate in vivo guidance of the balloon body 122 and catheter body 124 at the proximal end, and may provide at the proximal end 128 a diameter smaller than The diameter of the proximal end 128 is a cylindrical connector 129 which extends further in the proximal direction.
  • the distal end of the balloon body 122 is secured to the proximal end surface of the connector 129 and the proximal end of the balloon body 122 is secured to the distal end 132 of the catheter body 124 .
  • the balloon body 122 is hollow inside and can be inflated/fluid and other components penetrated.
  • the catheter body 124 is a hollow tube, and the proximal end extends into the control handle 200.
  • the catheter body also serves as a fluid channel, communicates with the interior of the balloon body, and delivers gas. /fluid is used to expand the balloon body 122.
  • the sheath 123 can be used to slide along the length direction of the catheter body 124 on the outer periphery of the catheter body 124 and the balloon body 122 to play a certain protective role.
  • the balloon body 122 and the catheter body 124 are both made of elastic material, which is convenient for deformation and change.
  • the balloon catheter 120 further includes:
  • the central tube 133 is inserted into the catheter body 124 , one end of the central tube 133 extends toward the proximal side of the delivery system and is connected to the control handle 200 , and the other end penetrates the balloon body 122 and is connected to the guide head 127 .
  • the central tube 133 is a hollow tube and is made of elastic material, which can be bent along with it. Both ends of the central tube 133 pass through, and the inside serves as a guide wire channel.
  • the setting method of the locking wire 126 can be as follows:
  • the locking wire 126 extends from the lumen 137 defined between the sheath 123 and the catheter body 124 toward the proximal side of the delivery system.
  • the sheath 123 is slidably disposed on the outer circumference of the catheter body 124 , and a lumen 137 for accommodating the locking wire 126 is formed therebetween.
  • the locking wire 126 extends from the lumen 137 defined inside the catheter body 124 toward the proximal side of the delivery system.
  • the tube wall of the catheter body 124 is provided with a through hole 161, and the distal end of the locking wire 126 extends to the outside of the catheter body 124 through the through hole for matching with the adjustment wire.
  • the tube wall of the catheter body 124 has a radially inward concave area 160 , and the through hole 161 is opened at the proximal end side of the radially inwardly concave area 160 .
  • the concave area 160 reduces the bending variation of the locking wire 126 at the through hole 161 , so that the locking wire 126 moves more smoothly.
  • the through hole is a bar-shaped hole, and the length direction is consistent with the axial direction of the catheter body.
  • the locking wire is a metal rod.
  • the locking wire 126 can be made of 304 or 316 stainless steel (the wire diameter of the locking wire can generally be about 0.5mm), which improves the strong axial pushing force and facilitates the penetration of the lock hole or the ring body.
  • the outer surface of the locking wire 126 is coated with PTFE, which reduces friction with other tubes and wires and is non-sticky, so that the locking wire 126 can slide smoothly.
  • the end of the adjustment wire is wound into a wire loop structure, and the inside of the wire loop structure is a lock hole.
  • the lock hole can also be another wire wound to form a ring structure, and then fixed with the end of the adjustment wire.
  • the wire material used can be the same as the adjustment wire or other materials.
  • the formation of the keyhole is not limited to this.
  • the circumferential direction of the lock hole is generally a closed structure, but in the case that the lock wire can be restricted from coming out, a circumferential non-closed structure can also be used.
  • the adjustment line includes:
  • the first adjustment wire 121 has a first locking hole 135, the first adjustment wire 121 is connected to the balloon catheter 120, and is adjacent to the distal end 106 of the balloon catheter 120;
  • the second adjustment wire 131 has a second locking hole 136, the second adjustment wire 131 is connected to the balloon catheter 120, and is adjacent to the proximal end 107 of the balloon catheter 120;
  • the locking wire 126 passes through the first locking hole 135 and the second locking hole 136 at the same time.
  • the two adjustment lines are located at the proximal end and the distal end of the balloon catheter 120 respectively, so as to limit the two axial directions of the implantable medical device 100 .
  • the first adjustment wire 121 and the second adjustment wire 131 may be one or more, respectively, and the multiple wires are arranged at intervals along the circumference of the balloon catheter 120. Both the first adjustment wire 121 and the second adjustment wire 131 are connected to the balloon.
  • the connection positions (circumferential positions) of the catheters 120 may be aligned or misaligned with each other.
  • One or more locking lines can be provided. Taking the first adjusting line 121 as an example, if the number of locking lines is less than that of the first adjusting line 121, the first locking holes 135 on the plurality of first adjusting lines 121 can share one of them. lock wire. When multiple locking lines are set, each locking line can be controlled independently or linked with each other, preferably synchronous movement.
  • the movable range of the implantable medical device 100 on the balloon catheter 120 is controlled.
  • the locking wire 126 passes forward through the first locking hole 135 and the second locking hole 136 and enters the insertion hole 138 in the guide head 127 .
  • the locking area LK in FIG. 3B shows the mating relationship at the locking position, in which the locking wire 126 passes through the locking holes in sequence after each locking hole passes through the corresponding ring body 105 .
  • the holes in the guide head 127 should have a certain depth so that the locking wire 126 can be securely locked in the guide head 127 .
  • the heart valve assembly 104 of the present embodiment is securely restrained on the balloon body 122 by the restraint provided by the first adjustment wire 121 and the second adjustment wire 131 and the locking wire 126 to prevent any lateral direction (the orientation of the catheter body 124 in the figure). length direction).
  • the distance between the end of the locking wire 126 and the first locking hole 135 is at least 5 mm, for example, 8-30 mm.
  • connection of each adjustment wire relative to the balloon catheter may be configured differently.
  • one of the first adjustment wire 121 and the second adjustment wire 131 is a fixed adjustment wire that is fixedly connected to the balloon catheter 120 , and the other is a movable adjustment wire that can be pulled and moved relative to the balloon catheter 120 . .
  • first adjustment wire 121 and the second adjustment wire 131 are fixedly connected to the balloon catheter 120, respectively.
  • the first adjustment wire 121 can be directly fixed to at least one of the guide head 127 , the connector 129 or the balloon body, and the specific fixing method can be at least one of tying, bonding and other methods.
  • the end of the adjustment wire is bound to the above-mentioned corresponding component (at least one of the guide head, the connector or the balloon body).
  • the corresponding component at least one of the guide head, the connector or the balloon body.
  • the end of the adjustment wire is wound into a wire loop
  • the end of the adjustment wire and the corresponding part are hot melt bonded.
  • the first adjustment wire 121 is fixed to the connector 129 , and the first adjustment wire 121 extends from the connector 129 toward the proximal end of the balloon body 122 .
  • the second adjustment wire 131 is fixed to the distal end 132 of the catheter body 124 and has a keyhole, and the second adjustment wire 131 extends from the distal end 132 in the distal direction of the balloon body 122 .
  • the first adjustment wire 121 is fixed into the guide head 127 .
  • the second adjustment wire 131 can be directly fixed to at least one of the catheter body or the balloon body, and the specific fixing method can refer to the connection method of the first adjustment wire 121 .
  • the second adjustment wire 131 is fixedly sleeved on the outer circumference of the catheter body 124 .
  • the outer circumference of the catheter body 124 is provided with a limit step 139, and the second adjustment wire 131 is limited by the limit step.
  • the connecting end of the second adjusting wire 131 and the catheter body 124 is bound to form a ring structure, and the ring structure is wound around the outer circumference of the catheter body 124 and is at the proximal end of the limiting step 139 .
  • a limiting slot can also be used, that is, the end of the second adjusting wire 131 is wound in the limiting slot.
  • both the first adjustment wire 121 and the second adjustment wire 131 are movably connected to the balloon catheter 120 .
  • One end of the two adjustment wires has a lock hole, and the other end can be regarded as a movable end, which can be controllably expanded and retracted relative to the balloon catheter 120 to control the length of the exposed part outside the balloon catheter 120, thereby limiting the implantable medical device. Sliding range of 100.
  • the first adjustment wire 121 and the second adjustment wire 131 are connected by a connecting wire 140 .
  • Operating the connecting wire 140 can simultaneously drive the first adjusting wire 121 and the second adjusting wire 131 .
  • 13A and 13B show the connection wire 140 in a relaxed state, so that the exposed portions of the first adjustment wire 121 and the second adjustment wire 131 are excessively long.
  • the implanted medical device 100 in the compressed state has a space for sliding back and forth (see the adjustable locking knot 11 a ), so it is fixed not effectively.
  • the connection wire 140 is pulled tight, the first adjustment wire 121 and the second adjustment wire 131 are also pulled, so that the exposed portions of the first adjustment wire 121 and the second adjustment wire 131 are shortened.
  • FIG. 13A shows the connection wire 140 in a relaxed state, so that the exposed portions of the first adjustment wire 121 and the second adjustment wire 131 are excessively long.
  • the first locking hole 135 and the second locking hole 136 located at the ends of the first adjustment wire 121 and the second adjustment wire 131, respectively, are aligned with the ring body 105 on the implantable medical device 100 (see available Adjust the locking knot 11b) so that the implantable medical device 100 is tightly fixed.
  • At least one of the first adjustment wire 121 and the second adjustment wire 131 and the connecting wire 140 are integrally formed.
  • the bonding of the two wires (eg gluing or tying) will increase the thickness at the connection point, and the one-piece construction will reduce one connection point.
  • the connecting wire 140 extends toward the proximal side of the delivery system.
  • the connecting wire 140 extends to the control handle 200 on the proximal side for easy control.
  • the specific extension path of the connecting wire 140 is not strictly limited, for example, it may extend radially inside the central tube, outside the catheter body, between the central tube and the catheter body, on the wall of the central tube, or on the tube wall of the catheter body.
  • the connecting wire 140 extends in the central tube 133 toward the proximal side of the delivery system, and can be pulled relative to the balloon catheter 120 .
  • the connecting wire 140 moves toward the proximal side, the exposed portions of the two adjustment wires are forced to shorten, and the relative movement of the implantable medical device 100 is restricted.
  • the connecting wire 140 may move slightly distally in order to accommodate the size change.
  • an appropriate margin can be left to accommodate the release of the implantable medical device 100.
  • the margin can at least avoid the implantable medical device 100. of excessive dislocation. This margin can also be relaxed if the axial length of the balloon catheter 120 is sufficient.
  • the central tube 133 has a plurality of lumens, and the movable adjustment line extends along one of the lumens.
  • Guide wires or other wires can be passed through the remaining lumen, and each wire and guide wire has a separate channel, which does not interfere with each other and avoids winding interference.
  • one of them is the central lumen 141
  • at least the other is the second lumen 142 arranged eccentrically
  • the movable adjustment wire extends through the second lumen 142 .
  • the guide wire extends through the central lumen 141 in use.
  • the cavity wall of the second cavity 142 is provided with two openings, and the first adjustment wire 121 and the second adjustment wire 131 extend out of the central tube 133 through the corresponding openings.
  • an intermediate sheath 150 is movably passed through the lumen defined between the sheath 123 and the catheter body 124 , and the movable adjustment wire is connected with the intermediate sheath 150 .
  • the intermediate sheath 150 is used as a transmission member, which is more convenient to extend to the proximal end and connect with the control handle.
  • the second adjustment wire 131 can be fixed to the distal end of the intermediate sheath 150, and the first adjustment wire 121 can be directly fixed to the connector 129 or Its fixed position is adjacent to the connector 129 .
  • the intermediate sheath 150 is advanced toward the distal side of the balloon body 122, and the distal end of the intermediate sheath 150 protrudes from the sheath 123 and is exposed, so that the first locking hole 135 and the second locking hole 136 can be extended through the corresponding ring body 105 .
  • FIG. 15B the intermediate sheath 150 is moved in a proximal direction away from the balloon body 122, which causes the first and second adjustment wires 121 and 131 to be tightened, and the first and second locking holes 135 and 131 are tightened. 136 is locked by the corresponding ring body 105 .
  • This embodiment (FIGS. 15A and 15B) operates on similar principles to the above-described embodiments, with the main difference being that an intermediate sheath 150 is provided instead of a longer adjustment wire or connecting wire.
  • the two opposite ends are located at both ends of the implantable medical device in the axial direction.
  • the two rings 105 are respectively provided for the first locking hole 135 and the second locking hole 136 to pass through. After the locking wire 126 passes through the two locking holes in sequence, the end of the locking wire 126 is fixed relative to the guide head to complete the locking.
  • the two ring bodies 105 can also pass through the first locking hole 135 and the second locking hole 136 correspondingly, and the locking wire 126 passes through the two ring bodies 105 in sequence and is fixed relative to the guide head to complete the locking.
  • the ring body can be aligned or misaligned in the circumferential direction of the implantable medical device.
  • the connection line between the two ring bodies 105 of the alignment finger is parallel to the axis of the implantable medical device (the overall shape of the implantable medical device is approximately a straight cylinder), and the dislocation finger is not parallel.
  • the ring body 105 is formed in at least one of the following manners:
  • Mode a use an independent component and fix it on the implantable medical device 100.
  • the ring body 105a can be made of the same or different material as that of the implantable medical device 100.
  • the ring Body 105a is manually mounted to bracket 103 .
  • Ring body 105a can be made of any conventional suture material (eg polypropylene, Teflon) or the same material as stent 103.
  • Mode b constituted by drilling holes on the implantable medical device 100 .
  • FIG. 12A shows through holes 115 opened in the tip 105c of the unit cell 102 , wherein the first adjustment wire 121 and the second adjustment wire 131 can pass through the corresponding through holes 115 or be passed through the corresponding through holes 115 .
  • Mode c directly utilize the structural gap of the implantable medical device 100 itself.
  • Fig. 11 shows another situation, in which the ring body 105 is the tip 105b of the cell 102, and the frame bar surrounding the cell is used to surround the ring body 105, and the tip 105b can be arc-shaped to avoid cutting the adjustment line.
  • An adjustment wire 121 and a second adjustment wire 131 are adapted to extend into the space defined by the tip 105b in the same way.
  • a single implantable medical device 100 allows the existence of various forms of ring bodies 105.
  • the implantable medical device 100 has a pair of ring bodies 105 aligned with each other in the circumferential direction, namely the ring body 105d and the ring body 105.
  • the ring body 105e and the ring body 105d are the structural clearances of the implantable medical device 100.
  • the ring body 105e is formed by punching.
  • the ring body 105d is located at one axial end of the implantable medical device 100, and the ring body 105e is not located at the axial end. but only in proximity.
  • the implantable medical device 100 has a tubular device body, and one end of the adjustment wire with a locking hole is guided radially from the inside of the device body toward the outside of the device body.
  • the side of the instrument body facing the balloon catheter 120 is defined as the inner side, and the corresponding outer side is the side facing away from the balloon catheter.
  • the locking hole passes through the corresponding ring body 105 from the inner side to the outer side, and is finally located at the outer side of the implantable medical device 100, and the locking wire 126 passes through the locking hole in sequence on the outer side of the device body.
  • the threading direction is consistent with the axial direction of the balloon catheter 120 .
  • the locking wire 126 can be passed through without being blocked on the outside, which is convenient for assembly.
  • an embodiment of the present application discloses a delivery system for an implantable medical device. , including balloon catheters, but also:
  • the sheath 123 is slidably fitted on the outer periphery of the balloon catheter 120 for wrapping the implantable medical device 100;
  • the adjustment wire is used for releasably fixing the implantable medical device 100 on the balloon catheter 120, one end of the adjustment wire can keep the fixation with the balloon catheter 120, and the other end is provided with a keyhole and can be fixed by the implantable type
  • the medical device 100 passes through;
  • the locking wire 126 has a relative locked state and an unlocked state. In the locked state, the locking wire 126 passes through the implantable medical device 100 to limit the separation of the implantable medical device 100 from the adjustment wire. In the unlocked state, the locking wire 126 is disengaged The implantable medical device 100 allows each keyhole to disengage and release the implantable medical device 100 .
  • the locking wire cooperates with the implantable medical device.
  • the implantable medical device 100 is provided with There is a ring body 105 , in the locked state, the ring body 105 passes through the end of the corresponding adjustment wire with the locking hole, and is matched with the locking wire 126 .
  • the delivery system further includes a bending member 300 .
  • the bending member 300 acts on the distal portion of the balloon catheter 120 to change the spatial orientation of the balloon catheter 120 .
  • the bending member 300 is located on the inner side, the outer side, or the interlayer of the pipe wall of the catheter body 124 , and the bending member 300 and the catheter body 124 are two The interaction at the distal end site causes the balloon catheter 120 to bend at the distal end site.
  • the bending member 300 itself may be a combination of one or more of tubes, wires or rods, and the proximal end of the bending member 300 is connected and controlled by the control handle 200 .
  • the deflection member 300 is capable of generating a force at the distal end that causes the catheter body 124 to bend.
  • the bending member 300 can directly or indirectly act on the balloon catheter 120 .
  • various specific connection methods between the bending member 300 and the catheter body 124 are provided.
  • the distal ends of the bending member 300 and the catheter body 124 are fixedly connected or movably matched.
  • the bending member 300 is a bending wire or a bending tube
  • the distal ends of the bending member 300 and the catheter body are fixed, and the proximal end slides and fits so that the balloon catheter 120 is positioned at the distal end. Bend the ends.
  • the distal ends of the bending member 300 and the catheter body 124 are fixed to each other. When the proximal side of one of them is subjected to a force and slides relative to the other, the distal ends of the two tend to bend, thereby producing delivery.
  • the distal end of the system can be adjusted as a whole to change the direction of the balloon catheter 120 to adapt to the intervention path or the lesion location. Taking the bending tube as an example, it can be arranged inside the conduit or outside the conduit.
  • the bending member 300 includes an inner bending tube 301 and an outer bending tube 302 that are nested with each other, and the inner and outer bending tubes 301 and 302 are fixed at their distal ends, and are close to each other.
  • the end slip fit allows the deflection member 300 to deflect and act on the catheter body 124 at the distal end.
  • the bending member 300 adopts an inner and outer double tube structure, and the relative movement of the proximal ends of the two can produce a bending tendency at the distal end, thereby driving the catheter body 124 to bend.
  • the bending member 300 is located inside or outside the catheter body 124 . In the figure, the bending member 300 is located outside the catheter body 124.
  • one of the two bending tubes can be replaced by a bending wire.
  • At least one of the inner bending pipe 301 and the outer bending pipe 302 is movably connected to the control handle 200 .
  • control handle 200 used to realize various remote operations can use the existing technology to drive the corresponding components.
  • the following will provide an improved structure of the control handle 200, and describe in detail in conjunction with the working principle:
  • the delivery system of the present application includes a control handle 200 for operating the implantable medical device.
  • the control handle 200 includes a support body 210 and a first drive assembly 220 mounted on the support body 210.
  • a drive assembly includes:
  • the first mounting seat 221 is slidably disposed on the support body 210;
  • the first driving member 222 is movably mounted on the support body 210 and is in driving cooperation with the first mounting seat 221;
  • the first mounting seat 221 includes a body with an inner cavity, and is opened on the body and communicated with the inner cavity:
  • the distal interface 261 is used for docking the balloon catheter 120;
  • Proximal port 264 for threading the guide wire.
  • the balloon catheter 120 extends through the support body through the tube and is relatively and fixedly connected to the distal interface 261.
  • the relative movement of the first drive member 222 to the support body drives the first mounting seat 221 to slide, and drives the tube connected to the balloon catheter 120 to slide. , and adjust the position of the balloon catheter 120 after reaching the vicinity of the lesion to achieve the optimal release position of the implantable medical device.
  • the first mounting seat 221 is disposed at the proximal end of the control handle 200 , which is a pipe and has at least nozzles corresponding to the four ports.
  • control handle 200 further includes a second drive assembly 230 mounted on the support body 210 , the second drive assembly is located at the proximal side of the first drive assembly, and the second drive assembly include:
  • the second mounting seat 231 is slidably disposed on the support body 210;
  • the second mounting seat 231 is used to connect the sheath 123 , and the second driving member 232 moves relative to the support body 210 to drive the second mounting seat 231 to drive the sheath 123 to slide to complete the operation of wrapping/exposing the balloon catheter 120 .
  • the third mounting seat 251 is slidably disposed on the support body 210;
  • the third driving member 252 is movably mounted on the support body 210 and is in driving cooperation with the third mounting seat 251 .
  • the outer bending pipe 302 is connected to the fixed mounting seat 253
  • the inner bending pipe 301 is connected to the third mounting seat 251
  • the third driving member 252 drives the third mounting seat 251 to move relative to the fixed mounting seat 253
  • the bending member as a whole will be in the position.
  • the distal part is bent, and then acts on the balloon catheter, resulting in a bending effect.
  • the support body 210 has an axial direction in space, and the support body is provided with a guide groove extending along its own axis.
  • each mounting seat is slidably arranged in the corresponding guide groove 211; each driving member is respectively rotatably sleeved on the periphery of the support body, and is screwed with the corresponding mounting seat.
  • the support body 210 has an axial direction in space
  • the first mounting seat is a four-way structure with four branch pipes
  • the distal interface, the drive interface, the limit interface and the proximal interface are respectively corresponding to one branch pipe. Orifice; along the axial direction of the support body, the distal interface and the proximal interface are aligned with each other.
  • the axes of the four branch pipes are approximately coplanar.
  • the branch pipes corresponding to the drive interface and the limit interface are opposite to each other on the two sides of the pipeline where the distal interface is located, which is convenient for connecting the pipelines.
  • the ends of the branch pipes where the drive interface, the limit interface and the proximal interface are located are provided with external threads. Easy to connect with external pipeline.
  • the proximal end of the catheter body 124 is sealedly connected to the distal interface, and the proximal end of the central tube 133 extends out of the catheter body and extends in the inner cavity of the first mounting seat and is sealedly connected to the proximal interface;
  • the drive interface communicates with the radial gap between the catheter body and the central tube, and fluid flows from the gap to the distal balloon body.
  • the proximal end of the locking wire 126 after the proximal end of the locking wire 126 extends into the inner cavity of the first mounting seat, it directly passes through the first mounting seat through the limit port, or passes through the side wall of the limit port branch pipe to pass through the first mounting seat. mount.
  • the branch pipe where the limiting interface is located extends obliquely toward the proximal end of the support body, and the included angle ⁇ with the axis of the support body satisfies 0° ⁇ 60°. For example, 10 degrees ⁇ 45 degrees, and for example, 15 degrees ⁇ 30 degrees.
  • the control handle 200 includes a vent assembly 240 that includes:
  • the connecting head 241 and the liquid injection pipe 242 are connected to one end of the liquid injection pipe 242 and the other end is connected to the fixed mounting seat 253 .
  • physiological saline is used for exhausting, and the physiological saline enters the fixed mounting seat 253 through the exhaust assembly 240, and then enters the gap between the adjacent pipes through the communication holes opened on the pipe wall of each pipe fitting to discharge the air.
  • the liquid injection tube 242 extends from the fixed mounting seat 253 inside the control handle to the distal end of the control handle, and then passes through the control handle and is matched with the connector 241 .
  • the control handle 200 operates the proximal end of the bending member 300, acts on the catheter body 124 to complete the bending adjustment of the balloon catheter 120, and then stops operating the bending member, so that the proximal end of the bending member 300 is fixed and the distal end is kept pointing constant.
  • the control handle 200 operates the balloon catheter 120 to move along the support body 300, drives the distal end of the balloon catheter 120 to move along its own axis, and adjusts the position of the balloon catheter relative to the lesion, so as to achieve the optimal release of the implantable medical device. Location.
  • Implantable implantable medical devices are expanded by balloon bodies, but when there is a local radial size change in the implantable medical devices, it is difficult to use conventional balloon bodies.
  • the type of medical device will also deform due to the joint deformation of other areas, resulting in the inability to achieve the expected effect in the expanded state.
  • an embodiment of the present application provides an implantable medical device 100 , which includes a stent 103 and leaflets 108 connected to the stent 103 .
  • the stent 103 is a radially deformable structure and Having a relative compressed state and an expanded state
  • the implantable medical device 100 further includes a bundle ring 109 connected to the stent 103 along the circumference of the stent.
  • the bundle ring 109 limits the diameter of the stent 103 when the stent 103 enters the expanded state. Amplitude of deformation.
  • the inside of the stent 103 is an axially penetrating blood flow channel
  • the valve leaflets 108 are 2, 3 or 4 valves, and each valve leaflet 108 cooperates with each other to open or close the blood flow channel.
  • the beam ring 109 is installed and positioned at a circle in the circumferential direction of the stent 103, so that the stent 103 exhibits a waist structure with a relatively reduced diameter in an expanded state.
  • the beam ring 109 is wound around the outer circumference or inner wall of the stent, or undulated and passed through the inner and outer sides of the stent.
  • the beam ring 109 is located in the middle of the stent or adjacent to the inflow side of the stent or adjacent to the inflow side of the valve leaflets.
  • the beam ring 109 is sewn on the edge of the hollow structure of the bracket.
  • the stent 103 includes a beam-shaped section corresponding to the position of the beam-shaped ring 109, and a free section on both sides of the beam-shaped section.
  • the beam-shaped section In the expanded state, the beam-shaped section has a smaller outer diameter than the free sections. .
  • the beam ring 109 changes the expansion deformation amount of the beam section relative to the free section, and the deformation amount of the beam section is smaller than the deformation amount of the free section per unit time.
  • the connecting section between the beam-shaped section and the free section is also subject to the beam-shaped ring 109 to slowly deform, and finally bends and transitions with the beam-shaped section and the free section.
  • the beam ring 109 is an annular structure.
  • the annular structure can be obtained by fixing two ends of a long strip to each other, or it can be obtained by processing a complete ring or other methods.
  • the width of the bundled ring 109 satisfies a width of 2-30 mm (the width of the bundled ring in a flattened state shall prevail). For example, 5 to 20 mm, and another example of 5 to 15 mm. Another example is 8mm.
  • the bundle ring 109 is a flexible material that can be compressed with the stent 103 .
  • the beam ring 109 has a low elongation rate, such as PTFE.
  • PTFE a low elongation rate
  • the bundle ring 109 can also be made of a metal wire, the two ends of the metal wire are fixed to form a ring, or an integral ring, and the cross-sectional shape of the metal wire can be a circle, an ellipse, or the like.
  • the stent 103 is a mesh cylinder with a hollow structure and has an axial direction in space. According to the blood flow direction, one end of the stent in the axial direction is the inflow side 113 and the other end is the outflow side 114.
  • the device 100 also includes a first covering 111 attached to the inside of the stent, the first covering 111 docking on the inflow side of the leaflets 108 .
  • the first covering film 111 is arranged around the inner circumference of the stent 103, and is connected to the connection between the valve leaflet 108 and the stent 103, so as to close the hollow structure part.
  • the second covering film 112 on the outer side of the stent, the second covering film 112 is butted on the inflow side of the beam ring 109 .
  • the second covering film 112 covers the outer periphery of the stent 103 and cooperates with the first covering film 111 to avoid circumferential leakage.
  • the second covering film 112 can be fixed to the bracket 103 in the same way as the first covering film 111 in a stitching manner.
  • both the first covering film 111 and the second covering film 112 extend to the inflow side of the stent 103 , and they are butted against each other to wrap the inflow side edge of the stent 103 .
  • first cover film 111 and the second cover film 112 are integrally formed.
  • the two membranes are actually a complete membrane.
  • the first membrane 111 and the second membrane 112 are formed after the edge of the inflow side of the stent 103 is bent and folded in half, and are fixedly connected to the stent 103 respectively.
  • the film is also fixedly connected to the bracket 103 at the folded portion.
  • the membrane is provided with a hole for the ring body 105 on the stent 103 to protrude.
  • one of the first covering film 111 and the second covering film 112 extends to the inflow side of the stent 103 and then folds over the inflow side edge of the stent 103 , and further extends to the other after being folded. the outflow side of the user.
  • the membranes When the stent 103 is in a compressed state, the membranes will be stacked on each other on the inflow side, increasing the radial thickness and interfering with the movement path of the sheath 123 , affecting the operation of the sheath 123 .
  • the first covering film 111 and/or the second covering film 112 is provided with a cutout at the edge portion adjacent to the inflow side of the stent, and the position of the cutout matches the shape of the inflow side edge of the stent 103 .
  • the inflow side of the stent 103 includes a plurality of cells 102 arranged in the circumferential direction, adjacent cells 102 have structural gaps facing the inflow side, and the incisions match the positions of the corresponding structural gaps.
  • the first covering film 111 and/or the second covering film 112 are serrated at the edge portion adjacent to the inflow side of the stent, and between adjacent teeth is an incision, and the two sides of the incision are sewn with the corresponding parts of the stent. suffix connection.
  • An embodiment of the present application provides an implantable system, including an implantable medical device and a delivery system matched with the implantable medical device.
  • the implantable medical device and the delivery system may adopt or combine any of the above embodiments.
  • the implantable medical device is radially folded and abutted against the outer peripheral wall of the balloon catheter in a compressed state.
  • the balloon The two ends of the implantable medical device on the balloon catheter are releasably fixed with adjustment wires with locking holes, and one end with the locking holes passes through the two axial ends of the implantable medical device.
  • the delivery system also includes a locking wire generally slidably arranged along the balloon catheter, and the locking wire is passed through the locking hole to prevent the adjustment wire from being separated from the implantable medical device.
  • the locking holes of the two adjustment wires allow a certain distance from the end of the implantable medical device, and the distance can be adjusted artificially, so that the relative position of the implantable medical device in the axial direction of the balloon catheter is controllable, and the distance can be zero , thereby restricting the movement of the implantable medical device on the balloon catheter.
  • An embodiment of the present application also provides a method for releasing an implantable medical device.
  • the implantable medical device 100 is pre-fixed on a delivery system, and the releasing method includes:
  • the balloon body 122 is deflated, and the balloon catheter 120 is moved toward the proximal side of the delivery system to separate from the implantable medical device 100 .
  • the delivery system may employ or combine any of the above embodiments.
  • the proximal end of the delivery system can be controlled by the distal end of the control handle to slide the sheath 123 to the proximal end along the axial direction of the balloon catheter, gradually exposing the implantable medical device 100 until the sheath 123 exits the radial expansion path of implantable medical device 100 completely.
  • the locking wire 126 is generally withdrawn in the axial direction of the balloon catheter, and the first locking hole 135 and the second locking hole 136 will automatically and completely disengage from their corresponding ring bodies 105 .
  • the locking area 8b shows the disengagement between the locking hole and its ring body 105 .
  • the locking wire 126 is fully withdrawn and the balloon body 122 is deflated into a deflated state.
  • the balloon catheter 120 is withdrawn.
  • the locking wire 126 can also be withdrawn after the implantable medical device 100 is expanded, so that during the expansion process, it can always remain in contact with the balloon catheter. relative axial position.
  • the fluid is released, the balloon body 122 is deflated and separated from the implantable medical device 100, and the delivery system is finally withdrawn from the body.
  • the balloon catheter 120 is moved away from the implantable medical device 100 toward the proximal side of the delivery system.
  • the locking wire 126 is adaptively deformed and bent (during the deformation process, the movement of the distal or proximal end can be used to compensate for the length change in the peripheral portion of the stent), but it is never detached.
  • the locking hole is used to limit the movement of the stent in the axial direction.
  • An embodiment of the present application also provides a method for loading an implantable medical device, which is used to fix the implantable medical device to a delivery system, wherein the delivery system can adopt or combine any of the above embodiments.
  • the sheath 123 is slid toward the distal side of the delivery system until the implantable medical device 100 is wrapped.
  • the implantable medical device 100 in the expanded state can be uniformly compressed in the circumferential direction by existing equipment such as a crimping device until it is switched to a compressed state.
  • the first locking hole 135 of the first adjustment wire 121 passes through the ring body 105 of the distal end 106 of the implantable medical device 100, and the second locking hole 136 of the second adjustment wire 131 passes through the implantable medical device Ring 105 at proximal end 107 of 100 .
  • the locking wire 126 is passed through the lumen 137 defined between the sheath 123 and the catheter body 124 and protrudes from the distal end 138 of the sheath 123 .
  • the locking wire 126 passes forward through the first locking hole 135 and the second locking hole 136 and enters the insertion hole 138 in the guide head 127 .
  • the locking area LK in FIG. 3B shows the mating relationship at the locking position, in which the locking wire 126 passes through each locking hole after each locking hole passes through the corresponding ring body 105 .
  • the holes in the guide head 127 should have a certain depth so that the locking wire 126 can be securely locked in the guide head 127 .
  • An embodiment of the present application also provides a method for fixing an implantable medical device on a balloon catheter, comprising the following steps:
  • an implantable medical device has a tubular device body, the tubular device body has a first end and a second end, the first end is provided with a first ring body, and the second end is provided with a second ring body;
  • a balloon catheter is provided, the balloon catheter includes:
  • balloon body adjacent to and proximal to the guide head, the balloon body having opposite distal and proximal ends;
  • first adjustment wire having a first locking hole
  • the first adjustment wire is adjacent to the distal end of the balloon catheter and fixed to the balloon catheter
  • the second adjustment wire is at a position adjacent to the proximal end of the balloon catheter, and is fixed to the balloon catheter;
  • the sheath for sliding movement over the catheter body and the balloon, the sheath having a distal end;

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Transplantation (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
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  • Prostheses (AREA)
  • Media Introduction/Drainage Providing Device (AREA)

Abstract

本申请公开了植入式医疗器械的输送系统,包括球囊导管,还包括护套、调节线和锁线。其中护套滑动配合在球囊导管的外周,用于包裹植入式医疗器械;调节线用于将植入式医疗器械可释放地固定在所述球囊导管上,所述调节线上的一端能够保持与球囊导管的固定,另一端可穿过植入式医疗器械并带有锁孔;锁线具有相对的锁定状态和解锁状态,在锁定状态下、所述锁线穿入各锁孔以限制植入式医疗器械,解锁状态下、所述锁线脱离各锁孔以释放植入式医疗器械。本申请有效地将可植入医疗器械固定到输送系统以输送到病变位置,通过锁线、调节线和植入式医疗器械之间的锁定调整或限制植入式医疗器械在球囊体轴向上的相对位置,并且通过可控滑动的护套的包裹防止植入式医疗器械的意外膨胀,提高手术安全性。

Description

植入式医疗器械的输送系统及其控制手柄、植入式医疗器械及其固定方法、装载方法、释放方法 技术领域
本申请涉及医疗设备领域,特别是涉及植入式医疗器械的输送系统及其控制手柄、植入式医疗器械及其固定方法、装载方法、释放方法。
背景技术
侵入性部署某些植入式医疗器械已成为治疗某些疾病的常规方法。例如,支架和人工心脏瓣膜现在通过一种避免侵入性手术的经导管程序被运送到血管内和心脏内的治疗部位。
为了便于输送到所需的治疗位置,需将植入式医疗器械(例如支架和人工心脏瓣膜)以压缩状态装载于球囊导管上,然后穿过插入血管系统的导管或护套到达目标位置。然后,通过球囊导管中的球囊体将植入式医疗器械膨胀到其预期尺寸,并固定在所需的治疗位置,最后将球囊体放气至溃缩状态并从体内拔出球囊导管。
植入式医疗器械在球囊体上的固定通常通过摩擦力来完成,或在球囊导管上设有肩部,以阻止植入式医疗器械在插入和输送期间移动。在球囊体充气/液时,通常先在球囊体两端充气/液,以起到阻挡作用,防止植入式医疗器械在球囊体上移动。
虽然上述装载方式较多的实用,当仍存在以下几个问题。
首先,压缩状态的的植入式医疗器械暴露于周围环境(例如,传统的鞘、血管等),这可能导致植入式医疗器械在插入过程中经历移动。当穿过主动脉弓时,暴露在外的植入式医疗器械往往会在其远端外表面向外扩张,这可能对动脉造成危害。
第二,用于将植入式医疗器械固定在球囊体上的肩部可以将植入式医疗器械固定在适当的位置,但植入式医疗器械会移动并压在肩部,因此肩部会有刺穿球囊体的风险。
因此,为避免上述缺点,仍需进一步完善输送系统或方法,将植入式医疗器械固定到输送系统以输送到治疗位置,并且用于将植入式医疗器械部署在治疗位置。
发明内容
为了解决上述技术问题,本申请公开了植入式医疗器械的输送系统,包括球囊导管,还包括:
护套,滑动配合在球囊导管的外周,用于包裹植入式医疗器械;
调节线,用于将植入式医疗器械可释放地固定在所述球囊导管上,所述调节线上的一端能够保持与球囊导管的固定,另一端可穿过植入式医疗器械并带有锁孔;
锁线,具有相对的锁定状态和解锁状态,在锁定状态下、所述锁线穿入各锁孔以限制植入式医疗器械,解锁状态下、所述锁线脱离各锁孔以释放植入式医疗器械。
以下还提供了若干可选方式,但并不作为对上述总体方案的额外限定,仅仅是进一步的增补或优选,在没有技术或逻辑矛盾的前提下,各可选方式可单独针对上述总体方案进行组合,还可以是多个可选方式之间进行组合。
可选的,所述输送系统还包括控制手柄,所述球囊导管、护套以及锁线均延伸至所述控制手柄,所述球囊导管、护套、以及锁线三者能够相对运动。
可选的,所述球囊导管包括:
引导头,开设有插孔,所述锁线在锁定状态下的端头部位伸入所述插孔;
球囊体,邻近所述引导头且位于所述引导头的近端侧,所述球囊体的外周为植入式医疗器械的装载区;
导管体,与所述球囊体相连通并向输送系统的近端侧延伸。
可选的,所述球囊导管还包括:
中心管,穿设在所述导管体内,中心管的一端向输送系统的近端侧延伸,另一端贯穿所述球囊体并与所述引导头相连。
可选的,所述锁线从所述护套和所述导管体之间限定的管腔中向输送系统的近端侧延伸。
可选的,所述锁线从所述导管体内部限定的管腔中向输送系统的近端侧延伸。
可选的,所述导管体的管壁开设有通孔,所述锁线的远端经由该通孔延伸至所述导管体的外部,用以同所述调节线配合。
可选的,所述导管体的管壁带有径向内凹区,所述通孔开设在该径向内凹区中的近端侧部位。
可选的,所述调节线与所述锁线之间仅为一处结合部位。
可选的,所述调节线与所述锁线之间至少有两处结合部位,其中至少一结合部位限制植入式医疗器械向远端方向运动,还有至少一结合部位限制植入式医疗器械向近端方向运动。
可选的,所述调节线是一根或多根,同一调节线可提供一个或多个锁孔。
可选的,所述锁孔成对布置,同对锁孔中,其中一者靠近球囊导管远端,另一者靠近球囊导管近端。
可选的,所述调节线的端部绕成线环结构,该线环结构的内部为所述锁孔。
可选的,所述调节线包括:
第一调节线,具有第一锁孔,所述第一调节线连接于所述球囊导管,且邻近所述球囊导管的远端;
第二调节线,具有第二锁孔,所述第二调节线连接于所述球囊导管,且邻近所述球囊导管的近端;
锁定状态下、所述锁线同时穿过所述第一锁孔和所述第二锁孔。
可选的,锁定状态下,所述锁线的末端距离所述第一锁孔的尺寸范围满足至少5mm,例如8~30mm。
可选的,所述第一调节线和所述第二调节线分别固定连接至所述球囊导管。
可选的,所述第一调节线固定至所述引导头。
可选的,所述第二调节线固定套设在所述导管体的外周。
可选的,所述导管体的外周带有限位台阶,所述第二调节线受限于所述限位台阶。
可选的,所述第一调节线和所述第二调节线均活动的连接至所述球囊导管。
可选的,所述第一调节线和所述第二调节线之间通过连接线相连。
可选的,所述第一调节线和所述第二调节线中的至少一者与所述连接线为一体结构。
可选的,所述连接线向所述输送系统的近端侧延伸。
可选的,所述连接线在所述中心管内向所述输送系统的近端侧延伸,并可相对所述球囊导管牵拉运动。
可选的,所述第一调节线和所述第二调节线中一者为固定连接至所述球囊导管的固定调 节线,另一者相对所述球囊导管可牵拉运动的活动调节线,所述护套和所述导管体之间限定的管腔中活动穿设有中间护套,活动调节线与所述中间护套相连。
可选的,所述中心管具有多个管腔,所述活动调节线沿其中一管腔延伸。
可选的,所述多个管腔中,其中一者为中心管腔,至少另一者为偏心布置的第二腔,所述活动调节线经由所述第二腔延伸。
可选的,所述第二腔的腔壁设有两个开口,所述第一调节线和所述第二调节线经由对应的开口延伸出所述中心管。
可选的,所述植入式医疗器械上设置有环体,在锁定状态下、所述调节线上带有锁孔的一端穿过对应的环体后、与所述锁线配合。
可选的,所述环体至少有两个,分别处在植入式医疗器械的两相对端。
可选的,所述环体的构成方式为以下方式的至少一种:
a、采用独立部件并固定于植入式医疗器械;
b、通过在植入式医疗器械上打孔构成;
c、直接利用植入式医疗器械自身的结构间隙。
可选的,所述植入式医疗器械具有管状的器械主体,所述调节线带有锁孔的一端由器械主体的内部沿径向朝器械主体的外部穿引。
可选的,所述环体至少有两个,分别处在器械主体轴向的两端。
可选的,所述锁线为金属杆。
可选的,所述输送系统还包括调弯件,所述调弯件处在所述导管体的内侧、外侧、或管壁夹层中,所述调弯件与所述导管体两者远端部位相互作用使所述球囊导管在远端部位调弯。
可选的,所述调弯件的近端连接并受控于所述控制手柄。
可选的,所述调弯件为调弯线或调弯管,所述调弯件与所述导管体两者远端固定,近端滑动配合使所述球囊导管在远端部位调弯。
可选的,所述调弯件包括相互嵌套的内调弯管和外调弯管,所述内调弯管和所述外调弯管两者远端固定,近端滑动配合使所述调弯件在远端部位调弯并作用至所述导管体。
可选的,所述调弯件与所述导管体两者远端部位固定连接或活动配合。
可选的,所述内调弯管和所述外调弯管两者中的至少一者相对控制手柄活动连接。
可选的,用于操作植入式医疗器械的控制手柄,包括支撑体以及安装于所述支撑体上的第一驱动组件,所述第一驱动组件包括:
第一安装座,滑动设置于所述支撑体;
第一驱动件,活动安装于所述支撑体,且与所述第一安装座传动配合;
其中,所述第一安装座包括带有内腔的本体,以及开设于所述本体且与内腔连通的:
远端接口,用于对接球囊导管
驱动接口,用于向球囊导管内注入流体,
限位接口,用于穿引锁线。
近端接口,用于穿引导丝。
可选的,所述控制手柄还包括安装于所述支撑体上的第二驱动组件,所述第二驱动组件处在所述第一驱动组件的近端侧,所述第二驱动组件包括:
第二安装座,滑动设置于所述支撑体;
第二驱动件,活动安装于所述支撑体,且与所述第二安装座传动配合。
可选的,所述控制手柄还包括安装于所述支撑体上的第三驱动组件,所述第三驱动组件处在所述第一、第二驱动组件之间,所述第三驱动组件包括:
固定安装座;
第三安装座,滑动设置于所述支撑体;
第三驱动件,活动安装于所述支撑体,且与所述第三安装座传动配合。
可选的,所述支撑体具有空间上的轴向,所述支撑体上开设有沿自身轴向延伸的导向槽,各安装座滑动设置在对应的导向槽内;各驱动件分别转动套设在支撑体外周,且与相应的安装座之间螺纹配合。
可选的,所述支撑体具有空间上的轴向,所述第一安装座为具有四个支管的四通结构,所述远端接口、驱动接口、限位接口和近端接口分别为对应一支管的管口;
沿支撑体轴向,所述远端接口与近端接口相互对正。
可选的,所述四个支管的轴线大致共面。
可选的,所述导管体的近端与远端接口密封连接,所述中心管的近端延伸出所述导管体后在第一安装座的内腔中延伸并密封连接至近端接口;
所述驱动接口连通至所述导管体与所述中心管两者的径向间隙。
可选的,所述锁线的近端延伸至第一安装座的内腔中后,再直接经由所述限位接口穿出第一安装座,或经由限位接口所在支管的侧壁穿出第一安装座。
可选的,所述限位接口所在支管向支撑体近端倾斜延伸且与支撑体轴线夹角α满足0度<α<60度。例如10度<α<45度,又例如15度<α<30度。
本申请公开了植入式医疗器械的输送系统,包括球囊导管,还包括:
护套,滑动配合在球囊导管的外周,用于包裹植入式医疗器械;
调节线,用于将植入式医疗器械可释放地固定在所述球囊导管上,所述调节线上的一端能够保持与球囊导管的固定,另一端带有锁孔并藉由植入式医疗器械穿过;
锁线,具有相对的锁定状态和解锁状态,在锁定状态下、所述锁线穿过植入式医疗器械以限制植入式医疗器械与调节线分离,解锁状态下、所述锁线脱离植入式医疗器械,容许所述各锁孔脱离并释放植入式医疗器械。
可选的,所述植入式医疗器械上设置有环体,在锁定状态下,所述环体穿过对应调节线上带有锁孔的一端后,且与所述锁线配合。
本申请还公开了一种植入式医疗器械,包括支架,以及连接于所述支架的瓣叶,所述支架为径向可形变结构且具有相对的压缩状态和膨胀状态,所述植入式医疗器械还包括沿支架周向绕置连接于所述支架的束形环,所述束形环在支架进入膨胀状态过程中限制支架的径向形变幅度。
可选的,所述束形环绕置在支架外周或内壁或起伏穿引于支架的内外两侧。
可选的,沿支架轴向,所述束形环的位置处在支架中部或邻近支架流入侧。
可选的,沿支架轴向,所述束形环的位置与瓣叶流入侧的位置邻近。
可选的,沿支架轴向,所述束形环的宽度为2~30mm。例如5~20mm,又例如5~15mm。又例如8mm。
可选的,所述束形环为可随支架压缩的柔性材料。
可选的,所述束形环缝缀至所述支架。
可选的,所述束形环的材质为PTFE。
可选的,所述束形环为金属丝。
可选的,沿支架轴向,所述支架包括与所述束形环位置相应的束形段,以及处在束形段两侧的自由段,膨胀状态下,所述束形段比各自由段具有更小的外径。
可选的,所述支架为具有镂空结构的网筒状且具有空间上的轴向,按照血流方向,支架轴向的一端为流入侧,另一端为流出侧,所述支架的内部为轴向贯通的血流通道,所述瓣叶为2、3或4瓣,各瓣叶相互配合以开放或封闭所述血流通道。
可选的,所述植入式医疗器械还包括连接在支架内侧的第一覆膜,该第一覆膜对接在所述瓣叶的流入侧。
可选的,所述植入式医疗器械还包括连接在支架外侧的第二覆膜,该第二覆膜对接在所述束形环的流入侧。
可选的,所述第一覆膜和所述第二覆膜为一体结构。
可选的,所述第一覆膜和所述第二覆膜两者延伸至支架的流入侧,且两者相互对接包裹支架的流入侧边缘。
可选的,所述第一覆膜和所述第二覆膜两者中的一者延伸至支架的流入侧后翻折包裹支架的流入侧边缘,且在翻折后进一步延伸对接至另一者的流出侧。
可选的,所述第一覆膜和/或所述第二覆膜在邻近支架流入侧的边缘部位带有切口,所述切口的位置与所述支架的流入侧边缘形状相匹配。
可选的,所述支架的流入侧包括沿周向排布的多个单元格,相邻单元格之间带有朝向流入侧的结构间隙,所述切口与相应的结构间隙位置匹配。
可选的,所述第一覆膜和/或所述第二覆膜在邻近支架流入侧的边缘部位为锯齿状,相邻齿之间为所述切口,切口两侧部位与支架的对应部位缝缀连接。
本申请提供了一种植入式系统,包括植入式医疗器械以及与所述植入式医疗器械相配合的输送系统。
本申请公开了一种植入式医疗器械的释放方法,植入式医疗器械预先固定在所述的输送系统上,所述释放方法包括:
驱动护套向输送系统近端侧运动以暴露植入式医疗器械;
拉动锁线从调节线的锁孔中抽出;
驱动球囊体外扩并带动植入式医疗器械形变至膨胀状态,还使调节线从植入式医疗器械中抽出;
使球囊体收缩,向输送系统近端侧运动球囊导管与植入式医疗器械分离。
本申请提供了一种植入式医疗器械的装载方法,用于将植入式医疗器械固定至所述的输送系统,所述装载方法包括:
将处于膨胀状态的植入式医疗器械置于收缩状态的球囊体外周;
使植入式医疗器械径向压缩至压缩状态;
将调节线带有锁孔的一端穿引过植入式医疗器械;
将锁线穿过锁孔;
向输送系统远端侧滑动护套直至将植入式医疗器械包裹。
本申请提供了一种将植入式医疗器械固定在球囊导管上的方法,包括以下步骤:
一种植入式医疗器械,植入式医疗器械具有管状的器械主体,所述管状的器械主体具有第一端和第二端,所述第一端设置有第一环体,所述第二端设置有第二环体;
提供一种球囊导管,所述球囊导管包括:
导管体,所述导管体具有引导头;
球囊体,邻近所述引导头且位于所述引导头的近端,所述球囊体具有相对的远端和近端;
第一调节线,具有第一锁孔,所述第一调节线邻近所述球囊导管的远端位置处,且固定于所述球囊导管;以及
第二调节线,具有第二锁孔,所述第二调节线在邻近所述球囊导管的近端位置处,且固定于所述球囊导管;
提供用于在所述导管体和所述球囊上滑动移动的护套,所述护套具有远端;
将处于膨胀状态的植入式医疗器械置于收缩状态的球囊体上;
将植入式医疗器械在收缩状态的球囊体上径向形变至压缩状态;
将第一调节线上的第一锁孔穿引过第一环体,以及第二调节线上的第二锁孔穿过第二环体;
将锁线穿过第一锁孔和第二锁孔并进入引导头;和
将所述护套滑过压缩状态的植入式医疗器械直至推进到引导头,以完全覆盖植入式医疗器械。
其中推进锁线的步骤包括推进锁线穿过护套和导管体之间限定的管腔以延伸出护套远端的步骤。
可选的,其中穿引第一和第二锁孔的步骤包括分别将第一和第二锁孔锁定在第一和第二环体上的步骤。
可选的,其中所述第一环体和第二环体中的每一个作为独立环体提供,并分别连接到植入式医疗器械的第一和第二端。
可选的,其中所述第一环体和第二环体中的每个环体分别在植入式医疗器械的第一端和第二端处被提供为圆形尖端。
可选的,其中所述第一环体和第二环体中的每一环体分别在植入式医疗器械的第一端和第二端的顶点中作为开口提供。
可选的,进一步提供连接第一和第二调节线的连接线。
可选的,还包括提供延伸穿过球囊体的中心管腔,其中连接线延伸穿过中心管腔。
可选的,还包括提供一个中间护套,该护套延伸穿过在护套和导管体之间限定的管腔,第二调节线连接到中间护套的远端。
可选的,一种将植入式医疗器械植入人体器官的方法,该方法将植入式医疗器械固定在球囊导管的上,包括以下步骤:
在近端直接抽出护套以暴露植入式医疗器械;
在近端方向上抽出锁线;
驱动球囊体外扩,使第一和第二调节线分别从第一和第二环体抽出;
使球囊体收缩;在近端直接取出球囊导管。
当植入式医疗器械优选为人工心脏瓣膜时,即本申请相应提供了的植入式人工心脏瓣 膜、植入式人工心脏瓣膜的输送系统、以及人工心脏瓣膜的植入式系统。
相关方法同理为植入式人工心脏瓣膜的释放方法、植入式人工心脏瓣膜的装载方法以及将植入式人工心脏瓣膜固定在球囊导管上的方法。
本申请有效地将可植入医疗器械固定到输送系统以输送到治疗位置,并且用于在治疗位置部署,改进的锁定方式可将医疗器械锁定在收缩的球囊体上避免位移;更进一步的还通过护套的覆盖防止植入式医疗器械的端部扩张,从而将刺穿球囊体的风险降到最低。
附图说明
图1A为本申请一个实施例的植入式医疗器械和球囊导管的分解示意图;
图1B为图1A中的植入式医疗器械被定位后围绕球囊体的示意图;
图2为图1A中的植入式医疗器械处在压缩状态并围绕球囊体的示意图;
图3A为调节线穿过植入式医疗器械端部上的环体后的示意图;
图3B为锁线通过调节上的锁孔后延伸到引导头的示意图;
图4为在植入式医疗器械外周推进护套后的示意图;
图5为抽出护套以暴露植入式医疗器械的示意图;
图6为球囊体展开后的示意图;
图7为锁线从锁孔中抽出并进入护套的过程示意图;
图8为球囊体放气进入收缩状态的示意图;
图9为球囊导管从植入式医疗器械中抽出的示意图;
图10~图12B为图1A中的植入式医疗器械变化不同环体结构后、不同实施例的示意图;
图13A为本申请另一实施例中植入式医疗器械处在压缩状态并围绕球囊体的示意图;
图13B为图13A的局部剖视图;
图14A是图13A中调节线拉紧后的示意图;
图14B为图14A的局部剖视图;
图15A本申请另一实施例配置有中间护套的示意图;
图15B是图15A的中间护套回撤且锁线被拉紧的示意图。
图16为本申请一实施例输送系统的结构示意图;
图17为植入式医疗器械端部的环体穿过调节线锁孔的示意图;
图18为锁线通过植入式医疗器械上的环体后延伸到引导头的示意图;
图19为图18中球囊体扩张后的示意图;
图20为本申请一实施例中调弯件与导管体远端部分连接示意图;
图21为图20中调弯件与导管体固定连接状态下的K部放大图;
图22为图21中调弯件运动后作用导向体调弯示意图;
图23为图20中调弯件与导管体活动连接状态下的K部放大图;
图24为图23中调弯件运动后作用导向体调弯示意图;
图25为本申请一实施例中球囊导管部分结构示意图;
图26为图25中J部放大图;
图27为本申请一实施例中第二调节线与导管体的限位台阶配合结构示意图;
图28为图16的爆炸图;
图29为图16中控制手柄的剖视图;
图30为图16中球囊导管处的剖视图;
图31为图28中A部放大图;
图32为图28中B部放大图;
图33为图29中G部放大图;
图34为图28中C部放大图;
图35为图28中D部放大图;
图36为图29中H部放大图;
图37为图28中E部放大图;
图38为图28中F部放大图;
图39为图29中I部放大图;
图40为图30中引导头处的局部放大图;
图41为图28中第一安装座的结构示意图;
图42为图16中第一驱动件处的剖视图;
图43为本申请一实施例的植入式医疗器械在装载有束形环后压缩状态下的示意图;
图44为本申请一实施例的植入式医疗器械在装载有束形环后膨胀状态下的示意图;
图45为本申请一实施例的植入式医疗器械在装载有束形环后膨胀状态下的立体图;
图46为本申请一实施例的植入式医疗器械中第一覆膜的部分结构示意图;
图47为本申请一实施例的植入式医疗器械中第一覆膜和第二覆膜的部分结构示意图;
图48为本申请另一实施例的植入式医疗器械中第一覆膜和第二覆膜的部分结构示意图;
图49为本申请一实施例的控制手柄中排气组件的结构示意图。
图中附图标记说明如下:
100、植入式医疗器械;102、单元格;103、支架;104、心脏瓣膜组件;105、环体;105a、环体;105b、尖端;105c、尖端;105d、环体;105e、环体;106、远端;107、近端;108、瓣叶;109、束形环;111、第一覆膜;112、第二覆膜;113、流入侧;114、流出侧;115、通孔;
120、球囊导管;121、第一调节线;122、球囊体;123、护套;124、导管体;126、锁线;127、引导头;128、近端;129、连接器;131、第二调节线;132、远端;133、中心管;135、第一锁孔;136、第二锁孔;137、管腔;138、插孔;139、限位台阶;
140、连接线;8a、锁定区域;8b、锁定区域;LK、锁定区域;11a、锁结;11b、锁结;141、中心管腔;142、第二腔;143、第二开口;144、第一开口;150、中间护套;
160、内凹区;161、通孔;
200、控制手柄;210、支撑体;211、导向槽;212、导向面;220、第一驱动组件;221、第一安装座;222、第一驱动件;230、第二驱动组件;231、第二安装座;232、第二驱动件;240、排气组件;241、连接头;242、注液管;250、第三驱动组件;251、第三安装座;252、第三驱动件;253、固定安装座;261、远端接口;262、驱动接口;263、限位接口;264、近端接口;265、操作件;
300、调弯件;301、内调弯管;302、外调弯管。
具体实施方式
下面将结合本申请实施例中的附图,对本申请实施例中的技术方案进行清楚、完整地描述,显然,所描述的实施例仅是本申请一部分实施例,而不是全部的实施例。基于本申请中的实施例,本领域普通技术人员在没有做出创造性劳动前提下所获得的所有其他实施例,都属于本申请保护的范围。
需要说明的是,当组件被称为与另一个组件“连接”时,它可以直接与另一个组件连接或者也可以存在居中的组件。当一个组件被认为是“设置于”另一个组件,它可以是直接设置在另一个组件上或者可能同时存在居中组件。
除非另有定义,本文所使用的所有的技术和科学术语与属于本申请的技术领域的技术人员通常理解的含义相同。本文中在本申请的说明书中所使用的术语只是为了描述具体的实施例的目的,不是在于限制本申请。本文所使用的术语“和/或”包括一个或多个相关的所列项目的任意的和所有的组合。
请参阅图1A,本申请提供了植入式医疗器械的输送系统,植入式医疗器械100可以是植入人体的任何植入式医疗器械,例如支架、经导管心脏瓣膜、支架移植物组件、闭合装置和塞子等。本申请中的附图结合可膨胀支架的经导管心脏瓣膜组件104或用于经导管心脏瓣膜的支架框架来说明。以心脏瓣膜为例,具体可以应用至主动脉瓣膜、二尖瓣、三尖瓣、肺瓣等。
心脏瓣膜组件104具有管状的器械主体,例如中空的圆柱形的支架103,支架103的被编织或雕刻为带有框条结构,例如可以由单根金属丝或多根金属丝编织而成,也可以由金属(如镍钛)管激光切割而成。并由框条结构限定出多个单元格102。
参阅图1A~图15B,本申请的植入式医疗器械的输送系统,包括球囊导管120,还包括:
护套123,滑动配合在球囊导管120的外周,用于包裹植入式医疗器械100;
调节线,用于将植入式医疗器械100可释放地固定在球囊导管120上,调节线上的一端能够保持与球囊导管120的固定,另一端可穿过植入式医疗器械100并带有锁孔;
锁线126,具有相对的锁定状态和解锁状态,在锁定状态下、锁线126穿入各锁孔以限制植入式医疗器械,解锁状态下、锁线126脱离各锁孔以释放植入式医疗器械100。
球囊导管120具有一轴向长度并具有相应的近端132和远端128,下述未做特殊说明时,远端128为球囊导管120率先伸入人体内的一端,近端132为与远端128相反的一端,输送系统具有与球囊导管120相同方向的近端和远端。即输送系统内的其余部件,例如护套123、锁线126等具有与球囊导管120的远端128和近端132。
植入式医疗器械100能够与输送系统分离,为了方便叙述,植入式医疗器械100具有远端106和近端107。
球囊导管120由弹性材料制成并且设置在输送系统的远端,能够弯曲并使得设置在其上的植入式医疗器械100到达病变位置。参考1B和图6,球囊导管120还能够充气/液,使自身扩张,驱使植入式医疗器械100切换成膨胀状态,当然放气/液后,球囊导管120切换至收缩状态。
植入式医疗器械100具有压缩状态和膨胀状态,并能够在膨胀和压缩状态之间切换。
参阅图4,护套123为中空的管状,其滑动安装在输送系统上并沿球囊导管轴向滑动,从而改变对植入式医疗器械100的约束状态,当护套123处于球囊导管120外周时能够将植 入式医疗器械100约束在其内部,限制植入式医疗器械100的膨胀,当护套123相对球囊导管120滑动并完全退出植入式医疗器械100的膨胀路径时,使得植入式医疗器械100暴露,容许植入式医疗器械100膨胀。
调节线用于在手术过程中,限制植入式医疗器械100与球囊导管120之间的错位(尤其是在球囊导管120的轴向上),两者彼此错位可能会影响植入式医疗器械100进入膨胀状态后的三维形态,甚至会有安全隐患,调节线将植入式医疗器械100可释放地固定在球囊导管120上可理解为在尽量避免轴向错位的前提下,并不影响植入式医疗器械100的释放。
为了保证限位,调节线一端能够保持与球囊导管120的固定,在某些情况下,该端也可以相对球囊导管120可控的运动,既可以灵活的调整植入式医疗器械100的位置,还可以避免对其释放的干涉。
可控的运动,可利用调节线自身弹性在可预期范围内的形变,或者利用传动部件操作调节线等等。
调节线的另一端穿过植入式医疗器械100后受锁线126的束缚,调节线与植入式医疗器械100的具体穿引方式并没有严格限制,调节线上锁孔与锁线的结合部位,可视为一限位点;就某一限位点而言,至少可限制或干涉植入式医疗器械在球囊导管轴向上某一方向的运动,以减少彼此错位。
而锁线的主要目的则是保持调节线与植入式医疗器械之间的穿引状态,避免调节线从植入式医疗器械上抽离,锁线自身可具有适宜的刚度,至少在局部可承受调节线锁孔部位的剪切力。
在一实施例,调节线与锁线之间仅为一处结合部位。在调节线自身为刚性件时即使一处结合部位也可限制植入式医疗器械在两个方向上的错位,若调节线为柔性且可形变的部位长度较短时,也基本可以满足上述要求。
在另一实施例,调节线与锁线之间至少有两处结合部位,其中至少一结合部位限制植入式医疗器械向远端方向运动,还有至少一结合部位限制植入式医疗器械向近端方向运动。
当然,若重点仅针对某一方向的错位限制,上述结构还可进一步简化。
调节线可以是一根或多根,同一调节线可提供一个或多个锁孔。在一实施例,锁孔成对布置,例如一对或多对,同对锁孔中,其中一者靠近球囊导管远端(使用状态下),另一者靠近球囊导管近端。
利用调节线对植入式医疗器械的牵引限位,对于调节线整体(当有多根调节线时,视为一整体看待)而言,与球囊导管之间需承受两个方向的彼此牵拉:
靠近球囊导管远端的锁孔与锁线的结合部位,可限制植入式医疗器械向近端运动;
靠近球囊导管近端的锁孔与锁线的结合部位,可限制植入式医疗器械向远端运动。
锁线与调节线之间的分离,既可以主动操控,也可以利用球囊导管以及植入式医疗器械的形变来驱动,继而在手术的特定阶段实现自动分离。
在本实施例中,植入式医疗器械100上设置有环体105,在锁定状态下,环体105穿过对应调节线上带有锁孔的一端后,与锁线126配合。
调节线带锁孔一端穿设过环体105后,再藉由锁线126限制调节线脱离环体105,使得调节线与植入式医疗器械100无法脱离,主要体现在当植入式医疗器械100在球囊导管120上滑动时,并最终在锁孔处被限制进一步滑动。限制植入式医疗器械100的压缩/膨胀状态下 相对球囊导管轴向上的滑动。当然也可以是环体105穿设过锁孔,再藉由锁线126限制环体105脱离调节线。
其中锁孔穿设过环体105或者环体105穿设过锁孔,以及锁线穿设锁孔或环体105的操作可以人工穿设或其他穿设方式。
锁线126活动穿设在输送系统内,锁定状态下,依次穿设过所有锁孔或环体105后,两端实现固定,三者之间相互作用限制调节线与植入式医疗器械100分离。锁线126在自身的远端能够与输送系统脱离。锁线126脱离操作后且完全退出所有锁孔或环体105,对应切换至解锁状态。
在其中一实施例中,输送系统还包括控制手柄200,球囊导管120、护套123以及锁线126均延伸至控制手柄200,球囊导管120、护套123、以及锁线126三者能够相对运动。
三者也可以相对于控制手柄200运动,运动控制可以是通过管、线延伸至近端的控制手柄200后实现远端控制。其中球囊导管120的运动能实现自身以及植入式医疗器械在病变位置的调整,护套123能够沿球囊导管轴向滑动实现包裹或者暴露植入式医疗器械100,锁线126的运动可实现与调节线的解脱。
参阅图1A~图3B,在一些实施例中,球囊导管120包括:
引导头127,开设有插孔138,锁线126在锁定状态下的端头部位伸入插孔;
球囊体122,邻近引导头127且位于引导头127的近端侧,球囊体122的外周为植入式医疗器械100的装载区;
导管体124,与球囊体122相连通并向输送系统的近端侧延伸。
其中,球囊导管120的远端为引导头127,锁线126伸入插孔内固定,避免调节线非预期的解脱。
球囊体122设置在引导头127附近,且处在引导头127的近端侧。引导头127可以具有从其近端128到其最远端逐渐缩径的锥形配置,便于在体内引导处于近端的球囊体122和导管体124,并且可以在近端128处提供直径小于近端128直径的圆柱形的连接器129,该连接器129进一步向近端方向上延伸。
球囊体122的远端固定到连接器129的近端表面,球囊体122的近端固定到导管体124的远端132。球囊体122内部中空,能够充气/液和穿设其他部件。
导管体124为中空的管件,近端延伸至控制手柄200内,导管体内部除了可以容纳用于远端控制的管、线外,还作为流体通道,与球囊体内部相连通,并输送气/液用于扩张球囊体122。护套123可用于在导管体124和球囊体122外周沿导管体124长度方向滑动,起到一定的防护作用。且球囊体122和导管体124均由弹性材料制成,便于形变变化。
参阅图1A,在一实施例中,球囊导管120还包括:
中心管133,穿设在导管体124内,中心管133的一端向输送系统的近端侧延伸并连接至控制手柄200,另一端贯穿球囊体122并与引导头127相连。
其中,中心管133为中空管件,且为弹性材料制成,能够随动弯曲。中心管133两端贯通,内部作为导丝通道。
针对上述部件的材料,在此集中说明,导管体124可以由Pebax、PTFE、尼龙或用于导管体的任何其他已知材料制成;护套123可由Pebax、PTFE、尼龙或用于类似可滑动护套的任何其他已知材料制成;调节线可以是聚丙烯线、编织PET线、PTFE线或任何常规线。球 囊体122可以由任何常规球囊体材料制成,例如尼龙和Pebax TM
请参阅图1A~图7,锁线126的设置方式可以是如下:
在一实施例中,锁线126从护套123和导管体124之间限定的管腔137中向输送系统的近端侧延伸。
护套123滑动设置在导管体124的外周,两者之间构成容纳锁线126的管腔137。
在另一实施例中,锁线126从导管体124内部限定的管腔137中向输送系统的近端侧延伸。
在另一实施例中,导管体124的管壁开设有通孔161,锁线126的远端经由该通孔延伸至导管体124的外部,用于同调节线配合。在本实施例中,导管体124的管壁带有径向内凹区160,通孔161开设在该径向内凹区160中的近端侧部位。
内凹区160减小锁线126在通孔161处的弯曲变化,使得锁线126的运动更顺畅,在其他实施例中,通孔为条形孔,且长度方向与导管体轴向一致。
在一实施例中,锁线为金属杆。
锁线126可以由304或316不锈钢制成(锁线线径一般可以是0.5mm左右),提高较强的轴向推送力,便于穿设锁孔或环体。锁线126的外表面带有PTFE涂层,减少与其他管、线之间的摩擦力且具备不黏性,保持锁线126顺畅地滑动。
在一实施例中,调节线的端部绕成线环结构,该线环结构的内部为锁孔。
锁孔还可以是另外的线材绕置形成环结构,再与调节线的端部固定,所用的线材材质可以与调节线相同,也可以是其他材质。当然,锁孔的形成方式不局限于此。
锁孔周向一般为封闭结构,但在能限制锁线脱出的情况下,也可以采用周向非封闭结构。
在一实施例中,调节线包括:
第一调节线121,具有第一锁孔135,第一调节线121连接于球囊导管120,且邻近球囊导管120的远端106;
第二调节线131,具有第二锁孔136,第二调节线131连接于球囊导管120,且邻近球囊导管120的近端107;
锁定状态下,锁线126同时穿过第一锁孔135和第二锁孔136。
两调节线相应的两端部的具体连接方式参考前述。且两调节线分别处在球囊导管120近端和远端,起到对植入式医疗器械100轴向两个方向的限制。
第一调节线121和第二调节线131可以分别是一根或多根,多根时沿球囊导管120周向间隔布置,第一调节线121和第二调节线131这两者与球囊导管120的连接位置(周向位置)可以相互对正或错位布置。
锁线可设置一根或多根,以第一调节线121为例,若锁线数量少于第一调节线121,则多根第一调节线121上的第一锁孔135可共用其中一锁线。设置多根锁线时,各锁线可独立控制或相互联动,优选同步运动。
根据第一锁孔135和第二锁孔136相对植入式医疗器械100的伸出距离,控制植入式医疗器械100在球囊导管120上的活动范围。如图3B、图30和图40所示,锁线126向前穿过第一锁孔135和第二锁孔136并进入引导头127内的插孔138。图3B中的锁定区域LK示出了锁定处的配合关系,其中锁线126在各锁孔穿过对应的环体105之后,再依次穿过各锁孔。引导头127内的孔应具有一定的深度,以便锁线126可以安全地锁定在引导头127。本实施 例心脏瓣膜组件104通过第一调节线121和第二调节线131以及锁线126提供的约束被安全地约束在球囊体122上,以防止任何横向(图中方位即导管体124的长度方向)移动。
其中,锁定状态下,锁线126的末端距离第一锁孔135的尺寸范围满足至少5mm,例如8~30mm。
在一些实施例中,各调节线相对于球囊导管的连接方式可有不同的配置方式。
在一实施例中,第一调节线121和第二调节线131中的一者为固定连接至球囊导管120的固定调节线,另一者相对球囊导管120可牵拉运动的活动调节线。
在一实施例中,第一调节线121和第二调节线131分别固定连接至球囊导管120。
就第一调节线121而言,可以直接固定至引导头127、连接器129或球囊体中的至少一者,具体的固定方式可采用绑扎、粘结等多种方式的至少一种。
例如调节线的端部绑扎至上述对应部件(引导头、连接器或球囊体中的至少一者),为了保证连接强度,还可以进一步配合以下上方式中的至少一者:
调节线的端部绕成线环;
对应部件上开设有供调节线穿设的通孔;
调节线的端部与对应部件之间热熔粘结。
在一实施例中,第一调节线121固定到连接器129,并且第一调节线121从连接器129向球囊体122近端方向延伸。类似地,第二调节线131固定到导管体124的远端132并且具有锁孔,第二调节线131从远端132向球囊体122的远端方向延伸。
在另一实施例中,第一调节线121固定至引导头127内。
就第二调节线131而言,可以直接固定至导管体或球囊体中的至少一者,具体的固定方式参考第一调节线121的连接方式。
在一实施例中,第二调节线131固定套设在导管体124的外周。
例如导管体124的外周带有限位台阶139,第二调节线131受限于限位台阶。
参阅图27,第二调节线131与导管体124的连接端绑扎形成环结构,该环结构绕置在导管体124外周并处于限位台阶139的近端。还可以采用限位槽的方式,即第二调节线131的端部绕置在限位槽内。
在另一实施例中,第一调节线121和第二调节线131均活动的连接至球囊导管120。
两调节线一端带有锁孔,另一端可视为活动端,相对于球囊导管120能够可控的伸缩,控制自身处于球囊导管120外的暴露部分的长度,进而限制植入式医疗器械100的滑动范围。
在图14B中,在一实施例中,第一调节线121和第二调节线131之间通过连接线140相连。操作连接线140可同时驱动第一调节线121和第二调节线131。
如图13A和13B示出处于松弛状态的连接线140,使得第一调节线121和第二调节线131的暴露部分过长。如图13A所示,当第一调节线121和第二调节线131的外露部分较长,压缩状态的植入式医疗器械100具有前后滑动的空间(参见可调节的锁结11a),因此固定效果不佳。当连接线140被拉紧时,第一调节线121和第二调节线131也被拉动,使得第一调节线121和第二调节线131的外露部分变短。如图14A所示,分别位于第一调节线121和第二调节线131的末端的第一锁孔135和第二锁孔136与植入式医疗器械100上的环体105对准(参见可调节的锁结11b),使得植入式医疗器械100被紧紧固定。
优选的,第一调节线121和第二调节线131中的至少一者与连接线140为一体结构。
两种线材的结合(例如粘接或绑扎)会在连接点处增厚,一体结构将减少一处连接点。
在其中一实施例中,连接线140向输送系统的近端侧延伸。
连接线140延伸近端侧的控制手柄200以便于控制。
连接线140的具体延伸路径并没有严格限制,例如在径向上可在中心管内部、导管体外部、中心管与导管体之间、中心管管壁、或导管体管壁延伸。
在一实施例中,连接线140在中心管133内向输送系统的近端侧延伸,并可相对球囊导管120牵拉运动。
例如当连接线140向近端侧运动时,驱使两调节线的暴露部分缩短,限制植入式医疗器械100的相对运动。植入式医疗器械100释放时,为了适应尺寸变化,连接线140可略向远端运动。
同理,当两调节线固定设置时,穿过植入式医疗器械100后可留有适当余量,适应植入式医疗器械100的释放,当然该余量至少可避免植入式医疗器械100的过度错位。若球囊导管120轴向长度足够,该余量也容许放宽。
如图13A-14B,为了方便线材(例如导丝、连接线、调节线)穿设布置。在一实施例中,中心管133具有多个管腔,活动调节线沿其中一管腔延伸。其余管腔能够穿设导丝或其他线材,每个线材、导丝均有单独通道,互不干扰,避免缠绕干涉。
在本实施例中,多个管腔中,其中一者为中心管腔141,至少另一者为偏心布置的第二腔142,活动调节线经由第二腔142延伸。使用时导丝经由中心管腔141延伸。
在一实施例中,第二腔142的腔壁设有两个开口,第一调节线121和第二调节线131经由对应的开口延伸出中心管133。
两开口间隔设置,且分别为处于远端的第一开口144,以及处于近端的第二开口143,两开口使第二腔142与中心管133的外部连通,容许两调节线伸出并暴露。其中第一调节线121延伸穿过第一开口144,第二调节线131延伸穿过第二开口143。连接线140穿过两个开口之间的第二腔142延伸,使得连接线140的第一端连接到第一调节线121,并且连接线140的相对的第二端连接到第二调节线131。
在一实施例中,护套123和导管体124之间限定的管腔中活动穿设有中间护套150,活动调节线与中间护套150相连。中间护套150作为传动件,更便于向近端延伸以及与控制手柄相连,第二调节线131可以固定到中间护套150的远端,而第一调节线121可以直接固定到连接器129或其固定位置与连接器129相邻。
在图15A中,中间护套150朝球囊体122的远端侧方向推进,中间护套150的远端伸出护套123并暴露,使得第一锁孔135和第二锁孔136可以延伸穿过相应的环体105。
在图15B中,中间护套150在远离球囊体122的近端方向上运动,这使得第一调节线121和第二调节线131被拉紧,并且第一锁孔135和第二锁孔136被相应的环体105锁紧。该实施例(图15A和图15B)在与上述实施例相似的原理下工作,主要区别在于提供中间护套150而不是较长的调节线或连接线。
结合上述,在其中一实施例中,植入式医疗器械上的环体105至少有两个,至少一者邻近植入式医疗器械100的相对端设置,或者分别处在植入式医疗器械100的两相对端。例如分别处在植入式医疗器械轴向的两端。
两个环体105分别供第一锁孔135和第二锁孔136穿设,锁线126依次穿设两锁孔后、 锁线126的端头再相对引导头固定即完成锁定。
反之,两个环体105也可以对应穿过第一锁孔135和第二锁孔136,锁线126依次穿设两个环体105再相对引导头固定即完成锁定。
环体在植入式医疗器械周向上可以对正或错位。其中,对正指两环体105之间的连线与植入式医疗器械轴线平行(植入式医疗器械整体造型近似为直筒),错位指非平行。
在一些实施例中,环体105的构成方式为以下方式的至少一种:
方式a:采用独立部件并固定于植入式医疗器械100,如图10所述,环体105a可以由与植入式医疗器械100的材料相同或不同的材料制成,在组装过程中,环体105a是手动安装至支架103。环体105a可由任何传统缝合材料(例如聚丙烯、聚四氟乙烯)或与支架103相同的材料制成。
方式b:通过在植入式医疗器械100上打孔构成。
图12A示出了开设在单元格102的尖端105c中的通孔115,其中第一调节线121、第二调节线131可穿过对应的通孔115中,或者被对应通孔115穿过。
方式c:直接利用植入式医疗器械100自身的结构间隙。
图11示出了另一种情况,其中环体105为单元格102的尖端105b部位,利用围成单元格的框条自身围成环体105,尖端105b可以采用弧形避免割断调节线,第一调节线121、第二调节线131适于以相同的方式延伸到尖端105b限定的空间中,尖端105b朝向所在单元格内侧的部位为开口侧,便于调节线进入环体105中。
其中,单个植入式医疗器械100允许存在多种形式的环体105,例如图12B所示,植入式医疗器械100周向上具有相互对正的一对环体105,分别为环体105d和环体105e,环体105d为植入式医疗器械100的结构间隙环体105e为打孔形成。关于环体的在植入式医疗器械100上的轴向位置,可以多种配置方式,例如环体105d处于植入式医疗器械100的轴向一端,环体105e并非处在轴向端部,而仅仅是邻近。
在其中一实施例中,植入式医疗器械100具有管状的器械主体,调节线带有锁孔的一端由器械主体的内部沿径向朝器械主体的外部穿引。
首先定义器械主体朝向球囊导管120一侧为内部,相应的外部为背向球囊导管一侧。
锁孔从内侧向外侧穿过对应环体105,并最终处于植入式医疗器械100的外侧,锁线126在器械主体外侧依次穿设过锁孔。例如穿设方向与球囊导管120轴向一致。锁线126可在外侧无遮挡的状况下穿设,方便装配。
调节线与植入式医疗器械相互穿引,且锁线限制两者相互解脱即可以实现定位,基于此参阅图17~图19,本申请一实施例公开了一种植入式医疗器械的输送系统,包括球囊导管,还包括:
护套123,滑动配合在球囊导管120的外周,用于包裹植入式医疗器械100;
调节线,用于将植入式医疗器械100可释放地固定在球囊导管120上,调节线上的一端能够保持与球囊导管120的固定,另一端带有锁孔并藉由植入式医疗器械100穿过;
锁线126,具有相对的锁定状态和解锁状态,在锁定状态下,锁线126穿过植入式医疗器械100以限制植入式医疗器械100与调节线分离,解锁状态下,锁线126脱离植入式医疗器械100,容许各锁孔脱离并释放植入式医疗器械100。
本实施例与上文实施例的主要区别在于调节线与植入式医疗器械相互穿引后,锁线与植 入式医疗器械配合,例如在一实施例中,植入式医疗器械100上设置有环体105,在锁定状态下,环体105穿过对应调节线上带有锁孔的一端后,且与锁线126配合。
参阅图20~图24,在其中一实施例中,输送系统还包括调弯件300,调弯件300作用至球囊导管120在远端部位,改变球囊导管120的空间指向。
在调弯件300与导管体124的径向关系上,在一些实施例中,调弯件300处在导管体124的内侧、外侧、或管壁夹层中,调弯件300与导管体124两者远端部位相互作用使球囊导管120在远端部位调弯。
调弯件300自身可以是管、线或杆的一种或多种的结合,调弯件300的近端连接并受控于控制手柄200。调弯件300能够在远端部位产生致使导管体124弯曲的作用力。
调弯件300可直接或间接作用至球囊导管120,在以下一些实施例中,以作用至导管体124为例,提供了调弯件300与导管体124两者多种的具体连接方式。例如调弯件300与导管体124两者远端部位固定连接或活动配合。
参阅图21和图22,在一实施例中,调弯件300为调弯线或调弯管,调弯件300与导管体两者远端固定,近端滑动配合使球囊导管120在远端部位调弯。
调弯件300与导管体124两者的远端部位相互固定,当其中一者的近端侧受到作用力相对另一者滑动时,会导致两者的远端产生弯曲的趋势,从而产生输送系统的远端整体调弯,改变球囊导管120方向,以适应介入路径或病变位置。以调弯管为例,可设置导管体内,也可设置在导管体外。
参阅图23和图24,在一实施例中,调弯件300包括相互嵌套的内调弯管301和外调弯管302,内调弯管301和外调弯管302两者远端固定,近端滑动配合使调弯件300在远端部位调弯并作用至导管体124。
调弯件300采用内外双管结构,两者近端的相对运动可在远端产生弯曲的趋势,从而驱使导管体124弯曲。其中调弯件300处于导管体124内部或外部。图中调弯件300处于导管体124外部,另外,两调弯管的其中一者可以用调弯线代替。
在本实施例中,内调弯管301和外调弯管302两者中的至少一者相对控制手柄200活动连接。
前文提及用于实现各种远端操作的控制手柄200,可利用现有技术来驱动相应的部件,以下将提供控制手柄200的改进结构,并结合工作原理进行详细说明:
参阅图16和图27~图42,本申请输送系统包括控制手柄200,用于操作植入式医疗器械,控制手柄200包括支撑体210以及安装于支撑体210上的第一驱动组件220,第一驱动组件包括:
第一安装座221,滑动设置于支撑体210;
第一驱动件222,活动安装于支撑体210,且与第一安装座221传动配合;
其中,第一安装座221包括带有内腔的本体,以及开设于本体且与内腔连通的:
远端接口261,用于对接球囊导管120;
驱动接口262,用于向球囊导管120内注入流体;
限位接口263,用于穿引锁线126;
近端接口264,用于穿引导丝。
球囊导管120通过管件延伸穿过支撑体并与远端接口261相对固定连接,第一驱动件222 的相对支撑体运动,驱使第一安装座221滑动,带动与球囊导管120连接管件滑移,调整球囊导管120在达到病变附近后的位置调整,达到最佳释放植入式医疗器械的位置。
第一安装座221设置在控制手柄200的近端,其为管件且至少具有与四个接口相对应的管口。
参阅图31~图33,在一实施例中,控制手柄200还包括安装于支撑体210上的第二驱动组件230,第二驱动组件处在第一驱动组件的近端侧,第二驱动组件包括:
第二安装座231,滑动设置于支撑体210;
第二驱动件232,活动安装于支撑体210,且与第二安装座231传动配合。
第二安装座231用于连接护套123,第二驱动件232相对支撑体210运动,驱使第二安装座231带动护套123滑移,完成包裹/暴露球囊导管120的操作。
参阅图34~图36,在一实施例中,控制手柄还包括安装于支撑体210上的第三驱动组件250,第三驱动组件处在第一、第二驱动组件之间,第三驱动组件包括:
固定安装座253;
第三安装座251,滑动设置于支撑体210;
第三驱动件252,活动安装于支撑体210,且与第三安装座251传动配合。
外调弯管302连接至固定安装座253,内调弯管301连接至第三安装座251,第三驱动件252带动第三安装座251相对于固定安装座253运动时,调弯件整体会在远端部位弯曲,继而作用至球囊导管,产生调弯效果。对于各驱动件与对应安装座的传动关系,以及与支撑体的配合关系为,在一实施例中,支撑体210具有空间上的轴向,支撑体上开设有沿自身轴向延伸的导向槽211,各安装座滑动设置在对应的导向槽211内;各驱动件分别转动套设在支撑体外周,且与相应的安装座之间螺纹配合。
在一实施例中,支撑体210具有空间上的轴向,第一安装座为具有四个支管的四通结构,远端接口、驱动接口、限位接口和近端接口分别为对应一支管的管口;沿支撑体轴向,远端接口与近端接口相互对正。
为减少空间占用,四个支管的轴线大致共面。驱动接口和限位接口所对应的支管对向处在远端接口所在管路的两侧,便于对接管路。
在一实施例中,驱动接口、限位接口和近端接口所在支管的端部带有外螺纹。方便与外部管路连接。
在一实施例中,导管体124的近端与远端接口密封连接,中心管133的近端延伸出导管体后在第一安装座的内腔中延伸并密封连接至近端接口;
驱动接口连通至导管体与中心管两者的径向间隙,流体从两者间隙流向远端的球囊体。
在一实施例中,锁线126的近端延伸至第一安装座的内腔中后,再直接经由限位接口穿出第一安装座,或经由限位接口支管的侧壁穿出第一安装座。
参阅图42,第一安装座在限位接口263处可拆卸连接有操作件265,操作件265与锁线126固定连接。操作件265在与第一安装座分离后,作为操作柄供术者持握,方便驱动锁线126运动。在不需要驱动锁线126时,将操作件265安装固定在第一安装座上。操作件265与第一安装座的连接方式为螺纹配合。
在一实施例中,限位接口所在支管向支撑体近端倾斜延伸且与支撑体轴线夹角α满足0度<α<60度。例如10度<α<45度,又例如15度<α<30度。参阅图49,在一实施例 中,控制手柄200包括排气组件240,排气组件包括:
连接头241和注液管242,注液管242一端连接连接头,一端连通至固定安装座253。
例如采用生理盐水进行排气,生理盐水经由排气组件240进入固定安装座253,而后可利用开设在各管件管壁上的连通孔进入相邻管件之间的缝隙,将空气排出。
为便于操作,减少对术者的干涉,注液管242由固定安装座253起在控制手柄内部延伸至控制手柄的远端处,而后再穿出控制手柄并与连接头241配合。
结合前文调弯件300与导管体124的远端相互活动配合的形式。
控制手柄200操作调弯件300的近端,作用于导管体124完成对球囊导管120的调弯,接着停止操作调弯件,使得调弯件300的近端固定不动,保持远端指向不变。
控制手柄200操作球囊导管120沿支撑体300运动,驱使球囊导管120的远端沿自身轴向移动,调整球囊导管相对于病变部位的位置,以到达释放植入式医疗器械的最佳位置。
植入式植入式医疗器械通过球囊体扩张后膨胀,但在植入式医疗器械局部存在径向尺寸变化时,难以利用常规球囊体实现,即使采用特定形状的球囊体,植入式医疗器械也会由于其他区域连带形变,导致膨胀状态下的无法达到预期效果。
为解决上述问题,参阅图43~图48,本申请一实施例提供了一种植入式医疗器械100,包括支架103,以及连接于支架103的瓣叶108,支架103为径向可形变结构且具有相对的压缩状态和膨胀状态,植入式医疗器械100还包括沿支架周向绕置连接于支架103的束形环109,束形环109在支架103进入膨胀状态过程中限制支架103的径向形变幅度。
支架103的内部为轴向贯通的血流通道,瓣叶108为2、3或4瓣,各瓣叶108相互配合以开放或封闭血流通道。
束形环109安装定位在支架103周向的一圈,使得支架103在膨胀状态下呈现相对缩径的腰部结构。在支架径向上,束形环109绕置在支架外周或内壁或起伏穿引于支架的内外两侧。沿支架103轴向,束形环109的位置处在支架中部或邻近支架流入侧或与瓣叶流入侧的位置邻近。绕置的方式有多种,例如束形环109缝缀在支架的镂空结构的边缘上。
根据束形环109在支架103轴向上的相对位置,缩颈的位置也会发生相应的改变。其中,沿支架轴向,支架103包括与束形环109位置相应束形段,以及处在束形段两侧的自由段,膨胀状态下,束形段比各自由段具有更小的外径。束形环109改变了束形段相对自由段的膨胀形变量,单位时间内,束形段的形变量小于自由段的形变量。相应的,束形段与自由段之间的连接段同样受制于束形环109而缓慢形变,并最终与束形段和自由段弯曲过渡。
在本实施例中,束形环109为环状结构。环状结构可以是长条的带状体两端相互固定而成,也可以是一完整的环或其他方式加工获得。
在一些实施例中,沿支架轴向,束形环109的宽度范围满足宽度为2~30mm(束形环展平状态的宽度为准)。例如5~20mm,又例如5~15mm。又例如8mm。其中,束形环109为可随支架103压缩的柔性材料。
束形环109拉伸率较低,例如PTFE等材质,在支架103膨胀过程中,束形环109先随支架103同步扩张,当接近其弹性极限时,减缓或阻止束形段的继续膨胀。
束形环109还可以采用金属丝,金属丝两端固定围成环状,或者为一体环,金属丝截面形状可以是圆形、椭圆形等。
在一实施例中,支架103为具有镂空结构的网筒状且具有空间上的轴向,按照血流方向, 支架轴向的一端为流入侧113,另一端为流出侧114,植入式医疗器械100还包括连接在支架内侧的第一覆膜111,该第一覆膜111对接在瓣叶108的流入侧。
第一覆膜111设置在支架103的内部周向一圈,且对接在瓣叶108与支架103连接处,用于封闭镂空结构部分,在一实施例中,植入式医疗器械还包括连接在支架外侧的第二覆膜112,该第二覆膜112对接在束形环109的流入侧。
第二覆膜112遮盖包覆在支架103的外周,与第一覆膜111相互配合,避免周漏。第二覆膜112可以与第一覆膜111一样采用缝缀的方式与支架103相互固定。
其中,第一覆膜111和第二覆膜112两者延伸至支架103的流入侧,且两者相互对接包裹支架103的流入侧边缘。
为了方便装配,在一实施例中,第一覆膜111和第二覆膜112为一体结构。
即两覆膜实则为一张完整的膜片,在支架103流入侧的端部边缘弯曲对折后形成第一覆膜111和第二覆膜112,并分别与支架103固定连接。
优选的,覆膜在对折处与支架103同样固定连接。
结合前述,覆膜开设有孔洞供支架103上的环体105伸出。
进一步优选的,第一覆膜111和第二覆膜112两者中的一者延伸至支架103的流入侧后翻折包裹支架103的流入侧边缘,且在翻折后进一步延伸对接至另一者的流出侧。
支架103在压缩状态下,覆膜在流入侧会相互叠置堆积,增加了径向厚度,并干涉到了护套123的运动路径,影响护套123的操作。
为解决上述问题,第一覆膜111和/或第二覆膜112在邻近支架流入侧的边缘部位带有切口,切口的位置与支架103的流入侧边缘形状相匹配。
相邻两切口之间存在间隙,在随支架103压缩过程中,间隙逐渐减小,减少了覆膜在流入侧的相互堆积,便于护套123的包覆。
在其中一实施例中,支架103的流入侧包括沿周向排布的多个单元格102,相邻单元格102之间带有朝向流入侧的结构间隙,切口与相应的结构间隙位置匹配。
在其中一实施例中,第一覆膜111和/或第二覆膜112在邻近支架流入侧的边缘部位为锯齿状,相邻齿之间为切口,切口两侧部位与支架的对应部位缝缀连接。
本申请一实施例提供了一种植入式系统,包括植入式医疗器械以及与植入式医疗器械相配合的输送系统。
其中植入式医疗器械以及输送系统可采用或结合上文任一实施例,植入式医疗器械在压缩状态下径向收拢贴靠在球囊导管的外周壁,沿球囊导管轴向,球囊导管上处于植入式医疗器械的两端可释放地固定有带锁孔的调节线,带锁孔的一端穿设过植入式医疗器械轴向的两端。输送系统还包括有大致沿球囊导管滑动设置的锁线,锁线穿设过锁孔防止调节线与植入式医疗器械分离。
两调节线的锁孔允许与植入式医疗器械的端部间距一定距离,该距离可人为调整,使得植入式医疗器械在球囊导管轴向的相对位置可控,且该距离可以为零,进而限制植入式医疗器械在球囊导管上的运动。
本申请一实施例还提供一种植入式医疗器械的释放方法,植入式医疗器械100预先固定在输送系统上,释放方法包括:
驱动护套123向输送系统近端侧运动以暴露植入式医疗器械100;
拉动锁线126从调节线的锁孔中抽出;
驱动球囊体122外扩并带动植入式医疗器械100形变至膨胀状态,还使调节线从植入式医疗器械100中抽出;
使球囊体122收缩,向输送系统近端侧运动球囊导管120与植入式医疗器械100分离。
其中输送系统可采用或结合上文任一实施例。
植入式医疗器械100输送至病变部位后,输送系统的近端可通过控制手柄远端控制护套123沿球囊导管轴向向近端滑动,逐渐让植入式医疗器械100暴露直至护套123完全退出植入式医疗器械100的径向膨胀路径。
锁线126大致沿球囊导管轴向被抽出,并且第一锁孔135、第二锁孔136将自动且完全从其相应的环体105脱离。锁定区域8b示出了锁孔与其环体105之间的脱离。接下来,在图8中,锁线126被完全抽出并且球囊体122被放气进入收缩状态。最后,在图9中,抽出球囊导管120。
若锁线126有足够的顺应性,不至于阻碍植入式医疗器械100膨胀,还可以在植入式医疗器械100膨胀后撤离锁线126,这样在膨胀过程中,可始终保持与球囊导管的轴向相对位置。
膨胀结束后,释放流体,球囊体122收缩并与植入式医疗器械100分离,最后将输送系统从体内抽出。
以上释放方法中的步骤不严格限制次序,例如还可以采用如下方式:
驱动护套123向输送系统近端侧运动以暴露植入式医疗器械100;
驱动球囊体122外扩并带动植入式医疗器械100形变至膨胀状态,还使调节线从植入式医疗器械100中抽出;
驱使球囊体122收缩;拉动锁线126从调节线的锁孔中抽出;
向输送系统近端侧运动球囊导管120与植入式医疗器械100分离。
与前述释放方法的区别在于:在支架膨胀过程中,锁线126适应性的形变弯曲(形变过程中可利用远端或近端的移动补偿处在支架外围部分的长度变化),但始终未脱离锁孔来限制支架在轴向上的运动,待膨胀结束且球囊体122收缩后,驱使锁线126脱离锁孔,再经由输送系统控制球囊导管与植入式医疗器械的分离,并从体内抽出。
本申请一实施例还提供了一种植入式医疗器械的装载方法,用于将植入式医疗器械固定至的输送系统,其中输送系统可采用或结合上文任一实施例。
装载方法包括:
将处于膨胀状态的植入式医疗器械100置于收缩状态的球囊体122外周;
使植入式医疗器械100径向压缩至压缩状态;
将调节线带有锁孔的一端穿引过植入式医疗器械100;
将锁线穿过锁孔;
向输送系统远端侧滑动护套123直至将植入式医疗器械100包裹。
膨胀状态下的植入式医疗器械100可通过压握器等现有设备周向均匀压缩,直至切换成压缩状态。
参考图3A,第一调节线121的第一锁孔135穿过植入式医疗器械100的远端106的环体105,第二调节线131的第二锁孔136穿过植入式医疗器械100的近端107处的环体105。
这可以在装配过程中使用手动完成,或借助工具完成。一旦完成该操作,锁线126就穿过在护套123和导管体124之间限定的管腔137,并且从护套123的远端138伸出。
接下来,如图3B所示,锁线126向前穿过第一锁孔135和第二锁孔136并进入引导头127内的插孔138。图3B中的锁定区域LK示出了锁定处的配合关系,其中锁线126在各锁孔穿过对应的环体105之后,再穿过各锁孔。引导头127内的孔应具有一定的深度,以便锁线126可以安全地锁定在引导头127。
本申请一实施例还提供了一种将植入式医疗器械固定在球囊导管上的方法,包括以下步骤:
提供一种植入式医疗器械,植入式医疗器械具有管状的器械主体,管状的器械主体具有第一端和第二端,第一端设置有第一环体,第二端设置有第二环体;
提供一种球囊导管,球囊导管包括:
导管体,导管体具有引导头;
球囊体,邻近引导头且位于引导头的近端,球囊体具有相对的远端和近端;
第一调节线,具有第一锁孔,第一调节线邻近球囊导管的远端位置处,且固定于球囊导管;以及
第二调节线,具有第二锁孔,第二调节线在邻近球囊导管的近端位置处,且固定于球囊导管;
提供用于在导管体和球囊上滑动移动的护套,护套具有远端;
将处于膨胀状态的植入式医疗器械置于收缩状态的球囊体上;
将植入式医疗器械在收缩状态的球囊体上径向形变至压缩状态;
将第一调节线上的第一锁孔穿引过第一环体,以及第二调节线上的第二锁孔穿过第二环体;
将锁线穿过第一锁孔和第二锁孔并进入引导头;
将护套滑过压缩状态的植入式医疗器械直至推进到引导头,以完全覆盖植入式医疗器械。
以上所述实施例的各技术特征可以进行任意的组合,为使描述简洁,未对上述实施例中的各技术特征所有可能的组合都进行描述,然而,只要这些技术特征的组合不存在矛盾,都应当认为是本说明书记载的范围。不同实施例中的技术特征体现在同一附图中时,可视为该附图也同时披露了所涉及的各个实施例的组合例。
以上所述实施例仅表达了本申请的几种实施方式,其描述较为具体和详细,但并不能因此而理解为对申请专利范围的限制。应当指出的是,对于本领域的普通技术人员来说,在不脱离本申请构思的前提下,还可以做出若干变形和改进,这些都属于本申请的保护范围。

Claims (71)

  1. 植入式医疗器械的输送系统,包括球囊导管,其特征在于,还包括:
    护套,滑动配合在球囊导管的外周,用于包裹植入式医疗器械;
    调节线,用于将植入式医疗器械可释放地固定在所述球囊导管上,所述调节线上的一端能够保持与球囊导管的固定,另一端可穿过植入式医疗器械并带有锁孔;
    锁线,具有相对的锁定状态和解锁状态,在锁定状态下、所述锁线穿入各锁孔以限制植入式医疗器械,解锁状态下、所述锁线脱离各锁孔以释放植入式医疗器械。
  2. 根据权利要求1所述的植入式医疗器械的输送系统,其特征在于,所述输送系统还包括控制手柄,所述球囊导管、护套以及锁线均延伸至所述控制手柄,所述球囊导管、护套、以及锁线三者能够相对运动。
  3. 根据权利要求2所述的植入式医疗器械的输送系统,其特征在于,所述球囊导管包括:
    引导头,开设有插孔,所述锁线在锁定状态下的端头部位伸入所述插孔;
    球囊体,邻近所述引导头且位于所述引导头的近端侧,所述球囊体的外周为植入式医疗器械的装载区;
    导管体,与所述球囊体相连通并向输送系统的近端侧延伸。
  4. 根据权利要求3所述的植入式医疗器械的输送系统,其特征在于,所述球囊导管还包括:
    中心管,穿设在所述导管体内,中心管的一端向输送系统的近端侧延伸,另一端贯穿所述球囊体并与所述引导头相连。
  5. 根据权利要求3所述的植入式医疗器械的输送系统,其特征在于,所述锁线从所述护套和所述导管体之间限定的管腔中向输送系统的近端侧延伸。
  6. 根据权利要求3所述的植入式医疗器械的输送系统,其特征在于,所述锁线从所述导管体内部限定的管腔中向输送系统的近端侧延伸。
  7. 根据权利要求6所述的植入式医疗器械的输送系统,其特征在于,所述导管体的管壁开设有通孔,所述锁线的远端经由该通孔延伸至所述导管体的外部,用以同所述调节线配合。
  8. 根据权利要求7所述的植入式医疗器械的输送系统,其特征在于,所述导管体的管壁带有径向内凹区,所述通孔开设在该径向内凹区中的近端侧部位。
  9. 根据权利要求1所述的植入式医疗器械的输送系统,其特征在于,所述调节线与所述锁线之间仅有一处结合部位。
  10. 根据权利要求1所述的植入式医疗器械的输送系统,其特征在于,所述调节线与所述锁线之间至少有两处结合部位,其中至少一结合部位限制植入式医疗器械向远端方向运动,还有至少一结合部位限制植入式医疗器械向近端方向运动。
  11. 根据权利要求4所述的植入式医疗器械的输送系统,其特征在于,所述调节线是一根或多根,同一调节线可提供一个或多个锁孔。
  12. 根据权利要求11所述的植入式医疗器械的输送系统,其特征在于,所述锁孔成对布置,同对锁孔中,其中一者靠近球囊导管远端,另一者靠近球囊导管近端。
  13. 根据权利要求11所述的植入式医疗器械的输送系统,其特征在于,所述调节线包括:
    第一调节线,具有第一锁孔,所述第一调节线连接于所述球囊导管,且邻近所述球囊导管的远端;
    第二调节线,具有第二锁孔,所述第二调节线连接于所述球囊导管,且邻近所述球囊导管的近端;
    锁定状态下、所述锁线同时穿过所述第一锁孔和所述第二锁孔。
  14. 根据权利要求13所述的植入式医疗器械的输送系统,其特征在于,所述第一调节线和所述第二调节线分别固定连接至所述球囊导管。
  15. 根据权利要求13所述的植入式医疗器械的输送系统,其特征在于,所述第一调节线固定至所述引导头。
  16. 根据权利要求13所述的植入式医疗器械的输送系统,其特征在于,所述第二调节线固定套设在所述导管体的外周。
  17. 根据权利要求16所述的植入式医疗器械的输送系统,其特征在于,所述导管体的外周带有限位台阶,所述第二调节线受限于所述限位台阶。
  18. 根据权利要求13所述的植入式医疗器械的输送系统,其特征在于,所述第一调节线和所述第二调节线均活动的连接至所述球囊导管。
  19. 根据权利要求13所述的植入式医疗器械的输送系统,其特征在于,所述第一调节线和所述第二调节线之间通过连接线相连。
  20. 根据权利要求13所述的植入式医疗器械的输送系统,其特征在于,所述第一调节线和所述第二调节线中的至少一者与所述连接线为一体结构。
  21. 根据权利要求20所述的植入式医疗器械的输送系统,其特征在于,所述连接线向所述输送系统的近端侧延伸。
  22. 根据权利要求21所述的植入式医疗器械的输送系统,其特征在于,所述连接线在所述中心管内向所述输送系统的近端侧延伸,并可相对所述球囊导管牵拉运动。
  23. 根据权利要求13所述的植入式医疗器械的输送系统,其特征在于,所述第一调节线和所述第二调节线中一者为固定连接至所述球囊导管的固定调节线,另一者相对所述球囊导管可牵拉运动的活动调节线,所述护套和所述导管体之间限定的管腔中活动穿设有中间护套,活动调节线与所述中间护套相连。
  24. 根据权利要求23所述的植入式医疗器械的输送系统,其特征在于,所述中心管具有多个管腔,所述活动调节线沿其中一管腔延伸。
  25. 根据权利要求24所述的植入式医疗器械的输送系统,其特征在于,所述多个管腔中,其中一者为中心管腔,至少另一者为偏心布置的第二腔,所述活动调节线经由所述第二腔延伸。
  26. 根据权利要求25所述的植入式医疗器械的输送系统,其特征在于,所述第二腔的腔壁设有两个开口,所述第一调节线和所述第二调节线经由对应的开口延伸出所述中心管。
  27. 根据权利要求11所述的植入式医疗器械的输送系统,其特征在于,所述植入式医疗器械上设置有环体,在锁定状态下、所述调节线上带有锁孔的一端穿过对应的环体后、与所述锁线配合。
  28. 根据权利要求27所述的植入式医疗器械的输送系统,其特征在于,所述环体至少有两个,分别处在植入式医疗器械的两相对端,或两环体中至少一者邻近设于植入式医疗器械的相对端。
  29. 根据权利要求27所述的植入式医疗器械的输送系统,其特征在于,所述环体的构成方式为以下方式的至少一种:
    a、采用独立部件并固定于植入式医疗器械;
    b、通过在植入式医疗器械上打孔构成;
    c、直接利用植入式医疗器械自身的结构间隙。
  30. 根据权利要求27所述的植入式医疗器械的输送系统,其特征在于,所述植入式医疗器械具有管状的器械主体,所述调节线带有锁孔的一端由器械主体的内部沿径向朝器械主体的外部穿引。
  31. 根据权利要求27所述的植入式医疗器械的输送系统,其特征在于,所述锁线为金属杆。
  32. 根据权利要求4所述的植入式医疗器械的输送系统,其特征在于,所述输送系统还包括调弯件,所述调弯件处在所述导管体的内侧、外侧、或管壁夹层中,所述调弯件与所述导管体两者远端部位相互作用使所述球囊导管在远端部位调弯。
  33. 根据权利要求32所述的植入式医疗器械的输送系统,其特征在于,所述调弯件的近端连接并受控于所述控制手柄。
  34. 根据权利要求32所述的植入式医疗器械的输送系统,其特征在于,所述调弯件为调弯线或调弯管,所述调弯件与所述导管体两者远端固定,近端滑动配合使所述球囊导管在远端部位调弯。
  35. 根据权利要求4所述的植入式医疗器械的输送系统,其特征在于,用于操作植入式医疗器械的控制手柄包括支撑体以及安装于所述支撑体上的第一驱动组件,所述第一驱动组件包括:
    第一安装座,滑动设置于所述支撑体;
    第一驱动件,活动安装于所述支撑体,且与所述第一安装座传动配合;
    其中,所述第一安装座包括带有内腔的本体,以及开设于所述本体且与内腔连通的:
    远端接口,用于对接球囊导管
    驱动接口,用于向球囊导管内注入流体,
    限位接口,用于穿引锁线。
    近端接口,用于穿引导丝。
  36. 根据权利要求35所述的植入式医疗器械的输送系统,其特征在于,所述控制手柄还包括安装于所述支撑体上的第二驱动组件,所述第二驱动组件处在所述第一驱动组件的近端侧,所述第二驱动组件包括:
    第二安装座,滑动设置于所述支撑体;
    第二驱动件,活动安装于所述支撑体,且与所述第二安装座传动配合。
  37. 根据权利要求36所述的植入式医疗器械的输送系统,其特征在于,所述控制手柄还包括安装于所述支撑体上的第三驱动组件,所述第三驱动组件处在所述第一、第二驱动组件之间,所述第三驱动组件包括:
    固定安装座;
    第三安装座,滑动设置于所述支撑体;
    第三驱动件,活动安装于所述支撑体,且与所述第三安装座传动配合。
  38. 根据权利要求37所述的植入式医疗器械的输送系统,其特征在于,所述支撑体具有空间上的轴向,所述支撑体上开设有沿自身轴向延伸的导向槽,各安装座滑动设置在对应的导向槽内;各驱动件分别转动套设在支撑体外周,且与相应的安装座之间螺纹配合。
  39. 根据权利要求38所述的植入式医疗器械的输送系统,其特征在于,所述支撑体具有空间上的轴向,所述第一安装座为具有四个支管的四通结构,所述远端接口、驱动接口、限位接口和近端接口分别为对应一支管的管口;
    沿支撑体轴向,所述远端接口与近端接口相互对正。
  40. 根据权利要求39所述的植入式医疗器械的输送系统,其特征在于,所述四个支管的轴线大致共面。
  41. 根据权利要求40所述的植入式医疗器械的输送系统,其特征在于,所述导管体的近端与远端接口密封连接,所述中心管的近端延伸出所述导管体后在第一安装座的内腔中延伸并密封连接至近端接口;
    所述驱动接口连通至所述导管体与所述中心管两者的径向间隙。
  42. 根据权利要求41所述的植入式医疗器械的输送系统,其特征在于,所述锁线的近端延伸至第一安装座的内腔中后,再直接经由所述限位接口穿出第一安装座,或经由限位接口所在支管的侧壁穿出第一安装座。
  43. 根据权利要求42所述的植入式医疗器械的输送系统,其特征在于,所述限位接口所在支管向支撑体近端倾斜延伸且与支撑体轴线夹角α满足0度<α<60度。
  44. 植入式医疗器械的输送系统,包括球囊导管,其特征在于,还包括:
    护套,滑动配合在球囊导管的外周,用于包裹植入式医疗器械;
    调节线,用于将植入式医疗器械可释放地固定在所述球囊导管上,所述调节线上的一端能够保持与球囊导管的固定,另一端带有锁孔并藉由植入式医疗器械穿过;
    锁线,具有相对的锁定状态和解锁状态,在锁定状态下、所述锁线穿过植入式医疗器械以限制植入式医疗器械与调节线分离,解锁状态下、所述锁线脱离植入式医疗器械,容许所述各锁孔脱离并释放植入式医疗器械。
  45. 根据权利要求44所述的植入式医疗器械的输送系统,其特征在于,所述植入式医疗器械上设置有环体,在锁定状态下,所述环体穿过对应调节线上带有锁孔的一端后,且与所述锁线配合。
  46. 植入式医疗器械,其特征在于,包括支架,以及连接于所述支架的瓣叶,所述支架为径向可形变结构且具有相对的压缩状态和膨胀状态,所述植入式医疗器械还包括沿支架周向绕置连接于所述支架的束形环,所述束形环在支架进入膨胀状态过程中限制支架的径向形变幅度。
  47. 根据权利要求46所述的植入式医疗器械,其特征在于,所述束形环绕置在支架外周或内壁或起伏穿引于支架的内外两侧。
  48. 根据权利要求46所述的植入式医疗器械,其特征在于,沿支架轴向,所述束形环的位置处在支架中部或邻近支架流入侧。
  49. 根据权利要求48所述的植入式医疗器械,其特征在于,沿支架轴向,所述束形环的位置与瓣叶流入侧的位置邻近。
  50. 根据权利要求46所述的植入式医疗器械,其特征在于,沿支架轴向,所述支架包括与所述束形环位置相应的束形段,以及处在束形段两侧的自由段,膨胀状态下,所述束形段比各自由段具有更小的外径。
  51. 根据权利要求46所述的植入式医疗器械,其特征在于,所述支架为具有镂空结构的网筒状且具有空间上的轴向,按照血流方向,支架轴向的一端为流入侧,另一端为流出侧,所述支架的内部为轴向贯通的血流通道,所述瓣叶为2、3或4瓣,各瓣叶相互配合以开放或封闭所述血流通道。
  52. 根据权利要求51所述的植入式医疗器械,其特征在于,所述植入式医疗器械还包括连接在支架内侧的第一覆膜,该第一覆膜对接在所述瓣叶的流入侧。
  53. 根据权利要求52所述的植入式医疗器械,其特征在于,所述植入式医疗器械还包括连接在支架外侧的第二覆膜,该第二覆膜对接在所述束形环的流入侧。
  54. 根据权利要求53所述的植入式医疗器械的输送系统,其特征在于,所述第一覆膜和所述第二覆膜为一体结构。
  55. 根据权利要求53所述的植入式医疗器械,其特征在于,所述第一覆膜和所述第二覆膜两者延伸至支架的流入侧,且两者相互对接包裹支架的流入侧边缘。
  56. 根据权利要求53所述的植入式医疗器械,其特征在于,所述第一覆膜和所述第二覆膜两者中的一者延伸至支架的流入侧后翻折包裹支架的流入侧边缘,且在翻折后进一步延伸对接至另一者的流出侧。
  57. 根据权利要求56所述的植入式医疗器械,其特征在于,所述第一覆膜和/或所述第二覆膜在邻近支架流入侧的边缘部位带有切口,所述切口的位置与所述支架的流入侧边缘形状相匹配。
  58. 根据权利要求57所述的植入式医疗器械,其特征在于,所述支架的流入侧包括沿周向排布的多个单元格,相邻单元格之间带有朝向流入侧的结构间隙,所述切口与相应的结构间隙位置匹配。
  59. 根据权利要求58所述的植入式医疗器械,其特征在于,所述第一覆膜和/或所述第二覆膜在邻近支架流入侧的边缘部位为锯齿状,相邻齿之间为所述切口,切口两侧部位与支架的对应部位缝缀连接。
  60. 植入式系统,其特征在于,包括植入式医疗器械以及与所述植入式医疗器械相配合 的输送系统;所述输送系统为权利要求1~45任一项所述的植入式医疗器械的输送系统。
  61. 植入式医疗器械的释放方法,其特征在于,植入式医疗器械预先固定在权利要求1~45任一项所述的输送系统上,所述释放方法包括:
    驱动护套向输送系统近端侧运动以暴露植入式医疗器械;
    拉动锁线从调节线的锁孔中抽出;
    驱动球囊体外扩并带动植入式医疗器械形变至膨胀状态,还使调节线从植入式医疗器械中抽出;
    使球囊体收缩,向输送系统近端侧运动球囊导管与植入式医疗器械分离。
  62. 植入式医疗器械的装载方法,其特征在于,用于将植入式医疗器械固定至权利要求1~45任一项所述的输送系统,所述装载方法包括:
    将处于膨胀状态的植入式医疗器械置于收缩状态的球囊体外周;
    使植入式医疗器械径向压缩至压缩状态;
    将调节线带有锁孔的一端穿引过植入式医疗器械;
    将锁线穿过锁孔;
    向输送系统远端侧滑动护套直至将植入式医疗器械包裹。
  63. 将植入式医疗器械固定在球囊导管上的方法,其特征在于,包括以下步骤:
    一种植入式医疗器械,植入式医疗器械具有管状的器械主体,所述管状的器械主体具有第一端和第二端,所述第一端设置有第一环体,所述第二端设置有第二环体;
    提供一种球囊导管,所述球囊导管包括:
    导管体,所述导管体具有引导头;
    球囊体,邻近所述引导头且位于所述引导头的近端,所述球囊体具有相对的远端和近端;
    第一调节线,具有第一锁孔,所述第一调节线邻近所述球囊导管的远端位置处,且固定于所述球囊导管;以及
    第二调节线,具有第二锁孔,所述第二调节线在邻近所述球囊导管的近端位置处,且固定于所述球囊导管;
    提供用于在所述导管体和所述球囊上滑动移动的护套,所述护套具有远端;
    将处于膨胀状态的植入式医疗器械置于收缩状态的球囊体上;
    将植入式医疗器械在收缩状态的球囊体上径向形变至压缩状态;
    将第一调节线上的第一锁孔穿引过第一环体,以及第二调节线上的第二锁孔穿过第二环体;
    将锁线穿过第一锁孔和第二锁孔并进入引导头;和
    将所述护套滑过压缩状态的植入式医疗器械直至推进到引导头,以完全覆盖植入式医疗器械。
    其中推进锁线的步骤包括推进锁线穿过护套和导管体之间限定的管腔以延伸出护套远端的步骤。
  64. 根据权利要求63所述的将植入式医疗器械固定在球囊导管上的方法,其特征在于,其中穿引第一和第二锁孔的步骤包括分别将第一和第二锁孔锁定在第一和第二环体上的步骤。
  65. 根据权利要求63所述的将植入式医疗器械固定在球囊导管上的方法,其特征在于,其中所述第一环体和第二环体中的每一个作为独立环体提供,并分别连接到植入式医疗器械的第一和第二端。
  66. 根据权利要求63所述的将植入式医疗器械固定在球囊导管上的方法,其特征在于,其中所述第一环体和第二环体中的每个环体分别在植入式医疗器械的第一端和第二端处被提供为圆形尖端。
  67. 根据权利要求63所述的将植入式医疗器械固定在球囊导管上的方法,其特征在于, 其中所述第一环体和第二环体中的每一环体分别在植入式医疗器械的第一端和第二端的顶点中作为开口提供。
  68. 根据权利要求63所述的将植入式医疗器械固定在球囊导管上的方法,其特征在于,进一步提供连接第一和第二调节线的连接线。
  69. 根据权利要求63所述的将植入式医疗器械固定在球囊导管上的方法,其特征在于,还包括提供延伸穿过球囊体的中心管腔,其中连接线延伸穿过中心管腔。
  70. 根据权利要求69所述的将植入式医疗器械固定在球囊导管上的方法,其特征在于,还包括提供一个中间护套,该护套延伸穿过在护套和导管体之间限定的管腔,第二调节线连接到中间护套的远端。
  71. 根据权利要求63所述的将植入式医疗器械固定在球囊导管上的方法,其特征在于,一种将植入式医疗器械植入人体器官的方法,该方法将植入式医疗器械固定在球囊导管的上,包括以下步骤:
    在近端直接抽出护套以暴露植入式医疗器械;
    在近端方向上抽出锁线;
    驱动球囊体外扩,使第一和第二调节线分别从第一和第二环体抽出;
    使球囊体收缩;在近端直接取出球囊导管。
PCT/CN2021/121154 2020-10-06 2021-09-28 植入式医疗器械的输送系统及其控制手柄、植入式医疗器械及其固定方法、装载方法、释放方法 WO2022073441A1 (zh)

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