Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M25/00—Catheters; Hollow probes

Definitions

• the present invention relates to a coronary catheter.
• Coronary artery catheters are known that are used for coronary angiography and various procedures in coronary arteries.
• Coronary artery catheters are available in various shapes and structures, such as the Judkins type and the Amplatz type.
• Patent Document 1 proposes a coronary artery catheter for right arm access that enables introduction and engagement of the catheter tip from an artery located in the patient's right arm (for example, the radial artery) to the left coronary artery ostium or the right coronary artery ostium. ing.
• the coronary artery catheter for right arm access is introduced from an artery located in the patient's right arm, sequentially passed through the innominate artery and the aorta, and then Introduce the tip of the coronary artery catheter for right arm access into the left or right coronary artery ostium.
• the distal end and the distal end are designed to prevent the distal end of the right arm access coronary artery catheter from being inadvertently disengaged from the left coronary artery ostium and the right coronary artery ostium.
• the angle (bending angle) formed by the bent part formed between the bent part and the straight part located on the proximal end side of the part is set to a predetermined size.
• a left coronary artery catheter and a right coronary artery catheter are proposed that have different external shapes and the above-mentioned bending angles. There is.
• the operator may introduce a coronary artery catheter from the radial artery located in the patient's left arm in order to preserve the radial artery located in the patient's right arm. Therefore, there is currently a need for a coronary artery catheter for left arm access that can be used in combination with both the left coronary artery ostium and the right coronary artery ostium, which can accommodate various blood vessel routes.
• the existing coronary artery catheter for left arm access which can be used in combination with both the left coronary artery ostium and the right coronary artery ostium, may have reduced operability depending on the course of the patient's blood vessels.
• the operator prepares a catheter shaped for the left coronary artery and a catheter shaped for the right coronary artery at the medical site, and uses them appropriately.
• preparing multiple types of catheters for a procedure and using multiple types of catheters depending on the content of the procedure creates problems such as an increase in the cost of the procedure and an increase in the patient's radiation exposure.
• the existing coronary artery catheter for right arm access which can be used for both the left and right coronary artery ostia and can accommodate various blood vessel routes, can be used for introduction from the left arm artery. It is possible that
• the present invention has been made to solve the above-mentioned problems, and is also excellent in selectively accessing the left coronary artery ostium and the right coronary artery ostium from the left arm artery for patients with various blood vessel routes.
• the purpose of the present invention is to provide a coronary artery catheter that exhibits operability.
• the coronary artery catheter according to the present invention is a coronary artery catheter whose distal end can be introduced from the left arm artery into both the left coronary artery ostium and the right coronary artery ostium, and has a tubular body communicating from the proximal end to the distal end, In its natural state, the tubular body has a substantially linear main body portion and a shaped portion that is bent and shaped at a plurality of locations on substantially the same plane, and the shaped portion is shaped like the main body portion.
• the axis passing through the center line of the main body portion is the first axis
• the first axis is the first axis.
• a bending start point located at the boundary with the tip of the main body part in the first bending part and starting to incline from the first axis toward the second bending part, and a second bending point having the smallest radius of curvature in the second bending part.
• An axis passing through the bending point is defined as a second axis
• an axis passing through the second bending point and a third bending point having the smallest radius of curvature in the third bending part is defined as a third axis
• the third axis passes through the third bending point and the third bending point.
• the axis passing through the fifth bending point with the smallest radius of curvature is defined as a fourth axis
• the line perpendicular to the first axis and passing through the bending start point is defined as a first perpendicular line
• the first axis and If a line that is perpendicular to the first axis and passes through the second bending point is a second perpendicular line
• a line that is perpendicular to the first axis and passes through the third bending point is a third perpendicular line
• the fourth axis is The angle between the fourth axis and the third perpendicular is more acute than the angle between the third axis and the second perpendicular, and is in the range of 1° to 30°.
• the fourth bent part is bent in a convex manner in a direction away from the fourth axis between the third bending point and the fifth bending point, and the second perpendicular line is ( The vertical width in the long axis direction - the distance between the second perpendicular line and the first perpendicular line)/(the distance between the second perpendicular line and the first perpendicular line) is in the range of 1/1 to 1/7. Characterized by being located in a certain position.
• the second bending point of the coronary artery catheter bends the shaped portion in the direction opposite to the direction in which the bending start point located near the distal end of the main body bends the shaped portion. Therefore, the second bending point does not overlap the first axis and is located on one side of the shaped portion in the width direction than the first axis.
• the above-mentioned coronary artery catheter is introduced from the left arm artery, and when introduced and engaged into the left coronary artery ostium via the left subclavian artery, the second axis is located on one side in the width direction of the first axis and the shaped part. A predetermined distance can be provided between the bending point and the bending point.
• the above-mentioned coronary artery catheter can prevent the tubular body from interfering with the left blood vessel wall of the ascending aorta when the distal end portion is introduced into and engaged with the left coronary artery ostium. Therefore, the above-mentioned coronary artery catheter has excellent operability when introducing and engaging the most distal end into the left coronary artery ostium.
• the second bending point is located on one side in the width direction of the shaped portion rather than the first axis. Therefore, when the above-mentioned coronary artery catheter is rotated with respect to the first axis, the center of rotation is located near the first axis, which is closer to the center position in the width direction of the shaped part than the second bending point. do. Therefore, when the above-mentioned coronary artery catheter is rotated, the operating force applied on the proximal side can be efficiently transmitted to the shaped portion side located on the distal end side of the main body portion.
• the above-mentioned coronary artery catheter has excellent operability when introducing and engaging the most distal end into the left coronary artery ostium and when introducing and engaging the most distal end into the right coronary artery ostium. .
• the third bending point and the fourth bending point are located between the second bending point and the fifth bending point. Therefore, the above-mentioned coronary artery catheter has a multi-stage bending (3 It has a structure of stepwise bending.
• the above coronary artery catheter is introduced from the left arm artery, and when introduced and engaged into the left coronary artery ostium via the left subclavian artery, the third bending point and the fourth bending point change the shape of the catheter to the left side of the ascending aorta. It is placed in a bent position away from the blood vessel wall.
• the above coronary artery catheter can effectively prevent the tubular body from coming into contact with the left blood vessel wall of the ascending aorta when the distal end portion is introduced into and engaged with the left coronary artery ostium. Furthermore, in the above-mentioned coronary artery catheter, since the fourth bending part is curved convexly in a direction away from the fourth axis between the third bending point and the fifth bending point, the distal end part is connected to the left coronary artery ostium. When introducing and engaging, while effectively preventing the third intermediate portion located on the proximal side of the fourth bending point from contacting the left blood vessel wall of the ascending aorta, the fourth bending point is used as the base point.
• the fourth intermediate portion located on the distal side of the fourth bending point can be disposed toward the left coronary artery ostium. Therefore, in the above-mentioned coronary artery catheter, the distal end portion located on the distal side of the fourth intermediate portion with the fifth bending point in between can be easily introduced and engaged into the left coronary artery ostium.
• the third bending point of the coronary artery catheter bends the shaped portion to the same side as the second bending point at a position on the distal side of the second bending point.
• the third bending point does not overlap the first axis, and is located on one side of the shape portion in the width direction than the first axis.
• the second intermediate portion located between the second bending point and the third bending point is also located on one side in the width direction of the shaped portion with respect to the first axis. Therefore, the above-mentioned coronary artery catheter can prevent the second intermediate portion from coming into contact with the left blood vessel wall of the ascending aorta when the distal end portion is introduced into and engaged with the left coronary artery ostium.
• the angle between the fourth axis and the third perpendicular is more acute than the angle between the third axis and the second perpendicular, and is in the range of 1° to 30°.
• the angle between the third axis and the second perpendicular is larger than the angle between the fourth axis and the third perpendicular, so the tubular body is introduced from the left arm artery and the left
• the second intermediate portion located between the second and third bending points is separated from the left vessel wall of the ascending aorta.
• the above-mentioned coronary artery catheter can effectively prevent the tubular body from coming into contact with the left side blood vessel wall of the ascending aorta when the distal end portion is introduced into and engaged with the left coronary artery ostium. Furthermore, in the above-mentioned coronary artery catheter, the angle between the fourth axis and the third perpendicular is more acute than the angle between the third axis and the second perpendicular, and is in the range of 1° to 30°.
• the above-mentioned coronary artery catheter can more reliably maintain a state in which the distal end portion is engaged with the left coronary artery ostium.
• the tubular body is introduced from the left arm artery and then inserted through the left subclavian artery.
• the distal end located on the distal side of the fifth bending point can be prevented from expanding excessively in the width direction of the shaped portion. Therefore, even when a relatively narrow access route from the left subclavian artery to the right coronary artery ostium is selected, the coronary artery catheter described above can smoothly introduce and engage the distal end at the right coronary artery ostium. .
• the second perpendicular line is (vertical width in the long axis direction of the shaped part - distance between the second perpendicular line and the first perpendicular line)/(distance between the second perpendicular line and the first perpendicular line). ) is located in the range of 1/1 to 1/7.
• the second bending point of the shaped part is located at the midpoint in the vertical width of the shaped part in the longitudinal direction, or at a position distal to the midpoint, so that the shaped part cannot be moved into the ascending aorta.
• the shaped portion When the distal end portion is disposed in the ostium of the left coronary artery and the distal end portion is engaged with the ostium of the left coronary artery, the shaped portion can be suitably prevented from coming into contact with the curved portion of the left side blood vessel wall of the ascending aorta. Therefore, when the shaped part is placed in the ascending aorta and the distal end part is engaged with the left coronary artery ostium, the second bent part, the third bent part, and the fourth bent part come into contact with the left blood vessel wall of the ascending aorta. This can be suitably prevented.
• FIG. 1 is a front view of a coronary artery catheter according to an embodiment.
• FIG. 2 is a rear view of the coronary artery catheter according to the embodiment.
• FIG. 1 is a left side view of a coronary artery catheter according to an embodiment.
• FIG. 2 is a right side view of the coronary artery catheter according to the embodiment.
• FIG. 1 is a plan view of a coronary artery catheter according to an embodiment.
• FIG. 2 is a bottom view of the coronary artery catheter according to the embodiment.
• FIG. 1 is an enlarged front view of a coronary catheter according to an embodiment.
• FIG. 1 is an enlarged front view of a coronary catheter according to an embodiment.
• FIG. 1 is an enlarged front view of a coronary catheter according to an embodiment.
• FIG. 1 is an enlarged front view of a coronary catheter according to an embodiment.
• FIG. 1 is an enlarged front view of a coronary catheter according to an embodiment.
• FIG. 1 is an enlarged
• FIG. 1 is an enlarged perspective view of a coronary catheter according to an embodiment.
• 1 is a diagram schematically showing an example of use of a coronary catheter according to an embodiment.
• FIG. 1 is a diagram schematically showing an example of use of a coronary catheter according to an embodiment.
• FIG. 7 is a front view of a coronary catheter according to a modified example.
• FIG. 7 is a rear view of a coronary catheter according to a modified example.
• FIG. 7 is a left side view of a coronary catheter according to a modified example.
• FIG. 7 is a right side view of a coronary catheter according to a modified example.
• FIG. 7 is a plan view of a coronary catheter according to a modified example.
• FIG. 7 is a bottom view of a coronary catheter according to a modified example.
• FIG. 7 is an enlarged front view of a coronary catheter according to a modified example.
• FIG. 7 is an enlarged front view of a coronary catheter according to a modified example.
• FIG. 7 is an enlarged front view of a coronary catheter according to a modified example.
• the range “X to Y” means “more than or equal to X and less than or equal to Y.” Moreover, the range “greater than X and less than Y” shown in this specification does not include X and Y.
• FIG. 1 to 6 are six side views of the coronary artery catheter 1 according to the present embodiment.
• FIG. 1 is a front view of a coronary artery catheter 1.
• FIG. 2 is a rear view of the coronary artery catheter 1.
• FIG. 3 is a left side view of the coronary artery catheter 1.
• FIG. 4 is a right side view of the coronary artery catheter 1.
• FIG. 5 is a plan view of the coronary artery catheter 1.
• FIG. 6 is a bottom view of the coronary artery catheter 1. Note that in FIGS. 1 to 6, the parts indicated by solid lines illustrate the design features of the tubular body 10 of the coronary artery catheter 1, and the parts indicated by broken lines illustrate other parts.
• FIGS. 8 and 9 are substantially the same drawings, they are attached to show examples of dimensions of each drawing of the coronary artery catheter 1.
• FIG. 10 is a schematic perspective view showing a part of the distal end side of the coronary artery catheter 1.
• Arrows X1-X2 shown in FIGS. 1 to 10 indicate the longitudinal direction of the tubular body 10.
• the distal end side (the side to be introduced into the living body) of the tubular body 10 is the side shown by arrow X1
• the proximal end side of the tubular body 10 is the side shown by arrow X2.
• arrows Y1-Y2 shown in FIGS. 1 to 10 indicate the width direction of the tubular body 10.
• FIG. 11 and 12 are diagrams for explaining the effects of the coronary artery catheter 1.
• FIG. 11 shows an example of use in which the coronary artery catheter 1 is applied to a procedure for introducing and engaging the left coronary artery ostium B8i.
• FIG. 12 shows an example of use in which the coronary artery catheter 1 is applied to a procedure for introducing and engaging the right coronary artery ostium B9i.
• 11 and 12 schematically show a part of the patient's body together with the coronary artery catheter 1.
• Symbol B1 indicates the left common carotid artery.
• Symbol B2 indicates the left subclavian artery.
• Symbol B3 indicates the right common carotid artery.
• Symbol B4 indicates the right subclavian artery.
• Reference numeral B5 indicates the innominate artery.
• Reference numeral B6 indicates the ascending aorta.
• Reference numeral B7 indicates the descending aorta.
• Reference numeral B8 indicates the left coronary artery.
• Symbol B8i indicates the left coronary artery ostium.
• Symbol B9 indicates the right coronary artery.
• Symbol B9i indicates the right coronary artery ostium.
• the symbol Aa indicates the aortic arch.
• the symbol Lv indicates the left ventricle.
• the symbol Bw1 indicates the left blood vessel wall of the ascending aorta B6.
• the symbol Bw2 indicates the right blood vessel wall of the ascending aorta B6.
• Reference numeral Bw3 indicates the blood vessel wall of the left subclavian artery B2.
• the coronary artery catheter 1 can be applied to any patient having a Type I, Type II, or Type III aortic arch Aa, which is classified based on the relative positional relationship of the left common carotid artery B1, right subclavian artery B4, and brachiocephalic artery B5. It can also be applied to
• the coronary artery catheter 1 is configured such that the distal end portion 260 can be selectively introduced into both the left coronary artery ostium B8i and the right coronary artery ostium B9i from the artery of the patient's left arm (for example, the radial artery). (See Figures 11 and 12).
• a leading edge 260 can be selectively introduced into B9i.
• the coronary artery catheter 1 includes a tubular body 10 communicating from the proximal end to the distal end, and a hub 300 located on the proximal end side of the tubular body 10.
• a lumen 20 is formed inside the tubular body 10.
• a distal end opening 261 communicating with the lumen 20 is formed in the distal end 260 of the tubular body 10 .
• the hub 300 is connected to the base end 110 of the main body 100, as shown in FIGS. 1 and 2.
• the hub 300 can be configured to function as an injection port for injecting a contrast agent or the like into the lumen 20 or an insertion port for inserting a therapeutic device or the like into the lumen 20.
• the tubular body 10 is shaped by bending at multiple locations on substantially the same plane (plane P1 shown in FIG. 10) as the substantially linear main body 100. It has a shaped part 200 attached thereto.
• the above-mentioned "natural state” means an unloaded state in which no external force is applied to the tubular body 10. 1 to 10 show the tubular body 10 in its natural state.
• the tubular body 10 can be constructed of a tubular member having a three-layer structure, for example, an inner layer, a middle layer, and an outer layer.
• the constituent materials of each layer include polyamide resin (for example, nylon 11, nylon 12, nylon 6), polyester polyamide resin, polyether polyamide resin, polyurethane, ABS resin, polyester elastomer resin, polyurethane elastomer resin, and fluorine-based resin. Resins (PFA, PTFE, ETFE, etc.) can be used. In particular, by using ABS resin or polyamide resin as the constituent material of the inner layer, middle layer, and outer layer, appropriate strength can be imparted to each part of the tubular body 10.
• the operability of the guide wire or treatment catheter inserted into the lumen 20 can be improved.
• the tubular body 10 can contain an X-ray opaque material such as barium sulfate, bismuth oxide, or tungsten.
• various reinforcing members such as braid wire, etc.
• a distal tip having higher flexibility than the tubular body 10 can be attached to the distal end portion 260 .
• the outer diameter of the tubular body 10 can be, for example, 1.0 mm to 3.8 mm. Further, the inner diameter of the tubular body 10 can be, for example, 0.8 mm to 3.6 mm.
• tubular body 10 is not limited to the materials and structures exemplified above, and any structure of coronary artery catheters known in the medical field can be adopted.
• the shaped portion 200 includes a first bent portion 210 bent at a position closer to the distal end than the main body portion 100, and a first intermediate portion located closer to the distal end than the first bent portion 210. 215, a second bent part 220 bent toward the opposite side of the first bent part 210 at a position on the distal side of the first intermediate part 215, and a second intermediate part 225 located on the distal side of the second bent part 220. and a third bent part 230 that is bent toward the same side as the second bent part 220 at a position on the distal side of the second intermediate part 225; and a third intermediate part 235 that is located on the distal side of the third bent part 230.
• a fourth bent part 240 that is bent toward the same side as the third bent part 230 at a position on the distal side of the third intermediate part 235; and a fourth intermediate part 245 that is located on the distal side of the fourth bent part 240;
• a fifth bent portion 250 that is bent toward the same side as the fourth bent portion 240 at a position closer to the tip side than the fourth intermediate portion 245, and a most distal end portion 260 that is disposed closer to the tip side than the fifth bent portion 250.
• the above-mentioned "bending to the opposite side (same side)” means bending to the opposite side (same side) when looking at the front end side from each bent part in the front view shown in FIG.
• the second bent portion 220, the third bent portion 230, the fourth bent portion 240, and the fifth bent portion 250 are each curved in the same direction so that the shaped portion 200 forms an arc clockwise.
• the first bent portion 210 is curved in the opposite direction to the bent portions 220, 230, 240, and 250.
• each position and each part of the tubular body 10 are defined as follows (see FIGS. 7, 8, and 9).
• An axis passing through the center line of the main body portion 100 is defined as a first axis A1.
• the first bending part 210 has a bending start point Sa located at the boundary between the tip of the main body part 100 and starting to incline from the first axis A1 toward the second bending part 220 side, and a bending start point Sa.
• the first bending point 210a is located closer to the second bending part 220 than the first bending part 210, and is located at a position where the radius of curvature is the smallest in the first bending part 210.
• the bending start point Sa is located at a position where the first axis A1 overlaps with the outer surface of the tubular body 10 in the plan views shown in FIGS. 7, 8, and 9.
• the axis passing through the bending start point Sa of the first bending part 210 and the second bending point 220a having the smallest radius of curvature in the second bending part 220 is defined as a second axis A2.
• the axis passing through the second bending point 220a and the third bending point 230a having the smallest radius of curvature in the third bending portion 230 is defined as a third axis A3.
• the axis passing through the third bending point 230a and the fifth bending point 250a having the smallest radius of curvature in the fifth bending part 250 is defined as a fourth axis A4.
• the axis passing through the third bending point 230a and the fourth bending point 240a having the smallest radius of curvature in the fourth bending part 240 is defined as a fifth axis A5.
• the axis passing through the fourth bending point 240a and the fifth bending point 250a is defined as a sixth axis A6.
• the fifth bending point 250a is located on the same plane as the bending start point Sa, the first bending point 210a, the second bending point 220a, the third bending point 230a, the fourth bending point 240a, and the fifth bending point 250a. , and the end on the first axis A1 side of the most extreme position 260a of the most extreme part 260 is defined as a seventh axis A7.
• a line that is perpendicular to the first axis A1 and passes through the bending start point Sa is defined as a first perpendicular line H1.
• a line that is perpendicular to the first axis A1 and passes through the second bending point 220a is a second perpendicular line H2.
• a line that is perpendicular to the first axis A1 and passes through the third bending point 230a is a third perpendicular line H3.
• the region located on the left side of the first axis A1 (the side indicated by the arrow Y1) of the shaped portion 200 is defined as "one side in the width direction.”
• the coronary artery catheter 1 is arranged such that the fourth axis A4 intersects the first axis A1 when each position and each part of the shaped portion 200 are defined as described above (see FIG. 8).
• the angle ⁇ a between the fourth axis A4 and the third perpendicular H3 is more acute than the angle ⁇ b between the third axis A3 and the second perpendicular H2, and is within a range of 1° to 30°. (see Figure 8).
• the second perpendicular line H2 is (vertical width L1 in the long axis direction of the shaped portion 200 - distance L3 between the second perpendicular line H2 and the first perpendicular line H1.
• distance L2 distance between the second perpendicular line H2 and the first perpendicular line H1.
• distance L3 distance between the second perpendicular line H2 and the first perpendicular line H1.
• distance L3 is located at a position where the range is 1/1 to 1/7 (see FIG. 7).
• the distance L2/distance L3 is more preferably in the range of 1/1.5 to 1/4.
• the angle ⁇ a is 5° to 25°. In the coronary artery catheter 1 of this embodiment, the angle ⁇ a is 16°.
• the angle ⁇ b is preferably 60° to 85°. In the coronary artery catheter 1 of this embodiment, the angle ⁇ b is 75°. Note that the size of the angle ⁇ b is not particularly limited as long as the angle ⁇ a is more acute than the angle ⁇ b.
• the longitudinal width L1 of the shaped portion 200 in the longitudinal direction is in the range of 70 mm to 160 mm (see FIG. 7). It is more preferable that the vertical width L1 is 80 mm to 122 mm.
• Distance L2 is preferably 24 mm to 53 mm on the premise that distance L2/distance L3 is in the range of 1/1 to 1/7. Further, when the distance L2 is 24 mm to 53 mm, the distance L3 is preferably 45 mm to 98 mm.
• the coronary artery catheter 1 of this embodiment has a vertical width L1 of 113 mm, a distance L2 of 36 mm, and a distance L3 of 77 mm.
• the coronary artery catheter 1 has a multilayer structure in which three intermediate parts, the second intermediate part 225, the third intermediate part 235, and the fourth intermediate part 245, are formed between the second bending point 220a and the fifth bending point 250a. It has a structure of step bending (3 step bending).
• the width W1 of the shaped portion 200 shown in FIG. 7 is 41 mm to 58 mm.
• the ratio (W2/W1) of the maximum width W2 from the first axis A1 to the second bent portion 220 on the second perpendicular line H2 to the width W1 of the shaped portion 200 is 1/2 to 1/2. It is preferable that it is 4.
• the width W1 is 41 mm to 58 mm.
• the coronary artery catheter 1 of this embodiment has a width W1 of 49 mm.
• the width W1 means the maximum width of the shaped portion 200 in the front view shown in FIG.
• the width W1 of this embodiment is defined by the end portion of the second bent portion 220 located on the second perpendicular line H2 on the side opposite to the first axis A1 side, and the end portion of the distal end portion 260. This is the distance of a straight line connecting the first axis A1 side of the position 260a and the position where the opposite end is projected onto the second perpendicular line H2.
• the maximum width W2 is preferably 12 mm to 26 mm, assuming that the ratio (W2/W1) is 1/2 to 1/4 when the width W1 is 41 mm to 58 mm.
• the coronary artery catheter 1 of this embodiment has a maximum width W2 of 22 mm.
• the angle between the first axis A1 and the second axis A2 is defined as a first angle ⁇ 1.
• the angle formed by the second axis A2 and the third axis A3 is defined as a second angle ⁇ 2.
• the angle formed by the third axis A3 and the fifth axis A5 is defined as a third angle ⁇ 3.
• the angle between the fifth axis A5 and the sixth axis A6 is defined as a fourth angle ⁇ 4.
• the angle formed by the sixth axis A6 and the seventh axis A7 is defined as a fifth angle ⁇ 5.
• the fifth angle ⁇ 5 is smaller than the fourth angle ⁇ 4, the fourth angle ⁇ 4 is smaller than the third angle ⁇ 3, the third angle ⁇ 3 is smaller than the second angle ⁇ 2, and the second angle ⁇ 2 is smaller than the third angle ⁇ 3.
• the angle can be configured to be smaller than the first angle ⁇ 1.
• the magnitude relationship of the first angle ⁇ 1, the second angle ⁇ 2, the third angle ⁇ 3, the fourth angle ⁇ 4, and the fifth angle ⁇ 5 is defined as described above,
• the linear distance L4 between the third bending point 230a and the fifth bending point 250a along the fourth axis A4 shown in FIG. it can be configured such that it is 1 times or more and less than 2 times.
• the first angle ⁇ 1 is preferably greater than 155° and less than 175°. Further, the first angle ⁇ 1 is more preferably 160° or more and 173° or less. In the coronary artery catheter 1 of this embodiment, the first angle ⁇ 1 is 167°.
• the second intermediate portion 225 comes into contact with the left blood vessel wall Bw1 of the ascending aorta B6 when the distal end portion 260 is introduced and engaged into the left coronary artery ostium B8i. It becomes easier to do.
• the first angle ⁇ 1 is 155° or less, the bending of the first bending portion 210 becomes excessively tight, making it difficult to cause the distal end portion 260 to reach the left coronary artery ostium B8i.
• the second angle ⁇ 2 is preferably greater than 130° and less than 170°. Moreover, it is more preferable that the second angle ⁇ 2 is 140° or more and 160° or less. In the coronary artery catheter 1 of this embodiment, the second angle ⁇ 2 is 153°.
• the third angle ⁇ 3 formed by the third bending portion 230 located on the distal side of the second bending portion 220 becomes sharp, and the third angle ⁇ 3 at the third bending portion 230 becomes sharp.
• the degree of bending becomes too large. Therefore, when the most distal end portion 260 of the coronary artery catheter 1 is engaged with the right coronary artery ostium B9i, the range in which the most distal end portion 260 is engaged with the right coronary artery ostium B9i becomes narrower. It becomes easier to get out of it.
• the second intermediate portion 225 comes into contact with the left blood vessel wall Bw1 of the ascending aorta B6 when the distal end portion 260 is engaged with the left coronary artery ostium B8i. It becomes easier to do. Accordingly, in the coronary artery catheter 1, the range in which the most distal end portion 260 is engaged with the left coronary artery ostium B8i becomes narrower, so that the most distal end portion 260 easily slips out from the left coronary artery ostium B8i.
• the third angle ⁇ 3 is preferably greater than 120° and less than 165°. Moreover, it is more preferable that the third angle ⁇ 3 is 130° or more and 155° or less. In the coronary artery catheter 1 of this embodiment, the third angle ⁇ 3 is 143°.
• the third angle ⁇ 3 is 165° or more
• the third intermediate portion 235 is largely separated from the left blood vessel wall Bw1 of the ascending aorta B6 when the distal end portion 260 is introduced into the right coronary artery ostium B9i. It will be arranged like this. Therefore, in the coronary artery catheter 1, when the third angle ⁇ 3 is 165° or more, it becomes difficult to introduce the most distal end portion 260 into the left coronary artery ostium B8i. Further, in the coronary artery catheter 1, when the third angle ⁇ 3 is 120° or less, the angle of the third bending portion 230 becomes too small.
• the coronary artery catheter 1 when the most distal end portion 260 is engaged with the right coronary artery ostium B9i, the range in which the most distal end portion 260 is engaged with the right coronary artery ostium B9i is narrowed, and the most distal end portion 260 is separated from the right coronary artery ostium B9i. It becomes easier to get out.
• the fourth angle ⁇ 4 is preferably greater than 70° and less than 160°. Moreover, it is more preferable that the fourth angle ⁇ 4 is 80° or more and 150° or less. In the coronary artery catheter 1 of this embodiment, the fourth angle ⁇ 4 is 140°.
• the fourth angle ⁇ 4 is 70° or less
• the fourth intermediate portion 245, the fifth bent portion 250, and the distal end portion 260 located on the distal side of the fourth bent portion 240 are aligned with the first axis A1.
• the distal end portion 260 is introduced into the left coronary artery ostium B8i
• the distal end portion 260 approaches the opening direction of the left coronary artery ostium B8i, making it difficult to insert. Therefore, when the coronary artery catheter 1 introduces the most distal end portion 260 into the left coronary artery ostium B8i, the range in which the most distal end portion 260 is engaged with the left coronary artery ostium B8i becomes narrower.
• the fourth intermediate portion 245 located on the distal side of the fourth bent portion 240 is arranged so as to run parallel to the left side blood vessel wall Bw1 of the ascending aorta B6, making it difficult to bring the most distal end 260 closer to the left coronary artery ostium B8i. It becomes difficult to place. Therefore, in the coronary artery catheter 1, the distal end portion 260 cannot be smoothly introduced into the left coronary artery ostium B8i.
• the fifth angle ⁇ 5 is preferably greater than 50° and less than 130°. Moreover, it is more preferable that the fifth angle ⁇ 5 is 60° or more and 120° or less. In the coronary artery catheter 1 of this embodiment, the fifth angle ⁇ 5 is 110°.
• the coronary artery catheter 1 When the fifth angle ⁇ 5 is 130° or more, the coronary artery catheter 1 is placed so that the most distal end portion 260 is separated from the left coronary artery ostium B8i when the most distal end portion 260 is introduced into the left coronary artery ostium B8i. Therefore, in the coronary artery catheter 1, when the fifth angle ⁇ 5 is 130° or more, it becomes difficult to introduce the most distal end portion 260 into the left coronary artery ostium B8i. Further, in the coronary artery catheter 1, when the fifth angle ⁇ 5 is 50° or less, the angle of the fifth bending portion 250 becomes too small.
• the coronary artery catheter 1 when the most distal end portion 260 is engaged with the right coronary artery ostium B9i, the range in which the most distal end portion 260 is engaged with the right coronary artery ostium B9i is narrowed, and the most distal end portion 260 is separated from the right coronary artery ostium B9i. It becomes easier to get out.
• the straight-line distance L4 shown in FIG. 8 is preferably 20 mm to 50 mm, on the premise that the straight-line distance L4 is at least one time and less than twice the straight-line distance L5. In the coronary artery catheter 1 of this embodiment, the straight-line distance L4 is 38 mm.
• the straight line distance L5 shown in FIG. 8 is preferably 11 mm to 35 mm. In the coronary artery catheter 1 of this embodiment, the straight-line distance L5 is 23 mm.
• the most extreme portion 260 can be arranged to be located closer to the fifth bent portion 250 than the third perpendicular H3 in the longitudinal direction of the shaped portion 200. That is, the most distal end portion 260 can be disposed closer to the distal end in the longitudinal direction than the third perpendicular line H3.
• the first intermediate portion 215 is curved toward the side away from the first axis A1 (the side indicated by the arrow Y1). Further, the second intermediate portion 225 is curved toward the side closer to the first axis A1 (the side indicated by the arrow Y2). Note that the second intermediate portion 225 may extend substantially linearly between the second bent portion 220 and the third bent portion 230.
• the third intermediate portion 235 is curved toward the fourth bent portion 240, which is located on the distal side of the third bent portion 230.
• the fourth intermediate portion 245 is curved toward a fifth bent portion 250 located closer to the distal end than the fourth bent portion 240 .
• the most distal end portion 260 is curved so as to be folded back toward the proximal end side at a fifth bending point 250a.
• the third intermediate portion 235 may extend substantially linearly between the third bent portion 230 and the fourth bent portion 240.
• the fourth intermediate portion 245 may extend substantially linearly between the fourth bent portion 240 and the fifth bent portion 250.
• the leading edge portion 260 may extend substantially linearly between the fifth bent portion 250 and the leading edge position 260a of the leading edge portion 260.
• the first intermediate portion 215 intersects with the second axis A2, which is a straight line connecting the bending start point Sa and the second bending point 220a. Further, a part of the first intermediate portion 215 on the bending start point Sa side is located closer to the first axis A1 than the second axis A2.
• the first bending point 210a of the first bending portion 210 is located between the first axis A1 and the second axis A2. Therefore, in the region between the bending start point Sa and the second bending point 220a, the shaped part 200 has a part of the first bending part 210 and the first intermediate part 215 between the first axis A1 and the second axis A2. configured to be located. Therefore, as shown in FIG.
• the coronary artery catheter 1 when the tubular body 10 is inserted into the aortic arch Aa via the left subclavian artery B2 and the distal end portion 260 is introduced into the left coronary artery ostium B8i, the coronary artery catheter 1 has a shape that The section 200 can be oriented toward the ascending aorta B6 side. In the state where the shaped portion 200 is oriented toward the ascending aorta B6 as described above, the coronary artery catheter 1 connects the second bent portion 220, the third bent portion 230, and the fourth bent portion 240 to each blood vessel of the ascending aorta B6. Each of the bent portions 220 and 230 can be arranged so that a predetermined distance is maintained between the walls Bw1 and Bw2.
• the coronary artery catheter 1 when the coronary artery catheter 1 is operated to introduce the most distal end portion 260 into the left coronary artery ostium B8i, the second bent portion 220, the third bent portion 230, and the fourth bent portion 240 are connected to the ascending aorta B6. Deterioration of operability due to contact can be suppressed.
• FIG. 11 shows the state when the distal end portion 260 of the coronary artery catheter 1 is introduced and engaged into the left coronary artery ostium B8i.
• FIG. 12 shows the state when the distal end portion 260 of the coronary artery catheter 1 is introduced and engaged into the right coronary artery ostium B9i.
• the second bending point 220a of the coronary artery catheter 1 bends the shaped part 200 in the direction opposite to the direction in which the bending start point Sa located near the tip of the main body part 100 bends the shaped part 200 (FIG. 7, (see Figure 8). Therefore, the second bending point 220a does not overlap with the first axis A1, and is located on one side of the width direction of the shaped portion 200 (the first axis A1 shown in FIGS. 7, 8, and 9) than the first axis A1. located on the left side). As shown in FIG.
• the coronary artery catheter 1 is introduced from the left arm artery, and when introduced and engaged into the left coronary artery ostium B8i via the left subclavian artery B2, the first axis A1 and the width of the shaped portion 200 A predetermined distance may be provided between the second bending point 220a located on one side of the direction.
• the coronary artery catheter 1 can suppress the tubular body 10 from coming into contact with the blood vessel walls Bw1 and Bw2 of the ascending aorta B6 when the distal end portion 260 is introduced and engaged into the left coronary artery ostium B8i. Therefore, the coronary artery catheter 1 has excellent operability when introducing and engaging the distal end portion 260 into the left coronary artery ostium B8i.
• the second bending point 220a is located on one side in the width direction of the shaped portion 200 than the first axis A1 (see FIGS. 7 and 8). Therefore, when the coronary artery catheter 1 is rotated with respect to the first axis A1, the coronary artery catheter 1 is rotated near the first axis A1, which is located closer to the center position in the width direction of the shaped portion 200 than the second bending point 220a. The center is located. Therefore, when the coronary artery catheter 1 is rotated, the operating force applied on the proximal side can be efficiently transmitted to the shaped part 200 side located on the distal end side of the main body part 100.
• the coronary artery catheter 1 has excellent operability when introducing and engaging the most distal end 260 into the left coronary artery ostium B8i, and when introducing and engaging the most distal end 260 into the right coronary artery ostium B9i. Become something.
• the coronary artery catheter 1 has a multi-stage structure in which three intermediate parts, a second intermediate part 225, a third intermediate part 235, and a fourth intermediate part 245, are formed between the second bending point 220a and the fifth bending point 250a. It has a bending (three-step bending) structure. Therefore, as shown in FIG.
• the coronary artery catheter 1 when the coronary artery catheter 1 is introduced from the left arm artery and is introduced and engaged into the left coronary artery ostium B8i via the left subclavian artery B2, the third bending point 230a and the fourth The shaped portion 200 is arranged in a bent state so as to be separated from the left blood vessel wall Bw1 of the ascending aorta B6 by the bending point 240a. Therefore, the coronary artery catheter 1 can effectively prevent the tubular body 10 from coming into contact with the left blood vessel wall Bw1 of the ascending aorta B6 when the distal end portion 260 is introduced into and engaged with the left coronary artery ostium B8i.
• the distal end part 260 is When introducing and engaging the left coronary artery ostium B8i, while effectively preventing the third intermediate portion 235 located on the proximal side of the fourth bending point 240a from coming into contact with the left blood vessel wall Bw1 of the ascending aorta B6. , the fourth intermediate portion 245 located on the distal side of the fourth bending point 240a with respect to the fourth bending point 240a can be disposed toward the left coronary artery ostium B8i. Therefore, in the coronary artery catheter 1, the most distal end portion 260 located on the distal side of the fourth intermediate portion 245 can be easily introduced and engaged into the left coronary artery ostium B8i via the fifth bending point 250a.
• the third bending point 230a of the coronary artery catheter 1 bends the shaped portion 200 to the same side as the second bending point 220a at a position on the distal side of the second bending point 220a.
• the third bending point 230a does not overlap with the first axis A1, and is located on one side of the shape portion 200 in the width direction than the first axis A1.
• the second intermediate portion 225 located between the second bending point 220a and the third bending point 230a is also located on one side in the width direction of the shaped portion 200 with respect to the first axis A1. Therefore, as shown in FIG.
• the coronary artery catheter 1 prevents the second intermediate portion 225 from coming into contact with the left blood vessel wall Bw1 of the ascending aorta B6 when the distal end portion 260 is introduced and engaged into the left coronary artery ostium B8i. can be suppressed.
• the angle ⁇ a between the fourth axis A4 and the third perpendicular H3 is more acute than the angle ⁇ b between the third axis A3 and the second perpendicular H2, and is within a range of 1° to 30°. (See Figure 8).
• the angle ⁇ a formed between the third axis A3 and the second perpendicular line H2 is larger than the angle ⁇ b formed between the fourth axis A4 and the third perpendicular line H3, as shown in FIG.
• the ascending aorta passes through the second intermediate portion 225 located between the second bending point 220a and the third bending point 230a. It can be arranged so as to be spaced apart from the blood vessel wall Bw1 on the left side of B6. Therefore, the coronary artery catheter 1 can effectively prevent the tubular body 10 from coming into contact with the left blood vessel wall Bw1 of the ascending aorta B6 when the distal end portion 260 is introduced into the left coronary artery ostium B8i.
• the angle ⁇ a formed between the fourth axis A4 and the third perpendicular line H3 is more acute than the angle ⁇ b formed between the third axis A3 and the second perpendicular line H2, and is within a range of 1° to 30°. Therefore, as shown in FIG. 11, when the distal end portion 260 is engaged with the left coronary artery ostium B8i, the fifth bend is prevented from coming into contact with the left blood vessel wall Bw1 of the ascending aorta B6. The most distal end portion 260 located on the distal side of the point 250a can be placed toward the left coronary artery ostium B8i. Therefore, the coronary artery catheter 1 can more reliably maintain the state in which the distal end portion 260 is engaged with the left coronary artery ostium B8i.
• the coronary artery catheter 1 is introduced from the left arm artery and passes through the left subclavian artery B2.
• the distal end portion 260 located on the distal side of the fifth bending point 250a can be prevented from expanding excessively in the width direction of the shaped portion 200. That is, the width W' formed when approaching the right coronary artery ostium B9i shown in FIG. 12 can be suppressed within a predetermined range.
• the coronary artery catheter 1 can smoothly introduce and engage the most distal end portion 260 into the right coronary artery ostium B9i. be able to.
• the second perpendicular line H2 is located at a position where the distance L2/distance L3 is in the range of 1/1 to 1/7 (see FIG. 7).
• the second bending point 220a of the shaped part 200 is located at the midpoint in the vertical width of the shaped part 200 in the longitudinal direction, or at a position closer to the tip than the midpoint, the shaped part 200
• the distal end portion 260 is placed in the ascending aorta B6 and the distal end portion 260 is engaged with the left coronary artery ostium B8i, it is possible to preferably prevent the shaped portion 200 from coming into contact with the curved portion of the left blood vessel wall Bw1 of the ascending aorta B6.
• the coronary artery catheter 1 places the shaped portion 200 in the ascending aorta B6 and introduces and engages the distal end portion 260 into the left coronary artery ostium B8i, the second bent portion 220, the third bent portion 230, and the fourth bent portion It is possible to suitably prevent the bent portion 240 from coming into contact with the left blood vessel wall Bw1 of the ascending aorta B6.
• the coronary artery catheter 1 is configured as a coronary artery catheter in which the distal end portion 260 can be introduced from the left arm artery into both the left coronary artery ostium B8i and the right coronary artery ostium B9i.
• Coronary artery catheter 1 has a tubular body 10 that communicates from the proximal end to the distal end. In its natural state, the tubular body 10 has a substantially linear main body portion 100 and a shaped portion 200 that is bent and shaped at a plurality of locations on substantially the same plane P1.
• the shaped portion 200 includes a first bent portion 210 bent at a position closer to the distal end than the main body portion 100 , a first intermediate portion 215 located closer to the distal end than the first bent portion 210 , and a first intermediate portion 215 bent at a position closer to the distal end than the first bent portion 210 .
• a second bent portion 220 bent toward the opposite side of the first bent portion 210 at a position on the distal side; a second intermediate portion 225 located on the distal side of the second bent portion 220; a third bent portion 230 bent toward the same side as the second bent portion 220 at a side position; a third intermediate portion 235 located on the distal side of the third bent portion 230; a fourth bent part 240 bent toward the same side as the third bent part 230 at the position; a fourth intermediate part 245 located on the distal side of the fourth bent part 240; It has a fifth bent part 250 that is bent toward the same side as the fourth bent part 240 at the same position, and a most distal end part 260 that is disposed on the distal side of the fifth bent part 250 .
• the first axis A1 is an axis passing through the center line of the main body 100, and is located at the boundary with the tip of the main body 100 at the first bent part 210, and extends from the first axis A1 to the second bent part 220.
• the second axis A2 is an axis passing through the bending start point Sa where the inclination starts towards the direction and the second bending point 220a having the smallest radius of curvature in the second bending part 220.
• the axis passing through the third bending point 230a with the smallest radius of curvature is called a third axis A3, and the axis passing through the third bending point 230a and the fifth bending point 250a with the smallest radius of curvature in the fifth bending part 250 is called a fourth axis A3.
• a line perpendicular to the first axis A1 and passing through the bending start point Sa is the first perpendicular H1
• a line perpendicular to the first axis A1 and passing through the second bending point 220a is the second perpendicular H2
• the third perpendicular line H3 is a line that is perpendicular to the first axis A1 and passes through the third bending point 230a
• the fourth axis A4 intersects the first axis A1
• the fourth axis A4 and the third perpendicular line H3 are
• the angle ⁇ a between the third axis A3 and the second perpendicular H2 is more acute than the angle ⁇ b between 1° and 30°.
• the coronary artery catheter 1 configured as described above is introduced from the left arm artery, and the distal end portion 260 is introduced and engaged into the left coronary artery ostium B8i and the right coronary artery ostium B9i via the left subclavian artery B2 and the ascending aorta B6.
• This provides superior operability in procedures.
• excellent operability means that the distal end portion 260 can be smoothly introduced and engaged into the left coronary artery ostium B8i and the right coronary artery ostium B9i by a simple operation such as pushing and pulling the tubular body 10.
• High torque transmittance to the leading edge portion 260 means that the following effects are achieved.
• the tubular body 10 is inserted into the other right coronary artery ostium B9i.
• Angiography may be performed by engaging the most distal end 260 and injecting a contrast agent from the most distal end 260.
• the operator grasps the hub 300 with the shaped portion 200 located in the ascending aorta B6 and descending aorta B7.
• the shaped portion 200 is rotated and the distal end portion 260 is moved.
• the coronary artery catheter 1 configured as described above rotates the shaped part 200, the shaped part 200 comes into contact with the left blood vessel wall Bw1 of the ascending aorta B6 and the right blood vessel wall Bw2 of the ascending aorta B6.
• the coronary artery catheter 1 has excellent operability, so that it is possible to shorten the procedure time and reduce the patient's radiation exposure and stress.
• an existing coronary artery catheter (hereinafter referred to as a "dual catheter") that has a shape that can be introduced into the left coronary artery ostium B8i and the right coronary artery ostium B9i by access from the right arm is introduced from the left arm artery and left
• a portion of the dual-use catheter may unintentionally interfere with the blood vessel wall or the like.
• the coronary artery catheter 1 has a fifth axis A5 that passes through the third bending point 230a and the fourth bending point 240a having the smallest radius of curvature in the fourth bending part 240, and the fourth bending point 240a and the fifth bending point 250a.
• the fourth angle ⁇ 4 formed by the fifth axis A5 and the sixth axis A6 is greater than 70° and less than 160°.
• the fourth angle ⁇ 4 is greater than 70° and less than 160°, as shown in FIG.
• the distal end portion 260 can be placed in a state where it is hooked on the left coronary artery ostium B8i, and the disposed state can be suitably maintained. Can be done.
• the coronary artery catheter 1 is configured to bring the most distal end portion 260 into contact with the left coronary artery ostium B8i, and to insert the most distal end portion 260 into the opening of the left coronary artery ostium B8i. It can be placed parallel to the direction. Therefore, the coronary artery catheter 1 effectively prevents the distal end portion 260 from slipping out from the left coronary artery ostium B8i when the contrast agent is discharged with the distal end portion 260 introduced into and engaged with the left coronary artery ostium B8i. can.
• the fourth angle ⁇ 4 of the coronary artery catheter 1 is larger than 70°, the fourth bent portion 240 is easily deformed into a substantially straight shape when the distal end portion 260 is introduced and engaged into the left coronary artery ostium B8i. , it is possible to smoothly rotate the shaped portion 200 within the ascending aorta B6.
• the fourth angle ⁇ 4 of the coronary artery catheter 1 is larger than 70° and smaller than 160°, as shown in FIG.
• the third bending part 230 and the fourth bending part 240 are located between the left blood vessel wall Bw1 and the right blood vessel wall Bw2, and are bent in multiple stages between the blood vessel walls of the ascending aorta B6.
• the coronary artery catheter 1 introduces and engages the most distal end portion 260 into the right coronary artery ostium B9i, the bending portions (the third bending portion 230 and the fourth bending portion 240) of the shaped portion 200 that bend in multiple stages,
• the force applied from the vascular wall of the ascending aorta B6 to the shaped portion 200 located between the vascular walls of the ascending aorta B6 can be dispersed, and kinking of the shaped portion 200 located between the vascular walls of the ascending aorta B6 can be effectively prevented.
• the angle between the first axis A1 and the second axis A2 is a first angle ⁇ 1
• the angle between the second axis A2 and the third axis A3 is a second angle.
• ⁇ 2 and the angle between the third axis A3 and the fifth axis A5 is a third angle ⁇ 3
• the sixth axis A6 the bending start point Sa, the first bending point 210a, the second bending point 220a, and the third bending point.
• the fifth angle ⁇ 5 is smaller than the fourth angle ⁇ 4
• the fourth angle ⁇ 4 is smaller than the third angle ⁇ 3
• the third angle ⁇ 3 is smaller than the second angle ⁇ 2.
• the second angle ⁇ 2 is smaller than the first angle ⁇ 1.
• the linear distance L4 between the third bending point 230a and the fifth bending point 250a along the fourth axis A4 is the same as that between the second bending point 220a and the third bending point 230a along the third axis A3.
• the linear distance L5 between them is 1 time or more and less than 2 times.
• the magnitude relationship of the angles ⁇ 1, ⁇ 2, ⁇ 3, ⁇ 4, and ⁇ 5 is defined such that the outer shape of the shaped portion 200 becomes more curved toward the distal end portion 260. . Therefore, when the coronary artery catheter 1 introduces and engages the most distal end portion 260 into the left coronary artery ostium B8i, the first bent portion 210, the first intermediate portion 215, the second bent portion 220, the second intermediate portion 225, and the third The bent portion 230, the third intermediate portion 235, the fourth bent portion 240, and the fourth intermediate portion 245 are bent at the most acute angle than the other bent portions while suppressing contact with the left blood vessel wall Bw1 of the ascending aorta B6.
• the distal end portion 260 can be placed so as to be hooked onto the left coronary artery ostium B8i. Furthermore, since the shaped portion 200 becomes more curved toward the most distal end 260, the return stress (stress that attempts to restore the shape to its natural state) when the shaped portion 200 is stretched into a substantially straight line is applied to the most distal end. It gets bigger as you go to 260. Therefore, in the coronary artery catheter 1, the backup force for maintaining the state in which the distal end portion 260 is engaged with the left coronary artery ostium B8i is improved.
• the linear distance L4 between the third bending point 230a and the fifth bending point 250a along the fourth axis A4 is the same as that between the second bending point 220a and the third bending point 230a along the third axis A3.
• the straight line distance L5 is at least 1 time and less than 2 times. Therefore, while suppressing the second intermediate portion 225 located between the second bending point 220a and the third bending point 230a from coming into contact with the left blood vessel wall Bw1 of the ascending aorta B6, the distal end of the third bending point 230a is suppressed.
• the width W1 of the shaped portion 200 is in the range of 41 mm to 58 mm, and the maximum width from the first axis A1 to the second bent portion 220 on the second perpendicular line H2 to the width W1 of the shaped portion 200.
• the ratio of W2 (W2/W1) is 1/2 to 1/4.
• the coronary artery catheter 1 configured as described above has a width W1 in the range of 41 mm to 58 mm, when the distal end portion 260 is introduced and engaged into the left coronary artery ostium B8i as shown in FIG. has a curved shape away from the ascending aorta B6. Further, since the ratio (W2/W1) is 1/2 to 1/4, the widthwise expansion of the shaped portion 200 can be suppressed within a predetermined range with respect to the first axis A1. Therefore, when introducing and engaging the most distal end portion 260 into the left coronary artery ostium B8i, as shown in FIG. can be directed toward the left coronary artery ostium B8i. This allows the coronary artery catheter 1 to more smoothly introduce and engage the distal end portion 260 into the left coronary artery ostium B8i.
• the longitudinal width L1 of the shaped portion 200 in the longitudinal direction is formed in a range of 70 mm to 160 mm.
• the coronary artery catheter 1 configured as described above, when a part of the shaped portion 200 is placed in the ascending aorta B6 and the most distal end portion 260 is introduced and engaged into the left coronary artery ostium B8i,
• the longitudinal distance L' of the shaped portion 200 located between the left subclavian artery B2 and the left coronary artery ostium B8i can be secured to a predetermined size.
• the coronary artery catheter 1 can suitably prevent the shaped portion 200 from coming into contact with the left blood vessel wall Bw1 of the ascending aorta B6.
• the first intermediate portion 215 intersects the second axis A2 connecting the bending start point Sa and the second bending point 220a, and the first intermediate portion 215 on the side of the bending start point Sa The portion is located closer to the first axis A1 than the second axis A2.
• the tubular body 10 is inserted into the aortic arch Aa via the left subclavian artery B2, and the distal end portion 260 is introduced into the left coronary artery ostium B8i.
• the shaped portion 200 located on the distal side of the main body portion 100 can be oriented toward the ascending aorta B6.
• the coronary artery catheter 1 connects the second bent portion 220, the third bent portion 230, and the fourth bent portion 240 to each blood vessel of the ascending aorta B6.
• Each of the bent portions 220 and 230 can be arranged so that a predetermined distance is maintained between the walls Bw1 and Bw2. Therefore, when the coronary artery catheter 1 is operated to introduce the most distal end portion 260 into the left coronary artery ostium B8i, the second bent portion 220, the third bent portion 230, and the fourth bent portion 240 are connected to the ascending aorta B6. Deterioration of operability due to contact can be suppressed.
• the distal end portion 260 is located closer to the fifth bent portion 250 than the third perpendicular line H3 in the longitudinal direction of the shaped portion 200.
• the coronary artery catheter 1 configured as described above is configured so that when the tubular body 10 is introduced from the left subclavian artery B2 into the ascending aorta B6, the tubular body 10 and each blood vessel wall of the ascending aorta B6
• the most distal end 260 can now be introduced and engaged into the left coronary ostium B8i.
• the coronary artery catheter 1 is configured such that when the tubular body 10 is inserted into the aortic arch Aa via the left subclavian artery B2 and the distal end portion 260 is introduced into the left coronary artery ostium B8i,
• the second bending part 220, the third bending part 230, and the fourth bending part 240 can be configured so as not to contact the blood vessel walls Bw1 and Bw2 of the ascending aorta B6.
• the coronary artery catheter 1 has the second bending part 220, the third bending part 230, and the fourth bending part 240 when the operation for introducing the most distal end part 260 into the left coronary artery ostium B8i is performed. contact with the ascending aorta B6 and deterioration of operability can be suppressed. Further, as shown in FIG.
• the coronary artery catheter 1 is configured such that when the tubular body 10 is inserted into the aortic arch Aa via the left subclavian artery B2 and the distal end portion 260 is introduced into the right coronary artery ostium B9i,
• the second bending portion 220 may be configured to contact the left blood vessel wall Bw1 of the ascending aorta B6.
• the second bending portion 220 is supported by the left blood vessel wall Bw1 of the ascending aorta B6 in a state in which the most distal end portion 260 is introduced into and engaged with the right coronary artery ostium B9i. Therefore, the backup force of the distal end portion 260 against the right coronary artery ostium B9i can be increased.
• the tubular body 10 is inserted into the aortic arch Aa via the left subclavian artery B2, and the distal end portion 260 is inserted into the left coronary artery ostium B8i or the right coronary artery ostium.
• the first bent portion 210 can be configured to be located at a position where it contacts the blood vessel wall Bw3 of the left subclavian artery B2 or at the aortic arch Aa.
• the coronary artery catheter 1 is configured such that the first bent portion 210 comes into contact with the blood vessel wall Bw3 of the left subclavian artery B2 when the distal end portion 260 is introduced into the left coronary artery ostium B8i or the right coronary artery ostium B9i.
• the operating force applied on the proximal side (for example, the rotational force during rotational operation) is applied to the distal side of the main body portion 100. This enables good transmission to the shaped portion 200 side.
• the coronary artery catheter 1 is configured such that the first bent portion 210 is located in the aortic arch Aa when the most distal end portion 260 is introduced into the left coronary artery ostium B8i or the right coronary artery ostium B9i, the first It is possible to suppress the bending portion 210 from coming into contact with the respective blood vessel walls Bw1 and Bw2 of the left subclavian artery B2. Therefore, the coronary artery catheter 1 can smoothly introduce and engage the most distal end portion 260 into the left coronary artery ostium B8i or the right coronary artery ostium B9i.
• the coronary artery catheter 1A according to the modified example differs in the shape of the shaped portion 200 from the coronary artery catheter 1 according to the embodiment described above. In other respects, it is substantially the same as the coronary artery catheter 1. Therefore, in the modified example, explanations other than the differences in shape will be omitted as appropriate.
• the coronary artery catheter 1A according to the modified example has a configuration in which the fourth axis A4 intersects the first axis A1, and the fourth axis A4 and the third perpendicular line H3 are provided in the coronary artery catheter 1 according to the embodiment described above.
• the angle ⁇ a is more acute than the angle ⁇ b between the third axis A3 and the second perpendicular H2, and is in the range of 1° to 30°
• the fourth bending portion 240 is formed between the third bending point 230a and the fifth bending point.
• the second perpendicular H2 is located at a position where the distance L2/distance L3 is in the range of 1/1 to 1/7. have a common structure.
• the coronary artery catheter 1A has the above structure, so that the most distal end portion 260 can be introduced and engaged from the left arm artery to both the left coronary artery ostium B8i and the right coronary artery ostium B9i. Moreover, by having the above-described structure, the coronary artery catheter 1 has the advantages described in the embodiment described above when introducing and engaging the distal end portion 260 from the left arm artery to the left coronary artery ostium B8i and the right coronary artery ostium B9i. It is possible to demonstrate excellent operability.
• FIG. 13 is a front view of a coronary artery catheter 1A according to a modified example.
• FIG. 14 is a rear view of a coronary catheter 1A according to a modified example.
• FIG. 15 is a left side view of a coronary artery catheter 1A according to a modified example.
• FIG. 16 is a right side view of a coronary artery catheter 1A according to a modified example.
• FIG. 17 is a plan view of a coronary catheter 1A according to a modified example.
• FIG. 18 is a bottom view of a coronary artery catheter 1A according to a modified example.
• the parts indicated by solid lines illustrate the design features of the tubular body 10 of the coronary artery catheter 1A according to the modified example, and the parts indicated by broken lines illustrate other parts. ing.
• FIG. 19, 20, and 21 are enlarged views of the coronary artery catheter 1A.
• FIG. 20, and FIG. 21 are partially enlarged views of the front view shown in FIG. 13, and are drawings corresponding to FIGS. 7, 8, and 9 shown in the above-described embodiment.
• each axis, each perpendicular line, etc. that serve as a reference for measuring the dimensions of each part of the coronary artery catheter 1A of Modification 1 shown below are substantially the same as those of the coronary artery catheter 1 of the embodiment described above.
• the most distal end portion 260 located on the distal side of the fifth bending portion 250 is based on the fifth bending portion 250. and extends toward the first axis A1 side. Therefore, in the plan view shown in FIG.
• the width W1 which is the maximum width of the shaped portion 200, is between the end portion of the second bent portion 220 located on the second perpendicular line H2 on the opposite side to the first axis A1 side, and the width W1, which is the maximum width of the shaped portion 200. It is defined by the distance of a straight line connecting the end portion 250b of the fifth bent portion 250 on the first axis A1 side and the opposite side projected onto the second perpendicular line H2.
• the coronary artery catheter 1A has an angle ⁇ a of 6°, an angle ⁇ b of 72°, a vertical width L1 of 102 mm, a distance L2 of 35 mm, a distance L3 of 67 mm, and a horizontal width W1 of 50 mm.
• the maximum width W2 is 16 mm
• the first angle ⁇ 1 is 168°
• the second angle ⁇ 2 is 150°
• the third angle ⁇ 3 is 143°
• the fourth angle ⁇ 4 is 127°
• 5 Angle ⁇ 5 is 108°
• straight line distance L4 is 41 mm
• straight line distance L5 is 22 mm.
• Coronary artery catheter 1A Coronary artery catheter 10 Tubular body 20 Lumen 100 Main body portion 110 Proximal end portion 200 Shape portion 210 First bending portion 210a First bending point 215 First intermediate portion 220 Second bending portion 220a Second bending point 225 2 intermediate part 230 3rd bent part 230a 3rd bent point 235 3rd intermediate part 240 4th bent part 240a 4th bent point 250 5th bent part 250a 5th bent point 260 Most extreme part 260a Most extreme position 261 Tip opening 300 Hub Sa Bending start point P1 Plane A1 First axis A2 Second axis A3 Third axis A4 Fourth axis A5 Fifth axis A6 Sixth axis A7 Seventh axis H1 First perpendicular H2 Second perpendicular H3 Third perpendicular L1 Shape Vertical width of the part L2 Vertical width of the shaped part in the long axis direction - Distance between the second perpendicular and the first perpendicular L3 Distance between the second

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• 2023
  • 2023-06-21 JP JP2024529044A patent/JPWO2023249040A1/ja active Pending
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