WO2023281878A1 - 医療デバイスおよびシャント形成方法 - Google Patents

医療デバイスおよびシャント形成方法 Download PDF

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Publication number
WO2023281878A1
WO2023281878A1 PCT/JP2022/016150 JP2022016150W WO2023281878A1 WO 2023281878 A1 WO2023281878 A1 WO 2023281878A1 JP 2022016150 W JP2022016150 W JP 2022016150W WO 2023281878 A1 WO2023281878 A1 WO 2023281878A1
Authority
WO
WIPO (PCT)
Prior art keywords
distal
proximal
extension
struts
strut
Prior art date
Legal status (The legal status 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 status listed.)
Ceased
Application number
PCT/JP2022/016150
Other languages
English (en)
French (fr)
Japanese (ja)
Inventor
侑右 高橋
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Terumo Corp
Original Assignee
Terumo Corp
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 Terumo Corp filed Critical Terumo Corp
Priority to JP2023533433A priority Critical patent/JP7824954B2/ja
Publication of WO2023281878A1 publication Critical patent/WO2023281878A1/ja
Priority to US18/398,703 priority patent/US20240122645A1/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
    • A61B2017/00252—Making holes in the wall of the heart, e.g. laser Myocardial revascularization for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/0016—Energy applicators arranged in a two- or three dimensional array
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00214—Expandable means emitting energy, e.g. by elements carried thereon
    • A61B2018/00267—Expandable means emitting energy, e.g. by elements carried thereon having a basket shaped structure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00351—Heart
    • A61B2018/0038—Foramen ovale
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00577—Ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00595—Cauterization
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
    • A61B18/082—Probes or electrodes therefor
    • A61B2018/087—Probes or electrodes therefor using semiconductors as heating element
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/142—Electrodes having a specific shape at least partly surrounding the target, e.g. concave, curved or in the form of a cave

Definitions

  • a traction shaft slidable with respect to the shaft portion; a radially outwardly convexly curved distal apex located proximally of the shaft portion; a second extension that includes an end extension and a proximal apex that is disposed on the distal side of the proximal extension and is curved in a radially outward convex shape; is recessed radially inward; a recess extending so as to connect the proximal side apex and the distal side apex and defining a receiving space capable of receiving living tissue when the expander is expanded, the recess extending in the radial direction.
  • the plurality of distal strut structures has twice as many of the first sections and the junctions as the plurality of energy transmission elements, wherein the junctions are circumferentially spaced from the plurality of energy a first merging portion arranged in the same phase as the transfer element arrangement portion and the plurality of opposing portions; and a second merging portion arranged in a phase different from the plurality of energy transfer element arrangement portions and the plurality of opposing portions. , alternately.
  • the expandable body has a form in which the adjacent distal strut structures support each other in the circumferential direction, so that it is difficult to twist during expansion.
  • the first extension portion 53 has a plurality of distal strut structures 60 extending radially outward from the force receiving portion 51 toward the proximal direction to form distal extension portions 56 .
  • Each first section 61 has a first strut 63 extending from the force receiving portion 51 substantially parallel to the axis of the extension body 21 when viewed from the radially outer side.
  • the recess 55 has a plurality of recessed strut structures 80 connected to a plurality of distal strut structures 60 via the distal apexes 57 .
  • Each of the plurality of recessed strut structures 80 has an energy transfer element placement portion 81 located on the proximal upright portion 73 and a facing portion 82 located on the distal upright portion 72 , and has a pair of bottom portions 71 . It has a bottom connection portion 83 that connects the energy transmission element placement portion 81 and the facing portion 82 .
  • Each bottom connecting portion 83 is arranged in a different phase from the first struts 63 in the circumferential direction of the expansion body 21 .
  • the extension body 21 can be made of a metal material.
  • the metal material for example, titanium-based (Ti--Ni, Ti--Pd, Ti--Nb--Sn, etc.) alloys, copper-based alloys, stainless steels, ⁇ -titanium steels, and Co--Cr alloys can be used. .
  • an alloy having spring properties such as a nickel-titanium alloy.
  • the material of the wire portion is not limited to these, and may be formed of other materials.
  • the second section 62 is provided between the energy transmission element arrangement portion 81 or the facing portion 82 and the distal end side apex portion 57 arranged in the same phase in the circumferential direction of the extension body 21 and the plurality of first confluence portions 65, It has an auxiliary curved portion 67 that functions as a buffer.
  • the compressive force can be further reduced by deforming the auxiliary bending portion 67, so that the compressive force is less likely to be converted into the expansive force.
  • the second extension portion 54 has a plurality of secondary struts 92 that connect the circumferentially adjacent third struts 91 among the plurality of second struts 64 structures.
  • Each of the plurality of support struts 93 has at least one support strut 93 having two joints 94 joined to each of two circumferentially adjacent third struts 91, and each of the plurality of support struts 93 has two It is formed longer than the linear distance between the joints 94 . This allows the support struts 93 to restrain the second strut 64 structure, which is subjected to compressive force, from twisting in the circumferential direction when the energy transmission element is pressed against the tissue. Therefore, in the medical device 10, the force of pressing the energy transmission element against the tissue is less likely to disperse, and the energy transmission element can be effectively pressed against the living tissue.
  • the expandable body 21 is compressed so that the 72 and the proximal upright portion 73 are brought closer to each other, and the cushioning portion is deformed in a direction different from the direction from the force receiving portion 51 to the distal top portion 57 along the distal expandable portion 56 .
  • the cushioning portion is deformed in a direction different from the direction from the force receiving portion 51 to the distal top portion 57 along the distal expandable portion 56 .
  • the energy transmission element arranged to face the recessed portion 55 along the distal side upright portion 72 or the proximal side upright portion 73 of the recessed portion 55 is brought into close contact with the living tissue while reducing the compressive force by deforming the portion. is a method of forming a shunt that ablates tissue located in a receiving space 74 using an energy delivery element in
  • the number of first struts 63 is one-fourth that of the embodiment shown in FIGS.
  • the number of (buffer portions) may be 1/4 or six.
  • Each of the six second struts 64 branched from the three first struts 63 is connected to each of the six auxiliary bending portions 67 (buffer portions) without gathering. Note that the auxiliary curved portion 67 may not be provided between the second strut 64 and the facing portion 82 .
  • the first strut 63 is arranged in a different phase than the third strut 91 , the energy transfer element arrangement portion 81 , the facing portion 82 and the energy transfer element 22 .
  • step S4 of expanding the diameter of the through hole Hh with the expander 21 or gripping the through hole Hh with the expander 21 and the step S5 of checking the hemodynamics in the vicinity of the through hole Hh may be reversed. good.
  • the operator moves the outer tube 30 toward the distal end side and accommodates the expansion body 21 in the outer tube 30.
  • the expansion body 21 is pulled out from the through hole Hh together with the outer cylinder 30 .
  • the through-hole Hh is expanded again using a balloon catheter having a balloon with an expansion diameter larger than that of the balloon 252 used in step S1, and the process returns to step S2.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Plasma & Fusion (AREA)
  • Medical Informatics (AREA)
  • Otolaryngology (AREA)
  • Physics & Mathematics (AREA)
  • Cardiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
PCT/JP2022/016150 2021-07-09 2022-03-30 医療デバイスおよびシャント形成方法 Ceased WO2023281878A1 (ja)

Priority Applications (2)

Application Number Priority Date Filing Date Title
JP2023533433A JP7824954B2 (ja) 2021-07-09 2022-03-30 医療デバイス
US18/398,703 US20240122645A1 (en) 2021-07-09 2023-12-28 Medical device and method for forming shunt

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP2021-114257 2021-07-09
JP2021114257 2021-07-09

Related Child Applications (1)

Application Number Title Priority Date Filing Date
US18/398,703 Continuation US20240122645A1 (en) 2021-07-09 2023-12-28 Medical device and method for forming shunt

Publications (1)

Publication Number Publication Date
WO2023281878A1 true WO2023281878A1 (ja) 2023-01-12

Family

ID=84801414

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/JP2022/016150 Ceased WO2023281878A1 (ja) 2021-07-09 2022-03-30 医療デバイスおよびシャント形成方法

Country Status (3)

Country Link
US (1) US20240122645A1 (https=)
JP (1) JP7824954B2 (https=)
WO (1) WO2023281878A1 (https=)

Families Citing this family (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2025081912A1 (zh) * 2023-10-15 2025-04-24 上海魅丽纬叶医疗科技有限公司 一种消融导管及相应的消融系统和消融方法
WO2025231292A1 (en) * 2024-05-03 2025-11-06 Edwards Lifesciences Corporation Implantless shunting

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2019189079A1 (ja) * 2018-03-29 2019-10-03 テルモ株式会社 医療デバイス
WO2020259492A1 (zh) * 2019-06-25 2020-12-30 杭州诺生医疗科技有限公司 房间隔造口装置

Family Cites Families (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20180085064A1 (en) * 2016-09-29 2018-03-29 Biosense Webster (Israel) Ltd. Basket catheter conforming to organ using strain-relief elements
EP3777740B1 (en) * 2018-03-29 2024-10-16 TERUMO Kabushiki Kaisha Medical device

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2019189079A1 (ja) * 2018-03-29 2019-10-03 テルモ株式会社 医療デバイス
WO2020259492A1 (zh) * 2019-06-25 2020-12-30 杭州诺生医疗科技有限公司 房间隔造口装置

Also Published As

Publication number Publication date
JPWO2023281878A1 (https=) 2023-01-12
US20240122645A1 (en) 2024-04-18
JP7824954B2 (ja) 2026-03-05

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