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
  • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
  • A61M25/09—Guide wires

Definitions

• the present invention relates to a wire delivery device that delivers a wire.
• CTO chronic total occlusion
• Patent Document 1 When penetrating an obstruction with a guidewire, the technician manually grasps and manipulates the guidewire via a torquer, so the distance the guidewire is advanced is determined by the technician's sense. There is a need for technology that can advance the guidewire a fixed distance without relying on the technician's sense.
• the technology described in Patent Document 1 is known as a technology that can advance a medical wire at a predetermined distance and effectively transmit the pressing force of the medical wire.
• Patent Document 1 the operator pushes the spring to deliver the medical wire.
• the pressure applied to the medical wire is relatively limited and may not be sufficient to cause the medical wire to penetrate the obstruction, making it necessary to replace the medical wire in order to penetrate the obstruction. This makes it impossible to solve the problems of the effort required to replace the medical wire and the cost involved in using multiple medical wires.
• the present invention was made based on the above circumstances, and its purpose is to make it possible to adjust the amount of wire movement to an appropriate amount and to send out the wire with an appropriate force.
• the wire feeding device is a wire feeding device that feeds out a wire in a distal direction, and includes a gripping portion that can grip and release the wire and can move in the distal direction and the rear direction, an elastic body that can bias the gripping portion in the distal direction, a biasing portion that deforms the elastic body to increase the biasing force in the distal direction, and a release portion that releases the deformed state of the elastic body in which the biasing force has been increased by the biasing portion, and is configured such that the gripping portion moves in the distal direction by the biasing force of the elastic body, the deformation state of which has been released by the release portion, thereby feeding out the wire gripped by the gripping portion in the distal direction, and the gripping portion has a first gripping portion and a second gripping portion, and is configured such that the timing of gripping the wire can be made different between the first gripping portion and the second gripping portion.
• the first gripping portion may be positioned further toward the tip than the second gripping portion.
• the first gripping portion may be formed to grip the wire on a flat surface
• the second gripping portion may be formed to grip the wire on a curved surface
• the wire feeding device is a wire feeding device that feeds out a wire in a distal direction, and includes a gripping section that can grip and release the wire and can move in the distal direction and the rear direction, an elastic body that can bias the gripping section in the distal direction, a biasing section that deforms the elastic body to increase the biasing force in the distal direction, and a release section that releases the deformed state of the elastic body whose biasing force has been increased by the biasing section, and is configured to move the gripping section in the distal direction by the biasing force of the elastic body whose deformation state has been released by the release section, thereby feeding out the wire gripped by the gripping section in the distal direction, and further includes a gripping operation section that can operate the gripping state of the wire by the gripping section, and an operation portion of the gripping operation section that is operated by a user is located in the rear direction from the gripping section.
• the gripping operation unit may include a link member that transmits the movement of the operation part to the gripping unit, and when the operation part is operated, the gripping state of the wire by the gripping unit may be manipulated via the link member.
• the wire delivery device may further include an erroneous operation prevention wall provided around the operating area to prevent erroneous operation of the operating area.
• the present invention allows the wire to be moved an appropriate amount and can be delivered with an appropriate force.
• FIG. 1 is a perspective view of a wire delivery device according to one embodiment.
• FIG. 1 is a perspective view of a wire delivery device with a guidewire and a catheter connected thereto.
• FIG. 4 is a top cross-sectional view of the wire feeding device shown in FIG. 3 in an initial state.
• FIG. 6 is a bottom perspective view of the inside of the wire feeding device in the initial state shown in FIG. 5 .
• FIG. 6 is a side cross-sectional view of the initial state shown in FIG. 5 .
• FIG. 1 is a perspective view of a wire delivery device according to one embodiment.
• FIG. 1 is a perspective view of a wire delivery device with a guidewire and a catheter connected thereto.
• FIG. 4 is a top cross-sectional view of the wire feeding device shown in FIG. 3 in an initial state.
• FIG. 6 is a bottom perspective view of the inside of the wire feeding device in the initial state shown in FIG. 5 .
• FIG. 6 is a side cross-sectional
• FIG. 4 is a perspective view of a slider of the wire feeding device.
• FIG. 4 is a perspective view of a firing switch of the wire feeding device.
• FIG. 2 is a perspective view of a hook of the wire delivery device.
• FIG. 2 is a perspective view of a slider trigger of the wire feeder;
• FIG. 13 is a perspective view of a slider lock of the wire delivery device.
• FIG. 4 is a configuration diagram of a gripper of the wire feeding device.
• FIG. 4A and 4B are a side view and a perspective view of a cam portion of the grip portion.
• 11A to 11C are diagrams showing the state of the gripping part at each point in time.
• FIG. 2 is a cross-sectional top view of the wire feeding device in a ready-to-feed state.
• FIG. 18 is a side cross-sectional view of the deliverable state shown in FIG. 17.
• FIG. 4 is a top cross-sectional view of the wire feeding device during feeding.
• FIG. 4 is a bottom cross-sectional view of the wire feeding device during feeding.
• 11 is a top cross-sectional view of the wire feeding device when the slider starts to move after feeding.
• FIG. 11 is a top cross-sectional view of the wire feeding device after the slider starts to move.
• FIG. FIG. 2 is a perspective view of the grip open/close switch in a closed state. 13 is a perspective view of relevant parts when the grip open/close switch is in a closed state.
• FIG. FIG. 2 is a perspective view of the grip open/close switch in an open state.
• FIG. 13 is a perspective view of relevant parts when the grip open/close switch is in an open state.
• FIG. 13 is a perspective view of a grip open/close switch according to a modified example in a closed state.
• FIG. 4 is a perspective view of a link portion of the grip open/close switch.
• FIG. 2 is a perspective view of the grip open/close switch in an open state.
• guidewire refers to a medical guidewire that is pushed into a surgical site in a body cavity such as a blood vessel and is used to guide a catheter to the surgical site.
• Rear end and “rear end direction” refer to the opposite side and direction of the distal end.
• Base end refers to the direction along the longitudinal direction of the guidewire, opposite the distal end.
• distal end refers to the distal end of any member or part
• base end refers to the base end of any member or part.
• the wire delivery device 1 is a device that delivers a guidewire, which is an example of a wire.
• the guidewire is pushed forward to a surgical site in a body cavity, such as a blood vessel, and is used to penetrate an obstruction at the surgical site.
• the wire delivery device 1 is used by connecting a catheter into which the guidewire is inserted to the device.
• Figure 1 is a diagram explaining the connectors for connecting the guidewire and catheter to the wire delivery device 1
• Figure 2 is a diagram showing their connection state.
• the guidewire GW is inserted into a hollow catheter 51.
• a catheter hub 52 for adjusting the direction is attached non-rotatably to the base end of the catheter 51.
• the left side of the drawing is the inside of the patient's body (the tip side)
• the right side of the drawing is the outside of the patient's body (the base end side).
• the catheter 51 is connected to the connector 60 as shown in FIG. 2, and is connected to the wire delivery device 1 via the connector 60.
• the connector 60 has a dial portion 60A, an attachment portion 60C, and a rear end portion 60D.
• the dial portion 60A is a portion for the operator (user) to operate the direction of the catheter 51 connected to the connector 60.
• the attachment portion 60C is formed in a cylindrical shape and is a portion for attachment to the connector connection portion 3 (see FIG. 3) of the wire delivery device 1, which will be described later.
• the axial length of the attachment portion 60C is approximately the same as the width in the X-axis direction of the connection pieces 3A and 3B of the connector connection portion 3, which will be described later.
• the rear end portion 60D is formed in a disk shape with a diameter larger than the cylinder of the attachment portion 60C. The rear end portion 60D acts to position the connector 60 in the X-axis direction relative to the connector connection portion 3.
• the connector 60 has a through hole 60B extending in the longitudinal direction.
• the through hole 60B is configured to engage with the rear end 52A of the catheter hub 52.
• the catheter hub 52 and the connector 60 are coupled and can rotate together.
• Fig. 3 is a perspective view of the wire delivery device
• Fig. 4 is a perspective view of the wire delivery device to which a guidewire and a catheter are connected.
• the wire delivery device 1 comprises a housing 2, a lever 31, a connector connection portion 3, a guidewire accommodating portion 4, and a grip portion 20.
• the wire delivery device 1 is basically placed on a flat surface such as a desk, and is used by the operator holding the grip 2E of the housing 2 with the left hand and operating the lever 31 with the right hand while positioned in the negative direction of the Y axis of Fig. 3 of the wire delivery device 1.
• the housing 2 has a generally rectangular parallelepiped shape with its axial direction (X-axis direction) being the longitudinal direction when the guidewire GW is attached, and includes inside it the gripping portion 20 as well as various configurations described below for gripping and delivering the guidewire GW.
• the lever 31 is rotatable around the lever rotation axis 31O (see FIG. 5), described below, and is the part that the operator operates when delivering the guidewire GW. In this embodiment, the operator can prepare to deliver the guidewire GW by grasping and rotating the lever 31 with one hand.
• the connector connection portion 3 is a portion for connecting the mounting portion 60C, and has a pair of connection pieces 3A, 3B extending in the X-axis direction.
• the connection pieces 3A, 3B are made of an elastic body such as resin, and clamp the outer peripheral surface of the mounting portion 60C from both sides in the Y-axis direction to rotatably connect the connector 60.
• the guidewire accommodating portion 4 is a portion for accommodating the guidewire GW to be delivered, and extends in the X-axis direction, and is formed in a concave shape with the positive direction of the Z-axis open over the entire X-axis direction.
• the gripping portion 20 is a portion capable of gripping the guidewire GW and moving in the X-axis direction, and is disposed in the middle of the guidewire accommodating portion 4 in the X-axis direction, with gripping surfaces 201A, 202A, and 203A (see FIG. 13) described later open to the outside.
• the guidewire GW when the guidewire GW is placed on the surface (here also referred to as the bottom surface) of the guidewire housing 4 in the negative direction of the Z axis, the guidewire GW is arranged in the gap (arrangement space) between the gripping surface 201A and the gripping surfaces 202A and 203A that hold the guidewire GW.
• the guidewire GW which is the portion closer to the base end than the connector 60, is placed on the bottom surface of the recessed portion of the guidewire accommodating portion 4, and the attachment portion 60C connected to the catheter 51 into which the guidewire GW has been inserted is fitted into the connection pieces 3A and 3B to be attached.
• the catheter 51 and the guidewire GW are connected to the wire delivery device 1.
• the operator can easily adjust the orientation of the catheter 51 by rotating the dial portion 60A (see FIG. 1).
• a gap is secured between the surface of the rear end portion 60D on the negative side of the X-axis and the surface of the housing 2 on the positive side of the X-axis, so that liquids such as blood and medicinal liquids that have passed through the catheter 51 tend to flow down through the gap, and the configuration on the housing 2 side can be appropriately prevented from coming into contact with the liquid.
• the guidewire GW is not gripped as described below, so the position and orientation of the guidewire GW can be adjusted by moving it back and forth and rotating it.
• the housing 2 is provided with an opening/closing part 80 for covering the guidewire housing 4.
• the opening/closing part 80 has a lid 81 and a shaft 82.
• the lid 81 has a lid part 81A extending in the X-axis direction, a rotation operation part 81B for rotating the lid part 81A, and an opening part 81C for preventing contact with the rib 2J formed toward the guidewire housing 4 of the housing 2.
• the shaft 82 is inserted into the lid 81, and the lid 81 is rotatably connected to the housing 2.
• the opening/closing part 80 can switch the guidewire housing 4 to an open state or a closed state by rotating the lid 81.
• the open state means a state in which the guidewire housing 4 is opened and the guidewire GW can be placed in the guidewire housing 4, and the closed state means a state in which at least a part of the guidewire housing 4 is closed and the guidewire GW does not fall out of the guidewire housing 4.
• the lid 81 may be fixed in the closed state when the guidewire housing 4 is closed.
• Figure 5 is a top cross-sectional view in its initial state.
• the wire feed device 1 comprises a housing, a grip, a compression spring, a return spring, a slider, a hook, a slider trigger, a slider lock, and an ejection switch
• Figure 6 is a bottom perspective view of the inside of the wire feed device 1 in its initial state.
• FIG. 7 is a side cross-sectional view of the wire feed device 1 in its initial state
• Figure 8 is a perspective view of the slider
• Figure 9 is a perspective view of the ejection switch
• Figure 10 is a perspective view of the hook
• Figure 11 is a perspective view of the slider trigger
• Figure 12 is a perspective view of the slider lock
• Figure 13 is a perspective view of the grip
• Figure 14 is an exploded perspective view of the grip
• Figure 15 is a side view and a perspective view of the cam
• Figure 16 is a diagram showing the state of the grip at each point in time.
• FIG. 6 shows the wire feed device 1 with a portion of the housing on the negative side of the Z axis removed, and the same state may be shown in the bottom oblique views of other figures in this specification.
• the wire feeding device 1 comprises a housing 2, a gripping portion 20, a hammer 11, a compression spring 12, a slider 13, a hook 14, a slider trigger 15, a return spring 16, a slider lock 17, a gripping open/close switch 40, and an ejection switch 45.
• the compression spring 12 is an example of an elastic body.
• the slider 13, the hook 14, and the slider trigger 15 are examples of a biasing portion.
• the hammer 11 is an example of a striking portion.
• the wire feeding device 1 further comprises a lever 31, links 35, 37, and joints 36, 38, as shown in Figure 6.
• the lever 31, the links 35, 37, the joints 36, 38, and the slider 13 are an example of a power transmission mechanism
• the slider 13, the hook 14, the slider trigger 15, the slider lock 17, and the ejection switch 45 are an example of a deformation maintaining unit
• the ejection switch 45 is an example of a maintaining state changing unit and an operating unit.
• the grip opening/closing switch 40 is an example of a grip operating unit.
• the slider 13, the hook 14, the slider trigger 15, the slider lock 17, and the ejection switch 45 are an example of a release unit.
• the housing 2 has a gripping part housing 2A that houses the gripping part 20 so that it can move in the X-axis direction, and a slider housing 2B that houses the slider 13, the hook 14, and the slider trigger 15 so that they can move in the X-axis direction.
• the housing 2 also has a support hole 2C that rotatably supports the cylindrical part 35A on one end side of the link 35.
• the housing 2 also has a grip 2E that is held by the operator, and an erroneous operation prevention wall 2F that covers a part of the periphery of an operation part 41 of the grip opening/closing switch 40 (in this embodiment, the negative side of the Z-axis) which will be described later.
• the slider 13 has a plate-shaped extension 13A extending in the X-axis direction, an attachment portion 13C to which the hook 14 can be attached, and a connection portion 13D that rotatably connects the link 37 via a joint 38 and also rotatably connects the slider trigger 15.
• a slit 13B is formed in the extension 13A to guide the operating convex portion 204A (see FIG. 13) of the grip portion 20 when the slider 13 moves.
• the width of the end of the slit 13B in the X-axis direction is equal to or greater than the movable range of the operating convex portion 204A in the Z-axis direction.
• the slit 13B is formed so that when the slider 13 moves to the base end side, the operation convex portion 204A is guided to a position (negative side of the Z axis) where the gripping portion 20 grips the guidewire GW, and when the slider 13 moves to the end on the tip side, the operation convex portion 204A is guided to a position (Z axis direction) where the gripping portion 20 releases the gripping of the guidewire GW.
• the shape of the slit 13B is not limited to this and may be changed depending on the usage situation.
• the ejection switch 45 has an operating portion 45A, a protruding portion 45B, a fixing hole 45C, and a spring accommodating portion 45D.
• the operating portion 45A is a portion that the operator presses to feed the wire.
• the fixing hole 45C is a hole into which a screw 46 is inserted for rotatably fixing the ejection switch 45 to the housing 2.
• the ejection switch 45 is fixed to the housing 2 by the screw 46, and is thereby rotatable about the fixing hole 45C.
• the spring accommodating portion 45D accommodates a spring (not shown) that biases the ejection switch 45 in the negative direction of the Y axis, so that when the ejection switch 45 is not pressed, the operating portion 45A protrudes from the side of the housing 2 in the negative direction of the Y axis.
• the ejection switch 45 instead of using a spring, the ejection switch 45 itself may be configured to have elasticity and be biased in the negative direction of the Y axis.
• the hook 14 is attached to the attachment portion 13C of the slider 13. As shown in FIG. 10, the hook 14 has a hammer hook 14A and a convex portion 14B.
• the hammer hook 14A can engage with a convex portion 11C of the hammer 11, which will be described later.
• the convex portion 14B is a portion that comes into contact with the convex portion 45B of the ejection switch 45.
• the convex portion 14B of the hook 14 is pressed in the positive direction of the Y axis by the convex portion 45B, the hook 14 is elastically deformed, and the hammer hook 14A is moved in the same direction.
• the slider 13 and the hook 14 are configured as separate bodies, but they may also be configured as one body.
• the slider trigger 15 has a protrusion 15A, a protrusion 15B, a connection portion 15C, and a return spring 15D.
• the slider trigger 15 is rotatably attached to the connection portion 13D of the slider 13 by inserting a pin member into the connection portion 15C.
• the protrusion 15A protrudes in the negative direction of the Y axis, and is configured to be located in the positive direction of the Y axis of the protrusion 11C of the hammer 11 when the hammer 11 is in a state where it can be sent out.
• the protrusion 15B is capable of engaging with a hook 17A of the slider lock 17, which will be described later.
• the return spring 15D biases the slider trigger 15 in the clockwise direction in the state shown in FIG. 11, centered on the connection portion 15C.
• the slider lock 17 is fixed to the housing 2. As shown in FIG. 12, the slider lock 17 has a hook 17A at the end on the positive side of the X-axis. The hook 17A is capable of engaging with the protrusion 15B of the slider trigger 15.
• the hammer 11 is disposed on the negative side of the X-axis of the gripping portion 20 with its longitudinal direction aligned with the X-axis
• the compression spring 12 is disposed around the negative side of the X-axis of the hammer 11 and on the negative side of the X-axis of the hammer 11 with its longitudinal direction aligned with the X-axis.
• the hammer 11 has a tip 11A made of resin, for example, and a metal part 11B, and is movable in the X-axis direction.
• a convex part 11C is formed on the tip 11A of the hammer 11 on the slider accommodating part 2B side.
• the convex part 11C is capable of engaging with the hammer hook 14A.
• the compression spring 12 is, for example, a metal spring, and is capable of deformation (compression) in the X-axis direction, and is capable of applying a biasing force to the hammer 11 in the positive direction of the X-axis.
• the return spring 16 is, for example, a metal spring, is deformable (compressible) in the X-axis direction, and biases the grip portion 20 toward the base end.
• the biasing force of the return spring 16 on the grip portion 20 is smaller than the biasing force on the grip portion 20 in the initial state of the compression spring 12 (a state in which no compression due to the movement of the hammer 11 occurs).
• the grip portion 20 is located at the most extreme position of the movable range (the most extreme position in the X-axis direction within the grip portion housing portion 2A), and when the compression spring 12 is compressed and no longer applies a biasing force to the grip portion 20, the biasing force of the return spring 16 positions the grip portion 20 at the most extreme position of the movable range (the most extreme position in the X-axis direction within the grip portion housing portion 2A).
• the gripping portion 20 which can grip the guidewire GW, can move in the direction along the X-axis in the gripping portion housing 2A.
• the gripping portion 20 has a main body portion 201, a flat surface opposing part 202, a curved surface opposing part 203, a cam portion 204, a grip release spring 205, a support pin 206, and a retaining ring 207.
• the main body portion 201 and the flat surface opposing part 202 correspond to the first gripping portion
• the main body portion 201 and the curved surface opposing part 203 correspond to the second gripping portion.
• the main body 201 has a gripping surface 201A and a wall 201B.
• the gripping surface 201A is a surface in the negative direction of the Y axis that grips the guidewire GW, and for example, a rubber member may be attached to this surface.
• the gripping surface 201A has a planar gripping surface 201Aa that faces the planar opposing part 202, and a curved gripping surface 201Ab that faces the curved opposing part 203.
• the wall 201B has a hole 201C for inserting a support pin 206 that rotatably supports the cam part 204, and a hole 201D for inserting a support pin 206 that rotatably supports the planar opposing part 202 and the curved opposing part 203.
• the cam portion 204 has an operation convex portion 204A, a through hole 204B, a contact surface 204C, and a contact surface 204D.
• the operation convex portion 204A is provided on the side of the cam portion 204 and is a portion for operating the state of the cam portion 204.
• the through hole 204B is a hole for inserting a support pin 206 for supporting the rotation of the cam portion 204.
• the contact surface 204C is a surface that contacts the surface of the flat surface opposing part 202 in the positive direction of the Y axis.
• the contact surface 204D is a surface that contacts the surface of the curved surface opposing part 203 in the positive direction of the Y axis.
• the contact surface 204C can contact the flat surface opposing part 202 at a timing before the contact surface 204D contacts the curved surface opposing part 203.
• the gripping portion 20 first grips the guidewire GW with the flat opposing part 202 and the main body portion 201, and then operates to grip the guidewire GW with the curved opposing part 203 and the main body portion 201.
• the planar opposing part 202 has a gripping surface 202A and a through hole 202B.
• the gripping surface 202A is a surface in the positive direction of the Y axis that grips the guidewire GW, and has a planar shape that corresponds to the planar gripping surface 201Aa of the main body 201.
• a rubber member may be attached to the gripping surface 202A.
• the through hole 202B is a hole into which a support pin 206 is inserted to support the rotation of the planar opposing part 202.
• the curved opposing part 203 has a gripping surface 203A and a through hole 203B.
• the curved opposing part 203 is arranged on the negative side of the X-axis relative to the flat opposing part 202.
• the gripping surface 203A is a surface on the positive side of the Y-axis that grips the guidewire GW, and has a curved shape that corresponds to the curved gripping surface 201Ab of the main body 201. This curved surface intersects with the X-axis.
• the through hole 203B is a hole into which a support pin 206 is inserted to support the rotation of the curved opposing part 203.
• the grip release spring 205 is arranged with a bias so as to open the gap between the opposing surfaces of the main body 201 and the flat opposing component 202, and the gap between the opposing surfaces of the main body 201 and the curved opposing component 203.
• the grip release spring 205 acts to open the gap between the opposing surfaces of the main body 201 and the flat opposing component 202, and the gap between the opposing surfaces of the main body 201 and the curved opposing component 203.
• the support pin 206 is a cylindrical member that has a head 206A at a first end and a groove 206B at a second end opposite the first end into which a retaining ring 207 is fitted.
• the retaining ring 207 is attached to the groove 206B of the support pin 206 to prevent the support pin 206 from falling out of the holes 201C and 201D.
• the grip portion 20 is assembled as follows. First, with the grip release spring 205 assembled into the main body 201, the support pin 206 is inserted into the hole 201D in the positive direction of the X-axis of the main body 201, the through hole 202B of the flat surface opposing component 202, the through hole 203B of the curved surface opposing component 203, and the hole 201D in the negative direction of the X-axis of the main body 201, and a retaining ring 207 is attached to the groove 206B of the support pin 206.
• the support pin 206 is inserted into the hole 201C in the positive direction of the X axis of the main body 201, the through hole 204B of the cam portion 204, and the hole 201C in the negative direction of the X axis of the main body 201, and the retaining ring 207 is attached to the groove portion 206B of the support pin 206. This completes the grip portion 20 shown in FIG.
• the gripping portion 20 is as shown in Fig. 16(A)(1).
• the contact surface 204C of the cam portion 204 is not pressing down on the surface of the planar opposing part 202 in the positive direction of the Y axis, and the gripping surface 202A of the planar opposing part 202 and the planar gripping surface 201Aa of the main body portion 201 are far enough apart that the guidewire GW cannot be gripped.
• the contact surface 204D of the cam portion 204 is not in contact with the surface of the curved surface opposing part 203 in the positive direction of the Y axis, and the gripping surface 203A of the curved surface opposing part 203 and the curved gripping surface 201Ab of the main body portion 201 are separated by such a distance that the guidewire GW cannot be gripped.
• the contact surface 204C of the cam portion 204 contacts and presses down on the surface of the planar opposing part 202 in the positive direction of the Y axis, and the gap between the gripping surface 202A of the planar opposing part 202 and the planar gripping surface 201Aa of the main body 201 is large enough to grip the guidewire GW (for example, a gap narrower than the diameter of the guidewire GW).
• the guidewire GW is gripped between the gripping surface 202A of the planar opposing part 202 and the planar gripping surface 201Aa of the main body 201.
• the guidewire GW and the gripping surface 202A of the planar opposing part 202 are arranged in parallel in advance, and the guidewire GW is gripped by a flat surface between the gripping surface 202A of the planar opposing part 202 and the planar gripping surface 201Aa of the main body 201, so there is no positional deviation in the X-axis direction relative to the guidewire GW.
• the contact surface 204D of the cam portion 204 does not press down on the surface of the curved surface opposing part 203 facing in the positive direction of the Y axis, and the gripping surface 203A of the curved surface opposing part 203 and the curved gripping surface 201Ab of the main body portion 201 are far enough apart that the guidewire GW cannot be gripped.
• the contact surface 204D of the cam portion 204 presses down on the surface of the curved surface opposing part 203 in the positive direction of the Y axis, and the distance between the gripping surface 203A of the curved surface opposing part 203 and the flat gripping surface 201Aa of the main body portion 201 is such that the guidewire GW can be gripped (for example, a distance narrower than the diameter of the guidewire GW).
• the guidewire GW is gripped between the gripping surface 203A of the curved surface opposing part 203 and the curved gripping surface 201Ab of the main body portion 201.
• the guidewire GW is held between the gripping surface 203A of the curved surface facing part 203 and the curved gripping surface 201Ab of the main body part 201, so the guidewire GW moves along the shape of the gripping surface, and the guidewire GW shifts in position in the X-axis direction by the length of the movement.
• the guidewire GW is already held by the gripping surface 202A of the flat surface facing part 202 and the flat gripping surface 201Aa of the main body part 201 in the positive direction of the X-axis relative to the gripping surface 203A of the curved surface facing part 203, so no shift in position occurs and there is no effect on the length of the guidewire GW in the positive direction of the X-axis from the gripping part 20.
• the cam portion 204 is used to shift the timing of gripping the guidewire GW by the flat surface opposing part 202 and the curved surface opposing part 203, but the present invention is not limited to this.
• the upper parts (positive direction of the Y axis) of the flat surface opposing part and the curved surface opposing part may be formed so that the length in the positive direction of the Y axis increases as the length approaches the negative direction of the X axis, and the movable part may be moved from the positive side of the X axis of the flat surface opposing part toward the negative direction so as to come into contact with the upper parts of the flat surface opposing part and the curved surface opposing part, thereby shifting the timing of gripping the guidewire GW by the flat surface opposing part and the curved surface opposing part.
• the lever 31, the links 35, 37, the joints 36, 38, and the slider 13 form a power transmission mechanism.
• the lever 31 is a part that is rotated manually by the operator using the wire feeding device 1.
• the lever 31 is rotatable around the lever rotation axis 31O.
• the lever 31 and the cylindrical portion 35A of the link 35 are connected via a joint (not shown) so that a rotational force can be transmitted from the lever 31 to the link 35.
• the link 35 is configured to rotate integrally with the rotation of the lever 31.
• link 35 and one end of link 37 are rotatably connected via joint 36.
• link 37 and slider 13 are rotatably connected via joint 38.
• Slider 13 is capable of linear movement in the X-axis direction.
• the power transmission mechanism adjusts the rotation angle of the lever 31 and the lengths of the links 35 and 37 so that the slider 13 can move over the entire range of movement in the X-axis direction within the range in which the lever 31 can rotate.
• the hammer hook 14A engages with the convex portion 11C of the hammer 11, and as it moves further, it moves the hammer 11 toward the base end and compresses the compression spring 12.
• the convex portion 15B of the slider trigger 15 overcomes the hook 17A of the slider lock 17 in the negative direction of the X-axis and the two engage with each other. As a result, with the compression spring 12 in a compressed state, the slider 13 cannot move in the positive direction of the X-axis.
• the convex portion 45B presses the convex portion 14B of the hook 14 in the positive direction of the Y-axis, and the part of the hook 14 on the positive side of the X-axis is deformed in the positive direction of the Y-axis, and the engagement between the hammer hook 14A of the hook 14 and the convex portion 11C of the hammer 11 is released.
• the compression spring 12 is suddenly released from its deformed state (compressed state), and the compression spring 12 pushes the hammer 11 in the X-axis direction.
• Fig. 17 is a top cross-sectional view of the wire feeding device in a state where it is ready to be fed
• Fig. 18 is a side cross-sectional view of the wire feeding device in a state where it is ready to be fed
• Fig. 19 is a top cross-sectional view of the wire feeding device during feeding
• Fig. 20 is a bottom cross-sectional view of the wire feeding device during feeding
• Fig. 21 is a top cross-sectional view of the wire feeding device when the slider starts to move after feeding
• Fig. 22 is a top cross-sectional view of the wire feeding device after the slider starts to move.
• the wire feeding device 1 is configured such that the gripping portion 20, hammer 11, slider 13, hook 14, and slider trigger 15 are interlocked to operate in the following order: (a) gripping the guidewire GW, (b) moving the gripping portion 20 toward the tip of the guidewire GW, and (c) releasing the gripping of the guidewire GW and moving the gripping portion 20 toward the rear end.
• the technician inserts the guidewire GW into the blood vessel, and then pushes the guidewire GW along the blood vessel to the occlusion site.
• the catheter 51 is pushed to the occlusion site using the guidewire GW as a guide.
• the connector 60 is connected to the catheter hub 52 of the catheter 51, and while pushing the connector 60 into the connector connection portion 3 of the wire delivery device 1 from the positive direction of the Z axis, the base end side of the guidewire GW is accommodated in the guidewire accommodation portion 4 of the housing 2 from the positive side of the Z axis, and the connector 60 is connected to the wire delivery device 1.
• the operating convex portion 204A of the gripping portion 20 is in a position where the gripping portion 20 does not grip the guidewire GW, i.e., where the gripping surface 201A of the main body 201 and the gripping surfaces 202A, 203A of the flat opposing part 202 and the curved opposing part 203 are separated by a distance greater than the diameter of the guidewire GW, forming an arrangement space. Therefore, as described above, by attaching the catheter 51 with the guidewire GW inserted therein to the wire delivery device 1, the guidewire GW can be easily accommodated in the arrangement space. This makes it possible to shorten the preparation time for delivering the guidewire GW by the wire delivery device 1, and reduce the burden on the patient and the operator.
• the gripping portion 20 is no longer pushed in the positive direction of the X-axis by the hammer 11, so the gripping portion 20 slides to the rear end of its movable range due to the biasing force of the return spring 16.
• the gripping portion 20 moves a distance D from the very end of its movable range (initial position) to the rear end of its movable range, as shown in FIG. 17.
• This distance D corresponds to the amount of wire being fed by the wire feeding device 1 in one go. For example, if the amount of wire being fed by the wire feeding device 1 in one go is 2 mm, then the gripping portion 20 will slide 2 mm toward the rear end from the initial position.
• the slit 13B of the extension 13A gradually guides the operating convex portion 204A of the gripping portion 20 to a position where it grips the guidewire GW, so that first the guidewire GW is gripped between the gripping surface 202A of the flat opposing part 202 and the flat gripping surface 201Aa of the main body 201, and then the guidewire GW is gripped between the gripping surface 203A of the curved opposing part 203 and the curved gripping surface 201Ab of the main body 201.
• the convex portion 45B presses the convex portion 14B of the hook 14 in the positive direction of the Y axis
• the portion of the hook 14 on the positive side of the X axis bends in the positive direction of the Y axis
• the hammer hook 14A moves in the positive direction of the Y axis as shown in FIG. 19, and the state in which the hammer hook 14A is engaged with the convex portion 11C of the hammer 11 is released.
• the force of the compression spring 12 is immediately applied to moving the hammer 11 toward the tip, causing the hammer 11 to move toward the tip and collide with the base end of the gripping portion 20.
• the gripping portion 20 gripping the guidewire GW moves toward the tip due to the impact of the collision with the hammer 11, and stops at the most distal position of the gripping portion 20. At this time, the gripping portion 20 maintains its grip on the guidewire GW.
• the gripping portion 20 moves from the rearmost position to the most distal position while maintaining the gripped state of the guidewire GW.
• the guidewire GW is sent out toward the distal end by a distance D from the rearmost position of the gripping portion 20 to the most distal position.
• the convex portion 15A of the slider trigger 15 is no longer in contact with the convex portion 11C of the hammer 11 as shown in FIG. 21, and the slider trigger 15 can rotate in the counterclockwise direction, so that the engagement between the convex portion 15B and the hook 17A is released and the slider 13 moves in the positive direction of the X-axis.
• the slider trigger 15 is then rotated in the clockwise direction by the return spring 15D and returned to the state shown in FIG. 22.
• the slit 13B of the extension 13A guides the operating convex portion 204A of the gripping portion 20 to a position where the grip of the guidewire GW is released, as shown in FIG. 7.
• the grip of the guidewire GW is released between the gripping surface 203A of the curved opposing part 203 and the curved gripping surface 201Ab of the main body 201, and then the grip of the guidewire GW is released between the gripping surface 202A of the flat opposing part 202 and the flat gripping surface 201Aa of the main body 201.
• the above operations correspond to the single-shot mode in which the wire is sent out once.
• the single-shot mode (a) the guidewire GW is grasped by the gripping portion 20, and the compression spring 12 is deformed by the slider 13, hook 14, and slider trigger 15. Then, by pressing the ejection switch 45, (b) the deformation of the compression spring 12 is released and energized, the gripping portion 20 gripping the guidewire GW is sent out toward the tip side, and then (c) the grip is released, allowing the guidewire GW to be sent out.
• the lever 31 can be rotated continuously and the same operation can be performed.
• the wire delivery device 1 can be operated in continuous mode.
• the operator operates the lever 31 and the compression spring 12 is compressed. Since the convex portion 45B of the ejection switch 45 is in a state of pressing the convex portion 14B, the hammer hook 14A of the hook 14 is disengaged from the convex portion 11C of the hammer 11, and the hammer 11 collides with the gripping portion 20.
• the guidewire GW can be delivered in the distal direction.
• the operator can continuously operate the lever 31 to continuously deliver the guidewire GW to the distal side. That is, it is possible to repeat a series of operations in the order of (a), (b), and (c) described above.
• the wire delivery device 1 can deliver an appropriate amount of wire by applying an impact force to the guidewire GW due to the biasing force accumulated in the compression spring 12. In this way, the wire can be delivered by applying an impact force to the guidewire GW, allowing the guidewire GW to effectively penetrate the obstruction.
• Figure 23 is an oblique view of the gripping open/close switch in a closed state
• Figure 24 is an oblique view of the relevant parts when the gripping open/close switch is in a closed state
• Figure 25 is an oblique view of the gripping open/close switch in an open state
• Figure 26 is an oblique view of the relevant parts when the gripping open/close switch is in an open state. Note that Figure 23 shows the state immediately after the wire feeding device 1 has entered a feeding-ready state as shown in Figures 17 and 18.
• the gripping open/close switch 40 includes an operation part 41, a first link part 42, a second link part 43, and a third link part 44.
• the first link part 42, the second link part 43, and the third link part 44 correspond to link members.
• the operation part 41 is disposed on the negative side of the X-axis from the grip part 20 outside the housing 2, and receives operation by the operator.
• the close operation part 41A on the positive side of the X-axis of the operation part 41 is a part that is pressed when the grip part 20 grips the guidewire GW, and the open operation part 41B on the negative side of the X-axis of the operation part 41 is a part that is pressed when the grip part 20 releases the grip of the guidewire GW.
• the operation part 41 has a convex part 41C that protrudes in the negative direction of the Y-axis.
• the first link portion 42 is disposed on the negative side of the Y axis of the operating portion 41.
• the first link portion 42 has a cylindrical portion 42A that protrudes in the positive direction of the Y axis on the positive side of the X axis, and a connecting portion 42B that rotatably connects the protruding portion 41C on the negative side of the X axis.
• the third link portion 44 is disposed on the positive side of the Y axis of the gripping portion 20, has a cylindrical portion 44A that protrudes in the positive direction of the Y axis on the positive side of the Y axis, and has a storage portion 44B that stores the operating convex portion 204A of the gripping portion 20 on the negative side of the Y axis. Note that when the wire feeding device 1 is in a state immediately after it has become ready for feeding as shown in FIG. 17, the storage portion 44B is in a position on the negative side of the Z axis (gripping position) when the operating convex portion 204A grips the guidewire GW.
• the second link part 43 is roughly triangular prism-shaped, with a rotating shaft mounting part 43A, a protruding part accommodating part 43B, and a protruding part accommodating part 43C at each apex of the triangle.
• the rotating shaft mounting part 43A is a part for rotatably connecting the second link part 43 to the housing 2 via the screw 7.
• the protruding part accommodating part 43B accommodates the cylindrical part 42A, and the protruding part accommodating part 43C accommodates the cylindrical part 44A.
• the operation convex part 204A of the grip part 20 is positioned at the gripping position for gripping the guidewire GW.
• the grip part 20 grips the guidewire GW.
• the grip of the guidewire GW by the gripping portion 20 can be released even when the wire feeding device 1 is in a state ready for feeding, as shown in FIG. 17. Therefore, after the wire feeding device 1 is in a state ready for feeding, the grip of the guidewire GW by the gripping portion 20 can be released, and adjustments such as changing the position or orientation of the guidewire GW can be easily made.
• Wire feeding device 1A is a wire feeding device 1 with a modified gripping open/close switch configuration.
• FIG. 27 is a perspective view of the grip open/close switch in the modified example in the closed state
• FIG. 28 is a perspective view of the link portion of the grip open/close switch
• FIG. 29 is a perspective view of the grip open/close switch in the open state. Note that FIG. 27 shows the state immediately after the wire feed device 1 has entered the feed-ready state as shown in FIG. 17.
• the grip open/close switch 70 includes an operation part 71, a link part 72, and a third link part 44.
• the operation part 71 is disposed on the negative side of the X-axis relative to the grip part 20 outside the housing 2, and receives operation by the operator.
• the close operation part 71A on the positive side of the X-axis of the operation part 71 is a part that is pressed when the grip part 20 grips the guidewire GW
• the open operation part 71B on the negative side of the X-axis of the operation part 41 is a part that is pressed when the grip part 20 releases the grip of the guidewire GW.
• the operation part 71 has a cylindrical protrusion 71C that protrudes in the negative direction of the Y-axis.
• the link portion 72 has a protrusion accommodating portion 72A, a rotating shaft mounting portion 72B, and an operation protrusion accommodating portion 72C.
• the protrusion accommodating portion 72A accommodates the protrusion 71C of the operation portion 71 and has a long hole that allows the distance between the protrusion 71C and the rotating shaft mounting portion 72B to be variable.
• the rotating shaft mounting portion 72B is a portion for rotatably connecting the link portion 72 to the housing 2 via the pin 8.
• the operation protrusion accommodating portion 72C has an opening that accommodates the cylindrical portion 44A of the third link portion 44.
• the convex portion 71C moves in the M8 direction, and as the convex portion 71C moves, the link portion 72 rotates in the R4 direction around the pin 8, causing the operation convex portion accommodating portion 72C to move in the M9 direction, and the cylindrical portion 44A also moves in the M9 direction.
• the operation convex portion 204A of the gripping portion 20 is positioned to grip the guidewire GW (gripping position). As a result, the gripping portion 20 grips the guidewire GW.
• the grip of the guidewire GW by the gripping portion 20 can be released even when the wire feeding device 1 is in a state ready for feeding, as shown in FIG. 17. Therefore, after the wire feeding device 1 is in a state ready for feeding, the grip of the guidewire GW by the gripping portion 20 can be released, and adjustments such as changing the position or orientation of the guidewire GW can be easily made.
• a metal spring is used as the compression spring 12, but other types of elastic bodies such as rubber cords or leaf springs may also be used, and the material of the elastic body may be a resin material.
• the tip 11A of the hammer 11 is made of resin, but the entire hammer may be made of metal, or the entire hammer may be made of resin.
• the urging force of the hammer 11 toward the tip end is increased by moving the hammer 11 and compressing the compression spring 12.
• an elastic body may be provided that expands in response to the movement of the base end side of the hammer 11, and the urging force may be increased by the expansion of the elastic body.
• the gripping part 20 may be moved directly toward the tip end by the compression spring 12 without using the hammer 11.
• a mechanism for adjusting the movable range of the gripper 20 in the X-axis direction for example, a mechanism for moving the position of the wall in the X-axis direction that determines the movable range. In this way, the amount of wire fed by the wire feeding device can be easily and appropriately adjusted.
• a mechanism for adjusting the amount of compression of the compression spring 12 in its initial state for example a mechanism for moving the position of the wall on the base end side of the compression spring 12, may be provided.
• the compression spring 12 is not compressed at all in its initial state, but the compression spring 12 may be slightly compressed in its initial state.
• the operator rotated the lever 31 by hand to deliver the guide wire GW, but it may also be delivered by an electrically powered motor.
• the link 35 may be rotated by the power of a motor.
• the motor may be stopped when the link 35 has been rotated a predetermined angle.
• a switch for driving the motor may be provided, and pressing this switch once may drive the motor enough to rotate the link 35 a predetermined angle.

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• 2022
  • 2022-10-05 JP JP2024555517A patent/JPWO2024075199A1/ja active Pending
  • 2022-10-05 WO PCT/JP2022/037228 patent/WO2024075199A1/ja not_active Ceased

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