JP2006271693A - Intravascular foreign object-sucking catheter and intravascular foreign object-sucking catheter system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an intravascular foreign object-sucking catheter with excellent flexibility and kink resistance for a thin bending blood vessel, with the narrow distal end, and with a gap capable of absorbing a crushed thrombosis. <P>SOLUTION: The catheter 20 for sucking a foreign object (the thrombosis K) inside a blood vessel and taking out the foreign object to the outside is characterized by a winding part 24 at the distal end of a catheter body 22. The winding part 24 is formed in the tapered shape and has a coiled piece 25 with at least one coil. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to an intravascular foreign matter suction catheter and an intravascular foreign matter suction catheter system for sucking and removing foreign matters such as crushed thrombus produced in the treatment of thrombosis.

  In recent years, as a means for treating a thrombosis in which a human blood vessel is blocked, research on a treatment method in which a liquid jet flow is generated by a laser beam and the thrombus is physically crushed has been advanced. This treatment method does not require administration of a large amount of a thrombolytic agent that may cause serious side effects such as bleeding, and blood can be restarted earlier than when using a thrombolytic agent alone, It is highly expected as a new treatment method for thrombosis. In particular, when the ischemic state continues for 6 hours or more in the brain tissue, it is considered difficult to recover the associated neurological symptoms. However, if the blood flow can be resumed within a few hours after the onset, the therapeutic effect is extremely high.

  However, in this treatment method, even if blood flow is resumed, if the crushed thrombus is not recovered, even if a thrombolytic agent is administered, there is little effect. There is a risk of occluding blood vessels.

  As a means for collecting the crushed thrombus, for example, a suction catheter is concentrically disposed on the catheter for thrombosis and the thrombosis is sucked through the gap between the two catheters. There is a possibility that it will become large and cannot be inserted up to a non-treetop part of a very thin blood vessel such as a cerebral blood vessel. In addition, if there is a blood vessel branch between the suction catheter tip and the thrombus crushing catheter tip, the crushed thrombus may flow from this branch and may not be collected.

  Therefore, a method of reducing the diameter of the aspiration catheter and increasing the reachability of the distal end to make the tip as close as possible to the vicinity of the distal end of the thrombus crushing catheter can be considered. The gap between the suction catheter and the thrombus crushing catheter is narrowed, and there is insufficient space for the clot thrombus collection path, it can be easily blocked, or the suction force from the proximal end of the suction catheter reaches the suction part at the tip. It is considered that problems such as inability to occur occur and the clot thrombus cannot be sufficiently recovered. If a large number of side holes are provided in the suction catheter in order to increase the suction force, kinks are likely to occur, which is not suitable for transportation or insertion into a bent cerebral blood vessel.

In Patent Document 1 described below, a coil-shaped member is provided in an outer sheath of a catheter to prevent deformation of the outer sheath during suction and ensure a flow path. However, when a coil-shaped member is provided in the outer sheath, although resistance to deformation due to suction force is improved, flexibility is poor and reachability to the periphery is reduced. Not suitable for insertion.
JP 2000-197696 A (abstract, paragraphs “0008” and “0009”, see FIG. 1)

  The present invention has been made to solve the above-described problems, and has excellent flexibility and kink resistance that can be inserted well into a thin and bent blood vessel, the thinness of the tip, and sufficient suction of crushed foreign matter. It is an object of the present invention to provide an intravascular foreign matter suction catheter and an intravascular foreign matter suction catheter system capable of ensuring a wide gap.

  An intravascular foreign matter suction catheter according to the present invention that achieves the above object is characterized in that a tapered portion having at least one coiled piece is provided at the distal end portion of the catheter body.

  An intravascular foreign matter suction catheter system of the present invention that achieves the above object comprises a suction catheter for sucking foreign matter in a blood vessel and taking it out, and a foreign matter crushing catheter that ejects a liquid jet flow from the tip to crush foreign matter. The foreign substance crushing catheter is disposed in the suction catheter, and the foreign substance crushed by the foreign substance crushing catheter is formed into a tapered taper shape having at least one coiled piece of the foreign substance suction catheter. It is characterized by sucking from the tip portion provided with the winding portion.

  Since the present invention is provided with a taper taper winding portion having at least one coiled piece at the distal end portion of the intravascular foreign matter suction catheter, the crushed thrombus is sucked from the distal end portion. The catheter tip is extremely flexible and has kink resistance, and can be made to approach a foreign object (such as a thrombus) even when inserted into a very thin blood vessel. Moreover, even if a suction force is applied to the catheter, the catheter is not deformed by the suction force, and foreign matter can be sucked not only from the opening of the tip but also from the gap between the coiled pieces.

  In the case of the intravascular foreign matter suction catheter system in which the foreign matter crushing catheter for crushing the intravascular foreign matter is inserted inside the intravascular foreign matter suction catheter, the inner diameter in the vicinity of the distal end portion of the foreign matter suction catheter Even if it is narrowed to such an extent that the distal end portion of the catheter for crushing foreign matter can be inserted, the foreign matter can be sucked from the gap between the windings of the coiled pieces. Therefore, it is possible to provide a system that can be used in combination with a foreign matter crushing device and has a high foreign matter suction effect.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

  FIG. 1 is a schematic view of a laser-induced liquid jet generating device to which an intravascular foreign matter suction catheter according to an embodiment of the present invention is applied. FIG. 2 is a cross-sectional view showing the main body portion of FIG. It is sectional drawing which shows the front-end | tip part of the catheter for medical use.

  The laser-induced liquid jet generating device 1 treats thrombosis in which a human blood vessel is occluded. Generally, a laser oscillator 2, a main body 3 connected to the laser oscillator 2, and an optical fiber attachment portion connected to the main body 3 are used. 4, a liquid supply unit 6 for injecting a predetermined liquid W (solid arrow) into the space 5 (see FIG. 2) of the main body 3 by a syringe pump P, a catheter hub 7 and a catheter attached to the distal end of the main body 3 A foreign substance crushing catheter 9 comprising a main body 8 and a foreign substance suction catheter 20 through which the foreign substance crushing catheter 9 is inserted are provided.

  Since the laser oscillator 2 is a known one, the description thereof is omitted. As shown in FIG. 2, the main body 3 is a kind of coupler and is made of a material having a high melting point and rigidity capable of withstanding the heat generated by the optical fiber 10, such as stainless steel and aluminum alloy. It has the elongate space part 5 extended in the shape. One end of the space portion 5 is closed by the end wall 11, and the other end has a later-described injection port 12.

  The optical fiber mounting portion 4 connected to the end wall 11 of the space portion 5 includes a tubular ferrule 13 having a narrow passage through which the optical fiber 10 is inserted, and a locking member 14 provided integrally at an intermediate position of the ferrule 13. And a female screw cap 16 for engaging the flange 15 of the locking member 14 with the engagement piece 16a. The female screw cap 16 is screwed into the male screw protrusion 2 a on the laser oscillator 2 side, and the optical fiber mounting portion 4 is fixed to the laser oscillator 2 by this screwing. The optical fiber 10 (shown by a broken line in FIG. 1) is also held in a fixed position by screwing between the female screw cap 16 and the screw projection 2a.

  The ferrule 13 is inserted into the space 5 through the end wall 11 at the front end side, and the optical fiber 10 is inserted into the ferrule 13. The front end of the optical fiber 10, that is, the laser irradiation unit 10 a is located outside the ferrule 13. From this, a laser having a wavelength that is easily absorbed by the liquid W is irradiated in a pulsed manner.

  On the inner wall 5a of the space portion 5, a light reflection layer (not shown) that reflects the laser light emitted from the laser irradiation portion 10a is formed to prevent the irradiated laser light from being absorbed by the main body 3. , Increase the efficiency of laser light utilization and increase the power of liquid jet flow.

  In the liquid supply unit 6, the tube 18 is connected to the connection unit 17, and a predetermined liquid W is injected by the syringe pump P. The installation position of the liquid supply unit 6 is preferably set to a position where the liquid W faces the laser irradiation unit 10a of the optical fiber 10 in the main body 3 so that the laser irradiation unit 10a can be reliably cooled.

  The liquid W is a solution in which a small amount of a thrombolytic agent is added to a physiological saline or the like that can be vaporized by absorbing the energy of the laser beam, if necessary. A part of the liquid W is absorbed by absorbing the energy of the laser beam. Vaporization causes bubbles (bubbles B) to be generated, and the rapid expansion of the bubbles B causes the liquid W to be jetted, that is, a so-called liquid jet stream J, which is ejected from the ejection port 12 of the main body 3.

  The foreign substance crushing catheter 9 attached to the injection port 12 is provided so that the inflow port is positioned substantially coaxially with the main body 3 so that the liquid jet flow J can easily flow in. A very thin catheter body 8 is extended from the catheter hub 7 formed. The catheter body 8 passes through the first port 19 a of the Y connector portion 19, extends into a foreign substance suction catheter 20 described later, and is provided so that the distal end portion 8 a protrudes from the distal end portion of the foreign substance suction catheter 20. Accordingly, the liquid jet flow J ejected from the ejection port 12 is propagated to the liquid W existing in the catheter body 8 and ejected from the distal end portion 8 a of the catheter body 8.

  On the other hand, in the foreign substance suction catheter 20, a catheter hub 21 is attached to the tip of the Y connector portion 19, and a thin catheter body 22 is extended from the catheter hub 21. Here, the Y connector portion 19 is a well-known one and will not be described in detail. However, the Y connector portion 19 includes a cylindrical elastic body inside and a compression member for compressing and deforming the elastic body. As described above, the foreign substance crushing catheter 9 is inserted into the internal first port 19a, and a suction syringe 23 is provided through the tube 22 in the second port 19b. In addition, this syringe 23 may be removed and a guide wire (not shown) may be inserted.

  The foreign substance crushing catheter 9 and the foreign substance suction catheter 20 are thin, flexible, and strong enough as a whole so that they can be easily inserted even if they are thin and winding blood vessels. For example, the material of these catheters 9 and 20 can be one layer of HDPE (High Density Polyethylene) or two layers of LLDPE (Linear Low Density Polyethylene). However, not only this but, for example, polyolefins such as polyvinyl chloride, polyethylene, polypropylene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, polyesters such as polyethylene terephthalate and polybutylene terephthalate, polyurethane, polyamide, polyimide Various thermoplastic resins such as polytetrafluoroethylene, polyvinylidene fluoride, and other fluororesins, thermoplastic elastomers such as thermosetting resins, polyamide elastomers, and polyester elastomers, and various rubbers can also be used.

  On the proximal end side of the first port 19a, the foreign substance crushing catheter 9 is provided in a liquid-tight manner, but on the distal end part side, the foreign substance suction catheter 20 is outside the foreign substance crushing catheter 9 and is concentric. It is provided so as to cover.

  In particular, in the foreign substance suction catheter 20 of the present embodiment, a coiled winding part 24 serving as an inlet for sucking foreign substances such as a thrombus is formed at the distal end portion of the catheter body 22.

  The winding portion 24 may be formed integrally with the catheter body 22 or may be formed separately, but in any case, it is thinner than the catheter body 22 and bends corresponding to the blood vessel. Any material that is flexible, has kink resistance, and can take in crushed thrombus inside.

  For example, as shown in FIG. 3, the winding portion 24 </ b> A of the present embodiment is formed integrally with the catheter body 22 made of the above-described material, and is formed by cutting the tip portion into a spiral. Spiral cutting is performed using a laser beam or the like, whereby a coil-shaped piece 25 having a cross-sectional plate shape is formed. In particular, the pitch width P of each coil-shaped piece 25 (general name of P1 and P2) is larger than the pitch width P1 on the base end side than on the base end side. That is, the coil-shaped pieces 25 are arranged so as to be separated from each other on the distal end side so that the end portions overlap each other on the proximal end side.

  In this way, in the winding portion 24A, even if the proximal end side is bent, a gap S is not easily generated between the coiled pieces 25 on the proximal end side, and foreign matter can be sucked from the gap S formed on the distal end side. Thus, the tip portion closer to the thrombus preferentially sucks foreign matter.

  The pitch width P may be gradually changed in size from the base end side to the tip end side. In this way, it is possible to cope with various blood vessel shapes, which is more preferable. In addition, the coil-like pieces 25 on the base end side where the pitch width P of each coil-like piece 25 is small may be brought into close contact with each other by thermal fusion after spiral cutting and overlapped with each other. The base end portion is easily deformed, and the coiled pieces 25 are kept in close contact with each other even during the deformation, so that suction force does not act on the base end portion, and the suction of foreign matter from the distal end side is further facilitated. Become.

  FIG. 4 is a sectional view showing a catheter according to another embodiment of the present invention. As shown in FIG. 4, a thin coating layer 26 made of a synthetic resin or metal may be provided on the base end side of each coiled piece 25 on the outside so as to close the gap S between the coiled pieces 25. This is because the winding part 24A can be easily bent, and even if the winding part 24A is bent and a gap S is generated between the coiled pieces 25, the foreign matter can be preferentially sucked from the tip side. The covering layer 26 is preferably not simply bonded to each coil-shaped piece 25 but merely covered. However, the covering layer 26 may be not only the inner surface of the winding portion 24A but also the outer surface or both inner and outer surfaces. In forming the covering layer 26, the catheter body 22 may be composed of an inner layer material 27 and an outer layer material 28, and a proximal coil-like piece 25 may be provided between the inner and outer layer materials 27, 28 in a sandwich shape. Good. In this way, not only molding becomes very easy, but also the base end portion can be easily deformed, and the gap S generated between the coiled pieces 25 at the time of deformation can be reliably closed.

  FIG. 5 is a cross-sectional view showing a catheter according to another embodiment of the present invention. The catheter of this embodiment is obtained by forming the winding portion 24B separately from the catheter main body 22, and the winding portion 24B is a coil-shaped thin wire rod at the distal end portion of the catheter main body 22, as shown in FIG. It is formed by attaching what was formed to.

  The material used here may be the above-described polymer material, but as the metal material, stainless steel, titanium or a superelastic alloy (for example, Ni-Ti alloy) is preferable, and in particular, if a superelastic alloy is used. Higher elasticity and more preferable. Also in the case of separate molding, the pitch width P of each coil-shaped piece 24b is the same as the above-described integrally wound portion 24A, the pitch width P1 on the proximal end side is small, and the pitch width P2 on the distal end side is large. Like that.

  When the coil-like pieces 24b on the proximal end side are bent in a state in which the wire having a circular cross section of the coil is in close contact as shown in FIG. There is a possibility that the crushed thrombus cannot be sucked preferentially from the tip side. Therefore, also in this case, a coating layer 26 (shown by a one-dot chain line) made of a material having some flexibility such as a synthetic resin or a polymer elastomer is formed on the inner surface and / or the outer surface of the proximal end portion of the winding portion 24B. It is preferable to provide it.

  Regardless of integral molding or separate molding, the surface of the catheter main body 22 and the wound portion 24 is preferably provided with a hydrophilic polymer coat having lubricity when wet in order to facilitate insertion and removal.

  When inserting the catheters 9 and 20, it is necessary to accurately position the wound portion 24 in the affected area. Therefore, the wound portion 24 does not substantially transmit radiation such as X-rays. If the material is made of a material such as gold, platinum, tungsten, tantalum, or an alloy thereof, or if these are provided or included in part, it functions as a so-called marker and The position can be confirmed, and the accuracy of treatment and the convenience of operation are improved.

  Next, the operation of this embodiment will be described.

  First, the surgeon prepares a foreign substance suction catheter 20 attached to the distal end of the Y connector portion 19 and a foreign substance crushing catheter 9 disposed coaxially within the foreign substance suction catheter 20. After so-called priming, in which both the catheters 9 and 20 are filled with the liquid W, a guide wire is inserted from the second port 19b of the Y connector portion 19, and both the catheters 9 and 20 are inserted to protrude from the distal ends. . Then, both the catheters 9 and 20 are inserted to the target position near the thrombus under X-ray fluoroscopy using the guide wire as a guide. The distal end portion 8a of the foreign substance crushing catheter 9 is slightly protruded from the winding part 24 at the distal end of the foreign substance suction catheter 20.

  When both the catheters 9 and 20 reach the target position, the guide wire is removed, the proximal end of the foreign substance crushing catheter 9 is connected to the main body 3, and the optical fiber 10 is inserted and fixed in the ferrule 13 in advance. The female screw cap 14 and the screw projection 2 a are screwed together to connect the optical fiber mounting portion 4 to the laser oscillator 2. Before connecting the catheter 9 and the main body 3, a syringe pump P is connected to the main body 3 via a tube 18 that supplies the liquid W to the connection portion 16 of the liquid supply portion 6. Liquid feeding is performed from the pump P, and the inside of the main body 3 is primed.

  The liquid is fed by the syringe pump P, and the optical fiber 10 is inserted into the main body 3 while flowing a predetermined liquid W into the foreign substance crushing catheter 9 and the main body 3. This is because when the liquid feeding is stopped, blood flows backward, and a thrombus adheres to the inside of the main body 3 and the like, and there is a possibility that the stable output of the liquid jet flow J is inhibited. When the valve body (not shown) of the Y connector portion 19 is tightened, the liquid feeding by the syringe pump P may be temporarily stopped.

  When the laser oscillator 2 is operated while the liquid is sent by the syringe pump P in this way, the pulse laser beam is irradiated to the liquid W in the main body 3 from the laser irradiation unit 10 a at the tip of the optical fiber 10. Since this irradiation is performed not in the foreign substance crushing catheter 9 but in the main body 3 made of metal, even if the main body 3 is irradiated with a high temperature and a pressing force due to the sudden generation of the bubble B, It can compete well and can irradiate powerful pulsed laser light.

  Bubbles B are intermittently generated by the irradiation of the pulsed laser light, the liquid W in the main body 3 is abruptly pressurized and discharged, a liquid jet flow J is generated, and the liquid jet flow J is rapidly ejected. The liquid jet flow J is transmitted to the liquid W inside the foreign substance crushing catheter 9 and ejected from the distal end portion 8 a of the foreign substance crushing catheter 9.

  As a result, for example, as shown in FIG. 6, the thrombus K in front of the foreign substance crushing catheter 9 is crushed by the collision of the powerful liquid jet flow J and the assistance of the thrombolytic agent, and the blood is recirculated in the blood vessel. Be started.

  When this reperfusion is confirmed, the crushed thrombus K is immediately recovered. When the syringe pump 23 is connected to the catheter main body 22 and sucked, the crushed thrombus K is sucked into the inside from the distal end opening or the gap S of the winding portion 24 at the distal end of the foreign substance suction catheter 20 together with the liquid W.

  In the present embodiment, the winding portion 24 has a pitch width P of each coil-shaped piece 25 that is larger on the distal end side than on the proximal end side. The crushed thrombus is aspirated from the more distal end portion. Even if the proximal end side of the winding part 24 is bent in a bent blood vessel, no gap S is generated between the coiled pieces 25 on the proximal end side, and the distal end of the winding part 24 The crushed thrombus K is aspirated from the side. When the covering layer 26 is provided on the outer surface and / or the inner surface of the proximal end portion of the winding portion 24, the clearance S is not generated at the proximal end portion. Will be sucked.

  As a result, after the blood flow is resumed, the crushed thrombus K is immediately collected without being flown around the affected area or unvascularized blood vessels, so that the possibility of re-occlusion due to the crushed thrombus K can be suppressed.

  The present invention is not limited to the above-described embodiments, and various modifications can be made by those skilled in the art within the technical idea of the present invention. For example, the winding part 24 at the distal end of the foreign substance suction catheter 20 described above is obtained by winding the coiled piece 25 a plurality of times, but the number of turns is not particularly limited, and if it is at least one turn or more. Also, regarding the structure, in the above-described embodiment, the single spiral structure is used, but not only this but also a multiple spiral structure may be used.

  In addition, the foreign substance crushing catheter 9 of the above embodiment is combined with a thrombus crushing device that ejects a liquid jet flow for crushing a thrombus. It can be combined with a balloon catheter, or combined with a wire (not shown) or the like for pushing a thrombus or the like and reopening a closed portion due to the thrombus or the like.

  INDUSTRIAL APPLICABILITY The present invention can be used as a therapeutic tool for crushing a thrombus present in an extremely thin cerebral blood vessel and quickly taking it out and collecting it.

1 is a schematic view of a laser-induced liquid jet generation device to which an intravascular foreign matter suction catheter according to an embodiment of the present invention is applied. It is sectional drawing which shows the main-body part of FIG. It is sectional drawing which shows the front-end | tip part of the catheter for the foreign material suction | inhalation in the blood vessel. It is sectional drawing which shows the modification of the front-end | tip part. It is sectional drawing which shows the front-end | tip part of the catheter for intravascular foreign material suction which concerns on other embodiment of this invention. It is sectional drawing which shows the use condition of the catheter for intravascular foreign material suction.

Explanation of symbols

8 ... catheter body,
8a: distal end portion of the foreign body crushing catheter,
9 ... catheter for crushing foreign matter,
20 ... Catheter for sucking intravascular foreign matter,
22 ... catheter body,
24 (24A, 24B) ... winding part,
25 ... Coiled piece,
26 ... coating layer,
27 ... Inner layer material,
28 ... outer layer material,
J ... Liquid jet flow,
K ... Thrombus (foreign matter),
P1: Pitch width on the base end side,
P2: Pitch width on the tip side,
S ... Gap,
W ... Liquid.

Claims (10)

  A catheter for sucking foreign matter in a blood vessel and taking it out to the outside is provided with a tapered tapered winding portion having at least one coiled piece at the distal end portion of the catheter body. catheter.   2. The intravascular foreign matter suction catheter according to claim 1, wherein the winding portion forms the coiled piece by cutting the catheter main body into a spiral shape. 3.   2. The intravascular foreign matter suction catheter according to claim 1, wherein the winding portion is formed by attaching a wire formed in a coil shape to the catheter body.   4. The intravascular foreign matter suction catheter according to claim 3, wherein the wound portion is formed of a superelastic alloy.   5. The intravascular foreign matter suction catheter according to claim 1, wherein the wound portion has a pitch width on a distal end side larger than a pitch width on a proximal end side.   6. The wound portion according to any one of claims 1 to 5, wherein a coiled piece on a proximal end side is sandwiched between the inner and outer layer materials of the catheter main body constituted by an inner layer material and an outer layer material. A catheter for intravascular foreign matter suction according to claim 1.   The intravascular foreign matter suction catheter according to claim 1, wherein the wound portion is formed of the coiled piece that is visible under X-ray fluoroscopy.   The inside of a blood vessel according to any one of claims 1 to 7, wherein the winding portion is provided with a coating layer so as to close a gap between the coil-shaped pieces in a proximal end portion of the winding portion. Foreign substance suction catheter.   The intravascular foreign matter suction catheter according to claim 1, wherein the catheter body has a hydrophilic coating on the surface.   A foreign substance suction catheter that sucks out foreign substances in the blood vessel and takes them out, and a foreign substance crushing catheter that sprays a liquid jet flow from the tip to crush the foreign substances, and the foreign substance crushing catheter is placed in the foreign substance suction catheter. The foreign matter crushed by the foreign matter crushing catheter is arranged to be sucked from the distal end portion of the foreign matter suction catheter provided with a taper taper winding portion having at least one coiled piece. A catheter system for suctioning foreign matter in a blood vessel.

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