JP2003506141A - フィルタフラッシュシステムおよびその使用方法 - Google Patents
フィルタフラッシュシステムおよびその使用方法Info
- Publication number
- JP2003506141A JP2003506141A JP2001514872A JP2001514872A JP2003506141A JP 2003506141 A JP2003506141 A JP 2003506141A JP 2001514872 A JP2001514872 A JP 2001514872A JP 2001514872 A JP2001514872 A JP 2001514872A JP 2003506141 A JP2003506141 A JP 2003506141A
- Authority
- JP
- Japan
- Prior art keywords
- catheter
- lumen
- filter
- guide
- angioplasty
- 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.)
- Granted
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
- A61B17/12109—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12136—Balloons
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/01—Filters implantable into blood vessels
- A61F2/0108—Both ends closed, i.e. legs gathered at both ends
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/01—Filters implantable into blood vessels
- A61F2/013—Distal protection devices, i.e. devices placed distally in combination with another endovascular procedure, e.g. angioplasty or stenting
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
- A61F2/958—Inflatable balloons for placing stents or stent-grafts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/01—Filters implantable into blood vessels
- A61F2002/018—Filters implantable into blood vessels made from tubes or sheets of material, e.g. by etching or laser-cutting
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0004—Rounded shapes, e.g. with rounded corners
- A61F2230/0006—Rounded shapes, e.g. with rounded corners circular
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0067—Three-dimensional shapes conical
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0073—Quadric-shaped
- A61F2230/008—Quadric-shaped paraboloidal
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0093—Umbrella-shaped, e.g. mushroom-shaped
-
- 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
- A61M2025/09175—Guide wires having specific characteristics at the distal tip
-
- 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
- A61M25/10—Balloon catheters
- A61M2025/1043—Balloon catheters with special features or adapted for special applications
- A61M2025/1052—Balloon catheters with special features or adapted for special applications for temporarily occluding a vessel for isolating a sector
-
- 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
- A61M25/06—Body-piercing guide needles or the like
- A61M25/0662—Guide tubes
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- Veterinary Medicine (AREA)
- Transplantation (AREA)
- Cardiology (AREA)
- Reproductive Health (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Surgical Instruments (AREA)
- Networks Using Active Elements (AREA)
- Prostheses (AREA)
- Separation Using Semi-Permeable Membranes (AREA)
Abstract
Description
。より具体的には、これらの装置および方法は、頚動脈および大動脈内、ならび
に鎖骨下静脈および上大静脈などの静脈内に一時的に配置するための血管濾過シ
ステムを提供する。このシステムはさらに、血管内装置、例えば、アテローム切
除用カテーテル、ステント留置用カテーテルまたは血管形成用カテーテルを目的
とする部位まで誘導するためのガイドワイヤと、濾過を支援する流体を押し流す
(フラッシュする)能力を有するガイドカテーテルとを備える。
化性病変の治療は、選択された患者において、外科的介入に代わる有効かつ信頼
し得る方法であることが最近になって証明された。例えば、ステントの留置を伴
うか、または伴わない方向性アテローム切除法および経皮経管的冠状動脈形成術
(PTCA)は、冠動脈閉塞を有する患者の治療に有用である。アテローム切除
法は、アテローム性硬化動脈内で、カテーテルによって送配可能な動脈内膜切除
装置を用いて、切除、粉砕、または削ぎ取ることによりプラクを物理的に除去す
る。血管形成術は、血管壁に機械的な力を加えて狭窄した血管の管腔径を拡大す
る。冠状脈管系で、血管形成術、ステント留置および/またはアテローム切除法
を用いることに加えて、これらの血管内手技は、他の血管の病変、例えば、頚動
脈狭窄症、末梢動脈閉塞性疾患(特に、大動脈、腸骨動脈および大腿動脈)、ア
テローム性動脈硬化症または線維筋性疾患によって引き起こされる腎動脈狭窄症
、上大静脈症候群、血栓溶解に耐性を有する腸骨静脈血栓症の治療にも有用であ
ることが証明された。
去であり、それによって、より細い血管の下流の閉塞や、血管が供給する器官の
虚血または梗塞が起こることは十分に認識されている。1995年に、ワックス
マン(Waksman)らは、冠動脈および伏在静脈移植片内における方向性ア
テローム切除法後に遠位塞栓形成がよく起こることを明らかにした。本願に援用
されるワックスマンらによるAmerican Heart Journal
第129巻(3):430〜5ページ(1995年)を参照されたい。この論文
において、アテローム切除法を受けた患者の28%(111人中31人)に遠位
塞栓形成が発生することが判明した。1999年1月に、ジョーダン(Jord
an)らは、ステント留置を伴う経皮的血管形成術を用いた頚動脈狭窄症の治療
が、頚動脈内膜切除術を用いた場合に見られる微小塞栓形成の8倍を超える率の
微小塞栓形成に関連することを明らかにした。本願に援用されるジョーダンらに
よるCardiovascular surgery 第7巻(1):33〜8
ページ(1999年)を参照されたい。この論文において、経頭蓋ドップラーモ
ニタリングにより検出されたように、微小塞栓は卒中の潜在的原因となることが
示された。塞栓物質は、カルシウム、血管内膜組織片、アテロームプラク、血栓
および/または空気を含む。
る。これらの装置の大多数は、肺塞栓症を防止するために静脈内に恒久的に留置
されるように形成されている。一時的な静脈フィルタ装置が、バジャジ(Baj
aj)に付与された米国特許第5,053,008号(この特許および本願に引
用される他のすべての参考文献は全文が本願に完全に記載されるように援用され
る)に開示されている。バジャジの装置は、例えば、股関節部手術、重篤な外傷
、腹部もしくは骨盤の大手術、または不動化のために、肺塞栓症にかかりやすい
患者の肺動脈幹内に一時的に配置するための心臓内カテーテルである。バジャジ
の装置は、静脈塞栓を肺に到達する前に捕捉するメッシュからなる傘を備えてい
る。この装置は、静脈濾過用に形成されており、動脈と静脈とにおける血行力学
の相違のために動脈には適さない。
であり、かつ弾性を有しており、動脈内において血流は、拡張期と収縮期の間の
大きな圧力変動に応じて脈打っている。これらの圧力変動により、動脈壁が拡張
したり収縮したりする。動脈内の血流速度は約1〜約5L/分の間において変動
する。ギンズバーグ(Gisburg)に付与された米国特許第4,873,9
78号は動脈フィルタシステムを開示しており、このシステムは、先端部にスト
レーナ装置を有するカテーテルを備えている。この装置は治療部位より下流の血
管内に挿入され、処置後、ストレーナは捕捉した塞栓の周囲に収縮されて体外に
抜去される。ギンズバーグの装置は5L/分の流速には耐えられなかった。この
装置は、小動脈専用に形成されており、したがって、身体のすべての部分に向か
う塞栓を捕捉することはできなかった。イング・ヴァルター・ヘングスト社(I
ng.Walter Hengst GmbH & Co.)に付与されたドイ
ツ特許DE3417738号も、フィルタを折り畳まれた状態から拡張状態に変
化させる折り畳み式リンケージシステムを有する別の動脈フィルタを開示してい
る。
ィルタが提案された。これらの装置の大多数は、ガイドワイヤに取り付けられた
フィルタを備えており、血管内に展開される支柱または事前成形バスケットを介
して機械的に作動される。これらのフィルタは、一般的には、メッシュの「パラ
シュート」であり、その先端部がワイヤのシャフトに、また、その基端部が半径
方向に外側に伸びるワイヤ支柱に取り付けられている。半径方向の支柱は、フィ
ルタの基端部を血管壁に向かって開く。血管内を流動する血液は、メッシュに押
し通され、それによって、塞栓物質をフィルタ内に捕捉する。これらのフィルタ
装置に関連する主な不都合は、通常、フィルタは血管の血流が破片をフィルタ中
に押し流すことに依存していることである。血管内の血流量が制限された状態に
なると、固着していない塞栓物質が正常な血液乱流を受けない可能性がある。塞
栓粒子は、正常な高流量が回復される(すなわち、フィルタが除去されるとき)
まで、フィルタの基端側の血管内に滞留し、それによってフィルタ装置の効力が
低下するであろう。
テーテルおよび血管クランプなどの一時的閉塞装置を利用する。血管内の血流を
遮断した後、塞栓破片を除去するために血管内の流体または血液を吸引する。こ
れらの閉塞装置に関連する不都合の1つは、これらの装置が、遠位器官の酸素付
加に悪影響を与え得る、遠位灌流の一時的停止または減少を必要とすることであ
る。遠位器官への灌流を維持するために、閉塞装置より遠位にシャントが配置さ
れ得る。しかし、シャントを挿入すると、血管にさらなる外傷を生成し、さらに
塞栓物質を生成する可能性がある。
的に阻止する血管内器具と共に使用され得る簡単かつ安全な血液濾過装置が必要
とされる。既存の装置はこの目的には適していない。
は他器官に対する虚血を引き起こす可能性がある。また、頚動脈内にプラクが沈
積すると、塞栓形成による虚血性卒中を起こす恐れがあるだけでなく、さらに血
管内腔の閉塞により血流量を低下させる恐れもある。腸骨動脈および大腿動脈内
に存在するプラクは、アテローム物質の遠位塞栓形成または病変血管の原位置狭
窄すなわち管腔径の狭窄による下肢の虚血を引き起こし得る。これらの血管にお
けるステント留置を伴うかまたは伴わないアテローム切除法もしくは血管形成術
は上記疾患の発生を防止するが、処置中に除去された塞栓物質を捕捉するように
装置が特別に形成されていない限り、これらの病態を生起し得る。
ための装置および方法を提供する。より具体的には、本発明は、アテローム性硬
化動脈プラクおよび/または血栓を除去して狭窄血管の内径を拡大するための血
管内カテーテルの挿入に適するフィルタフラッシュシステムを提供する。また、
このフィルタシステムは、血流を遮断している間に遠位の灌流を維持し、かつ低
流量状態の間にフィルタ中に塞栓破片を押し込み、それによって濾過性能を向上
するための手段をも提供する。
部に装着された、例えば、パラシュート、バスケットまたは巻物状の拡張可能な
フィルタ、基端部および先端のポートと連通する管腔を有する大直径カテーテル
(ガイドカテーテル、血管形成用カテーテル、イントロデューサシース、血管拡
張器などの)とを備える。カテーテルの先端部は、動脈または静脈内への挿入に
適している。カテーテルの基端部は止血弁を備え得る。ガイドカテーテルの先端
部の周囲には、エラストマーバルーンであり得る膨張可能な遮断装置が配置され
ており、この装置は、血管内の血流を遮断するための膨張管腔と連通している。
カテーテルの管腔は、先端のポートを通過するガイドワイヤを受容するのに適し
ている。ガイドワイヤの基端部は、一般的には、カテーテルとは独立にガイドワ
イヤを操作するためにカテーテルの基端部の外から操作可能である。また、カテ
ーテルの管腔は、血管内装置、例えば、血管形成用カテーテル、ステント留置用
カテーテル、またはアテローム切除用カテーテルを受容するのに適している。
する管腔とを備えている。アテローム切除用カテーテルの先端部分には、切除用
部材、例えば、切削ブレード、研磨部材、ワイヤカッター、ジョー、鉤爪、ペン
チ、係蹄などが備えられる。血管形成用カテーテルの先端部分には膨脹可能なバ
ルーンが備えられている。ステント留置用カテーテルの先端部分には、拡張可能
なステントが装着されている。アテローム切除用カテーテルは、血管内造影手段
、例えば、超音波トランスデューサをさらに任意に備え得る。いくつかの実施態
様において、血管形成用カテーテルは、先端部分のバルーンの周囲に配置された
ステントを備える。血管内造影装置およびステントは、当業界において十分に説
明されているので、本願ではこれ以上は説明しない。
の上に配置されたメッシュからなる。いくつかの実施態様において、フレームは
、第1端においてガイドワイヤに固着され、かつ複数の支柱を備え、該支柱は第
2端において半径方向外側に拡張する。フレームは、血管壁との接触を良好にす
るための膨張シールを備え得る。拡張手段及び関連するフィルタメッシュの構成
および使用法は、バーバット(Barbut)らにより1995年11月7日に
出願された米国出願第08/533,137号、バーバットらにより1995年
12月28日に出願された米国出願第08/580,223号、バーバットらに
より1996年1月9日に出願された米国出願第08/584,795号、バー
バットらにより1996年4月30日に出願された米国出願第08/640,0
15号、バーバットらにより1996年5月14日に出願された米国出願第08
/645,762号およびバーバットらに付与された米国特許第5,662,6
71号を含む先願に詳細に述べられている(これらの先願の内容は本願に援用さ
れる)。
注入ポートを備えている。このポートは、カテーテルの注入管腔と連通しており
、流体または医薬剤の注入用に適している。注入ポートを用いると、全身経路に
よる投与に比べて、局所効果を得るのに必要な医薬剤の投与量を減じることが可
能である。t−PAの全身投与に関連する副作用、例えば出血も最小限に抑え得
る。いくつかの実施態様において、血管形成用カテーテルは、血管形成用バルー
ンの基端側に注入ポートを、先端側に灌流ポートを備え得る。注入ポートおよび
灌流ポートはそれぞれ血管形成用カテーテル内に備えられた注入管腔および灌流
管腔と連通している。注入ポートは、流体、血液、空気または血管の破片を吸引
するのに適している。
、中大脳動脈、脳底動脈、鎖骨下動脈、上腕動脈、腋窩動脈、腸骨動脈、腎動脈
、大腿動脈、膝窩動脈、腹腔動脈、上腸間膜動脈、下腸間膜動脈、前脛骨動脈、
後脛骨動脈、および酸素付加血液を運ぶ他のすべての動脈からプラクおよび/ま
たは血栓を除去する血管内処置中において塞栓形成から患者を保護することから
なる。本発明の方法はさらに、上大静脈、下大静脈、外頚静脈、内頚静脈、腕頭
静脈、肺動脈、鎖骨下静脈、上腕静脈、腋窩静脈、腸骨静脈、腎静脈、大腿静脈
、大腿深静脈、大伏在静脈、門脈、脾静脈、肝静脈および奇静脈を含む静脈循環
における塞栓および/または異物を除去する血管内処置中に遠位塞栓形成を阻止
することも備える。
を有するガイドワイヤの先端部を動脈または静脈内に挿入する。フィルタおよび
ガイドワイヤの先端部分を血管内の目的とする部位を越えた位置に配置し、次い
で、フィルタを拡張させる。ガイドワイヤを伝ってガイドカテーテルを挿入し、
目的とする部位の近位に閉塞バルーンを配置する。ガイドカテーテルの管腔内に
保持されているガイドワイヤを伝ってアテローム切除用カテーテル、ステント留
置用カテーテル、または血管形成用カテーテルの先端部分を挿入し、目的とする
部位まで進める。次いで、血管内カテーテルが血管内腔の塞栓病変部を除去また
は治療している間、血管内の血流を遮断するために閉塞バルーンを膨張させる。
次いで、カテーテルを抜去するかまたは所定の位置に残してもよく、塞栓破片を
拡張されたフィルタ中に押し流す(フラッシュする)ために、ガイドカテーテル
の管腔を介して流体または血液を注入する。いくつかの実施態様においては、ア
テロームを血管壁からフィルタ中に破砕するために、流体をジェット流としてア
テロームに指向する。血管内カテーテルの挿入工程と、塞栓破片を押し流すため
の流体注入工程とは、適切な内径が得られるまで繰り返され得る。次いで、フィ
ルタを収縮し、ガイドワイヤを後退させることにより、捕捉した塞栓の破片と共
にフィルタを血管から抜去する。ガイドカテーテルは、閉塞バルーンを収縮させ
てから抜去する。
れぞれ遠位および近位に配置した後で、狭窄血管の内腔を拡大するために、血管
形成用カテーテルによって保持された血管形成用バルーンを膨張させる。閉塞バ
ルーンと血管形成用バルーンの間に存在する血液、流体、空気および/または塞
栓破片は吸引され得る。これに代わって、血管形成用バルーンを膨張させている
間に閉塞バルーンを収縮して、血管形成用バルーンより基端側のポートから血液
を吸引して血管形成バルーンより先端側の灌流ポートへ流出させ、これにより血
管形成術中の遠位器官への灌流を維持してもよい。
置および方法を用いることにはいくつかの利点があることが理解されよう。例え
ば、本発明のフィルタフラッシュシステムは、(1)塞栓破片を捕捉するために
任意の血管内の血液を一時的に濾過するのに特に適しており、それによって、遠
位の塞栓形成に関連する神経、認識および心臓の合併症を最小限に抑え、(2)
長時間にわたって高い動脈血流量に耐えることが可能であり、(3)可動性塞栓
を捕捉しながら血管内の適切な血流を許容するのに十分に多孔質性であるメッシ
ュを備えており、(4)造影装置を有するかまたは有していない血管内カテーテ
ルを収容するのに適しており、(5)ガイドカテーテルを介して押し流す(フラ
ッシュする)ことにより血管内の可動性プラクを除去し得、(6)血管内処置中
の遠位器官への灌流を維持する手段を備えており、(7)医薬剤、例えば、組織
プラスミノーゲンアクチベータまたはニトログリセリンを目的とする部位に局所
的に投与する手段を備えており、それによって、全身投与に関連する副作用を最
小限に抑え、かつ(8)成人患者にも小児患者にも使用され得る。
ィルタシステムが図1Aおよび図1Bに示されているように提供される。このフ
ィルタシステムは、基端部、先端部11および先端部に装着された拡張可能なフ
ィルタ20を有するガイドワイヤ10を備える。フィルタは、傘フレーム22お
よび傘フレームのアーム26に音波溶接または接着接合されたメッシュ25から
なる。メッシュ25上の血栓形成を減少させるために、メッシュにヘパリンおよ
びヘパリノイドなどの抗血液凝固剤を塗布してもよい。フィルタは、血管内への
挿入を容易にするために図1Aに示されているように折り畳まれ、その後で、図
1Bに示されているように拡張され得る。本発明に用いるための種々の適当なフ
ィルタガイドワイヤが、全文が本願に援用されるツギタ(Tsugita)らに
付与された米国特許第5,910,154号に記載されている。
る管腔33を有するガイドカテーテル30と、先端部の周囲に配置された閉塞バ
ルーン40とを備える。バルーン40は、膨張管腔41と連通しており、膨張管
腔41はバルーンを膨張させるための流体または空気を受容するのに適している
。ガイドカテーテルの管腔33は、先端ポート35と連通しており、ガイドワイ
ヤ10や、他の血管内装置、例えば、アテローム切除用カテーテル、血管内造影
装置、ステント留置用カテーテル、血管形成用カテーテル、血圧モニター、電気
生理学カテーテルおよび吸引器などを受容するのに適している。
タ20(収縮状態)とガイドワイヤの先端部11を経皮的に末梢の動脈または静
脈を介して血流方向に挿入する(しかし、ガイドワイヤ10を血流と反対の方向
に挿入し得ることも考えられる)。図2Aに示されるように、フィルタ20をア
テロームプラク100の遠位に進め、拡張させて血管壁101に接触させる。次
いで、ガイドワイヤ10を伝ってガイドカテーテル30を挿入し、その先端ポー
ト35がプラク100の近位に配置されるまで進める。ガイドワイヤ10を伝っ
て先端部分に装着されたアテローム切除用装置42を有するアテローム切除用カ
テーテル40をカテーテルの管腔33内に挿入する。アテローム切除用装置42
をカテーテルのポート35より遠位のプラク100に隣接する位置まで進める。
アテローム切除用装置42がプラク100を除去している間、図2Bに示されて
いるように、閉塞バルーン40を膨張させて血管内の血流を遮断する。
収縮させて、目的とする部位の血流を回復させ、処置中に生成された塞栓物質を
フィルタ20に向けて押し流し、遠位器官を灌流する。アテローム切除を繰り返
すか、または他の血管内処置、例えば吸引のために、閉塞バルーン40を再膨脹
させて血流を遮断することができる。処置完了後、図2Cに示されているように
、アテローム切除用カテーテルをガイドカテーテル30から抜去する。低流量状
態の結果として除去しきれなかった塞栓物質を押し流すためにガイドカテーテル
の管腔33を介して流体または血液をフィルタ20に向けて注入する。これは、
バルーン40を配置して行ってもよいし配置しないで行ってもよい。アテローム
切除後に残留する、緩慢に拘束されているアテロームを吹き飛ばすために流体を
血管壁に向けて押し流してもよい。場合によって、フィルタが過剰な物質で目詰
まり状態になることがある。このような場合には、ガイドカテーテルを介して別
個の吸引カテーテルをフィルタより遠位に延ばして配置し、それによって、メッ
シュに捕捉されている塞栓物質を吸引するように操作するのが望ましいであろう
。ガイドカテーテル30を血管から抜去する。捕捉した閉塞破片を有するフィル
タ20を折り畳み、ガイドワイヤ10を後退させて血管から抜去する。あるいは
、ガイドワイヤをガイドカテーテル30内に後退させて、その後、双方の装置を
同時に抜去してもよい。別の実施態様において、ガイドワイヤは別個の捕捉シー
スを有してもよく、捕捉シースは、ガイドワイヤを配置または抜去する前にシー
ス内に引き込むことによりガイドワイヤの配置および抜去を補助する。
れるように意図されている場合、この装置に必要なメッシュの面積は、バーバッ
トらにより1995年11月7日に出願された米国出願第08/553,137
号、バーバットらにより1995年12月28日に出願された米国出願第08/
580,223号、バーバットらにより1996年1月9日に出願された米国出
願第08/584,795号、バーバットらにより1996年4月30日に出願
された米国出願第08/640,015号、バーバットらにより1996年5月
14日に出願された米国出願第08/645,762号を含めた初期出願に記載
のように、ベルヌーイ方程式から計算される。上記米国出願はすべて本願に援用
される。
いては、以下の範囲内の寸法を有するメッシュが望ましい。メッシュ面積は、約
0.026〜約32.258cm2(0.004〜5in2)、より好ましくは約
0.0452〜約25.806cm2(0.007〜4in2)、より好ましくは
約0.0452〜約19.355cm2(0.010〜3in2)、より好ましく
は約0.0968〜約12.903cm2(0.015〜2in2)、より好まし
くは約0.129〜約6.452cm2(0.020〜1in2)、より好ましく
は約0.161〜約0.490cm2(0.025〜0.076in2)である。
メッシュの厚さは、60〜280μm、より好ましくは70〜270μm、より
好ましくは80〜260μm、より好ましくは90〜250μm、より好ましく
は100〜250μm、より好ましくは120〜230μm、より好ましくは1
40〜210μmである。糸の直径は、30〜145μm、より好ましくは40
〜135μm、より好ましくは50〜125μm、より好ましくは60〜115
μm、より好ましくは70〜105μmである。ポアサイズは、500μm以下
、より好ましくは400μm以下、より好ましくは300μm以下、より好まし
くは200μm以下、より好ましくは100μm以下、より好ましくは50μm
以下であり、通常、少なくとも赤血球よりも大きい。本発明の好ましい一実施態
様において、メッシュの面積は約12.903〜約51.613cm2(2〜8
in2)、メッシュの厚さは60〜200μm、糸の直径は30〜100μm、
ポアサイズは50〜300μmである。本発明のさらに好ましい実施態様におい
て、メッシュの面積は約19.355〜約32.258cm2(3〜5in2)、
メッシュの厚さは60〜150μm、糸の直径は50〜80μm、ポアサイズは
100〜250μmである。
た薄膜からなる。代表的な寸法は、孔径20〜500μm、厚さ約0.0012
7〜約0.00762cm(0.0005〜0.003インチ)であり、面積は
上記のメッシュの場合とほぼ同一である。
ちから適当なメッシュが見つけられ得る。例えば、サーティ社(Saati C
orporation)およびテトコ社(Tetko Inc.)製のメッシュ
などのポリエステルメッシュが用いられ得る。これらはシート形態で入手可能で
あり、簡単に切断されて所望の形状に成形され得る。1つの好ましい実施態様に
おいては、メッシュは円錐形に音波溶接される。所望の物理的特性を有する当業
において公知の他のメッシュも適当である。メッシュ上での凝血の可能性を減少
させるために、ヘパリンおよびヘパリノイドなどの抗血液凝固剤をメッシュに塗
布してもよい。ヘパリノイド以外の抗血液凝固剤、例えば、ReoPro(セン
トコール社(Centocor))などのモノクローナル抗体が用いられてもよ
い。抗血液凝固剤は、メッシュ上に塗布または噴霧され得る。抗血液凝固剤を含
む化学ディップが用いられてもよい。メッシュに化学物質を塗布するために、当
業において公知の他の方法が用いられてもよい。
ラッシュシステムにおける別の実施態様を示している。フィルタ20のメッシュ
25は、第1の端において膨張シール27に、また第2の端において端板28に
作動連結されている。膨張シールは、収縮状態と膨脹状態との間において伸縮可
能である。使用時には、収縮状態の膨張シール27とメッシュ25を、末梢血管
を介して目的とする部位に、一般的には図3Aに示されているようにアテローム
プラク100より遠位に挿入し得る。膨張シールは、流体またはガスの注入によ
り膨張させられて、血管内壁101と接触する。ガイドワイヤ10を伝ってガイ
ドカテーテル30を挿入し、先端ポート35をプラク100の近位に配置する。
栓症の治療において成功を収めている。American Heart Jou
rnal 125(第2巻1)、362〜6ページ(1993年)を参照された
い。図3Bにおいては、先端部分に装着された血管形成用バルーン52を有する
血管形成用カテーテル50を、ガイドワイヤ10を伝い、ガイドカテーテルの管
腔33を介して挿入する。収縮状態において、血管形成用バルーンを、ポート3
5を介してプラク100に隣接する位置まで進める。バルーン52を膨張させて
アテロームプラクを圧縮し、それによって血管内の狭窄部を広げる。
52より基端側の注入ポート54とバルーンより先端側の灌流ポート55とを備
える。注入ポート54は、医薬剤、例えば、t−PAまたはニトログリセリンの
投与や、空気、血栓、プラクおよび/または組織破片の吸引に用いられ得る。バ
ルーン40は、血管形成術中に膨縮され得る。血管形成術中に遠位器官に灌流を
提供し、かつ塞栓物質をフィルタ中に押し流し易くするために、ポート55を介
して酸素付与された媒体または血液を注入してもよい。
ーンと密着して係合する。ステントは、一般的には、バルーン上に緊縮され、目
的とする部位でステントの内側から半径方向外側に拡張する力の付加により半径
方向に制御して拡張され得る。ステントを備えたカテーテルシステムの構成は、
本願に援用されるヤング(Jang)らに付与された米国特許第5,749,8
48号に詳細に記載されている。
テルをガイドカテーテルの管腔33を介して血管から抜去する。血流を回復させ
るために閉塞バルーン40を収縮する。バルーン40の収縮前または収縮後に、
塞栓物質をフィルタ20に押し流すために管腔33およびポート35を介して流
体または血液を注入し得る。塞栓物質がフィルタに捕捉、保持された後、ガイド
カテーテル30を血管から抜去する。次いで、膨張シール27を収縮させてフィ
ルタを縮小し、捕捉した塞栓物質と共にフィルタを血管から後退させて、患者の
体外に抜去する。
に示されている。フィルタ20は、事前に成形されたバスケットの形態であり、
膨張シール27に作動連結されているメッシュ25を有する。膨張シールは、流
体を注入することにより膨縮され得る。使用時には、収縮状態において膨張シー
ル27およびメッシュ25を、図4Aに示されているように、末梢血管を介して
アテロームプラク100より遠位に挿入する。血管内壁101に接触させるため
に膨張シールを膨張させる。ガイドワイヤ10を伝ってガイドカテーテル30を
挿入し、その先端ポート35をプラク100の近位に配置する。
術では扱いにくい大動脈狭窄症および腸骨動脈狭窄症の治療に有効であった。オ
ナル(Onal)らによるCardiovascular Intervent
ional Radiology 第21巻(5):386〜92ページ(19
98年)を参照されたい。拡張可能な金属製ステントを用いた静脈系へのカテー
テル介入は、主として悪性腫瘍に関連しかつバルーン血管形成術および外科手術
を含めた他のいずれの療法でも効果がない上大静脈症候群の治療において成功を
収めている。ナカニシ(Nakanishi)ら,Rinsho Kyoby
Geka 第14巻(2):110〜4ページ(1994年)参照。図4Bに示
されているように、先端部分に自己拡張性ステント60を備えた血管内カテーテ
ル65を、ガイドワイヤ10を伝い、ガイドカテーテルの管腔33を介して挿入
する。ステントは、ニチノールなどの形状記憶金属からなり得る。カテーテル6
5は、自己拡張性ステントを保持するための手段を備える。保持手段は、カテー
テルの先端部分の周囲に配置されたシースの形態をとってもよく、保持手段は、
シースと作動連結され、シース内に収容され、シースを後退させるとステントが
解放されて自動的に拡張径に拡張される。図4Bおよび図4Cには、自己拡張性
かつ熱作動性のステント60によって減じられたプラク100が示されている。
自己拡張性ステントの構成および配置は、本願に援用されるモーゲンテイラー(
Morgentaler)に付与された米国特許第5,224,953号に開示
されている。
ーテル30の管腔33を流体媒体の注入に利用可能な状態にしたまま、血管内カ
テーテル65を抜去する。固化した基部と通常の拍動性血流によって押し流され
得る基部に付着した柔らかい突出物とからなる血管沈着物に関係する可動性プラ
クが、ステント60のメッシュを介して突き出しているのが分るであろう。ステ
ント60を介して流体を押し流すことにより、可動性プラクは移動されてフィル
タ20に捕捉され得る。塞栓物質をフィルタ内に捕捉、保持した後、ガイドカテ
ーテル30を血管から抜去する。ガイドカテーテルの抜去前または抜去後に、膨
張シール27を収縮させて、フィルタ20を縮小し、捕捉した塞栓物質と共に血
管から後退させて、患者の体外に抜去する。
を示しており、注入ポート70は、閉塞バルーン40より基端側に位置しており
、ガイドカテーテル30の管腔33と連通している。ポート70は、血管内処置
中に遠位器官への灌流を供給するために、流体の吸込みを許容し血液を閉塞バル
ーンの基端側から流れさせてカテーテルの先端ポート35から流出させる。いく
つかの実施態様において、ガイドカテーテルは、閉塞バルーンより基端側の複数
の注入ポートを備え、場合によっては、血流の逆流をなくすために注入ポート上
に一方向弁を備え得る。いくつかの実施態様において、ガイドカテーテルは、閉
塞バルーンより先端側に血管内処置中に生成した血管の破片を吸引するための1
つ以上の吸引ポートを備え得る。
、好ましくはおよそ50〜150cmである。カテーテル管腔の内径は、一般的
には1.0〜7mm、好ましくはおよそ1.5〜2.6mmである。拡張された
閉塞バルーンの直径は、一般的には1.5〜50.0mm、好ましくはおよそ3
.0〜8.0mmである。上記範囲は、単に代表的な装置寸法を説明する目的で
記載したに過ぎない。本発明の原理にしたがって構成された装置の実際の寸法は
、本発明の基本原理から逸脱することなく、列挙した範囲を超えて変動し得るこ
とは明らかである。
細に説明したが、添付クレームの範囲内に包含されるいくつかの変更および改良
が行われ得ることは自明であろう。例えば、任意の図面はいずれも特定の組合せ
しか示していないが、本願または先行出願に開示されている任意のタイプの拡張
フレームはいかなる治療用カテーテル介入にも用いられ得ることが理解されよう
。さらに、本願に開示されているいずれの実施態様にも、バルーン以外の閉塞装
置を用いることが可能である。
のフィルタの実施態様を示す図。
ヤおよび拡張状態のフィルタを示す図。
切除用カテーテルを示す図。
を示す図。
カテーテルを示す図。
す図。
置用カテーテルを示す図。
ル実施態様を示す図。
Claims (31)
- 【請求項1】 基端部および先端部を有するガイドワイヤと、 ガイドワイヤの先端部に装着された拡張可能なフィルタと、 基端部、先端部およびそれらの間の管腔を有するガイドカテーテルと、前記管
腔がガイドカテーテルの先端ポートを通過するガイドワイヤを受容するのに適し
ていることと、 ガイドカテーテルの先端部の周囲に配置された閉塞バルーンとからなる血管濾
過システム。 - 【請求項2】 基端部と、先端部と、ガイドワイヤを受容する管腔とを有する
血管形成用カテーテルをさらに備え、ガイドカテーテルの管腔が血管形成用カテ
ーテルを受容するのに適している請求項1に記載のシステム。 - 【請求項3】 拡張可能なフィルタが、拡張フレームとフレームの上に配置さ
れたメッシュとからなる請求項1に記載のシステム。 - 【請求項4】 メッシュが織成されている請求項3に記載のシステム。
- 【請求項5】 メッシュが流体を流出させる孔を有する薄膜からなる請求項3
に記載のシステム。 - 【請求項6】 フレームが、第1端においてガイドワイヤに固着され、第2端
において半径方向外側に拡張する複数の支柱からなる請求項3に記載のシステム
。 - 【請求項7】 フレームが膨張シールを備える請求項3に記載のシステム。
- 【請求項8】 ガイドカテーテルが閉塞バルーンより先端側に吸引ポートを備
え、吸引ポートが吸引管腔と連通している請求項1に記載のシステム。 - 【請求項9】 血管形成用カテーテルの周囲に配置されたステントをさらに備
える請求項2に記載のシステム。 - 【請求項10】 閉塞バルーンが膨張管腔と連通している請求項1に記載のシ
ステム。 - 【請求項11】 基端部と、先端部と、ガイドワイヤを受容する管腔とを有す
るアテローム切除用カテーテルをさらに備え、ガイドカテーテルの管腔が血管形
成用カテーテルを受容するのに適している請求項1に記載のシステム。 - 【請求項12】 ガイドカテーテルが閉塞バルーンより基端側に注入ポートを
備える請求項1に記載のシステム。 - 【請求項13】 注入ポートがガイドカテーテルの管腔と連通している請求項
12に記載のシステム。 - 【請求項14】 血管形成用カテーテルが血管形成用バルーンより基端側に注
入ポートを備える請求項2に記載のシステム。 - 【請求項15】 注入ポートが血管形成用バルーンより先端側にある灌流ポー
トと連通している請求項14に記載のシステム。 - 【請求項16】 先端部に拡張可能なフィルタを有するガイドワイヤを備える
工程と、 先端部の閉塞バルーンと先端部にあるポートまで延びる管腔を有するガイドカ
テーテルとを備える工程と、 血管内にガイドワイヤを挿入する工程と、 目的とする部位を越えて拡張可能なフィルタを進める工程と、 フィルタを拡張させる工程と、 ガイドワイヤを伝ってガイドカテーテルを挿入し、閉塞バルーンを目的とする
部位より近位に配置する工程と、 血管を閉塞するために閉塞バルーンを膨張させる工程と、 アテローム物質を拡張可能なフィルタ中に押し流すために、ガイドカテーテル
の管腔を介して流体を注入する工程とからなる塞栓破片をフィルタ中に押し流す
ための方法。 - 【請求項17】 フィルタを拡張させる工程の前に、ガイドワイヤを伝ってガ
イドカテーテルを挿入する請求項16に記載の方法。 - 【請求項18】 目的とする部位を越えて拡張可能なフィルタを進める工程の
前に、ガイドワイヤを伝ってガイドカテーテルを挿入する請求項16に記載の方
法。 - 【請求項19】 血管が冠動脈である請求項16に記載の方法。
- 【請求項20】 血管が頚動脈である請求項16に記載の方法。
- 【請求項21】 血管が内頚動脈である請求項16に記載の方法。
- 【請求項22】 血管が鎖骨下静脈である請求項16に記載の方法。
- 【請求項23】 血管が腸骨静脈である請求項16に記載の方法。
- 【請求項24】 ガイドワイヤを伝ってガイドカテーテルの管腔内に血管形成
用カテーテルを挿入し、血管形成用カテーテルを目的とする部位まで進める工程
と、 目的とする部位内の狭窄を拡張するために血管形成用バルーンを膨張させる工
程とをさらに備える請求項16に記載の方法。 - 【請求項25】 血管形成用カテーテルがステントを備え、血管形成用バルー
ンを膨張させる工程により、ステントを狭窄部に対して半径方向に拡張させる請
求項24に記載の方法。 - 【請求項26】 ガイドワイヤを伝ってガイドカテーテルの管腔内にアテロー
ム切除用カテーテルを挿入し、アテローム切除用カテーテルを目的とする部位ま
で進める工程をさらに含む請求項16に記載の方法。 - 【請求項27】 ガイドカテーテルが閉塞バルーンより基端側に注入ポートを
備える請求項16に記載の方法。 - 【請求項28】 遠位の器官を灌流するために、注入ポートを介して流体媒体
または血液を注入する工程をさらに備える請求項27に記載の方法。 - 【請求項29】 ガイドワイヤを伝ってステント留置用カテーテルをガイドカ
テーテルの管腔内に挿入し、ステント留置用カテーテルを目的とする部位まで進
める工程と、前記ステント留置用カテーテルはシース内に自己拡張性ステントを
備えることと、 シースを引っ込めて目的とする部位内において自己拡張性ステントを解放する
工程とをさらに備える請求項16に記載の方法。 - 【請求項30】 閉塞バルーンより先端側において流体を吸引する工程をさら
に備える請求項16に記載の方法。 - 【請求項31】 流体が酸素付加された血液である請求項16に記載の方法。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/369,052 | 1999-08-04 | ||
US09/369,052 US6168579B1 (en) | 1999-08-04 | 1999-08-04 | Filter flush system and methods of use |
PCT/US2000/040560 WO2001010343A1 (en) | 1999-08-04 | 2000-08-03 | Filter flush system and methods of use |
Publications (3)
Publication Number | Publication Date |
---|---|
JP2003506141A true JP2003506141A (ja) | 2003-02-18 |
JP2003506141A5 JP2003506141A5 (ja) | 2007-09-20 |
JP4667690B2 JP4667690B2 (ja) | 2011-04-13 |
Family
ID=23453887
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP2001514872A Expired - Fee Related JP4667690B2 (ja) | 1999-08-04 | 2000-08-03 | 血管濾過システム |
Country Status (8)
Country | Link |
---|---|
US (3) | US6168579B1 (ja) |
EP (1) | EP1117344B1 (ja) |
JP (1) | JP4667690B2 (ja) |
AT (1) | ATE328550T1 (ja) |
CA (1) | CA2345655C (ja) |
DE (2) | DE60028528T2 (ja) |
ES (1) | ES2265357T3 (ja) |
WO (1) | WO2001010343A1 (ja) |
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JP2005323702A (ja) * | 2004-05-13 | 2005-11-24 | Asahi Intecc Co Ltd | 医療用処置具 |
JP2008522755A (ja) * | 2004-12-09 | 2008-07-03 | ザ ファウンドリー, インコーポレイテッド | 大動脈弁修復 |
JP2006304835A (ja) * | 2005-04-26 | 2006-11-09 | Nippon Zeon Co Ltd | 医療用バスケット型処置器具 |
JP2013521063A (ja) * | 2010-03-04 | 2013-06-10 | グリフオルス・セラピユーテイクス・インコーポレーテツド | 治療薬送達装置、システム及び方法 |
KR101698294B1 (ko) * | 2016-05-17 | 2017-02-01 | 주식회사 인성메디칼 | 약물 주입용 포트 |
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WO2022004850A1 (ja) * | 2020-07-03 | 2022-01-06 | 和也 正林 | 生体管腔中でのカテーテルデリバリに用いる遠位スタビライザ、治療デバイスのデリバリシステム、及び治療デバイス |
Also Published As
Publication number | Publication date |
---|---|
DE1117344T1 (de) | 2002-06-13 |
ES2265357T3 (es) | 2007-02-16 |
US8444665B2 (en) | 2013-05-21 |
EP1117344B1 (en) | 2006-06-07 |
US6168579B1 (en) | 2001-01-02 |
DE60028528T2 (de) | 2007-01-04 |
WO2001010343A1 (en) | 2001-02-15 |
CA2345655C (en) | 2008-12-09 |
DE60028528D1 (de) | 2006-07-20 |
US6620148B1 (en) | 2003-09-16 |
CA2345655A1 (en) | 2001-02-15 |
WO2001010343A9 (en) | 2002-09-26 |
US20040006370A1 (en) | 2004-01-08 |
EP1117344A1 (en) | 2001-07-25 |
JP4667690B2 (ja) | 2011-04-13 |
ATE328550T1 (de) | 2006-06-15 |
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