JP2014500056A - グラフトまたはグラフトシステムの配置の器具および方法 - Google Patents
グラフトまたはグラフトシステムの配置の器具および方法 Download PDFInfo
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- 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
- A61F2/954—Instruments specially adapted for placement or removal of stents or stent-grafts for placing stents or stent-grafts in a bifurcation
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- 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
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2/06—Blood vessels
- A61F2/07—Stent-grafts
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- 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
- A61F2/962—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
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- 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
- A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
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- 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
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
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- A61F2002/061—Blood vessels provided with means for allowing access to secondary lumens
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- 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
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2/06—Blood vessels
- A61F2002/065—Y-shaped blood vessels
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- 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
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2/06—Blood vessels
- A61F2/07—Stent-grafts
- A61F2002/075—Stent-grafts the stent being loosely attached to the graft material, e.g. by stitching
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- 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
- A61F2002/821—Ostial stents
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- 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
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0075—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements sutured, ligatured or stitched, retained or tied with a rope, string, thread, wire or cable
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- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
- A61F2250/0008—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting a position by translation along an axis or two perpendicular axes
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Abstract
【選択図】図32
Description
この出願は、2010年11月2日に出願された(”APPARATUS AND METHOD OF PLACEMENT OF A GRAFT OR GRAFT SYSTEM”と題される)米国仮特許出願61/409,504号の優先権の利益を主張し、この米国仮特許出願は、あたかも本明細書中に十分に記載されるかのように参照することによりその全体が本願に組み入れられる。優先権の利益は、限定を伴うことなく35 U.S.C. § 119(e)下を含む適切な法的根拠の下で主張される。また、2010年4月28日に出願された(”APPARATUS AND METHOD OF PLACEMENT OF A GRAFT OR GRAFT SYSTEM”と題される)米国特許出願第12/769,506号も、あたかも本明細書中に十分に記載されるかのように参照することによりその全体が本願に組み入れられる。
関連技術の説明
主グラフトに側口を有する分岐グラフトまたは分岐グラフトシステムの配置の構造および方法が開示される。主グラフトは、側口(本明細書中では開窓とも称される)を分岐血管と位置合わせできるように大動脈などの主血管内に位置され、それにより、血液は、主グラフトの開口を通じて分岐血管内へと流れることができる。分岐血管の位置は、患者の生体構造によってまちまちであり、本明細書中に開示されるグラフトシステムは、分岐グラフト配置の効率を向上させるために外科医が本体の開窓の位置を調整してこれらの開窓と分岐血管とを位置合わせできるようにする。
Claims (28)
- カテーテル本体を備える送出カテーテルと、ルーメンが貫通されて成る主グラフト本体と該主グラフト本体の壁を側方から貫通する第1の開口とを有する管腔内プロテーゼと、前記送出カテーテル内に予め位置されて、前記カテーテル本体の少なくとも一部を通じて前記管腔内プロテーゼの主ルーメン内へと延びるとともに、前記送出カテーテルが事前配置状態にあるときに前記プロテーゼの壁の前記第1の開口を通じて延びる第1のガイドワイヤと、前記送出カテーテルの少なくとも一部を通じて延びて、第1の位置と第2の位置との間で前記第1のガイドワイヤに対して軸方向に移動できるように構成される第1の開窓位置合わせ装置とを備え、前記第1の開窓位置合わせ装置は、この第1の開窓位置合わせ装置が前記第2の位置へと押し進められるときに前記開窓位置合わせ装置の一部が前記第1の開口に隣接する前記主グラフト本体と係合するように構成される、開窓付きグラフト配置システム。
- 前記開窓位置合わせ装置の少なくとも一部は、前記第1のガイドワイヤの外面上にわたって摺動するように構成される請求項1の開窓付きグラフトシステム。
- 前記第1の開窓位置合わせ装置は、少なくとも前記第1の位置と前記第2の位置との間で前記第1のガイドワイヤに対して独立に移動できる請求項1または請求項2の開窓付きグラフトシステム。
- 前記開窓付きグラフト配置システムは、前記第1の開窓位置合わせ装置が前記第2の位置へと押し進められるときに前記第1の開窓位置合わせ装置の端部が前記第1の開口に隣接する前記主グラフト本体と係合するように構成される請求項1ないし請求項3のいずれか1項の開窓付きグラフトシステム。
- 前記第1の開窓位置合わせ装置は、前記第1の開窓位置合わせ装置が前記第2の位置へと押し進められるときに前記第1の開口と第1の対象分岐血管の口部とをほぼ位置合わせするように構成される請求項1ないし請求項4のいずれか1項の開窓付きグラフトシステム。
- 前記第1の開窓位置合わせ装置の少なくとも一部が少なくとも1つの方向で前記第1の開口よりも大きく、それにより、前記第1の開窓位置合わせ装置が前記第2の位置へと押し進められるときに前記開窓位置合わせ装置の一部が前記第1の開口に隣接する前記主グラフト本体と係合する請求項1ないし請求項5のいずれか1項の開窓付きグラフトシステム。
- 前記第1の開窓位置合わせ装置の先端部は、前記ガイドワイヤの少なくとも一部を取り囲む壁部を有する請求項1ないし請求項6のいずれか1項の開窓付きグラフトシステム。
- 前記開口を貫通して予め位置される前記第1のガイドワイヤが中空のガイドワイヤまたは中空のシースである請求項1ないし請求項7のいずれか1項の開窓付きグラフトシステム。
- 前記第1の開窓位置合わせ装置の先端部は、前記第1のガイドワイヤ上にわたって押し進められるときに曲がることができる十分な柔軟性を持つコイル状の構成要素を備える請求項1ないし請求項8のいずれか1項の開窓付きグラフトシステム。
- 前記第1の開窓位置合わせ装置の先端部の断面サイズまたは直径は、前記第1の開口の断面サイズまたは直径よりも大きい請求項1ないし請求項9のいずれか1項の開窓付きグラフトシステム。
- 前記第1の開窓位置合わせ装置は、管形状部材と、前記管形状部材の先端部の外面から突出する突出部とを備える請求項1ないし請求項10のいずれか1項の開窓付きグラフトシステム。
- 突出部材を有する前記第1の開窓位置合わせ装置の先端部の断面サイズまたは直径は、前記開口の断面サイズまたは直径よりも大きい請求項11の開窓付きグラフトシステム。
- 前記第1の開口が前記第1の対象血管の口部とほぼ位置合わせされた後に前記第1の開口内に少なくとも部分的に配置されるように構成される第1の分岐ステントを更に備える請求項1ないし請求項12のいずれか1項の開窓付きグラフトシステム。
- 第2のガイドワイヤと第2の開窓位置合わせ装置とを備える請求項1ないし請求項13のいずれか1項の開窓付きグラフトシステム。
- 前記管腔内プロテーゼの少なくとも一部を支持するように構成されるステントを更に備える請求項1ないし請求項14のいずれか1項の送出カテーテル。
- 開窓付きプロテーゼ配置カテーテルで用いる開窓押圧装置において、貫通するルーメンを画定する本体部であって、前記ルーメンが第1の直径または断面サイズを有する本体部と、前記本体部の先端またはその近傍に支持され、前記本体部の外面から離れるように突出するとともに、第2の断面サイズを規定する突出部とを備え、前記突出部の前記第2の断面サイズが前記本体部の前記第1の直径またはサイズよりも大きく、前記突出部の前記第2の断面サイズは、前記開窓押圧装置と共に使用される開窓付きグラフトに形成される開窓の断面サイズよりも大きい、開窓押圧装置。
- 請求項16の開窓押圧装置と開窓付きプロテーゼとを備える送出カテーテル。
- 前記送出カテーテル内に予め位置されるガイドシースを更に備え、それにより、前記送出カテーテルと前記開窓付きプロテーゼとが事前配置状態にあるときに、前記ガイドシースは、前記開窓付きプロテーゼのルーメンを挿通して位置されて、前記開窓付きプロテーゼの開窓を貫通して押し進められる請求項17の送出カテーテル。
- 前記本体部は、前記ガイドシースの外面上にわたって軸方向に並進するように構成される請求項18の送出カテーテル。
- 前記開窓押圧装置の少なくとも基端部は、前記送出カテーテルのハンドル部から装置のユーザへ向けて基端側に延び、それにより、ユーザは、前記開窓押圧装置の基端部を先端側に押し進めることによって前記開窓押圧装置を開窓付きプロテーゼの開窓へ向けて押し進めることができる請求項17ないし請求項19のいずれか1項の送出カテーテル。
- 前記開窓押圧装置の基端部がワイヤを備える請求項20の送出カテーテル。
- 患者の脈管構造内に開窓付き管腔内プロテーゼを配置する方法において、開窓付き管腔内プロテーゼを支持するカテーテルを患者の脈管構造を通じて対象血管部位へと押し進めるステップであって、前記プロテーゼがその壁を貫通する第1の開口を備える主グラフト本体を有するステップと、第1のガイドシースを前記第1の開口を通じて第1の分岐血管内へと押し進めるステップと、第1の開窓位置合わせ装置を押し進めて前記プロテーゼの壁を貫通する前記第1の開口に隣接する前記プロテーゼと接触させ、それにより、前記第1の開口と前記第1の分岐血管の口部とをほぼ位置合わせするステップとを備える、方法。
- 第1の分岐ステントを前記管腔内プロテーゼの壁を貫通する前記第1の開口内に少なくとも部分的に配置するステップを更に備える請求項22の管腔内プロテーゼを配置する方法。
- 前記第1の開窓位置合わせ装置を押し進めて前記プロテーゼの壁を貫通する前記第1の開口に隣接する前記プロテーゼと接触させ、それにより、前記第1の開口と前記第1の分岐血管の口部とをほぼ位置合わせする前記ステップは、前記第1のガイドシースに沿って前記第1の開窓位置合わせ装置を押し進めることを含む請求項22または請求項23の管腔内プロテーゼを配置する方法。
- 前記第1の開窓位置合わせ装置が前記第1のガイドシースを取り囲むように構成される管状本体部を備え、第1の開窓位置合わせ装置を押し進めて前記プロテーゼの壁を貫通する前記第1の開口に隣接する前記プロテーゼと接触させ、それにより、前記第1の開口と前記第1の分岐血管の口部とをほぼ位置合わせする前記ステップは、前記第1のガイドシースの外面上にわたって前記第1の開窓位置合わせ装置を押し進めることを含む請求項22ないし請求項24のいずれか1項の管腔内プロテーゼを配置する方法。
- 前記第1のガイドシースは、前記プロテーゼが事前配置状態にあるときに前記プロテーゼの壁を貫通する前記第1の開口を貫通して予め位置される請求項22ないし請求項25のいずれか1項の管腔内プロテーゼを配置する方法。
- 第2のガイドシースを前記プロテーゼに形成される第2の開口を通じて第2の分岐血管内へと押し進めるステップと、第2の開窓位置合わせ装置を押し進めて前記プロテーゼの壁を貫通する前記第2の開口に隣接する前記プロテーゼと接触させ、それにより、前記第2の開口と前記第2の分岐血管の口部とをほぼ位置合わせするステップとを更に備える請求項22ないし請求項26のいずれか1項の管腔内プロテーゼを配置する方法。
- 第2の分岐ステントを前記管腔内プロテーゼの壁を貫通する前記第2の開口内に少なくとも部分的に配置するステップを更に備える請求項27の管腔内プロテーゼを配置する方法。
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US20120109279A1 (en) | 2012-05-03 |
JP6261339B2 (ja) | 2018-01-17 |
WO2012061526A2 (en) | 2012-05-10 |
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US20240164924A1 (en) | 2024-05-23 |
WO2012061526A3 (en) | 2012-08-23 |
US20230218416A1 (en) | 2023-07-13 |
US20170128246A1 (en) | 2017-05-11 |
EP2635241A2 (en) | 2013-09-11 |
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