JP5584958B2 - 血管位置および血管形状の撮像装置および撮像方法 - Google Patents
血管位置および血管形状の撮像装置および撮像方法 Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
- A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
- A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
- A61B5/6852—Catheters
- A61B5/6857—Catheters with a distal pigtail shape
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
- A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
- A61B5/062—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using magnetic field
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- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
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- A—HUMAN NECESSITIES
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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
- A61F2/954—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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- A—HUMAN NECESSITIES
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- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
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- A—HUMAN NECESSITIES
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- A61B2017/00831—Material properties
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- A61B2034/2046—Tracking techniques
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
- A61B2562/04—Arrangements of multiple sensors of the same type
- A61B2562/043—Arrangements of multiple sensors of the same type in a linear array
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- A—HUMAN NECESSITIES
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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
- A61F2/02—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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- A—HUMAN NECESSITIES
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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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- 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
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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
- 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
- A61F2250/0001—Means for transferring electromagnetic energy to implants
- A61F2250/0002—Means for transferring electromagnetic energy to implants for data transfer
-
- 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
- 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
- A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
- A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
-
- 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
- A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
- A61M2025/0166—Sensors, electrodes or the like for guiding the catheter to a target zone, e.g. image guided or magnetically guided
-
- 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
- A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
- A61M25/0068—Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
- A61M25/007—Side holes, e.g. their profiles or arrangements; Provisions to keep side holes unblocked
-
- 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
- A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
- A61M25/0108—Steering means as part of the catheter or advancing means; Markers for positioning using radio-opaque or ultrasound markers
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- Surgery (AREA)
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- Heart & Thoracic Surgery (AREA)
- Animal Behavior & Ethology (AREA)
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- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Human Computer Interaction (AREA)
- Cardiology (AREA)
- Transplantation (AREA)
- Vascular Medicine (AREA)
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- Media Introduction/Drainage Providing Device (AREA)
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Description
図9Aから図9Eを参照して、使用される被トラッキング要素すなわちマーカが、感応コイル、より詳しくは電磁界(electromagnetic field、EMF) コイルであるシステム100の作動の一例を説明する。例示を目的として、この処置は、腎動脈の近傍へのAAA分枝ステント−グラフトの血管内デリバリおよび定置を含んでいる。下記の例では、この処置は、ナビゲーション経路の3次元モデルを創出すべく、ナビゲートされるべき血管構造の予処置またはスキャンまたは術中スキャンを用いて行うことができる。先ず、予処置スキャンアプローチの一例を説明し、次に、術中スキャンアプローチを説明する。
第一スキャンすなわち予処置スキャンおよび大動脈データ取得:手術の前に、トラッキングすべき血管構造の3次元モデルを創出すべく、患者は、CT、CTA、MRIまたはMRAスキャナのいずれかを用いてスキャンされる。対象とする腹部大動脈および分枝血管(例えば腎動脈)がスキャンされ、この血管構造についての3次元予処置データセットを創出しかつリアルタイムデータが重ねられるバーチャルモデルを創出すべく、対象とする血管に沿って画像が撮られる。
磁界発生器の配置:3つの磁界発生器502a、502b、502cが上記のように所定位置に固定され、これにより磁界発生器と感応コイルとの空間的関係が決定される。上記のように、他の個数の発生器コイルを使用することもできる。
磁界発生器の配置:3つの磁界発生器502a、502b、502cが、磁界発生器コイルと感応コイルとの間の空間関係が決定されるようにして、上記のように所定位置に固定される。前述のように、他の個数の発生器コイルを使用できる。
図10Aおよび図10Bを参照して、使用される被トラッキング要素すなわちマーカが感応コイル、より詳しくは電磁界(EMF)コイルである構成のシステム200を用いて、プロテーゼを定置する血管を探知する処置について説明する。例示の目的から、この処置は、腎動脈の近傍にAAA分枝ステント−グラフトの血管内デリバリおよび定置を含んでいる。
図15Aから図15Cを参照して、回路500および穿孔カテーテル1110に関連して電磁コイル形被トラッキング要素すなわちマーカが使用される構成のシステム800の例示作動を説明する。例示の目的から、処置は、腎動脈の上方でのAAA分枝ステント−グラフトの血管内デリバリおよび定置を含んでいる。
12 撮像器具
14 トラッキングシステム
16 ディスプレイ
18 コンピュータ
20 トラッカ
22aから22e 被トラッキング要素
V 主血管
BV1 分枝血管
BV2 他の分枝血管
Claims (10)
- 血管内システムであって、
遠位端部分および近位端部分を備えかつ患者の血管構造の一部を通って血管内を前進できる細長い部材を備えたカテーテルであって、少なくとも1つの電磁コイルが電磁場に曝されたとき信号処理装置に信号を送信するように前記遠位端部分に固定されているカテーテルと、
遠位端部分および近位端部分を備えかつ患者の血管構造の一部を通って血管内を前進できる第二の細長い部材と、備えた血管内システムにおいて、
前記細長い部材の少なくとも一方の遠位端部分が、記憶形状と変形形状とを有し、
前記遠位端部分が、前記変形形状から前記記憶形状に向けて動くように構成され、
前記遠位端部分は、中心部材と、該中心部材の回りに周方向に配置された複数のアームとを備え、該複数のアームは、前記中心部材に向けて付勢された前記変形形状から、前記中心部材から外側に向かって拡大された前記記憶状態にむけて動く傾向があり、
少なくとも1つの検出コイルが前記第二の細長い部材の中心部材の端部分に固定され、 前記システムは、更に、前記中心部材に取り付けられた複数のマーカを備えている、
ことを特徴とする血管内システム。 - 前記細長い部材の遠位端部分が、穴あきである、
請求項1に記載の血管内システム - 前記カテーテルが、血管造影カテーテルである、
請求項1または2に記載の血管内システム。 - 前記細長い部材が、操舵可能カテーテルである、
請求項1ないし3のいずれか1項に記載の血管内システム。 - 前記細長い部材が、マイクロカテーテルである、
請求項1ないし3のいずれか1項に記載の血管内システム。 - 前記細長い部材が、ガイドワイヤである、
請求項1ないし3のいずれか1項に記載の血管内システム。 - 前記細長い部材の少なくとも1つが、前記遠位端部分の前記コイルの近位側に形成された、約90度の予成形屈曲部を有している、
請求項1ないし5のいずれか1項に記載の血管内システム。 - 前記記憶形状が尖った形状である、
請求項1ないし3のいずれか1項に記載の血管内システム。 - プロテーゼデリバリシステムであって、
請求項1ないし8のいずれか1項に記載の血管内システムを備え、
前記カテーテルがプロテーゼデリバリカテーテルであって、
管状プロテーゼが、前記デリバリカテーテル内に配置され、
前記第2の細長い部材が、移植片材料に穿孔するように構成された穿孔端部を有する操舵可能穿孔カテーテルであり、
前記少なくとも1つの検出コイルが、前記操舵可能穿孔カテーテルの遠位端部分に取付けられている、
ことを特徴とするプロテーゼデリバリシステム。 - 前記細長い部材の遠位端部分の回りの摺動可能に配置されたシースをさらに備え、
該シースが、前記変形形状においては前記遠位端部分を拘束し、
前記遠位端部分を露出させて該遠位端部分を記憶形状に向けて動かすように、引込み可能である、
請求項9に記載のプロテーゼデリバリシステム。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11/622,935 US8473030B2 (en) | 2007-01-12 | 2007-01-12 | Vessel position and configuration imaging apparatus and methods |
US11/622,935 | 2007-01-12 |
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JP2008194475A JP2008194475A (ja) | 2008-08-28 |
JP2008194475A5 JP2008194475A5 (ja) | 2011-02-24 |
JP5584958B2 true JP5584958B2 (ja) | 2014-09-10 |
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US (1) | US8473030B2 (ja) |
EP (1) | EP1943974B1 (ja) |
JP (1) | JP5584958B2 (ja) |
ES (1) | ES2372924T3 (ja) |
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ES2372924T3 (es) | 2012-01-27 |
US8473030B2 (en) | 2013-06-25 |
JP2008194475A (ja) | 2008-08-28 |
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