JP7378153B2 - ステントグラフト型補綴具、システム、およびステントグラフト型補綴具の改善された送り込みのための方法 - Google Patents
ステントグラフト型補綴具、システム、およびステントグラフト型補綴具の改善された送り込みのための方法 Download PDFInfo
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Description
・補綴具側枝3の長さは、約15mmであり得る。
・他のいくつかの限定されない例示的な方法を、図7に示す。
・予め装填されるガイド要素10の特徴
好ましくは、ガイド要素10に接合して係合するためのカテーテルの配向を操作することを促進する位置にて、側枝に固定される。接続点は、たとえば、ガイドカテーテル30が側枝3のルーメンを通って、分岐血管オリフィスまたはルーメンに向かって、有利にナビゲートされ得るように、側枝3の遠位に方向付けられるような内側面にある。
予め装填されるガイド要素10は、カテーテル30、たとえば図6に示すダブルルーメンカテーテルが分岐血管に達するためのガイドとして機能する。
予め装填されるガイド要素10は、好ましくは、補綴具から容易に係止解除されるように構成される。
・補綴具側枝3が、外科医がカテーテル30を用いて分岐血管に入れることを補助するために、たとえば約30度の角度、または45度の角度など、本体2の長手方向軸に対する所定の角度を維持するために設けられる。
・側枝の内径は、約7mmの範囲内であってもよい。
・側枝補綴具3は、分岐血管に向けられる様々な接続角度への調節を可能にする、ある水準の移動を可能にするために設けられる。
1.イントロデューサシースにより、患者の体内にデリバリシステムを挿入する。
2.外側シース9を開口し、補綴具の近位端部から、側枝補綴具方向に向けて除去する。側枝補綴具が開放され、完全に拡張されるまで、開口を維持する。
3.側枝補綴具が完全に曝露されるまで開口を停止する。
4.初期適合のために補綴具の位置を調節する。
5.ダブルルーメンカテーテル30を、予め装填されたガイド要素10の上に挿入し、側枝補綴具に、接続点11の端部に当たるまで、進行させる。
6.追加のガイドワイヤを、ダブルルーメンカテーテル30により挿入し、側枝3から突出させる。
7.任意で、補綴具の位置のさらなる調節を行う。
8.分岐血管の位置が特定および確定されると、その位置を確保するために追加のガイドワイヤを前進させる。
9.追加のガイドワイヤが分岐血管内に安全に留まると、ダブルルーメンカテーテルを除去し、追加のガイドワイヤおよびガイド要素10を、所望のオーバーラップのために、オリフィス要素610の上で使用して、接続補綴具600を送り込む。
10.接続補綴具600が分岐血管内にあり、完全に拡張されると、その前の補綴具の外側シース9の残りを除去し、全体を解放する。
11.ガイド要素10を側枝補綴具からアンロックさせ、すべてのガイドワイヤおよび送達システムを患者の体内から除去する。
Claims (15)
- 少なくとも1つの側枝(3)を有する第1主要ステントグラフト型補綴具と、略管状の壁構造体(605)の本体(601)を有する第2側枝ステントグラフト型補綴具(600)と、ガイド要素(10)と、を含む医療システムであって、
前記側枝(3)は、遠位オリフィスを遠位端部に有し、前記遠位端部は、前記遠位端部に接続可能な前記第2側枝ステントグラフト型補綴具(600)を受容するように構成され、
前記第2側枝ステントグラフト型補綴具(600)の前記略管状の壁構造体は、前記ガイド要素(10)を通過させて受容するように構成されるオリフィス要素(610)を含み、
前記ガイド要素(10)は、前記側枝の接続点にある前記側枝(3)の内部で、前記遠位オリフィスの近位側で前記遠位オリフィスから所定の距離に位置決めされる遠位端部を有し、
前記第2側枝ステントグラフト型補綴具は、前記第2側枝ステントグラフト型補綴具(600)の送り込みおよび配置のために、前記オリフィス要素(610)を越える前記ガイド要素(10)に沿って、前記側枝(3)の前記遠位オリフィスまで、ガイド要素を挿通可能な、カテーテルのデリバリルーメンを通過して、摺動可能に配置され、
前記第2側枝ステントグラフト型補綴具(600)は、前記接続点における係合のために、前記オリフィス要素(610)が前記ガイド要素(10)上となる状態で前記第2側枝ステントグラフト型補綴具(600)が移動したときに、前記接続点を越えて遠位側に延びる、
システム。 - 前記第2側枝ステントグラフト型補綴具(600)の前記壁構造体は、前記第1主要ステントグラフト型補綴具の前記遠位端部への相互接続のためのオーバーラップ領域(630)を有し、前記オリフィス要素(610)は、前記オーバーラップ領域(630)に配置される、請求項1記載のシステム。
- 前記ガイド要素(10)は、織物用糸または縫合糸である、請求項2記載のシステム。
- 前記ガイド要素が、少なくとも前記ガイド要素(10)の長さの一部に沿って延びる、放射線不透過性マーカを有している、請求項3記載のシステム。
- 前記第2側枝ステントグラフト型補綴具(600)の前記オリフィス要素(610)は、前記略管状の壁構造体内の孔であり、前記孔は、前記壁構造体の壁材料中のアイレットである、請求項2記載のシステム。
- 前記孔は、前記アイレットの近傍の前記壁構造体の壁材料中に、補強された周縁部または補強された周縁領域を有する、請求項5記載のシステム。
- 前記第2側枝ステントグラフト型補綴具(600)の前記略管状の壁構造体は、外面を有し、前記オリフィス要素(610)は、前記壁構造体の前記外面に配置される、請求項2記載のシステム。
- 前記第2側枝ステントグラフト型補綴具(600)の前記オリフィス要素(610)は、側部開口である、請求項7記載のシステム。
- 前記側部開口は、前記ガイド要素(10)を受容するための、アイレットまたは筒状要素である、請求項8記載のシステム。
- 前記第2側枝ステントグラフト型補綴具(600)の前記略管状の壁構造体は内面を有し、前記オリフィス要素(610)は、前記ガイド要素(10)を受容するための前記孔の近位側に、前記孔に向かって、前記内面に配置される管状構造体を含む、請求項6記載のシステム。
- 前記第2側枝ステントグラフト型補綴具(600)の前記オリフィス要素(610)は、送り込みの際に、前記本体の回転方向の位置付けを容易にするために、前記略管状の壁構造体の所定の回転方向の位置に配置される、請求項1~10のいずれか1項に記載のシステム。
- 前記第2側枝ステントグラフト型補綴具が、ガイド接合部(9)上で前記ガイド要素(10)に沿って、前記側枝(3)の前記遠位オリフィスまで摺動するように、前記第2側枝ステントグラフト型補綴具(600)の前記オリフィス要素(610)は、前記ガイド要素を受容するように構成されるガイド接合部(9)である、請求項1~11のいずれか1項に記載のシステム。
- 前記ガイド要素(10)は、生分解性材料で作製される、請求項1~12のいずれか1項に記載のシステム。
- 請求項1~13のいずれか1項に記載のシステムのキットであって、前記キットは、側枝(3)を有する前記第1主要ステントグラフト型補綴具と、第2側枝ステントグラフト型補綴具(600)と、少なくとも1つの前記ガイド要素(10)とを含み、前記ガイド要素は、湾曲可能であるおよび/または柔軟性を有し、前記側枝(3)の前記遠位オリフィスから所定の距離で離間して、前記側枝(3)に持続的にまたは取り外し可能に、遠位側で付着される、キット。
- 請求項14記載のキットを含むシステムであって、
前記第2側枝ステントグラフト型補綴具の前記オリフィス要素(610)が、送り込まれると、前記側枝内で近位側のオーバーラップを有して配置されるように、前記ガイド要素(10)は、送り込みの間、前記第2側枝ステントグラフト型補綴具を、前記側枝(3)の前記遠位オリフィスに向かって、前記側枝(3)までガイドするために、前記オリフィス要素(610)を通過して近位に延びている、システム。
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EP17204247.5 | 2017-11-28 | ||
PCT/EP2018/082912 WO2019106057A1 (en) | 2017-11-28 | 2018-11-28 | A stent-graft prosthesis, system and method for improved delivery of a stent-graft prosthesis |
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