TWI794378B - 具有裂管和圓筒狀耦合件之可植入式醫療裝置剝離系統 - Google Patents

具有裂管和圓筒狀耦合件之可植入式醫療裝置剝離系統 Download PDF

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TWI794378B
TWI794378B TW107146490A TW107146490A TWI794378B TW I794378 B TWI794378 B TW I794378B TW 107146490 A TW107146490 A TW 107146490A TW 107146490 A TW107146490 A TW 107146490A TW I794378 B TWI794378 B TW I794378B
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胡安 羅倫佐
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Abstract

一種用於將可植入式醫療裝置遞送到身體血管的目標位置的剝離系統，該剝離系統具有：大致中空的遠側管。該遠側管包括近端、遠端以及該管本身的可壓縮部分，該可壓縮部分在該近端與該遠端之間，且可從壓縮狀況軸向移動到伸長狀況。大致中空的近側管，該近側管具有近端和遠端。耦合件，該耦合件結合該近側管和該遠側管。接合系統，該接合系統接合並部署接合在該遠側管的該遠端處的該可植入式醫療裝置。該接合系統在接合該可植入式醫療裝置時將該可壓縮部分移動到該壓縮狀況，並且部署該可植入式醫療裝置並將該可壓縮部分釋放到該伸長狀況。

Description

具有裂管和圓筒狀耦合件之可植入式醫療裝置剝離系統
本發明通常涉及可通過人類對象的身體血管進行導航的介入醫療裝置系統。更具體而言，本發明涉及用於將可植入式醫療裝置部署到身體血管的目標位置的剝離系統及其使用方法。
使用導管遞送系統在人體的血管系統中定位和部署治療裝置(諸如，擴張球囊、支架和栓塞線圈)已經成為治療血管內疾病的標準過程。已經發現，此類裝置在無法進行傳統操作過程或傳統操作過程對患者構成很大風險的治療領域中(例如，在顱內血管中動脈瘤的治療中)尤其有用。由於圍繞顱內血管的組織非常脆弱(尤其是例如腦組織)，執行外科手術來治療顱內血管的缺陷是非常困難的並且通常是有風險的。在此類情況下，對導管部署系統的改進提供了替代治療方案。導管遞送系統優點中的一些是，通過已經發現的降低對周圍組織造成創傷風險的方法來提供用於治療血管的方法，並且還允許治療過去視為無法手術的血管。
通常，這些手術涉及將遞送導管的遠端***到患者的血管系統中，並且引導其穿過血管系統到達預定的遞送部位。血管閉塞裝置(諸如，栓塞線圈)附接到遞送構件的端部，遞送構件推動線圈穿過導管並離開導管的遠端進入到遞送部位中。與這些過程相關聯的問題中的一些涉及確保線圈的完全釋放和部署。例如，授予Palermo的美國專利No.5,250,071描述了其中系統和線圈的互鎖扣件通過控制線保持在一起的剝離系統，該專利據此以引用方式併入本文。控制線 朝近側移動以使扣件彼此脫離。然而，系統不包括用於將脫離的扣件彼此分開的任何可靠裝置，因此僅回縮控制線無法確保線圈的釋放和部署。目前使用的許多其他剝離系統也存在類似的問題。
此外，美國專利No.8,062,325公開了遞送和部署血管閉塞裝置的單個管狀載體，但其僅具有單個可壓縮區段。因此，仍然需要可確保可植入式醫療裝置的釋放和部署的更快速的釋放剝離系統或方法。利用結合簡單且廉價的鎖定和部署系統的剝離系統或方法還可實現另外的優點。
剝離系統利用大致中空的遠側管將可植入式醫療裝置遞送到身體血管的目標位置。遠側管具有近端、遠端和遠側管自身的可壓縮部分，可壓縮部分可在近端與遠端之間從壓縮狀況軸向移動到伸長狀況。分離系統還包括大致中空的近側管、耦合件和接合系統，近側管具有近端和遠端，耦合件設置在遠側管的近端與近側管的遠端之間結合近側管和遠側管，接合系統接合並部署接合在遠側管的遠端處的可植入式醫療裝置。接合系統在接合可植入式醫療裝置時將可壓縮部分移動到壓縮狀況，並且部署可植入式醫療裝置並將可壓縮部分釋放到伸長狀況。
在另一個示例中，接合系統在接合可植入式醫療裝置時可以可移除地固定到遠側管的近端，以保持壓縮狀況。另外，接合系統在接合可植入式醫療裝置時可以可移除地固定到近側管的近端。
接合系統的實例具有鎖定構件和環線。當環線與鎖定構件相互作用以接合可植入式醫療裝置時，環線上的力將可壓縮部分移動到壓縮狀況，並且環線焊接到遠側管的近端以可移除地固定接合系統。鎖定構件上的力釋放環線，使可植入式醫療裝置脫離，並且允許可壓縮部分返回到伸長狀況。
其他實例具有遠側管的可壓縮部分作為遠側管的螺旋切割部分。當可壓縮部分移動到伸長狀況時，可壓縮部分可經調適以部署由接合系統接合的可植入式醫療裝置。此外，當接合系統與可植入 式醫療裝置脫離時，遠側管的可壓縮部分經調適以自動地/彈性地移動到伸長狀況。近側管還可包括近側管本身的在近端與遠端之間為可撓性的可撓性部分，並且遠側管可包含遠側管本身的在近端與可壓縮部分之間為可撓性的可撓性部分。
另外的實例具有部分地重疊耦合件的近側管、部分地重疊耦合件的遠側管，並且形成在近側管與遠側管之間的耦合件上的間隙包括焊接帶以將耦合件焊接到近側管和遠側管。在一個示例中，耦合件是不透射線的。
使用上述實例剝離可植入式醫療裝置的方法可包括以下步驟：在近端與遠端之間的遠側管上形成可壓縮部分；使可植入式醫療裝置與接合系統接合；向接合系統施加力以壓縮可壓縮部分；將接合系統固定到遠側管以保持壓縮狀態；並且使用耦合件將遠側管和近側管結合在一起。如上所述，接合系統可以可移除地固定到遠側管的近端。
剝離方法實例還可具有以下步驟：當接合可植入式醫療裝置時，將接合系統可移除地固定到近側管的近端。接合步驟可包括使用環線與鎖定構件來接合可植入式醫療裝置的步驟；並且施加步驟進一步包含將力施加到環線以將可壓縮部分移動到壓縮狀況的步驟。其他實例步驟包括：將力施加在鎖定構件上，使可植入式醫療裝置脫離，以及允許可壓縮部分返回到伸長狀況。
成形步驟的實例可包括螺旋切割遠側管的一部分的步驟，並且進一步具有通過將可壓縮部分移動到伸長狀況來部署所接合的可植入式醫療裝置的步驟。另外，當接合系統與可植入式醫療裝置脫離時，遠側管的可壓縮部分可調適以自動地/彈性地移動到伸長狀況。
此外，結合步驟進一步具有以下步驟：將近側管在耦合件上部分地重疊，將遠側管在耦合件上部分地重疊，在近側管與遠側管之間的耦合件上形成包含焊接帶的間隙，以及在焊接帶處將耦合件焊接到近側管和遠側管。
10:剝離系統/系統/一體裝置/遞送系統
12:醫療裝置
12a:醫療裝置/裝置
18:鎖定部分
100:管/遞送管/近側伸長遞送海波管組件/近側管
100a:近側管
102:近端
104:遠端
106:可撓性部分
108:管腔/軸向管腔
110:小管
112:近側開口
140:鎖定構件/接合系統
142:焊接
200:中間耦合件/耦合件
200a:耦合件
202:近端
204:遠端
206:焊接帶
208:管腔
210:焊接
300:管/遠側管/遞送管
300a:遠側管
302:近端
304:遠端
305:可撓性部分
306:可壓縮部分/可撓性部分
308:管腔
310:錨定部分
400:環線/接合系統
400a:環線
400b:環線
402:近端
404:遠端
405:開口
405a:開口
406:線焊點/區段
408:錨定焊接
1000:步驟
1002:步驟
1004:步驟
1006:步驟
1008:步驟
1010:步驟
1012:步驟
1014:步驟
A:軸線
D:距離
E:彈力
F:力
參見以下具體實施方式並結合圖式進一步討論本發明的上述態樣和進一步態樣，在圖式中，相同的編號指示各種圖中相同的結構元件和特徵。圖式未必按比例繪製，相反，將重點放在繪示本發明的原理。圖式僅以舉例方式而非限制方式描繪本發明裝置的一或多種實施方案。
圖1A是本發明的剝離系統的實例的分解圖，其中醫療裝置被部分地脫離；圖1B是圖1A的放大圖；圖2是本發明的剝離系統的實例的分解圖，其中醫療裝置被接合；圖3A是根據一個實例的環線的實例的側透視圖；圖3B是根據另一個實例的環線的實例的平面圖；圖4是替代實例中處於上翻狀況下的環線的開口的前透視細部圖；圖5A是本發明的剝離系統的實例的分解視圖，其中醫療裝置被接合並且環線被固定；圖5B是固定到遠側管的環線的放大圖；圖6是重疊耦合件的近側管和遠側管的平面圖；圖7是焊接到耦合件的近側管和遠側管的平面圖；圖8繪示在小管處的近側焊接；圖9繪示剝離系統的實例的螢光視圖；圖10繪示形成本發明的剝離系統的實例方法；圖11A至圖11D繪示具有部分橫截面的正在被剝離的醫療裝置；圖12是處於壓縮和膨脹狀態下的遠側管的實例的側視圖；及圖13是正在被剝離的醫療裝置的實例的前側透視圖。
圖式繪示根據本發明的大致中空或管狀的結構。當在本文中使用時，術語「管狀」和「管」應當被廣義地理解為但不限於正 圓柱體或橫截面呈嚴格圓周或在其整個長度上具有均勻橫截面的結構。例如，管狀結構或系統通常被繪示為實質上呈正圓形的結構。然而，在不脫離本發明範圍的情況下，管狀系統可具有錐形或彎曲外表面。
本發明的剝離系統10的實例(如圖1A、圖1B和圖2所示)可具有近側伸長遞送海波管(hypotube)組件100、中間耦合件200和遠側遞送管300。可植入式醫療裝置12接合在遠側遞送管300的一個端部處。可植入式醫療裝置12可為栓塞線圈，但應當理解，可通過根據本發明的剝離系統10遞送和部署幾乎任何可植入式醫療裝置12。使用鎖定構件140和環線400將醫療裝置12接合到系統。醫療裝置12具有鎖定部分18以與接合系統140、400介接。
近側遞送管100可具有近端102、遠端104和在這兩者之間的可撓性部分106。近側遞送管100在其中形成軸向管腔108。近端102沿軸向管腔108與直徑較小的管110接合(參見圖5A、圖6至圖8)。遠側遞送管300可具有近端302、遠端304和在這兩者之間的可壓縮部分306。在一個實例中，可壓縮部分306可更靠近遠端304，並且可撓性部分305可在近端302與可壓縮部分306之間。遠側遞送管300在其中形成軸向管腔308。
遞送管100、300可由生物相容性材料諸如不銹鋼製成。管100、300的直徑一般可介於約0.010吋至約0.018吋之間，較佳管的直徑為大約0.0145吋。管尺寸的這些實例適於將栓塞線圈遞送和部署到神經血管系統內的目標位置(一般為動脈瘤)。由其他材料構成的不同尺寸的管100、300可用於不同的應用，並且在本發明的範圍內。
可撓性部分106、305允許遞送管100、300彎曲並撓曲。這有助於通過穿過人類血管系統的導管和曲折路徑來跟蹤系統10。可撓性部分106、306可形成有干涉螺旋切口。這些切口允許有間隙以允許彎曲，但在一個實例中，不用作螺旋切割彈簧。因此，可彎曲並撓曲，但不壓縮。
可壓縮部分306可在伸長狀況與壓縮狀況之間軸向調節。較佳地，可壓縮部分306由通過雷射切割操作形成的管300的螺旋切割部分形成。然而，允許軸向調節的任何其他佈置(例如，纏繞線或螺旋帶)也適合與根據本發明的剝離系統併使用。最較佳地，除非另有限制，否則可壓縮部分306在靜止時處於伸長狀況並且從壓縮狀況自動地或彈性地返回到伸長狀況。本文更詳細地描述可壓縮部分306的功能。
耦合件200的實例具有近端202、遠端204、在這兩者之間的焊接帶206以及在其中的軸向管腔208。耦合件200橋接遞送管100、300兩者，並且可提供不透射線的標記以有助於在臨床使用中將剝離系統10在遞送導管中對齊。中間耦合件200的實例可為標記帶或線圈段。
圖3A、圖3B和圖4繪示環線400的實例。環線400可相對較小，在一些實施方案中它具有頭髮的厚度，因此它可較佳地被遠側遞送管300的遠端304完全屏蔽以預防因意外接觸而損壞。環線400可為成環的伸長線，如圖3A中所示。環線400a還可為具有開口405a的單個伸長線，如圖3B中所示。可通過鬆散地對半彎曲環線400a來形成開口405a。在替代實例中，環線400b包含限定在遠側部分處的開口405b的扁平帶，並且開口405b可處於適合接合可植入式醫療裝置12的端部的上翻狀況。環線400、400a、400b的實例可彈性變形到上翻狀況，由此使得在未以其他方式限制的情況下其將返回到基本上扁平的狀況下。環線400、400a、400b可由多種材料(包括鎳鈦諾(nitinol)和不銹鋼)中的任一種形成。
為了加載剝離系統10，鎖定構件140軸向***到兩個管100、300和耦合件200的管腔108、208、308內。環線400的遠端404通過定位在遠側管300的近端302上的錨定部分310***到遠側遞送管300中，並且穿過管腔308到達遠端304。然後，環線的遠端404可成環，以形成開口405。開口405穿過鎖定部分18，並且鎖定構件140穿過開口405以接合醫療裝置12。參見圖1A和圖11A。
在環線的近端402拉緊環線400，並且持續的施力F壓縮可壓縮部分306。在醫療裝置12安裝在遠側管300的遠端304上之後，可通過施加到環線400的近端402的力F的量來控制壓縮量。圖2和圖11A繪示安裝的醫療裝置12和處於壓縮狀態的遠側管300。一旦遠側管300被壓縮適當的量，環線400在線焊點406處(在近端402與遠端404之間)就錨定焊接408到在遠側遞送管300的錨定部分310處或附近的近端302(即，在可壓縮部分306後面)。參見圖5A和圖5B。在用錨定焊接部408將環線400固定就位之前，通過改變在環線400上的力F的大小來調整遠側遞送管300的壓縮水平。
圖6和圖7繪示使用耦合件200對近側遞送管100和遠側遞送管300進行的結合。圖6繪示朝向耦合件200的近端202被拉動並與之重疊的近側管100的遠端104。類似地，遠側管300的近端302朝向耦合件200的遠端204被拉動並與之重疊。在此實例中，近側管100和遠側管300不接觸耦合件200，而是將焊接帶206保留為在耦合件200上的間隙。然後將兩個管100、300在焊接帶206處周向焊接210在一起，以形成一體裝置10。中間耦合件200橋接遞送管100、300兩者，並且提供不透射線的標記以在臨床使用中將系統10與遞送導管(未示出)對齊。
在兩個管100、300與耦合件200重疊和焊接之前，拉動鎖定構件140(如上文該)穿過耦合件管腔208，並且穿過近側管管腔108到達小管110。在小管110中與近側管100的近端102相對的近側開口112處，鎖定構件140焊接142到小管110。這在圖8中繪示。
圖9繪示螢光視圖中的剝離系統10。鑒於耦合件200和醫療裝置12一般由不透射線標記製成或者具有不透射線標記，它允許近側管100a和遠側管300a的視圖具有與耦合件200a或醫療裝置12a的不同對照。這提供了視覺反饋以指示設備12a何時被釋放(將在下文中進一步討論)。
圖10繪示組裝剝離系統10的方法的實例。該方法包括在遠側管300上形成可壓縮部分306(步驟1000)以及在近側管100 上形成可撓性部分106(步驟1002)。步驟1002還可包括在遠側管300上形成可撓性部分305。可壓縮部分306可通過螺旋切割遠側管300或者通過形成可壓縮然後可快速返回到其未壓縮狀態的管的任何其他方式來形成。近側管100的可撓性部分106可被干涉切割或者通過任何其他方式來增加近側管100的可撓性。一旦至少遠側管300準備好，醫療裝置12就可與接合系統140、400接合(步驟1004)，並且可將力F施加到接合系統140、400以壓縮可壓縮部分306(步驟1006)。這裡應當注意，儘管上文示出將鎖定構件140和環線400用作接合系統的實例，但所屬技術領域中具有通常知識者可利用不同的方法來固定醫療裝置12，同時仍在可壓縮部分306上施加可釋放的力，以在接合系統140、400與醫療裝置12脫離時釋放該力。然後將接合系統140、400的區段406接合到遠側管300，以保持可壓縮部分306的壓縮狀態(步驟1008)。接合系統140、400的一部分穿過耦合件200和近側管100(步驟1010)。使用耦合件200將遠側管300和近側管100結合在一起(步驟1012)。此處，在此實例中，管100、300的遠端104和近端302與耦合件200重疊，並且所有三者焊接在一起210。然後接合系統140、400的遠端104可結合到近側管100的近端102(步驟1014)以完成裝置10。
轉到圖11A至圖11D，其更詳細地繪示醫療裝置12的剝離。圖11A繪示鎖定到醫療裝置12的鎖定部分18中的接合系統140、400。可穿過鎖定部分18放置環線400的開口405。當鎖定構件140穿過開口405時，醫療裝置12現在是固定的。預先施加力F以將遠側管300置於壓縮狀態下。圖11B繪示朝近側拉動鎖定構件140以開始醫療裝置12的釋放序列。圖11C繪示鎖定構件140退出開口405並被拉離環線400的瞬間。環線400的遠端404脫離/返回其預成形形狀(如上文所討論)並退出鎖定部分18。可以看出，現在沒有任何東西將醫療裝置12保持到剝離系統10。圖11D繪示釋放序列的結束。此處，可壓縮部分306已經膨脹/返回到其原始形狀並且向前「彈出」。彈力E由遠側管300的遠端304施加到醫療裝置12以「推動」其離開，以確保醫療裝置12的徹底分離和遞送。
圖12繪示遠側管300，其被繪示為不具有醫療裝置12，但其中可壓縮部分306在軸向長度上縮短到壓縮狀況。特別地，繪示距離「D」，在將可壓縮部分306從伸長狀況移動到壓縮狀況時，遠側管300軸向縮短距離「D」。這種壓縮可沿軸線A發生。圖13繪示剝離時的醫療裝置12的另一個視圖。已朝近側拉動鎖定構件140，使得其與環線400分離，從而允許醫療裝置12隨著遠側壓縮部分306膨脹而分離，並且還將醫療裝置12與遞送系統10分離。箭頭「E」表示彈力「推動」醫療裝置12遠離遠端304，以確保其徹底分離並遞送到患者體內的目標部位。彈力E作用在管腔308的軸線A上，並且沿相同的軸線A「推動」醫療裝置12(參見圖8和圖12)。
本文所包含的描述是本發明的實施方案的實例，並且不旨在以任何方式限制本發明的範圍。如本文所述，本發明設想了用於血管閉塞裝置的本發明的遞送和釋放系統的許多變化和修改，包括多種構型、多種剛度特性及其遞送方法。此外，存在材料和釋放機構的構型的許多可能變化。這些修改將對本發明所屬技術領域中具有通常知識者顯而易見，並且旨在處於以下申請專利範圍的範疇內。
10:剝離系統/系統/一體裝置/遞送系統
18:鎖定部分
100:管/遞送管/近側伸長遞送海波管組件/近側管
102:近端
104:遠端
106:可撓性部分
108:管腔/軸向管腔
140:鎖定構件/接合系統
200:中間耦合件/耦合件
300:管/遠側管/遞送管
302:近端
304:遠端
305:可撓性部分
306:可壓縮部分/可撓性部分
308:管腔
400:環線/接合系統
402:近端
404:遠端

Claims (16)

  1. 一種用於將一可植入式醫療裝置遞送到一身體血管的一目標位置的剝離系統，該剝離系統包含：大致中空的一遠側管，其包含：一近端；一遠端；及該遠側管本身的一可壓縮部分，該可壓縮部分在該近端與該遠端之間，且可從一壓縮狀況軸向移動到一伸長狀況；大致中空的一近側管，其具有一近端和一遠端；一耦合件，其設置在該遠側管的該近端與該近側管的該遠端之間，結合該近側管與該遠側管；一接合系統，其接合並部署接合在該遠側管的該遠端處的該可植入式醫療裝置；其中該接合系統在接合該可植入式醫療裝置時將該可壓縮部分移動到該壓縮狀況，其中該接合系統部署該可植入式醫療裝置，且將該可壓縮部分釋放到該伸長狀況，其中該近側管與該耦合件部分地重疊，其中該遠側管與該耦合件部分地重疊，且其中形成在該近側管與該遠側管之間的該耦合件上的一間隙包含一焊接帶，以將該耦合件焊接到該近側管和該遠側管。
  2. 如請求項1所述的剝離系統，其中該接合系統在接合該可植入式醫療裝置時可移除地固定到該遠側管的該近端，以保持該壓縮狀況。
  3. 如請求項2所述的剝離系統，其中該接合系統在接合該可植入式醫療裝置時可移除地固定到該近側管的該近端。
  4. 如請求項2所述的剝離系統，其中該接合系統包含：一鎖定構件；及一環線，其中當該環線與該鎖定構件相互作用以接合該可植入式醫療裝置時，該環線上的一力將該可壓縮部分移動到該壓縮狀況，且 其中該環線焊接到該遠側管的該近端，以可移除地固定該接合系統。
  5. 如請求項4所述的剝離系統，其中該鎖定構件上的一力釋放該環線，使該可植入式醫療裝置脫離，且允許該可壓縮部分返回到該伸長狀況。
  6. 如請求項1所述的剝離系統，其中該遠側管的該可壓縮部分係該遠側管的一螺旋切割部分。
  7. 如請求項1所述的剝離系統，其中當該可壓縮部分移動到該伸長狀況時，該可壓縮部分經調適以部署由該接合系統接合的該可植入式醫療裝置。
  8. 如請求項1所述的剝離系統，其中當該接合系統從該可植入式醫療裝置脫離時，該遠側管的該可壓縮部分經調適以自動地或彈性地移動到該伸長狀況。
  9. 如請求項1所述的剝離系統，其中該耦合件係不透射線的。
  10. 如請求項1所述的剝離系統，其中該近側管包含該近側管本身的在該近端與該遠端之間係可撓性的一可撓性部分；且其中該遠側管包含該遠側管本身的在該近端與該可壓縮部分之間係可撓性的一可撓性部分。
  11. 一種剝離一可植入式醫療裝置的方法，該可植入式醫療裝置包含一中空遠側管、一中空近側管、和一耦合件，該中空遠側管具有一近端和一遠端，該中空近側管具有一近端和一遠端，該方法包含以下步驟：在該近端與該遠端之間的該遠側管上形成一可壓縮部分；使該可植入式醫療裝置與一接合系統接合；施加一力至該接合系統以壓縮該可壓縮部分；將該接合系統固定到該遠側管，以保持一壓縮狀況；使用該耦合件將該遠側管和該近側管結合在一起；其中使用該耦合件將該遠側管和該近側管結合在一起的步驟進一步包含以下步驟： 將該近側管在該耦合件上部分地重疊；將該遠側管在該耦合件上部分地重疊；在該近側管與該遠側管之間的該耦合件上形成包含一焊接帶的一間隙；及在該焊接帶處將該耦合件焊接到該近側管和該遠側管。
  12. 如請求項11所述的方法，其中該接合系統可移除地固定到該遠側管的該近端。
  13. 如請求項12所述的方法，其進一步包含當接合該可植入式醫療裝置時將該接合系統可移除地固定到該近側管的該近端的步驟。
  14. 如請求項12所述的方法，其中該接合系統包含一鎖定構件和一環線，其中使該可植入式醫療裝置與一接合系統接合的步驟進一步包含使用該環線與該鎖定構件來接合該可植入式醫療裝置的步驟；且其中施加一力至該接合系統以壓縮該可壓縮部分的步驟進一步包含將力施加到該環線以將該可壓縮部分移動到該壓縮狀況的步驟。
  15. 如請求項11所述的方法，其中在該近端與該遠端之間的該遠側管上形成一可壓縮部分的步驟包含螺旋切割該遠側管的一部分的步驟。
  16. 如請求項11所述的方法，其中當該接合系統從該可植入式醫療裝置脫離時，該遠側管的該可壓縮部分經調適以自動地或彈性地移動到一伸長狀況。
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