CN118058873B - Parallel bracket for endovascular repair - Google Patents
Parallel bracket for endovascular repair Download PDFInfo
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- CN118058873B CN118058873B CN202410479508.8A CN202410479508A CN118058873B CN 118058873 B CN118058873 B CN 118058873B CN 202410479508 A CN202410479508 A CN 202410479508A CN 118058873 B CN118058873 B CN 118058873B
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- 230000008439 repair process Effects 0.000 title claims abstract description 38
- 210000002489 tectorial membrane Anatomy 0.000 claims abstract description 52
- 210000004204 blood vessel Anatomy 0.000 claims abstract description 24
- 210000000709 aorta Anatomy 0.000 claims description 11
- 230000007704 transition Effects 0.000 claims description 10
- 239000002184 metal Substances 0.000 claims description 5
- 239000011248 coating agent Substances 0.000 claims description 4
- 238000000576 coating method Methods 0.000 claims description 4
- 230000003247 decreasing effect Effects 0.000 claims description 3
- 238000009954 braiding Methods 0.000 claims description 2
- 238000002513 implantation Methods 0.000 claims description 2
- 238000010147 laser engraving Methods 0.000 claims description 2
- 230000017531 blood circulation Effects 0.000 abstract description 18
- 238000005516 engineering process Methods 0.000 abstract description 6
- 238000001125 extrusion Methods 0.000 abstract description 6
- 230000003902 lesion Effects 0.000 abstract description 5
- 210000002376 aorta thoracic Anatomy 0.000 description 10
- 210000002254 renal artery Anatomy 0.000 description 10
- 208000007536 Thrombosis Diseases 0.000 description 7
- 210000000702 aorta abdominal Anatomy 0.000 description 6
- 238000010586 diagram Methods 0.000 description 6
- 238000000034 method Methods 0.000 description 6
- 238000012276 Endovascular treatment Methods 0.000 description 5
- 230000015572 biosynthetic process Effects 0.000 description 5
- 230000008901 benefit Effects 0.000 description 4
- 230000036285 pathological change Effects 0.000 description 4
- 231100000915 pathological change Toxicity 0.000 description 4
- 230000002792 vascular Effects 0.000 description 3
- 230000036770 blood supply Effects 0.000 description 2
- 230000001788 irregular Effects 0.000 description 2
- 230000002093 peripheral effect Effects 0.000 description 2
- 208000002251 Dissecting Aneurysm Diseases 0.000 description 1
- 206010002895 aortic dissection Diseases 0.000 description 1
- 210000002302 brachial artery Anatomy 0.000 description 1
- 238000004891 communication Methods 0.000 description 1
- 230000006835 compression Effects 0.000 description 1
- 238000007906 compression Methods 0.000 description 1
- 238000010276 construction Methods 0.000 description 1
- 210000001105 femoral artery Anatomy 0.000 description 1
- 208000014674 injury Diseases 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 230000000750 progressive effect Effects 0.000 description 1
- 238000011084 recovery Methods 0.000 description 1
- 238000006467 substitution reaction Methods 0.000 description 1
- 230000008733 trauma Effects 0.000 description 1
Classifications
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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
-
- 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
-
- 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
- A61F2/852—Two or more distinct overlapping 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
- A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/856—Single tubular stent with a side portal passage
-
- 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
- A61F2002/061—Blood vessels provided with means for allowing access to secondary lumens
-
- 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
- A61F2002/068—Modifying the blood flow model, e.g. by diffuser or deflector
-
- 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
- A61F2002/823—Stents, different from stent-grafts, adapted to cover an aneurysm
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- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Cardiology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Gastroenterology & Hepatology (AREA)
- Pulmonology (AREA)
- Prostheses (AREA)
Abstract
The invention provides a parallel stent for endovascular repair, which relates to the field of medical appliances, wherein a main body stent comprises a main body proximal tectorial membrane stent and a main body distal stent which are connected with each other; the main body proximal end tectorial membrane bracket comprises a strong support section and a weak support section in the circumferential direction, wherein the radial support force of the strong support section is larger than that of the weak support section; the radial supporting force of the proximal end section of the branched tectorial membrane bracket is greater than the radial supporting force of the weak supporting section, so that when the proximal end section of the branched tectorial membrane bracket is arranged outside the weak supporting section in parallel and the proximal end section and the weak supporting section are extruded in radial opposite directions, the weak supporting section is sunken towards the inner direction of the main body proximal end tectorial membrane bracket, and the proximal end section of the branched tectorial membrane bracket is embedded in the sunken. The invention relieves the problems that in the prior parallel stent technology, the aortic lesion part can not completely isolate blood flow and is easy to cause I-shaped internal leakage caused by mutual extrusion of the branch tectorial stent and the main body stent, and the branch tectorial stent is extruded to deform and influence the blood flow of the inlet of a branch blood vessel.
Description
Technical Field
The invention relates to the technical field of medical equipment, in particular to a parallel bracket for endovascular repair.
Background
When aortic lesions (such as aortic dissection) involve branch vessels, a stent is usually required to be implanted in the aorta and the branch vessels simultaneously to isolate the lesion part from blood flow, and the implanted vascular stent is utilized to reconstruct the vessels and branches, so that the method has the advantages of small risk, small trauma, quick recovery, simplicity in operation flow and the like, and the parallel stent, the fenestration stent and other technologies are derived according to individual differences of cases.
Among them, the parallel stent technique includes, but is not limited to, a chimney technique, a periscope technique, etc., and as shown in fig. 1, the parallel stent includes a main stent 1 and a branch stent graft 2, and when the main stent 1 is implanted into the aorta during the operation, important vessel branches need to be covered, and in order to ensure the branch blood supply, the side-by-side branch stent grafts 2 are implanted. The advantage of the parallel stent technique is that the integrity of the main stent 1 is not destroyed during operation, the accurate branch opening positioning is not involved, and the technical operation is relatively simple. The parallel stent does not need individual customization, is suitable for patients needing urgent renal artery vascular reconstruction and aortic arch repair, has lower operation cost than the operation of a fenestrated stent or a branched covered stent, but has other problems:
Although the parallel stent technology can completely isolate the position of the pathological change of the branch blood vessel from blood flow, the branch tectorial membrane stent 2 and the main body stent 1 are mutually extruded to form an irregular section, so that the pathological change of the aorta can not completely isolate the blood flow, I-shaped internal leakage is easy to occur, in addition, the radial supporting force of the main body stent 1 is obviously far greater than that of the branch tectorial membrane stent 2, the branch tectorial membrane stent 2 is extruded to deform, the blood flow of the inlet of the branch blood vessel is influenced, and finally the thrombus formation of the branch blood vessel can be caused.
Disclosure of Invention
The invention aims to provide a parallel stent for endovascular repair, so as to alleviate the technical problems.
In order to achieve the above purpose, the embodiment of the present invention adopts the following technical scheme:
The embodiment of the invention provides a parallel stent for endovascular repair, which comprises a main body stent and a branch tectorial membrane stent which are arranged in a split manner; wherein:
the main body bracket comprises a main body proximal end tectorial membrane bracket and a main body distal end bracket which are connected with each other; the main body proximal end tectorial membrane bracket comprises a strong support section and a weak support section in the circumferential direction, wherein the radial support force of the strong support section is greater than that of the weak support section;
The radial supporting force of the proximal end section of the branch tectorial membrane bracket is greater than the radial supporting force of the weak supporting section, so that when the proximal end section of the branch tectorial membrane bracket is arranged outside the weak supporting section in parallel and the proximal end section and the weak supporting section are extruded in radial directions in opposite directions, the weak supporting section is sunken towards the inner direction of the main body proximal end tectorial membrane bracket, and the proximal end section of the branch tectorial membrane bracket is embedded in the sunken.
In the parallel stent for endovascular repair provided in this embodiment, optionally and preferably, the main body proximal stent graft includes a stent graft and at least one stent ring; each of the stent rings: the plurality of V-shaped bracket units are circumferentially arranged and connected to form a wave shape to serve as the strong supporting section, and the plurality of diamond-shaped bracket units are arranged and connected to form a grid shape to serve as the weak supporting section; wherein:
optionally, the cross-sectional area of the rack units of the weak support section is less than the cross-sectional area of the rack units of the strong support section;
Optionally, the weak support section has a plurality of peaks, and an arc length interval occupied by adjacent peaks thereof in a circumferential direction of the main body proximal stent graft is < an arc length interval occupied by adjacent peaks of the strong support section in a circumferential direction of the main body proximal stent graft, and a total arc length occupied by the strong support section as a whole in a circumferential direction of the main body proximal stent graft is > a total arc length occupied by the weak support section as a whole in a circumferential direction of the main body proximal stent graft.
Further preferably, the proximal section of the branched stent graft comprises a stent graft and a plurality of axially spaced stent rings; in the region where the proximal end section of the branched stent graft and the outer part of the weak support section are radially pressed toward each other: the cross section area of the support ring of the branch tectorial membrane support is larger than the cross section area of the support unit of the weak support section; and/or the peak height of the support ring of the branched tectorial membrane support is less than the peak height of the weak support section. Wherein, "and/or" means that, in the above structure, the radial supporting force of the proximal end section of the branched stent graft > the radial supporting force of the weak supporting section can be achieved simultaneously or optionally.
In the parallel stent for endovascular repair provided in this embodiment, optionally, but not limited to, the main body distal stent is a covered stent, and the cover of the main body distal stent is integrally or fixedly connected with the cover of the main body proximal covered stent.
In the parallel stent for endovascular repair provided in this embodiment, optionally, but not limited to, along a circumferential direction of the main body proximal stent graft, the weak support section is provided with two sections that are symmetrical to each other with respect to a central axis of the main body proximal stent graft.
In the parallel stent for endovascular repair provided in this embodiment, optionally and preferably, the distal section of the branched stent graft includes a stent graft and a lattice stent.
In the parallel stent for endovascular repair provided in this embodiment, optionally and preferably, a tapered transition section with a diameter gradually decreasing from the proximal end to the distal end is provided between the proximal end section and the distal end section of the branched stent graft.
Further preferably, the conical transition section comprises a covering film and a wavy transition support ring which is connected with the covering film and has a conical outer contour in a natural state.
In the parallel stent for endovascular repair provided in this embodiment, optionally, but not limited to, the main body proximal stent graft is a metal tube laser engraved stent or a wire braided stent.
The parallel stent for endovascular repair provided by the embodiment can be applied to endovascular treatment of aortic arch and branch positions thereof, or to endovascular treatment of branch positions of abdominal aorta and double renal arteries, and the number and positions of weak support sections are set according to actual needs. In the final release state, the proximal end of the main body stent graft and the proximal end of the branch stent graft are extruded in radial directions, the weak support section of the main body proximal end stent graft in the main body stent graft is extruded by the proximal end section of the branch stent graft to be sunken towards the inner direction of the main body proximal end stent graft, and the proximal end section of the branch stent graft is embedded into the sunken, so that the shape similar to the section of a blood vessel is formed, the section gap between the outer peripheral surface of the main body proximal end stent graft and the inner wall of the blood vessel is reduced as much as possible, the blood vessel inner cavity is almost completely filled by the main body proximal end stent graft, and the occurrence probability of I-shaped internal leakage is further reduced; in addition, the thrombus formed by the blood flow gradient of the branch blood vessel caused by serious deformation of the proximal end of the branch tectorial membrane stent due to extrusion is avoided, namely, the smooth passage of the blood flow at the inlet of the branch blood vessel can be ensured, and the thrombus formation probability of the branch blood vessel is reduced.
In summary, the parallel stent for endovascular repair provided in this embodiment relieves the technical problems that in the existing parallel stent technology, the aortic lesion part cannot be completely isolated from blood flow due to mutual extrusion of the branch stent graft and the main stent graft, I-type internal leakage is easily caused, and the branch stent graft is extruded to deform, so that the inlet blood flow of the branch vessel is affected.
Drawings
In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings that are needed in the description of the embodiments or the prior art will be briefly described, and it is obvious that the drawings in the description below are some embodiments of the present invention, and other drawings can be obtained according to the drawings without inventive effort for a person skilled in the art.
FIG. 1 is a schematic view of an implantation state of a conventional parallel stent;
fig. 2 is a schematic diagram of a main body stent structure of a parallel stent for endovascular repair according to an embodiment of the present invention;
Fig. 3 is a schematic diagram of a branch stent graft of a parallel stent for endovascular repair according to an embodiment of the present invention;
FIG. 4 is a first step diagram of implanting an endovascular repair parallel stent provided in an embodiment of the invention into an aortic arch and its branches;
FIG. 5 is a second step diagram of implanting the endovascular repair parallel stent provided in the embodiment of the invention into the aortic arch and its branches;
FIG. 6 is a third step diagram of implanting the endovascular repair parallel stent provided in the embodiment of the invention into the aortic arch and its branches;
FIG. 7 is a schematic view showing radially opposite extrusion of the proximal ends of the main body stent and the branched stent graft in the state shown in FIG. 6;
FIG. 8 is a view of the proximal recess of the body mount of FIGS. 6 and 7;
FIG. 9 is a radial cross-sectional view of the proximal end of the main body stent, the proximal end of the branched stent graft, within the aortic vessel in the condition shown in FIG. 6;
FIG. 10 is an anatomic view of the abdominal aorta and the double renal arteries of a human body;
FIG. 11 is a view showing a state after the endovascular prosthetic parallel stent provided in the embodiment of the invention is implanted in the abdominal aorta and the branch positions of the two renal arteries and released;
FIG. 12 is a view of the proximal recess of the body stent in the state shown in FIG. 11;
fig. 13 is a state diagram showing a proximal end depression of a main body stent after the endovascular parallel stent provided in the embodiment of the invention is implanted in the abdominal aorta and the branch positions of the two renal arteries and released.
Icon: 1-a main body support; 11-a main body proximal stent graft; 111-a strong support section; 112-weak support segments; 2-branching stent graft; 21-a conical transition section; 3-a guidewire; 4-a delivery sheath.
Detailed Description
For the purpose of making the objects, technical solutions and advantages of the embodiments of the present invention more apparent, the technical solutions of the embodiments of the present invention will be clearly and completely described below with reference to the accompanying drawings in the embodiments of the present invention, and it is apparent that the described embodiments are some embodiments of the present invention, but not all embodiments of the present invention. The components of the embodiments of the present invention generally described and illustrated in the figures herein may be arranged and designed in a wide variety of different configurations.
Thus, the following detailed description of the embodiments of the invention, as presented in the figures, is not intended to limit the scope of the invention, as claimed, but is merely representative of selected embodiments of the invention. All other embodiments, which can be made by those skilled in the art based on the embodiments of the invention without making any inventive effort, are intended to be within the scope of the invention.
It should be noted that: like reference numerals and letters designate like items in the drawings, and thus once an item is defined in one drawing, no further definition or explanation thereof is necessary in the subsequent drawings.
In the description of the present invention, it should be noted that the terms "proximal," "distal," "inner," "outer," and the like indicate an orientation or a positional relationship based on the orientation or positional relationship shown in the drawings, or the orientation or positional relationship in which the inventive product is conventionally put in use, merely for convenience in describing the present invention and simplifying the description, and do not indicate or imply that the apparatus or element in question must have a specific orientation, be configured and operated in a specific orientation, and therefore should not be construed as limiting the present invention. Furthermore, the terms "first," "second," and the like, are used merely to distinguish between descriptions and should not be construed as indicating or implying relative importance.
In the description of the present invention, it should also be noted that, unless explicitly specified and limited otherwise, the terms "disposed," "mounted," and "connected" are to be construed broadly, and may be, for example, fixedly connected, detachably connected, or integrally connected; can be directly connected or indirectly connected through an intermediate medium, and can be communication between two elements. The specific meaning of the above terms in the present invention will be understood in specific cases by those of ordinary skill in the art.
Some embodiments of the present invention are described in detail below with reference to the accompanying drawings. The following embodiments and features of the embodiments may be combined with each other without conflict.
In the prior art, as shown in fig. 1, a parallel stent comprises a main stent 1 and a branch stent-graft 2, when the main stent 1 is implanted into the aorta during operation, important blood vessel branches need to be covered, and in order to ensure branch blood supply, the side-by-side branch stent-grafts 2 are implanted. The advantage of the parallel stent technique is that the integrity of the main stent 1 is not destroyed during operation, the accurate branch opening positioning is not involved, and the technical operation is relatively simple. The parallel stent does not need individual customization, is suitable for patients needing urgent renal artery vascular reconstruction and aortic arch repair, has lower operation cost than the operation of a fenestrated stent or a branched covered stent, but has other problems:
Although the parallel stent technology can completely isolate the position of the pathological change of the branch blood vessel from blood flow, the branch tectorial membrane stent 2 and the main body stent 1 are mutually extruded to form an irregular section, so that the pathological change of the aorta can not completely isolate the blood flow, I-shaped internal leakage is easy to occur, in addition, the radial supporting force of the main body stent 1 is obviously far greater than that of the branch tectorial membrane stent 2, the branch tectorial membrane stent 2 is extruded to deform, the blood flow of the inlet of the branch blood vessel is influenced, and finally the thrombus formation of the branch blood vessel can be caused.
In contrast, the present embodiment provides a parallel stent for endovascular repair, which includes a main body stent 1 and a branch stent-graft 2 that are separately provided, with reference to fig. 2 to 13; wherein: as shown in fig. 2, the main body stent 1 comprises a main body proximal stent graft 11 and a main body distal stent which are connected to each other; the main body proximal end stent graft 11 includes a strong support section 111 and a weak support section 112 in the circumferential direction, and the radial supporting force of the strong support section 111 > the radial supporting force of the weak support section 112.
Referring to fig. 2 to 13, the radial supporting force of the proximal section of the branched stent graft 2 is greater than the radial supporting force of the weak supporting section 112 in the main body proximal stent graft 11, so that when the proximal section of the branched stent graft 2 is disposed in parallel outside the weak supporting section 112 of the main body proximal stent graft 11 and the two sections are radially pressed toward each other, the weak supporting section 112 of the main body proximal stent graft 11 is recessed toward the inside of the main body proximal stent graft 11, and the proximal section of the branched stent graft 2 is embedded in the recess.
The parallel stent for endovascular repair provided in this embodiment can be applied to endovascular treatment of aortic arch and its branch position, or to endovascular treatment of abdominal aorta and double renal artery branch positions, and the number and positions of the weak support segments 112 are set according to actual needs.
Taking the example of implanting the endovascular repair parallel stent into the aortic arch and the branch positions thereof, the specific operation steps refer to fig. 4 to 6, and as shown in fig. 4, the guide wire 3 is sent from the femoral artery to the ascending aorta, and the guide wire 3 is sent from the brachial artery to the descending aorta; as shown in fig. 5, the main body stent 1 and the branch stent graft 2 are respectively conveyed to a target site along a guide wire by means of a conveyer sheath 4, the angle of the weak support section 112 of the main body proximal stent graft 11 is determined according to the development marks on the main body stent 1 and the branch stent graft 2, and the main body stent graft 1 is released from the proximal end to the distal end first and then the branch stent graft 2 is released from the proximal end to the distal end according to the length of the proximal end section of the branch stent graft; the delivery sheath 4 is withdrawn, as finally shown in fig. 6. In the final release state shown in fig. 6, the proximal end of the main body stent graft 1 and the proximal end of the branch stent graft 2 are radially extruded in opposite directions, and details are shown in fig. 7, 8 and 9, the weak support section 112 of the main body proximal end stent graft 11 in the main body stent graft 1 is extruded by the proximal end section of the branch stent graft 2 to be recessed toward the inner direction of the main body proximal end stent graft 11, and the proximal end section of the branch stent graft 2 is embedded in the recess, so that the shape similar to the section of a blood vessel is formed, the section gap between the outer peripheral surface of the main body proximal end stent graft 11 and the inner wall of the blood vessel is reduced as much as possible, the blood vessel cavity is almost completely filled by the main body proximal end stent graft 11 (the enlarged view shown in fig. 9, the gaps which are not filled in the actual blood vessel cavity are smaller and negligible), and the occurrence probability of type I internal leakage is further reduced; in addition, the thrombus formed by the blood flow gradient of the branch blood vessel caused by serious deformation of the proximal end of the branch tectorial membrane stent 2 due to extrusion is avoided, namely, the smooth passage of the blood flow at the inlet of the branch blood vessel can be ensured, and the thrombus formation probability of the branch blood vessel is reduced.
In summary, the parallel stent for endovascular repair provided in this embodiment relieves the technical problems that in the existing parallel stent technology, the aortic lesion part cannot be completely isolated from blood flow due to mutual extrusion of the branch stent graft and the main stent graft, I-type internal leakage is easily caused, and the branch stent graft is extruded to deform, so that the inlet blood flow of the branch vessel is affected.
In the parallel stent for endovascular repair provided in this embodiment, optionally and preferably, as shown in fig. 2, the main body proximal stent graft 11 comprises a stent and at least one stent ring; in each stent ring: the plurality of V-shaped stent units are arranged and connected in a circumferential direction in a wavy shape as the strong supporting sections 111, and the plurality of diamond-shaped stent units are arranged and connected in a lattice shape as the weak supporting sections 112 (the number of rows and the number of columns of the lattice shape are not particularly limited). Wherein:
The first alternative construction is to have the cross-sectional area of the stent cells of the weak support section 112 < the cross-sectional area of the stent cells of the strong support section 111. Optionally, but not limited to, the main body proximal end tectorial membrane bracket 11 is a metal tube laser engraving bracket or a metal wire braiding bracket, so as to realize the technical scheme, thereby realizing that the radial supporting force of the strong supporting section 111 is greater than the radial supporting force of the weak supporting section 112;
The second alternative structure is that the weak support section 112 has a plurality of peaks, and the arc length interval occupied by the adjacent peaks of the weak support section 112 in the circumferential direction of the main body proximal stent graft 11 is < the arc length interval occupied by the adjacent peaks of the strong support section 111 in the circumferential direction of the main body proximal stent graft 11, and the total arc length occupied by the whole strong support section 111 in the circumferential direction of the main body proximal stent graft 11 is greater than the total arc length occupied by the whole weak support section 112 in the circumferential direction of the main body proximal stent graft 11.
The above first and second optional structures may be provided simultaneously or selectively to achieve the function of the radial supporting force of the strong supporting section 111 > the radial supporting force of the weak supporting section 112.
Further preferably, the proximal section of the branched stent graft 2 comprises a stent graft and a plurality of axially spaced stent rings; in the region where the proximal end section of the branched stent graft 2 and the outer portion of the weak support section 112 are radially pressed toward each other: the cross-sectional area of the stent ring of the branch stent graft 2 is greater than the cross-sectional area of the stent unit of the weak support section 112; and/or the peak height of the stent ring of the branched stent graft 2 < the peak height of the weak support section 112. Wherein, "and/or" means that, in the above structure, the radial supporting force of the proximal end section of the branched stent graft 2 > the radial supporting force of the weak supporting section 112 can be achieved simultaneously or optionally.
In the parallel stent for endovascular repair provided in this embodiment, optionally, but not limited to, the main body distal stent is a covered stent, and the covered stent of the main body distal stent and the covered stent of the main body proximal covered stent 11 are integrally or fixedly connected together, but when the main body distal stent covers other branch vessels, the main body distal stent can be a bare stent without covered stent. For example, but not limited to, as shown in fig. 2, the main body distal stent includes a plurality of stent rings axially spaced apart, and the proximal-most stent ring of the main body distal stent is axially spaced apart from the distal-most stent ring of the main body proximal stent 11.
In the parallel stent for endovascular repair provided in this embodiment, optionally but not limited to, the weak support section 112 is provided with two sections symmetrical to each other with respect to the central axis of the main body proximal stent graft 11 along the circumferential direction of the main body proximal stent graft 11. The structure can enable the parallel stent for endovascular repair provided by the embodiment to be applied to endovascular treatment at the branch positions of the abdominal aorta and the double renal arteries, as shown in fig. 10 to 13, and the two implanted weak support sections 112 respectively correspond to the branch stent graft 2 implanted at the branch openings of the left renal artery and the right renal artery. Of course, when applied to the aortic arch and the branch vessels thereof, the weak support section 112 may have a two-section structure symmetrical to each other with respect to the central axis of the main body proximal stent graft 11, so as to more conveniently rotate the main body stent 1 circumferentially to the side of one section of the weak support section 112 facing the branch vessels, to conveniently and rapidly align and release the branch stent graft 2, and the other section of the weak support section 112 of the main body proximal stent graft 11 which is not in contact with the branch stent graft 2 is in contact and bonded with the inner wall of the aortic vessel.
In the parallel stent for endovascular repair provided in this embodiment, optionally and preferably, the distal end section of the branch stent-graft 2 includes a stent-graft and a mesh stent, so that the branch stent-graft 2 has higher flexibility and can adapt to tortuous vessels.
In the parallel stent for endovascular repair provided in this embodiment, optionally and preferably, a tapered transition section 21 with a diameter gradually decreasing from the proximal end to the distal end is provided between the proximal end section and the distal end section of the branched stent-graft 2. Therefore, the proximal end diameter of the branch tectorial membrane stent 2 can be larger than the distal end diameter, on one hand, the radial supporting force of the proximal end section of the branch tectorial membrane stent 2 can be ensured, and the branch tectorial membrane stent 2 does not generate obvious deformation after being extruded by the main body proximal end tectorial membrane stent 11; on the other hand, when the diameter is slightly reduced due to slight deformation of the proximal section of the branch tectorial membrane stent 2 caused by compression, the proximal diameter and the distal diameter of the branch tectorial membrane stent are close to each other because the original diameter is larger than the distal diameter, so that the blood flow dynamics in the branch blood vessel is optimized, and the thrombus formation of the branch blood vessel is further reduced. Further preferably, as shown in fig. 11, the tapered transition section 21 includes a coating and a wavy transition stent ring connected to the coating and having a tapered outer contour in a natural state.
Finally, it should be noted that: in the present specification, each embodiment is described in a progressive manner, and each embodiment is mainly described by differences from other embodiments, and identical and similar parts between the embodiments are only required to be seen with each other; the above embodiments in the present specification are only for illustrating the technical solution of the present invention, and are not limiting; although the invention has been described in detail with reference to the foregoing embodiments, it will be understood by those of ordinary skill in the art that: the technical scheme described in the foregoing embodiments can be modified or some or all of the technical features thereof can be replaced by equivalents; such modifications and substitutions do not depart from the spirit of the invention.
Claims (8)
1. The utility model provides a parallel support is restoreed to blood vessel intracavity, includes main part support (1) and branch tectorial membrane support (2) that components of a whole that can function independently set up, its characterized in that:
The main body bracket (1) comprises a main body proximal end tectorial membrane bracket (11) and a main body distal end bracket which are connected with each other; the main body proximal end tectorial membrane bracket (11) comprises a strong support section (111) and a weak support section (112) in the circumferential direction, wherein the radial support force of the strong support section (111) is greater than the radial support force of the weak support section (112);
The radial supporting force of the proximal end section of the branched tectorial membrane bracket (2) is greater than the radial supporting force of the weak supporting section (112);
When in implantation, a guide wire is selected along the aorta to convey the main body stent (1) into the aorta, the main body proximal tectorial membrane stent (11) of the main body stent (1) reaches the proximal side of the opening of a branch vessel in the aorta, the guide wire is selected along the branch vessel from the branch vessel to the direction of the aorta to convey the branch tectorial membrane stent (2) into the branch vessel, and the proximal section of the branch tectorial membrane stent (2) reaches the proximal side of the opening of the branch vessel in the aorta; determining the angle of a weak support section (112) of the main body proximal-end tectorial membrane bracket (11), releasing the main body bracket (1) from the proximal end to the distal end direction firstly and then releasing the branch tectorial membrane bracket (2) from the proximal end to the distal end direction according to the length of the proximal-end section of the branch tectorial membrane bracket (2), so that in the final release state, the proximal-end sections of the branch tectorial membrane bracket (2) are arranged outside the weak support section (112) in parallel, the proximal-end inlets of the weak support section (112) face the same direction and the proximal-end inlets of the weak support section and the weak support section are extruded in the radial direction of the weak support section and the main body proximal-end tectorial membrane bracket (11), and the proximal-end sections of the branch tectorial membrane bracket (2) are embedded in the recess;
The main body proximal stent graft (11) comprises a graft and at least one stent ring; each of the stent rings: the plurality of V-shaped bracket units are circumferentially arranged and connected to form a wave shape to serve as the strong supporting section (111), and the plurality of diamond-shaped bracket units are arranged and connected to form a grid shape to serve as the weak supporting section (112);
Wherein:
The cross-sectional area of the support units of the weak support section (112) is less than the cross-sectional area of the support units of the strong support section (111);
And/or, the weak support section (112) has a plurality of peaks, and the arc length interval occupied by adjacent peaks of the weak support section (112) in the circumferential direction of the main body proximal film covered stent (11) is less than the arc length interval occupied by adjacent peaks of the strong support section (111) in the circumferential direction of the main body proximal film covered stent (11), and the total arc length occupied by the whole strong support section (111) in the circumferential direction of the main body proximal film covered stent (11) is greater than the total arc length occupied by the whole weak support section (112) in the circumferential direction of the main body proximal film covered stent (11).
2. The endovascular repair parallel stent of claim 1, wherein: the proximal end section of the branched tectorial membrane stent (2) comprises an tectorial membrane and a plurality of stent rings which are axially arranged at intervals; in the region of radially opposite pressing of the proximal section of the branched stent graft (2) and the outside of the weak support section (112):
The cross-sectional area of the stent ring of the branch tectorial membrane stent (2) is larger than the cross-sectional area of the stent unit of the weak support section (112);
And/or the peak height of the stent ring of the branched tectorial stent (2) is less than the peak height of the weak support section (112).
3. The endovascular repair parallel stent of claim 1, wherein: the main body distal end bracket is a covered bracket, and the covered of the main body distal end bracket and the covered of the main body proximal end covered bracket (11) are integrated or fixedly connected together.
4. The endovascular repair parallel stent of claim 1, wherein: along the circumferential direction of the main body near-end tectorial membrane bracket (11), the weak support section (112) is provided with two sections which are symmetrical to each other relative to the central axis of the main body near-end tectorial membrane bracket (11).
5. The endovascular repair parallel stent of claim 1, wherein: the distal end section of the branched tectorial membrane stent (2) comprises an tectorial membrane and a grid stent.
6. The endovascular repair parallel stent of claim 1, wherein: a conical transition section (21) with the diameter gradually decreasing from the proximal end to the distal end is arranged between the proximal end section and the distal end section of the branched tectorial membrane stent (2).
7. The endovascular repair parallel stent of claim 6, wherein: the conical transition section (21) comprises a coating film and a wavy transition support ring which is connected with the coating film and has a conical outer contour in a natural state.
8. The endovascular repair parallel stent of claim 1, wherein: the main body near end tectorial membrane support (11) is a metal tube laser engraving support or a metal wire braiding support.
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| CN104271074A (en) * | 2012-04-27 | 2015-01-07 | 美敦力瓦斯科尔勒公司 | Stent-graft prosthesis for placement in the abdominal aorta |
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| CN105496603B (en) * | 2015-12-30 | 2018-11-06 | 先健科技(深圳)有限公司 | Intraluminal stent |
| JP2020512914A (en) * | 2017-03-21 | 2020-04-30 | エンドスパン リミテッド | Stent graft for sealing around external disturbances |
| CN116019603A (en) * | 2021-10-26 | 2023-04-28 | 先健科技(深圳)有限公司 | Tectorial membrane support and combined support |
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| CN104271074A (en) * | 2012-04-27 | 2015-01-07 | 美敦力瓦斯科尔勒公司 | Stent-graft prosthesis for placement in the abdominal aorta |
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