A kind of taking thrombus device with bayonet fittings and thrombus treating apparatus thereof
Technical field
This utility model relates to a kind of taking thrombus device with bayonet fittings and thrombus treating apparatus thereof, specifically, particularly to a kind of medical apparatus and instruments getting involved blood vessel, for when acute ischemic stroke occurs, eliminating mechanically and be blocked in endovascular thrombosis to reach the Therapeutic Method of instant recovery blood flow, what be particularly suited for intracranial vessel takes bolt.
Background technology
Cerebral infarction is once occur, it is necessary within the shortest time, (effective time window) makes revascularization.At present, the Therapeutic Method of Intracranial thrombus mainly has two kinds: medicine thrombolytic and machinery take bolt.
Medicine thrombolytic is with thrombus by intravenous injection rt-PA (tissue-type plasminogen activator) or urokinase, it is possible to by intra-arterial contact thrombolysis, antiplatelet aggregation and anticoagulant treatment etc..Although thromboembolism treatment has been shown to improve preferably neurological outcome, but, according to US National sacred disease and apoplexy institute (TheNationalInstituteNeurologicalDisordersandStrokert-PAS trokeStudyGroup, NINDS) research is thought, intravenous thrombolysis should carry out within falling ill 3 hours, Arterial thrombolysis time window should within 6 hours, and the patient that so short thrombolytic time window causes only 4.5%-6.3% can accept thromboembolism treatment;Secondly, thromboembolism treatment is suitable only for the thrombosis of small volume, and the therapeutic effect of large volume thromboembolism is unsatisfactory;And, thrombolytic drug is had anaphylaxis by some patients, is not suitable for thromboembolism treatment.
In order to solve the problem of said medicine thrombolytic, for exceeding thrombolytic time window and not tolerating the patient of thromboembolism treatment, adopt machinery to take bolt and remove the thrombosis of blocking.In the prior art, it has been disclosed that machinery as described below takes pin device:
In the utility model patent that the patent No. is CN104000635A " take bolt device and take pin device " that China announces, have and multiple stretch into the cancellated intraluminal interior female rod with three-D profile, tube chamber is fixed at its two ends, in removal process after catching thrombosis, it is possible to by interior female rod fix blood bolt.
The utility model patent " for removing the device of thrombosis from blood vessel " that the patent No. disclosed in China is CN101340849A, by a caged or tubular structure, one distal member with the fiber extended radially out is taken in wherein, and safely eliminate thrombosis from Ink vessel transfusing under the help of fiber.
In the utility model patent " Intravascular Thrombus and embolus resectoscope " that the patent No. disclosed in China is CN101396295A; there is the thrombectomy device of a thrombectomby spring and the basket in contraction or release conditions; basket is positioned at the far-end of thrombectomy device; arrest thrombosis by the winding of thrombectomby spring, and take out to protect the far-end of blood vessel with basket together with thrombosis fragment by taking the clot of generation in bolt process.
In the utility model patent that the patent No. is CN102316809A " endovascular thrombosis grabber " that China announces, having the line main body haunted freely and be located at the thrombosis capture portion of its front end, the motion of the elastica circle body by being erected between fixed part and movable part removes, to catch, the thrombosis being attached to blood vessel wall.
In the utility model patent " device for removal of thromboses " that the patent No. disclosed in China is CN101035474A, there is the guide wire that a far-end is equipped with the fiber component of an orthohormbic structure, from body cavity and blood vessel, take out foreign body and thrombosis by the motion before and after it.
In the utility model patent that the patent No. is CN102014772A " method and apparatus for restoration of blood flow " that China announces, have a self expandable taper overlay structure by the cancellated parts of interconnective line or filament or pillar, by microtubular with push after wire is introduced into inaccessible blood vessel self expandable to recover blood flow.
In the utility model patent " for treating the system and method for cerebral infarction " that the patent No. disclosed in China is CN101027004A, there is guiding and occlusion catheter, conveying and draw catheter, lift suction pump, thromboembolic receiver and thromboembolic separator, lift suction pump passes through draw catheter by Biochemical analyzer to thromboembolic receiver, thus withdrawing from external.
In the utility model that the patent No. is ZL200620164685.4 " taking bolt device " of China's bulletin, there is the umbrella of the three-jaw short by two length one of elastic memory function, with periphery have net formed a circular configuration take pin device, by drawing push-pull bar to make three-jaw close up outward, thrombosis pocket is recovered in trocar sheath in umbrella portion, thrombosis is taken out.
In the utility model patent that the patent No. is US7931659B2 " SystemandMethodforTreatingIschemicStroke " of U.S. Publication, there is a receptor being surrounded into hollow tubular by many filaments being fixed on an elongated extension tube end, by extension tube, receptor is placed in blood vessel embolism position, and thrombosis taken in the intracavity of receptor hollow and takes out external.
In the utility model patent that the patent No. is US2006/0047286A1 " ClotRetrieverDevice " of U.S. Publication, there is one and be fixed on the expansible of pusher end and the recovery basket shunk, it has a tinsel that can pass through to be fixed on basket end control the uncovered in order to be caught in basket by thrombosis of opening and closing.
In the utility model patent that the patent No. is US2002/0049452A1 " ClotRetrieverDevice " of U.S. Publication, have one or more be fixed on slender conduit can in compression element movable have a shape memory take latch, after being transported to thromboembolism position by slender conduit, take in latch is flared out thrombosis is caught and is wrapped in.
In the utility model patent that the patent No. is US2009/0240238A1 " ClotRetrievalMechanism " of U.S. Publication, have one be fixed on a slender axles end can the snare of self-expanding and an attached to it folding sack being made up of flexible non-porous material, by slender axles, device is placed in thromboembolism position along internal passage, opens sack by thrombosis bag in the inner.
Various machineries described above take pin device, all there is open defect: when thrombosis cannot be looked at straight, the catching device of basket or web form tends not to entangle blood clot and causes taking bolt failure, and its volume is often excessive, cannot use in the cerebral arterieies such as thinner middle cerebral artery M1, M2 section of blood vessel diameter, when catching recovery after thrombosis, thrombosis is fixed insecure, it is easy to come off;Although although the pin device that takes having solves the problem of thrombus breaks loose, but its structure is complicated, the interior female rod structure for fixing thrombosis of increase makes the compliance taking pin device overall greatly reduce, so as to tortuous intracranial vessel can not be passed through.
On the other hand, although it is safe that the mode of existing negative pressure absorbing takes bolt, but only that relatively soft thromboembolism is effective by drawing removal;In order to strengthen drawing effect, adopt rotating blade or resectoscope fragmentation thrombosis, although this rotating blade feature improves the effect of this aspiration technique, but considerably increased the risk that blood vessel wall is caused damage;Although laser and ultrasound wave are cleaning and the effective energy, but such as misoperation, very easily peripheral vessels are caused damage, and energy is too low then invalid, too high then injured blood vessel, therefore it is difficult to determine that giving how high-octane laser intensity can be only achieved optimum curative effect.
Accordingly, it would be desirable to prior art is further improved, it is desirable to the intracranial vessel designing a kind of improvement takes bolt device, one, and volume should be sufficiently small, compliance should be enough good, so that device can enter the distal vessels that intracranial is thinner;Its two, capture rate is high, and thrombosis is grip good, fixation in taking bolt removal process, difficult drop-off;Its three, radially support force is little, and blood vessel wall and Peripheral Vascular Injuries is little.
Utility model content
Technical problem to be solved in the utility model is in that, it is provided that a kind of taking thrombus device with bayonet fittings and thrombus treating apparatus thereof, takes bolt device and is provided with bayonet fittings, takes during bolt the chucking power of thrombosis is sufficiently large, takes thrombosis in bolt process and does not slip;Compliance is good, takes bolt device and can pass through curved blood vessel or arrive the blood vessel that far-end is thinner;Radially support force is little, takes in bolt process and causes damage to be preferably minimized blood vessel wall and peripheral vessels.
This utility model is realized in, a kind of taking thrombus device with bayonet fittings is provided, can be used for intracranial, cervical region, including taking bolt device, it is positioned at the developing ring taking bolt device near-end and is positioned at the development circle taking bolt device far-end, described take webmaster shape or the cage structure that bolt device includes being made up of multiple unit grids being coupled to each other, each described unit grid by interconnective muscle around forming, this webmaster shape or cage structure can be collapsed folding under pressure and have self-expanding recovery capability in a free state, and, this webmaster shape or collapsing of cage structure fold and expand and can mutually change without difficulty;The inner space composition that described webmaster shape or cage structure surround takes the exocoel of bolt device;Being respectively provided with bayonet fittings on the muscle of some described unit grids, the outside intracavity of each described bayonet fittings extends, and the space composition that some described bayonet fittings surround into takes the inner chamber of bolt device, and described inner chamber is positioned at outer intracavity.This device can be used for human vas, and other adapts to position.
Further, described bayonet fittings is integrated with muscle and is connected, and described bayonet fittings is arc-shaped or linearity, and described bayonet fittings is along taking the genesis analysis of bolt device, and described bayonet fittings is along taking the longitudinal axis of bolt device symmetrically or spaced apart.
Further, the longitudinal direction of the direction of described bayonet fittings and netted or cage structure angle at an angle, this angle is optional between 0~90 °, and the angle of each bayonet fittings is identical or different.
Further, described bayonet fittings is arranged on the axially-aligned most significant end of unit grid or the muscle of least significant end.
Further, described bayonet fittings is arranged on the muscle of the unit grid at webmaster shape or cage structure edge.
Further, described bayonet fittings is arranged on the muscle of the unit grid of webmaster shape or cage structure pars intermedia.
Further, the length of described bayonet fittings is 1/3 to 1 with the ratio of the height of place unit grid.
Further, the width of described bayonet fittings and the ratio of the width of place muscle are more than 1 and less than 2.
Further, the side taking bolt device described in is open or closed.
Further, described in take bolt device there is oblong shape or oblong shape under self-expanding state, its length range is between 5 millimeters to 60 millimeters, and its diameter range is between 2 millimeters to 6 millimeters.
Further, the ratio of the length of described unit grid and height is more than 1 and less than 2.
Further, the proximal end taking bolt device described under self-expanding state is arranged to pyramidal structure, its proximate expand gradually, and its tapering is 30 ° to 60 °.
Further, the periphery tangent line of described exocoel and inner chamber forms the angle of 0~90 °.
Further, the surface-coated taking bolt device described in has the coating containing anticoagulant or antiplatelet drug.
Further, described developing ring and development circle all by can be visual under X ray material make.
Further, described developing ring and development circle are connected with taking bolt device by modes such as welding or crimp or be cementing.
Further, take bolt device described in be made up of shape-memory material.
The invention also discloses a kind of thrombus treating apparatus; employ the aforesaid taking thrombus device with bayonet fittings; this therapeutic instrument also includes protection sheath pipe, conveying silk, microtubular, guiding catheter and rotates haemostatic valve; the external diameter of described microtubular is less than the internal diameter of guiding catheter; described microtubular is pushed to blood embolization place along guiding catheter in guiding catheter; described protection sheath pipe is interconnected with microtubular by rotating haemostatic valve; the described bolt device that takes is placed in protection sheath pipe; it is pushed in microtubular by described conveying silk, and is pushed to blood embolization place.
Further, described conveying silk is made up of the soft tinsel with certain rigidity.
Further, described protection sheath pipe is made up of polymeric material.
Compared with prior art, taking thrombus device with bayonet fittings of the present utility model and thrombus treating apparatus thereof provide the benefit that: can thrust thrombosis inside easily by bayonet fittings and fix thrombosis firmly, taking the exocoel of bolt device can be overlapping and clamp thrombosis as clip with by the formed inner chamber of bayonet fittings, add the fastness that thrombosis is fixing, solve and take the problem that in bolt process, thrombus breaks loose causes new blocking in the past.Compared with other technologies, bayonet fittings compliance is enough good, simple in construction, it is easy to processing, the flexibility overall without influence on taking bolt device;Take the structure that bolt device side is open, both can fold up to adapt to relatively fine blood vessel, be greatly reduced support force radially, blood vessel wall and Peripheral Vascular Injuries are substantially reduced;Being connected to the label developing ring with not transmission X-ray taking bolt device two ends and development circle, making to take bolt device can operate visually under the support of digital subtraction angiography system, and makes to take bolt accurately and reliably.Doctor only advances and withdraws this device and just can complete to take bolt operation, with traditional take bolt operation compared with, operation process is greatly simplified, and has both alleviated the workload of doctor, get again the treatment time of preciousness for patient, strive for the more time for reversible ischemic tissue of brain.
Accompanying drawing explanation
Fig. 1 is the structural representation of the thrombus treating apparatus of the blood vessel with bayonet fittings of the present utility model;
The bolt device that takes that Fig. 2 is in Fig. 1 is accommodated in the viewgraph of cross-section protected in sheath pipe;
Fig. 3 is the schematic perspective view taking bolt device of the present utility model;
Fig. 4 is the axial schematic diagram of Fig. 3;
Fig. 5 is the expansion schematic diagram of Fig. 3, and wherein bayonet fittings is symmetrical in dislocation;
Fig. 6 is the second embodiment of the bayonet fittings distribution of Fig. 3, and bayonet fittings is slender type, spaced apart;
Fig. 7 is the third embodiment of the bayonet fittings distribution of Fig. 3, and bayonet fittings is tubbiness type, symmetrical between two;
Fig. 8 is the 4th kind of scheme of the bayonet fittings distribution of Fig. 3, barb-like in from top to bottom of bayonet fittings;
Fig. 9 is the size relationship schematic diagram of bayonet fittings and unit grid in Fig. 3;
Figure 10 is the schematic diagram that there is thrombosis in current-carrying blood vessel;
Figure 11 is the schematic diagram after microtubular traverse thrombosis;
Figure 12 takes bolt device to move to the schematic diagram of thrombosis far-end in microtubular;
Figure 13 takes bolt device to carry out taking the schematic diagram of bolt operation;
Figure 14 takes bolt operation to terminate the schematic diagram of rear bearing stream endovascular blood flow Channel Group state;
Figure 15 is an illustration for taking the axial schematic diagram fixing thrombosis after bolt device folds;
Figure 16 is the schematic perspective view of Fig. 8;
Figure 17 is the axial schematic diagram of Figure 16.
Detailed description of the invention
In order to make technical problem to be solved in the utility model, technical scheme and beneficial effect clearly understand, below in conjunction with drawings and Examples, this utility model is further elaborated.Should be appreciated that specific embodiment described herein is only in order to explain this utility model, be not used to limit this utility model.
In terms of the present utility model, " far-end " and " near-end " is appreciated that and observes from the direction of the doctor in charge.Far-end is remote from the side of the doctor in charge, and it relates to the parts of this utility model device being advanced in vascular system further, and near-end represents towards the doctor in charge, i.e. it is not far that the nearside arrangement component of this device is introduced in blood vessel.
In this utility model, if phrase " longitudinal direction " is with in this document, it is to be understood as the direction representing that this utility model device is pushed into, and the longitudinal axis of this device also overlaps along the longitudinal axis of its blood vessel moved forward with this device.It is defined as axially with longitudinally perpendicular direction.
Shown in Fig. 1, Fig. 3 and Fig. 4, a kind of taking thrombus device with bayonet fittings of this utility model, including taking bolt device 100, being positioned at the developing ring 300 taking bolt device 100 near-end and be positioned at the development circle 200 taking bolt device 100 far-end.Take webmaster shape or cage structure that bolt device 100 includes being made up of multiple unit grids 170 being coupled to each other, each unit grid 170 by interconnective muscle 120 around forming.This webmaster shape or cage structure can be collapsed folding under pressure and have self-expanding recovery capability in a free state, and, this webmaster shape or collapsing of cage structure fold and expand and can mutually change without difficulty.The inner space composition that webmaster shape or cage structure surround takes the exocoel 140 of bolt device 100.
Referring to, shown in Fig. 3 to Fig. 8, the muscle 120 of some unit grids 170 being respectively provided with bayonet fittings 110.Each bayonet fittings 110 extends in exocoel 140, and the space composition that some bayonet fittings 110 surround into takes the inner chamber 150 of bolt device 100, and inner chamber 150 is positioned at exocoel 140.Taking, collapse exocoel 140 and inner chamber 150 under folded state of bolt device 100 is overlapped.Utilize this structure, described bayonet fittings 110 can easily enter thrombosis inside and fix thrombosis firmly.Further, in removal process, exocoel 140 and inner chamber 150 can be overlapping and clamp thrombosis as clip, it is prevented that it comes off and flows to the blood vessel that far-end is tiny.
The side taking bolt device 100 is open or closed, it is preferred that open.Closed webmaster shape or the cage structure being interpreted as that unit grid 170 is interconnected to a closing, open be interpreted as unit grid 170 be interconnected to do not close, there are webmaster shape or the cage structure of open axial clearance 160 in its side, this axial clearance 160 has at least a place, it is possible to design has many places.As shown in Fig. 4, Figure 16 and Figure 17.With this structure, take bolt device 100 limitedly can fold in the axial direction in thinner blood vessel, makes taking bolt device and also applying in thinner blood vessel of bigger specification;Further, taking bolt device and can clamp thrombosis as clip after folding, it is prevented that it comes off and flows to the blood vessel that far-end is more tiny.
The near-end taking bolt device 100 is arranged to pyramidal structure 130, proximate expand gradually, and its tapering is 30 ° to 60 °.The advantage of this design is can greatly to reduce propelling resistance when taking bolt device 100 and reclaiming into guiding catheter.
Taking bolt device 100 and have oblong shape or oblong shape under self-expanding state, its length range is between 5 millimeters to 60 millimeters, and its diameter range is between 2 millimeters to 6 millimeters, to adapt to the anatomical structure of patient's intracranial vessel.
Bayonet fittings 110 is integrated with muscle 120 and is connected, and is shaped by heat treatment gradation.Bayonet fittings 110 is in arc-shaped or linearity, and bayonet fittings 110 is along the genesis analysis taking bolt device 100, and bayonet fittings 110 is along taking the longitudinal axis of bolt device 100 symmetrically or spaced apart.Symmetrical advantage is the quantity that can increase bayonet fittings 110, make it more effectively to thrust thrombosis, advantage spaced apart is to reduce the quantity of bayonet fittings 110 when ensureing thrombosis chucking power, can effectively reduce propelling movement resistance, make to take pin device and can arrive the intracranial vessel that diameter is less.
The longitudinal direction of the direction of bayonet fittings 110 and netted or cage structure angle at an angle, this angle is optional between 0~90 °, it is preferable that be 30 °~60 °.The angle of each bayonet fittings 110 is identical or different, and so the advantage of design is can to thrust thrombosis from different directions, increases and takes the bolt device crystallized ability to thrombosis.
This utility model gives the various embodiments that bayonet fittings 110 is arranged on muscle 120.Bayonet fittings 110 is symmetrical in dislocation, for first embodiment, as shown in Figure 5.Bayonet fittings 110 is slender type, spaced apart, is the second embodiment, as shown in Figure 6.Bayonet fittings 110 is tubbiness type, symmetrical between two, is the 3rd embodiment, as shown in Figure 7.Barb-like in from top to bottom of bayonet fittings 110, is the 4th embodiment, as shown in Figure 8.
Bayonet fittings 110 is arranged on the axially-aligned most significant end of unit grid 170 or the muscle 120 of least significant end.Bayonet fittings 110 is arranged on the muscle 120 of the unit grid 170 at webmaster shape or cage structure edge, as shown in Figure 8.Bayonet fittings 110 is arranged on the muscle 120 of the unit grid 170 of webmaster shape or cage structure pars intermedia, as shown in Figure 7.
Refer to shown in Fig. 9, the ratio of the length L1 of unit grid 170 and height H1, more than 1 and less than 2, is similar to diamond structure, and the advantage of this structure is easy to deformation, taking bolt device self-expanding expansion and retraction can be readily accomplished when subsiding folding.
The ratio of the length of bayonet fittings 110 and the height H1 of place unit grid 170 is 1/3 to 1, preferably, the length L2 of bayonet fittings 110 is the 1/2 to 2/3 of place unit grid 170 height, can change, by the different designs of the length L2 of bayonet fittings 110, the radial force taking bolt device 100 and thrombosis arrests power.
The ratio of the width W2 of the bayonet fittings 110 and width W1 of place muscle 120 is more than 1 and less than 2, and bayonet fittings 110 is more wide, and its intensity is more good, thrusts thrombosis more easy, but relative, and the overall compliance taking bolt device 100 also can be deteriorated, and pushes resistance and also can become big.
The surface-coated taking bolt device 100 has the coating containing anticoagulant or antiplatelet drug, to strengthen the mobility of blood, it is simple to take pushing of bolt device 100.
Developing ring 300 and development circle 200 all by can be visual under X ray material make, it is preferable that for platinum, platinoiridita, platinum-tungsten alloys, gold, silver etc..The not transmission X-ray label of the type adds to be located at and takes bolt device 100 proximally and distally so that the doctor in charge can monitor by imaging device location relative to each other and therapeutic advance thus improve the accuracy taking bolt.
Developing ring 300 and development circle 200 are connected with taking bolt device 100 by modes such as welding or crimp or be cementing.This connection should reach certain intensity, it is prevented that takes bolt device 100 and comes off in taking bolt process.
Take bolt device 100 to be made up of shape-memory material.The shape-memory material of this utility model indication refer in particular to generation be NiTi evanohm.Taking bolt device 100 is adopt NiTi evanohm to make via cut.
Shown in Fig. 4 and Figure 17, inner chamber 150 is less than exocoel 140 diameter, and the periphery tangent line of exocoel 140 and inner chamber 150 forms the angle α of 0~90 °.
Shown in Fig. 1 and Fig. 2; the invention also discloses a kind of thrombus treating apparatus; employ the above-mentioned taking thrombus device with bayonet fittings; this therapeutic instrument also includes protection sheath pipe 400, conveying silk 500, microtubular 600, guiding catheter (not shown) and rotates haemostatic valve (not shown), and the external diameter of microtubular 600 is less than the internal diameter of guiding catheter.Microtubular 600 is pushed to blood embolization place along guiding catheter in guiding catheter; protection sheath pipe 400 is interconnected with microtubular 600 by rotating haemostatic valve; take bolt device 100 and be placed in protection sheath pipe 400, conveying silk 500 be pushed in microtubular 600, and be pushed to blood embolization place.Guiding catheter has ratio for placing protection sheath pipe 400 and the bigger internal diameter of microtubular 600.So, whole thrombosis and be in the bolt device 100 that takes of its swelling state and can move and be placed in guiding catheter.During treating, microtubular 600 is also advanced to usually by guiding catheter, although guiding catheter can be pushed ahead until blood embolization position, but in the blood vessel that inner chamber is little especially, especially in intracranial area, only with the microtubular 600 that diameter is only small, take bolt device 100 and be placed in microtubular 600 and be transported to the enforcement of blood embolization position take bolt operation.
Conveying silk 500 is made up of the soft tinsel with certain rigidity.Should be appreciated that to expect purpose, the far-end of conveying silk 500; especially into intracranial vessel section, it is necessary to have enough rigidity, but simultaneously must be sufficiently flexible or flexible; make them can pass protection sheath pipe 400 or guiding catheter, and be damaged from blood vessel wall.Its length dimension should ensure that and will take pin device and be delivered to the position of thromboembolism.Protection sheath pipe 400 is made up of polymeric material.This polymeric material is politef.The internal diameter of protection sheath pipe 400 and length dimension should ensure that and the soft taking bolt device 100 and conveying silk 500 far-end is held protection wherein.
Referring to illustrating shown in Figure 10 to Figure 15 that the use taking thrombus device with bayonet fittings of the present utility model carries out the schematic diagram of taking thrombus operating process.The work process of thrombus treating apparatus of the present utility model is: when external pull acts on conveying silk 500, take bolt device 100 can flatly be folded in microtubular 600 and be transported to the far-end of thromboembolism position by microtubular 600, when microtubular 600 withdraw along proximal direction cause that taking bolt device 100 external pressure disappears time, take bolt device 100 self-expanding to launch, recovering to tubulose or cage structure, bayonet fittings 110 thereon thrusts captured thrombosis and is included in by thrombosis in empty inner chamber 150.Subsequently, taking bolt device 100 and microtubular 600 synchronizes proximally to withdraw until being finally rested in guiding catheter including of the present utility model, from vascular system, then removing described guiding catheter.In this way, it is possible to realize efficiently and safely removing thromboembolism thrombosis from relatively fine Ink vessel transfusing.
The foregoing is only preferred embodiment of the present utility model, not in order to limit this utility model, all any amendment, equivalent replacement and improvement etc. made within spirit of the present utility model and principle, should be included within protection domain of the present utility model.