DE102005053906A1 - Occlusion device e.g. for septal defects in medical technology, has interlaced structure of thin wires or threads whereby holder, on its free end, has top section with eyelet in form of cross bore - Google Patents

Abstract

Occlusion device (1) has an interlaced structure (2) of thin wires or threads (4). The holder (10), on its free end, has a top section (14) with an eyelet (16) in the form of a cross bore which can be received and retained by an implantation or explantation instrument (100,200) in a form-fit manner. An independent claim is also included for the method for coupling in a repeated manner.

Description

The The present invention relates to an occlusion device consisting made of a braid thinner wires which by means of a forming and heat treatment process a receives appropriate final shape and to implant or explant on the diameter one for an intravascular Surgery used catheter, with a proximal retention area, a distal retention area in which the ends of the wires or Threads in a version converge, and with a cylindrical bridge between the proximal retention area and the distal retention area, wherein the two retention areas after implantation on both sides one to be closed Shunts come to rest in a septum while the jetty passes through the shunt passes through. The invention further relates to a surgical kit for implantation and explanting an implant, in particular one above described Occlusionsinstrumentes. Finally, the present concerns Invention a method for repeatable coupling of an implant, in particular an occlusion instrument described above, to such a surgical kit.

In The medical technology has long been an endeavor to septal Defects, such as defects of the atrial septum, by means of a transvenous, interventional Access non-surgical, ie without surgery in the true sense, Catheterinterventionell close. There were different Occlusion systems proposed with different advantages and disadvantages without previously set a particular closure system through could. In the following, the various systems are called "occluder" or "occlusion devices". At all Interventional occlusion systems become transvenous over a present in a septum, a defect to be occluded a self-expanding Umbrella system introduced. Such a system could, for example consist of two umbrellas, each on the distal side (i.e., at the farther from the center of the body or from the heart) or at the proximal side (i.e. at the closer to the middle of the body positioned side) of the septum, and then the Both shield prostheses in the septal defect screwed into a double umbrella become. The closure system is thus then in the assembled State usually from two clamped Schirmchen, over a short, by the Defective passing pin are connected together. In such represents occlusion instruments known from the prior art However, it proves to be disadvantageous that the implantation procedure relatively complicated, difficult and expensive. Apart from the complicated implantation of the closure system in the septal defect to be closed In the case of the umbrellas used there is basically the risk of material fatigue with fracture of the sector. It is also common to expect thrombembolic complications.

Around to achieve that the Occlusionsinstrument invention means of an introducer or a guidewire introduced can be, is provided that the end of the distal retention area a socket which engages the introducer or guidewire can be brought. It is envisaged that the intervention after the positioning of the occlusion device in the defect again easily solved can be. For example, it is possible the braid at the end of distal retention area of the occlusion device such grasp that in the socket an internal thread is made, with the introducer engaged.

at the previously known nitinol wire mesh occluders, for example from AGA or JEN.meditec, the coupling is attached to the insertion wire as Screw thread executed. By means of insertion wire can the occluder in the catheter tube pushed back or forth. After Placement in the heart septum, the insertion wire is unscrewed and the Occluder final released. A correction is then no longer possible.

There the insertion wire and the coupling are relatively stiff, and the catheter in the minimally invasive Implantation of the occluder via the leg artery at anatomical reasons at a shallow angle the heart septum meets, becomes the occluder at its deployment held in an imbalance and the umbrellas can themselves do not put on both sides of the shunt. The surgeon can work in this Situation does not detect whether the Occluder in the uncoupled state will take its predetermined fit.

This results in a great uncertainty for the surgeon, in particular in that he can not reposition the decoupled occluder minimally invasive. To minimize these crucial disadvantages of the known systems, the claim of the present invention, namely the Occluder after positioning in the cardiac septum and the release from the introducer sheath all freedom of movement to give its self-unfolding and adaptation to the secreting septum defect to be closed, and not be forced by the introducer in a position that he would not take by itself and yet repositioned if necessary and can be brought back via the insertion kit. Of course, other embodiments are also conceivable here. At one their Occlusionsinstrumenttyp, the so-called lock-clamshell umbrella system, two are preferably provided with Dacron steel shades provided, which are stabilized by four arms. This type of occluder is implanted through a venous access of the patient. In the case of the lock clamshell occluder, however, it has proven to be problematic that the insertion set required for implantation has to be relatively large. Another disadvantage is that in other systems, eg. As the so-called "Anplatzer-Occluder", many different Occludergrößen are needed to meet the respective proportions of the septum defect to be closed.Such it has been found that the umbrellas in the inserted state does not flatten completely when the length or This results in incomplete endothelialization, and it has been shown that many of the systems implanted in the patient's body experience material fatigue and fractures in the metallic structures over an extended period due to significant mechanical stress This is especially the case when there are permanent stresses between the implant and the septum.

Around to overcome these disadvantages, Self-centering occlusion instruments were developed that by means of minimally invasive procedures, for example via a Catheter and guide wires, in the body introduced by the patient and in the to be closed Septum defect can be introduced. The construction is the case Principle that the occlusion device is based on the size of the intravascular surgical intervention used introducers or rejuvenate the catheter leaves. Such a rejuvenated Occlusion instrument is then over the catheter in the septal defect to be closed or in the one to be closed Shunt of the septal defect introduced. Afterwards the Occluder occurs from the catheter, followed by the self-expanding Umbrella or retention discs unfold, which are on both sides of the septum. The screens in turn contain, for example Fabric inserts made of Dacron or are covered by such, which closes the defect or shunt. The remaining in the body Implants become more or less after a few weeks to months Completely of endogenous tissue locked in.

One Example of a self-centering occlusion device of the beginning mentioned type and according to the preamble of claim 1 is known from WO 99/12478 A1, which is a Further development of the occlusion device known under the name "Amplatzer-Occluder" according to the US patent No. 5,725,552. It consists of a network of a variety fine, braided Nitinol wires in the form of a yoyo. That braid will be in its original Form produced as a round braid, which both at its beginning (or on its proximal side) as well as at its end (or on its distal side) has loose wire ends. For further processing of the round braid must then these loose ends are each taken in a sleeve and welded. After this appropriate further processing shows both the proximal Side as well as the distal side of the finished occluder respectively a protruding sleeve on. In the distal and proximal retention screen and in the Interposed web Dacron patches are sewn. by virtue of the "memory effect" of the used Nitinol material unfold the two retention screens Leaving the library independently. This is done first via a balloon-like intermediate, with the retention screens finally on either side of the septum final placed take a more or less flattened shape. Of the Footbridge centers during the Aufspannens the Schirmchen in the shunt to be closed independently. By protruding at the proximal retention area of the occluder Sleeve can However, the problem occurs that the implant used embolism-related problems, especially consecutive embolization, causes. Furthermore, a complete endothelialization of the Lock implant prevents.

Of Furthermore, WO 95/27448 A1 discloses a wire mesh existing occlusion device known. This instrument points but no version, so this Occluder also not, as is the case with the instruments described above the same way controlled by an introducer, introduced or - in the case a wrong seat - still can be removed again before uncoupling.

Of the The present invention is therefore based on the problem Such known from the medical technology and consisting of a mesh, to further develop a self-centering occlusion device, that the above-mentioned disadvantages can be overcome. Especially should be given an occlusion device, that for closure is applicable to defects of different sizes, the Implantation of Occluders done easily and also an explantation, z. B. should be possible for seat correction.

On the basis of this problem, the present invention has for its object to provide an occlusion device, which in the inserted state on the proximal side of the septal defect as flat as possible with the septum closes and after uncoupling is retrievable when a malposition is visible.

It is further an object of the present invention, a corresponding Surgical kit and a method for repeatable coupling an occlusion device to indicate such surgical instruments.

These The task is with an occlusion device of the aforementioned Type according to the invention thereby solved, that the socket at its free end a head portion with an eyelet in the form of a Transverse bore, the form-fitting of an implantation or explantation can be grasped and held. Alternatively, the task in a Occlusionsinstrument the aforementioned ax according to the invention thereby solved that the version at its free end a semispherical in longitudinal section as centering trained head section with an eyelet in the form of a transverse bore has and by means of a running through the eyelet fastening loop can be kept on an implant or explantation cutlery.

The underlying the present invention procedural The object is alternatively achieved by the method steps of patent claims 18, 19 or 20 solved.

present So it's going to be a solution the invention provided Task an entire system disclosed consisting of an implant in the form of an occlusion device, a matching surgical kit and a corresponding method of using that surgical instrument.

The Advantages of the invention are, in particular, that an intravascular occlusion device, especially for the treatment of septal defects, wel ches with a suitably trained surgical instrument for implantation reliable grab and check the Seat of Occlusionsinstrumentes again from the surgical kit can solve, with It should be emphasized that re-grasping the occlusion device, for example, to change his seat or for immediate explantation, is readily possible.

to Training the version of the Occlusionsinstrumentes according to the invention three alternative embodiments proposed.

To the one, the head portion of the socket formed as a ball head be, with the inner sides of the jaws of the grasping forceps of the surgical kit are formed according to the ball head shape such that a form-fitting Grasping that ball head with the grasping forceps of the surgical kit guaranteed is. So that a renewed gripping the ball head readily possible is after the connection between the surgical instrument and the Occlusion instrument solved The surgical kit has a guide thread or guide wire on, in the delivery state of the surgical kit at the proximal end in the form of a loop from the grasping forceps of the surgical kit protrudes and both loose ends by the surgeon in the area held the handle of the surgical kit or previously attached there become. With this guide or guidewire it is easily possible the grasping forceps of the surgical kit again with the Head section of the socket of Occlusionsinstrumentes connect and thus the occlusion device again - for example, for a repositioning or to explant - too to grab.

According to one second embodiment the socket of the occlusion device is the eyelet of the head section obliquely to the transverse bore slotted, wherein the ends of the inclined slot with respect to the the longitudinal direction overlap the transverse bore. This will make it possible the guide or Guidewire the as-delivered condition of the surgical instrument at its proximal End in the form of a loop protruding from the tongs, through the slanted slot into the eye the version of the Occlusionsinstrumentes hang, with the overlapping Ends of the slanted slot ensure, that the guide thread or guidewire not readily, and especially not after the guide thread or guidewire was cocked by the surgeon, unintentionally escape from the eyelet and yet intends by inclining the loop out the eyelet can be moved.

Preferably are the mutual exit sectional areas of the transverse bore with the lateral surface the ball head to the free end of the socket converging ausgebil det. This has the advantage that there are no sharp edges that the guide thread or guidewire to damage could and above addition is a threading the loop of the guide thread or guidewire through the eyelet the version of the first embodiment easier possible. After all but brings the converging formation of the exit intersections of the Transverse bore a material and weight savings with it.

According to a third embodiment of the version of the Occlusionsinstrumentes the head portion is formed as a longitudinal section in a semispherical centering sleeve and also with a Provide eyelet in the form of a transverse bore. To connect to the appropriate surgical kit, a loop, for example, surgical suture pulled by the eyelet, and adhering to a defined width of the fastening loop whose both ends are knotted and hooked to the hook of the appropriate surgical kit. While in the first and second embodiments of the head portion of the socket tensioning of the guide wire was performed manually by the operator pulling on one or both loose ends of the guide wire, the tightening of the fixing loop in the third embodiment is done by retracting the guide wire Hook inside the surgical kit.

Preferably includes the push and pull system of the surgical kit for the first and second embodiment following components: A spiral spring, through whose interior in axial direction an axially sufficient stiff, but sufficiently flexible actuator runs on whose proximal end a shaft of the gripping tongs is attached, and at its distal end a first handle. Furthermore included the push and pull system a cone sleeve, in its proximal end portion the shaft of the gripping tongs is received axially displaceable, and in its distal end portion, the proximal end of the coil spring butting against a stop is included. After all belongs also a second grip in addition, in which the distal end of the coil spring against a stop poking is received, wherein the gripping jaws by the outside fitting proximal end of the cone sleeve under the effect of force close the coil spring and open by advancing the actuator. The Advantages of this push and pull system are essentially in the simplicity and concomitant reliability of its components and in a secure gripping and releasing of the socket of the implant.

Of the control thread or guidewire, the as-delivered condition of the surgical instrument at its proximal End in the form of a loop sticking out of the tongs, and the with both loose ends through the inside of the cone sleeve and the interior of the coil spring to the first handle at the distal end of the surgical kit guided is in the first embodiment the socket with its loop before implanting the implant through the eyelet passed the version of the implant and attached to the gripper. A tensioning of the guide thread or guidewire leads to a Connection of the surgical instrument to the socket of the occlusion device, which can happen repeatedly while maintaining the connection. Thus, the connection between the surgical instrument and the Occlusion instrument, for example, initially - except for the guide thread or guide wire - to be loosened, to check the seat of the implant, and can with the help of the leadership thread or guidewire be easily restored if the seat of the implant changed and thus the version of the implant again with the surgical kit must be seized. Also for in the event that it becomes necessary to re-explant the implant, is thus a simple restoration of the connection between Surgical instruments and implants possible. In contrast, will the loop in the second embodiment through the oblique slot into the eye hooked and not, as in the first embodiment, passed through the eyelet.

Either in the first embodiment as well as the second embodiment the socket is a first loose end of the guide thread or guidewire in the area of the first grip attachable while the second loose end of the guide thread or guidewire provided with a nipple, by means of which the guide thread or wire either in the coupled state of the implant tensioned or can be pulled out of the surgical kit after the connection the first end with the handle solved has been. In the second embodiment the socket can hold the loop of the guide thread or guide wire through the slanted slot from the eyelet be moved out after at least one loose end of the guide thread or guidewire was loosened.

Preferably is the guide or guidewire from Nitinoldraht, from which, for example, the braid of Occlusion instrument itself can exist. Nitinol has turned out to be one for such Interventions proven Material proved.

For the third embodiment of the version of a Occlusionsinstrumentes a surgical kit is provided with a hook, which by means of a push and pull system axially on the eyelet to or away from her wegbewegbar, wherein a running through the eyelet and hooked into the hook fastening loop used comes by means of which the implant can be held by tightening the fastening loop on the surgical instrument when the hook is moved away from the eyelet. The advantage of this embodiment of the surgical kit is, in particular, that the guide thread or guide wire described in the other two embodiments is replaced by the attachment loop and thereby pulling on the loose ends of the guide thread or guide wire for tensioning the entire device is no longer necessary, but this tightening is done by pulling back the hook, which can be done by appropriate operation of the surgical kit.

For the third embodiment of the surgical cutlery essentially shows the push and pull system following components: A spiral spring, through whose interior in the axial direction an axially sufficiently stiff, but still sufficiently flexible actuating means runs, at the proximal end of a shaft of the hook is attached, and at the distal end of a first handle is attached; a cylindrical one sleeve, in its distal end portion, the proximal end of the coil spring butting against a stop is received and in which the shank of the hook axially displaceable is included; and a second handle in which the distal End of the coil spring is received against a stop abutting, wherein the hook under the action of the force of the coil spring from the eyelet axially moved away and moved by advancing the actuating means on the eyelet can be. Also, this push and pull system allows a very simple and reliable Handling of the occlusion device before and during the surgical procedure.

Around the connection of the eyelet the socket of the Occlusionsinstrumentes running fastening loop to further simplify with the push and pull system is preferred provided that the cylindrical sleeve at the proximal end a consistent first longitudinal groove has, in the central region a one-sided second longitudinal groove for non-twisting guide in the sleeve axially movable hook, and at right angles to the one-sided second longitudinal groove a transverse groove, which up to the longitudinal axis the sleeve ranges and in the middle an extension for the admission of a knot of Has fastening loop. The extension ensures the recording of the knot of the fastening loop among other things also for that the fastening loop a tight fit within the transverse groove Has.

Around a secure gripping the fastening loop through the hook guarantee is preferably provided that the cross section of the front portion of the hook opposite the section of the shaft formed flattened by about one-third is and fits with play in the second longitudinal groove of the cylindrical sleeve.

To the Disconnecting the connection between the surgical kit and the socket of the implant is at the distal end of the hook formed behind the hook Fensters provided a knife edge.

In Advantageously, as a material for the actuating means of the surgical instrument used a wire rope. However, every one else could Material which is axially sufficient stiff, but still flexible enough to be used.

In the following, the three mentioned embodiments of an occlusion device and correspondingly three embodiments of a surgical instrument as well as the three different methods for the repeatable coupling of an implant or occlusion device to the respective surgical instruments will be described in more detail with reference to a drawing. In this case, the embodiment 1 in the 1 to 7 shown, the embodiment 2 in the 8th to 14 , and the embodiment 3 in the 15 to 24 ,

It demonstrate

1 a side view of a first embodiment of a Occlusionsinstrumentes with appropriate surgical kit according to embodiment 1;

2 an enlarged sectional view of the partial section "A" according to 1 ;

3 a perspective view of an exemplary Occlusionsinstrumentes;

4 an enlarged side view of a first embodiment of a version of the Occlusionsinstrumentes;

5 a perspective view of the socket according to 4 ;

6 an enlarged detail view of the grasping forceps with guide wire and socket of Occlusionsinstrumentes;

7 a view of the front portion of the surgical instrument and a full-line Occlusionsinstrumentes;

8th a side view of a surgical instrument with Occlusionsinstrument on the guide wire or wire according to a second embodiment;

9 a partial sectional view of the front portion of the surgical instrument with the Occlusionsinstrument on the guide wire or wire according to 8th ;

10 an enlarged side view of a socket of Occlusionsinstrumentes according to embodiment 2;

11 a perspective view of the socket according to 10 ;

12 a simplified view of the front portion of the surgical instrument with grasping forceps and guidewire and Occlusionsinstrument;

13 an enlarged detail view of the section "A" according to 12 ;

14 a view of the front portion of the surgical instrument with grasping forceps and Occlusionsinstrument with hinged guide wire loop;

15 a shortened sectional view of a surgical instrument with attached Occlusionsinstrument according to embodiment 3;

16 a partial sectional view according to "B" in 15 ;

17 a section through the front portion of the surgical instrument with coupled Occlusionsinstrument;

18 an enlarged side view of the socket of an occlusion device according to embodiment 3;

19 a perspective view of the socket according to 18 ;

20 an enlarged perspective view of the cylindrical sleeve according to embodiment 3;

21 an enlarged perspective view of the hook according to 17 ;

22 a perspective view of the front portion of the surgical kit according to the third embodiment with coupled version of an occlusion device;

23 a perspective view similar 22 ; and

24 an enlarged perspective view of the front portion of the surgical kit according to embodiment 3 with an occlusion device for illustrating the coupling by means of a fastening loop.

The 1 and 2 show a side view and a partial section of a first embodiment of a surgical kit 100 for implanting and explanting an implant, which is an example of an implant to an occlusion device 1 is coupled. The surgical kit 100 has a grasping forceps 102 on, their jaws 103 . 104 . 105 can be opened and closed by means of a push and pull system. The inner surfaces of the jaws 103 . 104 . 105 are formed such that they form the spherical head portion 14 the version 10 can embrace the implant positively. The push and pull system has essentially the following components: A spiral spring 106 , by the inner in the axial direction of an axially sufficiently stiff, yet sufficiently flexible actuating means 107 runs, at the proximal end of a shaft 111 the tongs 102 is attached, and at its distal end a first handle 108 is appropriate. Furthermore, the push and pull system has a tapered sleeve 109 in, in its proximal end portion 112 the shaft 111 the tongs 102 is received axially displaceable, and in the distal end portion 113 the proximal end of the coil spring 106 against a stop 114 abutting is recorded. Furthermore, the push and pull system essentially has a second handle 110 in which the distal end of the coil spring 106 is received abutting against a stop, with the jaws 103 . 104 . 105 through the externally fitting proximal front end 115 the cone sleeve 109 under the effect of the force of the coil spring 106 close and by advancing the actuator 107 to open. A particularly important part of this surgical instrument 100 a guide thread or guide wire 116 on, in the as-delivered condition of the surgical kit 100 at its proximal end in the form of a loop 117 out of the tongs 102 sticking out, and the one with both loose ends 118 . 119 through the inside of the cone sleeve 109 and the interior of the coil spring 106 to the first handle 108 at the distal end of the surgical kit 100 is guided, with the loop 117 before implanting the implant through the eyelet 16 the version 10 of the implant can be guided and on the gripping tongs 102 at an attachment point 101 is fastened. The guide thread or guide wire 116 has a first loose end 119 on, which in the area of the first handle 108 attachable, and a second loose end 118 which with a nipple 120 is provided, with the help of the guide wire or wire 116 either in the coupled state of the implant tensioned or out of the surgical instrument 100 is removable after the connection of the first end 119 with the first handle 108 was solved. This extraction of the guide thread or guide wire from the surgical instrument 100 happens only when the implanted occlusion device has the desired by the surgeon seat. If this is not the case, the guide or guidewire is used 116 to that the surgeon the grasping forceps 102 of the surgical kit 100 easily with the head section again 14 the version 10 of the Occlusi onsinstrumentes 1 connect, so the jaws 103 . 104 . 105 the tongs 102 the spherical head portion 14 the version 10 can grip safely and positively.

3 shows, for example, an occlusion device, which with a version according to the invention 10 can be provided. This occlusion device essentially consists of a mesh 2 thin wires or threads 4 which is given a suitable final shape by means of a reshaping and annealing process and for implantation or explantation to the diameter of a catheter used for intravascular surgery 5 rejuvenates. The occlusion device has a proximal retention area 6 on, and a distal retention area 8th in which the ends of the wires or threads 4 in a version 10 converge, and a cylindrical bridge 12 between the proximal retention area 6 and the distal retention area 8th where the two retention areas 6 . 8th after implantation come to rest on either side of a shunt to be occluded in a septum, while the bridge 1 passes through the shunt. Thus, the occlusion device is particularly useful for treating septal defects, where the instrument is for delivery via a catheter 5 suitable for the defect to be closed. By doing that, the proximal retention area 6 of the braid 2 a single-disk-shaped flattening towards the proximal end of the occlusion device can be achieved in a particularly advantageous manner in that the occlusion device - regardless of the proportion of the diameter of the defect to be occluded and independent of the thickness of the septal wall - of the defect in the septal wall independently adapts, in such a way that on the proximal side of the defect no parts of the occlusion device protrude beyond the plane in which the septal wall is located with the defect. Thus, the usual associated complications no longer occur. In other words, this means that the occlusion device used is completely enclosed by the body's own tissue much faster than in the closure systems known from the prior art. From the use of a mesh constructed of thin wires or filaments as a starting material for the occlusion device according to the invention, the further advantage derives from having a long-term mechanical stability. Thus, the occurrence of cracks in the structure of the implant used can be largely prevented. Furthermore, the braid has sufficient rigidity. The disc-shaped shape of the mesh towards the proximal end 2 without a hub additionally allows the proximal retention area 6 of the occlusion device in the inserted state completely flattened on the rim of the defect. Thus, the occlusion device can be used over a wide range of septum defects of different sizes. This, that the braid 2 can taper to the diameter of a catheter used in intravascular surgery procedures, it is possible to introduce the occlusion device, for example, through a vein, so that an open surgery in the true sense is no longer necessary. Because the braid 2 is made of a material having a shape memory or "memory" effect, the occlusion device can also be referred to as a "self-expanding instrument", which unfolds automatically upon exiting the catheter, so that the two retention areas 6 . 8th can apply accordingly to the proximal or distal defect side.

4 shows an enlarged side view of a first embodiment of a socket 10 such an occlusion device. This version 10 has at its free end a head portion 14 with an eyelet 16 in the form of a transverse bore, the head portion 14 positive fit from the surgical instrument 100 can be grasped and held.

5 shows a perspective view of the socket according to 4 , On the basis of this illustration, it can be seen that the mutual exit cut surfaces 18 . 20 the transverse bore with the lateral surface of the ball head to the free end of the socket 10 are converging formed.

6 shows an enlarged detail view of the surgical instrument 100 with the through the eyelet 16 extending guidewire 116 in the form of a loop 117 on the shaft 111 the tongs 102 is mounted (cf. 2 , Attachment point 101 ). Based on this representation, it can be seen that the gripping tongs 102 provided in the front area with an outer cone and by means of longitudinal grooves in three gripping jaws 103 . 104 . 105 divided, which in the case of the conical shaft at the proximal end face 115 the cone sleeve 109 shut down. Here are the gripping jaws 103 . 104 . 105 Turned shell-shaped, around the spherical head section 14 the version 10 to grip positively. The shaft 111 the tongs 102 is flattened to the loop 117 of the guide thread or guidewire 116 inside the cone sleeve 109 to be able to lead past. The loop 117 is prepared in such a way that it comes out of the gripping pliers when it is delivered 102 protrudes (s. 7 ). The loose ends 118 . 119 of the guide thread or guidewire 116 be through the slots of the tongs 102 and by the coil spring 106 guided and are on the first handle 108 attached to the handle, with the first loose end 118 in addition with a nipple 120 provided that the Guide wire or wire easier to grip and tension.

7 shows a simplified view of the front portion of the surgical kit 100 with the cone sleeve 109 , the tongs 102 , the spiral spring 106 and the actuating means 107 , Front of the tongs 102 and already through the eyelet 16 of the head section 14 the version 10 guided is the loop 117 of the guide thread or wire 116 recognizable. The section highlighted by circle "A" represents the enlarged detail view 6 represents.

For coupling the occlusion device 1 becomes the loop 117 of the guide thread or wire 116 through the eyelet 16 brought and at a designated attachment point 101 (S. 2 ) on the shaft 111 the tongs 102 suspended. That the loop 117 forming thread or wire material of the guide thread or wire 116 runs in each case a slot between the jaws 103 . 104 and 105 , currency rend the receding ends in the third slot between the gripping jaws 104 . 105 run. Will the tongs 102 in the cone sleeve 109 by tensioning the guide thread or wire 116 withdrawn, the loop may be 117 do not hang out anymore. The loop 117 is then on the nipple 120 pulled so far, until the spherical head section 14 the version 10 in the jaws 103 . 104 . 105 the tongs 102 sunk. The other, not with the nipple 120 provided loose ends 119 of the guide thread or wire 116 is suitably in the range of the second handle 108 attached.

The following is a method of repeatedly coupling an implant having a socket as described above 10 , in particular an occlusion device 1 , to the surgical kit 100 described:
In a first step, the loop becomes 117 of the guide thread or guidewire 116 before beginning the intravascular surgical procedure through the eyelet 16 the version 10 guided the implant and at a designated attachment point 101 on the tongs 102 hung while the first and second loose end 119 . 118 of the guide thread or guidewire 116 held or in the area of the first handle 108 be attached. In a second step, the head section 14 the version 10 of the implant with the grasping forceps 102 resorted. In a third step this is done with the nipple 120 provided second loose end 118 of the guide thread or guidewire 116 curious until the head section 14 in the jaws 103 . 104 . 105 is completely recorded. By loosening it with the nipple 120 provided second loose finish 118 can the tongs 102 again from the head section 14 of the implant dissolved and the seat of the implant to be checked. With the help of the guide thread or wire 116 is at any time a Wiederankoppelung the gripper 102 to the version 10 of the implant possible.

The 8th and 9 show a shortened side view and a partial section of a second embodiment of a surgical kit 200 with an occlusion device to be coupled 1 which is a version 10 a second embodiment of the present invention. Here are the same components of the surgical kit 200 and the occlusion device 100 again with the reference numerals of 1 and 2 Mistake. The difference between this second embodiment of the occlusion device 1 or the second embodiment of the surgical kit 200 and the same parts of the first embodiment is the formation of the head portion 14 the version 10 of the occlusion device 1 and in the application and guidance of the guidewire 116 , which is already based 9 becomes clear: There is the loop 117 of the guide thread or wire 116 not with both threads or wires through the eyelet 16 of the head section 14 guided, but runs only with a thread through that eyelet 16 and will be otherwise with both its loose ends 118 . 119 through the inside of the cone sleeve 109 and the interior of the coil spring 106 to the first handle 108 at the distal end of the surgical kit 200 guided. The connection of the guide thread or wire 116 with the head section 14 the version 10 will be described below on the basis of 10 and 11 described.

The 10 and 11 show an enlarged side view ( 10 ) or a perspective view ( 11 ) of a second embodiment of a socket 10 an occlusion device 1 , This second embodiment differs from the first embodiment according to FIGS 4 and 5 in that the eyelet 16 of the head section 14 slotted obliquely to the transverse bore, with the ends 22 . 24 of the slanted slot 26 overlap with respect to the longitudinal direction of the transverse bore. Otherwise, this second embodiment also has the head section 14 a ball-head shape, and the mutual exit cut surfaces 18 . 20 the transverse bore with the lateral surface of the ball head are the free end of the socket 10 formed converging. Because of the eyelet 16 a slanted slot 26 can, the loop can 117 of the guide thread or guidewire 116 into the eye 16 be moved in without a loose end 118 . 119 of the guide thread through the eyelet 16 thread through or the entire loop 117 through the eyelet 16 pass it and on the shaft 111 the tongs 102 to have to hang. Of the oblique slot 26 thus allows a particularly simple hooking the loop 117 ,

The eyelet 16 has the advantage that the loop 117 in the same way can be removed at any time, namely, when the surgeon correct the occlusion instrument 1 has established and the surgical kit 200 from the occlusion device 1 finally to be solved. This is the loop 117 from the eyelet 16 and from the entire surgical kit 200 as in the first embodiment by pulling on one of the loose ends 118 . 119 , but preferably with the nipple 120 provided second loose finish 118 , withdrawn.

12 shows a simplified representation of the front portion of the surgical kit 200 with the from the top of the tongs 102 outstanding loop 117 and the occlusion device to be coupled 1 Everything according to the second embodiment.

13 shows an enlarged detail view of the tongs 102 with the between the jaws 103 . 104 . 105 (the jaws 104 . 105 are not visible in this illustration) outstanding loop 117 of the guide thread or guidewire 116 ,

14 shows a similar representation as 12 , where in 14 the surgical kit 200 already with the occlusion device 1 connected is.

The push or pull system of the second embodiment of the surgical kit 200 consists of the same components as described above for the first embodiment.

The following is the method of repeatedly coupling an implant to a socket 10 of the second embodiment, in particular an occlusion device 1 , to a surgical kit 200 described in the second embodiment: In a first step, the loop 117 of the guide thread or guidewire 116 prior to the beginning of the intravascular surgical procedure through the slanted slot 26 into the eye 16 in the version 10 of the implant introduced while the first and second loose ends 119 . 118 of the guide thread or guidewire 116 held or in the area of the first handle 108 be attached. In a next step, the header section becomes 14 the version 10 with the grasping forceps 102 resorted. Then that's with the nipple 120 provided second loose end 118 of the guide thread or guidewire 116 curious until the head section 14 in the jaws 103 . 104 . 105 is completely recorded. By loosening it with the nipple 120 provided second loose finish 118 can the tongs 102 again from the head section 14 of the implant dissolved and the seat of the implant to be checked. With the help of the guide thread or guidewire 116 is at any time a Wiederankoppelung the gripper 102 to the version 10 of the implant possible. Should the occlusion instrument 1 finally from the surgical kit 200 are separated, the guide thread or wire 116 by pulling on the one with the nipple 120 provided second loose finish 118 be pulled out of the surgical kit. When pulling out, it is important that the sling 117 flexible enough to wind around the tight radii and the deflection points at the eyelet 16 or the tongs 102 have no sharp edges. Regarding the eyelet 16 This is, as described above, ensured by the fact that the mutual exit cut surfaces 18 . 20 the transverse bore with the lateral surface of the ball head to the free end of the socket 10 are converging formed. In addition, the use of thin, super-elastic nitinol wire as Füh tion thread or wire 116 particularly suitable, although surgical suture can be used.

The 15 . 16 and 17 show a shortened sectional view ( 15 ) and a detailed perspective view according to circle "B" in 15 and a sectional view through the front region of a surgical instrument 300 with an occlusion device 1 all in the third embodiment. The surgical kit 300 essentially has a hook 302 on, by means of a push and pull system axially on the eyelet 16 of the head section 14 the version 10 of the occlusion device 1 to or from her wegbewegbar is, further one through the eyelet 16 running and in the hook 302 hook-in fastening loop 301 by which the implant by tensioning the fastening loop 301 at the surgical kit 300 can be held when the hook 302 from the eyelet 16 is moved away. In this case, the push and pull system essentially has the following components: First, a coil spring 106 , by the interior of which in the axial direction an axially sufficiently rigid, but nevertheless sufficiently flexible actuating means 107 runs, at the proximal end of a shaft 303 of the hook 302 is attached, and at its distal end a first handle 108 is appropriate. Furthermore, the push and pull system essentially has a cylindrical sleeve 304 on, in its distal end portion 113 the proximal end of the coil spring 106 against a stop 114 is abutting, and in the shaft 303 of the hook 302 is received axially displaceable, and in which the shaft 303 of the hook 302 is received axially displaceable. Finally belongs to the push and pull system of this third embodiment yet second handle 110 in which the distal end of the coil spring 106 is received abutting against a stop, with the hook 302 under the effect of the force of the coil spring 106 from the eyelet 16 moved axially and by advancing the actuator 107 on the eyelet 16 can be moved.

The 18 and 19 show an enlarged side view and an enlarged perspective view of the third embodiment of a socket 10 of the occlusion device 1 , This third embodiment differs from the other two embodiments in that the socket 10 at its free end a longitudinal section semispherically formed as a centering head section 14 with an eyelet 16 in the form of a transverse bore and the socket 10 by means of an eyelet 16 extending fastening loop 301 at the surgical kit 300 can be held (cf. 16 and 17 ).

20 shows a perspective view of the cylindrical sleeve 304 of the surgical kit 300 according to the third embodiment. The cylindrical sleeve 304 points to the proximal end 304 a continuous first longitudinal groove 306 on, in the middle region a unilateral second longitudinal groove 307 for torsion-proof guidance of the axially movable hook in the sleeve 302 , and at right angles to the unilateral second longitudinal groove 307 a transverse groove 308 , which up to the longitudinal axis of the sleeve 304 enough and in the middle an extension 309 for receiving a node 311 the fastening loop 301 has. Here is the second longitudinal groove 307 formed so that it the circumference of the sleeve 304 penetrates from the outer diameter to the inner diameter.

21 shows a perspective view of the hook 302 with his shaft 303 , The cross section of the front section of the hook 302 is opposite the cross section of the shaft 303 formed flattened by about one third, which is indicated by the reference numeral 314 is designated. This fits that flattened front portion of the hook 302 with play in the second longitudinal groove 307 the cylindrical sleeve 304 ( 20 ). Behind the top of the hook 302 is a material-free window 315 formed, which at its distal end a knife edge 310 having.

22 shows a perspective view of the front portion of the surgical kit 300 , which by means of the fastening loop 301 loose on the socket 10 of the occlusion device 1 is coupled. This is the attachment loop 301 in the transverse groove 308 inserted in such a way that the node 311 the fastening loop 301 in an extension 309 the transverse groove 308 to lie down while the thread of the fastening loop 301 the cylindrical sleeve 304 in the transverse groove 308 crossed diametrically. This is the transverse groove 308 designed such that the node 311 the hinged fastening loop 301 can not escape laterally.

23 shows one of the 22 similar representation, although dashed in the cylindrical sleeve 304 inserted hooks 302 is recognizable. By defined advancement of the hook 302 namely slips the fastening loop 301 while avoiding the second longitudinal groove 307 over the top of the hook and stays in the window formed behind it 315 lie. The knot of the fastening loop 301 is located in one of the lateral chambers, which are flattened 314 of the hook 302 be formed. By pulling back the hook 302 we use the occlusion device 1 with his version 10 and the front side 305 pulled the cylindrical sleeve and with the surgical kit 300 braced. The fastening loop 301 runs out of the continuous first longitudinal groove 306 on both sides and on the circumference of the sleeve 304 along until you get back to the cross-road 308 inside and behind the hooks 302 to be led. Thus, the occlusion device 1 Free of play on the push and pull system of the surgical kit 300 docked and can be in a catheter 5 (not shown here) are used.

For the final decoupling of the occlusion device 1 from the surgical kit 300 be in the second handle 110 located attacks 312 . 313 released, being the hook 302 defined can be pushed further forward. Here comes the at the distal end of the window 315 behind the top of the hook 302 arranged knife edge 310 for use. When retracting the surgical kit is namely the attachment loop 301 within the transverse groove 308 diametrically stretched and can thus by advancing the hook 302 from the knife edge 310 be severed. As a result, it dissolves when retracting the surgical kit 300 the knotless end of the fastening loop 301 from the eyelet 16 the version 10 with the other end of the attachment loop 301 with the node 311 inevitably within the transverse groove 308 and on the hook 302 remains.

24 shows one of the 23 similar representation, whereby here at the version 10 also the occlusion instrument 1 what is shown by means of the version 10 and by means of the fastening loop 301 in the transverse groove 308 the sleeve 304 is mounted.

The following is the method of repeatedly coupling an implant to a socket 10 the third embodiment, in particular that of an occlusion instrument 1 , to a surgical kit 300 described in more detail:
In a first process step is at the eyelet 16 the version 10 of the implant a fastening loop 301 fixed length fixed. Then the fastening loop 301 so in the transverse groove 308 the cylindrical sleeve 304 used that knot 311 the fastening loop 301 centered by the extension 309 fits and in the transverse groove 308 lying next section of the fastening loop 301 is held diametrically. By defined advancement of the hook 302 then slips in the transverse groove 308 lying portion of the fastening loop 301 while avoiding the second longitudinal groove 307 over the hook 302 and stays anchored there. By pulling back the hook 302 will be the version 10 of the implant to the proximal end face 305 the sleeve 304 pulled and braced. By again defined advancement of the hook 302 becomes the attachment loop 301 loose again and the proximal end 305 the sleeve 304 dissolves from the socket 10 and the seat of the implant can be checked. With the help of the fastening loop 301 is at any time a Wiederankoppe ment of the sleeve 304 to the version 10 of the implant possible. Inadvertent release of the occlusion device 1 from the surgical kit 300 is prevented by the following measures: First, the fastening loop 301 in the tensioned state not even from the hook 302 slip off. Second, the attachment loop 301 not in the loose state of the hook 302 slip, because the hook opening through the surrounding sleeve 304 closed is. Third, the catch 302 within the second longitudinal groove 307 the sleeve 304 secured against rotation, so that the hook opening also not in front of the transverse groove 308 can lay. Fourth, the knife edge remains 310 in that by the stops 312 . 313 in the second handle 110 secured condition behind the transverse groove 308 and can use both the relaxed and the tensioned attachment loop 301 do not touch or sever. Finally, the knife edge 310 in the window 315 of the hook 302 only in a conscious and intended interaction of the operating elements of the surgical instrument 300 and by its easy retraction against the tensioned fastening loop 301 be guided to sever these. Only when slightly withdrawing the surgical kit 300 the fastening loop spans 301 diametrically through the transverse groove 308 and only by defined advancement of the hook 302 with his knife edge 310 can the attachment loop 301 be severed.

reference numeral

1

occlusion device

2

weave

4

Wires or threads

5

catheter

6

proximal retention area

8th

distal retention area

10

version

12

web

14

header

16

Eyelet

18 20

Exit cut surfaces

22 24

Ends of 14

26

oblique slot

100 200, 300

In the- or explantation / surgical kit

101

Attachment point for 117 at 102

102

tongs

103 104, 105

jaws

106

spiral spring

107

actuating means

108

first grip

109

cone sleeve

110

second grip

111

shaft

112

end

113

end

114

Stop in 109

115

proximal end-face v. 109

116

control thread or guidewire

117

loop

118 119

Ends of 116

120

nipple

301

fastening loop

302

hook

303

Shank of 302

304

shell

305

proximal front

306

first longitudinal groove

307

second longitudinal groove

308

transverse groove

309

extension

310

knife edge

311

Knot of 301

312 313

Attacks in 110

314

flattening

315

Window behind 302

Claims (20)

Occlusion instrument consisting of a braid ( 2 ) thin wires or threads ( 4 ), which receives a suitable final shape by means of a forming and heat treatment process and for implanting or explanting on the a catheter used for an intravascular surgical procedure ( 5 ), with a proximal retention area ( 6 ), a distal retention area ( 8th ), in which the ends of the wires or threads ( 4 ) in one version ( 10 ), and with a cylindrical web ( 12 ) between the proximal retention area ( 6 ) and the distal retention area ( 8th ), the two retention areas ( 6 . 8th ) after implantation on both sides of a shunt to be closed in a septum come to rest, while the bridge ( 12 ) passes through the shunt, characterized in that the socket ( 10 ) at its free end a head portion ( 14 ) with an eyelet ( 16 ) in the form of a transverse bore, the form-fitting of an implantation or explantation ( 100 ; 200 ) can be grasped and held. Occlusion instrument according to claim 1, characterized in that the head section ( 14 ) is designed as a ball head. Occlusion instrument according to claim 1 or 2, characterized in that the mutual exit cut surfaces ( 18 . 20 ) of the transverse bore with the lateral surface of the ball head to the free end of the socket ( 10 ) converging are formed. Occlusion instrument according to one of claims 1 to 3, characterized in that the eyelet ( 16 ) slotted obliquely to the transverse bore, wherein the ends ( 22 . 24 ) of the inclined slot ( 26 ) overlap with respect to the longitudinal direction of the transverse bore. Occlusion instrument consisting of a braid ( 2 ) thin wires or threads ( 4 ), which receives a suitable final shape by means of a forming and heat treatment process and for implanting or explanting to the diameter of a catheter used for an intravascular surgical procedure ( 5 ), with a proximal retention area ( 6 ), a distal retention area ( 8th ), in which the ends of the wires or threads ( 4 ) in one version ( 10 ), and with a cylindrical web ( 12 ) between the proximal retention area ( 6 ) and the distal retention area ( 8th ), the two retention areas ( 6 . 8th ) after implantation on both sides of a shunt to be closed in a septum come to rest, while the bridge ( 12 ) passes through the shunt, characterized in that the socket ( 10 ) at its free end a semispherical longitudinal section in the form of a centering sleeve head portion ( 14 ) with an eyelet ( 16 ) in the form of a transverse bore and by means of a through the eyelet ( 16 ) extending fastening loop ( 301 ) on an implant or explantation cutlery ( 300 ) can be held. Surgical cutlery ( 100 ; 200 ) for implanting and explanting an implant with a socket ( 10 ) according to one or more of claims 1 to 5, in particular an occlusion device, characterized by a grasping forceps ( 102 ), whose gripping jaws ( 103 . 104 . 105 ) can be opened and closed by means of a push and pull system and are formed on the inside in such a way that they cover the head section ( 14 ) of the version ( 10 ) of the implant can engage around positively. Surgical cutlery ( 100 ; 200 ) according to claim 6, characterized in that the push and pull system essentially comprises the following components: a coil spring ( 106 ), through the interior of which in the axial direction an axially sufficiently rigid but nevertheless sufficiently flexible actuating means ( 107 ) extends at the proximal end of a shaft ( 111 ) of the tongs ( 102 ) is attached, and at its distal end a first handle ( 108 ) is attached; a cone sleeve ( 109 ), in its proximal end portion ( 112 ) the shaft ( 111 ) of the tongs ( 102 ) is received axially displaceable, and in the distal end portion ( 113 ) the proximal end of the coil spring ( 106 ) against a stop ( 114 ) is picked up; and a second handle ( 110 ), in which the distal end of the spiral spring ( 106 ) is abutted against a stop, wherein the jaws ( 103 . 104 . 105 ) by the externally fitting proximal end ( 115 ) of the cone sleeve ( 109 ) under the action of the coil spring ( 106 ) and by advancing the actuating means ( 107 ) to open. Surgical cutlery ( 100 ) according to claim 6 or 7, characterized by a guide thread or guide wire ( 116 ), in the delivery state of the surgical instrument at its proximal end in the form of a loop ( 117 ) from the tongs ( 102 ), and the one with both loose ends ( 118 . 119 ) through the interior of the cone sleeve ( 109 ) and the interior of the coil spring ( 106 ) to the first handle ( 108 ) is guided at the distal end of the surgical instrument, wherein the loop ( 117 ) before implanting the implant through the eyelet ( 16 ) of the version ( 10 ) of the implant and on the grasping forceps ( 102 ) is attachable. Surgical cutlery ( 100 ) according to claim 7 or 8, characterized in that a first loose end ( 119 ) of the guide thread or guidewire ( 116 ) in the region of the first handle ( 108 ), while the second loose end ( 118 ) of the guide thread or guidewire ( 116 ) with a nipple ( 120 ), with the aid of which the guide thread or wire ( 116 ) either in the coupled state of the implant can be tensioned or withdrawn from the surgical instrument, after the connection of the first end ( 119 ) With the first handle ( 108 ) was solved. Surgical cutlery ( 200 ) according to claim 7 or 8, for implanting and explanting an implant with a socket ( 10 ) according to claim 4, in particular an occlusion device, characterized in that a first loose end ( 119 ) of the guide thread or guidewire ( 116 ) in the region of the first handle ( 108 ), while the second loose end ( 118 ) of the guide thread or guidewire ( 116 ) with a nipple ( 120 ), with the aid of which the guide thread or wire ( 116 ) is tensioned either in the coupled state of the implant after the loop ( 117 ) through the slanted slot ( 26 ) in the eyelet ( 16 ) has been moved in, or for decoupling the implant from the surgical instrument is loosely so far loosely that the loop ( 117 ) through the slanted slot ( 26 ) from the eyelet ( 16 ) is moved out. Surgical cutlery ( 100 ; 200 ) according to any one of claims 8-10, characterized in that the guide thread or guide wire ( 116 ) consists of Nithinoldraht. Surgical cutlery ( 300 ) for implanting and explanting an implant with a socket ( 10 ) according to claim 5, in particular an occlusion device, characterized by a hook ( 302 ), which by means of a push and pull system axially on the eyelet ( 16 ) to or from her wegbewegbar, and by a through the Ose ( 16 ) and in the hooks ( 302 ) hook-in fastening loop ( 301 ), by means of which the implant by tensioning the fastening loop ( 301 ) on the surgical instrument ( 300 ) can be held when the hook ( 302 ) from the eyelet ( 16 ) is moved away. Surgical cutlery ( 300 ) according to claim 12, characterized in that the push and pull system essentially comprises the following components: a spiral spring ( 106 ), through the interior of which in the axial direction an axially sufficiently rigid but nevertheless sufficiently flexible actuating means ( 107 ) extends at the proximal end of a shaft ( 303 ) of the hook ( 302 ) is attached, and at its distal end a first handle ( 108 ) is attached; a cylindrical sleeve ( 304 ), in its distal end portion ( 113 ) the proximal end of the coil spring ( 106 ) against a stop ( 114 ) is received and in which the shaft ( 303 ) of the hook ( 302 ) is received axially displaceable; and a second handle ( 110 ), in which the distal end of the spiral spring ( 106 ) is abutted against a stop, wherein the hook ( 302 ) under the action of the coil spring ( 106 ) from the eyelet ( 16 ) moved axially and by advancing the actuating means ( 107 ) on the Ose ( 16 ) can be moved. Surgical cutlery ( 300 ) according to claim 13, characterized in that the cylindrical sleeve ( 304 ) on the proximal end side ( 305 ) a continuous first longitudinal groove ( 306 ), in the central region a one-sided second longitudinal groove ( 307 ) for the twist-proof guidance of the sleeve axially movable in the sleeve ( 302 ), and at right angles to the unilateral second longitudinal groove ( 307 ) a transverse groove ( 308 ), which up to the longitudinal axis of the sleeve ( 304 ) and in the middle an extension ( 309 ) for receiving a node ( 311 ) of the fastening loop ( 301 ) owns. Surgical cutlery ( 300 ) according to claim 14, characterized in that the cross section of the front portion of the hook ( 302 ) relative to the cross section of the shaft ( 303 ) is flattened by about one-third and with play in the second longitudinal groove ( 307 ) of the cylindrical sleeve ( 304 ) fits. Surgical cutlery ( 300 ) according to one of claims 12 to 15, characterized by a knife edge ( 310 ) at the distal end of the behind the hook ( 302 ) formed window ( 315 ). Surgical cutlery ( 100 ; 200 ; 300 ) according to one of claims 7 to 16, characterized in that the actuating means ( 107 ) is a wire rope. Method for repeatable coupling of an implant with a socket ( 10 ) according to one or more of claims 1-3, in particular an occlusion device, to a surgical instrument ( 100 ) according to one or more of claims 6-9 or 17, characterized by the following method steps: (a) the loop ( 117 ) of the guide thread or guidewire ( 116 ) is inserted through the eyelet before starting the intravascular surgical procedure ( 16 ) of the version ( 10 ) of the implant and at a designated attachment point ( 101 ) on the tongs ( 102 ) while the first and second loose ends ( 119 . 118 ) of the guide thread or guidewire ( 116 ) or in the area of the first grip ( 108 ) are attached; (b) the head section ( 14 ) of the version ( 10 ) of the implant with the grasping forceps ( 102 ) gripped; (c) that with the nipple ( 120 ) provided second loose end ( 118 ) of the guide thread or guidewire ( 116 ) is stretched until the head section ( 14 ) in the jaws ( 103 . 104 . 105 ) is included; (d) by loosening with the nipple ( 120 ) provided second loose end ( 118 ), the grasping forceps ( 102 ) again from the head section ( 14 ) of the implant and the seat of the implant are checked; (e) using the guide thread or guidewire ( 116 ) is always a Wiederankoppelung the grasping forceps ( 102 ) to the version ( 10 ) of the implant possible. Method for repeatable coupling of an implant with a socket ( 10 ) according to claim 4, in particular an occlusion device, to a surgical instrument ( 200 ) according to one of claims 10 or 17, characterized by the following method steps: (a) the loop ( 117 ) of the guide thread or guidewire ( 116 ) is initiated by the oblique slot (D) before the beginning of the intravascular surgical intervention. 26 ) in the eyelet ( 16 ) of the version ( 10 ) of the implant while the first and second loose ends ( 119 . 118 ) of the guide thread or guidewire ( 116 ) or in the area of the first grip ( 108 ) are attached; (b) the head section ( 14 ) of the version ( 10 ) of the implant with the grasping forceps ( 102 ) gripped; (c) that with the nipple ( 120 ) provided second loose end ( 118 ) of the guide thread or guidewire ( 116 ) is stretched until the head section ( 14 ) in the jaws ( 103 . 104 . 105 ) is included; (d) by loosening with the nipple ( 120 ) provided second loose end ( 118 ), the grasping forceps ( 102 ) again from the head section ( 14 ) of the implant and the seat of the implant are checked; (e) using the guide thread or guidewire ( 116 ) is at any time a Wiederankoppelung the gripping tongs ( 102 ) to the version ( 10 ) of the implant possible. Method for repeatable coupling of an implant with a socket ( 10 ) according to claim 5, in particular an occlusion device, to a surgical instrument ( 300 ) according to one or more of claims 12-17, characterized by the following method steps: (a) on the eyelet ( 16 ) of the version ( 10 ) of the implant is a fastening loop ( 301 ) defined length attached; (b) the fastening loop ( 301 ) is so in the transverse groove ( 308 ) of the cylindrical sleeve ( 304 ) that the node ( 311 ) of the fastening loop ( 301 ) in the middle of the extension ( 309 ) and in the transverse groove ( 308 ) lying section of the fastening loop ( 301 ) is held diametrically; (c) by defined advancement of the hook ( 302 ) slips in the transverse groove section of the fastening loop ( 301 ) while avoiding the second longitudinal groove ( 307 ) over the hook ( 302 ) and remains anchored there; (d) by pulling back the hook ( 302 ) the version ( 10 ) of the implant to the proximal end face ( 305 ) of the sleeve ( 304 ) pulled and strained; (e) by redefining the tick ( 302 ) the fastening loop ( 301 ) again loosely and the proximal end face ( 305 ) of the sleeve ( 304 ) dissolves from the version ( 10 ) and the seat of the implant can be checked; (f) by means of the fastening loop ( 301 ) is at any time a Wiederankoppelung the sleeve ( 304 ) to the version ( 10 ) of the implant possible.