CN114587441A - A kind of supporting equipment for interventional surgery in patients with coronary artery occlusion - Google Patents

Abstract

The invention relates to coronaries block patient and intervene supporting equipment for operation, including guide wire, sacculus pipe distal end have sacculus used for plugging the corresponding artery, supporting equipment also include used for inserting into the delivery catheter of the bypass vein from the artery to wear to locate in sacculus pipe, supporting equipment also includes the guide wire of puncturing, supporting equipment also include used for pushing to the tectorial membrane support of said artery, vein department along the inner bore of the delivery catheter, the tectorial membrane support includes matching section of artery, matching section of vein and connecting to matching section of artery, the transition connection section used for striding between artery and vein of matching section of vein, matching section of artery, matching section of vein and transition connection section include having elastic metal skeleton and coating in the metal skeleton inside and/or elastic blood-proof membrane of the outside. The invention provides a corollary equipment for interventional operation of a patient with coronary artery occlusion, which can realize the communication between a blocked coronary artery and a accompanied vein thereof.

Description

A kind of supporting equipment for interventional surgery in patients with coronary artery occlusion

technical field

The invention relates to an interventional operation supporting device, in particular to an interventional operation supporting device for patients with coronary artery occlusion.

Background technique

Coronary arteries are the arteries that supply blood to the heart. They originate from the aortic sinus at the root of the aorta and are divided into two branches, the left and the right, running on the surface of the heart. Coronary arteries are divided into arteries and veins, arteries and veins are accompanied, and the first-order arteries and veins are almost squarely distributed, with only a small amount of adipose tissue in between.

Chronic total occlusion of coronary artery (CTO for short) refers to the original coronary artery occlusion, angiography shows anterior flow TIMI grade 0, and the occlusion time is more than 3 months. Studies have shown that percutaneous coronary intervention (PCI) for CTO lesions can help improve patients' activity tolerance, ischemic load, quality of life and left ventricular function.

Evaluate the complexity of CTO lesions and establish a reliable scoring system for predicting the success rate of CTO-PCI based on the clinical conditions of the patients, select treatment strategies (drugs or PCI) for CTO patients, rationally allocate medical resources and decide CTO -PCI treatment strategies [anterior guide wire technique, retrograde guide wire technique, antegrade dissection reentry (ADR) and hybridization technique, etc.] are of great significance.

In recent years, the technology and equipment of CTO-PCI have been continuously improved, and various CTO-PCI scores have emerged, such as: J-CTO, CL, PROGRESS, ORA, CT-RECTOR and KCCT, etc. Success rate. However, there are still many cases where existing devices cannot open CTO lesions, and blocked coronary arteries cannot be effectively dredged.

SUMMARY OF THE INVENTION

The purpose of the present invention is to provide a supporting device for coronary artery occlusion patient interventional operation which can realize the communication between the blocked coronary artery and its accompanying vein.

In order to solve the above-mentioned technical problems, the technical scheme of the supporting equipment for interventional surgery for patients with coronary artery occlusion in the present invention is as follows:

A matching device for interventional surgery for patients with coronary artery occlusion, comprising a guide wire and a balloon catheter, the distal end of the balloon catheter has a balloon for blocking a corresponding artery, and the matching device also includes a balloon catheter for piercing through the balloon catheter. The delivery catheter used for insertion from the artery to the bypass vein, the supporting equipment also includes a puncture guide wire for puncturing from the artery to the bypass vein, the puncture guide wire has an inner hole for the guide wire to pass through, and the supporting equipment also includes a puncture guide wire. The stent-graft is pushed to the artery and vein along the inner hole of the delivery catheter, and the stent-graft includes an arterial matching section, a venous matching section, and a stent-graft connected between the arterial matching section and the vein matching section for connecting to the artery. The transitional connection segment with the vein, the arterial fitting segment, the vein fitting segment and the transitional connection segment all include an elastic metal skeleton and an elastic blood diaphragm covering the inside and/or outside of the metal skeleton.

The beneficial effects of the present invention are as follows: for the occluded arteries that are difficult to conduct, the present invention innovatively proposes to use the accompanying veins to achieve the purpose of normal blood circulation, and uses a guide wire to guide the balloon catheter to the occluded arteries. In the blood vessel, the balloon of the balloon catheter is deployed to temporarily seal the artery, and then the distal end of the puncture guide wire is punctured from the artery to the accompanying vein, and the distal end of the delivery catheter is inserted from the artery to the accompanying vein along the puncture guide wire. , take out the puncture guide wire, transport the stent-graft along the delivery catheter to the arterial and venous puncture positions, retract the delivery catheter, deploy the stent-graft, the arterial fitting section is fitted with the inner wall of the artery, and the venous fitting section is fitted with the inner wall of the vein. The blood of the artery is introduced into the accompanying vein through the stent-graft, and the vein is used to replace the occluded artery to achieve normal blood delivery.

Further, the diameter of the venous fitting segment is larger than the diameter of the arterial fitting segment.

Further, the transition connecting section is a tapered structure whose diameter gradually increases from the arterial fitting section to the venous fitting section.

Further, the supporting device further includes a vein blocking structure for blocking the vein upstream of the vein fitting segment after the stent-graft is deployed.

Further, the vein blocking structure is a vein occluder or a blocking glue block.

Further, the diameter of the vein blocking structure is 5-10 mm.

Further, the outer diameter of the balloon is 2.5-4.0 mm.

Further, the inner hole of the delivery catheter can allow the stent-graft with an outer diameter of 2.5 to 4 mm to pass through.

Description of drawings

The above and other objects, features and advantages of exemplary embodiments of the present disclosure will become readily understood by reading the following detailed description with reference to the accompanying drawings. In the accompanying drawings, several embodiments of the present disclosure are shown by way of example and not limitation, and like or corresponding reference numerals refer to like or corresponding parts,

1 is a schematic diagram of the coordination of a balloon catheter, a guide wire, an artery and a vein in Embodiment 1 of the present invention;

Fig. 2 is the structural representation of the balloon catheter in Fig. 1;

Fig. 3 is the schematic diagram of the coordination of puncture guide wire, delivery catheter and balloon catheter with arteries and veins in Fig. 1;

Fig. 4 is the state schematic diagram of the stent graft in Fig. 3 after deployment;

Fig. 5 is the structural representation of the stent-graft in Fig. 4;

6 is a schematic structural diagram of a stent graft in an embodiment of the present invention;

In the figure: 1. Balloon catheter; 2. Balloon; 3. Guide wire; 4. Artery; 5. Vein; 6. Thrombus; 7. The distal end of the balloon catheter; Covered stent; 10. Venous matching section; 11. Transition connecting section; 12. Arterial matching section; 13. Metal frame; 14. Elastic blood diaphragm.

Detailed ways

In order to facilitate understanding of the present invention, the present invention will be described in more detail below with reference to the accompanying drawings and specific embodiments. Preferred embodiments of the invention are shown in the accompanying drawings. However, the present invention may be embodied in many different forms and is not limited to the embodiments described in this specification. Rather, these embodiments are provided so that a thorough and complete understanding of the present disclosure is provided.

It should be noted that, unless otherwise defined, all technical and scientific terms used in this specification have the same meaning as commonly understood by those skilled in the technical field of the present invention. The terms used in the description of the present invention are only for the purpose of describing specific embodiments, and are not used to limit the present invention.

Embodiment 1 of a supporting device for interventional surgery for patients with coronary artery occlusion in the present invention is shown in Figures 1 to 5:

The supporting equipment in this embodiment can also be called CTO treatment equipment. CTO is the English abbreviation of chronic total occlusive disease of coronary artery. Coronary artery is divided into arteries and veins. distribution, with only a small amount of adipose tissue in the middle. This is the basis of this set of CTO therapy devices.

Ancillary equipment for interventional surgery in patients with coronary artery occlusion includes guide wire, balloon catheter, puncture guide wire, delivery catheter, stent-graft and vein closure structure.

The guide wire is 0.0014 inches in diameter and serves primarily as a guide.

The balloon catheter includes a catheter body and a balloon disposed at the distal end of the catheter body. The body wall of the catheter body is provided with a gas delivery hole that is connected to the balloon, and the gas is delivered into the balloon through the gas delivery hole, and the balloon can be expanded and unfolded, thereby Temporarily occlude the diseased artery. The outer diameter of the balloon is 2.5 to 4.0 mm. The distal end of the balloon catheter is an elbow structure, which is convenient for puncturing and guiding the puncture guide wire.

The delivery catheter is used to deliver the stent-graft to the bridging position of arteries and veins. The delivery catheter can move in the balloon catheter. The outer diameter of the delivery catheter can pass through the 6F balloon catheter, and the lumen can pass through the 2.5~4.0mm cover. Membrane stent.

The puncture guide wire is a hollow structure, the inner lumen can pass the guide wire, and the delivery catheter can move between the puncture guide wire and the balloon catheter.

The stent-graft includes an elastic metal skeleton and an elastic blood-separating membrane coated on the inside (or outside) of the metal skeleton, and the metal skeleton has mesh holes. From the proximal end to the distal end in the axial direction, the stent-graft is composed of an arterial fitting segment transitional connection segment and a vein fitting segment. The connecting segment is used to bridge between the artery and the vein. In this embodiment, in order to match the feature that the diameter of the artery is smaller than the diameter of the accompanying vein, the diameter of the matching section of the vein is larger than the diameter of the matching section of the artery, and the transition connecting section is a tapered structure whose diameter gradually increases from the matching section of the artery to the matching section of the vein. . After the stent-graft is deployed, a communication channel is formed between the artery and the vein. The blood is transported from the artery to the vein along the lumen of the stent-graft. The membrane is located on the inner side of the metal skeleton, and the metal skeleton forms a certain support for the elastic blood diaphragm, so as to avoid the elastic blood diaphragm of the transition connection section being supported too large due to excessive blood pressure. In this embodiment, the vein matching section, the arterial matching section, and the elastic blood diaphragm on the inner side of the transition connecting section are integrally formed.

After the stent-graft is expanded to connect the artery and the vein, the vein is permanently blocked by the vein blocking structure. In this embodiment, the vein blocking structure is a blocking glue block injected into the vein upstream of the vein fitting segment. In other embodiments of the present invention, the vein blocking structure can also be a vascular occluder in the prior art, and the vascular occluder can deliver a detachable blocking stent into the vein. For the convenience of showing the specific structure of the present invention, the thickness of the guide wire and the wall thickness of the balloon catheter are not shown in FIG. 1 ; the thickness of the puncture guide wire and the wall thickness of the delivery catheter are not shown in FIG. 3 .

Item 6 in the figure represents a thrombus blocking an artery. The main indications of the present invention are: 1. CTO; 2. Failed CTO; 3. CTO at the proximal end of the first-level coronary artery, in short, that is, arterial occlusion or other means after arterial occlusion This interventional procedure is performed under the background that it is not easy to dredge the arteries.

The following preparations and requirements are required for specific procedures: Routine PCI preparation

adequate anticoagulation;

Hybrid operating room with fusion function;

With a variety of imaging equipment, such as CT fusion DSA, IVUS, transesophageal ultrasound;

PCI team with critical care experience and cardiac critical CCU;

Have a coronary team;

With MCS equipment such as IABP, ECMO, IMPELLA, etc.

During the specific operation, a guide wire is introduced from the proximal end to the distal end of the femoral artery to the blocked blood vessel. The proximal end in the present invention refers to the end close to the operator. The balloon catheter is delivered to the arterial position, and the balloon of the balloon catheter is expanded to block the corresponding artery (to prevent the bleeding problem during subsequent puncture). As shown in Figure 1, the puncture guide wire sheath is connected to the guide wire, and the guide wire Under the guidance of the balloon catheter, the puncture guide wire passes through the artery to the accompanying vein, and then under the guidance of the puncture guide wire, the delivery catheter also passes through the artery to the accompanying vein, as shown in the figure. 3 shown. Then, the stent-graft is transported between the artery and the vein along the delivery guide wire, and the stent-graft is released. Membrane stents form a communication channel connecting arteries and veins. The vein upstream of the venous matching segment is permanently blocked by the vein blocking structure, and the operation is completed, as shown in Figure 4, which completely solves the problem of arterial occlusion.

Embodiment 2 of a supporting device for interventional surgery for patients with coronary artery occlusion is shown in FIG. 6 : Embodiment 2 is different from Embodiment 1 in that in this embodiment, the elastic blood diaphragm of the transition connecting section 11 is located on the corresponding metal skeleton The inner side is called the inner elastic blood diaphragm 15, the elastic blood diaphragm of the arterial matching section 10 and the venous matching section 12 are located on the outside of the corresponding metal skeleton, called the outer elastic blood diaphragm 16, the arterial matching section 10 and the transition Between the connecting sections 11 and between the transition connecting section 11 and the vein matching section 12, a metal transition ring 17 without a mesh structure is provided. The corresponding end of the elastic blood septum 16 is adhered to the outer wall of the corresponding metal transition ring, and the outer elastic blood septum can better fit with the blood vessel walls of the corresponding arteries and veins.

In the above description of this specification, unless otherwise expressly specified and limited, terms such as "fixed", "installed", "connected" or "connected" should be construed in a broad sense. For example, with regard to the term "connection", it may be a fixed connection, a detachable connection, or an integrated; it may be a mechanical connection or an electrical connection; it may be a direct connection or an indirect connection through an intermediate medium , or it can be a communication within two elements or an interaction relationship between two elements. Therefore, unless otherwise clearly defined in this specification, those skilled in the art can understand the specific meanings of the above terms in the present invention according to specific situations.

From the above description of this specification, those skilled in the art can also understand the following terms such as "upper", "lower", "front", "rear", "left", "right", "length", "width" ", "thickness", "vertical", "horizontal", "top", "bottom", "inner", "outer", "axial", "radial", "circumferential", "center", " Terms indicating orientation or positional relationship, such as longitudinal, lateral, clockwise, or counterclockwise, are based on the orientation or positional relationship shown in the drawings of this specification, which are only for the convenience of explaining the solution of the present invention For the purpose of simplifying the description, it is not expressly or implied that the device or element involved must have the specific orientation, be constructed and operate in the specific orientation, so the above-mentioned orientation or positional relationship terms should not be understood or interpreted as Limitations to the scheme of the present invention.

In addition, terms such as "first" or "second" used in this specification to refer to numbers or ordinal numbers are only for descriptive purposes, and should not be construed as expressing or implying relative importance or implicitly indicating the indicated the number of technical characteristics. Thus, a feature defined as "first" or "second" may expressly or implicitly include at least one of that feature. In the description of the present specification, "plurality" means at least two, such as two, three or more, etc., unless expressly and specifically defined otherwise.

Finally, it should be noted that the above embodiments are only used to illustrate the technical solutions of the present invention, but not to limit them; although the present invention has been described in detail with reference to the foregoing embodiments, those of ordinary skill in the art should understand: it can still be Modifications are made to the technical solutions described in the foregoing embodiments, or some technical features thereof are equivalently replaced; and these modifications or replacements do not make the essence of the corresponding technical solutions depart from the spirit and scope of the technical solutions of the embodiments of the present invention.

Claims (8)

1. A corollary equipment for interventional operation of coronary artery occlusion patients is characterized in that: including guide wire, sacculus pipe distal end has the sacculus that is used for the corresponding artery of shutoff, corollary equipment is still including being used for wearing to locate being used for inserting the delivery catheter of bypass vein from the artery in the sacculus pipe, corollary equipment is still including being used for puncturing the puncture seal wire to bypass vein from the artery, the puncture seal wire has the hole that supplies the guide wire to pass through, corollary equipment is still including being used for along the hole propelling movement of delivery catheter extremely the tectorial membrane support of artery, vein department, tectorial membrane support include artery cooperation section, vein cooperation section and connect in artery cooperation section, be used for between the vein cooperation section strideing the transitional coupling section between artery and vein, artery cooperation section, vein cooperation section and transitional coupling section all include have elastic metal framework and cladding in the inboard and/or the elastic blood-proof membrane in the outside of metal framework.

2. The kit of claim 1, wherein: the diameter of the venous mating section is larger than the diameter of the arterial mating section.

3. The kit of claim 2, wherein: the transition connecting section is a conical structure with the diameter gradually increased from the automatic vein matching section to the vein matching section.

4. The kit of claim 1, wherein: the corollary equipment also comprises a vein plugging structure used for plugging the vein at the upstream of the vein matching section after the tectorial membrane stent is unfolded.

5. The kit of claim 1, wherein: the vein plugging structure is a vein plugging device or a plugging rubber block.

6. The kit of claim 4, wherein: the diameter of the vein plugging structure is 5-10 mm.

7. The kit of claim 1, wherein: the outer diameter of the balloon is 2.5-4.0 mm.

8. The corollary equipment of any one of claims 1 to 6, wherein: the inner hole of the conveying conduit can be used for the covered stent with the outer diameter of 2.5-4 mm to pass through.

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