Patent Application
20050261626
1. Field of the Invention
The present invention relates to a balloon catheter, a medical apparatus, a method for treating a living organ and a use of the medical apparatus for treating a living organ. More particularly, the present invention relates to a balloon catheter which can cure a diseased tissue by heating and cooling a living organ in a very short time and, in particular, can expand a blood vessel without causing damages when the balloon catheter is used in the percutanuous transluminal coronary angioplasty, a medical apparatus comprising the balloon catheter, a method for treating a living organ using the balloon catheter and a use of the medical apparatus for treating a living organ.
2. Description of Related Art
The percutanuous transluminal coronary angioplasty (PTCA) using a balloon is being widely conducted recently. In the period shortly after the introduction of the technology, examples of the operation in which PTCA was applied and the diseases to which PTCA could be applied were rather limited. Due to the progress in instruments and technology, the application of this technology has been expanded not only to multivessel diseases but also to complete occlusion and acute myocardial infarction. However, the frequency of recurrence of stenosis is great, and this is considered to be the greatest problem of PTCA. To prevent the recurrence of stenosis, various stents have been developed and used. However, the effect of preventing the recurrence of stenosis is limited, and the presence of the remaining stent occasionally works as an obstacle for the treatment. Moreover, stainless steel used as the material of the stent occasionally exhibits allergic effects to the tissue. Therefore, it has been desired that stenosis is treated without using a foreign substance such as stainless steel and the recurrence of stenosis is prevented. Heretofore, it has been tried that a tissue of a tubular organ is burned or vaporized directly by a laser treatment or that the portion of stenosis is treated with argon laser beams. However, these trials failed without significant effects due to formation of serious damages to tissues or adverse effects of decomposition products.
It is considered that, when a cell of a smooth muscle is damaged and the tissue is restored by the stem cell, abnormal information due to the damage is transferred or abnormal division of a stem cell takes place, and the recurrence of stenosis of a tubular organ takes place. It is occasionally conducted that a blood vessel for the treatment is cut by a so-called transluminal extraction catheter (TEC) or a rotablator so that the outer membrane alone is left remaining, and a stent is disposed thereafter. When a necessary tissue is removed by the cutting, the tissue of the inner skin is not stabilized even when the tissue is formed, and this is considered to cause the recurrence of stenosis. Since a blood vessel is forced to expand by a pressure as great as 800 to 1,000 kPa in the ordinary PTCA, the tissue is torn or the tissue of the blood vessel is degraded by the great force. Therefore, the recurrence of stenosis tends to take place due to excessive growth of the cells of the smooth muscle during the restoration of the coronary artery.
The development of instruments and methods for expanding a blood vessel without causing damages to the blood vessel at the portion of stenosis have been conducted. For example, as the apparatus useful for applying heat to the inside of the body of a patient in a treatment such as the treatment for forming blood vessels, a system for expanding a tubular organ in the body having a means for controlling a catheter which applies heat and pressure to a tissue of a tubular organ simultaneously, detects the change in the behavior of yielding or the change in the thermal conductivity of the tissue of the tubular organ, and react to the behavior of the tissue, is proposed (Japanese Patent No. 2984056, page 2). However, it is very difficult that the physiological reaction of a portion of disease in a very different diseased condition in each case is examined under a single criterion and the most suitable treatment is applied to the portion of disease. In PTCA, as the catheter which can solidify the inner face of a blood vessel by heating to prevent recurrence of stenosis without causing damages on the inner membrane of the blood vessel, a catheter equipped with a balloon made of a fluororesin and having a heating tube absorbing laser beams and a laser fiber protruding into the balloon, is proposed (Japanese Patent No. 2535250. pages 1 and 2). However, the thickness of the blood vessel tends to decrease when the inner wall of the blood vessel is heated at 80 to 90° C. As the catheter which prevents excessive local heating of the inside of the balloon, a catheter which has a heating tube having a metal braid and a resin tube covering the metal braid and two thermocouples in the balloon, is proposed (Japanese Patent No. 2864094, pages 1 and 2). However, this catheter has a problem in that it is difficult that a excellent result is obtained with stability when an excessively great force or an excessively great invasion of heat is applied to a blood vessel.
The present invention has an object of providing a balloon catheter, a medical apparatus, a method for treating a living organ and a use of the medical apparatus for treating a living organ which can heat and cool the living organ within a very short time to cure a diseased tissue and expand a blood vessel without damages, in particular, in application to the percutanuous transluminal coronary angioplasty.
As the result of intensive studies by the present inventors to overcome the above problems, it was found that a blood vessel could be expanded without damages by using a medical apparatus equipped with a means for heating a balloon to 80° C. in a short time and a means for cooling the balloon to 45° C. in a short time. The present invention has been completed based on this knowledge.
The present invention provides:
The numbers and characters in the figures have the meanings as listed in the following:
The balloon catheter of the present invention comprises a proximally disposed connecting member comprising an inlet for a fluid, an outlet for a fluid and an inlet for energy, a balloon, a catheter shaft comprising a lumen for introducing the fluid into the balloon and a lumen for discharging the fluid from the balloon and a heat-generating member. The proximally disposed connecting member and a proximal portion of the catheter shaft are connected to each other, a distal portion of the catheter shaft and a proximal portion of the balloon is connected to each other, and the heat-generating member is in contact with the fluid at the inside of the balloon or in a distal portion of the catheter shaft. (“Proximal” or “proximally disposed” means that a position or a portion is located close to the portion for manipulating. “Distal” means that a position or a portion is located far from the portion for manipulating.)
This catheter is inserted into a living organ so that the balloon reaches the portion of disease. The balloon is expanded by introducing a fluid into the balloon. Laser beams are emitted, and the energy of the laser beams is converted into heat by the heat-generating member. The temperature of the surface of the balloon is raised to a prescribed temperature by the obtained heat in a short time. After a tubular organ is kept being expanded while the pressure and the temperature are kept at prescribed values for a prescribed time, the emission of the laser beams is stopped, and the surface of the balloon is cooled in a short time with a fluid at the room temperature. In this manner, the tubular organ can be expanded without causing damages to the living organ.
The shapes of the lumen for introducing the fluid into the balloon and the lumen for discharging the fluid from the balloon are not particularly limited. Two tubes may be used separately as the two lumens. As another shape, the inside of a single tube having a circular sectional shape may be separated into two portions with an inner wall extending in the longitudinal direction, and the formed two portions may be used as the two lumens. In combination with the lumens for the fluid, for example, a lead wire for passing a high frequency electric current as the energy and a lumen for inserting a thermocouple for the measurement of the temperature may be inserted.
As shown in the embodiments shown in
In the embodiment shown in
The form of the balloon catheter of the present invention is not particularly limited. The form may be a form of the monorail type having a guide wire lumen between the distal portion of the balloon and a guide wire port open at an intermediate portion of the catheter shaft, or a form of the over-the-wire type having a guide wire lumen inserted through the entire length of the catheter.
In the balloon catheter of the present invention, the energy supplied to the heat-generating member is not particularly limited. Examples of the energy include high frequency electric current of about 500 Hz and laser beams. When the high frequency electric current is used as the energy, a heat-generating material such as a wire of a Ni—Cr alloy, a heat-generating material containing carbon and tungsten can be used as the heat-generating member. When the laser beams are used as the energy, a metal member absorbing the laser beams and converting the beams into heat such as stainless steel, chromium steel, ferrite steel and a nickel/titanium ultraelastic alloy can be used as the heat-generating member. By forming the metal member into a shape of a blade, a coil, a net, a braid or wool, hardening of the catheter shaft can be prevented, and excellent operability can be maintained. The metal member can also be used as the X-ray marker.
In the balloon catheter of the present invention, when the heat-generating member is disposed at the inside of the balloon, it is preferable that a thermosetting resin having a great heat resistance is used as the material of the balloon. By using a thermosetting resin as the material of the balloon, damages caused by the contact of the heat-generating member and the balloon with each other can be prevented. In the balloon catheter of the present invention, when the heat-generating member is disposed in a distal portion of the catheter shaft, a thermoplastic resin can be used as the material of the balloon since there is no possibility that the heat-generating member and the balloon are in contact with each other. The thermoplastic resin can be formed into a thin film with more excellent productivity than the thermosetting resin, and the balloon can be produced economically in accordance with the blow molding or the like process. Since a thin film of the thermoplastic resin has a small modulus, the properties for folding, re-wrapping and insertion into a body cavity are excellent, and the folded balloon deforms delicately to follow the curved shape of the body cavity and can be inserted with a small resistance.
In the balloon catheter of the present invention, heat is transferred to the fluid through the contact of the heat-generating member with the fluid at the inside of the catheter or in the distal portion of the catheter shaft. In other words, since the heat transfer takes place in the field of flow, the over-all heat transfer coefficient is great, and the fluid can be heated efficiently. Since the fluid is heated to the prescribed temperature at the inside of the balloon or is introduced into the balloon immediately after being heated to the prescribed temperature, the entire portions at the surface and at the inside of the balloon can be kept at the same temperature.
In the balloon catheter of the present invention, when the heat-generating member is in contact with the fluid in the distal portion of the catheter shaft, it is preferable that the balloon comprises a thermoplastic resin and is produced in accordance with the blow molding process. In the present invention, not only thermoplastic resins having no crosslinking at all but also thermoplastic resins having partial crosslinking can be used as the thermoplastic resin as long as the thermoplastic resin can be molded in accordance with the extrusion molding process or the blow molding process. Examples of the thermoplastic resin used in the present invention include polyolefin resins, polyamide resin, polyamide elastomers, polyether amide resins, polyester resins, polyester elastomers, fluororesins, polyurethane resins, silicone resins, natural rubber and synthetic rubbers.
The process for producing the balloon comprising the thermoplastic resin in accordance with the blow molding is not particularly limited. For example, the balloon can be obtained by cutting a tube obtained from the thermoplastic resin in accordance with the extrusion molding process to form a parison, followed by blow molding the obtained parison with biaxial stretching. The stretching ratio in the blow molding with biaxial stretching is not particularly limited. It is preferable that the stretching ratio is in the range of 1.5 to 5 in the longitudinal direction and in the range of 2 to 5 in the radial direction, and more preferably in the range of 2 to 4 in the longitudinal direction and in the range of 2.5 to 4 in the radial direction.
In the present invention, it is preferable that the temperature of the blow molding to prepare the balloon is 100° C. or higher, more preferably 105° C. or higher and most preferable 110° C. or higher. Since a physiological saline or a contrast medium for X-ray using water as the solvent or the dispersion medium is used as the medium for heating the balloon in almost all cases, the temperature of the balloon does not exceed 100° C. in almost all cases. Therefore, when the blow molding to prepare the balloon is conducted at a temperature exceeding 100° C., the balloon can be used safely with little possibility of deformation by heating during the used of the balloon catheter. The balloon produced in accordance with the so-called cold blowing process at a temperature of about 40 to 80° C. tends to show a decrease in the diameter of the balloon due to the reversion of the shape when the balloon is heated at a temperature higher than that of the blow molding although the strength relative to the thickness is great due to the orientation of the polymer with crystallization. In the present invention, since the living organ is expanded without applying a great pressure to the balloon, a great resistance to pressure is not necessary for the balloon, and the balloon prepared in accordance with the blow molding process at a high temperature can be used with excellent stability under heating although the blow molding process at a high temperature has heretofore been considered to cause insufficient strength.
In the balloon catheter of the present invention, it is preferable that the entire catheter shaft or the distal portion of the catheter shaft where the heat-generating member is disposed comprises a heat-resistant material. Examples of the heat-resistant material include Ni—Ti ultraelastic alloys, stainless steel, polyimides, polyether imides, polysulfones, polyether ether ketones and composite materials comprising these materials. Since these materials have a suitable flexibility in combination with the heat resistance, the catheter shaft exhibiting an excellent balance can be obtained. By forming at least the distal portion of the catheter shaft, where the heat-generating member is disposed, with the heat-resistant material, the balloon catheter can be used safely without possibility of causing damages to the catheter shaft by excessive heating.
The medical apparatus of the present invention comprises a balloon catheter described above and a temperature sensor disposed at the inside of the balloon or at the catheter shaft at a distal position from the heat-generating member. The fluid at a low temperature is introduced from the inlet for a fluid, flows through the inside of the balloon and is discharged from the outlet for a fluid. Energy is introduced from the inlet for energy into the catheter shaft, is converted into heat by the heat-generating member and heats the fluid. A living organ is heated and cooled for a medical treatment by the balloon which is heated and cooled, respectively, with the fluid.
The medical apparatus of the present invention can heat the fluid efficiently and raise the temperature of the balloon in a short time since heat is transferred from the heat-generating member disposed at the inside of the balloon or in the distal portion of the catheter shaft to the fluid introduced into the balloon in the field of flow. The temperature of the balloon can be accurately controlled by sending the signal detected by the temperature sensor to the apparatus for output of the energy and controlling the amount of the introduced energy. Since the heat-generating member is disposed at the inside of the balloon or in the distal portion of the catheter shaft, the fluid at a low temperature flows through the inside of the balloon immediately after stopping the introduction of the energy, and the temperature of the balloon can be lowered in a short time.
A living organ is constituted with proteins containing collagen as the main component, and proteins are softened at higher temperatures similarly to ordinary polymers. The effect of heat to living cells is relatively mild with respect to the time. Necrosis of cells takes place when the cells are kept at a high temperature for a long time. Change in the physical properties of collagen in tissues of blood vessels is a physicochemical phenomenon and takes place instantaneously. Therefore, by heating a living tissue rapidly in a short time, very thin surface layers of the living tissue alone can be heated to kill the tissue or to provide the apoptosis factor without causing biological damages to deeper portions. By expanding the physicochemically softened blood vessel under a relatively small pressure, the tubular cavity for obtaining sufficient blood stream is secured without causing damages to the tissue due to excessive forces, and the stable opening of the tubular cavity can be achieved by the sufficient blood stream after the treatment.
It is preferable that the medical apparatus of the present invention has the ability of heating the balloon from 35˜40° C. to 60˜80° C. within 30 seconds and cooling from the temperature attained by the heating to a temperature of 45° C. or lower within 40 seconds. By heating the portion of disease of the living organ from 35˜40° C. to 60˜80° C. within 30 seconds and cooling from the temperature attained by the heating to a temperature of 45° C. or lower within 40 seconds, the medical treatment can be conducted without causing great invasion to the living organ.
It is preferable that the medical apparatus of the present invention comprises a means for detecting the pressure, and the balloon can be expanded by applying a pressure with adjustment of the degrees of opening of the inlet for a fluid and the outlet for a fluid or the pressure of the introduced fluid. By inserting the balloon into the stenosis portion of the living organ and expanding the stenosis portion by expanding the balloon while the pressure is controlled using the means for detecting a pressure to prevent application of an excessively great pressure, the medical treatment can be conducted without tearing or degrading the tissue of the blood vessel by a great force.
It is preferable that the medical apparatus of the present invention uses laser beams as the energy. Laser beams show quick responses, and a great output can be obtained using a small apparatus. The tip portion of the optical fiber for introduction of the laser beams may have a cone shape or a round shape having the diameter gradually decreasing towards the tip. Alternatively, the tip portion of the optical fiber may have a rough surface.
The medical apparatus of the present invention can be used for method for treating the diseases in which it is desirable to heat very thin surface layer of the living tissue of the portion of disease. Using the medical apparatus of the present invention, it is possible for example, to make the very thin surface layers of the living tissue of the portion of disease alone to die by heating the tissue rapidly in a short time or to provide the apoptosis factor without causing biological damages to deeper portions. It is particularly useful for the method of treating stenosis in a living organ. By expanding the physicochemically softened blood vessel, the softening being effected by rapid heating by the apparatus of the present invention and the expanding being attained by expanding the balloon under a relatively small pressure, the tubular cavity for obtaining sufficient blood stream is secured without causing damages to the tissue due to excessive forces, and the stable opening of the tubular cavity can be achieved by the sufficient blood stream after the treatment.
In applying the medical apparatus of the present invention to a patient in need of such treatment for treating a living organ, the catheter is inserted into a living organ so that the balloon of the catheter reaches the portion of disease and the fluid at low temperature is introduced into the balloon and energy is introduced to the heat-generating member during a period of time to effect the portion of disease is heated to a temperature level which is effective for the treatment of the portion of disease. The level of the temperature at which the portion of disease is heated and the period of time during which the energy is introduced to the heat-generating member are not particularly limited. They are determined so that the effect of heating the potion of disease is effective for the treatment but not excessive resulting in the damage of living organ. After the prescribed heating, the energy is cut off and the portion of disease is cooled quickly by the fluid at lower temperature flowing into the balloon to the temperature level at which the living organ is not damaged. If desired, the balloon is expanded by applying a pressure to an appropriate level.
In applying the medical apparatus of the present invention for treating stenosis of a tubular organ, a portion of disease of the living organ is heated from 35˜40° C. to 60˜80° C. within 30 seconds, expanded by applying a pressure of 500 kPa or smaller to the balloon and cooled from the temperature attained by the heating to a temperature of 45° C. or lower within 40 seconds. In the method of the present invention, the order of heating the portion of disease and expanding the balloon by application of a pressure is not particularly limited. For example, the temperature may be raised after a pressure of 500 kPa or smaller is applied to the balloon. In this case, when the pressure of 500 kPa or smaller is applied to the balloon, the expansion of the living organ does not take place at temperatures around the room temperature, but takes place when the temperature reaches 60 to 80° C.
In the method of the present invention, when the time required to raise the temperature from 35˜40° C. to 60˜80° C. exceeds 30 seconds, there is the possibility that the thickness of the living organ decreases due to damages, and the stenosis takes place with passage of time. When the temperature at the portion of disease of the living organ is lower than 60° C., there is the possibility that the expansion is insufficient under a pressure of the balloon of 500 kPa or smaller. When the pressure of the balloon exceeds 500 kPa, there is the possibility that the tissue of the living organ is torn or degraded. When the time of lowering the temperature to 45° C. or lower exceeds 40 seconds, there is the possibility that the thickness of the living organ decreases due to damages, and the stenosis takes place with passage of time.
The method of treating a living organ of the present invention can be advantageously applied to medical treatments of portions of disease of a blood vessel such as the percutanuous transluminal coronary angioplasty (PTCA). It is considered that, when a cell of a smooth muscle is damaged and the tissue is restored by the stem cell, abnormal information due to the damage is transferred or abnormal division of a stem cell takes place, and the recurrence of stenosis of a tubular organ takes place. It is occasionally conducted that a blood vessel for the treatment is cut by so-called TEC or a rotablator so that the outer membrane alone is left remaining, and a stent is disposed thereafter. When a necessary tissue is removed by the cutting, the tissue of the inner skin is not stabilized even when the tissue is formed, and this is considered to cause the recurrence of the stenosis. In contrast, in accordance with the method for treating a living organ of the present invention, the surface of the tissue of the blood vessel alone is heated instantaneously. The tissue of the tubular cavity is expanded by application of a small pressure without causing damages in deeper portions of the tubular cavity, and the tissue of the blood vessel is treated safely and effectively without causing damages to the tissue of the blood vessel by an unnecessarily great force. Thus, the excellent effect of the medical treatment can be obtained.
To summarize the advantages obtained by the invention, by using the balloon catheter and the medical apparatus and in accordance with the method for treating a living organ of the present invention, a living organ can be heated and cooled within a very short time to cure a diseased tissue and a blood vessel can be expanded without damages, in particular, in application to the percutanuous transluminal coronary angioplasty (PTCA).
The present invention will be described more specifically with reference to examples in the following. However, the present invention is not limited to the examples.
A medical apparatus shown in
A device for converting laser energy made of stainless steel and a contact point for the thermocouple were placed at the inside of the balloon. To a proximal portion of the lumen for introducing a fluid, a pressure sensor, a pressure-resistant syringe having a volume of 20 ml and an apparatus for introducing a fluid composed of an auto-injector were connected, and a fluid which was a mixture of a contrast medium and a physiological saline in a ratio of the amounts by volume of 1:1 was introduced while a prescribed pressure was maintained. The fluid flowing out of the end of the lumen for discharging a fluid was received into a vessel placed on a microbalance and weighed. To a proximal position of the quartz optical fiber, a YAG laser having an output of 5 W was connected. The information from the pressure sensor and the temperature sensor and the weight obtained by the microbalance were input into a computer, and the flow rate of the heating medium and the output of the laser were controlled so that the prescribed pressure, rate of raising the temperature, maintained temperature and rate of lowering the temperature in the balloon were achieved.
In advance, the catheter shaft and the balloon of the medical apparatus were placed in a tank kept constant at 37° C., and the condition of the operation for achieving the prescribed time, temperature and pressure was obtained. It was confirmed that the prescribed relations between the time, the temperature and the pressure were achieved when the medical apparatus was operated under the obtained condition.
A left hind leg of a rabbit was used in Example 1, and a right hind leg was used in Comparative Example 1. Into each of two inguinal arteries, a peel off sheath was inserted, and the catheter shaft was inserted through the sheath. The fluid was introduced through the catheter shaft, and the pressure was kept at 200 kPa. In Example 1 in which the left hind leg was used, the temperature at the surface of the balloon was raised from 37° C. to 70° C. in 30 seconds, kept at 70° C. for 20 seconds and lowered to 45° C. in 40 seconds. In Comparative Example 1 in which the right hind leg was used, the same procedures as those conducted in Example 1 were conducted except that the temperature was raised in 40 seconds and lowered in 50 seconds. After the bleeding was stopped, the rabbit was returned to a cage, bred there for 2 months and killed for examination. The rabbit was then dissected, and the condition of blood vessels was observed. The inner diameter of a blood vessel d1 at the treated portion and the inner diameter of a blood vessel d0 in an adjacent portion were measured, and the ratio of the inner diameters of blood vessels d1/d0 was obtained. Based on the result of the observation and the ratio of inner diameters of blood vessels obtained above, the overall evaluation was made.
Almost no abnormality was found in the blood vessel of the left hind leg. The ratio of the inner diameters of blood vessels was 1.3. The result of the overall evaluation was good. The thickness of the blood vessel of the right hind leg was found to have decreased. The ratio of the inner diameters of blood vessels was 0.7. The result of the overall evaluation was poor.
Similarly to Example 1 and Comparative Example 1, a left hind leg of a rabbit was used in Example 2, and a right hind leg was used in Comparative Example 2. In Example 2 in which the left hind leg was used, the temperature at the surface of the balloon was raised from 37° C. to 70° C. in 20 seconds, kept at 70° C. for 10 seconds and lowered to 45° C. in 20 seconds. In Comparative Example 2 in which the right hind leg was used, the temperature at the surface of the balloon was raised from 37° C. to 90° C. in 10 seconds, kept at 90° C. for 10 seconds and lowered to 45° C. in 10 seconds.
After two months, almost no abnormality was found in the blood vessel of the left hind leg. The ratio of the inner diameters of blood vessels was 1.3. The result of the overall evaluation was good. The thickness of the blood vessel of the right hind leg was found to have decreased. The ratio of the inner diameters of blood vessels was 0.7. The result of the overall evaluation was poor.
Similarly to Example 1 and Comparative Example 1, a left hind leg of a rabbit was used in Example 3, and a right hind leg was used in Example 4. In Example 3 in which the left hind leg was used, the temperature at the surface of the balloon was raised from 37° C. to 80° C. in 10 seconds, kept at 80° C. for 10 seconds and lowered to 45° C. in 10 seconds. In Example 4 in which the right hind leg was used, the same procedures as those conducted in Example 3 were conducted except that the temperature at the surface of the balloon was raised to 70° C. and kept at 70° C. for 10 seconds.
After two months, almost no abnormality was found in the blood vessel of the left hind leg. The ratio of the inner diameters of blood vessels was 1.5. The result of the overall evaluation was good. No abnormality was found at all in the blood vessel of the right hind leg. The ratio of the inner diameters of blood vessels was 1.5. The result of the overall evaluation was excellent.
Similarly to Example 1 and Comparative Example 1, a left hind leg of a rabbit was used in Example 5, and a right hind leg was used in Example 6. In Example 5 in which the left hind leg was used, the temperature at the surface of the balloon was raised from 37° C. to 65° C. in 10 seconds, kept at 65° C. for 10 seconds and lowered to 45° C. in 10 seconds. In Example 6 in which the right hind leg was used, the same procedures as those conducted in Example 5 were conducted except that the temperature at the surface of the balloon was raised to 60° C. and kept at 60° C. for 10 seconds.
After two months, no abnormality was found at all in the blood vessel of the left hind leg. The ratio of the inner diameters of blood vessels was 1.4. The result of the overall evaluation was excellent. No abnormality was found at all in the blood vessel of the right hind leg, either. The ratio of the inner diameters of blood vessels was 1.4. The result of the overall evaluation was excellent.
Similarly to Example 1 and Comparative Example 1, a left hind leg of a rabbit was used in Example 7, and a right hind leg was used in Example 8. In Example 7 in which the left hind leg was used, the temperature at the surface of the balloon was raised from 37° C. to 57° C. in 10 seconds, kept at 57° C. for 10 seconds and lowered to 45° C. in 10 seconds. In Example 8 in which the right hind leg was used, the same procedures as those conducted in Example 7 were conducted except that the temperature at the surface of the balloon was raised to 55° C. and kept at 55° C. for 10 seconds.
After two months, no abnormality was found at all in the blood vessel of the left hind leg. The ratio of the inner diameters of blood vessels was 1.2. The result of the overall evaluation was good. No abnormality was found at all in the blood vessel of the right hind leg, either. The ratio of the inner diameters of blood vessels was 1.1. The result of the overall evaluation was good.
A left hind leg of a rabbit was used in Example 9, and a right hind leg was used in Comparative Example 3. Into each of two inguinal arteries, the catheter shaft was inserted, and the heating medium was introduced through the catheter shaft. The pressure in the left hind leg was kept at 400 kPa, and the pressure in the right hind leg was kept at 600 kPa. In both hind legs, the temperature at the surface of the balloon was raised from 37° C. to 70° C. in 10 seconds, kept at 70° C. for 10 seconds and lowered to 45° C. in 10 seconds.
After two months, no abnormality was found at all in the blood vessel of the left hind leg. The ratio of the inner diameters of blood vessels was 1.5. The result of the overall evaluation was excellent. The thickness of the media in the blood vessel of the right hind leg was found to have increased although the diameter of the blood vessel increased. The ratio of the inner diameters of blood vessels was 1.2. The result of the overall evaluation was fair to poor.
A left hind leg of a rabbit was used in Comparative Example 4, and a right hind leg was used in Comparative Example 5. Into each of two inguinal arteries, the catheter shaft was inserted, and the heating medium at the room temperature was introduced through the catheter shaft without irradiation with the laser beams. After the pressure in the left hind leg was kept at 1,200 kPa for 10 seconds, and the pressure in the right hind leg was kept at 400 kPa for 10 seconds, the introduction of the heating medium was stopped.
After two months, it was found that the blood vessel in the left hind leg was damaged and the thickness increased. The ratio of the inner diameters of blood vessels was 0.8. The result of the overall evaluation was poor. Almost no abnormality was found in the blood vessel of the right hind leg. However, the blood vessel was not expanded. The ratio of the inner diameters of blood vessels was 1.0. The result of the overall evaluation was poor.
When the results of Example 1 and Comparative Example 1 are compared, the excellent result was obtained in Example 1 in which the temperature was raised in 30 seconds and lowered in 40 seconds. In contrast, the thickness of the blood vessel decreased, and the blood vessel was not expanded in Comparative Example 1 in which the times for raising and lowering the temperature were each longer than the above by 10 seconds even though the pressure applied to the balloon and the temperature at the surface of the balloon were kept at the same as those in Example 1, i.e., 200 kPa and 70° C., respectively. These results show that it is important for obtaining the excellent results that the surface of the balloon is heated and cooled in a short time.
When the results of Example 3 and Comparative Example 2 are compared, the excellent result was obtained in Example 3 in which the temperature of the surface of the balloon was 80° C. In contrast, the thickness of the blood vessel decreased, and the blood vessel was not expanded in Comparative Example 2 in which the temperature of the surface of the balloon was 90° C. even though the pressure applied to the balloon and the times for raising and lowering the temperature were kept at the same as those in Example 3, i.e., 200 kPa and 10 seconds, respectively. These results show that it is important for obtained the excellent results that the temperature of the surface of the balloon is not excessively high.
In Examples 4 to 6 in which the pressure applied to the balloon was 200 kPa, the temperature of the surface of the balloon was 60˜70° C. and the temperature was raised and lowered each in 10 seconds, the excellent results were obtained in that no abnormality was found at all in the condition of the blood vessel, and the degree of expansion of the blood vessel was great.
When the results of Example 9 and Comparative Example 3 are compared, the excellent result was obtained in Example 9 in which the pressure applied to the balloon was 400 kPa. In contrast, the thickness of the media in the blood vessel increased and, as the result, the ratio of the inner diameters of the blood vessels increased only to 1.2 in Comparative Example 3 in which the pressure applied to the balloon was increased to 600 kPa even though the temperature of the surface of the balloon and the times for raising and lowering the temperature were kept at the same as those in Example 9, i.e., 70° C. and 10 seconds, respectively. These results show that an excessively great pressure applied to the balloon gives the inferior result of the evaluation.
A medical apparatus shown in
Into an artery in the left femoral region of a rabbit, a 6 F sheath was inserted, and the balloon catheter was inserted through the sheath. The mixture of a contrast medium and a physiological saline in a ratio of the amounts by volume of 1:1 was continuously introduced under a pressure using a pump for injecting a contrast medium, and the pressure applied to the balloon was kept at 200 kPa. Laser beams were emitted from a YAG laser having an output capacity of 5 W, and the temperature of the balloon was raised from 37° C. to 70° C. in 20 seconds, kept at 70° C. for 10 seconds and lowered from 70° C. to 45° C. in 20 seconds. The signal output from the temperature sensor is fed back, and the temperature was adjusted by switching on and off the laser.
The balloon exhibited an excellent property for folding and re-wrapping. The property for inserting the balloon catheter was also excellent. Only slight deformation was found in the balloon after the use. Very slight deformation was found in the catheter shaft after the use.
After the operation, the bleeding was stopped, and the rabbit was killed and dissected. The diameter of the blood vessel d1 at the treated portion and the diameter of a blood vessel d0 at an adjacent portion were measured, and the ratio of the two diameters d1/d0 was obtained. The condition inside the blood vessels was observed. d1/d0 was found to be 2.0. No abnormality was found in the blood vessel.
An artery in the left femoral region of a rabbit was used for the examination under the same conditions in accordance with the same procedures as those in Example 10 except that a polyamide elastomer [manufactured by ATOFINA JAPAN Co., Ltd.; PEBAX 633SN01; the hardness: D63] was used as the material of the balloon, and a tube made of a polyamide [manufactured by UBE KOSAN Co., Ltd.; UBE NYLON 5033J12; the hardness: R80]/a polyimide [manufactured by TORAY Co., Ltd.; TI POLYMER; the hardness: E86] and having a braid of a metal was used for the catheter shaft.
The balloon exhibited an excellent property for folding and re-wrapping. The property for inserting the balloon catheter was also excellent. Only slight deformation was found in the balloon after the use. Very slight deformation was found in the catheter shaft after the use. d1/d0 was 2.0. No abnormality was found in the blood vessel.
An artery in the left femoral region of a rabbit was used for the examination under the same conditions in accordance with the same procedures as those in Example 10 except that a tube made of a polyamide [manufactured by UBE KOSAN Co., Ltd.; UBE NYLON 5033J12; the hardness: R80] and having a braid of stainless steel and a Ti—Ni lining at the inner face was used for the catheter shaft.
The balloon exhibited an excellent property for folding and re-wrapping. The property for inserting the balloon catheter was also excellent. Slight deformation was found in the balloon after the use. No deformation was found at all in the catheter shaft after the use. d1/d0 was 2.0. No abnormality was found in the blood vessel.
An artery in the left femoral region of a rabbit was used for the examination under the same conditions in accordance with the same procedures as those in Example 1 except that a balloon made of a polyamide [manufactured by UBE KOSAN Co., Ltd.; UBE NYLON 5033J12; the hardness: R80] and prepared in accordance with the blow molding process at a blowing temperature of 120° C. under a blowing pressure of 400 kPa was used, and a tube made of a polyamide [manufactured by UBE KOSAN Co., Ltd.; UBE NYLON 5033J12; the hardness: R80]/a polyimide [manufactured by TORAY Co., Ltd.; TI POLYMER; the hardness: E86] and having a braid of stainless steel was used for the catheter shaft.
The balloon exhibited an excellent property for folding and re-wrapping. The property for inserting the balloon catheter was also excellent. Very slight deformation was found in the balloon and the catheter after the use. d1/d0 was 2.0. No abnormality was found in the blood vessel.
When Example 4 was conducted, an artery in the right femoral region of the rabbit was used for the examination under the same conditions in accordance with the same procedures as those in Example 4 except that a balloon made of a polyester elastomer [manufactured by TOYO BOSEKI Co., Ltd.; PELPRENE S6001; the hardness: D72] and prepared in accordance with the blow molding process at a blowing temperature of 130° C. under a blowing pressure of 600 kPa was used, and a tube made of a polyamide [manufactured by TOYO BOSEKI Co., Ltd.; PELPRENE S6001; the hardness: D72]/a polyimide [manufactured by TORAY Co., Ltd.; TI POLYMER; the hardness: E86] and having a braid of a metal was used for the catheter shaft.
The balloon exhibited an excellent property for folding and re-wrapping. The property for inserting the balloon catheter was slightly inferior. Very slight deformation was found in the balloon after the use. Very slight deformation was found in the catheter shaft after the use. d1/d0 was 2.0. No abnormality was found in the blood vessel.
An artery in the left femoral region of a rabbit was used for the examination under the same conditions in accordance with the same procedures as those in Example 10 except that a balloon made of a polyimide [manufactured by TORAY Co., Ltd.; TI POLYMER; the hardness: E86] and prepared in accordance with the dipping process was used, and a tube made of a polyimide [manufactured by TORAY Co., Ltd.; TI POLYMER; the hardness: E86] and having a braid of stainless steel was used for the catheter shaft.
No deformation was found at all in the balloon or the catheter shaft after the use. d1/d0 was 2.0. No abnormality was found in the blood vessel.
When Example 15 was conducted, an artery in the right femoral region of the rabbit was used for the examination under the same conditions in accordance with the same procedures as those in Example 15 except that a balloon made of a perfluoroalkoxy resin [manufactured by MITSUI-DU PONT FLUORO-CHEMICAL Co., Ltd.; TEFLON PFA; the hardness: D60] and prepared in accordance with the blow molding process at a blowing temperature of 220° C. under a blowing pressure of 700 kPa was used, and a tube made of a perfluoroalkoxy resin [manufactured by MITSUI-DU PONT FLUORO-CHEMICAL Co., Ltd.; TEFLON PFA; the hardness: D60] and having a braid of stainless steel was used for the catheter shaft.
Very slight deformation was found in the balloon after the use. No deformation was found at all in the catheter shaft after the use. d1/d0 was 2.0. No abnormality was found in the blood vessel.
An artery in the left femoral region of a rabbit was used for the examination under the same conditions in accordance with the same procedures as those in Example 10 except that a balloon made of a polyamide [manufactured by UBE KOSAN Co., Ltd.; UBE NYLON 5033J12; the hardness: R80] and prepared in accordance with the blow molding process at a blowing temperature of 120° C. under a blowing pressure of 400 kPa was used, a tube made of a polyamide [manufactured by UBE KOSAN Co., Ltd.; UBE NYLON 5033J12; the hardness: R80]/a polyimide [manufactured by TORAY Co., Ltd.; TI POLYMER; the hardness: E86] and having a braid of stainless steel was used for the catheter shaft, and the temperature of the balloon was raised from 37° C. to 70° C. in 10 seconds, kept at 70° C. for 10 seconds and lowered from 70° C. to 45° C. in 10 seconds.
The balloon exhibited an excellent property for folding and re-wrapping. The property for inserting the balloon catheter was also excellent. Very slight deformation was found in the balloon and the catheter after the use. d1/d0 was 1.9. No abnormality was found in the blood vessel.
When Example 17 was conducted, an artery in the right femoral region of the rabbit was used for the examination under the same conditions in accordance with the same procedures as those in Example 17 except that a balloon made of a polyamide [manufactured by UBE KOSAN Co., Ltd.; UBE NYLON 5033J12; the hardness: R80] and prepared in accordance with the blow molding process at a blowing temperature of 120° C. under a blowing pressure of 400 kPa was used, a tube made of a polyamide [manufactured by UBE KOSAN Co., Ltd.; UBE NYLON 5033J12; the hardness R80]/a polyimide [manufactured by TORAY Co., Ltd.; TI POLYMER; the hardness: E86] and having a braid of stainless steel was used for the catheter shaft, and the temperature of the balloon was raised from 37° C. to 70° C. in 40 seconds, kept at 70° C. for 10 seconds and lowered from 70° C. to 45° C. in 50 seconds.
The balloon exhibited an excellent property for folding and re-wrapping. The property for inserting the balloon catheter was also excellent. Very slight deformation was found in the balloon and the catheter after the use. d1/d0 was 2.3. The thickness of the blood vessel was found to have decreased.
The conditions of Examples 10 to 17 and Comparative Example 6 are shown in Table 2, and the results are shown in Table 3.
As shown in Table 2, in Examples 10 to 14 and 17 in which the device for converting the laser energy was placed in the distal portion of the catheter shaft, the balloon made of a thermoplastic resin was used and the temperature was raised to 70° C. in 10 to 20 seconds and lowered to 45° C. in 10 to 20 seconds, the operability of the balloon catheter was excellent, the deformation of the balloon and the catheter shaft after the use was slight, and almost no abnormality was found in the blood vessel. The balloon catheter of Examples 15 and 16 in which the device for converting the laser energy was placed in the distal position of the catheter shaft and the balloon made of the polyimide resin or the fluororesin was used, showed almost no deformation of the balloon and the catheter after the use and almost no abnormality was found in the blood vessel although the operability was inferior to that in other Examples.
In contrast, in Comparative Example 6 in which the times for raising and lowering the temperature were long although the device for converting the laser energy was placed in the distal portion of the catheter shaft and the balloon made of a thermoplastic resin was used, the thickness of the blood vessel decreased.
