The present invention is intended for use in medicine in order to enable a maximally accurate, fast and safe positioning of a coronary stent in case of uncomplicated and complicated anatomic lesions of the coronary bed, in particular within the coronary artery in case of endovascular surgery by means of coronary stenting for recanalization of the artery portions constricted as a result of lesion.
The device is intended for use in case of coronary ostial lesions, coronary bifurcation lesions, including lesions of the left coronary artery trunk and ostial lesions of the right coronary artery, as well as in case of “stent-to-stent” implantation for reducing the “overlap” area.
The use of this device allows the radiation exposure of patients and medical personnel as well as the exposure of patients to radio-opaque contrast agents to be significantly reduced.
The device may be successfully used by young professionals at the time of their professional development in the field of interventional cardiology.
In addition, the claimed device may be also used for stenting renal, visceral arteries in a similar way.
A number of devices for positioning a stent within the coronary artery are available at the medical equipment market.
In particular, the U.S. Pat. No. 6,293,964 discloses OSTIAL PRO available from Merit Medica (USA). The device according to this patent comprises a cone made up of four tongues insertable into a guiding catheter together with a coronary stent. The guiding catheter is selectively positioned within the coronary ostium. The coronary stent is guided along the catheter to a location more distal that the coronary ostium, whereafter the guiding catheter is withdrawn from the coronary ostium and the device is deployed. As the device leaves the guiding catheter, its tongues unfold and abut against the aortal wall so that the guiding catheter tip cannot be selectively positioned within the coronary ostium as required for ostial stenting of the left coronary artery trunk and the right coronary artery trunk. The entire subsequent positioning of the coronary stent within the affected area is performed manually.
A disadvantage of the known device is its limited applicability, in particular only in cases of ostial lesions of the left coronary artery trunk and the right coronary artery trunk, as well as the manual positioning of the coronary stent.
Also known is a device for a safe positioning of a coronary stent within coronary arteries according to the patent of the Russian Federation No. 2598798 owned by Seven Sons OJSC.
The claimed device differs primarily in:
The device is industrially applicable.
The claimed device comprises the housing with the tail and different elements placed inside the housing: the screw rotating wheel and the screw that are made as a single element, runner with the arrow and thread elements for making contact with the screw, scale for identification of the runner distance, coupling with placed elastic fixing elements, the plug consisting of 2 elements, the spring and the fixing button.
The cylindrical housing is made from plastic using the casting method under pressure, being pebbled at spots, where the operator touches the device using his/her arm, with the right and left halves of the housing manufactured separately and connected after assembly of the mechanism. The upper part of the housing has the screw rotating wheel, placed in a slot for the screw rotating wheel and the fixing button placed in the side slot of the housing. The truncated front part of the housing has recesses on its both sides for the operator's left thumb and left forefinger to hold the device fixed in position, wherein the recess for the left thumb also serves as a pad for fixing the coronary guide, and the rear upper part of the housing is made in the form of the support for the right hand having the shape of a tail. There is a rectangular window in the upper part of the housing made of clear material, under which the control ruler to determine and control the location of the mechanism fixing the coronary stent delivery system into the housing. The maximum distance of moving of the mechanism fixing the coronary stent delivery system in each side is limited with the ruler's size based on the size of the device. The front and rear parts of the housing have holes for insertion of the coronary stent delivery system into the housing.
There is the screw rotating wheel in the housing between the truncated front part and the cylindrical part; the upper part of said wheel bulges over the housing and the lower is inside the housing made as a single detail with a horizontal screw inside the housing placed on the runner and able to move along inside the housing, on which axis the coupling with the fixing element made of the elastic element at points, where it contacts the delivery system is placed with a bushing, which can rotate around its axis; there is a plug comprising the side element and the tapered element and a spring contacting the edge of the side element via a through hole in the runner and fixed on the runner's wall on the side opposite to the button, placed on the opposite side of the runner.
In this case the side element of the plug is placed in the side hole of the runner, on the side, where the fixing button is, forming a rectangular block with a rounded side surface on the side of the fixing button; it has a through hole made by the cut on one side and the cut at an angle on the other side, such cuts made in a way that allows end-to-end placement of the tapered element therein, which lower part is cut at a certain angle and the upper part forms a cone emerging from the hole in the runner on the side of the coupling and contacting them. Both plug components have holes used to move the coronary stent delivery system, when the device is working. The side part of the runner on the side opposite to the fixing button has a spring contacting the surface of the plug side component.
Such structure allows fixing the coronary stent delivery system rigidly at its progressive movement back and forth making it rotating freely around its axis.
The side part of the housing has a fixing button, the internal part of which is placed inside the housing and is a rectangular plate. The fixing button is centered with reinforcement plates inside the housing, which allows it moving freely towards and from the plug. The button is placed in such a way that when it is pushed its inner surface presses on the rounded surface of the side plug element, which in turn presses on the tapered plug, this leading to opening the coupling and the coronary stent delivery system undergoes lock release. Here, the cross-cut end of the plug side element placed on the side of the spring goes into the through hole in the runner and presses on the spring in the runner channel.
To return the fixing mechanism into the initial position with the closed coupling, the button is released, the spring opens pulling the plug side element into the initial position. Here, the tapered element also returns to its initial position due to elasticity of the coupling thereby fixing the coronary stent delivery system inside the device.
Thus, when the button is released the coupling clamping leads to the coronary stent delivery system being fixed, and when the button is pushed pressure is applied to the plug unclamping the coupling and making the coronary stent delivery system free to move along the axis.
In the preparation for use, a coronary stent carried by the delivery system is first progressively inserted inside the device, to perform this operation the operator presses fixing button, the inner rectangular part presses the plug, which makes the coupling to unclamp, and through the holes of the housing the delivery system of a coronary stent is placed. When no pressure is exerted on the fixing button the spring moves the side element of the plug, thus returning the tapered element and the button in the initial position, and the coupling clamps fixing the delivery system. The operator manually advances the coronary stent carried by the delivery system placed within the device to the affected area of the coronary artery. Then, pressure is again exerted on the outer pressure surface of the release mechanism, the pressure roller causes the protrusions on the flaps to contract, the flaps open at the gripping point of the delivery system on the bushing side, and the operator brings the device to a necessary distance for fixing the same with his/her left arm, releases the pressure surface, and rotates the cylindrical rear part of the housing with his/her right arm to convert the rotary motion of the rear part of the housing into longitudinal translational motion of the runner with the gripping means along the guides inside the housing to displace the delivery system to a necessary distance for positioning of the coronary stent. Also when the operator pushes the button, he/she may return the mechanism fixing the coronary stent delivery system into the initial position by rotating the wheel in the required direction, which allows further positioning of the coronary stent forward or back within the range of the ruler in each side.
The device consists of the housing with the tail and screw rotating wheel, screw placed thereon and made as a single element, the rotation gear contacting the screw and the pressure cylinder placed on the button with components for spring placement, which hold the delivery system guide.
The cylindrical housing is made from plastic using the casting method under pressure c pebbled at spots, where the operator touches the device, with the right and left halves of the housing manufactured separately and connected after assembly of the mechanism. The cylindrical rear part of the housing is connected to the truncated front part of the housing so as to be rotatable around its axis relative to the said front part. The upper part of the housing has the screw rotating wheel, placed in a slot for the screw rotating wheel and the fixing button placed in the side slot of the housing. The truncated front part of the housing has recesses on its both sides for the operator's left thumb and left forefinger to hold the device fixed in position, wherein the recess for the left thumb also serves as a pad for fixing the coronary guide, and the rear upper part of the housing is made in the form of the support for the right hand having the shape of a tail.
There is the screw rotating wheel in the housing between the truncated front part and the cylindrical part; the upper part of said wheel bulges over the housing and the lower is inside the housing made as a single detail with a horizontal screw inside the housing contacting the rotation gear placed on the pressure cylinder, which is able to rotate and contacting the fixing button element, on which springs the coronary stent delivery system guide is placed; the outer side of the system has a shape of a cylinder inside the housing.
In an embodiment, the device may be already provided with the delivery system fixed therein.
In this case, the stage of inserting in advance the coronary stent carried by the delivery system inside the device is omitted. The coronary stent carried by the delivery system is manually advanced to the affected area of the coronary artery and then pressure is exerted on the pressure surface, the flaps unfold at the gripping point of the delivery system, and the operator brings the device to a necessary distance for fixing the same with his/her left arm, releases the pressure surface, and rotates the cylindrical rear part of the housing with his/her right arm to displace progressively the delivery system to a necessary distance for positioning the coronary stent within the artery. When pressure is exerted on the pressure surface, by fixing the delivery system, the operator may also return to initial position the mechanism fixing the coronary stent delivery system by rotating the cylindrical portion of the housing in the necessary direction so that further positioning of the coronary stent forwards and backwards may be continued within the dimensions of the guides inside the housing in each of the directions.
In an embodiment, for a safe placing of the stent on the delivery system, a hollow tube prearranged inside the device may be used for inserting therein the delivery system carrying the stent following which the tube is removed from the device.
Listed below are the attached drawings wherein:
The invention will be described below with reference to the attached drawings.
The device comprises a housing 1 (
The housing consists of the front truncated part 3 (
The mechanism placed in the housing 1 (
In the inner part of the housing, there is an internal fixing element 18 (
There is the hole 21 (
To position the delivery system 10 inside the device, the operator pushes the fixing button 18 (
Using the screw rotating wheel 11 (
In an embodiment of the invention, the device may be used with a prior fixed delivery system 10 (
In another embodiment of the invention for safe positioning of the stent in the delivery system, an empty tube may be used, which has been prior placed inside the device, in which the delivery system 10 (
The device comprises a housing 1 (
Housing 1 (
There is the screw rotating wheel 11 (
For placing a delivery system 10 (
Using holes 9 (
Another embodiment of the invention has the delivery system 10 (
Another embodiment of the invention for safe positioning of the stent in the delivery system, an empty tube may be used, which has been prior placed inside the device, in which the delivery system 10 (
Number | Date | Country | Kind |
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2016152734 | Dec 2016 | RU | national |
Filing Document | Filing Date | Country | Kind |
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PCT/RU2017/000235 | 4/14/2017 | WO | 00 |