The invention relates to a medical device for insertion into a hollow organ and to a method for producing such a device. A device of the type in question, with the features of the preamble of claim 1, is known, for example, from DE 101 27 602 A1.
For the treatment of aneurysms and stenoses and for the expansion of clots, lattice structures are suitable that have very fine meshes. By means of the fine meshes, the flow conditions in the aneurysm can be influenced, in particular by slowing down the flow through the aneurysm with the aim of effecting the coagulation and sclerosis of the aneurysm. The finely meshed lattice structure also promotes the rapid growth of cells (endothelialization). Moreover, in the expansion of stenoses and of clots, particles are efficiently blocked by the fine meshes.
A very fine mesh structure is achieved in particular by braids, which are therefore especially suitable for this type of use.
Braids are also used in the endovascular area whenever increased flexibility is demanded. For example, baskets for protecting against distal embolism or for removing clots can be produced in the form of braids. The good flexibility of braids also permits treatment in highly tortuous areas, for example in the brain. Baskets can also be used in other areas, for example in the bladder in order to remove stones. The flexibility is also advantageous in connection with the treatment of aneurysms or stenoses when these are located at highly tortuous vascular sites.
It is known to produce braids with an open structure. This means that the wires of the braid have free ends. In this way, the wires can be braided as a long strand, which is then cut to the suitable length. In this way, different units are formed with in each case open or free wire ends. This production technique is suitable if the braid has many wires and if individual production of individual units is uneconomical. Braids with a large number of wires are very finely meshed and have the aforementioned advantages.
Alternatively, braids can be produced with closed loops. This requires individual production of each braid. The braids thus produced have the advantage that the wire ends rounded off by the loops are atraumatic and reduce the risk of injury to the vessel wall.
An example of a braid with closed loops is disclosed in the aforementioned DE 101 27 602 A1. Said document describes a stent for implantation in the human body, with a hollow cylindrical body which is produced from a braid. At the braid ends, the free ends of the wires of the braid are brought together and connected in such a way that loops or meshes are formed at the braid ends. The loops at the braid ends lead to a terminating edge of the braid with a jagged contour.
Braids in which the wires end freely, and also braids with closed loops at the braid ends, as are described in DE 101 27 602 A1 for example, have the disadvantage that the free wire ends or the loops impede or even completely prevent a retraction of the braid into a catheter after the braid has been released from the catheter into the vessel. In braids with free wire ends at the braid end, there is the further problem, as regards the retractability of the braid, that a guide wire cannot in practice be connected to the braid for retraction thereof. Even if the braid were to be connected at some point to a guide wire that retracts the braid into the catheter, the free wires would catch on the catheter opening. This would damage the braid and the catheter. It is therefore not possible to draw the braid back.
It is also not possible for a braid ending with closed loops to be retracted into the catheter after it has been fully released. Such a braid has several tips at the braid end, and the tips become jammed during the retraction into the catheter. This is especially the case if the braid is connected to a guide wire at a single location.
The object of the invention is to make available a medical device for insertion into a hollow organ, which device comprises a braid, of which the axial braid end is designed such that the medical device can be drawn back into a delivery system, for example into a catheter, even when the medical device has been released completely or almost completely from the delivery system. The invention also has the object of making available a method for producing such a device.
According to the invention, the object is achieved, in respect of the device, by the subject matter of claim 1, and, in respect of the method, by the subject matter of claim 22.
The invention is based on the concept that a medical device for insertion into a hollow organ comprises a hollow body that has a braid of wire elements with a series of terminal meshes, which delimit an axial braid end. The terminal meshes comprise outer wire elements, which form a terminating edge of the braid and merge into inner wire elements arranged within the braid.
A first section of the terminating edge and a second section of the terminating edge each have several outer wire elements which together form a peripheral margin of the terminating edge. The margin is adapted in such a way that the axial braid end of the hollow body can be drawn into a delivery system.
The outer wire elements of the first section for forming the terminating edge are arranged directly one after another along the latter. The outer wire elements each have a first axial component, which extends in the longitudinal direction L of the hollow body.
The outer wire elements of the second section for forming the terminating edge are arranged directly one after another along the latter. The outer wire elements each have a second axial component, which extends in the longitudinal direction L of the hollow body. The second axial component is counter to the first axial component, wherein the two axial components are in relation to the same rotation direction of the margin.
The hollow body generally has an elongate shape with a longitudinal direction and is suitable to be inserted through a delivery system, for example through a catheter, into a hollow organ, in particular into a human hollow organ. The longitudinal direction of the hollow body corresponds to the direction in which the hollow body is moved through the delivery system and released in the hollow organ. The expression longitudinal direction of the hollow body thus corresponds to the expression direction of movement of the hollow body in the delivery system. The direction of movement of the hollow body in the delivery system can comprise the advance movement during the release of the hollow body and also the rearward movement during the retraction of the hollow body into the delivery system.
The expression terminal meshes is understood as meaning the outer meshes of the braid that delimit a braid end. In an elongate hollow body, the braid end is an axial braid end. The outer wire elements of the terminal meshes are the wire elements which are arranged on the outside of the terminal meshes and which represent the limit of the braid end. The outer wire elements form a terminating edge of the braid and merge into inner wire elements, which are arranged within the braid.
The outer wire elements can thus also be designated as edge-forming wire elements and the inner wire elements as braid-forming wire elements.
The first section of the terminating edge and the second section of the terminating edge each form a part-edge, which delimits the braid in the longitudinal direction of the hollow body. Each section has several outer wire elements or is formed by several outer wire elements which together form a peripheral margin of the terminating edge. The peripheral margin is adapted in such a way that the axial braid end of the hollow body can be drawn into a delivery system. This means that the hollow organ can be retracted in the longitudinal direction with the peripheral margin into the delivery system after the hollow body has been released completely or at least substantially from the delivery system.
The outer wire elements of the two sections for forming the terminating edge are in each case arranged directly one after another along the latter. This means that the outer wire elements of the first section form a first unit of the peripheral margin, which first unit is distinguished by the fact that the outer wire elements of this first unit each have a first axial component, which extends in the longitudinal direction of the hollow body.
The same applies analogously to the outer wire elements of the second section which, for forming the terminating edge, are arranged directly one after another along the latter and form a second unit of the peripheral margin. The outer wire elements of the second section are distinguished by the fact that they each have a second axial component, which extends in the longitudinal direction of the hollow body. The two axial components are arranged in opposite directions, wherein the two axial components are in relation to the same rotation direction of the margin. This means that one axial component faces forward in the longitudinal direction of the hollow body and the other axial component faces rearward in the longitudinal direction of the hollow body. In other words, one of the two axial components faces in the proximal direction, i.e. in the direction of the user, and the other of the two axial components faces in the distal direction, i.e. away from the user or physician. The different direction of the axial components is expressed by the fact that they are in relation to the same rotation direction of the margin. The same rotation direction of the margin is understood, for example, as the movement of an imaginary point on the margin in one and the same direction. It does not matter whether the movement of this imaginary point takes place clockwise or counter clockwise on the margin. For the definition of the direction of the axial components, it suffices if the rotation direction or the imaginary rotation is in the same sense.
By means of the novel type of braiding, the braid is structured such that the end contour of the braid, i.e. the contour in the area of the terminating edge, has, at least at one axial braid end, no protruding edges, or no edges protruding counter to the direction of retraction of the braid end into the delivery system. Rather, by means of the peripheral margin of the terminating edge and by means of the outer wire elements oriented according to the invention, the braid end can be retracted into the delivery system without parts of the braid end protruding radially outward beyond the opening of the delivery system and impeding the retraction. The outer wire elements form a common compact terminating edge.
The function of the retractability into a delivery system, particularly into a catheter, after the medical device has been completely released can be used both in implants and also in medical articles that are released only temporarily in a vessel, for example baskets, in particular clot catchers. In the case of implants, the advantage is that the positioning of the system, for example the positioning of stents, can be corrected after the release thereof. The implant can be deployed completely in the vessel and bear on the vessel wall. After checking the position of the implant, the user can draw the system back in again if incorrect positioning is observed and can then release the system anew, for example in front of an aneurysm or a stenosis. In the case of temporarily released devices, for example baskets or filters, the retractability function serves to ensure that the particles, for example clots, caught in the basket or filter can be removed from the vessel or from other hollow organs.
The invention also has the advantage that the braid can, at a single location of the braid end, be connected to an actuation element for retraction, for example to a guide wire, in order to ensure the retractability function. By virtue of the invention, it is not necessary (although the possibility is not ruled out) for the individual meshes to be connected to the guide wire in order thereby to achieve a radially inward orientation of the terminal meshes, so as to support the retractability function. In order to orient the terminal meshes inward, connecting wires would be needed between the terminal meshes and the guide wire, and this would result in the proximal end of the basket being obstructed by the connecting wires. The connecting wires would, for example, impede the catching of a clot. By contrast, the invention ensures that a braid configuration with an open braid lumen, particularly in the case of implants such as stents, or with an open proximal braid end, for example in baskets, whose distal end is closed, can be retracted into the delivery system after being completely released. The invention can also be applied to braid configurations with a closed braid lumen.
As regards the method according to the invention, the invention is directed to making available a method for producing a medical device, in which method a hollow body is braided from wire elements, and a first series of terminal meshes arranged next to one another and delimiting an axial braid end is formed. Each terminal mesh comprises at least one outer wire element. During the braiding, the outer wire elements of the terminal meshes are arranged such that they together form a terminating edge of the braid end, wherein inner wire elements arranged in the braid are deflected in order to form the outer wire elements. The deflection is such that the direction of winding and/or the direction of the axial component with respect to the longitudinal axis of the inner wire elements is changed. The change in the direction of winding or the change in the direction of the axial component with respect to the longitudinal axis L takes place at the transition from the inner to the outer wire elements.
In a preferred embodiment of the invention, the outer wire elements of the first section have a first circumferential component, and the outer wire elements of the second section have a second circumferential component, wherein the first and second circumferential components extend in the same circumferential direction of the hollow body. The circumferential direction of the hollow body is generally the direction in which the wall of the hollow body extends. For example, in a cylindrical hollow body, the circumferential direction is the direction in which the jacket surface of the hollow body extends. In contrast to the circumferential direction, which is generally in relation to the wall of the hollow body, the rotation direction of the margin is understood as the extent resulting from the contour of the margin. For example, the rotation direction of the margin corresponds to the circumferential direction of a hollow cylindrical body if the margin extends in a plane that is perpendicular to the longitudinal axis of the hollow body. If, for example, the plane in which the margin lies is inclined with respect to the longitudinal axis, the rotation direction of the margin and the circumferential direction of the hollow body are different.
In another preferred embodiment of the invention, the terminating edge is arranged obliquely with respect to the longitudinal direction of the hollow body. This further improves the retraction of the hollow body or of the medical device into a delivery system, since the oblique terminating edge results in the formation, in the longitudinal direction, of a proximal tip of the braid end, which proximal tip is moved first into the delivery system during the retraction and performs a guide function.
In a particularly preferred embodiment of the invention, at least one first outer wire element of a terminal mesh extends into the area of another terminal mesh, wherein the first outer wire element and at least one second outer wire element of the other terminal mesh overlap each other and are arranged together along the terminating edge. The overlapping of the two wire elements means that, in the area of the other terminal mesh, they together form the terminating edge and are arranged together along the latter. This arrangement of the outer wire elements is a preferred possibility for the design of a retractable peripheral margin or of such a terminating edge. The overlapping of the wire elements takes place mainly in the first section or in the second section of the terminating edge.
Preferably, the at least one first outer wire element and the at least one second outer wire element are connected. In the case of the wire elements arranged together along the terminating edge and overlapping each other, the connection of the wire elements has the advantage that the braid end, in particular the terminating edge, is stable. This further improves the retractability function. Moreover, a particularly smooth peripheral margin is formed which, in addition to being easy to retract, is also atraumatic.
In another preferred embodiment of the invention, the terminal meshes are formed by loops, which are staggered along the terminating edge and overlap each other. To form the in particular interconnected outer wire elements at the terminating edge, the loops are brought together at different locations that are arranged in succession along the terminating edge. A configuration of the braid end is thus achieved in which several wire loops are nested one inside another, and specifically such that the loops merge into one another at different locations along the terminating edge. A staggered arrangement of loops is achieved in this way, the staggered arrangement extending along the terminating edge.
The configuration of the terminal meshes by means of the above-described loops affords a simple possibility by which the braid end is formed and a smooth peripheral margin is obtained. In addition, the loop configuration provides a wide range of variation, since the staggered arrangement of the loops can be modified in various ways.
In another preferred embodiment, the inner wire elements are guided to the terminating edge. Alternatively, the inner wire elements are branched off from the terminating edge. This provides two possible ways of strengthening the terminating edge when forming a peripheral retractable margin. In the first possibility, starting from a thin section of the terminating edge, for example a section with only a single outer wire element, the inner wire elements are delivered to the terminating edge and the latter is thereby successively strengthened, such that the terminating edge with each subsequent terminal mesh has more outer wire elements and thus becomes thicker. In the second possibility, starting from a strengthened terminating edge or from a strengthened section of the terminating edge, the latter is reduced in strength by means of wire elements being branched off from the terminating edge and being guided onward as so-called inner wire elements in the braid. In both alternatives, the outer wire elements of the terminating edge merge into the branched-off or delivered inner wire elements.
The merging outer and inner wire elements of one and the same terminal mesh are sections of a continuous wire and can also generally be designated as inner or outer wire elements sections or as wire sections.
At the transition from the inner wire elements to the outer wire elements or, conversely, at the transition from the outer wire elements to the inner wire elements, the direction of winding and/or the direction of the axial component with respect to the longitudinal axis of the hollow body is changed. In terms of the braiding technique, the change in direction of the wire elements makes it easier to bring the individual wires together in a common terminating edge.
The inner wire elements and the outer wire elements can have the same braiding angle, as a result of which the terminating edge and the wires located in the braid do not collide. In addition, the same braiding angle avoids the structure distorting when retracted into the delivery system. This does not exclude the possibility of the braiding angle changing in the braid. It suffices if the inner wire elements adjoining the terminating edge, or the inner wire elements near the edge, and the outer wire elements have the same braiding angle.
The retractability into the delivery system is improved and facilitated particularly if all the wires or wire elements located at the same axial level have the same braiding angle. This applies to the inner wire elements and to the outer wire elements. The braiding angle is the angle between the wire element and a projection of the longitudinal center axis of the device. The angle can be between 0°, in particular more than 0°, and 90°. Depending on the spiral direction of different wire elements or wire sections, the braiding angle at the same absolute value can be differently oriented, for example in the area of the deflection of a wire element.
Preferably, all the inner wires and outer wires in the entire braid area of the terminating edge have the same braiding angle. The braid area of the terminating edge is the area of the medical device extending between two planes, of which one extends perpendicularly with respect to the axis of the braid and the other extends through the tip and through the apex of the terminating edge. This is therefore the entire area, limited in the longitudinal direction, to which the terminating edge belongs. It is preferable if all the wires in the braid area of the terminating edge, or at the same level in the braid area of the terminating edge, have a similar angle (absolute value). The difference between the braiding angle of two wires is preferably at most 20° 15° 10° 8° 6° 5° 4° 3° 2° 1°.
At the deflection locations, where the inner wire elements merge into the terminating edge, the wires have a changing braiding angle. The deflection location can be a kink. Preferably, the deflection location has a radius of less than 1 mm, 0.8 mm, 0.6 mm, 0.4 mm, 0.3 mm, 0.2 mm, 0.1 mm. In this way, the wire can change the spiral direction on a short path. The wires, preferably all wires which are deflected upstream and downstream of the deflection location, i.e. upstream and downstream of the radius of the kink, preferably have a braiding angle difference (absolute value) of at most 20° 15° 10° 8° 6° 5° 4° 2° 1°.
The interconnected outer wire elements of the terminal meshes can be connected by a form fit, in particular by twisting and/or intertwining, and/or by an integral bond, in particular by adhesive bonding, welding or soldering, and/or by mechanical connecting means, in particular by coils and/or sleeves and/or wires. In the connecting technique, sleeves are of advantage, particularly sleeves that are visible by X-ray, preferably platinum/iridium sleeves. In a preferred variant, the sleeves are mechanically crimped. However, the sleeves can also be welded. The placing of X-ray-visible material on the terminating edge, optionally on the entire edge, has the advantage that the opened braid end and its position can be easily seen.
In a preferred embodiment of the invention, the number of the outer wire elements of the first section and the number of the outer wire elements of the second section in each case increases toward a front area of the terminating edge in the longitudinal direction of the hollow body. The number of the outer wire elements of the first section and the number of the outer wire elements of the second section are each at a maximum in the front area. For example, in the case of a terminating edge arranged obliquely with respect to the longitudinal direction of the hollow body, the front area of the terminating edge is the area of the front tip or the proximal area of the terminating edge. Starting from a terminal mesh arranged remote from the front area, the number of the outer wire elements increases with each additional terminal mesh, and specifically in the direction of the front area. There, the number of the outer wire elements is at its maximum. This applies to each of the two sections. This embodiment provides a structure that is stable in the front area of the terminating edge and that improves the guide function of the terminating edge upon retraction into the delivery system.
The outer wire elements of the terminal meshes can be brought together in a front terminal mesh. This also increases the stability of the terminating edge in the front area: The outer wire elements can form a single group, which is deflected in the area of the front terminal mesh. This means that the free wire ends of the respective wires that form the outer wire elements are arranged in the area of the other braid end. There, the free wire ends can be fixed in a conventional manner. It is also possible to arrange the free wire ends as in the document DE 10 2009 006 180.0 going back to the applicant. The content of said application is incorporated in full by reference.
Alternatively, the outer wire elements can form at least two groups, which are connected in the area of the front terminal mesh. This means that the free ends of the associated wires, or those wires that form the respective outer wire elements, are brought together in the area of the front terminal mesh and are connected there. The free wire ends can be connected in a conventional manner.
Preferably, the number of the outer wire elements of the first section and of the second section in each case decreases toward a front area of the terminating edge in the longitudinal direction of the hollow body and is at a minimum in the front area. With regard to the arrangement of the front area, reference is made to the above comments. In contrast to the aforementioned embodiment, the number of the wire elements decreases in the proximal direction of the terminating edge. In other words, starting from the front area of the terminating edge, the number of the outer elements rises with increasing distance until the number of the outer wire elements is at a maximum. The outer wire elements are gathered to form a wire bundle which, in order to strengthen the hollow body, is arranged in the braid and forms a part of the braid. This means that the wire bundle forming the terminating edge is guided into the braid and forms a part of the braid. The resulting strengthening of the braid stabilizes the hollow body.
In another preferred embodiment of the invention, an intermediate area is arranged between the front area and a rear area of the terminating edge. The number of the outer wire elements, starting from the intermediate area, decreases toward the front area and toward the rear area of the terminating edge. The number of the outer wire elements is at a maximum in the intermediate area. The rear area of the terminating edge is that area in which the terminating edge merges into the closed wall of the braid. In the case of an obliquely arranged terminating edge, the rear area of the terminating edge is arranged opposite the front area and spaced apart therefrom, wherein the front area forms a braid tip. This applies to all the illustrative embodiments in which the terminating edge is arranged obliquely. In the aforementioned embodiment, the intermediate area is arranged between the front area and the rear area of the terminating edge and spaced apart from each of these. The associated lateral strengthening of the terminating edge opens up further possible uses of the device.
In another embodiment of the invention, the inner wire elements form inner mesh limits of the terminal meshes of the first section and/or of the second section which, starting from a terminating edge, extend into the braid interior, wherein the terminal meshes are at least in part interconnected at the inner mesh limits. In this embodiment, the connection of the terminal meshes to one another is effected mainly by the inner wire elements and less so by the outer wire elements. It has been shown that, in such a configuration of the invention too, a sufficiently stable terminating edge is achieved which permits retraction of the braid end into a delivery system, without the individual terminal meshes becoming caught on the admission opening of the delivery system.
The outer wire elements of the terminal meshes can be arranged such that they do not overlap. In this embodiment, edges can occur between the individual terminal meshes, but these edges do not impede the retraction of the hollow body into the delivery system, since they extend in the direction of retraction or do not protrude counter to the direction of retraction.
It will be noted that small projections can generally form along the terminating edge. These can be caused, for example, by the twisting of the wires. In the context of the invention, the terminating edge is designated as smooth when there is a substantially continuous profile of the wire elements. This means that no sharp edges arise to impede the retraction of the lattice braid into a delivery system. Individual wire elements can thus protrude in the area of the terminating edge, these wire elements describing a curve which describes such a large radius that the terminating edge is smooth as a whole or continuously smooth. Advantageously, the protruding wire element protrudes at most by an amount that corresponds maximally to the diameter of the wire element. In particular cases, it is also possible that the wire element protrudes beyond adjacent wire elements, the protrusion corresponding at most to three times the wire diameter. It is important that the terminating edge is made continuously smooth so as to permit the retraction into a delivery system.
In another embodiment, the terminal meshes of the first section and/or of the second section in each case have at least two loops, which are arranged next to each other along the terminating edge, wherein at least a third loop overlaps the first loop and the second loop. This embodiment has the advantage that the variously combinable loops permit production of a braid which is designed differently in the area of the terminating edge, such that the mechanical properties, for example the radial force, the flexibility and the mesh fineness, can be adapted very precisely. This applies not only to the area near the outer edge, but also to the entire braid.
In a particularly preferred embodiment of the invention, at least one outer wire element and/or an additional wire element forms a continuation which extends beyond the contour of the terminating edge. The continuation can be used, for example, to connect a guide wire to the hollow body. The continuation can be designed, for example, in the form of a loop, into which a corresponding mating piece of the guide wire is hooked.
The aforementioned features of the various embodiments are design features that can be implemented on the device and that characterize the latter. The aforementioned features of the various embodiments are also disclosed, where appropriate, as method features in connection with the method of production.
The invention is explained in more detail below on the basis of illustrative embodiments and with reference to the attached schematic drawings, in which:
a shows a schematic view illustrating the change in the winding direction of the wire elements of the device according to
b shows a schematic view illustrating the change of direction of the axial component of the wire elements in the device according to
a shows a perspective side view of a device in another illustrative embodiment according to the invention;
b shows a perspective side view of a device in another illustrative embodiment according to the invention;
a shows the developed view of a medical device in another illustrative embodiment according to the invention, with deflected first wire elements;
b shows the developed view of a medical device in another illustrative embodiment according to the invention, with non-deflected first wire elements;
a shows the developed view of a medical device in another illustrative embodiment according to the invention, with multiply wound individual wires and deflected first wire elements;
b shows the developed view of a medical device in another illustrative embodiment according to the invention, with multiply wound individual wires and non-deflected first wire elements; and
The invention can be generally applied to implants or to medical devices which are released temporarily in the body and in which it is important that they be retractable into the corresponding delivery system. The retractability can play a role in repositioning, in particular of implants such as stents, or generally in the recovery of temporarily released medical devices.
The device according to
As can be seen in
The first series 13 with the terminal meshes 14a, 14b, 14c, 14d arranged next to one another continues in the direction of the longitudinal axis in the form of further series of meshes which together form the braid 11. The further series of meshes are produced or braided in a manner known per se. The terminal meshes 14a, 14b, 14c, 14d of the first series 13 have outer wire elements 12a to 12d, which together form the terminating edge 16 of the braid end 15. The outer wire elements 12a, 12b, 12c, 12d are therefore all arranged in the longitudinal direction L on the outside of the braid edge.
The course or the arrangement of the first and second axial components AK1, AK2 is shown in
The first section 16a and also the (fully depicted) second section 16b of the terminating edge 16 are each composed of several outer wire elements 12a, 12b, 12c, 12d, which are arranged directly one after another along the terminating edge 16. In the present illustrative embodiment, the outer wire elements 12a, 12b, 12c, 12d are arranged flush in a line. It is also possible that the outer wire elements 12a, 12b, 12c, 12d at the terminating edge 16 are slightly offset outwardly or inwardly in relation to one another, in which case the resulting edges do not protrude counter to the retraction direction EZ.
The wire elements 12a, 12b, 12c, 12d are arranged directly one after another by means of the fact that, for each terminal mesh 14a, 14b, 14c, 14d, an inner wire element 12a′, 12b′, 12c′, 12d′ is delivered to the terminating edge and integrated into the latter. This results in the successive arrangement of additional outer wire elements 12a, 12b, 12c, 12d in the direction of the front terminal mesh 18. This principle applies to all the illustrative embodiments of this application, wherein the outer wire elements 12a, 12b, 12c, 12d are arranged substantially in a row along the terminating edge 16, whether or not they overlap in the course of the terminating edge 16.
By means of the uniform orientation of the outer wire elements 12a, 12b, 12c, 12d of the first section 16a and of the second section 16b with opposite axial components AK1, AK2, a shape of the terminating edge 16 is achieved which permits a retraction of the braid end into the delivery system. In this way, it is possible to form a smooth margin 15a of the terminating edge 16, which margin 15a slides without resistance into the delivery system. The orientation of the outer wire elements 12a, 12b, 12c, 12d with opposite axial components AK1, AK2 also permits the formation of edges that extend in the distal direction and thus likewise do not impede a retraction into the delivery system.
Moreover, the uniform orientation of the outer wire elements 12a, 12b, 12c, 12d of the respective section 16a, 16b does not exclude the possibility that the axial components of the individual outer wire elements 12a, 12b, 12c, 12d are of different sizes, such that a curved plane is obtained in which the terminating edge or the opening of the axial braid end lies. In the illustrative embodiment according to
It will also be seen from
The course of the two axial components AK1, AK2 and of the two circumferential components UK1, UK2, as described with reference to
As is shown in
The structure of the terminating edge 16 can be seen particularly clearly in
The wires 12a, 12b, 12c, 12d do not have to be interconnected along the entire length. A slight twisting, which allows the wires 12a, 12b, 12c, 12d to be movable relative to one another, is also possible. For example, the wire 12a winds only once around the wire 12b at the level of the mesh 12b. This has the effect that the movement, in particular the compression, of both end loops 14a and 14b cannot take place independently of the other. Both loops engage in each other.
As is shown in
The outer wire elements 12a of the first terminal mesh 14a, or of the group of wire elements 12a of the first terminal mesh 14a, extends into the area of the adjoining second terminal mesh 14b. The second terminal mesh 14b has an additional second outer wire element 12b, which is connected to the first outer wire element 12a of the first terminal mesh. In this way, the terminating edge 16 has an increased thickness in the area of the second terminal mesh 14a, as is shown by the thicker line in
Thus, the number of the outer wire elements generally increases in the circumferential direction and, in the case of an obliquely arranged terminating edge 16, toward the tip. In the illustrative embodiment according to
The wire elements of the respective terminal meshes 14a, 14b, 14c, 14d are interconnected, for example twisted or intertwined. Other connection possibilities, in particular integrally bonded or mechanical connecting means, are possible. This has the effect that the terminating edge 16 forms a stable margin.
As is shown in
The terminal meshes can be formed, for example, by loops which overlap each other along the terminating edge 16 or which are offset along the terminating edge 16. In the illustrative embodiment according to
This means that the loops are brought together in a staggered arrangement at the successive locations 17b, 17c and 17d in the circumferential direction. The loops can be arranged symmetrically with respect to the longitudinal axis L such that
Other loop configurations are possible, resulting in a different number of outer wire elements 12a, 12b, 12c, 12d per mesh along the circumference of the terminating edge 16.
As can also be seen in
The inner wire elements 12a′, 12b′, 12c′, 12d′ and outer wire elements 12a, 12b, 12c, 12d together form the loops described above.
At the transition of the inner wire elements 12a′, 12b′, 12c′ and 12d′ into the outer wire elements 12a, 12b, 12c, 12d according to
As can be seen in
It can also be seen in
As is shown in
In the illustrative embodiment according to
The outer wire elements 12a, 12b, 12c, 12d can be part of a single group of wire elements, which group is deflected in the area of the front terminal mesh. The ends of the respective wire elements are in this case fixed in another area of the braid, in particular at the other end of the braid. Alternatively, the wire elements 12a, 12b, 12c, 12d coming from the one circumferential direction can form a first group of wire elements, and the wire elements 12a, 12b, 12c, 12d coming from the other circumferential direction can form a second group of wire elements. The two groups of wire elements are interconnected in the area of the tip of the front terminal mesh 18.
Particularly in the case where the same wires 12a, 12b, 12c, 12d are deflected as a whole group, they are not deformed sharp in the area of the front terminal mesh 18, as shown schematically in the drawings. Instead, the end of the mesh has a rounding. If different wire groups are brought together, the groups can extend tangentially to one another in the distal direction.
In the illustrative embodiment according to
The wires are twisted in the area of the contour of the terminating edge 16, as a result of which a compact configuration is obtained. This permits the insertion of the device into small catheter lumens. The branching-off (or delivery) of each individual wire element can be such that the wire element merges smoothly into the twist. This is possible, for example, through the design of the twist and the exact position of the branch-off. It is also possible that the wire elements are not twisted but braided. This increases the stability of the wire strands in the area of the terminating edge 16. A combination of twisting and braiding is also possible.
Another illustrative embodiment of a device with another braid configuration is shown in
In the braid combination according to
The last loop consists of a single wire element 12a and is arranged in the area of the front terminal mesh 18. It will also be seen from
a,
6
b show two further illustrative embodiments of the device according to the invention, in which the outer wire elements 12a, 12b, 12c, 12d of the front terminal mesh 18 form a continuation 19, which extends beyond the contour of the terminating edge 16. The continuation 19 has a functional element, in particular a connecting element 20, which is designed as a loop, for example. The loop can be used to connect the device to an actuation element, in particular to a guide wire of a delivery system. Otherwise, the braid configuration of the illustrative embodiments according to
Generally, the wires in the area of the continuation 19, in particular the outer wire elements 12a, 12b, 12c, 12d, can be twisted together regardless of whether the wires in the terminating edge 16 are twisted or loose. The twisted arrangement of the wire elements in the area of the continuation 19 is therefore disclosed in connection with all wire configurations, in particular with twisted, loose, braided, mechanically connected or integrally bonded wire configurations. The twisting in the area of the continuation 19 increases the stability. Instead of the loop, the wires can have free ends. A sleeve, or generally a profiled endpiece, can be secured on the twisted arrangement in the area of the continuation 19. The sleeve, or the profiled endpiece, can be made of an X-ray-visible material, for example platinum. The connection between the sleeve, or the profiled endpiece, and the wires in the area of the continuation 19 can be in the form of a welded connection, a crimped connection, an adhesively bonded connection or another kind of mechanical connection. For example, the wire ends surrounded by the sleeve can, together with the sleeve, be welded at the front face, in particular by a semi-spherical weld. The front faces of the free ends can also be welded at the front face without a sleeve.
The continuation 19 preferably extends parallel to the longitudinal axis of the braid. This is not obligatory. The straight continuation can protrude radially outward. A radially outwardly rounded shape of the continuation 19 is likewise possible. The continuation 19 preferably extends in the same plane in which the oblique terminating edge 16 is arranged. The plane corresponds generally to a curved and oblique sectional face through a circular cylindrical hollow body. In this way, a gentle transition between the terminating edge 16 and the continuation 19 is formed. The cylinder jacket surface can be curved outward (flaring).
In all of the disclosed illustrative embodiments, the braid can have at least 8, 12, 16, 24, 32, 36, 40, 48, 60, 72, 84, 96 wires, this corresponding to the number of wires intersecting a plane perpendicular to the braid axis. In the case of closed loops, the actual number of wires is halved. The braiding angle, in particular the braiding angle of the terminating edge, is at least 20° 30° 40° 45° 50° 60° 70° 80°. In this way, the oval area is shortened. The braiding angle, in particular the braiding angle of the terminating edge, is at most 80° 70° 60° 50° 45° 40° 30° 20°. The gentle incline thereby obtained makes the insertion into the catheter easier.
The system is insertable into a catheter with an internal diameter of at most 2 mm, in particular at most 1.8 mm, in particular at most 1.5 mm, in particular at most 1.3 mm, in particular at most 1.1 mm, in particular at most 1.0 mm, in particular at most 0.9 mm, in particular at most 0.8 mm, in particular at most 0.7 mm, in particular at most 0.6 mm, in particular at most 0.5 mm, in particular at most 0.4 mm, in particular at most 0.3 mm, in particular at most 0.2 mm.
The braid can have wires with differing wall thickness.
The braid can be covered, preferably with PU. It can be partially covered. For example, the basket for removing a clot can be covered only in the distal area.
The wires can be made from nitinol, cobalt/chromium alloy or nitinol wires with a platinum core.
The coupling of the device according to
The holding means 35 specifically comprises, as shown in
The delivery system is described in more detail in the application entitled “Delivery system for a medical functional element”, which was filed by the applicant on the same day. The content of said application is incorporated in full into the present application by reference, since the example according to
Further illustrative embodiments with different braid configurations are shown in
In the illustrative embodiment according to
The wire path of a loop is indicated in
The loops of the first section 16a are arranged correspondingly.
It will also be seen from
This applies to all the embodiments of this application.
The illustrative embodiment according to
Another illustrative embodiment is shown in
In the illustrative embodiment according to
It is thus clear that the above-described illustrative embodiments permit different combinations, which allow a variable design of the braid, with the result that the mechanical properties, for example the radial force, flexibility and mesh fineness, can be very precisely adapted.
In all of the illustrative embodiments, the device in the expanded state can be funnel-shaped (flared) at the axial end, preferably in the area of the terminating edge 16. This means that the lattice braid is widened in the direction of the axial end, i.e. has a preferably continuously increasing cross-sectional diameter. The funnel-shaped widening is preferably arranged at a distal end of the lattice braid. The distal end corresponds to the axial end of the lattice structure which, upon release of the device from a catheter, is first to leave the catheter or the catheter tip. The distal end is thus arranged away from the user, whereas a proximal end of the lattice structure or of the device is directed toward the user. The funnel-shaped widening at the distal end of the lattice structure has the effect of facilitating the expansion of the device upon release from a delivery system. A widening at the distal axial end of the medical device is advantageous in particular in recanalization systems or baskets, particularly clot catchers or filters, which deploy distally in the hollow organ. Alternatively, the proximal axial end of the lattice braid, i.e. the axial end near the user during use, can have a funnel-shaped, in particular flared structure. This embodiment is suitable for devices which are designed as clot catchers or baskets with a proximally expandable axial end. It is also possible for both the proximal axial end and also the distal axial end of the lattice braid to have a funnel shape. This embodiment is advantageous, for example, in a device which is designed as a permanent implant or stent, in particular a stenosis stent or aneurysm stent. It is generally preferable if the funnel-shaped end forms an access to a cavity inside the lattice braid. A further axial end of the medical device can be closed or can likewise have a funnel shape.
As was explained at the outset, the outer wire elements 12a are formed by deflection, i.e. by a change in the direction of winding of the inner wire elements 12a′. An outer and inner wire element 12a, 12a′ thus form a one-part wire element 12A, of which the free end is arranged, and optionally fixed, in the area of the tip of the terminating edge 16 or at the axial braid end 15. The inner wire element 12a′ forms the braid-forming section of the one-part wire element 12A. The outer wire element 12a is formed by deflection of the inner wire element 12a′ and is integrated in the terminating edge 16. The outer wire element 12a forms the edge-forming section of the one-part wire element 12A. The inner wire element 12a′ thus corresponds to the non-deflected wire element 12A, and the outer wire element 12a corresponds to the deflected wire element 12A. This applies to all the wire elements, wherein the first wire element 12A, 12 comprise outer wire element 12a, which are guided into the terminating edge 16 without changing the spiral direction. In wires that are not deflected, 12a corresponds to the continuation of 12a′ in the terminating edge 16. The following explanations are therefore disclosed in connection with all of the illustrative embodiments and generally in connection with the invention.
a,
14
b,
15
a,
15
b and 16 show a medical device, in particular an implant for removal of concretions from hollow organs of the body, with a compressible and expandable lattice braid 11 that comprises several wire elements 12A, 12B, 12C, 12D with a first spiral direction and several wire elements 12E, 12F, 12G, 12H with a second spiral direction, which are each wound about a common longitudinal axis and intersect each other to form meshes. The lattice braid 11 has a peripheral terminating edge 16 with a first section 16a and second section 16b, wherein the first section 16a and second section 16b extend in different spiral directions along the terminating edge 16. The two sections 16a, 16b meet at the tip of the terminating edge 16 or at the braid end 15. Each of the two sections 16a, 16b is formed in each case by at least two wire elements, of which at least one wire element at the transition from the lattice braid 11 to the terminating edge 16 is deflected at a deflection location in such a way that the deflected wire element extends along the terminating edge 16 in another spiral direction than inside the lattice braid 11. The deflected wire element thus experiences a change in the spiral direction at the transition from the braid 11 to the terminating edge 16. The terminating edge 16 is smooth and runs round continuously, i.e. without projections.
The wire elements 12A, 12B, 12C, 12D with the first spiral direction are arranged axially symmetrically with respect to the wire elements 12E, 12F, 12G, 12H with the second spiral direction, as is shown in
Likewise, at the transition from the braid 11 to the terminating edge 16, specifically at the transition to the second section 16b, the first wire element 12H with the second spiral direction changes the spiral direction in such a way that the first wire element 12H in the area of the terminating edge 16 extends in the first spiral direction. Thus, with respect to the same rotation direction ULR of the margin 15a (see
Because of the cut-open view according to
The wire elements 12A, 12B, 12C, 12D, 12E, 12F, 12G, 12H, coming from the braid 11, open at different levels into the terminating edge 16, in each case at the same angle. Some, in particular half, of the wire elements 12A, 12B, 12C, 12D open into the first section 16a of the terminating edge 16, and some, in particular the other half, of the wire elements 12E, 12F, 12G, 12H open into the second section 16b of the terminating edge 16. The two sections 16a, 16b form symmetrical halves or, generally, segments of the terminating edge 16.
In connection with all the illustrative embodiments and, generally, in connection with the invention, it is disclosed that the wire elements 12A, 12B, 12C, 12D, 12E, 12F, 12G, 12H, which merge into the terminating edge 16, or the inner wire elements 12a′, 12b′, 12c′, 12d′ in the area of the terminating edge 16 experience an abrupt or discontinuous change in the spiral direction or the circumferential direction. The wire elements 12A, 12B, 12C, 12D, 12E, 12F, 12G, 12H thus form a defined angle at the transition to the terminating edge 16, for example an angle of ca. 90°. Other angles are possible, particularly in a range of 90° to 60°, preferably 70°. The braiding angle can be 45° to 60°, in particular ca. 55°. For example, the braiding angle of 45° corresponds to the transition angle of 90°. The other angles behave accordingly.
By means of the same orientation of the wire elements 12A, 12B, 12C, 12D, 12E, 12F, 12G, 12H at the transition to the terminating edge 16, i.e. by means of the deflection at the same angle, all the wire elements 12A, 12B, 12C, 12D, 12E, 12F, 12G, 12H have the same length. The wire elements 12A, 12B, 12C, 12D, 12E, 12F, 12G, 12H thus open into the terminating edge 16 at different discrete locations and at the same angle. For example, the first wire element 12A extends along the entire length of the first section 16a. The last wire element 12D extends only along one mesh in the area of the terminating edge 16, but is thus correspondingly longer in the braid, such that the same or at least approximately the same wire length is obtained. The same applies to the other wire elements.
The fact that the wire elements 12A, 12B, 12C, 12D, 12E, 12F, 12G, 12H are of substantially the same length means that the crimpability of the braid is improved, since no distortions, or at least no significant distortions, arise during the compression.
All of the wire elements 12A, 12B, 12C, 12D, 12E, 12F, 12G, 12H, or all of the inner wire elements 12a′, 12b′, 12c′, 12d′, can be deflected discontinuously into the terminating edge 16. This applies both to inner wire elements 12′ which are composed of individual wires or which are each composed of wire bundles. It is also possible that all of the wire elements 12B, 12C, 12D, 12E, 12F, 12G, or all of the inner wire elements 12b′, 12c′, 12d′, i.e. except for the first wire elements 12A, 12H or except for the first inner wire elements 12a′, are deflected completely.
In the case of the first wire elements 12A, 12H opening into the terminating edge in the area of the apex 39, it is thus necessary to distinguish between three possibilities. The two first wire elements 12A, 12H are deflected in the area of the apex and, on entering the terminating edge, each change the spiral direction, as is shown in
The two first wire elements 12A, 12H can each be composed of individual wires or of wire bundles having several individual wires or of a corresponding combination.
Alternatively, the two first wire elements 12A, 12H in the area of the apex can maintain their spiral direction, i.e. are not deflected, as shown in
If the two first wire elements 12A, 12H are each composed of wire bundles having several individual wires, some of the individual wires of a bundle can be deflected. The others can maintain the spiral direction. Thus, the individual wires of one first wire element 12A, 12H are divided at the apex 39 and some of them merge into the first section 16a and some into the second section 16b. Here too, no gap is formed. This applies to both first wire elements 12A, 12H. Otherwise they correspond to the aforementioned illustrative embodiments.
Therefore, for the two first wire elements 12A, 12H, the following combination possibilities exist: All of the individual wires are each deflected or are each guided into the terminating edge 16 without changing direction. All the individual wires of one wire element 12A are deflected, and all the individual wires of the other wire element 12H are not deflected. All of the wires open into the same section 16a, 16b. All the individual wires of one wire element 12A are deflected or not deflected. The individual wires of the other wire element 12H are split and in part deflected or undeflected.
The illustrative embodiments according to
The distance between the individual wires of the respective wire elements 12A, 12B, 12C, 12D, 12E, 12F, 12G, 12H decreases at least in the area of the last mesh, in particular in the area of the last two meshes before the terminating edge 16, until the individual wires touch each other in the area of the deflection location and continue together along the terminating edge 16. As the distance decreases, the individual wires come closer to each other tangentially. The tangential convergence is limited to the individual wires of each wire element. The deflection into the terminating edge 16 takes place discontinuously. Thus, on account of the tangential convergence before the terminating edge 16, there is only negligible distortion during crimping. In the example according to
The distortion of the braid 11 is also limited by the fact that the number of the individual wires per wire element 12A, 12B, 12C, 12D, 12E, 12F, 12G, 12H is limited in particular to a maximum of 6 individual wires, in particular a maximum of 5, in particular a maximum of 4, in particular a maximum of 3, in particular a maximum of 2.
On each pin there are two wires, which converge in the braid shortly before the pin. In each case, however, there are only two wires per pin. The distortion is thereby reduced. The main thing is that the number of wires converging tangentially is reduced, with a gradual or abrupt change of the course. The ratio of the number of individual wires per wire element to the total number of wires is at most 25%, in particular at most 20%, in particular at most 15%, in particular at most 10%, in particular at most 8%, in particular at most 6%, in particular at most 5%, in particular at most 4%.
The advantage of the multiple wire configuration is that, in a very fine wire braid, on account of the large number of individual wires, a correspondingly close positioning of the pins 23 of the manufacturing mandrel is limited by the maximum pin diameter. By means of the formation of wire bundles, the terminating edge 16 can be formed with a sufficiently large number of deflection pins 23, wherein the fine mesh of the braid is maintained. The individual wires of the wire bundles can be arranged in parallel, i.e. untwisted, next to each other. The individual wires can also be twisted or braided. The parallel individual wires of the respective wire elements 12A, 12B, 12C, 12D, 12E, 12F, 12G, 12H can form loose wire bundles. A loose wire bundle is understood as a wire bundle in which the individual wires are not fixed to each other, such that they are movable relative to one another, at least compared to a twisted or braided wire configuration in which the relative movement of the individual wires is limited.
The nature of the wire path toward the pin 23 is determined by the braiding technique. This can be, for example, 1 over 1, 1 over 2 or similar, and ensures that the convergence of the wires takes place just before the pin. This also stabilizes the braid. The braiding technique 2 over 2, 2 over 4, 4 over 4 or similar has the effect that the convergence is gentler, or the area of convergence longer. The braiding technique can change. For example, the braiding technique 1 over 1 can be present in the braid, and, closer to the terminating edge 16, the braiding technique 2 over 2, 2 over 4, 4 over 4 or similar may be present.
In the illustrative embodiment according to
The tangential convergence of the individual wires of the two first wire elements 12A, 12H takes place inter alia along the terminating edge 16, and specifically approximately over the edge length of at most two meshes. In the further course of the terminating edge 16, the individual wires of the two first wire elements 12A, 12H touch. If there are 2 individual wires per wire element 12A, 12H, the distortion is unproblematic. Here too, it is possible to have up to 6 individual wires, in particular a maximum of 5, in particular a maximum of 4, in particular a maximum of 3, in particular a maximum of 2. The tangential convergence is limited, for example, to 2 wires. The distortion is thus likewise limited. That wire at a certain distance from the terminating edge 16 is also arranged outside the terminating edge and therefore does not belong to the braid 11. The distortion is further limited for this reason too. The terminating edge 16 is clearly defined by the course of the pins 23 in the direction of the braid.
Another example of a multiple wire configuration with at least 2 wire elements, in particular at least 3 or at least 4, each having several individual wires, in particular having two individual wires, is shown in
All the features of the examples according to
To carry out the method for producing a device according to
If, in the illustrative embodiment according to
The following description of a method for producing the device according to the invention applies to all of the illustrative embodiments.
To produce a device according to the invention, in particular according to one of the illustrative embodiments explained above, a braiding machine is generally used. With the braiding machine, the wire elements are automatically braided to form the braid 11. The braiding machine comprises reels, onto each of which a wire element is wound. The reels are guided in a circle around a common braiding point, and the wire elements are unwound from the reels. During the braiding operation, the reels are moved further in the radial direction. This means that the reels are moved toward the braiding point or away from the braiding point. For this purpose, the reels are arranged on reel carriers or bobbins. In particular, two reels can be arranged on each bobbin. Several groups of bobbins are preferably provided, wherein at least a first group of bobbins rotates counter to a second group of bobbins around the braiding point. In doing so, the bobbins travel in a serpentine or zigzagging manner. The direction of rotation of the bobbin groups determines the direction of winding of the wire elements in the tubular braid. At the axial end, which is intended to have a particularly smooth edge, the wire elements are accordingly deflected by means of the direction of rotation of the bobbins being reversed. In order to twist the wire elements in the terminating edge, two reels are rotated about a common twist axis, or the bobbin carrying the two reels is rotated about the bobbin axis. The rotation of the reels about the common twist axis can be superposed by the rotation of the bobbin groups about the braid axis or the braiding point.
With the braiding machines known per se, it is possible to produce tubular lattice structures and also flat braids. A flat braid can then be bent into the tube shape and connected, for example welded, at the contiguous longitudinal edges. The braid 11 can be braided both in a closed structure and also in an open structure. In the closed structure, the braiding operation is started from the terminal mesh 18. The first section 16a and the second section 16b of the terminating edge 16 are produced at the same time. Alternatively, the lattice structure or the braid 11 can be produced as an open structure. The braid 11 is produced continuously and divided into desired length sections, which each have open wire ends. The open wire ends are then deflected and twisted, for example by hand, in order to form the terminating edge 16. It is also possible for the twisting to already take place in the braiding machine, such that, after the continuous braid strand has been divided, the terminating edge 16 is produced by suitable arrangement of the twisted sections. The twisted sections are arranged such that a continuously smooth terminating edge 16 is formed.
It is also possible for the device according to the invention, in particular according to one of the above-described illustrative embodiments, to be produced entirely by hand.
S section line
L longitudinal axis
LR longitudinal direction
UR circumferential direction
ULR rotation direction
10 hollow body
11 braid
12 wire element
12′ inner wire element
12
a first outer wire element
12
b second outer wire element
12
c third outer wire element
12
d fourth outer wire element
12
a′ first inner wire element
12
b′ second inner wire element
12
c′ third inner wire element
12
d′ fourth inner wire element
12
x edge-forming wire element
12
x′ braid-forming wire element
13 first series
14
a first terminal mesh
14
b second terminal mesh
14
c third terminal mesh
14
d fourth terminal mesh
15 braid end
15
a margin
16 terminating edge
16
a first section
16
b second section
16
c front area
16
d rear area
16
e intermediate area
17
b first location
17
c second location
17
c third location
18 terminal mesh
19 continuation
20 connecting element
21 wire bundle
22 distal end
23 “bobbin”
30 delivery system
31 catheter
32 actuation element/guide wire
33 decoupling mechanism
33
a proximal end
33
b release element
34 intermediate piece
35 holding means
35
a first locking element
35
b second locking element
36 inner mesh limit
37
a first loop
37
b second loop
37
c second loop
38 open cell
39 apex
40 clot/concretion
50 blood vessel/hollow organ
Number | Date | Country | Kind |
---|---|---|---|
10 2009 056 450.0 | Dec 2009 | DE | national |
Filing Document | Filing Date | Country | Kind | 371c Date |
---|---|---|---|---|
PCT/EP2010/007302 | 12/1/2010 | WO | 00 | 6/26/2012 |