The present invention relates to a technical field of a stent, and particularly to a structure of a self-expanding stent suitable for surgery of aortic dissection.
Conventionally, for aortic diseases, a thoracotomy surgery has been performed most commonly. The thoracotomy surgery is a surgery of literally performing thoracotomy and replacing a disease site with an artificial blood vessel, but a physical burden on a patient is high, and a death ratio is also high. Even if the surgery is successful, it is a reality that complications and the like are developed and a patient is bedridden in many cases.
Thereafter, it is also a reality that “stent graft surgery” is performed via the aorta by a catheter inserted from a groin without thoracotomy (see Non Patent Literature 1). Since thoracotomy is not required in the “stent graft surgery”, there is an advantage that surgery time is short and a physical burden and an economic burden on a patient can be reduced.
However, meanwhile, in a case of a disease such as arch aorta dissection, which is common in Japanese, it is extremely difficult to perform a surgery using this stent graft at present because there is a branch blood vessel in the arch aorta. Since the stent graft has a “membrane” structure on a surface of the stent, if the stent graft is directly placed on the arch aorta, a blood flow to the branch blood vessel is inhibited. Therefore, a method for partially opening (fenestration) the membrane only at a position corresponding to the branch blood vessel has also been proposed. However, it is extremely difficult to accurately position the branch blood vessel and the opening when the stent graft having the opening is disposed at a disease site with a catheter, and complications due to inconsistency are often developed.
On the other hand, there is a demand for using a general stent having no membrane structure (see Patent Literature 1), but the general stent has poor flexibility against bending in a direction perpendicular to an axial direction, and is usually not suitable for use in the arch aorta. For example, in a case of an all-linked stent illustrated in
Therefore, the present invention has been made in order to solve these problems, and an object of the present invention is to provide a stent that does not include such a membrane as in a stent graft, has sufficient kink resistance, and has excellent flexibility, and a method for manufacturing the stent.
That is, the stent according to the present invention is a stent having a tubular shape in a self-expanding state, the stent including: a first wire group including a plurality of wires; and a second wire group including a plurality of wires intersecting with the wires of the first wire group at a plurality of locations, in which the wires of the first wire group and the wires of the second wire group intersect with each other to form a plurality of cells having a substantially rhombic shape in a state of being self-expanding in a tubular shape, and a cross-sectional shape of each of the wires is a rectangular shape thick in a radial direction of the tubular shape.
A method for manufacturing a stent according to the present invention is a method for manufacturing a stent, including: a step of forming, from a tubular body made of a shape memory alloy, by laser processing, a mesh tubular body in which meandering structures in which wires meander in a circumferential direction at an equal pitch are arranged in an axial direction, and apexes of arc portions of the adjacent meandering structures are connected to each other to be integrated; a step of enlarging the mesh tubular body in diameter to a predetermined diameter; and a step of causing the mesh tubular body to memorize the shape thereof in a state where the mesh tubular body is enlarged in diameter, in which the wires intersect with each other to form a plurality of cells having a substantially rhombic shape in a state where the mesh tubular body is enlarged in diameter to the predetermined diameter, and a cross-sectional shape of each of the wires is a rectangular shape thick in the radial direction.
The present invention can provide a stent that does not include such a membrane as in the stent graft, has sufficient kink resistance, and has excellent flexibility, and a method for manufacturing the stent.
Hereinafter, a stent and a method for manufacturing the stent according to an embodiment of the present invention will be described with reference to the attached drawings. Note that, for easy understanding of the drawings, the size and dimensions of each part are exaggerated in some parts, and do not necessarily coincide with those of an actual product.
(Configuration of Stent)
The stent 100 illustrated in
The stent 100 of the present embodiment has a length and a diameter suitable for use in the arch aorta, for example, has a total length of 80 mm or more or 100 mm or more and 200 mm or less or 250 mm or less, and a diameter of 15 mm or more or 20 mm or more and 30 mm or less or 40 mm or less in a self-expanding state.
In a self-expanding state as illustrated in
Specifically, the six wires 101 to 106 of the first wire group 100a have spiral shapes whose phases are shifted by 60° from each other. The six wires 111 to 116 of the second wire group 100b also have spiral shapes whose phases are shifted by 60° from each other. The first wire group 100a and the second wire group 100b have spiral shapes in different directions, and therefore intersect with each other at a plurality of locations, and form a mesh extending in a tubular shape in the axis O direction as a whole. In the stent 100 constituted in this manner, for example, as illustrated by a hatched portion in
The intersecting portions between the wires 101 to 106 of the first wire group and the wires 111 to 116 of the second wire group are integrally formed without overlapping with each other in a radial direction of the stent 100. For example, as illustrated in
In addition, in the stent 100 of the present embodiment, a first intersection angle γ which is an angle opened in the axis O direction at the intersecting portion 120 in a self-expanding state is equal to or less than a second intersection angle σ which is an angle opened in a circumferential direction (that is, an opening degree of each of the arc portions α and β). A relationship between the first intersection angle γ and the second intersection angle σ is preferably σ/γ≥1.22, and more preferably σ/γ≥1.36. A basis for these numerical values will be described in Examples described later. Note that an upper limit of σ/γ is preferably σ/γ≤2.0 (for example, γ=60° and σ=120°) such that the stent 100 can ensure a sufficient length in the axis O direction in a self-expanding state.
That is, such a relationship between the first intersection angle γ and the second intersection angle σ is such that each cell S formed by the first wire group 100a and the second wire group 100b has a square shape or a rhombus shape long in the circumferential direction in the self-expanding state of the stent 100. When the cell S has a rhombus shape, as illustrated in
In addition, as illustrated in
Specifically, when the thickness of each wire in the radial direction is represented by t and the length of the short width orthogonal to the thickness (that is, line width) is represented by w, a relationship between the thickness t and the line width w is preferably w/t<0.9. The relationship is more preferably w/t<0.81. A basis for these numerical values will be described in Examples described later. Note that a lower limit of w/t is preferably w/t≥0.5 in consideration of strength and the like at the time of processing for manufacturing the stent 100 and using the stent 100.
As described above, in the stent 100 of the present embodiment, the wires of the first wire group 100a and the second wire group 100b have a rectangular shape thick in the radial direction, and the cell S formed by the first wire group 100a and the second wire group 100b has a square shape or a rhombus shape long in the circumferential direction.
(Method of Manufacturing Stent)
The stent 100 of the embodiment of the present invention is first formed from a tube (tubular body) 200 made of a shape memory alloy as illustrated in
As illustrated in
(Action and Function of Stent)
As described above, in the present embodiment, when the catheter 300 housing the stent 100 is disposed in the arch aorta model 400 and the stent 100 is sequentially delivered, the stent 100 expands (self-expands) to a state in which the shape thereof is memorized by temperature (body temperature in the body). Therefore, the stent 100 sticks to an inner peripheral wall of the arch aorta model 400 so as to sufficiently push and spread the inner peripheral wall and follows the curved shape flexibly.
The kink resistance of the stent 100 of the present embodiment will be described in detail below.
As illustrated in
As illustrated in
As illustrated in
In addition, in the curved stent 100 illustrated in
As described above, in the stent 100 of the present embodiment, the first intersection angle γ which is an angle opened in the axis O direction is equal to or less than the second intersection angle σ which is an angle opened in the circumferential direction. Meanwhile, in a comparative example illustrated in
In this case, a width ws of the wire of the present embodiment (hereinafter, a stress direction width ws) in a stress direction (circumferential direction) in
As described above, the stent 100 of the present embodiment achieves the flexible stent 100 having excellent kink resistance without including such a membrane as in the stent graft. Absence of the membrane makes it difficult to inhibit a blood flow to a branch blood vessel. In particular, in the stent 100 of the present embodiment, since each wire has a narrow line width w with respect to the thickness t, it is further difficult to inhibit the blood flow. Therefore, it is possible to reduce difficulty for a physician to perform precise stent positioning required to align an opening formed in the stent graft with the branch blood vessel.
Furthermore, since the intersecting portion (for example, 120) is integrally formed without overlapping in the radial direction of the stent 100, the thickness of the intersecting portion (for example, 120) is reduced by half as compared with an overlapping type stent, and unevenness is not generated in the portion. Therefore, insertion into the catheter 300 having a smaller diameter is possible, and the catheter 300 can be operated more smoothly at the time of stent placement with small frictional resistance. Furthermore, a blood vessel wall is less affected (stimulated). In addition, as compared with a wire braided stent, an expansion force of the stent itself can be ensured strongly, and the stent is also resistant to crush due to a pressing force caused by a blood flow that can flow into a detachment side.
Note that, in the stent 100 of the above embodiment, a metal tube is subjected to laser processing to be formed into a shape in which the wires 101 to 106 of the first wire group and the wires 111 to 116 of the second wire group are integrated, but the intersecting portion of the spiral wires may be fixed by heat or the like. In addition, the stent 100 may be made of a spring material. In a state where the stent 100 is enlarged in diameter, annealing is performed such that the spring material is in a free state, and the stent 100 is contracted when the stent is inserted into a catheter. Then, by exposing the stent 100 from the catheter, the stent 100 is enlarged in diameter by a reaction force of the spring. Also in this case, by forming the cross sections of the wires 101 to 106 of the first wire group and the wires 111 to 116 of the second wire group into a rectangular shape thick in the radial direction and setting the first intersection angle γ to be equal to or less than the second intersection angle σ, the first wires 101 to 106 and the second wires 111 to 116 are enlarged in diameter into a tubular shape, kink resistance to curving can be ensured while an internal space of the stent 100 is ensured, and flexibility can be ensured as a whole.
Hereinafter, results of a kink resistance test of the stent according to the present embodiment will be described with reference to Tables 1 to 5 and
Table 1 presents design specifications of a base material and a stent in each of Examples. Table 2 presents final specifications of a stent after forming in each of Examples. Table 3 presents results of a kink resistance test in each of Examples.
Specifically, Table 1 presents an outer diameter and a thickness of a base material which is a tube made of a shape memory alloy, and the outer diameter and the thickness of the base material in each of Examples are 3 mm and 0.3 mm, respectively. In addition, as design specifications of a stent, a line width, a width of a link portion (a length of a wire intersecting portion in an axial direction), the number of crowns, the number of cells, a slit length (a length of a substantially oval space in an axis O direction), presence or absence of a marker, and a total length (a length in the axis O direction) are described. Note that the marker is formed by welding a material having high radiation opacity, such as tantalum, to both ends of a stent in order to enhance visibility of the stent at the time of X-ray photography. The number of cells is the number of cells between markers (M to M) at both ends of a stent.
Table 2 presents specifications of a stent in a self-expanding state immediately before the kink resistance test is performed, and describes an expanded maximum diameter, a total length (a length in the axis O direction), a shortening ratio (total length in a self-expanding state/total length in a contracted state), a polishing ratio by electrolytic polishing, a thickness t, a line width w, a wire cross-sectional area, a cell width (short diagonal line of a cell), a cell height (long diagonal line of a cell), a cell area, a first intersection angle γ, a second intersection angle σ, and 80% [N/cm] (a pressure value per cm when a stent is contracted to 80% with a maximum expansion state as 100%) in each of Examples.
Table 3 presents results of the kink resistance test, and presents whether or not kink occurred when stents in Examples were fitted into molds having different curvatures. A case where no kink occurred is indicated by ∘, and a case where kink occurred is indicated by x.
For example,
Table 3 indicates that the stents in Examples 1 and 6 to 9 have the best kink resistance, the stents in Examples 2, 3, and 5 have the second-best kink resistance, and the stents in Examples 4 and 10 have poor kink resistance. Since the curvature of the arch aorta is usually R45 or more, Examples other than Examples 4 and 10 are suitable for use in the arch aorta.
Table 4 presents results of calculating w/t of each of Examples based on the thickness t and the line width w in Table 2, and sorting w/t in descending order together with the results of the kink resistance test in Table 3. As presented in Table 4, it can be seen that when w/t is 0.87 or less, kink resistance up to R45 is exhibited, and when w/t is 0.81 or less, kink resistance up to R40 is reliably exhibited. Therefore, in a relationship between the wire thickness t and the line width w in a stent, w/t<0.90 is preferable, and w/t≤0.81 is more preferable.
Table 5 presents results of calculating σ/γ of each of Examples based on the first intersection angle γ and the second intersection angle σ in Table 2, and sorting σ/γ in ascending order together with the results of the kink resistance test in Table 3. As presented in Table 5, when σ/γ is 1.22 or more, kink resistance up to R40 is exhibited. Note that, in Example 4 in which σ/γ is 1.21, kink occurs at R45, and therefore σ/γ is preferably 1.22 or more such that kink resistance is more reliably exhibited. Therefore, in a relationship between the first intersection angle γ and the second intersection angle σ in a stent, σ/γ≥1.22 is preferable, and σ/γ≥1.36 is more preferable.
The description of the embodiment and Examples of the present invention is completed here, but aspects of the present invention are not limited to the embodiment and Examples.
Number | Date | Country | Kind |
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2020-152496 | Sep 2020 | JP | national |
Filing Document | Filing Date | Country | Kind |
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PCT/JP2021/033253 | 9/10/2021 | WO |