Patent Application
20210298774
This application is based on and claims the benefit of priority from Japanese Patent Application 2020-052300, filed on 24 Mar. 2020, the content of which is incorporated herein by reference.
The present invention relates to a wire-equipped stent, a catheter, and a catheter-stent system.
In the related art, a catheter-stent system (hereinafter also referred to as a “CS system”) including a wire and a stent connected to the distal end of the wire is used to capture a blood clot formed in a blood vessel. When such a CS system is used, the stent is inserted into a blood vessel to capture a blood clot, and then the wire is pulled through the catheter so that the blood clot is retrieved with the stent pulled out of the body. A known catheter used for such a CS system has a structure including two types of coils overlapping each other (see, for example, Patent Document 1).
Patent Document 1: Japanese Unexamined Patent Application, Publication No. 2016-185206
Such a catheter has a highly-flexible, distal end portion and also has a high ability to transmit torque to the distal end portion. In such a catheter having the two coils overlapping each other, however, a resin covering the two coils has an undulated inner surface due to the steps formed by the coils. A wire-equipped stent to be inserted into such a catheter includes a wire and a coiled member connected to the distal end of the wire. The coiled member is a spirally coiled metal wire and thus has an undulated outer circumference.
When such a conventional wire-equipped stent is inserted into the above catheter and used, the undulated inner surface of the catheter rubs against the undulated circumference of the coiled member connected to the wire, which increases the sliding resistance of the wire-equipped stent in the catheter. As the sliding resistance of the wire-equipped stent increases inside the catheter, the ease of handling for the operator who pushes and pulls the wire decreases. Therefore, a need exists to improve the ease of handling of a wire-equipped stent inserted in a catheter having an undulated inner surface.
It is an object of the present invention to provide a wire-equipped stent, a catheter, and a catheter-stent system each having further improved ease of handling.
A first aspect of the present invention relates to a wire-equipped stent including: a wire; a stent connected to a distal end portion of the wire; and a highly smooth portion provided at or adjacent to a distal portion of the wire, the wire-equipped stent being adapted for insertion into and use in a catheter having a structure including a mesh coil and a spiral coil overlapping each other.
The highly smooth portion may be free of a coiled member.
The highly smooth portion may have an outer surface with a surface roughness Ra of 0.5 nm or more and less than 2.0 nm.
The highly smooth portion may be a solid layer including a hydrophobic material.
The highly smooth portion may be a fluid layer including a hydrophilic material.
The stent may be adapted to be delivered together with the catheter to a region at or downstream of M1 region in a skull and to be used together with the catheter in the skull.
The stent may also be adapted for use to retrieve a blood clot formed in a cerebral blood vessel in a region at or downstream of the M1 region.
A second aspect of the present invention relates to a catheter including: a structure including a mesh coil and a spiral coil overlapping each other, the catheter being adapted to receive inside and be used together with a wire-equipped stent including: a wire having a distal portion provided with a highly smooth portion free of a coiled member; and a stent connected to a distal end portion of the wire.
The catheter may have an undulated inner surface.
The catheter may be adapted to be delivered to a region at or downstream of M1 region in a skull and to be used in the skull.
A third aspect of the present invention relates to a catheter-stent system including the wire-equipped stent and the catheter.
The present invention makes it possible to provide a wire-equipped stent, a catheter, and a catheter-stent system each having further improved ease of handling.
Hereinafter, a wire-equipped stent, a catheter, and a catheter-stent system according to embodiments of the present invention will be described. It should be noted that the drawings attached hereto are all schematic views in which, for ease of understanding, the shape, scale size, aspect ratio, or other features of each component are changed or exaggerated relative to the actual component. It should also be noted that hatching for indicating a cross-section of some of components is omitted for clarity from the drawings.
The CS system 1 according to an embodiment of the present invention includes a wire-equipped stent 10 and a catheter 20, which will be described later. As shown in
The stent 11 is a part configured to capture a blood clot. The stent 11 is substantially cylindrical. The circumferential wall of the stent 11 includes a plurality of closed cells 11a that are each made of a wire-shaped material surrounding the cell. As used herein, the term “the circumferential wall of the stent 11” means a portion that separates the inside of the substantially cylindrical structure of the stent 11 from the outside. As used herein, the term “closed cell” refers to an opening portion surrounded by a wire-shaped material, which forms the mesh patterns of the stent 11 and is also called an opening or a compartment. It should be noted that
The stent 11 with the structure described above may be formed by laser-processing a tube including, for example, a biocompatible material, in particular preferably a tube made of a superelastic alloy. If the stent 11 should be made at a reduced cost from a superelastic alloy tube, the stent 11 is preferably formed by subjecting a superelastic alloy tube with a diameter of about 2 to 3 mm to laser processing and then expanding the tube to a desired diameter to subject the tube to shape-memory treatment. It will be understood that the stent 11 may be formed not only by laser processing but also by other methods such as cutting work or knitting a wire-shaped metal material into a tube.
The stent is preferably made of a highly rigid, biocompatible material. Such a material may be, for example, titanium, nickel, stainless steel, platinum, gold, silver, copper, iron, chromium, cobalt, aluminum, molybdenum, manganese, tantalum, tungsten, niobium, magnesium, calcium, or an alloy containing any of the above. Such a material may also be, for example, a synthetic resin material, such as a polyolefin such as polyethylene (PE) or polypropylene (PP), or polyamide, polyvinyl chloride, polyphenylene sulfide, polycarbonate, polyether, or polymethyl methacrylate. Such a material may also be, for example, a biodegradable resin (biodegradable polymer), such as polylactic acid (PLA), polyhydroxybutyrate (PHB), polyglycolic acid (PGA), or poly-ε-caprolactone.
Among these materials, titanium, nickel, stainless steel, platinum, gold, silver, copper, and magnesium or alloys containing any of them are preferred. Examples of such alloys include Ni—Ti alloys, Cu—Mn alloys, Cu—Cd alloys, Co—Cr alloys, Cu—Al—Mn alloys, Au—Cd—Ag alloys, and Ti—Al—V alloys. Examples of such alloys also include alloys of magnesium and Zr, Y, Ti, Ta, Nd, Nb, Zn, Ca, Al, Li, Mn, or the like. Among these alloys, Ni—Ti alloys are preferred.
The stent 11 has a proximal side D2 end portion connected to a marker 14. The marker 14 is a member that serves as a maker to identify the position of the proximal side D2 end portion of the stent 11. A pusher wire 12 is connected to the proximal side D2 end of the marker 14. The pusher wire 12 is a member that is to be handled by the operator who moves the stent 11. To move the stent 11 in a catheter 20 (describe later) or a blood vessel, the operator pushes or pulls the pusher wire 12 through a handling portion (not shown) connected to a proximal side D2 portion of the pusher wire 12.
A cover layer 13 is provided on a distal side D1 portion of the pusher wire 12. The cover layer 13 is a layer provided to increase the smoothness for contact with the inner surface of the catheter 20 (described later). The cover layer 13 is provided to cover the outer surface of a distal side D1 portion of the pusher wire 12. The distal side D1 portion of the pusher wire 12 may be, for example, a portion over a length of 50 mm to 3,000 mm from the distal side D1 end of the pusher wire 12 to a proximal side D2 site. The distal side D1 end of the cover layer 13 is bonded to the marker 14 with an adhesive (not shown) in between them. Preferably, the distal side D1 end of the cover layer 13 is bonded to the marker 14 with no gap between them as shown in
The cover layer 13 may include a solid layer of a hydrophobic resin. Such a solid hydrophobic resin layer may be made of, for example, polytetrafluoroethylene (PTFE) or diamond-like carbon (DLC). These materials can form a surface with low friction resistance (highly smooth surface) to reduce the sliding resistance generated when the pusher wire 12 rubs against the undulated inner surface of the catheter 20. As long as the cover layer 13 is provided on a distal side D1 portion of the pusher wire 12, the cover layer 13 may have a length in the axis direction LD larger or smaller than the length of the distal side D1 portion.
Alternatively, the cover layer 13 may include a fluid layer of a hydrophilic resin. Such a hydrophilic fluid layer may be made of, for example, hyaluronic acid, an MPC polymer, or the like. These materials may be applied to an outer surface of the pusher wire 12 to form a semisolid layer having a surface with lower friction resistance (highly smooth surface). Such a layer reduces the sliding resistance generated when the pusher wire 12 rubs against the undulated inner surface of the catheter 20.
In the wire-equipped stent 10 according to an embodiment of the present invention, the highly smooth portion may include a material having an outer surface with a surface roughness (arithmetic average roughness) Ra of 0.5 nm or more and less than 2.0 nm. In this embodiment, the highly smooth portion may include any material having human-safe properties. The wire-equipped stent 10 according to an embodiment of the present invention may include a coiled member between the distal side D1 end of the pusher wire 12 and the stent 11. In such a case, a material satisfying the above surface roughness Ra conditions may be provided on the outer surface of the coiled member, so that coiled member can serve as a highly smooth portion. In other words, the wire-equipped stent according to the present invention may include or may not include a coiled member as long as it has the highly smooth portion provided at or adjacent to a distal portion of the wire. The wire-equipped stent 10 according to an embodiment of the present invention may not include the cover layer 13. In such an embodiment, a distal side D1 portion of the pusher wire 12 serves as the highly smoothy portion. In the wire-equipped stent 10 according to such an embodiment, the highly smooth portion does not include any coiled member.
As shown in
As shown in an enlarged area A in
As shown in
As shown in
The catheter 20 configured as described above has an outer diameter of, for example, 0.55 mm to 2.10 mm. Its inner diameter is, for example, 0.33 mm to 1.78 mm. In the portion where the mesh coil 211 and the spiral coil 212 overlap, the resin layer has an inner surface with a surface roughness (arithmetic average roughness) Ra of, for example, about 1 μm to about 50 μm.
Next, an example of a method of using the catheter-stent system 1 equipped with the stent 11 according to the embodiment will be described.
First, as shown in
Subsequently, as shown in
Subsequently, as shown in
Subsequently, as shown in
In the CS system 1 according to this embodiment, the highly smooth cover layer 13 between the marker 14 and the distal side D1 end of the pusher wire 12 successfully reduces the sliding resistance generated when the pusher wire 12 rubs against the undulated inner surface of the catheter 20. Therefore, the operator can use a smaller force to push or pull the pusher wire 12, which further improves the ease of handling of the CS system 1.
The CS system 1 according to this embodiment may be mainly used to retrieve a formed blood clot from a cerebral blood vessel particularly in a region at or downstream of the M1 region inside the bone of the skull, in which the blood vessels have relatively small inner diameters and have many bent portions. In such a region, the conventional wire-equipped stent may have higher sliding resistance and lower ease of handling in the catheter used, which has a smaller inner diameter. In contrast, the CS system 1 according to this embodiment has higher ease of handling also in the area at or downstream of the M1 region inside the bone of the skull, because the wire-equipped stent has lower sliding resistance in the catheter.
Next, the results of testing on the sliding property of the wire-equipped stent according to the present invention will be described. Three types of wire-equipped stents having high sliding properties were prepared as Examples 1 to 3. The wire-equipped stent of Example 1 includes the pusher wire 12; and a highly smooth portion made of a PTFE layer (solid layer) with a thickness of 0.05 mm and a length of 250 mm on the outer surface of a distal side D1 portion of the pusher wire 12. The wire-equipped stent of Example 2 includes the pusher wire 12; and a highly smooth portion made of a hyaluronic acid resin layer (fluid layer) with a thickness of 0.001 mm and a length of 250 mm on the outer surface of a distal side D1 portion of the pusher wire 12. The wire-equipped stent of Example 3 includes a pusher wire and a stent that is connected to a distal side D1 end portion of the pusher wire with no coiled member between them. In the wire-equipped stent of Example 3, a distal side D1 portion of the pusher wire serves as a highly smooth portion. A wire-equipped stent prepared as a conventional example includes a pusher wire, a stent, and a coiled member between a distal side D1 end portion of the pusher wire and the stent. The conventional example is a general ready-made product used widely. The four types of wire-equipped stents were measured for tensile load under the conditions shown below.
Devices Used:
a catheter
which includes a core material portion including a mesh coil and a spiral coil overlapping each other; and a resin layer having an inner surface with a surface roughness (arithmetic average roughness) Ra of 1.5 nm;
a digital force gauge (push pull gauge);
a pulling device;
a thermostatic chamber; and
a thermometer
Speed: 60 mm/min
Pulling distance: the effective length of the stent+10 mm
Test temperature: 37° C.±2° C.
Test Method:
(1) confirming with the thermometer that the thermostatic chamber has a temperature of 37° C.±2° C.;
(2) placing the catheter in the thermostatic chamber, in which the catheter is in an S shape having an arc with a diameter of 5 mm for simulation of actual use through a bent portion in the body;
(3) inserting the wire-equipped stent into the catheter from the proximal side until the distal end of the stent is positioned at a site distal to the S-curve portion of the catheter;
(4) connecting the proximal end of the wire-equipped stent to the digital force gauge disposed in the pulling device;
(5) pulling the wire-quipped stent constantly at the specified speed toward the proximal side using the pulling device while the catheter and the wire-equipped stent are kept in an S shape; and
(6) measuring tensile loads using the digital force gauge when the wire-equipped stent is pulled over a distance equal to the effective length+10 mm and recording the minimum and maximum values of the tensile load.
The test on each of the wire-equipped stents of Examples 1 to 3 and the comparative example was repeated multiple times to measure tensile loads. An average tensile load of less than 1 N was evaluated as good (o), 1 N or more and less than 3 N as fair (Δ), and 3 N or more as poor (x). Among them, the rates evaluated as poor (x) are not acceptable, whereas the rates evaluated as fair (Δ) and good (o) are acceptable. The term “fair” (Δ) means a rating level acceptable practically but slightly lower than the level “good” (o).
Table 1 shows the results of the evaluation of each of the wire-equipped stents of Examples 1 to 3 and the comparative example by the test.
As shown in Table 1, the wire-equipped stents of Examples 1 to 3 all had an average tensile load of less than 1 N and were evaluated as good (o). The wire-equipped stent of the comparative example had an average tensile load of at least 3 N and was evaluated as poor (x). The results demonstrate that the wire-equipped stents of Examples 1 to 3 all have high ease of handling. In particular, the wire-equipped stents of Examples 1 and 2 with average tensile loads of at most 0.7 N were found to have higher ease of handling. In Example 1, a PTFE layer is provided on the outer surface of the distal side D1 portion of the pusher wire 12. In Example 2, a hyaluronic acid resin layer is provided on the outer surface of the distal side D1 portion of the pusher wire 12.
Besides the test described above, a sensory test was carried out to evaluate the ease of handling of the wire-equipped stents of Examples 1 to 3 and the comparative example. In the sensory test, 20 testers each pushed and pulled several times the pusher wire of each wire-equipped stent through a catheter having an S shape as in the test describe above. As a result, all testers evaluated the wire-equipped stents of Examples 1 to 3 as having improved ease of handling. On the other hand, none of the testers evaluated the wire-equipped stent of the comparative example as having improved ease of handling.
While embodiments of the present disclosure have been described, it will be understood that the embodiments are not intended to limit the present disclosure and may be altered or modified in various ways, such as those described below, and such modifications will also fall within the technical scope of the present disclosure. It will also be understood that the advantageous effects shown in the embodiments are merely non-limiting examples of the most advantageous effect brought about according to the present disclosure. The embodiments may be combined, as appropriate, with the modified embodiments described below, although such combinations are not described in detail here.
The wire-equipped stent 10 according to an embodiment of the present invention may include a coiled member between the distal side D1 end of the pusher wire 12 and the stent 11, and the cover layer 13 (see
The above embodiment shows an example in which the wire-equipped stent 10 includes the stent 11 of a retrieval type. Alternatively, the connected stent in the wire-equipped stent 10 may be an indwelling stent. In such a case, for example, the outer surface of a deflated balloon may be covered with the radially compressed stent, and the balloon may be inflated at a lesion site to expand the blood vessel and the stent. Thereafter, the balloon may be deflated and then removed together with the pusher wire so that only the stent is indwelled at the lesion site.
The above embodiment shows an example in which the highly smooth portion (e.g., the cover layer 13) has an outer surface with a surface roughness Ra of 0.5 nm or more and less than 2.0 nm. It will be understood that this is a non-limiting example, and alternatively, the outer surface of the highly smooth portion may have an average height Zc of 10 μm to 100 μm according to JIS B 0601.
The above embodiment shows an example in which the cover layer 13 may include a solid layer of a hydrophobic resin or a fluid layer of a hydrophilic resin. It will be understood that this is a non-limiting example, and alternatively, the cover layer 13 may include a solid layer including a hydrophobic material. The solid layer including a hydrophobic material may include, for example, diamond-like carbon (DLC) or the like. Alternatively, the cover layer 13 may include a fluid layer including a hydrophilic material. The fluid layer including a hydrophilic material may include, for example, silicone or the like.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2020-052300 | Mar 2020 | JP | national |
