JP7419633B2 - Skeleton for tubular treatment devices and tubular treatment devices - Google Patents

Description

The present invention relates to a skeleton for a tubular treatment device and a tubular treatment device.

BACKGROUND ART A stent graft compatible with branch blood vessels has been known as a tubular treatment device used to treat aortic aneurysms, aortic dissections, and the like occurring in the aorta (for example, see Patent Documents 1 and 2). Patent Documents 1 and 2 disclose stent grafts having a tubular main body (main body 107) and branch parts (movable external coupling parts 120) protruding from the circumferential surface of the main body.
For example, by placing a stent graft for a branch vessel compatible with a branch vessel in the main vessel, connecting a stent graft for a branch vessel to a branch portion, and placing a stent graft for a branch vessel within the branch vessel. , the blood flow between the main blood vessel and the branch blood vessels is maintained.

In a stent graft compatible with branch vessels, when loading the stent graft into the sheath, the branch portion is compressed from the standard state in the axial direction of the branch portion, and when the stent graft is released from the sheath, the branch portion It is assumed that the part restores from the compressed state to the reference state and assumes a predetermined shape. In particular, in Patent Documents 1 and 2, in order to assist the restoration of the branch portion from the compressed state to the standard state, the branch portion is provided with a skeleton (annular support wire form 140 in Patent Document 1, joint portion in Patent Document 2). device 132) is located.

Patent No. 6131441 Patent No. 5824759

However, depending on the shape of the skeleton placed at the branch, when the stent graft is contracted and loaded into the sheath, the branch may be twisted and compressed, making it difficult to load into the sheath. . Furthermore, if the stent graft is loaded into the sheath with the branch portions twisted, there is a risk that the branch portions may not be properly restored from the compressed state to the reference state.

An object of the present invention is to provide a skeleton for a tubular therapeutic device, which can appropriately compress from a standard state and restore to a standard state, and can appropriately perform loading work into a sheath and work to discharge from a sheath. The goal is to provide therapeutic equipment.

The skeleton for a tubular treatment device according to the present invention includes:
A skeleton for a tubular treatment device comprising a linear member whose shape is memorized to form a cylindrical shape,
The linear member is bent in the axial direction and has a plurality of bending parts that are folded back in the circumferential direction,
Two first bent portions of the plurality of bent portions are spaced apart in the circumferential direction and arranged close to each other with the cylindrical first generatrix interposed therebetween;
Two second bent portions of the plurality of bent portions are spaced apart in the circumferential direction and disposed close to each other with the cylindrical second generatrix interposed therebetween;
The separated portion of the first bent portion and the separated portion of the second bent portion are opposed to each other in the radial direction,
When partitioned into a first skeleton part and a second skeleton part by a plane passing through the first generatrix and the second generatrix, the first skeleton part and the second skeleton part are each divided from one side to the other side in the axial direction. The first bent portion and the second bent portion are alternately formed toward the
The two first bent portions are arranged between the first bent portions adjacent in the axial direction in one skeleton portion of the first skeleton portion and the second skeleton portion. axially shifted so that the first bent portion is located;
The two second bent portions are arranged between the second bent portions adjacent in the axial direction in one skeleton portion of the first skeleton portion and the second skeleton portion. They are arranged to be shifted in the axial direction so that the second bent portion is located .

The tubular treatment device according to the present invention includes:
A tubular treatment instrument having a tubular main body portion and a branch portion protruding radially outward from a circumferential surface of the main body portion,
The branch portion has a coating portion and a skeleton portion fixed to the coating portion,
The skeleton part is made of a linear member whose shape is memorized to have a cylindrical shape, and has a plurality of bending parts that bend the linear member in the axial direction of the branch part and fold back in the circumferential direction,
Two first bent portions of the plurality of bent portions are spaced apart in the circumferential direction and disposed close to each other with the cylindrical first generatrix interposed therebetween;
Two second bent portions of the plurality of bent portions are spaced apart in the circumferential direction and disposed close to each other with the cylindrical second generatrix interposed therebetween;
The separated portion of the first bent portion and the separated portion of the second bent portion are opposed to each other in the radial direction,
When partitioned into a first skeleton part and a second skeleton part by a plane passing through the first generatrix and the second generatrix, the first skeleton part and the second skeleton part are each divided from one side to the other side in the axial direction. The first bent portion and the second bent portion are alternately formed toward the
The two first bent portions are arranged between the first bent portions adjacent in the axial direction in one skeleton portion of the first skeleton portion and the second skeleton portion. axially shifted so that the first bent portion is located;
The two second bent portions are arranged between the second bent portions adjacent in the axial direction in one skeleton portion of the first skeleton portion and the second skeleton portion. The second bent portion is disposed offset in the axial direction,
The direction in which the two separated portions face each other coincides with the axial direction of the tubular treatment instrument.

According to the present invention, since the skeleton for a tubular treatment device and the skeleton of the branch portion of the tubular treatment device can be appropriately compressed from a reference state and restored to the reference state, the sheath of the tubular treatment device It is possible to properly perform the loading operation and the discharging operation from the sheath.

FIG. 1A and FIG. 1B are diagrams showing the configuration of a stent graft placement device. 2A and 2B are diagrams showing the configuration of the first stent graft. 3A and 3B are cross-sectional views showing the configuration of a branch portion of the first stent graft. FIGS. 4A to 4C are diagrams showing the configuration of the branch skeleton. FIG. 5 is a diagram showing the state of the branch skeleton when the first stent graft is loaded into the sheath. FIGS. 6A and 6B are diagrams showing a state in which the first and second stent grafts are placed in a blood vessel. FIGS. 7A and 7B are diagrams showing the configuration of a branch skeleton according to a modified example.

EMBODIMENT OF THE INVENTION Hereinafter, one embodiment of the stent graft based on this invention will be described in detail with reference to drawings.
In this embodiment, a case will be described in which a first stent graft 10 to which the present invention is applied is placed in a main blood vessel V1, and a second stent graft 50 is connected to the first stent graft 10 and placed in a branch blood vessel V2. (See FIGS. 6A and 6B).

1A and 1B are diagrams showing the configuration of a stent graft placement device 1. FIG. FIG. 1A shows the stent graft placement device 1 in an exploded state, and FIG. 1B shows the stent graft placement device 1 in an assembled state. In addition, in FIG. 1A and FIG. 1B, in order to facilitate understanding of the invention, the size (length, diameter, etc.) and shape of each member constituting the stent graft indwelling device 1 is schematically illustrated.

The stent graft placement device 1 is used when placing the first stent graft 10 in a blood vessel. As shown in FIGS. 1A and 1B, the stent graft placement device 1 has a tubular sheath 20, is arranged inside the sheath 20, and is configured to be able to advance and retreat within the sheath 20 along the axial direction (longitudinal direction) of the sheath 20. It includes an inner rod 30 and a first stent graft 10 accommodated within the sheath 20 in a radially expandable state.

The sheath 20 includes, for example, a tubular sheath main body 21 made of a flexible material, and is provided on the proximal end side (the right side in FIGS. 1A and 1B) of the sheath main body 21, and the inner rod 30 is connected to the sheath. It has a hub 22 for fixing to and releasing from the main body part 21.

The inner rod 30 includes, for example, a rod-shaped rod main body part 31, a holding part 32 that is formed to have a smaller diameter than the rod main body part 31 and holds the first stent graft 10 in a contracted state, and a distal end part of the inner rod 30. It has a distal tip 33 provided at the distal end.

Although not shown, the rod main body 31, the holding part 32, and the distal tip 33 include, for example, a guide wire lumen for passing the guide wire, and a guide wire lumen for expanding the first stent graft 10 in the contracted state at the affected area. A trigger wire lumen and the like are formed along the axial direction of the inner rod 30, through which the trigger wire is passed.
Further, the rod body portion 31, the holding portion 32, and the distal tip 33 are formed from various materials having appropriate hardness and flexibility, such as resin and metal, but detailed description thereof will be omitted here.

Although a detailed explanation will be omitted, the stent graft placement device (not shown) used to place the second stent graft 50 in the blood vessel has the same basic configuration as the stent graft placement device 1 described above. The dimensions of each member, such as the sheath 20 and the inner rod 30, are optimized for the second stent graft 50.

FIG. 2A is a perspective view of the first stent graft 10, and FIG. 2B is a plan view of the first stent graft 10 viewed from the branch portion 10B side. 3A is a sectional view taken along line AA in FIG. 2B (only on the side of branch 10B), and FIG. 3B is a sectional view taken on line BB in FIG. 2B (only on side of branch 10B).
In these figures, the expanded state of the first stent graft 10 is schematically shown to facilitate understanding of the invention. Further, in FIGS. 3A and 3B, the main body skeleton portion 11 is omitted. Further, in these figures, arrow D1 indicates the axial direction of the first stent graft 10 (hereinafter referred to as "main body axial direction D1"), and arrow D2 indicates the axial direction of the branch portion 10B (hereinafter referred to as "main body axial direction D1"). (referred to as "branch axis direction D2").

The first stent graft 10 is a main blood vessel stent graft compatible with branch vessels, and is placed in the main blood vessel V1 (see FIGS. 6A and 6B). As shown in FIGS. 2A and 2B, the first stent graft 10 has a tubular main body 10A.

The main body portion 10A includes a main body skeleton portion 11 and a tubular main body coating portion 12 provided along the main body skeleton portion 11. A branch portion 10B having a through hole (not shown) communicating with the inner cavity of the main body coating portion 12 is provided on the peripheral surface of the main body portion 10A (main body coating portion 12). With the first stent graft 10 placed in the main blood vessel V1, the second stent graft 50 is connected to the branch portion 10B, and the second stent graft 50 is placed in the branch blood vessel V2. Blood flow between the branch blood vessel V2 and the branch blood vessel V2 is maintained (see FIGS. 6A and 6B).

In this embodiment, the first stent graft 10 has a straight tube shape. ) or may have a twistingly curved shape.

The main body skeleton 11 is a self-expanding stent skeleton configured to be deformable from a contracted state in which it contracts radially inward to an expanded state in which it expands radially outward to define a tubular flow path. In this embodiment, the main body skeleton section 11 is composed of five tube-shaped skeleton pieces formed by folding thin metal wires in a zigzag shape, and the skeleton pieces are arranged side by side so that the inner cavities of the respective tubes communicate with each other. As a result, it has a tubular shape as a whole. Note that adjacent skeleton pieces may be connected with a connecting member.

Examples of the material for the thin metal wire forming the main body skeleton 11 include known metals or metal alloys such as stainless steel, nickel-titanium alloy, cobalt-chromium alloy, titanium alloy, and the like. Note that the main body frame portion 11 may be formed of a material other than metal (eg, ceramic, resin, etc.).

The main body membrane part 12 is arranged along the main body skeleton part 11 so as to cover the main body skeleton part 11, and defines the above-mentioned tubular flow path. Examples of the material forming the main body film portion 12 include fluororesins such as PTFE (polytetrafluoroethylene), polyester resins such as polyethylene terephthalate, and the like. The main body membrane part 12 is fixed to the main body skeleton part 11 by, for example, suturing with thread, adhesion with tape, adhesion, or welding.
The main body coating part 12 may be arranged on the outer circumferential side of the main body skeleton part 11, or may be arranged on the inner circumferential side of the main body skeleton part 11, or the main body membrane part 12 may be arranged on the outer circumferential side and the inner circumferential side of the main body skeleton part 11. It may be arranged so as to be sandwiched between.

The main body coating portion 12 has a recess 13 recessed radially inward in a part of the tube wall (approximately at the center in the main body axial direction D1 in FIGS. 2A and 2B). A branch portion 10B is formed approximately at the center of the flat bottom surface of the recess 13 so as to protrude outward in the radial direction (branch axis direction D2) of the main body portion 10A.

The branch portion 10B has a cylindrical shape and functions as a connection portion to which the second stent graft 50 (see FIGS. 6A and 6B) is connected. The cylindrical shape of the branch portion 10B may be a cylindrical shape, a tapered shape (truncated conical shape) whose diameter decreases toward the distal end side, or a rectangular cylindrical shape. In this embodiment, a case where the branch portion 10B has a cylindrical shape will be described. The branch portion 10B has such flexibility that the direction of the opening (not shown) can be changed by, for example, blood flow from the main blood vessel V1 to the branch blood vessel V2.

The branch portion 10B has a branch coating portion 15 that is integrally formed with the main coating portion 12. The branch coating portion 15 is made of the same material as the main coating portion 12, for example, and is composed of a single member together with the main coating portion 12. Note that the branch coating portion 15 may be formed of a separate member from the main coating portion 12 and may be formed by being joined to the main coating portion 12. In this case, the branch coating portion 15 may be formed of the same material as the main coating portion 12, or may be formed of a different material.

Further, in this embodiment, in order to assist in compressing the branch portion 10B from the reference state and restoring the compressed state to the reference state, the branch skeleton portion 14 is attached to the peripheral surface of the branch coating portion 15. is provided. The “standard state” is a state in which the branch portion 10B protrudes from the main body portion 10A and has a predetermined shape (in this case, a cylindrical shape), and the “compressed state” is a state in which the first stent graft 10 is inserted into the sheath 20. When loaded into the branch, it is compressed mainly in the branch axis direction D2. The skeleton for a tubular treatment device of the present invention is applied to this branched skeleton portion 14.

An example of the branched skeleton portion 14 is shown in FIGS. 4A to 4C. FIG. 4A is a perspective view of the branch skeleton 14 in a standard state, FIG. 4B is a perspective view of the branch skeleton 14 in a compressed state, and FIG. 4C is a perspective view of the branch skeleton 14 in a standard state (see FIG. 4A). It is a developed view cut in the circumferential direction along a generatrix L1 when the outer shape is assumed to be cylindrical. 4A to 4C, reference symbols L1 and L2 indicate generatrix lines forming the circumferential surface of the branch skeleton portion 14, and the generatrix lines L1 and L2 face each other in the radial direction of the branch skeleton portion 14.

As shown in FIGS. 4A to 4C, the branch skeleton portion 14 is composed of linear members and has a cylindrical shape as a whole. The branch skeleton section 14 is divided into a first skeleton section 141 and a second skeleton section 142 by a plane passing through the two generatrix lines L1 and L2, that is, a plane passing through the central axis of the branch skeleton section 14.

The branch skeleton portion 14 is a self-expanding stent skeleton configured to be deformable between a standard state (see FIG. 4A) and a compressed state (see FIG. 4B). The branch skeleton portion 14 is made of the same shape memory material as the main body skeleton portion 11, for example.
In addition, the branch skeleton part 14 may be comprised by one linear member, and may be comprised by connecting multiple linear members by caulking etc. Further, the branch skeleton section 14 may have a plurality of linear members each independently fixed to the branch coating section 15 so that the branch skeleton section 14 has a cylindrical shape as a whole. In this embodiment, a case will be described in which the branch skeleton portion 14 is composed of a single linear member, and the ends thereof are connected by caulking (not shown).

The branch skeleton portion 14 has circular arc portions A11 to A15 and A21 to A25 extending in the circumferential direction. The arc portions A11 to A15 and A21 to A25 are arranged side by side in the axial direction. The cylindrical shape of the branch skeleton portion 14 is mainly defined by arc portions A11 to A15 and A21 to A25.
In the first skeleton portion 141, the axially adjacent circular arc portions A11 and A12, A12 and A13, A13 and A14, and A14 and A15 are connected by bent portions B11 to B14 that are bent in the branch axis direction D2, respectively. There is. Further, in the second skeleton portion 142, the axially adjacent arcuate portions A21 and A22, A22 and A23, A23 and A24, and A24 and A25 are connected by bent portions B21 to B24 that are bent in the branch axis direction D2, respectively. has been done.
That is, the first skeleton part 141 and the second skeleton part 142 each have a meandering shape that is folded back in the circumferential direction and extends in the branch axis direction D2. By constructing the branch skeleton section 14 with one member having a meandering shape, the branch skeleton section 14 is deformed stably as a whole. Therefore, compression of the branch skeleton 14 when loading the first stent graft 10 into the sheath 20 and restoration of the branch skeleton 14 when releasing the first stent graft 10 from the sheath 20 are performed more appropriately. .

The arc portions A11 to A15 and A21 to A25 have a substantially semicircular shape, and each length is set to be the same. As a result, when the branch skeleton part 14 is compressed in the branch axis direction D2, the arc parts A11 to A15 and A21 to A25 are aligned (see FIG. 2B), so that the reference state of the branch skeleton part 14 is is properly compressed and restored to the reference state. Therefore, when loading the first stent graft 10 into the sheath 20, the branch portions 10B are neatly folded, so that the loading operation of the first stent graft 10 into the sheath 20 and the operation of discharging it from the sheath 20 can be performed appropriately. can.
In other words, if the lengths of the arc parts A11 to A15 and A21 to A25 are different, the arc parts A11 to A15 and A21 to A25 will be uneven when compressed in the branch axis direction D2, so that the first stent graft When loading the first stent graft 10 into the sheath 20, the branch portion 10B is twisted and folded, making it difficult to load and release the first stent graft 10. However, in this embodiment, such a problem is solved. can do.

The bent portions B11 to B14 and B21 to B24 bend the linear members constituting the branch skeleton portion 14 in the branch axis direction D2 and fold back in the circumferential direction. The bent portions B11 to B14 are located on one side (the right side in FIGS. 4A to 4C) with respect to the plane passing through the generatrix lines L1 and L2, and the bent portions B12 to B24 are located on the other side with respect to the plane passing through the generatrix lines L1 and L2. side (left side in FIGS. 4A to 4C).
The two bent parts B11 and B21, B13 and B23 are arranged close to each other with the cylindrical generating line L1 in between, and the bent parts B12 and B22, B14 and B24 are arranged close to each other across the cylindrical generating line L2. It is arranged as follows. That is, the branch skeleton portion 14 is spaced apart in the circumferential direction in the portions corresponding to the generatrix lines L1 and L2, and no linear members are disposed therein (except for the cylindrical upper and lower surfaces).

A separated portion formed by bent portions B21, B11, B23, and B13 arranged along the generatrix L1, and a separated portion formed by bent portions B22, B12, B24, and B14 arranged along the generatrix L2. and are arranged to face each other in the radial direction with the central axis of the branch skeleton section 14 interposed therebetween. That is, in the branch skeleton portion 14, the two bent portions are spaced apart from each other in the circumferential direction, and the separated portions (portions along the generatrix L1 or L2) face each other in the radial direction. More specifically, the branch skeleton portion 14 has two separated portions formed by bent portions spaced apart in the circumferential direction, and these two separated portions are opposed to each other in the radial direction. .

Further, regarding the generatrix L1, a spaced apart portion formed by bent portions B21 and B11 and a spaced apart portion formed by bent portions B23 and B13 are arranged side by side in the branch axis direction D2. Similarly, regarding the generatrix L2, a spaced apart portion formed by bent portions B22 and B12 and a spaced apart portion formed by bent portions B24 and B14 are arranged side by side in the branch axis direction D2. That is, in the branch skeleton portion 14, the two bent portions are arranged apart from each other in the circumferential direction, and the separated portions (for example, regarding the generatrix L1, the separated portion formed by the bent portions B11 and B21 and the bent portion B13, The spaced apart portions formed by B23) are aligned in the axial direction. More specifically, the branch skeleton portion 14 has a plurality of spaced apart parts formed by two bent parts spaced apart in the circumferential direction, and the plurality of spaced apart parts are lined up in the axial direction. .

As a result, even if a radial force acts on the separated portions of the branch skeleton 14 (portions corresponding to the generatrix L1 and L2) in the branch portion 10B, this force is not directly applied to the branch skeleton 14. It deforms only the branched film portion 15 without acting on the structure. The branch skeleton portion 14 only deforms following the deformation of the branch coating portion 15, and its planar shape when cut along a plane perpendicular to the branch axis direction D2 is stable.
That is, by arranging the branch skeleton parts 14 so that the separated parts of the branch skeleton parts 14 coincide with the main body axial direction D1, when loading the first stent graft 10 into the sheath 20, the main body axial direction D1 Even if a force of 2 is applied, the branch skeleton portion 14 deforms stably, and the branch portion 10B is not twisted excessively. Therefore, the operation of loading the first stent graft 10 into the sheath 20 can be performed appropriately, and the operation of discharging the first stent graft 10 from the sheath 20 can also be performed appropriately.

In addition, since the bent portions B11 to B14 and B21 to B24 are bent in the branch axis direction D2, when the branch portion 10B restores from the compressed state to the reference state, a large restoring force is generated in the branch axis direction D2. demonstrate. In addition, the branch skeleton portion 14 has a plurality of spaced apart portions formed by two bending portions spaced apart in the circumferential direction, and the plurality of spaced apart portions are lined up in the branch axis direction D2. Greater resilience can be demonstrated. As a result, when the first stent graft 10 is released from the sheath 20, the compressed branch portion 10B easily stands up in the branch axis direction D2, so that the release operation of the first stent graft 10 can be performed appropriately. I can do it.

In fact, when loading the first stent graft 10 into the sheath 20, the branch portion 10B is subjected to a force that extends in the main body axial direction D1, as well as a force that extends in the main body axial direction D1 (branch portion 10B Since a compressive force acts in the radial direction of the branch axis direction D2, the arcuate portions A12 to A14, A22 to A24 (the arcuate portions A11, A15 forming the upper and lower surfaces of the cylindrical shape, The arcuate portions (excluding A21 and A25) are in a crossed state as shown in FIG. 5, and the branched coating portions 15 are twisted to some extent. FIG. 5 is a plan view of the branch skeleton 14 when the first stent graft 10 is loaded into the sheath 20, viewed from the distal end side in the branch axis direction D2.

In this embodiment, the bent portions B21, B11, B23, and B13 arranged along the generatrix L1 and the bent portions B22, B12, B24, and B14 arranged along the generatrix L2 are separated in order from the tip side. They are arranged shifted in the branch axis direction D2. That is, the bent portions (for example, bent portions B12 and B22) that are arranged close to each other with the generatrix L1 or L2 in between are shifted in the axial direction.
As a result, when loading the first stent graft 10 into the sheath 20, adjacent bent portions (for example, bent portions B21 and B11) do not interfere with each other, so excessive twisting of the branch membrane portion 15 is unlikely to occur, and the branch The portion 10B can be neatly folded. Therefore, the first stent graft 10 can be loaded into the sheath 20 smoothly.

6A and 6B are diagrams showing a method for placing the first stent graft 10 and the second stent graft 50 in a blood vessel. In FIGS. 6A and 6B, the first stent graft 10 is placed in a diseased site of the main blood vessel V1 (for example, a site where an aortic aneurysm has occurred), and the second stent graft 50 is placed in the vicinity of the diseased site of the main blood vessel V1. The case is shown in which it is placed in a branch blood vessel V2 branching from. A second stent graft 50 is connected to the branch portion 10B of the first stent graft 10.

Note that the outer diameter of the second stent graft 50 in the expanded state is equal to or greater than the inner diameter of the branch portion 10B of the first stent graft 10. Further, the configuration of the second stent graft 50 is substantially the same as that of the first stent graft 10, except that it does not include the branch portion 10B, so a description thereof will be omitted.

When placing the first stent graft 10 and the second stent graft 50 in a blood vessel, for example, the stent graft placement device 1 is introduced into the blood vessel along a guide wire that has been inserted into the blood vessel in advance, and the distal end is placed at a predetermined lesion site. Deliver up to. By pulling out the sheath 20 in this state, the first stent graft 10 is released from the sheath 20. The released first stent graft 10 expands due to its self-expansion force and is placed in close contact with the main blood vessel V1 (see FIG. 6A). At this time, as the first stent graft 10 is released from the sheath 20, the branch skeleton section 14 disposed in the branch section 10B expands and returns to its original state. Due to the action of the bent portions B11 to B14 and B21 to B24 of the branch skeleton portion 14, the branch portion 10B rises neatly along the branch axis direction D2. Further, due to the action of the arcuate portions A11 to A15 and A21 to A25, the planar shape of the branch portion 10B returns to a circular shape. Therefore, the branch portion 10B is appropriately restored from the compressed state to the standard state and assumes a cylindrical shape.

Thereafter, for example, a guide wire for indwelling the second stent graft 50 is pulled out from the stent graft insertion site (eg, inguinal region) from the branch blood vessel V2 through the through hole of the branch portion 10B of the first stent graft 10. A stent graft placement device for the second stent graft 50 is introduced into the blood vessel along this guide wire, and the tip portion is delivered through the interior of the first stent graft 10 to a predetermined site in the branch blood vessel V2. The branch portion 10B of the first stent graft 10 and the second stent graft 50 are positioned so as to overlap, and the second stent graft 50 is released from the sheath 20 by pulling out the sheath 20 in this state. The released second stent graft 50 expands due to its self-expansion force and is placed in close contact with the branch blood vessel V2 (see FIG. 6B).
As a result, the inner circumferential surface of the first stent graft 10 (branch portion 10B) and the outer circumferential surface of the second stent graft 50 come into close contact with each other in the overlapping portion, and the first stent graft 10 and the second stent graft 50 are connected. .
Note that the second stent graft 50 may be transferred through the branch blood vessel V2 and inserted into the branch portion 10B of the first stent graft 10.

As described above, the first stent graft 10 (tubular treatment device) according to the present embodiment includes a tubular main body 10A, a branch part 10B protruding radially outward from the circumferential surface of the main body 10A, has. The branch portion 10B includes a branch coating portion 15 (coating portion) and a branch skeleton portion 14 (skeleton portion) fixed to the branch coating portion 15. The branch skeleton part 14 is made of a linear member whose shape is memorized to form a cylindrical shape, and the linear member is bent in the axial direction of the branch part 10B and folded back in the circumferential direction, including a plurality of bending parts B11 to B14, It has B21 to B24. Two of the plurality of bent portions B11 to B15 and B21 to B25 are arranged close to each other with the cylindrical generatrix L1 or L2 interposed therebetween.

As a result, for example, when loading the first stent graft 10 into the sheath 20 or releasing it from the sheath 20, the separated portions of the branch skeleton portion 14 (portions corresponding to the generatrix L1, L2) are provided with a radial direction. Even if a force acts, this force does not directly act on the branch skeleton portion 14, but can be released to the separated portions of the branch skeleton portion 14. For example, a force acting in the radial direction on the separated portions of the branched skeleton portion 14 is transmitted to the branched coating portion 15 corresponding to the separated portion of the branched skeleton portion 14, deforming only the branched coating portion 15. .
In addition, in the branch skeleton portion 14, the bent portions B11 to B14 and B21 to B24 are bent in the branch axis direction D2, so when restoring from the compressed state to the reference state, there is a large restoration in the branch axis direction D2. Demonstrate strength. As a result, when the first stent graft 10 is released from the sheath 20, the compressed branch portion 10B easily stands up in the branch axis direction D2, so that the release operation of the first stent graft 10 can be performed appropriately. I can do it.
That is, the branch skeleton portion 14 can be appropriately compressed from the standard state without greatly deforming its planar shape, and can be appropriately restored from the compressed state to the standard state. Therefore, the work of loading the first stent graft 10 into the sheath 20 can be performed appropriately, and the work of releasing the first stent graft 10 from the sheath 20 can also be performed appropriately.

In addition, in the branch skeleton section 14, the two bent portions are arranged apart from each other in the circumferential direction, and the separated portions (portions along the generatrix L1 or L2) are opposed to each other in the radial direction (main body axial direction D1). There is.
Further, in the branch skeleton portion 14, the two bent portions are arranged apart from each other in the circumferential direction, and the separated portions (for example, regarding the generatrix L1, the separated portion formed by the bent portions B11 and B21, and the bent portion B13, The separated portions formed by B23 are arranged along the branch axis direction D2.
Further, in the branch skeleton portion 14, two adjacent bent portions (for example, bent portions B11 and B21) are shifted in the branch axis direction D2.
Further, in the branch skeleton portion 14, the linear members are formed in a meandering shape.

The first stent graft 10 (tubular treatment device) includes a tubular main body 10A and a branch portion 10B that protrudes radially outward from the circumferential surface of the main body 10A. The branch portion 10B includes a branch coating portion 15 (coating portion) and a branch skeleton portion 14 (skeleton portion) fixed to the branch coating portion 15. The branch skeleton part 14 is made of a linear member whose shape is memorized to form a cylindrical shape, and has a plurality of circular arc parts A11 to A15 and A21 to A25 in which the linear members are arranged side by side in the axial direction. Among the circular arc portions A11 to A15 and A21 to A25, those that are adjacent to each other in the axial direction are connected by being folded back in the circumferential direction, and have the same length.
As a result, when the branch skeleton part 14 is compressed in the branch axis direction D2, the arc parts A11 to A15 and A21 to A25 are aligned, so that the branch skeleton part 14 can be compressed from the reference state and the reference state can be properly restored. Therefore, when loading the first stent graft 10 into the sheath 20, the branch portions 10B are neatly folded, so that loading the first stent graft 10 into the sheath 20 and releasing the first stent graft 10 from the sheath 20 can be carried out more appropriately. I can do it.

As above, the invention made by the present inventor has been specifically explained based on the embodiments, but the present invention is not limited to the above embodiments, and can be modified without departing from the gist thereof.

For example, in the embodiment, the two adjacent bent portions of the branch skeleton portion 14 are deviated from each other in the axial direction, but as shown in FIGS. 7A and 7B, the two adjacent bent portions (For example, bent portions B11 and B21) may be opposed in the circumferential direction. In this case, since the first skeleton part 141 and the second skeleton part 142 have a symmetrical structure, the design and manufacture of the branch skeleton part 14 can be facilitated.

Further, for example, the number of bent portions and arcuate portions provided in the branch skeleton portion 14 can be changed as appropriate depending on the height of the branch portion 10B and the required restoring force. Further, in the branch skeleton section 14, the separated portion formed by the two bent portions may be arranged along only one generatrix. For example, by making the arc portion substantially circular and forming it into a meandering shape in the branch axis direction D2, the spaced apart portion formed by the two bent portions can be arranged along only one generatrix.

Further, in the embodiment, a configuration has been described in which the first stent graft 10 has the recess 13 and one branch portion 10B is disposed in the recess 13, but this is only an example and is not limited to this. For example, whether or not the first stent graft 10 has the concave portion 13 can be arbitrarily changed as appropriate, and a plurality of branch portions 10B may be provided in the main body portion 10A.

Further, as shown in FIGS. 4A to 4C, the branch skeleton section 14 is made of a linear member whose shape is memorized to form a cylindrical shape, and the linear member is bent in the axial direction of the branch section 10B, and It has a plurality of bent parts B11 to B14 and B21 to B24 that are folded back in the direction, and two of the plurality of bent parts B11 to B14 and B21 to B24 are arranged close to each other across the cylindrical generatrix L1 or L2. It is not necessary to provide a plurality of arcuate portions A11 to A15 and A21 to A25.
Similarly, the branch skeleton part 14 is made of a linear member whose shape is memorized to form a cylindrical shape, and has a plurality of arcuate parts A11 to A15 and A21 to A25 arranged side by side in the axial direction. Of the circular arc parts A11 to A15 and A21 to A25, those adjacent in the axial direction are connected by being folded back in the circumferential direction, and only need to have the same length, and do not necessarily have a plurality of bent parts B11 to B14, B21 to B24. do not have to.

Furthermore, in the embodiment, a stent graft that is placed in a blood vessel as an example of a tubular tissue has been described, but the present invention also provides a stent graft that is placed in a tubular tissue other than a blood vessel, such as a branch part of a bile duct and a duodenum. The present invention can also be applied to a branch skeleton portion (skeleton for a tubular treatment device) disposed at a branch portion of the tubular treatment device.
Moreover, the skeleton for a tubular treatment device according to the present invention may be applied to the tubular treatment device itself, not to an auxiliary skeleton portion such as that provided at a branch portion. For example, it can be applied to a tubular treatment device that is compressed in a direction perpendicular to the extending direction of the sheath and loaded into the sheath.

The embodiments disclosed this time should be considered to be illustrative in all respects and not restrictive. The scope of the present invention is indicated by the claims rather than the above description, and it is intended that all changes within the meaning and range equivalent to the claims are included.

The disclosure contents of the specification, drawings, and abstract contained in the Japanese patent application No. 2018-215722 filed on November 16, 2018 are all incorporated into the present application.

1 Stent graft placement device 10 First stent graft 10A Main body portion 10B Branch portion 11 Main body skeleton portion 12 Main body membrane portion 13 Recessed portion 14 Branch skeleton portion (skeleton for tubular treatment device)
141 First skeleton part 142 Second skeleton part 15 Branch membrane part 50 Second stent graft V1 Main blood vessel V2 Branch blood vessel A11 to A16, A21 to A26 Arc part B11 to B15, B21 to B25 Bent part L1, L2 Branch Generatrix of skeleton

Claims (5)

A skeleton for a tubular treatment device comprising a linear member whose shape is memorized to form a cylindrical shape,
The linear member is bent in the axial direction and has a plurality of bending parts that are folded back in the circumferential direction,
Two first bent portions of the plurality of bent portions are spaced apart in the circumferential direction and arranged close to each other with the cylindrical first generatrix interposed therebetween;
Two second bent portions of the plurality of bent portions are spaced apart in the circumferential direction and disposed close to each other with the cylindrical second generatrix interposed therebetween;
The separated portion of the first bent portion and the separated portion of the second bent portion are opposed to each other in the radial direction,
When partitioned into a first skeleton part and a second skeleton part by a plane passing through the first generatrix and the second generatrix, the first skeleton part and the second skeleton part are each divided from one side to the other side in the axial direction. The first bent portion and the second bent portion are alternately formed toward the
The two first bent portions are arranged between the first bent portions adjacent in the axial direction in one skeleton portion of the first skeleton portion and the second skeleton portion. axially shifted so that the first bent portion is located;
The two second bent portions are arranged between the second bent portions adjacent in the axial direction in one skeleton portion of the first skeleton portion and the second skeleton portion. axially shifted so that the second bent portion is located;
Skeleton for tubular treatment instruments. The skeleton for a tubular treatment device according to claim 1, wherein separated portions of the two first bent portions and the two second bent portions are respectively aligned in the axial direction. The linear member is formed in a meandering shape,
A central bent portion that is not located at the end in the axial direction among the plurality of bent portions,
Of the two first bent portions, one of the first bent portions located on one side in the axial direction is bent in the axial direction of the other first bent portion located on the other side in the axial direction. The second bent portion connected to one side of the first bent portion is at the same position in the axial direction, and the other first bent portion is connected to the other side of the first bent portion in the axial direction. the second bent portion and the axial position are equal to each other;
The skeleton for a tubular treatment device according to claim 1. It has a plurality of circular arc parts connecting the first bending part and the second bending part adjacent in the circumferential direction among the plurality of bending parts,
The skeleton for a tubular treatment device according to any one of claims 1 to 3, wherein the plurality of circular arc portions are arranged side by side in the axial direction and have equal lengths. A tubular treatment instrument having a tubular main body portion and a branch portion protruding radially outward from a circumferential surface of the main body portion,
The branch portion has a coating portion and a skeleton portion fixed to the coating portion,
The skeleton part is made of a linear member whose shape is memorized to have a cylindrical shape, and has a plurality of bending parts that bend the linear member in the axial direction of the branch part and fold back in the circumferential direction,
Two first bent portions of the plurality of bent portions are spaced apart in the circumferential direction and arranged close to each other with the cylindrical first generatrix interposed therebetween;
Two second bent portions of the plurality of bent portions are spaced apart in the circumferential direction and disposed close to each other with the cylindrical second generatrix interposed therebetween;
The separated portion of the first bent portion and the separated portion of the second bent portion are opposed to each other in the radial direction,
When partitioned into a first skeleton part and a second skeleton part by a plane passing through the first generatrix and the second generatrix, the first skeleton part and the second skeleton part are each divided from one side to the other side in the axial direction. The first bent portion and the second bent portion are alternately formed toward the
The two first bent portions are arranged between the first bent portions adjacent in the axial direction in one skeleton portion of the first skeleton portion and the second skeleton portion. axially shifted so that the first bent portion is located;
The two second bent portions are arranged between the second bent portions adjacent in the axial direction in one skeleton portion of the first skeleton portion and the second skeleton portion. The second bent portion is disposed offset in the axial direction,
The opposing directions of the two separated portions are aligned with the axial direction of the tubular treatment device.
Tubular treatment device.

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