WO2003055133A9 - Intervention tool - Google Patents

Intervention tool

Info

Publication number
WO2003055133A9
WO2003055133A9 PCT/EP2002/014018 EP0214018W WO03055133A9 WO 2003055133 A9 WO2003055133 A9 WO 2003055133A9 EP 0214018 W EP0214018 W EP 0214018W WO 03055133 A9 WO03055133 A9 WO 03055133A9
Authority
WO
WIPO (PCT)
Prior art keywords
catheter
tip
instrument according
interventional instrument
central channel
Prior art date
Application number
PCT/EP2002/014018
Other languages
German (de)
French (fr)
Other versions
WO2003055133A1 (en
Inventor
Wolfgang Schinke
Khalid J Elkhayri
Original Assignee
Vitalux Gmbh
Wolfgang Schinke
Khalid J Elkhayri
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Vitalux Gmbh, Wolfgang Schinke, Khalid J Elkhayri filed Critical Vitalux Gmbh
Publication of WO2003055133A1 publication Critical patent/WO2003055133A1/en
Publication of WO2003055133A9 publication Critical patent/WO2003055133A9/en

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
    • A61B8/4444—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device related to the probe
    • A61B8/445—Details of catheter construction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
    • A61B8/0833—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving detecting or locating foreign bodies or organic structures
    • A61B8/0841—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving detecting or locating foreign bodies or organic structures for locating instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/12—Diagnosis using ultrasonic, sonic or infrasonic waves in body cavities or body tracts, e.g. by using catheters

Definitions

  • the invention relates to an interventional instrument for insertion into a lumen of the human body, in particular an instrument to be used intracardially for insertion into the cardiovascular system.
  • Such interventional instruments are e.g. B. catheters for placing vascular prostheses, so-called stents, with which constrictions in veins or vessels can be widened.
  • so-called balloon catheters are used, which are advanced in the patient's bloodstream to the constriction to be treated, after which the balloon, which is arranged at the tip of the catheter, is inflated, thereby expanding the constriction, so that again an essentially normal blood flow is reached through the blood vessel.
  • a stent may be placed to hold open theticianwe n Deten constriction.
  • Echocardiography is a special application of the pulse echo method in the time-motion or real-time method or the continuous sound Doppler method for cardiac diagnosis, with the transducer is positioned on the front wall of the chest.
  • Heart valve or mitral stenosis can be recorded and assessed, as well as aortic valve insufficiency, etc.
  • Interventional instruments are known, in particular for minimally invasive medicine, which enable intracorporeal treatment, for example laser treatment, with the treatment site being monitored optically at the same time. This is done e.g. B. with the help of an optical fiber that runs in the instrument and into which light from an external light source is radiated, wc ei the reflected light is recorded via a further optical fiber and displayed on a monitor, for example.
  • such instruments can not be used in the bloodstream of a patient "because blood is a bad light guide and optical monitoring is also disturbed in a possible intervention by turbulence within the blood in most cases.
  • the invention has for its object to provide an interventional instrument, in particular an intracardially used instrument for the coronary vascular system, with which the diagnosis and any intervention can be simplified.
  • the interventional instrument accordingly has the following features: a catheter with a flexible tube, e.g. B. made of PVC, and a central channel penetrating the tube in its longitudinal direction, which has a preferably central mouth in the region of the catheter tip;
  • a catheter with a flexible tube e.g. B. made of PVC
  • a central channel penetrating the tube in its longitudinal direction which has a preferably central mouth in the region of the catheter tip
  • an ultrasound transducer in the region of the tip of the catheter, which is preferably integrated in the wall of the catheter and is connected to an echocardiography device provided there via electrical lines running in the wall of the catheter to its distal end; the ultrasound transducer preferably surrounds the central channel of the tip of the catheter.
  • a hand-held device which surrounds the catheter and is located extracorporeally and which, for the controlled bending of the tip of the catheter, is connected to guide wires which run in the wall of the catheter and lead to the tip thereof;
  • a branching piece in the catheter between the handheld device and the echocardiography device which has at least one lockable channel leading into the central channel of the catheter;
  • Branch piece can be inserted into the central channel of the catheter and can be pushed up to its mouth, for performing a medical intervention.
  • the catheter is z. B. by an operator in the heart of a patient up to the area to be operated on Heart valve inserted, this insertion being controlled by observation of the image provided by the echocardiography device.
  • the surgical instrument is then inserted into the catheter and pushed to the treatment site.
  • the treatment site is displayed on the monitor of the echocardiography device, so that the desired operation can be carried out there with the surgical instrument; this in turn takes place while monitoring the image of the echocardiography device.
  • Possible surgery are about. Removal of a stenosis, removal of tissue samples etc. As surgical instruments for medical intervention such. B. scalpels, tweezers, pliers, scrapers, etc. into consideration.
  • the ultrasound transducer is preferably a phase-controlled transducer which operates in the range from approximately 5 to 10 MHz, a color Doppler mode preferably being used.
  • a phase-controlled transducer which operates in the range from approximately 5 to 10 MHz, a color Doppler mode preferably being used.
  • pulse mode i.e. M or 2D operation possible.
  • FIG. 1 shows a schematic representation of an interventional instrument according to the invention with a catheter receiving an operating instrument
  • FIG. 2 shows a longitudinal section of the instrument according to FIG. 1 in the region of the catheter tip;
  • Figure 3 is a schematic cross section along III-III in Figures 1 and 2;
  • FIG. 4 shows a cross section through the instrument along IV-IV in FIG. 1.
  • An interventional instrument 1 has a catheter 2 made of a thin PVC tube with a diameter of about 4 mm in this case, which is provided with a central channel 3 with a diameter of about 2 mm in this case, which is at the tip of the catheter Mouth 4 has.
  • an ultrasound transducer 5 is incorporated in the wall of the tube, which can be of conventional design and z.
  • B. consists of several segments 6, which are only indicated in Figure 2.
  • the catheter 2 is guided to and passes through a hand-held device 7.
  • the hand-held device 7 has two setting wheels 8 and 9, which can each be rotated clockwise or counterclockwise by 180 ° about the longitudinal axis of the catheter.
  • the handwheels 8 and 9 are connected in this case to four adjusting wires 10 which run from the adjusting wheels in the wall of the catheter 2 to the tip thereof.
  • the tip of the catheter can be bent in all directions up to an angle non about 45 °; this enables a controlled advancement of the catheter 2 z. B. through the bloodstream around curves of the blood vessel.
  • the catheter 2 has between the hand-held device 7 and the connector 12 a branch 17 with two connecting channels 18 and 19 which flow into the central channel 3 of the catheter and can be shut off at their distal ends by a valve 20 or 21.
  • an only indicated surgical instrument 22 in this case a scalpel, is introduced into the central channel 3 with the aid of a guide wire 23 via the channel 18 of the branching piece 17 and advanced to the tip of the catheter, where it emerges from the mouth 4 there.
  • this surgical instrument the desired medical intervention is carried out, for example by actuating an operating handle 24 at the end of the guide wire.
  • Physiological parameters can be determined via the connecting channel 19 of the branching piece 17, for. B. the pressure at the treatment site, for example in the heart chamber or in a blood vessel, blood samples are removed or contrast and drugs are injected.

Landscapes

  • Life Sciences & Earth Sciences (AREA)
  • Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Biophysics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Ultra Sonic Daignosis Equipment (AREA)

Abstract

The invention relates to an intervention tool which comprises a catheter (2) at the tip of which an ultrasound transducer (5), preferably a phase-controlled Doppler ultrasound transducer, is provided with which an image of the surroundings of the catheter tip can be displayed on an echography device. The catheter (2) furthermore has a central channel (3) that extends through the catheter in the longitudinal direction and that leads to the open in the area of the tip of the catheter. Surgical tools (22) can be inserted via said channel for the purpose of a medical intervention in the area of the catheter tip.

Description

interventional instrument
The invention relates to an interventional instrument for insertion into a lumen of the human body, in particular an instrument to be used intracardially for insertion into the cardiovascular system.
Such interventional instruments are e.g. B. catheters for placing vascular prostheses, so-called stents, with which constrictions in veins or vessels can be widened. For this purpose, so-called balloon catheters are used, which are advanced in the patient's bloodstream to the constriction to be treated, after which the balloon, which is arranged at the tip of the catheter, is inflated, thereby expanding the constriction, so that again an essentially normal blood flow is reached through the blood vessel. Subsequently or simultaneously, a stent may be placed to hold open the aufgewe n Deten constriction.
With special balloon catheters, stenoses in the area of the heart valves can also be removed, whereby this procedure is often monitored with the help of external echocardiography. The patient's chest is irradiated using an ultrasound transducer; the reflected waves are received, evaluated and z. B. displayed on a color monitor. Echocardiography is a special application of the pulse echo method in the time-motion or real-time method or the continuous sound Doppler method for cardiac diagnosis, with the transducer is positioned on the front wall of the chest. Heart valve or mitral stenosis can be recorded and assessed, as well as aortic valve insufficiency, etc.
It would be desirable to simplify the diagnosis of such diseases and, if necessary, also to be able to carry out an intervention on the affected area.
Interventional instruments are known, in particular for minimally invasive medicine, which enable intracorporeal treatment, for example laser treatment, with the treatment site being monitored optically at the same time. This is done e.g. B. with the help of an optical fiber that runs in the instrument and into which light from an external light source is radiated, wc ei the reflected light is recorded via a further optical fiber and displayed on a monitor, for example. However, such instruments can not be used in the bloodstream of a patient "because blood is a bad light guide and optical monitoring is also disturbed in a possible intervention by turbulence within the blood in most cases.
The invention has for its object to provide an interventional instrument, in particular an intracardially used instrument for the coronary vascular system, with which the diagnosis and any intervention can be simplified.
This object is achieved according to the invention by the features of claim 1.
The interventional instrument accordingly has the following features: a catheter with a flexible tube, e.g. B. made of PVC, and a central channel penetrating the tube in its longitudinal direction, which has a preferably central mouth in the region of the catheter tip;
an ultrasound transducer in the region of the tip of the catheter, which is preferably integrated in the wall of the catheter and is connected to an echocardiography device provided there via electrical lines running in the wall of the catheter to its distal end; the ultrasound transducer preferably surrounds the central channel of the tip of the catheter.
a hand-held device which surrounds the catheter and is located extracorporeally and which, for the controlled bending of the tip of the catheter, is connected to guide wires which run in the wall of the catheter and lead to the tip thereof;
a branching piece in the catheter between the handheld device and the echocardiography device, which has at least one lockable channel leading into the central channel of the catheter; and
a surgical tool that is about the
Branch piece can be inserted into the central channel of the catheter and can be pushed up to its mouth, for performing a medical intervention.
The catheter is z. B. by an operator in the heart of a patient up to the area to be operated on Heart valve inserted, this insertion being controlled by observation of the image provided by the echocardiography device. The surgical instrument is then inserted into the catheter and pushed to the treatment site. The treatment site is displayed on the monitor of the echocardiography device, so that the desired operation can be carried out there with the surgical instrument; this in turn takes place while monitoring the image of the echocardiography device. Possible surgery are about. Removal of a stenosis, removal of tissue samples etc. As surgical instruments for medical intervention such. B. scalpels, tweezers, pliers, scrapers, etc. into consideration.
The ultrasound transducer is preferably a phase-controlled transducer which operates in the range from approximately 5 to 10 MHz, a color Doppler mode preferably being used. Of course, the above. other ways of working in pulse mode, i.e. M or 2D operation possible.
Further refinements of the invention result from the subclaims.
The invention is explained in more detail in one embodiment using the drawing. In this represent:
FIG. 1 shows a schematic representation of an interventional instrument according to the invention with a catheter receiving an operating instrument;
FIG. 2 shows a longitudinal section of the instrument according to FIG. 1 in the region of the catheter tip; Figure 3 is a schematic cross section along III-III in Figures 1 and 2; and
FIG. 4 shows a cross section through the instrument along IV-IV in FIG. 1.
An interventional instrument 1 has a catheter 2 made of a thin PVC tube with a diameter of about 4 mm in this case, which is provided with a central channel 3 with a diameter of about 2 mm in this case, which is at the tip of the catheter Mouth 4 has. In the area of the catheter tip, an ultrasound transducer 5 is incorporated in the wall of the tube, which can be of conventional design and z. B. consists of several segments 6, which are only indicated in Figure 2. The catheter 2 is guided to and passes through a hand-held device 7. The hand-held device 7 has two setting wheels 8 and 9, which can each be rotated clockwise or counterclockwise by 180 ° about the longitudinal axis of the catheter. The handwheels 8 and 9 are connected in this case to four adjusting wires 10 which run from the adjusting wheels in the wall of the catheter 2 to the tip thereof. By turning the setting wheels, the tip of the catheter can be bent in all directions up to an angle non about 45 °; this enables a controlled advancement of the catheter 2 z. B. through the bloodstream around curves of the blood vessel.
In the wall of the hose 2, electrical lines 11 are incorporated, which lead to the individual segments 6 of the transducer 5. The lines are continued in the wall of the tube 2 beyond the handheld device 7 up to a plug 12 at the distal end of the catheter 1. This plug is connected to a corresponding plug 13 an echocardiography device 14, which, as indicated schematically, has a color monitor 15 and a control panel 16, which is connected to electronics, not shown here, which communicates with the lines of the plug 13. Transmit signals in Doppler mode in the range between 5 and 10 MHz are passed from the electrocardiography device 14 to the individual segments 6 of the transducer, the signals received by the transducer in turn being returned to the electrocardiography device 14 via the lines 11. According to the Doppler principle, these signals can then be evaluated by the electronics and passed on to the monitor 15, on which the image of the blood vessel then appears in the area of the catheter tip.
The catheter 2 has between the hand-held device 7 and the connector 12 a branch 17 with two connecting channels 18 and 19 which flow into the central channel 3 of the catheter and can be shut off at their distal ends by a valve 20 or 21. As soon as the tip of the catheter has reached the desired treatment location, which is defined with the aid of the echocardiography device, an only indicated surgical instrument 22, in this case a scalpel, is introduced into the central channel 3 with the aid of a guide wire 23 via the channel 18 of the branching piece 17 and advanced to the tip of the catheter, where it emerges from the mouth 4 there. With this surgical instrument, the desired medical intervention is carried out, for example by actuating an operating handle 24 at the end of the guide wire. An example of this is the removal of a stenosis from a heart valve. This intervention is controlled by an operator on the basis of the image appearing on the monitor 15. Physiological parameters can be determined via the connecting channel 19 of the branching piece 17, for. B. the pressure at the treatment site, for example in the heart chamber or in a blood vessel, blood samples are removed or contrast and drugs are injected.

Claims

claims
1. Catheter for insertion into a lumen of the human body, characterized by the following features:
- A catheter (2) with a flexible tube and a central channel (3) passing through the tube in its longitudinal direction and having a mouth (4) in the area of the tip of the catheter;
an ultrasound transducer (5) in the area of the tip of the catheter (2), which can be connected to an echocardiography device (14) provided there via electrical lines (11) running in the wall of the catheter (2) to its distal end;
a handheld device (7) surrounding the catheter and located extracorporeally, which is connected to controlled bending of the tip of the catheter (2) with adjusting wires (10) which run in the wall of the catheter (2) and lead to the tip thereof
a branching piece (17) in the catheter (2) between the handheld device (7) and the echocardiography device (14), which has at least one lockable channel 18, 19) leading into the central channel (3) of the catheter (2); and
an operating instrument (22) which via the branching piece (17) in the central channel (3) of the Catheter insertable and can be pushed up to its mouth (4) for performing a medical intervention.
2. Interventional instrument according to claim 1, characterized in that the ultrasonic transducer (5) is a phase-controlled transducer.
3. Interventional instrument according to claim 1 or 2, characterized in that the ultrasonic transducer (14) operates in the range from 5 to 10 MHz.
4. Interventional instrument according to one of the preceding claims, characterized in that the ultrasonic transducer (5) operates in Doppler mode.
5. Interventional instrument according to claim 4, characterized in that the echography device (14) is a Doppler echography device, in particular a Doppler echocardiography device.
6. Interventional instrument according to one of the preceding claims, characterized in that the central channel (3) at the tip of the catheter (2) opens out centrally and is surrounded by the ultrasound transducer (5) in the area of the tip of the catheter.
7. Interventional instrument according to one of the preceding claims, characterized in that the catheter (2) has a hand-held device (7) which is connected to control wires (10) which are incorporated in the wall of the catheter (2) and to the tip of the Guide the catheter (2). Interventional instrument according to claim 7, characterized in that the hand-held device (2) has adjusting wheels (8, 9) connected to the adjusting wires (10).
PCT/EP2002/014018 2001-12-10 2002-12-10 Intervention tool WO2003055133A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE2001160594 DE10160594A1 (en) 2001-12-10 2001-12-10 Instrument for introduction into a lumen of a human body comprises a catheter, an ultrasonic converter in the catheter end zone, a control handle, and an operation tool
DE10160594.3 2001-12-10

Publications (2)

Publication Number Publication Date
WO2003055133A1 WO2003055133A1 (en) 2003-07-03
WO2003055133A9 true WO2003055133A9 (en) 2004-12-29

Family

ID=7708661

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP2002/014018 WO2003055133A1 (en) 2001-12-10 2002-12-10 Intervention tool

Country Status (2)

Country Link
DE (1) DE10160594A1 (en)
WO (1) WO2003055133A1 (en)

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2068716B1 (en) * 2006-10-02 2011-02-09 Hansen Medical, Inc. Systems for three-dimensional ultrasound mapping

Family Cites Families (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5704361A (en) * 1991-11-08 1998-01-06 Mayo Foundation For Medical Education And Research Volumetric image ultrasound transducer underfluid catheter system
US5364352A (en) * 1993-03-12 1994-11-15 Heart Rhythm Technologies, Inc. Catheter for electrophysiological procedures
JPH11221229A (en) * 1997-09-24 1999-08-17 Eclipse Surgical Technol Inc Catheter
US5935108A (en) * 1997-11-14 1999-08-10 Reflow, Inc. Recanalization apparatus and devices for use therein and method
US6770070B1 (en) * 2000-03-17 2004-08-03 Rita Medical Systems, Inc. Lung treatment apparatus and method
JP4873816B2 (en) * 2000-05-16 2012-02-08 アトリオニックス・インコーポレイテッド Flexible tip catheter with guide wire tracking mechanism

Also Published As

Publication number Publication date
DE10160594A1 (en) 2003-06-26
WO2003055133A1 (en) 2003-07-03

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