CN101842061A - 自扩展假体 - Google Patents

自扩展假体 Download PDF

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CN101842061A
CN101842061A CN200880104160A CN200880104160A CN101842061A CN 101842061 A CN101842061 A CN 101842061A CN 200880104160 A CN200880104160 A CN 200880104160A CN 200880104160 A CN200880104160 A CN 200880104160A CN 101842061 A CN101842061 A CN 101842061A
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prosthese
temperature
shape
section
expansion
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泰·D·蒂尤
约瑟夫·古拉臣斯基
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MicroVention Inc
Micro Vention Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2002/823—Stents, different from stent-grafts, adapted to cover an aneurysm
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0014—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0014—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol
    • A61F2210/0023—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol operated at different temperatures whilst inside or touching the human body, heated or cooled by external energy source or cold supply
    • A61F2210/0033—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol operated at different temperatures whilst inside or touching the human body, heated or cooled by external energy source or cold supply electrically, e.g. heated by resistor

Abstract

在一个优选实施例中，提供一种假体，可以通过升高患者体内假体的温度来选择性地扩张该假体。假体是由形状记忆材料构成的，当被加热到高于平均体温的温度时该形状记忆材料扩张，从而允许使用者在所需部位选择性地加热并且因而扩张假体。

Description

自扩展假体
相关申请
本申请要求2007年6月25日提交的、名称为“Self-ExpandingProsthesis(自扩展假体)”的、序列号为60/946,101的美国临时申请的权益，在此将其全部内容并入本文作为参考。
背景技术
内用假体装置(更通常地被称为支架)在本领域中公知地用于治疗广泛的医疗情况。通常，内用假体由柱形装置构成，该柱形装置可以由较小直径构造扩展成较大直径构造。较小直径构造有助于使得内用假体前进通过患者的通常盘错的内腔，而张开的较大直径构造压抵患者内腔的壁，常用于锚定假体并恢复内腔的开放性。
可以根据其扩展方法来给许多内用假体装置分类。一些装置是通过在内用假体的内表面上施加指向外的径向力来扩展的。例如，内用假体可以被压缩或卷曲在气囊导管的已放气气囊之上。当内用假体被置于所需目标区域时，气囊充气，从而扩展内用假体。
其他内用假体是自扩展的，并且因而在压缩之后恢复到张开位置。例如，一些自扩展内用假体装置由例如镍钛诺(Ni-Ti合金)的形状记忆材料构成。形状记忆材料允许装置被压缩在传输导管内，而当在患者内腔内释放时在直径上扩展，类似于弹簧。对于一些应用而言，自扩展内用假体装置被看作是优于气囊可扩展装置的，因为自扩展装置通常需要较不精密的传输机构(例如，没有可充气气囊)并且通常在展开后不易损坏(例如由于被碾压或以其他方式永久性变形)。现有技术的形状记忆装置的示例可以参见授予Jervis的美国专利No.4,665,905和授予Sakamoto等人的美国专利No.4,925,445，其全部内容被并入本文以供参考。
不过，自扩展内用假体的传输系统并不是没有缺点的。例如，一个通常的传输系统包括具有可收缩鞘的导管。内用假体装置被预加载到导管远端上的直径减小区域上。可收缩鞘被置于装置之上，防止其在直径上扩展。当装置到达所需目标部位时，使用者缩回外鞘，释放自扩展装置。不过，自扩展力会导致装置从鞘侧向弹出，有时会错过所需目标区域。此外，装置可能倾向于被嵌到鞘壁之内，会导致损坏装置或者装置被卡住。附加的传输系统的细节可以参见美国专利No.4,580,568和No.4,732,152，其全部内容被并入本文以供参考。
因此，需要一种能克服现有技术缺点的自扩展内用假体传输系统。
发明内容
本发明的目标是克服现有技术的缺点。
本发明的另一个目标是提供可以在患者体内更加可预见性地释放假体的假体传输系统。
本发明的另一个目标是提供能减少假体在患者体内传输期间不希望的并发症的假体传输系统。
本发明试图通过提供一种可以选择性扩展的假体来实现这些目标。在一个优选实施例中，假体由形状记忆材料构成，当被加热到高于平均体温的温度时该形状记忆材料扩展。当位于假体内部的加热器被启动时，假体的形状记忆材料扩展到预定形状。
在另一个优选实施例中，使用电导线将电流直接供应到假体，从而导致假体主体本身变热并且因而在直径上扩展。一旦扩展，则电导线脱离假体并且从患者移除。
附图说明
图1示出了根据本发明的优选实施例的假体展开系统的未组装立体图；
图2示出了图1的假体展开系统的组装立体图；
图3示出了根据本发明的另一个优选实施例的假体展开系统的立体图；
图4示出了根据本发明的优选实施例的示例性形状记忆材料的差示扫描量热(DSC)图；
图5示出了图1中假体用于治疗动脉瘤的侧视图；以及
图6是具有假体线圈的图1中假体用于治疗动脉瘤的侧视图。
具体实施方式
参考图1和图2，示出了根据本发明优选实施例的假体展开系统100。这个展开系统100包括假体102(例如，支架)，可以通过启动加热器110使得该假体102在患者的内腔内选择性扩张。由于其成分，假体102当被加热到预定温度时在直径上扩张并且在患者体温时保持张开。这样，展开系统100允许使用者确定假体102何时在患者体内在直径上扩张。
优选地，假体102由例如镍钛诺的形状记忆材料构成，其由马氏体状态相变到奥氏体状态。在马氏体状态时，假体102保持延展性能，当传输假体102通过患者体内的迂曲脉管时这是特别有用的。在奥氏体状态时，假体102在直径上扩张到更大的预定形状且同时变得更具有刚性。
参考图4，示出了示例性形状记忆材料的差示扫描量热(DSC)图。从形状记忆材料的马氏体状态到奥氏体状态的转变温度范围开始于有效奥氏体开始温度(As)并且完成于有效奥氏体完成温度(AF)。类似地，从奥氏体状态到马氏体状态的转变温度范围开始于有效马氏体开始温度(Ms)并且完成于有效马氏体完成温度(MF)。如图所示，奥氏体温度范围通常高于马氏体温度范围。
现有技术的典型自扩张支架具有37℃或更低的AF以便确保支架在被传输到患者体内的所需目标部位时扩张。然而，根据本发明的优选实施例的假体具有高于37℃的As和AF而MF和Ms保持在这个温度之下。因此，假体102可以以其柔性马氏体状态被传输到目标部位，被加热以转变到其张开的奥氏体状态(例如具有更大直径的预设形状)，之后被允许冷却到37℃，而此时假体保持在其张开的奥氏体状态。换言之，可以通过简单加热使得假体102选择性地扩张。
可以例如从铸锭有效温度(Ingot Active temperature)或经由热处理来获得所需转变温度。
优选地，AF高于37℃并且更优选地在大约40℃至大约55℃的范围内。例如，假体材料的As是大约45℃而AF是大约55℃。
如图1的未组装图很好地示出，传输系统100包括加热器110，该加热器110由高电阻材料构成，当电流从中流过时该高电阻材料生热。图2示出了组装图，其中加热器110位于未张开假体100的内部。当假体102位于患者体内所需目标部位时，使用者向加热器110施加电流，导致加热器110温度升高并且因而导致假体102温度升高。当假体102到达其AF温度时，假体102抵靠患者内腔的壁在直径上扩张。因此，使用者可以首先将假体102置于内腔内的所需部位，并且之后使得假体102扩张。此外，如果使用者对假体102的初始位置不满意，则可以在扩张之前再次抓取该假体并且重新布置在更理想部位。
在本优选实施例中，假体102包括由中间段106连接的第一段104和第二段108。第一段104和第二段108优选地由轴向和径向互连区段构成，而中间段106包括仅轴向设置的构件105从而允许每段104和108彼此独立地扩张。优选地，中间段106与第一段104和第二段108是一体的并且因而具有与第一段104和第二段108相同的材料。不过，中间段106也可以由例如聚合物的不同材料构成从而进一步有助于两段104和108的独立扩张。
加热器110具有第一加热线圈112和第二加热线圈114形式的匹配区段，第一加热线圈112和第二加热线圈114分别位于段104和108内。电线116和118将电流供应给第一加热线圈112，而电线120和118(电连接于线圈112和114)将电流提供给第二加热线圈114。因此，每个线圈112和114可以彼此独立地被加热，这最终允许假体102的每段104和108彼此独立地扩张。类似加热机构的进一步讨论可以参见美国公开号2006/0052815，其全部内容被并入本文以供参考。
优选地，加热器110被提供足够的电流以达到等于或高于假体102的形状记忆材料的转变温度的温度。不过，还优选的是最大温度和加热持续时间被限定从而防止或最小化对患者内腔的进一步损害。此外，假体102可以覆盖有例如热缩管的薄膜从而限制对患者内腔的热暴露。
假体102的段104和108的独立扩张可以允许使用者将假体102更精确地定位在患者体内的目标部位。例如，一旦假体位于所需目标部位，则使用者可以首先扩张远端第一段104从而提供初始锚定点，并且之后扩张近端第二段108。因为许多现有技术的自扩张支架倾向于随着直径上的增大而在长度上收缩，在传输期间可能难以预测它们的最终位置。不过，通过首先扩张一个段104或108，假体102的最终张开位置可以被展开至更可预测的位置。
虽然本优选实施例中仅示出了两段104和108，不过也可以有附加段。例如，假体102可以具有3段或4段，并且具有相同数量的相应线圈来加热假体102的各段。
在工作中，假体展开系统100被用于通过最初使得导丝穿入患者以便将导丝的远端置于目标区域从而展开假体102。容纳加热器110和假体102的导管或微导管在导丝上滑动直到导管的远端到达患者内腔的所需目标区域。因为假体102处于其马氏体状态，所以其保持相对柔性并且因而可以容易地穿过迂曲通路从而到达目标区域。
一旦导管的远端到达目标区域，则外鞘(如果有的话)缩回从而暴露假体102。如果使用者对假体102的位置不满意，则假体102可以任选地被外鞘(同样，如果有的话)再次抓取并且前进或缩回直到实现所需位置。之后使用者通过导致第一加热器线圈112温度升高并因而使第一段104的相由马氏体转变为奥氏体(即，导致第一段104运动到其预定张开构造)从而扩张假体102的远端第一段104。之后，使用者通过导致第二加热器线圈114温度升高，因而改变第二段108的相，从而扩张近端第二段108。最后，使用者可以确认假体102的最终位置(例如借助无线荧光透视)并移除导管。在一些情形下，使用者可以优选地不扩张近端第二段108。
现在参考图3，示出了根据本发明的自加热假体200的另一个优选实施例。自加热假体200类似于前述假体102，其具有被中间段206连接的第一段202和第二段204，该中间段206有助于各段202和204彼此独立地扩张。
不过，自加热假体200被直接连接于电线208、210和212，这些电线208、210和212选择性地提供电流以便增加假体200的温度。更具体地，电线212被连接于第一段202的远端，而电线208被连接于中间段206。当电流流经这些电线212和208时，也会流经第一段202，从而增加其温度。这样，假体本身用作加热元件，类似于前述的加热器线圈。如同前述假体102那样，当第一段202经过As温度时开始扩张直到到达AF温度。
此外，电线210被连接于第二段204的近端，这允许电流选择性地在电线210和208之间流动、流经第二段204。因此，第二段204的温度类似地升高，最终导致其进入张开的奥氏体状态。这样，使用者可以通过使得电流流经电线212和208或电线210和208来控制段202或204中哪段升温并因而扩张。
在段202和204均已扩张后，电线208、210和212与假体200断开连接。例如，这些电线208、210和212可以具有热敏连接，当被加热到预定温度时该热敏连接断开。可替换地，电线208、210和212可以具有允许使用者选择性断开连接并移除的钩或闩锁机构。
虽然电流被优选地用于产生热并因而扩张根据本发明的假体，不过也可以使用其他能量形式。例如，可以使用RF电流。在另一个示例中，热的液体可以被传输到假体。在又一实施例中，可以使用生热的化学反应。
应该理解的是，包括前述优选实施例的本发明可以被用于患者体内的各种治疗、技术和程序。
图5示出了用于动脉瘤152的一个这样的示例性治疗，其中假体102被置于脉管150内的动脉瘤152的开口之上。一旦就位，则(例如单独使用假体102或使用组织促长剂)促进内皮细胞的组织增长，这最终导致了闭合动脉瘤152的组织层。
图6示出了类似示例，其中使用假体线圈160和假体102来处理动脉瘤152。更具体地，假体线圈160被传输到动脉瘤152内，而假体102被传输到动脉瘤152的开口之上从而防止假体线圈160运动到脉管150内。在前述并入的美国公开号2006/0052815中可以找到关于假体线圈使用的附加细节。
根据本发明的优选实施例包括一种在体内扩张假体的方法，其包括：提供包括形状记忆材料的假体；将假体传输至体内的所需部位；将假体温度升高到人体体温以上从而改变形状记忆材料的相，从而将假体扩张到张开状态；将假体的温度降低到人体体温同时维持张开状态。
在这个优选实施例的进一步示例中，扩张假体进一步包括扩张假体的直径。
在这个优选实施例的进一步示例中，升高温度还包括将形状记忆材料的相从马氏体状态转变为奥氏体状态。
在这个优选实施例的进一步示例中，将假体扩张到张开状态还包括：扩张假体的第一区段；以及扩张假体的第二区段。
在这个优选实施例的进一步示例中，扩张假体还包括邻近假体生热。
在这个优选实施例的进一步示例中，扩张假体还包括使用假体生热。
在这个优选实施例的进一步示例中，将假体传输至体内所需部位还包括：定位动脉瘤；以及将假体放置在假体的开口之上。
在这个优选实施例的进一步示例中，在提供包括形状记忆材料的假体之后，在动脉瘤内传输假体线圈。
根据本发明的另一个优选实施例包括用于在人体体内展开的假体，其包括在第一相时具有第一预定形状且在第二相时具有第二预定形状的假体主体；其中在高于人体体温的温度发生从所述第一相到所述第二相的转变，并且在低于人体体温的温度发生从所述第二相到所述第一相的转变。
在这个优选实施例的进一步示例中，假体主体包括形状记忆材料。
在这个优选实施例的进一步示例中，第一相是奥氏体状态，且第二相是马氏体状态。
在这个优选实施例的进一步示例中，假体包括高于37℃的有效奥氏体开始温度和有效奥氏体完成温度。
在这个优选实施例的进一步示例中，有效奥氏体完成温度在大约40℃至大约55℃的范围内。
在这个优选实施例的进一步示例中，假体主体还包括第一区段和第二区段，其中第一区段相对于第二区段可独立地扩张。
在这个优选实施例的进一步示例中，假体包括具有内部直径的管状形状；在第一预定形状期间该直径具有第一长度，且在第二预定形状期间该直径具有增加的第二长度。
根据本发明的另一个优选实施例包括假体传输系统，其包括被成形成以进入体内的传输工具；以及可移除地置于传输工具上的假体；假体包括第一形状记忆构造和第二形状记忆构造；假体在高于大约37℃的温度从第一形状记忆构造转变到第二形状记忆构造；其中传输工具选择性地加热体内的假体。
这个优选实施例的进一步示例包括被置于传输工具上的至少一个加热元件。
在这个优选实施例的进一步示例中，传输工具选择性地将电流传输到假体。
在这个优选实施例的进一步示例中，假体进一步包括多个可独立扩张的区域，并且其中传输工具进一步包括多个可单个启动的加热器。
在这个优选实施例的进一步示例中，所述多个可独立扩张的区域中的每一个被置于所述多个可单个启动的加热器中的相应加热器之上。
在本发明的优选实施例的另一个示例中，假体是管状的。更具体地，假体材料由激光切割管制成或者是由编织纤维或构件形成的管。
虽然已经以具体实施例和应用的方式描述了本发明，不过根据这个教导，本领域的普通技术人员可以在不脱离要求保护的发明的精神或不超出要求保护的发明范围的情况下得出附加实施例和改型。因此，可以理解的是这里通过示例方式提供的附图和说明是用于帮助理解本发明的，而不应被看作限制了本发明的范围。

Claims (19)

1.一种在体内扩张假体的方法，包括：
提供包括形状记忆材料的假体；
传输所述假体至体内的所需部位；
升高所述假体的温度至人体体温以上以改变所述形状记忆材料的相，从而扩张所述假体至张开状态；
将所述假体的所述温度降低到所述人体体温，同时维持所述张开状态。
2.根据权利要求1所述的方法，其中所述扩张所述假体进一步包括扩张所述假体的直径。
3.根据权利要求1所述的方法，其中所述升高温度进一步包括将所述形状记忆材料的相从马氏体状态改变到奥氏体状态。
4.根据权利要求1所述的方法，其中所述扩张所述假体至张开状态进一步包括：扩张所述假体的第一区段；以及扩张所述假体的第二区段。
5.根据权利要求1所述的方法，其中所述扩张所述假体进一步包括邻近所述假体生热。
6.根据权利要求1所述的方法，其中所述扩张所述假体进一步包括使用所述假体生热。
7.根据权利要求1所述的方法，其中所述传输所述假体至体内的所需部位进一步包括：
定位动脉瘤；以及
将所述假体置于所述动脉瘤的开口之上。
8.根据权利要求1所述的方法，其中在所述提供包括形状记忆材料的假体之后，在所述动脉瘤内传输假体线圈。
9.一种用于在人体体内展开的假体，包括：
假体主体，该假体主体在第一相时具有第一预定形状且在第二相时具有第二预定形状；
其中在高于人体体温的温度发生从所述第一相到所述第二相的转变；并且
其中在低于所述人体体温的温度发生从所述第二相到所述第一相的转变。
10.根据权利要求9所述的假体，其中所述假体主体包括形状记忆材料。
11.根据权利要求9所述的假体，其中所述第一相是奥氏体状态并且所述第二相是马氏体状态。
12.根据权利要求9所述的假体，其中所述假体进一步包括高于37℃的有效奥氏体开始温度和有效奥氏体完成温度。
13.根据权利要求12所述的假体，其中所述有效奥氏体完成温度在大约40℃至大约55℃的范围内。
14.根据权利要求9所述的假体，其中所述假体主体进一步包括第一区段和第二区段，其中所述第一区段相对于所述第二区段能独立地扩张。
15.根据权利要求14所述的假体，其中所述假体进一步包括具有内部直径的管状形状；在所述第一预定形状期间所述直径具有第一长度，在所述第二预定形状期间所述直径具有增加的第二长度。
16.一种假体传输系统，包括：
传输工具，该传输工具被成形为进入体内；以及
可移除地置于所述传输工具上的假体；
所述假体包括第一形状记忆构造和第二形状记忆构造；所述假体在高于大约37℃的温度从所述第一形状记忆构造转变到所述第二形状记忆构造；
其中所述传输工具选择性地加热所述体内的所述假体。
17.根据权利要求16所述的假体传输系统，进一步包括被置于所述传输工具上的至少一个加热元件。
18.根据权利要求16所述的假体传输系统，其中所述假体进一步包括多个能独立扩张的区域，其中所述传输工具进一步包括多个能单个启动的加热器。
19.根据权利要求18所述的假体输送系统，其中所述多个能独立扩张的区域中的每个区域被置于所述多个能单个启动的加热器中的相应加热器之上。
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