CN103349579A - Application of novel slide buckle bio-absorbable stent - Google Patents

Application of novel slide buckle bio-absorbable stent Download PDF

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Publication number
CN103349579A
CN103349579A CN2013102627395A CN201310262739A CN103349579A CN 103349579 A CN103349579 A CN 103349579A CN 2013102627395 A CN2013102627395 A CN 2013102627395A CN 201310262739 A CN201310262739 A CN 201310262739A CN 103349579 A CN103349579 A CN 103349579A
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China
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support
stent
pdo
slide fastener
rack body
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孙锟
孙康
冯其茂
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XinHua Hospital Affiliated To Shanghai JiaoTong University School of Medicine
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XinHua Hospital Affiliated To Shanghai JiaoTong University School of Medicine
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Abstract

The invention relates to an application of a novel slide buckle bio-absorbable stent in manufacture of a cardiovascular system or a lumen stent for cardiovascular or luminal stenosis diseases. The application has the advantages as follows: the novel slide buckle bio-absorbable stent has good degradability and biocompatibility and is applicable to pediatric intravascular stents, and late stent thrombosis cannot occur after implantation, so that antiplatelet drugs are not required to be taken for a long time, and possible subsequent surgical operations cannot be affected; the support force is high, the novel slide buckle bio-absorbable stent can be taken as a cardiovascular system stent or a lumen stent and can be widely applied in the cardiovascular or luminal stenosis diseases; the manufacture is simple and convenient, medicine carrying is facilitated, and the stent can be used as a drug or gene therapy carrier; the stent is equipped with a delivery system at the same time, and the operation difficulty is reduced; and a large number of animal experiments show that the novel slide buckle bio-absorbable stent has a higher success rate during the usage, the curative effect is remarkable, and the stent has a better clinical application prospect.

Description

A kind of application of Novel bioresorbable slide fastener scaffold
The application is November 12 2010 applying date, application number 201010543488.4, and invention and created name is divided an application for " a kind of Novel bioresorbable slide fastener scaffold and application thereof ".
Technical field
The present invention relates to a kind of medical apparatus and instruments, specifically, is a kind of application of Novel bioresorbable slide fastener scaffold.
Background technology
Congenital heart disease (hereinafter to be referred as congenital heart disease) is modal cardiovascular disease in children's's period, sickness rate is life birth baby's 0.678%, in the Congenital heart disease in infants with congenital pulmonary artery and pulmonary venous stenosis, the narrow 7%-15% that accounts for all congenital heart diseases of vena systemica and aorta and branch thereof, and acquired surgical postoperative right ventricle-pulmonary artery artificial nest (RV-PA pipeline) is narrow, pulmonary artery and pulmonary vein postoperative restenosis, the patient's such as narrow of the restenosis of vena systemica and aorta and branch thereof and Fontan passage quantity is along with the increase of congenital heart disease operation ability will continue to rise.
The diseases such as stenosis of pulmonary artery, PBS and coarctation of aorta of or surgical postoperative congenital for infant, percutaneous balloon angioplasty and intravascular stent implantation all are safe interventional therapy methods, but the former complication rate is higher, particularly at young infant, so implanting, support is considered to select preferably.But in view of the special physiological characteristics of infant, desirable department of pediatrics intravascular stent requires and should have: safety, effectiveness, degradability, initial diameter is little and transmission property.Stent safety refers to possess good blood compatibility (unlikely thrombosis, haemolysis etc.), histocompatibility (high-purity, nontoxic, non-stimulated, not carcinogenic, without mutagenicity, no antigen).Secondly, the support effectiveness refers to that support plays a supportive role to blood vessel, and enough radial strengths should be arranged.Because the infant blood vessel is in growth and development stage, requires support to have degradability, is beneficial to the blood vessel further growth and grows.The infant blood vessel is less simultaneously, requires the support initial diameter little; Transmission property and radiopacity make support be easy to be sent to the stenotic lesion place.
The supporting role of playing in early days after support is implanted blood vessel wall prevents retraction, and along with the endothelialization of support and the reconstruct of later stage blood vessel wall, in fact support only need play the temporary supporting effect.The intravascular stent of commonly using at present etc. is metal knitted forming.Size fixingly can not change with angiogenic growth after but metal rack was implanted, the later stage easily causes with blood vessel size does not mate and causes artificial narrowly, especially is not suitable for having the child's of growth feature department of pediatrics intravascular stent.
Also there is following defective in metal rack: (1) easily needs long-term Antiplatelet therapy to thrombosis; (2) be stranded in all the life in the human body, affect follow-up possible surgical operation therapy; (3) pseudo-shadow appears when nuclear magnetic resonance, NMR and CT inspection; The geometric configuration that (4) may change blood vessel stops up branch; (5) subsequent reconstruction and the expansion of obstruction tube chamber; (6) metal rack is such as residual small gap after often occurring implanting with not driving fit of tube wall.Therefore, if develop the similar and Biodegradable scaffold that after its mission is finished, can absorb fully of a kind of performance and metal rack, can overcome the above weakness of metal rack, will open up the new world for the intervention of congenital heart disease.
The application of biological absorbable support in cardiovascular disease begins one's study both at home and abroad, for the used material of biological absorbable support, at present research is mainly Poly-L-lactic acid, also has and gathers oxygen Ketohexamethylene and polycaprolactone, and these materials can implant by the U.S. FDA approval.Design at biological absorbable support has Igaki-Tamai support, REVA support and four impeller structure supports, the common feature of these supports is for being a complete column type before expansion, but all have problems, namely the standoff support force of institute is not enough, the rack elasticity retraction easily occurs, the complicate fabrication process of support, cost is higher, and be subject to the restriction of support force etc., can not be widely used in other luminal stenosis diseases except blood vessel.
China Patent Publication No. CN 101484195A, a kind of " compound rest " disclosed, this disclosure of the Invention multilamellar or the compound rest of a kind of biodegradable or biological absorbable, described support comprises the biological absorbable ceramic material that coats with the biodegradable polymeric material.But strong and make Novel bioresorbable slide fastener scaffold easy to use about support force, and the application in cardiovascular or luminal stenosis disease yet there are no report as cardiovascular system support or intraluminal stent.
Summary of the invention
The objective of the invention is provides a kind of purposes of Novel bioresorbable slide fastener scaffold for deficiency of the prior art.
Again one purpose of the present invention is that a kind of pair of button-type support is provided.
For achieving the above object, the technical scheme taked of the present invention is:
A kind of Novel bioresorbable slide fastener scaffold is being made for cardiovascular or the cardiovascular system support of luminal stenosis disease or the application of intraluminal stent, and described bioresorbable slide fastener scaffold comprises:
Flat rack body, described rack body has mesh-structured;
Be positioned at the support head of described rack body one end, described support head and rack body are integrally formed, and its size adapts with described rack body, and described support head plays the slide fastener effect in the curly course of described support; With
Bracket buckle, described bracket buckle are also integrally formed with described rack body, are used at the curly course of described support support being fixed into the bracket buckle of tubulose;
Described bioresorbable slide fastener scaffold material is PPDO (PDO), polylactic acid (PLA), PC (PCL), polyglycolic acid (PGA) or poly butyric (PHB) high molecular polymer.
The narrow disease of described cardiovascular system refers to that coronary stricture, carotid artery stenosis, renal artery stenosis, pulmonary artery and branch thereof are narrow, the narrow or body pulmonary venous stenosis of aorta and branch thereof.
Described luminal stenosis disease refers to trachea, esophagus, biliary tract, urethra or bowel narrow disease.
Described timbering material is PPDO (PDO).
Described support also comprises delivery apparatus, and described delivery apparatus comprises:
Trocar sheath, it has the inner chamber that extends between a near-end, a far-end and two ends; With
Interior sheath pipe, it has the inner chamber that extends between a near-end, a far-end and two ends, and the external diameter of described interior sheath pipe is suitable for being slidably inserted in the tube chamber of described trocar sheath; With
Foley's tube, it has the inner chamber that extends between a near-end, a far-end and two ends, the external diameter of described foley's tube is suitable for being slidably inserted in the tube chamber of described interior sheath pipe, the far-end of foley's tube has sacculus, laminar integrated slide fastener support can be arranged on the described sacculus, through catheter delivery in Stenosis.
For realizing above-mentioned second purpose, the technical scheme that the present invention takes is: a kind of novel pair of button-type biological absorbable support comprises:
Flat rack body, described rack body has mesh-structured;
Be positioned at the support head of described rack body one end, described support head and rack body are integrally formed, and its size adapts with described rack body, and described support head plays the slide fastener effect in the curly course of described support; With
Bracket buckle, described bracket buckle are also integrally formed with described rack body, comprise the button of the support head of the toothing that is positioned at the rack body both sides and support head, are used at the curly course of described support support being fixed into the bracket buckle of tubulose;
Described bioresorbable slide fastener scaffold material is PPDO (PDO), polylactic acid (PLA), PPDO (PDO), PC (PCL), polyglycolic acid (PGA) or poly butyric (PHB) high molecular polymer.
Described support also comprises delivery apparatus, and described delivery apparatus comprises:
Trocar sheath, it has the inner chamber that extends between a near-end, a far-end and two ends; With
Interior sheath pipe, it has the inner chamber that extends between a near-end, a far-end and two ends, and the external diameter of described interior sheath pipe is suitable for being slidably inserted in the tube chamber of described trocar sheath; With
Foley's tube, it has the inner chamber that extends between a near-end, a far-end and two ends, the external diameter of described foley's tube is suitable for being slidably inserted in the tube chamber of described interior sheath pipe, the far-end of foley's tube has sacculus, laminar integrated slide fastener support can be arranged on the described sacculus, through catheter delivery in Stenosis.
Described timbering material is PPDO (PDO).
The invention has the advantages that:
1, Novel bioresorbable slide fastener scaffold has good degradability and biocompatibility, more be applicable to the department of pediatrics intravascular stent, late thrombus in stents can not appear after the implantation, thus needn't the long-term taking antiplatelet drug, can not affect follow-up possible surgical operation yet;
2, support force is strong, can extensive use in cardiovascular or luminal stenosis disease as cardiovascular system support or intraluminal stent;
3, simple for production, make things convenient for medicine carrying, can be used as the carrier (gene stent) of medicine (drug stent) or gene therapy;
4, support is furnished with delivery system simultaneously, has reduced the operation technique difficulty;
5, prove that through a large amount of zooperies Novel bioresorbable slide fastener scaffold has higher success rate when using, and is evident in efficacy, has preferably potential applicability in clinical practice.
Description of drawings
Accompanying drawing 1 is the sketch map of the snap-type support of a kind of Novel bioresorbable slide fastener scaffold of the present invention.
Accompanying drawing 2 is sketch maps of the edge sliding buckle type support of a kind of Novel bioresorbable slide fastener scaffold of the present invention.
Accompanying drawing 3 is sketch maps of the middle sliding buckle type support of a kind of Novel bioresorbable slide fastener scaffold of the present invention.
Accompanying drawing 4 is sketch maps of two button-type supports of a kind of Novel bioresorbable slide fastener scaffold of the present invention.
Accompanying drawing 5 is sketch maps of the delivery system of a kind of Novel bioresorbable slide fastener scaffold of the present invention.
The specific embodiment
Below in conjunction with accompanying drawing the specific embodiment provided by the invention is elaborated.
The Reference numeral and the ingredient that relate in the accompanying drawing are as follows:
1. rack body 2. support heads
11. mesh 12. teeth
21. housing 22. bracket buckles
23. buckle structure 3. trocar sheaths
4. interior sheath pipe 5. foley's tubes
31. Y type adapter 41. Y type adapters
51. sacculus 52. bullets
Structural design and the comparison of embodiment 1 biological absorbable support
According to the performance of present clinically intravascular stent structure and bioabsorbable material, adopt the PDO design of material to go out the support of three kinds of structures.
(1) self-inflated webmaster support: utilize a rustless steel cylindrical die to obtain the webmaster support.The diameter of mould is consistent with the diameter of required support, makes a call to equably a circle hole on the circumference of both mold ends, inserts draw point, and the quantity of draw point is consistent up and down, and mutually alignment.The PDO fiber is back and forth braiding winding on mould, should be noted that the braiding order, just can directly knit out cylinder interlaced between a fiber and the fiber, mutual restriction, (90 ℃ of then thermal finalizations, 4 hours) make it to keep this shape, count and fiber angle can arbitrarily be regulated.
(2) self-inflated Zigzag support: utilize the macromolecular fibre heat setting method to obtain the Zigzag support.On the thick steel plate of 3mm, the method eyeletting with the line cutting inserts draw point again, utilize draw point fixedly the PDO fiber become the shape of sine wave, then transfer in suitable typing condition and put, possess shape memory effect thereby make fiber have the Zigzag shape.Require again some fibers to be bondd according to stent diameter, obtained support cylindraceous.
(3) sliding buckle type support: adopting three-dimensional micro-injection free forming technology to make the sliding buckle type support with the PDO pellet, is one laminar before support is implanted, and profile comprises mesh-structured support body, plays support head and the bracket buckle composition of slide fastener effect.Support is curled on the sacculus, and an end inserts the snap close (being similar to " belt fastener ") of other end particular design, forms cylindric support, support enlarges along with the expansion of sacculus, sacculus is removed after-poppet and is fastened immediately, can not inwardly slide again, keeps supporting role.Simultaneously can labelling, all loading one radiopaque metal marker in the middle of the network structure of sliding buckle type support under x-ray for support.
Different according to the residing position of slide fastener, the sliding buckle type support is divided into snap-type, edge sliding buckle type, middle sliding buckle type and four kinds of shapes of two button-type.
1. snap-type: as shown in Figure 1, shown the biological absorbable slide fastener support of one embodiment of the present invention.This support comprises: the rack body of flat 1 and be positioned at the support head 2 of body one end, and support head 2 comprises bracket buckle 22 and housing 21, the rack body several rows of mesh 11 that distributing on partly, each mesh 11 size can be identical or different.In an embodiment of the invention, each mesh 11 size is equally distributed, and for example, mesh 11 sizes are 0.5-3mm.Mesh 11 can be any shape, comprises circle, ellipse, square, rectangle, triangle, polygon etc.In an embodiment of the invention, mesh 11 is circular.Bracket buckle 22 is positioned near the support head 2, comprises 2-4 outstanding button, and the button of these projections consists of slide fastener device of the present invention with housing 21.The button that also can have more projections, this depends primarily on the size of required support and required application.The length of the button of projection is 0.5-1mm, and is angled with respect to the support plane, is generally the 20-40 degree.But it will be understood by those skilled in the art that it also can is any other angle.The size of housing 21 and rack body 1 size adapt, thereby guarantee that in the support curly course inner projection button can strictly slide along the sheet length direction, avoids misplacing.The button of described projection can be inserted into arbitrarily in the process of sliding in the middle of any row's mesh 11, and makes thin slice can fixedly become tubulose.
2. edge sliding buckle type: as shown in Figure 2, shown the biological absorbable slide fastener support of another embodiment of the present invention.This support comprises the rack body 1 and the support head 2 that is positioned at body one end of flat, and support head 2 comprises a housing 21, and its size adapts with rack body 1, and there are several teeth 12 rack body 1 both sides.Support comprises the longitudinal axis Z that is parallel to 2 extensions of support head and the transversal line X that extends perpendicular to support head 2, as shown in Figure 2.The several rows of mesh 11 that distributing on rack body 1 part, each mesh size can be identical or different.In an embodiment of the invention, each mesh 11 size is equally distributed, and for example, mesh 11 sizes are 0.5-3mm.Mesh 11 can be any shape, comprises circle, ellipse, square, rectangle, triangle, polygon etc.In an embodiment of the invention, mesh 11 is circular.In accompanying drawing 2 illustrated embodiment, bracket buckle shows as the tooth 12 of rack body 1 both sides, can pass described housing 21 at rack body 1 described in the support curly course, and tooth 12 structures on both sides can be slided along the two edges of described housing 21.In the process of sliding, described tooth 12 fastens described housing 21, and makes thin slice can fixedly become tubulose.In one embodiment, the size of tooth 12 is 0.1mm.All teeth 12 are dorsad support head extension all, and are angled with respect to the support transversal line, for example the 30-60 degree.In an embodiment of the invention, tooth 12 becomes 30 degree angles with respect to the support transversal line.
3. sliding buckle type in the middle of: as shown in Figure 3, shown the biological absorbable slide fastener support of the another embodiment of the present invention.This support comprises the rack body 1 of flat and is positioned at the support head 2 of body one end, support head 2 comprises a buckle structure 23 in the middle of a housing 21 and the housing, buckle structure 23 two ends all are connected with housing 21, comprise the tooth 12 corresponding with buckle structure 23 in the rack body 1, these teeth 12 extend back on support head 2.As shown in Figure 3, support comprises the longitudinal axis Z that is parallel to 2 extensions of support head and the transversal line X that extends perpendicular to support head 2.The several rows of mesh 11 that distributing on rack body 1 part, each mesh 11 size can be identical or different.In an embodiment of the invention, each mesh 11 size is equally distributed, and for example, mesh 11 sizes are 0.5-3mm.Mesh 11 can be any shape, comprises circle, ellipse, square, rectangle, triangle, polygon etc.In an embodiment of the invention, mesh 11 is circular.In one embodiment, the length 0.5-1mm of the buckle structure 23 in the support head 2.In one embodiment, the size of the tooth 12 on the rack body 1 is 0.1mm.Described tooth 12 is angled with respect to the support transversal line, for example becomes 30-60 degree angle.In an embodiment of the invention, tooth 12 becomes 30 degree angles with respect to the support transversal line.In the support curly course, slide in the both sides of the buckle structure 23 of described tooth 12 structures in the support head housing 21, and in the process of sliding, described tooth 12 fastens the buckle structure 23 in the described housing 21, and makes thin slice can fixedly become tubulose.
4. two button-types: as described in accompanying drawing 4, shown the two button-type supports of biological absorbable of one embodiment of the present invention.This support comprises: the rack body 1 of flat and the support head 2 that is positioned at body one end, support head 2 comprises bracket buckle 22 and housing 21, the several rows of mesh 11 that distributing on rack body 1 part, each mesh 11 size can be identical or different, and there are several teeth 12 rack body 1 both sides.Bracket buckle 22 is positioned near the support head 2, comprises 2-4 outstanding button, and button and the tooth on the rack body 12 of these projections consist of slide fastener device of the present invention with housing 21.The button that also can have more projections, this depends primarily on the size of required support and required application.The length of the button of projection is 0.5-1mm, and is angled with respect to the support plane, is generally the 20-40 degree.But it will be understood by those skilled in the art that it also can is any other angle.The size of housing 21 and rack body 1 size adapt, thereby guarantee that in the support curly course inner projection button can strictly slide along the sheet length direction, avoids misplacing.The button of described projection can be inserted into arbitrarily in the process of sliding in the middle of any row's mesh 11, and makes thin slice can fixedly become tubulose.The tooth 12 of rack body 1 both sides can pass described housing 21 at rack body 1 described in the support curly course, and tooth 12 structures on both sides can be slided along the two edges of described housing 21.In the process of sliding, described tooth 12 fastens described housing 21, and makes thin slice can fixedly become tubulose.In one embodiment, the size of tooth 12 is 0.1mm.All teeth 12 are dorsad support head extension all, and X is angled with respect to the support transversal line, for example the 30-60 degree.In an embodiment of the invention, tooth 12 becomes 30 degree angles with respect to the support transversal line.The existing buckle of two button-type supports has again the edge slide fastener, in use makes support have more support force, can ensure that again support fastens.
In Fig. 2, Fig. 3 and embodiment shown in Figure 4, because all teeth 12 all in the same direction, namely can not bounce back after support fastens again.In the process of sending in body, support is tightly rolled and is attached on the delivery apparatus sacculus, arrives after the appointed part, balloon expandable makes support slip enlarged-diameter, the resorption sacculus fastens immediately owing to be subject to the pressure arm of blood vessel wall, and blood vessel wall is played a supportive role.
1. support mechanics performance determining
Each 10 in the support sample of selection different structure, different-thickness, different-diameter, content measurement comprises: radial strength, rack surface coverage rate, the axial shrinkage factor of support, support spreading rate.
The support mechanical experimental results sees Table 1.Self-inflated webmaster support and Zigzag support radial strength all can not satisfy clinical demand (generally needs 80-120Kpa), so be not suitable for use in experiment.All on 80Kpa, edge sliding buckle type support has reached the metal rack radial strength to the radial strength of four kinds of balloon expandable formula sliding buckle type supports; The slide fastener support is all shaftless to shrinkage factor simultaneously, is better than metal rack (5%); But spreading rate (29%) is slightly poorer than metal rack (25%); Surface coverage is apparently higher than metal rack (20%).
Table 1 thickness 0.3mm different structure support mechanical experimental results
? n Diameter (mm) Length (mm) Radial strength (Kpa) Surface coverage (%) Axial shrinkage rate (%) Spreading rate (%)
Stainless steel stent 5 8 20 135±5.80 21±2.00 5±1.20 22±3.00
The Zigzag support 10 8 20 22.5±3.70 26±3.00 2±0.30 20±2.00
The webmaster support 10 8 20 32±4.30 30±3.00 3±0.50 25±3.00
Buckle-type 10 8 20 110.8±16.90 24±3.00 0 30±3.00
Middle slide fastener type 10 8 20 125.1±15.70 39±4.00 0 29±2.00
The edge slide fastener type 10 8 20 139.6±15.50 40±4.00 0 29.5±2.00
Double-hook 10 8 20 135.5±15.50 31±4.00 0 30±3.00
The PDO edge slide fastener support radial strength of different-thickness, different-diameter the results are shown in Table 2.The result shows: the support of same thickness, and along with the expansion of diameter, its radial strength reduces gradually; The support of same diameter is along with the increase of thickness simultaneously, and its radial strength also increases gradually; 0.20mm thickness namely can satisfy the radial strength requirement of the support of 4-8mm diameter.
Table 2 different-thickness, different-diameter PDO edge slide fastener support radial strength (Kpa)
Figure 2013102627395100002DEST_PATH_IMAGE001
2. in-vitro simulated
1. selecting simulated person's hemopoietic pipe diameter is 6mm, and the ratio of support and blood vessel is 1.3:1.With compression pump the sacculus of delivery system is inhaled into negative pressure first, recession epitheca pipe, with four kinds of slide fastener supports curling being wound on the delivery system sacculus respectively, push forward again the epitheca pipe to bullet to encase support, delivery system is inserted in the flexible pipe, and 10atm*30 expands releasing bracket second.
2. observation index:
Acute elastic relaxation shrinkage: support acute elastic relaxation shrinkage=(diameter when diameter-sacculus was removed after-poppet diameter/support and fully expanded when support was fully expanded) * 100%.
Successfully fasten rate: the evaluation criterion that successfully fastens rate is: success: remove sacculus after-poppet button and block immediately, blood vessel is played a supportive role; Failure: remove the sacculus after-poppet and do not fasten, the support head end is curling inwardly, fails support blood vessels.
Four kinds of different sliding buckle type supports are in-vitro simulated to the results are shown in Table 3.Middle sliding buckle type, edge sliding buckle type and two button-type support all can successfully fasten, and blood vessel wall is played a supportive role; But snap-type has an example failure.Four kinds of sliding buckle type supports all have minimum acute elastic relaxation shrinkage (0.40 ± 0.10%).
Four kinds of in-vitro simulated results of sliding buckle type support of table 3
? n Release pressure (atm) Fasten rate (%) Acute elastic relaxation shrinkage (%)
Snap-type 10 8±2.00 90 0.50±0.10
Middle sliding buckle type 10 10±2.00 100 0.40±0.10
The edge sliding buckle type 10 10±2.00 100 0.30±0.05
Two button-types 10 10±2.00 100 0.2510±0.05
3. sum up
Confirm that by the various support Mechanics Performance Testings to the PDO material self-inflated webmaster support and self-inflated Zigzag support radial strength can not reach requirement, and four kinds of slide fastener support radial strengths all can satisfy clinical demand; Edge sliding buckle type and middle sliding buckle type support be fastening of energy success all, proves that design is feasible; Four kinds of slide fastener supports have low elastical retraction rate, do not have axial shortening rate and the good advantages such as spike; But radial strength is based upon on the slightly large surface coverage preferably, and the dilatancy of slide fastener support is a little less than metal rack simultaneously.
The in-vitro simulated release conditions of 2 four kinds of PDO sliding buckle types of embodiment support
(1) observes the in-vitro simulated release conditions of PPDO (PDO) snap-type support
One, materials and methods:
Material: each 10 of PPDO (PDO) snap-type support 20*8mm, diameter 6cm band tubing, stent delivery system and compression pump.
Method:
1, with compression pump the sacculus of delivery system is inhaled into negative pressure first, recession epitheca pipe, with slide fastener support curling being wound on the delivery system sacculus respectively, push forward again the epitheca pipe to bullet to encase support.
2, along seal wire stent delivery system is inserted into the artificial blood vessel target site, 12atm*30 expands releasing bracket second.
3, the resorption sacculus becomes negative pressure, the recession sacculus.
Two, observation index:
1, lumen of vessels diameter: after sacculus is removed, measurement bracket place Endovascular diameter.
2, acute elastic relaxation shrinkage:
Support acute elastic relaxation shrinkage=(diameter-sacculus was removed the after-poppet diameter when support was fully expanded)/diameter when support is fully expanded.
3, successfully fasten rate:
Evaluation criterion: success: remove sacculus after-poppet button and block immediately; Failure: remove the sacculus after-poppet and do not fasten, in tube chamber, slide.
Three, result:
PDO snap-type support all can discharge (10-14atm) under conventional release pressure, support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (0.5%).Prove this support Design operation feasible.
The result of table 4:PDO snap-type support
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
Snap-type 10 12±2 7.79±0.2 0.5±0.1 100
(2) observe the in-vitro simulated release conditions of PPDO (PDO) edge sliding buckle type support
One, materials and methods:
Material: each 10 of PPDO (PDO) edge sliding buckle type support 20*8mm, diameter 6cm band tubing, stent delivery system and compression pump.
Method: (referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Two, observation index:
(referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Three, result:
PDO edge sliding buckle type support all can discharge (10-14atm) under conventional release pressure, support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (0.3%).Prove this support Design operation feasible.
The result of table 5:PDO edge sliding buckle type support
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
The edge sliding buckle type 10 12±2 7.82±0.2 0.3±0.1 100
(3) observe the in-vitro simulated release conditions of the middle sliding buckle type support of PPDO (PDO)
One, materials and methods:
Material: each 10 of sliding buckle type type support 20*8mm, diameter 6cm band tubing, stent delivery system and compression pump in the middle of the PPDO (PDO).
Method: (referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Two, observation index:
(referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Three, result:
The sliding buckle type support all can discharge (10-16atm) under conventional release pressure in the middle of the PDO, and support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (0.43%).Prove this support Design operation feasible.
The result of sliding buckle type support in the middle of the table 6:PDO
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
Middle sliding buckle type 10 13±3 7.83±0.2 0.43±0.1 100
(4) observe the in-vitro simulated release conditions of the two button-type supports of PPDO (PDO)
One, materials and methods:
Material: each 10 of the two button-type support of PPDO (PDO) 20*8mm, diameter 6cm band tubing, stent delivery system and compression pump.
Method: (referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Two, observation index:
(referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Three, result:
The two button-type supports of PDO all can discharge (10-14atm) under conventional release pressure, support all can successfully fasten, and do not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (0.3%).Prove this support Design operation feasible.
The result of the two button-type supports of table 7:PDO
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
Two button-types 10 12±2 7.67±0.3 0.25±0.1 100
(4) sum up
By investigating the in-vitro simulated release conditions of four kinds of PDO sliding buckle type supports, prove that four kinds of PDO sliding buckle type supports all can discharge under conventional release pressure, support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage.Prove this support Design operation feasible.Wherein the button of snap-type support must have certain angle, and guarantee inserts in the mesh and fastens, and the risk that certainly also exists support to fail to fasten needs to improve design.The design of edge sliding buckle type support has remedied the deficiency of snap-type support, and support can be guaranteed to fasten, but the little tooth design on support both sides should be meticulous, can not affect the expansion of support; But the length of support should guarantee that support maximum support power is prerequisite, and weak point is for can't be applicable to long stent.Middle sliding buckle type support has remedied again the deficiency of edge slide fastener support, is similar to two edge slide fastener supports are coupled together, and existing edge slide fastener has again middle slide fastener, is applicable to the support of long pathological changes.The existing buckle of two button-type supports has again the edge slide fastener, in use makes support have more support force, can ensure that again support fastens.
The in-vitro simulated release conditions of the edge sliding buckle type support of 3 five kinds of materials of embodiment
(1) observes the in-vitro simulated release conditions of PPDO (PDO) edge sliding buckle type support
One, materials and methods:
Material: each 10 of PPDO (PDO) edge sliding buckle type support 20*8mm, diameter 6cm band tubing, stent delivery system and compression pump.
Method: (referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Two, observation index:
(referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Three, result:
PDO edge sliding buckle type support all can discharge (10-14atm) under conventional release pressure, support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (0.3%).Prove this support Design operation feasible.
The result of table 8:PDO edge sliding buckle type support
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
The edge sliding buckle type 10 12±2 7.82±0.2 0.3±0.1 100
(2) observe the poly-in-vitro simulated release conditions of own Inner ester (PCL) edge sliding buckle type support
One, materials and methods:
Material: each 10 of poly-own Inner ester (PCL) edge sliding buckle type support 20*8mm, diameter 6cm band tubing, stent delivery system and compression pump.
Method: (referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Two, observation index:
(referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Three, result:
PCL edge sliding buckle type support all can discharge (11-15atm) under conventional release pressure, support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (0.35%).Prove this support Design operation feasible.
The result of table 9:PCL edge sliding buckle type support
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
The edge sliding buckle type 10 13±2 7.82±0.2 0.35±0.1 100
(3) observe the in-vitro simulated release conditions of polyglycolic acid (PGA) edge sliding buckle type support
One, materials and methods:
Material: each 10 of polyglycolic acid (PGA) edge sliding buckle type support 20*8mm, diameter 6cm band tubing, stent delivery system and compression pump.
Method: (referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Two, observation index:
(referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Three, result:
PGA edge sliding buckle type support all can discharge (11-15atm) under conventional release pressure, support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (0.35%).Prove this support Design operation feasible.
The result of table 10:PGA edge sliding buckle type support
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
The edge sliding buckle type 10 13±2 7.82±0.2 0.35±0.1 100
(4) observe the in-vitro simulated release conditions of poly butyric ester (PHB) edge sliding buckle type support
One, materials and methods:
Material: each 1 of poly butyric ester (PHB) edge sliding buckle type support 20*8mm, diameter 6cm band tubing, stent delivery system and compression pump.
Method: (referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Two, observation index:
(referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Three, result:
PHB edge sliding buckle type support all can discharge (11-15atm) under conventional release pressure, support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (0.35%).Prove this support Design operation feasible.
The result of table 11:PHB edge sliding buckle type support
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
The edge sliding buckle type 10 13±2 7.82±0.2 0.35±0.1 100
(5) observe the in-vitro simulated release conditions of Poly-L-lactic acid (PLLA) edge sliding buckle type support
One, materials and methods:
Material: each 10 of Poly-L-lactic acid (PLLA) edge sliding buckle type support 20*8mm, diameter 6cm band tubing, stent delivery system and compression pump.
Method: (referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Two, observation index:
(referring to observing the in-vitro simulated release conditions of PPDO (PDO) snap-type support).
Three, result:
PLLA edge sliding buckle type support all can discharge (11-15atm) under conventional release pressure, support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (0.35%).Prove this support Design operation feasible.
The result of table 12:PLLA edge sliding buckle type support
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
The edge sliding buckle type 10 13±2 7.82±0.2 0.35±0.1 100
The in-vitro simulated release conditions of the edge sliding buckle type support of five kinds of materials shows: the edge sliding buckle type support of five kinds of materials all can discharge under conventional release pressure, and support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage.Wherein PDO edge sliding buckle type support has minimum acute elastic relaxation shrinkage (0.3%), is the most optimum materials of making edge sliding buckle type support.
Embodiment 4
China Patent Publication No. CN 101484195A, a kind of " compound rest " disclosed, this disclosure of the Invention multilamellar or the compound rest of a kind of biodegradable or biological absorbable, described support comprises with the biodegradable polymeric material (such as polylactic acid PLA, polylactide and/or polyglycolic acid PGA, PGA and/or PGA PLGA) the biological absorbable ceramic material (such as calcium phosphate, bioactivity glass) that coats.Its weak point is, making material PLA and the PLGA degradation speed of this compound rest are slow, the degradable time surpasses 2 years, and the PGA degradation speed is too fast, and 70%-80% can degrade in 2 weeks, the yielding slip of the support of making, support effect is bad, and relatively poor to the antibacterial resistivity, easily moisture absorption degraded in air, be difficult for preserving, small number of patients can produce non-infectious inflammation etc.; Compound rest is made of a variety of materials, and the support number of plies is more, and manufacturing process is comparatively complicated; The design of compound rest buckle is less, has limited the compound rest amount of crimp, thereby has limited the scope that support uses; The angle of buckle is larger, causes increasing at the resistance of process of expansion medium-height trestle, and release pressure increases, and has increased the risk of complications.This support is that two ends have button simultaneously, middle not button, and middle support force can obviously reduce like this.
The two button-type supports of PDO: this support is made take PPDO (PDO) as material.Its fiber has good physical mechanical strength, chemical stability, biocompatibility and safety, and is biodegradable, is easy to the advantages such as machine-shaping.PDO monofilament structure smooth surface is smoother, has overcome the shortcoming that causes greatly fiber easy damaged tissue in the braiding structure because of surperficial coefficient of friction.The PDO compatibility is good, and tissue reaction is slight, does not have cell effect, by the degraded and absorbed effect, is progressively absorbed fully by body after 180 days, resolves into carbon dioxide and water, excretes, and is safe and reliable.Because in its chain ehter bond is arranged, Chain Flexibility is large, so be suitable for making the monofilament linea suturalis of various sizes.The tissue reaction that PDO causes is little, degrades by hydrolysis in the tissue in vivo, and strength retention ratio is large, and the long wound of healing time is particularly useful for sewing up.Consider to think that PDO is the high molecular polymer that is fit to very much make support from the angle soft, that strength retention ratio is large.
The two button-type supports of PDO adopt three-dimensional micro-injection free forming fabrication techniques, utilize computer-aided design, with pre-designed threedimensional model according to program making out, very accurate, technology is flexible, can change according to different requirements size, the thickness of support and the length of slide fastener etc. of support mesh, and the convenient medicine that loads, processing technology is simple.
The several rows of uniform mesh that distributing above the two button-type support bodies of PDO, big or small 1mm, the support head is a housing, is provided with 2-5 buckle in the housing, and the both sides of stake body are provided with snapper teeth, and the snapper teeth size is 0.1mm, and angle is 30 to spend, dorsad the support heads.The little tooth because the both sides of whole stake body all evenly distribute, so that this support can rationally be regulated amount of crimp according to the implant site diameter in use, the scope of application is wider.The angle of snapper teeth is less, has reduced the resistance at the process of expansion medium-height trestle, and release pressure is slightly little, has reduced the risk of complications.The buckle of support head can insert in the mesh of support in use simultaneously, can ensure that support has stronger and uniform support force.
In addition, the two button-type supports of PDO also are provided with supporting stent delivery system, make operation process more simple and easy.
This delivery apparatus is made of a trocar sheath 3, interior sheath pipe 4 and foley's tube 5, and structure as shown in Figure 4.Trocar sheath 3 has the inner chamber that extends between a near-end, a far-end and two ends.Interior sheath pipe 4 also has the inner chamber that extends between a near-end, a far-end and two ends, and the external diameter of interior sheath pipe 4 is suitable for being slidably inserted in trocar sheath 3 chambeies, and interior sheath pipe 4 is about 4-6cm than trocar sheath 3.Foley's tube 5 also has a near-end, a far-end and inner chamber, and the external diameter of this foley's tube 5 is suitable for being slidably inserted in interior sheath pipe 4 tube chambers.Foley's tube 5 far-ends are a bullet 52 and sacculus 51, and the length of sacculus 51, diameter can be selected according to the requirement of support.Respectively there is a metal marker thing at sacculus 51 two ends, can help the support location.Delivery apparatus also comprises two Y type adapters, and a Y type adapter 41 is placed in interior sheath pipe 4 near-ends, is communicated with its inner chamber; Another Y type adapter 31 is placed in trocar sheath 3 near-ends, is communicated with its inner chamber.The effect of these two Y type adapters is to inject and the required liquid of sucking-off in tube chamber respectively in the delivery process of slide fastener support.By support is curled on the sacculus 51, be fixed between the interior sheath pipe 4 of sacculus 51 far-end cones 52 and near-end, can prevent the support displacement; Rack outer surface is placed among the trocar sheath 3 simultaneously, can prevent the outer expansion of support.To fill standoff delivery apparatus and send to the narrow blood vessel place along seal wire, according to the metal marker thing on the sacculus 51, after accurately locating, recession trocar sheath 3, with sacculus 5 inflatable dilatations, support expands immediately again, is close to the narrow blood vessel inwall.And then interior sheath pipe 4 and trocar sheath 3 withdrawn from together, can finish support and implant.
Embodiment 5 new bio bioabsorbable stent zooperies
One, materials and methods
Material: 2-3 individual month childhood of healthy family pig (about body weight 25-30kg, male and female are not limit) 41 (agricultural college of Shanghai Communications University) after the birth, 45 on PDO edge sliding buckle type support (6 * 20mm, thickness 0.28mm), stent delivery system
Instrument and equipment: operation bag (child medical center, Shanghai); 7F Arterial sheath, compression pump, guiding wire (U.S. Cordis company); Puncture needle, angiography catheter (U.S. Diag company); Measuring cell (S﹠amp; W Medico Tekikls); GE LC/LP type DSA(General Electric Apparatus Co.(U.S.A.)); Electrocardiogram monitor, respirator (Phillip company); Leica microtome, Leica microscope and image analysis system (Leica company); Field emission scanning electron microscope (JEOL Ltd, Japan(JSW-7401F)).
Method:
1. anesthesia: art fasting the previous day, induction of anesthesia is carried out in ketamine 8-10mg/Kg intramuscular injection, atropine 0.02mg/Kg intramuscular injection, the rear venous channel of setting up.Behind the intravenous injection Choline Chloride Succinate 2mg/Kg, animal is given tracheal intubation immediately, respirator assisted ventilation, cardiac monitoring.Fentanyl 2ug/Kg, ketamine 2mg/Kg and Vecuronium Bromide 0.1mg/Kg are interrupted intravenously administrable to be kept.
2. fixing: as by special yoke, animal to be fixed on the cardiac catheter operating board.
3. the general aseptic towel of routine disinfection is separated left carotid artery, inserts the 7F Arterial sheath after the puncture.
4. the angiography catheter that inserts 6F carries out left and right sides angiography of iliac artery, selects implantable intravascular, and requiring stent diameter and blood vessel diameter ratio is 1.20-1.25:1.
5. with compression pump the sacculus of delivery system is inhaled into negative pressure first, recession epitheca pipe, with slide fastener support curling being wound on the delivery system sacculus respectively, push forward again the epitheca pipe to bullet to encase support.Remove 7F sheath pipe, along seal wire stent delivery system is inserted into target site, 12atm*30 expands releasing bracket second.Heparin 200U/Kg in the art, operating time surpasses 1 hour, appends heparin 2000U.
6. the postoperative wound is sewed up and to be sent experiment pig back to the raising center more than hemostasis by compression half an hour after stopping blooding fully and continue to raise.Injection in Cefazolin sodium 50mg/kg/ days 3 days, fraxiparine 5000u once subcutaneous/sky injected 5 days, and bamyl (aspirin) 5mg/kg/ days until be condemned to death.
Two, observation index
1. get involved success rate and complication rate
Get involved success rate: refer to that support successfully expands release at target site, without support come off, other complication such as displacement, vascular tear, massive hemorrhage.
Complication rate: refer to vascular tear that support and delivery system support cause, massive hemorrhage, tremulous pulse perforation, dead etc.
2. follow-up assessment biological absorbable support curative effect
Immediate postoperative, carry out the Stent therapeutic evaluation after 1 month, 3 months, 6 months, rely on the check Angiocardiography and measure stent diameter.
Target vessel diameter after support is implanted: computer measurement mount proximal end, stage casing, far-end measuring results averaged.
Support two ends reference vessel diameter: 0.5cm place reference vessel diameter measurement outside the support blood vessel two ends is averaged for three times, and two ends reference vessel diameter is averaged after the addition again.
3. the biocompatibility of support, degradation rate
Month after operation, 3 months, 6 months are put to death experiment pig, get support two and mid portion and bracket edge tissue and carry out HE dyeing, observe in the support and inflammatory reaction on every side, the growing state of granulation tissue, the endothelial growth situation of rack surface, the degraded situation of support etc.
4. isolated preparation scanning electron microscopic observation and evaluation after support is implanted
Support is taken out preparation specimen, scanning electron microscopic observation support endothelialization degree together with the long vascular tissue of two ends 0.5mm.
Three, result
1. ordinary circumstance
Have 41 pigs, 45 pieces of implant frames have 2 routine postoperatives anesthetic accident to occur, and it is dead to occur the vascular tear massive hemorrhage in the 2 routine arts, have 2 routine supports to fail fully expansion, have to occur the sacculus support that breaks in the routine support dispose procedure and fully discharge.All the other experiment pig post-surgical condition are good, and feed is normal, and the mental status is good.Activity freely, without hemiplegia, without dystropy, without diarrhoea, heating, without having blood in stool, without gross hematuria etc.
2. the Novel slippery buckle support is implanted the data feature
The Novel slippery buckle support is implanted the data feature and is seen Table 13, and it is 88.90% that support is implanted to power, and it is 93.30% that delivery system is sent success rate, and complication rate is 11.10%.
Table 13: the Novel slippery buckle support is implanted the data feature
Variable n(%)
Experiment pig 41
Body weight (Kg) 25.17±1.82
Female 16(39%)
Male 25(61%)
Left iliac artery 41(91.10%)
Right iliac artery 5 (8.90%)
Reference vessel diameter (mm) 4.68±0.17
Release pressure (atm) 16.10±2.20
Get involved success rate 40(88.90%)
Complication rate 2(4%)
The delivery system success rate 42(93.30%)
Get involved mortality 5(11.10%)
3. Novel slippery buckle support curative effect
1. the process of the following up a case by regular visits to vessel lumen vary in diameter that hits after support is implanted: see Table 14
The target vessel lumen diameter changes behind table 14 stenting
? N=9 after implanting A month n=9 Three months n=9 Six months n=9
Blood vessel diameter (mm) 5.92±0.06 5.85±0.04 4.86±0.09*● 4.84±0.11*●
* with after implanting compare P<0.01; ● with one month than P<0.01.
Table 13 show behind the stenting one month with implant after at once, the target vessel lumen diameter is without significant change, P〉0.05, not statistically significant; But three months, six months lumen diameters of postoperative are lost to some extent, and tube chamber reduces to some extent, with implant after at once with postoperative one month P<0.01 relatively, remarkable significant difference is arranged.But postoperative three months and six months lumen diameters are without significant change P〉0.05, not statistically significant.
4. the biocompatibility of support, degraded
1. histocompatibility
Behind the stenting one month: biological absorbable PDO support was covered by endotheliocyte, and it is complete that cradling piece keeps, few degraded; Prop up a small amount of cell infiltration of frame peripheral, inflammatory cell is take lymphocyte, plasma cell and eosinophilic granulocyte as main.Behind the stenting three months: biological absorbable PDO rack surface endotheliocyte was fine and close ripe, the cradling piece structural deterioration, and part is degraded; Still have inflammatory cell to assemble around the cradling piece, inflammatory cell is take lymphocyte, eosinophilic granulocyte as the more foreign body macrophage of main companion.Behind the stenting six months: the cradling piece major part was degraded; Prop up frame peripheral and still have a small amount of inflammatory cell, inflammatory cell is take foreign body macrophage, lymphocyte and plasma cell as main; Along with the degraded and absorbed of cradling piece, inflammatory cell reduces gradually simultaneously, and the support blood vessel reverts to normal blood vessels gradually.
2. cell compatibility
Biodegradable PDO support is implanted pig iliac artery place, and perusal shows: rack surface is visible thin inner membrance covering in the time of 1 month, and support is all covered by new intima in the time of 3 months, and rack surface has level and smooth and glossiness new intima in the time of 6 months.Scanning electron microscope shows: support is by the sparse covering of endotheliocyte in the time of one month, and fine and close covering of endotheliocyte has formed complete inner membrance in the time of 3 months in the time of 6 months, illustrates that this support has preferably cell compatibility.
3. degradability
Postoperative in the time of one month cradling piece still keep complete, few degraded, cradling piece structure destroyed in the time of 3 months, part is degraded, the cradling piece major part is degraded in the time of 6 months; This shows that the PDO support has better degradability.
5. conclusion
Biological absorbable PDO sliding buckle type support is successfully implanted the pig iliac artery by delivery system, and is technical feasible; Support and delivery system have preferably success rate and lower complication rate, design feasible; PDO support in a short time (one month) has preferably curative effect, and mid-term, blood vessel diameter was lost to some extent, be mainly neointimal hyperplasia and cause, but blood vessel still keeps better open-minded; Along with the degraded of support, inflammatory cell is assembled, but along with material is degradable gradually, inflammatory reaction also will fade away; Month endotheliocyte of PDO support covers fully, has preferably cell compatibility; The PDO support is degraded 6 months major parts, has preferably degradability.
The application of embodiment 6 supports in the coronary stenosis disease
1. materials and methods
Material: 4 of 18-20Kg miniature pigs, target coronary blood lumen diameter 2.2 ± 0.2mm, each 4 on PDO edge sliding buckle type support (stent length 20mm* stent diameter 2.5-2.75mm), seal wire, stent delivery system and compression pump.
Method:
1. oral aspirin 0.3g before the art, clopidogrel 75mg, art gave atropine 0.02mg/kg, ketamine 10mg/Kg intramuscular injection anesthesia in front 30 minutes.
2. cut skin after the anesthesia, separate subcutaneous tissue, puncture after the exposure right femoral artery, insert the 6F arterial sheath, give 200 u/kg heparin sodium anticoagulants, the angiography catheter that inserts 6F carries out left and right sides angiography of iliac artery, select implantable intravascular, requiring stent diameter and blood vessel diameter ratio is 1.10-1.20:1;
3. with compression pump the sacculus of delivery system is inhaled into negative pressure first, recession epitheca pipe, with slide fastener support curling being wound on the delivery system sacculus respectively, push forward again the epitheca pipe to bullet to encase support.Remove the sheath pipe, along seal wire stent delivery system is inserted into target site (anterior descending branch stage casing), 10-15atm*15-20 expands releasing bracket second;
4. the resorption sacculus becomes negative pressure, and the recession sacculus is all withdrawn from delivery system along seal wire.
2. observation index
1. postoperative lumen of vessels diameter: after sacculus is removed, measurement bracket place Endovascular diameter.
2. acute elastic relaxation shrinkage: support acute elastic relaxation shrinkage=(diameter-sacculus was removed the after-poppet diameter when support was fully expanded)/diameter when support is fully expanded.
3. successfully fasten rate: evaluation criterion: success: remove sacculus after-poppet button and block immediately; Failure: remove the sacculus after-poppet and do not fasten, sliding to Endovascular.
3. result
1. support curative effect: see Table 15
Table 15: Novel slippery buckle support curative effect
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
The PDO support 4 13±2 2.65±0.2 2±0.5 100
As can be seen from the table, PDO edge sliding buckle type support all can discharge (10-15atm) under conventional release pressure, and support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (2%).Prove this support Design operation feasible.
The application of embodiment 7 supports in periphery angiostenosis disease
1. materials and methods
Material: 2-3 individual month childhood of healthy family pig (about body weight 25-30kg, male and female are not limit) 4 after the birth, target peripheral blood tube chamber diameter 4.5 ± 0.2, two 4 on the button-type supports (stent length 20mm* stent diameter 6mm) of PDO, stent delivery system.
Method:
1. anesthesia: art fasting the previous day, induction of anesthesia is carried out in ketamine 8-10mg/Kg intramuscular injection, atropine 0.02mg/Kg intramuscular injection, the rear venous channel of setting up.Behind the intravenous injection Choline Chloride Succinate 2mg/Kg, animal is given tracheal intubation immediately, respirator assisted ventilation, cardiac monitoring.Fentanyl 2ug/Kg, ketamine 2mg/Kg and Vecuronium Bromide 0.1mg/Kg are interrupted intravenously administrable to be kept.
2. fixing: as by special yoke, animal to be fixed on the cardiac catheter operating board.
3. the general aseptic towel of routine disinfection is separated left carotid artery, inserts the 7F Arterial sheath after the puncture.
4. the angiography catheter that inserts 6F carries out the peripheral blood vessel radiography, selects implantable intravascular, and requiring stent diameter and blood vessel diameter ratio is 1.20-1.25:1.
5. with compression pump the sacculus of delivery system is inhaled into negative pressure first, recession epitheca pipe, with two button-type supports curling being wound on the delivery system sacculus respectively, push forward again the epitheca pipe to bullet to encase support.Remove 7F sheath pipe, along seal wire stent delivery system is inserted into target site, 12atm*30 expands releasing bracket second.Heparin 200U/Kg in the art, operating time surpasses 1 hour, appends heparin 2000U.
6. the resorption sacculus becomes negative pressure, and the recession sacculus is all withdrawn from delivery system along seal wire.
2. observation index
1. postoperative peripheral blood tube chamber diameter: after sacculus is removed, measurement bracket place peripheral blood vessel intracavity diameter.
2. acute elastic relaxation shrinkage: support acute elastic relaxation shrinkage=(diameter-sacculus was removed the after-poppet diameter when support was fully expanded)/diameter when support is fully expanded.
3. successfully fasten rate: evaluation criterion: success: remove sacculus after-poppet button and block immediately; Failure: remove the sacculus after-poppet and do not fasten, sliding to Endovascular.
3. result
1. support curative effect: see Table 16
Table 16: two button-type support curative effects
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
The PDO support 4 12±2 5.9±0.5 2±0.5 100
As can be seen from the table, the two button-type supports of PDO all can discharge (10-14atm) under conventional release pressure, and support all can successfully fasten, and do not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (2%).Prove this support Design operation feasible.
The application of embodiment 8 supports in the esophageal stricture disease
One, esophageal stricture experiment pig modeling type
Material: 4 of 18-20Kg miniature pigs, ketamine, atropine pin, stable pin, seal wire, cardiografin, sacculus, compression pump and GE-2005 angiographic apparatus.
The concrete steps method:
1,30min gives atropine 0.02mg/kg intramuscular injection before the art, and chlorine peace ketone 10mg/Kg anaesthetizes pig, places on the operating-table fixing.
2, per os inserts the foley's tube of the transformation of the way, under the X-ray its head end is inserted Esophageal Middle Segment, and dilating sacculus injects the sacculus top with 4%NaOH solution 1ml, behind the 30s, and the sacculus venting, the 20ml clear water slowly washes 1min.
3, two week row X-ray cardiografin radiographies after the modeling, modeling success standard: esophagostenosis is greater than 45%.
Two, slide fastener support in PDO edge is implanted in the experiment pig esophagus chamber
1. materials and methods:
Material: each 4 on PDO edge slide fastener support (stent length 20mm* stent diameter 8-12mm), seal wire, stent delivery system and compression pump, 4 of esophageal stricture experiment pig, the original esophagus of experiment pig chamber are 10 ± 2mm directly, and the esophagus chamber directly is 6 ± 0.5mm after the modeling.
Method:
1. art fasting in front 6 hours, art gave atropine 0.02mg/kg, ketamine 10mg/Kg intramuscular injection anesthesia in front 30 minutes.
2. the cardiografin radiography is determined the narrow bit position, and narrow section diameter and length are to select suitable support;
3. operation under X-ray monitors places the esophagus target site with the delivery system that loads PDO slide fastener support along the seal wire per os, and accurately 15atm*30 expands releasing bracket second behind the location;
4. the resorption sacculus becomes negative pressure, and the recession sacculus is all withdrawn from delivery system along seal wire.
2. observation index
1. postoperative esophagus chamber diameter: after sacculus is removed, measurement bracket place esophagus intracavity diameter.
2. acute elastic relaxation shrinkage: support acute elastic relaxation shrinkage=(diameter-sacculus was removed the after-poppet diameter when support was fully expanded)/diameter when support is fully expanded.
3. successfully fasten rate: evaluation criterion: success: remove sacculus after-poppet button and block immediately; Failure: remove the sacculus after-poppet and do not fasten, sliding to the esophagus intracavity.
3. result
1. support curative effect: see Table 17
Table 17: Novel slippery buckle support curative effect
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
The PDO support 4 15±2 9.5±0.5 2±0.5 100
As can be seen from the table, PDO edge sliding buckle type support all can discharge (13-17atm) under conventional release pressure, and support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (2%).Prove this support Design operation feasible.
The application of embodiment 9 supports in the tracheal stenosis disease
One, tracheal stenosis experiment pig modeling type
1. art fasting in front 6 hours, art gave atropine 0.02mg/kg, ketamine 10mg/Kg intramuscular injection anesthesia in front 30 minutes, and were fixed on the operating board.
2. separate skin, subcutaneous successively exposes trachea, adopts surgery local excision sewing, makes tracheal stenosis greater than 45%; Then layer-by-layer suture.
Two, the two button-type supports of PDO are implanted in the experiment pig trachea chamber
1. materials and methods:
Each 4 on the two button-type supports (the diameter 15mm of stent length 20mm * support) of material: PDO, Multifunctional catheter, seal wire, stent delivery system and compression pump, 4 of tracheal stenosis experiment pig, the original trachea of experiment pig chamber are 14 ± 1.5mm directly, and the trachea chamber directly is 7 ± 1mm after the modeling.
Method:
1. before the art by rabat and breast CT, air flue three-dimensional reconstruction, bronchoscopy, tentatively understand position and the scope of tracheal stenosis, narrow section diameter and length are to select suitable support;
2. subcutaneous injection atropine 0.5mg before the art, to reduce the secretions of respiratory tract, the capable local anesthesia of 4% lignocaine spray larynx, per nasal or mouthful insertion branchofiberoscope, the interior blood vessel that injects 2% lignocaine and the interior local anaesthesia of 1% epinephrine 2ml circulation of qi promoting pipe and contraction trachea of trachea reacts with the cough of minimizing art and is hemorrhage;
3. under perspective, cooperate the superslide seal wire to enter trachea through glottis Multifunctional catheter, change subsequently metal and strengthen seal wire and cross narrow section with conduit, seal wire is kept somewhere in the narrow section far-end, remove conduit;
4. will fill standoff delivery system and deliver to narrow section along seal wire, 14atm*30 dilating sacculus second releasing bracket; The resorption sacculus becomes negative pressure, and the recession sacculus is all withdrawn from delivery system along seal wire.
2. observation index
1. pig trachea chamber diameter: after sacculus is removed, measurement bracket place trachea intracavity diameter.
2. acute elastic relaxation shrinkage: support acute elastic relaxation shrinkage=(diameter-sacculus was removed the after-poppet diameter when support was fully expanded)/diameter when support is fully expanded.
3. successfully fasten rate: evaluation criterion: success: remove sacculus after-poppet button and block immediately; Failure: remove the sacculus after-poppet and do not fasten, sliding to the trachea intracavity.
3. result
1. support curative effect: see Table 18
Table 18: two button-type support curative effects
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
The PDO support 4 14±2 12.75±1.25 3±0.7 100
As can be seen from the table, the two button-type supports of PDO all can discharge (12-14atm) under conventional release pressure, and support all can successfully fasten, and do not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (3%).Prove this support Design operation feasible.
 
The application of embodiment 10 supports in the biliary tract stenosis disease
One, biliary tract stenosis experiment pig modeling type
1. art fasting in front 6 hours, art gave atropine 0.02mg/kg, ketamine 10mg/Kg intramuscular injection anesthesia in front 30 minutes, and were fixed on the operating board.
2. enter abdomen through upper right abdominal rib edge arc lower otch, isolate common bile duct.Adopt local seam contracting method to make stenosis of common bile duct 50%, layer-by-layer suture closes abdomen.The conventional antibiotic therapy of postoperative.
Two, the sliding buckle type support is implanted in the experiment pig biliary tract chamber in the middle of the PDO
1. materials and methods:
Each 4 on sliding buckle type support (the diameter 6-8mm of stent length 25 mm * supports), band tubing, stent delivery system and compression pump, 4 of biliary tract stenosis experiment pig, the original biliary tract of experiment pig chamber are 7.5 ± 0.5mm directly in the middle of material: the PDO, biliary tract diameter 4 ± 0.3mm after the modeling.
Method:
1. use the duodenoscope endoscopic retrograde cholangiopancreatography (ERCP) before the art, the character of clear and definite biliary tract stenosis and scope, narrow section diameter and length are to select suitable support;
2. fasting water 6h before the art, 30min intramuscular injection Anisodamine 10mg, Pethidine 50mg, diazepam 10mg before the art reduce enterokinesia, make duodenum be in a low state, so that operation;
3. use the duodenoscope endoscopic retrograde cholangiopancreatography (ERCP), clear and definite biliary tract stenosis position is inserted to left common hepatic duct or right common hepatic duct with seal wire by angiography tube, along seal wire stent delivery system is inserted into the biliary tract target site, and 12-14atm*30 expands releasing bracket second;
4. the resorption sacculus becomes negative pressure, and the recession sacculus is all withdrawn from delivery system along seal wire.
2. observation index
1. chamber, Fel Sus domestica road diameter: after sacculus is removed, measurement bracket place biliary tract intracavity diameter.
2. acute elastic relaxation shrinkage: support acute elastic relaxation shrinkage=(diameter-sacculus was removed the after-poppet diameter when support was fully expanded)/diameter when support is fully expanded.
3. successfully fasten rate: evaluation criterion: success: remove sacculus after-poppet button and block immediately; Failure: remove the sacculus after-poppet and do not fasten, sliding to the biliary tract intracavity.
3. result
1. support curative effect: see Table 19
Table 19: sliding buckle type support curative effect in the middle of novel
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
The PDO support 4 12±2 7.5±0.5mm 3±0.5mm 100
As can be seen from the table, the sliding buckle type support all can discharge (12-14atm) under conventional release pressure in the middle of the PDO, and support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (3%).Prove this support Design operation feasible.
The application of embodiment 11 supports in the urethral stricture disease
One, urethral stricture experimental dog modeling type
1. art fasting in front 6 hours, art gave atropine 0.02mg/kg, ketamine 10mg/Kg intramuscular injection anesthesia in front 30 minutes, and were fixed on the operating board.
2. do the prepuce of penis veutro and cut, fully expose external orifice of urethra.The per urethra collar extension inserts the F6 conduit, put pipe degree of depth 1cm, add normal saline with the 760g/L cardiografin, be diluted to 150g/L concentration and do retrograde urethrography, insert 10 children's's F resectoscopes, put mirror degree of depth 5-6cm, TURP power 30W, 5% glucose is made flushing liquor, 5-7 point position in the urethroscope visual field, direct-view is lower to the capable dog anterior urethra of diameter 2mm ring electrode electrotomy, causes the about 2mm * 3mm of area to penetrate the surgical wound surface of urethra holostrome.Make urethral stricture 50%, layer-by-layer suture.The conventional antibiotic therapy of postoperative.
Two, sliding buckle type support in PDO edge is implanted in the experimental dog urethra chamber
1. materials and methods:
Material: PDO edge sliding buckle type support (the diameter 10mm of stent length 20 mm* supports) each 4, seal wire, band tubing, stent delivery system and compression pump, urethral stricture experimental dog are only, the original urethra of experimental dog chamber is 10-12mm directly, and the urethra chamber directly is 5-6mm after the modeling.
Method:
1. inject the capable mucous membrane of urethra topical anesthesia of 1% lignocaine 5ml from external orifice of urethra before the art, inject contrast agent through conduit under the DSA guiding, carry out urethrography, determine the narrow bit position, narrow section diameter and length are to select suitable support;
2. use antibiotic therapy 3-5 days before the art, adopt the anesthesia of 1% lignocaine mucous membrane of urethra, per urethra inserts seal wire and enters bladder under the DSA guiding, according to the result of urethrography, along seal wire stent delivery system is inserted into the urethra target site, 12atm*30 expands releasing bracket second;
3. the resorption sacculus becomes negative pressure, and the recession sacculus is all withdrawn from delivery system along seal wire.
2. observation index
1. dog urethra chamber diameter: after sacculus is removed, measurement bracket place urethra intracavity diameter.
2. acute elastic relaxation shrinkage: support acute elastic relaxation shrinkage=(diameter-sacculus was removed the after-poppet diameter when support was fully expanded)/diameter when support is fully expanded.
3. successfully fasten rate: evaluation criterion: success: remove sacculus after-poppet button and block immediately; Failure: remove the sacculus after-poppet and do not fasten, sliding to the urethra intracavity.
3. result
1. support curative effect: see Table 20
Table 20: Novel slippery buckle support curative effect
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
The PDO support 4 12±2 10±2 5±1 100
As can be seen from the table, PDO edge sliding buckle type support all can discharge (10-14atm) under conventional release pressure, and support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (5%).Prove this support Design operation feasible.
The application of embodiment 12 supports in the bowel narrow disease
One, bowel narrow experiment pig modeling type
1. art fasting in front 6 hours, art gave atropine 0.02mg/kg, ketamine 10mg/Kg intramuscular injection anesthesia in front 30 minutes, and were fixed on the operating board.
2. enter abdomen through left side abdomen otch, separate descending colon.Adopt local seam contracting method to make descending colon narrow 50%, layer-by-layer suture closes abdomen, the conventional antibiotic therapy of postoperative.
Two, the sliding buckle type support is implanted in the experiment pig intestinal chamber in the middle of the PDO
1. materials and methods:
Each 4 on sliding buckle type support (the diameter 20mm of stent length 40mm * support), band tubing, seal wire, stent delivery system and compression pump, 4 of bowel narrow experiment pig, footpath, the original intestinal of experiment pig chamber 20 ± 18 in the middle of material: the PDO, modeling rear intestinal chamber directly is 10 ± 2mm.
Method:
1. regular injection 10mg 654-2 and 10mg are stable before the art, under the direct-view of intestinal mirror, the superslide seal wire inserted sent the stenosis of colon section to lower distal colon, introduce double channel catheter along seal wire, inject 60% diatrizoate meglumine inj under x-ray monitors, radiography is observed the narrow section situation, selects the support of suitable size;
2. with conduit further deeply to the narrow section far-end and exchange soft ultrahard guide wire, under X-ray monitors, along seal wire stent delivery system is inserted into the intestinal target site, 12-14atm*30 expands releasing bracket second;
3. the resorption sacculus becomes negative pressure, and the recession sacculus is all withdrawn from delivery system along seal wire.
2. observation index
1. chamber, Intestinum Sus domestica road diameter: after sacculus is removed, measurement bracket place intestinal intracavity diameter.
2. acute elastic relaxation shrinkage: support acute elastic relaxation shrinkage=(diameter-sacculus was removed the after-poppet diameter when support was fully expanded)/diameter when support is fully expanded.
3. successfully fasten rate: evaluation criterion: success: remove sacculus after-poppet button and block immediately; Failure: remove the sacculus after-poppet and do not fasten, sliding to the intestinal intracavity.
3. result
1. support curative effect: see Table 21
Table 21: sliding buckle type support curative effect in the middle of novel
? n Release pressure (atm) Support place lumen diameter (mm) Acute elastic relaxation shrinkage (%) Fasten rate (%)
The PDO support 4 12±2 18±2 5±2 100
As can be seen from the table, the sliding buckle type support all can discharge (10-14atm) under conventional release pressure in the middle of the PDO, and support all can successfully fasten, and does not have support curling in the tube chamber; Support is kept predefined lumen diameter substantially, has extremely low acute elastic relaxation shrinkage (5%).Prove this support Design operation feasible.
The above only is preferred implementation of the present invention; should be pointed out that for those skilled in the art, under the prerequisite that does not break away from the inventive method; can also make some improvement and replenish, these improvement and replenish and also should be considered as protection scope of the present invention.

Claims (8)

1. a Novel bioresorbable slide fastener scaffold is being made for cardiovascular or the cardiovascular system support of luminal stenosis disease or the application of intraluminal stent, and described bioresorbable slide fastener scaffold comprises:
Flat rack body, described rack body has mesh-structured;
Be positioned at the support head of described rack body one end, described support head and rack body are integrally formed, and its size adapts with described rack body, and described support head plays the slide fastener effect in the curly course of described support; With
Bracket buckle, described bracket buckle are also integrally formed with described rack body, are used at the curly course of described support support being fixed into the bracket buckle of tubulose;
Described bioresorbable slide fastener scaffold material is PPDO (PDO), polylactic acid (PLA), PC (PCL), polyglycolic acid (PGA) or poly butyric (PHB) high molecular polymer.
2. the application of Novel bioresorbable slide fastener scaffold according to claim 1, it is characterized in that, the narrow disease of described cardiovascular system refers to that coronary stricture, carotid artery stenosis, renal artery stenosis, pulmonary artery and branch thereof are narrow, the narrow or body pulmonary venous stenosis of aorta and branch thereof.
3. the application of Novel bioresorbable slide fastener scaffold according to claim 1 is characterized in that, described luminal stenosis disease refers to trachea, esophagus, biliary tract, urethra or bowel narrow disease.
4. the application of Novel bioresorbable slide fastener scaffold according to claim 1 is characterized in that, described timbering material is PPDO (PDO).
5. the application of Novel bioresorbable slide fastener scaffold according to claim 1 is characterized in that, described support also comprises delivery apparatus, and described delivery apparatus comprises:
Trocar sheath, it has the inner chamber that extends between a near-end, a far-end and two ends; With
Interior sheath pipe, it has the inner chamber that extends between a near-end, a far-end and two ends, and the external diameter of described interior sheath pipe is suitable for being slidably inserted in the tube chamber of described trocar sheath; With
Foley's tube, it has the inner chamber that extends between a near-end, a far-end and two ends, the external diameter of described foley's tube is suitable for being slidably inserted in the tube chamber of described interior sheath pipe, the far-end of foley's tube has sacculus, laminar integrated slide fastener support can be arranged on the described sacculus, through catheter delivery in Stenosis.
6. novel pair of button-type biological absorbable support is characterized in that, comprising:
Flat rack body, described rack body has mesh-structured;
Be positioned at the support head of described rack body one end, described support head and rack body are integrally formed, and its size adapts with described rack body, and described support head plays the slide fastener effect in the curly course of described support; With
Bracket buckle, described bracket buckle are also integrally formed with described rack body, comprise the button of the support head of the toothing that is positioned at the rack body both sides and support head, are used at the curly course of described support support being fixed into the bracket buckle of tubulose;
Described bioresorbable slide fastener scaffold material is PPDO (PDO), polylactic acid (PLA), PPDO (PDO), PC (PCL), polyglycolic acid (PGA) or poly butyric (PHB) high molecular polymer.
7. novel pair of button-type biological absorbable support according to claim 6 is characterized in that described support also comprises delivery apparatus, and described delivery apparatus comprises:
Trocar sheath, it has the inner chamber that extends between a near-end, a far-end and two ends; With
Interior sheath pipe, it has the inner chamber that extends between a near-end, a far-end and two ends, and the external diameter of described interior sheath pipe is suitable for being slidably inserted in the tube chamber of described trocar sheath; With
Foley's tube, it has the inner chamber that extends between a near-end, a far-end and two ends, the external diameter of described foley's tube is suitable for being slidably inserted in the tube chamber of described interior sheath pipe, the far-end of foley's tube has sacculus, laminar integrated slide fastener support can be arranged on the described sacculus, through catheter delivery in Stenosis.
8. novel pair of button-type biological absorbable support according to claim 6 is characterized in that, described timbering material is PPDO (PDO).
CN2013102627395A 2010-11-12 2010-11-12 Application of novel slide buckle bio-absorbable stent Pending CN103349579A (en)

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CN108720971A (en) * 2018-01-28 2018-11-02 杭州市第人民医院 A kind of controllable antibacterial trachea bracket
CN109316268A (en) * 2018-11-02 2019-02-12 李国剑 A kind of bioresorbable slide fastener scaffold and preparation method
CN115501021A (en) * 2021-06-22 2022-12-23 微创神通医疗科技(上海)有限公司 Support and medicine-carrying support

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CN108720971A (en) * 2018-01-28 2018-11-02 杭州市第人民医院 A kind of controllable antibacterial trachea bracket
CN109316268A (en) * 2018-11-02 2019-02-12 李国剑 A kind of bioresorbable slide fastener scaffold and preparation method
CN115501021A (en) * 2021-06-22 2022-12-23 微创神通医疗科技(上海)有限公司 Support and medicine-carrying support
CN115501021B (en) * 2021-06-22 2023-08-11 微创神通医疗科技(上海)有限公司 Support and medicine carrying support

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Application publication date: 20131016