DE3406294A1 - Catheter - Google Patents

Abstract

A catheter having at least one longitudinal channel for the examination and/or treatment of vessels carrying body fluid and having a sealing device provided on the free end and expandable at least to the width of the vessel, is to be improved such that examinations and/or treatments with the catheter can be carried out, where possible, with one and the same catheter and even in vessels or vascular sections through which body fluid flows. The catheter (1) is completely closed at its free end (2). A longitudinal channel (4) which in the region (5) of the free end (2) in front of the sealing device (7) has an opening (11) for emergence of a treatment agent into the vascular region in front of the sealing device (7), that is, on the side facing the therapist, is provided. Furthermore, the sealing device (7) of the sealing catheter (1) comprises an annular cuff (7) which is tightly fitted on the edges (6) and is provided in the region (5) of the free end (2) on the outside of the sealing catheter (1). The annular chamber (8) thus formed communicates with the longitudinal channel (3) of the sealing catheter (1) via an opening (9), provided within the length of the annular cuff (7), in the sealing catheter wall. <IMAGE>

Description

catheter

The present invention relates to a catheter for examination and / or treatment of vessels carrying body fluid according to the preamble of claim 1 or secondary claims 2 to 4.

Such a catheter for endoscopic laser beam treatment of Bladder tumors is known from DE-OS 29 45 080. There is a return pipe in there a sheathed optical fiber with a movable end piece provided, which can be actuated by a push rod also located in the tube is. Furthermore, there are two lines for the supply of rinsing liquid and one rigid one Tube provided for receiving an endoscope. This facility is due to their Training with tubes open at the free end only for essentially self-contained Cavities, such as the urinary bladder or the stomach, are suitable as the treatment is made in the practically closed cavity itself.

The present invention is intended to solve the problem of catheter examinations and / or treatments, if possible with one and the same catheter, also in von Vessels or vessel sections flowed through body fluid, specifically if necessary also in short sections.

This task is solved by the characteristic of the claim 1 or the dependent claims 2 to 4 specified features.

It is already from the magazine Münchner Medizinische Wochenschrift ", Extra sheet of April 8, 1983 known, at the free end of a catheter an inflatable Provide balloon with a light guide for laser beams stored in its center fixed. In addition to fiberglass optics, there is also a suction device in the catheter housed. However, the treatment also takes place here, as with the subject of DE-OS 29 45 080, seen by the therapist from behind the shut-off balloon.

With the various variants of the present invention, it is on the other hand, it is possible to seal vessels or vessel sections at any point or to select any desired and optionally any large vessel section and to be flushed through and thus accessible for observation and targeted treatment close.

The observation can be done visually via optical fibers and the treatment for example mechanically and / or by means of electrical energy and / or with a Laser can be made via a fiber optic cable. In particular, is suitable the catheter according to the invention for Treatment of strictures of all Species. For example, by inflating a on the guide catheter and on Sealing catheter provided hose section or an annular membrane a limited Treatment segment formed in which the stenosis is located.

By treating the vascular segment in front of the balloon the risk that blood clots or debris get into the vascular system is complete locked out.

Further advantageous details of the invention are set out in the subclaims and are given below with reference to the exemplary embodiments illustrated in the drawing described in more detail.

1 shows an end part of a single catheter from the side in section, FIG. 2 shows an end section of a single catheter with a sealing device to form a sealing bead, FIG. 3 shows an end part of a guide catheter from the side in section, FIG. 4 shows a detail of a tube section in the inflated state State, FIGS. 5a and 5b show an end section of the guide catheter with a sealing device for the formation of a sealing bead in different operating states, FIG. 6 shows a Guide catheter with inserted sealing catheter, FIG. 7 shows a guide catheter with a central tube in which a sealing catheter is guided, Fig. 8 shows the guide catheter according to FIG. 7 in cross section, FIG. 9 shows a side view of the upper half of a catheter inserted into a vessel with a treatment catheter in section, FIG. 10 a cross section of the catheter according to FIG. 9, FIGS. 11 to 15 Options for the implementation of tools in a treatment or tool catheter for a mechanical removal of stenoses, FIGS. 16 to 23 possible designs mechanical tools of such treatment catheters and FIGS. 24 to 32 possible Versions with optical fibers for observation and / or optical waveguide for laser beam treatment.

In Fig. 1, 1 is a catheter closed at its free end 2 denotes, which has a longitudinal channel 3 for supplying a pressure medium, for example Air, water or the like. And a longitudinal channel 4 for the supply and / or for the drain of detergents, such as water, physiological saline solution or the like. Has.

In the area 5 of the free end 2 of the catheter 1 there is a sealing device provided, which consist of an externally applied, for example at the edges 6 glued and / or welded annular collar 7 made of elastic material. The annular chamber 8 formed by the annular collar 7 is provided with an opening 9 connected to the longitudinal channel 3. Through this can the ring cuff 7 are inflated by pressed into the longitudinal channel 3 pressure medium, so that the outer wall 10 to the inner wall of a vessel, for example an artery or Vein, ureter or the like., Can create a seal. The catheter 1 is so as Sealing catheter formed.

In the vicinity of the annular cuff 7 there is an opening 11 in the catheter 1 on the side facing away from the free end 2, i.e. the side facing the therapist and thus provided in front of the annular collar 7 as seen from this point. When bloated Ring cuff 7 is therefore the vessel to the therapist from the rest of the vascular system separated and can thus be flushed through the longitudinal channel 4 or it can Medicinal or other treatment agents administered or samples taken will. The ring mesh 7 is preferably already without pressure or is included The negative pressure in the longitudinal channel 3 is applied completely smoothly to the catheter 1.

Another advantageous embodiment of a catheter with a the sealing device provided for its free end is shown in FIG. Here is in the catheter 1 instead of a longitudinal channel 3 for a pressure medium or in this a stiff wire 12 is provided.

This wire 12 consists for example of metal, such as steel or Stainless steel or plastic, such as polyamide.

It ends at the front part 13 of the free end 2 and is preferably with this materially tightly connected, in particular welded. An end portion 14 of the catheter 1, preferably the catheter 1 itself or a molded or attached tube section or a sleeve is designed to be rubber-elastic or flexible in such a way that it is subjected to tensile stress of the wire 12 of the end part 14 in the form of a shown in dashed lines in FIG Umbrella 15 snaps up radially in the form of a plate or bead or yourself bulges and presses itself with its outer wall 10 'sealingly against an inner wall of the vessel leaves.

In Figure 2, the end portion 14 is as on the free end 2 of the catheter 1 plugged-on or tightly glued or otherwise suitably tightly fastened Sheath formed, wherein the wire 12 has a rivet head 16, the sleeve of seals on the outside. Instead of a wire 12, an overpressure or underpressure can also be used in a preferably additional, separate from the other longitudinal channels 3, 4 Longitudinal channel serve to convert the end part 14 into the umbrella shape 15 or into the one shown to bring stretched position.

The catheter 1 embodied as a sealing catheter can preferably be inserted or pushed into a guide catheter 17, as will be based on later Figures 6 and 7 will be described in more detail. Such a guide catheter 17 is shown in FIG. In the wall 18 of the guide catheter 17 is a The longitudinal channel 20 is open at its beginning and closed at its free end 19 provided, through an opening 21 in a by inherent elasticity or by a Cuff 22 to be formed annular chamber 23 opens. This structure and the mode of operation of the guide catheter 17 corresponds to that of the annular cuff 7 and the annular chamber 8 of the sealing catheter 1. In FIG. 4, the cuff 22 is partially inflated Condition shown.

The outer wall 24 can seal against an inner wall of the vessel adjust. If necessary, several longitudinal channels 20 can be provided in the wall 18 or an annular channel can be formed, for example by two pushed one on top of the other Pipes or hoses, as indicated by dashed lines in the wall 18 below. Included can then also vep several openings 21 on the circumference shares provided be. Here, too, as in the case of the sealing catheter 1, the annular chamber 23 is in the end area 25 of the free end 19 is provided.

The guide catheter 17 is open at its free end 19 and his Front surface 26 is advantageously funnel-shaped towards the inside, in particular acute-angled funnel-shaped, narrowed. This makes it easier to pick up items to be washed.

Also in the case of the guide catheter 17, the sealing device can according to FIGS. 5 a and 5 b consist of an umbrella-like or expandable bead 27, like the Screen 15 of the sealing catheter 1. For this purpose, the guide catheter 17 is a double tube formed from two relatively closely spaced tubes 28 and 29, which are at the free End 19 in particular tightly connected to one another and displaceable relative to one another are. In the end region 25, the outer tube 29 is weakened at a certain point, so that it is elastically arched or it is with a rubber-elastic ring collar 30 provided. By pulling the inner tube 28 to the left and / or in the plane of the drawing Pushing the outer tube 29 to the right in the plane of the drawing will create the ring collar 30 brought into the position shown in Figure 5b, with its outer wall 24 ' can seal against an inner wall of the vessel.

FIG. 6 shows another catheter according to the invention, consisting from a guide catheter 17 and one inserted therein, in the lumen 31 of the same freely movable sealing catheter 1, as already described with reference to FIG became. The latter can also be provided with the sealing device according to FIG.

When using these two catheters 1 and 17 is between the sealing devices 7 and 22 in bloated state depending on by moving the Catheter 1, 17 a mutually selectable distance of the sealing devices 7, 22 a Vessel chamber 32 is formed. This vascular chamber 32 can be rinsed through and with water, physiological Saline solution, gas, air or the like. Be filled and can then be observed closely and possibly treated.

According to an advantageous embodiment of the invention, according to FIG. 7 and 8 in the guide catheter 17, a guide tube which is preferably arranged centrally 33 can be provided, in which a sealing catheter 1 is guided displaceably. The latter has no opening here (compare earlier item number 11) and no flushing channel (compare previous item 4), since the irrigation through the lumen 31 of the guide catheter 17 is possible. The guide tube 33 can be connected to the guide catheter 17 via ribs 34 must be firmly connected directly.

The ribs 34 can divide the lumen 31 into two longitudinal channels 40, 41 separate, which can be used for irrigation and / or for inserting additional catheters. In this embodiment, the ribs 34 are not associated with the guide catheter 17 connected, but with a tube 35 which can be pushed into its lumen 31, which is preferably is designed as a treatment catheter.

Another catheter, consisting of a guide catheter 17, a Sealing catheter 1 and a treatment catheter 35 are in a vessel in FIG 36 shown in longitudinal section. By moving the guide catheter 17 relative to the sealing catheter 1 and by inflating the cuffs 7, 22 is a closed Vascular chamber 32 is formed, in which the stenosis 37 is located. On the protruding A removal tool 39 is located at the end 38 of the guide tube 33 to the Removal of the stenosis 37. The guide tube 33, that is to say the treatment catheter 35, is displaceable relative to the guide catheter 17 and to the sealing catheter 1 and optionally also rotatable so that it or he over the entire length of the vessel chamber formed 32 can be moved. The stenosis 37 can be mechanically removed by the removal tool 39 worn, for example rubbed off or scraped off, and the detached Parts are either through the flushing channel 4 in the sealing catheter 1 and / or through the lumen 31 of the guide catheter 17 and / or through the lumen 40 or 41 of the treatment catheter 35 rinsed to the side of the therapist (Fig. 10).

It is useful for examining and observing the process at Removal of an observation catheter, for example an endoscope, into a lumen 31, 40, 41, insertable. The lumens 40, 41 are only formed by the ribs 34, which e.g. rest on the inside of the guide catheter 17 in a sealing manner. This is particularly evident shown in the cross section of this catheter shown in FIG.

The removal tool 39 in FIG. 9 consists of one or more distributed on the circumference, for example, circular segment-like ribs or lamellae or from a body of revolution corresponding to this cross section, for example one Ellipsoid of revolution or the like, the outer surface thereof with teeth 42 or knobs or bristles, for example in the manner of a rasp, are or is. In order to can by moving the guide tube 33 or the treatment catheter accordingly 35 the stenosis 37 is scraped off. The removed fragments are rinsed out by flushing agent squeezed out of the opening 11, which through at least one of the lumens 31, 40, 41 drains. The tools are preferably slightly elastic formed yielding.

In FIG. 11 there is a removal tool 39 composed of two arranged one behind the other "Rasping" shown. FIG. 12 shows an embodiment made from a wire loop 43 in the form of a longitudinal bridge, which is also knife-like, especially on the side can be ground out and FIG. 13 shows several such wire loops 43, if necessary protruding on two sides.

These can also be arranged on a spiral line around the catheter or form a corkscrew-like spiral.

The ends 44 of the wire loops 43 are molded into the guide tube 33, so that injuries are avoided. The removal tool 39 corresponds to FIG. 14 approximately that of Fig. 9, however, is somewhat more elongated and therefore essentially one Approximated double trapezoidal shape.

Finally, FIG. 15 shows a practically rectangular removal tool 39 shown, the one at the end a radially protruding, elastic in the longitudinal direction flexible scraper 45 can be assigned. As a solid of revolution, the rectangular, Removal tool beveled at the front and / or back, then cylindrical, if necessary each with an end cone formed.

The sealing catheter 1 in FIG. 9 can also be used again at the free end 2 have an umbrella-like, in particular elastically deflectable sealing device 15, as described with reference to FIG. If necessary, this can be done on the outer surface toothed or designed in a similar way and thus additionally as a removal tool to serve. Such a screen 15 can also be used as a removal tool at the end of the guide tube 33 or the or a treatment catheter 35 can be arranged.

As shown in Figures 16 and 17, the screens 15 can at the same time serve for sealing and they can be elastically deflected in the direction of arrow 46 for this purpose.

Appropriately, the screen 15 can be made very elastic and according to 17 are held in the tensioned state by means of stiffening ribs 47. According to In the exemplary embodiments shown in FIGS. 18 and 19, the screen 15 by a push rod 48 or a stiff metal or plastic wire be pushed to the right, whereby the screen 15 is reduced in diameter and then with the connected catheter 1 or the guide tube 33 and the treatment catheter 35 can be moved easily in the longitudinal direction.

According to FIGS. 20, 21, the removal tool 39 can also be used as lamellas, Ribs, bristles or the like or also be rotationally symmetrical and circumferential, sharp-edged ridges 49 and grooves 50 (FIG. 20) or bristles or disks 51 (FIG 21). These removal tools can be placed on the catheter 1 or on the guide tube 33 or pushed onto the treatment catheter 35 as a separately manufactured item and by press fit, gluing or the like. Be attached.

This enables the removal tools 39 to be of a better choice in terms of size be adapted to the processing and the respective conditions. Such on a Removal tools 39 attached to guide tube 33 are shown in FIGS. 20 to 23.

According to a further advantageous embodiment of the invention, can be arranged in the catheter two openings for rinsing the vascular chamber 32 so that a good rinse of the milk is guaranteed. This is expediently done so that in the vessel chamber 32 a turbulence through a correspondingly offset arrangement the openings occurs. For example, detergent from the opening 11 of the Adichtkatheters 1 and optionally additionally from a lumen 31 or 40 or 41 of the treatment catheter 35, that is to say at opposite ends of the vascular chamber 32, are discharged, the drainage then passing through a common drainage channel, takes place for example through the lumen 41 or 40 or 31. This allows an optimal Cleaning of the vessel chamber 32 can be achieved.

Particularly useful developments of the invention also exist that in at least one of the catheters or in a special light or Laser catheter at least one light guide or light wave guide, for example one or more glass fibers or optical waveguides or bundles are provided, in particular are molded into the wall or at least molded onto it. These end purposefully so that they enter the vessel chamber 32 with light for observation and / or laser light as well can irradiate for treatment.

For example, in the exemplary embodiment according to FIG. 24, an or are several optical waveguides or bundles 52 in the wall 18 of the guide catheter 17 is provided, specifically in the area within the sleeve 22. The optical waveguides 52 can be provided evenly distributed over the entire circumference, so that a uniform illumination of the vessel chamber 32 is possible and thus a rotary movement the light source is not necessary. For example, several individual fibers or bundles, preferably formed in a spiral shape or formed on the inside or outside be. The optical waveguides 52 end at the front surface 26 of the guide catheter 17th

Under certain circumstances it can be expedient to use the optical waveguides 53 to be placed over the cuff 22 on the outside or to be molded or molded on according to FIG. 25, optionally in addition to the optical waveguides arranged on the inside in FIG 52. As a result, when the cuff 22 is inflated, these lie directly on the inner wall 6 'of the vessel 36 (FIG. 25 a), so that under certain circumstances stenoses or deposits can be made more visible on this.

The end of the optical waveguides 52, 53 can be designed as an optical system or be provided with one. For example, the ends are with converging lenses or provided with a lenticular screen or shaped in this way.

In FIG. 26, an optical waveguide 54 is in the wall 55 of a treatment catheter 35 is provided and it radiates from its front surface 56. Again, several can Optical waveguides 54, optionally continuous or discontinuous, on the circumference of the treatment catheter 35 can be provided distributed in or on the wall 55, as shown in FIG. In both cases, of course, in accordance with 27 a and 27 b instead of a cuff 22 on the guide catheter 17 of this again consist of double pipes 28, 29 or the annular collar 30 can be provided, as described in detail with reference to FIGS. 5 a and 5 b and FIG. 2.

Possible further optical systems are shown in FIGS. 29 to 32. In these versions, it is also that of the optical waveguides 57 in the sealing catheter 1, possibly in addition to those in the guide catheter 17 and / or in the treatment catheter 35 is provided. These are expedient within of a longitudinal channel, for example the flushing channel 4, arranged to be longitudinally displaceable.

The end of the optical waveguide 57 in FIGS. 29 and 32 is with an inner cone 58, so that light or laser light 59 depending on the cone angle is emitted laterally. The optical waveguide 57 can of course also be used for observation serve the vessel chamber 32. When used as a treatment light waveguide for laser light the catheter 1 is designed, at least in the irradiation area, so that it can pass through the radiation is not or only insignificantly heated.

The material must therefore practically not absorb the laser light. An opening through which the laser light is emitted can also be provided in the catheter can be. This can for example be the flushing opening 11 of the sealing catheter 1 be.

In the embodiment according to FIG. 30, the end 59 is the optical waveguide 57 matted so that the light is emitted diffusely.

Another useful light guide is shown in FIG. 31. There is a cone 61 or a wedge is provided behind the end of the optical waveguide 60, that via a pulling device 62, for example a stiff wire, to the left can be drawn and thereby splices the optical waveguide 60 according to FIG. 31 a.

This allows the angle of light emission in a simple manner be managed.

A particularly good irradiation or treatment can be achieved with one execution according to Figure 32 can be achieved.

There is 7 on the free instead of a ring collar end 2 of the sealing catheter 1 a thin elastic balloon skin 63 made of laser light in practice non-absorbent material attached so that a balloon can be formed, in which only the optical waveguide 64 can be pushed. When inflating the balloon skin 63 this is applied to the stenosis to be treated and this can be accessed via the vom Optical waveguide 64 emitted laser light are evaporated. This collects the vapors or gases between the vessel and balloon skin 63 and by moving the Abdichtketheters 1 to the right, these are discharged into the vessel chamber 32.

The individual fiber-optic cables are connected to a coupling on the Therapist-facing side and guided to the various light sources, if necessary bundled, connectable.

To increase the efficiency of the irradiated laser light are advantageously parts or partial areas of walls directed towards the vessel chamber 32 a catheter 1, 17, 35 and / or a sealing device 7, 22, 15 and / or a Removal tool 39 or the like. With a reflective layer for the incident light Mistake. On the other hand, there is also the possibility of a part that is in the area the stenosis to be ablated is made of a material that absorbs the radiation well produce that heats up strongly without being destroyed. Through this evaporation of the stenosis may occur with reduced power supply can be achieved.

Instead of or in addition to a laser catheter or to one Treatment catheter can be a high frequency catheter with an end-face RF electrode be plugged in, with the RF leads provided in the catheter, in particular are molded. The electrode can be a ring electrode, helical electrode, or be provided as a wave-shaped or loop-shaped electrode, which also can be arranged at an angle to the longitudinal direction of the catheter.

The electrodes or ends of an HF catheter and the ends of the optical waveguides 52, 53, 54, 57, 60, 64 can advantageously be located within the area of the vascular chamber 32 or the stenosis 37 to be ablated via mechanical, pneumatic or hydraulic means Actuators, for example by means of a wire or air or gas pressure or by water, rinsing liquid or the like., In different angular positions with respect to the longitudinal axis of the catheter can be adjusted.

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Claims (50)

Claims @ Catheter with at least one longitudinal channel for examination and / or treatment of vessels carrying body fluid with one at the free one Sealing device provided at the end, which can be expanded at least to the width of the vessel, thereby characterized in that the catheter (1) is completely closed at its free end (2) is and that a longitudinal channel (4) is provided in the area (5) of the free end (2) in front of the sealing device (7) an opening (11) for a treatment agent to exit, in particular a detergent, in the vessel area in front of the sealing device (7), thus on the side facing the therapist, and that also the sealing device (7) of the sealing catheter (1) from one in the area (5) of the free end (2) of the sealing catheter (1) provided on the outside, there is a ring collar (7) tightly attached to the edges (6) and the annular chamber (8) thus formed over one within the length of the annular collar (7) provided opening (9) in the sealing catheter wall with or with a longitudinal channel (3) of the sealing catheter (1) is in communication. 2. Catheter with at least one longitudinal channel for examination and / or Treatment of vessels carrying body fluid with one provided at the free end, Sealing device expandable at least to the width of the vessel, characterized in that that the catheter (1) is completely closed at its free end (2) and that a longitudinal channel (4) is provided in the area (5) of the free end (2) in front of the Sealing device (7) an opening (11) for the exit of a treatment agent, in particular a rinsing agent, in the vessel area in front of the sealing device (7), thus on the side facing the therapist, and that also the sealing device (7) of the sealing catheter (1) from one provided at the free end (2) of the same flexible or rubber-elastic hose section (14) or an elongated, if necessary, there is a closed sleeve at the end and in or in a longitudinal channel (3) of the sealing catheter (1) a pulling and / or Pressure element or traction and / or pressure means (12) is provided, which is connected to the front part (13) of the free end (2) is firmly connected or acts against this and by train or suction can compress the hose section (14) or the sleeve, with their Wall bulges outward in the form of a bead and can be pressed against the inner wall of the vessel in a sealing manner is. 3. Catheters for the examination and / or treatment of body fluids leading vessels with a guide catheter open at its free end into the at least one second catheter, in particular a catheter according to claim 1 or 2 is provided or used and displaceable therein, characterized by the Use of the following features: - In the wall (18) of the guide catheter (17) at least one open at the beginning and one at Connecting part connectable, but more closed at the free end (19) and opening into an annular chamber (23) provided there Longitudinal channel (20) provided; the outer wall (24) of the annular chamber (23) is at the free End (19) or in the area of the free end (19) so elastic and / or flexible formed or with an elastic and / or flexible hose section (22) provided that the outer surface of the outer wall (24) by expanding the annular chamber (23) can be pressed against the inner wall of the vessel (36 ') in a sealing manner; into the lumen (31) of the Guide catheter (17), a sealing catheter (1) is inserted or can be pushed in and with its end (2) or end region (5) from the open end (19) of the guide catheter (17) can be pushed out; the sealing catheter (1) is at the beginning with at least one open and at the end (2) of the sealing catheter (1) closed longitudinal channel (3) provided; at the end (2) or in the area (5) of the end (2) of the sealing catheter (1) is a sealing device (7; 14, 15) which can be enlarged essentially radially outward is provided, the means provided in the longitudinal channel (3) can be enlarged and reduced in size in this way is that the sealing device (7 # 14, 15) in the enlarged state at least with part of its circumferential surface (10, 10 '), but over the full circumference, sealing can be pressed against the inner wall of the vessel (36 ') and in the reduced state at most however, is the same as the cross section of the guide catheter (17), and that the sealing catheter (1) optionally in the area (5) of the free end (2) in front of the sealing device (7; 14, 15) an opening (11) for the exit of a loading means of action, in particular a rinsing agent, in the vessel area (32) in front of the sealing device (7; 14, 15), i.e. on the side facing the therapist. 4. Catheters for the examination and / or treatment of body fluids leading vessels with a guide catheter open at its free end into the at least one second catheter, in particular a catheter according to claim 1 or 2 is provided or used and displaceable therein, characterized by the Use of the following features: the wall (18) of the guide catheter (17) is as a double tube with tubes that can be moved relative to one another and are closely interconnected (28, 29) formed; - The tubes (28, 29) are fixed to one another at their free ends tied together; - In the outer tube (29) in the area of the free end (19) is a rubber-elastic Ring collar (30) used, which when pushing back the inner tube (28) relative can be compressed to the outer tube (29) and thereby one radially outward facing bead (27), the peripheral surface (24) of which seals against the inner wall of the vessel (36 ') can be pressed; - In the lumen (31) of the guide catheter (17) is a sealing catheter (1) inserted or inserted and with its end (2) or end region (5) from the open end (19) of the guide catheter (17) can be pushed out; - the sealing catheter (1) has at least one open catheter at the beginning and one at the end (2) of the sealing catheter (1) provided closed longitudinal channel (3); - at the end (2) or in the area (5) of the The end (2) of the sealing catheter (1) is essentially radial after externally enlargeable sealing device (7; 14; 15) is provided, which over in the longitudinal channel (3) provided means can be enlarged and reduced again in such a way that the Sealing device (7; 14; 15) in the enlarged state with at least one part their circumferential surface (10, 10 '), but over the full circumference, sealing against the inner wall of the vessel (36 ') can be pressed and in the reduced state is at most equal to the cross section the guide catheter (17); - And that the sealing catheter (1) if necessary in the area (5) of the free end (2) in front of the sealing device (7; 14; 15) a Opening (11) for the exit of a treatment agent, in particular a rinsing agent, in the vessel area (32) in front of the sealing device (7; 14; 15), ie on the Has the side facing the therapist. 5. Catheter according to claim 3 or 4, characterized in that the Eu #hnrngskatheter (17) made of two at its free end (19) connected to one another Tubes (28, 29) and through the space between the tubes (28, 29) a liquid or, in particular, gaseous pressure medium is present or can be pressed in is. 6. Catheter according to claim 5, characterized in that in the outer tube (29) at least one mouth opening (21) is provided in the region of the end (19), into an elastic hose section attached to the outer tube (29) (30) formed annular chamber (23 ') opens, and that the hose section (30) to the Edges tightly connected to the outer tube (29). 7. Catheter according to one of claims 1 to 6, characterized in that that the front surface (26) of the free end (19) of the guide catheter (17) inwards is narrowed in a funnel shape. 8. Catheter according to claim 7, characterized in that the front surface (26) is narrowed at an acute angle, funnel-shaped. 9. Catheter according to one of claims 1 to 8, characterized in that that in addition to the sealing catheter (1) a flushing agent catheter (35) is provided respectively. can be pushed into the lumen (31) of the guide catheter (17) whose free end up into the vessel chamber (32) or up to the sealing device (7; 14; 15) of the sealing catheter (1) is sufficient or can be pushed. 10. Catheter according to one of claims 1 to 9, characterized in that that the sealing device consists of an elastic sealing washer provided at the end (15) exists. 11. Catheter according to claim 10, characterized in that the sealing washer (15) is designed like an umbrella and by internal stress and / or by additional elastic ribs (47) and / or by a mechanical and / or hydraulic and / or pneumatic pulling and / or pushing element (48) or pulling and / or pushing means can be clamped is. 12. Catheter according to one of claims 1 to 11, characterized in that that the sealing device (15) is designed as a tool for removing a stenosis (37) is. 13. Catheter according to one of claims 1 to 12, characterized in that that the longitudinal channel (3; 4) for receiving the tension and / or pressure element (12; 47) respectively. Pulling and / or pushing means is designed at the same time as a flushing channel. 14. Catheter according to one of claims 1 to 13, characterized in that that a treatment catheter (33; 35) is provided in the lumen (31) of the guide catheter (17) or can be inserted into it, which is longitudinally displaceable and / or rotatable in the lumen (31) or is rotatable at least by a limited angle of rotation and in the area of a free end (38) has a tool (39) for removing the stenosis (37). 15. Catheter according to claim 14, characterized in that the treatment catheter (33; 35) in addition to at least one further catheter (sealing catheter and / or flushing agent catheter) is provided in the lumen (31) or can be provided. 16. Catheter according to claim 14, characterized in that the treatment catheter (33; 35) concentrically around an already existing or insertable catheter (for example Sealing catheter (1)) is arranged or insertable. 17. Catheter according to one of claims 14 to 16, characterized in that that the treatment catheter (33; 35) through at least one longitudinal channel (40, 41) is also designed as a detergent catheter. 18. Catheter according to one of claims 14 to 17, characterized in that that the treatment catheter (33; 35) has at least one longitudinal channel for a pulling and / or rotary press element (12; 48) or for a pulling and / or pushing means having. 19. Catheter according to one of claims 1 to 18, characterized in that that on the sealing catheter (1) and / or on the treatment catheter (17) on the in the to forming the vessel chamber (32), a removal tool (39, 43, 44, 45, 51) is provided. 20. Catheter according to claim 19, characterized in that the removal tool (39) several rigidly or elastically deflectable arranged in the longitudinal and / or transverse direction in particular disks (51) projecting radially outwards and / or ribs and / or knobs and / or has lamellae and / or bristles. 21. Catheter according to claim 19, characterized in that the removal tool (39) at least one rigid or elastic wire in the form of at least one longitudinal bridge (43) and / or at least one cross loop or cross bridge and / or a corkscrew-like one Has spiral, 22. Catheter according to one of claims 19 to 21, characterized in that that the removal tool (39, 43, 44, 51) is tooth-shaped on the outside, in particular according to Art a rasp, is formed and / or has knife-like cutting edges. 23. Catheter according to one of claims 14 to 22, characterized in that that the removal tool (15; 39) is provided by a pressure and / or pulling and / or rotating element or by pulling and / or pushing means (48) is changeable in diameter. 24. Catheter according to one of claims 22 or 23, characterized in that that the rasp-like removal tool (39) is diamond-shaped or ellipsoidal or cylindrical and / or is tapered towards the front and / or towards the rear. 25. Catheter according to one of claims 14 to 24, characterized in that that the treatment catheter (33; 35) is designed as a two-channel catheter which is open at the end and in particular as a detergent catheter or as an additional detergent catheter serves. 26. Catheter according to one of claims 3 to 25, characterized in that that the guide catheter (17) has at least one continuous or at least two inwardly protruding and / or an existing or insertable catheter (for example Sealing catheter, treatment catheter, flushing agent catheter or the like.) At least two outwardly and / or inwardly projecting ribs as centering and / or as lumen cross-section partial ribs has or have serving ribs (34). 27. Catheter according to claim 26, characterized in that ribs (34) are provided for the displaceable and / or rotatable position fixation of a Catheters (1, 35) are used. 28. Catheter according to claim 26 or 27, characterized in that two or more ribs (34) are firmly connected to an additional tube (33). 29. Catheter according to claim 28, characterized in that the additional Tube (33) serves as a guide tube for the sealing catheter (1). 30. Catheter according to one of claims 1 to 29, characterized in that that the inlet and outlet openings (11; 40; 41; 31) of two detergent lumens (31; 40; 41) or catheters (1; 35; 17) are spatially provided or arranged in this way can be that a favorable or optimal flushing of the vessel chamber (32) is possible is. 31. Catheter according to one of claims 1 to 30, characterized in that that outside or inside, on or in the wall of the guide catheter (17) and / or on or in the treatment catheter (33; 35) and / or on or in the sealing catheter (1) or In a special laser catheter, at least one optical waveguide (52; 53; 54; 57; 60; 64) is provided, via which into the vascular chamber (32), in particular for the stenosis (37), light can be irradiated for observation and / or treatment. 32. Catheter according to claim 31, characterized in that at least an optical fiber (52, 53) in or on the outer wall (24) of the annular chamber (23) of the guide catheter (17) provided and with the outer wall (24) in the direction the inner wall of the vessel (36 ') is movable. 33. Catheter according to claim 31 or 32, characterized in that the end of the optical waveguide (s) (52; 53; 54; 57; 60; 64) as optical Are designed or provided with such a system or is. 34. Catheter according to one of claims 31 to 33, characterized in that that several optical fibers are combined into a bundle. 35. Catheter according to claim 34, characterized in that a bundle by a wedge which can be moved relative to the front plane of the optical waveguide (60) or cone (61) can be fanned out. 36. Catheter according to one of claims 31 to 35, characterized in that that several optical fibers or bundles of optical fibers at the beginning, i. on the side facing the therapist, are summarized and over at least a coupling of light energy can be radiated into at least one light source. 37. Catheter according to claim 36, characterized in that the or a light source is a laser light source. 38. Catheter according to one of claims 1 to 37, characterized in that that at least a portion of the parts of a vessel directed towards the vessel chamber (32) Catheter (1, 17, 33, 35) and / or removal tool (39) and / or a sealing device (7; 15) of the sealing catheter (1) with a reflective layer for radiated light waves is or are provided. 39. Catheter according to one of claims 31 to 38, characterized in that that an optical waveguide (57; 60; 64) in or in a longitudinal channel (3; 4) of the sealing catheter (1) is provided and ends in the region of the vessel chamber (32). 40. Catheter according to claim 39, characterized in that the LichtweSzßßeiter is displaceable in the longitudinal channel (3; 4). 41. Catheter according to claim 39 or 40, characterized in that the wall of the sealing catheter (i) in the area where laser light is emitted out of the optical waveguide in the direction of the stenosis (37), in particular shortly before the sealing device (7; 15) has an opening (11) or at least in this Area for the wavelength of the laser light is designed to be very transparent. 42. Catheter according to one of claims 31 to 41, characterized in that that in the case of optical waveguide (s) ending within an annular chamber (8, 8 '; 23, 23') the wall (7; 22) of the annular chamber (8, 8 '; 23, 23') and / or the sealing device (15; 63) at least on the Radiation point from at least For the irradiated light wavelength (s) there is or is well-permeable material exist. 43. Catheter according to claim 42, characterized in that at least an optical waveguide (64) is provided on or in the sealing catheter (1) and on its free end (2) protrudes and there from one for the irradiated light wavelength very well permeable material existing balloon (63) (Figure 32) is surrounded and that the balloon (63) can be pressed directly against the stenosis (37) in a sealing manner. 44. Catheter according to one of claims 31 to 43, characterized in that that part of a removal tool (39) onto which a high-energy radiation (laser light and / or HF energy), made of a material that is highly absorbent for this radiation exists or contains this or is coated therewith and can be heated by the radiation or heatable, but cannot be destroyed as a result. 45. Catheter according to one of claims 1 to 44, characterized in that that in addition to or instead of a treatment (33, 35) or laser catheter High-frequency catheter with an end RF radiation electrode provided according to and the RF lines are provided on or in the catheter. 46. Catheter according to claim 45, characterized in that a terminal Ring electrode is provided. 47. Catheter according to claim 45, characterized in that a terminal Reversible electrode is provided. 48. Catheter according to claim 45, characterized in that a wave-shaped Electrode is provided. 49. Catheter according to claim 21 or 45, characterized in that a loop-shaped electrode in the longitudinal direction or at an angle to the longitudinal direction of the catheter is provided. 50. Catheter according to one of claims 31 to 49, characterized in that that the end of an optical waveguide or bundle, especially for radiation Laser light or an HF catheter emerge from the front of the catheter (1, 17, 33, 35) and within the region of the vessel chamber (32) via mechanical or pneumatic means or hydraulic actuators in different angular positions with respect to the longitudinal axis of the catheter is adjustable.