A kind of novel aortic windowing stent systemTechnical field
The utility model relates to a kind of medical instruments, in particular to a kind of novel aortic windowing stent systems.
Background technique
Dissection of aorta (Aortic Dissection, AD) is that a kind of onset is hurried, the state of an illness is dangerous, and the death rate is highAcute Aortic disease.With universal and Examined effect the progress to disease cognitive, the illness rate and detection of dissection of aortaRate rises year by year.The acute Stanford A type dissection of aorta patient of studies have shown that nearly half untreated was in morbidity 1 monthInterior death, 90% Stanford A type dissection of aorta and 60% Stanford Type B dissection of aorta patient morbidity 1It is dead in year.
Aorta pectoralis endovascular repair (TEVAR) is because of its lower death rate and complication rate at present, in chest activeHuge success is achieved in the treatment of arteries and veins tumor and dissection of aorta.Have become the primary treatment regimen of Type B dissection of aorta.But TEVAR art is still faced with many problem and challenge at present, wherein arch of aorta top set reconstructing blood vessel is maximum difficult point.
Orthotopic fenestration technology becomes a kind of effective means for rebuilding aorta in recent years, after it refers to aortic stents releaseBranch vessel is covered, then drive in the wrong direction the distal end through bifurcated artery rupture of membranes.Balloon expandable after rupture of membranes success, puts in last branch vesselSet bracket.Aortic stents orthotopic fenestration technology makes full use of currently available instrument, before retaining bow top set's blood vesselIt puts, plays the minimally invasive advantage of TEVAR as far as possible.
But it is mostly at present cylindrical overlay film frame applied to the branch stent of orthotopic fenestration, generally has after bracket releaseThe even longer part 1.5cm is located in aortic stents.Have the following problems in the specific application process: 1, branch stent is in masterLed to local deformation, narrow by influence of blood flow in lumen of artery；2, branch stent is without special witness marker, and when release is difficult to accurately handleIt holds and protrudes into length in aorta；3, branch stent plays the role of barrier sample to blood flow in aorta lumen, influences blood flowForm, part thrombus easy to form is so as to cause distal artery embolism；4, blood flow is intravascular to rebuilding through columnar bracket, not close toPhysiological phenomenon easily leads to branch vessel blood flow and pressure, blood flow morphologic change；5, branch vessel is in aorta lumen with blood flowIt impacts and swings, stent migration easily occur.And it is easy by stress influence is swung for a long time between bracket tail end and reconstruction branch vessel wallLead to local inner film injury, hyperplasia；If 6, branch reconstruction bracket lumen is relatively thick, it is excessive in aorta lumen to protrude into, especially double to openWindow, three-way window case will affect blood flow in aorta and pass through, and alteration of left ventricular afterload increase and active distal arteries and veins blood supply is caused to subtractIt is few；7, branch vessel, which is excessively located in aorta lumen, influences secondary intracavity operation.
200520113624.0 Chinese patent of Patent No. provides a kind of carnival hat bracket, and providing one kind prevents junctionThe bracket of interior leakage.But the bracket is due to being uniform disk carnival hat, when using three-way window treatment Type B dissection of aorta, bracket giftCap diameter is excessive, and two neighboring bracket carnival hat overlapping can be caused excessive, cannot be bonded aorta tectorial membrane stent so as to cause carnival hatOn overlay film, cause interior leakage may.Furthermore the invention fails to explain the release system of the bracket of illustrating, in our concrete applications, oneAs selection sheath encase bracket, to designated position after slowly exit epitheca and open carnival hat (rear release), but to enable carnival hat to use upAmount fitting aorta tectorial membrane stent, is at this time typically chosen and bracket is dropped back.During this, if sheath removes excessive, bracketBarrel can then be opened, and influence bracket in the movement of vascular wall, if moving by force, can cause the possibility of vascular wall tearingProperty.If sheath recession is very little, it will lead to carnival hat and open incomplete, when rear removing supporters, occur that bracket recession is too many or even carnival hatInto in branch vessel.
Therefore one kind in short supply can be able to solve the above problem specifically for the branch stent of orthotopic fenestration in the market.
Utility model content
In order to solve the above technical problems, technical solution provided by the utility model are as follows: a kind of novel aortic windowing stentSystem, including proximal end umbrella bracket and distal tubular bracket are fixed in aortic stents after the proximal end umbrella bracket releasePortion is anchored in bifurcated artery after the distal tubular bracket release, and the proximal end umbrella bracket includes end disc portion bracket, instituteIt states and is connected between end disc portion bracket and distal tubular bracket by umbrella connecting bracket, the umbrella connecting bracket and distal tubeThe coaxial arrangement of shape bracket；
The distal tubular bracket forms tubular bracket by several Z-type bracing rings, and the Z-type bracing ring includes close to proximal endThe second Z-type bracing ring of the first Z-type bracing ring and distal end of umbrella bracket, the first Z-type bracket bracing ring to proximal end umbrella branchThe distance of frame is greater than the spacing between the second Z-type bracing ring of distal end.
Umbrella connecting bracket two sides and the junction of end disc portion bracket are respectively equipped with the first mark point, the second labelPoint.
Further, the end disc portion bracket is circular support, and the central axis of the umbrella connecting bracket passes through circleThe center of circle of bracket.
Further, the distance of the circular support outer to umbrella connecting bracket outer wall is 5mm.
Further, umbrella connecting bracket both ends and the junction of circular support are equipped with the first mark point.
Further, first mark point is " 8 " font mark point.
Further, the end disc portion bracket is ellipse support, and the umbrella connecting bracket is set to oval branchIt is divided into larger side and smaller side, the larger side long axis endpoint to umbrella connecting bracket outer wall on frame long axis and by ellipse supportDistance be 5mm, the distance of the smaller side long axis endpoint to umbrella connecting bracket outer wall is 3mm.
Further, the junction of the umbrella connecting bracket and larger side is equipped with the first mark point, the umbrella connectionThe junction of bracket and smaller side is equipped with the second mark point.
Further, second mark point is " 0 " font mark point.
Further, the end disc portion bracket is made discoid of a plane Z-type bracing ring.
Further, the distal tubular bracket is externally provided with structure of film.
After using the above structure, the utility model is had the advantages that
1, the utility model bracket is two different models, the first umbrella branch according to branch vessel different designs are usedFrame part is that size is identical uniformly discoid, and disk protrusion is 5mm, is suitable for branch vessel opening apart from periphery weightWant branch vessel >=5mm.Second umbrella holder part is ellipse, wherein larger side be 5mm, smaller side 3mm, it is main suitableThe case where closing the 2 branch vessel distance < 5mm that need to be rebuild, such setting solve the problems, such as to rebuild three branch vessels.
2, the utility model proximal end umbrella holder part is designed to the umbrella-shaped structure of major diameter, it is possible to reduce leakage in openingOccur and reinforce proximal end anchoring effect, allows bracket to be stuck in the lesser aortic stents of diameter when being impacted by blood flow and openedIn window, it is unlikely to shift, and avoids being located in aortic stent compared with long column shape overlay film frame, reduces to blood flow shape in aortaThe influence of state reduces the stimulation due to shaking of branch stent to branch vessel wall, and distal portions are fixed in bifurcated artery,Diameter and length are determined by bifurcated artery anatomical conditions.
3, the Z-type bracing ring spacing on the utility model distal tubular bracket is not identical, the width of first Z-type bracing ringGreater than the distance of other Z-type structures, it is such design be conducive to bracket use after discharge when removing vagina vasorum, umbrella part energyEnough sufficiently to open, bracket umbrella part is unlikely to move in branch vessel when cradle fits aortic stents of dropping back, safely and effectively.
4, the utility model proximal end umbrella bracket contact that is connected with distal tubular holder part has mark point, convenient for quasi- in artIt determines position, confirms the direction of bracket, realize the accurate release of bracket.
The present invention is specific to the branch stent of orthotopic fenestration, can be realized the accurate release of bracket, and few intercurrent disease.
Detailed description of the invention
Fig. 1 is a kind of structural schematic diagram of novel aortic windowing stent system embodiment one of the utility model.
Fig. 2 is a kind of bottom surface structure schematic diagram of novel aortic windowing stent system embodiment one of the utility model.
Fig. 3 is a kind of structural schematic diagram of novel aortic windowing stent system embodiment two of the utility model.
Fig. 4 is a kind of bottom surface structure schematic diagram of novel aortic windowing stent system embodiment two of the utility model.
Fig. 5 is a kind of novel aortic windowing stent system of the utility model locally release process schematic.
Fig. 6 is status diagram when a kind of novel aortic windowing stent system of the utility model removes sheath.
Fig. 7 is the structural schematic diagram under a kind of novel aortic windowing stent system use state of the utility model.
It is as shown in the figure: 1, proximal end umbrella bracket, 1.1, end disc portion bracket, 1.1a, circular support, 1.1b, ellipse branchFrame, 1.1c, larger side, 1.1d, smaller side, 1.2, umbrella connecting bracket, 2, distal tubular bracket, 2.1, Z-type bracing ring,2.1a, the first Z-type bracing ring, 2.1b, the second Z-type bracing ring of distal end, the 3, first mark point, the 4, second mark point, 5, aortaBracket, 6, bifurcated artery, 7, aorta, 8, sheath, 9, tubular bracket release the control line.
Specific embodiment
In conjunction with attached drawing
Embodiment one
A kind of novel aortic windowing stent system, including proximal end umbrella bracket 1 and distal tubular bracket 2, the proximal endUmbrella bracket 1 is fixed on inside aortic stents 5 after discharging, and is anchored to bifurcated artery 6 after 2 bracket of the distal tubular releaseInterior, the proximal end umbrella bracket 1 includes end disc portion bracket 1.1, the end disc portion bracket 1.1 and distal tubular bracket 2 itBetween connected by umbrella connecting bracket 1.2, the umbrella connecting bracket 1.2 is coaxially disposed with distal tubular bracket 1；
The distal tubular bracket 2 forms tubular bracket by several Z-type bracing rings 2.1, and the Z-type bracing ring 2.1 includesClose to the second Z-type bracing ring 2.1b of the first Z-type bracing ring 2.1a and distal end of proximal end umbrella bracket 1, the first Z-type bracket branchThe distance of support ring 2.1a to proximal end umbrella bracket 1 is greater than the spacing between the second Z-type bracing ring 2.1b of distal end.
1.2 two sides of umbrella connecting bracket and the junction of end disc portion bracket 1.1 are respectively equipped with the first mark point 3.
As the present embodiment preferred embodiment, the end disc portion bracket 1.1 is circular support 1.1a, the umbrellaThe central axis of shape connecting bracket 1.2 passes through the center of circle of circular support 1.1a.
As the present embodiment preferred embodiment, outside the outer the circular support 1.1a to umbrella connecting bracket 1.2The distance of wall is 5mm.
As the present embodiment preferred embodiment, 1.2 both ends of umbrella connecting bracket are with circular support 1.1a'sJunction is equipped with the first mark point 3.
As the present embodiment preferred embodiment, first mark point 3 is " 8 " font mark point.
As the present embodiment preferred embodiment, the end disc portion bracket 1.1 is by a plane Z-type bracing ring systemAt discoid.
As the present embodiment preferred embodiment, the distal tubular bracket 2 is externally provided with structure of film.
Embodiment two
A kind of novel aortic windowing stent system, including proximal end umbrella bracket 1 and distal tubular bracket 2, the proximal endUmbrella bracket 1 is fixed on inside aortic stents 5 after discharging, and is anchored to bifurcated artery 6 after 2 bracket of the distal tubular releaseInterior, the proximal end umbrella bracket 1 includes end disc portion bracket 1.1, the end disc portion bracket 1.1 and distal tubular bracket 2 itBetween connected by umbrella connecting bracket 1.2, the umbrella connecting bracket 1.2 is coaxially disposed with distal tubular bracket 1；
The distal tubular bracket 2 forms tubular bracket by several Z-type bracing rings 2.1, and the Z-type bracing ring 2.1 includesClose to the second Z-type bracing ring 2.1b of the first Z-type bracing ring 2.1a and distal end of proximal end umbrella bracket 1, the first Z-type bracket branchThe distance of support ring 2.1a to proximal end umbrella bracket 1 is greater than the spacing between the second Z-type bracing ring 2.1b of distal end.
The junction of 1.2 two sides of umbrella connecting bracket and end disc portion bracket 1.1 be respectively equipped with the first mark point 3,Second mark point 4.
The end disc portion bracket 1.1 is ellipse support 1.1b, and the umbrella connecting bracket 1.2 is set to oval branchDivide on frame 1.1b long axis and by ellipse support 1.1b for larger side 1.1c and smaller side 1.1d, the larger side 1.1c longitudinal endThe distance of point to 1.2 outer wall of umbrella connecting bracket is 5mm, outside the smaller side 1.1d long axis endpoint to umbrella connecting bracket 1.2The distance of wall is 3mm.
As the present embodiment preferred embodiment, the junction of the umbrella connecting bracket 1.2 and larger side 1.1cEquipped with the first mark point 3, the junction of the umbrella connecting bracket 1.2 and smaller side 1.1d is equipped with the second mark point 4.
As the present embodiment preferred embodiment, second mark point 4 is " 0 " font mark point.
As the present embodiment preferred embodiment, first mark point 3 is " 8 " font mark point.
As the present embodiment preferred embodiment, the end disc portion bracket 1.1 is by a plane Z-type bracing ring systemAt discoid.
As the present embodiment preferred embodiment, the distal tubular bracket 2 is externally provided with structure of film.
For the surgical procedure of the present embodiment are as follows:
1, in the case where 0.035 common 180cm loach seal wire and routine 5F angiography catheter are worked in coordination, through descending aorta by conduitIt is sent into aorta ascendens 7, fixed catheter exits loach seal wire exchange Lunderquist seal wire, is put into aorta ascendens 7, GuThis fixed seal wire.
2, enter aortic stents 5 to aortic arch along Lunderquist seal wire, position left common carotid artery distal end and dischargeBracket, bracket cover left subclavian artery.
3, enter 0.018 seal wire after left subclavian artery enters the success of disposable liver biopsy needle rupture of membranes, along seal wireIt respectively enters sacculus (4*40mm, 8*40mm) and carries out expansion backed off after random sacculus.
4, enter the present embodiment windowing stent along seal wire, observe mark point, make the first mark point 3 (" 8 " font mark point)It is directed at 7 longitudinal axis of aorta distal end, the second mark point 4 (" 0 " word mark point) is made to be directed at 7 longitudinal axis proximal end of aorta (nearly arteria carotis oneSide), into aortic stents in after recession formula (exiting sheath 8) release bracket open proximal end umbrella bracket 1, slowly withdraw bracketIt is close to proximal end umbrella bracket 1 with aortic stents 5, the first mark point 3, the second mark point 4 retreat to big cradle wall and experienceSecond step release operation is executed after to resistance, is pulled out distal tubular bracket and is released the control line 9, discharges distal tubular bracket 2, exitRelease system.
5, it is expanded after using sacculus in left subclavian artery branch stent.
6, umbrella-shaped structure is helped to be attached at master using three leaf balloon expandables in the aortic stents of left subclavian artery rootIn arterial bracket.
7, seal wire, conduit and sacculus are exited, operation terminates.
When specific operation, the present apparatus is divided to two sections of releases, and proximal end umbrella bracket 1 is convenient for using recession formula (recession sheath 8)It is precisely controlled the release of proximal end umbrella bracket 1,2 part of distal tubular bracket is discharged using stay-supported, easy to operate easy to learn, positioningAccurately.
The utility model and embodiments thereof are described above, this description is no restricted, shown in attached drawingBe also one of the embodiments of the present invention, actual structure is not limited to this.All in all if this fieldThose of ordinary skill is enlightened by it, without deviating from the purpose of the present invention, not inventively design withThe similar frame mode of the technical solution and embodiment, all should belong to the protection range of the utility model.