DE102013219509A1 - Expandable cooled electrode - Google Patents

Abstract

The invention relates to a balloon catheter (10) having a shaft (12) and at least one balloon (14; 14.1, 14.2) which is arranged along the shaft (12) and which can be expanded by means of an expansion medium, enclosing a balloon interior (18, 18.1, 18.2). The shaft (12) has a first lumen (20) which is enclosed by a shaft inner wall (19) and designed and arranged for guiding the expansion medium along the shaft (12) in the direction of a distal catheter end (36). A second lumen (22) of the stem (12) surrounded by a stem outer wall (23) and for guiding the expansion medium along the stem (12) towards a proximal catheter end (28) and through the balloon (14; 14.1, 14.2). is designed and arranged, serves to expand the balloon (14, 14.1, 14.2) by means of expansion medium from a contracted to an expanded state. The first lumen (20) is disposed within the second lumen (22) and opens into an orifice (21) so that liquid can escape from the first lumen (20) and enter the second lumen (22). The second lumen (22) is fluidly connected to at least two openings (25.1, 25.2) in the shaft outer wall (23) with a balloon interior (18; 18.1, 18.2), of which a first (25.1) of the openings is closer to a distal balloon section end (24) is as a second (25.2) of the openings.

Description

The invention relates to a balloon catheter having at least one expandable balloon arranged on a shaft.

Balloon catheters are known from the prior art, in particular in the form of expandable balloons, and in the form of expandable balloon electrodes.

Balloon catheters find use in angioplasty, where they serve to remove stenoses (constrictions of, for example, blood vessels or other hollow organs) by pushing the balloon into the constriction and inflating it with pressure, which results in a widening of the constriction. Furthermore, balloon catheter with conductive balloon surface can be used for the ablation and electrocoagulation of deposits / tissue. In this case, a high-frequency AC voltage is applied to the electrodes, which is generated by the surface of the balloons, which can ablate, coagulate or cut the surrounding tissue.

US 5,938,660 discloses a method for cylindrical ablation of vessels, in particular lungs-related veins leading to the left atrium of the heart, and devices for creating lesions by cylindrical ablation. The devices consist of a catheter which contains at its distal end two expandable balloons / seals and between which an ablation electrode is arranged. The balloons create a closed cylindrical cavity into which an electrically conductive liquid is introduced to perform over this the cylindrical ablation. The balloons additionally serve to occlude the pulmonary vein to prevent blood flow into the ablation area.

US 5,860,974 discloses a device for lesioning the vessels in the heart, which consists of a catheter characterized in that the end thereof comprises an electrode-occupied or conductive-surfaced balloon small on the way to the heart and thereby maneuverable Heart is inflated to produce the largest possible electrically conductive surface.

WO 2011/060200 and EP 2 320 821 each reveal balloon catheter with chilled balloon. A catheter shaft has for this purpose two lumens. A cooling fluid can be supplied to the interior of a balloon via a first lumen and can emerge from the balloon via a second lumen.

The aim of the invention is to provide an improved balloon catheter.

According to the invention, this object is achieved by a balloon catheter having a flexible elongated hollow shaft and at least one balloon which is arranged along the shaft and expandable by means of an expansion medium. The shaft includes a first lumen bounded by a shaft inner wall for guiding the expansion fluid along the shaft toward a distal catheter end. A second lumen is enclosed by a shaft outer wall and guides the expansion medium along the shaft towards the proximal catheter end and through the balloon to expand the balloon from a contracted to an expanded state by means of expansion medium. The first lumen is arranged within the second lumen and opens into an orifice in the second lumen, so that liquid can escape from the mouth of the first lumen and enter the second lumen. The second lumen is fluidly coupled to a balloon interior of the balloon via at least two openings in the shaft outer wall. A first one of the openings is closer to a distal balloon section end than a second one of the openings.

In a first contracted state, the maximum diameter of the balloon catheter is preferably at most 2 mm (6 French), which allows the balloon catheter to be delivered to its treatment site via an endoscope or directly through cavities in the human or animal body. The balloon can be expanded by means of the expansion medium, which is guided via the lumina located in the shaft into the interior of the balloon. When expanded, the maximum diameter of the balloon catheter is preferably up to 20 mm (60 French), which ensures that the tissue to be ablated is in contact with the expanded balloon. The second lumen, which is separated from the first lumen within the stem of the balloon catheter and fluidly connected to the balloon interior via openings to expand it, also serves to return the expansion medium to the catheter proximal end. Thus, a circulation of the expansion medium can be generated, wherein the expansion medium is preferably a cooling fluid, e.g. NaCl solution or the like, or is a cooling fluid.

The invention includes the realization that ablation with ablation electrodes without cooling only reaches closely adjacent tissue and thus the effective range is limited to the tissue layers closest to the ablation electrodes. Nearby tissue layers are dried out or burned (carbonized) during ablation due to the higher current density and the associated heat development in the vicinity of the ablation electrodes further guidance of the ablation current as well as heat is prevented by the closest tissue layers to more distant tissue layers. The invention provides an alternative solution for cooling the electrodes of a balloon catheter.

In a preferred embodiment, the expandable balloon has at least one electrically conductive surface portion, e.g. an electrode or a conductive material or the like which is formed as an ablation electrode and which is cooled by the cooling fluid contained in the expansion medium, whereby the Ablationsvolumen is increased, compared to the uncooled state.

The electrically conductive surface portion is such that it allows expansion and contraction of the balloon. The electrically conductive surface portion may comprise a reversibly deformable wire mesh, e.g. in the form of a cylindrical, braided, spiral lattice or cage or the like. In a further embodiment, the electrically conductive surface portion may be used as an electrically conductive elastomer with metal particles, e.g. Gold or the like, enriched. By almost any disposability of balloons along the shaft, bipolar balloon catheters with high versatility are conceivable, e.g. with balloon spacing adapted to an individual problem and location along the shaft.

In a preferred embodiment, between the two openings in the shaft outer wall at least one flow reducing agent, e.g. a flow restrictor, such as a throttle, a reduction, a restriction, such as a rib or the like arranged, which reduces a flow of an expansion medium along a flow reduction section in the second lumen in operation. In operation, it is meant herein as the condition in which expansion medium is delivered from the proximal end of the catheter through the first lumen into the shaft and over the second lumen and the balloon or balloons flow back to the proximal end of the catheter. The flow reduction section preferably extends between the first and second openings. Preferably, a flow reduction means is arranged at or near the first opening of the shaft outer wall. The flow reduction means may extend from a proximal opening end of the first opening into the second lumen, thereby reducing the flow of expansion medium along a portion of the second lumen during operation. This leads to an increased inflow of expansion medium through the first opening into the balloon interior. In addition, with a suitable form of flow-reducing agent, a flow-reducing agent extending into the second lumen can have the effect that expansion medium from the second lumen is increasingly directed into the balloon.

In a further embodiment, one or more openings is partially or completely bounded by a wall section of the outer wall of the shank which extends outward and / or inwardly with respect to the second lumen. The wall portion may be made of the material of the shaft outer wall or of another material, e.g. a pliable material that fits in the contracted state of the balloon in a part of the opening or completely in the opening and upon expansion of the balloon by the pressure prevailing in the expansion medium pressure completely releases the opening and extends into the balloon interior. Preferably, a wall portion bounding the first opening is disposed at a proximal opening end of the first opening and extends inwardly into the second lumen. Alternatively or additionally, a wall section bounding the first opening may also be arranged at a distal opening end of the first opening and extend outward into the interior of the balloon. A wall portion delimiting the second opening is preferably arranged at the distal opening end and extends inwardly into the second lumen. A further or alternative wall section delimiting the second opening may be arranged at the proximal opening end and extend outward into the interior of the balloon.

In a preferred embodiment, the mouth of the first lumen is closer to the distal catheter end than the first opening of the shaft outer wall. Instead of the mouth, the first lumen may also terminate in one or more openings or a point. The tip in which the first lumen ends is preferably rounded and made of the same material as the shaft inner wall. The openings may be arranged on the circumference of the first lumen and are preferably arranged near the distal end of the first lumen or near the tip. It is also conceivable that one or more openings of the shaft inner wall can be arranged in the vicinity of the first opening of the shaft outer wall and thus expansion medium from the first lumen through the openings of the shaft inner wall in the second lumen can flow to from this almost without travel through the first Opening into the balloon interior to flow. The openings of the shaft inner wall can also be positioned by moving the shaft inner wall or the first lumen with respect to the second lumen or the shaft outer wall and their openings.

The shank inner wall enclosing the first lumen may be partially connected to the shank outer wall, for example via transverse struts or similar. Alternatively, the shaft inner wall can also be displaceable along the longitudinal direction of the shaft, as a result of which the position of the mouth of the first lumen along the longitudinal direction of the shaft can be selected almost arbitrarily, in particular also during operation. A plurality of balloons arranged along the stem can thus be selectively supplied with expansion medium.

The balloon or balloons may form a distal end portion of the balloon catheter, referred to herein as a balloon portion. The balloon portion can also be arranged along almost any position of the shaft. The balloon or balloons are disposed between a proximal balloon portion end and a distal balloon portion end. The first opening may be located at or near the distal balloon portion end. The second opening is preferably located at or near the proximal balloon portion end, such that, in use, expansion medium exiting the first opening flows toward the proximal end of the catheter through the balloon interior to the second opening. The second lumen configured to recirculate the expansion medium may include a flow restrictor, e.g. Throttle valve, reduction or the like, with an upstream side and a downstream side, which are arranged so that they represent a flow resistance for the second lumen flowing through the expansion medium and at the same time cause on the upstream side of the flow restrictor in operation, a higher static pressure in the expansion medium prevails, as on the downstream side of the flow restrictor.

The expansion medium may, in addition to its expansion and cooling properties, additionally comprise a contrast agent, e.g. Barium sulfate-containing suspensions, iodine-containing contrast agents or the like, whereby the position and size of the balloon of the balloon catheter can be determined, e.g. by X-ray diagnostics.

The balloon catheter may have at its distal catheter end a probe tip which is connected to a tension member, e.g. a pull wire or the like, tensile and can be guided along the shaft to the proximal catheter end. There, a tension on the tension element can be exerted via a tensioning device, whereby the probe tip can be pulled in the proximal direction. The balloon can be pushed together in the catheter longitudinal direction by the compressive stress emanating from the probe tip and consequently bulge outwards, ie. he can expand. In a particularly preferred embodiment, the balloon is supported by spring-elastic deflectable spring struts arranged along its longitudinal axis, which are compressed by the compressive stress emanating from the probe tip and bulge in the circumferential direction and thus support the expansion of the balloon. As spring struts come all types of leaf spring elastically deflectable, in the relaxed state along the catheter longitudinal axis extending elements in question, which can span the balloon and, for. can also be integrated into the balloon envelope.

If expansion of the balloon is accomplished via the tension member, the expansion medium does not necessarily serve to expand the balloon and may also be a pure cooling fluid that is not needed for expansion and can be used solely for cooling. When there is both a traction element and a flow restrictor, balloon expansion can be accomplished by both one means (pressurized expansion medium) and the other means (traction element), as well as by the combination of both means.

In order to supply current to ablation electrodes contained on the balloon or the balloons, the tension element can be connected in an electrically conductive manner and at the proximal catheter end of the balloon catheter to a current or voltage source. The tension member may also be formed only to be supplied with current of the ablation electrodes, e.g. in the form of a wire.

In a further embodiment, the balloon may carry a stent or a plurality of stents, which rest on the balloon surface and are permanently settable at the treatment site.

In a preferred embodiment, the balloon or balloons on a sleeve or more sleeves, which can be displaced in the catheter longitudinal direction. The sleeve may be arranged to enclose the balloon at one longitudinal end over an adjustable length such that an expandable length of the balloon is adjustable. The sleeves can z. B. be designed as a hollow thread or the like. This allows the length of the cylindrical ablation / coagulation surface to be accurately adjusted to reduce excessive tissue destruction at the treatment site.

A non-expandable sleeve, when located between the longitudinal ends of the balloon, may divide the balloon portion into a plurality of balloons as it prevents the portion of the balloon portion surrounded by it from expanding. This is z. For example, it is possible to carry out several small-area cylindrical ablations. The cuff can be slidable, like a sliding sleeve or stationary. A cuff in the form of a glued ring is stationary and permanently divides a balloon section into two balloons.

The combination of multiple sleeves and / or cuffs along the balloon section provides many configuration options for the shape of the electrically conductive surface portion of the balloon, allowing the ablation surface created thereby to be tailored to the treatment site.

The balloon may have various shapes, for example, a typical spherical balloon shape, a diamond-shaped shape, or the like, e.g. by the balloon structure by ribs, cross struts, spring struts or the like is given.

The openings in the shaft outer wall and / or shaft inner wall may be slit-shaped, circular, elliptical, triangular, latticed, sieve-shaped openings or the like.

The invention will now be explained in more detail with reference to embodiments schematically illustrated in the figures. From the figures show:

1 a schematic representation of a balloon catheter;

2 a schematic representation of a balloon portion of a first embodiment of a balloon catheter according to the invention in a first (expanded) state;

3 a schematic representation of a balloon portion of a second embodiment of a balloon catheter according to the invention in a first (expanded) state;

4 a schematic representation of a balloon portion of a third embodiment of a balloon catheter according to the invention in a first (expanded) state;

5 a schematic representation of a shaft of a balloon catheter according to the invention from a second perspective;

6 a schematic representation of a balloon portion of a fourth embodiment of a balloon catheter according to the invention in a second (non-expanded) state;

7 a schematic representation of a balloon portion of a fourth embodiment of a balloon catheter according to the invention in a first (expanded) state;

In 1 is a balloon catheter according to the invention 10 shown schematically and in an expanded state. The balloon catheter 10 has a hinged, elongated hollow shaft 12 and at a distal catheter end 36 a balloon 14 standing in a balloon section 16 of the balloon catheter 10 is arranged. Instead of a balloon 14 can also have multiple balloons, eg, two balloons 14.1 and 14.2 be provided; please refer 6 and 7 ,

The balloon 14 or the balloons 14.1 and 14.2 are by introducing an expansion medium into a respective balloon interior 18 . 18.1 respectively. 18.2 of the respective balloon 14 . 14.1 respectively. 14.2 expandable, ie from a contracted state ( 6 ) into an expanded state ( 1 to 4 and 7 ). 2 to 4 show an enlargement of embodiments of a balloon section 16 with the balloon 14 in the expanded state. 7 shows an embodiment of a balloon section 16 with the balloons 14.1 and 14.2 in the expanded state and 6 shows an embodiment similar to the embodiment 7 in the contracted state. In the various embodiments, various features are highlighted, a combination of some or all of these features with the features of one of the other embodiment is conceivable insofar as this leads to a reasonable expert combination of meaningful combination of features.

For introducing expansion medium into the shaft 12 toward the distal end of the catheter 36 is a first lumen 20 provided, which longitudinally along the shaft 12 runs, from a shaft inner wall 19 is enclosed and in an estuary 21 empties. The estuary 21 or mouth openings 21 ( 6 ) of the shaft inner wall 19 may be slit-shaped, circular, elliptical, triangular, latticed, sieve-shaped openings or the like and at the distal end of the shaft inner wall 19 or near the distal end of the shaft inner wall 19 be arranged on the circumference.

For the expansion medium to circulate and serve as a cooling fluid, there is a second lumen 22 provided, which also in the longitudinal direction along the shaft 12 runs, from a shaft outer wall 23 is enclosed and from the first lumen 20 is disconnected. Both lumens 20 . 22 can, as in 1 to 7 is shown concentric, ie the first lumen 20 runs inside the second lumen 22 What's best in perspective 5 can be seen.

To a flow through the balloon 14 or the balloons 14.1 and 14.2 preferably over the entire length of the balloon section 16 to allow is a first opening 25.1 respectively. 25.1b in the shaft outer wall 23 near a balloon distal end 24 arranged while a second opening 25.2 respectively. 25.2b in the shaft outer wall 23 near a proximal balloon portion end 26 is arranged ( 2 ). The openings 25.1 and 25.2 can also be at other positions along the shaft outer wall 19 inside the balloon 14 . 14.1 respectively. 14.2 be arranged. Expansion medium can be along the second lumen 22 toward a proximal catheter end 28 flow and through the first opening 25.1 in the balloon interior 18 reach. From the balloon interior 18 can the expansion medium through the second opening 25.2 into the second lumen 22 drain into it and in the second lumen 22 along the shaft 12 toward the proximal end of the catheter 28 expire. As a result, expansion medium can circulate and serve as a cooling fluid.

Alternatively, however, also the second lumen 22 Expansion medium towards the distal end of the catheter 36 lead and the expansion medium from the first lumen 20 toward the proximal end of the catheter 28 expire (not shown).

In 2 is a flow restrictor 30 arranged so that they pass through the second lumen 22 flowing expansion medium is a flow resistance that leads to a pressure drop, with the result that on an upstream side 32 the flow restrictor 30 a higher static pressure prevails in the expansion medium than on the downstream side 34 the flow restrictor 30 , The flow restrictor 30 thus reduces the flow along a flow reduction section 29 between the first opening 25.1 and second opening 25.2 in the second lumen 22 and causes expansion medium preferably through the first opening 25.1 in the balloon interior 18 flows. ribs 27.1 and 27.3 extending from the shaft outer wall 19 in the balloon interior 18 are to guide the flow in and inside the balloon 18 provided and form limiting wall sections for the first opening 25.1 and for the second opening 25.2 ,

In 3 and 4 a rib extends 27.2 from a proximal opening end 33.1 the first opening 25.1 into the second lumen 22 and reduced with the rib 27.2 the flow along the flow reduction section 29 in the second lumen 22 , The rib 27.2 In addition, the flow of expansion medium from the second lumen serves 22 in the balloon interior 18 to guide and expand and cool this. Another rib 27.1 extends from the distal opening end 31.1 the first opening 25.1 in the balloon interior 18 and is designed to direct the flow. The second opening 25.2 is in the embodiments in 3 and 4 as a hole or slot, ie without limiting, in the second 22 Lumen or the balloon interior 18 protruding wall section or rib 27.3 respectively. 27.4 , executed. The openings 25.1 respectively. 25.2 in the shaft outer wall 23 For example, they may be slit-shaped, circular, elliptical, triangular, latticed, sieve-shaped openings or the like.

In 6 and 7 ribs extend 27.2 and 27.2b from the first openings 25.1 and 25.1b into the second lumen 22 and reduce the flow along a respective portion of the second lumen 22 , Ribs 27.1 and 27.1b are in 6 not visible as they close the openings. Only by pressure of the expansion medium on the ribs 27.1 and 27.1b These release the openings and enter the balloon interior 18.2 and 18.1 Press and expand the balloons 14.2 and 14.1 , compare to this 6 and 7 ,

There may also be one or more flow restrictors 30 ( 2 ) and / or one or more ribs 27.2 . 27.2b ( 3 . 4 . 6 . 7 ) respectively. 27.4 ( 1 ) so that they pass through the second lumen 22 flowing expansion medium represent a flow resistance, which leads to a pressure drop, with the result that on an inflow side 32 the flow restrictors 30 and / or ribs 27.2 . 27.2b respectively. 27.4 a higher static pressure prevails in the expansion medium than on the downstream side 34 the flow restrictors 30 and / or ribs 27.2 . 27.2b respectively. 27.4 , This causes the expansion medium through the first opening 25.1 in the balloon interior 18 . 18.1 respectively. 18.2 flows and expands and / or cools ( 1 to 4 and 7 ).

If in an embodiment, not shown, the second lumen 22 is used as a leading lumen and the first lumen 20 as the returning lumen, is the flow restrictor 30 between the second opening 25.2 and first opening 25.1 arranged such that a flow along a flow reduction section 29 of the second lumen 22 is reduced and the expansion medium through the balloon interior 18 . 18.1 respectively. 18.2 in the first opening 25.1 flows. Alternatively or additionally, a rib can also be used 27.4 in the second opening 25.2 be arranged, which the flow along a flow reduction section 29 of the second lumen 22 reduced. Also one at the distal opening end 33.1 the first opening 25.1 respectively. 25.1b attached rib 27.1 respectively. 27.1b It is conceivable that the flow in the balloon interior 18 . 18.1 respectively. 18.2 can support.

Generally one is at the distal 31.1 respectively. 31.2 and / or proximal opening end 33.1 respectively. 33.2 the first 25.1 or second opening 25.2 attached rib 27.1 . 27.2 . 27.3 respectively. 27.4 conceivable in the balloon interior 18 . 18.1 respectively. 18.2 or the second lumen 22 can extend and can be oriented with or against the flow direction during operation. It is also possible to combine several ribs at one or more openings.

Preferably, the ribs are made of a pliable material, so that the ribs in a contracted state of the balloon 14 . 14.1 respectively. 14.2 from the contracted balloons 14 . 14.1 respectively. 14.2 in the openings 25.1 respectively. 25.2 are pressed and these partially or completely close ( 6 ). Preferably, the ribs are only in operation by the pressure in the expansion medium to the outside in the balloon interior 18 . 18.1 respectively. 18.2 pressed and release the opening, allowing expansion medium into the balloon interior 18 . 18.1 respectively. 18.2 can get and the balloon 14 . 14.1 respectively. 14.2 can expand (cf. 6 to 7 ).

If like in 1 represented the first lumen 20 the expansion medium towards the distal end of the catheter 36 leading lumen is and near the distal balloon section end 24 Expands expansion medium flows as cooling fluid from the first lumen 20 out and into the second lumen 22 into it. The second lumen 22 guides the expansion medium along the shaft 12 toward the proximal end of the catheter 28 and over the openings 25.1 and 25.2 through the balloon interior 18 or the balloon interiors 18.1 and 18.2 back. However, the flow of the expansion medium can also take place in the opposite direction.

It makes sense in any case, if with coaxial arrangement of the lumens 20 and 22 the respective inner lumen near the distal end of the balloon 24 ends, while the outer of the two lumens at the distal end of the balloon section 26 ends. The first lumen may also be slidable in the second lumen 22 be arranged (not shown).

At its distal catheter end 36 is the balloon catheter 10 with a probe tip 37 sealed fluid-tight. The first, preferably expansion medium towards the distal end of the catheter 36 leading and inner lumens 20 ends just before the tip of the probe 37 ,

In the embodiments illustrated in the figures, the balloon catheter 10 also a tension element 38 on, which is along the shaft 12 and by the balloon 14 or the balloons 14.1 and 14.2 to the probe tip 37 leads and is firmly connected to this. The tension element 38 For example, a wire may be inside of the inner, first lumen 20 runs and from the proximal end of the catheter 28 off can be operated. With the help of the tension element 38 may be a pull on the probe tip 37 be exerted to the probe tip 37 towards the proximal end of the balloon section 26 to draw. With appropriate training of the balloon 14 or the balloons 14.1 and 14.2 This may or may be done solely by pulling the probe tip 37 In the direction of the proximal end of the balloon 26 - be expanded, ie the balloons in this training are zugexpandierbar. To the balloons 14 . 14.1 and 14.2 can be deployed to expand the balloons 14 . 14.1 and 14.2 for example, in the longitudinal direction of the balloon catheter 10 from the proximal balloon section end 26 to the distal end of the balloon 24 running, stretched in the relaxed state resilient deflectable spring struts 40 which bulge circumferentially (outwardly) as the probe tip 37 towards the proximal end of the balloon section 26 moves (s. 3 and 7 ). By this Nachaußenbölben the spring struts 40 becomes the balloon 14 or are the balloons 14.1 and 14.2 expanded. Will the tension element 38 released again, the spring struts return 40 back to their relaxed, stretched state and push the probe tip 37 again away from the proximal balloon section end 26 and the balloon 14 or the balloons 14.1 and 14.2 contract again.

The balloon 14 or the balloons 14.1 and 14.2 So you can alone with the help of the tension element 38 are expanded, so a pressurized expansion medium is not necessary. However, it may be beneficial to use the balloon 14 or the balloons 14.1 and 14.2 simultaneously both by means of the tension element 38 as well as by means of a pressurized expansion medium to expand.

Because expansion of the balloon 14 or the balloons 14.1 and 14.2 in a zusxpandierbaren execution not necessarily requires additional expansion medium, the expansion medium may also be a pure cooling fluid.

The shaft inner wall 19 and the shaft outer wall 23 are preferably made of a fluid-tight, elastic and electrically insulating material, for example of a plastic, such as PVDF, PEEK or the like. The outer shaft wall 23 can be inside of a wire helix 44 ( 6 ), which is designed so that the balloon catheter 10 overall sluggish is. Such a wire helix 44 may also be formed as an electrical conductor and also serves to axially on a proximal shaft portion 42 to absorb acting compressive forces, as is known for example from Bowden cables. The wire helix 44 can then help to ensure that between the distal wire coil end 46 and the probe tip 37 an axial compressive force on the balloon section 16 is formed so that it is shortened and the balloon 14 or the balloons 14.1 and 14.2 bulge in the above expandable sense.

On the outer surface of the balloon 14 or the balloons 14.1 and 14.2 is preferably in each case at least one ablation electrode 48 respectively. 48.1 and 48.2 provided, which is formed by an electrically conductive surface portion of the respective balloon 3 . 6 and 7 ). Preferably, the ablation electrode 48 respectively. 48.1 and 48.2 an elastically expandable and contractible wire mesh (not shown). The wire mesh may be formed, for example, in the form of a cylindrical, braided, spiral-shaped grid, cage or the like. An alternative embodiment is possible in the form of an electrically conductive elastomer, which is enriched with metallic particles, for example silver particles or the like. The wire mesh may be on the balloons 14 . 14.1 . 14.2 rest or the balloons 14 . 14.1 and 14.2 or form their balloon surface. The as ablation electrodes 48 respectively. 48.1 and 48.2 serving, electrically conductive surface portions of the balloon 14 or the balloons 14.1 and 14.2 are each with an electrical conductor of the balloon catheter 10 electrically connected. Such an electrical conductor, for example, on the one hand, the tension element 38 and on the other hand the wire helix 44 in the proximal shaft part 42 of the balloon catheter 10 , The tension element 38 can also be designed as a simple electrically conductive wire and fixed to the distal end of the catheter 36 or the top 37 be connected so that the tension element 38 in this case is not usable for expansion of the balloon. It is also conceivable that the expansion medium contains or is an electrically conductive fluid, for example an electrolyte.

In 3 is a balloon 14 shown with a typical spherical balloon shape. The balloon may also have other shapes, for example, a diamond-shaped shape as in 4 represented, or the like. The shape of the balloon 14 or the balloon structure can, for example by ribs, cross struts, spring struts 40 or the like may be predetermined.

The balloon 14 may have at its proximal end a displaceable sleeve in the form of a proximal hollow thread and at its distal end a displaceable sleeve in the form of a distal hollow thread (not shown). About the length of the in the balloon section 16 einragenden part of the hollow thread is the length and thus the expandable surface of the balloon 14 adjustable. Expanding the balloon 14 is in the surrounded by the hollow thread portion of the balloon section 16 prevented. The length and / or the material of the sleeves is designed such that the balloon catheter 10 limp is. Furthermore, only one end of the balloon can 14 have a hollow thread, for example, preferably the proximal end. Thus, the ablation area can be accurately adjusted, whereby unnecessary injury to healthy tissue can be reduced.

To several balloons on the balloon section 16 to create one or more non-expandable cuffs 54 on the balloon 14 be arranged. In 6 and 7 is a balloon 14 by attaching a non-expandable sleeve 54 in two balloons 14.1 and 14.2 split, because the non-expandable cuff 54 a section of the balloon 14 prevents it from expanding ( 7 ). The cuff 54 can be displaceable or not displaceable, z. B. in the form of a glued ring or the like.

A combination of different sleeves and / or cuffs can be used to make multiple balloons 14 . 14.1 . 14.2 different length in the balloon section 16 to arrange (not shown), whereby the Ablationsfläche can be adjusted more precisely. On the balloon section 16 , or on the balloons 14 . 14.1 . 14.2 Stents can rest with the balloon catheter 10 can be brought to a treatment location to be permanently discontinued there (not shown). The stents can additionally be used to cover the surface of the ablation electrode 48 . 48.1 . 48.2 increase if the stent or stents contain or consist of an electrically conductive material.

LIST OF REFERENCE NUMBERS

10

 balloon catheter

12

 shaft

14

 balloon

16

 balloon portion

18

 Balloon interior

19

 Stem inner wall

20

 first lumen

21

 muzzle

22

 second lumen

23

 Shank outer wall

24

 distal balloon end

25

 Opening in the shaft outer wall

26

 proximal balloon section end

27

 rib

28

 proximal catheter end

29

 Flow reduction section

30

 flow throttle

31

 proximal opening end

32

 inflow

33

 distal opening end

34

 outflow

36

 distal catheter end

37

 probe tip

38

 tension element

40

 spring braces

42

 proximal shaft part

44

 wire helix

46

 distal wire coil end

48

 ablation

54

 non-expandable cuff

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• US 5938660 [0004]
• US 5860974 [0005]
• WO 2011/060200 [0006]
• EP 2320821 [0006]

Claims (18)

Balloon Catheter ( 10 ) with a shaft ( 12 ) and at least one along the shaft ( 12 ) expandable by an expansion medium balloon ( 14 ; 14.1 . 14.2 ) having a balloon interior ( 18 ; 18.1 . 18.2 ), wherein the shaft ( 12 ) a first lumen ( 20 ), which of a shaft inner wall ( 19 ) and for guiding the expansion medium along the shaft ( 12 ) towards a distal catheter end ( 36 ) is formed and arranged, wherein the shaft ( 12 ) a second lumen ( 22 ), which of a shaft outer wall ( 23 ) and for guiding the expansion medium along the shaft ( 12 ) towards a proximal catheter end ( 28 ) and through the balloon ( 14 ; 14.1 . 14.2 ) is formed and arranged to the balloon ( 14 ; 14.1 . 14.2 ) to expand from a contracted to an expanded state by means of expansion medium, wherein the first lumen ( 20 ) within the second lumen ( 22 ) and in an orifice ( 21 ), so that there liquid from the first lumen ( 20 ) and into the second lumen ( 22 ), and wherein the second lumen ( 22 ) at least over two openings ( 25.1 . 25.2 ) in the shaft outer wall ( 23 ) with a balloon interior ( 18 ; 18.1 . 18.2 ) is fluidly connected, of which a first ( 25.1 ) of the openings to a distal balloon end ( 24 ) is closer than a second ( 25.2 ) of the openings. Balloon Catheter ( 10 ) according to claim 1, wherein between the two openings ( 25.1 . 25.2 ) in the shaft outer wall ( 23 ) at least one flow reduction agent ( 27 ; 30 ), which is a flow of an expansion medium along a flow reduction section (FIG. 29 ) in the second lumen ( 22 ) reduced during operation. Balloon Catheter ( 10 ) according to at least one of claims 1 or 2, wherein the first opening ( 25.1 ) a flow reducing agent ( 27 ) extending from a proximal opening end ( 31.1 ) of the first opening ( 25.1 ) into the second lumen ( 22 ) and a flow of an expansion medium in the second lumen (FIG. 22 ) reduced during operation. Balloon Catheter ( 10 ) according to at least one of claims 1 to 3, wherein at least one of the openings ( 25.1 . 25.2 ) at least partially from one with respect to the second lumen ( 22 ) outwardly and / or inwardly extending wall portion ( 27.1 . 27.2 ) of the shaft outer wall ( 23 ) is limited. Balloon Catheter ( 10 ) according to claim 4, wherein one at the proximal opening end ( 31.1 ) of the first opening ( 25.1 ), the first opening ( 25.1 ) delimiting wall section ( 27.1 ) into the second lumen ( 22 ) extends inwardly and / or at the distal opening end ( 33.1 ) of the first opening ( 25.1 ), the first opening ( 25.1 ) delimiting wall section ( 27.2 ) into the balloon interior ( 18 ; 18.1 . 18.2 ) extends outwards. Balloon Catheter ( 10 ) according to at least one of claims 1 to 5, wherein the mouth ( 21 ) of the first lumen ( 20 ) the distal end of the catheter ( 36 ) is closer than the first opening ( 23.1 ). Balloon Catheter ( 10 ) according to at least one of claims 1 to 6, wherein the balloon ( 14 ; 14.1 . 14.2 ) or the balloons ( 14 ; 14.1 . 14.2 ) a balloon section ( 16 ) as a distal end portion of the balloon catheter ( 10 ) extending from a proximal balloon end ( 26 ) to a distal balloon end ( 24 ) of the balloon section ( 16 ), wherein the first opening ( 25.1 ) at or near the distal balloon end ( 24 ), while the second opening ( 25.2 ) at or near the proximal balloon end ( 26 ) is arranged so that in operation from the first opening ( 23.1 ) exiting expansion medium in the direction of the proximal catheter end ( 28 ) through the balloon interior ( 18 ; 18.1 . 18.2 ) to the second opening ( 23.2 ) flows. Balloon Catheter ( 10 ) according to at least one of claims 1 to 7, characterized by an upstream side ( 32 ) and a downstream side ( 34 ) having flow restrictor ( 30 ) which is arranged to provide a flow resistance through the second lumen (FIG. 22 ) forms expanding expansion medium and causes on the upstream side ( 32 ) of the flow restrictor ( 30 ) in operation there is a higher static pressure in the expansion medium than on the downstream side ( 34 ) of the flow restrictor ( 30 ). Balloon Catheter ( 10 ) according to at least one of claims 1 to 8, wherein the balloon ( 14 ; 14.1 . 14.2 ) has at least one electrically conductive surface portion, which as ablation electrode ( 48 ; 48.1 . 48.2 ) and is adapted to cause expansion and contraction of the balloon ( 14 ; 14.1 . 14.2 ) allowed. Balloon Catheter ( 10 ) according to claim 9, wherein the electrically conductive surface portion of the balloon ( 14 ; 14.1 . 14.2 ) has a reversibly expandable and contractible wire mesh. Balloon Catheter ( 10 ) according to at least one of claims 1 to 10, wherein the balloon catheter ( 10 ) at its distal catheter end ( 36 ) a probe tip ( 37 ) having. Balloon Catheter ( 10 ) according to claim 11, characterized by a tension element ( 38 ) connected to the probe tip ( 37 ) tensile strength and along the shaft ( 12 ) is guided. Balloon Catheter ( 10 ) according to claim 12, wherein the tension element ( 38 ) is electrically conductive. Balloon Catheter ( 10 ) according to at least one of claims 1 to 13, wherein the balloon ( 14 ; 14.1 . 14.2 ) has a stent or stents on the balloon ( 14 ; 14.1 . 14.2 ) and are permanently deductible to a treatment location. Balloon Catheter ( 10 ) according to at least one of claims 1 to 14, wherein the maximum diameter of the balloon catheter ( 10 ) in the contracted state of the balloon ( 14 ; 14.1 . 14.2 ) is no larger than 2 mm (6 French). Balloon Catheter ( 10 ) according to at least one of claims 1 to 15, characterized by at least one sleeve displaceable in the catheter longitudinal direction ( 50 . 52 ), which is arranged so that the balloon ( 14 ; 14.1 . 14.2 ) at one longitudinal end over an adjustable length such that an expandable length of the balloon ( 14 ; 14.1 . 14.2 ) is adjustable. Balloon Catheter ( 10 ) according to at least one of claims 1 to 16, characterized by at least one in or near a surface of the balloon ( 14 ; 14.1 . 14.2 ) in the longitudinal direction within the balloon section ( 16 ) arranged resilient deflectable spring strut ( 40 ), which is arranged and executed in such a way that when the balloon section is shortened ( 16 ) elastically bulges outwards and the balloon ( 14 ; 14.1 . 14.2 ) expands. Balloon Catheter ( 10 ) according to at least one of claims 1 to 17, wherein the balloon ( 14 ; 14.1 . 14.2 ) or the balloons ( 14 ; 14.1 . 14.2 ) a balloon section ( 16 ) of the balloon catheter ( 10 ), the balloon ( 14 ; 14.1 . 14.2 ) or the balloons ( 14 ; 14.1 . 14.2 ) by at least one non-expandable cuff ( 54 ), which covers a portion of the balloon section ( 16 ) prevents it from expanding into other balloons ( 14 ; 14.1 . 14.2 ) are divided.

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