Stent graft sequential post-release device and stent graft delivery system

Abstract

The present invention provides a sequential post-release device for a coated stent and a coated stent delivery system, which relates to the field of medical devices, including a limit fork and a post-release limit assembly; the limit fork includes a fork seat and a plurality of fork rods, one end of the plurality of fork rods being connected to the radial circumferential surface of the fork seat in pairs; under the limit working condition, the other ends of the plurality of fork rods pass through the stent ring at the proximal end of the coated stent one by one, and are fixed to the post-release limit assembly; under the release working condition, the fork seat drives the plurality of fork rods to move toward the distal end direction of the post-release limit assembly, thereby releasing the proximal end of the coated stent; the post-release limit assembly is configured to cooperate with the limit fork, so that the action of the proximal end of the coated stent being released by the limit fork occurs after the action of the outer tube releasing the proximal end of the coated stent; the fork seat and the post-release limit assembly are both provided with operating holes that can be passed by a guide wire. The present invention alleviates the problem that the existing coated stent delivery system cannot ensure the primary and secondary sequential release of the coated stent.

Description

Technical Field

[0001] The present invention relates to the technical field of medical devices, and in particular to a stent graft sequential post-release device and a stent graft delivery system. Background Art

[0002] Aortic disease is a group of cardiovascular diseases that seriously threaten human health, including aortic dissection, aortic aneurysm, etc., which are mainly caused by hypertension, arteriosclerosis, injury, infection and other reasons, and pose a great threat to the patient's life. The traditional surgical method is to introduce extracorporeal circulation, perform open surgery, and replace artificial blood vessels at the damaged site, but open surgery takes a long time, causes great surgical trauma, and has an extremely high mortality rate.

[0003] In recent years, it has become popular to use minimally invasive interventional methods to repair patients' affected blood vessels. Through a unique delivery system, the covered stent is released to the location of vascular lesions to repair aortic dissection and aortic aneurysm vessels, thereby protecting the diseased blood vessels from rupture and causing death.

[0004] Before release, the stent graft needs to be loaded into the delivery system first, and then the stent graft is slowly opened by releasing the outer tube. This release is called a single release. After the single release is completed, the bare stent at the end of the stent graft is locked. Finally, the bare stent part of the stent graft is released by a secondary release to achieve the final complete release of the stent graft. The delivery system is then safely withdrawn from the human body without damaging the blood vessels during the withdrawal process. In the entire release process above, the order of the single release and the secondary release is crucial. Once the wrong order of release occurs, there will be two results. If the release is made outside the patient's body by mistake, the stent graft and the delivery device will be separated at the bare stent part and cannot be used again. If the release is made by mistake inside the patient's body, the stent graft will not be able to be accurately positioned, resulting in a complete failure of the operation. In severe cases, it will endanger the patient's life.

[0005] At present, the order of primary and secondary release of the stent graft by the conveyor in the stent graft delivery system cannot be fully guaranteed, which places high technical requirements on the doctor himself, resulting in high difficulty of the operation and low success rate of the operation. Summary of the invention

[0006] The purpose of the present invention is to provide a sequential post-release device for a coated stent and a coated stent delivery system to alleviate the technical problems in the prior art that the sequence of the first release and the second release of the coated stent by the conveyor in the coated stent delivery system cannot be fully guaranteed, which places high technical requirements on the doctor himself, resulting in high surgical difficulty and low surgical success rate.

[0007] To achieve the above objectives, the embodiments of the present invention adopt the following technical solutions:

[0008] In a first aspect, an embodiment of the present invention provides a sequential post-release device for a stent graft, which is applied to a stent graft conveyor with an outer tube, and includes a limit fork and a post-release limit assembly;

[0009] The limit fork comprises a fork seat and a plurality of fork rods, one ends of the plurality of fork rods being connected to the radial circumferential surface of the fork seat in pairs at intervals; the limit fork is configured such that: under the limit working condition, the other ends of the plurality of fork rods are fixed to the rear release limit assembly after passing through a plurality of stent rings arranged at the proximal end of the stent graft one by one, so as to retract the proximal end of the stent graft into the rear release limit assembly, and, under the release working condition, the fork seat drives the plurality of fork rods to move toward the distal end direction of the rear release limit assembly, so as to disengage the fork rods from the stent rings, thereby releasing the proximal end of the stent graft;

[0010] The rear release limiter assembly is configured to cooperate with the limiter fork, so that the proximal end of the stent graft is released by the limiter fork after the proximal end of the stent graft is released by the outer tube;

[0011] The fork seat and the rear release limit assembly are both provided with operation holes through which the guide wire can pass.

[0012] In an optional embodiment, a fork rod limiting groove is provided at one end of each fork rod away from the fork seat, and the notch of the fork rod limiting groove extends to the opposite surfaces of two adjacent fork rods facing each other;

[0013] The rear release limiter assembly comprises a limiter rod and a fixing seat;

[0014] The limiting rod comprises a rod body and two limiting wings, the proximal ends of the two limiting wings are symmetrically connected to the two sides of the proximal end of the rod body; the distal ends of the two limiting wings extend toward the distal end of the rod body and open in a direction away from the rod body; the two limiting wings are made of elastic material, or the two limiting wings are respectively connected to the rod body through torsion springs;

[0015] The fixing seat comprises a columnar body, one end of the columnar body in the axial direction is the proximal end of the columnar body, the other end of the columnar body in the axial direction is the distal end of the columnar body, a direction extending from the proximal end of the columnar body toward the distal end of the columnar body is a first direction, and a direction extending from the distal end of the columnar body toward the proximal end of the columnar body is a second direction:

[0016] The columnar body comprises: a first diameter-reduced section formed by reducing the diameter of a circumscribed circle of a cross section cut perpendicular to the first direction in the first direction; a radial outer peripheral surface of the first diameter-reduced section comprises a plurality of limiting units, each of the limiting units comprises a respective adjacent fork rod groove and limiting wing groove, the opening of the fork rod groove and the opening of the limiting wing groove are both toward the distal end of the columnar body, and the limiting wing groove is formed in a shape in which the opening gradually decreases in the second direction;

[0017] The limiting rod includes a plurality of limiting wing grooves corresponding to each other, and a rod body limiting portion is arranged on the radial outer circumferential surface of the columnar body. In each limiting rod, the rod body passes through the rod body limiting portion, and the proximal ends of the two limiting wings are inserted into and squeezed into the corresponding limiting wing grooves;

[0018] Under the above-mentioned limiting working condition, the working condition in which the multiple fork rods of the limiting fork are inserted into the multiple fork rod grooves one by one is the first working condition. In the first state of the first working condition, in each of the limiting rods, the distal ends of the respective limiting wings are respectively inserted into the fork rod limiting grooves of the adjacent fork rods, and the distal end of the rod body extends to the distal end of the columnar body; in the second state of the first working condition, the limiting rod slides along the second direction under the action of external force, so that in each of the limiting rods, the distal ends of the two limiting wings are continuously squeezed by the corresponding limiting wing grooves to move toward the rod body, thereby causing the distal ends of the respective limiting wings to separate from the corresponding fork rod limiting grooves.

[0019] In an optional embodiment, the rear release limiter assembly further includes an elastic energy storage member;

[0020] The elastic energy storage member comprises a plurality of elastic energy storage members which are installed in the plurality of the limiting wing grooves in a one-to-one correspondence, and the distal end of each elastic energy storage member is respectively connected or abutted with the proximal end of the rod body of the limiting rod inserted into the corresponding limiting wing groove;

[0021] In a first state of the first working condition, the elastic energy storage member is in a free or energy storage state; in a second state of the first working condition, the limit rod slides along the second direction to compress or release the elastic energy storage member.

[0022] In an optional embodiment, the elastic energy storage member is a spring; in a first state of the first working condition, the elastic energy storage member is in a state of not being fully compressed, and in a second state of the first working condition, the elastic energy storage member continues to be compressed; or, in the first state of the first working condition, the elastic energy storage member is in a free state, and in the second state of the first working condition, the elastic energy storage member is compressed.

[0023] In an optional embodiment, the elastic energy storage member adopts a spring; in the first state of the first working condition: the elastic energy storage member is in a stretched state, and in each of the limit rods, the sum of the components of the friction force of the groove wall of the limit wing groove on the two limit wings in the first direction is greater than the elastic restoring force of the corresponding elastic energy storage member acting on the two limit wings in the second direction.

[0024] In an optional embodiment, the columnar body further includes a second reduced diameter section formed by reducing the diameter of the circumscribed circle of a cross section cut perpendicular to the first direction in the first direction, and the rod body limiting portion is located between the first reduced diameter section and the second reduced diameter section.

[0025] In an optional embodiment, the rod body limiting portion includes a plurality of rod body limiting blocks;

[0026] The plurality of rod limit blocks are distributed in pairs at intervals on the radial outer circumferential surface of the distal end of the columnar body near the first diameter reduction section; guide holes are provided on the plurality of rod limit blocks, and the plurality of guide holes correspond one-to-one to the plurality of limit wing grooves; a gap is formed between each two adjacent rod limit blocks for the fork rod to pass through, and the gap corresponds one-to-one to the fork rod groove;

[0027] In each of the limiting rods, the rod body passes through a guide hole on the corresponding rod body limiting block.

[0028] In an optional embodiment, an opening area of ​​the spacing on the radial outer circumferential surface of the columnar body gradually decreases along the radial direction of the columnar body from the inside of the columnar body to the outside of the columnar body.

[0029] In an optional embodiment, in the limit rod, the rod body includes a main rod body and a guide rod body, the distal end of the guide rod body is connected to the proximal end of the main rod body, and the diameter of the circumscribed circle of the cross section formed by radially cutting the guide rod body is smaller than the diameter of the circumscribed circle of the cross section formed by radially cutting the main rod body;

[0030] The distal end of the elastic energy storage member is sleeved on the guide rod body, and the distal end surface of the elastic energy storage member abuts against the proximal end surface of the main rod body.

[0031] In an optional embodiment, a mounting blind hole is further opened inside the portion of the columnar body connected to the proximal end face of the limiting wing groove, the mounting blind hole is communicated with the limiting wing groove, and the guide rod body and the elastic energy storage member are inserted into the mounting blind hole.

[0032] In an optional embodiment, on each of the fork rods of the limiting fork, the fork rod limiting groove penetrates the fork rod along the radial circumferential direction of the fork seat.

[0033] In an optional embodiment, the fork rod limiting groove is formed by a side surface of the fork rod facing the columnar body, which is recessed in a direction away from the columnar body.

[0034] In an optional embodiment, a plurality of hooking protrusions are provided on the outer circumferential surface of the distal end of the columnar body, and the plurality of hooking protrusions are spaced apart in pairs along the radial outer circumferential surface of the columnar body for hooking a plurality of stent rings provided at the proximal end of the coated stent, and a stent ring limiting groove is formed between two adjacent hooking protrusions.

[0035] In an optional embodiment, the opening area of ​​the fork rod groove on the radial outer circumferential surface of the columnar body and the opening area of ​​the limit wing groove on the radial outer circumferential surface of the columnar body gradually decrease along the radial direction of the columnar body, from the inside of the columnar body to the outside of the columnar body.

[0036] In a second aspect, an embodiment of the present invention provides a stent graft delivery system, comprising a control handle, a guide wire tube, an inner tube, an outer tube, and a stent graft sequential post-release device according to any one of the aforementioned embodiments;

[0037] Wherein: the guide wire tube is used to pass through the guide wire; the guide wire tube passes through the inner tube, and the proximal end of the guide wire tube is inserted into and fixed in the operating hole of the rear release limit assembly; the proximal end of the inner tube is fixed in the operating hole on the fork seat; the distal ends of the outer tube and the inner tube are both connected to the control handle, and the control handle is configured to drive the outer tube and the inner tube to move forward and backward.

[0038] The embodiments of the present invention can achieve the following beneficial effects:

[0039] The first aspect of the embodiment of the present invention provides a sequential post-release device for a coated stent, which is applied to a coated stent conveyor with an outer tube, and includes a limit fork and a post-release limit assembly. Wherein: the limit fork includes a fork seat and a plurality of fork rods, one end of the plurality of fork rods is connected to the radial circumferential surface of the fork seat at intervals in pairs; the limit fork is configured to: in the limiting working condition, the other ends of the plurality of fork rods are fixed to the post-release limit assembly after passing through a plurality of stent rings arranged at the proximal end of the coated stent one by one, so as to gather the proximal end of the coated stent in the post-release limit assembly, and, in the release working condition, the fork seat drives the plurality of fork rods to move toward the distal end direction of the post-release limit assembly, so as to separate the fork rods from the stent rings, thereby releasing the proximal end of the coated stent; the post-release limit assembly is configured to cooperate with the limit fork, so that the action of the proximal end of the coated stent being released by the limit fork occurs after the action of the outer tube releasing the proximal end of the coated stent; the fork seat and the post-release limit assembly are both provided with operation holes through which a guide wire can pass.

[0040] In the sequential post-release device for the coated stent provided in the present embodiment, a limit fork and a post-release limit assembly are provided, and the post-release limit assembly cooperates with the limit fork so that the proximal end of the coated stent is released by the limit fork after the outer tube releases the proximal end of the coated stent. This ensures that the coated stent conveyor releases the coated stent once and then releases it a second time, that is, the sequential release of the first and second releases is ensured, thereby reducing surgical risks and improving surgical success rates.

[0041] In addition, an embodiment of the present invention also provides a coated stent delivery system, comprising a control handle, a guide wire tube, an inner tube, an outer tube and the coated stent sequential post-release device provided in the first aspect above; wherein: the guide wire tube is used to pass the guide wire; the guide wire tube passes through the inner tube, and the proximal end of the guide wire tube is inserted into and fixed in the operating hole of the rear release limit assembly; the proximal end of the inner tube is fixed in the operating hole on the fork seat; the distal ends of the outer tube and the inner tube are both connected to the control handle, and the control handle is configured to drive the outer tube and the inner tube to move forward and backward.

[0042] Since the coated stent delivery system provided in this embodiment includes the coated stent sequential post-release device provided in the first aspect, the coated stent delivery system provided in this embodiment can achieve all the beneficial effects that can be achieved by the coated stent sequential post-release device provided in the first aspect. BRIEF DESCRIPTION OF THE DRAWINGS

[0043] In order to more clearly illustrate the specific implementation methods of the present invention or the technical solutions in the prior art, the drawings required for use in the specific implementation methods or the description of the prior art will be briefly introduced below. Obviously, the drawings described below are some implementation methods of the present invention. For ordinary technicians in this field, other drawings can be obtained based on these drawings without paying creative work.

[0044] Figure 1 A schematic diagram of the overall structure of the connection between the sequential post-release device of the stent graft and the stent graft provided by an embodiment of the present invention;

[0045] Figure 2 for Figure 1 A magnified view of the local structure of part A;

[0046] Figure 3 It is a schematic diagram of the overall structure of an optional implementation mode of the limit fork in the embodiment of the present invention;

[0047] Figure 4 It is a schematic diagram of the overall structure of another optional implementation mode of the limiting fork in the embodiment of the present invention;

[0048] Figure 5 It is a schematic diagram of the overall structure of the columnar body of the fixing seat in the rear release limit assembly;

[0049] Figure 6 A schematic diagram of the overall structure of the columnar body of the fixing seat in the rear release limit assembly from another viewing angle;

[0050] Figure 7 for Figure 6 AA section view;

[0051] Figure 8 It is a schematic diagram of the overall structure of the limit rod in the rear release limit assembly;

[0052] Fig. 9 It is a schematic diagram of the overall structure of the rear release limiter assembly at one angle in an embodiment of the present invention;

[0053] Fig.10 It is a schematic diagram of the overall structure of the rear release limit assembly in another angle in an embodiment of the present invention;

[0054] Fig.11 for Fig.10 BB section view;

[0055] Fig.12 An assembly diagram of a stent graft sequential rear release device and an inner tube, a rear fixator and a guide wire tube in a stent graft delivery system provided in an embodiment of the present invention;

[0056] Fig.13 An exploded view of the assembly between the sequential rear release device of the coated stent and the inner tube, outer tube, rear fixator and guide wire tube in the coated stent delivery system provided in an embodiment of the present invention.

[0057] Icons: 1-limiting fork; 11-fork seat; 12-fork rod; 120-fork rod limiting groove; 2-rear release limiting assembly; 21-limiting rod; 211-rod body; 2111-main rod body; 2112-guide rod body; 2113-rod seat; 212-limiting wing; 22-fixing seat; 220-columnar body; 2201-first reduced diameter section; 20-limiting unit; 201-fork rod groove; 202-limiting wing groove; 203-installation blind hole; 2 04-hook protrusion; 2040-support ring limiting groove; 221-rod body limiting part; 2210-guide hole; 2202-second reduced diameter section; 23-elastic energy storage member; 100-fork seat mounting hole; 200-fixing seat mounting hole; 300-film support; 310-support ring; 4-guide head; 401-first connecting hole; 402-second connecting hole; 5-wire guide tube; 6-inner tube; 7-outer tube; 8-welding tube; 9-rear fixer. DETAILED DESCRIPTION

[0058] In order to make the purpose, technical solutions and advantages of the embodiments of the present invention clearer, the technical solutions in the embodiments of the present invention will be clearly and completely described below in conjunction with the drawings in the embodiments of the present invention. Obviously, the described embodiments are part of the embodiments of the present invention, not all of the embodiments. Generally, the components of the embodiments of the present invention described and shown in the drawings here can be arranged and designed in various different configurations.

[0059] Therefore, the following detailed description of the embodiments of the present invention provided in the accompanying drawings is not intended to limit the scope of the invention claimed for protection, but merely represents selected embodiments of the present invention. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field without creative work are within the scope of protection of the present invention.

[0060] It should be noted that similar reference numerals and letters denote similar items in the following drawings, and therefore, once an item is defined in one drawing, further definition and explanation thereof is not required in subsequent drawings.

[0061] In the description of the present invention, it should be noted that the terms "far", "near", "inner", "outer", "axial", "radial", etc. indicate the orientation or position relationship based on the orientation or position relationship shown in the drawings, or the orientation or position relationship in which the product of the invention is usually placed when in use. They are only for the convenience of describing the present invention and simplifying the description, and do not indicate or imply that the device or element referred to must have a specific orientation, be constructed and operated in a specific orientation, and therefore cannot be understood as limiting the present invention. In addition, the terms "first", "second", etc. are only used to distinguish the description, and cannot be understood as indicating or implying relative importance.

[0062] In the description of the present invention, it is also necessary to explain that, unless otherwise clearly specified and limited, the terms "setting", "installation" and "connection" should be understood in a broad sense, for example, it can be a fixed connection, a detachable connection, or an integral connection; it can be a mechanical connection or an electrical connection; it can be a direct connection, or it can be an indirect connection through an intermediate medium, or it can be the internal communication of two components. For ordinary technicians in this field, the specific meanings of the above terms in the present invention can be understood according to specific circumstances.

[0063] Some embodiments of the present invention are described in detail below in conjunction with the accompanying drawings. In the absence of conflict, the following embodiments and features in the embodiments can be combined with each other.

[0064] Embodiment 1

[0065] This embodiment provides a sequential post-release device for a stent graft, referring to Figure 1 and Figure 2 The sequential post-release device of the coated stent is applied to a coated stent conveyor with an outer tube 7, and includes a limiting fork 1 and a post-release limiting component 2.

[0066] Specifically, the limiting fork 1 includes a fork seat 11 and a plurality of fork rods 12, one end of the plurality of fork rods 12 is connected to the radial circumferential surface of the fork seat 11 at intervals in pairs; the limiting fork 1 is configured such that: in the limiting working condition, the other ends of the plurality of fork rods 12 are fixed to the rear release limiting assembly 2 after passing through the plurality of stent rings 310 provided at the proximal end of the stent graft 300 one by one, so as to gather the proximal end of the stent graft 300 in the rear release limiting assembly 2, and, in the releasing working condition, the fork seat 11 drives the plurality of fork rods 12 to move toward the distal end of the rear release limiting assembly 2, so as to separate the fork rods 12 from the stent rings 310, thereby releasing the proximal end of the stent graft 300. The rear release limiting assembly 2 is configured to cooperate with the limiting fork 1, so that the action of the proximal end of the stent graft 300 being released by the limiting fork 1 occurs after the action of the outer tube 7 releasing the proximal end of the stent graft 300. Both the fork seat 11 and the rear release limit assembly 2 are provided with operation holes through which the guide wire can pass.

[0067] In this embodiment, the proximal end refers to the end of the medical device close to the patient's blood vessel when working, and the distal end refers to the end of the medical device close to the doctor. The multiple stent rings 310 arranged at the proximal end of the coated stent 300 can be directly bent by the metal skeleton of the coated stent 300, or the stent rings 310 can be arranged separately and connected to the proximal end of the metal skeleton of the coated stent 300.

[0068] The use of the sequential post-release device of the stent graft provided in this embodiment is as follows:

[0069] The first step is to install the stent graft 300 on the stent graft delivery system. Specifically, Fig.12 and Fig.13 As shown, the coated stent 300 is compressed into the outer tube 7 of the conveyor, the rear fixer 9 fixes the rear end of the coated stent 300 from the inside of the outer tube 7, the inner tube 6 is threaded or welded or interference fit or otherwise fixedly connected to the operating hole of the fork seat 11, and the proximal end of the guide wire tube 5 is fixedly connected to the operating hole of the rear release limit assembly 2. There are many fixing methods, such as but not limited to the following Fig.13 As shown, a welding tube 8 is connected to the proximal end of the wire guide tube 5, and the welding tube 8 is welded in the operating hole of the rear release limit assembly 2, or a connecting thread is provided on the hole wall of the operating hole of the rear release limit assembly 2, and the proximal end of the wire guide tube 5 is threadedly connected to the operating hole of the rear release limit assembly 2, etc.;

[0070] The second step is to limit the working condition, refer to Figures 1 to 13 , so that the ends of the multiple fork rods 12 of the limiting fork 1 away from the fork seat 11 pass through the multiple stent rings 310 arranged at the proximal end of the stent graft 300 one by one, and are fixed to the rear release limiting assembly 2. At this time, the proximal end of the stent graft 300 is restrained by the limiting fork 1 and retracted to the rear release limiting assembly 2; operate the control handle of the stent graft conveyor to move the outer tube 7 forward, and the proximal end of the stent graft 300 is completely retracted into the outer tube 7;

[0071] The third step is to pass the guide wire through the guide wire tube 5, and use a conveyor to deliver the stent graft loaded with the stent graft 300 to the patient's vascular lesion position through percutaneous puncture along the guide wire, and then release the device in sequence;

[0072] Step 4: Use the control handle of the stent graft conveyor to withdraw the outer tube 7 to release the stent graft 300 from the outer tube 7, and release the stent graft 300 at one time;

[0073] Step 5: In the release condition, the fork seat 11 drives the multiple fork rods 12 to move toward the distal end of the rear release limit assembly 2, so that the fork rods 12 are separated from the stent ring 310, thereby releasing the proximal end of the stent graft 300 for a second time, thereby completely releasing the stent graft 300;

[0074] Step 6: withdraw the entire stent graft delivery device and the guide wire backwards.

[0075] In this embodiment, a limit fork 1 and a rear-release limit assembly 2 are provided, and the rear-release limit assembly 2 cooperates with the limit fork 1, so that the proximal end of the coated stent 300 is released by the limit fork 1 after the outer tube 7 releases the proximal end of the coated stent 300. Thus, it can be ensured that the coated stent conveyor releases the coated stent 300 once and then releases it a second time, that is, the sequential release of the first release and the second release is guaranteed, thereby reducing the surgical risk and improving the surgical success rate.

[0076] Continue to refer to Figures 1 to 13 In an optional implementation of the present embodiment, preferably, a fork rod limiting groove 120 is provided at one end of each fork rod 12 away from the fork seat 11, and the notch of the fork rod limiting groove 120 extends to the opposite surfaces of two adjacent fork rods 12 facing each other;

[0077] The rear release limit assembly 2 includes a limit rod 21 and a fixing seat 22, wherein: the limit rod 21 includes a rod body 211 and two limit wings 212, the proximal ends of the two limit wings 212 are symmetrically connected to the two sides of the proximal end of the rod body 211; the distal ends of the two limit wings 212 extend toward the distal end of the rod body 211 and open in a direction away from the rod body 211; the two limit wings 212 are both made of elastic material, or the two limit wings 212 are respectively connected to the rod body 211 through torsion springs. The fixing seat 22 includes a columnar body 220, one axial end of the columnar body 220 is the proximal end of the columnar body 220, and the other axial end of the columnar body 220 is the distal end of the columnar body 220, the direction extending from the proximal end of the columnar body 220 toward the distal end of the columnar body 220 is the first direction, and the direction extending from the distal end of the columnar body 220 toward the proximal end of the columnar body 220 is the second direction: the columnar body 220 includes: in the first direction, a first reduced diameter section 2201 is formed by reducing the diameter of the circumscribed circle of the cross section cut perpendicular to the first direction; the radial outer peripheral surface of the first reduced diameter section 2201 includes a plurality of limit units 20, each of which includes its own adjacent fork rod groove 201 and limit wing groove 202, the opening of the fork rod groove 201 and the opening of the limit wing groove 202 are both toward the distal end of the columnar body 220, and the limit wing groove 202 is formed in a shape in which the opening gradually decreases in the second direction. The limiting rod 21 includes a plurality of limiting wing grooves 202 corresponding to each other. A rod limiting portion 221 is provided on the radial outer circumferential surface of the columnar body 220. In each limiting rod 21, the rod body 211 passes through the rod limiting portion 221, and the proximal ends of the two limiting wings 212 are inserted into and squeezed into the corresponding limiting wing grooves 202.

[0078] Under the above-mentioned limiting working condition, the working condition that the multiple fork rods 12 of the limiting fork 1 are inserted into the multiple fork rod grooves 201 one by one is taken as the first working condition. In the first state of the first working condition, in each limiting rod 21, the distal end of each limiting wing 212 is respectively inserted into the fork rod limiting groove 120 of the adjacent fork rod 12, and the distal end of the rod body 211 extends to the distal end of the columnar body 220. Preferably, the rod body 211 of the limiting rod 21 includes a main rod body 2111 and a connecting rod body 2112. A rod seat 2113 connected to the distal end of the main rod body 2111, the rod seat 2113 is located at the distal end of the columnar body 220; in the second state of the first working condition, the limiting rod 21 slides along the second direction under the action of an external force, so that the distal ends of the two limiting wings 212 in each limiting rod 21 are further squeezed by the corresponding limiting wing groove 202 to move toward the rod body 211, thereby causing the distal ends of each limiting wing 212 to respectively detach from the corresponding fork rod limiting groove 120;

[0079] A fork seat mounting hole 100 is provided inside the fork seat 11 and extends from the proximal end of the fork rod 12 to the distal end of the fork rod 12 and passes through the fork seat 11, serving as an operating hole for the fork seat 11; a fixed seat mounting hole 200 is provided in the middle of the fixed seat 22 and passes through the columnar body 220 along the first direction and serves as an operating hole for the rear release limit assembly 2.

[0080] The use of the posterior release device of the stent graft provided in this preferred embodiment is as follows:

[0081] The first step is the same as the first step above;

[0082] The second step is to limit the working condition, refer to Figures 1 to 13 , so that the ends of the multiple fork rods 12 of the limiting fork 1 away from the fork seat 11 pass through the multiple stent rings 310 arranged at the proximal end of the coated stent 300 one by one, and then are inserted into the multiple fork rod grooves 201 one by one; and the distal ends of the limiting wings 212 in each limiting rod 21 are respectively inserted into the fork rod limiting grooves 120 of the fork rod 12 adjacent to the limiting wings 212, so that the ends of the multiple fork rods 12 of the limiting fork 1 away from the fork seat 11 are fixed to the rear release limiting assembly 2, at this time, the distal ends of the rod bodies 211 extend to the columnar body 220 The distal end of the stent graft 300 is thereby limited between the distal end of the rod body 211 of the limiting rod 21 and the distal outer peripheral surface of the columnar body 220, and the stent graft ring 310 of the stent graft 300 contacts the distal end of the rod body 211 of the limiting rod 21; the control handle of the stent graft conveyor is then operated to move the outer tube 7 forward, and the proximal end of the stent graft 300 is completely retracted into the outer tube 7, which is the first state of the first working condition, and in this state, the distal ends of the limiting wings 212 of each limiting rod 21 do not separate from the corresponding fork rod limiting groove 120;

[0083] The third step is the same as the third step above;

[0084] The fourth step is to use the control handle of the coated stent conveyor to withdraw the outer tube 7 to release the coated stent 300 from the outer tube 7, releasing the coated stent 300 at one time. During the releasing process, while the outer tube 7 releases the stent ring 310 of the coated stent 300, the stent ring 310 at the proximal end of the coated stent 300 loses the restraint of the outer tube 7 and pops open. During the popping-opening process, the stent ring 310 generates a thrust on the rod body 211 of the limiting rod 21 toward the proximal direction of the columnar body 220, that is, the above-mentioned External force, at this time, it is converted to the second state of the first working condition, and the limiting rod 21 slides in the second direction under the action of this external force. Since the limiting wing groove 202 is formed in a shape with an opening gradually decreasing in the second direction, as the limiting rod 21 slides in the second direction, the distal ends of the two limiting wings 212 in each limiting rod 21 are continuously squeezed by the corresponding limiting wing groove 202 to move toward the rod body 211, so that the distal ends of each limiting wing 212 are respectively separated from the corresponding fork rod limiting groove 120;

[0085] The fifth and sixth steps are the same as the above-mentioned fifth and sixth steps.

[0086] In a further preferred implementation manner of the present embodiment, the above-mentioned rear release limit assembly 2 also includes an elastic energy storage piece 23; the elastic energy storage piece 23 includes a plurality of elastic energy storage pieces 23 which are installed one by one in a plurality of limit wing grooves 202, and the distal end of each elastic energy storage piece 23 is respectively connected or abutted with the proximal end of the rod body 211 of the limit rod 21 inserted into the corresponding limit wing groove 202; in the first state of the above-mentioned first working condition, the elastic energy storage piece 23 is in a free or energy storage state; in the second state of the above-mentioned first working condition, the limit rod 21 slides along the second direction to compress or release the elastic energy storage piece 23.

[0087] Specifically, optionally, the elastic energy storage member 23 adopts a spring, and in the first state of the above-mentioned first working condition, the elastic energy storage member 23 is in a state of not being fully compressed, and in the second state of the above-mentioned first working condition, the elastic energy storage member 23 is further compressed; or, optionally, the elastic energy storage member 23 adopts a spring, and in the first state of the above-mentioned first working condition, the elastic energy storage member 23 is in a free state, and in the second state of the above-mentioned first working condition, the elastic energy storage member 23 is compressed, or, optionally, the elastic energy storage member 23 adopts a spring, and in the first state of the above-mentioned first working condition: the elastic energy storage member 23 is in a stretched state, and in each limiting rod 21, the sum of the components of the friction force of the groove wall of the limiting wing groove 202 on the two limiting wings 212 in the above-mentioned first direction is greater than the elastic restoring force of the corresponding elastic energy storage member 23 acting on the two limiting wings 212 in the above-mentioned second direction. Among them, it is more preferred that the above elastic energy storage member 23 adopts a spring. In the first state of the above-mentioned first working condition, the elastic energy storage member 23 is in a state of not being fully compressed. In the second state of the above-mentioned first working condition, the elastic energy storage member 23 is continuously compressed. Therefore, in the first state of the above-mentioned first working condition, under the action of the elastic energy storage member 23, it can be ensured that the distal end of each limiting wing 212 in each limiting rod 21 is inserted into the fork rod limiting groove 120 of the fork rod 12 adjacent to the limiting wing 212, thereby ensuring the connection reliability of the multiple fork rods 12 of the limiting fork 1 away from the fork seat 11 and being fixed to the rear release limiting assembly 2.

[0088] On the basis of any of the above optional implementations of the present embodiment, it is more preferred that the above-mentioned columnar body 220 also includes, in the first direction, a second reduced diameter section 2202 formed by reducing the diameter of the circumscribed circle of the cross-section cut perpendicular to the first direction, and the rod body limiting portion 221 is located between the first reduced diameter section 2201 and the second reduced diameter section 2202, thereby increasing the connection stability of the proximal end of the coated bracket 300 to the distal end of the columnar body 220.

[0089] In addition, if Figure 1 , Figure 5 , Figure 6 , Figure 7 , Fig. 9 , Fig.10As shown, on the basis of any of the above-mentioned optional implementation modes of the present embodiment, it is more preferred that the rod body limiting portion 221 includes a plurality of rod body limiting blocks; the plurality of rod body limiting blocks are distributed at intervals of two on the radial outer circumferential surface of the distal end of the columnar body 220, near the first reduced diameter section 2201; guide holes 2210 are provided on the plurality of rod body limiting blocks, and the plurality of guide holes 2210 correspond one-to-one to the plurality of limiting wing grooves 202; a gap for the fork rod 12 to pass through is formed between each two adjacent rod body limiting blocks, and the gap corresponds one-to-one to the fork rod groove 201; in each limiting rod 21, the rod body 211 passes through the guide hole 2210 on the corresponding rod body limiting block; of course, the rod body limiting portion 221 can also be an elastic ring structure mounted on the outside of the columnar body 220, and a groove for limiting and guiding the rod body 211 of the limiting rod 21 is provided on the inner ring surface of the elastic ring structure.

[0090] Further preferably, the opening area of ​​the above-mentioned intervals corresponding to the fork rod grooves 201 on the radial outer peripheral surface of the columnar body 220 gradually decreases along the radial direction of the columnar body 220, from the inside of the columnar body 220 to the outside of the columnar body 220, thereby, it can play a better limiting and guiding role for the fork rod 12.

[0091] In addition, refer to Figure 8 , Fig.10 and Fig.11 On the basis of any of the above optional implementations of the present embodiment, it is more preferred that, in the limiting rod 21, the rod body 211 includes a main rod body 2111 and a guide rod body 2112, the distal end of the guide rod body 2112 is connected to the proximal end of the main rod body 2111, and the diameter of the circumscribed circle of the cross section radially cut along the guide rod body 2112 is smaller than the diameter of the circumscribed circle of the cross section radially cut along the main rod body 2111; the distal end of the elastic energy storage member 23 is mounted on the guide rod body 2112, and the distal end face of the elastic energy storage member 23 abuts against the proximal end face of the main rod body 2111.

[0092] Further preferably, a mounting blind hole 203 is also opened inside the portion of the columnar body 220 that is connected to the proximal end face of the limiting wing groove 202 , the mounting blind hole is connected to the limiting wing groove 202 , and the guide rod body 2112 and the elastic energy storage component 23 are inserted into the mounting blind hole 203 .

[0093] In addition, refer to Figure 3 In an optional structure of the limit fork 1 of the present embodiment, on each fork rod 12 of the limit fork 1, the fork rod limit groove 120 penetrates the fork rod 12 along the radial circumferential direction of the fork seat 11; Figure 4 In another optional structure of the limiting fork 1 of the present embodiment, the fork rod limiting groove 120 is formed by a side surface of the fork rod 12 facing the columnar body 220 being recessed in a direction away from the columnar body 220 .

[0094] In addition, refer to Figure 5 On the basis of any of the above optional implementations of the present embodiment, it is more preferred that a plurality of hooking protrusions 204 are arranged on the outer circumferential surface of the distal end of the columnar body 220, and the plurality of hooking protrusions 204 are distributed in pairs along the radial outer circumferential surface of the columnar body 220, and are used to hook a plurality of stent rings 310 arranged at the proximal end of the coated stent 300, and a stent ring limiting groove 2040 is formed between two adjacent hooking protrusions 204.

[0095] In addition, based on any of the above-mentioned optional implementations of the present embodiment, it is more preferred that the opening area of ​​the fork rod groove 201 on the radial outer peripheral surface of the columnar body 220 and the opening area of ​​the limiting wing groove 202 on the radial outer peripheral surface of the columnar body 220 both gradually decrease along the radial direction of the columnar body 220, from the inside of the columnar body 220 to the outside of the columnar body 220.

[0096] In addition, if Figure 1 , Fig.12 and Fig.13 As shown, the fixing seat 22 also includes a guide head 4, the distal end of the guide head 4 is connected to the proximal end of the columnar body 220, and the fixing seat mounting hole 200 extends to penetrate the guide head 4. The guide head 4 and the columnar body 220 can be an integrally formed structure, or can be as shown in FIG. Figure 7 , Fig. 9 and Fig.13 As shown, a first connection hole 401 is provided on the proximal end face of the columnar body 220, and a second connection hole 402 is provided on the distal end face of the guide head 4. The guide head 4 is connected to the columnar body 220 by connecting a rod in the first connection hole 401 on the guide head 4 or in the second connection hole 402 on the columnar body 220. The rod can be fixed to the first connection hole 401 and the second connection hole 402 by interference fit or other connection methods; preferably, the outer peripheral surface of the guide head 4 is formed into a shape with a gradually decreasing diameter from the distal end to the proximal end, so as to reduce the damage of the fixing seat 22 to the blood vessel wall while being used as a guide.

[0097] In addition, in order to provide accurate release of the coated stent 300 during surgery, in various optional implementations of the present embodiment, it is more preferred that X-ray developing materials are connected to the multiple fork rods 12 of the limiting fork 1, so that under X-rays, the secondary release time and secondary release position of the coated stent 300 during the release process can be known more accurately, thereby improving the accuracy of the surgery.

[0098] Embodiment 2

[0099] The present embodiment provides a stent graft delivery system, which comprises a control handle, a guide wire tube 5, an inner tube 6, an outer tube 7, and a stent graft sequential post-release device provided in any optional implementation manner in the first embodiment. Among them: the guide wire tube 5 is used to pass the guide wire; the guide wire tube 5 passes through the inner tube 6, and the proximal end of the guide wire tube 5 is inserted into and fixed in the operating hole of the rear release limit assembly 2; the proximal end of the inner tube 6 is fixed in the operating hole on the fork seat 11; the distal ends of the outer tube 7 and the inner tube 6 are both connected to the control handle, and the control handle is configured to drive the outer tube 7 and the inner tube 6 to move forward and backward.

[0100] Since the stent graft delivery system provided in this embodiment includes the stent graft sequential post-release device described in Example 1, the stent graft delivery system provided in this embodiment can achieve all the beneficial effects that the stent graft sequential post-release device in Example 1 can achieve, and its specific structure and achievable effects can be obtained by referring to the various optional or preferred implementations in Example 1. Fig.12 and Fig.13 As shown, in various optional implementations of the present embodiment, preferably, the coated stent delivery system also includes a rear fixator 9, which is disposed in the outer tube 7, the inner tube 6 passes through the rear fixator 9, and the distal end of the rear fixator 9 is connected to a control handle, and the control handle is further configured to be able to drive the rear fixator 9 to move back and forth inside the outer tube 7, so that the front end of the rear fixator 9 abuts against or releases the rear end of the coated stent 300, thereby increasing the stability of the coated stent 300 during delivery.

[0101] Finally, it should be noted that: the various embodiments in this specification are described in a progressive manner, and each embodiment focuses on the differences from other embodiments, and the same or similar parts between the various embodiments can be referenced to each other; the above embodiments in this specification are only used to illustrate the technical solution of the present invention, rather than to limit it; although the present invention has been described in detail with reference to the aforementioned embodiments, ordinary technicians in this field should understand that: it is still possible to modify the technical solutions recorded in the aforementioned embodiments, or to replace some or all of the technical features therein with equivalents; and these modifications or replacements do not make the essence of the corresponding technical solution deviate from the scope of the technical solution of the embodiments of the present invention.

Claims

1. A stent graft sequential post-release device, applied to a stent graft conveyor with an outer tube (7), characterized in that: It comprises a limit fork (1) and a rear release limit assembly (2); The limit fork (1) comprises a fork seat (11) and a plurality of fork rods (12), one ends of the plurality of fork rods (12) being connected to the radial circumferential surface of the fork seat (11) at intervals of two or more; the limit fork (1) is configured such that: under the limit working condition, the other ends of the plurality of fork rods (12) are fixed to the rear release limit assembly (2) after passing through a plurality of stent rings (310) arranged at the proximal end of the coated stent (300) one by one, so as to retract the proximal end of the coated stent (300) into the rear release limit assembly (2); and, under the release working condition, the fork seat (11) drives the plurality of fork rods (12) to move toward the distal end of the rear release limit assembly (2), so as to disengage the fork rods (12) from the stent rings (310), thereby releasing the proximal end of the coated stent (300); The rear release limiting assembly (2) is configured to cooperate with the limiting fork (1) so that the proximal end of the stent graft (300) is released by the limiting fork (1) after the outer tube (7) releases the proximal end of the stent graft (300); The fork seat (11) and the rear release limit assembly (2) are both provided with operation holes capable of allowing a guide wire to pass through; A fork rod limiting groove (120) is provided at one end of each fork rod (12) away from the fork seat (11), and the notch of the fork rod limiting groove (120) extends to the opposite surfaces of two adjacent fork rods (12) facing each other; The rear release limiting assembly (2) comprises a limiting rod (21) and a fixing seat (22); The limiting rod (21) comprises a rod body (211) and two limiting wings (212); the proximal ends of the two limiting wings (212) are symmetrically connected to the two sides of the proximal end of the rod body (211); the distal ends of the two limiting wings (212) extend toward the distal end of the rod body (211) and open in a direction away from the rod body (211); the two limiting wings (212) are made of elastic material, or the two limiting wings (212) are respectively connected to the rod body (211) via torsion springs; The fixing seat (22) comprises a columnar body (220), one end of the columnar body (220) in the axial direction is the proximal end of the columnar body (220), the other end of the columnar body (220) in the axial direction is the distal end of the columnar body (220), a direction extending from the proximal end of the columnar body (220) toward the distal end of the columnar body (220) is a first direction, and a direction extending from the distal end of the columnar body (220) toward the proximal end of the columnar body (220) is a second direction: The columnar body (220) comprises: in the first direction, a first diameter-reduced section (2201) is formed by reducing the diameter of a circumscribed circle of a cross section cut perpendicular to the first direction; the radial outer peripheral surface of the first diameter-reduced section (2201) comprises a plurality of limiting units (20), each of the limiting units (20) comprises a respective adjacent fork rod groove (201) and a limiting wing groove (202), the opening of the fork rod groove (201) and the opening of the limiting wing groove (202) are both oriented toward the distal end of the columnar body (220), and the limiting wing groove (202) is formed in a shape in which the opening gradually decreases in the second direction; The limiting rod (21) comprises a plurality of limiting wing grooves (202) corresponding one to one, a rod body limiting portion (221) is provided on the radial outer circumferential surface of the columnar body (220), and in each limiting rod (21), the rod body (211) passes through the rod body limiting portion (221), and the proximal ends of the two limiting wings (212) are inserted into and pressed into the corresponding limiting wing grooves (202); In the limiting working condition, the working condition in which the plurality of fork rods (12) of the limiting fork (1) are inserted into the plurality of fork rod grooves (201) one by one is taken as the first working condition. In the first state of the first working condition, the distal ends of the respective limiting wings (212) in the respective limiting rods (21) are respectively inserted into the fork rod limiting grooves (120) of the adjacent fork rods (12), and the distal ends of the rod bodies (211) extend to the distal ends of the columnar body (220). In the second state of the first working condition, the limiting rods (21) slide along the second direction under the action of an external force, so that the distal ends of the two limiting wings (212) in the respective limiting rods (21) are continuously squeezed by the corresponding limiting wing grooves (202) to move toward the rod body (211), thereby causing the distal ends of the respective limiting wings (212) to respectively detach from the corresponding fork rod limiting grooves (120).

2. The stent graft sequential post-release device according to claim 1, characterized in that: The rear release limiter assembly (2) further comprises an elastic energy storage member (23); The elastic energy storage member (23) comprises a plurality of elastic energy storage members (23) which are installed in a one-to-one correspondence in the plurality of the limiting wing grooves (202), and the distal end of each elastic energy storage member (23) is respectively connected to or abutted against the proximal end of the rod body (211) of the limiting rod (21) inserted into the corresponding limiting wing groove (202); In a first state of the first working condition, the elastic energy storage member (23) is in a free or energy storage state, and in a second state of the first working condition, the limiting rod (21) slides along the second direction to compress or release the elastic energy storage member (23).

3. The stent graft sequential post-release device according to claim 2, characterized in that: The elastic energy storage member (23) is a spring; In a first state of the first working condition, the elastic energy storage member (23) is in a state of not being completely compressed, and in a second state of the first working condition, the elastic energy storage member (23) is further compressed; or, in the first state of the first working condition, the elastic energy storage member (23) is in a free state, and in the second state of the first working condition, the elastic energy storage member (23) is compressed.

4. The stent graft sequential post-release device according to claim 2, characterized in that: The elastic energy storage member (23) is a spring; In a first state of the first working condition: the elastic energy storage member (23) is in a stretched state, and in each of the limiting rods (21), the sum of the components of the friction force of the groove wall surface of the limiting wing groove (202) on the two limiting wings (212) in the first direction is greater than the elastic restoring force of the corresponding elastic energy storage member (23) acting on the two limiting wings (212) in the second direction.

5. The stent graft sequential post-release device according to any one of claims 2 to 4, characterized in that: The columnar body (220) further comprises a second diameter-reduced section (2202) formed by reducing the diameter of a circumscribed circle of a cross section cut perpendicularly to the first direction in the first direction, and the rod body limiting portion (221) is located between the first diameter-reduced section (2201) and the second diameter-reduced section (2202).

6. The stent graft sequential post-release device according to any one of claims 2 to 4, characterized in that: The rod body limiting portion (221) comprises a plurality of rod body limiting blocks; The plurality of rod body limiting blocks are distributed in pairs at intervals on the radial outer circumferential surface of the distal end of the columnar body (220) near the first reduced diameter section (2201); guide holes (2210) are provided on the plurality of rod body limiting blocks, and the plurality of guide holes (2210) correspond one-to-one to the plurality of limiting wing grooves (202); a gap for the fork rod (12) to pass through is formed between each two adjacent rod body limiting blocks, and the gap corresponds one-to-one to the fork rod groove (201); In each of the limiting rods (21), the rod body (211) passes through a guide hole (2210) on the corresponding rod body limiting block.

7. The stent graft sequential post-release device according to claim 6, characterized in that: The opening area of ​​the interval on the radial outer circumferential surface of the columnar body (220) gradually decreases along the radial direction of the columnar body (220) from the inside of the columnar body (220) to the outside of the columnar body (220).

8. The stent graft sequential post-release device according to claim 3 or 4, characterized in that: In the limiting rod (21), the rod body (211) comprises a main rod body (2111) and a guide rod body (2112), the distal end of the guide rod body (2112) is connected to the proximal end of the main rod body (2111), and the diameter of the circumscribed circle of a cross section formed by radially sectioning the guide rod body (2112) is smaller than the diameter of the circumscribed circle of a cross section formed by radially sectioning the main rod body (2111); The distal end of the elastic energy storage member (23) is sleeved on the guide rod body (2112), and the distal end surface of the elastic energy storage member (23) abuts against the proximal end surface of the main rod body (2111).

9. The stent graft sequential post-release device according to claim 8, characterized in that: A mounting blind hole (203) is also provided inside a portion of the columnar body (220) connected to the proximal end surface of the limiting wing groove (202), wherein the mounting blind hole is in communication with the limiting wing groove (202), and the guide rod body (2112) and the elastic energy storage member (23) are inserted into the mounting blind hole (203).

10. The stent graft sequential post-release device according to any one of claims 1 to 4, characterized in that: On each of the fork rods (12) of the limiting fork (1), the fork rod limiting groove (120) penetrates the fork rod (12) along the radial circumferential direction of the fork seat (11).

11. The stent graft sequential post-release device according to claim 10, characterized in that: The fork rod limiting groove (120) is formed by a surface of the fork rod (12) facing the columnar body (220) being recessed in a direction away from the columnar body (220).

12. The stent graft sequential post-release device according to any one of claims 1 to 4, characterized in that: A plurality of hooking protrusions (204) are arranged on the outer circumferential surface of the distal end of the columnar body (220), and the plurality of hooking protrusions (204) are spaced apart in pairs along the radial outer circumferential surface of the columnar body (220) for hooking a plurality of stent rings (310) arranged at the proximal end of the coated stent (300), and a stent ring limiting groove (2040) is formed between two adjacent hooking protrusions (204).

13. The stent graft sequential post-release device according to any one of claims 1 to 4, characterized in that: The opening area of ​​the fork rod groove (201) on the radial outer circumferential surface of the columnar body (220), and the opening area of ​​the limiting wing groove (202) on the radial outer circumferential surface of the columnar body (220), both gradually decrease along the radial direction of the columnar body (220), from the inside of the columnar body (220) to the outside of the columnar body (220).

14. A stent graft delivery system, characterized in that: It comprises a stent graft conveyor and a stent graft sequential post-release device according to any one of claims 1 to 13; Wherein: the stent graft conveyor comprises a control handle, a guide wire tube (5), an inner tube (6) and an outer tube (7); The guide wire tube (5) is used to pass the guide wire; The wire guide tube (5) passes through the inner tube (6), and the proximal end of the wire guide tube (5) is inserted into and fixed in the operating hole of the rear release limit assembly (2); the proximal end of the inner tube (6) is fixed in the operating hole on the fork seat (11); The distal ends of the outer tube (7) and the inner tube (6) are both connected to the control handle, and the control handle is configured to be able to drive the outer tube (7) and the inner tube (6) to move forward and backward.

Images