fig1 shows a catheter 10 whose distal end 12 is laterally deflectable by a deflection movement in any radial direction . this deflection movement is effected for example on the basis of the principle known from u . s . pat . no . 5 , 254 , 088 . for that purpose , at its proximal end , the catheter 10 has manual control means 14 and 16 which are connected to a spiral or coil casing 18 which encloses a lumen and which is flexible at its distal end , and two control wires 20 and 22 which are guided in the lumen of the spiral casing 18 . the manual control means 16 are connected to the two control wires 20 and 22 in known manner in such a way that the wires are slidable relative to each other in the axial direction . at their distal ends 24 the two control wires 20 and 22 are connected together . axial sliding movement of the control wires relative to each other causes lateral flexural deflection of the spiral casing 18 and thus the catheter 10 in the flexible region of the spiral casing 18 at the distal end 12 of the catheter 10 . the spiral casing 18 is arranged in the catheter 10 rotatably relative to the catheter 10 . the radial direction of the lateral deflection movement which occurs upon deflection of the distal end 12 of the catheter can be determined by a rotational movement of the spiral casing 18 with the control wires 20 and 22 guided therein , with respect to the catheter 10 . for that purpose , provided in the spiral casing 18 is a flat band or strip 26 which divides the lumen in the spiral casing 18 into two halves which each guide a respective one of the guide wires 20 and 22 . the flat band or strip 26 is engaged at the distal end by the manual control means 14 in such a way that the flat band or strip 26 and therewith the guide wires 20 and 22 are rotatable relative to the rest of the catheter 10 . the spiral casing 18 can be but does not necessarily have to be , rotated together with the flat band or strip 26 in the guide wires 20 and 22 relative to the rest of the catheter . the crucial consideration is the rotation of the guide wires 20 and 22 . fig1 a is a sectional view of the spiral casing 18 with the control wires 20 and 22 arranged therein , and the flat band or strip 26 . arranged in the region of the tip 30 of the catheter at the distal end 12 thereof is a spacing sensor 32 which is connected to a control unit 36 by way of a signal connection 34 illustrated in the form of a bus . the control unit 36 is in turn connected to a display unit 38 . the control unit 36 generates control signals for the display unit 38 , from spacing signals received from the spacing sensor 32 . the spacing information in respect of the relative position of the catheter tip 30 between the walls for example of a blood vessel , such information being obtained from the spacing signals , is represented by the display unit 38 in such a way that a symbol 40 for the tip 30 of a catheter is represented in a display area 42 whose outer boundary 44 represents the wall of the blood vessel in which the tip 30 of the catheter is disposed and which includes a marking 46 for identifying the middle of the blood vessel . by means of the information represented by way of the display unit 38 , the tip 30 of the catheter can be controlled by means of the manual control elements 14 and 16 in such a way that as far as possible it is always in the middle of the vessel through which the tip 30 of the catheter is being passed . for that purpose , the symbol 40 representing the tip 30 of the catheter must be held in the display area 44 as much as possible in the proximity of the mark 46 representing the middle of the vessel . it will be appreciated that any desired deviations can be set by hand at any time in order for example to be able to introduce the tip of the catheter into vessel branchings . fig2 shows a catheter 10 ′ which in terms of essential parts corresponds to that shown in fig1 . identical parts are denoted by the same references as in fig1 . the essential differences between the catheter 10 ′ in fig2 and the catheter 10 in fig1 are two mechanical control drives or actuators 54 and 56 for rotation of the guide wires 20 and 22 with respect to the rest of the catheter 10 ′ and for the axial movement of the control wires 20 and 22 relative to each other . as in the case of the catheter 10 shown in fig1 the control unit 36 ′ is connected to the spacing sensor 32 by way of a signal connection 34 . from the spacing signal received from the sensor 32 , the control unit 36 ′ generates control signals for the actuators 54 and 56 , to which the control unit 36 ′ is connected by way of suitable control lines 58 and 60 . the control signals for the actuators 54 and 56 are generated on the basis of the spacing signal in such a way that , as it approaches a vessel wall , the tip 30 of the catheter is moved away from the vessel wall by deflection of the distal end 12 of the catheter 10 ′, such deflection being produced by means of the actuators 54 and 56 . the catheter 10 ′ therefore represents a system which can be introduced into and passed through a blood vessel , without manual control . fig3 shows a similar catheter to fig2 . in addition to the components already shown in fig2 the catheter 10 ″ in fig3 has a manual control unit 62 with which the control signals for the actuators 54 and 56 , which are obtained from the spacing signal from the spacing sensor 32 , can be overridden in order deliberately and specifically to deflect the tip 30 of the catheter 10 ″ by hand towards a vessel wall and to introduce the tip 30 of the catheter for example into a vessel branching disposed at that location . for that purpose , the manual control unit 62 is connected to the control unit 36 ″. in addition , fig3 shows a somewhat different structure in respect of the control wires 20 ′ and 22 ′ which are arranged in the lumen of the spiral casing 18 . as can be seen from the sectional view in fig3 a , the wires are in the form of flat bands or strips and there is therefore no need to use an additional flat band or strip like that shown at 26 in fig1 and 2 . the spacing sensor 32 of the catheters 10 , 10 ′ and 10 ″ can be for example a capacitive spacing sensor . alternative spacing sensors are shown in fig4 through 6 . the distal end 12 of a catheter 10 , which is illustrated in fig4 is provided with two electrodes 70 and 72 of which the electrode 70 is in the form of a tip electrode at the tip 30 of the catheter while the electrode 72 is a ring electrode . the electrodes are connected by way of signal lines to the control unit 36 , 36 ′, 36 ″ which is not shown in fig4 . the electrodes 70 and 72 can be used for capacitive spacing measurement or for measurement of the impedance of the blood between the electrodes . it is possible in that way to obtain a spacing signal , in the manner described hereinbefore . in fig5 the spacing sensor 32 is in the form a temperature - dependent resistor , that is to say a thermistor 80 . the arrangement also includes a heating element 82 for heating the tip 30 of the catheter . a signal for the spacing of the tip 30 of the catheter relative to the vessel wall can be derived from cooling of the thermistor 80 , in the manner described hereinbefore . in the embodiment illustrated in fig6 the spacing sensor 32 is an optical sensor . the spacing sensor 32 is formed by six light guides or optical fibers 90 , 92 , 94 , 96 , 98 and 100 which are respectively associated in pairs with each other . the pairs of optical fibers are uniformly distributed on a peripheral line in the region of the tip 30 of the catheter so that a respective one of the optical fibers of a pair preferably receives light which falls on a sector of the tip of the catheter , which is near the respective pair of optical fibers . this arrangement of the ends of the optical fibers 90 , 92 , 94 , 96 , 98 and 100 can be seen from the plan view of the tip 30 of the catheter in fig6 a . of the optical fibers which are associated with each other in paired relationship , one serves to pick up light signals and transmit same to a control unit which is suitable for processing optical signals . the respective other optical fiber associated with a pair of optical fibers is connected to an infrared light source ( not shown ) at the proximal end of the catheter 10 and passes light from that light source to the distal end of the catheter 10 where it issues at the end of the corresponding optical fibers and illuminates the corresponding area around the tip 30 of the catheter . infrared light reflected by vessel walls is respectively picked up by the other optical fibers of a pair thereof and transmitted to the control unit where the light signal is compared to those of the other two light - receiving optical fibers of the other two pairs thereof . as blood in a wavelength range of between 600 and 650 nm has a transmission in the proximity of 90 %, the strength of the received light signal depends on how close a pair of optical fibers is disposed to a vessel wall . a greater degree of reflection signifies closer proximity to the vessel wall . for comparison of the three light signals obtained in the above - described manner , in the control unit , it is easily possible to ascertain in which radial direction , relative to the catheter , the tip 30 of the catheter is approaching a vessel wall and can be suitably controlled in opposite relationship by way of the actuators . the three light - receiving optical fibers of the light signals going to the control unit in that case together form the spacing signal . an alternative embodiment of the spacing sensor 32 which also operates with light guides or optical fibers and infrared light has only two light guides or optical fibers of which one emits light and the other receives light which is incident from the sides at the tip of the catheter 10 and passes same to the control unit . by virtue of transmission of the blood not being one hundred percent , the light signal as the spacing signal is at its weakest when the tip 30 of the catheter is in the middle of the vessel . the catheter 10 ′″ in fig7 in addition to the catheter 10 shown in fig1 has a display unit 110 which is connected to the sensor 32 . in this case the sensor 32 is in the form of an optical , imaging sensor . the image which is picked up - by the sensor 32 is represented by the display unit 110 . the catheter 10 ′″ thereby practically becomes an endoscope - like unit . the information obtained by means of the sensor 32 and represented by the display unit 110 can be used in particular for suitably positioning the catheter . with such a catheter it is possible to look for suitable electrode placements or suitable ablation locations if the catheter is an ablation catheter .
a catheter , in particular for insertion into blood vessels of the human body , having at least one sensor which is arranged at the distal end of the catheter and which is adapted to pick up a spacing signal which is dependent on the spacing of the sensor with respect to the vessel wall , and control means which are connected to the sensor for taking over the spacing signal .