K Number
K022026
Device Name
MEDTRONIC AVE BRIDGE POLARIS BILIARY STENT SYSTEM (POLARIS)
Date Cleared
2002-07-19

(28 days)

Product Code
Regulation Number
876.5010
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Aurora is indicated for use in the palliation of malignant neoplasm in the biliary tree.
Device Description
The subject device is a system consisting of a single-lumen, tubular, self-expanding nickel-titanium (“nitinol”) stent pre-loaded onto a sheathed delivery catheter. The stent design incorporates radiopaque markers to aid in stent placement during fluoroscopy. The delivery system is designed to deliver the stent to the stricture site. Once positioned at the stricture site, the sheath is withdrawn and the stent is released. Upon release, the stent expands and conforms to the inner lumen of the biliary duct. Two catheter mounted radiopaque markers aid in visibility during fluoroscopy.
More Information

Not Found

No
The device description focuses on the mechanical aspects of a stent and delivery system, with no mention of AI or ML in the device description, intended use, or performance studies.

Yes
The device is indicated for "palliation of malignant neoplasm in the biliary tree," which means it is used to alleviate symptoms or improve the quality of life for patients with malignant tumors, thus performing a therapeutic function.

No

The device is a stent used for palliation of malignant neoplasm in the biliary tree, which is a treatment, not a diagnostic process. It is used to maintain the patency of the biliary duct.

No

The device description clearly outlines a physical stent and delivery catheter, which are hardware components.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. They are used to provide information for diagnosis, monitoring, or screening.
  • Device Description: The description clearly states that the Aurora is a stent and a delivery system designed to be implanted within the biliary tree to palliate malignant neoplasms. This is an implantable medical device used for treatment, not a test performed on a sample outside the body.
  • Intended Use: The intended use is "palliation of malignant neoplasm in the biliary tree," which is a therapeutic intervention, not a diagnostic test.
  • Input Imaging Modality: Fluoroscopy is used for guiding the placement of the device during the procedure, not for analyzing a sample.

Therefore, based on the provided information, the Aurora device falls under the category of an implantable medical device used for treatment, not an in vitro diagnostic.

N/A

Intended Use / Indications for Use

The Aurora is indicated for use in the palliation of malignant neoplasms in the biliary tree.

Product codes (comma separated list FDA assigned to the subject device)

78 FGE

Device Description

The subject device is a system consisting of a single-lumen, tubular, self-expanding nickel-titanium ("nitinol") stent pre-loaded onto a sheathed delivery catheter. The stent design incorporates radiopaque markers to aid in stent placement during fluoroscopy. The delivery system is designed to deliver the stent to the stricture site. Once positioned at the stricture site, the sheath is withdrawn and the stent is released. Upon release, the stent expands and conforms to the inner lumen of the biliary duct. Two catheter mounted radiopaque markers aid in visibility during fluoroscopy.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

fluoroscopy

Anatomical Site

biliary tree

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Preclinical testing was conducted to confirm the safe and effective performance of this device as well as the biocompatibility of the device.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K011080, K014205

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 876.5010 Biliary catheter and accessories.

(a)
Identification. A biliary catheter and accessories is a tubular flexible device used for temporary or prolonged drainage of the biliary tract, for splinting of the bile duct during healing, or for preventing stricture of the bile duct. This generic type of device may include a bile collecting bag that is attached to the biliary catheter by a connector and fastened to the patient with a strap.(b)
Classification. Class II (special controls). The device, when it is a bile collecting bag or a surgical biliary catheter that does not include a balloon component, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.

0

K022026 Page lofz

JUL 1 9 2002

510(k) Summary for the Medtronic AVE Bridge Aurora Biliary Stent System

510(k) SummaryThis summary of 510(k) safety and effectiveness information is being submitted in accordance with the requirements of 21 C.F.R. § 807.92.
SubmitterMedtronic AVE, Inc. Peripheral Technologies 3576 Unocal Place Santa Rosa, California 95403
Contact PersonJohn Riolo Vice President, Regulatory Affairs and Quality Assurance Phone: (707) 541-3271 FAX: (707) 566-1159 e-mail: john.riolo@medtronic.com
Date PreparedJune 20, 2002
Trade NameMedtronic AVE Bridge Aurora Biliary Stent System ("Aurora")
Common NameBiliary Stent and Delivery System
Classification NameBiliary Catheter and Accessories
Device ClassificationClassification: Class II Classification Panel: 78FGE Regulation Number: 21 C.F.R. §876.5010
Predicate DeviceBridge SE (K011080, K014205)
Performance StandardsPerformance standards have not been established by the FDA under section 514 of the Federal, Food, Drug and Cosmetic Act

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K022026 Page 2 of 2

510(k) Summary for the Medtronic AVE Bridge Aurora Biliary Stent System

| Device Description | The subject device is a system consisting of a single-lumen, tubular, self-
expanding nickel-titanium (“nitinol”) stent pre-loaded onto a sheathed
delivery catheter. The stent design incorporates radiopaque markers to
aid in stent placement during fluoroscopy. The delivery system is
designed to deliver the stent to the stricture site. Once positioned at the
stricture site, the sheath is withdrawn and the stent is released. Upon
release, the stent expands and conforms to the inner lumen of the biliary
duct. Two catheter mounted radiopaque markers aid in visibility during
fluoroscopy. |

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Indications for Use The Aurora is indicated for use in the palliation of malignant neoplasm in the biliary tree.

The Aurora is substantially equivalent to the currently marketed Bridge Technological SE. The subject and predicate stents are technologically similar and are Characteristics intended for palliation of malignant neoplasms in the biliary tree. The subject and predicate stents are constructed of biocompatible materials. The subject and predicate stents are delivered via a sheathed delivery system. The subject device offers increased visibility under fluoroscopy. The subject and predicate stents are comparable and are intended to meet clinical needs. The difference between the subject and predicate devices are minor and are not relevant to the ability of the subject device to palliate malignant neoplasms in the biliary tree.

Preclinical testing was conducted to confirm the safe and effective Nonclinical performance of this device as well as the biocompatibility of the device. Performance

The Aurora is provided sterile. The device is not intended for reuse or Sterilization resterilization.

The Aurora is substantially equivalent to the currently cleared and Conclusion marketed device and meets the clinical needs of the physicians.

Premarket Notification for Aurora Page 2 of 2

2

Image /page/2/Picture/1 description: The image is a black and white seal for the Department of Health & Human Services - USA. The seal is circular, with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the top half of the circle. The bottom half of the circle contains a stylized image of three human profiles facing to the right, with a design that resembles a bird in flight above them.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUL 1 9 2002

Mr. Kevin Drisko Regulatory Affairs Manager Medtronic AVE, Inc. Medtronic Peripheral Technologies 2170-A Northpoint Parkway SANTA ROSA CA 95407

Re: K022026 Medtronic AVE Bridge Aurora Biliary Stent System Regulatory Class: II 21 CFR §876.5010 Product Code: 78 FGE Dated: June 20, 2002 Received: June 21, 2002

Dear Mr. Drisko:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act). You may, therefore, market the device, subject to the general controls provisions of the Act and the limitations described below. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

The Office of Device Evaluation has determined that there is a reasonable likelihood that this device will be used for an intended use not identified in the proposed labeling and that such use could cause harm. Therefore, in accordance with Section 513(i)(1)(E) of the Act, the following limitation must appear in the Warnings section of the device's labeling:

The safety and effectiveness of this device for use in the vascular system have not been established.

Furthermore, the indication for biliary use must be prominently displayed in all labeling, including pouch, box, and carton labels, instructions for use, and other promotional materials, in close proximity to the trade name, of a similar point size, and in bold print.

3

Page 2 - Mr. Kevin Drisko

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and permits your device to proceed to the market. This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification if the limitation statement above is added to your labeling, as described.

Please note that the above labeling limitations are required by Section 513(i)(1)(E) of the Act. Therefore, a new 510(k) is required before these limitations are modified in any way or removed from the device's labeling.

If you desire specific information about the application of other labeling requirements to your device (21 CFR Part 801 and additionally Part 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4616. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification"(21 CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html.

Sincerely yours,

Bernard E. Statland, M.D., Ph. Director Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

510(k) Number (if known): K022026

Device Name: Medtronic AVE Bridge Aurora Biliary Stent System (Aurora)

FDA's Statement of the Indications For Use for device:

The Aurora is indicated for use in the palliation of malignant neoplasms in the biliary tree.

Prescription Use _ OR Over-The-Counter Use _
(Per 21 CFR 801.109)

David A. Leverson

(Division Si Division of and Radi 510(k) Nu