K Number
K031168
Device Name
MATRIX STRETCH RESISTANT DETACHABLE COIL
Date Cleared
2003-05-14

(30 days)

Product Code
Regulation Number
882.5950
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Matrix Detachable Coils are intended for embolization of those intracranial aneurysms that - because of their morphology, their location, or the patient's general medical condition - are considered by the treating neurosurgical team to be a) very high risk for management by traditional operative techniques, or o) inoperable. Matrix Detachable Coils are also intended for embolization of other neuro vascular abnormalities such as arteriovenous malformations and arteriovenous fistulae. The Matrix Detachable Coils are also intended for arterial and venous ambolizations in the perioheral vasculature.
Device Description
Matrix Stretch Resistant Detachable Coils are comprised of a platinum-tungsten alloy coil which is coated with a biocompatible absorbable polymer. Packaging of the device is identical to that of the predicate Matrix Detachable Coils: the finished device is loaded into an introducer sheath and is then placed in a dispenser coil contained within a foil pouch. The foil pouch is then placed into a cardboard display box with a copy of the instructions for use. Matrix Stretch Resistant Detachable Coils are detached using Boston Scientific's GDC® Power Supply. The system consists of the power supply, powered by two 9 volt batteries, an occlusion coil attached to a delivery wire, a set of connecting cables and a patient return electrode. A positive cable (red) supplies current to the delivery wire while a negative cable (black) completes the circuit by connecting to the patient return electrode (either an adhesive patch attached to the patient's skin or a hypodermic needle inserted subcutaneously through the patient's skin). After placement of the coil in the anatomy, detachment occurs through the clectrolytic dissolving of a small portion of the delivery wire.
More Information

Not Found

No
The summary describes a physical medical device (detachable coils) and its detachment system, with no mention of software, algorithms, or data processing that would indicate the use of AI/ML.

Yes
The device is intended for embolization of intracranial aneurysms and other neurovascular abnormalities, which is a therapeutic intervention aimed at treating medical conditions.

No

The device is described as an embolization coil used to treat conditions like aneurysms, not to diagnose them. Its function is interventional, not diagnostic.

No

The device description clearly states that the device is comprised of a platinum-tungsten alloy coil coated with a polymer and is detached using a power supply system with cables and electrodes. This indicates a physical, hardware-based medical device, not a software-only one.

Based on the provided text, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices used to examine specimens taken from the human body, such as blood, urine, or tissue, to provide information for diagnosis, monitoring, or screening.
  • Device Description and Intended Use: The description clearly states that the Matrix Detachable Coils are intended for the embolization (blocking off) of blood vessels in the brain and peripheral vasculature. This is a therapeutic procedure performed within the patient's body, not an analysis of a specimen outside the body.
  • Mechanism of Action: The device works by being placed inside a blood vessel and then detached electrolytically. This is a physical intervention, not a diagnostic test.

The information provided focuses on the device's physical properties, deployment, and detachment mechanism, all of which are characteristic of an implantable or interventional medical device, not an IVD.

N/A

Intended Use / Indications for Use

Matrix Detachable Coils are intended for embolization of those intracranial aneurysms that - because of their morphology, their location, or the patient's general medical condition - are considered by the treating neurosurgical team to be a) very high risk for management by traditional operative techniques, or o) inoperable. Matrix Detachable Coils are also intended for embolization of other neuro vascular abnormalities such as arteriovenous malformations and arteriovenous fistulae. The Matrix Detachable Coils are also intended for arterial and venous ambolizations in the perioheral vasculature.

Product codes

HCG

Device Description

Matrix Stretch Resistant Detachable Coils are comprised of a platinum-tungsten alloy coil which is coated with a biocompatible absorbable polymer.

Packaging of the device is identical to that of the predicate Matrix Detachable Coils: the finished device is loaded into an introducer sheath and is then placed in a dispenser coil contained within a foil pouch. The foil pouch is then placed into a cardboard display box with a copy of the instructions for use.

Matrix Stretch Resistant Detachable Coils are detached using Boston Scientific's GDC® Power Supply. The system consists of the power supply, powered by two 9 volt batteries, an occlusion coil attached to a delivery wire, a set of connecting cables and a patient return electrode. A positive cable (red) supplies current to the delivery wire while a negative cable (black) completes the circuit by connecting to the patient return electrode (either an adhesive patch attached to the patient's skin or a hypodermic needle inserted subcutaneously through the patient's skin). After placement of the coil in the anatomy, detachment occurs through the clectrolytic dissolving of a small portion of the delivery wire.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Intracranial, peripheral vasculature.

Indicated Patient Age Range

Not Found

Intended User / Care Setting

treating neurosurgical team

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)

Verification Test Summary Table: Matrix Stretch Resistant Devices vs Predicate Matrix™ Devices was conducted. The following tests met acceptance criteria for the Matrix™ Stretch Resistant Detachable Coil: Friction, Deployment / Retraction, Catheter Coil Compatibility, Coil Bond Integrity, Suture-to-Coil Bond Integrity, Main Coil Conductivity, Tensile Strength: main coil-to-pusher wire, Tensile Strength: stretch resistant suture, Tensile Strength: distal tip ball, Proximal Coil Stiffness, Acute Particulate, Dynamic Particulate, Suture Degradation, Coil Stiffness, Secondary Coil OD Shape Retention.
Modification has no affect upon detachment time, inner coil weld strength, and coil migration.

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

Not Found

Predicate Device(s)

K012985, K030475

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 882.5950 Neurovascular embolization device.

(a)
Identification. A neurovascular embolization device is an intravascular implant intended to permanently occlude blood flow to cerebral aneurysms and cerebral ateriovenous malformations. This does not include cyanoacrylates and other embolic agents, which act by polymerization or precipitation. Embolization devices used in other vascular applications are also not included in this classification, see § 870.3300.(b)
Classification. Class II (special controls.) The special control for this device is the FDA guidance document entitled “Class II Special Controls Guidance Document: Vascular and Neurovascular Embolization Devices.” For availability of this guidance document, see § 882.1(e).

0

MAY 1 4 2003

Image /page/0/Picture/1 description: The image shows a handwritten string of characters, "K031168". The characters are written in a cursive style, with some connections between the numbers. The numbers are all distinct and legible.

Special 510(k): Matrix Stretch Resistant Coils (Matrix Standard-SR 2D, Matrix Soft-SR, Matrix Soft-SR 2D and Matrix UltraSoft-SR)

a. 510(k) Summary

Contact Person

Jim Leathley Regulatory Affairs Project Manager Boston Scientific Target 47900 Bayside Parkway Fremont, CA. 94538

Trade Name

Matrix™ Stretch Resistant Detachable Coils

Common Name

Occlusion Coil

Classification Name

Artificial Embolization Device (21 CFR Section 882,5950)

Prodicato Devices

NumberDescriptionPredicate forClearance Date
K012985
(Boston
Scientific)Matrix Detachable CoilMatrix Stretch Resistant
Detachable Coils31 January 2003
K030475
(Boston
Scientific)GDC Stretch Resistant
Detachable CoilsStretch Resistant feature of
the Matrix Stretch
Resistant Coils14 March 2003

Intended Use

Matrix Detachable Coils are intended for embolization of those intracranial aneurysms that - because of their morphology, their location, or the patient's general medical condition - are considered by the treating neurosurgical team to be a) very high risk for management by traditional operative techniques, or o) inoperable. Matrix Detachable Coils are also intended for embolization of other neuro vascular abnormalities such as arteriovenous malformations and arteriovenous fistulae. The Matrix Detachable Coils are also intended for arterial and venous ambolizations in the perioheral vasculature.

Boscon Scientific

Page 77

1

Device Description

Matrix Stretch Resistant Detachable Coils are comprised of a platinum-tungsten alloy coil which is coated with a biocompatible absorbable polymer.

Packaging of the device is identical to that of the predicate Matrix Detachable Coils: the finished device is loaded into an introducer sheath and is then placed in a dispenser coil contained within a foil pouch. The foil pouch is then placed into a cardboard display box with a copy of the instructions for use.

Matrix Stretch Resistant Detachable Coils are detached using Boston Scientific's GDC® Power Supply. The system consists of the power supply, powered by two 9 volt batteries, an occlusion coil attached to a delivery wire, a set of connecting cables and a patient return electrode. A positive cable (red) supplies current to the delivery wire while a negative cable (black) completes the circuit by connecting to the patient return electrode (either an adhesive patch attached to the patient's skin or a hypodermic needle inserted subcutaneously through the patient's skin). After placement of the coil in the anatomy, detachment occurs through the clectrolytic dissolving of a small portion of the delivery wire.

Principles of Cperation

Detachment of the occlusion coil from the delivery wire is accomplished by means of an electrolytic reaction in which the anode, or positive, electrode is the GDC stainless-steel delivery wire, and the cathode, or negative, electrode is a patient return clectrode. The body's electrolytes serve as the electrolytic carrier between the two electrodes. Since body fluids are relatively jonic, these fluids serve as good conductors for the minimal electric current generated by the GDC power supply. The GDC is designed so that electrolytic dissolution occurs only in the detachment zone.

Once the power supply circuitry detects coil detachment, the unit will emit 5 audible beeps signaling detachment. In addition, current flow will be stopped and all displays will freeze, indicating values at the time of detachment. This is the "pause" mode, designed to allow the clinician, utilizing fluoroscopy, to confirm that the coil has detached.

If the system has incorrectly signaled coil detachment, the current flow can be re-started by pressing the "Current" switch on the power supply. Restarting the current does not reset the elapsed time display on the power supply.

GDC® Power Supply Description

The GDC Power Supply is a battery-operated, self-contained unit designed to initiate and control the electrolytic detachment of a GDC coil inside an aneurysm.

Each time the GDC Power Supply is turned on, the unit defaults to the 1.0 mA current setting. Pressing the "Current" switch one time changes the setting to the 0.5 mA current setting; pressing a second time changes the setting to 0.75 mA; pressing a third time returns the unit to the default 1.0 mA setting. Each time the switch is pressed, the current display flashes the new current setting.

Bos ton Scientific

Page 78

2

The GDC Power Supply is designed to apply a constant current through the GDC System and to detect when coil detachment has occurred. It maintains a constant current by:

    1. sensing the amount of resistance to current flow through the GDC System, and
    1. adjusting the voltage needed to maintain the desired current setting. It is also designed to identify subtle changes in the way current is flowing through the GDC System and to recognize those changes which indicate detachment.

Once those patterns are identified, the GDC Power Supply signals detachment and stops the flow of current through the GDC System.

Accessories Description

Accessories consist of the following:

  • · Two connecting cables, one black (274 cm long), the other red (152 cm long)
  • · Two standard 9 volt alkaline batteries

Boston Scientific

Page 79

3

Technological Characteristics Comparison

Coil Dimensional Attributes (compared to the predicate device)

Matrix™ Stretch Resistant Detachable Coil
Coil Primary Wind ODWithin the range used for the predicate devices.
Secondary Coil ODWithin the range used for the predicate devices.
Coil Wire ODWithin the range used for the predicate devices.
Delivery Wire LengthSame as predicate device.
Delivery Wire Proximal ODSame as predicate device.
Delivery Wire Distal ODWithin the range used for the predicate devices.
Matrix™ Stretch Resistant Detachable Coils
Main CoilSame as predicate device
Polymer coatingSame as predicate device
Stretch Resistant Thread and anchor chainSame as predicate device for all except Matrix
Standard-SR 2D. Anchor Chain for Matrix
Standard-SR 2D utilizes new wire size
(0.00125").
Main Coil / delivery wire junction tubingSame as predicate device
AdhesiveSame as predicate device
Delivery Wire
Core wire w/coatingSame as predicate device
Proximal CoilSame as predicate device
Proximal Marker CoilSame as predicate device
Sheath, Delivery Wire (heat shrink tubing)Same as predicate device
Proximal TubingSame as predicate device
BushingSame as predicate device
Inner CoilSame as predicate device

Boston Scientific

:

Page 80

4

Special 510(k): Matrix Stretch Resistant Coils (Matrix Standard-SR 2D, Matrix Soft-SR, Matrix Sofi -SR 2D and Matrix UltraSoft-SR)

Technological Characteristics Comparison (cont.)

Materials

Boston Scientific

5

Special 510(k): Matrix Stretch Resistant Coils (Matrix Standard-SR 2D, Matrix Soft-SR 2D and Matrix UltraSoft-SR)

Test or Point of ComparisonMatrix™ Stretch Resistant Detachable Coil
FrictionMeets acceptance criteria.
Deployment / RetractionMeets acceptance criteria.
Catheter Coil CompatibilityMeets acceptance criteria.
Coil Bond IntegrityMeets acceptance criteria.
Suture-to-Coil Bond IntegrityMeets acceptance criteria.
Main Coil ConductivityMeets acceptance criteria.
Tensile Strength: main coil-to-
pusher wireMeets acceptance criteria.
Tensile Strength: stretch resistant
sutureMeets acceptance criteria.
Tensile Strength: distal tip ballMeets acceptance criteria.
Proximal Coil StiffnessMeets acceptance criteria.
Acute ParticulateMeets acceptance criteria.
Dynamic ParticulateMeets acceptance criteria.
Suture DegradationMeets acceptance criteria.
Coil StiffnessMeets acceptance criteria.
Secondary Coil OD Shape
RetentionMeets acceptance criteria.
Detachment TimeModification has no affect upon detachment time
Inner Coil Weld StrengthModification has no affect upon inner coil weld strength
Coil MigrationModification has no affect upon coil migration

Verification Test Summary Table: Matrix Stretch Resistant Devices vs Predicate Matrix™ Devices

Boston Scientific

6

Special 510(k): Matrix Stretch Resistant Coils (Matrix Standard-SR 2D, Matrix Soft-SR, Matrix Soft-SR 2D and Matrix UltraSoft-SR)

Verification Test Summary Table (cont.): Matrix Stretch Resistant Devices vs Predicate Matrix™ Devices

Bo: ton Scientific

Page 83

7

Image /page/7/Picture/1 description: The image is a black and white logo for the Department of Health & Human Services - USA. The logo is circular, with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the top half of the circle. Inside the circle is a stylized image of three wavy lines that resemble a human profile.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MAY 1 4 2003

Mr. Jim Leathley Regulatory Affairs Project Manager Boston Scientific Target 47900 Bayside Parkway Fremont, California 94538

Re: K031168

Trade/Device Name: Matrix™ Stretch Resistant Detachable Coils Regulation Number: 21 CFR 882.5950 Regulation Name: Artificial embolization device Regulatory Class: III Product Code: HCG Dated: April 11, 2003 Received: April 14, 2003

Dear Mr. Leathley:

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) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. 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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such 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.

8

Page 2 - Mr. Jim Leathley

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

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at (301) 594-4659. 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" (21CFR Part 807.97) you may obtain. 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,

Miriam C. Provost

Celia M. Witten, Ph.D., M.D. Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

9

K031168

Special 510(k): Matrix Stretch Resistant Coils (Matrix Standard-SR 2D, Matrix Soft-SR, Matrix Soft-SR 2D and Matrix UltraSoft-SR)

INDICATIONS FOR USE STATEMENT

510(k) Number:

Matrix Stretch Resistant Coils, comprising: Device Name:

Matrix™ Standard-SR 2D Matrix Soft-SR Matrix Soft-SR 2D Matrix UltraSoft-SR

Indications for Use:

Matrix Detachable Coils are intended for embolization of those intracranial aneurysms that - because of their morphology, their location, or the patient's general medical condition - are considered by the treating neurosurgical team to be a) very high risk for management by traditional operative techniques, or b) inoperable. Matrix Detachable Coils are also intended for embolization of other neuro vascular abnormalities such as arteriovenous malformations and arteriovenous fistulae. The Matrix Detachable Coils are also intended for arterial and venous embolizations in the peripheral vasculature.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)
----------------------------------------------------------
Prescription Use (Per 21 CFR 801.109)OROver The Counter Use
-----------------------------------------------------------------
Miriam C. Provost
(Division Sign-Off)
Division of General, Restorative and Neurological Devices
510(k) NumberK031168
------------------------
Boston ScientificApril 2003
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