K Number
K040825
Device Name
LAKE REGION HYDROPHILIC GUIDEWIRE
Date Cleared
2004-05-17

(48 days)

Product Code
Regulation Number
870.1330
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Lake Region Hydrophilic Guidewire is indicated for general intravascular use to aid in the selective placement of catheters in the coronary, peripheral, visceral and cerebral vasculature.
Device Description
The Lake Region Hydrophilic Guidewire consists of a flexible, tapered core wire that decreases in outer diameter from the proximal to the distal end. The hydrophilic coating reduces friction during use. The radiopaque distal coil facilitates fluoroscopic visualization. The Lake Region Hydrophilic Guidewire will be available in two configuration, with either an outer diameter of 0.010" or 0.014" and 180cm long.
More Information

Not Found

No
The device description and intended use describe a physical guidewire with a hydrophilic coating and radiopaque coil. There is no mention of software, algorithms, or any features that would suggest the use of AI or ML. The "Mentions AI, DNN, or ML" field is explicitly marked as "Not Found".

No
The device, a guidewire, is indicated for aiding in the placement of catheters. It facilitates a medical procedure rather than directly treating a disease or condition.

No

This device is a guidewire used to aid in the placement of catheters, not to diagnose a condition. Its function is interventional, enabling access for other procedures.

No

The device description clearly outlines a physical guidewire with a core wire, coating, and radiopaque coil, indicating it is a hardware medical device.

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

Here's why:

  • Intended Use: The intended use is to "aid in the selective placement of catheters in the coronary, peripheral, visceral and cerebral vasculature." This describes a device used within the body for a procedural purpose (guiding catheters), not for testing samples outside the body to diagnose or monitor a condition.
  • Device Description: The description details a physical guidewire with a core wire, coating, and coil. This is consistent with a medical device used in interventional procedures, not an IVD which typically involves reagents, analyzers, or test kits for analyzing biological samples.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting analytes, or providing diagnostic information based on laboratory testing.

Therefore, the Lake Region Hydrophilic Guidewire is a medical device used for guiding catheters within the vasculature, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The Lake Region Hydrophilic Guidewire is indicated for general intravascular use to aid in the selective placement of catheters in the coronary, peripheral, visceral and cerebral vasculature.

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

74DQX, DQX

Device Description

The Lake Region Hydrophilic Guidewire consists of a flexible, tapered core wire that decreases in outer diameter from the proximal to the distal end. The hydrophilic coating reduces friction during use. The radiopaque distal coil facilitates fluoroscopic visualization. The Lake Region Hydrophilic Guidewire will be available in two configuration, with either an outer diameter of 0.010" or 0.014" and 180cm long.

The guidewire dimensions are as follows:

Product DescriptionShaft OD(nominal)Shaft Length(nominal)Coil Length(nominal)
0.010" Guidewire.010"180 cm10 cm
0.014" Guidewire.014"180 cm10 cm

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

coronary, peripheral, visceral and cerebral vasculature

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)

As there were no changes to the device itself and Lake Region conducted the original design verification testing used to establish safety and effectiveness under Concentric Medical Hydrophilic Guidewire K003084, no further testing has been required.

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.

K003084

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

§ 870.1330 Catheter guide wire.

(a)
Identification. A catheter guide wire is a coiled wire that is designed to fit inside a percutaneous catheter for the purpose of directing the catheter through a blood vessel.(b)
Classification. Class II (special controls). The device, when it is a torque device that is manually operated, non-patient contacting, and intended to manipulate non-cerebral vascular guide wires, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 870.9.

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SECTION 2.0 - SUMMARY OF SAFETY AND EFFECTIVENESS

March 26, 2004

General Information 2.1

  • Company Name, Address, and Telephone Number 2.1.1
    Lake Region Manufacturing, Inc. (LRM) 340 Lake Hazeltine Drive Chaska, MN 55318 Telephone: (952) 448-5111 Fax: (952) 448-3441

Contact Name: Karen Mortensen Senior Regulatory Compliance Specialist

  • Device Trade Namc/Proprietary Name 2.1.2
    LRM produces guidewires on an OEM basis for other manufacturers, kit assemblers, and distributors. Consequently there are a large number of trade and proprietary names not including or associated with LRM. LRM has no proprietary names of its own to be included with this submission.

  • 2.1.3 Device Common Names/Usual Names and Classification Names
    These devices are commonly known as coronary and peripheral catheter guidewires. The current classification names and product codes are Wire, Guide, Catheter (74DQX).

  • 2.1.4 Establishment Registration Number: 2126666

  • Classification of Devices 2.1.5

Catheter guidewires have been classified as Class II devices by the Circulatory Systems Devices Panel (reference 21 CFR 870.1330).

  • 2.1.6 Applicability of Performance Standards
    LRM has determined that no mandatory performance standards have been established for these devices under Section 514 of the Medical Amendments to Federal Food, Drug, and Cosmetic Act or by any subsequent regulatory action. LRM has also determined that there are no applicable voluntary standards.

1

Labels, Labeling, and Advertising 2.2

LRM produces cardiovascular and vascular guidewires on an OEM basis for other manufacturers, kit assemblers, and distributors. There is no direct distribution by LRM. Changes to the customer controlled labels, labeling, or promotional material are at their discretion, including the resolution of any resulting regulatory obligations. A fraction of the total production bears LRM controlled labels and labeling.

2.3 Statement of Availability

This summary is being included in the Premarket Notification submission in lieu of a statement of availability.

Device Description 2-4

  • The Lake Region Hydrophilic Guidewire consists of a flexible, 2.4.1 tapered core wire that decreases in outer diameter from the The hydrophilic coating reduces proximal to the distal end. The radiopaque distal coil facilitates friction during use. The Lake Region Hydrophilic fluoroscopic visualization. Guidewire will be available in two configuration, with either an outer diameter of 0.010" or 0.014" and 180cm long.
    The guidewire dimensions are as follows:

| Product Description | Shaft OD
(nominal) | Shaft Length
(nominal) | Coil Length
(nominal) |
|---------------------|-----------------------|---------------------------|--------------------------|
| 0.010" Guidewire | .010" | 180 cm | 10 cm |
| 0.014" Guidewire | .014" | 180 cm | 10 cm |

Engineering Specifications 2.4.2

The design specifications are the same for the proposed device as they are for the predicate device (K003084). The finished devices must meet the same basic design criteria.

2.5 Substantial Equivalence Data

2.5.1 Background Information

The proposed device is the same device as the predicate device. Lake Region manufactured the predicate device for Concentric Medical and Concentric Medical contracted with Lake Region to do the design validation testing. Therefore, the majority of the information supplied in the Concentric Medical 510(k) submission originated with Lake Region Manufacturing.

2

| Item | Proposed Device Differences from Predicate cleared
under 510(k) K003084 |
|--------------------------|-----------------------------------------------------------------------------------------------------------------------------------|
| Raw Materials | No change |
| Assembly Process | No change |
| Physical Characteristics | No change |
| Labeling/IFU | The only change to the IFU will be to the manufacturer
information and the omission of the optional introducer
information. |
| Intended Use | No change |
| Anatomical Sites | No change |
| Target Population | No change |
| Performance Testing | No change |
| Safety Characteristics | No change |
| Biocompatibility | No change |
| Risk Analysis | No change |

2.5.2 Comparison table of predicate to proposed device

Design Control and Validation Activities 2.6

LRM is in conformance with the design control procedure requirements as specified in 21 CFR 820.30. Risk analysis was completed by means of a Failure Mode and Effect Analysis (FMEA) and all verification and validation activities resulted in the ability to demonstrate that the predetermined acceptance critcria could be met.

As there were no changes to the device itself and Lake Region conducted the original design verification testing used to establish safety and effectiveness under Concentric Medical Hydrophilic Guidewire K003084, no further testing has been required.

Material/Product/Process Qualification 2.7

LRM has formal quality systems in place to assure that the proposed product will remain equivalent to the predicate product. The quality include Engineering Change Order Review, Material systems Qualification, Product Qualification, and Process Qualification. These controls are applied to each product size/group.

2.8 Biocompatibility Testing

The materials for the proposed device are identical to the predicate device cleared under K003084 and are identically processed and sterilized. Therefore, biocompatibility testing for the proposed device is not required.

3

Packaging and Sterilization Information 2.9

LRM produces guidewires on an OEM basis for other manufacturers, kit assemblers, and distributors. There is no direct distribution by LRM. A portion of the production is private label, sterile packaged to customer specifications, a fraction of that product is provided sterile to the customer.

The single packaged guidewire is placed in a dispenser and then into a Tyvek®/poly pouch. The packaged product may be packaged singlely or in five or ten pouchs to a shelf carton, which are typical packaging configurations.

There will be no changes to the sterilization process for the portion of packaged product shipped sterile to the customer. For the product that is shipped bulk, the packaging design and sterilization process parameters are the customer's responsibility. LRM will not recommend that its customers modify their packaging or sterilization procedures as a result of this submission.

2.10 Intended Use Statement

The intended use statement is the same as the intended use statement for the predicate device cleared under K003084, specifically:

The Lake Region Hydrophilic Guidewire is indicated for general intravascular use to aid in the selective placement of catheters in the coronary, peripheral, visceral and cerebral vasculature.

Conclusion 2.11

The Lake Region Hydrophilic Guidewire is substantially equivalent to the predicate guidcwire cleared under 510(k) K003084. There have been no significant changes to the guidewire design as previously manufactured by Lake Region Manufacturing for Concentric Medical.

4

Public Health Service

Image /page/4/Picture/2 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized human figure with three wavy lines representing the body, and the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged in a circular pattern around the figure. The text is in all caps and appears to be in a sans-serif font. The logo is black and white.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MAY 17 2004

Lake Region Manufacturing, Inc. c/o Karen Mortensen Senior Regulatory Compliance Specialist 340 Lake Hazeltine Drive Chaska, MN 55318-1029

K040825 Re:

Lake Region Hydrophilic Guidewire Regulation Number: 21 CFR 870.1330 Regulation Name: Catheter guide wire Regulatory Class: Class II Product Code: DQX Dated: March 26, 2004 Received: March 30, 2004

Dear Ms. Mortensen:

We have reviewed your Section 510(k) premarket notification of intent to market the device we nave tevenced your boother of the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate 101 use stated in the enorosaly to regary the enactment date of the Medical Device Amendments, or to commerce provision in May 20, 1978, accordance with the provisions of the Federal Food, Drug, de necs that have boon require approval of a premarket approval application (PMA). and Cosmetic (110) therefore, subject to the general controls provisions of the Act. The I ou may, merelove, mains of the Act include requirements for annual registration, listing of general controll provincitive, 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 If your device to such additional controls. Existing major regulations affecting your device can he 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.

5

Page 2 – Ms. Karen Mortensen

Please be advised that FDA's issuance of a substantial equivalence determination does not mean Please be advised that FDA's issuance of a substitution with other requirements of the Act
that FDA has made a determination that your device Edger League of Soumust that FDA has made a determination and your creases by other Federal agencies. You must
or any Federal statutes and regulations administered by other to: registration and li or any Federal statutes and regulations and limited to: registration and listing (21)
comply with all the Act's requirements, including, but not itements as set comply with all the Act s requirements, mename, surving practice requirements as set
CFR Part 807); labeling (21 CFR Part 801); gractice requirements as set CFR Part 807); labeling (2) CFR Patl 801); good manufacturing platf.applicable, the electronic
forth in the quality systems (QS) regulation (21 CFR Part 820); and 1f applicab forth in the quality systems (QS) regulation (21-542 of the Act); 21 CFR 1000-1050.
product radiation control provisions (Sections 531-542 of the Action S product radiation control provisions (Scctions 95 described in your Section 510(k)
This letter will allow you to begin marketing your device of your device to a legal This letter will allow you to begin makemig your as walnece of your device to a legally
premarket notification. The FDA finding of substantial equivalend thus, permits vour premarket notification. The FDA imalig of substantal equivalies by the subsitive of the to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please
rs (11) 11 (11) (11) (11) (11) (11) - Alles mlesse note the requilation en If you desire specific advice for your uevice on on on nasmile (1) = 1 = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = contact the Office of Compliatice at (301) 574 10 107 (21CFR Part 807.97). You may obtain
"Misbranding by reference to premarket notification of Small "Misbranding by reference to premarket nontiedation of Set from the Division of Small
other general information on your responsibilities under the Act from worker (900) 638-2 other general information on your responsibilities and con-free number (800) 638-2041 or (301) 443-6597 or at its Internet address

(301)443-0597 or at its mtornol as a smamain. html

Sincerely yours,

Dana R. Vochner

Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

6

Indications for Use

510(k) Number (if known): ____________________________________________________________________________________________________________________________________________________

Device Name:__________________________________________________________________________________________________________________________________________________________________

Indications For Use:

The Lake Region Hydrophilic Guidewire is indicated for general intravascular use to aid in the selective placement of catheters in the coronary, peripheral, visceral and cerebral vasculature.

Prescription Use X (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Donna R. Vochner

(Division Sign-Off)
Division of Cardiovascular Devices

:0(k) Number Ko40825

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