K Number
K042338
Device Name
CORONARY PERIPHERAL AND RENAL STEERABLE GUIDEWIRE
Date Cleared
2004-09-16

(17 days)

Product Code
Regulation Number
870.1330
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Lake Region's steerable guidewires are intended for use in angiographic procedures to introduce and position catheters and interventional devices within the coronary and peripheral vasculature, including the renal vasculature. The steerability feature allows the guidewire to be torqued to facilitate navigation through the vasculature.
Device Description
This device is a guidewire with a PTFE coated stainless steel core that has been ground at the distal end to provide the appropriate tip flexibility. The coils are joined to the core at the ground end and a distal tip coil is soldered to the core. The proximal PTFE coated portion of the core has two sections of the PTFE removed to aid in estimating guidewire positioning. The product is offered with a shapeable straight tip or in a preshaped configuration. The guidewires are optionally coated with MDX (silicone). The guidewires are bound by the following parameters: Outside Diameter: .014" - .018", Lengths: 130cm - 300cm, Tips: Straight or shaped with various tip flexibilities.
More Information

Not Found

No
The device description and performance studies focus on the mechanical properties and physical characteristics of a guidewire, with no mention of AI or ML technologies.

No
The device is described as a guidewire used to introduce and position other devices, not to directly treat a medical condition.

No
The device is a guidewire used to introduce and position catheters and interventional devices, not to diagnose a condition.

No

The device description clearly details a physical guidewire made of stainless steel with PTFE coating and coils, indicating it is a hardware device.

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

Here's why:

  • Intended Use: The intended use clearly states the device is for "use in angiographic procedures to introduce and position catheters and interventional devices within the coronary and peripheral vasculature". This describes a device used within the body for a medical procedure, not a device used to test samples outside the body.
  • Device Description: The description details a physical guidewire with specific materials and features designed for navigation within blood vessels. This aligns with an invasive medical device, not an IVD.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting analytes, or providing diagnostic information based on in vitro testing.

IVD devices are designed to perform tests on samples taken from the human body to provide information for diagnosis, monitoring, or screening. This guidewire's function is purely mechanical and procedural within the patient's vasculature.

N/A

Intended Use / Indications for Use

Lake Region's steerable guidewires are intended for use in angiographic procedures to introduce and position catheters and interventional devices within the coronary and peripheral vasculature, including the renal vasculature. The steerability feature allows the guidewire to be torqued to facilitate navigation through the vasculature.

Product codes

HAP, DQX, JAJ

Device Description

This device is a guidewire with a PTFE coated stainless steel core that has been ground at the distal end to provide the appropriate tip flexibility. boon ground for the coils are joined to the core at the ground end and a distal tip coil is soldered to the core. The proximal PTFE coated portion of the core has two sections of the PTFE removed to aid in estimating guidewire positioning.

The product is offered with a shapeable straight tip or in a preshaped configuration. The guidewires are optionally coated with MDX (silicone). The guidewires are bound by the following parameters:

Outside Diameter: .014" - .018"
Lengths: 130cm - 300cm
Tips: Straight or shaped with various tip flexibilities

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

coronary and peripheral vasculature, including the renal 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)

Non-Clinical Tests:
In order to demonstrate equivalence of the proposed device, LRM performed testing to established requirements. Test pieces were tested and inspected tooling to established specific inspection criteria requirements for visual/tactile, dimensional and mechanical attributes. The results of these viouslikability, umonitionality and performance characteristics of these guidewires are comparable to the currently marketed devices.

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

Not Found

Predicate Device(s)

K022813, K011968

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

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.

0

K042338

SEP 1 6 2004

SECTION 2.0 – SUMMARY OF SAFETY AND EFFECTIVENESS

August 25, 2004

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

Company Name, Address, and Telephone Number:
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

Establishment Registration Number: 2126666

Device Trade Name/Proprietary Name:

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.

Device Common Names/Usual Names and Classification Names:

These devices are commonly known as guides, guidewires, or spring The current classification names, and product codes are quidewires. Angiographic Guidewire (74HAP), Catheter Guidewire (74DQX), and Radiological Catheter Guidewire (74JAJ).

Classification of Devices:

Olassification of Donoos listed above were originally classified as Class II devices by the Neurology (84HAD), Cardiovascular (74DQX), and Radiology (90JAJ) Review Panels, respectively.

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:

LRM produces cardiovascular and vascular guidewires on an OEM basis for ether manufacturers kit assemblers and distributors. There is no direct other manafacturer int ages to the customer controlled labels labeling or diotion by Erinals are at their discretion including the resolution of any promotion regulatory obligations. A fraction of the total production bears LRM controlled labels and labeling.

Device Description:

This device is a guidewire with a PTFE coated stainless steel core that has been ground at the distal end to provide the appropriate tip flexibility. boon ground for the coils are joined to the core at the ground end and a distal tip coil is soldered to the core. The proximal PTFE coated portion of the core has two sections of the PTFE removed to aid in estimating guidewire positioning.

The product is offered with a shapeable straight tip or in a preshaped configuration. The guidewires are optionally coated with MDX (silicone). The guidewires are bound by the following parameters:

Outside Diameter:.014" - .018"
Lengths:130cm - 300cm
Tips:Straight or shaped with various tip flexibilities

Engineering Specifications:

The design specifications are the same for the proposed device as they are for the LRM predicate device [reference 510(k)s K022813 and K011968] with the exception of the smaller outer diameter and the additional radiopaque marker coils soldered to the core proximal to the existing radiopaque coil. The finished device must meet the same basic design criteria as the predicate device.

2

SECTION 2.0 – SUMMARY OF SAFETY AND EFFECTIVENESS (continued)

Substantial Equivalence Data:

Lake Region believes this device is substantially equivalent to the predicate device. Eake Region belioved this active to between the predicate device and the proposed below lists the differences bettre the changes to the device met the device. predetermined acceptance criteria.

| Item | Proposed Device Differences from LRM Predicate
cleared under 510(k) K022813 |
|-----------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------|
| Raw Materials | Core:
No change to raw material

Coils:
No change to raw material |
| Assembly Process | No change to assembly processes with the exception
of the additional solder step to join the additional
radiopaque marker coils to the core. |
| Physical
Characteristics | No change except to offer a .014" along with the
.018" diameter. |
| Labeling/IFU | No change to the labeling/IFU except to change the
description to add the smaller diameter. |
| Intended Use | No change to intended use |
| Anatomical Sites | No change |
| Target Population | No change |
| Performance | No change |
| Testing | No change |
| Safety
Characteristics | No change |
| Biocompatibility | No change |
| Risk Analysis | No change |

3

SECTION 2.0 - SUMMARY OF SAFETY AND EFFECTIVENESS (continued)

Quality System Controls:

Design Control:

Design oonformance with the design control procedure requirements as ERM 10 11 0011 CFR 820.30. Risk analysis was completed by means of a Specifically 21 OFF ecolor sis (FMEA) and all verification and validation rativities resulted in the ability to demonstrate that the predetermined acceptance criteria were met.

Material/Product/Process Controls:

Matchain Todoon Tooob Donline in place to assure that each product manufactured remains equivalent to the predicate products, and that the mandidotarou Tomans o adverse affect on the safe and effective use of the The quality systems include Engineering Change Order Review, product. product. - The Qualification, Product Qualification, and Process Qualification. These controls are applied to each product size/group.

Qualification Testing:

Non-Clinical Tests:

In order to demonstrate equivalence of the proposed device, LRM performed testing to established requirements. Test pieces were tested and inspected tooling to established specific inspection criteria requirements for visual/tactile, dimensional and mechanical attributes. The results of these viouslikability, umonitionality and performance characteristics of these guidewires are comparable to the currently marketed devices.

Biocompatibility Testing:

There are no new materials used in the modification of this device. Biocompatibility testing has been performed on the predicate product and has been found to be applicable to the modified device. This testing, along with a market history of proven biocompatibility, establishes acceptable biocompatibility for this device.

4

SECTION 2.0 - SUMMARY OF SAFETY AND EFFECTIVENESS (continued)

Packaging and Sterilization Information:

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, some 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 as five or ten pouches in 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.

Intended Use Statement:

Lake Region's steerable guidewires are intended for use in angiographic procedures to introduce and position catheters and interventional devices within the coronary and peripheral vasculature, including the renal vasculature. The steerability feature allows the guidewire to be torqued to facilitate navigation through the vasculature.

NOTE: The modification of this device does not alter its intended use.

5

Image /page/5/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with three lines forming its body and wings. The eagle is positioned within a circle that contains the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" in a circular arrangement around the eagle.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

SEP 1 6 2004

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

Re: K042338

K042530
Trade/Device Name: Coronary, Peripheral and Renal Steerable Hydrophilic Guidewire Regulation Number: 21 CFR 870.1330 Regulation Name: Catheter guidewire Regulatory Class: Class II Product Code: DQX Dated: August 27, 2004 Received: August 30, 2004

Dear Ms. Mortensen:

We have reviewed your Section 510(k) premarket notification of intent to market the device we nave reviewed your becaused 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 conninered pror to May 20, 1978, in accordance with the provisions of the Federal Food, Drug, de vices that have been require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The r ou may, therefore, mains 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 i lease of a recommation 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

6

Page 2 – Ms. Karen Mortensen

forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic (21 CFR 1000-1050 forth in the quality systems (QD) regulation (Sections 531-542 of the Act); 21 CFR 1000-1050.
product radiation control provisions (Sections 531-542 of the Action Section S product radiation control provisions (Sections 35 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 manxemily of substantial equivalence of your device to a legally premarket notification. The FDA iniding of substantial equive 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
s and the may be and 1648 - the same of the same and the requires an the re If you desire specific advice for your de rice of east. Also, please note the regulation entitled, contact the Office of Comphalled at (301) 377-77-77 (21CFR Part 807.97). You may obtain " Misoranding by reference to premance notificals as the Act from the Division of Small other general information on your responsible.com and and the mumber (800) 638-2041 or (301) 443-6597 or at its Internet address

(301)445-0597 of at its internetadios
http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Dvina R. Vochner

A Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices

Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

7

Indications for Use

510(k) Number (if known): Ko42338

Device Name:___Coronary Periperal and Renal Steerable Hydrophilic Guidewire

Indications For Use:

Lake Region's steerable guidewires are intended for use in angiographic Lake Negron's Stocrable galability catheters and interventional devices procedures to introduce and peripheral vasculature, including the renal within the obronary and facilitate navigation through the vasculature.

Prescription Use X ___________________________________________________________________________________________________________________________________________________________

AND/OR

Over-The-Counter Use

(Part 21 CFR 801 Subpart D)

(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)

Muna D. Salmer

(Division Sian-Off) Division of Cardiovascular Devices

510(k) Number K042338

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