K Number
K061903
Device Name
RELIEVA SINUS BALLOON CATHETER
Manufacturer
Date Cleared
2006-08-18

(44 days)

Product Code
Regulation Number
874.4420
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
To provide a means to access the sinus space and to dilate the sinus ostia and spaces within the paranasal sinus cavities for diagnostic and therapeutic procedures.
Device Description
The Sinus Balloon Catheter—Integrated Wire is a sinus balloon catheter that has an integrated guidewire. The Sinus Balloon Catheter—Integrated Wire allows access to and dilation of the sinus ostia and paranasal spaces with a single device.
More Information

No
The summary describes a physical medical device (a balloon catheter with an integrated guidewire) and its intended use for dilation. There is no mention of software, algorithms, image processing, AI, or ML. The performance studies focus on the physical device's functionality.

Yes
The "Intended Use / Indications for Use" states that the device is used for "therapeutic procedures," and the device description details how it dilates sinus ostia and spaces.

Yes
The "Intended Use / Indications for Use" section explicitly states that the device is used for "diagnostic and therapeutic procedures."

No

The device description clearly describes a physical medical device (a catheter with an integrated guidewire) used for accessing and dilating sinus spaces. There is no mention of software as the primary or sole component.

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

Here's why:

  • Intended Use: The intended use describes a device used for accessing and dilating anatomical spaces within the body (sinus ostia and paranasal sinus cavities) for diagnostic and therapeutic procedures. This is an in vivo procedure, meaning it's performed within a living organism.
  • Device Description: The device is a balloon catheter with an integrated guidewire, designed for physical manipulation within the body.
  • Lack of IVD Characteristics: IVD devices are used to examine specimens (like blood, urine, tissue) outside of the body to provide information about a person's health. The provided description does not mention any such use or interaction with biological specimens.

Therefore, the Sinus Balloon Catheter—Integrated Wire is a medical device used for surgical/interventional procedures, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

To provide a means to access the sinus space and to dilate the sinus ostia and spaces within the paranasal sinus cavities for diagnostic and therapeutic procedures.

Product codes

LRC

Device Description

The Sinus Balloon Catheter—Integrated Wire is a sinus balloon catheter that has an integrated guidewire. The Sinus Balloon Catheter—Integrated Wire allows access to and dilation of the sinus ostia and paranasal spaces with a single device.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

sinus space, sinus ostia, paranasal sinus cavities

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)

The Sinus Balloon Catheter—Integrated Wire met all performance testing acceptance criteria. The Sinus Balloon Catheter—Integrated Wire is substantially equivalent to the predicate devices as confirmed through relevant performance tests.

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

Not Found

Predicate Device(s)

Relieva Sinus Balloon Catheter (K043527), Relieva Sinus Guidewire (K043445)

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 874.4420 Ear, nose, and throat manual surgical instrument.

(a)
Identification. An ear, nose, and throat manual surgical instrument is one of a variety of devices intended for use in surgical procedures to examine or treat the bronchus, esophagus, trachea, larynx, pharynx, nasal and paranasal sinus, or ear. This generic type of device includes the esophageal dilator; tracheal bistour (a long, narrow surgical knife); tracheal dilator; tracheal hook; laryngeal injection set; laryngeal knife; laryngeal saw; laryngeal trocar; laryngectomy tube; adenoid curette; adenotome; metal tongue depressor; mouth gag; oral screw; salpingeal curette; tonsillectome; tonsil guillotine; tonsil screw; tonsil snare; tonsil suction tube; tonsil suturing hook; antom reforator; ethmoid curette; frontal sinus-rasp; nasal curette; nasal rasp; nasal rongeur; nasal saw; nasal scissors; nasal snare; sinus irrigator; sinus trephine; ear curette; ear excavator; ear rasp; ear scissor, ear snare; ear spoon; ear suction tube; malleous ripper; mastoid gauge; microsurgical ear chisel; myringotomy tube inserter; ossici holding clamp; sacculotomy tack inserter; vein press; wire ear loop; microrule; mirror; mobilizer; ear, nose, and throat punch; ear, nose and throat knife; and ear, nose, and throat trocar.(b)
Classification Class I (general controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 874.9.

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:

K061903

APPENDIX A: 510(k) SUMMARY

| Sponsor/Submitter: | Acclarent, Inc.
1525-B O'Brien Drive
Menlo Park, California 94025 | AUG 18 2006 |
|-------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------|
| Contact Person: | Keri Yen
Quality Engineer
Phone: (650) 687-5874
Fax: (650) 687-5889 | |
| Date of Submission: | June 30, 2006 | |
| Device Trade Name: | To be determined | |
| Common Name: | Sinus Balloon Catheter—Integrated Wire | |
| Device Classification: | Class I | |
| Regulation Number: | 21 CFR 874.4420 | |
| Classification Name: | ENT Manual Surgical Instrument | |
| Product Code: | LRC | |
| Predicate Device: | Relieva Sinus Balloon Catheter (K043527)
Relieva Sinus Guidewire (K043445) | |
| Device Description: | The Sinus Balloon Catheter—Integrated Wire is a sinus balloon catheter that
has an integrated guidewire. The Sinus Balloon Catheter—Integrated Wire
allows access to and dilation of the sinus ostia and paranasal spaces with a
single device. | |
| Indications for Use: | To provide a means to access the sinus space and to dilate the sinus ostia and
spaces within the paranasal sinus cavities for diagnostic and therapeutic
procedures. | |
| Technological
Characteristics | The Sinus Balloon Catheter—Integrated Wire is a device that allows for the
capability to access and to dilate the sinus ostia with the same device. | |
| Performance Data | The Sinus Balloon Catheter—Integrated Wire met all performance testing
acceptance criteria. | |
| Summary of
Substantial
Equivalence: | The Sinus Balloon Catheter—Integrated Wire is substantially equivalent to the
predicate devices as confirmed through relevant performance tests. | |

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DEPARTMENT OF HEALTH & HUMAN SERVICES

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Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

AUG 1 8 2006

Acclarent, Inc. c/o Keri Yen Quality Assurance Engineer 1525-B O'Brien Drive Menlo Park, CA 94025

Re: K061903

Trade/Device Name: Sinus Balloon Catheter – Integrated Wire Regulation Number: 21 CFR 874.4420 Regulation Name: ENT Manual Surgical Instrument Regulatory Class: Class I Product Code: LRC Dated: July 31, 2006 Received: August 1, 2006

Dear Ms. Yen:

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.

2

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 (240) 276-0115. 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 from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

M.B. Eychlenis IWD

Malvina B. Eydelman, M.D. Director Division of Ophthalmic and Ear, Nosc and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Sinus Balloon Catheter-Integrated Wire

APPENDIX B: INDICATIONS FOR USE STATEMENT

510(k) Number (if known):

K061903

Trade Name:

To be determined

Common Name:

Sinus Balloon Catheter--Integrated Wire

Indications For Use:

To provide a means to access the sinus space and to dilate the sinus ostia and spaces within the paranasal sinus cavities for diagnostic and therapeutic procedures.

Prescription Use (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

on of Ophthalmic Ear.

510(k) Number K061903

Page / of /

(Posted November 13, 2003)

Prescription Use (Per 21 CFR 801.109)