K Number
K062387
Manufacturer
Date Cleared
2006-10-05

(51 days)

Product Code
Regulation Number
870.1250
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Small Peripheral Cutting Balloon catheters are indicated for percutaneous transluminal angioplasty of obstructive lesions of synthetic or native arteriovenous dialysis fistulae.

Device Description

The small Peripheral Cutting Balloon Catheter (PCB) with Monorail (MR) delivery system has features of a conventional angioplasty catheter with advanced microsurgical capabilities. The sPCB features a balloon with 3 or 4 atherotomes (microsurgical blades) mounted longitudinally on its outer surface. The device is inserted over a guidewire and delivered to the target lesion. When the PCB device is inflated, the atherotomes score the plaque, creating initiation sites for crack propagation. Percutaneous Angioplasty (PTA) with the PCB device allows dilatation of the target lesion with less pressure, minimizing barotrauma.

AI/ML Overview

This document is a 510(k) summary for the Boston Scientific Corporation Small Peripheral Cutting Balloon with Monorail Delivery System. It is a premarket notification for a medical device and does not contain information about acceptance criteria or a study proving that the device meets such criteria.

The document outlines:

  • The device's intended use.
  • The device's description.
  • Its classification and product code.
  • Its predicate device (K052038).
  • The conclusion that the new device is substantially equivalent to the predicate device due to shared indications for use, design, composition, and function.

Therefore, I cannot provide the requested information about acceptance criteria and a study that proves the device meets them from the provided text. This document is a regulatory submission demonstrating substantial equivalence to a previously cleared device, not a performance study report.

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Image /page/0/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 perimeter. In the center of the seal is a stylized image of an eagle with its wings spread, which is a common symbol of the United States.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

My 31, 2016

Boston Scientific Corporation c/o Mr. Joseph Ostendorf Regulatory Affairs Specialist One Scimed Place Maple Grove, MN 55311

Re: K062387

Small Peripheral Cutting Balloon Monorail Delivery System Regulation Number: 21 CFR 870.1250 Regulation Name: Percutaneous Catheter Regulatory Class: Class II (Two) Product Code: PNO Dated: September 25, 2006 Received: September 26, 2006

Dear Mr. Ostendorf:

This letter corrects our substantially equivalent letter of October 5, 2006.

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 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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

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

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Page 2 - Mr. Joseph Ostendorf

comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Misti L. Malone -S

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

Enclosure

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Boston Scientific Corporation

100 - 100 - 11 - 12 - 12 - 12 - 12 -

  1. Indications for Use Statement

510(k) Number:

K062387

Device Name: System

small Peripheral Cutting Balloon with Monorail Delivery

Indications for Use:

The Small Peripheral Cutting Balloon catheters are indicated for percutaneous transluminal angioplasty of obstructive lesions of synthetic or native arteriovenous dialysis fistulae.

Prescription Use × (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)

Duna R. Jachus
(Division Sign-Off)

Division of Cardiovascular Devices

510(k) Number_Ko 6238 7

Page 1 of _l

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Boston Scientific Corporation

5. 510(k) Summary

Submitter's Nameand AddressBoston Scientific CorporationOne Scimed PlaceMaple Grove, MN 55311
Contact Name andInformationAngie BylandRegulatory Affairs ManagerPhone: (763) 494-2887Fax: (763) 494-2981
Date PreparedAugust 14, 2006
ProprietaryName(s)Small Peripheral Cutting Balloon™
Common NamePTA Catheter
Product CodeLIT
Classification ofDeviceClass II, 21 CFR Part 870.1250
Predicate DeviceSmall Peripheral Cutting Balloon™with MonorailDelivery SystemK052038 August 16, 2005
DeviceDescriptionThe small Peripheral Cutting Balloon Catheter (PCB) withMonorail (MR) delivery system has features of aconventional angioplasty catheter with advancedmicrosurgical capabilities. The sPCB features a balloonwith 3 or 4 atherotomes (microsurgical blades) mountedlongitudinally on its outer surface. The device is insertedover a guidewire and delivered to the target lesion. Whenthe PCB device is inflated, the atherotomes score theplaque, creating initiation sites for crack propagation.Percutaneous Angioplasty (PTA) with the PCB deviceallows dilatation of the target lesion with less pressure,minimizing barotrauma.
Intended Use ofDeviceThe small Peripheral Cutting Balloon catheters are indicatedfor percutaneous transluminal angioplasty of obstructivelesions of synthetic or native arteriovenous dialysis fistulae.
Support ofSubstantialEquivalenceThe small Peripheral Cutting Balloon Catheter with Monoraildelivery system with the modified port weld is the sameindication, design, composition, and function as thePeripheral Cutting Balloon Catheter, small Monorail(K052038), cleared August 16, 2005.

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Boston Scientific Corporation

ConclusionBased on the indications for use and the technologicalcharacteristics, the small Peripheral Cutting Balloon withMonorail delivery system has been shown to be equivalentin intended use and is considered to be substantiallyequivalent to the Small Peripheral Cutting BalloonTM withMonorail delivery system (K052038, cleared June 22,2005).
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:

§ 870.1250 Percutaneous catheter.

(a)
Identification. A percutaneous catheter is a device that is introduced into a vein or artery through the skin using a dilator and a sheath (introducer) or guide wire.(b)
Classification. Class II (performance standards).