K Number
K093619
Device Name
EVOLUTION ESOPHAGEAL STENT FULLY COVERED, MODELS EVO-FC-18-23-8-E, EVO-FC-18-23-10-E, EVO-FC-18-23-12-E
Manufacturer
Date Cleared
2010-06-17

(206 days)

Product Code
Regulation Number
878.3610
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
This device is used to maintain patency of malignant esophageal strictures and / or to seal tracheoesophageal fistulas.
Device Description
This flexible, self-expanding stent is constructed of nitinol wire with a silicone cover. The total length of the stent is indicated by radiopaque markers on the inner catheter, indicating the actual length of the stent at nominal stent diameter. There are lasso loops at both the proximal and distal ends of the stent whose purpose is to reposition the stent as needed. Introducer System Description: The stent is mounted on an inner catheter, which accepts a 0.035 inch wire guide and is constrained by an outer catheter. A pistol-grip delivery handle allows stent deployment or recapture.
More Information

Not Found

No
The description focuses on the physical construction and mechanical properties of a stent and its delivery system, with no mention of AI or ML.

Yes
The device is used to maintain patency of malignant esophageal strictures and seal tracheoesophageal fistulas, which directly addresses a disease state and aims to restore normal physiological function.

No
The device's intended use is to maintain patency and seal fistulas, which are therapeutic actions, not diagnostic ones.

No

The device description clearly details a physical, implantable stent made of nitinol wire with a silicone cover, along with an introducer system including catheters and a delivery handle. This is a hardware medical device.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostics are devices used to examine specimens taken from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening.
  • Device Function: This device is a stent that is implanted into the esophagus to maintain patency or seal fistulas. It is a therapeutic device that directly interacts with the patient's anatomy.
  • Intended Use: The intended use clearly describes a therapeutic intervention within the body, not an analysis of a specimen outside the body.
  • Device Description: The description details a physical implantable device and its delivery system, not equipment for analyzing biological samples.

Therefore, based on the provided information, this device falls under the category of an implantable medical device used for therapeutic purposes, not an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

This device is used to maintain patency of malignant esophageal strictures and / or to seal · tracheoesophageal fistulas.

Product codes

ESW

Device Description

This flexible, self-expanding stent is constructed of nitinol wire with a silicone cover. The total length of the stent is indicated by radiopaque markers on the inner catheter, indicating the actual length of the stent at nominal stent diameter. There are lasso loops at both the proximal and distal ends of the stent whose purpose is to reposition the stent as needed.

Introducer System Description: The stent is mounted on an inner catheter, which accepts a 0.035 inch wire guide and is constrained by an outer catheter. A pistol-grip delivery handle allows stent deployment or recapture.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

esophageal

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 risks associated with the modifications to our subject device have been adequately addressed through our Design Control Process. Recommendations as per the FDA guidance document Guidance for Industry -Guidance for the content of Premarket Notifications for Esophageal and Tracheal Prostheses (28-April-1998) with respect to biocompatibility, sterility, labelling and performance testing including deployment testing, dimensional testing, expansion force testing, compression force testing, corrosion testing and tensile strength testing have been applied to the proposed device.

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

Not Found

Predicate Device(s)

K080359

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 878.3610 Esophageal prosthesis.

(a)
Identification. An esophageal prosthesis is a rigid, flexible, or expandable tubular device made of a plastic, metal, or polymeric material that is intended to be implanted to restore the structure and/or function of the esophagus. The metal esophageal prosthesis may be uncovered or covered with a polymeric material. This device may also include a device delivery system.(b)
Classification. Class II. The special control for this device is FDA's “Guidance for the Content of Premarket Notification Submissions for Esophageal and Tracheal Prostheses.”

0

Cook Ireland Evolution™ Esophageal Stent System -Fully Covered

1093619

Attachment D - 510(k) SummaryJUN 1 7 2010
Cook Ireland Ltd
O'Halloran Road
National Technology Park
Limerick, Ireland
+353 61 334440
+353 61239293
Jacinta Kilmartin, Regulatory Affairs
Specialist
Sinead Burke Senior Regulatory Affair
Specialist
+353 61 334440
+353 61 239293
November 20. 2009

Attachment D - 510(k) Summary

Evolution™ Esophageal Stent System -Fully Covered

Esophageal Stent

Esophageal Prosthesis (21 CFR 878.3610, Product Code: ESW)

Evolution™ Esophageal Stent System Stent Description:

This flexible, self-expanding stent is constructed of nitinol wire with a silicone cover. The total length of the stent is indicated by radiopaque markers on the inner catheter, indicating the actual length of the stent at nominal stent diameter. There are lasso loops at both the proximal and distal ends of the

Phone: Fax:

Name: Address:

/

Contact Persons

Phone: Fax: Date:

Trade Name:

Common Name:

Classification Name:

Legally Marketed Devices: Description of the Device:

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K093619
Page 2 of 2

Indications for use:

ﺗﺮ

Comparison of Characteristics:

Performance Data:

stent whose purpose is to reposition the stent as needed.

Introducer System Description: The stent is mounted on an inner catheter, which accepts a 0.035 inch wire guide and is constrained by an outer catheter. A pistol-grip delivery handle allows stent deployment or recapture.

This device is used to maintain patency of malignant esophageal strictures and / or to seal tracheoesophageal fistulas.

The proposed device is substantially equivalent to the currently marketed device, the Evolution™ Esophageal Stent System, as cleared by K080359.

The risks associated with the modifications to our subject device have been adequately addressed through our Design Control Process. Recommendations as per the FDA guidance document Guidance for Industry -Guidance for the content of Premarket Notifications for Esophageal and Tracheal Prostheses (28-April-1998) with respect to biocompatibility, sterility, labelling and performance testing including deployment testing, dimensional testing, expansion force testing, compression force testing, corrosion testing and tensile strength testing have been applied to the proposed device.

2

Food and Drug Administration 10903 New Hampshire Avenue Document Mail Center - WO66-G6 Silver Spring, MD 20993-0002

Ms. Jacinta Kilmartin Regulatory Affairs Specialist Cook Ireland Ltd. National Technology Park Limerick IRELAND

JUN 1 7 2010

· Re: K093619

Trade/Device Name: Evolution™ Esophageal Stent System -- Fully Covered Regulation Number: 21 CFR $878.3610 Regulation Name: Esophageal prosthesis Regulatory Class: II Product Code: ESW Dated: June 10, 2010 Received: June 14, 2010

Dear Ms. Kilmartin:

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. 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 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 of medical device-related

3

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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 go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. 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 Small Manufacturers, International and Consumer Assistance 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,

Janine M. Morris

Acting Director, Division of Reproductive. Abdominal, and Radiological Devices Office of Device Evaluation . Center for Devices and Radiological Health

Enclosure

4

Indications for Use

K093619 510(k) Number (if known):

Device Name: Evolution™ Esophageal Stent System - Fully Covered

Indications for Use:

This device is used to maintain patency of malignant esophageal strictures and / or to seal · tracheoesophageal fistulas.

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

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

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

(Division Sign-Off) Division of Reproductive, Abdominal, and Radiological Devices 510(k) Number _

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