K Number
K100663
Date Cleared
2010-04-16

(39 days)

Product Code
Regulation Number
870.3300
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Contour Embolization Particles are used for the embolization of peripheral hypervascular tumors, including leiomyoma uteri and peripheral arteriovenous malformations (AVMs).

Do not use particles smaller than 355 microns for the treatment of leiomyoma uteri.

Device Description

Contour Embolization Particles are artificial embolization devices. These devices are intended to provide vascular occlusion upon selective.placement via an angiographic catheter. Contour Embolization Particles are packaged sterile by gamma irradiation. Each vial is intended for single patient use only. The Contour™ Embolization particles are packaged in 1 cc dry volume per vial. The vials (glass with screw cap closure) are contained within a poly/Tyvek® pouch. The pouches are placed in boxes, in either a 2 vial/box or 5 vial/box configurations. All vials and boxes are appropriately labeled. The labels are color coded to differentiate between the different size ranges. The device is sterilized by gamma irradiation and labeled with a 26 month shelf life. The Contour Embolization Particles are available in a range of sizes as tabulated below:

SizeMinimum Compatible Catheter ID
45-150 µm0.53 mm (0.021 in) (e.g. Renegade™ 18, Renegade STC)
150-250 µm
250-355 µm
355-500 µm
500-710 µm0.69 mm (0.027 in) (e.g. Renegade Hi-Flo)
710-1000 µm
1000-1180 µm1.12 mm (0.044 in) (e.g. Imager™ II Selective)

The Contour Embolization Particles are made of polyvinyl alcohol, which has been used for embolization procedures since 1972.

AI/ML Overview

This document is a 510(k) summary for the Contour™ Embolization Particles. It does not contain information about acceptance criteria or a study proving the device meets acceptance criteria in the context of an AI/ML medical device.

The provided text details the submission of a medical device (Contour™ Embolization Particles) for clearance by the FDA based on substantial equivalence to a predicate device. This type of submission (510(k)) generally focuses on demonstrating that a new device is as safe and effective as a legally marketed predicate device, rather than providing detailed performance metrics from clinical trials, especially for a non-AI/ML device.

Here's why the requested information cannot be extracted from the provided text:

  • Non-AI/ML Device: The device described is "Contour™ Embolization Particles," which are physical artificial embolization devices made of polyvinyl alcohol. This is not an Artificial Intelligence or Machine Learning (AI/ML) device. Therefore, questions 1-9, which pertain to AI/ML device validation (acceptance criteria, test sets, ground truth, expert adjudication, MRMC studies, standalone performance, training sets), are not applicable to this document.
  • Substantial Equivalence: The core of this 510(k) submission is to demonstrate "substantial equivalence" to a previously cleared device (K030966). This means the manufacturer is asserting that the new device has the same intended use, technological characteristics, and safety/effectiveness profile as the predicate device. The only change mentioned is to the labeling (contraindications).
  • Lack of Performance Study Details: The document explicitly states: "This assessment is based upon identical device materials and design characteristics." It does not describe any new performance study, clinical trial, or data analysis to establish specific numerical performance metrics for the device itself against predefined acceptance criteria.

Therefore, I cannot provide a table of acceptance criteria, reported device performance, or details about studies for an AI/ML device, as the provided text describes a non-AI/ML embolization particle device and focuses on substantial equivalence rather than new performance studies with specific metrics.

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K100663
pg. 1 of 2

510(k) Summary

Per 21 CFR §807.92


،

APR 1 6 ZOTA

Submitter's Name and AddressBoston Scientific CorporationOne Scimed PlaceMaple Grove, MN 55311
Contact Name and InformationDebbie McIntireSenior Regulatory Affairs SpecialistPhone: (408) 935-4679Fax: (763) 494 2981
Date PreparedMarch 5, 2010
Proprietary Name(s)Contour™ Embolization Particles
Common NameContour Embolization Particles
Product CodeNAJ
Classification of DeviceClass II, 21 CFR Part 870.3300
Predicate DeviceContour™ Embolization Particles K030966 September 23, 2003
Device DescriptionContour Embolization Particles are artificial embolization devices.These devices are intended to provide vascular occlusion upon selective.placement via an angiographic catheter. Contour Embolization Particles are packaged sterile by gamma irradiation. Each vial is intended for single patient use only.The Contour™ Embolization particles are packaged in 1 cc dry volume per vial. The vials (glass with screw cap closure) are contained within a poly/Tyvek® pouch. The pouches are placed in boxes, in either a 2 vial/box or 5 vial/box configurations. All vials and boxes are appropriately labeled. The labels are color coded to differentiate between the different size ranges. The device is sterilized by gamma irradiation and labeled with a 26 month shelf life.The Contour Embolization Particles are available in a range of sizes as tabulated below:

:

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K100663
PG 2 of 2

Device Description (continued)

SizeMinimum CompatibleCatheter ID
45-150 µm0.53 mm (0.021 in)(e.g. Renegade™ 18, RenegadeSTC)
150-250 µm
250-355 µm
355-500 µm
500-710 µm0.69 mm (0.027 in)(e.g. Renegade Hi-Flo)
710-1000 µm
1000-1180 µm1.12 mm (0.044 in)(e.g. Imager™ II Selective)

The Contour Embolization Particles are made of polyvinyl alcohol, which has been used for embolization procedures since 1972.

Intended Use ofDeviceBoston Scientific's Contour Embolization Particles are used for theembolization of peripheral hypervascular tumors, including leiomyomauteri and peripheral arteriovenous malformations (AVMs).
Comparison ofTechnologicalCharacteristicsThe materials and design of the Contour Embolization Particles areequivalent to the predicate Contour Embolization Particles.
Support ofSubstantialEquivalenceBoston Scientific Corporation considers the proposed ContourEmbolization Particles to be substantially equivalent to the existingContour Embolization Particles (K030966, cleared September 23, 2003).This assessment is based upon identical device materials and designcharacteristics. The only change being initiated is to the labeling. The510(k) is being submitted to delete two contraindications from theDirections for Use and add two new contraindications.
ConclusionBased on the indications for use and the technological characteristics, theContour Embolization Particles has been shown to be equivalent inintended use and is considered to be substantially equivalent to theContour Embolization Particles (K030966; cleared September 23, 2003).

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Image /page/2/Picture/0 description: The image shows the seal for the Department of Health & Human Services - USA. The seal is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. In the center of the seal is an abstract image of an eagle.

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

Ms. Debbie McIntire Senior Regulatory Affairs Specialist Boston Scientific Corporation One Scimed Place MAPLE GROVE MN 55311

APR 1 6 2010

Re: K100663

Trade Name: Contour™ Embolization Particles Regulation Number: 21-CFR § 870.3300 Regulation Name: Vascular embolization device Regulatory Class: II Product Code: NAJ Dated: March 5, 2010 Received: March 8, 2010

Dear Ms. McIntire:

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

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Page 2 -

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/Resourcesfor You/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

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Indications for Use Statement

K100663 510(k) Number:

Device Name: Contour™ Embolization Particles

Indications for Use:

The Contour Embolization Particles are used for the embolization of peripheral hypervascular tumors, including leiomyoma uteri and peripheral arteriovenous malformations (AVMs).

Do not use particles smaller than 355 microns for the treatment of leiomyoma uteri.

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)

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

Page 1 of 1

§ 870.3300 Vascular embolization device.

(a)
Identification. A vascular embolization device is an intravascular implant intended to control hemorrhaging due to aneurysms, certain types of tumors (e.g., nephroma, hepatoma, uterine fibroids), and arteriovenous malformations. This does not include cyanoacrylates and other embolic agents, which act by polymerization or precipitation. Embolization devices used in neurovascular applications are also not included in this classification, see § 882.5950 of this chapter.(b)
Classification. Class II (special controls.) The special control for this device is the FDA guidance document entitled “Class II Special Controls Guidance Document: Vascular and Neurovascular Embolization Devices.” For availability of this guidance document, see § 870.1(e).