K Number
K101530
Device Name
EVOLUTION DUODENAL STENT SYSTEM, MODEL EVO-22-27-6-D, EVO-22-27-9-D, EVP-22-27-12-D
Manufacturer
Date Cleared
2011-03-29

(299 days)

Product Code
Regulation Number
878.3610
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
This device is used for palliative treatment of duodenal or gastric outlet obstruction and duodenal strictures caused by malignant neoplasms.
Device Description
Stent Description: This flexible, self-expanding stent is constructed of nitinol wire. 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. The stent has flanges at both stent ends. 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 characteristics of the stent and delivery system, and the performance studies are bench and clinical tests related to mechanical properties and equivalence to predicate devices. There is no mention of AI, ML, image processing, or data-driven algorithms.

Yes
The device is described as being used for the "palliative treatment of duodenal or gastric outlet obstruction and duodenal strictures caused by malignant neoplasms," which indicates a therapeutic purpose rather than diagnostic or prognostic.

No

The device is described as a stent used for the "palliative treatment of duodenal or gastric outlet obstruction and duodenal strictures caused by malignant neoplasms," indicating a therapeutic rather than diagnostic function. It is designed to physically treat blockages, not to identify or characterize medical conditions.

No

The device description clearly details a physical stent made of nitinol wire and an introducer system with catheters and a handle, indicating it is a hardware medical device.

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

Here's why:

  • Intended Use: The intended use is for the palliative treatment of duodenal or gastric outlet obstruction and duodenal strictures caused by malignant neoplasms. This is a therapeutic intervention performed directly on the patient's body.
  • Device Description: The device is a stent and an introducer system designed to be implanted within the body.
  • Lack of IVD Characteristics: An IVD is a medical device used to perform tests on samples taken from the human body (like blood, urine, tissue) to provide information about a person's health. This device does not perform any such tests on samples.

Therefore, this device falls under the category of an implantable medical device used for treatment, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

This device is used for palliative treatment of duodenal or gastric outlet obstruction and duodenal strictures caused by malignant neoplasms.

Product codes

MUM

Device Description

Stent Description: This flexible, self-expanding stent is constructed of nitinol wire. 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. The stent has flanges at both stent ends. 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

duodenal, gastric outlet

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

Performance (bench and clinical) testing was carried out to determine the equivalence of the Evolution™ Duodenal Stent System to the predicate devices and to verify the safety and effectiveness of the device. The following bench tests were carried out: deployment force testing, expansion force testing, compression force testing, dimensional testing, corrosion testing, tensile strength testing and MRI testing.

Key Metrics

Not Found

Predicate Device(s)

K991056, K062750

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

K101530

Section 5.0 510(k) Summary

MAR 2 9 2011

Name:Cook Ireland Ltd
Address:O'Halloran Road
National Technology Park
Limerick, Ireland
Phone:353 61 334440
Fax:353 61 239293
Contact Persons:Jacinta Kilmartin, Regulatory Affairs Specialist
Emmett Devereux, Director Quality &
Regulatory Affairs
Phone:353 61 334440
Fax:353 61 239 293
Date:March 24, 2011
Trade Name:Evolution™ Duodenal Stent System
Common Name:Stent, Metallic, Expandable, Duodenal
Classification Name:Stent, Metallic, Expandable, Duodenal (21 CFR
878.3610, Product Code: MUM)
Predicate Devices:Boston Scientific Wallstent® Enteral
Endoprosthesis with Unistep™ Delivery System
(K991056)
Boston Scientific WallFlex™ Enteral Duodenal
Stent System with Anchor Lock Delivery System
(K062750)
Description of the Device:Stent Description:
This flexible, self-expanding stent is constructed
of nitinol wire. 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. The stent has flanges at
both stent ends.
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.
Indications for use:This device is used for palliative treatment of
duodenal or gastric outlet obstruction and
duodenal strictures caused by malignant
neoplasms.
Comparison of Characteristics:The Evolution™ Duodenal Stent System is
substantially equivalent to the currently marketed
predicate devices, the Boston Scientific
Wallstent® Enteral Endoprosthesis with
Unistep™ Delivery System (K991056), and the
Boston Scientific WallFlex™ Enteral Duodenal
Stent System with Anchor Lock Delivery System
(K062750).
Performance Data:Performance (bench and clinical) testing was
carried out to determine the equivalence of the
Evolution™ Duodenal Stent System to the
predicate devices and to verify the safety and
effectiveness of the device. The following bench
tests were carried out: deployment force testing,
expansion force testing, compression force
testing, dimensional testing, corrosion testing,
tensile strength testing and MRI testing.

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Image /page/1/Picture/2 description: The image contains a sequence of alphanumeric characters, seemingly handwritten. The sequence reads 'KI01530', with each character distinct and clearly formed. The characters are arranged linearly from left to right, with consistent spacing between them.

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Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle or bird-like figure with three curved lines representing its wings or body. The logo is encircled by the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA". The text is arranged in a circular fashion around the bird-like figure.

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

Ms. Jacinta Kilmartin Regulatory Affairs Specialist Cook Ireland Ltd. National Technology Park O'Halloran Road Limerick IRELAND

MAR 2 9 201

. Re: K101530

Trade/Device Name: Evolution™ Duodenal Stent System Regulation Number: 21 CFR 8878,3610 Regulation Name: Esophageal prosthesis Regulatory Class: II Product Code: MUM Dated: February 14. 2011 Received: February 16, 2011

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 v 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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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/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 vours.

Hubert Lemon MD

Herbert P. Lerner, M.D., Director (Acting) Division of Reproductive, Gastro-Renal and Urological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Section 4.0 Indications for Use

| 510(k) Number (if known): | ﺳﺎﺗﮫ ﺍﻭﺭ ﺍﺱ ﮐﮯ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾﮏ ﺍﯾ
C
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Device Name: Evolution™ Duodenal Stent System

Indications for Use:

This device is used for palliative treatment of duodenal or gastric outlet obstruction and duodenal strictures caused by malignant neoplasms.

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

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)

Helen Klemm

(Division Sign-Off)
Division of Reproductive, Gastro-Renal, and
Urological Devices
510(k) Number K101530

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