K Number
K110741
Device Name
SCEPTER C OCCLUSION BALLOON CATHETER
Manufacturer
Date Cleared
2011-09-29

(197 days)

Product Code
Regulation Number
870.4450
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Scepter C Occlusion Balloon Catheter is intended for use in the peripheral and neurovasculature where temporary occlusion is desired. The balloon catheter provides temporary vascular occlusion which is useful in selectively stopping or controlling blood flow. The balloon catheter also offers balloon assisted embolization of intracranial aneurysms.
Device Description
The Scepter C Occlusion Balloon Catheter is a dual coaxial lumen catheter with a nondetachable low inflation pressure compliant balloon attached to the distal end of the catheter. The catheter is designed to track over a steerable guidewire. Radiopaque marker bands are located at ends of the balloon and distal tip of the catheter to facilitate fluoroscopic visualization. The outer surface of the catheter is coated with a hydrophilic polymer to increase lubricity. A luer fitting on the microcatheter hub is used for the attachment of accessories. The catheters are packaged sterile for single use only.
More Information

Not Found

No
The description focuses on the physical characteristics and performance of a balloon catheter for vascular occlusion and embolization. There is no mention of AI or ML in the intended use, device description, or performance studies.

Yes
The device is intended for use in "selectively stopping or controlling blood flow" and "balloon assisted embolization of intracranial aneurysms," which are medical treatments.

No

Explanation: The device is an occlusion balloon catheter used for temporary vascular occlusion and balloon-assisted embolization, not for diagnosing medical conditions. It is an interventional device, not a diagnostic one.

No

The device description clearly details a physical catheter with a balloon, lumens, marker bands, and coatings, indicating it is a hardware medical device, not software-only.

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

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. They are used to provide information for diagnosis, monitoring, or screening.
  • Device Function: The Scepter C Occlusion Balloon Catheter is a medical device used within the body (in vivo) to physically manipulate blood flow in the peripheral and neurovasculature. It's a therapeutic and interventional device, not a diagnostic test performed on a sample outside the body.
  • Intended Use: The intended use clearly states it's for "temporary occlusion" and "balloon assisted embolization," which are procedures performed directly on the patient's vascular system.
  • Device Description: The description details a physical catheter with a balloon, designed to be inserted into blood vessels.
  • Lack of Diagnostic Elements: There is no mention of analyzing biological samples, detecting biomarkers, or providing diagnostic information based on laboratory testing.

Therefore, based on the provided information, the Scepter C Occepter C Occlusion Balloon Catheter is a therapeutic/interventional medical device, not an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

The Scepter C Occlusion Balloon Catheter is intended for use in the peripheral and neurovasculature where temporary occlusion is desired. The balloon catheter provides temporary vascular occlusion which is useful in selectively stopping or controlling blood flow. The balloon catheter also offers balloon assisted embolization of intracranial aneurysms.

Product codes

MJN

Device Description

The Scepter C Occlusion Balloon Catheter is a dual coaxial lumen catheter with a nondetachable low inflation pressure compliant balloon attached to the distal end of the catheter. The catheter is designed to track over a steerable guidewire. Radiopaque marker bands are located at ends of the balloon and distal tip of the catheter to facilitate fluoroscopic visualization. The outer surface of the catheter is coated with a hydrophilic polymer to increase lubricity. A luer fitting on the microcatheter hub is used for the attachment of accessories. The catheters are packaged sterile for single use only.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

peripheral and neurovasculature, intracranial aneurysms

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)

Pre-clinical Testing:
Surface and physical attributes - Pass
Tensile strength - Pass
Leakage (liquid and air) - Pass
Static and dynamic burst pressure - Pass
Simulated use - Pass
Compatibility with devices - Pass
Kink resistance - Pass
Catheter flexural fatigue - Pass
Hydrophilic coating - Pass
Hub testing - Pass
Torque testing - Pass
Balloon testing - burst, compliance, deflation time, fatigue - Pass
Animal testing - acute study compared to predicate device - Pass
Bicompatibility testing (ISO 10993-1) - Pass

Other information provided in the 510(k) included published studies of balloon use. In addition, an in vivo animal study demonstrated safety including performance/handing.

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

Not Found

Predicate Device(s)

K091458

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.4450 Vascular clamp.

(a)
Identification. A vascular clamp is a surgical instrument used to occlude a blood vessel temporarily.(b)
Classification. Class II (performance standards).

0

K110741
P. 1 of 3

SEP 2 9 2011

510(k) Summary

Trade Name:Scepter C Occlusion Balloon Catheter
Generic Name:Occlusion Balloon Catheter
Classification:Class II
MJN - Catheter, intravascular occluding, temporary
21 CFR 870.4450 - Vascular clamp
Submitted By:MicroVention, Inc
1311 Valencia Avenue
Tustin, California U.S.A.
714-247-8000
Date Prepared:March 15, 2011
Contact:Naomi Gong
NumberDescription
K091458ev3 Neurovascular – HyperForm and

| K091458 | ev3 Neurovascular – HyperForm and
HyperGlide Balloon System | October 15, 2009 |

-------------------------------------------------------------------------------------------

Device Description:

The Scepter C Occlusion Balloon Catheter is a dual coaxial lumen catheter with a nondetachable low inflation pressure compliant balloon attached to the distal end of the catheter. The catheter is designed to track over a steerable guidewire. Radiopaque marker bands are located at ends of the balloon and distal tip of the catheter to facilitate fluoroscopic visualization. The outer surface of the catheter is coated with a hydrophilic polymer to increase lubricity. A luer fitting on the microcatheter hub is used for the attachment of accessories. The catheters are packaged sterile for single use only.

Indication For Use:

The Scepter C Occlusion Balloon Catheter is intended for use in the peripheral and neurovasculature where temporary occlusion is desired. The balloon catheter provides temporary vascular occlusion which is useful in selectively stopping or controlling blood flow. The balloon catheter also offers balloon assisted embolization of intracranial aneurysms.

1

Verification and Test Summary:

Pre-clinical TestingResult
Surface and physical attributesPass
Tensile strengthPass
Leakage (liquid and air)Pass
Static and dynamic burst pressurePass
Simulated usePass
Compatibility with devicesPass
Kink resistancePass
Catheter flexural fatiguePass
Hydrophilic coatingPass
Hub testingPass
Torque testingPass
Balloon testing - burst, compliance, deflation time, fatiguePass
Animal testing - acute study compared to predicate devicePass
Bicompatibility testing (ISO 10993-1)Pass

Technological Comparison:

Predicate Device (K091458)510(k) Subject Device
Intended UseFor use in the blood vessels of the
peripheral and neurovasculature where
temporary occlusion is desired. These
catheters offer a vessel selective
technique of temporary vascular
occlusion which is useful in selectively
stopping or controlling blood flow and
for balloon assisted embolization of
intracranial aneurysmsSame
Lumen configurationSingle lumenDual coaxial lumen
Inner Diameter0.010"0.0165"
Outer Diameter2.2 - 2.8 F2.6 - 2.8 F
Balloon Diameter/Length3-5 mm/ 10-30 mm4 mm/10-20 mm
MaterialPolyether block amide, polyolefin,
stainless steel, PTFE, chronoprene,
Pt alloy, polypropylenePolyether block amide,
polyolefin, stainless steel, PTFE,
polyurethane elastomeric alloy,
Pt/Ir, nylon
No. of Markers23
CoatingHydrophilic coatingSame
Guidewire compatibility0.010" wire0.014" or smaller wire
Method of supplySterile and single useSame

2

K110741
p. 3 of 3

Summary of Other Information:

Other information provided in the 510(k) included published studies of balloon use. In addition, an in vivo animal study demonstrated safety including performance/handing.

Summary of Substantial Equivalence:

The data presented in this submission demonstrates the technological similarity and equivalency of the Scepter C Occlusion Catheter when compared with the predicate device, evise HyperForm and HyperGlide Balloon System (K091458).

The devices,

  • Have the same intended use, 트
  • Use the same operating principle, ■
  • 트 Incorporate the same basic design,
  • 트 Use similar construction and material,
  • Are sterilized using same methods and processes. 트

In summary, the Scepter C Occlusion Balloon Catheter described in this submission is, in our opinion, substantially equivalent to the predicate devices.

3

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a stylized eagle with three lines representing its wings and body. The eagle is facing right. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged in a circular fashion around the eagle.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MI) 20993-0002

MicroVention, Inc. c/o Naomi Gong Regulatory Affairs Project Manager l 311 Valencia Avenue Tustin, CA 92780

SEP 29 2011

Re: K110741

Trade/Device Name: Scepter C Occlusion Balloon Catheter Regulation Number: 21 CFR 870.4450 Regulation Name: Vascular Clamp Regulatory Class: Class II Product Code: MJN Dated: July 29, 2011 Received: August 01, 2011

Dear Ms. Gong:

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 In Microu in Intelsstate devices that have been reclassified in accordance with the provisions of the Federal Food, Dr io 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, ilsting 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 of educations of class in (FMA).
found in the Galine SE at CE at CE at the major regulations affecting your 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.

4

Page 2 – Ms. Naomi Gong

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 (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 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,

ll l

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

Enclosure

5

Indications for Use

KII 0741 510(k) Number (if known):

Device Name: Scepter C Occlusion Balloon Catheter

Indications For Use:

The Scepter C Occlusion Balloon Catheter is intended for use in the peripheral and neurovasculature where temporary occlusion is desired. The balloon catherer provides temporary vascular occlusion which is useful in selectively stopping or controlling blood flow. The balloon catheter also offers balloon assisted embolization of intracranial aneurysms.

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

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)

vascular Devices

510(k) Number K110741