K Number
K112262
Device Name
REFLEX BALLON GUIDE CATHETER
Date Cleared
2011-11-02

(86 days)

Product Code
Regulation Number
870.1250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Reverse Medical ReFlex™ Balloon Guide Catheter is indicated for use in facilitating and guidance of intravascular catheters into a selected blood vessel in the peripheral and neurovascular systems. The balloon provides temporary vascular occlusion during these and other angiographic procedures.
Device Description
The ReFlex™ Balloon Guide Catheter is a flexible, variable stiffness composite catheter shaft has a hydrophilic coating to reduce friction during use. A compliant balloon is mounted on the distal end of the catheter. The ReFlex™ Balloon Guide Catheter dimensions are included on the individual device labels. The ReFlex™ Balloon Guide Catheter inner lumen can accommodate guidewires up to 0.038 inches in diameter to aid in placement of the catheter system. The proximal end of the ReFlex™ Balloon Guide Catheter has a bifurcated luer fitting to allow attachment of accessories and infusion of liquids through the system. The ReFlex™ Balloon Guide Catheter is offered in various sizes to accommodate physician preferences and anatomical variations. The catheter is provided sterile, non-pyrogenic, and is intended for single use only.
More Information

Not Found

No
The device description and intended use focus on the physical characteristics and function of a balloon guide catheter, with no mention of AI or ML capabilities.

No.
The device facilitates guidance and temporary occlusion during angiographic procedures, but it does not directly treat a disease or condition.

No
The device is described as a guide catheter used to facilitate and guide other intravascular catheters and provide temporary vascular occlusion during angiographic procedures. Its function is interventional and supportive, not diagnostic.

No

The device description clearly details a physical catheter with a balloon, a flexible shaft, and luer fittings, indicating it is a hardware medical device, not software-only.

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

Here's why:

  • Intended Use: The intended use clearly states that the device is used for "facilitating and guidance of intravascular catheters into a selected blood vessel" and for "temporary vascular occlusion during these and other angiographic procedures." This describes a device used within the body for procedural support, not for testing samples outside the body to diagnose a condition.
  • Device Description: The description details a physical catheter with a balloon, designed for insertion into blood vessels. This aligns with an interventional medical device, not an IVD.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), reagents, or any process related to diagnosing a disease or condition through in vitro testing.

IVD devices are designed to perform tests on samples taken from the human body to provide information for diagnosis, monitoring, or screening. This device's function is purely procedural and supportive within the vascular system.

N/A

Intended Use / Indications for Use

The Reverse Medical ReFlex™ Balloon Guide Catheter is indicated for use in facilitating and guidance of intravascular catheters into a selected blood vessel in the peripheral and neurovascular systems. The balloon provides temporary vascular occlusion during these and other angiographic procedures.

Product codes (comma separated list FDA assigned to the subject device)

DQY

Device Description

The ReFlex™ Balloon Guide Catheter is a flexible, variable stiffness composite catheter shaft has a hydrophilic coating to reduce friction during use. A compliant balloon is mounted on the distal end of the catheter. The ReFlex™ Balloon Guide Catheter dimensions are included on the individual device labels. The ReFlex™ Balloon Guide Catheter inner lumen can accommodate guidewires up to 0.038 inches in diameter to aid in placement of the catheter system.

The proximal end of the ReFlex™ Balloon Guide Catheter has a bifurcated luer fitting to allow attachment of accessories and infusion of liquids through the system. The ReFlex™ Balloon Guide Catheter is offered in various sizes to accommodate physician preferences and anatomical variations. The catheter is provided sterile, non-pyrogenic, and is intended 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 neurovascular systems

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)

Summary of Non-Clinical Data
Biocompatibility and Sterilization
The ReFlex™ Balloon Guide Catheter is classified as Externally Communicating Devices, Circulating Blood, Limited Contact (≤ 24 hours). Results of the testing demonstrate that the blood contacting materials are biocompatible.

Blood contacting materials were tested in accordance with the tests recommended in the FDA General Program Memorandum #G95-1 (5/1/95): Use of International Standard ISO 10993-1 guidelines "Biological Evaluation of Medical Devices Part 1: Evaluation and Testing." The ReFlex™ Balloon Guide Catheter successfully passed all of the following biocompatibility tests:

  • Cytotoxicity: L929 MEM Elution Test
  • Sensitization: Kligman Maximization
  • Intracutaneous Reactivity (Irritation): Intracutaneous Injection Test
  • Systemic Toxicity (Acute): ISO Acute Systemic Injection Test
  • Hemocompatibility: Complement Activation
  • Hemocompatibility: Hemolysis
  • Hemocompatibility: Inactivated Partial Thromboplastin Time Test
  • Hemocompatibility: In vivo thrombogenicity
  • Pyrogenicity: USP Material Mediated Rabbit Pyrogen Test
  • EtO Residuals: Ethylene oxide and Ethylene chlorohydrins residuals

Sterilization conditions have been validated according to ANSI / AAMI / ISO 11135, Sterilization of Health Care Products-Part 1: Requirement, validation and routine control of a sterilization process for medical devices to provide a Sterility Assurance Level (SAL) of 10-8.

Design Verification (Bench-Top Testing)
The physical, mechanical, and performance testing of the ReFlex™ Balloon Guide Catheter demonstrate that the product is substantially equivalent to the currently marketed predicate devices. Design verification testing was conducted to evaluate the physical and mechanical properties of the ReFlex™ Balloon Guide Catheter. All studies were conducted in accordance with Reverse Medical Design Control procedures. All testing was performed on units that were sterilized and met all inspection criteria. Tests on the ReFlex™ Balloon Guide Catheter included:
In vitro Tests

  • Dimensional and Visual Inspection: Met established criteria
  • Guidewire Compatibility: Met established criteria
  • Microcatheter Compatibility: Met established criteria
  • Torque Strength: Met established criteria
  • Kink Resistance: Met established criteria
  • Tip Buckling Test: Met established criteria
  • Flexibility Test (including tip flexibility): Met established criteria
  • Tensile Strength: Met established criteria
  • Catheter Leak Test (Liquid Leakage): Met established criteria
  • Catheter Leak Test (Air Leakage): Met established criteria
  • Dynamic Pressure Test: Met established criteria
  • Static Burst Test: Met established criteria
  • Aspiration Test: Met established criteria
  • Hub Gauging: Met established criteria
  • Corrosion Resistance: Met established criteria
  • USP Particulate Test: Met established criteria
  • Navigation, Accessibility, & Simulated Vascular Occlusion Capabilities in vitro: Met established criteria
  • Balloon Inflation/Deflation Times: Met established criteria
  • Balloon Cycle Fatigue: Met established criteria
  • Balloon Rated Volume (informational purposes): Met established criteria
  • Balloon Compliance (informational purposes): Met established criteria

In vivo Tests

  • System Deliverability, Compatibility, Visibility, and Temporary Vascular Occlusion Performance: Met established criteria
  • Acute Histopathology of Treated Vessels: Met established criteria
  • Biocompatibility Testing: Met established criteria

The physical, mechanical, and performance testing of the subject ReFlex™ Balloon Guide Catheter demonstrate that the product is Substantially Equivalent to the currently marketed predicate devices.

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

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K010954, K021899

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 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).

0

4. 510(k) Summary according to 807.92

Pursuant to Section 12, Part (a)(i)(3A) of the Safe Medical Devices Act of 1990, Reverse Medical -Corporation is providing the summary of Substantial Equivalence for the ReFlex™ Balloon Guide Catheter.

4.1 Sponsor /Applicant Name and Address

Reverse Medical Corporation 13900 Alton Parkway Suite 123 Irvine, CA 92618

4.2 Sponsor Contact Information

Jeff Valko, President & CEO Phone: 949-215-0660 x201 Fax: 949-215-0661 Email: jvalko@reversemed.com

4.3 Date of Preparation of 510(k) Summary

August 5, 2011

4.4 Device Trade or Proprietary Name

ReFlex™ Balloon Guide Catheter

4.5 Device Common/Usual or Classification Name

Catheter, Percutaneous (Product Code: DQY)

4.6 Identification of the Legally Marketed Devices to which Equivalence is Being Claimed:

| Name of Predicate Devices | Name of Manufacturer
(Town, State) | 510(k) Number |
|--------------------------------------|-----------------------------------------------|--------------------|
| Concentric Balloon Guide
Catheter | Concentric Medical, Inc.
Mountain View, CA | K010954
K021899 |

1

K112262 page

510(k) Summary according to 807.92 (continued)

4,7 Device Description

The ReFlex™ Balloon Guide Catheter is a flexible, variable stiffness composite catheter shaft has a hydrophilic coating to reduce friction during use. A compliant balloon is mounted on the distal end of the catheter. The ReFlex™ Balloon Guide Catheter dimensions are included on the individual device labels. The ReFlex™ Balloon Guide Catheter inner lumen can accommodate guidewires up to 0.038 inches in diameter to aid in placement of the catheter system.

The proximal end of the ReFlex™ Balloon Guide Catheter has a bifurcated luer fitting to allow attachment of accessories and infusion of liquids through the system. The ReFlex™ Balloon Guide Catheter is offered in various sizes to accommodate physician preferences and anatomical variations. The catheter is provided sterile, non-pyrogenic, and is intended for single use only.

4.8 Intended Use

The Reverse Medical ReFlex™ Balloon Guide Catheter is indicated for use in facilitating and guidance of intravascular catheters into selected blood vessels in the peripheral and neurovascular systems. The balloon provides temporary vascular occlusion during these and other angiographic procedures.

Concentric Balloon Guide CatheterReFlex™ Balloon Guide Catheter
510(k) NumbersK010954, K021899TBD
ClassificationClass II, DQYClass II, DQY
IndicationIndicated for use in facilitating and
guidance of intravascular catheters
into a selected blood vessel in the
peripheral and neurovascular
systems. The balloon provides
temporary vascular occlusion during
these and other angiographic
procedures.Indicated for use in facilitating and
guidance of intravascular catheters
into a selected blood vessel in the
peripheral and neurovascular
systems. The balloon provides
temporary vascular occlusion during
these and other angiographic
procedures.
Shaft MaterialsCoaxial lumen braided shaft variable
stiffness catheter with radiopaque
marker on distal end.Dual lumen wire reinforced shaft
variable stiffness catheter with
radiopaque marker on distal end.
Proximal End
ConfigurationLuer HubLuer Hub
Radiographic
markers/radiopacityRadiopaque marker at distal tipRadiopaque marker at distal tip
BalloonCompliantCompliant
PackagingCatheter attached to packaging card
inside PET/PE/Tyvek pouch
inside SBS carton.Catheter in polyethylene hoop attached
to packaging card inside PET/PE/Tyvek
pouch inside SBS carton.
SterilizationEtOEtO

4.9 Comparison to Predicate Devices

2

K112262 page 3 of 4

510(k) Summary according to 807.92 (continued)

4.10 Summary of Non-Clinical Data

4.10.1 Biocompatibility and Sterilization

The ReFlex™ Balloon Guide Catheter is classified as Externally Communicating Devices, Circulating Blood, Limited Contact (≤ 24 hours). Results of the testing demonstrate that the blood contacting materials are biocompatible.

Blood contacting materials were tested in accordance with the tests recommended in the FDA General Program Memorandum #G95-1 (5/1/95): Use of International Standard ISO 10993-1 guidelines "Biological Evaluation of Medical Devices Part 1: Evaluation and Testing." The ReFlex™ Balloon Guide Catheter successfully passed all of the following biocompatibility tests:

TestMethod
CytotoxicityL929 MEM Elution Test
SensitizationKligman Maximization
Intracutaneous Reactivity (Irritation)Intracutaneous Injection Test
Systemic Toxicity (Acute)ISO Acute Systemic Injection Test
HemocompatibilityComplement Activation
HemocompatibilityHemolysis
HemocompatibilityInactivated Partial Thromboplastin Time Test
HemocompatibilityIn vivo thrombogenicity
PyrogenicityUSP Material Mediated Rabbit Pyrogen Test
EtO ResidualsEthylene oxide and Ethylene chlorohydrins
residuals

Sterilization conditions have been validated according to ANSI / AAMI / ISO 11135, Sterilization of Health Care Products-Part 1: Requirement, validation and routine control of a sterilization process for medical devices to provide a Sterility Assurance Level (SAL) of 108.

4.10.2 Design Verification (Bench-Top Testing)

The physical, mechanical, and performance testing of the ReFlex™ Balloon Guide Catheter demonstrate that the product is substantially equivalent to the currently marketed predicate devices. Design verification testing was conducted to evaluate the physical and mechanical properties of the ReFlex™ Balloon Guide Catheter. All studies were conducted in accordance with Reverse Medical Design Control procedures. All testing was performed on units that were sterilized and met all inspection criteria. Tests on the ReFlex™ Balloon Guide Catheter included:

3

K112262 page 4 of 4

Verification and Test Summary

In vitro TestsResult
Dimensional and Visual InspectionMet established criteria
Guidewire CompatibilityMet established criteria
Microcatheter CompatibilityMet established criteria
Torque StrengthMet established criteria
Kink ResistanceMet established criteria
Tip Buckling TestMet established criteria
Flexibility Test (including tip flexibility)Met established criteria
Tensile StrengthMet established criteria
Catheter Leak Test (Liquid Leakage)Met established criteria
Catheter Leak Test (Air Leakage)Met established criteria
Dynamic Pressure TestMet established criteria
Static Burst TestMet established criteria
Aspiration TestMet established criteria
Hub GaugingMet established criteria
Corrosion ResistanceMet established criteria
USP Particulate TestMet established criteria
Navigation, Accessibility, & Simulated Vascular Occlusion Capabilities in vitroMet established criteria
Balloon Inflation/Deflation TimesMet established criteria
Balloon Cycle FatigueMet established criteria
Balloon Rated Volume (informational purposes)Met established criteria
Balloon Compliance (informational purposes)Met established criteria
In vivo TestsResult
System Deliverability, Compatibility, Visibility, and Temporary Vascular
Occlusion PerformanceMet established criteria
Acute Histopathology of Treated VesselsMet established criteria
Biocompatibility TestingMet established criteria

The physical, mechanical, and performance testing of the subject ReFlex™ Balloon Guide Catheter demonstrate that the product is Substantially Equivalent to the currently marketed predicate devices.

4.11 Substantial Equivalence

The performance of the ReFlex™ Balloon Guide Catheter in this submission demonstrates that the product is substantially equivalent to the performance of the predicate devices. The equivalence was shown through comparison of component materials and specifications, performance, biocompatibility testing, and sterilization validation.

The ReFlex™ Balloon Guide Catheter is substantially equivalent in intended use, design, technology/principles of operation, materials, and performance to the predicate devices. Differences between the devices do not raise any significant issues of safety or effectiveness.

4

Image /page/4/Picture/1 description: The image is a black and white logo for the U.S. Department of Health and Human Services. The logo features a stylized eagle with three lines representing its body and wings. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the eagle.

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

NOV - 2 2011

Reverse Medical Corporation c/o Mr. Jeffrey Valko 13700 Alton Parkway Suite 167 Irvine, CA 92618

Re: K112262

Trade Name: ReFlex Balloon Guide Catheter Regulation Number: 21 CFR 870.1250 Regulation Name: Percutaneous catheter Regulatory Class: Class II (two) Product Code: DQY Dated: October 10, 2011 Received: October 11, 2011

Dear Mr. Valko:

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.

5

Page 2 – Mr. Jeffrey Valko

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,

Brom D. Zucker

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

Enclosure

6

N11000:2 page

3. Indications for Use

510(k) Number (if known): K112262

Device Name: Reverse Medical ReFlex™ Balloon Guide Catheter

Indications for Use:

The Reverse Medical ReFlex™ Balloon Guide Catheter is indicated for use in facilitating and guidance of intravascular catheters into a selected blood vessel in the peripheral and neurovascular systems. The balloon provides temporary vascular occlusion during these and other angiographic procedures.

Prescription Use _ X (Part 21 CFR 801 Subpart D)

AND/OR

Over the Counter Use (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

510(k) i