K Number
K112631
Device Name
VSI GUIDEWIRE
Date Cleared
2011-10-27

(48 days)

Product Code
Regulation Number
870.1330
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The VSI Guidewire is indicated for percutaneous entry of peripheral vessels using the Seldinger Technique. The device is not indicated for use in the coronary or cerebral vasculature.

Device Description

The VSI Guidewire is available in a diameter of 0.018" and lengths ranging from 40-130 cm. The device is available with a stainless steel or nitinol shaft with a stainless steel or tungsten tip. Some models are PTFE coated to increase lubricity.

AI/ML Overview

The provided text is a 510(k) summary for the VSI Guidewire. It states that no performance testing was conducted because the subject device is identical in design, materials, construction, and indications for use to the predicate device (VascuPuncture™ PICC Guidewire, K012861 and K043398). Therefore, the device did not undergo a study to prove it met specific acceptance criteria in the context of device performance.

Here's a breakdown of why many of your requested items cannot be answered from this document:

  1. A table of acceptance criteria and the reported device performance: Not applicable. No performance testing was conducted.
  2. Sample size used for the test set and the data provenance: Not applicable. No test set was used for performance evaluation.
  3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts: Not applicable. No test set was used for performance evaluation.
  4. Adjudication method for the test set: Not applicable. No test set was used for performance evaluation.
  5. If a multi-reader multicase (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance: Not applicable. This is a medical device, not an AI/imaging device. No such study was performed.
  6. If a standalone (i.e., algorithm only without human-in-the-loop performance) was done: Not applicable. This is a medical device, not an AI/imaging device. No such study was performed.
  7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.): Not applicable. No performance testing was conducted.
  8. The sample size for the training set: Not applicable. No training set was used for an algorithm.
  9. How the ground truth for the training set was established: Not applicable. No training set was used for an algorithm.

Summary based on the provided text:

The submission for the VSI Guidewire relied on demonstrating substantial equivalence to a previously cleared predicate device rather than conducting new performance testing against specific acceptance criteria. The manufacturer explicitly states: "Because the subject and predicate devices are identical in design, materials, construction, and Indications for Use, no performance testing was conducted or is warranted in support of the determination of substantial equivalence."

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K112631 page 1 of 2
OCT 2 7 2011 VSI Guidewire

VSI Guidewire

. .

Vascular Solutions, Inc. Traditional 510(k) Premarket Notification

2 510(k) Summary

Date Prepared: September 8, 2011

Manufacturer's Information / Contact Person

ManufacturerContact
Vascular Solutions, Inc.Melinda Swanson
6464 Sycamore CourtSr. Director, Regulatory Affairs and Clinica l
Minneapolis, MN 55369 USAResearch
Establishment Registration # 2134812Tel: 763.656.4256(direct)
Fax: 763.656.4253
Email: mswanson@vasc.com

General Information

1

Trade NameVSI Guidewire
Common / Usual NameGuidewire
Classification Name870.1330; DQX; Wire, Guide, Catheter; Class II: A catheterguide wire is a coiled wire that is designed to fit inside apercutaneous catheter for the purpose of directing the catheterthrough a blood vessel.
Predicate Device(s)VascuPuncture™ PICC Guidewire (K012861 and K043398,Neometrics, Inc.)

Device Description

' The VSI Guidewire is available in a diameter of 0.018" and lengths ranging from 40-130 cm. The device is available with a stainless steel or nitinol shaft with a stainless steel or tungsten tip. Some models are PTFE coated to increase lubricity.

Intended Use / Indications

The VSI Guidewire is indicated for percutaneous entry of peripheral vessels using the Seldinger Technique. The device is not indicated for use in the coronary or cerebral vasculature.

しな

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K112651 Page 2 of 2

VSI Guidewire

Technological Characteristics

The subject and predicate devices are identical in design, materials, and construction. There are no differences in technological characteristics.

Substantial Equivalence and Summary of Studies

Because the subject and predicate devices are identical in design, materials, construction, and Indications for Use, no performance testing was conducted or is warranted in support of the determination of substantial equivalence. Further processing conducted by VSI leads to no new questions of safety or effectiveness.

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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 symbol with three curved lines representing its body and wings. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular fashion around the bird symbol.

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

Vascular Solutions, Inc. c/o Melinda Swanson 6464 Sycamore Court Minneapolis, MN 55369

OCT 2 7 2011

Re: K112631

Trade/Device Name: VSI Guidewire Regulation Number: 21 CFR 870.1330 Regulation Name: Catheter guide wire Regulatory Class: Class II (two) Product Code: DQX Dated: September 8, 2011 Received: September 9, 2011

Dear Ms. Swanson:

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

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Page 2 - Ms. Melinda Swanson

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 (OS) 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/ReportalProblem/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,

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

Enclosure

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K112631 page 1 of 1

Vascular Solutions, Inc. Traditional 510(k) Premarket Notification VSI Guidewire

Indications for Use

510(k) Number (if known): K112631

Device Name: VSI Guidewire

Indications for Use:

The VSI Guidewire is indicated for percutaneous entry of peripheral vessels using the Seldinger Technique. The device is not indicated for use in the coronary or cerebral vasculature.

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 OF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Division Sign-Off) ivision of Cardiovascular Devices

510(k) Number K112631

Confidential VSI Guidewire Traditional 510(k)

§ 870.1330 Catheter guide wire.

(a)
Identification. A catheter guide wire is a coiled wire that is designed to fit inside a percutaneous catheter for the purpose of directing the catheter through a blood vessel.(b)
Classification. Class II (special controls). The device, when it is a torque device that is manually operated, non-patient contacting, and intended to manipulate non-cerebral vascular guide wires, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 870.9.