K Number
K113778
Date Cleared
2012-04-20

(120 days)

Product Code
Regulation Number
870.1250
Reference & Predicate Devices
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Excelsior XT-27 Microcatheter is intended to assist in the delivery of diagnostic agents (such as contrast media), therapeutic agents, and non- liquid interventional devices (such as stents) that are indicated for use in the neurovasculature and with a catheter of 0.027 inches in inner diameter.

Device Description

The Excelsior® XT-27™ Microcatheter is a sterile, single lumen 0.027 in ID device with one tip marker designed to aid the physician in accessing distal vasculature when used with a guide catheter and steerable guidewire. Graded shaft stiffness ranging from a highly flexible tip to a semi-rigid proximal section aids the physician in tracking over selectively placed guidewires. A luer fitting located on the microcatheter hub is used for the attachment of accessories. One radiopaque tip marker is positioned at the distal tip of the device to facilitate fluoroscopic visualization. The Excelsior XT-27 Microcatheter is coated on the outer surface with Hydrolene™ coating which reduces friction during manipulation in the vessel.

The Excelsior XT-27 Microcatheters are available in effective lengths of both 135cm (53.1 inch) and 150 cm (59.1 inch), with two distal shaft configurations achieved through distal shaft lengths of 6 cm (XT-27 model) and 18 cm (XT-27 Flex model). Both straight tip and Pre-Shaped versions are available.

AI/ML Overview

This document describes the Stryker Neurovascular Excelsior® XT-27™ Microcatheter and its 510(k) submission for market clearance. The submission relies on demonstrating substantial equivalence to predicate devices through a series of bench tests.

Here's an analysis of the provided information regarding acceptance criteria and the study that proves the device meets them:

1. Table of Acceptance Criteria and Reported Device Performance

The acceptance criteria for the Excelsior XT-27 Microcatheter are largely based on demonstrating equivalence to the predicate devices (K000177, Renegade™ Hi-Flo™ Microcatheter and K042568, Excelsior® SL-10 Pre-Shaped Microcatheter). The "Result" column explicitly states "Met same criteria as predicate," indicating that the performance of the Excelsior XT-27 Microcatheter was found to be comparable to or better than the predicate devices for these specific tests.

Test / Performance MetricAcceptance Criteria (Implicitly based on Predicate)Reported Device Performance
Visual Inspection
Durable Hydrophilic CoatingPerformance comparable to predicate deviceMet same criteria as predicate
Surface DefectsPerformance comparable to predicate deviceMet same criteria as predicate
Surface-Extraneous matterPerformance comparable to predicate deviceMet same criteria as predicate
Dimensional Measurement
Kink Radius of Curvature / Proximal Shaft KinkPerformance comparable to predicate deviceMet same criteria as predicate
Distal OD ReductionPerformance comparable to predicate deviceMet same criteria as predicate
Tip ConfigurationPerformance comparable to predicate deviceMet same criteria as predicate
Catheter HubPerformance comparable to predicate deviceMet same criteria as predicate
Corrosion ResistancePerformance comparable to predicate deviceMet same criteria as predicate
Simulated Use:
IntroductionPerformance comparable to predicate device in simulated useMet same criteria as predicate
TrackingPerformance comparable to predicate device in simulated useMet same criteria as predicate
Reposition / DeploymentPerformance comparable to predicate device in simulated useMet same criteria as predicate
DetachmentPerformance comparable to predicate device in simulated useMet same criteria as predicate
Overall PerformancePerformance comparable to predicate device in simulated useMet same criteria as predicate
Advancement / Retraction ForcePerformance comparable to predicate deviceMet same criteria as predicate
Biocompatibility Testing:
In-vitro Cytotoxicity, MEM ElutionNon-cytotoxicNon-cytotoxic
Intracutaneous reactivityNon-irritatingNon-irritating
Acute systemic toxicity, InjectionNon-toxicNon-toxic
Sensitization, Guinea Pig MaximizationNon-sensitizingNon-sensitizing
Hemocompatibility (Direct Contact; Complement Activation C3a and SC5b-9; PTT; blood cell counts and hemoglobin / hematocrit levels)Non-hemolyticNon-hemolytic
Materials Mediated Pyrogen levels, Rabbit testNon-pyrogenicNon-pyrogenic
USP impurities, <661>No significant impurities / Comparable to predicateNone
Latex test, ELISA InhibitionNo latex present / Comparable to predicateNone

2. Sample Size Used for the Test Set and Data Provenance

The document does not explicitly state the sample sizes used for each of the bench tests. It also does not provide information about data provenance in terms of country of origin or whether the tests were retrospective or prospective. Given the nature of bench testing for a medical device, it is typically prospective, with samples of the device being manufactured and then tested in controlled laboratory environments.

3. Number of Experts Used to Establish Ground Truth for the Test Set and Qualifications of those Experts

This information is not provided in the document. For bench testing, "ground truth" is typically established through adherence to test methodologies and specifications, often informed by engineering standards and regulatory guidance, rather than expert consensus on individual cases.

4. Adjudication Method for the Test Set

This information is not provided. As mentioned above, bench testing relies on objective measurements and predefined acceptance criteria rather than expert adjudication in the way clinical studies might.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done, and the Effect Size of How Much Human Readers Improve with AI vs without AI Assistance

This information is not applicable and not provided. The Excelsior XT-27 Microcatheter is a physical medical device (microcatheter), not an AI-powered diagnostic or assistive tool. Therefore, an MRMC comparative effectiveness study comparing human readers with and without AI assistance would not be relevant to its evaluation.

6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) Was Done

This information is not applicable and not provided. As it is a physical medical device, there is no "algorithm only" performance to be evaluated in a standalone manner.

7. The Type of Ground Truth Used

The ground truth for most of these tests is established by:

  • Engineering Specifications and Design Requirements: For dimensional measurements, kink radius, advancement/retraction force.
  • Established Biomedical Test Standards: For biocompatibility tests (cytotoxicity, irritation, systemic toxicity, sensitization, hemocompatibility, pyrogenicity, USP impurities, latex). These standards define the methods and acceptance criteria for classifying a material as non-toxic, non-irritating, etc.
  • Comparison to Predicate Device Performance: For many performance characteristics (e.g., visual inspection, simulated use), the "ground truth" for the new device is that its performance must be equivalent or superior to the already legally marketed predicate devices.

8. The Sample Size for the Training Set

This information is not applicable and not provided. As a physical medical device, there is no "training set" in the context of machine learning or AI. The design and manufacturing processes are refined through engineering iterations, but this is distinct from an algorithmic training process.

9. How the Ground Truth for the Training Set Was Established

This information is not applicable and not provided for the same reasons as point 8.

In Summary:

The document focuses on demonstrating substantial equivalence of the Excelsior® XT-27™ Microcatheter to its predicate devices through comprehensive bench testing. The acceptance criteria for most tests are implicitly or explicitly that the new device must perform comparably to (or better than) the predicate devices, or meet established safety and performance standards (especially for biocompatibility). The study design is largely a series of controlled laboratory tests performed on samples of the device. Aspects related to AI, human readers, or large-scale data training sets are not relevant to this type of device submission and therefore not included.

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APR 2 0 2012

Stryker Neurovascular Traditional 510(k) Submission Excelsior® XT-27™ Microcatheter

i

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K113778

510(K) SUMMARY OF SAFETY AND EFFECTIVENESS

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Trade Name:Excelsior® XT-27™ Microcatheter
Generic Name:Percutaneous Catheter, Microcatheter
Classification:CLASS II, 21 CFR 870.1250
Submitted By:Stryker Neurovascular47900 Bayside ParkwayFremont, CA 94538-6515
Contact:Yoko Y Enrile
Predicate Device:K000177, Renegade™ Hi-Flo™ MicrocatheterK042568, Excelsior® SL-10 Pre-Shaped Microcatheter

Indications for Use: The Excelsior XT-27 Microcatheter is intended to assist in the delivery of
diagnostic agents (such as contrast media), therapeutic agents, and non-
liquid interventional devices (such as stents) that are indicated for use in
the neurovasculature and with a catheter of 0.027 inches in inner diameter.

Device Description: The Excelsior® XT-27™ Microcatheter is a sterile, single lumen 0.027 in
ID device with one tip marker designed to aid the physician in accessing
distal vasculature when used with a guide catheter and steerable
guidewire. Graded shaft stiffness ranging from a highly flexible tip to a
semi-rigid proximal section aids the physician in tracking over selectively
placed guidewires. A luer fitting located on the microcatheter hub is used
for the attachment of accessories. One radiopaque tip marker is positioned
at the distal tip of the device to facilitate fluoroscopic visualization. The
Excelsior XT-27 Microcatheter is coated on the outer surface with
Hydrolene™ coating which reduces friction during manipulation in the
vessel.

The Excelsior XT-27 Microcatheters are available in effective lengths of
both 135cm (53.1 inch) and 150 cm (59.1 inch), with two distal shaft
configurations achieved through distal shaft lengths of 6 cm (XT-27
model) and 18 cm (XT-27 Flex model). Both straight tip and Pre-Shaped
versions are available.

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Accessories: Each Excelsior XT-27 Microcatheter is provided with accessories (a shaping mandrel, and peel away introducer) within a separate inner Tyvek™ pouch (Accessory pouch). The Excelsior XT-27 Microcatheter is available in a single pack (one unit per package) only. The device pouch and Directions for Use (DFU) are both provided inside a shelf carton.

Summary Differences in Technological Characteristics: The Excelsior XT-27 Microcatheters introduce several enhanced design features:

  • a) The OD profile of the Excelsior XT-27 Microcatheter is smaller than the Renegade Hi-Flo Microcatheter.
  • b) The Excelsior XT-27 Microcatheter has up to five zones of polymer stiffness which vary from the distal to proximal shaft and help to enhance the trackability and pushability of the catheter.
  • c) The Excelsior XT-27 Microcatheter has a more supportive double helix winding reinforcement compared to the Renegade Hi-Flo Microcatheter.

Bench Test Summary:

TestResult
Visual Inspection:Durable Hydrophilic CoatingSurface DefectsSurface-Extraneous matterMet same criteria aspredicate
Dimensional Measurement:Kink Radius of Curvature / ProximalShaft KinkDistal OD ReductionTip ConfigurationCatheter HubMet same criteria aspredicate
Corrosion ResistanceMet same criteria aspredicate

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Simulated use:Met same criteria as predicate
* Introduction
* Tracking
* Reposition / Deployment
* Detachment
* Overall Performance
Advancement / Retraction ForceMet same criteria as predicate
In-vitro Cytotoxicity, MEM ElutionNon-cytotoxic
Intracutaneous reactivityNon-irritating
Acute systemic toxicity, InjectionNon-toxic
Sensitization, Guinea PigMaximizationNon- sensitizing
Hemocompatibility, Direct Contact;Complement Activation C3a andSC5b-9; PTT; blood cell counts andhemoglobin / hematocrit levelsNon-hemolytic
Materials Mediated Pyrogen levels,Rabbit testNon-pyrogenic
USP impurities, <661>None
Latex test, ELISA InhibitionNone

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Predicate / SubjectProduct Feature Comparison for Excelsior® SL-10 Pre-Shaped
DeviceMicrocatheter (K042568) and Renegade™ Hi-Flo™ Microcatheter(K000177)
Comparison:(K000177)
FeatureK042568Excelsior® SL-10Pre-ShapedMicrocatheterK000177Renegade™ Hi-Flo™MicrocatheterSubject Device
MaterialsPTFE, Pebax,Stainless Steelwire, Nylon,SantoprenePTFE, Pebax,Vectran Fiber andPt/Ir wire, Nylon,SantoprenePTFE, Pebax,Stainless Steelwire, Nylon,Santoprene
Tip shapePreshapedStraightOffers both shapes(Straight andPreshaped)
Option of steamshaping byphysician forproper adjustmentto the anatomyprior to useOption of steamshaping byphysician forproper adjustmentto the anatomyprior to useOption of steamshaping byphysician forproper adjustmentto the anatomyprior to use
EffectiveLengths150 cm135 cm, 150 cm135 cm, 150 cm
Proximal/Distal ODProximal OD 2.4FDistal OD 1.7FProximal OD 3FDistal OD 2.8FProximal OD: 2.9FDistal OD: 2.7F
ID0.0165 inch0.027inch0.027inch
HydrophilicCoatingLength100 cm60 cm80 cm
Tip Length6cm10cm and 20cm6cm and 18cm
Tip Markers90%Pt-10%Ir90%Pt-10%Ir90%Pt-10%Ir
CoatingPolyvinylpyrrolidone PolyacrylamideHydropassHydrophilicCoatingPolyvinylpyrrolidone Polyacrylamide
Method ofsupplySterile, single-use,non-pyrogenicSterile, single-use,non-pyrogenicSterile, single-use,non-pyrogenic

Summary of Substantial Equivalence: The Excelsior XT-27 Microcatheter subject of this submission is substantially equivalent to the predicate devices with regard to design, materials, sterilization, principle of operation, performance, and indications for use.

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DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/4/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 tail feathers, representing the department's commitment to promoting health, well-being, and human services. The eagle is positioned within a circle, and the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged around the upper portion of the circle.

Public Health Service

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

Stryker Neurovascular c/o Ms. Tina Lochner DEKRA Certification. Inc. 4377 County Line Road Chalfont, PA 18914

APR 2 0 2012

Re: K113778

Trade/Device Name: Excelsior XT-27 Microcatheter Regulation Number: 21 CFR 870.1250 Regulation Name: Percutaneous Catheter Regulatory Class: Class II Product Code: DQY, KRA Dated: March 16, 2012 Received: March 22, 2012

Dear Ms. Lochner:

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 r ou may, thereforey issues 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 fray be subject to additions, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

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Page 2 - Ms. Tina Lochner

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 (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/CDRH0ffices/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 vours.

Ea. Hemm

Malvina B. Eydelman, MD Director Division of Ophthalmic, Neurological, and Ear. Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known): K113778

Device Name: . . . . . _ _ _ Excelsior® XT-27™ Microcatheter

Indications For Use:

The Excelsior XT-27 Microcatheter is intended to assist in the delivery of diagnostic agents (such as contrast media), therapeutic agents, and non-liquid interventional devices (such as stents) that are indicated for use in the neurovasculature and with a catheter of 0.027 inches in inner diameter.

Prescription Use × (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)

Quyuh Hoang
(Division Sign-Off)

Division of Ophthalmic, Neurological and Ear, Nose and Throat Devices

510(k) Number_

K113778

Page 1 of 1

§ 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).