K Number
K121222
Manufacturer
Date Cleared
2012-06-22

(60 days)

Product Code
Regulation Number
870.5100
Reference & Predicate Devices
N/A
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

Balloon diameters 1.50 mm - 5.00 mm
The MINI TREKTM OTW and TREKTM OTW Coronary Dilatatoin Catheters are indicated for:
a) balloon dilatation of the stenotic portion of a coronary artery or bypass graft stenosis for the purpose of improving myocardial perfusion;
b) balloon dilatation of a coronary artery occlusion for the purpose of restoring coronary flow in patients with ST-segment elevation myocardial infarction;
c) balloon dilatation of a stent after implantation (balloon models 2.0 mm - 5.0 mm only).
Balloon diameter 1.20 mm
The MINI TREK OTW 1.20 mm Coronary Dilatation Catheter is indicated for initial balloon dilatation of the stenotic portion of a coronary artery bypass stent graft (≥ 70% stenosis).

Device Description

The TREK OTW and MINI TREK OTW Coronary Dilatation Catheter are an over-the-wire co-axial design with a balloon at the distal tip. The balloon segment expands to a known diameter and length at a specific inflation pressure and has radiopaque marker(s) under the balloon to aid in positioning the balloon in a stenosis. The co-axial shaft consists of a tubular inner and outer member. The inner lumen permits the use of a guide wire to facilitate advancement of the catheter to and through the stenosis to be dilated. The outer lumen provides for inflation and deflation of the balloon with contrast fluid. Along the proximal portion of the shaft are brachial and femoral markers to aid in gauging the catheter's position relative to the guiding catheter tip when introducing the catheter through the guiding catheter. An adaption arm is located at the proximal end to provide access to the inflation lumen and guide wire lumen and allows connection with an inflation device.

AI/ML Overview

This document describes the acceptance criteria and study proving the device meets the criteria.

1. A table of acceptance criteria and the reported device performance

Acceptance Criteria (Bench Test Category)Reported Device Performance (Met/Not Met)
Catheter PreparationMet
Balloon Inflation / Balloon DeflationMet
Catheter Shaft FatigueMet
Catheter Shaft RuptureMet
Distal Catheter Tensile StrengthMet
Proximal Adaption Tensile StrengthMet
Inner Member CollapseMet
Kink and FlexibilityMet
TorqueMet
Biocompatibility (cytotoxicity, sensitization, intracutaneous reactivity, acute systemic toxicity, hemolysis, pyrogen, complement activation)Met

Explanation: The document states that "These in vitro bench and biocompatibility tests demonstrated that the TREK OTW and MINI TREK OTW Coronary Dilatation Catheters met all acceptance criteria and performed similarly to the predicate devices."

2. Sample size used for the test set and the data provenance

The document does not specify the exact sample sizes used for each in vitro bench test or biocompatibility test. It indicates that the tests were conducted "according to the requirements of Guidance for Industry and FDA Staff – Class II Special Controls for Certain Percutaneous Transluminal Coronary Angioplasty (PTCA) Catheters, September 8, 2010." This suggests the sample sizes would have been determined by the established guidelines for these types of tests.

The data provenance is in vitro bench tests and biocompatibility tests, not human subject data. Therefore, concepts like "country of origin of the data" and "retrospective or prospective" do not directly apply in the same way they would to clinical studies.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

Not applicable. This device underwent in vitro bench testing and biocompatibility testing, not studies involving expert evaluation of medical images or patient data to establish ground truth. The "ground truth" for these tests comes from the established physical and chemical standards and guidelines for medical device performance.

4. Adjudication method for the test set

Not applicable. Since the tests were in vitro bench and biocompatibility tests, there was no need for adjudication by experts as would be required in clinical studies involving interpretation of results. The results of these tests are typically objective measurements.

5. If a multi reader multi case (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 document describes the 510(k) submission for a physical medical device (coronary dilatation catheter) and its performance through in vitro and biocompatibility testing. It does not involve AI or human reader interpretation for comparative effectiveness.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

Not applicable. This device is a physical medical instrument, not an algorithm or software. Therefore, the concept of "standalone algorithm performance" is not relevant.

7. The type of ground truth used

The "ground truth" for this study was based on:

  • Established industry standards and regulatory guidance: Specifically, "Guidance for Industry and FDA Staff – Class II Special Controls for Certain Percutaneous Transluminal Coronary Angioplasty (PTCA) Catheters, September 8, 2010."
  • Scientific principles and objective measurements: The performance of the catheter was measured against predefined physical and chemical specifications for attributes like tensile strength, fatigue, inflation/deflation characteristics, and biocompatibility.

8. The sample size for the training set

Not applicable. This is not a machine learning or AI-based device, so there is no concept of a "training set."

9. How the ground truth for the training set was established

Not applicable, as there is no training set for this type of medical device.

{0}------------------------------------------------

K121222
Page 1 of 3

SECTION 2 - 510(k) SUMMARY

JUN 2 2 2 2012

The 510(k) Summary is submitted in accordance with 21 CFR 807.92 and the requirements of the Safe Medical Device Act (SMDA) of 1990.

1. SUBMITTER'S NAMEAbbott Vascular
2. SUBMITTER'S ADDRESS26531 Ynez Road, Temecula, CA 92591
3. TELEPHONE(951) 914-3243
4. FAX(951) 914-0339
5. CONTACT PERSONSuzanne Redman
6. DATE PREPAREDApril 20, 2011
7. DEVICE TRADE NAMETREKTM OTW Coronary Dilatation CatheterMINI TREKTM OTW Coronary DilatationCatheter
8. DEVICE COMMON NAME• Coronary Dilatation Catheter• Percutaneous Transluminal CoronaryAngioplasty (PTCA) Catheter
9. DEVICE CLASSIFICATIONNAMEPTCA Catheter, LOX, Class II21 CFR 870.5100
10. PREDICATE DEVICE NAMETREKTM OTW Coronary Dilatation CatheterMINI TREKTM OTW Coronary DilatationCatheter

DEVICE DESCRIPTION 11.

The TREK OTW and MINI TREK OTW Coronary Dilatation Catheter are an over-the-wire co-axial design with a balloon at the distal tip. Table 1 provides a matrix of the balloon diameters and lengths available.

{1}------------------------------------------------

K121222

Page 2 of 3

Table 2-1TREK OTW and MINI TREK OTW Size Matrix
BalloonDiameter(mm)6mm8mm12mm15mm20mm25mm30mm
MINI TREK OTW Coronary Dilatation Catheter
1.20XXXXX
1.50XXXXX
2.00XXXXXXX
TREK OTW Coronary Dilatation Catheter
2.25XXXXXXX
2.50XXXXXXX
2.75XXXXXXX
3.00XXXXXXX
3.25XXXXXXX
3.50XXXXXXX
3.75XXXXXXX
4.00XXXXXXX
4.50XX
5.00XX
Table 2-1 TREK OTW and MINI TREK OTW Size Matrix
Balloon DiameterBalloon Length

The balloon segment expands to a known diameter and length at a specific inflation pressure and has radiopaque marker(s) under the balloon to aid in positioning the balloon in a stenosis. The co-axial shaft consists of a tubular inner and outer member. The inner lumen permits the use of a guide wire to facilitate advancement of the catheter to and through the stenosis to be dilated. The outer lumen provides for inflation and deflation of the balloon with contrast fluid. Along the proximal portion of the shaft are brachial and femoral markers to aid in gauging the catheter's position relative to the guiding catheter tip when introducing the catheter through the guiding catheter. An adaption arm is located at the proximal end to provide access to the inflation lumen and guide wire lumen and allows connection with an inflation device.

12. INDICATIONS FOR USE

The TREK OTW and MINI TREK OTW Coronary Dilatation Catheters (1.50 mm - 5.00 mm) are indicated for:

a) balloon dilatation of the stenotic portion of a coronary artery or bypass graft stenosis for the purpose of improving myocardial perfusion;

b) balloon dilatation of a coronary artery occlusion for the purpose of restoring coronary flow in patients with ST-segment elevation myocardial infarction;

c) balloon dilatation of a stent after implantation (balloon models 2.0 mm - 5.0 mm only).

{2}------------------------------------------------

K1212222
Page 3 of 3

The MINI TREK OTW 1.20 mm Coronary Dilatation Catheter is indicated for initial balloon dilatation of the stenotic portion of a coronary artery bypass graft stenosis (≥ 70% stenosis).

TECHNOLOGICAL CHARACTERISTICS 13.

Comparisons of the new and predicate devices show that the technological characteristics such as product performance, design and intended use are substantially equivalent to the current marketed predicate devices.

14. PERFORMANCE DATA

The modified TREK OTW and MINI TREK OTW Coronary Dilatation Catheters were subjected to the following in vitro bench tests according to the requirements of Guidance for Industry and FDA Staff – Class II Special Controls for Certain Percutaneous Transluminal Coronary Angioplasty (PTCA) Catheters, September 8, 2010:

  • Catheter Preparation .
  • Balloon Inflation / Balloon Deflation .
  • . Catheter Shaft Fatigue
  • Catheter Shaft Rupture .
  • . Distal Catheter Tensile Strength
  • Proximal Adaption Tensile Strength .
  • . Inner Member Collapse
  • . Kink and Flexibility
  • Torque .

Biocompatibility testing previously conducted included cytotoxicity, sensitization, intracutaneous reactivity, acute systemic toxicity, hemolysis, pyrogen, and complement activation.

These in vitro bench and biocompatibility tests demonstrated that the TREK OTW and MINI TREK OTW Coronary Dilatation Catheters met all acceptance criteria and performed similarly to the predicate devices. No new safety or effectiveness issues were raised during the testing program and, therefore, these devices may be considered substantially equivalent to the predicate devices.

{3}------------------------------------------------

Image /page/3/Picture/1 description: The image shows the logo for the Department of Health & Human Services USA. The logo features a stylized eagle with its wings spread, and the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged in a circular pattern around the eagle. The logo is black and white.

Public Health Service

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

JUN 2 2 2012

Abbott Vascular, Inc. Ms. Suzanne Redman Regulatory Affairs 26531 Ynez Road Temecula, CA 92591

Re: K121222

Trade/Device Name: TREK OTW Coronary Dilatation Catheter and MINI TREK OTW Coronary Dilatation Catheter Regulation Number: 21 CFR 870.5100 Regulation Name: PTCA Catheter Regulatory Class: Class II Product Code: LOX Dated: May 23, 2012 Received: May 24, 2012

Dear Ms. Redman:

We have reviewed your Section 510(k) premarket notification of intent to market the device we nave reviewed your becamed the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate for use stated in the encreativent of the enactment date of the Medical Device Amendments, or to conninered prices to May 20, 1978, are exactions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). and Costiete Act (71ct) that ao not required to the general controls provisions of the Act. The 1 ou may, mercerere, manel as act include requirements for annual registration, listing of general controls provision practice, labeling, and prohibitions against misbranding and ucvices, good manufacturing praction in the mot evaluate information related to contract liability adulteration. Tease note: ODIC access not ever labeling must be truthful and not misleading.

{4}------------------------------------------------

Page 2 – Ms. Suzanne Redman

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 r rease oc acribed that I Drimination that your device complies with other requirements of the Act that 1 27 Planal statutes and regulations administered by other Federal agencies. You must or uny I casual statutes and reguirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical Of ice rated 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 rord in and ation 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 n you desire specific ad 1700 sor you/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 note the regalation manied 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 Tou may obtain of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

(800) 030 2011 01 (50 (50 (50 corcesfor You/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

{5}------------------------------------------------

SECTION 1 - INDICATIONS FOR USE

510(k) Number (if known):

Device Names:TREKTM OTW Coronary Dilatation CatheterMINI TREKTM OTW Coronary Dilatation Catheter
Indicationsfor Use:Balloon diameters 1.50 mm - 5.00 mmThe MINI TREKTM OTW and TREKTM OTW Coronary DilatatoinCatheters are indicated for:a) balloon dilatation of the stenotic portion of a coronary artery orbypass graft stenosis for the purpose of improving myocardialperfusion;b) balloon dilatation of a coronary artery occlusion for the purpose ofrestoring coronary flow in patients with ST-segment elevationmyocardial infarction;c) balloon dilatation of a stent after implantation (balloon models 2.0mm - 5.0 mm only).Balloon diameter 1.20 mmThe MINI TREK OTW 1.20 mm Coronary Dilatation Catheter is

indicated for initial balloon dilatation of the stenotic portion of a coronary artery bypass stent graft (≥ 70% stenosis).

Prescription Use______________________________________________________________________________________________________________________________________________________________ X = (Per 21 CFR 801.109)

.

OR

Over-The-Counter__ (Optional Format 1-1-96)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)
(Division Sign-Off)Page __ of __
Division of Cardiovascular Devices
510(k) NumberK121222

1-1

§ 870.5100 Percutaneous Transluminal Coronary Angioplasty (PTCA) Catheter.

(a)
Standard PTCA Catheter —(1)Identification. A PTCA catheter is a device that operates on the principle of hydraulic pressurization applied through an inflatable balloon attached to the distal end. A PTCA balloon catheter has a single or double lumen shaft. The catheter features a balloon of appropriate compliance for the clinical application, constructed from a polymer. The balloon is designed to uniformly expand to a specified diameter and length at a specific pressure as labeled, with well characterized rates of inflation and deflation and a defined burst pressure. The device generally features a type of radiographic marker to facilitate fluoroscopic visualization of the balloon during use. A PTCA catheter is intended for balloon dilatation of a hemodynamically significant coronary artery or bypass graft stenosis in patients evidencing coronary ischemia for the purpose of improving myocardial perfusion. A PTCA catheter may also be intended for the treatment of acute myocardial infarction; treatment of in-stent restenosis (ISR) and/or post-deployment stent expansion.(2)
Classification. Class II (special controls). The special control for this device is “Class II Special Controls Guidance Document for Certain Percutaneous Transluminal Coronary Angioplasty (PTCA) Catheters.” See § 870.1(e) for the availability of this guidance document.(b)
Cutting/scoring PTCA Catheter —(1)Identification. A cutting/scoring PTCA catheter is a balloon-tipped catheter with cutting/scoring elements attached, which is used in those circumstances where a high pressure balloon resistant lesion is encountered. A cutting/scoring PTCA catheter is intended for the treatment of hemodynamically significant coronary artery stenosis for the purpose of improving myocardial perfusion. A cutting/scoring PTCA catheter may also be indicated for use in complex type C lesions or for the treatment of in-stent restenosis.(2)
Classification. Class III (premarket approval). As of May 28, 1976, an approval under section 515 of the act is required before this device may be commercially distributed. See § 870.3.