K Number
K132952
Device Name
MICROPLEX COIL SYSTEM (MCS), HYDROCOIL EMBOLIC SYSTEM (HES)
Manufacturer
Date Cleared
2013-12-19

(91 days)

Product Code
Regulation Number
882.5950
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Intended for the endovascular embolization of intracranial aneurysms and other neurovascular abnormalities such as arteriovenous malformations and arteriovenous fistulae. Also intended for vascular occlusion of blood vessels within the neurovascular system to permanently obstruct blood flow to an aneurysm or other vascular malformation and for arterial and venous embolizations in the peripheral vasculature.
Device Description
Treatment of cerebral aneurysms can be performed either by surgical clipping or endovascular techniques (e.g., embolization coils). Endovascular methods to embolize intracranial aneurysms with implantable platinum embolization coils were developed in the 1970s. Embolization coils including the MicroVention MCS and HES products are now widely used to treat all aneurysms. The MCS consists of an implantable coil made of bare platinum alloy (Platinum/Tungsten), and the HES consists of an implantable coil made of the same platinum alloy with a hydrogel inner core. The coil is attached to a delivery pusher via a polyolefin elastomer material. The delivery pusher contains radiopaque positioning markers at the distal end. The proximal end is inserted into a hand held battery powered V-Grip™ Detachment Controller. When the Detachment Controller is activated, the flow of electrical current heats the polyolefin elastomer filament, resulting in detachment of the implant segment. The V-Grip is packaged and sold separately. The modified MCS and HES devices are substantially equivalent to the cleared predicate devices with regard to intended use, principal of operation, materials, manufacturing processes, packaging configuration, and sterilization method.
More Information

Not Found

No
The device description focuses on the physical components and detachment mechanism of embolization coils, with no mention of software, algorithms, or data processing that would indicate AI/ML. The performance studies are bench and biocompatibility tests, not studies evaluating algorithmic performance.

Yes

The device is intended for the "endovascular embolization of intracranial aneurysms and other neurovascular abnormalities" and for "vascular occlusion...to permanently obstruct blood flow," which are therapeutic interventions.

No

This device is described as an implantable coil system used for the embolization and occlusion of blood vessels, treating conditions like aneurysms and arteriovenous malformations. It is a therapeutic device designed for treatment, not for diagnosing medical conditions.

No

The device description clearly details physical components including implantable coils, a delivery pusher, and a battery-powered detachment controller.

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

Here's why:

  • Intended Use: The intended use is for the endovascular embolization of intracranial aneurysms and other neurovascular abnormalities, as well as vascular occlusion in the peripheral vasculature. This is a therapeutic procedure performed in vivo (within the body) to treat a medical condition.
  • Device Description: The device is an implantable coil used to physically obstruct blood flow. This is a medical device used for treatment, not for analyzing samples taken from the body.
  • Lack of IVD Characteristics: There is no mention of the device being used to examine specimens derived from the human body (like blood, urine, tissue, etc.) to provide information for diagnosis, monitoring, or screening.

IVD devices are used to perform tests on samples taken from a patient to help diagnose or monitor a condition. This device is used to directly treat a condition within the patient's body.

N/A

Intended Use / Indications for Use

Intended for the endovascular embolization of intracranial aneurysms and other neurovascular abnormalities such as arteriovenous malformations and arteriovenous fistulae. Also intended for vascular occlusion of blood vessels within the neurovascular system to permanently obstruct blood flow to an aneurysm or other vascular malformation and for arterial and venous embolizations in the peripheral vasculature.

Product codes

HCG, KRD

Device Description

Treatment of cerebral aneurysms can be performed either by surgical clipping or endovascular techniques (e.g., embolization coils). Endovascular methods to embolize intracranial aneurysms with implantable platinum embolization coils were developed in the 1970s. Embolization coils including the MicroVention MCS and HES products are now widely used to treat all aneurysms.

The MCS consists of an implantable coil made of bare platinum alloy (Platinum/Tungsten), and the HES consists of an implantable coil made of the same platinum alloy with a hydrogel inner core. The coil is attached to a delivery pusher via a polyolefin elastomer material. The delivery pusher contains radiopaque positioning markers at the distal end. The proximal end is inserted into a hand held battery powered V-Grip™ Detachment Controller. When the Detachment Controller is activated, the flow of electrical current heats the polyolefin elastomer filament, resulting in detachment of the implant segment. The V-Grip is packaged and sold separately.

The modified MCS and HES devices are substantially equivalent to the cleared predicate devices with regard to intended use, principal of operation, materials, manufacturing processes, packaging configuration, and sterilization method.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

intracranial, neurovascular system, peripheral vasculature

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

Pre-Clinical Testing:
Design Verification and Validation Bench Test Summary included tests for:

  • Visual Inspection: Acceptance Criteria - Per product drawing. Result - Pass, Met established criteria. (Same as predicate: Y)
  • Simulated Use: The test simulates a neurointerventional embolization procedure to assess deployment, repositioning, and detachment in an aneurysm. Acceptance Criteria - All performance ratings shall be >= 3. Result - Pass, Met established criteria. (Same as predicate: Y)
  • Pusher Resistance: Using a digital multimeter, measure the resistance through a microcatheter. Acceptance Criteria - 36.7-53.0 Ohm. Result - Pass, Met established criteria. (Same as predicate: Y)
  • Detachment Zone Tensile: Using an Instron tester, measure the breakforce at the detachment zone. Acceptance Criteria - >= 0.08 lbf. Result - Pass, Met established criteria. (Same as predicate: Y)

Biocompatibility Test Summary - HES Coil Implant included tests for:

  • MEM Elution (ISO 10993-5) - Passed
  • ISO Cell Culture Agar Overlay (100 10993-2) - Passed
  • Sensitization-Guinea Pig Maximization (ISO 10993-10) - Passed
  • ISO Intracutaneous Reactivity Evaluation (ISO 10993-10) - Passed
  • Hemolysis (ISO 10993-4) - Passed
  • Prothrombin Time Assay - ISO (ISO 10993-4) - Passed
  • Systemic toxicity (IV injection) (ISO 10993-11) - Passed
  • Rabbit Pyrogen Test (material mediated) (ISO 10993-11) - Passed
  • Bacteria Reverse Mutation Assay (Ames) (180 10993-3) - Passed
  • 7-day Muscle Implantation (180 10993-6) - Passed
  • 13-week Intramuscular Implantation Test (ISO 10993-6) - Passed
  • 26-week Intramuscular Implantation Test (ISO 10993-6) - Passed

Biocompatibility Test Summary - MCS Coil Implant included tests for:

  • MEM Elution (ISO 10993-5) - Passed
  • ISO Cell Culture Agar Overlay (ISO 10993-5) - Passed
  • Sensitization-Guinea Pig Maximization (ISO 10993-10) - Passed
  • ISO Intracutaneous Reactivity Evaluation (ISO 10993-10) - Passed
  • Hemolysis (ISO 10993-4) - Passed
  • Prothrombin Time Assay - ISO (ISO 10993-4) - Passed
  • Systemic toxicity (IV injection) (ISO 10993-11) - Passed
  • Rabbit Pyrogen Test (material mediated) (ISO 10993-11) - Passed
  • Bacteria Reverse Mutation Assay (Ames) (SO 10993-3) - Passed
  • 7-day Muscle Implantation (ISO 10993-6) - Passed
  • 90-day Intramuscular Implantation Test (ISO 10993-6) - Passed
  • 100-day Intramuscular Implantation Test (ISO 10993-6) - Passed

Biocompatibility Test Summary - Delivery Pusher included tests for:

  • MEM Elution (ISO 10993-5) - Passed
  • ISO Cell Culture Agar Overlay (ISO 10993-5) - Passed
  • Sensitization-Guinea Pig Maximization (ISO 10993-10) - Passed
  • ISO Intracutaneous Reactivity Evaluation (ISO 10993-10) - Passed
  • Hemolysis (ISO 10993-4) - Passed
  • Prothrombin Time Assay - ISO (ISO 10993-4) - Passed
  • Systemic toxicity (IV injection) (ISO 10993-11) - Passed
  • Rabbit Pyrogen Test (material mediated) (ISO 10993-11) - Passed

Key Results: The results of the bench testing demonstrate that the subject device is safe and effective when used according to the instructions for use and performs equivalent to the predicate device. The testing was used in support of the risk analysis documentation for the subject device.

Key Metrics

Not Found

Predicate Device(s)

K103758, K091641, K111451, K103758, K08241, K093919, K090891, K093358, K102365, K091641, K103758, K113457, K112226, K120908, K090357, K100454, K091641, K080666

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 882.5950 Neurovascular embolization device.

(a)
Identification. A neurovascular embolization device is an intravascular implant intended to permanently occlude blood flow to cerebral aneurysms and cerebral ateriovenous malformations. This does not include cyanoacrylates and other embolic agents, which act by polymerization or precipitation. Embolization devices used in other vascular applications are also not included in this classification, see § 870.3300.(b)
Classification. Class II (special controls.) The special control for this device is the FDA guidance document entitled “Class II Special Controls Guidance Document: Vascular and Neurovascular Embolization Devices.” For availability of this guidance document, see § 882.1(e).

0

K132952

DEC 1 9 2013

510(K) SUMMARY

(Prepared November 12, 2013)

MicroPlex Coil System (MCS), HydroCoil Embolic System (HES)

Laraine Pangelina, Sr. Regulatory Affairs Project Manager

Trade Name:

Generic Name: Neurovascular Embolization Device

Class II, 21 CFR 882.5950 Classification:

Submitted By: MicroVention, Inc 1311 Valencia Avenue Tustin, California 92780 U.S.A.

Contact:

Predicate Devices:

MicroPlex Coil System (MCS) (K103758, K091641, K111451, K103758, K08241, K093919, K090891, K093358, K102365) HydroCoil Embolic System (HES) (K091641, K103758, K113457, K112226, K120908, K090357, K100454, K091641, K080666)

Intended for the endovascular embolization of Indications for Use: intracranial aneurysms and other neurovascular abnormalities such as arteriovenous malformations and arteriovenous fistulae. Also intended for vascular occlusion of blood vessels within the neurovascular system to permanently obstruct blood flow to

an aneurysm or other vascular malformation and for arterial and venous embolizations in the peripheral vasculature.

Treatment of cerebral aneurysms can be performed Device Description: either by surgical clipping or endovascular techniques (e.g., embolization coils). Endovascular methods to

embolize intracranial aneurysms with implantable platinum embolization coils were developed in the 1970s. Embolization coils including the MicroVention MCS and HES products are now widely used to treat all aneurysms.

The MCS consists of an implantable coil made of bare platinum alloy (Platinum/Tungsten), and the HES consists of an implantable coil made of the same platinum alloy with a hydrogel inner core. The coil is attached to a delivery pusher via a polyolefin elastomer material. The delivery pusher contains radiopaque positioning markers at the distal end. The proximal end is inserted into a hand held battery powered V-Grip™ Detachment Controller. When the Detachment Controller is activated, the flow of electrical current heats the polyolefin elastomer filament, resulting in detachment of the implant segment. The V-Grip is packaged and sold separately.

The modified MCS and HES devices are substantially equivalent to the cleared predicate devices with regard to intended use, principal of operation, materials, manufacturing processes, packaging configuration, and sterilization method.

1

MicroVention : ﺗ

Pre-Clinical Testing:

Design Verification and Validation Bench Test Summary
Test / Test DescriptionAcceptance CriteriaTest & Acceptance
Criteria same as
predicate device?
Y/NResult
Visual Inspection
Perform visual inspection
and measurements using
device drawingPer product drawingYPass
Met established
criteria
Simulated Use
The test simulates a
neurointerventional
embolization procedure to
assess deployment,
repositioning, and
detachment in an
aneurysm.All performance ratings
shall be ≥ 3YPass
Met established
criteria
Pusher Resistance
Using a digital multimeter,
measure the resistance
through a microcatheter.36.7-53.0 $Ω$YPass
Met established
criteria
Detachment Zone Tensile
Using an Instron tester,
measure the breakforce at
the detachment zone.≥0.08 lbfYPass
Met established
criteria

CONCLUSION: The results of the bench testing demonstrate that the subject device is safe and
effective when used according to the instructions for use and performs equivalen device. The testing was used in support of the risk analysis documentation for the subject device.

Biocompatibility Test Summary - HES Coil Implant
TestRequirementResult
MEM Elution10993-5Passed
ISO Cell Culture Agar Overlay100 10993-2Passed
Sensitization-Guinea Pig MaximizationISO 10993-10Passed
ISO Intracutaneous Reactivity EvaluationISO 10993-10Passed
HemolysisISO 10993-4Passed
Prothrombin Time Assay - ISOISO 10993-4Passed
Systemic toxicity (IV injection)ISO 10993-11Passed
Rabbit Pyrogen Test (material mediated)ISO 10993-11Passed
Bacteria Reverse Mutation Assay (Ames)180 10993-3Passed
7-day Muscle Implantation180 10993-6Passed
13-week Intramuscular Implantation TestISO 10993-6Passed
26-week Intramuscular Implantation TestISO 10993-6Passed

2

AlleroVention

Biocompatibility Test Summary - MCS Coil Implant
TestRequirementResult
MEM ElutionISO 10993-5Passed
ISO Cell Culture Agar OverlayISO 10993-5Passed
Sensitization-Guinea Pig MaximizationISO 10993-10Passed
ISO Intracutaneous Reactivity EvaluationISO 10993-10Passed
HemolysisISO 10993-4Passed
Prothrombin Time Assay - ISOISO 10993-4Passed
Systemic toxicity (IV injection)ISO 10993-11Passed
Rabbit Pyrogen Test (material mediated)ISO 10993-11Passed
Bacteria Reverse Mutation Assay (Ames)SO 10993-3Passed
7-day Muscle ImplantationISO 10993-6Passed
90-day Intramuscular Implantation TestISO 10993-6Passed
100-day Intramuscular Implantation TestISO 10993-6Passed
Biocompatibility Test Summary - Delivery Pusher
TestRequirementResult
MEM ElutionISO 10993-5Passed
ISO Cell Culture Agar OverlayISO 10993-5Passed
Sensitization-Guinea Pig MaximizationISO 10993-10Passed
ISO Intracutaneous Reactivity EvaluationISO 10993-10Passed
HemolysisISO 10993-4Passed
Prothrombin Time Assay - ISOISO 10993-4Passed
Systemic toxicity (IV injection)ISO 10993-11Passed
Rabbit Pyrogen Test (material mediated)ISO 10993-11Passed

Predicate / Subject Technological Comparison:

FeatureMCS Predicate DevicesHES Predicate DevicesSubject Devices
Indications for UseIntended for the endovascular embolization of intracranial aneurysms and other neurovascular abnormalities such as arteriovenous malformations and arteriovenous fistulae. The MCS is also intended for vascular occlusion of blood vessels within the neurovascular system to permanently obstruct blood flow to an aneurysm or other vascular malformation and for arterial and venous embolizations in the peripheral vasculature.SameSame
Device OverviewAn implantable coil attached to a delivery pusher via a polyolefin elastomer material. The delivery pusher contains radiopaqueSameSame

3

Special 510(k) MicroPlex Embolic System (MCS) & HydroCoil Embolic System (HES) with V-Trak Advanced Delivery Pusher

MicroVention

TERUMO
positioning markers at the distal end. The
proximal end is inserted into a hand held
battery powered Detachment Controller.
When the Detachment Controller is
activated, the flow of electrical current
heats the polyolefin elastomer filament,
resulting in detachment of the implant
segment. The Detachment Controller is
packaged and sold separately.
Coil shapeHelical, 3DSameSame
Coil OD (mm)1-241-24Same
Restrained coil
length (cm)1-681-50Same
Main coil wire
materialPlatinum/Tungsten (92/8%) alloySameSame
Coupler MaterialPlatinum (90%)/ iridium (10%)SameSame
Adhesive MaterialDYMAX 1128-AM-VT UV AdhesiveSameSame
Stretch resistance
filar materialPolyolefin Elastomer or PETPETSame
Implant-to-pusher
materialPolyolefin elastomerSameSame
Delivery methodV-Trak delivery pusherV-Trak delivery
pusherV-Trak
Advanced
delivery
pusher1
1 The subject device is the same as the predicate devices with the exception of the modified V-
Trak Advanced deliver pusher. Other than the colorant in the PET connector tube, the V-Trak
Advanced delivery pusher is essentially the same as the cleared V-Trak delivery pusher. The MCS
and HES devices with the V-Trak Advanced delivery pusher are the same with regard to intended
use and principal of operation. Any differences in technological characteristics do not introduce
any new issues of safety or effectiveness. Therefore, it is our conclusion that the MCS and HES
devices with the V-Trak Advanced delivery pusher is substantially equivalent to the predicate
devices.

Summary of Substantial Equivalence:

The subject devices are the same as the predicate devices with regard to intended use and principal of operation. Any differences in technological characteristics do not introduce any new issues of safety or effectiveness. Therefore, it is our conclusion that the MCS and HES devices with the V-Trak Advanced delivery pusher is substantially equivalent to the predicate devices.

4

Image /page/4/Picture/1 description: The image shows the logo for the Department of Health & Human Services - USA. The logo consists of a circle with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the circumference. Inside the circle is a stylized eagle symbol, which is a common emblem associated with the U.S. government.

Public Health Service

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

December 19, 2013

MicroVention Terumo c/o Ms. Laraine Pangelina Sr. Regulatory Affairs Project Manager MicroVention, Incorporated 1311 Valencia Avenue Tustin, CA 92780

Re: K132952

Trade/Device Name: Microplex Coil System (MCS), Hydrocoil Embolic System (HES) Regulation Number: 21 CFR 882.5950 Regulation Name: Neurovascular Embolization Device Regulatory Class: Class II Product Code: HCG, KRD Dated: November 18, 2013 Received: November 21, 2013

Dear Ms. Pangelina:

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 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

5

Page 2 - Ms. Laraine Pangelina

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 contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. 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/ResourcesforYou/Industry/default.htm.

Sincerely yours.

Joyce M. Whang -S

for Carlos Peña, Ph.D.

Director Division of Neurological and Physical Medicine Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

6

Indications for Use

510(k) Number (if known): K132952

Device Name: _ MicroPlex Coil System (MCS), HydroCoil Embolic System (HES)

Indications For Use:

ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﻤ

Intended for the endovascular embolization of intracranial aneurysms and other neurovascular abnormalities such as arteriovenous malformations and arteriovenous fistulae. Also intended for vascular occlusion of blood vessels within the neurovascular system to permanently obstruct blood flow to an aneurysm or other vascular malformation and for arterial and venous embolizations in the peripheral vasculature.

Prescription Use _ كا (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 Center for Devices and Radiological Health (CDRH)

Joyce M. Whang -S

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