K Number
K133566
Date Cleared
2013-12-20

(30 days)

Product Code
Regulation Number
870.4875
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Rotablator Rotational Atherectomy System with the Peripheral RotaLink Plus is intended to ablate occlusive material and restore luminal patency in the peripheral vasculature.

The Rotablator Rotational Atherectory System is intended for percutaneous use in peripheral vessels in patients with occlusive atherosclerotic disease who are acceptable candidates for endovascular procedures.

Device Description

The Rotablator Rotational Atherectomy System with the Peripheral RotaLink Plus consists of an Advancer pre-connected to a Catheter. The advancer functions as a guide for the sliding elements that control burr advancement and the catheter portion of the device guides the burr through the vasculature to the treatment site. The Peripheral RotaLink Plus devices are provided sterile and non-pyrogenic. It is intended for one procedure use only. The Rotablator Rotational Atherectomy System with the Peripheral RotaLink Plus currently offers burr sizes 1.5, 1.75, 2.00, 2.15, 2.25, 2.38 and 2.5mm, with 1.25mm being introduced in this submission.

AI/ML Overview

The provided text is a 510(k) summary for the Rotablator™ Rotational Atherectomy System with the Peripheral RotaLink™ Plus. It describes the device, its intended use, and the performance data submitted to support its substantial equivalence to predicate devices. However, this document does not contain acceptance criteria or detailed results of a study designed to prove the device meets specific acceptance criteria in the way one would expect for a deep learning algorithm or diagnostic AI tool.

Instead, the submission focuses on demonstrating substantial equivalence of a modified medical device to previously cleared predicate devices through a series of in-vitro performance tests and biocompatibility/chemical characterization tests. These tests ensure the new device iteration (with a new burr size) performs safely and effectively in a manner consistent with its predecessors.

Therefore, many of the requested elements (like "reported device performance" against acceptance criteria for a diagnostic measure, sample size for test/training sets, ground truth establishment, expert adjudication, MRMC studies, or standalone algorithm performance) are not applicable to the type of device and submission described.

Here's an analysis based on the information available:

1. Table of Acceptance Criteria and Reported Device Performance:

The document lists performance tests but does not provide specific numerical acceptance criteria or detailed performance results in the format of a typical diagnostic study. The "reported device performance" is essentially that the device passed these tests, affirming its safety and function consistent with predicate devices.

Test CategorySpecific TestAcceptance Criteria (Implied)Reported Device Performance
In-Vitro Performance TestsStrain ReliefConsistent with predicate device performance/safetyPassed (Implied by conclusion of substantial equivalence)
Operational SpeedsWithin specified ranges for safe and effective operationPassed (Implied by conclusion of substantial equivalence)
Stall TorqueConsistent with predicate device performance/safetyPassed (Implied by conclusion of substantial equivalence)
Infusate Temperature GenerationBelow thresholds for tissue damagePassed (Implied by conclusion of substantial equivalence)
Catheter AdvancementSmooth, controlled advancementPassed (Implied by conclusion of substantial equivalence)
Component Interface CompatibilityProper fitting and function of all componentsPassed (Implied by conclusion of substantial equivalence)
Burr Cutting AbilityEffective ablation of occlusive materialPassed (Implied by conclusion of substantial equivalence)
Tensile StrengthSufficient strength to withstand operational forcesPassed (Implied by conclusion of substantial equivalence)
Brake EngagementProper and reliable brake functionPassed (Implied by conclusion of substantial equivalence)
Infusate Flow RateWithin specified ranges for effective flushing/coolingPassed (Implied by conclusion of substantial equivalence)
Lumen PatencyMaintenance of lumen patency during usePassed (Implied by conclusion of substantial equivalence)
Functional LifeMeets single-procedure use requirementPassed (Implied by conclusion of substantial equivalence)
Biocompatibility & ChemicalNatural Rubber LatexAbsence of natural rubber latexAbsence confirmed (Implied by conclusion of substantial equivalence and standard safety testing)
Hemolysis Assay: Extract MethodNon-hemolyticPassed (Implied by conclusion of substantial equivalence)
Hemolysis Assay: Direct Contact MethodNon-hemolyticPassed (Implied by conclusion of substantial equivalence)
Complement Activation C3a and SC5b-9Non-activating of complement systemPassed (Implied by conclusion of substantial equivalence)
Partial Thromboplastin Time (PTT)No adverse effect on blood clottingPassed (Implied by conclusion of substantial equivalence)
In vitro Hemocompatibility AssayBiocompatible with bloodPassed (Implied by conclusion of substantial equivalence)
Guinea Pig Maximization SensitizationNon-sensitizingPassed (Implied by conclusion of substantial equivalence)
Intracutaneous Reactivity TestNon-irritatingPassed (Implied by conclusion of substantial equivalence)
Acute Systemic Injection TestNo systemic toxicityPassed (Implied by conclusion of substantial equivalence)
Materials Mediated Rabbit Pyrogen TestNon-pyrogenicPassed (Implied by conclusion of substantial equivalence)
USP Physicochemical Test for PlasticsMeets USP standards for plasticsPassed (Implied by conclusion of substantial equivalence)
In vitro Cytotoxicity Test: MEM ElutionNon-cytotoxicPassed (Implied by conclusion of substantial equivalence)
FTIR AnalysisMaterial composition consistent with predicate/expectedPassed (Implied by conclusion of substantial equivalence)

2. Sample size used for the test set and the data provenance:
* Sample Size: Not specified in the summary. Performance tests for medical devices typically involve testing a statistically representative sample of units.
* Data Provenance: Not applicable in the context of diagnostic data. These are engineering and biological tests conducted on the device itself.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts:
* Not applicable. The ground truth for these performance and biocompatibility studies would be established by validated test methods and industry standards, not expert consensus on diagnostic images.

4. Adjudication method for the test set:
* Not applicable. No image review or diagnostic adjudication is mentioned.

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 is not an AI/diagnostic software device.

6. If a standalone (i.e., algorithm only without human-in-the-loop performance) was done:
* Not applicable. This is not an AI/diagnostic software device.

7. The type of ground truth used:
* For performance tests: Engineering specifications, validated test methodologies, and established industry standards for mechanical, electrical, and functional properties.
* For biocompatibility tests: International standards (e.g., ISO 10993 series) and recognized test methods for assessing biological responses to medical devices.

8. The sample size for the training set:
* Not applicable. This is a physical medical device, not an AI algorithm requiring a training set.

9. How the ground truth for the training set was established:
* Not applicable.

Summary of the Study:

The "study" described in the 510(k) summary is a comprehensive set of in-vitro performance tests and biocompatibility/chemical characterization tests. These tests were conducted to demonstrate that the modified Rotablator Rotational Atherectomy System with the Peripheral RotaLink Plus (specifically, the introduction of a new 1.25mm burr size) is substantially equivalent to its predicate devices (K901206 and K121774) in terms of safety and effectiveness.

The conclusion states that "Based on the indications for use, technological characteristics, and safety and performance testing, the Peripheral Rotablator Atherectomy System with the Peripheral RotaLink Plus has been shown to be appropriate for its intended use and is considered to be substantially equivalent to the Peripheral Rotablator Rotational Angioplasty System as submitted in K901206 and K121774." This implies that the device passed all listed tests and met the internal acceptance criteria for each test, which would be consistent with the performance of the predicate device and established engineering/biological safety standards.

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K133566 510(k) Summary

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DEC 2 0 2013

Submitter'sName andAddressBoston Scientific CorporationOne Scimed PlaceMaple Grove, MN 55311Phone: 763-255-0877Fax: 763-494-2222
Contact NameandInformationMaylin TruesdellSenior Regulatory Affairs SpecialistPhone: 763-255-0877Fax: 763-494-2222e-mail: maylin.truesdell@bsci.com
Date PreparedNovember 19, 2013
ProprietaryNameRotablator™ Rotational Atherectomy System with the PeripheralRotaLink™ Plus
Common NameRotational Angioplasty System or Rotational Atherectomy System
Product CodeMCW - Catheter, Peripheral, Atherectomy
ClassificationClass II, 21 CFR Part 870.4875 - Intraluminal Artery Stripper
PredicateDevicesRotablator® Rotational Angioplasty SystemK901206, September 14, 1990
Rotablator™ Rotational Atherectomy System with the PeripheralRotaLink™ Plus
K121774, September 13, 2012
DeviceDescriptionThe Rotablator Rotational Atherectomy System with the PeripheralRotaLink Plus consists of an Advancer pre-connected to a Catheter. Theadvancer functions as a guide for the sliding elements that control burradvancement and the catheter portion of the device guides the burrthrough the vasculature to the treatment site. The Peripheral RotaLinkPlus devices are provided sterile and non-pyrogenic. It is intended for oneprocedure use only. The Rotablator Rotational Atherectomy System withthe Peripheral RotaLink Plus currently offers burr sizes 1.5, 1.75, 2.00,2.15, 2.25, 2.38 and 2.5mm, with 1.25mm being introduced in thissubmission.
Intended UseThe Rotablator Rotational Atherectomy System with the PeripheralRotaLink Plus is intended to ablate occlusive material and restore luminalpatency in the peripheral vasculature.
Indications forUseThe Rotablator Rotational Atherectomy System is intended forpercutaneous use in peripheral vessels in patients with occlusiveatherosclerotic disease who are acceptable candidates for endovascularprocedures.
K133566Page 2 of 2
Comparison ofTechnologicalCharacteristicsThe Rotablator Rotational Atherectomy System with the PeripheralRotaLink Plus incorporates substantially equivalent device materials anddesign, packaging materials and design, fundamental technology,manufacturing processes, sterilization process and intended use as thosefeatured in the Boston Scientific predicate devices, Peripheral RotablatorRotational Angioplasty System with the RotaLink Exchangeable Catheter.
PerformanceDataThe following in-vitro performance tests were completed on the PeripheralRotaLink Plus:
Strain ReliefBurr Cutting Ability
Operational SpeedsTensile Strength
Stall TorqueBrake Engagement
Infusate Temperature GenerationInfusate Flow Rate
Catheter AdvancementLumen Patency
Component Interface CompatibilityFunctional Life
The following biocompatibility and chemical characterization tests werecompleted on the Peripheral RotaLink Plus:
Natural Rubber LatexIntracutaneous Reactivity Test(Irritation)
Hemolysis Assay: ExtractMethodAcute Systemic Injection Test
Hemolysis Assay: DirectContact MethodMaterials Mediated RabbitPyrogen Test
Complement Activation C3aand SC5b-9 AssayUSP Physicochemical Test forPlastics
Partial Thromboplastin Time(PTT)In vitro Cytotoxicity Test: MEMElution
In vitro HemocompatibilityAssayFTIR Analysis
Guinea Pig MaximizationSensitization Test: Method forBiomaterial Extracts
ConclusionBased on the indications for use, technological characteristics, and safetyand performance testing, the Peripheral Rotablator Atherectomy Systemwith the Peripheral RotaLink Plus has been shown to be appropriate for itsintended use and is considered to be substantially equivalent to thePeripheral Rotablator Rotational Angioplasty System as submitted inK901206 and K121774.

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DEPARTMENT OF HEALTH & HUMAN SERVICES

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 circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized symbol that resembles an abstract human figure or a bird in flight, composed of three curved lines.

Public Health Service

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

December 20, 2013

Boston Scientific Corporation Ms. Maylin Truesdell Senior Regulatory Affairs Specialist One Scimed Place Maple Grove, MN 55311-1566

Re: K133566

Trade/Device Name: Rotablator Rotational Atherectomy System with the Peripheral RotaLink Plus Regulation Number: 21 CFR 870.4875 Regulation Name: Intraluminal Artery Stripper Regulatory Class: Class II Product Code: MCW Dated: November 19, 2013 Received: November 20, 2013

Dear Ms. Truesdell:

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. However, we remind you 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. Maylin Truesdell

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 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/Resourcesfor You/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/Resourcesfor You/Industry/default.htm.

Sincerely yours,

Kenneth J. Cavanaugh -S

for

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

Enclosure

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Indications for Use

K133566 510(k) Number (if known):

Device Name: Rotablator™ Rotational Atherectorny System with the Peripheral RotaLink™ Plus

Indications for Use:

The Rotablator Rotational Atherectory System is intended for perculaneous use in peripheral vessels in patients with occlusive atherosclerotic disease who are acceptable candidates for endovascular procedures.

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)

K

§ 870.4875 Intraluminal artery stripper.

(a)
Identification. An intraluminal artery stripper is a device used to perform an endarterectomy (removal of plaque deposits from arterisclerotic arteries.)(b)
Classification. Class II (performance standards).