K Number
K141516
Device Name
MINDFRAME CAPTURE LP REVASCULARIZATION DEVICE
Date Cleared
2015-02-05

(241 days)

Product Code
Regulation Number
870.1250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Capture™ LP Revascularization Device is intended to restore blood flow by removing thrombus from a large intracranial vessel in patients experiencing ischemic stroke within 8 hours of symptom onset. Patients who are ineligible for intravenous tissue plasminogen activator (IV t-PA) or who fail IV t-PA therapy are candidates for treatment.
Device Description
The Capture™ LP device is designed to restore blood flow in patients experiencing ischemic stroke due to large intracranial vessel occlusion within 8 hours of symptoms onset. It is indicated for subjects who are ineligible for intravenous tissue plasminogen activator (IV t-PA) or who fail IV t-PA therapy. The distal nitinol portion of the device facilitates clot retrieval and has Platinum -Iridium and Platinum-Tungsten radiopaque markers on the proximal and distal ends respectively. The device is supplied sterile and is intended for single-use only by physicians trained in interventional neuroradiology and treatment of ischemic stroke.
More Information

Not Found

No
The summary describes a mechanical device for clot retrieval and does not mention any software, algorithms, or data processing that would indicate the use of AI/ML.

Yes
The device is intended to restore blood flow by removing thrombus, which directly treats a medical condition (ischemic stroke).

No

The device is described as a "Revascularization Device" intended to "restore blood flow by removing thrombus." This function is therapeutic, not diagnostic.

No

The device description explicitly details a physical, implantable device made of nitinol with radiopaque markers, intended for mechanical clot retrieval. This is a hardware device, not software.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens taken from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening.
  • Device Function: The Capture™ LP Revascularization Device is a therapeutic device. Its purpose is to physically remove a thrombus (blood clot) from a blood vessel within the body to restore blood flow. It is used during a medical procedure on the patient, not on a sample taken from the patient.

The description clearly outlines a device used for an interventional procedure within the patient's body, which is the opposite of an in vitro diagnostic test.

N/A

Intended Use / Indications for Use

The Capture™ LP Revascularization Device is intended to restore blood flow by removing thrombus from a large intracranial vessel in patients experiencing ischemic stroke within 8 hours of symptom onset. Patients who are ineligible for intravenous tissue plasminogen activator (IV t-PA) or who fail IV t-PA therapy are candidates for treatment.

Product codes

NRY

Device Description

The Capture™ LP device is designed to restore blood flow in patients experiencing ischemic stroke due to large intracranial vessel occlusion within 8 hours of symptoms onset. It is indicated for subjects who are ineligible for intravenous tissue plasminogen activator (IV t-PA) or who fail IV t-PA therapy. The distal nitinol portion of the device facilitates clot retrieval and has Platinum -Iridium and Platinum-Tungsten radiopaque markers on the proximal and distal ends respectively. The device is supplied sterile and is intended for single-use only by physicians trained in interventional neuroradiology and treatment of ischemic stroke.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

large intracranial vessel

Indicated Patient Age Range

Not Found

Intended User / Care Setting

physicians trained in interventional neuroradiology and treatment of ischemic stroke.

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

Bench Testing:

  • Study Type: Bench testing
  • Sample Size: Not specified for all tests, but implied by testing of multiple devices.
  • Key Results:
    • All devices met acceptance criteria for total length.
    • Delivery and re-sheathing force testing met acceptance criteria and were comparable to the predicate.
    • Devices demonstrated no damage after delivery and withdrawal, durability same as predicate.
    • The transformational temperature is lowered as the size of the device increases.
    • Device was resistant to kinking around small radii turns. Kink radii smaller than predicate due to smaller device size.
    • System tensile testing met acceptance criteria. System tensile strength same as predicate.
    • The tensile strength of the distal radiopaque markers met acceptance criteria. The markercoil tensile strength same as predicate.
    • Torque strength testing met acceptance criteria. Torque strength same as predicate.
    • Radial force testing of the Capture™ LP device is comparable to the predicate device for the recommended vessel diameters.
    • Radiopacity of Capture™ LP device equivalent to that of the predicate device.
    • Capture™ LP device restored distal blood flow 100% of the time. Performance testing better than predicate device.
    • Capture™ LP rated similar to the predicate device when used with the Rebar-14 microcatheter.

Animal Studies:

  • Study Type: Acute animal study, 30-day and 90-day chronic animal studies.
  • Sample Size: A total of six swine were evaluated for usability effectiveness and safety in the acute study. Number of subjects for chronic studies not specified, but stated "In each study".
  • Data Source: Swine models.
  • Key Results:
    • Acute Study:
      • Successful Clot Retrieval: The Capture™ LP device was able to retrieve the manufactured clot in all test animals. Clot recovery is the same as the predicate device.
      • Sustained Flow (TIMI 2 or 3) In Clot Vessel: Blood flow was assessed with a TIMI score of 2 or 3 for all vessels where the Capture™ LP device was used to retrieve clot. Blood flow restoration the same as that for the predicate device.
      • Average Number of Passes for Clot Retrieval: The number of passes for the Capture™ LP to successfully retrieve clot from the target vessels is equivalent to that of the predicate device.
      • Histological findings observed for both Capture™ LP and predicate devices demonstrated that the artery response to neurothrombectomy was comparable.
    • Chronic Studies (30-day and 90-day):
      • Angiographic visualization during the procedure and just prior to subject sacrifice demonstrated that there was no wall damage or thrombus formation during the treatment.
      • Histopathologic evaluation demonstrated that the artery response to the neurothrombectomy procedure was considered to be comparable between the Capture™ LP device and the predicate device.

Key Metrics

  • Blood flow restoration: TIMI score of 2 or 3
  • Distal blood flow restoration: 100%

Predicate Device(s)

Solitaire™ FR Revascularization Device 510(k)#: K113455

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 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).

0

Image /page/0/Picture/1 description: The image shows the logo for the Department of Health & Human Services - USA. The logo features the department's name arranged in a circular fashion around a symbol. The symbol consists of a stylized caduceus, which is a staff with two snakes entwined around it, often associated with medicine and healthcare.

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

February 5, 2015

Micro Therapeutics, Inc., d/b/a ev3 Neurovascular Mr. Larry Boucher Senior Regulatory Affairs Specialist 9775 Toledo Way Irvine, California 92618

Re: K141516 Trade/Device Name: MindFrame Capture™ LP Revascularization Device Regulation Number: 21 CFR 870.1250 Regulation Name: Catheter, Thrombus Retriever Regulatory Class: Class II Product Code: NRY Dated: December 24, 2014 Received: January 5, 2015

Dear Mr. Boucher,

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 devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in

1

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 Industry and Consumer Education 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. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 Industry and Consumer Education 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,

Carlos L. Pena - 50/0

Carlos L. Peña, PhD, MS Director Division of Neurological and Physical Medicine Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K141516

Device Name

Capture™ LP Revascularization Device

Indications for Use (Describe)

The Capture™ LP Revascularization Device is intended to restore blood flow by removing thrombus from a large intracranial vessel in patients experiencing ischemic stroke within 8 hours of symptom onset. Patients who are ineligible for intravenous tissue plasminogen activator (IV t-PA) or who fail IV t-PA therapy are candidates for treatment.

Type of Use (Select one or both, as applicable)
☑ Prescription Use (Part 21 CFR 801 Subpart D)☐ Over-The-Counter Use (21 CFR 801 Subpart C)

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1. 510(k) Summary

| 510(k) Owner: | Micro Therapeutics, Inc. d/b/a ev3 Neurovascular
9775 Toledo Way
Irvine, CA 92618
Establishment Registration No. 2029214 | | |
|------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--|--|
| Contact Person: | Larry Boucher
Senior Regulatory Affairs Specialist
Telephone: (949) 297-9781
E-mail: larry.boucher@covidien.com | | |
| Date Summary
Prepared: | 28 January 2015 | | |
| Trade Name of
Device: | Capture™ LP Revascularization Device | | |
| Common Name of
Device: | Catheter, Thrombus Retriever | | |
| Classification of
Device: | 21 CFR 870.1250 – Class II | | |
| Predicate Device: | Solitaire™ FR Revascularization Device 510(k)#: K113455 | | |
| Performance Data: | The following bench testing was performed in support of the Capture™ LP Revascularization Device:
A f Temperature Testing Radial Force Testing Radiopacity Testing Kink Resistance Testing Dimensional Testing Durability Testing Delivery Force Testing Re-sheathing (withdrawal) Force Testing Component and Attachment (Tensile) Integrity Testing Torque Strength Testing Performance (Clot Retrieval) Testing Physician Usability Testing | | |

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| | Biocompatibility testing, sterilization validation, and a 2-year
accelerated aging study were also performed. In addition, an acute and
30-day and 90-day chronic animal studies were performed. |
|-------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Conclusion: | The Capture™ LP device is substantially equivalent to the Solitaire™
FR device based on the successful completion of non-clinical bench and
animal testing as well as similar principles of design, operation and
indications for use. |

Device Description:

The Capture™ LP device is designed to restore blood flow in patients experiencing ischemic stroke due to large intracranial vessel occlusion within 8 hours of symptoms onset. It is indicated for subjects who are ineligible for intravenous tissue plasminogen activator (IV t-PA) or who fail IV t-PA therapy. The distal nitinol portion of the device facilitates clot retrieval and has Platinum -Iridium and Platinum-Tungsten radiopaque markers on the proximal and distal ends respectively. The device is supplied sterile and is intended for single-use only by physicians trained in interventional neuroradiology and treatment of ischemic stroke.

Indications for Use:

The ev3 / Covidien Capture™ LP Revascularization Device is intended to restore blood flow by removing thrombus from a large intracranial vessel in patients experiencing ischemic stroke within 8 hours of symptom onset. Patients who are ineligible for intravenous tissue plasminogen activator (IV t-PA) or who fail IV t-PA therapy are candidates for treatment.

Device Comparison

The table below provides a comparison of the technological characteristics of the Capture™ LP Revascularization Device and the Solitaire™ FR Revascularization Device.

CharacteristicSolitaire™ FRCapture™ LPRationale for Difference (If Present)
Indication for UseThe Solitaire™ FR Revascularization Device is intended to restore blood flow by removing thrombus from a large intracranial vessel in patients experiencing ischemic stroke within 8 hours of symptom onset. Patients who are ineligible for intravenous tissue plasminogen activator (IV t-PA) or who fail IV t-PA therapy are candidates for treatment.The Capture™ LP Revascularization Device is intended to restore blood flow by removing thrombus from a large intracranial vessel in patients experiencing ischemic stroke within 8 hours of symptom onset. Patients who are ineligible for intravenous tissue plasminogen activator (IV t-PA) or who fail IV t-PA therapy are candidates for treatment.N/A
CharacteristicSolitaire™ FRCapture™ LPRationale for Difference (If Present)
Sizes Offered4x15mm
4x20mm
6x20mm
6x30mm3x20mm
3x30mm
4x20mm
4x30mmThe Capture™ LP device is designed to be delivered through a smaller ID (0.432 mm/0.017" inner diameter) micro catheter.
Device DesignLaser-cut stent attached to a nitinol push-wireLaser-cut stent attached to a nitinol push-wireN/A
Distal End Design"Overlapping" designTubular designThe results of bench testing and animal testing establish the equivalency of the Capture™ LP device and the Solitaire™ FR device.
Materials
StentNitinolNitinolN/A
Distal Marker90% Platinum/ 10% Iridium92% Platinum/ 8% TungstenThe material used for the Capture™ LP device was shown to be biocompatible per ISO 10993 testing. In addition, the Radiopacity of the material was shown to be equivalent to that of the Solitaire™ FR device through design verification testing.
Proximal Marker90% Platinum/ 10% Iridium90% Platinum/ 10% IridiumN/A
Tip AttachmentMechanical/Dymax adhesiveLaser weldedThe tensile strength of the attachment zone was shown to be equivalent to Solitaire™ FR through design verification testing.
Marker AttachmentLaser weldSolder (Gold/Tin)The material used for the Capture™ LP device was shown to be biocompatible per ISO 10993 testing. In addition, the tensile strength of the marker attachment was shown to be equivalent to that of the Solitaire™ FR device through design verification testing.
Pusher WireNitinolNitinolN/A
Introduction SheathPTFEHDPEThe material used for the Capture™ LP device was shown to be biocompatible per ISO 10993 testing.

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Sterilization and Shelf Life

The packaged Capture™ LP Revascularization device will be sterilized using a validated gamma irradiation sterilization cycle. The sterilization cycle has been validated to ensure a sterility assurance level (SAL) of 10 ° in accordance with ISO 11137-1/-2, Sterilization of health care products - Radiation sterilization - Substantiation of 25 kGy as a sterilization dose - Method VDmax25.

Aging studies for the Capture™ LP Revascularization Device have established the product and packaging remain functional and maintain sterility for up to 2 years. Aging studies for packaging integrity (per ASTM F2096-11), seal strength and device functionality were performed and met all acceptance criteria.

Biocompatibility

Biocompatibility testing for the Capture™ LP Revascularization Device was conducted to conform with FDA consensus standard, recognition number 2-156, AAMI/ANSI/ISO 10993-1:2009, Biological evaluation of medical devices – Part 1: Evaluation and testing within a risk management process. The table below summarizes the biocompatibility testing performed on the Capture™ LP device.

TestResultConclusion
Cytotoxicity - L929
MEM ElutionThe test article scored a "0" (no cytotoxic
reaction) at 24, 48, and 72±4 hoursNon -cytotoxic
Klingman Maximization
TestNo animal challenged with the test article
extracts were observed with a sensitization
response greater than "0."Non-sensitizer
Intracutaneous Injection
TestThe differences between the mean test and
control scores of the extract dermal
observations were less than 1.0Non-irritant
Acute Systemic Injection
Test – ISONone of the animals injected with the test
article extract show a significantly greater
biological reaction than animals treated with
the control extract vehicle.Not systemically toxic
Rabbit Pyrogen TestThe difference between the individual
rabbit's maximum temperature and
baseline temperature was ≤0.5°C.Non-pyrogenic
Complement Activation
C3a and SC5b-9Test article and control devices exhibited
similar activation respective of the
normalized C3a and SC5b concentration
produced by CVFLevels of the compliments
C3a and SC5b complements
were similar for Capture LP
and control device
Hemolysis: Direct
Contact/ExtractThe blood had a plasma free hemoglobin
level of 0.9455 mg/ml.Non-hemolytic
In Vitro
Hemocompatibility/
Platelet and LeukocyteThe mean of the three readings for the
reference material, negative control,
comparison and test articles were withinNo adverse effect on platelet
and leukocyte counts

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TestResultConclusion
Count±25% of the respective average values±25% of the respective average values
Partial Thromboplastin
TimeThe mean clotting time values for the test
article were 90% of the negative control.No adverse effect on
prothrombin coagulation
time of human plasma.
Thrombosis (In Vivo) –
2 dogImplantation of the test and control
devices in the jugular veins resulted in no
adverse effects or clinical signsThe Capture LP device and
control device have similar
thromboresistance
characteristics
Reverse Mutation Assay
(Ames)None of the tester strains shoes an increase
in reversion rates when treated with the
test articleNon-mutagenic
In Vitro Mouse
Lymphoma Assay with
Extended TreatmentThe mutant frequencies and cloning
efficiencies of preparations treated with
the test article were within the limits
defined for a negative response.Non-mutagenic
In Vivo Mouse
Micronucleus AssayThere were no biologically significant
increases in mPCE production in the test
article treated groups.Non-mutagenic

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Performance Data – Bench

A summary of the pre-clinical bench testing performed for the Capture™ LP Revascularization device is presented in the table below.

TestMethodConclusions
Total LengthThe total length of the device
was measured from distal tip to
proximal wireAll devices met acceptance
criteria.
Delivery and Re-sheathing Force
TestingDelivery and re-sheathing force
were tested during simulated use
in a representative tortuous
anatomical modelDelivery and re-sheathing force
testing met acceptance criteria.
Delivery and re-sheathing force
same as predicate.
Durability TestingDevice was evaluated for
delivery and withdrawal beyond
the recommended number of
passes and re-sheathings
recommended in the IFU.Devices demonstrated no damage
after delivery and withdrawal.
Durability same as predicate.
Differential Scanning
Calorimetry (DSC) TestingAf Temperature measured using
DSC testing per ASTM F2004-
05The transformational temperature
is lowered as the size of the
device increases.
Kink Resistance TestingDevice was delivered through a
bend in a fixture of known radius
and then inspected in-place for
any kinks or poor wall
apposition.Device was resistant to kinking
around small radii turns. Kink
radii smaller than predicate due
to smaller device size.
System Tensile TestingFully assembled devices were
tested to failure and peak tensile
strength recorded.System tensile testing met
acceptance criteria. System
tensile strength same as
predicate.
Markercoil Tensile Strength
TestingDevice was tested to determine
the tensile strength of the bonds
of the distal radiopaque markersThe tensile strength of the distal
radiopaque markers met
acceptance criteria. The
markercoil tensile strength same
as predicate.
Torque Strength TestingDevice was torqued in a
representative tortuous model to
determine number of rotations to
separate deviceTorque strength testing met
acceptance criteria. Torque
strength same as predicate.
TestMethodConclusions
Radial Force TestingRadial force testing performed on
device within recommended
vessel diameters specified in
IFU.Radial force testing of the
Capture™ LP device is
comparable to the predicate
device for the recommended
vessel diameters specified in
IFU.
RadiopacityAngiography of device taken in
porcine model.Radiopacity of Capture™ LP
device equivalent to that of the
predicate device.
Performance Test (Clot Retrieval
Bench Test)Device was delivered through a
tortuous anatomical model to
evaluate the effectiveness of the
device to retrieve soft and hard
clots of various lengths and
diametersCapture™ LP device restored
distal blood flow 100% of the
time. Performance testing better
than predicate device.
Physician Usability TestingThe device was delivered in a
tortuous benchtop model to assess
the users' ability reliably deploy and
use the neurothrombectomy device.Capture™ LP rated similar to the
predicate device when used
with the Rebar-14 microcatheter.

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Performance Data - Animal

An acute animal study was performed that assessed usability, effectiveness, and safety of the Capture™ LP device as compared to the predicate device. A total of six swine were evaluated for usability effectiveness and safety. Effectiveness was measured by placing manufactured clot in the animal pharyngeal artery and assessing the ability of the device to retrieve the clot and restore blood flow to the target vessel. Safety was assessed by passing the device multiple times through the chose vessel and conducting an angiographic and histopathological evaluation. A summary of the study results is presented in the table below.

TestResultConclusion
Successful Clot RetrievalThe device was deployed to retrieve
manufactured clot in the pharyngeal
artery of porcine model.The Capture™ LP device was able
to retrieve the manufactured clot in
all test animals. Clot recovery is the
same as the predicate device.
Sustained Flow (TIMI 2 or 3) In
Clot VesselAfter clot retrieval, blood flow to the
target vessel and distal vasculature
was assessed.Blood flow was assessed with a
TIMI score of 2 or 3 for all vessels
where the Capture™ LP device was
used to retrieve clot. Blood flow
restoration the same as that for the
predicate device.

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Average Number of Passes for ClotThe number of passes toThe number of passes for the
Retrievalsuccessfully retrieve clot wasCapture™ LP to successfully
evaluated.retrieve clot from the target vessels
is equivalent to that of the predicate
device.

The histological findings observed for both the Capture™ LP and the predicate devices demonstrated that the artery response to neurothrombectomy was comparable between the two devices.

30-day and 90-day chronic animal studies were performed to evaluate the usability and safety of the Capture™ LP device. In each study, the device was deployed and recovered in the vasculature of the swine test subjects and angiographic and histopathologic assessments were performed for vessel damage, thrombus formation, and vasospasm. Angiographic visualization during the procedure and just prior to subject sacrifice demonstrated that there was no wall damage or thrombus formation during the treatment. Histopathologic evaluation demonstrated that the artery response to the neurothrombectomy procedure was considered to be comparable between the Capture™ LP device and the predicate device.

Performance Testing - Clinical

Substantial equivalence of the Capture™ LP Revascularization Device has been established to the predicate device through the results of bench and animal testing. Equivalence has also been established through an evaluation of the indications for use, performance specifications, packaging, and the fundamental scientific technology. Therefore, clinical data is not required for the Capture™ LP device.