K Number
K142654
Manufacturer
Date Cleared
2014-10-28

(40 days)

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

The Fortrex 0.035" OTW PTA Balloon Catheter is intended to dilate stenoses in the iliac, femoral, popliteal, infra-popliteal, and renal arteries, and for the treatment of obstructive or synthetic arteriovenous dialysis fistulae. This device is also indicated for stent post-dilatation in the peripheral vasculature.

Device Description

The Fortrex™ 0.035" PTA Balloon Catheter (Fortrex Catheter) is an over the wire (OTW) 0.035"dual lumen catheter with a distally mounted semi-compliant inflatable balloon and an atraumatic tapered tip. The manifold includes a lumen marked "THRU". This is the central lumen of the catheter, which terminates at the distal tip. This lumen is used to pass the catheter over a guidewire with a maximum diameter of 0.035". The lumen marked "BALLOON" is the balloon inflation lumen, which is used to inflate and deflate the balloon with a mixture of contrast medium and saline solution. The balloon has two radiopague markers for positioning the balloon relative to the stenosis. The radiopaque marker bands indicate the dilating or working section of the balloon.

The Fortrex Catheter is available with balloon diameters 4.0 mm to 12.00 mm, balloon lengths 20 mm, 40 mm, 80 mm, and 100 mm and with shaft lengths of 40 cm, 80 cm, and 135 cm.

AI/ML Overview

This document is a 510(k) summary for the Fortrex™ 0.035" OTW PTA Balloon Catheter, which is a medical device intended to dilate stenoses in various arteries and for stent post-dilatation in the peripheral vasculature. The summary outlines the device's characteristics, its similarities to predicate devices, and the performance testing conducted to demonstrate substantial equivalence.

Here's an analysis of the provided text in response to your questions:

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

The document states: "The Fortrex catheter met all acceptance criteria for the performance testing. The results from these tests demonstrate that the technological characteristics and performance criteria of the Fortrex Catheter are comparable to the predicate EverCross Catheter and that the Fortrex Catheter performs in a manner equivalent to the predicate EverCross device currently on the market."

However, specific quantitative acceptance criteria values are not provided, nor are the numerical results for each test. The table below lists the performance tests conducted, but without the specific criteria or reported performance data.

Performance TestAcceptance Criteria (Not specified)Reported Device Performance (Not specified quantitatively)
Balloon Dimensional VerificationMet acceptance criteriaMet all acceptance criteria
Balloon Rated Burst PressureMet acceptance criteriaMet all acceptance criteria
Minimum Balloon Burst StrengthMet acceptance criteriaMet all acceptance criteria
Balloon FatigueMet acceptance criteriaMet all acceptance criteria
Balloon ComplianceMet acceptance criteriaMet all acceptance criteria
Catheter Dimensional VerificationMet acceptance criteriaMet all acceptance criteria
Inflation / Deflation TimeMet acceptance criteriaMet all acceptance criteria
Wire MovementMet acceptance criteriaMet all acceptance criteria
RadiopacityMet acceptance criteriaMet all acceptance criteria
Device TrackingMet acceptance criteriaMet all acceptance criteria
Insertion ForceMet acceptance criteriaMet all acceptance criteria
Balloon Pull-back ForceMet acceptance criteriaMet all acceptance criteria
Reinsertion ForceMet acceptance criteriaMet all acceptance criteria
Torque StrengthMet acceptance criteriaMet all acceptance criteria
Tensile StrengthMet acceptance criteriaMet all acceptance criteria
KinkMet acceptance criteriaMet all acceptance criteria
Marker Band to Balloon BodyMet acceptance criteriaMet all acceptance criteria
Biocompatibility (ISO 10993-1)Met acceptance criteriaMet all acceptance criteria
- CytotoxicityMet acceptance criteriaMet all acceptance criteria
- SensitizationMet acceptance criteriaMet all acceptance criteria
- Intracutaneous reactivityMet acceptance criteriaMet all acceptance criteria
- Acute systemic toxicityMet acceptance criteriaMet all acceptance criteria
- HemolysisMet acceptance criteriaMet all acceptance criteria
- PyrogenMet acceptance criteriaMet all acceptance criteria
- Complement activationMet acceptance criteriaMet all acceptance criteria
- ThromboresistanceMet acceptance criteriaMet all acceptance criteria
- Partial thromboplastin timeMet acceptance criteriaMet all acceptance criteria
- Platelet/leukocyte countsMet acceptance criteriaMet all acceptance criteria
- MutagenicityMet acceptance criteriaMet all acceptance criteria
- LymphomaMet acceptance criteriaMet all acceptance criteria
- Micronucleus assayMet acceptance criteriaMet all acceptance criteria

2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)

The document lists performance tests but does not specify the sample sizes used for each test. It also does not provide information on the data provenance in terms of country of origin or whether the study was retrospective or prospective. The study appears to be an internal bench testing and biocompatibility testing conducted by the manufacturer, Covidien llc.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g., radiologist with 10 years of experience)

This document describes performance testing of a medical device (PTA balloon catheter), not a diagnostic algorithm that requires expert-established ground truth from medical images or clinical data. Therefore, this question is not applicable to the type of study presented here. The "ground truth" for these tests would be established by validated test methods and reference standards.

4. Adjudication method (e.g. 2+1, 3+1, none) for the test set

Not applicable, as this is bench and biocompatibility testing of a physical device, not an assessment requiring human adjudication of results.

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 pertains to the 510(k) clearance of a physical medical device (balloon catheter), not an AI/software device that would involve human readers or AI assistance.

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

Not applicable. This document is about a physical medical device, not an algorithm.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)

For the performance tests:

  • Bench Testing: The "ground truth" is established by the specifications and validated test methods for a medical device (e.g., burst pressure measured by a pressure gauge, dimensions measured by calibrated instruments).
  • Biocompatibility Testing: The "ground truth" is established by the accepted standards and protocols defined in ISO 10993-1, using biological assays and analytical methods.

8. The sample size for the training set

Not applicable. This is not an AI/machine learning study, so there is no training set.

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

Not applicable. There is no training set for this type of device study.

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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized depiction of an eagle with three profiles of human faces incorporated into its design. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the eagle.

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

October 29, 2014

Covidien llc. c/o Mark Job Regulatory Technical Services LLC 1394 25th Street NW Buffalo, MN 55313

Re: K142654

Trade/Device Name: Fortrex 0.035" OTW PTA Balloon Catheter Regulation Number: 21 CFR 870.1250 Regulation Name: Percutaneous catheter Regulatory Class: Class II Product Code: LIT Dated: September 16, 2014 Received: September 18, 2014

Dear Mr. Job:

This letter corrects our substantially equivalent letter of October 28, 2014.

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

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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 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" (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 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,

Kenneth J. Cavanaugh -S

for

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

Enclosure

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Indications for Use

510(k) Number (if known)

K142654

Device Name

Fortrex™ 0.035" OTW PTA Balloon Catheter

Indications for Use (Describe)

The Fortrex 0.035" OTW PTA Balloon Catheter is intended to dilate stenoses in the iliac, femoral, popliteal, infra-popliteal, and renal arteries, and for the treatment of obstructive or synthetic arteriovenous dialysis fistulae. This device is also indicated for stent post-dilatation in the peripheral vasculature.

Type of Use (Select one or both, as applicable)

2 Prescription Use (Part 21 CFR 801 Subpart D)

__ Over-The-Counter Use (21 CFR 801 Subpart C)

PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON A SEPARATE PAGE IF NEEDED.

FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

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510(k) Summary

Fortrex™ 0.035" OTW PTA Balloon Catheter

This 510(k) summary is being submitted in accordance with the requirements of 21 C.F.R § 807.92.

1. Submitter Information

ApplicantCovidien llc4600 Nathan Lane NPlymouth, MN 55441-2651Tel: 763-398-7000Fax: 763-591-3248
Contact PersonRupali GuptaSenior Regulatory Affairs Specialist
Date PreparedAugust 25, 2014

2. Subject Device

Device Trade NameFortrex TM 0.035" OTW PTA Balloon Catheter
Device Common NamePTA Dilatation Catheter
Classification NameCatheter, Angioplasty, Peripheral, Transluminal (21 CFR§870.1250, Product Code LIT
Classification PanelCardiovascular

3. Predicate Devices

Device Trade NameEverCross TM .035” OTW PTA Dilatation Catheter (Primary Predicate)
510(k) NumberK103322, K110319
510(k) Clearance DateDecember 06, 2010, April 14, 2011
Device Trade NameMustangTM Balloon Dilatation Catheter
510(k) NumberK103751
510(k) Clearance DateMarch 22, 2011

4. Device Description

The Fortrex™ 0.035" PTA Balloon Catheter (Fortrex Catheter) is an over the wire (OTW) 0.035"dual lumen catheter with a distally mounted semi-compliant inflatable balloon and an atraumatic tapered tip. The manifold includes a lumen marked "THRU". This is the central lumen of the catheter, which terminates at the distal tip. This lumen is used to pass the catheter over a guidewire with a maximum diameter of 0.035". The lumen marked "BALLOON" is the

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Fortrex™ 0.035" OTW PTA Balloon Catheter 510(k) Summary

Image /page/4/Picture/1 description: The image contains the word "COVIDIEN" in a sans-serif font. To the left of the word is a blue square with a lighter blue cross shape in the center. The word "COVIDIEN" is in a dark blue color. The image appears to be a logo or branding element.

balloon inflation lumen, which is used to inflate and deflate the balloon with a mixture of contrast medium and saline solution. The balloon has two radiopague markers for positioning the balloon relative to the stenosis. The radiopaque marker bands indicate the dilating or working section of the balloon.

The Fortrex Catheter is available with balloon diameters 4.0 mm to 12.00 mm, balloon lengths 20 mm, 40 mm, 80 mm, and 100 mm and with shaft lengths of 40 cm, 80 cm, and 135 cm.

5. Indications for Use

The Fortrex™ 0.035" OTW PTA Balloon Catheter is intended to dilate stenoses in the iliac, femoral, ilio-femoral, popliteal, infra-popliteal, and renal arteries, and for the treatment of obstructive lesions of native or synthetic arteriovenous dialysis fistulae. This device is also indicated for stent post-dilatation in the peripheral vasculature.

Comparison of Technological Characteristics 6.

The proposed Fortrex Catheter uses very similar design and materials as the primary predicate EverCross Catheter. Modifications have been made to the proposed Fortrex device design and materials to improve performance of the balloon through higher burst pressure and improved joint strength and integrity. The Fortrex Catheter shares the following similarities to the predicate devices:

  • Similar fundamental scientific technology
  • . Same operating principle
  • . Similar balloon lengths
  • . Similar rated burst pressure

Additionally, the indications for use, device materials, and manufacturing site and methods are similar between the proposed Fortrex Catheter and the predicate EverCross Catheter.

7. Performance Testing Summary

To demonstrate substantial equivalence of the proposed Fortrex Catheter to the predicate EverCross device, bench testing and biocompatibility testing was performed. Results from these testing provide assurance that the proposed device has been designed and tested to assure conformance to the requirements for its intended use. Using internal Risk Analysis procedures, the following performance tests were performed:

Balloon Dimensional VerificationDevice Tracking
Balloon Rated Burst PressureInsertion Force
Minimum Balloon Burst StrengthBalloon Pull-back Force
Balloon FatigueReinsertion Force
Balloon ComplianceTorque Strength
Catheter Dimensional VerificationTensile Strength
Inflation / Deflation TimeKink
Wire MovementMarker Band to Balloon Body
Radiopacity

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Fortrex™ 0.035'' OTW PTA Balloon Catheter 510(k) Summary

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The Fortrex Catheter was tested for biocompatibility per ISO 10993-1 for short duration contact with blood (<24 hours). The testing included cytotoxicity, sensitization, intracutaneous reactivity, acute systemic toxicity, hemolysis, pyrogen, complement activation, thromboresistance, partial thromboplastin time, platelet/leukocyte counts, mutagenicity, lymphoma and micronucleus assay.

The Fortrex catheter met all acceptance criteria for the performance testing. The results from these tests demonstrate that the technological characteristics and performance criteria of the Fortrex Catheter are comparable to the predicate EverCross Catheter and that the Fortrex Catheter performs in a manner equivalent to the predicate EverCross device currently on the market.

8. Conclusions

Based on the intended use, technological characteristics, safety and performance testing included in this submission, Covidien considers the proposed Fortrex Catheter to be substantially equivalent to the currently marketed EverCross™ .035" OTW PTA Dilatation Catheter (K103322, K110319) and Mustang™ Balloon Dilatation Catheter (K103751).

§ 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).