K Number
K151153
Device Name
Pirouette 018
Manufacturer
Date Cleared
2015-08-20

(112 days)

Product Code
Regulation Number
870.1250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Pirouette 018 is intended for balloon dilation of the iliac, femoral, poplitean and renal arteries.
Device Description
Percutaneous Transluminal Angioplasty Catheter (PTA Catheter).
More Information

Not Found

No
The summary describes a standard balloon dilation catheter and does not mention any AI or ML capabilities, image processing, or data-driven features. The performance studies are focused on physical and biological properties, not algorithmic performance.

Yes
The device performs "balloon dilation" of arteries, which is a therapeutic intervention to treat conditions like stenosis (narrowing of vessels).

No

Explanation: The device is described as a "Percutaneous Transluminal Angioplasty Catheter (PTA Catheter)" and its intended use is for "balloon dilation of the iliac, femoral, popliteal and renal arteries." This indicates a therapeutic, not diagnostic, function.

No

The device description clearly states it is a "Percutaneous Transluminal Angioplasty Catheter (PTA Catheter)", which is a physical medical device. The performance studies also detail extensive non-clinical tests related to the physical properties and performance of a catheter, not software.

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

Here's why:

  • Intended Use: The intended use is "balloon dilation of the iliac, femoral, popliteal and renal arteries." This describes a therapeutic procedure performed directly on the patient's body to treat a condition.
  • Device Description: It is described as a "Percutaneous Transluminal Angioplasty Catheter (PTA Catheter)." This is a type of medical device used for interventional procedures within blood vessels.
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing samples (blood, urine, tissue, etc.)
    • Providing diagnostic information
    • Using reagents or assays

IVDs are devices used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device is used for a therapeutic intervention, not for analyzing samples to provide diagnostic information.

N/A

Intended Use / Indications for Use

Pirouette 018 is intended for balloon dilation of the iliac, femoral, popliteal and renal arteries.

Product codes (comma separated list FDA assigned to the subject device)

LIT

Device Description

Percutaneous Transluminal Angioplasty Catheter (PTA Catheter).

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

iliac, femoral, popliteal and renal arteries.

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 (study type, sample size, AUC, MRMC, standalone performance, key results)

Non-Clinical Tests:

  • Dimensional verification
  • Balloon preparation, pushability, trackability, deployment,withdrawal and balloon reinsertion
  • Balloon rated burst pressure (RBP)
  • Balloon fatigue (repeated balloon inflations)
  • Balloon Compliance at nominal and rated burst inflation pressure
  • Balloon Inflation/Deflation Time
  • Catheter Bond Strength (Tip to balloon, balloon to proximal shaft, shaft to manifold)
  • Flexibility and Kink test
  • Torque Strength
  • Radiopacity
  • Coating Integrity
  • Particulate evaluation
  • Guide wire compatibility
  • Introducer sheath compatibility
    The results showed that the Pirouette 018 met the pre-determined acceptance criteria.

Biocompatibility Tests:

  • MTT Cytotoxicity Study
  • ISO Maximization Sensitization Study
  • ISO Intracutaneous Study
  • ISO Systemic Toxicity Study
  • ASTM Hemolysis
  • C3a Complement Activation Assay
  • SC5b-9 Complement Activation Assay
  • ASTM Partial Thromboplastin Time
  • In Vivo Thromboresistance Study Jugular Vein
  • Pyrogenicity
    The test results show that the Pirouette 018 is biocompatible.

Sterilization, Shelf life tests and Packaging validation:

  • EtO sterilzation validation
  • EtO/ECH residue determination
  • Shelf life testing
  • Packaging validation
    Test results show that the Pirouette 018 is sterily is maintained by the packaging during the entire shelf life of the device. From the results it was also concluded that the device meets the criteria for Residual Testing, i.e. EtO/ECH residues.

Clinical Performance Data:

  • No clinical studies were performed for the purpose of obtaining safety and effectiveness data.
  • The Pirouette 018 has been approved for marketing in the European Union (CE certified) in 2014. and has been marketed in the EU for since then.

Conclusion:
The performance testing presented above establishes that the Pirouette 018 is as safe and effective for its intended use as the predicate device. The comparison tabulated above demonstrates that the Pirouette 018 device is substantially equivalent to the predicate devices.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K112335/K093139, K133843

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

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 U.S. Department of Health & Human Services. The logo is a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized image of three human profiles facing to the right, overlapping each other to create a sense of depth and connection.

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

August 20, 2015

ArraVasc Limited c/o Jan-Paul van Loon Qserve Group US Inc. P.O Box 940 Charlestown, NH 03603

Re: K151153

Trade/Device Name: Pirouette 018 Regulation Number: 21 CFR 870.1250 Regulation Name: Percutaneous Catheter Regulatory Class: Class II Product Code: LIT Dated: July 9, 2015 Received: July 13, 2015

Dear Jan-Paul van Loon:

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

1

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 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/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 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) K151153

Device Name Pirouette 018

Indications for Use (Describe)

Pirouette 018 is intended for balloon dilation of the iliac, femoral, popliteal and renal arteries.

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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510(k) Summary

1. Submitter

| Submitter Address: | ArraVasc Limited
2 Ballybrit Business Park,
Galway
Ireland |
|--------------------|---------------------------------------------------------------------|
| Phone Number: | +353-91-758939 |
| Fax Number: | +353-91-758930 |
| Contact Person: | Máiréad McCaffrey |
| Date Prepared: | 15 April 2015 |

2. Device

Device Trade Name:Pirouette 018
Common Name:OTW PTA catheter
Classification Name:Peripheral Transluminal Angioplasty Catheter
Classification number:21 CFR 870.1250
Product code:LIT
Class:II
Classification Panel:Cardiovascular

3. Predicate Devices

| Primary predicate: | Bantam and Bantam OTW PTA Catheter
Clearstream Technologies Ltd.
510(K) number: K112335/K093139 |
|----------------------|-------------------------------------------------------------------------------------------------------|
| Secondary predicate: | SABER IM PTA Dilation Catheter
Cordis Corporation
510(K) number: K133843 |

4. Device Description

Physical Description: Percutaneous Transluminal Angioplasty Catheter (PTA Catheter).

4

5. Indication for use

| Indications for Use | Pirouette 018 is intended for balloon dilation of the iliac, femoral,
popliteal, infra-popliteal and renal arteries. |
|---------------------|-------------------------------------------------------------------------------------------------------------------------|
| Statement: | |

6. Comparison of technological characteristics with the predicate device

| Summary of
Technological
Characteristics | The Pirouette 018 incorporates
substantially equivalent design, packaging, fundamental technology,
materials, manufacturing, sterilization and intended use as those
featured in the primary predicate Bantam and Bantam OTW PTA
catheters and contains a hydrophilic coating substantially equivalent to
the secondary predicate SABERTM PTA catheter. |

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Table 1 Summary of general and technical characteristics against the predicate devices.

ParameterCharacteristics
ClassificationClass II, 21 CFR 870.1250
Same Classification as predicate devices.
Intended UseSame intended use of balloon dilatation of the femoral, popliteal and
infra-popliteal arteries with additional vessels; iliac and renal indicated.
Balloon materialSame type of material
Balloon diameterSame range of balloon diameters: 2 - 9 mm
Balloon lengthComparable range of balloon lengths: 20 - 300mm
Nominal pressure (atm)Same or higher nominal pressure: 8 atm.
Rated burst pressureComparable rated burst pressure: 16atm (2.0-5.0mm balloon
(atm)diameter) / 14atm (6.0mm balloon diameter) / 12atm( 7.0-9.0mm
balloon diameter)
RadiopaqueTwo Markerbands, one at distal and one at proximal side of the
Marker bandsballoon, with the same function.
Outer shaftSame type material
Catheter shaftSame diameter or lower: 3.6 . 4.2 Fr
outer diameter
Catheter UsableComparable range of usable lengths: 45 - 150cm
Lengths (cm)
RecommendedComparable size or lower: 4 . 5 Fr
Introducer Sheath
compatibility
RecommendedSame compatibility; maximum 0.018+
Guidewire diameter
Catheter strain relief &Same type of material, with the same function.
manifold material
Catheter manifoldSame design, dual lumen Y design, with the same function.
design
Catheter coatingSimilar type of coating.
Sterilization MethodSame method; Ethylene Oxide.
Single Use / ReusableSingle Use

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7. Performance Data

The Pirouette 018 was thoroughly tested on the bench to evaluate and verify that it meets the required performance specifications and to support a determination of substantial equivalence. The bench testing plan was developed with the consideration of the recommendations outlined in the applicable FDA quidance documents, tests recommended in ISO 10555-1. Intravascular catheters- Sterile and single-use catheters - Part 1: General Requirements, and 10555-4, Intravascular catheters- Sterile and single-use catheters - Part 4: Balloon dilatation catheters. Testing performed on the Pirouette included the following:

Non-Clinical Tests:

  • Dimensional verification
  • Balloon preparation, pushability, trackability, deployment,withdrawal and balloon reinsertion ●
  • Balloon rated burst pressure (RBP) ●
  • Balloon fatigue (repeated balloon inflations) .
  • Balloon Compliance at nominal and rated burst inflation pressure
  • . Balloon Inflation/Deflation Time
  • Catheter Bond Strength (Tip to balloon, balloon to proximal shaft, shaft to manifold)
  • Flexibility and Kink test ●
  • Torque Strength ●
  • Radiopacity .
  • Coating Integrity ●
  • . Particulate evaluation
  • . Guide wire compatibility
  • Introducer sheath compatibility

The results showed that the Pirouette 018 met the pre-determined acceptance criteria.

Biocompatibility Tests:

Per ISO10993-1:2009, Biological evaluation of medical devices-Part 1: Evaluation and testing within a risk management process, the Pirouette 018 is classified as an externally communicating device, which contacts circulating blood during a limited contact duration (m24hours). Biocompatibility testing conducted on Pirouette 018 per ISO 10993-1:2009 included the following:

  • . MTT Cytotoxicity Study
  • ISO Maximization Sensitization Study ●
  • ISO Intracutaneous Study ●
  • ISO Systemic Toxicity Study ●
  • ASTM Hemolysis
  • C3a Complement Activation Assay .
  • SC5b-9 Complement Activation Assay ●
  • ASTM Partial Thromboplastin Time ●
  • In Vivo Thromboresistance Study Jugular Vein ●
  • . Pyrogenicity

The test results show that the Pirouette 018 is biocompatible.

6

Sterilization, Shelf life tests and Packaging validation:

  • . EtO sterilzation validation
  • . EtO/ECH residue determination
  • . Shelf life testing
  • . Packaging validation

Test results show that the Pirouette 018 is sterily is maintained by the packaging during the entire shelf life of the device. From the results it was also concluded that the device meets the criteria for Residual Testing, i.e. EtO/ECH residues.

Clinical Performance Data:

  • No clinical studies were performed for the purpose of obtaining safety and effectiveness data. .
  • The Pirouette 018 has been approved for marketing in the European Union (CE certified) in 2014. . and has been marketed in the EU for since then.

8. Conclusions

The performance testing presented above establishes that the Pirouette 018 is as safe and effective for its intended use as the predicate device. The comparison tabulated above demonstrates that the Pirouette 018 device is substantially equivalent to the predicate devices.

Information contained within this submission demonstrates that the Pirouette 018:

  • . Has legally marketed predicate devices;
  • Has identical indications for use as the identified primary predicate devices; ●
  • Incorporates the same fundamental technology, and uses accepted scientific methods and international standards to evaluate device safety and effectiveness;
  • Demonstrates that the design and performance of the Pirouette 018 has equivalent safety and performance characteristics of predicate devices, and does not raise different questions of safety and effectiveness.

Based upon the; intended use, design, performance characteristics, non-clinical performance testing performed, and comparison to legally marketed devices, it is concluded that the Pirouette 018 is appropriate for its intended use, and is substantially equivalent to the predicate devices.