K Number
K183022
Device Name
Solitaire 4 Revascularization Device
Date Cleared
2019-01-29

(89 days)

Product Code
Regulation Number
882.5600
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
1. The Solitaire™ Revascularization Device is indicated for use to restore blood flow in the neurovasculature by removing thrombus for the treatment of acute ischemic stroke to reduce disability in patients with a persistent, proximal anterior circulation, large vessel occlusion, and smaller core infarcts who have first received intravenous tissue plasminogen activator (IV t-PA). Endovascular therapy with the device should be started within 6 hours of symptom onset. 2. The Solitaire™ Revascularization Device is indicated 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 IV t-PA or who fail IV t-PA therapy are candidates for treatment.
Device Description
The Solitaire™ 4 Revascularization Device is designed to restore blood flow in patients experiencing ischemic stroke due to large intracranial vessel occlusion. The Solitaire™ 4 Revascularization Device is designed for use in the neurovasculature such as the Internal Carotid Artery (ICA), M1 and M2 segments of the middle cerebral artery, basilar, and the vertebral arteries. The distal nitinol portion of the Solitaire™ 4 Revascularization Device facilitates clot retrieval and has Platinum/Iridium radiopaque markers on the proximal and distal ends. The Solitaire™ 4 Revascularization Device also features radiopaque markers along the circumference of the working length of the device. The devices are supplied sterile and are intended for single-use only.
More Information

No
The device description and performance studies focus on the mechanical aspects of a revascularization device for stroke treatment, with no mention of AI or ML capabilities.

Yes
The device is indicated for restoring blood flow by removing thrombus in acute ischemic stroke patients, which is a direct therapeutic action to improve patient health.

No

The device description indicates that the Solitaire™ 4 Revascularization Device is designed to restore blood flow by removing thrombus, which is a therapeutic action, not a diagnostic one.

No

The device description clearly states it is a physical device made of nitinol with radiopaque markers, designed for mechanical clot retrieval. It is 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 Solitaire™ Revascularization Device is a physical device used inside the body (in the neurovasculature) to mechanically remove blood clots. It does not analyze biological specimens.
  • Intended Use: The intended use is to restore blood flow by removing thrombus, a physical intervention, not a diagnostic test performed on a sample.

The description clearly indicates it's a medical device used for a therapeutic procedure within the patient's body.

N/A

Intended Use / Indications for Use

  1. The Solitaire™ Revascularization Device is indicated for use to restore blood flow in the neurovasculature by removing thrombus for the treatment of acute ischemic stroke to reduce disability in patients with a persistent, proximal anterior circulation, large vessel occlusion, and smaller core infarcts who have first received intravenous tissue plasminogen activator (IV t-PA). Endovascular therapy with the device should be started within 6 hours of symptom onset.
  2. The Solitaire™ Revascularization Device is indicated 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 IV t-PA or who fail IV t-PA therapy are candidates for treatment.

Product codes

POL, NRY

Device Description

The Solitaire™ 4 Revascularization Device is designed to restore blood flow in patients experiencing ischemic stroke due to large intracranial vessel occlusion. The Solitaire™ 4 Revascularization Device is designed for use in the neurovasculature such as the Internal Carotid Artery (ICA), M1 and M2 segments of the middle cerebral artery, basilar, and the vertebral arteries. The distal nitinol portion of the Solitaire™ 4 Revascularization Device facilitates clot retrieval and has Platinum/Iridium radiopaque markers on the proximal and distal ends. The Solitaire™ 4 Revascularization Device also features radiopaque markers along the circumference of the working length of the device. The devices are supplied sterile and are intended for single-use only.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

neurovasculature, Internal Carotid Artery (ICA), M1 and M2 segments of the middle cerebral artery, basilar, and the vertebral arteries, large intracranial vessel

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

Bench tests were performed.
Test: Total System Length, Fluorosafe Marker Length, Delivery Force, Re-Sheathing Force, Particulate, Durability, System Tensile, Torque, Marker Tensile.
Results: Acceptance criteria met for all tests.
No animal or clinical testing was performed.

Key Metrics

Not Found

Predicate Device(s)

K181186

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 882.5600 Neurovascular mechanical thrombectomy device for acute ischemic stroke treatment.

(a)
Identification. A neurovascular mechanical thrombectomy device for acute ischemic stroke treatment is a prescription device used in the treatment of acute ischemic stroke to improve clinical outcomes. The device is delivered into the neurovasculature with an endovascular approach, mechanically removes thrombus from the body, and restores blood flow in the neurovasculature.(b)
Classification. Class II (special controls). The special controls for this device are:(1) The patient contacting components of the device must be demonstrated to be biocompatible.
(2) Non-clinical performance testing must demonstrate that the device performs as intended under anticipated conditions of use, including:
(i) Mechanical testing to demonstrate the device can withstand anticipated tensile, torsional, and compressive forces.
(ii) Mechanical testing to evaluate the radial forces exerted by the device.
(iii) Non-clinical testing to verify the dimensions of the device.
(iv) Non-clinical testing must demonstrate the device can be delivered to the target location in the neurovasculature and retrieve simulated thrombus under simulated use conditions.
(v) Non-clinical testing must demonstrate the device is radiopaque and can be visualized.
(vi) Non-clinical testing must evaluate the coating integrity and particulates under simulated use conditions.
(vii) Animal testing must evaluate the safety of the device, including damage to the vessels or tissue under anticipated use conditions.
(3) Performance data must support the sterility and pyrogenicity of the patient contacting components of the device.
(4) Performance data must support the shelf-life of the device by demonstrating continued sterility, package integrity, and device functionality over the specified shelf-life.
(5) Clinical performance testing of the device must demonstrate the device performs as intended for use in the treatment of acute ischemic stroke and must capture any adverse events associated with the device and procedure.
(6) The labeling must include:
(i) Information on the specific patient population for which the device is intended for use in the treatment of acute ischemic stroke, including but not limited to, specifying time from symptom onset, vessels or location of the neurovasculature that can be accessed for treatment, and limitations on core infarct size.
(ii) Detailed instructions on proper device preparation and use for thrombus retrieval from the neurovasculature.
(iii) A summary of the clinical testing results, including a detailed summary of the device- and procedure-related complications and adverse events.
(iv) A shelf life.

0

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January 29, 2019

Micro Therapeutics, Inc. d/b/a ev3 Neurovascular Helen Chow, PhD, RAC Senior Specialist. Regulatory Affairs 9775 Toledo Way Irvine, California 92618

Re: K183022

Trade/Device Name: Solitaire™ 4 Revascularization Device Regulation Number: 21 CFR 882.5600 Regulation Name: Neurovascular Mechanical Thrombectomy Device for Acute Ischemic Stroke Treatment Regulatory Class: Class II Product Code: POL. NRY Dated: December 21, 2018 Received: December 26, 2018

Dear Helen Chow:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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

1

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 of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.html; good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerelv.

Image /page/1/Picture/5 description: The image shows the name "Xiaolin Zheng" in a large, clear font. Below the name, there is a "-S" written in a smaller font size. The background of the image is a light blue color, with a faint FDA logo.

for 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) K183022

Device Name Solitaire™ 4 Revascularization Device

Indications for Use (Describe)

  1. The Solitaire™ Revascularization Device is indicated for use to restore blood flow in the neurovasculature by removing thrombus for the treatment of acute ische to reduce disability in patients with a persistent, proximal anterior circulation, large vessel occlusion, and smaller core infarcts who have first received intravenous tissue plasminogen activator (IV t-PA). Endovascular therapy with the device should be started within 6 hours of symptom onset.

  2. The Solitaire™ Revascularization Device is indicated 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 IV t-PA or who fail IV t-PA therapy are candidates for treatment.

X Prescription Use (Part 21 CFR 801 Subpart D)

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

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510(k) Summary - K183022

| 510(k) Owner: | Micro Therapeutics, Inc. d/b/a ev3 Neurovascular
9775 Toledo Way
Irvine, CA 92618
Establishment Registration No. 2029214 |
|---------------------------|-----------------------------------------------------------------------------------------------------------------------------------|
| Contact Person: | Helen Chow
Sr. Specialist, Regulatory Affairs
Telephone: (949) 297-5474
E-mail: helen.h.chow@medtronic.com |
| Date Summary Prepared: | October 30, 2018 |
| Trade Name of Device: | Solitaire™ 4 Revascularization Device |
| Common Name of Device: | Neurovascular Mechanical Thrombectomy Device for Acute
Ischemic Stroke Treatment;
Catheter, Thrombus Retriever |
| Classification of Device: | Class II, 21 CFR 882.5600; 21 CFR 870.1250 |
| Product Code: | POL; NRY |
| Predicate Device: | Solitaire™ Platinum Revascularization Device (K181186) |

Device Description:

The Solitaire™ 4 Revascularization Device is designed to restore blood flow in patients experiencing ischemic stroke due to large intracranial vessel occlusion. The Solitaire™ 4 Revascularization Device is designed for use in the neurovasculature such as the Internal Carotid Artery (ICA), M1 and M2 segments of the middle cerebral artery, basilar, and the vertebral arteries. The distal nitinol portion of the Solitaire™ 4 Revascularization Device facilitates clot retrieval and has Platinum/Iridium radiopaque markers on the proximal and distal ends. The Solitaire™ 4 Revascularization Device also features radiopaque markers along the circumference of the working length of the device. The devices are supplied sterile and are intended for singleuse only.

Indications for Use:

    1. The Solitaire™ Revascularization Device is indicated for use to restore blood flow in the neurovasculature by removing thrombus for the treatment of acute ischemic stroke to reduce disability in patients with a persistent, proximal anterior circulation, large vessel occlusion, and smaller core infarcts who have first received intravenous tissue plasminogen activator (IV t-PA). Endovascular therapy with the device should be started within 6 hours of symptom onset.
    1. The Solitaire™ Revascularization Device is indicated to restore blood flow by removing thrombus from a large intracranial vessel in patients experiencing ischemic stroke within

4

8 hours of symptom onset. Patients who are ineligible for IV t-PA or who fail IV t-PA therapy are candidates for treatment.

Device Comparison:

A comparison of the technological characteristics of the subject Solitaire™ 4 Revascularization Device and the predicate Solitaire™ Platinum Revascularization Device (K181186) is provided in Table 1. The Solitaire™ 4 Revascularization Device is a design modification of the delivery system to Solitaire™ Platinum. Modifying the delivery system allows for all of the sizes (diameters and lengths) of Solitaire™ 4 to fit through a 0.021'' inner diameter microcatheter.

Table 1: Device Comparison
Predicate Solitaire™
Platinum
Revascularization Device
(K181186)Subject Solitaire™ 4
Revascularization
DeviceRationale for Difference
(if applicable)
Indication for
Use1. The Solitaire™
Revascularization Device
is indicated for use to
restore blood flow in the
neurovasculature by
removing thrombus for
the treatment of acute
ischemic stroke to reduce
disability in patients with
a persistent, proximal
anterior circulation, large
vessel occlusion, and
smaller core infarcts who
have first received
intravenous tissue
plasminogen activator
(IV t-PA). Endovascular
therapy with the device
should be started within
6 hours of symptom
onset.
  1. The Solitaire™
    Revascularization Device
    is indicated 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 IV t-PA or
    who fail IV t-PA therapy
    are candidates for
    treatment. | Same | N/A |
    | Principles of
    Operation | The device is used in the
    neurovasculature to restore | Same | N/A |
    | Table 1: Device Comparison | | | |
    | | Predicate Solitaire™
    Platinum
    Revascularization Device
    (K181186) | Subject Solitaire™ 4
    Revascularization
    Device | Rationale for Difference
    (if applicable) |
    | | blood flow for treatment of
    acute ischemic stroke | | |
    | Dimensions and Materials | | | |
    | Device Size(s) | 4-20-05 mm
    4-20-10 mm
    4-40-10 mm
    6-20-10 mm
    6-24-06 mm
    6-40-10 mm | 4-20-05 mm
    4-20-10 mm
    4-40-10 mm
    6-20-10 mm
    6-24-06 mm
    6-40-10 mm | Same |
    | Device
    Materials | Stent: Nitinol
    Pushwire: Nitinol
    Markers: 90% Platinum/
    10% Iridium
    Push-wire shrink Tubing:
    PTFE
    Introducer Sheath:
    PTFE/Grilamid | Same | N/A |
    | Sterilization and Packaging | | | |
    | Packaging
    Materials | Stored within dispenser coil,
    Tyvek pouch, and shipping
    carton. | Stored within dispenser
    coil, Tyvek/Nylon
    pouch, and shipping
    carton. | The pouch is the only
    change in the key packaging
    materials. The Nylon/Tyvek
    pouch maintains sterility for
    the labeled shelf of the
    Solitaire™ 4 device. |
    | Sterilization
    Method | Ethylene Oxide | Same | N/A |
    | How Supplied | Sterile, Single Use | Same | N/A |

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Performance Data:

Biocompatibility:

Solitaire™ 4 does not introduce any new materials into the finished device nor the manufacturing processes. The material of the subject Solitaire™ 4 is identical to the material of the predicate Solitaire™ Platinum (K181186). Therefore, no new biocompatibility evaluations were conducted on the subject device. The prior completed biocompatibility evaluations on the predicate device were used to support the biocompatibility profile of the subject device.

The following non-clinical bench tests were performed to support the Solitaire™ 4 device.

TestTest Method SummaryConclusions
Total System LengthTotal System Length was
measured from the distal tip
of the distal marker to the
proximal tip of the delivery
system.Acceptance criteria met
TestTest Method SummaryConclusions
Fluorosafe Marker LengthFluorosafe marker length
was measured from the
measurement of the length
from the distal tip of the
device to distal end of the
marker.Acceptance criteria met
Delivery ForceDelivery force was
measured through a
representative tortuous
anatomical model.Acceptance criteria met
Re-Sheathing ForceRetrieval force was measured
through a representative
tortuous anatomical model.Acceptance criteria met
ParticulateParticulate was evaluated for
generation under simulated
use in a representative
tortuous anatomical model.Acceptance criteria met
DurabilityDurability was evaluated on
the ability to withstand
simulated use of the device,
including delivery,
resheathing and retrieval in a
representative tortuous model
with the appropriate ancillary
devices.Acceptance criteria met
System TensileFollowing simulated use, the
tensile force testing is
performed to verify the
amount of force it takes to
detach the device meets the
acceptance criteria.Acceptance criteria met
TorqueTorque testing is performed
to verify the stent joint
withstands a minimum of one
rotation on the proximal wire
following simulated use.Acceptance criteria met
Marker TensileMarker tensile strength
testing is performed to verify
the strength of the laser weld
of the Pt/Ir marker coil to
the Nitinol distal finger of
the device.Acceptance criteria met

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Performance Data - Animal, Clinical:

No clinical or animal testing was performed on the subject device because there is no change in the indications for use or the fundamental scientific technology of the device.

Conclusion:

Bench testing confirmed that the modifications to Solitaire™ 4 met product specifications and do not raise new questions on the safety and effectiveness of the device. Additionally, there are no changes to the indications for use or the fundamental scientific technology of the device. Therefore, the subject Solitaire™ 4 Revascularization Device is substantially equivalent to the predicate Solitaire™ Platinum Revascularization Device.