K Number
K190464
Device Name
Penumbra System 3D Revascularization Device
Manufacturer
Date Cleared
2019-04-26

(59 days)

Product Code
Regulation Number
870.1250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Penumbra Reperfusion Catheters and Separators: As part of the Penumbra System, the Reperfusion Catheters and Separators are indicated for use in the revascularization of patients with acute ischemic stroke secondary to intracranial large vessel occlusive disease (within the internal carotid, middle cerebral - M1 and M2 segments, basilar, and vertebral arteries) 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. Penumbra 3D Revascularization Device: As part of the Penumbra System, the Penumbra 3D Revascularization Device is indicated for use in the revascularization of patients with acute ischemic stroke secondary to intracranial large vessel occlusive disease (within the internal carotid, middle cerebral - M1 and M2 segments) 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. Penumbra Aspiration Tubing: As part of the Penumbra System, the Penumbra Sterile Aspiration Tubing is indicated to connect the Penumbra Reperfusion Catheters to the Penumbra Aspiration Pump. Penumbra Aspiration Pump: The Penumbra Aspiration Pump is indicated as a vacuum source for Penumbra Aspiration Systems.
Device Description
The Penumbra System 3D Revascularization Device is designed to revascularize patients experiencing acute ischemic stroke as a component of the Penumbra System. The Penumbra System's fundamental mechanism of action is aspiration removes clot by drawing it into the Penumbra Reperfusion Catheter. The 3D Revascularization Device is designed to assist the Reperfusion Catheter with thrombus removal if needed. Intended users for this device are physicians who have received appropriate training in interventional neuro-endovascular techniques and treatment of acute ischemic stroke. The device is provided sterile, non-pyrogenic, and intended for single use only.
More Information

Not Found

Not Found

No
The provided text describes a mechanical system for clot removal in stroke patients and does not mention any AI or ML components.

Yes
The devices are indicated for the revascularization of patients with acute ischemic stroke secondary to intracranial large vessel occlusive disease, which is a medical condition, making them therapeutic.

No

The device is indicated for revascularization and thrombus removal in patients with acute ischemic stroke, which are therapeutic interventions, not diagnostic ones.

No

The device description clearly outlines physical components like catheters, separators, tubing, and a pump, which are hardware. The mechanism of action involves aspiration, a physical process.

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

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. They are used to provide information for diagnosis, monitoring, or screening.
  • Device Function: The description clearly states that the Penumbra System, including the 3D Revascularization Device, is used for the revascularization of patients with acute ischemic stroke. This involves physically removing blood clots from arteries within the brain.
  • Mechanism of Action: The mechanism of action is described as aspiration, which is a physical process of drawing out the clot.
  • Intended Use: The intended use is to treat a medical condition by intervening directly within the patient's body.

The device is an interventional medical device used for treating a stroke, not for diagnosing or monitoring a condition through analysis of samples outside the body.

N/A

Intended Use / Indications for Use

Penumbra Reperfusion Catheters and Separators
As part of the Penumbra System, the Reperfusion Catheters and Separators are indicated for use in the revascularization of patients with acute ischemic stroke secondary to intracranial large vessel occlusive disease (within the internal carotid, middle cerebral - M1 and M2 segments, basilar, and vertebral arteries) 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.

Penumbra 3D Revascularization Device
As part of the Penumbra System, the Penumbra 3D Revascularization Device is indicated for use in the revascularization of patients with acute ischemic stroke secondary to intracranial large vessel occlusive disease (within the internal carotid, middle cerebral - M1 and M2 segments) 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.

Penumbra Aspiration Tubing
As part of the Penumbra System, the Penumbra Sterile Aspiration Tubing is indicated to connect the Penumbra Reperfusion Catheters to the Penumbra Aspiration Pump.

Penumbra Aspiration Pump
The Penumbra Aspiration Pump is indicated as a vacuum source for Penumbra Aspiration Systems.

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

NRY

Device Description

The Penumbra System 3D Revascularization Device is designed to revascularize patients experiencing acute ischemic stroke as a component of the Penumbra System. The Penumbra System's fundamental mechanism of action is aspiration removes clot by drawing it into the Penumbra Reperfusion Catheter. The 3D Revascularization Device is designed to assist the Reperfusion Catheter with thrombus removal if needed. Intended users for this device are physicians who have received appropriate training in interventional neuro-endovascular techniques and treatment of acute ischemic stroke. The device is provided sterile, non-pyrogenic, and intended for single use only.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Intracranial (internal carotid, middle cerebral - M1 and M2 segments, basilar, and vertebral arteries)

Indicated Patient Age Range

Not Found

Intended User / Care Setting

physicians who have received appropriate training in interventional neuro-endovascular techniques and treatment of acute 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 (study type, sample size, AUC, MRMC, standalone performance, key results)

Bench-top Testing:

  • Pouch Seal Strength: Pass
  • Dimensional / Visual Inspection: Pass
  • Simulated Use [Intracranial Access, Vessel Access Entry Performance & Clot Removal]: Pass
  • Physician Evaluation [Deliverability & Clot Removal]: Pass

§ 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).

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April 30, 2019

Penumbra, Inc. Michaela Mahl Senior Manager of Regulatory Affairs One Penumbra Place Alameda, California 94502

Re: K190464

Trade/Device Name: Penumbra System (3D Revascularization Device) Regulation Number: 21 CFR 870.1250 Regulation Name: Percutaneous Catheter Regulatory Class: Class II Product Code: NRY Dated: February 25, 2019 Received: February 26, 2019

Dear Michaela Mahl:

This letter corrects our substantially equivalent letter of April 26, 2019.

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).

Sincerely,

Xiaolin Zheng -S

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) K190464

Device Name

Penumbra System (3D Revascularization Device)

Indications for Use (Describe)

Penumbra Reperfusion Catheters and Separators

As part of the Penumbra System, the Reperfusion Catheters and Separators are indicated for use in the revascularization of patients with acute ischemic stroke secondary to intracranial large vessel occlusive disease (within the internal carotid, middle cerebral - M1 and M2 segments, basilar, and vertebral arteries) 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.

Penumbra 3D Revascularization Device

As part of the Penumbra System, the Penumbra 3D Revascularization Device is indicated for use in the revascularization of patients with acute ischemic stroke secondary to intracranial large vessel occlusive disease (within the internal carotid, middle cerebral - M1 and M2 segments) 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.

Penumbra Aspiration Tubing

As part of the Penumbra System, the Penumbra Sterile Aspiration Tubing is indicated to connect the Penumbra Reperfusion Catheters to the Penumbra Aspiration Pump.

Penumbra Aspiration Pump The Penumbra Aspiration Pump is indicated as a vacuum source for Penumbra Aspiration Systems.

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)☑ Prescription Use (Part 21 CFR 801 Subpart D)☐ Over-The-Counter Use (21 CFR 801 Subpart C)
☑ 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

(as required by 21 CFR 807.92)

Pursuant to Section 12, Part (a)(i)(3A) of the Safe Medical Devices Act of 1990, Penumbra Inc. is providing the summary of Substantial Equivalence for the Penumbra System® 3D Revascularization Device.

1.1 Sponsor/Applicant Name and Address

Penumbra, Inc. One Penumbra Place Alameda, CA 94502 USA

1.2 Sponsor Contact Information

Michaela Mahl Senior Manager, Regulatory Affairs Phone: (510) 748-3288 FAX: (510) 217-6414 Email: mmahl@penumbrainc.com

1.3 Date of Preparation of 510(k) Summary

February 22, 2019

1.4 Device Trade or Proprietary Name

Penumbra System® (3D Revascularization Device)

1.5 Device Classification

Regulatory Class: II Classification Panel: Neurology Classification Name: Percutaneous Catheter Regulation Number: 21 CFR §870.1250 Product Code: NRY (Catheter, Thrombus Retriever)

1.6 Predicate and Reference Devices

510(k) Number/Clearance DateName of DeviceName of Manufacturer
Predicate Device
K162901 cleared on April 20, 2017Penumbra 3D
Revascularization DevicePenumbra, Inc.
One Penumbra Place
Alameda, CA 94502 USA

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Image /page/4/Picture/0 description: The image shows the word "Penumbra" in a red, sans-serif font. To the right of the word is a red circle with a white "P" inside. The "P" is stylized with a horizontal line extending from the left side of the "P" to the edge of the circle.

Predicate Comparison 1.7

System NamePenumbra System®
Predicate DeviceSubject Device
Device NamePenumbra 3D Revascularization DevicePenumbra 3D
Revascularization
Device (Modified)
510(k) No.K162901K190464
ClassificationClass II, NRYSAME
Indication for UsePenumbra Reperfusion Catheters and Separators
As part of the Penumbra System, the Reperfusion Catheters and Separators are
indicated for use in the revascularization of patients with acute ischemic stroke
secondary to intracranial large vessel occlusive disease (within the internal
carotid, middle cerebral - M1 and M2 segments, basilar, and vertebral arteries)
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.
Penumbra 3D Revascularization Device
As part of the Penumbra System, the Penumbra 3D Revascularization Device
is indicated for use in the revascularization of patients with acute ischemic
stroke secondary to intracranial large vessel occlusive disease (within the
internal carotid, middle cerebral – M1 and M2 segments) 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.
Penumbra Aspiration Tubing
As part of the Penumbra System, the Penumbra Sterile Aspiration Tubing is
indicated to connect the Penumbra Reperfusion Catheters to the Penumbra
Aspiration Pump.
Penumbra Aspiration Pump
The Penumbra Aspiration Pump is indicated as a vacuum source for
Penumbra Aspiration Systems.SAME
Reperfusion Catheter and SeparatorsSAME
System Components3D Revascularization DeviceSAME
Aspiration TubingSAME
Aspiration Pump & Pump CanisterSAME
MaterialsPenumbra 3D Revascularization DevicePenumbra 3D
Revascularization
Device (Modified)
Delivery-Wire
Core wireStainless SteelSAME
CoatingPTFE Green PC 8-403GSAME
Outer coilStainless SteelSAME
Proximal SolderSilver SolderSAME
System NamePenumbra System®
Distal Inner CoilN/APlatinum Alloy
Distal SolderSilver SolderSAME
Distal Tip
Outer coilStainless SteelSAME
Radiopaque MarkersPlatinum AlloySAME
Attachment TipStainless SteelSAME
Solder jointGold Solder / Silver SolderSilver Solder
3D Nitinol Device
3D latticeNitinolSAME
Introducer sheathFEPSAME
Dimensions
- Device Nominal
Total Length26 mmSAME
- Device Nominal OD4.5 mmSAME
- Device Nominal
Usable Length20 mmSAME
- Delivery Wire Distal
OD0.014"SAME
- Delivery Wire
Length200 cmSAME
SterilizationEOSAME
Shelf-Life36 MonthsSAME

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Image /page/5/Picture/0 description: The image shows the word "Penumbra" in a red, sans-serif font. To the right of the word is a red circle with a white "P" inside. The "P" is stylized with a horizontal line extending from the left side of the "P" to the edge of the circle.

Device Description 1.8

The Penumbra System 3D Revascularization Device is designed to revascularize patients experiencing acute ischemic stroke as a component of the Penumbra System. The Penumbra System's fundamental mechanism of action is aspiration removes clot by drawing it into the Penumbra Reperfusion Catheter. The 3D Revascularization Device is designed to assist the Reperfusion Catheter with thrombus removal if needed. Intended users for this device are physicians who have received appropriate training in interventional neuro-endovascular techniques and treatment of acute ischemic stroke. The device is provided sterile, non-pyrogenic, and intended for single use only.

1.9 Indications for Use

Penumbra Reperfusion Catheters and Separators

As part of the Penumbra System, the Reperfusion Catheters and Separators are indicated for use in the revascularization of patients with acute ischemic stroke secondary to intracranial large vessel occlusive disease (within the internal carotid, middle cerebral - M1 and M2 segments, basilar, and

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Image /page/6/Picture/0 description: The image shows the Penumbra company logo. The logo consists of the word "Penumbra" in a red sans-serif font, followed by a red circle with a white "P" inside. The "P" is stylized with a horizontal line extending to the edge of the circle.

vertebral arteries) 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.

Penumbra 3D Revascularization Device

As part of the Penumbra System, the Penumbra 3D Revascularization Device is indicated for use in the revascularization of patients with acute ischemic stroke secondary to intracranial large vessel occlusive disease (within the internal carotid, middle cerebral - M1 and M2 segments) 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.

Penumbra Aspiration Tubing

As part of the Penumbra System, the Penumbra Sterile Aspiration Tubing is indicated to connect the Penumbra Reperfusion Catheters to the Penumbra Aspiration Pump.

Penumbra Aspiration Pump

The Penumbra Aspiration Pump is indicated as a vacuum source for Penumbra Aspiration Systems.

1.10 Summary of Non-Clinical Data

As required under Section 12, Part (a)(i)(3A) of the Safe Medical Devices Act of 1990, a summary of any information regarding substantial equivalence of the device follows.

Included in this section are descriptions of the testing, which substantiates the safe and effective performance of the subject Penumbra System 3D Revascularization Device as well as its substantial equivalence to the predicate device:

  • Biocompatibility
  • Design Verification (Bench-Top Testing) ●
  • Design Validation (Animal Study) ●
  • . Performance Data

The subject, Penumbra System 3D Revascularization Device met all established requirements.

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1.10.1 Previously Completed Biocompatibility Testing

The materials used in the subject Penumbra System 3D Revascularization Device [modified] are identical to those in the predicate device, Penumbra System 3D Revascularization Device [K162901]. The subject Penumbra System 3D Revascularization Device [modified] uses identical materials, equivalent processing, and identical sterilization methods as products that Penumbra has already successfully conducted biocompatibility testing per BS EN ISO 10993. The studies were selected in accordance with ISO 10993-1 guidelines (Biological Evaluation of Medical Devices) for a limited exposure (