K Number
K192525
Manufacturer
Date Cleared
2019-10-31

(48 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 087 Balloon Guide Catheter System is indicated for use in facilitating the insertion and guidance of an intravasular catheter into a selected blood vessel in the peripheral and neurovasculature. The balloon provides temporary vascular occlusion during such procedures. The 087 Balloon Guide Catheter System is also indicated for use as a conduit for retrieval devices.

Device Description

The 087 Balloon Guide Catheter System is a sterile, single-use intravascular catheter. The system consists of:

  • . 087 Balloon Guide Catheter
  • 1cc Inflation Syringe ●
  • 8Fr Peel Away Introducer ●
  • Hub Extension
  • Three Way Stopcock ●
    The 087 Balloon Guide Catheter is offered in three effective lengths, 90, 95, and 100 cm. The 087 Balloon Guide Catheter is an 8 French variable stiffness catheter utilizing a bifurcated dual port luer hub on the proximal end and dual radiopaque distal marker bands on each side of the balloon. The catheter shaft is stainless steel coil reinforced. The hub central port is positioned coaxial to the central lumen to facilitate introduction of interventional devices through the central lumen. The inflation port is positioned at an angle to the central port and is used with the accessory Inflation Syringe to facilitate inflating and deflating the balloon. The 087 Balloon Guide Catheter uses a distal hydrophilic coating to reduce friction between the catheter shaft and the vessel wall.
AI/ML Overview

The provided document is a 510(k) Premarket Notification from the FDA for the 087 Balloon Guide Catheter System. This document outlines the regulatory review of a medical device, focusing on demonstrating substantial equivalence to a legally marketed predicate device.

Here's an analysis of the acceptance criteria and the study that proves the device meets them, based on your request:

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

The document presents a "Nonclinical Performance Testing Summary" which serves as the primary evidence for meeting acceptance criteria. Each "Study Name" implicitly defines an acceptance criterion (e.g., "Conditioning, Distribution, and Shelf Life Aging Verification" implies a criterion for packaging strength and integrity). The reported device performance for all tests is simply "Pass" with the statement "All samples met the pre-determined acceptance criteria."

Acceptance Criteria (Derived from Study Description)Reported Device Performance
Product meets packaging strength and packaging integrity after accelerated aging (6-month shelf life equivalent)Pass (All samples met the pre-determined acceptance criteria)
Product meets packaging visual inspection requirementsPass (All samples met the pre-determined acceptance criteria)
Product satisfies visual surface requirementsPass (All samples met the pre-determined acceptance criteria)
Product meets dimensional specificationsPass (All samples met the pre-determined acceptance criteria)
Product meets inflation volume vs. balloon diameter specificationsPass (All samples met the pre-determined acceptance criteria)
Balloon is capable of withstanding an injection volume of 1.0CCPass (All samples met the pre-determined acceptance criteria)
Stiffness of the distal end of the product is similar to other marketed devicesPass (All samples met the pre-determined acceptance criteria)
Product is capable of 720 degrees of rotation about the central lumen axis without failurePass (All samples met the pre-determined acceptance criteria)
Product satisfies peak tensile requirementsPass (All samples met the pre-determined acceptance criteria)
Flow rate is comparable to the predicate devicePass (All samples met the pre-determined acceptance criteria)
Product meets the requirements for small-bore connectors (ISO 80369-7)Pass (All samples met the pre-determined acceptance criteria)
Product satisfies corrosion resistance requirementsPass (All samples met the pre-determined acceptance criteria)
Radiopaque characteristics of the device meet requirementsPass (All samples met the pre-determined acceptance criteria)
Hub Extension Liquid Leakage Under Pressure meets requirementsPass (All samples met the pre-determined acceptance criteria)
Hub Extension Hub Aspiration Air Leakage meets requirementsPass (All samples met the pre-determined acceptance criteria)
Quantity and size of particles generated during simulated use are acceptablePass (All samples met the pre-determined acceptance criteria)
Liquid Leakage Under Pressure meets requirements (ISO 10555-1)Pass (All samples met the pre-determined acceptance criteria)
Hub Aspiration Air Leakage meets requirements (ISO 10555-1)Pass (All samples met the pre-determined acceptance criteria)
No degradation of the Balloon after 20 inflation cyclesPass (All samples met the pre-determined acceptance criteria)
Product does not lose structural integrity when used in a tortuous path modelPass (All samples met the pre-determined acceptance criteria)
Product has acceptable kink resistancePass (All samples met the pre-determined acceptance criteria)
Device performance under simulated use conditions (including stent retrievers) compared to predicate device is acceptablePass (All samples met the pre-determined acceptance criteria)

2. Sample size used for the test set and the data provenance

The document explicitly states: "No animal or clinical studies were required to demonstrate substantial equivalence." The entire submission relies on non-clinical performance bench test data.

  • Sample Size: The document does not specify the numerical sample size for any of the individual bench tests. It consistently reports "All samples met the pre-determined acceptance criteria," implying that a specific sample size was tested for each criterion, but the exact number is not provided.
  • Data Provenance: The data is from non-clinical bench testing. There is no information about the country of origin of the data as these are laboratory tests. It is inherently retrospective in the sense that the testing was performed and then reported for this submission.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

This information is not applicable to this submission. The "ground truth" for the non-clinical performance bench tests is established by technical standards and pre-determined acceptance criteria (e.g., ASTM, ISO standards, or internal specifications). There's no indication that human experts were used to establish ground truth for these device performance metrics.

4. Adjudication method for the test set

This is not applicable. Since the ground truth for the bench tests is based on objective measurements against pre-defined numerical or qualitative criteria (e.g., "Pass/Fail" based on whether a specification is met), there is no need for expert adjudication.

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

There was no MRMC comparative effectiveness study done. This device is a physical medical instrument (catheter), not an AI/software device that assists human readers with interpretation. Therefore, questions regarding AI assistance and effect size are not relevant here.

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

This is not applicable. As mentioned above, this is a physical medical device, not an algorithm or AI.

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

The ground truth for the non-clinical performance bench tests is based on established engineering and material science standards (e.g., ISO and ASTM standards) and pre-determined internal acceptance criteria. For example:

  • ASTM F88 for Seal Strength
  • ASTM F2096 for Detecting Gross Leaks
  • ISO 10555-1 for General requirements of intravascular catheters
  • ISO 10555-4 for Balloon Dilatation Catheters
  • ISO 80369-7 for Small-bore connectors
  • AAMI TIR42 and USP <788> for particulates
  • DIN EN 13868 for kink resistance
  • FDA CTQ: Hydrophilic Coated and Hydrophobic Coated Vascular and Neurological Devices, August 2015 (for particulates)

These standards define the methodologies and acceptable limits for various physical and functional characteristics of catheters.

8. The sample size for the training set

This is not applicable. The device is a physical catheter, not a machine learning model. Therefore, there is no "training set."

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

This is not applicable for the same reason as point 8.

{0}------------------------------------------------

Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which consists of the letters "FDA" in a blue square, followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in blue text.

October 31, 2019

Q'Apel Medical LLC % Michele Lucey President Lakeshore Medical Device Consulting LLC 128 Blye Hill Landing Newbury, New Hampshire 03255

Re: K192525

Device Name: 087 Balloon Guide Catheter System Regulation Number: 21 CFR 870.1250 Regulation Name: Percutaneous Catheter Regulatory Class: Class II Product Code: DQY Dated: September 12, 2019 Received: September 13, 2019

Dear Michele Lucey:

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 statutes and regulations administered by other Federal agencies. You must comply with all the Act's

{1}------------------------------------------------

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/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (OS) 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). 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 (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-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, Ph.D. Director (Acting) DHT5A: Division of Neurosurgical. Neurointerventional and Neurodiagnostic Devices OHT5: Office of Neurological and Physical Medicine Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

{2}------------------------------------------------

Indications for Use

510(k) Number (if known) K192525

Device Name 087 Balloon Guide Catheter System

Indications for Use (Describe)

The 087 Balloon Guide Catheter System is indicated for use in facilitating the insertion and guidance of an intravasular catheter into a selected blood vessel in the peripheral and neurovasculature. The balloon provides temporary vascular occlusion during such procedures. The 087 Balloon Guide Catheter System is also indicated for use as a conduit for retrieval devices.

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)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff(@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

{3}------------------------------------------------

510(k) Summary Traditional 510(k) As required by 21 CFR 807.92

Submitter Information:

Submitter's Name:Q'Apel Medical LLC
Address:330 Wilshire BoulevardSanta Monica CA 90401
Telephone:310-395-3950
Fax:310-395-3950
Contact Person:Michele Lucey
Telephone:603-748-1374
Date Prepared:October 17, 2019
Device Trade Name:087 Balloon Guide Catheter System
Classification:Class II
Classification Name:Percutaneous Catheter
Product Code(s):DQY
Regulation Number(s):870.1250
Predicate Device:Concentric Medical, FlowGate2TM, K153729
Reference Device:087 Balloon Guide Catheter System K190749

Indication for Use:

The 087 Balloon Guide Catheter System is indicated for use in facilitating the insertion and guidance of an intravascular catheter into a selected blood vessel in the peripheral and neurovasculature. The balloon provides temporary vascular occlusion during such procedures. The 087 Balloon Guide Catheter System is also indicated for use as a conduit for retrieval devices.

Device Description

The 087 Balloon Guide Catheter System is a sterile, single-use intravascular catheter. The system consists of:

  • . 087 Balloon Guide Catheter
  • 1cc Inflation Syringe ●
  • 8Fr Peel Away Introducer ●
  • Hub Extension

{4}------------------------------------------------

  • Three Way Stopcock ●
    The 087 Balloon Guide Catheter is offered in three effective lengths, 90, 95, and 100 cm. The 087 Balloon Guide Catheter is an 8 French variable stiffness catheter utilizing a bifurcated dual port luer hub on the proximal end and dual radiopaque distal marker bands on each side of the balloon. The catheter shaft is stainless steel coil reinforced. The hub central port is positioned coaxial to the central lumen to facilitate introduction of interventional devices through the central lumen. The inflation port is positioned at an angle to the central port and is used with the accessory Inflation Syringe to facilitate inflating and deflating the balloon. The 087 Balloon Guide Catheter uses a distal hydrophilic coating to reduce friction between the catheter shaft and the vessel wall.

Nonclinical Performance Testing Summary:

Determination of substantial equivalence is based on an assessment of non-clinical performance bench test data. The 087 Balloon Guide Catheter System has successfully completed the following relevant performance testing to demonstrate substantial equivalence. Testing was performed to evaluate physical integrity, functionality, and performance of the 087 Balloon Guide Catheter. A summary of the tests performed is provided in the table below:

Performance Test Summary
Study NameDescriptionReference StandardResults
Conditioning.Distribution, and ShelfLife Aging VerificationTo demonstrate that the productmeets the packaging strength andpackaging integrity followingaccelerated aging to a 6-monthshelf life equivalentASTM F88 SealStrength of FlexibleBarrier materialsASTM F2096 StandardTest Method forDetecting Gross Leaksin Medical PackagingPassAll samples metthe pre-determinedacceptance criteria
Packaging VisualInspectionTo demonstrate that the productmeets the packaging visualinspection requirements givenN/APassAll samples metthe pre-determinedacceptance criteria
Visual SurfaceRequirementsTo demonstrate the productsatisfies the visual surfacerequirementsISO 10555-1:2013Intravascular catheters -Sterile and single-usecatheters - Part 1:General requirementsPassAll samples metthe pre-determinedacceptance criteria
Dimensional InspectionTo demonstrate that the productmeets the dimensionalspecificationsISO 10555-1:2013Intravascular catheters -Sterile and single-usecatheters - Part 1:General requirementsPassAll samples metthe pre-determinedacceptance criteria
Inflation Volume vsBalloon DiameterTo demonstrate that the productmeets the inflation volume vsballoon diameter specificationsIn consideration of ISO10555-4:2013Intravascular Catheters- Sterile and Single-UseCatheters - Part 4:Balloon DilatationCathetersPassAll samples metthe pre-determinedacceptance criteria
Performance Test Summary
Study NameDescriptionReference StandardResults
Balloon Burst Volume,To demonstrate that the Balloonis capable of withstanding aninjection volume of 1.0CC.In consideration of ISO10555-4:2013Intravascular Catheters- Sterile and Single-UseCatheters - Part 4:Balloon DilatationCathetersPassAll samples metthe pre-determinedacceptance criteria
Tip Deflection, FG 00100To demonstrate that the stiffnessof the distal end of the product issimilar to other marketed devices.N/APassAll samples metthe pre-determinedacceptance criteria
Torque TestingTo demonstrate that the product iscapable of 720 degrees of rotationabout the central lumen axiswithout failure.N/APassAll samples metthe pre-determinedacceptance criteria
Peak TensileTo demonstrate the productsatisfies the peak tensilerequirementsISO 10555-1:2013Intravascular catheters -Sterile and single-usecatheters - Part 1:General requirementsPassAll samples metthe pre-determinedacceptance criteria
Flow RateTo demonstrate that the flow rateis comparable to the predicatedevice.ISO 10555-1:2013Intravascular catheters -Sterile and single-usecatheters - Part 1:General requirementsPassAll samples metthe pre-determinedacceptance criteria
Small Bore ConnectorCompliance withStandardTo demonstrate that the productmeets the requirementsISO 80369-7 2016,Small-bore connectorsfor liquids and gases inhealthcare applications- Part 7, Connectorsfor intravascular orhypodermicapplications.PassAll samples metthe pre-determinedacceptance criteria
Corrosion ResistanceTo demonstrate the productsatisfies the corrosion resistancerequirementsISO 10555-1:2013Intravascular catheters -Sterile and single-usecatheters - Part 1:General requirementsPassAll samples metthe pre-determinedacceptance criteria
RadiopacityTo determine the radiopaquecharacteristics of the device.ISO 10555-1:2013Intravascular catheters -Sterile and single-usecatheters - Part 1:General requirementsASTM F640-12Standard Test Methodsfor DeterminingRadiopacity forMedical UsePassAll samples metthe pre-determinedacceptance criteria
Performance Test Summary
Study NameDescriptionReference StandardResults
Hub Extension LiquidLeakage Under PressureTo demonstrate that the productmeets the liquid leakagerequirementsISO 10555-1:2013Intravascular catheters -Sterile and single-usecatheters - Part 1:General requirementsPassAll samples metthe pre-determinedacceptance criteria
Hub Extension HubAspiration Air LeakageTo demonstrate that the productmeets the liquid leakagerequirementsISO 10555-1:2013Intravascular catheters -Sterile and single-usecatheters - Part 1:General requirementsPassAll samples metthe pre-determinedacceptance criteria
Particulates, CoatingIntegrityThis study was conducted todetermine the quantity and size ofparticles generated duringsimulated use, including use withstent retrieversAAMI TIR42:10Evaluation ofparticulates associatedwith vascular medicaldevicesUSP <788> ParticulateMatter in InjectionsFDA CTQ: HydrophilicCoated andHydrophobic CoatedVascular andNeurological Devices,August 2015PassAll samples metthe pre-determinedacceptance criteria
Liquid Leakage UnderPressureTo demonstrate that the productmeets the liquid leakagerequirements given in ISO 10555-1.ISO 10555-1:2013Intravascular catheters -Sterile and single-usecatheters - Part 1:General requirementsPassAll samples metthe pre-determinedacceptance criteria
Hub Aspiration AirLeakageTo demonstrate that the productmeets the hub aspiration airleakage requirements given inISO 10555-1.ISO 10555-1:2013Intravascular catheters -Sterile and single-usecatheters - Part 1:General requirementsPassAll samples metthe pre-determinedacceptance criteria
Balloon Inflation FatigueTo demonstrate that there is nodegradation of the Balloon after20 inflation cycles.In consideration of ISO10555-4:2013Intravascular Catheters- Sterile and Single-UseCatheters - Part 4:Balloon DilatationCathetersPassAll samples metthe pre-determinedacceptance criteria
Flex FatigueTo demonstrate that the productdoes not loose structural integritywhen used in the tortuous pathmodel.ISO 10555-1:2013Intravascular catheters -Sterile and single-usecatheters - Part 1:General requirementsPassAll samples metthe pre-determinedacceptance criteria
Performance Test Summary
Study NameDescriptionReference StandardResults
Kink ResistanceTo demonstrate that the producthas acceptable kink resistanceDIN EN 13868:2002,Test methods forkinking of single lumencatheters and medicaltubingPassAll samples metthe pre-determinedacceptance criteria
Simulated UseEvaluation of device performanceunder simulated use conditions,including stent retrieverscompared to the predicate deviceIn consideration of ISO10555-4:2013Intravascular Catheters- Sterile and Single-UseCatheters - Part 4:Balloon DilatationCathetersPassAll samples met thepre-determinedacceptance criteria

{5}------------------------------------------------

{6}------------------------------------------------

{7}------------------------------------------------

The results of these tests provide reasonable assurance that the 087 Balloon Guide Catheter System has been designed and tested to assure conformance to the requirements for its intended use and indications for use. No new safety or performance issues were raised during the testing; therefore, this device is considered to be substantially equivalent to the predicate device.

Animal or Clinical Testing: No animal or clinical studies were required to demonstrate substantial equivalence.

Biocompatibility Testing Summary

The device is categorized as Externally Communicating Device, Circulating Blood, Limited Contact (< 24 hours), per ISO 10993-1. There are no changes to the device materials or manufacturing processes, no additional biocompatibility testing was deemed necessary to implement this change.

Predicate Device Comparison

The following table provides a comparison of the key characteristics of the 087 Balloon Guide Catheter System to the predicate device.

Comparison of the Subject Device with the Predicate Device
FeatureSubject Device087 Balloon GuideCatheter SystemPredicate deviceFlowGate2 BalloonGuide CatheterComparison
Regulatory Clearance/Approval ReferenceK192525K153729NA
FDA ClassificationClass IIClass IISame
Product Code(s)DQYDQYSame
Regulation Number870.1250870.1250Same
Regulation NamePercutaneous CatheterPercutaneous CatheterSame
Indications for UseThe 087 Balloon GuideCatheter System isindicated for use infacilitating the insertion andguidance of an intravascularcatheter into a selectedFlowGate™ BalloonGuide Catheters areindicated for use infacilitating the insertionand guidance of anintravascular catheter intoIntended Use is thesame, the subject devicedoes not include anindication for use inangiographicprocedures. This
Comparison of the Subject Device with the Predicate Device
FeatureSubject Device087 Balloon GuideCatheter SystemPredicate deviceFlowGate2 BalloonGuide CatheterComparison
blood vessel in theperipheral andneurovasculature. Theballoon provides temporaryvascular occlusion duringsuch procedures. The 087Balloon Guide CatheterSystem is also indicated foruse as a conduit forretrieval devices.a selected blood vessel inthe peripheral and neurovascular systems. Theballoon providestemporary vascularocclusion during theseand other angiographicprocedures. The BalloonGuide Catheter is alsoindicated for use as aconduit for Retrievaldevices.difference does notraise new questions ofsafety and efficacy,
Anatomical LocationsPeripheral and neurovasculaturePeripheral and neurovasculatureSame
MaterialCommonly used medicalgrade plastics and stainlesssteel,Commonly used medicalgrade plastics andstainless steel,Same
Reinforced Catheter ShaftReinforcementStainless steel coilreinforcedStainless Steel braidreinforcedSimilar, minordifference does notraise new questionsregarding safety andefficacy, both deviceshave reinforced catheterwalls, same as referencedevice
Injection PortYesYesSame
Marker Band Locations0.06-in (1.5mm) from thedistal tip edge (distal of theballoon)0.66-in (16.8mm) from thedistal tip edge (proximal ofthe balloon)0.08-in (2mm) from thedistal tip edgeSimilar, minordifference does notraise new questionsregarding safety andefficacy, both devicesutilize radiopaquemarker bands, same asreference device
Compliant BalloonYes, low durometerurethaneYes, siliconeSimilar, materialdifferences do not raisenew questions of safetyand efficacy, bothmaterials are used forcompliant balloons forintravascular use, sameas the reference device
Labeled Shaft OuterDiameter0.110-in (max)(2.79mm)8.4Fr0.106-in (max)(2.7mm)8FrSimilar, minordifferences do not raisenew questions of safetyand efficacy, same asthe reference device
Comparison of the Subject Device with the Predicate Device
FeatureSubject Device087 Balloon GuideCatheter SystemPredicate deviceFlowGate2 BalloonGuide CatheterComparison
Labelled Shaft InnerDimension.087-in(2.21mm)6.6Fr.084-in(2.21mm)6.4FrSimilar, minordifferences do not raisenew questions of safetyand efficacy, same asthe reference device
Effective length90, 95, 100 cm(35.4, 37.4, 39.4 in)90cm, 100 cm(35.4, 39.4 in)Same
Tip ShapeStraightStraightSame
Maximum BalloonVolume0.6ml0.6mlSame
RadiopaqueDistal Tip has radiopaquemarker bands, stainlesssteel reinforcement in thecatheter shaft renders theshaft visible on fluoroscopyDistal Tip has radiopaquemarker bands, stainlesssteel reinforcement in thecatheter shaft renders theshaft visible onfluoroscopySame
CoatingHydrophilic Coating –Proximal to the balloon, onthe distal portionNoneDifference does notraise new questions ofsafety and efficacy.Hydrophillic coatingsare commonly used tolubricate vascularcatheters. Both devicesdo not have coating onthe balloon region,same as the referencedevice
Internal ConstructionMulti Lumen catheter wallCoaxial LumenDifferences do not raisenew questions of safetyand efficacy. Bothdesigns are intended tocreate a pathway to theside arm for ballooninflation, same as thereference device
Reinforced ShaftStainless steel reinforcedshaftStainless steel reinforcedshaftSame
Accessories Supplied3-Way Stopcock, PeelAway Sheath, Hubextension, 1ml SyringeDilator, RotatingHemostasis Valve, TuohyBorst Valve withSideport, Peel AwaySheaths, Luer-ActivatedValvesSimilar, minordifferences do not raisenew questions of safetyand efficacy., same asthe reference device
How SuppliedSterile, single useSterile, single useSame
Sterilization Method$EtO$$EtO$Same

{8}------------------------------------------------

{9}------------------------------------------------

{10}------------------------------------------------

Conclusion:

Q'Apel Medical LLC concludes through a review of the benchtop assessments, the comparison of the device classification, intended use, operating principle, technological characteristics, sterility, and biocompatibility that the 087 Balloon Guide Catheter System is substantially equivalent to the predicate device.

§ 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).