K Number
K221951
Device Name
Branchor Balloon Guide Catheter
Date Cleared
2022-10-11

(98 days)

Product Code
Regulation Number
870.1250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Branchor Balloon Guide Catheter is indicated for use to facilitate the insertion and guidance of an intravasular catheter into a selected blood vessel in the neuro vasculature, and injection of contrast media. The balloon provides temporary vascular occlusion during these procedures. The Branchor Balloon Guide Catheter can also be used as a conduit for retrieval devices.
Device Description
The Branchor Balloon Guide Catheter has the same design, materials and accessories as the predicate device (K203723). The change to the subject device includes performance testing and labeling to allow use with a power injector. This balloon guide catheter is a variable stiffness catheter that has a radiopaque marker at the distal end of the balloon and a branched connector at the proximal end, and is equipped with a braid reinforced coaxial lumen. A balloon is attached to the distal end, and the dimensions of this balloon guide catheter and the recommended balloon injection volume are indicated on the product label. The balloon quide catheter is provided sterile, using ethylene oxide, and is intended for single use only by physicians who have been adequately trained in neurointerventional procedures. The outer surface of this balloon quide catheter is coated with a hydrophilic coating in order to enhance lubricity when the surface is wet. The shaft lumen is provided with PTFE coating, except the connector part, to facilitate the passage of the quidewire and other devices through the section.
More Information

No
The 510(k) summary describes a physical medical device (a balloon guide catheter) and its intended use and performance testing. There is no mention of software, algorithms, image processing, AI, ML, or any related concepts. The changes described relate to allowing use with a power injector and associated performance testing.

No
The device is described as a guide catheter used to facilitate the insertion and guidance of other catheters and for temporary vascular occlusion, not as a device that directly treats a medical condition.

No

Explanation: The device is indicated for facilitating insertion and guidance of an intravascular catheter, temporary vascular occlusion, and as a conduit for retrieval devices. These are interventional/procedural uses, not diagnostic.

No

The device description clearly describes a physical catheter with a balloon, lumens, coatings, and a connector. It is a hardware device used in neurointerventional procedures.

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

Here's why:

  • Intended Use: The intended use clearly describes a device used within the body to facilitate the insertion and guidance of other catheters, provide temporary vascular occlusion, and act as a conduit for retrieval devices. This is an in vivo application, meaning it's used directly on or within a living organism.
  • Device Description: The description details a physical catheter with a balloon, coatings, and lumens designed for insertion into blood vessels. This aligns with an in vivo medical device.
  • Lack of IVD Characteristics: There is no mention of the device being used to examine specimens derived from the human body (like blood, urine, tissue, etc.) to provide information for diagnosis, monitoring, or screening. IVDs are typically used in a laboratory setting or at the point of care to analyze biological samples.

Therefore, the Branchor Balloon Guide Catheter is an in vivo medical device, not an IVD.

N/A

Intended Use / Indications for Use

The Branchor Balloon Guide Catheter is indicated for use to facilitate the insertion and guidance of an intravasular catheter into a selected blood vessel in the neuro vasculature, and injection of contrast media.

The balloon provides temporary vascular occlusion during these procedures.

The Branchor Balloon Guide Catheter can also be used as a conduit for retrieval devices.

Product codes

QJP

Device Description

The Branchor Balloon Guide Catheter has the same design, materials and accessories as the predicate device (K203723). The change to the subject device includes performance testing and labeling to allow use with a power injector.

This balloon guide catheter is a variable stiffness catheter that has a radiopaque marker at the distal end of the balloon and a branched connector at the proximal end, and is equipped with a braid reinforced coaxial lumen. A balloon is attached to the distal end, and the dimensions of this balloon guide catheter and the recommended balloon injection volume are indicated on the product label. The balloon quide catheter is provided sterile, using ethylene oxide, and is intended for single use only by physicians who have been adequately trained in neurointerventional procedures.

The outer surface of this balloon quide catheter is coated with a hydrophilic coating in order to enhance lubricity when the surface is wet. The shaft lumen is provided with PTFE coating, except the connector part, to facilitate the passage of the quidewire and other devices through the section.

Accessories
The Branchor Balloon Guide Catheter is packaged with a peel-away to protect the balloon during catheter introduction, a 1mL syringe for balloon inflation, and a three-way stopcock to connect the syringe for inflation and deflation of the balloon.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Neuro vascular

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Physicians who have been adequately trained in neurointerventional procedures.

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

Non-clinical bench testing was performed on the Branchor Balloon Guide Catheter to allow use with power injectors. The following testing was performed:

  • Burst Pressure under static condition: Pass
  • Power Injection: Pass
  • Flow Rate: Pass

The testing of non-aged and aged devices was performed.

The in vitro bench tests demonstrated that the Branchor Balloon Guide Catheter met all acceptance criteria. Performance data demonstrates that the device functions as intended and has a safety and effectiveness profile that is similar to the predicate device.

Key Metrics

Not Found

Predicate Device(s)

Branchor Balloon Guide Catheter (K203723)

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

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

October 11, 2022

Image /page/0/Picture/1 description: The image shows 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 a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

ASAHI INTECC Co., Ltd % Cynthia Valenzuela Director, Global Regulatory Affairs ASAHI INTECC USA, Inc. 3002 Dow Avenue, Suite 212 Tustin, California 92780

Re: K221951

Trade/Device Name: Branchor Balloon Guide Catheter Regulation Number: 21 CFR 870.1250 Regulation Name: Percutaneous Catheter Regulatory Class: Class II Product Code: QJP Dated: September 7, 2022 Received: September 13, 2022

Dear Cynthia Valenzuela:

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,

Naira Muradyan, Ph.D. Assistant Director 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

DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known) K221951

Device Name

Branchor Balloon Guide Catheter

The Branchor Balloon Guide Catheter is indicated for use to facilitate the insertion and guidance of an intravasular catheter into a selected blood vessel in the neuro vasculature, and injection of contrast media.

The balloon provides temporary vascular occlusion during these procedures.

The Branchor Balloon Guide Catheter can also be used as a conduit for retrieval devices.

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

X 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."

Form Approved: OMB No. 0910-0120 Expiration Date: 06/30/2023 See PRA Statement below.

3

510(K) Summary [as required by 21 CFR §807.92(c)]

510(K) K221951

DATE PREPARED:11 OCT 2022
SUBMITTER:ASAHI INTECC CO., LTD
3-100 Akatsuki-cho, Seto
Aichi 489-0071, Japan
Telephone: +81 561 48 5551
PRIMARY CONTACT:Mrs. Cynthia Valenzuela
Director, Global Regulatory Affairs
ASAHI INTECC USA, INC.
3002 Dow Avenue, Suite 212
Tustin, California 92780
Phone: (949) 413 0071
Email: cynthiav@asahi-intecc-us.com
TRADE NAME:Branchor Balloon Guide Catheter
DEVICE CLASSIFICATION:Class II, 21 CFR §870.1250
CLASSIFICATION NAME:Percutaneous Catheter
PRODUCT CODE:QJP, Catheter, Percutaneous, Neurovasculature
PREDICATE DEVICE:Branchor Balloon Guide Catheter (K203723)

Device Description:

The Branchor Balloon Guide Catheter has the same design, materials and accessories as the predicate device (K203723). The change to the subject device includes performance testing and labeling to allow use with a power injector.

This balloon guide catheter is a variable stiffness catheter that has a radiopaque marker at the distal end of the balloon and a branched connector at the proximal end, and is equipped with a braid reinforced coaxial lumen. A balloon is attached to the distal end, and the dimensions of this balloon guide catheter and the recommended balloon injection volume are indicated on the product label. The balloon quide catheter is provided sterile, using ethylene oxide, and is intended for single use only by physicians who have been adequately trained in neurointerventional procedures.

The outer surface of this balloon quide catheter is coated with a hydrophilic coating in order to enhance lubricity when the surface is wet. The shaft lumen is provided with PTFE coating, except the connector part, to facilitate the passage of the quidewire and other devices through the section.

4

Accessories

The Branchor Balloon Guide Catheter is packaged with a peel-away to protect the balloon during catheter introduction, a 1mL syringe for balloon inflation, and a three-way stopcock to connect the syringe for inflation and deflation of the balloon.

Intended Use/Indications for Use

The Branchor Balloon Guide Catheter is indicated for use to facilitate the insertion and guidance of an intravascular catheter into a selected blood vessel in the neuro vasculature, and injection of contrast media.

The balloon provides temporary vascular occlusion during these procedures.

The Branchor Balloon Guide Catheter can also be used as a conduit for retrieval devices.

Comparison of Indications for Use and Technological Characteristics:

The Branchor Balloon Guide Catheter has identical

  • Indications for use, .
  • Fundamental principles of operation, .
  • . Fundamental design and materials,
  • Packaging and sterilization of devices

as the marketed predicate device. A tabular comparison of the specific technological characteristics between the predicate device and subject device is provided below. The labeling changes to allow the use of power injectors with the subject device do not raise new questions of safety and effectiveness.

5

Table 1: Comparison Table

Name of DeviceBranchor Balloon Guide CatheterBranchor Balloon Guide Catheter
PredicateSubject Device
510(K) Number:K203723K221951
Indications for UseThe Branchor Balloon Guide
Catheter is indicated for use to
facilitate the insertion and
guidance of an intravascular
catheter into a selected blood
vessel in the neuro vasculature,
and injection of contrast media.The Branchor Balloon Guide
Catheter is indicated for use to
facilitate the insertion and
guidance of an intravascular
catheter into a selected blood
vessel in the neuro vasculature,
and injection of contrast media.
The balloon provides temporary
vascular occlusion during these
procedures.The balloon provides temporary
vascular occlusion during these
procedures.
The Branchor Balloon Guide Catheter
can also be used as a conduit for
retrieval devices.The Branchor Balloon Guide
Catheter can also be used as a
conduit for retrieval devices.
Device DescriptionThis balloon guide catheter is a
variable stiffness catheter that has a
radio-opaque marker at the distal end
of the balloon to facilitate fluoroscopic
visualization and indicate the balloon
position, a branched connector at the
proximal end, and is equipped with a
braid reinforced coaxial lumen. A
balloon is attached to the distal end,
and the dimensions of this balloon
guide catheter and recommended
balloon injection volume are provided
on the product label.
The outer surface of this balloon guide
catheter is coated with a hydrophilic
coating for enhanced lubricity when the
surface is wet.
The shaft lumen is provided with PTFE
coating, with the exception of the
connector section to facilitate the
passage of the guidewire and other
devices through the section.This balloon guide catheter is a
variable stiffness catheter that has a
radio-opaque marker at the distal end
of the balloon to facilitate fluoroscopic
visualization and indicate the balloon
position, a branched connector at the
proximal end, and is equipped with a
braid reinforced coaxial lumen. A
balloon is attached to the distal end,
and the dimensions of this balloon
guide catheter and recommended
balloon injection volume are provided
on the product label.
The outer surface of this balloon
guide catheter is coated with a
hydrophilic coating for enhanced
lubricity when the surface is wet.
The shaft lumen is provided with
PTFE coating, with the exception of
the connector section to facilitate
the passage of the guidewire and
other devices through the section.

6

Name of DeviceBranchor Balloon Guide CatheterBranchor Balloon Guide Catheter
510(K) Number:K203723K221951
Regulation
Number:21 CFR § 870.125021 CFR § 870.1250
Regulation
Description:Catheter, Percutaneous,
NeurovasculatureCatheter, Percutaneous,
Neurovasculature
Regulatory Class:IIII
Product Code:QJPQJP
SizeShaft OD: 3.00 mm
Shaft ID: 2.28 mmShaft OD: 3.00 mm
Shaft ID: 2.28 mm
Effective Length90 cm, 100 cm90 cm, 100 cm
Balloon MaterialPolyurethane elastomerPolyurethane elastomer
Shaft MaterialPolyurethane Elastomer
Polyamide 12 Elastomer
Polyamide 12
Stainless Steel
PolytetrafluoroethylenePolyurethane Elastomer
Polyamide 12 Elastomer
Polyamide 12
Stainless Steel
Polytetrafluoroethylene
AccessoriesPeel-away
Syringe
Three way stopcockPeel-away
Syringe
Three way stopcock
Sterilization MethodEthylene OxideEthylene Oxide
Sterility LevelSAL10-6SAL10-6
Single UseYesYes
Radiopaque MarkersYesYes
Anatomical SitesNeuro vascularNeuro vascular

7

PERFORMANCE TESTING:

Non-clinical bench testing was performed on the Branchor Balloon Guide Catheter to allow use with power injectors. The following testing was performed:

Table 2: Performance Testing

TestResult
Burst Pressure under static conditionPass
Power InjectionPass
Flow RatePass

The testing of non-aged and aged devices was performed.

The in vitro bench tests demonstrated that the Branchor Balloon Guide Catheter met all acceptance criteria. Performance data demonstrates that the device functions as intended and has a safety and effectiveness profile that is similar to the predicate device.

BIOCOMPATIBILITY, STERILIZATION and SHELF LIFE:

The change to the subject device does not impact biocompatibility, sterilization, and shelf life, as compared to the predicate device.

CONCLUSION:

The Branchor Balloon Guide Catheter has similar intended use, same technological characteristics, such as components, design, materials, sterilization method, shelf life and operating principles, as the predicate device. Performance data demonstrate that the subject device functions as intended. The conclusions drawn from the nonclinical tests demonstrate that the Branchor Balloon Guide Catheter is substantially equivalent to the legally marketed predicate device.