K Number
K222631
Device Name
VASSALLO GT EXT
Manufacturer
Date Cleared
2022-10-26

(56 days)

Product Code
Regulation Number
870.1330
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The VASSALLO GT EXT guide wire accessory is intended for extension of the working length of an already introduced guide wire when exchanging over-the-wire interventional devices during an angioplasty procedure. This device is intended for peripheral vascular use only.
Device Description
The VASSALLO GT EXT Guide Wire Extension accessory is used to elongate the working length of compatible peripheral extendable wires. The stainless-steel guide wire extension has an outer diameter of 0.014" (0.36 mm) and a length of 165 cm. The distal end consists of a pipe shaped nitinol-titanium connection port (extension tube). The straight stainless steel wire surface is coated with PTFE. The extension wire is intended to connect with a FILMECC peripheral guide wire shorter than 300 cm. The total length of the system after connection will be 300 cm to 400 cm.
More Information

Not Found

No
The device description and performance studies focus on mechanical properties and function, with no mention of AI/ML terms or capabilities.

No.
The device is an accessory intended for extending the working length of guide wires during angioplasty procedures, facilitating the exchange of interventional devices rather than directly treating a condition or restoring function.

No
The device is described as an accessory for extending the working length of guide wires during angioplasty procedures. Its purpose is to facilitate interventional device exchange, not to diagnose a medical condition.

No

The device description clearly states it is a stainless-steel guide wire extension with a physical form factor and material properties, indicating it is a hardware device.

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

Here's why:

  • Intended Use: The intended use clearly states that the device is for "extension of the working length of an already introduced guide wire when exchanging over-the-wire interventional devices during an angioplasty procedure." This describes a device used within the body during a medical procedure, not a device used to test samples outside the body to diagnose a condition.
  • Device Description: The description details a physical guide wire extension accessory made of stainless steel and nitinol-titanium, designed to connect to another guide wire. This is consistent with a medical device used in interventional procedures, not an IVD.
  • Lack of IVD Characteristics: There is no mention of the device being used to test biological samples (blood, urine, tissue, etc.), reagents, or any other components typically associated with in vitro diagnostics.

Therefore, the VASSALLO GT EXT guide wire accessory is a medical device used in interventional procedures, not an IVD.

N/A

Intended Use / Indications for Use

The VASSALLO GT EXT guide wire accessory is intended for extension of the working length of an already introduced guide wire when exchanging over-the-wire interventional devices during an angioplasty procedure. This device is intended for peripheral vascular use only.

Product codes

DQX

Device Description

The VASSALLO GT EXT Guide Wire Extension accessory is used to elongate the working length of compatible peripheral extendable wires. The stainless-steel guide wire extension has an outer diameter of 0.014" (0.36 mm) and a length of 165 cm. The distal end consists of a pipe shaped nitinol-titanium connection port (extension tube). The straight stainless steel wire surface is coated with PTFE.
The extension wire is intended to connect with a FILMECC peripheral guide wire shorter than 300 cm. The total length of the system after connection will be 300 cm to 400 cm.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Peripheral vascular

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Non-clinical laboratory testing was performed on the VASSALLO GT EXT to determine substantial equivalence. Testing involved evaluating the joint strength of the extension tube and core wire of extension wire in addition to the joint strength of the extension tube and the core extension wire.
The in vitro bench tests demonstrated that the VASSALLO GT EXT met all acceptance criteria and that the device functions as intended and has a safety and effectiveness profile that is similar to the predicate device.

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

Not Found

Predicate Device(s)

ASAHI Guide Wire Extension, K101985

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.1330 Catheter guide wire.

(a)
Identification. A catheter guide wire is a coiled wire that is designed to fit inside a percutaneous catheter for the purpose of directing the catheter through a blood vessel.(b)
Classification. Class II (special controls). The device, when it is a torque device that is manually operated, non-patient contacting, and intended to manipulate non-cerebral vascular guide wires, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 870.9.

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October 26, 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.

Filmecc Co. Ltd. % Candace Cederman Principal Consultant CardioMed Device Consultants, LLC 1783 Forest Drive. Suite 254 Annapolis, Maryland 21401

Re: K222631

Trade/Device Name: Vassallo Gt Ext Regulation Number: 21 CFR 870.1330 Regulation Name: Catheter Guide Wire Regulatory Class: Class II Product Code: DQX Dated: August 30, 2022 Received: August 31, 2022

Dear Candace Cederman:

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) Prem arket 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 w arranties. 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

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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 (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 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,

for Lydia Glaw Assistant Director DHT2C: Division of Coronary and Peripheral Intervention Devices OHT2: Office of Cardiovascular Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K222631

Device Name VASSALLO GT EXT

Indications for Use (Describe)

The VASSALLO GT EXT guide wire accessory is intended for extension of the working length of an already introduced guide wire when exchanging over-the-wire interventional devices during an angioplasty procedure. This device is intended for peripheral vascular use only.

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

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

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510(k) Summary

(as required by 21 CFR 807.92)

Image /page/3/Picture/2 description: The image shows the logo for Filmecc. The logo consists of a red abstract shape on the left, followed by the word "Filmecc" in black letters, with a red square on top of the "i". Below the logo, the text "FILMECC Extension Wire" is written in a smaller font size.

FILMECC Extension Wire VASSALLO® GT EXT

510(k) K222631

Date Prepared:October 14, 2022
Applicant:FILMECC CO., LTD.
1703 Wakita-cho, Moriyama-ku
Nagoya-shi, Aichi 463-0024
Japan
TEL : +81-52-768-1212, FAX : +81-52-768-1222
Contact:Takahiro Kuroiwa
Regulatory Affairs
FILMECC CO., LTD.
1703 Wakita-cho, Moriyama-ku
Nagoya-shi, Aichi 463-0024
Japan
TEL : +81-52-768-1212, FAX : +81-52-768-1222
e-mail: takahiro.kuroiwa@filmecc.com
Trade Name:VASSALLO GT EXT
Device Classification:Class 2 per 21 CFR §870.1330
Classification Name:Catheter, Guide, Wire
Product Code:DQX - Catheter Guide Wire
Predicate Devices:ASAHI Guide Wire Extension, K101985

INTENDED USE/INDICATIONS FOR USE:

VASSALLO GT EXT

The VASSALLO GT EXT Guide Wire Extension accessory is intended for extension of the working length of an already introduced guide wire when exchanging over-thewire interventional devices during an angioplasty procedure. This device is intended for peripheral vascular use only.

DEVICE DESCRIPTION:

The VASSALLO GT EXT Guide Wire Extension accessory is used to elongate the working length of compatible peripheral extendable wires. The stainless-steel guide wire extension has an outer diameter of 0.014" (0.36 mm) and a length of 165 cm. The distal end consists of a pipe shaped nitinol-titanium connection port (extension tube). The straight stainless steel wire surface is coated with PTFE.

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The extension wire is intended to connect with a FILMECC peripheral guide wire shorter than 300 cm. The total length of the system after connection will be 300 cm to 400 cm.

COMPARISON WITH PREDICATE DEVICES:

Comparison of the VASSALLO GT EXT and the predicate device show that the technological characteristics of the subject device such as the components, design, materials, sterilization method, shelf life and operating principle are identical to the currently marketed predicate device. The intended use of the subject device and its predicate are the same.

Name of DevicesVASSALLO GT EXTASAHI Guide Wire Extension
SubjectPredicate
510(k)K222631K101985
Intended Use and
IndicationsIntended for extension of the working
length of an already introduced guide
wire when exchanging over-the-wire
interventional devices during
an
angioplasty procedure This device is
intended for peripheral vascular use
only.Intended for extension of the working
length of an already introduced guide
wire when exchanging over-the-wire
interventional devices during
an
angioplasty procedure
Target locationPeripheralCoronary and Peripheral
Nominal OD0.36 mm0.36 mm
(0.014 inch)(0.014 inch)
Overall Length165 cm165 cm
Tapered Core WireStainless SteelStainless Steel
Extension TubeNi-Ti alloyNi-Ti alloy
Hydrophobic CoatingPTFEPTFE
SterilizationEOEO
Shelf Life3 years3 years

NON-CLINICAL TESTING/PERFORMANCE DATA:

Non-clinical laboratory testing was performed on the VASSALLO GT EXT to determine substantial equivalence. Testing involved evaluating the joint strength of the extension tube and core wire of extension wire in addition to the joint strength of the extension tube and the core extension wire.

The in vitro bench tests demonstrated that the VASSALLO GT EXT met all acceptance criteria and that the device functions as intended and has a safety and effectiveness profile that is similar to the predicate device.

CONCLUSION:

The VASSALLO GT EXT accessory has the same intended use and the same or similar technological characteristics such as components, design, materials, sterilization method, shelf life and operating principles as the predicate device. Performance data demonstrates that the device functions as intended. The conclusion drawn from the nonclinical tests demonstrate that the VASSALLO GT EXT is as safe, as effective, and performs as well as or better than the legally marketed predicate device.

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Therefore, the VASSALLO GT EXT is substantially equivalent to the predicate
devices.