K Number
K230743
Device Name
ICHOR 14F Embolectomy System
Manufacturer
Date Cleared
2023-09-05

(173 days)

Product Code
Regulation Number
870.5150
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The ICHOR 14F Embolectomy System is indicated for the non-surgical removal of emboli and thrombi from venous blood vessels. The System is intended for the peripheral vasculature and is not intended for use in the coronary or neurovasculature.
Device Description
The ICHOR 14F Embolectomy System is indicated for the non-surgical removal of emboli and thrombi from blood vessels. The System is intended for the peripheral venous vasculature (nominal size 8-14mm). - The System is composed of three catheters: (1) Introducer Sheath, (2) Guide Catheter, and (3) Balloon Catheter and accessories. - The outermost catheter is the Introducer Sheath, which travels to the occlusion site over the dilator. The Introducer Sheath is placed proximal to the occlusion and anchored into place by inflating the occluding balloon located at the distal tip. The balloon on the Introducer Sheath also serves to occlude flow. - The Guide Catheter, composed of the Basket Catheter telescoped within the Guide Catheter Sheath, is passed through the Introducer Sheath. When in place, the Guide Catheter Sheath, which serves as the capturing sleeve, is retracted proximally allowing a nitinol basket to expand within the vasculature proximal to the occlusion. - The Balloon Catheter is passed through the Guide Catheter and extended past the occlusion. The treatment balloon is inflated distal to the occlusion, and the Balloon Catheter is pulled proximally towards the basket until the occlusion is contained inside the basket. If desired the Guide Catheter can introduce aspiration to apply negative pressure to guide embolic material into the basket. - The accessories include a dilator, flush adapter, two 3cc syringes, a Tuohy Borst, and four extension lines with one-way stopcocks.
More Information

No
The device description focuses on mechanical components and procedures, with no mention of AI or ML. The "Mentions AI, DNN, or ML" section also explicitly states "Not Found".

Yes
The device is used for the non-surgical removal of emboli and thrombi from venous blood vessels, which constitutes a medical treatment for a disease or condition.

No.
The document describes a system for the "non-surgical removal of emboli and thrombi," indicating a therapeutic rather than diagnostic purpose.

No

The device description clearly outlines multiple physical components including catheters, sheaths, balloons, and accessories, indicating it is a hardware-based medical device.

Based on the provided information, the ICHOR 14F Embolectomy System is not an In Vitro Diagnostic (IVD) device.

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens (like blood, urine, or tissue) taken from the human body to provide information for diagnosis, monitoring, or screening. This testing is performed outside of the body (in vitro).
  • ICHOR 14F Embolectomy System Function: The description clearly states that the ICHOR 14F Embolectomy System is used for the "non-surgical removal of emboli and thrombi from venous blood vessels." This is a therapeutic procedure performed inside the body (in vivo) to remove blockages.
  • Lack of Specimen Analysis: There is no mention of the device analyzing any biological specimens or providing diagnostic information based on such analysis. Its purpose is mechanical removal of material from within blood vessels.

Therefore, the ICHOR 14F Embolectomy System falls under the category of a therapeutic medical device, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The ICHOR 14F Embolectomy System is indicated for the non-surgical removal of emboli and thrombi from venous blood vessels. The System is intended for the peripheral vasculature and is not intended for use in the coronary or neurovasculature.

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

QEW

Device Description

The ICHOR 14F Embolectomy System is indicated for the non-surgical removal of emboli and thrombi from blood vessels. The System is intended for the peripheral venous vasculature (nominal size 8-14mm).

  • The System is composed of three catheters: (1) Introducer Sheath, (2) Guide Catheter, and (3) Balloon Catheter and accessories.
  • The outermost catheter is the Introducer Sheath, which travels to the occlusion site over the dilator. The Introducer Sheath is placed proximal to the occlusion and anchored into place by inflating the occluding balloon located at the distal tip. The balloon on the Introducer Sheath also serves to occlude flow.
  • The Guide Catheter, composed of the Basket Catheter telescoped within the Guide Catheter Sheath, is passed through the Introducer Sheath. When in place, the Guide Catheter Sheath, which serves as the capturing sleeve, is retracted proximally allowing a nitinol basket to expand within the vasculature proximal to the occlusion.
  • The Balloon Catheter is passed through the Guide Catheter and extended past the occlusion. The treatment balloon is inflated distal to the occlusion, and the Balloon Catheter is pulled proximally towards the basket until the occlusion is contained inside the basket. If desired the Guide Catheter can introduce aspiration to apply negative pressure to guide embolic material into the basket.
  • The accessories include a dilator, flush adapter, two 3cc syringes, a Tuohy Borst, and four extension lines with one-way stopcocks.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

venous blood vessels, peripheral vasculature

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 Testing Performed
Biocompatibility Testing:

  • Acute Systemic Toxicity
  • Cytotoxicity
  • Hemocompatibility
    • complement activation
    • direct and indirect hemolysis
    • in vivo thrombogenicity (leveraged from GLP animal study)
  • Irritation
  • Material-Mediated Pyrogenicity
  • Sensitization

Bench Testing:

  • Accelerated Aging Testing Protocol
  • Balloon characterization Testing
    • balloon fatigue
    • balloon inflation/deflation time
    • balloon compliance
  • Basket Durability
  • Basket Radial Force Testing
  • Bend Radius Testing
  • Hub Pressurization Testing
  • Package Integrity and Bubble Leak
  • Radiopacity Testing
  • Seal Peel Testing
  • Simulated Use Testing
  • Tensile Testing
  • Torque Strength Testing
  • Visual and Dimensional

Sterilization: The device is ethylene oxide sterilized and met the requirements for ethylene oxide and ethylene chlorohydrin residuals per ISO 10993- 7:2008/Amd1:2019; and met the requirements for bacterial endotoxin per AAMI/ANSI ST72:2019.

Animal Study: A GLP study was conducted, comparing the ICHOR 14F Embolectomy System to a comparator device at an acute timepoint. Adverse Events, clinical observations, clinical pathology excursions, gross pathological, and histomorphological finding were evaluated.

Conclusion: The ICHOR 14F Embolectomy System is substantially equivalent to the predicate device.

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

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K182531, K182167

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

K171493, K152762

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 870.5150 Embolectomy catheter.

(a)
Identification. An embolectomy catheter is a balloon-tipped catheter that is used to remove thromboemboli, i.e., blood clots which have migrated in blood vessels from one site in the vascular tree to another.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/0 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 the FDA logo, which 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.

September 5, 2023

Ichor Angela Mallery Regulatory 1900 NW 25th St. Boca Raton, Florida 33431

Re: K230743

Trade/Device Name: ICHOR 14F Embolectomy System Regulation Number: 21 CFR 870.5150 Regulation Name: Embolectomy Catheter Regulatory Class: Class II Product Code: QEW Dated: August 3. 2023 Received: August 3, 2023

Dear Angela Mallery:

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,

Ariel G. Ash- Digitally signed by
Ariel G. Ash-shakoor -S
shakoor -S Date: 2023.09.05
15:45:12 -04'00'

For

Gregory O'Connell 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

2

Indications for Use

510(k) Number (if known) K230743

Device Name The ICHOR 14F Embolectomy System

Indications for Use (Describe)

The ICHOR 14F Embolectomy System is indicated for the non-surgical removal of emboli and thrombi from venous blood vessels. The System is intended for the peripheral vasculature and is not intended for use in the coronary or neurovasculature.

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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3

510(k) Summary K230743

Date preparedAugust 31, 2023
NameICHOR
1900 NW 25th St. Boca Raton FL 33431 United States
Contact personAngela Mallery
amallery@namsa.com
763-287-3830
Name of DeviceICHOR 14F Embolectomy System
Common nameEmbolectomy catheter
Regulation namePeripheral Mechanical Thrombectomy With Aspiration
Classification number21 CFR 870.5150
Product codeQEW
Regulatory classII
Predicate #Predicate Trade NameProduct Code
Predicate deviceK182531The ClotTriever Thrombectomy SystemQEW
K182167ICHOR PanaceaQEW
Reference deviceK171493MegaVac Mechanical Thrombectomy SystemQEW
K152762Fogarty Occlusion CatheterMJN

Device Description

Predicate and Reference

Devices

The ICHOR 14F Embolectomy System is indicated for the non-surgical removal of emboli and thrombi from blood vessels. The System is intended for the peripheral venous vasculature (nominal size 8-14mm).

  • The System is composed of three catheters: (1) Introducer Sheath, (2) Guide Catheter, and (3) Balloon Catheter and accessories.
  • · The outermost catheter is the Introducer Sheath, which travels to the occlusion site over the dilator. The Introducer Sheath is placed proximal to the occlusion and anchored into place by inflating the occluding balloon located at the distal tip. The balloon on the Introducer Sheath also serves to occlude flow.
  • · The Guide Catheter, composed of the Basket Catheter telescoped within the Guide Catheter Sheath, is passed through the Introducer Sheath. When in place, the Guide Catheter Sheath, which serves as the capturing sleeve, is retracted proximally allowing a nitinol basket to expand within the vasculature proximal to the occlusion.
  • · The Balloon Catheter is passed through the Guide Catheter and extended past the occlusion. The treatment balloon is inflated distal to the occlusion, and the Balloon Catheter is pulled proximally towards the basket until the occlusion is contained inside the basket. If desired the Guide Catheter can introduce aspiration to apply negative pressure to guide embolic material into the basket.
  • · The accessories include a dilator, flush adapter, two 3cc syringes, a Tuohy Borst, and four extension lines with one-way stopcocks.

The ICHOR 14F Embolectomy System is indicated for the non-surgical removal of emboli and thrombi Indications for Use from venous blood vessels. The System is intended for the peripheral vasculature and is not intended for use in the coronary or neurovasculature.

4

Comparison of Technological Characteristics with the Predicate Device

Summary of substantial

equivalence

Minor differences in the indication for use are acceptable and do not raise new questions of safety or effectiveness; the predicate had additional indications for injections and infusion of fluid; the lack of this indication does not raise additional questions.

Minor technological differences exist between the predicate and subject device; both devices are designed to capture clot with a basket and have the option to aspirate via a syringe; minor differences in dimensions have been verified and validated through bench and animal testing and the testing confirms these do not raise new questions of safety and effectiveness than the predicate device.

The reference devices were included to confirm/demonstrate the technology has similar situations FDA has encountered in the past; the reference devices are used in the identical anatomical location for the same purpose as the subject device. The ICHOR Panacea 7F uses the same basket/balloon configuration; the Mega Vac also uses a Nitinol Basket for removal of clot, the Fogarty devices use a balloon for the movement of clot. The MegaVac and Fogarty devices were the used to support the ICHOR Panacea 7F device.

Although the predicate and subject devices have different technological characteristics, all leveraged and performed design verification and validation tests confirm that these differences do not raise any new or different questions of safety or effectiveness.

Substantial Equivalence Executive Summary
ICHOR 14FClotTriever
K182531
Indications for UseThe ICHOR 14F Embolectomy System is
indicated for the non-surgical removal of emboli
and thrombi from venous blood vessels. The
device is intended for the peripheral vasculature,
and is not intended for use in the coronary or
neurovasculature.The ClotTriever Thrombectomy
System consists of the ClotTriever
Catheter and ClotTriever Sheath.
The ClotTriever Thrombectomy
System is indicated for:
The non-surgical removal of soft
thrombi and emboli from blood
vessels.
Injection, infusion, and/or
aspiration of contrast media and
other fluids into or from a blood
vessel.
The ClotTriever Thrombectomy
System is intended for use in the
peripheral vasculature
Nitinol Funnel
(max)18mm14mm
Treatment Balloon
Material/SizePebax
Diameter: 14mm / Length 15mmNo balloon, Nitinol coring element
Usable Catheter
LengthsBalloon catheter: 100cm
Guide catheter: 55cm
Introducer sheath: 15cm105cm deployed
74cm usable
BiocompatibilityTested to 10993-1Tested to 10993-1
SterilizationEOEO
PackagingTyvek PackagingTyvek Packaging
Aspiration
MechanismSyringeSyringe

Non-Clinical Testing Performed

Biocompatibility Testing:

  • Acute Systemic Toxicity ●
  • . Cytotoxicity
  • Hemocompatibility
    • o complement activation
    • direct and indirect hemolysis O
  • in vivo thrombogenicity (leveraged from GLP animal study O
  • Irritation
  • Material-Mediated Pyrogenicity .
  • Sensitization ●

5

Bench Testing:

  • Accelerated Aging Testing Protocol ●
  • Balloon characterization Testing ●
    • balloon fatigue o
    • balloon inflation/deflation time o
    • balloon compliance o
  • Basket Durability ●
  • Basket Radial Force Testing ●
  • . Bend Radius Testing
  • Hub Pressurization Testing
  • Package Integrity and Bubble Leak
  • . Radiopacity Testing
  • Seal Peel Testing ●
  • Simulated Use Testing
  • . Tensile Testing
  • Torque Strength Testing ●
  • Visual and Dimensional ●

Sterilization: The device is ethylene oxide sterilized and met the requirements for ethylene oxide and ethylene chlorohydrin residuals per ISO 10993- 7:2008/Amd1:2019; and met the requirements for bacterial endotoxin per AAMI/ANSI ST72:2019.

Animal Study: A GLP study was conducted, comparing the ICHOR 14F Embolectomy System to a comparator device at an acute timepoint. Adverse Events, clinical observations, clinical pathology excursions, gross pathological, and histomorphological finding were evaluated.

The ICHOR 14F Embolectomy System is substantially equivalent to the predicate device. Conclusion