K Number
K231629
Device Name
091 Balloon Guide Catheter
Manufacturer
Date Cleared
2023-10-31

(148 days)

Product Code
Regulation Number
870.1250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The 091 Balloon Guide Catheter is infacilitating the insertion and guidance of intravascular catheters into a selected blood vessel in the peripheral and neuro vascular systems. The balloon provides temporary vascular occlusion during these and other angiographic procedures. The Balloon Guide Catheter is also indicated for use as a conduit for Retrieval devices.
Device Description
The 091 Balloon Guide Catheter is a coaxial-lumen, coil-reinforced, variable stiffness catheter with a balloon at the distal end. A radiopaque marker is included at the distal end of the distal tip of the catheter) for fluoroscopic visualization. A compliant balloon is flush mounted on the catheter to provide temporary vascular occlusion during angiographic procedures. A bifurcated luer hub on the proximal end of the catheter allows attachments for flushing, and aspiration. This catheter is designed for use in facilitating the insertion and guidance of an intravascular catheter into a selected blood vessel in the peripheral and neuro vascular systems. The dimensions and maximum recommended balloon inflation volume for the 091 Balloon Guide Catheter are indicated on the product label. A peel-away introducer, dilator, and one-way luer valve accessory are included within the packaging. A similar dilator was cleared as part of the reference device under K172468. The 091 Balloon Guide Catheter is supplied sterile, non- pyrogenic, and is intended for single use only.
More Information

No
The device description and performance studies focus on the physical characteristics and mechanical performance of a catheter, with no mention of AI or ML capabilities.

No
Explanation: The device is used to facilitate the insertion and guidance of other intravascular catheters and provides temporary vascular occlusion, rather than directly treating a disease or condition.

No

Explanation: The device description and intended use clearly state that the catheter is for "facilitating the insertion and guidance of intravascular catheters" and providing "temporary vascular occlusion during angiographic procedures." It does not mention any function for diagnosing a condition or disease.

No

The device description clearly details a physical catheter with a balloon, lumens, reinforcement, and a radiopaque marker. It also mentions included hardware accessories like a peel-away introducer and dilator. This is a hardware medical device, not software-only.

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 and provide temporary vascular occlusion. This is an in vivo (within a living organism) application, not an in vitro (outside the body, typically on biological samples) diagnostic test.
  • Device Description: The description details a physical catheter with a balloon, designed for insertion into blood vessels. This aligns with an in vivo medical device.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting specific analytes, or providing diagnostic information based on laboratory testing.

Therefore, the 091 Balloon Guide Catheter is an in vivo medical device, not an IVD.

N/A

Intended Use / Indications for Use

The 091 Balloon Guide Catheter is infacilitating the insertion and guidance of intravascular catheters into a selected blood vessel in the peripheral and neuro vascular systems. The balloon provides temporary vascular occlusion during these and other angiographic procedures. The Balloon Guide Catheter is also indicated for use as a conduit for Retrieval devices.

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

DQY, QJP

Device Description

The 091 Balloon Guide Catheter is a coaxial-lumen, coil-reinforced, variable stiffness catheter with a balloon at the distal end. A radiopaque marker is included at the distal end of the distal tip of the catheter) for fluoroscopic visualization. A compliant balloon is flush mounted on the catheter to provide temporary vascular occlusion during angiographic procedures. A bifurcated luer hub on the proximal end of the catheter allows attachments for flushing, and aspiration. This catheter is designed for use in facilitating the insertion and guidance of an intravascular catheter into a selected blood vessel in the peripheral and neuro vascular systems. The dimensions and maximum recommended balloon inflation volume for the 091 Balloon Guide Catheter are indicated on the product label. A peel-away introducer, dilator, and one-way luer valve accessory are included within the packaging. A similar dilator was cleared as part of the reference device under K172468. The 091 Balloon Guide Catheter is supplied sterile, non- pyrogenic, and is intended for single use only.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Fluoroscopic imaging

Anatomical Site

Peripheral and Neuro 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)

The list of the performance testing conducted to demonstrate that the subject 091 Balloon Guide Catheter meets its performance specifications is presented below in Table 6.2. Verification test data from testing done on previously cleared version of the 091 Balloon Guide Catheter (K220331) were also used to support the new 091 Balloon Guide Catheter.

Test performedTest SummaryResults
Design Verification and Validation Testing
Catheter Tensile StrengthThe catheter must meet tensile strength specifications.Pass
Catheter BurstThe catheter must meet catheter burst specification.Pass
ParticulateThe catheters were tested in comparison to the predicate device for all particle sizes including the large particles to establish substantial equivalence to the predicate device.Pass
Dilator Working LengthThe dilator must meet working length specification.Pass
Dilator Inner Diameter (ID)The dilator must meet inner diameter (ID) specification.Pass
Dilator Outer Diameter (OD)The dilator must meet outer diameter (OD) specification.Pass
Dilator Hub CompatibilityThe hub luer shall meet the applicable criteria for each test as defined by ISO 594-1 and ISO 594-2.Pass
Dilator RadiopacityThe dilator shall be visible under fluoroscopic imaging.Pass
Dilator Tensile StrengthThe dilator must meet tensile strength specifications.Pass
Dilator Visual InspectionSamples were visually inspected under 2.5X magnification to ensure acceptance criteria were met.Pass
Label ContentThe label and directions for use (DFU) must meet content specifications.Pass
Usability - Simulated Use TestingSimulated use testing was conducted utilizing all accessory devices expected to be used during a clinical procedure.Pass

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.

091 Balloon Guide Catheter (K220331)

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.

091 Long Sheath (K172468)

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

§ 870.1250 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 31, 2023

Image /page/0/Picture/1 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 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.

EOSolutions, Corp. % Garry Koroshec Senior Design Quality Engineer / Regulatory Affairs InNeuroCo, Inc. 19700 Sterling Road, Suite 1 Pembroke Pines, Florida 33332

Re: K231629

Trade/Device Name: 091 Balloon Guide Catheter Regulation Number: 21 CFR 870.1250 Regulation Name: Percutaneous Catheter Regulatory Class: Class II Product Code: DQY, QJP Dated: October 3, 2023 Received: October 5, 2023

Dear Garry Koroshec:

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 (the 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 available 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.

Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device" (https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).

1

Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30, Design controls; 21 CFR 820.90, Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).

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 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 Part 803) for devices or postmarketing safety reporting (21 CFR Part 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 Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 -S

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

2

Indications for Use

510(k) Number (if known) K231629

Device Name 091 Balloon Guide Catheter

Indications for Use (Describe)

The 091 Balloon Guide Catheter is infacilitating the insertion and guidance of intravascular catheters into a selected blood vessel in the peripheral and neuro vascular systems. The balloon provides temporary vascular occlusion during these and other angiographic procedures. The Balloon Guide Catheter 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)

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3

510(k) Summary

Date Summary PreparedOctober 30, 2023
SubmitterInNeuroCo Inc.
19700 Stirling Road, Suite 1
Pembroke Pines, FL 33332
On behalf of:
EOSolutions, Corp.
19700 Stirling Road, Suite 1
Pembroke Pines, FL 33332
Primary Submission ContactGarry Koroshec
Staff Design Quality Engineer / Regulatory Affairs
InNeuroCo Inc.
19700 Stirling Road, Suite 1
Pembroke Pines, FL 33332
Telephone: 1-954-254-5003
Facsimile: 1-954-742-5989
E-Mail: garry@inneuroco.com
Secondary Submission ContactsMarianne Grunwaldt
Senior Director of Quality Assurance and Requlatory Affairs
InNeuroCo Inc.
19700 Stirling Road, Suite 1
Pembroke Pines, FL 33332
Telephone: 1-954-703-5271
Facsimile: 1-954-742-5989
E-Mail: marianne@inneuroco.com
Ming-Cheng Chew
Regulatory Consultant
RQM+
8401 73rd Avenue North, Suite 63
Brooklyn Park, MN 55428
Telephone: 763-232-3701
E-Mail: mchew@rqmplus.com
Trade Name091 Balloon Guide Catheter
Regulation Number21 CFR 870.1250
Device Common or Classification
NamePercutaneous Catheter, Neurovasculature
Product ClassClass II
Product PanelCardiovascular, Neurology
Product CodeDQY, QJP
Predicate Device091 Balloon Guide Catheter (K220331)
Reference Device091 Long Sheath (K172468)

4

6.1 Device Description

The 091 Balloon Guide Catheter is a coaxial-lumen, coil-reinforced, variable stiffness catheter with a balloon at the distal end. A radiopaque marker is included at the distal end of the distal tip of the catheter) for fluoroscopic visualization. A compliant balloon is flush mounted on the catheter to provide temporary vascular occlusion during angiographic procedures. A bifurcated luer hub on the proximal end of the catheter allows attachments for flushing, and aspiration. This catheter is designed for use in facilitating the insertion and guidance of an intravascular catheter into a selected blood vessel in the peripheral and neuro vascular systems. The dimensions and maximum recommended balloon inflation volume for the 091 Balloon Guide Catheter are indicated on the product label. A peel-away introducer, dilator, and one-way luer valve accessory are included within the packaging. A similar dilator was cleared as part of the reference device under K172468. The 091 Balloon Guide Catheter is supplied sterile, non- pyrogenic, and is intended for single use only.

6.2 Indications for Use

The 091 Balloon Guide Catheter is indicated for use in facilitating the insertion and guidance of intravascular catheters into a selected blood vessel in the peripheral and neuro vascular systems. The balloon provides temporary vascular occlusion during these and other angiographic procedures. The Balloon Guide Catheter is also indicated for use as a conduit for Retrieval devices.

6.3 Technological Characteristics and Basis for Substantial Equivalence

Table 6.1 Technological Comparison between the subject 091 Balloon Guide Catheter and 091 Balloon Guide Catheter (K220331)

| Parameter | Predicate Device
091 Balloon Guide Catheter (K220331) | Subject Device
091 Balloon Guide Catheter (K231629) |
|------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------|
| Indications for
Use | The 091 Balloon Guide Catheter is
indicated for use in facilitating the insertion
and guidance of intravascular catheters
into a selected blood vessel in the
peripheral and neuro vascular systems.
The balloon provides temporary vascular
occlusion during these and other
angiographic procedures. The Balloon
Guide Catheter is also indicated for use as
a conduit for Retrieval devices. | Same |
| Anatomical
Location | Peripheral and Neuro Vasculature | Same |
| Product Code | DQY, QJP | Same |
| Classification | Class II | Same |
| Requlation
Number | 870.1250 | Same |
| Catheter
Material | Outer Jacket: PTFE and Polyethylene
Inner Member: PTFE, Pebax, and Nylon
Distal Tip: Chronoflex and Polyolefin | Same |

5

| Parameter | Predicate Device
091 Balloon Guide Catheter (K220331) | Subject Device
091 Balloon Guide Catheter (K231629) |
|---------------------------|--------------------------------------------------------------------|-------------------------------------------------------------------------------|
| Reinforcement
Layer | Stainless Steel Coil | Same |
| Radiopaque
Marker Band | Platinum/Iridium | Same |
| Coating | None | Same |
| Internal
Construction | Co-axial Lumen | Same |
| Hub | Polycarbonate | Same |
| Strain Relief | Silicone | Same |
| Balloon
Material | Polyurethane Elastomer | Same |
| Working
Length | 95 cm | 75, 85, 95 cm |
| Max Outer
Diameter | 0.125 inches | Same |
| Shaft Inner
diameter | 0.0905 inches | Same |
| Accessories
supplied | Peel Away Introducer | Dilator, One-Way Valve, Peel Away
Introducer |
| Dilator | None | Working Length: 88, 98, 108 cm
Inner/Outer Diameter: 0.038 in max/0.087 in |
| Packaging | Polyethylene Tube and HDPE Packaging
Card
Tyvek/PE/PET Pouch | Same |
| Sterilization | Ethylene Oxide | Same |
| Number of
Uses | Single Use | Same |

6.4 Performance Data

The list of the performance testing conducted to demonstrate that the subject 091 Balloon Guide Catheter meets its performance specifications is presented below in Table 6.2. Verification test data from testing done on previously cleared version of the 091 Balloon Guide Catheter (K220331) were also used to support the new 091 Balloon Guide Catheter.

Test performedTest SummaryResults
Design Verification and Validation Testing
Catheter Tensile StrengthThe catheter must meet tensile strength specifications.Pass
Catheter BurstThe catheter must meet catheter burst specification.Pass
ParticulateThe catheters were tested in comparison to the predicate device for all
particle sizes including the
large particles to establish substantial equivalence to the predicate
device.Pass
Dilator Working LengthThe dilator must meet working length specification.Pass
Dilator Inner Diameter (ID)The dilator must meet inner diameter (ID) specification.Pass
Dilator Outer Diameter (OD)The dilator must meet outer diameter (OD) specification.Pass
Dilator Hub CompatibilityThe hub luer shall meet the applicable criteria for each test as defined
by ISO 594-1 and ISO 594-2.Pass
Dilator RadiopacityThe dilator shall be visible under fluoroscopic imaging.Pass
Dilator Tensile StrengthThe dilator must meet tensile strength specifications.Pass
Dilator Visual InspectionSamples were visually inspected under 2.5X magnification to ensure
acceptance criteria were met.Pass
Label ContentThe label and directions for use (DFU) must meet content specifications.Pass
Usability - Simulated Use TestingSimulated use testing was conducted utilizing all accessory devices
expected to be used during a clinical procedure.Pass

Table 6.2 – Performance Bench Tests Performed on the 091 Balloon Guide Catheter

6

6.5 Biocompatibility Testing

The 091 Balloon Guide Catheter and the dilator were assessed for biocompatibility in accordance with ISO 10993-1, "Biological evaluation of Medical Devices – Part 1: Evaluation and Testing within a Risk Management Process," as part of predicate and reference device submissions. There are no material or contact duration changes of these components in the current submission. The subject device an externally communicating medical device with circulating blood contact for less than 24 hours. The results of the prior testing demonstrate the biocompatibility of the 091 Balloon Guide Catheter and the dilator for their indicated use.

6.6 Sterilization Validation

A sterilization validation adoption assessment was conducted to verify that the subject device can be adopted into the previously validated ethylene oxide (EO) sterilization cycle. It concluded that the subject 091 Balloon Guide Catheter will likely present an equal or lesser challenge to the sterilization cycle than the existing products. EO residual testing and bioburden testing of the existing 091 Balloon Guide Catheter and dilator products are deemed applicable to the subject device.

6.7 Clinical Data and Animal Study

No clinical data or animal study were deemed necessary to support the subject device submission.

6.8 Conclusion

The review of the verification and validation test data as well as comparison of the device classification, indications for use, operating principle, technological characteristics, sterility, and biocompatibility, demonstrate that the subject device, the 091 Balloon Guide Catheter, is substantially equivalent to the predicate 091 Balloon Guide Catheter (K220331). The differences between the subject and the predicate devices do not raise new questions of safety and effectiveness.