K Number
K963016
Device Name
SIMON NITINOL FILTER SYSTEM
Date Cleared
1996-11-18

(108 days)

Product Code
Regulation Number
870.3375
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The intended use of Nitinol Medical Technologies, Inc.'s ("NMT") Simon Nitinol Filter™ System ("SNF System") is to prevent pulmonary embolisms from migrating to the pulmonary arteries.
Device Description
The cleared SNF System and the proposed models of the SNF System are composed of a SN Filter and a delivery system. The SN Filter component is made of a nitinol alloy which has thermal shape memory properties. These properties allow the nitinol alloy wires to be formed into the shape of a filter. When placed in saline, the wires become soft and can be straightened to allow delivery through a small diameter catheter. The SN Filter resumes its original shape, a dome with six legs, when warmed to body temperature in the vena cava. The SN Filters are delivered via the Seldinger technique, using a 7 French I.D. angiographic introducer sheath and a preliminary venacavogram. The sheath is introduced into the vein and positioned in the vena cava. When the sheath is positioned in the vena cava, the dilator is removed and the delivery system for the SN Filter is attached to the sheath. The SN Filter is then advanced through the sheath using the pusher wire until the SN Filter is at the tip of the sheath in the vena cava. The pusher wire has a stainless steel pusher cup or pad on the distal end of the pusher wire. The pusher wire is held in position while the sheath is withdrawn. This action releases the SN Filter into the vena cava: the SN Filter expands to its original shape which secures it against the vena cava. The sheath is then removed. NMT intends to make two types of modifications to the cleared SNF System. First, NMT intends to market models of the SNF System with zero, one, and two gold, radiopaque marker bands. Second, NMT intends to expand the device's delivery methods to include subclavian delivery using the same delivery system as used for jugular delivery.
More Information

Not Found

No
The description focuses on the mechanical properties of the nitinol alloy and the delivery system, with no mention of AI or ML for image analysis, decision support, or any other function.

Yes
The device is intended to prevent pulmonary embolisms, which is a therapeutic intervention aimed at treating or preventing a medical condition.

No

The device is described as a filter system intended to prevent pulmonary embolisms from migrating to the pulmonary arteries, which indicates a therapeutic rather than a diagnostic function.

No

The device description clearly details physical components made of nitinol alloy and stainless steel, a delivery system involving a catheter, sheath, and pusher wire, and a physical filter that expands within the vena cava. This is a hardware-based medical device.

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

Here's why:

  • Intended Use: The intended use is to "prevent pulmonary embolisms from migrating to the pulmonary arteries." This is a therapeutic intervention performed within the patient's body.
  • Device Description: The device is a physical filter made of nitinol that is implanted in the vena cava. It is delivered and deployed using a catheter system. This is a medical device used for treatment, not for testing samples in vitro.
  • Lack of IVD Characteristics: The description does not mention any components or processes related to analyzing biological samples (blood, urine, tissue, etc.) outside of the body.

IVD devices are used to examine specimens derived from the human body to provide information for diagnosis, monitoring, or screening. This device is a therapeutic implant.

N/A

Intended Use / Indications for Use

The intended use of Nitinol Medical Technologies, Inc.'s ("NMT") Simon Nitinol Filter™ System ("SNF System") is to prevent pulmonary embolisms from migrating to the pulmonary arteries.

Product codes

DTK

Device Description

The cleared SNF System and the proposed models of the SNF System are composed of a SN Filter and a delivery system. The SN Filter component is made of a nitinol alloy which has thermal shape memory properties. These properties allow the nitinol alloy wires to be formed into the shape of a filter. When placed in saline, the wires become soft and can be straightened to allow delivery through a small diameter catheter. The SN Filter resumes its original shape, a dome with six legs, when warmed to body temperature in the vena cava.

The SN Filters are delivered via the Seldinger technique, using a 7 French I.D. angiographic introducer sheath and a preliminary venacavogram. The sheath is introduced into the vein and positioned in the vena cava. When the sheath is positioned in the vena cava, the dilator is removed and the delivery system for the SN Filter is attached to the sheath. The SN Filter is then advanced through the sheath using the pusher wire until the SN Filter is at the tip of the sheath in the vena cava. The pusher wire has a stainless steel pusher cup or pad on the distal end of the pusher wire. The pusher wire is held in position while the sheath is withdrawn. This action releases the SN Filter into the vena cava: the SN Filter expands to its original shape which secures it against the vena cava. The sheath is then removed.

NMT intends to make two types of modifications to the cleared SNF System. First, NMT intends to market models of the SNF System with zero, one, and two gold, radiopaque marker bands. Second, NMT intends to expand the device's delivery methods to include subclavian delivery using the same delivery system as used for jugular delivery.

The proposed models of SNF System have the same intended use as the cleared SNF System and the SNF/SL System. These devices are intended to prevent pulmonary embolisms from migrating to the pulmonary arteries. They have equivalent principles of operation as they deliver a pusher wire to push the SN Filter through a sheath inserted into a vein to the inferior vena cava. The minor technological differences between the proposed models of the SNF System and the cleared SNF System, namely the addition of one or two radiopaque marker bands to some models and the revision of device labeling to include subclavian delivery of the device does not raise any new questions of safety or effectiveness. Thus, the proposed models of the SNF System are substantially equivalent to the cleared SNF System.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

vena cava, pulmonary arteries

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)

Not Found

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.

K940489, K912144, K894703, K944353

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.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.3375 Cardiovascular intravascular filter.

(a)
Identification. A cardiovascular intravascular filter is an implant that is placed in the inferior vena cava for the purpose of preventing pulmonary thromboemboli (blood clots generated in the lower limbs and broken loose into the blood stream) from flowing into the right side of the heart and the pulmonary circulation.(b)
Classification. Class II. The special controls for this device are:(1) “Use of International Standards Organization's ISO 10993 ‘Biological Evaluation of Medical Devices Part I: Evaluation and Testing,’ ” and
(2) FDA's:
(i) “510(k) Sterility Review Guidance and Revision of 2/12/90 (K90-1)” and
(ii) “Guidance for Cardiovascular Intravascular Filter 510(k) Submissions.”

0

K963816

NOV 1 8 1996

510(k) Summary

Nitinol Medical Technologies, Inc.'s

Simon Nitinol Filter™ System

Submitter's Name, Address, and Telephone Number

Nitinol Medical Technologies, Inc. 263 Summer Street, 7th Floor Boston, MA 02210 (617) 737-0930 Phone: Facsimile: (617) 737-0924

Contact Person

Jonathan S. Kahan, Esq. Hogan & Hartson, L.L.P. 555 13th Street, N.W. Washington, D.C. 20004-1109 Phone: (202) 637-5794 Facsimile: (202) 637-5910

as Regulatory Counsel to Nitinol Medical Technologies, Inc.

Date Prepared

August 2, 1996

Name of Device

Simon Nitinol Filter™ System

Classification Name

Cardiovascular Intravascular Filter

Common Name

Vena Cava Filter System

Product Code

DTK

1

Predicate Devices

Intended Use

The intended use of Nitinol Medical Technologies, Inc.'s ("NMT") Simon Nitinol Filter™ System ("SNF System") is to prevent pulmonary embolisms from migrating to the pulmonary arteries.

Substantial Equivalence

The cleared SNF System and the proposed models of the SNF System are composed of a SN Filter and a delivery system. The SN Filter component is made of a nitinol alloy which has thermal shape memory properties. These properties allow the nitinol alloy wires to be formed into the shape of a filter. When placed in saline, the wires become soft and can be straightened to allow delivery through a small diameter catheter. The SN Filter resumes its original shape, a dome with six legs, when warmed to body temperature in the vena cava.

The SN Filters are delivered via the Seldinger technique, using a 7 French I.D. angiographic introducer sheath and a preliminary venacavogram. The sheath is introduced into the vein and positioned in the vena cava. When the sheath is positioned in the vena cava, the dilator is removed and the delivery system for the SN Filter is attached to the sheath. The SN Filter is then advanced through the sheath using the pusher wire until the SN Filter is at the tip of the sheath in the vena cava. The pusher wire has a stainless steel pusher cup or pad on the distal end of the pusher wire. The pusher wire is held in position while the sheath is withdrawn. This action releases the SN Filter into the vena cava: the SN Filter expands to its original shape which secures it against the vena cava. The sheath is then removed.

NMT intends to make two types of modifications to the cleared SNF System. First, NMT intends to market models of the SNF System with zero, one, and two gold, radiopaque marker bands. Second, NMT intends to expand the device's delivery methods to include subclavian delivery using the same delivery system as used for jugular delivery.

The proposed models of SNF System have the same intended use as the cleared SNF System and the SNF/SL System. These devices are intended to prevent pulmonary embolisms from migrating to the pulmonary arteries. They have equivalent principles of operation as they deliver a pusher wire to push the SN Filter through a sheath inserted into a vein to the inferior vena cava. The minor technological differences between the proposed models of the SNF System and the

2

cleared SNF System, namely the addition of one or two radiopaque marker bands to some models and the revision of device labeling to include subclavian delivery of the device does not raise any new questions of safety or effectiveness. Thus, the proposed models of the SNF System are substantially equivalent to the cleared SNF System.