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The Tigertriever 17 Ultra Revascularization Device is intended to restore blood flow by removing thrombus from a large intracranial vessel in patients experiencing ischemic stroke within 8 hours of symptom onset. Patients who are ineligible for thrombolytic drug therapy or who failed thrombolytic drug therapy are candidates for treatment.

The Tigertriever 17 Ultra Revascularization Device (TRPP7266) is a line extension of the existing Tigertriever 17 Revascularization Device (TRPP7166) cleared under K203592. The Tigertriever 17 Ultra Revascularization Device is a stentriever that is comprised of an adjustable nitinol braided mesh, stainless steel shaft, nitinol core wire and a handle. The shaft connects the mesh and the handle by the core wire that runs inside the shaft from the distal end of the mesh to the slider activation element in the handle. The mesh is expanded when the physician pulls the slider, since the wires of the mesh are completely radiopaque, the physician sees the mesh under fluoroscopy and controls it until it conforms to the vessel diameter. The design of the wire mesh is optimized to penetrate the clot and encapsulate it during retrieval. The Tigertriever 17 Ultra Revascularization Device is supplied sterile and is intended for single-use only by physicians trained in neurointerventional procedures and the treatment of ischemic stroke.

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The BraidE Embolization Assist Device is indicated for use in the peripheral vasculature as a temporary endovascular device used to assist in the coil embolization of wide-necked peripheral aneurysms with a neck width ≤ 10 mm. A wide-necked peripheral aneurysm defines the neck width as > 4 mm or a dome-to-neck ratio < 2.

The BraidE Embolization Assist Device is a sterile single use endovascular device intended to provide temporary assistance for the coil embolization of wide-necked peripheral aneurysms. The BraidE is comprised of a nitinol braided mesh, stainless steel shaft, nitinol core wire and a handle. The braided mesh at the distal portion of the device is shown in Figure 2. The shaft connects the mesh and the handle by the core wire that runs inside the shaft from the distal end of the mesh to the slider activation element in the handle. The mesh is expanded when the physician pulls the slider. Because the wires of the mesh are completely radiopaque, the physician sees the mesh under fluoroscopy and controls it until it conforms to the aneurysm neck morphology and vessel requirement.

This document describes the regulatory acceptance of the BraidE Embolization Assist Device, leveraging data primarily from the Comaneci Embolization Assist Device due to shared design features. The core of the acceptance criteria and supporting studies are presented below:

1. Table of Acceptance Criteria and Reported Device Performance

The acceptance criteria are derived from the "Special Controls" section, which outlines the requirements for clinical, animal, and non-clinical performance, as well as biocompatibility and labeling. The reported device performance is extracted from the "Summary of Clinical Information" and "Summary of Nonclinical/Bench Studies" sections.

2. Sample Size Used for the Test Set and Data Provenance

• Test Set Sample Size:
  • Clinical (Neurovascular): 63 patients / 64 intracranial aneurysms.
  • Clinical (Peripheral): 6 patients across 3 case studies.
  • Animal: 20 rabbits (used to create 23 aneurysms).
• Data Provenance:
  • Clinical (Neurovascular): Retrospective collection from two sites outside the United States: Walton Center in Liverpool, United Kingdom, and University Hospital St. Ivan Rilski in Sofia, Bulgaria. Data collected between March to December 2017.
  • Clinical (Peripheral): Reported in the clinical literature (3 publications) - specifics on country of origin for these individual cases are not provided.
  • Animal: Conducted in a rabbit model (Good Laboratory Practice (GLP) standards). Location not specified.
  • Non-clinical/Bench: Performed internally or by contract labs.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and Their Qualifications

• Clinical (Neurovascular - Retrospective Study):
  • Imaging Data (Technical Success and Safety): Independently analyzed by the Angiography and Noninvasive Imaging Core Lab at the University of California - Los Angeles (UCLA) in Los Angeles, California. No specific number or qualifications of individual experts from the core lab are provided, but a core lab typically implies specialized radiologists/neuro-interventionalists.
  • Adverse Events (AE): Adjudicated independently by the Department of Neurology at the University of Southern California (USC). No specific number or qualifications of individual experts from the department are provided, but a neurology department implies neurologists with relevant expertise.
• Clinical (Peripheral - Case Studies): The ground truth for effectiveness (aneurysm exclusion/occlusion, patency) and safety observations would have been established by the treating physicians and reported in their publications. No specific number or qualifications of experts beyond the authors of these publications are provided.
• Animal Study: Aneurysmal healing was characterized by light microscopy and en face assessment by scanning electron microscopy (SEM). Histologic indicators of vessel wall healing were determined by light microscopy and SEM. These analyses would be performed by trained pathologists/histologists. No specific number or qualifications are mentioned.

4. Adjudication Method for the Test Set

• Clinical (Neurovascular - Retrospective Study):
  • Imaging data for technical success and safety were independently analyzed by the Angiography and Noninvasive Imaging Core Lab at UCLA.
  • Adverse events (AE) were adjudicated independently by the Department of Neurology at USC.
  • This suggests independent review by specialized entities, but no specific 'X+Y' method (e.g., 2+1, 3+1) for individual case agreement is explicitly stated within these "independent" reviews.
• Clinical (Peripheral - Case Studies): The data presented are observational reports from published case studies. There's no indication of an independent adjudication method for these specific cases beyond the reporting clinicians' assessments.
• Animal Study: The analyses (microscopy, SEM, angiographic evaluations) would involve expert interpretation. No explicit adjudication method for disagreements is described beyond the reporting of findings.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done

No, an MRMC comparative effectiveness study was not explicitly done in the provided text. The clinical data focuses on device performance in specific populations, and a "control device" was used in the animal study for comparison, but this is not framed as a human MRMC comparative effectiveness study. Human readers (clinicians) were involved in the treatment and assessment, but the study design was not an MRMC study comparing human readers' performance with and without AI assistance. The device itself is an assistive tool, not an AI diagnostic/interventional algorithm.

6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) Was Done

This question is not applicable as the BraidE Embolization Assist Device is a physical medical device intended for human-in-the-loop (physician) use to assist in procedures, not an AI algorithm.

7. The Type of Ground Truth Used

• Clinical (Neurovascular - Retrospective Study):
  • Technical Success: Established by independent analysis of imaging data (angiography) by a core lab.
  • Safety/Adverse Events: Established by independent adjudication by a neurology department based on clinical observation and reported events.
• Clinical (Peripheral - Case Studies): Clinical outcomes (aneurysm exclusion, vessel patency) observed and reported by treating physicians, likely based on imaging (e.g., CTA) and clinical assessment.
• Animal Study: Gross, histological, and clinical chemistry evaluations, combined with angiographic assessments and scanning electron microscopy (SEM), constituted the ground truth for safety and performance in the animal model.
• Non-clinical/Bench Studies: Physical measurements, material analysis, and simulated performance tests against predetermined specifications.

8. The Sample Size for the Training Set

The document does not describe a "training set" in the context of an AI algorithm or a de novo clinical trial for this device. The clinical "training" data for the BraidE (a physical device) would be the experience gained with the predecessor Comaneci device.

• The BraidE device leverages data from the Comaneci device. The Comaneci device itself was evaluated in a "historical post-market data" retrospective study involving 63 patients (64 intracranial aneurysms). This data effectively serves as the "prior experience" or "training" knowledge base for the regulatory acceptance of the BraidE, especially since BraidE shares clinically relevant design features.
• The "training plan for the use of the device with the novel adjustment feature of the mesh region was provided as part of the review," suggesting educational materials for physicians, rather than an algorithmic training set.

9. How the Ground Truth for the Training Set Was Established

As noted above, "training set" here refers to the clinical experience/data gathered from the Comaneci device, which is leveraged for the BraidE.

• For the neurovascular retrospective study of the Comaneci device:
  • Technical success and safety imaging data: Independently analyzed by the Angiography and Noninvasive Imaging Core Lab at UCLA.
  • Adverse events: Independently adjudicated by the Department of Neurology at USC.
• For the peripheral case studies of the Comaneci device: Ground truth was established by the treating physicians' assessments based on procedural outcomes, follow-up imaging (e.g., CTA), and clinical observations, as reported in the literature.

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The Tigertriever Revascularization Device is intended to restore blood flow by removing thrombus from a large intracranial vessel in patients experiencing ischemic stroke within 8 hours of symptom onset. Patients who are ineligible for intravenous tissue plasminogen activator (IV t-PA), or who fail IV t-PA therapy, are candidates for treatment.

The Tigertriever device is a stentriever that is comprised of an adjustable nitinol braided mesh, stainless steel shaft, nitinol core wire and a handle. The shaft connects the mesh and the handle by the core wire that runs inside the shaft from the distal end of the mesh to the slider activation element in the handle. The mesh is expanded when the physician pulls the slider, since the wires of the mesh are completely radiopaque, the physician sees the mesh under fluoroscopy and controls it until it conforms to the vessel diameter. The design of the wire mesh is optimized to penetrate the clot and encapsulate it during retrieval. The Tigertriever Revascularization Device is supplied sterile and is intended for single-use only by physicians trained in neurointerventional procedures and the treatment of ischemic stroke.

This document is a 510(k) summary for the Tigertriever 21, 17, and 13 Revascularization Devices. It largely references predicate devices and non-clinical testing for substantial equivalence, rather than a de novo clinical study with specific acceptance criteria.

Here's an analysis based on the provided text:

1. Table of Acceptance Criteria and Reported Device Performance

Since this is a 510(k) submission based on substantial equivalence to predicate devices and non-clinical testing, explicit numerical acceptance criteria and a single overall "device performance" metric are not presented in the same way they would be in a de novo clinical trial. Instead, the "acceptance criteria" are implied by successful completion of each test method as summarized in the tables below. The reported performance is that the device "met acceptance criteria" or "demonstrated acceptable performance."

2. Sample Size Used for the Test Set and Data Provenance

• Test Set Sample Size: The document does not specify a numerical sample size (e.g., number of devices, number of clots, number of anatomical models) for the bench tests. It refers to "devices" being tested. For biocompatibility, it refers to "a representative Tigertriever device."
• Data Provenance: The data is based on non-clinical (bench and in vitro) testing conducted by the manufacturer, Rapid Medical Ltd. The country of origin for the testing is not explicitly stated, but the manufacturer is based in Yokneam, Israel. The data is prospective in the sense that these tests were performed for this submission to demonstrate substantial equivalence.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications

• This information is not provided as the submission relies on non-clinical (bench) testing, not on human expert evaluation of images or clinical outcomes that would typically require ground truth establishment by experts.
• The simulated use test involved an "anatomical model," and the interpretation of its "effectiveness" would have been by the testers, not external experts establishing ground truth in the context of diagnostic performance.

4. Adjudication Method for the Test Set

• Again, this is not applicable as there was no clinical test set requiring expert adjudication. The tests described are engineering and chemical performance tests.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done

• No, an MRMC comparative effectiveness study was not done. The document explicitly states: "A clinical study was not deemed necessary to evaluate the modifications to the Tigertriever Revascularization Device." Therefore, no effect size of human readers improving with AI vs. without AI assistance can be reported.

6. If a Standalone (Algorithm Only Without Human-in-the-Loop Performance) Was Done

• No, this entire submission is for a physical medical device (stentriever), not an AI algorithm. Therefore, "standalone" algorithm performance is not relevant.

7. The Type of Ground Truth Used

• For the bench tests, the "ground truth" is established by the physical and chemical properties of the device meeting predetermined engineering specifications and international standards (e.g., ISO 10555-1 for tensile strength, USP limits for pyrogenicity). For the simulated use, the "ground truth" is the observed successful performance (clot retrieval, flow restoration) in the in vitro model.
• For biocompatibility tests, the ground truth is based on recognized biological endpoints and standard testing methodologies (e.g., Grade 0 reactivity for cytotoxicity/sensitization, specific SC5b-9 concentrations, non-hemolytic results, acceptable temperature rise for pyrogenicity).

8. The Sample Size for the Training Set

• This is not applicable. The device is a physical stentriever, not an AI model that requires a training set.

9. How the Ground Truth for the Training Set Was Established

• This is not applicable for the same reason as point 8.

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The Tigertriever Revascularization Device is intended to restore blood flow by removing thrombus from a large intracranial vessel in patients experiencing ischemic stroke within 8 hours of symptom onset. Patients who are ineligible for intravenous tissue plasminogen activator (IV t-PA), or who fail IV t-PA therapy, are candidates for treatment.

The Tigertriever 13 device is a stentriever that is comprised of an adjustable nitinol braided mesh, stainless steel shaft, nitinol core wire and a handle. The shaft connects the mesh and the handle by the core wire that runs inside the shaft from the distal end of the slider activation element in the handle. The mesh is expanded when the physician pulls the slider, since the wires of the mesh are completely radiopaque, the physician sees the mesh under fluoroscopy and controls it until it conforms to the vessel diameter. The design of the wire mesh is optimized to penetrate the clot and encapsulate it during retrieval. The Tigertriever 13 Revascularization Device is supplied sterile and is intended for single-use only by physicians trained in neuro-interventional catheterization and the treatment of ischemic stroke.

The provided document does not describe acceptance criteria for an AI/ML device or a study proving that an AI/ML device meets acceptance criteria. Instead, it is a 510(k) summary for a medical device called the "Tigertriever 13 Revascularization Device," which is a stentriever used to remove thrombus in ischemic stroke patients. This type of device is a physical medical instrument, not an AI/ML software.

The document discusses non-clinical performance data, including biocompatibility, sterilization, shelf life, and various bench tests for the Tigertriever 13 Revascularization Device. It also mentions pre-clinical animal testing.

Therefore, I cannot provide the requested information about acceptance criteria and studies for an AI/ML device based on the given input.

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The Tigertriever Revascularization Device is intended to restore blood flow by removing thrombus from a large intracranial vessel in patients experiencing ischemic stroke within 8 hours of symptom onset. Patients who are ineligible for intravenous tissue plasminogen activator (IV t-PA), or who fail IV t-PA therapy, are candidates for treatment.

The Tigertriever device is a stentriever that is comprised of an adjustable nitinol braided mesh, stainless steel shaft, nitinol core wire and a handle. The shaft connects the mesh and the handle by the core wire that runs inside the shaft from the distal end of the mesh to the slider activation element in the handle. The mesh is expanded when the physician pulls the slider, since the wires of the mesh are completely radiopaque, the physician sees the mesh under fluoroscopy and controls it until it conforms to the vessel diameter. The design of the wire mesh is optimized to penetrate the clot and encapsulate it during retrieval. Two versions of the device are available. The standard version Tigertriever (TRPP7155) has a net length of 32mm (unexpanded form) and it is delivered through a microcatheter with an internal diameter of 0.021 inches. The shorter version Tigertriever 17 (TRPP7166) has a net length of 23 mm (unexpanded form) and it is delivered through a microcatheter with an internal diameter of 0.017 inches. The Tigertriever is provided with a 3.5 Fr peelable loading sheath.

Here's a breakdown of the acceptance criteria and the study that proves the device meets them, based on the provided text:

Acceptance Criteria and Device Performance

The Tigertriever Revascularization Device's performance was evaluated against specific criteria established through a clinical trial (the TIGER study), with a performance goal derived from several other successful stroke device trials.

Table 1: Acceptance Criteria and Reported Device Performance

Note: The document explicitly states that "the TIGER study was successfully met all pre-defined success criteria." The reported performance for both primary endpoints falls within the predefined acceptable ranges/thresholds.

Study Details for Device Performance

The clinical study conducted to demonstrate the device meets the acceptance criteria is the TIGER (Treatment with Intent to Generate Endovascular Reperfusion) clinical trial.

1. Sample Size used for the test set and the data provenance:

   • Test Set Sample Size: 148 patients in the modified Intent-to-Treat (mITT) Cohort.
   • Data Provenance: Not explicitly stated, but it is a multi-center clinical trial. Given the nature of medical device trials and FDA submissions, it would be considered prospective data collection. The document does not specify the country of origin of the data, but the sponsor is Rapid Medical Ltd. (Israel).

2. Number of experts used to establish the ground truth for the test set and the qualifications of those experts:

   • Ground Truth for Effectiveness (revascularization): The revascularization (mTICI scores) were adjudicated by a Core Laboratory. The number and specific qualifications of the experts within this Core Laboratory are not provided in this document.
   • Ground Truth for Safety (sICH): The symptomatic intracranial hemorrhage (sICH) events were adjudicated by the Clinical Events Committee (CEC). The number and specific qualifications of the experts within this CEC are not provided in this document.

3. Adjudication method for the test set:

   • Effectiveness (mTICI): Adjudicated by a Core Laboratory (specific method like 2+1 not detailed).
   • Safety (sICH): Adjudicated by a Clinical Events Committee (CEC) (specific method like 2+1 not detailed).

4. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance:

   • No. This document describes a clinical trial for a physical medical device (thrombus retriever), not an AI-powered diagnostic or assistive tool. Therefore, an MRMC comparative effectiveness study involving AI assistance for human readers was not performed or relevant in this context.

5. If a standalone (i.e. algorithm only without human-in-the loop performance) was done:

   • No. This device is a manual thrombus retriever, requiring direct human intervention and skill in its operation. There is no "algorithm only" performance component to be evaluated in a standalone manner.

6. The type of ground truth used (expert consensus, pathology, outcomes data, etc.):

   • Clinical Outcomes Data:
     • Revascularization (mTICI score): Based on angiographic imaging, adjudicated by a Core Laboratory (implies expert consensus).
     • Clinical Outcome (mRS ≤ 2 at 90 days): Direct patient outcome survey/assessment.
     • Safety (Mortality, sICH): Patient outcome data and clinical assessment, with sICH adjudicated by a Clinical Events Committee (implies expert consensus based on imaging and clinical presentation).

7. The sample size for the training set:

   • As this is a physical medical device used for treatment and not an AI/machine learning algorithm, there is no concept of a "training set" in the typical sense. The "training" for the device's design and preclinical development would come from engineering principles, in vitro testing, and animal studies, rather than a data-driven training set.

8. How the ground truth for the training set was established:

   • Not applicable as there is no "training set" in the context of an AI algorithm. The device's efficacy and safety were established through a combination of engineering design, non-clinical bench testing, pre-clinical animal testing, and finally, a human clinical trial.

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