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510(k) Data Aggregation

    K Number
    K221204
    Date Cleared
    2022-06-23

    (58 days)

    Product Code
    Regulation Number
    870.5150
    Reference & Predicate Devices
    Why did this record match?
    Device Name :

    Excipio SV Thrombectomy Device

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Excipio SV Thrombectory Device is indicated for the non-surgical removal of soft emboli and thrombi from peripheral blood vessels.

    Device Description

    The Excipio SV Thrombectomy Device consists of a Thrombectomy Catheter to mechanically displace thrombus when used with an aspiration catheter. The Device will be sold as a sterile, single use device.

    Thrombectomy Catheter
    The Thrombectomy Catheter is a mechanical thrombus displacement device with a nitinol braided component (basket) at the distal end that can be opened and closed via an activation wire that attaches to the distal end of the braid and attaches to a proximal handle. The operator can open the braided component to a diameter that best matches the target vessel (4-8mm in diameter). Proximal and distal marker bands delineate the ends of the basket component, and 4 radiopaque markers delineate the circumference of the basket component to facilitate visualization under fluoroscopy.

    AI/ML Overview

    The provided document describes the Excipio SV Thrombectomy Device and its substantial equivalence to predicate devices, but it does not contain information about the acceptance criteria and a study proving the device meets those criteria in the context of an AI/ML medical device.

    The document is a 510(k) summary for a physical medical device (a thrombectomy device), and the testing described is standard for such a device (e.g., visual inspection, dimensional inspection, biocompatibility, animal study for thrombogenicity).

    Therefore, I cannot provide the requested information for the following points as they are not applicable to this physical medical device submission:

    1. A table of acceptance criteria and the reported device performance: This document refers to meeting acceptance criteria for non-clinical lab tests (e.g., kink resistance, tensile testing) and biocompatibility, but it doesn't provide specific quantitative acceptance criteria or detailed reported performance values for these tests in a table format that would be typical for an AI/ML device. It merely states that the device "met all acceptance criteria."
    2. Sample size used for the test set and the data provenance (e.g., country of origin of the data, retrospective or prospective): Not applicable to this type of device.
    3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts: Not applicable.
    4. Adjudication method (e.g., 2+1, 3+1, none) for the test set: Not applicable.
    5. 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: Not applicable.
    6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done: Not applicable.
    7. The type of ground truth used (expert consensus, pathology, outcomes data, etc): Not applicable.
    8. The sample size for the training set: Not applicable.
    9. How the ground truth for the training set was established: Not applicable.
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