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510(k) Data Aggregation

    K Number
    K123696
    Manufacturer
    Date Cleared
    2013-10-25

    (326 days)

    Product Code
    Regulation Number
    870.3300
    Reference & Predicate Devices
    Predicate For
    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Medusa™ Vascular Plug is intended for arterial and venous embolizations in the peripheral vasculature. The product is intended for use by physicians trained and experienced in embolization techniques. Standard techniques for placement of vascular access sheaths, angiographic catheters, and guide wires should be employed.

    Device Description

    The Medusa™ Vascular Plug is a coil-based occlusion device intended for embolization procedures in the peripheral vasculature. The Medusa™ Vascular Plug consists of an implant and a delivery system. The implant is constructed of multiple polymer coils that are pre-loaded on to the delivery system. The Medusa™ Vascular Plug coils are delivered concurrently for vascular occlusion in a single application. Like predicate embolic coils, vascular occlusion with the Medusa™ Vascular Plug is achieved by mechanical flow restriction resulting from coil pack delivery that leads to thrombus formation and rapid cessation of blood flow.

    AI/ML Overview

    This document describes the premarket notification (510(k)) for the Medusa™ Vascular Plug, focusing on its substantial equivalence to predicate devices. The review is based on non-clinical and animal testing.

    Here's a breakdown of the requested information:

    1. Table of Acceptance Criteria and Reported Device Performance

    Acceptance Criteria (Implicit)Reported Device Performance (Medusa™ Vascular Plug)
    Equivalent occlusion performance in a clinically relevant modelExhibited performance equivalent to the predicate Cook stainless steel embolization coils through the 95-day time point.
    Comparable stability of occlusionAchieved comparable stability of occlusion to predicate coils.
    Comparable occlusion timesAchieved comparable occlusion times to predicate coils.
    Comparable or better durability of occlusionAchieved comparable or better durability of occlusion compared to predicate coils.
    No acute or chronic complicationsDid not exhibit any acute or chronic complications.
    No new issues of safetyDid not raise any new questions of safety.
    Meets established specifications for consistent performance for intended useCollective results of non-clinical testing demonstrate that the device meets established specifications necessary for consistent performance for its intended use.

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

    The study was an in-vivo animal validation study conducted in an ovine (sheep) model. The sample size for this animal study is not explicitly stated in the provided text.

    The data provenance is prospective animal study data.

    3. Number of Experts Used to Establish Ground Truth and Qualifications

    The document mentions "occlusion assessed by the physician" during the angiographic assessment. This implies clinical assessment was part of the ground truth determination. However, the number of physicians/experts and their specific qualifications are not explicitly stated.

    4. Adjudication Method for the Test Set

    The adjudication method for the angiographic assessment and subsequent histopathology is not explicitly detailed. It mentions "occlusion assessed by the physician," but whether this involved multiple physicians, consensus, or a specific rule (e.g., 2+1) is not provided.

    5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was done

    No, a Multi-Reader Multi-Case (MRMC) comparative effectiveness study was not performed. This study focused on an animal model, not human readers assessing cases.

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

    Not applicable. This device is a vascular plug, not an AI algorithm. Therefore, the concept of "standalone (algorithm only without human-in-the-loop performance)" does not apply. The performance evaluated here is the physical device's occlusive capabilities.

    7. The Type of Ground Truth Used

    The ground truth was established through a combination of:

    • Angiographic assessment (visual assessment of occlusion by a physician).
    • Gross necropsy (post-mortem examination of the animal).
    • Microscopic examination.
    • Histopathology (microscopic examination of tissues for disease or abnormalities).

    This provides a multi-faceted biological and anatomical ground truth from the animal model.

    8. The Sample Size for the Training Set

    Not applicable. This device is a physical medical device (vascular plug), not an AI algorithm that requires a training set. The "testing" in this context refers to performance validation of the physical device.

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

    Not applicable, as there is no training set for a physical device like a vascular plug. The "ground truth" (or established performance criteria) for the device's function was derived from the performance of the predicate devices.

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