MEDTRONIC AVE BRIDGE CONSTANT BILIARY STENT SYSTEM OR ('CONSTANT

K030633 · Medtronic Ave, Inc. · FGE · Sep 2, 2003 · Gastroenterology, Urology

Device Facts

• Record ID: K030633
• Device Name: MEDTRONIC AVE BRIDGE CONSTANT BILIARY STENT SYSTEM OR ('CONSTANT
• Applicant: Medtronic Ave, Inc.
• Product Code: FGE · Gastroenterology, Urology
• Decision Date: Sep 2, 2003
• Decision: SESU
• Submission Type: Traditional
• Regulation: 21 CFR 876.5010
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Medtronic AVE Bridge Constant Biliary Stent System is indicated for use in the palliation of malignant neoplasms in the biliary tree.

Device Story

Single-use biliary stent system; includes stent mounted on over-the-wire delivery system with AV100 balloon. Used for percutaneous delivery to biliary tree to provide palliation of malignant neoplasms. Operated by clinicians in clinical settings. Device provides mechanical support to maintain biliary patency; benefits patient by palliating malignant obstructions.

Clinical Evidence

Bench testing only; preclinical/in-vitro testing conducted to confirm performance and biocompatibility.

Technological Characteristics

Balloon-expandable stent; sheathless delivery system; AV100 balloon; biocompatible materials; single-use; provided sterile.

Indications for Use

Indicated for palliation of malignant neoplasms in the biliary tree.

Regulatory Classification

Identification

A biliary catheter and accessories is a tubular flexible device used for temporary or prolonged drainage of the biliary tract, for splinting of the bile duct during healing, or for preventing stricture of the bile duct. This generic type of device may include a bile collecting bag that is attached to the biliary catheter by a connector and fastened to the patient with a strap.

Special Controls

*Classification.* Class II (special controls). The device, when it is a bile collecting bag or a surgical biliary catheter that does not include a balloon component, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.

Predicate Devices

• Bridge Extra Support (K991533)
• Bridge Assurant (K011817)

Submission Summary (Full Text)

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K030633

## 510(k) Summary for the Medtronic AVE Bridge Constant Biliary Stent System

. .

| 510(k)<br>Summary | This summary of 510(k) safety and effectiveness information is being<br>submitted in accordance with the requirements of 21 C.F.R. § 807.92. |
|--------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Submitter<br>807.92(a)(1) | Medtronic AVE, Inc.<br>Peripheral Technologies<br>3576 Unocal Place<br>Santa Rosa, California 95403 |
| Contact Person<br>807.92(a)(1) | Sarah Sheppard<br>Associate Product Regulation Manager<br>Phone: [phone]<br>Fax: [phone]<br>E-mail: [e-mail] |
| Date Prepared<br>807.92(a)(1) | February 26, 2003 / Name change notification: April 8th, 2003 |
| Trade Name<br>807.92(a)(2) | Medtronic AVE Bridge Constant Biliary Stent System per 807.92 (a) (2) |
| Common Name<br>807.92(a)(2) | Biliary Stent and Delivery System |
| Classification Name<br>807.92(a)(2) | Biliary Catheter and Accessories |
| Device<br>Classification<br>807.92(a)(2) | Classification: Class II<br>Classification Panel: 78FGE<br>Regulation Number: 21 C.F.R. §876.5010 |
| Predicate Device<br>807.92(a)(3) | Bridge Extra Support (K991533) cleared July 29th, 1999<br>Bridge Assurant (K011817) cleared August 22nd, 2001 |
| Performance<br>Standards | Performance standards have not been established by the FDA under<br>section 514 of the Federal, Food, Drug and Cosmetic Act |
| Device Description<br>807.92(a)(4) | The subject device is a single use only device with a stent mounted on an<br>over-the-wire delivery system. The device is equipped with an A V100<br>balloon mounted on the distal portion of the catheter to facilitate the<br>percutaneous delivery of the stent. |
| Indications for Use<br>807.92(a)(5) | The Bridge Constant Biliary Stent System is indicated for use in the<br>palliation of malignant neoplasm in the biliary tree. |
| Technological<br>Characteristics<br>807.92(a)(6) | The Bridge Constant is substantially equivalent to the currently marketed<br>Bridge Extra Support (K991533) and Bridge Assurant (K011817)<br>devices. The subject and predicate devices are technologically similar<br>and are intended for palliation of malignant neoplasms in the biliary tree.<br>The subject and predicate devices are constructed of biocompatible<br>materials. The subject and predicate devices are both balloon expandable<br>and feature stents pre-mounted on a sheathless stent delivery system. The<br>subject and predicate devices are comparable and are intended to meet<br>clinical needs. The difference between the subject and predicate devices<br>are not relevant to the ability of the subject device to palliate malignant<br>neoplasms in the biliary tree. |
| Nonclinical<br>Performance<br>807.92(b)(1) | Preclinical/in-vitro testing was conducted to confirm the safe and<br>effective performance of this device as well as the biocompatibility of the<br>device. |
| Sterilization<br>807.92(b)(1) | The Bridge Constant Biliary Stent System is provided sterile. The device<br>is not intended for reuse or resterilization. |
| Conclusion<br>807.92(b)(3) | The Bridge Constant Biliary Stent System is substantially equivalent to<br>the currently cleared and marketed devices (Bridge Extra Support –<br>K991533 and Bridge Assurant – K011817) and meets the clinical needs<br>of the physicians. |

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K030633

510(k) Summary for the Medtronic AVE Bridge Constant Biliary Stent System

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Image /page/2/Picture/1 description: The image is a black and white seal. The seal is circular and contains an image of a bird with three lines representing its wings. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is written around the edge of the circle.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

SEP - 2 2003

Ms. Sarah Sheppard Associate Product Regulation Manager Medtronic AVE 3576 Unocal Place SANTA ROSA CA 95403

Re: K030633

Trade/Device Name: Medtronic AVE Bridge Constant Biliary Stent System Regulation Number: 21 CFR §876.5010 Regulation Name: Biliary catheter and accessories Regulatory Class: II Product Code: 78 FGE Dated: June 3, 2003 Received: June 4, 2003

Dear Ms. Sheppard:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we 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 (Act). You may, therefore, market the device, subject to the general controls provisions of the Act and the limitations described below. 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.

The Office of Device Evaluation has determined that there is a reasonable likelihood that this device will be used for an intended use not identified in the proposed labeling and that such use could cause harm. Therefore, in accordance with Section 513(i)(1)(E) of the Act, the following limitation must appear in the Warnings section of the device's labeling:

The safety and effectiveness of this device for use in the vascular system have not been established.

Furthermore, the indication for biliary use must be prominently displayed in all labeling, including pouch, box, and carton labels, instructions for use, and other promotional materials, in close proximity to the trade name, of a similar point size, and in bold print.

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## Page 2 - Ms. Sarah Sheppard

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.

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); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and permits your device to proceed to the market. This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification if the limitation statement above is added to your labeling, as described.

Please note that the above labeling limitations are required by Section 513(i)(1)(E) of the Act. Therefore, a new 510(k) is required before these limitations are modified in any way or removed from the device's labeling.

If you desire specific information about the application of other labeling requirements to your device (21 CFR Part 801 and additionally Part 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at [phone]. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/dsmaldsmamain.html.

Sincerely yours,

Daniel G. Schultz, M.D.

Director Office of Device Evaluation Center for Devices and Radiological Health

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510(k) Number (if known): K030633

Device Name: Medtronic AVE Bridge Constant Biliary Stent System

FDA's Statement of the Indications For Use for device:

The Medtronic AVE Bridge Constant Biliary Stent System is indicated for use in the palliation of malignant neoplasms in the biliary tree.

Prescription Use OR (Per 21 CFR 801.109)

Over-The-Counter Use__________________________________________________________________________________________________________________________________________________________

Nancy C. Brogdon

(Division Sign-Off) Division of Reproductive, Abdominal, and Radiological Devices 510(k) Number_ 0311/2 53