MODIFICATION TO ATLANTIS PV IMAGING CATHETER, MODEL 36456

K041727 · Boston Scientific Scimed, Inc. · OBJ · Jul 23, 2004 · Cardiovascular

Device Facts

• Record ID: K041727
• Device Name: MODIFICATION TO ATLANTIS PV IMAGING CATHETER, MODEL 36456
• Applicant: Boston Scientific Scimed, Inc.
• Product Code: OBJ · Cardiovascular
• Decision Date: Jul 23, 2004
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 870.1200
• Device Class: Class 2

Intended Use

The Atlantis™ PV Imaging Catheter is intended for ultrasound examination of peripheral pathology only. Intravascular ultrasound imaging is indicated in patients who are candidates for transluminal interventional procedures.

Device Story

Atlantis PV Imaging Catheter; intravascular ultrasound (IVUS) device. Used by physicians during peripheral vascular interventional procedures. Device captures ultrasound images of peripheral vasculature; provides real-time visualization of vessel pathology. Assists clinicians in assessing vessel morphology; guides interventional decision-making. Benefits include improved procedural accuracy and visualization of peripheral anatomy.

Clinical Evidence

No clinical data provided; substantial equivalence based on technological characteristics and intended use.

Technological Characteristics

Diagnostic intravascular ultrasound catheter; peripheral application. Class II device (21 CFR 870.1200). Product code OBJ.

Indications for Use

Indicated for patients who are candidates for transluminal interventional procedures requiring ultrasound examination of peripheral pathology.

Regulatory Classification

Identification

An intravascular diagnostic catheter is a device used to record intracardiac pressures, to sample blood, and to introduce substances into the heart and vessels. Included in this generic device are right-heart catheters, left-heart catheters, and angiographic catheters, among others.

Submission Summary (Full Text)

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MAY 2 4 2007

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Boston Scientific/Scimed c/o Mr. Robert Z. Phillips Manager, Regulatory Affairs IVUS Technology Center 47900 Bayside Parkway Fremont, CA 94539-6515

Re: K041727

Trade/Device Name: Atlantic PV Imaging Catheter Regulation Number: 21 CFR 870.1200 Regulation Name: Diagnostic Intravascular Catheter Regulatory Class: II Product Code: OBJ Dated: June 24, 2004 Received: June 25, 2004

Dear Mr. Phillips:

This letter corrects our substantially equivalent letter of July 23, 2004.

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and 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) that do not require approval of a premarket approval (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. 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.

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.

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Page 2 - Mr. Phillips

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 (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to continue marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act 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/dsma/dsmamain.html

Sincerely yours,

Bram D. Zuckerman, M.D.

Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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## Indications for Use Statement

K041727 510(k) Number: Atlantis™ PV Imaging Catheter Device Name: The Atlantis™ PV Imaging Catheter is intended for Indications for Use: ultrasound examination of peripheral pathology only. Intravascular ultrasound imaging is indicated in patients who are candidates transluminal for interventional procedures.

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Concurrence of CDRH, Office of Device Evaluation (ODE)

Nith.P.Ogden

vision Signvision of Cardiovascular Devices

602

510(k) Number K041727

Prescription Use

OR

Over-The-Counter Use__________________________________________________________________________________________________________________________________________________________

(Per 21 CFR 801. 109)

Confidential

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