FlowTriever Retrieval/Aspiration System, Aspiration Guide Catheter

K173672 · Inari Medical · QEW · Feb 5, 2018 · Cardiovascular

Device Facts

• Record ID: K173672
• Device Name: FlowTriever Retrieval/Aspiration System, Aspiration Guide Catheter
• Applicant: Inari Medical
• Product Code: QEW · Cardiovascular
• Decision Date: Feb 5, 2018
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 870.5150
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Flow Triever Retrieval/Aspiration System consists of the FlowTriever Catheter, Aspiration Guide Catheter, and Retraction Aspirator. The FlowTriever Retrieval/Aspiration System is indicated for: -The non-surgical removal of emboli and thrombi from blood vessels. -Injection, infusion, and/or aspiration of contrast media and other fluids into or from a blood vessel. The FlowTriever Retrieval/Aspiration System is intended for use in the peripheral vasculature.

Device Story

FlowTriever Retrieval/Aspiration System is a single-use, over-the-wire, catheter-based system for minimally invasive treatment of thromboemboli in peripheral vasculature. System components: Aspiration Guide Catheter, FlowTriever Catheter (available in 6-10mm, 11-14mm, 15-18mm sizes), and Retraction Aspirator. Operation: FlowTriever Catheter advanced through Aspiration Guide Catheter to thrombus; self-expanding wireform disks deployed to engage thrombus; hand-lever operated Retraction Aspirator simultaneously aspirates fluids and retracts catheter with thrombus into Aspiration Guide Catheter to capture clot and restore blood flow. Used by physicians in clinical settings. Output is physical removal of thrombus/emboli, restoring blood flow. Benefits include non-surgical clot removal.

Clinical Evidence

No clinical data. Substantial equivalence supported by non-clinical bench testing, including visual/dimensional inspections, guidewire compatibility, leakage verification, vacuum testing, retraction force testing, simulated use, and burst testing.

Technological Characteristics

Single-use, over-the-wire catheter system. Components: Aspiration Guide Catheter, FlowTriever Catheter with self-expanding wireform disks, and hand-lever operated Retraction Aspirator. Mechanical aspiration and retraction mechanism. No electronic or software components.

Indications for Use

Indicated for non-surgical removal of emboli and thrombi from peripheral blood vessels and for injection, infusion, or aspiration of contrast media and fluids.

Regulatory Classification

Identification

An embolectomy catheter is a balloon-tipped catheter that is used to remove thromboemboli, i.e., blood clots which have migrated in blood vessels from one site in the vascular tree to another.

Predicate Devices

• Inari FlowTriever Retrieval/Aspiration System (K162970)

Reference Devices

• Inari ClotTriever Thrombectomy System (K163549)

Submission Summary (Full Text)

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February 5, 2018

Inari Medical, Inc. Mr. Eben Gordon Vice President, Regulatory Affairs and Quality Assurance 9272 Jeronimo Rd., Suite 124 Irvine, California 92618

Re: K173672

Trade/Device Name: FlowTriever Retrieval/Aspiration System Regulation Number: 21 CFR 870.5150 Regulation Name: Embolectomy Catheter Regulatory Class: Class II Product Code: DXE Dated: January 24, 2018 Received: January 26, 2018

Dear Mr. Gordon:

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 application (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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

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); medical device reporting of medical device-related adverse events) (21 CFR 803); 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.

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Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

# Kenneth J. Cavanaugh -S

for

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

510(k) Number (if known) K173672

#### Device Name

FlowTriever Retrieval/Aspiration System

Indications for Use (Describe)

The Flow Triever Retrieval/Aspiration System consists of the FlowTriever Catheter, Aspiration Guide Catheter, and Retraction Aspirator. The FlowTriever Retrieval/Aspiration System is indicated for:

-The non-surgical removal of emboli and thrombi from blood vessels.

-Injection, infusion, and/or aspiration of contrast media and other fluids into or from a blood vessel.

The FlowTriever Retrieval/Aspiration System is intended for use in the peripheral vasculature.

Type of Use (Select one or both, as applicable)

| <div> <span> <span style="font-size: 16px;">☑</span> Prescription Use (Part 21 CFR 801 Subpart D) </span> </div> |
|-----------------------------------------------------------------------------------------------------------------------------|
| <div> <span> <span style="font-size: 16px;">☐</span> Over-The-Counter Use (21 CFR 801 Subpart C) </span> </div> |

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## 510(K) SUMMARY

| Date prepared | November 28, 2017 |
|-----------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Name | Inari Medical, Inc.<br>9272 Jeronimo Road, Suite 124<br>Irvine, CA 92618<br>949.600.8433 x114 |
| Contact person | Eben Gordon<br>Vice President, Regulatory Affairs & Quality Assurance |
| Trade name | FlowTriever Retrieval/Aspiration System |
| Common name | Embolectomy catheter |
| Regulation name | Embolectomy catheter |
| Classification number | 21 CFR 870.5150 |
| Product code | DXE |
| Regulatory class | II |
| Predicate device | Inari FlowTriever Retrieval/Aspiration System (K162970) |
| Reference device | Inari ClotTriever Thrombectomy System (K163549) |
| Description | The FlowTriever Retrieval/Aspiration System is a single-use over-the-wire<br>catheter-based system for the minimally invasive treatment of thromboemboli in<br>the peripheral vasculature. The system is comprised of three main components<br>packaged separately:<br>● Aspiration Guide Catheter<br>● FlowTriever Catheter (available in 3 sizes: 6-10 mm, 11-14 mm, and 15-<br>18 mm)<br>● Retraction Aspirator<br>The FlowTriever Catheter is inserted through the Aspiration Guide Catheter and<br>advanced to the thrombus. Self-expanding wireform disks are deployed to engage<br>thrombus by retracting the outer delivery catheter. The hand-lever operated<br>Retraction Aspirator simultaneously aspirates fluids and retracts the FlowTriever<br>Catheter with thrombus into the Aspiration Guide Catheter to capture clot and<br>restore blood flow. |
| Indications for Use | The Flow Triever Retrieval/Aspiration System consists of the FlowTriever<br>Catheter, Aspiration Guide Catheter, and Retraction Aspirator. The FlowTriever<br>Retrieval/Aspiration System is indicated for:<br>● The non-surgical removal of emboli and thrombi from blood vessels.<br>● Injection, infusion, and/or aspiration of contrast media and other fluids<br>into or from a blood vessel.<br>The FlowTriever Retrieval/Aspiration System is intended for use in the peripheral<br>vasculature. |

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Device modifications The modification to the FlowTriever Retrieval/Aspiration System are primarily intended to streamline the user interaction with the device changes and include the following:

- . Replacement of the hemostasis valve seal with a user actuated hemostasis valve seal in the Aspiration Guide Catheter's proximal hub.
- Addition of a stopcock in the sideport tubing.
- . Elimination of the Valve Dilator, Aspiration Insert, Flush Port Adapter, and tubing clamp components.

Summary of There is no change of intended use or fundamental scientific technology between substantial equivalence the proposed and predicate devices.

#### Non-Clinical Testing

In accordance with the Design Failure Modes and Effects Analysis, verification and validation testing supported the substantial equivalence of the modified Retrieval/Aspiration System. This testing FlowTriever demonstrated compliance with relevant product specifications. These tests included:

- Visual and Dimensional Inspections ●
- Guidewire Compatibility Verification
- Leakage Verification, AGC Hemostasis Valve And Accessory Devices ●
- . Air Leakage From AGC Hemostasis Valve During Syringe Pullback
- Air Leakage During Syringe Pullback ●
- Vacuum Testing ●
- Retraction Force Testing
- Push Button Force
- Retraction Aspirator Device Retraction ●
- Simulated Use, Track and Tensile
- Stopcock Torque Testing ●
- Burst Testing of Hemostasis Valve and Stopcock .

Clinical testing was not required for the determination of substantial equivalence.

#### Conclusion

Test results demonstrated that all acceptance criteria were met; therefore, the device conforms to established product specifications and intended use. Based upon the same intended use and principle of operation, technology, and nonclinical testing it is concluded that the modified FlowTriever Retrieval/Aspiration System is substantially equivalent to the predicate device.