Revolution Peripheral Atherectomy System

K212351 · Rex Medical, L.P. · MCW · Dec 15, 2021 · Cardiovascular

Device Facts

• Record ID: K212351
• Device Name: Revolution Peripheral Atherectomy System
• Applicant: Rex Medical, L.P.
• Product Code: MCW · Cardiovascular
• Decision Date: Dec 15, 2021
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 870.4875
• Device Class: Class 2
• Attributes: Therapeutic

Indications for Use

The Revolution Peripheral Atherectomy System is intended for atherectomy of the peripheral vasculature and to break apart and remove thrombus from the peripheral arteries in patients with occlusive atherosclerotic disease.

Device Story

Revolution Peripheral Atherectomy System is a sterile, single-use rotational atherectomy device. It consists of a flexible drive shaft with a distal diamond-coated spheroid burr, a guidewire, infusion assembly, collection receptacle, and a reusable power supply. Operated by a physician in a clinical setting, the device tracks over a guidewire to the target lesion. The burr rotates at high speeds (up to 140,000 RPM) to ablate occlusive material into fine particles. These particles are mechanically conveyed proximally through the catheter into an external collection receptacle. The system restores luminal patency in peripheral arteries. Benefits include effective plaque removal and thrombus management in peripheral vasculature.

Clinical Evidence

Bench testing only. Performance was evaluated through dimensional verification, plaque removal efficiency, embolization analysis, fatigue, tensile/torsional, stall, heat generation, kink bend radius, corrosion resistance, flow rate, coating integrity, and comparative surface assessment. Electrical/EMC testing (EN 60601-1, EN 60601-1-2) and extensive biocompatibility testing (cytotoxicity, hemolysis, pyrogenicity, systemic toxicity, intracutaneous, sensitization, complement activation, and thromboresistance) were performed to demonstrate safety and equivalence.

Technological Characteristics

Rotational atherectomy system; diamond-coated spheroid burr; flexible drive shaft; mains-powered reusable power supply; available in 60cm, 145cm, and 200cm lengths; burr diameters 1.33mm to 2.33mm; over-the-wire guidewire compatibility (0.014"); mechanical debris conveyance; ethylene oxide sterilization; single-use patient-contact components.

Indications for Use

Indicated for patients with occlusive atherosclerotic disease requiring atherectomy of the peripheral vasculature and removal of thrombus from peripheral arteries.

Regulatory Classification

Identification

An intraluminal artery stripper is a device used to perform an endarterectomy (removal of plaque deposits from arterisclerotic arteries.)

Predicate Devices

• Revolution™ Peripheral Atherectomy System (K191419)

Submission Summary (Full Text)

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Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo in blue, with the words "U.S. FOOD & DRUG ADMINISTRATION" in blue as well. The FDA is a federal agency responsible for regulating and supervising the safety of food, drugs, and other products.

December 15, 2021

Rex Medical, L.P. Colin Valentis Project Leader and Senior Developement Engineer 555 East North Lane, Suite 5035 Conshohocken, Pennsylvania 19428

Re: K212351

Trade/Device Name: Revolution™ Peripheral Atherectomy System Regulation Number: 21 CFR 870.4875 Regulation Name: Intraluminal Artery Stripper Regulatory Class: Class II Product Code: MCW Dated: November 23, 2021 Received: November 24, 2021

Dear Colin Valentis:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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

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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) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). 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 (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

Gregory O'Connell Assistant Director DHT2C: Division of Coronary and Peripheral Intervention Devices OHT2: Office of Cardiovascular Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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## Indications for Use

510(k) Number (if known) K212351

Device Name Revolution Peripheral Atherectomy System

Indications for Use (Describe)

Atherectory of the peripheral vasculature and to break apart and remove thrombus from the peripheral arteries in patients with occlusive atherosclerotic disease.

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

X Prescription Use (Part 21 CFR 801 Subpart D)

Over-The-Counter Use (21 CFR 801 Subpart C)

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Image /page/3/Picture/0 description: The image shows the logo for Rex Medical. The logo features the company name in bold, black lettering. A blue swoosh design wraps around the left side of the word "REX".

| Submitter: | Rex Medical, L.P.<br>555 East North Lane, Suite 5035<br>Conshohocken, PA 19428 |
|-------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Contact<br>Person: | Colin Valentis<br>Project Leader and Senior Development Engineer<br>Tel: [phone]<br>Fax: [phone]<br>E-mail: [e-mail] |
| Date Prepared: | July 30th, 2021 |
| Trade Name: | Revolution™ Peripheral Atherectomy System |
| Common<br>Name: | Peripheral Atherectomy Catheter |
| Classification<br>Name: | Intraluminal Artery Stripper (21 CFR 870.4875) |
| Product Code: | MCW |
| Regulatory<br>Class: | Class II |
| Predicate<br>Device: | K191419<br>Revolution™ Peripheral Atherectomy System<br>Rex Medical, L.P. |
| Device<br>Description: | The Revolution Peripheral Atherectomy System is sterile, single-use device designed<br>for atherectomy of the peripheral vasculature and to break apart and remove thrombus<br>from the peripheral arteries in patients with occlusive atherosclerotic disease.<br><br>The Revolution device incorporates a flexible drive shaft designed to track over the<br>Revolution guidewire. Attached to the distal end of the drive shaft is a diamond coated<br>spheroid shaped burr which rotates at high speed to ablate occlusive material and<br>restore luminal patency. Power is derived from a mains source and converted using the<br>reusable power supply. During treatment, the rotating burr ablates material into fine<br>particles. This particulate is conveyed proximally by a mechanical means through the<br>catheter and handle into a collection receptacle that resides outside the patient. The<br>device is available in 145cm, 200cm, and 60cm lengths with burr diameters of 1.33mm,<br>1.66mm, 2.00mm, and 2.33mm.<br><br>The Revolution Peripheral Atherectomy System consists of the following components:<br>1. Single-use Revolution Device (provided sterile)<br>2. Single-use Revolution .014" Guidewire (provided sterile)<br>3. Single-use infusion assembly (provided sterile)<br>4. Single-use collection receptacle (provided sterile)<br>5. Single-use guidewire clip (provided sterile)<br>6. Reusable power supply (provided non-sterile) |
| Indication for<br>Use: | The Revolution Peripheral Atherectomy System is intended for atherectomy of the<br>peripheral vasculature and to break apart and remove thrombus from the peripheral<br>arteries in patients with occlusive atherosclerotic disease. |

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Image /page/4/Picture/0 description: The image shows the logo for Rex Medical. The logo features the text "REX MEDICAL" in a bold, sans-serif font. The word "REX" is slightly larger than "MEDICAL". A blue swoosh design wraps around the left side of the word "REX", adding a dynamic element to the logo. The overall design is clean and professional, conveying a sense of reliability and innovation.

510(k) Summa Per 21 CFR 807.

Technological The proposed Revolution Peripheral Atherectomy System is substantially equivalent to Characteristics the currently marketed Revolution Peripheral Atherectomy System (K191419). The Comparison: subject and predicate devices share the following technological characteristics:

- . Intended Use
- . Fundamental Cutting Mechanism
- Fundamental Scientific Technology .
- Principles of Operation ●
- Conditions of Use ●
- . Sterilization Method

The differences between the subject and predicate device include the addition of several product codes and modifications to the construction and materials of certain components.

Changes in catheter material and drive wire construction were implemented in order to reduce the total stiffness of the system to improve performance in highly tortuous anatomy.

The additional product code offerings include a 2.33mm bit, a 200cm length, and lowprofile sheath options for the 1.66mm and 2.00mm bits which reduces the sheath compatibility to 6F.

| Description | Revolution Peripheral<br>Atherectomy System<br>(Predicate) | Revolution Peripheral<br>Atherectomy System<br>(Subject) |
|-------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------|
| 510(k) Number | K191419 | K212351 |
| Indications for Use | Atherectomy of the peripheral<br>vasculature and to break apart<br>and remove thrombus from<br>the peripheral arteries in<br>patients with occlusive<br>atherosclerotic disease. | Unchanged |
| Cutting Mechanism | Spheroid diamond coated burr | Unchanged |
| Device Type | Rotational | Unchanged |
| Burr Advancement | Direct-Push Type | Unchanged |
| Debris Collection | Continuous collection and<br>removal of excised debris via<br>mechanical conveyance | Unchanged |
| Max. Rotational Speed | 140,000 RPM | Unchanged |
| Guidewire Exchange | Over-the-Wire | Unchanged |
| Guidewire Compatibility | 0.014" x 335cm | 0.014" x 335cm<br>0.014" x 445cm |
| Sheath Compatibility | 4F - 7F | Unchanged |
| Catheter Working Length | 60cm<br>145cm | 60cm<br>145cm<br>200cm |
| Crossing Profile | 1.33mm<br>1.66mm<br>2.00mm | 1.33mm<br>1.66mm<br>2.00mm<br>2.33mm |
| Capital Equipment | No | Unchanged |
| Rotation Profile | Axial, Rotational | Unchanged |
| Infusion | Yes, Saline | Unchanged |
| Sterilization | Ethylene Oxide | Unchanged |
| Single-Use | Yes | Unchanged |

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Image /page/5/Picture/0 description: The image shows the logo for Rex Medical. The logo features the text "REX MEDICAL" in a bold, sans-serif font. A blue crescent shape is above and to the left of the text, adding a visual element to the logo. The overall design is clean and professional.

**510(k) Summary**
(Per 21 CFR 807.92)

1 CFR 807.92)
K212351

| Non-Clinical<br>Performance<br>Data: | To demonstrate the substantial equivalence of the Revolution™ Peripheral Atherectomy<br>System to the selected predicate device, the performance and technological<br>characteristics will be evaluated in an anatomically correct model and under simulated<br>biological conditions, when necessary, in the following tests:<br><br>Dimensional Verification Testing Testing in Simulated Lesion Plaque Removal Efficiency and Embolization Analysis Fatigue Testing Tensile & Torsional Testing Stall Testing |
|--------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|--------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

- Heat Generation Testing
- Kink Bend Radius Testing
- Corrosion Resistance Testing .
- Flow Rate Testing ●
- Coating Integrity Testing
- Comparative Surface Assessment ●
- . Guidewire Testing
- Corrosion, Tensile, Flex, Fracture, and Fatigue O
- . Sterilization Validation
- Shelf Life
- Simulated Distribution ●
- Electrical and EMC Testing ●
- EN 60601-1 O
- o EN 60601-1-2
- Biocompatibility Testing ●
- Cytotoxicity Study Using the ISO Elution Method o
- O ASTM Hemolysis Study
- USP Rabbit Pyrogen Study, Material Mediated O
- ISO Systemic Toxicity Study in Mice O
- ISO Intracutaneous Study in Rabbits O
- ISO Maximization Sensitization Study Extract o
- C3a Complement Activation Assay O
- SC5b-9 Complement Activation Assay O
- In Vivo Thromboresistance Study O
- Partial Thromboplastin Time O
- Heparinized Blood Platelet and Leukocyte Count o
- Conclusion: Rex Medical, L.P. considers the proposed Revolution Peripheral Atherectomy System to be substantially equivalent to the currently marketed Revolution Peripheral Atherectomy System (K191419) based on the intended use, technological characteristics, and performance testing included in this submission.