Pounce Thrombectomy System

K220501 · Surmodics,Inc. · QEW · Mar 23, 2022 · Cardiovascular

Device Facts

• Record ID: K220501
• Device Name: Pounce Thrombectomy System
• Applicant: Surmodics,Inc.
• Product Code: QEW · Cardiovascular
• Decision Date: Mar 23, 2022
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 870.5150
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Pounce™ Thrombectomy System is intended for the non-surgical removal of thrombi and emboli from the peripheral arterial vasculature.

Device Story

Percutaneous catheter system for mechanical thrombus removal in peripheral arterial vasculature; used by physicians in clinical settings. System components: delivery catheter, basket wire, funnel catheter. Delivery catheter transports basket wire to thrombus site; basket wire features two self-expanding baskets for thrombus capture; funnel catheter collects and retrieves thrombus. Radiopaque markers on baskets and catheter tip facilitate fluoroscopic guidance. Physician operates slider button on funnel catheter handle to sheath/unsheath funnel. Mechanical design; no software or AI components. Benefits: minimally invasive thrombus removal.

Clinical Evidence

No clinical studies were required; substantial equivalence supported by performance bench testing and biocompatibility data.

Technological Characteristics

Percutaneous catheter system; 5Fr delivery catheter; self-expanding basket wire; funnel catheter with integrated handle. Radiopaque markers for fluoroscopic visualization. Requires minimum 7Fr guide sheath. Mechanical operation; no energy source. Sterilized device.

Indications for Use

Indicated for patients requiring non-surgical removal of thrombi and emboli from the peripheral arterial vasculature.

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

• Pounce™ Thrombectomy System (K211492)

Submission Summary (Full Text)

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March 23, 2022

Surmodics Inc. Holly Ramirez Senior Staff Regulatory Affairs Specialist 7905 Golden Triangle Drive Suite 190 Eden Prairie, Minnesota 55344

Re: K220501

Trade/Device Name: Pounce Thrombectomy System Regulation Number: 21 CFR 870.5150 Regulation Name: Embolectomy Catheter Regulatory Class: Class II Product Code: QEW Dated: February 21, 2022 Received: February 22, 2022

Dear Holly Ramirez:

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) K220501

Device Name Pounce™ Thrombectomy System

Indications for Use (Describe)

The Pounce™ Thrombectomy System is intended for the non-surgical removal of thrombi and emboli from the peripheral arterial vasculature.

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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# 510(k) Summary

## Date Prepared: 18 March 2022

### Submitters Name/Contact Person

## 510K Submitter and Contact for Routine Correspondence

Holly Ramirez Senior Staff Regulatory Affairs Specialist 7905 Golden Triangle Dr. Ste. 190 Eden Prairie, MN 88344 Phone [phone] Email: [e-mail]

### 510k Submitter Establishment Registration Number

3014687026

| General Information | |
|----------------------------|---------------------------------------|
| Trade Name: | Pounce™ Thrombectomy System |
| Common / Usual Name: | Thrombectomy Catheter |
| Classification Name | Embolectomy Catheter |
| Regulation/Product Code | 21 CFR 870.5150 |
| Device Panel | Cardiovascular |
| Regulatory Classification: | Class II |
| Product Code: | QEW |
| Predicate Device: | Pounce™ Thrombectomy System (K211492) |

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#### 1 Device Description

The Surmodics Pounce™ Thrombectomy System is a percutaneous catheter system designed to facilitate mechanical thrombus removal in the peripheral arterial vasculature. The system is comprised of three separate components: a Delivery Catheter, a Basket Wire with a preloaded loading tool, and the Funnel Catheter. The system contains radiopaque components to conduct the procedure and is intended to be introduced through a minimum 7Fr guide sheath.

The Delivery Catheter is a flexible 5Fr catheter designed to deliver the Basket Wire to the location of the thrombus. Incorporated in the catheter is a radiopaque marker band located at the distal tip.

The Basket Wire is comprised of two distal self-expanding baskets mounted a core wire for capturing thrombus. The distal capture baskets have integral radiopaque markers mounted on the struts of the basket for basket visibility under fluoroscopy.

The Funnel Catheter is used for thrombus collection and retrieval in conjunction with the Basket Wire. The Funnel Catheter is comprised of an inner funnel catheter and an outer delivery catheter. The two catheters work together to allow unsheathing and sheathing of the funnel using the slider button on the integrated handle.

#### 2 Indication for Use

The Pounce™ Thrombectomy System is intended for the non-surgical removal of thrombi and emboli from the peripheral arterial vasculature.

### 3 Comparison of Technological Characteristics

The Pounce Thrombectomy System is substantially equivalent to the previous Pounce Thrombectomy System (K211492) in design, intended use, principles of use, biocompatibility, sterility, and labeling. Changes to the predicate device that have led to the submission of this new 510(k) are ergonomic and branding in nature, including a new handle design, new packaging to accommodate the handle, and updated coloring. All characteristics that were not identical to the predicate device were verified through performance bench and biocompatibility testing and determined to be substantially equivalent.

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### 4 Performance Bench Testing

Results of design verification and biocompatibility testing demonstrates that the technological and material differences identified do not raise new questions of safety or effectiveness compared to the predicate device. The Pounce Thrombectomy System has been evaluated through the following tests:

- -Dimensional
- -Tensile Strength
- Air and Liquid Leak -
- -Handle Split Force
- Retention Force -
- Atraumatic Surfaces -
- Assembled Functionality -
- Torque Strength -
- -Lock and Unlock Force
- -Tensile Strength
- Packaging/Distribution -
- Biocompatibility -

#### 5 Clinical Studies and Testing

No clinical studies were required for the Pounce Thrombectomy System.

#### 6 Conclusion

Based on the device description, materials, technological characteristics, and accompanying performance and biocompatibility data it can be concluded that the device modifications made to the Pounce Thrombectomy System are substantially equivalent to the predicate device and the device will continue to function per its intended use.