Wingman Crossing Catheter

K151880 · Reflow Medical · DQY · Aug 7, 2015 · Cardiovascular

Device Facts

• Record ID: K151880
• Device Name: Wingman Crossing Catheter
• Applicant: Reflow Medical
• Product Code: DQY · Cardiovascular
• Decision Date: Aug 7, 2015
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 870.1250
• Device Class: Class 2

Intended Use

The Wingman Crossing Catheter is intended to be used in conjunction with steerable guidewires to access discreet regions of the peripheral vasculature. It may be used to facilitate placement and exchange of guidewires and other interventional devices and provide a conduit for the delivery of saline solutions or diagnostic/therapeutic agents.

Device Story

Support catheter for peripheral vasculature access; used with steerable guidewires; features concealed radiopaque beveled guide-tip and activating handle; provides conduit for saline or diagnostic/therapeutic agents; used by physicians in interventional procedures; device provides additional support to guidewire to facilitate navigation through vasculature; product line extension adds .018" diameter configuration.

Clinical Evidence

Bench testing only. Testing included simulated use, tensile strength, torque, pressure testing, coating verification, corrosion testing, and dimensional/visual inspections. All tests met specified criteria.

Technological Characteristics

Percutaneous catheter with concealed radiopaque beveled guide-tip and activating handle. Features .018" diameter configuration. No software or electronic components.

Indications for Use

Indicated for use in conjunction with steerable guidewires to access discrete regions of the peripheral vasculature; facilitates placement/exchange of guidewires and interventional devices; provides conduit for delivery of saline or diagnostic/therapeutic agents.

Regulatory Classification

Identification

A percutaneous catheter is a device that is introduced into a vein or artery through the skin using a dilator and a sheath (introducer) or guide wire.

Predicate Devices

• Wingman Extendable Support Catheter (K141547, K132420)

Submission Summary (Full Text)

{0}------------------------------------------------

Image /page/0/Picture/1 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo features the department's name in a circular arrangement around a symbol. The symbol consists of three stylized human profiles facing right, with a stylized eagle or bird-like element above them.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

August 7, 2015

ReFlow Medical Rebecca K. Pine Head of Regulatory Affairs/Quality Assurance 1003 Calle Sombra San Clemente, CA 92673

Re: K151880

Trade/Device Name: Wingman Crossing Catheter Regulation Number: 21 CFR 870.1250 Regulation Name: Percutaneous Catheter Regulatory Class: Class II Product Code: DQY Dated: July 8, 2015 Received: July 9, 2015

Dear Rebecca K. Pine:

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 (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set

{1}------------------------------------------------

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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21CFR 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.

You may obtain other general information on your responsibilities under the Act from the Division of Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours.

# Brian D. Pullin -S

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

Enclosure

{2}------------------------------------------------

# Indications for Use

510(k) Number (if known) K151880

Device Name Wingman Crossing Catheter

#### Indications for Use (Describe)

The Wingman Crossing Catheter is intended to be used in conjunction with steerable guidewires to access discreet regions of the peripheral vasculature. It may be used to facilitate placement and exchange of guidewires and other interventional devices and provide a conduit for the delivery of saline solutions or diagnostic/therapeutic agents.

| Type of Use (Select one or both, as applicable) | |
|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------|
| <div> <span> <svg fill="none" height="16" viewbox="0 0 16 16" width="16" xmlns="http://www.w3.org/2000/svg"> <path d="M13.7817 2.21826C14.0746 2.51113 14.0746 2.98887 13.7817 3.28174L6.28174 10.7817C5.98887 11.0746 5.51113 11.0746 5.21826 10.7817L2.21826 7.78174C1.92539 7.48887 1.92539 7.01113 2.21826 6.71826C2.51113 6.42539 2.98887 6.42539 3.28174 6.71826L5.75 9.25L12.7183 2.21826C13.0111 1.92539 13.4889 1.92539 13.7817 2.21826Z" fill="black"></path> </svg> Prescription Use (Part 21 CFR 801 Subpart D) </span> </div> | <div> <span> <input type="checkbox"/> Over-The-Counter Use (21 CFR 801 Subpart C) </span> </div> |

#### CONTINUE ON A SEPARATE PAGE IF NEEDED.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

#### *DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.*

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

> Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff [e-mail]

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

{3}------------------------------------------------

This 510(k) summary information is being submitted in accordance with the requirements of SMDA 1990 and 21 CFR 807.92.

| APPLICANT: | ReFlow Medical |
|---------------------------|----------------------------------------------------------------------------------------------------------|
| DATE PREPARED: | July 30, 2015 |
| CONTACT PERSON: | Rebecca K Pine<br>ReFlow Medical<br>1003 Calle Sombra<br>San Clemente, CA 92673<br>Phone: [phone] |
| TRADE NAME: | Wingman Crossing Catheter |
| COMMON NAME: | Guide Catheter |
| CLASSIFICATION<br>NAME: | Percutaneous Catheter |
| DEVICE<br>CLASSIFICATION: | Class 2, per 21 CFR 870.1250 |
| PRODUCT CODE | DQY |

PREDICATE DEVICES: Wingman Extendable Support Catheter (K141547, K132420)

### Substantially Equivalent To:

The modified Wingman Crossing Catheter is substantially equivalent in intended use, principal of operation and technological characteristics to the Wingman Extendable Support Catheter cleared under premarket notifications K141547 and K132420.

### Description of the Device Subject to Premarket Notification:

The Wingman Crossing Catheter is a device intended to provide additional support to a steerable guidewire when accessing discrete regions of the peripheral vasculature. The device consists of a support catheter, with a concealed radiopaque beveled guide-tip, and activating handle. The through-lumen of the device can serve as a conduit for the delivery of diagnostic and therapeutic agents. The Wingman Crossing Catheter product line is being extended to add a .018" diameter device configuration.

### Indication for Use:

The Wingman Crossing Catheter is intended to be used in conjunction with steerable guidewires to access discreet regions of the peripheral vasculature. It may be used to facilitate placement and exchange of guidewires and other interventional devices and provide a conduit for the delivery of saline solutions or diagnostic/therapeutic agents.

{4}------------------------------------------------

### Technical Characteristics:

The modified Wingman Crossing Catheter has similar physical and technical characteristics to the predicate device. The modified Wingman and predicate Wingman devices differ in the following:

- Product line extension; new diameter: .018" .
## Performance Data:

All necessary testing has been performed for the Wingman Crossing Catheter to assure substantial equivalence to the predicate device and demonstrate the device performs as intended. All testing was performed on test units representative of finished devices.

The additional product family size was qualified through the following tests:

- Simulated Use ●
- Tensile Strength ●
- Torque ●
- . Pressure Test
- Coating verification
- Corrosion Test
- Dimensional verification and visual inspections .

The modified Wingman Crossing Catheter met all specified criteria and did not raise new safety or performance questions.

### Basis for Determination of Substantial Equivalence:

The Indication/Intended Use and the fundamental scientific technology of the modified device have not been changed and are the same as those described in the unmodified predicate device. The modified Wingman Crossing Catheter is determined by ReFlow Medical, to be substantially equivalent to the Wingman Crossing Catheter (K141547, K132420).