FDA Adverse Event Malfunction Summary report: N

SUPERA BILIARY STENT DELIVERY SYSTEM

MDR report key: 1735789 · Received June 23, 2010

Report

Report Number
3005325609-2010-00009
Event Type
Malfunction
Date Received
June 23, 2010
Date of Event
May 11, 2010
Report Date
June 1, 2010
Manufacturer
IDEV TECHNOLOGIES, INC.
Product Code
FGE
PMA / PMN Number
K071646
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
WI, US
Reporter Occupation
PHYSICIAN

Narratives

Description of Event or Problem · 1

DURING STENT DEPLOYMENT, THE PHYSICIAN NOTED SOME RESISTANCE WHILE ADVANCING THE THUMB SLIDE BUT WAS ABLE TO DEPLOY THE STENT. THE DEPLOYMENT COLLAR WAS OPENED, THE STENT WAS FULLY DEPLOYED AND THE DELIVERY CATHETER WAS WITHDRAWN. WHILE WITHDRAWING THE DELIVERY CATHETER THE PHYSICIAN EXPERIENCED A SLIGHT RESISTANCE AND THEN HE SAW THAT THE STENT WAS OUT OF THE ARTERY AND IN THE SHEATH. THE SHEATH WAS REMOVED AND REPLACED. AN ANGIOGRAM WAS PERFORMED WHICH SHOWED NO FLOW TO THE SFA OR DISTAL VESSELS. THE PT WAS GIVEN ANGIOMAX AND SCHEDULED FOR SURGERY. BY THE TIME THE PT ARRIVED FOR SURGERY, THERE WAS BLOOD FLOW NOTED IN THE TIBIAL VESSELS. THE PHYSICIAN STATED THAT THE PT WAS MOST LIKELY IN HYPERTHROMBOTIC STATE PRIOR TO THE INITIAL STENT IMPLANT; THE PT WAS NOT THROMBOTICALLY TREATED PRIOR TO THE PROCEDURE. THE PHYSICIAN ALSO INDICATED THAT THE TORTUOUS ILIAC BIFURCATION MAY HAVE BEEN THE CAUSE OF THE RESISTANCE AND THERE WAS NO CALCIFICATION NOTED. IT WAS NOTED THAT A .014 GUIDEWIRE WAS USED. THE PHYSICIAN STATED THAT THE WITHDRAWAL OF THE STENT LIKELY AGGRAVATED THE THROMBOTIC CONDITION. THE DEVICE WAS DISCARDED, THEREFORE, A DEVICE EVAL CANNOT BE COMPLETED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SUPERA BILIARY STENT DELIVERY SYSTEM FGE IDEV TECHNOLOGIES, INC. S-05-120-120-G2 00332044

Patients

Seq Age Sex Outcome Treatment
1 66 YR Required Intervention 7FR PINNACLE SHEATH| 7MM SPIDER GUIDE WIRE