CASPER X
Report
- Report Number
- 2032493-2025-00153
- Event Type
- Injury
- Date Received
- February 21, 2025
- Date of Event
- December 7, 2024
- Report Date
- April 10, 2025
- Manufacturer
- MICROVENTION, INC.
- Product Code
- NIM
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- US
- Reporter Occupation
- PHYSICIAN
- Health Professional
- Yes
Narratives
THE DEVICE WAS DISCARDED AT THE USER FACILITY AND NOT AVAILABLE FOR RETURN TO THE MANUFACTURER FOR EVALUATION. HOWEVER, MEDICAL INFORMATION WAS PROVIDED AND WILL BE REVIEWED. THE INVESTIGATION IS ONGOING AND UPON COMPLETION OF THE INVESTIGATION, A SUPPLEMENTAL MDR WILL BE SUBMITTED. THE PRODUCT REPORTED IN THIS REPORT IS AN EXPORTED DEVICE NOT CLEARED OR APPROVED FOR MARKETING IN THE US. THE COMPLAINT IS BEING REPORTED BASED ON THIS PRODUCT MEETING SIMILAR PRODUCT CRITERIA (SIMILAR TO ROADSAVER/CASPER CAROTID STENT DEVICE ¿ PMA # P210030).
A MEDICAL REVIEW OF THE PROVIDED MEDICAL REPORT WAS PERFORMED. AS REPORTED, DURING THE PERFORMANCE OF THE PROCEDURE ON INDEX PROCEDURE DAY (B)(6) 2024, THE PATIENT RECEIVED TREATMENT FOR AN ATHEROSCLEROTIC PLAQUE LOCATED AT THE ICA WITH A CASPER X DEVICE. DURING THE PERFORMANCE OF THE PROCEDURE, IT WAS REPORTED THAT A COMPLETE STENT OCCLUSION OCCURRED DURING DEPLOYMENT AND PRIOR TO DETACHMENT OF THE CASPER X DEVICE. THE CASPER X WAS REMOVED FROM THE PATIENT PRIOR TO DEPLOYMENT. DURING THE DEPLOYMENT OF THE SECOND CASPER X DEVICE, THE FLOW WAS REPORTED AS GOOD, BUT THE STENT WAS NOT IN A GOOD POSITION. DURING RESHEATHING MANEUVER, IT WAS REPORTED THAT THE PATIENT MOVED (NOT FULLY SEDATED) AND IT CAUSED A DISLOCATION OF CASPER X AND DISSECTION OCCURRED. THIS LED TO THROMBUS FORMATION ON THE SECOND CASPER X STENT. THE SECOND CASPER X DEVICE WAS ALSO REMOVED AND A WALLSTENT WAS CHOSEN. DUE TO THROMBUS FORMATION ON THE WALLSTENT, THE OPERATIVE PHYSICIAN MADE AN INTRAOPERATIVE DECISION TO ABORT FURTHER TREATMENT. PATIENT STATUS WAS REPORTED AS "NIHSS 14, MRS 5, NO CHANGE DURING CHECKUP¿. STENOSES WAS TREATED ELECTIVE WITH WALLSTENT AT A LATER DATE. BASED ON THE REVIEW OF AVAILABLE DATA, A COMPLETE STENT OCCLUSION OCCURRED DURING DEPLOYMENT AND PRIOR TO DETACHMENT OF THE CASPER X DEVICE AND THE RELATIONSHIP OF THE EVENT TO THE CASPER X DEVICE CANNOT BE RULED OUT. NO DEVICE MALFUNCTION WAS REPORTED ASSOCIATED WITH THE CASPER X DEVICE AND/OR NO DEVICE MALFUNCTION WAS REPORTED AS THE CAUSE OF THE REPORTED STENT OCCLUSION. SUPPLEMENTAL IMAGING WAS UNAVAILABLE FOR REVIEW. WITHOUT THE RETURN AND EVALUATION OF THE PHYSICAL DEVICE, THE INVESTIGATION CANNOT FURTHER EXAMINE IF A CONDITION EXISTED THAT WOULD HAVE CONTRIBUTED TO THE REPORTED EVENT. A SEARCH FOR NON-CONFORMANCES ASSOCIATED WITH THIS PART/LOT NUMBER COMBINATION DID NOT REVEAL ANY PRODUCTION-RELATED ISSUES RELEVANT TO THE COMPLAINT THAT OCCURRED DURING MANUFACTURING OF THE DEVICE.
BASED ON A REVIEW OF THE DEVICE¿S RISK DOCUMENTATION, THE REPORTED EVENT DID NOT INDICATE THERE WERE THE PRESENCE OF ANY POTENTIAL OR NEW MANUFACTURING, DESIGN, QUALITY, OR OTHER SYSTEMIC ISSUES, OR NON-CONFORMANCES. THE COMPLAINT CODE IS MONITORED THROUGH THE TRENDING PROCESS; CORRECTIVE ACTION IS DETERMINED, AS NEEDED, THROUGH THIS PROCESS. INVESTIGATIONS OF HISTORIC COMPLAINT FILES WITH SIMILAR COMPLAINT CATEGORY CODING ARE RECORDED IN THE COMPLAINT HANDLING SYSTEM; WITHOUT THE ABILITY TO PERFORM AN ANALYSIS OF THE DEVICE, THIS INVESTIGATION CANNOT IDENTIFY WITH CERTAINTY ANY POTENTIAL ROOT CAUSES. COMPLAINT SYSTEM REVIEW: THERE ARE NO SIMILAR COMPLAINTS BASED ON THE COMPLAINT CATEGORY REGARDING THIS BATCH NUMBER FROM THE LAST TWO YEARS RECORDED IN THE COMPLAINT SYSTEM AT THE TIME OF THIS INVESTIGATION. IFU REVIEW (ADDITIONAL INFORMATION CAN BE FOUND IN THE IFU): POTENTIAL COMPLICATIONS POSSIBLE COMPLICATIONS INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING: ARRHYTHMIA, ANEURYSM AND PSEUDOANEURYSM FORMATION, ABRUPT VESSEL CLOSURE, ALLERGIC REACTIONS (INCLUDING TO ANTIPLATELET AGENTS, CONTRAST MEDIUM OR STENT MATERIALS), ARTERIOVENOUS FISTULA, BLEEDING FROM ANTICOAGULATION/ANTIPLATELET MEDICATION, BRADYCARDIA AND HYPOTENSION, CAROTID ARTERY SPASM, CORONARY ISCHEMIA, DEATH, DISSEMINATED INTRAVASCULAR COAGULATION, EMBOLI (AIR, TISSUE, PLAQUE, THROMBUS, DEVICE OR OTHER), EMERGENCY ARTERY BYPASS GRAFT SURGERY, HEMATOMA, HEMORRHAGIC OR EMBOLIC STROKE/TIA, INFECTION AND/OR PAIN AT INSERTION SITE/SEPSIS, INTIMAL TEAR/DISSECTION, MYOCARDIAL INFARCTION (MI), NEW OR WORSE ENCEPHALOPATHY, RENAL FAILURE/INSUFFICIENCY, RESPIRATORY ARREST, STENT MISPLACEMENT, TISSUE NECROSIS, VESSEL INJURY/DISSECTION/PERFORATION/RUPTURE/TRAUMA, VESSEL OCCLUSION OR THROMBOSIS, VESSEL SPASM OR RECOIL. WARNINGS: SHOULD UNUSUAL RESISTANCE BE FELT AT ANY TIME DURING ACCESS OR REMOVAL, THE SHEATH INTRODUCER/GUIDE CATHETER AND CASPER X SYSTEM SHOULD BE REMOVED AS A SINGLE UNIT. APPLYING EXCESSIVE FORCE DURING DELIVERY OR RETRIEVAL OF THE CASPER X SYSTEM CAN POTENTIALLY RESULT IN LOSS OR DAMAGE TO THE DEVICE AND DELIVERY COMPONENTS. IF AN EPD DEVICE IS USED, ALLOW FOR AND MAINTAIN ADEQUATE DISTANCE BETWEEN THE FILTER, THE STENT DELIVERY SYSTEM OR DEPLOYED STENT TO AVOID POTENTIAL ENTANGLEMENT. DO NOT REPOSITION THE CASPER X SYSTEM WITHOUT FULLY RETRIEVING THE DEVICE. THE CASPER X STENT MUST BE RETRIEVED INTO THE DELIVERY SYSTEM AND REDEPLOYED AT THE DESIRED TARGET LOCATION OR REMOVED COMPLETELY FROM THE PATIENT. THE USE OF A GUIDING SHEATH OR GUIDING CATHETER WITH A FIXED HEMOSTASIS VALVE MAY CAUSE THE DISTAL TIP OF THE DELIVERY CATHETER TO DETACH AT THE HEMOSTASIS VALVE UPON REMOVAL IF THE VALVE IS NOT ADEQUATELY OPENED. PRECAUTIONS EXERCISE CAUTION WHEN CROSSING THE DEPLOYED/DETACHED CASPER X SYSTEM WITH ADJUNCTIVE DEVICES SUCH AS GUIDEWIRES, CATHETERS OR BALLOON CATHETERS TO AVOID DISRUPTING THE DEVICE GEOMETRY AND DEVICE PLACEMENT. DIRECTIONS FOR USE INTRODUCTION OF THE STENT DELIVERY SYSTEM ACCESS THE TREATMENT SITE USING THE APPROPRIATE ACCESSORY EQUIPMENT AND INSERT AN EPD USABLE AS A GUIDEWIRE. IF AN EPD IS NOT PREFERRED, USE A SUFFICIENTLY LONG .014¿ GUIDEWIRE AND PLACE IT ACROSS THE LESION. WARNING: ALWAYS USE A GUIDEWIRE OR EPD WHEN ADVANCING OR WITHDRAWING THE DELIVERY SYSTEM. IF NECESSARY PERFORM A PRE-DILATATION AT THE LESION TARGET SITE USING A STANDARD PTA TECHNIQUE USING THE RECOMMENDED GUIDE SHEATH OR GUIDING CATHETER ON THE OUTER BOX LABEL. THE GUIDE WIRE OR EPD DEVICE SHOULD BE ADVANCED PAST THE TARGET LESION SITE. THEN THE DELIVERY SYSTEM SHOULD BE ADVANCED OVER THE GUIDE WIRE OR EPD TO THE LESION SITE USING FLUOROSCOPY. CAUTION: DO NOT ADVANCE THE DELIVERY SYSTEM AGAINST SIGNIFICANT RESISTANCE. THE CAUSE OF THE RESISTANCE SHOULD BE DETERMINED BY FLUOROSCOPY AND REMEDIAL ACTION TAKEN. WITHDRAW THE SYSTEM AND USE A NEW ONE. SLACK REMOVAL ENSURE THAT THE DELIVERY SYSTEM CATHETER OUTSIDE THE PATIENT REMAINS FLAT AND STRAIGHT. WARNING: SLACK IN THE DELIVERY SYSTEM CATHETER EITHER OUTSIDE OR WITHIN THE PATIENT MAY RESULT IN MISPLACEMENT OF THE STENT BEYOND THE LESION. STENT DEPLOYMENT NOTE: THE CASPER X STENT SHOULD BE SIZED TO THE VESSEL ACCORDING TO THE REFERENCE VESSEL DIAMETER RANGE LISTED ON THE PRODUCT LABEL. THE CASPER X STENT FORESHORTENS AS IT EXPANDS TO THE DIAMETER OF THE NATIVE VESSEL. THE STENT FORESHORTENING SHOULD BE TAKEN INTO ACCOUNT WHEN SIZING AND DEPLOYING THE CASPER X CAROTID STENT SYSTEM. IF THE CASPER X STENT POSITIONING IS NOT SATISFACTORY ACROSS THE TARGET LESION, THE STENT MAY BE RECAPTURED AND REPOSITIONED IF IT IS NOT FULLY DEPLOYED. THE IMPLANT MAY BE RECAPTURED UP TO 50% OF ITS DEPLOYMENT FROM THE CATHETER DELIVERY SYSTEM. RECAPTURING OF STENT CAN BE ACCOMPLISHED BY REMOVING THE SLACK IN THE DELIVERY CATHETER SHAFT AND THEN MAINTAINING THE INNER CATHETER (HANDLE) POSITION AND ADVANCING OR PUSHING FORWARD THE OUTER CATHETER. AFTER RECAPTURING THE STENT INTO THE DELIVERY SYSTEM THEN YOU CAN REDEPLOY THE STENT ACROSS THE LESION, TAKING INTO CONSIDERATION THE FORESHORTENING OF THE STENT. ENSURE THE RHV IS OPEN. THE STENT IS DEPLOYED BY OUTER CATHETER RETRACTION. DEPLOYMENT IS COMPLETE BY MAINTAINING INNER CATHETER POSITION (HOLDING HANDLE) WHILE RETRACTING THE OUTER CATHETER AND ALLOWING THE STENT TO EXPAND. WITHDRAWING STENT DELIVERY SYSTEM AFTER THE STENT HAS BEEN COMPLETELY DEPLOYED, USING FLUOROSCOPY, WITHDRAW THE DELIVERY SYSTEM CAREFULLY, LEAVING THE GUIDEWIRE OR EPD IN PLACE. PERFORM STANDARD POST-PROCEDURAL ANGIOGRAPHY. POST-DEPLOYMENT STENT DILATATION IF THE STENT IS NOT COMPLETELY EXPANDED WITHIN THE LENGTH OF THE LESION, POST-DILATION WITH THE BALLOON CATHETER INSIDE THE STENT MAY BE DONE WITH STANDARD PTA TECHNIQUE. THE INFLATED NOMINAL DIAMETER OF THE PTA BALLOON USED FOR POST-DILATION SHOULD BE APPROXIMATELY THE SAME AS THE DIAMETER OF THE REFERENCED NATIVE VESSEL.
UPDATED INFORMATION WAS RECEIVED VIA EMAIL ALONG WITH SOME MEDICAL DATA, THE ANALYSIS OF WHICH IS CURRENTLY ONGOING. CORRECTIONS WERE MADE TO B5, SECTION D, SECTION E AND H4.
IT WAS REPORTED THAT A CASPER STENT OCCLUDED DURING DEPLOYMENT, PRIOR TO DETACHMENT OR COMPLETE DEPLOYMENT. THE STENT WAS REMOVED FROM THE PATIENT AND NOT DEPLOYED. A SECOND CASPER STENT WAS ATTEMPTED TO BE IMPLANTED, WHICH IS REPORTED ON A SEPARATE MEDICAL DEVICE REPORT. DUE TO THROMBUS FORMATION ON THE TWO STENTS USED AFTER THIS ONE (ONE CASPER X AND ONE COMPETITOR DEVICE), IT WAS DECIDED TO NOT PROVIDE FURTHER TREATMENT AT THAT TIME. THE PATIENT STATUS WAS REPORTED TO BE "NIHSS 14, MRS 5, NO CHANGE DURING CHECK UP. STENOSES WAS TREATED ELECTIVE WITH WALLSTENT LATER."
IT WAS REPORTED THAT A CASPER STENT OCCLUDED DURING DEPLOYMENT, PRIOR TO DETACHMENT OR COMPLETE DEPLOYMENT. THE STENT WAS REMOVED FROM THE PATIENT AND NOT DEPLOYED. A SECOND CASPER STENT WAS ATTEMPTED TO BE IMPLANTED, WHICH IS REPORTED IN MDR 2032493-2025-00169. DUE TO THROMBUS FORMATION ON THE TWO STENTS USED AFTER THIS ONE (ONE CASPER X AND ONE COMPETITOR DEVICE), IT WAS DECIDED TO NOT PROVIDE FURTHER TREATMENT AT THAT TIME. THE PATIENT STATUS WAS REPORTED TO BE "NIHSS 14, MRS 5, NO CHANGE DURING CHECK UP. STENOSES WAS TREATED ELECTIVE WITH WALLSTENT LATER."
IT WAS REPORTED THAT A CASPER STENT OCCLUDED DURING DEPLOYMENT, PRIOR TO DETACHMENT OR COMPLETE DEPLOYMENT. THE STENT WAS REMOVED FROM THE PATIENT AND NOT DEPLOYED. A SECOND CASPER STENT WAS ATTEMPTED TO BE IMPLANTED, WHICH IS REPORTED IN MDR 2032493-2025-00169. DUE TO THROMBUS FORMATION ON THE TWO STENTS USED AFTER THIS ONE (ONE CASPER X AND ONE COMPETITOR DEVICE), IT WAS DECIDED TO NOT PROVIDE FURTHER TREATMENT AT THAT TIME. THE PATIENT STATUS WAS REPORTED TO BE "NIHSS 14, MRS 5, NO CHANGE DURING CHECK UP. STENOSES WAS TREATED ELECTIVE WITH WALLSTENT LATER."
IT WAS REPORTED THAT A CASPER STENT OCCLUDED DURING DEPLOYMENT, PRIOR TO DETACHMENT OR COMPLETE DEPLOYMENT. THE STENT WAS REMOVED FROM THE PATIENT AND NOT DEPLOYED. A SECOND CASPER STENT WAS ATTEMPTED TO BE IMPLANTED, WHICH IS REPORTED IN MDR 2032493-2025-00169. DUE TO THROMBUS FORMATION ON THE TWO STENTS USED AFTER THIS ONE (ONE CASPER X AND ONE COMPETITOR DEVICE), IT WAS DECIDED TO NOT PROVIDE FURTHER TREATMENT AT THAT TIME. THE PATIENT STATUS WAS REPORTED TO BE "NIHSS 14, MRS 5, NO CHANGE DURING CHECK UP. STENOSES WAS TREATED ELECTIVE WITH WALLSTENT LATER."
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1472353 | CASPER X | STENT CAROTID | NIM | MICROVENTION, INC. | XCPR-0825-143RX-ME | 0000424130 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | NA | Unknown |