FDA Adverse Event Injury Summary report: N

EXPRESS LD ILIAC / BILIARY

MDR report key: 21945293 · Received May 1, 2025

Report

Report Number
2124215-2025-25072
Event Type
Injury
Date Received
May 1, 2025
Date of Event
March 26, 2025
Report Date
May 1, 2025
Manufacturer
BOSTON SCIENTIFIC CORPORATION
Product Code
NIO
UDI-DI
08714729579663
PMA / PMN Number
K133110
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
VT, US
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

G4 - PREMARKET / 510(K) #: K133110, P090003.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE STENT DISLODGED, REQUIRING INTERVENTION. THE TARGET LESION WAS LOCATED IN THE TORTUOUS AND SEVERELY CALCIFIED OSTIAL STENOSIS OF THE CELIAC ARTERY. VASCULAR ACCESS WAS OBTAINED VIA THE RIGHT COMMON FEMORAL ARTERY TO THE CELIAC ARTERY. A 6F NON-BOSTON SCIENTIFIC GUIDE SHEATH WAS PLACED, AND A 7.0 X 30 X 75 CM EXPRESS LD STENT BALLOON EXPANDABLE WAS ADVANCED FOR TREATMENT OVER .035 WIRE. IT WAS NOTED THAT THE GUIDE SHEATH WAS ONLY PARTIALLY INTO THE CELIAC ARTERY, AND AN ATTEMPT WAS MADE TO ADVANCE THE BALLOON/STENT OVER THE WIRE AND PAST THE LESION. HOWEVER, WHEN ADVANCING, THE BALLOON PUSHED FORWARD, CAUSING THE WIRE TO LOSE ACCESS IN THE CELIAC ARTERY, AND MOVE FORWARD IN THE AORTA. WHEN ATTEMPTING TO PULL BACK THE STENT INTO THE SHEATH, THE STENT DISLODGED FROM THE BALLOON SHAFT. A SNARE WAS USED TO PULL THE STENT BACK TO THE COMMON FEMORAL ARTERY; HOWEVER, A SURGICAL CUTDOWN WAS PERFORMED TO REMOVE THE STENT. THE PROCEDURE WAS CANCELLED, AND THE PATIENT WAS UNDER LOCAL ANESTHESIA. THERE WERE NO PATIENT COMPLICATIONS AS A RESULT OF THIS EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1023537 EXPRESS LD ILIAC / BILIARY STENT, ILIAC NIO BOSTON SCIENTIFIC CORPORATION H74938046730750 0033824094 08714729579663

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown Required Intervention SHEATH: 6F TOUR GUIDE SHEATH