FDA Adverse Event Injury Summary report: N

PROMUS PREMIER?

MDR report key: 3881340 · Received June 18, 2014

Report

Report Number
2134265-2014-03318
Event Type
Injury
Date Received
June 18, 2014
Date of Event
May 20, 2014
Report Date
May 20, 2014
Manufacturer
BOSTON SCIENTIFIC - GALWAY
Product Code
NIQ
PMA / PMN Number
P110010
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

DEVICE EVALUATED BY MFR: THE BALLOON CONES PROFILES AND THE BALLOON TUBE PROFILE WERE REVIEWED. INITIAL ANALYSIS OF THE BALLOON NOTED THE BALLOON WAS FULLY DEFLATED WITH THE BALLOON WINGS TIGHTLY WRAPPED AND EVENLY FOLDED. AS PART OF THE EXAMINATION THE BALLOON WAS INFLATED. NO ISSUES WERE OBSERVED WITH THE BALLOON WALL OR THE INNER LUMEN DURING OR AFTER INFLATION. THERE WERE ALSO NO DIFFICULTIES WITH BALLOON DEFLATION. THE STENT WAS NOT RETURNED FOR ANALYSIS AS IT WAS PLACED IN THE MIDDLE OF THE LESION; HOWEVER CRIMP MARKINGS WERE EVIDENT ON THE WALL OF THE BALLOON AS WOULD BE EXPECTED. A MICROSCOPIC EXAMINATION OF THE BI-COMPONENT BOND LOCATION, MIDSHAFT BOND, PORT BOND, INNER LUMEN AND OUTER FOUND NO EVIDENCE OF DEFECTS OR DAMAGE. A VISUAL AND TACTILE EXAMINATION FOUND MULTIPLE KINKS ALONG THE HYPOTUBE SHAFT. THIS TYPE OF DAMAGE IS CONSISTENT WITH EXCESSIVE FORCE BEING APPLIED TO THE DELIVERY SYSTEM. THE BUMPER TIP OF THE DEVICE SHOWED NO SIGNS OF DAMAGE. THE MANUFACTURING BATCH RECORD REVIEW CONFIRMED THAT THE DEVICE MET ALL MATERIAL, ASSEMBLY AND PERFORMANCE SPECIFICATIONS. THE MOST PROBABLE ROOT CAUSE IS OPERATIONAL CONTEXT AS DEVICE PERFORMANCE WAS LIMITED DUE TO ANATOMICAL PROCEDURAL FACTORS. (B)(4).

Additional Manufacturer Narrative · 1

AGE AT TIME OF EVENT: 18 YEARS OR OLDER. DEVICE IS A COMBINATION PRODUCT.

Description of Event or Problem · 1

IT WAS REPORTED THAT CATHETER REMOVAL DIFFICULTY OCCURRED. THE 99% STENOSED TARGET LESION WAS LOCATED IN A SEVERELY TORTUOUS AND SEVERELY CALCIFIED DISTAL LEFT ANTERIOR DESCENDING ARTERY (LAD). AFTER A NON BSC GUIDE WIRE CROSSED THE LESION, PLAIN OLD BALLOON ANGIOPLASTY (POBA) WAS PERFORMED USING A 1.2X15MM AND A 2.0X15MM NON BSC BALLOON CATHETERS. THEN THE 20MM X 2.25MM PROMUS PREMIER¿ STENT WAS ADVANCED TO THE LESION BUT WAS UNABLE TO CROSS. THE DEVICE REACHED THE MIDDLE OF THE LESION BUT THE PHYSICIAN HAD DIFFICULTY IN RETRACTING THE DEVICE. THERE WAS A CONCERN THAT THE SHAFT WOULD BE DETACHED SO THE PHYSICIAN DEPLOYED THIS DEVICE IN THE MID LAD. THE DISTAL LAD WAS DILATED WITH A 2.0MM UNSPECIFIED BALLOON CATHETER. A 2.25MM X 12M PROMUS PREMIER¿ STENT WAS DEPLOYED AND THE PROCEDURE WAS COMPLETED. NO COMPLICATIONS WERE NOTED AND PATIENT'S STATUS IS GOOD.

Description of Event or Problem · 1

IT WAS REPORTED THAT CATHETER REMOVAL DIFFICULTY OCCURRED. THE 99% STENOSED TARGET LESION WAS LOCATED IN A SEVERELY TORTUOUS AND SEVERELY CALCIFIED DISTAL LEFT ANTERIOR DESCENDING ARTERY (LAD). AFTER A NON BSC GUIDE WIRE CROSSED THE LESION, PLAIN OLD BALLOON ANGIOPLASTY (POBA) WAS PERFORMED USING A 1.2X15MM AND A 2.0X15MM NON BSC BALLOON CATHETERS. THEN THE 20MM X 2.25MM PROMUS PREMIER¿ STENT WAS ADVANCED TO THE LESION BUT WAS UNABLE TO CROSS. THE DEVICE REACHED THE MIDDLE OF THE LESION BUT THE PHYSICIAN HAD DIFFICULTY IN RETRACTING THE DEVICE. THERE WAS A CONCERN THAT THE SHAFT WOULD BE DETACHED SO THE PHYSICIAN DEPLOYED THIS DEVICE IN THE MID LAD. THE DISTAL LAD WAS DILATED WITH A 2.0MM UNSPECIFIED BALLOON CATHETER. A 2.25MM X 12M PROMUS PREMIER¿ STENT WAS DEPLOYED AND THE PROCEDURE WAS COMPLETED. NO COMPLICATIONS WERE NOTED AND PATIENT'S STATUS IS GOOD.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
357641 PROMUS PREMIER? STENT, CORONARY, DRUG-ELUTING NIQ BOSTON SCIENTIFIC - GALWAY H7493925120220 16737366

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention GUIDE WIRE: SION BLUE (ASAHI INTECC)| BALLOON CATHETER: SAPPHIRE 1.2 X 15 MM (OBUSNEICH)| INTRODUCER SHEATH: (TERUMO)| INFLATION DEVICE: (ST.JUDE MEDICAL)| BALLOON CATHETER:SCOREFLEX 2.0X15MM (ORBUSNEICH)| GUIDING CATHETER: PROFIT 6FJL3.5 (GOODMAN)