MAUDE Adverse Event Report: AV-TEMECULA-CT XIENCE ALPINE EVEROLIMUS ELUTING CORONARY STENT SYSTEM; DRUG ELUTING CORONARY STENT SYSTEM

Catalog Number 1125275-23

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Angina (1710); Low Blood Pressure/ Hypotension (1914); Thrombosis (2100); Cardiogenic Shock (2262)

Event Date 07/01/2017

Event Type  Injury  

Manufacturer Narrative

(b)(4).Concomitant medical products: scaffold: absorb gt1 3.0x18, stent: xience alpine 3.25x23 (2), dual antiplatelet therapy: plavix and aspirin.The device was not returned for evaluation.A review of the lot history record identified no manufacturing nonconformities issued to the reported lot that would have contributed to this event.The reported patient effects of angina, hypotension, thrombosis and shock are listed in xience alpine everolimus eluting coronary stent systems instructions for use as known patient effects of coronary stenting procedures.A conclusive cause for the reported patient effects and the relationship to the product, if any, cannot be determined and there is no indication of a product quality issue with respect to manufacture, design or labeling.The absorb gt1 scaffold and the two other xience alpine stents are filed under separate medwatch reports.

Event Description

It was reported that on (b)(6) 2017, the patient underwent a coronary procedure, with implantation of a 3.0 x 18 mm absorb gt1 bioresorbable vascular scaffold (bvs) in the left anterior descending (lad) artery and a 3.25 x 23mm xience alpine stent in the right coronary artery (rca).The patient was prescribed dual anti-platelet therapy (dapt) of aspirin and clopidogrel and was discharged to home.On (b)(6) 2017, the patient was re-hospitalized with angina.Coronary angiography was performed and noted thrombosis in both the absorb bvs and in the xience stent.The patient reported being non-compliant with dapt.Thrombectomy was performed.Two additional xience alpine stents were implanted; one in the absorb scaffold in the lad and one in the xience alpine stent in the rca.The clopidogrel was changed to ticagrelor and the patient was discharged to home in stable condition.On (b)(6) 2017, the patient was re-hospitalized again, with angina, and thrombosis was noted in both locations (lad and rca).The patient was admitted in cardiogenic shock with blood pressure of 80/59.An intra-aortic balloon pump and a temporary pacemaker were placed and the blood pressure increased to the 150-160 range.The patient reported being non-compliant with dapt.Balloon angioplasty was performed.The patient was in stable condition post procedure.No additional information was provided.

• Brand Name: XIENCE ALPINE EVEROLIMUS ELUTING CORONARY STENT SYSTEM
• Type of Device: DRUG ELUTING CORONARY STENT SYSTEM
• Manufacturer (Section D): AV-TEMECULA-CT; abbott vascular; 26531 ynez road; temecula CA 92591 4628
• Manufacturer (Section G): CLONMEL, IRELAND REG# 9616693; abbott vascular; 26531 ynez road; temecula CA 92591 4628
• Manufacturer Contact: connie speck ; abbott vascular; 26531 ynez road; temecula, CA 92591-4628 ; 9519143996
• MDR Report Key: 6734927
• MDR Text Key: 80750471
• Report Number: 2024168-2017-06140
• Device Sequence Number: 1
• Product Code: NIQ
• UDI-Device Identifier: 08717648199271
• UDI-Public: 08717648199271
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: P110019
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Reporter Occupation: Health Professional
• Remedial Action: Other
• Type of Report: Initial
• Report Date: 07/21/2017

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 07/23/2017
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 03/22/2020
• Device Catalogue Number: 1125275-23
• Device Lot Number: 7030941
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 07/05/2017
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 03/01/2017
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Hospitalization; Required Intervention
• Patient Age: 87 YR