MAUDE Adverse Event Report: AV-TEMECULA-CT XACT CAROTID STENT SYSTEM

Catalog Number XRX04009T

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

Patient Problems Stroke/CVA (1770); Thrombosis (2100)

Event Date 01/03/2019

Event Type  Injury  

Manufacturer Narrative

(b)(4): during processing of this complaint, attempts were made to obtain complete event, patient and device information.The stent remains in the patient.Investigation is not yet complete.A follow up report will be submitted with all additional relevant information.

Event Description

It was reported that the procedure was performed to treat an 85% stenosed, moderately tortuous, and heavily calcified lesion in the left inner carotid artery.A 40x9-7mm x-act freestyle stent was deployed; however, the patient suffered a stroke some hours later.An angiogram was performed and thrombosis in the stent was confirmed.The patient was treated with antiplatelet therapy and was discharged home.No additional information was provided.

Event Description

Subsequent to the previously filed report, additional information was received: the patient did not suffer a stoke.The patient was transferred to another hospital and unspecified treatment was performed.No additional information was provided.

Manufacturer Narrative

Internal file number - (b)(4).Corrections: outcomes attributed to adverse event: the patient did not suffer a disability or permanent damage.Patient code 1770 was removed.The device was not returned for evaluation.The reported patient effect of thrombosis is listed in the xact instructions for use, as a known possible complication associated with carotid stenting procedures.A review of the lot history record and corrective action tracking system for the web revealed no exceptions associated with this lot.Based on the case information and related record review, a conclusive cause for the reported patient effect and the relationship to the product, if any, cannot be determined.There is no indication of a product quality issue with respect to manufacture, design or labeling.

• Brand Name: XACT CAROTID STENT SYSTEM
• Type of Device: CAROTID STENT SYSTEM
• Manufacturer (Section D): AV-TEMECULA-CT; abbott vascular; 26531 ynez road; temecula CA 92591 4628
• MDR Report Key: 8408838
• MDR Text Key: 138415915
• Report Number: 2024168-2019-01899
• Device Sequence Number: 1
• Product Code: NIM
• Combination Product (y/n): N
• PMA/PMN Number: P040038
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Remedial Action: Other
• Type of Report: Initial,Followup
• Report Date: 03/15/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 01/31/2021
• Device Catalogue Number: XRX04009T
• Device Lot Number: 8021461
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 02/14/2019
• Initial Date FDA Received: 03/11/2019
• Supplement Dates Manufacturer Received: 03/12/2019
• Supplement Dates FDA Received: 03/15/2019
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Hospitalization; Required Intervention; Disability