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Product complaint # (b)(4).The purpose of this mdr submission is to report the findings of the device investigation.Based on the product analysis, multiple kinked conditions were found on the embolic coil.The findings meet regulatory reporting criteria.Information regarding patient weight, height, medical history, race, and ethnicity was not reported.Section d2b ¿ procode: krd/hcg.A non-sterile og cmplx xtrasoft coil 3.5x7.5 was received contained in the decontamination pouch.Upon receiving the device, a visual inspection was performed, and the coil was noted to be outside from the introducer.The device was inspected under microscopic magnification, and multiple kinked conditions were found on the coil however, it was still attached to the gripper.The issue documented in the complaint that there was an impeded condition felt during the advancement of the coil through the microcatheter could not be evaluated through proper functional test since the multiple kinked conditions found on the coil prevented the ability to move the coil through the introducer.The coil kinking was not originally reported in the complaint.Such damage suggest that excessive force was inadvertently applied during the attempts to withdraw and re-insert the device.It is possible that clinical and procedural factors, including device manipulation and operator's technique, may have contributed to the reported failure.According to the risk documentation, delivery tube / embolic coil not pushing through the microcatheter is a potential issue that can occur during coil placement due to: 1) excessively tortuous anatomy; or 2) clot formation in the microcatheter.With the limited information available, the root cause remains speculative, however, there is no indication that the issues encountered during the procedure are a result of a defect inherently related to the device.A manufacturing record evaluation was performed for the finished device 31395228 number, and no non-conformances related to the malfunction were identified.As part of j&j medtech quality process, all devices are manufactured, inspected, and released to approved specifications.Since there was no evidence to suggest the event was related to a manufacturing or design issue, no capa activity is proposed at this time.It should be noted that product failure is multifactorial.The instructions for use contain the following precautions and warnings: if unusual friction is still noticed during advancement or retraction of the microcoil system, verify flush lines are open and properly pressurized.Then, slowly withdraw the entire microcoil system and examine for damage.Replace it with a new microcoil system.If friction still exists, withdraw and examine the delivery catheter system.During coil retraction, verify under fluoroscopy that a one-to-one relationship exists between the delivery tube and the coil.If not, the coil has been stretched, which could lead to premature detachment or coil fracture.If the one-to-one relationship does not exist, remove the infusion catheter and the detachable coil as an assembly and replace.As part of the post market surveillance program, information from this complaint is trended to identify statistical signals for consideration of further correction action.Since there was no evidence to suggest the event was related to a manufacturing or design issue, no corrective actions will be taken at this time.This report is being submitted pursuant to the provisions of 21 cfr, part 803 (and/or part 4, as applicable).This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by cerenovus, or its employees that the report constitutes an admission that the product, cerenovus, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.
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As reported by the field, during a coil embolization, an orbit galaxy xtrasoft coil (640cx3575, 31395228) became impeded in proximal of microcatheter and could not advance any more.The physician retracted the coil and switched a new one to complete the surgery.The microcatheter was not replaced.No patient injury was reported.Additional event information received on 21-nov-2024 stated that the event did not result in any undue procedural delay that could be considered clinically significant.The device did not appear to be damaged at any time.Continuous flush was maintained.Based on the product analysis of the device received, multiple kinked conditions were found on the embolic coil.
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