| Model Number |
OCB4508BA |
| Medical Device Problem Code |
Use of Device Problem (1670)
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| Health Effect - Clinical Code |
No Clinical Signs, Symptoms or Conditions (4582)
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| Date of Event |
02/18/2025
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Type of Reportable Event
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Malfunction
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Event or Problem Description
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The event description was provided to ostial via email by their sales representative, along with user facility report mdr # (b)(4) from the fda.The description stated that during a complex intervention, attempts were made to advance an ostial flash balloon into the coronary artery for angioplasty.The balloon would not advance all the way through the guide and had to be removed.The flash device was promptly removed from service, and there was no harm to the patient.The user facility report mdr # (b)(4) indicated a malfunction of devices.The device was returned to the manufacturer for product evaluation.
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Additional Manufacturer Narrative
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Based on the details of the case provided by the local sales representative and the hospital staff, there is no indication that the flash ostial system device did not perform as intended.The flash mini device used in the procedure was returned to the ostial corporation for evaluation.As part of bench testing, the complaint device and a 0.014" guide wire were advanced through a similar 6f guide catheter (medtronic) with no difficulty through the entire guide catheter under neural pressure.Additionally, as part of bench testing, the inner and outer balloons of the complaint device were inflated after exiting the 6f guide catheter to their nominal inflation volume/pressure and inspected for leaks/damage with no issues found.It was observed that catheter shaft was kinked near the hub (within ~30cm), which may have been due to excessive force applied during the unsuccessful passing of the flash.The likely root causes for this complaint are related to patient anatomy and potentially inadequate support from accessory devices (guide catheter and guidewire).In addition, ostial corporation reviewed the manufacturing documentation and lot release testing associated with the flash ostial system device lot that is suspected to have been used in this procedure.No issues were noted that would have contributed to the reported incident.Additionally, the flash device was not used and removed without incident from the patient.
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Additional Manufacturer Narrative
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This is the first follow-up report to the initial report # 3008700817-2025-00002.The related medical device report (mdr) report number (b)(4) was included in block h10, related report number field.
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Search Alerts/Recalls
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