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It was reported that the coil (subject device) was selected for anterior communicating artery aneurysm procedure.However, while advancing the coil within the microcatheter resistance was encountered.The physician attempted to retract the coil and found it to be stretched.Thus, the coil along with the microcatheter was withdrawn and the coil was found to be stretched and fractured.The subject device was replaced, and the procedure was completed successfully.No clinical consequences were reported to the patient due to this event.
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It was reported that the coil (subject device) was selected for anterior communicating artery aneurysm procedure.However, while advancing the coil within the microcatheter resistance was encountered.The physician attempted to retract the coil and found it to be stretched.Thus, the coil along with the microcatheter was withdrawn and the coil was found to be stretched and fractured.The subject device was replaced, and the procedure was completed successfully.No clinical consequences were reported to the patient due to this event.
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D9 - product available to stryker - updated.D9 - returned to manufacturer on ¿ updated.H3 device evaluated by mfg - updated.Due to the automated manufacturing execution system (mes) there are controls in the manufacturing process to ensure the product met specifications upon release.During visual inspection, the main coil was found to be stretched.The main coil was found to be kinked/bent.The main coil delivery wire was found to be broken/fractured near the detachment zone.The rest of the coil delivery wire was not returned.The main coil suture was found to be damaged.The reported event is covered in the device directions for use (dfu).As well, the risk of the reported event is documented in the risk documentation and there are current controls to mitigate the risk of the as reported event.The reported ¿coil in catheter friction¿ and ¿main coil stretched¿ was confirmed based on analysis.The reported ¿main coil broken/fractured during use¿ was not confirmed during the analysis as there was no breakage noted on the main coil.The device failed to meet specifications when received for complaint investigation based on the analyzed anomalies noted to the device.It was reported that resistance was encountered when the coil was approximately halfway inserted, preventing further advancement.Upon attempting retraction, it was noted that the coil had become stretched.The physician promptly withdrew both the stretched coil and the microcatheter from the body, confirming that the coil had indeed stretched and sustained a fracture.Additional information provided by the customer indicated that the device was prepared for use as per the dfu.There was no damage noted to the packaging prior to opening the packaging.The device was confirmed to be in good condition during preparation/ prior to use on the patient.Continuous flush was set up and maintained throughout the clinical procedure.The patient's anatomy was moderately tortuous.During analysis, the main coil was found to be stretched and kinked/bent.The main coil delivery wire was found to be broken/fractured near the detachment zone and rest of the coil delivery wire was not returned.The main coil suture was also found to be damaged.The reported ¿main coil broken/fractured during use¿ was not confirmed during the analysis as there was no breakage noted on the main coil, hence an assignable cause of not confirmed will be assigned.Based on the review of all available information, an assignable cause of procedural factors will be assigned to as reported ¿main coil stretched¿ and ¿coil in catheter friction¿ as well as the as analyzed codes ¿main coil kinked/bent¿, ¿main coil suture damage¿, ¿main coil stretched¿ and ¿coil delivery wire broken/fractured during use¿ as this complaint appears to be associated with a product that met stryker design and manufacturing specifications and was used in accordance with the dfu, but performance was limited due to procedural factors during use.
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