| Catalog Number |
M0036124120 |
| Medical Device Problem Code |
Premature Separation (4045)
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| Health Effect - Clinical Code |
No Clinical Signs, Symptoms or Conditions (4582)
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| Date of Event |
06/12/2025
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Type of Reportable Event
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Serious Injury
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Event or Problem Description
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It was reported that during coil embolization of subarachnoid hemorrhage (sah) procedure, the operator implanted six coils using a guidewire and a microcatheter.The subject coil was attempted to be placed as the seventh coil; however, while repositioning, the subject coil could not to be moved as intended.The operator attempted to retrieve the subject coil, which caused a premature detachment.The subject coil was removed using a goose neck snare.Upon retrieval, the subject coil was found to be stretched.The procedure was completed successfully.No clinical consequences were reported to the patient due to this event.
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Additional Manufacturer Narrative
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H4 manufacturing date ¿ added.H3 device evaluated by mfg ¿updated.D4 expiration date - added.D9 product available to stryker ¿ updated.D9 returned to manufacturer on ¿updated.D4 gtin - updated.Due to the automated manufacturing execution system (mes) system there are controls in the manufacturing process to ensure the product met specifications upon release.During visual inspection the coil was returned attached to a snare device.The delivery wire or introducer sheath were not returned.The coil was stretched proximally.Significant procedural fluid was noted on the device.The coil delivery wire was separated from the coil due to a break at the detachment zone.Functional inspection was not performed due to the damage noted to the device.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 complaint was confirmed based on returned device inspection.The device failed to meet specifications when received for complaint investigation based on the damage noted to the device.It was reported that while repositioning the seventh coil in the aneurysm, the operator felt the coil had stretched.In attempt to retrieve the coil, the coil detached.The coil was removed with a snare and the case was completed successfully without adding another coil.The device was returned for analysis, and it was noted that the coil was stretched on the proximal end and had detached mechanically at the detachment zone.An assignable cause of procedural factors will be assigned to the reported events: ¿main coil stretched¿ and ¿main coil prematurely detached/separated during use¿ as well as analyzed events: ¿main coil stretched¿ and ¿main coil prematurely detached/separated during use¿ as the 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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Event or Problem Description
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It was reported that during coil embolization of subarachnoid hemorrhage (sah) procedure, the operator implanted six coils using a guidewire and a microcatheter.The subject coil was attempted to be placed as the seventh coil; however, while repositioning, the subject coil could not to be moved as intended.The operator attempted to retrieve the subject coil, which caused a premature detachment.The subject coil was removed using a goose neck snare.Upon retrieval, the subject coil was found to be stretched.The procedure was completed successfully.No clinical consequences were reported to the patient due to this event.
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Search Alerts/Recalls
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