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MICRO THERAPEUTICS, INC. DBA EV3 PIPELINE FLEX W/SHIELD TECHNOLOGY; INTRACRANIAL ANEURYSM FLOW DIVERTER
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| Model Number |
PED2-500-25 |
| Medical Device Problem Codes |
Material Frayed (1262); Material Deformation (2976); Activation Failure (3270)
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| Health Effect - Clinical Code |
No Clinical Signs, Symptoms or Conditions (4582)
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| Date of Event |
12/12/2025
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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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Medtronic received a report that the pipeline failed to open.The patient was undergoing surgery for treatment of a saccular, unruptured aneurysm located in the petrous segment of the internal c arotid artery with a max diameter of 12 mm and a 5 mm neck diameter.Landing zone: distal: 4.9 mm and proximal: 5.1 mm.It was noted the patient's vessel tortuosity was moderate.Dual antiplatelet treatment was administered.The surgery was rescheduled.It was reported that the patient was undergoing a flow diverter and coil treatment of the aneurysm as planned.After positioning the microcatheter, the pipeline stent was delivered and the distal tip was deployed, but the distal tip of the stent could not be opened.Attempt was made to retrieve and redeploy the stent, but it still could not be opened.The entire system was then withdrawn, and it was found that the distal tip of the stent was roughened.The procedure was cancelled.The pipeline was not used for an indication that is off-label.The reported device and any accessory devices were prepared as indicated in the instructions for use (ifu).No patient symptoms or further complications were reported as a result of this event.Ancillary devices include a 6f navien guide catheter and xt27 microcatheter.
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Additional Manufacturer Narrative
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Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Medtronic will submit a supplemental report if additional relevant information becomes known.
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Additional Manufacturer Narrative
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Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
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Event or Problem Description
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Additional information was received stating that the cause of the failure to open or roughness was not determined.The pipeline had not been placed in a vessel bend when it failed to open; it was in a straight segment.Additional steps were taken, including retrieval and redeployment of the pipeline.
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Additional Manufacturer Narrative
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H3: product analysis as found condition: the pipeline flex shield was returned inside the inner pouch, biohazard bag, and shipping box.Visual inspection/damage location details: the distal and proximal dps restraints were found to be intact.The dps sleeves were found intact with no signs of damage.The distal hypotube and ptfe shrink tubing were found to be intact with no signs of elongation.The braid's distal and proximal ends were found open and frayed.No bends were found with the pushwire.No defects were found with the tip coil, distal marker, re-sheathing marker, re-sheathing pad, or the proximal bumper.No other anomalies were observed.Conclusion: based on the device analysis and reported information, the customer report of ¿failure/incomplete open distal¿ was not confirmed as the braid's distal and proximal ends were found opened and frayed.The cause of the ¿failure/incomplete open¿ could not be determined.Possible causes of ¿failure/incomplete open¿ include vessel tortuosity, damaged braid, and deployment of the braid in the vessel bend.However, the customer indicated that vessel tortuosity was moderate, and the braid was not positioned in the vessel bend, which eliminates these factors as potential causes.In this event, the damaged braid may have contributed to the failure to open.The braid can become damaged due to resheathing more than twice, over-manipulation, deployment techniques, delivering/retracting the delivery wire against resistance, or deploying/resheathing the braid against resistance.However, the cause of the braid damage could not be determined.Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
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