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It was reported that the procedure performed was to treat a de novo, moderately calcified, mildly tortuous right coronary artery that is 90% stenosed.The 3.00x48mm xience skypoint drug-eluting stent delivery system (sds) was advanced but failed to cross due to the anatomy.Upon removal, resistance was met with the guiding catheter; therefore, the sds and guiding catheter were removed as one unit.A new unspecified guiding catheter and new 3.00x48mm xience sds was successfully used to complete the procedure.Upon testing of the removed xience sds with both guiding catheters outside the anatomy, it was noted that only the first guiding catheter had an issue.There were no adverse patient effects and no clinically significant delay in the procedure.No additional information was provided.
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The device was not returned for analysis.Production record and corrective and preventative actions (capa) reviews were performed and revealed no indication of a product quality issue.Additionally, a query of the complaint handling database for the reported lot revealed there is no indication of a lot specific issue.Based on the information provided, a definitive cause for the reported difficulties could not be determined; however, factors that could contribute to failure to advance include, but are not limited to, patient anatomical morphology, patient disease state, pre-dilatation strategy, device placement technique, interaction with previously placed stents or accessory devices.Factors that can contribute to difficult to remove include, but are not limited to, kinks, bends, procedural technique, insufficient support, or interactions with other devices.In this case, it is possible the device may have interacted with the moderately calcified, mildly tortuous, 90% stenosed lesion during advancement, causing the reported failure to advance.Further interaction with the guide catheter during retraction of the device, as resistance was noted, may have contributed to the reported difficult to remove; however, based on the information provided and without the device to examine, this cannot be confirmed.Based on the results of the complaint investigation, there is no indication of a product quality issue with respect to the design, manufacture, or labeling of the device.
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