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H11: manufacturing review: the lot history records were reviewed with special attention to the manufacturing and inspection of this product and the product was found to have met the specification prior to shipment.Investigation summary: the returned catheter sample is in used condition with unlocked safety slider.The stent is shifted to distal inside the stent sheath, and the force transmitting adhesive joint between slide block and proximal catheter is separated which made a successful deployment impossible.Residuals of cured adhesive are clearly visible in the joint section.The investigation leads to confirmed result for failure of an adhesive joint and failure to deploy.A manufacturing related issue could not be found.In this case 10fx45cm introducer with 0.035 guidewire were used for access, the lesion was pre-dilated, and it was difficult to get through the stenosis.A manufacturing related root cause was considered.Based on the information available a definite root cause could not be identified.Based on the investigation of the provided information, the investigation is closed as confirmed for loss of an adhesive joint and subsequent deployment failure.A definite root cause for the reported event could not be determined.Labeling review: in reviewing the relevant labeling for this product, the potential issue was found addressed.The ifu state: do not constrict the delivery system during stent deployment.If excessive force is felt during stent deployment, do not force the stent system.Remove the stent system and replace with a new unit.Under required materials the ifu state: 8f introducer for stent diameters of 10 mm and 12 mm, 9f introducer for a stent diameter of 14 mm, 10f introducer for stent diameters of 16 mm, 18 mm and 20 mm, 0.035 inch diameter guidewire.The ifu further state: predilation of chronic lesions with a balloon dilatation catheter is recommended.Section a through f: the information provided by bd represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.
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