MAUDE Adverse Event Report: AV-TEMECULA-CT XIENCE ALPINE EVEROLIMUS ELUTING CORONARY STENT SYSTEM; DRUG ELUTING CORONARY STENT SYSTEM

Catalog Number	1125325-12
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	05/15/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).Evaluation summary: the device was returned for analysis.The reported hub crack and leak was confirmed.A review of the lot history record identified no manufacturing nonconformities issued to the reported lot that would have contributed to this event.Additionally, a review of the complaint history identified no similar incidents from this lot.There was no damage or leak noted to the stent delivery system (sds) during the inspection prior to use or during preparation of the device.The investigation determined the reported difficulties appear to be related to circumstances of the procedure as it is likely the sds was overly torqued during attachment to the inflation device resulting in the reported hub crack and subsequent hub leak.There is no indication of a product quality issue with respect to manufacture, design or labeling.
Event or Problem Description
It was reported that the procedure was to treat a 90% stenosed lesion in the mid left anterior descending artery.A 3.25x12mm xience alpine stent delivery system (sds) was prepped without issues.The sds was advanced; however, when the device was being pressurized it was noted that contrast was leaking out of the hub.The pressurization was stopped and all connections were confirmed to be tight.The connections were fine; however, there was a crack at the hub.The sds was removed from the patient anatomy without issues and once outside the anatomy, the balloon appeared as if it had never been inflated.The procedure was successfully completed with a new 3.25x12mm xience alpine sds.There were no adverse patient effects and no clinically significant delay in the procedure.No additional information was provided.

• Brand Name: XIENCE ALPINE EVEROLIMUS ELUTING CORONARY STENT SYSTEM
• Common Device Name: DRUG ELUTING CORONARY STENT SYSTEM
• Manufacturer (Section D): AV-TEMECULA-CT; abbott vascular; 26531 ynez road; temecula CA 92591 4628
• MDR Report Key: 7579942
• Report Number: 2024168-2018-04273
• Device Sequence Number: 1187414
• Product Code: NIQ
• UDI-Device Identifier: 08717648199424
• UDI-Public: 08717648199424
• Combination Product (Y/N): N
• Initial Reporter State: MS
• Initial Reporter Country: US
• PMA/510(K) Number: P110019
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Health Professional
• Remedial Action: Other
• Type of Report: Initial
• Report Date (Section B): 06/07/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 12/19/2020
• Device Catalogue Number: 1125325-12
• Device Lot Number: 7120761
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 05/23/2018
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/18/2018
• Initial Report FDA Received Date: 06/07/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1