MAUDE Adverse Event Report: ABBOTT VASCULAR XIENCE SIERRA DRUG ELUTING CORONARY STENT DELIVERY SYSTEM

Model Number 1550300-38

Device Problem Patient-Device Incompatibility (2682)

Patient Problems Angina (1710); Myocardial Infarction (1969); Thrombosis (2100); Respiratory Failure (2484)

Event Date 01/13/2020

Event Type  Death  

Manufacturer Narrative

The 3. 5x38mm xience sierra stent, referenced is being filed under a separate medwatch report number. The stent remains in patient. The device will not be returned for evaluation. Investigation is not yet complete. A follow-up report will be submitted with all additional relevant information.

Event Description

Patient id: (b)(6). It was reported that on (b)(6) 2020, a percutaneous coronary intervention (pci) was performed on the proximal right coronary artery (rca), 70% stenosed lesion. Pre-dilatation and atherectomy was performed on the rca. Following rotablator use, a proximal rca dissection occurred. Reportedly, a 3. 5x15mm xience sierra stent was implanted at the rca ostium due to this dissection. There was no underexpansion confirmed or reported and no device malfunction. As planned, 3. 0x38mm and 3. 5x38mm xience sierra stents were implanted in the proximal rca. Post-dilatation was performed using a non-compliant balloon. The diameter stenosis was reduced to 25% with timi flow iii. On (b)(6) 2020, the patient was hospitalized for severe substernal chest pain. Medications including nitroglycerin had been provided. Elevated troponin and a st elevated myocardial infarction (stemi) was diagnosed. Per imaging, the ostial-proximal rca was patent, however, the proximal rca with the 3. 0x38mm and 3. 5x38mm xience sierra stents, to the distal rca, was occluded with 100% thrombus. Reportedly, both the 3. 0x38mm and 3. 5x38mm xience sierra stents were underexpanded. High pressure balloon angioplasty was performed, resolving the occlusion. On (b)(6) 2020, the patient passed away due to respiratory failure, pneumonia, and the stemi, related to this hospitalization. No additional information was provided regarding this issue.

• Brand Name: XIENCE SIERRA
• Type of Device: DRUG ELUTING CORONARY STENT DELIVERY SYSTEM
• Manufacturer (Section D): ABBOTT VASCULAR; 26531 ynez rd.; temecula CA 92591 4628
• Manufacturer (Section G): ABBOTT VASCULAR, REG # 3005718570 (P099); cashel road; clonmel tipperary ; EI
• Manufacturer Contact: lindsey bell ; 26531 ynez rd.; temecula, CA 92591-4628 ; 9519143996
• MDR Report Key: 9713884
• MDR Text Key: 179510172
• Report Number: 2024168-2020-01499
• Device Sequence Number: 1
• Product Code: NIQ
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: P110019
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: health professional,study

Reporter Occupation

• Type of Report: Initial,Followup
• Report Date: 03/03/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 02/14/2020
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes

Device Operator

• Device Expiration Date: 09/16/2020
• Device Model Number: 1550300-38
• Device Catalogue Number: 1550300-38
• Device Lot Number: 9091141
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes

Was the Report Sent to FDA?

• Event Location: No Information
• Date Manufacturer Received: 02/17/2020
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 09/17/2019
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial

Patient Treatment Data

Date Received: 02/14/2020 Patient Sequence Number: 1

Treatment

2 XIENCE SIERRA STENTS; 6 FRENCH GUIDE CATHETER