IMPORTANT SAFETY INFORMATION
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Acculink® Carotid Stent System
The RX Acculink Carotid Stent System, used in conjunction with the Abbott Vascular embolic protection system specified below, is indicated for the treatment of patients at high and standard risk for adverse events from carotid endarterectomy who require carotid revascularization and meet the criteria outlined below:
Embolic Protection System
Abbott Vascular’s Accunet or Emboshield Family
With neurological symptoms
≥ 50% stenosis of the common or internal carotid artery by ultrasound or angiogram
≥ 70% stenosis of the common or internal carotid artery by ultrasound or ≥ 50% stenosis of the common or internal carotid artery by angiogram
Without neurological symptoms
≥ 80% stenosis of the common or internal carotid artery by ultrasound or angiogram
≥ 70% stenosis of the common or internal carotid artery by ultrasound or ≥ 60% stenosis of the common or internal carotid artery by angiogram
Reference vessel diameter
Must be within 4.0 mm – 9.0 mm at the target lesion
The RX Acculink Carotid Stent System is contraindicated for use in:
- Patients in whom anti-coagulant and / or anti-platelet therapy is contraindicated.
- Patients with severe vascular tortuosity or anatomy that would preclude the safe introduction of a guide catheter, sheath, embolic protection system, or stent system.
- Patients with known hypersensitivity to nickel-titanium.
- Patients with uncorrected bleeding disorders.
- Lesions in the ostium of the common carotid artery.
Only physicians who have received appropriate training and are familiar with the principles, clinical applications, complications, side effects and hazards commonly associated with carotid stent placement should use this device.
Refer to the Instructions for Use supplied with any interventional devices to be used in conjunction with the RX Acculink Carotid Stent System for their intended uses, contraindications, and potential complications.
The safety and efficacy of the RX Acculink Carotid Stent System have not been demonstrated with embolic protection systems other than Abbott Vascular’s Accunet or Emboshield family of Embolic Protection Systems (EPS). Refer to the Instructions for Use document for the Embolic Protection System that will be used for specific device instructions.
Clinical study results suggest lower event rates when the RX Acculink Carotid Stent System is used in conjunction with an embolic protection device.
The long-term performance (> 3 years) of the Acculink Carotid Stent has not been established.
As with any type of vascular implant, infection secondary to contamination of the stent may lead to thrombosis, pseudoaneurysm, or rupture.
Stenting across a major bifurcation may hinder or prevent future diagnostic or therapeutic procedures.
In patients requiring the use of antacids and / or H2-antagonists before or immediately after stent placement, oral absorption of antiplatelet agents (e.g. aspirin) may be adversely affected.
The appropriate antiplatelet and anticoagulation therapy should be administered pre- and postprocedure as suggested in these instructions. Special consideration should be given to those patients with recently active gastritis or peptic ulcer disease.
When multiple stents are required, stent materials should be of similar composition.
The safety and effectiveness of the RX Acculink Carotid Stent System have NOT yet been established in patients with the characteristics noted below.
Patients experiencing acute ischemic neurologic stroke or who experience a stroke within 7 days prior to the procedure ,Patients with an intracranial mass lesion (i.e., abscess, tumor, or infection) or aneurysm > 5 mm, Patients with arteriovenous malformations of the territory of the target carotid artery, Patients with coagulopathies, Patients with poor renal function who, in the physician’s opinion, may be at high risk for a reaction to contrast medium, Patients with perforated vessels evidenced by extravasation of contrast media, Patients with aneurysmal dilation immediately proximal or distal to the lesion, Pregnant patients or patients under the age of 18.
Patients with evidence of intraluminal thrombus thought to increase the risk of plaque fragmentation and distal embolization, Patients whose lesion(s) may require more than two stents, Patients with total occlusion of the target vessel, Patients with highly calcified lesions resistant to PTA.
Patients with known peripheral vascular, supra-aortic or internal carotid artery tortuosity that would preclude the use of catheter-based techniques, Patients in whom femoral access is not possible, Risk of distal embolization may be higher if the RX Acculink Carotid System cannot be used in conjunction with an embolic protection system during the carotid stenting procedure. The safety and effectiveness of concurrent treatment of lesions in patients with bilateral carotidartery disease have not been established.
This device is intended for single-use only. Do not reuse. Do not resterilize, as this can compromise device performance and increase the risk of cross contamination due to inappropriate reprocessing.
Do not use the product after the "Use By" date specified on the package.
Do not use the product if the temperature indicator on inner pouch is black.
Maintain the patient’s Activated Clotting Time (ACT) at > 250 seconds throughout RX Acculink Carotid Stent System usage to prevent thrombus formation on the device.
Maintain continuous flush while removing and reinserting devices on the guide wire. Perform all exchanges slowly to prevent air embolism or trauma to the artery.
Caution should be used if pre-dilating the lesion without embolic protection as this may increase the risk of an adverse outcome.
Implanting a stent may lead to dissection of the vessel distal and / or proximal to the stent and may cause acute closure of the vessel, requiring additional intervention (carotid endarterectomy, further dilatation, or placement of additional stents).
The stent may cause a thrombus, distal embolization or may migrate from the site of implant down the arterial lumen. Appropriate sizing of the stent to the vessel is required to reduce the possibility of stent migration. In the event of thrombosis of the expanded stent, thrombolysis and PTA should be attempted.
In the event of complications such as infection, pseudoaneurysm or fistulization, surgical removal of the stent may be required.
Overstretching of the artery may result in rupture and life-threatening bleeding.
If a filter-based embolic protection system (EPS) is used, allow for and maintain adequate distance between the RX Acculink Carotid Stent System and the EPS to avoid potential filter engagement with the RX Acculink Carotid Stent System tip and / or filter entanglement with the deployed stent. If filter engagement and / or entanglement or filter detachment occurs, surgical conversion or additional catheter based intervention may be required.
Ensure optimal positioning of the stent prior to deployment. Once deployment is initiated, the stent cannot be repositioned or recaptured. Stent retrieval methods (use of additional wires, snares and / or forceps) may result in additional trauma to the carotid vasculature and / or the vascular access site. Complications may include death, stroke, bleeding, hematoma or pseudoaneurysm.
Stent Handling – Precautions
Carefully inspect the RX Acculink Carotid Stent System to verify that the device has not been damaged in shipment. Do not use damaged equipment.
The delivery system has an internal hypotube. Take care to avoid unnecessary handling, which may kink or damage the delivery system. Do not use if device is kinked.
Do not expose the delivery system to organic solvents (e.g. alcohol) as structural integrity and / or function of the device may be impaired.
Do not remove the stent from its delivery system as removal may damage the stent. The stent on the delivery system is intended to perform as a system. If removed, the stent cannot be put back on the delivery system.
The delivery system should not be used in conjunction with other stents.
Special care must be taken not to handle or in any way disrupt the stent on the delivery system.
This is most important during catheter removal from packaging, mandrel removal, placement over the guide wire, and advancement through a Rotating Hemostatic Valve (RHV) adapter and guiding catheter hub.
Do not hold the sheath or stent during mandrel removal.
Stent Placement – Precautions
Use with bleedback control hemostatic valves is not recommended.
The RX Acculink Carotid Stent System is not compatible with any guide wire larger than 0.014” (0.36 mm).
Leave the safety lock closed until the stent is ready to deploy.
The RX Acculink Carotid Stent System must be used with a guiding catheter or introducer sheath to maintain adequate support of the 0.014” guide wire throughout the procedure.
For best device performance, the guide wire exit notch should remain within the guiding catheter or sheath.
Ensure the stent system is fully flushed with heparinized saline prior to use. Do not use the delivery system if flush is not observed exiting at the distal end of the sheath.
Do not attempt to pull a partially expanded stent back through the guiding catheter or sheath; dislodgment of the stent from the delivery system may occur.
Venous access should be available during carotid stenting to manage bradycardia and / or hypotension by either pharmaceutical intervention or placement of a temporary pacemaker, if needed.
When catheters are in the body, they should be manipulated only under fluoroscopy.
Radiographic equipment that provides high quality images is needed.
The delivery system is not designed for use with power injection. Use of power injection may adversely affect device performance.
If resistance is met during delivery system introduction, the system should be withdrawn and another system used.
Prior to stent deployment, remove all slack from the delivery system.
When more than one stent is required to cover the lesion, or if there are multiple lesions, the distal lesion should be stented first, followed by stenting of the proximal lesion. Stenting in this order obviates the need to cross the proximal stent for placement of the distal stent and reduces the chance of dislodging stents that have already been placed.
If overlap of sequential stents is necessary, the amount of overlap should be kept to a minimum (approximately 5 mm). In no instance should more than 2 stents overlap.
Post-Implant – Precautions
Care must be exercised when crossing a newly deployed stent with other interventional devices to avoid disrupting the stent geometry and placement of the stent.
In the event of thrombosis of the expanded stent, thrombolysis and PTA should be attempted.
POTENTIAL ADVERSE EVENTS
Based on the literature, and on clinical and commercial experience with carotid stents and embolic protection systems, the following alphabetical list includes possible adverse events associated with use of these devices:
Allergic reactions to anti-platelet agents / contrast medium, Aneurysm
Angina / coronary ischemia, Arrhythmia,Arterial occlusion / thrombosis at puncture site or remote site, Arteriovenous fistula, Bacteremia or septicemia, Bleeding from anticoagulant or antiplatelet medications, Cerebral edema, Cerebral hemorrhage, Cerebral ischemia / transient ischemic attack (TIA), Congestive heart failure (CHF), Death, Detachment and / or implantation of a component of the system , Emboli, distal (air, tissue or thrombotic emboli), Emergent or urgent, endarterectomy surgery (CEA), Fever, Filter thrombosis / occlusion, Groin hematoma, with or without surgical repair, Hemorrhage, with or without transfusion, Hyperperfusion syndrome, Hypotension / hypertension, Infection and pain at insertion site, Ischemia / infarction of tissue / organ, Myocardial infarction (MI), Pain (head, neck), Pseudoaneurysm, femoral, Renal failure / insufficiency, Restenosis of stented segment, Seizure, Severe unilateral headache, Stent / filter entanglement / damage, Stent embolization, Stent malposition, Stent migration, Stent thrombosis / occlusion, Stroke / cerebrovascular accident (CVA), Total occlusion of carotid artery, Vessel dissection, perforation, or rupture, Vessel spasm or recoil,
Prior to use, please reference the Instructions for Use at eifu.abbottvascular.com for more information on indications, contraindications, warnings, precautions, and adverse events.