Thoracic Aortic Aneurysms
Conditions
Keywords
thoracic aneurysm, thoracic aortic aneurysms, Thoracic Endovascular Aneurysm Repair (TEVAR), Talent Thoracic Stent Graft
Brief summary
The purpose of this study is to evaluate the long-term safety and effectiveness of the Talent Thoracic Stent Graft System for treatment of descending thoracic aneurysms (DTA)following U.S. market approval.
Detailed description
A descending thoracic aneurysm is a bulge in the aorta. The aorta is a large blood vessel that carries blood away from your heart to organs in the rest of your body. Your aneurysm is caused by a weakening in the artery wall. If left untreated, this bulge may continue to grow larger and may ultimately rupture (break open) or extend in size to seriously affect other major arteries in the area. In this clinical study the Talent Thoracic Stent Graft will be placed inside your aorta to block the weakened part of the artery wall from the circulatory system. Medtronic Vascular submitted a Pre-Market Application (PMA P070007) to the FDA on February 28, 2007, and received market approval for the Talent Stent Graft System on June 5, 2008. As a condition of approval, the FDA has requested a post-market trial. In collaboration with the FDA, Medtronic has designed a post-approval study to document the long-term performance of the Talent Stent Graft System under post market conditions. This study will examine the post-market performance of the Talent Thoracic Stent Graft System. This study is a prospective, non-randomized five-year trial. Originally, a total of 451 subjects were going to be analyzed. That group consisted of 195 enrolled subjects from the VALOR Test Group of the Talent Thoracic PMA Submission, and 256 planned de novo subjects enrolled after the PMA approval. However, Medtronic discontinued manufacturing of the study device for US commercialization, and as a result, enrollment was terminated in May 2014, when it was determined that no more proximal devices were available either in inventory or at the sites. A total of 349 subjects will be analyzed, based on 195 VALOR Test Group subjects and 154 de novo subjects. Update as of Aug 2017: Medtronic Vascular, Inc. discontinued manufacture of the Talent Thoracic Stet Graft System on 31-Jul-2012, and the final device expired in July 2014 (based on the two-year shelf life). Enrollment for De Novo subjects ended in May 2014, as there were no more proximal main devices available either in inventory or at the investigational sites. This resulted in a total of 349 subjects to be analyzed in this final report: the 195 VALOR subjects and 154 of the planned 256 De Novo subjects. Because of that, statistical results would have been inconclusive, so Medtronic decided to terminate the study and received FDA approval for early termination in April 2016. It is important to emphasize that THRIVE subjects will continue to be followed-up annually per standard of care and standard post-market surveillance program applies to them (e.g. device complaints will continue to be reported via the MDR (Medical Device Reporting) system.)
Interventions
endovascular repair of descending thoracic aortic aneurysms using the Talent Thoracic Stent Graft System.
Sponsors
Study design
Eligibility
Inclusion criteria
appropriate anatomy for elective repair of the descending thoracic aortic aneurysm * iliac/femoral access vessel morphology that is compatible with vascular access techniques, devices, and or accessories * non-aneurysmal aortic diameter in the range of 18-42mm; and * non-aneurysmal aortic proximal and distal neck lengths equal to or greater than 20mm * subject has a Descending Fusiform Thoracic Aneurysm = to or greater than 5cm in diameter OR is = to or greater than 2 times the diameter of the non-aneurysmal thoracic aorta and/or saccular aneurysms/penetrating ulcers * Signed patient informed consent
Exclusion criteria
* Less than 18 yrs old * pregnant * unable to comply w/follow-up * participating in other drug or device trials; * Subject has a co-morbidity causing expected survival to be less than 1 year
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Freedom From Aneurysm-related Mortality at 5 Years | 5 years | For all THRIVE subjects, Aneurysm-Related Mortality (ARM) is defined as: Death from rupture of the thoracic aortic aneurysm or from any procedure intended to treat the Descending Thoracic Aneurysm (DTA - fusiform aneurysms and saccular aneurysms/penetrating ulcers) as determined by an independent Clinical Events Committee (CEC). If a death occurred within 30 days of any procedure intended to treat the DTA, then it is presumed to be aneurysm related, unless there is evidence to the contrary. |
Other
| Measure | Time frame | Description |
|---|---|---|
| All-Cause Mortality | 1, 12, 24, 36, 48 and 60 months | Number of subjects who died during that interval or who were followed at least until the lower endpoint of the analysis window. |
| Number of Participants With Conversion to Surgery | 1, 12, 24, 36, 48 and 60 months | Conversion from endovascular to open repair required at the time of the original procedure or at the time beyond the initial endovascular procedure (for the same lesion treated during the initial implantation of the Talent Thoracic Stent Graft) |
| Number of Participants With Aneurysm Rupture | 1, 12, 24, 36, 48 and 60 months | Rupture or perforation of the targeted aneurismal sac as detected by angiography, CT scan, or direct observation at surgery or autopsy. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| De Novo Group 154 of the planned 256 prospectively enrolled De Novo subjects treated with the Talent Thoracic Stent Graft System following U.S. market approval of the device. | 154 |
| Valor Test Group 195 subjects from the Valor Test Group (PMA P070007) that were followed for 5 years per the VALOR protocol. | 195 |
| Total | 349 |
Baseline characteristics
| Characteristic | Valor Test Group | Total | De Novo Group |
|---|---|---|---|
| Age, Continuous | 70.2 years STANDARD_DEVIATION 11.1 | 70.6 years STANDARD_DEVIATION 11.2 | 71.1 years STANDARD_DEVIATION 11.4 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 5 Participants | 12 Participants | 7 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 190 Participants | 335 Participants | 145 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 2 Participants | 2 Participants |
| Race/Ethnicity, Customized American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Asian/Native Hawaiian or Pacific Islander | 2 Participants | 6 Participants | 4 Participants |
| Race/Ethnicity, Customized Black or African American | 25 Participants | 45 Participants | 20 Participants |
| Race/Ethnicity, Customized Other | 1 Participants | 4 Participants | 3 Participants |
| Race/Ethnicity, Customized Unknown or Not Available | 5 Participants | 5 Participants | 0 Participants |
| Race/Ethnicity, Customized White | 162 Participants | 289 Participants | 127 Participants |
| Sex: Female, Male Female | 80 Participants | 154 Participants | 74 Participants |
| Sex: Female, Male Male | 115 Participants | 195 Participants | 80 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 54 / 154 | 76 / 195 |
| other Total, other adverse events | 0 / 154 | 0 / 195 |
| serious Total, serious adverse events | 83 / 154 | 178 / 195 |
Outcome results
Freedom From Aneurysm-related Mortality at 5 Years
For all THRIVE subjects, Aneurysm-Related Mortality (ARM) is defined as: Death from rupture of the thoracic aortic aneurysm or from any procedure intended to treat the Descending Thoracic Aneurysm (DTA - fusiform aneurysms and saccular aneurysms/penetrating ulcers) as determined by an independent Clinical Events Committee (CEC). If a death occurred within 30 days of any procedure intended to treat the DTA, then it is presumed to be aneurysm related, unless there is evidence to the contrary.
Time frame: 5 years
Population: All participants were combined for analysis as a single arm, as pre-specified in the protocol. Subjects are censored because their last follow-up has not reached the end of the time interval or because they withdraw, are lost to follow-up or die from a non-aneurysm related cause.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Subjects | Freedom From Aneurysm-related Mortality at 5 Years | 92 Percentage of participants |
All-Cause Mortality
Number of subjects who died during that interval or who were followed at least until the lower endpoint of the analysis window.
Time frame: 1, 12, 24, 36, 48 and 60 months
Population: Based on all Intent to Treat (ITT) subjects.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Subjects | All-Cause Mortality | 0-30 days | 5 Participants |
| All Subjects | All-Cause Mortality | 0 - 365 days | 17 Participants |
| All Subjects | All-Cause Mortality | 366 - 731 days | 18 Participants |
| All Subjects | All-Cause Mortality | 732 - 1096 days | 8 Participants |
| All Subjects | All-Cause Mortality | 1097 - 1461 days | 8 Participants |
| All Subjects | All-Cause Mortality | 1462 - 1826 days | 3 Participants |
| Valor Test Group | All-Cause Mortality | 1097 - 1461 days | 9 Participants |
| Valor Test Group | All-Cause Mortality | 0-30 days | 4 Participants |
| Valor Test Group | All-Cause Mortality | 732 - 1096 days | 15 Participants |
| Valor Test Group | All-Cause Mortality | 0 - 365 days | 31 Participants |
| Valor Test Group | All-Cause Mortality | 1462 - 1826 days | 10 Participants |
| Valor Test Group | All-Cause Mortality | 366 - 731 days | 11 Participants |
Number of Participants With Aneurysm Rupture
Rupture or perforation of the targeted aneurismal sac as detected by angiography, CT scan, or direct observation at surgery or autopsy.
Time frame: 1, 12, 24, 36, 48 and 60 months
Population: Based on all Intent to Treat (ITT) subjects
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Subjects | Number of Participants With Aneurysm Rupture | 0-30 days | 0 participants |
| All Subjects | Number of Participants With Aneurysm Rupture | 0-365 days | 0 participants |
| All Subjects | Number of Participants With Aneurysm Rupture | 366-731 days | 2 participants |
| All Subjects | Number of Participants With Aneurysm Rupture | 732-1096 days | 1 participants |
| All Subjects | Number of Participants With Aneurysm Rupture | 1097-1461 days | 0 participants |
| All Subjects | Number of Participants With Aneurysm Rupture | 1462-1826 days | 0 participants |
| Valor Test Group | Number of Participants With Aneurysm Rupture | 1097-1461 days | 0 participants |
| Valor Test Group | Number of Participants With Aneurysm Rupture | 0-30 days | 0 participants |
| Valor Test Group | Number of Participants With Aneurysm Rupture | 732-1096 days | 2 participants |
| Valor Test Group | Number of Participants With Aneurysm Rupture | 0-365 days | 1 participants |
| Valor Test Group | Number of Participants With Aneurysm Rupture | 1462-1826 days | 2 participants |
| Valor Test Group | Number of Participants With Aneurysm Rupture | 366-731 days | 0 participants |
Number of Participants With Conversion to Surgery
Conversion from endovascular to open repair required at the time of the original procedure or at the time beyond the initial endovascular procedure (for the same lesion treated during the initial implantation of the Talent Thoracic Stent Graft)
Time frame: 1, 12, 24, 36, 48 and 60 months
Population: Based on all Intent to Treat (ITT) subjects.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Subjects | Number of Participants With Conversion to Surgery | 0-30 days | 1 participants |
| All Subjects | Number of Participants With Conversion to Surgery | 0-365 days | 2 participants |
| All Subjects | Number of Participants With Conversion to Surgery | 366-731 days | 0 participants |
| All Subjects | Number of Participants With Conversion to Surgery | 732-1096 days | 0 participants |
| All Subjects | Number of Participants With Conversion to Surgery | 1097-1461 days | 0 participants |
| All Subjects | Number of Participants With Conversion to Surgery | 1462-1826 days | 0 participants |
| Valor Test Group | Number of Participants With Conversion to Surgery | 1097-1461 days | 0 participants |
| Valor Test Group | Number of Participants With Conversion to Surgery | 0-30 days | 0 participants |
| Valor Test Group | Number of Participants With Conversion to Surgery | 732-1096 days | 1 participants |
| Valor Test Group | Number of Participants With Conversion to Surgery | 0-365 days | 1 participants |
| Valor Test Group | Number of Participants With Conversion to Surgery | 1462-1826 days | 1 participants |
| Valor Test Group | Number of Participants With Conversion to Surgery | 366-731 days | 1 participants |