Atherosclerosis
Conditions
Keywords
Atherosclerosis, Superficial Femoral Artery, Proximal Popliteal Artery
Brief summary
The purpose of this study is to confirm that the IN.PACT Admiral is safe and effective for the interventional treatment of new and non-stented restenotic lesions in the superficial femoral artery (SFA) and proximal popliteal artery (PPA) in Chinese patients.
Interventions
DEVICEIN.PACT Admiral Paclitaxel-Eluting Percutaneous Transluminal Angioplasty (PTA) Balloon Catheter
IN.PACT Admiral Paclitaxel-Eluting Percutaneous Transluminal Angioplasty (PTA) Balloon Catheter originally developed, approved and commercialized by Invatec Technology Center GmbH is the investigational medical device used in the study. Medtronic Inc. acquired Invatec on April 21, 2010. Medtronic
Sponsors
Medtronic Endovascular
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years and ≤ 85 years. * Subject with documented diagnosis of peripheral arterial disease (PAD) classified as Rutherford class 2-3-4 in the superficial femoral artery (SFA) and/or proximal popliteal artery (PPA) above the knee, located in the arterial segment starting at least 1 cm beyond the Common femoral artery (CFA) bifurcation between the superficial and profunda femoris arteries (proximal anatomical landmark to the distal P1 segment of the popliteal artery at the level of the proximal edge of the patella (distal anatomical landmark). * Target lesion consists of a single de novo or non-stented restenotic lesion (or a tandem lesion) or is a combination lesion * Reference vessel diameter ≥ 4 mm and ≤ 7 mm by visual estimate. * Subject able to walk without assistive devices (e.g. walker, cane). * If subject has ipsilateral/contralateral iliac disease that requires treatment during the index procedure * Angiographic evidence of adequate distal run-off to the foot (at least one native calf vessel \[posterior tibial, anterior tibial, or peroneal arteries\] is patent, defined as \< 50% diameter stenosis). * Female subjects of childbearing potential must have a negative pregnancy test ≤ 7 days before index procedure and willing to use a reliable method of birth control for the duration of the study or must have documented adequate birth control. * Signed and dated Patient Informed Consent (PIC) form. * Understands and accepts the duration of the study and is able and willing to comply with all requirements, including follow-up visits and evaluations. * Life expectancy, in the Investigator's opinion, of at least 12 months.
Exclusion criteria
* In the investigator's opinion subject is unlikely to comply with the followup schedule. * Stroke or STEMI within the 3 months prior to index procedure. * Either local or systemic thrombolytic therapy within 48 hours prior to the index procedure. * Inability to tolerate oral anticoagulation therapy (blood thinners such as warfarin) while on concomitant dual antiplatelet therapy (DAPT). * Known allergies or sensitivities to heparin, aspirin (ASA), other anticoagulant/anti-platelet therapies, and/or paclitaxel or an allergy to contrast media that cannot be adequately pre-treated prior to the index procedure. * Breastfeeding woman. * Chronic renal insufficiency with serum creatinine \> 2.5 mg/dL within 14 days prior to index procedure. * WBC \< 3.0 (3,000 cells/mm3) within 14 days prior to index procedure. * PLT count \< 80,000 cells/mm3 or \> 700,000 cells/mm3 within 14 days prior to index procedure. * Known or suspected active systemic infection evidenced by WBC \> 14.0 (14000/mm3) within 14 days prior to index procedure. * Diagnosed with bleeding diatheses or hypercoagulable state. * Subject is enrolled in another investigational device, drug or biologic study or subject was previously enrolled to the IN.PACT SFA China trial. * Any major (e.g., cardiac. peripheral, abdominal) surgical procedure or intervention performed within 30 days prior to the index procedure. * Any major (e.g., cardiac. peripheral, abdominal) elective procedure or intervention within 30 days post index procedure. * Contralateral SFA/PPA disease requiring treatment in the same setting as index procedure. * Presence of additional lesions in the target vessel that require treatment during index procedure but do not meet the definitions of tandem lesions. * Target lesion is an in-stent or post-DEB restenosis or has been previously treated with bypass surgery. * Failure to successfully cross the target lesion with a guide wire * Lesion within or adjacent to an aneurysm. * Acute or sub-acute thrombus in the target vessel. * Angiographic evidence of severe calcification * Target lesion known in advance of enrollment to require treatment with alternative therapy such as drug-eluting stent (DES), drug-eluting balloon (DEB), laser, atherectomy, cryoplasty, re-entry devices, cutting/scoring balloon, brachytherapy. Use of embolic protection devices is also prohibited. * Pre-dilation resulted in a major ( ≥ Grade D) flow-limiting dissection (observed on 2 orthogonal views) or residual stenosis \> 70% and translesional peak gradient \> 10mm Hg.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Primary effectiveness endpoint: Primary patency within 12 months post-index procedure | 12 months | Primary patency is defined as freedom from clinically-driven target lesion revascularization (TLR)1 and freedom from restenosis as determined by duplex ultrasound (DUS) Peak Systolic Velocity Ratio (PSVR) ≤ 2.4 |
| Primary Safety Endpoint | 30 days post-index procedure | A composite of freedom from device- and procedure-related mortality, freedom from major target limb amputation and freedom from clinicallydriven TLR within 30-day post-index procedure |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Target Lesion Revascularization | 30 days, 6 and 12 months | Clinically-driven TLR at 30 days, 6 and 12 months TLR at 6 and 12 months |
| Target Vessel Revascularization | 30 days, 6 and 12 months | Clinically-driven TVR at 30 days, 6 and 12 months TVR at 6 and 12 months |
| Major target limb amputation | 30 days, 6 and 12 months | Major target limb amputation at 30 days, 6 and 12 months |
| Thrombosis at the target lesion site | 30 days, 6 and 12 months | Thrombosis at the target lesion site at 30 days, 6 and 12 months |
| Secondary sustained clinical improvement | 6 and 12 months | Secondary sustained clinical improvement is defined as sustained upward shift of at least 1 category on Rutherford classification as compared to baseline including the need for repeated TLR or surgical revascularization in amputation-free surviving subjects. |
| Time to first clinically-driven Target Lesion Revascularization | 12 months | Time to first clinically-driven TLR through 12 months post-index procedure |
| Primary sustained clinical improvement | 6 and 12 months | Primary sustained clinical improvement is defined as sustained upward shift of at least 1 category on Rutherford classification as compared to baseline without the need for repeated TLR or surgical revascularization in amputation-free surviving subjects. |
| Duplex-defined binary restenosis (PSVR > 2.4) of the target lesion | 6 and 12 months | Duplex-defined binary restenosis (PSVR \> 2.4) of the target lesion at 6 and 12 months post-index procedure, or at the time of reintervention prior to any pre-specified time point |
| Major Adverse Events | 12 months | MAE is defined as all-cause mortality, clinically-driven Target Vessel Revascularization (TVR), major target limb amputation or thrombosis at the target lesion site, through 12 months |
| Walking capacity assessment | 30 days, 6 and 12 months | Walking capacity assessment by Walking Impairment Questionnaire (WIQ) at 30 days, 6 and 12 months |
| Walking distance | 30 days, 6 and 12 months | Walking distance as assessed by 6 Minute Walk Test (6MWT) at 30 days, 6 and 12 months as change from baseline |
| Quality of life assessment | 30 days, 6 and 12 months | Quality of life assessment by EQ5D questionnaire at 30 days, 6 and 12 months as change from baseline |
| Device success | Post procedure | Device success is defined as successful delivery, balloon inflation, deflation and retrieval of the intact study device without burst below the rated burst pressure (RBP). |
| Procedural success | Post procedure | Procedural success is defined as residual stenosis of ≤ 50% (non-stented subjects) or ≤ 30% (stented subjects) by core lab assessment. |
| Clinical success | Post procedure | Clinical success is defined as procedural success without procedural complications (death, major target limb amputation, thrombosis of the target lesion, or TVR) prior to discharge. |
| Days of hospitalization due to the target lesion | 6 and 12 months | Days of hospitalization due to the target lesion from procedure through 6 and 12 months |
| Duplex-defined binary restenosis (PSVR > 3.4) of the target lesion | 6 and 12 months | Duplex-defined binary restenosis (PSVR \> 3.4) of the target lesion at 6 and 12 months post-index procedure, or at the time of reintervention prior to any pre-specified time point |
| Death of any cause | 30 days, 6 and 12 months | Death of any cause at 30 days, 6 and 12 months |
Countries
China
Outcome results
None listed