Iliofemoral Occlusive Disease, May-Thurner Syndrome, Peripheral Vascular Disease, Venous Disease
Conditions
Keywords
Vernacular, Iliofemoral Occlusive Disease
Brief summary
The BARD® Venovo™ Venous Stent Study is a non-randomized clinical study intended to collect confirmatory evidence of the safety and effectiveness of the Venous Stent for the treatment of iliofemoral occlusive disease.
Detailed description
This is a prospective, multi-center, non-randomized, single-arm clinical study of the VENOVO ™ Venous Stent for the treatment of iliofemoral occlusive disease. The study will be conducted at a maximum of 35 investigational sites (sites) in the United States, and Europe and Australia/New Zealand. Enrollment will continue until a maximum of one hundred seventy (170) subjects are treated with the VENOVO™ Venous Stent, which is an estimated three-hundred forty (340) consecutive subjects in a non-randomized fashion. It is assumed that approximately 50% of the treated subjects will be U.S. subjects. Clinical follow-up for all treated subjects will be performed at hospital discharge, 30-days, and 6-, 12-, 24-, and 36-months post-index procedure.
Interventions
VENOVO™ Venous stent placement
Sponsors
Study design
Eligibility
Inclusion criteria
1. The subject provides written informed consent using an Informed Consent Form approved by Ethics Committee/ Institutional Review Board for the site. 2. Subject agrees to comply with the protocol-mandated follow-up procedures and visits. 3. The subject is a male or non-pregnant female ≥ 18 years old with an expected lifespan sufficient to allow for completion of all study procedures. 4. The subject has symptomatic (non-malignant) venous outflow obstruction in iliofemoral venous segments. 5. The subject has symptomatic venous outflow obstruction (non-malignant) in iliofemoral venous segments(Clinical-Etiology-Anatomic-Pathophysiologic (CEAP) C ≥ 3 or VCSS pain score of ≥ 2). 6. The subject is able and willing to comply with any required medication regimen. 7. The reference vessel diameters are between 7mm and 19 mm.
Exclusion criteria
1. Subject is unable or unwilling to provide written informed consent, or is unable or unwilling to conform to the study protocol follow-up procedures and visits. 2. Subject is or plans to become pregnant during the study. 3. Subject has contralateral disease of the common femoral vein, external iliac vein, common iliac vein, or any combination thereof and does not meet the venous outflow obstruction requirement or has a malignant obstruction. 4. The subject is asymptomatic, has a CEAP C \<3, or a VCSS pain score of \<2. 5. The subject has a venous obstruction that extends into the inferior vena cava (IVC) or below the level of the lesser trochanter. 6. The subject has a known uncorrectable bleeding diathesis or active coagulopathy. 7. The subject has a known allergy or sensitivity to Nickel or Titanium or intolerance to antiplatelet, anticoagulant or thrombolytic medications medications required per the protocol 8. The subject has a known allergy or sensitivity to contrast media, which cannot be adequately pre-medicated. 9. The subject has any planned surgical interventions within 30 days prior to, or within 30 days after the planned study procedure. 10. The subject has a lesion or occlusion which cannot be traversed with a guidewire. 11. The subject has had prior stenting in the target vessel. 12. The subject has iliofemoral venous segments unsuitable for treatment with available sizes of study devices. 13. The subject has another medical condition, which may cause him/her to be non-compliant with the protocol, confound the data interpretation, or is associated with a life expectancy insufficient to allow completion of study procedures and follow ups. 14. The subject is currently participating in an investigational drug, biologic, or another device study. 15. The subject is currently on dialysis or has a serum creatinine ≥2.5mg/dl.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Primary Patency of the Venous Stent at 12 Months Post-Index Procedure | 12 months post-index procedure | Primary patency rate at 12 months post-index procedure evaluated against a literature-derived Performance Goal (PG) of 74%. Primary patency defined as: freedom from Target Vessel Revascularization (TVR); freedom from thrombus occlusion and stenosis \> 50% as measured by Duplex Ultrasound (DUS). Please note that both the primary effectiveness and the primary safety endpoint are considered co-primary endpoints. That is, both endpoints need to be significant to claim the study as successful. |
| Number of Participants With Freedom From Major Adverse Events (MAEs) | 30 days post-index procedure | Freedom from major adverse events (MAEs) defined as: Target Vessel Revascularization; Device and/or procedure related death; Major amputation of target limb; Pulmonary Embolism which is clinically important; Vascular injury requiring surgical/endovascular intervention; Embolization /migration of stent; Device or procedure related acute DVT involving the treated limb. Please note that both the primary effectiveness and the primary safety endpoint are considered co-primary endpoints. That is, both endpoints need to be significant to claim the study as successful. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Endpoint Without Hypothesis Testing: Index of CEAP at 30 Days, 6 Months, and 12 Months Post Procedure | Evaluation through 30 day, 6 months and 12 months post index procedure | Clinical-Etiologic-Anatomic-Pathophysiologic (CEAP) Classification is a system that describes a doctor's physical exam findings for vein problem(s), the cause of the problem(s), the location in the leg, and the mechanism responsible for the manifestation of the vein problem. For Clinical classification, the clinical components indicates disease severity, ranging from none (0 points) to active ulcers (6 points).For each category of Etiology, Anatomy, and Pathophysiology classifications, at each time point, frequency of each category is reported. Subsequent clinical study reports will present CEAP at 24 and 36-months follow-up. Changes from baseline measures to given time points are presented. Lower mean scores represent an improvement from baseline measure. |
| Endpoint Without Hypothesis Testing: Number of Participants With Acute Technical Success | At time of Index Procedure | Acute technical success is defined as successful deployment of stent(s) to intended target with adequate lesion coverage as assessed by the Investigator. |
| Endpoint Without Hypothesis Testing: Number of Participants With Acute Procedure Success (ITT Subjects) | Less than 30 days post index procedure | Technical success is defined as no major adverse events experienced between index procedure and discharge |
| Endpoint With Hypothesis Testing: Index of Venous Clinical Severity Score (VCSS) From Baseline to 12 Months | Evaluation at 12 months post-index procedure | The Venous Clinical Severity Score (VCSS) system includes 10 clinical descriptions (pain, varicose veins, venous edema, skin pigmentation, inflammation, induration, number of active ulcers, duration of active ulceration, size of active ulceration. and level of compliance with medical compression therapy), scored from 0 to 3 (total possible score, 30) with 0 means absent, 1 means mild, 2 means moderate and 3 means severe. Total VCSS is the sum of all VCSS assessment scores from categories for a given time point. Twelve-month data is the change between baseline score and 12-month follow-up score. Results calculated for Intent-to-Treat (ITT) subjects. Lower values represent a better outcome, that is, a level of pain less than that experienced at baseline. |
| Endpoint Without Hypothesis Testing: Number of Participants With Freedom From Target Lesion Revascularization (TLR) (ITT Subjects) | Evaluation throrugh 30 day, 6 months and 12 months post index procedure | Freedom from Target Lesion Revascularization (TLR) through 30 days is specific to the first revascularization procedure of the target lesion. |
| Endpoint Without Hypothesis Testing: Number of Participants With Freedom From Target Vessel Revascularization (TVR) (ITT Subjects) | Evaluation through 30 days, 6 months and 12 months post index procedure | Freedom from Target Vessel Revascularization (TVR) is defined as the first revascularization procedure of the target vessel, as determined by an Independent Core Lab. Freedom from Target Lesion Revascularization (TLR) and Freedom from TVR results are the same through the 12 month analysis as all TLRs were also TVRs in this case. |
| Endpoint Without Hypothesis Testing: Number of Participants Without Device Stent Fracture at 12 Months Follow-Up | Evaluation at 12 months post-index procedure | Stents were evaluated at the 12 month follow-up for fracture analysis. Evaluable ITT subjects are included in this analysis. |
| Endpoint Without Hypothesis Testing: Number of Participants With Lesion Success (ITT Subjects) | At the conclusion of index procedure | Lesion Success is defined as the attainment of less or equal to 50% residual stenosis at the conclusion of the index procedure. |
| Endpoint With Hypothesis Testing: Index of Quality of Life (QoL) From Baseline to 12 Months | Evaluation at 12 months post-index procedure | The Quality of Life (QoL) assessment of Chronic Venous Insufficiency Questionnaire (CIVIC-20) is a 20-item questionnaire which provides a global index and an outline of 4 QoL dimensions - pain (4 items), physical (4 items), psychological (9 items) and social (4 items). Items are scored on a scale from 1 to 5. A low score corresponds to greater patient comfort. Total CIVIQ-20 score is the sum of all 20-item scores The score of each dimension was obtained by adding up the scores of each constituent item within that dimension. Twelve-month data is the change between baseline score and 12-month follow-up score. Results calculated for evaluable ITT subjects. Lower values represent a better outcome, that is, a better QoL than that experienced at baseline. |
Countries
Australia, Germany, Ireland, Netherlands, Spain, United Kingdom, United States
Participant flow
Recruitment details
The study was activated at 25 investigational sites in the U.S., Europe and Australia. First subject was enrolled June 15, 2016, and the last subject on May 1, 2017. Approximately 60% of subjects are in the U.S.
Pre-assignment details
Three U.S. sites were activated, but did not consent subjects. A fourth site enrolled 1 subject who was lost to follow-up after discharge (site closed). Fifty-eight (58) screen failures reported and three (3) eligible subjects were not treated with the device. In total, 170 subjects were treated with VENOVO.
Participants by arm
| Arm | Count |
|---|---|
| VENOVO™ Venous Stent. Implant of the VENOVO™ Venous Stent
VENOVO™ Venous Stent: VENOVO™ Venous stent placement | 170 |
| Total | 170 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Death | 4 |
| Overall Study | Lost to Follow-up | 3 |
| Overall Study | Missed 12-month follow-up visit | 4 |
| Overall Study | Withdrawal by Subject | 3 |
Baseline characteristics
| Characteristic | VENOVO™ Venous Stent. |
|---|---|
| Age, Customized < 65 years | 125 Participants |
| Age, Customized ≥ 65 years | 45 Participants |
| Cardiovascular Disease Angina | 5 Participants |
| Cardiovascular Disease Arrhythmia (other than A-FIB) | 8 Participants |
| Cardiovascular Disease Atrial Fibrillation (A-FIB) | 6 Participants |
| Cardiovascular Disease Cardiomyopathy | 3 Participants |
| Cardiovascular Disease Coronary Artery Disease (CAD) | 15 Participants |
| Cardiovascular Disease Deep Vein Thrombosis (DVT) | 92 Participants |
| Cardiovascular Disease Dyslipidemia | 47 Participants |
| Cardiovascular Disease Hypertension | 55 Participants |
| Cardiovascular Disease May-Thurner Syndrome | 102 Participants |
| Cardiovascular Disease Myocardial Infarction (MI) | 6 Participants |
| Cardiovascular Disease Peripheral Arterial Disease (PAD) | 18 Participants |
| Cardiovascular Disease Stroke | 4 Participants |
| Cardiovascular Disease Transient Ischemic Attack (TIA) | 3 Participants |
| Cardiovascular Disease Varicosis | 133 Participants |
| Cardiovascular Disease Vascular Heart Disease | 2 Participants |
| Cardiovascular Disease Venous Valve Disease | 12 Participants |
| Disease Category Non-Thrombotic Iliac Vein Lesions (NIVL) | 77 Participants |
| Disease Category Post-Thrombotic Syndrome (PTS) | 93 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 12 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 158 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Number of Study Devices Used 1 Study Device | 122 Participants |
| Number of Study Devices Used 2 Study Devices | 47 Participants |
| Number of Study Devices Used 3 Study Devices | 1 Participants |
| Number of Target Lesions 1 | 154 Participants |
| Number of Target Lesions 2 | 16 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 4 Participants |
| Race (NIH/OMB) Black or African American | 9 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants |
| Race (NIH/OMB) White | 156 Participants |
| Region of Enrollment Australia | 5 Participants |
| Region of Enrollment Germany | 34 Participants |
| Region of Enrollment Ireland | 4 Participants |
| Region of Enrollment Netherlands | 8 Participants |
| Region of Enrollment Spain | 11 Participants |
| Region of Enrollment United Kingdom | 8 Participants |
| Region of Enrollment United States | 100 Participants |
| Renal Disease Acute Renal Insufficiency | 1 Participants |
| Renal Disease Chronic Kidney Disease | 4 Participants |
| Renal Disease Uremia | 1 Participants |
| Sex: Female, Male Female | 107 Participants |
| Sex: Female, Male Male | 63 Participants |
| Target Limb Left Leg | 142 Participants |
| Target Limb Right Leg | 28 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 4 / 170 |
| other Total, other adverse events | 63 / 170 |
| serious Total, serious adverse events | 44 / 170 |
Outcome results
Number of Participants With Freedom From Major Adverse Events (MAEs)
Freedom from major adverse events (MAEs) defined as: Target Vessel Revascularization; Device and/or procedure related death; Major amputation of target limb; Pulmonary Embolism which is clinically important; Vascular injury requiring surgical/endovascular intervention; Embolization /migration of stent; Device or procedure related acute DVT involving the treated limb. Please note that both the primary effectiveness and the primary safety endpoint are considered co-primary endpoints. That is, both endpoints need to be significant to claim the study as successful.
Time frame: 30 days post-index procedure
Population: ITT subjects. Results adjudicated by CEC. MAEs that occurred prior to day 30 of each subject's follow-up were counted as failures toward primary safety (n= 11). Those subjects were considered not evaluable and not included in the denominator for the primary safety endpoint (total evaluable = 170 subjects).
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| VENOVO™ Venous Stent. | Number of Participants With Freedom From Major Adverse Events (MAEs) | 159 Participants |
Number of Participants With Primary Patency of the Venous Stent at 12 Months Post-Index Procedure
Primary patency rate at 12 months post-index procedure evaluated against a literature-derived Performance Goal (PG) of 74%. Primary patency defined as: freedom from Target Vessel Revascularization (TVR); freedom from thrombus occlusion and stenosis \> 50% as measured by Duplex Ultrasound (DUS). Please note that both the primary effectiveness and the primary safety endpoint are considered co-primary endpoints. That is, both endpoints need to be significant to claim the study as successful.
Time frame: 12 months post-index procedure
Population: ITT subjects. 25 subjects were excluded from the denominator due to discontinuation or other reasons prior to 12 month follow-up visit.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| VENOVO™ Venous Stent. | Number of Participants With Primary Patency of the Venous Stent at 12 Months Post-Index Procedure | 128 Participants |
Endpoint With Hypothesis Testing: Index of Quality of Life (QoL) From Baseline to 12 Months
The Quality of Life (QoL) assessment of Chronic Venous Insufficiency Questionnaire (CIVIC-20) is a 20-item questionnaire which provides a global index and an outline of 4 QoL dimensions - pain (4 items), physical (4 items), psychological (9 items) and social (4 items). Items are scored on a scale from 1 to 5. A low score corresponds to greater patient comfort. Total CIVIQ-20 score is the sum of all 20-item scores The score of each dimension was obtained by adding up the scores of each constituent item within that dimension. Twelve-month data is the change between baseline score and 12-month follow-up score. Results calculated for evaluable ITT subjects. Lower values represent a better outcome, that is, a better QoL than that experienced at baseline.
Time frame: Evaluation at 12 months post-index procedure
Population: Evaluable ITT subjects were included in this analysis. (n) varies in relation to the number of evaluable subjects. Accordingly, the (n) for each period may be different from the overall (N) reported in the Participant Flow section.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| VENOVO™ Venous Stent. | Endpoint With Hypothesis Testing: Index of Quality of Life (QoL) From Baseline to 12 Months | -15.7 Scores on a scale |
Endpoint With Hypothesis Testing: Index of Venous Clinical Severity Score (VCSS) From Baseline to 12 Months
The Venous Clinical Severity Score (VCSS) system includes 10 clinical descriptions (pain, varicose veins, venous edema, skin pigmentation, inflammation, induration, number of active ulcers, duration of active ulceration, size of active ulceration. and level of compliance with medical compression therapy), scored from 0 to 3 (total possible score, 30) with 0 means absent, 1 means mild, 2 means moderate and 3 means severe. Total VCSS is the sum of all VCSS assessment scores from categories for a given time point. Twelve-month data is the change between baseline score and 12-month follow-up score. Results calculated for Intent-to-Treat (ITT) subjects. Lower values represent a better outcome, that is, a level of pain less than that experienced at baseline.
Time frame: Evaluation at 12 months post-index procedure
Population: Evaluable ITT subjects are included in this analysis.(n) varies in relation to the number of evaluable subjects. Accordingly, the (n) for each period may be different from the overall (N) reported in the Participant Flow section.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| VENOVO™ Venous Stent. | Endpoint With Hypothesis Testing: Index of Venous Clinical Severity Score (VCSS) From Baseline to 12 Months | -1.7 Scores on a scale |
Endpoint Without Hypothesis Testing: Index of CEAP at 30 Days, 6 Months, and 12 Months Post Procedure
Clinical-Etiologic-Anatomic-Pathophysiologic (CEAP) Classification is a system that describes a doctor's physical exam findings for vein problem(s), the cause of the problem(s), the location in the leg, and the mechanism responsible for the manifestation of the vein problem. For Clinical classification, the clinical components indicates disease severity, ranging from none (0 points) to active ulcers (6 points).For each category of Etiology, Anatomy, and Pathophysiology classifications, at each time point, frequency of each category is reported. Subsequent clinical study reports will present CEAP at 24 and 36-months follow-up. Changes from baseline measures to given time points are presented. Lower mean scores represent an improvement from baseline measure.
Time frame: Evaluation through 30 day, 6 months and 12 months post index procedure
Population: Evaluable ITT subjects are included in this analysis. (n) varies in relation to the number of evaluable subjects at 30 days, 6 months and 12 months. Accordingly, the (n) for each period may be different from the overall (N) reported in the Participant Flow section.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| VENOVO™ Venous Stent. | Endpoint Without Hypothesis Testing: Index of CEAP at 30 Days, 6 Months, and 12 Months Post Procedure | 6 months post procedure | -1.3 Scores on a scale | Standard Deviation 1.34 |
| VENOVO™ Venous Stent. | Endpoint Without Hypothesis Testing: Index of CEAP at 30 Days, 6 Months, and 12 Months Post Procedure | 12 months post procedure | -1.5 Scores on a scale | Standard Deviation 1.33 |
| VENOVO™ Venous Stent. | Endpoint Without Hypothesis Testing: Index of CEAP at 30 Days, 6 Months, and 12 Months Post Procedure | 30 day post procedure | -1.1 Scores on a scale | Standard Deviation 1.26 |
Endpoint Without Hypothesis Testing: Number of Participants With Acute Procedure Success (ITT Subjects)
Technical success is defined as no major adverse events experienced between index procedure and discharge
Time frame: Less than 30 days post index procedure
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| VENOVO™ Venous Stent. | Endpoint Without Hypothesis Testing: Number of Participants With Acute Procedure Success (ITT Subjects) | 168 Participants |
Endpoint Without Hypothesis Testing: Number of Participants With Acute Technical Success
Acute technical success is defined as successful deployment of stent(s) to intended target with adequate lesion coverage as assessed by the Investigator.
Time frame: At time of Index Procedure
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| VENOVO™ Venous Stent. | Endpoint Without Hypothesis Testing: Number of Participants With Acute Technical Success | 170 Participants |
Endpoint Without Hypothesis Testing: Number of Participants With Freedom From Target Lesion Revascularization (TLR) (ITT Subjects)
Freedom from Target Lesion Revascularization (TLR) through 30 days is specific to the first revascularization procedure of the target lesion.
Time frame: Evaluation throrugh 30 day, 6 months and 12 months post index procedure
Population: (n) varies in relation to the number of evaluable subjects at 30 days, 6 months and 12 months. Accordingly, the (n) for each period may be different from the overall (N) reported in the Participant Flow section.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| VENOVO™ Venous Stent. | Endpoint Without Hypothesis Testing: Number of Participants With Freedom From Target Lesion Revascularization (TLR) (ITT Subjects) | 30 day post procedure | 164 Participants |
| VENOVO™ Venous Stent. | Endpoint Without Hypothesis Testing: Number of Participants With Freedom From Target Lesion Revascularization (TLR) (ITT Subjects) | 6 months post procedure | 161 Participants |
| VENOVO™ Venous Stent. | Endpoint Without Hypothesis Testing: Number of Participants With Freedom From Target Lesion Revascularization (TLR) (ITT Subjects) | 12 months post procedure | 151 Participants |
Endpoint Without Hypothesis Testing: Number of Participants With Freedom From Target Vessel Revascularization (TVR) (ITT Subjects)
Freedom from Target Vessel Revascularization (TVR) is defined as the first revascularization procedure of the target vessel, as determined by an Independent Core Lab. Freedom from Target Lesion Revascularization (TLR) and Freedom from TVR results are the same through the 12 month analysis as all TLRs were also TVRs in this case.
Time frame: Evaluation through 30 days, 6 months and 12 months post index procedure
Population: (n) varies in relation to the number of evaluable subjects at 30 days, 6 months and 12 months. Accordingly, the (n) for each period may be different from the overall (N) reported in the Participant Flow section.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| VENOVO™ Venous Stent. | Endpoint Without Hypothesis Testing: Number of Participants With Freedom From Target Vessel Revascularization (TVR) (ITT Subjects) | 30 days post procedure | 164 Participants |
| VENOVO™ Venous Stent. | Endpoint Without Hypothesis Testing: Number of Participants With Freedom From Target Vessel Revascularization (TVR) (ITT Subjects) | 6 months post procedure | 161 Participants |
| VENOVO™ Venous Stent. | Endpoint Without Hypothesis Testing: Number of Participants With Freedom From Target Vessel Revascularization (TVR) (ITT Subjects) | 12 months post procedure | 151 Participants |
Endpoint Without Hypothesis Testing: Number of Participants With Lesion Success (ITT Subjects)
Lesion Success is defined as the attainment of less or equal to 50% residual stenosis at the conclusion of the index procedure.
Time frame: At the conclusion of index procedure
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| VENOVO™ Venous Stent. | Endpoint Without Hypothesis Testing: Number of Participants With Lesion Success (ITT Subjects) | 170 Participants |
Endpoint Without Hypothesis Testing: Number of Participants Without Device Stent Fracture at 12 Months Follow-Up
Stents were evaluated at the 12 month follow-up for fracture analysis. Evaluable ITT subjects are included in this analysis.
Time frame: Evaluation at 12 months post-index procedure
Population: Evaluable ITT subjects are included in this analysis. (n) varies in relation to the number of evaluable subjects. Accordingly, the (n) for each period may be different from the overall (N) reported in the Participant Flow section.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| VENOVO™ Venous Stent. | Endpoint Without Hypothesis Testing: Number of Participants Without Device Stent Fracture at 12 Months Follow-Up | Device Stent Fracture at 12 months | 0 Participants |
| VENOVO™ Venous Stent. | Endpoint Without Hypothesis Testing: Number of Participants Without Device Stent Fracture at 12 Months Follow-Up | No Device Stent Fracture at 12 months | 137 Participants |