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4-EVER : a Trial Investigating the Safety of 4F Endovascular Treatment of Infra-Inguinal Arterial Stenotic Disease (4-EVER)

Primary Purpose

Peripheral Vascular Disease, Claudication

Status
Completed
Phase
Phase 4
Locations
International
Study Type
Interventional
Intervention
4F portfolio products from Biotronik
Sponsored by
Flanders Medical Research Program
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Peripheral Vascular Disease focused on measuring peripheral Vascular Disease, claudication, rest pain

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • De novo, restenotic or reoccluded lesion located in the femoropopliteal arteries suitable for endovascular treatment
  • Patient presenting with a score from 2 to 4 according to the Rutherford classification
  • Patient is willing to comply with specified follow-up evaluations at the predefined time intervals times
  • Patient is >18 years old
  • Patient understands the nature of the procedure and provides written informed consent, prior to enrollment in the study
  • Prior to enrollment, the target lesion was crossed with standard guidewire manipulation
  • Patient is eligible for treatment with 4F compatible devices

Angiographic Inclusion Criteria:

  • The target lesions are located within the native superficial femoral artery: Distal point 3 cm above knee joint and 1 cm below the origin of the profunda femoralis.
  • The target lesion has angiographic evidence of stenosis or restenosis > 50% or occlusion
  • Length of the target lesion is =20 cm by visual estimation and can be covered with one stent
  • Target vessel diameter visually estimated is =4 mm and =6.5 mm
  • There is angiographic evidence of at least one-vessel-runoff to the foot

Exclusion Criteria:

  • Presence of another stent in the target vessel that was placed during a previous procedure
  • Presence of an aortic thrombosis or significant common femoral ipsilateral stenosis
  • Previous bypass surgery in the same limb
  • Patients contraindicated for antiplatelet therapy, anticoagulants or thrombolytics
  • Patients who exhibit persistent acute intraluminal thrombus at the target lesion site
  • Perforation at the angioplasty site evidenced by extravasation of contrast medium
  • Patients with known hypersensitivity to nickel-titanium
  • Patients with uncorrected bleeding disorders
  • Female patient with child bearing potential not taking adequate contraceptives or currently breastfeeding
  • Life expectancy of less than 12 months
  • Ipsilateral iliac artery treatment before target lesion treatment with a residual stenosis > 30%
  • Use of thrombectomy, atherectomy or laser devices during procedure
  • Any planned surgical intervention/procedure 30 days after the study procedure
  • Any patient considered to be hemodynamically unstable at onset of procedure
  • Patient is currently participating in another investigational drug or device study that has not reached the primary endpoint

Sites / Locations

  • Imelda hospital
  • Universitair ziekenhuis antwerpen
  • AZ Sint Blasius
  • Park-Krankenhaus Leipzig
  • St Fransiskus hospital

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

4F portfolio products from Biotronik

Arm Description

The devices under investigation are the 4F portfolio products from Biotronik: Astron pulsar / Astron Pulsar-18, Fortress, Passeo-18 and Cruiser-18.

Outcomes

Primary Outcome Measures

Primary patency at 12 months as indicated by an independently verified duplex ultrasound peak systolic velocity ratio (PSVR) <2.5 in the target vessel with no reintervention
Primary patency at 12 months, defined as freedom from >50% restenosis

Secondary Outcome Measures

Technical success
Technical success, defined as the ability to cross and stent the lesion to achieve residual angiographic stenosis no greater than 30% and residual stenosis less than 50% by duplex imaging.
Puncture site complications
Number of puncture site complications in the absence of a closure device after intervention
Primary patency
Primary patency rate at 6- & 24-month follow-up, defined as freedom from >50% restenosis at 6 & 24 months as indicated by an independently verified duplex ultrasound peak systolic velocity ratio (PSVR) <2.5 in the target vessel with no reintervention.
Clinical success
Clinical success at follow-up is defined as an improvement of Rutherford classification at 6-, 12- & 24-month follow-up of one class or more as compared to the pre-procedure
Stent fracture rate at 12- & 24-month follow-up
Stent fracture rate at 12- & 24-month follow-up (in patient who were treated with stentplacement), as determined according the following classification on x-ray: Class 0 : no strut factures Class I : single tine fracture Class II : multiple tine factures Class III : Stent fracture(s) with preserved alignment of the components Class IV : Stent fracture(s) with mal-alignment of the components Class V : Stent fracture(s) in a trans-axial spiral configuration

Full Information

First Posted
July 1, 2010
Last Updated
September 30, 2013
Sponsor
Flanders Medical Research Program
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1. Study Identification

Unique Protocol Identification Number
NCT01413139
Brief Title
4-EVER : a Trial Investigating the Safety of 4F Endovascular Treatment of Infra-Inguinal Arterial Stenotic Disease
Acronym
4-EVER
Official Title
4-EVER Study - Physician-Initiated Trial Investigating the Safety of the Full 4F Endovascular Treatment Approach of Infra-Inguinal Arterial Stenotic Disease
Study Type
Interventional

2. Study Status

Record Verification Date
September 2013
Overall Recruitment Status
Completed
Study Start Date
July 2010 (undefined)
Primary Completion Date
May 2011 (Actual)
Study Completion Date
September 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Flanders Medical Research Program

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The objective of this clinical investigation is to evaluate puncture site complication rate as well as the short- and long-term (up to 24 months) outcome of treatment by means of Astron Pulsar / Astron Pulsar-18 stent implantation in symptomatic (Rutherford 2-4) femoro-popliteal arterial stenotic or occlusive lesions, using 4F compatible devices of BIOTRONIK and without the use of a closure device. The hypothesis is that the primary patency at 12 months is non-inferior to the primary patency obtained in the Durability study (72.2%).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Peripheral Vascular Disease, Claudication
Keywords
peripheral Vascular Disease, claudication, rest pain

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
120 (Actual)

8. Arms, Groups, and Interventions

Arm Title
4F portfolio products from Biotronik
Arm Type
Other
Arm Description
The devices under investigation are the 4F portfolio products from Biotronik: Astron pulsar / Astron Pulsar-18, Fortress, Passeo-18 and Cruiser-18.
Intervention Type
Device
Intervention Name(s)
4F portfolio products from Biotronik
Other Intervention Name(s)
Astron pulsar, Astron Pulsar-18, Fortress, Passeo-18, Cruiser-18
Intervention Description
4F portfolio products from Biotronik: Astron pulsar / Astron Pulsar-18, Fortress, Passeo-18, Cruiser-18
Primary Outcome Measure Information:
Title
Primary patency at 12 months as indicated by an independently verified duplex ultrasound peak systolic velocity ratio (PSVR) <2.5 in the target vessel with no reintervention
Description
Primary patency at 12 months, defined as freedom from >50% restenosis
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Technical success
Description
Technical success, defined as the ability to cross and stent the lesion to achieve residual angiographic stenosis no greater than 30% and residual stenosis less than 50% by duplex imaging.
Time Frame
1 day post-procedure
Title
Puncture site complications
Description
Number of puncture site complications in the absence of a closure device after intervention
Time Frame
10 days
Title
Primary patency
Description
Primary patency rate at 6- & 24-month follow-up, defined as freedom from >50% restenosis at 6 & 24 months as indicated by an independently verified duplex ultrasound peak systolic velocity ratio (PSVR) <2.5 in the target vessel with no reintervention.
Time Frame
6- & 24-month follow-up
Title
Clinical success
Description
Clinical success at follow-up is defined as an improvement of Rutherford classification at 6-, 12- & 24-month follow-up of one class or more as compared to the pre-procedure
Time Frame
6-, 12- & 24-month follow-up
Title
Stent fracture rate at 12- & 24-month follow-up
Description
Stent fracture rate at 12- & 24-month follow-up (in patient who were treated with stentplacement), as determined according the following classification on x-ray: Class 0 : no strut factures Class I : single tine fracture Class II : multiple tine factures Class III : Stent fracture(s) with preserved alignment of the components Class IV : Stent fracture(s) with mal-alignment of the components Class V : Stent fracture(s) in a trans-axial spiral configuration
Time Frame
12- & 24-month follow-up

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: De novo, restenotic or reoccluded lesion located in the femoropopliteal arteries suitable for endovascular treatment Patient presenting with a score from 2 to 4 according to the Rutherford classification Patient is willing to comply with specified follow-up evaluations at the predefined time intervals times Patient is >18 years old Patient understands the nature of the procedure and provides written informed consent, prior to enrollment in the study Prior to enrollment, the target lesion was crossed with standard guidewire manipulation Patient is eligible for treatment with 4F compatible devices Angiographic Inclusion Criteria: The target lesions are located within the native superficial femoral artery: Distal point 3 cm above knee joint and 1 cm below the origin of the profunda femoralis. The target lesion has angiographic evidence of stenosis or restenosis > 50% or occlusion Length of the target lesion is =20 cm by visual estimation and can be covered with one stent Target vessel diameter visually estimated is =4 mm and =6.5 mm There is angiographic evidence of at least one-vessel-runoff to the foot Exclusion Criteria: Presence of another stent in the target vessel that was placed during a previous procedure Presence of an aortic thrombosis or significant common femoral ipsilateral stenosis Previous bypass surgery in the same limb Patients contraindicated for antiplatelet therapy, anticoagulants or thrombolytics Patients who exhibit persistent acute intraluminal thrombus at the target lesion site Perforation at the angioplasty site evidenced by extravasation of contrast medium Patients with known hypersensitivity to nickel-titanium Patients with uncorrected bleeding disorders Female patient with child bearing potential not taking adequate contraceptives or currently breastfeeding Life expectancy of less than 12 months Ipsilateral iliac artery treatment before target lesion treatment with a residual stenosis > 30% Use of thrombectomy, atherectomy or laser devices during procedure Any planned surgical intervention/procedure 30 days after the study procedure Any patient considered to be hemodynamically unstable at onset of procedure Patient is currently participating in another investigational drug or device study that has not reached the primary endpoint
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marc Bosiers, MD
Organizational Affiliation
AZ Sint Blasius, Dendermonde, Belgium
Official's Role
Principal Investigator
Facility Information:
Facility Name
Imelda hospital
City
Bonheiden
State/Province
Antwerpen
ZIP/Postal Code
2820
Country
Belgium
Facility Name
Universitair ziekenhuis antwerpen
City
Edegem
State/Province
Antwerpen
ZIP/Postal Code
2650
Country
Belgium
Facility Name
AZ Sint Blasius
City
Dendermonde
State/Province
Oost-Vlaanderen
ZIP/Postal Code
9200
Country
Belgium
Facility Name
Park-Krankenhaus Leipzig
City
Leipzig
ZIP/Postal Code
04289
Country
Germany
Facility Name
St Fransiskus hospital
City
Münster
ZIP/Postal Code
48145
Country
Germany

12. IPD Sharing Statement

Citations:
PubMed Identifier
24325689
Citation
Bosiers M, Deloose K, Callaert J, Keirse K, Verbist J, Hendriks J, Lauwers P, D'Archambeau O, Scheinert D, Torsello G, Peeters P. 4-French-compatible endovascular material is safe and effective in the treatment of femoropopliteal occlusive disease: results of the 4-EVER trial. J Endovasc Ther. 2013 Dec;20(6):746-56. doi: 10.1583/13-4437MR.1.
Results Reference
derived

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4-EVER : a Trial Investigating the Safety of 4F Endovascular Treatment of Infra-Inguinal Arterial Stenotic Disease

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