A Multicenter, Open Label, Prospective, Non-randomized Study of the InCraft® Stent Graft System in Subjects With Abdominal Aortic Aneurysms (INSPIRATION) (INSPIRATION)
Primary Purpose
Abdominal Aortic Aneurysm
Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Endovascular AAA repair with InCraft®
Sponsored by
About this trial
This is an interventional treatment trial for Abdominal Aortic Aneurysm focused on measuring Abdominal Aortic Aneurysm
Eligibility Criteria
Inclusion Criteria:
Subject must meet ALL of the following inclusion criteria to be enrolled in the study:
- Male or Female age 20 years or older;
- Proximal aortic neck is 17-31mm in diameter;
- Supra-renal aorta, at 20mm above the anticipated landing location, is smaller than the nominal diameter of the aortic bifurcate prosthesis to be used;
- Infra-renal aortic neck is ≥10mm in length with supra-renal and infra-renal angulations ≤60°;
Subject has at least one of the following:
- AAA size > 5.0 cm;
- Increase of the AAA diameter of > 0.5 cm over the last 6 months;
- Abdominal treatment length (lowest renal artery origin to the aortic bifurcation) ≥ 9.4cm;
- Aortic bifurcation >18mm in diameter;
- Iliac landing zone ≥15mm in length;
- Iliac landing zone 7-22mm in diameter;
- Minimum access vessel size of ≥ 5mm;
- Minimum overall AAA treatment length (from lowest renal artery to distal landing zone) of 128 mm;
- Women of child bearing potential must be non-pregnant, non-lactating, and not planning to become pregnant during the course of the trial; and have a negative urine or serum pregnancy test within 7 days prior to index procedure;
- Provide written informed consent and as applicable written HIPAA authorization (For US sites only) prior to initiation of study procedures;
- Willing to comply with the specified follow-up evaluation schedule.
Exclusion Criteria:
Subjects will be excluded if ANY of the following exclusion criteria apply:
- Vascular anatomy in which the placement of the stent-graft will cause occlusion of both internal iliac arteries or necessitates surgical occlusion of both internal iliac arteries;
Subject has one of the following:
- Aneurysm sac rupture or leaking abdominal aortic aneurysm;
- Mycotic, dissecting, or inflammatory abdominal aortic aneurysm;
- Clinically significant acute vascular injury due to trauma;
- Significant aortic or iliac mural thrombus, plaque or calcification that would compromise fixation and seal of the device;
- A conical aortic neck defined as >3mm distal increase over a 10mm length in the planned seal zone;
- Thoracic aortic aneurysm ≥45mm;
- Any aortic dissection;
- Morbid obesity (BMI >40.0 kg.m2) or other clinical conditions that limit required imaging studies or visualization of the aorta;
- Renal insufficiency (Creatinine > 2.0mg/dL) or subject on renal dialysis;
- Known allergy or intolerance to nickel titanium (nitinol) , Polyethylene terephthalate (PET), or polytetrafluoroethylene (PTFE);
- Known contraindication to undergoing angiography or anticoagulation (e.g. contrast allergies which cannot be treated);
- Connective tissue disorder (such as Marfan's Syndrome or Ehlers-Danlos Syndrome);
- Coagulopathy, bleeding disorder, or other hypercoagulable state;
- Organ transplant recipient or subject requiring systemic immunosuppressant therapy;
- Cerebral vascular accident (CVA), MI, or intracranial bleeding within 3 months prior to the procedure;
- Active infection or chronic systemic illness at the time of index procedure that may interfere with the study objectives;
- Major surgical procedure within 1 month prior to the index procedure or pre-planned within 1 month afterwards;
- Co-existing condition with a life expectancy of less than 2 years at time of procedure;
- Current or planned participation in any other investigational drug or medical device clinical study that has not completed primary endpoint(s) evaluation;
- Existing AAA surgical graft and/or a AAA stent-graft system;
- Other medical, social, or psychological issues that in the opinion of the investigator preclude the subjects from receiving this treatment, and the procedures and evaluations pre- and posttreatment.
Sites / Locations
- Michel S. Makaroun, MD
- Takao Ohki, MD
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
InCraft® - AAA stent graft system
Arm Description
Intervention: Endovascular AAA repair using the InCraft device
Outcomes
Primary Outcome Measures
Number of Participants With Incidence of MAE (Major Adverse Events) Based Upon a Composite MAE Rate
defined as a composite of:
Death
Stroke
Myocardial Infarction
New Onset Renal Failure (requiring dialysis)
Respiratory Failure (requires mechanical ventilation)
Paralysis/paraparesis
Bowel ischemia (requiring surgical intervention)
Procedural blood loss ≥1,000 cc
Number of Participants With Successful Aneurysm Treatment
Successful aneurysm treatment which is a composite endpoint of the following:
Technical Success at the conclusion of the index procedure, defined as successful insertion of the delivery system through the vasculature and successful deployment of the device at the intended location. The endovascular graft must be patent, with absence of types I or III endoleaks or aneurysm sac rupture, at the time of procedure completion as confirmed by angiography or other imaging modality;
Absence of post-operative aneurysm enlargement (growth > 5 mm) or stent graft migration (> 10mm) compared to the one month size measurement at anytime up to 1-year;
Absence of post-operative conversion to open surgery, sac rupture, endoleak Type I / III, or graft occlusion (including unilateral or bilateral limb occlusion) at any time up to 1-year.
Secondary Outcome Measures
Procedure-related Complications
Adverse events that are a result of the procedure itself.
Aneurysm-related Mortality
Incidence of Secondary Interventions
The incidence of secondary interventions within 1 year post-procedure, needed to prevent the occurrence of a significant event. Significant event being defined as: aneurysm enlargement (growth > 5 mm), stent graft migration (> 10mm) compared to the one month size, endoleak type I / III, graft occlusion, sac rupture.
Major Adverse Events (MAEs) and Individual Components of the MAEs
Device-related Events
Endoleak(s), Aneurysm sac rupture, Fracture(s, Delivery System Malfunction, Device Malfunction, Stent Graft Migration - evidence of proximal or distal movement of the stent graft >10mm relative to fixed anatomic landmarks compared with 1 month, Graft Occlusion (including unilateral or bilateral limb occlusion, Conversion to open surgery, and Aneurysm Enlargement - defined as an increase in maximum aneurysm cross sectional diameter > 5mm compared to the 1-month measurement.
Technical Success Confirmed by CT or Other Imaging Modality
The study evaluated technical success at 30-days as one of the secondary effectiveness endpoints. The definition of technical success is defined as patency of the endovascular graft, with the absence of Type I or III endoleaks or aneurysm sac rupture, up to 30-days post-procedure completion as confirmed by CT or other imaging modality.
Length of Hospital Stay (Days) Post Index Procedure
Length of Intensive Care Unit (ICU) Stay (Hours) Post Index Procedure
Length of the Index Procedure (Minutes)
Full Information
NCT ID
NCT01664078
First Posted
August 9, 2012
Last Updated
August 6, 2020
Sponsor
Cordis Corporation
Collaborators
Carelon Research, Quintiles, Inc.
1. Study Identification
Unique Protocol Identification Number
NCT01664078
Brief Title
A Multicenter, Open Label, Prospective, Non-randomized Study of the InCraft® Stent Graft System in Subjects With Abdominal Aortic Aneurysms (INSPIRATION)
Acronym
INSPIRATION
Official Title
A Multicenter, Open Label, Prospective, Non-randomized Study of the InCraft® Stent Graft System in Subjects With Abdominal Aortic Aneurysms (INSPIRATION)
Study Type
Interventional
2. Study Status
Record Verification Date
August 2020
Overall Recruitment Status
Completed
Study Start Date
July 2012 (Actual)
Primary Completion Date
October 2014 (Actual)
Study Completion Date
October 10, 2018 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Cordis Corporation
Collaborators
Carelon Research, Quintiles, Inc.
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of this study is to evaluate the safety and effectiveness of InCraft® in subjects with abdominal aortic aneurysms requiring endovascular repair.
Detailed Description
In the US, abdominal aortic aneurysms (AAA) are found in 4-8% of older men and 0.5-1.5% of older women, resulting in 30,000-40,000 elective procedures and 1,400 peri-operative deaths. The most significant complication of AAA is an aneurysm sac rupture from which more than 15,000 patients die annually and is the 15th leading cause of death in elderly between 60 to 85 years of age . In Japan, it is estimated that approximately 14,000 endovascular aneurysm repair (EVAR) and open surgical repair cases were performed in the year 2010 .
Abdominal aortic aneurysms can be treated three ways: (1) Medical management; (2) Open surgical repair; and (3) Endovascular aneurysm repair (EVAR). EVAR has emerged as an alternative treatment of AAA for most patients. It is less invasive than open repair and carries lower rates of early mortality and morbidity . It has also extended treatment options to patients who cannot undergo conventional surgical procedures due to a high operative risk. As EVAR technology evolves, it allows treatment of AAA with increasing complexity of the aortic neck and access vessels.
The InCraft® AAA Stent Graft System is designed for endovascular repair of infrarenal AAAs with complex aortic anatomies. This stent-graft system utilizes nitinol stent and polyester graft technology in an ultra-low profile delivery system, which assists the physician in deploying the device in a controlled, consistent, and precise manner within the aortic neck and iliac arteries. By isolating the aneurysmal sac, the system provides an alternative blood flow path to relieve pressure on the arterial vessel walls and minimize aneurysm growth and the potential for aneurysm sac rupture.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Abdominal Aortic Aneurysm
Keywords
Abdominal Aortic Aneurysm
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
190 (Actual)
8. Arms, Groups, and Interventions
Arm Title
InCraft® - AAA stent graft system
Arm Type
Experimental
Arm Description
Intervention: Endovascular AAA repair using the InCraft device
Intervention Type
Device
Intervention Name(s)
Endovascular AAA repair with InCraft®
Primary Outcome Measure Information:
Title
Number of Participants With Incidence of MAE (Major Adverse Events) Based Upon a Composite MAE Rate
Description
defined as a composite of:
Death
Stroke
Myocardial Infarction
New Onset Renal Failure (requiring dialysis)
Respiratory Failure (requires mechanical ventilation)
Paralysis/paraparesis
Bowel ischemia (requiring surgical intervention)
Procedural blood loss ≥1,000 cc
Time Frame
30 days post-procedure
Title
Number of Participants With Successful Aneurysm Treatment
Description
Successful aneurysm treatment which is a composite endpoint of the following:
Technical Success at the conclusion of the index procedure, defined as successful insertion of the delivery system through the vasculature and successful deployment of the device at the intended location. The endovascular graft must be patent, with absence of types I or III endoleaks or aneurysm sac rupture, at the time of procedure completion as confirmed by angiography or other imaging modality;
Absence of post-operative aneurysm enlargement (growth > 5 mm) or stent graft migration (> 10mm) compared to the one month size measurement at anytime up to 1-year;
Absence of post-operative conversion to open surgery, sac rupture, endoleak Type I / III, or graft occlusion (including unilateral or bilateral limb occlusion) at any time up to 1-year.
Time Frame
Up to 1 year post-procedure
Secondary Outcome Measure Information:
Title
Procedure-related Complications
Description
Adverse events that are a result of the procedure itself.
Time Frame
Through 1 month, 180-days, 360-days and annually to 5-years post-procedure
Title
Aneurysm-related Mortality
Time Frame
At 30-days, 180-days, 360-days and annually to 5-years post-procedure
Title
Incidence of Secondary Interventions
Description
The incidence of secondary interventions within 1 year post-procedure, needed to prevent the occurrence of a significant event. Significant event being defined as: aneurysm enlargement (growth > 5 mm), stent graft migration (> 10mm) compared to the one month size, endoleak type I / III, graft occlusion, sac rupture.
Time Frame
through 5 years
Title
Major Adverse Events (MAEs) and Individual Components of the MAEs
Time Frame
At 180-days, 360-days and annually to 5-years post-procedure
Title
Device-related Events
Description
Endoleak(s), Aneurysm sac rupture, Fracture(s, Delivery System Malfunction, Device Malfunction, Stent Graft Migration - evidence of proximal or distal movement of the stent graft >10mm relative to fixed anatomic landmarks compared with 1 month, Graft Occlusion (including unilateral or bilateral limb occlusion, Conversion to open surgery, and Aneurysm Enlargement - defined as an increase in maximum aneurysm cross sectional diameter > 5mm compared to the 1-month measurement.
Time Frame
At 1 month, 6 months, 1 year and annually to 5-years post-procedure
Title
Technical Success Confirmed by CT or Other Imaging Modality
Description
The study evaluated technical success at 30-days as one of the secondary effectiveness endpoints. The definition of technical success is defined as patency of the endovascular graft, with the absence of Type I or III endoleaks or aneurysm sac rupture, up to 30-days post-procedure completion as confirmed by CT or other imaging modality.
Time Frame
At 30-days
Title
Length of Hospital Stay (Days) Post Index Procedure
Time Frame
up to 17 days
Title
Length of Intensive Care Unit (ICU) Stay (Hours) Post Index Procedure
Time Frame
up to 48 hours
Title
Length of the Index Procedure (Minutes)
Time Frame
1 day
Other Pre-specified Outcome Measures:
Title
Pain Post-Operatively
Description
Outcome measured by the SF36v2 Health Status Survey where all items are scored so that a high score defines a more favorable health state. Each item is scored on a 0 to 100 range so that the lowest and highest possible scores are 0 and 100, respectively.
Time Frame
Baseline, 1 month, 6 months and 1 year post-procedure
Title
Physical Functioning Post-operatively
Description
Physical Functioning (PF) Outcome measured by the SF36v2 Health Status Survey where all items are scored so that a high score defines a more favorable health state. Each item is scored on a 0 to 100 range so that the lowest and highest possible scores are 0 and 100, respectively.
Time Frame
Screening, 1 month, 6 months and 1 year post-procedure
10. Eligibility
Sex
All
Minimum Age & Unit of Time
20 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Subject must meet ALL of the following inclusion criteria to be enrolled in the study:
Male or Female age 20 years or older;
Proximal aortic neck is 17-31mm in diameter;
Supra-renal aorta, at 20mm above the anticipated landing location, is smaller than the nominal diameter of the aortic bifurcate prosthesis to be used;
Infra-renal aortic neck is ≥10mm in length with supra-renal and infra-renal angulations ≤60°;
Subject has at least one of the following:
AAA size > 5.0 cm;
Increase of the AAA diameter of > 0.5 cm over the last 6 months;
Abdominal treatment length (lowest renal artery origin to the aortic bifurcation) ≥ 9.4cm;
Aortic bifurcation >18mm in diameter;
Iliac landing zone ≥15mm in length;
Iliac landing zone 7-22mm in diameter;
Minimum access vessel size of ≥ 5mm;
Minimum overall AAA treatment length (from lowest renal artery to distal landing zone) of 128 mm;
Women of child bearing potential must be non-pregnant, non-lactating, and not planning to become pregnant during the course of the trial; and have a negative urine or serum pregnancy test within 7 days prior to index procedure;
Provide written informed consent and as applicable written HIPAA authorization (For US sites only) prior to initiation of study procedures;
Willing to comply with the specified follow-up evaluation schedule.
Exclusion Criteria:
Subjects will be excluded if ANY of the following exclusion criteria apply:
Vascular anatomy in which the placement of the stent-graft will cause occlusion of both internal iliac arteries or necessitates surgical occlusion of both internal iliac arteries;
Subject has one of the following:
Aneurysm sac rupture or leaking abdominal aortic aneurysm;
Mycotic, dissecting, or inflammatory abdominal aortic aneurysm;
Clinically significant acute vascular injury due to trauma;
Significant aortic or iliac mural thrombus, plaque or calcification that would compromise fixation and seal of the device;
A conical aortic neck defined as >3mm distal increase over a 10mm length in the planned seal zone;
Thoracic aortic aneurysm ≥45mm;
Any aortic dissection;
Morbid obesity (BMI >40.0 kg.m2) or other clinical conditions that limit required imaging studies or visualization of the aorta;
Renal insufficiency (Creatinine > 2.0mg/dL) or subject on renal dialysis;
Known allergy or intolerance to nickel titanium (nitinol) , Polyethylene terephthalate (PET), or polytetrafluoroethylene (PTFE);
Known contraindication to undergoing angiography or anticoagulation (e.g. contrast allergies which cannot be treated);
Connective tissue disorder (such as Marfan's Syndrome or Ehlers-Danlos Syndrome);
Coagulopathy, bleeding disorder, or other hypercoagulable state;
Organ transplant recipient or subject requiring systemic immunosuppressant therapy;
Cerebral vascular accident (CVA), MI, or intracranial bleeding within 3 months prior to the procedure;
Active infection or chronic systemic illness at the time of index procedure that may interfere with the study objectives;
Major surgical procedure within 1 month prior to the index procedure or pre-planned within 1 month afterwards;
Co-existing condition with a life expectancy of less than 2 years at time of procedure;
Current or planned participation in any other investigational drug or medical device clinical study that has not completed primary endpoint(s) evaluation;
Existing AAA surgical graft and/or a AAA stent-graft system;
Other medical, social, or psychological issues that in the opinion of the investigator preclude the subjects from receiving this treatment, and the procedures and evaluations pre- and posttreatment.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michel S Makaroun, MD
Organizational Affiliation
University of Pittsburgh
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Takao Ohki, MD
Organizational Affiliation
Jikei University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Michel S. Makaroun, MD
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15217
Country
United States
Facility Name
Takao Ohki, MD
City
Minato-ku
State/Province
Tokyo
ZIP/Postal Code
105-8461
Country
Japan
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
30879790
Citation
Iantorno M, Buchanan KD, Bernardo NL, Torguson R, Waksman R. Overview of the 2018 US Food and Drug Administration Circulatory System Devices Panel meeting on the INCRAFT AAA Stent Graft System. Cardiovasc Revasc Med. 2019 May;20(5):403-408. doi: 10.1016/j.carrev.2019.02.018. Epub 2019 Feb 18.
Results Reference
derived
Learn more about this trial
A Multicenter, Open Label, Prospective, Non-randomized Study of the InCraft® Stent Graft System in Subjects With Abdominal Aortic Aneurysms (INSPIRATION)
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