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Evaluation of the Pantheris Atherectomy System (VISION)

Primary Purpose

Peripheral Arterial Disease

Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Pantheris System
Sponsored by
Avinger, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Peripheral Arterial Disease focused on measuring Atherectomy, Optical Coherence Tomography, Lumivascular

Eligibility Criteria

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

Inclusion Criteria:

  • Age ≥ 18 years old;
  • Subject is a candidate for percutaneous intervention for peripheral arterial disease in the legs;
  • Subject is willing and able to give informed consent;
  • Documented symptomatic atherosclerotic peripheral arterial disease Rutherford Classification 2-5;
  • Reference vessel lumen proximal to target lesion ≥ 2.5 mm and ≤ 7.0 mm in diameter by visual estimation;
  • Subject has de novo target lesion(s) with stenosis >70% by visual estimation distal to the profunda femoral artery. No more than 2 lesions may be treated with the Pantheris device;
  • Target lesion length ≤ 15 cm (may be two tandem lesions that do not exceed 15cm in total length);
  • Subject is capable of meeting requirements and be present at the follow-up clinic visits at 30 days and 6 months;
  • At least one patent tibial run-off vessel at baseline.

Inclusion Criteria for the 24-month follow up:

  • Completed the 6-month follow-up visit
  • Re-consented prior to the 24-month follow-up visit

Exclusion Criteria:

  • Subject is pregnant or breast feeding;
  • Rutherford Class 0 to 1 (asymptomatic and mild claudication);
  • Rutherford Class 6 (critical limb ischemia);
  • Moderate to severe calcification of the target lesion;
  • Acute ischemia and/or acute thrombosis of the Superficial Femoral Artery (SFA)-Popliteal segment;
  • In-stent restenosis within the target lesion;
  • Target lesion with any type of stent or graft;
  • Target lesion in the iliac artery;
  • Target lesion stenosis <70%;
  • Subjects with significant (≥70%) occlusive lesions proximal to the target lesion not successfully treated during the index procedure (upstream disease) and prior to treatment of the target lesion;
  • Endovascular or surgical procedure performed on the index limb less than or equal to 30 days prior to the index procedure;
  • Planned endovascular or surgical procedure 30 days after the index procedure;
  • Lesion in the contralateral limb requiring intervention during the index procedure or within 30 days of the index procedure;
  • Subjects with active systemic infections whether they are being currently treated or not;
  • Subjects on chronic hemodialysis or creatinine level >2.0mg/dL;
  • Evidence or history of intracranial or gastrointestinal bleeding, intracranial aneurysm, myocardial infarction or stroke within the past 2 months;
  • Evidence or history of aneurysmal target vessel within the past 2 months;
  • History of severe trauma, fracture, major surgery or biopsy of a parenchymal organ within the past 14 days;
  • Known allergy to contrast agents or medications used to perform endovascular intervention that cannot be adequately pre-treated;
  • Subjects in whom anti-platelet, anticoagulant, or thrombolytic therapy is contraindicated;
  • History of heparin-induced thrombocytopenia (HIT);
  • Uncorrectable bleeding diathesis, platelet dysfunction, thrombocytopenia with platelet count less than 100,000/mm2, known coagulopathy, or International Normalized Ratio (INR) >1.5;
  • Any thrombolytic therapy within 2 weeks of the index procedure;
  • Any clinical and/or angiographic complication attributed to the use of another device prior to the insertion of the study device into the subject;
  • Subjects or their legal guardians who have not or will not sign the Informed Consent;
  • Subjects who are unwilling or unable to comply with the follow-up study requirements;
  • Participation in any study of an investigational device, medication, biologic or other agent within 30 days prior to enrollment that is either a cardiovascular study or could, in the judgment of the investigator, affect the results of the study.

Sites / Locations

  • St. Bernard's Medical Center
  • Arkansas Heart Hospital
  • Cedars Sinai Medical Center/Cardiovascular Research Foundation of Southern California
  • Medstar Washington Hospital
  • Coastal Vascular and Interventional
  • Alexian Brothers Medical Center, Cardiovascular Associates
  • Advocate Christ Hospital and Medical Center
  • St. Joseph's Hospital
  • Detroit Medical Center Cardiovascular Institute Harper-Hutzel Hospital
  • St. John Hospital and Medical Center
  • St. Dominic Hospital
  • University of Nebraska Medical Center
  • Deborah Heart and Lung Center
  • St. Peters University Hospital
  • Hatton Institute for Research and Education, Good Samaritan Hospital - Bethesda North
  • Dayton Heart Center/Good Samaritan Hospital
  • Jobst Vascular Center
  • Einstein Medical Center
  • Methodist Hospital
  • Austin Heart
  • Muenster Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Pantheris Treatment Arm

Arm Description

Intervention: Atherectomy using the Pantheris system.

Outcomes

Primary Outcome Measures

Primary Safety Endpoint
The primary safety endpoint is defined as freedom from a composite of major adverse events (MAE) through 6-Month follow-up as adjudicated by an independent Clinical Events Committee (CEC). Individual MAEs include: Cardiovascular related death Unplanned, major index limb amputation Clinically driven target lesion revascularization (TLR) Myocardial infarction Device related events: Clinically significant perforation Clinically significant dissection Clinically significant embolus Pseudoaneurysm
Primary Effectiveness Endpoint: Technical Success
The primary efficacy endpoint of technical success is defined as the percent of target lesions that have a residual diameter stenosis <50% post the Pantheris device alone, as assessed by an independent Angiographic Core Laboratory.

Secondary Outcome Measures

Secondary Safety Endpoint
Freedom from MAEs as defined above, through 30 days (or hospital discharge, whichever is longer) as adjudicated by an independent CEC.
Secondary Safety Endpoint
Freedom from procedural emboli, defined as a change in any visualized runoff vessel (other than vasospasm and dissection) at any time during the procedure.
Secondary Safety Endpoint
Freedom from clinically driven Target Vessel Revascularization (TVR) through 6 months, as adjudicated by an independent CEC.
Secondary Effectiveness Endpoint: Procedural Success
Procedural success defined as the percent of target lesions that have residual diameter stenosis < 30% post-Pantheris and any other adjunctive therapy, determined by independent Angiographic Core Laboratory.
Secondary Effectiveness Endpoint: ABI
Ankle-Brachial Index (ABI) at 30 days. ABI is the ratio of blood pressure in the lower legs to the blood pressure in the arms. ABI between 0.95 and 1.3 is considered normal (free from significant peripheral artery disease).
Secondary Effectiveness Endpoint: Rutherford Classification
Rutherford Classification at 30 days. Rutherford Classification is a commonly used clinical means for describing the degree of peripheral artery disease. Rutherford Classifications range from Class 0: asymptomatic, to Class 6: major tissue loss.
Secondary Effectiveness Endpoint: Quality of Life - 12-Item Short Form Survey (SF-12)
Change in Quality of Life measures between Baseline and 30 days using 12-Item Short Form Survey (SF-12). There are two components of the SF-12: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Each yields scores from 0 (representing the worst possible debilitation) to 100 (representing no reduction in quality of life).
Secondary Effectiveness Endpoint: Vascular Quality of Life Questionnaire (VascuQoL)
Change in Quality of Life measures between Baseline and 30 days using Vascular Quality of Life Questionnaire (VascuQoL). The VascuQoL is a disease-specific questionnaire developed to assess chronic limb ischemia. VascuQol uses a seven-point scale, with 1 representing the worst score and 7 representing the best score.
Secondary Effectiveness Endpoint: ABI
Ankle-Brachial Index (ABI) at 6 months. ABI is the ratio of blood pressure in the lower legs to the blood pressure in the arms. ABI between 0.95 and 1.3 is considered normal (free from significant peripheral artery disease).
Secondary Effectiveness Endpoint: Rutherford Classification
Rutherford Classification at 6 months. Rutherford Classification is a commonly used clinical means for describing the degree of peripheral artery disease. Rutherford Classifications range from Class 0: asymptomatic, to Class 6: major tissue loss.
Secondary Effectiveness Endpoint: Quality of Life - 12-Item Short Form Survey (SF-12)
Change in Quality of Life measures between Baseline and 6 Months using 12-Item Short Form Survey (SF-12). There are two components of the SF-12: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Each yields scores from 0 (representing the worst possible debilitation) to 100 (representing no reduction in quality of life).
Secondary Effectiveness Endpoint: Vascular Quality of Life Questionnaire (VascuQoL)
Change in Quality of Life measures between Baseline and 6 months using Vascular Quality of Life Questionnaire (VascuQoL). The VascuQoL is a disease-specific questionnaire developed to assess chronic limb ischemia. VascuQol uses a seven-point scale, with 1 representing the worst score and 7 representing the best score.

Full Information

First Posted
September 4, 2013
Last Updated
March 3, 2021
Sponsor
Avinger, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT01937351
Brief Title
Evaluation of the Pantheris Atherectomy System
Acronym
VISION
Official Title
Evaluation of the Pantheris Optical Coherence Tomography Imaging Atherectomy System for Use in the Peripheral Vasculature
Study Type
Interventional

2. Study Status

Record Verification Date
March 2021
Overall Recruitment Status
Completed
Study Start Date
June 25, 2013 (Actual)
Primary Completion Date
July 15, 2015 (Actual)
Study Completion Date
September 20, 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Avinger, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
A non-randomized, prospective, global clinical trial of the Avinger Pantheris System, an atherectomy device that provides directional visualization and imaging as an adjunct to fluoroscopy to aid removal of plaque in diseased lower extremity arteries.
Detailed Description
The trial will enroll up to 173 subjects diagnosed with peripheral arterial disease of the lower extremities at up to 20 sites (up to 3 international sites), including 133 Intention to Treat subjects and up to 2 additional Roll-In subjects at each site (up to 40 Roll-In subjects total). The primary disease must be located in reference vessel diameters ≥ 2.5 mm and ≤ 7.0 mm. Trial success is focused on safety including rates of major adverse events through 6 months as adjudicated by a Clinical Events Committee. Effectiveness will be evaluated using technical success, defined as the percent of target lesions that have a residual diameter stenosis <50% post-treatment with the Pantheris device alone as assessed by Angiographic Core Lab.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Peripheral Arterial Disease
Keywords
Atherectomy, Optical Coherence Tomography, Lumivascular

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
162 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Pantheris Treatment Arm
Arm Type
Experimental
Arm Description
Intervention: Atherectomy using the Pantheris system.
Intervention Type
Device
Intervention Name(s)
Pantheris System
Intervention Description
Atherectomy using directional visualization and imaging as an adjunct to fluoroscopy to aid removal of plaque from diseased lower extremity arteries.
Primary Outcome Measure Information:
Title
Primary Safety Endpoint
Description
The primary safety endpoint is defined as freedom from a composite of major adverse events (MAE) through 6-Month follow-up as adjudicated by an independent Clinical Events Committee (CEC). Individual MAEs include: Cardiovascular related death Unplanned, major index limb amputation Clinically driven target lesion revascularization (TLR) Myocardial infarction Device related events: Clinically significant perforation Clinically significant dissection Clinically significant embolus Pseudoaneurysm
Time Frame
Day 0 through 6 Months
Title
Primary Effectiveness Endpoint: Technical Success
Description
The primary efficacy endpoint of technical success is defined as the percent of target lesions that have a residual diameter stenosis <50% post the Pantheris device alone, as assessed by an independent Angiographic Core Laboratory.
Time Frame
Day 0
Secondary Outcome Measure Information:
Title
Secondary Safety Endpoint
Description
Freedom from MAEs as defined above, through 30 days (or hospital discharge, whichever is longer) as adjudicated by an independent CEC.
Time Frame
Day 0 through Day 30
Title
Secondary Safety Endpoint
Description
Freedom from procedural emboli, defined as a change in any visualized runoff vessel (other than vasospasm and dissection) at any time during the procedure.
Time Frame
Day 0 through 30 days
Title
Secondary Safety Endpoint
Description
Freedom from clinically driven Target Vessel Revascularization (TVR) through 6 months, as adjudicated by an independent CEC.
Time Frame
Day 0 through 6 Months
Title
Secondary Effectiveness Endpoint: Procedural Success
Description
Procedural success defined as the percent of target lesions that have residual diameter stenosis < 30% post-Pantheris and any other adjunctive therapy, determined by independent Angiographic Core Laboratory.
Time Frame
Day 0
Title
Secondary Effectiveness Endpoint: ABI
Description
Ankle-Brachial Index (ABI) at 30 days. ABI is the ratio of blood pressure in the lower legs to the blood pressure in the arms. ABI between 0.95 and 1.3 is considered normal (free from significant peripheral artery disease).
Time Frame
Day 30
Title
Secondary Effectiveness Endpoint: Rutherford Classification
Description
Rutherford Classification at 30 days. Rutherford Classification is a commonly used clinical means for describing the degree of peripheral artery disease. Rutherford Classifications range from Class 0: asymptomatic, to Class 6: major tissue loss.
Time Frame
Day 30
Title
Secondary Effectiveness Endpoint: Quality of Life - 12-Item Short Form Survey (SF-12)
Description
Change in Quality of Life measures between Baseline and 30 days using 12-Item Short Form Survey (SF-12). There are two components of the SF-12: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Each yields scores from 0 (representing the worst possible debilitation) to 100 (representing no reduction in quality of life).
Time Frame
Day 30
Title
Secondary Effectiveness Endpoint: Vascular Quality of Life Questionnaire (VascuQoL)
Description
Change in Quality of Life measures between Baseline and 30 days using Vascular Quality of Life Questionnaire (VascuQoL). The VascuQoL is a disease-specific questionnaire developed to assess chronic limb ischemia. VascuQol uses a seven-point scale, with 1 representing the worst score and 7 representing the best score.
Time Frame
Day 30
Title
Secondary Effectiveness Endpoint: ABI
Description
Ankle-Brachial Index (ABI) at 6 months. ABI is the ratio of blood pressure in the lower legs to the blood pressure in the arms. ABI between 0.95 and 1.3 is considered normal (free from significant peripheral artery disease).
Time Frame
6 Month
Title
Secondary Effectiveness Endpoint: Rutherford Classification
Description
Rutherford Classification at 6 months. Rutherford Classification is a commonly used clinical means for describing the degree of peripheral artery disease. Rutherford Classifications range from Class 0: asymptomatic, to Class 6: major tissue loss.
Time Frame
6 Month
Title
Secondary Effectiveness Endpoint: Quality of Life - 12-Item Short Form Survey (SF-12)
Description
Change in Quality of Life measures between Baseline and 6 Months using 12-Item Short Form Survey (SF-12). There are two components of the SF-12: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Each yields scores from 0 (representing the worst possible debilitation) to 100 (representing no reduction in quality of life).
Time Frame
6 Month
Title
Secondary Effectiveness Endpoint: Vascular Quality of Life Questionnaire (VascuQoL)
Description
Change in Quality of Life measures between Baseline and 6 months using Vascular Quality of Life Questionnaire (VascuQoL). The VascuQoL is a disease-specific questionnaire developed to assess chronic limb ischemia. VascuQol uses a seven-point scale, with 1 representing the worst score and 7 representing the best score.
Time Frame
6 Month

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥ 18 years old; Subject is a candidate for percutaneous intervention for peripheral arterial disease in the legs; Subject is willing and able to give informed consent; Documented symptomatic atherosclerotic peripheral arterial disease Rutherford Classification 2-5; Reference vessel lumen proximal to target lesion ≥ 2.5 mm and ≤ 7.0 mm in diameter by visual estimation; Subject has de novo target lesion(s) with stenosis >70% by visual estimation distal to the profunda femoral artery. No more than 2 lesions may be treated with the Pantheris device; Target lesion length ≤ 15 cm (may be two tandem lesions that do not exceed 15cm in total length); Subject is capable of meeting requirements and be present at the follow-up clinic visits at 30 days and 6 months; At least one patent tibial run-off vessel at baseline. Inclusion Criteria for the 24-month follow up: Completed the 6-month follow-up visit Re-consented prior to the 24-month follow-up visit Exclusion Criteria: Subject is pregnant or breast feeding; Rutherford Class 0 to 1 (asymptomatic and mild claudication); Rutherford Class 6 (critical limb ischemia); Moderate to severe calcification of the target lesion; Acute ischemia and/or acute thrombosis of the Superficial Femoral Artery (SFA)-Popliteal segment; In-stent restenosis within the target lesion; Target lesion with any type of stent or graft; Target lesion in the iliac artery; Target lesion stenosis <70%; Subjects with significant (≥70%) occlusive lesions proximal to the target lesion not successfully treated during the index procedure (upstream disease) and prior to treatment of the target lesion; Endovascular or surgical procedure performed on the index limb less than or equal to 30 days prior to the index procedure; Planned endovascular or surgical procedure 30 days after the index procedure; Lesion in the contralateral limb requiring intervention during the index procedure or within 30 days of the index procedure; Subjects with active systemic infections whether they are being currently treated or not; Subjects on chronic hemodialysis or creatinine level >2.0mg/dL; Evidence or history of intracranial or gastrointestinal bleeding, intracranial aneurysm, myocardial infarction or stroke within the past 2 months; Evidence or history of aneurysmal target vessel within the past 2 months; History of severe trauma, fracture, major surgery or biopsy of a parenchymal organ within the past 14 days; Known allergy to contrast agents or medications used to perform endovascular intervention that cannot be adequately pre-treated; Subjects in whom anti-platelet, anticoagulant, or thrombolytic therapy is contraindicated; History of heparin-induced thrombocytopenia (HIT); Uncorrectable bleeding diathesis, platelet dysfunction, thrombocytopenia with platelet count less than 100,000/mm2, known coagulopathy, or International Normalized Ratio (INR) >1.5; Any thrombolytic therapy within 2 weeks of the index procedure; Any clinical and/or angiographic complication attributed to the use of another device prior to the insertion of the study device into the subject; Subjects or their legal guardians who have not or will not sign the Informed Consent; Subjects who are unwilling or unable to comply with the follow-up study requirements; Participation in any study of an investigational device, medication, biologic or other agent within 30 days prior to enrollment that is either a cardiovascular study or could, in the judgment of the investigator, affect the results of the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gray Bennett, MD
Organizational Affiliation
Jackson Heart Clinic
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Billy Crowder, MD
Organizational Affiliation
Jackson Heart Clinic
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Arne Schwindt, MD
Organizational Affiliation
Muenster Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
St. Bernard's Medical Center
City
Jonesboro
State/Province
Arkansas
ZIP/Postal Code
72401
Country
United States
Facility Name
Arkansas Heart Hospital
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72211
Country
United States
Facility Name
Cedars Sinai Medical Center/Cardiovascular Research Foundation of Southern California
City
West Hollywood
State/Province
California
ZIP/Postal Code
90048
Country
United States
Facility Name
Medstar Washington Hospital
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010
Country
United States
Facility Name
Coastal Vascular and Interventional
City
Pensacola
State/Province
Florida
ZIP/Postal Code
32501
Country
United States
Facility Name
Alexian Brothers Medical Center, Cardiovascular Associates
City
Elk Grove Village
State/Province
Illinois
ZIP/Postal Code
60007
Country
United States
Facility Name
Advocate Christ Hospital and Medical Center
City
Oak Lawn
State/Province
Illinois
ZIP/Postal Code
60453
Country
United States
Facility Name
St. Joseph's Hospital
City
Fort Wayne
State/Province
Indiana
ZIP/Postal Code
46802
Country
United States
Facility Name
Detroit Medical Center Cardiovascular Institute Harper-Hutzel Hospital
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
Facility Name
St. John Hospital and Medical Center
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48236
Country
United States
Facility Name
St. Dominic Hospital
City
Jackson
State/Province
Mississippi
ZIP/Postal Code
39216
Country
United States
Facility Name
University of Nebraska Medical Center
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68198
Country
United States
Facility Name
Deborah Heart and Lung Center
City
Browns Mills
State/Province
New Jersey
ZIP/Postal Code
08015
Country
United States
Facility Name
St. Peters University Hospital
City
New Brunswick
State/Province
New Jersey
ZIP/Postal Code
08901
Country
United States
Facility Name
Hatton Institute for Research and Education, Good Samaritan Hospital - Bethesda North
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45220
Country
United States
Facility Name
Dayton Heart Center/Good Samaritan Hospital
City
Dayton
State/Province
Ohio
ZIP/Postal Code
45414
Country
United States
Facility Name
Jobst Vascular Center
City
Toledo
State/Province
Ohio
ZIP/Postal Code
43606
Country
United States
Facility Name
Einstein Medical Center
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19141
Country
United States
Facility Name
Methodist Hospital
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38116
Country
United States
Facility Name
Austin Heart
City
Austin
State/Province
Texas
ZIP/Postal Code
78756
Country
United States
Facility Name
Muenster Hospital
City
Muenster
ZIP/Postal Code
48145
Country
Germany

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
28393673
Citation
Schwindt AG, Bennett JG Jr, Crowder WH, Dohad S, Janzer SF, George JC, Tedder B, Davis TP, Cawich IM, Gammon RS, Muck PE, Pigott JP, Dishmon DA, Lopez LA, Golzar JA, Chamberlin JR, Moulton MJ, Zakir RM, Kaki AK, Fishbein GJ, McDaniel HB, Hezi-Yamit A, Simpson JB, Desai A. Lower Extremity Revascularization Using Optical Coherence Tomography-Guided Directional Atherectomy: Final Results of the EValuatIon of the PantheriS OptIcal COherence Tomography ImagiNg Atherectomy System for Use in the Peripheral Vasculature (VISION) Study. J Endovasc Ther. 2017 Jun;24(3):355-366. doi: 10.1177/1526602817701720. Epub 2017 Apr 10.
Results Reference
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Evaluation of the Pantheris Atherectomy System

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