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Safety and Performance Study of the Shockwave Lithoplasty System (DISRUPT-PAD)

Primary Purpose

Peripheral Arterial Disease

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

About this trial

This is an interventional treatment trial for Peripheral Arterial Disease

Eligibility Criteria

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

Inclusion Criteria:

  1. Subject is able and willing to comply with all assessments in the study.
  2. Subject or subject's legal representative have been informed of the nature of the study, agrees to participate and has signed the approved consent form.
  3. Age of subject is >18.
  4. Rutherford Clinical Category 2, 3, or 4.
  5. Resting ankle-brachial index (ABI) of ≤0.90, or ≤0.75 after exercise, of the target leg.
  6. Moderate to severe calcification of target lesion(s) per pre-procedure CT scan. (Calcification must be: 1) ≥180 degrees circumferential at some point in the lesion and 2) extend ≥50 percent length of lesion or absolute length ≥20mm.)
  7. Estimated life expectancy >1 year.

Exclusion Criteria:

  1. Rutherford Clinical Category 5 and 6.
  2. Subject has active infection in the target leg.
  3. Planned major amputation of the target leg (transmetatarsal or higher).
  4. In-stent restenosis within the target lesion(s).
  5. Highly tortuous arteries (bends greater than 30 degrees over the arc length of the balloon).
  6. Chronic total occlusion of the target lesion(s).
  7. Target lesion(s) within native or synthetic vessel grafts.
  8. Chronic total occlusion of inflow vessel.
  9. Lesion in contralateral limb requiring intervention within the next 30 days.
  10. History of prior endovascular or surgical procedure on the index limb within the past 30 days.
  11. Subject has significant stenosis (>50% stenosis) or occlusion of inflow tract (upstream disease) not successfully treated with plain old balloon angioplasty or stent and without complications before target lesion(s) treatment.
  12. Subject requires treatment of a peripheral lesion on the ipsilateral limb distal to the target lesion(s) at the time of the enrollment / index procedure.
  13. Subject has a known coagulopathy or has a bleeding diatheses, thrombocytopenia with platelet count less than 100,000/microliter, or international normalized ratio >1.5.
  14. Subject in whom antiplatelet, anticoagulant, or thrombolytic therapy is contraindicated.
  15. Subject has known allergy to contrast agents or medications used to perform endovascular intervention that cannot be adequately pre-treated.
  16. Subject has known allergy to urethane, nylon, or silicone.
  17. Myocardial infarction within 60 days prior to enrollment.
  18. History of stroke within 60 days prior to enrollment.
  19. History of unstable coronary artery disease or other uncontrollable comorbidity resulting in hospitalization within the last 60 days prior to enrollment.
  20. History of thrombolytic therapy within two weeks of enrollment.
  21. Subject has acute or chronic renal disease (e.g., as measured by a serum creatinine of >2.5 mg/dL or >220 umol/L), or on dialysis.
  22. Subject is pregnant or nursing.
  23. Subject is participating in another research study involving an investigational agent (pharmaceutical, biologic, or medical device) that has not reached the primary endpoint.
  24. Subject has other medical, social or psychological problems that, in the opinion of the investigator, preclude them from receiving this treatment, and the procedures and evaluations pre- and post-treatment.

Sites / Locations

  • Medizinische Universitaet Graz
  • Department of Angiology - Universitats Herzzentrum Freiburg
  • Auckland City Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Lithoplasty Treatment

Arm Description

Shockwave Lithoplasty System

Outcomes

Primary Outcome Measures

Composite of New-onset Major Adverse Events (MAE)
Need for emergency surgical revascularization of target limb. Unplanned target limb amputation (above the ankle). Symptomatic thrombus or distal emboli, defined as clinical signs or symptoms of thrombus or distal emboli detected in the treated limb in the area of the treated lesion, or distal to the treated lesion, after the index procedure or noted angiographically, and requiring mechanical or pharmacologic means to improve flow. Perforations and dissections of grade D or greater that require an intervention to resolve, including bail-out stenting.
Procedural Success:
The ability of the Shockwave Medical Lithoplasty System to achieve a post-Shockwave residual diameter stenosis of <50% (with or without adjunctive Percutaneous Transluminal Angioplasty therapy) as assessed by quantitative angiography via core lab evaluation.

Secondary Outcome Measures

Device Success
The ability of the Shockwave Medical Lithoplasty System to achieve a post-Shockwave residual diameter stenosis of <50% (without adjunctive percutaneous transluminal angioplasty therapy) as assessed via quantitative angiography via core lab evaluation.
Clinical Success:
The ability of the Shockwave Medical Lithoplasty System to achieve a post-Shockwave residual diameter stenosis of <50% (with or without adjunctive percutaneous transluminal angioplasty therapy) as assessed by the investigator via visual estimate and freedom from procedural major adverse events.
Technical Success:
The ability of the Shockwave Medical Lithoplasty System to delivery ShockWave treatment to the desired location in the target vessel. Up to two Shockwave Medical Lithoplasty Systems maybe used to complete treatment in the target vessel.
Freedom From Major Adverse Events
Freedom from Major Adverse Events at 30 days.
Freedom From Target Lesion Revascularization (TLR)
Freedom from Target Lesion Revascularization (TLR) at 30 days
Patency
Vessel patency at 30 days by Doppler Ultrasound defined as freedom from greater than 50% restenosis (as assessed by Duplex ultrasound peak systolic velocity ratio of ≥2.5).
Ankle Brachial Index (ABI)
Change in Ankle Brachial Index (ABI) of the target limb at 30 days. The Ankle Brachial Index (ABI) is the systolic pressure at the ankle, divided by the systolic pressure at the arm.
Rutherford Clinical Category
Change in Rutherford Clinical Category (RCC) at 30 days. RCC identifies three grades of claudication and three grades of critical limb ischemia ranging from rest pain alone to minor and major tissue loss. Grade I includes Category 0 - Asymptomatic, Category 1 - Mild claudication, Category 2 - Moderate claudication, and Category 3 - Severe claudication. Grade II includes Category 4 - Ischemic rest pain and Category 5 - Minor tissue loss. Grade III includes Category 6 - Ulceration or grangrene. Change of at least 2 categories considered statistically significant.
Freedom From Major Adverse Events
Freedom from Major Adverse Events at 6 months
Freedom From Target Lesion Revascularization (TLR)
Freedom from Target Lesion Revascularization (TLR) at 6 months
Patency
Vessel patency at 6 months at Doppler Ultrasound defined as freedom from greater than 50% restenosis (as assessed by Duplex ultrasound peak systolic velocity ratio of =2.5).
Ankle Brachial Index (ABI)
Change in Ankle Brachial Index (ABI) of the target limb at 6 months. The Ankle Brachial Index (ABI) is the systolic pressure at the ankle, divided by the systolic pressure at the arm.
Rutherford Clinical Category
Change in Rutherford Clinical Category (RCC) at 6 months. RCC identifies three grades of claudication and three grades of critical limb ischemia ranging from rest pain alone to minor and major tissue loss. Grade I includes Category 0 - Asymptomatic, Category 1 - Mild claudication, Category 2 - Moderate claudication, and Category 3 - Severe claudication. Grade II includes Category 4 - Ischemic rest pain and Category 5 - Minor tissue loss. Grade III includes Category 6 - Ulceration or grangrene. Change of at least 2 categories considered statistically significant.

Full Information

First Posted
February 22, 2014
Last Updated
February 3, 2017
Sponsor
Shockwave Medical, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02071108
Brief Title
Safety and Performance Study of the Shockwave Lithoplasty System
Acronym
DISRUPT-PAD
Official Title
Safety and Performance Study of the Shockwave Lithoplasty System
Study Type
Interventional

2. Study Status

Record Verification Date
February 2017
Overall Recruitment Status
Completed
Study Start Date
January 2014 (undefined)
Primary Completion Date
October 2014 (Actual)
Study Completion Date
March 2015 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To study the safety and performance of the Shockwave Medical Lithoplasty System in subjects to demonstrate that the Shockwave device can safely and effectively deliver localized shockwave energy for balloon dilatation of calcified, stenotic, infrainguinal peripheral arteries.
Detailed Description
Shockwave Medical, Inc. intends to conduct a prospective, single-arm, multi-center, clinical study designed to evaluate the safety and performance of the Shockwave Lithoplasty System in subjects with moderate to heavily calcified peripheral arteries with 3.50mm to 7.0mm reference vessel diameter at the target site. The Shockwave Lithoplasty System is indicated to generate sonic shockwave energy within the target treatment site and disrupt calcium within the lesion to allow for subsequent dilation of a peripheral artery stenosis using low balloon pressure. Up to thirty-five (35) subjects will be enrolled and treated with Lithoplasty to yield thirty (30) evaluable subjects complete the study assuming a 15% lost to follow-up rate.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Peripheral Arterial Disease

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Lithoplasty Treatment
Arm Type
Experimental
Arm Description
Shockwave Lithoplasty System
Intervention Type
Device
Intervention Name(s)
Shockwave Lithoplasty System
Primary Outcome Measure Information:
Title
Composite of New-onset Major Adverse Events (MAE)
Description
Need for emergency surgical revascularization of target limb. Unplanned target limb amputation (above the ankle). Symptomatic thrombus or distal emboli, defined as clinical signs or symptoms of thrombus or distal emboli detected in the treated limb in the area of the treated lesion, or distal to the treated lesion, after the index procedure or noted angiographically, and requiring mechanical or pharmacologic means to improve flow. Perforations and dissections of grade D or greater that require an intervention to resolve, including bail-out stenting.
Time Frame
30 days
Title
Procedural Success:
Description
The ability of the Shockwave Medical Lithoplasty System to achieve a post-Shockwave residual diameter stenosis of <50% (with or without adjunctive Percutaneous Transluminal Angioplasty therapy) as assessed by quantitative angiography via core lab evaluation.
Time Frame
Day of Procedure
Secondary Outcome Measure Information:
Title
Device Success
Description
The ability of the Shockwave Medical Lithoplasty System to achieve a post-Shockwave residual diameter stenosis of <50% (without adjunctive percutaneous transluminal angioplasty therapy) as assessed via quantitative angiography via core lab evaluation.
Time Frame
Day of Procedure
Title
Clinical Success:
Description
The ability of the Shockwave Medical Lithoplasty System to achieve a post-Shockwave residual diameter stenosis of <50% (with or without adjunctive percutaneous transluminal angioplasty therapy) as assessed by the investigator via visual estimate and freedom from procedural major adverse events.
Time Frame
Day of Procedure
Title
Technical Success:
Description
The ability of the Shockwave Medical Lithoplasty System to delivery ShockWave treatment to the desired location in the target vessel. Up to two Shockwave Medical Lithoplasty Systems maybe used to complete treatment in the target vessel.
Time Frame
Day of Procedure
Title
Freedom From Major Adverse Events
Description
Freedom from Major Adverse Events at 30 days.
Time Frame
30 days
Title
Freedom From Target Lesion Revascularization (TLR)
Description
Freedom from Target Lesion Revascularization (TLR) at 30 days
Time Frame
30 days
Title
Patency
Description
Vessel patency at 30 days by Doppler Ultrasound defined as freedom from greater than 50% restenosis (as assessed by Duplex ultrasound peak systolic velocity ratio of ≥2.5).
Time Frame
30 days
Title
Ankle Brachial Index (ABI)
Description
Change in Ankle Brachial Index (ABI) of the target limb at 30 days. The Ankle Brachial Index (ABI) is the systolic pressure at the ankle, divided by the systolic pressure at the arm.
Time Frame
Baseline and 30 days
Title
Rutherford Clinical Category
Description
Change in Rutherford Clinical Category (RCC) at 30 days. RCC identifies three grades of claudication and three grades of critical limb ischemia ranging from rest pain alone to minor and major tissue loss. Grade I includes Category 0 - Asymptomatic, Category 1 - Mild claudication, Category 2 - Moderate claudication, and Category 3 - Severe claudication. Grade II includes Category 4 - Ischemic rest pain and Category 5 - Minor tissue loss. Grade III includes Category 6 - Ulceration or grangrene. Change of at least 2 categories considered statistically significant.
Time Frame
Baseline and 30 days
Title
Freedom From Major Adverse Events
Description
Freedom from Major Adverse Events at 6 months
Time Frame
6 months
Title
Freedom From Target Lesion Revascularization (TLR)
Description
Freedom from Target Lesion Revascularization (TLR) at 6 months
Time Frame
6 months
Title
Patency
Description
Vessel patency at 6 months at Doppler Ultrasound defined as freedom from greater than 50% restenosis (as assessed by Duplex ultrasound peak systolic velocity ratio of =2.5).
Time Frame
6 months
Title
Ankle Brachial Index (ABI)
Description
Change in Ankle Brachial Index (ABI) of the target limb at 6 months. The Ankle Brachial Index (ABI) is the systolic pressure at the ankle, divided by the systolic pressure at the arm.
Time Frame
Baseline and 6 months
Title
Rutherford Clinical Category
Description
Change in Rutherford Clinical Category (RCC) at 6 months. RCC identifies three grades of claudication and three grades of critical limb ischemia ranging from rest pain alone to minor and major tissue loss. Grade I includes Category 0 - Asymptomatic, Category 1 - Mild claudication, Category 2 - Moderate claudication, and Category 3 - Severe claudication. Grade II includes Category 4 - Ischemic rest pain and Category 5 - Minor tissue loss. Grade III includes Category 6 - Ulceration or grangrene. Change of at least 2 categories considered statistically significant.
Time Frame
Baseline and 6 months
Other Pre-specified Outcome Measures:
Title
Exploratory Endpoint
Description
The clinical protocol provided for an Exploratory Secondary Endpoint to assess the ability of the device to achieve ≤30% residual stenosis without adjunctive PTA as assessed by the investigator via visual estimate.
Time Frame
Day of Procedure

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject is able and willing to comply with all assessments in the study. Subject or subject's legal representative have been informed of the nature of the study, agrees to participate and has signed the approved consent form. Age of subject is >18. Rutherford Clinical Category 2, 3, or 4. Resting ankle-brachial index (ABI) of ≤0.90, or ≤0.75 after exercise, of the target leg. Moderate to severe calcification of target lesion(s) per pre-procedure CT scan. (Calcification must be: 1) ≥180 degrees circumferential at some point in the lesion and 2) extend ≥50 percent length of lesion or absolute length ≥20mm.) Estimated life expectancy >1 year. Exclusion Criteria: Rutherford Clinical Category 5 and 6. Subject has active infection in the target leg. Planned major amputation of the target leg (transmetatarsal or higher). In-stent restenosis within the target lesion(s). Highly tortuous arteries (bends greater than 30 degrees over the arc length of the balloon). Chronic total occlusion of the target lesion(s). Target lesion(s) within native or synthetic vessel grafts. Chronic total occlusion of inflow vessel. Lesion in contralateral limb requiring intervention within the next 30 days. History of prior endovascular or surgical procedure on the index limb within the past 30 days. Subject has significant stenosis (>50% stenosis) or occlusion of inflow tract (upstream disease) not successfully treated with plain old balloon angioplasty or stent and without complications before target lesion(s) treatment. Subject requires treatment of a peripheral lesion on the ipsilateral limb distal to the target lesion(s) at the time of the enrollment / index procedure. Subject has a known coagulopathy or has a bleeding diatheses, thrombocytopenia with platelet count less than 100,000/microliter, or international normalized ratio >1.5. Subject in whom antiplatelet, anticoagulant, or thrombolytic therapy is contraindicated. Subject has known allergy to contrast agents or medications used to perform endovascular intervention that cannot be adequately pre-treated. Subject has known allergy to urethane, nylon, or silicone. Myocardial infarction within 60 days prior to enrollment. History of stroke within 60 days prior to enrollment. History of unstable coronary artery disease or other uncontrollable comorbidity resulting in hospitalization within the last 60 days prior to enrollment. History of thrombolytic therapy within two weeks of enrollment. Subject has acute or chronic renal disease (e.g., as measured by a serum creatinine of >2.5 mg/dL or >220 umol/L), or on dialysis. Subject is pregnant or nursing. Subject is participating in another research study involving an investigational agent (pharmaceutical, biologic, or medical device) that has not reached the primary endpoint. Subject has other medical, social or psychological problems that, in the opinion of the investigator, preclude them from receiving this treatment, and the procedures and evaluations pre- and post-treatment.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Thomas Zeller, MD
Organizational Affiliation
Bad Krozingen
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Andrew Holden, MD
Organizational Affiliation
Auckland City Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Medizinische Universitaet Graz
City
Graz
ZIP/Postal Code
8036
Country
Austria
Facility Name
Department of Angiology - Universitats Herzzentrum Freiburg
City
Bad Krozingen
State/Province
Baden-Württemberg
ZIP/Postal Code
79189
Country
Germany
Facility Name
Auckland City Hospital
City
Auckland
ZIP/Postal Code
92024
Country
New Zealand

12. IPD Sharing Statement

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Safety and Performance Study of the Shockwave Lithoplasty System

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