IN.PACT™ AV Access IDE Study
Primary Purpose
Arteriovenous Fistula Stenosis, Arteriovenous Fistula Occlusion, Arteriovenous Fistula
Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
IN.PACT AV DCB
Standard Balloon Angioplasty
Sponsored by
About this trial
This is an interventional treatment trial for Arteriovenous Fistula Stenosis
Eligibility Criteria
Inclusion Criteria:
- Patient is ≥21 years of age.
- Patient has a life expectancy of ≥ 12 months
- Patient has a native AV fistula created ≥ 60 days prior to the index procedure
- The target AV fistula has undergone successful dialysis for at least 8 of 12 sessions during a four week period
- Patient has a de novo and/or non-stented restenotic lesion located between the arteriovenous anastomosis and axillosubclavian junction with ≥50% stenosis. Note: If the lesion is located in the anastomosis, the treatment may be delivered up to 2 cm upstream on the arterial end. If the lesion is located in the cephalic arch, the treatment may be delivered up to 2 cm into the subclavian vein
- Patient has a target lesion or a tandem lesion that is ≤ 100 mm in length (by visual estimate) Note: Tandem lesions may be enrolled provided they meet all of the following criteria: Separated by a gap of ≤ 30mm (3 cm), total combined lesion length, including 30 mm gap, ≤ 100 mm, and able to be treated as a single lesion
- Patient has a target vessel diameter of 4.0 - 12.0 mm (by visual estimate).
- Patient underwent successful crossing of the target lesion with the guide wire and pre-dilatation with a high pressure PTA balloon defined as: residual stenosis of ≤ 30% and absence of a flow limiting dissection (Grade ≥ C) or perforation
- Patient provides written consent prior to enrollment in the study
- Patient is willing to comply with all follow-up evaluations at specified times
Exclusion Criteria:
- Women who are breastfeeding, pregnant, or are intending to become pregnant, or men intending to father children
- Patient is receiving immunosuppressive therapy
- Patient is anticipating a kidney transplant within 6 months of enrollment into the study
- Patient has undergone prior intervention of access site within 30 days of index procedure
- Patient with anticipated conversion to peritoneal dialysis
- Patient has an infected AV access or systemic infection
- Patient has planned surgical revision of access site
- Patient with secondary non-target lesion requiring treatment within 30-days post index procedure
- Patient with hemodynamically significant central venous stenoses that cannot be successfully treated prior to treatment of the target lesion
- Patient with target AVF or access circuit which previously had or currently has a thrombosis
- Patients judged to have a lesion that prevents complete inflation of an angioplasty balloon or proper placement of the delivery system
- Patient with target lesion located central to the axillosubclavian junction
- Patient has significant arterial inflow lesion requiring treatment more than 2 cm upstream from the anastomosis in the AV access
- Patient has presence of pseudoaneurysm or aneurysm requiring treatment at the lesion site
- Patient has presence of a stent located in the target AV access circuit
- Patients with known allergies or sensitivities to paclitaxel
- Patient with known contraindication, including allergic reaction, or sensitivity to contrast material that cannot be adequately pre-treated
- Patient who cannot receive recommended antiplatelet and/or anticoagulant therapy
- Patient with clinically significant Steal Syndrome requiring treatment
- Patient is enrolled in another investigational drug, device, or biological study and has not completed the primary endpoint, or was previously enrolled in this study
- Patient has a comorbid-condition that, in the judgment of the Investigator, may cause him/her to be non-compliant with the protocol of confound data interpretation
Sites / Locations
- University of Alabama at Birmingham (UAB) Hospital
- SKI Vascular Center
- Capital Nephrology Medical Group
- Florida Research Network
- Coastal Vascular and Interventional
- Christie Clinic Vein and Vascular Center
- Rush University Medical Center
- University of Iowa Hospitals and Clinics
- King's Daughters Medical Center
- Mayo Clinic
- Holy Name Medical Center
- The Mount Sinai Hospital
- North Carolina Nephrology PA
- Cleveland Clinic
- Dialysis Access Institute
- Sanford University of South Dakota Medical Center
- University Surgical Associates
- Dallas Nephrology Associates
- Sentara Vascular Specialists
- Richmond Vascular Center
- Vascular Institute of Virginia
- Kansai Rosai Hospital
- Shonan Kamakura General Hospital
- Kishiwada Tokushukai Hospital
- Saitama Medical Center Saitama Medical University
- Shizuoka General Hospital
- Tokyo Women's Medical University Hospital
- Auckland City Hospital
- Capital and Coast District Health Board
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
IN.PACT AV DCB
Standard Balloon Angioplasty
Arm Description
PTA will be performed using the IN.PACT AV Access Drug Coated Balloon. IN.PACT AV Access DCB was the device name used during the clinical study. Medtronic has changed the name of the device to IN.PACT™ AV Paclitaxel-Coated Balloon Catheter (also referred as IN.PACT AV DCB). Hence, throughout posting, the study device will be referred to as the "IN.PACT AV DCB."
PTA will be performed using a commercially available uncoated PTA balloon.
Outcomes
Primary Outcome Measures
Target Lesion Primary Patency Rate Through 6 Months
Freedom from clinically-driven target lesion revascularization (CD-TLR) or access circuit thrombosis measured through 6 months post-procedure.
Primary Safety Endpoint - Serious Adverse Event Rate
Serious Adverse Event (SAE) rate involving the AV access circuit
Secondary Outcome Measures
Access Circuit Primary Patency
Defined as freedom from re-intervention in the access circuit or access circuit thrombosis through 3 months, 6 months, 9 months,12 months, 18 months, and 24 months post-procedure.
Target Lesion Primary Patency
Percentage of participants with freedom from clinically driven target lesion revascularization or access thrombosis occurring in the target lesion through 3 months, 9 months,12 months, 18 months, and 24 months post-procedure.
Cumulative Target Lesion Revascularizations
The number and percentage of participants with target lesion revascularizations through 3 months, 6 months, 9 months,12 months, 18 months, and 24 months post-procedure.
Total Number of Interventions Required to Maintain Target Lesion Patency
The number of target lesion revascularizations per treatment arm through 3 months, 6 months, 9 months, 12 months,18 months, and 24 months post-procedure.
Total Number of Interventions Required to Maintain Access Circuit Patency
The number of re-interventions in the target lesion and/or access circuit through 3 months, 6 months, 9 months,12 months, 18 months, and 24 months.
Cumulative Access Circuit Thromboses
The number and percentage of participants with access circuit thrombosis through 3 months, 6 months, 9 months, 12 months, 18 months, and 24 months.
Device Success
Device Success is defined as successful delivery, inflation, deflation and retrieval of the intact study balloon device without burst at or below rated burst pressure (RBP) during the index procedure.
Procedure Success
Maintenance of patency (≤30% residual stenosis) in the absence of peri-procedural serious adverse device effect (SADE).
Clinical Success
Resumption of successful dialysis for at least one session after index procedure.
Rate of Device Related Adverse Events
Device Related Adverse Event Rate: defined as the number and percentage of participants with device related Adverse Events through 30 days, 3 months, 6 months, 9 months, 12 months, 18 months, and 24 months.
Procedure Related Adverse Event Rate
Procedure Related Adverse Event Rate: defined as the number and percentage of participants with procedure related Adverse Events reported post-index procedure until the first successful dialysis session through 30 days, 3 months, 6 months, 9 months, 12 months, 18 months, and 24 months.
Target Lesion Revascularizations (TLR)
Defined as the percentage of participants who had an event, the Kaplan-Meier method was used to estimate Cumulative Incidence up to 36 months post-index procedure.
Clinically-Driven Target Lesion Revascularizations (CD-TLR)
Defined as the percentage of participants who had an event, the Kaplan-Meier method was used to estimate Cumulative Incidence with CD-TLR up to 36 months post index procedure
Re-interventions in the Access Circuit
Defined as the percentage of participants who had a reinterventions occurring within the access circuit. The Kaplan-Meier method was used to estimate Cumulative Incidence up to 36 months post-index procedure.
Abandonment of Target AVF
Defined as number of participants with abandonment of the target AV abandonment up to 36 months post-index procedure.
Serious Adverse Event Rate
Serious Adverse Event Rate: defined as the number and percentage of participants with one or more Serious Adverse Events reported post-index procedure through 6 months, 12 months, 24 months, and 36 months.
Rate of Freedom From All-Cause Mortality Post Vital Status Update
Percentage of participants who had all-cause death post vital status update. The Kaplan-Meier method was used to estimate survival probability up to 60 months post-index procedure through 6 months, 12 months, 24 months, 36 months, and 48 months.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT03041467
Brief Title
IN.PACT™ AV Access IDE Study
Official Title
Randomized Study of IN.PACT™ AV Access Paclitaxel-Coated Percutaneous Transluminal Angioplasty (PTA) Balloon vs. Standard PTA for the Treatment of Obstructive Lesions in the Native Arteriovenous Dialysis Fistulae (AVF)
Study Type
Interventional
2. Study Status
Record Verification Date
June 2023
Overall Recruitment Status
Completed
Study Start Date
April 25, 2017 (Actual)
Primary Completion Date
December 6, 2018 (Actual)
Study Completion Date
May 5, 2023 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Medtronic Endovascular
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
To evaluate the safety and efficacy of the IN.PACT™ AV Access Drug Coated Balloon (DCB) compared to percutaneous transluminal angioplasty (PTA) for treatment of subjects presenting with de novo or non-stented restenotic obstructive lesion of native arteriovenous dialysis fistulae (AVF) in the upper extremity.
Detailed Description
This is a prospective, global, multi-center, single-blinded, 1:1 randomized clinical trial evaluating the IN.PACT™ AV Access Drug Coated Balloon (DCB) compared to percutaneous transluminal angioplasty (PTA) for treatment of subjects presenting with de novo or non-stented restenotic obstructive lesion of native arteriovenous dialysis fistulae (AVF) in the upper extremity. The trial will be conducted in up to 30 sites in the United States, Japan, and New Zealand.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Arteriovenous Fistula Stenosis, Arteriovenous Fistula Occlusion, Arteriovenous Fistula, Fistula
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
330 (Actual)
8. Arms, Groups, and Interventions
Arm Title
IN.PACT AV DCB
Arm Type
Experimental
Arm Description
PTA will be performed using the IN.PACT AV Access Drug Coated Balloon. IN.PACT AV Access DCB was the device name used during the clinical study. Medtronic has changed the name of the device to IN.PACT™ AV Paclitaxel-Coated Balloon Catheter (also referred as IN.PACT AV DCB). Hence, throughout posting, the study device will be referred to as the "IN.PACT AV DCB."
Arm Title
Standard Balloon Angioplasty
Arm Type
Active Comparator
Arm Description
PTA will be performed using a commercially available uncoated PTA balloon.
Intervention Type
Device
Intervention Name(s)
IN.PACT AV DCB
Intervention Description
IN.PACT™ AV Paclitaxel-Coated Percutaneous Transluminal Angioplasty (PTA) Balloon
Intervention Type
Device
Intervention Name(s)
Standard Balloon Angioplasty
Intervention Description
Standard PTA Balloon
Primary Outcome Measure Information:
Title
Target Lesion Primary Patency Rate Through 6 Months
Description
Freedom from clinically-driven target lesion revascularization (CD-TLR) or access circuit thrombosis measured through 6 months post-procedure.
Time Frame
6 Months Post-Procedure
Title
Primary Safety Endpoint - Serious Adverse Event Rate
Description
Serious Adverse Event (SAE) rate involving the AV access circuit
Time Frame
30 days post procedure
Secondary Outcome Measure Information:
Title
Access Circuit Primary Patency
Description
Defined as freedom from re-intervention in the access circuit or access circuit thrombosis through 3 months, 6 months, 9 months,12 months, 18 months, and 24 months post-procedure.
Time Frame
3, 6, 9, 12, 18, and 24 Months
Title
Target Lesion Primary Patency
Description
Percentage of participants with freedom from clinically driven target lesion revascularization or access thrombosis occurring in the target lesion through 3 months, 9 months,12 months, 18 months, and 24 months post-procedure.
Time Frame
3, 9, 12, 18, and 24 Months
Title
Cumulative Target Lesion Revascularizations
Description
The number and percentage of participants with target lesion revascularizations through 3 months, 6 months, 9 months,12 months, 18 months, and 24 months post-procedure.
Time Frame
3, 6, 9,12, 18, and 24 Months
Title
Total Number of Interventions Required to Maintain Target Lesion Patency
Description
The number of target lesion revascularizations per treatment arm through 3 months, 6 months, 9 months, 12 months,18 months, and 24 months post-procedure.
Time Frame
3, 6, 9, 12, 18, and 24 Months
Title
Total Number of Interventions Required to Maintain Access Circuit Patency
Description
The number of re-interventions in the target lesion and/or access circuit through 3 months, 6 months, 9 months,12 months, 18 months, and 24 months.
Time Frame
3, 6, 9, 12, 18, and 24 Months
Title
Cumulative Access Circuit Thromboses
Description
The number and percentage of participants with access circuit thrombosis through 3 months, 6 months, 9 months, 12 months, 18 months, and 24 months.
Time Frame
3, 6, 9, 12, 18, and 24 Months
Title
Device Success
Description
Device Success is defined as successful delivery, inflation, deflation and retrieval of the intact study balloon device without burst at or below rated burst pressure (RBP) during the index procedure.
Time Frame
Time of Procedure
Title
Procedure Success
Description
Maintenance of patency (≤30% residual stenosis) in the absence of peri-procedural serious adverse device effect (SADE).
Time Frame
Time of Procedure
Title
Clinical Success
Description
Resumption of successful dialysis for at least one session after index procedure.
Time Frame
From the time of the index procedure to the first successful dialysis session after index procedure. Typically, this is within 1 week of index procedure.
Title
Rate of Device Related Adverse Events
Description
Device Related Adverse Event Rate: defined as the number and percentage of participants with device related Adverse Events through 30 days, 3 months, 6 months, 9 months, 12 months, 18 months, and 24 months.
Time Frame
30 days, 3, 6, 9, 12, 18, and 24 Months.
Title
Procedure Related Adverse Event Rate
Description
Procedure Related Adverse Event Rate: defined as the number and percentage of participants with procedure related Adverse Events reported post-index procedure until the first successful dialysis session through 30 days, 3 months, 6 months, 9 months, 12 months, 18 months, and 24 months.
Time Frame
30 Days, 3, 6, 9, 12, 18, and 24 Months
Title
Target Lesion Revascularizations (TLR)
Description
Defined as the percentage of participants who had an event, the Kaplan-Meier method was used to estimate Cumulative Incidence up to 36 months post-index procedure.
Time Frame
6, 9, 12, 18, 24, and 36 Months
Title
Clinically-Driven Target Lesion Revascularizations (CD-TLR)
Description
Defined as the percentage of participants who had an event, the Kaplan-Meier method was used to estimate Cumulative Incidence with CD-TLR up to 36 months post index procedure
Time Frame
6, 9, 12, 18, 24, and 36 Months
Title
Re-interventions in the Access Circuit
Description
Defined as the percentage of participants who had a reinterventions occurring within the access circuit. The Kaplan-Meier method was used to estimate Cumulative Incidence up to 36 months post-index procedure.
Time Frame
6, 9, 12, 18, 24, and 36 Months
Title
Abandonment of Target AVF
Description
Defined as number of participants with abandonment of the target AV abandonment up to 36 months post-index procedure.
Time Frame
6, 9, 12, 18, 24, and 36 Months
Title
Serious Adverse Event Rate
Description
Serious Adverse Event Rate: defined as the number and percentage of participants with one or more Serious Adverse Events reported post-index procedure through 6 months, 12 months, 24 months, and 36 months.
Time Frame
6, 12, 24, and 36 Months
Title
Rate of Freedom From All-Cause Mortality Post Vital Status Update
Description
Percentage of participants who had all-cause death post vital status update. The Kaplan-Meier method was used to estimate survival probability up to 60 months post-index procedure through 6 months, 12 months, 24 months, 36 months, and 48 months.
Time Frame
6, 12, 24, 36, and 48 Months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patient is ≥21 years of age.
Patient has a life expectancy of ≥ 12 months
Patient has a native AV fistula created ≥ 60 days prior to the index procedure
The target AV fistula has undergone successful dialysis for at least 8 of 12 sessions during a four week period
Patient has a de novo and/or non-stented restenotic lesion located between the arteriovenous anastomosis and axillosubclavian junction with ≥50% stenosis. Note: If the lesion is located in the anastomosis, the treatment may be delivered up to 2 cm upstream on the arterial side. If the lesion is located in the cephalic arch, the treatment may be delivered up to 2 cm into the subclavian vein
Patient has a target lesion or a tandem lesion that is ≤ 100 mm in length (by visual estimate) Note: Tandem lesions may be enrolled provided they meet all of the following criteria: Separated by a gap of ≤ 30mm (3 cm), total combined lesion length, including 30 mm gap, ≤ 100 mm, and able to be treated as a single lesion
Patient has a target vessel diameter of 4.0 - 12.0 mm (by visual estimate).
Patient underwent successful crossing of the target lesion with the guide wire and pre-dilatation with a high pressure PTA balloon defined as: residual stenosis of ≤ 30% and absence of a flow limiting dissection (Grade ≥ C) or perforation
Patient provides written consent prior to enrollment in the study
Patient is willing to comply with all follow-up evaluations at specified times
Exclusion Criteria:
Women who are breastfeeding, pregnant, or are intending to become pregnant, or men intending to father children
Patient is receiving immunosuppressive therapy
Patient is anticipating a kidney transplant within 6 months of enrollment into the study
Patient has undergone prior intervention of access site within 30 days of index procedure
Patient with anticipated conversion to peritoneal dialysis
Patient has an infected AV access or systemic infection
Patient has planned surgical revision of access site
Patient with secondary non-target lesion requiring treatment within 30-days post index procedure
Patient with hemodynamically significant central venous stenoses that cannot be successfully treated prior to treatment of the target lesion
Patient with target AVF or access circuit which previously had or currently has a thrombosis
Patients judged to have a lesion that prevents complete inflation of an angioplasty balloon or proper placement of the delivery system
Patient with target lesion located central to the axillosubclavian junction
Patient has significant arterial inflow lesion requiring treatment more than 2 cm upstream from the anastomosis in the AV access
Patient has presence of pseudoaneurysm or aneurysm requiring treatment at the lesion site
Patient has presence of a stent located in the target AV access circuit
Patients with known allergies or sensitivities to paclitaxel
Patient with known contraindication, including allergic reaction, or sensitivity to contrast material that cannot be adequately pre-treated
Patient who cannot receive recommended antiplatelet and/or anticoagulant therapy
Patient with clinically significant Steal Syndrome requiring treatment
Patient is enrolled in another investigational drug, device, or biological study and has not completed the primary endpoint, or was previously enrolled in this study
Patient has a comorbid-condition that, in the judgment of the Investigator, may cause him/her to be non-compliant with the protocol of confound data interpretation
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert Lookstein, MD
Organizational Affiliation
The Mount Sinai Hospital
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
First Name & Middle Initial & Last Name & Degree
Hiroaki Haruguchi, MD
Organizational Affiliation
Haruguchi Vascular Access Clinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Alabama at Birmingham (UAB) Hospital
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35233
Country
United States
Facility Name
SKI Vascular Center
City
Tempe
State/Province
Arizona
ZIP/Postal Code
85281
Country
United States
Facility Name
Capital Nephrology Medical Group
City
Sacramento
State/Province
California
ZIP/Postal Code
95825
Country
United States
Facility Name
Florida Research Network
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32605
Country
United States
Facility Name
Coastal Vascular and Interventional
City
Pensacola
State/Province
Florida
ZIP/Postal Code
32504
Country
United States
Facility Name
Christie Clinic Vein and Vascular Center
City
Champaign
State/Province
Illinois
ZIP/Postal Code
61822
Country
United States
Facility Name
Rush University Medical Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Facility Name
University of Iowa Hospitals and Clinics
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Facility Name
King's Daughters Medical Center
City
Ashland
State/Province
Kentucky
ZIP/Postal Code
41101
Country
United States
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Facility Name
Holy Name Medical Center
City
Teaneck
State/Province
New Jersey
ZIP/Postal Code
07666
Country
United States
Facility Name
The Mount Sinai Hospital
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Facility Name
North Carolina Nephrology PA
City
Raleigh
State/Province
North Carolina
ZIP/Postal Code
27610
Country
United States
Facility Name
Cleveland Clinic
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
Facility Name
Dialysis Access Institute
City
Orangeburg
State/Province
South Carolina
ZIP/Postal Code
29118
Country
United States
Facility Name
Sanford University of South Dakota Medical Center
City
Sioux Falls
State/Province
South Dakota
ZIP/Postal Code
57105
Country
United States
Facility Name
University Surgical Associates
City
Chattanooga
State/Province
Tennessee
ZIP/Postal Code
37404
Country
United States
Facility Name
Dallas Nephrology Associates
City
Plano
State/Province
Texas
ZIP/Postal Code
75093
Country
United States
Facility Name
Sentara Vascular Specialists
City
Norfolk
State/Province
Virginia
ZIP/Postal Code
23507
Country
United States
Facility Name
Richmond Vascular Center
City
North Chesterfield
State/Province
Virginia
ZIP/Postal Code
23236
Country
United States
Facility Name
Vascular Institute of Virginia
City
Woodbridge
State/Province
Virginia
ZIP/Postal Code
22193
Country
United States
Facility Name
Kansai Rosai Hospital
City
Amagasaki
Country
Japan
Facility Name
Shonan Kamakura General Hospital
City
Kamakura
Country
Japan
Facility Name
Kishiwada Tokushukai Hospital
City
Kishiwada
Country
Japan
Facility Name
Saitama Medical Center Saitama Medical University
City
Saitama
Country
Japan
Facility Name
Shizuoka General Hospital
City
Shizuoka
Country
Japan
Facility Name
Tokyo Women's Medical University Hospital
City
Tokyo
Country
Japan
Facility Name
Auckland City Hospital
City
Auckland
Country
New Zealand
Facility Name
Capital and Coast District Health Board
City
Wellington
Country
New Zealand
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
32813949
Citation
Lookstein RA, Haruguchi H, Ouriel K, Weinberg I, Lei L, Cihlar S, Holden A; IN.PACT AV Access Investigators. Drug-Coated Balloons for Dysfunctional Dialysis Arteriovenous Fistulas. N Engl J Med. 2020 Aug 20;383(8):733-742. doi: 10.1056/NEJMoa1914617.
Results Reference
derived
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IN.PACT™ AV Access IDE Study
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