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Pantheris Atherectomy Treatment of In-Stent Restenosis In Lower Extremity Arteries (INSIGHT)

Primary Purpose

Peripheral Arterial Disease

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Atherectomy Catheter
Sponsored by
Avinger, 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:

  • Subject is >18 years old;
  • Subject is willing and able to give informed consent;
  • Subject has Rutherford Classification of I-V;
  • Subject presenting with a single Class I, II or III ISR lesion as per Tosaka's Classification criteria in the lower leg extremities;
  • Target lesion must be >70% stenosed and within a stented segment by angiographic visual estimation;
  • Reference vessel lumen acceptable for treatment with Pantheris catheter size as per visual angiographic estimation;
  • Target lesions must be within the stented segment and no more than 3 cm past the proximal or distal portions of the stent;
  • Target lesion is ≤30 cm in length;
  • Intraluminal crossing of totally occluded lesions prior to atherectomy;
  • At least one patent tibial run-off vessel at baseline; and
  • Subject is capable of meeting requirements and be present at the follow-up clinic visits at 30 days, 6 months and 12 months.

Exclusion Criteria:

  • Subject is pregnant or breast feeding;
  • Rutherford Class 0 or VI;
  • Severe calcification of the target lesion;
  • Acute ischemia and/or acute thrombosis of the target lesion segment;
  • Target lesion with a covered stent;
  • Target lesion in the iliac artery;
  • Target lesion stenosis <70%;
  • Target lesion >30 cm in length;
  • Subjects with totally occluded stented segments that are not successfully crossed intraluminally prior to atherectomy treatment;
  • Grade 4 or 5 stent fracture affecting target stent, or where evidence of stent protrusion into the lumen is noted on angiography in two orthogonal views;
  • Subjects on chronic hemodialysis or creatinine level >2.5 mg/dL;
  • CVA or stroke within 60 days prior to the index procedure;
  • 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;
  • Known allergy to contrast agents or medications used to perform endovascular
  • intervention that cannot be adequately pre-treated;
  • Subjects in whom anti-platelet, aspirin, anticoagulant, or thrombolytic therapy is contraindicated;
  • 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 during the index procedure;
  • 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; or
  • 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. Bernards Medical Center
  • Arkansas Heart Hospital
  • University of California San Diego (UCSD)
  • Advocate Christ Hospital and Medical Center
  • Baton Rouge General Medical Center
  • University of Missouri
  • Deborah Heart and Lung Center
  • TriHealth-Hatton Research Institute
  • Dayton Heart Center
  • Einstein Medical Center
  • University of Tennessee Health Science Center
  • Cardiovascular Associates of East Texas

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment Cohort

Arm Description

Atherectomy of in-stent restenosis

Outcomes

Primary Outcome Measures

Freedom from a composite of major adverse events (MAEs) through 30-day follow-up (safety)
The primary safety endpoint is freedom from a composite of major adverse events (MAEs) through 30-day follow-up, as adjudicated by an independent CEC. Individual MAEs include: Cardiovascular-related death; Unplanned, major index limb amputation; Clinically driven target lesion revascularization (TLR); Myocardial infarction; or Device-associated events: Clinically significant perforation, Clinically significant dissection, Clinically significant embolus, or Pseudoaneurysm.
Technical success of Pantheris catheter treatment (efficacy) device
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

Stent structure freedom from new or worsening stent fracture post Pantheris treatment (safety)
Assess the stent for new or worsening stent fracture per comparative Pantheris OCT evaluation pre- and immediately post-procedure.
Secondary Effectiveness Endpoint - Freedom from TLR
Freedom from TLR at 6 months as assessed 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 - Freedom from TLR
Freedom from TLR at 12 months as assessed by an independent CEC.
Secondary Effectiveness Endpoint - Ankle-Brachial Index
Ankle-Brachial Index at 30 days, 6 and 12 months
Secondary Effectiveness Endpoint - Rutherford Classification
Rutherford Classification at 30 days, 6 and 12 months
Secondary Effectiveness Endpoint - Use Adjunctive Devices
Adjunctive devices (stent placement (bare metal or drug eluting stent), drug eluting balloon or other) utilized during the index procedure.

Full Information

First Posted
June 12, 2017
Last Updated
March 27, 2023
Sponsor
Avinger, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03192696
Brief Title
Pantheris Atherectomy Treatment of In-Stent Restenosis In Lower Extremity Arteries
Acronym
INSIGHT
Official Title
INSIGHT: EvaluatIoN of the PantheriS OCT- ImaGing AtHerectomy SysTem For Treatment of In-Stent Restenosis (ISR) Lesions In Lower Extremity Arteries
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Completed
Study Start Date
October 19, 2017 (Actual)
Primary Completion Date
June 1, 2021 (Actual)
Study Completion Date
December 1, 2021 (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
Device Product Not Approved or Cleared by U.S. FDA
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
A prospective, non-randomized, international, multi-center study to evaluate the safety and effectiveness of the Pantheris OCT-Imaging System to perform atherectomy in In-Stent Restenotic (ISR) lesions in lower extremity arteries.
Detailed Description
This is a prospective, global, single-arm, multi-center study to evaluate the safety and effectiveness of the Pantheris OCT-Imaging System to perform atherectomy of in-stent restenotic (ISR) lesions in lower extremity arteries. The trial will enroll up to 140 subjects diagnosed with peripheral arterial disease of the lower extremities that have previously been treated with stenting at up to 20 sites. The primary disease must be located in reference vessel diameter of >3.0mm and ≤7.0mm. Trial success is focused on safety, including rates of major adverse events through 30 days as adjudicated by a Clinical Events Committee, and effectiveness, which will be evaluated using technical success defined as the percent of target lesions that have 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

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Treatment Cohort
Arm Type
Experimental
Arm Description
Atherectomy of in-stent restenosis
Intervention Type
Device
Intervention Name(s)
Atherectomy Catheter
Intervention Description
Treatment of restenotic lesions within stents previously placed within the artery.
Primary Outcome Measure Information:
Title
Freedom from a composite of major adverse events (MAEs) through 30-day follow-up (safety)
Description
The primary safety endpoint is freedom from a composite of major adverse events (MAEs) through 30-day follow-up, as adjudicated by an independent CEC. Individual MAEs include: Cardiovascular-related death; Unplanned, major index limb amputation; Clinically driven target lesion revascularization (TLR); Myocardial infarction; or Device-associated events: Clinically significant perforation, Clinically significant dissection, Clinically significant embolus, or Pseudoaneurysm.
Time Frame
Day 0 through 30 days post treatment procedure
Title
Technical success of Pantheris catheter treatment (efficacy) device
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
Stent structure freedom from new or worsening stent fracture post Pantheris treatment (safety)
Description
Assess the stent for new or worsening stent fracture per comparative Pantheris OCT evaluation pre- and immediately post-procedure.
Time Frame
Day 0
Title
Secondary Effectiveness Endpoint - Freedom from TLR
Description
Freedom from TLR at 6 months as assessed by an independent CEC.
Time Frame
6 months post treatment procedure
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 - Freedom from TLR
Description
Freedom from TLR at 12 months as assessed by an independent CEC.
Time Frame
12 months post treatment procedure
Title
Secondary Effectiveness Endpoint - Ankle-Brachial Index
Description
Ankle-Brachial Index at 30 days, 6 and 12 months
Time Frame
30 days, 6 and 12 months post treatment procedure
Title
Secondary Effectiveness Endpoint - Rutherford Classification
Description
Rutherford Classification at 30 days, 6 and 12 months
Time Frame
30 days, 6 and 12 months post treatment procedure
Title
Secondary Effectiveness Endpoint - Use Adjunctive Devices
Description
Adjunctive devices (stent placement (bare metal or drug eluting stent), drug eluting balloon or other) utilized during the index procedure.
Time Frame
Day 0

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject is >18 years old; Subject is willing and able to give informed consent; Subject has Rutherford Classification of I-V; Subject presenting with a single Class I, II or III ISR lesion as per Tosaka's Classification criteria in the lower leg extremities; Target lesion must be >70% stenosed and within a stented segment by angiographic visual estimation; Reference vessel lumen acceptable for treatment with Pantheris catheter size as per visual angiographic estimation; Target lesions must be within the stented segment and no more than 3 cm past the proximal or distal portions of the stent; Target lesion is ≤30 cm in length; Intraluminal crossing of totally occluded lesions prior to atherectomy; At least one patent tibial run-off vessel at baseline; and Subject is capable of meeting requirements and be present at the follow-up clinic visits at 30 days, 6 months and 12 months. Exclusion Criteria: Subject is pregnant or breast feeding; Rutherford Class 0 or VI; Severe calcification of the target lesion; Acute ischemia and/or acute thrombosis of the target lesion segment; Target lesion with a covered stent; Target lesion in the iliac artery; Target lesion stenosis <70%; Target lesion >30 cm in length; Subjects with totally occluded stented segments that are not successfully crossed intraluminally prior to atherectomy treatment; Grade 4 or 5 stent fracture affecting target stent, or where evidence of stent protrusion into the lumen is noted on angiography in two orthogonal views; Subjects on chronic hemodialysis or creatinine level >2.5 mg/dL; CVA or stroke within 60 days prior to the index procedure; 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; Known allergy to contrast agents or medications used to perform endovascular intervention that cannot be adequately pre-treated; Subjects in whom anti-platelet, aspirin, anticoagulant, or thrombolytic therapy is contraindicated; 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 during the index procedure; 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; or 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
Sean Janzer, MD
Organizational Affiliation
Einstein Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
St. Bernards 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
University of California San Diego (UCSD)
City
San Diego
State/Province
California
ZIP/Postal Code
92037
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
Baton Rouge General Medical Center
City
Baton Rouge
State/Province
Louisiana
ZIP/Postal Code
70809
Country
United States
Facility Name
University of Missouri
City
Columbia
State/Province
Missouri
ZIP/Postal Code
65212
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
TriHealth-Hatton Research Institute
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45220
Country
United States
Facility Name
Dayton Heart Center
City
Dayton
State/Province
Ohio
ZIP/Postal Code
45414
Country
United States
Facility Name
Einstein Medical Center
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19141
Country
United States
Facility Name
University of Tennessee Health Science Center
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38163
Country
United States
Facility Name
Cardiovascular Associates of East Texas
City
Tyler
State/Province
Texas
ZIP/Postal Code
75701
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Pantheris Atherectomy Treatment of In-Stent Restenosis In Lower Extremity Arteries

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