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ABLUMINUS DES BTK Registry - FIM

Primary Purpose

Peripheral Artery Disease, Arterial Disease of Legs, Atherosclerosis

Status
Recruiting
Phase
Not Applicable
Locations
Singapore
Study Type
Interventional
Intervention
ABLUMINUS DES drug eluting stent
Sponsored by
Concept Medical Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Peripheral Artery Disease focused on measuring Sirolimus, DES, PAD, PTA

Eligibility Criteria

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

Inclusion Criteria:

  1. Subject is 21 years or older and has signed and dated the trial informed consent document (ICD)
  2. Subject is willing and able to comply with the trial testing, procedures and follow-up schedule
  3. Subject has chronic, symptomatic diabetic related lower limb ischemia, determined by Rutherford categories 4 to 6 in the target limb, with wound(s) confined to toes/forefoot
  4. Subject is a male or non-pregnant female. If female of child-bearing potential, and if sexually active must be using, or agree to use, a medically-acceptable method of birth control as confirmed by the investigator

Intraoperative inclusion criteria

  1. Occlusive target lesion(s) located in the tibioperoneal trunk, anterior tibial, posterior tibial and/or peroneal artery(ies).
  2. Target lesion(s) must be at least 4cm above the ankle joint
  3. Degree of stenosis ≥ 70% by visual angiographic assessment
  4. RVD is between 2.5 - 3.75mm
  5. Total target lesion length (or series of lesion segments) to be treated is > 200 mm
  6. Target lesion(s) is located in an area that may be stented without blocking access to patent main branches
  7. Treatment of all above the knee inflow lesion(s) is successful prior to treatment of the target lesion
  8. Guidewire has successfully crossed the target lesion(s)

Exclusion Criteria:

  1. Life expectancy ≤ 1year
  2. Stroke ≤ 90 days prior to the procedure date
  3. Prior or planned major amputation in the target limb
  4. Previous surgery in the target vessel(s) (including prior ipsilateral crural bypass)
  5. Previously implanted stent in the target vessel(s)
  6. Failed PTA of target lesion/vessel ≤ 60 days prior to the procedure date
  7. Heel gangrene
  8. Subject has a platelet count ≤ 50 or ≥ 600 X 103/µL ≤ 30 days prior to the procedure date
  9. NYHA class IV heart failure
  10. Subject has symptomatic coronary artery disease (ie, unstable angina)
  11. History of myocardial infarction or thrombolysis ≤ 90 days prior to the procedure date
  12. Non-atherosclerotic disease resulting in occlusion (eg, embolism, Buerger's disease, vasculitis)
  13. Subject is currently taking Canagliflozin
  14. Body Mass Index (BMI) <18
  15. Active septicemia or bacteremia
  16. Coagulation disorder, including hypercoagulability
  17. Contraindication to anticoagulation or antiplatelet therapy
  18. Known allergies to stent or stent components
  19. Known allergy to contrast media that cannot be adequately pre-medicated prior to the interventional procedure
  20. Known hypersensitivity to heparin
  21. Subject is on a high dose of steroids or is on immunosuppressive therapy
  22. Subject is currently participating, or plans to participate in, another investigational trial that may confound the results of this trial (unless written approval is received from the Concept Medical study team)

Intraoperative exclusion criteria

  1. Angiographic evidence of intra-arterial acute/subacute thrombus or presence of atheroembolism
  2. Treatment required in > 2 target vessels (Note: a target lesion originating in one vessel and extending into another vessel is considered 1 target vessel)
  3. Treatment requires the use of alternate therapy in the target vessel(s)/lesion(s), (eg, atherectomy, cutting balloon, re-entry devices, laser, radiation therapy)
  4. Aneurysm is present in the target vessel(s)
  5. Extremely calcified lesions
  6. Failure to obtain <30% residual stenosis in a pre-existing lesion

Sites / Locations

  • Sengkang General HospitalRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

ABLUMINUS DES

Arm Description

ABLUMINUS DES drug eluting stent will be deployed after successful conventional balloon angioplasty. Sirolimus drug dosage on the ABLUMINUS DES drug eluting stent system is determined by Concept Medical to deliver the optimal dose of sirolimus to the abluminal surface of the BTK lesions.

Outcomes

Primary Outcome Measures

Primary patency using duplex ultrasound at 6 months post-procedure
Number of Primary patency using duplex ultrasound at 6 months post-procedure
Major adverse events (MAE) at 6 months post-procedure
Number of Major adverse events (MAE) (MAE is defined as above ankle amputation in index limb; major re-intervention; and perioperative (30 day) mortality)

Secondary Outcome Measures

Primary and assisted primary patency
Target lesion patency rate measured by duplex ultrasound
Clinically driven target lesion revascularization
Number of Clinically-driven target lesion revascularization
Major amputation rates
Rates of amputation of the lower limb at the ankle level or above
Subject quality-of-life values by change in EQ-5D (EuroQol 5 dimension)
The EQ-5D is a descriptive system of health-related quality-of-life states consisting of 5 dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) each of which can take 1 of 5 responses. The responses record 5 levels of severity (no problems/slight problems/moderate problems/severe problems/extreme problems) within a particular EQ-5D dimension). The levels are assigned a numeric code 1-5 (eg, 1= no problems and 5= extreme problems). Sub-scores are not applicable.
Wound Assessment
Descriptive characteristics of wound healing will be recorded
Rutherford classification
Change in Rutherford classification as assessed by the investigator
Adverse Events
Number of Adverse events
Unplanned hospital readmission
Unplanned hospital related to Critical Limb Ischemia readmission rate
All Cause Mortality
Number of patients with all-cause death
Hemodynamic outcomes
Changes in ankle brachial index (ABI) and/or Toe pressures (TP

Full Information

First Posted
September 18, 2020
Last Updated
August 28, 2023
Sponsor
Concept Medical Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT04562740
Brief Title
ABLUMINUS DES BTK Registry - FIM
Official Title
ABLUMINUS Below the Knee (BTK) Drug Eluting Stent (DES) Registry (ABLUMINUS BTK) - First in Men
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 20, 2020 (Actual)
Primary Completion Date
June 1, 2024 (Anticipated)
Study Completion Date
December 2, 2024 (Anticipated)

3. Sponsor/Collaborators

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

4. Oversight

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

5. Study Description

Brief Summary
A prospective, single center, single arm non-randomized trial collecting safety and effectiveness data for the ABLUMINUS DES System to treat BTK lesions in subjects with CLI.
Detailed Description
The burden of limb loss as a result of peripheral arterial disease (PAD) is high and this problem is set to worsen globally with increasing prevalence of diabetes. Treatment of PAD in diabetic critical limb ischemia (CLI) primarily involves revascularisation of the limb. Angioplasty as a first line strategy of revascularization over surgical procedures has been adopted by most vascular centers. Arterial blockages for diabetic CLI patients occur predominantly in below the knee arteries which can be challenging to treat effectively. This is due to the high incidence of arterial recoil after conventional balloon angioplasty due the natural tendency of the vessels to maintain their original shape and the high restenosis rates of calcified lesions. To address these problems the novel ABLUMINUS DES system is specifically designed to withstand the mechanical recoil of diseased BTK arteries whilst delivering sirolimus to biologically inhibit restenosis. This study postulates that the application of the ABLUMINUS DES system will be safe and will result in better vascular patency in BTK arteries for CLI patients. The investigators aim to conduct a prospective, all comers, single arm, single centre registry of the ABLUMINUS DES system for the treatment of BTK disease.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Peripheral Artery Disease, Arterial Disease of Legs, Atherosclerosis
Keywords
Sirolimus, DES, PAD, PTA

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
During the index angioplasty revascularisation procedure of the limb salvage programme, the ABLUMINUS DES drug eluting stent will be deployed after successful conventional balloon angioplasty.
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
ABLUMINUS DES
Arm Type
Experimental
Arm Description
ABLUMINUS DES drug eluting stent will be deployed after successful conventional balloon angioplasty. Sirolimus drug dosage on the ABLUMINUS DES drug eluting stent system is determined by Concept Medical to deliver the optimal dose of sirolimus to the abluminal surface of the BTK lesions.
Intervention Type
Device
Intervention Name(s)
ABLUMINUS DES drug eluting stent
Intervention Description
Following successful plain balloon angioplasty of the arterial lesion, (defined as <30% residual stenosis after treatment at rated burst pressure of the angioplasty balloon), the ABLUMINUS stent will be deployed at the lesion as per Instructions for Use (IFU) after appropriate sizing using the diameter of the plain balloon angioplasty. After deployment of the ABLUMINUS stent, further balloon angioplasty of the stent will be performed, using the same diameter standard balloon catheter at 2 minutes inflation, to ensure adequate moulding and expansion of the stent.
Primary Outcome Measure Information:
Title
Primary patency using duplex ultrasound at 6 months post-procedure
Description
Number of Primary patency using duplex ultrasound at 6 months post-procedure
Time Frame
at 6 months post-procedure
Title
Major adverse events (MAE) at 6 months post-procedure
Description
Number of Major adverse events (MAE) (MAE is defined as above ankle amputation in index limb; major re-intervention; and perioperative (30 day) mortality)
Time Frame
at 6 months post-procedure
Secondary Outcome Measure Information:
Title
Primary and assisted primary patency
Description
Target lesion patency rate measured by duplex ultrasound
Time Frame
6, 12, 24 months post procedure
Title
Clinically driven target lesion revascularization
Description
Number of Clinically-driven target lesion revascularization
Time Frame
1, 3, 6, 12, 24 months post procedure
Title
Major amputation rates
Description
Rates of amputation of the lower limb at the ankle level or above
Time Frame
1, 3, 6, 12, 24 months post procedure
Title
Subject quality-of-life values by change in EQ-5D (EuroQol 5 dimension)
Description
The EQ-5D is a descriptive system of health-related quality-of-life states consisting of 5 dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) each of which can take 1 of 5 responses. The responses record 5 levels of severity (no problems/slight problems/moderate problems/severe problems/extreme problems) within a particular EQ-5D dimension). The levels are assigned a numeric code 1-5 (eg, 1= no problems and 5= extreme problems). Sub-scores are not applicable.
Time Frame
1, 3, 6 and 12 months post procedure
Title
Wound Assessment
Description
Descriptive characteristics of wound healing will be recorded
Time Frame
1, 3, 6, 12, 24 months post procedure
Title
Rutherford classification
Description
Change in Rutherford classification as assessed by the investigator
Time Frame
3, 6, 12, 24 months post procedure
Title
Adverse Events
Description
Number of Adverse events
Time Frame
1, 3, 6, 12, 24 months post procedure
Title
Unplanned hospital readmission
Description
Unplanned hospital related to Critical Limb Ischemia readmission rate
Time Frame
Up to 30 days post procedure
Title
All Cause Mortality
Description
Number of patients with all-cause death
Time Frame
6, 12, 24 months years post procedure
Title
Hemodynamic outcomes
Description
Changes in ankle brachial index (ABI) and/or Toe pressures (TP
Time Frame
6 and 12 months post procedure

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject is 21 years or older and has signed and dated the trial informed consent document (ICD) Subject is willing and able to comply with the trial testing, procedures and follow-up schedule Subject has chronic, symptomatic diabetic related lower limb ischemia, determined by Rutherford categories 4 to 6 in the target limb, with wound(s) confined to toes/forefoot Subject is a male or non-pregnant female. If female of child-bearing potential, and if sexually active must be using, or agree to use, a medically-acceptable method of birth control as confirmed by the investigator Intraoperative inclusion criteria Occlusive target lesion(s) located in the tibioperoneal trunk, anterior tibial, posterior tibial and/or peroneal artery(ies). Target lesion(s) must be at least 4cm above the ankle joint Degree of stenosis ≥ 70% by visual angiographic assessment RVD is between 2.5 - 3.75mm Total target lesion length (or series of lesion segments) to be treated is > 200 mm Target lesion(s) is located in an area that may be stented without blocking access to patent main branches Treatment of all above the knee inflow lesion(s) is successful prior to treatment of the target lesion Guidewire has successfully crossed the target lesion(s) Exclusion Criteria: Life expectancy ≤ 1year Stroke ≤ 90 days prior to the procedure date Prior or planned major amputation in the target limb Previous surgery in the target vessel(s) (including prior ipsilateral crural bypass) Previously implanted stent in the target vessel(s) Failed PTA of target lesion/vessel ≤ 60 days prior to the procedure date Heel gangrene Subject has a platelet count ≤ 50 or ≥ 600 X 103/µL ≤ 30 days prior to the procedure date NYHA class IV heart failure Subject has symptomatic coronary artery disease (ie, unstable angina) History of myocardial infarction or thrombolysis ≤ 90 days prior to the procedure date Non-atherosclerotic disease resulting in occlusion (eg, embolism, Buerger's disease, vasculitis) Subject is currently taking Canagliflozin Body Mass Index (BMI) <18 Active septicemia or bacteremia Coagulation disorder, including hypercoagulability Contraindication to anticoagulation or antiplatelet therapy Known allergies to stent or stent components Known allergy to contrast media that cannot be adequately pre-medicated prior to the interventional procedure Known hypersensitivity to heparin Subject is on a high dose of steroids or is on immunosuppressive therapy Subject is currently participating, or plans to participate in, another investigational trial that may confound the results of this trial (unless written approval is received from the Concept Medical study team) Intraoperative exclusion criteria Angiographic evidence of intra-arterial acute/subacute thrombus or presence of atheroembolism Treatment required in > 2 target vessels (Note: a target lesion originating in one vessel and extending into another vessel is considered 1 target vessel) Treatment requires the use of alternate therapy in the target vessel(s)/lesion(s), (eg, atherectomy, cutting balloon, re-entry devices, laser, radiation therapy) Aneurysm is present in the target vessel(s) Extremely calcified lesions Failure to obtain <30% residual stenosis in a pre-existing lesion
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Edward Choke
Phone
65 69302164
Email
edward.choke.t.c@singhealth.com.sg
First Name & Middle Initial & Last Name or Official Title & Degree
Edward Choke
Facility Information:
Facility Name
Sengkang General Hospital
City
Singapore
ZIP/Postal Code
544886
Country
Singapore
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Edward Choke, Dr
Email
edward.choke.t.c@singhealth.com.sg

12. IPD Sharing Statement

Citations:
PubMed Identifier
18372148
Citation
Romiti M, Albers M, Brochado-Neto FC, Durazzo AE, Pereira CA, De Luccia N. Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia. J Vasc Surg. 2008 May;47(5):975-981. doi: 10.1016/j.jvs.2008.01.005. Epub 2008 Apr 18.
Results Reference
background
PubMed Identifier
19620014
Citation
Siablis D, Karnabatidis D, Katsanos K, Diamantopoulos A, Spiliopoulos S, Kagadis GC, Tsolakis J. Infrapopliteal application of sirolimus-eluting versus bare metal stents for critical limb ischemia: analysis of long-term angiographic and clinical outcome. J Vasc Interv Radiol. 2009 Sep;20(9):1141-50. doi: 10.1016/j.jvir.2009.05.031. Epub 2009 Jul 19.
Results Reference
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PubMed Identifier
19642789
Citation
Biondi-Zoccai GG, Sangiorgi G, Lotrionte M, Feiring A, Commeau P, Fusaro M, Agostoni P, Bosiers M, Peregrin J, Rosales O, Cotroneo AR, Rand T, Sheiban I. Infragenicular stent implantation for below-the-knee atherosclerotic disease: clinical evidence from an international collaborative meta-analysis on 640 patients. J Endovasc Ther. 2009 Jun;16(3):251-60. doi: 10.1583/09-2691.1.
Results Reference
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PubMed Identifier
15838475
Citation
Kudo T, Chandra FA, Ahn SS. The effectiveness of percutaneous transluminal angioplasty for the treatment of critical limb ischemia: a 10-year experience. J Vasc Surg. 2005 Mar;41(3):423-35; discussion 435. doi: 10.1016/j.jvs.2004.11.041.
Results Reference
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PubMed Identifier
23194941
Citation
Scheinert D, Katsanos K, Zeller T, Koppensteiner R, Commeau P, Bosiers M, Krankenberg H, Baumgartner I, Siablis D, Lammer J, Van Ransbeeck M, Qureshi AC, Stoll HP; ACHILLES Investigators. A prospective randomized multicenter comparison of balloon angioplasty and infrapopliteal stenting with the sirolimus-eluting stent in patients with ischemic peripheral arterial disease: 1-year results from the ACHILLES trial. J Am Coll Cardiol. 2012 Dec 4;60(22):2290-5. doi: 10.1016/j.jacc.2012.08.989.
Results Reference
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PubMed Identifier
22169682
Citation
Bosiers M, Scheinert D, Peeters P, Torsello G, Zeller T, Deloose K, Schmidt A, Tessarek J, Vinck E, Schwartz LB. Randomized comparison of everolimus-eluting versus bare-metal stents in patients with critical limb ischemia and infrapopliteal arterial occlusive disease. J Vasc Surg. 2012 Feb;55(2):390-8. doi: 10.1016/j.jvs.2011.07.099. Epub 2011 Dec 14.
Results Reference
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PubMed Identifier
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Citation
Rastan A, Tepe G, Krankenberg H, Zahorsky R, Beschorner U, Noory E, Sixt S, Schwarz T, Brechtel K, Bohme C, Neumann FJ, Zeller T. Sirolimus-eluting stents vs. bare-metal stents for treatment of focal lesions in infrapopliteal arteries: a double-blind, multi-centre, randomized clinical trial. Eur Heart J. 2011 Sep;32(18):2274-81. doi: 10.1093/eurheartj/ehr144. Epub 2011 May 26.
Results Reference
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ABLUMINUS DES BTK Registry - FIM

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