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BATTLE Trial: Bare Metal Stent Versus Paclitaxel Eluting Stent in the Setting of Primary Stenting of Intermediate Length Femoropopliteal Lesions (BATTLE)

Primary Purpose

Peripheral Arterial Disease, Femoropopliteal Lesions

Status
Terminated
Phase
Not Applicable
Locations
France
Study Type
Interventional
Intervention
Misago RX
Zilver PTX
Sponsored by
Nantes University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional health services research trial for Peripheral Arterial Disease focused on measuring Superficial femoral artery, paclitaxel, stent, self expandable, restenosis, endovascular, above-the-knee intermediate length

Eligibility Criteria

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

Inclusion criteria

  • Patient ≥18 years
  • Patient has a history of symptomatic peripheral arterial disease (Rutherford classification: 2-5)
  • Lesion is eligible for treatment with a maximum of 2 stents per lesion (treatment of both legs is not permitted)
  • Patient is affiliated to the Social Security or equivalent system
  • Patient has been informed of the nature of the study, agrees to its provisions (and only for swiss centers, has signed the informed consent form prior to any study related procedure)
  • Patient agrees to undergo all protocol required follow-up examinations and requirements at the investigational site
  • Reference vessel diameter 4 to 7-mm determined by CT scan (RVD obtained from averaging 5-mm segments proximal and distal to the lesions)
  • Target lesion has a pre-procedure percent diameter stenosis of ≥ 50% DS
  • De novo atherosclerotic lesions (stenosis and/or occlusion) of the superficial femoral artery, the proximal popliteal artery (P1), or both. The treatment area in the SFA and popliteal artery extended from 1 cm below the origin of the profunda femoris artery to 3 cm above the proximal margin of the intercondylar fossa of the femur.
  • Target lesion (single or multiple) has a maximal total length =14-cm and a minimal length = 2-cm
  • At least 1 patent runoff vessel (<50% DS throughout its course). The inflow artery(ies) cannot be treated using a drug eluting stent or drug coated balloon.

Exclusion Criteria

  • Asymptomatic lesion
  • Restenosis
  • No atheromatous disease
  • Untreated >50% DS of the inflow tract
  • Resting ankle brachial index (ABI) unavailable
  • Female of child bearing potential
  • Patient has received, or is on the waiting list for a major organ transplant
  • Patient has a history of coagulopathy or will refuse blood transfusions
  • Patient is receiving or scheduled to receive anticancer therapy for malignancy within 1 year prior to or after the procedure
  • Severe concomitant disease with life expectation < one year
  • Known allergy to paclitaxel
  • Contraindication to Aspirin or Clopidogrel and Ticlopidin (the patient must be able to receive Dual Anti-Platelet Treatment for 2 months after the procedure)
  • Patient has an infected wound or osteomyelitis on the ipsilateral extremity or foot.
  • Patient has had prior major amputation to the ipsilateral (target) extremity
  • Patient is not able to give informed consent (and only for swiss centers)
  • Patient is currently participating in an investigational drug or device study that has not completed the primary endpoint or that clinically interferes with the current study endpoints Note: Trials requiring extended follow-up for products that were investigational, but have become commercially available since then, are not considered investigational trials
  • Patient has previously had, or requires, bypass surgery, endarterectomy or other vascular surgery on any vessel of the ipsilateral extremity
  • In the Investigator's opinion patient has (a) co-morbid condition(s) that could limit the patient's ability to participate in the study, compliance with follow-up requirements or impact the scientific integrity of the study
  • Target lesion lies within or adjacent to an aneurysm
  • Patient with an allergy to contrast agent
  • Patient with a severe allergy to metal
  • Surgery or endovascular intervention of the target member within 14 days preceding the BATTLE procedure

Sites / Locations

  • Clinique d'Antony
  • CHU de Besançon
  • CHU de Bordeaux
  • Centre Hospitalier Pierre Oudot Bourgoin Jallieu
  • CHU de Clermont Ferrand
  • AP-HP, Hôpital Henri Mondor
  • CHU de Lyon
  • CHU Nantes
  • Clinique Ollioules
  • CHU de Rennes
  • Clinique Pasteur

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Other

Arm Label

Misago RX (Misago RX, Terumo Corp., Tokyo

Zilver PTX (Cook Medical, Bloomington, IN, USA)

Arm Description

The Misago RX is a peripheral stent (Misago RX, Terumo Corp., Tokyo, Japan) indicated to treat iliac and femoropopliteal arteries. The Misago RX is a flexible self-expanding nitinol stent that is delivered via a RX monorail delivery catheter.

Zilver PTX (Cook Medical, Bloomington, IN, USA) is a nitinol stent with a polymer-free paclitaxel coating designed to treat the above- the-knee femoropopliteal arteries. The anti-proliferative drug is the paclitaxel, a cytotoxic drug. The Zilver PTX stent is delivered via a over-the-wire system.

Outcomes

Primary Outcome Measures

Freedom from in-stent restenosis at 1 year
It was defined by restenosis of >50% and by a peak systolic velocity index >2.4 at the target lesion.

Secondary Outcome Measures

residual diameter stenosis
Technical success defined achievement of a final residual diameter stenosis of <30% on the procedural completion angiogram.
Primary sustained clinical improvement
sustained upward shift of _1 category of the Rutherford classification for claudicants and by wound healing and rest pain resolution for patients in CLI, without the need for repeated TLR in surviving patients.
Secondary sustained clinical improvement
primary sustained clinical improvement including the need for repeated TLR.
Primary patency
patency without any percutaneous or surgical intervention in the treated segment or in the adjacent areas.
Major adverse events
MACEs including all deaths, major amputation.
Limb salvage
freedom from major ipsilateral amputations
Death
Death (all cause)
Ankle brachial index
Ankle brachial index
Target Extremity Revascularization (TER)
TER is defined as any percutaneous intervention or surgical bypass of any segment of the target extremity. The target extremity is defined as the ipsilateral limb arteries proximal and distal to the target lesion, which includes upstream and downstream branches and excludes the target lesion itself.
Target lesion revascularization (TLR)
TLR expresses the frequency of the need for repeated procedures (endovascular or surgical) due to a problem arising from the stent (1 cm proximally and distally to include edge phenomena) in surviving patients with preserved limb.
Stent fracture
Stent fractures were assessed by biplane x-rays
EQ-5D-3L questionnaire
Quality of life - EQ-5D-3L questionnaire EQ-5D-3L = European Quality of Life 5 Dimensions and 3 Lines Scale from 0 to 100. 0 =Worst imaginable state of health 100= Best imaginable state of health
Economic analysis objective
Incremental cost-effectiveness ratio (ICER) based on quality of life for CUA and on freedom from in-stent restenosis for CEA

Full Information

First Posted
December 3, 2013
Last Updated
February 3, 2021
Sponsor
Nantes University Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT02004951
Brief Title
BATTLE Trial: Bare Metal Stent Versus Paclitaxel Eluting Stent in the Setting of Primary Stenting of Intermediate Length Femoropopliteal Lesions
Acronym
BATTLE
Official Title
BATTLE Trial: Bare Metal Stent Versus Paclitaxel Eluting Stent in the Setting of Primary Stenting of Intermediate Length Femoropopliteal Lesions
Study Type
Interventional

2. Study Status

Record Verification Date
February 2021
Overall Recruitment Status
Terminated
Why Stopped
Batch recall for Misago Terumo self-expanding peripheral stent systems.(withdrawal from the market)
Study Start Date
March 25, 2014 (Actual)
Primary Completion Date
August 31, 2017 (Actual)
Study Completion Date
August 7, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Nantes University Hospital

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Over the past years, endovascular interventions have become an important part of treatment in patients with peripheral arterial disease.1 Indication for endovascular repair of femoropopliteal lesions has been considerably enlarged as shown in the TASC classification.1 Enlargement of endovascular therapy indication was based on patient choice for a less invasive technique and evidence based medicine. Consequently, TASC classification of lesions has been modified to reflect increased evidence for endovascular treatment of more extensive femoropopliteal lesions, and indication for endovascular repair has been enlarged to more severe TASC types. In summary, endovascular treatment is indicated for TASC A and B lesions which correspond to femoropopliteal lesions ≤15-cm. To treat these lesions, the interventionalists have at their disposal a huge tool box. Evaluation of these tools is crucial to determine the right treatment strategy to avoid further reinterventions and overcosts. The objective of the BATTLE trial is to compare a bare metal self expandable nitinol stent (Misago RX) versus a paclitaxel eluting stent (Zilver PTX) in the treatment of above-the-knee intermediate length femoropopliteal lesions. From hospitals in Europe (France, Switzerland) we will randomly assign patients with symptomatic atherosclerotic femoropopliteal lesions to be treated either by bare metal stent or paclitaxel eluting stent. In total, 186 patients will be randomized (93 per group).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Peripheral Arterial Disease, Femoropopliteal Lesions
Keywords
Superficial femoral artery, paclitaxel, stent, self expandable, restenosis, endovascular, above-the-knee intermediate length

7. Study Design

Primary Purpose
Health Services Research
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
186 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Misago RX (Misago RX, Terumo Corp., Tokyo
Arm Type
Other
Arm Description
The Misago RX is a peripheral stent (Misago RX, Terumo Corp., Tokyo, Japan) indicated to treat iliac and femoropopliteal arteries. The Misago RX is a flexible self-expanding nitinol stent that is delivered via a RX monorail delivery catheter.
Arm Title
Zilver PTX (Cook Medical, Bloomington, IN, USA)
Arm Type
Other
Arm Description
Zilver PTX (Cook Medical, Bloomington, IN, USA) is a nitinol stent with a polymer-free paclitaxel coating designed to treat the above- the-knee femoropopliteal arteries. The anti-proliferative drug is the paclitaxel, a cytotoxic drug. The Zilver PTX stent is delivered via a over-the-wire system.
Intervention Type
Device
Intervention Name(s)
Misago RX
Other Intervention Name(s)
Treatment of above-the-knee intermediate length femoropopliteal lesions
Intervention Type
Device
Intervention Name(s)
Zilver PTX
Primary Outcome Measure Information:
Title
Freedom from in-stent restenosis at 1 year
Description
It was defined by restenosis of >50% and by a peak systolic velocity index >2.4 at the target lesion.
Time Frame
1 year
Secondary Outcome Measure Information:
Title
residual diameter stenosis
Description
Technical success defined achievement of a final residual diameter stenosis of <30% on the procedural completion angiogram.
Time Frame
Day 0
Title
Primary sustained clinical improvement
Description
sustained upward shift of _1 category of the Rutherford classification for claudicants and by wound healing and rest pain resolution for patients in CLI, without the need for repeated TLR in surviving patients.
Time Frame
1 month, 12 months and 24 months
Title
Secondary sustained clinical improvement
Description
primary sustained clinical improvement including the need for repeated TLR.
Time Frame
1 month, 12 months and 24 months
Title
Primary patency
Description
patency without any percutaneous or surgical intervention in the treated segment or in the adjacent areas.
Time Frame
1 month, 12 months and 24 months
Title
Major adverse events
Description
MACEs including all deaths, major amputation.
Time Frame
1 month, 12 months and 24 months
Title
Limb salvage
Description
freedom from major ipsilateral amputations
Time Frame
1 month, 12 months and 24 months
Title
Death
Description
Death (all cause)
Time Frame
1 month, 12 months and 24 months
Title
Ankle brachial index
Description
Ankle brachial index
Time Frame
1 month, 6 months, 12 months and 24 months
Title
Target Extremity Revascularization (TER)
Description
TER is defined as any percutaneous intervention or surgical bypass of any segment of the target extremity. The target extremity is defined as the ipsilateral limb arteries proximal and distal to the target lesion, which includes upstream and downstream branches and excludes the target lesion itself.
Time Frame
1 month, 12 months and 24 months
Title
Target lesion revascularization (TLR)
Description
TLR expresses the frequency of the need for repeated procedures (endovascular or surgical) due to a problem arising from the stent (1 cm proximally and distally to include edge phenomena) in surviving patients with preserved limb.
Time Frame
1 month, 12 months and 24 months
Title
Stent fracture
Description
Stent fractures were assessed by biplane x-rays
Time Frame
1 month, 12 months and 24 months
Title
EQ-5D-3L questionnaire
Description
Quality of life - EQ-5D-3L questionnaire EQ-5D-3L = European Quality of Life 5 Dimensions and 3 Lines Scale from 0 to 100. 0 =Worst imaginable state of health 100= Best imaginable state of health
Time Frame
1 month, 12 months and 24 months
Title
Economic analysis objective
Description
Incremental cost-effectiveness ratio (ICER) based on quality of life for CUA and on freedom from in-stent restenosis for CEA
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria Patient ≥18 years Patient has a history of symptomatic peripheral arterial disease (Rutherford classification: 2-5) Lesion is eligible for treatment with a maximum of 2 stents per lesion (treatment of both legs is not permitted) Patient is affiliated to the Social Security or equivalent system Patient has been informed of the nature of the study, agrees to its provisions (and only for swiss centers, has signed the informed consent form prior to any study related procedure) Patient agrees to undergo all protocol required follow-up examinations and requirements at the investigational site Reference vessel diameter 4 to 7-mm determined by CT scan (RVD obtained from averaging 5-mm segments proximal and distal to the lesions) Target lesion has a pre-procedure percent diameter stenosis of ≥ 50% DS De novo atherosclerotic lesions (stenosis and/or occlusion) of the superficial femoral artery, the proximal popliteal artery (P1), or both. The treatment area in the SFA and popliteal artery extended from 1 cm below the origin of the profunda femoris artery to 3 cm above the proximal margin of the intercondylar fossa of the femur. Target lesion (single or multiple) has a maximal total length =14-cm and a minimal length = 2-cm At least 1 patent runoff vessel (<50% DS throughout its course). The inflow artery(ies) cannot be treated using a drug eluting stent or drug coated balloon. Exclusion Criteria Asymptomatic lesion Restenosis No atheromatous disease Untreated >50% DS of the inflow tract Resting ankle brachial index (ABI) unavailable Female of child bearing potential Patient has received, or is on the waiting list for a major organ transplant Patient has a history of coagulopathy or will refuse blood transfusions Patient is receiving or scheduled to receive anticancer therapy for malignancy within 1 year prior to or after the procedure Severe concomitant disease with life expectation < one year Known allergy to paclitaxel Contraindication to Aspirin or Clopidogrel and Ticlopidin (the patient must be able to receive Dual Anti-Platelet Treatment for 2 months after the procedure) Patient has an infected wound or osteomyelitis on the ipsilateral extremity or foot. Patient has had prior major amputation to the ipsilateral (target) extremity Patient is not able to give informed consent (and only for swiss centers) Patient is currently participating in an investigational drug or device study that has not completed the primary endpoint or that clinically interferes with the current study endpoints Note: Trials requiring extended follow-up for products that were investigational, but have become commercially available since then, are not considered investigational trials Patient has previously had, or requires, bypass surgery, endarterectomy or other vascular surgery on any vessel of the ipsilateral extremity In the Investigator's opinion patient has (a) co-morbid condition(s) that could limit the patient's ability to participate in the study, compliance with follow-up requirements or impact the scientific integrity of the study Target lesion lies within or adjacent to an aneurysm Patient with an allergy to contrast agent Patient with a severe allergy to metal Surgery or endovascular intervention of the target member within 14 days preceding the BATTLE procedure
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yann GOUEFFIC, Professor
Organizational Affiliation
Nantes University Hospital
Official's Role
Study Chair
Facility Information:
Facility Name
Clinique d'Antony
City
Antony
Country
France
Facility Name
CHU de Besançon
City
Besançon
Country
France
Facility Name
CHU de Bordeaux
City
Bordeaux
Country
France
Facility Name
Centre Hospitalier Pierre Oudot Bourgoin Jallieu
City
Bourgoin Jallieu
ZIP/Postal Code
38302
Country
France
Facility Name
CHU de Clermont Ferrand
City
Clermont Ferrand
Country
France
Facility Name
AP-HP, Hôpital Henri Mondor
City
Créteil
Country
France
Facility Name
CHU de Lyon
City
Lyon
Country
France
Facility Name
CHU Nantes
City
Nantes
ZIP/Postal Code
44000
Country
France
Facility Name
Clinique Ollioules
City
Ollioules
Country
France
Facility Name
CHU de Rennes
City
Rennes
Country
France
Facility Name
Clinique Pasteur
City
Toulouse
Country
France

12. IPD Sharing Statement

Citations:
PubMed Identifier
25359394
Citation
Goueffic Y, Kaladji A, Guyomarch B, Montagne C, Fairier D, Gestin S, Riche VP, Vent PA, Chaillou P, Costargent A, Patra P. Bare metal stent versus paclitaxel eluting stent for intermediate length femoropopliteal arterial lesions (BATTLE trial): study protocol for a randomized controlled trial. Trials. 2014 Oct 30;15:423. doi: 10.1186/1745-6215-15-423.
Results Reference
derived

Learn more about this trial

BATTLE Trial: Bare Metal Stent Versus Paclitaxel Eluting Stent in the Setting of Primary Stenting of Intermediate Length Femoropopliteal Lesions

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