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DARTS I Feasibility Study (DARTS I)

Primary Purpose

Aortic Dissection, Intramural Hematoma

Status
Active
Phase
Not Applicable
Locations
Canada
Study Type
Interventional
Intervention
AMDS
Sponsored by
Ascyrus Medical LLC.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Aortic Dissection

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Subject must have one of the following diagnosed, based on CT angiography, within 0-14 days:

  1. Acute DeBakey type I dissection or
  2. Acute DeBakey type I intramural hematoma (IMH)

Exclusion Criteria:

General Exclusion Criteria

Patients must be excluded from the study if any of the following conditions are true:

  1. Less than 18 years of age or over 80 years of age
  2. Life expectancy less than 2 years
  3. Pregnant or breastfeeding or planning on becoming pregnant within 60 months
  4. Unwilling to comply with the follow-up schedule
  5. Refusal to give informed consent

Medical Exclusion Criteria

Patients must be excluded from the study if any of the following conditions are true:

  1. Uncontrolled systemic infection
  2. Uncontrollable anaphylaxis to iodinated contrast
  3. Known allergy(ies) to Nitinol and/or PTFE
  4. Patient in extreme hemodynamic compromise requiring cardiopulmonary resuscitation (CPR)
  5. Inability to obtain CT angiograms for follow-up
  6. Previously diagnosed with Marfan syndrome, Loeys- Dietz syndrome or Ehlers- Danlos syndrome with confirmed laboratory genetic testing on a date prior to the diagnosis of the dissection

Anatomical Exclusion Criteria

  1. Any pathology of mycotic origin
  2. Subacute or chronic dissection of the ascending aorta and aortic arch (>14 days after the index event)
  3. Aortic fistulous communication with non-vascular structure (e.g. esophagus, bronchial)
  4. Extensive thrombus or calcifications in the aortic arch as defined by CT angiography
  5. Excessive tortuosity precluding safe passage of the AMDS as defined by CT angiography
  6. Descending thoracic aneurysm involving the proximal third (1/3) of the descending aorta and measuring > 45mm in diameter.

Sites / Locations

  • Mazankowski Alberta Heart Institute, University of Alberta
  • London Health Sciences Center- University Hospital
  • University Health Network - Toronto General Hospital
  • Montreal Heart Institute
  • Centre Hospitalier de I'Universite de Montreal (CHUM)

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

AMDS Implantation

Arm Description

AMDS implantation is performed during an open chest procedure for intervention of aortic dissection repair.

Outcomes

Primary Outcome Measures

Number of participants with device-related mortality
The number of patients with mortality related to the treatment device
Number of participants with device-related mortality
The number of patients with mortality related to the treatment device
Number of participants with device-related mortality
The number of patients with mortality related to the treatment device
Number of participants with neurological complications (TIA, stroke)
The number of patients with neurological complications related to the treatment device
Number of participants with neurological complications (TIA, stroke)
The number of patients with neurological complications related to the treatment device
Number of participants with neurological complications (TIA, stroke)
The number of patients with neurological complications related to the treatment device

Secondary Outcome Measures

Thrombosis of the false lumen within the confines of the device
Efficacy outcome: Number of participants with false lumen exclusion within the treatment area confined by the treatment device.
Assess need for stent removal
Stent placement and retention. The number of patients requiring removal of the stent.
Successful reattachment of the intimal flap within the arch
The number of patients that has successful reattachment of the intimal flap within the arch following the implantation of AMDS
Successful device deployment, and radiographic evidence of false lumen exclusion within the confines of the device
The number of patients which has successful AMDS deployment and which also had radiographic evidence of false lumen exclusion within the confines of AMDS

Full Information

First Posted
January 20, 2017
Last Updated
February 25, 2022
Sponsor
Ascyrus Medical LLC.
Collaborators
Artivion Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03035643
Brief Title
DARTS I Feasibility Study
Acronym
DARTS I
Official Title
Dissected Aorta Repair Through Stent Implantation (DARTS): A Feasibility Study
Study Type
Interventional

2. Study Status

Record Verification Date
February 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
March 5, 2017 (Actual)
Primary Completion Date
January 31, 2024 (Anticipated)
Study Completion Date
May 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Ascyrus Medical LLC.
Collaborators
Artivion 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
The objective of this study is to investigate the feasibility and clinical benefits of the AMDS to treat patients with acute DeBakey type I dissections and/or intramural hematomas (IMH) involving the ascending aorta and aortic arch through open surgical repair.
Detailed Description
AMDS is designed to complement the replacement of the ascending aorta with conventional surgical technique utilizing a conventional polyester graft. AMDS is constructed of an uncovered Nitinol wire braided stent attached proximally to a polytetrafluoroethylene (PTFE) felt graft component. The PFTE felt graft component excludes the FL at the distal aortic anastomosis and the wire stent re-expands the dissection flap within the arch and descending aorta, which aims to treat malperfusion and promote positive remodeling of the aorta. The DARTS I Feasibility study is a prospective, non-randomized, non-blinded, single-arm, multi-institutional Canadian study evaluating the feasibility and safety of the AMDS graft. A goal of 40 subjects will be enrolled at approximately 5 sites in Canada. The enrollment period will span a minimum of 12 months from Institutional Review Board (IRB) approval and site activation. Candidates for this study are adults who require repair of an acute DeBakey type I aorta dissection and/or intramural hematoma (IMH). Patients will be consented pre-operatively and enrolled patients will be followed for approximately 5 years after their AMDS implantation date. Data will be collected at 10 time points: baseline (pre-operatively), discharge, 1 month post-operatively, 3 months post-operatively, and 6 months post-operatively, 1 year post-operatively and thereafter, annually, for a total of 5 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Aortic Dissection, Intramural Hematoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
Prospective, non-randomized, non-blinded, single-arm study evaluating the feasibility and safety of AMDS
Masking
None (Open Label)
Allocation
N/A
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Arm Title
AMDS Implantation
Arm Type
Experimental
Arm Description
AMDS implantation is performed during an open chest procedure for intervention of aortic dissection repair.
Intervention Type
Device
Intervention Name(s)
AMDS
Intervention Description
The device will be implanted during an already planned surgical intervention for aortic dissection repair. The participant will be observed and data gathered during the surgery and routine standard of care follow up visits.
Primary Outcome Measure Information:
Title
Number of participants with device-related mortality
Description
The number of patients with mortality related to the treatment device
Time Frame
Early (within 30 days)
Title
Number of participants with device-related mortality
Description
The number of patients with mortality related to the treatment device
Time Frame
Intermediate (3 months)
Title
Number of participants with device-related mortality
Description
The number of patients with mortality related to the treatment device
Time Frame
Late (6 months)
Title
Number of participants with neurological complications (TIA, stroke)
Description
The number of patients with neurological complications related to the treatment device
Time Frame
Early (within 30 days)
Title
Number of participants with neurological complications (TIA, stroke)
Description
The number of patients with neurological complications related to the treatment device
Time Frame
Intermediate (3 months)
Title
Number of participants with neurological complications (TIA, stroke)
Description
The number of patients with neurological complications related to the treatment device
Time Frame
Late (6 months)
Secondary Outcome Measure Information:
Title
Thrombosis of the false lumen within the confines of the device
Description
Efficacy outcome: Number of participants with false lumen exclusion within the treatment area confined by the treatment device.
Time Frame
Annually, through study completion, an average of 5 years
Title
Assess need for stent removal
Description
Stent placement and retention. The number of patients requiring removal of the stent.
Time Frame
Annually, through study completion, an average of 5 years
Title
Successful reattachment of the intimal flap within the arch
Description
The number of patients that has successful reattachment of the intimal flap within the arch following the implantation of AMDS
Time Frame
Annually, through study completion, an average of 5 years
Title
Successful device deployment, and radiographic evidence of false lumen exclusion within the confines of the device
Description
The number of patients which has successful AMDS deployment and which also had radiographic evidence of false lumen exclusion within the confines of AMDS
Time Frame
Annually, through study completion, an average of 5 years
Other Pre-specified Outcome Measures:
Title
Aortic injury associated with the implantation of the device
Description
The number of patients which has any aortic injury(ies) associated with the implantation of AMDS
Time Frame
Annually, through study completion, an average of 5 years
Title
Aortic arch branch vessel patency
Description
An evaluation of the patency of aortic arch branch vessels for patients which have had AMDS implantation. Aortic arch branch vessel patency will be evaluated by CTA with a Core Imaging Lab.
Time Frame
Annually, through study completion, an average of 5 years
Title
AMDS related re-interventions after the dissection repair
Description
The number of patients which have required re-interventions related to the AMDS implantation following the index procedure for aortic dissection repair.
Time Frame
Annually, through study completion, an average of 5 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject must have one of the following diagnosed, based on CT angiography, within 0-14 days: Acute DeBakey type I dissection or Acute DeBakey type I intramural hematoma (IMH) Exclusion Criteria: General Exclusion Criteria Patients must be excluded from the study if any of the following conditions are true: Less than 18 years of age or over 80 years of age Life expectancy less than 2 years Pregnant or breastfeeding or planning on becoming pregnant within 60 months Unwilling to comply with the follow-up schedule Refusal to give informed consent Medical Exclusion Criteria Patients must be excluded from the study if any of the following conditions are true: Uncontrolled systemic infection Uncontrollable anaphylaxis to iodinated contrast Known allergy(ies) to Nitinol and/or PTFE Patient in extreme hemodynamic compromise requiring cardiopulmonary resuscitation (CPR) Inability to obtain CT angiograms for follow-up Previously diagnosed with Marfan syndrome, Loeys- Dietz syndrome or Ehlers- Danlos syndrome with confirmed laboratory genetic testing on a date prior to the diagnosis of the dissection Anatomical Exclusion Criteria Any pathology of mycotic origin Subacute or chronic dissection of the ascending aorta and aortic arch (>14 days after the index event) Aortic fistulous communication with non-vascular structure (e.g. esophagus, bronchial) Extensive thrombus or calcifications in the aortic arch as defined by CT angiography Excessive tortuosity precluding safe passage of the AMDS as defined by CT angiography Descending thoracic aneurysm involving the proximal third (1/3) of the descending aorta and measuring > 45mm in diameter.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jessica Forcillo, MD
Organizational Affiliation
Centre Hospitalier de I'Universite de Montreal
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Maral Ouzounian, MD
Organizational Affiliation
University Health Network - Toronto General Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Michael Chu, MD
Organizational Affiliation
London Health Science Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Philippe Demers
Organizational Affiliation
Montreal Heart Institute
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Michael Moon, MD
Organizational Affiliation
University of Alberta
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mazankowski Alberta Heart Institute, University of Alberta
City
Edmonton
State/Province
Alberta
ZIP/Postal Code
T6G 2B7
Country
Canada
Facility Name
London Health Sciences Center- University Hospital
City
London
State/Province
Ontario
ZIP/Postal Code
N6A 5A5
Country
Canada
Facility Name
University Health Network - Toronto General Hospital
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 2C4
Country
Canada
Facility Name
Montreal Heart Institute
City
Montréal
State/Province
Quebec
ZIP/Postal Code
HIT 1C8
Country
Canada
Facility Name
Centre Hospitalier de I'Universite de Montreal (CHUM)
City
Montréal
State/Province
Quebec
Country
Canada

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
32673661
Citation
Bozso SJ, Nagendran J, Chu MWA, Kiaii B, El-Hamamsy I, Ouzounian M, Kempfert J, Starck C, Moon MC. Midterm Outcomes of the Dissected Aorta Repair Through Stent Implantation Trial. Ann Thorac Surg. 2021 Feb;111(2):463-470. doi: 10.1016/j.athoracsur.2020.05.090. Epub 2020 Jul 13.
Results Reference
background
PubMed Identifier
30501947
Citation
Bozso SJ, Nagendran J, MacArthur RGG, Chu MWA, Kiaii B, El-Hamamsy I, Cartier R, Shahriari A, Moon MC. Dissected Aorta Repair Through Stent Implantation trial: Canadian results. J Thorac Cardiovasc Surg. 2019 May;157(5):1763-1771. doi: 10.1016/j.jtcvs.2018.09.120. Epub 2018 Oct 26.
Results Reference
background
PubMed Identifier
31254509
Citation
Bozso SJ, Nagendran J, Chu MWA, Kiaii B, El-Hamamsy I, Ouzounian M, Kempfert J, Starck C, Shahriari A, Moon MC. Single-Stage Management of Dynamic Malperfusion Using a Novel Arch Remodeling Hybrid Graft. Ann Thorac Surg. 2019 Dec;108(6):1768-1775. doi: 10.1016/j.athoracsur.2019.04.121. Epub 2019 Jun 27.
Results Reference
background
PubMed Identifier
34010408
Citation
Montagner M, Kofler M, Heck R, Buz S, Starck C, Kurz S, Falk V, Kempfert J. Initial experience with the new type A arch dissection stent: restoration of supra-aortic vessel perfusion. Interact Cardiovasc Thorac Surg. 2021 Jul 26;33(2):276-283. doi: 10.1093/icvts/ivab085.
Results Reference
background

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DARTS I Feasibility Study

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