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Diamondback in Peripheral Vascular Disease (DIAMOND-PAD)

Primary Purpose

Peripheral Vascular Diseases, Critical Limb Ischemia

Status
Terminated
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Treatment with CSI atherectomy device
Sponsored by
Arkansas Heart Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Peripheral Vascular Diseases

Eligibility Criteria

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

Inclusion Criteria:

  • • Patient with lower extremity claudication and PAD due to significant SFA or below the knee stenosis (50%≤99%) or total occlusions (100%) that affects the quality of life despite medical therapy.

    • Evidence of significant SFA or below the knee disease involving the most symptomatic limb by noninvasive vascular testing with the use of the following:

      • ABI: <0.9 (If ABI>1.4, SFA systolic acceleration time should be > 140 milliseconds);
      • TBI: <0.6;
      • Computed Tomographic Angiography (CTA) confirming at least a 50% SFA stenosis with moderate to severe calcification; or
      • Magnetic Resonance Angiography (MRA) confirming at least a 50% SFA or below the knee stenosis with moderate to severe calcification.
    • At least one patent, non-treated below the knee vessel.
    • Male and female patients that are ≥ 18 years of age.
    • Subject has been advised of the beneficial effects of smoking cessation and regular exercise but must not be in the process of changing their smoking status at the time of screening. Patients may resume or increase exercising as an effect of post procedurally improved lower limb perfusion.
    • Peak Walking Time (PWT) limited only by claudication.
    • Willingness to participate in the study, documented by signed, written informed consent.

Exclusion Criteria:

  • • Planned amputation.

    • Any planned/scheduled revascularization procedures ≤ 30 days after baseline procedure.
    • Prior lower extremity revascularization ≤ 30 days before baseline procedure.
    • The target lesion is an in-stent restenosis.
    • Infra-popliteal disease involving the last remaining vessel.
    • Patients with a creatinine clearance < 30mL/min.
    • Patients with known bleeding disorders.
    • Patients with known active pathological bleeding.
    • Patients with known hypersensitivity to acetylsalicylic acid, clopidogrel bisulfate, ticagrelor, Aspirin, or other antiplatelets/anticoagulants.
    • Patients with known history of intracranial hemorrhage at any time, GI bleed in the past 6 months, or major surgery within the past 30 days.
    • Patients with known ischemic stroke during the past 3 months.
    • Patients with known severe liver disease.
    • Patient with known history of congestive heart failure (CHF) with an LVEF of < 30%.
    • Patients considered being at risk of bradycardic events unless treated with a permanent pacemaker.
    • Female patients with known pregnancy, breast feeding, or intend to become pregnant during the study period (all female patients 55 years and younger, without a history of hysterectomy must have a pregnancy test prior to PPI at baseline and at 6 months).
    • Concern for inability of the patient to comply with study procedures and/or follow up (e.g., alcohol or drug abuse).

Sites / Locations

  • Arkansas Heart Hospital
  • Arkansas Site Management Services LLC

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment with CSI atherectomy device

Arm Description

removal of the plaque from vessel wall by optical coherence tomography

Outcomes

Primary Outcome Measures

Change in luminal area gain, measured in mm, in treated segment of the vessel wall
Luminal area gain in the treated segment of the vessel wall between pre-and post-atherectomy OCT images.

Secondary Outcome Measures

Atherectomy OCT Analysis-plaque volume
Changes in calcified total plaque volume as compare to baseline.
Atherectomy OCT Analysis-fibrous tissue
Changes in fibrous tissue amount as compared to baseline
Atherectomy OCT Analysis- new dissections
Number of new dissections present at 7 months as compare to baseline
Atherectomy OCT Analysis-new injuries
Percentage of cross-sectional images with new injury to the adventitia or EEL as compared to baseline
Atherectomy images Analysis-Luminal area loss
Change in Luminal area loss as measure by calcified plaque volume as well as by the presence of lipid and fibrous tissue as compared to baseline
Atherectomy images Analysis-persistent dissections
Percentage of cross-sectional images with persistent dissections as compared to baseline

Full Information

First Posted
February 8, 2018
Last Updated
June 25, 2019
Sponsor
Arkansas Heart Hospital
Collaborators
Abbott Medical Devices
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1. Study Identification

Unique Protocol Identification Number
NCT03455374
Brief Title
Diamondback in Peripheral Vascular Disease
Acronym
DIAMOND-PAD
Official Title
Diamondback Atherectomy With OCT Visualization for Calcified PAD Lesions for Calcified Peripheral Vascular Disease Lesions
Study Type
Interventional

2. Study Status

Record Verification Date
June 2019
Overall Recruitment Status
Terminated
Why Stopped
PI/Sponsor mutual agreement due to poor enrollment
Study Start Date
August 8, 2017 (Actual)
Primary Completion Date
May 13, 2019 (Actual)
Study Completion Date
May 13, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Arkansas Heart Hospital
Collaborators
Abbott Medical Devices

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a prospective, nonrandomized, single-arm study using CSI Orbital Atherectomy System in patients with PAD (total occlusions or significant stenosis). Patients will be enrolled if they have claudication and/or critical limb ischemia, and identifiable PAD disease with moderate to severe calcification on Computer Tomography Angiogram (PCA) or peripheral angiogram requiring percutaneous peripheral intervention (PPI).
Detailed Description
Orbital atherectomy (OA) is one of the most commonly used modalities for the treatment of obstructive femoral-popliteal PAD, especially in patients with large and calcified atherosclerotic plaques, either as stand alone or with subsequent drug-coated balloon angioplasty or stent implantation. These atherectomy procedures were primarily guided by peripheral angiography which has significant resolution limitations in regards to the plaque morphology and characteristics such as extent of calcification, and how deep the cuts are made in the vessel wall. Optical coherence tomography (OCT) has recently emerged as a novel imaging modality. OCT imaging has been used both in coronary as well as in peripheral circulation extensively with no significant device related adverse effects. Previous research has shown the feasibility and safety of OCT use for peripheral artery imaging and its use in plaque characterization. The hypothesis for this study is that; use of diamond back atherectomy device will lead to effective removal of plaque in moderate to heavily calcified arteries without damaging deep into the adventitia or EEL or the adjacent healthy vessel wall and thus will lead to a favorable vascular response during follow up.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Peripheral Vascular Diseases, Critical Limb Ischemia

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Treatment with CSI atherectomy device
Arm Type
Experimental
Arm Description
removal of the plaque from vessel wall by optical coherence tomography
Intervention Type
Device
Intervention Name(s)
Treatment with CSI atherectomy device
Intervention Description
Following peripheral angiography, patients with significant SFA or below the knee artery disease (≥ 50%) or total occlusions (100%) will have a baseline OCT imaging of the target vessel and the lesion be treated with proper size CSI burr. Repeat OCT imaging will be performed after CSI. Drug eluting balloon angioplasty may be performed in discretion of the operator. If DEB is used, a final OCT imaging will be performed to assess lesion expansion and possible dissections. Balloon sizing will be based on 1:1 vessel ratio with the length covering from minimally diseased distal segment to minimally diseased proximal segment. We will try to avoid use of stents.
Primary Outcome Measure Information:
Title
Change in luminal area gain, measured in mm, in treated segment of the vessel wall
Description
Luminal area gain in the treated segment of the vessel wall between pre-and post-atherectomy OCT images.
Time Frame
Baseline and 7 month
Secondary Outcome Measure Information:
Title
Atherectomy OCT Analysis-plaque volume
Description
Changes in calcified total plaque volume as compare to baseline.
Time Frame
0 and 7 months
Title
Atherectomy OCT Analysis-fibrous tissue
Description
Changes in fibrous tissue amount as compared to baseline
Time Frame
0 and 7 months
Title
Atherectomy OCT Analysis- new dissections
Description
Number of new dissections present at 7 months as compare to baseline
Time Frame
0 and 7 months
Title
Atherectomy OCT Analysis-new injuries
Description
Percentage of cross-sectional images with new injury to the adventitia or EEL as compared to baseline
Time Frame
0 and 7 months
Title
Atherectomy images Analysis-Luminal area loss
Description
Change in Luminal area loss as measure by calcified plaque volume as well as by the presence of lipid and fibrous tissue as compared to baseline
Time Frame
0 and 7 months
Title
Atherectomy images Analysis-persistent dissections
Description
Percentage of cross-sectional images with persistent dissections as compared to baseline
Time Frame
0 and 7 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: • Patient with lower extremity claudication and PAD due to significant SFA or below the knee stenosis (50%≤99%) or total occlusions (100%) that affects the quality of life despite medical therapy. Evidence of significant SFA or below the knee disease involving the most symptomatic limb by noninvasive vascular testing with the use of the following: ABI: <0.9 (If ABI>1.4, SFA systolic acceleration time should be > 140 milliseconds); TBI: <0.6; Computed Tomographic Angiography (CTA) confirming at least a 50% SFA stenosis with moderate to severe calcification; or Magnetic Resonance Angiography (MRA) confirming at least a 50% SFA or below the knee stenosis with moderate to severe calcification. At least one patent, non-treated below the knee vessel. Male and female patients that are ≥ 18 years of age. Subject has been advised of the beneficial effects of smoking cessation and regular exercise but must not be in the process of changing their smoking status at the time of screening. Patients may resume or increase exercising as an effect of post procedurally improved lower limb perfusion. Peak Walking Time (PWT) limited only by claudication. Willingness to participate in the study, documented by signed, written informed consent. Exclusion Criteria: • Planned amputation. Any planned/scheduled revascularization procedures ≤ 30 days after baseline procedure. Prior lower extremity revascularization ≤ 30 days before baseline procedure. The target lesion is an in-stent restenosis. Infra-popliteal disease involving the last remaining vessel. Patients with a creatinine clearance < 30mL/min. Patients with known bleeding disorders. Patients with known active pathological bleeding. Patients with known hypersensitivity to acetylsalicylic acid, clopidogrel bisulfate, ticagrelor, Aspirin, or other antiplatelets/anticoagulants. Patients with known history of intracranial hemorrhage at any time, GI bleed in the past 6 months, or major surgery within the past 30 days. Patients with known ischemic stroke during the past 3 months. Patients with known severe liver disease. Patient with known history of congestive heart failure (CHF) with an LVEF of < 30%. Patients considered being at risk of bradycardic events unless treated with a permanent pacemaker. Female patients with known pregnancy, breast feeding, or intend to become pregnant during the study period (all female patients 55 years and younger, without a history of hysterectomy must have a pregnancy test prior to PPI at baseline and at 6 months). Concern for inability of the patient to comply with study procedures and/or follow up (e.g., alcohol or drug abuse).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mehmet Cilingiroglu, MD
Organizational Affiliation
Arkansas Heart Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Arkansas Heart Hospital
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72211
Country
United States
Facility Name
Arkansas Site Management Services LLC
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72211
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Diamondback in Peripheral Vascular Disease

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