ABLUMINUS DES BTK Registry - FIM

Sponsor

Concept Medical Inc. (Industry)

Overall Status

Recruiting

CT.gov ID

NCT04562740

Collaborator

(none)

Enrollment

Location

Arm

39.4

Anticipated Duration (Months)

0.8

Patients Per Site Per Month

Study Details

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.

Condition or Disease	Intervention/Treatment	Phase
Peripheral Artery Disease Arterial Disease of Legs Atherosclerosis	Device: ABLUMINUS DES drug eluting stent	N/A

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.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

30 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Intervention 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.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)

Primary Purpose:

Treatment

Official Title:

ABLUMINUS Below the Knee (BTK) Drug Eluting Stent (DES) Registry (ABLUMINUS BTK) - First in Men

Actual Study Start Date :

Aug 20, 2020

Anticipated Primary Completion Date :

Dec 1, 2022

Anticipated Study Completion Date :

Dec 2, 2023

Arms and Interventions

Arm	Intervention/Treatment
Experimental: ABLUMINUS DES 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.	Device: ABLUMINUS DES drug eluting stent 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.

Arm

Intervention/Treatment

Experimental: ABLUMINUS DES

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.

Device: ABLUMINUS DES drug eluting stent

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.

Outcome Measures

Primary Outcome Measures

Primary patency using duplex ultrasound at 6 months post-procedure [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 [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 [6, 12, 24 months post procedure]
Target lesion patency rate measured by duplex ultrasound
Clinically driven target lesion revascularization [1, 3, 6, 12, 24 months post procedure]
Number of Clinically-driven target lesion revascularization
Major amputation rates [1, 3, 6, 12, 24 months post procedure]
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) [1, 3, 6 and 12 months post procedure]
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 [1, 3, 6, 12, 24 months post procedure]
Descriptive characteristics of wound healing will be recorded
Rutherford classification [3, 6, 12, 24 months post procedure]
Change in Rutherford classification as assessed by the investigator
Adverse Events [1, 3, 6, 12, 24 months post procedure]
Number of Adverse events
Unplanned hospital readmission [Up to 30 days post procedure]
Unplanned hospital related to Critical Limb Ischemia readmission rate
All Cause Mortality [6, 12, 24 months years post procedure]
Number of patients with all-cause death
Hemodynamic outcomes [6 and 12 months post procedure]
Changes in ankle brachial index (ABI) and/or Toe pressures (TP

Eligibility Criteria

Criteria

Ages Eligible for Study:

21 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

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