A multi-center, non-randomized, single-arm, prospective trial evaluating the safety and effectiveness of the S.M.A.R.T.™ Nitinol Stent System implantation in approximately 250 patients with obstructive superficial femoral artery disease.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
250
The Cordis S.M.A.R.T.® Nitinol Stent System is a self-expandable, crush recoverable stent with a diameter larger than that of the arterial lumen. The stent is indicated for use in a vessel with a diameter 1 to 2 mm smaller than the nominal stent diameter. This stent will open to the diameter of the artery and will continue to apply expanding force on the artery.
Columbia University Medical Center
New York, New York, United States
12-month Primary Patency Rate
Primary patency is defined as no significant reduction of flow detectable by Duplex ultrasound through the index lesion and no further clinically driven target vessel revascularization performed in the interim. Significant reduction of flow is binary restenosis defined as the diameter stenosis \>50% with a peak systolic velocity ratio \>2.0 as measured by Duplex ultrasound.
Time frame: 12 months
Primary Safety Endpoint
Primary safety endpoint is defined as the rate of freedom from all causes of death, index limb amputation, and clinically driven target lesion revascularization (TLR) through 30 days. A clinically driven TLR is any intervention in the stented target lesion following documented recurrent symptomatic leg ischemia by Rutherford/Becker Classification (category 2, 3 or 4), with a resting or exercise ABI ≤ 0.8 and \>50% diameter in-lesion stenosis by angiography. Revascularization of a target lesion with an in-lesion diameter stenosis of \>70% by angiography, in the absence of the previously mentioned ischemic signs or symptoms, will also be considered clinically driven.
Time frame: 30 days
Death Rate at 30-day Post Procedure
Time frame: 30 days
Death at 12-month Post Procedure
Time frame: 12 months
Index Limb Amputation at 30-day Follow up
Index Limb Amputation is defined as surgical removal of all or part of the lower extremity from the toe up.
Time frame: 30 day
Clinically Driven Target Vessel Revascularization (TVR) at 30-day Post Procedure
A clinically driven TVR is any intervention of the target vessel following documented recurrent symptomatic leg ischemia by Rutherford/Becker Classification (category 2, 3 or 4), with a resting or exercise Ankle-Brachial Index (ABI) ≤ 0.8 and \>50% diameter in-lesion stenosis by angiography. Revascularization of a target vessel with an in-lesion diameter stenosis of \>70% by angiography, in the absence of the previously mentioned ischemic signs or symptoms, will also be considered clinically driven.
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Time frame: 30 days
Clinically Driven Target Vessel Revascularization (TVR) at 12-month Post Procedure
A clinically driven TVR is any intervention of the target vessel following documented recurrent symptomatic leg ischemia by Rutherford/Becker Classification (category 2, 3 or 4), with a resting or exercise Ankle-Brachial Index (ABI) ≤ 0.8 and \>50% diameter in-lesion stenosis by angiography. Revascularization of a target vessel with an in-lesion diameter stenosis of \>70% by angiography, in the absence of the previously mentioned ischemic signs or symptoms, will also be considered clinically driven.
Time frame: 12 months
Stent Fracture at 12-month Follow Up
Stent fracture was assessed by x-ray evaluation.
Time frame: 12 months
Index Limb Ischemia at 6-month Follow up
Index Limb Ischemia is defined by Rutherford/Becker Classification categories 3 through 6.
Time frame: 6 months
Index Limb Ischemia at 12-month Follow up
Index Limb Ischemia is defined by Rutherford/Becker Classification categories 3 through 6.
Time frame: 12 months
Rutherford/Becker Classification at 30-day Follow Up
The Rutherford/Becker Classification is a commonly used clinical staging system which allows clinicians to describe and discuss patients with peripheral artery disease. The classification has seven stages as follows: 1. Stage 0 - Asymptomatic, no hemodynamically significant occlusive disease 2. Stage 1 - Mild claudication 3. Stage 2 - Moderate claudication 4. Stage 3 - Severe claudication 5. Stage 4 - Ischemic rest pain 6. Stage 5 - Minor tissue loss, non-healing ulcer, focal gangrene with diffuse pedal ischemia 7. Stage 6 - Major tissue loss, extending above transmetatarsal level, functional foot no longer salvageable
Time frame: 30 days
Rutherford / Becker Classification Category at 12-month Follow Up
Time frame: 12 months
Major Adverse Events at 12-month Post Procedure
Major adverse events included death, index limb ischemia, index limb amputation, clinically driven TLR, and significant embolic events, which were defined as causing end-organ damage.
Time frame: 12 months