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).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
186
Clinique d'Antony
Antony, France
CHU de Besançon
Besançon, France
CHU de Bordeaux
Bordeaux, France
Centre Hospitalier Pierre Oudot Bourgoin Jallieu
Bourgoin, France
CHU de Clermont Ferrand
Clermont-Ferrand, France
AP-HP, Hôpital Henri Mondor
Créteil, France
CHU de Lyon
Lyon, France
CHU Nantes
Nantes, France
Clinique Ollioules
Ollioules, France
CHU de Rennes
Rennes, France
...and 1 more locations
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.
Time frame: 1 year
residual diameter stenosis
Technical success defined achievement of a final residual diameter stenosis of \<30% on the procedural completion angiogram.
Time frame: Day 0
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.
Time frame: 1 month, 12 months and 24 months
Secondary sustained clinical improvement
primary sustained clinical improvement including the need for repeated TLR.
Time frame: 1 month, 12 months and 24 months
Primary patency
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
Major adverse events
MACEs including all deaths, major amputation.
Time frame: 1 month, 12 months and 24 months
Limb salvage
freedom from major ipsilateral amputations
Time frame: 1 month, 12 months and 24 months
Death
Death (all cause)
Time frame: 1 month, 12 months and 24 months
Ankle brachial index
Ankle brachial index
Time frame: 1 month, 6 months, 12 months and 24 months
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.
Time frame: 1 month, 12 months and 24 months
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.
Time frame: 1 month, 12 months and 24 months
Stent fracture
Stent fractures were assessed by biplane x-rays
Time frame: 1 month, 12 months and 24 months
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
Time frame: 1 month, 12 months and 24 months
Economic analysis objective
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
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