The BIOPACT RCT tiral investigates the efficacy and safety of stenosis, restenosis or occlusions in the femoropopliteal artery of patients presenting a rutherford classification 2,3 or 4 with a Passeo-18 Lux drug-coated balloon of Biotronik. The Paclitaxel eluting balloons are designed for percutaneous transluminal angioplasties in which the balloon will dilate the artery upon inflation and deliver the paclitaxel locally. An expected total of 151 patients will be treated with the Passeo-18 Lux and compared to a control group of another 151 patients that will be treated with the IN.PACT Admiral drug-coated balloon of Medtronic. Assignment to the treatment groups will be at random. The study will be conducted in two phases. A first pilot study phase of 120 patients distributed evenly over both treatment groups and a second phase to formally test the non-inferiority hypothesis. The balloon is coated with Paclitaxel intended to avoid cellular proliferation. The drug is released by means of rapid inflation as to release a high dose in a short amount of time. Patients will be invited for a follow-up visit at 1, 6 and 12 months post-procedure. The primary efficacy endpoints are defined as follows. Freedom from clinically-driven target lesion revascularization at 12 months. Freedom from device- and procedure-related death through 30 days post-index procedure, major target limb amputation through 12 months post-procedure and clinically-driven target vessel revascularization through 12 months post-index procedure. The secondary endpoints are defined as acute device success, acute procedural success , freedom from all cause of death, major target limb amputation and clinically driven target vessel revascularisation through 30 days post-procedure, sustained clinical improvement, no major adverse events through 6 and 12 months post-procedure, primary patency, target lesion revascularisation, target vessel revascularisation, binary restenosis, major target limb amputation, thrombosis at target lesion, change of walking impairment questionnaire score from baseline, change in target limb rutherford classification or ABI.
The objective of this clinical investigation is to assess the safety and efficacy of the Passeo-18 Lux DCB for the treatment of stenotic, restenotic or occlusive lesions of the femoropopliteal arteries. Furthermore a non-inferiority hypothesis will be tested with the IN.PACT Admiral DCB as comparator. The patients will be selected based on the investigator's assessment, evaluation of the underlying disease and the eligibility criteria. The patient's medical condition should be stable, with no underlying medical condition which would prevent them from performing the required testing or from completing the study. Patients should be geographically stable, willing and able to cooperate in this clinical study, and remain available for long term follow-up. The patient is considered enrolled in the study after obtaining the patients informed consent, if there is full compliance with the study eligibility criteria and after successful guidewire passage through the study target lesion. Prior to the index procedure the following will be collected: an informed consent for data collection, demographics, medical history, medication record, physical examination, clinical category of acute limb ischemia (Rutherford category), the resting ankle-brachial index (ABI), blood sample test (complete blood count, comprehensive metabolic panel and if applicable pregnancy test) and a walking impairment questionnaire. During the procedure the guidewire will cross the entire study lesion after which the lesion will be assessed through angiography. A pre-dilatation with a standard non-drug-coated balloon will be performed followed by a dilatation of the lesion with either a Passeo-18 Lux (Biotronik) or an IN.PACT Admiral balloon (Medtronic). If dilatation was not successful (\>30% stenosis, perforation, occlusive or flow limiting dissection) prolonged inflation should be attempted after which bail-out stenting with a bare nitinol stent is allowed in case of inadequate results. The regular follow-up is necessary to monitor the condition of the patient and the results of the procedure. The patients will be invited for the following required follow-up visits at 1,6 and 12 months. During these visit the following data will be collected: medication record, physical exam, target limb ABI and Rutherford classification, duplex ultrasound of target vessel, walking impairment questionnaire and possible adverse events.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
302
Percutaneous endovascular angioplasty with the Passeo-18 lux
Percutaneous endovascular angioplasty with the IN.PACT Admiral
Medical University of Graz
Graz, Graz, Austria
Hanusch Hospital
Vienna, Vienna, Austria
UZA
Antwerp, Antwerp, Belgium
OLV Ziekenhuis Aalst
Aalst, Oost-Vlaanderen, Belgium
Imelda Hospital
Bonheiden, Belgium
A.Z. Sint-Blasius
Dendermonde, Belgium
Z.O.L.
Genk, Belgium
R.Z. Heilig Hart
Tienen, Belgium
CHU Bordeaux
Bordeaux, Nouvelle-Aquitaine, France
Clinique Pasteur
Toulouse, Occitanie, France
...and 4 more locations
freedom from clinically-driven target lesion revascularization (CD-TLR) at 12 months post-procedure
defined as any reintervention at the target lesion due to the following symptoms: drop of ABI \>20% or ABI \>0.15 compared to the post-procedure ABI.
Time frame: 12 months post-procedure
Safety composite: number of participants who deceased, had major amputation, or target vessel revascularization (CD-TVR)
composite of (1) freedom from device- and procedure-related death through 30 days post-index procedure, (2) freedom from major target limb amputation (above-the-ankle (ATA)) through 12 months post-procedure or (3) clinically-driven target vessel revascularization (CD-TVR) through 12 months post-index procedure
Time frame: 12 months post-procedure
acute device success
defined as successful delivery, balloon inflation, deflation and retrieval of the intact study device without burst below rated burst pressure
Time frame: Index procedure
acute procedural success
defined as restoration of the target lesion with ≤30% residual stenosis in the final angiogram
Time frame: index procedure
freedom from all causes of death, freedom from major target limb amputation and freedom from CD-TVR through 30 days
freedom from all cause death, major target limb amputation and CD-TVR through 30 days post-procedure
Time frame: 1 month post-procedure
Sustained clinical improvement
defined as freedom from major target limb amputation, TVR, worsening target limb Rutherford class (compared to baseline) and decrease in target limb ankle brachial index (ABI) or toe brachial index (TBI) ≥0.15 (compared to baseline)
Time frame: 6 and 12 months post-procedure
freedom from major adverse events
defined as composite of all-cause death, CD-TVR and major target limb amputation, or thrombosis at the target lesion
Time frame: 6 and 12 months post-procedure
primary patency rate
defined as a composite of freedom from clinically-driven target lesion revascularization (CD-TLR) and binary restenosis (restenosis defined as duplex ultrasound (DUS) peak systolic velocity ratio (PSVR) ≥2.4 or ≥50% stenosis as assessed by an independent DUS core lab) through 12 months post-index procedure
Time frame: 6 and 12 months post-procedure
freedom from target lesion revascularisation
defined as a reintervention to maintain or restore the patency in the target lesion. TLR is clinically-driven (CD) when the TLR was needed due to symptoms or drop of ankle brachial index (ABI) of ≥20% or \>0.15 when compared to post-procedure
Time frame: 6 and 12 months post-procedure
freedom from target vessel revascularisation
defined as a reintervention to maintain or restore the patency in the target vessel. TVR is clinically-driven (CD) when the TVR was needed due to symptoms or drop of ankle brachial index (ABI) of ≥20% or \>0.15 when compared to post-procedure
Time frame: 6 and 12 months post-procedure
freedom from binary restenosis
defined as restenosis confirmed by DUS PSVR ≥2.4 or ≥50% stenosis as assessed by independent angiographic and DUS core labs
Time frame: 6 and 12 months post-procedure
freedom from major target limb amputation
defined as an amputation above the ankle in the target limb
Time frame: 6 and 12 months post-procedure
freedom from thrombosis at target lesion
freedom from thrombosis at target lesion
Time frame: 6 and 12 months post-procedure
change in walking impairment questionnaire score from baseline to 6 and 12 months
change in walking impairment questionnaire (WIQ) score from baseline to 6 and 12 months. The WIQ consists of 6 sections each consisting of multiple questions. Each question is scored from 0 to 4 (0 meaning a lot of problems and 4 no problems at all). The scores per section are summed up and recalculated to percentages (100% meaning very good and 0% meaning very bad). All the sections are averaged to give the final WIQ-score.
Time frame: 6 and 12 months post-procedure
change in target limb rutherford class from baseline to 6 and 12 months
change in target limb rutherford class from baseline to 6 and 12 months
Time frame: 6 and 12 months post-procedure
change in target limb resting ABI or TBI from baseline to 6 and 12 months
change in target limb resting ABI or TBI from baseline to 6 and 12 months
Time frame: 6 and 12 months post-procedure
freedom from all causes of death
freedom from all causes of death
Time frame: 6 and 12 months post-procedure
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