To demonstrate the efficacy and safety of the Bashir™ Endovascular Catheter for the administration of pharmaco-mechanical catheter directed therapy using pulse spray of r-tPA for the treatment of acute submassive pulmonary embolism
Study Objective To demonstrate the efficacy and safety of the Bashir™ and Bashir™ S-B Endovascular Catheters for the administration of pharmaco- mechanical catheter directed therapy in a pulse spray mode using low dose r-tPA for the treatment of acute submassive pulmonary embolism. Endpoints Primary Efficacy Endpoint Reduction in RV/LV diameter ratio as measured by CTA within 48 hours after the completion of r-tPA treatment. Primary Safety Endpoint Major bleeding, as defined by International Society of Thrombosis and Hemostasis (ISTH), within 72 hours of initiation of r- tPA infusion. ISTH major bleeding in non-surgical patients is defined as having a symptomatic presentation and: a. Fatal bleeding; and/or b. Symptomatic bleeding in a critical area or organ, such as intracranial, intraspinal, intraocular, retroperitoneal, intra- articular or pericardial, or intramuscular with compartment syndrome; and/or c. Bleeding causing a fall in hemoglobin level of 2.0g/dL (1.24mmol/L) or more or leading to transfusion of two or more units of whole blood or red cells. Secondary Endpoints 1. Refined Modified Miller Score as measured on CTA within 48 hours after the completion of the r-tPA infusion compared to baseline as measured by core lab. 25 2. All-cause mortality at hospital discharge through 30-day follow-up. 3. SAEs through 30-day follow-up. 4. AEs through 30-day follow-up. 5. UADEs through 30-day follow-up. 6. Recurrent PE through 30-day follow-up. 7. Clinically Relevant Non-Major bleeding: Any sign or symptom of hemorrhage (e.g. more bleeding than would be expected for a clinical circumstance, including bleeding found by imaging alone) that does not fit the criteria for the ISTH definition of major bleeding but does meet at least one of the following criteria: 1. Requiring medical intervention by a healthcare professional. 2. Leading to hospitalization or increased level of care. 3. Prompting a face to face (i.e., not just a telephone or electronic communication) evaluation. 8. Technical procedural complications. 9. Systolic PA pressure measured at completion of pulse sprays and after BEC(s) removal and compared to baseline. 10. Cardiac output (CO by Modified Fick calculation) and cardiac index (CI) following completion of the r-tPA pulse sprays compared to the baseline. Please refer to Terms and Definitions section for the Modified Fick calculation to be done in the IR suite / cath lab at baseline and after BEC removal).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
To demonstrate the efficacy and safety of the Bashir™ Endovascular Catheter for the administration of pharmaco-mechanical catheter directed therapy using pulse spray of r-tPA for the treatment of acute submassive pulmonary embolism.
Temple University
Philadelphia, Pennsylvania, United States
Reduction in RV/LV diameter ratio as measured by contrast enhanced chest CT from baseline within 48 ± 6 hours of initiation of treatment. chest CT (CTA) within 48 hours after the completion of r-tPA treatment
Reduction in RV/LV diameter ratio as measured by contrast enhanced chest CT (CTA) within 48 hours after the completion of r-tPA treatment
Time frame: Through 30 day follow-up
Primary Safety Endpoint, major bleeding, as defined by International Society of Thrombosis and Hemostasis (ISTH), within 72 hours of initiation of rtPA infusion. ISTH major bleeding in non-surgical patients is defined as having a symptomatic presentation
Major bleeding, as defined by International Society of Thrombosis and Hemostasis (ISTH), within 72 hours of initiation of rtPA infusion. ISTH major bleeding in non-surgical patients is defined as having a symptomatic presentation and: 1. Fatal bleeding; and/or 2. Symptomatic bleeding in a critical area or organ, such as intracranial, intraspinal, intraocular, retroperitoneal, intraarticular or pericardial, or intramuscular with compartment syndrome; and/or Bleeding causing a fall in hemoglobin level of 2.0g/dL (1.24mmol/L) or more or leading to transfusion of two or more units of whole blood or red cells
Time frame: 72 hours
Refined Modified Miller Score
Refined Modified Miller Score as measured on CTA within 48 hours after the completion of the r-tPA infusion compared to baseline as measured by core lab
Time frame: Within 48 hours of completion of r-TPA
All-cause mortality
All-cause mortality at hospital discharge through 30-day follow-up.
Time frame: 30 DAYS
Serious adverse events
Serious adverse events through 30-day follow-up
Time frame: 30 days
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Adverse events
Adverse events through 30-day follow-up
Time frame: 30 days
Unanticipated adverse device events
Unanticipated adverse device events through 30-day follow-up
Time frame: 30 days
Recurrent pulmonary embolism through 30-day follow-up.
Recurrent pulmonary embolism through 30-day follow-up.
Time frame: 30 days
Clinically relevant non-major bleeding
Any sign or symptom of hemorrhage (e.g. more bleeding than would be expected for a clinical circumstance, including bleeding found by imaging alone) that does not fit the criteria for the ISTH definition of major bleeding but does meet at least one of the following criteria: 1. Requiring medical intervention by a healthcare professional. 2. Leading to hospitalization or increased level of care. 3. Prompting a face to face (i.e., not just a telephone or electronic communication) evaluation
Time frame: 30 days
Technical procedural complications.
Technical procedural complications.
Time frame: 1 day
Systolic PA pressure
Systolic PA pressure measured at completion of pulse sprays and after BEC(s) removal and compared to baseline
Time frame: Once r-tPA pulse sprays are given continue therapeutic anticoagulation with full does heparin or LMWH with sheaths sutured in place
Cardiac output (CO by Modified Fick calculation) and cardiac index (CI) following completion of the r-tPA pulse
Cardiac Index: Hemodynamic parameter that relates the cardiac output (CO) from right or left ventricle in one minute to body surface area (BSA), thus relating heart performance to the size of the individual. The unit of measurement is liters per minute per square meter (L/min/m2 ). CI = CO/BSA
Time frame: End of procedure