Balloon Angioplasty Versus Primary Stenting for the Treatment of Femoropopliteal Artery Chronic Total Occlusions

Chronic Total Occlusion of Artery of the Extremities Clinical Trial

— FACTORY  

Official title:

Balloon Angioplasty Versus Self-expanding Stent for Recanalization of Chronic Total Occlusions of the Femoral Artery

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT01268722
• Other study ID #: 30357/2-12-2010
• Status: Recruiting
• Phase: Phase 3
• First received: December 2, 2010
• Last updated: April 5, 2012
• Start date: December 2010
• Est. completion date: December 2016

Study information

• Verified date: December 2010
• Source: University of Patras
• Contact: Dimitrios Siablis, MD, PhD
• Phone: 2613603219
• Email: siablis[@]upatras.gr
• Is FDA regulated: No
• Health authority: Greece: Ethics Committee
• Study type: Interventional

Clinical Trial Summary

This is a multicenter double-arm randomized trial investigating plain balloon angioplasty versus primary placement of self-expanding nitinol stents after endovascular recanalization of femoral CTOs. Study will recruit up to 200 patients to be adequately powered for detection of a significant difference in vessel patency after 1 year.

Description:

Primary placement of new-generation nitinol stents compared to plain old balloon angioplasty has shown encouraging long-term results in the femoropopliteal artery. However, there is complete lack of data about performance of new-generation nitinol stents in the treatment of chronic total occlusions (CTO) of the Femoral artery. This is a multicenter double-arm randomized trial investigating plain balloon angioplasty versus primary placement of self-expanding nitinol stents after endovascular recanalization of femoral CTOs. Study will recruit up to 200 patients to be adequately powered for detection of a significant difference in vessel patency after 1 year.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 150
• Est. completion date: December 2016
• Est. primary completion date: December 2013
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 30 Years and older

Eligibility

Inclusion Criteria:

• Age >/= 30 years, both genders, no healthy volunteers

• Negative pregnancy test for women of childbearing age

• Symptomatic leg ischemia by Rutherford/Becker Classification (category 3, 4 or 5), i.e. lifestyle-limiting claudication or critical limb ischemia Single completely occluded de-novo superficial femoral artery lesion (femoral artery CTO target lesion)

• Combined overall length of treatable occluded SFA lesion >/= 4.0 cm to </= 15.0 cm, by visual estimate. The occlusion must be treatable with no more than two stents, minimizing the stent overlap.

• Randomization process before successful subintimal or intraluminal recanalization of the lesion in order to evaluate technical success

• Use of re-entry devices at the discretion of the operator

• All lesions are to be located at least three centimeters (3 cm) proximal to the superior edge of the patella

• Reference vessel diameter (RVD) >/= 4.0 mm and </ 6.0 mm by visual assessment

• At least 1 patent infrapopliteal and popliteal artery, i.e., single vessel runoff or better with at least one of three vessels patent (< 50% stenosis) to the ankle or foot

• Poor aortoiliac or common femoral "inflow" (i.e. angiographically defined > 50% stenosis of the iliac or common femoral artery) lesions must be successfully treated prior to treatment of the target lesion

• Bilateral obstructive SFA disease is eligible for enrollment into the study

• Patient or authorized representative must provide written informed consent prior to initiation of study procedures

• Patient must be willing to comply with the specified follow-up protocol

Exclusion Criteria:

• In-stent restenotic lesions (ISR occlusions)

• Distal popliteal of 3-vessel tibial occlusion

• Patients on hemodialysis because of heavily calcified vessels

• Recent thrombophlebitis, uremia, or deep venous thrombus (within past 30 days)

• Patients receiving dialysis or immunosuppressant therapy

• Thrombolysis of the target vessel within 72 hours prior to the index procedure with residual intraluminal thrombi

• Recent major stroke within the past 6 months

• Aneurysmal disease of the aorta, iliac, femoral or popliteal arteries

• Required stent placement across or within 0.5 cm of the femoral bifurcation

• Significant vessel tortuosity or other parameters prohibiting access to the lesion or 90° tortuosity which would prevent delivery of a stent device if necessary

• Known allergies to the following: aspirin, clopidogrel bisulfate (Plavix®) or ticlopidine (Ticlid®), heparin, Nitinol (nickel titanium), contrast agent, that cannot be medically managed

• Serum creatinine level >/= 2.5 mg/dl at time of screening visit

• Known or suspected active infection at the time of the procedure

• Bleeding diathesis

• Presence of an aortic, iliac or femoral artificial graft

• Life expectancy less than one year, or any other factors preventing clinical follow-up.

• Use of cryoplasty, laser, or atherectomy devices on the target vessel at the time of index procedure

• Patient is unwilling or unable to comply with procedures specified in the protocol or has difficulty or inability to return for follow-up visits as specified by the protocol

• Patient is known to be pregnant, incarcerated, mentally incompetent, and/or alcohol or drug abuser

• Patient is currently participating in any other investigational drug or medical device study that has not completed primary endpoint(s) evaluation or clinically interferes with the endpoints from this study or future participation in such studies prior to the completion of this study.

• Patient has had major surgical or interventional procedures unrelated to this study within 30 days prior to this study or planned surgical or interventional procedures within 30 days of entry into this study.

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Chronic Total Occlusion of Artery of the Extremities

Intervention

Device:
• Balloon angioplasty
This arm will include patients randomized to undergo the treatment of a chronic total occlusion of the femoropopliteal artery with the use of balloon angioplasty
• Primary stenting
This arm will include patients randomized to undergo primary stenting of the femoropopliteal chronic total occlusion

Locations

Country	Name	City	State
Greece	Attikon University Hospital	Athens	Attiki
Greece	Heraklion University Hospital	Heraklion
Greece	Patras University Hospital	Rion	Achaia
Italy	Insubria University Hospital	Varese
United Kingdom	Guy's and St Thomas' Hospitals, NHS Foundation Trust	London

Sponsors (1)

Lead Sponsor	Collaborator
University of Patras

Countries where clinical trial is conducted

Greece,  Italy,  United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Primary patency	Primary patency after 6 months follow-up defined as no significant reduction of flow detectable by vascular imaging through the index lesion and without any further clinically driven target vessel revascularization performed in the interim	Immediate and at 6 months follow-up	No
Primary	Primary Patency	Primary patency after 12 months follow-up defined as no significant reduction of flow detectable by vascular imaging through the index lesion and without any further clinically driven target vessel revascularization performed in the interim	12 months	No
Secondary	Freedom from major adverse event	30-days, 6 months and 1 year freedom from all causes of death, index limb amputation and target vessel recanalization (TVR)	30-days to 1year	Yes
Secondary	Binary vessel restenosis	6-month and 1-year binary vessel restenosis (>50%) defined by Duplex (=50% restenosis based on a peak systolic velocity ratio = 2.5), CTA, MRA or DSA according to well-established radiological criteria	6 months to 1 year	No
Secondary	Secondary vessel patency	Secondary patency up to 12 months follow-up defined as no significant reduction of flow detectable by vascular imaging through the index lesion following the loss of primary patency	Immediate to 1 year	No
Secondary	AHA Clinical Improvement Score		At 3 months, 6 months and 1 year	Yes
Secondary	QALY estimation	QALY estimation of the two study methods with the use of the SF36 questionnaire	At 6 months and 1 year	No