Comparison of Primary Long Full Coverage Stenting vs Primary Short Spot Stenting for Long Femoropopliteal Artery Disease.

Study Overview
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Brief Summary
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Hypothesis: Primary long full coverage stenting is superior to primary short spot stenting in the treatment of long (≥80 mm) femoropopliteal artery lesions. Study design : Prospective, randomized, multi-center study A total of 220 subjects with symptomatic peripheral artery disease of lower limbs who meet all inclusion and exclusion criteria will be included. Patients will be randomized in a two by two factorial manner according to the strategy of stenting (long versus short stenting) and the additional use of cilostazol. Each randomization of the enrolled subjects will be done 1:1. Patients will be followed clinically for 1 year after the procedure. Angiographic or CT follow-up will be performed at 1 year.

Conditions
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Claudication

Intervention / Treatment
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* Drug: Percutaneous transluminal angioplasty of femoropopliteal artery lesions with primary long
* Drug: short stenting for the primary outcome and use of cilostazol for 12 months for secondary outcome.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical criteria: Age 20 years of older Symptomatic peripheral artery disease: Moderate or severe claudication (Rutherford category 2 or 3) Critical limb ischemia (Rutherford category 4 or 5) Patients with signed informed consent Anatomical criteria: Target lesion length ≥80 mm by angiographic estimation Stenosis of more than 50 percent or occlusion of the ipsilateral superficial femoral artery At least one patent (less than 50 percent stenosed) tibioperoneal runoff vessel. Exclusion Criteria: Clinical criteria Acute critical limb ischemia Severe critical limb ischemia (Rutherford category 6) Major bleeding history within prior 2 months Known hypersensitivity or contraindication to any of the following medications: heparin, aspirin, clopidogrel or contrast agents Age > 85 years Severe hepatic dysfunction (> 3 times normal reference values) Significant renal dysfunction (Serum creatinine > 2.0 mg/dl Significant leucopenia, neutropenia, thrombocytopenia, anemia, or known bleeding diathesis LVEF < 40% or clinically overt congestive heart failure Pregnant women or women with potential childbearing Life expectancy <1 year due to comorbidity Angiographic criteria Previous bypass surgery or stenting of the superficial femoral artery Untreated inflow disease of the ipsilateral pelvic arteries (more than 50% stenosis or occlusion)

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 79 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: long coverage<br>Primary long full coverage stenting | Drug: Percutaneous transluminal angioplasty of femoropopliteal artery lesions with primary long<br>* Patients will be randomized in a two-by-two factorial manner according to the use of IVUS guidance (IVUS guidance vs. no IVUS guidance) for the PCI and the duration of dual anti-platelet therapy (100 mg/day aspirin and 75mg/day clopidogrel for 6 months vs. 12 months) after PCI. Each randomization of the enrolled subjects will be done 1:1.<br>|
| Active Comparator: short spot<br>primary short spot stenting | Drug: short stenting for the primary outcome and use of cilostazol for 12 months for secondary outcome.<br>* Patients will be randomized in a two-by-two factorial manner according to the use of IVUS guidance (IVUS guidance vs. no IVUS guidance) for the PCI and the duration of dual anti-platelet therapy (100 mg/day aspirin and 75mg/day clopidogrel for 6 months vs. 12 months) after PCI. Each randomization of the enrolled subjects will be done 1:1.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The rate of binary restenosis | The rate of binary restenosis (stenosis of at least 50 percent of the luminal diameter) in the treated segment 12 months after intervention, as determined by computed tomographic angiography (CTA) or catheter angiography according to the stenting strategy | 12months after the index procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ankle-brachial index, etc | Ankle-brachial index at 12 months according to the stenting strategy Maximal walking distance at 12 months according to the stenting strategy The rate of reintervention including repeat endovascular therapy or bypass surgery involving the target lesion The rate of limb salvage at 12 months according to the stenting strategy The rate of major adverse cardiovascular events (MACE) at 12 months according to the stenting strategy | at 12 months according to the stenting strategy |