Clinical trial NCT01566461: IN.PACT Admiral Drug-Coated Balloon vs. Standard Balloon Angioplasty for the Treatment of Superficial Femoral Artery (SFA) and Proximal Popliteal Artery (PPA)
Official title: Randomized Trial of IN.PACT (Paclitaxel) Admiral Drug-Coated Balloon (DCB) vs. Standard Percutaneous Transluminal Angioplasty (PTA) for the Treatment of Atherosclerotic Lesions in the Superficial Femoral Artery (SFA) and/or Proximal Popliteal Artery (PPA)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Femoral Artery Stenosis
Popliteal Artery Stenosis
Femoral Artery Occlusion
Popliteal Artery Occlusion
Keywords: Drug-Coated Angioplasty Balloon
Drug Coated Angioplasty Balloon
Peripheral Artery Disease
Experimental
Percutaneous Transluminal Angioplasty (PTA)
Lead sponsor: Medtronic Endovascular
Sponsor class: INDUSTRY
First posted: 2012-03-29
Enrollment: 331
Sex: ALL
Minimum age (years): 18
Maximum age (years): 85
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of the study is to demonstrate the safety and efficacy of the IN.PACT Admiral drug-coated balloon (DCB) in comparison to any standard balloon for treatment of peripheral arterial disease (PAD) in the superficial femoral artery and proximal popliteal artery.

Detailed description: The IN.PACT SFA Trial enrolled in 2 phases: IN.PACT SFA I and IN.PACT SFA II. The 150-patient IN.PACT SFA I phase is intended to support the second phase IN.PACT SFA II IDE trial with congruent design and protocol. Aggregate data from the two phases is intended to provide statistical power for the 12-month primary safety and effectiveness endpoints.

Eligibility criteria: Inclusion Criteria:

* Age: \> or equal to 18 years and \< or equal to 85 years
* Documented ischemia with Rutherford classification 2, 3, or 4
* Target lesion in the SFA and/or PPA
* Angiographic evidence that target lesion consists of a single de novo or non-stented restenotic lesion or is a combination lesion that meets the following criteria:

  1. 70 - 99% occlusion by visual estimate with lesion length \> or equal to 4 cm and \< or equal to 18 cm
  2. 100% occlusion by visual estimate with lesion length \< or equal to 10 cm
  3. Combination lesions must have a total lesion length of \> or equal to 4 cm and \< or equal to 18 cm with an occluded segment that is \< or equal to 10 cm (by visual estimate)
* Target vessel diameter \> or equal to 4 mm and \< or equal to 7 mm
* Angiographic evidence of adequate distal run-off to the ankle
* Able to walk without assistive devices

Exclusion Criteria:

* Stroke or heart attack within 3 months prior to enrollment
* Enrolled in another investigational drug, device or biologic study
* Any surgical procedure or intervention performed within 30 days prior to or post index procedure
* SFA or PPA disease in the opposite leg that requires treatment at the index procedure
* Failure to successfully cross the target lesion
* Angiographic evidence of severe calcification
* Target lesion requires treatment with alternative therapies such as stenting, laser, atherectomy, cryoplasty, brachytherapy, re-entry devices)
* Known allergies or sensitivity to heparin, aspirin, other anticoagulant/antiplatelet therapies, paclitaxel or contrast media that cannot be adequately pre-treated prior to index procedure
* Chronic kidney disease

Primary outcomes:
measure: Primary Patency
timeFrame: 12 month
measure: Primary Safety Composite
timeFrame: 12 month
Secondary outcomes:
measure: Major Adverse Event (MAE) Composite
timeFrame: 12 month
measure: All-cause Death
timeFrame: 12 month
measure: Target Vessel Revascularization (TVR)
timeFrame: 12 month
measure: Target Lesion Revascularization (TLR)
timeFrame: 12 month
measure: Time to First Clinically Driven Target Lesion Revascularization (CD-TLR)
timeFrame: 12 month
measure: Major Target Limb Amputation
timeFrame: 12 month
measure: Thrombosis at the Target Lesion
timeFrame: 12 month
measure: Primary Sustained Clinical Improvement
timeFrame: 12 month
measure: Secondary Sustained Clinical Improvement
timeFrame: 12 month
measure: Duplex-defined Binary Restenosis (Peak Systolic Velocity Ratio (PSVR) >2.4)
timeFrame: 12 month
measure: Duplex-defined Binary Restenosis (Peak Systolic Velocity Ratio (PSVR) >3.4)
timeFrame: 12 month
measure: Quality of Life Assessment by EuroQol Group 5-Dimension Self-Report Questionnaire (EQ5D)
timeFrame: 12 month
measure: Change in Walking Distance as Assessed by Six Minute Walk Test (6MWT)
timeFrame: From baseline to 12 month
measure: Walking Capacity Assessment by Walking Impairment Questionnaire (WIQ)
timeFrame: 12 month
measure: Device Success
timeFrame: Day 1
measure: Procedural Success
timeFrame: Day 1
measure: Clinical Success
timeFrame: Day 1
measure: Days of Hospitalization Due to the Index Lesion
timeFrame: 12 month
Other outcomes:
Locations:
city: Fremont
country: United States
facility: Washington Hospital
state: California
city: Honolulu
country: United States
facility: Kaiser Permanente Hawaii
state: Hawaii
Study officials:
References:
citation: Krishnan P, Farhan S, Schneider P, Kamran H, Iida O, Brodmann M, Micari A, Sachar R, Urasawa K, Scheinert D, Ando K, Tarricone A, Doros G, Tepe G, Yokoi H, Laird J, Zeller T. Determinants of Drug-Coated Balloon Failure in Patients Undergoing Femoropopliteal Arterial Intervention. J Am Coll Cardiol. 2022 Sep 27;80(13):1241-1250. doi: 10.1016/j.jacc.2022.06.043.
citation: Shishehbor MH, Schneider PA, Zeller T, Razavi MK, Laird JR, Wang H, Tieche C, Parikh SA, Iida O, Jaff MR. Total IN.PACT drug-coated balloon initiative reporting pooled imaging and propensity-matched cohorts. J Vasc Surg. 2019 Oct;70(4):1177-1191.e9. doi: 10.1016/j.jvs.2019.02.030.
citation: Laird JA, Schneider PA, Jaff MR, Brodmann M, Zeller T, Metzger DC, Krishnan P, Scheinert D, Micari A, Wang H, Masters M, Tepe G. Long-Term Clinical Effectiveness of a Drug-Coated Balloon for the Treatment of Femoropopliteal Lesions. Circ Cardiovasc Interv. 2019 Jun;12(6):e007702. doi: 10.1161/CIRCINTERVENTIONS.118.007702. Epub 2019 Jun 14.
citation: Schneider PA, Laird JR, Doros G, Gao Q, Ansel G, Brodmann M, Micari A, Shishehbor MH, Tepe G, Zeller T. Mortality Not Correlated With Paclitaxel Exposure: An Independent Patient-Level Meta-Analysis of a Drug-Coated Balloon. J Am Coll Cardiol. 2019 May 28;73(20):2550-2563. doi: 10.1016/j.jacc.2019.01.013. Epub 2019 Jan 25.
citation: Schneider PA, Laird JR, Tepe G, Brodmann M, Zeller T, Scheinert D, Metzger C, Micari A, Sachar R, Jaff MR, Wang H, Hasenbank MS, Krishnan P; IN.PACT SFA Trial Investigators. Treatment Effect of Drug-Coated Balloons Is Durable to 3 Years in the Femoropopliteal Arteries: Long-Term Results of the IN.PACT SFA Randomized Trial. Circ Cardiovasc Interv. 2018 Jan;11(1):e005891. doi: 10.1161/CIRCINTERVENTIONS.117.005891.
citation: Laird JR, Schneider PA, Tepe G, Brodmann M, Zeller T, Metzger C, Krishnan P, Scheinert D, Micari A, Cohen DJ, Wang H, Hasenbank MS, Jaff MR; IN.PACT SFA Trial Investigators. Durability of Treatment Effect Using a Drug-Coated Balloon for Femoropopliteal Lesions: 24-Month Results of IN.PACT SFA. J Am Coll Cardiol. 2015 Dec 1;66(21):2329-2338. doi: 10.1016/j.jacc.2015.09.063. Epub 2015 Oct 14.
citation: Tepe G, Laird J, Schneider P, Brodmann M, Krishnan P, Micari A, Metzger C, Scheinert D, Zeller T, Cohen DJ, Snead DB, Alexander B, Landini M, Jaff MR; IN.PACT SFA Trial Investigators. Drug-coated balloon versus standard percutaneous transluminal angioplasty for the treatment of superficial femoral and popliteal peripheral artery disease: 12-month results from the IN.PACT SFA randomized trial. Circulation. 2015 Feb 3;131(5):495-502. doi: 10.1161/CIRCULATIONAHA.114.011004. Epub 2014 Dec 3.