Intima Versus Adventitia Drug Delivery to Elucidate Mechanisms of Restenosis: Magnetic Resonance Imaging

a study on Peripheral Arterial DiseaseVascular DiseaseCritical Limb IschemiaMRI

Summary

for people ages 35 years and up (full criteria)
at San Francisco, California and other locations
study started
estimated completion
Warren Gasper

Description

Summary

This is a prospective, multicenter, randomized trial to determine the mechanisms of vascular healing. The study will evaluate subjects with peripheral artery disease (PAD) who require an endovascular intervention of the femoro-popliteal (SFA) artery to restore blood flow to the leg.

Details

Peripheral artery disease (PAD) affects at least 12 million Americans annually with more than half a million patients undergoing an endovascular or surgical revascularization procedure in order to treat the disease. Unfortunately, about two-thirds of patients still have blockages in the leg arteries, even after these procedures.

Advances in Magnetic resonance imaging (MRI) offer promise for understanding the mechanism of failure through insights into vessel wall composition, remodeling, and inflammation. Restenosis has a known relationship to inflammation. Advances in micro-catheter technologies offer the ability to deliver anti-inflammatory medications such as Dexamethasone (DEX) directly to the adventitia and advances in drug delivery on balloon surfaces to deliver paclitaxel to the intima of the artery.

This study aims to investigate if patient-specific parameters affect angioplasty outcomes, if DEX has a biological effect on the vessel wall, and if this effect is through the reduction of inflammation.

Keywords

Peripheral Artery DiseaseVascular DiseaseCritical Limb Ischemiaangioplastyperipheral vascular diseaseatherosclerosisballoon angioplastydexamethasonedrug coated balloonpaclitaxelwalkingclaudicationIschemiaVascular DiseasesPeripheral Arterial DiseaseDexamethasone acetateBB 1101Dexamethasone infusion

Eligibility

You can join if…

Open to people ages 35 years and up

Screening:

  1. Male or non-pregnant female ≥ 35 years of age
  2. Atherosclerotic, infrainguinal PAD
  3. Rutherford Clinical Category 2-6
  4. Stenosis detected by radiology that in the clinician's opinion is the reason for the PAD symptoms
  5. Patient is willing to provide informed consent and comply with the required follow up visits, testing schedule, and medication regimen
  6. Estimated Glomerular Filtration Rate (eGFR) ≥ 30 and/or threshold established by the local Institutional Review Board or Committee of Human Research

Procedural Criteria:

  1. De novo atherosclerotic lesion qualifying for angioplasty
  2. A patent artery proximal to the index lesion. Concomitant inflow procedures, including open femoral artery endarterectomy and/or stenting of the iliac arteries, are permissible.
  3. >50% diameter stenosis of the superficial femoral artery and/or popliteal artery (between the profunda and tibioperoneal trunk)
  4. Reference vessel diameter ≥3 mm and ≤ 8mm
  5. Successful wire crossing of lesion
  6. Successful angioplasty of the index lesion or part of the index lesion, defined as ≤30% residual lumen stenosis compared with adjacent non-diseased lumen diameter, without flow-limiting dissection

You CAN'T join if...

Screening Criteria:

  1. Any contraindication to receiving an MRI
  2. Pregnant, nursing, or planning on becoming pregnant in < 2yrs
  3. Life expectancy of < 1 yr
  4. History of solid organ transplantation
  5. Patient actively participating in another investigational device or drug study
  6. History of hemorrhagic stroke within 3 months of index procedure
  7. Previous or planned surgical or interventional procedure within 30 days of index procedure
  8. Chronic renal insufficiency with eGFR < 30
  9. Prior bypass surgery, stenting, atherectomy or angioplasty of the index lesion
  10. . Inability to take required study medications
  11. . Contra-indication or known hypersensitivity to dexamethasone sodium phosphate, contrast media, gadolinium, aspirin or Plavix
  12. . Systemic fungal infection
  13. . Acute limb ischemia
  14. . Prior participation of the index limb in the current study (contralateral treatment is allowed)
  15. . Patient is being treated with long-term steroids (not including treatment of a bronchial condition with inhaled steroids)

Procedural Criteria:

  1. Index lesions extending into the tibial trifurcation or above the profunda. Note: the outflow tibial artery can be treated concomitantly. Similarly, the common femoral artery can be treated concomitantly, either with open endarterectomy and patch angioplasty or with endovascular methods. However, the index lesion cannot be contiguous with either the CFA or the tibial trifurcation.
  2. Circumferential calcification at index lesion, which in the judgment of the investigator would prevent penetration of the Micro-Infusion catheter needle through the vessel wall
  3. Inadequate distal outflow defined as no patent tibial arteries (>50% stenosis). The outflow vessel can be established at the time of primary treatment
  4. Use of adjunctive therapies other than angioplasty. Chocolate balloons and/or scoring balloons are allowed, if used below reference diameter.

Locations

  • San Francisco VA Medical Center accepting new patients
    San FranciscoCalifornia94121United States
  • University of Washington accepting new patients
    SeattleWashington98104United States

Lead Scientist

  • Warren Gasper
    My current research interests fall broadly into the categories of vein / vein graft physiology and advanced endovascular aneurysm therapies.

Details

Status
accepting new patients
Start Date
Completion Date
(estimated)
Sponsor
University of California, San Francisco
ID
NCT02807779
Phase
Phase 4
Study Type
Interventional
Last Updated