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Clinical Study of the BARD® COVERA™ Arteriovenous (AV) Stent Graft (AVeNEW)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02649946
Recruitment Status : Active, not recruiting
First Posted : January 8, 2016
Results First Posted : May 13, 2019
Last Update Posted : June 11, 2020
Sponsor:
Information provided by (Responsible Party):
C. R. Bard

Brief Summary:
The objective of this study is to assess the safety and effectiveness of the COVERA™ Vascular Covered Stent for the treatment of stenotic lesions in the upper extremity venous outflow of the Arteriovenous (AV) access circuit.

Condition or disease Intervention/treatment Phase
Stenosis Restenosis Device: Covera Vascular Covered Stent following PTA Procedure: Percutaneous Transluminal Angioplasty (PTA) with Uncoated PTA Balloon Not Applicable

Detailed Description:
This study will compare the use of the COVERA™ Vascular Covered Stent (following percutaneous transluminal angioplasty (PTA)) to PTA alone for the treatment of stenotic lesions in the upper extremity venous outflow of the arteriovenous (AV) access circuit of subjects dialyzing with an AV fistula.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 280 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Prospective, Multi-Center, Randomized, Concurrently-Controlled Clinical Study of the BARD® COVERA™ Arteriovenous (AV) Stent Graft in the Treatment of Stenosis in the Venous Outflow of AV Fistula Access Circuits (AVeNEW)
Actual Study Start Date : June 2016
Actual Primary Completion Date : August 2018
Estimated Study Completion Date : August 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Angioplasty

Arm Intervention/treatment
Experimental: Covera Vascular Covered Stent following PTA
Placement of the Covera Vascular Covered Stent following percutaneous transluminal angioplasty (PTA)
Device: Covera Vascular Covered Stent following PTA
Treatment of stenoses with primary percutaneous transluminal angioplasty (PTA) and placement of the Covera Vascular Covered Stent.

Active Comparator: PTA only using uncoated PTA Balloon
Percutaneous Transluminal Angioplasty (PTA) will be performed using a commercially available uncoated PTA balloon. Balloons with an external wire support, cutting/scoring component or other similar modifications are not permitted. Multiple balloons, inflations and/or prolonged inflation may be used.
Procedure: Percutaneous Transluminal Angioplasty (PTA) with Uncoated PTA Balloon
Treatment of stenoses with PTA only
Other Name: Standard Balloon Angioplasty (POBA)




Primary Outcome Measures :
  1. Effectiveness Endpoint: Number of Participants With Target Lesion Primary Patency (TLPP) [ Time Frame: 6 months post index procedure ]
    TLPP is defined as the interval following the index intervention until the next clinically driven reintervention at, or adjacent to,the original treatment site or until the extremity is abandoned for permanent access. Primary patency ends when any of the following occurs: a) clinically driven reintervention in the treatment area; b) thrombotic occlusion within the treatment area; c) surgical intervention that excludes the original treatment area from the AV circuit, and/or d) abandonment of the AV fistula due to inability to treat the original treatment area. COVERA Vascular Covered Stent (following PTA) is evaluated against subjects treated PTA alone.

  2. Number of Participants With Freedom From AV Access Circuit Localized or Systemic Serious Adverse Events [ Time Frame: 30 days post index procedure ]
    Safety is defined as freedom from any adverse event(s) (AEs), localized or systemic, that reasonably suggests the involvement of the AV access circuit (not including stenosis or thrombosis) that require or result in any of the following alone or in combination: additional interventions (including surgery); in-patient hospitalization or prolongation of an existing hospitalization; or death.


Secondary Outcome Measures :
  1. Endpoint With Hypothesis Testing: Number of Patients With Target Lesion Primary Patency (TLPP) at 12 Months Post Index Procedure [ Time Frame: 12 months post-index procedure ]
    TLPP is defined as the interval following the index intervention until the next clinically driven reintervention at the original treatment site or until the extremity is abandoned for permanent access. Primary patency ends when any of the following occurs: a) clinically driven reintervention in the treatment area; b) thrombotic occlusion within the treatment area; c) surgical intervention that excludes the original treatment area from the AV circuit, and/or d) abandonment of the AV fistula due to inability to treat the original treatment area. Not all TLPP 12-month data were available at the time of writing the interim analysis report, therefore, the results for this outcome measure will be presented when the final study report is completed.

  2. Endpoint With Hypothesis Testing: Number of Participants With Access Circuit Primary Patency (ACPP). [ Time Frame: 6 months post index procedure ]

    ACPP is defined as the interval following the index intervention until the next access thrombosis or repeated intervention.

    ACPP ends with a reintervention anywhere within the access circuit. Vessel rupture caused by PTA is not an ACPP failure unless achieving hemostasis also causes thrombosis.

    Testing of this secondary endpoint is performed in a hierarchical fashion.Thus, In order to perform hypothesis test of ACPP at 6-month, TLPP at 12-months must be successful.Since not all TLPP at 12-month results were available at time of interim CSR report, results of ACPP at 6-month will be presented when the final report for the study is completed.


  3. Endpoint Without Hypothesis Testing: Number of Participants With Target Lesion Primary Patency (TLPP) [ Time Frame: 1 and 3 months post index procedure ]

    Defined as the interval following the index intervention until the next clinically driven reintervention at the original treatment site or until the extremity is abandoned for permanent access.

    mITT subjects results are presented. N= number of subjects in the mITT Population with evaluable data. Evaluation through 1, 3, 18 and 24 months post index procedure although at the time of this reporting, only the 1 and 3 months data was available.

    Secondary endpoints without formal hypothesis testing are limited to descriptive statistics and are presented, for this outcome, at 1 and 3 months follow-up.


  4. Endpoint Without Hypothesis Testing: Number of Participants With Access Circuit Primary Patency (ACPP) [ Time Frame: 1, 3, 12, 18, and 24 months post index procedure ]

    ACPP is defined as the interval following the index intervention until the next access thrombosis or repeated intervention.

    N = number of subjects in the mITT Population with evaluable data.

    Evaluation through 1, 3, 12, 18 and 24 months post index procedure although at the time of reporting to CT.gov, only the 1 and 3 months data was available.


  5. Endpoint Without Hypothesis Testing: Number of Participants Free From Device and Procedure Related AEs Involving the AV Access Circuit [ Time Frame: Evaluation through 1, 3, 6, 12, 18, and 24 months post-index procedure ]

    Number of Participants Free from Device and Procedure Related AEs Involving the AV Access Circuit (ITT population).

    Number of participants (n) in each follow-up periods varies from overall enrollment (N) as some subjects discontinued participation before the 30 days, 90 days and 6 months follow-up or did not meet endpoint inclusion criteria.

    The relationships with device/procedure of the events are based on CEC adjudications.

    Evaluation through 1, 3, 6, 12, 18 and 24 months post index procedure although at the time of reporting, only the 1, 3 and 6 months data was available.


  6. Endpoint Without Hypothesis Testing: Total Number of Arteriovenous (AV) Access Circuit Reinterventions [ Time Frame: 1, 3, 6, 12, 18 and 24 months post index procedure ]

    Defined as the number of reinterventions to the AV access circuit until access abandonment or through study completion.

    Whereas the outcome measure time frames for the overall study are 1, 3, 6, 12,18 and 24 months, the interim report only provides the 1, 3, and 6 months results. The 12,18 and 24 months results will be provided in the final reporting for the study.

    MITT results are presented for this analysis.


  7. Endpoint Without Hypothesis Testing: Total Number of Target Lesion Reinterventions [ Time Frame: 1, 3, 6, 12, 18 and 24 months post index procedure ]

    Total Number of Target Lesion Reinterventions defined as the number of reinterventions to maintain target lesion patency (mITT subjects).

    Whereas the outcome measure time frames for the overall study are 1, 3, 6, 12,18 and 24 months, this preliminary results report only provides the 1, 3, and 6 months results. The 12,18 and 24 months results will be provided in the final reporting for the study.


  8. Endpoint Without Hypothesis Testing: Index of Patency Function (IPF) [ Time Frame: 1, 3, 6, 12, 18 and 24 months post index procedure ]

    IPF is defined as the time from the index study procedure to study completion or access abandonment divided by the number of visits for a reintervention performed on the AV access circuit in order to maintain vascular access for hemodialysis. A visit is defined as one (1) procedural event, regardless of the number or type of interventions performed during the visit. The index procedure is counted as the first visit to ensure all subjects have a denominator of at least one.

    Whereas the measure time frames for the overall study are 1, 3, 6, 12,18 and 24 months, the preliminary report only provides the 1, 3, and 6 months results. The 12,18 and 24 months results will be provided in the final reporting for the study.

    The IPF is representative of the number of days between interventions to maintain access circuit patency. Higher values represent a better outcome, that is, more time elapsed between the Index study procedure and reinterventions.

    mITT results are analyzed.


  9. Endpoint Without Hypothesis Testing: Index of Patency Function - Target Lesion (IPF-T) [ Time Frame: 1, 3, 6, 12, 18 and 24 months post index procedure ]

    IPF-T (Index of Patency Function - Target Lesion) is defined as the time from the index study procedure to study completion or complete access abandonment divided by the number of visits for a reintervention performed at the target lesion in order to maintain vascular access for hemodialysis.

    Whereas the measure time frames for the overall study are 1, 3, 6, 12, 18 and 24 months, the interim report only provides the 1, 3, and 6 months results. The 12, 18 and 24 months results will be provided in the final reporting for the study.

    The IPF for target lesion patency is representative of the approximate (mean) number of days between interventions to maintain target lesion patency. Higher values represent a better outcome, that is, more time elapsed between the Index study procedure and reinterventions.


  10. Endpoint Without Hypothesis Testing: Number of Participants With Post-intervention Secondary Patency [ Time Frame: 1, 3, 6, 12, 18 and 24 months post index procedure ]

    Secondary Patency is defined as the interval after the index intervention until the access is abandoned. Multiple repetitive treatments can be included in post-intervention secondary patency.

    Whereas the measure time frames for the overall study are 1, 3, 6, 12,18 and 24 months, the interim report only provides the 1, 3, and 6 months results. The 12,18 and 24 months results will be provided in the final reporting for the study.

    mITT subjects results are presented.


  11. Endpoint Without Hypothesis Testing: Number of Participants withTechnical Success (for Stent Graft Placement) [ Time Frame: On Day of Index Procedure ]

    Technical Success is defined as successful deployment, based on the operator's opinion, of the implant to the intended location assessed at the time of the index procedure. Therefore, for this measure, only COVERA data are relevant.

    mITT results are presented. Number of participants (n) included in this analysis is different from overall enrollment (N) as some subjects discontinued participation before the 30 days, 90 days and 6 months follow-up or did not meet endpoint inclusion criteria.

    Technical success was assessed on the day the index procedure was performed, which may be a different day for each participant.


  12. Endpoint Without Hypothesis Testing: Number of Participants With Procedure Success [ Time Frame: On Day of Index Procedure ]

    Procedure Success is defined as anatomic success and resolution of the pre-procedural clinical indicator(s) (clinical success) of a hemodynamically significant stenosis.

    Procedure success was assessed on the day the index procedure was performed, which may be a different day for each participant.




Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   21 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Clinical Inclusion Criteria:

  • Subject must voluntarily sign and date the Informed Consent Form (ICF) prior to collection of study data or performance of study procedures.
  • Subject must be either a male or non-pregnant female ≥ 21 years of age with an expected lifespan sufficient to allow for completion of all study procedures.
  • Subject must be willing to comply with the protocol requirements, including the clinical and telephone follow-up.
  • Subject must have an upper extremity arteriovenous (AV) fistula that has undergone at least one successful dialysis session with two-needle cannulation, prior to the index procedure.

Angiographic Inclusion Criteria:

  • Subject must have angiographic evidence of a stenosis ≥ 50% (by visual estimation) located in the venous outflow of the AV access circuit and present with clinical or hemodynamic evidence of AV fistula dysfunction.
  • The target lesion must be ≤ 9cm in length. Note: multiple stenoses may exist within the target lesion.
  • The reference vessel diameter of the adjacent non-stenotic vein must be between 5.0 and 9.0mm.

Clinical Exclusion Criteria:

  • The subject is dialyzing with an AV graft.
  • The target lesion has had a corresponding thrombosis treated within 7 days prior to the index procedure.
  • The hemodialysis access is located in the lower extremity.
  • The subject has an infected AV fistula or uncontrolled systemic infection.
  • The subject has a known uncontrolled blood coagulation/bleeding disorder.
  • The subject has a known allergy or hypersensitivity to contrast media which cannot be adequately pre-medicated.
  • The subject has a known hypersensitivity to nickel-titanium (Nitinol) or tantalum.
  • The subject has another medical condition, which, in the opinion of the Investigator, may cause him/her to be non-compliant with the protocol, confound the data interpretation, or is associated with a life expectancy insufficient to allow for the completion of study procedures and follow-up.
  • The subject is currently participating in an investigational drug or another device study that has not completed the study treatment or that clinically interferes with the study endpoints. Note: Studies requiring extended follow-up visits for products that were investigational, but have since become commercially available, are not considered investigational studies.

Angiographic Exclusion Criteria:

  • Additional stenotic lesions (≥ 50%) in the venous outflow that are > 3cm from the edge of the target lesion and are not successfully treated (defined as < 30% residual stenosis) prior to treating the target lesion.
  • An aneurysm or pseudoaneurysm is present within the target lesion.
  • The location of the target lesion would require the COVERA™ Vascular Covered Stent be deployed across the elbow joint.
  • The target lesion is located within a stent.
  • The location of the target lesion would require that the COVERA™ Vascular Covered Stent be deployed at or across the segment of fistula utilized for dialysis needle puncture (i.e., "cannulation zone").
  • The location of the target lesion would require that the COVERA™ Vascular Covered Stent be placed in the central veins (subclavian, brachiocephalic, superior vena cava (SVC)) or under the clavicle at the thoracic outlet.
  • There is incomplete expansion of an appropriately sized angioplasty balloon to its expected profile, in the operator's judgment, during primary angioplasty at the target lesion prior to randomization.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02649946


Locations
Show Show 24 study locations
Sponsors and Collaborators
C. R. Bard
Investigators
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Principal Investigator: Bart Dolmatch, M.D. The Palo Alto Medical Foundation
  Study Documents (Full-Text)

Documents provided by C. R. Bard:
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Responsible Party: C. R. Bard
ClinicalTrials.gov Identifier: NCT02649946    
Other Study ID Numbers: BPV-14-005
First Posted: January 8, 2016    Key Record Dates
Results First Posted: May 13, 2019
Last Update Posted: June 11, 2020
Last Verified: May 2020
Keywords provided by C. R. Bard:
ESRD
Stenosis
Restenosis
Hemodialysis
AV Fistula
Arteriovenous (AV)
Additional relevant MeSH terms:
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Constriction, Pathologic
Pathological Conditions, Anatomical