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A Study of Hemodialysis Arteriovenous Fistulae Stenosis Treated With APERTO

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ClinicalTrials.gov Identifier: NCT02962141
Recruitment Status : Active, not recruiting
First Posted : November 11, 2016
Last Update Posted : November 29, 2018
Sponsor:
Information provided by (Responsible Party):
ZhuHai Cardionovum Medical Device Co., Ltd.

Brief Summary:
To evaluate the safety and efficacy of Paclitaxel Eluting Hemodialysis Shunt Balloon Dilatation Catheter (APERTO) compared with the Balloon Dilatation catheter (OHICHO II) for the treatment of Arteriovenous Fistulae Stenosis in patients undergoing hemodialysis.

Condition or disease Intervention/treatment Phase
Peripheral Arterial Disease Fistula Device: Paclitaxel Releasing Peripheral Balloon Dilatation Catheter Device: Balloon Dilatation Catheter Not Applicable

Detailed Description:

To evaluate the safety and efficacy of the Paclitaxel Eluting Hemodialysis Shunt Balloon Dilatation Catheter (APERTO) compared with the Balloon Dilatation catheter (OHICHO II) for the treatment of Arteriovenous Fistulae Stenosis in patients undergoing hemodialysis.

This is a prospective, multi-center, randomized controlled, open-label, superiority study. A total of 160 subjects will be enrolled from 10 sites in China. All subjects enrolled will be randomly assigned to the test group (APERTO group, n=80) and the control group (OHICHO II group, n=80) with randomized allocation ratio of 1:1. Subjects in the test group and the control group will be treated with APERTO OTW or OHICHO II respectively.


Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 161 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Evaluation of the Safety and Efficacy of the Paclitaxel Eluting Hemodialysis Shunt Balloon Dilatation Catheter (APERTO) in Treatment of Hemodialysis Arteriovenous Fistulae Stenosis: A Prospective, Multicenter, Randomized, Controlled Clinical Study
Study Start Date : October 2016
Actual Primary Completion Date : January 2018
Estimated Study Completion Date : April 2019

Resource links provided by the National Library of Medicine

Drug Information available for: Paclitaxel

Arm Intervention/treatment
Experimental: APERTO OTW group
in the APERTO OTW group the subject will be treated with APERTO OTW balloon (Paclitaxel Releasing Peripheral Balloon Dilatation Catheter)
Device: Paclitaxel Releasing Peripheral Balloon Dilatation Catheter
Treatment group
Other Name: APERTO OTW

Active Comparator: OHICHO II group
in the OHICHO II group the subject will be treated with OHICHO II balloon (Balloon Dilatation Catheter)
Device: Balloon Dilatation Catheter
Control group
Other Name: OHICHO II




Primary Outcome Measures :
  1. Primary patency rate of the target lesion [ Time Frame: at 6 month post procedure ]

    Primary patency is defined as freedom from restenosis as determined by DUS Peak Systolic Velocity Ratio (PSVR) ≤ 2.0 and freedom from clinically-driven target lesion revascularization (CD-TLR).

    Restenosis is defined as PSVR> 2.0 determined by independent DUS laboratory. Clinically-driven target lesion revascularization (CD-TLR) is defined as any re-intervention in target lesion (+/-5mm proximal or distal of the target lesion) determined by DUS due to clinical symptoms or dialysis indicators showing that it is unable to perform dialysis.



Secondary Outcome Measures :
  1. Device Success [ Time Frame: intraoperative ]
    Device Success is defined as ability of the Device to be delivered, inflated at pressure ≤ RBP, and retrieved from the Target Lesion without burst.

  2. Technical Success [ Time Frame: intraoperative ]
    Technical Success is defined as the residual stenosis of the lumen diameter ≤ 30% after treatment with either APERTO OTW or OHICHO II (compared with the referred vessel diameter of the nearest veins with no aneurysm).

  3. Clinical Success [ Time Frame: at 1 month ]
    Clinical Success is defined as improvement in hemodialysis access function and resumption of normal dialysis for at least one dialysis session after the index procedure.

  4. Procedural Success [ Time Frame: at 1 month ]
    Procedural Success is defined as technical success without the occurrence of MAE during the hospitalization or day of treatment (MAE defined here as: death, stroke, thrombotic occlusion, allergic reaction, pulmonary events (including pulmonary edema)

  5. MAE rates (death or stroke) [ Time Frame: at 1 month, 3 months, 6 months, and 12 months post procedure. ]
  6. The diameter stenosis rate in target lesion [ Time Frame: at 6 months post procedure ]
    The diameter stenosis (%)=100% × (1-(MLD/RVD))

  7. Clinical-driven Target Lesion Revascularization (CD-TLR) [ Time Frame: in1st, 3rd, 6th, 12th month post operation ]
    CD-TLR is defined as any re-intervention in target lesion (+/-5mm proximal or distal of the target lesion) determined by DUS due to clinical symptoms or dialysis indicators showing that it is unable to perform dialysis.

  8. Clinical-driven Target Shunt Revascularization (CD-TSR) [ Time Frame: in 1st, 3rd, 6th, 12th month post operation ]

    Target Shunt is defined as the reflux vein, which is from the anastomotic stoma of native arteriovenous fistula (AVF) to the distal end of the subclavian vein.

    CD-TSR is defined as any re-intervention in target lesion due to clinical symptoms or inability to perform dialysis.




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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion criteria:

Patients must meet all of the following criteria:

  • Age ≥ 18 years and ≤ 75 years, male or female.
  • Patient or legally authorized representative can understand the purpose of this clinic trial. He or She volunteers to participate in this trial and can provide written informed consent, and is willing to accept the scheduled follow-up in specific time points.
  • Angiography, ultrasound or clinical diagnosis shows that patients have hemodialysis access dysfunction due to stenosis lesions.
  • Patients with indications of the percutaneous endovascular therapy, that is, the AVF stenosis is related to hemodynamics and ≥ 50%, and with any of the following clinical and physiological abnormalities (referred to NKF-K/DOQI guideline definitions):

    1. Thrombosis in the AVF;
    2. Elevated venous pressure during dialysis
    3. Obvious abnormality in recirculation measurements
    4. Abnormal physical examination findings
    5. Unexplained decreases in dialysis dose
    6. Decreased access flow
  • Target lesion is a de novo or restenosis. The number of target lesions is 1.
  • Target lesion consists of a single lesion or a multiple lesions with target lesion length ≤ 40 mm.
  • Target lesion(s) is located in the reflux vein which is from the anastomosis of native arteriovenous fistula (AVF) to the distal end of subclavian vein, except the anastomosis of native AVF.
  • If patient has non-target lesion, it must be successfully treated using PTA before treating target lesion.
  • Reference vessel diameter of target lesion ≥ 4.0 mm and ≤ 7.0 mm by visual estimate (determined by angiography or DUS).
  • Hemodialysis access previously used (mature AVF) can no longer be successfully used due to insufficient shunt flow volume caused by local lumen stenosis.

Exclusion criteria:

Patients will be excluded if any of the following conditions applies:

  • Patients who have participated in another investigational drug or device trial.
  • Patients who have been enrolled in this trial previously.
  • Women of childbearing age with negative pregnancy test before procedure, and breastfeeding women.
  • Any major surgical procedure (such as thoracotomy, craniotomy, etc.) within 30 days prior to the procedure.
  • Any planned major surgical procedure (such as thoracotomy, craniotomy, etc.) within 30 days of entry into this study
  • Immature AVF, which cannot be used for Dialysis or has not been used successfully due to insufficient lumen diameter to ensure successfully puncture and insufficient shunt flow volume.
  • Patients with AVG.
  • AVF has been previously implanted with stent.
  • Lesion in AVF has been previously treated with DEB.
  • Target lesion is located in the anastomosis of native AVF.
  • Known allergies or intolerance to Paclitaxel or contrast medium.
  • Life expectancy < 1 year
  • Patients with comitans systemic lupus erythematosus and ANCA associated vasculitis.

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): NCT02962141


Locations
China, Hainan
Hainan General Hospital
Haikou, Hainan, China
China, Hebei
The First Hospital of Hebei Medical University
Shijiazhuang, Hebei, China
China, Hunan
The Third Xiangya Hospital of Central South University
Changsha, Hunan, China
China, Jiangxi
The First Affiliated Hospital of Nanchang University
Nanchang, Jiangxi, China
China, Sichuan
West China Hospital, Sichuan University
Chengdu, Sichuan, China
China, Zhejiang
Sir Run Run Shaw Hospital School of Medicine, Zhejiang University
Hangzhou, Zhejiang, China
The First Hospital of Zhejiang Province
Hangzhou, Zhejiang, China
China
Beijing Tongren Hospital, Capital Medical University
Beijing, China
Longhua Hospital Shanghai University of Tranditional Chinese Medicine
Shanghai, China
Sponsors and Collaborators
ZhuHai Cardionovum Medical Device Co., Ltd.
Investigators
Principal Investigator: Qizhuang Jin, professor Peking University First Hospital

Responsible Party: ZhuHai Cardionovum Medical Device Co., Ltd.
ClinicalTrials.gov Identifier: NCT02962141     History of Changes
Other Study ID Numbers: APERTO-2015-01
First Posted: November 11, 2016    Key Record Dates
Last Update Posted: November 29, 2018
Last Verified: October 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Keywords provided by ZhuHai Cardionovum Medical Device Co., Ltd.:
drug eluting balloon, Arteriovenous Fistulae

Additional relevant MeSH terms:
Fistula
Peripheral Arterial Disease
Peripheral Vascular Diseases
Arteriovenous Fistula
Pathological Conditions, Anatomical
Atherosclerosis
Arteriosclerosis
Arterial Occlusive Diseases
Vascular Diseases
Cardiovascular Diseases
Arteriovenous Malformations
Vascular Malformations
Cardiovascular Abnormalities
Vascular Fistula
Congenital Abnormalities
Paclitaxel
Albumin-Bound Paclitaxel
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action