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A Prospective, Randomized, Controlled Multi-center Study of ArtiFascia® Dural Repair Patch Compared With Commercially Available Dural Substitutes. To Evaluate the Safety and Effectiveness of ArtiFascia® in Subjects Requiring Dural Repair. (NEOART)

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ClinicalTrials.gov Identifier: NCT04145544
Recruitment Status : Recruiting
First Posted : October 30, 2019
Last Update Posted : March 13, 2020
Sponsor:
Information provided by (Responsible Party):
Nurami Medical Ltd

Brief Summary:

The objective of this study is to evaluate the safety and effectiveness of ArtiFascia® in comparison with commercially available dural substitutes in patients requiring Dural repair following neurosurgery.

Patients with planned cranial neurosurgery can take part in this study. During the surgery the soft membrane that covers the brain (called dura) is likely to be cut and damaged. A damaged dura can cause a leakage of brain fluids (cerebrospinal fluid [CSF] leakage) and increase the risk of infections. Sponsor of this study has developed the ArtiFascia®. ArtiFascia® is a medical synthetic dural substitute that is absorbed by the body. ArtiFascia® supports the re-formation of a new dura. In addition it has a sealant layer that can reduce CSF leakage and infection.


Condition or disease Intervention/treatment Phase
Dural Tear Cerebrospinal Fluid Leak Device: Implantation of the ArtiFascia® Device: Implantation of other commercial dural substitute Not Applicable

Detailed Description:

A Prospective, randomized, controlled multi-center study of ArtiFascia® Dural repair patch compared with commercially available dural substitutes- NEOART Study.

The dura mater is a fibrous connective tissue that surrounds the nervous system (brain and spinal cord) and provides a mechanical barrier that contains the cerebrospinal fluid (CSF). The dura mater may be damaged as a result of trauma or planned surgery. When dural defects cannot be repaired by primary closure, a dural substitute must be utilized in order to reduce CSF leakage.

There are devices that have been used as dural substitutes. Among the devices that are based on natural raw materials, collagen-based matrices are widely used. Although collagen was proven to be biocompatible, using collagen-based materials still possess several limitations such as CSF leaks. Synthetic dural substitutes are also used to repair dura mater. The most widely used raw-material for these synthetic products are polyesters - resorbable and biocompatible polymers. There are several dural substitutes based on synthetic polyesters that were successfully tested pre-clinically as well as in human studies.

Sponsor of this study has developed the ArtiFascia®. ArtiFascia® is a medical synthetic dural substitute that is absorbed by the body.

Before the study, the patients will have their blood taken and they will undergo neurological assessment. If they are suitable to participate in the study, and agree to participate, they will be randomly allocated into one of the following groups:

  • Experimental group (ArtiFascia® device);
  • Control group (Other commercially available dural substitutes).

The patients will undergo a surgery that is identical to the one that was planned by the surgeon. At the end of the surgery, the investigator will use ArtiFascia® patch or standard dural substitute to repair the damaged Dura. ArtiFascia® graft will be placed in areas where the native dural layer was damaged or missing. ArtiFascia® will be applied via a routine and well-known procedure, using a suturing technique. After implantation, the porous fibrous structure of ArtiFascia® provides a scaffold, which enables infiltration of fibroblasts and cells from the intact tissue, ultimately replacing damaged dural tissue. The patch is expected to resorb within a few months and to be replaced by the native tissue with complete dural closure.

During the surgery and until patient's release from the hospital the patient's health will be closely monitored. Before the discharge patients will have to undergo neurological examination. Patients will be obligated to attend the follow up visits after the surgery at the dates scheduled by the attending physician.

At each of the visits physical and neurological examinations will be performed. Radiographic Evaluation (Magnetic Resonance Imaging) will be performed also 6 months post operation.

A total of 90 patients will be enrolled and implanted with test or control device. Up to 10 centers in Europe and Israel are planned to participate in this study.

The primary endpoint will be achieved when the final study subject has completed a 6-months follow-up.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 90 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Treatment
Official Title: A Prospective, Randomized, Controlled Multi-center Study of ArtiFascia® Dural Repair Patch Compared With Commercially Available Dural Substitutes- NEOART Study.
Actual Study Start Date : January 7, 2020
Estimated Primary Completion Date : November 2021
Estimated Study Completion Date : May 2022

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Treatment arm

Procedure will be performed under general anaesthesia. The patients will undergo a surgery that is identical to the one that was planned by the surgeon. At the end of the surgery, the investigator will use the ArtiFascia® patch. Implantation of the ArtiFascia® will be according to clinical discretion of the physician, and in compliance with ArtiFascia® instructions for use. Detailed instructions are in the instructions for use.

Post operation the subject will stay at the hospital according to site standards and physician discretion.

Device: Implantation of the ArtiFascia®

Following are the general instructions for use for the ArtiFascia®:

  • Cut the ArtiFascia® to the required shape under aseptic conditions
  • Apply ArtiFascia® to the damaged area
  • Suture the ArtiFascia® in place
  • Suture bites should be taken 2-3 millimeters from the edges of the implant. Either a running suture or interrupted stitches' technique may be used, depending on clinical conditions or surgeon's decision.

Important Note: If clinically possible, do not use dural adhesive or sealants as it is an uncontrolled variable, that can influence the results.


Active Comparator: Control

Same procedure as for the treatment arm but using a commercial dural substitute.

Implantation of the commercial dural substitute will be according to clinical discretion of the physician, and in compliance with each specific device instructions for use. Detailed instructions are in the instructions for use.

Device: Implantation of other commercial dural substitute
Implantation of the commercial dural substitute will be according to clinical discretion of the physician, and in compliance with each specific device instructions for use. Detailed instructions are in the instructions for use




Primary Outcome Measures :
  1. Assess the safety and effectiveness of ArtiFascia® in comparison with commercially available suturable dural substitutes in subjects requiring Dural repair following neurosurgery [ Time Frame: The rate of adverse events, adverse device effects and device deficiencies will be assessed on a continuous basis from the baseline (following signing the ICF) through the study completion at 6 month. ]
    Safety and effectiveness will be assessed by evaluating the absence of CSF fistula (drainage from wound or sinus) and pseudo-meningocele post-operative as determined by MRI imaging. During MRI imaging CSF leakage will be assessed as: none/external leakage/subgaleal leakage. Additional if leakage is present, severity will be reported (mild/moderate/severe).


Secondary Outcome Measures :
  1. Wound healing assessment [ Time Frame: 6 month follow-up ]
    Clean and/or fully healed vs. Infected. Evaluation of wound will be done in physical examination: clean and/or fully healed/ infected. If wound is infected additional assessment of mild/moderate/severe will be done.

  2. Device Handling Characteristics [ Time Frame: 6 month follow-up ]
    Based on scale to evaluate device feasibility: cutting, suturing, seal quality, overall handling (Score from 1=easy to 5=difficult).

  3. Radiographic evaluation (Magnetic Resonance Imaging). [ Time Frame: 6 month follow-up ]
    To determine the presence or absence of the following measure: adhesion formation, new tissue formation, pseudomeningocele, extracerebal fluid collection and brain edema adjacent to device implant size Measurements will be done based on MRI imaging (X,Y,Z axis; in milimeters).



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

Inclusion Criteria:

  1. Subject between the ages of 18-75
  2. Subject is scheduled for an elective cranial surgery with a dural damage that can be completely repaired/closed by a suture-able dural substitute (ArtiFascia device or other commercially available dural substitutes)
  3. Subject has undergone radiographic imaging (such as, MRI) in the past 2 months before enrolment
  4. Surgical wound is expected to be Class I/clean
  5. Subject understands the study requirements and the treatment procedures and provides written Informed Consent before any study-specific tests or procedures are performed
  6. Subject is able and willing to adhere to the required follow-up visits and testing

Exclusion Criteria:

  1. Pregnant women or interest in becoming pregnant during the duration of the study
  2. Subject has known hydrocephalus
  3. Subject is unable to undergo MRI after the surgery
  4. Subject's life expectancy is less than 12 months
  5. Subject has a local or systemic infection (e.g. urinary tract infection (UTI), active pneumonia) or evidence of any surgical site infection, fever > 38.3℃, positive blood culture and/or a positive chest x-ray for acute infectious process
  6. Subject will require use of dural adhesive or sealant
  7. Subject is intended to undergo craniectomy wherein bone flap will not be returned
  8. Subject with suspected low success in wound healing due to past treatments (e.g. chemotherapy, radiation therapy, severe diabetes etc.) or other conditions (e.g. severe peripheral vascular disease, long standing steroids treatment)
  9. Subject has been clinically diagnosed with malignancy (other than basal cell carcinoma or low-grade glioma), uncontrolled diabetes (A1C>6.5%), sepsis, systemic collagen disease.
  10. Subject had chemotherapy and/or radiotherapy in the past 12 weeks before surgery or is planned to have chemotherapy or radiotherapy less than 12 weeks after surgery.
  11. Subject is an acute cranial trauma surgical case
  12. Subjects with a concurrent disease that would place the patient in excessive risk to the planned surgery
  13. Subject had a previous neurosurgery in the same anatomical site
  14. Subject with other undesirable symptoms defined by the principal investigator
  15. Patient has clinically significant coagulopathy as determined by the surgeon
  16. Subject is participating in another clinical trial using similar investigational devices/drugs

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): NCT04145544


Contacts
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Contact: Amir Bahar, Ph.D +972 747-408888 amir@nurami-medical.com
Contact: Joseph Milbaum, MD +972 747-408888 joseph@nurami-medical.com

Locations
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Belgium
Ziekenhuis Oost-Limburg Recruiting
Genk, Belgium, B-3600
Contact: Frank Weyns, Prof       Frank.Weyns@zol.be   
Contact: Sigrid Christiaens       Sigrid.Christiaens@zol.be   
Czechia
St. Anne's University Hospital Brno Recruiting
Brno, Czechia, 656 91
Contact: Radim Jancalek, MD, PhD       radim.jancalek@fnusa.cz   
Contact: Veronica Kubickova       veronika.kubickova@fnusa.cz   
Neurochirurgická klinika Přednosta FN Olomouc Not yet recruiting
Olomouc, Czechia, 779 00
Contact: Miroslav Vaverka, Prof       miroslav.vaverka@fnol.cz   
Contact: Marcela Jelinkova       marcela.jelinkova@fnol.cz   
Poland
Medical University of Gdańsk Recruiting
Gdańsk, Poland, 80-214
Contact: Paweł Słoniewski, Prof       pslonie@gumed.edu.pl   
Barlicki University Hospital Recruiting
Łódź, Poland, 90-153
Contact: Dariusz Jaskólski, Prof.       dariusz.jaskolski@umed.lodz.pl   
Contact: Jan Fortuniak         
Sponsors and Collaborators
Nurami Medical Ltd
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Responsible Party: Nurami Medical Ltd
ClinicalTrials.gov Identifier: NCT04145544    
Other Study ID Numbers: ARTIFASCIA® DURAL REPAIR PATCH
First Posted: October 30, 2019    Key Record Dates
Last Update Posted: March 13, 2020
Last Verified: March 2020

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Cerebrospinal Fluid Leak
Neurologic Manifestations
Nervous System Diseases
Craniocerebral Trauma
Trauma, Nervous System
Wounds and Injuries