Ultrasound to Enhance Paclitaxel Uptake in Critical Limb Ischemia: the PACUS Trial

NCT ID: NCT02625740

Last Updated: 2015-12-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

56 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-11-30

Study Completion Date

2015-11-30

Brief Summary

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The PACUS Trial was a single center, single blinded, randomized trial designed to evaluate the safety and efficacy of intravascular percutaneous catheter-delivered ultrasound energy to improve local Paclitaxel delivery effects in critical limb ischemia patients due to femoral-popliteal artery disease.

Detailed Description

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Study design The PACUS Trial was a single center, single blinded, randomized trial designed to evaluate the safety and efficacy of intravascular percutaneous catheter-delivered high intensity, low-frequency ultrasound utilizing CardioProlific Genesis™ System to improve local paclitaxel delivery effect in patients with CLI due to femoral-popliteal calcific lesions and occlusions. The protocol was approved by a Local Review Boards and the Institutional Ethics Committee. All patients provided written informed consent before enrollment. The trial was conducted in accordance with the declaration of Helsinki.

Randomization Randomization occurred after successful crossing and pre-dilatation of the target lesion with a standard percutaneous angioplasty balloon without sub-intimal approach and/or flow limiting dissections. Patients were enrolled when a successful angiographic control was performed after PTA pre-dilatation. Subjects were randomly assigned by a computer-generated random sequence (2 blocks in a 1:1 ratio). Randomization was done in advance for all patients and without any stratification. The patients and physicians involved in the follow-up control were blinded to the treatment assignments through the completion of all 6 month follow-up evaluation. Operators were not blinded due to differences in treatment protocol. Twenty eight (28) patients were treated with an intravascular percutaneous catheter-delivered high intensity, low-frequency ultrasound and local Paclitaxel delivery with temporarily blood flow occlusion created by distal occlusion balloon (Study Group), and twenty eight (28) patients were treated with drug eluting balloon with conventional method (Control Group).

Conditions

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Peripheral Arterial Disease, Angioplasty

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Study group

After crossing the lesion with a guidewire, patients will be treated with intravascular high intensity, low-frequency ultrasound followed by local administration of liquid mixture of Paclitaxel and Iopromide-370 with predetermined dosage of 1.0 µg/mm

Group Type EXPERIMENTAL

Local exposition of target lesion to high intensity, low-frequency ultrasound

Intervention Type DEVICE

Target lesion was exposed to 60 seconds of high intensity, low-frequency ultrasound generated by the Genesis™ system ( CardioProlific Inc., Hayward, CA). The ultrasound catheter is removed after the exposition.

Flow occlusion with an angioplasty balloon

Intervention Type DEVICE

Inflation of a 2 cm long balloon catheter Admiral (Medtronic) , located distally to the treatment area, in order to obtain a flow cessation

Local Paclitaxel infusion

Intervention Type DRUG

Paclitaxel in a mixture with contrast medium at 1.0 µg/mm³ concentration was delivered to the treatment area for 60 seconds. The column of the Paclitaxel mixture filling the vessel was observed under the fluoroscopy and sustained during 60 seconds. The Paclitaxel /contrast medium mixture was then aspired with a 50 cc syringe and the distal balloon was deflated.

Angiographic control

Intervention Type PROCEDURE

A final angiographic control was performed with injection of 10 cc of contrast medium and compared with the pre-procedural one.

Control group

After crossing the lesion with a guidewire, patients will be treated with drug eluting ballon angioplasty with the In.Pact Admiral ballon (Medtronic)

Group Type ACTIVE_COMPARATOR

drug eluting ballon angioplasty

Intervention Type DEVICE

Target lesion was treated with an angioplasty, performed using the INPACT Admiral drug eluting ballon (Medtronic)

Angiographic control

Intervention Type PROCEDURE

A final angiographic control was performed with injection of 10 cc of contrast medium and compared with the pre-procedural one.

Interventions

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Local exposition of target lesion to high intensity, low-frequency ultrasound

Target lesion was exposed to 60 seconds of high intensity, low-frequency ultrasound generated by the Genesis™ system ( CardioProlific Inc., Hayward, CA). The ultrasound catheter is removed after the exposition.

Intervention Type DEVICE

drug eluting ballon angioplasty

Target lesion was treated with an angioplasty, performed using the INPACT Admiral drug eluting ballon (Medtronic)

Intervention Type DEVICE

Flow occlusion with an angioplasty balloon

Inflation of a 2 cm long balloon catheter Admiral (Medtronic) , located distally to the treatment area, in order to obtain a flow cessation

Intervention Type DEVICE

Local Paclitaxel infusion

Paclitaxel in a mixture with contrast medium at 1.0 µg/mm³ concentration was delivered to the treatment area for 60 seconds. The column of the Paclitaxel mixture filling the vessel was observed under the fluoroscopy and sustained during 60 seconds. The Paclitaxel /contrast medium mixture was then aspired with a 50 cc syringe and the distal balloon was deflated.

Intervention Type DRUG

Angiographic control

A final angiographic control was performed with injection of 10 cc of contrast medium and compared with the pre-procedural one.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Rutherford category ≥4
* femoral-popliteal lesion ≥10cm
* successful intraluminal recanalization without need of a stent to obtain a satisfactory angiographic result
* at least one patent below the knee vessel
* patients older than 18 years

Exclusion Criteria

* Rutherford category \< 4
* pregnancy
* known allergies to study medications and materials
* need of sub-intimal approach to perform the recanalization
* target vessel stent release
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Rome Tor Vergata

OTHER

Sponsor Role lead

Responsible Party

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Roberto Gandini

Medical Doctor

Responsibility Role PRINCIPAL_INVESTIGATOR

Other Identifiers

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Tor Vergata University

Identifier Type: -

Identifier Source: org_study_id