MAgicTouch™ Intervention Leap for Dialysis Access (MATILDA) Trial

NCT ID: NCT04698512

Last Updated: 2021-03-17

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 35 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2019-05-21
• Study Completion Date: 2021-01-30

Brief Summary

For patients with End Stage Renal Failure (ESRF), the surgical creation of an Autogenous Arteriovenous Fistula (AVF) or Autogenous Arteriovenous Graft (AVG) is the recognised standard for providing vascular access. A functioning dialysis vascular access is essential to facilitate hemodialysis (HD) treatment. Advantages include improved hemodialysis initiation time, improved dialysis quality, better maintenance of accesses and generally, better outcomes in patients. Unfortunately almost 50% of AVF and AVG fail after a median lifetime of 3 to 7 years and 12 to 18 months respectively. Vascular access dysfunction is a major cause of morbidity and hospitalisation for ESRF patients, costing the healthcare system USD 18 million globally. Venous stenosis and scarring are caused by trauma from surgical access creation when the circuit comes arterialized and from repeated percutaneous punctures from subsequent hemodialysis. This study is performed to evaluate Sirolimus-coated balloon efficacy and safety using MagicTouch™ Drug coated balloon catheter (Concept Medical Inc, Tampa, FL, US) on AVF patency with de novo and recurrent stenosis.

Conditions

Dialysis Access Malfunction; End Stage Renal Failure on Dialysis; End Stage Renal Disease; Fistulas Arteriovenous; Stenosis

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Arteriovenous Fistuloplasty with MagicTouch™ Balloon

Patients above the age of 21 that have undergone AVF / AVG fistuloplasty with MagicTouch™ at Singapore General Hospital will be included in the study and followed up post-op for 12 months. Patients will be treated and followed-up following standard clinical care pathways.

AVFistuloplasty with Sirolimus coated balloon

Intervention Type: DEVICE

After an initial fistulogram, the lesion will first be predicated with standard high pressure balloon, followed by MagicTouch™ Sirolimus drug coated balloon

Interventions

AVFistuloplasty with Sirolimus coated balloon

After an initial fistulogram, the lesion will first be predicated with standard high pressure balloon, followed by MagicTouch™ Sirolimus drug coated balloon

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• Informed consent was obtained
• Patient aged ≥ 21 and ≤ 90 years
• Native AVF was created more than 2 months prior to index procedure and had undergone 10 or more haemodialysis sessions utilizing two needles
• Target lesion location had to be located between the anastomoses to the axillary-subclavian vein junction, as defined by insertion of the cephalic vein
• On initial fistulogram, target lesions stenosis had to be ≥50 on angiographic assessment and in keeping with the clinical indicator for intervention
• Stenosis had to <12cm in length (to allow for potential treatment with one SCB (length 15cm) only
• Stenosis had to be initially treated successfully with a high-pressure plain balloon prior to SCB treatment as defined by:- (A) no clinically significant dissection (flow limiting) (B) no extravasation requiring treatment/stenting (C) residual stenosis ≤30% by angiographic measurement (D) Ability to completely efface the lesion waist using the pre-dilation balloon
• No more than one additional ("nontarget") lesion in the access circuit that had to be also successfully treated (≤30% residual stenosis) before drug elution. Separate lesion was defined by at least 3cm in distance from the target lesion.
• Reference vessel diameter 5mm-8mm

Exclusion Criteria

• Women who were preganant, lactating, or planning on becoming pregnant during the study
• Subject had more than 2 lesions in the access circuit
• Subject had a secondary non-target lesion that could not be successfully treated
• Sepsis or active infection
• Asymptomatic target lesions
• A thrombosed access or an access with thrombosis treated ≤ 30 days prior to index procedure
• Surgical revision of the access site performed, planned or expected ≤ 3months before or after the index procedure
• Patients who were taking immunosuppressive therapy or are routinely taking ≥15 mg prednisone per day
• Currently participating in another investigational drug, biologic, or device study involving Sirolimus or paclitaxel
• Contraindication to Aspirin or Clopidogrel usage
• Mental condition rendering the subject unable to understand the nature, scope and possible consequences of the study, or language barrier such that the subject is unable to give informed consent
• Uncooperative attitude or potential for non-compliance with the requirements of the protocol making study participation impractical
• Where final angioplasty treatment requires a stent or drug eluting balloon >8mm in diameter
• Metastatic cancer or terminal medical condition
• Blood coagulation disorders
• Limited life expectancy (<12 months)
• Allergy or other know contraindication to iodinated media contrast, heparin, or Sirolimus

• Minimum Eligible Age: 21 Years
• Maximum Eligible Age: 90 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Singapore General Hospital

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Tjun Yip Tang

Role: PRINCIPAL_INVESTIGATOR

Singapore General Hospital

Locations

Singapore General Hospital

Singapore, , Singapore

Countries

Singapore

References

Lee T, Roy-Chaudhury P. Advances and new frontiers in the pathophysiology of venous neointimal hyperplasia and dialysis access stenosis. Adv Chronic Kidney Dis. 2009 Sep;16(5):329-38. doi: 10.1053/j.ackd.2009.06.009.

Reference Type: BACKGROUND

PMID: 19695501 (View on PubMed)

Pantelias K, Grapsa E. Vascular access today. World J Nephrol. 2012 Jun 6;1(3):69-78. doi: 10.5527/wjn.v1.i3.69.

Reference Type: BACKGROUND

PMID: 24175244 (View on PubMed)

Other Identifiers

MATILDA

Identifier Type: -

Identifier Source: org_study_id