TRAns-Femoral Access Intravascular Lithotripsy Comparison With PTA in TAVI

NCT ID: NCT05873842

Last Updated: 2025-05-16

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

RECRUITING

Total Enrollment

50 participants

Study Classification

OBSERVATIONAL

Study Start Date

2024-07-22

Study Completion Date

2026-11-01

Brief Summary

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To compare the effectiveness and the safety of femoral-iliac IVL versus balloon only PTA for successful deployment of transfemoral transcatheter aortic valve prosthesis.

Detailed Description

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Trans-femoral (TF) access has been identified as the best vascular approach for trans-catheter aortic valve implantation (TAVI) in the most recent European Guidelines for the treatment of valvular heart disease. Nevertheless, the TF approach is not possible in a substantial number of TAVI candidates, mainly due to the presence of important peripheral arterial disease (PAD) that is perceived as a contraindication. The presence of PAD limiting TF-TAVI feasibility has always remained a challenging scenario. The concept of preparing TF access through balloon dilatation in case of PAD had been developed and, in this context, percutaneous transluminal angioplasty (PTA) with plain-balloon has been investigated, although available literature is scarce. Intra-vascular lithotripsy (IVL) was proved effective and safe to treat calcified peripheral arteries and such new technology bares the potential for being applied in TF TAVI in patients with concomitant PAD. The rationale is that the Shockwave IVL balloon inflated at low pressure modifies the vessel rigidity with creation of multiple longitudinal and transversal cracks in the calcium present within the vessel wall. Thus, the improved vessel compliance facilitates the successful passage of the valve delivery system resulting in higher rates of procedural success and lower risk for crossover to surgery, vessel injury and major complications.

Conditions

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Trans-femoral TAVI With Calcified Ilio-femoral Arteries

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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PTA-assisted group

Trans-femoral TAVI

Intervention Type DEVICE

Trans-femoral TAVI (Trans-catheter Aortic Valve Implantation) with calcified ilio-femoral arteries via PTA (Percutaneous transluminal angioplasty ) or IVL (Intra-vascular Lithotripsy)

IVL-assisted group

Trans-femoral TAVI

Intervention Type DEVICE

Trans-femoral TAVI (Trans-catheter Aortic Valve Implantation) with calcified ilio-femoral arteries via PTA (Percutaneous transluminal angioplasty ) or IVL (Intra-vascular Lithotripsy)

Interventions

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Trans-femoral TAVI

Trans-femoral TAVI (Trans-catheter Aortic Valve Implantation) with calcified ilio-femoral arteries via PTA (Percutaneous transluminal angioplasty ) or IVL (Intra-vascular Lithotripsy)

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. Age \> 18 years
2. Written informed consent
3. Diagnosis of symptomatic severe aortic stenosis
4. Patient undergoing TAVI according to local institutional protocol and following Heart Team discussion.
5. High-quality Contrast-enhanced ECG gated computed tomography (CT) scan of the heart, aorta and low-limb arteries
6. Calcific severe PAD raising concerns within the Heart Team and judged as "arguable" for TF approach following angiography or CT-scan evaluation (hostile femoral access), with a RefD\>/=5 mm and a MLD\>/=3 mm.
7. Hostility score \>/= 23 in at least one segment of the axis under evaluation.

Exclusion Criteria

1. Life expectancy \< 1 year
2. Subject has active infection requiring antibiotic therapy.
3. STS score ≥8%
4. Leriche syndrome or other forms of total occlusion of the aorta or both iliac axes.
5. Planned target limb major amputation (above the ankle).
6. History of prior endovascular or surgical procedure on the index limb within the past 30 days or planned within 30 days of the index procedure.
7. Subject in whom antiplatelet or anticoagulant therapy is contraindicated.
8. Subject has known allergy to contrast agents or medications used to perform endovascular intervention that cannot be adequately pre-treated.
9. Subject has known allergy to urethane, nylon, or silicone.
10. Subject is participating in another research study involving an investigational agent (pharmaceutical, biologic, or medical device) that has not reached the primary endpoint.
11. Subject has other medical, social or psychological problems that, in the opinion of the investigator, preclude them from receiving this treatment, and the procedures and evaluations pre- and post-treatment.
12. The use of specialty balloons, re-entry or atherectomy devices
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Rede Optimus Hospitalar SA

NETWORK

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Flavio Ribichini, MD, PhD

Role: STUDY_DIRECTOR

AOUI, Verona

Locations

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AOU Cardiology Ancona

Ancona, , Italy

Site Status RECRUITING

AULLS3 Cardiology Mestre

Mestre, , Italy

Site Status RECRUITING

AULSS2 Cardiology Treviso

Treviso, , Italy

Site Status ACTIVE_NOT_RECRUITING

AOUI Cardiology Verona

Verona, , Italy

Site Status RECRUITING

AULLS8 Cardiology Vicenza

Vicenza, , Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Azinwi Phina Muna, phd

Role: CONTACT

+49 157 80 58 5869

Cristian Di Biase, Phd

Role: CONTACT

+49 176 89982768

Facility Contacts

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Tommaso Piva, PhD

Role: primary

+39 071 596 5165

Marco Barbierato, PhD

Role: primary

Flavio Ribichini, PhD

Role: primary

+3945 8122320

Francseco Caprioglio, PhD

Role: primary

+39 444753214

Other Identifiers

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RO-230301

Identifier Type: -

Identifier Source: org_study_id

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