EPIC Nitinol Stent System in the Treatment of Atherosclerotic Lesions in Iliac Arteries
- Conditions
- Iliac Artery Stenosis
- Interventions
- Device: Epic™ Nitinol Stent SystemDrug: Anti-platelet therapyDrug: Anti-coagulation therapy
- Registration Number
- NCT00896337
- Lead Sponsor
- Boston Scientific Corporation
- Brief Summary
The ORION study is being conducted to determine whether the Epic™ Nitinol Stent for primary stenting of iliac atherosclerotic lesions shows acceptable performance at 9 months.
- Detailed Description
ORION is a prospective, single arm, non-randomized, multicenter study. A subject could receive a maximum of 2 study stents for up to 2 target lesions. A maximum of 1 non-target lesion in 1 non-target vessel could be treated with a commercially approved treatment during the index procedure.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 125
- Documented chronic, symptomatic iliac artery atherosclerotic disease (Rutherford/Becker category 1, 2, 3 or 4)
- Lifestyle-limiting claudication or rest pain
- De novo or restenotic lesions in the common and/or external iliac artery
- Subjects with bilateral disease may have only one target lesion treated per side
- Two target lesions may be treated with a maximum of two stents (if two target lesions are treated, each lesion must be covered with a maximum of one stent)
- Length of diseased segment(s) <=13 cm and treatment is planned with no more than 2 overlapped Epic™ stents
- Baseline diameter stenosis >= 50% (operator visual assessment)
- Reference vessel diameter >= 5 mm and <=11 mm
- At least one sufficient ipsilateral infrapopliteal run-off vessel
- Origin of profunda femoris artery is patent
- Target vessel with in-stent restenosis
- Acute critical limb ischemia
- Tissue loss (Rutherford/Becker category 5 or 6)
- Any major amputations to the target limb
- Any minor amputation of the target limb in the last 12 months. If a minor amputation occurred greater than 12 months, stump needs to be completely healed.
- Life expectancy less than 24 months due to other medical co-morbid condition(s) that could limit the subject's ability to participate in the trial, limit the subject's compliance with the follow-up requirements, or impact the scientific integrity of the trial
- Known hypersensitivity or contraindication to contrast dye that, in the opinion of the investigator, cannot be adequately pre-medicated.
- Intolerance to antiplatelet, anticoagulant, or thrombolytic medications
- Platelet count < 150,000 mm3 or > 600,000 mm3
- Serum creatinine > 2.0 mg/dL
- Dialysis-dependent end stage renal disease
- Pregnancy
- Current participation in another drug or device trial that has not completed the primary endpoint or that may potentially confound the results of this trial
- Known allergy to Nitinol
- Presence of arterial lesions (with the exception of renal, carotid or short, focal SFA lesions) requiring intervention within 30 days of the index procedure - Superficial femoral artery occlusion in the limb supplied by target vessel
- Heavily calcified and/or excessively tortuous lesions in the target vessel as determined by angiography
- Target lesion is within or near an aneurysm
- Persistent, intraluminal thrombus of the proposed target lesion post-thrombolytic therapy
- Perforated vessel as evidenced by extravasation of contrast media
- Vascular graft, aneurysm or postsurgical stenosis of the target vessel
- Multiple lesions in the same target vessel unable to be treated with a maximum of two stents
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description ORION Epic™ Nitinol Stent System All subjects who meet the inclusion criteria and are enrolled in this trial will be treated with iliac artery stenting with the Epic™ Nitinol Stent System. ORION Anti-platelet therapy All subjects who meet the inclusion criteria and are enrolled in this trial will be treated with iliac artery stenting with the Epic™ Nitinol Stent System. ORION Anti-coagulation therapy All subjects who meet the inclusion criteria and are enrolled in this trial will be treated with iliac artery stenting with the Epic™ Nitinol Stent System.
- Primary Outcome Measures
Name Time Method Device- and/or Procedure-related Major Adverse Events (MAE) 9 Months MAE is defined as any device-related or index procedure-related death within 30 days, myocardial infarction during index hospitalization, target vessel revascularization through 9 months, or amputation of the index limb through 9 months
- Secondary Outcome Measures
Name Time Method Death 3 Years Death is classified as follows. Cardiac death: death due to immediate cardiac cause; death of unknown cause is classified as cardiac death, including all procedure related deaths including those related to concomitant treatment; Vascular death: death due to cerebrovascular disease, pulmonary embolism, ruptured aortic aneurysm, dissecting aneurysm, or other vascular cause; Non-cardiovascular death: any death not covered by the above definitions
Procedure Success In hospital (1-2 days post procedure) Technical success (residual lesion stenosis \<=30% based on visual assessment immediately postprocedure) and no in-hospital major adverse events (device- or index procedure-related death, myocardial infarction, target vessel revascularization or amputation of the index limb).
Rutherford Classification Distribution 1 Year Rutherford Classification is used to assess lower extremity ischemia as shown below:
Class 0 = Asymptomatic Class 1 = Mild claudication Class 2 = Moderate claudication Class 3 = Severe claudication Class 4 = Ischemic rest pain Class 5 = Minor tissue loss - non-healing ulcer, focal gangrene with diffuse pedal edema Class 6 = Major tissue lossAmputation of Index Limb 3 Years Major amputation: amputation of the lower limb at the ankle level or above Minor amputation: amputation of forefoot or toes
Target Vessel Revascularization (TVR) 3 Years Target vessel revascularization (TVR) is defined as any surgical or percutaneous intervention to the target vessel(s) after the index procedure. A TVR is considered ischemia-driven if the culprit lesion stenosis is ≥50% by quantitative angiography and the subject has ischemic symptoms.
A TVR is considered ischemia-driven if the culprit lesion diameter stenosis is ≥70% even in the absence of clinical or functional ischemia.Myocardial Infarction (MI) Index hospitalization Definition of myocardial infarction: New Q-waves in ≥2 leads lasting ≥0.04 sec with creatine kinase- myoglobin band (CK-MB)/troponin above upper limit of normal (ULN); if no new Q-waves elevation of post-procedure CK levels \>2.0× ULN with positive CK-MB, or, if the assay for CK-MB was not performed, elevation of CK levels \>2.0× ULN with positive troponin. Drawing a CK-MB or troponin is mandated if CK is greater than 2× ULN. If no CK-MB or troponin was drawn, CK \>2× ULN will be considered an MI. ULN is determined per local laboratory specifications.
Late Clinical Success 1 Year Improvement in Rutherford classification by 1 class as compared to baseline. Rutherford Classification is used to assess lower extremity ischemia as shown below:
Class 0 = Asymptomatic Class 1 = Mild claudication Class 2 = Moderate claudication Class 3 = Severe claudication Class 4 = Ischemic rest pain Class 5 = Minor tissue loss - non-healing ulcer, focal gangrene with diffuse pedal edemaEarly Hemodynamic Success 30 Days Improvement in ankle-brachial index (ABI) by ≥0.1 from the pre-procedure value and not deteriorated by \>0.15 from the maximum post-procedure value. Reported per limb.
Acute Stent Thrombosis 24 Hours Angiographic documentation of an acute, complete occlusion of a previously successfully treated lesion and/or Angiographic documentation of a flow-limiting thrombus within, or adjacent to, a previously successfully treated lesion
Acute stent thrombosis is defined as occurring \<=24 hours following the trial procedure. Subacute stent thrombosis is defined as occurring \>24 hours to \<=30 days following the trial procedure.Sub-acute Stent Thrombosis >24 Hours to <=30 Days Post-index procedure Angiographic documentation of an acute, complete occlusion of a previously successfully treated lesion and/or Angiographic documentation of a flow-limiting thrombus within, or adjacent to, a previously successfully treated lesion
Acute stent thrombosis is defined as occurring less than or equal to 24 hours following the trial procedure. Subacute stent thrombosis is defined as occurring \>24 hours to less than or equal to 30 days following the trial procedure.Technical Success Index procedure Residual lesion stenosis \<=30% based on visual assessment immediately postprocedure
Walking Impairment Questionnaire Score - Stair Climbing 1 Year The Walking Impairment Questionnaire is a functional-assessment questionnaire that evaluates walking ability with regard to speed, distance and stair climbing ability as well as the reasons that walking ability might be limited. Range of scores is between 0% and 100% with 100% being the best and 0% being the worst score.
Early Clinical Success 30 Days Improvement in Rutherford classification by 1 class as compared to baseline. Rutherford Classification is used to assess lower extremity ischemia as shown below:
Class 0 = Asymptomatic Class 1 = Mild claudication Class 2 = Moderate claudication Class 3 = Severe claudication Class 4 = Ischemic rest pain Class 5 = Minor tissue loss - non-healing ulcer, focal gangrene with diffuse pedal edemaLate Hemodynamic Success 1 Year Improvement in ankle-brachial index (ABI) by ≥0.1 from the pre-procedure value and not deteriorated by \>0.15 from the maximum post-procedure value. Reported per limb.
Stent Thrombosis 3 Years Angiographic documentation of an acute, complete occlusion of a previously successfully treated lesion and/or Angiographic documentation of a flow-limiting thrombus within, or adjacent to, a previously successfully treated lesion
Very late stent thrombosis is defined as \>365 days following the trial procedure.Target Lesion Revascularization (TLR) 3 Years Target lesion revascularization (TLR) is any surgical or percutaneous intervention to the target lesion(s) after the index procedure. A TLR will be considered ischemia-driven if the target lesion diameter stenosis is ≥50% by quantitative angiography and the subject has ischemic symptoms. A TLR will be considered ischemia-driven if the lesion diameter stenosis is ≥70% even in the absence of clinical or functional ischemia.
Ankle-Brachial Index (ABI) 1 Year Ratio between the systolic pressure measured at the ankle and the systolic pressure measured in the arm as follows:
Ankle: The systolic pressure will be measured in the index limb at the arteria dorsalis pedis and/or the arteria tibialis posterior. If both pressures are measured, the highest pressures will be used for the ABI calculation.
Brachial: The systolic pressure will be measured in both arms, and the highest of both pressures will be used for the ABI calculation.Ankle-Brachial Index Hospital Discharge (1-2 days post-procedure) Ratio between the systolic pressure measured at the ankle and the systolic pressure measured in the arm as follows:
Ankle: The systolic pressure will be measured in the index limb at the arteria dorsalis pedis and/or the arteria tibialis posterior. If both pressures are measured, the highest pressures will be used for the ABI calculation.
Brachial: The systolic pressure will be measured in both arms, and the highest of both pressures will be used for the ABI calculation.Primary Patency 1 Year Systolic velocity ratio (SVR) is the ratio of the measurement of systolic velocity in 2 arterial regions as determined by duplex ultrasound (DUS). Primary patency (defined per lesion) is defined as DUS SVR ≤2.5 with no target lesion revascularization, bypass of the target lesion, or amputation.
Primary-assisted Patency (PAP) 1 Year Systolic velocity ratio (SVR) is the ratio of the measurement of systolic velocity in 2 arterial regions as determined by duplex ultrasound (DUS). Primary-assisted patency (defined per lesion) is defined as DUS SVR ≤2.5 with no target lesion revascularization for total occlusion, bypass of the target lesion, or amputation. In 1 subject, SVR was invalid and DUS proximal peak systolic velocity was analyzed to assess restenosis.
Secondary Patency 1 Year Systolic velocity ratio (SVR) is the ratio of the measurement of systolic velocity in 2 arterial regions as determined by duplex ultrasound (DUS). Secondary patency (defined per lesion) is defined as having DUS SVR ≤2.5 in the absence of bypass of the target lesion or amputation. In 1 subject, SVR was invalid and proximal peak systolic velocity was analyzed to assess restenosis.
Restenosis Assessed by Duplex Ultrasound 1 Year Systolic velocity ratio (SVR) is the ratio of the measurement of systolic velocity in 2 arterial regions as determined by duplex ultrasound (DUS). Restenosis (defined per lesion)is defined as DUS SVR \>2.5 or the presence of a target lesion revascularization prior to the DUS examination, regardless of the SVR value. In 1 subject, SVR was invalid and proximal peak systolic velocity by DUS was analyzed to assess restenosis.
Walking Impairment Questionnaire Score - Distance 1 Year The Walking Impairment Questionnaire is a functional-assessment questionnaire that evaluates walking ability with regard to speed, distance and stair climbing ability as well as the reasons that walking ability might be limited. Range of scores is between 0% and 100% with 100% being the best and 0% being the worst score.
Walking Impairment Questionnaire Score - Speed 1 Year The Walking Impairment Questionnaire is a functional-assessment questionnaire that evaluates walking ability with regard to speed, distance and stair climbing ability as well as the reasons that walking ability might be limited. Range of scores is between 0% and 100% with 100% being the best and 0% being the worst score.
Walking Impairment Questionnaire Score-Stair Climbing Pre-procedure/baseline The Walking Impairment Questionnaire is a functional-assessment questionnaire that evaluates walking ability with regard to speed, distance and stair climbing ability as well as the reasons that walking ability might be limited. Range of scores is between 0% and 100% with 100% being the best and 0% being the worst score.
Trial Locations
- Locations (28)
St. Vincent's Hospital
🇺🇸Indianapolis, Indiana, United States
Cleveland Clinic
🇺🇸Cleveland, Ohio, United States
Wellstar Kennestone Hospital
🇺🇸Marietta, Georgia, United States
Mount Sinai Medical Center
🇺🇸New York, New York, United States
Advocate Christ Medical Center
🇺🇸Oak Lawn, Illinois, United States
UPMC - Shadyside Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Piedmont Hospital
🇺🇸Atlanta, Georgia, United States
MeritCare Hospital
🇺🇸Fargo, North Dakota, United States
Erlanger Medical Center
🇺🇸Chattanooga, Tennessee, United States
Fletcher Allen Health Care
🇺🇸Burlington, Vermont, United States
Baptist Hospital of San Antonio
🇺🇸San Antonio, Texas, United States
St. Thomas Research Institute
🇺🇸Nashville, Tennessee, United States
University of Oklahoma Health Science Center
🇺🇸Oklahoma City, Oklahoma, United States
St. Joseph's Hospital
🇺🇸Tucson, Arizona, United States
Mediquest Research at Munroe Regional Medical Center
🇺🇸Ocala, Florida, United States
Brandon Regional Hospital
🇺🇸Brandon, Florida, United States
Holy Cross Hospital
🇺🇸Fort Lauderdale, Florida, United States
Trinity Terrace Park
🇺🇸Davenport, Iowa, United States
Mid-Carolina Cardiology - Presbyterian Hospital
🇺🇸Charlotte, North Carolina, United States
Wake Medical Center
🇺🇸Raleigh, North Carolina, United States
Ohio State University Medical Center
🇺🇸Columbus, Ohio, United States
VA North Texas Health Care System
🇺🇸Dallas, Texas, United States
Parkview Hospital-Parkview Research Center
🇺🇸Fort Wayne, Indiana, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
North Memorial Medical Center
🇺🇸Robbinsdale, Minnesota, United States
York Hospital
🇺🇸York, Pennsylvania, United States
University of Michigan
🇺🇸Ann Arbor, Michigan, United States
Rhode Island Hospital
🇺🇸Providence, Rhode Island, United States