Singapore INfra-Genicular Angioplasty With PAclitaxel-eluting Balloon for Critical Limb Ischaemia (SINGA-PACLI) Trial

NCT02129634 | Completed

• 1 other identifier: SINGA-PACLI_01
• Study Type: interventional
• Target: 136
• Locations: 1 country
• Sites: 2

Brief Summary

Background \- In patients with critical limb ischaemia (CLI), the infragenicular arteries are often involved. Without revascularisation, amputation often is imperative. There is a high technical success rate of endovascular revascularisation of infragenicular arteries with percutaneous transluminal angioplasty (PTA), but mid- and long-term results are disappointing as restenosis frequently occurs. Drug-eluting balloon (DEB) PTA has been shown to improve patency rates after PTA of coronary arteries. Aim

• To study the results of DEB-PTA compared to conventional balloon CB-PTA for the treatment of infragenicular lesions in patients with CLI.
• To evaluate cost-effectiveness of DEB-PTA versus CB-PTA in patients with critical limb ischemia (CLI) by quantifying the incremental cost-effectiveness ratio (ICER). Hypothesis
• DEB PTA results in improved patency rates compared to CB-PTA for treatment of infragenicular arterial lesions in patients with CLI.
• DEB-PTA is a cost-effective strategy in patients with CLI compared with CB-PTA. Methodology Multi-center, prospective, randomised parallel-group trial. Patients are eligible for enrolment if they have CLI and at least one infragenicular lesion with a maximal total lesion length of 20cm. Randomisation will be performed on a 1:1 ratio to either DEB-PTA or CB-PTA. Patients will be assessed prior and directly after the intervention, at 3, 6 and 12 months by Rutherford classification, ankle-brachial index, toe pressure and adverse events. Duplex will be performed at 3 months. Angiography will be performed before and directly after PTA and at 6 months. Primary end-point will be primary patency of the treated lesions at 6 months on angiography (defined as \<50% stenosis, without re-intervention in the interim). Secondary end-points are limb salvage at 3, 6 and 12 months, primary patency of the treated lesion on Duplex at 3 months (defined as patency of the treated artery with peak systolic velocity (PSV) ≤2.0 m/sec), Rutherford classification, minor and major amputation, infrapopliteal endovascular re-intervention, patency of treated femoropopliteal sites (if applicable), infrapopliteal surgical bypass, peri-procedural complications and death at 3, 6 and 12 months. A cost-effectiveness analysis (CEA) from a societal perspective will be performed in parallel with the randomized clinical trial with a 12-month time horizon.

Conditions

Peripheral Arterial Disease

Keywords

Percutaneous Transluminal Angioplasty; Limb-salvage; Randomized Controlled Trial; Paclitaxel

Outcome Measures

Primary Outcomes (1)

• Primary patency of the treated (index) site at 6 months

  Primary patency is defined as less than or equal 50% loss of luminal diameter at the treated site on angiography without re-intervention in the interim.

  6 months

Secondary Outcomes (10)

• Limb-salvage rate

  at 3, 6 and 12 months

• Primary patency of the treated (index) site

  at 3 months

• Clinical categorisation of the treated ischemic leg

  at 3, 6 and 12 months

• Minor amputation

  at 3, 6 and 12 months

• Infrapopliteal surgical bypass of the trial leg

  at 3, 6 and 12 months

Study Arms (2)

CB-PTA arm

ACTIVE COMPARATOR

After successful crossing of the trial lesion, a conventional angioplasty balloon with a diameter matching the trial vessel is advanced over the guidewire and is inflated at the trial lesion site, according to the normal practice of the operator. Comparisons of pre- and post-angioplasty percentage stenosis will be made in the same angiographic projection(s).

Device: CB-PTA

DEB-PTA arm

EXPERIMENTAL

After successful crossing of the trial lesion, angioplasty with a conventional angioplasty balloon is performed before DEB-PTA. This is because the paclitaxel coating may be scrapped off the balloon if the DEB is used to cross the trial lesion. A conventional angioplasty balloon with a diameter matching the trial vessel is advanced over the guidewire and is inflated at the trial lesion site, according to the normal practice of the operator. A DEB with a diameter matching the trial vessel and lesion length is then advanced over the 0.018 inch guidewire and inflated at the trial lesion site for 60 seconds. If the lesion length is longer than the length of the balloon, a second inflation with another DEB will be required. The maximal total lesion length of the treated lesions will not exceed 20cm. Comparisons of pre- and post-angioplasty percentage stenosis will be made in the same angiographic projection(s).

Device: CB-PTA; Device: DEB-PTA

Interventions

CB-PTA DEVICE

Also known as: Conventional Balloon-Percutaneous Transluminal Angioplasty

CB-PTA arm; DEB-PTA arm

DEB-PTA DEVICE

Also known as: Paclitaxel-eluting Balloon-Percutaneous Transluminal Angioplasty

DEB-PTA arm

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Written informed consent
• Age \> 21 years
• If female patient with child bearing potential, patient may not be pregnant at the study entry and must utilize reliable birth control for the duration of her participation into the study
• Patient is willing and able to comply with the specified follow-up evaluation
• Critical Limb Ischaemia, Rutherford category 4 (ischaemic rest pain), 5 (minor tissue loss) or 6 (major tissue loss)
• Stenosis (\>50% luminal loss) or occlusion of infra-genicular arteries (defined as: distal to the infra-popliteal artery), including the tibiofibular trunk, the anterior tibial artery, the posterior tibial artery and the peroneal artery
• Infragenicular arterial lesions with length of \<20cm
• At least one crural (anterior tibial, posterior tibial or peroneal) artery with expected unobstructed runoff to ankle level after treatment
• Successful guidewire crossing of the trial lesion

You may not qualify if:

• Acute limb ischaemia
• Subacute limb ischaemia which requires thrombolysis as first treatment modality
• Previous major amputation of the affected limb (at or above the level of the ankle)
• Concurrent iliac or femoropopliteal artery disease not suitable for endovascular or surgical revascularisation
• Concurrent iliac or femoropopliteal artery occlusion of \>10cm, even if suitable for surgical or endovascular revascularization
• Patients without (expected) distal runoff to the index site
• Revascularization involving the same site within 30 days prior to the index procedure or planned revascularization of the same limb within 30 days of the index procedure
• Previous implanted stent at the index site
• Life expectancy of less than 6 months
• Factors making clinical follow-up very difficult or impossible
• Known allergy to paclitaxel
• Known allergy to contrast media
• Patients on Warfarin or any other anti-coagulants
• Known allergy to anti-platelet drugs (Aspirin/ Clopidogrel) (or) unable to tolerate dual anti-platelet drugs therapy
• Active history of gastritis and other bleeding tendencies precluding use of dual anti-platelet therapy

Sponsors & Collaborators

• Singapore General Hospital: lead
• Tan Tock Seng Hospital: collaborator
• Duke-NUS Graduate Medical School: collaborator
• Singapore Clinical Research Institute: collaborator

Study Sites (2)

Singapore General Hospital

Singapore, 169608, Singapore

Location

Tan Tock Seng Hospital

Singapore, 308433, Singapore

Location

Related Publications (26)

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Related Links

• The Panel on Handling Missing Data in Clinical Trials; National Research Council (2010). The Prevention and Treatment of Missing Data in Clinical Trials. National Academies Press
• Drummond M, Schulpher M, Torrance G, O'Brien B, Stoddart G. Methods for the economic evaluation of health care programmes. 3rd ed. New York: Oxford University Press; 2005.

MeSH Terms

Conditions

Peripheral Arterial Disease

Condition Hierarchy (Ancestors)

Atherosclerosis; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases; Cardiovascular Diseases; Peripheral Vascular Diseases

Study Officials

• Bien Soo Tan, MBBS, FRCR, FAMS

  Singapore General Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 9, 2014
• First Posted: May 2, 2014
• Study Start: December 27, 2013
• Primary Completion: October 6, 2018
• Study Completion: October 6, 2018
• Last Updated: August 20, 2019

Record last verified: 2019-08

Locations

SG (2)