Atrium iCAST Iliac Stent Pivotal Study (iCARUS)

Prospective, multicenter, non-randomized, single-arm registry to evaluate the safety and effectiveness of the iCAST Covered Stent System in the treatment of patients with symptomatic claudication or rest pain and angiographic confirmation of de novo or restenotic lesions in the common and/or external iliac artery.

Study Overview

• Status: Completed
• Conditions: Peripheral Vascular Disease
• Intervention / Treatment: Device: iCAST covered stent

Detailed Description

STUDY DESIGN: Prospective, multicenter, non-randomized, single-arm registry

OBJECTIVE: The primary objective is to evaluate the iCAST covered stent to a performance metric derived from studies of FDA-approved iliac stent devices for treating iliac artery stenoses in patients with de novo or restenotic lesions in the common and/or external iliac arteries.

NUMBER OF SUBJECTS: 165 subjects, including up to 25 subjects with totally occluded lesions.

PRIMARY ENDPOINTS: The primary endpoint is a composite endpoint defined as the occurrence of death within 30 days, target site revascularization or restenosis (by ultrasound determination) within 9 months post-procedure.

SECONDARY ENDPOINTS: Secondary endpoints include:

1. Major adverse vascular events (MAVE) defined as a composite rate of myocardial infarction at 30 days, stent thrombosis, clinically apparent distal embolization, defined as causing end-organ damage (e.g. lower extremity ulceration, tissue necrosis, or gangrene), arterial rupture, acute limb ischemia, target limb amputation or procedure related bleeding event requiring transfusion.
2. A major adverse event (MAE) is defined as a composite rate of MAVE or any death, or stroke, up to 30 days post-procedure.
3. Device success, defined as the successful delivery and deployment of the study stent and intact retrieval of the delivery system.
4. Acute procedural success, defined as device success and achievement of < 30% residual stenosis immediately after stent deployment, mean transtenotic pressure gradient of < 5 mmHg and without occurrence of in-hospital MAVE.
5. Clinical success, assessed both early (30 days) and late (6, 9 and 12 months).
6. Patency assessed at each follow-up time point, categorized as primary, primary-assisted or secondary patency.
7. Composite rate of 30 day death, 9 month target site revascularization and 9 month restenosis in subjects without iliac total occlusions.

PATIENT POPULATION: Eligible patients have symptomatic claudication or rest pain and angiographic confirmation of either de novo or restenotic lesions in the common and/or external iliac artery.

• Study Type: Interventional
• Enrollment (Actual): 165
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Germany
  • Bad Krozingen, Germany
    • Herzzentrum Bad Krozingen
• United States
  • Arkansas
    • Little Rock, Arkansas, United States, 72205
      • University of Arkansas for Medical Sciences
  • California
    • Mountain View, California, United States, 94040
      • Fogarty Clincal Research Incorporated
    • Sacramento, California, United States, 95817
      • University of California, Davis
  • Georgia
    • Atlanta, Georgia, United States, 30308
      • Emory University Hospital Midtown
    • Atlanta, Georgia, United States, 30309
      • Piedmont Hospital Research Institute
  • Illinois
    • Chicago, Illinois, United States, 60611
      • Northwestern University
  • Indiana
    • Indianapolis, Indiana, United States, 46202
      • Krannert Institute of Cardiology
  • Kentucky
    • Louisville, Kentucky, United States, 40202
      • University of Louisville
  • Louisiana
    • Houma, Louisiana, United States, 70360
      • Terrebonne General Medical Center
    • New Orleans, Louisiana, United States, 70121
      • Ochsner Clinic Foundation
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Mass General Hospital
  • Mississippi
    • Hattiesburg, Mississippi, United States, 39401
      • Forest General Hospital
  • Missouri
    • Kansas City, Missouri, United States, 64132
      • Kansas City Heart Foundation
  • New Hampshire
    • Lebanon, New Hampshire, United States, 03756
      • Dartmouth Hitchcock Medical Center
  • North Carolina
    • Durham, North Carolina, United States, 27710
      • Duke University Medical Center
  • Ohio
    • Cincinnati, Ohio, United States, 45219
      • Lindner Clinical Trial Center
    • Cleveland, Ohio, United States, 44195
      • Cleveland Clinic Foundation
    • Cleveland, Ohio, United States, 44106
      • University Hospitals, Case Medical Center
    • Columbus, Ohio, United States, 43214
      • MidWest Cardiology Research Foundation
  • Pennsylvania
    • Camp Hill, Pennsylvania, United States, 17011
      • Holy Spirit Cardiovascular Institute
  • South Dakota
    • Sioux Falls, South Dakota, United States, 57108
      • North Central Heart Institute
  • Tennessee
    • Knoxville, Tennessee, United States, 37934
      • Tennova Healthcare - Turkey Creek Medical Center
  • Texas
    • Dallas, Texas, United States, 75231
      • Cardiovascular Research Institute of Dallas
    • Houston, Texas, United States, 77030
      • The Methodist Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Subject is 18 years of age or older.
2. Subject has lifestyle limiting claudication or rest pain (Rutherford-Becker scale 2-4).
3. Presence of de novo and/or restenotic lesions in the common and/or external iliac artery.
4. Subject has single, bilateral or multiple target lesions that is (are) ≥ 50% stenosed by visual estimate.
5. The target lesion(s) can be successfully crossed with a guide wire and dilated.
6. The target segment of subject's lesion(s) is between 5 and 12mm in diameter and less than 110 mm in length.
7. Subject has angiographic evidence of a patent profunda or superficial femoral artery (SFA) in the target limb.
8. Subject has provided written informed consent.
9. Subject is able and willing to adhere to the required follow-up visits and testing through month 36.
10. Subject is able and willing to adhere to the required follow-up medication regimen.

Exclusion Criteria:

1. Presence of other non-target ipsilateral arterial lesions requiring treatment within 30 days post-procedure (Note that treatment of ipsilateral SFA lesions may be allowed under certain circumstances). Treatment of lesions in any other vascular bed must be completed at least 30 days prior to enrollment.
2. The target lesion(s) has adjacent, acute thrombus.
3. The target lesion(s) is highly calcified or was previously treated with a stent.
4. Target lesion involves the internal iliac artery resulting in crossing of the side-branch with the iCAST device (e.g. "jailing" of the side-branch).
5. Subject has an abdominal aortic aneurysm contiguous with the iliac artery target lesion.
6. Subject has a pre-existing target iliac artery aneurysm or perforation or dissection of the target iliac artery prior to initiation of the iCAST implant procedure.
7. Subject has a post-surgical stenosis and anastomotic suture treatments of the target vessel.
8. Subject has a vascular graft previously implanted in the native iliac vessel.
9. Subject has tissue loss, defined as Rutherford-Becker classification category 5 or 6.
10. Subject has contrast agent hypersensitivity that cannot be adequately pre-medicated, has a hypersensitivity to stainless steel, expanded polytetrafluoroethylene (ePTFE) or has intolerance to antiplatelet, anticoagulant, or thrombolytic medications.
11. History of neutropenia (WBC <3,000/mm3), coagulopathy, or thrombocytopenia (platelet count <80,000/ μL) that has not resolved or has required treatment in the past 6 months.
12. Known bleeding or hypercoagulability disorder or significant anemia (Hb< 8.0) that cannot be corrected.

13. Subject has the following laboratory values:

    1. platelet count less than 80,000/ μL,
    2. prothrombin time (PT)/partial thromboplastin time (PTT) not within normal limits
    3. serum creatinine level greater than 2.5 mg/dL
14. Subject requires general anesthesia for the procedure.
15. Subject is pregnant.
16. Subject has a co-morbid illness that may result in a life expectancy of less than 1 year.
17. Subject is participating in an investigational study of a new drug, biologic or device at the time of study screening. Note: Subjects who are participating in the long term follow-up phase of a previously investigational and now FDA-approved product are not excluded by this criterion.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
OTHER: iCAST covered stent; This is a one arm trial. All subjects received the iCAST covered stent.	Device: iCAST covered stent; Iliac stent implantation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of ITT Population Experiencing Death Within 30 Days, Target Site Revascularization or Restenosis	The primary endpoint is a composite endpoint defined as the occurrence of death within 30 days, target site revascularization within 9 months or restenosis (by ultrasound determination) at 9 months.	Within 9 Months post-procedure

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acute Procedural Success	Device success and achievement of < 30% residual stenosis immediately after stent placement and without occurrence of in-hospital MAVE.	Post-procedure
Device Success	Successful delivery and deployment of the study stent and intact retrieval of the delivery system.	Post-procedure
Major Adverse Event (MAE)	Composite rate of MAVE or any death, or stroke.	30 Days
Major Adverse Vascular Event (MAVE)	Composite rate of myocardial infarction at 30 days, stent thrombosis, clinically apparent distal embolization, arterial rupture, acute limb ischemia, target limb amputation, or procedure related bleeding event requiring transfusion.	30 Days
Major Adverse Vascular Event (MAVE)	Composite rate of myocardial infarction at 30 days, stent thrombosis, clinically apparent distal embolization, arterial rupture, acute limb ischemia, target limb amputation, or procedure related bleeding event requiring transfusion.	180 Days
Major Adverse Vascular Event (MAVE)	Composite rate of myocardial infarction at 30 days, stent thrombosis, clinically apparent distal embolization, arterial rupture, acute limb ischemia, target limb amputation, or procedure related bleeding event requiring transfusion.	270 Days
Major Adverse Vascular Event (MAVE)	Composite rate of myocardial infarction at 30 days, stent thrombosis, clinically apparent distal embolization, arterial rupture, acute limb ischemia, target limb amputation, or procedure related bleeding event requiring transfusion.	360 Days
Early Clinical Success	Improvement of the Rutherford-Becker clinical criteria by ≥ 1 category. (Classification system for evaluating clinical improvement as defined by Rutherford R, Becker G. Standards for evaluating and reporting the results of surgical and percutaneous therapy for peripheral arterial disease. Journal of Vascular Interventional Radiology 1991;2:169-174.)	1 Month
Late Clinical Success	Maintained improvement in ankle brachial index (ABI), the ratio of the blood pressure at the ankle to the blood pressure in the upper arm.	6 Months
Late Clinical Success	Maintained improvement in ankle brachial index (ABI), the ratio of the blood pressure at the ankle to the blood pressure in the upper arm.	9 Months
Late Clinical Success	Maintained improvement in ankle brachial index (ABI), the ratio of the blood pressure at the ankle to the blood pressure in the upper arm.	12 Months
Late Clinical Success	Maintained improvement in ankle brachial index (ABI), the ratio of the blood pressure at the ankle to the blood pressure in the upper arm.	24 Months
Late Clinical Success	Maintained improvement in ankle brachial index (ABI), the ratio of the blood pressure at the ankle to the blood pressure in the upper arm.	36 Months
Primary Patency	Continuous flow without revascularization, bypass or target limb amputation.	1 Month
Primary Patency	Continuous flow without revascularization, bypass or target limb amputation.	6 Months
Primary Patency	Continuous flow without revascularization, bypass or target limb amputation.	9 Months
Primary Patency	Continuous flow without revascularization, bypass or target limb amputation.	12 Months
Primary Patency	Continuous flow without revascularization, bypass or target limb amputation.	24 Months
Primary Patency	Continuous flow without revascularization, bypass or target limb amputation.	36 Months
Primary-Assisted Patency	Continuous flow assisted when the target vessel has restenosed at any time post-procedure.	1 Month
Primary-Assisted Patency	Continuous flow assisted when the target vessel has restenosed at any time post-procedure.	6 Months
Primary-Assisted Patency	Continuous flow assisted when the target vessel has restenosed at any time post-procedure.	9 Months
Primary-Assisted Patency	Continuous flow assisted when the target vessel has restenosed at any time post-procedure.	12 Months
Primary-Assisted Patency	Continuous flow assisted when the target vessel has restenosed at any time post-procedure.	24 Months
Primary-Assisted Patency	Continuous flow assisted when the target vessel has restenosed at any time post-procedure.	36 Months
Secondary Patency	Re-establishment of flow to distal arteries after occlusion has occurred at the target vessel.	1 Month
Secondary Patency	Re-establishment of flow to distal arteries after occlusion has occurred at the target vessel.	6 Months
Secondary Patency	Re-establishment of flow to distal arteries after occlusion has occurred at the target vessel.	9 Months
Secondary Patency	Re-establishment of flow to distal arteries after occlusion has occurred at the target vessel.	12 Months
Secondary Patency	Re-establishment of flow to distal arteries after occlusion has occurred at the target vessel.	24 Months
Secondary Patency	Re-establishment of flow to distal arteries after occlusion has occurred at the target vessel.	36 Months

Collaborators and Investigators

• Sponsor: Atrium Medical Corporation
• Investigators: Principal Investigator: John R Laird, MD, Adventist Health

Publications and helpful links

General Publications

• Laird JR, Loja M, Zeller T, Niazi KAK, Foster MT, Ansel G, Stone DH, Dave RM, Popma JJ, Jaff MR, Massaro JM. iCAST Balloon-Expandable Covered Stent for Iliac Artery Lesions: 3-Year Results from the iCARUS Multicenter Study. J Vasc Interv Radiol. 2019 Jun;30(6):822-829.e4. doi: 10.1016/j.jvir.2018.12.707. Epub 2019 Apr 25.

Study record dates

Study Major Dates

• Study Start: October 1, 2007
• Primary Completion (ACTUAL): August 1, 2011
• Study Completion (ACTUAL): May 1, 2014

Study Registration Dates

• First Submitted: January 2, 2008
• First Submitted That Met QC Criteria: January 14, 2008
• First Posted (ESTIMATE): January 15, 2008

Study Record Updates

• Last Update Posted (ACTUAL): May 17, 2018
• Last Update Submitted That Met QC Criteria: April 13, 2018
• Last Verified: April 1, 2018

More Information

Terms related to this study

• Keywords: Symptomatic claudication or rest pain and angiographic confirmation of either de novo or restenotic lesions in the common and/or external iliac artery.
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Atherosclerosis; Vascular Diseases; Peripheral Arterial Disease; Peripheral Vascular Diseases
• Other Study ID Numbers: Atrium 701

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED