Evaluation of the Pantheris Atherectomy System (VISION)

Evaluation of the Pantheris Optical Coherence Tomography Imaging Atherectomy System for Use in the Peripheral Vasculature

A non-randomized, prospective, global clinical trial of the Avinger Pantheris System, an atherectomy device that provides directional visualization and imaging as an adjunct to fluoroscopy to aid removal of plaque in diseased lower extremity arteries.

Study Overview

• Status: Completed
• Conditions: Peripheral Arterial Disease
• Intervention / Treatment: Device: Pantheris System

Detailed Description

The trial will enroll up to 173 subjects diagnosed with peripheral arterial disease of the lower extremities at up to 20 sites (up to 3 international sites), including 133 Intention to Treat subjects and up to 2 additional Roll-In subjects at each site (up to 40 Roll-In subjects total). The primary disease must be located in reference vessel diameters ≥ 2.5 mm and ≤ 7.0 mm. Trial success is focused on safety including rates of major adverse events through 6 months as adjudicated by a Clinical Events Committee. Effectiveness will be evaluated using technical success, defined as the percent of target lesions that have a residual diameter stenosis <50% post-treatment with the Pantheris device alone as assessed by Angiographic Core Lab.

• Study Type: Interventional
• Enrollment (Actual): 162
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Germany
  • Muenster, Germany, 48145
    • Muenster Hospital
• United States
  • Arkansas
    • Jonesboro, Arkansas, United States, 72401
      • St. Bernard's Medical Center
    • Little Rock, Arkansas, United States, 72211
      • Arkansas Heart Hospital
  • California
    • West Hollywood, California, United States, 90048
      • Cedars Sinai Medical Center/Cardiovascular Research Foundation of Southern California
  • District of Columbia
    • Washington, District of Columbia, United States, 20010
      • MedStar Washington Hospital
  • Florida
    • Pensacola, Florida, United States, 32501
      • Coastal Vascular and Interventional
  • Illinois
    • Elk Grove Village, Illinois, United States, 60007
      • Alexian Brothers Medical Center, Cardiovascular Associates
    • Oak Lawn, Illinois, United States, 60453
      • Advocate Christ Hospital and Medical Center
  • Indiana
    • Fort Wayne, Indiana, United States, 46802
      • St. Joseph's Hospital
  • Michigan
    • Detroit, Michigan, United States, 48236
      • St. John Hospital and Medical Center
    • Detroit, Michigan, United States, 48201
      • Detroit Medical Center Cardiovascular Institute Harper-Hutzel Hospital
  • Mississippi
    • Jackson, Mississippi, United States, 39216
      • St. Dominic Hospital
  • Nebraska
    • Omaha, Nebraska, United States, 68198
      • University of Nebraska Medical Center
  • New Jersey
    • Browns Mills, New Jersey, United States, 08015
      • Deborah Heart and Lung Center
    • New Brunswick, New Jersey, United States, 08901
      • St. Peters University Hospital
  • Ohio
    • Cincinnati, Ohio, United States, 45220
      • Hatton Institute for Research and Education, Good Samaritan Hospital - Bethesda North
    • Dayton, Ohio, United States, 45414
      • Dayton Heart Center/Good Samaritan Hospital
    • Toledo, Ohio, United States, 43606
      • Jobst Vascular Center
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19141
      • Einstein Medical Center
  • Tennessee
    • Memphis, Tennessee, United States, 38116
      • Methodist Hospital
  • Texas
    • Austin, Texas, United States, 78756
      • Austin Heart

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:

• Age ≥ 18 years old;
• Subject is a candidate for percutaneous intervention for peripheral arterial disease in the legs;
• Subject is willing and able to give informed consent;
• Documented symptomatic atherosclerotic peripheral arterial disease Rutherford Classification 2-5;
• Reference vessel lumen proximal to target lesion ≥ 2.5 mm and ≤ 7.0 mm in diameter by visual estimation;
• Subject has de novo target lesion(s) with stenosis >70% by visual estimation distal to the profunda femoral artery. No more than 2 lesions may be treated with the Pantheris device;
• Target lesion length ≤ 15 cm (may be two tandem lesions that do not exceed 15cm in total length);
• Subject is capable of meeting requirements and be present at the follow-up clinic visits at 30 days and 6 months;
• At least one patent tibial run-off vessel at baseline.

Inclusion Criteria for the 24-month follow up:

• Completed the 6-month follow-up visit
• Re-consented prior to the 24-month follow-up visit

Exclusion Criteria:

• Subject is pregnant or breast feeding;
• Rutherford Class 0 to 1 (asymptomatic and mild claudication);
• Rutherford Class 6 (critical limb ischemia);
• Moderate to severe calcification of the target lesion;
• Acute ischemia and/or acute thrombosis of the Superficial Femoral Artery (SFA)-Popliteal segment;
• In-stent restenosis within the target lesion;
• Target lesion with any type of stent or graft;
• Target lesion in the iliac artery;
• Target lesion stenosis <70%;
• Subjects with significant (≥70%) occlusive lesions proximal to the target lesion not successfully treated during the index procedure (upstream disease) and prior to treatment of the target lesion;
• Endovascular or surgical procedure performed on the index limb less than or equal to 30 days prior to the index procedure;
• Planned endovascular or surgical procedure 30 days after the index procedure;
• Lesion in the contralateral limb requiring intervention during the index procedure or within 30 days of the index procedure;
• Subjects with active systemic infections whether they are being currently treated or not;
• Subjects on chronic hemodialysis or creatinine level >2.0mg/dL;
• Evidence or history of intracranial or gastrointestinal bleeding, intracranial aneurysm, myocardial infarction or stroke within the past 2 months;
• Evidence or history of aneurysmal target vessel within the past 2 months;
• History of severe trauma, fracture, major surgery or biopsy of a parenchymal organ within the past 14 days;
• Known allergy to contrast agents or medications used to perform endovascular intervention that cannot be adequately pre-treated;
• Subjects in whom anti-platelet, anticoagulant, or thrombolytic therapy is contraindicated;
• History of heparin-induced thrombocytopenia (HIT);
• Uncorrectable bleeding diathesis, platelet dysfunction, thrombocytopenia with platelet count less than 100,000/mm2, known coagulopathy, or International Normalized Ratio (INR) >1.5;
• Any thrombolytic therapy within 2 weeks of the index procedure;
• Any clinical and/or angiographic complication attributed to the use of another device prior to the insertion of the study device into the subject;
• Subjects or their legal guardians who have not or will not sign the Informed Consent;
• Subjects who are unwilling or unable to comply with the follow-up study requirements;
• Participation in any study of an investigational device, medication, biologic or other agent within 30 days prior to enrollment that is either a cardiovascular study or could, in the judgment of the investigator, affect the results of the study.

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
EXPERIMENTAL: Pantheris Treatment Arm; Intervention: Atherectomy using the Pantheris system.	Device: Pantheris System; Atherectomy using directional visualization and imaging as an adjunct to fluoroscopy to aid removal of plaque from diseased lower extremity arteries.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Primary Safety Endpoint	The primary safety endpoint is defined as freedom from a composite of major adverse events (MAE) through 6-Month follow-up as adjudicated by an independent Clinical Events Committee (CEC). Individual MAEs include: Cardiovascular related death; Unplanned, major index limb amputation; Clinically driven target lesion revascularization (TLR); Myocardial infarction; Device related events:Clinically significant perforationClinically significant dissectionClinically significant embolusPseudoaneurysm	Day 0 through 6 Months
Primary Effectiveness Endpoint: Technical Success	The primary efficacy endpoint of technical success is defined as the percent of target lesions that have a residual diameter stenosis <50% post the Pantheris device alone, as assessed by an independent Angiographic Core Laboratory.	Day 0

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Secondary Safety Endpoint	Freedom from MAEs as defined above, through 30 days (or hospital discharge, whichever is longer) as adjudicated by an independent CEC.	Day 0 through Day 30
Secondary Safety Endpoint	Freedom from procedural emboli, defined as a change in any visualized runoff vessel (other than vasospasm and dissection) at any time during the procedure.	Day 0 through 30 days
Secondary Safety Endpoint	Freedom from clinically driven Target Vessel Revascularization (TVR) through 6 months, as adjudicated by an independent CEC.	Day 0 through 6 Months
Secondary Effectiveness Endpoint: Procedural Success	Procedural success defined as the percent of target lesions that have residual diameter stenosis < 30% post-Pantheris and any other adjunctive therapy, determined by independent Angiographic Core Laboratory.	Day 0
Secondary Effectiveness Endpoint: ABI	Ankle-Brachial Index (ABI) at 30 days. ABI is the ratio of blood pressure in the lower legs to the blood pressure in the arms. ABI between 0.95 and 1.3 is considered normal (free from significant peripheral artery disease).	Day 30
Secondary Effectiveness Endpoint: Rutherford Classification	Rutherford Classification at 30 days. Rutherford Classification is a commonly used clinical means for describing the degree of peripheral artery disease. Rutherford Classifications range from Class 0: asymptomatic, to Class 6: major tissue loss.	Day 30
Secondary Effectiveness Endpoint: Quality of Life - 12-Item Short Form Survey (SF-12)	Change in Quality of Life measures between Baseline and 30 days using 12-Item Short Form Survey (SF-12). There are two components of the SF-12: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Each yields scores from 0 (representing the worst possible debilitation) to 100 (representing no reduction in quality of life).	Day 30
Secondary Effectiveness Endpoint: Vascular Quality of Life Questionnaire (VascuQoL)	Change in Quality of Life measures between Baseline and 30 days using Vascular Quality of Life Questionnaire (VascuQoL). The VascuQoL is a disease-specific questionnaire developed to assess chronic limb ischemia. VascuQol uses a seven-point scale, with 1 representing the worst score and 7 representing the best score.	Day 30
Secondary Effectiveness Endpoint: ABI	Ankle-Brachial Index (ABI) at 6 months. ABI is the ratio of blood pressure in the lower legs to the blood pressure in the arms. ABI between 0.95 and 1.3 is considered normal (free from significant peripheral artery disease).	6 Month
Secondary Effectiveness Endpoint: Rutherford Classification	Rutherford Classification at 6 months. Rutherford Classification is a commonly used clinical means for describing the degree of peripheral artery disease. Rutherford Classifications range from Class 0: asymptomatic, to Class 6: major tissue loss.	6 Month
Secondary Effectiveness Endpoint: Quality of Life - 12-Item Short Form Survey (SF-12)	Change in Quality of Life measures between Baseline and 6 Months using 12-Item Short Form Survey (SF-12). There are two components of the SF-12: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Each yields scores from 0 (representing the worst possible debilitation) to 100 (representing no reduction in quality of life).	6 Month
Secondary Effectiveness Endpoint: Vascular Quality of Life Questionnaire (VascuQoL)	Change in Quality of Life measures between Baseline and 6 months using Vascular Quality of Life Questionnaire (VascuQoL). The VascuQoL is a disease-specific questionnaire developed to assess chronic limb ischemia. VascuQol uses a seven-point scale, with 1 representing the worst score and 7 representing the best score.	6 Month

Collaborators and Investigators

• Sponsor: Avinger, Inc.
• Investigators: Principal Investigator: Gray Bennett, MD, Jackson Heart Clinic; Principal Investigator: Billy Crowder, MD, Jackson Heart Clinic

Publications and helpful links

General Publications

• Schwindt AG, Bennett JG Jr, Crowder WH, Dohad S, Janzer SF, George JC, Tedder B, Davis TP, Cawich IM, Gammon RS, Muck PE, Pigott JP, Dishmon DA, Lopez LA, Golzar JA, Chamberlin JR, Moulton MJ, Zakir RM, Kaki AK, Fishbein GJ, McDaniel HB, Hezi-Yamit A, Simpson JB, Desai A. Lower Extremity Revascularization Using Optical Coherence Tomography-Guided Directional Atherectomy: Final Results of the EValuatIon of the PantheriS OptIcal COherence Tomography ImagiNg Atherectomy System for Use in the Peripheral Vasculature (VISION) Study. J Endovasc Ther. 2017 Jun;24(3):355-366. doi: 10.1177/1526602817701720. Epub 2017 Apr 10.

Study record dates

Study Major Dates

• Study Start (ACTUAL): June 25, 2013
• Primary Completion (ACTUAL): July 15, 2015
• Study Completion (ACTUAL): September 20, 2015

Study Registration Dates

• First Submitted: September 4, 2013
• First Submitted That Met QC Criteria: September 4, 2013
• First Posted (ESTIMATE): September 9, 2013

Study Record Updates

• Last Update Posted (ACTUAL): March 25, 2021
• Last Update Submitted That Met QC Criteria: March 3, 2021
• Last Verified: March 1, 2021

More Information

Terms related to this study

• Keywords: Optical Coherence Tomography; Atherectomy; Lumivascular
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Atherosclerosis; Peripheral Arterial Disease; Peripheral Vascular Diseases
• Other Study ID Numbers: P0555

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes