DCB Outcomes After Non-Compliant Balloon Vessel Preparation With or Without Scoring in Patients With Femoropopliteal Arterial Disease (DASBAD-NC)
Drug-coated Balloon Angioplasty After Non-Compliant Balloon Vessel Preparation With or Without Scoring for Femoropopliteal Arterial Disease: A Randomized Controlled Trial
The aim of this clinical trial is to determine whether vessel preparation with a non-compliant scoring balloon before drug-coated balloon (DCB) angioplasty provides superior procedural and clinical outcomes compared with vessel preparation using a non-compliant plain balloon in patients with chronic limb-threatening ischaemia (CLTI) undergoing femoropopliteal endovascular intervention.
The main questions the study aims to answer are:
- Does non-compliant scoring balloon vessel preparation reduce the need for bailout stenting during the index procedure?
- Does it improve primary patency after DCB angioplasty?
- Does it improve clinically relevant outcomes such as wound healing, freedom from clinically driven target lesion revascularisation, limb salvage and health-related quality of life?
- Does it provide procedural and economic advantages compared with non-compliant plain balloon vessel preparation?
Participants will be randomly assigned to undergo vessel preparation using either a non-compliant plain balloon or the DKutting™ non-compliant scoring balloon, followed by angioplasty with the Legflow XP™ drug-coated balloon. Patients will undergo clinical, duplex ultrasound and quality-of-life follow-up for 24 months.
Descripción general del estudio
Estado
Estado
Condiciones
Condiciones
Intervención / Tratamiento
Intervención / Tratamiento
Descripción detallada
The DASBAD-NC trial is a prospective, multicentre, randomised, patient-blinded, controlled clinical investigation designed to compare two vessel preparation strategies before drug-coated balloon (DCB) angioplasty for femoropopliteal arterial disease in patients with chronic limb-threatening ischaemia (Rutherford classification 4-5).
Eligible patients with significant atherosclerotic femoropopliteal disease (≥50% stenosis or chronic total occlusion) will be randomised in a 1:1 ratio, after successful guidewire crossing of the target lesion and confirmation of all eligibility criteria, to one of two treatment strategies:
- Vessel preparation using a non-compliant plain balloon (PBA arm), followed by Legflow XP™ drug-coated balloon angioplasty.
- Vessel preparation using the DKutting™ non-compliant scoring balloon (SB arm), followed by Legflow XP™ drug-coated balloon angioplasty.
Vessel preparation will be performed using a 1:1 balloon-to-reference vessel diameter ratio with a minimum inflation time of 180 seconds. Predilatation with a smaller balloon will only be permitted if the allocated study balloon cannot cross the lesion. Drug-coated balloon angioplasty will subsequently be performed using the Legflow XP™ drug-coated balloon according to the study protocol. Bailout stenting will only be permitted in the presence of residual stenosis ≥30% and/or flow-limiting dissection after DCB treatment.
The co-primary endpoints are bailout stenting during the index procedure and primary patency at 12 months. Secondary endpoints include freedom from clinically driven target lesion revascularisation, target limb major amputation, all-cause mortality, wound healing, health-related quality of life, procedural success, slow-flow phenomenon, procedural costs and other prespecified clinical and imaging outcomes.
Duplex ultrasound follow-up examinations will undergo blinded central review by an independent duplex ultrasound core laboratory. Procedural angiographic outcomes will undergo an independent blinded quality assurance review after database lock by experienced investigators according to the prespecified study methodology. Clinical events will be adjudicated by an independent Clinical Events Committee according to prespecified endpoint definitions.
Patients will be followed for 24 months after the index procedure.
Tipo de estudio
Tipo de estudio
Inscripción (Estimado)
Inscripción
Fase
Fase
- No aplica
Contactos y Ubicaciones
Estudio Contacto
Estudio Contacto
- Nombre: Marc Sirvent, PhD
- Número de teléfono: 2575 +34938425000
- Correo electrónico: msirvent@fphag.org
Criterios de participación
Criterio de elegibilidad
Criterio de elegibilidad
Edades elegibles para estudiar
- Adulto
- Adulto Mayor
Acepta Voluntarios Saludables
Descripción
Inclusion Criteria:
- ≥18 years of age.
- Rutherford class 4-5.
- Estimated life expectancy >1 year, per investigator's judgment.
- Significant atherosclerotic lesions (≥50% stenosis or chronic total occlusion) in the femoropopliteal segment, including in-stent restenosis.
- Signed informed consent.
- Willingness to comply with follow-up visits.
- ≥1 patent infragenicular artery (<50% stenosis) at the end of the procedure.
- Target vessel diameter ≤8 mm.
Exclusion Criteria:
- Pregnant or planning pregnancy during the study.
- Participation in another drug/device trial.
- Inability to cross the target lesion with a guidewire. Successful crossing is defined as advancement of the guidewire tip distal to the target lesion without vessel perforation or flow-limiting dissection.
- Inadequate treatment of proximal lesion (>30% residual stenosis).
- Severe calcification of the target vessel [group 4 of Fanelli classification17 defined as circumferential calcification (270º-360º)], evidenced before contrast injection or digital subtraction angiography.
- Thrombus in the target vessel.
- Anastomotic stenosis of a bypass.
- Use of atherectomy, thrombectomy, laser, or similar devices.
- Prior or planned above-the-ankle amputation of the target limb.
- Coagulopathy, hypercoagulable state, bleeding diathesis, platelets <80 000/µL or >700 000/µL, or other blood disorder.
- Gastrointestinal bleeding requiring transfusion within 3 months.
- Contraindication to antiplatelet/anticoagulant/thrombolytic therapy.
- Acute coronary syndrome within 30 days.
- Stroke or TIA within 90 days.
- Hypersensitivity/contraindication to nitinol.
- Comorbidities precluding treatment or follow-up (per investigator).
- Hypersensitivity/allergy to contrast not manageable medically.
- Hypersensitivity/allergy to heparin, aspirin, paclitaxel, clopidogrel, or other antiplatelet/anticoagulant agents.
- Contraindication to dual antiplatelet therapy.
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Doble
Número de brazos
Armas e Intervenciones
Grupo de participantes/brazoGrupo de participantes/brazo |
Intervención / TratamientoIntervención / Tratamiento |
|---|---|
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Comparador activo: Non-compliant plain balloon (PBA)
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The intervention consists of preparing the artery with a non-compliant plain balloon before using the DCB (Legflow XP™; Manufacturer: Cardionovum GmbH Bonn, Germany).
Otros nombres:
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Comparador activo: Scoring balloon (SB)
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The intervention consists of preparing the artery with a non-compliant scoring balloon (DKutting™; Manufacturer: DK Medical Technology Co., Ltd., Suzhou, China) before using the DCB (Legflow XP™; Manufacturer: Cardionovum GmbH Bonn, Germany) as definitve treatment.
Otros nombres:
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¿Qué mide el estudio?
Medidas de resultado primarias
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Bailout stenting
Periodo de tiempo: At index procedure
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The need for bailout stenting during the index procedure, defined as stent implantation due to residual stenosis >30% or a flow-limiting dissection (type C according to the Kobayashi classification)
|
At index procedure
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Primary Patency
Periodo de tiempo: At 12 months
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Primary patency at 12 months defined as absence of ≥50% restenosis (peak systolic velocity ratio<2.5)
and no clinically driven target lesion revascularisation (CD-TLR), as adjudicated by the duplex core laboratory and the Clinical Events Committee.
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At 12 months
|
Medidas de resultado secundarias
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Device success
Periodo de tiempo: During the index procedure
|
Device success, defined as successful delivery, inflation, and retrieval of the assigned balloon catheter, resulting in a residual stenosis <30% without flow-limiting dissection (FLD) on final angiography.
|
During the index procedure
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Technical success
Periodo de tiempo: During the index procedure.
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Technical success, defined as successful use of a device or technique to re-establish vessel patency with a residual stenosis <30% by visual estimation and <50% by duplex during the index procedure.
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During the index procedure.
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Procedural cost
Periodo de tiempo: During the index procedure
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Procedural cost, defined as the total acquisition cost (€) of all lesion preparation balloons (including adjunctive predilatation balloons, if required) and bailout stents used during the index procedure for the target lesion.
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During the index procedure
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Slow-flow phenomenon
Periodo de tiempo: During the index procedure
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Slow-flow phenomenon, defined as an angiographic reduction in antegrade flow occurring after DCB inflation compared with the immediately preceding angiogram, in the absence of residual stenosis >30%, flow-limiting dissection, or vasospasm.
The presence or absence of slow-flow phenomenon will be determined by the independent blinded angiographic review.
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During the index procedure
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Procedural success
Periodo de tiempo: Occurring <24 hours and <1 month of the index procedure.
|
Procedural success, defined as technical success with absence of rupture, distal embolization, thrombosis, access complications, or major adverse cardiovascular events.
These events should be listed as occurring <24 hours and <1 month of the procedure.
|
Occurring <24 hours and <1 month of the index procedure.
|
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Freedom from device and procedure-related death
Periodo de tiempo: Until 30 days post-procedure
|
Freedom from device and procedure-related death through 30 days post-procedure.
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Until 30 days post-procedure
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Freedom from Major Adverse Events (MAE)
Periodo de tiempo: Up to 24 months post-procedure
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Freedom from Major Adverse Events (MAE) up to 24 months post-procedure. MAE are defined as the composite of:
|
Up to 24 months post-procedure
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Primary patency
Periodo de tiempo: At 6 and 24 months post-procedure
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Primary patency at 6 and 24 months post-procedure, defined as absence of ≥50% restenosis (peak systolic velocity ratio<2.5)
and no CD-TLR, as adjudicated by the duplex core laboratory and the Clinical Events Committee (CEC).
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At 6 and 24 months post-procedure
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Freedom from CD-TLR
Periodo de tiempo: Up to 24 months post-procedure
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Freedom from CD-TLR up to 24 months post-procedure.
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Up to 24 months post-procedure
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Change in EQ-5D questionnaire
Periodo de tiempo: Up to 24 months post-procedure
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Change in EQ-5D questionnaire from baseline up to 24 months post-procedure
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Up to 24 months post-procedure
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Amputation free survival
Periodo de tiempo: Up to 24 months post-procedure.
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Amputation free survival up to 24 months post-procedure. • Amputation free survival is defined as survival without above-the-ankle amputation of the target limb. |
Up to 24 months post-procedure.
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Wound healing evolution
Periodo de tiempo: Up to 24 months post-procedure
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Wound healing evolution up to 24 months post-procedure, assessed according to the following predefined ordinal classification:
|
Up to 24 months post-procedure
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Wound healing time
Periodo de tiempo: Days from the index procedure to complete epithelialisation of the target wound
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Wound healing time is defined as the number of days from the index procedure to complete epithelialisation of the target wound, without drainage or need for dressing, as assessed by the treating physician. • Major amputation of the index limb or death prior to complete wound healing will be considered failure of the wound healing endpoint. |
Days from the index procedure to complete epithelialisation of the target wound
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Change in Rutherford classification
Periodo de tiempo: Up to 24 months post-procedure.
|
Change in Rutherford classification up to 24 months post-procedure.
|
Up to 24 months post-procedure.
|
Colaboradores e Investigadores
Patrocinador
Patrocinador
Colaboradores
Colaboradores
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Estimado)
Inicio del estudio
Finalización primaria (Estimado)
Finalización primaria
Finalización del estudio (Estimado)
Finalización del estudio
Fechas de registro del estudio
Enviado por primera vez
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Publicado por primera vez
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización publicada
Última actualización enviada que cumplió con los criterios de control de calidad
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
- Enfermedades Vasculares
- Enfermedades cardiovasculares
- Procesos Patológicos
- Enfermedad crónica
- Atributos de la enfermedad
- Aterosclerosis
- Arteriosclerosis
- Enfermedades arteriales oclusivas
- Enfermedades vasculares periféricas
- Isquemia
- Condiciones Patológicas, Signos y Síntomas
- Isquemia crónica que amenaza las extremidades
- Enfermedad arterial periférica
- Técnicas de investigación
- Diseño de investigación epidemiológica
- Métodos epidemiológicos
- Diseño de la investigación
- Métodos
- Grupos de control
Otros números de identificación del estudio
Otros números de identificación del estudio
- DASBAD-NC
Plan de datos de participantes individuales (IPD)
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Descripción del plan IPD
Información sobre medicamentos y dispositivos, documentos del estudio
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