Twelve-Month Results From the MAJESTIC Trial of the Eluvia Paclitaxel-Eluting Stent for Treatment of Obstructive Femoropopliteal Disease

Abstract

Purpose: To report the 12-month results of the MAJESTIC clinical study of the self-expanding Eluvia paclitaxel-eluting stent in the treatment of femoropopliteal lesions.

Methods: The prospective, single-arm, multicenter trial (clinicaltrials.gov identifier NCT01820637) enrolled 57 patients (mean age 69±9 years; 47 men) with chronic lower limb ischemia referable to de novo or restenotic lesions in the native superficial femoral and/or proximal popliteal arteries. A third of the patients had diabetes. Mean lesion length was 70.8±28.1 mm, and diameter stenosis was 86.3%±16.2%; 26 (46%) lesions were occluded. Primary patency was defined as duplex ultrasound peak systolic velocity ratio ≤2.5 and the absence of target lesion revascularization (TLR) or bypass. Major adverse events (MAEs) included all-cause death through 1 month and target limb major amputation and TLR through 12 months.

Results: All 57 patients had a single Eluvia stent implanted, employing pre- and postdilation in 93% (53/57) and 95% (54/57) of cases, respectively. Technical success was 97% (55/57; 2 failures due to residual stenosis >30%). At 12 months, primary patency was 96% (49/51) and the MAE rate was 4% (2/53); both MAEs were TLRs. No stent fractures were identified. There were no major amputations. One death occurred 368 days postprocedure, unrelated to the device or procedure. Improvements in the Rutherford category were sustained through 1 year, with 81% (43/53) exhibiting no symptoms (category 0) and 13% (7/53) presenting with mild claudication (category 1). Mean ABI improved from 0.73±0.22 at baseline to 1.02±0.20 at 12 months.

Conclusion: MAJESTIC results showed that patients whose femoropopliteal arteries were treated with the Eluvia drug-eluting stent sustained high patency and low MAE rates through 12 months.

Keywords: claudication; drug-eluting stent; paclitaxel; peripheral artery disease; popliteal artery; restenosis; superficial femoral artery; target lesion revascularization.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Stefan Müller-Hülsbeck serves as a consultant for Boston Scientific Corporation (BSC) and has received consulting fees, speaker honoraria, and support for accommodation and traveling when presenting BSC-related data. Thomas Zeller serves as a consultant for Boston Scientific, Cook, Medtronic, W.L. Gore, Veryan, Spectranetics, Trireme, and Terumo and has received consulting fees, speaker honoraria, and support for accommodation and traveling from these companies. Herman Schroë serves as a consultant for Boston Scientific and has received consulting fees, speaker honoraria, and support for accommodation and traveling when presenting BSC-related data. Juan Diaz-Cartelle is an employee of and owns stock in Boston Scientific Corporation.

© The Author(s) 2016.

Figures

Figure 1.

Kaplan-Meier estimate of primary patency. Intervals are end-inclusive; event rate and standard error estimates are for the interval end. Standard errors were ≤3% at each time point.

Figure 2.

The shift to lower Rutherford categories (less severe symptoms) persisted through 12 months.