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.
研究概览
地位
详细说明
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.
研究类型
注册 (估计的)
阶段
- 不适用
联系人和位置
学习联系方式
- 姓名：Marc Sirvent, PhD
- 电话号码：2575 +34938425000
- 邮箱：msirvent@fphag.org
参与标准
资格标准
适合学习的年龄
- 成人
- 年长者
接受健康志愿者
描述
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.
学习计划
研究是如何设计的？
设计细节
- 主要用途：治疗
- 分配：随机化
- 介入模型：并行分配
- 屏蔽：双倍的
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
|
有源比较器：Non-compliant plain balloon (PBA)
|
The intervention consists of preparing the artery with a non-compliant plain balloon before using the DCB (Legflow XP™; Manufacturer: Cardionovum GmbH Bonn, Germany).
其他名称：
|
|
有源比较器：Scoring balloon (SB)
|
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.
其他名称：
|
研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Bailout stenting
大体时间：At index procedure
|
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
|
|
Primary Patency
大体时间：At 12 months
|
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.
|
At 12 months
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Device success
大体时间：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
|
|
Technical success
大体时间：During the index procedure.
|
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.
|
During the index procedure.
|
|
Procedural cost
大体时间：During the index procedure
|
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.
|
During the index procedure
|
|
Slow-flow phenomenon
大体时间：During the index procedure
|
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.
|
During the index procedure
|
|
Procedural success
大体时间：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.
|
|
Freedom from device and procedure-related death
大体时间：Until 30 days post-procedure
|
Freedom from device and procedure-related death through 30 days post-procedure.
|
Until 30 days post-procedure
|
|
Freedom from Major Adverse Events (MAE)
大体时间：Up to 24 months post-procedure
|
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
|
|
Primary patency
大体时间：At 6 and 24 months post-procedure
|
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).
|
At 6 and 24 months post-procedure
|
|
Freedom from CD-TLR
大体时间：Up to 24 months post-procedure
|
Freedom from CD-TLR up to 24 months post-procedure.
|
Up to 24 months post-procedure
|
|
Change in EQ-5D questionnaire
大体时间：Up to 24 months post-procedure
|
Change in EQ-5D questionnaire from baseline up to 24 months post-procedure
|
Up to 24 months post-procedure
|
|
Amputation free survival
大体时间：Up to 24 months post-procedure.
|
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.
|
|
Wound healing evolution
大体时间：Up to 24 months post-procedure
|
Wound healing evolution up to 24 months post-procedure, assessed according to the following predefined ordinal classification:
|
Up to 24 months post-procedure
|
|
Wound healing time
大体时间：Days from the index procedure to complete epithelialisation of the target wound
|
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
|
|
Change in Rutherford classification
大体时间：Up to 24 months post-procedure.
|
Change in Rutherford classification up to 24 months post-procedure.
|
Up to 24 months post-procedure.
|
合作者和调查者
研究记录日期
研究主要日期
学习开始 (估计的)
初级完成 (估计的)
研究完成 (估计的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
关键字
其他相关的 MeSH 术语
其他研究编号
- DASBAD-NC
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