1
|
Tang TY, Chong TT, Yap CJQ, Soon SXY, Chan SL, Tan RY, Yap HY, Tay HT, Tan CS, Barnhill S, Hellinga D, DeGraw RT, Finn AV. Intervention with selution SLR™ Agent Balloon for Endovascular Latent Limus therapy for failing AV Fistulas (ISABELLA) Trial: Protocol for a pilot clinical study and pre-clinical results. J Vasc Access 2023; 24:289-299. [PMID: 34219511 PMCID: PMC10021111 DOI: 10.1177/11297298211020867] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this pilot clinical study is to evaluate the safety and efficacy of the Selution Sustained Limus Release (SLR)™ sirolimus-coated balloon (M.A. MedAlliance SA, Nyon, Switzerland) for improving the patency of failing arterio-venous fistulas (AVF) in hemodialysis patients. We also present herein a pre-clinical pharmacokinetic and safety evaluation of Selution™ to justify its first use in hemodialysis patients for endovascular access salvage. METHODS AND RESULTS This is an investigator-initiated prospective single-center, non-blinded single-arm trial. Forty patients with clinically significant de novo or recurrent stenoses in a mature AVF circuit will be recruited. All stenotic lesions will be prepared with high pressure non-compliant conventional balloon angioplasty (CBA) prior to deployment of the Sustained-Release Selution™ sirolimus drug-eluting balloon. The primary efficacy endpoint is 6-month target lesion primary patency and the primary safety endpoint is freedom from localized or systemic serious adverse events through 30 days. Secondary endpoints of interest include technical and clinical success rates and circuit access patency at 3 and 6 months. Follow-up will occur for 2 years for those patients whose AVFs remain patent. Pharmacokinetic and histological animal safety studies performed with the Selution™ coating formulation showed prolonged arterial tissue retention of sirolimus with therapeutic levels up to 60 days and non-toxic and rapidly declining blood levels. Histological results in animal models demonstrated safety, freedom from intraluminal thrombus, reduction in restenosis by sirolimus elution compared to CBA, and no evidence of embolic phenomena indicative of adverse particulate effects. DISCUSSION Long release sirolimus coated balloons may serve as a promising novel alternative therapy to paclitaxel-based technology for treating conduit stenosis secondary to neointimal hyperplasia. Pre-clinical pharmacokinetic and histological animal data are encouraging and provide suggestion of safety and efficacy in this setting. This single-center trial will provide a first step toward demonstration of efficacy and safety of this device for treatment of stenotic fistulas.
Collapse
Affiliation(s)
- Tjun Yip Tang
- Department of Vascular Surgery,
Singapore General Hospital, Singapore, Singapore
- Duke-NUS Graduate Medical School,
Singapore, Singapore
- Tjun Yip Tang, Duke-NUS Medical School,
Department of Vascular Surgery, Singapore General Hospital, Level 5; Academia,
20 College Road, Singapore 169856, Singapore.
| | - Tze-Tec Chong
- Department of Vascular Surgery,
Singapore General Hospital, Singapore, Singapore
| | - Charyl Jia Qi Yap
- Department of Vascular Surgery,
Singapore General Hospital, Singapore, Singapore
| | - Shereen Xue Yun Soon
- Department of Vascular Surgery,
Singapore General Hospital, Singapore, Singapore
| | - Sze Ling Chan
- Health Services Research Center,
SingHealth, Singapore, Singapore
| | - Ru Yu Tan
- Department of Renal Medicine, Singapore
General Hospital, Singapore, Singapore
| | - Hao Yun Yap
- Department of Vascular Surgery,
Singapore General Hospital, Singapore, Singapore
| | - Hsien Ts’ung Tay
- Department of Vascular Surgery,
Singapore General Hospital, Singapore, Singapore
| | - Chieh-Suai Tan
- Health Services Research Center,
SingHealth, Singapore, Singapore
| | | | | | | | - Aloke V Finn
- CVPath Institute Inc., Gaithersburg,
MD, USA
- University of Maryland School of
Medicine, Baltimore, MD, USA
| |
Collapse
|
2
|
Steiner S, Honton B, Langhoff R, Chiesa R, Kahlberg A, Thieme M, Zeller T, Garot P, Commeau P, Cremonesi A, Marone EM, Sauguet A, Scheinert D. 2-Year Results With a Sirolimus-Eluting Self-Expanding Stent for Femoropopliteal Lesions: The First-in-Human ILLUMINA Study. JACC Cardiovasc Interv 2022; 15:618-626. [PMID: 35219622 DOI: 10.1016/j.jcin.2021.12.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The aim of the study was to assess 24-month efficacy and safety of a novel drug-eluting stent (DES) for femoropopliteal interventions with an innovative stent design and abluminal reservoir technology releasing the amphilimus formulation (sirolimus plus fatty acid) for efficient drug transfer and optimized release kinetics. BACKGROUND DES releasing paclitaxel exhibited good patency rates after femoropopliteal interventions. No benefit has been reported when sirolimus or everolimus were used for antiproliferative stent coating. METHODS Within a multicenter, first-in-man, single-arm study, 100 patients with symptomatic femoropopliteal disease (Rutherford category 2-4, mean lesion length 5.8 ± 3.9 cm, 35.0% total occlusions) were treated with the NiTiDES stent (Alvimedica). Two-year follow-up included assessment of primary patency (defined as absence of clinically driven target lesion revascularization or binary restenosis with a peak systolic velocity ratio >2.4 by duplex ultrasound), safety, functional, and clinical outcomes. RESULTS At 24 months, Kaplan-Meier estimates of primary patency and freedom from clinically driven target lesion revascularization were 83.4% (95% CI: 73.9%-89.6%) and 93.1% (95% CI: 85.3%-96.9%), respectively. Over the study period, 3 deaths were reported with no major limb amputation. Functional and clinical benefits were sustained, as 82.1% of patients fell into Rutherford category 0 or 1 at 24 months, which was associated with preserved improvements in all walking disability questionnaire scores. CONCLUSIONS The 2-year results of the ILLUMINA (Innovative siroLimus seLf expanding drUg-eluting stent for the treatMent of perIpheral disease: evaluation of safety aNd efficAcy) study demonstrate a sustained treatment benefit with a novel sirolimus-eluting stent that also compares favorably to other femoropopliteal intervention trials. Head-to-head comparisons of NiTiDES with a paclitaxel-based DES are warranted. (The ILLUMINA Study [ILLUMINA]; NCT03510676).
Collapse
Affiliation(s)
- Sabine Steiner
- Division of Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany; Helmholtz Institute for Metabolic, Obesity and Vascular Research, Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | | | - Ralf Langhoff
- Department of Angiology, Center for Internal Medicine I, Campus Clinic Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Roberto Chiesa
- Department of Vascular Surgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Kahlberg
- Department of Vascular Surgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | | | - Thomas Zeller
- Department of Angiology, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philippe Garot
- Institut Cardio-vasculaire Paris Sud, Hôpital Privé Claude Galien, Ramsay-Générale de santé, Quincy-sous-Sénart, France
| | | | - Alberto Cremonesi
- Cardiovascular Department, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Enrico Maria Marone
- Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Department of Vascular Surgery, Policlinico di Monza Group, Monza and Ivrea, Ollioules, Italy
| | | | - Dierk Scheinert
- Division of Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany.
| |
Collapse
|
3
|
Secemsky EA, Kochar A. Illuminating the Path for Novel Peripheral Drug-Eluting Stents. JACC Cardiovasc Interv 2022; 15:627-629. [PMID: 35219619 DOI: 10.1016/j.jcin.2022.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Eric A Secemsky
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Ajar Kochar
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Brigham & Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|