An interventional study of Pantheris System in Peripheral Arterial Disease, sponsored by Avinger, Inc.. Completed at 21 sites in 2 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-03-25.
Sponsored by Avinger, Inc. · Not applicable, Interventional, and Treatment
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.
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.
Inclusion Criteria:
Inclusion Criteria for the 24-month follow up:
Exclusion Criteria:
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.
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: 1. Cardiovascular related death 2. Unplanned, major index limb amputation 3. Clinically driven target lesion revascularization (TLR) 4. Myocardial infarction 5. Device related events: 1. Clinically significant perforation 2. Clinically significant dissection 3. Clinically significant embolus 4. Pseudoaneurysm
Time frame: 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.
Time frame: Day 0
Secondary Safety Endpoint
Freedom from MAEs as defined above, through 30 days (or hospital discharge, whichever is longer) as adjudicated by an independent CEC.
Time frame: 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.
Time frame: 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.
Time frame: 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.
Time frame: 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).
Time frame: 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.
Time frame: 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).
Time frame: 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.
Time frame: 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).
Time frame: 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.
Time frame: 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).
Time frame: 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.
Time frame: 6 Month
| Milestone | Primary Cohort | Roll-in Cohort |
|---|---|---|
| Started | 134 | 28 |
| Treated w study device | 130 | 28 |
| 30-day follow-up | 128 | 27 |
| 6-month follow-up | 125 | 26 |
| Completed | 125 | 26 |
| Not completed | 9 | 2 |
| Withdrew: Withdrawal by subject | 4 | 2 |
| Withdrew: Death | 1 | 0 |
| Withdrew: Not treated w device, per protocol fail | 4 | 0 |
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: 1. Cardiovascular related death 2. Unplanned, major index limb amputation 3. Clinically driven target lesion revascularization (TLR) 4. Myocardial infarction 5. Device related events: 1. Clinically significant perforation 2. Clinically significant dissection 3. Clinically significant embolus 4. Pseudoaneurysm
| percentage of subjects | Primary Cohort: Per Protocol | Primary Cohort: Intention-to-Treat |
|---|---|---|
| Primary Safety Endpoint | 82.4 | 82.4 |
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.
| percentage of lesions | Primary Cohort: Per Protocol | Primary Cohort: Intention-to-Treat |
|---|---|---|
| Primary Effectiveness Endpoint: Technical Success | 96.3 | 94.0 |
Freedom from MAEs as defined above, through 30 days (or hospital discharge, whichever is longer) as adjudicated by an independent CEC.
| percentage of subjects | Primary Cohort: Per Protocol | Primary Cohort: Intention-to-Treat |
|---|---|---|
| Secondary Safety Endpoint | 93.1 | 93.3 |
Freedom from procedural emboli, defined as a change in any visualized runoff vessel (other than vasospasm and dissection) at any time during the procedure.
| Percentage of subjects | Primary Cohort: Per Protocol | Primary Cohort: Intention-to-Treat |
|---|---|---|
| Secondary Safety Endpoint | 97.7 (93.4 to 99.5) | 97.8 (93.6 to 99.5) |
Freedom from clinically driven Target Vessel Revascularization (TVR) through 6 months, as adjudicated by an independent CEC.
| Percentage of subjects | Primary Cohort: Per Protocol | Primary Cohort: Intention-to-Treat |
|---|---|---|
| Secondary Safety Endpoint | 91.2 (84.8 to 95.5) | 91.2 (84.8 to 95.5) |
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.
| percentage of lesions | Primary Cohort: Per Protocol | Primary Cohort: Intention-to-Treat |
|---|---|---|
| Secondary Effectiveness Endpoint: Procedural Success | 78.7 | 79.0 |
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).
| Index | Primary Cohort: Per Protocol | Primary Cohort: Intention-to-Treat |
|---|---|---|
| Secondary Effectiveness Endpoint: ABI | 0.95 ± 0.16 | 0.95 ± 0.16 |
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.
| Percentage of subjects | Primary Cohort: Per Protocol | Primary Cohort: Intention-to-Treat |
|---|---|---|
| Rutherford Classification: 0 - Asymptomatic | 52.9 | 52.8 |
| Rutherford Classification: 1 - Mild Claudication | 31.4 | 31.2 |
| Rutherford Classification: 2 - Moderate Claudication | 10.7 | 10.4 |
| Rutherford Classification: 3 - Severe Claudication | 4.1 | 4.8 |
| Rutherford Classification: 4 - Ischemic Rest Pain | 0 | 0 |
| Rutherford Classification: 5 - Minor Tissue Loss | 0.8 | 0.8 |
| Rutherford Classification: 6 - Major Tissue Loss | 0 | 0 |
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).
| Score on a scale | Primary Cohort: Per Protocol | Primary Cohort: Intention-to-Treat |
|---|---|---|
| Mean SF-12 Mental Component Score: Baseline | 50.0 ± 10.3 | 50.3 ± 10.3 |
| Mean SF-12 Mental Component Score: 30-Day | 52.1 ± 9.3 | 52.4 ± 9.3 |
| Mean SF-12 Physical Component Score: Baseline | 35.6 ± 8.7 | 35.5 ± 8.6 |
| Mean SF-12 Physical Component Score: 30-Day | 41.5 ± 10.5 | 41.5 ± 10.4 |
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.
| score on a scale | Primary Cohort: Per Protocol | Primary Cohort: Intention-to-Treat |
|---|---|---|
| Mean VascuQoL Score at Baseline | 4.1 ± 1.2 | 4.1 ± 1.2 |
| Mean VascuQoL Score at 30 Days | 5.4 ± 1.5 | 5.4 ± 1.5 |
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).
| Index | Primary Cohort: Per Protocol | Primary Cohort: Intention-to-Treat |
|---|---|---|
| Secondary Effectiveness Endpoint: ABI | 0.85 ± 0.23 | 0.85 ± 0.23 |
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.
| Percentage of subjects | Primary Cohort: Per Protocol | Primary Cohort: Intention-to-Treat |
|---|---|---|
| Rutherford Classification: 0 - Asymptomatic | 41.7 | 41.7 |
| Rutherford Classification: 1 - Mild Claudication | 29.2 | 29.2 |
| Rutherford Classification: 2 - Moderate Claudication | 14.2 | 14.2 |
| Rutherford Classification: 3 - Severe Claudication | 11.7 | 11.7 |
| Rutherford Classification: 4 - Ischemic Rest Pain | 1.7 | 1.7 |
| Rutherford Classification: 5 - Minor Tissue Loss | 1.7 | 1.7 |
| Rutherford Classification: 6 - Major Tissue Loss | 0 | 0 |
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).
| score on a scale | Primary Cohort: Per Protocol | Primary Cohort: Intention-to-Treat |
|---|---|---|
| Mean SF-12 Mental Component Score: Baseline | 50.0 ± 10.3 | 50.3 ± 10.3 |
| Mean SF-12 Mental Component Score: 6-Month | 51.0 ± 11.0 | 51.0 ± 11.0 |
| Mean SF-12 Physical Component Score: Baseline | 35.6 ± 8.7 | 35.5 ± 8.6 |
| Mean SF-12 Physical Component Score: 6-Month | 39.3 ± 9.7 | 39.3 ± 9.7 |
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.
| score on a scale | Primary Cohort: Per Protocol | Primary Cohort: Intention-to-Treat |
|---|---|---|
| Mean VascuQoL Score at Baseline | 4.1 ± 1.2 | 4.1 ± 1.2 |
| Mean VascuQoL Score at 6 Months | 5.0 ± 1.5 | 5.0 ± 1.5 |
Collected over All subjects between enrollment and 6 month follow-up.. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Primary Cohort | 5/134 (3.7%) | 89/134 (66.4%) | 22/22 (100%) |
| Event | Primary Cohort |
|---|---|
| Clinically Driven Target Lesion RevascularizationVascular disorders | 10/134 |
| Vessel dissection, Grade A or BSurgical and medical procedures | 4/134 |
| Myocardial InfarctionCardiac disorders | 3/134 |
| Access Site ComplicationSurgical and medical procedures | 3/134 |
| Bleeding (other than access site)Injury, poisoning and procedural complications | 3/134 |
| Pain, new onset or worsening from baselineVascular disorders | 3/134 |
| Emboli requiring intervention to resolve acutelyVascular disorders | 3/134 |
| Vessel dissection, Grade C or greaterVascular disorders | 3/134 |
| Clinically Driven Target Vessel RevascularizationVascular disorders | 2/134 |
| Pseudoaneurysm defined as device related disruption of the arterial wallVascular disorders | 2/134 |
| Event | Primary Cohort |
|---|---|
| Pain, New Onset or Worsening from BaselineGeneral disorders | 14/22 |
| Access Site ComplicationSurgical and medical procedures | 8/22 |
The study consisted of Roll-In Cohort and a Primary Analysis Cohort. Up to 2 Roll-In subjects could be treated at each study site prior to initiation of enrollment in the Primary Analysis Cohort.Roll-In subjects were designed to provide the Investigator an opportunity to gain experience with the Pantheris System for learning curve purposes.
| Age, Continuous(years) | Primary Cohort | Roll-In Cohort | Total |
|---|---|---|---|
| Mean | 67.4 ± 10.5 | 66.7 ± 10.5 | 67.3 ± 10.5 |
| Sex: Female, Male(Participants) | Primary Cohort | Roll-In Cohort | Total |
|---|---|---|---|
| Female | 58 | 13 | 71 |
| Male | 76 | 15 | 91 |
| Race/Ethnicity, Customized(participants) | Primary Cohort | Roll-In Cohort | Total |
|---|---|---|---|
| Caucasian | 80 | 20 | 100 |
| African American | 35 | 8 | 43 |
| Hispanic or Latino | 8 | 0 | 8 |
| Asian | 1 | 0 | 1 |
| Other | 1 | 0 | 1 |
| Unknown or Unavailable | 9 | 0 | 9 |
| Region of Enrollment(participants) | Primary Cohort | Roll-In Cohort | Total |
|---|---|---|---|
| United States | 127 | 28 | 155 |
| Germany | 7 | 0 | 7 |
| Weight(pounds) | Primary Cohort | Roll-In Cohort | Total |
|---|---|---|---|
| Mean | 179.5 ± 43.0 | 199.3 ± 45.3 | 182.9 ± 44.0 |
| Height(inches) | Primary Cohort | Roll-In Cohort | Total |
|---|---|---|---|
| Mean | 66.8 ± 3.8 | 66.5 ± 4.1 | 66.7 ± 3.8 |
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Avinger, Inc.