SlroliMus coated angioplasty versus plain balloon angioplasty in the tREatment of dialySis access dysfunctION (IMPRESSION): study protocol for a randomized controlled trial

Background: Percutaneous transluminal angioplasty is the current standard treatment for arteriovenous fistula (AVII stenosis. The mid- and long-term patency with plain balloon angioplasty (PBA) is however far from satisfactory. While paclitaxel-coated balloon angioplasty has been shown to be superio...

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Veröffentlicht in:Trials 2021-12, Vol.22 (1), Article 945
Hauptverfasser: Pang, Suh Chien, Tan, Ru Yu, Choke, Edward, Ho, Jackie, Tay, Kiang Hiong, Gogna, Apoorva, Irani, Farah G., Da Zhuang, Kun, Toh, Luke, Chan, Shaun, Krishnan, Pradesh, Lee, Kristen A., Leong, Sum, Lo, Richard, Patel, Ankur, Tan, Bien Soo, Too, Chow Wei, Chua, Jasmine, Tng, Ren Kwang Alvin, Tang, Tjun Yip, Chng, Siew Ping, Chong, Tze Tec, Tay, Hsien Ts'ung, Yap, Hao Yun, Wong, Julian, Dharmaraj, Rajesh Babu, Ng, Jun Jie, Gopinathan, Anil, Loh, Eu Kuang, Ong, Shao Jin, Yoong, Gary, Tay, Jia Sheng, Chong, Kay Yuan, Tan, Chieh Suai
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container_issue 1
container_start_page
container_title Trials
container_volume 22
creator Pang, Suh Chien
Tan, Ru Yu
Choke, Edward
Ho, Jackie
Tay, Kiang Hiong
Gogna, Apoorva
Irani, Farah G.
Da Zhuang, Kun
Toh, Luke
Chan, Shaun
Krishnan, Pradesh
Lee, Kristen A.
Leong, Sum
Lo, Richard
Patel, Ankur
Tan, Bien Soo
Too, Chow Wei
Chua, Jasmine
Tng, Ren Kwang Alvin
Tang, Tjun Yip
Chng, Siew Ping
Chong, Tze Tec
Tay, Hsien Ts'ung
Yap, Hao Yun
Wong, Julian
Dharmaraj, Rajesh Babu
Ng, Jun Jie
Gopinathan, Anil
Loh, Eu Kuang
Ong, Shao Jin
Yoong, Gary
Tay, Jia Sheng
Chong, Kay Yuan
Tan, Chieh Suai
description Background: Percutaneous transluminal angioplasty is the current standard treatment for arteriovenous fistula (AVII stenosis. The mid- and long-term patency with plain balloon angioplasty (PBA) is however far from satisfactory. While paclitaxel-coated balloon angioplasty has been shown to be superior to PBA, concern over its safety profile has recently arisen after a reported possible increased mortality risk with a meta-analysis of large lower limb studies. An angioplasty balloon with a new type of drug coating, the sirolimus-coated balloon (SCB), has been proven to improve patency in the coronary arteries. However, its effect on AV access has yet to be studied. Methods/design: This is an investigator-initiated, prospective, multicenter, double-blinded, randomized controlled clinical trial to assess the effectiveness of SCB compared to PBA in improving the patency of AVF after angioplasty. A total of 170 patients with mature AVF that requires PTA due to AVF dysfunction will be randomly assigned to treatment with a SCB or PBA at a 1:1 ratio, stratified by location of AVF and followed up for up to 1 year. The inclusion criteria include [1] adult patient aged 21 to 85 years who requires balloon angioplasty for dysfunctional arteriovenous fistula [2]; matured AVF, defined as being in use for at least 1 month prior to the angioplasty; and [3] successful angioplasty of the underlying stenosis with PBA, defined as less than 30% residual stenosis on digital subtraction angiography (DSA) and restoration of thrill in the AVF on clinical examination. The exclusion criteria include thrombosed or partially thrombosed access circuit at the time of treatment, presence of symptomatic or angiographically significant central vein stenosis that requires treatment with more than 30% residual stenosis post angioplasty, and existing stent placement within the AVF circuit The primary endpoint of the study is access circuit primary patency at 6 months. The secondary endpoints are target lesion primary patency; access circuit-assisted primary patency; access circuit secondary patency at 3, 6, and 12 months; target lesion restenosis rate at 6 months; total number of interventions; complication rate; and cost-effectiveness. The trial is supported by Concept Medical. Discussion: This study will evaluate the clinical efficacy and safety of SCB compared to PBA in the treatment of AVF stenosis in hemodialysis patients.
doi_str_mv 10.1186/s13063-021-05920-3
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The mid- and long-term patency with plain balloon angioplasty (PBA) is however far from satisfactory. While paclitaxel-coated balloon angioplasty has been shown to be superior to PBA, concern over its safety profile has recently arisen after a reported possible increased mortality risk with a meta-analysis of large lower limb studies. An angioplasty balloon with a new type of drug coating, the sirolimus-coated balloon (SCB), has been proven to improve patency in the coronary arteries. However, its effect on AV access has yet to be studied. Methods/design: This is an investigator-initiated, prospective, multicenter, double-blinded, randomized controlled clinical trial to assess the effectiveness of SCB compared to PBA in improving the patency of AVF after angioplasty. A total of 170 patients with mature AVF that requires PTA due to AVF dysfunction will be randomly assigned to treatment with a SCB or PBA at a 1:1 ratio, stratified by location of AVF and followed up for up to 1 year. The inclusion criteria include [1] adult patient aged 21 to 85 years who requires balloon angioplasty for dysfunctional arteriovenous fistula [2]; matured AVF, defined as being in use for at least 1 month prior to the angioplasty; and [3] successful angioplasty of the underlying stenosis with PBA, defined as less than 30% residual stenosis on digital subtraction angiography (DSA) and restoration of thrill in the AVF on clinical examination. The exclusion criteria include thrombosed or partially thrombosed access circuit at the time of treatment, presence of symptomatic or angiographically significant central vein stenosis that requires treatment with more than 30% residual stenosis post angioplasty, and existing stent placement within the AVF circuit The primary endpoint of the study is access circuit primary patency at 6 months. The secondary endpoints are target lesion primary patency; access circuit-assisted primary patency; access circuit secondary patency at 3, 6, and 12 months; target lesion restenosis rate at 6 months; total number of interventions; complication rate; and cost-effectiveness. The trial is supported by Concept Medical. 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The mid- and long-term patency with plain balloon angioplasty (PBA) is however far from satisfactory. While paclitaxel-coated balloon angioplasty has been shown to be superior to PBA, concern over its safety profile has recently arisen after a reported possible increased mortality risk with a meta-analysis of large lower limb studies. An angioplasty balloon with a new type of drug coating, the sirolimus-coated balloon (SCB), has been proven to improve patency in the coronary arteries. However, its effect on AV access has yet to be studied. Methods/design: This is an investigator-initiated, prospective, multicenter, double-blinded, randomized controlled clinical trial to assess the effectiveness of SCB compared to PBA in improving the patency of AVF after angioplasty. A total of 170 patients with mature AVF that requires PTA due to AVF dysfunction will be randomly assigned to treatment with a SCB or PBA at a 1:1 ratio, stratified by location of AVF and followed up for up to 1 year. The inclusion criteria include [1] adult patient aged 21 to 85 years who requires balloon angioplasty for dysfunctional arteriovenous fistula [2]; matured AVF, defined as being in use for at least 1 month prior to the angioplasty; and [3] successful angioplasty of the underlying stenosis with PBA, defined as less than 30% residual stenosis on digital subtraction angiography (DSA) and restoration of thrill in the AVF on clinical examination. The exclusion criteria include thrombosed or partially thrombosed access circuit at the time of treatment, presence of symptomatic or angiographically significant central vein stenosis that requires treatment with more than 30% residual stenosis post angioplasty, and existing stent placement within the AVF circuit The primary endpoint of the study is access circuit primary patency at 6 months. The secondary endpoints are target lesion primary patency; access circuit-assisted primary patency; access circuit secondary patency at 3, 6, and 12 months; target lesion restenosis rate at 6 months; total number of interventions; complication rate; and cost-effectiveness. The trial is supported by Concept Medical. Discussion: This study will evaluate the clinical efficacy and safety of SCB compared to PBA in the treatment of AVF stenosis in hemodialysis patients.</description><subject>Life Sciences &amp; Biomedicine</subject><subject>Medicine, Research &amp; Experimental</subject><subject>Research &amp; Experimental Medicine</subject><subject>Science &amp; Technology</subject><issn>1745-6215</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>HGBXW</sourceid><recordid>eNqVjj1PwzAQhi0kRMvHH2C6EYQCdpy0DWtVRIcCatgr13HAyPFF9gUUfhM_Eg8sbDDdc-89Or2MnQt-LcRidhOF5DOZ8VxkvKxynskDNhXzosxmuSgn7DjGN84LWcniiE1kUUlecDFlX7UL6OxmiKBRkWlA-ReLvVORRng3IaZL2qyHvXIO0f8SUkyvBmi7UtQZT4AtNFa5sbYRlNYmRmjG2A5e0_rxAS7Wm6ftqq4TX95CpKEZoQ9IqNFBiwEUBOUb7OxnqqLRU2rnElJIX0_ZYatcNGc_84Rd3a2el_fZh9ljG7U1XptdH2ynwrjjnM9lXpVcJOJS_tde_N1eWlJk0S9x8CS_AWHxfmc</recordid><startdate>20211220</startdate><enddate>20211220</enddate><creator>Pang, Suh Chien</creator><creator>Tan, Ru Yu</creator><creator>Choke, Edward</creator><creator>Ho, Jackie</creator><creator>Tay, Kiang Hiong</creator><creator>Gogna, Apoorva</creator><creator>Irani, Farah G.</creator><creator>Da Zhuang, Kun</creator><creator>Toh, Luke</creator><creator>Chan, Shaun</creator><creator>Krishnan, Pradesh</creator><creator>Lee, Kristen A.</creator><creator>Leong, Sum</creator><creator>Lo, Richard</creator><creator>Patel, Ankur</creator><creator>Tan, Bien Soo</creator><creator>Too, Chow Wei</creator><creator>Chua, Jasmine</creator><creator>Tng, Ren Kwang Alvin</creator><creator>Tang, Tjun Yip</creator><creator>Chng, Siew Ping</creator><creator>Chong, Tze Tec</creator><creator>Tay, Hsien Ts'ung</creator><creator>Yap, Hao Yun</creator><creator>Wong, Julian</creator><creator>Dharmaraj, Rajesh Babu</creator><creator>Ng, Jun Jie</creator><creator>Gopinathan, Anil</creator><creator>Loh, Eu Kuang</creator><creator>Ong, Shao Jin</creator><creator>Yoong, Gary</creator><creator>Tay, Jia Sheng</creator><creator>Chong, Kay Yuan</creator><creator>Tan, Chieh Suai</creator><general>Springer Nature</general><scope>BLEPL</scope><scope>DTL</scope><scope>HGBXW</scope></search><sort><creationdate>20211220</creationdate><title>SlroliMus coated angioplasty versus plain balloon angioplasty in the tREatment of dialySis access dysfunctION (IMPRESSION): study protocol for a randomized controlled trial</title><author>Pang, Suh Chien ; 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The mid- and long-term patency with plain balloon angioplasty (PBA) is however far from satisfactory. While paclitaxel-coated balloon angioplasty has been shown to be superior to PBA, concern over its safety profile has recently arisen after a reported possible increased mortality risk with a meta-analysis of large lower limb studies. An angioplasty balloon with a new type of drug coating, the sirolimus-coated balloon (SCB), has been proven to improve patency in the coronary arteries. However, its effect on AV access has yet to be studied. Methods/design: This is an investigator-initiated, prospective, multicenter, double-blinded, randomized controlled clinical trial to assess the effectiveness of SCB compared to PBA in improving the patency of AVF after angioplasty. A total of 170 patients with mature AVF that requires PTA due to AVF dysfunction will be randomly assigned to treatment with a SCB or PBA at a 1:1 ratio, stratified by location of AVF and followed up for up to 1 year. The inclusion criteria include [1] adult patient aged 21 to 85 years who requires balloon angioplasty for dysfunctional arteriovenous fistula [2]; matured AVF, defined as being in use for at least 1 month prior to the angioplasty; and [3] successful angioplasty of the underlying stenosis with PBA, defined as less than 30% residual stenosis on digital subtraction angiography (DSA) and restoration of thrill in the AVF on clinical examination. The exclusion criteria include thrombosed or partially thrombosed access circuit at the time of treatment, presence of symptomatic or angiographically significant central vein stenosis that requires treatment with more than 30% residual stenosis post angioplasty, and existing stent placement within the AVF circuit The primary endpoint of the study is access circuit primary patency at 6 months. The secondary endpoints are target lesion primary patency; access circuit-assisted primary patency; access circuit secondary patency at 3, 6, and 12 months; target lesion restenosis rate at 6 months; total number of interventions; complication rate; and cost-effectiveness. The trial is supported by Concept Medical. Discussion: This study will evaluate the clinical efficacy and safety of SCB compared to PBA in the treatment of AVF stenosis in hemodialysis patients.</abstract><cop>LONDON</cop><pub>Springer Nature</pub><pmid>34930401</pmid><doi>10.1186/s13063-021-05920-3</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record>
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subjects Life Sciences & Biomedicine
Medicine, Research & Experimental
Research & Experimental Medicine
Science & Technology
title SlroliMus coated angioplasty versus plain balloon angioplasty in the tREatment of dialySis access dysfunctION (IMPRESSION): study protocol for a randomized controlled trial
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