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Critical Lower Limb IschemiaINPACT-DEEPNCT00941733

Study of IN.PACT Amphirion™ Drug Eluting Balloon vs. Standard PTA for the Treatment of Below the Knee Critical Limb Ischemia

A study testing IN.PACT Amphirion and Standard PTA in people with Critical Lower Limb Ischemia, run by Medtronic Endovascular at 13 sites in 6 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This is a prospective, multi-center, randomized (2:1) trial of symptomatic patients with critical limb ischemia (CLI) secondary to atherosclerotic lesions (stenotic or occluded) of the infrapopliteal vessels. Read more about this study

Who is it for?
Ages 18 to 85 years
Conditions the study is for
Critical Lower Limb Ischemia
What is being tested?
IN.PACT Amphirion and Standard PTA
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
358 participants
Where
13 sitesin 6 countries
Study dates
Sep 2009to 30 Nov 2017
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • General Inclusion Criteria
  • Age ≥18 years and ≤85 years
  • Patient or patient's legal representative have been informed of the nature of the study, agrees to participate and has signed an Ethical Committee approved consent form
  • Female patients of childbearing potential have a negative pregnancy test ≤7 days before the procedure and are willing to use a reliable method of birth control for the duration of study participation
  • Patient has documented chronic Critical Limb Ischemia (CLI) in the target limb prior to the study procedure with Rutherford Category 4, 5 or 6
  • Life expectancy >1 year in the Investigator's opinion
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  • General Angiographic Inclusion Criteria
  • Reference vessel(s) diameter between 2 and 4 mm
  • Single or multiple lesions with ≥70% diameter stenosis (DS) of different lengths in one or more main afferent crural vessels including the tibioperoneal trunk
  • At least one non occluded crural vessel with angiographically documented run-off to the foot either direct or through collaterals
  • Angiographic Inclusion Criteria for Late Lumen Loss (LLL) assessment
  • Angio-target lesion (TL) is one identifiable single solitary or series of multiple adjacent lesions with a diameter stenosis (DS) ≥70% and a cumulative length ≤100 mm that can be covered by a single IN.PACT Amphirion™ (10 mm balloon landing zone in both edges is mandatory)
  • Angio-target lesion (TL) is the only lesion in that vessel (only one Angio-TL per patient is allowed)

Who cannot join

  • General Exclusion Criteria
  • Patient unwilling or unlikely to comply with Follow-Up schedule
  • Planned major index limb amputation
  • General Angiographic Exclusion Criteria
  • Lesion and / or occlusions located or extending in the popliteal artery or below the ankle joint space
  • Inflow lesion or occlusion in the ipsilateral Iliac, Superficial Femoral Artery (SFA), popliteal arteries with length ≥15 cm
Show all 16Show fewer
  • Significant (≥50% DS) inflow lesion or occlusion in the ipsilateral Iliac, Superficial Femoral Artery (SFA) and popliteal arteries left untreated
  • Previously implanted stent in the target lesions(s)
  • Aneurysm in the target vessel
  • Acute thrombus in the target limb
  • General Procedural Exclusion Criteria
  • Failure to obtain a <30% residual stenosis in pre-existing, hemodynamically significant (≥50% diameter stenosis (DS) and <15 cm length) inflow lesions in the ipsilateral iliac, SFA and popliteal artery. No Drug Eluting Stents (DES) and / or Drug Eluting Balloon (DEB) allowed for the treatment of inflow lesions.
  • Failure to cross the TL with a 0.014" guide wire
  • Use of alternative therapy, e.g. atherectomy, cutting balloon, laser, radiation therapy, DES as part of the index procedure
  • ANGIOGRAPHIC cohort General Exclusion Criteria:
  • Glomerular Filtration Rate (GFR) <30 ml/min except for patients with renal end stage disease on chronic haemodialysis

Trial locations and contacts

13 sites in 6 countries.

13 sites in 6 countries

Belgium4 sites
  • Imelda Hospital

    Bonheiden

  • AZ Sint-Blasius

    Dendermonde

  • ZOL St. Jan

    Genk

  • Ghent University Hospital

    Ghent

Other trials in Belgium

Germany4 sites
  • Herz-Zentrum Bad Krozingen

    Bad Krozingen, 79189

  • Medical Care Center

    Hamburg

  • University Hospital Heidelberg

    Heidelberg

  • Park-Krankenhaus Leipzig

    Leipzig, 04289

Other trials in Germany

Switzerland2 sites
  • University of Bern

    Bern, 3010

  • Luzerner Kantonsspital

    Lucerne

Other trials in Switzerland

Austria1 site
  • Medical University Graz

    Graz

Other trials in Austria

Italy1 site
  • Villa Maria Eleonora Hospital

    Palermo

Other trials in Italy

Netherlands1 site
  • St. Antonius Hospital

    Nieuwegein

Other trials in Netherlands

About this study

Official title: Randomized Study of IN.PACT Amphirion™ Drug Eluting Balloon vs. Standard PTA (Percutaneous Transluminal Angioplasty) for the Treatment of Below the Knee Critical Limb Ischemia

This is a prospective, multi-center, randomized (2:1) trial of symptomatic patients with critical limb ischemia (CLI) secondary to atherosclerotic lesions (stenotic or occluded) of the infrapopliteal vessels. Patients will undergo a percutaneous transluminal endovascular procedure with either the IN.PACT Amphirion™ drug eluting balloon or with a standard (Percutaneous Transluminal Angioplasty) PTA balloon. Patients will be followed with pre-study, post-study, and follow-up evaluations.

Being tested
IN.PACT Amphirion, Standard PTA
Keywords
BTK, CLI, PTA

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • IN.PACT AmphirionDevice

    Balloon Angioplasty

  • Standard PTADevice

    Balloon Angioplasty

Study groups in NCT00941733
Study groupRoleWhat they receive
Drug Eluting BalloonExperimentalIntervention: IN.PACT Amphirion™
Receives: Device: IN.PACT Amphirion
Standard PTAActive comparatorIntervention: Standard PTA
Receives: Device: Standard PTA

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Late Lumen Loss (LLL) of the Target Lesion by Quantitative Vascular Angiography (QVA)

    The difference between minimum lumen diameter (MLD) immediately after Percutaneous Transluminal Angioplasty (PTA) and MLD at 12 months follow-up

    Measured: 12 months or at Target Lesion Revascularization (TLR) time

  2. Clinically Driven Target Lesion Revascularization (TLR) of the Target Lesion in the Amputation Free Surviving Patients

    Percentage of participants in the amputation free survival population with Clinically driven Target Lesion Revascularization (CD-TLR) at 12 months, CD-TLR defined as any TLR of the target lesion associated with Deterioration of Rutherford Class and / or increase in size of pre-existing wounds and / or occurrence of a new wound(s).

    Measured: 12 months

  3. Composite of All Cause Death, Major Amputation and Clinically Driven Target Lesion Revascularization (CD-TLR)

    Percentage of participants experiencing all cause death, major amputation and clinically driven Target Lesion Revascularization (CD-TLR) at 6 months. CD-TLR defined as any TLR of the target lesion associated with Deterioration of Rutherford Class and / or increase in size of pre-existing wounds and / or occurrence of a new wound(s)

    Measured: 6 months

Secondary outcomes (15)
  1. Amputation Free Survival

    Percentage of participants with a 1 year amputation free survival.

    Measured: 12 months

  2. Rate of Wound Healing

    Percentage of participants with completed wound healing, wound healing as defined as core lab adjudication of > 50% area/volume reduction of baseline ulcer(s) in the treated leg at 1 year.

    Measured: 12 months

  3. Amputation Free Survival and Wound Healing

    Percentage of participants with a 1 year amputation free survival and wound healing. Wound healing is defined as core lab adjudication of > 50% area/volume reduction of baseline ulcer(s) in the treated leg at a specified time point.

    Measured: 12 months

  4. Amputation Free Survival and Resolved Critical Limb Ischemia (CLI)

    Percentage of participants with an amputation free survival and resolved Critical Limb Ischemia (CLI) at 1 year.

    Measured: 12 months

  5. Death, Amputation and Clinically Driven Target Lesion Revascularization (TLR)

    Percentage of participants that experienced death, amputation and clinically driven Target Lesion Revascularization (TLR) at 1 year.

    Measured: 12 months

  6. Primary Sustained Clinical Improvement

    Percentage of participants that experienced primary sustained clinical improvement at 1 year, specified as an improvement shift in the Rutherford classification of one class in amputation free, clinically driven target lesion revascularization (TLR) free surviving subjects.

    Measured: 12 months

  7. Secondary Sustained Clinical Improvement

    Percentage of participants that experienced a secondary sustained clinical improvement, specified as an improvement shift in the Rutherford classification of one class including the need for clinically driven TLR in amputation free surviving subjects at 1 year.

    Measured: 12 months

  8. Quality of Life Assessment by EQ5D

    Quality of life assessment by EQ5D at 1 year compared to baseline. EQ-5D is a standardised measure of health status and economic appraisal. The EQ-5D-3L essentially consists of 2 parts:the EQ-5D descriptive system and the EQ visual analogue scale (EQ VAS). The EQ-5D-3L descriptive system comprises the following 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: (1) no problems, (2) some problems, (3) extreme problems. The EQ VAS records the respondent's self-rated health on a vertical, visual analogue scale where the endpoints are labelled 'Best imaginable health state' and 'Worst imaginable health state'.

    EQ-5D health states can be converted into a single summary index where 0.0='worst possible outcome' and 1.0='best possible outcome'.

    Measured: 12 months

  9. Walking Capacity Assessment

    Walking Impairment assessment by WIQ at 1 year compared to baseline. The Walking Impairment Questionnaire (WIQ) is a questionnaire for evaluating walking impairment in patients with peripheral arterial disease (PAD). This can be used to identify patients with significant impairment and to monitor effectiveness of therapeutic interventions. The questionnaire was self-administered by the patients and contains three domains measuring three important factors of walking impairment in patients with intermittent claudication: (1) difficulty walking a distance during the past month, (2) difficulty walking at a certain speed during the past month, (3) symptoms associated with walking impairment. For each separate domain, a subscore was calculated. The total WIQ score was defined as the mean of the three subscores.

    A WIQ score of 42.5 or less identified low performers; while a score of 75.5 or more identified high performers. The WIQ score range is 0 (minimum) - 100 (maximum).

    Measured: 12 months

  10. MAE (Major Adverse Events)

    Percentage of participants with a MAE (Major Adverse Events) at 1 year. Major Adverse Events, defined as Death of any Cause, Major Amputation of target limb, Minor Amputation of target limb

    Measured: 12 months

  11. Device Success

    Percentage of device success defined as exact deployment of the device according to the instructions for use as documented with suitable imaging modalities

    Measured: Day 1

  12. Technical Success

    Percentage of technical success defined as successful vascular access and completion of the endovascular procedure and immediate morphological success with less or equal to 50% residual diameter reduction of the treated lesion on completion angiography

    Measured: Day 1

  13. Procedural Success

    Percentage of patients with a procedural success defined as combination of technical success, device success and absence of procedural complications

    Measured: Day 1

  14. Days of Hospitalization

    Days of hospitalization at 1 year

    Measured: 12 months

  15. Improvement % Diameter Stenosis (%DS) of the Target Leasion (TL) Assessed by Quantitative Vascular Angiography (QVA)

    Percentage of participants with an improvement in percent diameter stenosis (%DS) of the target leasion (TL) assessed by Quantitative Vascular Angiography (QVA)

    Measured: 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Jul 2009 (estimated)
  2. Study startSep 2009
  3. Primary completionAug 2013
  4. Study completion30 Nov 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
358 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00941733
Sponsor's protocol ID
P998
Acronym
INPACT-DEEP
Status last verified
Jan 2018
First submitted
16 Jul 2009
Last updated
28 Feb 2018
Data monitoring committee
Yes

Publications

  • Ma GW, Bernatchez J, Yarranton B, Dueck AD, Rajan DK, Forbes TL, de Mestral C, Kayssi A. Drug-eluting balloon angioplasty versus uncoated balloon angioplasty for peripheral arterial disease of the lower limbs. Cochrane Database Syst Rev. 2026 Aug 10;8:CD011319. doi: 10.1002/14651858.CD011319.pub3.

    PubMed 42573020
  • Zeller T, Micari A, Scheinert D, Baumgartner I, Bosiers M, Vermassen FEG, Banyai M, Shishehbor MH, Wang H, Brodmann M; IN.PACT DEEP Trial Investigators. The IN.PACT DEEP Clinical Drug-Coated Balloon Trial: 5-Year Outcomes. JACC Cardiovasc Interv. 2020 Feb 24;13(4):431-443. doi: 10.1016/j.jcin.2019.10.059.

    PubMed 32081236
  • Zeller T, Baumgartner I, Scheinert D, Brodmann M, Bosiers M, Micari A, Peeters P, Vermassen F, Landini M, Snead DB, Kent KC, Rocha-Singh KJ; IN.PACT DEEP Trial Investigators. Drug-eluting balloon versus standard balloon angioplasty for infrapopliteal arterial revascularization in critical limb ischemia: 12-month results from the IN.PACT DEEP randomized trial. J Am Coll Cardiol. 2014 Oct 14;64(15):1568-76. doi: 10.1016/j.jacc.2014.06.1198.

    PubMed 25301459
  • Zeller T, Baumgartner I, Scheinert D, Brodmann M, Bosiers M, Micari A, Peeters P, Vermassen F, Landini M; IN.PACT DEEP Trial Investigators. IN.PACT Amphirion paclitaxel eluting balloon versus standard percutaneous transluminal angioplasty for infrapopliteal revascularization of critical limb ischemia: rationale and protocol for an ongoing randomized controlled trial. Trials. 2014 Feb 19;15:63. doi: 10.1186/1745-6215-15-63.

    PubMed 24552184

Questions about this trial

What is this clinical trial studying?

A study testing IN.PACT Amphirion and Standard PTA in people with Critical Lower Limb Ischemia, run by Medtronic Endovascular at 13 sites in 6 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 13 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 28 Feb 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 13 sites in Belgium, Germany, Switzerland, Austria, Italy and 1 more country. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 27 Oct 2014). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Late Lumen Loss (LLL) of the Target Lesion by Quantitative Vascular Angiography (QVA) (time frame: 12 months or at Target Lesion Revascularization (TLR) time). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00941733, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Feb 2018.

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