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Stent RestenosisBIOFLEX-COFNCT03097679

Self-expanding Nitinol Stents of High vs. Low Chronic Outward Force in De-novo Femoropopliteal Occlusive Arterial Lesions

A study testing Pulsar Stent and LifeStent Flexstar Vascular Stent in people with Stent Restenosis and Intimal Hyperplasia, run by Medical University of Vienna at 1 site in Austria.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The objective of the BIOFLEX-COF trial is to investigate differences in formation of intimal hyperplasia at one and two years after implantation of nitinol-stents with high vs. low COF in de-novo femoropopliteal occlusive lesions in patients with symptomatic peripheral arterial disease. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Stent Restenosis, Intimal Hyperplasia
What is being tested?
Pulsar Stent and LifeStent Flexstar Vascular Stent
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
86 participants
Where
1 siteAustria
Study dates
1 Oct 2015to 31 Dec 2020
Phase
Interventional
Are there results?
None posted in the registry

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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient related:
  • Subject (or their legal guardian) has read, understood and provided written informed consent, which has been reviewed and approved by the Institutional Review Board.
  • At least 18 years of age.
  • Male, infertile female or female participants of child bearing potential practicing an acceptable method of birth control with a negative pregnancy test within 7-days prior to study procedure.
  • Projected life expectancy of greater than two years.
  • The ability to comply with protocol follow-up requirements and required testing.
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  • Clinical:
  • Lifestyle-limiting claudication or CLI (meeting angiographic entry criteria) affecting a lower extremity (Rutherford stages 2-5). Patients with Rutherford stage 2 are only eligible after unsuccessful conventional and/or medicamentous therapy.
  • Resting ankle-brachial index (ABI) ≤ 0.8 in the study limb.
  • Inflow lesion - if present - has been treated successfully (inflow treatment in same procedure permissible)
  • Angiographic and Lesion Requirements (assessed intraoperatively):
  • TASC A-D lesions from stenoses /occlusions ≤ 35cm.
  • Popliteal artery is patent 5 cm proximal to the radiographic knee joint line.
  • Reference diameter of 4.0 - 7.0 mm in proximal and distal treatment segments within the SFA.
  • Patent SFA orifice (the proximal 5 mm after femoral bifurcation).
  • At least one patent (<50% stenotic) inflow vessel present, proven angiographically. Study eligibility is given when inflow lesion has been treated successfully (inflow treatment in same procedure permissible). Successful treatment of inflow lesion is defined as <50% stenosis without death or severe vascular complication.
  • At least one patent (<50% stenotic)tibial artery runoff to the ankle present, proven angiographically. Study eligibility is given when runoff vessel lesion has been treated successfully (inflow treatment in same procedure permissible). Successful treatment of inflow lesion is defined as <50% stenosis without death or severe vascular complication.Guidewire has successfully traversed lesion and is within the true lumen of the distal vessel.

Who cannot join

  • Pregnant and/or breast-feeding women.
  • Lesion length > 35 cm.
  • Flow-limiting occlusive disease of inflow and / or outflow arteries that cannot be treated sufficiently.
  • Previous stenting or femoral bypass surgery in the target vessel.
  • Clinical relevant aneurysmatic disease of the abdominal aorta, ipsilateral femoral arteries or arteries of the knee.
  • Rutherford stage 0, 1 or 6
Show all 17Show fewer
  • Non-atherosclerotic disease resulting in occlusion (e.g., embolism, Buerger's disease, vasculitis).
  • Septicaemia.
  • Ischemic stroke within the last three months.
  • Any previously known coagulation disorder, including hypercoagulability
  • Morbid obesity or operative scarring that precludes percutaneous approach (physician's discretion).
  • Contraindication to anticoagulation or antiplatelet therapy.
  • Known allergy to medication or contrast media used in this trial, if pre-treatment is not possible (physician's discretion).
  • Known allergies to stent components (especially Nickel).
  • Severe calcification of the target lesion.
  • Current participation in another clinical research trial, that has not reached its primary endpoint.
  • The patient is institutionalized based on a legal verdict.

Trial locations and contacts

1 site in 1 country.

Austria1 site
  • Medical University of Vienna

    Vienna, 1090

Other trials in Austria

About this study

The objective of the BIOFLEX-COF trial is to investigate differences in formation of intimal hyperplasia at one and two years after implantation of nitinol-stents with high vs. low COF in de-novo femoropopliteal occlusive lesions in patients with symptomatic peripheral arterial disease.

The BIOFLEX-COF trial is a prospective, randomized controlled trial. 80 subjects will be enrolled and randomly assigned to either a high COF group (LifeStent Vascular Stent) or low COF group (Pulsar).

Read the detailed description

Self-expanding nitinol stents must be oversized at least by a minimal amount to ensure contact with the vessel wall and prevent migration. Once the stent is deployed it exerts a continuous force upon the vascular wall, termed chronic outward force (COF). Data about COF and neointimal hyperplasia in humans are currently lacking. Some animal studies, though, found a markedly increased neointimal hyperplasia in stents with high oversizing and thus high COF. The objective of the BIOFLEX-COF trial is to investigate differences in formation of intimal hyperplasia at one and two years after implantation of nitinol-stents with high vs. low COF in de-novo femoropopliteal occlusive lesions in patients with symptomatic peripheral arterial disease.

The BIOFLEX-COF trial is a prospective, randomized controlled trial. 80 subjects will be enrolled and randomly assigned to either a high COF group (LifeStent Vascular Stent) or low COF group (Pulsar). Diameter of implanted stents will be measured at every two millimetres along the stent axis on DICOM images of the respective completion angiography using image processing software.

The scheduled time for recruitment is 2 years. There will be two follow-up evaluations at 12 and 24 months.

Primary endpoint is the amount of in-stent neointima at one year, assessed by contrast-enhanced CT angiography (CTA). Secondary objectives are the amount of in-stent neointima at two years, device- and procedure-related adverse events and target lesion revascularisation (TLR) rate.

In the control examinations stent diameter and true lumen diameter will be measured on DICOM images every two millimetres along the stent axis to quantify the relative amount of in-stent restenosis.

The present study is challenging in that it compares two different self-expanding nitinol-stents head-to-head against each other. To optimize the power of this study, both clinical TLR and binary re-stenosis at Colour flow Doppler Ultrasound were dropped as primary endpoints. Instead the amount of neointima inside the stent accessed by CTA was selected as outcome parameter.

The study differs further from similar previous trials in its generous inclusions criteria. This was done in effort to perform the trial on a patient sample that closely represents real-world patients of a specialised endovascular centre.

Being tested
Pulsar Stent, LifeStent Flexstar Vascular Stent

What participants receive

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

  • Pulsar StentDevice

    Percutane transluminal stent angioplasty with a Pulsar Stent of the superficial femoral artery for the treatment of peripheral arterial occlusive disease.

  • LifeStent Flexstar Vascular StentDevice

    Percutane transluminal stent angioplasty with a LifeStent Flexstar Vascular Stent of the superficial femoral artery for the treatment of peripheral arterial occlusive disease.

Study groups in NCT03097679
Study groupRoleWhat they receive
low COF-groupActive comparatorThe low COF-group receives a thin-strut stent (Pulsar, Biotronik AG, Bülach, Switzerland) with minimal oversizing (according to manufacturer's Instructions For Use)
Receives: Device: Pulsar Stent
high COF-groupActive comparatorThe high COF-group receives a stiffer-stent (Lifestent Flexstar, Bard Peripheral Vascular Inc., Tempe, AZ, USA) with maximal oversizing (according to manufacturer's Instructions For Use).
Receives: Device: LifeStent Flexstar Vascular Stent

What is being measured

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

  1. Amount of in-stent restenosis

    Mean amount of in-stent restenosis in percent along the stent axis at one and two years post-procedure.

    Measured: one and two years post-procedure

Secondary outcomes (2)
  1. Adverse Events ISO 14155:2011

    Adverse Events ISO 14155:2011

    Measured: within two years post-procedure

  2. Target lesion revascularisation (TLR)

    In patients with TLR the amount of in-stent restenosis will be assessed at the time of TLR.

    Measured: within two years post-procedure

Timeline

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

  1. First posted31 Mar 2017
  2. Study start1 Oct 2015
  3. Primary completion31 Jul 2019
  4. Study completion31 Dec 2020 (estimated)

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
None (open label)
Enrolment
86 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03097679
Sponsor's protocol ID
1026/2015
Acronym
BIOFLEX-COF
Status last verified
Feb 2020
First submitted
14 Mar 2017
Last updated
20 Feb 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Lammer J, Zeller T, Hausegger KA, Schaefer PJ, Gschwendtner M, Mueller-Huelsbeck S, Rand T, Funovics M, Wolf F, Rastan A, Gschwandtner M, Puchner S, Beschorner U, Ristl R, Schoder M. Sustained benefit at 2 years for covered stents versus bare-metal stents in long SFA lesions: the VIASTAR trial. Cardiovasc Intervent Radiol. 2015 Feb;38(1):25-32. doi: 10.1007/s00270-014-1024-9. Epub 2014 Dec 5.

    PubMed 25472936
  • Jaff MR, White CJ, Hiatt WR, Fowkes GR, Dormandy J, Razavi M, Reekers J, Norgren L. An Update on Methods for Revascularization and Expansion of the TASC Lesion Classification to Include Below-the-Knee Arteries: A Supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II): The TASC Steering Comittee(.). Ann Vasc Dis. 2015;8(4):343-57. doi: 10.3400/avd.tasc.15-01000. Epub 2015 Oct 23.

    PubMed 26730266
  • Saxon RR, Dake MD, Volgelzang RL, Katzen BT, Becker GJ. Randomized, multicenter study comparing expanded polytetrafluoroethylene-covered endoprosthesis placement with percutaneous transluminal angioplasty in the treatment of superficial femoral artery occlusive disease. J Vasc Interv Radiol. 2008 Jun;19(6):823-32. doi: 10.1016/j.jvir.2008.02.008. Epub 2008 Apr 10.

    PubMed 18503895
  • Rastan A, Krankenberg H, Baumgartner I, Blessing E, Muller-Hulsbeck S, Pilger E, Scheinert D, Lammer J, Beschorner U, Noory E, Neumann FJ, Zeller T. Stent placement vs. balloon angioplasty for popliteal artery treatment: two-year results of a prospective, multicenter, randomized trial. J Endovasc Ther. 2015 Feb;22(1):22-7. doi: 10.1177/1526602814564386.

    PubMed 25775675
  • Dick P, Wallner H, Sabeti S, Loewe C, Mlekusch W, Lammer J, Koppensteiner R, Minar E, Schillinger M. Balloon angioplasty versus stenting with nitinol stents in intermediate length superficial femoral artery lesions. Catheter Cardiovasc Interv. 2009 Dec 1;74(7):1090-5. doi: 10.1002/ccd.22128.

    PubMed 19859954
  • Krankenberg H, Schluter M, Steinkamp HJ, Burgelin K, Scheinert D, Schulte KL, Minar E, Peeters P, Bosiers M, Tepe G, Reimers B, Mahler F, Tubler T, Zeller T. Nitinol stent implantation versus percutaneous transluminal angioplasty in superficial femoral artery lesions up to 10 cm in length: the femoral artery stenting trial (FAST). Circulation. 2007 Jul 17;116(3):285-92. doi: 10.1161/CIRCULATIONAHA.107.689141. Epub 2007 Jun 25.

    PubMed 17592075
  • Dake MD, Ansel GM, Jaff MR, Ohki T, Saxon RR, Smouse HB, Zeller T, Roubin GS, Burket MW, Khatib Y, Snyder SA, Ragheb AO, White JK, Machan LS; Zilver PTX Investigators. Paclitaxel-eluting stents show superiority to balloon angioplasty and bare metal stents in femoropopliteal disease: twelve-month Zilver PTX randomized study results. Circ Cardiovasc Interv. 2011 Oct 1;4(5):495-504. doi: 10.1161/CIRCINTERVENTIONS.111.962324. Epub 2011 Sep 27.

    PubMed 21953370
  • Deloose K, Lauwers K, Callaert J, Maene L, Keirse K, Verbist J, Peeters P, Bosiers M. Drug-eluting technologies in femoral artery lesions. J Cardiovasc Surg (Torino). 2013 Apr;54(2):217-24.

    PubMed 23558657
  • Brodmann M. Prime time for drug eluting balloons in SFA interventions? J Cardiovasc Surg (Torino). 2014 Aug;55(4):461-4. Epub 2014 Jun 18.

    PubMed 24941235
  • Minar E, Schillinger M. Innovative technologies for SFA occlusions: drug coated balloons in SFA lesions. J Cardiovasc Surg (Torino). 2012 Aug;53(4):481-6.

    PubMed 22854528
  • Schmidt W, Wissgott C, Andresen R, Behrens P, Schmitz KP. Performance characteristics of modern self-expanding nitinol stents indicated for SFA. Rofo. 2011 Sep;183(9):818-25. doi: 10.1055/s-0031-1273445. Epub 2011 Jul 12.

    PubMed 21751121
  • Johnston CR, Lee K, Flewitt J, Moore R, Dobson GM, Thornton GM. The mechanical properties of endovascular stents: an in vitro assessment. Cardiovasc Eng. 2010 Sep;10(3):128-35. doi: 10.1007/s10558-010-9097-9.

    PubMed 20717726
  • Cho H, Nango M, Sakai Y, Sohgawa E, Kageyama K, Hamamoto S, Kitayama T, Yamamoto A, Miki Y. Neointimal hyperplasia after stent placement across size-discrepant vessels in an animal study. Jpn J Radiol. 2014 Jun;32(6):340-6. doi: 10.1007/s11604-014-0311-3. Epub 2014 Apr 9.

    PubMed 24715330
  • Zhao HQ, Nikanorov A, Virmani R, Jones R, Pacheco E, Schwartz LB. Late stent expansion and neointimal proliferation of oversized Nitinol stents in peripheral arteries. Cardiovasc Intervent Radiol. 2009 Jul;32(4):720-6. doi: 10.1007/s00270-009-9601-z. Epub 2009 May 30.

    PubMed 19484292
  • Freeman JW, Snowhill PB, Nosher JL. A link between stent radial forces and vascular wall remodeling: the discovery of an optimal stent radial force for minimal vessel restenosis. Connect Tissue Res. 2010 Aug;51(4):314-26. doi: 10.3109/03008200903329771.

    PubMed 20388019

Questions about this trial

What is this clinical trial studying?

A study testing Pulsar Stent and LifeStent Flexstar Vascular Stent in people with Stent Restenosis and Intimal Hyperplasia, run by Medical University of Vienna at 1 site in Austria.

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 17 inclusion and 17 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: status not confirmed, as of the sponsor's last update on 20 Feb 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Austria. 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?

Results are not available in the source record.

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?

Amount of in-stent restenosis (time frame: one and two years post-procedure). 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 NCT03097679, which also lists 21 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 20 Feb 2020.

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