Posts Tagged ‘critical limb ischemia (CLI)’

Bioresorbable Stent Clinical Trials with New Esprit Below-the-knee Scaffold

Reporter: Irina Robu, PhD

Abbott announced on September 3, 2020, the beginning of the LIFE-BTK clinical trial to evaluate effectiveness and safety of  the Esprit BTK Everolimus Eluting Resorbable Scaffold System. The Esprit BTK System consists of a thin strutted scaffold made of poly-L-lactide, a semi-crystalline bioresorbable polymer engineered to resist vessel recoil and provide a platform for drug delivery. The scaffold is coated with poly-D, L-lactide (PDLLA) and the cytostatic drug, everolimus.

This trial is the first Investigational Device Exemption in the US to assess a fully bioresorbable stent to treat blocked arteries below the knees, also known as critical limb ischemia in people battling advanced stages of peripheral artery disease. For people with CLI, blocked vessels weaken blood flow to the lower extremities, which can lead to severe pain, wounds, and in severe cases, limb amputation.

At this time, the standard of care for patients battling critical limb ischemia is balloon angioplasty, which depend on on a small balloon delivered via a catheter to the blockage to compress it against the arterial wall, opening the vessel and restoring blood flow. Yet, blockages treated only with balloon angioplasty have poor short- and long-term results, and in many cases the vessels become blocked again, lacking additional treatment.

Patients treated with balloon angioplasty often require several procedures on treated arteries, and  a drug eluting resorbable device is if at all possible suited to provide mechanical support, decrease the chance of the vessel re-narrowing and then slowly disappear over time. At this time, there are no drug eluding stents, drug coated balloons or bare metal stents approved for use below the knee. Since, there is a limited number of options for stents below the knee, the FDA has granted Esprit BTK breakthrough device designation, which simplifies review and pre-market approval timelines.

According to Abbott, Espirit BTK System is not a permanent implant, but it does provide support to an artery right after a balloon angioplasty, stopping the vessel from reclosing. As soon as it is implanted, the scaffold distributes a drug over a few months that encourages healing and keeps the artery open. The scaffold is naturally resorbed into the body over time, like dissolving sutures, and eventually leaves only a healed artery behind.

The LIFE-BTK trial is the first Investigational Device Exemption trial in the U.S. to evaluate a fully dissoluble device to treat critical limb ischemia in people battling advanced stages of peripheral artery disease (PAD). The trial will be run by principal investigators Brian DeRubertis, M.D. (vascular surgeon, UCLA), Sahil Parikh M.D., (interventional cardiologist, New York-Presbyterian/Columbia University Irving Medical Center.






Read Full Post »

Endovascular procedures associated with lower mortality, LOS, cost vs. surgical bypass: Results of Critical Limb Ischemia National Study

Reporter: Aviva Lev-Ari, PhD, RN







a new comprehensive analysis of a nationwide hospital sample of nearly 650,000 patients conducted from 2003 to 2011.

Mehdi Shishehbor

Mehdi Shishehbor, DO, MPH, PhD

“We found that rates of surgery for CLI are going down while rates of endovascular procedures are going up,” says Mehdi Shishehbor, DO, MPH, PhD, Director of Endovascular Services at Cleveland Clinic. “Meanwhile hospital admissions for CLI have remained constant even as rates of amputation and death from CLI have gone down. This suggests there’s something at work other than improved medical therapy for CLI.”

Dr. Shishehbor led the Cleveland Clinic-conducted analysis, which was just published in Journal of the American College of Cardiology and will also be presented at the 65th Annual Scientific Session of the American College of Cardiology (ACC.16) in Chicago in early April.

Key findings

The researchers’ key findings are reflected in the figure below and include the following:

Figure 1

Figure. Nationwide trends in CLI hospital admissions and outcomes over time, based on the analysis by Shishehbor and colleagues. Reprinted from Agarwal S, Sud K, Shishehbor MH, J Am Coll Cardiol. 2016 Mar 21 [Epub ahead of print], ©2016, with permission from the American College of Cardiology Foundation.

  • The annual rate of CLI admissions remained relatively constant (at ~150/100,000 population) throughout the 2003-2011 period despite a progressive increase in the rate of admissions for PAD. “The rise in PAD might be secondary to the rise in prevalence of cardiovascular risk factors, which we observed,” notes Dr. Shishehbor. “An increase in the rate of PAD-related admissions, with the constant rate of CLI-related admissions, might suggest early detection of PAD, leading to improved PAD management and the relative stabilization of CLI rates.”
  • The proportion of patients with CLI undergoing surgical revascularization declined significantly during the study period (from 13.9 percent in 2003 to 8.8 percent in 2011) while the proportion undergoing endovascular treatment rose significantly (from 5.1 percent to 11.0 percent).
  • There was a steady and significant decline in rates of in-hospital death and major amputation across the study period among patients with CLI as well as a significant overall decline in mean length of stay. Despite these improvements, mean hospitalization cost remained unchanged throughout the study period.
  • Compared with surgical revascularization, endovascular treatment of CLI was associated with significantly lower in-hospital mortality, mean LOS and mean hospitalization cost — even after adjustment for potential confounders — despite statistically comparable rates of major amputation.



Read Full Post »

%d bloggers like this: