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Tang TY, Chong TT, Yap CJQ, Soon SXY, Chan SL, Tan RY, Yap HY, Tay HT, Tan CS, Barnhill S, Hellinga D, DeGraw RT, Finn AV. Intervention with selution SLR™ Agent Balloon for Endovascular Latent Limus therapy for failing AV Fistulas (ISABELLA) Trial: Protocol for a pilot clinical study and pre-clinical results. J Vasc Access 2023; 24:289-299. [PMID: 34219511 PMCID: PMC10021111 DOI: 10.1177/11297298211020867] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this pilot clinical study is to evaluate the safety and efficacy of the Selution Sustained Limus Release (SLR)™ sirolimus-coated balloon (M.A. MedAlliance SA, Nyon, Switzerland) for improving the patency of failing arterio-venous fistulas (AVF) in hemodialysis patients. We also present herein a pre-clinical pharmacokinetic and safety evaluation of Selution™ to justify its first use in hemodialysis patients for endovascular access salvage. METHODS AND RESULTS This is an investigator-initiated prospective single-center, non-blinded single-arm trial. Forty patients with clinically significant de novo or recurrent stenoses in a mature AVF circuit will be recruited. All stenotic lesions will be prepared with high pressure non-compliant conventional balloon angioplasty (CBA) prior to deployment of the Sustained-Release Selution™ sirolimus drug-eluting balloon. The primary efficacy endpoint is 6-month target lesion primary patency and the primary safety endpoint is freedom from localized or systemic serious adverse events through 30 days. Secondary endpoints of interest include technical and clinical success rates and circuit access patency at 3 and 6 months. Follow-up will occur for 2 years for those patients whose AVFs remain patent. Pharmacokinetic and histological animal safety studies performed with the Selution™ coating formulation showed prolonged arterial tissue retention of sirolimus with therapeutic levels up to 60 days and non-toxic and rapidly declining blood levels. Histological results in animal models demonstrated safety, freedom from intraluminal thrombus, reduction in restenosis by sirolimus elution compared to CBA, and no evidence of embolic phenomena indicative of adverse particulate effects. DISCUSSION Long release sirolimus coated balloons may serve as a promising novel alternative therapy to paclitaxel-based technology for treating conduit stenosis secondary to neointimal hyperplasia. Pre-clinical pharmacokinetic and histological animal data are encouraging and provide suggestion of safety and efficacy in this setting. This single-center trial will provide a first step toward demonstration of efficacy and safety of this device for treatment of stenotic fistulas.
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Affiliation(s)
- Tjun Yip Tang
- Department of Vascular Surgery,
Singapore General Hospital, Singapore, Singapore
- Duke-NUS Graduate Medical School,
Singapore, Singapore
- Tjun Yip Tang, Duke-NUS Medical School,
Department of Vascular Surgery, Singapore General Hospital, Level 5; Academia,
20 College Road, Singapore 169856, Singapore.
| | - Tze-Tec Chong
- Department of Vascular Surgery,
Singapore General Hospital, Singapore, Singapore
| | - Charyl Jia Qi Yap
- Department of Vascular Surgery,
Singapore General Hospital, Singapore, Singapore
| | - Shereen Xue Yun Soon
- Department of Vascular Surgery,
Singapore General Hospital, Singapore, Singapore
| | - Sze Ling Chan
- Health Services Research Center,
SingHealth, Singapore, Singapore
| | - Ru Yu Tan
- Department of Renal Medicine, Singapore
General Hospital, Singapore, Singapore
| | - Hao Yun Yap
- Department of Vascular Surgery,
Singapore General Hospital, Singapore, Singapore
| | - Hsien Ts’ung Tay
- Department of Vascular Surgery,
Singapore General Hospital, Singapore, Singapore
| | - Chieh-Suai Tan
- Health Services Research Center,
SingHealth, Singapore, Singapore
| | | | | | | | - Aloke V Finn
- CVPath Institute Inc., Gaithersburg,
MD, USA
- University of Maryland School of
Medicine, Baltimore, MD, USA
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