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雷帕霉素靶向洗脱球囊治疗外周动脉疾病:ILLUMENATE 关键性随机对照临床试验 5 年结果。

Stellarex Drug-Coated Balloon for the Treatment of Peripheral Artery Disease: Five-Year Results from the ILLUMENATE Pivotal Randomized Controlled Trial.

机构信息

Department of Cardiology, Cardiovascular Institute, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.

Division of Vascular Surgery, Mount Sinai Hospital, New York, New York.

出版信息

Am J Cardiol. 2024 Sep 15;227:83-90. doi: 10.1016/j.amjcard.2024.06.027. Epub 2024 Jul 15.

Abstract

This study aimed to report the 5-year outcomes from the ILLUMENATE Pivotal randomized controlled trial of the lower dose (2 µg/mm) Stellarex drug-coated balloon (DCB) (Philips, formerly Spectranetics Corp, Colorado Springs, Colorado) compared with percutaneous transluminal angioplasty (PTA) for the treatment of symptomatic peripheral arterial disease. Long-term safety and effectiveness data for DCBs remains limited. The ILLUMENATE Pivotal was a prospective, randomized, multi-center, single-blinded study. Patients (Rutherford Clinical Category 2 to 4) were randomized 2:1 to Stellarex DCB or PTA. Follow-up was through 60 months. In total, 300 patients were enrolled. The mean age was 68.8 ± 10.2 years. At 60 months, freedom from a primary safety event was 69.2% in the Stellarex DCB arm and 68.2% in the PTA arm (log-rank, p = 0.623). The cumulative rate of major adverse events was 41.0% compared with 44.6% (p = 0.597), respectively. Freedom from clinically-driven target lesion revascularization (CD-TLR) was 70.3% in the Stellarex DCB arm compared with 68.2% in the PTA arm (p = 0.505). Time to first CD-TLR was 768.3 ± 478.9 days compared with 613.5 ± 453.4 days, respectively (p = 0.161). Kaplan-Meier estimates of freedom from all-cause mortality were 80.1% in the Stellarex DCB arm and 80.2% in the PTA arm (log-rank, p = 0.980). In conclusion, the 5-year results of the ILLUMENATE Pivotal randomized controlled trial add to the consistent safety data from the broader ILLUMENATE clinical program. These are the first data to report the 5-year safety and efficacy of a lower dose (2 µg/mm) DCB for the treatment of symptomatic peripheral arterial disease. Clinicaltrials.gov Registration:NCT01858428.

摘要

本研究旨在报告低剂量(2μg/mm) Stellarex 药物涂层球囊(DCB)(Philips,前身为 Spectranetics 公司,科罗拉多斯普林斯,科罗拉多州)与经皮腔内血管成形术(PTA)治疗症状性外周动脉疾病的 5 年结果。长期安全性和有效性数据仍有限。ILLUMENATE 关键性研究是一项前瞻性、随机、多中心、单盲研究。患者(Rutherford 临床类别 2 至 4)按 2:1 随机分为 Stellarex DCB 组或 PTA 组。随访时间为 60 个月。共纳入 300 例患者。平均年龄为 68.8 ± 10.2 岁。在 60 个月时,Stellarex DCB 组的主要安全性事件无复发率为 69.2%,PTA 组为 68.2%(对数秩检验,p = 0.623)。主要不良事件的累积发生率分别为 41.0%和 44.6%(p = 0.597)。Stellarex DCB 组的临床驱动的靶病变血运重建(CD-TLR)无复发率为 70.3%,PTA 组为 68.2%(p = 0.505)。首次 CD-TLR 的时间分别为 768.3 ± 478.9 天和 613.5 ± 453.4 天(p = 0.161)。Stellarex DCB 组和 PTA 组的全因死亡率的 Kaplan-Meier 估计值分别为 80.1%和 80.2%(对数秩检验,p = 0.980)。总之,ILLUMENATE 关键性随机对照试验的 5 年结果增加了更广泛的 ILLUMENATE 临床研究项目的一致安全性数据。这些是报告治疗症状性外周动脉疾病的低剂量(2μg/mm)DCB 的 5 年安全性和有效性的首批数据。临床试验注册:NCT01858428。

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