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COVERA™动静脉(AV)支架移植物治疗动静脉内瘘通路静脉流出道狭窄的前瞻性、多中心、非随机临床研究(AVeNEW PAS)的六个月结果。

Six-Month Outcomes from the Prospective, Multi-Center, Non-Randomized Clinical Study of the COVERA™ Arterio VeNous (AV) Stent Graft in the Treatment of Stenosis in the VEnous OutfloW of AV Fistula Access Circuits (AVeNEW PAS).

作者信息

Dolmatch Bart, Saber Talar, Underwood Margo

机构信息

The Palo Alto Medical Foundation, Sutter Health, Palo Alto, USA.

Clinical Affairs, Becton, Dickinson and Company, Tempe, USA.

出版信息

Cardiovasc Intervent Radiol. 2025 Apr;48(4):460-471. doi: 10.1007/s00270-024-03930-7. Epub 2025 Jan 9.

DOI:10.1007/s00270-024-03930-7
PMID:39789255
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11958458/
Abstract

PURPOSE

The AVeNEW Post-Approval Study (AVeNEW PAS) follows upon results from the AVeNEW IDE clinical trial and was designed to provide additional clinical evidence of safety and effectiveness using the Covera™ Vascular Covered Stent to treat arteriovenous fistula (AVF) stenoses in a real-world hemodialysis patient population.

MATERIALS AND METHODS

One hundred AVF patients were prospectively enrolled at 11 clinical trial sites in the USA and treated with the covered stent after angioplasty of a clinically significant target stenosis. The primary safety outcome was freedom from any adverse event that suggests the involvement of the AV access circuit evaluated at 30 days. The primary efficacy outcome was Target Lesion Primary Patency (TLPP) at six months, determined by an independent core laboratory. Secondary outcome measures included technical success defined as successful deployment to the intended location and access circuit primary patency (ACPP).

RESULTS

Safety was 94.9% with no device-related deaths nor in-patient hospitalization. Technical success was 100%. TLPP rates at 1, 3, and 6 months were 100, 89.7, and 82.2%. ACPP rates at 1, 3, and 6 months were 98, 76.3, and 60.0%. Target stenoses were 81% restenotic, and 75% located in the cephalic vein arch. There were 35% non-target stenoses treated with angioplasty during the index procedure.

CONCLUSION

The 6-month results of the AVeNEW PAS confirm results from the AVeNEW IDE clinical trial and demonstrate safety and efficacy using the Covera™ Covered Stent in a real-world US hemodialysis patient population.

TRIAL REGISTRATION

NCT04261686.

LEVEL OF EVIDENCE

3 - prospective, multicenter.

摘要

目的

AVeNEW批准后研究(AVeNEW PAS)基于AVeNEW IDE临床试验的结果开展,旨在提供更多临床证据,以证明在实际的血液透析患者群体中,使用Covera™血管覆膜支架治疗动静脉内瘘(AVF)狭窄的安全性和有效性。

材料与方法

在美国的11个临床试验地点前瞻性纳入了100例AVF患者,在对具有临床意义的目标狭窄进行血管成形术后,使用覆膜支架进行治疗。主要安全结局是在30天时未发生任何提示AV通路回路受累的不良事件。主要疗效结局是6个月时的靶病变原发通畅率(TLPP),由独立的核心实验室确定。次要结局指标包括定义为成功部署到预期位置的技术成功率和通路回路原发通畅率(ACPP)。

结果

安全性为94.9%,无器械相关死亡或住院治疗情况。技术成功率为100%。1、3和6个月时的TLPP率分别为100%、89.7%和82.2%。1、3和6个月时的ACPP率分别为98%、76.3%和60.0%。靶狭窄的再狭窄率为81%,75%位于头静脉弓。在首次手术过程中,35%的非靶狭窄接受了血管成形术治疗。

结论

AVeNEW PAS的6个月结果证实了AVeNEW IDE临床试验的结果,并证明了在实际的美国血液透析患者群体中使用Covera™覆膜支架的安全性和有效性。

试验注册

NCT04261686。

证据水平

3 - 前瞻性、多中心。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ac3/11958458/bca49211173b/270_2024_3930_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ac3/11958458/be8b4e64486e/270_2024_3930_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ac3/11958458/bca49211173b/270_2024_3930_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ac3/11958458/be8b4e64486e/270_2024_3930_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ac3/11958458/bca49211173b/270_2024_3930_Fig2_HTML.jpg

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本文引用的文献

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BMC Nephrol. 2024 Sep 10;25(1):299. doi: 10.1186/s12882-024-03737-1.
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Prospective, randomized, multicenter clinical study comparing a self-expanding covered stent to percutaneous transluminal angioplasty for treatment of upper extremity hemodialysis arteriovenous fistula stenosis.
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IN.PACT AV Access Randomized Trial: 12-Month Clinical Results Demonstrating the Sustained Treatment Effect of Drug-Coated Balloons.IN.PACT AV 血管接入随机试验:12 个月临床结果显示药物涂层球囊的持续治疗效果。
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ASDIN white paper: Management of cephalic arch stenosis endorsed by the American Society of Diagnostic and Interventional Nephrology.ASDIN 白皮书:美国诊断与介入肾脏病学会认可的颅穹窿狭窄管理。
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Drug-Coated Balloon Angioplasty in Failing Arteriovenous Fistulas: More Data, Less Clarity.药物涂层球囊血管成形术治疗失功动静脉内瘘:数据增多,清晰度降低。
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