Cardiovascular Systems Seeking Japanese Approval for Diamondback Coronary Orbital Atherectomy System

Cardiovascular Systems Inc. (CSI) has submitted an application to Japan’s Pharmaceuticals and Medical Devices Agency (PMDA) for approval of its Diamondback 360 Coronary Orbital Atherectomy System (OAS) Micro Crown to treat severely calcified coronary arteries for the facilitation of stent placement.
 
Pending approval, Japan would become the first international market for any CSI product and would represent a significant milestone for the company. CSI expects commercialization beginning in 2018 and is currently working to find a distribution partner in Japan.
 
The second-generation device builds on the technology of the first generation coronary OAS, which was approved in the United States on Oct. 21, 2013. The fundamental, novel mechanism of action remains unchanged; however, the second generation device incorporates a diamond-coated tip for immediate engagement in tight lesions. Additionally, the increased mass of the sanding crown allows for lower rotational speeds while maintaining the same orbit potential as the first generation OAS. The unique orbital mechanism of action for both the first and second generation OAS is designed to allow continuous flow of blood during treatment, which is important for both acute and long-term success.
 
“The presence of severely calcified coronary lesions contributes to both poor patient outcomes and higher treatment costs around the world,” said Scott Ward, chairman and interim president and CEO of CSI. “The data we presented at CRT demonstrates the ability of our technology to treat this very challenging condition and patient population on a global scale. We look forward to working with PMDA to bring this alternative technology, with compelling clinical evidence, to the Japanese market.”
 
Application for approval was made following the completion of the company’s Harmonization-By-Doing clinical study, COAST, conducted in both the United States and Japan. COAST is a single-arm, multi-center, global investigational device exemption (IDE) study to evaluate the safety and efficacy of CSI’s next-generation OAS in treating patients with severely calcified coronary lesions for the facilitation of stent placement. The company completed COAST enrollment of 100 patients, including 74 patients at 12 sites in the United States and 26 patients at five sites in Japan, in July 2015. Data from the study showed a 30-day freedom from MACE (major adverse cardiac events) rate of 85 percent and a successful stent delivery rate of 99 percent.
 
Research has shown that an increased amount of calcium deposits leads to a higher incidence of MACE when compared to non-calcified lesions. Calcified lesions have been shown to respond poorly to balloon angioplasty and, therefore, are associated with a high frequency of restenosis, target lesion revascularization (TLR), vessel dissection during percutaneous coronary intervention (PCI), failure to deliver a stent, balloon ruptures and un-dilatable lesions. Up to 50 percent of coronary stents deployed in calcified lesions have been found to have asymmetric stent expansion, potentially increasing the likelihood of stent thrombosis and/or restenosis. As the concentration of calcium increases, so do the odds of a vessel perforation during PCI.
 
Coronary artery disease (CAD) is a life-threatening condition and a leading cause of death in men and women in the United States. CAD occurs when a fatty material called plaque builds up on the walls of arteries that supply blood to the heart. The plaque buildup causes the arteries to harden and narrow (atherosclerosis), reducing blood flow. The risk of CAD increases if a person has one or more of the following: high blood pressure, abnormal cholesterol levels, diabetes, or family history of early heart disease. According to the American Heart Association, 16.3 million people in the United States have been diagnosed with CAD, the most common form of heart disease. Heart disease claims more than 600,000 lives in the United States each year and is the second most common cause of death in Japan. According to estimates, significant arterial calcium is present in nearly 40 percent of patients undergoing a percutaneous coronary intervention (PCI). Significant calcium contributes to poor outcomes and higher treatment costs in coronary interventions when traditional therapies are used, including a significantly higher occurrence of death and major adverse cardiac events.
 
Cardiovascular Systems, based in St. Paul, Minn., develops and commercializes vascular and coronary disease treatment technology. The company’s Orbital Atherectomy Systems treat calcified and fibrotic plaque in arterial vessels throughout the leg and heart in a few minutes of treatment time, and address many of the limitations associated with existing surgical, catheter and pharmacological treatment alternatives. The U.S. Food and Drug Administration granted 510(k) clearance for the use of the Orbital Atherectomy System in peripheral arteries in August 2007. To date, more than 249,000 of CSI’s devices have been sold across the United States.

The Coronary OAS Micro Crown is limited by federal law to investigational use and is currently not commercially available in the United States or Japan.