One can interpret the last sentence in a couple of ways. As written it implies, to me, that selected sites were already prepared to start. With FDA Approval in hand, ADDITIONAL sites will NOW be added. That perhaps, of the total compliment of desired sites; those which were easier, cheaper, less complicated or previously engaged in relationship with the CRO (one or more of the above conditions, add your own conditions as you see fit), were signed-up while others; more expensive to secure, more complicated to contract or, by their own pre-condition, desirous of FDA trial approval could NOW be secured. The Approval was a hurdle that had to be overcome before investing resources and executing final agreements with a subset of test sites.
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