Optical Coherence Tomography for Drug Eluting Stent Safety

NCT ID: NCT00693030

Last Updated: 2008-06-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

77 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-08-31

Study Completion Date

2008-12-31

Brief Summary

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Increasing lesion complexity in percutaneous coronary interventions (PCI) has warranted the use of overlapping drug-eluting stents. Whether the substantial impairment of arterial healing observed at sites of overlap in preclinical pathologic studies persists in patients undergoing PCI is unknown. Consecutive patients with long lesions in native coronary vessels requiring stents in overlap are prospectively randomized to receive multiple sirolimus-,paclitaxel polymer-or zotarolimus eluting stents versus bare metal stents. The completeness of stent struts coverage and/or late malapposition are evaluated by Optical Coherence Tomography at 6 months follow-up

Detailed Description

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If overlapping drug-eluting stents provide increased vessel toxicity is not known. Given the association of delayed healing and incomplete endothelialization observed in animal and human autopsy studies at overlapping sites it is unclear why most patients do well with multiple DES implanted. OCT detecs smaller degrees of in-stent neointima more accurately than IVUS and might be a useful method for identify strut coverage and/or malapposition.

Patients if eligible on the basis of clinical and angiographic criteria, are randomized (2:2:2:1) to receive multiple TAXUS Libertè™ vs Cypher Select™ vs Endeavor™ vs Libertè BM stents, in overlap. Stent implantation are done accordingly to the normal interventional practice. QCA and IVUS are performed at the end of optimal stents placement per visual judgement (residual stenosis \< 10%, TIMI 3 flow). Stent, lumen size and volume as well as complete stent strut apposal will be determined by IVUS analysis. Clinical follow-up will take place at 1 month (±1 week), 6 months (±2 weeks) and 1 year (±2 weeks). At 6-months follow-up all patients will undergo a quantitative coronary angiography (QCA), IVUS and Optical Coherence Tomography (LightLab OCT Imaging M2, automated pull back and flushing combination)assessments.

OCT images will be acquired at 15-30 frames per second. Blind corelab quantitative strut by strut analysis will be performed using a novel dedicated software at each 0.5 mm section. The following OCT variables will be evaluated:number of visualized strut per section, mean-max neointimal thickness per section, % struts well apposed with neointima at overlapping vs non overlapping sites, % struts without neointima, % struts malapposed, rate of \> 30% uncovered struts/total number of struts per section.

Conditions

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Coronary Artery Disease

Keywords

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Coronary Artery Disease Percutaneous Coronary Interventions Drug-Eluting stents Optical Coherence Tomography Thrombosis Long lesions in native vessel requiring stents in overlap

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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1

Device, Sirolimus drug-eluting stents implanted in overlap

Group Type ACTIVE_COMPARATOR

sirolimus drug eluting coronary stent Cypher™ (Cordis Corp, Johnson & Johnson Co)

Intervention Type DEVICE

comparison of multiple drug eluting stents

2

Device, paclitaxel polymer drug eluting stent

Group Type ACTIVE_COMPARATOR

paclitaxel polymer drug eluting stent Taxus Libertè™ (Boston Scientific, Natick MS)

Intervention Type DEVICE

comparison of multiple drug eluting coronary stents

3

Device, zotarolimus drug eluting stent

Group Type ACTIVE_COMPARATOR

zotarolimus drug eluting coronary stent Endeavor™ (Medtronic, Santa Rosa, CA)

Intervention Type DEVICE

comparison of multiple drug eluting coronary stents

4

bare metal coronary stents

Group Type ACTIVE_COMPARATOR

Libertè bare metal coronary stent Libertè™ BMS(Boston Scientific, Natick, MS)

Intervention Type DEVICE

comparison of DES in overlap vs BMS in overlap

Interventions

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sirolimus drug eluting coronary stent Cypher™ (Cordis Corp, Johnson & Johnson Co)

comparison of multiple drug eluting stents

Intervention Type DEVICE

paclitaxel polymer drug eluting stent Taxus Libertè™ (Boston Scientific, Natick MS)

comparison of multiple drug eluting coronary stents

Intervention Type DEVICE

zotarolimus drug eluting coronary stent Endeavor™ (Medtronic, Santa Rosa, CA)

comparison of multiple drug eluting coronary stents

Intervention Type DEVICE

Libertè bare metal coronary stent Libertè™ BMS(Boston Scientific, Natick, MS)

comparison of DES in overlap vs BMS in overlap

Intervention Type DEVICE

Other Intervention Names

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Cypher™ (Cordis Corp, Johnson & Johnson Co) DES Taxus Libertè™ (Boston Scientific, Natick MS) DES Endeavor™ (Medtronic, Santa Rosa, CA) DES Libertè™ BMS(Boston Scientific, Natick, MS)

Eligibility Criteria

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Inclusion Criteria

1. Native coronary artery disease with ≥ 75% diameter stenosis
2. Lesion length ≥ 20 mm,
3. Vessel size in between 2.5 and 3.5 mm.
4. Multiple, overlapped DES vs BMS placement (intention to overlap ≥ 4 mm)
5. Signed patient informed consent

Exclusion Criteria

1. left main coronary artery disease,
2. lesions in coronary artery bypass grafts,
3. acute myocardial infarction,
4. poor cardiac function as defined by left ventricular global ejection fraction ≤ 30%.
5. allergy to aspirin and or clopidogrel/ticlo,
6. renal failure with creatinine value \> 2.5,
7. no suitable anatomy for OCT scan
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Case Western Reserve University

OTHER

Sponsor Role collaborator

Medtronic Vascular

INDUSTRY

Sponsor Role collaborator

Boston Scientific Corporation

INDUSTRY

Sponsor Role collaborator

A.O. Ospedale Papa Giovanni XXIII

OTHER

Sponsor Role lead

Responsible Party

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Cardiovascular Department Ospedali Riuniti di Bergamo ITALY

Principal Investigators

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Giulio Guagliumi, MD

Role: PRINCIPAL_INVESTIGATOR

Cardiovascular Department Ospedali Riuniti di Bergamo

Locations

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Cardiovascular Department Ospedali Riuniti di Bergamo

Bergamo, , Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Monia Lorini, MD

Role: CONTACT

Phone: 39-03-526-9751

Email: [email protected]

Facility Contacts

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Giulio Guagliumi, MD

Role: primary

Giuseppe Musumeci, MD

Role: backup

References

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Joner M, Finn AV, Farb A, Mont EK, Kolodgie FD, Ladich E, Kutys R, Skorija K, Gold HK, Virmani R. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol. 2006 Jul 4;48(1):193-202. doi: 10.1016/j.jacc.2006.03.042. Epub 2006 May 5.

Reference Type BACKGROUND
PMID: 16814667 (View on PubMed)

Finn AV, Kolodgie FD, Harnek J, Guerrero LJ, Acampado E, Tefera K, Skorija K, Weber DK, Gold HK, Virmani R. Differential response of delayed healing and persistent inflammation at sites of overlapping sirolimus- or paclitaxel-eluting stents. Circulation. 2005 Jul 12;112(2):270-8. doi: 10.1161/CIRCULATIONAHA.104.508937. Epub 2005 Jul 5.

Reference Type BACKGROUND
PMID: 15998681 (View on PubMed)

Finn AV, Joner M, Nakazawa G, Kolodgie F, Newell J, John MC, Gold HK, Virmani R. Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation. 2007 May 8;115(18):2435-41. doi: 10.1161/CIRCULATIONAHA.107.693739. Epub 2007 Apr 16.

Reference Type BACKGROUND
PMID: 17438147 (View on PubMed)

Finn AV, Nakazawa G, Joner M, Kolodgie FD, Mont EK, Gold HK, Virmani R. Vascular responses to drug eluting stents: importance of delayed healing. Arterioscler Thromb Vasc Biol. 2007 Jul;27(7):1500-10. doi: 10.1161/ATVBAHA.107.144220. Epub 2007 May 17.

Reference Type BACKGROUND
PMID: 17510464 (View on PubMed)

Nakazawa G, Finn AV, John MC, Kolodgie FD, Virmani R. The significance of preclinical evaluation of sirolimus-, paclitaxel-, and zotarolimus-eluting stents. Am J Cardiol. 2007 Oct 22;100(8B):36M-44M. doi: 10.1016/j.amjcard.2007.08.020.

Reference Type BACKGROUND
PMID: 17950831 (View on PubMed)

Matsumoto D, Shite J, Shinke T, Otake H, Tanino Y, Ogasawara D, Sawada T, Paredes OL, Hirata K, Yokoyama M. Neointimal coverage of sirolimus-eluting stents at 6-month follow-up: evaluated by optical coherence tomography. Eur Heart J. 2007 Apr;28(8):961-7. doi: 10.1093/eurheartj/ehl413. Epub 2006 Nov 29.

Reference Type BACKGROUND
PMID: 17135281 (View on PubMed)

Bouma BE, Tearney GJ, Yabushita H, Shishkov M, Kauffman CR, DeJoseph Gauthier D, MacNeill BD, Houser SL, Aretz HT, Halpern EF, Jang IK. Evaluation of intracoronary stenting by intravascular optical coherence tomography. Heart. 2003 Mar;89(3):317-20. doi: 10.1136/heart.89.3.317.

Reference Type BACKGROUND
PMID: 12591841 (View on PubMed)

Takano M, Inami S, Jang IK, Yamamoto M, Murakami D, Seimiya K, Ohba T, Mizuno K. Evaluation by optical coherence tomography of neointimal coverage of sirolimus-eluting stent three months after implantation. Am J Cardiol. 2007 Apr 15;99(8):1033-8. doi: 10.1016/j.amjcard.2006.11.068. Epub 2007 Feb 23.

Reference Type BACKGROUND
PMID: 17437723 (View on PubMed)

Yamaguchi T, Terashima M, Akasaka T, Hayashi T, Mizuno K, Muramatsu T, Nakamura M, Nakamura S, Saito S, Takano M, Takayama T, Yoshikawa J, Suzuki T. Safety and feasibility of an intravascular optical coherence tomography image wire system in the clinical setting. Am J Cardiol. 2008 Mar 1;101(5):562-7. doi: 10.1016/j.amjcard.2007.09.116. Epub 2008 Jan 10.

Reference Type BACKGROUND
PMID: 18307999 (View on PubMed)

Guagliumi G, Musumeci G, Sirbu V, Bezerra HG, Suzuki N, Fiocca L, Matiashvili A, Lortkipanidze N, Trivisonno A, Valsecchi O, Biondi-Zoccai G, Costa MA; ODESSA Trial Investigators. Optical coherence tomography assessment of in vivo vascular response after implantation of overlapping bare-metal and drug-eluting stents. JACC Cardiovasc Interv. 2010 May;3(5):531-9. doi: 10.1016/j.jcin.2010.02.008.

Reference Type DERIVED
PMID: 20488410 (View on PubMed)

Other Identifiers

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0106

Identifier Type: -

Identifier Source: org_study_id