Computer Prediction of Restenosis Following Peripheral Angioplasty

NCT ID: NCT01202344

Last Updated: 2024-12-06

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

TERMINATED

Clinical Phase

NA

Total Enrollment

2 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-09-30

Study Completion Date

2024-12-03

Brief Summary

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The purpose of this study is to develop a computer program that might be able to accurately assess the risk of artery re-narrowing following angioplasty or stenting based on computer images. After angioplasty (a procedure to re-open narrowed or blocked blood vessels) the patients will have extra images taken in order to assess the results of the procedure; which will then be used to see whether or not these images can help predict outcomes such as the patient having to come back to the hospital to have the procedure done again.

Detailed Description

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The study involves medical imaging of patients undergoing an angioplasty intervention in a peripheral artery. It is similar to an observational study, except that additional imaging is performed which is above the standard-of-care. Some risks may be associated with the additional imaging due to a small increase in radiation exposure and intravenous contrast administration. No investigational drug or device will be tested in this study. No control group will be used.

Logistic regression analysis will be performed using NCSS statistical software to identify which explanatory variable(s), selected from the simulation results, can be used to predict binary restenosis, the categorical dependent variable.

For each subject, binary restenosis will be determined by comparing the CT-scan images obtained 1 hour post-intervention to those obtained at the 6 month follow-up study. The CT-scan images will be segmented and a mesh of the target vessel will be reconstructed as described in objective 1. The lumen area will be measured in every cross-section of the mesh perpendicular to the vessel centerline, with 2 mm steps between cross-sections. The minimum lumen diameter will be calculated from the minimum lumen area. If the minimum lumen diameter at follow-up is less than 50% of the minimum lumen diameter post-intervention, then the binary restenosis is positive. Otherwise it is negative.

Objective 1: Evaluate the accuracy of computer predictions of artery dilatation and stent implantation from CT-scan images. This information is hypothesized to be indicative of the accuracy of other quantities predicted by computer simulation of angioplasty, such as those used as independent variables in objective 2.

Objective 2: Establish a regression model with 80% sensitivity and 80% specificity for predicting binary restenosis based on one or several injury parameters in patients undergoing angioplasty. The candidate injury parameters are:

* endothelium denudation (in % of total endothelium area)
* descriptors of the magnitude and spatial distribution of stretch ratio in the arterial wall
* descriptors of the magnitude and spatial distribution of intramural stress in the arterial wall All injury parameters are predicted by computer simulation of angioplasty.

Conditions

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Peripheral Angioplasty

Keywords

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Angioplasty Stenosis Restenosis Elastic Recoil cheduled for percutaneous dilation of a peripheral artery Target lesion in native artery Baseline lumen diameter greater than 4 mm

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Restenosis

Patients who have restinosis immediately following angioplasty.

Group Type OTHER

Additional x-ray images

Intervention Type OTHER

Approximately 3 additional x-ray images following angioplasty (within 1 hour)

No Restenosis

Patients who do not have restinosis immediately following angioplasty.

Group Type OTHER

Additional x-ray images

Intervention Type OTHER

Approximately 3 additional x-ray images following angioplasty (within 1 hour)

Interventions

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Additional x-ray images

Approximately 3 additional x-ray images following angioplasty (within 1 hour)

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* scheduled for percutaneous dilation of a peripheral artery;
* age more than 18 years;
* informed consent signed by the subject;
* target lesion in native artery;
* baseline lumen diameter greater than 4 mm.

Exclusion Criteria

* previous revascularization of the target lesion;
* subject undergoing chemotherapy.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Dheeraj Rajan

OTHER

Sponsor Role lead

Responsible Party

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Dheeraj Rajan

Associate Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Dheeraj Rajan, MD

Role: PRINCIPAL_INVESTIGATOR

University Health Network, Toronto

Locations

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University Health Network

Toronto, Ontario, Canada

Site Status

Countries

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Canada

References

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Hoffmann R, Mintz GS, Mehran R, Kent KM, Pichard AD, Satler LF, Leon MB. Tissue proliferation within and surrounding Palmaz-Schatz stents is dependent on the aggressiveness of stent implantation technique. Am J Cardiol. 1999 Apr 15;83(8):1170-4. doi: 10.1016/s0002-9149(99)00053-3.

Reference Type BACKGROUND
PMID: 10215278 (View on PubMed)

Koyama J, Owa M, Sakurai S, Shimada H, Hikita H, Higashikata T, Ikeda S. Relation between vascular morphologic changes during stent implantation and the magnitude of in-stent neointimal hyperplasia. Am J Cardiol. 2000 Oct 1;86(7):753-8. doi: 10.1016/s0002-9149(00)01075-4.

Reference Type BACKGROUND
PMID: 11018195 (View on PubMed)

Syeda B, Wexberg P, Gyongyosi M, Denk S, Beran G, Kiss K, Sperker W, Glogar D. Effects of radial stretch on target lesion revascularization after percutaneous coronary intervention: an intravascular ultrasound study. Can J Cardiol. 2003 May;19(6):691-7.

Reference Type BACKGROUND
PMID: 12772020 (View on PubMed)

Schwartz RS, Huber KC, Murphy JG, Edwards WD, Camrud AR, Vlietstra RE, Holmes DR. Restenosis and the proportional neointimal response to coronary artery injury: results in a porcine model. J Am Coll Cardiol. 1992 Feb;19(2):267-74. doi: 10.1016/0735-1097(92)90476-4.

Reference Type BACKGROUND
PMID: 1732351 (View on PubMed)

Rogers C, Tseng DY, Squire JC, Edelman ER. Balloon-artery interactions during stent placement: a finite element analysis approach to pressure, compliance, and stent design as contributors to vascular injury. Circ Res. 1999 Mar 5;84(4):378-83. doi: 10.1161/01.res.84.4.378.

Reference Type BACKGROUND
PMID: 10066671 (View on PubMed)

Capron L, Bruneval P. Influence of applied stress on mitotic response of arteries to injury with a balloon catheter: quantitative study in rat thoracic aorta. Cardiovasc Res. 1989 Nov;23(11):941-8. doi: 10.1093/cvr/23.11.941.

Reference Type BACKGROUND
PMID: 2611802 (View on PubMed)

Olson NE, Chao S, Lindner V, Reidy MA. Intimal smooth muscle cell proliferation after balloon catheter injury. The role of basic fibroblast growth factor. Am J Pathol. 1992 May;140(5):1017-23.

Reference Type BACKGROUND
PMID: 1580326 (View on PubMed)

Jamal A, Bendeck M, Langille BL. Structural changes and recovery of function after arterial injury. Arterioscler Thromb. 1992 Mar;12(3):307-17. doi: 10.1161/01.atv.12.3.307.

Reference Type BACKGROUND
PMID: 1547190 (View on PubMed)

Doornekamp FN, Borst C, Post MJ. Endothelial cell recoverage and intimal hyperplasia after endothelium removal with or without smooth muscle cell necrosis in the rabbit carotid artery. J Vasc Res. 1996 Mar-Apr;33(2):146-55. doi: 10.1159/000159143.

Reference Type BACKGROUND
PMID: 8630348 (View on PubMed)

Nugent HM, Rogers C, Edelman ER. Endothelial implants inhibit intimal hyperplasia after porcine angioplasty. Circ Res. 1999 Mar 5;84(4):384-91. doi: 10.1161/01.res.84.4.384.

Reference Type BACKGROUND
PMID: 10066672 (View on PubMed)

Other Identifiers

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08-0335-BE

Identifier Type: -

Identifier Source: org_study_id