Covered CP Stents for the Prevention or Treatment of Aortic Wall Injury Associated With Coarctation of the Aorta

NCT ID: NCT01278303

Last Updated: 2023-04-11

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 82 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2010-07-31
• Study Completion Date: 2014-12-31

Brief Summary

Coarctation of the aorta (CoA) is a congenital abnormality producing obstruction to blood flow through the aorta. Coarctation can occur in isolation, in association with bicuspid aortic valve or with major cardiac malformations. CoA accounts for 5-8% of the 8/1000 (4-6/10,000) children born with congenital heart disease. Most CoA is newly diagnosed in childhood; < 25% recognized beyond 10 yrs.

CoA is mostly repaired in childhood by surgery or by balloon catheter dilation. Recurrence rates range from 5-20%. Recurrence is often not recognized until adolescence. Balloon expandable stents have become the predominant therapy in the USA and Europe for CoA treatment in this age group. There are no FDA approved stents for this use. Biliary stents are currently being used off label. Enrollment into a trial of bare metal Cheatham Platinum (CP) Stents, designed for use in CoA, is completed. The Coarctation of the Aorta Stent Trial (COAST) aims to confirm safety and efficacy of CP Stent for native and recurrent CoA.

There are CoA patients with clinical situations that place them at high risk of aortic wall injury during bare metal stenting. Extreme narrowing, genetic aortic wall weakness and advanced age are examples. Patients may present with aortic wall injury (aneurysm) related to prior CoA repair. The occurrence after surgical repair is 3-4% and after balloon dilation 10-20%. Repair of these aneurysms is surgically challenging. The use of fabric-covered CP Stents to prevent or repair aortic wall injury has become the treatment of choice in Europe and recently in the US through the FDA Compassionate Use process. There are no alternative devices available in the US. COAST II will test safety and efficacy of Covered CP Stents to repair or prevent aortic wall injury associated with CoA.

Funding Source-FDA OOPD

Detailed Description

There are no prior trials of preventing or treating aortic injury associated with CoA and thus no basis for comparison. A single outcome assessment will not suffice since patients can receive a device for either indication. A 3-category Severity of Illness Scale (SIS) was developed based on clinical judgment of a panel of pediatric cardiologists and reviewed by a Data & Safety Monitoring Board (DSMB) and the FDA Office of Device Evaluation. Five levels of severity have been defined for each of the 3 illness categories, including: Upper extremity hypertension, Upper to lower extremity pressure difference, and Severity of aortic wall injury. The DSMB will assign a level of illness from the SIS for each patient at baseline and one year follow up. Improvement by at least one level will indicate clinical importance. Safety is evaluated by identifying adverse events and comparing their occurrence to surgical repair of CoA in similar age groups reported in the medical literature.

Conditions

Aortic Coarctation

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Treatment of Aortic Wall Injury

Repair of aortic wall injury with covered CP Stents

Group Type: OTHER

Treatment of Aortic Wall Injury

Intervention Type: DEVICE

A Cheatham covered platinum stent will be implanted in the Descending aorta to repair coarctation of the aorta in qualified patients.

Interventions

Treatment of Aortic Wall Injury

A Cheatham covered platinum stent will be implanted in the Descending aorta to repair coarctation of the aorta in qualified patients.

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

Native or recurrent aortic coarctation* associated with ONE OR MORE of the following:

1. Acute or chronic aortic wall injury, or

2. Nearly atretic descending aorta to 3 mm or less in diameter, or

3. Genetic Syndromes associated with aortic wall weakening. Individuals with genetic syndromes such as Marfan Syndrome, Turner's Syndrome or familial bicuspid aortic valve and ascending aortic aneurysm

• The significance of aortic obstruction is left to the judgment of the participating investigator.

indications might include mild resting aortic obstruction associated with:

• Exercise related upper extremity hypertension;
• Severe coarctation with multiple and/or large arterial collaterals;
• Single ventricle physiology
• Left ventricular dysfunction
• Ascending aortic aneurysm

+ Aortic wall injury might include:

• Descending aortic aneurysm
• Descending aortic pseudo-aneurysm
• Contained aortic wall rupture
• Non-contained rupture of the aortic wall

Exclusion Criteria

1. Patient size too small for safe delivery of the device. The absolute lower limit for inclusion under this protocol is 20 kg. However, serious femoral artery injury can occur in small patients, particularly those in the 20-30 kg range and this risk must be reviewed in detail with parents or guardians of children in this weight range.

2. Planned deployment diameter less than 10 mm or greater than 22 mm

3. Location requiring covered stent placement across a carotid artery*

4. Adults lacking capacity to consent

5. Pregnancy

• crossing or covering of a subclavian artery is acceptable in certain situations, but only after alternative treatments have been considered.

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Harvard University

OTHER

Sponsor Role: collaborator

Johns Hopkins University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

John Moore, MD

Role: PRINCIPAL_INVESTIGATOR

Rady Children's Hospital

John F Rhodes, MD

Role: PRINCIPAL_INVESTIGATOR

Nicklaus Children's Hospital f/k/a Miami Children's Hospital

Thomas Jones, MD

Role: PRINCIPAL_INVESTIGATOR

Seattle Children's Hospital

Lisa Bergersen, MD

Role: PRINCIPAL_INVESTIGATOR

Boston Children's Hospital

Julie A Vincent, MD

Role: PRINCIPAL_INVESTIGATOR

Morgan Stanley Children's Hospital

Allison Cabalka, MD

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic

Henri Justino, MD

Role: PRINCIPAL_INVESTIGATOR

Baylor College of Medecine, Texas Children's Hospital

Thomas Forbes, MD

Role: PRINCIPAL_INVESTIGATOR

Children's Hospital of Michigan

Jonathan Rome, MD

Role: PRINCIPAL_INVESTIGATOR

Children's Hospital of Philadelphia

Joshua Kanter, MD

Role: PRINCIPAL_INVESTIGATOR

Children's National Research Institute

Phil Moore, MD

Role: PRINCIPAL_INVESTIGATOR

University of California, San Francisco

Russel Hirsch, MD

Role: PRINCIPAL_INVESTIGATOR

Children's Hospital Medical Center, Cincinnati

Jacqueline Kreutzer, MD

Role: PRINCIPAL_INVESTIGATOR

University of Pittsburgh

Thomas Zellers, MD

Role: PRINCIPAL_INVESTIGATOR

Children's Medical Center Dallas

Lourdes Prieto, MD

Role: PRINCIPAL_INVESTIGATOR

The Cleveland Clinic

Gregory Fleming, MD

Role: PRINCIPAL_INVESTIGATOR

Duke University

Dennis Kim, MD

Role: PRINCIPAL_INVESTIGATOR

Children's Healthcare of Atlanta

John Cheatham, MD

Role: PRINCIPAL_INVESTIGATOR

Nationwide Children's Hospital

Gregory A Fleming, MD

Role: PRINCIPAL_INVESTIGATOR

Duke University

Locations

Rady Children's Hospital and Health Center

San Diego, California, United States

University of California, San Francisco

San Francisco, California, United States

Children's National Medical Center

Washington D.C., District of Columbia, United States

Miami Children's Hospital

Miami, Florida, United States

Children's Healthcare of Atlanta

Atlanta, Georgia, United States

Johns Hopkins Hospital

Baltimore, Maryland, United States

Boston Children's Hospital

Boston, Massachusetts, United States

Children's Hospital of Michigan

Detroit, Michigan, United States

Mayo Clinic

Rochester, Minnesota, United States

Children's Hospital of New York - Presbyterian

New York, New York, United States

Duke University

Durham, North Carolina, United States

Cincinnati Children's Hospital and Medical Center

Cincinnati, Ohio, United States

Cleveland Clinic Foundation

Cleveland, Ohio, United States

Nationwide Children's Hospital

Columbus, Ohio, United States

Children's Hospital of Philadelphia

Philadelphia, Pennsylvania, United States

Children's Hospital of Pittsburgh of UPMC

Pittsburgh, Pennsylvania, United States

Children's Medical Center Dallas

Dallas, Texas, United States

Baylor College of Medicine, Texas Children's Hospital

Houston, Texas, United States

Children's Hospital and Regional Medical Center, Seattle

Seattle, Washington, United States

Countries

United States

References

Holzer RJ, Gauvreau K, McEnaney K, Watanabe H, Ringel R. Long-Term Outcomes of the Coarctation of the Aorta Stent Trials. Circ Cardiovasc Interv. 2021 Jun;14(6):e010308. doi: 10.1161/CIRCINTERVENTIONS.120.010308. Epub 2021 May 27.

Reference Type: DERIVED

PMID: 34039015 (View on PubMed)

Other Identifiers

RFD003898A

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

G060057a

Identifier Type: -

Identifier Source: org_study_id