RETRIEVE-AMI Study

NCT ID: NCT05307965

Last Updated: 2025-09-05

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

81 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-05-06

Study Completion Date

2025-05-28

Brief Summary

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Heart attacks are caused by the sudden formation of a clot inside a diseased coronary artery which reduces blood flow beyond the blockage site. During conventional treatment of the blockage with what is known as a stent; a stainless steel tub that keeps the artery open, the clot that has formed is disrupted and is pushed further down leading to damage in smaller blood vessels supplying the heart muscle. This additional damage can lead to long-term heart muscle damage influencing recovery and wellbeing. The original concept that was tested to prevent this 'clot shower' was that of a suction device to withdraw the clot before stenting. However, this approach has not translated to patient benefit. Amongst the reasons put forward for the inefficacy of the suction device was that it does not remove the entire clot as it does not interact with it. A new device that physically interacts with the clot and traps it before pulling it out - the stent retriever - is now routinely used in stroke therapy to remove clots in the arteries supplying the brain. This device has been successfully used as a last resort to remove clots in a small number of heart attacks. The investigators hypothesize that stent retriever therapy will be more effective in clot removal than the current standard of care; suction or stenting. To study this, the investigators propose the RETRIEVE-AMI randomised controlled trial.

Detailed Description

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Conditions

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Myocardial Infarction Thrombus Coronary Artery Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The study will consist of 3 arms. Eligible participants will be 1:1:1 randomised to receive either standalone percutaneous coronary intervention (PCI) (Arm 1), thrombus aspiration + PCI (Arm 2) or retriever thrombectomy + PCI (Arm 3).
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Due to the interventional nature of the trial, masking is not feasible for operators, the clinical care team and participants. However, analysis of the OCT-derived primary and secondary end-points will be conducted offline in a blinded fashion.

Study Groups

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Standalone Percutaneous Coronary Intervention

Participants will have standard of care treatment. They will undergo PCI with devices and techniques driven by clinical decision making at the patient level and institutional level, and carried out in accordance with the Oxford University Hospitals NHS Foundation Trust department guidelines.

Group Type ACTIVE_COMPARATOR

Percutaneous Coronary Intervention

Intervention Type PROCEDURE

Standard of care

Percutaneous Coronary Intervention and Thrombus Aspiration

Participants will have standard of care treatment with manual thrombectomy catheter and PCI. They will undergo PCI with devices and techniques driven by clinical decision making at the patient level and institutional level, and carried out in accordance with the Oxford University Hospitals NHS Foundation Trust department guidelines.

Group Type ACTIVE_COMPARATOR

Percutaneous Coronary Intervention

Intervention Type PROCEDURE

Standard of care

Thrombus Aspiration

Intervention Type PROCEDURE

Standard of care treatment with manual thrombectomy catheter

Percutaneous Coronary Intervention and Retriever Thrombectomy

Participants randomised to the stent-retriever thrombectomy arm of the RETRIEVE AMI trial will undergo stent-retriever thrombectomy with the SolitaireTM X Revascularisation Device.

Group Type EXPERIMENTAL

Retriever Thrombectomy

Intervention Type DEVICE

The SolitaireTM X revascularisation device is a self-expanding stent designed for dynamic clot integration with radiopaque markers that enhance visualisation of the optimal working length. After a thrombotic occlusion has been identified and crossed with a guidewire, the stent-retriever thrombectomy proceeds. A microcatheter (e.g., PhenomTM, MarksmanTM) is advanced over the guidewire and once it has traversed the thrombotic occlusion, the SolitaireTM X device is advanced through the microcatheter until the usable length of the stent extends past each side of the thrombus in the vessel. As the microcatheter is retracted to the proximal radiopaque marker of the stent, the stent self-expands and entangles the thrombus. The microcatheter and SolitaireTM X Revascularisation Device are withdrawn as a unit into the guide catheter under continuous aspiration. PCI then proceeds driven by clinical decision making and department guidelines.

Percutaneous Coronary Intervention

Intervention Type PROCEDURE

Standard of care

Interventions

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Retriever Thrombectomy

The SolitaireTM X revascularisation device is a self-expanding stent designed for dynamic clot integration with radiopaque markers that enhance visualisation of the optimal working length. After a thrombotic occlusion has been identified and crossed with a guidewire, the stent-retriever thrombectomy proceeds. A microcatheter (e.g., PhenomTM, MarksmanTM) is advanced over the guidewire and once it has traversed the thrombotic occlusion, the SolitaireTM X device is advanced through the microcatheter until the usable length of the stent extends past each side of the thrombus in the vessel. As the microcatheter is retracted to the proximal radiopaque marker of the stent, the stent self-expands and entangles the thrombus. The microcatheter and SolitaireTM X Revascularisation Device are withdrawn as a unit into the guide catheter under continuous aspiration. PCI then proceeds driven by clinical decision making and department guidelines.

Intervention Type DEVICE

Percutaneous Coronary Intervention

Standard of care

Intervention Type PROCEDURE

Thrombus Aspiration

Standard of care treatment with manual thrombectomy catheter

Intervention Type PROCEDURE

Other Intervention Names

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SolitaireTM X Revascularisation Device Stent Retriever Aspiration-assisted thrombectomy

Eligibility Criteria

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Inclusion Criteria

* Primary PCI patient with ST elevation myocardial infarction (STEMI)
* TIMI 0/1 flow at presentation
* Angiographic thrombus score ≥ 4
* Vessel diameter at site of occlusion ≥ 3.0 mm (measured by quantitative coronary angiography)

Exclusion Criteria

* Female participant who is pregnant or lactating
* Participant with known hypersensitivity to nickel-titanium
* Unconscious at presentation
* Late presenter (pain to wire time \> 12 h)
* Class Killip III/IV and/or profound bradycardia (Heart rate \< 40 bpm)
* Known history of kidney failure
* Ostial occlusion
* Highly tortuous vessel
* Highly calcified vessel
* Suspected (angiographically) spontaneous coronary artery dissection
* Stent thrombosis
* Previous stent implanted proximal to the occlusion site
* Previous coronary artery bypass graft surgery (CABG)
* Previous STEMI/Transient Ischemic Attack/Stroke
* Known anaemia (Hemoglobin \<9)
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medtronic

INDUSTRY

Sponsor Role collaborator

Terumo Corporation

INDUSTRY

Sponsor Role collaborator

Oxford University Hospitals NHS Trust

OTHER

Sponsor Role lead

Responsible Party

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Giovanni Luigi De Maria

Primary Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Giovanni Luigi De Maria

Role: PRINCIPAL_INVESTIGATOR

Oxford University Hospitals NHS Trust

Locations

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Oxford Heart Centre

Oxford, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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15488

Identifier Type: -

Identifier Source: org_study_id

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