Optical Coherence Tomography in Long Lesions
- Conditions
- Coronary Artery Disease
- Interventions
- Device: Sirolimus Eluting StentDevice: Resolute SprintDevice: Paclitaxel Eluting StentDevice: Zotarolimus eluting stent
- Registration Number
- NCT01133925
- Lead Sponsor
- A.O. Ospedale Papa Giovanni XXIII
- Brief Summary
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 assigned to receive multiple zotarolimus eluting stents (Resolute Sprint). The completeness of stent struts coverage and/or late malapposition are evaluated by Optical Coherence Tomography at 6 months follow-up.Data will be compared to the historical arm of ODESSA trial (patients treated with multiple sirolimus-,paclitaxel polymer-or zotarolimus eluting stents).
- Detailed Description
It is not unknown whether overlapping drug-eluting stents provide increased vessel toxicity. 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 detects 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 assigned to receive multiple Resolute Sprint™. 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.
Obtained data will be compared with the data from a historical comparator (ODESSA trial that presented results from TAXUS Libertè™ vs Cypher Select™ vs Endeavor™ stents implanted in overlap to treat long lesions.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 22
- Patient must be at least 18 years of age
- Patient must have evidence of myocardial ischemia (e.g., stable or unstable angina, silent ischemia, positive functional study or a reversible change in the electrocardiogram (ECG) consistent with ischemia)
- Native coronary artery disease with >75% diameter stenosis (no prior stent implant, no prior brachytherapy)
- Lesion length > 20 mm
- Vessel size between 2.5 and 3.5 mm
- Multiple, overlapped Endeavor Resolute stents placement (intention to overlap > 4 mm).
- Left main coronary artery disease
- Lesions in coronary artery bypass grafts
- Acute myocardial infarction
- Killip class IV
- Recent major bleeding (6 months)
- Renal failure with creatinine value > 2.5 mg/dl
- Left ventricular global ejection fraction ≤ 30%.
- Allergy to aspirin and or clopidogrel/ticlopidine
- Patient in anticoagulant therapy
- No suitable anatomy for OCT scan: (only ostial location, very tortuous anatomy, very distal or large vessels [> 3.5 mm in diameter])
- Target lesion(s) located in a major epicardial vessel or a side branch that has been previously treated with any type of percutaneous intervention (e.g., balloon angioplasty, cutting balloon, atherectomy) < 9 months prior to index procedure
- Target lesion restenotic from previous stent implantation
- Any lesion (target or non-target) that has been previously treated with brachytherapy
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description ODESSA Sirolimus Eluting Stent ODESSA trial (NCT 00693030)Patients were randomized (2:2:2:1) to receive multiple TAXUS Libertè™ vs Cypher Select™ vs Endeavor™ vs Libertè BM stents, in overlap. At 6-months follow-up coronary angiography (QCA), IVUS and Optical Coherence Tomography assessments were made. Data reported in J. Am. Coll. Cardiol. Intv. 2010;3;531-539. DOI 10.1016/j.jcin.2010.02.008. Resolute Sprint arm Resolute Sprint Zotarolimus Eluting stents (Resolute Sprint) implanted in overlap to treat long coronary lesions ODESSA Paclitaxel Eluting Stent ODESSA trial (NCT 00693030)Patients were randomized (2:2:2:1) to receive multiple TAXUS Libertè™ vs Cypher Select™ vs Endeavor™ vs Libertè BM stents, in overlap. At 6-months follow-up coronary angiography (QCA), IVUS and Optical Coherence Tomography assessments were made. Data reported in J. Am. Coll. Cardiol. Intv. 2010;3;531-539. DOI 10.1016/j.jcin.2010.02.008. ODESSA Zotarolimus eluting stent ODESSA trial (NCT 00693030)Patients were randomized (2:2:2:1) to receive multiple TAXUS Libertè™ vs Cypher Select™ vs Endeavor™ vs Libertè BM stents, in overlap. At 6-months follow-up coronary angiography (QCA), IVUS and Optical Coherence Tomography assessments were made. Data reported in J. Am. Coll. Cardiol. Intv. 2010;3;531-539. DOI 10.1016/j.jcin.2010.02.008.
- Primary Outcome Measures
Name Time Method In stent NIH at overlapping vs non overlapping sites 6 month In-stent neointimal hyperplasia (NIH) thickness at 6 months, as measured by OCT, at overlapping vs non overlapping sites: superiority of Endeavor Resolute stent compared to Endeavor Sprint
Percent uncovered and malapposed struts in OCT 6 month Proportion of stent struts uncovered and/or malapposed at 6 months, as measured by OCT, at overlapping vs non overlapping sites: non inferiority of Endeavor Resolute compared to Endeavor Sprint.
- Secondary Outcome Measures
Name Time Method QCA Parameters 6 months Based on Angiographic Core Lab analysis utilizing Quantitative Coronary Angiography (QCA) including:
Mean lumen diameter, acute gain, late loss through 6 months, and binary restenosis (≥ 50% diameter stenosis) rate at 6 months post index procedure.Rate of > 30% uncovered struts/total number of struts per section. 6 months MACE Rates 1-6 and 12 months All specific components of MACE (cardiac death, myocardial infarction (Q wave and non Q wave), and target vessel revascularization) will be summarized. MACE shall be assessed at, discharge (or within 7 days, whichever comes first), 1, 6 and 12 months post index procedure.
IVUS parameters 6 months Based on IVUS Core Lab analysis including:
* Neointimal volume, stent volume, lumen volume and percent net volume obstruction
* Neointimal Thickness: Neointimal hyperplasia (NIH) inside all struts (mean, median, max)
* Percent NIH Area= (\[stent area-lumen area\]/stent area) X 100
* Rate of \> 30% uncovered struts/total number of struts per section.
Trial Locations
- Locations (1)
Cardiovascular Department Ospedali Riuniti di Bergamo
🇮🇹Bergamo, BG, Italy