Intravascular Lithotripsy Versus Conventional Therapy for Severely Calcified Coronary Artery Lesions: an Investigator-initiated, Open-label, Multicentre, Randomised, Superiority Trial
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 220
- 试验地点
- 1
- 主要终点
- Final stent expansion (%) assessed by OCT
研究概览
简要总结
Percutaneous coronary intervention (PCI) encounters challenges with calcified coronary lesions, leading to potential issues such as failed balloon dilatation, incomplete stent expansion, and increased risks of adverse events post-PCI, including stent restenosis and thrombosis.
Intravascular lithotripsy (IVL), a novel approach for severely calcified coronary lesion preparation, has shown promising preliminary outcomes. Combining IVL with conventional approaches, such as Rotational atherectomy (RA), non-compliant balloons, or cutting balloons, may associated with additional benefit than conventional approaches only in terms of better stent expansion and lower long-term adverse events.
This pilot randomized trial aims to investigate whether combining IVL to conventional therapy surpasses the efficacy of conventional approaches alone. The primary effectiveness endpoint is final stent expansion assessed by post-procedure optical coherence tomography (OCT), and the primary safety endpoint is target lesion failure (TVF). The trial seeks to provide valuable insights into the optimal approach for managing severely calcified coronary lesions during PCI.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •General Inclusion Criteria:
- •Patients with acute or chronic coronary artery syndrome indicated for PCI with stenting.
- •Able to understand and provide informed consent and comply with all study procedures
- •Angiographic Inclusion Criteria:
- •Native and de novo coronary artery disease
- •Lesion navigable by a 0.014" guidewire.
- •Target lesion is severely calcified, meeting one of the following criteria:
- •Presence of calcium ≥ 270°, lengths ≥ 5mm, and thickness ≥ 0.5mm at one cross-section as assessed by OCT
- •If the OCT catheter is unable to pass through the target lesion after dilatation due to calcification or tortuosity, and the target lesion is severely calcified on both sides of the arterial wall during angiography, with the length of the calcification >15 mm, the lesion will be recognized as a severely calcified lesion, meeting the criteria for enrollment
排除标准
- •General Exclusion Criteria:
- •Patients under 18 years of age.
- •Incapable of providing informed consent.
- •Female patients who are pregnant or nursing (a pregnancy test must be conducted within 7 days before the index procedure for women of childbearing potential, as per local practice).
- •Concurrent medical conditions with a life expectancy of less than 1 year.
- •Hemodynamic instability.
- •Known contraindications to medications such as Heparin, anticoagulation, antiplatelet drugs, or contrast.
- •Active bleeding.
- •New-onset stroke or transient ischemic attack (TIA) within 90 days prior to enrollment.
- •Severe renal dysfunction (eGFR ≤ 30 ml/min).
- •Patients scheduled to undergo cardiac intervention or cardiac surgery within 30 days of the index procedure.
- •Recent ST-segment elevation myocardial infarction (STEMI) within 7 days or recent cardiogenic shock.
- •Lesions located in surgical conduits.
- •Angiographic Exclusion Criteria:
- •Target vessel exhibiting C-F type dissection.
- •Thrombosis observed by angiography or OCT.
- •Presence of an aneurysm within 10 mm of the target lesion.
- •Left main ostial lesion
结局指标
主要结局
Final stent expansion (%) assessed by OCT
时间窗: Measured by the data collected at the end of the PCI procedure
The primary efficacy endpoint of the trial is the Final stent expansion %, defined as the minimum stent area (MSA) / mean reference lumen area assessed by OCT.
Target vessel failure (TVF)
时间窗: 1, 12, 36, and 60 months
The primary safety endpoint of the trial is target vessel failure (TVF), defined as a non-hierarchical composite endpoint of cardiovascular death, target-vessel myocardial infarction (TV-MI), and clinically indicated target vessel revascularization (CI-TVR).
次要结局
- Major cardiovascular adverse events(1, 12, 36, and 60 months)
研究者
LingTao
Professor in Cardiology, Director of the department of Cardiology
Xijing Hospital