Evaluation of Neointimal Healing of Endothelial Progenitor Cell Capturing Sirolimus-Eluting (COMBO) Stent by Optical Coherence Tomography: the EGO-COMBO Pilot Study
试验速览
- 阶段
- 1 期
- 状态
- 已完成
- 发起方
- 入组人数
- 61
- 试验地点
- 1
- 主要终点
- Primary end-point: OCT findings on percentage stent strut coverage in the 2nd to the 5th months (4 monthly groups).
研究概览
简要总结
All subjects requiring percutaneous coronary intervention (PCI) and stenting are eligible to participate in the study. Restudy coronary angiogram with Optical Coherence Tomography (OCT) would be performed between 1 to 5 months at the time of a staged PCI procedure (for remaining coronary disease) or as clinically indicated, and then at 9 months. At the time of the 9-month restudy (a proper time window for drug eluting stent to develop into restenosis should it occur), any new disease detected or restenosis will be treated. The reported incidence of drug eluting stent restenosis is around 10% in simple lesions and is expected to be higher in diabetic patients, long lesions and multi-vessel diseases; a restudy at 9 months actually confers better protection to the patients with advanced disease and any restenosis can be treated timely. All data on clinical events and progress will be monitored and regular follow-ups will be carried out.
详细描述
The GENOUS Stent (the EPC Capturing R-stent, OrbusNeich Medical Inc., Fort Lauderdale, FL) is commercially available and has been extensively used in standard coronary intervention procedures treating >200 patients with critical coronary stenoses at Queen Mary Hospital. The COMBO Stent (OrbusNeich Medical Inc., Fort Lauderdale, FL) is a hybrid version of the GENOUS Stent with an abluminal sirolimus coating, and is currently under the investigational use for clinical research in the REMEDEE Study; over 20 patients have been treated and all remained in good condition since the treatment.
The GENOUS Stent is a bio-engineered 316L stainless steel coronary stent with a biocompatible circumferential coating of anti-CD34 antibody, and will bind to and therefore capture the circulatory endothelial progenitor cells (EPC) which have CD34 antigen on the surface. Immobilization of EPCs on the stent surface will encourage differentiation and proliferation of the EPCs into endothelial and neointimal layer. Animal model has demonstrated that a functional endothelial layer could be formed as soon as 24 to 48 hours after GENOUS stent implantation (1). The HEALING-FIM registry has shown that GENOUS stent is clinically safe and effective in the treatment of coronary stenosis (2). Recent reports have further confirmed its efficacy in patients with acute coronary syndrome requiring urgent revascularization (3,4).
The COMBO Stent is a hybrid version of the GENOUS Stent, with an additional abluminal, drug eluting sirolimus coating, targeted to reduce excessive neointima formation, while maintaining the EPC capturing capacity and therefore continue to promote healing after stent injury. The hybrid function of these two technologies in this new COMBO stent is expected to produce better clinical results in terms of accelerated healing, less stent thrombosis and less restenosis; these are being investigated in the current REMEDEE Study.
Animal study has shown the COMBO Stent promotes endothelialization and reduces neointima formation, as assessed by both optical coherence tomography (OCT) and histopathology (5). Even though COMBO Stents have been used and found to be safe in over 180 patients world-wide and in about 30 patients at Queen Mary Hospital under the REMEDEE Study Protocol, such benefits of "early" endothelial coverage as assessed by OCT has never been fully documented in human subjects.
The current EGO-COMBO study protocol is designed based on the approved protocols of the ongoing REMEDEE Study (IRB: UW 09-384) and the EGO Study (IRB: UW 10-256); both are still active in this Hospital. In the multi-center REMEDEE Study, the COMBO stent is compared to the TAXUS stent (Boston Scientific) in patients with coronary artery disease requiring stent implantation, looking at the 9 months late loss results. This EGO-COMBO Study is different from the REMEDEE Study and focuses mainly on the very early time frames assessing the degree of early neointimal healing (enhanced endothelialization) between 2nd to 5th months, and the subsequent neointimal proliferation at 9 months after the COMBO Stent implantation, as assessed by the very high resolution of the frequency domain optical coherence tomography (OCT) used in the existing EGO study. This is a single centre, non-randomized, open-label study.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 85 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •patient aged 18-85 years old,
- •patient with coronary stenosis requiring percutaneous coronary intervention without contraindications to implantation of drug eluting stents
- •patient who consents to receive follow-up coronary angiogram and OCT examination.
排除标准
- •patient who refuses to consent to follow-up coronary angiogram or OCT examination.
结局指标
主要结局
Primary end-point: OCT findings on percentage stent strut coverage in the 2nd to the 5th months (4 monthly groups).
时间窗: On 2nd, 3rd, 4th, and 5th months
Primary end-point: OCT findings on percentage stent strut coverage, malapposition, and neointimal thickness in the 2nd to the 5th months (4 monthly groups).
次要结局
- OCT findings on late loss (neointimal thickness and neointimal area) at 9 months restudy.(9 months)
- Major Adverse Cardiac Events(Initial OCT follow up, 9 months OCT follow up and one year follow up)
- Any Stent Thrombosis according the Academic Research Consortium(Initial OCT follow up, 9 months OCT follow up and one year follow up)
- Stroke(Initial OCT follow up, 9 months OCT follow up and one year follow up)
- Bleeding complication(Initial OCT follow up, 9 months OCT follow up and one year follow up)
研究者
Prof. Stephen Lee
Professor and Chief
The University of Hong Kong