Trial of Orbital Atherectomy Versus Standard Strategy in Calcified Bifurcation Lesions (OraBil)
Randomized Trial of Orbital Atherectomy Versus Standard Strategy in Calcified Bifurcation Lesions
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
The risk profile of patients and their comorbidities have worsened and the observed lesions undergoing treatment are increasingly complex. This has promoted the development of new technologies for plaque modification, especially in the context of calcified lesions. These predispose to suboptimal results of the intervention due to an increased risk of malapposition and underexpansion of the stents, the main variables for restenosis and/or thrombosis of the stents. Thus, compared with non-calcified lesions, the increased amount of calcium in the coronary artery leads to a higher incidence of major adverse cardiac events (MACE).
Coronary bifurcation stenting remains complex and is associated with a high risk of stent thrombosis and restenosis even with contemporary techniques, and suboptimal outcomes are frequently observed due to side branch (SL) involvement that increases cardiovascular events.
Our hypothesis is that the use of orbital atherectomy (OA) for coronary revascularization in the presence of calcified bifurcation lesions is feasible and safe compared to the more common technique, favoring the subsequent performance of provisional stenting (PS).
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: FUNDACION EPIC
- Phone Number: 0034987876135
- Email: iepic@fundacionepic.org
Study Contact Backup
- Name: JORGE PALAZUELOS, MD, PhD
- Phone Number: 0034659768506
- Email: jpalaz@gmail.com
Study Locations
-
-
-
Alicante, Spain, 03010
- Recruiting
- H. G.U. de ALICANTE DR. BALMIS
-
Barcelona, Spain, 08003
- Recruiting
- Hospital del Mar
-
Barcelona, Spain, 08041
- Recruiting
- H. de La Santa Creu I Sant Pau
-
Córdoba, Spain, 14004
- Recruiting
- Hospital Universitario Reina Sofia
-
Fuencarral-El Pardo, Spain, 28046
- Recruiting
- Hospital Universitario La Paz
-
Lugo, Spain, 270003
- Recruiting
- Hospital Universitario Lucus Augusti
-
Madrid, Spain, 28003
- Recruiting
- Hospital Universitario La Luz
-
Salamanca, Spain, 37007
- Recruiting
- Hospital Universitari de Salamanca
-
Seville, Spain, 41013
- Recruiting
- Hospital Universitario Virgen del Rocío
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients over 18 years of age and
- Patients with moderately or severely calcified bifurcation lesions (lateral vessel ≥ 2mm), candidates for PCI with coronary stent implantation, in whom there is the possibility of adequate clinical follow-up at 1 year and
- Patients agree to participate in the study, by signing the Informed Consent.
Exclusion Criteria:
- Patients with revascularization of the artery to be treated within 9 months prior to the index procedure.
Patients with contraindication for the use of Orbital Atherectomy:
- Patients in cardiogenic shock.
- Patients with Thrombotic lesions.
- Patients with Vascular graft disease.
- Patients with remain vessel disease.
- Patients with severe left ventricular dysfunction.
- Patients allergic to the components of the washing serum (glide).
- Patients with life expectancy less than one year.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Active Comparator: Balloon Angioplasty (BA)
|
Percutaneous coronary intervention of a calcified bifurcation coronary lesion with Orbital Atherectomy followed by drug eluting stent.
Baseline and post dilation OCT will be performed.
|
|
Active Comparator: Orbital Atherectomy (OA)
|
Percutaneous coronary intervention of a calcified bifurcation coronary lesion with balloon angioplasty followed by drug eluting stent.
Selection of balloon type is at operator´s discretion.
Baseline and post dilation OCT will be performed.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
EFFICACY: Angiographic criteria success
Time Frame: At the end of PCI (Percutaneous Coronary Intervention)
|
Percentage of Main vessel and side branch (≥2 mm) patency (final stenosis <20%) without the presence of: residual lesion >70% and TIMI flow < 3 and residual ≥ type C disection
|
At the end of PCI (Percutaneous Coronary Intervention)
|
|
EFFICACY: OCT criteria: Stent expansion
Time Frame: At the end of PCI
|
Percentage of MLA / mean reference luminal area (mean proximal and distal reference luminal)
|
At the end of PCI
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
SAFETY:Major adverse cardiac events (MACE)
Time Frame: 12 months
|
Rate of cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and non-target lesion target vessel revascularization (TVR non-TLR), thrombosis and stroke
|
12 months
|
|
SAFETY:Major adverse cardiac events (MACE)
Time Frame: 6 months
|
Rate of cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and non-target lesion target vessel revascularization (TVR non-TLR), thrombosis and stroke
|
6 months
|
|
SAFETY:Major adverse cardiac events (MACE)
Time Frame: 30 days
|
Rate of cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and non-target lesion target vessel revascularization (TVR non-TLR), thrombosis and stroke
|
30 days
|
|
SAFETY:Major adverse cardiac events (MACE)
Time Frame: At the end of PCI
|
Rate of cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and non-target lesion target vessel revascularization (TVR non-TLR), thrombosis and stroke
|
At the end of PCI
|
|
EFFICACY: Other variables related to stent expansion. Minimal Lumen Area (MLA) in mm2
Time Frame: At the end of PCI
|
Cut-off point >5 mm2
|
At the end of PCI
|
|
EFFICACY: Other variables related to stent expansion. Minimal Lumen Area (MLA)
Time Frame: At the end of PCI
|
Percentage of Cut-off point >90 mm2
|
At the end of PCI
|
|
EFFICACY: Other variables related to stent expansion. Mean stent expansion
Time Frame: At the end of PCI
|
Percentage of mean stent area (sum of stent area/analyzed stent length)/mean reference lumen area (cut-off point>80%)
|
At the end of PCI
|
|
EFFICACY: Other variables related to stent expansion. Stent expansion using linear model
Time Frame: At the end of PCI
|
Percentage of stent volume/adaptative reference lumen volume.
(cut-off point>65%)
|
At the end of PCI
|
Collaborators and Investigators
Sponsor
Sponsor
Publications and helpful links
General Publications
- Parikh K, Chandra P, Choksi N, Khanna P, Chambers J. Safety and feasibility of orbital atherectomy for the treatment of calcified coronary lesions: the ORBIT I trial. Catheter Cardiovasc Interv. 2013 Jun 1;81(7):1134-9. doi: 10.1002/ccd.24700. Epub 2013 Mar 5.
- Jurado-Román A, Gómez-Menchero A, Gonzalo N, et al. Plaque modification techniques to treat calcified coronary lesions. Position paper from the ACI-SEC. REC Interv Cardiol Engl Ed. Published online February 7, 2023:9672. doi:10.24875/RECICE.M22000345
- Burzotta F, Louvard Y, Lassen JF, Lefevre T, Finet G, Collet C, Legutko J, Lesiak M, Hikichi Y, Albiero R, Pan M, Chatzizisis YS, Hildick-Smith D, Ferenc M, Johnson TW, Chieffo A, Darremont O, Banning A, Serruys PW, Stankovic G. Percutaneous coronary intervention for bifurcation coronary lesions using optimised angiographic guidance: the 18th consensus document from the European Bifurcation Club. EuroIntervention. 2024 Aug 5;20(15):e915-e926. doi: 10.4244/EIJ-D-24-00160.
- den Dekker WK, Siskos AA, Wilschut JM, Nuis RJ, Scarparo P, Neleman T, Masdjedi K, Ligthart JMR, Diletti R, Daemen J, Van Mieghem NM. Initial experience with orbital atherectomy in a tertiary centre in the Netherlands. Neth Heart J. 2023 May;31(5):196-201. doi: 10.1007/s12471-022-01742-3. Epub 2022 Dec 12.
- Donatelle M, Agasthi P, Parise H, Igyarto Z, Martinsen BJ, Leon MB, Beohar N. Coronary Orbital Atherectomy in Patients With Severe Aortic Stenosis. J Invasive Cardiol. 2022 Oct;34(10):E696-E700. doi: 10.25270/jic/22.00066.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- EPIC44-OraBil
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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