Boston Scientific Embolic Protection, Inc. (EPI): A Carotid Stenting Trial for High-Risk Surgical Patients (BEACH) (BEACH)

Boston Scientific EPI: A Carotid Stenting Trial for High-Risk Surgical Patients

The purpose of this study is to determine whether morbidity and mortality for high-risk surgical patients treated with the Carotid Wallstent in conjunction with the FilterWire EX and EZ System distal protection device will be less than or equal to that of objective performance criteria (OPC) derived from historic controls undergoing surgical intervention with a carotid endarterectomy (CEA).

Study Overview

• Status: Completed
• Conditions: Stroke; Carotid Artery Diseases; Cerebral Arteriosclerosis
• Intervention / Treatment: Device: WALLSTENT® Endoprosthesis™

Detailed Description

Stroke is the third leading cause of death in this country with approximately 600,000 new stroke cases each year. Mortality rates as high as 40 percent have been reported for stroke as a result of ischemia associated with the carotid distribution. Currently, the primary therapy for carotid artery occlusive disease is carotid endarterectomy (CEA) or the surgical removal of atheromatous material from inside the artery.

Although CEA is an effective treatment for the majority of patients with carotid occlusive disease, there remains a need for a treatment option for those patients with significant surgical risk factors. These patients have been shown to have much higher rates of morbidity and mortality. There are approximately 50,000-70,000 patients each year who are considered poor surgical candidates. These patients present with either one or more anatomical or co-morbid conditions and have a one-year stroke and death rate of up to 15% with traditional surgical treatment.

Carotid artery stenting (CAS) has been reported by numerous single-center trials to be feasible in the treatment of carotid artery stenosis. Moreover, the risk benefit ratio has been suggested to be the largest in those patients with a higher risk profile for the CEA treatment option.

This trial will study the effects of percutaneous intervention using the Monorail™ Carotid Wallstent® Endoprosthesis (Carotid Wallstent) in conjunction with the FilterWire System distal protection device (FilterWire EX and EZ) on rates of common peri-procedural complications as well as on long-term outcomes as compared to historical outcomes of patients undergoing CEA.

• Study Type: Interventional
• Enrollment (Actual): 747
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States, 35294
      • University of Alabama at Birmingham
    • Birmingham, Alabama, United States, 35211
      • Bapatist Medical Center
  • Arizona
    • Phoenix, Arizona, United States, 85006
      • Arizona Heart Institute
    • Phoenix, Arizona, United States, 85013
      • St. Joseph's Hospital & Medical Center
  • California
    • Mountain View, California, United States, 94040
      • El Camino Hospital
    • Newport Beach, California, United States, 92658
      • Hoag Memorial Hospital
    • Stockton, California, United States, 95204
      • St. Joseph's Medical Center
  • District of Columbia
    • Washington, District of Columbia, United States, 20010
      • Washington Hospital Center
  • Florida
    • Ft. Lauderdale, Florida, United States, 33308
      • Holy Cross Hospital
    • Lakeland, Florida, United States, 33805
      • Lakeland Regional Medical Center
    • Miami, Florida, United States, 33101
      • University of Miami School of Medicine - Jackson Memorial Hospital
    • Miami, Florida, United States, 33176
      • Miami Cardiac and Vascular Institute
    • Plantation, Florida, United States, 33324
      • Northwest Medical Center
  • Georgia
    • Atlanta, Georgia, United States, 30309
      • Piedmont Hospital
    • Atlanta, Georgia, United States, 30342
      • St. Joseph's Hospital of Atlanta/American Cardiovascular Research Institute
  • Illinois
    • Chicago, Illinois, United States, 60612
      • Rush Presbyterian-St. Luke's Medical Center
    • Peoria, Illinois, United States, 61637
      • St. Francis Medical Center
    • Springfield, Illinois, United States, 62701
      • St. John's Hospital - Prairie Heart Institute
  • Kentucky
    • Lexington, Kentucky, United States, 40504
      • Central Baptist Hospital
  • Louisiana
    • New Orleans, Louisiana, United States, 70121
      • Ochsner Clinic Foundation
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Massachusetts General Hospital
    • Hyannis, Massachusetts, United States, 02601
      • Cape Cod Hospital
  • Michigan
    • Detroit, Michigan, United States, 48034
      • Wayne State University- Detroit Medical Center
    • Royal Oak, Michigan, United States, 48073
      • William Beaumont Hospital
  • Missouri
    • Kansas City, Missouri, United States, 64111
      • St. Luke's Hospital of Kansas City
  • New York
    • Bronx, New York, United States, 10467
      • Montefiore Medical Center
    • Buffalo, New York, United States, 14209
      • Kaleida Health/Millard Fillmore Hospital
    • New York, New York, United States, 10021
      • Lenox Hill Heart and Vascular Institute
    • New York, New York, United States, 10032
      • New York Presbyterian Hospital/Columbia Vascular Interventional Radiology
    • Rochester, New York, United States, 14603
      • Strong Memorial Hospital
    • Roslyn, New York, United States, 11576
      • St. Francis Hospital
  • North Carolina
    • Durham, North Carolina, United States, 27710
      • Duke University Medical Center
  • Ohio
    • Cleveland, Ohio, United States, 44195
      • Cleveland Clinic & Foundation
    • Columbus, Ohio, United States, 43202
      • Riverside Methodist Hospital
    • Toledo, Ohio, United States, 43614
      • Medical College of Ohio
  • Oregon
    • Portland, Oregon, United States, 97201
      • Oregon Health Sciences University
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19102
      • Hahnemann University/ Tenet Healthcare Corporation
    • Pittsburgh, Pennsylvania, United States, 15232
      • UPMC-Shadyside Hospital Pittsburgh Vascular Institute
    • Wormleysburg, Pennsylvania, United States, 17101
      • Pinnacle Health at Harrisburg Hospital
  • South Carolina
    • Columbia, South Carolina, United States, 29204
      • Providence Hospital South Carolina Heart Center
  • Tennessee
    • Knoxville, Tennessee, United States, 37920
      • Baptist Hospital of East Tennessee
    • Nashville, Tennessee, United States, 37207
      • Skyline Medical Center/ Howell Allen Clinic
  • Texas
    • Houston, Texas, United States, 77030
      • St. Luke's Episcopal Hospital Texas Heart Institute
    • Houston, Texas, United States, 77030
      • University of Texas-Houston Medical School
    • Lubbock, Texas, United States, 79430
      • Texas Tech University Health Sciences Center
    • San Antonio, Texas, United States, 78201
      • Baptist Hospital
  • Utah
    • Salt Lake City, Utah, United States, 84143
      • LDS Hospital
  • Virginia
    • Richmond, Virginia, United States, 23226
      • St. Mary's Hospital
  • Washington
    • Spokane, Washington, United States, 99204
      • Deaconess Medical Center
  • Wisconsin
    • Milwaukee, Wisconsin, United States, 53215
      • Aurora St. Luke's Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Key General Inclusion Criteria:

• Patient must meet criteria for either A or B:

A. Symptomatic: Carotid stenosis of greater than or equal to 50% via angiography with associated cerebral or retinal TIA or ischemic stroke symptoms within 180 days of the procedure, which are determined to have occurred in the cerebral hemisphere or eye ipsilateral to the target carotid artery lesion and to be reasonably attributable to that lesion; or

B. Asymptomatic: Carotid stenosis greater than or equal to 80% via angiography without associated cerebral or retinal TIA or ischemic stroke symptoms within 180 days of the procedure.

• Target lesion is in the native common carotid artery (CCA), internal carotid artery (ICA), or carotid bifurcation.
• Target arterial segment to be stented has a diameter of greater than or equal to 4.0 mm to less than or equal to 9.0 mm.
• Vessel diameter distal to the target lesion is greater than or equal to 3.5 mm and less than or equal to 5.5 mm as an optimal "landing zone" for placement of the FilterWire EZ System with visual angiographic recommendations as described in the instructions for use (IFU).

Key High-Risk Eligibility Inclusion Criteria:

• Patients must qualify in at least one high-risk category. The high-risk categories are defined as:

  • Anatomical conditions [one (1) criterion qualifies]
  • Co-morbid conditions Class I [one (1) criterion qualifies]
  • Co-morbid conditions Class II [two (2) criteria qualify]

Exclusion Criteria:

• Patient has experienced an evolving, acute, or recent stroke within 21 days of study evaluation.
• A total occlusion of the ipsilateral carotid artery. (Only for Roll-In and Pivotal patients.)
• A total occlusion of the contralateral carotid artery. (Only for Bilateral Registry patients.)

• Pre-existing stent(s):

  • Roll-In and Pivotal Patients: located within the ipsilateral carotid distribution; a stent was placed in a contralateral vessel within the previous 30 days of the study enrollment.
  • Bilateral Registry Patients: located within the carotid distribution.
• A target lesion which is expected to require more than one stent.
• Known cardiac sources of emboli of a type likely to be associated with cerebral ischemic events [e.g. endocarditis, intracardiac thrombus, embolic-associated cardiovascular lesions, or any current arrhythmia (e.g. atrial fibrillation, atrial flutter, etc.)].
• Myocardial infarction (MI) within 72 hours prior to the index procedure, defined as creatine kinase (CK)-MB > 2 X the local laboratory's upper limit of normal (ULN).
• Any surgery requiring general anesthesia (e.g. coronary artery bypass graft [CABG], valve replacement, or abdominal aortic aneurysm) less than or equal to 30 days preceding the stent procedure.
• The patient is enrolled in another investigational study protocol and has not completed the required follow-up period of the evaluation. The patient may not participate in another investigational study that may confound the treatment or outcomes of the BEACH protocol.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Arm 1	Device: WALLSTENT® Endoprosthesis™; Carotid Artery Stent

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
The primary endpoint is one-year morbidity and mortality, defined as the cumulative incidence of any non Q-wave myocardial infarction within the 24 hours following carotid stenting	1 year
peri-procedural (within 30 days of procedure) death, stroke, Q-wave myocardial infarction	Within 30 days of Procedure
late ipsilateral stroke or death due to neurologic events from 31 days up to and including twelve-month follow-up.	1 year

Secondary Outcome Measures

Outcome Measure	Time Frame
Peri-procedural morbidity and mortality	Within 30 Days of procedure
FilterWire EX and EZ System technical success	Post procedure
Carotid Wallstent technical success	Post Procedure
system technical success	Post Procedure
angiographic success	Post Procedure
procedural success	Post Procedure
30-day clinical success	30 days post procedure
peri-procedural overall morbidity	30 days post procedure
one-year clinical success	1 Year post procedure
late stroke, transient ischemic attack (TIA) and death.	1 year post procedure

Collaborators and Investigators

• Sponsor: Boston Scientific Corporation
• Investigators: Principal Investigator: Christopher White, MD, Ochsner Health System; Principal Investigator: Sriram Iyer, MD, Lenox Hill Heart and Vascular Institute; Study Director: Pamela G Grady, Ph.D, Boston Scientific Corporation

Publications and helpful links

General Publications

• Iyer SS, White CJ, Hopkins LN, Katzen BT, Safian R, Wholey MH, Gray WA, Ciocca R, Bachinsky WB, Ansel G, Joye JD, Russell ME; BEACH Investigators. Carotid artery revascularization in high-surgical-risk patients using the Carotid WALLSTENT and FilterWire EX/EZ: 1-year outcomes in the BEACH Pivotal Group. J Am Coll Cardiol. 2008 Jan 29;51(4):427-34. doi: 10.1016/j.jacc.2007.09.045.

Study record dates

Study Major Dates

• Study Start: February 1, 2002
• Primary Completion (Actual): May 1, 2005
• Study Completion (Actual): November 1, 2007

Study Registration Dates

• First Submitted: April 18, 2006
• First Submitted That Met QC Criteria: April 18, 2006
• First Posted (Estimate): April 20, 2006

Study Record Updates

• Last Update Posted (Estimate): August 28, 2014
• Last Update Submitted That Met QC Criteria: August 26, 2014
• Last Verified: August 1, 2014

More Information

Terms related to this study

• Keywords: Stroke; Stent; Stenosis; Carotid Artery Stenting; Carotid Endarterectomy; Carotid; Atherosclerotic Disease; Transient Ischemic Attack
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Arterial Occlusive Diseases; Intracranial Arterial Diseases; Arteriosclerosis; Carotid Artery Diseases; Intracranial Arteriosclerosis
• Other Study ID Numbers: S5385; COR2000001U