- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01124942
MGuard Stent in ST-elevation Myocardial Infarction (GUARDIAN)
MGuard vs bAre-metal Stents Plus Manual Thrombectomy in Real World STEMI Patients: a Prospective Multicenter Randomized Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Embolization of thrombotic debris still represents a complication for ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary interventions (PCI).
Distal embolization may decrease coronary and myocardial reperfusion after PCI in STEMI setting.
Unfortunately, intracoronary filters present several important limitations limiting their use and their efficacy especially in presence of huge amount of thrombus. In this respect, recent trials investigated whether a default manual thrombectomy strategy before stenting would ameliorate angiographic as well as clinical outcomes for STEMI patients undergoing percutaneous revascularization.
Of note, the most of embolization occurs when guidewire, and thrombectomy device cross the thrombus, and after the stent has been implanted as a consequence of plaque prolapse through the stent struts.
MGuard net protective stent, the investigational device, is a bare-metal stent covered with a ultra-thin flexible polyethylene terephthalate (or Dacron) mesh sleeve, that is anchored to the external surface of the struts. This biocompatible fiber net (string diameter 10-22 μm) has minimal effects on the stents' trackability and deliverability. During stent deployment, the net stretches and slides over the expanding stent struts, trapping the thromboembolic debris underneath the fiber net and isolating the prothrombotic intima components from the blood stream.
This protocol will test the hypothesis that MGuard stent would be superior to conventional revascularization strategy (i.e. bare-metal stenting plus manual thrombectomy), for STEMI patients undergoing urgent PCI in terms of angiographic as well as clinical outcomes.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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-
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Naples, Italy, 80131
- Federico II University of Naples
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- >/= 18-year-old patients, willing to participate the study, after informed consent signature
- Female not pregnant or potentially child-bearing
- > 1 mV ST segment elevation in two or more contiguous leads
- Acute MI lasting more than 30 minutes and less than 12 hours
- De novo acute MI
- Infarct related artery reference vessel diameter >/= 2.5 mm
- Patient suitable for stenting according to vessel and lesion features
Exclusion Criteria:
- Dual antiplatelet therapy contraindication
- Ischemic stroke less than 30 days or previous haemorrhagic stroke
- WBC count less than 1000 per mm3;
- Platelet count less than 50.000 per mm3
- Life expectancy less than 1 year
- Cardiogenic shock at admission
- Previous stented infarct related artery
- Stent thrombosis as the responsible for current STEMI
- Inability to identify infarct related artery
- True bifurcation lesion, or lesion near a side branch with a reference vessel diameter >/= 2.5 mm that could be diseased after stenting procedure
- LBBB
- Definitive pacing (or ECG abnormalities precluding ST-segment resolution evaluation
- Participation other study
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: MGuard
MGuard net protective stent, investigational device
|
It is a new closed-cell design stent concept.
with an ultra-thin flexible polyethylene terephthalate (or Dacron) mesh sleeve, anchored to the external surface of the struts.
This net (string diameter 10-22 μm) minimally affects stents' trackability and deliverability.
During stent deployment, the net stretches and slides over the expanding stent struts, trapping the thromboembolic debris underneath the fiber net.
Other Names:
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Active Comparator: BMS plus thrombectomy
Bare-metal stent plus manual thrombectomy device
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Manual thrombectomy device as an adjunctive strategy for conventional stenting with a bare-metal stent
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of patients with Myocardial Perfusional Blush Grade 2-3
Time Frame: 30 minutes after revascularization
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Myocardial Perfusional Blush Grade 2-3 at the end of the procedure
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30 minutes after revascularization
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of MACE
Time Frame: 1 month
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Number of Major Adverse Cardiovascular Events experienced among study population, including: cardiac death, myocardial infarction, target vessel failure.
|
1 month
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Complete ST-segment resolution
Time Frame: 60 minutes after revascularization
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Complete (>70%) ST-segment resolution at 60 minutes post-revascularization
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60 minutes after revascularization
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Thrombolysis in myocardial infarction antegrade coronary flow
Time Frame: 30 minutes after revascularization
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TIMI coronary flow at the end of the procedure
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30 minutes after revascularization
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Corrected TIMI Frame count
Time Frame: 30 minutes after revascularization
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Corrected TIMI Frame count at the end of the procedure
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30 minutes after revascularization
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Infarct related area reduction and left ventricular ejection fraction recovery
Time Frame: 6 months
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Six-month infarct related area reduction and left ventricular ejection fraction recovery as compared with infarct related area and and left ventricular ejection fraction at admission.
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6 months
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Procedural device performance
Time Frame: 60 minutes after revascularizationl
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Device performance evaluated during the procedure in terms of pushability, trackability, crossability and deliverability
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60 minutes after revascularizationl
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Number of MACE
Time Frame: 6 months
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Number of Major Adverse Cardiovascular Events experienced among study population, including: cardiac death, myocardial infarction, target vessel failure.
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6 months
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Number of MACE
Time Frame: 12 months
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Number of Major Adverse Cardiovascular Events experienced among study population, including: cardiac death, myocardial infarction, target vessel failure.
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12 months
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Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Federico Piscione, Associate Professor, Federico II University of Naples
Publications and helpful links
General Publications
- Piscione F, Danzi GB, Cassese S, Esposito G, Cirillo P, Galasso G, Rapacciuolo A, Leosco D, Briguori C, Varbella F, Tuccillo B, Chiariello M. Multicentre experience with MGuard net protective stent in ST-elevation myocardial infarction: safety, feasibility, and impact on myocardial reperfusion. Catheter Cardiovasc Interv. 2010 Apr 1;75(5):715-21. doi: 10.1002/ccd.22292.
- Rapacciuolo A, D'andrea C, Maresca G, di Pietro E, Piscione F, Chiariello M. Multiple MGuard stent implantation to treat massive right coronary artery dissection during primary coronary angioplasty. J Cardiovasc Med (Hagerstown). 2011 May;12(5):356-60. doi: 10.2459/JCM.0b013e328334092d.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- NA116/09
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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