NeoVas Bioresorbable Coronary Scaffold Randomized Controlled Trial

Clinical Evaluation of a Bioresorbable Sirolimus-eluting Coronary Scaffold in the Treatment of Patients With Denovo Coronary Artery Lesion (NeoVas): Randomized Controlled Trial

The NeoVas Bioresorbable Coronary Scaffold Randomized Controlled Trial is a prospective, multi-center, randomized trial. The study compares NeoVas sirolimus-eluting bioresorbable coronary scaffold with XIENCE PRIME Everolimus Eluting Coronary Stent System (EECSS) to evaluate the safety and efficacy of NeoVas in the treatment of patients with de novo coronary lesion.

Study Overview

• Status: Unknown
• Conditions: Coronary Artery Disease
• Intervention / Treatment: Device: NeoVas BCS; Device: XIENCE PRIME EECSS

Detailed Description

Approximately 560 subjects will be randomly enrolled at a 1:1 ratio, patients in experimental group receiving NeoVas BCS(Lepu Medical Technology (Beijing) Co.,Ltd), and subjects in control group receiving XIENCE PRIME EECSS(Abbott Vascular, Inc). Subjects will have clinical follow-up at 30, 90, 180 and 270 days and at 1,2,3,4 and 5 years. All subjects will undergo coronary angiography at 1 year post-index procedure. The primary endpoint is in-segment late lumen loss(LLL) at 1 year follow-up.

Among the RCT study, a subgroup study is designed to evaluate the functional recovery of vasomotion before and after the complete degradation of the NeoVas Bioresorbable Coronary Scaffold with the aid of angiography, OCT and FFR. The subgroup study will be performed in two centers and 160 subjects will be enrolled on a 1:1 randomization basis. Subjects will receive angiography and OCT examination before procedure, and will receive angiography, OCT and FFR after procedure and at 1, 3 years follow-up.

• Study Type: Interventional
• Enrollment (Anticipated): 560
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Anhui
    • Hefei, Anhui, China, 230001
      • Anhui Provincial Hospital
  • Beijing
    • Beijing, Beijing, China, 100029
      • Beijing Anzhen Hospital, Capital Medical University
    • Beijing, Beijing, China, 100039
      • General Hospital of Armed Police Forces
    • Beijing, Beijing, China, 100049
      • Aerospace Center Hospital
  • Fujian
    • Fuzhou, Fujian, China, 350001
      • Fujian Medical University Union Hospital
  • Gansu
    • Lanzhou, Gansu, China, 730000
      • The First Hospital of Lanzhou University
  • Guangdong
    • Guangzhou, Guangdong, China, 510515
      • Nanfang Hospital Southern Medical University
  • Guangxi
    • Nanning, Guangxi, China, 530021
      • The First Affiliated Hospital of Guangxi Medical University
  • Hebei
    • Shijiazhuang, Hebei, China, 050081
      • Bethune Peace Hospital of PLA
  • Hubei
    • Wuhan, Hubei, China, 430060
      • Renmin Hospital of Wuhan University
    • Wuhan, Hubei, China, 430070
      • Wuhan General Hospital of Guangzhou Military
  • Hunan
    • Changsha, Hunan, China, 410008
      • Xiangya Hospital Central South University
  • Jiangsu
    • Nanjing, Jiangsu, China, 210029
      • Jiangsu Province Hospital
    • Nanjing, Jiangsu, China, 210009
      • Zhongda Hospital Southeast University
    • Nanjing, Jiangsu, China, 210008
      • Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
  • Liaoning
    • Shenyang, Liaoning, China, 110016
      • The General Hospital Of Shenyang Military Region
  • Shanghai
    • Shanghai, Shanghai, China, 200433
      • Changhai Hospital of Shanghai
    • Shanghai, Shanghai, China, 200001
      • Renji Hospital Shanghai Jiaotong University School of Medicine
    • Shanghai, Shanghai, China, 200072
      • Shanghai Tenth People's Hospital of Tongji University
  • Shanxi
    • Xi'an, Shanxi, China, 710061
      • The First Affiliated Hospital of Xi'an Jiaotong University
    • Xi'an, Shanxi, China, 710032
      • Xijing Hospital, The Fourth Military Medical University
  • Sichuan
    • Chengdu, Sichuan, China, 610083
      • Chengdu Military General Hospital
  • Tianjin
    • Tianjin, Tianjin, China, 300192
      • Tianjin First Center Hospital
    • Tianjin, Tianjin, China, 300162
      • Affiliated Hospital of The Chinese People's Armed Police Forces Logistic College
  • Yunnan
    • Kunming, Yunnan, China, 650032
      • Kunming General Hospital of Chengdu Military Region
  • Zhejiang
    • Hangzhou, Zhejiang, China, 310003
      • The First Affiliated Hospital, Zhejiang University
    • Hangzhou, Zhejiang, China, 310016
      • Sir Run Run Shaw Hospital,School of Medicine, Zhejiang University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Age must be 18-75 years, men or unpregnant women.
• Patient must have evidence of myocardial ischemia, suitable for elective PCI. Subjects with stable angina or silent ischemia and <70% diameter stenosis must have objective sign of ischemia as determined by one of the following, echocardiogram, nuclear scan, ambulatory ECG or stress ECG. In the absence of noninvasive ischemia, fractional flow reserve(FFR) must be done and indicative of ischemia.
• Total number of target lesion =1 per patient.
• Target lesion must be≤20mm in length and 2.50 to 3.75 mm in diameter(visual estimation).
• Target lesion is with a visually estimated stenosis of ≥70%(or≥50% and evidence of myocardial ischemia) with a TIMI flow of ≥1.
• The target lesion can be covered by one scaffold(except the rescue scaffold).
• Patient must be an acceptable candidate for coronary artery bypass graft.
• Patient or a legally authorized representative must provide written Informed Consent prior to any study related procedure.

Exclusion Criteria:

• Patients has had a known diagnosis of acute myocardial infarction(AMI) within 30 days preceding the procedure; CK and CK-MB have not returned within normal limits at the time of procedure
• Chronic total occlusion lesions (TIMI 0 grade blood flow prior to implantation), left trunk vessel lesion, ostial lesion, multi-branch lesions needing treated, bifurcation lesion (diameter ≥2.0mm, branch opening stenosis exceeds 50% or need balloon expansion) and bridge vessel lesions; there is thrombus visible in the target blood vessels.
• Severe calcified lesions and twisted lesions which cannot be pre-expanded, and lesions unsuitable for delivering and expanding stents.
• In-stent restenosis lesion.
• Patient has undergone previous stenting anywhere within the target vessel(s) within the previous 12 months, or will require stenting within the target vessel(s) within 1 year after the study procedure; target vessels that has been implanted with stents.
• Severe heart failure(over NYHA III grade ), or left ventricular ejection fraction(LVEF)<40%( supersonic inspection or left ventricular radiography ).
• Known renal insufficiency(eGFR<60 ml/min, serum creatinine>2.5mg/dL, or subject on dialysis).
• Patients with hemorrhage tendency, an active digestive ulcer history, a cerebral hemorrhage or subarachnoid hemorrhage history, or cerebral apoplexy within half a year, and these patients who contraindicate against platelet inhibitors and anticoagulant therefore cannot bear anticoagulation treatment.
• Patient has a known hypersensitivity or contraindication to aspirin, clopidogrel, ticagrelor or prasugrel, heparin, contrast agent, polylactic acid or sirolimus that cannot be adequately pre-medicated.
• Life expectancy < 12 months
• Patient is participating in another device or drug study that has not reached the primary endpoint of the study.
• Patient's inability to fully cooperate with the study protocol.
• Patient has a heart transplant.
• Patient has current unstable arrhythmias, such as high risk ventricular premature beat and ventricular tachycardia.
• Patient is receiving or scheduled to receive chemotherapy for malignancy within 30 days prior to or after the procedure.
• Patient is receiving immunosuppression therapy and has known immunosuppressive or autoimmune disease.
• Patient is receiving or scheduled to receive chronic anticoagulation therapy (e.g., heparin, warfarin).
• Elective surgery is planned within the first 6 months after the procedure that will require discontinuing either aspirin, clopidogrel, ticagrelor or prasugrel.
• Platelet count<100,000 cells/mm3 or>700,000 cells/mm3, a WBC of<3,000 cells/mm3, or documented or suspected liver disease.
• Patient has extensive peripheral vascular disease that precludes safe 6 French sheath insertion.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: NeoVas; The NeoVas sirolimus-eluting bioresorbable coronary scaffold system is a PLLA- based polymer scaffold and contains the antiproliferative drug sirolimus. Intervention: Device: NeoVas BCS	Device: NeoVas BCS; Subjects receiving NeoVas BCS; Other Names: NeoVas Bioresorbable Coronary Scaffold
Active Comparator: XIENCE PRIME; XIENCE PRIME Everolimus Eluting Coronary Stent System is a balloon expandable metallic platform stent manufactured from a flexible cobalt chromium alloy with a multicellular design and coated with a thin nonadhesive, durable, biocompatible acrylic, and fluorinated everolimus-releasing copolymer. Intervention: Device: XIENCE PRIME EECSS	Device: XIENCE PRIME EECSS; Subjects receiving XIENCE PRIME EECSS; Other Names: XIENCE PRIME Everolimus Eluting Coronary Stent System

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
In-segment late lumen loss (LLL)	In-segment late loss is defined as the change in minimal lumen diameter (MLD) within the margins of the scaffold and 5 mm proximal and 5 mm distal to the scaffold from post-procedure to 1 year by angiography.	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Device Success	Successful delivery and deployment of the assigned scaffold at the intended target lesion and successful withdrawal of the delivery system with attainment of final in-scaffold residual stenosis of less than 30% by quantitative coronary angiography (QCA) (by visual estimation if QCA unavailable). The success or failure of the first-aid stent is not included.	intraoperative
Procedural Success	Achievement of final in-scaffold residual stenosis of less than 30% by QCA (by visual estimation if QCA unavailable) with successful delivery and deployment of at least one assigned scaffold at the intended target lesion and successful withdrawal of the delivery system for the target lesion without the occurrence of cardiac death, target vessel MI or repeat TLR. For the circumstance of two target lesions, both lesions must meet the success criteria.	At time of procedure up to 7 days in hospital
Ischemia-driven Target Lesion Revascularization (iTLR)		30 days, 3,6,9 months and 1, 2, 3, 4, 5 years
Ischemia-driven Target Vessel Revascularization (iTVR)		30 days, 3,6,9 months and 1, 2, 3, 4, 5 years
Major secondary endpoint: Percentage of patients who experienced angina within 1 year	Angina is defined as any angina or angina equivalent symptoms determined by the physician and/or research coordinator after interview of the patient, and as adjudicated by a clinical events committee (CEC).	From 7 days post-procedure to 1 year
Target lesion failure(TLF)	Target lesion failure is a composite endpoint of cardiac death, target vessel related myocardial infarction (TV-MI) and the ischemia-driven target lesion revascularization.	30days, 3,6,9 months and 1,2,3,4,5 years
All coronary revascularization (PCI and CABG)	percutaneous coronary intervention (PCI) coronary artery bypass graft (CABG)	30 days, 3,6,9 months and 1, 2, 3, 4, 5 years
Scaffold thrombosis	Scaffold thrombosis will be categorized as acute (≤1day), subacute (>1day ≤30 days) and late (>30 days).Clinical presentation of acute coronary syndrome with angiographic evidence of scaffold thrombosis (angiographic appearance of thrombus within or adjacent to a previously treated target lesion).In the absence of angiography, any unexplained death, or acute MI (ST segment elevation or new Q-wave) in the distribution of the target lesion within 30 days.	30days, 3,6,9 months and 1, 2, 3, 4, 5 years
Percentage of patients who experienced angina	Angina is defined as any angina or angina equivalent symptoms determined by the physician and/or research coordinator after interview of the patient, and as adjudicated by a clinical events committee (CEC).	30days, 3,6,9 months and 2, 3, 4, 5 years
Patient oriented composite endpoint	Patients oriented composite endpoint includes all-cause death, all myocardial infarction and any revascularization.	30 days, 3,6,9 months and 1, 2, 3, 4, 5 years

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Primary Endpoint for the Subgroup Study: Changes of the average lumen diameter before and after the usage of nitroglycerin		3 years
Secondary Endpoint for the Subgroup Study: Angiographic Endpoint(after the usage of nitroglycerin)	In-segment, in-scaffold, 5mm proximal and 5mm distal Late and very late lumen loss (mm); In-segment, in-scaffold, 5mm proximal and 5mm distal Minimal lumen diameter(mm); In-segment, in-scaffold, 5mm proximal and 5mm distal Diameter stenosis (%);In-segment, in-scaffold, 5mm proximal and 5mm distal Angiographic Binary Restenosis (%).	Index procedure, 1 and 3 years
Secondary Endpoint for the Subgroup Study: OCT Endpoint (after the usage of nitroglycerin)	Mean/minimal lumen area, mean/minimal stent area, average neointimal hyperplasia (NIH) area, proportion of covered struts, proportion of malapposed struts.	Index procedure, 1 and 3 years
Secondary Endpoint for the Subgroup Study: FFR Endpoint (after the usage of nitroglycerin): Late and very late FFR loss/changes		1 and 3 years
Secondary Endpoint for Subgroup Study: FFR Endpoint (after the usage of nitroglycerin): Target lesion FFR		post-procedure, 1 and 3 years

Collaborators and Investigators

• Sponsor: Lepu Medical Technology (Beijing) Co., Ltd.

Publications and helpful links

General Publications

• Han Y, Xu B, Fu G, Wang X, Xu K, Jin C, Tao L, Li L, Hou Y, Su X, Fang Q, Chen L, Liu H, Wang B, Yuan Z, Gao C, Zhou S, Sun Z, Zhao Y, Guan C, Stone GW; NeoVas Randomized Controlled Trial Investigators. A Randomized Trial Comparing the NeoVas Sirolimus-Eluting Bioresorbable Scaffold and Metallic Everolimus-Eluting Stents. JACC Cardiovasc Interv. 2018 Feb 12;11(3):260-272. doi: 10.1016/j.jcin.2017.09.037.

Study record dates

Study Major Dates

• Study Start: November 1, 2014
• Primary Completion (Actual): December 1, 2016
• Study Completion (Anticipated): June 1, 2020

Study Registration Dates

• First Submitted: November 27, 2014
• First Submitted That Met QC Criteria: December 1, 2014
• First Posted (Estimate): December 2, 2014

Study Record Updates

• Last Update Posted (Estimate): December 8, 2016
• Last Update Submitted That Met QC Criteria: December 7, 2016
• Last Verified: December 1, 2016

More Information

Terms related to this study

• Keywords: Randomized Controlled Trial; Sirolimus; NeoVas; Bioresorbable Coronary Scaffold
• Additional Relevant MeSH Terms: Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Coronary Disease; Coronary Artery Disease; Physiological Effects of Drugs; Antineoplastic Agents; Immunosuppressive Agents; Immunologic Factors; Everolimus
• Other Study ID Numbers: LPM-201402