- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02819531
Efficacy CompariSon of Pre-stenting Atherectomy Versus Scoring ballooN for calcifieD Coronary Lesions Coronary Lesions (ECSPAND)
A Single Center, Randomized Trial of Treatment Strategies for Obstructive Calcified Coronary Lesions: Efficacy CompariSon of Pre-stenting Atherectomy Versus Scoring ballooN for calcifieD Coronary Lesions Coronary Lesions (ECSPAND)
Design: The proposed study is a randomized study comparing the relative effectiveness of three lesion modification strategies (RA, SBS, or OAS) in the treatment of obstructive CCLs using the change in lumen size measurements (MLA, RLA, MSA and the ratio of MSA/MLA) obtained with IVUS or OCT. Patients will be blinded to treatment assignment for the duration of the study.
Treatment: Patients who are randomized to RA will undergo coronary wiring of the CCL and subsequent advancement of the RA burr. The RA system is performed using standard technique under intravenous infusion of heparin. The atherectomy burr size will be determined by the operator.
Patients who are randomized to OAS will undergo coronary wiring of the CCL and subsequent advancement of the OAS according to the manufacturer's guidelines.
Control: Patients who are randomized to SBS will undergo coronary wiring and balloon inflation with SBS performed by standard technique under intravenous infusion of heparin. SBS will be used according to the AngioSculpt manufacturer's guidelines.
Duration: 30 days follow-up.
The primary trial objective is to determine which of the three treatment strategies for treating calcified coronary lesions (RA, SBS, or OA) is superior for obtaining higher ratio of final in-stent minimum lumen area/reference lumen area, as determined by IVUS or OCT (primary study endpoint).
The secondary objectives are to compare the following:
- Difference in pre- vs. post-treatment minimum lumen area (MLA, lumen area gain), as determined by IVUS or OCT (secondary endpoint)
- Mean final minimal stent area (MSA), as assessed by IVUS or OCT (secondary endpoint)
- Ratio of final in-stent minimum lumen diameter/reference lumen diameter, as determined by quantitative coronary angiography (secondary endpoint)
- Incidence of major adverse cardiac events (death, myocardial infarction, target vessel revascularization) during 30 days of follow-up (secondary endpoints)
- Procedure time, fluoroscopy time, and contrast volume (secondary endpoints)
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- 18 years of age or older
- Clinical indication for coronary intervention such as ischemic symptoms and/or a positive functional study
- Found to have a de novo severe calcification (radio opacities noted without cardiac motion on contrast injection, lesion length >15 mm, or presence of >270° calcification on one cross-sectional view of IVUS) in a native coronary artery on fluoroscopy or IVUS
Exclusion Criteria:
- Subject is currently participating in an investigational device or pharmaceutical treatment protocol
- Persistent (>10 minutes) hypotension (systolic blood pressure <90 mmHg)
- Need for revascularization of multiple lesions during the index PCI
- Unprotected left main (>50%) or equivalent left main disease
- Non-calcified lesions
- Chronic total occlusions, extreme lesion tortuosity including Type B/C lesions
- Severe left ventricular dysfunction (ejection fraction <25%)
- History of bleeding diathesis or coagulopathy
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Rotational atherectomy
RA protocol: After IVUS protocol, patients who are randomized to RA will undergo coronary wiring of the target lesion and subsequent advancement of the RA burr.
The RA system is performed using standard technique under intravenous infusion of heparin.
The atherectomy burr size will be determined by the operator.
|
Pre-stenting lesion modification using the rotational atherectomy device using standard technique under intravenous infusion of heparin.
Burr size will be selected by the operator according to vessel size.
IVUS images will be obtained before lesion modification and after stenting.
|
Active Comparator: Orbital atherectomy
OAS protocol: After IVUS protocol, patients who are randomized to OAS will undergo coronary wiring of the target lesion and subsequent advancement of the OAS according to the manufacturer's guidelines.
|
Pre-stenting lesion modification using the orbital atherectomy device according the manufacturer's guidelines.
IVUS images will be obtained before lesion modification and after stenting.
|
Active Comparator: Scoring balloon system
SBS protocol: After IVUS protocol, patients who are randomized to SBS will undergo coronary wiring of the target lesion and balloon inflation with SBS performed by standard technique under intravenous infusion of heparin.
SBS will be used according to the manufacturer's guidelines.
|
Pre-stenting lesion modification using the scoring balloon system according the manufacturer's guidelines.
IVUS images will be obtained before lesion modification and after stenting.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Ratio of final in-stent minimum lumen area/reference lumen area
Time Frame: Immediately after stenting
|
IVUS measurement based determination of ratio of final in-stent minimum lumen area/reference lumen area, as determined by IVUS
|
Immediately after stenting
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Difference in pre- vs. post-treatment minimum lumen area (MLA, lumen area gain)
Time Frame: Immediately after stenting
|
IVUS measurement based determination of difference in pre- vs. post-treatment minimum lumen area (MLA, lumen area gain)
|
Immediately after stenting
|
Mean final minimal stent area (MSA)
Time Frame: Immediately after stenting
|
IVUS measurement based determination of Mean final minimal stent area (MSA)
|
Immediately after stenting
|
Ratio of final in-stent minimum lumen diameter/reference lumen diameter
Time Frame: Immediately after stenting
|
Quantitative coronary angiography based determination of ratio of final in-stent minimum lumen diameter/reference lumen diameter
|
Immediately after stenting
|
Lower incidence of major adverse cardiac events (death, myocardial infarction, target vessel revascularization) during 30 days of follow-up
Time Frame: 30 days
|
30 days
|
|
Procedure time
Time Frame: Immediately after the end of the interventional procedure
|
Immediately after the end of the interventional procedure
|
|
Fluoroscopy time
Time Frame: Immediately after the end of the interventional procedure
|
Immediately after the end of the interventional procedure
|
|
Contrast volume
Time Frame: Immediately after the end of the interventional procedure
|
Immediately after the end of the interventional procedure
|
Collaborators and Investigators
Investigators
- Study Chair: Emmanouil S Brilakis, MD, PhD, North Texas Veterans Healthcare System
- Principal Investigator: Jerrold Grodin, MD, North Texas Veterans Healthcare System
Publications and helpful links
General Publications
- Genereux P, Madhavan MV, Mintz GS, Maehara A, Palmerini T, Lasalle L, Xu K, McAndrew T, Kirtane A, Lansky AJ, Brener SJ, Mehran R, Stone GW. Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes. Pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS. J Am Coll Cardiol. 2014 May 13;63(18):1845-54. doi: 10.1016/j.jacc.2014.01.034. Epub 2014 Feb 19.
- Vaquerizo B, Serra A, Miranda F, Triano JL, Sierra G, Delgado G, Puentes A, Mojal S, Brugera J. Aggressive plaque modification with rotational atherectomy and/or cutting balloon before drug-eluting stent implantation for the treatment of calcified coronary lesions. J Interv Cardiol. 2010 Jun;23(3):240-8. doi: 10.1111/j.1540-8183.2010.00547.x.
- Genereux P, Lee AC, Kim CY, Lee M, Shlofmitz R, Moses JW, Stone GW, Chambers JW. Orbital Atherectomy for Treating De Novo Severely Calcified Coronary Narrowing (1-Year Results from the Pivotal ORBIT II Trial). Am J Cardiol. 2015 Jun 15;115(12):1685-90. doi: 10.1016/j.amjcard.2015.03.009. Epub 2015 Mar 24.
- Adamian M, Colombo A, Briguori C, Nishida T, Marsico F, Di Mario C, Albiero R, Moussa I, Moses JW. Cutting balloon angioplasty for the treatment of in-stent restenosis: a matched comparison with rotational atherectomy, additional stent implantation and balloon angioplasty. J Am Coll Cardiol. 2001 Sep;38(3):672-9. doi: 10.1016/s0735-1097(01)01458-9.
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
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
- 16-017
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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.
Clinical Trials on Coronary Artery Disease
-
Elixir Medical CorporationIstituto Clinico HumanitasActive, not recruitingCoronary Artery Disease | Chronic Total Occlusion of Coronary Artery | Multi Vessel Coronary Artery Disease | Bifurcation of Coronary Artery | Long Lesions Coronary Artery DiseaseItaly
-
Fundación EPICActive, not recruitingCoronary Artery Disease | Left Main Coronary Artery Disease | Left Main Coronary Artery Stenosis | Restenosis, CoronarySpain
-
Peking Union Medical College HospitalNot yet recruitingCoronary Artery Disease | Inflammation | Coronary Artery Disease Progression | Coronary Artery Stenosis | Coronary Artery Restenosis | Inflammatory Disease | Inflammation VascularChina
-
Peking Union Medical College HospitalRecruitingCoronary Artery Disease | Inflammation | Coronary Artery Disease Progression | Coronary Artery Stenosis | Coronary Artery Restenosis | Inflammatory Disease | Inflammation VascularChina
-
IGLESIAS Juan FernandoUniversity of BernNot yet recruiting
-
National Institutes of Health Clinical Center (CC)National Heart, Lung, and Blood Institute (NHLBI)CompletedCoronary Arteriosclerosis | Coronary Artery Disease (CAD) | Obstructive Coronary Artery DiseaseUnited States
-
Barts & The London NHS TrustImperial College London; Brunel UniversityNot yet recruitingCORONARY ARTERY DISEASE
-
Fundación EPICRecruitingCoronary Artery Disease | Coronary Disease | Coronary Occlusion | Left Main Coronary Artery Disease | Coronary Artery StenosisSpain
-
Abbott Medical DevicesCompletedCoronary Artery Disease | Coronary Disease | Coronary Occlusion | Chronic Total Occlusion of Coronary Artery | Coronary Restenosis | Coronary Artery Stenosis | Coronary Artery RestenosisBelgium
-
China National Center for Cardiovascular DiseasesRecruitingLeft Main Coronary Artery DiseaseChina
Clinical Trials on Rotational atherectomy
-
Xijing HospitalCompletedCoronary Artery DiseaseChina
-
National Heart Centre SingaporeBoston Scientific CorporationRecruitingCoronary Artery CalcificationSingapore, Japan
-
Seung-Jung ParkCardioVascular Research Foundation, KoreaRecruitingCoronary Stenosis | Atherosclerosis, CoronaryKorea, Republic of
-
Segeberger Kliniken GmbHCompleted
-
SS Annunziata Hospital, SaviglianoNot yet recruitingMyocardial Infarction | Coronary Artery Disease
-
University Hospital, ToulouseCompletedAngioplastySpain, Russian Federation, Italy, France, Austria, Germany, Greece, Poland
-
Beijing Anzhen HospitalBSC International Medical Trading (Shanghai) Co., Ltd.Completed
-
Rex MedicalSyntactxCompletedPeripheral Artery DiseaseUnited States
-
Samsung Medical CenterUnknownCoronary Artery DiseaseKorea, Republic of
-
Columbia UniversityCompletedCoronary Artery Disease (CAD)United States