- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03434665
Transradial Selective Catheterization of the Celiac Artery in Obese Patients
November 25, 2019 updated by: Olivier F. Bertrand, Laval University
Transradial Selective Catheterization of the Celiac Artery in Obese Patients: A Pilot Study
BACKGROUND:
- Obesity, with its associated comorbidities, is set to become a major risk factor for cardiovascular disease in the 21st century. To this day, diet and medical therapy have proven only limited efficacy and bariatric surgery remains the last resort for many severely obese patients who wish to lose weight, modify their cardiovascular risk factors and ultimately modify their long-term prognosis. However, bariatric surgery remains associated with significant procedural morbidity and many patients are not eligible for such a surgery procedure as the risk-benefit ratio of bariatric surgery in severe obese patients with coronary artery disease is not yet well known.
- Recently, percutaneous left gastric artery embolization has been reported as a promising technique leading to a body weight loss that is equivalent to bariatric surgery.
- In the context of an endovascular procedure in obese patients, vascular access is a major concern. Transradial access (or radial artery approach) has been consistently associated with significant reductions in access-site related vascular complications and peri-procedural bleeding compared to the standard transfemoral access (or femoral artery approach). This is particularly evident in patients with severe obesity.
- Visceral arteries most often have an acute angulation with the aorta which makes them more easily cannulated from above (transradial access) compared to below (transfemoral access). Preliminary experience has shown that cannulation of the celiac artery is feasible from transfemoral and transradial access, the latter being associated with shorter procedural time and less contrast agent use. To date, several pilot studies have reported successful percutaneous embolization of the left gastric artery with biodegradable microspheres. This appears to be a promising technique to reduce weight in severely obese patients.
- Prior to launching a randomized trial, further study is warranted regarding the feasibility and safety aspects of transradial angiography of the celiac artery.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
RATIONALE:
- A significant proportion of patients referred to IUCPQ-UL catheterization laboratory are overweight (body mass index >25 kg/m²).
- Ongoing research and early clinical experience suggest that embolization of the left gastric artery could drastically reduce ghrelin levels and be associated with significant weight loss.
- In obese patients, catheterization using femoral artery access is associated with higher risks of vascular complications and peri-procedural bleeding compared to a radial artery approach.
- Given the anatomy (angle) of the celiac artery, selective catheterization of the celiac and left gastric arteries remains challenging, especially in obese patients.
- Before studying the effects of bariatric embolization, more data regarding the access of the left gastric artery is necessary.
HYPOTHESES:
- Transradial angiography of the celiac artery/left gastric artery is feasible and safe.
- Given the angulation of celiac artery, catheterization through a radial approach could be simpler.
- Selective angiography of the celiac artery and the left gastric artery can be performed in the setting of uncomplicated coronary angiography/percutaneous coronary intervention (PCI).
- Detailed anatomy of the celiac artery and its branches can be visualized by selective transradial angiography.
OBJECTIVES:
- The primary objective is to demonstrate the feasibility and safety of performing selective angiography of the celiac artery using a transradial approach in obese patients referred for diagnostic coronary angiography and/or PCI.
- The secondary objective is to observe anatomical variations of the celiac artery and the left gastric artery.
STUDY DESIGN:
> A prospective pilot study performed at Quebec Heart & Lung Institute (Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval; IUCPQ-UL).
Study Type
Interventional
Enrollment (Actual)
54
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Quebec
-
Quebec City, Quebec, Canada, G1V 4G5
- Quebec Heart & Lung Institute (IUCPQ-UL)
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Patients undergoing coronary angiography with a BMI >30 kg/m² will be eligible.
Exclusion Criteria:
- Kidney disease defined by a glomerular filtration rate less than 60 ml/min/m² according to the Modification of Diet in Renal Disease (MDRD) formula;
- Previous gastric or bariatric surgery;
- Emergency coronary procedure.
Furthermore, the procedure will be cancelled if one of the following criteria are met during the coronary angiography:
- Contrast volume >250 ml;
- Radiation dose >180 Gy.cm² as assessed by the dose area product (DAP).
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Recruited patients
Transradial celiac artery angiography
|
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of successful selective angiographies
Time Frame: Baseline
|
The primary end-point will be the percentage of successful selective angiographies of the celiac artery.
|
Baseline
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of complications of angiographies
Time Frame: Baseline
|
As catheterization and angiography of the celiac artery is an endovascular procedure, the incidence of vessel trauma (such as dissection or perforation) during the procedure will be assessed.
All cine films will be reviewed by a multidisciplinary team.
|
Baseline
|
Procedure duration
Time Frame: Baseline
|
Time (minutes) required to complete the angiography of the celiac artery
|
Baseline
|
Contrast volume
Time Frame: Baseline
|
Volume (mL) of contrast required to complete the angiography of the celiac artery
|
Baseline
|
Radiation exposure (duration)
Time Frame: Baseline
|
Fluoroscopy time (minutes) required to complete the angiography of the celiac artery
|
Baseline
|
Radiation exposure (dose)
Time Frame: Baseline
|
Dose area product (Gy·cm2) required to complete the angiography of the celiac artery
|
Baseline
|
Number of catheters
Time Frame: Baseline
|
The number of catheters required to complete the angiography of the celiac artery
|
Baseline
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Olivier F Bertrand, MD PhD, IUCPQ-UL and Laval University
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
February 9, 2018
Primary Completion (Actual)
May 31, 2019
Study Completion (Actual)
September 30, 2019
Study Registration Dates
First Submitted
January 30, 2018
First Submitted That Met QC Criteria
February 9, 2018
First Posted (Actual)
February 15, 2018
Study Record Updates
Last Update Posted (Actual)
November 26, 2019
Last Update Submitted That Met QC Criteria
November 25, 2019
Last Verified
November 1, 2019
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- EASY-AngioBar
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
UNDECIDED
IPD Plan Description
To be completed
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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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